Trimester-specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta-analysis

BACKGROUND

This study aimed to assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second and third trimester ultrasound in pregnancies at risk for PAS.

METHODS

PubMed, Embase, and Web of Science, databases were searched to identify relevant studies published from inception until March 10th, 2023. Inclusion criteria were all studies, including cohort, case-control, or cross-sectional studies, that evaluated the diagnostic accuracy of first trimester ultrasound performed prior to 14 weeks (first trimester) or after 14 weeks of gestation (second/third trimester) for diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was to assess the diagnostic accuracy of ultrasound in detecting PAS in the first trimester, and to compare it with the accuracy of ultrasound in the second and third trimesters. The secondary outcome was to evaluate the diagnostic accuracy of each ultrasonographic marker individually across the trimesters of pregnancy. Reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and positive (LR+) and negative (LR-) likelihood ratios.

RESULTS

A total of 37 studies including 5,764 pregnancies at risk of PAS, with 1,348 cases of confirmed PAS, were included in our analysis. The meta-analysis yielded a sensitivity of 86% (95% CI: 78%, 92%) and specificity of 63% (95% CI: 55%, 70%) during the 1st trimester, while the sensitivity was 88% (95% CI: 84%, 91%) and specificity was 92% (95% CI: 85%, 96%) during the 2nd/3rd trimester. Regarding ultrasonographic markers examined in the 1st trimester, lower uterine hypervascularity exhibited the highest sensitivity of 97% (95% CI: 19%, 100%), and uterovesical interface irregularity demonstrated the highest specificity of 99% (95% CI: 96%, 100%). However, in the 2nd/3rd trimester, loss of clear zone had the highest sensitivity of 80% (95% CI: 72%, 86%), while uterovesical interface irregularity exhibited the highest specificity of 99% (95% CI: 97%, 100%).

CONCLUSION

First trimester ultrasound has similar accuracy to second and third trimester ultrasound for the diagnosis of PAS. Routine first trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management. This article is protected by copyright. All rights reserved.

A Framework for Pilot Testing Health Risk Video Narratives

Narrative messages may be superior to didactic messages when providing educational information due to their natural format for information sharing, ability to engage audiences, and engender positive thoughts about the message. Although narrative messages are gaining popularity in health promotion, little guidance exists regarding the development phase. Our team created a psychosocial narrative video intervention grounded in the Health Belief Model to increase breast cancer survivors' attendance at genetic counseling after treatment. Here we report the use of Learner Verification (LV) during an iterative video development process. Using LV, we conducted individual semi-structured interviews with patients and providers, after they viewed the video. Demographic information was analyzed using descriptive statistics, and verbatim interview transcripts were used to conduct a two-phase qualitative content analysis. Patient and provider participants (n = 30) believed the video was attractive, relatable, and informative, and they identified areas for improvement including narrative coherence, changes to text and graphical information, and including more specific information. LV framework elicited audience feedback on the video intervention relevant to theoretical principles of narrative interventions, and highlighted audience preferences. In this study, LV interviews tapped into theoretical constructs of narratives and facilitated the iterative intervention design process.

Comparison of penetrating and non-penetrating captive bolt in an alternative occipital approach in calves

The objective of this study was to describe the effect of penetrating or non-penetrating captive bolt using an occipital approach in 4–5 month old, Holstein steers weighing between 100–200 kg. Twelve calves were divided into two treatment groups; penetrating captive bolt (PCB; n = 6) and non-penetrating captive bolt (NPCB; n = 6). This sample size was chosen out of convenience and in conjunction with a separate study. Each calf was sedated with xylazine hydrochloride, then a captive-bolt device, outfitted with a standard penetrating bolt or a non-penetrating bolt, was placed flush on the dorsal midline of the cranium at the external occipital protuberance and aimed downward as though to intersect the intermandibular area. Following impact, indicators for loss of consciousness, such as respiration, righting response, corneal reflex, movement and vocalisation were recorded and characterised along with electrocardiogram and electroencephalogram recordings. After a 5-min observation period, all calves were administered potassium chloride. All calves experienced immediate and sustained loss of consciousness. The mean (± SEM) time to cessation of respiration was 60 (± 53.67) and 0 (± 0.0) s for PCB and NPCB, respectively. The mean time to cessation of convulsions was 310.4 (± 79.74) and 180.0 (± 60.24) s, respectively, and the mean number of convulsions was 2.75 (± 1.03) and 2.0 (± 0.837) for PCB and NPCB, respectively. Isoelectric EEG patterns were observed in 3/5 PCB and 3/4 NPCB with mean time to onset of isoelectric pattern in 69.0(± 52.24) and 113.5 (± 56.87) s. Both treatments induced a successful stun, which suggests these techniques are appropriate for humane euthanasia in calves of this age.

