Peripheral plasma levels of prostaglandin metabolites, cortisol and prolactin in women undergoing falope ring application and tubal cautery

The levels of 11-deoxy-13,14-dihydro-15-keto-11 beta, 16 xi-cyclo PGE2 (bicyclo PGEM), 13,14-dihydro-15-keto PGF 2 alpha (PGFM), cortisol and prolactin were measured by radioimmunoassays in five serial plasma samples collected from fourteen patients undergoing falope ring application and three patients undergoing tubal electrocautery. Bicyclo PGEM, PGFM and cortisol levels were unchanged regardless of the type of tubal occlusion procedure or the type of anesthesia administered (7 received general and 10 local anesthesia). Prolactin levels, on the other hand, markedly increased. The increase was greatest in women that received general anesthesia. The lack of change in bicyclo PGEM and PGFM in peripheral plasma would suggest a local transfer of PGs produced by injured tubal tissue to other parts of the tube and the uterus resulting in increased contractions and pelvic pain.

Effect of diuretics on intestinal transport of electrolytes, glucose, and amino acid

The jejunal mucosal membrane of albino mice was used to study the electrical properties and ion transport. The membrane was bathed in Krebs-Ringer solution with or without glucose. When ethacrynic acid (EA), furosemide, or amiloride was added to the bathing fluid of both sides, a transient increase followed by a decrease of both potential difference (PD) and short circuit current (Isc) were observed. In glucose-containing bathing medium, EA inhibited both net Na and Cl flux and residual flux; however, EA had little effect on both Na and Cl flux in glucose-free bathing medium. Studies using everted intestinal sac technique showed that EA inhibited both glucose and L-tyrosine across the mucosal membrane against concentration gradients. Furosemide and amiloride were less potent than EA in inhibiting the Na and Cl flux when the bathing solution contained glucose. But these two compounds had no effect on glucose and L-tyrosine transport across the intestinal mucosa. Furthermore, they did inhibit Cl flux even in the condition of glucose-free bathing medium. It is postulated that all three diuretics act on the brush-border membrane of the intestine. EA probably inhibits the Na-glucose cotransporting system; furosemide and amiloride inhibit the simple diffusion process of Na entry of Cl exit by decreasing the conductance of the membrane.

Obesity and its related diseases in Taiwan

Obesity is related to increased morbidity and mortality, and prevails worldwide. It has become an important health issue and requires urgent attention. In Taiwan, overweight and obesity are defined as body mass index > or = 24 and 27 kg m(-2), respectively. These cut-offs differ from Caucasian standards, as Asians have higher comorbidities and fat mass at lower BMI levels than Caucasians. The prevalence of obesity and overweight in Taiwan are 19.2% and 30.5% in men, 13.4% and 21.3% in women. This implies that a more profound increase in obesity prevalence is found in men than in women. A high-fat diet, sedentary lifestyle and betel nut chewing may increase substantially this obesity epidemic. Recently, type 2 diabetes mellitus has been found to be the most common type of diabetes, and obesity is significantly related to type 2 diabetes in children. In addition, obesity is associated with cardiovascular diseases risk factors and cannot be neglected in elderly. Therefore, a comprehensive prevention and management programme of obesity is urgently warranted for controlling the growing obesity trend and its related diseases in Taiwan.

Effect of nicotine on gastric acid secretion: evidence of electrogenic pump theory

In vitro studies on H+ secretion, potential difference (PD), short-circuit current (Isc), and resistance across stripped mucosa of frog stomach in Cl-medium have shown that addition of nicotine in the serum bathing fluid caused a marked inhibition of the H+ secretory rate and an increase of PD and Isc without change of the transmucosal resistance. A dose-response correlation was indicated. During the first 8 min, the changes in the measured parameters, namely, PD versus Ih and Isc versus Ih, were linear. After 8 min, a deviation from linearity was observed. From the slope of the regression lines, the resistance of the electrogenic Cl- pump on the mucosal membrane (Rcl) was calculated to be 127 omega cm2 and the resistance of the chloride pathway on the serosal side (Rcl) was 407 omega cm2. The resistance of the H+ pump on the mucosal membrane (Rh) in Cl- medium was estimated to be 385 omega cm2. The sum of the emf's of the Cl+ pump on the mucosal membrane and of the Cl- gradient across the serosal membrane, namely Ecl + Ecl, was found to be 35 mV. The presence of such linear relationships between measured versus the H+ rate and Isc versus Ih lends support to the electrogenic theory of HCl secretion.

P5644Hypoglycemic episodes increase the risk of ventricular arrhythmias and sudden cardiac arrest in patients with type 2 diabetes - a nationwide cohort study

Background

Hypoglycemic episode (HE) increases the risk of cardiovascular mortality. The impact of HE on the risk of sudden death remains unclear. We hypothesized that HE increases the risks of ventricular arrhythmia (VA) and sudden cardiac arrest (SCA), and that anti-diabetic agents (ADAs) causing hypoglycemia also increase the risks of VA and SCA.

