Outcomes of extremely low birth weight infants given early high-dose erythropoietin.

OBJECTIVE: To evaluate long-term outcomes of 60 extremely low birth weight (ELBW) infants treated with or without three injections of high-dose erythropoietin (Epo). STUDY DESIGN: A retrospective analysis of anthropometric and neurodevelopmental outcome data comparing 30 ELBW infants enrolled in a phase I/II study examining the pharmacokinetics of high-dose Epo (500, 1000 and 2500 U/kg × 3 doses) administered to 30 concurrent controls. RESULT: Birth characteristics and growth from 4 to 36 months were similar for untreated and Epo-treated patients. Multiple linear regression analysis of neurodevelopmental follow-up scores from 17/25 Epo-treated and 18/26 control infants identified that Epo correlated with improvement of cognitive (R=0.22, P=0.044) and motor (R=0.15, P=0.026) scores. No negative long-term effects of Epo treatment were evident. CONCLUSION: Retrospective analysis of the only available long-term follow-up data from ELBW infants given high-dose Epo treatment suggests that Epo treatment is safe and correlates with modest improvement of neurodevelopmental outcomes.

The effect of pasteurization on transforming growth factor alpha and transforming growth factor beta 2 concentrations in human milk.

Transforming growth factor alpha (TGF-alpha) and beta 2 (TGF-beta2) are present in human milk and are involved in growth differentiation and repair of neonatal intestinal epithelia. Heat treatment at 56 degrees C has been shown effective for providing safe banked donor milk, with good retention of other biologically active factors. The purpose of our study was to determine the effect of heat sterilization on TGF-alpha and TGF-beta2 concentrations in human milk. Twenty milk samples were collected from 20 lactating mothers in polypropylene containers and frozen at -20 degrees C for transport or storage. Before heat treatment by holder pasteurization, the frozen milk was thawed and divided into 1-mL aliquots. All samples were heated in an accurately regulated water bath until a holding temperature was achieved, then held for 30 minutes using constant agitation. Holding temperature ranged from 56.5 degrees C to 56.9 degrees C. The milk was then stored at 4 degrees C overnight for analysis the following day. The concentration of TGF-alpha was measured by radioimmunoassay. Mean concentration +/- SD of TGF-alpha in raw milk samples was 119+/-50 pg/mL, range 57 to 234. The mean concentration +/- SD of TGF-alpha in heat treated samples was 113+/-50 pg/mL, range 51 to 227. TGF-alpha concentration was minimally affected by pasteurization, with an overall loss of 6.1%. Of 19 samples, 4 had increased and 15 had decreased concentrations after pasteurization (mean percent SEM: 94%+/-7% of raw milk, range 72%+/-107%). The concentration of acid-activated TGF-beta2 was measured by enzyme-linked immunosorbent assay. Mean concentration +/- SD of TGF-beta2 in raw milk samples was 5624+/-5038 pg/mL, range 195 to 15480. The mean concentration +/- SD of TGF-beta2 in heat-treated samples was 5073+/-4646 pg/mL, range 181 to 15140. TGF-beta2 survived with relatively little loss (0.6%): of 18 samples, 11 had increased and 7 had decreased concentrations after pasteurization (mean percent +/- SEM: 99.4+/-6.7% of raw milk, range 79%-120%). In conclusion, both TGF-alpha and TGF-beta2 were well-preserved in whole milk after holder pasteurization at 56.5 degrees C. The relative increase in growth factor concentration in some of the samples may be attributable to the release of that factor from the cellular and/or fat compartments into the aqueous fraction of human milk. These findings have implications regarding use of donor milk as an alternate source of growth factors and cytokines for the newborn gut when mother's milk is unavailable.

Substantia nigra glutamate antagonists produce contralateral turning and basal ganglia Fos expression: interactions with D1 and D2 dopamine receptor agonists.

