[Intravenous sedation for gastroscopy: comparison between midazolam and diazepam]

Benzodiazepines are often used as premedication or intravenous sedative agents for endoscopies. The present study included 74 patients. It compared the sedative and amnestic properties of midazolam and diazepam, their relative potencies as well as the comfort of both the patient and the endoscopist during gastroscopy. The comparison has shown some statistically significant differences, allowing the following conclusions: amnesia was more frequent with midazolam; the dose requirement (in mg X kg-1) for adequate sedation was more important with diazepam, confirming the greater potency of midazolam; generally speaking, sedation was excellent with both drugs.

Effect of acipimox on plasma lipids and glucose/insulin in pregnant rats

To determine how a reduction in maternal hypertriglyceridemia during late pregnancy may affect glucose/insulin relationships, pregnant and virgin rats were orally treated with acipimox, a potent antilipolytic agent. In 20-day pregnant rats receiving 80 mg of acipimox, plasma triglycerides (TG), free fatty acids (FFA), and glycerol decreased more than in virgin rats shortly after the drug (up to 7 hours), when compared with animals treated with distilled water, whereas plasma glucose level was unaffected by the treatment in either group of rats. When acipimox was given every 12 hours from day 17 to day 20 of pregnancy, plasma TG, FFA, and glycerol levels progressively increased, whereas they either decreased or did not change in virgin rats receiving the same treatment, with no effect in plasma glucose levels in either group. Fetal body weight was lower than in controls in 20-day pregnant rats that received acipimox for 3 days. On day 20 of pregnancy, 3 hours after receiving acipimox or distilled water, rats received a 2 g glucose/kg oral load and it was found that the change in plasma glucose was similar in both groups, whereas the increase in plasma insulin was greater in pregnant rats treated with acipimox. However, no difference was found in either variable after the oral glucose load in virgin rats receiving acipimox or distilled water. No differences in plasma glucose levels were found after intravenous (i.v.) administration of insulin in pregnant rats treated or not treated with acipimox. In conclusion, present results show that administration of acipimox during the last days of gestation inhibited lipolysis and decreased fetal weight. Over a short period of time, in pregnant rats, reductions of plasma FFA and TG after acipimox treatment improved the glucose-induced insulin release, but did not seem to have any effect in peripheral insulin resistance.

Effects of exogenous insulin on placental transfer of maternal glucose to the rat fetus

There is controversy concerning the possible modulation of glucose transfer to the fetus by insulin acting on the maternal side of the placenta. To study this question, 20.5 day pregnant rats were infused simultaneously with (U-14C)-D-glucose (via the jugular vein) and with different doses of insulin (via the left uterine artery) so that placentas from the left uterine horn were exposed to a higher insulin concentration than those from the right uterine horn. Placentas and fetuses from each uterine side were processed separately. No differences were detected in total blood radioactivity, plasma-14C-glucose, -14-C-lactate, -glucose, or -radioimmunoassayable insulin in fetuses from the left versus the right uterine horn. Total placenta radioactivity and 14C-glycogen were also similar in the left and right uterine sides at all insulin doses studied. Infusion of insulin (66 mU/min) to the pregnant rat caused hyperinsulinaemia and hypoglycaemia, decreased blood total radioactivity and plasma 14C-glucose, and increased plasma 14C-lactate in the mother. The level of fetal plasma 14C-glucose paralleled that of the mother. It is concluded that in the rat, placental glucose uptake, its transfer to the fetus, and fetal glucose utilization are not directly affected by maternal circulating insulin. Metabolic changes occurring in fetuses of hyperinsulinaemic mothers are secondary to the decreased availability of glucose.

Fish oil diet in pregnancy and lactation reduces pup weight and modifies newborn hepatic metabolic adaptations in rats

PURPOSE

To determine the effects of a diet containing fish oil (FD) during pregnancy and lactation in rats on the metabolic adaptations made by the offspring during early extrauterine life and to compare it to an olive oil diet (OD).

METHODS

Rats were mated and randomly allocated to OD or FD containing 10 % of the corresponding oil. During lactation, litters were adjusted to eight pups per dam. Fetuses of 20 days and pups of 0, 1, 10, 20 and 30 days of age were studied.

RESULTS

Body weight and length were lower in pups of the FD group from birth. The diet, milk, pups' plasma and liver of FD group had higher proportions of n-3 LCPUFA, but the content of arachidonic acid (ARA) was lower. Plasma glucose was higher, but unesterified fatty acids, triacylglycerols (TAG), 3-hydroxybutyrate and liver TAG in 1-day-old pups were lower in the FD group, and differences in some of these variables were also found in pups up to 30 days old. Liver lipoprotein lipase activity and mRNA expression, and the expression of carnitine palmitoyl transferase I, acyl-CoA oxidase and 3-hydroxy 3-methyl glutaryl-CoA synthase increased more at birth in pups of the FD group, but the expression of sterol regulatory element binding protein-1c and Δ6-desaturase mRNA was lower in the FD group.

