IMMPACT-recommended outcome measures and tools of assessment in burning mouth syndrome RCTs: an international Delphi survey protocol.

BACKGROUND: A core outcome set (COS) represents the agreed minimum set of domains and measurement instruments that should be measured and reported in any clinical trial for a given condition. In BMS randomized controlled trials (RCTs), the outcomes identified in the existing literature regarding the efficacy of therapeutic interventions are numerous and diverse. Although the standardized IMMPACT core outcome domains has been developed for measurement of outcomes in chronic pain RCTs, no BMS-specific COS have been adopted and validated. With the evolving landscape of BMS management end points and the development of new therapies, a consensus on a COS for use in future BMS trials is paramount to reduce heterogeneity in outcome reporting. The aim of this study was to reach a consensus for adopting the standardized Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) outcome domains, and their tools of assessment, for burning mouth syndrome (BMS) clinical trials and clinical practice. METHODS: A BMS-specific COS will be developed using the method recommended by the Core Outcome Measures in Effective Trials (COMET) initiative (Registration: http://www.comet-initiative.org/studies/details/1357 ). Selection of questionnaire outcome measures was informed by the IMMPACT consensus and previous systematic review of RCTs in BMS conducted by the consortium. An international group of clinicians and researchers will be invited to participate in several rounds of a Delphi survey. A consensus meeting will be held with the objective of ratifying the outcomes for inclusion in the COS. A finalized COS explanatory document will be drafted, including all outcomes and measurements as determined by the Delphi rounds and consensus meeting. DISCUSSION: A COS for the management of BMS will improve the quality of future RCTs, reduce outcome reporting heterogeneity, and facilitate more vigorous data synthesis of management interventions for systematic reviews and meta-analysis. This would ensure enhanced quality evidence for clinical management of the condition.

Management of Challenging Cardiopulmonary Bypass Separation.

SEPARATION from cardiopulmonary bypass (CPB) after cardiac surgery is a progressive transition from full mechanical circulatory and respiratory support to spontaneous mechanical activity of the lungs and heart. During the separation phase, measurements of cardiac performance with transesophageal echocardiography (TEE) provide the rationale behind the diagnostic and therapeutic decision-making process. In many cases, it is possible to predict a complex separation from CPB, such as when there is known preoperative left or right ventricular dysfunction, bleeding, hypovolemia, vasoplegia, pulmonary hypertension, or owing to technical complications related to the surgery. Prompt diagnosis and therapeutic decisions regarding mechanical or pharmacologic support have to be made within a few minutes. In fact, a complex separation from CPB if not adequately treated leads to a poor outcome in the vast majority of cases. Unfortunately, no specific criteria defining complex separation from CPB and no management guidelines for these patients currently exist. Taking into account the above considerations, the aim of the present review is to describe the most common scenarios associated with a complex CPB separation and to suggest strategies, pharmacologic agents, and para-corporeal mechanical devices that can be adopted to manage patients with complex separation from CPB. The routine management strategies of complex CPB separation of 17 large cardiac centers from 14 countries in 5 continents will also be described.

Assessment of mitral valve geometric deformity in patients with ischemic heart disease using three-dimensional echocardiography.