Experiments measuring behavior and immediate-early gene expression in the basal ganglia can reveal interactions between dopamine (DA) and glutamate neurotransmission. Nigrostriatal DA projections influence two striatal efferent pathways that, in turn, directly and indirectly influence the activity of the substantia nigra pars reticulata (SNr). This report tests the interactions between striatal DA receptors and nigral glutamate receptors on basal ganglia function by examining both contralateral turning and Fos immunoreactivity in striatum and pallidum following unilateral intranigral microinfusions of glutamate antagonists given to intact and 6-OHDA-lesioned rats. The NMDA antagonist AP5 (1 microg), or the AMPA/kainate antagonist DNQX (0.015-1.5 microg), injected into the SNr (0.5 microl) elicited contralateral turning as well as both striatal and pallidal Fos expression. Moreover, intranigral DNQX elicited more turning and greater numbers of Fos-positive striatal neurons in 6-OHDA-lesioned animals than in unlesioned controls, suggesting that the 6-OHDA injection induces functional changes in nigral glutamate transmission. In 6-OHDA-lesioned rats, systemic injections of the DA D1 receptor agonist SKF38393 (0.5 mg/kg, i.p.) increased striatal Fos expression due to intranigral DNQX. In contrast, the D2 agonist quinpirole (0.1 mg/kg, i.p.) decreased striatal Fos expression but increased the pallidal Fos arising from intranigral AP5. In additional experiments, both intact and 6-OHDA-lesioned rats were given simultaneous intranigral and intrastriatal infusions and turning and pallidal Fos expression were measured. 6-OHDA-lesioned rats given 5 microg of intrastriatal quinpirole exhibited both turning and pallidal Fos that was significantly increased by intranigral AP5. These results indicate that the opposing influences of D2 agonists and endogenous nigral glutamate transmission are mediated by striatal D2 receptors. Finally, the behavioral effects of intranigral glutamate antagonism can be dissociated from the effects on striatal or pallidal immediate-early gene expression.

Intrastriatal AP5 differentially affects behaviors induced by local infusions of D1 vs. D2 dopamine agonists.

Using bilateral infusions into the rat striatum, the effects of the competitive NMDA receptor antagonist 2-amino-5-phosphopentanoic acid (AP5) on behaviors induced by the dopamine (DA) D1 receptor agonist SKF 82526 (fenoldopam) or the D2 receptor agonist quinpirole were determined. These effects were tested in DA-replete (intact) rats and in rats that were receiving injections of the monoamine-depleting drug reserpine. In both intact and reserpinized rats, fenoldopam induced significant sniffing. This effect was attenuated by simultaneous co-infusion of AP5 in the reserpinized rats. Quinpirole induced locomotion, sniffing, and oral behaviors, all of which were attenuated by AP5 co-infusion in the intact rats. In contrast, AP5 enhanced the quinpirole-induced sniffing of reserpinized rats. These findings suggest that distinct D1/glutamate and D2/glutamate relationships exist in the striatum, and that the nature of the latter is influenced by DA tone.

Posterior capsule reopacification after neodymium:YAG laser capsulotomy.

We report a case of complete posterior capsule reopacification after successful neodymium:YAG (Nd:YAG) capsulotomy in an adult. Review of the records of all patients who had an Nd:YAG capsulotomy at our hospital revealed an incidence of reopacification of 0.7%. All affected patients were younger than 50 years at the time of cataract surgery.

Excitotoxic striatal lesions protect against subsequent methamphetamine-induced dopamine depletions.

Repeated administration of methamphetamine (m-AMPH) produces a prolonged elevation of extracellular dopamine (DA) levels in rat striatum and subsequent damage to striatal DA terminals. In the present study, a unilateral striatal infusion of quinolinic acid (QA) (15 ug/0.5 microliter) 2 weeks before repeated m-AMPH treatment (four injections of 4 mg/kg, s.c., at 2-hr intervals) protected that striatum from m-AMPH-induced DA terminal injury. One week after m-AMPH treatments, striatal DA contents were substantially below control values in the vehicle-infused striata, whereas the DA contents of the QA-infused striata were equal to those of animals not exposed to m-AMPH. The QA infusions alone injured striatal neurons, as indicated by decreased [3H]SCH 23390 and [3H]spiroperidol binding to D1 and D2 receptors, respectively. However, QA infusions by themselves did not significantly change the DA content or [3H]mazindol binding to the high-affinity DA transporter of the infused striata 3 weeks later. In vivo microdialysis was performed in the previously QA- or vehicle-infused striata during regimens of repeated m-AMPH or saline treatments. QA infusions that were effective in protecting against m-AMPH neurotoxicity did not significantly reduce stimulant-induced DA overflow, compared with the overflow that occurred in the vehicle-infused striata of m-AMPH-treated rats. Thus m-AMPH-induced DA overflow appears to be dissociated from the resulting DA terminal injury in the QA-infused striatum.(ABSTRACT TRUNCATED AT 250 WORDS)