Maternal mood disorders and lithium exposure in utero were not associated with poor cognitive development during childhood.

AIM: This study evaluated whether maternal mood disorders (MMD), particularly bipolar disorder, and lithium treatment during pregnancy influenced the neonatal health and cognition of children born from 2006 to 2010. METHODS: Our study at Karolinska University Hospital, Stockholm, Sweden, focused on women with and without mood disorders and their children. Information on pharmacotherapy, mental health, delivery and neonatal complications was retrospectively collected from electronic patient records. Children were tested in a blinded manner at four to five years of age with the Wechsler Preschool and Primary Scale of Intelligence, 3rd edition. Maternal health, child health and social situations were evaluated. RESULTS: Of the 39 children, 20 were exposed to lithium and MMD during pregnancy, eight were exposed to MMD but not lithium and 11 were not exposed to MMD or lithium. The children's full scale intelligence quotient (IQ), performance IQ and verbal IQ results did not differ significantly between the groups. The processing speed quotient was significantly lower in children exposed to mood disorders, but there was a high level of missing data for this subtest. CONCLUSION: This small, clinical cohort showed no significant association between mothers' prenatal exposure to lithium or mood disorders and their offspring's IQ.

Divergent effects of weight reduction and oral anticonception treatment on adrenergic lipolysis regulation in obese women with the polycystic ovary syndrome.

The influence of weight reduction and female sex hormones on the regulation of lipolysis was investigated in isolated abdominal sc adipocytes from 20 obese hyperandrogenic women with polycystic ovary syndrome (PCOS). Nine PCOS women were reinvestigated after 8-12 weeks of weight reduction therapy (WR) with a very low calorie diet, inducing a mean loss of 8 +/- 3 kg, and 8 PCOS women were reinvestigated after 12 weeks of treatment with combined oral contraceptives (OC), containing ethinyl estradiol and norethisterone; the remaining 3 subjects were drop-outs. Both WR and OC normalized hyperandrogenicity. WR caused a 50% reduction of basal lipolysis rate and a 5- to 7-fold increased noradrenaline and terbutaline sensitivity (P < 0.02); the latter could be ascribed to a 2-fold increased beta2-adrenoceptor density (P < 0.02) as determined with radioligand binding. There was no change with regard to dobutamine (beta1-adrenoceptor sensitivity) or clonidine, (alpha2-adrenoceptor sensitivity) or to beta1-adrenoceptor density. OC treatment did not influence the basal lipolysis rate or beta2- or alpha2-adrenoceptor sensitivity, but lowered the beta1-adrenoceptor sensitivity 7-fold (P < 0.03) without a reduction in beta1-adrenoceptor density. The OC treatment effect was not observed when forskolin and dibutyryl cAMP, acting on adenylate cyclase or protein kinase A, respectively, were used, suggesting a partial uncoupling of beta1-adrenoceptors. WR therapy, but not OC therapy, caused, in addition to changes in lipolysis function, improved in vivo insulin sensitivity and lower plasma noradrenaline levels. These findings suggest that factors other than hyperandrogenicity modulate lipolysis regulation in obese subjects with PCOS. Disturbances in sympathetic pathways could be of pathogenic importance.

Impaired adipocyte lipolysis in nonobese women with the polycystic ovary syndrome: a possible link to insulin resistance?

The polycystic ovary syndrome (PCOS) is the most common hyperandrogenic disorder among women and is characterized by metabolic and cardiovascular aberrations similar to those seen in the so-called insulin resistance syndrome. The regulation of lipolysis was investigated in isolated abdominal sc adipocytes from 10 nonobese women with PCOS and in 11 age- and body mass index-matched healthy women. Eight PCOS women were reinvestigated after 3 months of treatment with combined oral contraceptives containing ethinyl estradiol and norethisterone, which normalized hyperandrogenicity. The PCOS women showed a marked resistance to the lipolytic effect of noradrenaline due to defects at two different levels in the lipolytic cascade: first, a 7-fold reduction in sensitivity to the beta 2-selective agonist terbutaline (P < 0.005), which could be ascribed to a 50% lower beta 2-adrenoceptor density (P < 0.02) as determined with radioligand binding; there was no difference with regard to dobutamine (beta 1) or clonidine (alpha 2-sensitivity) or beta 1-adrenoceptor density; second, the maximum lipolytic response was also 35% lower (P < 0.02) in the PCOS women compared to that in the healthy women. This was seen with all beta-adrenergic agonists and the postreceptor-acting agents forskolin (activating adenylyl cyclase) and dibutyryl cAMP (activating protein kinase). Neither beta 2-adrenoceptor sensitivity or density nor the reduced lipolytic responsiveness was restored by 3 months of oral contraceptives treatment. The results indicate the existence of a marked impairment of catecholamine-induced lipolysis in nonobese PCOS women displaying early features of the insulin resistance syndrome due to multiple lipolysis defects as a lower beta 2-adrenoceptor density and reduced function of the protein kinase, hormone-sensitive lipase complex. These lipolysis defects are identical to those observed in the insulin resistance (metabolic) syndrome and could be a primary pathogenic mechanism for the development of these disorders.

