Intermittent Hypoxemia in Preterm Infants: A Potential Proinflammatory Process

Objective A major consequence of prematurity is intermittent hypoxemia (IH). Data from both adult studies and neonatal animal models suggest that IH is proinflammatory; however, there is limited data in preterm infants. Here, we assess the relationship between IH and systemic inflammation, namely, serum C-reactive protein (CRP) in preterm infants. Study Design Serum CRP was measured at 30 days of life, at the time of peak IH frequency. IH measures (e.g., per cent time in hypoxemia, frequency, duration) were calculated the week prior to CRP collection. Statistical analyses were based on Spearman's correlation. Results A total of 26 infants were included. Median gestational age and birth weight were 274/7 weeks and 980 g, respectively. There were positive correlations between primary IH measures and CRP levels, especially for events longer than 1-minute duration (r range: 0.56–0.74, all p < 0.01). Conclusion We demonstrate that IH is associated with increased CRP for the first time in preterm infants. Our findings are consistent with studies from adults and neonatal animal models suggesting that IH is a proinflammatory process. Key Points

Targeting glucose control in preterm infants: pilot studies of continuous glucose monitoring

ObjectiveHyperglycaemia is common in very preterm infants and is associated with adverse outcomes. Preventing hyperglycaemia without increasing the risk of hypoglycaemia is difficult. Real time tracking with continuous glucose monitors (CGM) may improve glucose control. We assessed the feasibility and safety of CGM to target glucose control in preterm infants, to inform a randomised controlled trial (RCT).DesignWe performed a single centre study in very preterm infants during the first week of life. Accuracy was assessed by comparison of CGM with blood glucose levels (n=20 infants). In a separate pilot study of efficacy (n=20), real-time CGM combined with a paper guideline to target glucose control (2.6–10 mmol/L) was compared with standard neonatal care (masked CGM). Questionnaires were used to assess staff acceptability.ResultsNo concerns were raised about infection or skin integrity at sensor site. The sensor performed well compared with point-of-care blood glucose measurements, mean bias of −0.27 (95% CI −0.35 to −0.19). Per cent time in target range (sensor glucose 2.6–10 mmol/L) was greater with CGM than POC (77% vs 59%, respectively) and per cent time sensor glucose >10 mmol/L was less with CGM than POC (24% vs 40%, respectively). The CGM also detected clinically unsuspected episodes of hypoglycaemia. Staff reported that the use of the CGM positively improved clinical care.ConclusionsThis study suggests that CGM has sufficient accuracy and utility in preterm infants to warrant formal testing in a RCT.

Growing Muskmelon (Cucumis melo L.) under Low-input System in Arid trans-Himalayan Ladakh, India

<p>Feasibility of growing muskmelon (Cucumis melo L.), a warm season crop, was studied under a low-input cultivation system in open field condition in high altitude (elevation 3344 m) trans-Himalayan Ladakh region. The marketable yield of five cultivars in different treatments varied from 5.4±0.4 t.ha-1 to 18.8±1.7 t.ha-1 and 4.0±0.2 t.ha-1 to 15.8±1.0 t.ha-1 in 2014 and 2015, respectively. Treatment of black polyethylene mulch (BPM) increased marketable yield by 25 per cent to 155 per cent depending on year and cultivar. The marketable yield of the best performing cultivar (Pusa Madhuras) under BPM was 17.3 t.ha-1, which suggested that muskmelon can successfully be grown in open field condition in trans-Himalaya. The fruit become ready for harvest in mid-August. Number of fruit per plant ranged from 2.3 to 6.3, and TSS ranged from 8.9 to 14.1 °Brix depending on cultivar. Temperature 10 cm beneath the BPM was 2.9±0.4 ºC higher than in bare soil. BPM reduced 74 per cent weed and save 77 per cent time in manual weeding.</p>

Black Polyethylene Mulch Doubled Tomato Yield in a Low-input System in Arid Trans-Himalayan Ladakh Region

<p>The influence of black polyethylene mulch (BPM) on growth and yield of tomato was investigated under a low-input cultivation system in arid high altitude (elevation 3344 m) in trans-Himalaya. The mean marketable yield varied from 27.8±2.5 t.ha-1 in open-pollinated varieties with no mulch treatment to 81.2±11.9 t.ha-1 in hybrid tomatoes with BPM. The yield of hybrid tomatoes with BPM is similar or greater than those reported in high-input systems. With BPM, total marketable yield in hybrid varieties increased by 102 per cent and 107 per cent in 2014 and 2015, respectively. Yield increase due to mulching in open-pollinated varieties was 86 per cent and 80 per cent in 2014 and 2015, respectively. Increase in early fruiting under BPM was observed in all the five varieties studied. Difference in soil temperature between mulch and unmulch was significantly higher at early growth stage than during later stages. BPM reduced 57 per cent weed and save 74 per cent time in manual weeding. Incidence of insect-pest and diseases was minimal, and rotten fruit was less than 2 per cent of marketable yield without staking and pesticide or fungicide application.</p>

