Safety and Feasibility of Skin-to-Skin Contact in the Delivery Room for High-Risk Cardiac Neonates.

Early skin-to-skin contact (SSC), beginning in the delivery room, provides myriad health benefits for mother and baby. Early SSC in the delivery room is the standard of care for healthy neonates following both vaginal and cesarean delivery. However, there is little published evidence on the safety of this practice in infants with congenital anomalies requiring immediate postnatal evaluation, including critical congenital heart disease (CCHD). Currently, the standard practice following delivery of infants with CCHD in many delivery centers has been immediate separation of mother and baby for neonatal stabilization and transfer to a different hospital unit or a different hospital altogether. However, most neonates with prenatally diagnosed congenital heart disease, even those with ductal-dependent lesions, are clinically stable in the immediate newborn period. Therefore, we sought to increase the percentage of newborns with prenatally diagnosed CCHD who are born in our regional level II-III delivery hospitals who receive mother-baby SSC in the delivery room. Using quality improvement methodology, through a series of Plan-Do-Study-Act cycles we successfully increased mother-baby skin-to-skin contact in the delivery room for eligible cardiac patients born across our city-wide delivery hospitals from a baseline 15% to greater than 50%.

Alterations in endothelial cell proteinase and inhibitor polarized secretion following treatment with interleukin-1, phorbol ester, and human melanoma cell conditioned medium.

Polarized secretion of matrix metalloproteinases and plasminogen activators by monkey aortic endothelial cells was studied in vitro, using transwell inserts. The endothelial cells constitutively expressed matrix metalloproteinase-2, tissue inhibitors of metalloproteinases 1 and 2, urokinase, and tissue plasminogen activator, all with basal preference. Matrix metalloproteinase-9 activity was induced by phorbol 12-myristate 13-acetate (apical), interleukin-1 alpha (basal), and by conditioned medium from DX3 human melanoma cells (basal). The DX3 melanoma conditioned medium also stimulated basal secretion of matrix metalloproteinase-2, urokinase, tissue plasminogen activator, and tissue inhibitors of metalloproteinases. The rise in proteolytic activity in the basal direction was reflected by increased capacity to degrade subendothelial basement membrane type IV collagen, shown immunohistologically, using monkey kidney tissue sections and basement membrane deposited by endothelial cells into the transwell membrane. Thus, IL-1 alpha and DX3 melanoma conditioned medium can stimulate endothelial cells in vitro to concentrate secretion of proteinases spatially onto the underlying basement membrane. We suggest that the stimulation of endothelial cell proteinase activity by tumor cells may facilitate tumor cell extravasation.

In vivo induction of liver P-glycoprotein expression by xenobiotics in monkeys.

P-glycoprotein (pgp), the protein product of the multidrug resistance (mdr) gene family, can confer a multidrug resistance (mdr) phenotype to cells in which it is expressed. One member of the pgp family, pgp2, is located on the hepatocyte biliary pole where it may have a role in biliary excretion. Using primates we sought to determine if mdr gene expression and pgp levels were affected by xenobiotics excreted via the bile in man. Five drugs were studied in male and female rhesus monkeys: erythromycin, rifampicin, tamoxifen, diethylstilbesterol (DES), and probenecid. For each xenobiotic, with the exception of DES, an increase in mdr2 mRNA was observed. The results suggest that expression of mdr2 is responsive to xenobiotics, or their metabolites, that require biliary excretion. We speculate that the mdr2 gene may be a member of a class of xenobiotic responsive genes coding for proteins that actively excrete xenobiotics and/or their metabolites into the bile.

Immunomagnetic separation as a final purification step of liver endothelial cells.

We describe a fast and reproducible method that can be used as a final step in obtaining pure populations of liver endothelial cells. This method employs endothelial cell specific lectin covalently bound to magnetic polystyrene beads (Dynabeads). Evonymus europaeus agglutinin (EEA)-coated Dynabeads were used to purify monkey liver endothelium from Percoll gradient separated nonparenchymal cells. EEA-coated beads were also successfully used to purify monkey aortic endothelial cells. The endothelial cells grew to confluence as a cobblestonelike monolayer, expressed Factor VIII related antigen, and incorporated acetylated-low density lipoprotein. The magnetic beads seemed not to modify the normal properties of the isolated endothelium, thus facilitating their use in experimental studies. This immunomagnetic separation technique may be applicable for purification of endothelial cells from a wide variety of tissue sources.

