Is artificial reproductive technology a risk factor for retinopathy of prematurity independent of the generation of multiple births?

PURPOSE: There is some debate regarding whether artificial reproductive technology (ART) constitutes an independent risk factor for retinopathy of prematurity (ROP). We wanted to assess the prevalence of ART in multiple birth infants seen for ROP screening and whether or not ROP was identified or treated, in order to evaluate whether ART contributes a risk factor for ROP independent of the generation of multiple births. METHODS: A retrospective audit was performed of all multiple birth babies admitted to a tertiary neonatal unit who met the UK ROP screening criteria (<32 weeks gestational age [GA] and/or <1,501 g birthweight [BW]). RESULTS: A total of 205 babies met our criteria, of whom 87.3% were twins. A total of 39.5% were born following ART. A total of 30.5% of the non-ART group developed ROP vs 34% of the ART group (p = 0.837). Stage 3 ROP developed in 5.1% of non-ART babies and 6% of ART babies. A total of 8.5% of non-ART babies and 10% of ART babies required treatment for ROP. Logistic regression demonstrated that ART was not independently associated with development of ROP. CONCLUSIONS: Artificial reproductive technology multiple birth babies make up a considerable proportion of the ROP screening burden and their number is likely to increase as ART is increasingly available and utilized. We found no significant difference between the numbers of babies developing ROP in the ART vs non-ART groups, but the numbers are small. The estimated odds of developing ROP are slightly higher in the ART babies, so our data do not rule out a possible association.

A newborn with unilateral limb enlargement.

On routine neonatal examination, a newborn term male was noted to have unilateral enlargement of the right lower limb, loose thickened red skin over the palm and widening of all the fingers on the right hand. His body was pinker and warmer on the right side compared with the left and he had a right undescended testicle and hypoplastic scrotum. Radiological examination of the lower limbs demonstrated the enlargement of the soft tissue of the right lower limb compared to the left (Fig. 1). Therefore, the diagnosis was unclear from this constellation of findings and an ophthalmic assessment was requested.

Gill hematoxylins: first person account.

This is a personal and practical account of Gill hematoxylin, how it came to be, its composition, illustrations of its appearance in solution with subsequent additions of hematoxylin, oxidizing agent, mordant, a tabular history of relevant contributions, identification of the surface precipitate that forms on concentrated hematoxylin formulations (e.g., Harris), the role of acetic acid, the difference between progressive and regressive staining, differentiation, bluing, quality assurance using buccal smears, and troubleshooting. As a de facto case study, the information can be extrapolated to all other extant hematoxylin formulations and to a comprehensive approach to the implementation of all stains.

Racial variation in the proximal and distal femur: heritability and forensic utility.

The femur has been studied successfully by physical anthropologists for many years. Such traits as femoral head diameter and bicondylar width have been examined extensively and are of great value to forensic anthropologists and other skeletal biologists in sex identification. A number of studies over the past decade by the author and his former students have shown marked racial differences in the shape of the proximal femur and in at least one trait of the distal femur--intercondylar notch height. Anterior-posterior (AP) diameter of the proximal femur is much greater among Whites and Blacks than among East Asians and American Indians. Blacks have slightly greater intercondylar notch height than Whites. Other features, such as torsion, also differ between the major geographic racial populations. Current analysis suggests that the East Polynesians fall close to the American Indians and East Asians in the degree of flatness of the proximal femur. One study has tracked the degree of change in flatness during individual development, and finds little change within major populations from the youngest to the oldest individuals. Temporal changes within populations are likewise minimal. Two studies have examined sex differences within populations, which are also found to be very slight. Racial differences, on the other hand, are quite significant, and individuals of admixed ancestry fall intermediate between the two parental populations. Such suggestions of high heritability in the shape of the proximal and distal femur make these traits very useful in assessing ancestry in forensic contexts.

Eradication of house dust mite from homes of atopic asthmatic subjects: a double-blind trial.

