Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers.

OBJECTIVE: To investigate the effect of a 2 minutes-delayed cord clamp (DCC) versus early cord clamp (ECC) on neonate haemoglobin concentration 24 hours and 1 month after birth, and assess the safety of DCC concerning the risk of HIV infection. DESIGN: Sixty-four mother-infant peers were enrolled. All mothers were on stable ARV therapy. Viral load, CD4+ count and blood haemoglobin (Hb) concentrations 24 hours before delivery were collected from all mothers and their infants. METHODS: All patients were enrolled at the Department of Paediatrics, AO FBF Sacco Hospital in Milan, and were followed until 18 months after birth. Women with haematological diseases and obstetrical complications were excluded. All of 64 mother and infants couples (32 ECC group and 32 DCC group) completed the study. ECC and DCC are defined as application of umbilical clamp within 30 seconds and 120 seconds after birth, respectively. RESULTS: Mean birth weight was significantly higher in the DCC compared with ECC group. Mean Hb levels at birth were significantly higher in DCC than in ECC group (p = .05): this difference persisted at 1 month of life. All newborns showed negative viral load. CONCLUSIONS: DCC 2 minutes after birth is proven to be a safe procedure, particularly beneficial in newborns from HIV mothers. The risk of anemia is significantly decreased at 24 hours after birth and persists at age of 1 month without any increased risk of neonatal jaundice or polycitemia.

Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis.

PURPOSE: Skull radiography (SR) and Computed Tomography (CT) are still proposed as the first-line imaging choice for the diagnosis of craniosynostosis (CS) in children with abnormal head shape, but both techniques expose infants to ionizing radiation. Several studies shown that ultrasound may play an important role in the diagnosis of craniosynostosis. The aim of our study is to assess the diagnostic accuracy of cranial ultrasound scan (CUS) and confirm if it is a reliable first step imaging evaluation for the diagnosis of craniosynostosis in newborn. METHOD: A cohort of 196 infants (122/74 males/females), with a mean age of 4 months, clinically suspected to have abnormal closure of cranial sutures, were firstly examined by CUS and then referred to neuroradiologists to perform volumetric CT scan if the suspicion of stenosis was ecographically confirmed; otherwise, a routine follow-up and physical treatment was performed, to observe the evolution of the head shape. RESULTS: Of the 196 children studied by CUS, only two had inconclusive studies due to age limitation (>12 months). Thirty children were diagnosed with cranial synostosis at CUS and verified by CT; all the CUS results were confirmed, except two cases, that were revealed as false positives in the starting phase of the study. Twelve patients with very prominent head deformity and negative CUS underwent CT, which confirmed the CUS results in all of them; one case of closure of both temporal sutures, not studied by CUS, was documented by CT. All the 148 children with poor clinical suspicion and negative CUS underwent just a prolonged clinical follow-up. In all of them, a progressive normalization of head shape was observed, and the craniosynostosis was excluded on a clinical base. CONCLUSIONS: CUS is a highly specific and sensitive imaging technique. In referral centers, expert hands can use it as a reliable first-step screening for infants younger than 1 year, suspected to have a craniosynostosis, thus avoiding unnecessary exposure to ionizing radiation. The "golden age" to obtain the best CUS results is under 6 months of life. Because the method is operator-dependent and there is a learning curve, a case centralization is advisable.

Nevus anemicus associated with neurofibromatosis type 1 in a neonate: a case report.

Neurofibromatosis type 1 (NF1) is a multisystemic autosomal dominant disease affecting approximately 1 individual in 3500. The diagnostic criteria developed by NIH in 1988 allow unequivocal diagnosis in all cases but the youngest children. Due to the variable phenotypic expression, the diagnosis of NF1 in the youngest may be challenging, particularly when the distinctive cutaneous lesions are missing. We describe the case of a neonate who presented at birth solely with a nevus anemicus. Although this is not considered a diagnostic feature, given the presence of a few café au lait lesions in the patient's father, the genetic test was performed and the diagnosis of NF1 confirmed. To our knowledge, the association between nevus anemicus and NF1 is only anedoctal. The peculiarity clinical manifestation of this case highlights the high variable expressivity of the NF1 gene mutation and reinforces the importance of genetic counseling in affected individuals.

