Myenteric plexus in spastic motility disorders

Previous studies have often revealed an absence or reduction of ganglia in Auerbach’s plexus in many patients with achalasia, which has been postulated to be related to the elevated lower esophageal sphincter pressure in these patients. We undertook a prospective study to determine whether microscopic changes were present in the myenteric plexus of patients with hypertensive lower esophageal sphincter, nutcracker esophagus, and diffuse esophageal spasm and if there was a correlation with lower esophageal sphincter pressure. Nine patients (3 men and 6 women; ages 49 to 72 years, mean 58 years) underwent a laparoscopic esophagomyotomy with fundoplication for symptomatic spastic motility disorder. A 10 mm X 5 mm segment of esophageal muscle was removed from the border of the myotomy incision, fixed in formalin, and examined under light microscopy for the presence or absence of ganglia and inflammation. Correlation between the presence of ganglia and lower esophageal sphincter pressure was tested by Pearson’s bivariant correlation. Manometry revealed three patients with hypertensive lower esophageal sphincter, four patients with nutcracker esophagus, and two patients with diffuse esophageal spasm. All three patients with a hypertensive lower esophageal sphincter revealed an absence of ganglia, whereas the six patients with nutcracker esophagus and diffuse esophageal spasm exhibited ganglia despite an elevated lower esophageal sphincter pressure in four. Hypertensive lower esophageal sphincter resembled achalasia in its absence of ganglia in Auerbach’s plexus, whereas nutcracker esophagus and diffuse esophageal spasm exhibited ganglia. There was no significant correlation in our series between the presence of ganglia and an elevated lower esophageal sphincter pressure in spastic motility disorders.     

Sensation seeking needs among 8th and 11th graders: characteristics associated with cigarette and marijuana use

This cross-sectional school-based study explored the relationship between adolescent use of cigarettes and marijuana and the sensation seeking personality factors of (1) Disinhibition and (2) Thrill and Adventure Seeking. The study population included a representative sample of both male and female 8th and 11th graders in the state of Delaware. Analytic methods utilized included correlational analysis and multivariate logistic regression. In the multivariate logistic regression models, the Disinhibition personality factor accounted for cigarette and marijuana using behaviors with odds ratios ranging between 2 and 3. Thrill and Adventure Seeking was not a significant explanatory variable in any of the final multivariate models. Potential confounders (age, gender and race) were considered in all analyses. Of all the two-way interactions assessed, none was significant. The findings from this study utilizing a large general community sample indicate that sensation seeking needs are a potential risk factor for adolescent substance use.     

Mental health versus substance abuse treatment programs for dually diagnosed patients

The aim of this study was to assess the similarities and differences of patients with co-existing psychiatric and substance use disorders attending treatment in either a mental health setting or a substance abuse treatment setting. A total of 129 patients were assessed, including 65 individuals from the substance abuse treatment center and 64 individuals from the mental health program. Treatment records were reviewed for diagnoses and sociodemographic data. While the two groups were highly similar with regard to age and ethnicity, there were significant differences in psychiatric profile, with the substance abuse treatment group having less severe diagnoses and no patients with schizophrenia, while the mental health treatment group had a majority of patients with schizophrenia. Other differences in the two groups, such as marital and parental status, disability status, and medical problems appeared to be directly linked with the aforementioned diagnostic profile. These data suggest important differences in characteristics of patients with comorbid disorders that appear to be dependent on the type of treatment program they attend. For the most effective management, integrated treatment programs should be aware of these differences and tailor service provision accordingly.     

Maternal, obstetric variables, perceived stress and health-related quality of life among pregnant women in Macao, China

Objective

to identify associations between demographic, socio-economic and obstetric variables and health-related quality of life with perceived stress among Macao Chinese pregnant women.

Design

a cross-sectional, exploratory quantitative study.

Setting

an antenatal clinic of a university-affiliated regional public hospital in Macao.

Participants

a community-based sample (n=1151) of pregnant women in the second trimester of pregnancy.

Measurements

perceived stress was measured using the Perceived Stress Scale, and health-related quality of life was measured using the standard Short Form-12 Health Survey.

Findings

a multiple linear regression analysis revealed that pregnant women who were younger (β=0.085, p=0.002), single, divorced, separated or cohabiting (β=0.067, p<0.009), had a lower level of education (β=0.079, p=0.003), worked long hours (β=0.102, p<0.001) or who had an unplanned pregnancy (β=0.063, p=0.014) with late initiation of antenatal care (β=0.066, p=0.008) or poor physical (β=−0.501, p<0.001) or mental (β=−0.115, p<0.001) health-related quality of life had higher levels of perceived stress.

