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We present a case of an infant born to a mother with COVID-19, who at 24 hours of life was treated with a glycerin suppository for failure to pass meconium and went on to develop bilious emesis and abdominal distention as feeding continued over the next several hours. After a barium enema identified the distal obstruction, the pediatric surgical team used rectal irrigation to remove a large meconium plug, which mimicked the appearance of the descending colon on plain film, in a case of small left colon syndrome. Although intestinal obstruction in the newborn is rare, it is imperative that it is promptly diagnosed and treated appropriately to avoid negative outcomes; which, even in perhaps the mildest form of functional distal obstruction, meconium plug syndrome, can lead to an impressive clinical illness with risk of intestinal perforation and subsequent meconium peritonitis if the obstruction is not relieved.

PDF file - 343KB, Marker Validation of Differentiated Cells.

PDF file - 123KB, K14 loss is coincidental with integrin a6 loss.

PDF file - 134KB, Constitutive Myc expression leads to cell death after differentiation.

Quick response (QR) codes allow for quick and easy accessibility of just-in-time training (JiTT) for a variety of online materials. They are becoming more widely utilized to share educational materials, with potential vast applications for health professions education. In this article, we describe the development of a novel video-based equipment skills training curriculum incorporating QR codes and discuss the broader implications for educators.

In preterm infants, the goal of aggressive extrauterine nutritional management is to mimic in utero growth and nutrient accretion. Over the latter half of the 20th century, nutritional optimization through the practice of fortifying human milk rose to practice with increased survival rates in preterm infants of younger gestational age. The quest for optimal preterm fortification and nutrition remains a contentious area of debate. This review aims to summarize the historical perspectives of human milk fortification as well as the current literature advocating for the use of liquid human milk fortifiers in enterally fed premature infants.

Background Serratia marcescens is a well-known cause of nosocomial infectious outbreaks in the neonatal intensive care unit, with a high mortality rate in the vulnerable preterm population. However, it is not typically associated with neonatal sepsis secondary to intrapartum vertical transmission. We present the case of a preterm male born at 25 weeks and 4 days of gestation in Okinawa, Japan with culture-proven S. marcescens chorioamnionitis and sepsis, as well as a review of the previously published literature. Methods We conducted a literature search utilizing MeSH indexing with the headings [chorioamnionitis], [Serratia], and [infant, newborn] limited to "humans" with a publication date range between 1950 and 2020. Results All reported cases of preterm S. marcescens chorioamnionitis occurred in coastal locations. The majority of cases resulted in spontaneous abortion, and we found no published reports of confirmed S. marcescens chorioamnionitis in conjunction with viable preterm delivery and positive neonatal cultures. In the case presented herein, S. marcescens chorioamnionitis with associated neonatal sepsis was confirmed by positive placental and blood cultures. Bacterial clearance was achieved following an antibiotic course consisting of 5 days of gentamicin and 14 days of meropenem therapy. Conclusions S. marcescens is an uncommon cause of chorioamnionitis that can have devastating neonatal consequences, especially in the at-risk preterm population.

OBJECTIVE: The goal of this study was to determine if a previously observed axis of placental gene expression associated with early onset and severe preeclampsia (EOSPE) was operative in term pregnancy and correlated with vitamin D sufficiency. METHODS: qPCR analysis of Nkx2-5, Sam68, sFlt-1 and membrane bound VEGFR1/Flt-1 mRNA expression was conducted in placentas from 43 subjects enrolled in a vitamin D3 pregnancy supplementation trial. Pair-wise rank order correlations between patient-specific gene expression levels were calculated, and their relationship to maternal 25(OH)D status was assessed by a two-sample Wilcoxon test. Additionally, we probed the mechanistic link between Sam68 and sFlt-1 using siRNA depletion in a human trophoblast cell line model. RESULTS: Positive and highly significant correlations were found between Sam68 vs. sFlt-1 and Sam68 vs. Flt-1 expression levels, as were significant and differential correlations between the expression of these genes and perinatal 25(OH)D status. The variability when stratified by race/ethnicity was qualitatively distinct from those previously observed in EOSPE. Mechanistic studies confirmed a functional role for Sam68 protein in the regulation of sFlt-1 expression. Nkx2-5 expression was not significantly correlated with sFlt-1 or Sam68 expression in these samples, suggesting that its e may be mainly operative at earlier stages of pregnancy or be restricted to pathological settings. CONCLUSIONS: These data further support our overarching hypothesis that Sam68 expression is a key determinant of VEGFR1 isoform expression in the placenta, and provide additional insights into how this gene pathway may be differentially deployed or modified in normal and pathological pregnancy.

