Objective: Comparison of the differences between availability of animalderived surfactant preparations used to treat premature infants is incomplete. The objective of this study was to assess the short-term treatment efficacy of the two most commonly used surfactant preparations in the United States, beractant (100 mg kg Result: We studied 52 infants 24 0/7 to 29 6/7 weeks gestation; 25 received poractant alfa (27.1±1.6 weeks, birth weight of 930±231 g) and 27 received beractant (26.7 ± 1.7 weeks, P ¼ 0.343 and birth weight 900 ± 271 g, P ¼ 0.668). Respiratory support for the first 72 h of life was lower in the poractant alfa than beractant group for mean airway pressure (MAP, P ¼ 0.003) and respiratory index (MAP Â FiO 2 , P ¼ 0.032). Infants in the poractant alfa group had a greater number of infants extubated at 48 (13/25 vs 6/27, P ¼ 0.027) and 72 h (15/25 vs 8/27, P ¼ 0.029) than the beractant group. Although the study was not powered to detect morbidities of prematurity, the prevalence of PDA and air leaks was less in the infants treated with poractant alfa than in those treated with beractant. Rates of bronchopulmonary dysplasia (8/23 vs 11/ 22, P ¼ 0.303) or death (2/15 vs 5/27, P ¼ 0.272) were similar in the infants treated with poractant alfa and beractant, respectively. Conclusion:This study suggests significant short-term benefits to the use of the larger initial dose of poractant alfa than beractant in very premature infants with RDS. Further studies involving a larger number of preterm infants are needed to assess long-term effects.

Background/Aim: To assess the impact of vitamin D supplementation on genomic and metabolomic profiles and relate them to the individual's responsiveness to varying doses of vitamin D 3 . Patients and Methods: Healthy adults were given either 600, 4000 or 10,000 IUs vitamin D 3 /day for 6 months. Circulating parathyroid hormone (PTH), 25hydroxyvitamin D [25(OH)D], calcium, peripheral white blood cells broad gene expression and urine and serum metabolomic profiles were evaluated. Results: There was a dose-dependent effect of vitamin D supplementation on serum 25(OH)D, PTH and broad gene expression. Serum calcium levels remained normal for all study subjects and no untoward toxicity was observed. The metabolomic profiles were related to the genomic expression analysis. There were significant inter-individual effects on gene expression and metabolomic profile in response to the same dose of vitamin D 3 supplementation, despite similar changes in 25(OH)D and PTH concentrations. Conclusion: These results may help explain the variability observed in clinical trials regarding vitamin D's non-calcemic health benefits.

Objective: Respiratory distress syndrome (RDS), requiring mechanical ventilation and exogenous surfactant treatment, and patent ductus arteriosus (PDA), are common co-morbidities in very premature infants. The effects of intra-tracheal surfactant administration on the cardiovascular and pulmonary systems in very premature infants with RDS and PDAs are not well characterized. We evaluated the effects of poractant alfa and beractant, surfactants with different rapidity of onset and duration of action, in very premature infants with RDS. To assess whether there were differences in PDA hemodynamics in very premature infants with RDS treated with poractant alfa and beractant during the first week of life and to assess whether poractant alfa or beractant had a direct effect on PDAs and PDA hemodynamics following the second dose of surfactant.Study Design: We studied 50 in-born, very premature infants with RDS, 24 0 of 7 to 29 6 of 7 weeks gestation, treated with poractant alfa or beractant, in an open label, 1:1, randomized clinical trial. A subgroup of 16 patients with severe RDS, treated with a second dose of surfactant, had echocardiographical assessments before and 20 to 30 min after the second dose of surfactant.Result: There were 25 infants treated with poractant alfa (27.1 ± 1.6 weeks, birth weight 930±231 g) and 25 treated with beractant (26.7 ± 1.7 weeks, P ¼ 0.407 and birth weight 898 ± 282 g, P ¼ 0.666). Clinically significant PDAs were diagnosed and treated in 8 of 25 (32%) of the poractant alfa and 19 of 25 (76%) of the beractant group (P ¼ 0.002). Indomethacin treatment was slightly earlier (3.4 ± 2.5 days) in the poractant alfa than in the beractant group (5.1±4.9 days, P ¼ 0.038). Right ventricle pressure (RVP)/systolic arterial pressure (SAP) ratio in the first week was slightly lower in the poractant alfa (64±20%) than in the beractant (78 ± 26%, P ¼ 0.048) group. Following a second dose of surfactant, neither poractant alfa nor beractant changed PDA flow. These hemodynamic observations were associated with less respiratory support in the poractant alfa group, allowing earlier extubation (13 of 25 at 48 h and 15 of 25 at 72 h), than in the beractant group (6 of 25 at 48 h, P ¼ 0.044, and 8 of 25 at 72 h, P ¼ 0.049). Conclusion:The more rapid improvement in pulmonary function in the poractant alfa-treated infants was associated with a lower RVP/SAP ratio and a corresponding earlier treatment with indomethacin. Neither surfactant had a significant direct effect on PDA hemodynamics. The lower frequency of clinically significant PDAs in the poractant alfa compared with the beractant group may represent an indirect effect of the differences in the pulmonary improvement induced by the two surfactants.

