Expansion of distribution ranges and current population status of Cheer pheasant (Catreus wallichii) in Northern Pakistan (AJ&K).

We studied the distribution and population status of the Cheer pheasant (Catreus wallichii) in Azad Jammu and Kashmir (AJ&K). Study was mainly conducted in four localities Jhelum Valley (JV), Machiara National Park (MNP), Haveli and Nar Sher Ali Khan (NSAK) from 2016-2020, for five breeding seasons. Population status of Cheer pheasant was determined by the call counts method. In total 105 breeding pairs (210 birds) were estimated highest (134) being recorded from Jhelum valley followed by MNP, Haveli and Nar Sher Ali Khan While applying correction factor 158 birds were recorded. Extensive surveys were carried out in an area of 19.23 km2. Our results indicate an expansion in distribution ranges of Cheer pheasant and population has established in several new sites. Highest Mean population density of 6.11pair/km2 was recorded in Qazi Nag area of Jhelum Valley. The mean population density of Cheer pheasant was slightly higher in the month of May. Furthermore, 58% of the calling birds were detected at elevations ranging from 2300-2600m, while 17% were found at elevations between 1900-2200m. Expansion in distribution ranges of Cheer might be due to reason that bird might have been underestimated in the past or conservation measures and community awareness programs taken by the Department of Wildlife and Fisheries, AJ&K.

Effect of Raphanus raphanistrum on chronic kidney disease induced by ethanol in animal model rats / Efeito do Raphanus raphanistrum na doença renal crônica induzida por etanol em ratos modelo animal

The aim of this study is to investigate the effect of Raphanus raphanistrum (radish) on chronic kidney disease damage by reactive oxygen species or free radicals in animal model rats. Total of 18 rats were used in this study, divided into 3 groups and each group consist of 6 rats. Group 1 control (C), group 2 model (M) and group 3 test (T). Model and test group were treated with alcohol to produce chronic kidney disease by reactive oxygen spices for 9 weeks a dose of 1 ml. After that test group was treated with Raphanus raphanistrum juice for 4 weeks 80mg/kg body weight to determine it effect. Raphanus raphanistrum juice effect on behavior of rats through increases the locomotor activity and anxiety. The serum creatinine and uric acid level were significantly improved in T group. The reactive oxygen enzyme test shows that Super Oxide Dismutase (SOD) and Glutathione Peroxidase (GPx) was increase in T group. The Glutathione S-Transferases (GST) and Catalase (CAT) enzyme level was nearly same in C and T groups. This study concludes that compound 1,1-diphenyl-2-picrylhydrazyl found in Raphanus raphanistrum juice and possess strong antioxidant activity on Chronic kidney disease induce by ethanol through reactive oxygen species. There is need of more researches to determine the use of natural compound to treat different disease.

O objetivo deste estudo é investigar o efeito de Raphanus raphanistrum (rabanete) nos danos da doença renal crônica por espécies reativas de oxigênio ou radicais livres em ratos modelo animal. Um total de 18 taxas foi utilizado neste estudo, divididas em 3 grupos e cada grupo consistia em 6 ratos. Grupo 1 controle (C), grupo 2 modelo (M) e grupo 3 teste (T). O modelo e o grupo de teste foram tratados com álcool para produzir doença renal crônica por meio de especiarias reativas de oxigênio por 9 semanas, uma dose de 1 ml. Após esse teste, o grupo foi tratado com suco de Raphanus raphanistrum por 4 semanas 80 mg / kg de peso corporal para determinar seu efeito. Efeito do suco de Raphanus raphanistrum no comportamento de ratos por meio do aumento da atividade locomotora e ansiedade. A creatinina sérica e o nível de ácido úrico melhoraram significativamente no grupo T. O teste da enzima oxigênio reativa mostra que a Super Óxido Dismutase (SOD) e a Glutationa Peroxidase (GPx) aumentaram no grupo T. O nível das enzimas Glutationa S-Transferases (GST) e Catalase (CAT) foi quase o mesmo nos grupos C e T. Este estudo conclui que o composto 1,1-difenil-2-picrilhidrazil encontrado no suco de Raphanus raphanistrum possui forte atividade antioxidante na doença renal crônica induzida pelo etanol por meio de espécies reativas de oxigênio. Há necessidade de mais pesquisas para determinar o uso de compostos naturais no tratamento de diferentes doenças.

