Spectroscopic noninvasive measurement of hemoglobin compared with capillary and venous values in neonates.

BACKGROUND: Venepuncture-related blood loss is a common cause of neonatal anemia. Currently, this is the only way to obtain hemoglobin levels. This causes distress for the infant but can also lead to the need for blood transfusions. Recently, a new technique for measuring hemoglobin levels non-invasively has been developed to reduce iatrogenic blood loss and pain. OBJECTIVE: To compare hemoglobin levels obtained using a transcutaneous spectroscopic device (Mediscan 2000, MBR Optical Systems, Wuppertal, Germany) with venous or capillary blood samples in neonates. METHODS: Single-center prospective cohort study of term and preterm infants. The white light spectroscopic device was placed on the forearm for 60 s to measure hemoglobin content within 4 h of venous or capillary blood sampling. Pain reactions of the infants were assessed by using a neonatal pain assessment tool. Results were analyzed by Bland-Altman comparison and Wilcoxon signed-rank test. RESULTS: 80 infants (mean gestational age 29.8 +/- 3.8 weeks, mean birth weight 1,300 +/- 690 g) were enrolled into the study. A total of 313 spectroscopic recordings within 2 h of a clinically indicated blood sample (181 capillary, 142 venous) were taken. The correlation coefficient R(2) was 0.96 for capillary/spectroscopic and 0.99 for venous/spectroscopic pairs. Pain scores were significantly less for the spectroscopic measurements (p < 0.01). CONCLUSION: The results show good correlation between the hemoglobin blood levels and spectroscopic measurements. The slightly lower correlation coefficient for the capillary samples demonstrates a naturally higher variance in these values due to the laboratory method.

Noninvasive reflection spectra provide quantitative information about the spatial distribution of skin chromophores.

In this work, a new method of analyzing noninvasive reflection spectra is presented. The approach explicitly models the inhomogeneity of chromophore distributions in living tissues and thus extracts not only apparent chromophore concentrations but also relative chromophore distributions in tissues. Furthermore, it works with spectra obtained with short source-detector separations where the diffusion theory of light transport through turbid media is not valid, and formerly presented methods thus fail. The effect of inhomogeneously distributed chromophores in a multicompartment model of tissues on measured reflection spectra is explained and an algorithm to deconvolute tissue spectra based on this model is presented. It is evaluated using simulated spectra and measurements on phantoms, which are made up of partially printed pieces of paper to simulate inhomogeneous dye distributions. Its applicability to real tissue is proven using reflection spectra obtained with 130 microm source-detector separation from a hemoperfusion stop experiment. The proposed model accurately determines apparent chromophore concentrations and corresponding distributions in simulated spectra and phantoms. Regarding real tissue spectra, the results correspond to former publications and the spectral reconstruction yields only minimal residuals, indicating a complete and accurate spectral deconvolution. In conclusion, the presented approach is a suitable extension and amendment to existing models of light transport through inhomogeneous samples.

Penetration studies of vitamin E acetate applied from cosmetic formulations to the stratum corneum of an in vitro model using quantification by tape stripping, UV spectroscopy, and HPLC.

The skin activation and penetration capability of vitamin E acetate as an ingredient in a basic o/w cream (lamellar type), in liposomes (Rovisome) and microparticles (Roviparts), was investigated under in vitro conditions (BUS model) by the adhesive stripping method. The aim of the study was to compare the analytical results obtained by UV spectroscopy (transmission) and the conventional HPLC method. For the quantitative spectrometric assay, a classical least-squares evaluation of the spectra between 265 and 350 nm, based on the constituent spectra, was used. UV spectroscopy is an economic analytical method for evaluating a large population of samples of the horny layer taken by the adhesive tape stripping method, which is an established tool for depth profiling of substances within the stratum corneum. With regard to the irritation test, no cytotoxicity was recorded for all formulations tested. However, the Roviparts and Rovisome cream formulations induced a considerable activation of the epidermal cells that may contribute to the penetration efficiency of Rovisome-formulated vitamin E acetate. The Rovisome-formulated cream delivered a maximum amount of vitamin E acetate into the horny layer compared to the other formulations tested. The difference can be explained by an alteration of the plasticity of the horny layer inducing a strong reservoir capacity and an activation of upper epidermal cells. Moreover, the opening of the potential pathway for a follicular penetration may be part of the increased reservoir capacity.

Carotenoids and carotenoids plus vitamin E protect against ultraviolet light-induced erythema in humans.

