Anorectal malformation and Hirschsprung's disease: a cross-sectional multicentre comparison of quality of life and bowel function to a healthy population

PURPOSE

Children with anorectal malformation (ARM) and Hirschsprung's disease (HD) often experience bowel symptoms into adulthood, despite definitive surgery. This study evaluates the quality of life (QOL) and bowel functional outcome of children treated for ARM and HD in comparison to healthy controls.

METHODS

Between December 2020 and February 2023, we recruited patients with ARM and HD aged 3-17 years at four tertiary referral centres, who had primary corrective surgery done >12 months prior. Healthy controls were age-matched and sex-matched. All participants completed the Pediatric Quality of Life Inventory Generic Core Scales 4.0, General Well-Being (GWB) Scale 3.0 and Family Impact (FI) Module 2.0 Questionnaires. Bowel Function Score (BFS) Questionnaires were also administered. We also performed subgroup analysis according to age categories. Appropriate statistical analysis was performed with p<0.05 significance. Ethical approval was obtained.

RESULTS

There were 306 participants: 101 ARM, 87 HD, 118 controls. Patients with ARM and HD had significantly worse Core and FI Scores compared with controls overall and in all age categories. In the GWB Scale, only ARM and HD adolescents (13-17 years) had worse scores than controls. ARM and HD had significantly worse BFSs compared with controls overall and in all age categories. There was significant positive correlation between BFS and Core Scores, GWB Scores and FI Scores.

CONCLUSION

Patients with ARM and HD had worse QOL than controls. Lower GWB Scores in adolescents suggests targeted interventions are necessary. Bowel function influences QOL, indicating the need for continuous support into adulthood.

Single-Fraction Stereotactic Ablative Body Radiotherapy for Primary and Extracranial Oligometastatic Cancers

Stereotactic ablative body radiotherapy (SABR) consists of delivering high doses of ionising radiation, typically across three to eight fractions with high precision and conformity. SABR has become increasingly commonplace throughout the last quarter of a century and is offered for the treatment of various primary and metastatic tumour types. Delivering SABR in a single fraction has arisen as an appealing possibility for several reasons. These include fewer hospital visits, greater patient convenience, improved sustainability and lower costs. However, these factors must be balanced against considerations such as toxicity, side-effects and, most importantly, progression-free and overall survival. In this review we seek to analyse the results of studies looking at the efficacy of single-fraction SABR for lung, prostate, renal and pancreas primary tumours, as well as oligometastases. The tumour type to be most widely treated with single-fraction SABR is lung, but its remit continues to expand. We also look at the biological rationale underpinning SABR and how this can be extended to single-fraction regimens. Finally, we turn our attention towards the future directions of SABR and specifically single-fraction regimens. These include the possibility of combining SABR with immunotherapy and technological advances in the field, which could serve to expand the scope of SABR. We conclude by summarising the current clinical studies of single-fraction SABR.

A one-health approach to design an mRNA-based vaccine candidate against the lumpy skin disease virus as an alternative to live-attenuated vaccines

OBJECTIVE

Recently, lumpy skin disease (LSD) has been spread over the Asian, European, and Middle Eastern regions making it a significant hazard to the chain of cattle production, milk production, and human milk consumption, requiring prompt attention. Lumpy skin disease virus has high morbidity and low fatality rates, but its infections have led to terrible economic and agricultural consequences. Although live-attenuated vaccines have been commercialized, farmers in different regions have not taken them well because of the allergic responses against the vaccines. The study aims to develop an mRNA-based vaccine candidate for LSDV, using immunoinformatic approaches to minimize allergenicity and homology while maximizing immunogenic potential.

MATERIALS AND METHODS

The study used extensive immunoinformatic approaches to shortlist five proteins from the LSDV genome that belong to the transmembrane region and are crucial in early viral interaction with host cells. The B-cell and T-cell-specific epitopes were chosen based on non-allergenicity, antigenicity, non-homology, surface accessibility, and lower IC50 inhibition values. The construct's stability, hydrophilicity, and antigenic potential were analyzed using the instability index, Grand Average of Hydropathicity (GRAVY) index, and antigenicity, respectively.

RESULTS

We selected a total of 34 epitopes, consisting of 12 B-cell-specific epitopes and 22 T-cell-specific epitopes. These epitopes were chosen based on their characteristics such as non-allergenicity, antigenicity, non-homology, surface accessibility, and lower IC50 inhibition values. Specifically, 11 epitopes were selected for Major Histocompatibility Complex-I, and another 11 epitopes were chosen for Major Histocompatibility Complex-II. The inclusion of the RS09 adjuvant enhanced the immunogenic potential of the vaccine. The instability index was found to be 38.60. Additionally, the GRAVY index, indicating hydrophilicity, was calculated as -0.151. Furthermore, the antigenicity value of 0.6073 confirmed its potential to elicit an immune response. Further supporting its immunogenic potential, strong immune stimulation was observed, with IgM+IgG titers reaching 6,000 (arbitrary units) and IFNg titers measuring 400,000 ng/mL. These results provide additional evidence of the vaccine's ability to stimulate a robust immune response.

CONCLUSIONS

The study results indicate that the developed mRNA-based vaccine candidate for LSDV has high immunogenic potential and could serve as an effective alternative to live-attenuated vaccines. Further experimental validations are required to test its efficacy. The study also highlights the potential of the One-Health approach to tackle non-zoonotic diseases that have significant consequences for the environment and humanity.

