Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives

Purpose

Gender-affirming hormones (hormones)-the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals-are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care.

Methods

We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively.

Results

We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals.

Conclusion

A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.

Contraceptive decisions among individuals with medical conditions in Michigan, USA: A qualitative explanatory model informed by the Health Belief Model and the principle of respect for patient autonomy

OBJECTIVE

We aimed to qualitatively describe the contraceptive experiences of individuals with medical conditions and develop an explanatory model of contraceptive decision-making in this context.

STUDY DESIGN

We conducted 41 interviews with pre-menopausal patients with a range of medical conditions from Michigan, USA. We identified themes through open coding and comparative analysis until we reached theoretical saturation. We analyzed the themes in the context of the Health Belief Model constructs and patient autonomy. To develop the explanatory model, we qualitatively mapped out relationships between constructs and how they informed contraceptive-decision making.

RESULTS

The model posits that contraceptive decisions are affected by the perceived impact of chronic disease on pregnancy, parenting, and contraceptive options. These perceptions were strongly affected by others, particularly health care providers (HCPs). Most worried that pregnancy could threaten their health, fetal health, or ability to parent. Active symptoms of chronic disease (e.g., pain, fatigue) amplified this perceived threat. Patients appreciated when their HCPs acknowledged, rather than dismissed, their concerns about contraceptive side effects that affected their chronic disease symptoms and management (e.g., headaches, worsening mood). Patients with medical contraindications to hormonal contraception and preferred to use coital-dependent methods (e.g. condoms) did not feel supported to do so by their HCPs. Patients who were Black, young, living on low-incomes, or considered medically "high risk" felt discriminated against by HCPs who limited or coerced their contraceptive decisions.

CONCLUSIONS

This explanatory model synthesizes factors that underlie, constrain, or promote reproductive and contraceptive decisions and autonomy for individuals with medical conditions.

IMPLICATIONS

This new explanatory model can guide the development and evaluation of interventions that support the contraceptive decisions and autonomy of individuals with medical conditions.

A theoretical model of contraceptive decision-making and behaviour in diabetes: A qualitative application of the Health Belief Model

AIM

People with diabetes have contraceptive needs that have been inadequately addressed. The aim of this qualitative study was to develop a theoretical model that reflects contraceptive decision-making and behaviour in the setting of diabetes mellitus.

METHODS

We conducted semi-structured, qualitative interviews of 17 women with type 1 or type 2 diabetes from Michigan, USA. Participants were recruited from a diabetes registry and local clinics. We adapted domains from the Health Belief Model (HBM) and applied reproductive justice principles to inform the qualitative data collection and analysis. Using an iterative coding template, we advanced from descriptive to theoretical codes, compared codes across characteristics of interest (e.g. diabetes type), and synthesized the theoretical codes and their relationships in an explanatory model.

RESULTS

The final model included the following constructs and themes: perceived barriers and benefits to contraceptive use (effects on blood sugar, risk of diabetes-related complications, improved quality of life); perceived seriousness of pregnancy (harm to self, harm to foetus or baby); perceived susceptibility to pregnancy risks (diabetes is a 'high risk' state); external cues to action (one-size-fits-all/anxiety-provoking counselling vs. personalized/trust-based counselling); internal cues to action (self-perceived 'sickness'); self-efficacy (reproductive self-efficacy, contraceptive self-efficacy); and modifying factors (perceptions of biased counselling based upon one's age, race or severity of disease).

CONCLUSIONS

This novel adaptation of the HBM highlights the need for condition-specific and person-centred contraceptive counselling for those with diabetes.

“It Wasn’t for the Sake of Me and My Mental Health”: Transgender People’s Perspective on the Role of Mental Health Providers in Initiating Gender-Affirming Hormones - a Qualitative Study

Introduction: Hormone therapy can be an essential part of medical transition for some transgender people. Despite ongoing debate on the role of mental health providers in the initiation of gender-affirming hormones, little evidence exists to guide the discussion. We seek to elucidate the patient perspective on the feasibility, utility, risks, and benefits of mandatory mental health evaluation (MHE) prior to hormone initiation.

Methods: We conducted semi-structured interviews with individuals who have initiated gender-affirming hormone therapy (n=21). We purposively sampled respondents to include those who indicated that they were required to have mental health evaluation prior to hormone initiation, and those who did not. A transgender advisory board helped develop the semi-structured interview guide. Interviews were transcribed verbatim and coded using emergent and a priori codes.

Results: The majority of respondents saw the requirement for MHE prior to hormone initiation as distinct from, and often discordant with, their mental health care. We identified the following roles of mental health care as seen by patients: 1) General psychosocial support; 2) Identity formation: therapy as a safe space to explore gender and self; and 3) Logistics: assistance navigating the healthcare system. Themes that emerged regarding the MHE requirement included 1) Access: for some, the MHE requirement delayed access to gender-affirming care; 2) “pathologizing my existence”: the effects of having one’s identity result in a diagnosis of mental disorder; and 3) “auditioning” for care: fear of being denied care if one does not present with a stereotypical transgender narrative. Many participants drew direct connections between the MHE requirement and negative effects on their mental health and the patient/provider relationship, while concurrently identifying mental health care as essential for wellbeing.

Conclusion: While mental health care is appreciated, many transgender people see the universal MHE requirements as having significant negative implications on access, safety, and on even on their mental health. Guidelines should explicitly account for and mitigate the structural barriers preventing transgender individuals from accessing medical and mental health care.

Awareness and Attitudes Around the New Subspecialty Within Ob/Gyn Called Complex Family Planning: A CERA Survey of Family Medicine Chairs

BACKGROUND AND OBJECTIVES

Family physicians play an important role in delivery of family planning services, but many factors impact scope of practice. One important factor is the development of subspecialties, such as the new subspecialty within obstetrics and gynecology called complex family planning (CFP).

METHODS

In 2019, we conducted a survey of family medicine department chairs as part of the Council of Academic Family Medicine Educational Research Alliance survey. We used descriptive statistics and logistic regression to test for associations between program and chair characteristics, knowledge of CFP, and attitudes regarding family planning services (complex contraceptive counseling, pregnancy options counseling, first trimester miscarriage management, and pregnancy termination).

RESULTS

The survey response rate was 54% (105/193). Only 8% of respondents were aware of the CFP subspecialty. The majority of chairs considered all queried family planning services as part of family medicine's scope of practice, including pregnancy termination by medication abortion (77%) and by uterine aspiration (60%). Chairs of departments with a faculty champion in family planning had higher odds of advocating for all queried family planning services as part of family medicine scope of practice (OR 3.0, 1.1-8.2) than those without a faculty champion.

CONCLUSIONS

Few chairs are aware of the new subspecialty of CFP, but most would advocate to maintain some form of abortion care in family medicine's scope of practice. Given family medicine's role in the health care safety net, supporting faculty champions in family planning is important to preserve access to family planning services for marginalized communities.

Youth opinions about Title X funding and policy in the United States: A mixed methods text message survey

OBJECTIVE

We aim to assess youth awareness of and opinions about Title X policy changes in 2019.

STUDY DESIGN

We analyzed data from four open-ended questions and demographic items collected through MyVoice, a national text message survey of youth aged 14-24. We calculated descriptive statistics to summarize awareness of and opinions about Title X. We integrated the quantitative findings with qualitative themes to achieve deeper understanding of the beliefs that inform youth opinions.

RESULTS

Seven hundred and fifty youth responded to the text message survey (58.0% response rate). The majority (74.9%) was unaware of recent Title X changes. Most (79.3%) were unsupportive of these changes, and a sizable portion (40%) worried these changes could impact them. Opposition to Title X changes was based upon five themes: (1) youth need to be aware of their health options, including abortion; (2) the policy will undermine reproductive rights; (3) the policy is unfair; (4) the policy is unconstitutional; (5) the policy will threaten public health and health services, including affordable and safe abortion. Those who supported Title X changes (13.8%) described moral objections to abortion and beliefs that the government should not be responsible for abortion care.

