History of the hip joint pectineofoveal fold.

Although Josias Weitbrecht described the retinacula of the hip joint in his 1742 Syndesmologia, the anatomist Cesare Amantini of Perugia specifically studied the medial retinacula he referred to as the pectineofoveal fold in a late 19th-century monograph. This particular synovial fold stretches from the lesser trochanter to the osteocartilaginous junction of the femoral head along a virtual line connecting the lesser trochanter and the fovea for the ligament of the head. Although mentioned by some anatomists and radiologists, and despite its possible involvement in specific hip joint pathologies (fractures, impingements), it is surprising that Amantini's pectineofoveal fold remains ignored by most anatomy and clinical anatomy books. This study aims to verify if Cesare Amantini effectively drew attention to this synovial fold for the first time and coined the term "pectineofoveal fold," as well as determine whether most classical textbooks (i.e., published from 1890 to 2017) acknowledge the discovery and include it in the description of the hip joint. A possible evolutionary link between this synovial fold and the ambiens and pectineus muscles exists and should be discussed.

Eating disorders: When food "Eats" time.

The presence of a physical or mental health issue, such as an eating disorder (ED), impacts daily activities, also known as occupations. For example, an overinvestment in body shape and weight undoubtedly can lead to an underinvestment in other, more meaningful occupations. To address ED-related perceptual disturbances, a detailed log of daily time use can pinpoint food-related occupational imbalances. This study aims to characterize the daily occupations associated with EDs. The first specific objective (SO.1) is to categorize and quantify the temporal organization of a typical day's occupations as self-reported by individuals with an ED. The second specific objective (SO.2) is to compare daily occupational time use among people with different ED types. This retrospective study based on time-use research principles was conducted by analyzing data from an anonymized secondary dataset (Loricorps's Databank). Data were collected between 2016 and 2020, from 106 participants, with descriptive analysis completed to determine the average daily time use for each occupation. A series of one-way analyses of variance (ANOVAs) were performed to compare perceived time use in each occupation for participants with different types of EDs. The outcomes show a marked underinvestment in leisure categories compared to the general population. In addition, personal care and productivity can represent the blind dysfunctional occupations (SO.1). Moreover, compared to those with binge eating disorder (BED), individuals with anorexia nervosa (AN) are significantly more invested in occupations that focus explicitly on perceptual disturbances, such as personal care (SO.2). The highlight of this study is the distinction between marked versus blind dysfunctional occupation, which offers specific avenues for clinical intervention.

[Findings from 10 years of CIRS-AINS : An analysis of usepatterns and insights into new challenges]. / Erkenntnisse aus 10 Jahren CIRS­AINS : Eine Analyse von Nutzerverhalten und Ausblick auf neue Herausforderungen.

BACKGROUND: Critical incident reporting systems (CIRS) serve to sensitize organizations and individuals to unknown events relevant to patient safety and therefore help in developing safer systems; however, the use and impact of these systems in healthcare has recently been questioned for a variety of reasons, among them unclear and imprecise reporting criteria. Some authors claim that fundamental aspects of successful CIRS have been misunderstood, misapplied or entirely missed during the adaptation to the healthcare context. The aim of this study was the analysis of all reports accumulated over 10 years in the German system CIRSmedical Anesthesiology (CIRS-AINS) as a basis for improved reporting guidelines, user training and generation of further hypotheses. METHODS: In a retrospective analysis all reports from CIRS-AINS entered between April 2010 and June 2019 were analyzed for structure and content. RESULTS: A total of 6013 reports were filed consisting of 3492 incidents (58.1%), 1734 near misses (28.8%) and 787 others (13.1%). Those other reports contained 21 interpersonal conflicts (0.4%), 102 general complaints (1.7%), 89 stress or workload complaints (1.5%) and 575 reports that did not contain any critical incident or safety-related content (9.6%). Since 2015 these other reports have increased 2.8-fold from 7.4% to 20.8%. Of the reports 20.1% contained information about technical problems and 27.7% about certified medical devices. Medication was mentioned in 10.7% of reports, 47.8% of inpatient incidents concerned the perioperative setting, 24.6% were reported from intensive care units (ICU) and postanesthesia care units (PACU). Of the cases 198 (3.3%) explicitly mentioned communication issues, 346 cases (5.8%) concerned incomplete or inadequate documentation involving orders, blood products or laboratory tests. Of the reports 36.1% were analyzed and commented on by the CIRS team of the German Society of Anesthesiologists (BDA). CONCLUSION: The analysis provides insights into reporting practices and can influence both reporting guidelines as well as user training. Report format, content and context are of utmost importance for further analysis: A distinction has to be made between reports that contain locally rational information and cannot be understood without further context and reports that may help inform about patient safety activities on a national level. Especially in light of the limited resources for incident analysis, the content should be critically reflected upon by the user when submitting a report to support a wise allocation of available capacities. In this respect, the increase of non-CIRS reports has to be considered in the future implementation of nationwide IRS. Also, it has to be questioned whether adequate alternative means of communication for these non-CIRS reports exist. The majority of reports were made by physicians, which is in contrast to international experiences with increased engagement of nursing staff and underlines the need for increased interprofessional collaboration with incident reporting and analysis activities in Germany. Reports containing workload complaints, while constituting important signals on a local level, usually fail to address the idea of learning from others inherent to the philosophy of national IRS.

