Effect of fluctuation of oxygenation and time spent in the target range on retinopathy of prematurity in extremely low birth weight infants.

BACKGROUND: The association between saturation of peripheral oxygenation (SpO2) fluctuation and severity of retinopathy of prematurity (ROP) is well elucidated in extremely low birth weight (ELBW) infants. Time spent in the Target range of SpO2 is also associated with the severity of ROP. METHODS: In a prospective observational study, the SpO2 of all ELBW infants admitted to our unit were monitored for the first four weeks of life, and averaged every minute for analysis. The percent time spent at SpO2 <90%, 90-95%, and >95% and weekly SpO2 fluctuations [as SpO2 coefficient of variation (CoV)] were calculated. RESULTS: During the study period 21 infants had moderate to severe ROP and 35 infants served as controls. Infants with moderate to severe ROP were smaller and younger than their controls [676±124 grams vs. 796±148 grams (p < 0.001); and 24.0±1.0 weeks vs. 25.0±1.7 weeks (p < 0.001) respectively]. There were no significant differences in time spent in the 90-95% range between groups (p = 0.66). However there was a significant increase in weekly SpO2 CoV in infants with moderate to severe ROP vs. controls (p = 0.007). CONCLUSION: In ELBW infants, there was an association between SpO2 fluctuation during the first four weeks of life and severity of ROP, although, no association was established with time spent in the target range of SpO2.

Longitudinal changes in infant body composition: association with childhood obesity.

BACKGROUND: Rapid weight gain in infancy has been established as a risk factor for the development of later obesity. OBJECTIVE: We aimed to investigate the role of changes in infant body composition (assessed via total body electrical conductivity) on the development of overweight/obesity in mid-childhood. METHODS: Fifty-three term infants were evaluated at birth, three times during infancy and in mid-childhood. Logistic regression was used to determine associations between rates of total weight gain, fat mass gain and lean mass gain during infancy and later overweight/obesity (defined as body mass index [BMI] ≥85th percentile), adjusted for birth weight and parent education. RESULTS: At follow-up (age 9.0 ± 1.8 years), 30% were overweight/obese. More rapid total weight gain from 0 to 4 months was associated with twofold odds (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.05-3.74, P = 0.04) of overweight/obesity in mid-childhood. From 0 to 8 months, more rapid weight gain was associated with nearly fivefold odds (OR 4.76, 95% CI 1.05-21.5, P = 0.04), and more rapid fat mass gain was associated with eightfold odds (OR 8.03, 95% CI 1.11-58.2, P = 0.04) of later overweight/obesity. CONCLUSION: This exploratory study suggests that rapid weight gain, especially fat mass gain, in earlier infancy predisposes to mid-childhood overweight/obesity.

A class of distribution-free models for longitudinal mediation analysis.

Mediation analysis constitutes an important part of treatment study to identify the mechanisms by which an intervention achieves its effect. Structural equation model (SEM) is a popular framework for modeling such causal relationship. However, current methods impose various restrictions on the study designs and data distributions, limiting the utility of the information they provide in real study applications. In particular, in longitudinal studies missing data is commonly addressed under the assumption of missing at random (MAR), where current methods are unable to handle such missing data if parametric assumptions are violated.In this paper, we propose a new, robust approach to address the limitations of current SEM within the context of longitudinal mediation analysis by utilizing a class of functional response models (FRM). Being distribution-free, the FRM-based approach does not impose any parametric assumption on data distributions. In addition, by extending the inverse probability weighted (IPW) estimates to the current context, the FRM-based SEM provides valid inference for longitudinal mediation analysis under the two most popular missing data mechanisms; missing completely at random (MCAR) and missing at random (MAR). We illustrate the approach with both real and simulated data.

It's the procedure not the patient: the operative approach is independently associated with an increased risk of complications after rectal prolapse repair.

AIM: This study compares 30-day outcomes following rectal prolapse repair, examining potential surgical and patient factors associated with perioperative complications. METHOD: Using the NSQIP database, patients with rectal prolapse were categorized by surgical approach to repair (perineal or abdominal) and abdominal cases were further subdivided by procedure (resection compared with rectopexy alone). Univariate and multivariate analyses compared major and minor complication rates between the groups. RESULTS: Of 1275 patients, the perineal group (n=706, 55%) was older, with more comorbidity, than those undergoing an abdominal procedure. There were fewer minor (odd ratio (OR)=0.35; 95% confidence interval (CI), 0.20-0.60; P=0.0038) and major complications (OR=0.46; 95% CI, 0.31-0.80; P=0.0038) in the perineal compared with the abdominal cohort. There was a significant increase in major complications amongst patients undergoing a resection compared with rectopexy only (OR=2.15; 95% CI, 1.10-4.41; P=0.0299). There was no difference in major complications between abdominal rectopexy and a perineal approach, but the latter had a lower chance of minor complications (OR=0.47; 95% CI, 0.24-0.94; P=0.0287). CONCLUSION: A perineal approach is safer than an abdominal approach to the treatment of rectal prolapse. Regarding an abdominal operation, rectopexy has fewer major complications than resection.

A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn's disease: an analysis of outcomes from the NSQIP database.

