Towards health promotion indicators

This article examines the state of the art in health promotionindicator development over the past few years and presents fiveconclusions from this review, The authors put forward proposalsfor the development of health promotion indicators based onthe question, "What research in health promotion will lead toappropriate indicators?". The authors illustrate some areasof concern both for researchers and policymakers and suggesta number of indicators, appropriate to each of these groups,for important dimensions of health, health-related processesand health resources. The dialogue between health researchersand health decision-makers is growing and links are being made;it is important to continue this process.     

A VARIANT FORM OF BRANCHED-CHAIN KETO ACIDURIA

A case of branched-chain keto aciduria is described. The boy's clinical picture was similar to that of patients with the intermittent form of this disorder, but severe mental retardation was present. It proved possible to treat him successfully with a diet low in branched-chain amino acids and, at the age of 3 years, after 18 months' treatment, his mental development corresponded with his age. Details are given of the clinical course and the dietary treatment. The findings in the patient's family are also described, with the results of oral loading tests with 1-leucine performed on all members of the family.     

Unusual thionation of a cyclic hexapeptide

One carbonyl oxygen of the cyclic hexapeptide cycle(-Gly¹-Pro²-Phe³-Val⁴-Phe⁵-Phe⁶-) (A) can be selectively exchanged with sulphur using Yokoyama's reagent. Surprisingly it was not the C=O of Gly¹ but that of Phe⁵ which was substituted and cyclo(-Gly¹-Pro62-Phe³-Va1⁴-Phe⁵ψ[CS-NH]Phe⁶-) (B)was obtained. Thionation results in a conformational change of the peptide backbone although the C=O of Phe⁵ and the corresponding C=S are not involved in internal hydrogen bonds. Two isomers in slow exchange, containing a CIS Gly¹-Pro² bond in a βVIa-turn (minor) and a trans Gly-Pro bond in a βII′-turn (major), were analyzed by restrained molecular dynamics in vacuo and in DMSO as well as using time dependent distance constraints. It is impossible to fit all experimental data to a static structure of each isomer. Interpreting the conflicting NOES, local segment flexibility is found. MD simulations lead to a dynamic model for each structure with evidence of an equilibrium between a βI- and βII-turn about the Val⁴-Phe⁵ amide bond in both the cis and trans isomers. Additionally proton relaxation rates in the rotating frame (R_1p) were measured to verify the assumption of this fast βI/βII equilibrium within each isomer. Significant contributions to R_1p-rates from intramolecular motions were found for both isomers. Therefore it is possible to distinguish between at least four conformers interconverting on different time scales based on NMR data and MD refinement. This work shows that thionation is a useful modification of peptides for conformation-activity investigations.     

Oral recognition of forms and oral muscular coordination ability. A longitudinal study in young adults

A study has been carried out to investigate the constancy of results in oral recognition of forms (RF-test) and in tests which demand a fine coordination of the oral muscular apparatus (MA-test). Twenty examinees with a mean age of 22.5 years were tested with both test forms in 1972 and retested 4 years later in 1976. The performances in the RF- as well as in the MA-test improved considerably. As to the learning (training) effect in both test forms, the test results acquired by training during the previous period have largely been preserved until the next test period 4 years later. Individuals with a given capacity to perform either the RF- or MA-test, showed about the same grade of ability 4 years later. The RF- as well as the MA-test seem to reflect a given ability, which, at least in this age-group, remained constant during a period of 4 years. These results may be explained by reference to the notion of schema in which some motor-sensory feed-back will be stored. The specificity of the perceptual and motor patterns used, may have produced schemata with good resistance against forgetting.     

Human gastric mucosal adenylate cyclase activity: effects of various cytoprotective prostaglandins

Several prostaglandins prevent ulcer formation (called cytoprotection) by a mechanism other than inhibition of gastric acid secretion. One suggestion is that they increase cyclic AMP in non-parietal cells. A variety of prostaglandins with potent cytoprotective properties were tested for their capacity to modulate adenylate cyclase activity in homogenates of human gastric mucosa. Prostaglandin E2, prostacyclin (PGI2) and 15(S)-methyl-PGE2 stimulated the cyclase in human gastric mucosal biopsy specimens in a dose-dependent manner. Cytoprotective prostaglandins without antisecretory properties such as PGF2 beta were also able to activate the enzyme system dose-dependently. In contrast, cytoprotective prostaglandins such as PGD2, the PGE1-analogue, SC-29333, and the prostaglandin-like compound C83 did not stimulate human gastric adenylate cyclase. Whereas PGD2 did not modulate enzyme activity at all, SC-29333 and C83, at concentrations greater than 10 mumol/l, inhibited basal and PGE2-stimulated enzyme activities. These studies suggest that cyclic AMP is not directly related to the cytoprotective effect of prostaglandins, at least in human gastric mucosa.     