A comprehensive model for the implementation of agricultural land levelling and consolidation plan in the Abu Fazel region of Ahvaz / Modelo abrangente para a implementação do plano de nivelamento e consolidação de terras agrícolas na região de Abu Fazel, de Ahvaz

It has been shown that land fragmentation can negatively impact the efficiency of farming. Therefore, experts recommend land consolidation process, as a logical and workable solution to solve the problems and complications caused by land fragmentation. Land levelling and consolidation is a process of land reform that changes the construction of agricultural lands which leads to rural development through reforming farm management. However, a single plan cannot be applied to different regions, even though they might be in the same country. Hence, it is vital to investigate multiple factors in a certain region to devise the perfect consolidation plan. The present study, which is a survey-exploratory research, is conducted to provide a comprehensive model to implement the plan for levelling and consolidation of agricultural lands in the Abu Fazel region of Ahvaz, Iran. This research is an applied field research which uses both library and field methods to collect the required data. The study population is in Abu Fazel in the northeast of Ahvaz in Zargan region. The results of the study show that cultural, social, economic, policy-making, educational, agricultural and managerial factors have an effect on the participation of farmers in the levelling and consolidation of agricultural lands in the study area (p≥0.01). Also, there is a strong positive relationship between these factors and the farmers' participation in levelling and consolidation of agricultural lands (p≥0.01). Among these factors, it is observed that policy is main factor. Policymakers can play an effective role in land consolidation and macro development on the one hand and agricultural and rural development. On the other, by accurately assessing the interactive effect of land consolidation and related factors, along with the effects of this process on the evolution of agronomic systems.

Tem sido demonstrado que a fragmentação da terra pode impactar negativamente a eficiência da agricultura. Portanto, os especialistas recomendam o processo de consolidação de terras como uma solução lógica e viável para resolver os problemas e as complicações causadas pela fragmentação de terras. O nivelamento e a consolidação da terra são processos de reforma agrária que alteram a construção de terras agrícolas, o que leva ao desenvolvimento rural por meio da reforma da gestão agrícola. No entanto, um único plano não pode ser aplicado a diferentes regiões, mesmo que estejam no mesmo país. Portanto, é vital investigar vários fatores em determinada região para elaborar o plano de consolidação perfeito. O presente estudo, que é uma pesquisa exploratória de levantamento, é realizado para fornecer um modelo abrangente para implementar o plano de nivelamento e consolidação de terras agrícolas na região de Abu Fazel, de Ahvaz, no Irã. Trata-se de uma pesquisa de campo aplicada que usa métodos de biblioteca e de campo para coletar os dados necessários. A população do estudo está em Abu Fazel, no nordeste de Ahvaz, na região de Zargan. Os resultados do estudo mostram que fatores culturais, sociais, econômicos, políticos, educacionais, agrícolas e gerenciais influenciam a participação dos agricultores no nivelamento e na consolidação das terras agrícolas na área de estudo (p ≥ 0,01). Além disso, há forte relação positiva entre esses fatores e a participação dos agricultores no nivelamento e na consolidação das terras agrícolas (p ≥ 0,01). Entre esses fatores, observa-se que a política é o principal deles. Os formuladores de políticas, por um lado, podem desempenhar um papel efetivo na consolidação da terra e no macrodesenvolvimento e desenvolvimento agrícola e rural e, por outro, avaliar com precisão o efeito interativo da consolidação de terras e fatores relacionados, juntamente com os efeitos desse processo na evolução dos sistemas agronômicos.

A comprehensive model for the implementation of agricultural land levelling and consolidation plan in the Abu Fazel region of Ahvaz.

