Comparison of Transcutaneous and Serum Bilirubin Measurements in Neonates 30 to 34 Weeks' Gestation Before, During, and After Phototherapy.

BACKGROUND: The use of noninvasive, transcutaneous bilirubin monitoring (TcB) as a jaundice screen in full-term infants is well established; however, there is a paucity of research evaluating the use of TcB in premature infants. PURPOSE: To compare agreement and consistency of transcutaneous and serum bilirubin measurements in a multiracial premature infant population ranging from 30 to 34(Equation is included in full-text article.)weeks' gestation before, during, and after phototherapy. METHODS: Forty-five neonates, 30 to 34(Equation is included in full-text article.)weeks' gestation, were enrolled in this prospective, correlational study over a 12-month period. One set of paired transcutaneous and serum bilirubin measurements, per neonate, was obtained before phototherapy, during therapy, and after phototherapy. Exclusion criteria included neonates with positive direct coombs test or evidence of hemolytic disease, major congenital anomalies, hydrops fetalis, and those not expected to survive. RESULTS: There was a strong, positive correlation between TcB and total serum monitoring (TSB) measurements obtained pretherapy (r = 0.797, P < .001). A moderate correlation was noted between TcB and TSB measurements obtained during therapy (r = 0.588, P < .001). A strong correlation was noted between TcB and TSB measurements obtained posttherapy (r = 0.869, P < .001). There were no significant differences between paired samples across time (F = 0.891, P = .41, partial η = 0.01). The TSB measurements were consistently lower than TcB pretherapy, during, and posttherapy. IMPLICATIONS FOR PRACTICE: The TcB measurements provide a reliable estimation, generally within 2 to 3 mg/dL of TSB levels, in premature infants 30 to 34(Equation is included in full-text article.)weeks' gestation. IMPLICATIONS FOR RESEARCH: Investigation of consumption of time and nursing personnel required to perform TcB testing, compared with TSB testing, is indicated. Cost analyses comparing TcB-driven screening protocols and interval TSB measurements, among premature infants, are indicated. As newer generations of TcB devices are approved for use, additional studies using mixed-race populations of premature infants will be necessary to continue to evaluate the reliability and validity of this screening tool within the everyday neonatal intensive care unit.

Hypofractionated Versus Standard Fractionated Proton-beam Therapy for Low-risk Prostate Cancer: Interim Results of a Randomized Trial PCG GU 002.

OBJECTIVE: To identify differences in terms of quality of life, the American Urological Association Symptom Index (AUA), or adverse events (AEs) among patients with prostate cancer treated with either standard fractionation or hypofractionation proton-beam therapy. MATERIALS AND METHODS: Patients were prospectively randomized to receive 38 Gy relative biological effectiveness (RBE) in 5 treatments (n=49) or 79.2 Gy RBE in 44 treatments (n=33). All patients had low-risk prostate cancer and were treated with proton therapy using fiducial markers and daily image guidance. RESULTS: Median follow-up for both groups was 18 months; 33 patients had follow-up of 2 years or longer. Baseline median (range) AUA was 4.7 (0 to 13) for the 38 Gy RBE arm and 4.8 (0 to 17) for the 79.2 Gy RBE arm. We observed no difference between the groups regarding the Expanded Prostate Index Composite urinary, bowel, or sexual function scores at 3, 6, 12, 18, or 24 months after treatment. The only significant difference was the AUA score at 12 months (8 for the 38 Gy RBE arm vs. 5 for the 79.2 Gy RBE arm; P=0.04); AUA scores otherwise were similar between groups. No grade 3 or higher AEs occurred in either arm. CONCLUSIONS: Patients treated with proton therapy in this randomized trial tolerated treatment well, with excellent quality-of-life scores, persistent low AUA, and no grade 3 or higher AEs on either arm. We showed no apparent clinical difference in outcomes with hypofractionated proton-beam therapy compared with standard fractionation on the basis of this interim analysis.

Color stability of denture resins after staining and exposure to cleansing agents.

STATEMENT OF PROBLEM: Hard denture acrylic resins must maintain color stability to remain esthetic. PURPOSE: The purpose of this in vitro study was to measure the color stability of denture resins subjected to staining agents and cleaned with denture cleansers MATERIAL AND METHODS: Forty-five disks (10-mm diameter, 2-mm thick) fabricated from 3 denture resins (light polymerized Eclipse; heat polymerized Lucitone 199 Heat; autopolymerized Lucitone 199 Repair) were stored for 24 hours in 37°C water. After baseline colorimetry measurement were made, the specimens were soaked for 8 hours in a staining agent: coffee, cola, or grape juice. Subsequently, the specimens were soaked for 12 hours in a commercial denture cleanser (Polident, GlaxoSmithKline; Efferdent, Prestige Brands Inc) or water (control). This procedure was repeated every 24 hours. Staining agents and cleansers were replenished every 24 hours. Color change (ΔE) was determined after 2, 4, 6, and 8 weeks (n=5). Results were submitted to analysis of variance and Tukey honest significant difference test (α=.05). RESULTS: Significant interaction was found between cleansers and staining agents (P=.006), cleansers and resins (P=.034), and resins and staining agents (P<.001). For the staining agent of grape juice, water allowed more discoloration (ΔE=16.93) than Efferdent (ΔE=14.41) or Polident (ΔE=14.81); Efferdent and Polident effects were not significantly different (P=.761). The Lucitone 199 Repair resin cleaned with water discolored more (ΔE=15.24) than with Efferdent (ΔE=14.14) or Polident (mean ΔE=13.82); the difference between Polident and Efferdent was not significant (P=.566). For Eclipse, grape juice discolored more (ΔE=16.43) than coffee (ΔE=12.23; P<.001) or cola (ΔE=13.78; P=.001); coffee and cola staining were not significantly different (P=.071). CONCLUSIONS: Eclipse resin stained most, especially in grape juice. Compared with water, Polident and Efferdent reduced discoloration better in Lucitone 199 Repair and grape juice stains. Nevertheless, discolorations in all 3 resins were perceivable, regardless of cleanser.