Factors affecting umbilical cord blood stem cell suitability for transplantation in an in utero collection program.

BACKGROUND: The greatest limiting factor in the use of umbilical cord blood (UCB) for transplantations is the number of stem cells available in any given collected unit. This study examines maternal, neonatal, and obstetric factors that influence the suitability for banking and transplantation of UCB units collected in utero. STUDY DESIGN AND METHODS: This study examined 7839 UCB units collected in utero at two hospitals from August 1, 2008, to August 31, 2011. The variables were collected from cord blood records, patient charts, delivery records, and data processed by StemCyte, Inc. (Covina, CA), our parent bank. The mean total nucleated cell (TNC) count between units selected for transplant and those banked but not selected for transplant were also compared. RESULTS: Of the 11 variables evaluated, six had a significant influence on the acceptable banking TNC count of at least 90 × 10(7) . Of these, cord blood volume was the best predictor. The other variables that were predictors of the acceptable TNC count of significance were gestational age, infant race, parity, birthweight, and infant sex. The minimal bankable TNC count for banking is considerably lower than the mean TNC count of units actually selected for transplantation. CONCLUSION: Maternal, neonatal, and obstetric factors can all influence the acceptability of a cord blood unit collected in utero for banking. Furthermore, units with high TNC counts are more likely to be selected for banking. Identifying these variables in potential donors can likely increase the number of adequate collections.

More than an Incidentaloma: The Nonreportable NIPT.

Noninvasive prenatal testing (NIPT), which utilizes a maternal blood sample to detect fetal gender and screen for fetal aneuploidy (abnormal chromosomes), is widely used in obstetrics to screen for Trisomies 21, 18, and 13. Per the literature, approximately 0.3% of pregnant woman's results are nonreportable. Reasons include low fetal fraction, insufficient DNA, vanishing twin, twin pregnancy, clonal mosaicism, and maternal neoplasia. Here, we describe a 25-year-old G2P1 pregnant woman who had two nonreportable NIPT results and subsequently was diagnosed with lymphoma. We discuss the importance of clinical exam in correlation with the results to offer comprehensive evaluation of the patient with a nonreportable finding, given malignancy occurs in 1/1000 pregnant women. This report overviews proposed management guidelines for pregnant women with a nonreportable result and helps to address discomfort the treating physician may feel in discussing this result with their patient.

Lighting a Path for Autonomous Vehicle Communication: The Effect of Light Projection on the Detection of Reversing Vehicles by Older Adult Pedestrians.

Pedestrian understanding of driver intent is key to pedestrian safety on the road and in parking lots. With the development of autonomous vehicles (AVs), the human driver will be removed, and with it, the exchange that occurs between drivers and pedestrians (e.g., head nods, hand gestures). One possible solution for augmenting that communication is an array of high-intensity light-emitting diodes (LEDs) to project vehicle-to-pedestrian (V2P) messages on the ground plane behind a reversing vehicle. This would be particularly beneficial to elderly pedestrians, who are at particular risk of being struck by reversing cars in parking lots. Their downward gaze and slower reaction time make them particularly vulnerable. A survey was conducted to generate designs, and a simulator experiment was conducted to measure detection and reaction times. The study found that elderly pedestrians are significantly more likely to detect an additional projected message on the ground than detect the existing brake light alone when walking in a parking lot.

Use of bifunctional ureas to increase the rate of proline-catalyzed alpha-aminoxylations.

The rate of the proline-catalyzed alpha-aminoxylation of aldehydes is significantly increased in the presence of a bifunctional urea. Structure-activity relationship data indicate that both an amine and a urea are crucial for rate enhancement. The evidence presented herein suggests that this rate enhancement originates from the hydrogen bonding interaction between the bifunctional urea and an oxazolidinone intermediate to increase the rate of enamine formation. Proline derivatives that are incapable of forming oxazolidinones exhibit no rate enhancement in the presence of the bifunctional urea. The rate enhancement is general for a variety of aldehydes, and the faster reactions do not reduce yields or selectivities.

