bluuebunny/crossref_metadata_2025 huggingface dataset:
Ischemic Nephropathy in an Elderly Nephrologic and Hypertensive Population
Authors: Coen Giorgio , Manni Micaela , Giannoni Maria Fabrizia , Bianchini Gabriella , Calabria Santo , Mantella Daniela , Pigorini Francesco , Taggi Franco
Published: April 2003

Background: Atherosclerotic renovascular disease is a frequent cause of end-stage renal failure leading to dialysis in the elderly population. Its prevalence is known from autopsy or retrospective arteriographic investigations. This prospective study was conducted in 133 subjects with the inclusion criteria of hypertension and/or chronic renal failure starting after 50 years of age. Renal failure was unrelated to other known causes of renal disease. Methods: The patients were subjected to echo-color doppler ultrasonography of renal arteries (104) and/or to renal scintigraphy (112). Thirteen of 27 patients with positivity using one or both noninvasive techniques were subjected to digital selective angiography. Results: All the patients with positivity of echo-color doppler technique were true positives, with a consequent predictive value reaching 100%. Renal scintigraphy was of markedly lower predictive value. Based on the echo-color doppler investigation, percentage positivity for hemodynamically significant stenosis (>50%) was 3.2 (16.3% had mild nonsignificant stenosis of renal arteries) in the 50- to 59-year-old group, 20% (plus 12.5% with nonsignificant stenosis) in the 60- to 69-year-old group and 25% (plus 17.8% nonsignificant stenosis) in the >70-year age group. Patients with significant stenosis also had a significantly higher degree of renal insufficiency and received a higher number of hypotensive drugs (p < 0.013). The percentage of hypertensive patients was not different in the stenotic and nonstenotic groups. Conclusions: A large percentage of the elderly population is affected by renal vascular obstructive disease and is at risk of developing end-stage renal failure. Considering the wide number of cases with foreseeable renal arterial stenosis in the vast population meeting the selection criteria, it is possible to conclude that not all cases evolve to renal failure due to different rates of progression or to untimely nonrenal death.
Immunotactoid Glomerulopathy Associated with Idiopathic Hypereosinophilic Syndrome
Authors: Choi Yeong-jin , Lee Jeong Deuk , Yang Ki Hwa , Woo Je Young , Kim Byung Kee , Bang Byung Kee , Shim Sang In
Published: April 2003

A case of immunotactoid glomerulopathy in an 18-year-old man with an idiopathic hypereosinophilic syndrome is presented. The patient showed cervical lymphadenopathy, asymptomatic proteinuria of nephrotic range, and hematuria without any defined immunologic disease. Marked and prolonged hypereosinophilia was found in peripheral blood (eosinophil count; 6,248/mm3) and bone marrow (eosinophil series; 32%). Diffuse and/or nodular eosinophilic infiltration was identified in multiple organs such as kidney, stomach, liver, lymph node, and skin. Renal biopsy revealed endocapillary proliferative features of typical immunotactoid glomerulopathy with IgG and C3 deposition and microtubular structures of variable size, 20–80 nm in diameter, mainly in the subendothelium. This study suggests that immunotactoid glomerulopathy may be a secondary immunologic manifestation of the tissue damage by eosinophils in the idiopathic hypereosinophilic syndrome.
Effect of Angiotensin-Converting Enzyme Inhibitors on Response to Erythropoietin Therapy in Chronic Dialysis Patients
Authors: Charytan Chaim , Goldfarb-Rumyantzev Alexander , Wang Y.F. , Schwenk Michael H. , Spinowitz Bruce S.
Published: April 2003

Background: Erythropoietin (EPO) therapy is a common and effective treatment for the correction of anemia in patients with end-stage renal disease. Simultaneous treatment with angiotensin-converting enzyme (ACE) inhibitors for the control of hypertension and/or heart failure is often necessary. Recent reports in the literature have raised concern about a potential interaction between these drugs, with a resultant decreased EPO efficacy. Methods: To investigate whether this interaction occurs in chronic dialysis patients, we retrospectively reviewed the records of 175 patients receiving chronic dialysis. All study patients were treated with EPO for at least 3 months, and had normal iron indices. Patients were treated with ACE inhibitors for at least 3 months, at a constant daily dose for at least 1 month (group 1, n = 32), or did not receive ACE inhibitors (group 2, n = 143). Patients with infections or overt iron deficiency were excluded. Total weekly EPO doses and hematocrit (Hct)/hemoglobin (Hgb) values in the two groups were compared. Variables known to affect response to EPO were compared, including ferritin, transferrin saturation, dialysis dose and serum aluminum. Results: Total weekly EPO dose was 17,358 ± 6,871 units in group 1 and 17,612 ± 7,744 units in group 2 (p = 0.854). The achieved Hct was 32.1 ± 4.4% (group 1) and 30.5 ± 4.0% (group 2) (p = 0.079). Similarly, Hgb, ferritin, transferrin saturation, Kt/V, and serum aluminum were not different. The dose or duration of ACE inhibitor therapy did not affect Hgb or Hct. Thus, ACE inhibitor therapy does not appear to affect response to EPO in chronic dialysis patients.
Tuberculosis in Active Dialysis Patients in Jeddah
Authors: Shohaib Saad Al , Scrimgeour Euan M. , Shaerya Fouad
Published: April 2003

