Health care access, psychosocial outcomes and mental health in adults living with epilepsy during the COVID-19 pandemic

PURPOSE

People living with epilepsy (PLWE) have a higher prevalence of mental health comorbidities and poorer psychosocial outcomes compared to the general population. The aim of this study was to examine psychosocial outcomes, mental health, healthcare accessibility, and seizure burden in PLWE during the COVID-19 pandemic.

METHODS

We conducted a cross-sectional study of adults with epilepsy treated in an urban multicenter health system from 2021 to 2022. A standardized questionnaire assessed for COVID-19 history, comorbidities, access to antiseizure medications (ASMs) and neurological care, seizure burden, and psychosocial outcomes (e.g., employment, social and financial support). The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were administered to evaluate for depression and anxiety. Frequency and proportions for categorical variables and median and interquartile ranges for continuous variables were calculated.

RESULTS

Fifty-five PLWE participated (95 % response rate). Median age was 40 years (IQR 31.5-66.5), 61.8 % were women, 47.3 % had a bachelor's degree or higher and 29.1 % each had Medicaid and Medicare insurance. Race (from highest to lowest %) was: 32.7 % White, 20 % Black, 20 % Latinx, 14.5 % Asian, and 12.7 % selected "other" or "prefer not to say." COVID-19 had been diagnosed in 21.8 % of participants. Symptoms of anxiety and depression were self-reported by 43.6 % and 34.5 % of patients, respectively, with many describing this symptom as new post-pandemic (37.5 % and 31.6 %, respectively). Using validated scales, 52.7 % had depression (PHQ-9 score ≥ 5) with 30.9 % having moderate/severe depression (PHQ-9 score ≥ 10), while 29.1 % had probable generalized anxiety disorder (GAD-7 score ≥ 8). Seizure burden increased in 21.8 % of participants, while 20 % reported fewer seizures and 29.1 % were seizure free since the COVID-19 pandemic. Economic impacts of the pandemic included job loss (25 % amongst those employed at onset of pandemic), new or worsened financial difficulties (40 %), and new or worsened social support issues (30.9 %). Of all participants, 18.2 % reported difficulties accessing ASMs and 25.5 % cancelled visits, but of those with cancelled visits, 78.6 % had their appointments rescheduled as a telehealth visit.

CONCLUSION

Our cohort of PLWE experienced some challenges during the COVID-19 pandemic including poorer mental health and financial and employment-related stressors. Encouragingly, healthcare access was relatively spared during the COVID-19 crisis, with some patients even reporting a reduction in seizure burden. However, PLWE require ongoing psychosocial support with particular attention to decompensation of mental health and social stressors that may be exacerbated by the COVID-19 pandemic.

A global perspective on bacterial diversity in the terrestrial deep subsurface

While recent efforts to catalogue Earth's microbial diversity have focused upon surface and marine habitats, 12-20 % of Earth's biomass is suggested to exist in the terrestrial deep subsurface, compared to ~1.8 % in the deep subseafloor. Metagenomic studies of the terrestrial deep subsurface have yielded a trove of divergent and functionally important microbiomes from a range of localities. However, a wider perspective of microbial diversity and its relationship to environmental conditions within the terrestrial deep subsurface is still required. Our meta-analysis reveals that terrestrial deep subsurface microbiota are dominated by Betaproteobacteria, Gammaproteobacteria and Firmicutes, probably as a function of the diverse metabolic strategies of these taxa. Evidence was also found for a common small consortium of prevalent Betaproteobacteria and Gammaproteobacteria operational taxonomic units across the localities. This implies a core terrestrial deep subsurface community, irrespective of aquifer lithology, depth and other variables, that may play an important role in colonizing and sustaining microbial habitats in the deep terrestrial subsurface. An in silico contamination-aware approach to analysing this dataset underscores the importance of downstream methods for assuring that robust conclusions can be reached from deep subsurface-derived sequencing data. Understanding the global panorama of microbial diversity and ecological dynamics in the deep terrestrial subsurface provides a first step towards understanding the role of microbes in global subsurface element and nutrient cycling.

An integrated model of provision of palliative care to patients with cystic fibrosis

Palliative care of patients with cystic fibrosis (CF) is often undertaken by CF teams rather than palliative care teams because of the specialist nature of the disease and the potential role of lung transplantation. We developed an integrated model of provision of palliative care whereby most care is delivered by the CF team using palliative guidelines and pathways, with additional support available from the specialist palliative care team when needed. We report our experience of the terminal care of 40 patients with CF with regard to the circumstances of death, lung transplantation status, specific symptoms and provision of palliative treatments. The transition from disease modifying treatments to palliative care was particularly complex. Patients had a high level of symptoms requiring palliation and most died in hospital. Palliative care is a crucial component of a CF service and requires the specialist skills of both the CF and palliative care teams.

Patterns of cardiovascular reactivity in disease diagnosis

BACKGROUND

Aberrations of cardiovascular reactivity (CVR), an expression of autonomic function, occur in a number of clinical conditions, but lack specificity for a particular disorder. Recently, a CVR pattern particular to chronic fatigue syndrome was observed.

AIM

To assess whether specific CVR patterns can be described for other clinical conditions.

