Age-related effects on the modulation of gut microbiota by pectins and their derivatives: an in vitro study

Introduction

The present study investigates whether supplementation with pectin-type polysaccharides has potential to improve aging-associated dysbiosis of the gut microbiota. The influence of different types of pectins on the gut microbiota composition and short-chain fatty acids (SCFAs) profiles of elderly was compared to younger adults.

Methods

Pectins studied included a pectin polysaccharide (PEC), a partially hydrolyzed pectin (PPH), and a pectin oligosaccharide (POS). Additionally, inulin was used as a reference prebiotic substrate. Individual fecal samples were collected from healthy elderly volunteers (70-75 years) and younger adults (30-35 years). In vitro fermentations were performed using the CoMiniGut model with controlled temperature and pH. Samples were withdrawn at baseline and after 24 h fermentation for measurement of SCFAs production and microbiota composition by 16S rRNA gene sequencing.

Results and Discussion

The results showed that fermentations with PEC and PPH resulted in a specific stimulation of Faecalibacterium prausnitzii regardless of the age groups. Collinsella aerofaciens became a dominating species in the young adult group with fermentations of all three pectins, which was not observed in the elderly group. No significant differences in SCFAs production were found among the pectins, indicating a high level of functional redundancy. Pectins boosted various bacterial groups differently from the reference prebiotic substrate (inulin). We also found inulin had reduced butyrogenic and bifidogenic effects in the elderly group compared to the younger adult group. In conclusion, the in vitro modulating effects of pectins on elderly gut microbiota showed potential of using pectins to improve age-related dysbiosis.

New opportunities for nurses in medical education: facilitating valuable community learning experiences

A new 4 week community programme, developed through a successful Department of Health Bid in partnership with the Community NHS Trust, provides a vital clinical learning block for all medical students at the Leicester/Warwick Medical school. The course owes its success to the pivotal role played by nurses. Working with an Academic co-ordinator the course was operationalised in the county's market towns and provided student access to the work of the entire front line community workforce in the care of people with life limiting diseases and disabled people. Senior nurses in each locality led the work with both community hospital and community nurses sharing their expertise with a wide range of front line health and social care professionals. The lead nurses and their teaching teams attended university training days prior to developing a locality student programme and played a key role in identifying preparing and supporting suitable patients for student learning. Students highly praised the work of the lead nurses who supported their learning throughout the course. All nurses felt the educational involvement was worthwhile, having overcome identified barriers and with funding support nurses have been able to assimilate the teaching into their annual workload.

Effect of parental smoking on cotinine levels in newborns

BACKGROUND

Smoking is a major risk factor for cot death. Many infants smoke passively as a result of parental smoking. This paper reports on infants exposed to a smoking environment and how they accumulate metabolites of cigarette smoke, such as cotinine, which may be physiologically harmful.

AIM

To assess cotinine levels in infants of smoking parents.

METHOD

Cotinine excretion in urine was assessed in 104 infants, of whom 71 had smoking parents and 33 had non-smoking parents. All cotinine levels were measured at approximately 12 weeks of age. The subjects were selected from a database of infants in developmental physiological studies which assessed the impact of various factors on early postnatal development.

RESULTS

On average babies with at least one parent who was a current cigarette smoker excreted 5.58 (95% CI 3.4 to 9.5) times as much cotinine in the urine as did the babies of non-smoking parents. Maternal smoking was the largest contributing factor. Co-sleeping (p = 0.037) and the minimum room temperature (p = 0.028) were significant contributory factors.

CONCLUSION

Infants from smoking households accumulate cotinine, a metabolite of nicotine, which may have a detrimental effect on the cardiorespiratory system.

Distinguishing between natural and aquaculture-derived sediment concentrations of heavy metals in the Broughton Archipelago, British Columbia

Marine sediment samples were collected in the Broughton Archipelago, British Columbia, to assess the use of a geochemical normalization technique in the identification of a chemical tracer of aquaculture waste material. Zinc and copper were suggested as tracers of feed pellets, while copper was considered an indicator of anti-foulant agents used on netpen systems. The sediment samples were analyzed for carbon, nitrogen, organic matter, water, trace-element, and free sulfide concentrations, and sediment grain-size distribution. Sediment texture analysis revealed a wide range of substrate types from sand to silty loam categories. Strong relationships between sediment texture, sediment porosity, and organic content were observed across both near-field and far-field stations. Excess zinc and copper sediment concentrations, identified using a lithium-normalization technique, were restricted to near-field sampling stations (0 and 30m from netpen systems). The relationships between these metal tracers and organic content and sulfur concentrations were explored to account for variations in sediment concentrations of zinc and copper.

The use of meiofauna as an indicator of benthic organic enrichment associated with salmonid aquaculture

Sediment chemistry and meiofaunal samples were collected in the Broughton Archipelago, British Columbia, to examine the relationship between sediment variables and meiofauna diversity across near- and far-field gradients surrounding several finfish aquaculture operations. The sediment variables examined consisted of free sulfide concentrations, redox potential (E(NHE)), organic content, and sediment grain size. A strong trend between sediment texture and organic content was observed across all sampling locations, which reflected a wide range of sediment types (sand-silt) that exist within the Broughton Archipelago. The abundance of certain meiofaunal groups (kinorhynchs, crustaceans, polychaetes) declined in an asymptotic fashion with increasing free sulfide concentrations, an indicator of benthic organic enrichment. Within these relationships, low meiofaunal abundances occurred in fine sediments associated with higher organic contents. Although other groups (nematodes, foraminifera) showed a slight decline in abundance with increasing organic enrichment, a high amount of variability in abundance was observed at high free sulfide concentrations, rendering these groups not suitable as indicators of organic enrichment. This study reports both horizontal and vertical trends in meiofaunal distributions relative to free sulfide concentrations. The abundance of nematode and crustacean taxa decreased with sediment depth as well as increasing sulfide concentration, while polycheate abundance increased with increasing free sulfide concentration. The ratio of nematodes to copepods was also shown to represent the degree of organic loading associated with aquaculture operations and its application as an indicator of benthic impact is discussed.