Methods

Patients aged ≥20 years with newly diagnosed diabetes were identified from the Taiwan National Insurance Database. HE was defined as the presentation of hypoglycemic coma or specified/unspecified hypoglycemia. For control group, we included diabetic patients without HE, and they were frequency-matched to the HE group at a 4:1 ratio. The primary outcome was the occurrence of any event of VA (including ventricular tachycardia and fibrillation) and SCA during the defined follow-up periods. Multivariate Cox hazards regression model was used to evaluate the hazard ratio (HR) for VA or SCA.

Results

A total of 54,303 diabetic patients were screened with 1,037 of them in the HE group, and 4,148 in the control group. During a mean follow-up period of 3.3±2.5 years, 29 VA/SCA events had occurred. Compared to the control group, the HE group had a higher incidence of VA/SCA (adjusted HR: 2.42, p=0.04). Diabetic patients medicated with insulin for glycemic control increased the risk of VA/SCA compared to those without insulin (adjusted HR: 3.05, p=0.01).

Kaplan-Meier survival curves

Conclusions

HEs in patients with diabetes increased the risks of VA and SCA compared to those without. Their use of insulin also independently increased the risk of VA/SCA.

Serum leptin and leptin receptor isoforms in omental adipose tissue of nondiabetic women undergoing gynecologic surgery for benign disease

BACKGROUND AND PURPOSE

Leptin is important in the regulation of fat mass and body weight. Adipose tissue not only secretes leptin but also serves as a site of action for leptin. This study was designed to examine the relationships among tissue expression of leptin receptors, serum leptin, and body mass index.

METHODS

Omental adipose tissue and fasting blood samples were obtained from 57 nondiabetic women who underwent surgery for either myoma of the uterus or ovarian cyst. Tissue RNA was extracted using Trizol reagent and serum leptin concentrations were determined with commercial kits. The leptin receptor isoforms in tissues were quantified using real-time Taqman technology.

RESULTS

Three leptin receptor isoforms, Ob-Rb, HuB219.1, and HuB219.3, were found in human omental adipose tissue. The amounts of HuB219.1 and HuB219.3 mRNA relative to that of Ob-Rb were 1314.2 and 16.7, respectively. Higher body mass index was significantly correlated with an increase in serum leptin concentration and a decrease in leptin receptor HuB219.1 isoform in omental fat, even after adjustment for age and menopausal status. There was no direct association between serum leptin concentration and tissue HuB219.1 mRNA level.

CONCLUSIONS

HuB219.1 is the major isoform of leptin receptor expressed in human omental adipose tissue. Our findings suggest that the shorter leptin receptor isoforms in human omental adipose tissue might play an important role in body weight control. Further studies on the inter-relationship between leptin concentrations and multiple leptin receptor isoforms are needed to elucidate the exact mechanism of obesity.

[The reasonable design of the combined spinal epidural needles (CSEN) in aneasthesia]

This paper discusses the reasonable factors of parameters in CSEN design and has also raised some useful reasonable parameters concerned.

[Acetabular roof reconstruction with femoral head bone-graft for severe acetabular deficiency in total hip replacement]

From July 1984 to September 1989 at Taichung Veterans General Hospital, 14 patients (15 hips) received femoral head bone-grafting by modified Harris method as a part of their total hip replacement for acetabular bony deficiencies. They were followed up for an average of 31.7 months (range from 7 to 66 months). The clinical results were classified as excellent (58.3%) and good (41.7%) by Harris hip scoring system. All the grafts presented as "solid incorporation" with the pelvic wall and only one of the grafts was assessed to be "definite resorption" (volume reduction greater than 50%) by radiologic study. The "biologic viability" of these grafts were proved to be positive by scintigraphy in three-dimensional technique (SPECT). According to our limited experience and primary follow-up studies, we found that good clinical results depend on ideal positioning of the acetabular component in the true acetabulum and femoral head bone-grafting is an ideal procedure for the reconstruction of severe acetabular dysplasia in total hip arthroplasty.

