Impact of early postnatal exposure of red blood cell transfusions on the severity of retinopathy of prematurity.

BACKGROUND: Postnatal exposure to red blood cell transfusion (RBCT) in premature infants is an important risk factor for Retinopathy of Prematurity (ROP) progression. We hypothesized that higher number and earlier timing of RBCT are associated with worse ROP severity and result in laser treatment at an earlier postmenstrual age (PMA) in very low birth weight (≤1500 g, VLBW) infants. METHODS: A retrospective medical record review of 631 VLBW infants over a 5-year period was performed. Demographic features and potential clinical risk factors including number of RBCT, ROP severity, and progression to laser treatment were collected to evaluate predictors of severe ROP. ANCOVA, pairwise post-hoc analyses, and multivariate regression were used to determine associations between frequency and timing of RBCT and ROP severity. RESULTS: Of the 456 eligible infants, 61 developed severe ROP (13%). There was significant correlation between number of RBCTs and ROP severity, adjusted for gestational age and birthweight (Adjusted R2 = 0.53; p < 0.001). Compared to infants with No/Mild and Type 2 ROP, infants with Type 1 ROP received more RBCTs, with higher number of RBCTs per week during the first month of life (mean RBCT in ROP No/Mild 5.7±0.4 vs Type 2 16.3±1.8 vs Type 1 22.4±1.5, p = 0.042). Laser-treated infants received a higher number of RBCTs than non-treated infants (mean RBCT 22.3 vs. 6.5, p < 0.001) but no correlation was observed between number of RBCTs and PMA at time of laser treatment. CONCLUSION: Higher number of RBCTs in early postnatal life of VLBW infants was associated with more severe ROP.

Adenylation Activity of Carboxylic Acid Reductases Enables the Synthesis of Amides.

Carboxylic acid reductases (CARs) catalyze the reduction of a broad range of carboxylic acids to aldehydes using the cofactors adenosine triphosphate and nicotinamide adenine dinucleotide phosphate, and have become attractive biocatalysts for organic synthesis. Mechanistic understanding of CARs was used to expand reaction scope, generating biocatalysts for amide bond formation from carboxylic acid and amine. CARs demonstrated amidation activity for various acids and amines. Optimization of reaction conditions, with respect to pH and temperature, allowed for the synthesis of the anticonvulsant ilepcimide with up to 96 % conversion. Mechanistic studies using site-directed mutagenesis suggest that, following initial enzymatic adenylation of substrates, amidation of the carboxylic acid proceeds by direct reaction of the acyl adenylate with amine nucleophiles.

Cardiovascular risk assessment in rheumatoid arthritis: impact of the EULAR recommendations on a national calibrated score risk index.

OBJECTIVES: To evaluate the impact of the application of the EULAR task force recommendations in the cardiovascular (CV) risk assessment of rheumatoid arthritis (RA) patients according to a national calibrated SCORE. METHODS: Two hundred and one consecutive RA patients seen at the rheumatology outpatient clinics of the University Hospital 'San Cecilio', Granada, Southern Spain, were studied. Information on demographic, classic CV risk factors, history of CV events and disease clinical features were obtained. Both the systematic coronary risk evaluation (SCORE) risk index and the modified SCORE (mSCORE) following the EULAR recommendations were performed. RESULTS: Based on the classic CV risk factors the mean ± standard deviation SCORE was 2.2 ± 2.6 (median 2). Twenty-two (11%) patients were above the threshold of high risk for the Spanish population. Following the EULAR recommendations 52 of the 124 patients (41.93%) initially classified as having intermediate risk were reclassified as having high CV risk. Therefore, the mean mSCORE was 3.3 ± 4 (median 3) and, due to this, 74 (36.8%) patients were above the threshold of high CV risk for the Spanish population. As expected, patients who had experienced CV events were older, had more CV risk factors and higher mSCORE than those without CV events. CONCLUSIONS: These observations support the claim that the mSCORE should be specifically adapted to the population to be assessed. However, the use of additional tools should be considered in an attempt to fully identify high-risk RA patients.

