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We investigated the secular trends of the incidence and hospitalization cost of hip fracture in Tangshan, China. The incidence of hip fracture and the hospitalization cost were both increasing during the observation period. The present study aimed to determine sex-, age-, and fracture type-specific incidence and annual changes in hip fractures in Tangshan, China, between 2007 and 2018. We analyzed annual hip fracture incidence using urban hospital data during 2007–2018 and calculated incidence rate/100,000 person years in each age group and sex. We assessed annual changes in incidence among people aged >60 years using linear-by-linear association tests and evaluated hospitalization costs with the Kruskal–Wallis test. During the study period, we observed an increasing proportion of hip fractures in people >60 years old from 14.2 to 22.79%. Crude hip fracture incidence increased markedly from 140.87 to 306.56/100,000 in women (p 60 years. Type-specific analysis indicated significantly increased trends in incidence of cervical and trochanteric fractures among women and cervical fracture among men (p < 0.01). In people aged 36–60 years, the trend of hip fracture increased significantly in both sexes. The total and cervical-to-trochanteric ratio in men increased, with significant upward trends (p < 0.01). The proportion of cervical fracture was higher than that for trochanteric fracture in women, with stable levels from 2007 to 2018. Hospitalization costs for cervical and trochanteric fractures increased by 51.91% and 53.20%, respectively, during 2011–2018. Tangshan will have an increasing burden on health care resources attributable to a considerable rise in hip fracture incidence and the older population. Further investigation of risk factors and subsequent implementation of effective measures to prevent hip fracture are needed.

Since its launch, in December 2015, the satellite-based DAMPE (DArk Matter Particle Explorer) particle detector is taking data smoothly. The Silicon-Tungsten tracKer-converter (STK) of DAMPE consists of six tracking planes (6x, 6y) of single-sided silicon micro-strip detectors mounted on seven support trays. The STK is able to measure the charge and precisely reconstruct the track of traversing charged particles. Tungsten plates (1 mm thick) are integrated in the second, third and fourth tray from the top to serve as $\gamma \rightarrow e^+e^−$ converters. Commissioned rapidly after the launch, the STK is running extremely well since then. The STK in-orbit calibration and performance during its first more than 5 years of operation, including the noise behaviour and the thermal and mechanical stability, are presented in this contribution.

The DArk Matter Particle Explorer (DAMPE) is the first Chinese cosmic-ray direct detection experiment. It has been operating smoothly on-orbit since its successful launch at the end of 2015. Currently, its sub-detectors and the satellite are in good working order. The DAMPE payload employs a BGO Calorimeter for energy measurements, trigger and e/p identification. The calorimeter is constructed of 308 BGO crystals, and PMTs are coupled to the crystals with optical filters to readout scintillation light. In this work, we present the status and performance of the calorimeter, including status of detector units, energy measurement, especially in TeV range, detector endurance, and long term performance in a duration of 65 months.

The focal plane camera is the core component of the Wide Field-of-view Cherenkov/fluorescence Telescope Array (WFCTA) of the Large High-Altitude Air Shower Observatory (LHAASO). Because of the capability of working under moonlight without aging, silicon photomultipliers (SiPM) have been proven to be not only an alternative but also an improvement to conventional photomultiplier tubes (PMT) in this application. Eighteen SiPM-based cameras with square light funnels have been built for WFCTA. The telescopes have collected more than 100 million cosmic ray events and preliminary results indicate that these cameras are capable of working under moonlight. The characteristics of the light funnels and SiPMs pose challenges (e.g. dynamic range, dark count rate, assembly techniques). In this paper, we present the design features, manufacturing techniques and performances of these cameras. Finally, the test facilities, the test methods and results of SiPMs in the cameras are reported here., Comment: 45 pages, 21 figures, article

The main scientific goal of the LHAASO WFCTA experiment is to measure the cosmic ray energy spectra and composition from 10 TeV to 1 EeV. Cherenkov photons in the extensive air shower measured by the SiPM camera of Cherenkov telescopes can be used to reconstruct the cosmic ray energy. The absolute calibration of the camera is a crucial step to achieve the accurate measurement of the cosmic ray energy spectrum. A multi-wavelength cylindrical illuminator based on LEDs is developed and mounted inside the telescope to calibrate and monitor the camera, and the illuminator’s stability is better than 0.5% under the temperature variation from -26 to 26 ° C. A portable probe with a single photoelectron resolution of 21.6% is developed. After calibration by National Institute of Metrology, China (NIM), the probe is taken to the LHAASO site to measure the absolute photon density of the cylindrical illuminator inside the telescope. Based on the illuminator with known photon density, the photon conversion factor of the camera can be calibrated, and the overall calibration uncertainty is less than 2.6%.

The LHAASO-WFCTA experiment, which aims to observe cosmic rays in the sub-EeV range using the fluorescence technique, uses a new generation of high-performance telescopes. To ensure that the experiment has excellent detection capability associated with the measurement of the energy spectrum, the primary composition of cosmic rays, and so on, an accurate geometrical reconstruction of air-shower events is fundamental. This paper describes the development and testing of geometrical reconstruction for stereo viewed events using the WFCTA (Wide Field of view Cherenkov/Fluorescence Telescope Array) detectors. Two approaches, which take full advantage of the WFCTA detectors, are investigated. One is the stereo-angular method, which uses the pointing of triggered SiPMs in the shower trajectory, and the other is the stereo-timing method, which uses the triggering time of the fired SiPMs. The results show that both methods have good geometrical resolution; the resolution of the stereo-timing method is slightly better than the stereo-angular method because the resolution of the latter is slightly limited by the shower track length.

