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As of 2021 November 29, booster vaccination against SARS-CoV-2 infection has been recommended for all individuals aged 18 years and older in the United States. A key reason for this recommendation is the expectation that a booster vaccine dose can alleviate observed waning of vaccine effectiveness (VE). Although initial reports of booster effectiveness have been positive, the level of protection from booster vaccination is unclear. We conducted two studies to assess the impact of booster vaccination, with BNT162b2 or mRNA-1273, on the incidence of SARS-CoV-2 infection between August and December 2021. We first compared SARS-CoV-2 infection incidence in cohorts of 3-dose vaccine recipients to incidence in matched cohorts of 2-dose vaccine recipients (cohort size = 24,539 for BNT162b2 and 14,004 for mRNA-1273). Additionally, we applied a test-negative study design to compare the level of protection against symptomatic infection in 3-dose recipients to that observed in recent 2-dose primary vaccine series recipients. The 3-dose recipients experienced a significantly lower incidence rate of SARS-CoV-2 infection than the matched 2-dose cohorts (BNT162b2 Incidence Rate Ratio: 0.11, 95% CI: 0.09 to 0.13 and mRNA-1273 IRR: 0.11, 95% CI: 0.08 to 0.15). Results from the test-negative study showed the third vaccine dose mitigated waning of VE, with the risk of symptomatic infection in 3-dose recipients being comparable to that observed 7 to 73 days after the primary vaccine series. These results show that 3-dose vaccine regimens with BNT162b2 or mRNA-1273 are effective at reducing SARS-CoV-2 infection and support the widespread administration of booster vaccine doses.

COVID-19 vaccines are effective, but breakthrough infections have been increasingly reported. We conducted a test-negative case-control study to assess the durability of protection after full vaccination with BNT162b2 against polymerase chain reaction (PCR)-confirmed symptomatic SARS-CoV-2 infection, in a national medical practice from January 2021 through January 2022. We fit conditional logistic regression (CLR) models stratified on residential county and calendar time of testing to assess the association between time elapsed since vaccination and the odds of symptomatic infection or non-COVID-19 hospitalization (negative control), adjusted for several covariates. There were 5,985 symptomatic individuals with a positive test after full vaccination with BNT162b2 (cases) and 32,728 negative tests contributed by 27,753 symptomatic individuals after full vaccination (controls). The adjusted odds of symptomatic infection were higher 250 days after full vaccination versus at the date of full vaccination (Odds Ratio [OR]: 3.62, 95% CI: 2.52 to 5.20). The odds of infection were still lower 285 days after the first BNT162b2 dose as compared to 4 days after the first dose (OR: 0.50, 95% CI: 0.37 to 0.67), when immune protection approximates the unvaccinated status. Low rates of COVID-19 associated hospitalization or death in this cohort precluded analyses of these severe outcomes. The odds of non-COVID-19 associated hospitalization (negative control) decreased with time since vaccination, suggesting a possible underestimation of waning protection by this approach due to confounding factors. In summary, BNT162b2 strongly protected against symptomatic SARS-CoV-2 infection for at least 8 months after full vaccination, but the degree of protection waned significantly over this period.

Mitochondria are central to metabolism, nutrition, and health, but many factors can influence their efficiency. The objectives of this study were to determine if the mitochondrial enzyme activities of citrate synthase, complex I, complex IV, and complex V from peripheral blood mononuclear cells in Holstein and Jersey dairy calves were affected by age or relative gain as a percent of initial weight. Twenty-three Holstein and 23 Jersey heifer calves were enrolled between 3 and 6 d of age and whole blood samples were collected via jugular venipuncture at 1, 2, and 8 wk of age. Crude mitochondrial extracts were obtained from the peripheral blood mononuclear cell fraction at each time point and subsequently assayed for enzymatic activity. Age-dependent changes in activity were observed in complex V for both breeds. In Jersey calves complex IV and citrate synthase activity differed with age. Complex I activity was greater for high relative gain Jerseys and tended to be greater for high relative gain Holstein calves. Holstein calves had greater incidence of scours compared with Jersey calves, and in both breeds scouring calves exhibited greater complex V activity compared with those without scours. These data suggest that age and immune challenge in the form of scours affect mitochondrial complex V activity. Additionally, complex I activity may serve as a marker for calf growth potential because it was influenced by relative gain and not age.

