Aims  To identify clinical characteristics and co-morbidity rates of children diagnosed with Type 1 diabetes mellitus at younger than 6 years of age. Methods  Data were obtained from a retrospective chart review of 103 patients diagnosed with Type 1 diabetes at younger than 6 years (study group) and 220 patients at older than 6 years (comparison group). Measures of glycaemic control and occurrence of co-morbidities (coeliac disease, autoimmune thyroid disease, hypertension, nephropathy and retinopathy) were compared. Results  The mean follow-up period was more than 8 years. For the study group, mean HbA(1c) levels ranged from 64 mmol/mol to 66 mmol/mol (8.0-8.2%) until age 10 years, and then rose to 73 mmol/mol (8.8%). The HbA(1c) levels were higher in the study than in the comparison group for comparable ages (P = 0.003). After adjustment for duration of diabetes this difference was not significant. The overall rate of severe hypoglycaemic events was greater in the study group than in the comparison group (P = 0.03). Kaplan-Meier diagnosis rates of celiac disease, 10 years after Type 1 diabetes diagnosis, were 14.4% and 4.2% in the study and comparison groups, respectively (P log-rank = 0.03). There were no differences in rates of autoimmune thyroid disease, hypertension, nephropathy or retinopathy. Conclusions  Children diagnosed with Type 1 diabetes before the age of 6 years were in greater risk of developing celiac disease, compared with children diagnosed after the age of 6 years. For children diagnosed with Type 1 diabetes aged under 6 years, good metabolic control was achievable until age 10 years, after which it deteriorated. Higher HbA(1c) levels observed in children diagnosed before the age of 6 years were associated with longer duration of disease. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

OBJECTIVES: To assess risk factors and develop a simple estimate method for poor neonatal outcomes for specific groups of extremely premature infants at birth. DESIGN: Population-based study. SETTING: Israel National Very Low Birth Weight Infant Database. PARTICIPANTS: Infants born at 23 to 26 weeks' gestation between January 1, 1995, and December 31, 2008. Intervention  We developed a tool to estimate poor neonatal outcomes for infants born at 24 to 26 weeks' gestation (n = 2544) that incorporated factors at birth significantly associated with poor outcomes into a linear regression model. MAIN OUTCOME MEASURES: Poor neonatal outcomes defined as the composite of mortality or severe neurologic or pulmonary morbidity at discharge from the hospital. RESULTS: Major factors associated with poor outcomes at 24 to 26 weeks' gestation were gestational age, male sex, sex-specific birth weight percentile, and lack of prenatal steroid therapy. Estimated poor outcomes for January 1, 2000, to December 31, 2008, were calculated as the sum of the percentages determined for each of the 4 parameters:(1) gestational age (26, 25, and 24 weeks; 0%, 17%, and 34%, respectively),(2) birth weight percentile (>75th, 25th-75th, and <25th percentiles; 0%, 13%, and 26%, respectively),(3) lack of prenatal steroids (16%), and (4) male sex (7%). There was also an intercept value of 25%. Estimated poor outcome rates for the 36 subgroups of infants ranged from 25% to 100% and correlated well with observed rates (intraclass correlation coefficient, 0.93). CONCLUSIONS: The combined outcomes of deaths or severe morbidities in the neonatal period of infants born at 24 to 26 weeks' gestation could be simply estimated at birth. The provision of an appropriate and up-to-date estimate of poor neonatal outcomes for specific infants may be useful in counseling families on treatment options for these infants.

This study addresses polymer-surfactant interactions at solid-liquid interfaces and how these can be manipulated by modulating the association between ionic surfactant and oppositely charged polymer, with a particular focus on electrostatic interactions. For this purpose, the interaction of a series of cationic copolymers of vinylpyrrolidone and quaternized vinylimidazol with sodium dodecyl sulfate (SDS) at the silica-aqueous interface was followed by in situ ellipsometry. To reveal the nature of the interaction, we performed measurements for different copolyion charge densities, in the absence and presence of added salt. The path-dependence of the interaction was studied by comparing the adsorption under two different conditions, adsorption from premixed solutions and sequential addition of surfactant to the polymer solution, but the same end state. The reversibility of the adsorption process was studied by following the effect of dilution on the adsorbed layer. All copolyions adsorbed to both silica and hydrophobized silica, revealing the importance of both hydrophobic and electrostatic attractive interactions. On both types of surface, an increase in adsorbed amount was found on lowering the fraction of charged units. An increased ionic strength gave an increased adsorbed amount in all cases, but especially on hydrophobic surfaces. The adsorbed amount on silica from mixtures of the copolyions with SDS peaked at an SDS concentration corresponding closely to the concentration of cationic charges of the different polyions. Around the region of charge equivalence, there was also a phase separation in the bulk. At higher concentrations of SDS, a redissolution in the bulk, and a decrease in adsorbed amount, occurred as a result of excess SDS binding to the complexes. For the most highly charged polyions, we observed a decrease in adsorbed amount, and a shift in the adsorption maxima to lower SDS concentrations, with increasing ionic strength.

