Fermentation of Cauliflower and White Beans with Lactobacillus plantarum - Impact on Levels of Riboflavin, Folate, Vitamin B12, and Amino Acid Composition

As diets change in response to ethical, environmental, and health concerns surrounding meat consumption, fermentation has potential to improve the taste and nutritional qualities of plant-based foods. In this study, cauliflower, white beans, and a 50:50 cauliflower-white bean mixture were fermented using different strains of Lactobacillus plantarum. In all treatments containing cauliflower, the pH was reduced to <4 after 18 h, while treatments containing only white beans had an average pH of 4.8 after 18 h. Following fermentation, the riboflavin, folate, and vitamin B12 content of the cauliflower-white bean mixture was measured, and compared against that of an unfermented control. The riboflavin and folate content of the mixture increased significantly after fermentation. Relative to control samples, riboflavin increased by 76-113%, to 91.6 ± 0.6 μg/100 g fresh weight, and folate increased by 32-60%, to 58.8 ± 2.0 μg/100 g fresh weight. For one bacterial strain, L. plantarum 299, a significant 66% increase in vitamin B12 was observed, although the final amount (0.048 ± 0.013 μg/100 g fresh weight) was only a small fraction of recommended daily intake. Measurements of amino acid composition in the mixture revealed small increases in alanine, glycine, histidine, isoleucine, leucine, and valine in the fermented sample compared to the unfermented control.

Why should midwives be concerned with ethics?

Is there such a thing as midwifery ethics? Yes, there is. As human beings (moral agents), midwives are to be ethical, moral, responsible persons and professionals. Midwives work in moral relationships with other persons. They serve by the moral standards of their profession as now embodied in written codes of ethics, a profession that is part of the larger health care profession. As part of the professional world, midwives participate in the general standard that to be professional is to be ethical and to be unethical is to be unprofessional. The professions, in turn, are part of what Eric Fromm calls "human ethics." If midwives are to be ethical, we suggest they need to understand ethics and to reason morally. Better health care for all is the result.

Medical therapy for the hydropic fetus with congenital complete atrioventricular block

Early delivery, immediate ventricular pacing, and inotropic support have failed to improve the outcome of hydropic fetuses with congenital complete atrioventricular block. On detection of hydrops, two fetuses were treated with maternally administered digoxin and furosemide with prompt and sustained resolution of intrathoracic fluid accumulations. Clearance of serosal fluid collections may prevent pulmonary hypoplasia and improve cardiac function. Before proceeding with premature delivery in such patients, a brief trial of transplacental anti-congestive therapy is indicated.

An infant with trisomy 9 mosaicism presenting as a complete trisomy 9 by amniocentesis

We present a case in which amniocentesis performed at 33 weeks' gestation because of symmetrical intrauterine growth retardation and decreased amniotic fluid volume led to the prenatal diagnosis of a fetus with a karyotype of 47,XX,+9,t(1;20)(q42;p11.2) pat, i.e., with an extra chromosome 9 and a balanced translocation between chromosomes 1 and 20. At delivery, the baby showed clinical features of trisomy 9, yet chromosome analysis of the cord blood revealed no trisomy 9 cells, a finding confirmed by neonatal blood karyotyping. The balanced translocation was present in all cells. A skin biopsy confirmed trisomy 9 mosaicism with 10 per cent trisomy 9 cells. The baby died at 6 weeks and an autopsy was obtained. Chromosome analysis of different organs demonstrated different frequencies of the mosaicism of trisomy 9. The possible underlying mechanism for the discrepancy between the karyotype results by amniocentesis and those of other tissues is discussed.

Type I second-degree AV block (Mobitz type I, Wenckebach AV block) during ritodrine therapy for preterm labor

A patient, while on intravenous ritodrine therapy for preterm labor, experienced an episode of acute chest pain. The electrocardiogram (ECG), which was read as normal prior to ritodrine infusion, demonstrated a type I second-degree AV block which disappeared upon discontinuation of ritodrine therapy. This case illustrates the need for close ECG monitoring during ritodrine treatment when clinical symptoms arise.