CONCLUSIONS

Most youth in this sample were unsupportive of Title X changes. Limited youth awareness of Title X changes suggests that better youth outreach is needed regarding sexual and reproductive health (SRH) policies.

IMPLICATIONS

Although youth represent 40% of clients who receive SRH services through Title X, more efforts are needed to inform and engage them in salient policy changes that may directly affect their SRH health and health care access.

Pregnancy Intendedness by Maternal Disability Status and Type in the United States

CONTEXT

Societal views about sexuality and parenting among people with disabilities may limit these individuals' access to sex education and the full range of reproductive health services, and put them at increased risk for -unintended pregnancies. To date, however, no national population-based studies have examined pregnancy -intendedness among U.S. women with disabilities.

METHODS

Cross-sectional analyses of data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth were conducted; the sample included 5,861 pregnancies reported by 3,089 women. The proportion of pregnancies described as unintended was calculated for women with any type of disability, women with each of five types of disabilities and women with no disabilities. Multivariate logistic regression analyses were conducted to examine the relationship of disability status and type with pregnancy intendedness while adjusting for covariates.

RESULTS

A higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities (53% vs. 36%). Women with independent living disability had the highest proportion of unintended pregnancies (62%). In regression analyses, the odds that a pregnancy was unintended were greater among women with any type of disability than among women without disabilities (odds ratio, 1.4), and were also elevated among women with hearing disability, cognitive disability or independent living disability (1.5-1.9).

CONCLUSIONS

Further research is needed to understand differences in unintended pregnancy by type and extent of disability. People with disabilities should be fully included in sex education, and their routine care should incorporate discussion of reproductive planning.

Amorphophallus konjac anthracnose caused by Colletotrichum siamense in China

AIMS

Amorphophallus konjac is an important commercial crop grown in China because it is the only plant species which is rich in glucomannan concentration. Recently, an outbreak of anthracnose (incidence ranging from 10-15%) was observed in a field survey conducted from June to August 2018. This study aims to identify the causal agent of A. konjac anthracnose.

METHODS AND RESULTS

The pathogen was isolated on potato dextrose agar (PDA) medium. The fungal colony on PDA was greyish to dark grey. Conidia were falcate, one-celled and hyaline. Based on the micro-morphological and cultural characteristics, the pathogen was identified as Colletotrichum sp. blast search and phylogenetic analysis of the ITS, GAPDH, CHS1, ACT, CAL and TUB2 genes revealed the pathogen as Colletotrichum siamense. Koch's postulates were conducted on 2-month konjac leaves with conidial suspension. Development of typical anthracnose disease was recorded 5 days after inoculation and the pathogen's identity was confirmed by re-isolation and molecular identification.

CONCLUSIONS

Amorphophallus konjac anthracnose was caused by C. siamense in China.

SIGNIFICANCE AND IMPACT OF THE STUDY

Identification of causal agent of A. konjac anthracnose will be helpful in designing effective disease control strategies.

[Correlation between(Pro) renin receptor levels and gender and disease severity in patients with obstructive sleep apnea syndrome]

Objective:The aim of this study is to investigate the relationship between the level of (pro) renin(P)RR in obstructive sleep apnea syndrome (OSA) patients, and the gender and disease severity of the disease.b>Method:From March 2010 to March 2018, eighty OSA patients who were treated and diagnosed in our hospital were selected as subjects. Another 20 healthy subjects were selected as the control group.Plasma soluble (pro) renin receptor ［s(P)RR］ levels and clinical parameters were measured in healthy subjects and OSA patients with different sex and disease severity. Result:The plasma s(P)RR concentrations were significantly higher in OSA patients than that in control group. In all patients, plasma s(P)RR concentrations increased with increasing disease levels and showed the same trend between men and women. In addition,in all patients, plasma s(P)RR concentrations were significantly positively correlated with waist-to-hip ratio, HbA1c, AHI, and oxygen desaturation index. There was a significant negative correlation between saturation (MSpO₂) and minimum oxygen saturation (minSpO₂) (P<0.05).In female subjects,plasma s(P)RR concentrations were significantly positively correlated with waist-to-hip ratio and AHI,but significantly negatively correlated with eGFR (P<0.05).In male subjects,plasma s(P)RR concentration was significantly positively correlated with waist-to-hip ratio,HbA1c,renin level,AHI and oxygen desaturation index, but negatively correlated with eGFR, MSpO₂ and minSpO₂ (P<0.05). Plasma s(P)RR concentrations were significantly reduced after treatment with nasal continuous positive airway pressure ventilator. In addition, ESS,AHI,MSpO₂,minSpO₂,and oxygen desaturation index were all significantly improved (P<0.05).Conclusion: Plasma s(P)RR levels in OSA patients are significantly positively correlated with the severity of the disease and can directly reflect the severity of the disease. In addition, the patient with higher waist-to-hip ratio and HbA1c, and lower eGFR can effect plasma s(P)RR levels, and may lead to OSA aggravation.

Contraceptive Care for Women With Medical Conditions: A Qualitative Study to Identify Potential Best Practices for Primary Care Physicians

BACKGROUND AND OBJECTIVES

Women with medical conditions are at higher risk of pregnancy-related morbidity and mortality than women without medical conditions. Thus, women who do not desire pregnancy should be offered contraceptive counseling and methods. The objective of this qualitative study was to identify potential best practices to guide primary care physicians (PCPs) in providing contraception and contraceptive counseling for women with medical conditions.

METHODS

We conducted semistructured qualitative interviews of 10 PCPs who routinely provide contraception including long-acting reversible contraception (LARC). To inform the data collection and analysis, we adapted constructs from the Theoretical Domains Framework. We coded transcripts and identified themes until saturation of our theoretical constructs was achieved.

RESULTS

Physician time constraints, lack of patient knowledge, and competing demands related to medical condition management were identified as barriers to contraceptive care. The study participants reported multiple strategies to mitigate these barriers. They emphasized providing reproductive health education in the context of an individual's chronic conditions and medications, educating about LARC methods, and using the US Medical Eligibility Criteria (US MEC) as a point-of-care clinical tool to guide contraceptive selection.

CONCLUSIONS

The study participants (PCPs experienced in contraceptive care), described multifaceted approaches to providing contraception for women with medical conditions, including tailored contraceptive education and use of the US MEC for clinical guidance. Future research is needed to assess if such strategies can improve patient outcomes and be adopted by PCPs who have less experience with contraceptive care.

[Evaluation of carotid plaque neovascularization in carotid stenosis by contrast-enhanced ultrasound]

Objective: The identification of neovascularization in carotid plaque in carotid artery stenosis by contrast-enhanced ultrasound (CEUS) provides other risk markers for stroke besides carotid artery stenosis -intraplaque neovascularization. Methods: From January 2017 to September 2017, 40 patients with carotid atherosclerosis plaque were examined by contrast-enhanced ultrasound in China-Japanese Friendship Hospital. The enhancement intensity (EI) measured by contrast-enhanced ultrasound was compared with the micro-vessel density (MVD) measured by histopathology after carotid endarterectomy (CEA). Contrast-enhanced ultrasound was used to observe whether there was enhancement in the plaque and the enhancement was divided into 0-2 grades. The EI in plaque, the ratio of EI in plaque to EI in carotid artery lumen were calculated by time intensity curve quantitative analysis software. Pathological sections of carotid plaques after CEA were stained with CD34 and neovascularization density was measured. Results: There were significant differences in age, EI1, EI1/EI2 and CD34 among patients with different grades of plaque enhancement (P<0.05), but no significant differences in gender and EI2 (P>0.05). The density of neovascularization obtained by CD34 staining was highly positively correlated with EI1 (r=0.836, P<0.001), EI1/EI2 (r=0.955, P<0.001), but not with age (r=0.066, P=0.684), EI2 (r=0.159, P=0.328). Conclusions: Contrast-enhanced ultrasound can observe the neovascularization in carotid plaque, which is a simple and non-invasive method to evaluate the stability of carotid plaque. CEUS may also help to extract features of vulnerable plaques, such as acute intraplaque hemorrhage.

