Body mass index and hypertensive disorders of pregnancy.

OBJECTIVES: We compared the incidence of the hypertensive disorders of pregnancy in obese women with women of a normal body mass index (BMI). STUDY DESIGN: Prospective observational study in which BMI was calculated accurately early in pregnancy. Women were enrolled after a sonographic confirmation of an ongoing pregnancy. To reduce confounding variables the study was confined to white European women with a singleton pregnancy. MAIN OUTCOME MEASURES: Incidence of pre-eclampsia and gestational hypertension. RESULTS: In 2230 women, 16.8% were obese. Pre-eclampsia was diagnosed in 3.3% (n=74) and gestational hypertension in 3.0% (n=67). Both pre-eclampsia (p=0.01) and gestational hypertension (p<0.01) were common in obese women compared with normal weight women. Overall 13.1% of obese women developed a hypertensive disorder during pregnancy. When analysed by parity pre-eclampsia occurred in 2.1% of primigravidas and 0.3% of multigravidas. Pre-eclampsia was increased in obese multigravidas (p=0.001), but not obese primigravidas, suggesting that parity is more influential than obesity in the development of pre-eclampsia. CONCLUSIONS: Obese multigravidas are more likely to develop hypertensive disorders in pregnancy and obese primigravidas are more likely to develop gestational hypertension. This is important in clinical practice because maternal weight, unlike parity, is potentially modifiable before or during pregnancy.

Polycystic ovary syndrome and the peripheral blood white cell count.

This retrospective cross-sectional study examined if the white cell count (WCC) is increased in women with polycystic ovary syndrome (PCOS) and if so, is it due to PCOS or to the associated obesity? Body mass index (BMI) was calculated and body composition was measured using bioelectrical impedance analysis. Of the 113 women studied, 36 had PCOS and 77 did not. The mean WCC was higher in the PCOS group compared with the non-PCOS group (8.9 × 10(9)/l vs 7.4 × 10(9)/l p = 0.002). This increase was due to a higher neutrophil count (5.6 × 10(9)/l vs 4.3 × 10(9)/l; p = 0.003). There was a leucocytosis (WCC >11 × 10(9)/l) present in 19% of the PCOS group compared with 1% in the non-PCOS group (p < 0.001). The neutrophil count was abnormally high (>7.7 × 10(9)/l) in 14% of the PCOS group compared with 4% in the non-PCOS group (p < 0.001). On regression analysis, however, the only independent variable which explained both the increased WCC and the increased neutrophil count was PCOS. We found that PCOS is associated with an increased WCC due to increased neutrophils, which supports the evidence that PCOS is associated with low-grade inflammation. The increase appears to be due to the underlying PCOS, and not to the increased adiposity associated with PCOS.

X-rays destroy the lamellar structure of model membranes.

Lipid membranes undergo a dramatic lamellar-to-non-lamellar phase transformation upon being irradiated with X-rays. The structure change was evidenced by chemical breakdown of the lipid and by a change in the X-ray diffraction properties of the model membrane indicating complete disruption of lamellar stacking. Considering the importance of X-ray diffraction as a structure probe the problem of radiation damage to biological materials must be duly recognized. Because X-ray damage has been shown to be free radical-mediated these results suggest a means by which free radicals accumulating in cells during aging might compromise membrane integrity and contribute to cell death.

Calorimetric and x-ray diffraction studies of rye glucocerebroside mesomorphism.

Glucocerebrosides (GlcCer) isolated from the leaves of winter rye (Secale cereale L. cv Puma) differ from the more commonly investigated natural and synthetic cerebrosides, in that greater than 95% of the fatty acids are saturated and monounsaturated hydroxy fatty acids. Isomers of the trihydroxy long chain base hydroxysphingenine (t1(8:18 cis or trans)) and isomers of sphingadienine (d18:2(4trans, 8 cis or trans)) comprise 77% and 17%, respectively, of the total long chain bases. The phase behavior of fully hydrated and dry rye leaf GlcCer was investigated using differential scanning calorimetry (DSC) and x-ray diffraction. On initial heating, aqueous dispersions of GlcCer exhibit a single endothermic transition at 56 degrees C and have an enthalpy (delta H) of 46 J/g. Cooling to 0 degrees C is accompanied by a small exothermic transition (delta H = -8 J/g) at 8 degrees C. On immediate reheating, a broad exothermic transition (delta H = -39 J/g) is observed between 10 and 20 degrees C in addition to a transition at 56 degrees C. These transitions are not reversible, and the exothermic transition rapidly diminishes when the sample is held at low temperature. Using x-ray diffraction, it was determined that the endotherm at 56 degrees C represents a transition from a highly ordered lamellar crystalline phase (Lc) with a d-spacing of 57 A and a series of wide-angle reflections in the 3-10 A range, to a lamellar liquid crystalline (L alpha) phase having a d-spacing of 55 A and a diffuse wide-angle scattering peak centered at 4.7 A. Cooling leads to the formation of a metastable gel phase (L beta) with a d-spacing of 64.0 A and a single broad reflection at 4.28 A. Subsequent warming to above 15 degrees C restores the original Lc phase. Thus, rye GlcCer in excess water exhibit a series of irreversible transitions and gel phase metastability. Dry GlcCer undergo an initial heating endothermic transition at 130 degrees C, which is ascribed to a transformation into the HII phase from a two phase state characterized by the coexistence of phases with disordered (alpha) and helical (delta) type chain conformations but of unknown lattice identity: An exotherm at 67.5 degrees C observed upon subsequent cooling is of unknown origin. Since an undercooled HII phase persists down to 19 degrees C, the exotherm may derive in part from an alpha-to-delta type chain packing conformational change especially under slow cooling conditions. Upon reheating from low temperatures to 65 degrees C, a phase with a two-dimensional, primitive rectangular lattice and delta-like chain packing (R8 phase) in coexistence with the HI, phase emerges. With continued heating to 90 degrees C these coexisting phases give way to a phase with a two-dimensional, centered rectangular lattice and delta-like chain packing (P8phase) which again coexists with the HI, phase. Above 130 degrees C, the Pb phase disappears and the sample converts completely to the HI, phase as observed upon initial heating. These results indicate that the mesomorphic behavior of rye leaf GIcCer is distinct from that of other cerebrosides.

Competency-based training for severely behaviorally handicapped children and their parents.

This paper describes the major components of a treatment program for severely behaviorally handicapped children. The program's goal is to help the children develop the necessary skills to function in regular classrooms or special education classes. The article presents descriptions of the procedures used in the Day School Learning and Treatment Center and the Parent Training Program at the Judevine Center for Autistic Children. Criteria for acceptance, assessment systems, training techniques, and methods for follow-up are outlined. Also, the paper delineates what are considered to have been five major trends in the development of the program.