Nutrition Management in Women with Gestational Diabetes Mellitus: A Review by ADA's Diabetes Care and Education Dietetic Practice Group

Gestational diabetes mellitus (GDM) is the most common medical disorder complicating pregnancy that requires the services of a registered dietitian. Despite three international workshops on GDM, many questions remain regarding its epidemiology, pathophysiology, screening, diagnosis, and management. Registered dietitians encounter these controversial issues when working with women referred for GDM education and counseling. Nutrition intervention remains the cornerstone of therapy. The purpose of this article is not to provide practice guidelines but to review the literature and current practices in research centers across the United States. Registered dietitians are in a position to individualize nutrition care to each woman's needs and to participate in the decision-making process of nutrition management. J Am Diet Assoc. 1995; 95:460–467.     

Ability to judge lung volumes at different CO2-drives for ventilation and the possible influence of such a judgment on the ventilatory CO2-responsiveness

Possible influences of changes in the CO₂-respiratory drive on the ability to judge lung volumes and the possible effects of such judgments on the ventilatory CO₂-responsiveness were studied in healthy subjects. The psychophysical relationships between objective and subjective magnitudes of lung volumes were determined at normocapnia, at three different levels of hypercapnia (breathing 1–3% CO₂ in air) and at hypocapnia (after volitional hyperventilation). The relationships, expressed by a power function with the mean exponent 1.5 (SD±0.3), were analyzed with respect to slope, intercept and correlation coefficient of the regression lines. None of these parameters was affected by variations in end-tidal P_CO2 or by the concomitant changes in ventilation. In the ‘attentive’ pre-judgment breathing (APJB) the ventilatory response to CO₂ was lower than during non-attentive breathing in three or four subjects. It is speculated that in these subjects the CO₂-responsiveness was depressed by the increased attention during APJB. The question whether volitional hyperventilation gave rise to any specific post-hyperventilatory breathing pattern was analyzed. The results showed that the majority of post-hyperventilatory breathing pattern was apnoeic or hypopnoeic in character.     

Indications and effects of botulinum toxin A for obstetric brachial plexus injury: a systematic literature review

Aim To give an overview of indications for the use of botulinum toxin A (BoNT‐A) treatment for children with obstetric brachial plexus injury (OBPI), and to present the best available evidence of the effectiveness of this treatment. Method Searches were performed in Cinahl, Cochrane Library, Embase, PubMed, and Web of Science, using the keywords ‘botulinum’ and ‘plexus’, to identify articles reporting on the use of BoNT‐A as a treatment for children with OBPI. Studies found through the references of related articles were also selected. Results Ten full‐text papers and six congress abstracts were included, involving 343 children. Four groups of indications could be identified: internal rotation/adduction contracture of the shoulder, limited active elbow flexion, limited active elbow extension, and pronation contracture of the lower arm. Overall, positive results were reported for all except the indication for limited active elbow extension. However, only one study was comparative in nature; all others were classified as having a low level of evidence. There was a large variation in outcome measures. Interpretation To provide better evidence for the already partly promising results of BoNT‐A treatment for children with OBPI, multicentre randomized controlled trials are needed.     

Sickle Cell Disease. A Serum Defect in the Thromboplastin Generation Test

1. A defective ability of sickle cell disease (SCD) serum to support thromboplastin generation was demonstrated.

2. The serum defect was associated primarily with homozygous SCD, although defects of varying severity were also noted in the heterozygous forms.

3. The deficiency appears to be due to an accelerated loss of thrombin orthrombin-like factors from serum.

Submitted on April 29, 1964 Accepted on November 1, 1964     

Quantification of CMV viraemia in a case of transfusion-related graft-versus-host disease associated with purine analogue treatment

We report a patient who developed transfusion-associated graft-versus-host-disease (GvHD) and concurrent cytomegalovirus (CMV) infection, both complications thought to be related to severe T lymphocyte depletion induced by treatment with a purine analogue drug, fludarabine. CMV viraemia was detected by qualitative PCR and the viral load in positive samples was measured using a fully quantitative PCR assay. This quantitative assay enabled the evaluation of the efficacy of antiviral interventions based on the qualitative PCR result. The case illustrates the risks associated with the use of purine analogue drugs, as well as the value of quantitative CMV PCR assays for monitoring CMV infection in immunocompromised patients.     

Evaluation of recombinant protein r140, a polypeptide segment of tegumental glycoprotein Sm25, as a defined antigen vaccine against Schistosoma mansoni

To investigate the role of tegumental glycoprotein Sm25 in protective immunity against schistosomiasis, codons 43-182 of its gene (GP22) were amplified by PCR and cloned in the pET 15b bacterial expression system. Recombinant protein r140 was inducibly expressed in the presence of rifampicin and purified by Ni-affinity chromatography. In different vaccination trials, Balb/c mice and Fischer rats repeatedly immunized with r140 in combination with one of several adjuvants (alum, cholera toxin or complexed into proteosomes) produced high titre anti-r140 responses. These antibodies detected an N-glycanase sensitive, 25 kDa antigen in a detergent solubilized worm fraction using Western immunoblotting. The choice of adjuvant affected the isotype distribution of the specific anti-r140 antibodies. Despite the presence of high antibody titres and isotypes which have been shown to correlate with protective immunity, protection against subsequent cercarial challenge was not observed. In addition, no appreciable effects on worm sex ratios or liver egg yields were detected in mice. Studies involving biotin labelling of membrane proteins in live worms showed that the majority of anti-r140 reactive molecules present in adult schistosomes are biotinylated after permeabilization of the parasite surface. Several possibilities to account for the lack of protective immunity are analysed .     

Cyclooxygenase-1 and Cyclooxygenase-2 in the Human Optic Nerve Head

To investigate the hypothesis that eicosanoids act as cellular mediators in the optic nerve head of normals and of patients with glaucoma, we have determined the presence of the two cyclooxygenase (COX) isoforms in human tissue. Histological sections of optic nerve heads were studied by immunohistochemistry. Age matched normal donors were compared with eyes from glaucoma patients with moderate to severe nerve damage. Polyclonal antibodies to human COX-1 and COX-2 were localized with immunoperoxidase staining. Specific antibodies for vascular endothelia and microglia were also co-localized. In normal and glaucomatous eyes, COX-1 was localized exclusively to the prelaminar and lamina cribrosa regions of the optic nerve head. No staining for COX-1 was observed in the nerve fiber layer or the myelinated optic nerve. COX-1 was associated with the astrocytes of the glial columns and the cribriform plates, but not with the endothelia lining the capillaries. In glaucoma, more astrocytes appeared to be stained with antibody to COX-1 than in normals and staining was intensely perinuclear. There was no staining for COX-2 in normal tissue. A few COX-2 positive cells were found in the prelaminar, lamina cribrosa and postlaminar regions of the glaucomatous optic nerves. Positive staining for COX-2 was not associated with microglia. COX-1 is constitutively present in astrocytes that are localized exclusively to the prelaminar and lamina cribrosa regions of the human optic nerve head. Eicosanoids, synthesized by COX-1 in this tissue, may have a homeostatic and a neuroprotective role related to the axons of the retinal ganglion cells. The sparse presence of COX-2 in glaucomatous tissue probably reflects the lack of inflammation associated with glaucomatous optic neuropathy.