Short report: zinc sulphate supplementation corrects abnormal erythrocyte membrane long-chain fatty acid composition in patients with Crohn's disease

Patients with Crohn's disease may become zinc-deficient and, in such patients, an altered metabolism of radiolabelled long-chain fatty acids has been reported. We have investigated the possible reversal by zinc supplementation of altered long-chain fatty acid profiles of red cells in Crohn's disease. Twenty patients with long-standing Crohn's disease in clinical remission received 200 mg of zinc sulphate daily for 6 weeks. Phospholipid fatty acid profiles of washed red cells were analysed before and after zinc treatment and compared to those of 20 unsupplemented healthy controls. Plasma zinc levels in Crohn's were 72 ± 8 μg/dL before zinc treatment and increased to 114 ± 10 μg/dl after the therapy. Prior to zinc supplementation, the percentage of palmitic, stearic and oleic acids was significantly higher in Crohn's disease, while linoleic, arachidonic and n-3 fatty acids were reduced in Crohn's disease compared to healthy controls. Zinc supplementation abolished these pre-treatment differences in red-cell long-chain fatty acid profiles but did not affect plasma fatty acid values. Further studies are needed to clarify whether these fatty acid changes can be related to the clinical course of the disease.     

Bioavailability of single and multiple doses of a new oral formulation of 5-ASA in patients with inflammatory bowel disease and healthy volunteers

Aims: An oral multiparticulate coated formulation of 5-aminosalicylic acid (5-ASA; mesalazine) has been developed to provide a controlled release of the drug, in a pH-dependent fashion, in the distal ileum and colon. The purpose of the present study was to assess the systemic availability of the drug and its metabolite, acetyl-5-ASA, following single (800 mg) and multiple (2400 mg for 56 days) oral dose administration. Methods: Three groups were investigated: six healthy volunteers, six patients with ulcerative colitis, and nine patients with Crohn's disease in remission. In the single oral dose study (800 mg) all three groups participated, whereas in the multiple oral dose study (2400 mg/day for 56 days) only the patients with inflammatory bowel disease took part. Plasma and urine 5-ASA and Ac-5-ASA were measured for 48 h. Results: In the single oral dose regimen, systemic absorption of 5-ASA and Ac-5-ASA were low and did not differ between the three groups. Only about 20% of the 5-ASA given was absorbed, with more than 80% of the drug being available in the terminal ileum and colon for therapeutic activity. The multiple oral dose regimen in patients with inflammatory bowel disease produced a significantly higher plasma concentration and urine excretion of both 5-ASA and Ac-5-ASA by the end of the treatment, in comparison to the first dose. There was a statistically higher systemic absorption of 5-ASA in patients with ulcerative colitis than in patients with Crohn's disease. After 56 days of dosing, no adverse event was reported and laboratory screening tests remained within normal ranges. Conclusions: The new oral 5-ASA formulation is gradually released throughout the small and large intestine, reflected by a low plasma concentration of the drug and its metabolite, with about 80% of the drug being available for ileum-colon therapeutic activity.     

Asystole with Syncope Secondary to Hyperventilation in Three Young Athletes

We describe three athletes who had syncope after (case 1) or during (cases 2, 3) hyperventilation. During the episode, ECG showed prolonged sinus arrest. Clinical data and noninvasive investigations were normal and the phenomenon was not reproducible. Electrophysiological study after autonomic blockade allowed a prolonged intrinsic heart rate in case 1, and abnormal corrected sinus node recovery time in cases 1 and 2. During follow-up, symptomatic sinus arrest provoked by deep inspiration occurred in case 3. These cases document prolonged asystole of unknown etiology, secondary to hyperventilation, and probably caused by different vagally-mediated mechanisms.     