Welcoming transgender and nonbinary patients: expanding the language of "women's health"

In this article, we consider the impact of gendered language on our ability to provide inclusive care and to address health disparities experienced by transgender and nonbinary people. We posit that while obstetrician-gynecologists and others trained in women's health are already well positioned to extend care to this population, we can improve this care through simple adjustments in the framing and language we use.

Female Sterilization and Cognitive Disability in the United States, 2011-2015

OBJECTIVE

To compare female sterilization among three mutually exclusive groups of females: 1) those without any self-reported disability, 2) those with noncognitive disabilities (sensory or physical disabilities), and 3) those with cognitive disabilities.

METHODS

We conducted a secondary analysis of nationally representative data from the National Survey of Family Growth 2011-2015, which surveyed individuals aged 15-44 years in the U.S. civilian population. Disability status (self-reported) was ascertained using a standard set of questions about hearing, vision, cognitive, ambulatory, self-care, and independent living difficulties. Regression models were used to calculate odds of female sterilization, hysterectomies, and age of sterilization while accounting for sociodemographic differences.

RESULTS

Female sterilization rates were higher among females with cognitive (22.1% [n=272]) and noncognitive disabilities (24.7% [n=150]) than among those without disabilities (14.8% [n=1,132]). After adjusting for sociodemographic covariates, females with cognitive disabilities had significantly higher odds of female sterilization (adjusted odds ratio [OR] 1.54, 95% CI 1.19-1.98, P<.01) and hysterectomy (adjusted OR 2.64, 95% CI 1.53-4.56, P<.001) than those without cognitive disabilities. Females with cognitive disabilities also underwent sterilization at significantly younger ages (27.3 years, 95% CI 27.0-27.6) than those with noncognitive disabilities (28.3 years, 95% CI 27.9-28.8) and those without any disability (29.8 years, 95% CI 29.5-30.0).

CONCLUSION

U.S. females with cognitive disabilities were more likely to have undergone female sterilizations and hysterectomies and at younger ages than those with other disabilities or without disabilities. Drivers of these disability-related differences in female sterilization patterns must be explored.

A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study

BACKGROUND

Women with chronic medical conditions, such as diabetes and hypertension, have a higher risk of pregnancy-related complications compared with women without medical conditions and should be offered contraception if desired. Although evidence based guidelines for contraceptive selection in the presence of medical conditions are available via the United States Medical Eligibility Criteria (US MEC), these guidelines are underutilized. Research also supports the use of decision tools to promote shared decision making between patients and providers during contraceptive counseling.

OBJECTIVE

The overall goal of the MiHealth, MiChoice project is to design and implement a theory-driven, Web-based tool that incorporates the US MEC (provider-level intervention) within the vehicle of a contraceptive decision tool for women with chronic medical conditions (patient-level intervention) in community-based primary care settings (practice-level intervention). This will be a 3-phase study that includes a predesign phase, a design phase, and a testing phase in a randomized controlled trial. This study protocol describes phase 1 and aim 1, which is to determine patient-, provider-, and practice-level factors that are relevant to the design and implementation of the contraceptive decision tool.

METHODS

This is a mixed methods implementation study. To customize the delivery of the US MEC in the decision tool, we selected high-priority constructs from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to drive data collection and analysis at the practice and provider level, respectively. A conceptual model that incorporates constructs from the transtheoretical model and the health beliefs model undergirds patient-level data collection and analysis and will inform customization of the decision tool for this population. We will recruit 6 community-based primary care practices and conduct quantitative surveys and semistructured qualitative interviews with women who have chronic medical conditions, their primary care providers (PCPs), and clinic staff, as well as field observations of practice activities. Quantitative survey data will be summarized with simple descriptive statistics and relationships between participant characteristics and contraceptive recommendations (for PCPs), and current contraceptive use (for patients) will be examined using Fisher exact test. We will conduct thematic analysis of qualitative data from interviews and field observations. The integration of data will occur by comparing, contrasting, and synthesizing qualitative and quantitative findings to inform the future development and implementation of the intervention.

RESULTS

We are currently enrolling practices and anticipate study completion in 15 months.

CONCLUSIONS

This protocol describes the first phase of a multiphase mixed methods study to develop and implement a Web-based decision tool that is customized to meet the needs of women with chronic medical conditions in primary care settings. Study findings will promote contraceptive counseling via shared decision making and reflect evidence-based guidelines for contraceptive selection.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03153644; https://clinicaltrials.gov/ct2/show/NCT03153644 (Archived by WebCite at http://www.webcitation.org/6yUkA5lK8).

The effect of energy restriction on fatty acid profiles of longissimus dorsi and tissue adipose depots in sheep

Sheep production systems in northwest China depend mostly on natural grasslands. Seasonal growth and maturity fluctuations can cause periodical restrictions in food quality and quantity. These fluctuations, in turn, result in variability in fat deposition and fatty acid profiles in different fat depots. Consequently, the study objective was to compare fat deposition, intramuscular fat (IMF) percentage and fatty acid profiles of the longissimus dorsi (LD), kidney fat (KF), tail fat (TF), and subcutaneous fat (SF) in lambs under ME restrictions similar to seasonal changes observed in the natural grasslands of northwest China. Nineteen male Dorper × Small Tailed Han lambs were assigned to 2 treatments, a control (CON) fed at 1.0 MJ / W × d and restricted (RES) by restricting ME sequentially every 30 d (0.56 MJ / W × d, 0.84 / W × d, 1.0 MJ / W × d, 0.84 MJ / W × d, 0.56 MJ / W × d, 0.28 MJ / W × d). All lambs were harvested at the end of the 180 d experimental period. Compared to CON fed lambs, restricting ME resulted in lesser IMF, fat deposition indexes ( < 0.05) except testicular and heart fat and greater ( < 0.05) SFA in LD, KF, and TF depots. The RES fed lambs had greater ( < 0.05) -3 PUFA, eicosatrienoic acid (C20:3n3), eicosapentaenoic acid (C20:5n3, EPA), and trans-linolelaidic acid (C18:2n6t) in LD muscle. The conjugated linoleic acids (CLA) content was greater in the SF depots of the CON fed lambs compared to the RES fed lambs. Fatty acid ratios (unsaturated fatty acid; USFA:SFA, MUFA:SFA, PUFA:SFA), and percentage USFA in RES fed lambs were lesser in muscle and adipose tissue compared to CON fed lambs ( < 0.05), except SF depots. In RES fed lambs, EFA were less ( < 0.05) in LD and KF depots and the ratios of functional fatty acids were lesser in LD and some adipose tissues ( < 0.05), including lesser n-6:n-3 in KF and SF ( < 0.05) depots, lesser USFA, SFA, MUFA, SFA in LD, KF, and TF ( < 0.05) depots, and lesser PUFA and SFA in LD and TF ( < 0.05) depots. Results from this research demonstrate that sequential energy restriction, as might be experience during seasonal forage quality and quantity changes in natural grasslands, result in lesser intramuscular fat with associated lesser quality, as well as, changes in fatty acid composition in different fat depots, which has implications for both meat quality and animal physiological functions.

