Poultry Consumption and Human Cardiometabolic Health-Related Outcomes: A Narrative Review

Poultry meats, in particular chicken, have high rates of consumption globally. Poultry is the most consumed type of meat in the United States (US), with chicken being the most common type of poultry consumed. The amounts of chicken and total poultry consumed in the US have more than tripled over the last six decades. This narrative review describes nutritional profiles of commonly consumed chicken/poultry products, consumption trends, and dietary recommendations in the US. Overviews of the scientific literature pertaining to associations between, and effects of consuming chicken/poultry on, body weight and body composition, cardiovascular disease (CVD), and type II diabetes mellitus (T2DM) are provided. Limited evidence from randomized controlled trials indicates the consumption of lean unprocessed chicken as a primary dietary protein source has either beneficial or neutral effects on body weight and body composition and risk factors for CVD and T2DM. Apparently, zero randomized controlled feeding trials have specifically assessed the effects of consuming processed chicken/poultry on these health outcomes. Evidence from observational studies is less consistent, likely due to confounding factors such as a lack of a description of and distinctions among types of chicken/poultry products, amounts consumed, and cooking and preservation methods. New experimental and observational research on the impacts of consuming chicken/poultry, especially processed versions, on cardiometabolic health is sorely needed.

Effects of Consuming Ounce-Equivalent Portions of Animal- vs. Plant-Based Protein Foods, as Defined by the Dietary Guidelines for Americans on Essential Amino Acids Bioavailability in Young and Older Adults: Two Cross-Over Randomized Controlled Trials

BACKGROUND

The Dietary Guidelines for Americans (DGA) recommends consuming a variety of "Protein Foods" based on "ounce-equivalent" (oz-eq) portions. No study has assessed the same oz-eq portions of animal- vs. plant-based protein foods on essential amino acid (EAA) bioavailability for protein anabolism in young and older adults.

OBJECTIVES

We assessed the effects of consuming two oz-eq portions of pork, eggs, black beans, and almonds on postprandial EAA bioavailability in young and older adults.

METHODS

We conducted two investigator-blinded, randomized crossover trials in young (n = 30; mean age ± SD: 26.0 ± 4.9 y) and older adults (n = 25; mean age ± SD: 64.2 ± 6.6 y). Participants completed four testing sessions where they consumed a standardized meal with two oz-eq of either unprocessed lean pork, whole eggs, black beans, or sliced almonds. Blood samples were taken at baseline and 30, 60, 120, 180, 240, and 300 min postprandially. Plasma EAA bioavailability was based on postprandial integrated positive areas under the curve.

RESULTS

Participant age did not affect EAA bioavailability among the four protein foods tested. Two oz-eq portions of pork (7.36 g EAA) and eggs (5.38 g EAA) resulted in greater EAA bioavailability than black beans (3.02 g EAA) and almonds (1.85 g EAA) in young and older adults, separately or combined (p < 0.0001 for all). Pork resulted in greater EAA bioavailability than eggs in young adults (p < 0.0001), older adults (p = 0.0007), and combined (p < 0.0001). There were no differences in EAA bioavailability between black beans and almonds.

CONCLUSIONS

The same "oz-eq" portions of animal- and plant-based protein foods do not provide equivalent EAA content and postprandial bioavailability for protein anabolism in young and older adults.

Poultry Consumption and Human Health: How Much Is Really Known? A Systematically Searched Scoping Review and Research Perspective

This scoping review was conducted to systematically search and chronicle scientific literature pertinent to poultry intake and human health. The protocol (uploaded to Open Science Framework, https://osf.io/2k7bj/) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. Articles with observational and experimental research, narrative and systematic reviews, and meta-analyses were included. Among 13,141 articles identified, 525 met inclusion criteria. Among these 525 articles, 212 focused on cancer morbidity and mortality; 41 on cardiovascular disease (CVD) morbidity and mortality; 52 on CVD risk factors; 32 on type 2 diabetes mellitus (T2DM) morbidity and mortality; 33 on T2DM risk factors; and 42 on body weight and body composition. An "Other" category (181 articles) included nutrient status, psychological well-being/mental health, cognition, microbiome, chronic kidney disease, nonalcoholic fatty liver disease, skin disorders, and fertility, among others. Among the 525 included articles, 366 were observational, 64 were experimental, and 76 were reviews and meta-analyses. Eighty-three percent of articles focused on adults or older adults. A paucity of research exists to support poultry as health-promoting foods, with most research only indirectly assessing poultry intake compared with other foods of interest (e.g., red meats or plant-based protein foods). No randomized controlled trials and only 1% of OBS assessed the influence of processed poultry intake on human health. In the future, the relative health effects of consuming poultry will be compared with a widening array of traditional and new protein-rich food products, necessitating the need for research to assess poultry as foods of choice. Science and health professionals, the poultry industry, and the public will benefit from new observational and experimental research to address cutting-edge scientific, public policy, and consumer topics pertinent to poultry intake and human health.