The incidence of tuberculosis in The Kingdom of Saudi Arabia remains high. The objective of this study is to determine the prevalence of Tuberculosis among haemodialysis patients, since they are highly susceptible to this infection. A retrospective study, over a 5-year period, was carried out in the Renal Units of two large hospitals in Jeddah. Diagnosis was established by Ziehl Neelsen microscopy and culture of specimens on Lowenstein-Jensen media, radiological and histological examinations. Tuberculosis was diagnosed in 17 of 210 patients on hemodialysis. Pulmonary tuberculosis was present in 10 cases and tuberculous lymphadenitis in 8 cases. One patient had both pulmonary and lymph node involvement while another one had both pulmonary and peritoneal tuberculosis. Mycobacterium tuberculosis was diagnosed in sputum in 5 cases, by lymph node histopathology in 5 cases, and combined radiological and clinical evidence in the remaining patients. The Mantoux test was positive in 9 (60%) cases. Eight patients were diabetics (47%) and there appears to be some association of tuberculosis with diabetes in patients on dialysis. Treatment with first-line anti-tuberculosis agents was continued for 6–18 months. Fourteen (82%) patients were completely cured while 3 showed clinical improvement only. The study showed that successful therapy of tuberculosis in this group of dialysis patients could be achieved but high index of suspicion is required to recognize the unusual presentation in this group of patients so that early diagnosis can be achieved and prompt treatment instituted. Diabetic patients presenting for dialysis, in areas with high endemicity for tuberculosis, chemoprophylaxis with anti-tuberculosis agents should be considered.
History of Renal Physiology in Germany during the 19th Century
Authors: Hierholzer Klaus , Ullrich Karl Julius
Published: April 2003

The roots of renal physiology in Germany in the last century have been traced. Vitalistic concepts became replaced by physical, chemical and mechanistic laws which govern biological processes. First, the main exponents of renal physiology, J. Henle, C. Ludwig and R.P.H. Heidenhain, are discussed, then the (indirect) contributions of A. Fick, K. Peter, H. Helmholtz, E. du Bois-Reymond, J.L. Schönlein and A. Dohrn are evaluated. The original literature bearing on renal physiology in the 19th century is screened by a survey of publications in Pflügers Archiv and Archiv der experimentellen Pathologie und Pharmakologie. We point to the international cooperation in the field. At the turn of the century, renal function was adequately described by a theory of glomerular filtration, tubular secretion and tubular reabsorption.
Hyponatremia in Acute-Phase Response Syndrome Patients in General Surgical Wards
Authors: Ferreira da Cunha Daniel , Pontes Monteiro Jacqueline , Modesto dos Santos Vitorino , Araújo Oliveira Frederico , Freire de Carvalho da Cunha Selma
Published: April 2003

Background: In surgical patients, hypoalbuminemia may occur as a component of acute-phase response (APR) syndrome, which we hypothesized could decrease serum sodium levels. Aim: To compare the frequency of hyponatremia in adult surgical inpatients with or without APR syndrome. Methods: All the simultaneous plasma sodium and albumin results (n = 168), obtained from adults in surgical wards and corresponding to a 6-month period, were searched in the hospital mainframe. Other relevant laboratory and clinical data were also registered. APR was ascertained by the presence of major physical trauma, surgery or infection, plus hypoalbuminemia (serum albumin <3.5 g/dl) and neutrophil left shift (≥7% of band count) associated with peripheral leukopenia (white blood cells <4,000/mm3) or leukocytosis (WBC >9,000/mm3). Hyponatremia was defined by serum sodium concentration <135 mEq/l. Results: APR-positive patients (n = 113) had lower blood hemoglobin (10.92 ± 2.18 vs. 13.53 ± 2.30 g/dl), and serum albumin levels (median, range: 2.8, 1.9–3.4 vs. 3.7, 3.5–4.2 g/dl) than APR-negative (n = 55) ones, the same occurring in relation to antibiotics (54.8 vs. 10.9%) and intravenous 5% dextrose in water (55.7 vs. 20.0%) or isotonic saline (46.0 vs. 9.1%) infusion. The hyponatremia frequency was higher among APR-positive patients (31.0 vs. 10.9%). Conclusion: The higher percentage of hyponatremia among APR-positive patients could be attributed to decreased serum albumin levels associated with APR.
Pentoxifylline Reduces in vitro Renal Myofibroblast Proliferation and Collagen Secretion
Authors: Hewitson Tim D. , Martic Marina , Kelynack Kristen J. , Pedagogos Eugenia , Becker Gavin J.
Published: April 2003

Interstitial myofibroblasts (MF) are cells with features of both smooth muscle cells and fibroblasts. They have been universally recognized in situations of tubulointerstitial injury, where their presence has been shown to be a marker of disease progression. The objective of this study was to determine if functions of MF relevant to fibrogenesis can be modified in vitro by the phosphodiesterase inhibitor pentoxifylline (PTX). MF were obtained from sub-culture of normal rat kidney explant outgrowths maintained in DMEM + 20% fetal calf serum (FCS), supplemented with antibiotics. Cells were characterized on the basis of growth characteristics and immunohistochemistry. MF constituted >95% of cells at passage 3. Cell culture media was supplemented with the potential antagonist PTX alone (0, 1, 10, 100 μg/ml) and in combination with TGFβ1 (5 ng/ml). Population kinetics, proliferation and collagen production were determined from cell growth, [3H]thymidine incorporation and [3H]proline incorporation in collagenous proteins, respectively. Both serum-stimulated population growth and proliferation were reduced in a linear fashion by 1, 10 and 100 μg/ml PTX (all p < 0.05 versus 0 μg/ml). Effect of PTX on cell population growth was however reversible when PTX was removed. Basal collagen secretion was decreased by PTX at 10 and 100 μg/ml (p < 0.05 versus 0 μg/ml), although cell layer collagen remained unchanged. Collagen production (secreted and cell layer) was augmented by 5 ng/ml TGFβ1. These effects on collagen production were partially reduced when 100 μg/ml PTX was added. The authors conclude that myofibroblast function can be altered with agonists/antagonists. Attempts to down-regulate fibrogenic functions of MF may therefore offer a valuable therapeutic strategy.
Hand Contamination with Hepatitis C Virus in Staff Looking after Hepatitis C-Positive Hemodialysis Patients
Authors: Alfurayh O. , Sabeel A. , Al Ahdal M.N. , Almeshari K. , Kessie G. , Hamid M. , Dela Cruz D.M.
Published: April 2003