AIM: Studies to date examining the impact of laparoscopy in resection for Crohn's disease on short-term morbidity have been limited by small study populations. The aim of this study was to establish the impact of the operative approach (laparoscopic or open) on outcomes after ileocolic resection for Crohn's disease. METHOD: Ileocolic resections for Crohn's disease were identified using Current Procedural Terminology (CPT) and International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes from the National Surgical Quality Improvement Program (NSQIP) database (2005-2009). Complications were categorized as major (organ system damage and systemic sepsis) or minor (incisional and urinary infections). Multivariate 30-day outcomes and length of stay were determined using linear models adjusting for patient characteristics, comorbidities and operative approach. RESULTS: Of 1917 ileocolic resections, 644 (34%) were performed laparoscopically. At baseline, the open group was significantly older, had more comorbidities, higher American Society of Anesthesiology (ASA) classes, and more intra-operative transfusions (all variables, P<0.05). On multivariate analysis, laparoscopic ileocolic resections were associated with a decrease in major (OR=0.629, 95% CI: 0.430-0.905, P=0.014) and minor (OR=0.576, 95% CI: 0.405-0.804, P=0.002) complications compared with open resections. Laparoscopy was associated with a significant reduction in adjusted length of stay compared with the open approach (-1.08±0.29 days, P=0.0002). CONCLUSION: After adjusting for comorbidities and perioperative factors, such as preoperative sepsis, higher ASA class and higher transfusion rates in the open group, laparoscopic ileocolic resection for Crohn's disease was found to be a safer choice than the open approach, resulting in fewer complications and length of stay. All other things being equal, such patients should be offered the laparoscopic approach as a first-choice option.

[The detection of bovine herpesvirus type 1 (BHV 1) using an intradermal test. I. Field studies]. / Untersuchungen zum Nachweis des bovinen Herpesvirus Typ 1 (BHV 1) mittels Intrakutantest. I. Mitteilung: Feldversuche.

An intradermal test (delayed hypersensitivity test) for the diagnosis of BHV1 infection was evaluated in 791 cattle of 16 dairy farms. The skin reactions were compared with the results of serological examinations using a commercial BHV1 ELISA kit (Trachitest). As antigen concentrated, purified and inactivated BHV1 was used. The skin reaction (increase of the skin fold thickness) was used for the interpretation of test results. The best results were obtained with the control of the skin reaction on the third day after injection of the antigen. From 393 serologically BHV1 negative cattle with an age of more than 6 months 391 (99.5%) had a skin reaction up to 1.0 mm and 2 animals (0.5%) had a reaction of 1.3 and 1.9 mm, respectively. The mean increase of skin fold thickness was 0.2 mm. Out of 291 serologically BHV1 positive cattle with an age of more than 6 months 270 had antibodies from natural infection and, partially, from additional vaccination with inactivated BHV1 vaccine. 266 (98.5%) of these animals showed a skin reaction of more than 2.0 mm, in 3 animals (1.1%) a skin reaction up to 1.0 mm was observed and 1 animal (0.4%) had a reaction of 2.0 mm. The mean increase of the skin fold thickness was 6.3 mm. 21 animals had BHV1 antibodies only because of vaccination with inactivated BHV1 vaccine. Only 4 animals had a skin reaction of more than 2.0 mm. Among 107 animals with an age up to 6 months 30 were serologically BHV1 positive and 77 were BHV1 negative. In all animals the skin reaction was less than 1.0 mm, the mean was 0.2 mm.

[Liver cirrhosis in young calves]. / Leberzirrhosen bei jungen Kälbern.

Among the cattle admitted to the II. Medizinische Tierklinik of the University of Munich during the years 1982-86, 38 calves of up to 6 weeks of age had a dystrophy (n=5), pre-cirrhosis (n=21) or cirrhosis (n=12) of the liver. Similar hepatic lesions were found in three 1- to 7-day-old calves and in 1 foetus aborted in the 7th month of gestation which were submitted for necropsy. Of the 38 patients (74% male, 87% German Fleckvieh) 25 had been ill since the first seven days of life (mean age on admittance: x=14 days). These hepatopathies showed no significant preponderance in regard to breed, sex or season. The general condition of the calves was moderately to severely disturbed. Catarrhal enteritis resistant to treatment was the main clinical finding in 32 of the 38 patients. Nine calves developed central nervous symptoms (delayed reflexes, impaired coordination, convulsions, opisthotonus). Neurohistological examination of one of these calves revealed massive astrocytic oedema, shrinkage of individual nerve cells and formation of the so-called hepatic glia (hepatoencephalopathy). Even in the last days before death icterus of the sclera was noted in only 11 of the 38 patients; of these, nine also displayed icterus of the mucous membranes. The calves died between the third day to seventh week of life; mean age at death 18 days. Haematological examination: in 12 cases mild to marked anaemia (but without signs of haemolysis), marked granulocytosis with a shift to the left in 20 cases, sometimes additionally neutrocytes with nuclei resembling Pelger's nuclear anomaly (pseudo-Pelger), granulocytes with basophilic stippling as well as lymphoidocytes. The blood glucose levels were usually markedly reduced. 15 calves had a pronounced refractory hypoglycaemia with blood glucose levels under 1,66 mmol/l. Neither albumin concentration nor the specific serum globulin fractions showed significant differences when compared to an age matched control group.(ABSTRACT TRUNCATED AT 250 WORDS)