When are amniotic fluid viral PCR studies indicated in prenatal diagnosis?

OBJECTIVE: To determine which prenatal ultrasound findings indicate the need to also obtain PCR studies for viral genome in women undergoing midtrimester amniocentesis. METHODS: This was a retrospective observational study on women that underwent amniotic fluid karyotyping and viral PCR testing for history or ultrasound based indication. Amniotic fluid was tested for adenovirus, cytomegalovirus, respiratory syncytial virus, enterovirus, Epstein-Barr virus, and parvovirus B19 using multiplex PCR study with multiple appropriate controls. Ultrasound findings were coded as normal or abnormal with 34 categories of ultrasound abnormality stratified into 18 subgroups. Relationships between these subgroups and karyotype/PCR results were tested by Pearson chi-square method or Fisher's exact test and overall logistic regression analysis. RESULTS: Amniotic fluid samples from 1191 patients were obtained for the study. Abnormal karyotype was detected in 5.4% of cases (64/1191), and PCR was positive in 6.5% of cases (77/1191). Abnormal fetal ultrasonographic findings were observed in 28.4% of cases (338/1191). There was an association between intrauterine growth restriction, nonimmune hydrops fetalis, hand/foot anomalies or neural tube defects (NTDs), and PCR positivity. NTDs were associated with PCR positivity in fetuses with normal karyotype and nuchal thickening, cardiac or ventral wall defects were specifically associated with aneuploidy. CONCLUSION: Amniotic fluid viral PCR testing should be considered for fetuses with intrauterine growth restriction, nonimmune hydrops fetalis, hand/foot anomalies, or NTDs. After aneuploidy is excluded, NTDs are associated with PCR positivity.

Hexagonal spiral growth in the absence of a substrate.

Experiments on the formation of spiraling hexagons (350-1000 nm in width) from a solution of nanoparticles are presented. Transmission electron microscopy images of the reaction products of chemically synthesized cadmium nanocrystals indicate that the birth of the hexagons proceeds without assistance from static screw or edge dislocations, that is, they spiral without constraints provided by an underlying substrate. Instead, the growth mechanism relies on a dynamical dislocation identified as a dense aggregate of small nanocrystals that intersects the spiraling hexagon at the crystal surface. This nanocrystal bundle, which we term the "feeder," also appears to release nanocrystals into the spiral during the growth process.

Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback.

OBJECTIVE: To develop a practical set of measures for routine monitoring, performance feedback, and improvement in the quality of palliative care in the intensive care unit (ICU). DESIGN: Use of an interdisciplinary iterative process to create a prototype "bundle" of indicators within previously established domains of ICU palliative care quality; operationalization of indicators as specified measures; and pilot implementation to evaluate feasibility and baseline ICU performance. SETTING: The national Transformation of the Intensive Care Unit program developed in the United States by VHA Inc. PATIENTS: Critically ill patients in ICUs for 1, > 3, and > 5 days. MEASUREMENTS AND MAIN RESULTS: Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Pilot testing in 19 ICUs (review of > 100 patients' records) documented feasibility, while revealing opportunities for quality improvement in clinician-patient/family communication and other key components of ICU palliative care. CONCLUSIONS: The new bundle of measures is a prototype for routine measurement of the quality of palliative care in the ICU. Further investigation is needed to confirm associations between measured processes and outcomes of importance to patients and families, as well as other aspects of validity.

Observation of discrete energy levels in a quantum confined system.

Low temperature scanning tunneling microscope images and spectroscopic data have been obtained on subnanometer size Pb clusters fabricated using the technique of buffer layer assisted growth. Discrete energy levels were resolved in current-voltage characteristics as current peaks rather than current steps. Distributions of peak voltage spacings and peak current heights were consistent with Wigner-Dyson and Porter-Thomas distributions, respectively, suggesting the relevance of random matrix theory to the description of the electronic eigenstates of the clusters. The observation of peaks rather than steps in the current-voltage characteristics is attributed to a resonant tunneling process involving the discrete energy levels of the cluster, the tip, and the states at the interface between the cluster and the substrate surface.