Enantioselective synthesis of Garner's aldehyde by asymmetric hydroformylation.

Both enantiomers of Garner's aldehyde (3) are prepared from the same alkene 4 by catalytic asymmetric hydroformylation.

A broadband absorption spectrometer using light emitting diodes for ultrasensitive, in situ trace gas detection.

A broadband absorption spectrometer has been developed for highly sensitive and target-selective in situ trace gas measurements. The instrument employs two distinct modes of operation: (i) broadband cavity enhanced absorption spectroscopy (BBCEAS) is used to quantify the concentration of gases in sample mixtures from their characteristic absorption features, and (ii) periodic measurements of the cavity mirrors' reflectivity are made using step-scan phase shift cavity ringdown spectroscopy (PSCRDS). The latter PSCRDS method provides a stand-alone alternative to the more usual method of determining mirror reflectivities by measuring BBCEAS absorption spectra for calibration samples of known composition. Moreover, the instrument's two modes of operation use light from the same light emitting diode transmitted through the cavity in the same optical alignment, hence minimizing the potential for systematic errors between mirror reflectivity determinations and concentration measurements. The ability of the instrument to quantify absorber concentrations is tested in instrument intercomparison exercises for NO(2) (versus a laser broadband cavity ringdown spectrometer) and for H(2)O (versus a commercial hygrometer). A method is also proposed for calculating effective absorption cross sections for fitting the differential structure in BBCEAS spectra due to strong, narrow absorption lines that are under-resolved and hence exhibit non-Beer-Lambert law behavior at the resolution of the BBCEAS measurements. This approach is tested on BBCEAS spectra of water vapor's 4v+delta absorption bands around 650 nm. The most immediate analytical application of the present instrument is in quantifying the concentration of reactive trace gases in the ambient atmosphere. The instrument's detection limits for NO(3) as a function of integration time are considered in detail using an Allan variance analysis. Experiments under laboratory conditions produce a 1sigma detection limit of 0.25 pptv for a 10 s acquisition time, which improves with further signal averaging to 0.09 pptv in 400 s. Finally, an example of the instrument's performance under field work conditions is presented, in this case of measurements of the sum of NO(3)+N(2)O(5) concentrations in the marine boundary layer acquired during the Reactive Halogens in the Marine Boundary Layer field campaign.

Synthesis of thromboxane B2 via ketalization/ring-closing metathesis.

Total synthesis of thromboxane B2 using intermolecular ketalization followed by ring-closing metathesis is reported. Other key steps include a Sharpless asymmetric epoxidation to form an oxirane on the endo face of the bicyclic acetal, epoxide opening using lithioacetonitrile, an allylic alcohol 1,3-transposition, and Mitsunobu lactonization.

Effect of color schemes and environmental sensitivity on job satisfaction and perceived performance.

Effects of interior office color and individual stimulus screening ability, i.e. instinctive perceptual filtering of irrelevant stimuli, on perceived performance and job satisfaction were examined on various outcome measures over a 4-day work week in a laboratory setting. Workers performed specific tasks and worked regular hours for 4 consecutive days in the same office. They were separated into three groups according to their ability to ignore irrelevant stimuli in the interior space. Those in the white and predominantly blue-green offices reported higher perceived job performance and satisfaction than those in the predominantly red office regardless of stimulus screening ability. Workers with high to moderate stimulus screening ability indicated greater perceived performance and job satisfaction than did workers with low stimulus screening ability. Results for color schemes are discussed in terms of preference and social expectations.

Acute renal failure from complete uterine prolapse: role of polycystic kidney disease.

