Assessment of metabolic stability and pharmacokinetics by LC-MS/MS and establishment of the safe dose of IMID-2, a novel anticancer molecule under drug discovery

Pyruvate kinase (PK) M2 activators ramp up glycolysis in cancer cells, leading to a reversal of the Warburg effect in cancer cells. A promising PKM2 activator molecule, IMID-2, developed by the National Institute of Pharmaceutical Education and Research-Ahmedabad showed promising anticancer activity against MCF-7 and COLO-205 cell lines, which represent breast and colon cancer. Its physicochemical properties, like solubility, ionization constant, partition coefficient and distribution constant, have already been established. Its metabolic pathway is also well established through in vitro and in vivo metabolite profiling and reported previously. In this study, we have evaluated the metabolic stability of IMID-2 using LC-MS/MS and investigated the safety aspect of the molecule through an acute oral toxicity study. In vivo studies in rats confirmed that the molecule is safe even at a dose level of 175 mg/kg. Furthermore, a pharmacokinetic study of IMID-2 was also carried out using LC-MS/MS to understand its absorption, distribution, metabolism, and excretion profile. The molecule was found to have promising bioavailability through the oral route. This research work is thus another step in the drug testing of this promising anticancer molecule. The molecule can be considered to be a potential anticancer lead based on the earlier report substantiated by current findings.

Quantum circuits with many photons on a programmable nanophotonic chip

Growing interest in quantum computing for practical applications has led to a surge in the availability of programmable machines for executing quantum algorithms1,2. Present-day photonic quantum computers3-7 have been limited either to non-deterministic operation, low photon numbers and rates, or fixed random gate sequences. Here we introduce a full-stack hardware-software system for executing many-photon quantum circuit operations using integrated nanophotonics: a programmable chip, operating at room temperature and interfaced with a fully automated control system. The system enables remote users to execute quantum algorithms that require up to eight modes of strongly squeezed vacuum initialized as two-mode squeezed states in single temporal modes, a fully general and programmable four-mode interferometer, and photon number-resolving readout on all outputs. Detection of multi-photon events with photon numbers and rates exceeding any previous programmable quantum optical demonstration is made possible by strong squeezing and high sampling rates. We verify the non-classicality of the device output, and use the platform to carry out proof-of-principle demonstrations of three quantum algorithms: Gaussian boson sampling, molecular vibronic spectra and graph similarity8. These demonstrations validate the platform as a launchpad for scaling photonic technologies for quantum information processing.

Assessment of sleep studies in myotonic dystrophy

Myotonic dystrophy (MD) is the commonest adult muscular dystrophy and is associated with respiratory muscle weakness. The role of screening sleep studies is unclear in MD. We prospectively evaluated polysomnography/overnight oximetry in a group of MD patients and related this to the daytime respiratory function in an attempt to evaluate the usefulness of screening sleep studies. Twenty-five patients with type I MD [15 males; mean age (SD) 40.0 (10.9) years] who had at least one symptom suggestive of nocturnal hypoventilation were included in the study. We performed spirometry, maximal inspiratory and expiratory mouth pressures, sniff nasal inspiratory pressure, arterial blood gases and polysomnography or overnight oximetry. Excessive tiredness and sleepiness were the most common presenting symptoms. Prevalence of sleep related breathing disorder (SRBD) was 36%. FVC was found to be normal in 33% of subjects with significant SRBD. Mouth pressures were reduced more than FVC, even in patients with normal overnight oxygen saturation. Of all the daytime measures, FVC correlated best with arterial carbon dioxide tension ( r = -0.7). Sleep studies were useful to identify a small group of myotonic dystrophy patients (12%, three out of 25 in our series) with SRBD that would have been missed with routine daytime assessments. Targeted sleep monitoring in patients who are older, with multiple symptoms suggestive of SRBD, especially if they are over-weight seems to be the best way to utilize the existing resources. Home unattended oximetry was well tolerated and offers a practical screening tool in this challenging patient group where excess daytime sleepiness is often due to causes other than SRBD.

Prioritization of active antimalarials using structural interaction profile of Plasmodium falciparum enoyl-acyl carrier protein reductase (PfENR)-triclosan derivatives

An empirical relationship between the experimental inhibitory activities of triclosan derivatives and its computationally predicted Plasmodium falciparum enoyl-acyl carrier protein (ACP) reductase (PfENR) dock poses was developed to model activities of known antimalarials. A statistical model was developed using 57 triclosan derivatives with significant measures (r = 0.849, q(2) = 0.619, s = 0.481) and applied on structurally related and structurally diverse external datasets. A substructure-based search on ChEMBL malaria dataset (280 compounds) yielded only two molecules with significant docking energy, whereas eight active antimalarials (EC(50) < 100 nM, tested on 3D7 strain) with better predicted activities (pIC(50) ~ 7) from Open Access Malaria Box (400 compounds) were prioritized. Further, calculations on the structurally diverse rhodanine molecules (known PfENR inhibitors) distinguished actives (experimental IC(50) = 0.035 μM; predicted pIC(50) = 6.568) and inactives (experimental IC(50) = 50 μM; predicted pIC50 = -4.078), which showed that antimalarials possessing dock poses similar to experimental interaction profiles can be used as leads to test experimentally on enzyme assays.

