Bed-sharing in the first four months of life: a risk factor for sudden infant death

AIM: To investigate the risk of sudden infant death in the Netherlands during bed-sharing in the first half year of life and the protective effect of breastfeeding on it. METHODS: During a 10-year period between September 1996 and September 2006 nationwide, 213 cot deaths were investigated. RESULTS AND DISCUSSION: Of 138 cot deaths of less than 6 months of age, 36 (26%) bed-shared. In a reference group of 1628 babies from infant welfare centres only 9.4% were bed-sharing in the night prior to the interview. After correction for smoking of one or both parents the odds ratio for cot death during bed-sharing with parents decreased with age from 9.1 (CI 4.2-19.4) at 1 month, to 4.0 (CI 2.3-6.7) at 2 months, to 1.7 (CI 0.9-3.4) at 3 months and to 1.3 (CI 1.0-1.6) at 4 through 5 months of age. The excess risk (OR > 1) associated with bed-sharing is itself not significantly influenced by the presence or absence of breastfeeding. CONCLUSION: Bed-sharing is a serious risk factor for sudden infant death for all babies of less than 4 months of age. From 4 months onwards bed-sharing did not contribute significantly to the risk of cot death anymore in our study.     

How long does it take to coil an intracranial aneurysm?

Introduction The change in the treatment of choice for intracranial aneurysms from clipping to coiling has been associated with an important change in logistics. The time needed for coiling is variable and depends on many factors. In this study, we assessed the procedural time for the coiling of 642 aneurysms and tried to identify predictors of a long procedural time. Methods The procedural time for coiling was defined as the number of minutes between the first diagnostic angiographic run and the last angiographic run after embolization. Thus, induction of general anesthesia and catheterization of the first vessel were not included in the procedural time. A long procedural time was defined as the upper quartile of procedural times (70–158 min). Logistic regression analysis was performed for several variables. Results The mean procedural time was 57.3 min (median 52 min, range 15–158 min). More than half of the coiling procedures lasted between 30 and 60 min. Multiple logistic regression analysis identified the use of a supportive device (OR 5.4), procedural morbidity (OR 4.5) and large aneurysm size (OR 3.0) as independent predictors of a long procedural time. A poor clinical condition of the patient, the rupture status of the aneurysm, gender, the occurrence of procedural rupture, and aneurysm location were not related to a long procedural time. The mean time for the first 321 coiling procedures was not statistically significantly different from mean time for the last 321 procedures. Conclusion With optimal logistics, coiling of most intracranial aneurysms can be performed in one to two hours, including patient handling before and after the actual coiling procedure.     

Protective effects of interferon-γ on squamous-cell carcinoma of head and neck targets in antibody-dependent cellular cytotoxicity mediated by human natural killer cells

An in vitro model of antibody-dependent cellular cytotoxicity (ADCC) was established, using squamous-cell carcinoma of the head and neck (SCCHN) targets, human/mouse chimeric monoclonal antibodies (cMAbs) SF-25 and 323/A3 and human peripheral blood mononuclear cells (PBMC). We previously showed that natural killer (NK) cells are the main effector population mediating ADCC in the presence of the cMAbs. ADCC was significantly inhibited by the overnight pre-treatment of SCCHN targets with exogenous interferon-γ (IFN-γ). This inhibition was dose-dependent, reproducible and consistently observed with various SCCHN cell lines. SCCHN cells pre-treated with IFN-γ had a significantly higher expression of intercellular adhesion molecule-1 (ICAM-I) and major histocompatibility complex (MHC) class I antigens compared with untreated target cells. No differences in expression of the SCCHN-associated antigens on these targets or in the formation of NK-SCCHN conjugates were found, using flow cytometry. IFN-γ-pre-treated SCCHN cells were less effective in competing with untreated targets in cold target inhibition assays and in inducing cytokine production from NK cells in co-incubation experiments. Protective effects of IFN-γ on target cell sensitivity to lysis were blocked by pre-treatment of target cells with actinomycin-D or cycloheximide. The susceptibility of the target cells was restored by removal of MHC class I antigens from their surface by acid stripping before ADCC. Our results suggest that the decreased ADCC seen with SCCHN targets pre-treated with IFN-γ is related to post-binding events, possibly altered signaling from targets to effector cells, and requires protein synthesis in the target cells. © 1996 Wiley-Liss, Inc.     

