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The increasing pollution levels, rising energy demand, and the inadequacy of conventional fuels have spurred interest in alternative sources of fossil fuel supply and demand. This problem has shifted the focus towards the examination of a promising sustainable alternative for diesel fuels. In this sense, biodiesel can be a more suitable candidate for energy, environmentally harmless, and cost-competitive approach to respond to the energy demand. The application of ultrasonic energy in biodiesel production via transesterification has been endorsed as an efficient approach that improves mass transfer factors resulting in decreased reaction times and potentially lower process expense. This study investigates the advancements in ultrasonic energy for biodiesel generation from various raw materials utilizing different catalysts. A critical assessment of the current approach is furnished, emphasizing the application of ultrasonic irradiation. Besides, in order to better understand ultrasonic energy, each ultrasonic cavitation (UC) and hydrodynamic cavitation (HC) is discussed. Regarding each approach, the fundamental concepts are discussed in detail. Generally, the present study aims at conveying a comprehensive overview of ultrasonic energy usage in transesterification reactions and furnishing an outlook on prospective developments in the technology.

Abstract In this research, the photocatalytic removal of reactive blue 19 (RB19) dye is investigated employing zinc oxide/cerium (ZnO@Ce) nanoparticles decorated with biochar under LED irradiation. Synthesis of ZnO@Ce nanoparticles decorated with biochar was performed utilizing the co-precipitation procedure and, then, the texture and morphology of the fabricated nanocomposite were analyzed using energy dispersive X-ray (EDX), field emission scanning electron microscopy (FE-SEM), X-ray powder diffraction (XRD), transmission electron microscopy (TEM), Brunauer–Emmett–Teller (BET), and Fourier transform infrared (FTIR) spectroscopy techniques. Moreover, FE-SEM images demonstrate that ZnO–Ce nanoparticles were successfully decorated on the surface of biochar. The specific surface areas of biochar and biochar/ZnO–Ce were 519.75 and 636.52 m2/g, respectively. To achieve the maximum yield in the removal of RB19 dye, the effects of operating variables including dye concentration, LED lamp power, biochar@ZnO–Ce catalyst dose, pH and H2O2 dose were explored. Besides, the maximum percentage of RB19 dye removal was 96.47% under optimal conditions, i.e. catalyst dosage of 100 mg, H2O2 dosage of 1 mL, pH of 9, initial dye concentration of 5 ppm, LED power of 50 W, and reaction time of 140 min. Furthermore, the kinetic analysis reveals that the removal of RB19 dye follows the pseudo-first order kinetic model, with calculated values of a reaction rate constant of 0.045 min−1 and a correlation coefficient of R2 = 0.99, respectively. Moreover, the reusability and recyclability of biochar@ZnO/Ce nanocatalyst was promising over five runs, with only a 6.08% decrease in RB19 dye removal efficiency. Therefore, it can be concluded that the biochar @ZnO/Ce photocatalyst can be promisingly applied for the removal of azo dyes in aqueous solutions.

In this research, the photocatalytic degradation of methylene blue (MB) dye was explored by employing Zn-La (zinc-lanthanum) oxide nanocatalysts under UV irradiation. Preparation of Zn-La oxide nanocatalysts was executed utilizing the co-precipitation technique, and the surface and morphology of the fabricated nanocatalyst were examined via X-Ray diffraction analysis (XRD), Fourier-transform infrared spectroscopy (FTIR), Brunauer-Emmett-Teller (BET), Barrett-Joyner-Halenda (BJH), Field emission scanning electron microscopy (FESEM), Transmission electron microscopy (TEM), and energy dispersive X-ray (EDX) methods. BET-BJH analysis demonstrated that the specific surface area of the Zn-La oxide nanocatalyst was 20.43 m2/g. Moreover, the response surface methodology (RSM) procedure was utilized to influence the operational factors i.e., catalyst amount, pH, H2O2 dose, and UV power. The quadratic model proposed via the RSM technique with a high R2 value of 0.89, demonstrates its reliability. Besides, the maximum percentage of MB dye removal reached 75.18% under optimal conditions, which include a catalyst amount of 12.05 mg, pH of 9, H2O2 dose of 0.44 mL, UV power of 23 W, and a reaction time of 45 min. Further, under the mentioned conditions, after 120 min, the MB degradation efficiency reached 98.8%. The kinetic study exhibited that the reaction rate constant was 0.0363 min−1. According to the outcomes, Zn-La oxides have a higher ability to remove MB. After 5 consecutive reuse rounds, the reduction in the yield of MB removal using Zn-La oxide nanocatalysts was 5.4%. This study demonstrates that the Zn-La oxide nanocatalyst can be promisingly utilized for the degradation of MB dye suspension solution.

The growing fuel demands and drastic restrictions of politics on greenhouse gas emissions are motivating bioenergy research. In this paper, the yield improvement of the produced biodiesel from canola oil using the transesterification process, in attendance of ZnO nanocatalyst and ultrasound waves, was investigated. The crystal size, morphology, and particle size of the prepared nanoparticles were recognized by applying Xray diffraction (XRD), scanning electron microscopy (SEM), and transverse electron microscopy (TEM) analyses, respectively. The size of ZnO nanoparticles was 45 nm with a hexagonal-shaped structure. The response surface methodology (RSM) and the Box Behnken design (BBD) were employed to analyze the impact of the independent variables on biodiesel production yield. The reliability of the proposed model was verified by applying the analysis of variance (ANOVA) to evaluate response. Regarding the yield, satisfactory accordance was obtained between the calculated and prognosticated data from RSM, with R2= 0.9910 and R2 adj= 0.9748. The optimum reaction conditions were acquired at a methanol to oil molar ratio of 11.19:1 mol: mol, ultrasound irradiation time of 31.98 min, and nanocatalyst amount of 3.17 wt.%. The optimum value for the sonobiodiesel yield was achieved equal to 90.16%. Moreover, the kinetic study exhibited that the values of activation energy and Arnius frequency factor were achieved 46.23 kJ mol-1 and 5.83× 105 min-1, respectively. Accordingly, this research indicated that ZnO nanoparticles can be utilized as a promising and efficient heterogeneous catalyst for biodiesel production.

