Parents' experience of family-centred care in the post-anaesthetic care unit during non-clinical delays: A qualitative study

The qualitative exploratory descriptive study explored parents' experience of family-centred care during delayed transfer from a paediatric post-anaesthetic care unit to an inpatient ward. Data were collected in a tertiary children's hospital in Melbourne, Australia, using in-depth, semi-structured interviews. Participants (n = 15) were parents of children (n = 10, aged 6 months to 16 years) delayed in a Stage 1 post-anaesthetic care unit for longer than 30 min. Elements of the family-centred care framework guided thematic analysis, the core concepts of which are respect and dignity, information sharing, participation and collaboration. Respect and dignity was most often identified, expressed in three subthemes: (1) the caring behaviour of staff, (2) being present with their child and (3) a journey shared with other families. Information sharing was also common, illustrated through (1) being told information and (2) being heard. Participation, the third element of the framework, was infrequently identified by participants; however, parents of children under 6 years of age alluded to contributing to their child's care. The final element, collaboration, was not identified in the study data. Only two of four elements of the family-centred care framework were common in parents' experiences: respect and dignity, and information sharing. 'Being with' their child emerged as a central concern for parents' perceptions of family-centred care.

Bond strength and internal adaptation of customized glass fiber posts using different bulk-fill flow resins

Background

Material and Methods

Results

Conclusions

Cutaneous mammary loxoscelism: An unknown cause of breast inflammation: A case report and review of the literature

Envenomation due to a Loxosceles spider bite is a rare event in France and no case concerning the breast has yet been reported. We report the case of a 48-year-old woman who presented at Saint-Etienne University Hospital with a pulsatile pain in her left breast two days after feeling a fleeting bite. An abscess was diagnosed and antibiotics were prescribed. A few days later, a necrotic zone appeared around the areola and 75 percent of the surrounding skin was inflamed. The patient reported a persistent fever and a burning pain in her breast. Loxoscelism was finally concluded and surgical debridement was undertaken, followed by supervised wound therapy and local skin care. Complete healing was achieved after 4 weeks of treatment. The diagnosis of loxoscelism is generally presumptive, as the bite is usually painless and the spider rarely captured. Its diagnosis should be considered when an abscess responds poorly to antibiotics.

Parental Preference for Treatment Location and Inclusion in Decision Making in Painful Pediatric Procedures: Towards an Evidence-Based Clinical Guideline

PURPOSE

To determine parental preference for treatment location of painful procedures for pediatric patients, and the involvement of parents in decision-making about procedure location.

DESIGN AND METHOD

A descriptive survey design was applied. Parents of hospitalized children were asked what procedures their child had undergone, where the procedures were performed, who decided on the location, what their preference was, and why. Data was collected over a twelve-day period in seven wards of a tertiary pediatric hospital.

RESULTS

Of 312 different procedures, 244 (78%) were performed in the patient's room. The treatment room was reserved for complex procedures such as lumbar punctures. Seventy-three percent of parents surveyed indicated a strong preference for procedures to be performed in the patient's room, with the most common reason being 'comfortability'. Parents were only involved in procedure location decision-making in 50% of the reported cases.

CONCLUSIONS

For parents, the patient's room is the preferred location for many procedures. The opinion of parents was not always taken into consideration by health care professionals, in contrary to the principles of patient-centered care. These findings are important for health care professionals in pediatric settings to reconsider the location of procedures and how parents are involved in decision making.

DOP76 No durable impact of COVID-19 on disease activity and microbiome composition in patients with IBD

Background

Although patients with inflammatory bowel disease (IBD) reported an increased frequency of gastrointestinal (GI) symptoms following infection, the durable impact of COVID-19 on underlying IBD is not well defined.

Methods

In 118 IBD patients with COVID-19, clinical and endoscopic IBD activity, laboratory markers (ESR, CRP, hemoglobin (Hb), fecal calprotectin(FCP)), and medication utilization was assessed up to 6 months post-infection and compared to during infection or up to 6 months prior to infection. Active disease was defined by a Harvey Bradshaw Index > 4, Mayo Score ≥2, SES-CD ≥2, Mayo endoscopic score ≥1. 16S rRNA analysis was used to evaluate microbiome composition in a subset of 12 patients before and after COVID-19.