Effect of Mulching, Shading, Spacing and Cutting Thickness on Propagation of Seabuckthorn (Hippophae rhamnoides L.) by Cuttings

<p>The effect of plastic mulching, coloured shade netting, spacing and cutting thickness on rooting success and growth of Seabuckthorn (Hippophae rhamnoides L.) through hard wood cuttings is addressed. Use of silver black plastic mulching film resulted in 10 per cent higher rooting success and significant plant growth. Suppression of weed emergence by the plastic mulch resulted in 75.8 per cent time saving in manual weeding by farm workers. No significant gender difference in rooting success was observed. Reduction in light intensity by 66 per cent using green shade net resulted in significant reduction in rooting and growth of nursery plants. Three different spacing between cuttings did not show significant difference in rooting and growth related parameters suggesting that cuttings can be planted denser (3"×3") under mulching to get higher number of nursery stock per unit area. Cutting thickness showed significant effect on rooting success. Highest rooting percentage was observed in pencil thickness cuttings (7.5 ± 1.6 mm dia) followed by cuttings with 2.9 ± 0.8 mm and 11.3 ± 1.7 mm basal diameter. The result of the present study could facilitate establishment of a vegetative propagation method wherein faster growth and larger number of cuttings can be propagated with higher rooting success rate.</p>

Cholesteatoma surgery in children: 10-year retrospective review

Objective:To review outcomes following paediatric cholesteatoma surgery performed between 1999 and 2009 in a tertiary paediatric ENT unit.Study design:Retrospective case note review.Results:A total of 137 mastoid procedures were recorded. Fifty-four per cent of children were observed to have disease involving the entire middle-ear cleft and mastoid complex. The revision rate was 25 per cent. Time to recurrence was one to three years in 17 patients, three to six years in five patients, and six to nine years in three cases. Eight of 25 revision cases demonstrated spontaneous improvement in air conduction thresholds following primary surgery. A high facial ridge and inadequate meatoplasty correlated highly with disease recurrence.Conclusion:Children tend to present with aggressive disease. Disease extent and ossicular chain involvement are associated with a higher risk of recurrent disease. Spontaneous improvement in hearing thresholds following cholesteatoma surgery should alert the clinician to recurrent disease.

Head and neck mucosal squamous cell carcinoma: results of palliative management

Objective: To document the outcome of patients deemed at initial diagnosis to be appropriate for palliative care.Materials and methods: Over a five-year period, all patients with head and neck mucosal squamous cell carcinoma (HNMSCC) were referred to one consultant surgeon, and data were collated retrospectively.Results: Of 286 patients with HNMSCC, 60 (21 per cent) were deemed appropriate for palliative care at initial diagnosis. Their median survival was 154 days, with hypopharyngeal and oropharyngeal tumours forming a disproportional percentage of the initial diagnoses (p < 0.001). After initial assessment, 66 per cent of patients were discharged to their home, 17 per cent to hospice care and 17 per cent were transferred to other institutions. Including deaths during the initial admission, 29 per cent of patients did not return home after diagnosis. Palliative treatment included operative interventions in 35 per cent and radiotherapy in 43 per cent. Time spent in further hospital care averaged 47 days, and 47 per cent of patients eventually died in hospital.Conclusion: One in five patients presenting with HNMSCC were deemed appropriate for palliative care at initial presentation and survived less than six months after diagnosis. More than one-third required surgical intervention, and 29 per cent never returned home.

FIFTY PER CENT TIME TO PUPATION AS A MEASURE OF DEVELOPMENTAL TIME IN TRIBOLIUM

A technique for measuring developmental time in insects is proposed. The method is similar to the widely used 50% lethal dose (LD50). The major advantage for this technique, TP50 for pupation time and TE50 for adult emergence time, is the complete avoidance of introducing environmental correlations to the relationship among traits by handling. Standard deviations for TP50 and TE50 are obtained from the slope fitted to the data without resorting to individual observations.

Personality and the Alpha Rhythm

Since human electroencephalography was first introduced by Berger in 1929, there have been many attempts to correlate the alpha rhythm with various aspects of personality. Lemere (1936) first reported a relationship between “good” and “poor” alpha rhythms and cyclothymic and schizoid personalities respectively. Gottlober (1938) found a correlation between a high alpha index (per cent. time alpha) and extraversion. However, Henry and Knott (1941) pointed out that the group studied by Gottlober was loaded both with high alpha indices and extraverts, and with additional data were unable to find a significant relationship between extraversion-introversion and alpha index.