Background: Hepatitis C virus (HCV) is a major cause of hepatitis in hemodialysis (HD) patients. Routes other than blood transfusion play a role in the spread of HCV in HD patients. Molecular studies of HCV implicate nosocomial transmission of the virus in HD units. We conducted a clinicovirological study in our HD unit to investigate if the hands of dialysis personnel could represent a mode of transmission of HCV among HD patients. Methods: One liter of sterile water was used for each handwashing of dialysis personnel. The washing was collected in a sterile container and tested for HCV-RNA by polymerase chain reaction (PCR) within 3 h of collection. Eighty handwashings from nurses dialyzing HCV-positive patients (groupe A) and 100 handwashing from nurses dialyzing HCV-negative patients (group B) were tested for HCV-RNA. As a control, 60 handwashings were collected from the dialysis personnel before entering the dialysis unit (group C) and tested for HCV-RNA. Results: HCV-RNA was positive in 19 (23.75%) of samples of group A, in 8 (8%) of samples of group B (p < 0.003) and in 2 (3.3%) of samples of group C (p < 0.35). These two positive samples of group C were from nurses who had dialyzed HCV-negative patients. Conclusion: These results indicate the presence of HCV-RNA on the hands of some dialysis personnel in our HD unit, in spite fo adherence to the standard precautions. The hands of dialysis personnel are therefore a potential mode for facilitating transmission of HCV between HD patients.
Acute Renal Failure from Myoglobinuria Secondary to Myositis from Severe Falciparum Malaria
Authors: Sinniah Raja , Lye Wai-Choong
Published: April 2003

Renal disease is a common complication in malaria infection. In acute falciparum malaria renal involvement is usually mild, but in severe disease acute renal failure is a major problem. Acute renal failure has been attributed to ischaemic tubular necrosis from hypovolaemia resulting from vasodilatation due to endothelial injury. Though myositis is recorded as a common manifestation in falciparum malaria, only 1 case with myositis and myoglobinuria with acute renal failure has been documented; but no renal biopsy was performed in the patient. In the present study we examined the case of a 17-year-old man with severe falciparum malaria with myositis and myoglobinuria who developed acute renal failure requiring dialysis. Muscle biopsy revealed severe myositis with macrophages and T lymphocytes including CD4+ cells. The kidney biopsy showed scanty T cells and macrophages in the glomeruli which were only mildly hypercellular. The renal tubules showed myoglobin casts in the lumen and foci of interstitial inflammatory cells, including macrophages and T lymphocytes but no CD4+ cells. Rhabdomyolysis induced by macrophages and T cells with myoglobinuria and acute renal failure is a problem in severe falciparum malaria infection.
Long-Term Outcome of Ménière’s Disease: Endolymphatic Mastoid Shunt versus Natural History
Authors: Quaranta Antonio , Marini Francesco , Sallustio Vincenzo
Published: April 2003

This retrospective study evaluates the outcome of 38 patients with intractable Ménière’s disease with a minimum of 7 years follow-up. Twenty underwent endolymphatic-mastoid shunt (EMS) and 18 were offered surgery but declined (natural history, NH, group). At the last control, 85% of the patients who were operated on (EMS group) and 74% of the NH patients had complete or substantial control of vertigo. The difference between the two groups was not significant. However, it was significant at 2 and 4 years follow-up. At 2 years, EMS patients had complete or substantial control of vertigo in 65% of the cases, at 4 and 6 years in 85% of the cases. Only 32% of the NH patients had complete or substantial control of vertigo at 2 years. This percentage rose to 50% at 4 years and to 74% at 6 years. Hearing results in the two groups were not significantly different. Tinnitus disappeared or decreased in 56% of the EMS patients and in 18% of the NH patients. Sixty-seven percent of the EMS patients and 29% of the NH patients reported that their aural fullness was abolished. In conclusion, over the years, approximately 8 out of 10 of our patients with Ménière’s disease achieved complete or substantial control of vertigo; however, this reduction was observed earlier in EMS patients than in those who declined surgery.
Intracerebral Sources of Human Auditory-Evoked Potentials
Authors: Picton T.W. , Alain C. , Woods D.L. , John M.S. , Scherg M. , Valdes-Sosa P. , Bosch-Bayard J. , Trujillo N.J.
Published: April 2003

Evoked potentials to brief 1,000-Hz tones presented to either the left or the right ear were recorded from 30 electrodes arrayed over the head. These recordings were submitted to two different forms of source analysis: brain electric source analysis (BESA) and variable-resolution electromagnetic tomography (VARETA). Both analyses showed that the dominant intracerebral sources for the late auditory-evoked potentials (50–300 ms) were in the supratemporal plane and lateral temporal lobe contralateral to the ear of stimulation. The analyses also suggested the possibility of additional sources in the frontal lobes.
Modelling of Components of the Human Middle Ear and Simulation of Their Dynamic Behaviour
Authors: Beer Hans-Joachim , Bornitz Matthias , Hardtke Hans-Jürgen , Schmidt Rolf , Hofmann Gert , Vogel Uwe , Zahnert Thomas , Hüttenbrink Karl-Bernd
Published: April 2003