As the comparative pathophysiology of perinatal infection in the fetus and newborn is uncertain, this study contrasted the cerebral effects of endotoxemia in conscious fetal sheep and newborn lambs. Responses to intravenous bacterial endotoxin (lipopolysaccharide, LPS) or normal saline were studied on three consecutive days in fetal sheep (LPS 1 μg/kg, n = 5; normal saline n = 5) and newborn lambs (LPS 2 μg/kg, n = 10; normal saline n = 5). Cerebro‐vascular function was assessed by monitoring cerebral blood flow (CBF) and cerebral vascular resistance (CVR) over 12 h each day, and inflammatory responses were assessed by plasma TNF alpha (TNF‐α), nitrate and nitrite concentrations. Brain injury was quantified by counting both resting and active macrophages in the caudate nucleus and periventricular white matter (PVWM). An acute cerebral vasoconstriction (within 1 h of LPS injection) occurred in both the fetus (ΔCVR +53%) and newborn (ΔCVR +63%); subsequently prolonged cerebral vasodilatation occurred in the fetus (ΔCVR −33%) in association with double plasma nitrate/nitrite concentrations, but not in the newborn. Abundant infiltration of activated macrophages was observed in both CN and PVWM at each age, with the extent being 2–3 times greater in the fetus (P

In the Large High Altitude Air Shower Observatory (LHAASO), the main physics objective of the water Cherenkov detector array (WCDA) is to survey the sky for gamma-ray sources in the energy range of 100 GeV to 30 TeV. In order to extend the dynamic range of the WCDA, a 1.5-inch photomultiplier tube (PMT) is placed aside the 8-inch PMT in each cell of the WCDA. All of these 1.5-inch PMTs (900 in total) consist of the WCDA dynamic extended system (WCDA++). These PMTs are required to maintain linearity within four orders of magnitude. The performance of the 1.5-inch PMTs with a specially designed bi-readout voltage divider is tested with a PMT test system. Accordingly, the effects of the working high voltage and signal width on the dynamic range of the PMTs are studied. The test results show that the dynamic range with a 5% non-linearity for a driven signal width of 5.5 ns is more than 200 kPEs (photoelectrons). The dark noise count rate is less than 200 Hz for a 1 mV threshold at a PMT gain of 2 × 1 0 5 . These results confirm that the PMT performance meets the WCDA++ requirements.

Thomsen-Friedenreich (TF) antigen belongs to the mucin-type tumor-associated carbohydrate antigen. Notably, TF antigen is overexpressed in colorectal cancer (CRC) but is rarely expressed in normal colonic tissue. Increased TF antigen expression is associated with tumor invasion and metastasis. In this study, we sought to validate a novel nanobeacon for imaging TF-associated CRC in a preclinical animal model. We developed and characterized the nanobeacon for use with fluorescence colonoscopy. In vivo imaging was performed on an orthotopic rat model of CRC. Both white light and fluorescence colonoscopy methods were utilized to establish the ratio-imaging index for the probe. The nanobeacon exhibited specificity for TF-associated cancer. Fluorescence colonoscopy using the probe can detect lesions at the stage which is not readily confirmed by conventional visualization methods. Further, the probe can report the dynamic change of TF expression as tumor regresses during chemotherapy. Data from this study suggests that fluorescence colonoscopy can improve early CRC detection. Supplemented by the established ratio-imaging index, the probe can be used not only for early detection, but also for reporting tumor response during chemotherapy. Furthermore, since the data obtained through in vivo imaging confirmed that the probe was not absorbed by the colonic mucosa, no registered toxicity is associated with this nanobeacon. Taken together, these data demonstrate the potential of this novel probe for imaging TF antigen as a biomarker for the early detection and prediction of the progression of CRC at the molecular level.

Conducting surveys on the status quo of sea area resources, figuring out the basic information about endowment of sea area resources, constructing an accounting standard system for sea area resource assets - value and establishing a physical account and a value account for sea area resource reserve are the foundation for sea area price evaluation and necessary conditions for the perfection of natural resource asset property rights system. This paper analyzes the survey on the status quo of sea area resources in China and the status quo of resource account and value account, brings up a problem that surveys and accountings of sea area resources cannot meet the management requirements of paid utilization of sea area and offers specific suggestions such as carrying out surveys on the space resources of sea area, evaluating the value of resources.

A new experimental method for determining elastic constants of thin films is proposed. The curvatures of the single crystal substrates before and after depositing thin film are first measured using high-resolution X-ray rocking curve technique with high quality monochromatic and high intensity synchrotron radiation. The residual stress in the film is then calculated from the change in substrate curvature based on the well-known modified Stoney's equation. The formulae for calculating thin film's Young's modulus and Poisson's ratio are deduced based on measured residual stress and the lattice spacing dψ versus sin2ψ curves of the film before and after an unknown mechanical loading. LaNiO3 film grown on single crystal silicon substrate using pulsed laser deposition is employed to demonstrate the measurement method.

SUMMARY The pattern of growth of 235 very low-birthweight children, whose weights were appropriate for gestational age, was characterised by a significant decline in weight, length and head circumference from birth to discharge from hospital, followed by partial recovery in all three measures of growth by two years corrected age. 29 per cent of the children were below the 10th percentile for weight at two years, and this group had a significantly higher incidence of major disabilities, poorer muscular development, more hypotonia and lowered performance on the psychomotor index of the Bayley Scales of Infant Development than their heavier peers. These children's mothers more often perceived them as actively disliking close physical contact, and they were reported by their mothers to have had more infections, minor surgery and chronic otitis media. Taken together, the suboptimal weight-gain, delayed gross motor development and increased maternal perceptions of ‘sickliness’ and lack of ‘cuddliness’ in these children are reminiscent of non-organic failure to thrive. RESUME Sequelles de defauts de croissance chez les enfants de tres faible poids de naissance avec poids normal pour l'âge de gestation L'allure de la croissance de 235 prematures de tres faible poids de naissance, avec poids normal pour l'âge de gestation a ete marquee par une chute significative pour le poids, la longueur et le tour de tete, depuis la naissance jusqu'au depart de l'hopital avec une recuperation partielle pour les trois mesures de croissance a deux ans d'âge corrige. 29 pour cent des enfants etaient en dessous du dixieme percentile pour le poids a deux ans et ce groupe presentait une incidence significativement plus elevee d'incapacites majeures, de developpement musculaire mediocre, une hypotonie plus marquee et des performances moindres a l'index psychomoteur de l'echelle de developpement infantile de Bayley que des enfants de poids plus lourd. Les meres de ces enfants les percevaient plus souvent comme rejetant activement le contact physique rapproche et egalement aux dires de leurs meres, ils avaient plus souvent des infections, des besoins de chirurgie mineure et des otites moyennes chroniques. Consideres tout ensemble, ce gain de poids sous-optimal, le retard global du developpement moteur et l'accroissement des perceptions maternelles d'etat maladif et ce rejet du contact chez tous ces enfants rappellent les defauts de croissance non organiques. ZUSAMMENFASSUNG Folgen einer Wachstumsverzogerung fur die Entwicklung bei Kindern mit sehr niedrigem Geburtsgewicht, deren Gewicht aber dem Gestationsalter entsprach Der Wachstumsverlauf von 235 Kindern mit sehr niedrigem Geburtsgewicht, das dem Gestationsalter entsprach, war charakterisiert durch einen signifikanten Abfall in Gewicht, Kopfumfang und Lange von der Geburt bis zur Entlassung aus dem Krankenhaus; gefolgt von einer teilweisen Erholung aller drei Wachstumsparameter bis zum korrigierten Alter von zwei Jahren. 29 Prozent der Kinder mit zwei Jahren lageru mit ihrem Gewicht unter der 10. Perzentile und diese Gruppe hatte signifikant haufiger schwere Behinderungen, schlechtere Muskelentwicklung, Hypotonie und schlechtere Leistungen im psychomotorischen Bereich der Bayley Scales of Infant Development als die schwereren Kinder aus der Gruppe. Die Mutter dieser Kinder gaben an, das sie engem Korperkontakt widerstrebten, das sie haufiger Infektionen, kleinere chirurgische Eingriffe und chronische Mittelohrentzundungen hatten. Zusammengenommen sind die nicht optimale Gewichtszunahme, die verzogerte grobmotorische Entwicklung und die Angaben der Mutter uber haufiges Krankeln und fehlende Anschmiegsamkeit dieser Kinder Zeichen einer nicht-organischen Wachstumsverzogerung.