Atypical clinical presentations are common in TIA and minor stroke patients with DWI-MRI confirmed ischaemia

Background and Aims

Current diagnostic criteria for TIA/minor stroke disqualify several atypical clinical presentations, but pre-date DWI-MRI use. We investigated the proportion of DWI-positive patients with atypical presentations, identifying clinical factors predicting DWI positivity.

Methods

We retrospectively reviewed consecutive patients with suspected TIA/minor stroke (NIHSS<5) undergoing MRI at our comprehensive stroke centre from March 2020-February 2021. We identified pre- dictors of DWI positivity using logistic regression.

Results

Of 1615 patients, 442 DWI-positive, 39% had atypical presentations including 20% with progres- sive symptom onset. Atypical symptoms common in DWI-positive patients included headache(17%), unsteadiness(15%), positive sensory symptoms(11%), presyncope(10%), confusion(9%) and vertigo(8%). Symptoms independently associated with DWI-positivity included weakness(OR 1.30, 95% CI 1.01-1.67), dysarthria(OR 2.06, CI 1.56-2.70), and ataxia (OR 3.75, CI 2.27-6.20). Fluctuating symptoms(22%) predicted DWI positivity(OR 1.37, CI 1.00-1.81), but sudden onset(80%) did not (OR 1.05, CI 0.80-1.38). Risk factors associated with DWI positivity included increasing age(OR 1.01/year, CI 1.01-1.02), hypertension (OR 1.70, CI 1.30-2.22), diabetes(OR 1.44, CI 1.07-1.93), and smoking(OR 1.68, CI 1.19-2.39). DWI-positive patients had significantly more risk factors (mean 2.65 vs 1.95 p=<0.001).

Conclusions

Over one-third with DWI-confirmed TIA/minor stroke present atypically. The value of atypical symptoms in excluding ischaemia, particularly in patients with vascular risk factors, appears limited.

Sphacelation with auto-anastomosis of the intestine: a rare outcome of intussusception in a child—a case report

Background

Intussusception is the telescoping of a proximal segment of the bowel into a distal segment. It can be idiopathic or pathological. Children commonly present with colicky abdominal pain, vomiting, a palpable abdominal mass, and bloody stools. Our case describes the unusual presentation of bowel sphacelation with auto-anastomosis in a child with intussusception and its clinical progression.

Case presentation

A 3-year-old boy with underlying stage IV rhabdomyosarcoma of the left orbit presented with high-grade fever and diarrhea for 1 day. He was treated for neutropenic sepsis in view of low absolute neutrophil count and recent history of chemotherapy. During his admission, he developed abdominal distension, high bilious aspirates, and diarrhea with bloody stools. Abdominal X-ray showed dilated bowel loops. Impression was septic ileus with coagulopathy. He was treated with blood transfusion and bowel rest. On the 6th day of illness, he passed out a tubular structure per rectum which was confirmed to be a segment of gangrenous bowel by histopathological examination. A diagnosis of intussusception with bowel sphacelation was made. He was treated conservatively, and his obstruction was resolved. He was discharged well with no abdominal symptoms during follow-up.

Conclusion

Intussusception is a common cause of small bowel obstruction in children. A high index of suspicion of intussusception should be maintained in children presenting with vomiting and bloody stools complemented by ultrasound to avoid missing this diagnosis. Sphacelation of the intussuscepted bowel with auto-anastomosis is a rare presentation of intussusception with a favorable outcome.

Silver decorated 2D nanosheets of GO and MoS2serve as nanocatalyst for water treatment and antimicrobial applications as ascertained with molecular docking evaluation

In this work, synthesis of graphene oxide (GO) and reduced graphene oxide (rGO) was realized through a modified Hummers route. Different concentrations (5 and 10 wt%) of Ag were doped in MoS₂and rGO using a hydrothermal technique. Synthesized Ag-MoS₂and Ag-rGO were evaluated through XRD that confirmed the hexagonal structure of MoS₂along with the transformation of GO to Ag-rGO as indicated by a shift in XRD peaks while Mo-O bonding and S=O functional groups were confirmed with FTIR. Morphological information of GO and formation of MoS₂nanopetals as well as interlayer spacing were verified through FESEM and HRTEM respectively. Raman analysis was employed to probe any evidence regarding defect densities of GO. Optical properties of GO, MoS₂, Ag-rGO, and Ag-MoS₂were visualized through UV-vis and PL spectroscopy. Prepared products were employed as nanocatalysts to purify industrial wastewater. Experimental results revealed that Ag-rGO and Ag-MoS₂showed 99% and 80% response in photocatalytic activity. Besides, the nanocatalyst (Ag-MoS₂and Ag-rGO) exhibited 6.05 mm inhibition zones againstS. aureusgram positive (G+) and 3.05 mm forE. coligram negative (G-) in antibacterial activity. To rationalize biocidal mechanism of Ag-doped MoS₂NPs and Ag-rGO,in silicomolecular docking study was employed for two enzymes i.e.β-lactamase and D-alanine-D-alanine ligase B (ddlB) from cell wall biosynthetic pathway and enoyl-[acylcarrier-protein] reductase (FabI) from fatty acid biosynthetic pathway belonging toS. aureus. The present study provides evidence for the development of cost-effective, environment friendly and viable candidate for photocatalytic and antimicrobial applications.

