Dietary fibre linked to decreased inflammation in overweight minority youth.

OBJECTIVE: The objective of this study was to examine the relationship between diet and inflammation, and adiposity in minority youth. DESIGN AND METHODS: The study was designed as a cross-sectional analysis of 142 overweight (≥85th body mass index percentile) Hispanic and African-American adolescents (14-18 years) with the following measures: anthropometrics, adiposity via magnetic resonance imaging, dietary intake via 24-h dietary recalls, and inflammation markers from fasting blood draws utilizing a multiplex panel. Partial correlations were estimated and analysis of covariance (ancova) models fit to examine the relationship among dietary variables, inflammation markers and adiposity measures with the following a priori covariates: Tanner stage, ethnicity, sex, total energy intake, total body fat and total lean mass. RESULTS: Inference based on ancova models showed that the highest tertile of fibre intake (mean intake of 21.3 ± 6.1 g d(-1) ) vs. the lowest tertile of fibre intake (mean intake of 7.4 ± 1.8 g d(-1) ) was associated with 36% lower plasminogen activator inhibitor-1 (P = 0.02) and 43% lower resistin (P = 0.02), independent of covariates. Similar results were seen for insoluble fibre. No other dietary variables included in this study were associated with inflammation markers. CONCLUSIONS: These results suggest that increases in dietary fibre could play an important role in lowering inflammation and therefore metabolic disease risk in high-risk minority youth.

Association of gestational diabetes and breastfeeding on obesity prevalence in predominately Hispanic low-income youth.

OBJECTIVE: The goal of this study was to examine if breastfeeding duration by gestational diabetes mellitus status impacted the prevalence of obesity in offspring. METHODS: Data were obtained from a 2011 phone survey with caregivers of low-income children (2-4 years) participating in the Women, Infants and Children programme in Los Angeles County. The final sample included 2295 children, 84% Hispanic and 48% female. Chi-square and binary logistic regression were used to assess gestational diabetes status and breastfeeding duration on the prevalence of obesity, with the following a priori covariates: child's ethnicity, birth weight, age in months and sex. RESULTS: Breastfeeding and gestational diabetes were significantly associated with obesity prevalence (P < 0.01). Using gestational diabetes mellitus and no breastfeeding as the referent category, gestational diabetes mellitus offspring who were breastfed ≥12 months had a 72% decrease in obesity prevalence (adjusted odds ratio = 0.28, confidence interval 0.89-0.03, P = 0.05). CONCLUSIONS: These findings suggest that > 12 months of breastfeeding duration in the gestational diabetes mellitus group and any duration of breastfeeding in the non-gestational diabetes mellitus mothers is needed to reduce obesity levels in a primarily Hispanic population.

Increased eating frequency linked to decreased obesity and improved metabolic outcomes.

BACKGROUND: We previously reported that more frequent eating in overweight minority youth was linked to lower visceral adiposity and circulating triglycerides. The aim of this study was to examine this issue in more detail by assessing the relationship between eating frequency and adiposity and metabolic disease risk in a cohort of exclusively overweight Hispanic youth. METHODS: This analysis included 191 overweight (⩾ 85th percentile body mass index (BMI)) Hispanic youth (8-18 years) with the following cross-sectional measures: height, weight, BMI, dietary intake via multiple 24 h recalls, body composition via dual-energy X-ray absorptiometry, lipids and insulin action (insulin sensitivity, acute insulin response (AIR) and disposition index, a measure of ß-cell function) via a frequently sampled intravenous glucose tolerance test. Each eating occasion (EO) was defined as ⩾ 50 calories and ⩾ 15 min from any prior EO. Infrequent eaters (IEs) were classified as any subject who ate <3 EOs on any dietary recall (n = 32), whereas frequent eaters (FEs) always consumed ⩾ 3 EOs (n = 159). RESULTS: Using analyses of covariance, FEs compared with IEs consumed 23% more calories per day (P ⩽ 0.01), ate 40% more often and consumed 19% less calories per EO (P ⩽ 0.01). FEs also exhibited 9% lower BMI Z-scores (P ⩽ 0.01), 9% lower waist circumferences (P ⩽ 0.01), 29% lower fasting insulin (P = 0.02), 31% lower HOMA-IR (Homeostatic Model Assessment: Insulin Resistance) values (P = 0.02) and 19% lower triglycerides (P ⩽ 0.01), as well as an 11% higher AIR (P = 0.02) and 31% higher disposition index (P=0.01). The following a priori covariates were included: Tanner, sex, body fat and reported energy intake. CONCLUSION: These findings suggest that increased eating frequency is related to decreased obesity and metabolic disease risk in overweight Hispanic youth, despite increases in energy intake.