Effects of Consuming Ounce-Equivalents Portions of Animal and Plant Protein Foods, As Defined by the Dietary Guidelines for Americans on Essential Amino Acid Availability

Objectives

The objective of this study was to assess the effects of consuming ounce-equivalents (oz-eq) portions of lean pork versus nuts, beans, and eggs, as defined by the Dietary Guidelines for Americans (DGA), as part of a meal, on essential amino acid (EAA) substrate availability for protein anabolism in young adults.

Methods

In this single-blinded, randomized crossover study, 30 participants (15 male, 15 female; age: 26 ± 4.9 y; BMI: 26.4 ± 4.5 kg/m²; mean ± SE) completed four testing sessions where they consumed a standardized test salad on each day with 2 oz-eq of either lean pork, whole eggs, black beans, or almonds. Blood samples were taken at baseline (prior to commencing meal consumption) and at 30, 60,120, 180,240, and 300 minutes following the initiation of meal consumption. Plasma from the blood samples were analyzed for amino acid concentrations via high-performance liquid chromatography (HPLC).

Results

The EAAs positive incremental area under the curve (iAUCpos) over 300 minutes for lean pork, egg, black beans, and almonds was 7353 ± 397 μg/mL (least-square mean ± standard error (SE)), 4653 ± 408 μg/mL, 2100 ± 398 μg/mL, and 1220 ± 398 μg/mL, respectively. Pork resulted in signifcantly greater EAAs availability compared to egg, black beans, and almonds (Tukey adjusted, P < 0.0001 for all, while egg resulted in significantly greater EAAs availability compared to black beans and almonds (Tukey adjusted P < 0.0001 for both). No difference for EAAs iAUCpos was found between black beans and almonds.

Conclusions

Based on the oz-eq concept used for the DGA, the protein sources included in this study, namely lean pork, whole egg, black beans, and almonds, are not equivalent regarding plasma EAAs availability for protein anabolism in young adults, in response to being consumed as part of a meal. More specifically on an oz-eq basis, lean pork provides a greater response than whole egg, followed by black beans and almonds, in terms of its ability to provide plasma EAAs as a substrate for protein anabolism This research serves as an important resource for future Dietary Guidelines Advisory Committees to reevaluate the appropriateness of equating Protein Foods on the current oz-eq basis.

Funding Sources

National Pork Board - Pork Checkoff and American Egg Board - Egg Nutrition Center.

Whey Protein Supplementation and Type 2 Diabetes Mellitus Risk Factors: A Scoping Review of Systematic Reviews and/or Meta–Analyses of Randomized Controlled Trials

Objectives

Emerging research on whey protein supplementation WPS suggests it may be a potential modifier of type 2 diabetes mellitus (T2DM) risk factors, including glycemic regulation. As systematic reviews and/or meta-analyses of RCTS are gaining importance in nutrition literature, we conducted a scoping review to systematically search and chronicle published systematic reviews and/or meta-analyses of RCTs pertinent to WPS and T2DM modifiable risk factors.

Methods

The protocol was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Potentially eligible articles were identified via a systematic search of five electronic health research databases (PubMed, Cochrane Library, CINAHL (EBSCO), Scopus, and SPORTDiscus). Included articles were assessed for quality using the AMSTAR-2 critical appraisal tool.

Results

Eight of the 1,692 identified articles met the inclusion criteria. Of the 8 included articles, the outcomes related to T2DM risk factors reported in articles were as follows; 4 included HDL-cholesterol and triglycerides; 3 included fasting blood glucose, total cholesterol, LDL-cholesterol, and body weight; 1 included fasting insulin, HbA1c, blood pressures BMI, and CRP. The results of AMSTAR 2 critical appraisal tool showed that of the 8 included articles, 5 were deemed high quality, 2 were deemed moderate quality, and 1 article was deemed low quality.