[Second hip fracture]

During the period from 1982-1990, a total of 1644 patients were admitted to our hospital with proximal femoral fractures. Trochanteric fractures were encountered in 54 per cent of the cases (887/1644) with a mean age of 68 years. Cervical fractures were encountered in 46 per cent of the cases (757/1644) with a mean age of 62 years. We found 28 patients who had been readmitted with a second hip fracture in this retrospective study, including twenty three males and five females. Two of these second hip fractures occurred on the same side as the initial fracture and twenty six occurred on the opposite side. The time interval between the first and the second hip fracture was shorter in males than that in females (1.7 years V.S. 2.7 years) and the interval also was shorter in those with a previous trochanteric fracture as compared to those with a previous cervical fracture (1.5 years V.S. 2.6 years). It appeared that a hip fracture reduced the risk of a subsequent hip fracture on the same side, and almost all second hip fractures were located on the opposite side of the patient (93 per cent). A possible reason for this "protective mechanism" is increased strength of the bone due to callus formation. A significant symmetry (trochanteric-trochanteric or cervical-cervical) was found between the first and the second hip fractures (69 per cent). We believe the symmetrical fracture pattern is due to senile osteoporosis, a kind of ongoing systemic weakening of the skeletal system among the elderly.

Effect of penicillin on the renal tubular secretion of methotrexate in the monkey

The effect of penicillin on the renal tubular secretion of methotrexate (MTX) in rhesus and cynomolgus monkeys was studied in vivo and in vitro. In stop-flow experiments in ketamine-anesthetized monkeys, the ratios of urine/plasma MTX concentration to urine/plasma inulin concentration of proximal tubular samples were about 2-fold greater than the base-line free-flow values of 3.3 to 4.8, indicating net proximal tubular secretion. MTX secretion was inhibited by penicillin, which lowered the base-line U/PMTX/U/Pinulin ratios to 0.8 to 1.3; the effect persisted over a 30-min period after discontinuation of penicillin administration. Penicillin also slowed the disappearance of MTX from plasma over a 2-hr period after i.v. bolus administration of MTX. In experiments with renal cortical slices, MTX uptake at 25 degrees was linear over the initial 30 min. The uptake Km and Vmax were 0.09 mM and 0.11 mumol/g of tissue/30 min, respectively. Penicillin competitively inhibited MTX uptake; the Ki was 0.83 mM. MTX efflux from preloaded slices (incubated with 0.5 mM MTX for 45 min) was a first-order process with an initial t1/2 of 7.1 min, which decreased to 2.0 min in the presence of 1.36 mM penicillin. It was concluded that MTX and penicillin share a common secretory system in the kidney and that penicillin blocks MTX secretion by inhibiting cellular uptake and stimulating efflux.

Anterior tarsal tunnel syndrome: case report

Anterior tarsal tunnel syndrome is a rare entrapment neuropathy involving the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle and foot. This syndrome may be a clinically under-recognized entity, thus making a missed diagnosis and delayed treatment likely. We present the case of a 53-year-old woman who for many years had experienced the clinical symptoms of anterior tarsal tunnel syndrome, including pain in the dorsum of the right foot with numbness radiating to the first web space. Roentgenograms of the foot revealed osteophytes on the dorsum of the talus as it articulated with the navicular bone. During surgery, the osteophytes were found to be irritating the deep peroneal nerve. After surgical decompression of the anterior tarsal tunnel, the patient had a significant reduction of symptoms. One year later, she was noted to be asymptomatic with normal physical findings. We believe that this case points to the necessity of more thoughtful attention to this syndrome and its diagnosis. That is to say, a thorough knowledge of the pathogenesis and a comprehensive physical examination are the prerequisites for correct diagnosis and appropriate treatment.

Transport of methotrexate in cortical slices of monkey kidney: effect of organic anions and vincristine

Thin cortical slices of cynamolgus and rhesus monkey kidney were used to study the renal transport of methotrexate (MTX). In experiments with renal cortical slices, MTX uptake at 25 degrees C was linear over the initial 30 min and was temperature-dependent. The Km was 0.094 mM for MTX uptake at 25 degrees C and Vmax was 0.098 mumol/g of tissue/30 min. In the presence of either 1 mM 2,4-dinitrophenol, p-aminohippurate or acetylsalicylate, MTX uptake was competitively inhibited. 2,4-Dinitrophenol had the greatest and acetylsalicylate had the least inhibitory effect. Folinic acid, folic acid and ouabain produced little or no effect on MTX uptake. MTX efflux from preloaded slices (preincubated with 0.5 mM MTX for 45 min) was a first-order process with T 1/2 of 7.13 +/- 0.86 min. In the presence of vincristine or p-aminohippurate the half-lives for MTX were 15.25 +/- 0.91 and 4.59 +/- 0.47 min, respectively. Thus vincristine, an organic base, was found to augment MTX uptake, due to a reduction in the rate of efflux of MTX from the cortical tissues, whereas p-aminohippurate, an organic acid, was found to decrease MTX intracellular concentration by blocking influx and stimulating efflux. It was concluded that the renal transport of MTX in monkey kidney is mediated predominantly by an organic anion secretory process and that there is probably little or no reabsorptive transport.