Safety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention: A Randomized Clinical Trial.

Importance: The treatment effects of individual mechanical thrombectomy devices in large-vessel acute ischemic stroke (AIS) remain unclear. Objective: To determine whether the novel 3-dimensional (3-D) stent retriever used in conjunction with an aspiration-based mechanical thrombectomy device (Penumbra System; Penumbra) is noninferior to aspiration-based thrombectomy alone in AIS. Design, Setting, and Participants: This randomized, noninferiority clinical trial enrolled patients at 25 North American centers from May 19, 2012, through November 19, 2015, with follow-up for 90 days. Adjudicators of the primary end points were masked to treatment allocation. Patients with large-vessel intracranial occlusion AIS presenting with a National Institutes of Health Stroke Scale (NIHSS) score of at least 8 within 8 hours of onset underwent 1:1 randomization to 3-D stent retriever with aspiration or aspiration alone. The primary analyses were conducted in the intention-to-treat population. Interventions: Mechanical thrombectomy using intracranial aspiration with or without the 3-D stent retriever. Main Outcomes and Measures: The primary effectiveness end point was the rate of a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2 to 3 with a 15% noninferiority margin. Device- and procedure-related serious adverse events at 24 hours were the primary safety end points. Results: Of 8082 patients screened, 198 patients were enrolled (111 women [56.1%] and 87 men [43.9%]; mean [SD] age, 66.9 [13.0] years) and randomized, including 98 in the 3-D stent retriever with aspiration group and 100 in the aspiration alone group; an additional 238 patients were eligible but not enrolled. The median baseline NIHSS score was 18.0 (interquartile range, 14.0-23.0). Eighty-two of 94 patients in the 3-D stent retriever and aspiration group (87.2%) had an mTICI grade of 2 to 3 compared with 79 of 96 in the aspiration alone group (82.3%; difference, 4.9%; 90% CI, -3.6% to 13.5%). None of the other measures were significantly different between the 2 groups. Device-related serious adverse events were reported by 4 of 98 patients in the 3-D stent retriever with aspiration group (4.1%) vs 5 of 100 patients in the aspiration only group (5.0%); procedure-related serious adverse events, 10 of 98 (10.2%) vs 14 of 100 (14.0%). A 90-day modified Rankin Scale score of 0 to 2 was reported by 39 of 86 patients in the 3-D stent retriever with aspiration group (45.3%) vs 44 of 96 patients in the aspiration only group (45.8%). Conclusions and Relevance: The present study provides class 1 evidence for the noninferiority of the 3-D stent retriever with aspiration vs aspiration alone in AIS. Future trials should evaluate whether these results can be generalized to other stent retrievers. Trial Registration: clinicaltrials.gov Identifier: NCT01584609.

Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma.

BACKGROUND: The purpose of this study was to assess the ability of intensity-modulated radiation therapy (IMRT) to achieve favorable disease-control rates while minimizing parotid gland doses in patients treated for small primary tumors of the oropharynx. METHODS AND MATERIALS: We retrospectively identified all patients who received IMRT as treatment for a small (<4 cm) primary tumor of the oropharynx between October 2000 and June 2002. Tumor characteristics, IMRT parameters, and patient outcomes were assessed. RESULTS: Fifty-one patients met the criteria for our study. All patients had treatment to gross disease with margin (CTV1), and all but 1 had treatment to the bilateral necks. The most common treatment schedule (39 patients) was a once-daily fractionation of prescribed doses of 63-66 Gy to the CTV1 and 54 Gy to subclinical sites, delivered in 30 fractions. Twenty-one patients (40%) had gastrostomy tubes placed during therapy; in 4 patients, the tube remained in place for more than 6 months after completion of IMRT. The median follow-up was 45 months. The 2-year actuarial locoregional control, recurrence-free, and overall survival rates were 94%, 88%, and 94%, respectively. CONCLUSIONS: These preliminary data suggest that treatment with IMRT results in favorable locoregional control of small primary oropharynx tumors. IMRT did not appear to have a more favorable acute toxicity profile in this group with respect to the use of a feeding tube; however, the mean dose of radiation delivered to the parotid gland by IMRT was decreased, because 95% of patients had a mean dose of <30 Gy to at least one gland.

