Inflammatory and Nutritional Biomarkers in Patients With Esophageal Squamous Cell Carcinoma Undergoing Neoadjuvant Chemotherapy and Radiation Therapy

OBJECTIVES

To investigate the relationship between pretreatment inflammatory and nutritional biomarkers in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemotherapy and radiation therapy (nCRT).

SAMPLE & SETTING

213 patients with newly diagnosed stage II-III ESCC who received nCRT at an academic hospital in Taiwan.

METHODS & VARIABLES

Electronic health record data were used. Records on inflammatory and nutritional biomarkers and clinical outcomes were extracted. Logistic regression analysis was used to predict treatment-related adverse events, Cox regression was used for survival outcomes, and receiver operating characteristic curve analysis was used to determine optimal cutoff values.

RESULTS

There was a significant association between low prognostic nutritional index (PNI) and nCRT toxicities and survival. Advanced cancer stage, high platelet-to-lymphocyte ratio, and occurrence of pneumonia/infection were linked to survival outcomes.

IMPLICATIONS FOR NURSING

PNI shows promise in predicting prognosis, helps identify high-risk patients, and enables nurses to apply tailored interventions.

The Experiences of Nursing Managers in Implementing Palliative Care in Long-Term Care Facilities

Purpose

The purpose of this study was to explore the experiences of nursing managers in implementing palliative care in long-term care facilities and to provide recommendations for managers who plan to introduce palliative care into their facilities.

Methods

This study used semi-structured interviews and grounded theory methodology, with purposive sampling. A total of 11 long-term care facilities in eastern Taiwan that had implemented palliative care were selected, and 11 facility nursing managers participated in in-depth, face-to-face interviews.

Results

The introduction of palliative care in long-term care facilities can be divided into four stages: (1) the opportunity for change, (2) playing a supportive role, (3) a new collaboration model, and (4) facility transformation. The core category shared by the participants may be summed up as "the palliative care captain in the facility". It reflects the spirit of the successful implementation of palliative care by managers in long-term care facilities.

Conclusion

The study reveals that during the initial phases of implementing palliative care, the palliative care teams assume a crucial leadership role, while the facilities play a supportive role. At this stage, managers should focus on personnel training and addressing internal issues within the facilities to facilitate successful collaboration with the palliative care teams. In the later stages, the facilities transition from a supportive role to one of independence, marking a critical juncture for the facilities' potential stable development. During this period, managers are tasked not only with establishing the facilities' own palliative care team but also with facilitating the transformation of staff from learners to instructors. Finally, even after successful implementation, managers must contemplate how to innovate and set more ambitious goals.

Investigating sarcopenia, physical activity, and inflammation biomarkers in newly diagnosed oral cancer patients during curative treatment: A prospective longitudinal study

Objective

This prospective longitudinal study aimed to investigate changes in sarcopenia, physical activity, and inflammation biomarkers in patients with oral cavity cancer during curative treatment and explore their association with treatment outcomes.

Methods

Patients newly diagnosed with oral cavity cancer who underwent primary surgery with (chemo)radiation therapy were included. Along with physical activity and inflammatory markers, sarcopenia was assessed using a 5-time chair stand test, hand grip strength, and skeletal muscle index (SMI). Data were collected before operation and after 3 months (T₂) and 6 months after operation. Logistic regression and Cox proportional hazards models were used to identify predictors of treatment outcomes.

Results

Out of 56 patients, 21 (37.5%) had sarcopenia. SMI score, physical activity, and neutrophil-to-lymphocyte ratio (NLR) showed significant changes after surgery, with exacerbation at T₂. Patients with sarcopenia exhibited a significant decrease in SMI scores at T₂. Advanced cancer stage and sarcopenia were associated with treatment-related dysphagia (odds ratio [OR] ​= ​3.01, P ​= ​0.034; OR ​= ​7.62, P ​= ​0.018). Sarcopenia (OR ​= ​3.02, P ​= ​0.002) and NLR (OR ​= ​5.38, P ​< ​0.001) were significantly associated with infections. Pretreatment SMI independently predicted poor survival outcomes (hazard ratio ​= ​7.00, P ​= ​0.005).

Conclusions

Identifying patients with oral cavity cancer, sarcopenia, and high NLR levels can ensure prompt education and vigilant monitoring, potentially improving treatment outcomes and patient well-being during curative treatment.

Comprehensive Assessment of the Clinical Risk Factors of Postoperative Adverse Events and Survival in Patients With Non-small-cell Lung Cancer

BACKGROUND/AIM

Postoperative adverse events are associated with poor clinical outcomes and survival in patients with non-small-cell lung cancer (NSCLC) treated with curative operation. However, comprehensive evaluation of the clinical characteristics associated with postoperative adverse events and survival outcomes is lacking.

PATIENTS AND METHODS

A retrospective study that evaluated patients with NSCLC who underwent curative surgery between 2008 and 2021 was conducted in a medical center. The baseline characteristics, five-item modified frailty index, sarcopenia, inflammatory biomarkers, surgical approach, postoperative adverse events, and survival were statistically analyzed.

RESULTS

Patients with a history of smoking and preoperative sarcopenia were at a higher risk of developing postoperative pulmonary complications. Smoking, frailty, and traditional open thoracotomy (OT) were associated with infections, and sarcopenia was identified as a risk factor for major complications. Advanced tumor stage, high neutrophil-to-lymphocyte ratio, OT, major complications, and infections were identified as risk factors for overall and disease-free survival.

CONCLUSION

Pre-treatment sarcopenia was found to be a predictor of major complications. Infections and major complications were associated with survival outcomes in patients with NSCLC.

Predictors of success in the registered nurse licensure exam for nursing graduates whose education was affected by the COVID-19 pandemic

The Coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health-care education. However, the relationship between changes in nursing internships in Taiwan during the COVID-19 pandemic and outcome in the national registered nurse (RN) licensure exam for new nursing graduates is underexplored. The study was to explore the predictors of first-attempt success in the RN licensure exam in 2022. A retrospective review of secondary data was employed in this study. Adjusted binary logistic regression was used to analyze data. A convenience sample of 78 new graduates attempted the exam. Of these graduates, 87.2% passed the RN licensure exam. Age was the main predictor of exam success, followed by grand mean academic score and total alternative (nontraditional in-person) internship hours. Compared with those who failed the exam, the graduates who passed the exam were significantly more likely to be younger, have better academic performance, and have engaged in more alternative internship hours. Nursing faculties should consider implementing supportive strategies early for students who are underperforming or those who are older than their classmates on average to help them pass the RN exam on the first attempt. The optimal duration and long-term consequences of alternative nursing internships must be analyzed in further detail.

Perioperative exercise intervention in patients with lung cancer: A systematic literature review of randomized controlled trials

Objectives:

During perioperative, lung cancer (LC) patients are often left to experience debilitating disease-related symptoms, impaired physical activity and health-related quality of life (HRQoL), and social difficulties, despite the progress achieved in terms of treatment efficacy. Nonpharmacological intervention, such as exercise, has been identified as an effective strategy in LC patients before and after lung resection. Therefore, we aimed to assess evidence of the effect of perioperative exercise among patients with LC.