Completely isolated enteric duplications cysts: a survey of four cases.

Enteric duplication cysts are uncommon congenital abnormalities with epithelial lining. They are cystic or tubular structures intimately attached to a portion of the gastrointestinal tract; they are usually located on the mesenteric site of the digestive tract sharing common blood supply. Isolated cystic duplications are an extremely rare variant with their own blood supply: in literature only five cases have been reported. We present our four cases series of this uncommon anomaly.

Height of the cerebellar vermis and gestational age at birth.

OBJECTIVES: The objective of this study was to construct reference ranges of the neonatal cerebellar vermis height with respect to the gestational age at birth. METHODS: This observational study assessed 434 neonates born at 25-42 weeks' gestation. The neonates were singleton and appropriate in size for gestational age, and did not exhibit any abnormalities or neonatal disease. Gestational age was based on the date of the last menstrual period and confirmed by ultrasound examination performed within the 12(th) week of pregnancy. Sonographic measurements of the height of the cerebellar vermis in the mid-sagittal plane were performed within 24 h of birth by the same neonatal sonographer. Reference ranges (5(th), 50(th) and 95(th) centiles) were estimated by a mean and SD model based on least-squares polynomial regression. RESULTS: Neonatal sonographic measurements were obtained in all cases. Mean (SD) maternal age was 30.2 (4.3) years. Mean cerebellar vermis height adjusted for gestational age did not differ between males and females, the mean adjusted difference being 0.012 (95% CI, - 0.009 to 0.033) cm. Mean cerebellar vermis height (cm) against gestational age (weeks) was suitably modeled by a linear-cubic polynomial as - 1.784 + 0.137 x GA - 0.000019 x GA(3) (SD = - 0.147 + 0.008 x GA), where GA = gestational age. CONCLUSIONS: Reference ranges for the height of the cerebellar vermis at birth with respect to gestational age at birth have been constructed in appropriate-for-gestational-age neonates.

Predictability and prediction of lowest observed adverse effect levels in a structurally heterogeneous set of chemicals.

A database of chronic lowest observed adverse effect levels (LOAELs) for 234 compounds, previously compiled from different sources (Toxicology Letters79, 131-143 (1995)), was modelled using graph theoretical descriptors. This study reveals that data are not homogeneous. Only those data originating from the U.S. Environmental Protection Agency (EPA) reports could be well modelled by multilinear regression (MLR) and linear discriminant analysis (LDA). In contrast, data available from the specific procedures of the National Toxicology Program (NTP) database introduced noise and did not render good models either alone, or in combination with the EPA data.

Hypothermia reduces neurological damage in asphyxiated newborn infants.

BACKGROUND: Perinatal asphyxia remains one of the most devastating neurologic processes. There is experimental and clinical evidence that cerebral cooling may suppress the biochemical cascades leading to delayed cerebral damage. OBJECTIVE: To determine if hypothermia started soon after delivery reduces cerebral damage in term infants. DESIGN/METHODS: Retrospective chart analysis with historical controls. Ten asphyxiated newborns treated with hypothermia between October 1998 and October 1999 were compared to 11 asphyxiated newborns admitted from September 1997 to September 1998. Characteristics at birth of infants of the two groups (control and hypothermia) were comparable. After obtaining parental consent, whole-body hypothermia was induced before the 6th hour of life by placing a cold blanket (Polar Air, Augustine Medical Inc., model 600) around the body of the patients. Rectal temperature was maintained between 32 and 34 degrees C for 72 h. Outcome was assessed by neurological evaluation at birth and every 3 months up to the 12th month. Brain MRI was performed in the 2nd month. We had no evidence of severe adverse events related to hypothermia. In the hypothermic group there was a significant (p < 0.05) reduction of major neurologic abnormalities at follow-up and abnormal MRI findings. CONCLUSIONS: Hypothermia appears to be safe. Our results on morphological damage evaluated by brain MRI and neurological outcome are encouraging: randomized controlled trials are needed to confirm this experience.