Validation of the bag-mediated filtration system for environmental surveillance of poliovirus in Nairobi, Kenya

AIMS

This study compared the bag-mediated filtration system (BMFS) and standard WHO two-phase separation methods for poliovirus (PV) environmental surveillance, examined factors impacting PV detection and monitored Sabin-like (SL) PV type 2 presence with withdrawal of oral polio vaccine type 2 (OPV2) in April 2016.

METHODS AND RESULTS

Environmental samples were collected in Nairobi, Kenya (Sept 2015-Feb 2017), concentrated via BMFS and two-phase separation methods, then assayed using the WHO PV isolation algorithm and intratypic differentiation diagnostic screening kit. SL1, SL2 and SL3 were detected at higher rates in BMFS than two-phase samples (P < 0·05). In BMFS samples, SL PV detection did not significantly differ with volume filtered, filtration time or filter shipment time (P > 0·05), while SL3 was detected less frequently with higher shipment temperatures (P = 0·027). SL2 was detected more frequently before OPV2 withdrawal in BMFS and two-phase samples (P < 1 × 10-5 ).

CONCLUSIONS

Poliovirus was detected at higher rates with the BMFS, a method that includes a secondary concentration step, than using the standard WHO two-phase method. SL2 disappearance from the environment was commensurate with OPV2 withdrawal.

SIGNIFICANCE AND IMPACT OF THE STUDY

The BMFS offers comparable or improved PV detection under the conditions in this study, relative to the two-phase method.

Dye degradation performance, bactericidal behavior and molecular docking analysis of Cu-doped TiO2 nanoparticles

Copper-doped TiO2 was prepared with a sol-gel chemical method. Various concentrations (3, 6, and 9 wt%) of Cu dopant were employed. Several techniques were implemented to assess the structural, optical, morphological and chemical properties of the synthesized samples. Evaluation of elemental composition using SEM-EDS and XRF techniques showed the presence of dopant element in the prepared samples. XRD analysis confirmed the presence of anatase (TiO2) phase with interstitial doping. Incorporation of dopant was observed to enhance the crystallinity and increase the crystallite size of the synthesized products. SAED profiles revealed a high degree of crystallinity in the prepared specimens, which was also evident in the XRD spectra. Optical properties studied using UV-vis spectroscopy depicted a shift of the maximum absorption to the visible region (redshift) that signified a reduction in the band gap energy of Cu-doped TiO2 samples. Examination of morphological features with scanning and high-resolution transmission electron microscopes revealed the formation of spherical nanoparticles with a tendency to agglomerate with increasing dopant concentration. Molecular vibrations and the formation of Ti-O-Ti bonds were revealed through FTIR spectra. PL spectroscopy recorded the trapping efficiency and migration of charge carriers, which exhibited electron-hole recombination behavior. Doped nanostructures showed enhanced bactericidal performance and synergism against S. aureus and E. coli. In summary, Cu-doped TiO2 nanostructures were observed to impede bacteria effectively, which is deemed beneficial in overcoming ailments caused by pathogens such as microbial etiologies. Furthermore, molecular docking analysis was conducted to study the interaction of Cu-doped TiO2 nanoparticles with multiple proteins namely β-lactamase (binding score: -4.91 kcal mol-1), ddlB (binding score: -5.67 kcal mol-1) and FabI (binding score: -6.13 kcal mol-1) as possible targets with active site residues. Dye degradation/reduction of control and Cu-doped samples were studied through absorption spectroscopy. The obtained outcomes of the performed experiment indicated that the photocatalytic activity of Cu-TiO2 enhanced with increasing dopant concentration, which is thought to be due to a decreased rate of electron-hole pair recombination. Consequently, it is suggested that Cu-TiO2 can be exploited as an effective candidate for antibacterial and dye degradation applications.

The peculiar size and temperature dependence of water diffusion in carbon nanotubes studied with 2D NMR diffusion-relaxation D -T 2eff spectroscopy

It is well known that water inside hydrophobic nano-channels diffuses faster than bulk water. Recent theoretical studies have shown that this enhancement depends on the size of the hydrophobic nanochannels. However, experimental evidence of this dependence is lacking. Here, by combining two-dimensional nuclear magnetic resonance diffusion-relaxation ( D - T 2 e f f ) spectroscopy in the stray field of a superconducting magnet and molecular dynamics simulations, we analyze the size dependence of water dynamics inside Carbon Nanotubes (CNTs) of different diameters ( 1.1 - 6.0  nm), in the temperature range of 265 - 305  K. Depending on the CNT diameter, the nanotube water is shown to resolve in two or more tubular components acquiring different self-diffusion coefficients. Most notably, a favorable CNT diameter range ( 3.0 - 4.5  nm) is experimentally verified for the first time, in which water molecule dynamics at the center of the CNTs exhibits distinctly non-Arrhenius behavior, characterized by ultrafast diffusion and extraordinary fragility, a result of significant importance in the efforts to understand water behavior in hydrophobic nanochannels.

