Initial microbial community of the neonatal stomach immediately after birth

The purpose of this prospective cross-sectional cohort pilot study is to explore the initial microbial community of gastric aspirate fluid as collected immediately after birth and its relationships with mode of delivery and preterm birth. Twenty-nine gastric aspirate samples collected immediately after birth from infants born between 24–40 weeks gestation were analyzed for microbial composition. Total microbial content was low in many samples, with a substantial number sharing taxonomic composition with negative controls. qPCR targeting the 16S rRNA gene showed that infants delivered vaginally had a higher microbial load than infants delivered by C-section. Some pre-term samples showed high relative abundance of genus Ureaplasma, consistent with previous literature that has implicated infections with this taxon as a potential cause of pre-term birth. Vaginally born term infant samples, by contrast, had significantly higher levels of genus Lactobacillus with Lactobacillus crispatus the most dominant species. Microbial evaluation showed that vaginally born term infant gastric aspirate samples had higher levels of lactobacilli than pre-terms. Samples from many infants had low microbial load near the edge of the detection limit.     

The Influence of Rapid Solidification on Corrosion Behavior of Mg60Zn20Yb15.7Ca2.6Sr1.7 Alloy for Medical Applications

Biodegradable magnesium alloys with Zn, Yb, Ca and Sr additions are potential materials with increased corrosion resistance in physiological fluids that ensure a controlled resorption process in the human body. This article presents the influence of the use of a high cooling rate on the corrosion behavior of Mg₆₀Zn₂₀Yb_15.7Ca_2.6Sr_1.7 alloy proposed for medical applications. The microstructure of the alloy in a form of high-pressure die-casted plates was presented using scanning electron microscopy in the backscattered electrons (BSEs) mode with energy-dispersive X-ray spectrometer (EDX) qualitative analysis of chemical composition. The crystallization mechanism and thermal properties were described on the basis of differential scanning calorimetry (DSC) results. The corrosion behavior of Mg₆₀Zn₂₀Yb_15.7Ca_2.6Sr_1.7 alloy was analyzed by electrochemical studies with open circuit potential (E_OCP) measurements and polarization tests. Moreover, light microscopy and X-ray photoelectron spectroscopy were used to characterize the corrosion products formed on the surface of studied samples. On the basis of the results, the influence of the cooling rate on the improvement in the corrosion resistance was proved. The presented studies are novel and important from the point of view of the impact of the technology of biodegradable materials on corrosion products that come into direct contact with the tissue environment.     

Morphological and topographical anatomy of nutrient foramina in the lower limb long bones and its clinical importance

Background

Knowledge regarding nutrient foramina of bones is useful in surgical procedures such as microvascular bone transfer in order to preserve the circulation. The objective of the present study was to study the morphology and topography of nutrient foramina and to determine the foraminal index of the lower limb long bones to provide detailed data on such features.

Method

The study comprised examination of 206 lower limb long bones which included femora, tibiae and fibulae. The nutrient foramina were identified analysed macroscopically and the foramen index calculated. Each bone was divided into five parts and topographical analysis was performed on each section.

Results

Femora had single nutrient foramen in 47.7% of the cases, double foramen in 44.2% of the cases, triple in 3.5% of the cases and an absence of foramen in 4.6%. In the case of tibiae, 98.6% showed single foramen and in 1.4% of the cases, the foramen was absent. With respect to fibulae, 90.2% had single foramen and foramen was absent in 9.8%. The mean foraminal index was 38.9 for the femora, 32.5 for tibiae and 49.2 for fibulae. The majority (51.3%) of the foramina in the femora were located at the 2/5^th part, 98.3% of the tibiae foramina at the 2/5^th part and 60% of the fibulae at the 3/5^th part.

Conclusion

The study provides information on the morphology and topography of nutrient foramina in lower limb long bones. The double foramina were more common in femur and rare in the tibia and fibula. The foramina of the femur and tibia were commonly observed at their upper part, whereas in the fibula they were present on the lower part. This knowledge of the nutrient foramina has to be kept in mind during surgical procedures.     