It has been shown that land fragmentation can negatively impact the efficiency of farming. Therefore, experts recommend land consolidation process, as a logical and workable solution to solve the problems and complications caused by land fragmentation. Land levelling and consolidation is a process of land reform that changes the construction of agricultural lands which leads to rural development through reforming farm management. However, a single plan cannot be applied to different regions, even though they might be in the same country. Hence, it is vital to investigate multiple factors in a certain region to devise the perfect consolidation plan. The present study, which is a survey-exploratory research, is conducted to provide a comprehensive model to implement the plan for levelling and consolidation of agricultural lands in the Abu Fazel region of Ahvaz, Iran. This research is an applied field research which uses both library and field methods to collect the required data. The study population is in Abu Fazel in the northeast of Ahvaz in Zargan region. The results of the study show that cultural, social, economic, policy-making, educational, agricultural and managerial factors have an effect on the participation of farmers in the levelling and consolidation of agricultural lands in the study area (p≥0.01). Also, there is a strong positive relationship between these factors and the farmers' participation in levelling and consolidation of agricultural lands (p≥0.01). Among these factors, it is observed that policy is main factor. Policymakers can play an effective role in land consolidation and macro development on the one hand and agricultural and rural development. On the other, by accurately assessing the interactive effect of land consolidation and related factors, along with the effects of this process on the evolution of agronomic systems.

Association between gastrointestinal cancers and fingerprint patterns in the Iranian population.

Gastrointestinal cancers are malignant diseases with high mortality rate. Early diagnosis of patients could improve the results of treatment. Many studies used dermatoglyphics as a biomarker to predict the incidence of genetic diseases and cancers. This study assessed the association between gastrointestinal cancers and particular fingerprint patterns, which could be useful in early diagnosis of these malignancies. The study was conducted on 153 histopathologically confirmed gastrointestinal cancer patients and 299 healthy individuals. The fingerprints were taken by a specific method of rolling the subject's fingers or thumbs in ink. The data were analyzed for the significance using the chi-square test and the t-test. Odds ratio with 95% confidence intervals were calculated. Dermatoglyphic analysis showed that whorl and loop patterns significantly changed in the case group as compared to control. However, the odds ratio suggested that whorl pattern in 6 or more fingers might be a risk factor for developing gastrointestinal cancers. Our results showed that there is an association between fingerprint patterns and gastrointestinal cancers, and so, the dermatoglyphic analysis may aid in the early diagnosis of these cancers.

Temperature-Dependent Development Modeling of the Phorid Fly Megaselia halterata (Wood) (Diptera: Phoridae).

The effect of temperature on the development of Megaselia halterata (Wood) (Diptera: Phoridae) on A15 variety of button mushroom in the stages of casing and spawn-running was investigated at eight constant temperatures (10, 12.5, 15, 18, 20, 22.5, 25, and 27°C) and developmental rates were modeled as a function of temperature. At 25 and 27°C, an average of 22.2 ± 0.14 and 20.0 ± 0.10 days was needed for M. halterata to complete its development from oviposition to adult eclosion in the stages of casing and spawn-running, respectively. The developmental times of males or females at various constant temperatures were significantly different. Among the linear models, the Ikemoto and Takai linear model in the absence of 12.5 and 25°C showed the best statistical goodness-of-fit and based on this model, the lower developmental threshold and the thermal constant were estimated as 10.4°C and 526.3 degree-days, respectively. Twelve nonlinear temperature-dependent models were examined to find the best model to describe the relationship between temperature and development rate of M. halterata. The Logan 10 nonlinear model provided the best estimation for T opt and T max and is strongly recommended for the description of temperature-dependent development of M. halterata.

Adrenal function in premature infants during inhaled beclomethasone therapy.

OBJECTIVE: We tested the hypothesis that inhaled beclomethasone therapy for prevention of bronchopulmonary dysplasia does not cause adrenal suppression. STUDY DESIGN: Infants receiving ventilatory support with birth weights

Regional hemodynamic effects of dopamine in the sick preterm neonate.

