Neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios, any association with metabolic syndrome?

Background

Metabolic syndrome is a critical health concern associated with an elevated risk of chronic health problems including cardiovascular disease and diabetes. There are shreds of evidence that novel inflammatory ratios including neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios serve as prognostic biomarkers for metabolic syndrome (MetS). This hypothesis was investigated in a cohort of the Iranian population.

Methods

selection of MetS + subjects was based on the National Cholesterol Education Program Adult Treatment Panel III criteria 3 (NCEP ATP 3). The control group consisted of participants negative for any of the five MetS criteria. Demographic and laboratory data were extracted from the Tabari cohort study.

Results

A total of 1930 subjects including 965 Mets positive and 965 MetS criteria negative participants were evaluated. Diabetes (84.8%), hypertension (48.9%), hypertriglyceridemia (81.7%), low HDL cholesterol (70.3%), and high waist circumference (78.9%) were observed in patients. There were no differences between NLR (1.66±0.71 vs. 1.69±0.72 P=0.42), LMR (11.23±3.13 vs. 11.30±11.99, P= 0.86) and PLR (113.85±68.67 vs 114.11±35.85, P=0.91) between case and control groups, respectively. Logistic regression analysis revealed no association between ratios and MetS risk even after adjusting for potential confounders including age, gender, living place, and BMI.

Conclusion

In a relatively large population from Northern Iran, no association was observed between CBC-derived inflammatory ratios and the presence of MetS.

Obesity Mediates the Effect of Past and Current Mental Health on Diabetes Treatment Outcomes

Background

Anxiety and depression (A&D) are common among patients with diabetes (DM). We assessed the mediatory effect of obesity on the pathway between past and current mental health (as measured by A&D) on self-care DM treatment adherence and DM treatment failure.

Methods

We used data collected in two rounds (2009-12, 2014-2018) of a population-based cohort study in Kerman, Iran (KERCADRS). By a random cluster sampling approach, 5900 residents of Kerman aged 15 to 75 yr were recruited to the study to measure demographic characteristics, body measures (to calculate BMI), adherence to DM treatment, and symptoms for A&D (Beck questionnaires). Fasting blood also collected for biochemical tests and glycemic control (as an indicator for treatment failure). We used path analysis and Structural Equation Modeling (SEM) for analysis.

Results

We analyzed data for 264 patients with diabetes who attended in both study rounds. While only 5.7% reported not adherence to DM treatment, 67.9% had diabetes treatment failure. Past mental health had a significant positive association with HbA1c (standard beta coefficient for total effect =0.148, P=0.044), of which 42% was indirect effect through obesity. Current mental health had a positive association with current no adherence to diabetes treatment (standard beta coefficient for total effect=0.077, P=0.001).

Conclusion

Our study showed an important indirect path from A&D to diabetes treatment failure outcome which mediated by obesity. Screening for A&D symptoms and treating those as well as obesity among patients with diabetes may improve glycemic control.

Impact of the peer education model on nursing students' anxiety and psychomotor skill performance: A quasi-experimental study

Background

Peer-assisted education (PAE) is a collaborative and active learning strategy in which another student or another student group teaches one group of students. This model is quite widely used in social and health science vocational education.

Aim

This study was carried out to determine the effect of peer education on clinical skill learning and anxiety in nursing students. A quasi-experimental and a single-blinded design were used.

Subjects and Methods

This study was conducted using experimental (n = 45) and control groups (n = 47) in a university in the Central Anatolia Region, Turkey. A total of 92 students were included. The experimental group received peer education nursing skills. The control group also received education in the traditional model. An Objective Structured Clinical Examination (OSCE) pretest and posttest were used to assess student performance.

Results

It was found that the total scores of posttraining exam success in both experimental and control groups increased (35.20 ± 4.63; 36.70 ± 5.36, respectively) and there was no statistically significant difference between the two groups (P > 0.264). The posttest scores of anxiety in the experimental group were less than the control group (30.18 ± 2.25; 41.21 ± 4.20, respectively).

Conclusions

The use of the peer education model in nursing education has been found to reduce the level of learning anxiety and positively affect psycho-motor skill acquisition. It is proposed to be used as an alternative method in vocational skills training within this context in this area.