How far are molecular connectivity descriptors from I(S) molecular pseudoconnectivity descriptors?

A comparison of the characteristics of the molecular connectivity and intrinsic-state pseudoconnectivity indices in modeling different activities and properties of different classes of compounds is performed. Two different activities of chlorofluorocarbons, an activity of 2-Br-2-phenetylamines, an activity of benzimidazoles, and the boiling points of primary amines and primary alcohols are modeled. The simultaneous modeling of these last two classes of compounds is also accomplished. The comparison encompasses also the molar mass as descriptor. Further, the influence of the rescaling procedure on the modeling for the case of benzimidazoles is analyzed as well as the relationship between degeneracy of connectivity values and quality of the modeling. Molecular pseudoconnectivity terms seem to compete advantageously with molecular connectivity terms in the descriptive power of the activity and property of many classes of compounds. In many cases new mixed higher-order connectivity-pseudoconnectivity terms have been detected that consistently improve the quality of the description.

[The "guaranteed volume" in pressure support ventilation reduces the risk of barotrauma in premature children with severe respiratory syndrome]. / Il "volume garantito" (VG) in corso di pressure support ventilation (PSV) riduce il rischio di barotrauma in pretermine con sindrome respiratoria grave (RDS).

Chronic Lung Disease (CLD) remains a major complication of prematurity, and barovolutrauma is thought to be one of the most important predisposing factors. In view of reducing the damage due to variability of tidal volume (Vt), we studied the application of the new option of volume guarantee (VG). We analyzed ventilatory data of 25 preterm infants with respiratory distress syndrome (RDS) in two situations: pressure support ventilation (PSV) + VG vs PSV alone. Data collected showed application of significantly lower peak inspiratory pressure (p < 0.001) and mean airway pressure (p < 0.001) with the constant Vt. We conclude that this ventilatory strategy, by reducing the barotrauma, could be considered a protective ventilation.

Modeling the solubility and activity of amino acids with the LCCI method.

The linear combinations of connectivity indices method (LCCI) is here employed to model the water solubility and activity of 19 natural amino acids. Starting with the molecular connectivity indices, reciprocal and supra molecular connectivity indices are designed to model the solubility and activity spaces of the natural amino acids. The reciprocal and supra molecular reciprocal connectivity indices have been obtained following the variability of the connectivity indices along solubility space of the natural amino acids. A linear combination of the reciprocals of the connectivity indices (LCRCI) showed a satisfactory modelling of the solubility and activity space while a model based on the LCRCI together with the introduction of supra reciprocal molecular connectivity indices for Pro, Ser and Arg achieved an optimal modelling of the solubility and activity space of the natural amino acids.

An NMR and molecular mechanics study of squalene and squalene derivatives.

Various squalene derivatives, including squalene, squalene 2,3-epoxide (monoepoxide, SQME), squalene 2,3;22,23-diepoxide (SQDE), 2-aza-2,3-dihydrosqualene (SQN) and 2-aza-2,3-dihydrosqualene N-oxide (SQNO), were studied in chloroform solutions using ID high-resolution 1H spectra and 13C longitudinal relaxation studies, 2D proton NOESY and COSY and 2D proton-carbon HETCOR spectroscopy. A full interpretation of the 1H and 13C-NMR spectra is presented. Staggered conformations along the C11-C12 bond are favoured and a relatively rigid structure of the central part of the chain is indicated in relaxation and coupling data, while further away from the central part the molecular mobility grows. A detected NOE dipolar interaction between terminal and central parts of the molecule indicates the presence of dynamically folded structures in solution. The proposed model also explains the selective reactivity of the mobile chain endings with respect to the central part which is protected by these moving ends. Different solvents at different concentrations induce some variations in this molecular model with a shortening or a lengthening of the mean path covered by the tail endings. Molecular mechanics and molecular dynamics calculations on the free squalene molecule indicate that the mobility of the chain is almost equivalent in all its isoprenic moieties, and the greater mobility of the chain ends may be ascribed to co-operative movements from the center to the tails. The solvent probably plays an important role in hindering the motion of the central part of the molecule.

