Effects of single and chronic intracerebroventricular administration of the orexins on feeding in the rat

Two novel hypothalamic neuropeptides, orexin-A and -B, are suggested to regulate feeding. A single intracerebroventricular injection of orexin-A (23.4 nmol), administered 3 h into the light phase, increased feeding in satiated rats and prolonged feeding in fasted rats; it also increased feeding when given 6 h into, but not at the start of, the dark phase. An 8-day intracerebroventricular infusion with orexin-A (18 nmol/day) increased daytime feeding on days 2 and 8, but nocturnal feeding was reduced and there was no change in 24 h intake. Orexin-B had no effects. These results demonstrate a circadian variation in feeding responses to orexin-A.

Lymphocyte and eosinophil influx into alveolar tissue in nocturnal asthma

We have shown in nocturnal asthma that alveolar tissue eosinophils are increased at night as compared with the proximal airway, and that they correlate with the overnight decrement in lung function. As the CD4+ cell is thought to be the principal orchestrating cell in eosinophil recruitment, we evaluated its presence in the proximal and distal airways in nocturnal asthma. Eleven patients with nocturnal asthma (NA) and 10 patients with non-nocturnal asthma (NNA) underwent two bronchoscopies with proximal airway endobronchial and distal alveolar tissue transbronchial biopsy in a random order at 4:00 P.M. and at 4:00 A.M. separated by 1 wk. Immunohistochemical staining and morphometric analysis were used to determine the number of CD3+, CD4+, and CD8+ cells and EG2+ eosinophils per mm2 in the epithelium, lamina propria, and alveolar tissue. At 4:00 A.M., the NA group had a significantly greater number of CD4+ cells in the alveolar tissue than the NNA group (9.8 cells/ mm2 [5.6-30.8, interquartile (IQ)] versus 1.5 cells/mm2 [0-6. 3, IQ], p = 0.04). Within the NA group, there were significantly greater numbers of CD3+, CD4+, CD8+, and EG2+ cells in the proximal airway lamina propria than in the distal airway at both 4:00 P.M. and 4:00 A.M. There were no differences within the epithelium between the groups at either time point. Only alveolar tissue, not airway tissue, CD4+ cells correlated inversely with the percentage predicted FEV1 at 4:00 A.M. (r = -0.68, p = 0.0018) and positively with the number of alveolar tissue EG2+ cells (r = 0.66, p = 0.01). These findings suggest that the CD4+ lymphocyte is increased in the alveolar tissue at night in nocturnal asthma as compared with non-nocturnal asthma.

Comforting strategies used during nasogastric tube insertion

Nasogastric tube insertion is a procedure that commonly involves discomfort, yet requires the cooperation of the conscious patient. This study employed qualitative ethology to investigate how comforting strategies were used during the insertion of nasogastric tubes in trauma care. Practitioners used eight direct and indirect comforting strategies in uniquely patterned styles (technical, affective and blended). In addition, a form of 'team comforting' was implemented as multiple trauma team members made a concerted effort to complete the procedure. Further study is needed to explicate how the nurse's style affects the behavioural state displayed by the patient.

The effect of electronic dental anesthesia on behavior during local anesthetic injection in the young, sedated dental patient

PURPOSE

The purpose of this study was to evaluate the effectiveness of the 3M Electronic Dental Anesthesia (EDA) finger electrode on reducing sedated patient responsiveness during local anesthesia administration.

METHODS

Thirty patients between the ages of 24 to 48 months, ASA I, and in need of treatment of maxillary anterior teeth using local anesthesia were used in this study. Each of the patients received chloral hydrate (CH) and hydroxyzine (50 mg/kg and 2 mg/kg, respectively). The patients were divided randomly in two groups. The experimental group received activated electronic dental anesthesia (AEDA) while the control group had a nonactive EDA (NAEDA). Physiological parameters were recorded and behavior was videotaped and rated using the Ohio State University Behavior Rating Scale. A repeated-measures ANOVA, Student's tests, and descriptive statistics were used.

RESULTS

The results indicated that the heart rate and diastolic blood pressure of both groups were significantly affected as a function of time and dental procedures. A significant effect in the percent change of heart rate between groups was noted during local anesthetic injection with the NAEDA group having an increased heart rate. There was a higher occurrence of movement in the NAEDA compared to the AEDA.

CONCLUSION

The EDA appears to be beneficial in reducing the discomfort, as judged by behavioral and physiologic observations, associated with local anesthetic administration in young sedated dental patients.

The effects of regular inhaled formoterol, budesonide, and placebo on mucosal inflammation and clinical indices in mild asthma

The present study was designed to observe the effects of 8 wk of treatment with formoterol (Foradil) 24 microgram, budesonide 400 microgram, and matched placebo inhaled twice a day on inflammatory indices in the bronchial mucosa of 64 patients with mild atopic asthma. Biopsies were obtained at the start and 1 wk before stopping a 9-wk period of treatment, and inflammatory cell numbers were assessed in the submucosa and epithelium by immunohistochemistry. Regular formoterol significantly reduced the number of submucosal mast cells, with a similar trend for eosinophils but not activated T cells. A subgroup analysis conducted in biopsies with >= 10 eosinophils per mm2 revealed a significant reduction in eosinophil numbers when compared with both pretreatment baseline (p < 0.01) and changes after placebo (p < 0.01). Parallel, but less pronounced, effects were observed on mast cell but not on CD25(+) T cell numbers. There was no effect of any of the three treatments on BAL levels of mast cell or eosinophil mediators. We conclude that regular treatment with inhaled formoterol reduces rather than increases inflammatory cells in the mucosa of asthmatic patients. It is possible that these cellular effects of formoterol may contribute to the therapeutic efficacy of this drug when used regularly in the treatment

Presenting characteristics and treatment outcomes for tongue lacerations in children

PURPOSE

Tongue lacerations in children require treatment decisions by clinicians, but there is conflicting literature on the topic of suturing.

