Perceptions of Magnetic Resonance Imaging During Pregnancy: A Newfoundland and Labrador Perspective

OBJECTIVES

This study aimed to identify enablers and barriers to participation in MRI for clinical indications and scientific research, and to determine the perceptions of MRI performed during pregnancy.

METHODS

We conducted a survey of 156 pregnant people in Newfoundland and Labrador including sociodemographic information, obstetrical history, MRI history, and willingness to participate in an MRI. Categorical variables were analyzed using a Fisher exact test and open-ended questions were analyzed using thematic analysis.

RESULTS

In total, 80% of participants reported willingness to receive an MRI while pregnant for clinical indications compared to 24% for research. Only 10% reported prior knowledge about MRI during pregnancy and most participants (94%) wanted additional information from their physician before feeling comfortable with the procedure. Participants who knew someone with complications during pregnancy were more likely to be willing to participate in an MRI for research (uncorrected P < 0.05). Participants' positive perceptions towards MRI during pregnancy for clinical indications were that it was a necessary and useful procedure, while the negative perceptions identified MRI as unsafe. For research MRI, participants' positive perceptions included that it would add to the advancement of knowledge and the negative perceptions were that it was an unnecessary and risky procedure.

CONCLUSIONS

Strategies are needed to improve patient knowledge about the benefits and safety of MRI during pregnancy. The present study suggests recruitment for research should incorporate education on safety concerns and relative risk, personal stories about the benefits of MRI in diagnosing pregnancy complications and should highlight the contribution to advancing scientific knowledge.

Regulation of cAMP metabolism in mouse parotid gland by cGMP and calcium

The interaction of hormones acting via the mobilization of calcium and stimulation of cAMP levels in cells was examined by determining the effects of carbachol and forskolin on cAMP and cGMP accumulation in mouse parotid gland. Treatment of isolated acini with either carbachol (0.01 to 20 microM) or forskolin (1 microM) alone produced little or no increase in cAMP levels; carbachol, however, augmented the effect of forskolin on cAMP accumulation approximately 3- to 4-fold. The effects of carbachol on forskolin-stimulated cAMP levels were further augmented approximately 10-fold in the presence of the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine (MIX) but not in the presence of "low Km" cGMP-inhibited phosphodiesterase inhibitor milrinone. Augmentation of cAMP levels also occurred in the presence of carbachol plus the beta-adrenergic agonist isoproterenol (0.01 microM). In either the presence or absence of forskolin, carbachol increased cGMP levels independently of the inclusion of MIX and in a fashion parallel to that observed for cAMP accumulation. In the presence of forskolin (1 microM), the concentration of carbachol that produced half-maximal effects on cAMP and cGMP levels was 0.62 and 0.72 microM, respectively. Similar values were obtained in the presence of MIX. Cyclic GMP levels were also enhanced by carbachol plus isoproterenol. Hydroxylamine, as well as dibutyryl-cGMP and 8-bromo-cGMP in combination with forskolin, mimicked the effects of carbachol plus forskolin on cAMP levels. LY83583 (6-anillino-5,8-quinolinedione), an agent that lowers cGMP by inhibiting guanylate cyclase, reduced basal levels of cGMP and also completely prevented the increase in cGMP caused by carbachol plus forskolin. In these experiments, however, the augmentation of forskolin-stimulated cAMP levels by carbachol was reduced by approximately 50%. Additional studies suggest that calcium is also required for carbachol augmentation of forskolin-stimulated cAMP accumulation by effects on the adenylate cyclase complex. Augmentation of cAMP levels by carbachol did not involve effects on cAMP degradation. The results suggest that, when cAMP synthesis is stimulated by forskolin or isoproterenol, the muscarinic agonist carbachol augments cAMP accumulation by mechanisms involving cGMP and calcium in mouse parotid gland.

Two techniques to improve adherence to dietary sodium restriction in the treatment of hypertension

To improve adherence to dietary sodium restriction, we validated two simple techniques for providing rapid and accurate estimated of urinary content-overnight urine collections and an immediate analysis of urine sodium content. These techniques were then applied in a trial with a group of patients with hypertension who were considered to be resistant to the adoption of dietary changes. After six months, 68% of the patients on the lower-sodium diet reduced their urine sodium content by one third or more. They had an 11-mm Hg fall in mean BP compared with a 3-mm Hg rise in the control group, who were not on a lower-sodium diet, and a lesser fall in plasma potassium levels.