Improved outcomes with a standardized feeding protocol for very low birth weight infants.

OBJECTIVE: The objective of this study was to evaluate the impact of a standardized enteral feeding protocol for very low birth weight (VLBW) infants on nutritional, clinical and growth outcomes. STUDY DESIGN: Retrospective analysis of VLBW cohorts 9 months before and after initiation of a standardized feeding protocol consisting of 6-8 days of trophic feedings, followed by an increase of 20 ml/kg/day. The primary outcome was days to reach full enteral feeds defined as 160 ml/kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of parenteral nutrition and growth end points. RESULT: Data were analyzed on 147 VLBW infants who received enteral feedings, 83 before ('Before') and 64 subsequent to ('After') feeding protocol initiation. Extremely low birth weight (ELBW) infants in the After group attained enteral volumes of 120 ml/kg/day (43.9 days Before vs 32.8 days After, P=0.02) and 160 ml/kg/day (48.5 days Before vs 35.8 days After, P=0.02) significantly faster and received significantly fewer days of parenteral nutrition (46.2 days Before vs 31.3 days After, P=0.01). Necrotizing enterocolitis decreased in the After group among VLBW (15/83, 18% Before vs 2/64, 3% After, P=0.005) and ELBW infants (11/31, 35% Before vs 2/26, 8% After, P=0.01). Late-onset sepsis decreased significantly in the After group (26/83, 31% Before vs 6/64, 9% After, P=0.001). Excluding those with weight <3rd percentile at birth, the proportion with weight <3rd percentile at discharge decreased significantly after protocol initiation (35% Before vs 17% After, P=0.03). CONCLUSION: These data suggest that implementation of a standardized feeding protocol for VLBW infants results in earlier successful enteral feeding without increased rates of major morbidities.

Estrogen modulation of the cyclic AMP response element-binding protein pathway. Effects of long-term and acute treatments.

Actions of estrogen include mechanisms leading to alterations in gene transcription that may be independent of nuclear estrogen receptors, as well as those involving direct action of the estrogen receptor on the genome. Also, the influence of estrogen in the brain appears to extend well beyond areas associated with reproduction and may include forebrain areas linked to affective and cognitive behaviors. We investigated the effects of acute and long-term estradiol benzoate (E2) treatment on total and phosphorylated cyclic AMP responsive element-binding (CREB) protein levels and on cyclic AMP response element (CRE)-DNA binding in forebrain areas of ovariectomized (OVX) rats. Long-term E2 treatment increased CRE-DNA binding in the amygdala but not in hippocampus, frontal cortex, or cerebellum. The increase in CRE-DNA binding in the amygdala was associated with increased levels of total and phosphorylated CREB (pCREB) protein during protracted E2 exposure. To localize the estrogenic effect in the amygdala and determine if an effect in one hippocampal region was masked by a lack of effect in another subregion, we performed immunolabeling of pCREB in brain structures of chronically treated OVX animals with or without E2. This treatment resulted in a significant increase in relative total immunolabeled nuclei in the anteroventral subdivision of the medial amygdala. In the hippocampus, a significant increase in relative total immunolabeled nuclei was seen in the CA1 and CA3 regions, but not in the dentate gyrus or hilus of the dentate gyrus. Acute E2 treatment resulted in increased CRE-DNA binding in the frontal cortex but not in amygdala, hippocampus, or cerebellum. However, no changes in levels of total CREB or pCREB protein were observed in the frontal cortex under E2 treatment. No changes were observed either in basal or cAMP-stimulated protein kinase A (PKA) activity or in PKA-alpha catalytic subunit immunoreactivity in the amygdala or the frontal cortex. Our study indicates that both long-term and acute treatments with estrogens influence the function of CREB in specific brain structures.

Estrogen affects the expression of Ca2+/calmodulin-dependent protein kinase IV in amygdala.

