A controlled trial of skin-to-skin contact in extremely preterm infants

BACKGROUND: Extremely preterm birth, even in the absence of significant neurological impairment, is associated with altered pain responses and impaired memory and behaviour. Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship, factors that in turn are also associated with impaired infant outcome. Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects. METHODS: We conducted a pragmatic, prospective, controlled, intention-to-treat trial in two neonatal intensive care units. Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving standard care, or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks. We assessed infant behaviour at time of discharge from hospital, responses to immunisation at 4 and 12 months of age, and memory, behaviour and development at 1 year corrected (postmenstrual) age. Indices of maternal depression, stress, anxiety, lactation performance and infant interaction were assessed at time of infant discharge, 4 months and 1 year. RESULTS: No significant difference was identified in any infant or maternal measure at any time point. CONCLUSIONS: Mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences. Although there is no reason to dissuade mothers who wish to provide STS contact, we are unable to recommend resource allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit setting.     

新缩瞳剂包公藤甲素人工合成研究

包公藤甲素是从包公藤(Erycibe obtusifolia Benth.)茎中提得的一个新莨菪烷生物碱,具有强烈的缩瞳作用,临床用于治疗青光眼。本文报道用合成的6β-乙酰氧基托品酮为原料,经卤代、水解、还原和N-去甲基化等反应合成包甲素(8)。经光谱测定证实8与天然包甲素的结构完全一致。合成品系外消旋体,其作用机理与天然品相同,而强度则减半。     

Urinary creatinine excretion and estimation of muscle mass in infants of 25-34 weeks gestation

The urinary excretion rate of creatinine was measured over 89 days in 31 infants of gestational ages 25-34 weeks in the first week of life. Creatinine excretion was shown to have a significant positive correlation with weight and postconceptional age. Creatinine excretion factored by body weight was also positively correlated with weight and postconceptional age. Pooled analysis of published data together with our own, confirms that this correlation is important. Muscle mass was estimated from creatinine excretion rate. A regression equation was derived predicting muscle mass from birth-weight and gestational age. Muscle mass increases from 12% of birthweight at 25 weeks gestation to 19% at 34 weeks and 24% at 40 weeks. This is in agreement with classic dissection studies which showed muscle mass to be 25% of body weight at term.     

Interdonor Incompatibility Due to Anti-Kell Antibody Undetectable by Automated Antibody Screening

A unit of whole donor blood, the plasma of which contained anti-Kell antibody, was transfused into a Kell-negative patient who had received a unit of Kell-positive blood 4 weeks previously. A haemolytic transfusion reaction ensued. The antibody had gone undetected in routine automated screening of the donor blood. Automated antibody detection techniques do not offer reliable detection of anti-Kell antibodies.     

Culturing Periprosthetic Joint Infection: Number of Samples,Growth Duration,and Organisms

Background

Owing to the difficulty isolating microorganisms in periprosthetic joint infection (PJI), current guidelines recommend that 3-5 intraoperative samples be cultured and maintained for 3-14 days. We investigated (1) the optimal number of culture samples and growth duration to diagnose PJI and (2) the microbiology profile at our institution.

Management of HIV-associated focal brain lesions in developing countries

BACKGROUND: HIV-associated focal brain lesions (HFBL) are caused by opportunistic infections, neoplasms, or cerebrovascular diseases. In developed countries, toxoplasma encephalitis (TE) is the most frequent cause, followed by primary CNS lymphoma (PCNSL). Guidelines based on these causes however are poorly suited to developing countries, where treatable infections predominate as causes of HFBL. AIM: To determine a practical approach to the management of HFBL in developing countries. DESIGN: Case series. METHODS: Patients (n = 32) were managed based on presumed aetiologies of the focal brain lesions, determined by collating information from CT scans, CSF and blood studies, concurrent non-neurological illness and response to treatment. RESULTS: The principal presumed cause of HFBL was tuberculosis (69%). The therapeutic response was good in 69% of patients. DISCUSSION: In developing countries, infections are the predominant cause of HFBL, the principal causes being infections that are endemic to the populations being studied. Empiric treatment based on limited investigations should be directed according to the nature of such infections. A modified algorithm is proposed.     

Targeting PSMA with a Cu-64 Labeled Phosphoramidate Inhibitor for PET/CT Imaging of Variant PSMA-Expressing Xenografts in Mouse Models of Prostate Cancer

Purpose

Prostate-specific membrane antigen (PSMA) is highly up-regulated in prostate tumor cells, providing an ideal target for imaging applications of prostate cancer. CTT-1297 (IC₅₀?=?27 nM) is an irreversible phosphoramidate inhibitor of PSMA that has been conjugated to the CB-TE1K1P chelator for incorporation of Cu-64. The resulting positron emission tomography (PET) agent, [⁶⁴Cu]ABN-1, was evaluated for selective uptake both in vitro and in vivo in PSMA-positive cells of varying expression levels. The focus of this study was to assess the ability of [⁶⁴Cu]ABN-1 to detect and distinguish varying levels of PSMA in a panel of prostate tumor-bearing mouse models.

Procedures

CTT-1297 was conjugated to the CB-TE1K1P chelator using click chemistry and radiolabeled with Cu-64. Internalization and binding affinity of [⁶⁴Cu]ABN-1 was evaluated in the following cell lines having varying levels of PSMA expression: LNCaP late-passage?>?LNCaP early passage?≈?C4-2B?>?CWR22rv1 and PSMA-negative PC-3 cells. PET/X-ray computed tomography imaging was performed in NCr nude mice with subcutaneous tumors of the variant PSMA-expressing cell lines.

Results

[⁶⁴Cu]ABN-1 demonstrated excellent uptake in PSMA-positive cells in vitro, with ～80 % internalization at 4 h for each PSMA-positive cell line with uptake (fmol/mg) correlating to PSMA expression levels. The imaging data indicated significant tumor uptake in all models. The biodistribution for late-passage LNCaP (highest PSMA expression) demonstrated the highest specific uptake of [⁶⁴Cu]ABN-1 with tumor-to-muscle and tumor-to-blood ratios of 30?±?11 and 21?±?7, respectively, at 24 h post-injection. [⁶⁴Cu]ABN-1 cleared through all tissues except for PSMA-positive kidneys.

Conclusion

[⁶⁴Cu]ABN-1 demonstrated selective uptake in PSMA-positive cells and tumors, which correlated to the level of PSMA expression. The data reported herein suggest that [⁶⁴Cu]ABN-1 will selectively target and image variant PSMA expression and in the future will serve as a non-invasive method to follow the progression of prostate cancer in men.