Association of maternal serum concentrations of 2,2', 4,4'5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE) levels with birth weight, gestational age and preterm births in Inuit and European populations

Background

Epidemiological studies on the association between maternal exposure to persistent organic pollutants (POPs) and fetal growth alteration report inconsistent findings which weights in favor of additional studies.

Methods

Blood samples were collected from interviewed pregnant women in Greenland (572), Kharkiv (611) and Warsaw (258) and were analyzed for CB-153 and p,p'-DDE by gas chromatography-mass spectrometry. Data on birth weight, gestational age and preterm birth were obtained for 1322 singleton live births. We examined the association between natural log-transformed serum POPs concentration and birth weight and gestational age using multiple linear regression and the association with prematurity using logistic regression controlling for potential confounding factors.

Results

The median serum concentrations of CB-153 and p,p'-DDE were for Inuit mothers 105.6 and 298.9, for Kharkiv mothers 27.0 and 645.4 and for Warsaw mothers 10.7 and 365.2 ng/g lipids, respectively. Increase in CB-153 concentration by one unit on the log scale in Inuit mothers serum was associated with significant decrease in infant birth weight of -59 g and gestational age by -0.2 week. Decreases observed in the cohorts in Kharkiv (-10 g and -0.1 week) and in Warsaw (-49 g and -0.2 week) were not statistically significant. Increase in p,p'-DDE concentration by one unit on the log scale was associated with a statistically significant decrease in infant birth weight of -39.4 g and -104.3 g and shortening of gestational age of -0.2 week and -0.6 week in the Inuit and Warsaw cohorts, respectively. In the Kharkiv cohort decrease in birth weight (-30.5 g) was not significant, however a shortening of gestational age of -0.2 week per increase in p,p'-DDE concentration by one unit on the log scale was of the borderline significance. There was no significant association between CB-153 and p,p'-DDE concentrations and risk of preterm birth however, in all cohorts the odds ratio was above 1.

Conclusions

In utero exposure to POPs may reduce birth weight and gestational age of newborns however, new insights as to why results vary across studies were not apparent.     

Health care providers underestimate symptom intensities of cancer patients: A multicenter European study

Background  

Many patients with advanced cancer depend upon health care providers for symptom assessment. The extent of agreement between patient and provider symptom assessments and the association of agreement with demographic- and disease-related factors was examined.     

Differential item functioning (DIF) analyses of health-related quality of life instruments using logistic regression

Background

Despite the burden of progressive incurable disease in Africa, there is almost no evidence on patient care or outcomes. A primary reason has been the lack of appropriate locally-validated outcome tools. This study aimed to validate a multidimensional scale (the APCA African Palliative Outcome Scale) in a multi-centred international study.

Methods

Validation was conducted across 5 African services and in 3 phases: Phase 1. Face validity: content analysis of qualitative interviews and cognitive interviewing of POS; Phase 2. Construct validity: correlation of POS with Missoula-Vitas Quality of Life Index (Spearman's rank tests); Phase 3. Internal consistency (Cronbach's alpha calculated twice using 2 datasets), test-retest reliability (intraclass correlation coefficients calculated for 2 time points) and time to complete (calculated twice using 2 datasets).

Results

The validation involved 682 patients and 437 family carers, interviewed in 8 different languages. Phase 1. Qualitative interviews (N = 90 patients; N = 38 carers) showed POS items mapped well onto identified needs; cognitive interviews (N = 73 patients; N = 29 carers) demonstrated good interpretation; Phase 2. POS-MVQoLI Spearman's rank correlations were low-moderate as expected (N = 285); Phase 3. (N = 307, 2nd assessment mean 21.2 hours after first, SD 7.2) Cronbach's Alpha was 0.6 on both datasets, indicating expected moderate internal consistency; test-retest found high intra-class correlation coefficients for all items (0.78-0.89); median time to complete 7 mins, reducing to 5 mins at second visit.