Introduction & Objective: Joint position sense is impaired after Anterior Cruciate Ligament (ACL) tearing. The objective of the present study was to evaluate the effect of reconstruction surgery on position sense in patients with A.C.l tear Materials & Methods: This study was Quasi- experimental and the patients were selected in a nonprobability sampling manner. 30 patients with ACL tear, with mean age of 26.52±8.72 years old were recruited. The patients were 16 males and 14 females. Two centered Electrogoniometer were used to test the position sense as a dependent variable. The data were analyzed with Paired T-Test, ICC, SEM and K-S tests. Results: The difference of the position sense before and after the reconstruction surgery on the impaired ligament was significant (p

Objective: In some clients, for lower extremity, long leg brace, is prescribed. Then it will be fabricated bye orthotist and worn by patient. According to clinical principles, the brace should be as fit as possible with limb form. Also, an individual, walks and sits with his or her brace. Brace functions around joint motion axis. Quality and exact place of movement is define by biomechanical principles. Therefore, brace should be adapted with biochemical principles of the limb. Materials & Methods: A brace is made up several components which are assembled through acceptable technical orthopaedic methods and this procedure should be done without omission or neglect. If orthotist has enough scientific knowledge and observes all details, he or she will fabricate a perfect brace. We considered fabricated long leg brace according to this principle to meet study objectives while answering some question of study, we will disguss on the finding of our assessment. Also, we examine some possible deviations with accured by unsuitable fabrication, more over we suggest that some failur in designing procedure which leads to such deviation material and methods: In this descriptive analytic cross sectional study, long leg braces of 193 clients who were selected by random stratified sampling method, were evaluated by a previously designed questionare . Results: A. By assessment of 7 variables, it was revealed that 28.86% of manufactured braces, was not adapted with defined fundamentals, biomechanically. B. By evaluation of 9 variables, it was made known that 30 % of produced braces was not adapted with established fabricating fundamentals of lower limb braces clinically. C. By examination of 23 variables it was find out that 25.4% of fabricated braces, it was observed, which has some failures by attention to defined fabricating technical orthopaedic fundamentals. Conclusion: All the details, fabrication and design procedures should be carefully observed and associated theories should be considered.

Objective: to investigate whether a neoprene ankle support and elastic bandage around the ankle joint of subjects with ankle sprain (grade I&II) would , in short term (a) reduce pain (b) improve ankle joint position sense and comparison of their effect with each other if they have. Materials & Methods: In a semi-experimental study, 30 subjects (16men, 14 women, age between 16-52) with ankle sprain grade I&II). Subjects had to have at least 2cm from 10cm visual analogue scale (VAS) of ankle pain for study entry. All patients were randomly assigned to either an elastic bandage or a neoprene ankle support. One week later they were assigned to the opposite selection. Joint position sense was assessed in the sitting position using an electrogoniometer and pain by VAS where 0cm equals no pain and 10 cm equals worst pain. ankle pain and JPS were assessed for each selection one week apart. During each visit assessment were performed at baseline and after 20 min of bandage/neoprene ankle support application. Results: the mean of scores for ankle variables JPS and VAS was taken and paired-t test and Wilcoxon signed rank test was employed to calculate the different between two trails. Neoprene ankle support had significant effect on ankle JPS (P=0.034). But elastic bandage had no effect (P=0.539). Both of them had significantly reduced ankle pain. (P=0.000) Conclusion: In subjects with both neoprene ankle support and elastic bandage reduced ankle pain with more effect of neoprene ankle support. Only the neoprene ankle support had effect on knee JPS.

Objective: Muscle weakness and atrophy due to immobilization and disuse are most common problems that clinicians especially physiotherapists encounter with them. There are many approachs for overcoming these problems the more intresting of them is cross transfer effect of uninvolved limb exercises. The aim of this study was to investigate the bilateral effect or cross transfer effect of unilateral quadriceps exercises in terms of strength, endurance and electromyographic activities on contralateral homologue muscle. Materials & Methods: 46 healthy male student (yrs=22.5, SE=4.5) participated in this study , 23 of them were in experimental group who undergone 3 weeks of strengthening exercises, and 23 control group continued their usual life . Variables including MVC, (Maximal Voluntary Contraction), END (Endurance), IEMG (Integrated Electromyography) were measured before and after 3 wks in all subject Finding: Data analysis (Paired T Test) revealed that in experimental group all variables of both trained and nontrained quadriceps muscles had been significantly changed (P

Objective: to investigate whether a neoprene sleeve and elastic bandage around the knee joint of subjects with knee osteoarthritis (OA) would , in short term (a) reduce pain (b) improve knee joint position sense and comparison of their effect with each other if they have. Materials & Methods: In a semi-experimental study, 30 subjects (11 men, 19 women, age between 33-75) with unilateral knee OA. Subjects had to have at least 2cm from 10cm visual analogue scale (VAS) of knee pain for study entry.All patients were randomly assigned to either an elastic bandage or a neoprene sleeve. One week later they were assigned to the opposite selection. Joint position sense was assessed in the sitting position using an electrogoniometer and pain by VAS where 0cm equals no pain and 10 cm equals worst pain. Knee pain and JPS were assessed for each selection one week apart. During each visit assessment were performed at baseline and after 20 min of bandage/neoprene sleeve application. Results: the mean of scores for knee variables JPS and VAS was taken and paired-t test and Wilcoxon signed rank test was employed to calculate the different between two trails. Neoprene sleeve had significant effect on knee JPS (P=0.037). But elastic bandage had no effect (P=0.631). Both of them had significantly reduced knee pain. (P=0.000) Conclusion: In subjects with both neoprene sleeve and elastic bandage reduced knee pain with more effect of neoprene sleeve. Only the neoprene sleeve had effect on knee JPS.

