Birthweight and social deprivation: influences on serum lipids and fibrinogen

Epidemiological studies have shown that adults with low birthweight have a higher risk of cardiovascular disease and some others have shown that they have a less favourable serum lipid and lipoprotein profile. If cholesterol metabolism were programmed in utero, we would expect to see an influence of birthweight on blood lipids in children. In 422 children aged 11-15 y in Middlesborough, Cleveland, UK, we investigated the association between birthweight and serum lipids and plasma fibrinogen. We also investigated the influence of childhood social deprivation, measured using the Townsend deprivation index, on these measures. CONCLUSIONS: We found a significant inverse association between birthweight and serum triglyceride level, but not with other serum lipid levels. From a regression model we estimate that triglyceride rose by 1.1 mmol l(-1) kg(-1) fall in birthweight after adjustment for sex, current age and weight. Findings were similar in boys and girls separately. This could contribute to the observed inverse association between birthweight and cardiovascular mortality. Social deprivation was associated with higher fibrinogen, but not lipid levels. Our data highlight the importance of considering influences throughout the life course on adult disease.     

Properties of an adrenal medullary protein immunorelated to steroid acute regulatory (StAR) protein

Immunohistochemistry using a StAR peptide antiserum had previously revealed strong staining in rat and bovine adrenal medulla, suggesting the presence of a protein immunogenically related to StAR. Western blots of bovine medulla tissue homogenates showed the principal adrenal medullary immuno-reactive species to have a higher molecular weight (50 kDa) compared to StAR protein (30 kDa). Subcellular fractionation localised the 50 kDa species principally to the medulla cytosol. StAR peptide antiserum binding to both the 30 kDa and 50 kDa species could be specifically competed by the peptide antigen. These data suggest that the adrenal medullary immuno-reactive species and StAR protein are distinct entities, which share some features in common.     

Binocular interactions in accommodation control: effects of anisometropic stimuli.

In binocular viewing of real targets, the accommodative demand in the two eyes is not in general identical, yet the accommodation response in the two eyes is equal. In order to investigate how the accommodative signals from the two eyes are combined, this study has examined the effects of several forms of dynamic anisometropic stimulation on the accommodation response in both man and the rhesus monkey (Macaca mulatta). All experiments were performed in a computer-controlled haploscopic apparatus to allow independent control of the accommodative stimuli to the two eyes and of the vergence stimulus. The vergence stimulus was held constant while the accommodation demand was modulated independently in each eye. Accommodation was monitored continuously with a dynamic infrared optometer. Four anisometropic conditions were used. In two of these conditions, accommodation demand was varied sinusoidally with time in both eyes, but with phases differing by 90 degrees or 180 degrees between the two eyes. In the two remaining conditions, accommodation demand in one eye varied sinusoidally, while the accommodation demand was constant in the other. In all cases, the form of the target pattern was identified in the two eyes. The accommodation responses observed with these stimulus conditions were similar in both man and the monkey. When presented with conflicting stimuli in the two eyes, the accommodation response appeared to be best described as a compromise between the inputs to the two eyes; there were no indications of a purely random alternation of eye dominance of the form seen in binocular contour rivalry. When the accommodation demand was modulated in only one eye, there was a modulated accommodation response of similar phase to the control condition (i.e., both eyes modulated in phase) but with a much smaller gain (mean, 39% of control gain). When the accommodation demand was modulated in both eyes with a phase difference of 180 degrees, no significant modulation was observed in the accommodation response at the stimulation frequency. When the interocular phase difference was 90 degrees, a modulated response was observed that showed a mean phase lag 41 degrees more than that observed in the control condition (both eyes modulated in phase) and an appreciably smaller gain (mean, 55% of control gain). The extent to which the results can be described by a linear vector average of the uniocular inputs is considered.     