[Traditional nasal therapy in Uighur medicine]

Nasal therapy, extensively documented in the ancient Uighur medical literature, is one of the external therapies of Uighur medicine. Based on the relevant records of 14 Uighur medical works, the application, classification, clinical features, and medications characteristics of nasal therapy were preliminarily sorted out. The results show that the nasal therapy can be divided into 7 categories, covering more than 200 kinds of common medicinal herbs, 8 kinds of processing methods and 10 kinds of preparations. Clinically, there is a large number of nasal therapy prescriptions, with flexible administration of prescriptions and medications, significant features of comprehensive therapy, with significance of application for further development.

Use of Reversible Contraceptive Methods Among U.S. Women with Physical or Sensory Disabilities

CONTEXT

Women with disabilities experience a higher rate of adverse pregnancy outcomes than women without disabilities. Preventing or delaying pregnancy when that is the best choice for a woman is a critical strategy to reducing pregnancy-related disparities, yet little is known about current contraceptive use among women with disabilities.

METHODS

A cohort of 545 reproductive-age women with physical disabilities (i.e., difficulty walking, climbing, dressing or bathing) or sensory disabilities (i.e., difficulty with vision or hearing) was identified from among participants in the 2011-2013 National Survey of Family Growth. Those at risk for unplanned pregnancy were categorized by whether they were using highly effective reversible contraceptive methods (IUD, implant), moderately effective ones (pill, patch, ring, injectable), less effective ones (condoms, withdrawal, spermicides, diaphragm, natural family planning) or no method. Multinomial regression was conducted to examine the association between disability and type of contraceptive used.

RESULTS

Some 39% of women with disabilities were at risk of unplanned pregnancy, and 27% of those at risk were not using contraceptives. The presence of disability was associated with decreased odds of using highly effective methods or moderately effective methods, rather than less effective ones (odds ratio, 0.6 for each), but had no association with using no method.

CONCLUSION

There is a significant need to reduce contraceptive disparities related to physical or sensory disabilities. Future research should explore the extent to which contraceptive use differs by type and severity of disability, as well as identify contextual factors that contribute to any identified differences.

Promoter analysis and tissue expression of the chicken ASB15 gene

1. This study was conducted to explore the promoter region of the chicken ASB15 gene by detecting the activities of the dual luciferase reporter gene and to assess expression profiles of the ASB15 gene in 10 different tissues from Gushi chickens. 2. Five dual luciferase reporter gene vectors were constructed and transfected into DF1 cells. The activities of recombined plasmids were measured and the core promoter was confirmed by bioinformatic analysis. Total RNA was extracted and the relative expression of the ASB15 gene was examined. 3. Data analysis indicated that the promoter was located from -955 to -212 bp. Results showed that the chicken ASB15 gene was expressed in heart, breast muscle and leg muscle. 4. This study has confirmed the promoter region and the expression profile of the chicken ASB15 gene, which provides a foundation for further exploring its transcriptional regulation and function.

Polymorphisms of Flanking Region of the ASB15 Gene and Their Associations with Performance Traits in Chicken

Research on the identity of genes and their relationship with traits of economic importance in chickens could assist in the selection of poultry. In this study, an F₂ resource population of Gushi chickens crossed with Anka broilers was used to detect single-nucleotide polymorphisms (SNPs) in the flanking region of the ASB15 gene by DNA sequencing and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). One SNP of -1271 C>T in 5' flanking region of the chicken ASB15 gene and two SNPs of the 10618 A>G and 10716 G>A in 3' flanking region were identified. Furthermore, the 10618 A>G and 10716 G>A in 3' flanking region were in complete linkage. Association analysis results showed that -1271 C>T was not associated with performance traits, while the 10618 A>G and 10716 G>A were significantly associated with BW2, 4, 6, 8, 10, 12, SL12, CD8, CW4, 8, 12, BSL4, 8, 12, and SEW, EW, WW, BMW, LW, CW, SFT. Our results suggest that the ASB15 gene profoundly affects chicken performance traits.

Are the Contraceptive Recommendations of Family Medicine Educators Evidence-Based? A CERA Survey

BACKGROUND AND OBJECTIVES

Our study aims were to: (1) describe the scope of contraceptive methods provided by US family medicine educators and (2) assess the extent to which US family medicine educators' recommendations regarding eligibility criteria for contraceptive methods are consistent with Centers for Disease Control and Prevention (CDC) guidelines.

METHODS

We contributed survey items as part of the 2014 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey, which is distributed annually to a national cohort of US family medicine educators. We created two summary scales, comprised of clinical scenarios, to assess the extent to which provider recommendations regarding eligibility criteria for oral contraceptive pills (OCPs, six scenarios) and the intrauterine device (IUD, eight scenarios) were consistent with CDC guidelines.

RESULTS

Among the 1,054 respondents (33% response rate), 98% prescribe OCPs and 66% insert IUDs. The OCP scale mean was 4.6 ± SD 1.6 (range 0-6), and the IUD scale mean was 4.8 SD ± 2.3 (range 0-8). These scores reflect that 23% of providers' OCP recommendations and 40% of their IUD recommendations were inconsistent with CDC guidelines.

CONCLUSIONS

The contraceptive recommendations of this cohort of family medicine educators only partially reflected evidence-based guidelines. More misconceptions were noted regarding eligibility criteria for the IUD than for OCPs. To avoid denying safe and effective contraception to otherwise appropriate candidates and putting women at risk of unintended pregnancy, evidence-based contraceptive recommendations must be improved among family medicine educators.

Patterns of Contraceptive Consistency among Young Adult Women in Southeastern Michigan: Longitudinal Findings Based on Journal Data

BACKGROUND

We aimed to determine patterns of contraceptive consistency among heterosexually active, young adult women who do not desire pregnancy, and to identify factors associated with these patterns.

METHODS

We analyzed longitudinal data from a population-based study of young adult women aged 18 and 19 who were representative of a single county in southeastern Michigan. Using multinomial logistic regression, we identified associations between contraceptive consistency (dependent outcome) and sociodemographic characteristics and personal factors.

FINDINGS

We categorized women into three patterns of contraceptive consistency: 1) always consistent (40%; reference group), 2) sometimes consistent (49%), 3) never consistent (11%). Not being employed was associated with increased odds of being sometimes consistent (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.2) and never consistent (OR, 1.9; 95% CI, 1.1-3.4). Those who reported a grade point average of 3.0 or less were more likely to be never consistent (OR, 2.5; 95% CI, 1.2-5.3). Women in a serious relationship had a two times greater odds of being sometimes consistent. Among always consistent users, the oral contraceptive pill was most often used (55%); only 4% used the intrauterine device or implant. Sometimes consistent and never consistent users most frequently relied on condoms (35%) and withdrawal (68%), respectively.

CONCLUSIONS

This analysis of longitudinal data revealed that the majority of young adult women inconsistently used short-acting or coital-specific methods; few used the most effective, long-acting methods. Interventions to improve contraceptive consistency among young adult women should include periodic assessments of personal factors (i.e., work, school, relationships) and promotion of long-acting reversible contraceptive methods when appropriate.