Objective: Evaluate the effect of fathers' participation in the Preemie Prep for Parents (P3) program on maternal learning and fathers' preterm birth knowledge., Methods: Mothers with preterm birth predisposing medical condition(s) enrolled with or without the baby's father and were randomized to the P3 intervention (text-messages linking to animated videos) or control (patient education webpages). Parent Prematurity Knowledge Questionnaire assessed knowledge, including unmarried fathers' legal neonatal decision-making ability., Results: 104 mothers reported living with the baby's father; 50 participated with the father and 54 participated alone. In the P3 group, mothers participating with the father (n = 33) had greater knowledge than mothers participating alone (n = 21), 85 % correct responses vs. 76 %, p = 0.033. However, there was no difference in knowledge among the control mothers, 67 % vs. 60 %, p = 0.068. P3 fathers (n = 33) knowledge scores were not different than control fathers (n = 17), 77 % vs. 68 %, p= 0.054. Parents who viewed the video on fathers' rights (n = 58) were more likely than those who did not (n = 96) to know unmarried fathers' legal inability to decide neonatal treatments, 84 % vs. 41 %, p < 0.001., Conclusions: Among opposite-sex cohabitating couples, fathers' participation in the P3 program enhanced maternal learning., Practice Implications: The P3 program's potential to educate fathers may benefit high-risk pregnancies., Clinical Trial Registration: ClinicalTrials.gov, NCT04093492, https://clinicaltrials.gov/study/NCT04093492., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

•Black women receiving the smartphone P3 program had more preterm birth knowledge.•Black women receiving the P3 program were more prepared for healthcare decisions.•Black women receiving the P3 program talked more with partners about preterm birth.•Smartphone preterm birth education may overcome clinic-based education barriers., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mir A Basir reports financial support was provided by National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier B.V.)

Objective: Evaluate the effect of fathers' participation in the Preemie Prep for Parents (P3) program on maternal learning and fathers' preterm birth knowledge., Methods: Mothers with preterm birth predisposing medical condition(s) enrolled with or without the baby's father and were randomized to the P3 intervention (text-messages linking to animated videos) or control (patient education webpages). Parent Prematurity Knowledge Questionnaire assessed knowledge, including unmarried fathers' legal neonatal decision-making ability., Results: 104 mothers reported living with the baby's father; 50 participated with the father and 54 participated alone. In the P3 group, mothers participating with the father (n=33) had greater knowledge than mothers participating alone (n=21), 85% correct responses vs. 76%, p =0.033. However, there was no difference in knowledge among the control mothers, 67% vs. 60%, p =0.068. P3 fathers (n=33) knowledge scores were not different than control fathers (n=17), 77% vs. 68%, p =0.054. Parents who viewed the video on fathers' rights (n=58) were more likely than those who did not (n=96) to know unmarried fathers' legal inability to decide neonatal treatments, 84% vs. 41%, p <0.001., Conclusions: Among opposite-sex cohabitating couples, fathers' participation in the P3 program enhanced maternal learning., Practice Implications: The P3 program's potential to educate fathers may benefit high-risk pregnancies.

Background: The increasing kidney retransplantation rate has created a parallel field of research, including the risk factors and outcomes of this advanced form of renal replacement therapy. The presentation of experiences from different kidney transplantation centers may help enrich the literature on kidney retransplantation, as a specific topic in the field of kidney transplantation., Aim: To identify the risk factors affecting primary graft function and graft survival rates after second kidney transplantation (SKT)., Methods: The records of SKT cases performed between January 1977 and December 2014 at a European tertiary-level kidney transplantation center were retrospectively reviewed and analyzed. Beside the descriptive characteristics, the survivals of patients and both the first and second grafts were described using Kaplan-Meier curves. In addition, Kaplan-Meier analyses were also used to estimate the survival probabilities at 1, 3, 5, and 10 post-operative years, as well as at the longest follow-up duration available. Moreover, bivariate associations between various predictors and the categorical outcomes were assessed, using the suitable biostatistical tests, according to the predictor type., Results: Out of 1861 cases of kidney transplantation, only 48 cases with SKT were eligible for studying, including 33 men and 15 women with a mean age of 42.1 ± 13 years. The primary non-function (PNF) graft occurred in five patients (10.4%). In bivariate analyses, a high body mass index ( P = 0.009) and first graft loss due to acute rejection ( P = 0.025) were the only significant predictors of PNF graft. The second graft survival was reduced by delayed graft function in the first ( P = 0.008) and second ( P < 0.001) grafts. However, the effect of acute rejection within the first year after the first transplant did not reach the threshold of significance ( P = 0.053). The mean follow-up period was 59.8 ± 48.6 mo. Censored graft/patient survival rates at 1, 3, 5 and 10 years were 90.5%/97.9%, 79.9%/95.6%, 73.7%/91.9%, and 51.6%/83.0%, respectively., Conclusion: Non-immediate recovery modes of the first and second graft functions were significantly associated with unfavorable second graft survival rates. Patient and graft survival rates of SKT were similar to those of the first kidney transplantation., Competing Interests: Conflict-of-interest statement: The authors have no financial relationships to disclose., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Gestational diabetes (GDM) complicates 10% of pregnancies in the US. First-line treatment is medical nutrition therapy (MNT) and exercise. Second line is pharmacotherapy. The definition of what constitutes an unsuccessful trial of MNT and exercise has not been established. Tight glycemic control has been demonstrated to reduce GDM-related neonatal and maternal clinical complications. However, it could also increase rates of small-for-gestational age and carry negative effects on patient-reported outcomes such as anxiety and stress. We will study the effect of earlier and stricter pharmacotherapy in GDM on clinical and patient-reported outcomes., Methods: GDM and pharmacotherapy (GAP) study is a two-arm parallel, pragmatic randomized controlled trial, where 416 participants with GDM are randomized 1:1 to: 1) Intervention group - insulin initiation at 20% elevated glucose values on a weekly glucose log following MNT and exercise trial and insulin titration to keep elevated glucose values <20%; or 2) Active control group - insulin initiation at 40% elevated glucose values on a weekly log following MNT and exercise and insulin titration to keep elevated glucose values <40%. The primary outcome is a composite neonatal outcome of large-for-gestational-age, macrosomia, birth trauma, preterm birth, hypoglycemia, and hyperbilirubinemia. Secondary outcomes include preeclampsia, cesarean birth, small-for-gestational-age, maternal hypoglycemia, and patient-reported outcomes of anxiety, depression, perceived stress, and diabetes self-efficacy., Conclusions: The GAP study will investigate the optimal glycemic threshold for pharmacotherapy addition to MNT and exercise in GDM. The GAP study will promote standardization in GDM management and will have direct relevance for clinical practice., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Importance: Preterm birth is a leading cause of infant mortality and child morbidity. Preterm birth is not always unexpected, yet standard prenatal care does not offer anticipatory education to parents at risk of delivering preterm, which leaves parents unprepared to make health care choices during the pregnancy that can improve survival and decrease morbidity in case of preterm birth., Objective: To evaluate the effect of the Preemie Prep for Parents (P3) program on maternal knowledge of preterm birth, preparation for decision-making, and anxiety., Design, Setting, and Participants: Recruitment for this randomized clinical trial conducted at a US academic medical center took place from February 3, 2020, to April 12, 2021. A total of 120 pregnant persons with a risk factor for preterm birth were enrolled between 16 and 21 weeks' gestational age and followed up through pregnancy completion., Intervention: Starting at 18 weeks' gestational age, P3 program participants received links delivered via text message to 51 gestational age-specific short animated videos. Control participants received links to patient education webpages from the American College of Obstetricians and Gynecologists., Main Outcomes and Measures: At 25 weeks' gestation, scores on the Parent Prematurity Knowledge Questionnaire (scored as percent correct), Preparation for Decision Making Scale (scored 0-100), and Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety computerized adaptive test. Analysis was based on an intention to treat., Results: A total of 120 pregnant participants (mean [SD] age, 32.5 [4.9] years) were included in the study; 60 participants were randomized to each group. Participants in the P3 group scored higher than those in the control group on knowledge of long-term outcomes at 25 weeks (88.5% vs 73.2%; estimated difference, 15.3 percentage points; 95% CI, 8.3-22.5 percentage points; P < .001). Participants in the P3 group reported being significantly more prepared than did participants in the control group for neonatal resuscitation decision-making at 25 weeks (Preparation for Decision Making Scale score, 76.0 vs 52.3; difference, 23.7; 95% CI, 14.1-33.2). There was no difference between the P3 group and the control group in anxiety at 25 weeks (mean [SE] PROMIS Anxiety scores, 53.8 [1.1] vs 54.0 [1.1]; difference, -0.1; 95% CI, -3.2 to 2.9)., Conclusions and Relevance: In this randomized clinical trial, pregnant persons randomly assigned to the P3 program had more knowledge of core competencies and were more prepared to make decisions that affect maternal and infant health, without experiencing worse anxiety. Mobile antenatal preterm birth education may provide a unique benefit to parents with preterm birth risk factors., Trial Registration: ClinicalTrials.gov Identifier: NCT04093492.

