Abnormal cytokine levels in non-pregnant women with a history of recurrent miscarriage

OBJECTIVE: To compare cytokine levels in serum from non-pregnant women with a history of recurrent miscarriage with those found in non-pregnant women with no such history. STUDY DESIGN: Two patient groups were enrolled into the study. Group 1 comprised 25 non-pregnant women with no history of recurrent miscarriage. Group 2 comprised 50 non-pregnant women who had a history of at least three previous miscarriages. Fifteen of these women have since become pregnant again--10 had a successful pregnancy and five miscarried. Serum levels of IL-4, IFN gamma, IL-12 and IL-18 were measured. RESULTS: Results showed IFN gamma ( 0.68 +/- 0.72 versus 0.45 +/- 0.29 P < 0.05) and IL-12 levels (66 +/- 25 versus 51 +/- 24 P < 0.05) were significantly higher in Group 2 compared to Group 1. Levels of IL-18 were significantly lower in Group 2 patients (318 +/- 140 versus 246 +/- 219 P < 0.05). Of the 15 women who became pregnant, those who miscarried again had significantly higher IL-18 levels when not pregnant than those women whose next pregnancies went successfully to term (547 +/- 20 versus 274 +/- 129 P < 0.05). CONCLUSION: These results suggest that women with a history of recurrent miscarriage can have abnormal cytokine expression even when not pregnant. This may influence the potential for future successful immune modulatory therapy.     

A novel method for the detection of transient myocardial ischaemia using body surface electrocardiac mapping

BACKGROUND: The limitations of the 12-lead ECG in the detection of myocardial ischaemia are well known. This study sought to test the hypothesis that a Body Surface Mapping (BSM) system can detect and localise the transient regional ischaemia induced by elective percutaneous coronary intervention (PCI) in patients with stable angina. METHODS AND RESULTS: 25 patients undergoing elective single vessel PCI were studied: 11 with RCA lesions, 9 with LAD lesions and 5 with circumflex lesions. Patients had BSM readings every 30 s following the inflation of a dilating balloon in the target vessel for 1 min. BSMs were analysed for ST segment change at 60 ms after the J point (ST60). Peak ST changes were analysed and colour map reconstruction made. Characteristic ST segment changes in each arterial domain were observed following inflation of the balloon. Maximal change occurred in a standard V lead on only 2/46 occasions. Statistically significant rapid rise and fall of ST 60 readings were observed indicating the onset recovery and location of the transient ischaemia. A novel method for the presentation of colour map reconstruction that removes baseline noise has been developed. CONCLUSIONS: These data confirm the hypothesis that this BSM system can detect and display transient myocardial ischaemia. BSM may represent a novel clinical tool for the assessment of clinical ischaemia.     

Fracture rate in a population-based sample of men in Reykjavik

The population-based Reykjavik Heart Study, started in 1967, aims at finding and evaluating risk factors for cardiovascular diseases. It included 4,137 men born between 1907 and 1934 and we examined all fractures recorded in these subjects from January 1977 until the end of December 2000, or death. Their mean age at the start of this study was 54 (42-69) years and the mean follow-up time 19 years. We examined the patients' records, including those from the Radiological Departments in all Reykjavik hospitals and the only out-patient accident clinic in Reykjavik. Old fractures and those caused by a malignancy were excluded. The intensity of the trauma was estimated from E-numbers. Altogether 1,531 fractures were recorded in 939 (23%) persons. A low-energy trauma caused 53% of all fractures. 612 had a single fracture during this period. 323 had two or more fractures--a 53% risk of sustaining additional fractures. The fracture incidence increased by 40% in each 10-year period. Fractures of the ribs were commonest (246), followed by those of the hand (241). 135 were hip fractures, 75% caused by low-energy trauma. The fracture rate was 20 per 1000 persons year--i.e., similar to that in other studies.     