Effects of tail docking on the expression of genes related to lipid metabolism in Lanzhou fat-tailed sheep

To evaluate stearoyl-CoA desaturase (SCD), hormone-sensitive lipase (HSL), lipoprotein lipase (LPL), and peroxisome proliferator-activated receptor (PPARγ) expression in Lanzhou fat-tailed sheep (with and without docked tails), 18 rams were randomly divided into two equal groups (docked group, LT; control group, LC). These data were also used to increase the understanding of sheep fat deposition and metabolism. All animals were harvested at the age of 18 months, and expression was determined for 10 tissues. The results indicated that the fat weight of each tissue in LT was higher than in LC (P < 0.05). SCD expression in semitendinosus, omentum majus fat (OF), subcutaneous fat, kidney fat (KF), and subcutaneous rump fat was higher in LT than in LC rams (P < 0.05). Trends (P < 0.10) associated with higher HSL expression of LC in comparison to that of LT rams in intestinal fat, OF, and KF tissues were detected. Numerically, LPL expression was the highest in KF, OF, and kidney tissues, but there were few differences (P > 0.10). PPARγexpression was greater in LT than in LC rams in liver tissues (P < 0.05), but there were few differences in other tissues. No significant differences were found with regard to the regression analysis of expression and adipose tissue weights, but the two indices exhibited the same trend. The results indicated that changes in fatty deposits may be due to the common control of docking management and the minor effects associated with the regulation of SCD, HSL, LPL, and PPARγexpression.

Comparison of longissimus dorsi Fatty Acids Profiles in Gansu Black Yak and Chinese Yellow Cattle Steers and Heifers

Fatty acid (FA) composition of longissimus dorsi intramuscular fat in Black Yak and Chinese Yellow Cattle were evaluated in 44 Black Yak and 41 Chinese Yellow Cattle of both genders. Interactions of species with gender were observed for total saturated fatty acid (SFA), unsaturated fatty acid (UFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), palmitic acid, stearic acid, oleic acid, linolenic acid, arachidonic acid, EPA, and DHA concentrations, as well as PUFA/SFA ratio in the longissimus dorsi (p<0.05). The SFA percentage was greater in yellow cattle than yak in both genders but the species difference in heifers was greater than in steers (p<0.05). Yak had greater UFA, MUFA and PUFA percentages than yellow cattle in both steers and heifers (p<0.05) but the difference between yak and yellow cattle heifers was greater than yak and yellow cattle steers. The percentages of inolenic acid, arachidonic acid, eicosapentaenoic acid, and docosahexaenoic acid; and PUFA/SFA were greater in yak than yellow cattle in both steers and heifers (p<0.05). In addition, the ratio of n-6/n-3 PUFA in yak was lesser than in yellow cattle (p<0.05). These results indicated that FA composition generally differed between yak and yellow cattle but the differences were not the same in heifers as compared to steers. Results also suggested that species differences in FA composition tended to favor Black Yak over Chinese Yellow Cattle, indicating that the longissimus dorsi of Black Yak may have a higher nutritive value than that of Chinese Yellow Cattle and potential for development as a desirable natural product.

Relationships of milk yield and quality from six breed groups of beef cows to preweaning average daily gain of their calves

Milk yield and quality influence calf preweaning growth and ultimately the sale value of the calf at weaning. This study was conducted to evaluate the relationships of milk production and quality of beef cows to calf preweaning ADG in beef cows sired by Bonsmara, Brangus, Charolais, Gelbvieh, Hereford, and Romosinuano and from Brangus dams to determine whether the relationships were homogeneous across cow breed group. Approximately 50 cows/yr were milked monthly for 6 mo in each of the 7 yr of this study. Milk traits were included in models as linear and quadratic covariates along with interactions of the covariates with sire breed. Tests for curvilinearity and homogeneity of regression coefficients indicated the relationship of calf preweaning ADG to milk yield and quality was quadratic and homogeneous across Charolais and Gelbvieh; linear and homogeneous across Bonsmara, Brangus, and Romosinuano; and linear and different from other sire breeds in Herefords (P < 0.05). Exceptions to this were in the regression of calf preweaning ADG on the natural logarithm of somatic cell count (SCC) and milk urea nitrogen (MUN). The relationship of calf preweaning ADG to SCC was quadratic in Brangus (P < 0.05) and linear in Gelbvieh (P < 0.05) with little evidence (P > 0.05) of a relationship in Bonsmara, Charolais, Hereford, or Romosinuano. There was little evidence (P > 0.05) of a relationship of calf preweaning ADG to MUN in any of the sire breed groups. Results from this study confirmed the importance of the influence of milk yield and quality on calf preweaning growth but indicated this influence can depend on the breed composition of the cow. Furthermore, results suggest that breed origin or adaptation may have influenced the relationships of calf preweaning ADG to cow milk yield and quality.

Women's satisfaction with abortion care in academic family medicine centers

BACKGROUND AND OBJECTIVES

The primary study aim was to describe patient satisfaction regarding abortion experiences in urban academic family medicine centers (FMCs).

METHODS

We conducted a cross-sectional survey of 210 women obtaining a first trimester medication or aspiration abortion at four FMCs. The 32-item written survey consisted of multiple choice, open-ended questions and Likert scale measures (for satisfaction: 1=very dissatisfied, 2=somewhat dissatisfied, 3=somewhat satisfied, 4=very satisfied, for quality of care: 1=poor, 2=average, 3=good, 4=excellent). We used Fisher's exact test to examine bivariate relationships. Responses to open-ended questions were coded and categorized.

RESULTS

The majority of women (93%) were very satisfied with their abortion experience in their FMC, regardless of clinical site or abortion method. Mean scores for the quality of the staff, doctor, abortion counseling, and contraceptive counseling were all at least 3.9 (out of 4). Women most commonly cited positive interactions with the staff and physicians as the best part of their experience.

CONCLUSIONS

This study demonstrates that women who receive abortion services at academic FMCs are highly satisfied with their care.

Study of the correlation between GH gene polymorphism and growth traits in sheep

The growth hormone gene plays an important role in the physiological function of an organism. The current study aimed to investigate the correlation between polymorphisms in the 5' regulatory region, exon 4, and 3' untranslated region (UTR) of the sheep GH gene and sheep growth traits. The DNA from 510 adult sheep was analyzed by DNA sequencing and polymerase chain reaction single-strand conformation polymorphism. Two alleles (A and B) and 3 genotypes (AA, AB, and BB), 2 alleles (A and B) and 3 genotypes (AA, AB, and BB), and 3 alleles (A, B, and C) and 4 genotypes (AA, AB, BB, and AC) were found within the 5' regulatory region, exon 4, and 3' UTR, respectively. In Tibetan sheep, the association analysis indicated that there were statistically significant differences in the scores of weight, length, and heart girth within the 5' regulatory region; weight, length, wither height, and heart girth within exon 4; and weight, length, wither height, and heart girth within the 3' UTR among the different genotypes. For exon 4, Poll Dorset sheep individuals with genotype AA showed a lower score than those of genotypes BB and AB (P<0.05). With regard to the 3' UTR, Poll Dorset sheep with genotype AC showed higher scores than those of genotypes AA and AB (P<0.05).

Establishment of the optimum two-dimensional electrophoresis system of ovine ovarian tissue

Lambing performance of sheep is the most important economic trait and is regarded as a critic factoring affecting the productivity in sheep industry. Ovary plays the most roles in lambing trait. To establish the optimum two-dimensional electrophoresis system (2-DE) of ovine ovarian tissue, the common protein extraction methods of animal tissue (trichloroacetic acid/acetone precipitation and direct schizolysis methods) were used to extract ovine ovarian protein, and 17-cm nonlinear immobilized PH 3-10 gradient strips were used for 2-DE. The sample handling, loading quantity of the protein sample, and isoelectric focusing (IEF) steps were manipulated and optimized in this study. The results indicate that the direct schizolysis III method, a 200-μg loading quantity of the protein sample, and IEF steps II (20°C active hydration, 14 h→500 V, 1 h→1000 V 1 h→1000-9000 V, 6 h→80,000 VH→500 V 24 h) are optimal for 2-DE analysis of ovine ovarian tissue. Therefore, ovine ovarian tissue proteomics 2-DE was preliminarily established by the optimized conditions in this study; meanwhile, the conditions identified herein could provide a reference for ovarian sample preparation and 2-DE using tissues from other animals.