Recent reports on waning of COVID-19 vaccine-induced immunity have led to the approval and rollout of additional doses and booster vaccinations. Individuals at increased risk of SARS-CoV-2 infection are receiving additional vaccine doses in addition to the regimen that was tested in clinical trials. Risks and adverse event profiles associated with additional vaccine doses are currently not well understood.To evaluate the safety of third-dose vaccination with US Food and Drug Administration (FDA)-approved COVID-19 mRNA vaccines.This cohort study was conducted using electronic health record (EHR) data from December 2020 to October 2021 from the multistate Mayo Clinic Enterprise. Participants included all 47 999 individuals receiving 3-dose COVID-19 mRNA vaccines within the study setting who met study inclusion criteria. Participants were divided into 2 cohorts by vaccine brand administered and served as their own control groups, with no comparison made between cohorts. Data were analyzed from September through November 2021.Three doses of an FDA-authorized COVID-19 mRNA vaccine, BNT162b2 or mRNA-1273.Vaccine-associated adverse events were assessed via EHR report. Adverse event risk was quantified using the percentage of study participants who reported the adverse event within 14 days after each vaccine dose and during a 14-day control period, immediately preceding the first vaccine dose.Among 47 999 individuals who received 3-dose COVID-19 mRNA vaccines, 38 094 individuals (21 835 [57.3%] women; median [IQR] age, 67.4 [52.5-76.5] years) received BNT162b2 (79.4%) and 9905 individuals (5099 [51.5%] women; median [IQR] age, 67.7 [59.5-73.9] years) received mRNA-1273 (20.6%). Reporting of severe adverse events remained low after the third vaccine dose, with rates of pericarditis (0.01%; 95% CI, 0%-0.02%), anaphylaxis (0%; 95% CI, 0%-0.01%), myocarditis (0%; 95% CI, 0%-0.01%), and cerebral venous sinus thrombosis (no individuals) consistent with results from earlier studies. Significantly more individuals reported low-severity adverse events after the third dose compared with after the second dose, including fatigue (2360 individuals [4.92%] vs 1665 individuals [3.47%]; P .001), lymphadenopathy (1387 individuals [2.89%] vs 995 individuals [2.07%]; P .001), nausea (1259 individuals [2.62%] vs 979 individuals [2.04%]; P .001), headache (1185 individuals [2.47%] vs 992 individuals [2.07%]; P .001), arthralgia (1019 individuals [2.12%] vs 816 individuals [1.70%]; P .001), myalgia (956 individuals [1.99%] vs 784 individuals [1.63%]; P .001), diarrhea (817 individuals [1.70%] vs 595 individuals [1.24%]; P .001), fever (533 individuals [1.11%] vs 391 individuals [0.81%]; P .001), vomiting (528 individuals [1.10%] vs 385 individuals [0.80%]; P .001), and chills (224 individuals [0.47%] vs 175 individuals [0.36%]; P = .01).This study found that although third-dose vaccination against SARS-CoV-2 infection was associated with increased reporting of low-severity adverse events, risk of severe adverse events remained comparable with risk associated with the standard 2-dose regime. These findings suggest the safety of third vaccination doses in individuals who were eligible for booster vaccination at the time of this study.

Purpose In this prospective, multicenter, 14-day inception cohort study, we investigated the epidemiology, patterns of infections, and outcome in patients admitted to the intensive care unit (ICU) as a result of severe acute respiratory infections (SARIs). Methods All patients admitted to one of 206 participating ICUs during two study weeks, one in November 2013 and the other in January 2014, were screened. SARI was defined as possible, probable, or microbiologically confirmed respiratory tract infection with recent onset dyspnea and/or fever. The primary outcome parameter was in-hospital mortality within 60 days of admission to the ICU. Results Among the 5550 patients admitted during the study periods, 663 (11.9 %) had SARI. On admission to the ICU, Gram-positive and Gram-negative bacteria were found in 29.6 and 26.2 % of SARI patients but rarely atypical bacteria (1.0 %); viruses were present in 7.7 % of patients. Organ failure occurred in 74.7 % of patients in the ICU, mostly respiratory (53.8 %), cardiovascular (44.5 %), and renal (44.6 %). ICU and in-hospital mortality rates in patients with SARI were 20.2 and 27.2 %, respectively. In multivariable analysis, older age, greater severity scores at ICU admission, and hematologic malignancy or liver disease were independently associated with an increased risk of in-hospital death, whereas influenza vaccination prior to ICU admission and adequate antibiotic administration on ICU admission were associated with a lower risk. Conclusions Admission to the ICU for SARI is common and associated with high morbidity and mortality rates. We identified several risk factors for in-hospital death that may be useful for risk stratification in these patients. Electronic supplementary material The online version of this article (doi:10.1007/s00134-015-4206-2) contains supplementary material, which is available to authorized users.