DIBI, a polymeric hydroxypyridinone iron chelator, reduces ocular inflammation in local and systemic endotoxin-induced uveitis

BACKGROUND/OBJECTIVE

Non-infectious uveitis is an inflammatory disease of the eye commonly treated by corticosteroids, though important side effects may result. A main mediator of inflammation are oxygen free radicals generated in iron-dependent pathways. As such, we investigated the efficacy of a novel iron chelator, DIBI, as an anti-inflammatory agent in local and systemic models of endotoxin induced uveitis (EIU).

METHODS

Firstly, the effects of DIBI in systemic EIU in Lewis rats were established. 2 hours post intravenous LPS or LPS/DIBI injections, leukocyte activation and functional capillary density (FCD) were examined using intravital microscopy (IVM) of the iridial microcirculation. Secondly, the toxicity of DIBI was evaluated in BALB/C mice for both acute and chronic dosages through gross ocular examination, intraocular pressure measurements and hematoxylin-eosin staining of ocular tissue. Lastly, three groups of BALB/C mice, control, LPS or DIBI + LPS, were studied to evaluate the effectiveness of DIBI in treating local EIU. Five hours post-local intravitreal (i.v) injection, leukocyte activation and capillary density were examined via IVM.

RESULTS

Treatment of systemic EIU with DIBI resulted in a reduction of leukocyte activation and FCD improvement within the iridial microcirculation. Toxicity studies suggested that acute and chronic DIBI administration had no adverse effects in the eye. In the local EIU model, DIBI was shown to reduce leukocyte activation and restored the FCD/DCD ratio, providing evidence for its anti-inflammatory properties.

CONCLUSIONS

Our study has provided evidence that DIBI has anti-inflammatory effects in experimental uveitis. Additionally, no local ocular toxicity was observed.

Voice emotion perception and production in cochlear implant users

Voice emotion is a fundamental component of human social interaction and social development. Unfortunately, cochlear implant users are often forced to interface with highly degraded prosodic cues as a result of device constraints in extraction, processing, and transmission. As such, individuals with cochlear implants frequently demonstrate significant difficulty in recognizing voice emotions in comparison to their normal hearing counterparts. Cochlear implant-mediated perception and production of voice emotion is an important but relatively understudied area of research. However, a rich understanding of the voice emotion auditory processing offers opportunities to improve upon CI biomedical design and to develop training programs benefiting CI performance. In this review, we will address the issues, current literature, and future directions for improved voice emotion processing in cochlear implant users.

Panel-based testing for inherited colorectal cancer: a descriptive study of clinical testing performed by a US laboratory

Next-generation sequencing enables testing for multiple genes simultaneously (‘panel-based testing’) as opposed to sequential testing for one inherited condition at a time (‘syndrome-based testing’). This study presents results from patients who underwent hereditary colorectal cancer (CRC) panel-based testing (‘ColoNext™’). De-identified data from a clinical testing laboratory were used to calculate (1) frequencies for patient demographic, clinical, and family history variables and (2) rates of pathogenic mutations and variants of uncertain significance (VUS). The proportion of individuals with a pathogenic mutation who met national syndrome-based testing criteria was also determined. Of 586 patients, a pathogenic mutation was identified in 10.4%, while 20.1% had at least one VUS. After removing eight patients with CHEK2 mutations and 11 MUTYH heterozygotes, the percentage of patients with ‘actionable’ mutations that would clearly alter cancer screening recommendations per national guidelines decreased to 7.2%. Of 42 patients with an ‘actionable’ result, 30 (71%) clearly met established syndrome-based testing guidelines. This descriptive study is among the first to report on a large clinical series of patients undergoing panel-based testing for inherited CRC. Results are discussed in the context of benefits and concerns that have been raised about panel-based testing implementation.

Conflict of interest

Cristi Radford and Jill Dolinsky are full-time employees for the commercial laboratory Ambry Genetics, which performs ColoNext™ testing. Elizabeth Chao is a paid consultant for Ambry. Deborah Cragun, Meghan Caldwell, and Tuya Pal report no potential conflicts of interest. Specifically, they are not employed by Ambry, and they did not receive any financial or other incentives from Ambry.

Efficacy of moxidectin against cyathostomins after long-term use in a large herd of draught horses with a high stocking density

This study was undertaken to determine whether resistance to moxidectin had developed in a large herd of draught horses, maintained on a small acreage, which had been routinely treated with moxidectin for five years. Faeces were collected for egg counts immediately before moxidectin gel was administered orally, and seven, 30, 60 and 90 days later. The faecal egg counts were significantly reduced at seven and 30 days after treatment, but were not significantly different from pretreatment counts at 60 and 90 days after treatment. There was no evidence of resistance having developed.