1. Shannon E. Brockman, MD*,† 2. Katherine M. Ottolini, MD†,‡ 3. Elizabeth V. Schulz, MD†,‡ 1. *United States Navy Medicine Readiness and Training Command Okinawa, Okinawa, Japan 2. †Department of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 3. ‡Department of Neonatology, 18th Healthcare Operations Squadron, Kadena AB, Okinawa, Japan A newborn girl is noted to have a midline lumbar depression at birth. She is twin A born by uncomplicated vaginal delivery at 38 weeks and 5 days of gestation to a 31-year-old gravida 2, now para 3 mother after dichorionic/diamniotic twin pregnancy via in vitro fertilization. The pregnancy was otherwise complicated by diet-controlled gestational diabetes and maternal history of herpes simplex virus without lesions or prodromal symptoms at the time of delivery. Maternal medications during pregnancy included prenatal vitamins and valacyclovir prophylaxis. The infant transitions well and requires only routine care at the time of delivery. Her initial physical examination reveals a circumferential 1 × 0.5-cm punched-out, skin-covered lesion overlying the midline spine at the level of L4-L5 vertebrae with surrounding dermal melanocytosis extending from the midline to the left flank (Fig 1). The examination findings are otherwise normal, with appropriate tone for age, symmetrical movement of all extremities, and intact neonatal reflexes. Spinal ultrasonography is performed on the second day after birth because of the cutaneous findings and is notable for a low-lying spinal cord with conus termination at the level of L3-L4 with a thickened appearance of the filum terminale. Head ultrasonography is also performed, and findings are normal. Figure 1. Photograph demonstrating a punched-out lesion with a melanocytic area overlying lumbar and sacral region skin. This photograph has not been enhanced or altered in any way. ### Differential Diagnosis The differential diagnosis of a punched-out skin lesion overlying the lumbar region includes, but is not limited to, a lumbosacral dimple, vascular malformation, skin atrophy, cutis aplasia, dermal sinus, and ulcerative or necrotizing skin infection. A sacral dimple is a depression in the skin of the lower back, typically occurring just above the crease between the buttocks. Lumbosacral dimples are common in newborn infants and are usually normal anatomic variants when solitary …

A male infant is born at 36 2/7 weeks’ estimated gestational age to a 30-year-old, gravida 1, para 1 woman who is blood group O positive with negative prenatal serologies. Maternal history is significant for a body mass index greater than 30 kg/m2 and elevated 1-hour glucose tolerance screening result but a normal result on 3-hour glucose tolerance screening. Serum analyte screening demonstrates an elevated trisomy 21 risk (1:70) with normal cell-free DNA (46X,Y) and anatomy scan at 20 weeks’ gestation. The woman presents with decreased fetal movement and receives a single dose of betamethasone 4 hours before delivery. The delivery is via primary cesarean section for nonreassuring fetal heart rate tracing with difficult extraction requiring vacuum assistance. In the delivery room, Apgar scores are 7 at 1 minute and 8 at 5 minutes. Growth parameters are appropriate for gestational age. The infant develops respiratory distress requiring continuous positive airway pressure (CPAP) and is admitted to the NICU for further care. A blood specimen is obtained for culture and ampicillin and gentamicin therapy are initiated because of hypoglycemia and respiratory distress. At 4 hours after birth, he develops gross hematuria with passage of small, bright-red blood clots. A firm, discrete left flank mass is noted on physical examination. In addition, the examination reveals a grade I/VI systolic murmur with normal pulses and perfusion. Phototherapy is initiated 10 hours after birth for pathologic jaundice, with a total serum bilirubin level of 8.8 mg/dL (150.5 μmol/L) and conjugated bilirubin of less than 0.2 mg/dL (

