Nursery Neurobiologic Risk Score: important factor in predicting outcome in very low birth weight infants

We developed a nursery Neurobiologic Risk Score (NBRS) based on potential mechanisms of brain cell injury in preterm infants and correlated it with developmental outcome at the corrected ages of 6, 15, and 24 months. The NBRS was determined at 2 weeks of age and at the time of discharge from intensive care in 58 preterm infants with birth weights less than or equal to 1500 gm. The NBRS correlated significantly with the Bayley Scales of Infant Development, Mental Development Index (MDI) (r = -0.61 to -0.40) and Psychomotor Development Index (PDI) (r = -0.59 to -0.46), and with abnormal neurologic examination findings (r = 0.59 to 0.73) at the three testing periods. Although 12 of the 13 items composing the NBRS individually correlated with one or more outcome variables, seven items (infection, blood pH, seizures, intraventricular hemorrhage, assisted ventilation, periventricular leukomalacia, and hypoglycemia) accounted for almost all of the explained variance. Logistic regression of individual items demonstrated intraventricular hemorrhage to be the most important item for predicting the MDI at 24 months; pH was the most influential item for predicting the PDI at every testing period. A shorter, revised NBRS that included only the seven significant items demonstrated as strong a correlation with developmental outcome as the original NBRS. A revised 2-week score of greater than or equal to 5 or a discharge score of greater than or equal to 6 demonstrated 100% specificity and had a 100% positive predictive value for an abnormal outcome at 24 months of age in this group of infants. We conclude that the NBRS identifies during the intensive care nursery stay those infants at highest risk for an abnormal outcome related to nursery events. In addition, analysis of NBRS items provides insight into the relative importance of individual factors for influencing mental, motor, and neurologic outcome.     

Childhood abuse and the use of inhalants: differences by degree of use.

OBJECTIVES: Using two existing ethnographic studies of drug-involved adults, this study evaluates the association between child-abuse victimization and levels of involvement in inhalant use. METHODS: Historical accounts of childhood exposure to physical or sexual abuse were compared among nonusers of inhalants (n = 197), light inhalant users (n = 64), and heavy inhalant users (n = 24). Crude and adjusted odds ratios were used to compare informants with no history of inhalant use with those having a history of light inhalant use and those having a history of heavy inhalant use. RESULTS: Heavy inhalant use was associated with history of any child abuse (adjusted odds ratio [OR] = 4.6) and physical abuse (adjusted OR = 3.8). Light inhalant use showed no association with child-abuse history. CONCLUSIONS: Child abuse may be an important correlate of extensive involvement in inhalant use. The findings invite speculation with respect to a hypothetical causal role for child abuse in the etiology of inhalant use. The lack of support for causality in this study underscores the need for replication and more carefully designed longitudinal research.     

Accessory atrioventricular pathway, supra-, and infrahisian conduction impaired due to mitral annulus calcification

Disorders of conduction occurring simultaneously in both normal and accessory pathways of patients with Wolff-Parkinson-White (WPW) syndrome have only rarely been observed. To our knowledge this is the first report of impaired conduction in both pathways in WPW syndrome due to mitral annulus calcification (MAC). This case of WPW syndrome type A presented the following conduction abnormalities: (1) right bundle-branch block; (2) transient second-degree AV block with prolonged PR interval of the conducted beats; (3) during electrophysiological study, induction of tachycardia, dependent (phase 3) second-degree AV block, and occasionally conduction of two consecutive beats, the second showing an increased H-V interval (from 25 to 60 ms) and left bundle-branch block (LBBB) pattern, due to (4) infrahisian conduction abnormality.     

Parental communication deviance: its relationship to parent, child, and family system variables

Audiotape recordings of family interaction samples from 30 nondistressed and 32 multiproblem families were coded for communication deviance (CD). Maternal CD was found to be higher in families high on measures of "preschizophrenic" child behavior, externalizing or "acting out" offspring behavior, overall family distress, and maladaptive marital and family alliance structures. Paternal CD was found to be higher in families in which offspring were rated high on externalizing behaviors.     

One year of health and social services for adults 40–50 years old with Down's syndrome

Summary The costs of the public health and social security system supporting adults 40–50 years old with Down's syndrome during one year (1984) have been investigated in the county of Aarhus, representing about 10% of the Danish population. 77% of the probands live in institutions, the rest in private homes or sheltered residences. The average yearly price of an institutionalized adult is DKr. 237,900 =US$ 21,128 = £ 18,174. If the person lives in a private home, the same figures are DKr. 107,239 =US$ 9,524= 8,393. Average for all probands: DKr. 207,587 = US$18,436 = £ 15,858, which is 127% of a skilled worker's salary.     

Possible heterogeneity in the segregation pattern of breast cancer in families with bilateral breast cancer

We investigated the segregation pattern of breast cancer in families with bilateral breast cancer, classifying families with respect to menopausal status (premenopausal versus postmenopausal) and the interval between diagnosis of the two primary tumors in the probands. Probands were "synchronous" if both primaries were diagnosed within 1 year; "asynchronous" if the interval was at least 2 years. Results for four complex segregation analyses are here presented; the findings support heterogeneity in the transmission of breast cancer. In the asynchronous premenopausal-cases-only analysis, a dominant Mendelian gene can explain the breast cancer pattern. A recessive gene is sufficient to describe the breast cancer distribution in the synchronous premenopausal-cases-only analysis. The synchronous all-cases and the asynchronous all-cases analyses add postmenopausal cases of breast cancer to the premenopausal ones, considering any case to be affected. In the asynchronous all-cases analysis, neither the single-locus model nor the mixed model (that is, a major locus plus other factors, genetic and/or cultural) without generation differences in heritability can be rejected by the unrestricted mixed model with generation differences in heritability. For the synchronous all-cases analysis, a mixed model with generation differences in heritability is necessary to explain the breast cancer transmission. Potential sources of error and possible interpretations are discussed.     

Cognitive mapping after unilateral temporal lobectomy

An investigation of the extension of O'KEEFE and NADEL's [The Hippocampus as a Cognitive Map. Oxford University Press, Oxford 1978] theory of hippocampal functioning is described in patients who have undergone unilateral temporal lobectomy for the relief of epilepsy. A new spatial task, incorporating a recall-for-designs test but based on studies of spatial memory and cognitive mapping in animals was devised. Results supported the prediction of temporal lobe structure involvement in the mediation of non-egocentric but not egocentric space, and of the role of right temporal lobe structures in conditions designed to encourage "place" but not "cue" learning strategies. The role of verbal mediation in task performance is also discussed.     

Hyperpolarization moves S4 sensors inward to open MVP,a methanococcal voltage-gated potassium channel

MVP, a Methanococcus jannaschii voltage-gated potassium channel, was cloned and shown to operate in eukaryotic and prokaryotic cells. Like pacemaker channels, MVP opens on hyperpolarization using S4 voltage sensors like those in classical channels activated by depolarization. The MVP S4 span resembles classical sensors in sequence, charge, topology and movement, traveling inward on hyperpolarization and outward on depolarization (via canaliculi in the protein that bring the extracellular and internal solutions into proximity across a short barrier). Thus, MVP opens with sensors inward indicating a reversal of S4 position and pore state compared to classical channels. Homologous channels in mammals and plants are expected to function similarly.