A computational model for non-conserved mature miRNAs from the rice genome

Several computational approaches employ the high complementarity of plant miRNAs to target mRNAs as a filter to recognize miRNA. Numerous non-conserved miRNAs are known with more recent evolutionary origin as a result of target gene duplication events. We present here a computational model with knowledge inputs from reported non-conserved mature miRNAs of Oryza sativa (rice). Sequence- and structure-based approaches were used to retrieve miRNA features based on rice Argonaute protein and develop a multiple linear regression (MLR) model (r(2) = 0.996, q(2)cv = 0.989) which scored mature miRNAs as predicted by the MaturePred program. The model was validated by scoring test set (q(2) = 0.990) and computationally predicted mature miRNAs as external test set (q(2)test = 0.895). This strategy successfully enhanced the confidence of retrieving most probable non-conserved miRNAs from the rice genome. We anticipate that this computational model would recognize unknown non-conserved miRNA candidates and nurture the current mechanistic understanding of miRNA sorting to unveil the role of non-conserved miRNAs in gene silencing.

The Babinski sign--a critical review

In 1896, Josph Babinski, a French neurologist, first described the best known neurologic eponym--"the Babinski sign". This sign is characterised by dorsiflexion of the big toe, by recruitment of the extensor hallucis longus muscle, on stimulating the sole of the foot. He himself emphasised from the outset the intimate relationship between this sign and the shortening movement in other leg muscles, which forms the flexion synergy of the lower limb. The Babinski sign is not a new reflex, rather it is released as a result of breakdown of the harmonious integration of the flexion and extension component of the normal defence reflex mechanism, due to pyramidal tract dysfunction. A pathological Babinski sign should be clearly distinguished from upgoing toes that may not always be a part of the flexion synergy. This article reviews the Babinski sign in detail, focusing on the historical perspectives, role of pyramidal tract dysfunction, art of elicitation and interpretation. The significance of assessing this phenomenon in the entire leg and the clinical clues that will help to dispel the myths regarding the Babinski sign has been emphasized.

Free radical scavenging active components from Cedrus deodara

An activity-directed fractionation and purification process was used to identify the antioxidant components of Cedrus deodara. Dried heartwood powder of C. deodara was first defatted with petroleum ether and then extracted with chloroform. The chloroform extract showed strong antioxidant activity on 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical. This fraction was then subjected to separation and purification using silica gel column chromatography. Three compounds with potent antioxidant activity were isolated in significant yields and identified by spectroscopic methods ((1)H NMR, (13)C NMR, IR, and MS). They were identified as (-)-matairesinol, (-)-nortrachelogenin, and a dibenzylbutyrolactollignan (4,4',9-trihydroxy-3,3'-dimethoxy-9,9'-epoxylignan). This is the first report of the occurrence of these compounds in C. deodara.

The Babinski sign--a reappraisal

In 1896, Joseph Babinski, a French neurologist, first described the best known neurologic eponym 'the Babinski sign'. This sign is characterised by dorsiflexion of the big toe and recruitment of the extensor hallucis longus muscle, on stimulating the sole of the foot. He has emphasised from the outset, the intimate relationship between this sign and the shortening movement in other leg muscles, which form the flexion synergy of the lower limb. The Babinski sign is not a new reflex, rather it is released as a result of breakdown of the harmonious integration of the flexion and extension components of the normal defence reflex mechanism, due to pyramidal tract dysfunction. A pathological Babinski sign should be clearly distinguished from upgoing toes that may not always be a part of the flexion synergy. This article reviews the Babinski sign in detail, focusing on the historical perspectives, role of pyramidal tract dysfunction and art of elicitation and interpretation. The significance of assessing this phenomenon in the entire leg, and the clinical clues that will help to dispel the myths regarding the Babinski sign, have been emphasised.

Profound hypothermic circulatory arrest in management of aortic aneurysms

A total of 15 patients having aneurysms of aorta were operated from June 1997 to December 1998 using deep hypothermic circulatory arrest as a modality of brain protection. There were 12 males and 3 females. The age ranged from 19 years to 74 years and the mean age was 44.9 years. Nine patients had aneurysms of ascending aorta (group I), one had aneurysm of ascending aorta and arch of aorta (group II), four had aneurysm of the distal aortic arch (group III) and one patient had thoracoabdominal aortic aneurysm (group IV). In group I, six patients underwent Bentall procedure, two underwent Wheat procedure and one patient had repair of pseudoaneurysm of ascending aorta. The only patient in group II had his ascending aorta and arch replaced, with reimplantation of left common carotid and innominate artery. In group III, three patients had interposition Gelseal graft and one had repair of the tear in distal aortic arch. The lone patient in group IV had interposition Gelseal graft of thoracoabdominal aorta. The hypothermic circulatory arrest was used in all of them for brain and/or spinal cord protection. Retrograde cerebral perfusion was used in two patients. There were two (13%) operative deaths. One patient died of cerebrovascular accident on eighth post-operative day and second died of inadequate surgical repair. There was one instance of left hemiparesis secondary to an infarct in right frontoparietal region. To conclude, hypothermic circulatory arrest could provide an adequate brain protection for aortic aneurysm surgery. Retrograde cerebral perfusion could be an adjuvant when the anticipated time of hypothermic circulatory arrest is likely to exceed 45 minutes.

Profile of antiepileptic pharmacotherapy in a tertiary referral center in South India: a pharmacoepidemiologic and pharmacoeconomic study

PURPOSE

To study the current pharmacotherapy practices of epilepsy and its economics in a developing country by correlating the epidemiology and economics of antiepileptic drug (AED) treatment in general epilepsy care and comprehensive epilepsy care.

METHODS

We compared the AED-use profiles, efficacy, and tolerability at entry and at last follow-up for 972 patients seen at a comprehensive epilepsy care program in South India from 1993 to 1995. The relative cost was expressed as the average percentage of the per capita gross national product (GNP/capita) each individual spent for AED treatment.