Anatomical perspectives on adult neural stem cells

The concept of stem cells within the adult brain is not new. However, only recently have scientific techniques become sufficiently advanced to identify them although this remains problematic and the technology is still developing. Nevertheless, it is now generally recognized that stem cells are restricted to two germinal regions within the intact brain. From here they can migrate to specific destinations where they integrate with existing circuitry. Their identity remains controversial but a growing body of evidence suggests it may have an astrocytic phenotype. Within the germinal regions the stem cells are confined to a niche environment and are capable of responding to environmental signals generated locally in an autocrine or paracrine fashion. The niche environment is also modulated by more generalized systemic and physiological activity. These observations are exciting in their own right and form the basis of this review. They are also beginning to alter how we think about neural injury and disease and to impact on the development of novel therapies.

Stump appendicitis: a rare but important entity

A case of right lower quadrant pain in a 35-year-old male who underwent an appendicectomy 14 years previously is presented. Recurrent appendicitis with perforation was noted in an appendiceal stump on exploratory laparotomy. Although rare, inlammation of the appendiceal stump can occur and is still an important clinical entity. It is difficult to diagnose pre-operatively. A wide spectrum of causes in the differential diagnosis of right lower quadrant pain of the abdomen and a previous appendicectomy in a patient's history may delay the diagnosis. Knowledge of the condition should permit the physician to make an early diagnosis and, thus, limit the resultant morbidity.

Pneumococcal immunizations at flu clinics: the impact of community-wide outreach

This study examined the effectiveness of a community-wide outreach campaign to promote the use of pneumococcal vaccine at public flu immunization clinics, and assessed whether this intervention was more effective than simply making pneumococcal vaccination available at such clinics. In 1997, a community-wide outreach campaign promoting pneumococcal and influenza immunizations was launched in a 17 zip code area of Dutchess County, NY. The campaign was aimed at 7,961 Medicare beneficiaries urging them to obtain pneumococcal immunization from local flu clinics. Medicare reimbursement data were used to assess the countywide pneumococcal vaccination rate, and to analyze differences between rates for beneficiaries in the target area and elsewhere in the county. Between 1996 and 1997 there was a 94% increase in pneumococcal vaccination billed to Medicare beneficiaries in Dutchess County. The 1997 annual rate of pneumococcal immunization in the target area reached 16.3% versus 12.2% elsewhere in the county (p < 0.001), with an increase over the previous year of 8.7% and 5.6%, respectively. Nearly all of the increase is accounted for by pneumococcal vaccination delivered at flu clinics. It is possible to significantly increase the use of pneumococcal immunization by linking its delivery to community-based flu clinics and by developing local outreach strategies. The outreach campaign has a significant additive effect over simply making PPV available at flu shot clinics. Additional community-wide outreach can further improve pneumococcal immunization utilization rates.

The major components of human energy balance during chronic beta-adrenergic blockade

PURPOSE

The authors compare the major components of energy balance--dietary food intake, resting metabolic rate, and physical energy expenditure--in patients receiving beta-blocking medications and healthy controls.

METHODS

The authors recruited subjects who were receiving beta-blocking agents (n = 22) from local hospitals and clinics. Twenty-two healthy controls were matched to each patient based on age, weight, and gender. Resting metabolic rates were determined using indirect calorimetry. Three-day dietary intakes and physical activity assessments were analyzed.

RESULTS

There were no between-group differences in calories ingested or self-reported physical activity patterns. However, resting metabolic rates were lower in the beta-blocked subjects (beta-blocked = 1,541 +/- 464 kcals/day; controls = 1,817 +/- 426 kcals/day; P < 0.05).

CONCLUSIONS

beta-adrenergic blockade causes a reduction in resting metabolic rate. Therefore, beta-blocked individuals should increase physical activity, decrease dietary intake, or both to maintain daily energy balance and prevent weight gain that accompanies a reduction in metabolic rate.

Murine phospholipid hydroperoxide glutathione peroxidase: cDNA sequence, tissue expression, and mapping