Conclusions

Results of the scoping review identified no published systematic reviews and/or meta-analyses of RCTs that provide a comprehensive assessment specifically pertaining to the effects of WPS on T2DM modifiable risk factors. Future systematic reviews and/or meta-analyses of RCTs specifically investigating the effects of WPS on modifiable T2DM risk factors in a comprehensive manner are warranted.

Funding Sources

The Whey Protein Research Consortium

Comparison of Wrist- and Hip-Worn Activity Monitors When Meeting Step Guidelines

Introduction

Physical activity (PA) guidelines aimed at accumulating 10,000 steps per day have become increasingly common with the advent of wristband PA monitors. However, accumulated steps measured with wristband PA monitors may not be equal to steps measured with validated, hip-worn pedometers. Consequently, evaluating and developing guidelines for step counts using wristband PA monitors for the general population is needed. We compared step counts accumulated with hip-worn pedometers with those accumulated with wrist-worn activity monitors during 1) treadmill exercise, 2) treadmill walking, and 3) activities of daily living (ADL) to determine their accuracy in meeting step count guidelines (ie, 10,000 steps/d).

Methods

Eighty-six adults (aged 18–65 y; body mass index, 19–45 kg/m²) completed 30 minutes of treadmill exercise while simultaneously using a hip-worn pedometer and wrist-worn PA monitor. Remaining steps needed to reach 10,000 steps (ie, 10,000 steps minus the number of pedometer steps recorded from treadmill exercise = remainder) were completed via treadmill walking or ADL. Steps were recorded for both devices after treadmill exercise, treadmill walking, and ADL for both devices.

Results

Fewer steps were accumulated via wrist-worn PA monitors than via hip-worn pedometers during treadmill exercise (3,552 [SD, 63] steps vs 3,790 [SD, 55] steps, P < .01) and treadmill walking (5,877 [SD, 83] steps vs 6,243 [SD, 49] steps, P < .01). More steps were accumulated via wrist-worn PA monitors than hip-worn pedometers during ADL (7,695 [SD, 207] steps vs 6,309 [SD, 57] steps, P < .01). Consequently, total steps were significantly higher for wristband PA monitors than hip-worn pedometers (11,247 [SD, 210] steps vs 10,099 [SD, 39] steps; P < .01).

Conclusion

The widely used 10,000-step recommendation may not be accurate for all users of all activity monitors, given the discrepancy in daily step count among wrist-worn and hip-worn devices. Having a more accurate indication of number of steps taken per day based on the device used could have positive effects on health.

Medically managed prosthetic valve endocarditis caused by Salmonella enteritidis

Infective endocarditis is associated with morbidity and mortality even when appropriately treated. It can be more complicated to treat when prosthetic material is present, often necessitating surgical revision as well as antimicrobial therapy. Endocarditis caused by gram-negative bacilli is a rare occurrence, with some literature and expert opinion suggesting superior outcomes with combined surgery and antibiotics when a prosthetic valve is involved. In cases where the prosthetic valve is well-functioning and undamaged, or cardiothoracic surgery represents a significant operative risk, it can be unclear how best to proceed. This report documents a case of Salmonella enterica subspecies enterica serovar enteritidis endocarditis of a mechanical mitral valve. The patient was managed with 6 weeks of intravenous antibiotics followed by suppressive oral antibiotic therapy. They remain in good health at 24 months.

Chicken and Poultry Consumption and Human Health: A Scoping Review of Available Research Literature

Objectives

The purpose of this scoping review was to systematically search and chronicle the available scientific literature pertinent to chicken/poultry intake and human health.

Methods

The protocol was uploaded to Open Science Framework (https://osf.io/2k7bj/) and was conducted in accordance with recommended guidelines from PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews (PRIMSA-Scr). Studies and scientific literature of all types (observational, experimental, narrative/literature reviews, systematic reviews and meta-analyses) assessing chicken/poultry intake and human health were included.