Gestational Diabetes as a Predictor of Sexual Dysfunction in Pregnant Women

Introduction: Pregnancy is associated with changes in sexual function and perhaps many more sexual problems when accompanied by particular disorders such as gestational diabetes. Objective: The present study was conducted to investigate factors associated with sexual functions in women with gestational diabetes. Materials and Methods: The present analytical, cross-sectional study was conducted on 300 women with gestational diabetes (150) and low-risk pregnant women (150) attending clinics affiliated to Mazandaran University of Medical Sciences in the north of Iran in 2019. A multistage cluster random sampling method was used, and samples were selected by convenience sampling method. The study data were collected using a demographic and obstetrics questionnaire, female sexual distress scale-revised, prenatal distress questionnaire, world health organization quality of life questionnaire, depression, anxiety, stress questionnaire, and a female sexual function index. Data analysis was done by descriptive statistics indicators, the Chi-square test, t-test, and multivariate linear regression. Results: The frequency of sexual dysfunction was 87.3% in women with gestational diabetes and 34.67% in low-risk pregnant women. Compared to women with low-risk-pregnancy, women with gestational diabetes reported lower sexual function scores (P=0.001). Women with gestational diabetes experience lower quality of life (P<0.05) than low-risk pregnant women. Besides, women with gestational diabetes experience higher levels of stress (P=0.001), more prenatal concerns (P=0.014), and higher sexual distress (P<0.05). The linear regression test showed that gestational diabetes in pregnant women predicts a significant reduction in sexual desire (β=-0.599; P= 0.001). Conclusion: Gestational diabetes predicts a significant reduction in sexual function during pregnancy due to the physical and psychological effects of gestational diabetes. Thus, it is recommended that pregnant women with gestational diabetes should be trained and counseled about gestational diabetes control and sexual function.

Dietary pattern, colonic microbiota and immunometabolism interaction: new frontiers for diabetes mellitus and related disorders

In this review, the numerous possible mechanisms that provide supportive evidence for how colonic dysbiosis denotes metabolic dysfunction, dysregulates glucose homeostasis and leads to diabetes mellitus and related metabolic disorders are defined. Information was gathered from articles identified by systematic reviews and searches using Google, PubMed and Scopus. The composition of the colonic microbiota plays an integral role in maintaining host homeostasis by affecting both metabolic activities and underlying functional gene transcription in individuals with diabetes and related metabolic disorders. Increased colonic microbiome-derived concentrations of lipopolysaccharides, also known as 'metabolic endotoxaemia', as well as alterations in bile acid metabolism, short-chain fatty acids, intestinal hormones and branched-chain amino acid secretion have been associated with the diverse production of pro-inflammatory cytokines and the recruitment of inflammatory cells. It has been shown that changes to intestinal bacterial composition are significant even in early childhood and are associated with the pathogenesis of both types of diabetes. We hope that an improved understanding of related mechanisms linking the colonic microbiome with glucose metabolism might provide for innovative therapeutic approaches that would bring the ideal intestinal ecosystem to a state of optimal health, thus preventing and treating diabetes and related metabolic disorders.

Prevalence of metabolic syndrome using international diabetes federation, National Cholesterol Education Panel- Adult Treatment Panel III and Iranian criteria: results of Tabari cohort study

BACKGROUND

Metabolic syndrome is defined by co-incidence of multiple metabolic disorders such as central obesity, high triglycerides, low HDL, hyperglycemia and high blood pressure, which increases the risk of cardiovascular disease and diabetes. The aim of this study was to estimate the prevalence of metabolic syndrome using Adult Treatment Panel III (ATP-III), International Diabetes Federation (IDF) and Iranian criteria in large-scaled population based cohort study and to determine the concordance between these criteria.

METHODS

In the present study all information collected in Tabari cohort study(TCS) were utilized. These information were collected using a structural questionnaire and taking blood samples from all the participants. Blood pressure and anthropometric indices were measured for all participants by trained practitioners. Categorical variables were compared using chi-square test. In addition, the quantitative variables were compared between the two the groups using independent t-test. Kappa coefficient was estimated to show the agreement between the results of the three criteria.