Phospholipid hydroperoxide glutathione peroxidase (PHGPx), also known as glutathione peroxidase 4 (GPX4), is a 19-kDa, monomeric enzyme that protects cells from lipid peroxide-mediated damage by catalyzing the reduction of lipid peroxides. PHGPx is synthesized in two forms, as a 194-amino acid peptide that predominates in gonadal tissue and localizes to mitochondria, and as a 170-amino acid protein that predominates in most somatic tissues and localizes to the cytoplasm. With the rapid amplification of cDNA ends (RACE) procedure, an 876-bp PHGPx cDNA was amplified from mouse testis, and a 767-bp PHGPx cDNA was amplified from mouse heart. The cDNA sequences were identical except that the testis cDNA contained an additional 109 bp at its 5' end. With a partial cDNA with complete homology to both the testis and myocardial PHGPx cDNAs, the murine tissue distribution of PHGPx mRNA expression was determined by Northern blotting. Highest level of PHGPx expression was found in the testis, followed by the kidney, heart and skeletal muscle, liver, brain, lung, and spleen. Northern blotting performed with a cDNA specific for the longer PHGPx transcript demonstrated that this longer PHGPx transcript was present only in the testis. A 1.4-kb PHGPx genomic fragment was amplified from murine kidney DNA and used to map the PHGPx gene by linkage analysis of restriction fragment length variants (RFLVs). The murine PHGPx gene (Gpx4) was mapped to a region of murine Chromosome (Chr) 10, located 43 cM from the centromere, that is syntenic with the human locus, which is located at the terminus of the short arm of human Chr 19. This information may be valuable in characterizing the role of PHGPx in modulating susceptibility to lipid peroxide-mediated injury in inbred murine strains and for targeted disruption of the gene.

Long-term functional status and quality of life after lower extremity revascularization

OBJECTIVE

The objective of this study was to assess the longer term (up to 7 years) functional status and quality of life outcomes from lower extremity revascularization.

METHODS

This study was designed as a cross-sectional telephone survey and chart review at the University of Minnesota Hospital. The subjects were patients who underwent their first lower extremity revascularization procedure or a primary amputation for vascular disease between January 1, 1989, and January 31, 1995, who had granted consent or had died. The main outcome measures were ability to walk, SF-36 physical function, SF-12, subsequent amputation, and death.

RESULTS

The medical records for all 329 subjects were reviewed after the qualifying procedures for details of the primary procedure (62.6% arterial bypass graft, 36.8% angioplasty, 0.6% atherectomy), comorbidities (64% diabetics), severity of disease, and other vascular risk factors. All 166 patients who were living were surveyed by telephone between June and August 1996. At 7 years after the qualifying procedure, 73% of the patients who were alive still had the qualifying limb, although 63% of the patients had died. Overall, at the time of the follow-up examination (1 to 7.5 years after the qualifying procedure), 65% of the patients who were living were able to walk independently and 43% had little or no limitation in walking several blocks. In a multiple regression model, patients with diabetes and patients who were older were less likely to be able to walk at follow-up examination and had a worse functional status on the SF-36 and a lower physical health on the SF-12. Number of years since the procedure was not a predictor in any of the analyses.

CONCLUSION

Although the long-term mortality rate is high in the population that undergoes lower limb revascularization, the survivors are likely to retain their limb over time and have good functional status.

Mouse glycosylphosphatidylinositol-specific phospholipase D (Gpld1) characterization

Glycosylphosphatidylinositol-specific phospholipase D (GPI-PLD) is an 110-kDa monomeric protein found in the circulation that is capable of degrading the GPI anchor utilized by dozens of cell-surface proteins in the presence of detergent. This protein is relatively abundant (5-10 microgram/ml in human serum), yet its sites of synthesis, gene structure, and overall function are unclear. It is our purpose to use the mouse system to determine its putative roles in lipid transport, pathogen control, and diabetes. We have isolated murine full-length cDNA for GPI-PLD from a pancreatic alpha cell library. The deduced amino acid sequence shows 74% homology to bovine and human GPI-PLD. There is a single structural gene (Gpld1) mapping to mouse Chromosome (Chr) 13, and among nine tissues, liver showed the greatest abundance of GPI-PLD mRNA. Genetic differences in serum GPI-PLD activity were seen among four mouse strains, and no correlation was seen between GPI-PLD activity and circulating levels of high density lipoproteins in these mice. This is the first report of map position and genetic regulation for Gpld1. This information will enable us to further study the expression and function of GPI-PLD in normal and pathological conditions.

Weight training increases fat-free mass and strength in untrained young women

OBJECTIVE

To examine the effects of a weight training program on the resting metabolic rate, fat-free mass, strength, and dietary intake of untrained young women.

DESIGN

A 12-week weight training program was completed by 20 previously untrained women aged 19 through 44 years.

SUBJECTS

Twenty-three study subjects and 14 control subjects were recruited on a volunteer basis. Twenty study subjects and 10 control subjects completed the study.

INTERVENTIONS

Study subjects participated in a 12-week moderate-intensity, progressive resistance weight training program consisting of 2 supervised sessions per week with 6 types of lifting exercises per session. Resting metabolic rate, fat-free mass, strength, and dietary intake were measured before and immediately after the study.