RESULTS

At entry, 562 (57.8%) subjects were receiving polytherapy; at last follow-up, 743 (76.4%) patients were receiving monotherapy, an increase of 34.3% in the use of monotherapy. One or more adverse drug reactions were reported by 28.6% of patients at entry and by 19.8% at last follow-up. The proportion of patients who were seizure free increased from 29.0 to 44.8%. Carbamazepine (CBZ) was the most frequently used AED, followed by diphenylhydantoin (DPH), valproate (VPA), and phenobarbitone (PB). The relative cost (% GNP/capita) for standard AEDs were as follows: PB, 4.4%; DPH, 7.1%; CBZ, 16.8%; and VPA, 29.5%. The average annual cost of AED treatment per patient in U.S. dollars was $64.32 at entry and $47.73 at last follow-up. Reduction in polytherapy resulted in the net annual saving of $16,128 ($16.59 per patient, or 5.4% GNP/capita).

CONCLUSIONS

The more frequent use of relatively expensive drugs like CBZ and VPA and the use of polytherapy-still quite prevalent in developing countries-has escalated the cost of AED therapy. Although in recent years AEDs have become more available in developing regions, primary and secondary care physicians have not been adequately educated about the current trends in the pharmacotherapy of epilepsy.

"Changing trends (clinico-biochemical) in gall-bladder stone disease"--an observation

Present study has been undertaken to know the causative factors responsible for change in trend of gall-stone disease from middle aged, fertile, fat females to young asthenic females in twenties. Our findings reveal high incidence of gall stone formation in non-obese young females. Average fat consumption in non-obese patients was less (17%) than that of obese (26%). However, use of oral contraceptives was high in non-obese females and maximum users were in young age group while in obese in middle age group. Bilirubin content in gall bladder stones of non-obese was significantly more than that of obese (p < 0.01) whereas cholesterol content in gall bladder stones of obese was significantly high when compared to non-obese subjects. Analysis of bile showed significant increase in bilirubin and calcium level of non-obese when compared to control and obese subjects whereas phosphorus levels were significantly decreased in the bile of non obese subjects. These findings suggest that in non-obese females less intake of fat, early use of oral contraceptives, higher contents of bilirubin and calcium and low content of phosphorus in bile may be responsible for gall stone formation.

The sheep as an animal model for heart valve research

The first test used to assess new heart valve prostheses and devices is to implant them in a medium-sized animal. This is a costly piece of research and it is important to select the most appropriate animal. The authors feel that the sheep is an appropriate animal model for heart valve research and describe their experience in this area. It is hoped that the detailed description provided will be useful to any other group contemplating similar studies.

Critical role of the sinuses of Valsalva in the durability of valved conduits

BACKGROUND AND AIMS OF THE STUDY

Most work in search of an ideal extracardiac valved conduit has assumed that the type of tissue used for construction is the determining factor for its behavior and durability. The excellent results of our study with a valved conduit incorporating sinuses of Valsalva and made of autologous pericardium showed that the design plays a crucial role in addition to the type of material.

MATERIALS AND METHODS

We report the experimental results of three different pericardial sinus bearing valved conduits made of 0.5% glutaraldehyde treated autologous pericardium (Group 1), dye mediated photooxidized bovine pericardium (Group 2), and glutaraldehyde treated bovine pericardium (Group 3) implanted in the right ventricular outflow tract of sheep. Groups 1, 2 and 3 had 11, 11 and four animals available for assessment out of 12, 18 and six implantations respectively. The valved conduits were explanted at varying intervals between one and 11 months. The conduit function was assessed with hemodynamic, echocardiographic and Doppler studies both at the time of implantation and sacrifice. The explanted conduit was studied macroscopically and subjected to histopathologic examination.

RESULTS

The hemodynamic and echocardiographic studies at implantation showed very satisfactory results in all three groups. At the time of sacrifice, Group 1 showed consistently good results. In a significant number of animals in Groups 2 and 3, one, two or even three cusps had become adherent to the conduit wall, resulting in severe regurgitation. The sinuses were well preserved in Group 1, while they were less prominent in Group 2 and least in Group 3. Histopathologically, the three groups basically showed the same feature, a process of fibrocellular proliferation resulting in thickening. In this study the adhesion of the cusps to the sinus wall was related to the degree of prominence of the sinuses of Valsalva, which in turn depended on the ability to shape the pericardium at the time of construction of the valved conduit.

CONCLUSIONS

This study stresses the importance of the sinuses in the behavior of the semilunar valve leaflets.

Comparison of fresh and glutaraldehyde-treated autologous stented pericardium as pulmonary valve replacement

The use of fresh autologous pericardium in valve surgery has shown poor results in the past mainly due to thickening and retraction. Recently, it has been suggested that a short treatment with glutaraldehyde might radically change its behavior. In an attempt to determine whether this disparity in results is due to the glutaraldehyde treatment or to a better present-day surgical technique, fresh and glutaraldehyde-treated autologous pericardium was mounted in a frame and implanted in the pulmonary position of adult sheep. Six survivors obtained in each group were sacrificed between 2 and 8 months in the "fresh" group and between 2 and 6 months in the "glutaraldehyde-treated" group. Macroscopically, the fresh pericardium became thickened and retracted in all specimens, eventually resulting in severe regurgitation, while the glutaraldehyde-treated, although slightly thickened, retained its pliability without significant retraction. Microscopically, viability of the central core of the collagen was more often preserved in the fresh pericardium. Endothelialization was irregular. In conclusion, short glutaraldehyde treatment seems to improve the results of autologous pericardium mounted on a valve stent. Its effect on calcification remains to be ascertained.