RESULTS

The prevalences of Metabolic syndrome were 41.10%(CI 95%:40.10-42.02), 44.60%(CI 95%:43.61-45.54), and 30.80% (CI 95%:29.89-31.69) based on ATPIII, international IDF and IDF Iranian criteria respectively. The Kappa agreement coefficients between Iranian IDF with ATPIII definition and international IDF were estimated as 61.80% and 71.20% in the total population respectively.

CONCLUSION

Kappa coefficient showed that the Iranian IDF had a good agreement with International IDF and an intermediate agreement with the ATP-III. Considering more emphasis of international and Iranian IDF on waist circumference (WC), a better agreement between these two criteria is plausible. Regarding the high prevalence of abdominal obesity among Iranian population, applying these criteria to identify high risk persons might be helpful.

Enrolment Phase Results of the Tabari Cohort Study: Comparing Family History, Lipids and Anthropometric Profiles Among Diabetic Patients

Objectives

Different factors are responsible for the silent epidemic of diabetes mellitus in developing and developed countries. This study aimed to determine the role of demographic factors, lipid profile, family history (the estimation of genetic association) and anthropometric factors on diabetes onset.

Methods

Data from the enrolment phase of the Tabari Cohort study was applied for this study and included 10,255 participants aged between 35–70 years. Anthropometric variables were measured by trained staff using standard tools. Blood specimens were collected for lipid profile and blood glucose measurements. Data analyses were performed using SPSS version 24, with univariate and multivariate logistic regression.

Results

The prevalence of diabetes mellitus was estimated to be 17.2% in the cohort population, 15.6% in men, and 18.3% in women. The adjusted odds ratios (95% confidence intervals) for age groups 40–49, 50–59 and over 60 were 2.58 (2.20–3.69), 5.80 (4.51–7.48) and 8.72 (6.67–11.39), respectively. In addition, the odds ratios (95% confidence intervals) for 2 (or more), and 1 affected family member were 4.12 (3.55–4.90) and 2.34 (2.07–2.65), respectively. Triglyceride concentrations more than 500, and abnormal high-density lipoprotein levels increased the odds of diabetes mellitus by 3.29- and 1.18-fold, respectively.

Conclusion

The current study showed that old age and a family history were strong predictors for diabetes mellitus.

Dose administration time from before breakfast to before dinner affect thyroid hormone levels?

BACKGROUND

Levothyroxine is commonly used in the treatment of patients with hypothyroidism. Levothyroxine is often administered in the morning, on an empty stomach, to increase its absorption. However, many patients have trouble for taking levothyroxine in the morning. The aim of this study was to evaluate the effect of changing administration time of levothyroxine from before breakfast to before dinner on serum levels of TSH and T4.

METHODS

Fifty hypothyroidism patients aged 18-75 years old were included in the study and randomly divided into two groups. Each group received two tablets per day blindly (one levothyroxine tablet and one placebo tablet) before breakfast and before dinner. After two months, the administration time for the tablets was changed for each group, and the new schedule was continued for a further two-month period. The serum TSH and T4 levels were measured before and after treatment in each group.

RESULTS

Changing the levothyroxine administration time, resulted in 1.47±0.51 µIU/mL increase in TSH level (P=0.001) and 0.35±1.05µg/dL decrease in T4 level (P=0.3).

CONCLUSION

Changing the levothyroxine administration time from before breakfast to before dinner minimally reduced the therapeutic efficacy of levothyroxine.

Changes in Serum TSH and T4 Levels after Switching the Levothyroxine Administration Time from before Breakfast to before Dinner

Background. Levothyroxine is commonly used in the treatment of patients with hypothyroidism. Levothyroxine is most often administered in the morning, on an empty stomach, in order to increase its oral absorption. However, many patients have difficulties taking levothyroxine in the morning. Aim. The aim of this study was evaluating the effect of changing levothyroxine administration time from before breakfast to before dinner on the serum levels of TSH and T4. Subjects and Methods. Fifty patients between 18 and 75 years old with hypothyroidism were included in the study and were randomly divided into two groups. Each group received two tablets per day (one levothyroxine tablet and one placebo tablet) 30 minutes before breakfast and 1 hour before dinner. After two months, the administration time for the tablets was changed for each group, and the new schedule was continued for a further two-month period. The serum TSH and T4 levels were measured before and after treatment in each group. Results. Changing the levothyroxine administration time resulted in 1.47 ± 0.51 µIU/mL increase in TSH level (p = 0.001) and 0.35 ± 1.05 µg/dL decrease in T4 level (p = 0.3). Conclusions. Changing the levothyroxine administration time from before breakfast to before dinner reduced the therapeutic efficacy of levothyroxine.

