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Objective: To identify barriers or facilitators that influenced mothers to provide mother's own milk (MOM) for 6 months to their infants who were hospitalized in the NICU after major surgery., Design: Descriptive qualitative., Setting: An 80-bed, Level 4 NICU of a regional pediatric hospital in the western United States., Participants: Fourteen mothers who provided MOM for their infants who required surgery within 1 week of age., Methods: We conducted in-person interviews upon admission and discharge of the infant, phone interviews 1 and 2 weeks after discharge, and phone interviews monthly for 6 months or until discontinuance of the provision of MOM. We analyzed interviews using the Brooks thematic template analysis method., Results: Eleven infants received exclusive MOM at discharge, and nine infants remained on exclusive MOM at 6 months. We generated four principal themes from the participants' comments: Value of Breast Milk, Challenges of Providing MOM, Emotional Fluctuation, and Coping With Reality of Circumstances., Conclusion: Internalizing the value of MOM, family support, and coping with barriers were key factors that influenced participants to provide MOM for at least 4 months. Findings of this study suggest that prenatal education with anticipatory guidance and lactation support in the NICU can help mothers achieve the goal of extended provision of MOM to infants with serious conditions that require surgery. Education and support may be especially helpful for young, first-time mothers., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2024 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: To test a predictive model of the associations among prepregnancy body mass index (BMI), third-trimester biological and behavioral variables, and symptoms of depression at 4 weeks postpartum., Design: Secondary data analysis from a longitudinal, biobehavioral repeated-measures study of women during the third trimester of pregnancy through 6 months postpartum., Setting: Communities surrounding a Midwestern and a Western U.S. city., Participants: Participants were 111 women enrolled during their third trimesters of pregnancy who were studied through 4 weeks postpartum., Methods: Whole blood and saliva were used for biological measures, and validated questionnaires were used for behavioral measures. Principal component analysis and path analysis with principal component variables were used to iteratively test the model., Results: There were three statistically significant direct effects in the model: the path from prepregnancy BMI to inflammation, the path from prepregnancy BMI to stress, and the path from stress to symptoms of depression at 4 weeks postpartum. Indirect effects of prepregnancy BMI on postpartum depression through intervening variables were not statistically significant, nor was the model-based total effect of prepregnancy BMI on postpartum depression., Conclusion: Stress was significantly linked to prepregnancy BMI and postpartum depression. This finding highlights continuing possibilities for improving outcomes for mothers, infants, and families through stress-mitigating preventive strategies., (Copyright © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background: ALK-negative anaplastic large cell lymphoma associated with breast implant (i-ALCL) has been recently recognized as a distinct entity. Among 43 830 lymphomas registered in the French Lymphopath network since 2010, 300 breast lymphomas comprising 25 peripheral T-cell lymphomas (PTCL) were reviewed. Among PTCL, ALK-negative ALCL was the most frequent and all of them were associated with breast implants., Patients and Methods: Since 2010, all i-ALCL cases were collected from different institutions through Lymphopath. Immuno-morphologic features, molecular data and clinical outcome of 19 i-ALCLs have been retrospectively analyzed., Results: The median age of the patients was 61 years and the median length between breast implant and i-ALCL was 9 years. Most implants were silicone-filled and textured. Implant removal was performed in 17 out of 19 patients with additional treatment based on mostly CHOP or CHOP-like chemotherapy regimens (n = 10/19) or irradiation (n = 1/19). CHOP alone or ABVD following radiation without implant removal have been given in two patients. The two clinical presentations, i.e. effusion and less frequently tumor mass correlated with distinct histopathologic features: in situ i-ALCL (anaplastic cell proliferation confined to the fibrous capsule) and infiltrative i-ALCL (pleomorphic cells massively infiltrating adjacent tissue with eosinophils and sometimes Reed-Sternberg-like cells mimicking Hodgkin lymphoma). Malignant cells were CD30-positive, showed a variable staining for EMA and were ALK negative. Most cases had a cytotoxic T-cell immunophenotype with variable T-cell antigen loss and pSTAT3 nuclear expression. T-cell receptor genes were clonally rearranged in 13 out of 13 tested cases. After 18 months of median follow-up, the 2-year overall survival for in situ and infiltrative i-ALCL was 100% and 52.5%, respectively., Conclusions: In situ i-ALCLs have an indolent clinical course and generally remain free of disease after implant removal. However, infiltrative i-ALCLs could have a more aggressive clinical course that might require additional therapy to implant removal., (© The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To determine whether kangaroo holding of healthy preterm infants over the first eight weeks of an infant's life facilitates co-regulation of salivary cortisol between mother and infant., Study Design: Randomized control trial. Infants were assigned to receive 1h of daily kangaroo (skin-to-skin contact on the chest of mother) or blanket holding (dressed and held in mother's arms). A registered nurse visited mothers weekly for eight weeks to encourage holding and provide information about infant development. A control group had no holding restrictions and received weekly brief social visits., Subjects: The study included 79 preterm infants, born between 32 and 35weeks gestational age and were a mean of 15days (±5.7) at enrollment., Outcome Measures: Co-regulation was conceptualized as progressive reduction in the absolute difference between mother and infant cortisol levels across 60min of holding at each holding session. Mother and infant cortisol levels were measured before holding and at 30 and 60min after holding began during three holding sessions (baseline and at two and eight weeks after study initiation). Primary analyses were conducted using hierarchical linear models., Results: There was much variability in cortisol levels. Levels of mother and infant cortisol decreased during holding. No significant co-regulation occurred in any group at any holding session or over time., Conclusions: Decreasing level of cortisol in both mothers and infants suggests that holding promoted the expected decline in stress hormone levels. However, supported holding methods did not differentially affect co-regulation compared to controls. Holding is pleasurable and stress may need to be present in order for mothers and infants to demonstrate co-regulation in cortisol levels., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To examine whether a supportive nursing intervention that promoted kangaroo holding of healthy preterm infants by their mothers during the early weeks of the infant's life facilitated coregulation between mother and infant at 6 months of age., Design: Randomized controlled trial., Participants: Sixty-five mother/infant dyads with mean gestational age at birth of 33 weeks. Fifty percent of infants were male, and 50% were non-White., Interventions: An 8-week home intervention encouraged daily 1-hour, uninterrupted holding with either blanket (baby wrapped in blanket and held in mother's arms) or the kangaroo (baby in skin-to-skin contact on mother's chest) method. In both conditions, weekly home visits by an experienced RN included encouragement to hold the infant, emotional support, and information about infant behavior and development. A control group received brief social visits, had no holding constraints, and participated in all assessments., Main Outcome Measures: When infants were 6 months of age, the Still-Face Paradigm was used to assess mother/infant interaction. Outcome measures were coregulation of the dyad's responses during the play episodes of the Still-Face Paradigm and vitality in infant efforts to reengage the mother during the neutral face portion of the Still-Face Procedure., Results: Significant differences among groups were found in mother/infant coregulation. Post hoc analysis showed that dyads who were supported in kangaroo holding displayed more coregulation behavior during play than dyads in the blanket-holding group. No differences were found between groups in infant vitality during the neutral face portion of the Still-Face Procedure., Conclusion: Dyads supported in practicing kangaroo holding in the early weeks of life may develop more coregulated interactional strategies than other dyads.