Utilisation of antithrombotic therapy for stroke prevention in atrial fibrillation in a Sydney hospital: then and now

Objective Evidence from pivotal clinical trials conducted more than a decade ago supports the use of antithrombotic therapy, particularly warfarin, for stroke prevention in atrial fibrillation (AF). Despite the wide dissemination of this evidence since that time, there is anecdotal evidence that utilisation of therapy remains suboptimal, especially in the target elderly population, which is reflected in the development of practice tools such as the TAG Clinical Indicator (??Antithrombotics in AF?? Indicator 1.6, 2007). Therefore, the objective of this study was to determine the current utilisation of antithrombotic therapy for elderly patients with AF in the local setting, and to compare this utilisation with the results of a prior audit (AUDIT 1), as well as against the recommendations of the TAG Clinical Indicator (TAG IND). Setting A major teaching hospital in Sydney, Australia. Method A retrospective audit (AUDIT 2) of medical records of hospital inpatients (aged 65?years, with a significant diagnosis of AF), pertaining to admissions over the 12-month period 1st June 2006?C31st May 2007, was conducted. Main outcome measure Proportion of patients receiving antithrombotic therapy at the point of discharge from hospital. Results A total of 201 patients (mean age 79.8?±?7.8?years) were reviewed in AUDIT 2. Most (85%) patients received antithrombotic therapy (vs. 79.2%, AUDIT 1), with ??warfarin?±?antiplatelets?? most frequently (46.3%) used (vs. 34.5%, AUDIT 1), followed by ??aspirin?±?other antiplatelet?? (33.3% AUDIT 2 vs. 43.1% AUDIT 1). Patients aged 80?years were significantly less likely to receive warfarin therapy, compared to those <80?years (40.2% vs. 52.5%, P?=?0.01). Of those patients who were deemed ??eligible?? for warfarin according to AUDIT 2 (n?=?155), only 55.0% of patients were actually prescribed this treatment. Results obtained by AUDIT 2 and TAG IND were overall comparable. Conclusion Whilst there have been temporal improvements in the overall utilisation of antithrombotic therapy, including warfarin, there are still significant gaps in the translation of evidence from clinical trials to clinical practice. Further sustainable intervention is warranted to help apply treatment recommendations to the target population.     

The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation

Objective: to investigate the impact of frailty on the utilisationof antithrombotics and on clinical outcomes in older peoplewith atrial fibrillation (AF). Design: prospective study of a cohort of 220 acute inpatientsaged 70 years with AF, admitted to a teaching hospital in Sydney,Australia (April–July 2007), with 207 followed up over6 months. Results: a total of 140 patients (64%) were identified as frailusing a validated tool. Frail patients were less likely to receivewarfarin than non-frail on hospital admission (P = 0.002) anddischarge (P < 0.001). During hospitalisation, the proportionof frail participants prescribed warfarin decreased by 10.7%and that of non-frail increased by 6.3%. Over the 6-month follow-up,43 major or severe haemorrhages (20.8%), 20 cardioembolic strokes(9.7%) and 40 deaths (19.2%) were reported. Compared to non-frail,frail participants were significantly more likely to experienceembolic stroke (RR 3.5, 95% CI 1.0–12.0, P < 0.05),had a small non-significant increase in risk of major haemorrhage(RR 1.5, 95% CI = 0.7–3.0, P = 0.29) and had greater mortality(RR 2.8, 95% CI 1.2–6.5, P = 0.01). Conclusion: frail older inpatients with AF are significantlyless likely to receive warfarin than non-frail and appear morevulnerable to adverse clinical outcomes, with and without antithrombotictherapy.     

Postmenopausal hot flushes: A disorder of thermoregulation

The changes in cutaneous and body temperature and cutaneous conductance during hot flushes in eight postmenopausal women were studied. The vasomotor changes occurred approx. 45 sec after the patients experienced the initial subjective symptoms of the attacks. The rise in skin conductance appeared to be a more reliable index of the flushing episode than did the change in skin temperature.On the basis of the changes recorded it is suggested that the hot flush syndrome may represent a specific thermoregulatory disorder rather than being due to a non-specific central autonomic discharge. The episodes may be triggered by a neuroendocrine imbalance following the disruption of ovarian function and fall in estrogen production.In assessing the frequency and severity of hot flushes, and the effects of treatment, objective measurements of skin and core temperature and skin conductance should replace subjective criteria.