From May to August 1987, 137Cs activity was measured in a total-body counter (4 pi counter) in 33 premature and mature newborns (group I), 40 infants and young children up to 2 4/12 years of age (group II), and 15 children between 3 and 6 8/12 years (group III), all from Bonn or its environs. The mean of measurements in group II, at 3.7 Bq/kg body-weight, was lower than that of group I (5.8 Bq) and III (9.4 Bq). Mean radiation exposure, calculated from these data, was 1.7 mrem/a for group I, 1.1 mrem/a for group II, and 2.8 mrem/a for group III. A comparison with present Cs values in adults and measurements made at the end of the 1950's and beginning of 60's showed good agreement. There were no significant differences, as regards Cs activity, between newborns or infants who had been formula-fed or breast-fed. The measured radiation exposure of the three groups is about 1% of natural radiation exposure. Thus, present-day results indicate that there will be no damage to health outside the natural scatter.

Recruiting and retaining an adequate nursing workforce is a priority as well as a challenge, and creating an environment that respects every individual's unique differences is key. The authors describe a method for gauging organizational readiness to respond to this challenge. The Diversity Competency Model is used to conduct an in-depth assessment of one nursing organization's diversity initiatives. Leadership commitment, structural linkages, organizational culture, and continuous measurement constitute the Diversity Competency Model assessment. The authors discuss the model and its use.

Four portable analyzers, HemoCue B-Glucose (I), Accu-Check III (II), One-touch II (III), and Glucometer Elite (IV), with different measuring principles were tested for their suitability for measuring blood glucose in neonates. Precision of all instruments is satisfactory. In the analysis of capillary blood from newborns, two instruments show an excellent accuracy; however, the scatter of the results for instrument (II) is about 1.6 times greater than for instrument (I). The inaccuracy of instruments (III) and (IV) is not acceptable from a clinical point of view. All devices show an influence of hematocrit, the magnitude of which varies between 5% (I) and 12% (III) for every 10% change of hematocrit. Instruments II and IV show that temperature has a marked influence on the readings; the same is true for oxygen in instrument IV. In conclusion, only instrument (I) has met the requirements of accurate and precise blood glucose determinations in neonates.

The breastfeeding experience of a mother and her preterm conjoined twins is described. Assisting the mother in achieving her breastfeeding goal presented unusual nursing-care problems in securing, positioning, and comforting the twins. This case report emphasizes the individualized support provided to this mother and her infants, which was a critical factor in their breastfeeding success.

Pregnancy complicated by insulin-dependent diabetes mellitus carries severe physiologic risks for both the mother and the fetus. This article presents a case study to illustrate disease progression through multiple systems and psychosocial complications associated with diabetes mellitus in pregnancy. The case study also illustrates the role of nursing interventions, the use of technology, and interdisciplinary collaboration in caring for the patient and her family.

With the reflectance meter Reflolux S (Accucheck III) high as well as low blood glucose levels can be determined with excellent precision irrespective of the sample's hematocrit value. Within the range from 20-50 mg/dl we found an average deviation from the expected value of less than 2 mg/dl; in selected samples, however, a difference of up to 10 mg/dl was recorded. The scatter can be explained by the influence of hematocrit values on the results. An increase of 10% in hematocrit lowered the measured glucose value by approximately 10%. At glucose concentrations below 40 mg/dl and in the presence of high resp. low hematocrit values any results obtained with this glucose meter will only have screening character; they should be re-run using an established method.

Cesium 137 activity was measured after the Chernobyl incident in a whole-body radiation counter (4-π-scintillation counter) in 85 premature and mature newborns (group 1), 174 infants and young children up to 2 11/12 years (group 2), and 48 children between 3 and 8 years (group 3) from Bonn (Germany) and surroundings. In 1987 the mean level of radioactivity in group 2, at 3.7 Bq/kg body weight corresponding to a mean radiation exposure of 11 µSv/y, was lower than that of group 1 (5.8 Bq/kg, 17 µSv/y) and 3 (9.4 Bq/kg, 28 µSv/y). Up to 1990 the values of all groups revealed a continuous decrease. The latest measurements showed mean values of 0.5 Bq/kg (1.5 µSy/y) in group 1, 0.6 Bq/kg (1.8 µSv/y) in group 2, and 0.8 Bq/kg (2.4 µSv/y) in group 3. A comparison with present cesium 137 values and determinations at the end of the 1950s and beginning of 1960s, both in adults, showed good agreement. The effective dose-equivalent rates amounted to less than 1% of that from natural radiation exposure. These levels should present no teratogenic risks to the population studied and, while there are theoretical mutagenic risks, the dose is so low that no increase in measurable mutagenic effects should be observed.