Materials and Methods:

Seven databases were searched from January 1998 to September 2020. All randomized controlled trials (RCTs) that evaluated the effect of exercise on the physical and psychological status of patients with LC during the perioperative period were reviewed. Two reviewers independently assessed the quality of all studies included here using the revised Cochrane risk of bias tool for RCTs.

Results:

Seventeen RCTs (1199 participants) published between 2011 and 2019 met for this literature review. The outcome measures that emerged from these studies included subjective outcomes, such as HRQoL, pain score, fatigue, and objective effects, such as cardiorespiratory fitness, pulmonary function, physical activity, and biological markers. Overall, these studies suggest that exercise should be an optimal option for LC; however, its efficacy and effectiveness regarding HRQoL should be investigated further.

Conclusion:

Perioperative exercise could be included in the rehabilitation program of patients with LC. More extensive, high-quality RCTs evidence is needed on the ideal exercise type, duration, intensity, and timing across the LC perioperative care.

The effectiveness of far-infrared irradiation on foot skin surface temperature and heart rate variability in healthy adults over 50 years of age: A randomized study

BACKGROUND

Far-infrared irradiation (FIR) is used in the medical field to improve wound healing, hemodialysis with peripheral artery occlusive disease, and osteoarthritis but seldom used in ameliorating poor lower extremity circulation. The purpose of this study was to evaluate the effect of FIR on changes in foot skin surface temperature (FSST) and autonomic nerve system (ANS) activity to evaluate its effectiveness in improving lower limb circulation.

METHODS

A randomized controlled study was conducted. Subjects (n = 44), all over the age of 50 years and satisfying the inclusion criteria, were randomly allocated into 2 groups. The intervention group received FIR on a lower limb for 40 minutes and the control group received no intervention. Left big toe (LBT), right big toe (RBT), left foot dorsal (LFD), right foot dorsal (RFD) surface skin temperature, autonomic nervous activity, and blood pressure were assessed.

RESULTS

The main results were skin surface temperature at the LBT increased from 30.8 ± 0.4°C to 34.8 ± 0.4°C, at RBT increased from 29.6 ± 0.4°C to 35.3 ± 0.4°C and LFD increased from 31.9 ± 0.3°C to 36.4 ± 0.4°C, RFD increased from 30.7 ± 0.3°C to 37.7 ± 0.2°C. FIR caused a significant increase of the FSST ranging in a 4°C to 7°C increase after 40 minutes irradiation (P < .001). The ANS low-frequency (LF) and high-frequency (HF) activity showed a statistically significant increase in the FIR group (P < .05) but not the LF/HF ratio.

CONCLUSION

FIR significantly increased the FSST from between 4°C and 7°C after 40 minutes irradiation, which might improve lower extremity circulation and regulation of ANS activity.

The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers

PURPOSE

The purpose of this study was to explore the experiences of caregivers in long-term care facilities as they implement palliative care. Although palliative care has been available in Taiwan for more than 30 years, it is often provided in hospitals, few models in the long-term care facilities.

METHODS

Semi-structured interviews using grounded theory methodology and purposive sampling. Two small long-term care facilities that had performed well in palliative care were selected from eastern Taiwan. A total of 12 caregivers participated in in-depth semi-structured face-to-face interviews.

RESULTS

Four major stages in the implementation of palliative care were identified: (1) feeling insecure, (2) clarifying challenges, (3) adapting to and overcoming the challenges, and (4) comprehending the meaning of palliative care. The core category of these caregivers as "the guardians at the end of life" reflects the spirit of palliative care.

CONCLUSION

This study demonstrates that successful palliative care implementation would benefit from three conditions. First, the institution requires a manager who is enthusiastic about nursing care and who sincerely promotes a palliative care model. Second, the institution should own caregivers who possess personality traits reflective of enthusiasm for excellence, unusual ambition, and a true sense of mission. Third, early in the implementation phase of the hospice program, the institution must have the consistent support of a high-quality hospice team.

Association Between Sarcopenia and Clinical Outcomes in Patients With Esophageal Cancer Under Neoadjuvant Therapy

BACKGROUND/AIM

This study aimed to evaluate the association of sarcopenia and Clinical Outcomes with esophageal cancer under neoadjuvant chemoradiotherapy (CRT).

PATIENTS AND METHODS

A retrospective study assessing patients with esophageal cancer who underwent CRT between 2001 and 2014 was conducted in the medical center. Hospital patients' records on sarcopenia and treatment outcomes were statistically analyzed.

RESULTS

The sarcopenia group had significantly lower body mass index than the non-sarcopenia group. CRT-related severe adverse events with mucositis, fever, and neutropenic fever were greater in the sarcopenia group. Overall survival and disease-free survival were significantly better in the non-sarcopenia group. Sarcopenic patients who received nutritional support with enteral access had less severe mucositis. There was no difference in mortality of sarcopenia patients with nutritional support via enteral access or without. Moreover, sarcopenia and advanced tumor stage were independent factors for mortality outcome.

CONCLUSION

Sarcopenia before CRT may be associated with increased toxicities and worse overall survival/ disease-free survival in esophageal cancer patients.

Enteral Access Potentially Endangers Esophageal Carcinoma Patients Under Multi-modality Therapy: A Population-based Study

BACKGROUND/AIM

This study aimed to evaluate the clinical outcome of esophageal cancer (EC) patients with enteral access (EA) undergoing multimodality therapy.

PATIENTS AND METHODS

This retrospective study analyzed data between 1997 and 2012 in Taiwan using the National Health Insurance Research Database. Patients with newly-diagnosed EC undergoing multimodality therapy were identified and classified as either EA group or no-EA group.

RESULTS

The mortality incidence of EC patients with EA was significantly higher than in no-EA patients. The Cox model revealed the EA group had a higher risk of mortality than the no-EA group. Patients with chronic obstructive pulmonary disease (COPD) were at significantly higher risk of mortality compared to patients without COPD.

CONCLUSION

EA in EC patients undergoing multimodality therapy was associated with an increased risk of mortality.

Efficacy of Enteral Access in Patients with Esophageal Squamous Cell Carcinoma Under Neoadjuvant Therapy

BACKGROUND

Enteral feeding tubes used to manage the nutritional status of esophageal cancer were evaluated regarding their effectiveness in patients receiving neoadjuvant therapy.

PATIENTS AND METHODS

A retrospective study evaluating patients with esophageal squamous cell carcinoma undergoing neoadjuvant therapy between 2001 and 2014 was conducted at a medical center. Hospital patients' records for enteral access (EA) insertion and treatment outcomes were statistically analyzed.

RESULTS

Patients with EA at initial diagnosis had lower body mass index than the group without EA (p=0.012). Chemotherapy-related adverse events with grade 3-4 mucositis were significantly less frequent in the EA group (p=0.008), and grade 3-4 anemia was significantly more frequent (p=0.012). The 4-year mortality rate was 63.0% in the EA group and 67.7% in the group without EA (p_{non-inferiority}=0.035), which met the non-inferiority criterion with a non-inferiority margin of 10%.