Bronchopulmonary dysplasia (BPD) is a chronic lung disease commonly affecting extremely preterm infants. Although mechanical ventilation and oxygen requirements in premature infants are identified as inciting mechanisms for inflammation and the development of BPD over time, data now support an array of perinatal events that may stimulate the inflammatory cascade prior to delivery. Corticosteroids, such as dexamethasone and hydrocortisone, have proven beneficial for the prevention and management of BPD postnatally due to their anti-inflammatory characteristics. This review aims to examine the pharmacologic properties of several corticosteroids, appraise the existing evidence for postnatal corticosteroid use in preterm infants, and assess steroid management strategies to ameliorate BPD. Finally, we aim to provide guidance based on clinical experience for managing adrenal suppression resulting from prolonged steroid exposure since this is an area less well-studied.

Die Stadt Lodz gehorte zur Zeit meiner Geburt im Oktober 1905 infolge der letzten polnischen Teilung zum russischen Reich. Sie hatte sich im Laufe der letzten Jahrzehnte des 19. Jahrhunderts aus einem kleinen Dorf an dem Flusschen Ludka zu einer grosen, hasslichen Industriestadt von etwa einer halben Million Menschen entwickelt. Ihr Aufbau war ganz unregelmasig. Neben mit Bretterzaunen umgebenen Fabrikgrundstucken standen kleine Dorfhauser und naturlich viele hohe Mietshauser.

Obgleich ich fest entschlossen war, ein naturwissenschaftliches Fach zu studieren, folgte ich dem Rat meines Vaters, mir den Betrieb seiner Fabrik zunachst anzusehen, damit ich wusste, was ich aufgab. Es war interessanter, als ich mir vorgestellt hatte. Meister Muller fuhrte mich zunachst in die Produktion ein und erklarte mir, dass das „Gesetz der Schwere“ bei zahlreichen Vorgangen eine grose Rolle spiele.

Im Jahre nach meiner Emeritierung fand in Rio de Janeiro eine IUPAC-Tagung statt, auf der ich einen von der Deutschen Forschungsgemeinschaft unterstutzten Vortrag hielt. Rio war wie stets hinreisend schon. Zwar war die Stadt in letzter Zeit stark angewachsen, aber da sie sich entlang der Kuste ausdehnte, war ihre Silhouette mit dem Corcovado und dem Zuckerhut erhalten geblieben. Der Autoverkehr in den Strasen war noch rasanter als damals, auf dem Meer waren die bunten Segel der Surfer hinzugekommen.

Als wir an einem truben Herbsttag in Freiburg ankamen, war uns zunachst gar nicht nach Aufstieg zumute. Staudinger nahm mich sehr kuhl auf, da er von einem Vortrag im Harnack-Haus den Eindruck hatte, dass man seiner Idee der Makromolekule dort sehr skeptisch gegenuberstand. Ein Lichtblick war nur der freundliche Empfang von Inspektor Hall, der mich noch von meiner Freiburger Studienzeit kannte. Sonst aber kam mir Freiburg nach der anregenden Zeit in Berlin sehr beengt vor.

Atmospheric pressure plasmas have been ground-breaking for plasma science and technologies, due to their significant application potential in many fields, including medicinal, biological, and environmental applications. This is predominantly due to their efficient production and delivery of chemically reactive species under ambient conditions. One of the challenges in progressing the field is comparing plasma sources and results across the community and the literature. To address this a reference plasma source was established during the ‘biomedical applications of atmospheric pressure plasmas’ EU COST Action MP1101. It is crucial that reference sources are reproducible. Here, we present the reproducibility and variance across multiple sources through examining various characteristics, including: absolute atomic oxygen densities, absolute ozone densities, electrical characteristics, optical emission spectroscopy, temperature measurements, and bactericidal activity. The measurements demonstrate that the tested COST jets are mainly reproducible within the intrinsic uncertainty of each measurement technique.

