Regional tissue oxygenation in asymptomatic neonates at high risk for neonatal abstinence syndrome and impact of non-pharmacologic interventions: A case report

BACKGROUND

Improving neonatal abstinence syndrome (NAS) management is an important concern, and objective measures of its physiologic impact remain elusive. We sought to determine whether near-infrared spectroscopy (NIRS)-derived tissue oxygenation (rSO2) and fractional tissue oxygen extraction (FTOE) demonstrated physiologically plausible changes correlating with standard NAS scoring.

METHODS

Thirty subjects (mean 39 weeks' GA and 3 127 g BW) underwent cerebral and peripheral muscle NIRS monitoring on Days of Life (DOL) Three, Five, and Seven. We examined correlations between NAS scores and FTOE and assessed the impact of non-pharmacologic swaddling and cuddling.

RESULTS

No statistically significant correlations between NAS scores and FTOE were observed; however, plausible trends were demonstrated between NAS scores and cerebral measurements. Buprenorphine-exposed babies (57%) showed significantly lower FTOE when swaddled (DOL7).

CONCLUSIONS

Tissue oxygenation monitoring demonstrates potential to provide objective, clinically relevant physiologic information on infants at risk for NAS. Further study is required to determine whether NIRS-derived measures could assist in individualizing NAS care.

Relation between informant-rated personality and clinician-rated depression in patients with memory disorders

OBJECTIVE

The goal of this study was to examine the convergent validity of informant-rated changes in depressive and related personality traits with clinician-assessed depression in memory-disordered patients.

BACKGROUND

Depressive symptoms are frequent complications in persons with dementias such as Alzheimer disease, and caregiver informants consistently report changes in depression and related neurotic traits on the NEO Personality Inventory (NEO-PI) in dementia patients.

METHODS

In 78 patients undergoing evaluation of memory complaints at an Alzheimer disease clinic, depression was characterized by clinical diagnosis, a clinician-rated scale, and informant ratings of premorbid versus current depression, anxiety, vulnerability, and neuroticism on the NEO-PI.

RESULTS

The diagnostic groups differed in meaningful patterns on the NEO-PI measures. Those with a diagnosis of major depression differed from never-depressed patients in all personality areas, although those with depressed mood differed only on NEO-PI depression. The clinician-rated depression scale correlated modestly with current personality and change from baseline personality.

CONCLUSIONS

The NEO-PI provides a useful measure of informants' perspectives on depressive personality changes in patients with memory disorders but does not correspond fully with a clinical syndrome of depression.

The effect of a structured neonatal resuscitation program on delivery room practices

PURPOSE

This study evaluated the introduction of the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics and the American Heart Association into the delivery room of an Irish maternity hospital.

DESIGN

Prospective, controlled observational study of 51 deliveries before and 51 deliveries following the training of delivery room personnel in the NRP.

SAMPLE

Participants were 33 nurse-midwives and 11 pediatric resident physicians.

MAIN OUTCOME VARIABLE

Evaluation of postdelivery, newborn resuscitation practices.

RESULTS

The introduction of the NRP was associated with significant improvements in delivery room preparation, in the evaluation and management of the newborn infant, and in thermal protection at birth. Although there was a trend to use more free-flow oxygen following the introduction of the NRP, this was not statistically significant. Bag and mask ventilation was also used more frequently following NRP training. However, there were no significant differences in the use of endotracheal intubation, chest compressions, and medications. Fifteen of the 51 infants became hypothermic prior to the introduction of the NRP; none of the infants developed hypothermia in the post-NRP part of the study.

Magnetic resonance imaging correlates of depression in early- and late-onset Alzheimer's disease

BACKGROUND

Depressive symptoms are frequent complications of Alzheimer's disease (AD). We hypothesized that AD patients with depression would be more likely than nondepressed AD patients to show deep white-matter, subcortical gray-matter, and periventricular hyperintensities on magnetic resonance imaging (MRI).

METHODS

In a retrospective study of 31 AD patients, depression was characterized by clinical diagnosis (DSM-III-R major depression, depressive symptoms, or no depression), a clinician-rated depression scale, and informant ratings of premorbid (before memory disorder) as well as current depression using the NEO Personality Inventory (NEO-PI), and related to qualitative and quantitative ratings of MRI hyperintensities.

RESULTS

In contrast to reports in nondemented elderly patients, there was no relationship between clinical diagnosis of major depressive episode and hyperintensities; however, clinician-rated depressive symptoms were higher in subjects with large anterior hyperintensities. In the early-onset AD group only, MRI abnormalities were related to greater premorbid depression, and less increase in depression after the onset of dementia, as rated by informants on the NEO-PI.

CONCLUSIONS

Results highlight the need to consider early- and late-onset AD separately when assessing relationships between personality and MRI abnormalities, and to consider premorbid personality style when drawing conclusions about the etiology of depressive features seen in AD.