CONCLUSION

Patients with esophageal squamous cell carcinoma with malnutrition status undergoing neoadjuvant therapy with EA showed an improved outcome at maintaining nutritional status, reduced severity of mucositis and improved survival rate.

[Physiological Relevance and Nursing Care Applications of Moxibustion as Applied to the Sanyinjiao Acupoint on Females]

Moxibustion is a thermal therapy procedure that applies burning material to the surface of specific acupoints, which warms the meridians and dispels cold. This procedure is widely used in traditional Chinese medicine care and treatment. It is also an important complementary and replacement therapy in many countries. Moxibustion on the Sanyinjiao acupoint of females is one of the main methods used to treat and care for women's health problems. The physiological effects of moxibustion on the Sanyinjiao acupoint include heightening the skin surface temperature to improve circulation and adjusting the balance of the autonomic nervous system via the meridians in order to regulate the affiliated organs (liver, spleen, and kidney). Moxibustion carries health risks, including the possibility of burns. Therefore, this therapy must follow the principles of moxibustion in order to safely complete the course and achieve the intended efficacy. In nursing-care applications, we must consider the process, time, distances, and safety of moxibustion. In exploring this theme, we hope the present paper helps readers better apply moxibustion in nursing-care applications and in the nursing education curriculum.

Changes in skin surface temperature at an acupuncture point with moxibustion

OBJECTIVE

This study evaluates the thermographic changes associated with moxa burner moxibustion at the SP6 acupuncture point to establish an appropriate, safe distance of efficacy for moxibustion.

METHODS

Baseline temperature changes using a moxa burner were obtained for a paper substrate at various distances and times, and the tested with volunteers in a pilot study. A single-group trial was then conducted with 36 healthy women to monitor temperature changes on the body surface at the acupuncture point (SP6).

RESULTS

Based on the temperature changes seen for the paper substrate and in the pilot study, a distance of 3 cm was chosen as the intervention distance. Moxibustion significantly increased the SP6 point skin surface temperature, with a peak increase of 11°C at 4 min (p <0.001). This study also found that during moxibustion the temperature of the moxa burner's rubber layer and moxa cautery were 56.9±0.9°C and 65.8±1.2°C, as compared to baseline values of 35.1°C and 43.8°C (p<0.001).

CONCLUSIONS

We determined 3 cm was a safe distance between the moxa burner and acupuncture point. Moxibustion can increase the skin surface temperature at the SP6 point. This data will aid traditional Chinese medicine (TCM) practitioners in gauging safer treatment distances when using moxibustion treatments.

Effects of music on immunity and physiological responses in healthcare workers: a randomized controlled trial

Research-based evidence supports the effectiveness of soothing music in improving stress-related psycho-physiological indices in a clinical setting. However, there is currently insufficient scientific knowledge of the effects of music on immune markers of stress in humans. Therefore, the aims of the study were to compare the effects of music and quiet rest on the levels of interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), interleukin-10 (IL-10), heart rate and mean arterial pressure among healthcare workers. By using a randomized controlled trial design, 60 nurses were randomly assigned to the stimulating or sedating music or rest groups for 30 min. Participants' psychoneuroimmunological parameters were measured using enzyme-linked immunosorbent assays. General estimating equation was used to analyse data. Results revealed that IL-6, TNF-α and IL-10 were not detectable in this population. No significance differences in heart rate were found among the three groups. However, the stimulating music group had significantly higher mean arterial pressure levels than the sedating music group but no differences between the quiet rest group and the sedating music group. Music with different tempi had little effect on mean arterial pressure. Any effect of music on immune markers of stress requires further research.

Hypothermia caused by slow and limited-volume fluid resuscitation decreases organ damage by hemorrhagic shock

BACKGROUND

Hypothermia frequently occurs during fluid resuscitation of trauma victims, especially in patients with a major blood loss. Recent studies have suggested that mild hypothermia may ameliorate hemorrhagic shock (HS) induced splanchnic damage.

OBJECTIVE

The aim of the present study is to compare the status of body temperature and splanchnic injury under different resuscitation speeds for HS in conscious rats.

METHODS

Experimental study in an animal model of HS. Twenty-four male Wistar-Kyoto rats were used in the study. To mimic HS, 40% of the total blood volume was withdrawn. Fluid resuscitation was given 30 min after blood withdrawal. The rats were randomly divided into three groups; the control group, the 10-min rapid group, and the 12-h slow group.

RESULTS

Levels of blood biochemical parameters, including aspartate transferase (GOT), and alanine transferase (GPT), were measured. Levels of serum tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) were measured and levels of bronchoalveolar lavage fluid (BALF) TNF-α and nitric oxide (NO) were measured by ELISA. The lung, liver and small intestine were examined for pathological changes 48 h after HS.

CONCLUSIONS

Initially slow rate resuscitation with limited-volume significantly decreased body temperature, serum GOT, GPT, TNF-α, and IL-6 levels, levels of TNF-α, and NO in BALF. Moreover, the slow group had lower injury scores in the lung, liver and small intestine than the rapid group after HS. This finding suggests that mild hypothermia induced by a slow fluid resuscitation rate with limited-volume ameliorates HS-induced splanchnic damage in conscious rats.

[Relationships among clinical symptoms, bladder condition, and subjective perceptions in patients with interstitial cystitis/painful bladder syndrome]

BACKGROUND

Interstitial cystitis (IC) is a silent challenge for patients. Various symptoms related to IC are causes of physical disability and mental distress.

PURPOSE

This study investigated the relationships between clinical symptoms, bladder condition and patient perceptions.

METHODS

This study enrolled 107 patients diagnosed with interstitial cystitis at a medical center in eastern Taiwan and employed a cross-sectional design. Patient medical charts were reviewed. Structural questionnaires were used to collect data.

RESULTS

Participants with a high symptom problem index had poor bladder compliance, severe glomerulation and high visual analog scale (VAS) scores. There was a positive correlation between Hunner's ulcer and a high VAS score. Patients with severe lower urinary symptoms, low competency and severe glomerulation earned significantly higher patient perception of bladder condition scores.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

This study found significant correlations between clinical symptoms, bladder condition and patient perceptions. This study may help enhance nursing staff knowledge of IC clinical symptoms so that they may provide appropriate interventions and education to improve patient self-care abilities and life quality.

Rosiglitazone protects against severe hemorrhagic shock-induced organ damage in rats

Background

Hemorrhagic shock (HS) followed by resuscitation can induce the production of several inflammatory mediators and lead to multiple organ dysfunction. The molecular mechanism of biologic responses to rosiglitazone has an anti-inflammatory effect. The present study was designed to investigate the effects of rosiglitazone on physiopathology and inflammatory mediators after HS in rats.

Material/Methods

HS was induced in rats by withdrawing 60% of the total blood volume from a femoral artery catheter, immediately followed by intravenous injection of 0.3 mg/kg rosiglitazone. Mean arterial pressure (MAP) and heart rate (HR) were monitored continuously for 12 h. Levels of biochemical parameters, including GOT, GPT, BUN, Cre, LDH, CPK, and lactate were measured at 30 min before induction of HS and 0, 1, 3, 6, 9, and 12 h after HS, while an equal volume of normal saline was replaced as fluid resuscitation. Inflammatory mediators, including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1), were measured in serum at 1 and 12 h after HS. The kidneys, liver, lungs, and small intestine were removed for histological assessment by hematoxylin and eosin stained at 48 h after HS.