Objective To compare the efficacy of two available preparations (heparin, 10 U/mL, 1 mL, vs. normal saline, 1 mL) used for maintaining patency in peripheral intravenous (IV) locks during pregnancy. Design Prospective, randomized, and double-blind. Eligible patients who were to receive a peripheral intermittent IV lock were randomly assigned to receive either heparin flushes or normal saline flushes for IV lock maintenance. IV locks were flushed after each medication administration, or at least every 24 hours, with the assigned blinded flush solution. Intermittent IV lock sites were also evaluated every 12 hours for the development of phlebitis. Setting A large academic medical center in the Midwest that has both community-based and regional-referral obstetric practices with more than 2,000 deliveries per year. Participants A convenience sample included 73 hospitalized pregnant women who were between 24 and 42 weeks gestation. Exclusions from the study were women with significant abnormalities in the fetal heart tracing on admission, cervical dilation > 4 cm, presence of hypersensitivity to heparin, presence of clotting abnormalities, and anticoagulation therapy (including low-dose aspirin). Results Data indicate there were no statistically significant differences in IV lock patency nor in phlebitis between heparin or normal saline flushes. Conclusions This study provides support that both normal saline and heparin in the doses studied may be equally effective in the maintenance of peripheral IV locks. Due to small sample size, additional studies are needed to determine optimal therapy over time.

A pregnant woman with post-term birth developed a varicella rash on the day, when birth was to be initiated. The date was then postponed, until varicella zoster virus (VZV) IgG-antibodies could be proved in the mother, so as to allow the child to achieve an adequate diaplacental passive immunisation. Cesarean section was performed on the 7th day after the rash, but a comparison of the child's blood (from the umbilical cord) with the mother's blood showed, that the VZV antibodies developed by the mother during this time were only present in a tenfold reduced amount in the child. Antibodies to herpes simplex virus, already present in the mother's blood before the VZV infection, also increased because of the close relationship of the virus to VZV. Similar to the VZV antibodies, these antibodies did not increase in the baby as in the mother. Our results show that maternal antibodies are not transferred rapidly to the baby, and therefore it seems reasonable, that in the case of chickenpox at the time of delivery, the birth should be delayed, not only until seroconversion in the mother's blood, but - if possible - a few days longer.

In 2018 consecutive newborn ultrasound examination of the hip was performed according to the method of Graf within the first 14 days of life (average 4th day). Typ IIa was seen as normal in newborn child. Birth weight was classified according to standards of Lubchenco and Hohenauer. Newborn with high birth weight (LGA) revealed an incidence of CDH (Typ IIc according to Graf or worse) nearly twice as high as in normal weighted newborn (AGA) (6.11% vs 3.51% [Lubchenco] and 7.95 vs 3.09 [Hohenauer]). Even in children with birth weight between 75th and 90th percentile we found a CDH incidence of 5.54%. Ultrasound examination of the hip is suggested in newborn children with high birth weight because of a higher risk for development of a CDH. Other risk-factors like breech position or of CDH.

Four portable analyzers, HemoCue B-Glucose (I), Accu-Check III (II), One-touch II (III), and Glucometer Elite (IV), with different measuring principles were tested for their suitability for measuring blood glucose in neonates. Precision of all instruments is satisfactory. In the analysis of capillary blood from newborns, two instruments show an excellent accuracy; however, the scatter of the results for instrument (II) is about 1.6 times greater than for instrument (I). The inaccuracy of instruments (III) and (IV) is not acceptable from a clinical point of view. All devices show an influence of hematocrit, the magnitude of which varies between 5% (I) and 12% (III) for every 10% change of hematocrit. Instruments II and IV show that temperature has a marked influence on the readings; the same is true for oxygen in instrument IV. In conclusion, only instrument (I) has met the requirements of accurate and precise blood glucose determinations in neonates.

Pregnancy complicated by insulin-dependent diabetes mellitus carries severe physiologic risks for both the mother and the fetus. This article presents a case study to illustrate disease progression through multiple systems and psychosocial complications associated with diabetes mellitus in pregnancy. The case study also illustrates the role of nursing interventions, the use of technology, and interdisciplinary collaboration in caring for the patient and her family.

With the reflectance meter Reflolux S (Accucheck III) high as well as low blood glucose levels can be determined with excellent precision irrespective of the sample's hematocrit value. Within the range from 20-50 mg/dl we found an average deviation from the expected value of less than 2 mg/dl; in selected samples, however, a difference of up to 10 mg/dl was recorded. The scatter can be explained by the influence of hematocrit values on the results. An increase of 10% in hematocrit lowered the measured glucose value by approximately 10%. At glucose concentrations below 40 mg/dl and in the presence of high resp. low hematocrit values any results obtained with this glucose meter will only have screening character; they should be re-run using an established method.

