Building evidence for practice: a pilot study of newborn bulb suctioning at birth

The purpose of the study was to examine the effects of bulb suctioning on healthy, term newborns and the feasibility of conducting a large-scale study of this practice. In a randomized, controlled two-group design pilot study, 10 newborns received oronasopharyngeal bulb suctioning at birth and 10 did not. Differences in Apgar scores, heart rates, and oxygen saturation levels were determined. Infants were randomized to groups before delivery. The participants were 20 term, healthy newborns of uncomplicated pregnancies. Apgar scores, heart rates, and oxygen saturation levels in the first 20 minutes of life were the main outcome variables. There were no statistically significant differences in Apgar scores between groups. Apgar scores at 5 and 10 minutes were 9 or 10 for all newborns. Newborns receiving bulb suctioning showed a statistically significant, lower heart rate (P=.042) during the first 20 minutes and a significantly higher SpO2 level (P=.005) by 15 minutes of age. Although statistically significant, these findings were not considered clinically significant because values remained within normal parameters.     

Contributions of infertility treatment to very-low-birth-weight multiple birth infants receiving neonatal intensive care

OBJECTIVE: This study was undertaken to determine proportions of very-low-birth-weight (VLBW) multiple birth infants receiving neonatal intensive care whose mothers received various types of infertility treatment and to evaluate infertility treatment-associated morbidity and mortality. STUDY DESIGN: Study infants were multiples with birth weight 401 to 1500 g cared for in Cincinnati neonatal intensive care units from January 1996 to December 2000. Data were obtained retrospectively from the National Institute for Child Health and Human Development Neonatal Research Network registry. Use of infertility treatment (in vitro fertilization, injection or oral ovulation, and intrauterine insemination) was determined by maternal interview or chart review. The generalized estimating equation approach to logistic regression was used. RESULTS: The study included 382 infants of 212 mothers: 201=spontaneous conception (53%), 93=in vitro fertilization (24%), 55=injection (14%), 15=oral (4%), and 18=intrauterine insemination (5%). Neither gestational age nor birth weight differed between groups. More female (58%, P=.003) and white infants (95%, P<.001) resulted from infertility treatment-induced pregnancies than from spontaneous pregnancies. Advancing gestational age significantly decreased odds for all outcomes. CONCLUSION: Of VLBW multiples receiving neonatal intensive care, 47% are associated with infertility treatment. Infertility treatment does not influence outcomes in VLBW multiples.     

Comparison of the rectilinear biphasic waveform with the monophasic damped sine waveform for external cardioversion of atrial fibrillation and flutter

External cardioversion using the monophasic damped sine (MDS) waveform is successful 70% to 94% of the time when using up to 360 J. The rectilinear biphasic (RLB) defibrillator has been shown to be superior in efficacy to the MDS waveform in atrial cardioversion in a small randomized study. This larger, retrospective study compares the results of the RLB waveform with those of the MDS waveform for cardioversion of atrial fibrillation (AF) and atrial flutter in a large cohort of patients. We performed 1,877 external cardioversion procedures in 1,361 patients for AF and atrial flutter by using the RLB defibrillator. We compared these results with those of the MDS defibrillator in 2,025 patients who underwent 2,818 cardioversion procedures. The overall success rates for the RLB defibrillator were 99.1% for AF and 99.2% for atrial flutter, and the corresponding success rates for the MDS defibrillator were 92.4% and 99.8% (p <0.001; RLB superior for AF). The median overall successful energy level for the MDS waveform was 200 J, whereas the corresponding RLB energy level was 100 J. Multivariate analyses demonstrated that underlying clinical conditions or use of antiarrhythmic drugs does not significantly affect overall success rates. Our results from >4,000 procedures confirmed and extended those of the previous report by showing a very high success rate for cardioversion of AF and atrial flutter using the RLB waveform. The MDS waveform was equally effective for atrial flutter but significantly less effective in terminating AF.     