Structure property relationships of amino acids and some dipeptides.

A molecular connectivity model of the crystal densities and specific rotations of some natural amino acids and of the longitudinal relaxation rates of some natural amino acids and cyclic dipeptides is presented. While crystal densities and relaxation rates are better described by a set of three valence molecular connectivity indices {D (v),(0) X (v),(1) X (v)}, specific rotations are better described by a set of two simple molecular connectivity indices {(1) X,(0) X}. Relaxation rates are, also, well described by the simple molecular connectivity {D,(1) X} index set. Use of orthogonal indices, derived from the corresponding ordinary indices shows, in the case of specific rotations, the possibility to condense the information by the aid of a single high quality descriptor underlining, thus, the versatility of these indices and also their dependence on the orthogonalisation process.

Molecular connectivity: treatment of the electronic structure of amino acids.

A molecular connectivity model of atomic charges on the second-row atoms in alpha-amino acids is discussed. A correlation was found between the valence delta (delta v) index from molecular connectivity theory and the charges on atoms that belong to the same class, whereas different classes of carbon atoms had the same slopes on the Q versus sigma v matrix, where Q is the calculated charge distribution. A similar correlation was found for nucleotide bases.

Molecular connectivity model for determination of isoelectric point of amino acids.

A molecular connectivity model for the calculation of the isoelectric point of amino acids is presented. The model requires calculation of the molecular connectivity values of only the functional fragments of the amino acids. Multiple linear regression with two variables shows the best fit between experimental and calculated data.

The PCr/Pi ratio in in vivo injured rat brain.

A new ratio, R+ = PCr/(mP + Pi), is proposed to analyses brain metabolism after injury. The Pcr/Pi and PCr/(mP + Pi) ratios of a series of injured rat brains show similar trends in the case of well-defined Pi and mP peaks, while they diverge in the case of mutual overlap.

[Evaluation of the treatment with levodropropizine of respiratory diseases in children]. / Valutazione del trattamento con Levodropropizina nelle affezioni respiratorie del bambino.

Sometimes, antitussives can be a valid adjuvant to respiratory tract infections treatment. Although not always needed, this therapeutic support can be extremely useful in selected cases, and when patient is resident and monitored. In this line, the efficacy of a new peripheral antitussive, levodropropizine (Dompé farmaceutici, Milan), has been evaluated in 70 children inpatients of the Pediatric Department at san Paolo Hospital - Milan University - from September 1987 to May 1988. Thirty one male and 29 female children, aged 4 years and 6 months +/- 3 years and 5 months, suffering from various respiratory tract diseases were included in the study. Underlying diseases were represented by 21 acute bronchitis, 20 asthmatic attacks, 18 bronchopneumonia, 11 tracheitis, 6 acute episodes of chronic bronchitis, 2 hypoglottis laryngitis, 1 pertussis, 1 spontaneous pneumothorax. All parents gave their oral informed consent. The basic treatments were antibiotics in 44 patients associated or not with beta 2 agonists (31), theophylline (15), corticosteroids via aerosol (9) or parenterally (3), immunomodulators (2). Treatment with levodropropizine in the oral drops formulation at 2 mg pro kg a day was continued for 5 days and withdrawn according to the clinical evolution. Cough was registered by means of appropriate record forms given to the parents as well as with 120' tape recording whenever possible, i.e. 60 minutes before and 60 minutes after drug administration, on day one and 2. At treatment end, parents and investigator gave an antitussive efficacy judgement. Tolerability was evaluated as per clinical evolution and laboratory parameters.

Brain death in moderately injured rat brains by in vivo P-31 NMR spectroscopy.

In the course of a systematic in vivo P-31 NMR study of moderately insulted rat brains, some brains died after such injury. Changes in high-energy phosphate metabolism of these brains after injury were rationalised by the aid of a model based on the depletion of an insoluble Pi pool followed by depletion of PCr and ATP pools.