Post-parotitis myocarditis: case report

In November, 1993,M.G., a 6 year and 11 month-old girl, was admitted at Hospital Infantil Joana de Gusm?o--Florianópolis, SC, Brazil--with post-parotitis myocarditis and congestive heart failure. Three days after admission it was evidenced, on an echocardiogram, a thrombus in the left ventricle apex which, despite of correct treatment, embolized to iliac and small mesenteric arteries. Epidemic parotitis (mumps) is very common, being endemic around the world. Complications are rare and myocarditis, one of them, is more common than diagnosed because of its poor and benign manifestations, generally transient abnormalities of cardiac rhythm and conduction. This case was astonishing because of its rare subsequent event, that is, the formation of a ventricular mural thrombus during an acute myocarditis.     

Effective instruction for English learners

The fastest-growing student population in U.S. schools today is children of immigrants, half of whom do not speak English fluently and are thus labeled English learners. Although the federal government requires school districts to provide services to English learners, it offers states no policies to follow in identifying, assessing, placing, or instructing them. Margarita Calderón, Robert Slavin, and Marta Sánchez identify the elements of effective instruction and review a variety of successful program models. During 2007-08, more than 5.3 million English learners made up 10.6 percent of the nation's K-12 public school enrollment. Wide and persistent achievement disparities between these English learners and English-proficient students show clearly, say the authors, that schools must address the language, literacy, and academic needs of English learners more effectively. Researchers have fiercely debated the merits of bilingual and English-only reading instruction. In elementary schools, English learners commonly receive thirty minutes of English as a Second Language (ESL) instruction but attend general education classes for the rest of the day, usually with teachers who are unprepared to teach them. Though English learners have strikingly diverse levels of skills, in high school they are typically lumped together, with one teacher to address their widely varying needs. These in-school factors contribute to the achievement disparities. Based on the studies presented here, Calderón, Slavin, and Sánchez assert that the quality of instruction is what matters most in educating English learners. They highlight comprehensive reform models, as well as individual components of these models: school structures and leadership; language and literacy instruction; integration of language, literacy, and content instruction in secondary schools; cooperative learning; professional development; parent and family support teams; tutoring; and monitoring implementation and outcomes. As larger numbers of English learners reach America's schools, K-12 general education teachers are discovering the need to learn how to teach these students. Schools must improve the skills of all educators through comprehensive professional development-an ambitious but necessary undertaking that requires appropriate funding.     

Drug sensitivity of Helicobacter pylori strains in children and young people from the region of Łódź

Combined therapy with a proton pump inhibitor and two antibiotics (metronidazole, clarithromycin and amoxicillin or tetracycline) is applied in the treatment of H. pylori infection. The effects of the treatment depend on drug sensitivity of H. pylori. Growing resistance to some of the applied antibiotics has been observed. The aim of the study was to assess drug sensitivity of Helicobacter pylori strains which were isolated from the gastric mucosa of children and young people living in the macroregion of ?ód?. The study comprised 45 children aged between 5 and 18 years. Biopsy specimens were put on transport medium, incubated in microaerophilic environment, then identified. Drug sensitivity to metronidazole, clarithromycin, amoxicillin and tetracycline was assessed. We found resistance to metronidazole in 18% (8/45) children, resistance to clarithromycin in 16% (7/45) children and resistance to both antibiotics in 4% (2/45) children. No resistance to amoxicillin or tetracycline was noted.     

Surgery of intractable epilepsy in infants and adolescents: Case report

Our objective is to present a serie of 20 cases of children under 15 years operated on of intractable epilepsy in the last 12 years in Sanatorio Allende of Córdoba, based on medical records and follow up. Were included 8 patients with cortical dysplasias, 6 with tumors, 2 with Rasmüssen syndrome, 1 with mesial gliosis, 1 with porencephalic cyst, 1 with gliosis due to traumatic brain injury, and 1 with encephalitis history. Localization was temporal in 9 cases and extra-temporal in 11 cases (4 were frontal, 4 occipital, and 3 parietal). There was no surgical mortality. Patients with brain tumors present a satisfactory control over convulsive crises after tumor resection (Engel IA in 100%). Good results were also achieved in nontumor pathologies: 8 cases Engel IA, 1 Engel I B; 3 cases Engel III A, one IV A and other IV C.     