BACKGROUND: A full understanding of the geometry of the nonplanar saddle-shaped mitral annulus can provide valuable information regarding the pathophysiology of mitral regurgitation (MR). AIM OF THE WORK: To investigate mitral annular geometric deformities using three-dimensional echocardiography among patients with ischemic coronary illness with and without mitral regurgitation. METHODS: Three-dimensional transesophageal echocardiographic data were acquired intraoperatively from patients with ischemic heart disease with or without associated mitral regurgitation who experienced coronary artery bypass grafting and normal control subjects. The mitral annulus was analyzed for differences in geometry using QLAB software. RESULTS: Left ventricular ejection fraction was reduced in patients with ischemic heart disease and MR (n = 21; Group 1) and without MR (n = 7; Group 2) compared with that in normal subjects (n = 14; Group 3) (43.4% ± 11.8% and 35.9% ± 13.6% vs. 52.6% ± 9.3%, respectively; p = 0.015). Mitral annular height and mitral annular saddle-shaped nonplanarity were significantly lower in Group 1 compared to Group 2 and Group 3 (6.00 ± 1.07 mm, 7.96 ± 0.93 mm and 8.31 ± 1.12 mm; p < 0.0001) and (0.19 ± 0.04, 0.26 ± 0.04 and 0.26 ± 0.03; p < 0.0001) respectively while mitral annular ellipsicity and Mitral valve tenting volume were significantly higher in the same group (1) (114.82% ± 22.47%, 100.21% ± 9.87% and 97.29% ± 14.37%; p = 0.0421) and (2.73 ± 1.11, 2.20 ± 1.39 and 0.87 ± 0.67) respectively. Vena contracta diameter was inversely correlated with the mitral annular height (r = -0.82; p < 0.0001) and saddle-shaped nonplanarity of the annulus (r = -0.68; p < 0.0001). CONCLUSION: Among patients with ischemic heart disease, there are significant increases in mitral valve tenting volume and height, and those with mitral regurgitation exhibited a reduced mitral annular height, a shallower saddle shape annulus and losses of ellipsicity of the annulus.

The electronic absorption spectra of some acyl azides molecular orbital treatment.

The electronic absorption spectra of benzoyl azide and its derivatives: p-methyl, p-methoxy, p-chloro and p-nitrobenzoyl azide were investigated in different solvents. The observed spectra differ basically from the electronic spectra of aryl azides or alkyl azides. Four intense pi-pi* transitions were observed in the accessible UV region of the spectrum of each of the studied compounds. The contribution of charge transfer configurations to the observed transitions is rather weak. Shift of band maximum with solvent polarity is minute. On the other hand, band intensity is highly dependent on the solvent used. The observed transitions are delocalized rather than localized ones as in the case with aryl and alkyl azides. The attachment of the CO group to the azide group in acyl azides has a significant effect on the electronic structure of the molecule. The arrangements as well as energies of the molecular orbitals are different in acyl azides from those in aryl azides. The first electronic transition in phenyl azide is at 276 nm, whereas that of bezoyle azide is at 251 nm. Ab initio molecular orbital calculations using both RHF/6-311G* and B3LYP/6-31+G* levels were carried out on the ground states of the studied compounds. The wave functions of the excited states were calculated using the CIS and the AM1-CI procedures.

Effects of acclimation on the toxicity of stream water contaminated with zinc and cadmium to juvenile cutthroat trout.

We investigated the influence of acclimation on results of in situ bioassays with cutthroat trout in metal-contaminated streams. Cutthroat trout (Oncorhynchus clarki) were held for 21 days (1) in live containers at a reference or "clean" site having dissolved metals near detection limits (0.01 microg/L cadmium [Cd] and 2.8 microg/L zinc [Zn]; hardness 32 mg/L as CaCO(3)) and (2) at a site in a mining-impacted watershed having moderately increased metals (0.07 microg/L Cd and 38 to 40 microg/L Zn; hardness 50 mg/L as CaCO(3)). The 96-hour survival of each treatment group was then tested in situ at five sites from September 5 to 9, 2002, and each group exhibited a range of metal concentrations (0.44 to 39 microg/L arsenic [As], 0.01 to 2.2 microg/L Cd, and 0.49 to 856 microg/L Zn). Survival was 100% at three sites for both treatments. However, a higher percentage of metal-acclimated fish survived at the site with the second highest concentrations of Cd and Zn (0.90 and 238 microg/L, respectively) compared with fish acclimated at the reference site (100% vs. 55%, respectively). Survival was 65% for acclimated fish and 0% for metal-naïve fish at the site with the largest metal concentrations (2.2 microg/L Cd and 856 microg/L Zn). Water collected from the site with the largest concentrations of dissolved metals (on October 30, 2002) was used in a laboratory serial dilution to determine 96-hour LC(50) values. The 96-hour LC(50) estimates of naïve fish during the in situ and laboratory experiments were similar (0.60 mug Cd/L and 226 microg Zn/L for in situ and 0.64 microg Cd/L and 201 microg Zn/L for laboratory serial dilutions). However, mortality of naïve cutthroat trout tested under laboratory conditions was more rapid in dilutions of 100%, 75%, and 38% site water than in situ experiments.