Results

HS significantly increased blood GOT, GPT, BUN, Cre, LDH, CPK, lactate, glucose, TNF-α, IL-6 and MCP-1 levels, induced tachycardia, and decreased mean arterial pressure (MAP) in rats. Treatment with rosiglitazone improved survival rate, decreased the markers of organ injury, and suppressed the release of TNF-α, IL-6, and MCP-1 after HS in rats.

Conclusions

Treatment with rosiglitazone suppresses the release of serum TNF-α, IL-6 and MCP-1, and ameliorates HS-induced organ damage in rats.

Antibacterial silver-containing silica glass prepared by ion implantation

Recently, there is much interest in nanocomposites consisting of metal nanoparticles dispersed in dielectric matrix. Silver is the first candidate used in antibacterial research. In the present study, sliver-containing silica glass is prepared by ion implantation. The bactericidal properties of Ag-implanted samples are investigated using E. coli. The implanted samples are characterized by optical absorption spectroscopy, atomic force microscopy and transmission electron microscopy. The size and position of the silver nanoparticles formed by ion implantation can be optimized by adjusting the implanted process parameters. All the implanted samples show antibacterial properties. But the samples with silver nanoparticle-enriched surfaces possess excellent antibacterial properties in comparison with other implanted samples. This indicates that ion implantation is a potential method for synthesizing antibacterial biomaterials.

Synthesis and Magnetic Properties of Maghemite (gamma-Fe(2)O(3)) Short-Nanotubes

We report a rational synthesis of maghemite (gamma-Fe(2)O(3)) short-nanotubes (SNTs) by a convenient hydrothermal method and subsequent annealing process. The structure, shape, and magnetic properties of the SNTs were investigated. Room-temperature and low-temperature magnetic measurements show that the as-fabricated gamma-Fe(2)O(3) SNTs are ferromagnetic, and its coercivity is nonzero when the temperature above blocking temperature (T(B)). The hysteresis loop was operated to show that the magnetic properties of gamma-Fe(2)O(3) SNTs are strongly influenced by the morphology of the crystal. The unique magnetic behaviors were interpreted by the competition of the demagnetization energy of quasi-one-dimensional nanostructures and the magnetocrystalline anisotropy energy of particles in SNTs.

[Fluid resuscitation therapy application and nursing following hemorrhagic shock]

Hemorrhagic shock is the most important cause of early death following major trauma. Aggressive fluid resuscitation therapy is an important treatment approach for hemorrhagic shock, and nurses in critical care units must be adept at the skills to administer such. However, past studies have shown that failure in multiple organs has been induced by aggressive fluid resuscitation therapy. This article first discusses the two hit theory following trauma or shock, then discusses how aggressive crystalloid-based resuscitation strategies are associated with cell, multiple organs and immunological and inflammatory mediator dysfunction. While the Advanced Trauma Life Support (ATLS) training program has provided fluid resuscitation therapy guidelines since 1997, resuscitation volume, rate and time as well as crystalloid and colloid ratios remain uncertain. Therefore, we hope this article can provide evidence-based knowledge related to fluid resuscitation therapy in order to avoid secondary organ damage in critical care.

Stability of Blood Biochemistry Levels in Animal Model Research: Effects of Storage Condition and Time

The purpose of this study was to compare whole blood and plasma in terms of the subsequent accuracy of blood lactate, glucose, lactate dehydrogenase (LDH), creatine phosphokinase (CPK), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) measurement. Blood samples were drawn from 8 male Wistar-Kyoto rats. The rats were homologous, weighed 300— 380 g, were housed in the same environment, and were provided with food and water under the same conditions. Blood draws occurred in all rats at same time. The blood specimens were divided into two samples, one to be stored as whole blood (WBS) and one to be stored as plasma (PS). All the blood sample analyses were performed by trained and experienced personnel to ensure that differences in results were due to variation in form in which specimens were stored rather than to technique. The lactate concentration in the WBS group gradually increased over time, intraclass correlation coefficient (ICC) = 0.541, 95% confidence interval (CI; —0.197, 0.893), and was higher than that of the PS group, ICC = 0.897, 95% CI (0.733, 0.976). By contrast, glucose level gradually declined for the WBS group, ICC= —0.367, 95% CI (—2.563, 0.682). Whole blood storage increased measurement variation for lactate, glucose, LDH, and CPK. Plasma storage prolonged the stability of the biochemical components. This study demonstrates the importance of evaluating validity at each stage of developing and testing animal models.

Melatonin ameliorates hemorrhagic shock-induced organ damage in rats

BACKGROUND

Hemorrhagic shock (HS) followed by resuscitation can result in production of several inflammatory mediators, such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), leading to multiple organ dysfunction. Melatonin can attenuate organ damage with its anti-inflammation effects. The present study was designed to investigate the effects of melatonin on the physiopathology and cytokine levels after HS in rats.

METHODS

HS was induced in rats by withdrawing 40% of the total blood volume (6 mL/100 gm body weight) from a femoral artery catheter, immediately followed by intravenous injection of 10mg/kg melatonin. Mean arterial pressure and heart rate were monitored continuously for 48 h after the start of blood withdrawal. Biochemical parameters, including levels of hemoglobulin, glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), blood urea nitrogen (BUN), creatinine (Cre), lactic dehydrogenase (LDH), creatine phosphokinase (CPK), and lactate, were determined 30 min before and 0, 1, 3, 6, 12, 24, and 48 h after induction of HS while an equal volume of normal saline was replaced as fluid resuscitation. Cytokine levels including TNF-α and IL-6 in the serum were measured at 1, 24, and 48 h after HS. The kidney, liver, lung, and small intestine were removed for pathology assessment at 48 h after HS.

RESULTS

HS significantly increased the heart rate, blood GOT, GPT, BUN, Cre, LDH, CPK, lactate, TNF-α, and IL-6 levels, and decreased hemoglobulin and mean arterial pressure in rats. Treatment with melatonin preserved the mean arterial pressure, decreased tachycardia, and markers of organ injury, and suppressed the release of TNF-α and IL-6, with no change in hemoglobulin after HS in rats.

CONCLUSION

Treatment with melatonin suppresses the release of serum TNF-α and IL-6, and decreases the levels of markers of organ injury associated with HS, thus ameliorating HS-induced organ damage in rats.