In situ mitral valve stabilization with glutaraldehyde

Mitral valve repair in the young rheumatic patient carries a high reoperation rate due to progression of the disease. In an attempt to halt or at least slow down this process, the possibility of fixing in situ the valve tissues with glutaraldehyde was explored. Six weanling sheep underwent tanning of their anterior mitral leaflet for two minutes with 0.5% buffered glutaraldehyde. The non-treated posterior mitral leaflet served as control. The animals were sacrificed at varying intervals between 2.5 and 6 months. At sacrifice, Doppler echocardiography and hemodynamic studies were done. The leaflets were subjected to histopathologic examination and calcium and glutaraldehyde contents were estimated. Glutaraldehyde treatment of the anterior leaflet caused thickening of the cusp and chordae associated with partial devitalization of its core tissue, partial loss of endothelium and intense fibrocellular reaction with abundant elastic fibers without altering its functional integrity. It did not induce calcification. There were no detectable levels of glutaraldehyde at explantation. The posterior mitral leaflets were normal. Although the absence of calcification and partial viability of the tissue are encouraging, it does not necessarily follow that this treatment would arrest progression of the underlying disease. This process may have clinical application in the future, but it is not yet recommended.

Functional analysis of spontaneous movements in preterm infants

Spontaneous movements of premature infants between 25 and 34 weeks conceptional age were observed for 1 hr on two or three occasions. Subjects had low-risk prognoses and were clinically stable at the time of testing. Behavioral acts were scored using a 0/1 time sampling technique in 60 continuous, 1-min time blocks. Temporal associations between individual movements were found using chi-square analyses. Some associated behaviors contained combinations consistent with neonatal action patterns, for example, single and bilateral leg kicking, head turning, and mouthing. Features of state organization were also evident in that general motor activity (GM), which has been used as a marker of active sleep (AS) in neonates, was found to cluster temporally with startle, facial, and head movements but not eye movements. Behavioral quiescence (> or = 5 s) was dissociated from AS-related behaviors (GM, facial, head, and eye movements). Combinations of state-segregated behaviors were more likely to exhibit co-occurrence within 1-min intervals in infants 30 weeks conceptional age and older.

Neonatal cushingoid syndrome resulting from serial courses of antenatal betamethasone

BACKGROUND

Antenatal steroid therapy has been shown to induce accelerated pulmonary maturation in preterm fetuses when delivery is imminent. Although this form of therapy has been used for 20 years, few studies or case reports have discussed the indications for or complications of retreatment, especially when more than two courses of steroids have already been given. We report a case of neonatal cushingoid syndrome with hypothalamic-pituitary-adrenal axis suppression following maternal treatment with seven courses of betamethasone.

CASE

A 31-year-old white woman, gravida 3, para 1, spontaneous abortion 1, presented with a single intrauterine pregnancy at 24 weeks' gestation, a bulging amniotic sac, and repeated cerclage failure. Antenatal betamethasone therapy was begun at 12.5 mg intramuscularly every 12 hours for two doses. Because of cervical dilatation, bulging membranes, and intermittent contractions, the expectation of imminent premature delivery did not diminish over the next 42 days. As the effect of antenatal steroids wanes after 7 days, a course of therapy was administered each week for as long as the threat of preterm delivery remained. Seven courses of betamethasone were given before delivery at 34.5 weeks post-conception age. The 2625-g male neonate appeared cushingoid on physical examination, with basal serum cortisol levels less than 3.3 micrograms/dL.

CONCLUSION

Physical findings of the neonate and laboratory investigation of both infant and mother suggested combined hypothalamic-pituitary-adrenal axis suppression. The cushingoid features of the infant demonstrate an undesired and previously unreported complication of an effective antenatal therapy. The unusual variant in this case was that the initial indication for steroid therapy (risk of premature delivery) persisted for 8 weeks after the first dose of betamethasone. It remains unknown how many weekly antenatal steroid courses can be administered before marked fetal adrenal suppression becomes evident. Risk-benefit ratios should be carefully considered before each retreatment.

Subgaleal hemorrhage in the newborn infant associated with silicone elastomer vacuum extractor

Subgaleal hemorrhage in the newborn infant has been reported worldwide, but despite the efforts of previous authors, this entity has not received the necessary attention in pediatric literature, and continues to represent a potentially fatal problem. Although the association of subgaleal hemorrhage with the use of the metal cup vacuum extractor has clearly been documented, its association with the silicone elastomer version has not been previously reported. We describe two cases in newborn infants where silicone elastomer cup vacuum extractor was used. The diagnosis of subgaleal hemorrhage must be considered in any infant with a scalp swelling and a falling hematocrit, and coagulation studies should be performed in all infants with a diagnosis of subgaleal hemorrhage. Complications include shock and death if subgaleal hemorrhage is massive and acute, and anemia and hyperbilirubinemia if it is slowly progressive. The familiarity with and ability of care givers to recognize the signs and symptoms of subgaleal hemorrhage are essential in preventing fatalities. A systematic approach to diagnosis with close monitoring of vital signs, hematocrit, blood gases, head circumference, and signs of tissue hypoperfusion is recommended for infants after instrument deliveries. Pathogenesis of this lesion needs to be emphasized in pediatric literature so that early recognition and prompt treatment may avoid a fatal outcome.