SUMMARY A three-year cohort of extremely low-birthweight (ELBW, >1000g) survivors born between 1st January 1979 and 31st December 1981 were followed prospectively at one, two and five years of age, corrected for preterm birth. 57 of 110 infants survived, and 53 children were still alive at five years. The diagnoses of cerebral palsy, blindness, deafness and developmental delay fluctuated markedly according to age at developmental assessment. Although 13 of the 53 children were found to have impairments at five years, only seven were identified at one year, while 17 were identified at two years. In relation to the five-year assessment, impairments were underestimated at one year and developmental delay was overestimated at two years, which suggests that valid and reliable estimation of adverse neurodevelopmental sequelae among ELBW survivors may not be possible until school-age. ReSUMe Devenir neurodeveloppemental, croissance et sante de survivants avec poids de naissance extremement faible: a partir de quand peut on etablir un pronostic? Un groupe de survivants de poids de naissance extremement faible (PNEF > 1000g) sur trois ans, nes entre le ler Janvier 1979 et le 31 Decembre 1981 ont ete suivis prospectivement a un, deux et cinq ans d'âge corrige apres naissance prematuree. 57 des 110 nourrissons survecurent, et 53 enfants etaient toujours vivants a l'âge de cinq ans. L'incidence de l'infirmite motrice cerebrale, de la cecite, de la surdite et des retards de developpement etaient tres variables selon l'âge d'appreciation du developpement. Bien que 13 des 53 enfants aient ete trouves avec des alterations a cinq ans, seulement sept etaient identifies a un an, 17 a deux ans. En relation avec l'appreciation a cinq ans, les troubles etaient sous-estimes a un an et le retard de developpement sur-estime a deux ans ce qui suggere qu'une estimation valable et fidele des sequelles neurodeveloppementales parmi les survivants PNEF n'est pas possible avant l'âge scolaire. ZUSSAMENFASSUNG Entwicklungsneuroligischer Outcome, Wachstum und Gesundheit bei uberlebenden Kindern mit extrem niedrigem Geburtsgewicht: wie fruh ist eine Beurteilung moglich? Eine Gruppe von uberlebenden Kindern mit extrem niedrigem Geburtsgewicht (ELBW > 1000g), die vom 1. Januar 1979 bis zum 31. Dezember 1981 geboren wurden, wurden prospektiv im korrigierten Alter von einem, zwei und funf Jahren untersucht. 57 von 110 Kindern uberlebten und 53 lebten noch mit funf Jahren. Die Haufigkeit von Cerebralparese, Blindheit, Taubheit und Entwicklungsverzogerung schwankte erheblich in den verschiedenen Altersstufen. Obwohl 13 der 53 Kinder mit funf Jahren auffallige Befunde zeigten, waren diese nur bei sieben Kindern im Alter von einem Jahr bereits festgestellt worden, wahrend mit zwei Jahren 17 Kinder aufgefallen waren. Bezogen auf den Kontrollzeitraum von funf Jahren fand sich, daβ mit einem Jahr die Storungen unterschatzt und mit zwei Jahren die Entwicklungsverzogerungen uberbewertet wurden. Diese Befunde zeigen, daβ verwertbare und verlaβliche Beurteilungen der entwicklungsneuroligischen Folgen bei ELBW Kindern erst im Schulalter moglich sind. RESUMEN Curso neuroevolutivo, crecimiento y salud de supervivientes con un peso al nacer extremadamente bajo. ?Con que precocidad puede vaticinarse? Un grupo de tres anos de edad, nacidos con un peso extremadamente bajo (PNEB de menos de 1000g), supervivientes y nacidos entre el primero de Enero de 1979 y el 31 de Diciembre de 1981 fueron seguidos prospectivamente a las edades de uno, dos y cinco anos corregidos. 57 de 110 lactantes sobrevivieron y 53 ninos aun vivian a los cinco anos. Las incidencias de paralisis cerebral, ceguera, sordera y retraso en el desarrollo fluctuaron marcadamente segun la edad en que se determino la evaluacion del desarrollo. Aunque se hallo que 13 de los 53 ninos tenian dificultades a los cinco anos solo siete fueron identificados en la evaluacion de los cinco anos, mientras que 17 fueron identificados a los dos anos. En relacion con la evaluacion de los cinco aflos, las dificultades fueron subestimadas al ano de edad, y el retraso en el desarrollo fue superestimado a los dos anos. Esto sugiere que una evaluacion valida y fiable de las secuelas adversas neuroevolutivas en ninos con PNMB no puede ser posible hasta la edad escolar.

Fifty (13%) of 375 infants who weighed 1500 g or less at birth had necrotizing enterocolitis (NEC). Haematological changes suggestive of sepsis occurred in 83% and positive bacteriological cultures were found in 38%, the most common organism isolated being Clostridium perfringens. Complications included intestinal perforation in six patients and recurrence of NEC in five, of whom one subsequently developed an intestinal stricture. Five of the eight nursery deaths were secondary to peritonitis and overwhelming sepsis from NEC. In spite of the discontinuation of milk feeds for prolonged periods, satisfactory caloric intake and weight gain were achieved with parenteral nutrition in the survivors. Of the 41 long‐term survivors, six (15%) were found to have a disability at 2 years of ago, corrected for prematurity, compared with 48 (20%) of 241 very low birthweight survivors from the same study period who did not have NEC. None had evidence of gastrointestinal dysfunction. Six (15%) children remained below the 10th percentile for both weight and height. This study showed that early diagnosis and therapy for NEC in very tow birthweight infants were associated with a favourable short‐ and long‐term outcome.

