Managing unexpected births in the emergency department

Nurses in emergency departments can be the first contact for patients who require assessment and management because they suspect they are about to give birth. This article discusses some of the challenges of caring for these women and considers the development of guidelines for practice.

Are sexual problems more common in women who have had a tubal ligation? A population-based study of Australian women

OBJECTIVE

To investigate whether women who have had a tubal ligation are more likely to experience sexual problems than other women.

DESIGN

Population-based telephone survey.

SETTING

Australia-wide, including cities, regional towns, and rural areas.

POPULATION

A total of 3448 Australian women aged between 16 and 64 years.

METHODS

Women were surveyed using random-digit dialling throughout 2004 and 2005.

MAIN OUTCOME MEASURES

Prevalence of sexual problems and ratings of sexual satisfaction, relationship satisfaction, and sexual pleasure.

RESULTS

From a weighted sample of 2721 women, 447 (16.4%) reported having had a tubal ligation, with 85.0% currently aged between 40 and 64 years. Having a tubal ligation was not associated with any specific sexual problem, such as physical pain during sex or an inability to reach orgasm. In fact, after controlling for age and other sociodemographic differences, sterilised women were significantly less likely than non-sterilised women to lack an interest in having sex (OR 0.69, 95% CI 0.54-0.89), to take 'too long' to reach orgasm (OR 0.69, 95% CI 0.50-0.96), to experience vaginal dryness during sex (OR 0.70, 95% CI 0.50-0.96), and to find sex unpleasurable (OR 0.64, 95% CI 0.46-0.90). Sterilised women were also more likely to experience extremely high levels of sexual satisfaction (OR 1.66, 95% CI 1.27-2.18), relationship satisfaction (OR 1.29, 95% CI 1.01-1.67), and sexual pleasure (OR 1.59, 95% CI 1.20-2.12).

CONCLUSIONS

Our findings suggest no adverse effects, and possibly some benefits, for the sexual lives of women undergoing tubal ligation. These findings should be included with other educational material for couples considering sterilisation as a contraception option.

Bacterial strain-specific induction of Foxp3+ T regulatory cells is protective in murine allergy models

BACKGROUND

The incidence of atopic disease has increased dramatically during recent decades and the potential immunoregulatory influence of the microbiota in these individuals is under investigation.

OBJECTIVE

The aim of our study was to identify a bacterial strain that is protective in murine allergy models and to determine if microbial induction of T regulatory cells was associated with protection from allergic inflammation.

METHODS

Three microbes (Bifidobacterium breve AH1205, B. longum AH1206 and Lactobacillus salivarius AH102) of human origin were fed to newborn, adult and germ-free animals. Induction of Foxp3(+) T regulatory cells was assessed by flow cytometry. Gene array analysis was performed on Peyer's patches. Strains were also examined for their protective effects in the ovalbumin (OVA) respiratory allergy model and the OVA-cholera toxin dietary allergy model.

RESULTS

Bifidobacterium longum AH1206 consumption resulted in increased numbers of Foxp3(+) T regulatory cells in infant, adult and germ-free animals. B. breve AH1205 induced Foxp3(+) T regulatory cell expansion only in infant mice while L. salivarius AH102 did not alter T regulatory cell numbers in any animal model tested. B. longum AH1206 reduced the Peyer's patch gene expression associated with antigen presentation, TLR signalling and cytokine production while increasing the expression of genes associated with retinoic acid metabolism. B. longum AH1206 protected against airway inflammation in OVA-sensitized animals and B. longum AH1206 blocked the induction of IgE to orally administered OVA. Neither B. breve AH1205 nor L. salivarius AH102 had a protective effect in either model.

CONCLUSION

Bacterial strain-specific induction of Foxp3(+) T regulatory cells in vivo is associated with protection from respiratory and oral allergy.

A high-precision apparatus for the characterization of thermal interface materials

An apparatus has been designed and constructed to characterize thermal interface materials with unprecedented precision and sensitivity. The design of the apparatus is based upon a popular implementation of ASTM D5470 where well-characterized meter bars are used to extrapolate surface temperatures and measure heat flux through the sample under test. Measurements of thermal resistance, effective thermal conductivity, and electrical resistance can be made simultaneously as functions of pressure or sample thickness. This apparatus is unique in that it takes advantage of small, well-calibrated thermistors for precise temperature measurements (+/-0.001 K) and incorporates simultaneous measurement of electrical resistance of the sample. By employing precision thermometry, low heater powers and minimal temperature gradients are maintained through the meter bars, thereby reducing uncertainties due to heat leakage and changes in meter-bar thermal conductivity. Careful implementation of instrumentation to measure thickness and force also contributes to a low overall uncertainty. Finally, a robust error analysis provides uncertainties for all measured and calculated quantities. Baseline tests were performed to demonstrate the sensitivity and precision of the apparatus by measuring the contact resistance of the meter bars in contact with each other as representative low specific thermal resistance cases. A minimum specific thermal resistance of 4.68x10(-6) m(2) K/W was measured with an uncertainty of 2.7% using a heat transfer rate of 16.8 W. Additionally, example measurements performed on a commercially available graphite thermal interface material demonstrate the relationship between thermal and electrical contact resistance. These measurements further demonstrate repeatability in measured effective thermal conductivity of approximately 1%.