Objectives: To examine whether presenting a 30% or a 60% chance of survival in different survival information formats would influence hypothetical periviable birth treatment choice and whether treatment choice would be associated with participants' recall or their intuitive beliefs about the chances of survival., Study Design: An internet sample of women (n = 1052) were randomized to view a vignette with either a 30% or 60% chance of survival with intensive care during the periviable period. Participants were randomized to survival information presented as text-only, in a static pictograph, or in an iterative pictograph. Participants chose intensive care or palliative care and reported their recall of the chance of survival and their intuitive beliefs about their infant's chance of survival., Results: There was no difference in treatment choice by presentation with a 30% vs 60% chance of survival (P = .48), by survival information format (P = .80), or their interaction (P = .18). However, participants' intuitive beliefs about chance of survival significantly predicted treatment choice (P < .001) and had the most explanatory power of any participant characteristic. Intuitive beliefs were optimistic and did not differ by presentation of a 30% or 60% chance of survival (P = .65), even among those with accurate recall of the chance of survival (P = .09)., Conclusions: Physicians should recognize that parents may use more than outcome data to make treatment choices and in forming their own, often-optimistic, intuitive beliefs about their infant's chance of survival., Trial Registration: ClinicalTrials.gov: NCT04859114., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Parents of premature infants engage in shared decision-making regarding the care of their infant. The process of prenatal counseling typically involves a verbal conversation with a neonatal provider during hospitalization. Support people may not be available, and the pregnant person's memory is impaired by medications, pain, and stress. The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development have called for improvements to this process, including the development of educational aids., Objective: This study aimed to investigate whether a multimedia tablet would be more effective than a paper handout in supplementing verbal clinician counseling during preterm birth hospitalization., Study Design: This was a randomized controlled trial including English-speaking pregnant people aged ≥18 years and hospitalized at 22 to 33 weeks' gestation for preterm birth. Exclusion criteria were known fetal or chromosomal anomaly and delivery before study completion. Pregnant people received either a multimedia tablet or a paper handout before verbal clinician counseling. Preintervention assessment included demographics and State-Trait Anxiety Inventory, and postintervention assessment included the Parent Knowledge of Premature Birth Questionnaire and State-Trait Anxiety Inventory. Continuous variables were analyzed by t-test and categorical variables by Fisher exact test., Results: A total of 122 pregnant people referred for counseling were screened; 76 were randomized, and 59 completed the study. Demographics were similar between groups, except that pregnant people in the handout group were older (mean 32 vs 29 years; P=.03). The multimedia tablet group (n=32) was less likely to report reviewing all the educational material than the paper handout group (n=27) (41% vs 72%; P=.037). Both groups correctly answered a similar number of knowledge items (P=.088). Postintervention state anxiety decreased in both groups (P<.0001), with no difference between groups. Computerized tracking showed that the multimedia group spent a median of 37 minutes reviewing the tablet., Conclusion: Contrary to our hypothesis, a paper handout and multimedia tablet were equally effective in the labor unit for supplementing verbal preterm birth counseling, and both decreased parental anxiety., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Pain and quality of death are important considerations in treatment choices for children. Our objective is to assess the intensive care-associated experiences of 22-25 weeks gestational age (GA) infants who die despite intensive care treatment., Study Design: In a 1:1 case-control study, medical records were screened for all inborn 22-25 weeks GA infants who received intensive care treatments between 2014 and 2020. Cases were all infants who died. Each case was matched by GA and birth weight to an infant who survived to discharge (control). Data was collected on cases and controls for a matched timeframe based on the case's duration of intensive care treatment. Information collected included intensive care-associated negative experiences (invasive procedures, surgeries, use of pain medication) and positive experiences (enteral feedings, being held by family)., Results: The cases (n=20) survived for 0 to 93 days, with median (IQR) survival 8 (5, 24) days. The mean (SD) number of invasive procedures was higher for cases than controls, 34 (30) vs. 24 (22), p=0.004. Cases underwent 8 surgeries compared to 4 in the controls. Additionally, compared to controls, cases spent more time receiving pain medications (64% vs. 27%, p<0.001) and without being fed (54% vs. 39%, p<0.001). Half of cases were never held by parents until the day they died., Conclusion: Extremely premature infants who die despite intensive care face more treatment burdens than the survivors. Larger studies are needed to confirm these findings and gather information necessary for informed decisions about intensive care treatment of these infants., Competing Interests: Conflict of Interest: None declared.