Aim: A commercially available light emitting diode (LED) that transmitted narrow band ultraviolet B (UVB) radiation was evaluated for its efficacy and efficiency to produce vitamin D 3 in human skin. Materials and Methods: Human skin samples were obtained from surgical procedures. The LED had peak emission wavelength of 295 nm. Skin samples were exposed to the UVB-LED for varying times and then were analyzed by high-pressure liquid chromatography (HPLC) to determine the vitamin D 3 content. Results: There was a statistically significant time-and dosedependent increase in the percent of 7-dehydrocholesterol that was converted to vitamin D 3 in the skin type II samples; 1. 3%±0.5, 2.3%±0.6 and 4.5%±1.67 after exposure to 0.75 (11.7 mJ/cm 2 ), 1.5 (23.4 mJ/cm 2 ) and 3 (46.8 mJ/cm 2 ) minimal erythemal doses (MEDs), respectively. Conclusion: The UVB-LED was effective and efficient in generating vitamin D 3 in human skin, in vitro. The amount of vitamin D 3 production increased in a dose-dependent fashion with increased UVB energy. UVB-LEDs can be developed for devices that can efficiently produce vitamin D 3 in human skin.Vitamin D is mainly obtained from sun exposure, as well as from few dietary sources (1, 2). Specifically, during sun exposure, epidermal 7-dehydrocholesterol (7-DHC or provitamin D 3 ) absorbs solar ultraviolet (UV) B radiation, which results in the thermodynamically unstable molecule, previtamin D 3 . Once formed, the triene system in previtamin D 3 rearranges to form the more thermodynamically stable product, vitamin D 3 (1-4). After its formation, vitamin D 3 enters the circulation from the skin and is transported to the liver to be metabolized into 25-hydroxyvitamin D 3 (25(OH)D), and to the kidneys to undergo additional metabolism to 1,25-dihydroxyvitamin D 3 (1, 3, 5-7).The Sperti lamp, which contained a mercury arc lamp, was produced in the 1940s in the United States, where it was available in pharmacies to treat and prevent the bone disorder known as rickets (1, 6, 7). Since then, there has been an evolution of improved, more user-friendly vitamin D-producing devices for the treatment and prevention of vitamin D deficiency. In particular, the modern version of the Sperti lamp, Sperti D/UV-Fluorescent lamp (KBD, Inc., Las Vegas, NV, USA), was designed with UVB emitting fluorescent bulbs, which have the benefit of a lower heat emission than the previously mercury arc lamps. Additionally, these new UVB-emitting bulbs allow for a larger area of the user's skin to be exposed (8-10). Indeed, the Sperti D/UV-Fluorescent lamp has been shown to be effective in raising blood levels of 25(OH)D in healthy adults, as well as in patients with fat malabsorption syndromes who may not benefit from oral vitamin D supplementation (8,9).The modern version of the Sperti lamp includes improved gallium nitride-based UV light-emitting diode (LED), and is commercially available for use in clinical application (11,12). These LEDs can also be designed to emit specific UV narrow band in order to be utilized therapeu...