BACKGROUND: House dust mite (HDM) allergens can accumulate to very high levels in homes. From the observed sensitivity of HDMs to heat and their allergens to steam, a novel treatment of furnishings has been developed. OBJECTIVE: We sought to determine whether combined steam and heat treatment of home furnishings reduced asthmatic patients' bronchial hyperreactivity (BHR) and lowered HDM antigen loads. METHODS: The homes of 30 asthmatic subjects aged 18 to 45 years were randomly allocated into 3 groups. In groups 1 and 2 mattresses and duvets were treated with hot air (110 degrees C), followed by steam and then heat again. All their carpets were steam cleaned. Group 2 also had a special ventilation system installed above each patient's bedroom. The homes of subjects in group 3 were sham treated. Neither patient nor laboratory staff was aware of the types of treatment. Der p 1 and 2 levels in the household dust from the lounge, bedroom carpet, and beds were determined before and after treatment and then at 6 and 12 months. BHR, measured by using histamine PD(20) values, was recorded during the 4-week run-in period and at 3, 6, 9, 12 months after treatment. RESULTS: Active heat-steam treatment of homes caused a sustained reduction of Der p 1 (P =.003) and Der p 2 (P =.001) compared with no change in sham-treated group 3 homes. Patients whose homes were treated showed a 4-fold reduction in BHR at 9 months in group 1 and throughout the posttreatment period in group 2. No change was observed in the asthmatic subjects whose homes were not treated. These improvements were sustained for 12 months in the homes with bedroom ventilation units. CONCLUSIONS: A single treatment of home furnishings reduced mite allergen load to below the risk level for sensitization and improved the asthmatic patients' BHR by 4-fold.

Challenge on the frontier: discerning American Indians from whites osteologically.

Throughout much of the western region of the United States the traditional metric method for discerning Amerindian skeletal remains from those of Whites or Blacks, that is, the Giles-Elliot discriminant function approach, has simply been shown to be ineffective. It also seems to fail at correctly identifying the crania of Black males. The region of the West that produces the lowest percentages of correct placement of American Indian skeletons appears to be the Northwestern Plains (Wyoming, Montana). For this reason, in that area of the West a number of new methods have emerged (both metric and non-metric) in recent years. The effectiveness of each of these approaches in the process of skeletal identification varies, but most of them appear to be quite useful in forensic contexts. It is also suggested that some additional new approaches which seem to hold much promise for the future, be tested objectively as well, in order to ascertain their effectiveness in forensic casework.

Racial identification from the midfacial skeleton with special reference to American Indians and whites.

Successful approaches to race determination of unidentified human remains have been developed by anatomists and physical anthropologists, but few quantitative methods are available for distinguishing American Indian crania from those of whites. The leading method in use today is particularly ineffective in its placement of American Indian skulls from the western regions of the United States. Recent development and testing of a new metric method suggests a much more effective technique. The method involves six breadth and projection measurements of the midfacial skeleton, the calculation of three indices, and a simple direct reading of results. The method has the additional advantage of use in the autopsy room with minimal dissection of soft tissue required. Based upon a less extensive test of East Asian and Arctic Mongoloid crania, the method appears to be even more effective in separating them from the sharp featured whites. Larger samples of American blacks and Polynesians are presently under study and these also appear to separate quite readily from whites using the same or similar sectioning values.

A quantitative method for the detection and localization of quantum-limited events from radionuclides in cells and tissue sections by computer-enhanced video microscopy.

Cellular dynamics often involve extremely low concentrations of biologically active substances, which can be radiolabeled and detected, localized and quantitated by autoradiography. The latter may require exposures from a few days to many months. The objective of this research was to demonstrate the feasibility of reducing this long period of data collection by one to two orders of magnitude, while maintaining or improving the spatial resolution and localization in tissues and the quantitative characteristics inherent in autoradiography. A mathematical model describing the complete system was generated using energy partition calculations to estimate photon production via scintillant per H3 beta particle emission and to estimate the subsequent photon capture based upon imaging system parameters and microscope geometry. Calculations showed that, typically, a single tritium beta particle produces a maximum of 5.8 X 10(3) photons. A photon-limited camera and microscope imaging system were selected and optimized in conjunction with a specially developed physical scintillation model. Results showed that the number of detected photoevents increases monotonically with both signal integration time and, independently, with the concentration of the radionuclide. Consequently, this work demonstrates that video microscopy imaging methods can spatially and temporally quantify very low concentrations of radiolabeled substances and can reduce data acquisition times.