Background: Cognitive interviewing is a technique that can be used to improve and refine questionnaire items. We describe the basic methodology of cognitive interviewing and illustrate its utility through our experience using cognitive interviews to refine a questionnaire assessing parental understanding of concepts related to preterm birth., Methods: Cognitive interviews were conducted using current best practices. Results were analyzed by the multidisciplinary research team and questionnaire items that were revealed to be problematic were revised., Results: Revisions to the questionnaire items were made to improve clarity and to elicit responses that truly reflected the participants understanding of the concept., Conclusion: Cognitive interviewing is a useful methodology for improving validity of questionnaire items, we recommend researchers developing new questionnaire items design and complete cognitive interviews to improve their items and increase confidence in study conclusions.

Background: While physiologic stabilization followed by repair has become the accepted paradigm for management of congenital diaphragmatic hernia (CDH), few studies have examined the effect of incremental changes in operative timing on patient outcomes. We hypothesized that later repair would be associated with higher morbidity and mortality., Methods: Data were queried from the CDH Study Group (CDHSG) from 2007-2020. Patients with chromosomal or cardiac abnormalities and those who were never repaired or required pre-repair extra-corporeal life support (ECLS) were excluded. Time to repair was analyzed both as a continuous variable and by splitting the cohort into top/bottom percentiles. The primary outcome of interest was in-hospital mortality. Secondary outcomes included need for and duration of post-repair ventilatory and nutritional support., Results: A total of 4,104 CDH infants were included. Median time to repair was 4 days (IQR 2-6). On multivariable analysis, high-risk (CDHSG stage C/D) defects and lower birthweight predicted later repair. Overall, in-hospital mortality was 6%. On univariate analysis, there was no difference in the number of days to repair between survivors and non-survivors. On risk-adjusted analysis, single-day changes in day of repair were not associated with increased mortality. Later repair was associated with longer time to reach full oral feeds, increased post-repair ventilator days, and increased need for tube feeds and supplementary oxygen at discharge., Conclusions: For infants with isolated CDH not requiring pre-operative ECLS, there is no difference in mortality based on timing of repair, but single-day delays in repair are associated with increased post-repair duration of ventilatory and nutritional support.

Objectives: To examine whether the order of presenting survival vs disability information, with or without the description of infant neonatal intensive care unit (NICU) experiences would influence treatment choice during hypothetical periviable birth counseling., Study Design: An internet sample of childbearing-aged women (n = 839) viewed a pictograph displaying the chances of survival and a pictograph on the chances of disability for a baby resuscitated during the periviable period. The sample was randomized to the order of pictographs and level of description of infant NICU experiences. Participants selected between intensive care or comfort care and reported their personal values., Results: The order of the information influenced treatment choices (P = .02); participants were more likely to choose intensive care if they saw the survival pictograph first (70%) than the disability pictograph first (62%). Level of description of premature infant NICU experiences did not influence treatment choice (P = .92). Participants who valued sanctity of life, autonomy in making decisions, who were more religious, and had adequate health literacy were more likely to choose intensive care. Such participant characteristics had greater explanatory power than the experimental manipulations., Conclusions: Subtle differences in how information is presented may influence critical decisions. However, even among women with the same values, diversity in treatment choice remains., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Describe the characteristics and content of intrapartum counseling provided to women hospitalized for premature birth between 23 and 34 weeks' gestation age (GA). The study was conducted between April and December 2009 in two teaching hospitals with labor and delivery units and level 3 neonatal intensive care units. Counselors completed a postcounseling survey. From 60 sessions, 46 surveys were collected. The median counseling duration was 30 minutes; this was not associated with gestational age. The support-person was not present for most (57%) counseling sessions. There was a positive correlation ( p  = 0.001) between the number of maternal questions and her education. There was no difference in counseling content across the 23 to 34 weeks' GA regarding delivery room care, physical/mental disability, and vision problems. This study of characteristics and content of premature birth counseling for birth between 23 and 34 weeks' GA found that the duration of most sessions is 30 minutes; the father of the baby is not present during counseling for most premature births, and the topics discussed by counselors are fairly similar and extensive irrespective of the GA. These findings highlight the existing contrast between the recommended counseling practices and the actual practice reported by counselors., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Objectives: To compare the efficacy, complications, and costs of percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (SWL) in the treatment of a 20 to 30 mm single renal pelvic stone with a density ≤1000 HU. Patients and Methods: Eighty patients were prospectively randomized to receive either PNL or SWL during May 2017 to April 2019. The relevant demographic and clinical characteristics were compared. Results: The mean age in the PNL and SWL groups was 43.25 ± 15.16 and 44.18 ± 12.08 years, respectively. The mean stone sizes were 25.2 ± 3.9 and 24.6 ± 2.3 mm, respectively. The stone-free rate (SFR) was significantly different after the primary procedures (92.5% vs 37.5%, respectively; p  < 0.04), but it was comparable after 3 months (97.5% vs 90%, respectively; p  = 0.723), with a higher rate of auxiliary procedures after SWL ( p  = 0.017). On multivariate analysis, stone density was the only significant variable for the SFR in the SWL group ( p  = 0.004). Complications occurred in 27.5% and 22.5% of cases, respectively ( p  = 0.796). The mean costs of SWL (650.23 ± 424.74 United States Dollars [US$]) were significantly lower than those of PNL (1137.65 ± 224.43 US$; p  < 0.0001). Conclusions: The SFRs for PNL and SWL were not significantly different after 3 months in the treatment of a 20 to 30 mm single renal pelvic stone with ≤1000 HU, although PNL provided a significantly higher rate after its primary procedure. SWL was significantly less costly, but it mandated a significantly higher number of auxiliary procedures than PNL.