In order to get a better insight into the function of the human middle ear it is necessary to simulate its dynamic behaviour by means of the finite-element method. Three-dimensional measurements of the surfaces of the tympanic membrane and of the auditory ossicles malleus, incus and stapes are carried out and geometrical models are created. On the basis of these data, finite-element models are constructed and the dynamic behaviour of the combinations tympanic membrane with malleus in its elastic suspensions and stapes with annular ligament is simulated. Natural frequencies and mode shapes are computed by modal analysis. These investigations showed that the ossicles can be treated as rigid bodies only in a restricted frequency range from 0 to 3.5 kHz.
Towards Optimal Recording and Analysis of the Mismatch Negativity
Authors: Sinkkonen Janne , Tervaniemi Mari
Published: April 2003

In this paper, the conceptual and practical issues related to the measurement of mismatch negativity (MMN) are discussed from the viewpoint of cost-efficiency. First, various criteria for efficiency or optimality of measurements are described, including reliability and signal-to-noise ratio. Then a critical look is taken at some currently used concepts and data analysis methods. Practical guidelines for the measurement and analysis of MMN are given, complementing the earlier reviews on the subject. Finally, reliability studies on MMN are critically reviewed.
Clinical Importance of Pain and Stress in Preterm Neonates
Authors: Anand K.J.S.
Published: April 2003

Clinical and laboratory investigations of neonatal pain suggest that preterm neonates have an increased sensitivity to pain and that acute painful stimuli lead to the development of prolonged periods of hyperalgesia. Non-noxious stimuli during these periods of hyperalgesia may expose preterm neonates to established or chronic pain. Acute physiologic changes caused by painful or stressful stimuli can be implicated as important factors in the causation or subsequent extension of early intraventricular hemorrhage (IVH) or the ischemic changes leading to periventricular leukomalacia (PVL). Therapeutic interventions that provide comfort/analgesia in preterm neonates were correlated with a decreased incidence of severe IVH. Long-term follow-up studies of preterm neonates may substantiate the preliminary data associating repetitive painful experiences with some of the neurobehavioral and developmental sequelae resulting from neonatal intensive care.
Dexamethasone for Pulmonary Interstitial Emphysema in Preterm Infants
Authors: Fitzgerald Dominic , Willis Diana , Usher Robert , Outerbridge Eugene , Davis G. Michael
Published: April 2003

The efficacy of a 3-day course of dexamethasone (0.5 mg/kg/day) in 10 preterm infants (≤30 weeks gestation) with pulmonary interstitial emphysema (PIE) was studied in a retrospective case review. PIE was diagnosed at a median age of 7.5 days and treatment with dexamethasone began at 8.5 days. Seven of the 10 subjects had at least 2 days of conservative treatment (lowered mean airway pressure) preceding dexamethasone during which the mean airway pressure (MAP), oxygenation index (OI) and mechanical ventilation index (MVI) were not significantly different although within 3 days of dexamethasone each variable improved significantly (p < 0.05). Similarly, for all 10 infants, OI and MAP were significantly lower at 3 and 7 days from baseline (p < 0.005). By day 7, FiO2 (p = 0.022) and MVI (p = 0.011) were significantly lower and PIE had resolved on chest X-ray in 7/9 (78%) and improved in the remaining 2/9 (22%). Nine of the 10 infants survived to term. Three days of dexamethasone was associated with significant clinical improvement in most of these infants. The mechanism may relate to reduced airway oedema and inflammation and reduced airway obstruction.
Influence of Thyrotrophin-Releasing Hormone on Thermoregulation in Newborn Lambs
Authors: Bird Jane A. , Clarke Lynne , Symonds Michael E.
Published: April 2003

This study examined the effect of thyrotrophin-releasing hormone (TRH) administration on thermoregulation in the newborn. Twin lambs were either delivered near-term by caesarean section or born vaginally at term. Colonic temperature, O2 consumption, CO2 production, breathing and heart rates, plus plasma thyroid hormone and nonesterified fatty acid (NEFA) concentrations and thermogenic activity (i.e. GDP binding) of brown adipose tissue (BAT) were measured. In caesarean section delivered lambs colonic temperature decreased rapidly after birth, a response that was greater in the group designated for TRH treatment, in which colonic temperature fell to below 36.0°C at 80 min of life, prior to TRH administration. At this age colonic temperature had been restored to a mean of 38.70°C in controls. TRH had no influence on the composition or thermogenic activity of BAT. The incidence of shivering was not influenced by TRH, but treated lambs maintained a higher rate of O2 consumption and ventilation compared with controls after colonic temperature had been restored to 38.56°C. TRH appeared to promote fat oxidation as O2 consumption remained unchanged and CO2 production declined by a greater rate in treated lambs, resulting in a lower respiratory quotient compared to controls. Heart rate and plasma concentrations of NEFA increased following TRH administration although this did not result in values greater than controls. Normothermic lambs born vaginally had BAT with a greater thermogenic activity, higher plasma thyroid hormone and NEFA concentrations compared with caesarean section delivered lambs, but a thermogenic response was not observed to TRH despite a rise in thyroid hormone concentrations. In conclusion, TRH can improve thermoregulation, an effect that could be linked to an increase in fat oxidation.
Ontogeny of Extracellular Matrix Gene Expression by Rat Lung Cells at Late Fetal Gestation
Authors: Rolland Gaëlle , Xu Jing , Tanswell A. Keith , Post Martin
Published: April 2003