The potential for chromium to affect the fertilization process of Chinook salmon (Oncorhynchus tshawytscha) in the Hanford reach of the Columbia River, Washington, USA.

The Hanford Nuclear Reservation in south central Washington was claimed by the federal government as a site for the production of plutonium. During the course of production and operation of the facilities at Hanford, radionuclides and chromium were discharged directly into the river and also contaminated the groundwater. This study was designed to assess the effects of chromium (Cr) on Chinook salmon (Oncorhynchus tshawytscha) fertilization under exposure conditions similar to those of the Hanford Reach of the Columbia River. Chinook salmon gametes were exposed to aqueous Cr concentrations ranging from 0 to 266 microg Cr l(-1). The current ambient water-quality criteria (AWQC) established for the protection of aquatic life (United States Environmental Protection Agency [USEPA] 1986) is 11 microg Cr l(-1). Cr has been measured in pore water from bottom sediments of the Columbia River at concentrations >600 microg Cr l(-1). Under exposure conditions designed to closely mimic events that occur in the river, the fertilization of Chinook salmon eggs was not affected by concentrations of Cr ranging from 11 to 266 microg Cr l(-1). Data suggest that the instantaneous nature of fertilization likely limits the potential effects of Cr on fertilization success. As a result, the current AWQC of 11 mug Cr l(-1) is most likely protective of Chinook salmon fertilization.

Bioavailability and toxicity of dietborne copper and zinc to fish.

To date, most researchers have used dietborne metal concentrations rather than daily doses to define metal exposure and this has resulted in contradictory data within and between fish species. It has also resulted in the impression that high concentrations of dietborne Cu and Zn (e.g. > 900 mg kg(-1) dry diet) are relatively non-toxic to fish. We re-analyzed existing data using rations and dietborne metal concentrations and used daily dose, species and life stage to define the toxicity of dietborne Cu and Zn to fish. Partly because of insufficient information we were unable to find consistent relationships between metal toxicity in laboratory-prepared diets and any other factor including, supplemented metal compound (e.g. CuSO(4) or CuCl(2)), duration of metal exposure, diet type (i.e. practical, purified or live diets), or water quality (flow rates, temperature, hardness, pH, alkalinity). For laboratory-prepared diets, dietborne Cu toxicity occurred at daily doses of > 1 mg kg(-1) body weight d(-1) for channel catfish (Ictalurus punctatus), 1-15 mg kg(-1) body weight d(-1) (depending on life stage) for Atlantic salmon (Salmo salar) and 35-45 mg kg(-1) body weight d(-1) for rainbow trout (Oncorhynchus mykiss). We found that dietborne Zn toxicity has not yet been demonstrated in rainbow trout or turbot (Scophthalmus maximus) probably because these species have been exposed to relatively low doses of metal ( < 90 mg kg(-1) body weight d(-1)) and effects on growth and reproduction have not been analyzed. However, daily doses of 9-12 mg Zn kg(-1) body weight d(-1) in laboratory-prepared diets were toxic to three other species, carp Cyprinus carpio, Nile tilapia Oreochromis niloticus, and guppy Poecilia reticulata. Limited research indicates that biological incorporation of Cu or Zn into a natural diet can either increase or decrease metal bioavailability, and the relationship between bioavailability and toxicity remains unclear. We have resolved the contradictory data surrounding the effect of organic chelation on metal bioavailability. Increased bioavailability of dietborne Cu and Zn is detectable when the metal is both organically chelated and provided in very low daily doses. We have summarized the information available on the effect of phosphates, phytate and calcium on dietborne Zn bioavailability. We also explored a rationale to understand the relative importance of exposure to waterborne or dietborne Cu and Zn with a view to finding an approach useful to regulatory agencies. Contrary to popular belief, the relative efficiency of Cu uptake from water and diet is very similar when daily doses are compared rather than Cu concentrations in each media. The ratio of dietborne dose:waterborne dose is a good discriminator of the relative importance of exposure to dietborne or waterborne Zn. We discuss gaps in existing data, suggest improvements for experimental design, and indicate directions for future research.