Imaging modalities have developed rapidly in recent decades. In addition to improved resolution as well as whole-body and faster image acquisition, the possibilities of functional and molecular examination of tissue pathophysiology have had a decisive influence on imaging diagnostics and provided ground-breaking knowledge. Many promising approaches are currently being pursued to increase the application area of devices and contrast media and to improve their sensitivity and quantitative informative value. These are complemented by new methods of data processing, multiparametric data analysis, and integrated diagnostics. The aim of this article is to provide an overview of technological innovations that will enrich clinical imaging in the future, and to highlight the resultant diagnostic options. These relate to the established imaging methods such as CT, MRI, ultrasound, PET, and SPECT but also to new methods such as magnetic particle imaging (MPI), optical imaging, and photoacoustics. In addition, approaches to radiomic image evaluation are explained and the chances and difficulties for their broad clinical introduction are discussed. The potential of imaging to describe pathophysiological relationships in ever increasing detail, both at whole-body and tissue level, can in future be used to better understand the mechanistic effect of drugs, to preselect patients to therapies, and to improve monitoring of therapy success. Consequently, the use of interdisciplinary integrated diagnostics will greatly change and enrich the profession of radiologists.Die bildgebenden Verfahren haben sich in den letzten Jahrzehnten rasant weiterentwickelt. Neben verbessertem Auflösungsvermögen, Ganzkörpererfassung und schnellerer Bilderstellung haben vor allem die Möglichkeiten der funktionellen und molekularen Untersuchung der Gewebepathophysiologie die bildgebende Diagnostik maßgeblich beeinflusst und wegweisende Erkenntnisse geliefert. Viele aussichtsreiche Ansätze werden derzeit verfolgt, um das Spektrum der Anwendbarkeit von Geräten und Kontrastmitteln zu erhöhen und deren Sensitivität und quantitative Aussagekraft zu verbessern. Hinzu kommen neuartige Verfahren der Datenverarbeitung, der multiparametrischen Datenanalyse und der integrierten Diagnostik. Ziel dieses Beitrags ist es, einen Überblick zu geben, welche technologischen Neuerungen die klinische Bildgebung in Zukunft bereichern werden und welche diagnostischen Möglichkeiten daraus resultieren. Diese betreffen sowohl etablierte Bildgebungsverfahren wie Computertomographie, Magnetresonanztomographie, Ultraschall, Positronenemissionstomographie und „single photon emission computed tomography“ als auch neue Verfahren wie „magnetic particle imaging“, die optische Bildgebung und die Photoakustik. Ferner werden Ansätze der Radiomics-basierten Bildauswertung erläutert und die Möglichkeiten und Schwierigkeiten bei deren breiter klinischer Einführung diskutiert. Das Potenzial der Bildgebung, pathophysiologische Zusammenhänge in stetig steigendem Detailgrad sowohl auf Ganzkörperniveau als auch auf Gewebeebene zu beschreiben, kann in Zukunft genutzt werden, um die Wirkungsweise von Medikamenten besser zu verstehen, Patienten für Therapien gezielt auszuwählen und die Überwachung der Therapieerfolge zu verbessern. In der Folge wird der Einsatz fachübergreifender integrierter Diagnostik das Berufsbild des Radiologen stark verändern und bereichern.

В статье на материале анализа дискурса как одного из ведущих направлений в современной социолингвистике и «анализе разговора» (преконструкт как след в самом дискурсе предшествующих эпох, поставляющих материал для дискурсной формации; интердискурс как отношение дискурса к «уже услышанному»; интрадискурс как функционирование дискурса по отношению к нему самому) выстраивается типология форм молчания как конструктов завершающейся реальности, в которой заложено концептуальное начало новой реальности (забвение, умолчание, скрытые смыслы, эзопов язык, эвфемизм, «немая сцена»). Забвение рассматривается как спонтанный мнемонический механизм и как технология инструментального воздействия на память. В статье анализируется «невысказанное» как один из основных конструктов дискурса, демонстрируется иллюзорность прозрачности смыслов в тексте, обосновывается принцип открытости дискурса для множественной интерпретации, раскрывается механизм стыковки отдельных конструктов дискурса с зонами молчания, которые при всей эксплицитной асемантичности имплицитно наполнены множественными смыслами. Молчание как конструкт, берущий на себя роль сцепления между вербальным и невербальным, соотносится по принципу антитезы с полифонией (полилогом) М.М. Бахтина, понимаемым как множество авторских голосов.

Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth—particularly brain development—that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification—including targeted and adjusted fortification—show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.

Capacitively coupled micro atmospheric pressure plasma jets are important tools for the generation of radicals at room temperature for various applications. Voltage waveform tailoring (VWT), which is based on the simultaneous use of a set of excitation frequencies, has been demonstrated to provide an efficient control of the electron energy probability function (EEPF) in such plasmas and, thus, allows optimizing the electron impact driven excitation and dissociation processes as compared to the classical single-frequency operation mode. In this work, the effects of changing the driving frequencies on the spatio-temporally resolved electron power absorption dynamics, the generation of helium metastables and the dissociation of nitrogen molecules are investigated in He/N2 plasmas based on experiments and simulations. We find that under a single-frequency excitation, the plasma and helium metastable densities are enhanced as a function of the driving frequency at a fixed voltage. When using valleys-type driving voltage waveforms synthesized based on consecutive harmonics of the fundamental driving frequency, the spatial symmetry of the electron power absorption dynamics and of the metastable density profile is broken. Increasing the fundamental frequency at a constant voltage is found to drastically enhance the plasma and metastable densities, which is a consequence of the change of the EEPF. Finally, we compare the energy efficiency of the formation of radicals under single-frequency and VWT operation at different driving frequencies. For a given power dissipated in the plasma, VWT yields a higher helium metastable as well as electron density and a higher dissociation rate of N2.

Enterovirus infections in neonates have the potential to cause a cascade of devastating clinical complications that can lead to death. Because of vague maternal symptom presentations, the diagnosis may not be obvious to antepartum adult providers. Clinicians evaluating infants in the newborn nursery and following initial hospital discharge must be alert for this potential infection. Common newborn issues, such as hyperbilirubinemia and weight loss, may be early signs of a more life-threatening diagnosis. Enterovirus infections may be responsible for a continuum of critical diagnoses in the neonate. Utilization of viral panels during the initial rule-out sepsis evaluation may provide rapid diagnosis and, ultimately, earlier response times to devastating clinical symptoms. Antepartum history and presenting features of enteroviral infections warrant rapid diagnosis with viral polymerase chain reaction detection panels to potentially reduce antibiotic usage and inpatient length of stay. The purpose of this case report is to review risk factors, presentation, and management of neonatal enterovirus infections. As this infant was born in a remote setting and required air evacuation, the logistics of this transport are also discussed.

The androgen receptor (AR) is the major driver of prostate cancer growth and survival. However, almost all patients relapse with castration-resistant disease (CRPC) when treated with anti-androgen therapy. In CRPC, AR is often aberrantly activated independent of androgen. Targeting survival pathways downstream of AR could be a viable strategy to overcome CRPC. Surprisingly, little is known about how AR drives prostate cancer survival. Furthermore, CRPC tumors in which Pten is lost are also resistant to eradication by PI3K inhibitors. We sought to identify the mechanism by which AR drives tumor survival in CRPC to identify ways to overcome resistance to PI3K inhibition. We found that integrins α6β1 and Bnip3 are selectively elevated in CRPC downstream of AR. While integrin α6 promotes survival and is a direct transcriptional target of AR, the ability of AR to induce Bnip3 is dependent on adhesion to laminin and integrin α6β1-dependent nuclear translocation of HIF1α. Integrins α6β1 and Bnip3 were found to promote survival of CRPC cells selectively on laminin through the induction of autophagy and mitophagy. Furthermore, blocking Bnip3 or integrin α6β1 restored sensitivity to PI3K inhibitors in Pten-negative CRPC. We identified an AR driven pathway that cooperates with laminin and hypoxia to drive resistance to PI3K inhibitors. These findings can help explain in part why PI3K inhibitors have failed in clinical trials to overcome AR-dependent CRPC.