STATISTICAL ANALYSES

Repeated measures analysis of variance and t tests (unequal variance and paired) were used to determine interaction effects and differences within and between groups.

RESULTS

The study group increased their fat-free mass (mean+/-standard deviation) from 44.2+/-5.4 kg to 46.2+/-6.0 kg (P<.001). Elbow flexion, elbow extension, and knee flexion strength all increased from 28.9+/-5.3 to 34.5+/-3.8, 16.9+/-4.9 to 22.1+/-5.3, and 39.5+/-8.6 to 48.6+/-7.3 ft-lb, respectively (P<.001). Percent body fat decreased from 29.8+/-2.8 to 27.2+/-2.6 (P<.001) without a significant change in body weight. Resting metabolic rate did not change significantly (P>.05).

APPLICATION

A moderate-intensity weight training program increased strength and fat-free mass and decreased body fat in normal-weight young women. Favorable changes in body composition were obtained without restricting food intake. The increase in fat-free mass did not increase resting metabolic rate significantly.

Susceptibility of pollen to UV-B radiation: an assay of 34 taxa

Much of the ultraviolet-B radiation (UV-B) research on plants has concentrated on vegetative plant parts, and only a small fraction has dealt with the reproductive system. The present study analyzed pollen grains of 34 taxa germinated and grown under two levels of UV-B radiation (187 and 460 mW/m2) or no UV-B (control group). Visible radiation at 260 mmol/m/s was present in all treatments. Taxa included those with binucleate and trinucleate pollen types. We detected differences among species. A significant reduction in pollen germination occurred in only five species. Pollen tubes of >50% of the species showed significant reduction in length. Trinucleate pollen types were more likely to exhibit tube length reduction than the binucleate types. Proportionately more monocotyledonous species were sensitive to UV-B treatment than dicotyledonous species, and proportionately more wild species were sensitive than cultivated species and pollen collected from plants growing in the field were somewhat more sensitive than pollen collected from plants grown in the greenhouse. Species in which pollination occurred earlier in the season were more likely to be susceptible to UV-B radiation than those for which anthesis took place later in the season, suggesting a possible adaptation to UV-B radiation.

Swimming-associated haemorrhagic colitis due to Escherichia coli O157:H7 infection: evidence of prolonged contamination of a fresh water lake

We describe an Escherichia coli O157:H7 outbreak associated with a fresh water lake at a county park. Campers were surveyed for diarrhoeal illness within 10 days of their visit, and a case-control study of day visitors was conducted. A confirmed case was a symptomatic person with a stool culture positive for E. coli O157:H7 and a probable case was a person with bloody diarrhoea. Clinical isolates of E. coli O157 were subtyped by pulsed field gel electrophoresis (PFGE). In the camper survey, 12 (38%) of 32 swimmers had a diarrhoeal illness (relative risk [RR] = 12.4; 95% confidence interval [CI] = 1.7-89.7). For the case-control study, the 12 cases were more likely than controls to have purposefully ingested lake water (odds ratio [OR] = 6.9, 95% CI = 0.9-55.8). The PFGE patterns of six clinical isolates were indistinguishable. This report further demonstrates that contaminated fresh-water lakes can be the source of community outbreaks of E. coli O157:H7.

The effects of MK-801, ifenprodil, JO 1784, JO 1994 and JO 1997 on PK 11195 receptor binding, nitric oxide synthase (NO synthase) activity and infarct volume in a mouse model of focal cerebral ischaemia

Middle cerebral artery occlusion (MCAO) is a widely used surgical procedure for inducing focal cortical ischaemia in mice. In the present study, all experiments were performed on 4-week-old, male Swiss mice (OF-1 Iffa Credo, France), 20-25 g at the time of surgery. Sham-operated mice were subjected to simple exposure of the middle cerebral artery. Mice were injected with either MK-801, ifenprodil, JO 1784, JO 1994 or JO 1997 at the following time points after surgery; 5, 15, 45 min and 3, 6, 24, 30, 48 and 54 h. Mice were sacrificed 72 h after surgery and both ipsilateral and contralateral cortices were dissected in their entirety, weighed, and assayed for [3H]PK 11195 binding while the brain-stem and cerebellum were assayed for nitric oxide synthase (NO synthase) activity. In a separate experiment the area of ischaemic damage was determined planimetrically by means of an image analysis system. Coagulation of the middle cerebral artery induced a marked enhancement of the ipsilateral cortical omega 3 peripheral-type benzodiazepine binding site (PTBB'S) densities, an increase in NO synthase activity in the brain-stem and cerebellum, and an increase in the cortical infarct area. MK-801, ifenprodil, JO 1784, JO 1994 and JO 1997 demonstrated comparable neuroprotective effects on all three indices of cortical damage. A down-regulation of cortical omega 3 peripheral-type benzodiazepine binding site (PTBB'S) densities and a decrease in NOS activity occurred following pharmacological intervention. In contrast to JO 1784, JO 1994 and JO 1997 have a bimodal effect on omega 3 PTBB'S densities.