CONCLUSIONS

Maternal intake of high n-3 LCPUFA retards postnatal development, which could be the result of impaired ARA synthesis, and affects hepatic metabolic adaptations to extrauterine life.

Comparative changes with age of the fasting response in circulating ketone bodies, glucose and insulin and oral glucose tolerance test in the rat

1. Body weight loss in 48 hr fasted rats decreased with age. 2. Blood glucose and plasma RIA-insulin levels correlated negatively and positively respectively with body weight in fed rats. Fasting produced a greater fall in blood glucose and a smaller decrease in RIA-insulin in young than in old rats. 3. Blood ketone bodies correlated negatively with body weight after 48 hr fasting. 4. In oral glucose tolerance tests, blood glucose rose more in adult and old rats than in prepuberals when both fed and fasted. RIA-insulin levels rose more in prepuberals than in older rats when fed but not when fasted. 5. Changes in body composition and reduced insulin sensitivity with age are discussed.

Effect of diabetes on protein synthesis rate and eukaryotic initiation factor activities in the liver of virgin and pregnant rats

To study the effect of prolonged diabetes on protein synthesis and on the activities of initiation factors eIF-2 and eIF-2B in the liver, female rats were treated with streptozotocin. Some animals were mated and studied on day 20 of pregnancy, whereas others were kept virgin and studied in parallel. The protein synthesis rate was measured with an "in vitro' cellfree system, and was lower in diabetic pregnant and virgin animals than in pregnant and virgin controls (30-60%). The fetuses of diabetic rats had a lower protein synthesis rate than those from controls, although they always showed a higher protein synthesis rate than their mothers or virgin rats. Protein synthesis rate, RNA concentration, and initiation factor 2 activity were higher in pregnant than in virgin rats. Both activity and level of eIF-2 factor changed in parallel to the protein synthesis rate, although no differences could be detected between control and diabetic animals. The eIF-2B activity in tissue extracts from diabetic virgin rats and fetuses was lower than in extracts from their controls, whereas no differences could be detected between pregnant and virgin control rats nor between pregnant control and pregnant diabetic animals. The percentage of the phosphorylated form of eIF-2 factor, eIF-2(alpha P), was slightly lower in virgin than in pregnant rats but was unaffected by the diabetic condition, while in diabetic fetuses this parameter was lower than in their corresponding controls. The cyclic adenosine monophosphate dependent protein kinase level was lower in diabetic rats than in controls, whereas no changes in the activity of casein kinase II were found. The isoelectric forms of the beta subunit of eIF-2 factor, eIF-2 beta, were different in the diabetic and the control animals, indicating that insulin deficiency modifies the phosphorylation of specific substrates. Since no differences were detected in RNA or eIF-2 content between control and diabetic rats, translation may, at least partly, be inhibited in the liver by an impairment of peptide chain initiation caused by the decreased eIF-2B activity which nevertheless is independent of eIF-2 alpha phosphorylation.

Pain management in adult acute sickle cell pain crisis: a viewpoint

BACKGROUND

The acute pain crisis of sickle cell disease is inadequately treated in many countries.

OBJECTIVE

To present a simple protocol that controls acute pain in most adult patients within 72 hours, based on our experience in an area where sickle cell disease is highly prevalent.

METHODS

Patients aged 14 years and above with sickle cell disease presenting with pain crisis are treated initially in the Emergency Room. Those responding adequately are discharged home on oral analgesics while those with persisting pain after 6 hours are treated further, for up to 72 hours, in an Observation Unit attached to the Emergency Room. Narcotic analgesics are administered regularly for the first 24 hours.

RESULTS

Using this protocol, acute pain crisis could be terminated or controlled in over 80% of patients within 72 hours.

CONCLUSION

Regular intravenous narcotic analgesia for the initial 24 hours, supplemented by oral analgesia, is useful for adult patients with severe acute sickle cell pain crisis when the pain is inadequately controlled by initial Emergency Room treatment. There may be gender differences in pain perception and response in acute sickle cell pain crisis.