Participation of disadvantaged parents in child care research

AIM

To assess the level to which parents from deprived and socially dysfunctional families collaborate in complex and time-consuming research.

DESIGN

Home-based study, of early physiological development in infants from a severely deprived area. Overnight continuous recordings of deep-body temperature with twice daily urine collection, parental daily diary of life-events and completion of child care social and psychological assessment by interview questionnaire. Measurements taken between age 6-12 weeks, each lasted 8-12 h per night, averaging four nights per baby. Level of parental participation assessed in relation to ongoing lifestyle pressures. Setting Home based. Inner city deprived estate.

PARTICIPANTS

Random sample of mothers with newborn healthy infants.

MEASUREMENTS

A total of 87 overnight deep body temperature recordings were made on 22 infants each lasting 8-12 h; 174 urine samples were taken; and 22 sets of questionnaires were completed.

RESULTS

Of 62 inner city deprived parents, 39 (62%) agreed to participate. 22 (35%) completed the study. Ongoing lifestyle pressures were high including incidents of burglary, fire and family violence. Family and partner pressures and life crises overwhelmed 10 non-participations.

CONCLUSIONS

Research partnerships can be developed with underprivileged families facing severe life-events. Parents were highly motivated to complete what they perceived as important infant care research.

Early physiological development of infants with intrauterine growth retardation

OBJECTIVES

To assess the patterns of early postnatal physiological adaptation and maturation in intrauterine growth retarded (IUGR) infants by measuring changes in sleeping deep body temperature, heart rate, and concentrations of urinary cortisol.

SETTING

At home.

PATIENTS

Sixty five IUGR babies and 127 controls matched for sex, social class, and levels of parental smoking.

RESULTS

Night time sleeping deep body temperature, heart rate, and cortisol excretion fell with age, eventually establishing an adult type diurnal rhythm of physiological function. Minimum overnight temperature showed a linear decline with age (p < 0.001), but the IUGR infants and the controls had significant differences in intercept (p = 0.007) and slope (p = 0.02). The estimated rate of decline per week was 0.020 degrees C for IUGR infants and 0.031 degrees C for controls. Maximum temperature did not show similar changes. IUGR infants had a mean (SE) age adjusted minimum overnight heart rate that was 4.2 (1.5) beats/min (p = 0.005) higher than controls. Overnight cortisol/creatinine ratios declined with age at a rate of 4.1% per week (log ratio -0.421 (0.0165), p = 0.01), but the ratio for IUGR infants was on average 42% higher (log ratio 0.35 (0.11), p = 0.002) than for controls of the same age. Morning cortisol concentrations did not show a similar pattern.

CONCLUSIONS

Postnatal physiological adaptation and maturation of IUGR infants is slower than normal and therefore they remain in a physiologically immature state for longer. The higher heart rates and greater cortisol excretion in such infants may be precursors to hypertension and cardiovascular disease seen in adults.

Overnight deep body temperature and urinary cortisol excretion in infants from economically deprived areas

OBJECTIVES

To assess the pattern of postnatal physiological maturation in economically deprived infants by measuring the age-related changes in deep body temperature during night-time sleep.

SETTING

Inner city Leicester, UK.

PARTICIPANTS

Forty-eight infants aged 6-21 weeks from economically deprived areas and 87 control infants from more affluent areas.

OUTCOME MEASURES

Average deep body temperature between 2 and 4 h after bedtime, overnight and early morning urinary cortisol excretion.

RESULTS

Both groups showed a decline in overnight deep body temperature with age that averaged 0.030 degrees C per week (SE = 0.003). Over the age range studied, the average age-adjusted overnight temperature in the infants from deprived homes was 0.090 degrees C (SE = 0.028) higher than that for the affluent group (P = 0.001). Deprived infants had on average 51% higher overnight urinary cortisol and 80% higher morning cortisol. The differences remained when the effects of room temperature, clothing, smoking, birthweight and gestational age were taken into account.

CONCLUSION

These indicators of postnatal physiological maturation suggest that infants from economically deprived homes mature less quickly. This might increase their vulnerability to illness.

Deep body temperature changes in twins

Twins show differences in physiological maturity within and between twin sets; where one infant is 5-weeks later than its sibling; while one pair may both be slow but develop together. Zygosity, birth weight and sex may be contributory but not causative factors. How vulnerability to illness may be affected, is discussed.

Child care decisions: parental choice or chance?

AIM

A study of the context of child care decision making by inner city and suburban mothers, using parents to help develop and administer a semi-structured questionnaire.

METHODS

A total of 131 mothers were interviewed (73 inner city and 58 suburban) at home.

RESULTS

Inner city mothers were more likely to bottle feed, smoke and adopt risky infant sleeping positions, for example the settee. Virtually all babies (98%) were fully vaccinated and placed prone (95%) to sleep at night. Inner city mothers smoked (71%) despite the known health risks and continued postnatally (55%), mainly as a means of relieving stress. In total, 30% of inner city mothers wanted to breast feed; 19% had succeeded to 6-8 weeks postnatally. Bottle feeding helped both mother and baby to have uninterrupted nights of sleep. Suburban mothers (59%) succeeded in breast feeding, with others choosing bottle feeding mostly because of returning to work. The average weekly alcohol consumption, 32 units inner city and 15 units suburban, was taken in weekend binges by inner city parents, but in daily small amounts by suburban mothers.