Background: As technology has advanced over the last decade, handheld Mobile Health (mHealth) applications have increased in popularity. Pregnancy is one area of mHealth that has rapidly expanded, however very few pregnancy apps are developed in collaboration with health professionals. This creates an environment where the pregnancy information women are accessing may be inaccurate or even dangerous. Additionally, there are relatively few medical apps devoted to prematurity or targeted to women at risk for premature birth. To address the gap in premature birth education, we assembled a multidisciplinary team, including health care professionals, and developed the Preemie Prep for Parents (P3) app., Methods: Our team previously conducted 5 focus group meetings to assess the information needs of our target audience. Based on this information we developed a low fidelity P3 prototype. Our software development team transferred the low fidelity prototype into a high fidelity prototype which was hosted on Test Flight (a beta testing platform). We performed heuristic evaluation as well as user testing to improve the P3 app., Results: User testing of the high fidelity P3 prototype was performed with 13 diverse participants. 6 participants were parents of currently admitted Neonatal Intensive Care Unit (NICU) babies and 7 participants were women who had been or were currently pregnant. The native language of participants included English, Spanish, and Hmong and their educational level varied between completing high school and graduate degree. Participants provided feedback on the content of the P3 app, as well as its organization and aesthetics. The feedback led to 83 iterations of the P3 app prior to its deployment. Overall, participants noted that the information was "informative" and "reliable". They also noted that the P3 app provided control over the information they could view and when they viewed it, stating "I could see info on my time". Overall, participants felt that the P3 app was a valuable tool for mothers in preterm labor and it would help them ask questions., Conclusions: Development of a mHealth app provides unique challenges regarding content, reliability of information, organization, and aesthetics. Creation of the P3 app to address the educational needs of women at risk for premature birth required assembling a multidisciplinary team, which included target users, and implementing an iterative design process. The efficacy of this app in improving user knowledge and decreasing anxiety is currently being tested in a randomized controlled trial., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Parent-clinician shared decision making is the recommended model for the care of premature infants; thus, clinicians provide prenatal prematurity counseling to parents in the event of a mother's hospitalization for premature birth. However, parental understanding of medical jargon commonly used during prematurity counseling is unknown., Methods: Within an overall research agenda to develop and test an educational aid for prenatal prematurity education, we designed the Parental Knowledge of Premature Birth questionnaire. To evaluate parental comprehension of the medical jargon contained within the questionnaire, we conducted cognitive interviews, a formal method for evaluating comprehension and response to questionnaire items. Parents were recruited from a Level IV Neonatal Intensive Care Unit; purposeful recruitment ensured diversity with respect to gender, race, literacy level, and child's gestational age. Data collection and analysis followed standard qualitative methods for cognitive interviewing. We report on the insights gained from these cognitive interviews regarding parental understanding of crucial medical jargon commonly used during prenatal prematurity counseling., Results: Participants included 10 women and 6 men who ranged in age from 23 to 38 years and represented Black/African-American (38%), Asian (6%), and white (56%) backgrounds. Five participants (31%) had less than a high school education or reading level below 9th grade (Wide Range Achievement Test version 4 reading subtest). In the first round of interviews, parents of all education and literacy levels had difficulty with medical jargon commonly used in prematurity counseling. Terms that parents found difficult to understand included "gestational age", "mild or no developmental problems", and "neonatologist". Modified terms tested in a second round of interviews showed improved comprehension., Conclusion: Cognitive interviews provided empirical testing of parental understanding of crucial medical jargon and highlighted that language commonly used during prenatal prematurity counseling is not understood by many parents. For parents to participate in shared decision making, plain language should be used to maximize their understanding of medical information.

Background: Parents at risk for preterm birth frequently receive prematurity education when the mother is hospitalized for premature labor. Parental ability to learn and consider the information is limited because of the stress of the hospitalization. A promising approach is dissemination of information to at-risk parents before the birth hospitalization., Purpose: This article describes formative research used to develop smartphone-based prematurity education app for parents at-risk for preterm birth., Methods: Stakeholders were parents with a prior preterm birth. Using stakeholder meeting transcripts, constant comparative analysis was used to reflect upon the parental voice., Results: The parents named the app, Preemie Prep for Parents (P3). Parent perspectives revealed desire for information in the following 5 categories. (1) Power in knowledge and control: parents want autonomy when learning information that may influence medical decision-making. (2) Content and framing of information: they desire information from a trusted resource that helps promote prenatal health and provides neonatal intensive care information. (3) Displaying content: parents want personalization, push notifications, photographs displaying fetal development, and easy-to-understand statistics. (4) Providing information without causing harm: they desire non-value-laden information, and they do not support "gamifying" the app to enhance utilization. (5) Decision making: parents want information that would benefit their decision making without assuming that parents have a certain outlook on life or particular values., Implications for Practice: These findings support the need for the P3 App to aid in decision making when parents experience preterm birth., Implications for Research: The findings highlight the need to study the effects of smartphone-based prematurity education on medical decision-making.

Error in clinician-parent communication is not a new issue in pediatrics. It has been the impetus behind national initiatives, namely, family-centered rounds. While family-centered rounds have proven effective, their success is dependent on the family being present during rounds. This does not always occur during prolonged hospitalizations, particularly in the Neonatal Intensive Care Unit (NICU). Current communication methods with parents not present during rounds rely heavily on the provider's prerogative and ability to multitask. Thus, errors in communication are commonplace and are largely accepted as inevitable. For the sake of the parents of a patient in the NICU, a high-fidelity communication system is urgently needed. NICUs must move beyond the telephone and use modern innovations in communication technology.

Objective: To develop an educational mobile application (app) for expectant parents diagnosed with risk factors for premature birth., Methods: Parent and medical advisory panels delineated the vision for the app. The app helps prepare for preterm birth. For pilot testing, obstetricians offered the app between 18-22 weeks gestational age to English speaking parents with risk factors for preterm birth. After 4 weeks of use, each participant completed a questionnaire. The software tracked topics accessed and duration of use., Results: For pilot testing, 31 participants were recruited and 28 completed the questionnaire. After app utilization, participants reported heightened awareness of preterm birth (93%), more discussion of pregnancy or prematurity issues with partner (86%), increased questions at clinic visits (43%), and increased anxiety (21%). Participants reported receiving more prematurity information from the app than from their healthcare providers. The 15 participants for whom tracking data was available accessed the app for an average of 8 h., Conclusion: Parents with increased risk for preterm birth may benefit from this mobile app educational program., Practice Implications: If the pregnancy results in preterm birth hospitalization, parents would have built a foundation of knowledge to make informed medical care choices., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: Congenital diaphragmatic hernia (CDH) survivors experience increased risk of medical and neurodevelopmental challenges. This study describes the health-related quality of life (HRQOL), special education utilization and the family impact among neonatal CDH survivors., Methods: A single-center prospective cohort of CDH survivors born between 1995 and 2006 was followed. Parents completed the PedsQL HRQOL index and a Family Impact survey to assess the need for medical equipment, home health services, and special education and quantify the burden placed on the family by their child's medical needs., Results: Parents of 32 survivors participated at a mean survivor age of 8 ± 4 years. Many survivors utilized medical equipment (62%), home health services (18%) and special education (28%). CDH survivor HRQOL (79 ± 17) did not differ significantly from that of healthy children (83 ± 15, p = 0.12). HRQOL was diminished among survivors who required special education (67 ± 8 vs 82 ± 3; p = 0.04) and those reporting increased Family Impact score (p = 0.001)., Conclusion: Many CDH survivors continue to require home medical equipment and home health services at school age. Most survivors have normal parent-reported HRQOL; however, the need for special education and higher family impact of neonatal CDH correlates with decreased HRQOL.