Thyroid function, plasma insulin, glucose and ketones and in vitro hepatic gluconeogenesis in rats under chronic low iodine intake

Weaning female rats were fed for 13–14 months with a low iodine diet (LID) and compared with age matched controls on KIO3 supplemented LID (C). At sacrifice the LID rats had large goitres, low plasma PBI and thyroidal 127I content, a rapid thyroidal-131I (*I) turnover and increased *MIT/*DIT and *T3/*T4 ratios. Body weights were slightly higher in LID and pituitary growth hormone like protein bands were the same in both groups. There were no differences between LID and C, whether fed or fasted for 48 h with regard to plasma insulin, glucose and ketone bodies. In vitro disposition of trace or 10−2 m alanine-U-14C by liver slices were the same as measured by 14C incorporation into CO2, glucose and lactic acid. The response of these parameters to fasting was normal: plasma insulin and glucose decreased and ketone bodies and in vitro gluconeogenesis increased. The lack of alteration in the intermediary metabolism of rats, sufficiently iodine deficient to develop goitre, has been interpreted as indicating either that: 1) thyroid hormones have no direct effect on the parameters of intermediary metabolism studied, or 2) there is enough hormone available to the tissues to keep a normal metabolism but not to suppress TSH secretion, thus suggesting different sensitivities to the hormone.

[Intermittent use of etanercept in psoriasis]

Systemic treatment for psoriasis has radically changed since the emergence of new biological therapies. One of these biological agents is etanercept. Until recently, the use of etanercept for treatment of moderate-to-severe psoriasis in Spain was only approved in an intermittent way or in cycles of treatment (not exceeding 24 weeks). However, from September 2009, its administration has been also approved in a continuous way for patients who require it. This decision is based on the results of several studies that evaluate the efficacy and safety of etanercept administrated in short and long term and in a continuous or intermittent therapy. One of these studies is Crystel study, what evaluates the efficacy and safety of continuous and paused etanercept regimens in psoriasis patients for 54-week-period. Crystel study results showed that both continuous and paused etanercept therapies improved PGA and PASI scores and patient satisfaction rates, no unexpected adverse effects were observed. Therefore, doctors may use one treatment or another according to patients needs.

Correction to: Pregnant women with gestational diabetes and with well controlled glucose levels have decreased concentrations of individual fatty acids in maternal and cord serum

The authors regret that the incorrect figure was shown in Fig. 3d. The corrected figure is reproduced here.

Rapid effects of insulin and glucose on the hepatic incorporation of gluconeogenic substrates into glyceride glycerol and glycogen

1. The hepatic utilization of gluconeogenic substrates was investigated shortly after portal infusion of either insulin or glucose in fasted rats. 2. After 20 min of insulin infusion blood glucose concentration decreased. However, neither glucose generation from precursors such as alanine or pyruvate nor their incorporation into fatty acids was modified. Under these conditions, insulin rapidly increased the incorporation of gluconeogenic substrates into the hepatic glyceride glycerol fraction. Insulin treatment led to a decrease in substrate incorporation into liver glycogen. 3. After 20 min of portal glucose infusion both plasma insulin and glucose concentrations increased and the incorporation of pyruvate into hepatic glyceride glycerol and into glycogen was also stimulated. 4. A close relationship was observed between blood glucose concentrations and the level of incorporation of gluconeogenic substrates into liver glycogen. 5. In conclusion, during fasting insulin stimulates the incorporation of gluconeogenic substrates into the glycerol moiety of hepatic glycerides, which may be the preferential mechanism through which fatty acid esterification is accomplished during refeeding. This effect of insulin is rapid and detected even before other classical modifications induced by the hormone such as gluconeogenesis inhibition or lipogenesis activation. Furthermore, the effect is not related to insulin-induced hypoglycemia since glucose infusion mimics insulin action on glyceride glycerol synthesis.

Effects of insulin on the disposal of 14C-labelled very low density lipoprotein triglycerides in intact and hepatectomized rats

In sham-operated rats, intravenous administration of 14C-very low density lipoprotein triglycerides (with labelled esterified fatty acids) caused an initial decrease and subsequent increase in plasma 14C-lipids of both very low density lipoproteins (VLDL) (density less than 1.006) and lipoproteins of density greater than 1.019. There was a similar change in 14C-lipids in adipose tissue and heart whereas in kidney, spleen and liver, 14C-lipids increased initially and then decreased. Insulin treatment in sham-operated animals decreased circulating 14C-lipids in VLDL and in lipoproteins of density greater than 1.019, while intermediate density (1.006-1.019) lipoproteins increased. Insulin also enhanced the radioactivity retained in spleen. In functionally hepatectomized rats, 14C-lipids progressively increased in heart. Insulin treatment in these rats enhanced the disappearance from circulation of 14C-VLDL and of lipoproteins of density greater than 1.019, as well as the appearance of 14C-intermediate density lipoproteins. The appearance of 14C-lipids in white adipose tissue also was augmented, while it decreased in heart and lung. Thus, in sham-operated animals, insulin apparently stimulates the uptake of products of VLDL metabolism by cells in the reticuloendothelial system, while in functionally hepatectomized rats there is increased heart utilization of VLDL triglycerides, and insulin enhances the net extrahepatic catabolism of these lipoproteins.