Results

Although upper respiratory (86.6%) and new GI symptoms (39.1%) were common in patients with IBD, there was no significant change in IBD clinical disease activity (Pre vs. Post-COVID-19 HBI: 4.7 vs. 4.9; partial Mayo: 3.0 vs. 2.1), endoscopic evaluation (Pre vs. Post-COVID-19 SES-CD: 7.2 vs. 8.9, Mayo endoscopic score: 1.5 vs. 1.7), or laboratory markers (Pre vs. Post-COVID-19 CRP: 1.2 vs. 1.3; ESR: 25 vs. 26; Hb 12.8 vs. 13.2; FCP: 388 vs. 250) up to 7 months post-COVID-19 compared to the 6 months prior to infection (Table 1). Overall active disease was present in 60% of the cohort prior to COVID-19 and 55% and 59% during and post-COVID-19, respectively. More subjects (8.5%) reported a delay in medical therapy during COVID-19, but there were no differences in the need for corticosteroids, a change in medical therapy, or IBD-related surgery or hospitalization during or post-COVID-19 compared to the prior 6 months. Microbiome composition stratified by underlying IBD disease activity, but did not show significant change post-COVID-19 (Figure 1).

Conclusion

COVID-19 showed no durable impact on clinical IBD disease activity or microbiome composition supporting guidelines for continued maintenance care.

Targeted nanostructured lipid carriers for doxorubicin oral delivery

The treatment with anticancer drugs remains a challenge, as available drugs still entail the risk of deleterious off-target effects. The present study describes folic acid conjugated nanostructured lipid carriers (NLCs) as an effective doxorubicin delivery approach targeted to breast cancer cells. Two distinct NLCs formulations were designed and optimized leading to an encapsulation efficiency over than 65%. Cytotoxic and targeting potential of NLCs were studied in vitro, using MDA-MB-231 cell line. Results showed an enhanced cellular uptake of conjugated NLCs. In vitro release studies, mimicking the path in the body after oral administration, show that all formulations would reach the tumor microenvironment bearing 50% of the encapsulated doxorubicin. Moreover, NLCs demonstrated storage stability at 25 °C for at least 42 days. Overall, results revealed that the developed NLCs enable the possibility of oral administration and are a promising approach for the targeted delivery of doxorubicin to breast cancer cells.

Barriers and Facilitators to Seeking Sleep Solutions for Children With Cerebral Palsy: A Qualitative Study

Background: Published evidence to date suggests that sleep problems are common in children with cerebral palsy (CP). This qualitative study is a follow up to a previously published quantitative phase on the experience and impact of sleep problems in this population. Aims: The aim of this study was to explore the experience and impact of sleep disturbance and seeking of sleep solutions for parents of school aged children with CP. Materials and Methods: Semi-structured 19 qualitative interviews were conducted with parents of children with CP aged 6-12 years. Interview data were transcribed verbatim and the thematic analysis techniques by Braun and Clarke was used to identify themes. Results: Thematic analysis identified 7 themes: (1) My Child Doesn't Fit into the Box, (2) A Mother's Ears are Always On, (3) Sleep Disturbance is like Water Torture, (4) Sleep is One of Many Spot Fires, I Put it on the Backburner, (5) Luck, Money or Jumping Up and Down, (6) There is Never One Silver Bullet and (7) Help: The Earlier the Better. The key finding was that parents of children with CP often described their child's needs being distinct from what is provided by systems and services. Conclusion: Parents face significant challenges sourcing effective sleep solutions for their child with CP. Sleep is often not a priority for either the parent or the clinician as other health problems take precedence. Parents reflected that early sleep intervention for their child was or would have been helpful. The barriers and facilitators to sleep care identified in this study should be used to inform clinical change in care for children with CP. Sleep needs to be prioritized in healthcare for children.

Sleep problems and solution seeking for children with cerebral palsy and their parents

AIM

Sleep problems are common in school-aged children with cerebral palsy (CP). Despite the significant impact of sleep disturbance and deprivation, there is a paucity of research in the area. The aims of this study were to (i) investigate the frequency of sleep problems in children with CP and their parents and (ii) understand what happens when parents ask for help with sleep problems from their health-care professionals.