METHODS

Six groups of patients, matched for age and gender, were evaluated with a shortened head-up tilt test: patients with chronic fatigue syndrome (CFS) (n = 20), non-CFS fatigue (F) (n = 15), neurally-mediated syncope (SY) (n = 21), familial Mediterranean fever (FMF) (n = 17), psoriatic arthritis (PSOR) (n = 19) and healthy subjects (H) (n = 20). A 10-min supine phase was followed by recording 600 cardiac cycles on tilt (5-10 min). Beat-to-beat heart rate (HR) and pulse transit time (PTT) were measured. Results were analysed using conventional statistics, recurrence plot analysis and fractal analysis.

RESULTS

Multivariate analysis evaluated independent predictors of the CVR in each patient group vs. all other groups. Based on these predictors, equations were determined for a linear discriminant score (DS) for each group. The best sensitivities and specificities of the DS, consistent with disease-related phenotypes of CVR, were noted in the following groups: CFS, 90.0% and 60%; SY, 93.3% and 62.5%; FMF, 90.1% and 75.4%, respectively.

DISCUSSION

Pathological disturbances may alter cardiovascular reactivity. Our data support the existence of disease-related CVR phenotypes, with implications for pathogenesis and differential diagnosis.

The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome

BACKGROUND

Studying patients with chronic fatigue syndrome (CFS), we have developed a method that uses a head-up tilt test (HUTT) to estimate BP and HR instability during tilt, expressed as a 'haemodynamic instability score' (HIS).

AIM

To assess HIS sensitivity and specificity in the diagnosis of CFS.

DESIGN

Prospective controlled study.

METHODS

Patients with CFS (n=40), non-CFS chronic fatigue (n=73), fibromyalgia (n=41), neurally mediated syncope (n=58), generalized anxiety disorder (n=28), familial Mediterranean fever (n=50), arterial hypertension (n=28), and healthy subjects (n=59) were evaluated with a standardized head-up tilt test (HUTT). The HIS was calculated from blood pressure (BP) and heart rate (HR) changes during the HUTT.

RESULTS

The tilt was prematurely terminated in 22% of CFS patients when postural symptoms occurred and the HIS could not be calculated. In the remainder, the median(IQR) HIS values were: CFS +2.14(4.67), non-CFS fatigue -3.98(5.35), fibromyalgia -2.81(2.62), syncope -3.7(4.36), generalized anxiety disorder -0.21(6.05), healthy controls -2.66(3.14), FMF -5.09(6.41), hypertensives -5.35(2.74) (p<0.0001 vs. CFS in all groups, except for anxiety disorder, p=NS). The sensitivity for CFS at HIS >-0.98 cut-off was 90.3% and the overall specificity was 84.5%.

DISCUSSION

There is a particular dysautonomia in CFS that differs from dysautonomia in other disorders, characterized by HIS >-0.98. The HIS can reinforce the clinician's diagnosis by providing objective criteria for the assessment of CFS, which until now, could only be subjectively inferred.

Assessment of cardiovascular reactivity by fractal and recurrence quantification analysis of heart rate and pulse transit time

Methods used for the assessment of cardiovascular reactivity are flawed by nonlinear dynamics of the cardiovascular responses to stimuli. In an attempt to address this issue, we utilized a short postural challenge, recorded beat-to-beat heart rate (HR) and pulse transit time (PTT), assessed the data by fractal and recurrence quantification analysis, and processed the obtained variables by multivariate statistics. A 10-min supine phase of the head-up tilt test was followed by recording 600 cardiac cycles on tilt, that is, 5-10 min. Three groups of patients were studied, each including 20 subjects matched for age and gender--healthy subjects, patients with essential hypertension (HT), and patients with chronic fatigue syndrome (CFS). The latter group was studied on account of the well-known dysautonomia of CFS patients, which served as contrast against the cardiovascular reactivity of the healthy population. A total of 52 variables of the HR and PTT were determined in each subject. The multivariate model identified the best predictors for the assessment of reactivity of healthy subjects vs CFS. Based on these predictors, the "Fractal & Recurrence Analysis-based Score" (FRAS) was calculated: FRAS=76.2+0.04*HR-supine-DET -12.9*HR-tilt-R/L -0.31*HR-tilt-s.d. -19.27*PTT-tilt-R/L -9.42*PTT-tilt-WAVE. The median values and IQR of FRAS in the groups were: healthy=-1.85 (IQR 1.89), hypertensives=+0.52 (IQR 5.78), and CFS=-24.2 (5.34) (HT vs healthy subjects: P=0.0036; HT vs CFS: P<0.0001). Since the FRAS differed significantly between the three groups, it appears likely that the FRAS may recognize phenotypes of cardiovascular reactivity.

Guiding across the generations: rediscovering nursing's promise

This report describes the parallels between guiding and nursing. The principles of guiding, safety, discovery, integrity, and intention are reviewed and tied to specific skills. Nursing guides integrate these principles and skills to show the way to people for whom they care. The safety that guiding provides serves multiple generations and their unique needs.

Aspirin reduces blood cholesterol in copper-deficient rats: a potential antioxidant agent?

The purpose of this study was to examine whether the hypocholesterolemic effect of aspirin is to due to its antioxidant properties. Oxidative stress was induced in rats by feeding them a copper-deficient diet. Copper deficiency reduced the activity of the enzyme superoxide dismutase (SOD) and lowered liver copper concentration but elevated liver iron. The combination of reduced SOD activity, high liver iron, and low liver copper resulted in an oxidative stress assessed by increased liver lipid peroxidation compared with copper-adequate controls. In addition, copper-deficient rats exhibited elevation of blood cholesterol. The administration of aspirin lowered both liver lipid peroxidation and blood cholesterol. It is suggested that the hypocholesterolemic properties of aspirin could be due to its ability to reduce oxidative stress.