OBJECTIVE: To study the effects of dopamine on renal, mesenteric, and cerebral blood flow in sick preterm neonates. STUDY DESIGN: The pulsatility index was used to assess the dopamine-induced changes in renal, mesenteric, and cerebral blood flow by means of color Doppler ultrasonography in 23 nonhypotensive preterm neonates (birth weight: 981 +/- 314 g; postnatal age: <2 days). Dopamine was given at a dose of 6.1 +/- 3.0 microgram/kg per minute to combat oliguria, impaired peripheral perfusion, or both. Blood flow velocity measurements were made before and during dopamine administration, with each patient serving as his or her own control subject. RESULTS: Dopamine significantly increased blood pressure and urine output. Dopamine decreased the pulsatility index in the renal artery (2.98 +/- 1.18 vs 1.68 +/- 0.45; P <.05) while the pulsatility index in the superior mesenteric and medial cerebral artery was not affected. Thus renal blood flow increased while mesenteric and cerebral blood flow remained unchanged during dopamine treatment. The increase in renal blood flow was independent of the blood pressure changes. CONCLUSIONS: These findings suggest a functionally mature renal, but not mesenteric, vasodilatory dopaminergic response in the preterm neonate. The observations also indicate the lack of an effect of low- to medium-dose dopamine on cerebral hemodynamics in the nonhypotensive preterm neonate.

Penicillin- and cephalosporin-resistant strains of Streptococcus pneumoniae causing sepsis and meningitis in children with sickle cell disease.

OBJECTIVE: We investigated the possibility that antimicrobial-resistant pneumococci were causing invasive disease in children with sickle-cell disease (SCD). STUDY DESIGN: Records of all children with SCD observed at the Mid-South Sickle Cell Center (MSSCC) at LeBonheur Children's Medical Center were reviewed from January 1990 to June 1994. Children with SCD and pneumococcal sepsis were identified. The Streptococcus pneumoniae isolates from these children were examined for serotype and antimicrobial susceptibilities. Two additional children not observed in the MSSCC had pneumococcal sepsis caused by penicillin-resistant isolates and were also included. RESULTS: Antimicrobial susceptibility testing of the six penicillin-resistant isolates revealed that four were resistant to trimethoprim-sulfamethoxazole, two to erythromycin, and one to clindamycin. The two isolates that were resistant to ceftriaxone also were multiply resistant. From the MSSCC, 26 children had pneumococcal sepsis during the 4 1/2-year period studied. Five of these children (19%) died. Four (15%), including one who died, were infected with penicillin-resistant strains. CONCLUSION: Pneumococcal sepsis, meningitis, and infections of other foci in children with SCD may be caused by S. pneumoniae that is resistant to one or more antimicrobial agents, including penicillin. The addition of vancomycin to the antibiotics currently used for initial management should be considered in areas where the antibiotic resistance of S. pneumoniae is prevalent.

Severe retinopathy of prematurity in infants with birth weights less than 1250 grams: incidence and outcome of treatment with pharmacologic serum levels of vitamin E in addition to cryotherapy from 1985 to 1991.

OBJECTIVE: To determine the effect of vitamin E prophylaxis and treatment on the sequelae of severe (threshold) retinopathy of prematurity (ROP) in infants treated with cryotherapy at Pennsylvania Hospital from 1985 to 1991. STUDY DESIGN: Beginning on day 0, all infants with birth weights < or = 1250 gm received supplements of vitamin E using standard preparations. Serum E levels of 23 to 58 mumol/L (1 to 2.5 mg/dl) were targeted for infants with immature retinal vasculature or ROP of stage 2 or less in severity, and levels of 58 to 81 mumol/L (2.5 to 3.5 mg/dl) for infants with prethreshold ROP. At diagnosis of threshold ROP, treatment with a parenteral investigational new drug preparation of alpha-tocopherol was begun to raise serum levels to the pharmacologic range (93 to 116 mumol/L or 4 to 5 mg/dl). Within 3 days of diagnosis, and at the discretion of the retinal specialist, one or both eyes were treated with cryotherapy. Visual outcome at 4 years was compared with the 42-month outcome reported for eyes in the infants randomly assigned to treatment in the 1986-1987 Multicenter Trial of Cryotherapy for ROP (CRYO-ROP). RESULTS: Threshold ROP developed in 22 of 450 surviving infants (age 3 months). All were treated with pharmacologic serum levels of vitamin E; 17 infants were also treated with cryotherapy (10 in one eye and 7 in both eyes). These 17 infants, in comparison with infants in the CRYO-ROP trial (n = 187), were at least at equal risk for poor visual outcome on the basis of birth weight, gestational age, the percentage of zone 1 ROP, and mean interval from appearance of ROP to diagnosis of prethreshold ROP, which was shorter at Pennsylvania Hospital (4.1 days for the Pennsylvania Hospital group, 10.3 days for the CRYO-ROP group). However, on the basis of the mean number of days from diagnosis of prethreshold to threshold ROP (12.5 days for Pennsylvania Hospital, 10.5 days for CRYO-ROP) and the extent of extraretinal neovascularization at threshold (mean 7.9 sectors for Pennsylvania Hospital, 9.7 for CRYO-ROP), progression of retinopathy beyond the prethreshold stage had slowed and visual outcome in the eyes of infants at Pennsylvania Hospital treated with both cryotherapy and vitamin E (worse eye used for those treated with bilateral cryotherapy) was better than that reported for the treated eye of infants in the CRYO-ROP group (percentage of favorable visual acuity, 76% vs 48%, p = 0.04; percentage of normal structure posterior retinal pole, 71% vs 38%, p < or = 0.02). CONCLUSIONS: In this small case series, the combination of cryotherapy with anti-oxidant prophylaxis and treatment appeared to decrease the severity and sequelae of threshold ROP. This hypothesis deserves testing in a large, randomized clinical trial.

