RESUMO
OBJECTIVE: We earlier identified that the histone methyltransferase Disruptor of telomeric silencing 1-like (DOT1L) is as a master protector of cartilage health via limiting excessive activation of the Wnt pathway. However, cartilage-specific homozygous Dot1l knockout mice exhibited a severe growth phenotype and perinatal death, which hampered their use in induced or ageing models of osteoarthritis (OA). The aim of this study was to generate and examine haploinsufficient and inducible conditional Dot1l-deficient mouse models to evaluate the importance of DOT1L during post-traumatic or ageing-associated OA onset and progression. METHOD: We used cartilage-specific heterozygous and postnatal tamoxifen-inducible Dot1l knockout mice and performed destabilization of the medial meniscus (DMM) and ageing as OA models. Mice were examined histologically using X-rays and micro-computed tomography (µCT), and cartilage damage and osteophyte formation were assessed based on OARSI guidelines. Immunohistochemistry of DOT1L, H3K79me2, TCF1 and COLX was performed. RESULTS: Both Dot1l-deficient strains exhibit a phenotype characterized by joint remodeling with extensive osteophyte formation and ectopic ossification upon ageing, indicating accelerated development of spontaneous osteoarthritis. In the DMM-induced OA mouse model, absence of Dot1l resulted in increased cartilage damage. Wnt signalling hyper-activation and ectopic chondrocyte hypertrophy were observed in the articular cartilage of both Dot1l-deficient mice. CONCLUSIONS: This study demonstrated the functional relevance of DOT1L in vivo during the development of OA using genetically modified mice. Thus, maintaining or enhancing DOT1L activity during ageing or after trauma might prevent OA onset and progression.
Assuntos
Histona-Lisina N-Metiltransferase/deficiência , Articulações/lesões , Osteoartrite/etiologia , Animais , Articulações/diagnóstico por imagem , Articulações/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Osteoartrite/diagnóstico por imagem , Radiografia , Microtomografia por Raio-XRESUMO
OBJECTIVE: To determine whether complex gastroschisis (ie, intestinal atresia, perforation, necrosis, or volvulus) can prenatally be distinguished from simple gastroschisis by fetal stomach volume and stomach-bladder distance, using three-dimensional (3D) ultrasound. METHODS: This multicenter prospective cohort study was conducted in the Netherlands between 2010 and 2015. Of seven university medical centers, we included the four centers that performed longitudinal 3D ultrasound measurements at a regular basis. We calculated stomach volumes (n = 223) using Sonography-based Automated Volume Count. The shortest stomach-bladder distance (n = 241) was determined using multiplanar visualization of the volume datasets. We used linear mixed modelling to evaluate the effect of gestational age and type of gastroschisis (simple or complex) on fetal stomach volume and stomach-bladder distance. RESULTS: We included 79 affected fetuses. Sixty-six (84%) had been assessed with 3D ultrasound at least once; 64 of these 66 were liveborn, nine (14%) had complex gastroschisis. With advancing gestational age, stomach volume significantly increased, and stomach-bladder distance decreased (both P < .001). The developmental changes did not differ significantly between fetuses with simple and complex gastroschisis, neither for fetal stomach volume (P = .85), nor for stomach bladder distance (P = .78). CONCLUSION: Fetal stomach volume and stomach-bladder distance, measured during pregnancy using 3D ultrasonography, do not predict complex gastroschisis.
