Severity of metabolic syndrome unfavorably influences oxidative stress and fatty acid metabolism in men

Metabolic syndrome (MS) is defined by the clustering of several components (MSC), which include abdominal fat accumulation, impaired glucose homeostasis, hypertriglyceridemia, lowered high-density lipoprotein cholesterol, increased blood pressure, and hyperuricemia. Metabolic syndrome is also accompanied by increased oxidative stress and inflammation as well as by altered composition of esterified fatty acids (FA). Therefore, we have investigated 210 men (categorized into six groups with increasing number of MSC) to find trends in the extent of oxidative stress, FA pattern and frequency of pathological alleles of the selected candidate genes for lipid metabolism. Increasing number of MSC was connected with the raised serum glucose and insulin, increased concentrations of conjugated dienes in low-density lipoprotein (all p < 0.0001), and high frequency of e2 and e4 alleles of the apolipoprotein E gene (p < 0.005). However, the last significance was lost after the adjustment for age. The incidence of 54Thr allele for intestinal isoform of the fatty acid-binding protein (FABP-2) gene was comparable in all groups. The most important findings were the raised content of saturated FA and the increased activities of Delta9 and Delta6 desaturases (all p < 0.0001), and the decreased content of polyunsaturated FA n-6 family and the decreased activity of Delta5 desaturase (both p < 0.001) in connection with increasing number of MSC. In conclusion, the severity of MS is connected with the progression of oxidative stress and the unfavorable changes in the FA composition. These changes are independent of the studied gene polymorphisms.     

A study comparing chloroprocaine with lidocaine for skin infiltration before intravenous catheter insertion

A prospective, double-blind, mixed, crossover study was conducted to determine the perception of pain associated with intradermal lidocaine and chloroprocaine for insertion of an 18-gauge intravenous catheter. A convenience sample of 64 healthy, adult volunteers was used. Each participant received an intradermal injection of lidocaine or chloroprocaine on the dorsum of one hand followed by insertion of an 18-gauge intravenous catheter. The procedure was repeated on the opposite hand with the other anesthetic. Half of the subjects received lidocaine first, and half received chloroprocaine first. Subjects were asked to rate their pain on a 100-mm visual analogue scale immediately after injection of each local anesthetic and immediately after insertion of the catheter. A repeated analysis of variance was used to determine whether there was significant difference in pain associated with the injections and with the insertion of the catheters. There was no significant difference in the amount of pain associated with the intradermal injections (P = .955) or with insertion of an 18-gauge needle (P = .977). Both local anesthetics were effective in reducing pain from the initial injection of the local anesthetics to the insertion of the 18-gauge needle (P = .000).     

Post-pyloric enteral nutrition in septic patients: effects on hepato-splanchnic hemodynamics and energy status

Objective To evaluate the effects of post-pyloric enteral nutrition (EN) on hepato-splanchnic and systemic hemodynamics, metabolism and gastric mucosal energy balance in septic patients.Design Prospective clinical study.Setting Medical intensive care unit (ICU) in a university hospital.Patients Ten hemodynamically stable, mechanically ventilated patients with severe sepsis. Eight patients required norepinephrine.Intervention Low dose post-pyloric EN (Survimed, 40 ml bolus, 40 ml h^–1 continuously).Measurements and results Three data sets: F1 = baseline fasting, EN₁₂₀ = after 120 min of EN, F2=120 min after EN cessation. In addition to global hemodynamics and gastric mucosal PCO₂, we measured hepato-splanchnic blood flow (HSBF) using continuous primed indocyanine green dye infusion with hepatic venous sampling. The mean arterial pressure remained unchanged. During EN systemic vascular resistance decreased (p<0.05), while cardiac index increased (p<0.001). Simultaneously, HSBF increased during EN and decreased again at F2 (1.54 [0.88; 1.66] l min^–1 m^–2 at F1; 1.72 [1.18; 1.83] l min^–1 m^–2 at EN and 1.38 [0.91; 1.63] l min^–1 m–² at F2, p<0.001). Hepatic venous acid base status, lactate/pyruvate ratio and splanchnic lactate balance remained unchanged. There was also no change in splanchnic oxygen extraction ratio or in gastric mucosal to arterial PCO₂ difference.Conclusion The initiation of low dose post-pyloric EN in medical ICU patients with severe sepsis led to the parallel increase of systemic and hepato-splanchnic blood flow. Hepato-splanchnic energy metabolism, oxygen kinetics and gastric mucosal energy balance did not deteriorate during EN, suggesting that EN during sepsis may not be harmful even in patients requiring norepinephrine.Electronic Supplementary Material Supplementary Material is available in the online version of this article at Presented in part at 15th Annual ESICM congress, Geneva, October 2001     