CONCLUSIONS

The well-being of the baby was the prime concern of all mothers, irrespective of social background. However, inner city mothers made rational decisions to smoke and bottle feed to reduce the impact of stress and allow the mother much needed respite for the good of the entire family.

Changes in body temperature and urinary cortisol after routine immunization in babies with intrauterine growth retardation

AIM

To investigate whether infants with intrauterine growth retardation (IUGR) experience different changes in temperature and cortisol excretion after routine immunization compared with normal healthy infants.

METHODS

Overnight deep body temperature and urinary cortisol to creatinine ratios were measured on the night after immunization and a control night in normal and IUGR infants.

RESULTS

In 60 normal infants, first vaccination at about 10 wk of age led to a significant increase in minumum overnight temperature compared to the control night, mean rise 0.25 degrees C (95% CI, 0.12 to 0.38). In 35 IUGR infants the mean rise in temperature between immunization night and control night was 0.35 degrees C (95% CI, 0.15 to 0.55). The increases in minimum temperature did not differ significantly between the normal and IUGR infants (p = 0.11). Cortisol to creatinine ratios measured from overnight urine samples showed that 23 IUGR infants had consistently higher levels than 39 normal infants: control night medians 34 and 15 (p=0.01) and immunization night medians 56 and 26 (p = 0.02), respectively. However, the percentage increase did not differ significantly between the IUGR infants and the normal infants. A smaller number of second immunizations were studied, but no significant differences were found.

CONCLUSION

These results suggest that although the impact of immunization is the same for IUGR and normal infants, because IUGR infants are less mature and at greater stress before immunization, the absolute levels that they experience after immunization are higher than those for normal infants.

Relations between the development of patterns of sleeping heart rate and body temperature in infants

Overnight patterns of rectal temperature and heart rate were recorded from 119 normal infants at weekly intervals from 7 to about 16 weeks of age. All data were collected in the infants' own homes. As previously reported, different infants developed an adult-like night time rectal temperature pattern abruptly at different ages. When heart rate data were collated by age, there was an apparently gradual fall in sleeping heart rate from 7 to about 14 weeks of age. This was, however, an artefact of data collation. Individual infants showed abrupt falls in heart rate at the time that the adult-like body temperature pattern appeared, but this occurred at different ages in different babies, so when data were collated cross sectionally, an apparently gradual fall resulted. The relation between the developmental changes in sleeping heart rate and rectal temperature was different in boys and girls, with girls showing a more abrupt and greater change in heart rate at the time of development of the adult-like body temperature pattern. Infants whose parents smoked had significantly lower heart rates once the adult-like body temperature pattern had appeared.

Posterior shoulder instability

Understanding the anatomic restraints to posterior shoulder instability and the resulting pathophysiology helps the treating physician make a correct diagnosis and formulate an appropriate treatment plan. A nonoperative program directed at reducing pain and increasing stability through comprehensive shoulder strengthening methods has generally been successful in treating recurrent posterior shoulder subluxation. Surgical options for treatment are reserved for those patients who fail to recognize improvement after six months of therapy and have no evidence of a psychological disturbance as the cause of their posterior instability.

Glutamate receptor expression regulates quantal size and quantal content at the Drosophila neuromuscular junction

At the Drosophila glutamatergic neuromuscular junction, the postsynaptic cell can regulate synaptic strength by both changing its sensitivity to neurotransmitter and generating a retrograde signal that regulates presynaptic transmitter release. To investigate the molecular mechanisms underlying these forms of plasticity, we have undertaken a genetic analysis of two postsynaptic glutamate receptors that are expressed at this synapse. Deletion of both genes results in embryonic lethality that can be rescued by transgenic expression of either receptor. Although these receptors are redundant for viability, they have important differences. By transgenically rescuing the double mutant, we have investigated the relationship of receptor gene dosage and composition to synaptic function. We find that the receptor subunit composition regulates quantal size, Argiotoxin sensitivity, and receptor desensitization kinetics. Finally, we show that the activity of the receptor can regulate the retrograde signal functioning at this synapse. Thus, the diversity of receptors expressed at this synapse provides the cell with mechanisms for generating synaptic plasticity.

Revision of failed total shoulder arthroplasty

The complexity of revision shoulder surgery remains a supreme challenge for the experienced shoulder surgeon. The difficulty of surgery is often accompanied by unpredictable patient cooperation during the postoperative rehabilitation program. Recognition of the problems associated with the failed shoulder arthroplasty is necessary for successful revision surgery. Numerous reconstructive techniques are necessary for restoration of soft tissue and bony deficiencies. Component revision is often necessary in treating component loosening or glenohumeral instability. Glenoid component removal may be necessary in the presence of severe rotator cuff insufficiency or marked glenoid bone deficiency. Humeral revision is most predictably treated with methylmethacrylate fixation. Humeral fractures associated with humeral arthroplasty are most successfully treated surgically, except in those instances where a long oblique or spiral fracture is not associated with prosthetic loosening. Deep infection is most predictably treated by extensive debridement, parenteral antibiotics, and delayed exchange of the components. The success of revision shoulder arthroplasty is often unpredictable, with 60% of revisions offering satisfactory pain relief and restoration of function. Critical to the success of revision arthroplasty is the status of the soft tissues, particularly the anterior deltoid and rotator cuff.