Assuntos
Gastrosquise/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento Tridimensional , Estudos Longitudinais , Gravidez , Estudos Prospectivos , Estômago/diagnóstico por imagem , Estômago/embriologia , Ultrassonografia Pré-Natal , Adulto JovemRESUMO
OBJECTIVE: To evaluate the management of imminent preterm delivery with respect to prescription of antenatal corticosteroids (ACS) and referral to a tertiary center. STUDY DESIGN: A retrospective cohort study existing of 1 perinatal center and 9 referring hospitals. All women who received their first dose of ACS in 1 of the 10 hospitals between 24+0 and 32+0 weeks of gestation and/or delivered before 32 weeks of gestation from 2005 until 2010. Patients were identified using the electronic database of hospital pharmacies. Main outcome measures were time interval from administration to delivery for different indications and number of women who were not referred in time to a tertiary center. RESULTS: In total, 1375 women received ACS. Main indications were suspected preterm labor (44.7%), preterm prelabor rupture of membranes (15.9%), maternal indication (12.8%), fetal indication (9.2%) and vaginal blood loss (8.4%). Overall, 467 (34.0%) women delivered ≤7 days after ACS administration; 8.7% of women with vaginal blood loss and 54.5% of women with maternal indication. Among the 931 women who received ACS in the secondary hospitals, 452 (48.5%) women were referred to a tertiary hospital and 89 (6.5%) women delivered in a secondary hospital with a gestational age of less than 32 weeks. CONCLUSION: One-third of all women receiving ACS delivered within 7 days and half of the women who received ACS in a secondary hospital were referred to a tertiary center. There seems to be room for improvement regarding the timing of ACS administration and subsequently referral to a tertiary center.
Assuntos
Betametasona/uso terapêutico , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Glucocorticoides/uso terapêutico , Doenças do Prematuro/prevenção & controle , Trabalho de Parto Prematuro/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Adulto , Esquema de Medicação , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Estimativa de Kaplan-Meier , Masculino , Países Baixos , Gravidez , Nascimento Prematuro , Cuidado Pré-Natal/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários , Centros de Atenção Terciária , Fatores de TempoRESUMO
The benefits of using urine for the detection of human papillomavirus (HPV) DNA have been evaluated in disease surveillance, epidemiological studies, and screening for cervical cancers in specific subgroups. HPV DNA testing in urine is being considered for important purposes, notably the monitoring of HPV vaccination in adolescent girls and young women who do not wish to have a vaginal examination. The need to optimize and standardize sampling, storage, and processing has been reported.In this paper, we examined the impact of a DNA-conservation buffer, the extraction method, and urine sampling on the detection of HPV DNA and human DNA in urine provided by 44 women with a cytologically normal but HPV DNA-positive cervical sample. Ten women provided first-void and midstream urine samples. DNA analysis was performed using real-time PCR to allow quantification of HPV and human DNA.The results showed that an optimized method for HPV DNA detection in urine should (a) prevent DNA degradation during extraction and storage, (b) recover cell-free HPV DNA in addition to cell-associated DNA, (c) process a sufficient volume of urine, and (d) use a first-void sample.In addition, we found that detectable human DNA in urine may not be a good internal control for sample validity. HPV prevalence data that are based on urine samples collected, stored, and/or processed under suboptimal conditions may underestimate infection rates.
Assuntos
DNA Viral/isolamento & purificação , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Manejo de Espécimes/métodos , Urina/virologia , Adolescente , Adulto , Feminino , Humanos , Técnicas de Diagnóstico Molecular/métodos , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Reação em Cadeia da Polimerase em Tempo Real , Adulto JovemRESUMO
BACKGROUND: Reintroduction of enteral nutrition in neonates with necrotizing enterocolitis (NEC) should take place when the gut is ready for its normal function. Too early a start of oral feeding might lead to disease relapse, whereas prolonged discontinuation of enteral nutrition is associated with impaired gut function and parenteral nutrition-related complications. This study evaluated whether noninvasive urinary measurement of intestinal fatty acid binding protein (I-FABP) at the time of refeeding can predict clinical outcome in neonates with NEC. METHODS: Urinary I-FABP concentrations were measured in 21 infants with NEC just before reintroducing enteral nutrition. Poor outcome was defined as unsuccessful reintroduction of enteral feeding (EF), (re)operation for NEC, or death related to NEC after reintroduction of EF. RESULTS: Median urinary I-FABP levels in neonates with poor outcome (n = 5) were significantly higher as compared with I-FABP levels in neonates with good outcome (n = 16) (P < 0.01). A clinically significant cutoff value of 963 pg/ml was found to discriminate between infants with poor outcome and those with good outcome (sensitivity 80%, specificity 94%). CONCLUSION: Noninvasive urinary I-FABP measurement at time of refeeding differentiates neonates with poor outcome from neonates with good outcome in NEC. Urinary I-FABP measurement may therefore be helpful in the timing of EF in neonates with NEC.
