Recombinant erythropoietin and blood transfusion in very low birth weight infants

Background: Very low birth weight infants (<1500 g) frequently require blood transfusions because of repeated blood sampling accompanied by anemia of prematurity. Methods: In an attempt to identify the effect of human recombinant erythropoietin to decrease the requirement for blood transfusions, erythropoietin was administered to 24 preterm infants less than 1500 g prospectively from September 1999 till December 2000. Data about the characteristics of the population, the severity of diseases, and treatment with erythropoietin, clinical diagnosis, initial and subsequent hemoglobin, volume of blood loss, and the number of blood transfusions were recorded. These results were compared with data from the recorded information of 49 infants who did not receive erythropoietin during those past 2 years. There were no differences between the 2 groups with regard to the gestational age, birth weight, clinical diagnosis, severity of the illness, primary causes of admission, and initial hematologic parameters such as hemoglobin, hematocrit and reticulocytes. Erythropoietin was administered in a dose of 200 IU/kg three times weekly for 6-8 weeks accompanied with iron supplement 6 mg/kg/day. Transfusions were administered according to protocol. Results: There was no significant difference between the number of blood transfusion among these 2 groups (p=0.07). However, transfusions in the erythropoietin treated group were fewer in comparison to the other group (1.9 +/- 1.6 to 3.2 +/- 1.1). No difference was observed between final hemoglobin and hematocrit levels among the two groups (10.3 +/- 0.9 vs. 10.4 +/- 0.7 and 33.7 +/- 2.3 vs. 32.2 +/- 2.2). Conclusion: Very low birth weight infants receive frequent blood transfusions but a reduction in transfusion requirements was not apparent after administration of erythropoietin and iron in preterm infants in this study. However, the lack of impact on transfusion requirements fails to support routine use of erythropoietin

Multiple cavernous hemangiomas presenting as orbital apex syndrome

A 41-year-old man presented with a 7-year history of gradually increasing right proptosis and a 2-year history of decreased vision and limited eye movements. Right proptosis (11 mm), limitation of movement in all gazes, anisocoria, and visual impairment implied orbital apex compression. Computed tomography showed several distinct lesions with mild delayed enhancement extending to the orbital apex. Through a lateral orbitotomy, 10 discrete hemangiomas were removed uneventfully. Histopathologic findings were consistent with cavernous hemangioma in all tumors removed. Proptosis resolved after surgery at 3 to 4 weeks. Visual acuity was unchanged (20/25), and eye movement significantly improved at last follow-up, 15 months after surgery. ©2005 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc

On the Efficacy of Isolating Shoulder and Elbow Movements with a Soft, Portable, and Wearable Robotic Device

Treatment intensity has a profound effect on motor recovery following neurological injury. The use of robotics has potential to automate these labor-intensive therapy procedures that are typically performed by physical therapists. Further, the use of wearable robotics offers an aspect of portability that may allow for rehabilitation outside the clinic. The authors have developed a soft, portable, lightweight upper extremity wearable robotic device to provide motor rehabilitation of patients with affected upper limbs due to traumatic brain injury (TBI). A key feature of the device demonstrated in this paper is the isolation of shoulder and elbow movements necessary for effective rehabilitation interventions. Herein is presented a feasibility study with one subject and demonstration of the device's ability to provide safe, comfortable, and controlled upper extremity movements. Moreover, it is shown that by decoupling shoulder and elbow motions, desired isolated joint actuation can be achieved

Physicians’ and nurses’ decision making to encounter neonates with poor prognosis in the neonatal intensive care unit

This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 03/06/2020. Available online: https://journals.sagepub.com/doi/abs/10.1177/1477750920927173This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 03/06/2020.Available online: https://journals.sagepub.com/doi/abs/10.1177/1477750920927173acceptedVersio

Efficacy of transarterial chemoembolization on lesion reduction in colorectal liver metastases

Following failure of systemic chemotherapy, transarterial chemoembolization (TACE) is an available method to control unresectable liver metastases from colorectal carcinoma (CRC). The aim of present study was to evaluate the efficacy of chemoembolization for inoperable metastatic liver lesions from CRC. Forty-five CRC patients with liver metastases resistant to systemic chemotherapy were enrolled in our study. For each patient, three session of TACE were conducted with 45 days interval. A combination of mitomycin, doxorubicin, and lipiodol were used for TACE. A tri-phasic computed tomography scan and biochemical laboratory tests were performed for all patients at baseline and 30 days after each TACE. Image analysis included measurement of lesion diameters as well as contrast enhancement. Eleven patients deceased before completing three session and the final analyses were performed on the remaining 34 patients. Evaluation of a total 93 lesions in all patients after chemoembolization sessions revealed a 25.88 reduction in anteroposterior (AP) diameter, 33.92 transverse (T) diameter, and 42.22 in product of APxT diameter of lesions (P<0.001 for all instances). CT scan showed a total disappearance of 33 of lesions and evident reduction in contrast enhancement in 16 of them. There were no changes in contrast enhancement in 51 of lesions. Evaluation of single largest lesion in each patient revealed 57.32 reduction in AP diameter, 59.66 in T diameter, and 62.17 in product of APxT diameters (P<0.001 for all diameters). TACE offers a viable option for CRC patients with unresectable liver metastases by significantly reducing lesion size and contrast enhancement. © 2012 Tehran University of Medical Sciences. All rights reserved