Multi-drug resistance and reduced susceptibility to ciprofloxacin among Salmonella enterica serovar Typhi isolates from the Middle East and Central Asia.

Typhoid fever is common in developing countries, with an estimated 120 million infections and 700 000 annual deaths, worldwide. Fluoroquinolones have been the treatment of choice for infection with multidrug-resistant (MDR) Salmonella enterica serovar Typhi (S. Typhi). However, alarming reports of fluoroquinolone-resistance and failure of typhoid fever treatment have recently been published. To determine the proportion of S. Typhi isolates with reduced susceptibility to ciprofloxacin (RSC) from six countries in the Middle East and Central Asia, 968 S. Typhi isolates collected between 2002 and 2007 from Egypt, Uzbekistan, Pakistan, Qatar, Jordan and Iraq were tested for antibiotic susceptibility to five antibiotics using the disc-diffusion method. MDR was defined as resistance to amicillin, chloramphenicol and trimethoprim-sulfamethoxazole. The E-test was employed to determine the MIC of ciprofloxacin only. Nalidixic acid resistance was evaluated as a marker for RSC. Interpretations were made according to CLSI guidelines. MDR strains were considerably more prevalent in Iraq (83%) and Pakistan (52%) compared with the other countries studied (13-52%). Nearly all isolates were susceptible (99.7%) to ceftriaxone. RSC was detected in a total of 218 isolates (22%), mostly from Iraq (54/59, 92%), Uzbekistan (98/123, 80%), Qatar (23/43, 54%) and Pakistan (31/65, 47%). Many of these (21%) were also MDR. Use of nalidixic acid resistance as an indicator for RSC was 99% sensitive and 98% specific. This study reinforces the need for routine antimicrobial susceptibility surveillance of enteric fever isolates and close review of current therapeutic policies in the region.

Analytical evidence of heterogeneous lead accumulation in the hypothalamic defence area and nucleus tractus solitarius.

Lead is a potent toxicant associated with adverse cardiovascular effects and hypertension in children. Yet, few studies have determined if autonomic dysfunction associated with lead exposure involves brain regions which regulate autonomic responses. Central autonomic nuclei such as the nucleus tractus solitarius (NTS) and hypothalamic defence area (HDA) may be particularly sensitive to lead infiltration because they are adjacent to ventricles and areas with semi-permeable blood-brain-barriers. To understand if autonomic nuclei are sensitive to lead accumulation Wistar rats were exposed to lead from the gestational period and lead levels were quantified in brain regions that regulate arterial pressure: the NTS and the HDA. Energy dispersive X-ray fluorescence (EDXRF) was used to quantify total brain lead levels and revealed no differences between exposed and control tissues; measured values were close to the detection limit (2µg/g). Electrothermal atomic absorption spectrometry (ETAAS) was also used, which has a greater sensitivity, to quantify lead. There was ∼2.1µg/g lead in the NTS and ∼3.1µg/g lead in the HDA of exposed rats, and no lead in the control rats. There were greater lead levels in the HDA (∼50%) as compared with the NTS. Pathology studies revealed more prominent lead granules in the HDA as compared with the NTS. Increased microglia and astrocyte activation was also noted in the NTS of lead exposed rats as compared with the HDA. Regional differences in neuro-inflammatory responses likely contribute to heterogeneous lead accumulation, with enhanced clearance of lead in the NTS. Future studies will resolve the mechanisms underpinning tissue-specific lead accumulation.

Evaluation of the safety and immunogenicity of Plasmodium falciparum apical membrane antigen 1, merozoite surface protein 1 or RTS,S vaccines with adjuvant system AS02A administered alone or concurrently in rhesus monkeys.

