Short-term regulation of fatty acid synthesis in isolated alveolar type II cells from adult rat lung. Effects of free fatty acids and hormones

We measured the total rate of fatty acid synthesis in alveolar type II cells freshly isolated from the lungs of adult rats. The rate of incorporation of 3H from 3H2O into cellular fatty acids was linear during 3-hr incubations and was very brisk [18 ng-atoms 3H/10(6) cells/hr +/- 2 (mean +/- SD, n = 23)]. When the nutrient medium (Minimum Essential Medium) was supplemented with various hormones or free fatty acids, the long-chain fatty acids (C14-C20) caused a decrease in the rate of 3H incorporation to a variable degree depending on the species of fatty acid. Stearate (10(-4) M) and palmitate (10(-4) M) caused the greatest inhibition of de novo cellular fatty acid synthesis, followed by myristate, arachidonate, and oleate. Insulin (10(-7) M), glucagon (10(-8) M), terbutaline (10(-5) M), 8-bromo-cyclic AMP (10(-3) M), the essential fatty acid linoleate (10(-4) M), and the medium-chain-free fatty acids laurate and octanoate (10(-4) M) did not alter the rate of fatty acid synthesis in type II cells. We demonstrated that the alveolar type II cell is a major lipogenic cell type in the rat. We also demonstrated that the availability of preformed fatty acids in the extracellular milieu is one factor regulating the rate of fatty acid synthesis in these cells.     

Uncertainty and opposition of medical students toward assisted death practices

To explore medical students' views of assisted death practices in patient cases that describe different degrees and types of physical and mental suffering, an anonymous survey was administered to all students at one medical school. Respondents were asked about the acceptability of assisted death activities in five patient vignettes and withdrawal of life support in a sixth vignette. In the vignettes, actions were performed by four possible agents: the medical student personally; a referral physician; physicians in general; or non-physicians. Of 306 medical students, 166 (54%) participated. Respondents expressed opposition or uncertainty about assisted death practices in the five patient cases that illustrated severe forms of suffering which were secondary to amyotrophic lateral sclerosis, treatment-resistant depressive and somatoform disorders, antisocial and sexually violent behavior, or AIDS. Students supported the withdrawal of life support in the sixth vignette depicting exceptional futility secondary to AIDS. Students were especially opposed to their own involvement and to the participation of non-physicians in assisted death activities. Differences in views related to sex, religious beliefs, and personal philosophy were found. Medical students do not embrace assisted death practices, although they exhibit tolerance regarding the choices of medical colleagues. How these attributes of medical students will translate into future behaviors toward patients and peers remains uncertain. Medical educators must strive to understand the perspectives of physicians-in-training. Expanded, empirically informed education that is attuned to the attitudes of medical students may be helpful in fulfilling the responsibility of imparting optimal clinical care skills.     

Transient swallow syncope during periods of hypoxia in a 67-year-old patient after self-extubation

OBJECTIVE: To describe the case of an adult patient with swallow syncope after bypass surgery, possibly related to hypoxia. DESIGN: Case report. SETTING: University hospital, medical-cardiologic intensive care unit. PATIENT: A 67-yr-old patient after second aortocoronary bypass operation for unstable angina. MAIN RESULTS: After the patient managed to extubate himself, he was in a borderline respiratory condition with an oxygen mask. When drinking for the first time after extubation, asystole was observed coincidentally with interruption of oxygen insufflation. During the next days, similar events occurred during food ingestion or when drinking liquids after a fall of oxygen saturation. The bradyarrhythmia was readily reversible on administration of atropine and ventricular backup pacing via temporary pacing wires. After normalization of gas exchange, no more episodes of swallowing-associated asystole were observed and the patient was discharged without a permanent pacemaker. There was no esophageal or gastrointestinal disease. Pre- and postoperative PR and QRS durations were normal. CONCLUSION: Extrinsic and transient mechanisms, rather than intrinsic conduction system disease, seem to have been operative in this case. It is suggested that hypoxia reinforced the vagal pharyngocardiac reflex as described in pediatric patients.     

Pacemaker dysfunction in the clinical practice

Lead dysfunction is still the predominant cause of pacemaker dysfunction. Beyond lead dysfunction clinicians might encounter problems resulting from the surgical procedure of pacemaker implantation, from specific programmable pacemaker functions (e.g. undersensing of premature ventricular complexes when autosensing is activated) and from interference with electromagnetic fields. Electromagnetic interference between pacemakers and mobile phones has been demonstrated both in vitro and in vivo, but in daily life pacemaker patients can readily use mobile phones when certain security measures are taken into account. Electromagnetic interference between anti-theft devices and pacemakers can arise from situations where the pacemaker is in close proximity to the anti-theft device, but in daily life these interferences are rare. The electromagnetic fields generated during magnetic resonance imaging (MRI) are considerably stronger than those generated by mobile phones or anti-theft devices, therefore permanent pacemakers are still considered a contraindication for MRI, although several case reports have recently been published that reported on uneventful MRI procedures in pacemaker patients. The present review summarizes the current knowledge on the most frequent pacemaker dysfunctions and electromagnetic interferences that might be relevant in clinical practice.     

3DMR osseous reconstructions of the shoulder using a gradient-echo based two-point Dixon reconstruction: a feasibility study

Objective

To create 3DMR osseous models of the shoulder similar to 3DCT models using a gradient-echo-based two-point/Dixon sequence.