A detailed in situ scattering study has been carried out on the formation of amorphous calcium carbonate (ACC) particles modulated by the presence of small amounts of sodium polyacrylate chains. The work is aiming at an insight into the modulation of ACC formation by means of two polyacrylate samples differing in their molecular weight by a factor of 50. The ACC formation process was initiated by an in situ generation of CO(3)(2-) ions via hydrolysis of 10 mM dimethylcarbonate in the presence of 10 mM CaCl(2). Analysis of the formation process by means of time-resolved small-angle X-ray and light scattering in the absence of any additives provided evidence for a monomer addition mechanism for the growth of ACC particles. ACC formation under these conditions sets in after a lag-period of some 350 s. In the presence of sodium polyacrylate chains, calcium polyacrylate aggregates are formed during the lag-period, succeeded by a modulated ACC growth in a second step. The presence of anionic polyacrylate chains changed the shape of the growing particles toward loose and less homogeneous entities. In the case of low amounts (1.5-7.5 mg/L) of the long chain additive with 97 kDa, the size of the aggregates is comparable to the size of the successively formed hybrid particles. No variation of the lag-period has been observed in this case. Use of the short chain additive with 2 kDa enabled increase of the additive concentration up to 100 mg/L and resulted in a significant increase of the lag-period. This fact, together with the finding that the resulting hybrid particles remained stable in the latter case, identified short chain sodium polyacrylates as more efficient modulators than long chain polyacrylates.

OBJECTIVE: We sought to evaluate the impact of severity of growth restriction on mortality and major neonatal morbidity among very-low-birthweight small-for-gestational-age infants. STUDY DESIGN: This was a population-based observational study using data collected by the Israel National Very-Low-Birth-Weight Infant Database 1995 through 2007 including infants 24-31 weeks' gestation, with birthweight (BW) ≤50th percentile without major malformations. Four BW percentile groups were considered:<3rd, 3rd-<10th, 10th-<25th, and a reference group 25th-50th percentile. Univariate and multivariable logistic regression analyses were performed. RESULTS: Infants of BW 3rd-<10th percentile were at increased risk for grades 3-4 retinopathy of prematurity (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.54-2.78), bronchopulmonary dysplasia (OR, 2.52; 95% CI, 2.03-3.12), necrotizing enterocolitis (OR, 1.32; 95% CI, 1.04-1.68), and mortality (OR, 2.37; 95% CI, 1.94-2.90). The risk was further increased among infants of BW <3rd percentile. CONCLUSION: Growth restriction severity may serve as a clinical marker of degree of risk for neonatal mortality and various morbidities.

Objective:We hypothesized that maternal diabetes mellitus (DM) increases the risk for mortality, respiratory distress syndrome (RDS), and major complications of prematurity.Methods:Analysis of prospectively collected (1995-2007) Israel National Very Low Birth Weight Infant Database. Maternal DM was recorded as pregestational or gestational. Multivariable logistic regression analysis was used to assess the independent effect of maternal DM status on infant mortality, RDS, and other complications of prematurity.Results:Infants of mothers with pregestational (n = 120) and gestational (n = 825) DM were similar, and their data were pooled for analyses. Mothers with DM were more likely to have received a complete course of prenatal steroids than control mothers. Infants of diabetic mothers (IDM) had a slightly higher gestational age and birthweight than non-IDM's. Distribution of birthweight percentiles and the mean birthweight z scores were similar. Apgar scores were statistically higher in the IDM group. There were no significant differences between the 2 groups in terms of delivery room mortality, RDS, and other major complications of prematurity. Total mortality and bronchopulmonary dysplasia rates were significantly higher in the nondiabetic group. The adjusted odds ratios for mortality, RDS, bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and patent ductus arteriosus were not significantly increased in the IDM group.Conclusions:With modern management and adequate prenatal care, IDM born very low birthweight do not seem to be at an excess risk of developing RDS or other major complications of prematurity compared with non-IDM.

