Use of probiotics in the NICU: Evaluating the stability of a three-strain probiotic blend in various media for enteral feeding.

BACKGROUND: There is little published data on how to prepare probiotic supplements for enteral delivery in the NICU. The objective of this study was to determine how a three-strain probiotic blend (Bb-02, TH-4® and BB-12®) would behave when mixed and held for 4 hours with saline water, sterile water, dextrose 5% in water (D5W), 24 kcal preterm formula, and human milk. METHODS: A packet of a three-strain probiotic supplement was mixed with 3 mL of saline water, sterile water, D5W, 24 kcal preterm formula, and human milk (tested at 3 mL and 2 mL). Samples were stored at room temperature for 60 minutes then refrigerated for 180 minutes. Probiotic survival, using quantitative enumeration, and pH were monitored over 4 hours. Samples were passed through a 5 French (Fr) feeding tube at the end of the study to evaluate viscosity. RESULTS: The largest variation in total cell count from 0-time was sterile water with a + 0.26 log(CFU)/mL change at 90 minutes and typical variation is considered±0.50 log units indicating no significant change between samples in 4 hours. Saline water had the lowest final pH at 4.88. All samples easily passed through a 5 Fr feeding tube. CONCLUSION: The study showed minimal change in cell counts across solutions for 4 hours of storage, indicating health care facilities may be able to prepare probiotic supplements with a variety of solutions in pharmacies or milk rooms. This allows greater flexibility for probiotic delivery to preterm infants.

Frequency of symptomatic zinc deficiency in very low birth weight infants.

Current concepts on zinc requirements for premature infants rely on studies dating back more than 20 years. Given that nowadays more premature infants frequently survive we aimed to obtain recent frequency data on zinc deficiency in very low birth weight (VLBW) infants.226 VLBW infants born between July 2005 and December 2009 were retrospectively included in this study. Mean gestational age (GA) was 28.7 weeks (range 23+0 to 38+0) and mean birth weight 1120g (range 354-1495). All infants received zinc supplementation according to the ESPGHAN guidelines. 26 (11.5%) patients showed clinical signs for zinc deficiency of whom 15 had serum zinc concentrations < 50µg/dl, 9 between 50 and 70 µg/dl and 2 > 70 µg/dl. Infants presenting with dermatitis had significantly lower concentrations (mean 26.7 µg/dl, range 19-31) when compared to infants with diarrhoea or isolated peripheral oedema (35.3 µg/dl and 51.8 µg/dl respectively). Strongest independent risk factors were low GA, being small for GA and suffering from intestinal resection due to necrotizing enterocolitis. Frequency of zinc concentrations <50 µg/dl were calculated to be 6.6% in VLBW infants.Even though current guidelines for zinc supplementation were followed the frequency of zinc deficiency was found to be unexpectedly high in ELBW and SGA infants. Despite the retrospective nature of this single centre study, our data strongly suggest that recommendations on zinc supplementation in ELBW and SGA infants should be reviewed.

Validity of cycle test in air compared to underwater cycling.

According to international guidelines, fitness to dive is generally assessed using a bicycle stress test (BST) in air. To date, there is no study explicitly addressing the question whether the results of a BST in air really predict performance status under water. Therefore, the aim of the present study was twofold: first, to design an experimental setting allowing the examination of physical performance status under water, and second, to examine whether there is an association of response to exercise in air compared to exercise under water using self contained underwater breathing apparatus (SCUBA). We constructed and evaluated a measurement technique for a bicycle ergometry and for gas analysis under water. Part of the work was the development of a new valve system which allowed to collect the exhaled air in total and to transport it to the spirometer next to the pool. Twenty-eight healthy male divers underwent a BST. Compared to a given workload in air, gross capacity decreased significantly by about 50% underwater. High performance in air was associated with a high performance underwater. The examinations were carried out without any complications. In conclusion, our experimental setting allowed the safe and reliable examination of physical performance status under water. First results indicate that the results of a BST in air correlate well with the cardio-circulatory performance status underwater. A subsequent study with a larger sample size will enable us to more precisely model this correlation.