Background and Aims: The increased use of salivary cortisol as a biomarker of stress and/or diurnal rhythms has facilitated research of Hypothalamic-pituitary-adrenocortical (HPA)function. Saliva collection remains problematic with preterm infants. The twofold purpose of this study is to 1) establish validity of the filter paper method for saliva collection and 2) apply the filter paper method for saliva collection to preterm infants., Design and Measures: Whole saliva was collected from six normal adult subjects to create a pool. Validation measures included comparison of levels obtained from whole saliva and filter paper, an evaluation of storage effects, assessing spiking recovery, and measurement of linearity of dilution. In the application study, saliva was collected every three hours, before feedings for three consecutive days from 26 hospitalized preterm infants. Diurnal variation in cortisol was examined using hierarchical linear modeling and individual calculation of diurnal pattern using an accepted technique., Results: Validation studies revealed acceptable recovery of whole saliva from filters, no effect of room temperature storage of filters for up to six months, and acceptable linearity of dilution up to 4. Saliva from preterm infants was easily collected. Only 2% of the samples were lost due to inadequate wetting of the filters. An inverse association was found between postconceptional age and one-minute APGAR scores and infant cortisol levels. Variable daily cortisol patterns and no discernable rhythm were found for this sample; however, four infants appeared to show atypical diurnal pattern., Conclusions: The filter paper method is a valid method of saliva collection that is feasible to use with preterm infants.