Lentiviral-mediated RNAi targeting caspase-3 inhibits apoptosis induced by serum deprivation in rat endplate chondrocytes in vitro

Current studies find that degenerated cartilage endplates (CEP) of vertebrae, with fewer diffusion areas, decrease nutrient supply and accelerate intervertebral disc degeneration. Many more apoptotic cells have been identified in degenerated than in normal endplates, and may be responsible for the degenerated grade. Previous findings suggest that inhibition of apoptosis is one possible approach to improve disc regeneration. It is postulated that inhibition of CEP cell apoptosis may be responsible for the regeneration of endplates. Caspase-3, involved in the execution phase of apoptosis, is a candidate for regulating the apoptotic process. In the present study, CEP cells were incubated in 1% fetal bovine serum. Activated caspases were detected to identify the apoptotic pathway, and apoptosis was quantified by flow cytometry. Lentiviral caspase-3 short hairpin RNA (shRNA) was employed to study its protective effects against serum deprivation. Silencing of caspase-3 expression was quantified by reverse transcription-polymerase chain reaction and Western blots, and inhibition of apoptosis was quantified by flow cytometry. Serum deprivation increased apoptosis of rat CEP cells through activation of a caspase cascade. Lentiviral caspase-3 shRNA was successfully transduced into CEP cells, and specifically silenced endogenous caspase-3 expression. Surviving cells were protected by the downregulation of caspase-3 expression and activation. Thus, lentiviral caspase-3 shRNA-mediated RNAi successfully silenced endogenous caspase-3 expression, preventing inappropriate or premature apoptosis.

Fatty acid composition differences between adipose depot sites in dairy and beef steer breeds

The objective of the study was to compare fatty acid composition of longissimus dorsi (LD) and kidney fat (KF) in Holstein steers (HS), Simmental steers (SS) and Chinese LongDong Yellow Cattle steers (CLD). All steers received the same nutrition and management but in different locations. Cattle were harvested at approximately 550 kg and fatty acid composition of longissimus dorsi and kidney fat was analyzed in samples taken after 3 days of aging. There was evidence (P < 0.05) that C18:3n6 was greater in KF than LD in CLD cattle but not in HS or SS cattle. Percentage C18:1n9, C18:2n6, C18:3n3, and n6 fatty acids were greater in LD than KF for all breeds (P < 0.05), but the difference between fat sources for n6 in CLD cattle was smaller than the other two breeds. The LD had greater percentage of polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA), and a greater ratio of n6:n3 PUFAs compared to the KF in each breed (P < 0.05). The △(9)-desaturase catalytic activity index was greater in LD than in KF in each breed group (P < 0.05). Percentage cis-9, trans-11 CLA was greater in KF than LD in HS (P < 0.05) but not SS or CLD cattle. These results indicate fatty acid percentages generally differed between longissimus dorsi fat and kidney fat. Further, there was some indication that some of these differences between fatty acid deposition sites were not consistent across breed group.

Microstructural analysis of collagen and elastin fibres in the kangaroo articular cartilage reveals a structural divergence depending on its local mechanical environment

OBJECTIVE

To assess the microstructure of the collagen and elastin fibres in articular cartilage under different natural mechanical loading conditions and determine the relationship between the microstructure of collagen and its mechanical environment.

METHOD

Articular cartilage specimens were collected from the load bearing regions of the medial femoral condyle and the medial distal humerus of adult kangaroos. The microstructure of collagen and elastin fibres of these specimens was studied using laser scanning confocal microscopy (LSCM) and the orientation and texture features of the collagen were analysed using ImageJ.

RESULTS

A zonal arrangement of collagen was found in kangaroo articular cartilage: the collagen fibres aligned parallel to the surface in the superficial zone and ran perpendicular in the deep zone. Compared with the distal humerus, the collagen in the femoral condyle was less isotropic and more clearly oriented, especially in the superficial and deep zones. The collagen in the femoral condyle was highly heterogeneous, less linear and more complex. Elastin fibres were found mainly in the superficial zone of the articular cartilage of both femoral condyle and distal humerus.

CONCLUSIONS

The present study demonstrates that the collagen structure and texture of kangaroo articular cartilage is joint-dependent. This finding emphasizes the effects of loading on collagen development and suggests that articular cartilage with high biochemical and biomechanical qualities could be achieved by optimizing joint loading, which may benefit cartilage tissue engineering and prevention of joint injury. The existence of elastin fibres in articular cartilage could have important functional implications.

Molecular characterization and functional analysis of sheep thyroid transcription factor-1

Thyroid transcription factor-1 (TTF-1), a member of the Nkx2 family of homeodomain-containing proteins, is involved in binding to and in activating the promoters of several important genes in the thyroid, lungs, and brain, and in regulating expression of these tissue-specific genes. We investigated potential roles of sheep (Ovis aries) TTF-1 in regulating cell fate and organ morphogenesis and in controlling puberty and reproductive capability of females. We amplified and cloned the sheep TTF-1 full-length DNA for the first time, analyzed its functional domains and regions, predicted molecular structure of its homeodomain and DNA-binding sites, and examined its expression in pituitary, brain, thyroid gland, ovary, and hypothalamus. We found that sheep TTF-1 has a high degree of homologous identity with that of other mammals, and it has several important domains including domain N, DNA-binding domain, domain C, TN-domain, domain I, and NK2-SD. The DNA-binding domain of sheep TTF-1 has 10 potential DNA-binding sites and is a novel mammalian homeodomain that shows considerable sequence homology with the corresponding rat homeodomain. Several functional regions in sheep TTF-1 share high sequence identity with rat TTF-1, indicating that these regions may have the same activity as in the rat. Expression of TTF-1 in several specific tissues implies that sheep TTF-1 in involved in sheep sexual development and reproductive capability. These results suggest a role of sheep TTF-1 in enhancing sheep reproduction performance and we propose it as a candidate gene for selection.

Successful retrieval of an intrauterine device with "missing strings" using a manual vacuum aspirator in a desired early pregnancy: case report

Intrauterine pregnancy in the presence of an intrauterine device (IUD) is a rare event. If the pregnancy is desired, IUD removal must be negotiated so that the risk of pregnancy disruption is minimized. Cases in which the IUD strings are "missing" present further challenges. We report successful removal of a copper T380A IUD with missing strings using a hand-held manual vacuum aspirator in the setting of a desired pregnancy. Under real-time abdominal ultrasound guidance, the IUD was removed from the lower cervical canal using a 6-mm cannula attached to a manual vacuum aspirator. Fetal cardiac activity was undisturbed throughout the procedure. The patient subsequently delivered a healthy full-term infant via spontaneous vaginal delivery. Manual vacuum aspiration, a simple office-based procedure, may be a useful approach to removal of an IUD with missing strings.

Pyrazinoindolone inhibitors of MAPKAP-K2

Optimization of pyrazinoindolone inhibitors of MAPKAP-K2 (MK2) provides a reasonable balance of cellular potency and physicochemical properties. Mechanistic studies support the inhibition of MK2 which is responsible for the sub-micromolar cellular efficacy.

A family medicine training collaborative in early abortion

OBJECTIVES

This study's objective was to assess participation and perceived benefits of abortion training among residents at programs with integrated early abortion care.

INTERVENTION

We developed a collaborative early abortion training network.

RESULTS

Residents at training sites had high participation (71%) and were more likely to report familiarity and comfort with providing early abortion care than comparison sites. Residents reported benefits to overall training (78%), satisfaction (55%), and plans to provide abortion care (40%).