OBJECTIVES We aimed to study the trends in management and outcome of post CABG patients presenting with acute MI. BACKGROUND Primary angioplasty is the treatment of choice in patients with acute myocardial infarction. Saphenous vein grafts used for CABG are large-diameter conduits that tend to accumulate a large mass of thrombus when they are the culprit artery for acute myocardial infarction (MI). We hypothesized that performing PCI in these patients is more complex and possibly results in worse outcome compared to non-CABG patients. METHODS Data for patients with STEMI was obtained from five acute coronary syndromes Israeli biennial Surveys (ACSIS) during 2000-2008. Baseline characteristics, management and outcome of post-CABG patients were compared to non-post CABG patients during 2006-2008 surveys. RESULTS A total of 9,781 patients were included. About 1,002 (10.2%) were post-CABG. Reperfusion therapy for post-CABG patients (34-48%) was consistently lower compared to non-CABG patients (57-65%). Angiographic outcome in patients with STEMI who underwent primary PCI (17 post-CABG, mean age 66.6 ± 9.1 and 821 non-CABG, age 60.1 ± 12.9) was successful (TIMI flow 3) in 86 and 88%, respectively. Thirty-day mortality was 5.9 and 5.1%(P = 0.89) and MACE rates were 17.6 and 12.5%, respectively (P = 0.54). CONCLUSIONS Use of primary PCI in post-CABG patients was lower than in non-CABG patients but increased steadily and to a similar extent in both groups. Angiographic and clinical outcome was similar despite assumingly larger thrombus burden in post CABG patients. Therefore, primary angioplasty is appropriate also in post-CABG patients presenting with STEMI.

Structural rearrangement in a latex powder during dry sintering at temperatures higher than the minimum film formation temperature was investigated by means of synchrotron small-angle X-ray scattering. Two major effects were identified:(1) Deformation of latex particles leads to a closure of voids between them and an extensive perfectioning of the face centered cubic colloidal crystalline ordering. Such an improvement of the colloidal crystalline structure involves preferential crystal growth along certain crystallographic directions as was evidenced by the measured unmatched relative diffraction intensity distribution of the crystallographic (111) and (220) planes.(2) Interdiffusion of polymeric chains between adjacent particles promotes a nanometer sized aggregation of nonpolymeric materials previously located in the interstices between particles. Size and size distribution of the aggregates at different dry sintering conditions were evaluated by using a model considering spheres dispersed in the system.

Copper was determined in environmental matrices following generation, separation, and atomization of a volatile species formed by the merging of an acidified sample solution with an aqueous sodium tetrahydroborate solution at room temperature. The copper species, as yet unidentified, was phase separated in a conventional gas-liquid separator and directed via a stream of Ar carrier gas to an inductively coupled plasma atomic emission detection system. Optimum conditions for generation were investigated. The efficiency of generation/transfer was estimated to be 50%, and no interference from the presence of 1000 mg/L concentration of As, Cd, Co, Ni, Fe, Cr, Mn, Pb, Se, and Zn concomitants was evident. Simple aqueous standards were used for calibration purposes, and good agreement was obtained with certified values in the analysis of National Research Council of Canada marine sediment BCSS-1 and lobster hepatopancreas tissue TORT-1.

Patients with recurrent acute myocardial infarction (AMI), who represent ≤35% of hospitalized patients with AMI, are at an increased risk of complications and death. Our study purpose was to compare the treatment and outcome of patients hospitalized with recurrent acute ST-segment elevation myocardial infarction (STEMI) from 1998 to 2006 with those of patients with a first STEMI. We performed 5 biennial nationwide 2-month surveys during 1998 to 2006, collecting data prospectively from all patients hospitalized for AMI or acute coronary syndrome in all 25 coronary care units in Israel. The present cohort included 4,543 patients with STEMI, 3,679 (76%) with first and 864 (24%) with recurrent STEMI. The patients with recurrent STEMI were older (66 ± 13 vs 62 ± 13 years), had greater rates of diabetes, hypertension, and previous angina, had a worse Killip class on admission, and experienced more in-hospital complications. The all-cause hospital crude mortality rate was 8.1% in patients with recurrent STEMI versus 5.5% in those with a first STEMI (adjusted odds ratio 1.71 95% confidence interval 1.19 to 2.44), and the 1-year mortality rate was 18.9% versus 10.9%, respectively (hazard ratio 1.85, 95% confidence interval 1.41 to 2.43). From 1998 to 2006, an insignificant trend toward a 1-year mortality reduction among patients with recurrent STEMI was seen and those with a first STEMI had a significant mortality decrease. In conclusion, patients admitted for recurrent STEMI have worse in-hospital and 1-year outcomes that did not improve during the study period. An improved therapeutic approach is needed for these high-risk patients.