Bioavailability of vitamin D biofortified pork meat: results of an acute human crossover study in healthy adults

Vitamin D intakes are concerningly low. Food-based strategies are urgently warranted to increase vitamin D intakes and subsequently improve 25-hydroxyvitamin D (25(OH)D) concentrations. This acute randomised three-way crossover study investigated the efficacy of vitamin D biofortified pork derived from pigs exposed to UVB light to increase serum 25(OH)D₃ concentrations, compared to a dose-matched vitamin D₃ supplement and control pork in adults (n = 14). Blood samples were obtained at baseline and then 1.5, 3, 6, 9 and 24 h postprandially. There was a significant effect of time (p < 0.01) and a significant treatment*time interaction (p < 0.05). UV pork and supplement significantly increased within-group serum 25(OH)D₃ concentrations over timepoints (p < 0.05) (max. change 0.9 nmol/L (2.2%) UV pork, 1.5 nmol/L (3.5%) supplement, 0.7 nmol/L (1.9%) control). Vitamin D biofortified pork modestly increased 25(OH)D₃ concentrations and produced a similar response pattern as a dose-matched vitamin D supplement, but biofortification protocols should be further optimised to ensure differentiation from standard pork.

[Anticonvulsant add-on therapy with Eslicarbazepine acetate : Results of the EPOS-study in adults in Germany]

BACKGROUND

Due to inadequate seizure control achieved with antiepileptic drug (AED) monotherapy and the considerable side effects at high required doses, patients with partial-onset seizures (POS) often require AED combination therapy. Eslicarbazepine acetate (ESL) is licensed as an add-on therapy for POS and has a favorable tolerability profile.

OBJECTIVES

To investigate retention, utilization, reported efficacy, safety and tolerability as well as effects on health-related quality of life using ESL as an add-on treatment to an established monotherapy in a real-world adult population with POS in Germany.

PATIENTS AND METHODS

A subgroup analysis was performed on the data derived from the German study sites that had participated in an international, non-interventional, open-label study conducted in eight European countries (eslicarbazepine acetate in partial-onset seizures, EPOS). Adult patients with POS whose physician had decided to prescribe add-on treatment with ESL to an established monotherapy were followed over a total period of approximately six months (three visits: baseline and after periods of approximately three and six months). Data collection included patient retention, reported efficacy, safety and tolerability as well as quality of life (QOLIE-10).

RESULTS AND DISCUSSION

The subgroup analysis included 104 patients which had been enrolled at 38 German study sites. After 6 months, retention of ESL add-on therapy was 86.5 %, with 44.7 % of patients reporting seizure freedom over the 3 months prior to this visit. The overall tolerability of ESL add-on therapy was favorable: 32 adverse events (AE) were reported in 20 patients (19.2 %), while only two events in two patients were considered serious. No new safety signals were detected.

Real-world data on eslicarbazepine acetate as add-on to antiepileptic monotherapy

Objective

To assess retention, tolerability, and safety, efficacy and effects on quality of life (QoL) of eslicarbazepine acetate (ESL) add‐on treatment over 6 months in a real‐world adult population with partial‐onset seizures.

Methods

This non‐interventional, multicenter, prospective study was performed in eight European countries. Adult patients (n = 247) for whom the physician had decided to initiate ESL as add‐on to an existing antiepileptic drug (AED) monotherapy were invited to participate. The study comprised three visits: baseline, and after 3 and 6 months. Data on ESL retention, efficacy, tolerability, safety, and QoL were collected.

Results

After 6 months, the retention rate of ESL was 82.2%, and 81.8% of patients reported a reduction of seizure frequency of at least 50%; 39.2% of patients reported seizure freedom at this time. The mean QOLIE‐10 score improved from 2.9 (SD ± 0.8) at baseline to 2.1 (SD ± 0.8) after 6 months. 109 adverse events (AEs) were reported in 57 patients (26.0%); the majority were rated as related to ESL by the investigator and led to a discontinuation of ESL in 25 patients (11.4%). Eight patients (3.7%) suffered at least one serious AE. The most frequently reported AEs were dizziness, headache, convulsion, and fatigue.