Materials and methods

CT and 3TMR examinations of 7 cadaveric shoulders were obtained. Glenoid defects were created in 4 of the cadaveric shoulders. Each MR study included an axial Dixon 3D-dual-echo-time T1W-FLASH (acquisition time of 3 min/30 s). The water-only image data from the Dixon sequence and CT data were post-processed using 3D software. The following measurements were obtained on the shoulders: surface area (SA), height/width of the glenoid and humeral head, and width of the biceps groove. The glenoid defects were measured on imaging and compared with measurements made on en face digital photographs of the glenoid fossae (reference standard). Paired t tests/ANOVA were used to assess the differences between the imaging modalities.

Results

The differences between the glenoid and humeral measurements were not statistically significant (cm): glenoid SA 0.12?±?0.04 (p?=?0.45) and glenoid width 0.13?±?0.06 (p?=?0.06) with no difference in glenoid height measurement; humeral head SA 0.07?±?0.12 (p?=?0.42), humeral head height 0.03?±?0.06 (p?=?0.42), humeral head width 0.07?±?0.06(p?=?0.18), and biceps groove width 0.02?±?0.01 (p?=?0.07). The mean/standard deviation difference between the reference standard and 3DMR measurements was 0.25?±?0.96 %/0.30?±?0.14 mm; 3DCT 0.25?±?0.96 /0.75?±?0.39 mm. There was no statistical difference between the measurements obtained on 3DMR and 3DCT (percentage, p?=?0.45; mm, p?=?0.20).

Conclusion

Accurate 3D osseous models of the shoulder can be produced using a 3D two-point/Dixon sequence and can be added to MR examinations with a minor increase in imaging time, used to quantify glenoid loss, and may eliminate the need for pre-surgical CT examinations.     

Screening for Postpartum Depression Among Low-Income Mothers Using an Interactive Voice Response System

This study tested the feasibility of using an interactive voice response (IVR) phone system to screen for postpartum depression among low-income, English- and Spanish-speaking mothers. Newly delivered mothers were interviewed in the hospital. Consenting subjects completed a background questionnaire and were asked to call an automated phone system 7 days postpartum to complete an IVR version of the Edinburgh Postnatal Depression Screen (EPDS). During the phone screen, subjects were branched to different closing narratives based on their depression scores which were later posted to a password protected website. Logistic regression was used to assess relationships between demographic and psychosocial factors, IVR participation, and depression scores. Among 838 ethnically diverse, low income, postpartum mothers, 324 (39%) called into the automated phone screening system. Those who called were more likely to have at least a high school education (OR = 1.63, 95%CI: 1.23, 2.16), be employed (OR = 1.48, 95%CI: 1.08, 2.03) and have food secure households (OR = 1.50, 95%CI: 1.06, 2.13). There was no statistically significant difference between callers and non-callers in terms of marital status, race/ethnicity, parity, or self-reported history of depression. Postpartum depression symptoms were present in 17% (n = 55) and were associated with being single (AOR = 2.41, 95% CI: 1.29, 4.50), first time mother status (AOR = 2.43, 95% CI: 1.34, 4.40), temporary housing (AOR = 2.35, 95% CI: 1.30, 4.26), history of anxiety (AOR = 2.79, 95% CI: 1.69, 6.67), and history of self-harm (AOR = 2.66, 95% C: 1.01, 6.99). Automated phone screening for postpartum depression is feasible among disadvantaged mothers but those with the highest psychosocial risk factors may not choose or be able to access it. IVR could be used to supplement office- and home visit-based screening protocols and to educate patients about mental health resources.     

Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women

Background

In Canada, there has been a considerable increase in the number of women infected with the human immunodeficiency virus (HIV). Within a stigmatized social context, disclosure of HIV positivity is still a prevailing concern among women. Little is known about the global understanding of how French-speaking, Quebec-born women living with HIV, live their serostatus disclosure experience. The aim of this qualitative study is to describe and understand the disclosure experience of these women.

Methods

We conducted semi-structured interviews with seven women. A convenience sample of French-speaking, Quebec-born women was chosen because they all responded to the criteria of wishing to share their disclosure experience. The mean age of the participants was 46 years old (SD±12). They lived with HIV for an average of 10 years; time since diagnosis varied from 8 months to 23 years. Two out of four mothers had given birth to HIV positive children. Data analysis proposed by van Manen was performed to discover the essential themes of the experience.

Results

Seven themes were identified to understand the experience of disclosure in women: 1) Respecting for self and confidants; 2) Feeling apprehension; 3) Exercising control to ensure protection; 4) Deliberately engaging in a process of disclosure/non-disclosure; 5) Exposing oneself to stigma and social exclusion; 6) Suffering internally; and 7) Benefitting from the positive effects of one’s decision. For these women, disclosing their HIV status meant: Living the ambivalence of a paradoxical process of revealing/concealing, in a state of profound suffering, exacerbated by stigma, while also being enriched by the benefits attained.

Conclusions

Understanding the experience of disclosure in WLHIV is important to guide actions in the practice to support and accompany these women in their unique reality. Health professionals have to broaden their role and work on individual, interpersonal, inter-organizational and intersectoral levels. Mobilization of actors from different sectors would facilitate the implementation of pertinent and opportune interventions.