Propofol protects against hemorrhagic shock-induced organ damage in conscious spontaneously hypertensive rats

Patients with hypertension have higher mortality rates from hemorrhagic shock (HS) than normotensive patients. Several inflammatory mediators such as tumor necrosis factor alpha (TNF-alpha) and interleukin 10 (IL-10) can be produced by HS and lead to multiple organ dysfunction and death. We investigated the effects of high dose (10 mg/kg/hr) and low dose (1 mg/kg/hr) propofol treatment after HS in conscious spontaneously hypertensive rats (SHRs). By withdrawing 40% of total blood volume from a femoral arterial catheter (6 ml/100 g body weight [BW]) for more than 30 min, HS was induced. The mean arterial pressure (MAP) and heart rate (HR) were monitored continuously for 24 hr after the start of blood withdrawal. Levels of biochemical parameters, including glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), blood urea nitrogen (BUN), creatinine (Cre), creatine phosphokinase (CPK), and lactic dehydrogenase (LDH) were measured 30 min before and 0, 1, 3, 6, 9, 12, 18, and 24 hr after the 30-min blood withdrawal period. Cytokine levels, including TNF-alpha and IL-10 in the serum, were measured 1 hr after HS. The kidney, liver, and lung were removed for pathology assessment at 48 hr after HS. HS significantly increased blood GOT, GPT, BUN, LDH, CPK, TNF-alpha, and IL-10 levels in conscious SHRs. Posttreatment propofol decreased serum TNF-alpha level, increased serum IL-10 level, attenuated the severity of organ damage, and improved survival rate after HS. This treatment protected SHRs against HS-induced organ damage. Moreover, high-dose propofol had a more protective effect than low-dose propofol against HS in conscious SHRs.

Freshwater clam extract ameliorates acute liver injury induced by hemorrhage in rats

The freshwater clam is a widely-consumed shellfish and is used as a remedy for chronic hepatitis in Asia. However, its contribution to acute liver injury (ALI) remains unclear. The aim of this study is to assess the protective effects of freshwater clam extract (CE) in ALI induced by hemorrhage in rats. Rats were randomly divided into 5 groups, (1) blood loss (BL) 40%, (2) CE 150 mg/kg plus BL 40%, (3) CE 75 mg/kg plus BL 40%, (4) CE 150 mg/kg, and (5) CE 75 mg/kg groups. CE was given by femoral vein catheter in Groups 2 to 5. Initial hemorrhage was induced by withdrawing blood (loss 40% of total blood volume) from a femoral arterial catheter after CE administration in Groups 2 and 3. The levels of blood tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) were measured at several time points during the experimental period. Rats were sacrificed after 48 hours, and the liver was harvested for hematoxylin and eosin (HE) stain to show liver tissue injury. The results indicated that hemorrhage significantly decreased mean arterial pressure (MAP), increased blood AST, ALT and LDH levels and induced liver injury. Pre-treatment with the CE increased MAP and IL-10 levels and decreased AST, ALT, LDH and TNF-alpha levels after hemorrhage. The HE stains showed diminished organ injury in the CE groups. In conclusion, freshwater clam extract is a potential immunomodulating agent and ameliorates acute liver injury.

Randomized crossover trial studying the effect of music on examination anxiety

The purpose of this study was to assess the effect of lento music on examination anxiety among nursing students. A randomized crossover classroom-based trial was conducted. Thirty-eight students with a mean age of 19.4 years (SD = .54) were randomly assigned to either a music/silence or a silence/music group sequence. The students in the music group were given a 40-min group-based music intervention in a classroom, whereas the students in the silence group received the regular test without music. Using paired t-tests, there were no significant different in pretest scores for state anxiety, examination anxiety, finger temperature and pulse rate between the two conditions. Nonetheless, the findings indicated that music intervention did effectively decrease examination anxiety and state anxiety as well as reducing pulse rate and increasing higher finger temperature (p = 0.05 to 0.001). In addition, significant differences were detected between the pretest and posttest measures for silence (p = 0.001). The results suggest that lento music is effective at anxiety reduction. This study provides evidence for nursing faculty and clinical educators to foster nursing students' mastering over the anxiety of examination by using lento music.

Intensive care unit staff nurses: predicting factors for career decisions

AIMS AND OBJECTIVES

The aim of this study was to understand the factors related to intention to leave their job among intensive care unit (ICU) nurses in eastern Taiwan and to make between-group comparisons between an intention to leave and an intention to stay as well as to predict the influencing factors that affect ICU staff nurses' intention to leave.

BACKGROUND

Nurses' intention to leave their job may have an important impact on the actual turnover of nurses. The issue has always been of concern to nursing executives. Only limited empirical studies in the area have been investigated in an Asian culture context and particularly the eastern Taiwan region.

METHODS

A cross-sectional predictive study was performed during 2005 with 130 nurses recruited from two ICUs at a medical centre. A researcher-designed questionnaire based on the Cooper's model with structured interviews was used to determine each nurse's characteristics and their intention to leave their job. Multiple logistic regression analysis was employed to investigate the various factors associated with this.

RESULTS

The overall response rate was 100%; 63 (48.9%) revealed that they intended to leave their jobs. The findings were that their self-rated health status, the number of diseases, the level of happiness, the presence of depression, job satisfaction, sleep quality, type of license and their unit were significantly associated with an intention to leave (p = 0.05-0.001). Depression and sleep quality proved to be the most significant predictors of ICU staff nurses' intention to leave their job.

CONCLUSIONS

The findings suggest that there is a need to take steps to improve nurses' health-related quality of life and to develop effective strategies to improve nurse retention.

RELEVANCE TO CLINICAL PRACTICE

A succinct validated instrument would help identify the important factors that predict ICU nurses' intention to leave their job, which may result in job disengagement. Predictors found in this study may be used as outcome variables for developing such an effective method of improving nurse retention in ICUs.

Is nursing profession my first choice? A follow up survey in pre-registeration student nurses

The purpose of this study was to explore how nursing students' value factors, motivational factors, institutional factors and competence factors contributed to career intent. All fifth-year nursing students (n=231) in a college in eastern Taiwan completed a survey which followed-up a study done 1 year previously in the same population were followed for 1 year. A validated and reliable self-administered questionnaire developed by the investigators in 2004 and modified in 2005 was used in the study. Data on value factors, competence factors, motivational factors, and situational factors were collected. The overall response rate was 87.4%. The rates of considering nursing as their first choice improved from 19.1% at the point of college-entry to 34.6% in 2004 and 46.5% in 2005 in the same cohort students. Past experience with being ill, degree of stress, self-rated clinical competency, perceived support from staff nurses, and perceived value were associated with career decision after the completion of a whole year of clinical practice (p<0.05-0.01). In multivariate analysis, perceived support from staff nurses, past experience with being ill, and perceived value proved to be significant predictors of the career intent of pre-registration student nurses. Nursing faculty and nurse administrators need to provide assistance to reduce nursing students' career attrition.

Factors associated with career decision in Taiwanese nursing students: A questionnaire survey

The vocational decisions of nursing students have always been a concern for nursing educators and administrators. It is unclear, however, what factors play a role in determining the professional choices made by these students. Limited research into this area has been undertaken in Taiwan. This study, therefore, was designed to investigate the factors associated with career choices in Taiwan's nursing students. The convenience sample included all fourth-year nursing students of a college in eastern Taiwan. A validated and reliable self-administered questionnaire developed by the investigators was used in the study. The sample population consisted of 231 fourth-year nursing students. Notably, 65.4% reported that they would not choose nursing as a career after graduation. Significant variables associated with this career decision were clinical ability (t=2.35, p<0.05), degree of stress during clinical practice (t=-3.04, p<0.01), and perceived support from staff nurses (t=2.28, p<0.05). These results suggest that both educators and administrators need to reconsider the way nursing students are educated, and indicate that strategies must be developed to enhance students' motivation to select nursing as a career.