Based on a consecutive series of 70 hearing patients with unilateral acoustic neurinomas and intraoperative monitoring of brain-stem auditory evoked potentials (BAEP), 4 dynamic BAEP patterns could be characterized. These patterns correspond with early and late postoperative hearing outcome. All patients with stable wave V (pattern 1) showed definite hearing preservation, all patients with irreversible abrupt loss of BAEP (pattern 2) lost their hearing, despite early hearing preservation in two cases. All patients with irreversible progressive loss of either wave I or wave V (pattern 3) eventually suffered from definite postoperative hearing loss, despite early hearing preservation in two cases. Those cases with intraoperative reversible loss of BAEP (pattern 4) showed variable short and long term hearing outcome. In 34% hearing was preserved, 44% suffered from postoperative hearing loss, the remaining 22% showed postoperative hearing fluctuation, either as a delayed hearing loss or as reversible hearing loss. Postoperative hearing fluctuation indicates anatomical and functional preservation of the cochlear nerve during surgery and is suggestive of a pathophysiological mechanism initiated during the surgical procedure and continuing thereafter. Patients at risk for delayed hearing loss can be identified during surgery by a characteristic BAEP pattern and may benefit from vasoactive treatment.

Objective: To explore parents' perception of skin-to-skin care with their preterm infant who is on assisted ventilation, and to elucidate factors influencing the decision to continue or discontinue skin-to-skin care., Design: Naturalistic inquiry, using open-ended, transcribed and audiotaped face-to-face and telephone interviews., Setting: Tertiary neonatal care setting and homes of parents., Participants: Eight mothers and one father who participated in skin-to-skin care., Interventions: Two 60-minute skin-to-skin care sessions., Results: Three themes emerged: (a) ambivalence of parents toward skin-to-skin care, including subthemes of yearning to hold the infant and apprehension to do so; (b) need of a supportive environment; and (c) special quality of the parent-infant interaction, including subthemes of intense connectedness and active parenting. Perceptions of apprehension, need for a supportive environment, and active parenting differed between parents who continued skin-to-skin care during their infants' hospitalization and parents who did not. Three of the four parents who discontinued skin-to-skin care in the hospital resumed when their infants were home., Conclusions: Differences in narratives of parents highlighted the importance of individualizing the skin-to-skin experience to the needs of parent and infant. Parents who resumed skin-to-skin care at home valued the experience while their infant was hospitalized but needed intervention to alleviate their apprehension, enhance their feeling of autonomy, and modify the environment.

Ligand-induced conformational change in transferrins has been studied by site-directed mutagenesis of human serum half molecule (N-lobe), X-ray absorption fine structure (XAFS) spectroscopy and X-ray solution scattering. Use of recent advances in data analysis has been made for extracting model-independent molecular shapes from X-ray solution scattering data for the intact, the half molecule and its mutants. Clear evidence is provided that the transferrin molecule (intact as well as N-lobe), in its apo and holo forms, exists for the majority of the time in well-defined specific conformations representing the "fully opened" and "closed" states of the molecule, respectively. Evidence is also provided for the existence of an additional conformation, referred to here as the "intermediate" conformation for simplicity, which is trapped in the case of some of the mutants in the iron-bound form. We suggest that domain closure in the transferrin molecule is a two-step process, with the intermediate conformation representing the first stage of domain closure (approximately 20 degrees hinge-twist of domain II). Our data are not inconsistent with the ligand-free molecule sampling the closed states occasionally (< or = 10%) but are not in support of a continuous conformational search between the fully opened and closed states in the absence of iron.