Conclusions

This study shows that ESL was well tolerated and efficacious as add‐on therapy to one baseline AED. The use of ESL in patients less refractory than those included in previous clinical trials led to higher responder and seizure freedom rates. No new safety issues were observed.

Raloxifene analog LY117018 enhances the regeneration of sciatic nerve in ovariectomized female mice

The aim of this study was to examine the effects of LY117018, a selective estrogen receptor modulator, on peripheral nerve regeneration, using a model of sciatic nerve crush injury in mice. Sciatic functional index, an index of functional recovery, was significantly higher in LY117018 treated mice throughout regeneration. Analysis of semi-thin sections revealed a significant increase in both the total number of regenerating nerve fibers at day 7, and the mean axonal area of myelinated fibers at 7, 14, and 21 days after injury, in LY117018 treated mice. Analysis of axonal transport through retrograde labeling of motor neurons showed that LY117018 increased transport, and ICI 182,780 blocked the effects of LY117018, delineating estrogen receptors as its target. Our study suggests that LY117018 may markedly accelerate peripheral nerve regeneration and functional recovery through activation of estrogen receptors.

Leptin and obesity in mother-child pairs

Defects in the leptin gene or the leptin receptor may be a genetic cause of obesity, but little is known about the familial associations of leptin and obesity. This study compared plasma leptin and measures of obesity in a sample of 248 subjects (124 mother-offspring pairs); 34% were African American and 66% were white. Youth were aged 12 to 16 years. Plasma leptin and body mass index (BMI) were higher in mothers than in their offspring and, among the offspring, higher in girls than boys, even after correcting for BMI or body fat. Racial differences in leptin were present in both mothers and youth when adjusting for percentage body fat but disappeared when adjusting for BMI. In univariate analyses of the associations between mothers and offspring, BMI was associated with leptin in all groups but was most strongly associated in white pairs and in mother-son pairs. In multiple regression analyses, when adjusting for BMI, significant predictors of leptin levelfor the boys and girls together were gender, BMI, and pubertal status of the offspring; in girls only BMI was significant (R2 = 0.72), and in boys the significant predictors were their BMI (R2 = 0.66) followed by their pubertal status (R2 = 0.06) and the leptin level of their mothers (R2 = 0.02). When adjusting for body fat, the predictors were the offspring's percentage bodyfat (R2 = 0. 67) and mother's leptin (R2 = 0.03), with similar results in gender-specific analyses. The authors conclude that leptin levels of youth are most closely associated with their degree of obesity or body fat; mother's leptin and, for boys only, pubertal status also play a small role. Although the small association between maternal leptin on leptin in their offspring could be due to either heredity or shared environment, the results of this study suggest that individual obesity and environmental factors are important predictors of leptin levels in children.

Alveolar hemorrhage and renal microangiopathy in systemic lupus erythematosus

CONTEXT

Acute alveolar hemorrhage in systemic lupus erythematosus usually occurs as a pulmonary-renal syndrome. In most cases, the lungs show "bland" alveolar hemorrhage with little or no inflammation. Whether this alveolar injury is similar to the better-defined noninflammatory renal lupus vasculopathy is unresolved.

OBJECTIVES

To investigate the relationships and the mechanisms of small vascular injury in the lung and kidney of 2 lupus patients who died of diffuse AH.

METHODS

We investigated the relationship of AH to immune complex deposition in the lungs of 6 patients with systemic lupus erythematosus and correlated the findings with glomerular and vascular disease in the kidney. Lung and kidney were studied by light, immunofluorescence, and/or electron microscopy; apoptosis was investigated using in situ nick-end labeling.

