Urinary Claudin-2 Measurements as a Predictor of Necrotizing Enterocolitis: A Pilot Study.

BACKGROUND: Necrotizing Enterocolitis (NEC) affects 5-10% of NICU patients where initially patients may have only nonspecific clinical findings. A noninvasive tool for detection would aid in diagnosis. Increased urinary claudins have been associated with active adult inflammatory bowel disease. METHODS: Institutional Review Board approval was obtained. Neonatal intestinal tissue samples were obtained from patients with and without NEC. Immunofluorescence analysis of claudin-2 was performed on the intestinal tissue. Thirty two urine samples were collected from 6 NICU patients. Proteins were extracted and urinary claudin-2 expression was measured using Western Blot Analysis. All sample concentrations were normalized to urinary creatinine. Differences were analyzed with ANOVA or Student's T-test. Findings were correlated to the patient's clinical status. RESULTS: Neonatal intestinal immunofluorescence analysis revealed that claudin-2 is present in healthy intestinal epithelium and is decreased in NEC intestinal tissue (p=0.0001). Of the six patients evaluated, three patients had NEC. All 3 patients with NEC had spikes in urinary claudin-2 levels (p<0.001, p<0.001, p 0.0598 respectively). Spikes did not appear to correlate with other etiologies of neonatal sepsis, medication use or need for mechanical ventilation. Levels during active NEC were almost twice that of NEC-free periods (p<0.0001). CONCLUSION: A tool for early detection would facilitate early intervention and potential prevention of severe NEC. Preliminary findings indicate that urinary claudin-2 may represent a potential biomarker for NEC worth further investigation.

Research on posttreatment return of claustrophobic fear, arousal, and avoidance using mock diagnostic imaging.

Fear sometimes returns after attenuation via exposure. Return of fear is poorly understood due to conflicting results from diverse experiments. This article reports on two experiments in which claustrophobic fear during mock diagnostic imaging was attenuated and allowed to return so the experiments could be evaluated and return of fear studied. Attentional focus versus distraction during exposure was a between-subjects independent variable. Attempts were made to predict return of fear, return of heart-rate responsivity, and behavioral avoidance using levels of fear and heart-rate during initial mock diagnostic imaging as predictor variables. One third of participants displayed return of fear, heart-rate response, or avoidance 1 week after fear reduction. Heart-rate response during initial mock imaging predicted posttreatment return-of-fear classification; level of fear during initial imaging did not. Neither initial heart rate nor initial fear predicted return of heart-rate reactivity or avoidance. The experiments are offered as models for programmatic research.

Wessex perinatal mortality survey 1982.

A survey of 335 perinatal deaths in the Wessex region revealed a perinatal mortality rate of 10.1 per 1000 total births. Lethal malformations accounted for 82 (24%) deaths. Of the 253 normally formed infants, 124 (49%) died during pregnancy and 33 (13%) in labour. More than 60% of the stillbirths weighed greater than 1500 g. Of the 96 postpartum deaths, half occurred within 24 h of delivery, mostly following complications of labour and circumstances suggesting hypoxia. The Aberdeen classification showed half of the mothers had pregnancy complications: other predisposing factors were identified in 10% of perinatal deaths. There were 185 neonatal deaths of which 150 occurred within 7 days and 35 within the next 3 weeks. Sixteen (46%) of the late neonatal deaths were due to a congenital abnormality; pregnancy or labour complications were present in six (32%) of the remaining 19 normally formed infants. Review of existing methods of antenatal supervision in particular, followed by the use of better monitoring systems for earlier detection of fetal distress and prompt action when indicated, together with improvement in neonatal care in the first 24 h after birth should further reduce the perinatal mortality.

Fanconi anemia. Oxymetholone hepatic tumors, and chromosome aberrations associated with leukemic transition.

Jaundice and hepatomegaly developed in a boy with Fanconi anemia after he had undergone treatment with oxymetholone for nine years. A liver scan showed patchy uptake consistent with the presence of space-occupying lesions. After oxymetholone treatment was stopped, the jaundice resolved, the liver size decreased, and the filling defects were no longer detectable on the liver scan. A year later, 5% of his white blood cells showed a consistent chromosomal abnormality. His leukocyte count increased and 85% of these cells showed the same chromosomal abnormality. The rapid replication of this abnormal clone suggests that it was leukemic. The significance of oxymetholone therapy and the occurrence of hepatic tumors and leukemia is discussed.

Contrasts in visual responsiveness and emotional arousal between rhesus monkeys raised with living and those raised with inanimate substitute mothers.

Rhesus monkeys were raised with dogs or inanimate surrogates in outdoor cages which provided them with complex, highly varied visual surroundings. Visual responsiveness to a variety of colored transparencies was investigated in three experiments, completed when the monkeys were between 18 and 30 mo old. Results indicated that the frequency and duration of looking at slides was significantly higher for dog-raised than for inanimate-surrogate-raised monkeys and that dog-raised monkeys were much more responsive to the novelty, complexity, ansal were obtained during the final experiment. Heart rate, vocalization, and changes in plasma cortisol were higher for monkeys raised with dogs. The frequency of most self-directed behaviors, however, was higher for monkeys raised with inanimate surrogates. Differences between rearing groups can only be the result of contrasts in attributes of the substitute mothers.

Severe echo 19 virus infection in a neonatal unit.

An epidemic of echo 19 virus infection in a neonatal unit affecting 12 babies with one death is described. With one exception it was confined to the neonatal unit and medical and nursing staff were also affected. The unit was closed for 9 days, then was disinfected, and there was no recurrence.

Breast-milk jaundice and oral contraceptives.

Among breast-fed infants in the normal lying-in wards of a maternity hospital a significantly higher incidence of "idiopathic" jaundice was found in infants of mothers who had been receiving the contraceptive pill before the present pregnancy than in the infants whose mothers never had the pill. The pill became widely used in society at about the same time as breast-milk jaundice was first reported.