A pregnant woman with post-term birth developed a varicella rash on the day, when birth was to be initiated. The date was then postponed, until varicella zoster virus (VZV) IgG-antibodies could be proved in the mother, so as to allow the child to achieve an adequate diaplacental passive immunisation. Cesarean section was performed on the 7th day after the rash, but a comparison of the child's blood (from the umbilical cord) with the mother's blood showed, that the VZV antibodies developed by the mother during this time were only present in a tenfold reduced amount in the child. Antibodies to herpes simplex virus, already present in the mother's blood before the VZV infection, also increased because of the close relationship of the virus to VZV. Similar to the VZV antibodies, these antibodies did not increase in the baby as in the mother. Our results show that maternal antibodies are not transferred rapidly to the baby, and therefore it seems reasonable, that in the case of chickenpox at the time of delivery, the birth should be delayed, not only until seroconversion in the mother's blood, but - if possible - a few days longer.

Fragestellung: Durch eine streng normoglykamische Stoffwechseleinstellung der schwangeren Diabetikerin kann die perinatale Mortalitat und Morbiditat gesenkt werden und das Auftreten einer ausgepragten Makrosomie (Fetopathia diabetica) verringert werden. Wahrend die Stoffwechselsituation der Schwangeren durch ein erweitertes Blutzuckertagesprofil und die Bestimmung von HbAlc bzw. Fructosamin gut charakterisiert werden kann, fehlen vergleichbare Kriterien fur die objektive Beurteilung der Neugeborenen.

Age specific IgE reference values were determined in serum of 224 children by the aid of the ImmunoCAP fluorescence enzyme immunoassay method.Cord blood: less than 0.35 kU/l; Till 0.5 year: less than 2.0 kU/l; 0.5-2 years: up to 3.8 kU/l; 2-5 years: up to 16.0 kU/l; 5-8 years: up to 26.2 kU/l; 8-12 years: up to 34.6 kU/l; 12-16 years: up to 26.3 kU/l. These IgE reference values can be used for the diagnosis of pathological elevated IgE concentrations in serum of children.

Cesium 137 activity was measured after the Chernobyl incident in a whole-body radiation counter (4-pi-scintillation counter) in 85 premature and mature newborns (group 1), 174 infants and young children up to 2 11/12 years (group 2), and 48 children between 3 and 8 years (group 3) from Bonn (Germany) and surroundings. In 1987 the mean level of radioactivity in group 2, at 3.7 Bq/kg body weight corresponding to a mean radiation exposure of 11 muSv/y, was lower than that of group 1 (5.8 Bq/kg, 17 muSv/y) and 3 (9.4 Bq/kg, 28 muSv/y). Up to 1990 the values of all groups revealed a continuous decrease. The latest measurements showed mean values of 0.5 Bq/kg (1.5 muSv/y) in group 1, 0.6 Bq/kg (1.8 muSv/y) in group 2, and 0.8 Bq/kg (2.4 muSv/y) in group 3. A comparison with present cesium 137 values and determinations of the end of the 1950s and beginning of 1960s, both in adults, showed good agreement. The effective dose-equivalent rates amounted to less than 1% of that from natural radiation exposure. These levels should present no teratogenic risks to the population studied and, while there are theoretical mutagenic risks, the dose is so low that no increase in measurable mutagenic effects should be observed.

We report on 79 pregnancies in 66 female outpatients with epilepsy. An increase of seizure frequency was significantly more frequent in complex partial seizures than in grand mal seizures and in absences. The reason for these disparities are not clear. In most patients a raised frequency of seizures during pregnancy decreased again after delivery. Carbamazepine was the antiepileptic drug prescribed most frequently followed by valproic acid. The course of the blood levels of carbamazepine and valproic acid was nonuniform during pregnancy. Total concentrations of carbamazepine in cord blood were on average 84.5% of those in maternal blood (n = 22). Valproic acid blood levels were on average 183% of those in maternal blood (n = 15). It is still unclear whether these differences are clinically relevant. During the last weeks of pregnancy we found an increase of the free fraction of carbamazepine and valproic acid. Simultaneously the total protein concentration decreased. Until now these findings are without clinical relevance. The course of labor did not differ from normal population concerning the ratios of spontaneous labor, cesarean section and delivery by forceps. Miscarriage and perinatal mortality were 2.7% each and outnumbered the risk in the general population. In 42.8% of the neonates one to three perinatal complications were observed. The ratio of perinatal complications is not different between patients with monotherapy and combined therapy respectively. There was a tendency to lower values of length, weight and head circumference in the male neonates but not in the female neonates. The risk of minor malformations was 26%, the risk of major malformations was 14% (including one case of suspected malformation) without a discernible correlation with a specific antiepileptic drug.