Randomized controlled trial of music during kangaroo care on maternal state anxiety and preterm infants’ responses

The purpose of this randomized controlled trial was to investigate the influences of music during kangaroo care (KC) on maternal anxiety and preterm infants' responses. There are no experimental studies that explore the influences of combination of music and KC on psychophysiological responses in mother-infant dyads. Purposive sampling was used to recruit 30 hospitalized preterm infants body weight 1500 gm and over, gestational age 37 weeks and lower from two NICUs. Mother-infant dyads were randomly assigned to the treatment and the control group using permuted block randomization stratified on gender. There were 15 mother-infant dyads in each group. Subjects in the treatment dyads listened to their choice of a lullaby music during KC for 60 min/section/day for three consecutive days. Control dyads received routine incubator care. Using a repeated measures design with a pretest and three posttests, the responses of treatment dyads including maternal anxiety and infants' physiologic responses (heart rate, respiratory rate, and O2 saturation) as well as behavioural state were measured. The results revealed that there were no significant differences between the two groups on infants' physiologic responses and the values were all in the normal range. However, infants in the treatment group had more occurrence of quiet sleep states and less crying (p<0.05-0.01). Music during KC also resulted in significantly lower maternal anxiety in the treatment group (p<0.01). Maternal state anxiety improved daily, indicating a cumulative dose effect. The findings provide evidence for the use of music during KC as an empirically-based intervention for bahavioural state stability and maternal anxiety in mother-infant dyads.

Nitric oxide mediates lung injury induced by ischemia-reperfusion in rats

Nitric oxide (NO) has been reported to play a role in lung injury (LI) induced by ischemia-reperfusion (I/R). However, controversy exists as to the potential beneficial or detrimental effect of NO. In the present study, an in situ, perfused rat lung model was used to study the possible role of NO in the LI induced by I/R. The filtration coefficient (Kfc), lung weight gain (LWG), protein concentration in the bronchoalveolar lavage (PCBAL), and pulmonary arterial pressure (PAP) were measured to evaluate the degree of pulmonary hypertension and LI. I/R resulted in increased Kfc, LWG, and PCBAL. These changes were exacerbated by inhalation of NO (20-30 ppm) or 4 mM L-arginine, an NO precursor. The permeability increase and LI caused by I/R could be blocked by exposure to 5 mM N omega-nitro-L-arginine methyl ester (L-NAME; a nonspecific NO synthase inhibitor), and this protective effect of L-NAME was reversed with NO inhalation. Inhaled NO prevented the increase in PAP caused by I/R, while L-arginine had no such effect. L-NAME tended to diminish the I/R-induced elevation in PAP, but the suppression was not statistically significant when compared to the values in the I/R group. These results indicate that I/R increases Kfc and promotes alveolar edema by stimulating endogenous NO synthesis. Exogenous NO, either generated from L-arginine or delivered into the airway, is apparently also injurious to the lung following I/R.

Nitric oxide mediates lung injury induced by ischemia-reperfusion in rats

Nitric oxide (NO) has been reported to play a role in lung injury (LI) induced by ischemia-reperfusion (I/R). However, controversy exists as to the potential beneficial or detrimental effect of NO. In the present study, an in situ, perfused rat lung model was used to study the possible role of NO in the LI induced by I/R. The filtration coefficient (Kfc), lung weight gain (LWG), protein concentration in the bronchoalveolar lavage (PCBAL), and pulmonary arterial pressure (PAP) were measured to evaluate the degree of pulmonary hypertension and LI. I/R resulted in increased Kfc, LWG, and PCBAL. These changes were exacerbated by inhalation of NO (20-30 ppm) or 4 mM L-arginine, an NO precursor. The permeability increase and LI caused by I/R could be blocked by exposure to 5 mM N omega-nitro-L-arginine methyl ester (L-NAME; a nonspecific NO synthase inhibitor), and this protective effect of L-NAME was reversed with NO inhalation. Inhaled NO prevented the increase in PAP caused by I/R, while L-arginine had no such effect. L-NAME tended to diminish the I/R-induced elevation in PAP, but the suppression was not statistically significant when compared to the values in the I/R group. These results indicate that I/R increases Kfc and promotes alveolar edema by stimulating endogenous NO synthesis. Exogenous NO, either generated from L-arginine or delivered into the airway, is apparently also injurious to the lung following I/R.

Peripartum cardiomyopathy--a case report

Peripartum cardiomyopathy in the form of congestive heart disease of unknown etiology appears relatively rarely during the last month of pregnancy or within 5 months after delivery, and it is potentially life-threatening. This case report describes a 34-year-old female, G4P1, at 36 weeks' gestation who was admitted for cesarean section under lumbar epidural anesthesia due to twin pregnancy. She had no past history of cardiovascular diseases. However, rapid onset of dyspnea at ward and acute cardiac failure developed 15 h after cesarean section. Peripartum cardiomyopathy was diagnosed. After a 7-day intensive treatment she was discharged. Since then she was symptom-free and her two babies were doing well during a period of one more years after discharge.

Does augmented growth impose an increased risk of fetal death?

OBJECTIVE

Our purpose was to examine the risk of fetal death associated with augmented fetal growth.

STUDY DESIGN

All live births recorded in Virginia between January 1, 1991, and December 31, 1993, were examined. Mortality rates were examined for infants born at or beyond 24 weeks' gestational age with weights between the 75th and 90th percentiles, from the 90th to the 95th percentile, and >95th percentile.

RESULTS

Mortality rates were found to rise only slightly with birth weights >90th percentile. A recorded diagnosis of maternal diabetes, however, was associated with a significant risk in the presence of augmented fetal growth. Augmented fetal growth without maternal glucose intolerance showed no increase in mortality.

CONCLUSION

Augmented fetal growth in the absence of maternal glucose intolerance appeared not to be associated with a significant increase in the risk of death among these births. Increased risk was found when augmented fetal growth was associated with maternal diabetes.

Epidural anesthesia for emergency caesarean section in a patient with single ventricle and aortic stenosis

A 24-year-old parturient with single ventricle and moderate aortic stenosis was admitted due to preeclampsia and fetal distress at 31 weeks' gestation. Emergency Caesarean section was performed under lumbar epidural anesthesia and epidural analgesia was given for post-operative pain control. Mother and baby both survived. The anesthetic techniques and managements in other parturients with similar congenital cardiac anomalies are also reviewed and described.

A selective aggressive approach to the neonate exposed to meconium-stained amniotic fluid

OBJECTIVE

We attempted to determine the effect on meconium aspiration syndrome from a selective approach of neonatal endotracheal intubation in meconium-exposed fetuses.