Multimedia improves understanding of information. Professionally developed digital multimedia educational modules are expensive. We tested educational modules developed by a medical student without extensive multimedia production training. The modules were developed with neonatologist collaboration, uploaded to YouTube, and presented via iPad to neonatal intensive care unit family members who were ≥ 18 years, English literate, and unexposed to topic they were reviewing. Thirty-six participants viewed the modules once and then answered topic-specific key questions. Thirty of 36 (83%) of the participants answered 4/4 (100%) of questions correctly and 6/36 (17%) answered three-fourths (75%) correctly, demonstrating success of the educational modules. Health care workers can economically create effective digital multimedia educational materials without extensive training.

Objective: To improve informed medical decision-making, principles for family-centered neonatal care recommend that parents have access to their child's medical record on an ongoing basis during neonatal intensive unit care (NICU) hospitalization. Currently, many NICUs do not allow independent parent access to their child's electronic medical record (EMR) during hospitalization. We undertook a cross-sectional survey pilot study of medical professionals and parents to explore opinions regarding this practice., Study Design: Inclusion criteria: 18-years old, English-literate, legal guardian of patients admitted to the NICU for 14 days. NICU medical professionals included physicians, nurse practitioners, nurses, and respiratory therapists., Result: Medical professionals believed parent access would make their work more difficult, increase time documenting and updating families, making them more liable to litigation and hesitant to chart sensitive information. However, parents felt that they lacked control over their child's care and desired direct access to the EMR. Parents believed this would improve accuracy of their child's medical chart, and increase advocacy and understanding of their child's illness., Conclusion: NICU parents and medical professionals have differing perspectives on independent parental access to their child's EMR. More research is needed to explore the potential of independent parental EMR access to further improve family-centered neonatal care.

The current process of educating and informing parents of the concerns and outcomes of premature infants is suboptimal, mostly because of modifiable factors. Proven methods to improve the transference of information are underused. In most institutions, the task to inform and educate parents is left to individual providers. Effective parent-clinician communication depends collectively on parents, clinicians, and the health care systems. Efforts must focus on improving communication and not on decreasing information provided to parents. If done successfully, we might find new and worthy allies in the trenches of the NICU., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background/purpose: Neonates with significant congenital diaphragmatic hernia (CDH) require cardiopulmonary support. Management has been characterized by progressive abandonment of hyperventilation. Ability to prognosticate outcomes using measures of ventilation and oxygenation with gentle ventilation remains unclear. We sought to determine whether assessment of gas exchange at the time of NICU admission is predictive of survival in this current era., Methods: Neonates with CDH admitted to a Children's Hospital from 1995 to 2006 were evaluated for demographics, blood gas (ABG) measurements and ventilator settings for the first 48hours, and discharge outcome., Results: One-hundred-and-nineteen CDH patients were admitted, 88 (74%) survived. Mean admission ABG pCO2 was higher in infants who died compared to survivors (86±48 versus 49±20, p≤0.001); positive predictive value (PPV) for mortality of pCO2≥80mmHg was 0.71. Mean first hour preductal oxygen saturation (preductalO2Sat) was lower in infants who died compared to survivors (81±17 versus 97±5, p<0.001); PPV for mortality of preductalO2Sat<85% was 0.82. Eleven patients met both pCO2 and preductalO2Sat criteria, and 10 (91%) died, PPV of 0.92. Within hours of admission, pCO2 and preductalO2Sat differences between survivors and nonsurvivors lost significance., Conclusion: Admission pCO2 and preductalO2Sat may be useful in predicting survival in neonatal CDH. The differential in gas exchange between survivors and nonsurvivors loses significance with contemporary neonatal care., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Alveolar capillary dysplasia is a rare and fatal disease of newborn infants. Here we describe a patient with alveolar capillary dysplasia, multiple congenital anomalies, a novel genetic mutation and previously undocumented airway findings on bronchoscopy. Knowledge of these associations may help diagnose this rare disorder in neonates with hypoxemic respiratory failure.

Objective: We studied several counselor-independent elements of prenatal counseling regarding prematurely born infants. Elements studied include: indications to offer counseling, clinical settings in which counseling is offered, personnel assigned to counsel, availability of tools to assist counseling and post-counseling documentation requirements., Method: As the study aimed to explore system-based practices and not counselor-based practices, we surveyed Neonatal Intensive Care Unit medical directors., Result: Responses were received from 352 hospitals (53%) in 47 states. Analysis was based on responses from the 337 hospitals that routinely counseled women anticipating a premature birth. In 299 (≈ 90%) hospitals, counseling was primarily performed by neonatal professionals. Premature labor was the most common indication to offer counseling; however, in 54 hospitals most counseling was offered before labor and based on maternal risk factors for preterm delivery. In nearly all (99.7%) hospitals information was provided verbally and face-to-face; a third of the hospitals also provided written information. For non-English-speaking Hispanic patients, 208 (62%) of the hospitals had certified hospital-based Spanish interpreters. Five (1%) hospitals provided specialized training to the designated prenatal counselors. The upper gestational age eligible for counseling at all 337 hospitals included 33 weeks; in 134 hospitals, gestational age of <23 weeks was not eligible for counseling., Conclusion: Antenatal parental counseling for premature delivery is a widely practiced intervention with substantial system-based variability in execution. Interventions and strategies known to improve overall counseling effectiveness are not commonly utilized. We speculate that guidelines and tool-kits supported by Pediatric and Obstetric professional organizations may help improve system-based practices.