Characterization of recombinant influenza A virus as a vector for HIV-1 p17

We have generated a recombinant influenza A virus with the HIV-1 p17^Gag (rFlu-p17) gene inserted into the influenza virus neuraminidase (NA) gene. Expression of HIV-1 p17 protein was detected by conventional Western blot analysis and also by liquid chromatography/tandem mass spectrometry (LC–MS/MS) analysis of rFlu-p17 infected cells. The latter method does not depend on protein-specific antibody preparations and proved to be a powerful tool to detect proteins of interest. Next, antigen presentation of p17 expressed after infection of antigen-presenting cells was determined. Cloned p17-specific CD8+ T-cells were co-cultured with rFlu-p17 infected B-cells and produced IFN-γ upon stimulation. Furthermore, we showed that immunization with rFlu-p17 elicited a humoral immune response in mice. This study shows that replication-deficient rFlu-p17 is antigenic in vitro and immunogenic in vivo and warrants further development as a candidate vaccine vector.     

Development and validation of the pelvic floor inventories Leiden (PelFIs)

AIMS: To evaluate the validity and reliability in Dutch of the Pelvic Floor Inventories Leiden (PelFIs) for men and women, an administered questionnaire, developed to create a condition-specific pelvic floor questionnaire addressing all symptoms of micturition, defecation and sexual dysfunction related to pelvic floor dysfunction. METHODS: The PelFIs is an 83-item instrument for women and 76-item instrument for men measuring the degree of pelvic floor dysfunction, containing nine different domains. Questions have been selected which, from a clinical point of view, should configure a domain. The PelFIs was administered to healthy volunteers (N = 120), and to patients (N = 100). Reliability of the PelFIs was assessed by internal consistency and test-retest reliability. Construct validity was established comparing healthy volunteers and patients by intercorrelating the domains. RESULTS: A total of 220 questionnaires were completed; by 147 women and 73 men. Some domains in the men's questionnaire had a low alpha (alpha) although the overall alpha was good. The overall of the domains for men ranged from 0.53 to 0.90. The internal consistency for the total scale of men's questionnaire was 0.84. The overall of the domains in women ranged from 0.60 to 0.85. The internal consistency of the women's questionnaire was 0.88 for the total scale. Intraclass correlation ranged from 0.65 to 0.88. Differences between healthy volunteers and patients were statistically significant for all domains. CONCLUSION: The PelFIs is a new, practical and conceptually clear questionnaire, which focus on micturition, defecation and/or sexual dysfunction related to pelvic floor dysfunction.     

Bariatric Surgery and Bariatric Psychology: Evolution of the Dutch Approach

Background Success of bariatric surgery is largely dependent on patients’ abilities to change their lifestyle and underlying psychosocial and behavioral factors; these factors should be carefully scrutinized. However, no consensus or guidelines exist for these evaluations. Materials and Methods To get a better understanding of the practice of bariatric surgery and bariatric psychology in The Netherlands and its evolution, a survey of bariatric surgery programs was conducted. Results Between 2000 and 2005, performance of bariatric surgery in The Netherlands has increased from 564 to more than 2,000 annually, mostly adjustable gastric banding. Most hospitals have a multidisciplinary selection process, and in 89% of the cases, a mental health specialist was involved. Conclusion Bariatric surgery in The Netherlands has increased tremendously; however, it is mostly limited to restrictive procedures, and there is no consensus regarding the psychological evaluation of patients.