Intestinal beta-carotene 15,15'-dioxygenase activity is markedly enhanced in copper-deficient rats fed on high-iron diets and fructose

The purpose of the present work was to examine effects of the Cu-Fe interaction on intestinal beta-carotene 15,15'-dioxygenase activity when a wide range of dietary Fe (deficiency to excess) was used in relation to Cu status of rats. The effect of dietary carbohydrates was also examined since they play a role in the Cu-Fe interaction in vivo. Weanling male Sprague-Dawley rats (n 72) were divided into twelve dietary groups, which were fed on either low-, normal-, or high-Fe levels (0.9, 9.0, and 90.0 mmol Fe/kg diet respectively) combined with Cu-adequate or -deficient levels (0.94 and 0.09 mmol Cu/kg diet respectively) and with starch or fructose in the diets. The data showed that both Fe concentration and beta-carotene 15,15'-dioxygenase activity in small intestinal mucosa were enhanced with increasing dietary Fe and with Cu deficiency v. Cu adequacy. Dietary fructose did not aggravate the Fe-enhancement, related to Cu deficiency, in the small intestine; however, fructose increased the intestinal dioxygenase activity in rats fed on normal- or high-Fe diets when compared with starch controls. Thus, the highest intestinal dioxygenase activity associated with the lowest hepatic retinol (total) concentration was found in rats fed on the Cu-deficient, high-Fe, fructose-based diet. Finally, a positive linear relationship was found between the dioxygenase activity and Fe concentration in intestinal mucosa. In conclusion, the data indicate that beta-carotene 15,15'-dioxygenase activity requires Fe as cofactor in vivo and the enzyme is modulated by the three dietary components: Cu, Fe, and fructose.

Expression and regulation of relaxin-like factor gene transcripts in the bovine ovary: differentiation-dependent expression in theca cell cultures

The relaxin-like factor (RLF) was recently discovered as a new member of the insulin-insulin-like growth factor-relaxin family of growth factors and hormones predominantly in the Leydig cells of the testis. In cattle, in contrast to other species, the RLF gene is also expressed to a high level in the ovary, where its expression pattern in the corpus luteum of the late cycle and pregnancy is similar to that of relaxin in the pig. The RLF gene was also transcribed to a high level in the theca cells of estrogen-rich, large antral follicles. Long-term primary cultures of bovine theca cells showed that expression was insulin dependent. After an initial decline in specific mRNA concentrations, there was a switch to a transcript with a longer poly(A) tail at about Day 6 of culture, which continued to increase to very high levels by Day 15 of culture. Addition of fetal calf serum to cultures caused a rapid and irreversible down-regulation of the RLF gene. Also, LH caused a decline in specific gene expression in long-term primary theca cell cultures. As in the Leydig cells of the testis, the pattern of RLF gene expression appears to reflect the differentiation state of the ovarian theca-luteal cell lineage, and should prove useful for mapping the fate of these cells under differing stimulation regimes.

Beta-carotene 15,15'-dioxygenase activity is responsive to copper and iron concentrations in rat small intestine

OBJECTIVE

Previous in vitro studies have suggested that beta-carotene 15,15'-dioxygenase is an iron-dependent enzyme. However, in vivo, it is difficult to alter iron tissue concentration by varying dietary iron because of homeostatic control. On the other hand, an interaction between iron and copper has been shown, i.e., copper-deficiency results in an increase of iron in rat liver. Therefore, we hypothesized that intestinal iron concentration could be increased by copper-deficiency. Our objective was to examine the effects of iron as affected by dietary copper on beta-carotene 15,15'-dioxygenase activity in the small intestine.

METHODS

Weanling male Sprague-Dawley rats (40 to 45g) were divided into four dietary groups: two copper-adequate groups (6.0 microg Cu/g diet) and two copper-deficient groups (0.6 microg Cu/g) combined with either normal iron (44 microg Fe/g) or high iron (87 microg Fe/g). Iron and copper concentrations were determined by atomic absorption spectrophotometry and the dioxygenase activity by reverse phase HPLC.

RESULTS

Intestinal copper concentration was significantly reduced (40%) by the consumption of the copper-deficient diets, but intestinal iron was not changed by doubling dietary iron in rats fed either copper-adequate or copper-deficient diets. However, as hypothesized, the two copper-deficient groups exhibited higher intestinal iron concentration (> or =137%, p<0.001) than the copper-adequate controls. In addition, intestinal beta-carotene 15,15'-dioxygenase activity was increased by 27% and 106%, respectively, for copper-deficient rats fed either normal or high iron diets, compared to the respective copper-adequate controls (p<0.01). The dioxygenase activity was not significantly affected by dietary iron in either copper-adequate or copper-deficient groups. Finally, the enzyme activity was positively correlated (r=0.67, p<0.0001) with iron concentration and negatively correlated (r=-0.49, p<0.01) with copper concentration in small intestine.

CONCLUSIONS

Intestinal beta-carotene 15,15'-dioxygenase may be an iron-dependent enzyme sensitive to copper status in vivo.