Complementary and alternative medicine: applications and implications for cognitive functioning in elderly populations.

OBJECTIVE: Aged populations in the United States are growing in numbers, and stand to be affected most by the changing shape of healthcare delivery. Within these elderly populations, the problem of decreased cognitive functioning due to dementing disorders is rising. Recent compelling research on complementary and alternative medicine interventions targeted at cognitive deficits in the elderly is reviewed in this survey. DATA SOURCES: A literature review was undertaken to identify original clinical research studies, review articles, chapters, and books on treating cognitive deficits in the elderly. Contact with complementary and alternative medicine researchers provided additional information concerning developments in this field. STUDY SELECTION: Research studies that were methodologically sound were selected for review. More purely clinical studies also were included to provide a thorough overview of the limited amount of accumulated knowledge in this field. DATA SYNTHESIS: A qualitative synthesis of the above data was used to comprehensively present all information accumulated to date in this field. CONCLUSIONS: Although still in the preliminary stages of development, clinical research exploring the benefits of complementary and alternative therapies for cognitive deficits among the elderly shows a significant level of promise that warrants a further investment of resources.

Insertion of indwelling urethral catheters in infants and children: a survey of current nursing practice.

The purpose of this study was to identify current nursing practice standards for the insertion of indwelling urethral catheters in infants and children. A comparative descriptive design was used to survey a sample of 46 children's hospitals to determine recommended practice guidelines for size, type of catheter, insertion length, and source of nursing policies. Findings revealed a wide variation in practice often without a clear scientific or research base. In the absence of nursing research and established standards, it is essential that nurses base their practice decisions on an understanding of anatomical structure of the urethra and bladder and on knowledge of the dimensions of available catheters.

Physical activity assessment for epidemiologic research: the utility of two simplified approaches.

We assessed the utility of two simplified approaches for the assessment of physical activity in a random sample of 348 college students (218 white, 130 black), mean age 19.3 years. Self-assessment of physical activity level was obtained from the response (4-point scale) to the question "Compared with others your age and sex would you consider yourself to be" (I) much more active to (IV) somewhat less active. In addition, the frequency of exercise-induced sweating (days/week) was assessed. Responses were compared with measurements of resting heart rate, triceps skinfolds, and physical activity as assessed by the Harvard Alumni Survey. Results for the self-assessment question indicated significantly lower resting heart rates (beats/min) (73.0 vs 64.6, P less than 0.01), triceps skinfolds (mm) (10.9 vs 20.4, P less than 0.001), and higher Harvard Survey scores (kcal/week) (5,654 vs 1,310, P less than 0.001) for those responding (i) compared with (iv). Similar results were noted for the sweat-episode question. Those reporting 5-7 sweat episodes per week had significantly lower resting heart rates (67.0 vs 74.8, P less than 0.01), triceps skinfolds (14.7 vs 17.3, P less than 0.01), and higher Harvard Survey scores (5,717 vs 1,453, P less than 0.001) than those reporting 0-1 sweat episodes per week. The results suggest that these simplified approaches may provide useful indices of physical activity for epidemiologic research and warrant further investigation in other populations.

Red blood cell sodium-lithium countertransport and cardiovascular risk factors in black and white college students.

Whites with essential hypertension have high activity of cell membrane sodium-lithium (Na+-Li+) countertransport when compared with normotensives. To determine whether elevated Na+-Li+ countertransport is related to the twofold higher risk of hypertension in US blacks, maximal rates of red blood cell (RBC) Na+-Li+ countertransport were measured in 34 black and 21 white male college students. The race groups were similar in social and physical measurements. Mean Na+-Li+ countertransport activity (mmol Li/RBC per h) was significantly lower in blacks than in whites (0.214 +/- 0.083 versus 0.295 +/- 0.083, P less than 0.001). Countertransport activity was positively correlated with Type A behaviour among whites (r = 0.45, P = 0.039). Other within race correlations between Na+-Li+ countertransport activity and blood pressure and cardiovascular risk factors were generally positive though not significant in whites, whereas they were small or negative in blacks. If Na+-Li+ countertransport has a role in the aetiology of hypertension, it would appear to differ between blacks and whites.