Spontaneous motility in premature infants: features of behavioral activity and rhythmic organization

The spontaneous motor activity of clinically stable premature infants, 26-36 weeks gestational age, was investigated. Movements were recorded using a pressure-sensitive transducer positioned below the infant's head and torso. Behavior samples were digitized every 0.5 s during 2 and 3-hr continuous recording sessions. Time-series analyses revealed prominent motility cycles of circa 80 min and circa 30 min. These results are consistent with periodicities in motility and REM activation observed in full-term neonates. The longer rhythms of 70-100 min of motility found in this study establish that these periods are present at this stage of development independent of maternal zeitgebers. Developmental changes in motility rhythms and movement burst durations were also observed. Bout durations became somewhat longer in older (> 30 weeks) infants, but the relative time devoted to movement per session was comparable in older and younger (< or = 30 weeks) infants.

Effects of caloric restriction and dietary fat on epithelial cell proliferation in rat colon

Epidemiological studies indicate that caloric intake and dietary fat content influence colonic carcinogenesis. In rodents, caloric restriction reduces, and some fats increase, carcinogen-induced colon cancer incidence. The present study was designed to investigate the effects of caloric restriction on colonic cell proliferation (CCP) in carcinogen-treated or control rats fed low- or high-fat diets. F344 rats were treated with azoxymethane (15 mg/kg x2) and then fed an isocaloric AIN 76A diet containing either 5 or 23% corn oil, ad libitum or calorie-restricted to 70 or 80% of the kilocalories consumed by ad libitum rats. Biopsies of the distal colon were taken at 10 and 20 weeks, and rats were sacrificed at 21 or 34 weeks on the experimental diets. Distal CCP was determined by microautoradiography after [3H]thymidine labeling in vitro or presacrifice administration in vivo. The labeling index and number of labeled cells per crypt column were significantly reduced by caloric restriction at all time points (10, 20, 21, 34 weeks). Caloric restriction reduced CCP in high fat- and low fat-fed rats and in azoxymethane-treated and control rats. High fat resulted in decreased CCP in the distal colon compared to low fat at 34 weeks but not earlier. The findings indicate that: (a) caloric restriction is effective in favorably modulating CCP, an intermediate biomarker of colon cancer risk; (b) a high fat ad libitum diet, which increased tumor yield, does not increase distal colon proliferation; (c) dietary fat intake alters proliferation in a manner differing from that induced by changing dietary caloric intake.

Pericardial effusion in primary hypothyroidism

Pericardial effusion is reported to occur in 30% to 80% of subjects with hypothyroidism. However, these earlier studies were conducted when the diagnosis of hypothyroidism was only suspected and was confirmed only in the presence of classic clinical features. In contrast, the diagnosis has recently been established in the early mild stage or more often in an asymptomatic stage because of more frequent or routine determinations of thyroid function tests, especially in the elderly. Thus the subjects in the older studies were severely hypothyroid at the time of diagnosis and may not be representative of the present hypothyroid population. For this reason, 30 subjects with hypothyroidism were evaluated with echocardiography to reassess the evidence of pericardial effusion in this disorder. Only two subjects demonstrated pericardial effusion, and in only one of them with severe disease could the pericardial effusion be attributed to hypothyroidism, since it resolved on the patient's attaining the euthyroid state. Thus the incidence of pericardial effusion was only 3% to 6%, depending on the inclusion of one or both subjects, an extremely infrequent occurrence when compared with that of previous studies. Moreover, the occurrence of pericardial effusion in hypothyroidism appears to be dependent on the severity of the disease. Thus pericardial effusion may be a frequent manifestation in myxedema, an advanced severe stage, as previously found, but a rare association of hypothyroidism, an early mild stage, because of the timeliness with which the latter condition is nowadays detected.

Effect of different levels of calorie restriction on azoxymethane-induced colon carcinogenesis in male F344 rats

Epidemiological and animal model studies indicate that increased calorie intake increases the risk for colon cancer development. Previous studies in animal models restricted the calorie intake severely, and none of these studies have investigated a dose-response effect of different levels of calorie restriction on colon carcinogenesis. The present study was designed to investigate the effect of various levels of calorie restriction on colon carcinogenesis in male F344 rats fed the low and high fat diets and the effect of these diets on the activities of colonic mucosal and tumor ornithine decarboxylase (ODC) and protein tyrosine kinase. Starting at 5 weeks of age, groups of male F344 rats were fed the low fat or high fat diets ad libitum. At 7 weeks of age, all animals except the vehicle-treated groups were given s.c. injections of azoxymethane (AOM) (15 mg/kg body weight, once weekly for 2 weeks). Four days after the second injection, groups of animals were restricted to 90, 80, or 70% of total calories consumed by the high fat ad libitum group (i.e., 10, 20, and 30% calorie restriction, respectively). In the low fat groups, animals were restricted to 80% of total calories consumed by the low fat ad libitum group (i.e., 20% restriction). Thirty-six weeks after AOM injections, all animals were necropsied and colon tumors were used for histopathology and ODC and protein tyrosine kinase analysis. In the second experiment, the protocol was the same as above except that the animals were sacrificed 5 days after the second AOM injection and colonic mucosal ODC and protein tyrosine kinase activities were assayed. The incidence and multiplicity of colon tumors were significantly inhibited in animals fed the high fat 20% calorie-restricted and high fat 30% calorie-restricted diets, as compared to those fed the high fat ad libitum diet. The regression coefficient representing the dose-response effect of different levels of calorie restriction in both high fat groups is significant. Results also indicate that AOM treatment significantly increased the colonic mucosal ODC and protein tyrosine kinase activities. This stimulation was inhibited by feeding the calorie-restricted diets. ODC and protein tyrosine kinase activities were lower in the colon tumors of animals fed the calorie-restricted diets.