Level of dietary iron, not type of dietary fat, is hyperlipidemic in copper-deficient rats

OBJECTIVE

This study was conducted to determine whether high dietary iron will negate the protective effect of unsaturated fat against hyperlipidemia.

METHODS

Forty-eight weanling, male Sprague Dawley rats were randomly assigned to eight dietary groups differing in the levels of copper and iron and type of dietary fat (saturated or unsaturated). The diets were either deficient (0.6 microg Cu/g) or adequate (6.8 microg Cu/g) copper and either adequate (53 microg Fe/g) or high (506 microg Fe/g) iron. All diets contained starch as the sole source of dietary carbohydrate.

RESULTS

Regardless of the type of dietary fat, three copper-deficient rats fed the high levels of dietary iron died prematurely due to ruptured hearts. Surviving rats belonging to the copper deficiency and high-dietary iron regimen developed severe anemia, enlarged hearts and livers, and exhibited the highest levels of liver iron. These rats also developed hypercholesterolemia. Triglycerides were elevated by the consumption of high iron diets.

CONCLUSION

Data show that levels of dietary iron, not the type of dietary fat, are potential inducers of hypertriglyceridemia. Data also show that the combination of high iron intake and dietary copper deficiency is responsible for elevating blood cholesterol.

Cholesterol-lowering nature of unsaturated fat in rats may be due to its inability to increase hepatic iron

The present investigation was conducted to determine whether the cholesterol-raising properties of saturated fat and cholesterol-lowering properties of unsaturated fat are associated with levels of hepatic iron. The magnitude of hepatic iron retention was manipulated by feeding rats diets that were either copper-deficient or -adequate, iron-adequate or -supplemented, and contained either beef tallow or corn oil. Weanling male Sprague-Dawley rats were randomly divided into eight dietary groups according to the type of dietary fat (beef tallow or corn oil) and level of dietary copper (0.74 or 6.9 microg Cu/g diet) or iron (44.4 or 86.7 microg Fe/g diet). Beef tallow and copper deficiency alone increased hepatic iron levels, which in turn were associated with increased plasma cholesterol. When the three dietary factors were combined, ie, iron, beef tallow, and copper deficiency, they induced the highest magnitude of hepatic iron retention, which in turn was associated with the highest concentration of plasma cholesterol. In contrast, when hepatic iron retention was not increased, such as by feeding a diet containing corn oil or by consumption of a copper-adequate diet, plasma cholesterol was not elevated. Based on these data, it is suggested that nutrients that have the ability to increase hepatic iron have the potential to increase plasma cholesterol.

Dietary fructose but not starch is responsible for hyperlipidemia associated with copper deficiency in rats: effect of high-fat diet

OBJECTIVE

To test the hypothesis that copper deficiency in rats may be hyperlipidemic only when the diets consumed contain nutrients which contribute to blood lipids such as fructose and high fat.

METHODS

Weanling male Sprague Dawley rats were fed diets which contained either starch or fructose as their sole carbohydrate source. The diets were either inadequate (0.6 microg Cu/g) or adequate (6.0 microg Cu/g) in copper and contained either high (300 g/kg) or low (60 g/kg) fat. At the end of the 4th week the rats were killed. Livers were analyzed for copper content. Plasma was analyzed for cholesterol and triglyceride concentrations.

RESULTS

High-fat diet did not increase blood lipids in rats fed a copper-deficient diet containing starch. In contrast, the combination of high-fat diet with fructose increased blood triglycerides and fructose with copper deficiency resulted in a significant increases in blood cholesterol.

CONCLUSIONS

Hyperlipidemia of copper deficiency in rats is dependent on synergistic effects between dietary fructose and copper deficiency and fructose and amount of dietary fat. Hyperlipidemia does not develop if starch is the main source of dietary carbohydrate in a copper-deficient diet even if a high-fat diet is fed.

Nutritional factors adversely influencing the glucose/insulin system

For the majority of people, particularly if they do not smoke, the food they eat is the largest controllable factor determining their long-term health. The disproportionate consumption of foods high in fat, especially high in saturated fat, and high in simple sugars at the expense of foods high in complex carbohydrate and unsaturated fat has the potential of inducing abnormal metabolic processes in a normal healthy individual and to promote chronic degenerative diseases. Some of the effects of individual macronutrients such as fat, refined sugars and alcohol in promoting abnormalities in glucose/insulin system are presented. These nutrients were chosen because they also have the ability to alter oxidative state of the individual, which in turn could affect the glucose/insulin system. This review focuses on the role of dietary nutrient interactions in influencing the glucose/insulin system through the generation of reactive oxygen species. The importance of dietary macronutrient interaction with micronutrients such as copper and iron and the potential it has in affecting the glucose/insulin system is addressed.

Effect of hepatic iron on hypercholesterolemia and hypertriacylglycerolemia in copper-deficient fructose-fed rats

The purpose of this investigation was to establish whether plasma cholesterol and triacylglycerol(s) in copper deficiency can be increased or decreased by hepatic iron levels. Weanling male Sprague-Dawley rats were randomly divided into six dietary groups based on levels of dietary copper and iron. They were fed from weaning their respective diets for 6 wk. Forty percent of the copper-deficient rats fed a 15.7 mumol Fe/g diet died; 22% of those fed a diet containing 8.6 mumol Fe/g died; and there were no deaths in the 3.4 mumol Fe/g diet group. Rats belonging to the group fed the high-iron diet also exhibited the highest levels of liver iron, liver glutathione, and plasma cholesterol and triacylglycerol(s) compared with those fed either the adequate or low levels of dietary iron. There was a direct correlation (r = 0.82 and 0.77, respectively) between levels of cholesterol and triacylglycerol(s) in plasma and hepatic iron concentrations. These results provide strong evidence that points to a major involvement of iron in the lipemia of copper deficiency. These data may be important to those individuals who consume large quantities of fortified iron foods and supplement with iron but whose intake of copper is suboptimal.