Bactericidal behavior of chemically exfoliated boron nitride nanosheets doped with zirconium

In this work, boron nitride nanosheets (BNNS) were produced through chemical exfoliation of bulk boron nitride (BN). Furthermore, hydrothermal technique was used to incorporate various concentrations (2.5, 5, 7.5, and 10 wt%) of zirconium (Zr) as a dopant. The prepared undoped and doped BN samples were evaluated for its antimicrobial activity against E. coli and S. aureus. Structural analysis was undertaken using x-ray diffraction which identified the presence of hexagonal BN. FTIR and Raman spectroscopy were utilized to outline IR fingerprint and electronic properties of the synthesized material. Morphological information was obtained through micrographs extracted using field emission scanning electron spectroscope (FESEM) and high resolution transmission electron microscope (HRTEM), while d-spacing was also calculated through HRTEM analysis. Optical properties and emission spectra were examined by applying UV–vis and photoluminescence spectroscope (PL); whereas, band gap analysis was carried out via Tauc plot. Zr-doped BN nanosheets at increasing concentrations (0.5, 1.0 mg/50 μl) revealed enhanced antibacterial activity against E. coli compared to S. aureus (p < 0.05).

Application of Chemically Exfoliated Boron Nitride Nanosheets Doped with Co to Remove Organic Pollutants Rapidly from Textile Water

Two-dimensional layered materials doped with transition metals exhibit enhanced magnetization and improved catalytic stability during water treatment leading to potential environmental applications across several industrial sectors. In the present study, cobalt (Co)-doped boron nitride nanosheets (BN-NS) were explored for such an application. Chemical exfoliation process was used to exfoliate BN-NS and the hydrothermal route was adopted to incorporate Co dopant in various concentrations (e.g., 2.5, 5, 7.5, and 10 wt%). X-ray diffraction (XRD) study indicated that crystallinity improved upon doping with the formation of a hexagonal phase of the synthesized material. Selected area electron diffraction (SAED) confirmed enhanced crystallinity, which corroborates XRD results. Interlayer spacing was evaluated through a high-resolution transmission electron microscope (HR-TEM) equipped with Gatan digital micrograph software. Compositional and functional group analysis was undertaken with energy dispersive X-ray (EDS) and Fourier transform infrared (FTIR) spectroscopy, respectively. Field emission scanning electron microscope (FE-SEM) and HR-TEM were utilized to probe surface morphologies of prepared samples. Bonding modes in the sample were identified through Raman analysis. Optical properties were examined using UV-vis spectroscopy. Photoluminescence spectra were acquired to estimate the separation and recombination of excitons. Magnetic properties were studied by means of hysteresis loop acquired using VSM measurements. Methylene blue dye was degraded with as-prepared host and doped nanosheets used as catalysts and investigated through absorption spectra ranging from 250 to 800 nm. The experimental results of this study indicate that Co-doped BN-NS showed enhanced magnetic properties and can be used to degrade dyes present as an effluent in industrial wastewater.

Photocatalytic and bactericidal properties and molecular docking analysis of TiO2 nanoparticles conjugated with Zr for environmental remediation

Despite implementing several methodologies including a combination of physical, chemical and biological techniques, aquatic and microbial pollution remains a challenge to this day. Recently, nanomaterials have attracted considerable attention due to their extraordinary prospective for utilization toward environmental remediation. Among several probable candidates, TiO₂ stands out due to its potential for use in multifaceted applications. One way to improve the catalytic and antimicrobial potential of TiO₂ is to dope it with certain elements. In this study, Zr-doped TiO₂ was synthesized through a sol–gel chemical method using various dopant concentrations (2, 4, 6, and 8 wt%). Surface morphological, microstructural and elemental analysis was carried out using FESEM and HR-TEM along with EDS to confirm the formation of Zr–TiO₂. XRD spectra showed a linear shift of the (101) anatase peak to lower diffraction angles (from 25.4° to 25.08°) with increasing Zr⁴⁺ concentration. Functional groups were examined via FTIR, an ample absorption band appearing between 400 and 700 cm⁻¹ in the acquired spectrum was attributed to the vibration modes of the Ti–O–Ti linkage present within TiO₂ nanoparticles, which denotes the formation of TiO₂. Experimental results indicated that with increasing dopant concentrations, photocatalytic potential was enhanced significantly. In this respect, TiO₂ doped with 8 wt% Zr (sample 0.08 : 1) exhibited outstanding performance by realizing 98% elimination of synthetic MB in 100 minutes. This is thought to be due to a decreased rate of electron–hole pair recombination that transpires upon doping. Therefore, it is proposed that Zr-doped TiO₂ can be used as an effective photocatalyst material for various environmental and wastewater treatment applications. The good docking scores and binding confirmation of Zr-doped TiO₂ suggested doped nanoparticles as a potential inhibitor against selected targets of both E. coli and S. aureus. Hence, enzyme inhibition studies of Zr-doped TiO₂ NPs are suggested for further confirmation of these in silico predictions.

Despite implementing several methodologies including a combination of physical, chemical and biological techniques, aquatic and microbial pollution remains a challenge to this day.