[Does annual simulation training influence the safety climate of a university hospital? : Prospective 5­year investigation using dimensions of the safety attitude questionnaire]. / Beeinflusst jährliches Simulationstraining das Sicherheitsklima einer universitären Klinik? : Prospektive Fünfjahresuntersuchung anhand Dimensionen des "Safety Attitudes Questionnaire".

BACKGROUND: Simulation-based training with a focus on non-technical skills can have a positive influence on safety relevant attitudes of participants. If an organization succeeds in training sufficient staff, it may experience a positive change in the safety climate. As the effects of a single training are of a transient nature, annual training sessions may lead to an incremental improvement of safety relevant attitudes of employees over time. In spring 2012 the Department of Anesthesia at the University Hospital of Erlangen established an annual simulation-based training for staff members (e.g. consultants, trainee anesthetists and nurse anesthetists). OBJECTIVE: The study aimed to test whether an annual simulation-based training would result in an incremental longitudinal improvement in attitudes towards teamwork, safety and stress recognition. METHODS: A survey comprising three domains (teamwork climate, safety climate and stress recognition) of the safety attitudes questionnaire (SAQ) and items addressing briefing and speaking up was distributed to all participants in an annual in-house simulation training. Participants filled out the questionnaire in the morning of each training day. The attitudes were measured before the first training series in 2012, 6 months after the first training and then every year (2013-2016). Participants generated a personalized identification code which allowed individuals to be anonymously tracked over time. Results of the 5­point Likert scale were transformed to a 100-point scale. Results were calculated at the group level and at the individual level. Univariable linear regression was used to calculate mean changes per year. RESULTS: Over a period of 5 years (2012-2016) a total of 255 individuals completed the questionnaire. Each year, 14-20% of all nurse anesthetists and 81-90% of all anesthetists participated in the simulation-based training. As a result of annual staff turnover 16-24% of participants were new staff members. A personalized code allowed the before and after comparison of 99 staff members who had participated twice or more. Physicians had a higher mean score for teamwork climate before the first training (+8.7 p < 0.001). Mean teamwork climate and safety climate scores before the first training increased over a period of 5 years (3.11 for teamwork climate, p < 0.001 and 2.73 for safety climate, p < 0.001). Repeat participation led to a bigger mean change of individual attitudes in nurse anesthetists: teamwork climate 5.2 (nurses) vs. 1.4 (physicians) and safety climate 5.3 (nurses) vs. 2.8 (physicians) without reaching significance. Participants acknowledged the importance of briefings but confirmed their existence in less than half of the cases. The frequency of briefings increased over the 5­year period. There were no changes in attitude towards speaking up. CONCLUSION: Over a 5-year period, small positive changes in attitudes towards teamwork and safety occurred. Low participation of nurse anesthetists as well as personnel turnover may have weakened the impact of simulation-based training on the safety climate.

[Learning how to learn for specialist further education]. / Für die Facharztweiterbildung Lernen lernen.

The world of medicine is becoming from year to year more complex. This necessitates efficient learning processes, which incorporate the principles of adult education but with unchanged periods of further education. The subject matter must be processed, organized, visualized, networked and comprehended. The learning process should be voluntary and self-driven with the aim of learning the profession and becoming an expert in a specialist field. Learning is an individual process. Despite this, the constantly cited learning styles are nowadays more controversial. An important factor is a healthy mixture of blended learning methods, which also use new technical possibilities. These include a multitude of e­learning options and simulations, which partly enable situative learning in a "shielded" environment. An exemplary role model of the teacher and feedback for the person in training also remain core and sustainable aspects in medical further education.