Implementing the National Institute of Clinical Excellence improving outcome guidelines for head and neck cancer: developing a business plan with reorganisation of head and neck cancer services

The implementation of the National Institute of Clinical Excellence improving outcome guidelines (NICE-IOG) manual for head and neck cancer may have a huge potential cost implication. Head and neck cancer is a rare disease which utilises large quantities of resources which can only be provided in a tertiary centre. Head and neck cancer services should be centralised into a single site for each cancer network. A new higher tariff rate for complex head and neck cancer cases is needed which recognises the true cost of this work. Each network should set its own tariff to make head and neck cancer care financially viable.

The performance of lucerne - wheat rotations on Western Australian duplex soils

In field experiments on duplex soils in the south-eastern and central Western Australian wheatbelt, lucerne (Medicago sativa L.) was compared with subterranean clover (Trifolium subterraneum L.) in pasture–crop rotations. Comparative pasture plant densities and biomass, soil water content, available soil nitrogen, wheat grain yield, and protein content were measured during 2 and 3 years of pasture followed by 2 and 1 year of wheat, respectively. Lucerne densities declined by 60–90% over the 3-year pasture phase but produced up to 3 times more total annual biomass than weed-dominant annual pastures and similar total annual biomass when annual pastures were legume dominant. Lower soil water contents were measured under lucerne than under annual pastures from 6 months after establishment, with deficits up to 60 mm in the 0–1.6 m soil profile. However, significant rain events and volunteer perennial weeds periodically negated comparative deficits. Wheat yields were lower following lucerne (1.3 t/ha) than following an annual pasture (1.8 t/ha) in a low-rainfall season, higher (3.7 v. 2.9 t/ha) in a high-rainfall season, and much higher when the previous annual pastures were grass dominant (3.4 v. 1.5 t/ha). Grain protein contents were 1–2% higher in response to the lucerne pasture phase. Overcropping wheat into a lucerne pasture of 19 plants/m2 reduced wheat grain yields, but a lucerne density of 4 plants/m2 reduced yields only where rainfall was low. The study has shown that lucerne–wheat rotations provide a productive farming system option on duplex, sodic soils in both the south-eastern and central cropping regions of Western Australia. This was most evident in seasons of above-average summer and growing-season rainfall and when compared with grass-dominant annual pastures.

Transient activation of Jun N-terminal kinases and protection from apoptosis by the insulin-like growth factor I receptor can be suppressed by dicumarol

The insulin-like growth factor I receptor (IGF-IR) activated by its ligands insulin-like growth factor (IGF)-I or IGF-II mediates suppression of apoptosis and contributes to tumorigenesis and cell growth. Here we investigated the activation of the stress-activated protein kinases including Jun N-terminal Kinases and p38 MAPK by IGF-I in interleukin-3-dependent FL5.12 lymphocytic cells that overexpress the IGF-IR (FL5.12/WT). We have shown previously that IGF-I protects these cells from apoptosis induced by interleukin-3 withdrawal but does not promote proliferation. IGF-I induced a rapid and transient activation of JNK that peaked at 40 min that was paralleled by a transient and robust phosphorylation of c-Jun. p38 was constitutively phosphorylated in FL5.12/WT cells. Activation of the JNK pathway by IGF-I occurred in the presence of phosphatidylinositol 3-kinase inhibitors and could be enhanced by anisomycin. Analysis of a series of FL5.12 cells expressing mutated IGF-IRs and analysis of 32D/IGF-IR cells showed that neither the C terminus of the receptor nor IRS-1 and IRS-2 were required for JNK activation, although tyrosine 950 was essential for full activation. The JNK inhibitor dicumarol suppressed IGF-I-mediated activation of JNK and phosphorylation of c-Jun but did not affect p38 and IkappaB phosphorylation or activation of AKT. IGF-I-mediated protection from apoptosis in FL5.12/WT cells was completely suppressed by dicumarol and partially suppressed by a p38 inhibitor. In the breast carcinoma cell line MCF-7, treatment with dicumarol also induced apoptosis. These data indicate that transient activation of JNK by IGF-I is mediated by signals that are distinct from those leading to phosphatidylinositol 3-kinase and AKT activation. The data further suggest that the SAPK pathways contribute to suppression of apoptosis by the IGF-IR.