Results

A total of 13,141 articles were identified and 540 met the inclusion criteria. Among these 540 articles, 215 articles focused on cancer morbidity and mortality; 23 on cancer risk factors; 38 on cardiovascular disease (CVD) morbidity and mortality; 42 on CVD risk factors; 32 on diabetes morbidity and mortality; 33 on diabetes risk factors; 43 articles on body weight and body composition, and; 179 categorized as “Other”, which included nutrient status, psychological well-being/mental health, cognitive outcomes, microbiome outcomes, chronic kidney disease, non-alcoholic fatty liver disease, skin disorders, and fertility, among others. Among the included articles, 413 were observational, 93 were reviews and meta-analyses, and 78 were experimental.

Conclusions

This inaugural scoping review that systematically identified existing scientific literature pertinent to poultry intake and human health provides a foundation for future systematic reviews and meta-analyses. It also underscores the need for new experimental research to complement the current preponderance of evidence from observational studies.

Funding Sources

National Chicken Council

Vitamin D status and supplementation impacts on skeletal muscle function: comparisons between young athletes and older adults

PURPOSE OF REVIEW

The present narrative review analyzes emerging research implicating vitamin D status and supplementation with skeletal muscle homeostasis and functions in two distinct segments of the adult population: young athletes and older adults.

RECENT FINDINGS

Vitamin D deficiency compromises multiple indices of muscle function in young athletes and older adults. A variety of vitamin D3 (cholecalciferol) supplementation regimens may transition young athletes and older adults from deficient or inadequate to adequate vitamin D status. Vitamin D supplementation, used to treat a vitamin D deficiency, but not necessarily an inadequacy, promotes muscle anabolism in older adults. For both young athletes and older adults, vitamin D supplementation, which transitions them from inadequate to adequate vitamin D status, may not beneficially affect measures of muscle strength and power, or physical performance. Also, when vitamin D status is adequate, vitamin D supplementation to further increase serum 25(OH)D concentrations does not seem to confer additional benefits to muscle strength and power and physical performance.

SUMMARY

The impacts of vitamin D status and supplementation on skeletal muscle homeostasis and functions seem comparable in young athletes who strive to maximize physical performance and older adults who seek to attenuate muscle mass and physical performance declines.

A Single Bout of Foam Rolling Increases Flexibility of the Hip Adductor Muscles without Compromising Strength

Foam rolling (FR) is a method of self-myofascial release (SMR) implemented to reduce tension in underlying soft tissue, leading to increased range of motion (ROM). The hip adductor muscles of the groin are commonly less flexible and often a site for soft tissue injuries. Limited research has been done to determine the most effective flexibility exercises to increase ROM in the groin muscles prior to exercise without comprising strength. The purpose was to determine the effect of an acute bout of FR on passive groin flexibility and strength. Randomized crossover study with 3 × 2 (Condition × Time) repeated measures ANOVA statistical design. 40 volunteers (n = 20 males; n = 20 females) with limited flexibility in groin ROM participated. Following warm-up, maximal voluntary isometric contraction (MVC) and static ROM were measured pre and postintervention. Conditions included 60 seconds of FR, SS, and CON. The Condition × Time interaction was not significant for MVC or ROM. A main effect of time showed a significant increase in ROM from pre to post for FR (1.2°, p < 0.001), SS (1.0°, p < 0.001), and CON (0.5°, p = 0.039). No significant changes in MVC were observed for FR from pre to post (p > 0.05), whereas SS and CON both increased (p < 0.05). An increase in passive groin ROM after acute bouts of SMR or SS without compromising MVC was observed. This suggests that 60 seconds of FR may be employed before exercise to improve flexibility without strength decrement.

Overactivation of the middle cingulate cortex and the caudate nucleus as neural correlates of the familial liability to major depressiive disorder

Introduction

Unaffected healthy 1st degree relatives of patients with major depressive disorder (MDD) are 3.6 times more liable to develop the disease themselves than the standard population without the history of the disorder. Neural correlates of this liability are of particular interest since the phenomenon does not always have behavioral manifestations and early detected can enhance quicker and better MDD prevention.

Objective

The objective of our study was to establish neuronal correlates of susceptibility MDD in unaffected healthy 1st degree relatives of patients with MDD. Inhibition of emotional information was examined in the present study.

Aims

The aim of the study was to better understand the development of MDD and the role of altered inhibition of emotional processing in it. That, in consequence, may contribute to establishing new methods of prevention and quicker detection of MDD liability.