Assessment of long-term results in cleft lip and palate

The study concerned 230 patients (175 UCLP and 55 BCLP) aged 14-20, who had been treated in the years 1972-82 in accordance with the Centre for Congenital Defects programme, at the Department of Plastic Surgery, Medical University of Lód?. The follow-up comprised: aesthetic and functional assessment of the lip, upper vestibule and nose as well as evaluation of occlusion and speech abilities (intelligibility, articulation, nasality). The assessment of lip and vestibule gave good and acceptable results in 97% of UCLP patients and in 89% of BCLP. The external nose appeared aesthetically and functionally good in 67% of UCLP and in 94% of BCLP. The defects of occlusion, mainly various forms of cross-bite, were found in 48% of UCLP, who had undergone orthodontic treatment. The maxillo-occlusal defects with no prior orthodontics were found in 63% of UCLP. Alike the defects of occlusion in untreated BCLP were most frequent. The intelligibility and articulation of speech were significantly better in patients who had undertaken the postoperational speech therapy (95%:75%). The assessment in general presented better results in UCLP patients, who had been submitted not only to surgery but also took up orthodontic treatment and speech therapy.     

Differences between the nutritional status of children in public preschools and nutritional transition

OBJECTIVE: To verify if there are different patterns of nutritional status among preschool children, and if these patterns deserve special interventions. METHODS: This cross-sectional study included 1,200 children from public preschools in Cosmópolis, a small town in the state of S?o Paulo. The z scores indices for height/age, weight/age, and weight/height were analyzed in terms of age, sex, type of school, and school location. RESULTS: Anthropometric indices were similar to those of the reference population (NCHS). Males had lower indices than females. Important differences in anthropometric indices were found among children from different schools. Higher prevalence of moderate deficits in height and weight was observed in children from non-downtown areas, while higher prevalence of obesity was found in children from downtown areas. However, the prevalence of obesity was higher than the prevalence of malnutrition even in schools located in non-downtown areas. CONCLUSIONS: We concluded that even in a small city and in a relatively homogeneous group, it is possible to detect different nutritional patterns in subgroups of the population. The differences related to nutritional status, and the high prevalence of obesity among children from public schools, point out the need for different approaches and interventions.     

Congenital syphilis: incidence among newborns

OBJECTIVE: To determine the incidence of congenital syphilis among newborns at the maternity of a public hospital. METHODS: The study was conducted at the maternity of Funda??o Santa Casa de Misericórdia do Pará, from May to September 1996; 361 mothers were interviewed, and physical examination was performed in their newborns. Serum samples from both, mothers and neonates, were tested using three methods: VDRL, FTA - Abs, ELISA IgM. The diagnosis of congenital syphilis was established according to the criteria defined by Ministério da Saúde in 1993. RESULTS: The rate of congenital syphilis was of 9.1% (33); in 14 cases, there were one or more signs of the disease: prematurity, hepatomegaly, stillbirth, splenomegaly, perinatal death, abdominal distention, nasal stuffiness, jaundice, newborn small for gestational age. The majority of the infected mothers belonged to the age group of 20-35 years (81.8%); 60.6% were married; 63.6% received prenatal care; 48.5% reported previous spontaneous abortion, and 12.1% previous stillbirth. The rate of bisexuality among fathers was of 9.1%. CONCLUSION: The syphilis control measures and the prenatal care, have not been sufficient to prevent the high rate of the disease.     