Dextran Sulfate Complexes with Potassium Phosphate to Interfere in Determinations of High-Density Lipoprotein Cholesterol

The interference of dextran sulfate with the colorimetric determination of free cholesterol causes an increase in the absorbance that is proportional to the dextran sulfate concentration in the sample. This makes estimation of the free cholesterol concentration unreliable in high-density lipoprotein-containing supernates obtained after plasma precipitation with dextran sulfate/MgCl2. Analysis of the absorption spectrum demonstrated that the absorbance increase was due to turbidity. We observed this effect with colorimetric reagents based on potassium phosphate buffer but not with those based on sodium phosphate or Tris buffers. This effect is ascribed to dextran sulfate because neither the omission of Mg2+ ions nor their chelation with EDTA prevented turbidity, whereas precipitation of dextran sulfate with Ba2+ counteracted this effect. Therefore, potassium phosphate-buffered reagents appear unsuitable for colorimetric lipid determinations in samples containing dextran sulfate.

A sucrose-rich diet during pregnancy causes a similar response in Sprague-Dawley and Wistar rats

BACKGROUND/AIMS

In order to determine whether the response to a sucrose-rich diet (SRD) during pregnancy in the rat varies depending on the strain, the responsiveness to a SRD (63 g sucrose/100 g) during pregnancy in Wistar and Sprague-Dawley rats was studied.

METHODS

One group of rats of each strain was fed the SRD, whereas another group received the same diet except that sucrose was replaced by an equal amount of cornstarch. Half of the rats were mated, and all animals were studied 20 days later.

RESULTS

Initial body weight did not differ among groups, but final body weight of pregnant Wistar rats was lower than in Sprague-Dawley, and this difference corresponded to a decrease in fetal body weight in the former. Feeding a SRD did not modify pregnancy outcome in either rat strain. Plasma triglycerides increased with a SRD, although this effect was milder in Wistar pregnant rats than in the other groups. Adipose tissue lipoprotein lipase activity was lower in pregnant than in virgin rats, but no differences were found as result of either diet or rat strain. Liver triglyceride concentration increased in virgin rats fed SRD, the effect being greater in Sprague-Dawley than in Wistar rats.

CONCLUSION

Differences in the response to a SRD in pregnant and virgin rats do not depend on the strain of rats used.

Effect of etofibrate on bile production in the normolipidemic rat

1. The effect of etofibrate, the ethandiol-1,2 diester of nicotinic and clofibric acids on bile production was studied in male rats that received a daily dose of 300 mg of etofibrate/kg body weight by stomach tube for 10 days and were compared with control rats receiving the medium. 2. The bile duct was cannulated, animals were intravenously given 1 microCi (4-14C)-cholesterol/100 b.w. and bile was collected at different intervals for a total of 4 hr. 3. Etofibrate treatment decreased plasma cholesterol and triglyceride concentrations and increased the bile flow. The cummulative amount of both bile volume and total bile radioactivity secreted increased linearly in all the animals; the respective slopes being higher in etofibrate treated rats than in controls. 4. The main labelled component found in the bile was always bile acids rather than cholesterol and the proportion of each of these compounds was similar in both groups. Neither was any difference between the groups found in the concentration of bile acids, cholesterol and phospholipids nor in the cholesterol/(bile+phospholipid) ratio. 5. Besides other factors, the present results indicate that an increase in bile flow and biliary cholesterol excretion in its free form and after its conversion into bile acids should contribute to the hypocholesterolemic effect of etofibrate.

Effect of heparin on the utilization in vitro of labelled glycerides from triglyceride-rich lipoproteins in rat adipose tissue

Triglyceride-rich lipoproteins from adult rat plasma were labelled in vivo with 3H in the esterified fatty acids and 14C in the labelled glyceride glycerol of neutral lipids by injecting i.v. sodium 9-10 (n)-[3H] palmitate and [U-14C] glycerol, after which the prelabelled lipoproteins were purified by ultracentrifugation and dialysis. The lipoproteins were incubated in vitro, in the presence or not of heparin, with pieces of epididymal fat pads or isolated adipocytes from fed rats. The disappearance of both [3H]- and [14C] lipids from the media was greater when incubations were performed with adipocytes than with fat-pad pieces and it increased with heparin in both preparations. More 3H-label than 14C was found in the tissue lipids, a higher percentage being present in adipocytes than in fat-pad pieces, and the amount of label in tissue lipids was always enhanced by heparin. Some 14C-label appeared as esterified fatty acids in both tissue preparations and it also was enhanced by the presence of heparin. These findings are in agreement with the recognized influence of heparin on the release of lipoprotein lipase and show the direct relationship between heparin action and tissue ability to take up products of lipoprotein triglyceride breakdown. They also demonstrate the ability of adipose tissue to metabolize glycerol coming from the hydrolysis of lipoprotein glycerides.