Intrapartum antibiotics and childhood asthma and allergic rhinitis: a retrospective cohort study.

OBJECTIVE: This study aimed to evaluate the association between intrapartum antibiotics (IABX) and asthma and allergic rhinitis among children by ages 6, 8 and 10 years. DESIGN: Retrospective cohort. SETTING AND POPULATION: Data were collected though Kaiser Permanente Northern California's (KPNC) integrated healthcare system. Children were eligible if they were born in a KPNC hospital between 1997 and 2012 and stayed enrolled through age 6. METHODS: Modified Poisson regressions with robust error variances were used to estimate risk ratios for IABX and each outcome at each follow-up age during two separate time periods: 1997-2004 (n = 91 739) and 2005-2012 (n = 108 314). MAIN OUTCOME MEASURES: Asthma and allergic rhinitis by ages 6, 8 and 10. RESULTS: The proportion of women receiving IABX increased drastically over the study period (from 4% in 1997 to 49% in 2011), while the incidence of asthma (8%) and allergic rhinitis (6%) stayed relatively stable. In adjusted models, risk ratios for the association between IABX and asthma and allergic rhinitis were largely compatible with the null, with some slightly elevated risk ratios observed. For births from 1997 to 2004, risk ratios for asthma were 1.08 (95% CI 1.00-1.17) at age 6, 1.05 (95% CI 0.97-1.15) at age 8, and 1.08 (95% CI 0.99-1.18) at age 10. For births from 2005 to 2012, risk ratios were 1.00 (95% CI 0.95-1.04) at age 6, 1.07 (95% CI 1.01-1.12) at age 8, and 1.11 (95% CI 1.03-1.20) at age 10. CONCLUSIONS: Exposure to intrapartum antibiotics is not a strong predictor of childhood asthma or allergic rhinitis risk. TWEETABLE ABSTRACT: Exposure to intrapartum antibiotics is not a strong predictor of childhood asthma or allergic rhinitis risk.

Maternal caffeine intake during pregnancy and risk of obesity in offspring: a prospective cohort study.

BACKGROUND/OBJECTIVES: In-utero exposures through adverse fetal programming are emerging as an important contributing factor to the epidemic of childhood obesity. This study examines the impact of in-utero exposure to caffeine on the risk of childhood obesity in offspring. SUBJECTS/METHODS: A prospective study of pregnant women with 15 years follow-up of their offspring was conducted to examine the impact of in-utero exposure to caffeine on the risk of childhood obesity. Maternal caffeine intake was prospectively ascertained during pregnancy and outcome measures (body mass index (BMI)) were ascertained from medical charts, with 17 BMI measurements per child, on average, during the follow-up period. Potential confounders including known perinatal risk factors for childhood obesity were adjusted for using the generalized estimating equations model with repeated measurements. RESULTS: After controlling for potential confounders, compared with those without caffeine exposure, in-utero exposure to caffeine overall is associated with 87% increased risk of childhood obesity: odds ratio (OR) =1.87, 95% confidence interval (CI): 1.12-3.12. This association demonstrated a dose-response relationship: OR=1.77 (1.05-3.00) for maternal daily caffeine intake <150 mg per day, OR=2.37 (1.24-4.52) for caffeine intake ⩾150 mg per day during pregnancy, respectively. We also observed a linear relationship: every one unit increase (log10 scale) in the amount of maternal caffeine intake was associated with 23% increased risk of obesity in offspring. The dose-response relationship appears stronger for persistent obesity than for transitory obesity (occasional high BMI), and for girls than for boys. CONCLUSIONS: We observed an association of in-utero exposure to caffeine with increased risk of childhood obesity. If this observation is further replicated in other studies, the finding will contribute to the understanding of fetal programming of childhood diseases and development of intervention strategy to prevent childhood obesity.

Efficient creation of multipartite entanglement in flux qubits.

We investigate three superconducting flux qubits coupled in a loop. In this setup, tripartite entanglement can be created in a natural, controllable, and stable way. Both generic kinds of tripartite entanglement--the W type as well as the GHZ type entanglement--can be identified among the eigenstates. We also discuss the violation of Bell inequalities in this system and show the impact of a limited measurement fidelity on the detection of entanglement and quantum nonlocality.

Occupational exposure to bisphenol-A (BPA) and the risk of self-reported male sexual dysfunction.