BACKGROUND: Carotenoids and tocopherols, known to be efficient antioxidants and capable of scavenging reactive oxygen species generated during photooxidative stress, may protect the skin from ultraviolet light-induced erythema. beta-Carotene is widely used as an oral sun protectant but studies on its protective effects are scarce. OBJECTIVE: The objective of this study was to investigate the protective effects of oral supplementation with carotenoids and a combination of carotenoids and vitamin E against the development of erythema in humans. DESIGN: A carotenoid supplement (25 mg total carotenoids/d) and a combination of the carotenoid supplement and vitamin E [335 mg (500 IU) RRR-alpha-tocopherol/d] were given for 12 wk to healthy volunteers. Erythema was induced by illumination with a blue-light solar simulator. Serum beta-carotene and alpha-tocopherol concentrations and skin carotenoid levels were assessed by HPLC and reflection photometry. RESULTS: Serum beta-carotene and alpha-tocopherol concentrations increased with supplementation. Erythema on dorsal skin (back) was significantly diminished (P < 0.01) after week 8, and erythema suppression was greater with the combination of carotenoids and vitamin E than with carotenoids alone. CONCLUSION: The antioxidants used in this study provided protection against erythema in humans and may be useful for diminishing sensitivity to ultraviolet light.

Rhythmical variations of haemoglobin oxygenation in cutaneous capillaries.

The consequences of rhythmical arteriolar vasomotion for nutrition and the tissue oxygen supply to human skin are largely unknown. In the study presented here, the periodic variations of haemoglobin oxygenation in the small cutaneous vessels have been evaluated with a new reflection spectrophotometer. For the assessment of spatial variations, we examined 24 different sites in 20 healthy volunteers. For quantification of the relatively long duration of periodic variations, a Digital Fourier Transformation with a specially programmed filter was used. In 265 out of 480 spectra (55.2%), periodic variations of the haemoglobin oxygenation were found. The average of the main frequency of waves was 7.0 +/- 2.5 cycles per minute. The occurrence of variations of haemoglobin oxygenation depended on the measuring site. In the gluteal region, variations were observed in 17 out of 20 subjects, on the palms in 16 out of 20, at the foot plantar in 18 out of 20 in comparison to the cheek (8/20), the lip (5/20) and the eyelid (6/20). On the head we observed significantly more variations per minute than in the lower extremities. Because these variations, with duration of up to 30 s, have a relatively slow dynamic compared with heart rate and breathing frequency, consequences for the cutaneous diffusion and metabolism of other substrates are very likely.

Increased dermal carotenoid levels assessed by noninvasive reflection spectrophotometry correlate with serum levels in women ingesting Betatene.

beta-Carotene is being used as an oral sun protectant, and evidence indicates that carotenoids may protect human skin from light-induced lesions. However, limited information is available on the distribution and accumulation of beta-carotene in skin, especially with respect to various skin regions. With the use of reflection spectroscopy, we investigated the accumulation of total carotenoids in human skin after repeated supplementation of 12 women with beta-carotene from a natural source Betatene, an algal extract. After daily ingestion of 24 mg beta-carotene (in Betatene) for 12 wk, an increase in carotenoid skin levels was observed. Highest basal values were measured in skin of the forehead, palm of the hand and dorsal skin, with lower levels measured in skin of the arm and back of the hand. Upon treatment, increases in carotenoid skin levels were found in all areas as follows: 2.4-fold in forehead, 0.7-fold in dorsal skin, 2.2-fold in the palm of the hand, 17-fold on the back of the hand and 1.7-fold on the inside of the arm. After cessation of treatment, the carotenoid levels decreased in all skin areas. Serum beta-carotene levels were elevated upon treatment and correlated with carotenoid skin levels. Correlations for serum vs. skin from the palm of the hand (r = 0.94) and skin from the forehead (r = 0.89) were calculated, indicating that serum levels appeared to be a suitable indicator for carotenoid accumulation in specific regions of the skin. With doses of approximately 20-25 mg carotenoids/d, it is possible to raise dermal carotenoid levels.

Evidence for antioxidant nutrients-induced pigmentation in skin: results of a clinical trial.

The aim of this study was to demonstrate that modification of the cellular redox-equilibrium occurs as a consequence of antioxidant nutrients intake (carotenoids, vitamine E and vitamine C) and that these nutrients play a role in the pigmentation of the skin without any UV exposure. We conducted a randomized, double-blind study in 20 healthy subjects to evaluate and to compare the efficacy of two mixtures of dietary antioxidants with regard to direct determination of melanin and carotenes by chromametry at selected skin sites and multiple reflection spectrometry from a 1 cm2 region of skin of different parts of the body. Efficacy was assessed by a significant improvement of these parameters, in comparison with measurements performed on the day of randomization, before dietary supplement intake. The formulations per capsule of study dietary supplements are: 13 mg of beta-carotene, 2 mg of lycopene, 5 mg of vitamine E and 30 mg of vitamine C (B13/L2) or 3 mg of beta-carotene, 3 mg of lycopene, 5 mg of vitamine E and 30 mg of vitamine C (B3/L3). A 8-week B13/L2-supplementation lead to a detectable carotenodermia whereas the B3/L3-supplementation not. Signicative increase of melanin concentrations in skin were found after 4, 5, 6 and 8 weeks of dietary antioxidant intake in both groups (p < 0.05). These results are discussed with regard to the redox control theory of melanocytes which regulates the tyrosinase activity.

