Small fetal abdominal circumference in the second trimester and subsequent low maternal plasma glucose after a glucose challenge test is associated with the delivery of a small-for-gestational age neonate

OBJECTIVES

To evaluate the predictive value of a combination of the 1 h 50-g glucose challenge test (GCT) and second-trimester ultrasound measurement of fetal abdominal circumference (AC) in identifying patients who will go on to deliver small-for-gestational age (SGA) neonates. The individual predictive power of these tests has been indicated by previous studies, but this study examines the combined use of these indicators in predicting SGA.

METHODS

This retrospective cohort study included 576 consecutive patients with singleton gestations examined over a 3-year period. Patients' electronic medical records were abstracted to obtain the result of the GCT, the fetal AC measured by ultrasound examination between 18 and 22 weeks' gestation, and the birth weight. SGA and small AC were defined as birth weight or AC < 10(th) percentile for gestational age, according to published nomograms. A low GCT was defined as < 100 mg/dL. P < 0.05 was considered significant.

RESULTS

The prevalence of SGA in the study population was 8.7% (50/576). The frequency of SGA neonates was significantly higher in patients with a low GCT (27/207) in the second trimester than in those with a normal GCT (23/369) (13% vs. 6.2%, P = 0.005). Similarly, the frequency of SGA neonates was higher among patients with fetal AC < 10(th) percentile than among those with a normal fetal AC on second-trimester ultrasound examination (17% vs. 8%, P = 0.08), although this difference did not reach statistical significance. Of interest, among patients with both a small fetal AC and a low GCT the incidence of SGA neonates was 32% (6/19), but there were no SGA neonates among those with a small AC and normal GCT (0/17) (P = 0.014). Among patients with a small fetal AC the sensitivity of using low GCT to predict subsequent delivery of a SGA neonate was 100%, with a specificity of 57%, positive predictive value 32% and negative predictive value 100%.

CONCLUSIONS

Small AC on routine second-trimester anomaly sonogram should trigger a closer evaluation of maternal GCT. If the GCT is also low, more intensive surveillance for the possible development of a SGA infant is warranted.

The serine protease Omi/HtrA2 is involved in XIAP cleavage and in neuronal cell death following focal cerebral ischemia/reperfusion

Omi/HtrA2 is a pro-apoptotic mitochondrial serine protease involved in both forms of apoptosis, caspase-dependent as well as caspase-independent cell death. However, the impact of Omi/HtrA2 in the apoptotic cell machinery that takes place in vivo under pathological conditions such as cerebral ischemia remains unknown. The present study was monitored in order to examine whether Omi/HtrA2 plays a decisive role in apoptosis observed after focal cerebral ischemia in rats. Male adult rats were subjected to 90min of focal cerebral ischemia followed by reperfusion and treated with vehicle or ucf-101, a novel and specific Omi/HtrA2 inhibitor, prior reperfusion. Focal cerebral ischemia/reperfusion induced a mitochondrial up-regulation of Omi/HtrA2 and significantly increased cytosolic accumulation of Omi/HtrA2. Furthermore, ischemia led to activation of caspase-3 and degradation X-linked inhibitor of apoptosis protein (XIAP). Treatment of animals prior ischemia with ucf-101, the specific inhibitor of Omi/HtrA2, was able to (1) reduce the number of TUNEL-positive cells, to (2) attenuate the XIAP-breakdown and to (3) reduce the infarct size. This study shows for the first time that focal cerebral ischemia in rats results in Omi/HtrA2 translocation from the mitochondria to the cytosol, where it participates in neuronal cell death. Blocking the proteolytic activity of Omi/HtrA2 with specific inhibitors, such as the ucf-101, could be a novel way to afford neuroprotection and minimize cellular damage in cerebral ischemia/reperfusion.