Naturalized salmonid populations occur in the presence of elevated trace element concentrations and temperatures in the Firehole River, Yellowstone National Park, Wyoming, USA.

We investigated the effects of geothermally influenced waters on the distribution of rainbow trout, Oncorhynchus mykiss, and brown trout, Salmo trutta, in the Firehole River and its tributaries in Yellowstone National Park (WY, USA) from June 1997 to June 1998. Geothermal features in the Firehole River basin elevate mineral content and temperature in portions of the river and its tributaries. We found concentrations of boron and arsenic to be elevated in geothermally influenced areas compared with upstream sites. Boron concentrations occasionally exceeded 1,000 microg/L, a proposed limit for the protection of aquatic organisms. Arsenic concentrations occasionally exceeded 190 microg/L, the chronic ambient water quality criterion. Temperatures in geothermally influenced sites ranged up to 30 degrees C and were consistently 5 to 10 degrees C higher than upstream sites unaffected by geothermal inputs. Rainbow trout occurred at sites with elevated concentrations of boron, arsenic, and other trace elements and elevated water temperatures. Rainbow trout inhabited and spawned at sites with the most elevated trace element concentrations and temperatures; however, brown trout were absent from these sites. Water temperature may be the major factor determining brown trout distributions, but we cannot exclude the possibility that brown trout are more sensitive than rainbow trout to boron, arsenic, or other trace elements. Further investigations are needed to determine species-specific tolerances of boron, arsenic, and other trace elements among salmonids.

Kaempferol triosides from Reseda muricata.

A flavonoid trioside and its coumaryl ester together with seven known flavonoids and five phenolic acids were isolated from the leaves of Reseda muricata. Their structures were elucidated by spectroscopic methods including UV, FAB MS, 1H, 13C and 2D-NMR, DEPT, HMBC and HMQC experiments. The two compounds were identified as kaempferol 3-O-beta-D-glucopyranosyl-(1''' --> 2'')-O-alpha-L-rhamnopyranoside 7-O-beta-D-glucopyranoside and kaempferol 3-O-beta-D-glucopyranosyl-(1''' --> 2'')-O-alpha-L rhamnopyranoside 7-O-beta-D-(6''''-O-E-coumarylglucopyranoside), respectively.

Caudal block in children: ropivacaine compared with bupivacaine.

BACKGROUND: Bupivacaine provides reliable, long-lasting anesthesia and analgesia when given via the caudal route. Ropivacaine is a newer, long-acting local anesthetic that (at a concentration providing similar pain relief) has less motor nerve blockade and may have less cardiotoxicity than bupivacaine. METHODS: In a double-blind trial, 81 healthy children, undergoing ambulatory surgical procedures, were randomly allocated to receive caudal analgesia with either bupivacaine or ropivacaine, 0.25%, 1 mVkg. All blocks were placed by an attending anesthesiologist or an anesthesia fellow after induction of general anesthesia. RESULTS: Data were available for 75 children. There were no significant differences between the two groups in baseline characteristics or in anesthesia, surgery, recovery room, or day surgery unit durations. The quality and duration of postoperative pain relief did not differ. Motor and sensory effects were similar. Time to first micturition did not differ. CONCLUSION: Ropivacaine (0.25%, 1 ml/kg) provided adequate postoperative analgesia with no difference from bupivacaine (0.25%, 1 ml/kg) in quality and duration of pain relief, motor and sensory effects, or time to first micturition in our study children.