Postsynaptic PKA controls quantal size and reveals a retrograde signal that regulates presynaptic transmitter release in Drosophila

Two distinct mechanisms regulate synaptic efficacy at the Drosophila neuromuscular junction (NMJ): a PKA-dependent modulation of quantal size and a retrograde regulation of presynaptic release. Postsynaptic expression of a constitutively active PKA catalytic subunit decreases quantal size, whereas overexpression of a mutant PKA regulatory subunit (inhibiting PKA activity) increases quantal size. Increased PKA activity also decreases the response to direct iontophoresis of glutamate onto postsynaptic receptors. The PKA-dependent modulation of quantal size requires the presence of the muscle-specific glutamate receptor DGluRIIA, since PKA-dependent modulation of quantal size is lost in homozygous viable DGluRIIA- mutants. Furthermore, elevated postsynaptic PKA reduces the quantal amplitude and the time constant of miniature excitatory junctional potential (mEJP) decay to values that are nearly identical to those observed in DGluRIIA mutants. The PKA-dependent reduction in quantal size is accompanied developmentally by an increase in presynaptic quantal content, indicating the presence of a retrograde signal that regulates presynaptic release.

Genetic analysis of glutamate receptors in Drosophila reveals a retrograde signal regulating presynaptic transmitter release

Postsynaptic sensitivity to glutamate was genetically manipulated at the Drosophila neuromuscular junction (NMJ) to test whether postsynaptic activity can regulate presynaptic function during development. We cloned the gene encoding a second muscle-specific glutamate receptor, DGluRIIB, which is closely related to the previously identified DGluRIIA and located adjacent to it in the genome. Mutations that eliminate DGluRIIA (but not DGluRIIB) or transgenic constructs that increase DGluRIIA expression were generated. When DGluRIIA is missing, the response of the muscle to a single vesicle of transmitter is substantially decreased. However, the response of the muscle to nerve stimulation is normal because quantal content is significantly increased. Thus, a decrease in postsynaptic receptors leads to an increase in presynaptic transmitter release, indicating that postsynaptic activity controls a retrograde signal that regulates presynaptic function.

Higher rectal temperatures in co-sleeping infants

The effect on deep body temperature of infants co-sleeping (with either or both parents) is investigated in this case control study. Overnight continuous recordings of rectal temperature were made from 34 babies co-sleeping with one or both parents throughout the night and 34 infants matched for age, feeding regimen, parental smoking, thermal environment, sleeping position, and sex who slept alone. The co-sleeping infants had significantly higher rectal temperatures from two hours after bedtime, when the initial fall in sleeping body temperature was complete. The mean rectal temperature of co-sleeping infants between two and eight hours was 0.1 degree C higher than that of infants sleeping alone (p < 0.04). Given the very small variance in rectal temperature this probably reflects a considerable physiological difference between the two groups.

Factors affecting rectal temperature in infancy

The recordings of 1197 overnight rectal temperatures from infants of up to 24 weeks of age have been analysed with respect to 12 variables, including a number of risk factors for sudden infant death syndrome. Multivariable regression was used to identify if parental smoking, bottle feeding, sleeping position, and birth weight affect the overnight rectal temperature of infants. The rectal temperature, averaged over the period from three to five hours after the infants were put to bed, correlated well (R = 0.36) with the collected variables. An increase in the infant's age, birth weight, and the supine sleeping position all decreased the night time rectal temperatures. However, an increase in the night time room temperature, weight, and the combination of bottle feeding and parental smoking produced an increase in rectal temperature. The individual effects of bottle feeding and parental smoking were not significant. The results show that some of the major risk factors have the effect of raising the rectal temperature of sleeping infants.

Prone sleeping infants have a reduced ability to lose heat

The heat loss coefficients of a group of infants have been calculated and compared to see if there is a difference in the ability to lose heat between prone and non-prone sleeping infants. For a group of 43 infants aged 4-29 weeks, a simple mathematical model of exponential cooling in a body has been fitted to the fall in rectal temperature which occurs in infants at bedtime. One of the parameters yielded by the fitting process is the coefficient of thermal heat loss. After validation against the estimated heat loss from supine sleeping infants, the heat loss coefficient was compared at different sleep positions and gender. The mean heat loss coefficient, measured from the non-prone sleeping infants (0.269 W/degrees C, S.D. 0.197) agreed well with the value calculated for supine sleepers with the same tog levels (0.4 W/degrees C). Prone sleeping infants were found to have a considerably smaller heat loss coefficient which was approximately 60% of the value for non-prone sleeping infants (P = 0.000097). Female infants were found to have a heat loss coefficient that was approximately 70% of that of male infants but this gender difference was only significant (P = 0.025) for non-prone sleeping infants. These results suggest that infants sleeping in the prone position may be unable to lose heat as rapidly as those infants sleeping non-prone.

Urinary excretion of cortisol after immunisation

Urinary cortisol excretion and rectal temperature were measured in 66 infants before and after immunisation against diphtheria, tetanus, pertussis, and Haemophilus influenzae type b. Immunisation produced a significant increase of rectal temperature the next night at all ages. Infants without an adult-like night time body temperature pattern had a significant increase in urinary cortisol excretion night and morning after immunisation. Once an adult-like night time body temperature pattern developed immunisation no longer significantly raised urinary cortisol output.

Lower body temperature in sleeping supine infants

Night time rectal temperature recordings were made from 103 infants sleeping in their own home in different sleeping positions. In most cases sleeping position was verified by video monitoring throughout the night. In the period before an adult-like night time body temperature pattern appeared there was no significant effect of sleeping position upon night time body temperature, in line with previous reports. Once an adult-like night time temperature pattern appeared, infants sleeping supine reached significantly lower rectal temperatures than those sleeping prone or lateral. Babies sleeping supine moved significantly more during the night and were more likely to uncover their hands and arms. These findings suggest that supine sleepers are in a different physiological condition from those sleeping prone or lateral, which may be associated with their lower vulnerability to sudden unexpected infant death.