BackgroundVACTERL association is a sporadic, nonrandom series of congenital malformations diagnosed by the presence of three or more of the following: vertebral malformations, anal atresia, cardiac defects, tracheoesophageal fistula, renal malformations, and limb malformations. Situs inversus totalis (SIT) and esophageal malformations are rarely associated. This is the first reported case in North America of VACTERL association with SIT.Implications for PracticeRespiratory distress in the term infant requires full exploration of all possible causes because the etiology may be far more complex than routinely diagnosed respiratory distress syndrome. This particular case demonstrates physical exam findings and supportive imaging that would be observed in infants with VACTERL association and with SIT, highlighting considerations when, rarely, both occur simultaneously.

Bone-metastatic castration-resistant prostate cancer (CRPC) is lethal due to inherent resistance to androgen deprivation therapy, chemotherapy, and targeted therapies. Despite the fact that a majority of CRPC patients (approximately 70%) harbor a constitutively active PI3K survival pathway, targeting the PI3K/mTOR pathway has failed to increase overall survival in clinical trials. Here, we identified two separate and independent survival pathways induced by the bone tumor microenvironment that are hyperactivated in CRPC and confer resistance to PI3K inhibitors. The first pathway involves integrin α6β1-mediated adhesion to laminin and the second involves hypoxia-induced expression of PIM kinases. In vitro and in vivo models demonstrate that these pathways transduce parallel but independent signals that promote survival by reducing oxidative stress and preventing cell death. We further demonstrate that both pathways drive resistance to PI3K inhibitors in PTEN-negative tumors. These results provide preclinical evidence that combined inhibition of integrin α6β1 and PIM kinase in CRPC is required to overcome tumor microenvironment-mediated resistance to PI3K inhibitors in PTEN-negative tumors within the hypoxic and laminin-rich bone microenvironment.

This review highlights clinical outcomes of human milk from infancy through adulthood. Human milk outcomes of both preterm and term infants, including critically ill term infants (such as infants with congenital heart disease and those requiring therapeutic hypothermia) are summarized. Several human milk diets are identified to reduce the risk of specific diseases. Emerging research of newly discovered components of human milk are also reviewed. Human milk has significant effects on the gut microbiome, somatic growth, and neurocognitive outcomes. Continued research promises to improve donor human milk and donor milk derived products to achieve better outcomes for infants who do not receive their own mother's milk. The promotion of human milk is well-founded on evidence from the previous half century.

Absolute atomic oxygen densities measured space resolved in the active plasma volume of a COST microplasma reference jet operated in He/O2 and driven by tailored voltage waveforms are presented. The measurements are performed for different shapes of the driving voltage waveform, oxygen admixture concentrations, and peak-to-peak voltages. Peaks- and valleys-waveforms constructed based on different numbers of consecutive harmonics, N, of the fundamental frequency f 0 = 13.56 MHz, different relative phases and amplitudes are used. The results show that the density of atomic oxygen can be controlled and optimized by voltage waveform tailoring (VWT). It is significantly enhanced by increasing the number of consecutive driving harmonics at fixed peak-to-peak voltage. The shape of the measured density profiles in the direction perpendicular to the electrodes can be controlled by VWT as well. For N > 1 and peaks-/valleys-waveforms, it exhibits a strong spatial asymmetry with a maximum at one of the electrodes due to the spatially asymmetric electron power absorption dynamics. Thus, the atomic oxygen flux can be directed primarily towards one of the electrodes. The generation of atomic oxygen can be further optimized by changing the reactive gas admixture and by tuning the peak-to-peak voltage amplitude. The obtained results are understood based on a detailed analysis of the spatio-temporal dynamics of energetic electrons revealed by phase resolved optical emission spectroscopy.