Conclusions

The APCA African POS has sound psychometric properties, is well comprehended and brief to use. Application of this tool offers the opportunity to at last address the omissions of palliative care research in Africa.     

Cementless acetabular fixation in total hip arthroplasty using polyglycolide-lactide screws: an in vivo canine study

Bone ingrowth into cementless acetabular components was evaluated in a canine total hip arthroplasty model, comparing components initially stabilized with polyglycolide-lactide screws with those initially stabilized with titanium screws. The acetabular shell was anchored with 2 polyglycolide-lactide screws in 16 dogs and with 2 titanium screws in 12 dogs. The dogs were followed and sacrificed at 7 weeks, 14 weeks, 10 months, or 15 months. Histomorphometric analysis of bone ingrowth into the weight-bearing dome of the acetabular shell was conducted. No difference was detected in mean bone ingrowth into the acetabular shell comparing the 2 screw groups. The results of this study do not support a significant advantage to the use of biodegradable screws for the initial stabilization of cementless acetabular components in canine total hip arthroplasty.     

Reactive airway and anaesthesia: challenge to the anaesthetist and the way forward

Background

Patients with concurrent medical conditions such as Reactive airway disease presenting for anaesthesia, and surgery have potentially increased risk of perioperative morbidity and mortality if not well managed.

Objective

To highlight the need for adequate perioperative care and review the evidence for selection of techniques in the anesthesia for such cases”

Materials and methods

An illustrative case is presented.

Conclusion

The main goal of the anaesthetist is to administer safe and sufficient anaestheia without precipitating bronchospasm.     

Dynamic monitoring of NET activity in mature murine sympathetic terminals using a fluorescent substrate

Background and purpose:

To validate a fluorescence approach for monitoring norepinephrine transporter (NET) transport rate in mature sympathetic terminals, and to determine how prejunctional muscarinic receptors affect NET rate.

Experimental approach:

Confocal imaging of a fluorescent NET substrate [neurotransmitter transporter uptake assay (NTUA)] as it accumulates in the mature sympathetic nerve terminals of the mouse isolated vas deferens. Fluorescence recovery after photobleaching (FRAP), enhanced green fluorescence protein (EGFP)-transgenic mice and contraction studies were also used.

Key results:

NTUA fluorescence accumulated linearly in nerve terminals, an effect that was prevented with NET inhibition with desipramine (1 µM). Such accumulation was reversed by amphetamine (10 µM), which is known to reverse the direction of transport of NET substrates. NTUA labelling was not present in cholinergic terminals (identified using EGFP fluorescence expressed in transgenic mice under a choline acetyltransferase promoter). FRAP experiments, altered nerve terminal distribution with reserpine pretreatment and co-imaging in terminals filled with a cytoplasmic marker (Alexa 594 dextran) indicated that the NTUA labelling was largely confined to vesicles within varicosities; vesicular exchange between varicosities was rare. The rate of NTUA accumulation was slower in the presence of the muscarinic agonist carbachol (10 µM) demonstrating muscarinic inhibition of NET rate.

Conclusions and implications:

A straightforward protocol now exists to monitor NET transport rate at the level of the single nerve terminal varicosity, providing a useful tool to understand the physiology of NET regulation, the action of NET inhibitors on mature sympathetic terminals, dynamic vesicular tracking and to identify sympathetic terminals from mixed terminal populations in living organs.This article is part of a themed section on Imaging in Pharmacology. To view the editorial for this themed section visit http://dx.doi.org/10.1111/j.1476-5381.2010.00685.x     

Comparison of initial limb salvage in 98 consecutive patients with either reversed autogenous or in situ vein bypass graft procedures