Myelopolyneuropathy and pancytopenia due to copper deficiency and high zinc levels of unknown origin: further support for existence of a new zinc overload syndrome

OBJECTIVE: To describe a patient with idiopathic zinc overload without an identifiable source and secondary copper deficiency causing myelopolyneuropathy and pancytopenia. DESIGN: Case report. PATIENT AND RESULTS: A 46-year-old man presented with severe bone marrow suppression and subsequently developed progressive myelopathy with sensory ataxia. No identifiable cause of myelopathy was detected, and his neuroimaging findings were unremarkable. Plasma analysis demonstrated a low copper level and an increased zinc level (<10 micro g/dL [<12.6-18.9 micro mol/L] and 184 micro g/dL [28.2 micro mol/L], respectively; normal range for both, 80-120 micro g/dL [12.6-18.9 micro mol/L and 12.3-18.4 micro mol/L, respectively) and a low level of ceruloplasmin. There was no evidence for an external source of zinc. Daily oral supplementation with 2 mg resulted in the prompt reversal of hematologic abnormalities, improved but still subnormal plasma copper levels, and normalization of ceruloplasmin values. The patient's neurologic condition deteriorated further, with worsening of myelopathy and development of polyneuropathy. Analyses of plasma copper and zinc levels demonstrated persisting hyperzincemia and subnormal copper levels during 4 years of follow-up. Increased copper supplementation to 8 mg/d partially reversed his neurologic signs. A clinical investigation of 6 siblings and 1 surviving parent did not identify family members with similar abnormalities. CONCLUSIONS: Persistent hyperzincemia without an identifiable external source appears to be a primary metabolic defect, while copper deficiency is a secondary phenomenon, causing hematologic and neurologic abnormalities. Two unrelated patients with similar idiopathic hyperzincemia and hypocupremia have been recently described. This suggests the existence of a new metabolic disorder with idiopathic zinc overload.     

Low-density lipoprotein receptor and apolipoprotein A-I and B expression in human enterocytes

Low-density lipoprotein receptor (LDL-R) was found to be expressed in human small intestine epithelial cells, enterocytes. The relative abundance of LDL-R mRNA and protein was compared with that of apolipoproteins A-I (apoA-I) and B (apoB) in enterocytes and two other cell types: CaCo-2 and HepG2. The LDL-R mRNA content was comparable in three cell types. Human enterocytes expressed 5.2- to 14-fold more apoA-I mRNA than the other cells. In contrast, HepG2 cells expressed 10-to 19-fold more apoB mRNA than CaCo-2 cells and human enterocytes. Immunoprecipitation of [(35)S]methionine pulse-labeled intracellular proteins from these cell types demonstrated that human enterocytes synthesize more apoA-I and apoB, while HepG2 cells synthesize a slightly higher amount of LDL-R.     

A longitudinal study of patient- and observer-rated quality of life in schizophrenia

Patient-rated life satisfaction and observer-rated quality of life (ORQOL) appear to have different determinants in patients with schizophrenia, although most studies conducted to date have used cross-sectional methods or related clinical dimensions at one time point with quality of life (QOL) measured at another. The aim of this study was to investigate the relationship between changes in patient-rated QOL (PRQOL) and ORQOL over time and changes in clinical variables. Two hundred and thirty-one patients taking part in the Schizophrenia Care Assessment Program (SCAP) study at Dandenong in Australia were included in this analysis. Subjective ratings of several domains of social functioning and life satisfaction were taken from the SCAP instrument and comparisons made with data from the QOL Scale rated by research staff, as well as several psychopathology measures. Changes in these scores over 1 year were correlated to investigate relationships between measures. Weak correlations were seen between changes in PRQOL and ORQOL domains. Patient-rated domains related most closely to depressive symptoms (Montgomery-Asberg Depression Rating Scale scores) whereas observer-rated domains related to both negative symptoms and depressive symptoms. Positive psychotic symptoms had little effect on either domain. Longitudinal data appear to confirm that PRQOL and ORQOL are not closely related and may have differing determinants in patients with schizophrenia. They should be considered as separate and complementary outcome variables and utilized accordingly.     

Cortical changes in cholecystokinin mRNA are related to spontaneous pain behaviors following excitotoxic spinal cord injury in the rat

Cholecystokinin (CCK) in the CNS antagonizes the opioid system and has been implicated post-spinal cord injury (SCI) pain. The current study found that excitotoxic SCI alters levels of CCK mRNA levels in the cortex, diencepahlon, and mesencephalon of rats. Animals that developed pain post-SCI had significantly higher levels than animals that did not develop pain. Upregulation of CCK mRNA in the cortex may be related to post-SCI pain in rats.