Effects of Food Supplementation During Pregnancy on Maternal Weight Gain,Hemoglobin Levels and Pregnancy Outcomes in Iran

Maternal and Child Health Journal - Objectives In this study, the effects of food supplementation during pregnancy on maternal weight gain, hemoglobin (Hb) levels, and pregnancy outcomes were...     

Predictors of arrhythmic events during second day monitoring in patients with normal first day Holter recordings

BACKGROUND: The diagnostic yield of Holter monitoring in patients with syncope is variably reported to be between 6%-20%. This study was done to define predictors of arrhythmic events during the second day of Holter monitoring in patients whose first day Holter recording was normal. METHODS AND RESULTS: Two serial 24-hour Holter recordings were obtained in a consecutive series of 100 patients (49 patients with unexplained syncope and/or pre-syncope and 51 patients with palpitation). The age of patients was 53.4 +/- 16.9 years and 51 were men. Seventy-six patients had underlying heart disease. Main electrocardiographic findings were found in 40 (40%) patients including non-sustained ventricular tachycardia in 19, sinus pause in 13, symptomatic bradycardia in 5, paroxysmal atrial fibrillation in 4, sustained supraventricular tachycardia in 2, and Mobitz type II second-degree atrioventricular block in 3 patients. Twenty-seven (27%) patients had 33 main electrocardiographic findings during the first day and 13 out of the remaining 73 patients (17.8%) had it during the second day of Holter recording. Presenting symptom (syncope/pre-syncope), age > 65 years, and male gender were significantly associated with increased likelihood of main electrocardiographic findings during the second day of Holter monitoring (p = 006, 0.023, and 0.024, respectively). The risk of main electrocardiographic findings ranged from 5% in patients with one or no predictor to 35% in those with > or = 2 predictors (OR = 9.95, 95% CI = 2.01-49.2, p = 0.002). CONCLUSIONS: Presenting symptom (syncope/pre-syncope), age > 65 years, and male gender increased the likelihood of main electrocardiographic findings during the second day of Holter monitoring.     

The role of B cells in the immunopathogenesis of multiple sclerosis

There is ongoing debate on how B cells contribute to the pathogenesis of multiple sclerosis (MS). The success of B-cell targeting therapies in MS highlighted the role of B cells, particularly the antibody-independent functions of these cells such as antigen presentation to T cells and modulation of the function of T cells and myeloid cells by secreting pathogenic and/or protective cytokines in the central nervous system. Here, we discuss the role of different antibody-dependent and antibody-independent functions of B cells in MS disease activity and progression proposing new therapeutic strategies for the optimization of B-cell targeting treatments.     