Breastfeeding, socio-economic conditions and nutritional status of children younger than 12 months in Brazil

Taking account of socio-economic determinants such as maternal education and family income, nutritional status and its relationship to breastfeeding and socio-economic conditions were studied in 419 children aged 3-12 months in the city of Niterói in south-eastern Brazil. Data were obtained by sampling a population during a high coverage (90%) vaccination campaign in 1992. After stratifying by maternal educational level, the relative risk (prevalence ratio) for height-for-age (H/A) Z-score < -1 in relation to no breastfeeding was 2.2 (95% CI 1.1-4.2) for families where mothers had been educated for less than 4 years and 0.7 (95% CI 0.4-1.1) otherwise, indicating a significant interaction (modifying effect) between breastfeeding and the control variable (chi 2 = 7.4; p = 0.006). Similar results were found when family income was used as the stratification variable (RR 2.2, 95% CI 1.1-4.3 in the lower and RR 0.7, 95% CI 0.4-1.2 in the higher income stratum; chi 2 = 6.7; p = 0.009). The population-attributable risk fraction indicated that in the age group analysed a reduction of about 40% in the number of children with HAZ < -1 could be achieved in low-income/low-education families by the widespread adoption of breastfeeding.     

Immunological evaluation of 60 children with AIDS

OBJECTIVE: The immunologic defects that occur in children with HIV infection are important tests to both diagnosis and therapeutic response. The objective of this study was to verify the immunologic abnormalities in 60 children with AIDS, in Florianópolis, Santa Catarina State, Brazil. METHODS: Serum immunoglobulin levels were determined by nephelometry and compared to a normal pattern for Brazilian children. The lymphocyte T helper (CD4+) and the lymphocyte T suppressor (CD8+) count and percentage, and the ratio between them, determined by commercial flow cytometry, were compared to a pattern for healthy children of HIV-positive mothers. RESULTS: The mean serum IgG levels was higher in the children with AIDS (p<0.005). The mean serum IgM levels was higher in the children with AIDS in the age group between 13 and 108 months (p<0.005). The CD4+ lymphocytes count was below the inferior limit of the 95% confidence interval of the median reference values to each group of age in 50 (84.7%) of the 59 determinations. The CD4+ lymphocytes percentage was much lower than the percentages of reference. The graph curve of the medians of the ratio between lymphocytes CD4+ and CD8+ to each group of age was below the fifth percentile of the graph curve of the medians of reference. CONCLUSIONS: The hypergamaglobulinemia and the lymphocyte T CD4+ count and percentage are sensitive indicators of HIV infection, observed in the present study. Immunologic evaluation of the HIV-positive children is recommended, including those younger than 18 months of age.     

Study of intrauterine growth of normal newborn infants

OBJECTIVE: To evaluate the intrauterine normal growth profile and its variations. To draw an intrauterine growth standard at the maternity ward of Hospital Universitário Antonio Pedro (UFF-RJ) by studying the variables of weight, length, cephalic perimeter and ponderal index, at birth, from single foetus pregnancies. We compare those curves with those in other national research works, as well as with the classical one by Lubchenco.METHODS: The starting number of 1566 live births which happened between April, 1992 and September, 1993 was cut down to 1031 due to exclusions resulting from interfering factors of foetus growth (Hypertensive Disease of Pregnancy, smoking mother, chronic arterial hypertension and major malformations). We also excluded from analysis those foetus of mothers who could not remember the date of their last period or when it was discordant in more than a week from Dubowti?s score.RESULTS: Comparing this standard of intrauterine growth to those chosen in literature, the present values were similar to other national curves that exclude intrauterine growth interfering factors. Comparing our curve with the classical Lubchencós curve, we observed higher mean values at lower gestational ages than the ones in Denvers study, and lower late desaceleration of the ponderal gain in the present one.The Ponderal Indexes of the present study have higher mean values compared to the ones in other studies, denoting, perhaps, higher prevalence of type I, or symmetric, intrauterine growth retard pattern.CONCLUSION: This study proposes a standard which is adequate to the assessment of intrauterine growth of similar populations.     