Methods

Twenty-one unaffected healthy 1st degree relatives of patients with MDD and twenty-five matched healthy controls underwent a functional magnetic resonance imaging procedure with a task involving inhibition of emotional processing of positive, negative and neutral emotional information. 2 × 3 ANOVA was performed to establish if the two groups differed significantly in the inhibition of one of the three types of emotions.

Results

The unaffected healthy 1st degree relatives displayed an increased neural activation during the inhibition of negative emotional information in the bilateral middle cingulate cortex (MCC) and the left caudate nucleus (p< 0.05, family wise error).

Conclusions

The overactivation of the MCC and caudate nucleus can be a marker of MDD liability

Females Achieve Higher Plasma Amino Acid Concentrations Than Males After Consuming a 20-gram Whey Protein Supplement but Not a 30-gram Protein Meal (P08-058-19)

Objectives

We sought to assess whether there are sex differences in postprandial amino acid (AA) responses to different quantities and sources of dietary protein.

Methods

In a randomized, crossover design, 12 participants [6 males, age: 29 ± 3 y; BMI: 27.1 ± 5.1 kg/m2; mean ± SEM, and 6 females, age: 30 ± 6 y; BMI: 25.0 ± 1.8 kg/m2] completed three 5-h acute feeding trials. They consumed breakfasts containing 10 g of protein from foods (10-PRO), 30 g of protein from foods (30-PRO), and 10 g of protein from foods with an additional 20 g of whey protein isolate (WPI) consumed 120 minutes later (10/20-PRO). Blood samples were collected at times -30, 0, 30, 60, 120, 150, 180, 240, and 300 min relative to breakfast intake.

Results

For each trial, protein intakes were quantitatively the same for females and males, which resulted in greater protein intakes for females when expressed per kg body mass and liter of plasma volume (Table 1). Plasma AA concentrations did not increase for either sex after 10-PRO (300 min time period) or the first 120 min of 10/20-PRO (before WPI consumed). Plasma total free amino acid (TAA), essential amino acid (EAA), and leucine concentrations (µg/mL) peaked at 240 min for males and at 150, 180, and 240 min respectively, for females, after 30-PRO. TAA, EAA, and leucine concentrations peaked 60 min after consuming 20 g WPI (180 min after breakfast) for 10/20-PRO for both sexes. No differences in composite iAUCpos over 300 min were observed between sexes for 30-PRO. Composite iAUCpos (µg/mL) over 300 min for TAA, EAA, and leucine were greater for females compared to males, by 41, 57, and 40% respectively, for 10/20-PRO.

Conclusions

Plasma AA responses to consuming a high-protein breakfast are not different between females and males, but are greater for females after consuming a whey protein supplement. This greater increase in AA concentrations for females may be due to greater rates of absorption and/or a greater quantity of protein intake relative to body mass and plasma volume. Males may require more whey protein than females to achieve comparable plasma AA responses.

Funding Sources

Purdue University, Ingestive Behavioral Research Center and Lynn Fellowship to JLH

Supporting Tables, Images and/or Graphs

Screening for asymptomatic urogenital Chlamydia trachomatis infection at a large Dublin maternity hospital: results of a pilot study

BACKGROUND

There are currently no Irish guidelines on screening for Chlamydia trachomatis infection in pregnancy. Prevalence rates in the antenatal population are not known which has prevented the development of screening recommendations for this group.

AIMS

The objective of this study was to determine the prevalence of asymptomatic urogenital C. trachomatis infection in young women attending for care at a large maternity hospital.

METHODS

All patients aged 25 years and under attending the Hospital between December 2011 and December 2013 were offered screening for urogenital C. trachomatis infection. Nucleic acid amplification testing of the C. trachomatis cryptic plasmid was performed on either endocervical swabs or first void urine samples.

RESULTS

There were 2687 women tested for C. trachomatis infection, 83.4 % (2241/2687) through the antenatal clinics, 7.1 % (193/2687) through the gynaecology clinic, and 9.4 % (253/2687) through the emergency department. The rate of a positive test result was 5.6 % (151/2687) overall. The rates in women ages 16-18, 19-21 and 22-25 years were 9.1 % (31/340), 6.5 % (50/774) and 4.4 % (69/1561), respectively. A positive test result was more likely in those who were unemployed (p = 0.04), those who were Irish (p = 0.03) and those who were unmarried (p < 0.01). There were no cases of neonatal C. trachomatis infection in babies born to mothers who were screened in early pregnancy.

