Effects of prenatal ethanol exposure on regulation of basal hypothalamic-pituitary-adrenal activity and hippocampal 5-HT1A receptor mRNA levels in female rats across the estrous cycle

Prenatal ethanol exposure, like other early adverse experiences, is known to alter hypothalamic-pituitary-adrenal (HPA) activity in adulthood. The present study examined the modulatory effects of the gonadal hormones on basal HPA regulation and serotonin Type 1A receptor (5-HT(1A)) mRNA levels in adult female rats prenatally exposed to ethanol (E) compared to that in females from pair-fed (PF) and ad libitum-fed control (C) conditions. We demonstrate, for the first time, long-lasting consequences of prenatal ethanol exposure for basal corticosterone (CORT) regulation and basal levels of hippocampal mineralocorticoid (MR), glucocorticoid (GR) and serotonin Type 1A (5-HT(1A)) receptor mRNA, as a function of estrous cycle stage: (1) basal CORT levels were higher in E compared to C females in proestrus but lower in E and PF compared to C females in estrus; (2) there were no differences among groups in basal levels of adrenocorticotropin (ACTH), estradiol or progesterone; (3) hippocampal MR mRNA levels were decreased in E compared to PF and C females across the estrus cycle, with the greatest effects in proestrus, whereas E (but not PF or C) females had higher hippocampal GR mRNA levels in proestrus than in estrous and diestrus; (4) 5-HT(1A) mRNA levels were increased in E compared to PF and C females in diestrus. That alterations were revealed as a function of estrous cycle stage suggests a role for the ovarian steroids in mediating the adverse effects of ethanol. Furthermore, it appears that ethanol-induced nutritional effects may play a role in mediating at least some of the effects observed. The resetting of HPA activity by early environmental events could be one mechanism linking early life experiences with long-term health consequences. Thus, changes in basal CORT levels, a shift in the MR/GR balance and alterations in 5-HT(1A) receptor mRNA could have important clinical implications for understanding the secondary disabilities, such as an increased incidence of depression, in children with FASD.

Prenatal ethanol exposure alters the effects of gonadectomy on hypothalamic-pituitary-adrenal activity in male rats

Prenatal ethanol exposure has marked effects on development of the hypothalamic-pituitary-adrenal (HPA) and -gonadal (HPG) axes. In adulthood, ethanol-treated rats show altered gonadal hormone responses and reproductive function, and increased HPA responsiveness to stressors. Importantly, prenatal ethanol differentially alters stress responsiveness in adult males and females, raising the possibility that the gonadal hormones play a role in mediating prenatal ethanol effects on HPA function. To examine a possible testicular influence on HPA activity in males, we compared the effects of gonadectomy on HPA stress responses of adult male offspring from ethanol, pair-fed (PF) and ad libitum-fed control dams. Intact ethanol-treated rats showed increased adrenocorticotrophic hormone (ACTH) but blunted testosterone and luteinising hormone (LH) responses to restraint stress, and no stress-induced elevation in arginine vasopressin (AVP) mRNA levels compared to those observed in PF and/or control rats. Gonadectomy: (i) significantly increased ACTH responses to stress in control but not ethanol-treated and PF males; (ii) eliminated differences among groups in plasma ACTH and AVP mRNA levels; and (iii) altered LH and gonadotrophin-releasing hormone responses in ethanol-treated males. Taken together, these findings suggest that central regulation of both the HPA and HPG axes are altered by prenatal ethanol exposure, with normal testicular influences on HPA function markedly reduced in ethanol-treated animals. A decreased sensitivity to inhibitory effects of androgens could contribute to the HPA hyperresponsiveness typically observed in ethanol-treated males.

An outpatient program to treat deep venous thrombosis with low-molecular-weight heparin

CONTEXT

Although recent trials have demonstrated the safety and efficacy of low-molecular-weight (LMW) heparin, clinicians may need help incorporating this drug into routine practice.

OBJECTIVE

To describe the development, implementation, and early results of an outpatient LMW heparin program for acute deep venous thrombosis (DVT).

DESIGN

Before-after study.