BACKGROUND: Animal studies have suggested that bisphenol-A (BPA) is a potential human endocrine disrupter; but evidence from human studies is needed. METHODS: We conducted an occupational cohort study to examine the effect of occupational exposure to BPA on the risk of male sexual dysfunction. Current workers from BPA-exposed and control factories were recruited. The exposed workers were exposed to very high BPA levels in their workplace. Male sexual function was ascertained through in-person interviews using a standard male sexual function inventory. RESULTS: BPA-exposed workers had consistently higher risk of male sexual dysfunction across all domains of male sexual function than the unexposed workers. After controlling for matching variables and potential confounders, exposed workers had a significantly increased risk of reduced sexual desire [odds ratios (OR) = 3.9, 95% confidence interval: 1.8-8.6), erectile difficulty (OR = 4.5, 95% CI 2.1-9.8), ejaculation difficulty (OR = 7.1, 95% CI 2.9-17.6), and reduced satisfaction with sex life (OR = 3.9, 95% CI 2.3-6.6). A dose-response relationship was observed with an increasing level of cumulative BPA exposure associated with a higher risk of sexual dysfunction. Furthermore, compared with the unexposed workers, BPA-exposed workers reported significantly higher frequencies of reduced sexual function within 1 year of employment in the BPA-exposed factories. CONCLUSIONS: Our findings provide the first evidence that exposure to BPA in the workplace could have an adverse effect on male sexual dysfunction.

Fungi and pollen exposure in the first months of life and risk of early childhood wheezing.

BACKGROUND: Many studies have found that the risk of childhood asthma varies by month of birth, but few have examined ambient aeroallergens as an explanatory factor. A study was undertaken to examine whether birth during seasons of elevated ambient fungal spore or pollen concentrations is associated with risk of early wheezing or blood levels of Th1 and Th2 type cells at 24 months of age. METHODS: 514 children were enrolled before birth and followed to 24 months of age. Early wheezing was determined from medical records, and Th1 and Th2 type cells were measured in peripheral blood using flow cytometry. Ambient aeroallergen concentrations were measured throughout the study period and discrete seasons of high spore and pollen concentrations were defined. RESULTS: A seasonal pattern was observed, with birth in autumn to winter (the spore season) associated with increased odds of early wheezing (adjusted odds ratio 3.1; 95% confidence interval 1.3 to 7.4). Increasing mean daily concentrations of basidiospores and ascospores in the first 3 months of life were associated with increased odds of wheeze, as were increasing mean daily concentrations of total and specific pollen types. Levels of Th1 cells at age 24 months were positively associated with mean spore concentrations and negatively associated with mean pollen concentrations in the first 3 months of life. CONCLUSIONS: Children with higher exposure to spores and pollen in the first 3 months of life are at increased risk of early wheezing. This association is independent of other seasonal factors including ambient levels of particulate matter of aerodynamic diameter

Arterial to end-tidal carbon dioxide difference during craniotomy in severely head-injured patients.

Clinical data suggest that cerebral blood flow (CBF) can be abnormally low within the first four to eight hours after severe head injury (SHI). An aggressive hyperventilation can additionally worsen CBF and provoke cerebral ischemia. Therefore an accurate PCO2 monitoring in SHI patients (pts) is necessary. PetCO2 failed to reflect PaCO2 in SHI pts treated in neurosurgical ICU. Up to now, the validity of PetCO2 monitoring in estimating PaCO2 during an acute posttraumatic craniotomy has not been studied. Forty five adult SHI pts operated on because of an acute intracranial posttraumatic haematoma within 8 hours after head trauma entered the study. The standard anaesthetic protocol included N2O/O2, fentanyl and pancuronium bromide anaesthesia, and mechanical ventilation with respiratory rate 10 divided by 12 bpm and tidal volume in mL = body weight (kg) x 10 - 100. After obtaining a stable PetCO2 arterial blood sample was taken for PaCO2 measurement and P(a-et)CO2 = PaCO2 - PetCO2 was calculated. P(a-et)CO2 ranged -9 divided by 20 mm Hg (5 +/- 6; mean +/- SD). P(a-et)CO2 between 2 mm Hg and 6 mm Hg was found in 17 (38%) patients only. A negative P(a-et)CO2 was stated in 20% of patients. No relationships between P(a-et)CO2 and pts age and mean arterial pressure were found. P(a-et)CO2 was higher in normocapneic pts than in hyperventilated ones and tended to decrease with an increase in heart rate. We can conclude that during an acute craniotomy in SHI pts, PetCO2 does not reflect accurately PaCO2 and the monitoring of adequacy of ventilation should be based on repeated or continuous measurements of an arterial PCO2.

[The effect of small doses of 7.5% NaCl on brain bulk during elective craniotomies]. / Wplyw malych dawek 7.5% NaCl na objetosc mózgu podczas planowych kraniotomii.

