Bariatric surgery affects obesity-related protein requirements.

CONTEXT: Following bariatric surgery, protein deficiency intakes are reported in morbidly obese patients, whereas post-bariatric protein requirements are not specifically defined with validated method in this population. OBJECTIVE: To assess average protein requirement (APR) in obese subjects, before, 3 months and 12 months after bariatric surgery using the validated method of nitrogen balance. DESIGN AND SETTING: Prospective longitudinal study conducted in 21 morbidly obese patients (BMI 43.9 ± 1.4 kg/m2) before (M0), 3 months (M3) and 12 months (M12) after sleeve gastrectomy or Roux-en-Y gastric by-pass. An additional larger cross-sectional study was performed to validate APR before surgery in non-operated matched obese patients (n = 106). APR was evaluated at M0, M3, M12 by measuring 3 days dietary intakes together with losses of nitrogen in urine and stools. MAIN OUTCOME MEASURE: APR was defined as the mean value of protein intake required to achieve balance nitrogen equilibrium. RESULTS: Before surgery, APR in morbidly obese patients was 0.76 [95%CI, 0.66-0.92] g/kg Body Weight (BW)/d in the experimental group, and 0.74 [0.70-0.80] g/kg BW/d in the validation group. APR was 0.62 [0.51-0.75] g/kg/d at M3 and 0.87 [0.75-0.98] g/kg/d at M12, with no difference between surgical procedures. Spontaneous protein intakes were respectively 0.80 ± 0.05, 0.43 ± 0.03 and 0.71 ± 0.04 g/kg BW/d respectively at M0, M3 and M12. CONCLUSION: This study demonstrates a temporal change in protein requirement after bariatric surgery whatever the type of surgery. Spontaneous protein intakes following bariatric surgery does not cover protein requirements for most patients, suggesting that specific dietary protein recommandations have to be adapted in obese patients with bariatric surgery. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01249326.

Extreme prematurity and school outcomes.

The purpose of this study was to assess the impact of extreme prematurity on three global measures of school outcomes. Using a matched cohort design, exposed infants comprised all surviving singleton infants < or = 28 weeks gestation born at one regional neonatal intensive care hospital between 1983 and 1986 (n = 132). Unexposed infants comprised randomly selected full-term infants (> or = 37 weeks gestation) frequency matched on date of birth, zip code and health insurance. All children were selected from a regional tertiary children's centre serving western New York population. Standardised telephone interviews elicited information on grade repetition, special education placement and use of school-based services. Unconditional logistic regression was used to estimate odds ratios (OR) and corresponding 95% confidence intervals (CI) adjusted for potential confounders for children without major handicaps. Extreme prematurity was associated with a significant increase in risk of grade repetition (OR = 3.22; 95% CI = 1.63, 6.34), special education placement (OR = 3.16; 95% CI = 1.14, 8.76) and use of school-based services (OR = 4.56; 95% CI = 1.82, 11.42) in comparison with children born at term, even after controlling for age, race, maternal education, foster care placement and the matching factors. These findings suggest that survivors of extreme prematurity remain at risk of educational underachievement.

The WeeFIM instrument: its utility in detecting change in children with developmental disabilities.

OBJECTIVE: To examine the utility of the WeeFIM instrument ("WeeFIM") in detecting changes in the functional status of children with disability. DESIGN: Prospective longitudinal design with correlation and responsiveness analysis. SETTING: Three facilities providing services to children with developmental disabilities in western New York State. PARTICIPANTS: Two hundred five children (72 girls, 133 boys) with identified medical disabilities receiving special services were administered the WeeFIM. Subjects ranged in age from 11 to 87 months and came from diverse socioeconomic and ethnic backgrounds. Scores for 174 children were available for 3 administrations performed over a 1-year period. MAIN OUTCOME MEASURES: The responsiveness of the WeeFIM instrument was examined using 5 statistical procedures: Reliability Change Index, Proportional Change Index, effect size, standardized response means, and paired t tests. RESULTS: All 5 indexes of responsiveness indicated statistically significant (p < .05) or reliable changes over time. The transfer subscale of the WeeFIM showed a skewed distribution that affected the results for some responsiveness indexes. The advantage, limitations, and assumptions of the responsiveness indexes are described and graphic examples of change over time are presented to validate the responsiveness of the WeeFIM instrument. CONCLUSION: The WeeFIM instrument showed the ability to document change in functional abilities over a 1-year period in children with chronic disabilities.

