Sweet solutions and pacifiers for pain relief in newborn infants.

In this study we aimed to assess and compare the analgesic effects of orally administered sucrose, dextrose, dextrose or sucrose followed by a pacifier, and sterile water during minor painful procedures in neonates. One hundred thirty-eight healthy term newborn infants were enrolled in this prospective study. They received either sweet solutions or sweet solutions followed by pacifiers before the heel prick (group 1, dextrose 12.5%; group 2, dextrose 12.5% followed by a pacifier; group 3, sucrose 12.5%; group 4, sucrose 12.5% followed by a pacifier; and group 5, sterile water). The median values for crying time and the pain scores performed according to the neonatal facial coding system were recorded. The median crying times were 16.5, 55, 92.5, 102, and 132 seconds in groups 4, 2, 3, 1, and 5, respectively (P = .0001). The pain scores showed that babies in group 4 had significantly lower scores followed by groups 2, 3, 1, and 5 (P = .0001). Although group 4 had a lower pain score and shorter crying time than group 2, the difference was not statistically significant (P = .27 and P = .39). In conclusion, 12.5% dextrose or sucrose followed by a pacifier was found to be superior to dextrose only and sucrose only solutions in pain relief; sucrose followed by a pacifier resulted in lower pain scores and shorter crying time than dextrose when combined with a pacifier. The antinociceptive effect of sweet solutions can be enhanced with a pacifier.     

Dense genome‐wide linkage analysis of rheumatoid arthritis,including covariates

Objective

Rheumatoid arthritis (RA) is a heterogeneous disease that exhibits a complex genetic component. Previous RA genome scans confirmed the involvement of the HLA region and generated data on suggestive signals at non‐HLA regions, albeit with few overlaps in findings between studies. The present study was undertaken to detect potential RA gene regions and to estimate the number of true RA gene regions, taking into account the heterogeneity of RA, through performance of a dense genome scan.

Methods

In a study of 88 French Caucasian families (105 RA sibpairs), 1,088 microsatellite markers were genotyped (3.3‐cM genome scan), and a multipoint model‐free linkage analysis was performed. The statistical assessment of the results relied on 10,000 computer simulations. A covariate‐based multipoint model‐free linkage analysis was performed on the locations of regions with suggestive evidence for linkage.

Results

Involvement of the HLA region was strongly confirmed (P = 6 × 10⁻⁵), and 19 non‐HLA regions showed suggestive evidence for linkage (P < 0.05); 9 of these overlapped with regions suggested in other published RA genome scans. A routine 12‐cM genome scan with the same families would have detected only 7 of the 19 regions, including only 4 of the 9 overlapping regions. From the 10,000 computer simulations, we estimated that 8 ± 4 regions (mean ± SD) were true‐positives. RA covariate–based analysis provided additional linkage evidence for 3 regions, with age at disease onset, erosions, and HLA–DRB1 shared epitope as covariates.

Conclusion

The results of this study provide evidence of 19 non‐HLA RA gene regions, with an estimate of 8 ± 4 as true‐positives, and provide additional evidence for 3 regions from covariate‐based analysis.