Risk factors associated with preterm (<37+0 weeks) and early preterm birth (<32+0 weeks): univariate and multivariate analysis of 106 345 singleton births from the 1994 statewide perinatal survey of Bavaria.

OBJECTIVE: The study was conducted to identify medical, obstetrical and social risk factors associated with early preterm births (<32+0 gestational weeks). STUDY DESIGN: The Statewide Perinatal Survey of Bavaria is a collection of perinatal data from all Bavarian maternity units using a uniform numbered questionnaire. Data on 106345 singleton births from the 1994 Survey were analysed using univariate and multivariate logistic regression analysis. RESULTS: In the multivariate analysis, early preterm birth was associated with premature rupture of the membranes (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.37-1.86), treatment for infertility (OR 1.7, 95% CI 1.19-2.34), previous induced abortion (OR 1.8, 95% CI 1.57-2.13), maternal age >35 years (OR 1.8, 95% CI 1.47-2.16), premature cervical dilatation (OR 2.3, 95% CI 1.86-2.94), a history of stillbirth (OR 3.2, 95% CI 2.13-4.83), a history of preterm birth (OR 3.3, 95% CI 2.45-4.48), maternal age <18 years (OR 3.4, 95% CI 2.03-5.61), malpresentation (OR 3.9, 95% CI 3.10-4.93), preeclampsia (OR 4.0, 95% CI 3.20-4.94), uterine bleeding (OR 5.0, 95% CI 4.08-6.02), preterm labour (OR 7.0, 95% CI 5.94-8.22), and chorioamnionitis (OR 22.3, 95% CI 17.40-28.66). CONCLUSION: These data identify a subgroup of women at an increased risk for early preterm birth and may benefit from an intensified prenatal care. Risk factors related to the obstetrical history, genital infections, preeclampsia and maternal age are the most relevant for early preterm birth.

Cardiovascular effects of Org 9487 under isoflurane anaesthesia in man.

The cardiovascular effects of Org 9487 during isoflurane anaesthesia have been evaluated using three doses around its ED90 for neuromuscular blockade, i.e. 1 mg kg-1, 2 mg kg-1 and 3 mg kg-1. Heart rate increased to 110%, 115% and 118% in patients receiving 1 mg kg-1, 2 mg kg-1 and 3 mg kg-1 respectively. There were no significant effects on systolic and diastolic blood pressures for the two lower dose groups. Patients receiving Org 9487 3 mg kg-1 displayed significant decreases in systolic and diastolic blood pressures (91% and 82% of the control values respectively). Except for heart rate in the group receiving 3 mg kg-1, all measurements returned to baseline after a maximum of 15 min. Six patients experienced a transient increase in airway pressure after administration of Org 9487, which was accompanied by a decrease in oxygen saturation in two out of six subjects, but there was no audible wheezing. These episodes were self-limiting and required no treatment. There were no other adverse reactions to this drug during this study.

Competition between annihilation and trapping leads to strongly reduced yields of photochemistry under ps-flash excitation.

Excitation of photosynthetic systems with short intense flashes is known to lead to exciton-exciton annihilation processes. Here we quantify the effect of competition between annihilation and trapping for Photosystem II, Photosystem I (thylakoids from peas and membranes from the cyanobacterium Synechocystis sp.), as well as for the purple bacterium Rhodospirillum rubrum. In none of the cases it was possible to reach complete product saturation (i.e. closure of reaction centers) even with an excitation energy exceeding 10 hits per photosynthetic unit. The parameter α introduced by Deprez et al. ((1990) Biochim. Biophys. Acta 1015: 295-303) describing the competition between exciton-exciton annihilation and trapping was calculated to range between ≈4.5 (PS II) and ≈6 (Rs. rubrum). The rate constants for bimolecular exciton-exciton annihilation ranged between (42 ps)(-1) and (2.5 ps)(-1) for PS II and PS I-membranes of Synechocystis, respectively. The data are interpreted in terms of hopping times (i.e. mean residence time of the excited state on a chromophore) according to random walk in isoenergetic antenna.