We examined the effects of long-term estradiol benzoate (E2) treatment on protein expression of Ca2+/calmodulin-dependent protein kinase IV (CaMK IV) in the amygdala of ovariectomized (OVX) rats. Western blot analysis revealed increased protein levels of CaMK IV in the nuclear but not in the membranal or cystolic fraction of total amygdala in E2-treated compared to OVX rats. Significant increases in levels of CaM kinase IV gold immunolabeling were seen in the medial and basomedial, but not in the central or basolateral, amygdala of E2 compared to OVX rats, indicating the neuroanatomical heterogeneity of the E2 effect. These results suggest that CaMK IV may act as a molecular target for actions of estrogen in the amygdala of rats.

Life expectancy of major league baseball umpires.

UNLABELLED: Analysis of umpires' age at death suggests that fears regarding risks of their profession are unfounded. BACKGROUND: The on-field death 4 years ago of a veteran Major League Baseball (MLB) umpire raised questions regarding the mortality risks of this profession. OBJECTIVE: To determine if the life expectancy of MLB umpires differs from that of the general population. DESIGN: Ages of death of MLB umpires were determined, and the differences between the ages of death and age-adjusted life expectancies were calculated. T-score analysis was performed on these differences. Correlational analysis was also done on many different factors, including umpire debut year, debut age, life expectancy at debut, and length of career. RESULTS: No significant difference was found between the age at death of MLB umpires and their age-adjusted life expectancy. Correlational analyses showed that only length of career correlated with age at death. CONCLUSION: MLB umpiring is not associated with a shortened life expectancy. While this is most likely attributable to the profession having no inherent risk, it could also be explained by inherent risks being overcome by yet unidentified, unique factors.

Once-daily gentamicin dosing in newborn infants.

OBJECTIVE: We developed a simplified gentamicin dosing protocol for all neonates using a loading dose and once-daily dosing that would have an equal or lower incidence of toxicity and an equal or improved effectiveness compared with a regimen with no loading dose that included use of divided daily dosing. METHODS: All neonatal intensive care unit patients with a postnatal age /=37 weeks; weight, >/=2500 g). One hundred percent of the initial and maintenance peak SDL in term protocol neonates were 5 to 12 micrograms/mL; compared with 84% of the initial and 61% of maintenance peak SDL in the term control group. One hundred percent of the initial and maintenance trough SDL were in the desired range of <2 micrograms/mL in term protocol neonates; compared with 70% of the initial and 94% of maintenance trough SDL in the term control group. No significant differences were found in any SDL in low birth weight neonates (gestational age <37 weeks or weight <2500 g and >1500 g) in the protocol compared with the control group. The very low birth weight (weight <1500 g) protocol neonates had a significantly higher mean initial trough SDL (2.3 +/- 0.7 micrograms/mL vs 1.5 +/- 0.6 micrograms/mL) and a lower incidence of initial trough SDL <2.0 micrograms/mL (30% vs 95%) than very low birth weight neonates in the control group. No differences were seen between groups in incidence of significant rise in serum creatinine or failure of hearing screen. CONCLUSION: A loading dose followed by once-daily dosing was shown to result in SDL in the safe and therapeutic range in all term neonates in this study. In low birth weight neonates, this regimen resulted in peak and trough SDL throughout therapy that were similar to those observed in the control group. Delaying the initiation of maintenance once-daily dosing until 36 to 48 hours after the loading dose would be expected to result in a higher incidence of initial trough SDL in target range for very low birth weight neonates.

The role of oocyte transcription, the 5'UTR, and translation repression and derepression in Drosophila gurken mRNA and protein localization.

The establishment of the major body axes of the Drosophila egg and future embryo requires strict regulation of gurken mRNA and protein localization. Here, we show that grk mRNA and protein localization is dependent on synthesis of grk transcripts in the oocyte nucleus and on RNA localization elements in the 5' portion of the transcript. We also show that gurken mRNA and protein localization is dependent on region-specific translation of gurken transcripts and identify K10 as a probable negative regulator of gurken translation.

Estrogen alters behavior and forebrain c-fos expression in ovariectomized rats subjected to the forced swim test.

