Venous and Capillary Hematocrit in Newborn Infants and Placental Transfusion

Hematocrit values were measured on one hundred and eleven sets of capillary (from unwarmed and warmed heels) and venous blood samples obtained simultaneously during the first 5 days of life from 60 full term newborn infants, 40 of which the umbilical cords were clamped late, and 20 clamped early a t the time of birth. In the late clamped infants, the capillary hematocrits showed an initial rise during the first 6 hours of life seemingly due to fluid transudation in the capillary beds, followed by a fall a t 12 to 24 hours of age due to a subsequent fluid reabsorption into the vascular space in response to increasing circulatory demands in the visceral organs. In the early clamped infants, the capillary hematocrits remained stable during the first 6 hours, but a slight decline was observed a t 12 to 24 hours of age. The simultaneously measured venous hematocrits of both late and early clamped infants plotted against age revealed a strikingly similar pattern of alterations. A marked capillary venous hematocrit difference was observed in the late clamped infants and to a much lesser extent in the early clamped infants during the first 5 days of life, with the venous being lower than the capillary values. Warming the heels prior to capillary sampling improves the capillary venous hematocrit correlations in the late clamped infants and the improvement achieved by this procedure increases as the infant becomes older. In the early clamped infants heel warming produces relatively less effects because there was less capillary venous hematocrit discrepancy initially. In infants over 12 hours of age where venipuncture is difficult or inadvisable, capillary blood samples obtained from warmed heels could be used for hematocrit measurements. However, the hematoples do not exactly correspond with the venous values and the approximate venous reading could be estimated by using the regression lines derived from our samples, and their 95% confidence limit could be calculated from the appropriate formulas.     

Allogeneic bone marrow transplantation versus chemotherapy in high-risk childhood acute lymphoblastic leukaemia in first remission

We compared the outcome of children with high-risk acute lymphoblastic leukaemia (HR-ALL) in first complete remission (first CR) treated with chemotherapy (CHEMO) or with allogeneic bone marrow transplantation (BMT) in a multicentre study.   All children treated by the Italian Paediatric Haematology Oncology Association for HR-ALL in first CR between 1986 and 1994 were eligible for the study. 30 children were given BMT at a median of 4 months from first CR, with preparative regimens including total-body irradiation ( n  =25/30). 130 matched controls for BMT patients were identified among 397 HR-ALL CHEMO patients. Matching on main prognostic factors and duration of first CR was adopted to control the selection and time-to-transplant biases. The comparative analysis was based on the results of a stratified Cox model. The estimated hazard ratios of BMT versus CHEMO at 6 months, 1 year and 2 years after CR were 1.38 (CI 0.59–3.24), 0.69 (CI 0.27–1.77) and 0.35 (CI 0.06–1{\raise 5mu ..91), with an overall non-significant difference between the two groups ( P  = 0.34). With a median follow-up of 4 years, the disease-free survival was 58.5% (SE 9.3) in the BMT group and 47.7% (SE 4.8) in the CHEMO group, at 4 years from CR. Non-leukaemic death occurred in 4% of CHEMO and 10% of BMT patients. In the BMT group the estimated cumulative incidence of relapse at 1.5 years from CR was 31.5% (SE 8.8) and did not change thereafter, whereas in the CHEMO group the corresponding figure was 29.2% (SE 4.1) and the incidence continued to increase thereafter (48.2% (SE 4.8) at 4 years from CR).   The results of this study suggest that, with respect to the CHEMO group, the higher risk of early failure in the BMT group is outweighed by the lower risk of relapse after 1 year. Results prompt the need for a prospective study, in order to demonstrate the likely advantage of BMT in HR childhood ALL in first CR.     