RESULTS

The clinical course of 2 patients was complicated by alveolar hemorrhage, and the lungs of these patients revealed alveolar wall immune complex deposits and bland alveolar hemorrhage. These 2 patients had World Health Organization class IV lupus nephritis and renal arterioles involved by a noninflammatory lupus vasculopathy. Apoptosis was identified in the lupus microangiopathy and in alveolar walls within areas of alveolar hemorrhage. Alveolar wall immune complex deposits were not found in 4 patients who had a lupus glomerulonephritis but did not have renal lupus vasculopathy. Apoptosis was not seen in renal arterioles or lungs of these 4 cases, except in areas of diffuse alveolar damage or herpesvirus pneumonia.

CONCLUSIONS

Our findings indicate that alveolar hemorrhage in systemic lupus erythematosus, characterized by bland alveolar wall changes, is pathogenetically similar to the lupus microangiopathy of the kidney. In both lung and kidney, the pathogenesis of the microvascular injury appears to be related to immune complex deposition and the induction of apoptosis.

Rehabilitation and total hip replacement: patients' perspectives on provision

This paper examines the effectiveness of the rehabilitation component of total hip replacement (THR). It focuses on contrasting rehabilitation regimes in two hospitals in the north of England. Using qualitative methods, patients' perceived needs and goals are described, and the responsiveness of the interventions to their requirements is examined. The provision of information, equipment, and therapy was found to be useful in terms of preparing patients for their operation and facilitating their recovery, but less so in terms of helping them cope with any problems experienced after the operation. Drawing on patients' perspectives, a set of guidelines for good practice in rehabilitation for THR is presented.

Measurement of patient perceptions of pain and disability in relation to total hip replacement: the place of the Oxford hip score in mixed methods

OBJECTIVES

To describe the practical difficulties experienced by patients when completing the Oxford hip score, and to highlight the need to reconsider aspects of its structure and conceptual base.

DESIGN

Qualitative study incorporating the Oxford hip score in semi-structured interviews with patients before and four months after their operation.

SETTING

Two hospitals in the North of England.

SUBJECTS

Osteoarthritic patients undergoing primary elective total hip replacement.

RESULTS

Use of the Oxford hip score provided quantitative data on disability in the sample, particularly about pain and immobility. It also facilitated the collection of qualitative data, serving as a useful starting point for interviews and as a prompt for indepth discussion. Concerns about the clarity, coverage, and content validity of the score were identified, however, raising questions about the measure's conceptual base.

CONCLUSION

The Oxford hip score was found to be a useful precursor to the semi-structured interviews. However, deficiencies in instruction and lack of clarity in purpose have implications for its ongoing development and future application, both in this type of study and other, more general, contexts.

Acute polyarthritis. Fifth disease passed from child to adult

Physicians are familiar with the "slapped cheek" rash seen in childhood cases of erythema infectiosum. Less well known is that infection with its pathogen, parvovirus B19, often becomes manifest in adults as acute viral arthropathy. In evaluation of suspected cases, a complete blood cell count and blood chemistry profile are useful additions to thorough history taking and physical examination. Differential diagnosis includes Lyme disease, other viral infections, acute rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Treatment is symptomatic with nonsteroidal anti-inflammatory drugs.

Hyperprolactinemia in male NZB/NZW (B/W) F1 mice: accelerated autoimmune disease with normal circulating testosterone