Estrogen has been implicated in brain functions related to affective state, including hormone-related affective disorders in women. Although some reports suggest that estrogen appears to decrease vulnerability to affective disorders in certain cases, the mechanisms involved are unknown. We used the forced swim test (FST), a paradigm used to test the efficacy of antidepressants, and addressed the hypotheses that estrogen alters behavior of ovariectomized rats in the FST and the FST-induced expression of c-fos, a marker for neuronal activity, in the rat forebrain. The behaviors displayed included struggling, swimming, and immobility. One hour after the beginning of the test on day 2, the animals were perfused, and the brains were processed for c-fos immunocytochemistry. On day 1, the estradiol benzoate-treated animals spent significantly less time struggling and virtually no time in immobility and spent most of the time swimming. Control rats spent significantly more time struggling or being immobile during a comparable period. On day 2, similar behavioral patterns with still more pronounced differences were observed between estradiol benzoate and ovariectomized control groups in struggling, immobility, and swimming. Analysis of the mean number of c-fos immunoreactive cell nuclei showed a significant reduction in the estradiol benzoate versus control groups in areas of the forebrain relating to sensory, contextual, and integrative processing. Our results suggest that estrogen-induced neurochemical changes in forebrain neurons may translate into an altered behavioral output in the affective domain.

Regulation of neuronal nitric oxide synthase mRNA in lordosis-relevant neurons of the ventromedial hypothalamus following short-term estrogen treatment.

Short-term estrogenic regulation of neuronal nitric oxide synthase (nNOS) mRNA in the ventrolateral subdivision of the ventromedial nucleus (VLVMN), an area central to lordosis, was demonstrated using in situ hybridization. Estrogen-treated animals showed a significantly greater signal in the VLVMN, but not the arcuate or supraoptic nuclei, compared to ovariectomized controls. Neuronal NOS may be involved in early actions of estrogen in the VLVMN.

Measurement of facial movement with computer software.

OBJECTIVE: To adapt desktop computer software to objectively grade facial movement. DESIGN: The criteria of the facial nerve grading system by House and Brackmann, the current "gold standard," are prone to ambiguous interpretation. Proposed objective grading systems compare the movement of points on each side of the face or use subtraction and thresholding of digitized images of the face to yield images that represent moving areas of the face. The movement of a point on the face and the area of motion determined by digital subtraction were compared during an increasing smile in healthy subjects. The Nottingham system (calculated using measurement of the movement of 4 points on the face) using desktop computer software (Adobe Photoshop 3.0, Adobe Systems Inc, Mountain View, Calif) to measure movement of the points was compared with the system by House and Brackmann. The computer software was used to subtract digitized images and derive a facial movement score, which was compared with the scores of the systems by Nottingham and House and Brackmann. SETTING: Academic otologic practice. STUDY PARTICIPANTS: Nine patients with varying degrees of facial nerve disability and 7 individuals with normal facial nerve function. RESULTS: The movement of the oral commissure compared with the apparent area of movement of the face determined by digital subtraction had high intersubject variability. In patients with facial weakness, the Nottingham score had a correlation coefficient of -0.97 compared with the House and Brackmann grade, and the digital subtraction score had a correlation coefficient of -0.62 (paired Student t test). CONCLUSIONS: The desktop computer software can be used to calculate the Nottingham score. Digital subtraction as a measure of facial function warrants further study.

Multicenter controlled clinical trial of high-frequency jet ventilation in preterm infants with uncomplicated respiratory distress syndrome.