In an effort to broaden the immune response induced by the RTS,S/AS02(A),vaccine, we have evaluated the immunogenicity of the RTS,S antigen when combined with MSP1(42) and with AMA1, antigens derived from the asexual blood stage. The objectives of this study were (i) to determine whether MSP1(42) and AMA1 vaccines formulated with the AS02(A) Adjuvant System were safe and immunogenic in the rhesus monkey model; (ii) to investigate whether MSP1(42) or AMA1 induced immune interference to each other, or to RTS,S, when added singly or in combinations at a single injection site; (iii) in the event of immune interference, to determine if this could be reduced when antigens were administered at separate sites. We found that MSP1(42) and AMA1 were safe and immunogenic, eliciting antibodies, and Th1 and Th2 responses using IFN-gamma and IL-5 as markers. When malaria antigens were delivered together in one formulation, MSP1(42) and RTS,S reduced AMA1-specific antibody responses as measured by ELISA however, only MSP1(42) lowered parasite growth inhibitory activity of anti-AMA1 antibodies as measured by in vitro growth inhibition assay. Unlike RTS,S, MSP1(42) significantly reduced AMA1 IFN-gamma and IL-5 responses. MSP1(42) suppression of AMA1 IFN-gamma responses was not seen in animals receiving RTS,S+AMA1+MSP1(42) suggesting that RTS,S restored IFN-gamma responses. Conversely, AMA1 had no effect on MSP1(42) antibody and IFN-gamma and IL-5 responses. Neither AMA1 alone or combined with MSP1(42) affected RTS,S antibody or IFN-gamma and IL-5 responses. Immune interference by MSP1(42) on AMA1 antibody responses was also evident when AMA1, MSP1(42) and RTS,S were administered concurrently at separate sites. These results suggest that immune interference may be complex and should be considered for the design of multi-antigen, multi-stage vaccines against malaria.

Acid-stress-induced changes in enterohaemorrhagic Escherichia coli O157 : H7 virulence.

Enterohaemorrhagic Escherichia coli (EHEC) O157 : H7 is naturally exposed to a wide variety of stresses including gastric acid shock, and yet little is known about how this stress influences virulence. This study investigated the impact of acid stress on several critical virulence properties including survival, host adhesion, Shiga toxin production, motility and induction of host-cell apoptosis. Several acid-stress protocols with relevance for gastric passage as well as external environmental exposure were included. Acute acid stress at pH 3 preceded by acid adaptation at pH 5 significantly enhanced the adhesion of surviving organisms to epithelial cells and bacterial induction of host-cell apoptosis. Motility was also significantly increased after acute acid stress. Interestingly, neither secreted nor periplasmic levels of Shiga toxin were affected by acid shock. Pretreatment of bacteria with erythromycin eliminated the acid-induced adhesion enhancement, suggesting that de novo protein synthesis was required for the enhanced adhesion of acid-shocked organisms. DNA microarray was used to analyse the transcriptome of an EHEC O157 : H7 strain exposed to three different acid-stress treatments. Expression profiles of acid-stressed EHEC revealed significant changes in virulence factors associated with adhesion, motility and type III secretion. These results document profound changes in the virulence properties of EHEC O157 : H7 after acid stress, provide a comprehensive genetic analysis to substantiate these changes and suggest strategies that this pathogen may use during gastric passage and colonization in the human gastrointestinal tract.

Nurse--physician communication. Women and men at work.

Delivering comprehensive nursing care has become more of a challenge in the current environment, which demands efficiency of effort and resources. To provide such care, nurses are encouraged to establish alliances with other providers. Physicians are certainly key to this model. This article identifies the gender issues that may impede nurse--physician communication and offers suggestions for improving it.

Preliminary report of impaction grafting for exchange femoral arthroplasty.

Gie and Ling have described a method for femoral component revision using compressed morselized cancellous allograft and a cemented collarless polished taper stem. The authors report their early experience with this technique. Of the first 67 patients who had femoral exchange by impaction grafting, 60 were alive 2 to 5 years after hip revision; 2 hips failed because of late sepsis, and 5 patients were decreased. In 56 individuals available for review, the Harris Hip Score average was 90 points, with > 80% reporting no pain. On radiograph, 48% of the stems showed an average of 2.8 mm of subsidence in the polymethylmethacrylate mantle, but only 7% of the cement graft composites had subsided in the cortical tube. Lucent lines were rare, and in 93% of revised femurs the radiographs showed evidence of graft incorporation and bone remodeling. There were 6 reoperations in the group: 3 for late fracture of the femoral shaft and 3 for cup exchange (2 chronically dislocating, 1 loose). No evidence for femoral component loosening was found in this group. Further study is necessary, but these preliminary findings give rise to cautious optimism that this is a reliable method for femoral revision, reconstruction, and reconstitution.