Cross-modal effects of value on perceptual acuity and stimulus encoding

Cross-modal interactions are very common in perception. An important feature of many perceptual stimuli is their reward-predicting properties, the utilization of which is essential for adaptive behavior. What is unknown is whether reward associations in one sensory modality influence perception of stimuli in another modality. Here we show that auditory stimuli with high-reward associations increase the sensitivity of visual perception, even when sounds and reward associations are both irrelevant for the visual task. This increased sensitivity correlates with a change in stimulus representation in the visual cortex, indexed by increased multivariate decoding accuracy in simultaneously acquired functional MRI data. Univariate analysis showed that reward associations modulated responses in regions associated with multisensory processing in which the strength of modulation was a better predictor of the magnitude of the behavioral effect than the modulation in classical reward regions. Our findings demonstrate a value-driven cross-modal interaction that affects perception and stimulus encoding, with a resemblance to well-described modulatory effects of attention. We suggest that multisensory processing areas may mediate the transfer of value signals across senses.The world is structured such that objects or events that cause sensations in one sensory modality influence those in another modality, a mechanism that underlies the near-ubiquitous phenomenon of multisensory interaction (1). This phenomenon has been the focus of a large and burgeoning theoretical and experimental literature (1–4). One feature of environmental stimuli important for adaptive behavior is their rewarding or reward-predicting properties. Surprisingly, we know little about how reward associations in one sensory modality influence processing in other modlities. In particular, whether an association with increased reward, known to increase the accuracy of perceptual processing within that sensory modality (5–10), can transfer between modalities for concurrently presented stimuli is unclear. This is important both because of what it reveals about the nature of cross-modal associations and because it might constitute an important perceptual mechanism in its own right. For example, one can easily imagine the importance of increased sensitivity to change in the visual scene to the concurrent sound of a tiger roaring or the mating call of a conspecific.To study cross-modal transfer of value, we designed a visual orientation discrimination task in which visual stimuli were presented concurrently with one of two arbitrary pure tones previously associated with different levels of monetary reward. Critically, these tones were task-irrelevant and bore no relationship either to the orientation of the visual stimulus or to the outcome of the trial. (No feedback was presented about the accuracy of perceptual judgments, and performance on the orientation discrimination task was not related to the payment subjects received at the end of the trial.) We hypothesized that psychophysical measures of visual orientation judgment (d′ and performance accuracy) would show improvement in the presence of a sound with high (compared with low) reward association. Furthermore, simultaneous and spatially overlapping stimuli are more likely to have a common source and thus a shared reward association. Previous studies have shown that interactions between sensory modalities are strongest when stimuli are presented simultaneously and at contiguous spatial locations (1, 2, 11–13), especially at the earliest stages of processing (2, 11). On this basis, we hypothesized that the effect of rewarded sounds on vision should be strongest when visual and auditory stimuli overlap in time and in space. Owing to the low temporal resolution of functional MRI (fMRI) signals, here we manipulated only the spatial overlap of stimuli while keeping their temporal alignment constant (with simultaneous presentation).We had two specific questions regarding the neuronal underpinnings of any observed behavioral effects, which we addressed in simultaneously acquired fMRI data. First, we were interested in whether better behavioral performance owing to the presence of high-reward sounds was accompanied by a more differentiated stimulus representation in early visual areas, as assessed by classification accuracy in a multivariate pattern analysis (MVPA). Second, we were interested in whether this effect involved multimodal cortical areas known to play a role in the integration of audiovisual information, such as the superior temporal sulcus (STS) (14–16), or instead solely involved processing in classical reward-related areas, such as the ventromedial prefrontal cortex (vmPFC) (17, 18) or ventral striatum (19, 20).Our first question draws on evidence demonstrating a nonuniform spatial distribution of reward effects across the visual cortex (21) and a sharpening of sensory representations through suppression of redundant signals elicited by reward/information predictive signals (10, 22). This evidence suggests that reward information might be reflected in the spatial pattern, rather than the absolute magnitude, of blood-oxygen-level–dependent (BOLD) responses. The second question is based on two possible mechanistic schemes of how reward impacts on perception, where reward could exert its effect either directly on perceptual (here visual) processing or via intermediate and presumably task-specific stages (here via regions involved in integrating auditory and visual information). Although both schemes predict a change in response magnitude or spatial pattern of BOLD responses in the visual cortex, only the latter predicts involvement of specific cross-modal areas. We provide evidence that supports task-specific influences of reward on perception.     

The effect of somatostatin analogs on vitamin D and calcium concentrations in patients with acromegaly

Purpose

The goals of this study were to determine: (1) 25OH vitamin D (25OHD) and calcium levels in patients with acromegaly and their association with insulin-like growth factor (IGF-1) and (2) whether somatostatin analog (SSA) therapy effects calcium and 25OHD levels.

Methods

125 patients with acromegaly were studied. Serum calcium and 25OHD levels were compared prior to and after vitamin D supplementation between patients receiving versus not receiving SSA in whom medical therapy included pegvisomant and/or dopamine agonists. Calcium and 25OHD levels were also evaluated longitudinally prior to and during short-term (mean 3 months, range 1–5) and long-term (mean 49 months, range 7–180) SSA administration. Vitamin D2 50,000 units weekly were given to 3 patients in the cross sectional and 1 in the longitudinal group; 400–4,000 units/day of D3 were given to 11 and 5 in respective groups.

