Integrity of mitochondrial membrane potential reflects human sperm quality.

The aim of this work was to evaluate intracellular reactive oxygen species (ROS) levels, phosphatidylserine (PS) externalisation and mitochondrial membrane potential integrity in the spermatozoa of healthy donors and outpatients who consulted for infertility and to correlate the results with the classic sperm parameters. For the evaluation of intracellular ROS levels, PS externalisation and mitochondrial membrane potential integrity, the fluorescent compounds dihydroethidium, annexin V-FITC and JC-1, respectively, were used and analysed by using flow cytometry. Conventional seminal analysis, including motility, viability, morphology, sperm count and volume, was performed according to the WHO criteria. The mitochondrial membrane potential and ROS results showed significant differences between the spermatozoa of individuals with a normal semen analysis and those of the group presenting abnormality in at least one of the sperm parameters. Mitochondrial membrane potential showed a significant and direct correlation with all the sperm parameters analysed. ROS were inversely correlated with motility, viability and morphology. PS externalisation, however, did not show any differences between the two groups, nor was it correlated with the sperm parameters examined. The evaluation of mitochondrial membrane potential integrity is a test that reflects sperm quality, which makes it highly recommendable to be applied as a complement to routine sperm analyses.

[Measurement of transdiaphragmatic pressure in pulmonary emphysema, a relevant contribution to clinical management?]. / Messung des transdiaphragmalen Drucks beim Lungenemphysem, ein wichtiger Beitrag zum klinischen Management?

In 50 patients with advanced pulmonary emphysema, admitted for operative lung volume reduction, transdiaphragmatic pressure was measured by a double balloon catheter, using the sniff technique.Transdiaphragmatic pressure (pdi) is the difference between gastric pressure (pga) and esophageal pressure (pes). The mean value of pdi in the sitting position was 5,9 kPa (SD 1,6 kPa), in the lying position 5,6 kPa (SD 1,3 kPa). 94 % of the patients had a pathologic pdi (below 8,2 kPa). The reduction of diaphragm function in this patient group was quantified. No significant difference was found between sitting or lying position. There was no clear correlation between pdi and the reduction in lung function. Maybe there are other important factors, for example the influence of the deformation in the chest wall itself.

The preterm labor experience: a balancing act.

The purpose of the study was to identify how women described, interpreted, and managed their preterm labor experience. Ten married, middle-class women participated in an in-depth, tape-recorded interview in the hospital after preterm labor was stabilized; periodically over the telephone after discharge from the hospital; and in the hospital, home, or via telephone after birth, for a total of 31 interviews. Using qualitative data analysis techniques, the findings were conceptualized as five recursive stages: becoming aware that something was wrong and feeling unbalanced, making sense of the experience as they sought to understand why preterm labor occurred, trying different strategies to re-create a balance in their lives, addressing other life stressors that threatened restoring balance, and emerging from the preterm labor experience with added growth. An increased understanding of the preterm labor experience from the women's perspective can be helpful to health care professionals and others who support women during pregnancy.

Rationale and perspectives on the development of fungicides.

Fungicides continue to be essential for the effective control of plant diseases. New classes of fungicides with novel modes of action are being developed in the 1990s. These include the strobilurins, phenylpyrroles, anilinopyrimidines, phenoxyquinolines, and compounds that trigger defense mechanisms in the plant. For the foreseeable future, new toxophores will be identified through a process of random screening, with natural products representing a rich source of fungicide leads. Progress is being made in the development of high-throughput screens comprised of target enzyme sites or cell-based assays; these techniques will improve the probability of discovery. Following the identification of suitable leads, biorational design is used to optimize specific properties. In vivo glasshouse screens and field trials are expected to remain the dominant methods for characterizing new compounds. Low toxicity to humans and wildlife, low environmental impact, low residues in food, and compatibility with integrated pest management (IPM) programs are increasingly important considerations in the selection of fungicides for development.

Drug use behavior under the constraints of a Medicaid prescription cap.

Limiting the number of prescriptions reimbursed per month is a cost-containment measure used by state Medicaid programs. The purpose of this study was to identify and examine the strategies used by patients who exceed the limits of the cap. Nineteen patients identified by community pharmacists as meeting this criterion were interviewed in their homes by a member of the project team. The sample consisted predominantly of women. Seven of the 19 individuals reported that they had altered the way they took their medication, primarily by reducing the frequency of dosing, to make the medication last longer. Eight individuals reported that, at some time during the past year, they did not obtain a prescribed medication because of the prescription cap. These medications were prescribed for a variety of conditions, including diabetes, asthma, and congestive heart failure. Patients made the purchase/nonpurchase decision based primarily on importance of the condition for which the medication was prescribed. What was deemed important, however, could change over time as a result of changing symptoms. Patients obtained some help from friends, family, and health care professionals in coping with the constraints of the prescription cap. However, the cap forced a significant group of patients into noncompliance, and thus placed them at risk for poor health outcomes.