Amantadine for neurobehavioural deficits following delayed post-hypoxic encephalopathy

Delayed post-hypoxic encephalopathy is an uncommon but potentially debilitating consequence of hypoxic-ischemic brain injury. This condition is characterized by delayed neurological deterioration days-to-weeks after an initial partial or complete recovery from hypoxic-ischemic brain injury. The course of recovery from this condition is highly variable, ranging from rapid and fatal progression over several weeks to delayed but occasionally complete recovery. There are no reports describing neurorehabilitative, including neuropharmacologic, interventions for persons with persistent neurological and/or neurobehavioural deficits following delayed post-hypoxic encephalopathy. This study describes the case of a 24-year old male who developed delayed post-hypoxic encephalopathy following an unintentional methadone and diazepam overdose and who demonstrated cognitive and neurobehavioural improvements during treatment with amantadine HCl hydrochloride in a single-case, open-label design. A brief review of the literature regarding this condition, its treatment and suggestions for further study are presented.     

Imaging of bioluminescent LNCaP-luc-M6 tumors: a new animal model for the study of metastatic human prostate cancer

BACKGROUND: Animal experiments examining hormone-sensitive metastatic prostate cancer using the human LNCaP cell line have been limited to endpoint analyses. To permit longitudinal studies, we generated a luciferase-expressing cell line and used bioluminescent imaging (BLI) to non-invasively monitor the in vivo growth of primary LNCaP tumors and metastasis. METHODS: LNCaP.FGC cells were transfected to constitutively express firefly luciferase. LNCaP-luc-M6 cells were tested for bioluminescent signal intensity and hormone responsiveness in vitro. The cells were implanted in subcutaneous and orthotopic sites in SCID-bg mice and imaged over time. RESULTS: The LNCaP-luc-M6 cells formed subcutaneous and orthotopic tumors in SCID-bg mice, and nearly all tumor-bearing animals developed pulmonary metastases. Early detection and temporal growth of primary tumors and metastatic lesions was successfully monitored by BLI. CONCLUSIONS: The LNCaP-luc-M6 cell line is a bioluminescent, hormone-sensitive prostate cancer cell line applicable for BLI studies to non-invasively monitor subcutaneous and orthotopic prostate tumor growth and metastasis in vivo.     

Accuracy of SRM and power tap power monitoring systems for bicycling

PURPOSE:: Although manufacturers of bicycle power monitoring devices SRM and Power Tap (PT) claim accuracy to within 2.5%, there are limited scientific data available in support. The purpose of this investigation was to assess the accuracy of SRM and PT under different conditions. METHODS:: First, 19 SRM were calibrated, raced for 11 months, and retested using a dynamic CALRIG (50-1000 W at 100 rpm). Second, using the same procedure, five PT were repeat tested on alternate days. Third, the most accurate SRM and PT were tested for the influence of cadence (60, 80, 100, 120 rpm), temperature (8 and 21 degrees C) and time (1 h at ~300 W) on accuracy. Finally, the same SRM and PT were downloaded and compared after random cadence and gear surges using the CALRIG and on a training ride. RESULTS:: The mean error scores for SRM and PT factory calibration over a range of 50 - 1000 W were 2.3 +/- 4.9% and -2.5 +/- 0.5%, respectively. A second set of trials provided stable results for 15 calibrated SRM after 11 months (-0.8 +/- 1.7%), and follow-up testing of all PT units confirmed these findings (-2.7 +/- 0.1%). Accuracy for SRM and PT was not largely influenced by time and cadence; however, power output readings were noticeably influenced by temperature (5.2% for SRM and 8.4% for PT). During field trials, SRM average and max power were 4.8% and 7.3% lower, respectively, compared with PT. CONCLUSIONS:: When operated according to manufacturers instructions, both SRM and PT offer the coach, athlete, and sport scientist the ability to accurately monitor power output in the lab and the field. Calibration procedures matching performance tests (duration, power, cadence, and temperature) are, however, advised as the error associated with each unit may vary.     

Prospective evaluation of sestamibi scan, ultrasonography, and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism

BACKGROUND: The aim of this study was to determine the ability of localizing studies and rapid intraoperative parathyroid hormone (PTH) to predict the success of a limited approach in patients who then underwent bilateral exploration. METHODS: Preoperative sestamibi-iodine subtraction scan and neck ultrasonography (US) were used to direct a focal (1-gland) and unilateral (1-sided) parathyroid exploration by using rapid intraoperative PTH determinations in 350 patients with sporadic primary hyperparathyroidism. Regardless of the findings, the contralateral side was then explored. RESULTS: A single gland was predicted by sestamibi in 290 patients (83%), US in 298 patients (85%), and concordance of both in 205 patients (59%). Unilateral parathyroid exploration, directed by these studies, would correctly identify single-gland disease in only 68%, 74%, and 79%, respectively. The addition of intraoperative PTH would increase the success rate to 73%, 77%, and 82%, respectively. The finding of 2 normal or 2 abnormal glands on 1 side would force bilateral exploration, and additional unsuspected pathology was found in 13%, 13%, and 9%, respectively. This failure rate would increase to 21%, 18%, and 15%, respectively, if the analysis assumed a focal rather than unilateral approach to the initial exploration. CONCLUSIONS: Even in patients with concordant sestamibi and US scans, and an appropriate PTH drop, additional abnormal parathyroid glands were found on complete exploration in 15%. A bilateral approach offers the best opportunity for the long-term cure of primary hyperparathyroidism.     

When can personal best peak flow be determined for asthma action plans?

BACKGROUND: Written asthma action plans based on personal best peak expiratory flow (PEF) consistently improve health outcomes, whereas those based on predicted PEF do not. Guidelines state that personal best PEF should be assessed over 2-3 weeks during good asthma control, but it is unclear how long to wait after commencing or changing treatment. METHODS: Electronically recorded spirometric data from 61 subjects with initially poorly controlled asthma from a 72 week budesonide study were analysed. For each week, average morning pre-bronchodilator PEF was calculated and personal best PEF was determined as the highest PEF in the previous 2 weeks. The time to plateau was defined as the week beyond which no further improvement occurred. RESULTS: At baseline, average morning PEF was 61% predicted and personal best PEF was 87% predicted. Personal best PEF from twice daily monitoring increased to a plateau of 95% predicted (p<0.0001) after only 3 weeks of budesonide treatment. However, average morning PEF continued to improve for 3 months and "as needed" reliever use for 7 months. CONCLUSIONS: Personal best PEF is a useful concept for asthma self-management plans when determined as the highest PEF over the previous 2 weeks. With twice daily monitoring, personal best PEF reaches plateau levels after only a few weeks of corticosteroid treatment.     

The epidemiology of posttraumatic adult respiratory distress syndrome

BACKGROUND: Although adult respiratory distress syndrome is an important early complication of blunt trauma, the epidemiology and risk factors for its development remain poorly defined. The aims of this study were to determine the prevalence and demographics of this complication in a prospective cohort series of patients admitted to the hospital following injury. We also assessed the contribution of the severity and pattern of the injury to the risk of this complication developing. By identifying factors associated with the highest risk of the development of adult respiratory distress syndrome, we aimed to produce guidelines to facilitate earlier detection. METHODS: We prospectively studied 7192 patients admitted to a single university hospital, over an eight-year period, for treatment of a traumatic injury. With the exception of patients who had sustained a hip fracture or who had been discharged within seventy-two hours after admission, all patients who required hospital admission following trauma, were older than thirteen years of age, and were a resident within the catchment area were included in the analysis. The prevalence and demographics of posttraumatic adult respiratory distress syndrome were identified for patients who had sustained musculoskeletal, thoracic, abdominal, and head injuries, either in isolation or in combination. The relative risks of this condition developing were calculated according to the injury pattern. Multiple logistic regression analysis was performed to identify the most highly significant predictors of the development of adult respiratory distress syndrome. RESULTS: Adult respiratory distress syndrome developed in thirty-six (0.5%) of the patients. The prevalence was significantly higher among younger patients (p = 0.002), and 83% of the cases followed high-energy trauma. The prevalence of adult respiratory distress syndrome after isolated thoracic, head, abdominal, or extremity injury was <1%. Patients with injuries to two anatomical regions had a higher prevalence (up to 2.9%), and those with injuries to three anatomical regions had an even higher prevalence (up to 10.2%). Multiple logistic regression analysis showed the Injury Severity Score, the presence of a femoral fracture, the combination of abdominal and extremity injuries, and observations of compromised physiological function on admission each to be an independent predictor of the later development of adult respiratory distress syndrome. CONCLUSIONS: The prevalence of adult respiratory distress syndrome increases with injury severity and combinations of injuries to more than one anatomical region. We have been able to quantify the importance and relative risks associated with these injuries. The implications of our findings with regard to facilitating early detection of this complication are discussed.