The structure of metabolic syndrome components across follow-up survey from childhood to adolescence

BACKGROUND

The choice of what parameters are needed for the diagnosis of Metabolic syndrome (MetS) has been criticized due to the lack of an actual "gold standard" diagnostic test even in adults. This problem seems to be greater in children and adolescents.

OBJECTIVES

Stability assessment of factor structure underlying metabolic syndrome (MetS) components from childhood to adolescence in a panel study.

PATIENTS AND METHODS

A total number of 643 (305 boys and 338 girls) children (from 1999 to 2001), aged 6-10 years, with a complete median follow-up of 6.7 years (from 2006 to 2008) were selected among participants of Tehran Lipid and Glucose Study. We proposed 6 measured variables based on risk factors defined in Adult Treatment Panel III guidelines to describe clustering of MetS components.

RESULTS

The Goodness of fit of the two-factor model, extracted from exploratory factor analysis, was appropriate for boys and girls in both stages of the study using confirmatory factor analysis. Systolic blood pressure (SBP) and triglycerides (TGs), with parameter estimates (PE) of 1 and 0.75, respectively, were the greatest risk factors at baseline in boys and girls. Waist circumference with PE of 0.88 and 0.62, and SBP with PE of 0.99 and 0.86 in adolescent boys and girls, respectively, were important risk factors.

CONCLUSIONS

Our panel study supports the stability of the two-factor six-variable model across two developmental stages from childhood to adolescence, among which adiposity, SBP, and TG were the predominant risk factors.

Elevated androgens during puberty in female rhesus monkeys lead to increased neuronal drive to the reproductive axis: a possible component of polycystic ovary syndrome

BACKGROUND

Hyperandrogenemia is associated with several clinical disorders in which both reproductive dysfunction and metabolic changes may coexist [i.e. polycystic ovary syndrome (PCOS), obesity and congenital adrenal hyperplasia]. Moreover, there is growing evidence that the elevated levels of circulating androgens in obese girls may lead to an increased neuroendocrine drive to the reproductive axis, similar to that associated with PCOS.

METHODS

To test whether androgen exposure in the childhood and adolescent period could lead to pubertal alterations in LH secretory patterns, female rhesus monkeys received subcutaneous testosterone implants prepubertally beginning at 1 year of age, maintaining a 3.7-fold increase (P = 0.001) in circulating testosterone levels over cholesterol-implant controls (n = 6/group) into the post-pubertal period. In early adulthood, pulsatile secretion of LH was measured over 12 h during the early follicular phase of a menstrual cycle, and responsiveness of the pituitary to gonadotrophin-releasing hormone was determined. In addition, ultrasounds were performed to assess ovarian morphology and glucose tolerance testing was performed to assess insulin sensitivity.

RESULTS

The timing of menarche was similar between groups. Testosterone-treated animals had a significantly greater LH pulse frequency during the early follicular phase compared with controls (P = 0.039) when measured at 5 years of age. There was a larger LH response to GnRH when testosterone-treated animals were 4 years of age (P = 0.042), but not when the animals were 5 years old (P = 0.57). No differences were seen in insulin sensitivity or ovarian morphology, and the groups showed similar rates of ovulation in early adulthood.

CONCLUSIONS

Exposure to increased levels of androgens over the course of pubertal development appears to trigger physiological changes in the neural drive to the reproductive axis that resemble those of obese hyperandrogenemic girls in early adulthood and are characteristic of PCOS.