Applying the decision-making model: case study 1

The options for decision making in this situation are reviewed in step 8. As you select one of these options or add one not listed, ask yourself the following questions: Why did I select that particular option? Is this option I selected consonant with my own personal and professional values? If not, where are the conflicts? Have I considered all the evidence in a logical sequence, or did I jump to my conclusion when I first read through the case? Have I had experience caring for a mother and infant in a similar situation? If so, to what extent did my previous experience influence my choice of action in this situation? Can I implement the decision? If not, why? This series of questions can assist the nurse or other health professional in actually making a decision and thinking about their personal reaction to implementing it (accountability). Critical thinking and taking time to analyze one's decision-making process are important tools that help each of us make morally appropriate decisions in clinical practice. The results are better patient care and the personal satisfaction of knowing you have done your best to promote the best interests of infants assigned to your care.

Ultrasonographic fetal weight estimation by an integrated computer-assisted system: can each laboratory improve its accuracy?

Estimated fetal weights from 1684 cases with singleton, live infants born within 7 days of an ultrasonographic examinations were compared with their birth weights, which ranged from 520 to 5920 gm. Estimated weight calculated from Shepard's equation produced a linear relationship of birth weight against estimated weight with an intercept and slope of 209.5 gm and 0.929. Overall, 75% of the estimated weights were within 15% of the actual weight. A separate regression model that used the same variables from Shepard's equation failed to improve the comparison between estimated and actual weights. All cases were reevaluated with multiple regression modeling. Various examination-to-birth intervals were analyzed; intervals less than or equal to 3 days appeared optimal. The best equation increased the percent of cases that were within 15% of the actual birth weight to 80%. The plot of birth weight against estimated weight had an intercept and slope of 33.1 gm and 0.994. Unlike Shepard's equation, the best equation was not statistically different from the ideal one-to-one relationship between estimated and actual weight. When the new equation was applied to an additional 339 new cases, equally accurate results were obtained. Customizing a laboratory's ultrasonographic weight estimation equations may be necessary to obtain the best estimate of fetal weight.

Sources of moral authority: what is right?

This variety of rightness--the end, the means, personal moral development--is a reminder of the need for tolerance of several "right" actions. Again, it is a balance between viewpoints, between concern for the individual and the rights of society. Tolerance is a major aspect of American history--tolerance for a variety of religious traditions, tolerance for a variety of ethnic and cultural traditions, tolerance for a variety of interpretations (values) of life and its meaning. We grow up with variety in religious beliefs, values, ethical principles, or theories (ethical pluralism). We also function at varying levels of moral development at different times, which influences our choice of what is right or good in nursing care. The variety of "right" actions can be confusing. We know firsthand the complexity of trying to choose among several morally right actions, one of which is in the best interests of the neonate and his family. This is the challenge of modern neonatal care. This is the challenge of bioethical decision making. This is the challenge for ethical nursing practice.

Transient oligohydramnios in a severely hypovolemic gravid woman at 35 weeks' gestation, with fluid reaccumulating immediately after intravenous maternal hydration

Oligohydramnios is known to accompany chronically hypovolemic maternal conditions, usually preeclampsia, pregnancy-induced hypertension, and intrauterine growth retardation. A case is presented in which an acute maternal hypovolemic situation with oligohydramnios was treated vigorously with intravenous fluid hydration; ultrasonography documented immediate reaccumulation of normal amniotic fluid volume.

Teaching ethics to nursing students

Ethical practice is the responsibility of all nurses. But if they are to understand the principles of ethics and carry them out in their work, nursing curricula must incorporate ethics into course content. Such content requires faculty who understand both ethical theories and their application to nursing. Appropriate methods of evaluating student learning are also needed. The growing complexity of our health care system demands that nurses assume increasing responsibility for ethical decision making. We can no longer ignore the link between ethics and nursing. Ethics education for nurses is mandatory, not elective.