CONCLUSIONS

This collaborative abortion training program was valued by residents and was associated with greater self-assessed skills and positive attitudes toward providing early abortion care than at comparison sites.

The effect of polycarbophil gel (Replens™) on bacterial vaginosis: A pilot study

OBJECTIVE

To determine if use of intravaginal polycarbophil gel (Replens) for 1 month will: (1) lower vaginal pH; (2) improve signs of bacterial vaginosis (BV).

STUDY DESIGN

Seventeen women with BV self-administered polycarbophil gel every third day for 4 weeks in an open-label, prospective pilot study. Primary outcome measures included vaginal pH, presence of amines and Nugent scores.

RESULTS

At week 4, there was improvement in Nugent scores, vaginal odor and clue cell count (p<0.05). Eleven women converted from amine positive to negative (73+/-20%). There was no significant change in vaginal pH.

CONCLUSIONS

Polycarbophil gel is associated with improved signs of BV, although not vaginal pH.

Characterization of metallothioneins (MT-I and MT-II) in the yak

The cDNA-encoding sequences for yak metallothionein isoforms I (MT-I) and II (MT-II) were amplified and cloned by reverse-transcription PCR to characterize the nucleotide sequence and protein structure of metallothionein in the yak. The cDNA sequences of MT-I and MT-II were subjected to BLAST searching at the National Center for Biotechnology Information, and the results indicated that the nucleotide sequences of yak MT-I and MT-II, when compared among different species of mammals, are highly conserved. The yak open reading frames have a length of 183 nucleotides, which encode for yak MT-I and MT-II proteins of 61 AA, respectively. Analysis of hydrophobicity, trans-membrane region, and signal peptides suggested that metallothioneins of the yak are nonsecretory proteins. There were several conserved tripeptide sequences, such as C-X-C, C-C-X-C-C, and C-X-X-C (X designates AA excluding cysteine in MT-I and MT-II), and they are highly conserved in their evolution. By homologous comparative modeling, we predicted the molecular spatial structures of yak MT-I and MT-II, which are composed of alpha- and beta-domains that are linked by the conserved tripeptide Lys(30)-Lys(31)-Ser(32) (KKS).

The effect of a simple educational intervention on interest in early abortion training among family medicine residents

OBJECTIVES

We aimed to assess the effect of an educational intervention on the interest in and support for abortion training among family medicine residents.

METHODS

We conducted a cross-sectional survey before and after an educational lecture on medical and surgical abortion in primary care among 89 residents in 10 New Jersey family medicine programs.

RESULTS

Before the lecture, there was more interest in medical abortion training than surgical abortion. Resident interest in surgical abortion and overall support for abortion training increased after the educational intervention (p<.01).

CONCLUSIONS

Efforts to develop educational programs on early abortion care may facilitate the integration of abortion training in family medicine.

Expression of neural cell adhesion molecule in spinal cords following a complete transection

Neural cell adhesion molecule (NCAM) regulates tissue organization during development and in the adult. NCAM upregulation occurs after an injury to brains and sciatic nerves. However, little is known about NCAM expression after spinal cord injury (SCI). By using a complete spinal cord transection with a 5 mm tissue removal, an increase in the NCAM level is detected in spinal cord stumps proximal and distal to the transection site at 1 d and 3 d post injury, while its expression at 8 d is declined to a lower level than that observed in sham-operated spinal cords. The strong NCAM expression is present in motor neurons at 3 d post transection whereas the intensive NCAM immunostaining is localized in dorsal sensory and corticospinal fiber tracts at 8 d following injury. Collectively, NCAM level is elevated and strongly expressed in dorsal fiber tracts after SCI, implying that the endogenous process for spinal cord regeneration may take place after SCI.

Tetrandrine inhibits inward rectifying potassium current in cultured bovine aortic endothelial cells

AIM

To study the effect of tetrandrine (Tet) on inward rectifying potassium current in cultured bovine aortic endothelial cells.

METHODS

Inward rectifying potassium current (IRK) was observed by the whole cell patch-clamp technique.

RESULTS

IRK was inhibited by Tet in a concentration-dependent manner and recovered to normal after wash with drug-free external solution. IRK was reduced from (582 +/- 48) pA to (221 +/- 40) pA at a holding potential of -70 mV by Tet 30 mumol/L. IC50 was 2.8 mumol/L.

CONCLUSION

Tet inhibited inward rectifying potassium current in cultured bovine aortic endothelial cells.

Tumor necrosis factor-alpha modulates the proliferation of neural progenitors in the subventricular/ventricular zone of adult rat brain

Little is known about the response of neural progenitors to inflammation following injuries of the central nervous system. In combination with bromodeoxyuridine (BrdU) intraperitoneally (i.p.) injected, tumor necrosis factor-alpha (TNF-alpha), a proinflammatory cytokine that increased ED1+ activated microglia/macrophage population at injured sites, was administrated into adult rat brains. No difference in the immunostaining for proliferating cell nuclear antigen (PCNA) was observed in the subventricular/ventricular zone (SVZ/VZ) between TNF-alpha injected sites and controls. However, BrdU+ cells were apparently observed in the SVZ/VZ proximal to TNF-alpha injected site, and the number of BrdU+ cells increased at 6 and 24 h post injection. Since cell apoptosis was rarely found in the SVZ/VZ after TNF-alpha injection, these observations suggest that the diffusible TNF-alpha may directly and/or indirectly modulate the proliferation of neural progenitors.

Microstimulation-induced inhibition of neuronal firing in human globus pallidus

Neurosurgical treatment of Parkinson's disease (PD) frequently employs chronic high-frequency deep brain stimulation (DBS) within the internal segment of globus pallidus (GPi) and can very effectively reduce L-dopa-induced dyskinesias and bradykinesia, but the mechanisms are unknown. The present study examined the effects of microstimulation in GPi on the activity of neurons close to the stimulation site. Recordings were made from GPi using two fixed or independently controlled microelectrodes, with the electrode tips usually approximately 250 or >600 micrometer apart in PD patients undergoing stereotactic exploration to localize the optimal site for placement of a lesion or DBS electrode. The spontaneous activity of nearly all of the cells (22/23) recorded in GPi in three patients was inhibited by microstimulation at currents typically <10 microA (0.15-ms pulses at 5 Hz). The inhibition had a duration of 10-25 ms at threshold. These findings suggest that microstimulation within GPi preferentially excites the axon terminals of striatal and/or external pallidal neurons causing release of GABA and inhibition of GPi neurons.

Responses of microglia and neural progenitors to mechanical brain injury

Neural cells have distinct responses to CNS injury; however, neural progenitor response to CNS injury is not yet documented. Stab injury combined with injection of bromodeoxyuridine (BrdU), a thymidine analog, into adult rat cortex above the lateral ventricle for 10 min resulted in activated microglia/macrophage infiltration along with nuclear factor kappa B (NF kappa B)/p65 activation at the lesion site. Most NF kappa B/p65+ cells displayed a phagocytic morphology. Under these conditions, profound cell apoptosis took place in the injured corpus callosum, but not in the subventricular/ventricular zone (SVZ/VZ). The SVZ/VZ-derived neural progenitors in both injected and non-injected contralateral hemispheres showed strong BrdU immunostaining, indicating that SVZ/VZ-derived neural progenitors of both hemispheres may undergo DNA synthesis in response to unilateral brain injury.