Concentrations of metals associated with mining waste in sediments, biofilm, benthic macroinvertebrates, and fish from the Coeur d'Alene River basin, Idaho.

Arsenic, Cd, Cu, Pb, Hg, and Zn were measured in sediments, biofilm, benthic macroinvertebrates, and fish from the Coeur d'Alene (CDA) River to characterize the pathway of metals transfer between these components. Metals enter the CDA Basin via tributaries where mining activities have occurred. In general, the ranking of food-web components from the greatest to smallest concentrations of metals was as follows: biofilm (the layer of abiotic and biotic material on rock surfaces) and sediments > invertebrates > whole fish. Elevated Pb was documented in invertebrates, and elevated Cd and Zn were documented in sediment and biofilm approximately 80 km downstream to the Spokane River. The accumulation of metals in invertebrates was dependent on functional feeding group and shredders-scrapers that feed on biofilm accumulated the largest concentrations of metals. Although the absolute concentrations of metals were the largest in biofilm and sediments, the metals have accumulated in fish approximately 50 km downstream from Kellogg, near the town of Harrison. While metals do not biomagnify between trophic levels, the metals in the CDA Basin are bioavailable and do biotransfer. Trout less than 100 mm long feed exclusively on small invertebrates, and small invertebrates accumulate greater concentrations of metals than large invertebrates. Therefore, early-lifestage fish may be exposed to a larger dose of metals than adults.

Relationships between boron concentrations and trout in the Firehole River, Wyoming: historical information and preliminary results of a field study.

The Firehole River (FHR) in Yellowstone National Park (YNP) is a world-renowned recreational fishery that predominantly includes rainbow trout (RBT, Oncorhynchus mykiss) and brown trout (BNT, Salmo trutta). The trout populations apparently are closed to immigration and have been self-sustaining since 1955. Inputs from hot springs and geysers increase the temperature and mineral content of the water, including elevating the boron (B) concentrations to a maximum of approximately 1 mg B/L. Both RBT and BNT reside in warm-water reaches, except when the water is extremely warm (> or = approximately 25 degrees C) during midsummer. They spawn in late fall and early winter, with documented spawning of BNT in the cold-water reach upstream from the Upper Geyser Basin and of RBT in the Lower Geyser Basin reach, where water temperatures presumably are the warmest; however, successful recruitment of RBT in waters containing approximately 1 mg B/L has not been demonstrated conclusively. Thus, we began investigating the relationships among temperature, B concentrations, other water-quality parameters, and the distribution and reproduction of trout in the FHR in spring 1997. However, atypical high water flows and concomitant lower than historical temperatures and B concentrations during summer 1997 preclude conclusions about avoidance of high B concentrations.

A pilot study of lactic acid as an enamel and dentin conditioner for dentin-bonding agent development.

The purpose of this pilot study was to determine how lactic acid solution at various concentrations and etching times affected prepared human enamel and dentin surfaces and to assess whether it could be used in place of phosphoric or maleic acid as an etchant. The occlusal surfaces of extracted molar teeth were ground wet with 600-grit silicon carbide paper and treated with various aqueous solutions of lactic acid. Random samples were prepared for observation by scanning electron microscopy. The rest were used to determine shear bond strength of bonded dental composite cylinders. The micrographs revealed that lactic acid dissolved the smear layer with various degrees of etching and demineralization. The degree of smear layer and matrix removal was proportional to the concentration of the acid and the length of application time. A 20% lactic acid concentration applied for 10 seconds produced a clearly etched surface with minimal demineralization. A 30% concentration not only removed the smear layer and enlarged the dentin tubule orifices but also appeared to affect the collagen matrix. The shear bond strength to enamel treated with 50% lactic acid (17.5 +/- 1.5 MPa) and All-Bond 2 etchant (18.9 +/- 1.3 MPa) were not significantly different (p > 0.05). However, mean dentin bond strengths for all groups of lactic acid etchant and All-Etch etchant (10% phosphoric acid) were statistically similar.