NG-nitro-L-arginine methyl ester protects against lipid peroxidation in the gerbil following cerebral ischaemia

The aim of this study was to assess the role of nitric oxide (NO) in lipid peroxidation following 5 min of bilateral carotid occlusion in the Mongolian gerbil. The study consisted of 4 experimental groups (n = 10). Animals were either sham operated, subjected to bilateral carotid occlusion or administered the NO synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) (10 mg/kg i.p.) 30 min, 6, 24 and 48 h following sham operation or 5 min bilateral carotid occlusion. Animals were killed 96 h post surgery and changes in the concentrations of malonaldehyde and 4 hydroxyalkenals (the main decomposition products of peroxides derived from polyunsaturated fatty acids and related esters) were measured in the hippocampus and cortex using the LPO-586 colorimetric method. The results showed a significant increase in the concentrations of both decomposition products following 5 min of bilateral carotid occlusion. L-NAME administered to sham operated controls had no effect, but in those animals subjected to 5 min of bilateral carotid occlusion L-NAME significantly decreased the levels of both decomposition products. These results suggest that inhibition of NO synthase activity decreases lipid peroxidation in the gerbil model of cerebral ischaemia.

The sigma receptor ligand JO 1784 (igmesine hydrochloride) is neuroprotective in the gerbil model of global cerebral ischaemia

To assess the effects of the novel sigma receptor ligand JO 1784 ((+)-N-cyclopropyl-methyl-N-methyl-1,4-diphenyl-1-yl-but-3-en-1-ylami ne, hydrochloride or igmesine hydrochloride) on behavioural and histological changes following cerebral ischaemia, the gerbil model of cerebral ischaemia was used. Two experiments were carried out. In the first animals were either sham operated, subjected to 5 min of bilateral carotid occlusion or administered JO 1784 (25, 50, 75 or 100 mg/kg p.o.) 1, 24 and 48 h after 5 min bilateral carotid occlusion and histological evaluation carried out 96 h after surgery. In the second experiment the effects of JO 1784 administered at a dose of 100 mg/kg i.p. 30 min, 6, 24 and 48 h post-surgery on home cage activity and nitric oxide (NO) synthase activity in the cortex, hippocampus, cerebellum and brain stem 4 days after surgery was examined. Extensive neuronal death was observed in the CA1 region of 5 min occluded animals. JO 1784 (50, 75 and 100 mg/kg) provided significant protection against this ischaemia-induced cell death (P < 0.03-0.005). In the second experiment a large increase in home cage activity was observed for 5 min occluded animals for 12 h after surgery (P = 0.0018-0.02). A large increase in NO synthase activity was observed in all brain regions for 5 min occluded animals. Post-administration of JO 1784 attenuated the ischaemia-induced hyperactivity and increased NO synthase activities.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of 2-amino-3-phosphonopropionic acid (AP-3) in the gerbil model of cerebral ischaemia

The effect of 2-amino-3-phosphonopropionate (AP-3), a metabotropic glutamate receptor antagonist on behavioral and histological changes following global ischaemia was investigated on the Mongolian gerbil. Ischaemia was induced by bilateral carotid occlusion for 5 min. AP-3 was administered i.p. (25 or 250 mg/kg) 30 min before and 24 h after surgery. Significant neuroprotection was observed 96 h after surgery to cells in the CA1 region of the hippocampus in drug treated animals. AP-3 (250 mg/kg) significantly attenuated the increase in locomotor activity measured 72 h after surgery. These results suggest that metabotropic glutamate receptors play a role in the neurodegeneration seen following ischaemia.

NG-Nitro-L-arginine protects against ischaemia-induced increases in nitric oxide and hippocampal neuro-degeneration in the gerbil

To assess the effects of the nitric oxide synthase inhibitor NG-Nitro-L-arginine on behavioural, biochemical and histological changes following global ischaemia, the Mongolian gerbil was used. Ischaemia was induced by bilateral carotid occlusion for 5 min. NG-Nitro-L-arginine was administered i.p. at either 1 or 10 mg/kg 30 min, 6, 24, and 48 h after surgery. 5 min bilateral carotid occluded animals were hyperactive 24, 48 and 72 h after surgery. NG-Nitro-L-arginine caused some attenuation in this hyperactivity. The activity of nitric oxide synthase was increased in the cerebellum, brain stem, striatum, cerebral cortex and hippocampus of 5 min bilateral carotid occluded animals. NG-Nitro-L-arginine reversed the increase in nitric oxide synthase activity in all brain regions. Extensive neuronal death was observed in the CA1 layer of the hippocampus in 5 min bilateral carotid occluded animals 96 h after surgery. NG-Nitro-L-arginine significantly protected against the neuronal death of cells in the CA1 layer.