The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology

The relative prevalence of various acromial shapes, appearance of the coracoacromial ligament and enthesophytes along the inferior aspect of the acromioclavicular joint in patients with and without rotator cuff tears were evaluated. Of 76 patients with clinical instability and impingement, 31 had a normal rotator cuff and 45 demonstrated a partial or full tear of the supraspinatus tendon at surgery. Results were compared with those from magnetic resonance (MR) scans of 57 asymptomatic volunteers. Of the 45 patients with a supraspinatus tear, 38% (17) had a flat acromial undersurface (type I), 40% (18) had a concave acromial undersurface (type II), 18% (8) had an anteriorly hooked acromion (type III), and 4% (2) had an inferiorly convex acromion (type IV). Among the 31 patients with a normal rotator cuff at surgery and the 57 asymptomatic volunteers, the respective prevalences of the type I acromion were 39% (12) and 44% (25), of type II 48% (15) and 35% (20), type III 3% (1) and 12% (7), and type IV 10% (3) and 9% (5). Shoulders with surgically proven rotator cuff tears showed a tendential association with a type III acromion (8/45) and statistically significant associations with a thickened coracoacromial ligament (17/45) and acromioclavicular enthesophytes (18/45). For the association between inferiorly directed acromioclavicular joint enthesophytes and rotator cuff tears, age appears to be a confounding factor. The type IV acromion, newly classified by this study, does not have a recognizable association with rotator cuff tears.(ABSTRACT TRUNCATED AT 250 WORDS)

Interactions between infant care practices and physiological development in Asian infants

Asian infants are less likely to suffer cot death despite apparently higher prevalence of some risk factors. This paper compares the development of night time body temperature patterns in a small sample of Asian babies with the pattern already established for white infants, where babies who develop an adult-like night time temperature pattern later than usual share characteristics with victims of SIDS. The Asian infants had similar body temperature patterns to whites, but tended to develop the adult-like pattern later, not earlier as might have been expected. More Asian infants than white in our sample slept in the parental bed, and, before the adult-like body temperature patterns appeared, co-sleeping infants had higher body temperatures than those in their own cots. Asian infants slept in significantly warmer rooms than whites, but under similar amounts of bedding. These studies do not therefore reveal any physiological difference between Asians and whites which might account for low vulnerability to cot death, indeed, if anything the reverse.

Body temperature changes before minor illness in infants

This study aimed to examine the overnight temperature pattern of babies during the prodromal phase of minor illnesses. The overnight rectal temperature pattern of 123 babies was recorded weekly from about 6 to at least 16 weeks old, while parents maintained detailed records of signs of illness. By analysis of patterns of signs and visits to the general practitioner, 86 periods of minor illness were identified, mostly upper respiratory tract infections, though it was not usually possible to identify the infection by conventional virology. Data were analysed separately for babies who had developed an adult-like night time temperature pattern and those who had not. In both groups, obvious signs of illness were preceded by a disturbance of night time temperature pattern. Temperature was significantly raised over control weeks, though few babies were clinically febrile. The greatest temperature disturbances were seen in the three days before illness, though some disturbances were seen up to seven days before. A similar disturbance of temperature was seen the night after diphtheria, pertussis, and tetanus immunisation, and individual responses to natural infection and immunisation were well correlated, suggesting that the temperature change is more a function of the host response than the infecting agent.

Unicompartmental knee arthroplasty. Sequential radiographic and scintigraphic imaging with an average five-year follow-up

Clinical, radiographic, and scintigraphic results of 33 consecutive unicompartmental knee arthroplasties were reviewed after a mean follow-up period of 68 months (range, 24 to 112 months). Clinical grades employing criteria established by the Hospital for Special Surgery showed 74% good to excellent and 11% fair to poor results. Four knees (15%) required revision to a total knee arthroplasty after an average postoperative interval of 7.4 years. Within the subset of surviving medial compartment arthroplasties (23 knees), superior clinical results were associated with a central or slightly medialized mechanical axis (p < 0.05). Periprosthetic radiolucency showed no correlation with clinical scores or failures resulting in revision surgery. There was no radiographic evidence of progressive arthrosis within the unreplaced compartments. Comparative analysis of preoperative and annual postoperative technetium bone scans showed no temporally related changes indicative of impending prosthetic failure or disease progression within the unoperated compartments. The surgically treated compartments maintained uniformly intense femorotibial activity, whereas the unoperated compartments, including the patellofemoral joint, remained scintigraphically quiescent. Disease progression in unreplaced compartments is unusual after contemporary unicompartmental knee arthroplasty. Most failures and poor results arise from mechanical inadequacies amendable to surgical technique and/or future design considerations.

A prospective comparison of computerized arthrotomography and magnetic resonance imaging of the glenohumeral joint

Twenty-five patients with shoulder instability or shoulder pain of undetermined etiology were prospectively evaluated with magnetic resonance imaging and computerized arthrotomography. Actual lesions were determined by arthroscopy or at the time of open surgical repair. The images obtained were interpreted independently by three radiologists blinded to both surgical results and the results of previous diagnostic tests. Sensitivity, specificity, and accuracy were determined for each imaging technique for a variety of pathologic entities, including anterior and posterior labral abnormalities, capsular redundancy, biceps-labral complex abnormalities, humeral head (Hill-Sachs) impression lesions, and glenohumeral loose bodies. Analysis of imaging techniques also included construction of receiver operator curves for labral abnormalities. Magnetic resonance imaging showed better diagnostic results in the evaluation of glenoid labral and humeral head impression lesions (P < 0.05). Both imaging techniques were equally successful in identifying biceps-labral lesions and intraarticular loose bodies within the glenohumeral joint. Neither imaging technique was consistent in the evaluation of capsular redundancy. Receiver operator curve analysis confirmed that magnetic resonance imaging was the more accurate imaging study in evaluating anterior and posterior glenoid labral abnormalities.