Impaction grafting: preliminary report of a new method for exchange femoral arthroplasty.

ABSTRACTGie et al described a method for femoral component revision using compressed morselized cancellous allograft and a cemented collarless polished taper stem. We have reviewed our first 37 exchanges performed in this manner. Results after 2 to 5 years have reflected few complications, a majority of satisfactory results, evidence of graft incorporation, and no mechanical loosening. Further study is necessary; however, these preliminary findings give rise to cautious optimism.

Meat composition and palatability of Holstein and beef steers as influenced by forage type and protein source.

This experiment determined meat composition and palatability changes resulting from feeding Holstein (HOL) and crossbred beef (XB) steers diets containing corn silage (CS) or alfalfa haylage (AH) (forage type) and soybean meal (SM) or fish meal (FM) (protein source). Fifty-nine steers (30 HOL and 29 XB) were randomly assigned to diet combinations for a 2 x 2 x 2 (breed x forage x protein) factorial arrangement. Steers were fed to a fat-constant end point (fat depth over the longissimus muscle measured by ultrasound: 1.0 cm XB, .6 cm HOL). Proximate and fatty acid analysis and sensory evaluation were conducted on a rib eye roast and steaks, respectively, removed from the left side of each carcass at ribs 9 to 12. Proximate analysis of the longissimus muscle showed no significant difference (P greater than .05) in moisture, protein, or fat content due to breed, forage, or protein treatment. Forage type had no significant effect (P greater than .05) on amount of individual fatty acids found in longissimus muscle. However, total polyunsaturated fatty acids were higher (P greater than .05) for AH than for CS-fed animals. Longissimus muscle from steers fed FM had higher palmitoleic and lower stearic acid contents (both P less than .05) than longissimus muscle from animals fed SM. Muscle from HOL had higher palmitoleic and lower stearic acid contents than that from XB steers (both P less than .05). There was no significant interaction (P greater than .05) of breed with either diet treatment for individual fatty acid contents.(ABSTRACT TRUNCATED AT 250 WORDS)

Questioning: an essential ingredient in effective teaching.

Questions asked in a teaching session can be used to challenge and stimulate learners, direct thought processes, influence the social and emotional milieu of the teaching environment, and evaluate learning. This article focuses on the mechanics and dynamics of questioning as a teaching technique, specifically addressing the concept of hierarchical levels of questioning, application of probing questions to promote higher levels of cognitive processing, and use of questioning as an instructional tool. Specific examples of eliciting questions, questioning levels, and probing questions are included.

Some current issues in children's selective attention.

A large part of the history of learning theory of the last 25 years consists of devising ways to deal with stimulus selectivity. Earlier theories that assumed contiguity of stimulus and response to be a sufficient condition for formation of an association were found wanting. This paper has described some of the ways theorists have attacked the problem. These theoretical solutions were of two general types--two-stage theories with stimulus selection preceding association and theories that altered associative processing. Both types of theories successfully handled selective phenomena, and there is no clear basis at present for preferring one or the other. A question generally neglected by early attention theorists concerns the nature of a stimulus. How is the stimulus complex available to a subject divided into cues or elements that can be selectively responded to? Related questions are whether the experimenter's perception of stimulus elements correspond to the subject's view, and whether elements are perceived the same by all subjects. The answer to the last two questions appears to be in the negative. Recent research relative to these questions with children, adults, and nonhuman organisms is reviewed.

Effects of ALO 2145 on intraocular pressure following argon laser trabeculoplasty.