The constitution and formation of bleaching powder

"Bleaching powder" is made by the action of chloride gas on calcium hydroxide, the reaction being essentially: 2Ca(OH) 2 + 2Cl 2 → Ca(OCl) 2 + CaCl 2 + 2H 2 O. The constitution of the solid formed in this way has been the subject of investigation and speculation for many years, since its properties are not those to be expected of a mixture formed according to the above equation. In the first place, the reaction represented by the above equation never goes to completion; commercial bleaching powder usually contains 15-25% of calcium hydroxide and only about 35% chlorine available for oxidation; while even under special laboratory conditions it is extremely difficult to reduce the calcium hydroxide content below 5%. Secondly, the physical properties of bleaching powder are not those of a simple mixture of calcium hypochlorite, calcium chloride and unreacted calcium hydroxide; for instance, ordinary bleaching powder is not markedly deliquescent, and therefore does not contain free calcium chloride.In the account which follows, no attempt is made to summarize the whole of the previously published work; references are given only to publications which appear to have immediate connection with the issues raised here.

An integrated physical map of human chromosome 16

We describe an integrated physical, genetic and cytogenetic map of human chromosome 16 comprising both a low-resolution megaYAC map and a high-resolution cosmid contig/miniYAC map, which provides nearly complete coverage of the euchromatic arms of the chromosome. The physical map is anchored to a high-resolution cytogenetic breakpoint map and is integrated with genetic and gene transcript maps of the chromosome by sequence-tagged sites and clone hybridizations.

The relationship between self-care and metabolic control in children with insulin-dependent diabetes mellitus

To assess the relationship between insulin-dependent diabetes mellitus (IDDM) self-care management and metabolic control in school-aged children, 21 children ages 10 to 14 years with a duration of IDDM of 5.5 years (range 1 to 13 years) were studied. Self-care was defined as the activities that children with IDDM initiate and perform on their own in the management of their disease. Self-care activity was assessed by a revised Self-Care Questionnaire (SCQ), and metabolic control was determined by HbA1c levels obtained at the same time the SCQ was completed. A higher level of self-care management (higher SCQ) was hypothesized to correlate with better metabolic control (lower HbA1c). Regression analysis of SCQ and HbA1c supported the expected inverse relationship but not at a significant level. The only significant predictors of self-care activity and metabolic control were experience at a specialized camp for children with diabetes and race, with Caucasian children scoring higher in self-care and having lower HbA1c values than African American children.

Cytological and molecular characterization of centromeres in Mus domesticus and Mus spretus

We have applied EM in situ hybridization (EMISH) and pulsed field gel electrophoresis (PFGE) to samples from diploid primary cell cultures and an established cell line to examine in detail the relative organization of the major and minor satellite DNAs and telomere sequences in the genomes of Mus domesticus and Mus spretus. EMISH localizes the Mus domesticus minor satellite to a single site at the centromere-proximal end of each chromosome. Double label hybridizations with both minor satellite and telomere probes show that they are in close proximity and possibly are linked. In fact, PFGE of M. domesticus DNA digested with Sal I and Sfi I reveals the presence of fragments which hybridize to both probes and is consistent with the physical linkage of these two sequences. The M. domesticus minor satellite is the more abundant satellite in Mus spretus. Its distribution in M. spretus is characterized by diffuse labeling with no obvious concentration near chromosome ends. In addition to this repeat the M. spretus genome contains a small amount of DNA that hybridizes to a M. domesticus major satellite probe. Unlike the M. domesticus minor satellite, it is not telomere proximal but is confined to a domain at the border of the centromere and the long arm. Thus, although both species possess all three sequences, except for the telomeres, their distribution relative to one another is not conserved. Based on the results presented, we propose preliminary molecular maps of the centromere regions of Mus domesticus and Mus spretus.

Insulin pumps in children with diabetes

Insulin pump therapy or continuous subcutaneous insulin infusion is becoming more common. Nurses can expect to encounter a growing number of children who have insulin pumps and an increasing number of questions concerning the general application and efficacy of these pumps. Therefore it is important that pediatric nurse practitioners, school nurses, and pediatric nurses understand insulin pump therapy and its role in the overall treatment of children with diabetes. This article describes the advantages, disadvantages, and alternatives to insulin pump therapy. It also discusses staff expertise, patient selection criteria, and patient education as elements of successful insulin pump management.

Isolation and molecular characterization of a highly polymorphic centromeric tandem repeat in the family Falconidae

An abundant tandem repeat has been cloned from genomic DNA of the merlin (Falco columbarius). The cloned sequence is 174 bp in length, and maps by in situ hybridization to the centromeric regions of several of the large chromosomes within the merlin karyotype. Complementary sequences have been identified within a variety of falcon species; these sequences are either absent or in very low copy number in the family Accipitridae. The cloned merlin repeat reveals highly polymorphic restriction patterns in the peregrine falcon (Falco peregrinus). These polymorphisms, which have been shown to be stably inherited within a family of captive peregrines, can be used to differentiate the Greenland and Argentina populations of this endangered raptor species.

Construction of fifteen human chromosome-specific DNA libraries from flow-purified chromosomes

We report the construction of 15 human chromosome-specific DNA libraries. Metaphase chromosomes were purified by flow sorting and the DNA was extracted and cleaved with HindIII before cloning into the lambda vector Charon 21A. A sensitive miniblot hybridization method was used to monitor the physical and biochemical steps in the cloning procedure. Using this method, we have developed a highly efficient protocol for producing large numbers of recombinant phage from 0.2-1.0 X 10(6) sorted chromosomes. DNA from the following chromosomes was cloned: #4, 6, 8, 9, 11, 13, 14 + 15, 16, 17, 18, 19, 20, 21, 22 and Y. These libraries are available to the scientific research community and will be valuable in the genetic analysis of the human genome.

Persistent Hyaloid Canal (Canal of Cloquet) in Left Eye

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