OBJECTIVE: To test the hypothesis that high-frequency jet ventilation (HFJV) will reduce the incidence and/or severity of bronchopulmonary dysplasia (BPD) and acute airleak in premature infants who, despite surfactant administration, require mechanical ventilation for respiratory distress syndrome. DESIGN: Multicenter, randomized, controlled clinical trial of HFJV and conventional ventilation (CV). Patients were to remain on assigned therapy for 14 days or until extubation, whichever came first. Crossover from CV to HFJV was allowed if bilateral pulmonary interstitial emphysema or bronchopleural fistula developed. Patients could cross over to the other ventilatory mode if failure criteria were met. The optimal lung volume strategy was mandated for HFJV by protocol to provide alveolar recruitment and optimize lung volume and ventilation/perfusion matching, while minimizing pressure amplitude and O2 requirements. CV management was not controlled by protocol. SETTING: Eight tertiary neonatal intensive care units. PATIENTS: Preterm infants with birth weights between 700 and 1500 g and gestational age <36 weeks who required mechanical ventilation with FIO2 >0.30 at 2 to 12 hours after surfactant administration, received surfactant by 8 hours of age, were <20 hours old, and had been ventilated for <12 hours. Outcome Measures. Primary outcome variables were BPD at 28 days and 36 weeks of postconceptional age. Secondary outcome variables were survival, gas exchange, airway pressures, airleak, intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and other nonpulmonary complications. RESULTS: A total of 130 patients were included in the final analysis; 65 were randomized to HFJV and 65 to CV. The groups were of comparable birth weight, gestational age, severity of illness, postnatal age, and other demographics. The incidence of BPD at 36 weeks of postconceptional age was significantly lower in babies randomized to HFJV compared with CV (20.0% vs 40.4%). The need for home oxygen was also significantly lower in infants receiving HFJV compared with CV (5.5% vs 23.1%). Survival, incidence of BPD at 28 days, retinopathy of prematurity, airleak, pulmonary hemorrhage, grade I-II IVH, and other complications were similar. In retrospect, it was noted that the traditional HFJV strategy emphasizing low airway pressures (HF-LO) rather than the prescribed optimal volume strategy (HF-OPT) was used in 29/65 HFJV infants. This presented a unique opportunity to examine the effects of different HFJV strategies on gas exchange, airway pressures, and outcomes. HF-OPT was defined as increase in positive end-expiratory pressure (PEEP) by >/=1 cm H2O from pre-HFJV baseline and/or use of PEEP of >/=7 cm H2O. Severe neuroimaging abnormalities (PVL and/or grade III-IV IVH) were not different between the CV and HFJV infants. However, there was a significantly lower incidence of severe IVH/PVL in HFJV infants treated with HF-OPT compared with CV and HF-LO. Oxygenation was similar between CV and HFJV groups as a whole, but HF-OPT infants had better oxygenation compared with the other two groups. There were no differences in PaCO2 between CV and HFJV, but the PaCO2 was lower for HF-LO compared with the other two groups. The peak inspiratory pressure and DeltaP (peak inspiratory pressure-PEEP) were lower for HFJV infants compared with CV infants. CONCLUSIONS: HFJV reduces the incidence of BPD at 36 weeks and the need for home oxygen in premature infants with uncomplicated RDS, but does not reduce the risk of acute airleak. There is no increase in adverse outcomes compared with CV. HF-OPT improves oxygenation, decreases exposure to hypocarbia, and reduces the risk of grade III-IV IVH and/or PVL.

Neuropsychiatric manifestations following the use of 3,4-methylenedioxymethamphetamine (MDMA: "Ecstasy").

1. The recurring side-effects associated with MDMA consumption are reviewed. 2. The recreational use of "Ecstasy" has been implicated in the onset of various psychological, neurological, and organic complications. A table has been employed to depict the deleterious reactions that have occurred following MDMA ingestion. 3. An original case report is presented in which an individual developed perpetual neuropsychiatric symptomatology after having consumed MDMA. This case indicates that MDMA may induce long lasting effects, even after one exposure.

Glyceraldehyde-3-phosphate dehydrogenase activity and F-actin associations in synaptosomes and postsynaptic densities of porcine cerebral cortex.