Expression of the gene encoding the pro-apoptotic BNIP3 protein and stimulation of hypoxia-inducible factor-1α (HIF-1α) protein following focal cerebral ischemia in rats

Hypoxia is a common cause of cell death and is implicated in many disease processes including stroke and chronic degenerative disorders. In response to hypoxia, cells express a variety of genes which allow adaptation to altered metabolic demands, decreased oxygen demands, and the removal of irreversibly damaged cells. Hypoxia-inducible factor-1 (HIF-1) is a transcription factor that regulates the adaptive response to hypoxia in cells. In this study, we reported an early, time-related, gradual up-regulation of HIF-1alpha, and a moderate increase in vascular endothelial growth factor (VEGF)- and erythropoietin (Epo)-levels following transient focal ischemia. Moreover, we demonstrated, for the first time a specific localization of the pro-apoptotic regulator BNIP3 in striatal and cortical neurons after transient focal ischemia in rats. Prolonged intranuclear BNIP3 immunoreactivity was associated with delayed neuronal death. Experiments showed protein increases on Western blots of brain tissue with peaks at 48h after ischemia. Epo responds to ischemia in an early stage, whereas VEGF and BNIP3 accumulate in cells at later times after ischemia. This suggests the possibility that BH3-only proteins might be one of the major downstream effectors of HIF-1alpha in hypoxic cell death. These findings open the possibility that the hypoxia-regulated pro-apoptotic protein BNIP3 enters the nucleus and could interact with other proteins involved in DNA structure, transcription or mRNA splicing after focal brain ischemia.

Anorectic effect of amylin is not transmitted by capsaicin-sensitive nerve fibers

Abdominal vagal and splanchnic afferents play an important role in the control of food intake in that they transmit various satiety signals to the central nervous system. Inasmuch as previous studies have shown that the anorectic effect of intraperitoneally injected amylin was not abolished by subdiaphragmatic vagotomy, the aim of the present study was to elucidate the role of splanchnic afferents in mediating amylin's anorectic effect after intraperitoneal injection. Rats were pretreated intraperitoneally with the neurotoxin capsaicin, which destroys primary sensory (vagal and splanchnic) afferents. Sham-treated rats served as control. Capsaicin-pretreatment had no influence on the anorectic effects of amylin (5 microg/kg) and the related peptide, calcitonin gene-related peptide (CGRP; 5 microg/kg), in 24-h food-deprived rats. Abolition of cholecystokinin's (3 microg/kg) anorectic effect agrees with previous studies and confirmed the effectiveness of the capsaicin pretreatment. In conclusion, the anorectic effects of intraperitoneally injected amylin and CGRP are not mediated by capsaicin-sensitive primary sensory neurons. Both anorectic peptides are, therefore, most likely to act within the central nervous system. Previous studies suggest that the relevant receptors might be located in neurons of the area postrema-nucleus of the solitary tract region.

Inhibitors of fatty acid oxidation (mercaptoacetate, R-3-amino-4-trimethylaminobutyric acid) stimulate feeding in mice

Several lines of evidence indicate that fatty acid oxidation contributes to control of eating. We examined the effect of inhibitors of fatty acid oxidation (mercaptoacetate, R-3-amino-4-trimethylaminobutyric acid = emeriamine) on food intake in mice because fatty acid oxidation has been shown recently to increase the hepatic membrane potential in mouse liver, and this potential has been proposed to represent a signal for control of food intake. The effect of intraperitoneal injection of mercaptoacetate (200, 400, or 600 micromol/kg body weight) and emeriamine dihydrochloride (8.7, 17.4, 34.8, or 69.6 micromol/kg body weight) was investigated in mice fed a fat-enriched diet (18% fat). Both mercaptoacetate (400 or 600 micromol/kg) and emeriamine (34.8 or 69.6 micromol/kg) significantly increased food intake. These results suggest that fatty acid oxidation is also involved in feeding control in mice. Therefore, the pertinent mechanisms can be studied in mice.