It has been proposed that the immunostimulatory hormone, prolactin, is associated with flares of systemic lupus erythematosus (SLE). In autoimmune female NZB/NZW F1 (B/W) mice with accelerated lupus-like disease, hyperprolactinemia accelerated autoimmunity. The current study explored effects of moderate and severe hyperprolactinemia in male B/W mice, which have late-onset SLE. Autoimmune disease in B/W males was assessed by measurement of anti-DNA antibodies (anti-DNA), gp70-anti-gp70 immune complexes (gp70IC), IgM, IgG, and renal function. Serum testosterone concentrations were assayed serially. All mice were necropsied when moribund. Hyperprolactinemic B/W males were characterized by premature appearance of anti-DNA and gp70IC and elevation of IgM and IgG. Hyperprolactinemia accelerated mortality with vasculitis and renal disease compared to control mice. Serum testosterone concentrations were not suppressed. In male B/W mice, chronic hyperprolactinemia stimulated autoimmune disease activity; the deleterious effects of prolactin were not mediated through suppression of the immunoprotective hormone, testosterone. This observation supports the proposed association between elevated prolactin levels and exacerbations of SLE.

Prolactin influences autoimmune disease activity in the female B/W mouse

Prolactin, an anterior pituitary hormone, stimulates humoral and cell-mediated immunity. This study investigated effects of manipulating prolactin levels in the autoimmune B/W mouse model of SLE. A group of B/W females was treated with daily injections of the prolactin-suppressing drug, bromocriptine. These mice had delayed elevation of anti-DNA antibodies and serum IgG; longevity was increased compared to control mice. Functioning syngeneic pituitary glands, implanted under the renal capsule, produced prolonged hyperprolactinemia in a separate group of female B/W mice. Hyperprolactinemic animals were characterized by premature albuminuria, elevated circulating gp70IC and IgG, and accelerated mortality. Analyses of thymic and splenic lymphocytes revealed no differences in lymphocyte subpopulations in mice with altered prolactin levels. This is the first report to substantiate an immunomodulatory role for prolactin in B/W mice. Further evaluation of this model may identify specific means of intervening clinically with immunosuppressive hormone-modulating therapy in SLE.

Prolactin influences autoimmune disease activity in the female B/W mouse

Prolactin, an anterior pituitary hormone, stimulates humoral and cell-mediated immunity. This study investigated effects of manipulating prolactin levels in the autoimmune B/W mouse model of SLE. A group of B/W females was treated with daily injections of the prolactin-suppressing drug, bromocriptine. These mice had delayed elevation of anti-DNA antibodies and serum IgG; longevity was increased compared to control mice. Functioning syngeneic pituitary glands, implanted under the renal capsule, produced prolonged hyperprolactinemia in a separate group of female B/W mice. Hyperprolactinemic animals were characterized by premature albuminuria, elevated circulating gp70IC and IgG, and accelerated mortality. Analyses of thymic and splenic lymphocytes revealed no differences in lymphocyte subpopulations in mice with altered prolactin levels. This is the first report to substantiate an immunomodulatory role for prolactin in B/W mice. Further evaluation of this model may identify specific means of intervening clinically with immunosuppressive hormone-modulating therapy in SLE.

Nonweightbearing exercise during pregnancy on land and during immersion: a comparative study

Seven women at 25 weeks' gestation exercised on land and in the water at 70% maximum oxygen capacity (VO2max) on a bicycle ergometer. Women had significantly lower heart rates and lower systolic blood pressures during immersion exercise. Women had a mean diuresis of 207 ml (6.5 ml/min) during water exercise compared with 98 ml. (2.4 ml/min) during land exercise. Fetal heart rates showed a tendency toward being higher after land exercise compared with water exercise. Six of seven fetuses displayed tachycardia after land exercise compared to one of seven after water exercise. Exercise on land and during immersion at 70% VO2max was well tolerated. However, exercise during immersion offers several physiologic advantages during pregnancy.

Renal responses to immersion and exercise in pregnancy

Twelve healthy pregnant women were studied at 15, 25, and 35 weeks' gestation and at 8 to 12 weeks postpartum. Women were immersed for 20 minutes at 30 degrees C. They then exercised at 60% maximum oxygen capacity on a modified ergometer. Substantial diuresis and natriuresis occurred without changes in osmolarity or serum sodium. The diuresis was significantly greater during pregnancy than postpartum. The natriuresis was similar. Diuresis and natriuresis were greater than would be expected from investigations in nonpregnant subjects. This study suggests that immersion may be a beneficial therapy for edema without decreasing plasma volume.

