Remote image based retinopathy of prematurity diagnosis: a receiver operating characteristic analysis of accuracy.

BACKGROUND/AIMS: Telemedicine offers potential to improve the accessibility and quality of diagnosis of retinopathy of prematurity (ROP). The aim of this study was to measure accuracy of remote image based ROP diagnosis by three readers using receiver operating characteristic (ROC) analysis. METHODS: 64 hospitalised infants who met ROP examination criteria underwent two consecutive bedside procedures: dilated examination by an experienced paediatric ophthalmologist and digital retinal imaging with a commercially available wide angle camera. 410 images from 163 eyes were reviewed independently by three trained ophthalmologist readers, who classified each eye into one of four categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Sensitivity and specificity for detection of mild or worse ROP, type 2 prethreshold or worse ROP, and ROP requiring treatment were determined, compared to a reference standard of dilated ophthalmoscopy. ROC curves were generated by calculating values for each reader at three diagnostic cut-off levels: mild or worse ROP (that is, reader was asked whether image sets represented mild or worse ROP), type 2 prethreshold or worse ROP (that is, reader was asked whether image sets represented type 2 prethreshold or worse ROP), and ROP requiring treatment. RESULTS: Areas under ROC curves ranged from 0.747-0.896 for detection of mild or worse ROP, 0.905-0.946 for detection of type 2 prethreshold or worse ROP, and 0.941-0.968 for detection of ROP requiring treatment. CONCLUSIONS: Remote interpretation is highly accurate among multiple readers for the detection of ROP requiring treatment, but less so for detection of mild or worse ROP.

Intracellular survival of Staphylococcus aureus within cultured enterocytes.

BACKGROUND: Little is known about the mechanisms involved in bacterial translocation from the intestinal lumen to extraintestinal sites. Because Staphylococcus aureus can colonize the intestinal tract, and because the intestinal tract is a reservoir for antibiotic resistant S. aureus, experiments were designed to clarify the interactions of S. aureus with cultured intestinal epithelial cells, and assays included measurements of bacterial internalization, enterocyte apoptosis, and epithelial barrier function. METHODS AND RESULTS: Mature, confluent enterocytes were incubated 1 h with S. aureus, and the gentamicin protection assay was used to quantify intracellular bacterial survival at various time intervals up to 120 h later. Enterocyte apoptosis was assessed using Annexin V, and the permeability of confluent enterocyte cultures was measured by transepithelial electrical resistance and by transmigration of Escherichia coli across confluent enterocytes.S. aureus was internalized by cultured enterocytes and remained viable for up to 120 h within both HT-29 and Caco-2 enterocytes. S. aureus intracellular survival was associated with enterocyte apoptosis and with decreased transepithelial electrical resistance across confluent Caco-2 enterocytes. S. aureus intracellular survival over time was also associated with increased E. coli transmigration across confluent Caco-2, but not HT-29, enterocytes. CONCLUSIONS: S. aureus appeared to survive within cultured enterocytes for prolonged time periods, up to several days. Survival of S. aureus within host eukaryotic cells, such as enterocytes, might facilitate persistence of S. aureus in infected tissue despite appropriate antibiotic therapy.

Effect of tumor necrosis factor alpha, interferon gamma, and interleukin-4 on bacteria-enterocyte interactions.