Cytomorphologic evaluation of the neoplastic potential of 28 cell culture lines by a panel of diagnostic cytopathologists.

A panel of 7 diagnostic cytopathologists, i.e., physicians trained to diagnose the malignant potential of human cells in Papanicolaou-stained smears, was asked to evaluate two sets of microscope slides of stained coverslip preparations of 28 cell culture lines, 15 of which were neoplastic. Slide Set I consisted of 13 pairs of cell lines, one member of each pair being nontumorigenic and the other tumorigenic; the lines were of mouse (9 pairs), rat (3 pairs), and human (1 pair) origin. Slide Set II contained 4 human lines: one lung cancer, one melanoma, and two fibroblast lines. Of a total of 114 diagnostic decisions by the panel, 88 were correct (66/86, 77%) in choosing which member of a pair was neoplastic and 22 were correct (22/28, 79%) in choosing whether a given individual human line was or was not neoplastic. Two members of the panel were correct more frequently, with 16/17 (94%) correct diagnoses, each. Five nuclear morphologic criteria of malignancy used by cytopathologists were prominent in the tumorigenic lines: altered chromatin pattern characterized by increasing size of chromatin granules and chromatin clumping, sharp angularity of large nucleolar and/or chromocenter borders with spicule formation (pointed projection), irregular parachromatin clearing (increase in the clarity of the clear spaces between chromatin threads, granules and clumps), uneven thickness of chromatin at the nuclear border, and variability in nuclear size and shape from cell to cell. These markers of neoplastic transformation, when added to those previously reported, should increase overall accuracy in the diagnosis of neoplastic transformation of mammalian cells in culture.

Action of almitrine bismesylate on ventilation-perfusion matching in cats and dogs with part of the lung hypoventilated.

Ventilation to one lobe of lung was reduced in anaesthetized open-chest cats and dogs to simulate the ventilation/perfusion (V/Q) mismatching of chronic lung disease. Blood flow to this lobe fell less than ventilation; thus lobar V/Q diminished. In seven cats almitrine (0.5 mg/kg + 10 micrograms/kg per min, i.v.) caused a rise in pulmonary artery pressure (PPA), increased flow through the hypoventilated lobe in six out of seven cats and both increased or decreased lobar vascular resistance (PVR); the lobar V/Q ratio therefore fell. Arterial and lobar venous oxygen tension (PO2) fell. In five dogs almitrine caused a rise in PPA and PVR but lobar flow changes were variable. Arterial and lobar venous PO2 fell. With fixed ventilation, almitrine failed to improve V/Q matching; there was no improvement in gas exchange in the hypoventilated lobe. In eight dogs the hypoventilated lobe was perfused at constant flow with right atrial blood (i.e. while V/Q was held constant). Almitrine caused a rise in perfusion pressure, vasoconstriction, followed, in five out of eight dogs, by vasodilatation. In six similar cat preparations, vasoconstriction but not vasodilatation was clearly shown. In two cats dilatation after almitrine was demonstrated during ventilation with Nitrogen. In all experiments there was no significant effect of the solvent. Thus the dual action of almitrine seen in other species was seen in a proportion of cats and dogs. Results do not support the view that improved arterial gas tensions in patients after almitrine are attributable to diversion of blood flow away from hypoxic lung. Alternative mechanisms are discussed.

Action of almitrine on the pulmonary vasculature in ferrets and rats.

The action of almitrine on pulmonary vessels was studied under constant ventilation during normoxia and hypoxia. We used ferrets, in which one lobe of lung was perfused with venous blood at constant flow rate in vivo and isolated lungs perfused with blood at constant flow in both ferrets and normal and chronically hypoxic (three weeks in 10% O2) rats. Almitrine caused constriction of the relaxed vessels of normoxic lung. During hypoxic pulmonary vasoconstriction, when pulmonary artery pressure (Ppa) was raised, almitrine had a dual action; it caused further constriction followed by dilatation over a wide dose range (0.7-118 micrograms X kg-1 in ferrets). Similar effects were seen in normal and chronically hypoxic rats; the latter have narrowed muscularized arterioles like patients with chronic obstructive airways disease. Almitrine caused a larger rise in Ppa in normoxic than hypoxic rat lungs (7.9 instead of 1.7 mmHg; p less than 0.001) and dilatation followed constriction in the latter. Verapamil reduced both the constrictor action of almitrine and hypoxic vasoconstriction and there was a strong correlation between the effect of the two stimuli before and after verapamil (r = 0.9). Attempts to identify a substance which might cause the dilator action of almitrine were unsuccessful.