The effects of immersion and exercise on prolactin during pregnancy

Prolactin is an important hormone during pregnancy, affecting mother, fetus, and amniotic fluid volume. Immersion is known to affect prolactin levels significantly. To determine the effect of immersion and exercise on the prolactin response during pregnancy, we examined serum prolactin levels at 15, 25, and 35 weeks' gestation and 10 weeks post partum. Twelve women completed 20 min land rest, 20 min immersion in 30 degrees C water to the xiphoid, and 20 min exercise in the water at 60% VO2max. Resting prolactin levels were 1.91 +/- 0.32, 4.55 +/- 0.5, and 5.85 +/- 0.27 nmol.l-1 +/- standard error of the mean at 15, 25, and 35 weeks' gestation, respectively. Postpartum lactating women had a resting mean prolactin level of 3.95 +/- 1.6 versus 0.22 +/- 0.4 nmol.l-1 in non-lactating women. Prolactin levels declined significantly during immersion even after correction for dilution by plasma volume shifts. The immersion response was inversely related to the duration of pregnancy with 29%, 22%, and 12% drops during 15-, 25- and 35-week trials, respectively. Compared to rest, exercise prolactin levels remained depressed during the 15th and 25th week trials. We hypothesize that immersion in water caused prolactin levels to decline.

Fetal and uterine responses to immersion and exercise

We evaluated the responses of the fetal-maternal unit to immersion and exercise in the water at 15, 25, and 35 weeks' gestation. As seen by underwater ultrasound, fetuses demonstrated body, limb, and breathing movements. Fetal heart rates (FHRs) were normal, and unchanged from those at rest, during maternal exercise in the water at 60% VO2 maximum. In 21 of 23 cases, post-exercise nonstress tests were reactive within ten minutes. There was no uterine activity seen at either 25 or 35 weeks' gestation. Maternal serum alpha-fetoprotein was unaffected at all gestational ages. Neither maternal temperature nor calculated plasma volume changed during exercise. This general lack of effect contrasts with results from other studies involving similar levels of exercise on land. We speculate that the plasma volume expansion with immersion contributes to the normal FHR responses seen in this study.

The effect of exercise on plasma somatomedin-C/insulinlike growth factor I concentrations

Because inadequate intake of energy or protein causes reduction in the plasma concentrations of somatomedin-C/insulinlike growth factor I (Sm-C/IGF-I), we have completed studies to determine whether the energy deficit induced by vigorous exercise sustained for 1 week would also be associated with a reduction in this peptide. When six healthy, exercise-conditioned males were fed a diet consisting of 35 kcal/kg ideal body weight (IBW) and 1.0 g protein/kg and exercised so that 14.1 to 16.3 kcal/kg of energy was expended each day, their plasma Sm-C/IGF-I concentrations declined from a mean basal value of 1.15 +/- 0.78 U/mL (1 +/- SD) to 0.62 +/- 0.41 U/mL during the last two days of a seven-day exercise period (P less than .05). This decrease in Sm-C/IFG-I occurred almost entirely in the first four days of the study period. After 3 weeks for reacclimation, the calorie intake of each volunteer was reduced by the same number of calories as had been expended in the form of exercise during each day of the exercise week (mean of 15.1 kcal/kg IBW/d). On this regimen the mean plasma Sm-C/IGF-I declined from 1.12 +/- 0.57 U/mL, to 0.69 +/- 0.37 U/mL on the last two days of dietary restriction. The magnitude of fall with dietary restriction was not significantly different from that observed during exercise. During the last three days of the exercise period the mean daily nitrogen balance was -1.60 +/- 1.70 g/d, while this value was -3.50 +/- 1.73 g/d during the last three days of dietary restriction (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)