The potential beneficial effect of leptin on an experimental model of hyperlipidemia, induced by chronic ethanol treatment

BACKGROUND: Obesity is known to predispose individuals to liver disease by increasing hepatic sensitivity to endotoxin. The aim of the present study was to determine the effect of mouse recombinant leptin on food intake, body weight, hepatic and plasma lipids and lipoproteins in alcohol-induced liver injury. METHOD: Male Swiss mice weighing 28-32 g were administered ethanol (6.32 g x kg(-1) body weight, p.o.) for the first 30 days. Subsequently, ethanol-fed mice were given intraperitoneal injections of exogenous leptin (230 microg x kg(-1) body weight, i.p.) every alternate day for 15 days. At the end of the total experimental period of 45 days, plasma concentrations of total cholesterol, free fatty acids, triglycerides, lipoprotein lipase and lipoproteins were measured. RESULTS: Exogenous leptin injections to alcohol-fed mice significantly (P<0.05) inhibited the rise in hepatic and plasma lipid and lipoprotein concentrations as compared with those of the unsupplemented ethanol fed mice. Food intake and average body weight at the end of the experimental period was significantly decreased on leptin administration. CONCLUSION: Chronic administration of exogenous mouse recombinant leptin prevents the rise in lipids and lipoprotein concentrations significantly in an animal model of alcohol-induced hyperlipidemia.     

A global perspective on embryological and fetal collections: Where to from here?

Human fetal and embryos collections (FECs) peaked in the late 19th century, an era before informed consent, and hence have unclear provenance. These collections are not only historical artifacts, but prized resources for education and research. This study aimed to determine, via a narrative review, the present location, status, and profile of reported human fetal and embryonic collections. Twenty-seven articles that reported on collections appropriate to the study were selected from an initial search pool of 120 articles. The reported collections were in: Australia (n = 1), Germany (n = 6), Japan (n = 1), Spain (n = 1), and the United States (n = 5). The largest collection is reported to contain 45,000 prenatal remains and the smallest, three remains. The purpose of establishing majority of the collections was for education and research. Eight collections contain both embryos and fetuses, one collection contained embryos, exclusively. Another collection contained only fetuses and one neonatal cadaver. The provenance, where mentioned, specified gynecologists and obstetricians as the main source of remains (n = 5). Except for the Kyoto Collection, information regarding informed consent from the next-of-kin was lacking. This paper draws upon the three themes of purpose, provenance, and profile and highlights the need to establish agreed international guidelines for the most appropriate ethical and sustainable practice with respect to establishment, procurement of remains, access, and maintenance of these collections. Nine domains for these guidelines are recommended: consent, privacy, commercial gain, digital and emerging technologies, commemorations and memorials, destruction and disposal, dignity of donors, global database and collaboration, and sustainability.     

Concept of the Ambulatory Pain Physician

Purpose of Review

Given the growing number of ambulatory surgeries being performed and the variability in postoperative pain requirements, early discharge, and inconsistent follow-up, ambulatory surgery presents a unique challenge for this patient population and warrants the presence of an ambulatory pain specialist to evaluate a patient preoperatively and postoperatively to optimize patient safety and satisfaction. This article explores the crucial role that a dedicated pain physician would have in the ambulatory surgery setting.

Recent Findings

The prevalence of chronic pain, opioid use, and substance abuse is growing in this country, while ambulatory and same-day surgery have also experienced considerable growth. Inevitably, more patients with challenging chronic pain or substance abuse are having ambulatory surgery. Increased BMI, advanced age, more comorbidities warranting a higher ASA physical status classification, and longer surgeries are now all components of ambulatory surgery that contribute to increased risk too. Certain surgeries including breast surgery, inguinal hernia repair, and thoracotomy are at higher risk for the conversion of acute to chronic pain, and an ambulatory pain specialist would be beneficial for added focus on these patients.