Lung epithelial and mesenchymal cells are separated by a basement membrane. At late fetal gestation, this basement membrane in fenestrated, allowing epithelial cytoplasmic extensions to reach in close proximity of the interstitial fibroblast. The enzymes responsible for this focal basement membrane remodelling, and their cellular origin, remains to be defined. Basement membrane remodelling generally involves a special class of matrix-degrading enzymes, called metalloproteinases. Herein, we report that fetal lung cells originating from both tissue layers, mesoderm and endoderm, express the metalloproteinase genes, MMP-1 or interstitial collagenase, and MMP-3 or stromelysin. The inhibitor of metalloproteinases, TIMP-1, is mainly expressed in fetal lung fibroblasts. During late fetal development, MMP-1 mRNA expression in both cell types increases close to term (day 21, term = 22 days), while that of stromelysin and TIMP-1 remain constant. Both fibroblasts and epithelial cells express fibronectin (FN) mRNA. The expression of the FN gene in epithelial cells decreases slightly at the canalicular stage of lung development (days 19–20), whereas FN expression in fibroblasts is not changed with advancing gestation. Procollagen α1(I) mRNA is predominantly detected in fibroblasts whereas message for laminin B1 chain is primarily found in epithelial cells. Expression of procollagen α1(I) mRNA decreases in fibroblasts during the canalicular stage of fetal lung development compared to the pseudoglandular stage (day 18) but increases thereafter at the saccular stage (day 21) of development. Laminin B1 expression in epithelial cells declines with advancing gestation. These data are consistent with a process of basement membrane thinning during the canalicular stage, followed by metalloproteinase-mediated penetration. Further, a progressive reduction in laminin expression is consistent with progressive epithelial differentiation.
Effects of Epidermal Growth Factor, Cholecystokinin, and Secretin on Growth of the Alimentary Tract in the Neonatal Guinea Pig
Authors: Herrington Margery K. , Adrian Thomas E.
Published: April 2003

Gut hormones and growth factors are likely to be involved in the functional changes and substantial growth of the alimentary tract that occurs during early neonatal life. The present experiments investigated the effects of continuous subcutaneous infusion of cholecystokinin (CCK), secretin, and epidermal growth factor (EGF) in neonatal guinea pigs for 4 or 15 days. At doses of 20, 100 or 500 pmol/kg/h, CCK and secretin had no effect on alimentary tract organs except for an increase in pancreatic weight at 4 days with the highest dose of CCK and an increase in stomach weight at 4 days with the highest dose of secretin. In contrast, EGF showed dose-dependent and time-dependent effects on all the alimentary tract organs when infused at 70, 210 and 630 pmol/kg/h. These results suggest that EGF, but not CCK or secretin, is likely to be an important trophic factor during the neonatal period.
Movement Quality in Preterm Infants Prior to Term
Authors: Kakebeeke Tanja H. , von Siebenthal Kurt , Largo Remo H.
Published: April 2003

Quality of spontaneous movement behavior (fluency, spatiotemporal variation and sequencing) was studied from birth to term in high-risk preterm (n = 18), low-risk preterm (n = 18) and term (n = 20) infants. Cranial ultrasonography was performed during the first week of life and the child’s general health was considered. The results were as follows: (1) In their first week of life, preterm infants displayed lower scores on all quality parameters when compared to term infants (p < 0.001). (2) Quality of spatiotemporal variation and sequencing decreased up to term (p < 0.01). These findings could be attributed to maturational differences, too early exposure to an extrauterine environment, and cerebral lesions.
Unconjugated and Conjugated Bilirubin Pigments during Perinatal Development
Authors: Kaplan Michael , Muraca Maurizio , Hammerman Cathy , Vilei Maria Teresa , Rubaltelli Firmino F.
Published: April 2003

Objective: To determine the effect of phototherapy on serum conjugated bilirubin fractions, an index of bilirubin conjugation, in hyperbilirubinemic neonates. Method: Serum was sampled from 21 jaundiced (serum diazo total bilirubin ≥274 µmol/l), term, otherwise healthy neonates prior to starting phototherapy, and 24 h after the commencement of treatment. Alkaline methanolysis followed by reverse-phase, high-performance liquid chromatography, specific for determination of unconjugated bilirubin and the monoconjugated and diconjugated fractions of total conjugated bilirubin in serum, was used for the analysis. Prephototherapy values were compared to those at 24 h. Results: Serum total bilirubin and total conjugated bilirubin values decreased during the study period, from 220 (211–239) to 177 (157–213) µmol/l (median (25–75% range)) p = 0.001, for the former, and from 1.4 (0.87–1.57) to 0.93 (0.69–1.84) µmol/l, p = 0.005, for the latter. These parameters decreased by a similar percentage (–16.6 ± 14.8% and –14.0 ± 23.4%, respectively; p > 0.05). Both monoconjugated and diconjugated bilirubin, calculated as a percentage of total conjugated bilirubin, remained constant over the study period (88.2 (72.2–96.4)% before phototherapy and 92.5 (87.3–96.8)% after 24 h, p > 0.05, for monoconjugated bilirubin, and 11.8 (3.6–27.8)% and 7.5 (3.2–12.7)%, respectively, p > 0.05, for diconjugated bilirubin). Conclusions: Serum total conjugated bilirubin values decreased in parallel to serum total bilirubin levels during phototherapy, maintaining a constant relationship between these two parameters. The ratios of monoconjugated and diconjugated bilirubin to total conjugated bilirubin remained constant. These findings imply that phototherapy does not alter bilirubin conjugation in hyperbilirubinemic neonates.
Effect of Inhaled Nitric Oxide in Endothelin-1-Induced Pulmonary Hypertension
Authors: Truog William E. , Norberg Michael , Thibeault Donald W.
Published: April 2003

