Synthesis and cytotoxic activity of C-glycosidic nicotinamide riboside analogues.

The C-glycosidic nicotinamide riboside analogue (2) was prepared by reaction of ribonolactone 24 with the lithiated oxazoline 19 followed by triethylsilane reduction to 26 and deprotection. Selective phosphorylation to the pseudonucleotide 34 was effected via the isopropylidene compound 33. In contrast to the benzoic acid riboside (28) the benzamide riboside (2) showed extremely high cytotoxicity at nanomolar concentrations to S49.1 lymphoma cells but only slightly increased dexamethasone toxicity.

A randomized trial of nurse-midwifery prenatal care to reduce low birth weight.

In a randomized, controlled trial in five regional centers with state health department clinics, 1458 women at high risk for low birth weight (LBW) outcome received either prenatal interventions provided by nurse-midwives and nurses under their supervision or the standard high-risk prenatal care provided by obstetricians. The intervention administered by the nurse-midwives included patient education to identify the signs and symptoms of preterm labor, activity counseling in response to monitoring of the cervix by frequent examinations, stress reduction by enhancing social support, nutrition counseling with emphasis on weight gain, and substance-abuse counseling. For women in the control group, care was provided by obstetricians according to local standards for the management of high-risk pregnancies. We hypothesized that the LBW rate among live births to women who had received care from nurse-midwives would be lower than that in the control group. Although the LBW rate was lower in the intervention group than in the control group, the observed difference was not statistically significant. Race was not prespecified as a possible effect modifier, but examination of the data post hoc suggested that black women at high statistical risk of giving birth to an LBW infant may have derived benefit from the program. Although the results do not suggest any striking advantage of the nurse-midwifery intervention over standard obstetric care for women at high statistical risk of having an LBW infant, neither do they suggest any disadvantage. Nurse-midwives could provide care to certain populations of high-risk women and facilitate future coverage of these presently underserved populations.

Social support in improving perinatal outcome: the Resource Mothers Program.

This report studies the Resource Mothers Program, an organization that improves perinatal outcome through social support. Resource Mothers are nonprofessional women who combine warmth, parenting experience, and knowledge of their local community services to reduce the hazards associated with rural adolescent pregnancy. Each Resource Mother is assigned to a pregnant teenage primigravida and serves as part of her support system throughout pregnancy and until the infant's first birthday. We studied 565 matched pairs (case/control) of rural teenage primigravidas with single pregnancies with and without the social support of the Resource Mother. There were significantly more patients with adequate prenatal care in the program group (P less than .000001). The frequency of low birth weight infants was significantly less (P = .006), as was the small-for-gestational-age rate (P = .002).

Improved perinatal knowledge in community hospitals through a self-instructional program.

The Perinatal Continuing Education Program (PCEP) was conducted throughout South Carolina. The program was well received and greatly valued; however, participants requested more information covering obstetrics. To meet this need, we developed the Perinatal Education Program for Community Hospitals (PEPCH), patterned after and similar to PCEP, and tested it in South Carolina and southern California. In the South Carolina trial, the posttest was found reliable (Kuder-Richardson index = .77). In the California trial, the pretest/posttest reliability was confirmed. Learning for nurses was documented (pretest = 30.8 +/- 5.3, posttest = 36.8 +/- 5.5, P less than .001). Completion rate for this voluntary program was 84%. We conclude that a self-study program based in the community hospital can improve knowledge of perinatal professionals.

Benefits of a statewide high-risk perinatal program.

A study was undertaken to determine whether newborn infants of women in a statewide high-risk program had less perinatal mortality and higher birth weight than newborn infants of high-risk women not in the program. The number of fetal and neonatal deaths was twice as high in the nonprogram group, but there was no statistical difference in birth weight distribution in the two groups. Possible reasons for the program's effectiveness are the facts that a greater number of program women had more prenatal visits and were delivered in a Level II or Level III hospital by appropriate personnel.

[The significance of LP-X cholesterol in the differential diagnosis of cholestasis (author's transl)]. / Die Bedeutung des Lipoprotein-X-Cholesterins in der Differentialdiagnostik der Cholestase.

The aim of this study was to investigate whether quantification of Lipoprotein X (LP-X) through its cholesterol moiety is advantageous in the differential diagnosis of obstructive jaundice. In the case of mechanic cholestasis, LP-X cholesterol never exceeds 22% of the total serum cholesterol. Lipoprotein-X cholesterol exceeded 70 mg/dl in the plasma of 85% of all cases of acute hepatitis. The combination of lipoprotein with the activities of alkaline phosphatase and GPT allows the recognition of almost 80% of cases acute hepatitis and thereby excludes all other causes of obstructive jaundice. In addition, 84% of all patients investigated can be correctly classified using a combination of LP-X with classical parameters for cholestasis. The concentration of LP-X cholesterol alone apparently is as powerful as the usually used clinical chemical parameters. A combination of lipoprotein and the classical parameters allows a better differentiation of cholestatic liver disease with regard to the underlying cause as it is possible with each group of parameters alone.

Ultrasonography of mucocutaneous lymph node syndrome.

Clinical findings associate mucocutaneous lymph node syndrome (MCLS) with diffuse arteritis leading to the formation of large aneurysms. Ultrasound assists in the diagnosis of the associated aneurysms, and aids the clinical management of the patients.