A new method to measure the piezoelectric constants of d33f and d31f of thin films using x-ray diffraction (XRD) is proposed. Piezoelectric constant d33f is calculated from the measurement of change in out-of-plane lattice spacing of the piezoelectric films while piezoelectric constant d31f is obtained from the change in the slope of d ψ versus sin2 ψ curves before and after applying an electric field over the film. This method improves the accuracy by directly measuring the strains in the films induced by the externally applied electric field instead of the surface displacement that could easily be interfered with by environment/vibration and surface morphology of the thin films.

This paper presents a data-hiding scheme, which hides the secret data in VQ compressed images using multiple codebooks. The secret data are hidden in the codebook indices after the VQ image compression is completed. The secret data can be extracted from the codebook indices when the decoding of the compressed image is performed. According to the experimental results, the hiding capacity and image quality outperform Jo and Kim's scheme. In other words, the proposed scheme is proved to be capable of supporting high hiding capacity and good image quality.

A new experimental method for determining the x-ray elastic constants (S1 and (1/2)S2) of thin films is proposed. The curvatures of the single-crystal substrates before and after depositing thin films are first measured using a high-resolution x-ray rocking curve technique with high-quality monochromatic and high-intensity synchrotron radiation. The residual stresses in the films are then calculated from the change in substrate curvature based on the well-known modified Stoney's equation. The formulae for calculation of S1 and (1/2)S2 are deduced based on measured residual stress and the lattice spacing dψ versus sin2ψ curves before and after a mechanical loading, while the magnitude of the external loading does not need to be known. Values of (1/2)S2 of films can even be obtained without loading. Pb(Zr0.52Ti0.48) and LaNiO3 films grown on a single-crystal silicon substrate using pulsed laser deposition are employed to demonstrate the measurement method.

Regionalized perinatal care was first advocated in Canada 35 years ago. Its development in the United States of America (from 1971), United Kingdom (from 1972) and Australia (from 1978), has been described. In all instances, the efforts and perseverance of visionary individuals were crucial in introducing the concepts to the medical profession, and in bringing the principles to national consciousness at a governmental level. Official endorsement of regionalized perinatal care by both the national professional bodies and the central and regional governments was necessary. An important milestone along the path of regionalized perinatal care was the establishment of national training programmes, and the recognition of maternal-fetal medicine and neonatal-perinatal medicine as respective subspecialties for obstetricians and paediatricians. The developmental process requires close collaboration among all three groups (individuals, professional bodies and government) to improve both the quality and availability of perinatal services to a geographically defined region.

The present review examines the role of dietary nucleotides in infants, and the scientific rationale and benefits of nucleotide supplementation of infant formula. The immunoprotective benefits of human milk, the biology of human milk nucleotides, and the immunological and gastrointestinal effects of dietary nucleotides in animal studies and in vitro experiments are examined. Clinical studies are reviewed, especially those examining the efficacy of nucleotide-supplemented infant formula in enhancing immunity and reducing the risk of sepsis. The presence of human milk cells, and a variety of immunoactive and trophic components of human milk, can explain the reduced incidence of sepsis in breastfed term and preterm infants. Nucleotides, believed to play an immunomodulatory role, are found in lower concentrations in infant formula. Animal studies have shown that dietary nucleotides enhance a number of immune responses and the growth, differentiation and repair of the gut. Several clinical studies have reported beneficial effects of nucleotide supplementation on gut microflora, diarrhoea and immune function, and one study has reported better catch-up growth in term infants with severe intrauterine growth retardation. More basic research studying the metabolism of nucleotides in neonates is encouraged. Additional randomized controlled trials are necessary to demonstrate the clinical benefits of nucleotide supplementation of infant formula, as it cannot be presumed that nucleotides produce the same benefits for the infant as human milk. Studies are especially necessary in high-risk neonatal situations, such as extreme prematurity, significant suboptimal nutrient intake before and after birth, and recovery from gut injury.

In this study, binary CdSe and ternary Zn 0.5 Cd 0.5 Se quantum dots (QDs) with monochromatic light are blended with conventional phosphors and those monochromatic lights of Zn 0.5 Cd 0.5 Se QDs are also mixed together and then packaged as remote type. Besides, white light CdSe QD are used alone to fabricate white light-emitting diode (LED). We have demonstrated that the color rendering index (CRI) and luminous efficacy can be improved by blending conventional phosphors with QDs. The Zn 0.5 Cd 0.5 Se QDs incorporated with yellow phosphors have better device performance and optical properties. Zn 0.5 Cd 0.5 Se QDs with different emission wavelength are blended with each other. The result reveals that mixing ratios and photoluminescence efficiency (PLE) between different colors of QDs are important factors. When white CdSe QD is excited by ultraviolet LED (UV-LED) without mixing multi-colors of phosphor, high CRI can be obtained for CdSe-based white LED.

If metastasis of lung cancer can be found and treated early, a victim might have an improved chance to prevail over it, but routine examinations such as chest radiography, computed tomography and biopsy cannot characterize the metastatic potential of lung cancer cells; critical diagnoses to define optimal therapeutic strategies are thus lost. We designed a portable microfluidic device for the rapid diagnosis of cancer metastatic potential. Featuring a micro system to control temperature and a bicarbonate buffered environment, our device discriminates a rate of surface detachment as an index of the migratory ability of cells cultured on pH-responsive chitosan. We labeled metastatic subpopulations of lung cancer cell lines, and verified that our device is capable of separating cells according to their metastatic ability. As only few cells are needed, a patient's specimen from biopsies, e.g. from fine-needle aspiration, can be processed on site to offer immediate information to physicians. We expect that our design will provide valuable information in pre-operative evaluations to assist the definition of therapeutic plans for lung cancer, as well as for metastatic tumors of other types.

The effects of ion motion on the generation of short-cycle relativistic laser pulses during radiation pressure acceleration are investigated by analytical modeling and particle-in-cell simulations. Studies show that the rear part of the transmitted pulse modulated by ion motion is sharper compared with the case of the electron shutter only. In this study, the ions further modulate the short-cycle pulses transmitted. A 3.9 fs laser pulse with an intensity of $1.33\times 10^{21}\ {\rm W}\ {\rm cm}^{-2}$ is generated by properly controlling the motions of the electron and ion in the simulations. The short-cycle laser pulse source proposed can be applied in the generation of single attosecond pulses and electron acceleration in a small bubble regime.