Severe pre-eclampsia and eclampsia in Abha, the south west region of Saudi Arabia

A retrospective study was conducted over a 10-year period on 32,000 maternities at Abha General Hospital, Abha, Saudi Arabia, to estimate the contribution of eclampsia and severe pre-eclampsia to maternal mortality and morbidity and also fetal wastage. It included 18 cases of eclampsia and 297 cases of severe pre-eclampsia. Multiple regression analysis revealed that only the presence of prodromal symptoms significantly affected the occurrence of eclampsia, p < 0.05, while nulliparous patients were a high risk group for eclampsia. Maternal complications including eight cases of massive ascites occurred exclusively in severe pre-eclamptics. Although no maternal deaths were reported, the perinatal mortality rate was 16.6% and 14.1% among the eclamptics and severe pre-eclamptic patients, mainly from prematurity. Regarding the eclamptic patients, 17(94.4%) had the first fit before arrival at the hospital, 13(72.2%) before labour, while 3(16.6%) had fits before and during labour and 1(5.6%) had the fits after delivery. Suggestions are proffered to reducing maternal morbidity and perinatal mortality and morbidity.

Intrauterine diagnosis and management of fetal goitrous hypothyroidism: a report of an Iranian family with three consecutive pregnancies complicated by fetal goiter

The diagnosis and treatment of hypothyroidism during the fetal period may decrease perinatal morbidity and are believed to be important to optimize growth and intellectual development. Herewith a case report of fetal goitrous hypothyroidism is presented in a euthyroid mother, detected at 34 weeks' gestation by ultrasonography, and treated with intra-amniotic levothyroxine injections. The mother had two previous consecutive pregnancies (13 and 8 years ago), also complicated by the occurrence of fetal goiter, resulting in tracheal compression, asphyxia, and early neonatal death in the first and in an emergency cesarean section delivery, because of fetal malpresentation, in the second neonate affected by congenital hypothyroidism (CH). The present male newborn, although born without observable goiter, had a large thyroid on ultrasonography and an early rise of his peripheral venous blood thyrotropin confirmed the diagnosis of CH. Low serum thyroglobulin in the proband and his older brother and parental consanguinity was mostly compatible with a thyroglobulin defective synthesis and secretion as the cause of CH and fetal goiter. Despite apparently sufficient dose of intraamniotic levothyroxine injections repeated weekly from 34-37 weeks' gestation (i.e., four injections of 500 microg levothyroxine), neonatal bone age on the second day of life showed delayed skeletal maturation.

The effect of caudal bupivacaine versus tramadol in post-operative analgesia for paediatric patients

In this study 20 paediatric surgical patients were randomized to two groups after induction of general anaesthesia. Group 1 received 0.25% bupivacaine (2 mg/kg) and group 2 received 5% tramadol (2 mg/kg) both as a caudal block. Heart rate, mean arterial pressure, arterial oxygen saturation, respiratory rate and pain and sedation scores were recorded at 1, 2, 4, 6, 12 and 24 h post-operatively. Acetaminophen was administered rectally (20 mg/kg) if the pain score was > 3/10. The pain and sedation scores in group 2 were significantly lower compared with group 1. There were no significant differences in heart rate, mean arterial pressure, arterial oxygen saturation and respiratory rate between the two groups. In conclusion, caudal tramadol was superior to bupivacaine in analgesic efficacy and in reducing the need for additional analgesia during the post-operative period in paediatric patients.

Prediction of recurrence of nonfunctioning pituitary tumours by loss of heterozygosity analysis

BACKGROUND

Postsurgical regrowth or recurrence of nonfunctioning pituitary adenomas (NFAs) is not uncommon and often requires further surgery or radiotherapy (DXT). Routine postoperative DXT increases the incidence of hypopituitarism, which is associated with increased morbidity and mortality. Identification of genetic abnormalities in the tumour tissue, which can predict recurrence, may allow targeting DXT to the most appropriate patients.

DESIGN AND METHODS

We have performed loss of heterozygosity (LOH) analysis on 96 NFAs of which 43 (45%) were recurrent and 53 (55%) were nonrecurrent tumours. Analysis of all tumours was performed on the surgical specimen obtained at the time of first surgery. All tumours underwent allelotyping across nine highly informative microsatellite markers selected on the basis of high LOH frequency in an earlier study involving genome-wide allelotyping. LOH frequency across all microsatellite markers as well as across individual markers was compared between the two cohorts of tumours.