Assuntos
Nutrição Enteral , Enterocolite Necrosante/terapia , Células Epiteliais/metabolismo , Mucosa Intestinal/metabolismo , Biomarcadores/urina , Nutrição Enteral/efeitos adversos , Nutrição Enteral/mortalidade , Enterocolite Necrosante/mortalidade , Enterocolite Necrosante/patologia , Enterocolite Necrosante/urina , Células Epiteliais/patologia , Proteínas de Ligação a Ácido Graxo/urina , Feminino , Humanos , Lactente , Recém-Nascido , Mucosa Intestinal/patologia , Masculino , Nutrição Parenteral Total , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento , UrináliseRESUMO
OBJECTIVE: To assess substandard care factors in the case of delivery-related asphyxia. DESIGN: Prospective cohort study. SETTING: Catchment area of the Neonatal Intensive Care Unit (NICU) of the University Medical Center Utrecht; a region in the middle of the Netherlands covering 13% of the Dutch population. POPULATION: Term infants, without congenital malformations, who died intrapartum or were admitted to the Neonatal Intensive Care Unit due to asphyxia. METHODS: During a two-year period, cases were prospectively collected and audited by an expert panel. MAIN OUTCOME MEASURES: Substandard care factors. RESULTS: 37 735 term infants without congenital malformations were born. There were 19 intrapartum deaths, and 89 NICU admissions of which 12 neonates died. In 63 (58%) cases a substandard care factor was identified that was possibly (n= 47, 43%) or probably (n= 16, 15%) related to perinatal death or NICU admission. In primary care, substandard care factors were mainly the low frequency of examination during labor and delay in referral to secondary care. In secondary care, misinterpretation of cardiotocography and failure to respond adequately to clinical signs of fetal distress were the most common substandard care factors. CONCLUSIONS: Substandard care is present in a substantial number of cases with delivery-related asphyxia resulting in perinatal death or NICU admission. Improving the organization of obstetric care in the Netherlands as well as training of obstetric caregivers might reduce adverse outcomes.
Assuntos
Asfixia Neonatal/etiologia , Parto Obstétrico/efeitos adversos , Qualidade da Assistência à Saúde , Adulto , Asfixia Neonatal/epidemiologia , Cardiotocografia , Feminino , Humanos , Recém-Nascido , Países Baixos/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To assess substandard care factors in antepartum stillbirths at term. Design. Prospective cohort study. SETTING: A region in the middle of the Netherlands covering 13% of the Dutch population. POPULATION: Antepartum stillbirths (≥ 37 weeks) without congenital malformations. METHODS: During a two-year period, all antepartum term stillbirths were prospectively collected and audited by an expert panel. MAIN OUTCOME MEASURES: Substandard care factors. RESULTS: During the study period, 37 735 normally formed infants were delivered ≥ 37 weeks of gestation. There were 60 antepartum stillbirths (1.59 per 1,000, 95%CI 1.19-1.99). Most stillbirths occurred during apparently uncomplicated pregnancies. Twenty-one infants (35%) were small-for-gestational age but growth restriction was only suspected in 10 (47.6%) of these cases. Substandard care factors were identified in 21 (35%) cases. A relation between these factors and fetal demise was possible in nine (15%) and probable in seven (12%) of these cases. Inadequate management and recognition of suspected growth restriction (n=9) or hypertension (n=6) were the most common substandard care factors. Ten (16.7%) women felt none or decreased fetal movements for 24 hours or more before they consulted a doctor or midwife. CONCLUSION: Twenty-seven percent of all stillbirths were possibly or probably avoidable. Special attention to the recognition and adequate management of suspected growth restriction and hypertension as well as guidelines about patient information and management of decreased fetal movements might result in a reduction of stillbirths in the Netherlands.