Ventricular rhythm with intermediate rate in the neonate without heart disease

Nonsustained, sustained, or incessant AVR, a form of VRIR, although infrequent, can present in the neonatal period. It must be considered in the differential diagnosis of wide QRS tachycardia. It seems to be different from VI, and it is asymptomatic and self-limited. It has good long-term prognosis and requires no treatment. These patients should not undergo invasive diagnostic evaluation unless symptoms develop.

Blood-brain barrier to hydrogen ion during acute metabolic acidosis in piglets

The present study investigates the integrity of the blood-brain barrier to H+ or HCO3- during acute plasma acidosis in 35 newborn piglets anesthetized with pentobarbital sodium. Cerebrospinal fluid acid-base balance, cerebral blood flow (CBF), and cerebral oxygenation were measured after infusion of HCl (0.6 N, 0.191-0.388 ml/min) for a period of 1 h at a constant arterial PCO2 of 35-40 Torr. HCl infusion resulted in decreased arterial pH from 7.38 +/- 0.01 to 7.00 +/- 0.02 (P less than 0.01). CBF measured by the tracer microsphere technique was decreased by 12% from 69 +/- 6 to 61 +/- 4 ml.min-1.100 g-1 (P less than 0.05). Infusion of 0.6 N NaCl as a hypertonic control had no effect on CBF. Cerebral metabolic rate for O2 and O2 extraction was not significantly changed from control (3.83 +/- 0.20 ml.min-1.100 g-1 and 5.7 +/- 0.6 ml/100 ml, respectively) during acid infusion. Cerebral venous PO2 was increased from 41.6 +/- 2.1 to 53.8 +/- 4.0 Torr by HCl infusion (P less than 0.02) associated with a shift in O2-hemoglobin affinity of blood in vivo from 38 +/- 2 to 50 +/- 1 Torr. Cisternal cerebrospinal fluid pH decreased from 7.336 +/- 0.014 to 7.226 +/- 0.027 (P less than 0.005), but cerebrospinal fluid HCO3- concentration was not changed from control (25.4 +/- 1.0 meq/l). These data suggest that there is a functional blood-brain barrier in newborn piglets, that is relatively impermeable to HCO3- or H+ and maintains cerebral perivascular pH constant in the face of acute severe arterial acidosis. (ABSTRACT TRUNCATED AT 250 WORDS)

Anxiety, depression, and hostility in mothers of preterm infants

Anxiety, depression, and hostility in 47 mothers of high-risk preterm infants were tested at the time of infant discharge and when the infant was 9 months old. Mothers of these high-risk preterms were significantly more anxious and depressed before their infant was discharged than when the infant was 9 months old. Before infant discharge, multiparas were significantly more depressed than primiparas. Additionally, mothers whose infants remained in the hospital longer than the mean of 51 days were significantly less depressed at infant discharge than were mothers whose infants had shorter hospital stays. Maternal anxiety, depression, and hostility did not differ based on marital status, maternal education, socioeconomic status, or maternal age at the time of infant discharge or when the infant was 9 months old.

Passage of the first stool in very low birth weight infants

Times of first stool passage were studied in 171 infants who weighed less than 1,500 g at birth. Delayed passage (greater than 48 hours) was noted in 20.4% of this group. Significant differences were noted between the delayed and nondelayed groups for gestational age, presence of severe respiratory distress syndrome, and the time of the first enteral feeding. In very low birth weight infants, delay in the passage of the first stool is a common occurrence. This delay is probably due to physiologic immaturity of the motor mechanisms of the gut, lack of triggering effect of enteral feeds on gut hormones, and the presence of severe respiratory distress syndrome, which may singly or in concert adversely affect gastrointestinal motility.

Effect of sympathetic nerve stimulation on cerebral blood flow in newborn piglets

The purpose of this study was to determine the effect of sympathetic nerve stimulation on regional cerebral blood flow during the first 3 wk of postnatal development in piglets. Forty-one piglets ranging in age from 2 to 24 days were studied while anesthetized with 30% N2O, paralyzed and mechanically ventilated (PaCO2 = 35-40 mm Hg). Regional cerebral blood flow was measured with tracer microspheres (15 +/- micron) during electrical stimulation (15 Hz, 15 V, 3 ms) of the right cervical sympathetic trunk. Sympathetic stimulation decreased blood flow to the ipsilateral cerebrum (gray and white matter) (-15 +/- 2%), hippocampus (-9 +/- 2%), choroid plexus (-50 +/- 5%), and masseter muscle (-93 +/- 2%) compared to the contralateral side where blood flow to these regions was 74 +/- 4, 45 +/- 2, 258 +/- 26, and 24 +/- 4 ml/min/100 g, respectively (mean +/- SEM; p less than or equal to 0.05). The magnitude of the reduction in cerebral blood flow was not dependent on postnatal age as no significant differences were noted when the piglets were grouped according to age. Hypercapnia (PaCO2 = 64 +/- 5 mm Hg) increased blood flow 2- to 4-fold above control in all brain regions except the choroid plexus. The effect of sympathetic nerve stimulation was augmented during hypercapnia where blood flow to the ipsilateral cerebrum, hippocampus, and caudate nucleus was decreased by -34 +/- 4, -23 +/- 5, and -16 +/- 3%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Infections in newborn infants in a special care unit. A changing pattern of infection

An analysis of infections in the intensive and intermediate care nurseries (special care unit) of the Hospital of the University of Pennsylvania was made over a three year period. From January 1982 to September 1984, 98 bacteremias were identified in 2571 infants, giving an overall incidence of 3.8 per 100 infants admitted to the special care unit and 11.8 per 1000 hospital births; 7 of 98 infants died, all from early onset disease. Fifty-eight percent of bacteremias were nosocomial. Gram positive organisms accounted for 89 percent of all bacteremias, with coagulase negative staphylococcus and beta hemolytic streptococcus Group B (GBS) being the most frequently identified organisms. Coagulase negative staphylococcus was responsible for 42 percent of bacteremias and 75 percent of all nosocomial infections during this period. Streptococcus Group B was responsible for 78 percent of early onset infection; mortality rate from GBS was 11 percent. In view of the changing pattern of infection and the predominance of coagulase negative staphylococcus, the therapy for nosocomial infection should include antibiotics effective against this organism.