Immunomagnetic separation as a final purification step of liver endothelial cells.

We describe a fast and reproducible method that can be used as a final step in obtaining pure populations of liver endothelial cells. This method employs endothelial cell specific lectin covalently bound to magnetic polystyrene beads (Dynabeads). Evonymus europaeus agglutinin (EEA)-coated Dynabeads were used to purify monkey liver endothelium from Percoll gradient separated nonparenchymal cells. EEA-coated beads were also successfully used to purify monkey aortic endothelial cells. The endothelial cells grew to confluence as a cobblestonelike monolayer, expressed Factor VIII related antigen, and incorporated acetylated-low density lipoprotein. The magnetic beads seemed not to modify the normal properties of the isolated endothelium, thus facilitating their use in experimental studies. This immunomagnetic separation technique may be applicable for purification of endothelial cells from a wide variety of tissue sources.

Basement membrane type IV collagen degradation: evidence for the involvement of a proteolytic cascade independent of metalloproteinases.

Current hypotheses suggest that both the plasmin system and metalloproteinases are involved in tumor invasion of basement membrane. In this study, we demonstrate that plasmin can directly degrade native and denatured type IV collagen in solution as well as in tissue sections. Tumor cell lines secreted plasminogen activators into culture supernatants that activated exogenous plasminogen to degrade type IV collagen in zymograms and to remove collagen IV immunoreactivity from tissue sections. Inhibition of metalloproteinase activity in culture supernatants by EDTA did not interfere with plasminogen-mediated type IV collagen degradation. We propose that tumor cells possess a mechanism for the degradation of basement membrane type IV collagen, independent of metalloproteinases but dependent on plasminogen conversion to plasmin.

Prognostic indicators of tumor response to Staphylococcus aureus Cowan strain I plasma perfusion.

Ten tumor-bearing dogs were treated with passage of autologous plasma over fixed Staphylococcus aureus Cowan strain I. Five similar dogs were treated identically except for the exposure to S. aureus. These animals have been assessed to identify positive and negative prognostic variables for response. Nonresponder treated animals had significantly larger chest wall tumor bulk than did the responder and control groups (P less than .01). Responder animals had fewer initial circulating immune complexes than did the nonresponders, though each group had similar reductions in immune complexes with therapy. Nonresponder animals had smaller volumes of plasma processed per kilogram of body weight per procedure than did controls (P = .016), whereas responder and control animals had similar volumes processed per kilogram of body weight per procedure (P = .84). These data suggest that the response observed in our original series was significantly related to the larger amount of plasma treated per procedure and suggest that a factor may be eluted from the S. aureus cartridge that mediates this response.

Phase I trial of Staphylococcus aureus Cowan I immunoperfusion.

Staphylococcus aureus Cowan I has shown antitumor activity in in vitro and in animal tumor models. It is hypothesized that this antineoplastic effect results from the interaction of protein A on the cell surface of Cowan I strain S. aureus and immunosuppressive circulating immune complexes. Therefore, we treated five patients with ex vivo plasma immuno-perfusion over killed and fixed S. aureus Cowan I. Toxic effects were marked in all patients and appeared to be related to the plasma volume infused and rate of infusion. Toxic reactions occurred in the cardiovascular, respiratory, and hematopoietic systems. No responses even minimal or transient, were observed in this phase I trial. This toxicity may be reduced if the rate of plasma infusion decreases.

A modification of the canine carotid-jugular shunt.

A shunt modification was used for implantation in the carotid-jugular vessels of the dog. The shunt was made of plastic tubing and was tied to each vessel with three silk ligatures. The tubing was exteriorized and anchored to the skin. The exposed tubing was cut and attached to the input and output lines of a tubing kit for leukapheresis with a continuous flow centrifuge. Surgical implantation of the shunt was accomplished with ease and minimum trauma to the animal. Useful life of the shunt extended over a 3-week period with minimal requirements for anticoagulants.