METHODS

This was a prospective cohort study using an online survey sent to parents/primary care givers of children with CP aged 6-12 years recruited through the Victorian Cerebral Palsy Register. The following sleep assessment tools: The Children's Sleep Habits Questionnaire, the Pittsburgh Sleep Quality Index and the Gross Motor Function Classification System Parent Rating Tool were administered along with custom-designed questions that were informed by a preceding qualitative scoping study.

RESULTS

Complete data sets were received from 126 parents/care givers. Almost half (46%) of the parents reported their child had sleep problems. Of the 64 parents who reported seeking help for a child's sleep problem, only 21 indicated that their attempt was successful. If a child had poor sleep, the parent was more likely to have a sleep problem than parents who did not report poor child sleeping.

CONCLUSION

Sleep problems are common in children with CP and their parents. Parents do not always seek help, and those who do may not find an effective solution. Future research should explore how sleep problems can be effectively prioritised for children with CP and their parents/care givers.

Vaccination in people with disability: a review

People with disabilities are vulnerable to complications from vaccine-preventable diseases, and every effort should be made to ensure equitable access to immunization for this population. This paper aims to summarize the research on immunizations in people with disabilities, in order to ensure a comprehensive understanding of knowledge in this area and direct further research. The literature is weighted towards coverage data that is difficult to synthesize because of the different definitions of disability, and the variety of settings, vaccinations and age groups across the studies. In-depth qualitative data and data from a variety of health-care providers and people with disability is notably lacking. This is vital to redress in order to develop effective immunization interventions in this population.

Abstract P5-03-05: Sphingosine-1-phosphate produced by sphingosine kinase 1 and exported via ABCC1 shortens survival of mice and humans with breast cancer

Background: Sphingosine-1-phosphate (S1P), a bioactive sphingolipid mediator that is generated by sphingosine kinase 1 (SphK1) when it is phosphorylated (pSphK1) inside cells, has been implicated in regulation of many process important for breast cancer progression. Previously we have shown that S1P is exported out of human breast cancer cells by ATP-binding cassette (ABC) transporter ABCC1, but not by ABCB1, both known multidrug resistance proteins that efflux chemotherapeutic agents. However, the pathological consequences of these events to breast cancer progression and metastasis have not been elucidated. Here, we report that high expression of ABCC1, but not ABCB1, is associated with poor prognosis in breast cancer patients via exporting S1P.

Materials and methods: Microarray based gene expression data of 2509 patients associated with their survival were obtained from METABRIC database. Single gene survival analysis based on expressin of SphK1, and dual ABCC1 or ABCB1 and SphK1 survival analyses were perfomerd. For protein analyses, tissues were obrained from 275 patients with stage 1-3 breast cancers treated in Yokohama City University Medical Center in Japan between 2006 and 2008. The expression of pSphK1 was analyzed by immunohistochemistry and investigate the relationship with clinicopathological findings. For in vitro and in vivo experiments, breast cancer cell lines were transfected by ABCB1, ABCC1 or vector transiently or stably. BALB/c nu/nu mice and BALB/c mice were used for in vivo experiments. S1P was measured by LC-ESI-MS/MS.

Results: SphK1 expression significantly associate with worse overall survival (median survival of 124 months with high SphK1 expression compared to 163 months for patients with low SphK1 expression, p=0.0014). Although patients with high ABCC1 expression had only a slightly worse overall survival of 150 months, those with high levels of both SphK1 and ABCC1 had much worse prognosis with median overall survival of 114 months (p < 0.0068). Such association was not observed with ABCB1 expression. The frequency of strong pSphK1 protein expression was higher in HER2 enrhiched or TNBC than in Luminal. pSphK1 was more prevalent and increased in a larger tumors and in tumors from patients with lymph node metastases. Patients with breast cancers that express both pSphK1 and ABCC1 proteins have significantly shorter disease free survival. Overexpression of ABCC1, but not ABCB1, in human MCF7 and murine 4T1 cells enhanced S1P secretion, proliferation and migration of breast cancer cells. Implantation of breast cancer cells overexpressing ABCC1, but not ABCB1, into the mammary pad markedly enhanced tumor growth, angiogenesis and lymphangiogenesis with concomitant increases in lymph node and lung metastases as well as shorter survival of mice. Interestingly, S1P exported via ABCC1 from breast cancer cells upregulated transcription of SphK1 and its own formation.