The role of computed tomography in the assessment of dental disease in 66 guinea pigs

Sixty-six guinea pigs with dental disease were presented to the University of Veterinary Medicine, Vienna, Austria, from 2006 to 2010. Almost all patients had a history of eating difficulties (95 per cent) and underwent clinical and oral examination as well as CT of the head. Findings on extra- and intraoral examination were asymmetric elongation (n=28) and symmetric bridging (n=24) of cheek teeth, obliquely worn incisors (n=17), palpable lower jaw swellings (n=13), exophthalmos (n=10) and incisor macrodontia (n=6). Eighty per cent of guinea pigs with exophthalmos showed ipsilateral periapical disease of the maxillary cheek teeth on CT. Ninety-two per cent of patients with palpable lower jaw swellings showed corresponding dental pathologies on CT. Periapical disease of incisors (n=11) and cheek teeth (n=32) were the most common findings on CT. All abnormally large incisors were found on oral examination and CT, but macrodontia of cheek teeth could only be visualised by CT. Deviation of the lower jaw evaluated in awake animals by visual inspection appeared to correlate with cheek teeth abnormalities. Results emphasise the importance of diagnostic imaging, in particular CT, in guinea pigs with dental disease in order to localise lesions and underlying aetiologies.

Use of a geographic information system to map cases of measles in real-time during an outbreak in Dublin, Ireland, 2011

In 2011, there was a large measles outbreak in Dublin. Nationally 285 cases were notified to the end of December 2011, and 250 (88%) were located in the Dublin region. After the first case was notified in week 6, numbers gradually increased, with 25 notified in June and a peak of 53 cases in August. Following public health intervention including a measles-mumps-rubella (MMR) vaccination campaign, no cases were reported in the Dublin region in December 2011. Most cases (82%) were children aged between 6 months and 14 years, and 46 cases (18%) were under 12 months-old. This is the first outbreak in Dublin to utilise a geographic information system for plotting measles cases on a digital map in real time. This approach, in combination with the analysis of case notifications, assisted the department of public health in demonstrating the extent of the outbreak. The digital mapping documented the evolution of two distinct clusters of 87 (35%) cases. These measles cases were infected with genotype D4-Manchester recently associated with large outbreaks across Europe. The two clusters occurred in socio-economically disadvantaged areas and were attributable to inadequate measles vaccination coverage due in part to the interruption of a school-based MMR2 vaccination programme.

ISOLATION AND CHARACTERIZATION OF INFECTIOUS LARYNGOTRACHEITIS VIRUS IN LAYER CHICKENS

The present research work was conducted for the isolation and characterization of infectious laryngotracheitis (ILT) virus in layer chickens from commercial farms of Gazipur District. A total of 25 field samples were collected from suspected layer chickens of five commercial farms and were cultivated into 10-12 days old embryonated chicken eggs through chorioallantoic membrane (CAM) route for isolation of field virus. The field viruses were characterized by physico-chemical properties against pH, heat, ether and chloroform, serological test such as virus neutralization test (VNT) and passive haemagglutination (PHA) test and pathogenicity testing. In the embryonated chicken eggs, virus produced discrete pock lesions as early as 2 days of post inoculation and embryo death was recorded within 4-6 days of inoculation. The viruses could be inactivated by pH 4 within 2 hours. Inactivation of viruses was observed at 600C for 6 minutes, 550C for 15 minutes and 380C for 2 days. Ether-chloroform treatment also inactivated the viruses. Virus neutralization test revealed that all the virus isolates were neutralized by antiserum to ILT vaccine. Passive haemagglutination test showed that the tanned sheep RBC sensitized with the virus isolates were agglutinated in presence of the antiserum to ILT vaccine. The pathogenicity test recorded 100% mortality in experimental chickens. Data of this study suggest that the field isolates might be infectious laryngotracheitis virus.DOI = http://dx.doi.org/10.3329/bjvm.v8i2.11194 Bangl. J. Vet. Med. (2010). 8 (2) : 123-130 

Multi-Lorentzian representation of deuterium spectrum to study water spin magnetization exchange in MCM-41

Water behavior on the pore surface of nano-silica MCM-41, at a hydration level corresponding to one water molecule per OH group, is studied using (2)H NMR spectra in the temperature range 213 to 313 K. In an earlier study [J. Hassan, E. Reardon, H. Peemoeller, Microporous Mesoporous Materials, 122 (2009) 121-127] it was shown that at this hydration level, deuterons of water at single OH sites exhibit a Lorentzian line shape and deuterons of water at hydrogen-bonded OH sites exhibit a powder pattern. Here it is shown that magnetization exchange occurs between these two deuteron spin groups. This exchange cannot be described using the common, two-site exchange model, involving two Lorentzians. We successfully apply a multi-Lorentzian exchange model, prompted by Woessner's work [D. E. Woessner, Mol. Phys. 34, 4, (1977) 899-920] on the effects of motion on the shape of water spin resonance lines exhibiting doublet splitting. For this low hydration sample the rate of magnetization exchange out of the hydration site, where the water deuterons exhibit a Lorentzian line in the (2)H spectra, is 1.3 ms(-1) and the activation energy for the exchange is found to be 3.4±0.1 kcal/mole.

Transvaginal sonography of cervical length and Bishop score as predictors of successful induction of term labor: the effect of parity

OBJECTIVE

To evaluate the predictive value for successful labor induction of transvaginal ultrasound (TVS) of cervical length according to parity.

METHOD

TVS of the cervix was performed before term labor induction. Induction was considered successful if vaginal delivery was achieved within 24 hours; 231 women were available for final analysis.