[Briefing improves the management of a difficult mask ventilation in infants : Simulator study using Web-based decision support]. / Briefing verbessert das Management einer schwierigen Maskenbeatmung beim Säugling : Simulatorstudie unter Verwendung einer webbasierten Entscheidungshilfe.

BACKGROUND: Unanticipated airway problems in infants can rapidly develop into severe hypoxemia. Team members can provide support and suggest steps of action if a shared mental model of the next steps exists. Briefing prior to induction of anaesthesia may create such a shared mental model among all team members. OBJECTIVES: The aim of the study was to assess whether a short briefing on the recommendations for an unexpected difficult airway, developed by the Working Group on Paediatric Anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine, would influence the management of an unexpected difficult mask ventilation in an infant. The study also aims to assess whether a shared mental model would encourage the anaesthesia nurse to speak up and foster implicit coordination. METHODS: Nineteen teams consisting of an anaesthesia resident and an anaesthesia nurse participated in a scenario of an urgent induction of anaesthesia in an infant. Teams were randomized to either conduct a briefing on the recommendations for an unexpected difficult airway prior to induction of anaesthesia or to have access to a Web-based cognitive aid with an emergency manual page containing the identical algorithm if needed. Induction of anaesthesia triggered upper airway obstruction and desaturation. The time course of desaturation followed published physiologic modelling. The time until the obstruction was relieved was recorded. Video recordings of the scenarios were analysed with respect to coordination patterns prior to induction as well as to coordination forms (implicit vs. explicit) during the emergency. At the end of the course, participants were asked to fill out a questionnaire. RESULTS: Teams of both groups checked on the availability of airway equipment, but teams in the briefing group talked more often about treatment steps to relieve airway obstruction (p < 0.005). The time until the obstruction was relieved was significantly shorter in the briefing group (median: 80 s vs. 126 s; p < 0.005). In 45 % of the intervention scenarios the nurse suggested the solution to the airway problem whereas only 10 % of the nurses in the control group proposed a measure to relieve the obstruction (n.s.). Both groups showed no difference in the frequency of implicit vs. explicit coordination patterns. Nurses from the intervention group found the situation to be less an emergency and felt better prepared than nurses from the control group (p < 0.05). CONCLUSION: Briefings prior to anaesthesia induction in paediatric anaesthesia should include management of unanticipated problems. In a simulation setting, a briefing on treatment steps for an unexpected difficult airway improves management of an upper airway obstruction. Explicit communication of intended actions by the anaesthesiologist may foster speaking up by team members.

National critical incident reporting systems relevant to anaesthesia: a European survey.

BACKGROUND: Critical incident reporting is a key tool in the promotion of patient safety in anaesthesia. METHODS: We surveyed representatives of national incident reporting systems in six European countries, inviting information on scope and organization, and intelligence on factors determining success and failure. RESULTS: Some systems are government-run and nationally conceived; others started out as small, specialty-focused initiatives, which have since acquired a national reach. However, both national co-ordination and specialty enthusiasts seem to be necessary for an optimally functioning system. The role of reporting culture, definitional issues, and dissemination is discussed. CONCLUSIONS: We make recommendations for others intending to start new systems and speculate on the prospects for sharing patient safety lessons relevant to anaesthesia at European level.

[Safe patient care: safety culture and risk management in otorhinolaryngology]. / Patientenversorgung--aber sicher: Sicherheitskultur und Risikomanagement in der Hals-,Nasen-, Ohrenheilkunde.

Safety culture is positioned at the heart of an organisation's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organizations maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organisation's "safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality.Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate simulation based team trainings into their curriculum.

[Do residents and nurses communicate safety relevant concerns? : simulation study on the influence of the authority gradient]. / Äußern assistenzärzte und pflegekräfte sicherheitsrelevante bedenken? : simulatorstudie zum einfluss des "autoritätsgradienten"