Conclusions: Our findings suggest that production and export of S1P via ABCC1, but not ABCB1, is associated with worse overall and disease free survival of breast cancer patients and that S1P axis play a role in aggressive biology of breast cancer progression and metastasis.

Citation Format: Yamada A, Nagahashi M, Aoyagi T, Huang W-C, Lima S, Miyazaki H, Narui K, Ishikawa T, Endo I, Waters MR, Milstien S, Spiegel S, Takabe K. Sphingosine-1-phosphate produced by sphingosine kinase 1 and exported via ABCC1 shortens survival of mice and humans with breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-03-05.

The first 3 minutes: Optimising a short realistic paediatric team resuscitation training session

Inadequate resuscitation leads to death or brain injury. Recent recommendations for resuscitation team training to complement knowledge and skills training highlighted the need for development of an effective team resuscitation training session. This study aimed to evaluate and revise an interprofessional team training session which addressed roles and performance during provision of paediatric resuscitation, through incorporation of real-time, real team simulated training episodes. This study was conducted applying the principles of action research. Two cycles of data collection, evaluation and refinement of a 30-40 minute resuscitation training session for doctors and nurses occurred. Doctors and nurses made up 4 groups of training session participants. Their responses to the training were evaluated through thematic analysis of rich qualitative data gathered in focus groups held immediately after each training session. Major themes included the importance of realism, teamwork, and reflective learning. Findings informed important training session changes. These included; committed in-situ training; team diversity; realistic resources; role flexibility, definition and leadership; increased debriefing time and the addition of a team goal. In conclusion, incorporation of interprofessional resuscitation training which addresses team roles and responsibilities into standard medical and nursing training will enhance preparedness for participation in paediatric resuscitation.

Brain magnetic resonance imaging findings in relapsing neuromyelitis optica

Background

Some studies showed abnormalities in brain magnetic resonance imaging (MRI) of relapsing neuromyelitis optica (R-NMO) from 12 to 46%. These abnormalities are described as compatible/non-compatible with multiple sclerosis (MS).

Objective

To describe the abnormal brain MRI lesions in R-NMO with imaging studies conducted with more sensitive white matter change techniques.

Methods

Thirty patients with R-NMO were selected. All MRI brain studies were performed with a 1.5-T Siemens MRI system according to the Standardized MR Imaging Protocol for Multiple Sclerosis from the Consortium of MS Centers Consensus Guidelines.

Results

Brain MRI images were evaluated in 29 R-NMO cases because in one case the MRI images were not appropriate for the study. Of these 29 brain MRI studies, 19 cases (65.5%) had at least one or more lesions (1–57) and 10 were negative (34.4%). Brain MRI findings in 19 cases were characterized in T2/fluid-attenuated inversion-recovery (FLAIR) by the presence of subcortical/deep white matter lesions in 16 (84.2%) cases (1–50), most of them < 3 mm and without juxtacortical localization. Periventricular lesions were observed in 13 (68.4%) cases, but morphologically they were not oval, ovoid or perpendicularly orientated. Infratentorial lesions, all >3 mm, were observed in 4 (21.05%) cases without cerebellar involvement. T1 studies demonstrated absence of hypointense regions. Optic nerve enhancement was observed in 6/19 patients (31.5%). None of the brain MRI abnormalities observed were compatible with Barkhof et al. criteria of MS.

Conclusions

This study, based on a Cuban patient population, with long duration of disease, good sample size and detailed characterization by MRI, demonstrated the brain MRI pattern of R-NMO patients, which is different from MS. Multiple Sclerosis 2007; 13: 186–192. http://msj.sagepub.com

Creating a journal club competition improves paediatric nurses' participation and engagement

BACKGROUND

To improve journal club participation, innovative approaches are required but few have been described. It was unknown if adding an element of competition, to an established journal club, would increase nurses' participation.

OBJECTIVE

To explore the impact on attendance and participation in a hospital-wide nursing journal club through the introduction of an element of competition.

DESIGN

A descriptive exploratory study.

SETTING AND PARTICIPANTS

An Australian specialist tertiary paediatric hospital with over 1600 nurses.

METHODS

In 2013, 12 hospital wards/departments were randomly assigned a month each to present journal club. Nurses were supported to evaluate an article according to a published framework. A predetermined rubric guided marking. Post competition, all hospital nurses received an anonymous online survey invitation. Demographic, Likert scale and qualitative data were collected. Questions elicited attitudes and perceived barriers or facilitators to participation in the journal club.