Functional assessment and care of children with neurodevelopmental disabilities.

OBJECTIVES: To determine the relationship between pediatric assessment scores and ratings by parents and teachers regarding the amount of assistance required to complete basic activities of daily living; and to examine the relationship among scores for three commonly used pediatric assessments. DESIGN: Prospective correlational study. 205 children with developmental disabilities. The children ranged in age from 11 to 87 mo and included 72 females and 133 males of diverse socioeconomic and ethnic backgrounds. The children were evaluated by using the Battelle Developmental Inventory Screening Test, Vineland Adaptive Behavior Scales, Functional Independence Measure for Children (WeeFIM instrument), and the Amount of Assistance Questionnaire. RESULTS: The test-retest reliability coefficients for items on the Amount of Assistance Questionnaire were found to range from 0.82 to 0.97. Correlations among subscale scores and amount of assistance ratings were highest for the WeeFIM instrument and Battelle Developmental Inventory Screening Test. The highest correlation was between WeeFIM total rating and total amount of assistance rating (r = 0.91). CONCLUSION: Total WeeFIM instrument ratings and severity of disability were the best predictors of amount of assistance ratings provided by parents and teachers.

Measuring developmental and functional status in children with disabilities.

This study compared performance on the Functional Independence Measure for Children (WeeFIM), the Battelle Developmental Inventory Screening Test (BDIST), and the Vineland Adaptive Behavior Scales (VABS) in children with developmental disabilities. The three instruments were administered to 205 children with identified disabilities. All 205 children were tested using the WeeFIM instrument. The BDIST was administered to 101 children and the VABS to the remaining 104 children. Administration was counterbalanced and randomized across all three instruments. A proportional sampling plan was used to select the 205 children, who ranged in age from 11 to 87 months. A variety of medical diagnoses and levels of severity of motor, cognitive, and communication impairments were systematically included in the sample. Correlations (r) among subscales for all three instruments ranged from 0.42 to 0.92. Correlations for total scores ranged from 0.72 to 0.94. Analyses of potential moderator variables found no significant relation between age and severity of disability (r=0.05) or between socioeconomic status (SES) and severity of disability (r=0.21). Correlations with age were strongest for those subscale scores involving gross and fine motor skills. Correlations with SES and subscale scores ranged from 0.03 to 0.18. The three instruments provide important information regarding childhood performance in motor, self-care, communicative, cognitive, and social skills. The WeeFIM instrument requires less administration time and provides information directly relevant to evaluating functional outcomes for children with disabilities and their families.

Inflammatory cytokine mRNAs in surgical specimens of necrotizing enterocolitis and normal newborn intestine.

