Autologous umbilical cord blood infusion followed by oral docosahexaenoic acid and vitamin D supplementation for C-peptide preservation in children with Type 1 diabetes.

We sought to determine if autologous umbilical cord blood (UCB) infusion followed by 1 year of supplementation with vitamin D and docosahexaenoic acid (DHA) can preserve C-peptide in children with type 1 diabetes. We conducted an open-label, 2:1 randomized study in which 15 type 1 diabetes subjects with stimulated C-peptide > .2 pmol/mL received either (1) autologous UCB infusion, 1 year of daily oral vitamin D (2000 IU), and DHA (38 mg/kg) and intensive diabetes management or (2) intensive diabetes management alone. Primary analyses were performed 1 year after UCB infusion. Treated (N = 10) and control (N = 5) subjects had median ages of 7.2 and 6.6 years, respectively. No severe adverse events were observed. Although the absolute rate of C-peptide decline was slower in treated versus control subjects, intergroup comparisons failed to reach significance (P = .29). Area under the curve C-peptide declined and insulin use increased in both groups (P < .01). Vitamin D levels remained stable in treated subjects but declined in control subjects (P = .01). DHA levels rose in treated subjects versus control subjects (P = .003). CD4/CD8 ratio remained stable in treated subjects but declined in control subjects (P = .03). No changes were seen in regulatory T cell frequency, total CD4 counts, or autoantibody titers. Autologous UCB infusion followed by daily supplementation with vitamin D and DHA was safe but failed to preserve C-peptide. Lack of significance may reflect small sample size. Future efforts will require expansion of specific immunoregulatory cell subsets, optimization of combined immunoregulatory and anti-inflammatory agents, and larger study cohorts.

Assessing the relationship between preterm delivery and various microorganisms recovered from the lower genital tract.

OBJECTIVE: To determine if the likelihood of preterm delivery is more dependent on the specific organisms present in the vagina than on the presence of bacterial vaginosis. METHODS: We evaluated the vaginal fluid of a prospective cohort of women at 23-32 weeks of gestation with signs and symptoms of preterm labor and intact membranes. Forward stepwise logistic regression models were used to evaluate the relationship between preterm delivery and the presence of anaerobic bacteria, Gardnerella, ureaplasmas and mycoplasmas, and sialidase. RESULTS: The cohort included 137 women, and complete delivery information was available for 134 of them. The rate of preterm delivery was 28% (37 of 134). Mycoplasma genitalium independently was associated with spontaneous preterm delivery (OR 3.48; 95% CI 1.41, 8.57). After controlling for this factor, none of the other variables were significantly prognostic for spontaneous preterm delivery (residual overall p = 0.19). CONCLUSION: The presence of Mycoplasma genitalium in the vagina of pregnant women is an independent risk factor for spontaneous preterm delivery.

Loyalty and positive word-of-mouth: patients and hospital personnel as advocates of a customer-centric health care organization.

The ability to attract and retain loyal customers depends on the successful implementation of a customer-centric strategy. Customer loyalty is an attitude about an organization and its' services that is manifested by intentions and behaviors of re-patronization and recommendation. In the context of many medical services, loyalty through repeat patronization is not pertinent, whereas loyalty through positive word-of mouth (WOM) recommendation can be a powerful marketing tool. The Shouldice Hospital, a well-known institution for the surgical correction of hernias, instituted a marketing plan to develop a stable base of patients by creating positive WOM advocacy. This study focused on the consequences of both hernia patient overall satisfaction (and overall service quality) and hospital personnel satisfaction on the level of positive WOM advocacy. Using a commitment ladder of positive WOM advocacy, respondents were divided into three categories described as passive supporters, active advocates and ambassador advocates. Patient assessments of overall satisfaction and service quality were significantly related to these progressive levels of WOM for recommending the hospital to potential patients. Similarly, the satisfaction of the hospital employees was also significantly related to these progressive levels of positive WOM about recommending the hospital to potential patients and to potential employees. High levels of satisfaction are required to create true ambassadors of a service organization.

