Vitamin D deficiency at birth among military dependants in Hawai'i.

Vitamin D has long been known to be essential in bone mineralization as well as calcium and phosphate regulation. An increasing body of literature suggests that Vitamin D is also key in many other areas to include immune function, brain development, prevention of autoimmune disease, and prevention of certain types of cancers. Studies also suggest that, with decreased sun exposure due to concern for skin cancer risk, much of the world's population is becoming increasingly deficient in vitamin D. Our hypothesis was that vitamin D deficiency exists, and can be detected, even in sunny climates such as the state of Hawai'i. To test this hypothesis, eighty-six cord blood samples were collected in the process of routine clinical testing. These samples were tested for 25-hydroxy vitamin D via liquid chromatography mass spectroscopy. Percent deficiency (<20ng/mL) and insufficiency (20-31.9ng/mL) were determined by statistical analysis. Forty-six percent (n=37) of cord blood samples tested were deficient in vitamin D; 47 percent (n=38) of samples had insufficient 25-OH vitamin D. Only 7 percent (n=6) of samples showed vitamin D concentrations at the recommended levels. A vast majority of military dependents in Hawai'i have less than optimal vitamin D levels at birth. Further investigation of vitamin D supplementation during pregnancy is required to optimize vitamin D status at birth. We conclude that a vast majority of military dependents in Hawai'i have less than optimal vitamin D levels at birth supporting the recommendation for supplementation in this population.

Continuous renal replacement therapy to reduce inflammation in a piglet hemorrhage-reperfusion extracorporeal membrane oxygenation model.

BACKGROUND: During extracorporeal membrane oxygenation (ECMO), circulation of blood across synthetic surfaces triggers an inflammatory response. Therefore, we evaluated the ability of continuous renal replacement therapy (CRRT) to remove cytokines and reduce the inflammatory response in a piglet hemorrhage-reperfusion ECMO model. METHODS: Three groups were studied: (i) uninjured controls (n = 11); (ii) hemorrhage-reperfusion while on venoarterial ECMO (30% hemorrhage with subsequent blood volume replacement within 60 min) (n = 8); (iii) treatment with CRRT after hemorrhage-reperfusion while on ECMO (n = 7). Hemodynamic parameters, oxygen utilization, and plasma and broncho-alveolar lavage (BAL) cytokine levels were recorded and lung tissue samples collected for histologic comparison. RESULTS: Whereas mean arterial pressures decreased among hemorrhage-reperfusion piglets, ECMO with CRRT did not significantly alter mean arterial pressures or systemic vascular resistance and was able to maintain blood flow as well as oxygen delivery after hemorrhage-reperfusion. Plasma interleukin (IL)-6 and IL-10, and BAL tumor necrosis factor (TNF)-α, IL-1ß, IL-6, IL-8, and IL-10 increased as a result of hemorrhage-reperfusion while on ECMO. After a 6-h period of CRRT, plasma IL-6 and BAL TNF-α, IL-6, and IL-8 levels decreased. CONCLUSION: Data suggest CRRT may decrease inflammatory cytokine levels during the initial phase of ECMO therapy following hemorrhage-reperfusion while maintaining cardiac output and oxygen utilization.

Molecular typing of Mycobacterium tuberculosis by using nine novel variable-number tandem repeats across the Beijing family and low-copy-number IS6110 isolates.

Molecular epidemiological tools for genotyping clinical isolates of Mycobacterium tuberculosis have been developed and used to help track and contain transmission of tuberculosis. We identified 87 short sequence repeat loci within the genome of the M. tuberculosis H37Rv strain. Nine tandem repeats were found to be variable (variable-number tandem repeats [VNTRs]) in a set of 91 isolates. Fifty-seven of the isolates had only four IS6110 bands. The other 34 isolates were members of the Beijing strain family. The number of alleles of each these nine VNTRs was determined by examining each isolate. Six of the loci (Mtb-v1, -v4, -v10, -v15, -v18, and -v20) were able to differentiate the Beijing spoligotype identical isolates into seven distinct genotypes. Five of the loci (Mtb-v3, -v5, -v6, -v10, and -v15) were informative in discriminating the four-band IS6110 restriction fragment length polymorphism isolates from each other. The Nei's diversity values of each marker ranged from 0.02 to 0.59, with the number of alleles ranging from two to eight across the entire strain set. These nine loci provide a useful, discriminatory extension of VNTR typing methods for application to molecular epidemiologic studies of M. tuberculosis.