Behavioral factors and blood pressure in black college students.

The relationship of behavioral factors and resting blood pressure was assessed in a random sample of 192 young middle class black adults. Framingham Type A behavior was positively associated with diastolic blood pressure (r = 0.17, p less than 0.05) among the women. Also, anger-in and trait anxiety were positively correlated with diastolic blood pressure for the women, r = 0.20, p less than 0.05 and r = +0.28 and p less than 0.01, respectively. After control for body mass index, trait anxiety and anger-in remained independent predictors of diastolic blood pressure among the women. For men, marijuana use was positively associated with blood pressure. Marijuana use was an independent predictor for systolic blood pressure after adjusting for body mass index among the males. The present study demonstrated a sex difference related to behavioral factors and blood pressure in young middle class blacks.

Echocardiographic left ventricular mass and physical activity: quantification of the relation in spinal cord injured and apparently healthy active men.

To assess the relation of echocardiographic left ventricular (LV) mass to reported physical activity, 2 groups of subjects with widely different physical activity levels were evaluated: 50 men with spinal cord injuries and 166 apparently healthy, active men. Multivariate analysis revealed that reported physical activity was a significant independent predictor of LV mass index (LV mass/body surface area) in both injured patients and healthy, active subjects after controlling for age and blood pressure. The relation between LV mass index and physical activity (linear regression) was similar for both groups; LV mass index = 0.00321 (physical activity) + 82.8 and LV mass index = 0.00335 (physical activity) +88.4 for patients and healthy active subjects, respectively. These results suggest that physical activity as assessed by self-report is associated with echocardiographically detectable differences in LV mass in groups with widely divergent physical activity levels. In addition, for each of these groups 1,000 kcal/week of physical activity apparently results in a change of approximately 3 g/m2 in LV mass index. This information may have practical use for correction of LV mass for the effects of physical activity.

Activity in the spinal cord-injured patient: an epidemiologic analysis of metabolic parameters.

Individuals with traumatic spinal cord injury (SCI) represent a population with extreme inactivity. The purpose of the current research was to investigate the metabolic differences between extremely inactive disabled individuals (SCI sedentary group), active disabled individuals (SCI athletes), and able-bodied individuals. Fasting morning blood samples were obtained for the determination of high density lipoprotein cholesterol (HDLc) subfractions, glucose, and insulin. The sedentary SCI group was comprised of 77 consecutive male admissions to a rehabilitation center. The 17 SCI athletes were recruited prior to competition at the annual National Wheelchair Games. Total HDLc and both its subfractions were significantly lower (P less than 0.01) in the male SCI sedentary population than in the SCI athletes or able-bodied controls. HDL2 was significantly elevated (P less than 0.01) in the SCI athlete compared to the SCI sedentary group (42.7 vs 34.1 mg X dl-1) and was similar to the control population (46.1 mg X dl-1). Glucose levels were similar in the two SCI groups but were both significantly lower (P less than 0.05) than in the able-bodied controls. These data suggest that the extreme inactivity observed in disabled populations is associated with lower HDLc concentrations and presumably an increase in coronary heart disease risk if these values were to persist over time. Additionally, it appears that physical activity is associated with increases in total HDLc, primarily through the HDL2 subfraction. Glucose and insulin were similar for both SCI groups despite the marked difference in activity levels, suggesting that these parameters may not be associated with activity.

Blood pressure determinants in a middle-class black population: the University of Pittsburgh experience.