Moderate alcohol consumption--need for intervention programs in pregnancy?

Consumption of alcohol was investigated in two groups of pregnant women: an intervention group (n = 58) (two structured interviews during pregnancy including counseling focused on reduction of alcohol consumption and potential benefits to the fetus, and interview after delivery), and a control group (n = 74) (interview after delivery). Prepregnancy 80% of the women were light or moderate alcohol consumers, and 20% teetotalers. Pregnancy considerably reduced alcohol consumption in both groups. 66% abstained from alcohol during pregnancy, and use of liquor nearly ceased. The changes in alcohol consumption occurred independently to the intervention program. Strategy for reducing alcohol consumption during pregnancy should include a structured alcohol anamnesis at the first ante-natal visit, accompanied by counseling focused on reduction of alcohol consumption. More extensive intervention programs may be reserved for pregnancies at higher risk (high-consumers, abusers).

Evaluation of methods for electrical stimulation of human skeletal muscle in situ.

A comparison was made between three different techniques for electrical stimulation of human skeletal muscle: percutaneous stimulation via large aluminum foil electrodes or via ordinary ECG-electrodes and intramuscular stimulation via platinum-coated wires.--The relationship between voltage and duration of the stimulating pulses and the evoked force of contraction is described.--A series of experiments on surgical patients who were curarized showed that these electrical stimulation techniques selectively activate nerve-endings within the muscle, and not the muscle fibres directly.--In a group of male volunteers there were linear relationships between body weight and maximum voluntary contraction force (MVC) of the knee extensors and between body weight and the stimulating voltage needed to produce 50% of MVC.

Analysis of succinylcholine in tissues and body fluids by ion-pair extraction and gas chromatography-mass spectrometry.

The neuromuscular blocking agent succinylcholine (SCh) has been identified and quantitated in biological material using gas chromatography-mass spectrometry. The bisquaternary ammonium compound SCh is extracted from tissue homogenates or body fluids into dichloromethane as an ion pair with hexanitrodiphenylamine (DPA). The evaporated ion pair residue is demethylated with sodium benzenethiolate to form the corresponding tertiary amine which is identified and quantitated by gas chromatography-mass spectrometry using a glass capillary column coated with SE 52. In the quantitative analysis deuterated SCh is used as internal standard. The instrument is focussed on m/z 58 for demethylated SCh and m/z 62 or 64 for the internal standard. Concentrations as low as 5 ng SCh iodide/g tissue or body fluid are easily detected.

Enhanced in vivo platelet activation in diabetes mellitus.

Plasma levels of platelet factor 4 (PF4) determined in 58 apparently healthy subjects were found to increase with age. In 66 insulin dependent diabetics, PF4 plasma levels were increased but unrelated to the age of subject. Mean fibrinopeptide A levels were elevated in the diabetics but not correlated to PF4 levels. Activation of the coagulation system with thrombin generation thus seems to be operative in diabetes, but the enhanced platelet activation also observed in this disease is probably not thrombin mediated. No correlation was found between PF4 plasma concentration and the degree of vascular complication, HbA1C, blood glucose, 24-h urinary glucose, serum cholesterol or serum triglycerides.

Platelet factor 4 plasma levels at rest and after exercise in patients with recent myocardial infarction.

Plasma levels of platelet factor 4 (PF 4) were determined in 30 patients with recent acute myocardial infarction. Comparisons were made with the levels in 26 age-matched controls. In another 15 patients, also with recent myocardial infarction, PF 4 plasma levels were determined before and immediately after a standardized exercise stress test. At rest, none of the patients had elevated PF 4 levels. Only one patient demonstrated an increase after exercise. These findings are in conflict with some recent reports. The importance of age-matched controls, the hazard of in vitro platelet activation and the possible effect of beta-blocking and calcium-antagonistic drugs on PF 4 plasma levels is discussed below.

Noninvasive diagnosis of acute deep vein thrombosis. A comparison between thermography, plethysmography and phlebography.

Fifty-five patients with clinical signs of acute DVT were investigated with thermography, plethysmography and phlebography. A comparison between phlebography and thermography showed a diagnostic agreement of 84%. Thermography was found, however, to have a low reliability for the localization of acute thrombi and was therefore combined with plethysmography in an attempt to obtain better results in this respect. Compared to the invasive phlebography, the noninvasive combination of thermography and plethysmography adequately located acute DVT in 95% of the cases.