Epstein-Barr virus infection in children with AIDS

OBJECTIVE: The association of the HIV and Epstein-Barr virus infections has been reported in several studies, specially in children that present lymphocytic interstitial pneumonitis. The analysis of the incidence of Epstein-Barr virus infection was performed in children with AIDS, in those with AIDS with and without lymphocytic interstitial pneumonitis, comparing to children without HIV infection. METHODS: A cross-sectional study was performed with 60 children with AIDS and 54 children not infected by HIV, matched by sex and age, in the Hospital Infantil Joana de Gusm?o in Florianópolis city, Santa Catarina State, Brazil, between June 1994 and June 1995. The selection of the cases followed the order of the consultation. The detection of antibodies against Epstein-Barr capsid antigen was performed by standard indirect immunofluorescence techniques and ELISA, and antibodies against nuclear antigen only by ELISA. The stage of the infection was defined according to serologic responses. RESULTS: Lymphadenopathy occurred in 59 cases (98.3%), hepatomegaly in 51 (85.0%), splenomegaly in 46 (76.7%), recurrent bronchopneumonia in 41 (68.3%). Lymphocytic interstitial pneumonitis was observed in 21 cases (35.0%), 90.5% of which showed positive serologic reactions to EBV. The geometric mean of the IgG against capsid antigen titers was 1:439.5 in the cases group and 1:42.8 in the controls. The IgM against capsid antigen by indirect immunofluorescence techniques was positive in 16 (26.7%) of the 60 cases and only in one of the 53 controls (1.9%) (p=0.0002). The primary Epstein-Barr virus infection was evidenced with greater frequency in the children with AIDS (p<0.0001), as well as the reactivated infection (p=0.0745). CONCLUSIONS: The incidence of primary and reactivated Epstein-Barr virus infection was more frequent in the patients with AIDS. The primary and reactivated Epstein-Barr virus infection was observed in almost all of the patients with diagnosis of lymphocytic interstitial pneumonitis (90.5%).     

Risk factors to periventricular-intraventricular hemorrhage in newborns weighing less than 2000g

OBJECTIVE: To study the incidence and analyze risk factors to neonatal periventricular-intraventricular hemorrhage; to suggest a working protocol for diagnosis in newborns at risk.METHODS: This is a cohort prospective study including 120 out of 129 children weighing less than 2000g born from May 18 th, 1994 to May 17 th,1995 at the Hospital das Clínicas da UFMG. The study group comprised 39 newborns with the ultrasound diagnosis of periventricular-intraventricular hemorrhage; the control group comprised 81 newborns who although submitted to the same evaluation protocol did not show any echographic signs of hemorrhage. The ultrasound examinations were all done by the same researcher who was not aware of the clinical history or the neurologic and laboratory examinations. The hemorrhage was classified according to Papilés criteria: grade I (13%); grade II (7%); grade III (9%) and grade IV (3%).RESULTS: Low gestational age, low birth weight, masculine sex, vaginal delivery, and neonatal sepsis were significantly associated (p < 0.05) with periventricular-intraventricular hemorrhage in univariate analysis. Apgar score in the first or fifth minute and Battagliás and Lubchenkós classification for the weight in relation to gestational age were not predisposing factors to the hemorrhage. Low gestational age (p = 0.002), vaginal delivery (p = 0.037), and masculine sex (p = 0.016) kept statistical significance after multivariate adjustment. Birth weight may substitute for gestational age in the multivariate model because they are highly associated. The best cutoff point to screen for periventricular-intraventricular hemorrhage was 1750 g instead of the traditionally adopted point of 1500 g. CONCLUSIONS: The incidence of neonatal periventricular-intraventricular hemorrhage was similar to those reported by other studies. Low gestational age or low birth weight, vaginal delivery and masculine sex were the most important risk factors to the hemorrhage. The screening cutoff point of 1750 g seems to be more adequate than the commonly used birth weight of 1500 g.     