Effect of prone position on hepato-splanchnic hemodynamics in acute lung injury

OBJECTIVE: To evaluate the effects of prone position on hepato-splanchnic hemodynamics, metabolism and gut mucosal energy balance. DESIGN: Prospective clinical study. SETTING: Medical intensive care unit in a university hospital. PATIENTS: Eleven hemodynamically stable patients with acute lung injury (ALI) requiring mechanical ventilation. INTERVENTION: Patients were studied in the supine position, after 90 min in the prone position and after 90 min of supine repositioning. MEASUREMENTS AND RESULTS: In addition to global hemodynamics we measured intra-abdominal pressure (IAP, bladder), hepato-splanchnic blood flow (HSBF, steady state indocyanine green technique using a hepatic vein catheter) and gastric mucosal-arterial PCO(2) gap (PCO(2) gap, automated air tonometry). Systemic hemodynamics did not change during the whole study. Prone positioning did not significantly affect IAP. HSBF as well as splanchnic oxygen consumption remained unaltered, too. Similarly, neither liver lactate uptake nor indocyanine green extraction were influenced by positional changes. Finally, stable regional hemodynamics were accompanied by an unchanged PCO(2) gap. CONCLUSION: We conclude that if IAP and systemic hemodynamics remain unaffected, the prone position in ALI patients compromises neither hepato-splanchnic perfusion nor gastric mucosal energy balance.     

Further study of the effects of dopaminergic D1 drugs on place avoidance behavior using pretraining: some negative evidence

Dopaminergic neurotransmission is considered to modulate cognitive processes, including spatial memory. The aim of this study was to further evaluate the role of the D1 receptor system in an active allothetic place avoidance (AAPA) task using pretrained rats. Our previous results showed enhanced AAPA learning after systemic injections of low doses of D1 agonist A77636, and the impairment of AAPA acquisition by D1 blocker SCH23390 [Stuchlik A, Vales K. Effect of dopamine D1 receptor antagonist SCH23390 and agonist A77636 on active allothetic place avoidance, a spatial cognition task. Behav Brain Res 2006;172(2):250-255]. In the present study, we used the intact-pretraining paradigm, in which animals were trained to the task prior to the injections and subsequently retrieval and reacquisition of AAPA while under the effects of the drugs was tested. Results showed that the intact pretraining partly eliminated the effects of A77636 and SCH23390 on AAPA performance, but a higher dose of SCH23390 caused a motor deficit in the retrieval session. We conclude that in the previous study, D1-active drugs may have had influence upon the non-spatial aspects of the AAPA.     

Infective endocarditis of the tricuspid valve caused by Staphylococcus aureus after ear piercing

Right-sided endocarditis usually involves the tricuspid valve, predominantly in intravenous drug abusers, in patients with anti-arrhythmic devices or central venous lines, and in patients with skin or genitourinary infection and with congenital heart disease 1. We describe a case of a 15-y-old patient, who had tricuspid valve endocarditis in a morphologically normal valve after having his ear pierced, without history of parenteral drug addiction and vascular catheter use. Progression of vegetation size and development of tricuspid valve regurgitation in spite of the intensive antibiotic treatment eventually required surgical intervention.     

Visual mismatch negativity among patients with schizophrenia

Event related potentials (ERPs) provide an insight into sensory and cognitive processes in health and disease. Studies of an ERP negative amplitude deflection elicited by a change in a series of auditory stimuli is known as mismatch negativity (MMN). The generation of MMN is impaired in schizophrenia. Its deficit is associated with lower everyday functioning and may be also interpreted as the marker of progression in schizophrenia. MMN elicited by visual stimuli (vMMN) was described by several research teams, but it has not been investigated in schizophrenia as yet. Using a motion-direction paradigm, we elicited visual MMN in 24 patients with schizophrenia and schizoaffective disorder. The vMMN was computed as differences in areas under curve of visual ERPs to standard and deviant motion-direction stimuli recorded from midline derivations at the interval of 100-200 ms. They were compared between groups of patients with schizophrenia and healthy controls. The significantly smaller vMMN indicated an impaired generation of mismatch negativity in patients with schizophrenia. In secondary analyses there was an association of vMMN impairment among patients with higher dose of medication, lower level of functioning and the presence of deficit syndrome. This impairment appears analogous to the impairment of MMN in the auditory domain and is probably related to early visual information processing. Its relationship to cognitive functioning of patients with schizophrenia deserves further attention.