In 16 patients (ASA I i II) aged 16-76 years (48 +/- 15; mean +/- SD) operated on because of intracranial expanding mass, the effect of hypertonic saline (7.5%--1 ml/kg b.w.) on brain bulk (BB) was evaluated. Patients were anaesthetised with a slight hypocarbia (PaCO2 = 33.3 +/- 3.5 mmHg). BB was scored after opening the dura (T0) and 15 min. (T15) after hypertonic saline (HS) infusion. Five points BB scale was used. Brain bulk reduction (D BB) was calculated as a difference: BB15-BB0. Tomographic signs of intracranial expansion (TSIE) in preoperative CT were scored using the scale from 5 to 15 points assessing (1 to 3 points) the size of mass lesion, the size of perifocal oedema, midline shift, displacement of ventricles and basal cisterns compression. Systolic (SBP), diastolic (DBP) blood pressures and heart rate (HR) were monitored. Serum natrium (SNa), kalium (SK) and osmolarity (Sosm) were measured at T0, T15 and Tp0 (one hour after operation). Student's t-test, Wilcoxon test and Spearman correlation were used for statistical analysis. P < 0.05 was considered as statistically significant. HS caused significant decrease in BB (p = 0.002). In 12 patients with a solid brain tumor a negative correlation between BB and TSIE was found (r = -0.68). A slight but significant decreases in SBP and DBP at Tp0 and T15 as well as decrease in HR due to HS were stated. SNa and Sosm increased at T15 and reminded elevated at Tpo. We can conclude that 7.5% saline in a dose of 1 ml/kg b.w. reduces brain bulk during craniotomy in patients with supratentorial mass lesions. In patients with a solid brain tumor this effect correlates negatively with a size of expanding mass. A slight changes in blood pressure and heart rate due to HS as well as moderate decrease in SK are within limits of clinical acceptance.

Hyperventilation increases muscle protein synthesis in critically ill trauma patients.

BACKGROUND: Critically ill trauma patients are often in negative nitrogen balance and demonstrate advanced muscle protein wasting, which is in part due to a decrease in muscle protein synthesis. Previous studies have been performed on the relationship between pH and protein metabolism. Some evidence suggests that alkalosis might enhance protein synthesis. The purpose of the present study is to determine whether protein synthesis is increased in trauma patients who have a respiratory alkalosis from hyperventilation. METHODS: Trauma patients in the intensive care unit (n = 8) who were treated with hyperventilation for elevated intracranial pressures were enrolled. Muscle protein synthesis rates were determined in vivo using the flooding method with l-[(2)H(5)]phenylalanine. Measurements were performed twice on each patient within a 36-h period, first during hyperventilation and then after hyperventilation was discontinued. Hemoglobin oxygen saturation was maintained above 95% for all measurements. RESULTS: Protein synthesis in muscle was 1.38 +/- 0.11%/day during hyperventilation (pH 7.50 +/- 0.02, pCO(2) 27.3 +/- 1.0 mm Hg) and 0.93 +/- 0.15%/day after respiratory parameters were normalized (pH 7.39 +/- 0.01, pCO(2) 39.4 +/- 1.5 mm Hg). The synthesis rate was significantly higher (P < 0.01, paired t test), 0.46 +/- 0.13%/day (32.6%), at the time of hyperventilation. CONCLUSION: Muscle protein synthesis is elevated during hyperventilation in critically ill patients with traumatic brain injury. We believe this preliminary study provides data that warrant confirmation in larger clinical studies. It suggests that this ventilatory therapeutic strategy may have a role in mitigating the negative nitrogen balance and muscle protein wasting that can impair the recovery of these patients.

Tramadol for postoperative analgesia in intracranial surgery. Its effect on ICP and CPP.