Blunt injury augments interleukin-6 but not tumor necrosis factor in isolated, perfused rat hindlimbs

An isolated, perfused hindlimb model in rats was used to examine the immediate inflammatory response after blunt tissue injury. A femur-fracture degloving model was used in isolated rat hindlimbs perfused with a modified Kreb's buffer (pH 7.4) containing albumin, washed human red blood cells (RBCs), amino acids, and glucose at 37 degrees C. Arterial and venous perfusate was sampled at 5, 20, and 80 minutes of perfusion. Initial experiments were conducted in perfusate void of white blood cells (WBCs), group 1 (-inj/-WBC, n = 6) and group 2 (+inj/-WBC). Subsequent experiments were conducted in perfusate containing activated WBCs, group 3 (-inj/+WBC, n = 6) and group 4 (+inj/+WBC, n = 7). Hindlimb muscle was analyzed for adenylate energy charge (EC) and lactate-to-pyruvate ratios (LPR) at the end of each perfusion. This preparation appeared metabolically stable in that oxygen consumption and lactate remained stable during the 80-minute perfusion and muscle EC and LPR indicated aerobic metabolism. Tumor necrosis factor (TNF) and thromboxane B2 (TXB2) were measured in all four groups while prostaglandin F (PGF1 alpha), IL-6, myeloperoxidase, and 8-isoprostane were measured in groups 3 and 4. Initial perfusions in the -WBC hindlimbs indicated no change in TNF release after injury. The TXB2 level increased during perfusion irrespective of injury. The PGF1 alpha was elevated at 80 minutes in both groups 3 and 4, however at 20 minutes PGF1 alpha levels were higher in group 4 compared with group 3. Interestingly, the IL-6 level was significantly elevated at 80 minutes in group 4 but not in group 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation by nutritional status of lipids and apolipoproteins A-I, A-II, and A-IV in inbred mice

This study illustrates that genetic strain and feeding status can markedly influence tissue lipid concentrations and mRNA levels of apolipoprotein genes. C57BL/6 and BALB/c mice were maintained for 2 weeks on four test diets differing in amount of cholesterol and type of fat, and fasted for 4 h or 16 h prior to collection of tissues. For both strains, the primary effect of fasting from 4 h to 16 h was to paradoxically elevate triglyceride levels in plasma and liver, and to elevate hepatic apoA-IV mRNA levels. Triglyceride secretion rates, estimated after the injection of Triton WR-1339, suggested that elevations in plasma triglyceride levels were due to reduced clearance of very low density lipoproteins. Although plasma glucose levels decreased with fasting time for both strains, insulin levels decreased for BALB/c but not C57BL/6 mice regardless of diet. This suggests that factors thought to be mediated by insulin, (e.g., plasma free fatty acid concentrations; hepatic apoA-IV mRNA levels) may be influenced by local changes in insulin sensitivity, which are controlled genetically and are not reflected by plasma insulin levels. In summary, nutritional status influences a constellation of factors involved in lipid transport that also show strong genetic components and may influence subsequent analyses of gene expression in the mouse system.

Anesthetic care during thiopental tests to evaluate epileptic patients for surgical therapy

A thiopental test 2 weeks after insertion of intracranial electrodes may be used to evaluate patients with refractory epilepsy for surgical therapy. Barbiturates normally produce beta activity on the electroencephalogram. The absence of this response in a monitored brain region implies focal cerebral dysfunction. We describe a technique used to perform this test and the resultant morbidity. The thiopental test consists of intravenous injection of thiopental, 25 mg, every 30 s until either corneal reflexes are abolished, 1,000 mg of thiopental has been administered, or adverse events occur. In children, the dose is adjusted to approximately 0.3 mg/kg of thiopental every 20 s. A retrospective chart review was performed on 104 patients who underwent thiopental tests at the University of Pittsburgh Epilepsy Center. Records were systematically reviewed for thiopental dose, mean arterial blood pressure, heart rate, oxygen saturation in arterial blood, time to responsivity, need for airway intervention, and occurrence of nausea or vomiting. Thirty-six patients developed upper airway obstruction which required jaw lift maneuver, six patients were given 1,000 mg of thiopental without loss of corneal reflexes, and one patient briefly sustained an arterial saturation of 67%. Five patients exhibited electrographic seizures with clinical seizures evident in two patients. No permanent effects were evident in any patient as a consequence of the test. We conclude, with appropriate monitoring and personnel, that the thiopental test, as described, can be performed safely with acceptable morbidity.