Amylin reduces food intake more potently than calcitonin gene-related peptide (CGRP) when injected into the lateral brain ventricle in rats

Amylin and the structurally and functionally related peptide calcitonin gene-related peptide (CGRP) have been shown to reduce food intake in rats. The aim of the present study was to compare the anorectic potency of both peptides over a wide dose range when administered into the lateral brain ventricle (ICV). Furthermore, we also tested the influence of a lesion in the area postrema/nucleus of the solitary tract (AP/NTS) region on the anorectic effects of amylin and CGRP after ICV administration because AP/NTS lesion has been shown to reduce the anorectic effects of both peptides when injected intraperitoneally (IP). Amylin [1-510 pmol/rat (0.004-2 microg/rat) ICV] and CGRP [1-131 pmol/rat (0.004-0.5 microg/rat) ICV] dose-dependently reduced food intake in food-deprived rats. At a dose of 26 pmol/rat (0.1 microg/rat), amylin almost completely suppressed food intake for 1 h after injection. Amylin [EC50 = 2 pmol/rat (0.007 microg/rat)] was markedly more potent than CGRP [57 pmol/rat (0.215 microg/rat)] with regard to its anorectic effect. A lesion in the AP/NTS region did not influence the anorectic effects of amylin and CGRP after administration into the lateral ventricle. It is concluded that amylin is more potent than CGRP in reducing food intake after administration into the lateral brain ventricle. Receptors in the forebrain may mediate the anorectic effects of both peptides when administered via this route.

Lesion of the area postrema/nucleus of the solitary tract (AP/NTS) attenuates the anorectic effects of amylin and calcitonin gene-related peptide (CGRP) in rats

The area postrema/nucleus of the solitary tract (AP/NTS) region plays an important role in the control of food intake since it receives peripheral satiety signals via splanchnic and vagal afferents. Due to the lack of the blood brain barrier in this region, blood borne signals can directly be monitored in the AP/NTS. Furthermore, receptors for anorectic peptides such as amylin or calcitonin gene-related peptide (CGRP) have been found in the AP/NTS. It was therefore the aim of the present study to investigate the role of the AP/NTS region in mediating the anorectic effects of these peptides. Thermal ablation of the AP/NTS resulted in a significant reduction of the anorectic effects of IP injected amylin (5 microg/kg) and CGRP (5 microg/kg) in food deprived rats. The anorectic actions of CCK and BBS were also reduced by the AP/NTS lesion which agrees with previous studies. We conclude that the AP/NTS region is an important brain site for mediating the anorectic effects of amylin and CGRP. It remains to be clarified whether this effect is due to amylin and CGRP action on receptors within the AP/NTS region or peripheral receptors on afferent nerves projecting to the AP/NTS.

Evidence for a physiological role of central calcitonin gene-related peptide (CGRP) receptors in the control of food intake in rats

In the present study, we investigated the role of central calcitonin gene-related peptide (CGRP) and amylin receptors in mediating the anorectic effects of CGRP and amylin in rats chronically cannulated in the lateral brain ventricle. Intracerebroventricular (ICV) injection of the CGRP and amylin receptor antagonist CGRP(8-37) failed to influence the anorectic effects of peripherally injected CGRP and amylin. CGRP(8-37) alone, however, increased food intake in food deprived rats when administered 2 h before food presentation. Under the same experimental conditions, the more specific amylin receptor antagonists amylin(8-37) or AC 187 did not affect food intake. We therefore conclude, that CGRP is a physiological regulator of food intake within the central nervous system, acting at central CGRP receptors. Peripheral receptors, however, are likely to mediate the anorectic effects of peripherally administered amylin and CGRP.

Coagulation problems in patients with cancer

The cases of 43 cancer patients and nine patients without cancer were reviewed to assess the coagulation mechanism in patients with cancer. Of the 43 patients with cancer, at least one factor known to be associated with coagulation disturbances was present in 26. Hematologic or coagulation studies disclosed one or more abnormalities in 34 of the patients. A subgroup of 17 patients had no clinical or laboratory evidence of ongoing variables that should interfere with coagulation or hemostasis. Of these, 11, or 65%, had one or more abnormal results from coagulation studies. Of the nine members of the control group (patients without cancer), no patient had a positive history for a clinical coagulation disorder except for one incidence of thrombophlebitis in the year preceding the study. During the study, at least one coagulation abnormality was disclosed by hematologic testing. The results support the concept that coagulation problems in cancer patients are attributable to debilitation, multiple organ involvement, and coagulation-interfering variables rather than to a primary effect of the malignant tumor.