Effects of ibuprofen and hypoxia on neutrophil apoptosis in neonates

BACKGROUND: Ibuprofen is a cyclooxygenase inhibitor that is effective in treating patent ductus arteriosus in preterm infants. However, recent trials have suggested that it may increase the risk of developing necrotizing enterocolitis and chronic lung disease. Apoptosis of neutrophils is impaired in newborns, leading to reduced clearance of activated cells and possibly contributing to the susceptibility of infants to these inflammatory diseases. OBJECTIVES: In the present studies, we investigated the hypothesis that ibuprofen reduces neonatal neutrophil apoptosis in the setting of hypoxia or lipopolysaccharide (LPS). METHODS: Neutrophils and peripheral blood mononuclear cells were isolated from adult and cord blood and cultured in the presence or absence of ibuprofen (1.5 mM), hypoxia (<5% O2), and bacterial LPS (100 ng/ml). Apoptosis was quantified by measuring binding of FITC-Annexin V using flow cytometry. Cytokine concentrations in cell supernatants were measured by ELISA. RESULTS: After 24 h, 20% of adult and 14% of neonatal neutrophils were apoptotic. Apoptosis was reduced by hypoxia in both adult and neonatal cells. Ibuprofen further reduced neutrophil apoptosis, but only when the cells were cultured in the presence of mixed leukocytes. This suggests that the effects of ibuprofen on apoptosis are dependent on soluble products secreted by peripheral blood mononuclear cells. We found that production of tumor necrosis factor (TNF)-alpha by neonatal leukocytes was significantly increased by ibuprofen, and was further increased following exposure to ibuprofen in the presence of LPS and hypoxia. In contrast, production of macrophage inflammatory protein (MIP)-1alpha was not affected by treatment with ibuprofen, and ibuprofen blocked induction of this chemokine by LPS. CONCLUSION: We conclude that the net effect of ibuprofen on neutrophils is antiapoptotic, especially in the presence of hypoxia or LPS. This effect may be mediated, in part, by increased production of TNF-alpha by peripheral blood mononuclear cells. These data suggest that treatment of infants with ibuprofen, in the presence of infection and/or tissue hypoperfusion/hypoxia, may contribute to the development of inflammatory diseases.     

The evolving role of genomics in shaping care for persons with dementia

Alzheimer's disease and other chronic dementing conditions remain formidable challenges for individuals, their families, and health care providers. In addition to the challenges inherent in the sheer numbers affected, the complex and relatively unpredictable progression of these disorders complicates the delivery of interventions for health care providers. Identifying genetic and environmental etiologic factors and understanding their relationship to the natural history of dementia brings health care providers closer to more effective pharmacologic treatments and perhaps cure. In the meantime, genomics research brings professional nurses closer to providing more specific, perhaps individualized, anticipatory guidance and to providing nonpharmacologic interventions in a genotype-directed way to patients with chronic dementing conditions. The emergence of a genomics-based health care environment presents an opportunity and a challenge for gerontological nurse clinicians, educators, and researchers--an opportunity to evolve practice toward a higher level of specificity and effectiveness and a challenge to do so in a equitable and sensitive manner that improves health and quality of life for all served.     

Percutaneous vertebroplasty

Percutaneous vertebroplasty is a minimally invasive procedure used to stabilise vertebral compression fractures caused by osteoporosis, haemangioma, myeloma, metastases and bone cysts. Acrylic bone cement is injected into the vertebral body to relieve pain and structurally reinforce the fracture. Interest in percutaneous vertebroplasty has grown as a result of technical procedural advances in radiology and the publication of an appraisal of, and guidelines for, the procedure by the National Institute for Clinical Excellence (2003). Nurses should be aware of the potential benefits of vertebroplasty and be involved in patient selection, and care of the patient before, during and after the procedure. Nurses should also be involved in audit analysis of the results of the procedure. More research into the effects of vertebroplasty is required and should involve nurses caring for this patient group.     

Assessing pain in cognitively impaired older adults

BACKGROUND: Accurate assessments of pain help healthcare professionals to identify its source and manage it appropriately. Pain in cognitively impaired older adults is difficult to assess and this can result in poor management and outcomes. In response to the vulnerability of this patient group, researchers have produced a variety of tools for pain assessment in cognitively impaired older adults. CONCLUSION: Replication research is recommended to validate further and generalize results, although there is enough evidence to support the use of direct observation of behaviour in identifying pain in this group of patients.     

Intrauterine growth retardation in full-term newborn infants with birth weights greater than 2,500 g

Intrauterine growth retardation (IUGR) is an overlooked problem in full-term infants with birth weights greater than 2,500 g. Birth weight less than the 10th percentile underestimates the presence of IUGR. The purpose of this study was to determine the prevalence of IUGR in full-term infants and to identify sociodemographic and maternal characteristics associated with IUGR. The Ohio Department of Health Vital Statistics database was used to obtain data related to sociodemographic and maternal characteristics. The fetal growth ratio (FGR) was used to determine the presence of IUGR. The sample consisted of 1,569 infants with normal ratios and 1,364 infants classified as IUGR. Infants with IUGR were more often male and African American or Asian American. Maternal characteristics associated with IUGR included history of smoking during pregnancy, lower pre-pregnancy weight, lower weight gain during pregnancy, and inadequate prenatal care. IUGR is present in a significant number of full-term infants with birth weights greater than 2,500 g. The long-term effects of IUGR in these infants remain to be determined.