Prolonged fasting in patients with chronic pain syndromes leads to late mood-enhancement not related to weight loss and fasting-induced leptin depletion

Periods of fasting are practiced worldwide on a cultural/religious background, and related mood-enhancing effects are postulated. We aimed to assess the effect of fasting on mood and to explore the interaction with neuroendocrine activation and leptin depletion in a controlled explorative study on consecutive inpatients (BMI < 35 kg/m2) of a nutritional ward. 36 subjects (38.9 +/- 7.0 years; 29 female, BMI 26.7 +/- 4.1 kg/m2) participated in an 8-day modified fast (300 kcal/day), 19 patients (38.1 +/- 5.9 years; 18 female, 23.5 +/- 4.1 kg/m2) received a mild low calorie diet. Measurements included daily ratings of mood (VAS), weight and levels of leptin and cortisol at four time-points of the 2-week study period. Weight loss was 4.8 +/- 1.2 and 1.6 +/- 0.9 kg in fasters and controls, respectively. Fasters showed a more pronounced decrease of leptin (58% vs. 20%; P < 0.001) and a 17% increase of cortisol levels (P < 0.001). Mood ratings increased significantly in the late phase of fasting (P < 0.01) but were not related to weight-loss, leptin-depletion or cortisol increase. Our findings suggest that fasting induces specific mood-enhancement. The physiological mediator appears to be neither leptin nor cortisol, the role of other mechanisms has to be further studied.     

Ethical considerations behind the limitation of cardiopulmonary resuscitation in Hungary--the role of education and training

INTRODUCTION: Although the long term success of cardiopulmonary resuscitation (CPR) is still less than hoped for, its value cannot be questioned when carried out appropriately in selected cases. Resuscitation frequently brings only short-term success, and several patients suffer severe consequences also causing an economic, medical and ethical burden to society. The issue of limitation of resuscitation, including Do Not Attempt Resuscitation (DNAR) and the termination of resuscitation has been surveyed in many European countries using a structured questionnaire. In Hungary no such comprehensive study has been conducted yet. The goal of this investigation was to recognise the ethical factors limiting resuscitation in Hungary. METHODS: We contacted 72 doctors personally during 2003, who were working actively at an intensive care unit (ICU) and asked them to answer a structured questionnaire in strict anonymity. We investigated the role of different ethical issues in beginning and suspending resuscitation efforts in conjunction with medical experience, sex, ideology, and education using a five point visual analogue scale. The answers given were categorised to autonomy, futility, obtainable quality of life, resource utilization, and to "another" category detailed later on. The questionnaire and the plan of this investigation was approved by the Semmelweis Medical University's Ethical Committee (SE-TUKEB 109/2003). RESULTS: The decision not to attempt resuscitation was mostly dictated by the opinion of the head of department and the doctor in charge of the patient (3.53 +/- 1.30), and after this the presumed obtainable quality of life (3.13 +/- 1.40), objective futility (3.11 +/- 0.94), and patient autonomy (2.02 +/- 1.63). The other objective (0.57 +/- 1.59), and subjective (1.04 +/- 1.21) factors, as well as resource utilization (0.29 +/- 0.66) played a less important role. The decision to terminate resuscitation efforts was mostly dictated by the objective futility criteria (3.39 +/- 0.88), obtainable quality of life (3.31 +/- 1.50), subjective futility (3.19 +/- 1.47), and autonomy (1.57 +/- 1.67) to a smaller extent. Among the doctors who participated in an appropriate-an internationally accredited (ERC/RC(UK)/AHA)-Advanced Life Support (ALS) training-the frequency of the appearance of the principle of modern bioethics-such as autonomy-was significantly higher and the same tendency could be observed in those who completed their studies at the medical university in the last 5 years. CONCLUSIONS: The results underline the original presumption that the Hungarian resuscitation practice is at first influenced by professional (or "thought to be professional") standpoints. The quality of life, and patient autonomy plays an important role in the decision making about limitation of resuscitation efforts. Current CPR education emphasizes the importance of ethical considerations, and this could be observed clearly in the answers.     