K-12 educational outcomes of immigrant youth

The children from immigrant families in the United States make up a historically diverse population, and they are demonstrating just as much diversity in their experiences in the K-12 educational system. Robert Crosnoe and Ruth López Turley summarize these K-12 patterns, paying special attention to differences in academic functioning across segments of the immigrant population defined by generational status, race and ethnicity, and national origin. A good deal of evidence points to an immigrant advantage in multiple indicators of academic progress, meaning that many youths from immigrant families outperform their peers in school. This apparent advantage is often referred to as the immigrant paradox, in that it occurs despite higher-than-average rates of social and economic disadvantages in this population as a whole. The immigrant paradox, however, is more pronounced among the children of Asian and African immigrants than other groups, and it is stronger for boys than for girls. Furthermore, evidence for the paradox is far more consistent in secondary school than in elementary school. Indeed, school readiness appears to be one area of potential risk for children from immigrant families, especially those of Mexican origin. For many groups, including those from Latin America, any evidence of the immigrant paradox usually emerges after researchers control for family socioeconomic circumstances and youths' English language skills. For others, including those from Asian countries, it is at least partially explained by the tendency for more socioeconomically advantaged residents of those regions to leave their home country for the United States. Bilingualism and strong family ties help to explain immigrant advantages in schooling; school, community, and other contextual disadvantages may suppress these advantages or lead to immigrant risks. Crosnoe and Turley also discuss several policy efforts targeting young people from immigrant families, especially those of Latin American origin. One is the DREAM Act, proposed federal legislation to create a pathway to citizenship for undocumented youth who meet certain criteria. Another effort includes culturally grounded programs to support the college preparation of immigrant adolescents and the educational involvement of immigrant parents of young children.     

成纤维生长因子在大鼠后肢骨骼发育早期不同阶段表达的变化及意义

目的通过大鼠肢体发育早期血清学成纤维生长因子（fibroblast growth factors,FGFs）的表达以及后肢标本中碱性成纤维生长因子（base fibroblast growth factor,bFGF）的表达情况,观察其在大鼠后肢肢体骨骼发育早期过程中,组织学上随时问变化的规律。方法将5只清洁级孕鼠的新生鼠分组为A、B、C、D、E五组,分别为10、6、6、8、6、6只。用ELISA法测定各组血清中FGF的浓度,并对其后肢标本进行bFGF的免疫组化染色,从而观察bFGF在关节软骨、骨骺、干骺端及骨膜中的表达情况。结果在新生小鼠的后肢标本免疫组化染色中,bFGF在软骨、骨膜和关节面均有表达,且随出生后时问的变化存在一定的规律：①在关节软骨中bFGF在关节面软骨的表达要强于中心部位的软骨,这种表达随出生后天数增加呈逐渐减弱的趋势。@bFGF在骨骺部增殖层和肥大细胞层以及骨膜内早期表达较强,随时间变化呈逐渐减弱趋势,在出生后10d以后bFGF表达已不明显。③在干骺端成骨细胞内bF-GF的表达不同于它在其他组织内的表达,一直呈现为较高表达,并不随生后时间的延长而呈现减弱趋势。结论在大鼠后肢发育早期,bFGF在后肢肢体各组织中存在良好的表达,提示它在肢体发育过程中与软骨增殖、关节发育与关节内软骨基质的形成和发育有密切的关系。     

Extrapyramidal syndrome following chloroquine therapy.

Chloroquine is considered essentially nontoxic when used for the chemosuppression of malaria, but gastrointestinal upsets, headache, blurring of vision, pruritis, and uritcaria may occur during chloroquine therapy. Recently, Bhargava et al. and Eronini and Eronini have reported the extrapyramidal syndrome (EPS) following chloroquine therapy in adults. The clinical manifestations included upward rolling of the eyeballs, retraction of neck and back, trismus with marked difficulty in speech, and coarse tremors. Observations of 4 instances of EPS in children following chloroquine therapy for malaria are reported. A 2-1/2 year old girl was admitted to the All India Institute of Medical Sciences Hospital with a 4 day history of intermittent high grade pyrexia with chills and rigors. Following treatment with oral chloroquine in the recommended therapeutic dosage, the fever responded, but the child became drowsy and developed paroxysms of involuntary movements of the tongue, torticollis, torsion dystonia of the limbs, and parosysms of tonic muscular spasms. She completely recovered spontaneously within 48 hours. The 2nd case was that of a 12-year old female brought to the hospital with a 15-day history of intermittent high grade fever with chills and rigors. The patient was started on chloroquine sulfate in the recommended therapeutic dose. After an interval of 4 days she developed coarse tremors of the hands, upward rolling of the eyeballs, episodic deviation of the angle of the mouth towards the left, and trismus. These symptoms disappeared spontaneously within 8 hours. A 6-year old girl, the 3rd case, developed episodes of opisthotonous, upward rolling of the eyeballs, protrusions of the tongue, intermittent writhing movements of the upper limbs, and drowsiness following the ingestion of 6 tablets of chloroquine sulfate for suspected diagnosis of malaria. She spontaneously recovered from EPS over a period of about 48 hours. The 4th case, a 7-year old boy, gave a history of high grade fever with chills and rigors of 1 day's duration. He developed drowsiness, tonic spasms of the neck, upward rolling of the eyeballs, and writhing contortions of all limbs about 2 hours following intravenous administration of 100 mg of chloroquine. 8 hours later an additional 100 mg chloroquine was given intravenously for the mistaken diagnosis of cerebral malaria. On examination the child was drowsy, had generalized stiffness, torticollis, and trismus. He recovered gradually over a 48-hour period without any specific therapy. The exact mechanism of production of EPS remains uncertain.     