BACKGROUND: Little is known about the mechanisms involved in bacterial translocation from the intestinal lumen to extraintestinal sites. Because the cytokine cascade associated with sepsis, inflammation, and trauma has been shown to affect intestinal epithelial permeability, experiments were designed to clarify the effects of selected cytokines on bacterial adherence to and internalization by cultured HT-29 and Caco-2 enterocytes. METHODS: Mature, confluent enterocytes were pretreated 48 to 72 h with tumor necrosis factor alpha (TNF-alpha), interferon gamma, (IFN-gamma), or interleukin-4 (IL-4). Adherence of Listeria monocytogenes, Salmonella typhimurium, Proteus mirabilis, and Escherichia coli was measured by enzyme-linked immunosorbent assay and bacterial internalization was quantified by the gentamicin protection assay. Enterocyte permeability was measured by transepithelial electrical resistance and by flux of 40-kDa fluorescent dextran. Bacterial transmigration across confluent enterocytes was measured using enterocytes cultivated on permeable supports. RESULTS: TNF-alpha, IFN-gamma, and IL-4 had variable effects on bacterial adherence to HT-29 and Caco-2 enterocytes, although the most consistent finding was increased bacterial adherence associated with INF-gamma. However, none of these cytokines had a noticeable effect on bacterial internalization by either Caco-2 or HT-29 enterocytes. In addition, none of these cytokines had a noticeable effect on the permeability of confluent enterocytes as measured by transepithelial electrical resistance or dextran flux. Bacterial transmigration across confluent HT-29 enterocytes was not altered by TNF-alpha, IFN-gamma, or IL-4; however, IL-4 consistently decreased bacterial transmigration across confluent Caco-2 enterocytes. CONCLUSIONS: IFN-gamma may augment the epithelial adherence of selected species of enteric bacteria, and IL-4 may act as a barrier-sustaining agent to decrease bacterial migration across the intestinal epithelium.

Integrin expression, enterocyte maturation, and bacterial internalization.

BACKGROUND: Little is known about the molecular mechanisms involved in the translocation of enteric bacteria. Adhesion molecules mediate interactions between some enteric pathogens and mammalian cells, but no such interactions have been identified for enterocytes and normal enteric bacteria. Using enteric pathogens, adhesion molecule expression has been linked to bacterial internalization and to enterocyte differentiation. Therefore, experiments were designed to study enterocyte integrin expression and differentiation, as well as enterocyte internalization of Salmonella typhimurium, Proteus mirabilis, and Escherichia coli. MATERIALS AND METHODS: Relative expression of the alpha2, alpha3, and beta1 integrin subunits on Caco-2 and HT-29 enterocytes (mature and immature) was measured by ELISA. Bacteria-enterocyte surface interactions were observed by light and scanning electron microscopy. Bacterial internalization by enterocytes was quantified using the gentamicin protection assay. RESULTS: Expression of the alpha2, alpha3, and beta1 integrin subunits was consistently increased in immature compared to mature Caco-2 enterocytes; however, compared to mature enterocytes, immature HT-29 enterocytes had similar expression of alpha3 and beta1 but decreased alpha2. Compared to untreated mature enterocytes, bacterial internalization was increased in immature enterocytes as well as mature enterocytes with lateral membranes artifactually exposed. However, there was no difference in bacterial internalization between immature enterocytes and mature enterocytes treated to expose the lateral membrane. CONCLUSIONS: Bacterial internalization by enterocytes appeared to be due to factors other than integrin expression or enterocyte differentiation. Exposure of the lateral enterocyte membrane may play an important role in facilitating bacterial internalization by enterocytes.

Extracorporeal tissue engineered liver-assist devices.

The treatment of acute liver failure has evolved to the current concept of hybrid bioartificial liver (BAL) support, because wholly artificial systems have not proved efficacious. BAL devices are still in their infancy. The properties that these devices must possess are unclear because of our lack of understanding of the pathophysiology of liver failure. The considerations that attend the development of BAL devices are herein reviewed. These considerations include choice of cellular component, choice of membrane component, and choice of BAL system configuration. Mass transfer efficiency plays a role in the design of BAL devices, but the complexity of the systems renders detailed mass transfer analysis difficult. BAL devices based on hollow-fiber bioreactors currently show the most promise, and available results are reviewed herein. BAL treatment is designed to support patients with acute liver failure until an organ becomes available for transplantation. The results obtained to date, in this relatively young field, point to a bright future. The risks of using xenogeneic treatments have yet to be defined. Finally, the experience gained from the past and current BAL systems can be used as a basis for improvement of future BAL technology.

