Asthma medication use in pregnancy and fetal growth

BACKGROUND: Given the high prevalence of asthma in pregnancy, it is important to understand the relationship between asthma medications and fetal growth in the context of appropriate treatment. OBJECTIVE: This study examines the effect of inhaled corticosteroids, systemic corticosteroids, and beta(2)-agonists on fetal growth in 654 infants born to women with asthma compared with 303 infants born to controls without asthma. METHODS: Subjects for this prospective study were enrolled throughout North America between 1998 and 2003 and followed up by the Organization of Teratology Information Services. Incidence of small for gestational age (SGA) infants and mean birth size measures were compared among groups. RESULTS: Mean birth weight of full-term infants born to mothers who used systemic corticosteroids (3373 g) was lower than in the beta(2)-agonist group (3552 g) and controls without asthma (3540 g; P < .05) after adjustment for other risk factors. However, no differences in the incidence of SGA for weight were observed among groups. Adjusted mean birth length was slightly shorter in the systemic steroid group compared with controls (P=.02). Incidence of SGA for length and head circumference and mean head circumference did not vary among groups (P>.05). CONCLUSION: The treatment of asthma with systemic corticosteroids resulted in a deficit of about 200 g in birth weight compared with controls and exclusive beta(2)-agonist users and no increased incidence of SGA. These results suggest that asthma management with beta(2)-agonists and/or inhaled corticosteroids during pregnancy does not impair fetal growth, whereas systemic corticosteroids have a minimal effect which should be weighed against the necessity to control severe asthma.     

Determination of the in vivo cavitation nuclei characteristics of blood

Cavitation has been documented in the in vitro testing of blood-handling devices. To predict whether cavitation will occur clinically, the nuclei content of blood and the threshold pressure for activation of the in situ nuclei must be characterized. A single-pass flow apparatus is described for determining the nuclei characteristics of blood. The flow apparatus consists of a syringe pump and a venturi-geometry hydrodynamic device, called a cavitation susceptibility meter (CSM). Blood is accelerated through the throat of the CSM, thus exposing the nuclei in the blood to a well-defined pressure profile. The apparatus was used in an ex vivo sheep model for the determination of the in vivo nuclei characteristics of blood. The active nuclei concentration of in vivo blood was measured to be at most 2.7 nuclei per liter of plasma at a minimum throat pressure of -1610 mm Hg gauge (i.e., tension of 900 mm Hg). At this pressure, bubble stability theory predicts the active nuclei to have a radius on the order of 0.3 microm. Based on these results, in vitro studies to determine the cavitation potential of blood-handling devices must utilize test fluids that contain a minimum nuclei size distribution and concentration. It cannot be assumed that in vivo blood is nuclei rich, such that it will cavitate at or near vapor pressure.     

Temporal aspects of the dependency of a dimorphic rate of extinction on testosterone.

Previous work has shown that rate of extinction of a conditioned taste aversion is affected by concurrent levels of testosterone in adult rats. In the present study, castrated male and female adult rates were given either oil or testosterone during acquisition of the conditioned taste aversion and then either oil or testosterone during extinction. The males and females that received testosterone during the extinction of the aversion showed the slower, masculine rate of extinction regardless of the type of injections they received during acquisition. Conversely, the animals that received oil during extinction showed the faster, feminine rate of extinction regardless of the type of injection during acquisition. In light of these findings, a number of alternative behavioral changes that could account for the effect of testosterone on the rate of extinction were evaluated.     

Reproductive and metabolic differences between Aedes aegypti and Ae. albopictus (Diptera: Culicidae).

Aedes albopictus (Skuse) females were more likely to develop eggs after they ingested small blood meals than were Aedes aegypti (L.) when both species were maintained under the same suboptimal adult nutritional regimen. The longevity of adult female Ae. albopictus under conditions of starvation was also significantly greater than that of Ae. aegypti. Analyses of total body proteins, lipids, and glycogen indicated that the increased reproductive efficiency of Ae. albopictus may be a result of its greater reserves accumulated during a longer larval period.     

Adoptive transfer of dendritic cells from allergic mice induces specific immunoglobulin E antibody in naïve recipients in absence of antigen challenge without altering the T helper 1/T helper 2 balance