Japanese fermented soybean food as the major determinant of the large geographic difference in circulating levels of vitamin K2: possible implications for hip-fracture risk

Increasing evidence indicates a significant role for vitamin K in bone metabolism and osteoporosis. In this study, we found a large geographic difference in serum vitamin K2 (menaquinone-7; MK-7) levels in postmenopausal women. Serum MK-7 concentrations were 5.26 +/- 6.13 ng/mL (mean +/- SD) in Japanese women in Tokyo, 1.22 +/- 1.85 in Japanese women in Hiroshima, and 0.37 +/- 0.20 in British women. We investigated the effect of Japanese fermented soybean food, natto, on serum vitamin K levels. Natto contains a large amount of MK-7 and is eaten frequently in eastern (Tokyo) but seldom in western (Hiroshima) Japan. Serum concentrations of MK-7 were significantly higher in frequent natto eaters, and natto intake resulted in a marked, sustained increase in serum MK-7 concentration. We analyzed the relation between the regional difference in natto intake and fracture incidence. A statistically significant inverse correlation was found between incidence of hip fractures in women and natto consumption in each prefecture throughout Japan. These findings indicate that the large geographic difference in MK-7 levels may be ascribed, at least in part, to natto intake and suggest the possibility that higher MK-7 level resulting from natto consumption may contribute to the relatively lower fracture risk in Japanese women.

The role of exon 5 in fibroblast collagenase (MMP-1) substrate specificity and inhibitor selectivity

Interstitial collagen is degraded by members of the matrix metalloproteinase (MMP) family, including MMP-1. Previous work has shown that the region of MMP-1 coded for by exon 5 is implicated both in substrate specificity and inhibitor selectivity. We have constructed a chimeric enzyme, the exon 5 chimera, consisting primarily of MMP-1, with the region coded for by exon 5 replaced with the equivalent region of MMP-3, a noncollagenolytic MMP. Unlike MMP-3, the exon 5 chimera is capable of cleaving type I collagen, but the activity is only 2.2% of trypsin-activated MMP-1. 'Superactivation' of the chimera has no discernible effect, suggesting that the salt bridge formed in 'superactive' MMP-1 is not present. The kinetics for exon 5 chimera cleavage of two synthetic substrates display an MMP-3 phenotype, however, cleavage of gelatin is slightly impaired as compared to the parent enzymes. The K(iapp) values for the exon 5 chimera complexed with synthetic inhibitors and N-terminal TIMP-2 also show a more MMP-3-like behaviour. However, the k(on) values for N-terminal TIMP-1 and N-terminal TIMP-2 are more comparable to those for MMP-1. These data show that the region of MMP-1 coded for by exon 5 is involved in both substrate specificity and inhibitor selectivity and the structural basis for our findings is discussed.

Development of an ultralow-light-level luminescence image analysis system for dynamic measurements of transcriptional activity in living and migrating cells

We have developed an approach to study in single living epithelial cells both cell migration and transcriptional activation, which was evidenced by the detection of luminescence emission from cells transfected with luciferase reporter vectors. The image acquisition chain consists of an epifluorescence inverted microscope, connected to an ultralow-light-level photon-counting camera and an image-acquisition card associated to specialized image analysis software running on a PC computer. Using a simple method based on a thin calibrated light source, the image acquisition chain has been optimized following comparisons of the performance of microscopy objectives and photon-counting cameras designed to observe luminescence. This setup allows us to measure by image analysis the luminescent light emitted by individual cells stably expressing a luciferase reporter vector. The sensitivity of the camera was adjusted to a high value, which required the use of a segmentation algorithm to eliminate the background noise. Following mathematical morphology treatments, kinetic changes of luminescent sources were analyzed and then correlated with the distance and speed of migration. Our results highlight the usefulness of our image acquisition chain and mathematical morphology software to quantify the kinetics of luminescence changes in migrating cells.

Injury induces deficient interleukin-12 production, but interleukin-12 therapy after injury restores resistance to infection

OBJECTIVE

To assess at serial intervals the production of interleukin-12 (IL-12) by monocytes/macrophages from the peripheral blood of injured patients and control subjects, and using a mouse model to confirm human findings and explore the effectiveness of low-dose IL-12 therapy in restoring resistance to infection after injury.