An ideal analgesic for patients after craniotomy should neither cause respiratory depression, nor affect intracranial pressure (ICP) and cerebral perfusion pressure (CPP). The aim of the study was to evaluate the effect of Tramadol (T) on ICP and CPP, as well as to determine its analgetic efficacy in patients (pts) after craniotomy. Thirty five pts aged 16 divided by 78 years (mean 46) entered the study. Twelve had GCS (Glasgow Coma Scale) scores < or = 8 and 23 pts had scores > or = 12. Fourteen pts were mechanically ventilated and 21 pts were breathing spontaneously (BS). Tramadol was injected i.v. at a dose of 0.75 mg/kg over 3 minutes in 11 pts (Group 1), 1.0 mg/kg over 5 minutes in 13 pts (Group 2) and 1.0 mg/kg over 10 minutes in 11 pts (Group 3) PaCO2 was measured before T in all pts and at 8 minute after injection in 21 BS pts. Heart rate (HR), mean arterial blood pressure (MBP), ICP, CPP and respiratory frequency (f) were registered before and in the 1st, 3rd, 8th, and 15th minute after T. Analgetic effect was evaluated in 22 conscious pts by comparing the pain intensity before and 30 minutes after T using a five-point verbal response scale. Mean control ICP was 17 mmHg. ICP over 15 mmHg was diagnosed in 15 pts (mean ICP equal 26 mmHg). Mean CPP for all 35 pts was 85 mmHg. There were no statistically significant changes in HR, MBP, ICP, and CPP after T in any particular group, nor were there changes in ICP in subgroups with normal and elevated ICP. No significant changes in PaCO2 and f were found in BS pts. Satisfactory analgesia was obtained in 50% of pts of Group 1, and in 88% of pts of Groups 2 and 3. We conclude that tramadol in doses of 0.75 mg/kg and 1.0 mg/kg i.v. does not affect ICP and CPP in adult postcraniotomy patients and seems to be a safe and effective analgesic at a dose of 1.0 mg/kg for postcraniotomy pain control.

A cure for the Blues: resolving nonprofit Blue Cross conversions.

This Article analyzes the issues involved in converting nonprofit Blue Cross organizations to for-profit status. These issues have arisen in the context of litigation regarding the "reorganization" of Blue Cross and Blue Shield of Missouri ("BCBSMo"). BCBSMo had reorganized by creating and transferring a majority of its business to a new for-profit subsidiary. Missouri consumer groups and state regulators characterized the "reorganization" as a conversion requiring BCBSMo to transfer its assets to a foundation dedicated to charitable health purposes. BCBSMo, however, denied that it had any obligation to leave behind its assets in the nonprofit sector. The BCBSMo litigation raises issues common to most conversions of nonprofit healthcare organizations, particularly conversions of nonprofit Blue Cross plans. This Article provides a road map for state regulators and the public to follow in ensuring that the public interest is fully protected in such conversions.

Measurement of NO synthesis in humans by L-[15N2]arginine: application to the response to vaccination.

Induction of nitric oxide (NO) synthesis is a key element of the inflammatory response in humans. We describe a sensitive gas isotope ratio mass spectrometric (GIRMS) method for measuring urinary [15N]nitrate production during intravenous infusion of L-[guanidino-15N2]arginine and its application to investigate the effects of a controlled inflammatory stimulus, typhoid vaccination, on NO synthesis in humans. Intravenous infusion of L-[15N2]arginine at 5-12 mumol.kg-1.h-1 for 24 h in three subjects was used to determine arginine and nitrate pool kinetics. Eight subjects received primed constant infusion of 2.5 mumol.kg-1.h-1 of L-[15N2]arginine for 12 h once before and again after typhoid vaccination. NO synthesis was calculated from 15N enrichment of plasma arginine and urinary nitrate, measured by gas chromatography mass spectrometry and GIRMS, respectively, and total urinary nitrate excretion. Baseline NO synthesis was 298 +/- 44 nmol.h-1.kg lean body mass-1, representing 0.41% of arginine flux. After vaccination, NO synthesis (267 +/- 77 nmol.h-1.kg-1) was not increased (P = 0.18), despite demonstration of an acute phase response. Typhoid vaccination is not accompanied by accelerated NO synthesis.

Childhood abuse and neglect among women outpatients with chronic mental illness.

OBJECTIVE: The purposes of the study were to determine the prevalence of childhood sexual abuse, physical abuse, and neglect among women outpatients with severe and persistent mental illness; to examine patterns of co-occurrence of the various types of abuse; and to explore the relationships between childhood abuse and adult psychiatric symptomatology. METHODS: Childhood histories of abuse and data on clinical characteristics of 78 women enrolled in a New York State outpatient clinic were elicited in face-to-face interviews using a structured questionnaire. RESULTS: Sixty-five percent of the women reported histories of some type of abuse or neglect during childhood. Forty-five percent of the sample had been sexually abused, 51 percent had been physically abused, and 22 percent had experienced neglect. Seventy-four percent of the sexually abused women, 70 percent of the physically abused women, and 94 percent of the women who experienced neglect reported at least one additional form of abuse or neglect. Respondents who had been abused in childhood had higher levels of depressive and psychotic symptoms and higher rates of sexual victimization in adulthood than those who had not been abused. Women who experienced neglect as children had higher rates of homelessness in adulthood. CONCLUSIONS: Chronic mentally ill women seem to experience higher rates of abuse and more types of abuse than the general population. Clinicians should try to determine whether chronic mentally ill women have histories of abuse and to develop interventions to meet their special needs.