Analgesia versus sedation during Broviac catheter placement.

Premature infants are capable of mounting physiologic and metabolic responses to pain. Systemic and local anesthesia reduce stress responses to major and minor surgical procedures. We evaluated the effects of local anesthesia (5 mg/kg lidocaine) preceded by either 1 mg/kg secobarbital (S) intravenously or by 2 micrograms/kg fentanyl (F) intravenously on the stress response to Broviac catheter placement. Twenty-nine premature infants ages 5 to 30 days, weighing between 650 and 1350 gm, were randomly assigned to either S or F groups. Age, birthweight, sex, race, and severity of illness were similar among S and F groups. Heart rate and blood pressure remained unchanged throughout the procedure. Oxygen saturation (O2sat) declined significantly in both groups during skin preparation and wound closure, but not during incision, dissection, or tunneling. In spite of fractional inspired oxygen adjustments made in 13 of 14 S- and 3 of 15 F-treated patients, decline in O2sat was more common and more pronounced (p less than 0.01) in S-treated babies. Hyperglycemic responses occurred in all S- and in none of the F-treated patients (p less than 0.001). Norepinephrine plasma concentrations did not change during Broviac catheter placement in either F or S group. Epinephrine concentrations were more elevated in S- than in F-treated patients, although these differences were not statistically significant. Low-dose fentanyl analgesia effectively complements local lidocaine anesthesia during Broviac catheter placement. Sedatives neither abolish metabolic responses to surgical stress nor prevent profound and persistent oxygen desaturation.     

Antioxidant action of Vaccinium myrtillus extract on human low density lipoproteins in vitro: initial observations

Summary— Oxidative modifications of low density lipoproteins (LDL) are now recognised as one of the major processes in atherogenesis. Various drugs, as well as a number of natural products, have been proposed to inhibit such processes. Among the naturally-occurring constituents of plants which appear to possess antioxidant activity are polyphenolic compounds such as flavonoids. The aqueous extract of Vaccinium myrtillus is rich in such molecules. In this report, we describe the in vitro antioxidative potential of this extract on human LDL. The copper-induced oxidative modification of these lipoproteins was assessed using 1) measurement of oxidative resistance as determined by the lag-phase preceding conjugated diene formation; 2) quantification of the amount of lipoperoxides and thiobarbituric acid-reactive substances generated, and measurement of the modification in the net negative electrical charge of the lipoproteins, over a 7-hour time course experiment. Trace amounts of V myrtillus extract (15 to 20 μg/mL) induce statistically significant changes in the oxidation behaviour of LDL, which include 1) prolongation of the lag-phase of conjugated diene production ( P < 0.01); 2) reduction in the formation of lipoperoxides and of thiobarbituric acid-reactive substances up to 7 hours and especially between 1 and 5 hours ( P < 0.01); and 3) inhibition of modification in the net negative charge of LDL. These results demonstrate that V myrtillus extract exerts potent protective action on LDL particles during in vitro copper-mediated oxidation. Calculation of IC₅₀ values indicates that, on a molar basis, this extract may indeed be more potent than either ascorbic acid or butylated hydroxytoluene in the protection of LDL particles from oxidative stress.     

An evaluation of age and intellectual functioning on rates of psychopathology

Rates of psychopathology in 783 individuals with severe and profound mental retardation were evaluated. Differences were apparent not only across the two levels of mental retardation, but also for age groups of 21 to 30, 31 to 40, 41 to 50, and over 50. Disorders studied in order from highest to lowest prevalence were schizophrenia, organic disorders, autism, pervasive developmental disorder (PDD), psychosis not otherwise specified (NOS), and bipolar disorder. Rates of identified psychopathology were generally lower in the group with profound mental retardation, particularly for autism and bipolar disorder. Regarding age differences, organicity was more common in the groups aged over 30, as might be expected. However, rates did not differ markedly from 31 to 40, 41 to 40, and over 50. Little difference across ages was noted in psychosis NOS or schizophrenia. However, PDD was more common in younger individuals. Implications of these findings are discussed.     

Fertilization and early embryology: Alleviation of the '2-cell block' and development to the blastocyst of CF1 mouse embryos: role of amino acids, EDTA and physical parameters

The role of amino acids, ethylenediaminetetraacetic acid (EDTA),transferrin, oxygen, glucose, glutamine, taurine and ammoniumin CF1 mouse zygote development in culture was examined. Non-essentialamino acids and glutamine were shown to alleviate the 2-cellblock in culture, and acted in synergy with EDTA to facilitatedevelopment to the blastocyst stage. In the presence of aminoacids and EDTA, transferrin conferred no beneficial effect Developmentof zygotes was significantly impaired if amino acids were removedfrom the collection medium, even when they were subsequentlycultured in the presence of amino acids. Zygote developmentto the blastocyst stage was significantly improved when modularincubator chambers were used compared to using a conventionalincubator, and when an oxygen concentration of 7% was used asopposed to 20%. Addition of taurine to medium containing non-essentialamino acids had no effect on embryo development, whereas theremoval of glutamine and/or glucose from the culture mediumsignificantly reduced blastocyst cell number. Removal of glucosefrom the culture medium also resulted in a significant decreasein implantations. Ammonium, generated from the breakdown ofamino acids, significantly reduced blastocyst development EDTAwas found to confer its beneficial effects during the first48 h of culture, and indeed was inhibitory during the second48 h, resulting in loss of subsequent viability. In summary,the data demonstrate that development of CF1 zygotes to theblastocyst stage is readily achievable. In the presence of non-essentialamino acids and glutamine the removal of glucose is detrimentalto CF1 mouse embryo development in culture and reduces subsequentviability. Optimal development and maintenance of viabilityrequires more than one culture medium to support the preimplantationperiod.