[Topographic electroencephalometry following anesthesia induction with ketamine-midazolam]. / Topographische Elektroenzephalometrie während Narkoseinduktion mit Ketamin-Midazolam.

The neurophysiological action of ketamine has attracted increasing interest in recent years, with special interest in receptor action and in neurophysiological differences between and psychomimetic side effects of the two enantiomorphs. Most of the neurophysiological examinations published deal with ketamine as a single anaesthetic agent, although it has been suggested to that psychomimetic side-effects and haemodynamic deterioration could be avoided by combining ketamine with a sedative drug. The primary aim of our study was to examine the combined ketamine-midazolam action on cerebral activity; secondly, we planned to look at these interactions topographically at different points of the cortex to evaluate topographical differences in the combination's action; thirdly, the cerebral and haemodynamic reactions to anaesthesiological stimuli (intubation, gastric tube) were evaluated and compared. METHODS. Sixteen patients scheduled for elective aortocoronary bypass surgery were examined. Topographical electroencephalometric data were obtained by processed EEG with a CATEEM system at 17 recording points over the cortex and compared with heart rate and arterial blood pressure during the induction period. After documentation of the baseline data ketamine (3 mg/kg) and midazolam (0.15 mg/kg) were applied within 10 min by means of an automatic device. At the end of the infusion period patients were intubated, and after a further 10 min a gastric tube was placed. RESULTS. Induction resulted in increases in delta and beta 2 output (P < 0.05) in the early induction period and in significant decreases (P < 0.05) in alpha 1, alpha 2 and beta 1 activity. No significant change in theta activity was observed throughout the observation period. Intubation led to significant increases of power particularly in the temporal and parietal leads of all frequency bands, but not in the frontal area. Insertion of the gastric tube did not alter cerebral function. CONCLUSION. The interaction of ketamine and midazolam leads to increases in beta 2 and delta power and to significant decreases in the alpha bands and beta 1. Increases of theta activity, a typical effect of single-agent anaesthesia with ketamine, were not observed. Thus, the action of combined ketamine and midazolam on cerebral function is not an additive, but an interactive process. Despite a relatively high induction dosage, haemodynamic changes during intubation occurred and were accompanied by changes in cerebral activity. This can be regarded as incomplete cerebral suppression even by these induction dosages.

The impact of timing and frequency of prenatal visits on the outcome of pregnancy in the perinatal registry of Bavaria 1987-1988.

A retrospective analysis was made on the singleton births included in the Bavarian statewide perinatal registry (Bayerische Perinatalerhebung, BPE; 99,252 births from BPE 1987 and 79,661 births from BPE 1988) with respect to the timing of the first prenatal consultation and the frequency of visits during pregnancy. If the first prenatal visit was scheduled after 21 weeks, the rates of infants transferred to pediatric units relative risk (RR = 1.34, P < 0.0001, chi 2-test), of low birth weight (RR = 1.41, P < 0.0001) and of stillbirths (RR = 1.70, P < 0.025) were higher than if the first visit was at 9-12 weeks. Similarly, after < 4 prenatal visits, the rates of infants transferred (RR = 3.91), of low birth weight (RR = 9.18), of stillbirths (RR = 7.65) and of neonatal deaths (RR = 29.5) were significantly (P < 0.0001) higher than after > 10 visits. Prenatal care was defined as 'standard' if the initial consultation was scheduled at or before 12 weeks and whether 10-12 visits were completed during a normal duration of pregnancy. 'Below standard' prenatal care was associated with a higher rate of infants transferred (P < 0.01) and of stillbirths (P < 0.0005). Prenatal care was more frequently (P < 0.0001) classified as 'below standard' in mothers older than 39 years (40.45%, RR = 2.45) and in adolescent mothers (58.67%, RR = 5.12) than in those 25-29 years of age (21.71%), in fourth and subsequent (48.22%, RR = 3.44) than in first pregnancies (21.32%) and in foreign (39.65%, RR = 2.18) than in German mothers (23.19%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Topographic changes in cerebral electric activity after premedication with flunitrazepam]. / Topographische Anderungen der hirnelektrischen Aktivität nach Prämedikation mit Flunitrazepam.