In der vorliegenden Arbeit wird der gegenwartige Kenntnisstand hinsichtlich einer optimalen neonatalen Betreuung des Neugeborenen der diabetischen Mutter aus padiatrischer Sicht anhand der Literatur umrissen. In den einzelnen Kapiteln finden sich detaillierte Angaben zur Morbiditat, wobei die diagnostischen Methoden und die Therapie ausfuhrlich dargestellt werden. Weiterhin wird der Versuch einer Bestandsaufnahme der aktuellen Morbiditat und perinatalen Mortalitat in Deutschland gemacht. Bei wenig neueren Publikationen zu diesem Thema stutzt sich die Arbeit im wesentlichen auf 2 reprasentative grose Studien, die im Vergleich ausgewertet wurden. Ungeloste Probleme sind weiterhin die Makrosomie und Hypoglykamie sowie die Spatprognose. Es zeigt sich ein deutlicher Ruckgang der perinatalen Mortalitat und Morbiditat von 1980–1990, der dem internationalen Niveau entspricht. Als Voraussetzung dafur hat sich eine regionalisierte/zentralisierte Betreuung der Diabetikerinnen mit Kinderwunsch durch ein spezialisiertes Team von Internisten, Gynakologen und Padiatern erwiesen. Wie die Analyse aber auch zeigt, weicht die gegenwartige Praxis mit der Betreuung und Entbindung der schwangeren Diabetikerinnen von den geforderten Standards und dem bewahrten Prinzip erheblich ab. Durch diese Dezentralisierung fehlen auch Daten fur eine kindliche Morbiditatsstatistik zur Qualitatskontrolle. In Entbindungskliniken ohne ausreichende Spezialerfahrung ist die perinatale Mortalitat am hochsten. Nur reprasentative statistische Ergebnisse des Padiaters, der das letzte Glied in der Behandlungskette ist, konnen im Feedback mit Internisten und Gynakologen das Management des Diabetes in der Schwangerschaft beeinflussen.

Es wird uber 4 eigene Beobachtungen einer freien Trisomie 22 berichtet, wobei ein Fet ein Mosaik aufwies. In drei Fallen wurde die Diagnose im ersten, in einem Fall im dritten Trimenon gestellt. Es lies sich jeweils ein charakteristisches Fehlbildungs- bzw. Retardierungsmuster im embryonalen und extraembryonalen Gewebe erkennen. Unsere Befunde belegen die unterschiedliche Haufigkeit einzelner Chromosomenstorungen in verschiedenen Entwicklungsperioden der Schwangerschaft. Four cases of trisomy 22 in different stages of pregnancy are reported, one of them showing a mosaicism. The diagnosis was made in three of the observations during the first trimenon, in one in the third trimenon. A typical pattern of malformations of developmental retardation could be demonstrated in the embryonic as well as in the extraembryonic tissues. Our findings confirm the different frequency of the single chromosome abnormality in the various stages of development in pregnancy.

Based on a case report of a 19-year-old woman with Hodgkin's disease in pregnancy and on several casuistic communications and comparative studies from the literature the problems of cytostatic therapy in pregnancy are discussed. The following conclusions may be drawn: Cytostatic therapy in varying combination seems not to be associated with a damage to the fetus, even when applied in the first trimester of pregnancy. Fetal disturbances occurred almost exclusively under a combination chemotherapy and radiation therapy. In the case observed by us a combination chemotherapy with adriblastin, vincristine and prednisone was successfully applied from the 28th week of pregnancy on. The child showed no disturbances apart from a slight degree of intrauterine growth retardation which must also be seen in connection with a severe anemia of the mother or her nicotine abuse.

A case of prenatally diagnosed non-immune hydrops fetalis, that was later shown to be caused by listeriosis, is presented, and the clinical course, as well as the appropriate diagnostic and therapeutic procedures are described. We conclude, that listeriosis should be excluded, whenever a non-immune hydrops fetalis is associated with septicemia, influenza-like illness and fever of unknown origin.