Adverse drug reactions in the newborn

Adverse drug reactions have been noted to occur in one of three newborns admitted to intensive care units. The factors associated with adverse drug reactions and the adverse reactions to commonly used medications in neonatal intensive care units are discussed. Methods of preventing or reducing these undesired effects are suggested.

Red cell glycolytic intermediates and adenosine triphosphate in preterm infants on the first day of life

Red cell glycolytic intermediates and ATP were evaluated in 47 appropriate for gestational age preterm infants on the 1st day of life who were divided into three groups on the basis of gestational age: 28-30, 31-33, and 34-36 wk. The results were compared to those previously obtained in term infants. The concentrations of glucose-6-phosphate, total triose phosphates, and ATP were significantly higher than in term infants but appeared to be appropriately elevated for the young mean age of the red cell population. The concentration of red cell 2,3-diphosphoglycerate (2,3-DPG) was significantly decreased when compared to term infants and was lowest at 28-30 wk gestation. The content of red cell 3-phosphoglycerate was increased in term infants and was inappropriately elevated for the age of the red cell population at 28-30 wk gestation. This pattern of glycolytic intermediates was suggestive of a young red cell population metabolizing at an increased glycolytic rate with increased flow through the phosphoglycerate kinase step rather than the 2,3-DPG bypass in "normal" preterm infants. Two preterm infants of 28-30 wk gestation with low red cell intracellular pH were also evaluated and had markedly decreased concentrations of red cell 2,3-DPG and ATP and all phosphorylated intermediates distal to the phosphofructokinase reaction, indicative of a cross-over at the phosphofructokinase step secondary to acidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Chylothorax--a complication of chest tube placement in a neonate

A premature infant with respiratory distress syndrome developed a left chylothorax after evacuation of a left tension pneumothorax. The Argyle catheter noted in the posterosuperior mediastinum possibly traumatized the thoracic duct. Although the infant's chylothorax resolved with conservative management, he subsequently died of severe bronchopulmonary dysplasia. The potential complication of chylothorax from thoracostomy tubes can be prevented by avoiding penetration into the posterosuperior mediastinum.

Edema, hypoproteinemia, and zinc deficiency in low-birth-weight infants

Three premature infants with zinc deficiency who had an unusual presentation with generalized edema and hypoproteinemia between 5 and 9 weeks of age are described. The infants were fed their own mother's milk, supplemented with a proprietary formula after the first 2 to 3 weeks of life. None of the infants had diarrhea, liver disease, or urinary protein loss. Treatment with oral zinc supplements led to rapid resolution of the edema, with an increase in values for serum proteins, alkaline phosphatase, and zinc. There was no recurrence of symptoms following discontinuation of zinc therapy 1 month later. At 1-year follow-up, all infants were doing well and had normal growth and development. As zinc plays a critical role in nucleic acid and protein synthesis, it is postulated that dietary zinc deficiency in the phase of rapid postnatal growth precipitated edema and hypoproteinemia in these infants. Zinc deficiency should be included in the list of causes of generalized edema in the low-birth-weight infant.

Red cell metabolic alterations in postnatal life in term infants: possible control mechanisms

Red cell glycolytic intermediates and enzymes in term infants in the first year of life were correlated with the fetal hemoglobin concentration (%F), intra- and extracellular venous pH, plasma inorganic phosphorus (Pi) and pyruvate kinase (PK) activity. Changes in the non-age-dependent enzymes phosphoglycerate kinase, enolase, and phosphofructokinase correlated most significantly with the postnatal decline in %F (P less than 0.001), not the age of the red cell population, as reflected in PK activity. The age-dependent enzymes, hexokinase and glucose-6-phosphate dehydrogenase, however, correlated well with PK activity (P less than 0.001). The concentration of glucose-6-phosphate did not correlate significantly with the postnatal decline in %F (P greater than 0.05) or PK (P greater than 0.10), but correalted significantly with the plasma Pi concentration (P less than 0.001). "Total triose phosphate" and 2,3-diphosphoglycerate did not correlate with Pi. It appears from these studies that an extracellular factor, Pi alters the pattern of glycolytic intermediates in term infants and that the postnatal changes in phosphoglycerate kinase, enolase, and phosphofructokinase are unique to the "fetal" red cell and reflect passage from fetal to "adult" erythropoiesis.

Red cell metabolic alterations in postnatal life in term infants: glycolytic intermediates and adenosine triphosphate