Factors affecting the development of night time temperature rhythms

The rectal temperature of 26 infants between 6 and 16 weeks old was monitored continuously for one night each week. Rectal temperature always decreased with sleep but the minimum temperature attained changed with age. Some time between 8 and 16 weeks old the minimum sleeping rectal temperature decreased abruptly from around 36.8 degrees C to around 36.4 degrees C. This change was complete within one week and did not normally revert unless the infant became ill. Some infants changed as early as 8 weeks old, others not until 16 weeks. Breast fed infants changed significantly earlier than bottle fed infants. Girls changed significantly earlier than boys. First born infants changed significantly earlier than second or subsequent infants. Early changes were significantly more likely to be sleeping lateral or supine, and to have older mothers. They tended to come from more affluent families. There was no association between the time of change and the thermal environment in which the infant slept or the number of episodes of minor illness in the early weeks of life.

MR imaging of the shoulder: appearance of the supraspinatus tendon in asymptomatic volunteers

MR imaging has been shown to be accurate in the diagnosis of rotator cuff disruption and tear. Uncertainty remains about the significance of increased signal intensity in the critical zone of the supraspinatus tendon without visible disruption of tendon fibers and about the significance of other secondary findings commonly encountered with rotator cuff abnormalities, such as musculotendinous retraction or obliteration and fluid in the subacromial space. We evaluated proton density-weighted and T2-weighted coronal images (obtained on a 1.5-T superconductive MR imager) of 55 shoulders in 32 asymptomatic volunteers for signal intensity in the supraspinatus tendon, location of the musculotendinous junction, fluid in the subacromial-subdeltoid space, and appearance of the fat plane. In 89% of shoulders, the supraspinatus tendon showed focal, linear, or diffuse increased signal intensity with or without loss of the low-signal-intensity tendon margin on proton density-weighted images. None of these findings were confirmed on T2-weighted images. The musculotendinous junction was always located within an area 15 degrees medial to 30 degrees lateral to the highest point (12 o'clock) on the humeral head convexity. A peribursal fat plane was poorly defined or absent in 49%, and fluid in the subacromial-subdeltoid space was found in 20%. Increased signal intensity in the supraspinatus tendon on proton density-weighted images without a corresponding increase on T2-weighted images, the presence of small amounts of fluid in the subacromial space, and the lack of preservation of the subdeltoid fat plane are common findings in asymptomatic shoulders and by themselves are poor predictors of rotator cuff disease.

ATP overflow from the mouse isolated vas deferens

1. A modified form of the highly specific luciferin-luciferase assay was used to measure the overflow of adenosine 5'-triphosphate (ATP) from the field-stimulated mouse vas deferens in vitro. Precise timing of the stimulation, superfusate collection and assay minimized ATP degradation before assay, offering the opportunity for quantitative studies. 2. Stimulation with between 50 and 200 supramaximal pulses at 5 Hz increased ATP overflow by between 7 and 28 times over basal. 3. ATP overflow increased steadily with increasing numbers of stimuli from 50 to 200 pulses. Increasing the frequency of stimulation initially had no effect, but above 10 Hz there was increased overflow, suggesting an interaction between facilitated release and the rate of degradation by extracellular ATPases. 4. Contractions of the vas induced by exogenous (-)-phenylephrine produced only a small increase in ATP overflow, suggesting that the stimulation induced increase in ATP overflow is mostly pre-junctional in origin, though tetrodotoxin eliminated stimulation-induced overflow only in a proportion of preparations.

MR imaging of the labral-capsular complex: normal variations

Understanding the normal anatomy of the shoulder and its variations is important for the proper interpretation of MR images. This study was performed to describe variations in the normal labral-capsular complex as seen on MR images. MR images of 52 shoulders in 30 asymptomatic volunteers and 27 shoulders of symptomatic patients who had subsequent arthroscopy and/or reconstructive surgery were obtained with 1.5-T MR. The 52 scans of the asymptomatic group were reviewed by three radiologists in conference, and the assessment of labral shapes and capsular insertions was done by consensus. The 27 MR scans of the shoulders in the symptomatic group were reviewed by one radiologist before and after the asymptomatic cases were interpreted. Differences in these two interpretations were shown on receiver-operating-characteristic curves by using the results of subsequent arthroscopy and surgery as the gold standard. The anterior and posterior parts of the labra, respectively, varied in shape but showed several dominant features: triangular (45%, 73%), round (19%, 12%), cleaved (15%, 0%), notched (8%, 0%), flat (7%, 6%), and absent (6%, 8%). Most capsules inserted anteriorly on the labrum (47%) or glenoid rim (49%). All posterior insertions were on the labrum (100%). Intrinsic labral signal was noted on proton density-weighted images, but never on T2-weighted images. Receiver-operating-characteristic curves from interpretations of the symptomatic and clinical cases made before and after evaluation of the asymptomatic shoulders showed the interpretations improved considerably after scans of asymptomatic volunteers were studied. Our study reveals a wide variability in the MR appearance of the labral-capsular complex in asymptomatic shoulders.