Summary: A questionnaire survey of Australian neonatologists was conducted to ascertain their antenatal counselling and resuscitation practices, and attitudes towards life support in the extremely preterm infant. This study showed that in antenatal parental counselling, whether a paediatrician was given the opportunity to participate depends on the gestation at the time of the threatened preterm delivery. The counselling employed almost invariably covered mortality and morbidity. The obstetrician's opinion was considered to be of utmost importance. Both financial and moral obligations were found to be of little importance in counselling and resuscitation. Only one-third of institutions had guidelines for limiting resuscitation. The onus remained on the neonatologists concerning which infant to resuscitate, and the level of the resuscitation to be conducted. In Australia, resuscitation at birth was restricted to infants of 23 weeks' gestation or above, and neonatologists did not believe the legal system has a role to play in limiting or mandating resuscitation of extremely preterm infants. Neither were they concerned with the threat of litigation when they decide to limit resuscitation. The majority of neonatologists agreed with their institution's approach to life support in extremely preterm infants. One grey area was the question of withholding assisted feeding in an infant for which the decision to withdraw life support has been made. Australia lacked a current consensus policy on selective non-treatment. The establishment of national guidelines would be helpful to aid Australian obstetricians and neonatologists in their clinical practice.

In planning enteral feeding in the preterm infant, decisions need to be made regarding the feeding schedule, choice of milk, and the route of administration. Feeds should be commenced within a week after birth beginning with subnutritional quantities. Preterm human milk from the infant's own mother is the milk of choice. When full enteral feeding is established, supplementation with human milk fortifier is recommended. Donor human milk and preterm formula are alternatives. Early establishment of enteral nutrition and maintenance of optimal nutrition during infancy are important as dietary manipulations in preterm infants have potential long-term influences on their health, growth and neurodevelopment.

SUMMARY 1. In conscious rabbits, when alerting stimuli elicit vasoconstriction in the ear vascular bed, there is little or no associated change in cardiac output (CO), as measured by chronically implanted Doppler ultrasonic probes. 2. Local anaesthetic injected around the base of the ear substantially diminished the degree of the vasoconstriction elicited during responses. 3. Our results emphasize that selective cutaneous vasoconstriction, an integral part of the response to alerting stimuli in conscious animals, is part of a patterned redistribution of the CO, organized by the brain.

A combined Computational Fluid Dynamics (CFD)–Kirchoff method is presented for predicting high-speed impulsive noise generated by a rotor in hover. Two types of Kirchoff integral formulas are used: one of them is a classical linear Kirchoff formulation and the other a non-linear Kirchoff formulation. An Euler finite-difference solver is executed first, from which a flow field is obtained to be used as an input to the Kirchoff formulation to predict the acoustic far-field. The calculations are performed at Mach numbers of 0·90 and 0·95 to investigate the effectiveness of the linear and non-linear Kirchoff formulas for delocalized flow. During these calculations, the retarded time equation is also carefully examined, in particular, for the cases where a control surface is located outside the sonic cylinder, for which multiple roots are obtained. Predicted results of acoustic far-field with the linear Kirchoff formulation agree well with the experimental data when the control surface is at a particular location ( R cs / R =1·46), but the correlation weakens as it moves away from this specific location of the control surface due to the delocalized non-linear aerodynamic flow field. Calculations based on the non-linear Kirchoff equation using the sonic cylinders as the control surfaces show reasonable agreements with the experimental data in the negative amplitudes for both tip Mach numbers of 0·90 and 0·95, except for some computational integration problems over a shock. It can be concluded that a non-linear formulation is necessary if the control surface is close to the blade and the flow is delocalized.

Summary: The aim of this study of extremely low birth-weight (ELBW, birth-weight 500–999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979-80, 1985-87, and 1991-92, in the proportions who were born outside level 3 perinatal centres (outbom), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn fell significantly over successive eras, from 30.2% (106 of 351) in 1979-80, to 23.0% (129 of 560) in 1985-87, and to 15.6% (67 of 429) in 1991-92. Between 1979-80 and 1985-87, die proportions who were outborn fell predominantly in those of birth-weight from 800–999 g, whereas between 1985-87 and 1991-92 the proportions who were outborn fell predominandy in those of birth-weight 500–799 g. The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in die 3 eras, at 49.1%, 38.0% and 41.2%, respectively. The survival rates for outborn infants were lower in each era dian for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level-3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 1991-92 (34.6%, 36.7% and 60.7%, respectively). The rates of sensorineural impairments and disabilities in survivors fell significantly between die first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high-risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres.

Objective: To determine the efficacy and side-effects of prolonged low-dose indomethacin therapy in very low birthweight (VLBW

The advantage of knowing outcome by gestational age is obvious to the obstetrician managing a pregnancy threatening to deliver at the borderline of viability. Accuracy of gestational age assessment is improved with early pregnancy ultrasound measurements. The increasing number of studies with outcome reported by gestational age indicates that the survival rate for babies born before 26 weeks' gestational age is rising progressively with improvements in perinatal care, and with a recognition that survival of such babies is possible. However, in individual studies, livebirths at less than 26 weeks' gestational age are few in number and, since their survival rate is low, there are even fewer survivors. In addition, there are problems with pooling or comparing data between studies because of variation in the numerators and denominators. Long-term outcome studies of extremely tiny babies from geographically defined regions have less variation in numerators and denominators, and have provided important data on recent changes over time. In spite of improving survival rates, sensorineural disability rates remain higher than for non-preterm survivors, although there is no obvious demarcation that would preclude intensive care below a particular gestational age. Methods to prevent sensorineural disability in survivors must be sought diligently.

Extremely tiny babies are human beings who deserve the same respect that we would wish if we were critically ill. Non-treatment may have to be considered by medical staff because (a) maximum intensive care can increase pain and prolong the process of dying, (b) the quality of life of some survivors with bilateral parenchymal brain lesions, chronic lung disease, necrotizing enterocolitis and retinopathy is extremely poor, and (c) shortage of resources creates de facto rationing of care. Our personal practice is based on four steps (i) accurate diagnosis and assessment of prognosis, (ii) unanimous decision among medical and nursing staff to stop intensive care, (iii) presentation of the medical assessment to the parents, and (iv) if the parents accept the decision, palliative care with symptomatic relief as intensive care is stopped.

The evidence behind the efficacy and safety of assisted ventilation in the newborn is discussed: continuous distending pressure (CDP), intermittent mandatory ventilation (IMV), muscle relaxation, nursing and technical aspects, weaning and extubation, oxygen and carbon dioxide monitoring, high frequency ventilation and extracorporeal membrane oxygenation (ECMO). This review will focus on the condition of respiratory distress syndrome (RDS) in preterm infants although some of the principles of assisted ventilation are applicable to other causes of neonatal respiratory failure.