RESULTS

LOH frequency in tumours that subsequently recurred was significantly higher across all microsatellite markers as compared to tumours that did not recur (P < 0.05). Allelic loss across one or more microsatellite marker was significantly higher in recurrent tumours (30/43) as compared to their nonrecurrent counterparts (17/53) (P < 0.01). On Poisson regression analysis, the higher LOH frequency in recurrent tumours was independent of the invasiveness of tumours determined radiologically. In addition, LOH at the microsatellite markers D1S215 and D1S459 was significantly higher in tumours that recurred as compared to tumours that did not (32%vs. 3% and 27%vs. 2%, respectively; P < 0.01 for both). No significant difference in LOH frequency between the two tumour groups was evident at the other markers. No association could be demonstrated between the frequency and pattern of LOH and the time to manifest recurrence.

CONCLUSIONS

We have shown that it may be possible to predict recurrence of NFAs by LOH analysis of the initial tumour specimen at predefined microsatellite markers, especially on chromosome 1q. This merits further prospective study.

Reference values of umbilical cord and third-day cystatin C levels for determining glomerular filtration rates in newborns

The aim of this study was to determine reference values for serum cystatin C at, and 3 days after, birth, and to determine if the concentration was influenced by gender, gestational age or bilirubin level. Umbilical cord and peripheral venous blood was taken, and serum cystatin C, creatinine, and total and direct bilirubin levels were measured. The mean concentration of cystatin C was not significantly different between cord blood and blood taken on day 3 (1.36 +/- 0.35 mg/l and 1.35 +/- 0.33 mg/l, respectively). Comparison of subgroups, divided by gender, duration of gestation and bilirubin levels, using the Mann-Whitney U-test and Wilcoxon analysis, showed no effect of these parameters on cystatin C levels.

Oral health condition and endemic goitre, in an iodine-deficient area in Bali, Indonesia

Iodine deficiency is a major determinant of endemic goiter which affects bone growth. The purpose of this study was to clarify the relationship between iodine deficiency and oral health. A cross-sectional survey was carried out on 181 inhabitants aged 17 to 40 years in two villages in an iodine-deficient area in Bali, Indonesia. Thyroid swelling, serum level of thyroid-stimulating hormone, DMFT index, plaque index, gingival index, dietary habits and socioeconomic status were examined. Thirty two subjects (21%) had thyroid swelling considered to be endemic goiter, with the highest prevalence in females aged 21 to 30 years (40-41%). The DMFT, food habits, and socioeconomic status were different between both villages. Multiple regression analysis adjusted for age, sex, and location (village) did not detect any association between DMFT and serum thyroid-stimulating hormone level or thyroid swelling. Further studies will be required to confirm these findings.

The olfactory receptor gene superfamily: data mining, classification, and nomenclature

The vertebrate olfactory receptor (OR) subgenome harbors the largest known gene family, which has been expanded by the need to provide recognition capacity for millions of potential odorants. We implemented an automated procedure to identify all OR coding regions from published sequences. This led us to the identification of 831 OR coding regions (including pseudogenes) from 24 vertebrate species. The resulting dataset was subjected to neighbor-joining phylogenetic analysis and classified into 32 distinct families, 14 of which include only genes from tetrapodan species (Class II ORs). We also report here the first identification of OR sequences from a marsupial (koala) and a monotreme (platypus). Analysis of these OR sequences suggests that the ancestral mammal had a small OR repertoire, which expanded independently in all three mammalian subclasses. Classification of "fish-like" (Class I) ORs indicates that some of these ancient ORs were maintained and even expanded in mammals. A nomenclature system for the OR gene superfamily is proposed, based on a divergence evolutionary model. The nomenclature consists of the root symbol 'OR', followed by a family numeral, subfamily letter(s), and a numeral representing the individual gene within the subfamily. For example, OR3A1 is an OR gene of family 3, subfamily A, and OR7E12P is an OR pseudogene of family 7, subfamily E. The symbol is to be preceded by a species indicator. We have assigned the proposed nomenclature symbols for all 330 human OR genes in the database. A WWW tool for automated name assignment is provided.

[Surgery for groin and lower abdominal pain in soccer players]

We treated 57 professional soccer players with groin and lower abdominal pain, 44 of them successfully, using conservative methods and 13 by surgery. Because of its anatomical site, the gracilis muscle is involved in almost all movements of the femur. It therefore is frequently involved in injury due to overuse, especially at its insertion (enthesopathy). In all 13 operated on, the gracilis was cut percutaneously, sometimes as a single procedure and sometimes with concomitant sportsmen's inguinal hernioplasty. All except 1 of those operated on returned to their professional sport activities.