1. Glyceraldehyde-3-phosphate dehydrogenase (G3PD) is a glycolytic enzyme that has also been implicated in a wide variety of functions within neurons. Because of the well-documented role of G3PD as an actin-binding protein, we sought evidence for a G3PD-actin complex in synaptosomes and postsynaptic densities (PSDs). 2. We have shown G3PD association with 0.5-microgram synaptosomal particles by immunofluorescence as similarly demonstrated for actin (Toh et al., Nature 264:648-650, 1976). An immunoblot analysis also showed G3PD and actin to be enriched in synaptosomes. Further analysis of subcellular fractions from synaptosomes showed the PSD but not the synaptosomal plasma membranes to be enriched in G3PD and actin. 3. Highest levels of G3PD catalytic activity were found in synaptosomes and PSDs. Although synaptosomes showed significant activity for phosphoglycerate kinase (PGK), an enzyme in sequence with G3PD for ATP production in the glycolytic pathway, no such activity was detected in the PSD fraction. 4. Our studies indicate that a G3PD-actin complex may exist at the synapse. A physical association of G3PD with endogenous F-actin in synaptosomes and PSDs was demonstrated by combined phalloidin shift velocity sedimentation/immunoblot studies. By this approach, synaptosomal G3PD-actin complexes were also found to be significantly less dense than the PSD G3PD-actin complexes. 5. G3PD and PGK catalytic activity in synaptosomes suggests a role in glycolysis, as well as actin binding, in the presynaptic terminals. On the other hand, the high levels of G3PD activity in PSDs but lack of PGK activity suggests that G3PD is involved in nonglycolytic functions, such as actin binding and actin filament network organization.

Critique of the National Cancer Institute of Canada's framework for cancer control.

This paper offers a critique of the National Cancer Institute of Canada's (NCIC) framework for cancer control. The critique has been prepared by researchers who used the framework to review the literature in 5 substantive areas. These reviews, published in the current and previous issues of CPC, were designed to begin to outline a research agenda for the Sociobehavioural Cancer Research Network. In this paper, the authors reflect on the strengths and limitations of the framework. Perceived strengths are that the framework (a) facilitates systematic thinking about research options and priorities, (b) helps foster clear communication, (c) links science and practice, (d) may assist grant review panels to place proposed studies in context and (e) emphasizes important values. Perceived concerns include the following: (a) potential users are not familiar with the framework, (b) lack of clarity of definitions and classification criteria, (c) the utility of the framework is not immediately self-evident to potential users, (d) the framework lacks emphasis on environmental and policy interventions and (e) it is not clear how the values espoused are to be integrated with other dimensions of the framework. The concerns were seen as remediable. In short, the framework was seen to be valuable in its current form; refinement may enhance its value.

NADPH diaphorase activity and nitric oxide synthase immunoreactivity in lordosis-relevant neurons of the ventromedial hypothalamus.

The distribution of the enzymes NADPH diaphorase and nitric oxide synthase in the ventromedial nucleus of the hypothalamus of cycling and ovariectomized/estrogen-treated and control female rats was demonstrated using histochemical and immunocytochemical methods. Serial section analysis of vibratome sections through the entire ventromedial nucleus showed that NADPH diaphorase cellular staining was localized primarily in the ventrolateral subdivision. NADPH diaphorase staining was visible in both neuronal perikarya and processes. Light microscopic immunocytochemistry using affinity-purified polyclonal antibodies to brain nitric oxide synthase revealed a similar pattern of labelling within the ventromedial nucleus and within neurons of the ventrolateral subdivision of the ventromedial nucleus. Control experiments involved omitting the primary antibodies; no labelling was visible under these conditions. Some, but not all, neurons in the ventrolateral subdivision of the ventromedial nucleus contained both NADPH diaphorase and brain nitric oxide synthase as demonstrated by co-localization of these two enzymes in individual cells of this area. That NADPH diaphorase and brain nitric oxide synthase were found in estrogen-binding cells was shown by co-localization of NADPH diaphorase and estrogen receptor and brain nitric oxide synthase and estrogen receptor at the light and ultrastructural levels, respectively. Our studies suggest that brain nitric oxide synthase is present and may be subject to estrogenic influences in lordosis-relevant neurons in the ventrolateral subdivision of the ventromedial nucleus. The hypothalamus is a primary subcortical regulatory center controlling sympathetic function. Therefore, not only is nitric oxide likely to be important for reproductive behavior, but also for the regulation of responses to emotional stress and other autonomic functions.