Assuntos
Cuidado Pré-Natal/normas , Natimorto/epidemiologia , Adulto , Causas de Morte , Auditoria Clínica , Feminino , Retardo do Crescimento Fetal/diagnóstico , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Países Baixos/epidemiologia , Gravidez , Estudos Prospectivos , Padrão de Cuidado , Nascimento a TermoRESUMO
OBJECTIVES: To improve diagnosis of necrotizing enterocolitis (NEC) by noninvasive markers representing gut wall integrity loss (I-FABP and claudin-3) and gut wall inflammation (calprotectin). Furthermore, the usefulness of I-FABP to predict NEC severity and to screen for NEC was evaluated. METHODS: Urinary I-FABP and claudin-3 concentrations and fecal calprotectin concentrations were measured in 35 consecutive neonates suspected of NEC at the moment of NEC suspicion. To investigate I-FABP as screening tool for NEC, daily urinary levels were determined in 6 neonates who developed NEC out of 226 neonates included before clinical suspicion of NEC. RESULTS: Of 35 neonates suspected of NEC, 14 developed NEC. Median I-FABP, claudin-3, and calprotectin levels were significantly higher in neonates with NEC than in neonates with other diagnoses. Cutoff values for I-FABP (2.20 pg/nmol creatinine), claudin-3 (800.8 INT), and calprotectin (286.2 microg/g feces) showed clinically relevant positive likelihood ratios (LRs) of 9.30, 3.74, 12.29, and negative LRs of 0.08, 0.36, 0.15, respectively. At suspicion of NEC, median urinary I-FABP levels of neonates with intestinal necrosis necessitating surgery or causing death were significantly higher than urinary I-FABP levels in conservatively treated neonates. Of the 226 neonates included before clinical suspicion of NEC, 6 developed NEC. In 4 of these 6 neonates I-FABP levels were not above the cutoff level to diagnose NEC before clinical suspicion. CONCLUSIONS: Urinary I-FABP levels are not suitable as screening tool for NEC before clinical suspicion. However, urinary I-FABP and claudin-3 and fecal calprotectin are promising diagnostic markers for NEC. Furthermore, urinary I-FABP might also be used to predict disease severity.
Assuntos
Enterocolite Necrosante/diagnóstico , Proteínas de Ligação a Ácido Graxo/urina , Complexo Antígeno L1 Leucocitário/análise , Proteínas de Membrana/urina , Biomarcadores/análise , Claudina-3 , Enterocolite Necrosante/patologia , Fezes/química , Humanos , Recém-Nascido , Índice de Gravidade de DoençaRESUMO
INTRODUCTION: In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15-20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. METHODS: Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. RESULTS: In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. DISCUSSION: The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed.
Assuntos
Tomada de Decisões/ética , Ética Médica , Eutanásia Ativa/ética , Padrões de Prática Médica/ética , Suspensão de Tratamento/ética , Humanos , Lactente , Recém-Nascido , Países Baixos , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de TempoRESUMO
The relevance of tumor markers in clinical diagnosis of cancer has given rise to the development of new approaches based on the use of nanoparticles to improve the features of the immunoassays developed for their control. This article reviews the usefulness of different nanoparticles to develop direct, sandwich and competitive assays for the individual and multiplexed determination of these compounds.