Sequence, structure, and evolution of a complete human olfactory receptor gene cluster

The olfactory receptor (OR) gene cluster on human chromosome 17p13.3 was subjected to mixed shotgun automated DNA sequencing. The resulting 412 kb of genomic sequence include 17 OR coding regions, 6 of which are pseudogenes. Six of the coding regions were discovered only upon genomic sequencing, while the others were previously reported as partial sequences. A comparison of DNA sequences in the vicinity of the OR coding regions revealed a common gene structure with an intronless coding region and at least one upstream noncoding exon. Potential gene control regions including specific pyrimidine:purine tracts and Olf-1 sites have been identified. One of the pseudogenes apparently has evolved into a CpG island. Four extensive CpG islands can be discerned within the cluster, not coupled to specific OR genes. The cluster is flanked at its telomeric end by an unidentified open reading frame (C17orf2) with no significant similarity to any known protein. A high proportion of the cluster sequence (about 60%) belongs to various families of interspersed repetitive elements, with a clear predominance of LINE repeats. The OR genes in the cluster belong to two families and seven subfamilies, which show a relatively high degree of intermixing along the cluster, in seemingly random orientations. This genomic organization may be best accounted for by a complex series of evolutionary events.

Marginal dietary protein restriction reduced nonprotein nitrogen, but not protein nitrogen, components of human milk

OBJECTIVE

This study was designed to determine whether marginal dietary protein intakes of lactating women alter their milk production and composition. The study followed the observation that marginal dietary protein intakes lead to significantly negative nitrogen balances in these women.

METHODS

Twenty-four healthy, mature lactating women were divided evenly into three groups on the basis of postpartum times; 1, 5, or 12 months. Each woman was given a controlled protein diet of either 1.5 (HP) or 1.0 (MP) g/kg body weight/day for 7 to 10 days. Milk production was measured for 72 hours by test weighing the infant before and after feeding. Milk samples from alternate breasts were collected for 24 hours, pooled, and analyzed for their protein nitrogen, nonprotein nitrogen, free and protein-bound amino acid, and lactoferrin concentrations.

RESULTS

Reduced dietary protein intakes were associated with a decrease (p < 0.05) in the nonprotein nitrogen and total free amino acid fractions of milk. Although urea was unaffected, the concentrations of milk free leucine, phenylalanine, histidine, and ornithine were lower (p < 0.05) in the MP than in the HP group, while the output of leucine and histidine tended to be lower in the MP group. The amount of milk produced, as well as the amounts of protein nitrogen, protein-bound amino acid, and lactoferrin and their concentrations were unaffected by a reduction of dietary protein.

CONCLUSIONS

Maternal milk production and the protein nitrogen, but not the nonprotein nitrogen, fraction of human milk were relatively well-preserved in the presence of a short-term, marginal reduction of dietary protein.

The effect of normal pulsed Nd-YAG laser irradiation on pits and fissures in human teeth

The effects of normal pulsed Nd-YAG laser irradiation on the acid resistance of human dental enamel of pits and fissures, the cleaning of the pit and fissure contents and fluoride uptake into deep pits and fissures were examined. The acid resistance of the pit and fissure enamel was evaluated by the amount of dissolved calcium per square millimeter of the surface area. The pit and fissure enamel treated with laser irradiation obtained an acid resistance 30% higher than that of the unlased controls. The cleaning effect of laser irradiation on the pit and fissure contents was compared with chemicomechanical and mechanical methods. The laser irradiation was found to clean the pits and fissures to a greater depth without alterating the shape of pits and fissures, compared with the other two methods. The distribution of calcium, phosphorus and fluoride in the enamel of the pits and fissures was then measured by electron probe microanalyzer. At the entrance and in the deep part of the pits and fissures, the fluoride content of the enamel treated with acidulated phosphate fluoride after laser irradiation was higher than that of the enamel treated with acidulated phosphate fluoride alone. These results thus suggest that Nd-YAG laser irradiation might be effective in increasing the acid resistance of the pit and fissure enamel, while removing the pit and fissure debris contents and increasing the fluoride uptake into the pit and fissure enamel.