CONCLUSIONS

The prevalence rate of detected C. trachomatis infection was 5.6 % in the study population. Screening of antenatal patients may have a role in preventing vertical transmission of infection to the neonate.

Fertility after abdominal myomectomy

This study aimed to evaluate the morbidity and pregnancy outcome of myomectomy in infertile women with uterine fibroids. This was a cross-sectional study. Records were reviewed for 100 consecutive women in the Rotunda Hospital who underwent myomectomy in the years 1995-1996. A questionnaire regarding subsequent fertility was sent. The study was carried out in the infertility unit at the Rotunda Hospital, Dublin, Ireland. Seventy-five women responded. Multiple myomectomy was performed in 52 (70%). Mean fibroid size was 6.8 cm (range 2-14.5 cm). Nine women (12%) developed complications; five had menstrual problems, two had wound discomfort and two had abdominal discomfort. Twenty-five women (33%) became pregnant. Seven (28%) were IVF pregnancies. Overall six (24%) miscarried. In 19 of 25, pregnancy occurred where fibroids were the only identifiable cause of infertility. We conclude that abdominal myomectomy is associated with a favourable outcome in infertile women particularly if no other confounding variable is present.

Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey

OBJECTIVE

To evaluate the psychosocial and behavioural impact of the first ever national level comprehensive workplace smoke-free law, implemented in Ireland in March 2004.

DESIGN

Quasi-experimental prospective cohort survey: parallel cohort telephone surveys of national representative samples of adult smokers in Ireland (n = 769) and the UK (n = 416), surveyed before the law (December 2003 to January 2004) and 8-9 months after the law (December 2004 to January 2005).

MAIN OUTCOME MEASURES

Respondents' reports of smoking in key public venues, support for total bans in those key venues, and behavioural changes due to the law.

RESULTS

The Irish law led to dramatic declines in reported smoking in all venues, including workplaces (62% to 14%), restaurants (85% to 3%), and bars/pubs (98% to 5%). Support for total bans among Irish smokers increased in all venues, including workplaces (43% to 67%), restaurants (45% to 77%), and bars/pubs (13% to 46%). Overall, 83% of Irish smokers reported that the smoke-free law was a "good" or "very good" thing. The proportion of Irish homes with smoking bans also increased. Approximately 46% of Irish smokers reported that the law had made them more likely to quit. Among Irish smokers who had quit at post-legislation, 80% reported that the law had helped them quit and 88% reported that the law helped them stay quit.

CONCLUSION

The Ireland smoke-free law stands as a positive example of how a population-level policy intervention can achieve its public health goals while achieving a high level of acceptance among smokers. These findings support initiatives in many countries toward implementing smoke-free legislation, particularly those who have ratified the Framework Convention on Tobacco Control, which calls for legislation to reduce tobacco smoke pollution.

Stage- and CA125-related survival in patients with epithelial ovarian cancer treated at a cancer center

Current accepted prognostic indicators in ovarian cancer include performance status, surgical (FIGO) staging, and residual disease after operation. Here we present data from a prospective analysis of patients with ovarian cancer treated at the Christie Hospital. We confirm the independent prognostic effects of FIGO staging, performance status, and residual disease in our group of patients and furthermore show that CA125 levels at presentation to the oncology service are of independent prognostic significance (P= 0.02). We present survival data and show that the 3-year, cancer-specific survival for stage I disease is 90%. We postulate that this good survival may in part be due to the use of computed tomography scanning at presentation to allow accurate staging. Further clinical trials are needed to test whether combinations of surgical, histologic, biochemical, and radiologic parameters can be used to identify a population with such a good prognosis that adjuvant therapy is not required.

Stage- and CA125–related survival in patients with epithelial ovarian cancer treated at a cancer center

Current accepted prognostic indicators in ovarian cancer include performance status, surgical (FIGO) staging, and residual disease after operation. Here we present data from a prospective analysis of patients with ovarian cancer treated at the Christie Hospital. We confirm the independent prognostic effects of FIGO staging, performance status, and residual disease in our group of patients and furthermore show that CA125 levels at presentation to the oncology service are of independent prognostic significance (P= 0.02). We present survival data and show that the 3-year, cancer-specific survival for stage I disease is 90%. We postulate that this good survival may in part be due to the use of computed tomography scanning at presentation to allow accurate staging. Further clinical trials are needed to test whether combinations of surgical, histologic, biochemical, and radiologic parameters can be used to identify a population with such a good prognosis that adjuvant therapy is not required.

