Basal and glucocorticoid induced changes of hepatic glucocorticoid receptor during aging: relation to activities of tyrosine aminotransferase and tryptophan oxygenase

The characteristics of glucocorticoid receptors, their sensitivity to glucocorticoid as well as the basal and glucocorticoid induced thyrosine aminotranferase (TAT) and tryptophan oxygenase (TO) activities were studied in rat liver during aging. The concentration (N) and dissociation constant (K_d) of glucocorticoid receptor (GR) significantly change during the aging both in untreated and dexamethasone treated animals. The level of receptors was lower in dexamethasone treated rats of all analyzed aged groups compared to untreated animals. In comparison to untreated groups, there was no correlation between the changes of N and K_d during the lifespan. According to immunochemical analysis, the decline of receptor protein content occurs during lifespan. Dexamethasone treatment reduced the level of receptor protein compare to respective age group of untreated rats. The glucocorticoid-receptor (G-R) complexes from both untreated and treated animals underwent thermal activation, although the extent of activation was more pronounced in the case of untreated groups compared to treated animals. The magnitude of heat activation of receptor complexes was more pronounced in the liver of the youngest untreated rats compared to elderly ones, while the receptor activation between treated groups of studied ages has shown less significant differences. Besides, basal as well as induced TAT and TO activities after dexamethasone injection also showed age-related alterations. The observed alterations in GR might play a role in the changes of the cell responses to glucocorticoid during the age. This presumption is supported by detected changes in basal and dexamethasone induced TAT and TO activities during aging.     

Two cases of pulmonary embolism in spinal surgeries

We experienced two cases of pulmonary embolism (PE) in the perioperative period. Although the incidence of perioperative PE is low, it may lead to a critical outcome. The first case is a 59-year-old man without risk factors of PE, scheduled for laminectomy. The end tidal CO2 of 25 mmHg and Pa(CO2) of 48 mmHg developed at the same time during the operation, suggesting PE. He was diagnosed as PE by pulmonary perfusion scan later. The second case was a 71-year-old woman with hypertension and diabetes mellitus, scheduled for laminectomy. Although there were no events during the surgery, she complained of chest pain and dyspnea after the operation. Blood gas analysis showed Pa(O2) of 55 mmHg (FI(O2) 0.4). She was also diagnosed as PE by pulmonary perfusion scan. Both patients made satisfactory progress by appropriate diagnosis and treatment. PE may occur in spite of prevention, and it is important to find out the signs of PE and to prepare for the occurrence of PE.     

Patient Insurance Status Is Associated With Care Received After Transfer Among Pediatric Patients in the Emergency Department

ObjectiveTo determine whether frequency of interfacility transfer varied by insurance status among pediatric emergency department (ED) patients. Secondarily, we tested for an association between insurance status and odds of transfer with discharge from the second ED without observation or admission.MethodsWe used the 2016 New York State ED and Inpatient Databases to identify all patients <18 years. ED and hospital characteristics were from American Hospital Association and National ED Inventory-USA. Among all ED patients, we calculated the proportion transferred stratified by insurance status (private, public, none). Among ED-to-ED transfers, we identified transfers without subsequent observation or admission, and used hierarchical logistic regression modeling (adjusting for patient and transferring ED/hospital characteristics) to determine whether insurance status was associated with odds of discharge from the second ED without observation or admission.ResultsOf 1,303,575 pediatric ED visits, 6086 (0.5%) were transferred. Transfers were less frequent among patients with public or no insurance. Of 3801 ED-to-ED transfers, 1451 (38%) were without subsequent observation or admission. In bivariate and multivariable analysis, transferred patients with public and with no insurance were less likely to be discharged without observation or admission relative to privately insured patients.ConclusionAmong ED-to-ED transfers, pediatric patients with public or without insurance were more often kept for observation or admission at the second hospital after transfer. Differences in disease acuity or in providers’ perception of follow-up availability may play a role in explaining these patterns. This disparity merits further investigation.     

Effects of Breastfeeding,Formula Feeding,and Complementary Feeding on Rapid Weight Gain in the First Year of Life

ObjectiveTo determine whether proportion of breast versus formula feeding and timing of complementary food introduction affect the odds of rapid gain in weight status in a diverse sample of infants.MethodsUsing data from Greenlight Intervention Study, we analyzed the effects of type of milk feeding (breastfeeding, formula, or mixed feeding) from the 2- to 6-month well visits, and the introduction of complementary foods before 4 months on rapid increase in weight-for-age z-score (WAZ) and weight-for-length z-score (WLZ) before 12 months using multivariable logistic regression models.ResultsOf the 865 infants enrolled, 469 had complete data on all variables of interest, and 41% and 33% of those infants had rapid increases in WAZ and WLZ, respectively. Odds of rapid increase in WAZ remained lowest for infants breastfeeding from 2 to 6 months (adjusted odds ratio [aOR] 0.34; 95% confidence interval [CI]: 0.17, 0.69) when compared to infants who were formula-fed. Adjusted for feeding, introduction of complementary foods after 4 months was associated with decreased odds of rapid increase in WLZ (aOR 0.64; 95% CI: 0.42, 0.96).ConclusionsFeeding typified by predominant breastfeeding and delaying introduction of complementary foods after 4 months reduces the odds of rapid increases in WAZ and WLZ in the first year of life.     

The ups and downs of Parkinson disease: a prospective study of mood and anxiety fluctuations.

BACKGROUND: Parkinson disease (PD) patients with motor fluctuations experience mood fluctuations, but studies have been limited in number and methodology. OBJECTIVES: To better understand the phenomenology of mood, anxiety, and motor fluctuations in PD. METHOD: Eighty-seven PD patients and 19 spouse controls completed questionnaires, rating scales, and diaries using visual analogue scales (VAS) to rate mood, anxiety, and motor states. Average daily variance in VAS scores was determined, and PD patients whose average daily variance was larger than that for all of the control subjects were considered to have fluctuations. RESULTS: Twenty-nine percent of patients had fluctuations in anxiety, 24% motor, and 21% mood; 65% had no fluctuations. Seventy-five percent of patients with motor fluctuations had mood and/or anxiety fluctuations, but 5 subjects reported emotional fluctuations without motor fluctuations. The combination of mood and anxiety fluctuations was frequent, but anxiety and mood did not always appear to fluctuate together. Visual inspection of diaries revealed that not all patients exhibited a temporal relationship between emotional and motor fluctuations. Compared with nonfluctuators, those with mood or anxiety fluctuations were more likely to have higher scores on psychiatric rating scales, report histories of depression or anxiety, and use psychotropic medications. CONCLUSIONS: PD patients are heterogeneous with regard to the presence, range, and pattern of fluctuations. In general, patients with mood fluctuations also have anxiety fluctuations.     

Urinary excretion of 5-hydroxyindolacetic acid in occupational exposure to polyvinyl chloride and polyurethane foams

The effect of plastics as polyurethane foams and polyvinyl chloride on the metabolism of tryptophan was investigated by determining the concentration of 5-hydroxyindoleacetic acid (5-HIAA) as its metabolic end product excreted in the urine. Investigation of persons occupationally exposed to polyurethane and polyvinyl chloride showed that these plastics inhibit the metabolism of tryptophan, causing increased excretion of its easily measurable metabolite 5-HIAA. This fact points to the possibility of practical use of this laboratory test which, together with other biological parameters, could improve methods for early detection of occupational exposure to polyurethanes and polyvinyl chloride.