Does almitrine bismesylate improve V/Q matching? An animal study.

Pulmonary vascular actions of almitrine bismesylate were studied in ferrets, rats, cats and dogs in conditions which simulated those of patients with hypoxic lung disease. All or part of a lung was made hypoxic or hypoventilated so that affected vessels were constricted. Rats were made chronically hypoxic (10%, O2, normobaric chamber). In vivo and isolated preparations were used. In all preparations and species almitrine bismesylate caused vasoconstriction in normoxia, constriction followed by dilation in hypoxia or hypoventilation. In hypoventilated lung there is ventilation/perfusion mismatching which was not improved by almitrine bismesylate . Ventilatory measurements in chronically hypoxic/hypercapnic rats showed that almitrine bismesylate increased tidal volume but not frequency. It is uncertain whether vascular (Q) or small ventilatory (V) changes are the cause of the improved gas tensions and V/Q matching in patients with chronic obstructive lung disease receiving almitrine bismesylate .

The effects of localized hypoventilation on ventilation/perfusion (V/Q) ratios and gas exchange in the dog lung.

1. Hypoventilation of one lobe of lung was studied in open-chest anaesthetized dogs. Lobar blood flow, pulmonary-artery pressure and gas exchange were measured, the latter from breath-by-breath analysis with a mass spectrometer. 2. Hypoventilation of the lobe by reducing the respiratory pump stroke led, at each step, to a reduction in blood flow to that lobe. The flow (Q) reduction was variable, but always less than the ventilation (VE) reduction, so that the V/Q ratio to the lobe was reduced. O2 tension and pH fell and CO2 tension rose in effluent blood. Thus V/Q regulation achieved by flow reduction varied between individuals and was of low gain. 3. Anatomical or series dead space (VD series) was reduced in proportion to ventilation. When VD series was less than the apparatus dead space, some gas exchange still took place. 4. Oxygen uptake (VO2) and CO2 output (VCO2) were reduced during hypoventilation. VCO2 fell more than VO2, so that the respiratory exchange ratio (R) was reduced. 5. Whether the deterioration in gas tensions in effluent blood during hypoventilation of the lobe was due to shunt of blood past unventilated alveoli, or to V/Q mismatching, was not resolved. 6. The plateau phase of the CO2-output curves at low tidal volumes was usually regular; thus either hypoventilation was uniform, or some ventilation units were totally closed.

Heparinized bottles for the collection of body cavity fluids in cytopathology.

A method of preparing cytopathology specimen collection bottles with a heparin solution is described. The need and benefits of using heparinized bottles for the collection of body cavity fluids are discussed briefly. The formulation of the heparin solution and procedure for preparation of the bottles are given in detail. Collection techniques are discussed briefly. Use of the heparinized bottles results in more reliable diagnostic procedures.

Automatic cell identification and enrichment in lung cancer. I. Light scatter and fluorescence parameters.

Two physical parameters were investigated to automatically recognize cells in sputum from human squamous cell carcinoma of the lung and to separate them for preparation by the Papanicolaou methods, for human interactive identification and for automated high resolution image analysis. The two parameters, 0.5-15.0 degrees forward argon-ion laser light scatter to estimate total cell size and 546 nm Acridine orange fluorescence to approximate total cell DNA content, were measured in a flow-through fluorescence activated cell sorting system. Enrichment for neoplastic cells in three cases of squamous cell carcinoma of the lung averaged 7.8-fold over the original sputum when only green fluorescence was used and 10.5-fold using green fluorescence and forward light scatter. The average enrichment for neoplastic cells was 65.6-fold relative to polymorphonuclear deenrichment.