[Delivery room cardiopulmonary resucitation of very preterm infant is associated with adverse short- and long-term outcomes]. / La reanimación cardiopulmonar en sala de partos del recién nacido muy prematuro está asociada con resultados adversos a corto y a largo plazo.

OBJECTIVE: To assess the short- and long-term outcome of infants

La reanimación cardiopulmonar en sala de partos del recién nacido muy prematuro está asociada con resultados adversos a corto y a largo plazo / Delivery room cardiopulmonary resucitation of very preterm infants is associated with adverse shoirt and long term outcomes

Objetivo Evaluar los resultados a corto y largo plazo de la reanimación cardiopulmonar en sala de partos (RCP-SP) en neonatos 1.250 g o menos. Métodos En una cohorte de neonatos con y sin RCP-SP con peso de 1.250 g o inferior nacidos entre enero de 2000 y diciembre de 2003, comparamos las tasas de mortalidad, hemorragia intracraneana severa (HIC-S), leucomalacia periventricular (LPV) y las variables combinadas (VC) adversas a corto plazo; a los 18 meses de edad posconcepcional (EPC) comparamos los índices del desarrollo mental (IDM) y psicomotor (IDP) según la escala de Bayley-II. Resultados En 397 niños, los 53 (13 %) que habían recibido RCP-SP tuvieron mayor riesgo de mortalidad, HIC-S, LPV y VC adversas. A los 18 meses de edad posconcepcional la puntuación de IDM e IDP fue más baja en el grupo con RCP-SP (67,7 ± 18,3 frente a 81,3 ± 17,7; p = 0,006) y (74,4 ± 19,9 frente a 85,1 ± 17,2; p = 0,027), respectivamente. Conclusión La RCP-SP en recién nacidos de 1.250 g o menos está asociada con mayor mortalidad y con peores tasas de morbilidad, en el corto plazo y en el seguimiento a largo plazo

Objective To assess the short- and long-term outcome of infants <= 1250 grams who have received delivery room cardiopulmonary resuscitation (DR-CPR). Methods In a cohort of infants <=1250 grams born between 01/2000 and 12/2003, we compared the rates of death, severe intraventricular hemorrhage (S-IVH), periventricular leukomalacia and combined poor short-term outcome (CO). At 18 months post- conception age (PCA) we compared DR-CPR and non-DR-CPR groups on the Bayley II Mental and Psychomotor Developmental Indices (MDI and PDI). Results Of 397 infants who met enrollment criteria, the 53 (13%) who received DR-CPR had a higher risk for mortality, S-IVH, PVL and CO. At 18 months PCA, MDI and PDI scores were lower in the DR-CPR group (67.7 ± 18.3 vs. 81.3 ± 17.7; p = 0.006) and (74.4 ± 19.9 vs. 85.1 ± 17.2; p = 0.027), respectively. Conclusion DR-CPR in infants < 1250 grams is associated with higher mortality and greater short- and long-term morbidity

Avoiding hyperoxia in infants < or = 1250 g is associated with improved short- and long-term outcomes.

OBJECTIVE: To determine the rate and severity of short- and long-term morbidity in very low birth weight infants treated before and after the implementation of a change in clinical practice designed to avoid hyperoxia. METHODS: Analysis of a prospectively collected database of all infants < or = 1250 g admitted to two Emory University NICU's from January 2000 to December 2004. A change in practice was instituted in January 2003 with the objective of avoiding hyperoxia in preterm infants with target O2 saturation (SpO2) at 93 to 85% (Period II). Before the change in practice, SpO2 high alarms were set at 100% and low alarms at 92% (Period I). Statistical analysis included bivariate analyses and multivariate logistic regression comparing outcomes between the two periods. RESULTS: From January 2000 to December 2004, 502 infants met enrollment criteria and 202 (40%) were born in period II, after change in SpO2 targets. Birth weight, gestational age and survival were similar between both periods. The rates for any retinopathy of prematurity, supplemental oxygen at 36 weeks post-conceptional age and the use of steroids for chronic lung disease were significantly lower in the infants born in Period II. There was no difference in the rates of necrotizing enterocolitis, intraventricular hemorrhage and periventricular leukomalacia. At 18 months corrected age (CA), the infants treated during Period II had a higher Mental Developmental Index (MDI) scores (80.2 +/- 18.3 vs 89.2 +/- 18.5; P 0.02) and similar Psychomotor Developmental Index (PDI) scores (83.9 +/- 18.6 vs 89.4 +/- 17.2; P 0.08) than those treated during Period I. The proportion of infants with an MDI or a PDI less than 70 was similar between the periods. CONCLUSIONS: The change in practice to avoid hyperoxia is associated with a significant decrease in neonatal morbidity and does not have a detrimental effect on developmental outcomes at 18 months CA.