Assuntos
Biomarcadores Tumorais/análise , Imunoensaio/métodos , Nanopartículas , Nanotecnologia/métodos , Animais , Biomarcadores Tumorais/imunologia , Humanos , Nanopartículas/química , Neoplasias/diagnósticoRESUMO
BACKGROUND: Perinatal mortality is an important indicator of health. European comparisons of perinatal mortality show an unfavourable position for the Netherlands. Our objective was to study regional variation in perinatal mortality within the Netherlands and to identify possible explanatory factors for the found differences. METHODS: Our study population comprised of all singleton births (904,003) derived from the Netherlands Perinatal Registry for the period 2000-2004. Perinatal mortality including stillbirth from 22+0 weeks gestation and early neonatal death (0-6 days) was our main outcome measure. Differences in perinatal mortality were calculated between 4 distinct geographical regions North-East-South-West. We tried to explain regional differences by adjustment for the demographic factors maternal age, parity and ethnicity and by socio-economic status and urbanisation degree using logistic modelling. In addition, regional differences in mode of delivery and risk selection were analysed as health care factors. Finally, perinatal mortality was analysed among five distinct clinical risk groups based on the mediating risk factors gestational age and congenital anomalies. RESULTS: Overall perinatal mortality was 10.1 per 1,000 total births over the period 2000-2004. Perinatal mortality was elevated in the northern region (11.2 per 1,000 total births). Perinatal mortality in the eastern, western and southern region was 10.2, 10.1 and 9.6 per 1,000 total births respectively. Adjustment for demographic factors increased the perinatal mortality risk in the northern region (odds ratio 1.20, 95% CI 1.12-1.28, compared to reference western region), subsequent adjustment for socio-economic status and urbanisation explained a small part of the elevated risk (odds ratio 1.11, 95% CI 1.03-1.20). Risk group analysis showed that regional differences were absent among very preterm births (22+0 - 25+6 weeks gestation) and most prominent among births from 32+0 gestation weeks onwards and among children with severe congenital anomalies. Among term births (>or= 37+0 weeks) regional mortality differences were largest for births in women transferred from low to high risk during delivery. CONCLUSION: Regional differences in perinatal mortality exist in the Netherlands. These differences could not be explained by demographic or socio-economic factors, however clinical risk group analysis showed indications for a role of health care factors.
Assuntos
Serviços de Saúde Materna/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Mortalidade Perinatal , Nascimento Prematuro/epidemiologia , Adulto , Feminino , Humanos , Recém-Nascido , Países Baixos/epidemiologia , Razão de Chances , Assistência Perinatal/tendências , Mortalidade Perinatal/tendências , Densidade Demográfica , Gravidez , Sistema de Registros , Fatores de Risco , Classe Social , Adulto JovemRESUMO
We critically evaluate the usefulness of different nanostructures described as labels, nanoscaffolds or separation media in immunoassays and nucleic-acid hybridization assays. Many of the great number of publications describe only theoretical aspects of using these nanostructures or nanoparticles, but do not verify their applicability in the presence of potential interferents that can be present in the sample matrix. We attempt a systematic study of the advantages and the limitations of using these new reagents in bioassays, the different assay formats for individual and multiplexed detection, and the capability of these assays in analyzing real samples.
RESUMO
OBJECTIVE: To study respiratory outcome in preterm small for gestational age (SGA) fetuses with or without signs of intrauterine growth restriction due to placental insufficiency, and with or without maternal hypertension. METHODS: This was a retrospective study of 187 neonates with birth weight <10(th) percentile and gestational age <34 weeks. Results from umbilical artery Doppler velocimetry were used to identify the abnormal Doppler subgroup. RESULTS: No significant difference in respiratory outcome between SGA fetuses with normal (SGA-N) or abnormal (SGA-A) umbilical artery Doppler examination was found. Within the SGA-A group, the respiratory distress syndrome (RDS) incidence (OR 5.6, 95% CI 1.7-18.3), RDS grade (OR 6.7, 95% CI 1.2-38.5), and need for surfactant (OR 5.3, 95% CI 1.1-24.4) were higher in infants of women with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome as compared to those of normotensive mothers. CONCLUSIONS: Lung maturation is not accelerated with placental insufficiency. SGA-A fetuses of mothers with HELLP syndrome have a significantly poorer respiratory outcome than those with healthy mothers. Possibly, fetuses of mothers with HELLP syndrome are subjected to 'oxidative stress' causing lung damage rather than lung maturation.