STUDY DESIGN

All pregnancies delivered at the Medical College of Virginia in 1990 were included. Meconium was noted at membrane rupture and qualified as thick, moderate, or thin. Neonates underwent suctioning with a DeLee device at delivery. They were observed without endotracheal intubation if they fulfilled the following criteria: vaginal delivery, gestational age > 37 weeks, birth weight > 2500 gm, and anticipated Apgar score > or = 8 at 1 minute.

RESULTS

Of 4289 deliveries, 659 were exposed to meconium and 48% of infants were intubated. Birth weights, gestational ages at delivery, and umbilical arterial pH were similar between intubated and nonintubated neonates. Neonatal intensive care unit admissions were significantly higher in intubated neonates. All 9 neonates diagnosed with meconium aspiration syndrome were intubated at birth.

CONCLUSIONS

Utilization of this protocol resulted in reduction of neonatal intubation. Meconium aspiration syndrome did not occur in the nonintubated group.

Maternal disease and injury in pregnancy

Progress in the management of medical disorders of pregnancy has occurred in many areas. Only salient features are reviewed. The pathophysiology of maternal hyperglycemia in diabetes and its effects on the fetus are explored. Antiphospholipid antibodies, implicated in adverse pregnancy sequelae, come under closer scrutiny in terms of management and correlation with outcome. Studies defining a need for a strict diet for optimal neonatal outcome are presented regarding maternal phenylketonuria. Coagulopathies including protein C deficiency and deep venous thrombosis are reviewed for their impact on pregnancy. Uncommon disorders including cerebrovascular accidents, ureteric obstruction, and myocardial infarction are discussed in relation to management and outcome in pregnancy.

Obstetric complications in a patient with Bernard-Soulier syndrome

We describe the obstetric complications and management of a patient with Bernard-Soulier syndrome. Severe bleeding at the time of delivery and delayed postpartum hemorrhage were prominent features of her pregnancies. Further complicating this woman's pregnancies was the development of antibodies to platelet glycoprotein IB/IX, leading to neonatal alloimmune thrombocytopenia.

Lower serum osteocalcin in ethanol-fed rats

Serum osteocalcin was remarkably and significantly (-34 and -41% in two separate experiments; p less than 0.001) lower in rats fed an 8% (w/v) ethanol liquid diet (ELD) for 1 week than in rats fed an isocaloric control liquid diet (CLD). In a longer experiment that spanned 4 weeks, the ELD rats were given 6% ethanol on day 4, increased stepwise to 8% by day 9, and then maintained at 8% until day 28, when the experiment was terminated. Again, serum osteocalcin was much lower (-32%, p less than 0.001) in the ELD-fed rats than in CLD-fed rats. Even in rats fed only a 6% ELD for 12 days, serum osteocalcin was lower (-33%, p less than 0.001) than in controls. Also, the femora were weaker, more compliant, and more ductile in ELD-than in CLD-fed rats, findings that confirmed our earlier, related work. The fall in serum osteocalcin in ELD-fed rats is associated with a fall in femur ash weight and bone strength. There were significant correlations between serum osteocalcin and bone strength (r = 0.80; p less than 0.001) and between serum osteocalcin and bone stiffness (r = 0.83; p less than 0.001). Serum ionized calcium, like osteocalcin, was consistently lower in rats given ethanol for 1 or 4 weeks than in controls. From these experiments we conclude that excessive ethanol consumption inhibits osteoblastic activity as indicated by the reduced serum osteocalcin. The inhibition is also associated with other deleterious effects of ethanol on bone, including ash weight, bone strength, and bone stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

An integrated, hospital information system based obstetrical medical record and database

Described in this paper is the implementation and integration of an obstetrical medical record and database into an existing hospital information system. A unique feature of this system was the integration of existing data captured by the established hospital information systems with the newly implemented obstetrical database to form a complete patient data profile. This complete database integrated data from hospital functions such as demographic data obtained at patient registration, outpatient visits and tests, inpatient admission historical data, tests and procedures, newborn data and miscellaneous data required for birth registration. An important second feature was the utilization of physicians and nurses to enter the obstetrical data. This permitted immediate access to patient data from any hospital information system terminal, immediate retrieval for generating reports, and subsequently, ad hoc queries, statistical analysis and the electronic transfer of birth registration data to the State Vital Statistics Registry.

Prevalence of human papillomavirus infections in term pregnancy

The prevalence of human papillomavirus (HPV) infections in the lower genital tracts of pregnant and nonpregnant women was studied. Cervical and vaginal exfoliated cells were obtained during a routine pelvic examination in 45 pregnant women in early labor, and in 44 nonpregnant women. A detailed questionnaire with emphasis on sexual history and sexually transmitted diseases was administered. The two groups of women were comparable with respect to mean age, prior pregnancy experiences, and number of lifetime sexual partners. Compared with pregnant women, the nonpregnant women had a more frequent history of sexually transmitted diseases (61% versus 39%; p = 0.06), and of genital warts (16% versus 0%; p = 0.01). Utilizing Southern transfer and hybridization with 32P-labeled viral DNA probes for HPV types 6, 11, 16, 18, and 31, DNAs extracted from cervicovaginal exfoliated cells were assessed for HPV genomic sequences. HPV genomic sequences were identified in 25% of nonpregnant women compared with 13.5% of term pregnant women. This difference was not statistically significant (p = 0.26). Six HPV isolates identified in pregnant women were distributed as follows: type 6/11, 1; type 16, 1, type 31, 1; and unknown type, 3. Eleven isolates were identified in nonpregnant women and were distributed as follows: type 6/11, 2; type 16, 6; type 18, 2; and type 31, 1. HPV type 6/11, the type responsible for laryngeal papillomatosis of juvenile onset, was identified in 2% of the pregnant population and accounted for only one of six isolates. HPV DNA-positive pregnant and nonpregnant women were predominantly asymptomatic and had normal Papanicolaou smears and normal clinical examinations.

Vulvar leiomyosarcoma in pregnancy

To our knowledge, this is the first case of vulvar leiomyosarcoma occurring during pregnancy to be reported. The neoplasm was resected immediately after a term vaginal delivery. A wide local excision of the vulva with bilateral superficial inguinal node sampling was performed 6 weeks post partum. Four previous cases of vulvar sarcoma occurring in pregnancy are reviewed. The need to perform biopsy of vulvar lesions during pregnancy is emphasized.

Evaluation of inhospital cardiopulmonary resuscitation

Of 77 patients who received cardiopulmonary resuscitation (CPR) for an inhospital cardiac arrest from Jan. 1987 to Mar. 1988. 48(68%) survived the initial resuscitation, but only 11(16%) survived to leave hospital. A follow-up survey to Oct. 1988, of these 11 patients showed that one died within 11 months of discharge, but that others were all alive and living independently. The major cause of cardiopulmonary arrest was airway obstruction. Survival rates were lower if resuscitation efforts lasted more than 30 minutes or if the event occurred between midnight and 8:00 AM. Thirty of the 48 patients who were successfully resuscitated initially were transferred to the intensive care unit for prolonged cardiac life support. Of the patients who had underlying disease or severe neurologic impairment due to hypoxic encephalopathy, 19(63%) were dead within a few days or even hours after CPR. Therefore, we recommend (1) programs for routine CPR assessment (2) extension of CPR training for key personnel, especially ward staff working night shifts (3) assessment by CPR providers as to whether or not to continue or to give DNR (do-not-resuscitate) orders.

