Non-Heart-Beating Donors: An Inquiry to ICU Nurses in a Belgian University Hospital

Demand for organs for transplantation continues to be greater than supply. Non-heart-beating donation (NHBD) has been reintroduced to reverse this trend. We describe the findings of a short questionnaire that determined the attitudes and feelings of nursing staff in a department of intensive care with an established NHBD program. Despite several educational sessions, only 3% of the nurses thought they were adequately informed about NHBD. Thirty-eight percent of nurses were less comfortable with NHBD than with brain death organ donation. NHBD is an ethically controversial area but one that can improve organ availability for transplantation. Adequate education, ongoing audit, and full transparency are needed in units that use NHBD.     

Atypical antipsychotic use and risk of fracture in persons with Parkinsonism

Our objective was to estimate the effect of atypical antipsychotics (AAs) on the rate of fractures in a parkinsonism population. We conducted an age‐ and state‐matched nested case‐control study in five states (CA, FL, NY, OH, IL) using the Medicaid analytic extract from 2001 to 2002. Eligible participants had a diagnosis of parkinsonism, excluding persons with secondary parkinsonism, bone cancer, bone infections, schizophrenia, schizoaffective disorder, and those who used conventional antipsychotics. The primary outcome was the occurrence of a fracture of the femur, ankle, fibula, tibia, humerus, radius, or ulna (N = 851). Risk‐set sampling defined controls (N = 4220). We used conditional‐logistic regression to derive adjusted odds ratios (AOR) and 95% confidence intervals of the association between fracture and use of quetiapine, risperidone, or olanzapine in the 60 days before the index date compared to nonuse. After adjustment for confounding, use of quetiapine (AOR 2.4; 95% CI 1.5–3.8), risperidone (AOR 1.2; 95% CI 0.9–1.7), or olanzapine (AOR 1.7; 95% CI 1.2–2.4) was associated with a higher rate of fracture. Use of an AA was associated with a higher rate of fracture in persons with parkinsonism. Prescribers must be cautious when using these agents in elderly persons with parkinsonism. © 2009 Movement Disorder Society     

A community-based study of case fatality proportion among those who carry out suicide acts

Objective  

To investigate the case fatality proportion and associated factors in those carrying out suicide acts in Nantou, Taiwan.     

Extensive recurrent cardiac lipoma

A 56-year-old woman with a history of surgical removal of a invasive myocardial lipoma presented with progressive dyspnea. Transthoracic echocardiogram showed severe mitral and tricuspid regurgitation and severely impaired biventricular systolic function. Cardiac computed tomography was performed, showing extensive biventricular basal and mid-myocardial replacement by an infiltrating tumor that had the density of fat resulting in large aneurysms of the basal segments of both the ventricles. The patient is currently awaiting orthotopic heart transplantation.     

Cytokines, nitric oxide, and cGMP modulate the permeability of an in vitro model of the human blood-brain barrier

The endothelial cells (EC) of the microvasculature in the brain form the anatomical basis of the blood-brain barrier (BBB). In the present study, the effects of agents that modify the permeability of a well-established in vitro model of the human BBB were studied. The monolayers formed by confluent human brain microvessel endothelial cell (HBMEC) cultures are impermeable to the macromolecule tracer horseradish peroxidase (HRP) and have high electrical resistance. Exposure of HBMEC to various cytokines including TNF-alpha, IL-1beta, interferon gamma (IFN-gamma), or lipopolysaccharide (LPS) decreased transendothelial electrical resistance (TEER) mainly by increasing the permeability of the tight junctions. Primary cultures of HBMEC express endothelial nitric oxide synthase (eNOS) and produce low levels of NO. Treatment with the NO donors sodium nitroprusside (SNP) and DETA NONOate or the cGMP agonist 8-Br-cGMP significantly increased monolayer resistance. Conversely, inhibition of soluble guanylyl cyclase with ODQ rapidly decreased the resistance, and pretreatment of HBMEC with Rp-8-CPT-cGMPS, an inhibitor of cGMP-dependent protein kinase, partially prevented the 8-Br-cGMP-induced increase in resistance. Furthermore, NO donors and 8-Br-cGMP could also reverse the increased permeability of the monolayers induced by IL-1beta, IFN-gamma, and LPS. These results indicate that NO can decrease the permeability of the human BBB through a mechanism at least partly dependent on cGMP production and cGMP-dependent protein kinase activation.     

1H NMR metabolomics study of age profiling in children

Metabolic profiling of urine provides a fingerprint of personalized endogenous metabolite markers that correlate to a number of factors such as gender, disease, diet, toxicity, medication, and age. It is important to study these factors individually, if possible to unravel their unique contributions. In this study, age‐related metabolic changes in children of age 12 years and below were analyzed by ¹H NMR spectroscopy of urine. The effect of age on the urinary metabolite profile was observed as a distinct age‐dependent clustering even from the unsupervised principal component analysis. Further analysis, using partial least squares with orthogonal signal correction regression with respect to age, resulted in the identification of an age‐related metabolic profile. Metabolites that correlated with age included creatinine, creatine, glycine, betaine/TMAO, citrate, succinate, and acetone. Although creatinine increased with age, all the other metabolites decreased. These results may be potentially useful in assessing the biological age (as opposed to chronological) of young humans as well as in providing a deeper understanding of the confounding factors in the application of metabolomics. Copyright © 2009 John Wiley & Sons, Ltd.     

Preterm Labor: CD55 in Maternal Blood Leukocytes

Problem Intrauterine inflammation is a frequent and significant factor associated with the pathogenesis of preterm labor/birth (PTL/PTB). However, it remains unclear whether the intrauterine inflammatory responses activate the maternal peripheral circulation. We explored the association between PTL/PTB and the ‘activation’ of the peripheral circulatory system by determining whether CD55 mRNA expression within peripheral WBCs differed between PTL and control patients not in labor. Method of Study RNA was purified from white blood cells collected from pregnant women with preterm labor (n = 45), and from pregnant (n = 30) control women. CD55 gene expression was evaluated by quantitative PCR. Results The mean CD55 mRNA level within the PTL group (0.77 ± 0.03) was 1.48‐fold higher than that observed (0.52 ± 0.02) within the control group (P < 0.0001); 71% of PTL patients and only 6.7% of control subjects expressed elevated CD55 mRNA. The receiver operating characteristics (with 95% CI) of CD55 as a marker for PTL were as follows: Sensitivity, 69% (53–82%); Specificity, 93% (78–99%); Positive Predictive Value, 94% (80–99%); and Negative Predictive Value, 67% (51–80%). In the patient population that delivered prematurely (before 37 weeks), 81% expressed elevated CD55 mRNA levels with a mean of 0.78 ± 0.03 and 95% CI of 0.71–0.84. The receiver operating characteristics were as follows: Sensitivity, 73% (54–88%); Specificity, 86% (71–95%); Positive Predictive Value, 81.5% (62–94%); and Negative Predictive Value, 80% (64–91%). Conclusion Here we report for the first time that CD55 mRNA expression was elevated in the peripheral WBCs of subjects with preterm labor compared with control gestationally‐matched pregnant woman and that elevated leukocyte CD55 may be a useful predictor of subsequent PTB.