Fingertip ultrasound evaluation of umbilical catheter position in the neonatal intensive care unit compared to conventional ultrasound radiography: a preliminary investigation.

OBJECTIVE: The purpose of the study is to compare conventional linear and fingertip ultrasound transducers, for the evaluation of umbilical catheters, with radiography. Fingertip ultrasound transducers have the potential to simplify sonographic examination due to their small size and ability to fit on a finger. STUDY DESIGN: A prospective, IRB approved comparative study was performed. Linear and fingertip sonographic images were obtained around the same time as a radiograph in neonates with umbilical catheters by two board certified pediatric radiologists and a radiology resident. The positions of catheters were then compared across all three modalities. RESULT: A total of 41 catheters were evaluated, which included 14 arterial and 27 venous catheters. Two venous catheters were not identified by the linear transducer and one arterial catheter tip was not identified by the fingertip transducer. CONCLUSION: A fingertip ultrasound probe can be used to evaluate umbilical catheter positioning for potentially faster sonographic examination and decrease the need for repeated radiation.

TNF but not Fas ligand provides protective anti-L. major immunity in C57BL/6 mice.

The pro-inflammatory cytokine TNF is essential for a protective immune response to some but not all strains of Leishmania major. TNF-deficient mice of a resistant genetic background succumbed rapidly to an infection with L. major BNI. Another member of the TNF superfamily, Fas ligand (FasL), has also been reported to be critical for the immune response to L. major. To test the relative importance of TNF versus FasL for the control of L. major BNI, we infected wildtype C57BL/6 (B6.WT), B6.TNF(-/-), B6.gld and C57BL/6.gld x TNF(-/-) (B6.gld.TNF(-/-)) double-negative mice. Visceral, fatal disease was only observed in B6.TNF(-/-) mice, but not in B6 gld mice. The course of infection and the immune response of B6.gld.TNF(-/-) mice were similar to those of B6.TNF(-/-) mice. B6.gld.TNF(-/-) mice had a high tissue parasite burden and expressed prominent amounts of inducible nitric oxide synthase (iNOS) in the skin, the lymph nodes (LN) and the spleen as previously reported for B6.TNF(-/-) mice, whereas the tissue parasite load and the iNOS expression of B6.gld mice resembled that of B6.WT controls. Neither the TNF- nor the FasL-deficiency exerted a detectable intrinsic effect on the proliferation of T cells. Thus, TNF, but not FasL is essential for the control of L. major BNI. The discrepancy between these and other published data are most likely due to the use of different strains of the pathogen.

Mothers in the NICU: outsider to partner.

The emerging care delivery model for Neonatal Intensive Care Units (NICU) is family-focused, developmentally supportive care. The purpose of this study was to explore and describe mothers' experience of becoming a mother while their infants were receiving care in the NICU. A qualitative research design was used. Interviews with 15 mothers whose infants were in a Level III NICU were analyzed using Spradley's domain analysis approach. Mothers developed from outsider to engaged parent along four continua: (1) focus: from NICU to baby; (2) ownership: from their baby to my baby; (3) caregiving: from passive to active; and (4) voice: from silence to advocacy. Mothers entered the continua at different points and moved at different rates toward "engaged parenting." The final stage, partnering, required active participation of nurses. Mothers' development evolved in predictable patterns. The results of this study can be considered in implementation and evaluation plans for NICUs moving to family-focused developmental care.

Breast augmentation & lactation outcome: a case report.

This article contains two case reports that illustrate the difficulty two mothers experienced when they mechanically expressed their milk for their very preterm infants. Each of the mothers was enrolled in a separate research study and had previously undergone surgery for breast augmentation. Neither of the mothers was able to provide an adequate milk supply for her preterm infant. Preoperative counseling and informed consent for breast augmentation is vital if the mother desires to exclusively provide mother's milk for the infant.

Shhh I'm growing: noise in the NICU.

Attempting to mitigate operational and structural noise is important in improving the outcomes of high-risk preterm infants. It was anticipated that a culture change in nursing behaviors to include "Quiet Time" would result in reducing the noise levels towards the National Recommended Safe Sound Level. This culture change alone was inadequate to meet NRL. Both operational and structural changes were also required in order to provide a safer neurophysiological environment for the rest and growth of the neonate.

Beta1 integrin is not essential for hematopoiesis but is necessary for the T cell-dependent IgM antibody response.

Several experimental evidences suggested that beta1 integrin-mediated adhesion of hematopoietic stem cells (HSC) is important for their function in the bone marrow (BM). Using induced deletion of the beta1 integrin gene restricted to the hematopoietic system, we show that beta1 integrin is not essential for HSC retention in the BM, hematopoiesis, and trafficking of lymphocytes. However, immunization with a T cell-dependent antigen resulted in virtually no IgM production and an increased secretion of IgG in mutant mice, while the response to a T cell-independent type 2 antigen showed decreases in both IgM and IgG. These data suggest that beta1 integrins are necessary for the primary IgM antibody response.

Membrane lymphotoxin contributes to anti-leishmanial immunity by controlling structural integrity of lymphoid organs.

Lymphotoxin (LT)alpha in combination with LTbeta forms membrane-bound heterotrimeric complexes with a crucial function in lymph node (LN) organogenesis and correct morphogenesis of secondary lymphoid tissue. To study the role of membrane LT (mLT) in lymphoid tissue organogenesis we generated an LTbeta-deficient mouse strain on a pure genetic C57BL/6 background (B6.LTbeta-/-) and compared it to a unique series of LTalpha-, TNF- and TNF/LTalpha-gene-targeted mice on an identical genetic background (B6.LTalpha-/-, B6.TNF-/- and B6 TNF/LTalpha-/-). B6.LTbeta-/- mice lacked peripheral LN with the exception of mesenteric LN, and displayed a disturbed micro-architecture of the spleen, although less profoundly than LTalpha- or TNF/LTalpha-deficient mice. Radiation bone marrow chimeras (B6.WT-->B6.LTbeta-/- developed Peyer's patch (PP)-like lymphoid aggregates in the intestinal wall indicating a possible role for soluble LTalpha(3) in the formation of the PP anlage. After infection with Leishmania major, B6.LTbeta-/- mice developed a fatal disseminating leishmaniasis resulting in death after 8 to 14 weeks, despite the natural resistance of the C57BL/6 genetic background (B6.WT) mice to the parasite. Both, the cellular and the humoral anti-L. major immune responses were delayed and ineffective. However, the expression pattern of the key cytokines IFN-gamma and IL-12 were comparable in B6.WT and B6.LTbeta-/- mice. Infection of radiation bone marrow chimeras showed that it is the LTbeta-dependent presence of lymphoid tissue and not the expression of mLT itself that renders mice resistant to leishmaniasis.