Clinical indicators for oncology, cardiovascular, and surgical patients: report of the ADA Council on Practice Quality Assurance Committee

Clinical indicators were developed as an ADA project for use by the membership and the Joint Commission on Accreditation of Healthcare Organizations as part of its Agenda for Change. This 3-year project involved three clinical indicator task forces who developed clinical indicators for oncology, cardiovascular, and surgical adult acute-care setting patient populations. The task forces developed clinical indicators that were revised after an extensive field review and validation by field test. The following indicators were recommended: Cardiovascular--Patients at high risk for impaired nutritional status receive nutrition intervention within 5 days of admission or within consecutive 5 days on clear liquid diet/nothing by mouth; Patients make food choices consistent with therapeutic diet. Oncology--No patient is on clear-liquid diet/nothing by mouth without nutrition support for more than 5 days; All patients at moderate or high risk are identified by screening and assessed within 72 hours of admission; Patients at moderate or high risk are able to implement nutrition care plan at discharge. Surgery--No patient is on clear-liquid diet/nothing by mouth without nutrition support for more than 7 days; No patient has weight loss greater than 10% of admission weight at discharge; calorie and protein and/or volume goals for patients on enteral or parenteral nutrition are documented in the medical record; Patients on enteral or parenteral nutrition receive at least 1,000 kcal/day by the fourth day after an operation.

Three-year follow-up of Pawtucket Heart Health's community-based weight loss programs

PURPOSE

The purpose of the study was to evaluate the effectiveness of a community-based weight loss program.

DESIGN

A questionnaire was administered by telephone to subjects one to three years following participation in a weight loss program.

SETTING

The study took place in Pawtucket, Rhode Island. The Pawtucket Heart Health Program is part of this setting.

SUBJECTS

A stratified sample of 400 subjects was randomly selected from 2,186 people who participated in weight loss programs between 1985 and 1987. A total of 285 subjects completed the questionnaire; 229 subjects provided sufficient information to be included in the study.

INTERVENTION

The subjects participated in community-based and worksite-based weight loss programs.

MEASURES

Self-reported heights and weights before and after intervention and demographic data were collected. Desirable body weight and Garrow's health risk classifications were calculated.

RESULTS

Overall, there was a 3.2% reduction in body weight between time of entrance into weight loss programs and time of interview. Eighty percent of the participants lost weight in the program; mean weight loss was 11 pounds. At time of follow-up interview one to three years later, 65% of subjects weighed less than at entrance into the community programs; on average, subjects weighed six pounds less. Sixty-nine percent of the sample was above 20% desirable body weight at entrance and 26% of this group lost enough weight to lower their health risk category.

CONCLUSIONS

Weight loss in this community-based program compares favorably with those reported by more intense and expensive clinic-bound programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Self-reported and measured weights and heights of participants in community-based weight loss programs

Self-reported weights and heights of 82 adults were compared with measured weights and heights 1 to 3 years after participation in community weight loss programs. The mean self-reported weight was 2.3 +/- 1.9 kg lower than measured weight (P < .05). Differences in underreporting were not significant for gender or age group. Heavier individuals misreported their weight to a greater extent (P < .05) than lighter persons, and individuals who had not recently weighed themselves underreported their weight to a greater extent than those who had weighed recently (P < .05). On the average, height was overreported by a mean of 1.8 +/- 2.7 cm. Overreporting increased with increasing height, and men overestimated their height to a greater extent than women (P < .05). Younger subjects reported their height more accurately than those older than 60 years. Results of our study are similar to those of previous investigations that examined self-reporting bias in subjects enrolled in weight loss programs. The mean discrepancy in body weight, however, was greater than that reported in samples drawn from the general population. Our findings indicate that self-reported weight and height values in overweight populations should be interpreted with caution.

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Riboflavin status of nutritionally supported multiple-trauma accident patients

This study evaluates riboflavin status of multiple-trauma accident patients receiving nutritional support. Riboflavin excretion, erythrocyte glutathione reductase (EGR-AC), erythrocyte riboflavin (ERC-B2), nitrogen balance and riboflavin, and nitrogen and energy intake were assessed periodically throughout the study. Mean intakes of nitrogen, energy, and riboflavin were less than recommended. All patients but one were in negative nitrogen balance; however, patients retained riboflavin except when nitrogen and energy intakes were very low. EGR-AC values were within normal range and did not reflect changes in riboflavin retention. ERC-B2 values were also within normal range but decreased over time in patients with the largest riboflavin excretion and most negative nitrogen balance. ERC-B2 in combination with riboflavin intake and excretion data may offer a suitable method for assessing riboflavin status in multiple-trauma patients.