GDM women in good glycemic control: which meal-related measure enhances fetal well-being?

OBJECTIVE: To determine which meal-related glucose measure maximizes perinatal outcome in gestational diabetes mellitus (GDM) women who have achieved established levels of glycemic control. METHODS: Two thousand two hundred and ninety-eight GDM women were stratified by meal-related blood glucose measures: fasting (<95 mg/dL); pre-meal (< or =90 mg/dL); 2-h post-meal (< or =120 mg/dL); mean (< or =100 mg/dL). The rates of unidentified adverse outcome for composite outcome, neonatal intensive care unit (NICU), metabolic and respiratory complications and cesarean section delivery within each meal-related glucose threshold were calculated. RESULTS: Overall, 25-69% of large-for-gestational-age (LGA)/macrosomic infants were not identified within the recommended meal-related glucose threshold measurements. The lowest rates of unidentified morbidity were found in the pre-meal and mean blood glucose categories while the highest rates were in the post-meal category despite subjects achieving recommended levels of glycemic control. The increased rate of LGA/macrosomia within 10 mg/dL increments for each meal-related glucose category revealed that regardless of the meal-related category, the rate of LGA was significantly higher (15-25%). Logistic regressions (dependent variable= composite outcome or LGA) showed that mean blood glucose was the only significant contributor. CONCLUSION: Currently recommended meal-related glucose measures do not preclude adverse fetal outcome.     

Percutaneous, transvenous retraction of a vena cava filter from the right ventricle

Percutaneous, transluminal implantation of the Greenfield vena cava filter for the prevention of recurring pulmonary embolism is considered to be advantageous compared to the risk of surgical cava clip or filter implantation procedures. However, as exemplified by this report, a displacement of the device into the right atrial and/or ventricular cavity must be taken into consideration. In our study, the retraction of the filter into the inferior vena cava was performed by the Dotter set, which is routinely used by us for the retraction of catheter fragments from central vessels and right heart chambers.     

Dietary fat, plasma lipoproteins, and immune function in middle-aged American men

Dietary fat has been incriminated as a positive risk factor for the development of neoplasia in human populations. We used adipose tissue fatty acid analysis as an index of dietary fat intake to study the association between dietary fat and immune function in a group of 94 free-living American males (avg age 47 years). Immunocompetence was tested by a battery of T- and B-lymphocyte stimulation tests and also by natural killer (NK) cell activity. Correlations were sought between fatty acid composition, plasma lipids, and immune responsivity. The degree of unsaturation of the diet over a polysaturated-to-saturated fat ratio range of 0.54-1.01 had no predictable effect on the immune function. Stepwise regression analysis showed that the concentrations of plasma triglycerides and cholesterol and its subfractions did not explain any of the variance in the immune tests. Palmitic acid (16:0) was associated with 7% of the variance of the response to C. albicans and E. coli, perhaps through influencing B-cell activity. Stearic acid (18:0) was correlated negatively to concanavalin A responsivity (18% of the variance) and positively to NK activity (20% of the variance). If impaired in vitro immune function is a marker of increased risk for carcinogenesis, then our data do not support a role for dietary fat influencing in any systematic manner lymphocyte function in vitro, as reflected by proliferative response or NK activity. Further, plasma lipoproteins, in particular cholesterol levels, did not appear to affect any immune function test. It remains to be studied whether dietary fat, lipoproteins, or fat-soluble substances may influence membrane structure and function and prostaglandin formation as alternative pathways in the promotion of neoplasia.     

Creating a patient-safe environment in a perioperative setting

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AS A RESULT OF NEW regulatory requirements and consumer demands for optimal health care, a focus on patient safety is even more important.

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IN 2001, A CORPORATE PATIENT SAFETY project was initiated by managers at one facility's six hospital-based perioperative suites. Although each suite had its own policies and procedures, no formal assessment of compliance with policies existed.

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A PERIOPERATIVE SAFETY ASSESSMENT was designed by resource management department consultants. The assessment included a tool, a questionnaire, and an assessment process.

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AFTER BEING TESTED AT ONE FACILITY, perioperative safety assessments were performed in the organization's six ORs and two ambulatory surgery centers. Best practices then were shared across the system. AORN J 81 (January 2005) 168-180.

     

Statins: Mechanisms of neuroprotection

Clinical trials report that the class of drugs known as statins may be neuroprotective in Alzheimer's and Parkinson's disease, and further trials are currently underway to test whether these drugs are also beneficial in multiple sclerosis and acute stroke treatment. Since statins are well tolerated and have relatively few side effects, they may be considered as viable drugs to ameliorate neurodegenerative diseases. However, the mechanism of their neuroprotective effects is only partly understood. In this article, we review the current data on the neuroprotective effects of statins and their underlying mechanisms.