年龄与发育进程问卷中文版的婴幼儿发育筛查界值标准研究

目的 研究年龄与发育进程问卷中文版(ASQ-C)不同界值对婴幼儿发育筛查的效度及准确性.方法 收集了3～31个月婴幼儿269例.由父母/照看人完成婴幼儿月龄相应的ASQ-C,由专业人员用贝利婴儿发育量表第二版(BSID Ⅱ)测试婴幼儿.采用BSID Ⅱ平均值((-x))-2标准差(s)为发育迟滞的界值、(-x)-s为可疑发育迟滞和发育迟滞的界值,检验不同ASQ-C界值的效度及准确性.结果 BSID Ⅱ为(-x)-2 s时,ASQ-C为(-x)-2 s的一致百分率为83.64%,敏感度及特异度都在80%以上、ROC下面积为0.86;ASQ-C为(-x)-1.5 s的一致百分率为71.75%,敏感度为100.00%、特异度为68.72%、ROC下面积为0.84;ASQ-C为(-x)-s的一致百分率为55.02%,敏感度为100.00%、特异度为50.21%、ROC下面积为0.75.BSID Ⅱ为(-x)-s时,ASQ-C为(-x)-2 s的一致百分率为85.87%,敏感度为68.57%,特异度为91.96%、ROC下面积为0.77;ASQ-C为(-x)-1.5 s的一致百分率为80.67%,敏感度及特异度都在70%以上、ROC下面积为0.82;ASQ-C为(-x)-s的一致百分率为68.40%,敏感度为94.29%、特异度为59.30%、ROC下面积为0.80;BSID Ⅱ为(-x)-(1～2)s时,ASQ-C为(-x)-2 s、(-x)-1.5 s及(-x)-s的识别率分别为56.82%、77.27%及90.91%.结论 识别婴幼儿发育迟滞,ASQ-C的(-x)-2 s效度最好,准确性最高;识别婴幼儿可疑发育迟滞和发育迟滞,ASQ-C的(-x)-1.5 s敏感度及特异度都比较适宜,准确性最高;识别婴幼儿可疑发育迟滞,ASQ-C的(-x)-s识别率最高.     

Investigation of the transport of trace elements across barriers in humans: studies of placental and mammary transfer

The barrier function of the human mammary gland for selected trace elements was evaluated by analysing 27 maternal sera and corresponding colostrum samples for 14 trace elements. To investigate the impact of the human placenta at the end of gestation on the transfer of 17 trace elements from the mother to the baby, 29 maternal and corresponding umbilical cord sera (UCS) were studied. The uptake of trace elements from the UCS by the fetus was investigated in nine pairs of arterial and venous UCS. In colostrum, the concentration of Cu was 19%, of Se 47%, of Co 80%, of Mg 146%, of Ca 222%, of Sn 228%, of Mn 275%, of Mo 814%, and of Zn 1470% of that of the maternal sera. For Cd and Pb the corresponding values were 200% and 325%, respectively. These data show that the mammary gland can exert an activating as well as an inhibiting effect on the trace element transfer. A concentration gradient mode of action for the transfer of Li, Mo and Sr could be found. In UCS the concentration of Cu was 20%, of Se 55%, of Co 60%, of Sn 85%, of Mo 100%, of Mg 105%, of Ca 120%, of Zn 148%, and of Mn 150% of that of the maternal sera. The corresponding values for Cd were 66% and for Pb 50%. Conclusions: These findings indicate that the placenta can exhibit an activation or inhibition on transfer as well as a gradient mode of action as for Mo, Cs, Li and Sr. The uptake of essential trace elements from venous UCS by the unborn ranged from 2.5% for Ca to 16.7% for Mo. Both the placenta and the mammary gland can exert an activating, inhibiting or gradient mode of action for selected trace elements, the biological impact of which needs to be further elucidated.     