RESULTS

Compared to 2012, there was a statistically significant increase in journal club attendance (2013 median=20.5 [IQR=18.2, 27.7] vs. 2012 median=9 [IQR=6.5, 12.5], Mann-Whitney U test, p<0.01). Full online survey responses were received from 289/1674 (response rate 17.3%) of sent invitations (Non-Attendees n=224, Attendees n=65 (including 18 presenters). Overall, Attendees reported journal club had a positive impact on their professional engagement. Presenters rated the journal club format highly as it developed skills and increased their confidence in journal club presentation. Emergent themes were time and location, engagement, topics and content.

CONCLUSION

A competition format can increase nurses' journal club attendance and participation. Further work is required to establish applicability of this format to other settings.

Metabolic surgery for the treatment of type 2 diabetes in pancreas after kidney transplant candidates

Metabolic surgery for the treatment of type 2 diabetes mellitus (T2DM) in patients not morbidly obese (BMI <35) has been widely studied. Taking into account that ∼12% of pancreas transplants are performed in patients with T2DM, our goal was to evaluate the impact of metabolic surgery on the management of obese patients with T2DM on waiting lists for a pancreas transplant. We performed a Roux-en-Y gastrointestinal bypass in 5 patients with insulin-dependent T2DM who were candidates for pancreas after kidney transplant and with a BMI <35. Three patients became insulin independent by the end of the first year while the other 2 reduced their insulin requirements by 70%. Furthermore, all patients achieved improved control of lipid levels. We concluded that the surgery was effective in controlling blood glucose and lipid metabolism in these obese T2DM kidney transplant recipients. In this population, a pancreas transplant, along with its associated morbidity, may be avoided.

Evaluation of the effects of ultraviolet light on bacterial contaminants inoculated into whole milk and colostrum, and on colostrum immunoglobulin G

Raw milk and colostrum can harbor dangerous microorganisms that can pose serious health risks for animals and humans. According to the USDA, more than 58% of calves in the United States are fed unpasteurized milk. The aim of this study was to evaluate the effect of UV light on reduction of bacteria in milk and colostrum, and on colostrum IgG. A pilot-scale UV light continuous (UVC) flow-through unit (45 J/cm(2)) was used to treat milk and colostrum. Colostrum and sterile whole milk were inoculated with Listeria innocua, Mycobacterium smegmatis, Salmonella serovar Typhimurium, Escherichia coli, Staphylococcus aureus, Streptococcus agalactiae, and Acinetobacter baumannii before being treated with UVC. During UVC treatment, samples were collected at 5 time points and bacteria were enumerated using selective media. The effect of UVC on IgG was evaluated using raw colostrum from a nearby dairy farm without the addition of bacteria. For each colostrum batch, samples were collected at several different time points and IgG was measured using ELISA. The UVC treatment of milk resulted in a significant final count (log cfu/mL) reduction of Listeria monocytogenes (3.2 ± 0.3 log cfu/mL reduction), Salmonella spp. (3.7 ± 0.2 log cfu/mL reduction), Escherichia coli (2.8 ± 0.2 log cfu/mL reduction), Staph. aureus (3.4 ± 0.3 log cfu/mL reduction), Streptococcus spp. (3.4 ± 0.4 log cfu/mL reduction), and A. baumannii (2.8 ± 0.2 log cfu/mL reduction). The UVC treatment of milk did not result in a significant final count (log cfu/mL) reduction for M. smegmatis (1.8 ± 0.5 log cfu/mL reduction). The UVC treatment of colostrum was significantly associated with a final reduction of bacterial count (log cfu/mL) of Listeria spp. (1.4 ± 0.3 log cfu/mL reduction), Salmonella spp. (1.0 ± 0.2 log cfu/mL reduction), and Acinetobacter spp. (1.1 ± 0.3 log cfu/mL reduction), but not of E. coli (0.5 ± 0.3 log cfu/mL reduction), Strep. agalactiae (0.8 ± 0.2 log cfu/mL reduction), and Staph. aureus (0.4 ± 0.2 log cfu/mL reduction). The UVC treatment of colostrum significantly decreased the IgG concentration, with an observed final mean IgG reduction of approximately 50%. Development of new methods to reduce bacterial contaminants in colostrum must take into consideration the barriers imposed by its opacity and organic components, and account for the incidental damage to IgG caused by manipulating colostrum.

