[Small area analysis of infant mortality in Bielefeld with special consideration of the migration status of parents, 2000-2006]. / Kleinräumige Analyse der Säuglingssterblichkeit in Bielefeld unter besonderer Berücksichtigung des Migrationshintergrundes, 2000-2006.

OBJECTIVE: From 2002 to 2005 the infant mortality rate in the city of Bielefeld has been higher than that of the state of North Rhine Westphalia, in which Bielefeld is located. The 3-year average in Bielefeld was 7.3 vs. 4.7 per 1 000 live births in the period 2002-2004. The aim of our study was to examine the causes of the elevated infant mortality in Bielefeld. METHODS: We conducted a small area analysis and an analysis of the migration status of parents and children in the context of infant mortality. We collected data from death certificates stored at the health office of Bielefeld and coded the cause of death according to ICD-10. We extracted nationality and country of birth from the local population registry. RESULTS: The most frequent causes of death were perinatal factors, malformations and sudden infant death syndrome. Three city districts with a high proportion of population groups with specific sociological risks had an elevated infant mortality. Among infants of migrants, malformations were a more common cause of death (40% of all deaths) than among those without migration background. Perinatal causes were less common among infants with a migration background than without one (42% vs. 54%. of deaths). The authors question whether or not a cause-effect relationship exists here. CONCLUSIONS: The infant mortality rate and the proportion of low birth-weight infants are associated with the social status. Thus, infant mortality is not distributed evenly within a city, either in geographic or in sociological terms. Conversely, statistics about infant mortality define focal points which can be identified and improved. Analysis according to migration background and socio-spatial structures can help to assess health care provided and to initiate targeted interventions, e.g., via local health conferences.

Omega-3 lipid infusion in a heart allotransplant model. Shift in fatty acid and lipid mediator profiles and prolongation of transplant survival.

BACKGROUND: omega-3 Fatty acids may have a major impact on immune responses involved in heart transplant rejection. We compared the effects of posttransplant intravenous supplementation with omega-3-rich versus omega-6-rich lipid emulsions on graft survival, plasma fatty acid profiles, and levels of arachidonic acid versus eicosapentaenoic acid-derived lipid mediators. METHODS AND RESULTS: Inbred PVG and Wistar-Kyoto rats were used as donors and recipients, respectively, in a model of heterotopic heart transplantation. Animals received 9 g/kg body wt per day of either fish oil-derived (n = 8) or soybean oil-derived fat (n = 7) in the form of a continuously infused lipid emulsion; controls were sham-infused with saline (n = 8). Graft rejection was assessed by loss of activity of the transplant. The fish oil-derived preparation but not that originating from soybean oil caused an increase in total and free plasma fatty acids. Substantial quantities of eicosapentaenoic acid and docosahexaenoic acid appeared in the free fatty acid fraction, surpassing those of arachidonic acid. Ex vivo stimulation of neutrophils with the Ca2+ ionophore A23187 demonstrated an increase in 5-series leukotriene (LT) generation in animals undergoing omega-3 lipid infusion (LTB5, omega-oxidation products of LTB5, LTA5 secretion), with 5-series/4-series LT ratios ranging between 0.08 and 0.36. Ratios of TX B3/B2 liberated from ex vivo stimulated platelets even approached 1:1 in omega-3 supplemented rats. Graft survival was 7.6 +/- 0.3 (mean +/- SEM) days in saline-infused, 10.4 +/- 0.7 in omega-6 lipid-infused, and 12.9 +/- 0.4 in omega-3 lipid-infused animals. CONCLUSIONS: Posttransplant intravenous alimentation with fish oil-derived lipid emulsions prolongs heart transplant survival in excess to omega-6 lipids. Profound changes in fatty acid profiles and lipid mediator generation may underlie this finding.

Immunoregulation by parenteral lipids: impact of the n-3 to n-6 fatty acid ratio.

BACKGROUND: The immune system is reported to be influenced by polyunsaturated fatty acids. Therefore, immunoregulation caused by intravenous fat emulsions with different n-3 to n-6 fatty acid ratios was studied in an in vivo model. METHODS: Experimental rat heart allotransplantation served as a defined immunologic challenge. Twenty percent emulsions of safflower oil (n-3 to n-6 = 1:370), fish oil (n-3 to n-6 = 7.6:1), and soybean oil (n-3 to n-6 = 1:6.5), and a 1:1 mixture of safflower oil and fish oil (n-3 to n-6 = 1:2.1) were continuously infused (9 g of fat per kg of body weight per day) after transplantation until complete rejection. The prolongation of graft survival, an accepted parameter of immunosuppression, was assessed. Beyond that, cytokine release by mitogen-stimulated peripheral-blood mononuclear cells (PBMCs) from animals exsanguinated on day 4 after transplantation was evaluated. RESULTS: The mean rejection time was 7.8 days in the sham-infused saline control group and 6.7 days in the safflower- and fish-oil-mixture group (oil control group). Continuous infusion of soybean oil prolonged the graft survival time to 10.4 days, fish oil to 12.3 days, and safflower oil to 13.3 days. PBMC alpha-tumor necrosis factor release was significantly reduced in the fish-oil group (51.9 +/- 13.0 pg/10(6) PBMCs vs 70.8 +/- 10.9 pg/10(6) PBMCs [controls], p < .004). Interleukin-6 release was diminished in both the fish-oil group (22.2 +/- 13.6 pg/10(6) PBMCs vs 40.7 +/- 8.3 pg/10(6) PBMCs [controls], p < .002) and the safflower-oil group (28.4 +/- 6.9 pg/10(6) PBMCs, p < .002). CONCLUSIONS: The n-3 to n-6 fatty acid ratio determined the immunoregulatory potential of intravenous fat emulsions in vivo. Both n-3 and n-6 fatty acids were immunosuppressive when applied as the main polyunsaturated fatty acid sources. PBMC cytokine release was significantly reduced in these groups. The more balanced the n-3 to n-6 ratios, the less immunosuppressive the fat emulsion. There was no immunosuppressive effect at an n-3 to n-6 ratio of 1:2.1.

Technological advances in radiology.

This overview examines the principles underlying modern diagnostic imaging techniques already in use and those expected in the near future. As new techniques have become accepted, older ones such as air studies have been dispensed with. Although many of the new modes appear expensive, they give the doctor an opportunity to effect large cost savings to the community if he employs them wisely.