Early developmental outcome after the Norwood procedure for hypoplastic left heart syndrome

OBJECTIVE: To assess intellect and adaptive behavior in children with hypoplastic left heart syndrome (HLHS) who had undergone at least two surgical stages of the Norwood procedure. METHODS: Fourteen children with HLHS >3 years of age participated in the study. The patients underwent intelligence quotient (IQ) testing, and their parents were interviewed regarding their children's adaptive behavior. Results were compared with those of 10 family controls. Outcomes were studied for possible correlation with perioperative variables. RESULTS: Among the HLHS patients, the median scores for full scale IQ and adaptive behavior were 88 and 91, respectively (normal = 100 +/- 15). One child met criteria for mental retardation. Family controls scored generally higher than did HLHS patients, but only differences in adaptive behavior were statistically significant. A negative correlation was found between stage I circulatory arrest time and full scale IQ. CONCLUSIONS: Children with HLHS most often function in the low-normal range of intelligence and adaptive behavior. A prolonged circulatory arrest time may result in decreased intellectual function.     

Lipid peroxidation in human milk and infant formula: effect of storage, tube feeding and exposure to phototherapy

Preformed lipid peroxidation products present in the feed may contribute to the total reactive oxygen radical load infants have to deal with and may play a role in the pathogenesis of necrotizing enterocolitis and bronchopulmonary dysplasia. In this study, the occurrence of lipid peroxidation in human milk and feeding formulas for preterm babies was evaluated in vitro. Free linoleic acid (18:2) and its hydroperoxide (18:2OOH) were measured by gas chromatography-mass spectrometry and the concentration of 18:2OOH and the 18:2OOH/18:2 ratio were used as indices of peroxidation. In all feeds peroxidation products were present, but the proportion of peroxidized 18:2 was greater in infant formula. Storage of human milk (+ 4°C for four days) increased lipid peroxidation. Exposure to light during tube feeding incrcased pcroxidation in infant formula but not in human milk. Different procedures for preparation, storage and feeding may decrease the concentration of these potentially toxic peroxidized lipids in human milk and infant formula.     

Comparison of health‐related quality of life and emotional distress among Chinese cancer survivors

The purpose of this study is to compare health‐related quality of life (HRQoL) and emotional distress among diverse cancer survivors who had completed all treatment within the previous year. A convenience sample of 353 cancers survivors (lung, head and neck, breast and prostate cancers) were recruited to complete a survey, which consisted of (i) Hospital Anxiety and Depression Scales; (ii) Chinese version of the Functional Assessment of Cancer Therapy—General version; and (iii) demographic and clinical data. The HRQoL scores were similar among the four types of survivors. Mild anxiety and depression levels were reported, but no significant difference was noted. Younger females with financial burdens and uncertain prognosis were particularly associated with HRQoL and emotional distress. Further studies are essential to identify specific problems that cancer patients experience after cancer diagnosis that might lead to the early detection of those most at risk of ongoing problems.     

香港血红蛋白病分析研究——玛丽医院五年经验总结

本研究的目的是分析香港血红蛋白病的类型分布,介绍筛选病例的经验以及用统计学方法找出一些在筛选及鉴别血红蛋白病方面有用的方法。结果显示,香港以HbE为最多(69％),其中杂和性HbE占大多数。RBC在筛选血红蛋白病方面意义不大,而RDW和MCV在筛选血红蛋白病方面较MCH和Hb更为重要。另外,相关分析显示,RDW与MCV,Hb,MCH和RBC呈负相关,这在鉴别某些红细胞疾病方面可能是有用的。     

Dengue disease severity in Indonesian children: an evaluation of the World Health Organization classification system

Background  

Dengue disease severity is usually classified using criteria set up by the World Health Organization (WHO). We aimed to assess the diagnostic accuracy of the WHO classification system and modifications to this system, and evaluated their potential practical usefulness.     