The interaction of two vasoactive substances, the vasodilator nitric oxide (NO) and the complex-acting peptide endothelin-1 (ET-1), may help explain the pathophysiology of pulmonary hypertension, an important part of many pulmonary disorders in neonates. To understand better the interactions of inhaled NO and ET-1, we investigated the effects of ET-1 infusions with and without inhaled NO in two groups of piglets, one group pretreated with L-nitro-arginine methylester (L-NAME) and the other not pretreated. Inhaled NO (60 ppm) was administered during infusion of 1.0 µg/kg or 2.5 µg/kg of ET-1. In animals not pretreated with L-NAME, the increase in PVR and in SVR induced by either dose of ET-1 was not reduced with administration of NO. The increase in systemic vascular resistance with ET-1 was greater (mean increase of 50% above baseline with 1.0 µg/kg ET-1 and 100% with 2.5 µg/kg ET-1 by 5 min) than the increase in PVR, but the PVR/SVR ratio did not change during ET-1 administration. In contrast, animals pretreated with L-NAME did demonstrate inhibition of ET-1-induced increase in PVR with NO. No differences in effects on SVR were noted. We conclude that ET-1-induced increases in PVR are not diminished by 60 ppm of inhaled NO unless there has been inhibition of endogenous NO production.
Nitric Oxide Modulates Anoxia-Induced Gasping in the Developing Rat
Authors: Gozal David , Torres José E. , Gozal Evelyne , Nuckton Thomas J. , Dixon Michelle K. , Gozal Yair M. , Hornby Pamela J.
Published: April 2003

Gasping is an important mechanism for survival. Nitric oxide (NO) plays an excitatory role in brainstem regions mediating respiratory responses to hypoxia. We hypothesized that neural structures mediating anoxia-induced gasping would display NO dependency. Two- to 15-day-old rat pups underwent anoxic exposures with 100% N2 in a plethysmograph following administration of N-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase (NOS) blocker, L-arginine (L-Arg), a NO precursor, or normal saline. In general, gasp latencies were significantly shorter after L-Arg, and were prolonged with L-NAME. Furthermore, NOS inhibition prolonged gasping duration and reduced gasping frequency at all postnatal ages, although this effect was particularly increased with advancing postnatal age. NADPH-diaphorase staining and Western blots of protein lysates from the lateral tegmental field, the putative neural center underlying gasp generation, revealed progressively increased neuronal NOS abundance with animal maturation. We conclude that anoxia-induced gasping neurogenesis is modulated by NO mechanisms in neonatal pups. We postulate that higher NO brainstem concentrations may favor early autoresuscitation but be detrimental to overall survival during prolonged asphyxia.
Delivery of Total Parenteral Nutrition (TPN) via Umbilical Catheterization: Development of a Piglet Model to Investigate Therapies to Improve Gastrointestinal Structure and Enzyme Activity during TPN
Authors: Park Yoo Kyoung , Monaco Marcia M. , Donovan Sharon M.
Published: April 2003

Nutritional support of preterm infants by total parenteral nutrition (TPN) is common; however, TPN compromises intestinal structure and enzyme activity. Our goal was to develop a piglet model to assess the effect of limited enteral stimulation with formula and insulin-like growth factor-I (IGF-I) on intestinal morphology and enzyme activity. A nutritionally complete TPN solution was infused for 7 days and piglets were gavaged twice daily with 4 ml sterile water, formula, or formula containing 1,000 µg/l IGF-I. Litter mate piglets fed formula served as orally fed controls. On day 7, body weights and plasma hormone profiles of TPN and orally fed piglets were similar. However, intestinal weight, jejunal and ileal villus height and surface area, and mucosal lactase and sucrase activity of TPN piglets was reduced by ∼50%. No effect of limited enteral stimulation or IGF-I was observed likely due to the small volume of formula administered enterally, which resulted in a low dose of IGF-I (4.3 µg IGF-I/kg/day).
Are Biochemical Parameters of Lung Maturation from Gastric, Tracheal, and Pharyngeal Aspirates Comparable?
Authors: Rüdiger Mario , Haupt Renate , Rüstow Bernd , Wauer Roland R.
Published: April 2003

Phospholipid parameters – lecithin/sphingomyelin (L/S) ratio and palmitic acid/stearic acid (P/S) ratio – of gastric (GA), pharyngeal (PA), and tracheal aspirates (TA) have often been used for estimation of lung maturation. However, it was not known whether values from different sources can be alternatively used. The study was performed to test whether P/S and L/S ratios in GA, PA, and TA are comparable. 11 GA, 30 PA, and 10 TA were obtained from infants within 10 min after birth. All infants were healthy, vaginally delivered with no respiratory distress, and had a gestational age ≥34 weeks. Patterns of fatty acids were determined by gas chromatography and the L/S ratio by high-performance liquid chromatography. We found lower L/S ratios in GA (16.5 ± 5.2) when compared with PA (39 ± 16) or TA (41 ± 15; p < 0.01); there were no differences between PA and TA. The P/S ratio was in the same range in PA and TA, but lower in GA. As compared with TA and PA, in GA the relative percentage of palmitic acid of all fatty acids was lower, the percentage of monounsaturated fatty acids, however, higher. We conclude that phospholipid parameters of lung maturation in PA and TA, but not in GA, can be alternatively used.
Maternal and Neonatal Lead Exposure in Southern Italy
Authors: Carbone Ruggiero , Laforgia Nicola , Crollo Elisabetta , Mautone Angela , Iolascon Achille
Published: April 2003