Lateral tibial rim (Segond) fractures: MR imaging characteristics

The magnetic resonance (MR) imaging characteristics of lateral tibial rim (Segond) fractures and their associated injuries were reviewed in 12 patients with radiographic evidence of this fracture. Bone marrow adjacent to the fracture emitted a focally abnormal MR signal, which indicated an injury of the lateral capsular junction. The Segond fragment, however, was seen on MR images in only four of 12 patients. Associated ligamentous and meniscal injuries identified with MR imaging and arthroscopy involved the anterior (n = 11) and medial (n = 7) cruciate ligaments and the lateral (n = 4) and medial (n = 1) menisci. Focal bone marrow edema was due to injury of the lateral capsular junction. MR imaging evidence of such edema should indicate the presence of a lateral capsular injury and fracture, if one has not already been demonstrated with conventional radiography. A high association of Segond fractures with tears of the anterior cruciate ligament was confirmed, and MR imaging signs of a Segond fracture may therefore be used as indirect evidence for tears of that ligament.

Sleeping position and rectal temperature

The effects of sleeping position upon body temperature were assessed by continuous monitoring of rectal temperature in 137 babies sleeping at home under conditions chosen by their parents. There were three groups of subjects: (1) normal babies aged 12-22 weeks whose temperature rhythms were developed, (2) normal babies aged 6-12 weeks who were developing their night time temperature rhythms, and (3) babies the night after diphtheria, pertussis, and tetanus immunisation, whose temperature rhythms were disturbed. Sleeping in the prone position was not associated with higher rectal temperatures at any time of night in young babies, nor did it exaggerate the disturbance of rectal temperature rhythm after immunisation. In older normal babies the prone position did not disturb rectal temperature in the first part of the night, though prone sleepers warmed a little faster prior to walking, especially in warm conditions. Prone sleepers were, however, born earlier in gestation and tended to be of lower birth weight. Normal babies can therefore thermoregulate effectively whatever their sleeping posture, even in warm conditions, though the prone position may make it slightly more difficult to lose heat. It is difficult to see how the prone position, even interacting with warm conditions, could induce lethal hyperthermia in otherwise normal babies. Perhaps the prone position is associated with other risk factors for sudden infant death syndrome.

MRI in the evaluation of patients with suspected instability of the shoulder joint including a comparison with CT-arthrography

Thirty-two patients with clinical suspicion of shoulder instability were the subject of this assessment of MRI (1.5 T G. E. Signa) and its comparison with CT-arthrography (GE8800 and GE9800) of the shoulder. Twenty-seven patients had a final diagnosis established by arthroscopy and five by arthrotomy. The imaging examinations were interpreted independently by three radiologists blinded against history, surgical diagnosis and results of the compared test. The statistical analysis included ROC-curves, sensitivity, specificity and accuracy as well as predictive values. The significance of the comparative results was assessed by the McNemar Sign test. MRI showed significantly better diagnostic results in the evaluation of labral structures (sensitivity 85%, specificity 90%, accuracy 88%) and humeral head impression fractures (75, 82, 78 %). None of the tests were of sufficient diagnostic value to identify capsular abnormalities. CT and MRI results regarding the biceps tendon and loose bodies were similar, however, statistically not significant. MRI proved to be of high diagnostic value in the assessment of the unstable shoulder and compared favorably with CT-A.

Development of night time temperature rhythms over the first six months of life

Continuous recordings of night time rectal temperature were made at regular intervals over the first six months of life in 49 babies. In the first two weeks of life rectal temperature changed little overnight, but by 6 weeks of age rectal temperature at bedtime was significantly higher than later in the night. By around 12 weeks of age sleeping deep body temperature fell below 36.5 degrees C, and by 16 weeks of age all babies exhibited a consistent rhythm of rectal temperature. This fell by about 0.8 degrees C within two hours of bedtime, and then remained low until an hour or two before waking. As babies got older the mean interval between bedtime and first disturbance of parents got longer. Sleeping rectal temperature fell below 36.5 degrees C at about the time babies slept for seven hours. From 6 weeks of age, as individual baby's rectal temperatures fell more with sleep, sleep got longer.

The Keller resection arthroplasty: a 13-year experience

The clinical results following Keller resection arthroplasty were reviewed in 54 feet with a 2- to 10-year follow-up. Patients were evaluated by radiographs, physical examination, and questionnaire. The primary indication for surgery was painful hallux valgus with associated degenerative changes of the first metatarsophalangeal joint. Additionally, rheumatoid arthritis was the underlying diagnosis in four feet. Seventy-five percent of all patients had complete relief of their symptoms. There was significant (P less than .01) improvement in both the metatarsophalangeal and intermetatarsal angles, but a decreased range of motion in the first metatarsophalangeal joint, with a complete lack of plantarflexion in 67%. Application of the Bonney and MacNab2 grading system yielded a 72% rate of good and excellent results. The subjective patient satisfaction rate was 87.5%. Patient satisfaction was most strongly associated with the use of a K-wire for postoperative fixation (P = .03), and a limited resection of the proximal phalanx (P = .03). We conclude that the Keller resection arthroplasty is a reasonable alternative for the treatment of hallux valgus in the presence of degenerative changes in the first metatarsophalangeal joint.

Effects of suramin on the concentration--response relationship of alpha, beta-methylene ATP on the mouse vas deferens

1. The effect of suramin on the concentration-effect curve for the contractile response of the isolated mouse vas deferens to alpha, beta-methylene ATP (alpha, beta-meATP) was investigated. 2. The concentration-response curve to alpha, beta-meATP had a consistent discontinuity at about 3 x 10(-6) M, giving it a biphasic appearance. 3. Suramin in a dose-dependent, reversible manner both shifted the curve to the right and at the same time elevated the maximum response. 4. The P2y inhibitor Reactive Blue 2, on the other hand, both shifted the curve to the left and elevated the maximum response. 5. These results show that alpha, beta-meATP in this preparation is an agonist both at excitatory, presumably P2y receptors and inhibitory P2y receptors, and that suramin antagonizes both effects.