Fluoride bioavailability from slow-release sodium fluoride given with calcium citrate

Clinical pharmacology of slow-release sodium fluoride given with calcium citrate was examined in acute and long-term studies. Following a single oral administration of 50 mg slow-release sodium fluoride, a peak serum fluoride concentration (Cmax) of 184 ng/ml was reached in 2 h; thereafter, serum fluoride concentration declined with a T1/2 of 5.9 h. The concurrent administration of calcium citrate (400 mg calcium) gave an equivalent Tmax (time required to attain Cmax) and T1/2, but a lower Cmax of 135 ng/ml. The coadministration of a meal with fluoride also reduced Cmax but increased Tmax. The area under the serum concentration curve of slow-release sodium fluoride was reduced 17-27% by a meal or calcium citrate. Thus, calcium citrate reduced fluoride absorption and peak fluoride concentration in serum of slow-release sodium fluoride but did not affect the time required to reach peak concentration or the rate of subsequent decline. The effect of a meal was similar, except for a longer period required to reach peak serum concentration. During long-term administration of 25 mg slow-release sodium fluoride coadministered with 400 mg calcium as calcium citrate on a twice daily schedule, the trough level of serum fluoride could be kept between 95 and 190 ng/ml, believed to be the therapeutic window.

Humeral lengthening for septic neonatal growth arrest

A 9-year-old girl was treated by humeral lengthening for a 8.5 cm deficit caused by a septic arthritis 2 days after birth. A Wagner distraction apparatus was used after an osteotomy was done distal to the deltoid insertion. Six centimeters of length were gained. A second lengthening of about 7.5 cm is planned at the end of the patient's growth. No complications were encountered; by dividing the lengthening into two procedures, none are anticipated. At 1-year follow-up, there was a full range of shoulder, elbow, and hand motion; the humeri were virtually the same length.

Late results after correction of hallux valgus deformity by basilar phalangeal osteotomy

In a long-term follow-up study (average, 10.7 years) of 222 patients (351 feet), the results after proximal phalangeal osteotomy (the Akin procedure) for hallux valgus deformity were found to be unsatisfactory, both subjectively and objectively. The range of motion in the metatarsophalangeal joint was limited postoperatively in 90 per cent of the patients, and in 21 per cent there was recurrence of deformity. The appearance of the foot was poor in 75 per cent. Only 53 per cent of the patients expressed satisfaction with the result of the operation. There was a direct relationship between the development of subluxation or dislocation of the metatarsophalangeal joint and postoperative dissatisfaction of the patient. We concluded that the operation is biomechanically unsound because it does not address the principal mechanical factors that are responsible for the deformity: abnormal function of the adductor hallucis and the abnormal intermetatarsal angle. The Akin procedure is indicated only in combination with other operations that are designed to correct the two cited abnormalities.

Gangrene of the upper extremity following intra-arterial injection of drugs. A case report and review of the literature

A case of inadvertent intra-arterial self-injection of crushed codeine tablets in an 37-year-old man, resulting in gangrene of an upper extremity, is presented. The problem studied was whether the gangrene was caused by the codeine or by one of the excipients found in the tablets. The cause of the gangrene was investigated in an experimental study. Each of the components of the tablet (codeine, lactose, gelatin, carboxymethyl cellulose, calcium stearate, talc, and microcrystalline cellulose) was injected into the femoral arteries of dogs. The results of the study clearly demonstrate that the unique component producing the gangrene was the micro-crystalline cellulose, while the injection of pure codeine was harmless. To date, the only reported deleterious effects of intravascular injection of micro-crystalline cellulose have been pulmonary embolism and granulomatosis. Some examples of drugs that include microcrystalline cellulose are methadone, methaqualone, oxcycodone, acetaminophen, aspirin with codeine, propoxyphene napsylate, meprobamate, and phenobarbital. Recently, the vulnerability of drug addicts who habitually inject drugs into veins to the accidental injection of an artery has been noted, and it seems likely that in the future the problem of intra-arterial injection will increase in severity. The literature of the last 40 years is reviewed, and a list of drugs known to have produced gangrene when injected intra-arterially is cited.