A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI)

BACKGROUND

Menopausal hormone therapy (HT) has shown benefits for women; however, associated drawbacks (i.e. risks, costs, fears) have currently determined its low use.

OBJECTIVE

To determine the prevalence of current HT use among mid-aged women and describe the characteristics of those who have never used, have abandoned or are currently using HT. In addition, reasons for not using HT were analyzed.

METHOD

This was a cross-sectional study that analyzed a total of 6731 otherwise healthy women (45-59 years old) of 15 cities in 11 Latin American countries. Participants were requested to fill out the Menopause Rating Scale (MRS) and a questionnaire containing sociodemographic data and items regarding the menopause and HT use.

RESULTS

The prevalence of current HT use was 12.5%. Oral HT (43.7%) was the most frequently used type of HT, followed by transdermal types (17.7%). The main factors related to the current use of HT included: positive perceptions regarding HT (odds ratio (OR) 11.53, 95% confidence interval (CI) 9.41-14.13), being postmenopausal (OR 3.47, 95% CI 2.75-4.36) and having a better socioeconomic level. A total of 48.8% of surveyed women had used HT in the past, but abandoned it due to symptom improvement or being unconcerned; fear of cancer or any other secondary effects were also reported but in less than 10%. Among women who had never used HT, 28% reported the lack of medical prescription as the main reason, followed by the absence of symptoms (27.8%). Among those reporting lack of prescription as the main reason for not using HT, 30.6% currently had severe menopausal symptoms (total MRS score > 16); 19.5% of women were using alternative 'natural' therapies, with 35.1% of them displaying severe menopausal symptoms as compared to a 22.5% observed among current HT users.

CONCLUSION

The use of HT has not regained the rates observed a decade ago. Positive perceptions regarding HT were related to a higher use. Lack of medical prescription was the main reason for not using HT among non-users, many of whom were currently displaying severe menopausal symptoms.

Pediatric pressure injuries: does modifying a tool alter the risk assessment outcome?

The aim of this study was to determine whether assessing patient risk of developing pressure injuries in Pediatric Intensive Care (PICU) and Neonatal Units (NNU) using a modification of the Glamorgan Scale (mGS) would alter the risk identification when compared to the Glamorgan Scale (GS). Prospective data were collected from a convenience sample of patients admitted to PICU or NNU during a 2-month period. The patients' pressure injury risk score using both instruments was collected by observing patients, reviewing patient records, and clarifying information with bedside nurses. Chi square analysis was used to compare the risk category allocations. A total of 133 patients were assessed with complete data available for 112 (PICU = 68, NNU = 65). The total number of admissions during the data collection period was 202 in PICU and 100 in NNU. There was an extensive spread of patients allocated to the "High Risk" and "Very High Risk" categories in both units. Only one was in the lower "At Risk" category. There was little difference in allocated risk category between the mGS and the GS (p = 0.982). Only one patient was not allocated to the same risk category by both tools. In addition to identifying little difference in risk identification the mGS was found to be easier to complete. The mGS delivered the same risk rating as the GS when applied to patients in the PICU and NNU. It is not clear if a similar agreement exists in the general pediatric population. When modifying a validated tool for local use consideration should be given as to how those modifications might alter outcomes.

[Immunoglobulin treatment for neonatal hemochromatosis: a case report in a context of immunoglobulin delivery quotas]

Neonatal hemochromatosis is a rare disease characterized by iron deposits in several organs. The natural course leads to lethal liver failure. A preventive treatment was recently introduced: high-dose intravenous immunoglobulins during pregnancy to prevent fetomaternal allo-immunization. Nevertheless, the prescription of massive quantities of immunoglobulins can lead to a drug shortage which the hospital pharmacist must deal with. We report the case of a pregnant woman with high risk of transmitting neonatal hemochromatosis. We discuss the pharmaceutical difficulties encountered when managing patients with a high risk of neonatal hemochromatosis in the context of immunoglobulin shortage with the delivery quotas established by the French National Health Authority. In this context, a national stock would be useful to deal with rare diseases and thus to support hospitals.