Rectal temperature of normal babies the night after first diphtheria, pertussis, and tetanus immunisation

Continuous rectal temperature recordings were made from 32 babies the night after their first diphtheria, pertussis, and tetanus immunisation and compared with recordings made before immunisation. Tog values of clothes and wrapping and room temperatures were also recorded. We found that immunisation the day before disturbs the normal night time rhythm of deep body temperature. The rectal temperature of immunised babies was significantly higher than non-immunised babies from two hours into the night. We also found that there were considerable individual variations in the extent of disturbance of temperature rhythm. They were not correlated with thermal environment. There is no reason to suppose that these mild physiological responses to immunisation are in any way harmful.

Factors influencing the body temperature of 3-4 month old infants at home during the day

Continuous recordings of rectal temperature were made from 40 normal infants, aged 3-4 months, at home during two days of normal activities. We found that the rectal temperature of a normal, healthy baby may vary from 36.0 degrees C at night to 37.8 degrees C during active periods of the day. During daytime sleep rectal temperature fell, but to a lesser extent, and for less time than during night time sleeps. Feeds raised the temperature unless the baby slept, when they reduced the rate of fall of temperature. Bottle feeds affected temperature more quickly than breast feeds. The changes in temperature during sleep and after feeds were independent of the room temperature or thermal insulation of clothing and wrapping.

Use of thermographic imaging to study babies sleeping at home

Two 3 month old infants sleeping under different thermal conditions were found to maintain similar deep body temperatures. Thermographic imaging suggested that though the uncovered head is the main source of heat transfer, other parts of the body such as the hands may be used when necessary.

Disturbed nights and 3-4 month old infants: the effects of feeding and thermal environment

Parents completed a prospective diary of a night's sleep for 87, 3-4 month old infants at home whose body temperatures were continuously recorded. We found that about half of the babies disturbed their parents in the night. Breast fed babies were more likely to wake parents in the middle of the night. The babies who disturbed their parents in the middle of the night were significantly more heavily wrapped in significantly warmer rooms. We suggest that discomfort from efforts at active thermoregulation in warm environments may lead some babies to disturb their parents at 'unsocial hours'.

Keeping babies warm: have we got it right?

Concern has recently centred on the risks of babies overheating in their cots at night. We review the conditions under which babies sleep at home, and their effects on body temperature. Parents do not choose room heating, clothing and wrapping at random, but according to a 'formula' based on perceived risk to the infant of cooling. This formula allows 95 per cent of 3-4 month babies to produce controlled fall in body temperature at night, but most have to cooly by active thermoregulation, which relies heavily on the head as a route of heat loss. We conclude with some general recommendations about room heating and wrapping of babies which may reduce the risk of thermal stress during sleep.

Properties of excitatory junction potentials and currents in smooth muscle cells of the mouse vas deferens

Intracellular recordings made from superficial smooth muscle cells of the mouse vas deferens confirmed the presence of two populations of cells, distinguishable by their membrane potential and measured input resistance. In this study, we have concentrated on cells with high input resistance (50-500 M omega) and membrane potentials of -45 to -65 mV. These cells fired action potentials when depolarized by intracellular current injection and appeared to be electrically isolated from adjacent cells. Stimulation of the intramural nerves evoked excitatory junction potentials (e.j.p.s.), which fluctuated in amplitude, with the largest firing action potentials. The e.j.p. amplitude was increased by hyperpolarizing and decreased by depolarizing the cell membrane. Under voltage-clamp, nerve stimulation evoked excitatory junction currents (e.j.c.s.) which reached a peak in 5 ms, and declined exponentially with a time-constant of 28 ms. The e.j.c. amplitude was linearly related to membrane potential with a reversal potential near -10 mV.

Sleeping body temperatures in 3-4 month old infants

Rectal, skin, and ambient temperatures were continuously recorded overnight from 3-4 month old normal infants in their home cots under conditions of room temperature and wrapping chosen freely by parents. It was found that rectal temperature was above 37 degrees C when infants were put down, but fell rapidly to 36.4 degrees C within one and a half hours, then stabilised for a few hours before rising steadily. This pattern was tied more closely to the time of putting down than time of day. The extent and rate of temperature fall did not correlate with any feature of the thermal environment. We also found that skin temperature changed much less than rectal temperature over the night, and for the first two hours in the cot there was no relation between skin and rectal temperature. There is therefore a well organised, endogenous rhythm of temperature in 4 month old infants.

The thermal environment in which 3-4 month old infants sleep at home

The thermal insulation of clothing and wrapping (tog value), room temperature, and body temperature was measured for 3-4 month old infants sleeping in their home cots under conditions chosen freely by parents during a cold winter. We found that ambient temperature averaged 18.4 degrees C when infants were put down, but fell by an average of 4.4 degrees C during the night. Minimum room temperature correlated with outside temperature, but most rooms were heated to some degree; smaller babies were kept in warmer rooms. The tog value of clothing before putting the baby down averaged 5.1, supplemented by 9.6 tog units of wrapping in the cot--a 188% increase for a 4.4 degrees C drop in temperature. Total tog of clothing and wrapping correlated negatively with minimum room temperature; smaller born babies tended to be more heavily wrapped. Despite the large increase in insulation in the cot, most babies maintained normal body temperatures.

[Pulmonary hypertension in children treated with ventriculo-atrial shunt in hydrocephalus]

Four infants treated with ventriculo-atrial shunt for hydrocephalus developed sudden pulmonary hypertension, several years after the first operation. All infants died in spite of replacement of the distal shunt and AK treatment. At necropsy, old microemboli were found in the small lung vessels in two infants whereas the two other infants were suspected of having the same lesions from clinical investigations. The overall frequency for this complication was estimated to be 6.7% (95% CI 1.4-14.3%).