SETTING

Eight health centers of Harvard Vanguard Medical Associates, a multispecialty group practice in Boston.

PATIENTS

Patients with confirmed acute, lower-extremity DVT before (40 patients given a diagnosis from January to August 1996) and after (67 patients given a diagnosis from September 1996 to April 1997) implementation of the LMW heparin program.

INTERVENTION

A centrally coordinated outpatient LMW heparin program.

DATA SOURCES

Hospital and HMO financial databases; electronic patient medical records.

OUTCOME MEASURES

Costs of care for 2-week episodes and short-term clinical outcomes.

RESULTS

The proportion of patients with DVT treated in the hospital decreased from 90% to 46% after the introduction of the LMW heparin program. The mean cost of treatment for all patients with DVT decreased from $5465 to $3719 per patient. For the subset of patients actually treated in the outpatient program, the average cost was $1402 per patient. There were no deaths, no clinically recognized pulmonary emboli, and no cases of significant bleeding among patients treated in the program, although 3 patients were subsequently hospitalized for worsening leg pain.

CONCLUSIONS

The cost of caring for patients with DVT decreased after introduction of the outpatient LMW heparin program. Given explicit selection criteria, short-term clinical outcomes after outpatient management have been excellent. This program may serve as a model for physicians and health plans interested in establishing a program for treating acute DVT in the outpatient setting.

Prevention of patient falls through perceived control and other techniques

Every year thousands of patients suffer injury while attempting to make use of bathroom facilities. In addition to the suffering and protracted inpatient care that these incidents cause, hospitals have been faced with staggering costs in the form of increased insurance premiums arising directly out of an increased number of lawsuits. This problem has reached a proportion such that it clearly deserves careful and indepth industry study.

This article, while far from a comprehensive study, will attempt to draw certain conclusions and perhaps dispel certain myths based upon a study of 181 patient falls at a 200+-bed community hospital in the Northeastern United States.

In the not too distant past, hospitals could not generally be held legally responsible for failure to raise bedrails absent specific medical direction. Such was the case because few, if any, hospitals had guidelines or procedures for the placement of bedrails in the absence of a physician's order.

Behavioral and physiological control of yolk synthesis and deposition in the female red-sided garter snake (Thamnophis sirtalis parietalis)

Ovarian recrudescence in female garter snakes, Thamnophis sirtalis parietalis, follows spring emergence from hibernation and mating. In the laboratory, courtship and mating stimuli significantly increased the proportion of female garter snakes becoming pregnant, although some noncourted nonmated controls also became pregnant. Females given artificial mating stimuli under anesthetic, without courtship stimuli, were no more likely than either noncourted, nonmated or anesthetized controls to become pregnant. Hormonal changes and yolk synthesis rapidly followed mating in both laboratory and field females; serum estradiol increased more than 10-fold in 2 days and serum calcium, a measure of yolk precursor lipoprotein (vitellogenin) concentration, increased more than two times in 10 days. Administration of exogenous estradiol stimulated yolk synthesis, but did not result in yolk deposition into ovarian follicles. However, administration of ovine follicle-stimulating hormone induced both hepatic yolk synthesis and yolk deposition. Our results are consistent with the hypotheses that courtship and copulation are facilitatory to ovarian recrudescence but neither alone nor in combination is necessary nor sufficient, and in this species yolk synthesis and yolk deposition are separately regulated.

Metabolic changes in male snakes, Thamnophis melanogaster, during a breeding period

1. Daily basking periods were lengthened substantially during a breeding period in a natural population of the snake, Thamnophis melanogaster. 2. In the laboratory, oxygen consumption of male T. melanogaster significantly increased during a breeding period, compared to pre- and post-breeding levels in the same males. 3. In both laboratory and field males, serum lipid increased initially and then decreased during the breeding period. 4. Serum protein of laboratory males decreased significantly following the breeding period. 5. Serum glucose did not change significantly in laboratory males, but increased significantly during the breeding period in field males. 6. Changes in oxygen consumption and nutrient distribution may reflect changing energy demands attendant with gonadal recrudescence in this snake.