Prevalence of alpha1-antitrypsin phenotypes in patients with IgA nephropathy

BACKGROUND: alpha1-antitrypsin (AAT) is the main protease inhibitor in the blood. Several different AAT phenotypes exist. The most common variant is the MM phenotype, which is also associated with normal AAT levels. The less common phenotypes with Z and S variants are associated with low AAT levels. AAT deficiency is a risk factor for pulmonary emphysema, liver impairment and some immune-mediated diseases, some of which are also associated with IgA nephropathy (IgAN). In fact, liver impairment resulting from AAT deficiency may directly contribute to renal abnormalities resembling IgAN. PATIENTS AND METHODS: We investigated AAT phenotype and AAT levels in 100 IgAN patients who did not have end-stage liver disease. Fifteen patients in our sample had secondary IgAN. We also tested for the presence of renal deposition of AAT in patients heterozygous for AAT variants as well as in a randomly chosen group of patients with MM phenotype. We checked for any association between AAT phenotype and the progression of IgAN as well as the prevalence of diseases associated with IgAN (i.e. secondary IgAN). RESULTS: Twelve patients in our sample were heterozygous for AAT variants. Phenotypes were MZ in 5 patients, MS in 3, MF in 1, ML in 2 and ME in 1 patient. AAT levels were lower in these 12 patients than in those homozygous for the M variant (1.17+/-0.46 vs. 1.44+/-0.34 g/l, p < 0.05). We found renal deposition of AAT in 2 heterozygous patients and in 1 of the 12 patients which were randomly chosen. End-stage renal (ESRF) failure developed in 3 of the 12 heterozygous patients and in 6 of the 88 homozygous patients (p = 0.07) during the follow-up. The prevalence of heterozygosity was significantly higher in patients with secondary IgAN than in those with primary IgAN ((5/15 vs. 7/85; p < 0.02). CONCLUSIONS: AAT phenotype is not associated with the risk of primary IgA nephropathy, but might have an impact on disease outcome as well as on the risk of secondary IgAN.     

Antinociceptive activity of Sempervivum tectorum L. extract in rats

The extract of Sempervivum tectorum L. (Crassulaceae) containing several flavonoids is widely used as an antiinflammatory agent in folk medicine. Previous studies have demonstrated that various flavonoids or flavonoid-containing plant extracts produce significant antinociception, but no data are available concerning their antinociceptive effect especially at the spinal level. The purpose of the present study was to investigate the antinociceptive activity of Sempervivum tectorum L. extract on acute and inflammatory pain sensitivity in awake rats.The pain sensitivity was assessed by the acute tail- flick test in intact rats and by the paw withdrawal test after carrageenan-induced inflammation using heat stimulus. The plant extract was administered intraperitoneally and intrathecally in rats.The intraperitoneal injection of a high dose of the extract (1000 mg/kg) significantly (p < 0.05) increased the paw withdrawal latency of the inflamed paw. The intrathecal administration (30-300 micro g) caused a small, but significant increase (10%-15%) in tail- flick latency. In the carrageenan-induced inflammatory model, the intrathecally applied extract (30-1000 micro g) significantly decreased, but did not relieve the thermal hyperalgesia. The results suggest that the spinal cord does not seem to play an important role in the antinociceptive effects of this plant extract.     

Alterations of urinary carbon dioxide tension, electrolyte handling and low molecular weight protein excretion in acute pyelonephritis

Renal tubular function tests were performed in 45 children suffering from upper and lower urinary tract infections. Determinations were made of the urinary carbon dioxide tension in maximally alkaline urine as an index of distal tubular H+-ion secretion, of urinary protein excretion, and of urinary sodium and phosphate handling. Urinary PCO2 was low (2.7 +/- 13.9 mmHg) in acute pyelonephritis compared to values in healthy children (52 +/- 32 mmHg) or those with cystitis (48 +/- 34 mmHg). At the onset of pyelonephritis an elevated fractional excretion of sodium (1.38 +/- 0.38 vs. 0.50 +/- 0.20%) and decreased phosphate reabsorption (69.2 +/- 7.1 vs. 90.4 +/- 4.9%) were also observed. Significantly elevated urinary low molecular weight protein excretion was also found in pyelonephritis. These data indicate the existence of proximal and distal tubular dysfunction at the onset of acute bacterial pyelonephritis.     

Cloning and expression of NDV hemagglutinin-neuraminidase cDNA in a baculovirus expression vector system

The hemagglutinin-neuraminidase (HN) gene of the Hitchner B1 strain of Newcastle disease virus (NDV) was cloned as a cDNA and inserted into a baculovirus expression vector. The recombinant HN (recHN) expressed in Spodoptera frugiperda cells had both hemagglutinating and neuraminidase activities both of which were inhibited by polyclonal anti-NDV sera or a monoclonal antibody (MAb) against HN. Infected insect cells could hemadsorb chicken red blood cells suggesting that the recHN is properly glycosylated and transported to the cell surface. A 67-kDa recHN precursor and a 74-kDa, presumably mature, recHN from infected cells were detected by Western blot analysis and were found to comigrate with similar proteins from NDV-infected chick embryo fibroblast cells. The kinetics of synthesis of recHN was similar to that for polyhedrin and some HN appeared in the extracellular medium. HN was copurified with extracellular virus (ECV) from the extracellular medium and was used to immunize chickens. The anti recHN serum was specific to NDV in both ELISA and Western blot analysis.