METHODS

In this prospective study, 28 patients (mean age 3.0 +/- 2.3 yr) with traumatic tongue lacerations were triaged according to an existing protocol to determine if the laceration would be sutured. At least 2 weeks post-trauma, 22 patients were evaluated by examination or report for quality of result and post-trauma complications. The most common location was anterior dorsum. A fall at home was the most common situation. Mean delay from injury to treatment was 4.5 +/- 9.0 h. No statistically significant difference was found for quality of result or post-trauma morbidity between those lacerations sutured and those not. No significant relationship was found between quality of result and size of laceration or bleeding at the time of presentation. Time delay did not significantly affect the quality of result.

CONCLUSION

Results suggest that suturing does not improve outcome or post-trauma course for tongue lacerations in young children.

Wellness intervention with pregnant soldiers

The purpose of this study was to measure the effects that wellness program intervention for pregnant soldiers, exercise and/or education, had on methods of delivery, pregnancy outcomes, rates of complications, Army Physical Fitness Test scores, and labor and delivery costs. The study consisted of a retrospective review and analysis of 823 active duty Army obstetric and newborn records, 181 Army Physical Fitness Test records, and 411 initial and 148 postpartum subjective questionnaires. Data were collected from records of soldiers who delivered at Madigan Army Medical Center (Tacoma, Washington) between January 1992 and December 1994. Group I (N = 211) included soldiers who received wellness intervention, group II (N = 147) included those who did not receive wellness intervention. Limited data from the records of soldiers who delivered before a wellness program was offered on post constituted group III, a historical control group (N = 413). Group IV included data from a high-risk population (N = 52) collected during the wellness program. Data were also divided into additional subgroups to ascertain if one aspect of the wellness program (i.e., exercise versus education) influenced any or all of the dependent variables. A soldier's data were excluded if a pregnancy was terminated before 20 weeks of gestation or if it was a multiple gestation. Demographic data and variables were compared using multivariate methods of analysis to evaluate the effect of the independent variable, wellness intervention. Results indicated that infants of the wellness group participants had proportionately increased gestational age and birth weight, with reduced incidence of the complications fetal bradycardia, hyperbilirubinemia, preeclampsia, and premature labor. Likewise, African-American female soldiers in this study, assessed in other studies as a high-risk group, had a lower incidence of premature delivery and low birth weight when they participated in wellness intervention. Of clinical interest, it appeared as though wellness intervention shortened labor duration and reduced the number of neonatal intensive care unit admissions and the number of neonatal intensive care unit days, which resulted in reduced health care costs.

Orphan G-protein-coupled receptors: the next generation of drug targets?

The pharmaceutical industry has readily embraced genomics to provide it with new targets for drug discovery. Large scale DNA sequencing has allowed the identification of a plethora of DNA sequences distantly related to known G protein-coupled receptors (GPCRs), a superfamily of receptors that have a proven history of being excellent therapeutic targets. In most cases the extent of sequence homology is insufficient to assign these 'orphan' receptors to a particular receptor subfamily. Consequently, reverse molecular pharmacological and functional genomic strategies are being employed to identify the activating ligands of the cloned receptors. Briefly, the reverse molecular pharmacological methodology includes cloning and expression of orphan GPCRs in mammalian cells and screening these cells for a functional response to cognate or surrogate agonists present in biological extract preparations, peptide libraries, and complex compound collections. The functional genomics approach involves the use of 'humanized yeast cells, where the yeast GPCR transduction system is engineered to permit functional expression and coupling of human GPCRs to the endogenous signalling machinery. Both systems provide an excellent platform for identifying novel receptor ligands. Once activating ligands are identified they can be used as pharmacological tools to explore receptor function and relationship to disease.

Changes in cerebral perfusion pressure in puerperal women with preeclampsia

OBJECTIVE

To determine the variation in the estimated maternal cerebral perfusion and cerebrovascular resistance (the resistance area product) in the puerperium.

METHODS

The maternal middle cerebral artery was evaluated by transcranial Doppler ultrasound in ten women 2 days before labor, in 21 women in early labor and at 24 and 48 hours postpartum, and in 6 women at 1 week postpartum. Cerebral blood flow velocities were determined. Women were diagnosed initially with mild preeclampsia. Estimated cerebral perfusion pressure was Vmean/[Vmean - Vdiastolic] [BPmean - BPdiastolic]. Because the diameter of the vessels could not be measured directly, an index of resistance was calculated: the resistance area product = BPmean/velocitymean. We calculated an index of cerebral blood flow to be estimated cerebral perfusion pressure divided by resistance area product. Our study had a power of 80% to detect a 16-cm/second increase in middle cerebral blood flow velocity.

RESULTS

Estimated maternal cerebral perfusion was maintained for up to 1 week postpartum. Cerebrovascular resistance did not change in the puerperium. Cerebral blood flow index (+/-standard deviation) was significantly increased at 1 week postpartum compared with early labor levels (28.3 +/-6.9 versus 46.7+/-15.6, respectively) (P < .05).

CONCLUSION

Cerebral blood flow 1 week postpartum increased significantly over early labor values. These persistent changes in the cerebral vasculature might put patients at risk for seizures up to 1 week postpartum.