BACKGROUND: Due to the negative impact on decision-making too steep authority gradients in teams represent a risk factor for patient safety. As residents and nursing staff may fear sanctions they may be reluctant to forward critical information to or challenge planned actions of attending physicians. In the setting of a simulation course it was investigated whether and to what extent team members would challenge decisions of familiar attending physicians. In each case where participants did not voice an opinion the underlying motives for the behavior were investigated. METHODS: A total of 59 physicians and 18 nursing staff participated in the scenario. During a rapid sequence induction they were confronted with 7 critical situations created by the attending physician who had been instructed by the simulation team. Recommendations of the German Society of Anaesthesiology were ignored as well as clinical standard operating procedures (SOPs) and two potentially fatal drug administrations were ordered. An attempt was made to determine whether team members were aware of the safety threat at all and if so how they would solve the resulting conflicts. The level of verbal challenge was scored. During debriefing participants were asked to verbalize the motives which they thought might account for their silence or level of challenge. RESULTS: In situations where non-verbal conflict resolution was possible 65% of the participants pursued that strategy whereas 35% voiced an opinion. Situations necessitating verbal intervention were identified in 66% but 72% of the participants chose to remain silent. Team members decided to challenge the attending physician in only 28% of the situations. In 35% their statement was oblique, in 25% the problem was addressed but not further pursued and only in 40% did participants show crisp advocacy and assertiveness and initiated discussion. Asked why they had refrained from challenging the attending physician 37% had no answer, in 35% of situations participants observed a discrepancy between their own knowledge and the intended course of action yet they decided not to address the problem, 12% explained their behavior with the perceived authority of the attending physician and 8% stated that in their opinion attending physicians violated SOPs on a daily basis. None of the participants had the feeling that the simulation setting had provoked a response different to what they might have done in everyday life. CONCLUSIONS: The authority gradient can have a major negative impact on perioperative patient care. Residents and nursing staff are seldom able to challenge the attending physicians when patient safety is at risk. However, even attending physicians who normally accept feedback and criticism from team members can fail to receive support.

Temporal expression profiles of organic anion transport proteins in placenta and fetal liver of the rat.

Physiological cholestasis linked to immature hepatobiliary transport systems for organic anions occurs in rat and human neonates. In utero, the placenta facilitates vectorial transfer of certain fetal-derived solutes to the maternal circulation for elimination. We compared the ontogenesis of organic anion transporters in the placenta and the fetal liver of the rat to assess their relative abundance throughout gestation and to determine whether the placenta compensates for the late maturation of transporters in the developing liver. The mRNA of members of the organic anion transporting polypeptide (Oatp) superfamily, the multidrug resistance protein (Mrp) family, one organic anion transporter (OAT), and the bile acid carriers Na(+)-taurocholate cotransporting polypeptide (Ntcp) and bile salt export pump (Bsep) was quantified by real-time PCR. The most abundant placental transporters were Oatp4a1, whose mRNA increased 10-fold during gestation, and Mrp1. Mrp1 immunolocalized predominantly to epithelial cells of the endoplacental yolk sac, suggesting an excretory role that sequesters fetal-derived solutes in the yolk sac cavity, and faintly to the basal syncytiotrophoblast surface. The mRNA levels of Oatp2b1, Mrp3, and Bsep in the placenta exceeded those in the fetal liver until day 20 of gestation, suggesting that the fetus relies on placental clearance of substrates when expression in the developing liver is low. Mrp3 immunolocalized to the epithelium of the endoplacental yolk sac and less abundantly in the labyrinth zone and endothelium of the maternal arteries. The placental expression of Oatp1a1, Oatp1a4, Oatp1a5, Oatp1b2, Oat, Ntcp, Mrp2, and Mrp6 was low.

[Simulator-based modular human factor training in anesthesiology. Concept and results of the module "Communication and Team Cooperation"]. / Simulatorgestütztes, modulares Human Factors Training in der Anästhesie. Konzept und Ergebnisse des Trainingsmoduls "Kommunikation und Kooperation im Team".

BACKGROUND: Human factors (HF) play a major role in crisis development and management and simulator training can help to train HF aspects. We developed a modular training concept with psychological intensive briefing. The aim of the study was to see whether learning and transfer in the treatment group (TG) with the module "communication and team-cooperation" differed from that in the control group (CG) without psychological briefing ("anaesthesia crisis resource management type course"). METHODS: A total of 34 residents (TG: n=20, CG: n=14) managed 1 out of 3 scenarios and communication patterns and management were evaluated using video recordings. A questionnaire was answered at the end of the course and 2 months later participants were asked for lessons learnt and behavioral changes. RESULTS: Good communication and medical management showed a significant correlation (r=0.57, p=0.001). The TG showed greater initiative ( p=0.001) and came more often in conflict with the surgeon ( p=0.06). The TG also reported more behavioral changes than the CG 2 months later. The reported benefit of the simulation was training for rare events in the CG, whereas in the TG it was issues of communication and cooperation ( p=0.001). CONCLUSIONS: A training concept with psychological intensive briefing may enhance the transfer of HF aspects more than classical ACRM.