Coagulation necrosis, inflammation, and hemorrhage are pathologic hallmarks of necrotizing enterocolitis (NEC). Because cytokines are peptides that mediate inflammatory cell recruitment and amplify the immune response, several of the inflammatory cytokines have been implicated in NEC. We hypothesized that mRNA levels for the interrelated cytokines interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), IL-6, and the neutrophil chemotactic factor IL-8 would be increased in NEC and would be associated with the presence of inflammation. In this study, we determined the relative levels and localization of mRNA for these cytokines in surgical pathology archival intestinal tissue from 29 premature infants with acute NEC and 15 control infants with congenital intestinal malformations using a novel quantitative in situ hybridization technique. Compared with controls, there were higher IL-1 beta mRNA levels in full-thickness sections and higher TNF-alpha mRNA levels in full-thickness and mucosa sections of acute NEC samples, suggesting a potential role for these cytokines in the pathogenesis of local inflammation in NEC. IL-6 and IL-8 mRNA levels were similar in samples of control and acute NEC cases. Analysis of covariance including all subjects showed that the presence of acute inflammation was associated with increased IL-1 beta mRNA levels in mucosa (P = .035) and increased IL-8 in full-thickness sections (P = .005) and mucosa (P = .01). In four of five NEC cases in which intestinal specimens were available from reanastomosis surgery, cytokine mRNA levels decreased to low or undetectable levels. These data suggest that the inflammatory cytokines are involved in neutrophil recruitment and augmentation of the inflammatory response in neonatal intestine.

Interrater agreement and stability of the Functional Independence Measure for Children (WeeFIM): use in children with developmental disabilities.

OBJECTIVE: Examination of the interrater agreement and stability of ratings obtained using the Functional Independence Measure for Children (WeeFIM) in a sample of children with developmental disabilities. DESIGN: A relational design was used in which two sets of WeeFIM scores were collected under four conditions: same rater-short interval; same rater-long interval; different rater-short interval; and different rater-long interval. SETTING: WeeFIM scores were collected in outpatient developmental rehabilitation centers, school programs, and the children's homes. PARTICIPANTS: Data were collected for 205 children ranging in age from 11 to 87 months. All children had a medical diagnosis of disability and were receiving habilitative-educational intervention or follow-along services including neurodevelopmental surveillance. INSTRUMENT: The WeeFIM instrument examines basic daily living and functional skills in children from birth to 7 years of age. The WeeFIM is modeled after the Functional Independence Measure (FIM) for adults and includes 18 items in the following subscales: self-care, sphincter control, transfers, locomotion, communication, and social cognition. RESULTS: Kappa values for items ranged from .44 to .82. Intraclass correlation coefficients (ICC) for the six subscales ranged from .73 to .98. Total WeeFIM ICC values were greater than .95 for all analyses. CONCLUSIONS: The WeeFIM ratings for the 205 children with developmental disabilities participating in this investigation were consistent across raters and time.

Neurodevelopmental outcome of infants with hypoplastic left heart syndrome.

The neurodevelopmental outcome of hypoplastic left heart syndrome in infants remains unclear. All 11 survivors of staged surgical repair of hypoplastic left heart syndrome received standardized neurodevelopmental assessments at one regional children's hospital. Seven children (64%) had major developmental disabilities. Quality-of-life outcomes must be considered when management options for children with hypoplastic left heart syndrome are evaluated.

The importance of temporal structure in analyzing schizophrenic behavior: some theoretical and diagnostic implications.

THEME, a new method for analyzing the temporal structure of responding on a two-choice task, is described. This method reveals the time relationships (temporal patterns) between all response events, even those not occurring in direct sequence. It selects those temporal patterns that are significantly different (p < 0.0001) from the patterns found in a random Poisson distribution of the same events. The method was applied to data from Lyon et al. (1986) in which n = 17 outpatient schizophrenics were compared with n = 17 age-, sex-, and education-matched normal control subjects. Results revealed that responding of schizophrenic outpatients, in comparison to control subjects, had a larger number of significant temporal patterns, more different types of patterns, and more branching (connectivity) of patterns at a higher level. The latter indicates a higher degree of internal structure. These results are not predicted by standard (DSM-III-R) diagnostic procedures, but are in agreement with studies of two-choice behavior in schizophrenia based on the Lyon-Robbins (1975) theory of behavioral change, which has possible relationship to dopamine/acetylcholine imbalance in the brain. Diagnostic procedures in schizophrenia might benefit from tests oriented toward these findings, which are also consistent with Bleuler's original descriptions of schizophrenic symptomatology.

Neonatal lupus erythematosus and maternal lupus erythematosus mimicking HELLP syndrome.