Organ perfusion is one of the possible strategies to attenuate rejection of discordant xenografts by reducing the levels of the recipient's xenoreactive natural antibodies (XNA). Its efficacy in terms of XNA removal was studied in models of primate blood or plasma perfusion through porcine kidneys or livers, with special attention to haematological consequences and potential side-effects. We first perfused the blood of rhesus monkeys through pig kidneys and livers, and demonstrated that the perfusion of a pig liver resulted in higher XNA adsorption (72 +/- 13%) than the perfusion of a pig kidney (51 +/- 25%). However, when we normalized for the weight of the perfused organs and for levels of natural antibodies in individual monkeys, livers adsorbed less antibody (1.4 +/- 0.9 U antibody/g) than kidneys (7.2 +/- 7 U antibody/g). Histological signs of rejection were observed in perfused kidneys, but not in perfused livers. A major drawback of the perfusion of blood through livers was a considerable decrease in the primates' haemoglobin and platelet levels. To avoid this, we developed a plasma liver perfusion device. This method allowed a significant improvement in the haemodynamic state of primates and was particularly effective in preventing anaemia. Moreover, plasma liver perfusion was as effective as blood liver perfusion to remove natural antibodies and, resulted in a marked decrease in their functional activity as assessed by complement-dependent cytotoxicity (CDC) and antibody-dependent cell-mediated cytotoxicity (ADCC). The level of other plasma proteins was not significantly affected, apart from a dilution effect. After xenoperfusion a strong antibody response was evidenced by ELISA, CDC and ADCC between days 7 and 14 and then decreased progressively. We conclude that the separation of blood to allow the perfusion of plasma through a pig organ is safer than the perfusion of unseparated blood and is associated with efficient natural antibody removal. However, organ perfusion is limited by a rebound in antibody levels after a few days, and thus will have to be associated with anti-B cell immunosuppressive therapy for long-term or repeated applications.

Recent X-ray crystallographic and solution X-ray scattering studies have shown that transferrins (serum transferrin, lactoferrin and ovotransferrin) undergo a major conformational change when iron is incorporated into the molecule. Apo-proteins show a structure with open interdomain clefts which close when iron is bound. The closed conformation has been suggested as an important step in the receptor recognition. Here, we report X-ray solution scattering experiments of the mutated N-terminal fragment of human serum transferrin with Asp63-->Ser (Cys). The data provide the first direct experimental evidence for the existence of a trigger mechanism for the closure of the interdomain cleft and that this trigger mechanism is disrupted by mutation of Asp63, the only ligand of iron from domain I.

Recent studies on iron-loaded transferrins have revealed a conformational change upon binding iron due to a domain closure. It has been suggested that the domain closure may be the key for the receptor recognition of the metal loaded transferrin (Grossmann et al., 1992). Small angle X-ray scattering has been used to provide direct structural information on the conformational changes that may take place upon the binding and release of different metals to the transferrins in solution. The data show that In3+ and Cu2+ induce the same domain closure as Fe3+; Al3+ causes a conformational change of somewhat smaller magnitude while Hf4+ does not induce any conformational change. The results are discussed in terms of the molecular recognition of metal loaded transferrin by the receptor.

X-ray solution scattering has been used for studying the structural changes that take place upon uptake and release of iron from serum and chicken ovo-transferrin and human lactoferrin. In the case of chicken ovo-transferrin, data have been obtained for both the intact protein and the isolated N and C-lobes with and without iron. These studies reveal that both lobes undergo a change that is consistent with an opening of the inter-domain cleft when iron is removed from the protein. We suggest that the conformational change of the protein increases the specificity of receptor binding and that the closed configuration of the iron-loaded protein is one, or perhaps the, decisive step in the mechanism for receptor-mediated endocytosis.