Structural specificity in the renal tubular transport of tyrosine

The structural requirements for aromatic amino acid reabsorption and secretion in the dog were investigated using a series of tyrosine analogs. In clearance experiments, l-tyrosine and l-phenylalanine underwent net reabsorption at rates 5 to 6 times greater than those of the corresponding d-enantiomers and about 1.5 time those of o- and m-dl-tyrosine. 3-(p-hydroxyphenyl)Propionic acid underwent net secretion under conditions of polyuria and high urinary pH and net reabsorption under conditions of oliguria and low pH. In stop-flow experiments, (U/Pl-amino acid)/(U/Pln) ratios, where U/P = concentration in urine and plasma and In = inulin, of proximal tubular samples were 1.5 to 5-fold greater than the control (free-flow) values of 0.1 to 0.3, indicating tubular secretion. Secretion was inhibited, and net reabsorption enhanced, by probenecid, p-aminohippuric acid and 2,4-dinitrophenol. (U/Pd-amino acid)/(U/PIN) ratios of proximal tubular samples were below the control values of 0.6 to 0.8, indicating tubular reabsorption. Probenecid had no effect on the overall pattern but caused a slight decrease in the relative clearance values. The stop-flow pattern of 3-(p-hydroxyphenyl)propionic acid excretion was similar to that of the I-amino acids. It was concluded that the I-amino acids undergo bidirectional transport and that the I-configuration and amino group are required for optimal active reabsorption, whereas ring hydroxylation has little effect on reabsorption transport. No absolute structural requirements for active secretion were elucidated.

Video stethoscope--a simple method for assuring continuous bilateral lung ventilation during anesthesia

Complications of endotracheal intubation and mechanical ventilation are infrequent but important causes of intraoperative morbidity and mortality. We have developed a simple method of monitoring the ventilation of both lungs during general anesthesia and have evaluated this technique in 25 patients undergoing surgery under general anesthesia. A small plastic electrocardiographic electrode casing fitted with a microphone was affixed to the skin overlying each hemithorax in a location where preliminary auscultation showed that breath sounds could be heard. The sounds from each microphone were amplified and displayed on an oscilloscope screen in an X-Y format. The patterns seen on the screen allowed easy identification of right mainstem intubation, esophageal intubation, or proper endotracheal tube placement. This preliminary study suggests that our technique is feasible and provides more information about the position of the endotracheal tube than presently used methods.

Renal tubular transport of methotrexate in the rhesus monkey and dog

The mechanism and localization of renal transport of methotrexate (MTX) were studied in the rhesus monkey and the dog. It was found that in both animals MTX was bound with plasma protein in a range of 50 to 68% varying with the MTX plasma concentration. Paper chromatographic analysis showed that a negligible amount of MTX was metabolized. The excretion of MTX in rhesus monkey was mainly by tubular secretion which was blocked by probenecid, but in the dog a bidirectional transport mechanism for MTX was indicated. Tubular secretion was localized in the proximal tubules, and a tubular reabsorptive process was in the distal section. Simultaneous administration of folic acid blocked the tubular reabsorption of MTX, resulting in an increase of renal excretion. Maximum tubular excretory capacity determination showed that a maximum tubular excretory capacity value of approximately 5 mumol/100 ml of glomerular filtrate was observed in the rhesus monkey at a plasma concentration of 0.07 mM and a value of 2 mumol/100 ml of glomerular filtrate for the dog. Studies with renal cortical slice technique also indicated that the monkey kidney can accumulate greater amounts of MTX than can the dog kidney.

Linezolid vs. vancomycin in treatment of methicillin-resistant staphylococcus aureus infections: a meta-analysis

OBJECTIVE

This study aims to explore the treatment of methicillin-resistant staphylococcus aureus (MRSA) infection by using meta-analysis method.

MATERIALS AND METHODS

Pubmed/Medline, ScienceDirect, CNKI and Wanfang database were comprehensively searched to obtain the randomized controlled trials (RCTs) on linezolid and vancomycin in the treatment of MRSA infections. We extracted features and information of included studies and selected appropriate effect models based on the heterogeneity test results. The funnel plot was used to analyze publication bias.

RESULTS

A total of seven RCTs including 5376 cases met the inclusion criteria. Meta-analysis showed that the clinical cure rate of linezolid group was higher than that of vancomycin group after treatment (OR = 1.85; 95% CI: 1.33-2.59, p<0.001) and follow-up (OR = 1.49; 95% CI: 1.17-1.91, p=0.001). In the microbiologically evaluable patients, end of therapy (EOT) MRSA clearance rate, and test of cure (TOC) MRSA clearance rate of linezolid were superior to those of vancomycin.

CONCLUSIONS

Based on the combined analysis of randomized controlled trials, the efficacy of linezolid should be better than that of vancomycin in the treatment of infections caused by MRSA, but conclusions still need to be further validated by more well-designed RCTs of a large sample.