Too many medications, too little money: how do patients cope?

Many individuals with chronic illnesses have multiple medications prescribed that often are not covered by third party payers. In South Carolina, Medicaid pays for only three prescriptions per month per recipient. A qualitative pilot study was conducted to learn how Medicaid recipients with more than three prescriptions decide which ones to have filled under Medicaid and what they do about the remaining medications. Nineteen Medicaid recipients who had more than three prescriptions were interviewed in their homes. Research participants paid for medications out-of-pocket, borrowed money, were extended credit by the pharmacy, got samples from the physician, did not get prescriptions filled or refilled, took medicines less frequently or in lower doses to stretch their supply, and very infrequently took someone else's medication. These individuals decided which medications to take based on: their perceptions of the importance of the medication or the seriousness of the condition for which it was prescribed, current symptoms, and the drug's cost. Some participants had to choose monthly whether to buy medications or food.

Correlation of metabolic acidosis with outcome following injury and its value as a scoring tool.

This study looked at preresuscitation arterial pH as a predictor of outcome in injury. Seriously injured patients admitted to the Trauma Service over a 5-month period were evaluated prospectively. Data collected included basic patient demographics, initial arterial blood gas determinations (ABGs) including pH, bicarbonate (HCO3), base deficit or excess (BASE), admitting trauma score (TS), discharge injury severity score (ISS), total blood products used for initial resuscitation (TBP), and outcome. There were 191 patients averaging 34.7 years old with average TS 13.6, ISS 19.5, initial pH 7.38 +/- 0.09, HCO3 20.9 +/- 4.0, and BASE -3.3 +/- 4.7. The average TBP was 1309 cc, and overall mortality was 13/191 (6.8%). Comparing survivors to nonsurvivors, the ISS (18.2 vs. 38.3), TS (14.1 vs. 7.8), TBP (976 vs. 5881 cc), HCO3 (21.1 vs. 17.6), and BASE (-3.1 vs. -5.8) data were significantly different; pH (7.38 vs. 7.36) and age (34.4 vs. 38.5) were not. Using multiple regression with TBP as the dependent variable, BASE, age, TS, and to a lesser extent pH and HCO3 correlated (r = 0.536; p < 0.001); using outcome as the dependent variable, only TS and age correlated (r = 0.465; p < 0.0001). Although metabolic acidosis (pH, HCO3, BASE) predicts the TBP used, it does not improve on TS and age for predicting outcome.

An improved method for transpyloric placement of nasoenteric feeding tubes.

Post pyloric placement of small bore feeding tubes can be an elusive goal. Failure to achieve the post pyloric position can result in fatal complications. The following study presents a cost-effective, rapid technique for achieving post pyloric placement of feeding tubes utilizing gastric insufflation and right lateral decubitus positioning. Four study groups were identified. Group I utilized the new technique as first attempt (n = 21). Group 2 utilized the traditional, standard technique of insertion as first attempt (n = 20). Group 3 consisted of Group I failures after which the new technique was utilized (n = 19) Group 4 consisted of Group 3 failures after which the new technique was reattempted. Overall success rate of the new technique was 93%. This was highly significant with p < 0.0001. No significant difference was noted between inserters or type of tube used. The new technique described required no expensive equipment, minimal training and consistently allowed for transpyloric passage of the feeding tube.

Women's views of the preterm labor experience.

This study used a naturalistic approach to describe the childbearing woman's views of her preterm labor and delivery experience. Specifically, the aim was to identify how women describe, interpret, and manage preterm labor and subsequent preterm or term delivery. The views of 20 women who were hospitalized for preterm labor (before 37 weeks) were documented with semistructured, tape-recorded, in-depth interviews during their hospitalization for preterm labor and after delivery. Qualitative data analysis focused on the process of becoming a preterm labor patient and on living with a diagnosis of preterm labor. Women either waited for a period of time before seeking care or sought care immediately for the symptoms they were experiencing. Women interpreted the experience by identifying causes of preterm labor and by worrying about the outcome for the baby. Managing preterm labor required extensive, moderate, or limited changes in their lives. Women who delivered at term appeared to have more tangible help than those who delivered preterm. A better understanding of women's preterm labor experiences will provide clues to nurses on how to improve the care they provide.