Brainstem projections to the ventromedial medulla in cat: retrograde transport horseradish peroxidase and immunohistochemical studies

Stimulation of the nucleus magnocellularis (NMC) of the medulla produces changes in locomotion, muscle tone, heart rate, and blood pressure. Glutamatergic input has been found to modulate muscle tone, whereas cholinergic input has been found to mediate cardiovascular changes produced by stimulation of the NMC. The current study was designed to identify the brainstem afferents to NMC by using retrograde transport of wheat germ agglutinin and horseradish peroxidase (WGA-HRP) combined with glutamate and choline acetyltransferase (ChAT) immunohistochemical and nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) histochemical techniques. Fifty nanoliters of 2.5% WGA-HRP were microinjected into the NMC in the cat. A heavy density of WGA-HRP-labeled neurons was found in the ipsilateral mesencephalic reticular formation (MRF), periaqueductal gray, Kolliker-Fuse nucleus, and pontis centralis caudalis (PoC), in the contralateral pontis centralis oralis (PoO), and bilaterally in the nucleus paragigantocellularis lateralis. A moderate density of retrogradely labeled neurons was found in the ipsilateral side of the nuclei parvocellularis, retrorubral (RRN), PoO, and vestibular complex, in the contralateral PoC and nucleus gigantocellularis, and bilaterally in the inferior vestibular nucleus. Retrograde HRP/glutamate-positive cells could be found throughout the brainstem, with a high percentage in RRN, PoO, PoC, and MRF. Double-labeled WGA-HRP/ChAT neurons were found in the pedunculopontine nucleus. Double-labeled WGA-HRP/NADPH-d-positive neurons could be seen in many nuclei of the brainstem, although the number of labeled neurons was small. The dense glutamatergic projections to the NMC support the hypothesis that rostral brainstem glutamatergic mechanisms regulate muscle activity and locomotor coordination via the NMC, whereas the pontine cholinergic projections to the NMC participate in cardiovascular regulation.

Neurotoxic N-methyl-D-aspartate lesion of the ventral midbrain and mesopontine junction alters sleep-wake organization

The dorsal regions of the midbrain and pons have been found to participate in sleep regulation. However, the physiological role of the ventral brainstem in sleep regulation remains unclear. We used N-methyl-D-aspartate-induced lesions of the ventral midbrain and pons to address this question. Unlike dorsal mesencephalic reticular formation lesions, which produce somnolence and electroencephalogram synchronization, we found that ventral midbrain lesions produce insomnia and hyperactivity. Marked increases in waking and decreases in slow wave sleep stage 1 (S1), stage 2 (S2) and rapid eye movement sleep were found immediately after the lesion. Sleep gradually increased, but never returned to baseline levels (baseline/month 1 post-lesion: waking, 30.6 +/- 4.58%/62.3 +/- 10.1%; S1, 5.1 +/- 0.74/3.9 +/- 1.91%; S2, 46.2 +/- 4.74%/23.1 +/- 5.47%; rapid eye movement sleep, 14.1 +/- 3.15%/7.2 +/- 5.42%). These changes are comparable in magnitude to those seen after basal forebrain lesions. Neuronal degeneration was found in the ventral rostral pons and midbrain, including the substantia nigra, ventral tegmental area, retrorubral nucleus, and ventral mesencephalic and rostroventral pontine reticular formation. We conclude that nuclei within the ventral mesencephalon and rostroventral pons play an important role in sleep regulation.

Ferrous ion diminished the antiarrhythmic effect of naloxone in myocardial ischemia of isolated rat hearts

This investigation was to examine the effect of ferrous ion (a prooxidant) on the antiarrhythmic effect of naloxone (an endogenous opioid receptor antagonist) in isolated rat hearts. Isolated Sprague-Dawley rat hearts were perfused in the Langendorff mode and myocardial ischemia was performed by ligating the left descending coronary artery. Cardiac rhythm was recorded. Heart alpha-tocopherol concentrations were analyzed. Naloxone (1.2 micromol/heart) was effective in reducing the severity of arrhythmia (arrhythmia score; mean+/-S.E.M: 2.82+/-0.69 for naloxone vs. 5.18+/-0.38 for control, p<0.01). Fe2+ (100 nmol/heart) alone did not significantly affect the arrhythmia score (5.63+/-0.32) when compared with the control, however, Fe2+ administration did cause significant early onset of ventricular premature contraction and ventricular tachycardia. Additionally, Fe2+ administration diminished the naloxone's antiarrhythmic effect (arrhythmia score 4.12+/-0.40). Alpha-tocopherol, a major free radical scavenger that exerts protective functions on heart tissues during myocardial ischemia/reperfusion, was significantly higher in the naloxone-treated group (59.05+/-3.00 nmol/g wet wt) than in the control group (43.84+/-4.17 nmol/g wet wt, p<0.05). These results suggest that endogenous opioid peptides and reactive oxygen species might be related to ischemia-induced arrhythmia.

Quantitative study of Stewart-Holmes test

Stewart-Homes test (SHT) is an ordinary neurological test performed for the diagnosis for cerebellar disease. We developed a quantitative method based on SHT carried out on the upper limb. Nineteen cerebellar patients and fifteen volunteer healthy subjects were tested. During the test, acceleration of forearm and two associated surface EMGs over biceps and triceps brachialis were recorded and analyzed. (1) Acceleration curve showed an oscillating pattern with flexion and extension over the elbow in both groups, but in cerebellar patient group, the acceleration oscillation wave was more pronounced and latencies of peak acceleration were significantly longer. (2) Correspondingly, the EMGs timing parameters were also different between the two groups: in patient group, ceasing isometric biceps contraction was delayed; rebound EMGs bursts over both biceps and triceps were prolonged. (3) Modelization of the oscillation of acceleration curve with dampened oscillation model showed that in patient group the oscillating amplitude attenuated much more slowly than in control group. A standard curve was established for detecting the acceleration profile abnormalities of SHT in cerebellar patients.

Evaluation of extracellular lipid peroxidation in brain cortex of anaesthetized rats by microdialysis perfusion and high-performance liquid chromatography with fluorimetric detection

A method for in vivo evaluation of lipid peroxidation in the extracellular space of anaesthetized rat brain cortex was developed. This method involved the use of microdialysis perfusion and high-performance liquid chromatography. The microdialysates, eluted from implanted probes, were reacted with thiobarbituric acid (TBA) prior to analysis by an HPLC system equipped with a fluorescence detector (excitation and emission wavelengths were 515 and 550 nm, respectively). Lipid peroxidation in the extracellular space was evaluated as the concentration of malondialdehyde, a lipid peroxidation end product which reacts with TBA to form a fluorescent conjugate. Significantly increased production of malondialdehyde following hydrogen peroxide perfusion (0.03%, 0.3% at a flow-rate of 1 microl/min) was observed in the brain cortex of anaesthetized rats.

In vivo, continuous and automatic monitoring of extracellular ascorbic acid by microdialysis and on-line liquid chromatography

A system for in vivo, automatic, continuous monitoring of organ extracellular ascorbic acid in anesthetized rat is described. This system involves microdialysis perfusion and a LC system equipped with an electrochemical detector. Microdialysate, eluted from a microdialysis probe implanted in the brain cortex or in the left ventricular myocardium of anesthetized rats was collected in the sample loop of an on-line injector for direct injection onto the LC system. This automated method provides a shortened sample processing time. This system was utilized to investigate the effect of cerebral ischemia on cortex extracellular ascorbic acid and the effect of myocardial ischemia on left ventricular myocardium extracellular ascorbic acid in anesthetized rats. Basal ascorbic acid concentrations in the cortex and left ventricular myocardium ranged from 9.7 to 15.4 microM (mean +/- S.D., 12.7 +/- 2.5 microM from the results of eight rats) and from 9.3 to 36.0 microM (mean +/- S.D., 24.3 +/- 8.9 microM from the results of twelve rats), respectively. Cerebral ischemia significantly elevated ascorbic acid levels in the cortex extracellular space, while myocardial ischemia did not significantly alter ascorbic acid levels in the left ventricular myocardium extracellular space.