A community study of gynecological and related morbidities in rural Egypt.

This study assesses the prevalence of gynecological and related morbidity conditions in a rural Egyptian community. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women. For gynecological morbidities, genital prolapse was diagnosed in 56 percent, reproductive tract infections in 52 percent, and abnormal cervical cell changes in 11 percent of the women. For related morbidities, anemia was present in 63 percent of the women, followed by obesity (43 percent), hypertension (18 percent), and urinary tract infection (14 percent). Regression analysis of risk factors demonstrated the contribution of social conditions and medical factors to these diseases. Reproductive tract infections were shown to occur more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload showed significant associations with related morbidity conditions. This evidence challenges national health programs to go beyond safe motherhood, child survival, and family planning in its services to women, and to consider the social context of health as well.

PIP: The prevalence of gynecological and related morbidity in a rural Egyptian community was assessed as part of the Program of Research and Technical Consultation in Family Resources. Child Survival, and Reproductive Health. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women from November 1989 to July 1990. A logistic regression using Generalized Linear Interactive Modeling was performed for each type of morbidity. For gynecological morbidities, genital prolapse was diagnosed in 56%, reproductive tract infections in 52%, and abnormal cervical cell changes in 11% of the women. For related morbidities, anemia was present in 63% of the women, followed by obesity (43%), hypertension (19%), and urinary tract infection (14%). Most of the women were suffering from at least 1 morbidity, with only 3% free of all the morbidity conditions considered. Gynecological morbidity, together with urinary tract infection and syphilis, showed that 35% of the women had 1 morbidity, 34% had 2, and 17% had 3 or more morbidities. Regression analysis of risk factors demonstrated that social conditions and medical factors contributed to these diseases. Reproductive tract infections occurred more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload revealed significant associations with related morbidity conditions. The risk of anemia was significantly related to age and to a pregnancy within the previous 2 years. With every increase of 1 year of age, the risk of hypertension increased by 9%. For every increase of 1 year of age, the risk of obesity increased by 7%. Women with the highest level of education had a 3 times greater risk of urinary tract infection than did uneducated women, while women of low-middle socioeconomic status had almost 4 times the risk of women in the lowest class.

Markers for endothelial injury, clotting and platelet activation in preeclampsia.

The etiology of disseminated intravascular coagulation (DIC) in preeclampsia is not well understood. We measured plasma levels of fibronectin (FN), which may reflect endothelial cell injury, fibrinopeptide A (FPA), a specific marker of clotting, platelet counts (PLC) and mean platelet volumes (MPV), as well as beta-thromboglobulin (beta TG) and platelet factor 4 (Pf4), products of irreversible platelet activation in 24 preeclamptic patients and 24 controls matched for age, gestational age, labor status, and parity. In preeclampsia, FN and FPA were significantly elevated while PLC were significantly decreased (P less than 0.0001, less than 0.05 and less than 0.01, respectively). beta TG, Pf4, and MPV values did not show significant differences. These findings support the hypothesis that endothelial injury, clotting activation and platelet consumption are increased in preeclampsia. However, the much closer association of preeclampsia with FN levels as compared to FPA, beta TG, Pf4, suggests that endothelial injury is a more basic mechanism of preeclampsia than clotting or platelet activation.

Study on the factors affecting ABO grouping of blood stains.