We evaluated the blood lead levels in 159 pregnant women and in their healthy newborns at birth. The blood lead levels were higher in mothers as compared with neonates, with a linear correlation between maternal and neonatal levels. The blood lead levels were also higher in neonates as compared with infants aged 6–12 months, and, besides, 2.5% of the newborns had blood lead levels >10 µg/dl, the actual level of concern according to the Center for Disease Control. The study of blood and urinary lead levels during the 1st week of life showed a steady decrease of blood lead levels, together with increasing levels of urinary lead. The mechanism of renal elimination is important to avoid persistently high free blood lead levels, with possible deposition in tissues with high lead affinity, such as bone. In newborns, the possibility of a functional renal insufficiency during the first days of life suggests that newborns with high cord blood lead levels and impaired renal function could be at high risk of lead toxicity, so that it could be advisable to perform a careful and prolonged follow-up.
Insulin-Like Growth Factor Binding Protein 1 Level in Amniotic Fluid: Correlation with Birth Weight
Authors: Chevallier Bertrand , Lagarde Angélique , Degrelle Hervé , Belaisch-Allart Joelle , Giraudet Paul , Gallet Jean-Paul
Published: April 2003

Insulin-like growth factor binding protein 1 is the predominant insulin-like growth factor binding protein in amniotic fluid. It is produced by the decidua and by fetal tissues, and it is thought to play an important role in fetal growth. We have measured this protein in 58 samples of amniotic fluid, from 13 to 19 gestational weeks, and found a highly significant negative correlation with fetal weight at birth. We conclude that the level of insulin-like growth factor binding protein 1 in amniotic fluid at midpregnancy is a good marker of fetal growth failure.
Responses to Stress and Novelty in Adult Rats Born Vaginally, by Cesarean Section or by Cesarean Section with Acute Anoxia
Authors: Boksa Patricia , Wilson David , Rochford Joseph
Published: April 2003

The aim of this study was to test the hypothesis that alterations in birth conditions, specifically vaginal birth vs. birth by Cesarean section (C-section) vs. birth by C-section with an added period of acute global anoxia, produces long-term differences in behavioral responses to stress or novelty in the rat at adulthood. In comparison to animals born by rapid C-section alone, animals born by C-section with 10 or 15 min of added anoxia were significantly more immobile during forced swim stress administered for 6 trials over several weeks. In a step-down passive avoidance task, there were no group differences in acquisition or retention of the avoidance response. However, when initially placed in the passive avoidance apparatus before delivery of shock, animals born by C-section with 15 min of anoxia required significantly more pretrials to step down from the wooden platform, than did vaginally born or C-sectioned animals. No group differences were observed on measures of exploratory behavior in an elevated plus-maze or of approach behavior either to food or to a novel object in an open field. These findings suggest that birth conditions which include a degree of perinatal hypoxia can contribute to variability in selective responses to stress and novelty in the adult rat.
Long-Chain Polyunsaturated Fatty Acids
Authors: Hamosh Margit , Salem Jr. Norman
Published: April 2003

Long-chain polyunsaturated fatty acids (LC-PUFA) are essential for normal development. Fetal accretion of LC-PUFA occurs during the last trimester of gestation; therefore, premature infants are born with minimal LC-PUFA reserves. Recent studies indicate that the newborn can synthesize LC-PUFA from essential fatty acid precursors; however, the extent of de novo synthesis remains to be established. Postnatally, human milk provides LC-PUFA to the newborn. Maternal LC-PUFA reserves depend upon diet and can be improved by supplementation of docosahexaenoic acid and arachidonic acid during pregnancy and lactation. This in turn affects fetal LC-PUFA accretion and postnatal provision through mother’s milk. Supplementation of formula-fed preterm or full-term infants with docosahexaenoic acid and arachidonic acid leads to plasma and red blood cell LC-PUFA levels similar to those of breast-fed infants. The higher blood and presumably tissue levels of LC-PUFA following supplementation lead, however, to only temporary functional benefits.
Immune Protection of Human Milk
Authors: Xanthou Marietta
Published: April 2003

Human milk contains a very large number of specific and nonspecific immunologic and nonimmunologic factors who provide passive and active protection to the newborn. The immunologic factors are either immunostimulatory or immunosuppressive. The immunostimulatory ones increase host defense mechanisms mainly against infective illness, and the immunosuppressive ones downregulate inflammation and the development of allergies. Furthermore, human milk has been found to promote intestinal growth and maturation and to have immunomodulating effects beyond infancy, later on in life. In conclusion, human milk represents a very valuable weapon for enhancing the immature immunologic system of the newborn and for strengthening its deficient host defense mechanisms against infective or other foreign agents.
Heliox® Tolerance in Spontaneously Breathing Neonates with Bronchopulmonary Dysplasia
Authors: de Gamarra E. , Moriette G. , Farhat M. , Walti H.
Published: April 2003

The use of a gas mixture in which helium is substituted for nitrogen allows a decrease in pulmonary resistances and in resistive work of breathing. This treatment might allow a reduction in energy expenditure in infants with bronchopulmonary dysplasia (BPD) and spare calories for growth. In a preliminary study designed to assess tolerance to Heliox®, 4 infants with BPD and 4 controls were studied firstly when breathing air and secondly when breathing Heliox®, at 10, 20 and 30 min exposure (T10, T20, T30). The following parameters were recorded: respiratory and cardiac rates, room (RT) and skin temperatures (ST) and transcutaneous (Tc) blood gases. When breathing air, TcPO2 was normal in the two groups (mean ± SEM: 70 ± 4 mm Hg in BPD vs. 78 ±4 in controls). TcPCO2 was higher in the BPD group (41 ± 2 vs. 35 ± 1 mm Hg in controls; p = 0.028). Spontaneously breathing Heliox had immediate consequences such as wakening, crying, decrease in ST and hypoxia. Hypoxia was more serious and more rapid in the BPD group. At the 10-min exposure, mean TcPO2 was 39 ± 4 mm Hg in BPD vs. 69 ± 7 in controls (p = 0.042). Hypoxia was immediatly corrected when breathing room air. TcPCO2 was unchanged in both groups.
Maternal and Paternal Perception of Individual Odor Signatures in Human Amniotic Fluid – Potential Role in Early Bonding?
Authors: Schaal Benoist , Marlier Luc
Published: April 2003

