Trends in severe bronchopulmonary dysplasia rates between 1994 and 2002

OBJECTIVE: To examine temporal trends in the rates of severe bronchopulmonary dysplasia (BPD) between 1994 and 2002. STUDY DESIGN: In a retrospective cohort study, all infants with a gestational age (GA) <33 weeks in a large managed care organization were identified. Annual rates of BPD (defined as an oxygen requirement at 36 weeks corrected GA), severe BPD (defined as respiratory support at 36 weeks corrected GA), and death before 36 weeks corrected GA were examined. RESULTS: Of the 5115 infants in the study cohort, 603 (12%) had BPD, including 246 (4.9%) who had severe BPD. There were 481 (9.5%) deaths before 36 weeks corrected GA. Although the decline in BPD in this period was not significant, the rates of severe BPD declined from 9.7% in 1994 to 3.7% in 2002. Controlling for gestational age, the odds ratio (95% CI) for annual rate of decline in severe BPD was 0.890 (0.841-0.941). Controlling for gestational age, deaths before 36 weeks corrected GA also declined, with the odds ratio (CI) for the annual decline being 0.944 (0.896-0.996). CONCLUSIONS: In this study population, the odds of having of BPD remained constant after controlling for GA. However, the odds of having severe BPD declined on average 11% per year between 1994 and 2002.     

Improved psychomotor performance in aged mice fed diet high in antioxidants is associated with reduced ex vivo brain interleukin-6 production

Psychomotor performance is decreased in the aged. This study investigated the relationship between brain oxidative stress, interleukin-6 (IL-6) production by brain tissue ex vivo and psychomotor deficits during aging, and the effects of feeding an antioxidant-rich diet on ex vivo brain IL-6 production and motor function in aged mice. Male BALBc mice reared in SPF conditions and ranging in age from 3 to 24 months were studied. There was a precipitous decline in motor function after 12 months of age and an increase in brain lipid peroxidation and IL-6 production by coronal brain slices ex vivo. In another study, 12-month-old mice were fed diets formulated to provide a disparate range of antioxidants. At 18 months of age psychomotor coordination, motor learning, and ex vivo brain IL-6 production were evaluated. Mice fed an antioxidant-rich diet had improved psychomotor coordination compared to mice fed diet adequate or low in antioxidants. When mice were tested on successive days, only those fed adequate and high antioxidants exhibited motor learning. Analysis of IL-6 production by coronal brain slices indicated that as dietary antioxidants increased, IL-6 production decreased. Collectively, these data indicate that antioxidants improve psychomotor performance in aged mice, and suggest antioxidants may be useful for reducing brain IL-6 production, which has been shown to increase in aged mice.     

Ductoscopy-assisted microdochectomy

Until 10 years ago, examination of the ductal system of the breast required excision of all the major ducts, in a block of tissue. With mammary ductoscopy, direct visualization of the ducts in vivo has been possible. In the present series of 40 cases, ductoscopy was used to guide the infusion of methylene blue dye, through the endoscope, to find the index duct, which is then removed through a small incision just inside the areola.     

Flow patterns in the aortic root and the aorta studied with time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging: implications for aortic valve-sparing surgery

OBJECTIVE: Sparing the aortic valve has become a surgical option for patients who require repair of aortic root ectasia and have normal valve leaflets. Surgical approaches to valve sparing differ with regard to preservation of the native sinuses of Valsalva. The role of the sinuses and the importance of maintaining them remain controversial. METHODS: By using a time-resolved, 3-dimensional, phase-contrast magnetic resonance imaging technique, aortic root and aortic blood velocity data were acquired from 2 patients with Marfan syndrome 6 months after aortic valve-sparing surgery with straight Dacron grafts and contrasted with data from 6 normal volunteers. RESULTS: In normal aortas vortical blood flow became apparent in the individual sinuses after peak systole. The vortices filled the available space behind the valve leaflets and persisted until diastole, expanding and moving inward during aortic valve closure. In contrast, no vortices were observed in the postoperative patients with Marfan syndrome with negligible sinuses. CONCLUSIONS: Changes in supravalvular flow accompany loss of sinus architecture. Whether the presence, size, and velocity of supravalvular vortices affects the function or durability of the preserved aortic valve remains to be studied.