A retrospective review of 98 consecutive patients undergoing femoropopliteal or distal bypass procedures was conducted to determine whether in situ bypass grafting offers statistically significant initial limb salvage over reversed autogenous techniques. Over a 40 month period, 98 consecutive patients received either in situ or reversed autogenous vein grafts to effect limb salvage. The groups were similar in incidences of diabetes and previous myocardial infarctions, as well as in site of distal anastomosis (beneath the tibial peroneal trunk in more than 80 percent). The in situ vein graft group had an overall limb salvage rate of 92 percent with an 88 percent cumulative patency rate at 4 to 18 month follow-up, whereas the reversed autogenous vein graft group had a limb salvage rate of 86 percent with a 79 percent cumulative patency rate at up to 18 months. Results after 30 days showed 47 patients had improvement and 3 patients (6 percent) had died in the in situ vein graft group. In the reversed autogenous vein graft group, 44 patients improved, 4 did not improve and required amputations, and 2 (1 percent) died. Our study supports the use of in situ vein bypass grafting for limb salvage.     

Klinischer Stellenwert der modernen elektrophysiologischen Diagnostik bei Mukoviszidose (zystischer Fibrose)

In many patients cystic fibrosis is not diagnosed or diagnosed too late. In Germany about 4500 patients are known. As an incidence of 1:3000 is postulated for Central Europe, we suppose that 25–30% of the patients are not detected (and, therefore, are not appropriately treated). There are different reasons for not detecting those patients: deficiency of experience, variety of disease manifestations, ambiguous laboratory results. In the last years the electrophysiological diagnosis has proved to be an additional useful diagnostic method.     

Contralateral ovulation shortens follicular phase length and favours pre-embryo development during ovarian stimulation with clomiphene citrate

The present study was undertaken to evaluate whether the site of ovulation affects the following follicular phase length and pre-embryo development during infertility treatment with ovarian stimulation using clomiphene citrate. A total of 363 cycles in 97 patients undergoing infertility treatment (182 intrauterine insemination (IUI) cycles in 60 patients and 181 in-vitro fertilization (IVF) cycles in 52 patients) were studied. The cycles were divided into two main groups: preceding unilateral ovulation (PUO) and preceding bilateral ovulation (PBO). In the PUO group, the cycles were subdivided into contralateral ovulation, bilateral ovulation and ipsilateral ovulation. In IVF cycles alone, bilateral ovulations were further divided into bilateral ovulation- contralateral side and bilateral ovulation, ipsilateral side. Contralateral ovulations were seen in 134 of 240 cycles (56%), excluding bilateral ovulation and PBO. The follicular phase length in contralateral ovulation (16.2 +/- 2.6 days, mean +/- SD) was significantly (P < 0.05) shorter than that of ipsilateral ovulation (16.9 +/- 2.8). There were no significant differences of follicular phase length among contralateral ovulation, bilateral ovulation and PBO. Of IVF cycles including contralateral ovulation-ipsilateral ovulation and bilateral ovulation a total of 107 preovulatory follicles was assessed in the contralateral side (contralateral ovulation + bilateral ovulation-contralateral side) and 97 in the ipsilateral side (ipsilateral ovulation + bilateral ovulation, ipsilateral side). The oocyte retrieval rate (88%), fertilization rate (84%), cleavage rate (95%), embryo transfer rate (70%) of contralateral follicles were higher than those of ipsilateral follicles (71, 62, 86, 38% respectively) and those of PBO (76, 62, 87, 41% respectively). The total pregnancy rate of both IUI and IVF did not differ among contralateral ovulation (15%), ipsilateral ovulation (8%), bilateral ovulation (11%) and PBO (10%). The results confirm and extend our previous findings in natural cycles, suggesting that local ovarian factors, e.g. from corpus luteum, affect the health of preovulatory follicle and the enclosed oocyte in the same ovary (ipsilateral) negatively. Contralateral selection of preovulatory follicles in the succeeding cycle shortens the follicular phase length and favours pre- embryo development. The chance of conceiving during ovarian stimulation with clomiphene citrate may thus be affected by the site of ovulation in the previous cycle.