RESULTS

Analysis of the receiver operator characteristics curve showed an optimal cut-off for cervical length of < or = 20 mm for successful induction. Following multivariate logistic regression analysis, a sonographic short cervix (AOR 5.6; p < 0.001) was an independent predictor of successful induction but not a favorable Bishop score (p = 0.47). Among multiparas with a short cervix, positive and negative predictive values for successful induction were 98% (95% CI 90-100%) and 21% (95% CI 13%-32%) and among nulliparas, predictive values were 69% (95% CI 53%-82%) and 77% (95% CI 64%-87%) respectively.

CONCLUSION

In nulliparas, cervical length can usefully predict labor induction outcome.

Six-minute walk test in children with chronic conditions

OBJECTIVES

The 6-minute walk test (6MWT) is a frequently used indicator of functional exercise capacity. The goals of this study were to compare the 6-minute walk performance of three paediatric patient groups with that of healthy peers, to assess differences between published reference values and to investigate which anthropometric characteristics best predict 6-minute walk performance.

METHODS

47 children with haemophilia (mean (SD) age 12.5 (2.9) years), 44 with juvenile idiopathic arthritis (JIA) (mean age 9.3 (2.2) years) and 22 with spina bifida (SB) (mean age 10.3 (3.1) years) were included. Subjects performed a 6MWT, and the distance walked (6MWD) was compared with published reference values.

RESULTS

The haemophilia, JIA and SB patients achieved 90%-92%, 72%-75% and 60%-62% of predicted walking distances, respectively. There were significant associations between 6MWD and age, height and weight in the haemophilia group and 6MWD and height in the JIA group. None of the anthropometric variables was significantly related to 6MWD in the SB group. All anthropometric variables were strongly correlated with walking distance-body weight product (6Mwork) in all groups. Height explained 24% (haemophilia) and 11% (JIA) of the variance in 6MWD and 84% (haemophilia), 78% (JIA) and 73% (SB) of the variance in 6Mwork.

CONCLUSIONS

Walking distances of children with haemophilia, JIA and SB are significantly reduced compared with healthy references. Walking distance-body weight product seems to be a better outcome measure of the 6MWT compared with distance walked alone. Height is the best predictor of 6MWD and 6Mwork.

Predictors of newborn admission after labour induction at term: Bishop score, pre-induction ultrasonography and clinical risk factors

INTRODUCTION

Following labour induction at term, 12 percent of neonates can expected to be admitted to the neonatal intensive care unit. We aimed to evaluate the Bishop score, pre-induction ultrasonography (US) assessment of amniotic fluid, foetal weight and cervical length, and pre-induction and intrapartum risk factors as predictors of neonatal admission.

METHODS

152 women at term, scheduled for labour induction, consented to participate in this prospective study. Transabdominal US was performed to obtain foetal biometry and amniotic fluid index, followed by transvaginal US to measure cervical length. US findings were concealed. The Bishop score was obtained at initiation of labour induction. Pre-induction and intrapartum risk factors were also considered in the multivariate logistic regression analysis. All study women received standard care.

RESULTS

On univariate analysis, factors associated with neonatal admission were: gestational age at less than or equal to 40 weeks, labour induction for diabetes mellitus, Bishop score of less than 5 at initiation of labour induction, estimated foetal weight of less than 2.5 kg by US, induction to delivery interval of more than 24 hours, caesarean delivery and umbilical cord blood pH of less than 7.1. Cervical length of greater than 20 mm on transvaginal US (p-value is 0.10) was not significant. After multivariate logistic regression analysis, controlling for the significant variables, only the unfavourable Bishop score (adjusted OR 4.2; 95% CI 1.2-13.8; p-value is 0.02) and caesarean delivery (adjusted OR 3.9; 95% CI 1.1-13.7; p-value is 0.035) were independent predictors of neonatal admission.

CONCLUSION

The identification of an unfavourable Bishop score as an independent predictor of neonatal admission is useful in the counselling of women who are considering labour induction.

Translational mini-review series on infectious disease: congenital cytomegalovirus infection: 50 years on

Cytomegalovirus (CMV) is the leading cause of congenital viral infection, with an incidence of 0.5-3% of live births worldwide. Clinical evidence has shown hearing and vision loss, mental retardation and sometimes death in affected newborns. Primary maternal CMV infection during gestation poses a 40% risk of intrauterine transmission in contrast to recurrent infection. European laboratories have made significant progress in the last decade in solving diagnostic problems linked to infection in pregnancy. With the advances in CMV serology, such as detection of anti-CMV IgM by enzyme immunoassays (EIA), confirmed by Western blot, together with seroconversion and anti-CMV IgG avidity evaluation in pregnant mothers, can help to identify recent infection. Preventative measures such as screening for CMV in the routine serological work-up of pregnant women have been introduced in countries such as Spain and Italy. The development of specific T cell-mediated immune responses in mothers, fetus and neonates is now emerging with regard to antigen-specific CD4 and CD8 T cells, differentiation status, proliferative and cytokine responses. A protective vaccine against CMV is a major public health priority and the study of vaccines in animal model systems has identified potential strategies for interrupting transmission and preventing disease in newborns. Congenital CMV infection has a variable outcome and therefore novel diagnostic methods are required to identify those at risk and therapeutic interventions are needed to improve the long-term prognosis of those infected. CMV was first isolated in 1957. We are now 50 years on, so procrastination is not an option.