Benfluorex, a hypotriglyceridemic drug, reduces lipid peroxidation and alleviates adverse metabolic complications of copper deficiency

The pathologies associated with copper deficiency in rats fed fructose may be induced, in part, by hypertriglyceridemia and lipid peroxidation. Reducing triacylglycerol levels in plasma may result in lowering lipid peroxidation, which in turn could ameliorate metabolic effects resulting from the combination of fructose feeding and copper deficiency. Benfluorex, a hypolipidemic factor able to reduce hypertriglyceridemia, was administered to weanling male rats fed either copper-deficient (0.6 microgram Cu/g) or adequate (6.0 micrograms Cu/g) diets containing fructose as the sole dietary carbohydrate. In copper-deficient rats, benfluorex (50 micrograms.kg-1.d-1) reduced plasma triacylglycerols from 45 to 31 mg/dL, reduced lipid peroxidation by approximately 50%, and prevented the enlargements of heart and liver size and the atrophy of the pancreas, and ameliorated anemia. It is suggested that lipid peroxidation associated with hypertriglyceridemia may be responsible for the pathologies induced by the combination of fructose consumption and copper deficiency.

Impaired endocrine and exocrine pancreatic functions in copper-deficient rats: the effect of gender

OBJECTIVE

To examine the effect of gender on endocrine and exocrine pancreatic function in female and male rats fed from weaning a copper-deficient diet.

METHODS

Weanling male and female rats were fed a copper-deficient or adequate diet for 4 weeks. Rats were sacrificed after an overnight fast. Livers and pancreata were removed, weighed and the concentrations of copper and iron were determined. In addition, insulin was measured in pancreatic tissue and plasma. Lipase and amylase activities were measured in pancreas. Lipid peroxidation was assessed in liver.

RESULTS

Copper deficiency in the male resulted in a profound reduced glandular mass of the pancreas. The pancreas continued low activities of lipase and amylase but excessive levels of insulin. Iron retention in the pancreas of the copper-deficient male rat was greater than in the female counterpart. Effects of copper deficiency in female rats on pancreas mass and endocrine pancreas were of lesser magnitude compared with males. Plasma insulin in the female rat was much higher than in the male rat. Hepatic lipid peroxidation was increased by copper deficiency in the male rat but was unaffected in the female.

CONCLUSIONS

Data show that pancreatic atrophy is more pronounced in males compared with females, and the endocrine pancreas of the male is more susceptible to dietary copper deprivation than the female rat. The greater degree of pancreatic atrophy and associated abnormalities in males compared with females may be related to the greater retention of pancreatic iron and subsequent peroxidative damage.

Hepatic iron overload may contribute to hypertriglyceridemia and hypercholesterolemia in copper-deficient rats

The present study was conducted in order to determine whether hepatic iron retention in rats fed a copper-deficient diet containing fructose is associated with hypertriglyceridemia and hypercholesterolemia, and whether a reduction of iron intake will prevent elevation of blood triglycerides and cholesterol. Rats were fed from weaning either a copper-deficient (0.6 microgram Cu/g) or copper-adequate (6.0 micrograms Cu/g) diet for 4 weeks. Half the rats consumed either an adequate level of iron (50 micrograms Fe/g) or a low level (17 micrograms Fe/g). Reduction of iron intake reduced blood levels of both triglycerides and cholesterol in rats fed a copper-deficient diet containing fructose. In addition, hepatic lipid peroxidation was also decreased. The combination of high iron, low copper, and fructose may be responsible for increased levels of risk-factor metabolites associated with heart disease.

Responses of insulin to oral glucose and fructose loads in marginally copper-deficient rats fed starch or fructose

The purpose of this study was to assess the effects of dietary fructose either alone or in combination with marginal copper deficiency in weanling male rats exposed to their respective diets for only 2 wk. This short duration of exposure to inadequate copper intake prevents progressive morbidity brought about by increasing periods of exposure to dietary copper deprivation. Weanling male rats were fed a copper-deficient (0.6 microgram Cu/g) or a copper-adequate (6.0 micrograms Cu/g) diet containing 62% fructose or 62% starch for 2 wk. Either an oral glucose or an oral fructose tolerance test was conducted after an overnight fast. Insulin levels were elevated by either oral glucose or oral fructose at fasting and at 30 min postload in rats fed fructose compared with those fed starch. Despite high levels of plasma, insulin blood glucose was not reduced. Marginal copper deficiency had no effect on either plasma insulin or blood glucose. Data identify fructose as the sole agent responsible for inducing adverse changes in glucose metabolism. Two weeks of fructose consumption was sufficient to produce these changes.

