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.     

Hemodynamic Effect of Propafenone and the Experience in Patients with Congestive Heart Failure

The effects of propafenone on left ventricular function and hemodynamics are presented in this study. In one group of 13 patients who underwent electrophysiological testing and subsequent chronic oral therapy with propafenone, eight had left ventricular ejection fractions determined by nuclear study before and during therapy with the drug. Initial measurements ranged from 22% to 39% (mean 30%), while those on chronic therapy showed no statistical difference and ranged from 22% to 48% (mean 30%). In a separate dose titration study of 14 patients, left ventricular ejection fraction showed a modest but significant decrease (52%± 9% to 48%± 11%; p < 0.05). This change was more marked in patients with an initial low ejection fraction. Propafenone appears to be safe in these patients but should be administered with caution in patients with particularly low ejection fractions.     

Childbirth Stress An Immunologic Study

The study examined salivary immunoglobulin A (IgA) concentrations during pregnancy and at parturition. A significant drop in salivary IgA (p less than 0.001) occurred at parturition. State anxiety appeared to account for some of the variance in IgA concentration during pregnancy and at childbirth. Mothers who had very low or undetectable IgA concentrations when they gave birth had increased incidences of postpartum complications, and their infants had more illnesses during the first six weeks postpartum.     

Characterization of the Coagulant Activity of Cultured Human Fibroblasts

Skin fibroblasts were cultured fromnormal individuals, from patients withhemophilia, and from known andsuspected carriers of hemophilia. All celllysates studied had similar coagulantactivity unaffected by incubation witha specific antibody to factor VIII and,therefore, presumably not factor VIII.Further investigation indicated that thecoagulant had many properties indistinguishable from those associated with"tissue factor," including heat lability,sedimentation characteristics, and dependency on factor VII for expression ofcoagulant activity. The presence of tissuefactor in skin fibroblasts is consistentwith the wide distribution of this coagulant, and the ability to maintain this material in tissue culture provides anopportunity for further investigation ofthe role of tissue factor in normal andpathologic states.

Submitted on May 22, 1970 Revised on August 20, 1970 Accepted on August 21, 1970     

Investigation into Causes of Abnormal Cerebral MRI Findings Following PVAC Duty‐Cycled,Phased RF Ablation of Atrial Fibrillation

Asymptomatic Cerebral Lesions with Phased RF. Introduction: Left atrial catheter ablation of the pulmonary veins (PVs) is an established option for patients with atrial fibrillation (AF). Asymptomatic cerebral emboli (ACE) detected by diffusion weighted MRI (DW‐MRI) following AF ablation has been reported at varying rates. This variability may be linked to procedural variables and demographic risk factors. Animal studies with the multielectrode pulmonary vein ablation catheter (PVAC) have identified potential sources of emboli, including air introduced during PVAC introduction, inadequate anticoagulation, and high current densities when the distal (E1) and proximal (E10) electrodes are in contact. We sought to evaluate the incidence, size, and number of DW‐MRI findings with procedural modifications that potentially reduce the embolic load. Methods: Thirty‐seven AF patients (59 ± 10 years, 73% male, all with paroxysmal AF, left atrial [LA] diameter 44 ± 7 mm, left ventricular ejection fraction 57 ± 7%) underwent MRI sequences preceding ablation, within 24 hours postablation, and at 4–6 weeks. During the procedure all patients were on uninterrupted phenprocoumon, an attempted activated clotting time (ACT) level >300 seconds, had the PVAC introduced under saline, and antral ablation was started with a 2:1 bipolar/unipolar mode. Files from the ablation unit (GENius v14.4) were retrospectively analyzed to determine the relationship between E1 and E10 in close proximity and DW‐MRI findings. Results: Post procedure, 10/37 patients (27%) were positive for new DWI cerebral lesions. Nine of 10 patients had a single lesion, and 1/10 patient had 2 lesions. Average lesion size was 3.1 ± 3.9 mm (2–14 mm). One of 10 (10%) had lesions at MRI follow‐up. No neurological symptoms were observed. Eighteen of 37 (49%) of procedures had evidence of E1/E10 interaction. In the subgroup of patients with and without E1 and E10 in close proximity, the DW‐MRI rate was 8/18 (44%) and 2/19 (11%), respectively (P = 0.029). Conclusions: The source of positive DW‐MRI findings in LA ablation involves several factors. Controlling anticoagulation and careful sheath management helps to reduce the number and size of DW‐MRI lesions. With the PVAC catheter, an ablation with the E1 and E10 in close proximity increases the risk of a DW‐MRI finding. In the future, electrodes E1 and E10 should be kept apart to help reduce the incidence of acute ACE. (J Cardiovasc Electrophysiol, Vol. 24, pp. 121‐128, February 2013)     