Immunological response to cytomegalovirus in congenitally infected neonates

Cytomegalovirus (CMV) is the most common cause of congenital infection worldwide and occurs as a result of transplacental transmission of the virus. The human neonate is highly susceptible to infection due to a combination of immaturity of the immune system and antigenic inexperience. This study uses the in vivo model of congenital CMV to examine both the humoral and cell-mediated immune responses in vertically infected neonates and their mothers. Ten pairs of matched neonates and their mothers were evaluated for specific IgM responses to three immunodominant CMV antigens: pp38 (pUL80a), pp52 (pUL44) and pp150 (pUL32). In contrast to conventional enzyme immunoassay (EIA) testing for CMV-specific IgM, which found five of the mothers and four of the neonates to be positive, Western immunoblotting showed all 10 adults and nine newborns to be positive. Eight mothers and nine newborns had serological evidence of primary infection. All neonates showed a response to pp38, an assembly protein, nine responded to the pp52 immediate early antigen but only four had reactivity to the pp150 tegument associated protein. Of the mothers, eight had pp38 reactivity, 10 showed a response to the pp52 antigen and seven to the pp150 antigen. T cell-mediated immunity was assessed by measuring cytokines using a multiplex microarray assay. Levels of interferon (IFN)-gamma were high in both groups [mean +/- standard error of the mean (s.e.m.): neonates = 657 +/- 238 pg/ml, mothers = 1072 +/- 677 pg/ml, pNS]; however, neonates had significantly higher levels of interleukin (IL)-8 (316 +/- 136 pg/ml versus 48 +/- 28 pg/ml, P < 0.005). Similar levels of IL-2, IL-7, IL-10 and IL-12 were measured in both groups, but levels of IL-1alpha, IL-1beta, IL-4, IL-6 and tumour necrosis factor (TNF)-alpha were either absent or low. In response to CMV, neonates and adults mount a predominant T helper 1 (Th1) response, as evidenced by the presence of IL-2, IL-8, IL-12 and IFN-gamma with concomitant lack of IL-4. These findings suggest that the neonate, when presented with infection in utero, is capable of mounting an individual response; however, the lower IFN-gamma and higher IL-8 levels suggest reduced immune responsiveness when compared to their adult counterparts.

Transvaginal sonographic measurement of cervical length vs. Bishop score in labor induction at term: tolerability and prediction of Cesarean delivery

OBJECTIVES

To compare transvaginal sonography for cervical length measurement and digital examination for Bishop score assessment in women undergoing labor induction at term, to assess their tolerability (in terms of pain) and ability to predict need for Cesarean delivery.

METHODS

A prospective study was performed on 249 women admitted for labor induction. Cervical length was measured using transvaginal ultrasound examination. A 10-point visual analog scale (VAS) for procedure-related pain was obtained. Bishop score was determined just before labor induction and another pain score was obtained. Delivery outcome was recorded. Analyses were by t-test, Fisher's exact test, receiver-operating characteristics (ROC) curves and multivariate logistic regression.

RESULTS

Transvaginal sonography was significantly less painful than digital examination for Bishop score assessment (mean difference in VAS score 3.46; P<0.001). Analyses of the ROC curves for cervical length and Bishop score indicated that both were predictors of Cesarean delivery (area under the curve 0.611 vs. 0.607; P=0.012 vs. P=0.015, respectively) with optimal cut-offs for predicting Cesarean delivery of >20 mm for cervical length and Bishop score<or=5. Cervical length had superior sensitivity (80% vs. 64%) and marginally better positive (30% vs. 27%) and negative (89% vs. 83%) predictive values. Multivariate logistic regression analysis revealed that only nulliparity (adjusted odds ratio (AOR) 4.1; 95% CI, 2.1-8.1; P<0.001) and transvaginal sonographic cervical length>20 mm (AOR 3.4; 95% CI, 1.4-8.1; P=0.006) were independent predictors of Cesarean delivery.

CONCLUSIONS

Transvaginal sonography for cervical length measurement is better tolerated than digital examination for Bishop score assessment. Both cervical length and Bishop score are useful predictors of the need for Cesarean delivery following labor induction. A cervical length>20 mm at labor induction at term is an independent predictor of Cesarean delivery.

Phytoestrogens levels determination in the cord blood from Malaysia rural and urban populations

This study is a result of an analysis of free and conjugated phytoestrogens daidzein, genistein, daidzin, genistin and coumesterol in human cord blood plasma using LCMS. Cord blood was collected from urban and rural populations of Malaysia (n=300) to establish a simple preliminary database on the levels of the analyzed compounds in the collected samples. The study also aimed to look at the levels of phytoestrogens in babies during birth as this may have a profound effect on the developmental process. The sample clean up was carried out by solid-phase extraction using C18 column and passed through DEAE sephadex gel before analysis by LCMS. The mean concentrations of total phytoestrogens were daidzein (1.4+/-2.9 ng/ml), genistein (3.7+/-2.8 ng/ml), daidzin (3.5+/-3.1 ng/ml), genistin (19.5+/-4.2 ng/ml) and coumesterol (3.3+/-3.3 ng/ml). Distribution of phytoestrogen was found to be higher in samples collected from rural areas compared to that of urban areas.