A 4-month-old boy had a faint, confluent, macular erythema involving the forehead, nose, and philtrum, and matlike telangiectases over the forehead and eyelids. The clinical features, course, and laboratory studies were characteristic of neonatal lupus erythematosus. He was otherwise healthy and the product of a preterm twin pregnancy complicated by the development of maternal HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. The patient had elevated Ro(SSA) and La(SSB) antibody titers, and studies performed on maternal blood disclosed positive antinuclear antibodies and elevated Ro and La antibody titers.

Effects of systemic indomethacin, meclizine, and BW755C on chronic ultraviolet B-induced effects in hairless mouse skin.

Chronic exposure of hairless mice to ultraviolet B (UVB) radiation is associated with inflammation as well as an altered macromolecular composition of the dermis. This study was designed to determine whether or not various systemic anti-inflammatory agents inhibit chronic UVB-induced changes in the macromolecular content of the dermis and, if so, whether each agent had the same or different effects. The agents and doses were chosen for their ability to inhibit the changes induced by a single exposure to UVB radiation (increased vasopermeability, neutrophil accumulation, and skin-fold thickness). Indomethacin, a cyclooxygenase inhibitor, and meclizine, an H1 histamine receptor antagonist, were administered from slow-release pellets. BW755C, a combined cyclooxygenase and lipoxygenase inhibitor, was administered intraperitoneally 30 min prior to UVB exposure. Animals were exposed to UVB three times per week for 20-26 weeks or were unirradiated. The elastin, glycosaminoglycan and collagen content of the skin were determined by measuring the desmosine, uronic acid, and hydroxyproline levels, respectively. The amount of each macromolecule per area of skin increased after chronic UVB exposure. The increase in desmosine was inhibited by indomethacin; the increase in hydroxyproline was inhibited by meclizine and BW755C. None of the agents inhibited the uronic acid increase. These results suggest that chronic inflammation contributes to the dermal changes seen in chronically UVB-exposed skin and that different inflammatory mediators are involved in the increases observed in elastin, glycosaminoglycans, and collagen.

The profile of cognitive impairment in elderly dyskinetic subjects.

Cognitive performance was assessed in 107 psychiatric patients whose age exceeded 59 years and who did not carry the diagnosis of organic mental syndrome. In this sample, tardive dyskinesia (TD) was associated with greater impairment in each of the seven cognitive domains assessed. These data do not address the etiology of TD but raise questions regarding the use of antipsychotics in young patients with cognitive impairment. Insofar as TD is an expression of basal ganglia dysfunction, these data also emphasize the critical role of relatively caudal brain structures in cognition and emotional expression.

Left turning (swivel) in manic patients.

Nineteen bipolar inpatients in manic episodes and 19 normal control subjects were tested on a two-button task which required turning (swiveling) 180 degrees to collect coin-reinforcers. Significantly more right-handed (8/16) manic patients turned left (consistently 16 times to collect reinforcement) than right-handed normal controls (1/15), most of whom turned consistently right 16 times. Right-handed manic patients were also significantly slower with both hands on a motor sequencing task (Pin Test) than the normal controls. Left hemi-spatial preference may be linked to asymmetric striatal dopaminergic activity common to all psychoses.

Left turning (swivel) in medicated chronic schizophrenic patients.

34 medicated schizophrenic inpatients, 34 normal control subjects, 18 affective disorder patients (four in manic phase), nine schizoid personality disorder subjects, and nine anxiety/histrionic disorder patients were tested on a two-button task which required turning 180 degrees to collect coin reinforcers. Schizophrenic patients turned consistently left (16 times) significantly more (nine of 34) than normal controls, all of whom turned consistently right (chi 2 = 10.37, P = 0.005). Schizophrenic patients also turned left significantly more than the 18 affective disorder subjects, all of whom turned consistently right (chi 2 = 5.76, P = 0.02). All schizoid personality disorder subjects turned consistently right, and eight of nine anxiety histrionic disorder subjects turned consistently right. Left turning was not correlated with any other variables measured, including handedness, demographic, diagnostic and symptom variables. Left rotation has been previously measured during free ambulation in acute, non-medicated patients (Bracha, Biol. Psychiatry 22 (1987), 995-1003). Left turning bias in a subset of medicated, chronic schizophrenic inpatients may be linked to an underlying asymmetric striatal dopaminergic activity, specifically, an ipsilateral hypoactivity or contralateral hyperactivity, which would lead to left turning and right hemi-spatial neglect.