Conclusion

preliminary information was provided about Macao pregnant women who had higher perceived stress during pregnancy that was associated with the demographic, socio-economic, obstetric and health-related quality-of-life variables.

Implications for practice

the development of a checklist or structured questions for clinical situations is necessary, and programmes of stress management should be tailor made during pregnancy.     

Correlates of human herpesvirus-8 seropositivity among U.S. military members recently infected with human immunodeficiency virus

BACKGROUND: Human herpesvirus 8 (HHV-8), the cause of Kaposi's sarcoma, is common among HIV-infected persons. The exact route of transmission of HHV-8 in various populations is still debated. GOAL: The goal was to define the correlates of HHV-8 infection among men recently infected with human immunodeficiency virus. STUDY DESIGN: Three hundred forty-two HIV-infected U.S. military men were evaluated using a questionnaire regarding potential risk factors and laboratory data, including HHV-8, herpes simplex virus 2 (HSV-2), syphilis, hepatitis B, and hepatitis C serologies. RESULTS: The seroprevalence of HHV-8 was 32%. HHV-8 was significantly associated with hepatitis B seropositivity (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.5-4.1), and black ethnicity was negatively associated with HHV-8 (OR, 0.6; 95% CI, 0.3-0.9) in the multivariate analysis. HHV-8 was not associated with drug use or hepatitis C seropositivity. Among men who have sex with men (MSM), HHV-8 infection correlated with hepatitis B seropositivity (OR, 2.2; 95% CI, 1.1-4.3) and HSV-2 (OR, 2.6; 95% CI, 1.4-4.9). Among heterosexuals, the correlates of HHV-8 were different; blacks as compared with whites (OR, 0.3; 95% CI, 0.1-0.8) and married versus single status (OR, 0.4; 95% CI, 0.2-0.9) were associated with a lower rate of HHV-8 infection. Among heterosexuals, hepatitis B, HSV-2, and sexual behaviors were not associated with HHV-8. CONCLUSION: This study suggests that the seroprevalence of HHV-8 is increased in both MSM and heterosexual men with HIV infection, and that the route(s) of HHV-8 acquisition might be different between MSM and heterosexuals.     

Depressed mood and cause-specific mortality: a 40-year general community assessment

PurposeThe current study describes how the excess mortality risk associated with depression translates into specific causes of death occurring during a 40-year follow-up period, with focus on deaths related to injuries, cardiovascular diseases, and cancer.MethodsData come from a cross-sectional survey (Community Mental Health Epidemiology Study) conducted in the early 1970s in Washington County, Maryland. Random sampling for the survey resulted in 2762 interviews. For the current analyses, baseline depressed mood was linked to current participant vital status through the use of death certificates.ResultsThe relative subdistribution hazards for cardiovascular deaths (3.08 [1.74–5.45]) and fatal injuries (4.63 [1.76–12.18]) were significant during the entire 40-year period for young adults (18–39 years old at baseline). The relative subdistribution hazard for cardiovascular deaths during the first 15 years of follow-up was pronounced in elderly (≥65 years) males (2.99 [1.67–5.37]) subjects. There were no significant associations between depressed mood and cancer deaths.ConclusionsIndividuals in the general community with depressed mood may be at increased risk of deaths as the result of cardiovascular disease and injury, even several decades after exposure assessment. Young adults with depressed mood appear to be particularly vulnerable to these associations.     

A new <Emphasis Type="BoldItalic">in vitro</Emphasis> lipid digestion – <Emphasis Type="BoldItalic">in vivo</Emphasis> absorption model to evaluate the mechanisms of drug absorption from lipid-based formulations

Purpose

In vitro lipid digestion models are commonly used to screen lipid-based formulations (LBF), but in vitro-in vivo correlations are in some cases unsuccessful. Here we enhance the scope of the lipid digestion test by incorporating an absorption ‘sink’ into the experimental model.

Methods

An in vitro model of lipid digestion was coupled directly to a single pass in situ intestinal perfusion experiment in an anaesthetised rat. The model allowed simultaneous real-time analysis of the digestion and absorption of LBFs of fenofibrate and was employed to evaluate the influence of formulation digestion, supersaturation and precipitation on drug absorption.

Results

Formulations containing higher quantities of co-solvent and surfactant resulted in higher supersaturation and more rapid drug precipitation in vitro when compared to those containing higher quantities of lipid. In contrast, when the same formulations were examined using the coupled in vitro lipid digestion – in vivo absorption model, drug flux into the mesenteric vein was similar regardless of in vitro formulation performance.

Conclusion

For some drugs, simple in vitro lipid digestion models may underestimate the potential for absorption from LBFs. Consistent with recent in vivo studies, drug absorption for rapidly absorbed drugs such as fenofibrate may occur even when drug precipitation is apparent during in vitro digestion.