Assuntos
Síndrome HELLP/fisiopatologia , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Avaliação de Resultados em Cuidados de Saúde , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Artérias Umbilicais/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Uso de Medicamentos , Feminino , Glucocorticoides/uso terapêutico , Humanos , Mortalidade Infantil , Recém-Nascido , Masculino , Gravidez , Surfactantes Pulmonares/uso terapêutico , Respiração Artificial , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Estudos Retrospectivos , Índice de Gravidade de Doença , Ultrassonografia DopplerRESUMO
A chromatographic method based on the use of a fused-core column and luminescence detection is described for the determination of six penicillin antibiotics used in veterinary practice, namely amoxicillin, ampicillin, penicillin G, oxacillin, cloxacillin and nafcillin. The use of this column provides the separation of these antibiotics with retention times lower than 4.5min. The tris(2,2'-bipyridyl)ruthenium(II) [Ru(bpy)32+] - Ce(IV) system has been used as post-column derivatization reagent, obtaining a luminescence signal (λem 610nm) proportional to the analyte concentration when the system is excited at 450nm. The dynamic ranges of the calibration graphs are 100-10,000ngmL-1 for all the antibiotics assayed and the limits of detection are in the range of 44-51ngmL-1. The precision, established at two concentration levels of each analyte and expressed as the percentage of the relative standard deviation is in the range of 6.9-9.8%. The method has been satisfactorily applied to the analysis of water and pharmaceutical samples, with recoveries ranging from 88.6% to 108.5%.
Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Água Potável/análise , Penicilinas/análise , Drogas Veterinárias/análise , Poluentes Químicos da Água/análise , Cromatografia Líquida de Alta Pressão/economia , Cromatografia Líquida de Alta Pressão/instrumentação , Desenho de Equipamento , Limite de Detecção , Medições Luminescentes/economia , Medições Luminescentes/instrumentação , Medições Luminescentes/métodos , Preparações Farmacêuticas/química , Fatores de TempoRESUMO
OBJECTIVE: To determine outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities). STUDY DESIGN: International cohort study and meta-analysis. PRIMARY OUTCOME: time to full enteral feeding (TFEF); secondary outcomes: Duration of mechanical ventilation, length of stay (LOS), mortality and differences in outcome between simple and complex gastroschisis (complex; born with bowel atresia, volvulus, perforation or necrosis). To compare the cohort study results with literature three databases were searched. Studies were eligible for inclusion if cases were born in developed countries with isolated gastroschisis after 1990, number of cases >20 and TFEF was reported. RESULTS: The cohort study included 204 liveborn cases of isolated gastroschisis. The TFEF, median duration of ventilation and LOS was, 26days (range 6-515), 2days (range 0-90) and 33days (range 11-515), respectively. Overall mortality was 10.8%. TFEF and LOS were significantly longer (P<0.0001) and mortality was fourfold higher in the complex group. Seventeen studies, amongst the current study, were included for further meta-analysis comprising a total of 1652 patients. Mean TFEF was 35.3±4.4days, length of ventilation was 5.5±2.0days, LOS was 46.4±5.2days and mortality risk was 0.06 [0.04-0.07 95%CI]. Outcome of simple and complex gastroschisis was described in five studies. TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 [1.95-6.83 95%CI] times higher in complex cases. CONCLUSIONS: These results give a good indication of the expected TFEF, ventilation time and LOS and mortality risk in children born with isolated gastroschisis, although ranges remain wide. This study shows the importance of dividing gastroschisis into simple and complex for the prediction of outcome.