Dendritic cells (DCs) are important in the regulation of immune responses and it has been proposed that these cells play an important role in asthma; however, their role in food allergy is still largely unknown. Our aim was to study specific immunoglobulin E (IgE) and immunoglobulin G (IgG) responses in naïve recipients following adoptive transfer of myeloid DCs from allergic and control mice. The phenotypic features and lymphokine production of DCs were also investigated. CD11c ^{+ /hi} B220^? DCs isolated from spleen and Peyer's patches (PP) of cow's milk (CM) allergic and control mice were transferred intravenously (i.v.) into naïve syngeneic recipients, and IgE‐ and IgG‐specific responses were evaluated. Experiments were also carried out to determine the levels of interferon‐γ (IFN‐γ) and interleukin (IL)‐4 produced by splenocytes from naïve recipients following the adoptive transfer, and CD40 ligand (CD40L)‐mediated IL‐10 production by DCs from allergic and control mice. DCs isolated from spleen and PP of allergic mice, but not control groups, induced CM‐specific IgG and IgE antibody production in naïve recipients in the absence of previous immunization, but did not modify the T helper 1 (Th1) and T helper 2 (Th2) balance. Furthermore, although no difference was observed in the expression of canonical DC surface markers, PP DCs from allergic mice produced less IL‐10 than DCs from controls. We interpret these data as showing that DCs play a pivotal role in allergen‐specific IgE responses and that a Th2‐skewed response may not be involved in the early phase of allergic responses. The identification of the mechanisms underlying these events may help to design novel strategies of therapeutic intervention in food allergy.     

Impaired diet-induced thermogenesis in brown adipose tissue from rats made obese with parasagittal hypothalamic knife-cuts

Two experiments were performed to determine if bilateral parasagittal hypothalamic knife-cuts (KCs), which produce long-term overeating and obesity, after biochemical indices of brown adipose tissue (BAT) reactivity to thermogenic stimuli. In the first study, responses to environmental cold were tested. Four weeks after surgery, KC rats had gained 4-5 times more weight than controls and were obese (increased Lee Obesity Index and weight of gonadal white fat). Before being sacrificed, groups of KC and control rats were exposed to 4 degrees C for 21 hr or remained at 28 degrees C. Interscapular BAT weighed 300% more in KC rats, due largely to increased white fat content. Functional indices of BAT thermogenic capacity (protein content, DNA content, cytochrome oxidase activity and mitochondrial guanosine diphosphate (GDP) binding) were normal at 28 degrees C. Exposure to 4 degrees C produced greatly enhanced responses but these were equivalent for both groups. This suggested an intact capacity for non-shivering thermogenesis in obese KC rats. In the second study, the same BAT responses were examined in other rats fed a palatable "cafeteria" diet (CAFE). One week after surgery, KC and control rats were subdivided into groups that received chow alone or chow plus four different palatable foods daily. Before sacrificing 4-5 weeks later, KC rats had gained 3-4 times more weight than controls and were obese. Interscapular BAT weighed 200-300% more in KC rats. CAFE feeding produced larger increments in all variables for KC vs. control rats. Most importantly, GDP binding was reduced in both KC groups, and significantly more so after CAFE feeding.(ABSTRACT TRUNCATED AT 250 WORDS)     

Formation of encrustations on indwelling urinary catheters in the elderly: a comparison of different types of catheter materials in "blockers" and "nonblockers"

In order to determine the effect of catheter materials on formation of encrustations in long-term indwelling urinary catheters in the elderly we performed a crossover study utilizing commercially available silicone, silicone-coated, teflon-coated and latex catheters that were left in place for 14 days. The study was conducted with #18 french catheters fitted with a 30 ml. balloon since smaller size catheters frequently fell out spontaneously. The distinction between patients who were "blockers" and "nonblockers" was found to be clinically useful since "nonblockers", who constituted about half the population, did well regardless of type of catheter material used. Formation of encrustations and blockage was significantly less in "blockers" with silicone than with teflon-coated or latex catheters. The more rapid flow-time through silicone catheters appears to be related to a larger bore. Although this study supports the use of silicone catheters for "blockers" on long-term drainage the results should not be interpreted to imply that they are preferable to other types of catheters for short-term use or to changing less expensive catheters more frequently when needed.     

Humidity

The humidity of gases is an important topic within anaesthesia and intensive care medicine. An appreciation of the underlying physics helps to ensure that we monitor and deliver optimally humidified gases to our patients, thus minimizing the pathophysiological consequences when normal humidification processes are bypassed. In this article the different techniques and equipment used to measure humidity are illustrated, as well as the methods of humidification used in clinical practice.     

Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

PurposeThe purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method.MethodsThe panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached.ResultsConsensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade.ConclusionThis study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP.Level of evidenceV     

To each according to need: a community-based approach to allocating health care resources.

OBJECTIVE: To develop a method of allocating publicly funded health care resources among communities according to their relative levels of need for health care independent of their current patterns of use. DESIGN: For each health care program population mean levels of resource allocation were calculated and were adjusted for age and sex to produce a national age- and sex-adjusted share of program resources. Indices of relative need for health care (for most programs the standardized mortality ratio) were derived from existing data on aspects of illness and death and were then used to weight the age- and sex-adjusted shares for between-community differences in health risks and health care needs. SETTING: The populations of the 49 counties in Ontario were used as the communities among which resources were allocated. Health care expenditures in 1988-89 by the Ontario Ministry of Health were used as the "budget." MAIN RESULTS: Age- and sex-adjusted resource allocations weighted for between-community differences in health care needs differed from allocations based on population size, in certain cases by up to 100%. CONCLUSION: Existing data can be used to propose allocations of health care resources that relate to relative levels of need for care across communities.