Peritonitis meconial / Meconium peritonitis

La peritonitis meconial es una inflamación estéril, química, del peritoneo, causada comúnmente por perforación intrauterina del intestino delgado, asociado frecuentemente al ileo meconial de la mucoviscidosis u otras lesiones obstructivas o malformaciones. Clinicamente predominan los signos de obstrucción intestinal ultrasonografía es también un medio de gran utilidad en la identificación post natal del problema. El tratamiento quirúrgico es siempre necesario para resolver la obstrucción

Perseverative structuring of responses by schizophrenic and affective disorder patients.

Some theoretical implications from a CNS stimulation model of psychosis were tested by analysing the response patterns of schizophrenic (N = 34), affective disorder patients (N = 18), schizoid personality disorder patients (N = 9), neurotic patients (N = 9) and normal controls (N = 34) on a visual two-choice task with reinforcement. The subjects were required to press a left and right button in order to cause a cross (+) to appear on the monitor screen above one of the buttons. Certain subsequences of right and left presses were required in order for the cross to appear, and a coin-reinforcement was delivered on a variable-ratio schedule with respect to the cross condition. An analysis of structured responding in categories: one-side greater than 6, switching (RLRL), 2-1 switching (RRL) and double alternations (RRLL), revealed that the schizophrenic and affective disorder patients were significantly more perseverative in these response categories than normal controls, schizoid or neurotic patients. The last three subject groups were not significantly different from each other. The majority of the schizophrenics and all four manic patients showed the highest percentage of responding in one sided responses greater than 6, switching and 2-1 switching. Normal control subjects showed more varied response patterns with responses in double, triple and quadruple alternations and other combinations. The results are seen to support a CNS stimulation, behavioral competition model of psychosis.

Stereotyped responding by schizophrenic outpatients: cross-cultural confirmation of perseverative switching on a two-choice task.

Some theoretical implications from amphetamine-based models of psychosis were tested during a study of stereotyped responding by schizophrenic patients. Non-institutionalized Danish schizophrenic outpatients (N = 17) and their matched normal controls were asked to guess on which side (R or L) a cross (+) would appear on a computer screen. The sequence of cross positions was random. Multiple analyses of the patients' responses revealed a significantly greater number of single alterations (RLRL), while the matched controls displayed no such tendency. Controls showed instead, significantly more right side repetitions (RRRR) and more frequent double alterations (RRLL and LLRR). The patient response sequences were similar to those seen in an earlier study by Frith and Done (Psychol Med, 13, 779-786, 1983), but some control group differences emerged. Parallels are drawn between the development of perseverative response switching in schizophrenics and predictions derived from the Lyon-Robbins theory of amphetamine-induced stereotypy.

Kinetics of extraction of proteoglycans from human cartilage.

Fifty-one uniformly sliced human patellar cartilage specimens were extracted with physiologic buffer containing inhibitors. Galactosamine-rich proteoglycans were more easily extracted than glucosamine-rich proteoglycans. Extraction occurred in 2 phases. There was a large proteoglycan extraction during the first 30 minutes, followed by a steady loss proportional to the square root of time. The amount of proteoglycans extracted during phase 1 was approximately half that of phase 2. Extraction of proteoglycans varied with age, structural integrity, and cartilage thickness. Intact osteoarthritic cartilage had normal proteoglycan extraction.