Antioxidant efficacy on human skin in vivo investigated by UVA-induced chemiluminescence decay analysis via induced chemiluminescence of human skin.

BACKGROUND/AIMS: Exogenous factors (e.g. physical: UV irradiation; or chemical: hydrogen peroxide) and endogenous metabolic processes (e.g. cellular respiration, oxidative burst, etc.) generate oxidative stress in living tissues which are in balance with enzymatic antioxidative systems and ingested antioxidants under normal conditions. These complex biological reactions are accompanied by chemiluminescence (ultraweak photon emission). However, knowledge about the chemiluminescence decay characteristics of human skin and the modulatory influence of topically applied antioxidants is still scarce. METHODS: Using ICL-S (induced chemiluminescence of human skin), a highly sensitive in vivo method, the decay characteristics of UVA-induced photon emission caused by different UVA doses were investigated in detail. In addition, modulatory properties of topical antioxidant pretreatment were examined for 2 weeks. RESULTS: UVA-induced chemiluminescence signals were generally characterized by two distinct decay phases: an initial burst (0-5 s), contributing approximately 80% of the complete signal with an inverse dose-response relationship (UVA dose vs. chemiluminescence intensity), followed by a second decay phase (delayed chemiluminescence, 5-200 s) showing a direct correlation. Antioxidant pretreatment caused a reduction in signal intensity of approximately 50%, which was calculated by signal integration and confirmed using the modulation of the intersection point of decay curves resulting from irradiation with different UVA doses at constant intensity with and without treatment. CONCLUSION: In addition to the established UVA filter testing (independent from UVB filter content) on human skin in vivo, ICL-S is also a valuable tool for the efficacy testing of topically applied antioxidants under in vivo conditions in humans. The first rapid, but short, decay phase not only provides approximately 80% of the complete chemiluminescence signal, but is also essential for the investigation of antioxidant-mediated effects. Chemiluminescence signal modulations induced by UVA intensity reduction (e.g. UV filters in daily care products) can be clearly distinguished from antioxidant-mediated signal modulations. The probe head dimensions permit comprehensive in vivo testing in humans on practically every skin area (e.g. arms, legs, back, abdomen and face).

Very preterm children who do not cooperate with assessments at three years of age: skill differences at five years.

This study examined skill differences at 5 years of age for very preterm children who were or were not cooperative with developmental testing at 3 years of age. All children born between 1986 and 1991 who were less than 30 weeks of gestation were followed prospectively. Two hundred one children were seen at both the 3- and 5-year assessments. Of the 201 children, 24 (11.9%) who had been uncooperative in the assessment at 3 years were seen at 5 years. Uncooperative children were matched to a group of cooperative children for sex, gestation, and/or birth weight. Nonparametric analyses revealed that scores on the Binet Pattern Analysis (p < .01) and the Bead Memory (p < .01) subtests were significantly different between the groups. The uncooperative children scored significantly more often in the at-risk range for tests of minor neurological dysfunction (MND; p < .01) compared with cooperative matched controls. The authors speculate that in very preterm children, uncooperative behavior shown at 3 years of age associated with poor visual/spatial skills and a high level of MND at 5 years of age may reveal children at risk for the development of nonverbal learning disabilities.

Short- and long-term neurological outcomes following neonatal chest physiotherapy.

OBJECTIVE: To test the hypothesis that chest physiotherapy in extremely premature infants is associated with abnormal neurological outcomes. METHODS: All babies born during the years 1992-1994 at gestations of 24-29 weeks who survived to 28 days were included in the study cohort (n=213). Chest physiotherapy was provided by trained physiotherapists for babies with secretions causing obstruction to the airway or for babies with evidence of collapse and/or consolidation. The relationship between chest physiotherapy and cystic brain lesions at discharge, or cerebral palsy (CP) and developmental quotient (DQ) at 1 year corrected age, were then explored. RESULTS: Ninety-seven babies (45% of the cohort) received physiotherapy. No baby had a brain lesion similar to that described as encephaloclastic porencephaly. Babies receiving physiotherapy had significantly lower birthweights and gestational ages. Of the 13 babies found to have either periventricular leucomalacia or porencephalic cysts, seven (7%) were in the physiotherapy group, and six (5%) were in the nonphysiotherapy group. Of the babies surviving to 1 year corrected age, 189 (92%) had multidisciplinary follow-up. Eleven (13%) of the babies who received physiotherapy had suspected CP, and 14 (13%) of those not receiving physiotherapy had CP. The DQ of those who received physiotherapy was 96.0+/-16.6, and 101.6+/-16.6 for those who did not. Following adjustment for gestational age and other unequal risk factors using logistic regression, none of the above outcomes was significantly associated with the number of physiotherapy treatments. CONCLUSION: We could find no evidence that chest physiotherapy, as given in our unit, was associated with abnormal neurological outcomes in extremely preterm infants.

A neonatal early discharge and home support programme: shifting care into the community.