A prospective, randomized, double-masked study compared topical 1% ALO 2145, an alpha 2-agonist, with placebo in therapy for immediate postoperative intraocular pressure (IOP) rise after argon laser trabeculoplasty. Seventy-three eyes (73 patients) underwent 360 degrees of treatment utilizing 80 spots of 800 to 1000 mW of power. Intraocular pressure rise was measured hourly for the first three hours after operation, at one week, and at one month. Eyes treated with ALO 2145 had both significantly lower mean IOPs and greater IOP decreases from baseline than placebo-treated eyes during the first three hours after operation. No eyes treated with ALO 2145 and six eyes (18%) treated with placebo experienced an IOP rise of 10 mm Hg or greater. Twenty eyes (59%) in the placebo group and eight eyes (21%) treated with ALO 2145 had an IOP elevation. No change was detected in the mean heart rate. ALO 2145 appears to be effective in eliminating large, acute IOP elevations after argon laser trabeculoplasty.

Retinal toxicity of ganciclovir in vitrectomy infusion solution.

The authors investigated the retinal toxicity of the antiviral agent ganciclovir after its addition to vitrectomy infusion fluid in rabbit eyes. Intravitreal infusion of the drug in concentrations up to 30 micrograms/ml produced no electroretinographic or histologic changes suggestive of retinal toxicity. Ganciclovir in vitrectomy infusion fluid has potential therapeutic benefit in viral retinitis (particularly in cytomegalovirus retinitis) associated with vitreous traction or rhegmatogenous retinal detachment. Based on the median inhibitory doses of ganciclovir against various herpes group viruses and the results of this study, a concentration of 30 micrograms/ml or less of the drug is recommended for vitrectomy infusion solution.

Effect of CW YAG and argon green lasers on experimentally detached retinas.

We evaluated the effects of argon-green (514.5 nm) and CW neodymium YAG (1060 nm) wavelengths on experimentally detached retinas of primates. Neither laser produced damage to the sensory retina of the fovea. The argon green wavelength, which was absorbed by haemoglobin in the vessel or by extravasated red blood cells, created vasospasm and nerve fiber layer damage. The beam of the CW YAG was not absorbed by haemoglobin; therefore, no vasospasm could be produced on experimentally detached retinas.

Transpupillary CW YAG laser coagulation. A comparison with argon green and krypton red lasers.

The authors have developed a CW YAG laser for transpupillary coagulation. The effects of CW YAG coagulation on the retina, retinal vessels, and fovea were compared with those produced by the krypton red and argon green lasers. To produce threshold coagulative lesions in monkeys and rabbits, we needed five to ten times more energy with the CW YAG than with the krypton red or argon green lasers. Nerve fiber damage was observed only when coagulating retinal vessels with the argon green laser. At the parameters used, none of the lasers damaged the sensory retina of the fovea. The CW YAG may be used as a new mode of laser coagulation in the treatment of retinal diseases.

High-dose allopurinol modulation of 5-FU toxicity: phase I trial of an outpatient dose schedule.

In an attempt to decrease the activation of 5-FU by normal cells relative to cancer cells, 20 patients with metastatic cancer were given 72 courses of 5-FU and allopurinol (HPP) in a phase I trial. 5-FU was given daily by iv bolus injection for 5 consecutive days every 4 weeks: HPP, 300 mg orally every 8 hours for 6 consecutive days, was started 24 hours before the first injection of 5-FU. HPP appeared to modulate 5-FU toxicity by allowing higher doses (18-21 mg/kg daily for 5 days) to be given. Unexpectedly, neurotoxicity was the dose-limiting toxicity; it was slowly reversible and manifested primarily as encephalopathy, with some patients having cerebellar signs. Gastrointestinal and hematologic toxic effects were mild and infrequent. Because of the high incidence of neurotoxicity and low response rate, this program does not appear to offer any advantages over conventional dose schedules of 5-FU alone.

Moxalactam (Moxam) in the treatment of experimental staphylococcal endophthalmitis.

We investigated the intraocular penetration, retinal toxicity, clearance from the vitreous, and antibacterial activity of moxalactam (Moxam), a new third-generation cephalosporin with activity against aerobic and anaerobic gram positive organisms and many gram negative organisms. Seventy-four albino rabbits were used. Subconjunctival injection yielded therapeutic aqueous and vitreous levels for all hours studied. Intraocular penetration following single dose intravenous and intramuscular administration was poor. Two mg injected into the vitreous produced rare focal retinal toxicity. Eleven of the 11 eyes receiving intravitreal injections of 2 mg moxalactam eight hours after inoculation with S. aureus were sterile and free of morphologic changes. Moxalactam appears to be a potent broad spectrum antibiotic with a low degree of toxicity to rabbit retinal tissue.