[Shoulder dystocia: a ten-year descriptive study in a level-III maternity unit]

OBJECTIVE

Shoulder dystocia is one of the most dreadful complications of vaginal deliveries. The aim of this observational study was to evaluate risk factors of dystocia, maternal and neonatal complications and recurrent risk factors.

PATIENTS AND METHODS

Sixty-six cases of shoulder dystocia occurring between January 1998 and August 2008 in our university hospital were identified. Demographic data, labor management, management of the shoulder dystocia and neonatal outcome were recorded.

RESULTS

The incidence of shoulder dystocia was 0.3%. Multiparity, weight gain greater than 12 kg, and post-term delivery were more present in our study group. McRoberts' manoeuver and symphyseal pressure were first realised. Brachial plexus injuries affected 9% of neonates with skeletal fractures in 7.5% of cases. Maternal morbidity was evaluated at about 8%. Twenty per cent had a recurrent shoulder dystocia.

DISCUSSION AND CONCLUSION

Shoulder dystocia is an obstetric emergency which requires a prompt management of trained personnel. Despite the difficulty of being able to prevent shoulder dystocia, training the obstetric staff could probably improve management of shoulder dystocia.

How does β-cyclodextrin affect oxygen solubility in aqueous solutions of sodium perfluoroheptanoate?

The solubility of oxygen in aqueous solutions of sodium perfluoroheptanoate (NaPFHept) at different concentrations was measured at 310.15 K with an apparatus based on the saturation method. The effect of adding beta-cyclodextrin (betaCD) on the solubility of oxygen was also studied. Conductimetry measurements showed that the presence of betaCD in aqueous solutions of NaPFHept increases its critical micellar concentration (CMC). In the presence of betaCD (15 mM), the characteristic minimum of oxygen solubility observed at the CMC is shifted from 83 to 114 mM, and the curvature at the minimum is reduced to 64% of the value in the absence of betaCD. Chemical shift changes for the H5 protons of betaCD, recorded as functions of the initial concentration of NaPFHept, point to the formation of a relatively strong 1:1 inclusion in betaCD of the perfluoroheptanoate anion. Hence, it is suggest that the effect of adding betaCD on the solubility of oxygen cannot be accounted for only by the perfluoroheptanoate anion inclusion in betaCD, but has to be ascribed to the direct influence of this inclusion complex on disrupting the aggregation process reducing the increase of oxygen solubility after the CMC value.

Exercise effects on cardiac size and left ventricular diastolic function: relationships to changes in fitness, fatness, blood pressure and insulin resistance

OBJECTIVES

To determine exercise training effects on cardiac size and left ventricular (LV) diastolic function and relationships of exercise induced changes in physiological and body composition parameters with cardiac parameters.

DESIGN

Prospective, randomised controlled trial.

SUBJECTS

Men and women (63.6 (5.7) years, body mass index 29.5 (4.4) kg/m(2)) with untreated hypertension (systolic blood pressure (BP) 130-159 or diastolic BP 85-99 mm Hg).

MAIN OUTCOME MEASURES

Cardiac size and LV diastolic function, peak oxygen uptake (Vo(2)), muscle strength, general and abdominal fatness, and insulin resistance.

INTERVENTIONS

6 months of exercise training versus usual care.

RESULTS

When analysed by group at six months, cardiac size and LV diastolic function did not differ between exercisers (n = 51) and controls (n = 53), whereas exercisers had significantly higher peak Vo(2) (28 v 24 ml/kg/min) and strength (383 v 329 kg), and lower fatness (34% v 37%), diastolic BP (73 v 75 mm Hg) and insulin resistance (quantitative insulin sensitivity check index 0.35 v 0.34) versus controls (all p <or= 0.05). By regression analysis, among six month changes, increased peak Vo(2) and reduced abdominal fat were associated with increased cardiac size. Increased peak Vo(2) and reduced abdominal fat, BP and insulin resistance were associated with improved LV diastolic function. r Values ranged from 0.20 to 0.32 (p <or= 0.05).

CONCLUSIONS

When examined by group assignment, exercise had no effect on cardiac size or LV diastolic function. When individual variations in six month changes were examined, participants attaining the greatest increases in fitness and reductions in abdominal fatness, insulin resistance and BP showed a modest trend towards physiological hypertrophy characterised by increased cardiac size and improved LV diastolic function. These results suggest that decreased abdominal fatness may have a role in improving cardiovascular health.