Assuntos
Gastrosquise/epidemiologia , Gastrosquise/diagnóstico , Gastrosquise/terapia , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Nutrição Parenteral/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricosRESUMO
A new magnetic dispersive solid-phase extraction approach based on Eu- and Tb-coated magnetic nanocomposites, combined with ultra-high performance liquid chromatography with fluorometric detection, is reported for the extraction and simultaneous determination of veterinary antibiotics. The method is aimed at monitoring of potential residues of three tetracyclines, namely oxytetracycline, tetracycline, chlortetracycline and three acidic quinolones, such as oxolinic acid, nalidixic acid and flumequine, chosen as model analytes, in animal muscle samples. The nanocomposites were obtained by synthesizing magnetic nanoparticles by a co-precipitation method and their coating with terbium and europium ions. The limits of detection obtained using standard solutions were: 1.0, 1.5, 3.8, 0.25, 0.7 and 1.2ngmL(-1), which corresponds to 3.3, 5.0, 12.7, 0.8, 2.3 and 4.0µgkg(-1) for oxytetracycline, tetracycline, chlortetracycline, oxolinic acid, nalidixic acid and flumequine, respectively, in meat samples. The precision values, obtained in the presence of the sample matrix, were in the ranges 0.12-2.0% and 2.6-15.4% for retention times and areas, respectively. The selectivity of the method was checked by assaying different veterinary drugs, finding that most of them did not interfere at the same concentration levels as that of analytes. A recovery study was performed in the presence of chicken and pork muscle samples, which provided values in the range of 61.5-102.6%.
Assuntos
Antibacterianos/análise , Resíduos de Drogas/análise , Európio/química , Carne/análise , Nanocompostos , Quinolonas/análise , Térbio/química , Tetraciclinas/análise , Animais , Galinhas , Cromatografia Líquida de Alta Pressão/métodos , Extração em Fase Sólida/métodos , Suínos , Drogas Veterinárias/análiseRESUMO
A new method based on ultra high performance liquid chromatography (UPLC) with photometric and fluorometric detection for the determination of acetylsalicylic acid and its main metabolites, namely gentisic, salicylic and salicyluric acids, in bovine urine samples is reported. Photometric detection was used for acetylsalicylic acid determination, whereas the native fluorescence of the metabolites was monitored using fluorometric detection. The separation was performed under isocratic conditions, using acetonitrile-phosphate solution (3.5mM, pH 3.5) (26:74, v/v) as the mobile phase. The retention times of the four compounds were lower than 2min, which are shorter than those achieved using conventional HPLC. Under the optimum separation conditions, the dynamic ranges and detection limits (ngmL(-1)) were: 0.2-2500, 0.09 for gentisic acid; 0.2-2500, 0.08 for salicylic acid and 2.5-15,000, 1.1 for salicyluric acid, using fluorescence detection, and 10-25,000, 2.2 for acetylsalicylic acid, using UV detection. Intra-day and inter-day precision data were assessed at two levels of concentration of each analyte using both detection systems. The selectivity of the method was checked by assaying different drugs of veterinary use showing that most of them did not interfere with the determination of the analytes. The method has been applied to the analysis of bovine urine samples, which only required a simple clean up step of the samples prior to injection in the UPLC system. A recovery study was performed, which provided values in the range of 80-100%. This fact proves the practical usefulness of this method as an ultrafast analytical tool for the therapeutic control of acetylsalicylic acid administration in bovine animals intended for food production.