Molecular analysis of major histocompatibility complex allelic associations with systemic lupus erythematosus in Taiwan.

OBJECTIVE: To investigate the association of HLA class II alleles/haplotypes, type I C2 deficiency gene, and tumor necrosis factor a gene promoter allele (TNF2) with systemic lupus erythematosus (SLE) in the Chinese population in Taiwan. METHODS: The HLA-DRB1 and DQB1 alleles were studied in 105 SLE patients and 115 controls by the polymerase chain reaction (PCR)/sequence-specific oligonucleotide probe method, the subtyping of DRB1*15/16 and DRB5 by PCR with sequence-specific primers, type I C2 deficiency gene by PCR, and TNF2 by PCR-Nco I restriction fragment length polymorphism. RESULTS: The frequencies of the HLA class II alleles DRB1*02, DRB1*1502, DRB5*0102, DQB1*0501, and DQB1*0602 and DR2-associated haplotypes DRB1* 1501,DRB5*0101,DQB1*0602 and DRB1*1502,DRB5* 0102,DQB1*0501 were higher among SLE patients than among controls; however, only DQB1*0501 was statistically significantly associated with SLE. No specific allele/haplotype was significantly associated with lupus nephritis. No subject had type I C2 deficiency. SLE patients had a marginally higher percentage of TNF2, which was in linkage disequilibrium with DR3. Since DR3 was not associated with SLE in this Taiwanese Chinese population, TNF2 might play a role in the immunopathogenesis of SLE. CONCLUSION: Although no HLA-DRB1 allele was found to be significantly associated with SLE, the associations with DQB1*0501 and TNF2 suggest that DQB1 and tumor necrosis factor a may be important genetic factors in SLE susceptibility in the Chinese population in Taiwan.

Defect in Th1-like cells of nonresponders to hepatitis B vaccine.

Peripheral blood lymphocytes from nonresponders to hepatitis B vaccine (HBsAg) failed to undergo a proliferative response to recombinant HBsAg in vitro, whereas cells from responders proliferated vigorously. The lack of proliferative response was not due to defective antigen presentation in that MHC-identical responder and nonresponder antigen presenting cells were equally effective in stimulating responder T cells. Nonresponder T cells did not proliferate in response to antigen-pulsed MHC identical responder antigen presenting cells. The present study demonstrated that: 1) there were no detectable (1 in < 20 x 10(4) HBsAg-precursor T cells in any of the nonresponders, while in responders the frequency of HBsAg-precursor T cells ranged from 1 in 3.2 x 10(3) to 1 in 40 x 10(3); 2) nonresponder cell cultures did not secrete IL-2 in response to HBsAg stimulation; 3) exogenous recombinant IL-2 did not restore the proliferative response of the T cells in HBsAg-pulsed cultures of nonresponders. These results suggest that the cellular basis for the lack of response to HBsAg is a defect in HBsAg-specific Th1-like cells; either there is an absence of the Th1 cells or cells with TCR specificity for HBsAg are present but are unresponsive to the HBsAg peptide-MHC complex (i.e., anergy or tolerance).

MHC class II alleles and haplotypes in patients with pemphigus vulgaris from India.

Pemphigus vulgaris (PV) is a blistering disease of the skin and mucous membranes characterized by an autoantibody response against a keratinocyte adhesion molecule, desmoglein 3, causing acantholysis and blister formation. We compared high resolution MHC class II alleles and haplotype frequencies (HLA-DRB, DQA1 and DQB1) in 37 patients with PV to 89 haplotypes of normal relatives from New Delhi and Ahmedabad. We found that PV patients had significantly increased frequencies of DRB1*1404 (P < 0.0001), DQA1*0101 (P = 0.001), and DQB1*0503 (P < 0.0001). These associations were due to the increased frequencies of the haplotype HLA-DRB1*1404, DRB3*0202, DQA1*0101, DQB1*0503 in patients compared to control haplotypes (p < 0.0001). Also, patients from Ahmedabad had a significant increase in HLA-DQB1*0302 (p = 0.03). An identical amino acid sequence (Leu-Leu-Glu-Arg-Arg-Arg-Ala-Glu), in positions 67-74 of the beta domain of DRB alleles is restricted to some DR14 alleles. Therefore, there are three possible explanations for class II allele involvement in autoantibody in PV patients with class II haplotypes marked by HLA-DR14. First, the class II alleles could be markers for an unidentified susceptibility gene in linkage disequilibrium with them. Second, the primary association could be with DQB1*0503 and the association with HLA-DR14 alleles would be the result of linkage disequilibrium. Third, the HLA-DRB1 locus susceptibility could involve a specific amino acid sequence in the third hypervariable region shared by several HLA-DR14 alleles.