The relationship between blood pressure and cardiovascular risk factors including obesity, smoking, Type A behavior, anger, stress, geographic mobility, and socioeconomic status was assessed in 173 black college freshmen ages 16-22. In comparison with the overall black population of the United States, these students were generally from better educated, relatively affluent, black families. Among women, body mass index was a positive, independent predictor of systolic blood pressure, whereas alcohol consumption and state anger were inverse, independent predictors. Geographic mobility was found to be a positive, independent predictor of diastolic blood pressure among women. Among men, body mass index and heart rate were independent, positive predictors of systolic blood pressure. This study demonstrates important correlations between biological and psychosocial factors and blood pressure in an understudied population.

Sex differences in high-density lipoprotein cholesterol and subfractions among young black adults.

The high-density lipoprotein cholesterol and high-density lipoprotein subfraction (HDL2 and HDL3) concentrations were examined in 170 young black adults. The women examined had significantly higher total high-density lipoprotein cholesterol concentrations than the men, i.e., 57.0 mg/dl vs 51.2 mg/dl, P less than 0.002. The increased high-density lipoprotein cholesterol among women represented a significant increase in both HDL2 and HDL3 cholesterol concentrations. The sex differential could not be explained by body mass index, alcohol consumption, or physical activity. The determinants of high-density lipoprotein cholesterol for men appeared to be different than those for women.

The association of lipoprotein cholesterol with vitamin A.

Several studies have linked total serum cholesterol concentrations below 200 mg/dl with increased cancer risk, especially among men. Cancer risk appears to be associated primarily with low concentrations of total cholesterol and of low-density lipoprotein cholesterol but not of high-density lipoprotein cholesterol (HDL). It has been suggested that low concentrations of total cholesterol are associated with increased cancer risk indirectly by virtue of their association with low concentrations of carotene and/or retinol. The relationship between serum carotene and cholesterol in a biracial group of 146 first-year college students was investigated. White men and women had similar carotene concentrations. Blacks had higher serum carotene concentrations than whites. There was a significant relationship between carotene concentrations and total cholesterol, which was most evident in men, both black (r = +0.72; P less than 0.01) and white (r = +0.49; P less than 0.01). The correlations for the women were significant, but of lower magnitude than for the men. Significant carotene-HDL relationships were observed among black men (r = 0.31; P less than 0.05) and among women (r = 0.35; P less than 0.05 and r = 0.31; P less than 0.05, black and white, respectively). Furthermore, the women also demonstrated a significant carotene-HDL2 association. The results are consistent with the hypothesis that the association between low serum cholesterol concentrations and cancer may be the result of a relationship between lipoprotein cholesterol concentrations and vitamin A metabolism.

Inhibition of hepatic triglyceride formation by clofibrate.

The effect of clofibrate (CPIB) on hepatic glycerolipid formation has been studied in vivo and in vitro in the rat. Feeding 0.25% CPIB in laboratory chow significantly reduced serum triglyceride levels by 6 hr and concomitantly decreased the rate of glycerol-(14)C incorporation into hepatic and serum glycerides, in vivo. These changes persisted for at least 14 days. A similar decrease in serum triglyceride and glycerol incorporation into hepatic glycerides was observed in rats fed high glucose diets containing 0.25% CPIB. Serum glycerol was reduced by feeding CPIB for 14 days. The formation of diglyceride and triglyceride from (14)C-sn-glycerol-3-P by rat liver homogenates was inhibited by addition of 1-40 mM CPIB to the reaction mixture. These results suggest that CPIB reduces hepatic glycerolipid synthesis, possibly by inhibition of one or more reactions in the esterification of sn-glycerol-3-P. This change may account for the early fall in serum triglyceride. At later time periods, serum glycerol levels fall and in some experiments, hepatic triglyceride content increases. Therefore, it is likely that additional metabolic alterations may contribute to the sustained hypotriglyceridemic effects of CPIB.