The high fetal pulmonary vascular resistance and pulmonary arterial pressure fall after birth with normal expansion and oxygenation of the lungs. In the condition of persistent pulmonary hypertension (PPH), previously known as persistent fetal circulation, either these physiological changes do not occur or the pulmonary vascular resistance subsequently increases. When the pulmonary arterial pressure exceeds the systemic arterial pressure, right-to-left shunting of blood occurs through the foramen ovale (right to left atrium) and ductus arteriosus (pulmonary artery to thoracic aorta) leading to significant hypoxaemia.

A series of Al-doped amorphous silicon oxide films have been grown on p-type silicon (100) substrates by a dual ion beam cosputtering method. Visible electroluminescence (EL) from the devices, made by films with different contents of Al, can be seen with the naked eye under forward bias and reverse bias for films containing sufficient amounts of Al. The EL spectra are found to have a luminescence band peaked at 510 nm (2.4 eV), which is the same result as that obtained from silicon oxide films. With the increase in the amounts of Al, the peak position does not shift, the onset of the bias decreases, and the intensity of EL peak increases. Experiment results show that the doping of Al is beneficial to improving the conduction condition of films while the structure of the films associated with luminescence centers is affected hardly at all.

We report the pattering of sp3- and sp2-bonded carbon by using conducting atomic-force microscopy (AFM) working in the noncontact mode. A ta-C film with ∼80% sp3 bonds was scanned by the conducting AFM with a biased tip. A current image that clearly shows gray/white and black features was obtained while scanning in the noncontact mode. These features were proposed to be the result of the different electron emission abilities of the sp3- and sp2-bonded carbon in the film. The result not only enables us to image the distribution of the sp3 and sp2 bonds of a-C, but also extends the AFM to provide the electron emission information of a-C on a nanometer scale.

The impact of endotoxemia on cerebral endothelium and cerebral blood flow (CBF) regulation was studied in conscious newborn lambs. Bacterial endotoxin [LPS, 2 μg/kg iv] was infused on 3 consecutive days. Cerebrovascular function was assessed by monitoring CBF and cerebral vascular resistance (CVR) over 12 h each day and by the endothelium-dependent vasodilator bradykinin (BK) ( n = 10). Inflammatory responses were assessed by plasma tumor necrosis factor-α (TNF-α, n = 5). Acutely, LPS disrupted the cerebral circulation within 1 h, with peak cerebral vasoconstriction at 3 h (CBF −28 and CVR +118%, P < 0.05) followed by recovery to baseline by 12 h. TNF-α and body temperature peaked ∼1 h post-LPS. BK-induced vasodilatation (CVR −20%, P < 0.05) declined with each LPS infusion, was abolished after 3 days, and remained absent for at least the subsequent 5 days. Histological evidence of brain injury was found in four of five LPS-treated newborns. We conclude that endotoxin impairs cerebral perfusion in newborn lambs via two mechanisms: 1) acute vasoconstriction (over several hours); and 2) persistent endothelial dysfunction (over several days). Endotoxin-induced circulatory impairments may place the newborn brain at prolonged risk of CBF dysregulation and injury as a legacy of endotoxin exposure.

The 5-year outcome of 101 extremely low birthweight (ELBW, < 1000 g) children discharged from the Neonatal Intensive Care Unit was reported. Over this period, there were four post-discharge deaths. The neurodevelopmental impairment rate was 18% overall: cerebral palsy 7%, blindness 3%, deafness 3% and developmental delay 10%. Seventy-one percent of children were readmitted to hospital. The mean number of admissions was 2.4 per child and the mean duration of total hospital stay was 11.3 days per child in the 5-year period. A trend was observed in a reduction in the readmission rate and hospital days in the 2–5-year period compared to the period between discharge and 2 years, though the differences were not statistically significant. The most common reason for readmission was for surgical procedures, primarily aural ventilation tube insertion and tonsillectomy and adenoidectomy. Significant health problems included recurrent wheezing episodes, stridor and croup in the period up to 2 years and otitis media and tonsillitis between 2 and 5 years. There was some catch-up growth, especially in height, between 2 and 5 years. Children with < 800 g birthweight had similar rates of neurodevelopmental impairment and hospital readmission to those of 800–999 g birthweight. However, they experienced more otitis media and pneumonia, had more ear, nose and throat operations, and at 5 years of age, more were below the 3rd centile for weight. This study showed that the health status of ELBW children had improved between 2 and 5 years, but they continued to experience recurrent health problems and hospital readmissions which would have resulted in added financial and emotional burdens to their families.

Pulse oximeters are programmed with a calibration curve derived from studies done in adults. Whether fetal haemoglobin levels affect their reliability is unclear. This study reports the accuracy of pulse oximetry in 22 preterm infants (mean 31 weeks, range 25-36 weeks gestation) between 1 h and 73 days of age. Oxygen saturation obtained from a Nellcor N-200 pulse oximeter (SpO2) was compared with simultaneous arterial values (functional SaO2) measured by a Radiometer OSM3 Hemoximeter over a SpO2 range of 83-99%. Fetal haemoglobin (HbF), carboxyhaemoglobin (HbCO) and methaemoglobin (HbMet) measured by the hemoximeter ranged between 0-100%, 0-3.5% and 0-0.8% respectively. Linear regression analysis revealed a close correlation between SpO2 and functional SaO2 (SpO2 = 0.75 SaO2 + 24.43, r = 0.88, P less than 0.001) over a wide range of values for PCV, heart rate, blood pressure, PaO2, PaCO2 and pH. The mean SpO2-SaO2 difference of 1.3, (s.d. 2.5%, P less than 0.001) was unaffected by HgF, HbCO or HbMet but was increased in infants receiving inotropic support. We conclude that the Nellcor N-200 pulse oximeter gives reliable oxygen saturation measurements unaffected by the HbF level in preterm infants.