Identification of steroid sulfate transport processes in the human mammary gland.

Circulating hormones and local biotransformation of steroid precursors are both sources of estrogen in human mammary tissue. Estrone-3-sulfate (E(1)S) is an important estrogenic form in premenopausal women, and dehydroepiandrosterone sulfate (DHEAS) constitutes a major adrenal precursor. Membrane transport systems that govern delivery of these anionic steroid conjugates to the mammary gland were investigated. RNA was screened by RT-PCR and Northern blotting for expression of organic anion transporting polypeptide (OATP) (solute carrier family 21A) and organic anion transporter (OAT) (solute carrier family 22A) gene families. OATP-B (SLC21A9) was the major carrier expressed; OATP-D (SLC21A11) and OATP-E (SLC21A12) were less abundant. In normal sections, OATP-B immunolocalized to the myoepithelium that surrounds the ductal epithelial cells. In invasive carcinoma, ductal epithelial cells were positive. OATP-B was characterized in stable transfected Chinese hamster ovary cells. E(1)S affinity constant (K(m)) [K(m) = 5 micro mol/liter, maximum velocity (V(max)) V(max) = 777 pmol/mg.min] and DHEAS (K(m) = 9 micro mol/liter, V(max) = 85 pmol/mg.min) were substrates. The prostaglandins (PG) A(1) and PGA(2) stimulated uptake of E(1)S and DHEAS by increasing V(max) 2-fold but not changing K(m). The effect of PGA was selectively blocked by the lipophilic thiol reagent N-ethylmaleimide but not by the hydrophilic acetamido-4'(iodoacetyl)aminostilbene-2,2'-disulfonic acid, suggesting an interaction between the electrophilic cyclopentenone ring and specific cysteine residues of OATP-B.

Effect of ursodeoxycholic acid on the impairment induced by maternal cholestasis in the rat placenta-maternal liver tandem excretory pathway.

We investigated the effects of ursodeoxycholic acid (UDCA; 60 microg/day/100 g b.wt.) on the impairment induced by maternal obstructive cholestasis during pregnancy (OCP) in the rat placenta-maternal liver tandem excretory pathway. A blunted catheter was implanted in the common bile duct on day 14 of pregnancy, and the tip was cut on day 21. [(14)C]Glycocholate (GC) was then administered through the umbilical artery of "in situ" perfused placenta (placental transfer test) or through the maternal jugular vein (biliary secretion test), and GC bile output was measured. OCP impaired both GC placental transfer and maternal biliary secretion. UDCA moderately improved the latter but had a more marked beneficial effect on GC placental transfer. Histological examination revealed trophoblast atrophy and structural alterations, e.g., loss of apical membrane microvilli in OCP placentas. Gene expression level was investigated by real-time quantitative reverse transcription-polymerase chain reaction and Western blot analysis. OCP reduced both placental lactogen II (a trophoblast-specific gene) mRNA and the functional amount of epithelial tissue, determined by transplacental diffusion of antipyrin. Using a rapid filtration technique, impairment in the ATP-dependent GC transport across trophoblast apical plasma membranes obtained from OCP placentas was found. UDCA partially prevented all these changes. The expression level of organic anion transporters Oatp1, Oatp2, and Oatp4, and multidrug resistance-associated proteins Mrp1, Mrp2, and Mrp3 in whole placenta were not affected or were moderately affected by OCP but greatly enhanced by UDCA. In summary, UDCA partially prevents deleterious effects of OCP on the rat placenta-maternal liver tandem excretory pathway, mainly by preserving trophoblast structure and function.

[Recovery from anaesthesia and incidence and intensity of postoperative nausea and vomiting following a total intravenous anaesthesia (TIVA) with S-(+)-ketamine/propofol compared to alfentanil/propofol]. / Aufwachverhalten sowie Ubelkeit und Erbrechen nach einer totalen intravenösen Anästhesie mit S-(+)-Ketamin-Propofol Ein Vergleich mit Alfentanil-Propofol.