Influence of ethanol on stiffness, toughness, and ductility of femurs of rats

Recently, we reported that the ingestion of alcohol in rats reduced the mechanical strength of femurs. Our results showed that, as the dose exceeded 0.012 g of ethanol per gram of body weight, a significant (p less than 0.001) loss of "strength" occurred that was independent of sex according to the relationship, Strength (N) = 140.4 - 6003 dose (g/g). In the present effort, the same flexure tests were reevaluated to include the parameters of stiffness, toughness, and ductility. These latest results confirm that the femurs of rats fed an ethanol liquid diet for 4 weeks are not only weaker but also more compliant and less energy absorbing. Although the femurs of rats fed ethanol are more ductile, the bones are more prone to fracture in fatigue and impact circumstances as well as under simple loading situations. The rat may be an appropriate model to study the mechanisms that lead to the higher incidence of fractures in the alcoholic human.

Ethanol-induced changes in morphology and strength of femurs of rats

Chronic ingestion of ethanol resulted in ultrastructural and mechanical changes in rat femurs. Scanning electron microscopy of the distal end of the femur revealed that the trabeculae of bones from ethanol-fed rats were thinner, more columnar, and more extensive than those from control rats. Three-point bending tests of the rat femurs showed that the maximum force or so-called "strength" required to break the bone was less in ethanol- than in control-fed animals. A significant inverse correlation was observed between the strength required to break the femur and the dose of ethanol calculated on a body weight basis. For the first time our study presents quantitative proof that a relationship exists between bone strength and the consumption of ethanol in rats. The study revealed that ethanol consumption resulted in a weaker femur compared to controls. We suggest that a common mechanism may be responsible for the decreased bone strength of ethanol-fed rats and the increased incidence of fractures in human alcoholics.

Modulation of serum parathyroid hormone and ionized calcium concentrations during reproduction in rats fed a low calcium diet

Moderate dietary restriction of calcium (0.1% Ca) was used to accentuate the changes in serum immunoreactive parathyroid hormone (iPTH) that had been reported earlier in lactating rats fed 0.4% Ca diet. In addition, the effects of this low-Ca diet on serum total and ionized Ca and iPTH during pregnancy, extended lactation, and weaning were examined. The positive correlation between serum total and ionized Ca was highly significant (r = 0.88, p less than 0.001, n = 120). Serum iPTH was significantly higher (36%) in pregnant rats on the day of parturition compared to nonmated controls, and there was a concomitant decrease in both total and ionized serum Ca. Within 1 day after parturition, however, serum Ca had risen to the control level. Serum iPTH remained significantly elevated during the first 2 weeks of lactation, and increased further during the third week of lactation to a level more than twice that of nonlactating controls. Serum Ca fell gradually during the second week of lactation. The high serum iPTH levels were maintained for another 2 weeks when lactation was extended with foster litters. Within 6 hr of removal of the suckling pups on day 16 of lactation, maternal serum ionized and total Ca had risen and serum iPTH had fallen; all three parameters were at levels similar to those of nonmated controls by 24-48 hr after weaning. The data suggest that serum ionized Ca is a major factor contributing to the hyperparathyroid state during lactation in rats fed a low-Ca diet.

Effect of number of suckling pups and dietary calcium on bone mineral content and mechanical properties of femurs of lactating rats

The bone loss that occurs during lactation in rats was aggravated by increasing the number of suckling pups and was further accentuated by feeding the rats a calcium (Ca)-deficient diet. The bone loss was evenly distributed along the whole length of the femur in severe cases. In less severe cases, the metaphyses were affected more than the midshaft. Mechanical properties of femurs, i.e., bone 'strength', 'stiffness', 'toughness' and 'ductility', were all affected in lactating rats suckling seven to eleven pups and fed the 0.1% Ca diet. The positive correlation between bone 'strength' and ash weight is consistent with the concept that when there is loss of bone, bone becomes more susceptible to fracture. The fall in serum ionized Ca and the rise in serum iPTH were closely related to the intensity of lactation and were profoundly affected by litter size and Ca concentration of the diet. We conclude that the change in Ca homeostasis in lactating rats is due to the large loss of Ca required for milk production and that the loss of Ca is associated with hyperfunction of the parathyroid gland. Furthermore, a Ca-deficient diet severely reduced bone mineral content and affected the mechanical properties of femurs of lactating rats adversely, especially those suckling large litters of pups.

Interrelationships of bone ash and whole bone properties in the lactating and parous rat

Several investigators have studied the mechanical properties of long bones of rats and have found that bone strength may be associated with bone mineral content. In this study we examined further the interrelationships of whole bone properties and bone ash weight of the rat femur. Using a 3-point bending test, the bones were evaluated during lactation and after one to three pregnancy + lactation periods--experiments in which bone ash was significantly reduced. A relationship was established between the time of lactation and the ash weight, stiffness, strength, and toughness but not the ductility. Using all of the experimental data, a highly significant relationship was observed between ash weight and stiffness. A similar significant correlation was revealed between bone ash and strength or toughness, although drawing individual lines for each experiment rather than a common line for all the experiments appeared more appropriate. Given the inherent inaccuracies in the material property measurements of bone, the results suggest that routine measurements of whole bone properties provide an important and sensitive way to evaluate bone quality and that these properties correlate significantly with the bone ash weight.

Increase in serum parathyroid hormone concentration in the lactating rat: effects of dietary calcium and lactational intensity

The change in circulating levels of immunoreactive parathyroid hormone (iPTH), measured with an N-terminal specific radioimmunoassay, was examined during lactation in rats. In lactating rats consuming a diet containing 0.4% Ca (basic diet), serum iPTH was a) increased by an average of 53% between days 10 and 18 compared to the level of age-matched nonlactating rats (24.7 +/- 2.1 pg/ml vs 16.1 +/- 0.8 pg/ml, mean +/- SE, p less than 0.01) and b) significantly higher in dams suckling large litters (10-15 pups) than in dams suckling small litters (3 pups) over the period 3-13 days of lactation. Lactating rats consuming a low calcium diet (0.04% Ca), had serum iPTH levels on days 16-18 of lactation approximately twice those of nonlactating rats fed the same diet and 73% higher than those of lactating rats fed the basic diet. Serum Ca concentrations were 22% and 10% lower in dams consuming the 0.04 and 0.4% Ca diets, respectively, than in the nonlactating controls fed the same diets. Regression analysis showed a significant (p less than 0.001) negative correlation between iPTH and total serum calcium. Compared with nonmated controls, net mineral loss from femurs of dams consuming the 0.4% Ca diet was a) insignificant at day 6, b) 27% at day 15, and c) 34% at day 21 of lactation. Our data demonstrate that lactation in the rat is characterized by hyperparathyroidism that appears to be related to lactational intensity and that is accentuated when dietary calcium intake is restricted.(ABSTRACT TRUNCATED AT 250 WORDS)