Summary

Multimodal pain control with non-opioids and regional anesthesia adjuvants are beneficial, while emphasis on a patient’s functional capacity may be more useful than quantifying the severity of pain. Despite the best efforts of patients’ primary care providers or surgeons, patients often are discharged with more chronic opioid therapy than they presented with, and an ambulatory pain specialist can help manage the complications and prevent further escalation of this opioid epidemic. An onsite anesthesiologist with interest in pain management in each ambulatory surgery center administering anesthesia and available onsite to deal with immediate preoperative, intraoperative, and recovery room would be ideal to curb and manage complication from uncontrolled pain and related pain issues.

     

Ambient particulate matter accelerates coagulation via an IL-6-dependent pathway

The mechanisms by which exposure to particulate matter increases the risk of cardiovascular events are not known. Recent human and animal data suggest that particulate matter may induce alterations in hemostatic factors. In this study we determined the mechanisms by which particulate matter might accelerate thrombosis. We found that mice treated with a dose of well characterized particulate matter of less than 10 microM in diameter exhibited a shortened bleeding time, decreased prothrombin and partial thromboplastin times (decreased plasma clotting times), increased levels of fibrinogen, and increased activity of factor II, VIII, and X. This prothrombotic tendency was associated with increased generation of intravascular thrombin, an acceleration of arterial thrombosis, and an increase in bronchoalveolar fluid concentration of the prothrombotic cytokine IL-6. Knockout mice lacking IL-6 were protected against particulate matter-induced intravascular thrombin formation and the acceleration of arterial thrombosis. Depletion of macrophages by the intratracheal administration of liposomal clodronate attenuated particulate matter-induced IL-6 production and the resultant prothrombotic tendency. Our findings suggest that exposure to particulate matter triggers IL-6 production by alveolar macrophages, resulting in reduced clotting times, intravascular thrombin formation, and accelerated arterial thrombosis. These results provide a potential mechanism linking ambient particulate matter exposure and thrombotic events.     

Impact of a Pilot School-Based Nutrition Intervention on Fruit and Vegetable Waste at School Lunches

ObjectiveTo determine the preliminary impact of the Brighter Bites nutrition intervention on decreasing fruit and vegetable (F&V) waste at school lunches among fourth- and fifth-grade children.MethodThis was a nonrandomized pre–post-controlled study in Houston and Dallas, TX. Two schools received the Brighter Bites intervention (n = 76), and 1 comparison school (n = 39), during the 2017-2018 school year. Brighter Bites is a 16-week school-based nutrition intervention providing weekly distribution of fresh F&V plus nutrition education. Main outcome measures were direct observation and weights to measure the number of F&V dishes selected at school lunches, amount of F&V wasted (gm), and related nutrient waste (4 time points/child). Mixed-effects linear regression analysis was used to determine change in F&V selection and waste over time.ResultsThere was a significant decrease over time in proportion of F&V selected among those in the comparison school, but not the intervention schools (P < .001). Compared with children in the comparison group, those receiving Brighter Bites showed a significant decrease in the amount of F&V wasted at each meal (P < .001) and per item (P < .05) at the end of both 8 and 16 weeks of intervention. There were significant decreases in waste of energy (kcal); dietary fiber (gm); vitamins B₁, B₃, and B₆ (mg); total folate (µg); and B₁₂ (µg) among those receiving Brighter Bites (P < .05).Conclusions and ImplicationsAlthough absolute food or nutrient changes were small even when significant, programs such as Brighter Bites may contribute to a healthy intake. Future studies are warranted that include a larger sample size with a stringent, cluster-randomized control trial design and consideration for other covariates.     

Radiotherapy in paediatric Cushing’s disease: efficacy and long term follow up of pituitary function