Molecular defects in the β-globin gene identified in different ethnic groups/populations during prenatal diagnosis for β-thalassemia: a Malaysian experience

Beta-thalassemia is the most-common genetic disorder of hemoglobin synthesis in Malaysia, and about 4.5% of the population are heterozygous carriers of the disorder. Prenatal diagnosis was performed for 96 couples using the Amplification Refractory Mutation System and Gap-Polymerase Chain Reaction. We identified 17 beta-globin defects-initiation codon for translation (T-G), -29 (A-G), -28 (A-G), CAP +1 (A-C), CD 8/9 (+G), CD 15 (G-A), CD 17 (A-T), CD 19 (A-G), Hb E (G-A), IVS1-1 (G-T), IVS1-5 (G-C), CD 41/42 (-CTTT), CD 71-72 (+A), IVS2-654 (CT), poly A(A-G), 100-kb Ggamma(Agammadeltabeta) degrees and 45-kb Filipino deletions. The 192 beta-alleles studied comprised Chinese (151 patients), Malay (21), Orang Asli from East Malaysia (15), Filipino (1), Indian (1), Indonesian Chinese (2), and Thai (1). In the Chinese, 2 beta-globin defects at CD 41/42 and IVS2-654 were responsible for 74% of beta-thalassemia. beta-mutations at CD 19, IVS1-1 (G-T), IVS1-5, poly A, and hemoglobin E caused 76% of the hemoglobin disorders in the Malays. The Filipino 45-kb deletion caused 73.3% of bthalassemia in the Orang Asli. Using genomic sequencing, the rare Chinese beta-mutation at CD 43 (G-T) was confirmed in 2 Chinese, and the Mediterranean mutation IVS1-1 (G-A) was observed in a Malay beta-thalassemia carrier. The beta-globin mutations confirmed in this prenatal diagnosis study were heterogenous and 65 (68%) couples showed a different globin defect from each other. The use of specific molecular protocols has allowed rapid and successful prenatal diagnosis of beta-thalassemia in Malaysia.

A. Kim, k.f. Anderson, j. Berliner, j. Hassan, j. Jensen, h.j. Mertz, h. Pietsch, a. Rao, R. Scherer, and a. Sutterfield

In this study, three dummies were evaluated on the component level and as a whole. Their responses were compared with available volunteer and embalmed Post Mortem Human Subject (PMHS) data obtained under similar test conditions to evaluate their biofidelity. The volunteer and PMHS data, used as comparators in this study, were used previously to establish some of the biofidelity requirements of the Hybrid III. The BioRID II, the Hybrid III, and the RID2 were all subjected to rear impact HYGE sled tests with deltaVs of 17 and 28 km/hr to determine their biofidelity in these conditions. A static pull test, where a load was manually applied to the head of each dummy, was used to evaluate the static strength of their necks in flexion and extension. Finally, pendulum tests were conducted with the Hybrid III and RID2 to evaluate the dynamic characteristics of their necks in flexion and extension. The sled test results indicate that out of the three dummies, the overall flexibility of the Hybrid III is comparable to that of the volunteer anticipating the impact. The overall flexibilities of the BioRID II and the RID2 are greater than those of all the comparators used in this study (the tensed volunteer and the two embalmed PMHSs). The responses of the Hybrid III are closer to those of the tensed volunteer than those of the PMHSs. The responses of the BioRID II and the RID2 are closer to those of the PMHSs than to the tensed volunteer.

A Comparison of the Hybrid III and BioRID II Dummies in Low-Severity, Rear-Impact Sled Tests

A BioRID II dummy and a Hybrid III dummy, each representative of a midsize adult male, were tested side-by-side in simulated rear-impact sled tests. In all tests the dummies were restrained by 3-point belt systems. The results of 4 test sets conducted at a nominal change in velocity (deltaV) of 16 km/hr are presented and discussed. In three of the test sets, bucket seats were used. The head restraints were placed in the up-position in two of the three test sets and in the down-position in the third set of tests. In the fourth test set, rigid seats without any head restraints were used. While analyzing the BioRID II data, the presence of an axial neck load acting on the head, which bypassed the upper neck load transducer, was discovered in all the reported tests. The implication of this observation is that the axial force and all the moments measured by the BioRID II upper neck load transducer could be erroneous. A second concern with the BioRID II data was the high frequency noise observed, especially on the T1 acceleration response which is used in the NIC calculation. The 18 Hz filter used to process the T1 acceleration data for the NIC calculation attenuated the peak NIC values by 15% as compared to the SAE 180 filtered values. The unmeasured neck loads and high-frequency noise issues need to be resolved before additional BioRID II testing is done. A third concern with the BioRID II is the initial position of its head in the automotive seating posture. It is higher and more forward than that of the 50(th) percentile adult male.

Human recent thymic emigrants--identification, expansion, and survival characteristics

This study shows that, in humans at birth, circulating T cells represent recent thymic emigrants (RTEs) as reflected in their high level of expression of TCR excision circles. RTEs express "thymocyte-like" characteristics with regard to rapid rate of apoptosis. In the presence of common gamma-chain cytokines, in particular IL-7, they show enhanced potential to survive, entry into cell cycle, and proliferation. Although common gamma-chain cytokines were also potent antiapoptotic stimuli for mature adult-derived naive CD4+CD45RA+ T cells, these cells were refractory to IL-7-induced expansion in vitro. RTEs cultured with IL-7 could not reinduce recombination-activating gene-2 gene expression in vitro. These data suggest that postthymic naive T cells in the periphery during early life are at a unique stage in ontogeny as RTEs, during which they can undergo homeostatic regulation including expansion and survival in an Ag-independent manner while maintaining their preselected TCR repertoire.