Bilateral rhegmatogenous retinal detachments with unilateral vitreous base avulsion as the presenting signs of child abuse.

PURPOSE: To describe a 7-year-old boy with bilateral rhegmatogenous retinal detachments and unilateral vitreous base avulsion as the presenting signs of child abuse. METHOD: Case report. RESULTS: Examination demonstrated no external signs of trauma or ocular findings typically found in battered child syndrome; however, findings of rhegmatogenous retinal detachments and vitreous base avulsion raised the suspicion of child abuse, which was confirmed with further history. A scleral buckle procedure and pars plana vitrectomy with silicone oil tamponade were performed in the right eye followed by a similar procedure in the left eye 1 week later. CONCLUSION: Vitreous base avulsion and rhegmatogenous retinal detachments may be the only presenting signs of child abuse.

Early discharge from the NICU.

Early discharge from the NICU has created much controversy and concern among health care professions and parents. It sparked legislative discussions at the state and federal levels spawned from the legislative mandates for mother/baby discharges of not less than 48 hour for uncomplicated vaginal deliveries. However, unlike the term, healthy newborn and the mother, there are no uniform criteria for NICU discharges. Much of the health care once given in the confines of the NICU has moved into the home. Parents are being expected to provide "high-tech" care with little or no professional help. This article discusses the rationale for the health care delivery changes and the need for guidelines for safe, early NICU discharges. Developmental care and community resources within the context of early intervention programs are discussed and individualized family service plans explained.

Career opportunities for neonatal nurses.

This article will outline career opportunities now available for neonatal nurses in acute care and community settings. Healthcare reform has increased the emphasis on health promotion, holistic care, and patient teaching, vital aspects of all nursing education and practice. Nurses choosing to capitalize on these strengths have opportunities to develop and shape their future nursing careers.

Families caring for children with fetal alcohol syndrome: the nurse's role in early identification and intervention.

Alcohol is a teratogenic substance that, when ingested during pregnancy, may cause the fetus to be born with a condition known as fetal alcohol syndrome (FAS). FAS is a life-long condition that leads to serious primary and secondary disabilities. Holistic early identification and intervention for children with FAS and their families may ameliorate the secondary disabilities associated with FAS. Nurses working with families and young children could play a key role in early identification and intervention for children with FAS.

Technology and alternative cancer therapies: an analysis of heterodoxy and constructivism.

Theories of the construction of technology are reviewed from the wider interdisciplinary conversation known as science and technology studies (STS) and from the growing field of the anthropology of science and technology. These theories are used to contribute to research situated at the intersection of the anthropology of alternative medicine and of medical technologies. Cases drawn from the research tradition on microbial theories of cancer are considered to show how unorthodox medical theories become embedded in technologies through choices in microscope design and treatment technologies. In turn, the technologies contribute to the heterodox standing of the researchers, their research, and their therapies.

Qualified retirement plans. Yours may be worth just 17 on the dollar.

In summary, let's review the result of the Joneses' coordinated retirement income and estate planning strategy: 1. The Joneses maximized their estate assets, converting an inefficient estate asset to an efficient estate asset, without jeopardizing their current or future standard of living. 2. They committed to a gifting program for only 10 years, after which they have the flexibility to continue gifting the trust or to retain all the current IRA income. 3. They are free to "consume" their other taxable assets during their lifetimes without worrying about saving something for their three children. The Wealth Replacement Trust will leave approximately $1 million for each child. This strategy is obviously not available to everyone, nor is it applicable to everyone. While this solution worked extremely well for these clients, everyone's situation is different. Every situation needs a professional and personalized plan based upon individual objectives. Only after objectives have been clearly identified and alternatives thoroughly explored can a suitable solution be identified. It is important that a thorough review of the entire financial picture be performed by a competent financial planning team before you attempt to correct a potential problem. Make certain your advisers are familiar with solving this type of problem so as not to create additional problems.