A general approach to creating soluble catalytic polymers heterogenized in microcapsules.

A general method for preparing site-isolated polymeric catalysts is presented. Linear chloromethyl and azide polymers have been sequestered within polyurea microcapsules and small molecule catalysts soaked through the shell walls to functionalize the soluble polymers. Reaction onto each type of support is quantitative and MacMillan, DMAP, and TEMPO test catalysts are shown to have faster reaction rates than the analogous resin-supported catalysts.

Visual recovery and OCT evolution following central retinal artery occlusion treated with intra-arterial verapamil and alteplase infusion.

A 69-year-old woman presented with a "veil" over the left eye. Clinical examination demonstrated signs of central retinal artery occlusion. Visual acuity was compromised to 1/200 E in the left eye. Ocular massage and anterior chamber paracentesis failed to improve vision. An emergent intra-arterial catheterization with verapamil and alteplase infusion was performed less than 12 hours following symptom onset. Initial optical coherence tomography (OCT) showed inner retinal edema. One year later, OCT revealed relatively minor thinning, which could explain the patient's visual recovery to 20/40. This may be the first article to report OCT changes following this treatment for central retinal artery occlusion.

Developing a wellness program for people with multiple sclerosis: description and initial results.

Because multiple sclerosis (MS) is a multidimensional chronic disease, effective management of the illness requires a multidimensional approach. We describe a wellness program that was designed to facilitate positive health choices throughout the course of MS and present initial data analyses. We hypothesized that over the course of the program, participants would demonstrate improvement in the domains assessed. The wellness program included educational sessions in physical, mental, social, intellectual, and spiritual domains specifically targeting improved self-efficacy, physical functioning, coping skills, symptom management, and nutrition. An outcomes data collection software program was adapted to facilitate real-time patient self-report and clinician entry data collection for many domains throughout the wellness program. Initial assessment of serial measures (intake to discharge) from 65 people with MS showed improvement in several domains, including functional status (P < .05), fatigue (P < .05), fear-avoidance beliefs regarding physical activities (P < .05), depression (P < .05), somatization (P < .05), and pain (P < .05). In addition, using a model of risk for interpersonal distress, patients whose risk of elevated depression and anxiety decreased over the course of the program reported greater gains in functional status (P < .05). The results suggest possible future treatment strategies and indicate strengths and weaknesses of the wellness program, which are being used to improve the program.

Microcapsules with three orthogonal reactive sites.

Polymeric microcapsules containing reactive sites on the shell surface and two orthogonally reactive polymers encapsulated within the interior are selectively labeled. The capsules provide three spatially separate and differentially reactive sites. Confocal fluorescence microscopy is used to characterize the distribution of labels. Polymers encapsulated are distributed homogeneously within the core and do not interact with the shell even when oppositely charged.

Microencapsulated linear polymers: "soluble" heterogeneous catalysts.

A new strategy for supporting catalysts based on the microencapsulation of linear polymers is presented. In this paper, we present a DMAP capsule that is capable of catalyzing acylation reactions. The catalyst is compared to DMAP on cross-linked and linear polystyrene, as well as small molecule DMAP. Rapid optimization through modification of encapsulation conditions is demonstrated. The optimization provides a dynamic range of catalysis from 90 to 300% of the rate of DMAP on polystyrene.

The effects of maxillary protraction therapy with or without rapid palatal expansion: a prospective, randomized clinical trial.