Gastrointestinal and renal blood flow velocity profile in neonates with birth asphyxia.

Pulsed Doppler ultrasound blood flow profiles were studied, before the initiation of enteral feedings, in 23 neonates with birth asphyxia. We observed a significant direct correlation between the reduction of peak velocity and increased resistance in the renal and superior mesenteric arteries to the severity of asphyxia (r = 0.8; p < 0.05); the changes often persisted up to 3 days of age. Longitudinal evaluation of flow in these vessels might help to time the initiation of enteral nutrition in neonates with asphyxia.

Effect of enteral gavage feeding rate on pulmonary functions of very low birth weight infants.

To compare the effects of intermittent and continuous feedings on pulmonary function, we studied 24 very low birth weight neonates (mean +/- SD: birth weight, 1.2 +/- 0.3 kg; gestational age, 30.5 +/- 1.1 weeks) at 2 to 4 weeks of age. All infants had a previous diagnosis of respiratory distress syndrome but no subsequent diagnosis of bronchopulmonary dysplasia. Pulmonary mechanics were measured before the beginning of intermittent or continuous feedings and 10 minutes after each meal was completed. Twelve infants were randomly assigned to intermittent and 12 to continuous feedings. These infants had similar birth weight, gestational age, study age, and baseline lung function. After intermittent feedings, there was a significant decrease in tidal volume (38%), minute ventilation (44%), and dynamic compliance (28%), whereas pulmonary resistance increased significantly (100%). In comparison, the pulmonary function data remained unchanged after continuous feedings. These data demonstrate that intermittent feeding of very low birth weight infants can lead to airflow and respiratory instability. These adverse effects appear to be dependent on the rate that feedings are administered. A slower pace of feeding may be more advantageous for infants prone to respiratory instability.

Long-term pulmonary consequences of respiratory distress syndrome in preterm infants treated with exogenous surfactant.