Summary: The serum valproic acid levels of 18 maternity patients at the time of delivery were compared with the valproic acid levels in the umbilical cord serum. The levels in the umbilical cord serum were 1.1–4.6 times higher than those in the maternal serum, with a mean value of 1.38. One explanation for this difference apparently is an increased protein binding of valproic acid in the infant's serum. Protein binding was determined in nine patients, in six by equilibrium dialysis and in three by ultrafiltration. The median value of the free fraction of valproic acid was 9.1% (range, 5.8–16.4%) in the umbilical cord serum (equilibrium dialysis) and 15% (range, 12.7–35.3%) in the maternal serum. The difference between the infant and the maternal serum is significant. RESUME Les niveaux seriques ďacide valproique de 18 patientes ďune maternitye au moment de Ľaccouchement ont ete comparees aux niveaux de Ľacide valproique dans le serum du cordon ombilical. Ces derniers etaient de 1,1 a 4,6 fois plus eleves dans le serum maternel, en moyenne 1,38 fois. Cette difference peut apparem-ment s'expliquer par une augmentation de la liaison proteique de Ľacide valproique dans le serum du nouveau-ne. La liaison proteique a ete determinee chez 9 patients, par dialyse aĽequi-libre chez 6, et par ultra filtration chez 3. La valeur mediane de la fraction libre ďacide valproique dans le serum du cordon (dialyse a Ľequilibre) etait de 9,1% (de 5,8 a 16,4), et dans le serum maternel de 15% (de 12,7 a 35,3). Cette difference est significative. Les valeurs medianes de la fraction libre ďacide valproique etaient de 9,1% (de 5,8 a 16,4) dans le serum du cordon (dialyse aĽequilibre) et de 15% (de 12,7 a 35,3) dans le serum maternel. Cette difference entre le serum de la mere et celui du nouveau-ne est significative. RESUMEN Se han comparado los niveles sericos de acido valproico en 18 parturientas, con los niveles en el suero del cordon umbilical. Los niveles en el cordon fueron 1.1–4.6 veces mas altos que los niveles en la sangre materna con un valor medio de 1.38. Apar-entemente la explicacion de esta diferencia se basa en un au-mento de la union del acido valproico a las proteinas en el suero del nino. Esta union a las proteinas fue determinada en 9 pa-cientes, en 6 mediante dialisis en equilibrio y, en tres, mediante ultrafiltracion. El valor medio de las tres fracciones del acido valproico en el suero del cordon umbilical (dialisis en equilibrio) fue 9.1% (5.8–16.4). y en el suero materno 15% (12.7–35.3). La diferencia entre los sueros del nino y de la madre es significativa. ZUSAMMENFASSUNG Bei 18 Patientinnen wurde der Valproinsaure-Serumspiegel zum Zeitpunkt der Entbindung mit dem Valproinsaure-Spiegel im Nabelschnurserum verglichen. Der Valproinsaure-Spiegel im Nabelschnurserum war 1.1–4.6 mal hoher als im mutterlichen Serum mit einem Medianwert von 1.38. Einer der Grunde fur diese Differenz ist offenbar die hohere Eiweisbindung der Val-proinsaure im kindlichen Serum. Sie wurde bei 9 Patientinnen bestimmt, 6 mal mit Hilfe der Gleichgewichtsdialyse, 3 mal durch Ultrafiltration. Der Medianwert des freien VPA-Anteils im Nabelschnurserum (bei Gleichgewichtsdialyse) betrug 9.1% (5.8–16.4%), im mutterlichen Serum 15% (12.7–35.3%). Der Unterschied zwischen kindlichem und mutterlichem Serum ist signifikant.

A prenatal chromosome analysis for a parental Robertsonian translocation 13/14 is absolutely imperative. In the present case of a twin pregnancy, it was possible to present the chromosome complement of only one foetus. Since this foetus showed the Robertsonian translocation in the same form as the phenotypically healthy mother, and since the ultrasound findings were normal, it was concluded that foetus I was normal. Further measures for the cytogenetic analysis of foetus II were abandoned after the first amniotic sample could not be analysed. At the time of the amniocentesis this child was retarded when compared to foetus I. Since the life expectancy of a possibly chromosomally unbalanced child is slight, it was not necessary for the parents to take further steps. During the rest of the pregnancy however, this difference in the development of the children evened out unexpectedly and two phenotypically healthy children were born. The implications of a delayed growth rate as an indication of abnormal foetal development are discussed.

The determination of bilirubin in serum was performed by the 2.5-dichlorphenyldiazonium method (DPD) and in capillary plasma by the direct photometric method (DPM). Both methods showed a good precision and accuracy. The investigation was carried out in 135 samples with a bilirubin concentration up to 25 mg/dl. The comparison of the two methods in 62 samples with a bilirubin concentration up to 10 mg/dl showed a correlation coefficient of r = 0.862 and in 73 samples with a bilirubin concentration between 10 and 25 mg/dl a correlation coefficient of r = 0.893. In 29 cases (21.5%) we found differences between the two methods of 1.5-4.0 mg/dl. Most of them were in the critical higher range. Discussion of the DPD and DPM methods.