Globally, there are 141 million annual live births; 127 million (90%) of which occur in developing countries. These regions also have a higher rate of contribution to the 7.5 million annual perinatal deaths and 5.1 million neonatal deaths. The perinatal mortality rate (PMR) and the neonatal mortality rate (NMR) have often been used as indicators of the standard of a country’s social, educational, and health-care systems. Developing regions of the world, and particularly rural areas, where there are few skilled birth attendants experience disproportionately high perinatal mortality rates. This chapter presents an overview of perinatal health, providing data on perinatal mortality rates, stillbirth rates, and neonatal mortality rates across the globe. Underlying causes of stillbirths and neonatal deaths are exacerbated by lack of health-care and poorly distributed health-care access and funding. Discrepancies in data collection and measurement in some regions and the resulting lack of comparable data pose challenges to assessment and response to perinatal mortality. Sixteen low-cost, community-based interventions with proven efficacy for neonatal survival have been identified across the prenatal, antenatal, intrapartum, and postpartum stages. Standardizing and improving available data and directing more funding to prevention of perinatal mortality are key factors in reducing mortality rates. Strategies that address inequalities both within a country, and between countries are necessary if there is going to be further improvement in global perinatal health. Perinatal mortality refers to death in the perinatal period that includes late pregnancy, birth, and the neonatal period. By avoiding the difficult judgment of whether a fetus exhibits signs of life or not at birth, it is a useful measure for comparison of reproductive loss and perinatal health between countries. Although the global perinatal mortality rate (PMR) has fallen by about 10% in the last decade, the total number of perinatal deaths has remained unchanged because the number of births has increased in the same period. No systematic global estimates of stillbirths exist, and any statistical modeling used to predict stillbirth number and stillbirth rate (SBR) probably underestimates both figures. Epidemiological data on the estimated 450 neonatal deaths every hour around the world remain sparse, but most of these deaths are considered preventable and, halving of the global neonatal mortality rate (NMR) is an achievable goal. In this chapter, published data on perinatal outcomes (including available estimates of global and regional PMR, SBR, and NMR) are Victor Y.H. Yu (*) Monash University, Australia

We studied the impact of endotoxemia on cerebral blood flow (CBF), cerebral vascular resistance (CVR), and cerebral oxygen transport (O2 transport) in fetal sheep. We hypothesized that endotoxemia impairs CBF regulation and O2 transport, exposing the brain to hypoxic-ischemic injury. Responses to lipopolysaccharide (LPS; 1 μg/kg iv on 3 consecutive days, n = 9) or normal saline ( n = 5) were studied. Of LPS-treated fetuses, five survived and four died; in surviving fetuses, transient cerebral vasoconstriction at 0.5 h (ΔCVR approximately +50%) was followed by vasodilatation maximal at 5–6 h (ΔCVR approximately −50%) when CBF had increased (approximately +60%) despite reduced ABP (approximately −20%). Decreased CVR and increased CBF persisted 24 h post-LPS and the two subsequent LPS infusions. Cerebral O2 transport was sustained, although arterial O2 saturation was reduced ( P < 0.05). Histological evidence of neuronal injury was found in all surviving LPS-treated fetuses; one experienced grade IV intracranial hemorrhage. Bradykinin-induced cerebral vasodilatation (ΔCVR approximately −20%, P < 0.05) was abolished after LPS. Fetuses that died post-LPS ( n = 4) differed from survivors in three respects: CVR did not fall, CBF did not rise, and O2 transport fell progressively. In conclusion, endotoxin disrupts the cerebral circulation in two phases: 1) acute vasoconstriction (1 h) and 2) prolonged vasodilatation despite impaired endothelial dilatation (24 h). In surviving fetuses, LPS causes brain injury despite cerebral O2 transport being maintained by elevated cerebral perfusion; thus sustained O2 transport does not prevent brain injury in endotoxemia. In contrast, cerebral hypoperfusion and reduced O2 transport occur in fetuses destined to die, emphasizing the importance of sustaining O2 transport for survival.

Syphilis testing guidelines in China are usually based on symptomatic criteria, overlooking risk assessment and ultimately opportunities for disease detection and control. We used data from 10,695 sexually transmitted disease (STD) clinic patients in Guangxi, China, to assess the efficacy of a potential screening tool inquiring about behavioural and health risk factors in identifying the STD patients who should not be triaged for syphilis testing under current guidelines, but on the contrary receive such testing. Validity testing of the screening tool was performed and receiver-operating characteristic curves were plotted to determine an optimal total risk score cut-off for testing. About 40.9% of patients with positive toluidine red unheated serum test and Treponema pallidum particle agglutination test did not show hallmark signs of syphilis. The screening tool was more sensitive in detecting infection in non-triaged male versus female patients (highest sensitivity = 90% vs. 55%) and the cut-off score to warrant testing was lower in non-triaged female patients than in non-triaged male patients (cut-off = 1 vs. 2). Most of the cases were missed among female STD patients. In spite of selective testing based on behavioural and health indicators that improve case detection, cases were still missed. Our study supports universal testing for syphilis in the STD population.

We examined whether serum C-reactive protein (CRP) measurements used in conjunction with leucocyte counts help in the diagnosis of perinatally acquired and nosocomial infections in very preterm newborn infants. One hundred and twenty-five infants born at a gestational age between 23 and 31 weeks with respiratory distress were studied at birth. A similar group of 85 infants beyond 3 days of age were also studied on 100 occasions for suspected infection. The diagnosis of proven or probable infection was correlated with abnormal haematology (leucopenia less than 5000/mm3, leucocytosis greater than 20,000/mm3 or ratio of immature forms to total neutrophils of greater than 0.2) and an elevated CRP (greater than 10 mg/L) singly or in combination. The sensitivity of an elevated CRP was relatively higher than abnormal haematology in both early and late infections and the sensitivity was highest when either test was abnormal. Similarly, the specificity, positive and negative predictive values and efficiency of an elevated CRP was relatively higher than abnormal haematology. The performance of the tests in 45 infants born at 23-28 weeks gestation was similar to that in 80 infants born at 29-31 weeks gestation. It was concluded that both CRP and leucocyte counts should be determined as they provide valuable information in the diagnosis of neonatal bacterial infection.

Developmental changes in regional cerebral blood flow (CBF) responses to hemorrhagic hypotension during normoxia and normocapnia were determined using radioactively labeled microspheres to measure flow to the cortex, brainstern, cerebellum, white matter, caudate nucleus, and choroid plexus in three groups of chromically catheterized lambs: 90− to 100-d preterm fetal lambs (n = 9); 125− to 136-d near-term fetal lambs (n = 9); and new born lambs 5− to 35-d-old (n = 8). Heart rate, central venous pressure, and arterial blood pressure were monitored continously and arterial blood gas tensions, pH. Hb. and oxygen saturation together with regional CBF were measured periodically. Hemorrhagic hypotension produced a mean decrease in arterial blood pressure of 27 ± 4, 23 ± 2, and 41 ± 4% in the three groups, respectively, whereas reinfusion of the lamb's blood resulted in a return to control blood pressure within 3% in all three groups. In the preterm fetal lamb, CBF decreased significantly in all regions during hypotension. In the nearterm fetal lamb, only blood flow to the cortex decreased significantly during hypotension. In the newborn lamb, only the choroid plexus demonstrated a significant decrease in blood flow during hypotension The lower limit of regional CBF autoregulation was identical to the resting mean arterial pressure in fetal life but significantly lower in newborn lambs. These experiments demonstrate for the first time that vulnerability to hypotension decreases with increasing maturity and that the brainstem, the phylogenetically oldest region of the brain, is the least vulnerable to the effects of hypotension at any age in the lamb model.