Normal HBsAg presentation and T-cell defect in the immune response of nonresponders.

Lymphocytes from nonresponders to HBsAg fail to proliferate in vitro in the presence of HBsAg-pulsed antigen presenting cells. We studied four pairs of major histocompatibility complex (MHC)-matched, mixed lymphocyte reaction-negative individuals discordant for HBsAg response. For each pair, responder lymphocytes proliferated in the presence of nonresponder antigen-pulsed antigen presenting cells. Responder and nonresponder antigen presenting cells were equally effective. There was no evidence for inhibition of responder T-cell proliferation by nonresponder lymphocytes or antigen presenting cells. The defect is thus in the helper T cells of nonresponders and not in the antigen processing or binding of processed peptides to MHC molecules on antigen presenting cells.

Major histocompatibility complex class II alleles and haplotypes and blood groups of four Amerindian tribes of northern Colombia.

MHC class II alleles and haplotypes were determined from unrelated individuals and families of the Arhuaco (n = 107), Kogi (n = 42), Arsario (n = 18), and Wayú (n = 88) tribes located in the northern part of Colombia. Class II DRB, DQA1, and DQB1 alleles were determined by PCR-SSO and PCR-RFLP based methods. Four haplotypes, [DRB1*0407, DRB4*0101, DQA1*03, DQB1*0302]; [DRB1*0403, DRB4*0101, DQA1*03, DQB1*0302]; [DRB1*1402/1406, DRB3*0101, DQA1*0501, DQB1*0301]; and [DRB1*0802, DQA1*0401, DQB1*0402], were observed among these four tribes. In addition to these haplotypes, the Wayú Indians showed a frequency of 21.3% for the [DRB1*1602, DRB5*02, DQA1*0501, DQB1*0301] haplotype, 13.1% for the [DRB1*0411, DRB4*0101, DQA1*03, DQB1*0302] haplotype, and 8.1% for the [DRB1*0411, DRB4*0101, DQA1*03, DQB1*0402] haplotype. Red cell antigen typing was used to calculate genetic admixture. The Kogi and Arsario showed no genetic admixture while the Arhuaco tribe showed admixture with genes of African origin and the Wayú showed admixture with Caucasians as well as genes of African origin. These findings were confirmed by the MHC class II allele and haplotype data obtained, as alleles and haplotypes of Caucasian and African origin were detected in the Wayú and Arhuaco and not in the Kogi or Arsario. These studies will be important in disease association and transplantation studies for Amerindian and colombian populations and for correlating genetic traits with the anthropologic and linguistic data available in order to better understand the Amerindian populations.

Common major histocompatibility complex class II markers in clinical variants of cicatricial pemphigoid.

Cicatricial pemphigoid (CP) is a chronic autoimmune blistering disease affecting multiple mucous membranes derived from stratified squamous epithelium and occasionally the skin. CP has a wide spectrum of disease manifestations. Patients with oral pemphigoid (OP) have a benign self-limited disease in which pathological changes are restricted to the oral mucosa. On the other hand, patients with ocular cicatricial pemphigoid (OCP), a chronic condition marked with relapses and remissions, have ocular involvement and also perhaps involvement of other mucous membranes. All clinical subsets are characterized by the presence of a similar anti-basement zone autoantibody. The factors that determine the development of one form of CP or the other are not known. In a previous study, we described the association between OCP and the DQB1*0301 allele (P = 0.006). In this study, we have analyzed 22 Caucasian patients with OP and their family members for major histocompatibility complex DRB generic, DQA1, and DQB1 allele associations by PCR-sequence-specific oligonucleotide probe hybridization. The results were compared to those obtained from 17 Caucasian patients with OCP and to control Caucasian alleles and haplotypes. The DQB1*0301 allele frequency was 38.6% in OP, 52.9% in OCP, and 17.8% in controls. Statistically significant associations were detected between the DQB1*0301 allele and both OP (P = 0.0047) and OCP (P < 0.0001). In addition, DRB1*04 showed a statistically significant association (P = 0.005) with OCP when compared to controls. Analysis of major histocompatibility complex class II haplotypes showed significant statistical associations between both OCP and OP and the HLA-DRB1*04, DRB4*0101, DQA1*03, DQB1*0301 haplotype (P < 0.0001 and P = 0.0012, respectively). Our results indicate that DQB1*0301 is a marker of both oral and ocular forms of CP. The analysis of the amino acid sequence of the DQB1 alleles present in both OP and OCP suggested that amino acid residues at position 57 and positions 71-77 may also be markers of CP.