Birth-weight trends in primiparous women in the twentieth century

We investigated the trend in birth-weights in the Rotunda hospital in primiparous women over the 20th century. There was a significant increase in birth-weight particularly in the latter third of the century. In light of these findings we believe that new approaches to the management of labour in primiparous mothers be developed.

The caesarean section rate in the Republic of Ireland in 1998

The Caesarean section (CS) rate has risen dramatically in the United Kingdom and North America over the past 20 years. There are no recent data in the Republic of Ireland on CS rates. Our aim was to ascertain the national CS rate for the year 1998. In addition, we sought to determine instrumental delivery rates and epidural rates. Twenty-two of 24 units replied to a questionnaire giving a response rate of 92%. The CS rate was 17.8% (12.8-26.7%), 7.5% were elective and 10.3% were emergency. The size or type of the maternity unit did not influence the CS rate. The cause for the rise in the CS rate is multifactorial. Review of the current literature would suggest that a further rise in the CS rate in Ireland is likely.

The case for fire safe cigarettes made through industry documents

OBJECTIVES

To examine the extensive research undertaken by the tobacco industry over the past 25 years toward development of a fire safe cigarette.

METHODS

Research was conducted through a web based search of internal tobacco industry documents made publicly available through the 1998 Master Settlement Agreement.

RESULTS

The documents reveal that the tobacco industry produced a fire safe cigarette years ago, but failed to put it on the market. These findings contradict public industry claims that denied the technical feasibility and commercial acceptability of fire safe cigarettes. Internal documents also reveal a decades long, coordinated political strategy used to block proposed legislation and obfuscate the fire safe issue.

CONCLUSIONS

Federal legislation mandating fire safe cigarettes is needed.

Inspiratory flow limitation during sleep in pre-eclampsia: comparison with normal pregnant and nonpregnant women

Self-reported snoring is common in pregnancy, particularly in females with pre-eclampsia. The prevalence of inspiratory flow limitation during sleep in preeclamptic females was objectively assessed and compared with normal pregnant and nonpregnant females. Fifteen females with pre-eclampsia were compared to 15 females from each of the three trimesters of pregnancy, as well as to 15 matched nonpregnant control females (total study population, 75 subjects). All subjects had overnight monitoring of respiration, oxygen saturation, and blood pressure (BP). No group had evidence of a clinically significant sleep apnoea syndrome, but patients with pre-eclampsia spent substantially more time (31+/-8.4% of sleep period time, mean+/-SD) with evidence of inspiratory flow limitation compared to 15.5+/-2.3% in third trimester subjects and <5% in the other three groups (p=0.001). In the majority of preeclamptics, the pattern of flow limitation was of prolonged episodes lasting several minutes without associated oxygen desaturation. As expected, systolic and diastolic BPs were significantly higher in the pre-eclamptic group (p<0.001), but all groups showed a significant fall (p< or =0.05) in BP during sleep. Inspiratory flow limitation is common during sleep in patients with pre-eclampsia, which may have implications for the pathophysiology and treatment of this disorder.

The HELLP syndrome, a prospective study

OBJECTIVE

We undertook this study to evaluate the incidence and outcome of HELLP in Irish patients. In addition, duration and trends of the abnormal laboratory results were studied.

STUDY DESIGN

This prospective observational study screened 12068 pregnant women between January 1995 and March 1997. Any pregnant woman with hypertension, proteinuria, thrombocytopenia or anemia was monitored for hemolysis and elevated liver transaminases, from the time of recruitment till six weeks postpartum or resolution.

RESULTS

Thirteen of 12068 pregnant women (0.11%) developed HELLP. All had hypertension and 84.6% had proteinuria. Delivery was the only factor found to terminate the syndrome. Acute renal dysfunction was noted in 53.8% but none required dialysis. Laboratory parameters stabilized by the sixth postpartum day. Fetal mortality was 1 out of 14. There were no maternal deaths.

CONCLUSIONS

HELLP syndrome is a rare but potentially serious complication of pregnancy. Correlation with laboratory data and early intervention are vital in achieving a favorable outcome for both mother and fetus.