Garment needs of pregnant women based on content analysis of in‐depth interviews

Aims. This study aims to identify the needs, concerns and problems of pregnant women when using maternity support garments. Background. Maternity support belt is regarded as helpful in reducing low back pain during pregnancy. However, several garment‐related problems exist which might lead to poor adherence behaviour undermining the benefit of garment therapy. Design. A qualitative exploratory study. Methods. Semi‐structured interviews were conducted with 10 pregnant Chinese women who experienced low back pain during pregnancy. All the interviews followed an interview guide and different maternity support garments were shown to the participants as a method of tangible objects to stimulate responses. Content analysis was used to analyse the data. Results. The results showed that 60% of pregnant women discontinued using maternity support garments due to excessive heat, perceived ineffectiveness, itchiness, excessive pressure around the abdomen and inconvenience of adjustment. The content analysis generated five main themes of needs including effective function, safety, skin comfort, ease to put on and take off and aesthetics of maternity support garments. Discussion. The findings of the five main themes of needs were largely consistent with previous studies examining medical garments for overall satisfaction and compliance. The results revealed that women’s physiological and psychological changes during pregnancy influenced their clothing preferences on both functional and aesthetical values. Conclusions. Maternity support garments are convenient and easily‐accessible therapy to manage LBP during pregnancy and are frequently recommended and worn by pregnant women. However, inappropriate choice of garment therapy not only led to ineffectiveness but also undesirable effects. The key findings of the five main themes of garment needs in pregnant women will facilitate healthcare professionals in providing evidence‐based advice to assist patients in the selection of an appropriate and optimal maternity support garment. Relevance to clinical practice. These recommendations in the clinical practice will assist patients in making well informed treatment decisions and ultimately improve the quality of care.     

Social, emotional, and behavioral functioning of children with cancer

OBJECTIVE: It was hypothesized that children with cancer would have more social problems and difficulties with emotional well-being than case control, same race/gender, similarly aged classmates. STUDY DESIGN: Using a case controlled design, children with any type of cancer requiring chemotherapy except brain tumors (n = 76), currently receiving chemotherapy, ages 8 to 15, were compared with case control classroom peers (n = 76). Peer relationships, emotional well-being, and behavior were evaluated based on peer, teacher, parent, and self-report, and were compared using analysis of variance and structural equation modeling. RESULTS: Relative to case controls, children with cancer were perceived by teachers as being more sociable; by teachers and peers as being less aggressive; and by peers as having greater social acceptance. Measures of depression, anxiety, loneliness, and self-concept showed no significant differences, except children with cancer reported significantly lower satisfaction with current athletic competence. There were also no significant differences in mother or father perceptions of behavioral problems, emotional well-being, or social functioning. Scores on all standardized measures were in the normal range for both groups. Comparisons of the correlation matrices of children with cancer and to the correlation matrix of the comparison children using structural equation modeling suggested they were not significantly different. CONCLUSIONS: Children with cancer currently receiving chemotherapy were remarkably similar to case controls on measures of emotional well-being and better on several dimensions of social functioning. These findings are not supportive of disability/stress models of childhood chronic illness and suggest considerable psychologic hardiness.     

Rhabdomyosarcoma cells show an energy producing anabolic metabolic phenotype compared with primary myocytes

Background

The functional status of a cell is expressed in its metabolic activity. We have applied stable isotope tracing methods to determine the differences in metabolic pathways in proliferating Rhabdomysarcoma cells (Rh30) and human primary myocytes in culture. Uniformly ¹³C-labeled glucose was used as a source molecule to follow the incorporation of ¹³C into more than 40 marker metabolites using NMR and GC-MS. These include metabolites that report on the activity of glycolysis, Krebs' cycle, pentose phosphate pathway and pyrimidine biosynthesis.

Results

The Rh30 cells proliferated faster than the myocytes. Major differences in flux through glycolysis were evident from incorporation of label into secreted lactate, which accounts for a substantial fraction of the glucose carbon utilized by the cells. Krebs' cycle activity as determined by ¹³C isotopomer distributions in glutamate, aspartate, malate and pyrimidine rings was considerably higher in the cancer cells than in the primary myocytes. Large differences were also evident in de novo biosynthesis of riboses in the free nucleotide pools, as well as entry of glucose carbon into the pyrimidine rings in the free nucleotide pool. Specific labeling patterns in these metabolites show the increased importance of anaplerotic reactions in the cancer cells to maintain the high demand for anabolic and energy metabolism compared with the slower growing primary myocytes. Serum-stimulated Rh30 cells showed higher degrees of labeling than serum starved cells, but they retained their characteristic anabolic metabolism profile. The myocytes showed evidence of de novo synthesis of glycogen, which was absent in the Rh30 cells.

Conclusion

The specific ¹³C isotopomer patterns showed that the major difference between the transformed and the primary cells is the shift from energy and maintenance metabolism in the myocytes toward increased energy and anabolic metabolism for proliferation in the Rh30 cells. The data further show that the mitochondria remain functional in Krebs' cycle activity and respiratory electron transfer that enables continued accelerated glycolysis. This may be a common adaptive strategy in cancer cells.