[Effect of crankshaft position on the results of supine bicycle ergometry testing. Hemodynamics in coronary heart disease patients with normal and impaired left ventricular function]. / Einfluss der Kurbelachsenhöhe auf die Ergebnisse der Fahrradergometrie im Liegen. Hämodynamik bei koronarherzkranken Patienten mit normaler und eingeschränkter linksventrikulärer Funktion.

In 50 patients with coronary heart disease (CHD), 44 of them with a recent history of myocardial infarction, 2 tests on the bicycle-ergometer in the supine position, one with the crankshaft on the level of the examination cot and one with an elevation of the pedal axle by 30 cm were carried out within 30-minute intervals after initiating a flow directed right heart catheterization. In chronological sequence of the recruitment the patients began the ergometric tests alternately with a low or an elevated crank. The applied exercise loads of 50 and 75 watts lasted 3 minutes each. The results show clinically relevant differences between the 2 positions of the pedal axle, being in many cases statistically significant (p less than or equal to 0.01). The pressure of the pulmonary artery (PAP) was elevated at rest and under exercise load when the pedal axle was elevated. The changes of the pressure of the pulmonary artery through the exercise load are greater in patients with an impaired left ventricular function at rest with both pedal axle positions than in patients with a normal left ventricular function. We observed under increasing exercise load a diverging more pronounced elevation of PAP-curves only as a trend in the group of patients with an impaired left ventricular function. Heart rate and systolic blood pressure were on average likewise higher with the elevated crank then with the low one, however the mean variations were considerable. The oxygen saturation of the blood was somewhat less at rest and during exercise load when the pedal axle was elevated compared to the findings with the low pedal axle. The decrease of the oxygen saturation under exercise load was most pronounced in patients having already at rest an impaired left ventricular function. However, with both positions of the pedal axle the behaviour was identical.

[The principles of health resort treatment]. / Prinzipien der kurörtlichen Behandlung.

"Cures" prescribed in spas and health resorts are useful especially for patients who are chronically ill. The differences between pharmacotherapy and physiotherapy are discussed. The treatment in health resorts produces adaptations to repeated irritations, which need time, mostly four weeks. However, the changes of the function of circulatory system, lungs, metabolism etc. do not disappear after the end of the cure. To this extent, the principles of treatment in health resorts are comparable to sporting training. The days of incapacity to working are reduced to 50-60% in the following two years after a successful cure.

[Influence of starvation and kinesitherapy on blood lipids and their fractions (author's transl)]. / Einfluss von Nahrungskarenz und Bewegungstherapie auf die Blutfette und ihre Fraktionen.

In 24 obese patients triglycerides, cholesterol, HDL- and LDL-cholesterol were determined repeatedly during a period of starvation up to 21 days, combined with kinesitherapy. The average loss of body weight was after 10 days 6.4 kg and after 21 days 10.5 kg. While the triglycerides decreased only in the first week significantly, cholesterol decreased highly significant in 21 days from an average of 224 mg/dl to an average of 160 mg/dl. LDL-cholesterol was reduced from the 4th to the 21st day of starvation highly significant to an average of 100 mg/dl. On the other hand HDL-cholesterol decreased only in the first days and showed later a tendency to increase. Therefore the quotient LDL/HDL-cholesterol changed from 3.0 to 2.0. It is discussed that starvation diminishes the atherogenic fractions of cholesterol much more than the fractions which may have a protective effect against coronary heart disease.

[Are coronary patients endangered through arrhythmias in diving?]. / Sind Koronarkranke beim Tauchen durch Herzrhythmusstörungen gefährdet?

In 25 patients suffering from coronary heart disease with myocardial infarction electrocardiograms were registered continuously during diving and under water swimming. The results are compared to findings in the same patients during bicycle ergometry. Submersion under water produced a highly significant bradycardia and an increase of arrhythmias. During under water swimming heart rate increased less than during 50 Watt ergometry and premature beats were very frequent. It is discussed that the diving bradycardia combined with breath holding provokes the accumulation of arrhythmias. After myocardial infarction patients should not submerge the head under water.

[Oxygen affinity of haemoglobin 3 hours after passive increase in altitude from 400 to 1800 metres (author's transl)]. / Die Sauerstoffaffinität des Hämoglobins 3 Stunden nach passivem Höhenwechsel von 400 auf 1800 m.