Objective: It is common clinical practice to counsel parents expecting an early-moderate premature birth. The aim of the current study was to assess maternal knowledge of potential problems of prematurity after counseling., Study Design: Prospective study of 49 participants admitted between 23 and 33 weeks gestation with threatened premature birth; a prematurity knowledge questionnaire and the State-Trait Anxiety Inventory were administered after counseling but before delivery., Result: Across all gestational-ages, participants were more aware of short-term problems than long-term problems. With increasing gestational age the knowledge of long-term problems decreased (P=0.01). Maternal knowledge was 82% for gestational ages where clear guidelines exist regarding goal of counseling and information that should be provided to the parents., Conclusion: Most mothers of early-moderate premature infants are not aware of the potential for long-term problems. Guidelines, which outline the information that should be provided to parents, may improve maternal knowledge after counseling.

Objective: To determine if maternal knowledge of prematurity is improved when verbal gestational age-specific counseling is supplemented with written gestational age-specific information., Methods: Prospective, randomized study of 60 pregnant participants assessed to be at risk for premature delivery between 23 and 34 weeks' gestation. Counseling in the control group consisted of gestational age-specific verbal information, and counseling in the intervention group consisted of written gestational age-specific information 1 hour before the verbal gestational age-specific information. Both groups completed a Prematurity Knowledge Questionnaire after counseling and the State-Trait Anxiety Inventory before and after counseling. The Prematurity Knowledge Questionnaire consisted of questions regarding short-term problems (immature lungs, intraventricular hemorrhage, retinopathy, feeding problems, infection, apnea, and jaundice), long-term problems (chronic lung disease, postdischarge respiratory infections, visual impairment, hearing impairment, brain damage, and learning and behavior problems), and numerical outcome data (probabilities of survival, survival without significant morbidity, severe intraventricular hemorrhage, severe retinopathy, and chronic lung disease)., Results: Knowledge of short-term problems was not statistically different between the intervention (82%) and control groups (67%). Knowledge of long-term problems was better in the intervention (71%) than the control group (45%). Knowledge of numerical data was better in the intervention (48%) than the control group (29%). State-Trait Anxiety Inventory scores decreased after counseling in the intervention group., Conclusions: Supplementation of face-to-face verbal counseling with written information improved knowledge of long-term problems and knowledge of numerical outcome data, and it also decreased anxiety in women expecting a premature delivery.

Despite careful investigation, the etiology of many perinatal arterial strokes is unknown. We report on a 5-day-old boy with a cardiac thrombus of prenatal origin resulting in a fatal postnatal stroke. The thrombus was discovered only at autopsy, challenging the assumption of a placental source of embolus in perinatal strokes in the absence of macroscopic and microscopic examination of the heart.

Objective: To evaluate the potential role of tamsulosin in the medical treatment of distal ureteral stones., Material and Methods: Ninety patients with symptomatic distal ureteral calculi were enrolled. They were randomly divided into two groups: Group A (n=45) received diclofenac 100 mg on demand for 4 weeks plus levofloxacin 250 mg daily for the first week and were well hydrated; and Group B (n=45) received the same therapy plus tamsulosin 0.4 mg/daily for 4 weeks. Abdominal ultrasound scans and KUB X-rays were performed weekly. Stone expulsion rates, time to expulsion, pain episodes and analgesic usage were determined. Intervention by means of shock-wave lithotripsy (SWL) or ureteroscopy was evaluated., Results: The stone expulsion rate was 51.1% for Group A, compared to 88.9% for Group B (p=0.001). The average time to expulsion was 12.53+/-2.12 days for Group A and 7.32+/-0.78 days for Group B (p=0.04). The number of pain episodes was significantly lower in Group B and mean use of analgesics was lower for Group B (0.14+/-0.5 vials) than Group A (2.78+/-2.7 vials). Twenty-two patients in Group A failed to pass their stones after 4 weeks but only five in Group B. Of the patients who were not stone-free, 19 were treated with SWL and eight underwent ureteroscopy., Conclusion: Our study reveals the efficacy of tamsulosin for the treatment of distal ureteral stones. Tamsulosin should be added to the standard medical approach for treating these stones.

Purpose: To determine the effects on semen of extracorporeal shockwave lithotripsy for distal-ureteral stones., Patients and Methods: We examined the semen of 62 patients 1 day before and 1 week and 3 months after SWL for distal-ureteral stones. The results were compared with those of 62 patients similarly treated for upper- ureteral stones., Results: Sperm density and motility decreased significantly after SWL for distal-ureteral stones (P < 0.001 for both). Macroscopic hemospermia was reported by 16 patients. These changes were reversed by 3 months. No change was observed after SWL for upper-ureteral stones., Conclusion: Transient deterioration of semen characteristics can be expected after SWL for distal-ureteral stones, which may be attributable to damage to the seminal vesicles or ejaculatory ducts. The changes are transient, and normal semen characteristics are found by 3 months after SWL. The long-term effects in subfertile men warrant further investigation.

Background: Use of sodium bicarbonate (NaHCO3) may result in intracellular acidosis due to the generation of CO2. Carbicarb, has been reported to be superior to sodium bicarbonate (NaHCO3) because of lesser generation of CO2. The present study was designed to investigate whether Carbicarb or NaHCO3 is superior to normal saline in the treatment of hypoxic lactic acidosis., Methods: Hypoxia was induced by ventilation with 8% O(2) in 30 piglets with fixed ventilation. When the pH fell to < 7.2, hypoxia was reversed by placing the animals in 21% O2 (experiment 1) or 100% O(2) (experiment 2) and either saline, Carbicarb or NaHCO3 were given. Data were collected for 120 minutes after therapy., Results: In both experiment 1 (severe acidosis, pH < or = 7.1) and 2 (moderate acidosis, pH < or = 7.2) use of Carbicarb and NaHCO3 increased the arterial carbon dioxide tension (pCO2) significantly (p < 0.05). With moderate acidosis: 1) use of alkalinizing agents compared to saline resulted in an initial improvement in arterial pH at 1 minute, but thereafter, the differences were not statistically significant; and 2) there were no differences in hemodynamic variables and plasma lactic acid concentration between the three groups., Conclusions: The data demonstrate that 1) both Carbicarb and NaHCO3 significantly increase arterial pCO2; and 2) use of either alkalinizing agent in moderate acidosis does not alter the course of acidosis.

We report a new case of Rubinstein-Taybi syndrome with a hypoplastic right kidney, persistent pulmonary hypertension, and mitral valve regurgitation. Other pertinent features included broad thumbs, broad big toes, syndactyly of the third and fourth fingers bilaterally, beaked nose, broad columella of the nose, patent ductus arteriosus, and motor and mental retardation. The testes were descended. The 3 month old patient had delayed motor and mental development corresponding to a 1 month old infant.