Antioxidant defense system in lung of male and female rats: interactions with alcohol, copper, and type of dietary carbohydrate

Male and female rats were used to investigate the effects of type of dietary carbohydrate (CHO), copper, and ethanol consumption on lung antioxidant enzyme activities and levels of phosphorylated compounds in whole blood. Copper-deficient female rats exhibited a greater degree of copper deficiency than males, as assessed by hepatic copper concentration and hepatic copper superoxide dismutase (CuSOD) activity. However, copper-deficient male rats fed fructose-containing diets exhibited greater growth retardation, anemia, and heart hypertrophy than females consuming the same diets and males fed starch. In addition, one of 10 copper-deficient male rats that ate a fructose-based diet and drank water and one of 10 copper-deficient male rats that ate a starch-based diet and drank ethanol died. Copper-deficient, starch-fed males exhibited the highest activities of glutathione peroxidase (GSH-Px) and catalase as compared with fructose-fed rats. Ethanol consumption elevated the activities of GSH-Px and catalase. Copper-deficient female rats exhibited higher catalase but lower GSH-Px activities than males. It is suggested that in copper deficiency, the ability to increase antioxidant enzyme activities in rats consuming starch is greater than in rats consuming fructose. Rats fed starch are provided with a greater degree of protection against oxidative damage than rats fed fructose. In addition, polyphosphorylated compounds in blood were reduced in copper-deficient male rats that consumed fructose-based diets. This may impair supply of oxygen to tissues.

Allopurinol, an inhibitor of xanthine oxidase, reduces uric acid levels and modifies the signs associated with copper deficiency in rats fed fructose

This study was designed to focus on the potential stress that xanthine oxidase could produce in copper-deficient rats fed fructose. Fructose consumption results in an excess production of uric acid due to an increased degradation of nucleotides. The enzyme xanthine oxidase catalyzes the oxidation of both hypoxanthine and xanthine. During the oxidation process free radicals are generated, which in turn, induce lipid peroxidation and premature death. Allopurinol -- a competitive inhibitor of xanthine oxidase -- could alleviate the combined effects of fructose feeding and copper deficiency. Twenty-five male rats were fed for 4 weeks from weaning a copper-deficient or adequate diet containing fructose. Twelve rats were given a daily oral dose of 5 mg allopurinol/100 g b.wt. Two copper-deficient rats that were not treated with allopurinol died prematurely during the fourth week of the study. No mortality occurred in the group of copper-deficient rats that had been treated with allopurinol. Anemia was alleviated by allopurinol, which in turn, could be responsible for improved growth rate. Allopurinol was effective in inhibiting xanthine oxidase activity in vivo as measured by the dramatic reduction of uric acid production. Lipid peroxidation, however, was not affected by allopurinol. It is concluded that the beneficial effects of allopurinol in copper deficiency do not appear to be related to prevention of oxygen radicals, but rather, to the protection against the catabolic destruction of purines, which in turn, increases nucleotide pool.

Oxytocin and oxytocin receptor gene expression in the reproductive tract of the pregnant cow: rescue of luteal oxytocin production at term

The peptide hormone oxytocin is produced both in the hypothalamus and in certain peripheral organs. The extent of extra-hypothalamic hormone synthesis in the pregnant cow has not previously been examined. In this study we have analyzed different tissues from the pregnant bovine reproductive tract and corpus luteum for the presence of mRNA encoding the oxytocin peptide as well as the oxytocin receptor. In uterine tissues oxytocin mRNA could only be detected sporadically with the help of a reverse transcription-polymerase chain reaction method, implying only very low levels of expression. The caruncles showed a consistently low level of oxytocin gene expression, which appeared up-regulated at term. However, in the corpus luteum there was a significant level of oxytocin gene expression at term, particularly following the onset of labor. The transcript levels were sufficiently high to be measurable by both RNase protection assay and by Northern hybridization; these levels imply a rescue of the oxytocin gene expression seen in the corpora lutea of cyclic and early pregnant cows. At the peptide level this expression was confirmed by immunohistochemistry. A sensitive RNase protection assay was developed to detect transcripts encoding the oxytocin receptor. Transcripts were detected in most uterine tissues, including the caruncles, with highest levels in the endometrium and myometrium at term. No transcripts could be detected in the corpus luteum at any stage of pregnancy, nor in the amnion. The results suggest the possibility of local, paracrine effects of oxytocin within the uterus of the pregnant cow. The rescue of luteal oxytocin at term could act to supplement the circulating hormone of pituitary origin.

Dietary ferric vs. ferrous iron in copper-deficient rats fed fructose-based diets

OBJECTIVE

This preliminary study was undertaken to determine whether the valence state of dietary iron affects signs associated with copper deficiency in rats fed fructose.

METHODS

Rats were fed either copper-deficient or adequate diets containing 62% fructose as the sole dietary carbohydrate for 5 weeks. The mineral mixture contained equal concentration of either ferric or ferrous iron.

RESULTS

Copper deficiency resulted in growth retardation, anemia, heart hypertrophy but pancreatic atrophy. The consumption of ferrous iron resulted in increased hematocrit and pancreas size. The combination of ferrous iron with copper deficiency reduced heart size.

CONCLUSIONS

Copper deficiency had a major impact on each parameter measured. Although the valence state of iron did not protect the rats against the pathological consequence of copper deficiency it did have some positive effects. It may be that ferrous iron is a more available form than ferric iron.