A 48-year-old female developed acute renal failure from obstruction caused by a complete uterine prolapse. She had polycystic kidney disease (ADPKD) with previously stable mild renal impairment. She presented with rapidly declining renal function and oliguria which reversed following manual reduction of the prolapse and insertion of a ring pessary. None of the usual risk factors for uterine prolapse were present, however ADPKD may have contributed to the prolapse. Rapid deterioration of renal function in female patients with ADPKD should prompt gynecological examination to exclude a uterine prolapse as a cause.

Association of birth weight and current body size to blood pressure in female twins.

It has been proposed that low birth weight is associated with high levels of blood pressure in later life. The aim of this study was to assess the relationship of blood pressure to birth weight and current body size during growth and adulthood. A total of 711 female multiple births, with one group of 244 in their growth phase mean age 12.0 (2.3)(SD) years and the other of 467 adults (mean age 35.2 (12.6) years), had height, weight and both systolic (SBP) and diastolic (DBP) blood pressures measured, and self-reported their birth weight. Regression analyses were performed to assess the cross-sectional and within-pair associations of blood pressure to birth weight, with and without adjustments for current body size. Within-pair analysis was based on 296 twin pairs. Cross-sectionally, a reduction in birth weight of 1 kg was associated with 2 to 3 mm Hg higher age-adjusted SBP, which was of marginal significance and explained about 2% of the population variance. Adjustment for body mass index did not significantly change this association. Within-pair analyses found no association between birth weight and SBP or DBP,even after adjusting for current body size. After age, current body size was the strongest predictor of systolic BP. The weak association of blood pressure to birth weight cross-sectionally is of interest, but any within-pair effect of birth weight on blood pressure must be minimal compared with the effect of current body size.

Immunomycology: rapid and specific immunocytochemical identification of fungi in formalin-fixed, paraffin-embedded material.

We report the rapid (less than 1 hr), immunocytochemical identification of various fungi in formalin-fixed, paraffin-embedded tissues using antisera originally developed for use in immunodiffusion assays. Primary antisera directed towards fungal genera including Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus, Histoplasma, and Sporothrix were examined. The specificity of each antiserum was evaluated by the presence or absence of crossreactivity with other morphologically similar fungi in both paraffin-embedded pure fungal cultures and tissues with culture-confirmed fungal infections. Each antiserum reacted strongly with the fungus to which it had been raised, whether examined in pure culture or infected tissues. The antisera raised against Candida, Cryptococcus, and Sporothrix did not exhibit cross-reactivity with any other fungus tested. However, the antisera raised to Aspergillus, Blastomyces, Coccidioides, and Histoplasma demonstrated significant crossreactivity with other genera of fungi, thus precluding their routine use in diagnostic immunocytochemistry. The results indicate that immunocytochemistry may provide an important adjunct to other methods, such as immunodiffusion or complement fixation assays and histochemical stains such as the Grocott methenamine silver or periodic acid-Schiff, when attempts are made to specifically identify certain fungi in formalin-fixed, paraffin-embedded tissues before mycology culture results are available.

Prenatal diagnosis of a double bisatellited marker with an unusual copy number ratio.

Prenatal diagnosis, by amniocentesis, revealed mosaicism with respect to a bisatellited, apparently dicentric, DA/DAPI positive, de novo marker. The following cell lines were observed in decreasing order of frequency: 46,XX greater than 48,XX,+mar,+mar much greater than 47,XX,+mar. The pregnancy was terminated and post-mortem examination revealed an apparently normal fetus. Cytogenetic studies of fetal and placental tissues revealed approximately the same level of mosaicism together with the unusual copy number ratio seen in the amniotic fluid cultures. Non-disjunction at the first post-zygotic mitotic division giving rise to a mosaic: 46,XX/48,XX,+mar,+mar followed by subsequent mitotic instability of the marker could account for the unusual copy number ratio.

Hyperactive Children: Which Sports Have the Right Stuff?

In brief: The number of children diagnosed as hyperactive continues to grow each year. And a question often arises about whether athletic activity is appropriate for these children. Evidence strongly suggests that not only is it appropriate, but that certain sports can improve self-esteem and can make them feel less like oddities among their peers.