Pituitary radiotherapy (RT) is an effective second-line treatment for paediatric Cushing’s disease (CD). We report long-term efficacy and anterior pituitary function in a cohort of paediatric CD patients treated with RT. Between 1988 and 2008, from our cohort of 48 paediatric CD patients, eight paediatric CD patients (5 males and 3 females) underwent second-line pituitary RT (45 Gy in 25 fractions), following unsuccessful transsphenoidal surgery. Out of eight whose long term follow up is available, four patients were cured by RT. Minimum follow up of 2 years is available for all patients. Four patients achieved cure after RT. Two patients were not cured even after follow up of 60 and 132 months, respectively. Out of four uncured patients, two of them had suppressible low dose dexamethasone cortisol with altered circadian rhythm suggesting possibility of response in near future with follow up of just 26 months. Five patients were hypogonadal and one patient was hypothyroid. All patients were below their target height at the time of last follow up. None of the patients had posterior pituitary dysfunction. This series of patients illustrates the efficacy and long-term follow up of pituitary function in children with CD treated with RT. This study also emphasizes the need of growth hormone statues assessment and timely intervention.     

Cadmium a metalloestrogen: are we convinced?

Metalloestrogens are inorganic metal ions that bind to and activate oestrogen receptors. They are implicated in the aetiology of oestrogen-dependent diseases such as cancers of the breast and endometrium as well as endometriosis. Cadmium is one of the most studied metalloestrogens. In this review, scientific evidence for the oestrogenic effects of cadmium is critically evaluated to determine if there is sufficient evidence to support cadmium as an aetiological factor of oestrogen-dependent disease in humans. Results of the review indicated that, although the in vitro and in vivo evidence of the oestrogenic properties of cadmium was persuasive, evidence from population-based human studies remains conflicting. Considerable knowledge gaps exist on the potential oestrogenic effect of cadmium in humans. Research that focuses on bridging these knowledge gaps would be useful in preventing and managing oestrogen-dependent disease in humans.     

Randomized controlled trial of albendazole in new onset epilepsy and MRI confirmed solitary cerebral cysticercal lesion: effect on long-term seizure outcome

No trials to date have focused on long-term seizure outcome in solitary cerebral cysticercal lesion (SCCL), which is believed to produce a relatively benign form of epilepsy. This is a prospective randomized controlled study to evaluate the effect of Albendazole on long-term seizure outcome in patients with MRI-confirmed solitary cerebral cysticercal lesion (SCCL). One hundred and twenty-three patients with new-onset seizures and SCCL on contrast MRI were randomized to treatment with albendazole and followed for up to five years with serial MRI and clinical evaluation. At final analysis 103 patients (M-54, F-49) with a mean age of 18.6+/-10.7 years and follow-up period more than 12 months were included. The mean follow-up duration was 31.4+/-14.8 months (12-64). At one month follow-up more patients receiving albendazole were seizure-free (62% versus 49% for controls). Subsequently there was no significant difference in overall seizure outcome between the two groups. There was no correlation between seizure semiology, albendazole therapy and long-term seizure outcome. Baseline MRI showed active lesions in all; 23% remained active at 12 months with no difference between the albendazole and control groups. Patients whose lesions resolved at 12 months showed better seizure outcome. Reduction in mean cyst area was greater in the albendazole group as compared to the controls and the difference at six months was significant (p<0.05). At three months follow-up perilesional edema also resolved faster in albendazole group (p<0.05). Thus, albendazole did not alter the long-term seizure outcome in patients with SCCL and epilepsy. However, albendazole hastened resolution of SCCL on MRI, but interestingly 23% of lesions were still active 12 months after treatment.     

A Social Cognitive Model of Health for HIV-Positive Adults Receiving Care in India

In-depth interviews were conducted with 50 HIV-positive adults (23 women, 27 men) with access to care at a non-governmental organization in Chennai, India to gain a broad understanding of how they managed their HIV infection. Using a Social Cognitive Model of Health, we identified factors within the model's three domains--Personal, Environmental, and Behavioral--that are applicable to this socio-cultural context. The Personal domain's factors were a positive self-concept, family-focused goals, and treatment optimism; the Environmental domain comprised family-based support, treatment availability, access and quality, and HIV stigma and discrimination; and the Behavior domain's factors were medication adherence and health habits, sexual behavior, and social relationships and emotional well-being. Significant differences for many of the factors within the three domains were observed across married men and women, widowed women, unmarried men, and female sex workers. Implications for an enhanced intervention for HIV-infected individuals in similar treatment settings are discussed.