Results

In patients with a comparable mean IGF-1 index and season of testing, mean serum levels of 25OHD prior to vitamin D supplementation did not differ in patients receiving versus not receiving SSA (30 ± 3 vs. 30 ± 1 ng/ml, p = 0.99) and the prevalence of vitamin D sufficiency was similar between SSA and non SSA groups (42 vs. 57 %, p = 0.20), prior to vitamin D supplementation. In patients with a comparable mean IGF-1 index and season of testing, mean serum 25OHD levels in patients increased after vitamin D supplementation in both those who were (37 ± 2 ng/ml, N = 23, p = 0.007) and were not receiving SSA (35 ± 1 ng/ml, N = 69, p = 0.005) compared to pre-D supplementation levels but were not different between these groups, p = 0.95) after D supplementation. Calcium and albumin were normal throughout longitudinal follow up. Calcium correlated with IGF-1 index (ρ = 0.29, p = 0.001, N = 125). In the longitudinal subset, serum calcium decreased transiently, in patients receiving short-term SSA (pretreatment 9.9 ± 0.1 mg/dl vs. short-term SSA 9.5 ± 0.1, p = 0.004). After long-term SSA therapy, calcium increased compared to levels on short-term therapy (9.8 ± 0.1 mg/dl vs. 9.5 ± 0.1, p = 0.017) and were unchanged compared to baseline. Mean vitamin D levels were sufficient at baseline prior to SSA therapy (33 ± 5.0 ng/ml), and did not change during short term (29 ± 6 ng/ml, p = 0.85) and long term SSA therapy (35 ± 5 ng/ml, p = 0.43).

Conclusions

Prior to and after vitamin D supplementation, patients with acromegaly receiving long-term SSA had vitamin D levels similar to those receiving other therapies, suggesting that long-term SSA therapy does not affect serum vitamin D. However, given the limitations of this retrospective study, further prospective studies evaluating the impact of SSA on vitamin D levels are necessary to confirm these findings definitively. Calcium levels are positively associated with IGF-1 index in patients with acromegaly. There is a transient decrease in calcium levels with short-term SSA use. The acute effect of SSA on calcium does not appear to be mediated by albumin, 25OHD or PTH and resolves with long-term SSA treatment. The transient decrease in calcium with short-term SSA use resolved with long-term SSA therapy.

     

The influence of human leukocyte antigen and IL-10 gene polymorphisms on hepatitis B virus outcome

Context

The clinical outcome of hepatitis B virus (HBV) infection is variable, ranging from spontaneous recovery to an inactive carrier state, chronic hepatitis, occult HBV infection, liver cirrhosis, or hepatocellular carcinoma.

Evidence Acquisition

This variable pattern and clinical outcomes of the infection were mainly determined by virological and host genetic factors. Since the most of host genetic factors associated with HBV infection have currently focused on human leukocyte antigen (HLA) associations and interleukin (IL)-10 gene polymorphisms, this review focuses on the recent progresses in these issues to provide prognostic markers for the outcome of HBV infection.

Results

A study on serum levels of IL-10 in occult HBV infected patients reported that the higher level of IL-10 production may suppress function of the immune system against HBV in patients with occult HBV infection. IL-10 promoter polymorphism at position -592 is associated with susceptibility to occult HBV infection.

Conclusions

Findings of this study suggest that the host HLA polymorphism is an important factor in determining outcome of HBV infection but regarding IL-10 gene promoter polymorphisms, we are still have a long way to achieve a definite conclusion.     

Correlation of quantitative heel ultrasonography with central dual-energy X-ray absorptiometric bone mineral density in postmenopausal women.

OBJECTIVES: In this study, we sought the proper cutoff level for quantitative ultrasonography (QUS) of the heel in identifying bone mineral density (BMD) categories as determined by dual-energy x-ray absorptiometry (DXA) in postmenopausal women. METHODS: With the use of DXA, BMD categories of the lumbar spine and different areas of the left femur of 420 healthy women according to World Health Organization definitions were determined. Quantitative ultrasonography of the heel was also performed in each subject. Receiver operating characteristic curves were plotted, and sensitivity and specificity of QUS to diagnose osteoporosis were examined at different points to identify the best cutoff level. The diagnostic agreement between the two techniques in identifying osteoporosis was assessed with kappa scores. RESULTS: The kappa scores were 0.31 for the lumbar region and 0.5 for the femoral neck region. On the receiver operating characteristic study, a score of -1 was found to be the appropriate cutoff point for QUS studies, in which the sensitivity of QUS to diagnose BMD osteoporosis varied between 78% and 87.5% depending on the site of the DXA study. With the proposed cutoff point (-1), sensitivity and specificity of QUS in detecting osteoporosis at the lumbar spine were 83.9% and 51%, respectively, and at the femoral neck were 84% and 50%, respectively. CONCLUSIONS: Insufficient agreement between QUS and DXA led to uncertainty on expected BMD in people tested by QUS. The proposed cutoff value could achieve higher sensitivity but only by accepting higher rates of false-positive results.