Antioxidant defense mechanisms in the female rat: interactions with alcohol, copper, and type of dietary carbohydrate

The purpose of this study was to examine the effects of ethanol, type of dietary carbohydrate (fructose vs. starch), and levels of dietary copper (deficient vs. adequate) on antioxidant defense mechanism in the female rat. The consumption of 20% ethanol in the drinking water depressed growth rate due to a reduction of feed efficiency. Ethanol also lowered hepatic copper concentration, but had no effect on hepatic iron. Among the three antioxidant enzymes studied [i.e., superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase], only catalase activity was increased by ethanol. This effect was independent of copper or the type of dietary carbohydrate. As expected, copper deficiency dramatically reduced SOD. Copper deficiency also reduced GSH-Px activity; however, the combination of fructose feeding with copper deficiency caused a further reduction in GSH-Px. The data show that copper deficiency, per se, and the combination of copper deficiency with fructose feeding lower the antioxidant defense system in female rats.

Antioxidant defense mechanisms in the male rat: interaction with alcohol, copper, and type of dietary carbohydrate

The activities of enzymes participating in cellular protection against free radical reactions were measured in hepatic tissues from copper-adequate and copper-deficient rats fed fructose or starch-based diets. Half of the rats consumed 20% ethanol in their drinking water. The consumption of ethanol depressed growth rate, reduced hematocrit, and hepatic copper concentration. Feed efficiency was greatly depressed by ethanol. Mortality due to copper deficiency occurred in fructose-fed rats and in starch-fed rats that drank ethanol. Ethanol had no effect on superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), or catalase. In contrast, copper deficiency reduced SOD and fructose feeding depressed catalase activity. GSH-Px was not affected by either the type of dietary carbohydrate, copper, or ethanol. Taken together, these data suggest that additional mechanisms to antioxidant defense systems are responsible for the metabolic changes that occur during the interactions between ethanol low copper and dietary carbohydrates.

Coverage gaps in child-restraint and seat-belt laws affecting children

Although most U.S. states have enacted mandatory-seat-belt-use laws and all states have child-restraint laws requiring children under specified ages to be properly restrained in vehicles, some children are covered by neither law. Other children are covered only by belt-use laws that do not make any adult responsible for their compliance. This note analyzes the child-restraint and belt-use laws in each state and demonstrates the deficiencies in coverage as they apply to children younger than age 16.

Requirements for biotin are not affected by the combination of copper deficiency and fructose feeding

OBJECTIVE

The objective of the present study was to establish whether copper (Cu)-deficient rats fed a diet containing fructose as their sole carbohydrate source require more biotin than the recommended 2 mg/kg diet when egg-white serves as the dietary protein.

METHODS

Eighty weanling male Sprague-Dawley rats were randomly divided into 8 groups according to type of dietary carbohydrate (starch or fructose), level of Cu (0.6 micrograms Cu/g diet or 6.0 micrograms Cu/g diet) and level of biotin (2 mg/kg diet or 10 mg/kg diet).

RESULTS

Regardless of the level of dietary biotin, Cu-deficient rats fed a fructose-containing diet exhibited growth retardation, anemia, atrophied pancreata, enlarged hearts and similar death rates. The remaining Cu-deficient rats fed fructose were emaciated and sick regardless of dietary biotin levels. The concentration of biotin in serum and biotin content of liver of rats fed fructose were higher than corresponding values from rats fed starch.

CONCLUSION

Cu-deficient rats fed fructose are not deficient in biotin compared to published normal values. Supplementation of 10 mg/biotin/kg diet did not improve morbidity or mortality and therefore was not beneficial.

Alcohol consumption mimics the effects of a high-fructose, low-copper diet in rats

The consumption of a high-fructose diet that is inadequate in copper produces numerous pathologies which eventually lead to the mortality of the animals. In contrast, the consumption of a high-starch diet that is inadequate in copper does not produce abnormalities and the animals survive. Ethanol has been chosen as an agent to mimic the fructose effect in copper deficiency. The administration of 20% ethanol in the drinking water of rats fed a starch-based diet that was inadequate in copper resulted in a depressed growth rate, anemia, pancreatic atrophy, and heart hypertrophy. All these signs were similar to the signs exerted by fructose feeding when it was combined with copper deficiency. Polyol pathway in the liver and kidney was affected by both ethanol and fructose consumption. Ethanol did not aggravate the signs associated with copper deficiency in rats fed fructose, but it exacerbated the signs associated with copper deficiency in rats fed starch. Certain metabolic pathways that are unique for fructose and ethanol may be responsible for the exacerbation of copper deficiency.

Copper deficiency in rats: the effect of type of dietary protein

The present investigation was conducted to determine whether type of dietary protein can exacerbate the pathology induced by the combination of fructose feeding and copper (Cu) deficiency. Weanling male Sprague-Dawley rats were assigned to three different groups differing in the nature of dietary protein. The proteins used were egg-white, casein or lactalbumin. All diets contained 62.5% carbohydrate as fructose and were low in Cu (0.6-0.72 microgram Cu/g diet). Although the lowest concentration of Cu was found in the livers of rats fed egg-white, the pathology associated with Cu deficiency was more severe in rats fed lactalbumin. The highest concentration of hepatic Cu was found in rats fed casein. The data show that the type of dietary protein can exacerbate signs associated with Cu deficiency. The concentrations of hepatic Cu do not reflect accurately the pathology associated with Cu deficiency.