Determinants of condom use among intravenous drug users in Spain

Attitudes to and perception of health care delivery are consideredto be important factors for patient compliance in diabetes.To Investigate insulin-treated diabetic patients' use of, experienceof and attitudes to diabetes care a questionnaire was sent to561 patients, 20–50 years old, living in northern Sweden.Four hundred and eighty-eight patients (87%) participated inthe study. Data were analysed against social, medical and geographicalbackground factors. Female patients more often than men hadseen an ophthalmologist (93 versus 87%, p<0.05), a diabetesnurse specialist (74 versus 64%, p<0.05) and a chiropodist(49 versus 30%, p<0.001) at least once during the courseof their diabetes. Women also used the services of a medicalsocial worker (17 versus 10%, p-0.05) or a psychologist (14versus 8%, p<0.01) more often. More men than women were satisfiedwith the health care they had at the onset (65 versus 38%, p<0.001),but no gender difference in attitude to their present care wasfound. Diabetic patients with chronic complications comparedto those without were less satisfied both with the care theyreceived at the onset of diabetes (40 versus 61%, p<0.001)and at the time they answered the questionnaire (59 versus 72%,p<0.01). Patients in the most sparsely populated health districtwere more seldom able to be seen by the same physician (70 versus93% and 94%, p<0.001) and patient-physician continuity waspoorer over a 3 year period (48 versus 80%, p<0.001). Basedon results of this study, we conclude that use of, experienceof and attitudes to diabetes care are primarily related to genderand sickness factors. Living in sparsely populated areas probablyaffects the use and continuity of hearth care depending on themeans available. The differences demonstrated might be an argumentfor planning more individualized care for diabetic patientsin the future.     

Transthoracic Sensor for Noninvasive Assessment of Left Ventricular Contractility: Validation in A Minipig Model of Chronic Heart Failure

Background: Invasively measured left ventricular (LV) dP/dt is the accepted standard for measuring acute and chronic directional changes in LV contractility. Recently, we developed a noninvasive force sensor based on an accelerometer positioned on the chest, which measures the vibrations generated by isovolumic myocardial contraction. The aim of this paper was to compare noninvasive (accelerometer) versus invasive (LV dP/dt) indices of myocardial contractility in a chronic minipig model of pacing‐induced heart failure (HF). Comparative assessment was performed both at rest and following dobutamine infusion. Methods: In adult male minipigs (n = 6), LV contractility was simultaneously assessed both invasively (LV dP/dt, Millar catheter) and noninvasively (accelerometer) at rest and following dobutamine (up to 7.5 mcg/kg/min), both before and after development of HF by pacing the LV at 180 beats/min for 3 weeks. Results: Invasive and noninvasive assessments were obtained in 24 conditions (12 at rest and 12 after dobutamine infusion). Sensor‐based cardiac force changes were significantly related to positive peak LV dP/dt_max changes following dobutamine infusion both in normal (r = 0.88, P < 0.001) and failing heart (r = 0.89, P < 0.001). The force‐frequency relation showed a tight correlation between invasive and noninvasive assessment (r = 0.68, P = 0.02). Conclusions: The force‐frequency relation can be assessed noninvasively by a transthoracic sensor based on an accelerometer. The method can efficiently detect the development of resting dysfunction and the contractile reserve at different HF steps, with potential for wearable HF monitoring. (PACE 2010; 795–803)     

Laboratory Evaluation and Clinical Application of a New One-Bottle Adhesive

Abstract: Purpose: The purposes of this project were to compare the enamel and dentin bond strengths of a new nanofilled one-coat adhesive system with its predecessor, an unfilled two-coat adhesive system; to analyze the dentin interfacial ultramorphology, using scanning and transmission electron microscopy (SEM and TEM); and to illustrate the clinical technique associated with the use of the new nanofilled one-coat adhesive system.
Material and Methods: Twenty flat dentin surfaces and 20 flat enamel surfaces were polished on the labial surface of bovine incisors mounted in acrylic resin. The specimens were equally and randomly assigned to four bonding groups: (1) dentin with Prime & Bond 2.1; (2) dentin with Prime & Bond NT; (3) enamel with Prime & Bond 2.1; and (4) enamel with Prime & Bond NT. A composite post was then adapted to the treated area and light-cured. After thermocycling, shear bond strengths were determined by testing the shear strength of the specimens. The data were analyzed using one-way analysis of variance (ANOVA) and Student's t-test. For SEM and TEM, six dentin disks were obtained from middle dentin of human third molars and assigned equally to each adhesive. The adhesives were applied to dentin according to manufacturer's directions. The hybrid layer and resin penetration into dentin tubules were analyzed at an ultramorphologic level, and the observations were compared.
Results: Shear bond strengths were as follows: group 1: 17.8 + 4.1 MPa; group 2: 20.5 + 3.5 MPa; group 3: 24.7 + 6.7 MPa; and group 4: 27.0 + 5.4 MPa. Electron microscopy showed that both adhesives penetrated the dentin tubules and formed a fully infiltrated hybrid layer. The nanofiller included in the new one-application adhesive penetrated the dentin tubules and infiltrated the microspaces between the collagen fibers within the hybrid layer.