SUMMARY BACKGROUND DATA

Serious injury is associated with loss of function of the T helper 1 lymphocyte phenotype, but little is known about IL-12 production in injured patients. The authors previously reported that early, moderate-dose IL-12 therapy in a mouse model of burn injury restored resistance to a later infectious challenge (cecal ligation and puncture, CLP). However, the efficacy of clinically relevant low-dose IL-12 therapy carried out to or beyond the time of septic challenge remains to be tested.

METHODS

Peripheral blood mononuclear cells (PBMCs) and adherent cells were obtained from 27 patients with major burns or traumatic injury and 18 healthy persons and were studied at serial intervals for IL-12 production stimulated by bacterial lipopolysacharide (LPS). PBMCs from 18 of the same patients were studied for IL-10 production as well. IL-12 production by adherent cells from the spleens of burn or sham burn mice was studied at serial intervals after injury to confirm the human findings. Low-dose IL-12 or vehicle was given every other day to groups of burn and sham burn mice, which were then challenged with CLP on day 10, and survival was determined. Finally, spleens were harvested from burn or sham burn animals receiving low-dose IL-12 or vehicle after CLP. After splenic cellularity was determined by hemocytometer, splenocytes were cultured and production of tumor necrosis factor-alpha, interferon-gamma, and IL-10 were assessed by immunoassay.

RESULTS

Adherent cells from patients' PBMCs produced significantly less IL-12 than normal PBMCs after injury, reaching a nadir 8 to 14 days after injury. Stimulation of whole PBMCs by LPS indicated that at 8 to 14 days after injury, IL-12 production by PBMCs was significantly lower and IL-10 production was significantly higher than that of PBMCs from healthy persons. Low-dose IL-12 therapy significantly increased survival after CLP. Splenocytes from burn mice treated with IL-12 had significantly increased production of TNF-alpha and IF-beta, both before and after CLP, when compared with vehicle-treated burn animals. IL-10 production by bum splenocytes remained high after IL-12 treatment. Splenic cellularity increased after IL-12 treatment in burn mice.

CONCLUSION

The capacity to produce IL-12 by adherent cells of the monocyte/macrophage lineage is significantly reduced after serious injury in humans and in a mouse burn model. In humans, there is a reciprocal relation between diminished IL-12 production and increased IL-10 production at approximately 1 week after injury. Low-dose IL-12 therapy in the mouse burn model markedly increased survival after a septic challenge, even when treatment was carried beyond the onset of sepsis. Low-dose IL-12 treatment in the mouse increased production of proinflammatory mediators important in host defense and at the same time maintained or increased production of IL-10, an important antiinflammatory cytokine.

Protective effects of early interleukin 10 antagonism on injury-induced immune dysfunction

HYPOTHESIS

Interleukin 10 (IL-10) plays a central role in the development of postinjury immune suppression, and early in vivo IL-10 antagonism can be protective.

DESIGN

Male A/J mice underwent sham or burn injury and were treated with monoclonal anti-IL-10 antibody or control antibody at 1 day or 3 days after injury. Their ability to survive polymicrobial sepsis induced by the cecum ligation and puncture (CLP) technique was then tested. The response of sham- and burn-injured mice and burn-injured mice treated with anti-IL-10 to immunization with a T-cell-dependent antigen, trinitrophenyl (TNP)-haptenated ovalbumin (TNP-OVA) was also assessed.

MAIN OUTCOME MEASURES

Mortality was monitored for a total of 7 days after CLP to assess the effect of anti-IL-10 therapy on the survival of burn-injured, immunecompromised mice. Serum antibody isotype formation was measured in sham- and burn-injured mice and burn-injured mice treated with anti-IL-10 to determine how IL-10 antagonism influenced helper T-cell responses in vivo. In vitro cytokine production by antigen-stimulated spleen cells was assessed to study the effect of blocking IL-10 activity at 1 day vs 3 days after burn injury.

RESULTS

Treating mice with anti-IL-10 at 1 day after injury significantly improved CLP survival, whereas delaying treatment 3 days had no beneficial effect. The analysis of T-cell function in vivo as determined by serum antibody isotype formation indicated that anti-IL-10 treatment at 1 day or 3 days after injury increased T helper cell 1-type antibody formation to sham injury levels by day 10. Moreover, these treatments restored the injury-induced reduction of antigen-stimulated IL-2, interferon gamma, and IL-10 production.

CONCLUSIONS

Interleukin 10 plays an early role in the development of burn injury-induced immune suppression. Its in vivo inhibition at 1 day after injury may be a useful approach toward preventing the development of injury-induced immune dysfunction and may do so by restoring T-cell function and cytokine production.