Both human mothers and fathers are able to discriminate the odors of 2 samples of amniotic fluid (AF), one from their own newborn infant and one from an unrelated infant. Moreover, both parents are able to accurately identify the odor of the AF from their own infant. They report qualitative similarity descriptions of their infant’s AF odor to the odor of the actual newborn infant and to the odor of the mother, especially at the end of gestation. These data indicate that human AF carries individualized odor properties, the roles of which in the initiation of parent-infant interactions are hypothesized.
Indications of Coagulation and/or Fibrinolytic System Activation in Healthy and Sick Very-Low-Birth-Weight Neonates
Authors: Aronis Sophie , Platokouki Helen , Photopoulos Spiros , Adamtziki Eftychia , Xanthou Marietta
Published: April 2003

A combined hemostatic defect consisting of a reduction in certain procoagulants, anticoagulants (antithrombin III-ATIII-, protein C-PC-) and components of the fibrinolytic system (plasminogen-Plg-) was demonstrated in very-low-birth-weight infants (VLBW <1,500 g) with gestational age 26–32 weeks. Sixteen of them were healthy, 28 were suffering from RDS and 24 from septicemia. The hemostatic defect was more profound in the RDS group, nevertheless increased TAT (thrombin + ATIII complex) and/or PAP values (plasmin + a2-antiplasmin complex) was a more frequent finding in the septicemic group of infants (91.8 vs. 17.9%). Moderate-to-severe thrombocytopenia was detected in a higher percentage in the septicemic (70.8%) than in the RDS group (50%), and increased D-dimers were demonstrated in 34.8 and 28.6% of the infants, respectively. Elevated TAT or PAP values were not always associated with gross coagulation abnormalities, and advanced disseminated intravascular coagulation (DIC) was only documented in 16.7% of the septicemic and 7.1% of the RDS infants. None of the VLBW neonates presented with clinical evidence of thrombosis, although hemorrhagic manifestations were apparent in 34.8 and 14.3% of the neonates with septicemia or RDS, respectively, mainly due to DIC or severe thrombocytopenia. In conclusion, increased TAT and/or PAP values are good indicators of the in vivo activation of the hemostatic system, but still their impact on sick neonates morbidity and mortality remains unknown.
Increase in the Renal Damage Induced by Paracetamol in Rats Exposed to Ethanol Translactationally
Authors: Llamas Javier , Martínez Ma Consolación , Jaramillo-Juárez F. , Muñoz-Fernández Luis , Bustos Luis , Reyes José L.
Published: April 2003

Administration of ethanol (8%) or acetone (1%) to nursing dams in the drinking water, for 10 days, increased the nephrotoxicity of paracetamol (APAP) in the 14-day-old lactating offspring. The percentage of proximal tubular cells with evidence of necrotic damage in male rats was higher in those animals that received APAP (500 mg/kg, i.p.) and whose nursing rats were exposed to ethanol (25.0 ± 8.4%) or acetone (17.2 ± 1.2%), than in the group treated with APAP alone (10.6 ± 1.6%). The activity of urinary N-acetylglucuronidase was also significantly higher in the rats exposed translactationally to ethanol or acetone than in animals treated with the APAP alone. Nephrotoxicity showed a sexual dimorphic pattern with a higher toxicity in male than in female rats. The percentage of necrotic tubules in the male rats not exposed to inductor was 10.6 ± 1.6%, and in female rats 5.0 ± 1.4% (p < 0.05). Animals exposed to ethanol or acetone and treated with APAP showed less weight gain than the group treated only with APAP. Our results suggest that renal toxicity is enhanced in the nursing animals that were exposed, via maternal milk, to ethanol or acetone (inductors of cytochrome P4502E1), than in the control animals. This circumstance may be relevant in alcoholic women while they are lactating.
Platelet-Activating Factor Is an Important Mediator in Hypoxic Ischemic Brain Injury in the Newborn Rat
Authors: Akisü Mete , Kültürsay Nilgün , Coker Isil , Hüseyinov Afig
Published: April 2003

Hypoxic-ischemic encephalopathy is still a very important cause of neonatal mortality and morbidity. Recently, platelet-activating factor (PAF) has been accused of being responsible for the neuronal damage in hypoxic-ischemic brain. We investigated tissue PAF concentrations in hypoxic-ischemic brain injury in immature rats. Endogenous PAF concentration in brain tissue showed a marked increase in hypoxic-ischemic pups (85.6 ± 15.5 pg/mg protein) when compared to that of control (9.05 ± 3.1 pg/mg protein). In addition, we examined the effects of flunarizine, a selective calcium channel blocker, and Ginkgo biloba extract (EGb 761) on endogenous PAF concentration in hypoxic-ischemic brain injury. Endogenous PAF concentrations in both flunarizine-pretreated (16.6 ± 4.8 pg/mg protein) and EGb 761-pretreated (33.5 ± 8.9 pg/mg protein) pups were significantly lower than the untreated group. These results indicate that PAF is an important mediator in immature rat model of cerebral hypoxic-ischemic injury. The suppressor effect of flunarizine and EGb 761 on PAF production may open new insight into the treatment of hypoxic-ischemic brain injury.