A five year review of scar dehiscence in the Rotunda Hospital, Dublin

The aims of this study were to identify risk factors for scar dehiscence in labour, to illustrate the clinical presentations of patients with scar dehiscence and to quantify the risk posed by the use of oxytocin in labour. This was a case controlled, 5 year retrospective study. Patients with scar dehiscence were identified from labour ward records with matched controls and chart review of case and control patients were performed. Our results showed that the vaginal delivery rate for trial of scar was 76.9%. The incidence of scar dehiscence was 0.043%. Oxytocic labour augmentation was a risk factor (OR 4.5, 95% CI 0.9313-42.8, p=0.065) but induction of labour using oxytocin was not (p=0.222). The commonest symptom of scar dehiscence was fetal distress (OR 12.3, 95% CI 1.9-81). There was no maternal or fetal mortality. We concluded that trial of labour after one caesarean section is acceptable practice with a good success rate and a low incidence of serious morbidity. The use of oxytocin to augment labour is associated with scar dehiscence.

Attitude to home birth in an antenatal population at the Rotunda Hospital

195 Women attending the antenatal clinics at the hospital were interviewed, about their attitudes to home birth using a standardised questionnaire. One hundred and seventy one women (88%) said that they would not favour a home birth in a subsequent delivery, 19 (9.5%) said that they would consider a home birth in a subsequent pregnancy and the remaining 5 (2.5%) were unsure. Although the majority of women attending the Rotunda Hospital would not consider a home birth, approximately 10% of the sample population would consider this in their next pregnancy. This pilot study indicates that there may be a demand for home birth in patients attending our hospital and further evaluation of this need is warranted.

The effect of strength training on the apparent inhibition of eccentric force production in voluntarily activated human quadriceps

Ten male and ten female young adults trained the knee extensors of one leg eccentrically and those of the other concentrically for 6 weeks, using a gymnasium leg-extension machine. Before and after training, both legs of each subject were tested isometrically for maximum voluntary knee-extensor force, and in both eccentric and concentric isokinetic modes at 30-250 degrees x s(-1) All limbs showed improvements in mean eccentric force (ranging from 18% in the concentrically trained legs of the females to 31% in the eccentrically trained legs of the males, P < 0.01-0.001). Upward trends in isometric and concentric forces were smaller and less- or nonsignificant. In three of the four groups, mean eccentric forces after training were significantly greater than mean isometric forces, a difference that was not evident before training. Ten further subjects of each gender, not trained but tested isometrically and isokinetically three times in 2 weeks, showed no significant improvement over the series of tests. The explanation suggested is that the increased percentage activation ("decreased inhibition"), often regarded as the main mechanism of strength gain in the early weeks of training, had been displayed particularly in the subjects' eccentric performance. This implies that the activation-shortfall, which is reduced by the initial phase of strength training, is largely or completely the same as that responsible for the fact that untrained, voluntary eccentric force is less than that of isolated muscle.

Pregnancy in Irish renal transplant recipients in the cyclosporine era

BACKGROUND

The effect of renal transplantation on pregnancy in Irish women not receiving CyA has been reported previously.

AIM

To examine all pregnancies occurring in Irish female renal transplant recipients since the introduction of CyA.

METHODS

Using a community based approach, we identified 29 pregnancies in 19 women, aged between 16 and 45, mean age 30.3 years.

RESULTS

These pregnancies ended in four miscarriages (13%), two intra-uterine deaths (6.9%) and 23 live births (79.3%). Of these live births, 73.9% were premature (< or = 36 weeks) and 65.2% were of low birth weight (< 2500 g). Admission to the neonatal intensive care was necessary in 61%, and two babies (8.7%) died in the neonatal period. Mean gestational age was 34 weeks, and mean birth weight was 2190 g. There was no change in graft function during pregnancy, with a small rise in serum creatinine post-partum (+9.64 mumol/L). The renal graft failed in three women (15.8%) by the end of the follow-up period. Compared with the precyclosporine era, the live birth rate was higher (79.3% versus 58%) with a trend towards lower birth weight and shorter gestation.

CONCLUSION

Renal transplantation with CyA use is not a contraindication to pregnancy, but it is associated with increased risk, especially when the serum creatinine is > 175 mumol/L.