Glycosylation of therapeutic proteins in different production systems

Glycosylation plays an important role in a number of therapeutic proteins, including monoclonal antibodies. The enzymatic activity of a therapeutic protein is mainly determined by the protein structure, whereas the pharmacokinetics, pharmacodistribution, solubility, stability, enhancement of effector function and receptor binding are all influenced by the carbohydrate moiety. Hyperglycosylated proteins show increased serum half-life, are less sensitive to proteolysis and more heat-stable compared with the non-glycosylated forms. Molecular engineering of the TNK-tissue plasminogen activator molecule results in a more complex type of glycosylation and increases the half-life of the protein, which allows a single bolus injection at a lower dose for the treatment of acute myocardial infarction. Antibody-dependent cell cytotoxicity (ADCC) is determined partially by the specific N-glycosylation of the Fc domain of the monoclonal antibody. Specific glycoforms of monoclonal antibodies, which interact solely with the FcgammaRIIIa receptor of natural killer cells, result in superior ADCC compared with heterogeneous glycoforms that interact with different Fc receptors. This demonstrates that glycoengineering for directed glycosylation of therapeutic proteins can improve the therapeutic effect. While the amino acid sequence of the therapeutic protein is determined by the nucleotide sequence of the inserted gene, glycosylation depends on the glycosylating enzymes in the endoplasmatic reticulum and the Golgi apparatus of the eukaryotic host cell. In addition, the glycosylation of the therapeutic protein is affected by the culture medium used, the efficiency of protein expression and the physiological status of the host cell. CONCLUSION: For a given protein, changes in the type of host cell, composition of the culture media and fermentation conditions during process development will most likely result in changes in the site occupation and heterogeneity of glycosylation. This, of course, can influence the therapeutic profile. Therefore, the early selection of the host cell and selection of upstream parameters are key in the process development of a product.     

Embryopathy and diabetic fetopathy in a premature stillborn infant. Case report and review of the disease picture

The diabetic embryopathy syndrome comprises a number of developmental anomalies among fetuses of diabetic mothers. Fetopathia diabetica, on the other hand, is characterized by typical, hormonal, and metabolic dysfunctions and their morphological sequelae in fetuses and offsprings of diabetic mothers. We observed the combination of both these conditions in an immature stillborn fetus. The 34 year-old diabetic mother, who had been treated by insulin since age 16, was first seen at 27 weeks of gestation. Sonography revealed severe congenital malformations of the fetus, and a late abortion was induced. The stillborn female revealed the typical congenital malformations of the diabetic embryopathy syndrome, such as abnormalities of face and skull, skeletal malformations of the thorax, spine, and lower extremities, and malformations of the heart, great vessels and the genitourinary system. We, too, found the characteristic features of fetopathia diabetica, i.e. obesity, macrosomia, increased weight and size of the internal organs, polynesia and macronesia of the pancreas, increased extramedullary hematopoiesis and cellular depletion of lymphoid tissues. A review of the literature revealed various hypotheses about the etiology and pathogenesis of both conditions.     

Physiologic sequelae of prematurity: the nurse practitioner's role. Part IV. Anemia

Anemia in the immediate newborn period may be caused by hemolysis, by a failure of red-cell production, or by a combination of both. However, anemia of prematurity often is the result of hemolysis, of a lack of erythropoietin, and/or of nutritional deficits. Transfusion without a search for the cause may obscure the underlying pathology of the anemia. Because severe anemia can be life-threatening, prompt diagnosis and treatment are required. In this article, the fourth of a series of articles on the sequelae of prematurity, a discussion of the pathophysiology, signs and symptoms, data collection, treatment modalities pertinent to the anemia of prematurity, and parental education are discussed.