The pulmonary outcome for preterm infants 1 year after synthetic surfactant replacement for respiratory distress syndrome was assessed by examining their pulmonary status and the results of pulmonary function tests. A total of 47 infants were followed: 13 infants mean +/- SD: birth weight, 1960 +/- 616 gm; gestation, 32 +/- 1.1 weeks) had been assigned to the placebo group and 34 (birth weight = 1890 +/- 530 gm; gestation = 32 +/- 2.5 weeks) to surfactant treatment. The infants were examined at 3 to 6 months of age (n = 45) and at 9 to 12 months of age (n = 36). There were no significant differences between the two groups in predisposing clinical conditions that would lead to chronic lung disease. The infants had similar patterns of growth, respiratory-related illness, and need for theophylline therapy, diuretic therapy, or both. None had hypoxemia by pulse oximetry. Mean (+/- SEM) values for pulmonary mechanics and energetics in surfactant-treated infants were significantly (p < 0.01) lower for total pulmonary resistance in late infancy (57.7 +/- 11.7 vs 35.3 +/- 4.6 cm H2O/L per second). Lower values (mean +/- SEM) of resistive work of breathing were also measured in the surfactant-treated group (60.7 +/- 12.0 vs 38.2 +/- 3.6 gm-cm/kg per breath). The dynamic pulmonary compliance values were in the low-normal range for both groups, and the mean (+/- SEM) peak-to-peak esophageal pressure values were elevated (11.47 +/- 2.26 cm H2O in the placebo group; 9.24 +/- 0.69 cm H2O in the surfactant group). Forced expiratory flow measurements in late infancy demonstrated significant (p < 0.01) improvement in expiratory reserves and reduced evidence of airflow obstruction in the surfactant-treated infants (peak flow (mean +/- SEM): 287.1 +/- 69 vs 396.9 +/- 27 ml/sec; forced expiratory flow (mean +/- SEM) at functional residual capacity: 56.3 +/- 7.5 vs 83.4 +/- 19.5 ml/sec). No significant differences in pulmonary functions were noted in early infancy. These data suggest that surfactant replacement for respiratory distress syndrome may be associated with beneficial long-term effects on the resistive airflow properties of larger preterm infants.

Alpha-adrenergic bronchoprovocation in neonates with bronchopulmonary dysplasia.

Ophthalmic administration of phenylephrine caused decreased pulmonary compliance, tidal volume, and peak airflow values in infants with bronchopulmonary dysplasia but not in control infants. The alpha-adrenergic effects of phenylephrine may aggravate the bronchospastic component of bronchopulmonary dysplasia.

Relative likelihood of bronchopulmonary dysplasia based on pulmonary mechanics measured in preterm neonates during the first week of life.

We studied 143 low birth weight infants (less than or equal to 1500 gm) with respiratory distress syndrome who required mechanical ventilation, and determined the efficacy of using the alterations in pulmonary mechanics (measured at 1 to 3 days, 4 to 7 days, 2 weeks, and 4 weeks) as possible predictors for the subsequent diagnosis of bronchopulmonary dysplasia (BPD). The sensitivity and specificity of pulmonary compliance and resistance as predictors of BPD were ascertained by logistic regression correlation (p less than 0.01) and receiver operating characteristic curves. With these pulmonary mechanics data and logistic discriminant analysis techniques, we developed BPD prediction models based on pulmonary mechanics, measured between 4 and 7 days of age, to define the likelihood ratio for the subsequent diagnosis of BPD. Eight different BPD prediction models were developed by using combinations of four vectors (pulmonary compliance, total pulmonary resistance, birth weight, gestational age), and each model was validated in a subsequent low birth weight study population (n = 53). All models were deemed accurate for negative prediction of BPD. The models dependent on gestational age and dynamic pulmonary compliance had the highest positive predictive accuracy. The predictive impact of total pulmonary resistance appeared to be minimal. These prediction models may be used to calculate the likelihood ratio for a subsequent BPD diagnosis and thereby objectively categorize both the risk and the magnitude of acute lung injury by the first week of life.

Pulmonary mechanics and energetics in preterm infants who had respiratory distress syndrome treated with synthetic surfactant.

Pulmonary mechanics and energetics were determined in 32 neonates with respiratory distress syndrome, who were randomly assigned to receive treatment with an exogenous synthetic surfactant, Exosurf Neonatal, or air placebo. Pulmonary mechanics were measured before and 2 hours after surfactant (n = 13) or air placebo (n = 19) treatment, then longitudinally at 24, 48, and 72 hours after treatment, and again at 7, 14, and 28 days of age. There were no significant differences in the values for pulmonary mechanics or energetics 2 hours after the first dose of surfactant. Improvement in pulmonary mechanics was apparent 24 hours after surfactant treatment, when dynamic compliance was 36% greater than in the placebo group (p less than 0.03). Lung compliance values were also higher in surfactant-treated infants 48 and 72 hours after treatment, with a maximal increase of 64% at 7 days of age (p less than 0.03). Surfactant treatment also caused a significant decrease in total pulmonary resistance at 48 and 72 hours after initial treatment and at 14 days of age (p less than 0.04). Similarly, a decrease in flow-resistive work of breathing was demonstrated 24, 48, and 72 hours after surfactant treatment. At 28 days of age, pulmonary mechanics were not different in the two groups. We conclude that beneficial effects of surfactant on pulmonary mechanics were not apparent 2 hours after dosing but were evident 24 hours after dosing and persisted for the first 7 to 14 days of life.

