Age of sitting unsupported and independent walking in very low birth weight preterm infants with normal motor development at 2 years

Aims:  The aims of this study is to (i) determine the age of sitting unsupported and independent walking in preterm infants with birth weight under 1500 g (very low birth weight, VLBW); (ii) estimate differences between VLBW children and a reference population and (iii) estimate the association between clinical characteristics and late age at sitting and walking.
Methods:  A longitudinal study was conducted of a cohort of 876 children with VLBW. The World Health Organization (WHO) motor development study population was used as a reference. Ages for both skills were established by interview with parents. Means were compared with t -test, ANOVA and Bonferroni adjustment where appropriate.
Results:  The inclusion criteria were complied with 694 patients; 50% of VLBW sat at 7 m corrected age (CA) and walked at 13 m CA. Both motor skills were acquired later (7.3 ± 1.5  and 13.6 ± 2.8 m) compared with the control group (6 ± 1.1  and 12.1 ± 1.8 m). Weight or head circumference at birth below the 10th percentile or the presence of bronchopulmonary dysplasia were associated with delayed acquisition of both skills.
Conclusion:  Very low birth weight infants typically sit unsupported and walk later than term infants. Tables describing reference values for milestones acquisition for different categories of infants (gestational age, birth weight and other determinants) may contribute to inform the decision making process on access to available resources.     

Aspirin: benefit and risk in thromboprophylaxis

Aspirin is often perceived either as a harmless panacea or as a useless poison which causes endless, needless trouble. We have carefully reviewed the literature on all aspects of aspirin and find that neither view is justified. Regular use of even low-dose aspirin (150 mg/day or less) may lead to clinically-important adverse events, particularly haemorrhage. The risk of such an event is considerably outweighed by the benefit for patients with a significant risk of a thromboembolic event. For individuals without a clear risk of thrombosis or thromboembolism, the balance is more even: indiscriminate aspirin- taking is to be discouraged.      

Transforming growth factor-β (TGF-β) activity in urine of patients with glomerulonephritis is related to their renal functional and structural changes

Transforming growth factor-β (TGF-β) has been considered the principal cytokine involved in the pathogenesis of renal fibrosis. In the present study, we evaluated TGF-β activity in occasional samples from 22 normal individuals and 29 patients (11 with focal glomerulosclerosis, 11 with membranous nephropathy, five with Berger disease, one with type I membranoproliferative glomerulonephritis and one with postinfectious glomerulonephritis) using a CCL-64 mink lung cell growth inhibition assay.
A significantly increased urinary TGF-β activity (reported in relation to urine creatinine, Ucreat. and median) was observed in patients with glomerulonephritis compared with normal individuals ( P <0.01). The patients with Berger disease [median (Md)=9.96/10 μg Ucreat.], membranous glomerulonephritis (Md=7.23/10 μg Ucreat.) and focal glomerulosclerosis (Md=16.6/10 μg Ucreat.) showed higher urinary TGF-β than normal individuals (Md=1.09/10 μg Ucreat.) ( P <0.01). We found a positive correlation between the TGF-β activity in the urine of these patients and the incidence of segmental glomerulosclerosis ( r =0.45, P <0.05) and their plasma creatinine levels ( r =0.87, P <0.01). A negative correlation was observed between the TGF-β activity in the urine of these patients and their creatinine clearance ( r =−0.75, P <0.01).
Our data suggest that measurement of urinary TGF-β activity could be a useful non-invasive procedure for the evaluation of renal TGF-β production, permitting the assessment of prognosis and the evaluation of therapeutic efficacy in patients with renal disease.