Safety of Transcatheter Aortic Valve Implantation in a Hospital With Visiting On‐Site Cardiac Surgery

Objectives

To describe the feasibility and safety of transcatheter aortic valve implantation (TAVI) with a visiting on‐site cardiac surgery program for surgical back‐up.

Background

Both European and American guidelines recommend institutional cardiac surgery back‐up for TAVI. However, the conversion to cardiac surgery is very rare, many complications of TAVI can be managed by catheter techniques and a visiting team can also provide surgical stand‐by. Therefore, the need for institutional cardiac surgery (by a surgeon who routinely performs conventional surgical valve replacement at the institution performing TAVI) has been questioned.

Methods

A retrospective review of consecutive TAVI cases with visiting on‐site cardiac surgery was performed. Key demographic, echocardiographic, and procedural data were collected prospectively.

Results

A total of 97 patients (81.9 ± 6.3 years) with high‐risk criteria (log Euroscore 21.6 ± 14.4, chronic renal failure 39.2%, severe systolic dysfunction 24.7%) underwent TAVI with visiting on‐site cardiac surgery at our institution. Local anesthesia with or without conscious sedation was used in 94.8% of patients. Procedural technical success was 100%, with 2 episodes of tamponade (both treated with pericardiocentesis) and a 16.5% vascular complication rate (all treated conservatively or percutaneously). Thirty‐day mortality was 3.1%, with 5.2% rate of stroke and 8.2% rate of major bleeding. There were no conversions to surgery.

Conclusions

TAVI can be done safely in the setting of a hospital with visiting on‐site cardiac surgery. This requires careful patient selection, experienced operators and surgeons in experienced centers with well‐established criteria and processes of care. In this setting, it may be an option for hospitals without institutional cardiac surgery. (J Interven Cardiol 2015;28:76–81)

     

Testosterone and other gonadal factor(s) restrict the efficacy of genes controlling resistance to Plasmodium chabaudi malaria

The effect of circulating concentrations of testosterone (Te) on resistance to Plasmodium chabaudi malaria was investigated in the H-2 congenic mouse strains C57BL/10, B10.A, B10.A(3R), B10.A(4R), and B10.D2. Te-levels were determined by radioimmunoassay and resistance was expressed in terms of percent self-healers after challenge with 10(6) P. chabaudi-infected erythrocytes. Our data indicate: (i) Females and castrated males reveal very similar interstrain variations of resistance. These do not correlate with the interstrain variations of the Te-levels. This is consistent with the view that resistance to P. chaubaudi is controlled by genes of the H-2 complex and genes of the non-H-2 B10-background, (ii) The polygenic control of resistance is inefficacious at high Te-levels. This is evident as high susceptibilities of males, Te-treated females and Te-treated castrated males. Moreover, high Te-levels correlate with susceptibilities to P. chabaudi within mice of the same sex of a given strain, (iii) B10-males chemically castrated using buserelin display the same low Te-level as those surgically castrated. The latter become resistant, while the former remain as highly susceptible to P. chabaudi as untreated B10-males. Obviously, other gonadal factor(s), besides Te, impose restrictions on genes controlling resistance to P. chabaudi malaria.     

S- and C-glycopeptide derivatives of an LH-RH agonist

The S- and C-glycosylated nonapeptides 1 and 2 were synthesized as analogs of the non-glycosylated LH-RH agonist buserelin (pGlu-His-Trp-Ser-Tyr-D-Ser(tBu)-Leu-Arg-Pro-NHEt) by segment condensation in solution. 1 and 2 differ from this peptide in the amino acid in position 6. In the first case (l), D-serine (tBu) is substituted by D-CySteine carrying a rhamnosyl residue, in the second case (2) D-alanine carrying a galactosyl moiety bound as C-glycoside is incorporated. The bioactivity of both glycopeptides as fertility drugs was determined from the dose dependent LH release in male rats. Additionally, in female rats the ovulation rate was assessed. As a result the analog 1 exhibits a similar biological activity as buserelin while analog 2 shows about 25% of this potency. Compared to buserelin the solubility of the analogs 1 and 2 in aqueous buffer is improved by more than two orders of magnitude due to the carbohydrate moieties. © Munksgaard 1996.