OBJECTIVE: The Neonatal Early Discharge and Family Support Programme (NEDP) was an initiative aimed at providing extended care for families whose infants had required neonatal special care, thereby allowing earlier discharge. METHODOLOGY: Two groups of families were examined; one before and one after the instigation of the NEDP. Hospital and community service usage and psychosocial effects were examined. RESULTS: Families who received support were able to be discharged earlier and rooming-in was unnecessary as support was provided at home. Visits to family doctors for mothercraft issues were less frequent. Transport of babies from the Level 3 nursery to other nurseries in order to be closer to home was also provided by the nursing team, saving on ambulance costs and freeing their time for emergencies. There was no increase in maternal anxiety and infants were less difficult in the patient group. CONCLUSIONS: NEDP and family support programme is a worthwhile extension of neonatal intensive care.

Developmental outcome at 12 months corrected age for infants born less than 30 weeks gestation: influence of reduced intrauterine and postnatal growth.

Infants born at less than 30 weeks gestation were prospectively followed to examine the consequences of size at birth and subsequent growth on development in the first year of life. A total of 438 infants were admitted to the intensive care nursery; 53 (12.1%) infants were small for gestational age (SGA). A total of 315 infants survived to discharge; 19 (6%) were SGA. SGA infants were matched with appropriate for gestational age (AGA) infants for sex, GA, incidence of chronic lung disease and head ultrasound at discharge. The high death rate amongst SGA infants was attributable to a combination of extreme prematurity and inappropriate intrauterine growth. There was no difference between SGA and AGA groups for major developmental disability at 1-year corrected age. The effect of subsequent growth on development was examined by comparing children in the cohort above (Appropriate) and below (Small) the 10th percentile for weight at 1 year. Children small at 1 year had a significantly higher rate of major developmental disability at 1 year. Perinatal variables demonstrate that those infants small at 1 year had been of significantly younger GA, lighter BW, had received more ventilator and oxygen therapy. They also had a higher incidence of chronic lung disease. Thus, being born SGA at less than 30 weeks is not of itself associated with increased disability at 1 year when other confounding factors are taken into account. While a causal link has not been established, poor growth in the first year of life does appear to be associated with poorer outcome at 1 year, irrespective of birth status.

Predictive value of umbilical artery pH in preterm infants.

Compared with term infants, little information is available about the usefulness of the umbilical artery pH in relation to outcome in extremely preterm infants. This prospective study evaluates the relation between umbilical artery pH (UapH), Apgar scores, perinatal events, and outcome in infants born at less than 32 weeks' gestation. Six hundred and twenty three infants of < 32 weeks' gestation were studied. The median UapH was 7.25, with a range of 6.78-7.49. A low UapH was significantly associated with male sex, hyaline membrane disease, grade 3 or 4 intraventricular haemorrhage, and neonatal death. It was also associated with lower birth weight and lower birthweight centile. The relations between the UapH and outcomes of neonatal death, cerebral palsy, and developmental quotient at 1 year, and other perinatal risk factors were then examined using multiple logistic regression. After adjusting for other risk factors, UapH was not significantly associated with any outcome. In contrast, a low one minute Apgar (< 4) remained a significant risk factor, with odds ratios of 2.7 (95% confidence interval (CI) 1.5 to 5.2) for neonatal death and 3.8 (95% CI 1.4 to 10.4) for cerebral palsy.

Serum analyte pattern characteristic of fulminant hepatic failure.

Fulminant hepatic failure (FHF) is a poorly understood condition in which total liver failure occurs and is thought to be caused by a variety of conditions including Reye's syndrome, hepatitis, drug overdoses, and vascular insufficiency. While this condition is an uncommon one, it carries with it a high fatality rate and must therefore be diagnosed as rapidly as possible. Six patients have been observed over a two-year period with biopsy and/or autopsy-confirmed FHF: one with acute hepatitis B-delta; three with histories of alcoholism, two of them with cirrhosis; one with acute tylenol overdose; and one with hepatic vascular insufficiency. All of these patients, except one, exhibited a rapid, fatal downhill course after onset of symptoms. In all of these patients, a consistent elevation was observed in serum levels of aspartate aminotransferase (AST) or serum glutamate oxaloacetate transaminase (SGOT) and alanine aminotransferase (ALT) or serum glutamate pyruvate transaminase (SGPT) such that the ratio of AST to ALT was significantly greater than 1 and in serum levels of ammonia. Other liver function tests were found to be abnormal but not in so consistent a pattern, although total protein and albumin were found to be significantly decreased in all of these patients. The stereotypical elevation of the transaminases with high AST-to-ALT ratios and the rise in ammonia appear to characterize this life-threatening illness most reliably.

Sleep disorders in children.

Everyone who cares for families with young children will be familiar with the pale sleepless look on a mother's face, the bags under her eyes and the extra rouge worn to camouflage her fatigue if she is trying to cope with a child with a sleep disorder. An explanation of simple behavioural techniques can markedly improve the situation and help parents regain confidence in their parenting skills.