An intestinal epithelial defect conferring ER stress results in inflammation involving both innate and adaptive immunity

We recently characterized Winnie mice carrying a missense mutation in Muc2, leading to severe endoplasmic reticulum stress in intestinal goblet cells and spontaneous colitis. In this study, we characterized the immune responses due to this intestinal epithelial dysfunction. In Winnie, there was a fourfold increase in activated dendritic cells (DCs; CD11c+ major histocompatibility complex (MHC) class IIhi) in the colonic lamina propria accompanied by decreased colonic secretion of an inhibitor of DC activation, thymic stromal lymphopoietin (TSLP). Winnie also displayed a significant increase in mRNA expression of the mucosal TH17 signature genes Il17a, IL17f, Tgfb, and Ccr6, particularly in the distal colon. Winnie mesenteric lymph node leukocytes secreted multiple TH1, TH2, and TH17 cytokines on activation, with a large increase in interleukin-17A (IL-17A) progressively with age. A major source of mucosal IL-17A in Winnie was CD4+ T lymphocytes. Loss of T and B lymphocytes in Rag1-/- × Winnie (RaW) crosses did not prevent spontaneous inflammation but did prevent progression with age in the colon but not the cecum. Adoptive transfer of naive T cells into RaW mice caused more rapid and severe colitis than in Rag1-/-, indicating that the epithelial defect results in an intestinal microenvironment conducive to T-cell activation. Thus, the Winnie primary epithelial defect results in complex multicytokine-mediated colitis involving both innate and adaptive immune components with a prominent IL-23/TH17 response, similar to that of human ulcerative colitis

Rehabilitation of hand function after spinal cord injury using a novel handgrip device: a pilot study

BackgroundActivity-based therapy (ABT) for patients with spinal cord injury (SCI), which consists of repetitive use of muscles above and below the spinal lesion, improves locomotion and arm strength. Less data has been published regarding its effects on hand function. We sought to evaluate the effects of a weekly hand-focused therapy program using a novel handgrip device on grip strength and hand function in a SCI cohort.MethodsPatients with SCI were enrolled in a weekly program that involved activities with the MediSens (Los Angeles, CA) handgrip. These included maximum voluntary contraction (MVC) and a tracking task that required each subject to adjust his/her grip strength according to a pattern displayed on a computer screen. For the latter, performance was measured as mean absolute accuracy (MAA). The Spinal Cord Independence Measure (SCIM) was used to measure each subject's independence prior to and after therapy.ResultsSeventeen patients completed the program with average participation duration of 21.3&nbsp;weeks. The cohort included patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (n = 12), AIS B (n = 1), AIS C (n = 2), and AIS D (n = 2) injuries. The average MVC for the cohort increased from 4.1&nbsp;N to 21.2&nbsp;N over 20&nbsp;weeks, but did not reach statistical significance. The average MAA for the cohort increased from 9.01 to 21.7% at the end of the study (p = .02). The cohort's average SCIM at the end of the study was unchanged compared to baseline.ConclusionsA weekly handgrip-based ABT program is feasible and efficacious at increasing hand task performance in subjects with SCI

An extended multisensory temporal binding window in autism spectrum disorders

Autism spectrum disorders (ASD) form a continuum of neurodevelopmental disorders, characterized by deficits in communication and reciprocal social interaction, as well as by repetitive behaviors and restricted interests. Sensory disturbances are also frequently reported in clinical and autobiographical accounts. However, surprisingly few empirical studies have characterized the fundamental features of sensory and multisensory processing in ASD. The current study is structured to test for potential differences in multisensory temporal function in ASD by making use of a temporally dependent, low-level multisensory illusion. In this illusion, the presentation of a single flash of light accompanied by multiple sounds often results in the illusory perception of multiple flashes. By systematically varying the temporal structure of the audiovisual stimuli, a “temporal window” within which these stimuli are likely to be bound into a single perceptual entity can be defined. The results of this study revealed that children with ASD report the flash-beep illusion over an extended range of stimulus onset asynchronies relative to children with typical development, suggesting that children with ASD have altered multisensory temporal function. These findings provide valuable new insights into our understanding of sensory processing in ASD and may hold promise for the development of more sensitive diagnostic measures and improved remediation strategies

Aberrant Mucin Assembly in Mice Causes Endoplasmic Reticulum Stress and Spontaneous Inflammation Resembling Ulcerative Colitis

Michael McGuckin and colleagues identify two mutations that cause aberrant mucin oligomerization in mice. The resulting phenotype, including endoplasmic reticulum stress, resembles clinical and pathologic features of human ulcerative colitis