Ultrasound surveillance of the cervix during pregnancy in diethylstilbestrol-exposed offspring

Twenty-three diethylstilbestrol (DES)-exposed patients were evaluated through 27 pregnancies to determine their eligibility for admission to a prospective protocol that combined serial ultrasound surveillance of the lower uterine segment-cervical complex with periodic pelvic examinations to diagnose cervical incompetency. Of these, 21 pregnant women, including seven vaginectomy patients, were matched to 84 low-risk controls to determine the following: 1) the effect of DES exposure on reproductive performance, 2) the efficacy of ultrasound selection of cerclage candidates, and 3) the influence of previous partial vaginectomy on reproductive outcome. Five DES-exposed patients were diagnosed as having cervical incompetency and had cerclages placed. There were no missed diagnoses of cervical incompetency. The DES-exposed patients delivered statistically earlier in gestation than did controls (268 +/- 13 versus 276 +/- 10 days). It was not evident that this difference was important clinically, as there were no neonatal deaths, very low birth weight infants, second-trimester losses, or deliveries before 252 days (36 weeks) among the study patients. Previous vaginectomy did not affect the frequency of the diagnosis of cervical failure or the neonatal outcome. After ultrasound surveillance and treatment for incompetent cervix, a majority of our patients delivered at term without cerclage placement. Therefore, routine cerclage placement is not recommended. Knowledge of the ultrasound criteria for diagnosing cervical incompetency is required.

Ultrasound diagnosis of defects in the scarred lower uterine segment during pregnancy

A prospective study was begun using ultrasound to diagnose defects in the lower uterine segment. Seventy patients were examined and delivered by cesarean section, including 58 at risk because of previous cesarean section and 12 nulliparous controls not at risk. Of the at-risk patients, 12 had confirmed defects, for an incidence of 20.7%. All the controls were normal. The false-positive rate for at-risk patients was 7.1%, and the positive and negative predictive values were 92.3 and 100%, respectively. For the diagnosed cases, the sonographic lower uterine segment seemed to form earlier (P less than .01) and was thinner (P less than .01) than that in the negative cases or the controls. Although our study design was observational and did not allow us to test the performance of the lower uterine segment when a defect was found, we discuss the use of a three-stage classification system to assist in identifying sonographically detected defects in a future trial of labor protocol. We conclude that sonographic surveillance is a reliable and practical means of evaluating the lower uterine segment after conception and before labor or delivery.

In vitro penicillamine competition for protein-bound gold(I)

The reactions of penicillamine with gold sodium thiomalate (Myochrysine), gold-albumin complexes, and gold bound to urinary and kidney cytosolic proteins were examined. Large excesses of penicillamine (20 to 100:1 penicillamine/gold ratios) are required to mobilize significant amounts of protein bound gold. Quantitative comparisons of cysteine and penicillamine displacements of serum albumin bound gold indicate that penicillamine is approximately 5-6 times more effective than cysteine. Urinary gold is observed to be present in low molecular weight and protein bound forms, which exist in a labile chemical equilibrium and can be shifted by addition of penicillamine. These results are discussed in terms of the structure of gold(I)-penicillamine complexes and the distribution of gold(I) among protein and nonprotein thiol groups. The inappropriateness of using AuCl4- in vitro to study the biochemistry of chrysotherapy agents is delineated.

Bis(L-cysteinato)gold(I): chemical characterization and identification in renal cortical cytoplasm

L-Cysteinatogold(I) was prepared by the reaction of L-cysteine with KAuBr4 in acidic media and its solubility determined from pH 4 to 10. The solubility at pH 7.4 and 37 degrees C is 1 microM. In the presence of excess cysteine, the solubility increases because of formation of bis(L-cysteinato)gold(I). The equilibrium-constant for formation of the bis complex is 2.1 +/- 0.4 X 10(-3), which at pH 7.4 CORRESPONDs to an apparant formation constant of 4.4 X10(4). The formation of the bis adduct was confirmed by chromatographic separation of the products of the reaction between [35S]-L-cysteine and Na2AuTM. This complex elutes with Kav = 1.15 which allows it to be distinguished from other gold thiolates that might form in vivo. The bis(cysteinato)gold(I) complex is shown to be present in kidney cytosol isolated from rats given Na2AuTM in vivo. When additional cysteine is added to the cytosol in vitro, the peak at 1.15 is increased, but if glutathione is added, the low molecular weight gold elutes at Kav = 1.00, which is taken as evidence for the existence of bis(cysteinato)gold(I) in the cytosol preparation. The amount of gold present as bis(cysteinato)gold(I) after 4 different dose schedules has been measured and found to increase with the total cytosol gold concentration. L-Cysteinatogold(I) does not dissolve in the presence of bovine serum albumin to form an adduct.