An investigation was undertaken in 9 male subjects of the effect of short exposure to moderate altitude on the oxygen affinity of haemoglobin and other parameters. Initial measurements were performed at 425 m and repeated 3 hours after ascent by cable car to an altitude of 1800 m (Untersberg, Salzburg), no muscular activity being allowed (first period). The same protocol was repeated 3 days subsequently except that after ascent the individuals were exercised on an ergometer bicycle (second part). Altitude exposure without exercise leads to a small, but significant increase in the pH corrected P50 value (= half-saturation tension), whereas the non-corrected P50 value showed no significant change. In the second part of the study the corrected and non-corrected P50 values both increased significantly. The whole body pH and the intraerythrocytic pH rose, whereas PCO2 decreased significantly. The intraerythrocytic 2,3-DPG concentration showed a significant increase (1.2 mumol/gHb) after 3 hours of altitude exposure with and without muscular exercise. The prealtitude DPG concentration and the P50 values in the second period were higher than the first control values. The red blood count and sodium and chloride concentration showed no changes. Potassium rose in both experimental periods, whereas inorganic plasma phosphates decreased. These findings show that 3 hours after cable-car ascent to a medium altitude a DPG increase occurs which is able to counteract the Bohr effect. This means that the expected impairment of tissue oxygenation, caused by the alkalosis-induced shift of the dissociation curve to the left, is prevented. These findings also indicate that a repeated "passive" ascent to moderate altitude can lead to an increased oxygen delivery to the tissue.

[Results with outpatient coronary groups. Five years of the Hamburg model (author's transl)]. / Ergebnisse mit ambulanten Koronargruppen. 5 Jahre Hamburger Modell.

Three and six months after joining the outpatient coronary groups in their area, follow-up studies became possible in 543 patients after their myocardial infarction. The subjective complaints had fallen in this six months, the physical performance measured ergometrically, had distinctly increased. Patients who had joined the coronary group were able to work again significantly earlier. At the time of the.follow-up 5% were pensioners, 76.2% were able to work, 51% fully active at their old workplace.

[The relative ejection time under different conditions of cardiac stress and in aortic valve disease (author's transl)]. / Untersuchungen der relativen Austreibungszeit unter verschiedenen Belastungen und bei Aortenvitien.

In 51 healthy young people the carotid arterial pulse wave was registered externally during bicycle-exercise in a lying position. The ejection time in relation to the duration of diastole (not pulse period or heart rate!) increased significantly. These results are compared with measurements made by Schulz (15) who found normal ejection times in tachycardia provoked by pacer-stimulation and shortened values during isoproterenol-induced tachycardia. Women have longer ejection times than men especially under physical stress. In 18 patients suffering from aortic insufficiency, ejection times were slightly prolonged and in 28 patients who had a systolic pressure gradient of more than 20 mm Hg between the left ventricle and the aorta ejection times were markedly prolonged. There is also a significant positive correlation between ejection time and pressure gradient. The authors consider that the autonomic innervation plays an important role in the duration of ejection time in normal subjects while in patients with aortic heart disease the ejection time is predominantly influenced by mechanical factors. For the diagnosis of the severity of aortic stenosis measurements of ejection time are only useful in connection with other clinical parameters (pulse pressure, creast time of the arterial pulse wave).

Return to work after myocardial infarction.

The period of inability to work after acute myocardial infarction was examined in follow-up studies. Without organized rehabilitation, 7.5% of patients past myocardial infarction returned to work after 6 months. After early mobilization in the hospital and intensive follow-up treatment in a rehabilitation center, 18% of the patients returned to work within 6 months. After the establishment of coronary groups in the vicinity of the patients' homes for the continuation of therapy, the percentage of patients able to return to work within 6 months rose to 42.5%, as shown in a later study. A further study checked the reliability of the rehabilitation clinic's prediction as to the expected date of return to work; only 24% of these predictions were correct. But this percentage rose to 82% after prolonged talks between physician and patient as to the motivation for return to work, modification of the conditions and a detailed report to the local physician.

[Arrhythmias in athlets (author's transl)]. / Herzrhythmusstörungen bei Hochleistungssportlern.

380 athletes in optimal performance were examinated within 10 years between 2 and 13 times (average: 4 times): ECG were taken at rest, during breathing tests and under maximal physical load by ergometry. 88 (23.2%) of them showed arrhythmias, 32 in the same examination different forms of premature beats. All kinds of arrhythmias were seen except atrial flatter, total av-block and paroxysmal tachycardias. Breathing tests provoked most of arrhythmias followed by the recovery after maximal physical load. Follow-up studies and clinical examinations proved that in 86 sportsmen these arrhythmias were not a symptom of heart disease. Only in 2 athletes heart injury could not be excluded. But in nearly 50% extracardial inflammations, like tonsillitis, bronchitis etc., were found. It is discussed that bradycardia and vagotonia of the highly trained sportsmen cause the arrhythmias. This vagotonia is intensified by breathing tests. But arrhythmias found in athletes should cause an examination for other chronical sicknesses.