Assuntos
Aspirina/metabolismo , Aspirina/urina , Cromatografia Líquida de Alta Pressão/métodos , Animais , Bovinos , Limite de Detecção , Modelos Lineares , Reprodutibilidade dos TestesRESUMO
The usefulness of terbium oxide nanoparticles (Tb4O7NPs) as post-column derivatizing reagent for the liquid chromatographic determination of residues of quinolone antibiotics in milk samples has been studied. Seven quinolones of veterinary use have been chosen as model analytes to develop this method. The derivatization step is based on the formation of luminescent chelates of quinolones with Tb4O7NPs, which are monitored at λex=340nm and λem=545nm. Another relevant feature of the method is that the use of a 10-cm column and a ternary mixture of methanol, acetonitrile and acetic acid as mobile phase in gradient elution mode allow the chromatographic separation of the quinolones in about 13min, whereas previously described chromatographic methods require about 20min. The dynamic ranges of the calibration graphs and limits of detection are, respectively: 65-900ngmL(-1) and 35ngmL(-1) for marbofloxacin, 7.2-900ngmL(-1) and 2.5ngmL(-1) for ciprofloxacin, 6-900ngmL(-1) and 2ngmL(-1) for danofloxacin, 50-900ngmL(-1) and 20ngmL(-1) for enrofloxacin, 35-900ngmL(-1) and 12ngmL(-1) for sarafloxacin, 5-900ngmL(-1) and 2ngmL(-1) for oxolinic acid, and 7-900ngmL(-1) and 2.5ngmL(-1) for flumequine. The precision, established at two concentration levels of each analyte and expressed as the percentage of the relative standard deviation is in the range of 1.9-8.1% using standards, and of 3.4-10.7% in the presence of milk samples. The method has been satisfactorily applied to the analysis of skimmed, semi-skimmed and whole milk samples, with recoveries ranging from 89.0 to 106.5%.
Assuntos
Antibacterianos/análise , Complexos de Coordenação/análise , Leite/química , Quinolonas/análise , Térbio/química , Animais , Cromatografia Líquida/métodos , Fluoroquinolonas/análise , NanopartículasRESUMO
OBJECTIVE: To assess the effects of different oxygen concentrations and flow rates on the measurement errors of neonatal pneumotachometers in heated and unheated situations and to develop correction factors to correct for these effects. DESIGN: Prospective laboratory study. SETTING: Outpatient clinic with equipment in a standardized setting. SUBJECTS: Neonatal pneumotachometers. INTERVENTIONS: In standardized conditions, the tested pneumotachometer was calibrated at a flow rate of 3 L/min with 60% oxygen and was set in series with a closed spirometer system being used as a reference. Different air-flow levels (1-9 L/min) and oxygen concentrations (21-100%) were infused into the closed system with the pneumotachometer and spirometer. MEASUREMENTS AND MAIN RESULTS: The pneumotachometers were significantly affected by changing oxygen concentrations (p < .01) and increasing flow rates (p < .01), increasing the actually measured flow rate. Correction factors, developed by multiple regression analysis, significantly reduced the overall maximum errors of the pneumotachometers from -1.1 to 0.6 L/min to -0.5 to 0.4 L/min. CONCLUSIONS: The effects of changes in oxygen concentrations and flow rates on neonatal pneumotachometers could be considerably decreased by the use of correction factors such as were calculated in this study. This will preclude frequent calibration procedures with actual flow and oxygen levels during changes in experimental settings.
Assuntos
Oxigenoterapia/instrumentação , Desenho de Equipamento , Humanos , Recém-NascidoRESUMO
The reaction between paraquat, ascorbic acid, and Cresyl Violet in alkaline medium and in the presence of sodium dodecyl sulfate has been applied for the first time to the development of a kinetic-fluorometric method for the determination of paraquat. The reaction rate of this system is measured by using the stopped-flow mixing technique, which makes the method applicable to automatic routine analysis. Analytical data are obtained in approximately 30 s. The calibration graph is linear over the range 6-500 ng mL(-)(1), and the detection limit is 1.8 ng mL(-)(1). The relative standard deviation is <3%. The use of dynamic measurements at long wavelength favors the high selectivity of the method. Diquat behaves in this system similarly to paraquat, but its interferent effect is easily avoided by using cysteine. The proposed method has been applied to the determination of paraquat in tap water, milk, and white wine samples with recoveries of 89-104%.