BACKGROUND: Opioids contribute to postoperative nausea and vomiting (PONV). An intraoperative analgesia with S-(+)-ketamine will make opioid administration dispensable and may reduce postoperative analgesic requirements. The aim of the study was to record the incidence and intensity of PONV following a total intravenous anesthesia (TIVA) with S-(+)-ketamine/propofol (K/P) or alfentanil/propofol (A/P) as well as recovery from anaesthesia. PATIENTS AND METHODS: A total of 145 patients received a TIVA with K/P or A/P. Recovery time,PONV, intensity of pain and overall acceptance of the delivered anaesthesia were recorded. RESULTS: Recovery times were prolonged in the K/P group. Both groups had a comparable incidence of PONV (26% and 22% for K/P vs A/P, respectively), the intensity was low in both groups with a VAS of <6/100 mm at all times. The intensity of postoperative pain and analgesic requirement did not differ. Overall acceptance of the delivered anaesthesia was lower in the K/P group. Unpleasant dreams were not more common in the K/P group. CONCLUSIONS: A TIVA with K/P did not reduce PONV when compared to A/P, but prolonged recovery.

[Phytotherapeutic drugs in gastroenterology and hepatology]. / Phytotherapeutika in Gastroenterologie und Hepatologie.

More and more patients are trying out herbal medicine. It is estimated that half of the population have used alternative products at least once in their live. Gastrointestinal diseases often require long-lasting treatments involving many side-effects that can impair the patient's motivation. The majority of persons with symptoms of the irritable bowel syndrome or chronic liver disease resort to non-conventional therapies. However, potential hepatotoxicity of herbal products should not be underestimated. In this article, we discuss herbal preparations in specific gastrointestinal and hepatological indications, concentrating on products that have been tested in randomized, controlled clinical trials. Effective symptomatic treatment of obstipation, irritable bowel and inflammatory bowel disease has been demonstrated with plant-derived preparations. On the other hand phytotherapeutic preparations can not be recommended at present for the treatment of cirrhosis or chronic viral hepatitis based on the available data.

Characterization of an organic anion-transporting polypeptide (OATP-B) in human placenta.

Organic anion-transporting polypeptides (OATPs) are a family of multispecific carriers that mediate the sodium-independent transport of steroid hormone and conjugates, drugs, and numerous anionic endogenous substrates. We investigated whether members of the OATP gene family could mediate fetal-maternal transfer of anionic steroid conjugates in the human placenta. OATP-B (gene symbol SLC21A9) was isolated from a placenta cDNA library. An antiserum to OATP-B detected an 85-kDa protein in basal but not apical syncytiotrophoblast membranes. Immunohistochemistry of first-, second-, and third-trimester placenta showed staining in the cytotrophoblast membranes and at the basal surface of the syncytiotrophoblast. Trophoblasts that reacted with an antibody to Ki-67, a proliferation-associated antigen, expressed lower levels of OATP-B. OATP-B mRNA levels were measured in isolated trophoblasts under culture conditions that promoted syncytia formation. Real-time quantitative PCR estimated an 8-fold increase in OATP-B expression on differentiation to syncytia. The uptake of [(3)H]estrone-3-sulfate, a substrate for OATP-B, was measured in basal syncytiotrophoblast membrane vesicles. Transport was saturable and partially inhibited by pregnenolone sulfate, a progesterone precursor. Pregnenolone sulfate also partially inhibited OATP-B-mediated transport of estrone-3-sulfate in an oocyte expression system. These findings suggest a physiological role for OATP-B in the placental uptake of fetal-derived sulfated steroids.

Conversion between bromcresol green- and bromcresol purple-measured albumin in renal disease.

BACKGROUND: Albumin measured by a bromcresol purple dye-binding assay (Alb(BCP)) agrees more closely with the gold standard of immunonephelometry than does bromcresol green (Alb(BCG)) measurement. Both tests are in current clinical use. A method for converting between the two would be useful. METHODS: We measured albumin by bromcresol green and bromcresol purple in 535 patients, 155 of whom had renal disease. We randomly divided data from the patients with renal disease into two equal-sized sets, and used one set to derive, and the remaining set to validate, a regression equation relating the two values. RESULTS: The relationship Alb(BCG)=5.5+Alb(BCP) performed very well in both the renal patient validation set and in the data from 380 unselected in-patients and out-patients. Intraclass correlations for agreement between measured Alb(BCG) and predicted Alb(BCG) was 0.98 in both analyses. CONCLUSIONS: The ability to convert between these measurements will be of use in clinical situations where the absolute value of the serum albumin is important, when data from laboratories using different methodologies must be combined, and in the application of the Modification of Diet in Renal Disease formula to estimate glomerular filtration rate in patients whose albumin has been measured by bromcresol purple.