The interleukin-1 beta +3953 single nucleotide polymorphism: cervical protein concentration and preterm delivery risk.

PROBLEM: To determine the associations between preterm delivery <37 weeks (PTD), cervical fluid interleukin-1beta (IL-1beta) concentration, and its +3953 single nucleotide polymorphism (SNP). METHOD OF STUDY: Cervical fluid, peripheral blood, and cord blood samples were obtained from a cohort of women 23-32 weeks gestation with preterm labor symptoms and intact membranes. RESULTS: Increased cervical fluid concentrations of IL-1beta were associated with PTD (P = 0.017) and spontaneous PTD (P = 0.001). Maternal IL-1beta +3953 SNP genotype was associated neither with PTD (P = 0.43) nor with cervical fluid IL-1beta concentrations (P = 0.35). Neonatal IL-1beta +3953 SNP genotype was associated neither with PTD nor cervical IL-1beta concentrations. CONCLUSIONS: Cervical fluid concentrations of IL-1beta were elevated in symptomatic women destined to have a spontaneous PTD. The gene dosage of maternal IL-1beta +3953 allele 2 was associated neither with increased cervical fluid concentrations of IL-1beta nor with risk of PTD.

The interleukin-6--174 single nucleotide polymorphism: cervical protein production and the risk of preterm delivery.

OBJECTIVE: The purpose of this study was to determine the associations between preterm delivery (PTD), cervical fluid interleukin-6 (IL-6) concentration, and the single nucleotide polymorphism at position -174 in the IL-6 gene. STUDY DESIGN: Cervical fluid samples were obtained from women 23 to 32 weeks' gestation with symptoms of preterm labor. Concentrations of IL-6 were determined by enzyme-linked immunosorbent assay (ELISA). IL-6 genotyping was performed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. RESULTS: One hundred thirty-seven women were enrolled, and complete information was available for 126. Cervical fluid IL-6 concentrations were not elevated in women destined to have a spontaneous PTD ( P = .86). IL-6 -174 genotype was not associated with PTD ( P = .62) or cervical fluid IL-6 concentration ( P = .36). Neonatal IL-6-174 genotype was not associated with PTD or IL-6 concentration. CONCLUSION: Cervical fluid concentrations of IL-6 were not elevated in symptomatic women destined to have a spontaneous PTD. The presence of maternal IL-6 -174C was not associated with cervical fluid concentration of IL-6 or risk of PTD.

Assessment of cervical antibody concentrations fails to enhance the value of cervical length as a predictor of preterm delivery.

OBJECTIVE: The purpose of this study was to determine if cervical fluid antibody concentrations can enhance the value of cervical length in predicting risk of preterm delivery. STUDY DESIGN: We obtained cervical fluid samples with preweighed cellulose wicks from a prospective cohort of women 23 to 32 weeks' gestation with signs and symptoms of preterm labor and intact membranes. Total immunoglobulin A and G (IgA and IgG) concentrations were determined by enzyme-linked immunosorbent assay. Bacterial vaginosis was diagnosed by Gram stain, and cervical length was measured with endovaginal ultrasound. RESULTS: For subjects with term (n = 77) and preterm (n = 24) deliveries, median IgA and IgG concentrations were 736 vs 643 microg/mL (P = .33) and 1528 vs 1769 microg/mL (P = .85). For subjects with normal flora (n = 71), intermediate flora (n = 14), and bacterial vaginosis (n = 16), median IgA and IgG concentrations were 717, 624, and 774 microg/mL (P = .90) and 1383, 1553, and 2731 microg/mL (P = .02). In a forward stepwise logistic regression model, cervical length was the only factor associated with preterm delivery (P < .001). CONCLUSION: Measuring the concentrations of IgA and IgG in cervical fluid does not enhance the value of cervical length in predicting risk of preterm delivery.