AIM: The effects on cerebral function of premedication with the benzodiazepine flunitrazepam and with morphine were studied on the evening of the preoperative day (2 mg flunitrazepam p.o.) and 90 minutes before induction of anaesthesia (2 mg flunitrazepam plus 15 mg morphine i.m.). DESIGN: The EEG was analysed topographically (17 electrodes) and quantitatively. RESULTS: As a typical effect of benzodiazepines, increases in electrical activity in the frequency band beta-1 of the power spectrum were observed, and could be demonstrated 10 minutes after oral application, mainly in the frontal and central parts of the cortex. Increases in the powerbands delta and theta indicated induction of sleep approximately 15-20 minutes after application and were not looked upon as an effect of the benzodiazepine exclusively. These increases were noticed first in the central, occipital and temporal areas and after 30 minutes in the frontal parts of the cortex. Flunitrazepam plus morphine showed qualitatively similar but quantitatively less pronounced results. Topographical differences were similar to the results of an application of flunitrazepam alone. DISCUSSION: The results demonstrate the importance of a topographical as well as quantitative evaluation in studies on complex interactions of sedative or narcotic drugs and their clinical effects on cerebral function.

Primary charge separation in photosystem I: a two-step electrogenic charge separation connected with P700+A0- and P700+A1- formation.

A PS I membrane preparation from a PS II deficient mutant of Synechocystis sp. PCC 6803 (psb DI/DII/C) was investigated by picosecond photovoltage and fluorescence measurements. The photovoltage kinetics show two distinct phases. At low excitation energies the fast phase correlates with the fluorescence decay time constant of 22 +/- 4 ps. This phase is ascribed to the trapping of excitons as described by the reaction (AntiP700)* A0-->AntiP700+A0-. In addition to this phase, the photovoltage displays a second rising phase of smaller amplitude with a time constant of 50 +/- 15 ps. We assign the latter phase to further electron transfer from A0 to the secondary acceptor, A1. Assuming the protein as a homogeneous dielectric, our results suggest that the transmembrane distance A0-A1 spans only a small part (20 +/- 8%) of the distance P700-A1.

Theoretical fluorescence induction curves derived from coupled differential equations describing the primary photochemistry of photosystem II by an exciton-radical pair equilibrium.

Fluorescence induction curves were calculated from a molecular model for the primary photophysical and photochemical processes of photosystem II that includes reversible exciton trapping by open (PHQ(A)) and closed (PHQ(-) (A)) reaction centers (RCs), charge stabilization as well as quenching by oxidized (P(+)HQ((-)) (A)) RCs. For the limiting case of perfectly connected photosynthetic units ("lake model") and thermal equilibrium between the primary radical pair (P(+)H(-)) and the excited singlet state, the primary reactions can be mathematically formulated by a set of coupled ordinary differential equations (ODE). These were numerically solved for weak flashes in a recursive way to simulate experiments with continuous illumination. Using recently published values for the molecular rate constants, this procedure yielded the time dependence of closed RCs as well as of the fluorescence yield (= fluorescence induction curves). The theoretical curves displayed the same sigmoidal shapes as experimental fluorescence induction curves. From the time development of closed RCs and the fluorescence yield, it was possible to check currently assumed proportionalities between the fraction of closed RCs and either (a) the variable fluorescence, (b) the complementary area above the fluorescence induction curve, or (c) the complementary area normalized to the variable fluorescence. By changing selected molecular rate constants, it is shown that, in contrast to current beliefs, none of these correlations obeys simple laws. The time dependence of these quantities is strongly nonexponential. In the presence of substances that quench the excited state, the model predicts straight lines in Stern-Volmer plots. We further conclude that it is impossible to estimate the degree of physical interunit energy transfer from the sigmoidicity of the fluorescence induction curve or from the curvature of the variable fluorescence plotted versus the fraction of closed RCs.