Thermal control of the newborn: knowledge and practice of health professionals in seven countries

Hypothermia is a common problem in neonates, particularly in developing countries where it is an important contributory factor to neonatal mortality and morbidity. An evaluation of the knowledge and practices of health professionals on the thermal control of newborns was carried out in seven countries: Brazil, India, Indonesia, Kazakhstan, Mozambique, Nepal and Zimbabwe. The evaluation, conceived as a preliminary phase for a one-day training course on thermal control, involved 28 health facilities and 260 health professionals (61 doctors and 199 nurses and midwives). It included an assessment of thermal control practices carried out in each health facility by external investigators and a questionnaire on knowledge about thermoregulation administered to health professionals involved in newborn care. The findings of the evaluation were consistent across countries and showed that thermal control practices were frequently inadequate in the following areas: ensuring a warm environment at the time of delivery; initiation of breastfeeding and contact with mother; bathing; checking the baby's temperature; thermal protection of low birth weight babies, and care during transport. Knowledge on thermal control was also insufficient, especially concerning the physiology of thermoregulation and criteria for defining hypothermia. During the one-day course that followed the evaluation, participants were able to recognize the existing gaps and to identify appropriate interventions. Knowledge and practice on the thermal control of the newborn are currently insufficient. However, awareness of the importance of thermal control and basic knowledge on thermal regulation and thermal protection can be easily acquired and on this basis motivation for improving thermal control practices can be developed.     

Familial arachnoid cysts associated with oculopharyngeal muscular dystrophy.

Cerebral arachnoid cysts that occur in more than one member of a family have been rarely reported. These familial cases are important because they imply a genetic component in the pathophysiology of these arachnoid cysts. We present an unusual family in which two conditions, a genetic myopathy, oculopharyngeal muscular dystrophy (OPMD), and arachnoid cysts occur together. OPMD is caused by a mutation in the PAPB2 gene that localizes to chromosome 14. In this family, two siblings with genetically confirmed OPMD both have left hemispheric intracranial arachnoid cysts unassociated with other cerebral abnormalities. The association of these two disorders suggests that in this family, a chromosome 14 gene may play a role in the development of arachnoid cysts.     

KASS内固定治疗胸腰段脊柱侧凸畸形

[目的]评价应用Kaneda脊柱前路矫形系统(Kaneda anterior scoliosis system,KASS)治疗胸腰椎侧凸畸形的临床疗效。[方法]回顾分析43例脊柱侧凸畸形通过前路椎间盘摘除、松解、椎间植骨融合及KASS内固定矫正侧凸畸形的临床资料,男性17例,女26例。年龄11~24岁(平均14.6岁)。侧弯病因:特发性35例,先天性8例。[结果]所有患者均达到满意矫正效果,平均随访时间为22个月(6个月~4年)。胸腰椎术前侧凸Cobb s角平均为66°(43°~98°),术后矫正至18°(0°~32°),畸形矫正率为91.7%。无明显并发症出现。术后随访3例出现矫正度部分丢失。[结论]KASS内固定系统治疗脊柱侧凸具有能早期矫正畸形,创伤小,融合固定节段少,矫形效果好,维持术后矫正度理想等优点,是一种值得推广的手术方法。     

In-vivo gene transfer to the uterine endometrium

Therapeutic interventions in reproductive biology have relied largely on steroids and antisteroids which act to regulate gene expression in target tissues. Whilst their use has transformed women's lives, few conceptual advances have been made in contraceptive technology, no means identified to improve human implantation and no new strategies developed for the treatment of benign gynaecology. A novel alternative is direct gene transfer to the organ of interest. As a first step to achieving this goal in the uterus, we used reporter gene constructs to transfect mouse endometrium in vivo and human endometrial epithelial cells in vitro. We injected DNA-liposome complexes into the uterine lumen of mice on day 2 of pseudopregnancy and detected reporter gene activity 2 days later. The liposomes used were a 3:1 (w/w) mixture of 2,3-dioleyloxy-N-[2(sperminecarboxamido) ethyl]-N-N-dimethyl-1- propanaminium trifluoroacetate and dioleoylphosphatidyl ethanolamine. Freshly isolated human endometrial epithelial cells were successfully transfected in vitro with similar DNA-liposome complexes. These data suggest that endometrial gene transfer may be effective in humans. This may lead to the development of new therapeutic agents, including contraceptives, for the improvement of women's health.      

Thoracoscopic excision of a paraesophageal bronchogenic cyst in a child.

BACKGROUND: Bronchogenic cysts are not uncommon in either children or adults. In children, they comprise approximately 6% of all mediastinal masses. Their presentation can range from an asymptomatic incidental finding to sudden respiratory distress. CASE REPORT: Video-assisted thoracoscopy was utilized to remove a bronchogenic cyst that was densely adherent to the adjacent esophagus in a child. This was accomplished with a Harmonic scalpel. The chest tube was removed on postoperative day 1, and the patient was discharged on postoperative day 2. An esophagogram obtained 2 weeks after surgery was normal, and the patient's preoperative symptoms had not returned. CONCLUSIONS: Bronchogenic cysts should be considered in the differential diagnoses for mediastinal masses at any age. Given their benign nature, thoracoscopy offers an excellent alternative to open thoracotomy for their removal.     

Site-specific DNA cleavage within the MLL breakpoint cluster region induced by topoisomerase II inhibitors [see comments]

The MLL gene located at 11q23 is frequently disrupted by chromosomal translocation in a wide spectrum of newly diagnosed acute leukemias. Recently, it has become apparent that the MLL gene is very frequently disrupted by chromosomal translocations in patients with secondary leukemias associated with chemotherapeutic regimens incorporating topoisomerase II inhibitors. These secondary leukemias associated with topoisomerase II inhibitors (most commonly teniposide, etoposide, or doxorubicin) have distinct clinical and biologic features which have led to the speculation that they are induced by treatment with topoisomerase II inhibitors. We have identified a site within the MLL breakpoint cluster region (bcr) that is highly sensitive to double- strand DNA cleavage induced by topoisomerase II inhibitors. This finding is quite specific and highly reproducible. Although it was initially discovered in malignant lymphoblasts isolated from a patient receiving multiagent chemotherapy, this site-specific double-strand DNA cleavage can be induced in tissue culture using malignant cell lines as well as peripheral blood from normal individuals. Site-specific cleavage occurs in a significant fraction of cells using a variety of model systems, is both time and dose dependent, and can be induced with either doxorubicin or etoposide. This site-specific cleavage maps to the same region as a consensus topoisomerase II cleavage site within the MLL bcr. These results suggest that site specific cleavage within the MLL bcr induced by topoisomerase II inhibitors may be an early step leading to MLL translocations and secondary leukemia.