Effect of sustained pharmacologic vitamin E levels on incidence and severity of retinopathy of prematurity: a controlled clinical trial.

The incidence and severity of retinopathy of prematurity (ROP) as affected by vitamin E prophylaxis at pharmacologic serum levels (5 mg/dl) were evaluated in a double-masked clinical trial of infants with a birth weight less than or equal to 2000 gm or a gestational age less than or equal to 36 weeks. The infants were enrolled by age 5 days and randomly assigned to receive parenterally administered, and later orally administered, free alpha-tocopherol (vitamin E) or its placebo. Study medication was continued until retinal vascularization was complete or active ROP had subsided, except in infants with a diagnosis of severe disease, in whom vitamin E was substituted for study medication. Acute ROP data were collected on 755 infants. Logistic regression analysis, with control for immaturity, oxygen exposure, and other illness risk factors, showed a decrease in incidence of ROP in vitamin E-treated infants (p = 0.003, all infants; p = 0.035, infants weighing less than or equal to 1500 gm at birth). Among the 424 infants weighing less than or equal to 1500 gm at birth, the age at enrollment influenced treatment effect (age day 0 to 1, p = 0.006 (n = 288) vs age day 2 to 5, p greater than 0.1 (n = 136]. Overall, 77.6% of infants with ROP had mild disease. Moderate to severe ROP was confined to infants weighing greater than or equal to 1500 gm at birth (25 given placebo, 25 given vitamin E), with progression to severe disease in nine placebo-treated versus three vitamin E-treated infants (p = 0.048). The incidence of severe ROP per se was not significantly decreased (all birth weights, p = 0.086; less than or equal to 1500 gm birth weight, p = 0.080); the sample size was too small, however, to assess this end point adequately. An increased incidence of sepsis and late-onset necrotizing enterocolitis was found among vitamin E-treated infants weighing less than or equal to 1500 gm at birth who received study medication for greater than or equal to 8 days (p = 0.006). Because most ROP is mild in degree and regresses completely, the risk/benefit ratio of pharmacologic prophylaxis for ROP is unfavorable. Treatment of moderate and severe ROP with vitamin E above physiologic serum levels (greater than 3 mg/dl) appears promising and should be further investigated. The interpretation of cicatricial outcome was confounded by the small number of patients involved and by subsequent treatment of severe ROP in placebo-treated infants with vitamin E.

Sequential changes in pulmonary mechanics in the very low birth weight (less than or equal to 1000 grams) infant.

Pulmonary function tests were performed on 36 very low birth weight neonates (birth weight less than or equal to 1000 gm, gestational age less than or equal to 30 weeks, appropriate size for gestational age) from birth until 8 weeks of age. Tidal airflow was measured by means of a pneumotachygraph, and the transpulmonary pressure changes were determined by the esophageal balloon technique. Pulmonary mechanics and energetics were calculated by the least mean square analysis technique at 1/2, 1, 2, 4, 6, and 8 weeks of age. Compliance was lowest at 2 weeks and subsequently increased linearly (at approximately 0.1 ml/cm H2O/wk). When compliance was based on body weight, however, no change was noted with advancing age. Resistance was greatest at 2 weeks and subsequently decreased. The infants maintained a normal minute ventilation with a slightly increased resistive work of breathing. Despite our ability to wean 53% of the infants to room air by 8 weeks, none of them had pulmonary mechanics considered normal for term infants. Infants with and without bronchopulmonary dysplasia (BPD) had similar patterns of pulmonary development. At 8 weeks of age, the pulmonary mechanics in infants with BPD who had been weaned to room air were comparable to those in infants without BPD, an observation that calls into question the rationale for defining BPD at 4 weeks in this population. These data suggest that such pulmonary function profiles provide evidence of persistent lung parenchymal abnormalities.