The Biologist in forensic work is confronted with many problems on grouping of dry blood stains, these problems are due to many factors and environmental changes which may mislead the analysis. The present work deals with the factors affecting ABO grouping of dry blood stains in Riyad, including exposure to extremes of temperature, from refrigeration at -4 degrees C up to heating at 150 degrees C, effect of time till 6 months, occurrence of the stains on different fabrics, and effect of putrefaction. The results showed that, ABO grouping of dry blood stains was not affected by different substrata or cloth fabrics. 30% of the samples gave erroneous results when exposed to temperature at 150 degrees C for 2 hours. Storage for 6 months at room temperature ranged from 29 degrees -44 degrees C, representing the ambient temperature met with in Riyad, gave no effects. Putrefaction showed that the antigens were deteriorated in 80% of cases after 90 days. Chromatographic separation was a suitable procedure before grouping the samples which were buried in sand or mud.

Serum bilirubin levels in newborns of diabetic and hypertensive mothers.

PIP: The aim of this study was to investigate the effect of oxytocin induction and augmentation on neonatal bilirubin levels in newborns of diabetic and hypertensive mothers. All women included in the study were admitted to the obstetrics department at Al Hussein Hospital. They were 18-38 years old, and their gestational ages were 38-41 weeks by date. A total number of 140 newborn infants were divided into 3 groups and studied for bilirubin levels. The first group consisted of 40 infants of diabetic mothers, 20 of whom were given oxytocin for labor induction and 20 of whom received it for labor augmentation. The second group consisted of 40 infants of hypertensive mothers, 20 of whom were given oxytocin for labor induction and 20 of whom received it for labor augmentation. The third group consisted of 60 controls, 20 of whom were given oxytocin for labor induction, 20 of whom received it for labor augmentation, and 20 of whom received no oxytocin. It was found that total and unconjugated bilirubin levels were higher in infants delivered after induction of labor, whether their mothers were diabetic, hypertensive, or neither, than in infants delivered without labor induction. Bilirubin levels were mildly high in infants of diabetic mothers after augmented delivery and then nullified after 24 hours. However, the study suggested that the increased bilirubin levels were related to induced labor rather than the medical problem of the mothers, provided that the newborns were of average weight.^ieng

Evaluation of potential early markers of chorioamnionitis associated with preterm premature ruptured membranes.

Optimal expectant management of preterm premature rupture of membranes (PROM) requires the early detection of chorioamnionitis. To date, however, no universally sensitive and specific marker for chorioamnionitis has been identified. Recently, the serial determination of plasma fibronectin, antithrombin, and prekallikrein has been reported to facilitate the early detection of sepsis in critically ill neonates and adult surgical patients. A cross-sectional study was undertaken to determine if plasma levels of these markers change significantly in patients with overt chorioamnionitis following expectant management of preterm PROM. Plasma levels of fibronectin and prekallikrein were not significantly different between the study (30 patients with overt chorioamnionitis following preterm PROM) and control (30 undelivered patients without antenatal complication matched for gestational age) groups. Antithrombin levels were significantly lower in the study group (p less than 0.05), but the magnitude of the difference (102% versus 94%) is not likely to be of clinical significance. We conclude that determination of plasma levels of fibronectin, prekallikrein, and antithrombin is not likely to aid in the early detection of chorioamnionitis in the setting of preterm (PROM).

Prothrombin times and clottable fibrinogen determination on an automated coagulation laboratory (ACL-810).

Our laboratory evaluated an Automated Coagulation Laboratory (ACL-810) by Instrumentation Laboratory. Prothrombin times and fibrinogen levels from the ACL-810 were compared to results from a Fibrometer and another automated coagulation instrument - either the Coag-A-Mate (prothrombin times) or the Multistat III centrifugal analyzer (fibrinogen). The performance of different thromboplastins on the ACL-810 was also evaluated. Correlation studies revealed excellent performance characteristics and precisions for both the prothrombin time and fibrinogen not only with different instruments, but also with different thromboplastins on the ACL-810. Overall, we found the instrument to be quick, efficient, and easy to operate.