Red cell glycolytic intermediates and adenosinetriphosphate were evaluated in term infants from birth to on year of age and compared to values obtained from normal adults and subjects wit a population of a similar mean cell age. The concentration of glycolytic intermediates, with the exception of phosphoenolypyruvate were elevated at birth when compared to normal subjects, consistent with a young mean red cell population. The mean levels of red cell glucose-6-phosphate, fructose-6-phosphate, and "total triose phosphate" were elevated on days 1 and 4 of life when compared to both red cells from normal adults and subjects with a similar young mean red cell age. Glucose-6-phosphate steadily increased in concentration, peaked at 3 to 4 wk of age, and then progressively decreased in value. Total triose phosphate declined to a mildly elevated concentration by 3 to 4 wk of age. The mean concentrations of 2,3-diphosphoglycerate and adenosine triphosphate were normal on day 1, increased on day 4, and then declined by 3 to 4 wk to normal values, until 5 to 6 months when both increased. The mean phosphoenolpyruvate concentration was decreased on day 1 of age when compared to red cells of a similar mean age, but this decrease was not significant (P greater than 0.05). The mean concentrations of 3-phosphoglycerate increased at 3 to 4 wk of age and remained elevated for cell age at 11 to 12 months but this increase was no statistically significant (P greater than 0.05). 3-Phosphoglycerate levels did not change significantly throughout the first year of life. At one year of age, all red glycolytic intermediates and adenosine triphosphate were elevated when compared to red cells from normal adults, but were comparable to those observed in subjects with a red cell population of a similar mean cell age, consistent with the persistence of a young red cell population throughout the first year of life.

Red cell metabolic alterations in postnatal life in term infants: glycolytic enzymes and glucose-6-phosphate dehydrogenase

The activities of red cell enzymes enolase (ENO), phosphoglycerate kinase (PGK), phosphofructokinase (PFK), glucose-6-phosphate dehydrogenase (G-6-PD), hexokinase (HK), aldolase (ALD), and pyruvate kinase (PK) were followed sequentially in term infants from birth to one year of age. At birth, red cell PGK and ENO activities were disproportionately elevated when compared to both red cells with a similar mean cell age and those with a younger mean cell age; red cell PFK was significantly decreased. There was a progressive full in PGK and ENO activities and rise in PFK levels toward normal values in the first year of life. The most significant changes in PGK, ENO, and PFK appeared to begin at 8 to 9 wk of age. ENO and PFK activities stabilized at approximately 5 to 6 months of age at values compatible with mean cell age; mean PGK levels remained mildly elevated at 11 to 12 months. The age-dependent enzymes G-6-PD, PK, ALD, and HK were all elevated in term newborns. G-6-PD and ALD progressively decreased in activity during the first year of life. PK and HK decreased in activity until 8 to 9 wk when there was a secondary rise in mean activity. Mean red cell G-6-PD, PK, ALD, and HK levels remained mildly to moderately elevated at 11 to 12 months of life, suggesting the persistence of a relatively young red cell population throughout the first year of life.

Follow-up studies of very low birth weight infants (1,250 grams or less) born and treated within a perinatal center

The growth and development of inborn very low birth weight infants was evaluated in 50 of 60 survivors from 132 babies weighing less than or equal to 1,250 gm born July 1974 to December 1977. Mean +/- SE birth weight and gestation was 1,066 +/- 19.3 gm and 29.5 +/- 0.3 weeks, respectively, with 13 infants small-for-gestational age. Of the survivors, 26% weighed less than or equal to 1,000 gm. Male to female ratio was 1:1.4. Apgar scores less than or equal to 5 at five minutes occurred in 16% of the infants. Respiratory distress syndrome occurred in 56%, but only 10% (5/50) required mechanical ventilation. At 1 year, 46% small for gestational age (SGA) and 8% appropriate for gestational age (AGA) infants were less than the third percentile for weight. Major neurologic abnormality occurred in three infants (6%), one of whom is also blind. Grade V retrolental fibroplasia occurred in two others. Severe developmental delay (development quotient < 80, Gesell) occurred in these five infants and two other neurologically normal babies. Of 15 infants weighing less than or equal to 1,000 gm, two had major handicaps. Eight percent of the AGA infants and 30% of the SGA infants had major handicaps. These data indicate that infants born and treated in a perinatal center have a decreased incidence of asphyxia and severe respiratory distress syndrome and that the incidence of major handicaps is reduced, especially in the appropriate for gestational age baby.

Monocyte-induced potentiation of bovine fetal thymocyte mitogenic responses to concanavalin A

Peripheral blood monocytes significantly potentiated the mitogenic response of bovine fetal thymocytes to Concanavalin A as measured by incorporation of [3H] thymidine into cellular DNA. Mononuclear cells obtained from either normal or Mycobacterium bovis sensitized cattle were cultured with or without purified protein derivative (PPD) for 24 hours at which time bovine fetal thymocytes and concanavalin A were added. After 3 days of culture, both activated or non-activated monocytes significantly potentiated Con A-induced blastogenic responses. of monocytes from thymocyte cultures completely abrogated thymocyte responses to Concanavalin A.

Unusual artifacts in electrocardiographic monitoring

Three unusual artifacts noted during Holter and telemetry monitoring, not previously described, are presented. Recognition of the artifacts prevented misinterpretation and wrong treatment. The clues to the identification of the artifacts and the need for avoiding wrong interpretation and inappropriate treatment are discussed. The cause of the telemetry artifact is discussed.

Potentiation of lymphocyte mitogenic responses to concanavalin A by antigen-activated peripheral blood monocytes

Purified protein derivative (PPD)-stimulated monocytes derived from Mycobacterium bovis-sensitized cattle significantly potentiated lymphocyte mitogenic responses to concanavalin A (conA), as measured by incorporation of [3H] thymidine into cellular DNA. Monocytes were cultured for 24 hours in the presence of PPD, washed thoroughly, and mixed with purified lymphocytes; various doses of conA were added to these cultures, and the cultures were incubated for 4 days and assayed for DNA synthesis. The lymphocyte mitogenic responses to suboptimal, buy not optimal, doses of conA were significantly enhanced by the presence of PPD-activated monocytes from M bovis-sensitized cattle. Treatment nonsensitized cattle with PPD did not result in any significant enhancement of conA-induced lymphocyte mitogenic responses at any dose of conA tested.