Team care: an analysis of verbal behavior during patient rounds in a rehabilitation hospital.

Patient rounds are an important aspect of multidisciplinary team care. Team perceptions of ideally functioning rounds were compared with the actual communication patterns in rounds in a physical rehabilitation hospital. Perceptions of the patients' needs in the content areas of physical, psychosocial, and support systems were also compared with the actual distribution of content in rounds. Physicians spoke more (41%) and made more authoritative statements (62%) than did staff from any other discipline. The physicians participated far more than was perceived as ideal in all areas but the physical. Patients contributed only 9% of the discussion and less than 1% of authoritative statements. The physical content area was overemphasized (65%) and the psychosocial area was underemphasized (14%) when compared with the perceived needs of the patients. Interpretations of these findings and implications for investigation of the impact of team care are discussed.

Membership issues within the American Congress of Rehabilitation Medicine: results of a survey.

A questionnaire survey of the membership of the American Congress of Rehabilitation Medicine ( ACRM ) was conducted in early 1983. Results relating to membership issues indicate that the organization should not return to physician-only membership. The issue of opening membership to baccalaureate-level rehabilitation professionals polarized the membership. The dimension of polarization is not between physicians/non-physicians. The membership is uncertain whether the current size of the organization is too small. The data suggest that appeals for new members should be primarily based on aspects of professionalism. Secondary reasons for joining differ for subgroups of members. The recommendation of a current ACRM member may be a decisive influence in a potential new member's decision to join. It is suggested that a major discriminating factor among members relates to belief in interdisciplinary rehabilitation as the ultimate concern of the ACRM .

The "limiting proximal gastric pouch": the evolving solution of morbid obesity.

Seventy-five patients received the "limiting proximal gastric pouch." The technique used is the complete transverse gastric stapling with Roux-en-Y reconstruction of gastrointestinal continuity. There was one death, 13 patients required rehospitalization, and five patients required reoperation because of complications. Both the weight loss and percentage of excess weight loss were satisfactory. The patients' acceptance was very high. The limiting proximal gastric pouch is evolving as the procedure of choice for morbid obesity.

Exteriorized repair in the management of colon injuries.

In an attempt to reduce septic complications following colonic injury in penetrating abdominal trauma, we tested the efficacy of the exteriorized repair, also known as primary repair and exteriorization of the injured colonic segment. From June 1973 to August 1979, 50 patients with colonic injuries suitable for exteriorized repair were entered into this study. Their ages ranged from 4 to 47 years; 42 were male, eight, female. Thirty-eight had gunshot wounds, 12 had stab wounds. The majority had various associated injuries, but only five were in shock. In 33 patients (66%) the colonic wounds successfully healed and the exteriorized loop was returned into the peritoneal cavity within 14 days. In 17 patients (34%), fecal leakage developed at the repair site and the exteriorized loops were converted into colostomies without sepsis. There was no mortality and a low complication rare (18%). This method of management for selected patients has a special merit in combining the safety of exteriorization with the economy of primary repair.

Quality of life: some measurement requirements.

The current view of quality of life as subjective responses is briefly reviewed. A new view emphasizing quality of life as the reciprocal relationships between persons and their environments is presented conceptually. This ecological view of quality of life is illustrated by summarizing 2 analyses conducted on a large archive of detailed data descriptive of the actual functional performance of 15 patients with spinal cord injury during 1st hospitalization for comprehensive rehabilitation. The 1st analysis identifies generic dimensions of patients' behavior during hospitalization. These behavioral vital signs represent the minimum requirements for measuring quality of life. The 2nd analysis demonstrates that the measures of performance during hospitalization have an extremely high level of predictive validity in the community or postdischarge environment. Thus, the minimum requirements for measuring quality of life should include measures of actual functioning along the generic dimensions.