Identification of subunit- and antagonist-specific amino acid residues in the N-Methyl-D-aspartate receptor glutamate-binding pocket

The resolved X-ray crystal structures of the glutamate-binding domain (S1/S2 domains) of the GluR2 and NR1 glutamate receptor subunits were used to model the homologous regions of the N-methyl-D-aspartate (NMDA) receptor's NR2 subunits. To test the predictive value of these models, all four stereoisomers of the antagonist 1-(phenanthren-2-carbonyl) piperazine-2,3-dicarboxylic acid (PPDA) were docked into the NR2B glutamate-binding site model. This analysis suggested an affinity order for the PPDA isomers of d-cis > L-cis > L-trans = D-trans and predicted that the 2-position carboxylate group of the cis-PPDA isomers, but not of the trans-PPDA isomers, may be interacting with histidine 486 in NR2B. Consistent with these predictions, cis-PPDA displays a 35-fold higher affinity for NR2B-containing NMDA receptors than trans-PPDA. In addition, mutating NR2B's H486 to phenylalanine decreased cis-PPDA affinity 8-fold but had no effect on trans-PPDA affinity. In contrast, the NR2B H486F mutation increased the affinity of the typical antagonists CGS-19755 [(2R*,4S*)-4-phosphonomethyl-2-piperidine carboxylic acid] and 4-(3-phosphonopropyl) piperidine-2-carboxylic acid. In the NR1-based NR2 models, there were only four subunit-specific amino acid residues exposed to the ligand-binding pocket (and six in the GluR2-based models). These residues are located at the edge of the binding pocket, suggesting that large antagonists may be necessary for subtype specificity. Of these residues, mutational analysis and modeling suggest that A414, R712, and G713 (NR2B numbering) may be especially useful for developing NR2C- and NR2D-selective NMDA receptor antagonists and that residues A414 and T428 may determine subunit variations in agonist affinity.     

Respiratory management of extremely preterm infants

Lindner's study of respiratory management of extremely preterm infants, while not providing a definitive answer, demonstrates that many of the smallest infants can be managed in and beyond the delivery room without intubation and without apparent increased early mortality. Conclusion: These novel techniques deserve further evaluation.     

Evaluation of a hypertension screening programme in Independence, Belize

This study assesses the effectiveness of a hypertension-screening programme in Independence, Belize. Forty-nine of the 101 patients screened were found to have elevated blood pressure readings and were advised to seek medical care. Four months later, interviews with 35 of the 49 patients from the hypertensive group revealed that 85.7% of the patients had sought medical care. Women, elderly patients and patients with a previous history of hypertension were more likely than men, younger patients and those without a history of hypertension to seek follow-up medical care. The screening programme successfully directed a high proportion of patients with elevated blood pressure to seek appropriate medical care.     

Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents

BACKGROUND: Anorexia-related weight loss can have devastating consequences on quality-of-life, morbidity, and mortality. Without a simple tool to evaluate appetite, health care providers often use inaccurate surrogates, such as measurement of energy consumption and nutritional risk, to reflect appetite. OBJECTIVE: We aimed to validate a simple tool for assessing appetite and predicting weight loss. DESIGN: This was a cross-sectional measurement study conducted on long-term care residents and community-dwelling adults. Construct validity of the 8-item Council on Nutrition appetite questionnaire (CNAQ) and its 4-item derivative, the simplified nutritional appetite questionnaire (SNAQ), were examined through correlation with a previously validated research tool: the appetite hunger and sensory perception questionnaire (AHSP). The length and complexity of the AHSP render it inefficient for clinical use. The sensitivity and specificity of the CNAQ and SNAQ to predict significant weight loss were calculated. RESULTS: Cronbach's alpha coefficients for the CNAQ were 0.47 (long-term care group) and 0.72 (community-dwelling group). In the long-term care group, the CNAQ correlated with the AHSP (r = 0.60, P < 0.001) and with the AHSP domains of taste (r = 0.47, P < 0.0001), hunger (r = 0.51, P < 0.0001), and smell (r = 0.53, P < 0.0001). The CNAQ showed sensitivities and specificities for 5% and 10% weight losses of 80.2 and 80.3 and 82.4 and 81.9, respectively. The SNAQ had sensitivities and specificities for 5% and 10% weight losses of 81.3 and 76.4 and 88.2 and 83.5, respectively. CONCLUSIONS: The SNAQ and CNAQ are short, simple appetite assessment tools that predict weight loss in community-dwelling adults and long-term care residents. The SNAQ is a 4-item derivative of the CNAQ and thus is clinically more efficient.