INTRODUCTION: The purpose of this controlled randomized clinical trial was to quantify the effects of maxillary protraction with or without palatal expansion. METHODS: Forty-six children aged 5 to 10 years were randomly assigned to 1 of 3 groups: (1) facemask with palatal expansion, (2) facemask without palatal expansion, and (3) observation for 12 months. Cephalometric analysis with traditional cephalometric measurements, an x-y coordinate system, and an occlusal-plane analysis were used. RESULTS: Student t tests showed no significant differences (P < .05) between expansion and nonexpansion groups in any measured variable. Comparisons of treated and control subjects showed significant (P < .01) treatment effects beyond normal Class III growth. Analysis of x-y coordinate variables showed the following: 2 mm additional forward displacement of the maxillary complex with counterclockwise rotation, mandibular clockwise rotation, posterior movement of B-point by an average of 1.5 mm, and forward movement of the maxillary dentition of nearly 1 mm. Analysis of traditional cephalometric measures showed improvements in ANB angle of nearly 4 degrees and Wits appraisal of nearly 4 mm. The occlusal plane analysis showed an apical base change of 4 mm, 1.5 mm forward displacement of the maxillary complex, mandibular clockwise rotation of 2.5 mm, and forward maxillary molar movement of 1.9 mm. CONCLUSIONS: The results of this continuing 5-year clinical trial indicate that early facemask therapy, with or without palatal expansion, is effective to correct skeletal Class III malocclusions.

Calcium channel blocker, nimodipine, for the treatment of bipolar disorder during pregnancy.

Bipolar disorder in pregnancy was treated with nimodipine, because of lithium-induced nephrogenic diabetes insipidus. A 33-year-old primigravida woman at approximately 22 weeks 6 days of gestation had increasing blood pressure since 16 weeks of gestation, despite methyldopa 500 mg twice daily. She also had hypothyroidism and bipolar disorder, which were treated with levothyroxine and lithium carbonate, respectively. Nephrogenic diabetes insipidus developed, presumably because of chronic lithium exposure in high doses. She did not tolerate carbamazepine (the other agent commonly used for bipolar disorder in pregnancy). Thus, nimodipine was tried and tolerated well; furthermore, it was very effective in controlling her bipolar disorder. Nimodipine successfully controlled the bipolar disorder of a woman during pregnancy, who was intolerant of more commonly used agents.

Cellular-free magnesium depletion in brain and muscle of normal and preeclamptic pregnancy: a nuclear magnetic resonance spectroscopic study.

Preeclampsia is a pregnancy disorder of unknown origin, characterized by vasospasm, elevated blood pressure, and increased neuromuscular irritability, features common to syndromes of magnesium deficiency. Evidence of serum and ionized magnesium metabolism disturbances have been observed in women with preeclampsia. This and the therapeutic utility of magnesium in preeclampsia led us to investigate the extent to which an endogenous tissue magnesium deficiency might be present in and contribute to its pathophysiology. We used (31)P nuclear magnetic resonance spectroscopy to noninvasively measure in situ intracellular-free magnesium levels in brain and skeletal muscle of fasting nonpregnant women (n=12), and of third trimester women with uncomplicated pregnancies (n=11) and preeclampsia (n=7). Compared with nonpregnant controls (brain 519+/-59 micromol/L; muscle 604+/-34 micromol/L), brain and skeletal muscle intracellular magnesium levels were significantly lower in both normal pregnant (brain 342+/-23 micromol/L; muscle 482+/-40 micromol/L; P=0.05 for both tissues) and preeclamptic women (brain 229+/-17 micromol/L; muscle 433+/-46 micromol/L; P=0.05 for both tissues). Brain intracellular magnesium was further reduced in preeclamptics compared with normal pregnant subjects (P=0.05). For all pregnant subjects, blood pressure was significantly and inversely related to the concomitantly measured intracellular magnesium level in brain (systolic, r=-0.59, P=0.01; diastolic, r=-0.52, P=0.02) but not in muscle. Cellular magnesium depletion is characteristic of normal pregnancy and may be one factor contributing to the pathophysiology of preeclampsia. Furthermore, the influence of central nervous system factors on blood pressure may be mediated, at least in part, by ambient intracellular magnesium levels.