Improved Efficacy of Mode Switching During Atrial Fibrillation Using Automatic Atrial Sensitivity Adjustment

Automatic mode switching (AMS) during atrial fibrillation (AF) in a dual chamber pacemaker is dependent on the accurate detection of an atrial electrogram. As atrial amplitude is often reduced during AF compared with sinus rhythm, this may result in failure of the AMS and a rapid ventricular response. In addition, undersensing of AF may result in competitive atrial pacing that sustains AF. We hypothesize that the use of automatic atrial sensitivity adjustment (ASA) may enhance AF sensing in a dual chamber pacemaker. We studied the AMS response with and without ASA of the Marathon DDDR (model 294–09, Intermedics, Inc.) pacemaker in 10 patients with paroxysmal AF. Intracardiac atrial electrograms during sinus rhythm and induced AF were recorded onto an analog tape recorder. They were replayed into the pacemaker to assess the AMS response at various starting atrial sensitivities from 3.5 to 0.8 mV with ASA activated and without. Atrial amplitude was reduced during AF. The higher the initial atrial sensitivity, the better is the AMS response and the lower the incidence of AF undersensing. The percentage of AMS before ASA ranged from 2.1% at an atrial sensitivity 3.5 mV to 95.6% at highest sensitivity of 0.5 mV (P < 0.05). After 10 minutes of ASA, the AMS response was improved from 1.7% to 50.6% and from 9.5% to 50.9% at starting atrial sensitivities of 3.5 mV and 2.5 mV, respectively (P < 0.05 in both instances). Undersensing during AF was also significantly reduced after ASA from 70% to 10% at a sensitivity of 3.5 mV and from 33.8% to 10.8% at 2.5 mV. There was no increase in oversensing. In four patients with paroxysmal AF with an implanted pacemaker, ASA improved AMS response in patients with a low implant atrial amplitude. In conclusion, efficacy of mode switching and AF sensing are dependent on the programmed atrial sensitivity, which can be enhanced with the use of ASA, particularly when P wave sensing during AF is borderline.     

A technique for establishing the identity of 'isolated' fossil hominin limb bones

Associated skeletons, which are specimens preserving more than one body part from the same individual, are especially important for taxonomic and functional analyses. This study concentrates on the subset of associated skeletons which preserve the reciprocal surfaces of a joint. It uses laser scanning to explore whether the shapes of the reciprocal surfaces of a joint of an individual are significantly more congruent than the surfaces of randomly-matched pairings taken from the same species. Laser scanning was used to capture the distal articular surface of the left tibia of OH35 and the trochlear articular surface of the talus of OH8, both from Bed I, Olduvai Gorge, Tanzania. The degree of congruency between those articular surfaces was tested against the congruency of the talocrural joint of AL 288-1 ( Australopithecus afarensis ), and the congruency of both associated and randomly-matched talocrural joints of modern humans, chimpanzees and gorillas. The results suggest that OH35 and OH8 do not come from the same individual and may not come from the same species. Although this analysis leaves open the taxonomic affinity of OH35, it demonstrates the potential of laser scanning for capturing 3D data in palaeoanthropology. It also demonstrates the potential for using the relative congruency of reciprocal joint surfaces as a test of the likelihood that isolated limb bones are components of a single individual.