Effect of coenzyme Q10 supplementation on cardiac hypertrophy of male rats consuming a high-fructose, low-copper diet

Administration of coenzyme Q10 to humans and animals has a beneficial effect on a number of cardiac diseases. The purpose of the present study was to determine if coenzyme Q10 treatment could ameliorate cardiac abnormalities associated with the carbohydrate x copper interaction in rats. Weanling male rats were provided with a copper-deficient diet (0.6 microgram Cu/g) containing either 62.7% starch (S-Cu) or fructose (F-Cu) for 5 wk. Half of the rats provided with the F-Cu diet were given daily oral supplements of 300 mg coenzyme Q10/kg body weight (F-Cu + Q). Heart hypertrophy, liver enlargement, or pancreatic atrophy were not affected by, nor was body growth or anemia improved by, supplementation with coenzyme Q10 when compared to rats fed only the F-Cu diet. Hearts from rats fed the F-Cu diet had severe inflammation, degeneration, fibrosis, and giant mitochondria with abnormal cristae. Hearts from F-Cu + Q rats had similar mitochondrial changes as the F-Cu rat hearts but without any apparent degenerative changes. None of the F-Cu + Q rats, but 30% of the F-Cu rats, died during the study as a result of heart rupture. These observations show that whereas coenzyme Q10 treatment did not prevent the cardiac hypertrophy of the carbohydrate x copper interaction, it did play a role in maintaining the integrity of the heart.

Low dietary iron prevents free radical formation and heart pathology of copper-deficient rats fed fructose

Two studies were conducted to determine whether hepatic iron overload in rats fed fructose plays a role in the exacerbation of the signs associated with copper deficiency. When fed the adequate iron diet (50 micrograms Fe/g), copper-deficient rats fed either fructose or starch exhibited hepatic iron overload of similar magnitude. However, only livers of copper-deficient rats fed fructose exhibited the presence of high peaks associated with an iron compound detected by electron spin resonance. In addition, only copper-deficient rats fed fructose developed anemia, pancreatic atrophy, and heart hypertrophy with histopathologic changes, and they died prematurely of heart-related abnormalities. Lowering dietary iron from 50 micrograms/g to 30 micrograms/g was not sufficient to protect the animals against the pathologic consequences of copper deficiency. In contrast, the consumption of a fructose diet inadequate in both copper (0.6 micrograms/g) and iron (17 micrograms/g) resulted in the reduction of hepatic iron, which in turn caused the amelioration of the deficiency, compared with rats fed the adequate iron (50 micrograms/g) diet. None of these rats developed pancreatic atrophy, none exhibited myocardial lesions, and none died of the deficiency. Electron spin resonance spectra of their livers did not show the presence of free radicals. The data suggest that hepatic iron overload plays a role in the exacerbation of copper deficiency only when fructose diets are consumed.

The effect of time of introduction of a high-fructose, low-copper diet on copper deficiency in male rats

The purpose of the present study was to compare the time of introduction of the high-fructose low-copper diet on the expression of copper (Cu) deficiency. Weanling male rats were randomly assigned to either a diet containing 62.7% fructose or starch, and 6.0 (F+Cu) or 0.6 (S-Cu) microgram Cu/g diet, respectively, for either 1, 2, or 3 wk before being transferred to a diet containing fructose and inadequate in copper (F-Cu). At week 10, body weight and relative heart size of rats initially consuming the F + Cu diet was inversely related to the week placed on the F-Cu diet, but not for those initially consuming S-Cu. Hematocrit, hepatic Cu concentration and RBC superoxide dismutase activity were significantly lower in rats initially consuming S-Cu when compared to those fed F + Cu. Mortality was greatest in rats switched to the F-Cu diet at weeks 1 and 2 when compared to those switched at week 3 regardless of the type of diet initially consumed. Plasma cholesterol, triacylglycerols, and blood urea nitrogen concentrations were not significantly altered by the type of diet initially consumed or by the time of introduction of the F-Cu diet. It was concluded that changing rats to a F-Cu diet at 1, 2, or 3 wk after weaning did not significantly improve some of the characteristic signs associated with Cu deficiency, but the later that the F-Cu diet was introduced after weaning the greater the chances for survival.

The influence of gender on developing copper deficiency and on free radical generation of rats fed a fructose diet

The present investigation was conducted to determine whether differences in copper and iron status between male and female rats can be detected during the development of copper deficiency. These differences may explain the protection of the female against the severity of copper deficiency. In addition, the livers of all rats were exposed to electron-spin resonance (ESR) spectroscopy for the presence of free radicals. Male and female rats were fed from weaning either copper-deficient or -adequate diets containing fructose for 31 days. Rats were killed at day 0, 8, 16, 24, and 31 of the study. Throughout the study, copper-deficient males exhibited the same organ copper concentrations as copper-deficient female rats. However, only in the male did copper deficiency cause a reduction in body weight and an increase in liver and heart sizes but a decrease in pancreas size. In contrast, organ iron concentrations were different between males and females. Only copper-deficient males were anemic. Only the livers of copper-deficient males showed the presence of free radicals. Although the livers of copper-deficient female rats exhibited higher concentrations of hepatic iron than their male counterparts, their livers did not show the presence of free radicals. The data of the present study suggest that changes in organ sizes and the severity of copper deficiency are not solely due to the total concentrations of iron and/or copper. The type of iron compound and the presence of free radicals may be involved in the pathology of copper deficiency of the male.