Valproic acid (VPA) concentrations were measured by a sensitive and highly specific gas chromatographic/mass spectrometric assay in breast milk from 16 patients treated with VPA during 17 lactation periods. The range of VPA levels in 36 breast milk samples was 0.4-3.9 micrograms/ml (mean 1.9 +/- 1.2 microgram/ml). During the investigations of breast milk it was found that the concentration of total VPA in breast milk was not much higher than that of unbound VPA. These findings agree with clinical observations of infants fed with milk from VPA-treated mothers.

Non-immunologic hydrops fetalis-a review of 31 cases: 31 Patients with non-immunologic hydrops fetalis (NIHF) seen between 1984 and 1987 are described. 13 infants survived. The infants with major congenital malformations and connatal infections died. In 8 of the patients who died a cause for NIHF could not be identified. 10 of the survivors presented chylous ascites and/or chylothorax without major congenital anomalies. 2 infants had fetal tachyarrhythmia and 1 patient showed severe anemia due to fetomaternal hemorrhage.

Populations of the sand dollar Dendraster excentricus (Eschscholtz) occur in different habitats along the west coast of the USA. Two subtidal populations from the San Diego, California, area, one from an exposed coastal location and a second from a protected tidal channel, were compared for several aspects of their population and reproductive biology. Both populations demonstrated a similar schedule of reproductive activity with peak gonad volumes occurring in the early spring. However, population reproductive readiness and individual reproductive effort and size varied considerably between the populations; individuals in the protected tidal channel were larger and produced proportionately larger gonads with ripe gametes for a longer period, than those on the exposed coast. The differences between the populations are explained by the greater demands of the rigorous exposed habitat for maintenance at the cost of reproductive effort and growth.

Beds of Halophila decipiens Ostenfeld, at depths between 15 and 27 m, were studied using a saturation diving facility (NULS-1: Hydrolab) in the Salt River submarine canyon off St. Croix, US Virgin Islands. Distribution, biomass, production and decomposition of the seagrass were studied during two missions in June 1983 and July 1984. Biomass of H. decipiens ranged from 5 to 12 g m−2 during summer months. Due to the rapid turnover of H. decipiens, biomass distribution was closely related to concurrently measured growth rates. Production estimates using oxygen production techniques or rhizome elongation were similar ranging between 100 and 500 mg C m−2 day−1. Decomposition of H. decipiens occurred rapidly, losing over 50% of its original weight in approximately 3 days. Under most conditions, weight loss from litter bags occurred more rapidly than nitrogen loss. H. decipiens exhibits a number of adaptations to a low ambient light environment, including a high ratio of leaf tissue to non-photosynthetic tissue, low leaf area index to reduce self-shading, high turnover leaf material and the ability to rapidly colonize sandy bottoms when light conditions are suitable.

Submarine canyons may be particularly important in the transport process of drift seagrasses and seaweeds from highly productive shallow lagoon areas to deeper water. We studied the composition, export, and faunal utilization of shallow, nearshore benthic vegetation as it was transported to offshore areas via the Salt River submarine canyon on the island of St Croix, U.S. Virgin Islands. The study was conducted using a saturation diving system (NULS-1: Hydrolab) during two missions in April and August, 1980. Using bottom drifters deployed in Salt River Bay and the submarine canyon, we recorded net benthic current flow up to 2 cm s−1 moving out of the lagoon and down the canyon to deeper water. Using bottom nets set up at the canyon head and at the 29 m isobar, and from transect surveys and drift clump samples, we determined drift plant export rates and drift clump biomass and species composition. The dominant drift plants were Thalassia testudinum and Syringodium filiforme and algae in the genera Dictyota, Dictyopterus, and Diloplus. During the second mission, the seagrass Halophila decipiens became more abundant, both in the drift and in large patches along the canyon floor. In both missions, more drift was collected in the nets during high wind conditions than during calmer days. Calculated turnover times ranged from 0·01 to 4·4 days for algae in the order Dictyotales and 4·4 to 18 days for Thalassia blades. Total exported biomass of drift vegetation varied between 1·4 to 65·1 kg wet wt day−1. Samples of drift vegetation contained mostly juvenile forms of both invertebrates and fishes, but in relatively low numbers. Faunal numbers were most strongly related to rate of drift movement.