Computer-Assisted Instruction Improves Clinical Reasoning Skills of Dietetics Students

Objective The effects of a computer-assisted instruction (CAI) tutorial program on learning clinical reasoning skills were compared in undergraduate dietetics students.Design A drill-and-practice program to control for time on task, a tutorial program, and a simulation program, as the test vehicle, were developed. The tutorial and simulation programs presented data on a patient with cardiovascular disease.Setting Subjects were tested in 30 undergraduate dietetics programs.Subjects Participants were 413 undergraduate diet therapy students enrolled in a coordinated program in dietetics (CPD) or a didactic program in dietetics (DPD).Intervention After completion of lectures on cardiovascular disease, subjects were given the drill-and-practice program plus a simulation test (group 1), the tutorial plus a simulation test (group 2), or the simulation test only (group 3).Main outcome measures Scores on the simulation test were compared. Variables included type of CAI, dietetics program, year in school, computer experience, and experience using a medical chart. Mastery of objectives related to lower- and higher-level clinical reasoning skills introduced in the tutorial program was compared.Statistical analysis One-way analysis of variance and Student-Newman Keuls tests were conducted to determine any differences among the three groups. Reliability was determined using the Kuder-Richardson Formula 20.Results The reliability coefficient of the simulation test was 0.93. Group 2 scored higher on the simulation test than group 1 or group 3. As a group, the CPD students scored higher than the DPD students. When CPD and DPD students were divided into the three experimental groups, there was no significant difference between the CPD and DPD student simulation scores. Group 2 mastered all objectives for lower-level reasoning skills and the higher-level decision-making objective better than groups 1 and 3.Applications/conclusions A computer tutorial program enhanced clinical reasoning skills in undergraduate dietetics students. This type of program could be used to supplement many topics taught in diet therapy and provide DPD students with experiential learning before their clinical intern practicums. J Am Diet Assoc. 1995; 95:868–873.     

Five-Month Oral (Diet) Toxicity/lnfectivity Study of Bacillus thuringiensis Insecticides in Sheep

Five-Month Oral (Diet) Toxicity/Infectivity Study of Bacillusthuringiensis Insecticides in Sheep. HADLEY, W. M., BURCHIEL,S. W., MCDOWELL, T. D., THILSTED, J. P., HIBBS, C. M., WHORTON,J. A., DAY, P. W., FRIEDMAN, M. B., and STOLL, R. E. (1987).Fundam. Appl. Toxicol. 8, 236–242. Bacillus thuringiensisinsecticides (Bt) [Dipel (test substance D or Thuri-cide-HP(test substance T)] were administered in the diet for 5 monthsto castrated mixed ram-bouillet/merino sheep (24–34 kgat the beginning of the study) at a dose of 500 mg/kg/day (approximately10¹² spores per day). No treatment-related effect was seen onweight gain or clinical chemistry parameters nor were significantgross clinical changes observed. Several blood and tissue samplestaken just prior to the time the animals were killed or at necropsywere found to be positive for Bt when cultured. Detailed grossand microscopic pathologic examination of the sheep revealedseveral incidental lesions. However, the only lesion that mayhave been associated with the treatment was lymphocytic hyperplasiain Peyer's patches seen in the cecum of three sheep and it wasnot considered to be clinically significant.     

Diesel Exhaust Is a Pulmonary Carcinogen in Rats Exposed Chronically by Inhalation

Diesel Exhaust Is a Pulmonary Carcinogen in Rats Exposed Chronicallyby Inhalation. MAUDERLY, J. L., JONES, R. K., GRIFFITH, W. C.,HENDERSON, R. F., AND MCCLELLAN, R. O. (1987). Fundam. Appl.Toxicol 9, 208–221. Male and female F344 rats were exposed7 hr/day, 5 day/week for up to 30 months to automotive dieselengine exhaust at soot concentrations of 0.35, 3.5, or 7.0 mg/m³or were sham-exposed to clean air. Rats were terminated at 6-monthintervals to measure lung burdens of diesel soot and for histopathology.Other rats either died or were terminated after 30 months ofexposure. Lungs were fixed, sectioned into 3-mm slices, andexamined by a dissecting microscope to detect tumors. Lesionswere stained and examined by light microscopy. Survival andbody weight were unaffected by exposure. Focal fibrotic andproliferative lung disease accompanied a progressive accumulationof soot in the lung. The prevalence of lung tumors was significantlyincreased at the high (13%) and medium (4%) dose levels abovethe control prevalence (1%). Four tumor types, all of epithelialorigin, were observed: adenoma. adenocarcinoma, squamous cyst,and squamous cell carcinoma. Logistic regression modeling demonstrateda significant relationship between tumor prevalence and bothexposure concentration and soot lung burden. These results demonstratethat diesel exhaust, inhaled chronically at a high concentration,is a pulmonary carcinogen in the rat.