This study reported the prevalence and severity of retinopathy of prematurity (ROP) in less than or equal to 28 weeks gestation or less than or equal to 1000 g birthweight infants over a 12-year period. Among 328 survivors of less than or equal to 28 weeks gestation, 30% had ROP, 12% had severe ROP of Stage 3 or worse, 5% had at least one blind eye and 3% were bilaterally blind. Among 201 survivors of less than or equal to 1000 g birthweight, the above abnormalities were found in 40, 16, 6 and 4% respectively. In both cohorts there was a significant increase in the prevalence of ROP and severe ROP between the period 1977-80 and 1981-84, but the lesser increase observed between the periods 1981-84 and 1985-88 was not statistically significant. The rates of ROP-induced blindness were not significantly different between the three 4-year periods. An inverse relationship was noted between the prevalence of ROP and gestational age. The results suggest a resurgence of ROP in less than or equal to 28 weeks or less than or equal to 1000 g infants, the cause of which is uncertain. In view of this trend, continued surveillance of ROP is warranted.

This article describes the patterns of delivery and resuscitation for very-low-birthweight infants who were born in Victoria from 1982 to 1985. Caesarean delivery rates increased from 15% to 30% for infants of birthweights of 500-999 g, and from 39% to 52% for infants of birthweights of 1000-1499 g. In level-III hospitals, the proportion of live-born infants who did not receive active resuscitation fell from 32% to 18% for those who weighed 500-999 g, and from 28% to 15% for those who weighed 1000-1499 g. Time trends over the four years showed the management of very-low-birthweight infants to be in a state of rapid transition in all birth settings. At the same time there was a fall in the still-birth rate of infants of birthweights of 500-999 g. Still-births rates for infants of birthweights of 1000-1499 g remained unchanged, as did neonatal mortality rates in both weight groups.

A 2-year-old Chinese boy was referred to Hospital UKM for investigation of recurrent episodes of dark-coloured urine and pallor since birth. He was born prematurely at 34 weeks gestation and developed severe early-onset neonatal jaundice requiring exchange blood transfusion. Screening at birth showed Glucose-6-phosphate dehydrogenase (G6PD) deficiency. On admission, physical examination revealed pallor, jaundice and mild hepatomegaly. Results of laboratory investigations showed a hemoglobin level of 11.0 g/dl with a hemolytic blood picture, reticulocytosis of 20% and red cell G6PD activity reported as undetectable. The patient's DNA was analysed for G6PD mutations by PCR-based techniques and DNA sequencing and results showed a 24 bp deletion of nucleotide 953-976 in the exon 9 of the G6PD gene. DNA analysis was also performed on blood samples of the patient's mother and female sibling confirming their heterozygous status, although both showed normal red cell G6PD activity levels. The patient was discharged well and his parents were appropriately advised on the condition and the importance of taking folic acid regularly. This is a first case report in Malaysia of G6PD deficiency causing chronic-hemolytic anemia. The rare 24 bp deletion causes the G6PD Nara variant, previously reported only in two other unrelated males, a Japanese and a Portuguese both with chronic hemolytic anemia.

To evaluate the relation between chorioamnionitis and hypotension in very low birthweight infants.Retrospective cohort study in infants with a birth weight of1500 g born between January 2002 and September 2004. The placentas were examined for evidence of chorioamnionitis and funisitis. Hypotension was defined by the use of vasopressors.Of 105 infants, 37 (35%) were chorioamnionitis positive. The onset of hypotension had a skewed distribution: day 1 for 30 episodes and scattered from day 2 to day 19 for the remaining 22. Of the 30 infants who developed hypotension on day 1, 17 (57%) were chorioamnionitis positive. The mean maturity of the chorioamnionitis positive group was 27.91 weeks, marginally less than the mean maturity of 29.05 weeks of the chorioamnionitis negative group (p = 0.05). After adjustment of the effects for confounding variables (birth weight, gestation, surfactant therapy, mechanical ventilation on day 1, high frequency oscillatory ventilation, patent ductus arteriosus), chorioamnionitis was the significant factor in line with hypotension developing on day 1 (adjusted odds ratio 5.14, 95% confidence interval 1.51 to 17.50). There was no evidence that hypotension developing after day 1 was associated with chorioamnionitis.There is a strong association between chorioamnionitis and hypotension developing on day 1 in very low birthweight infants.

both serum ferritin and aminotransferase level as well as C-peptide level at baseline. Biochemical parameters also measured at baseline. To characterize serum ferritin level variable according to metabolic traits and liver function, we analyzed liver function and beta cell function, respectively. To compensate the gender differences, each subject was analyzed separately by sex. Male subjects were categorized into two groups, Group I (abnormal liver function test group) or Group II (normal liver function group) based on aminotransferase level. Result: Of the 108 subjects (67 men and 41 women), male subjects (n=67) had significantly higher ferritin level (202.6ng/ml vs 87.6ng/ml, p= 0.001) and hemoglobin (Hb) level (13.5g/dl vs 12.2g/dl, p< 0.001) than women (n=41) subjects. However total cholesterol level was lower inmale thanwomen subjects. (158.4mg/dl vs 183.9mg/dl, p= 0.005) Subjects with higher aminotransferase level than 40IU/L were defined Group I (n=17). Group I showed significantly higher serum ferritin level (309.8ng/ml vs 166.1ng/ml, p= 0.01) and basal C-peptide level (1.6ng/ml vs 2.7ng/ml, P = 0.025) than Group II. Multiple linear regression analyses showed that basal C-peptide level (p= 0.005) and total cholesterol level (p =0.015) were independently associated with serum ferritin level, only in women subjects. Also, a significant positive correlation was observed serum ferritin level and basal C-peptide level (r = 0.409, P = 0.012) and waist circumference(r = 0.399, P =0.016) in women subjects. Conclusion: Serum ferritin was significantly increased in male subjects with abnormal liver function and insulin resistance. In women subjects, serum ferritin level was positively associated with metabolic syndrome components, such as waist circumference and insulin resistance.