Comparative analysis of the kinetics and dynamics of K10, bicoid, and oskar mRNA localization in the Drosophila oocyte.

The localization of mRNAs to discrete cytoplasmic sites is important for the function of many, and perhaps all, cells. Many mRNAs are thought to be localized in a directed fashion along microtubule tracts. This appears to be the case for several mRNAs that are synthesized in Drosophila nurse cells and then transported into, and localized within, the oocyte. In this report, we compare the transport/localization kinetics and dynamics of three such mRNAs, K10, bicoid, and oskar. We generated flies carrying heat shock-K10, -bicoid, or -oskar fusion genes, which allowed us to carry out the molecular genetics equivalent of a pulse chase experiment. Our analyses indicate that K10, bicoid, and oskar mRNA transport and localization are a continuous process involving multiple movements of the same mRNA molecules. The transport and early localization dynamics of the three mRNAs are indistinguishable from each other and, in order, include accumulation in the apical regions of nurse cells, transport to the posterior pole of the oocyte, and movement to the oocyte's anterior cortex at stage 8. We also show that the rate of transport is the same in each case, approximately 1.1 microns/min. Only after stage 8 are RNA-specific movements seen. The similarities in the transport/ early localization kinetics and dynamics of K10, bicoid, and oskar mRNAs suggest that such events are mediated by a common set of factors. We also observe that all three mRNAs localize to the apical regions of somatic follicle cells when expressed in such cells, suggesting that the transport/early localization factors are widespread and involved in the localization of mRNAs in many tissues.

A small predicted stem-loop structure mediates oocyte localization of Drosophila K10 mRNA.

The establishment of dorsoventral polarity in the Drosophila oocyte and future embryo is dependent on the efficient transport of K10 mRNA from nurse cells into the oocyte. To investigate the cis-requirements of K10 mRNA transport, we used a transgenic fly assay to analyze the expression patterns of a series of K10 deletion variants. Such studies identify a 44 nucleotide sequence within the K10 3' untranslated region that is required and sufficient for K10 mRNA transport and subsequent localization to the oocyte's anterior cortex. An inspection of the 44 nucleotide transport/localization sequence (TLS) reveals a strong potential for the formation of a stem-loop secondary structure. Nucleotide substitutions that interfere with the predicted base-pairing of the TLS block mRNA transport and anterior localization. Conversely, mutations that alter the base composition of the TLS while maintaining predicted base-pairing do not block mRNA transport or anterior localization. We conclude that K10 mRNA transport and anterior localization is mediated by a 44 nucleotide stem-loop structure. A similar putative stem-loop structure is found in the 3' untranslated region of the Drosophila orb mRNA, suggesting that the same factors mediate the transport and anterior localization of both K10 and orb mRNAs. Apart from orb, the K10 TLS is not found in any other localized mRNA, raising the possibility that the transport and localization of other mRNAs, e.g., bicoid, oskar and gurken, are mediated by novel sets of cis- and trans-acting factors. Moreover, we find that the K10 TLS overrides the activity of oskar cis-regulatory elements that mediate the late stage movement of the mRNA to the posterior pole. We propose the existence of a family of cis-regulatory elements that mediate mRNA transport into the oocyte, only some of which are compatible with the elements that mediate late stage movements.

Subjective reports on the effects of the MDMA ('ecstasy') experience in humans.

1. The objective of this paper was to provide an understanding of methylenedioxymethamphetamine (MDMA) use. This investigation provides the subjective effects that were reported by MDMA users. 2. There were a total of (500) humans who participated in this study. 3. Using a survey device, data from users were collected. Symptomatology associated with both the consumption of MDMA and its residual effects are documented. 4. Tables have been constructed to present prevalent psychological and physical side-effects associated with MDMA intake. 5. The results suggest that MDMA has significant implications with various psychological disorders and physical manifestations.