Omega-3 polyunsaturated fatty acid enriched diet attenuates stress-induced lactacidemia in 10-day-old rats.

BACKGROUND: Lactacidemia is often seen under stress conditions including septic shock in the newborn. Under stress conditions, plasma catecholamine concentrations are increased and play an important role in lactate metabolism. Our previous study shows that perinatal feeding of omega-3 polyunsaturated fatty acid enriched diet (omega-3PUFA) attenuates lactacidemia of endotoxic shock in 10-day-old rats. In the omega-6 fatty acids series, decosapentanoic acid, two series prostaglandins and four series leukotrienes are synthesized through linoleic acids. As plasma lactate concentration correlates with the outcome of septic shock in the newborn, it is important to understand the effects of omega-3PUFA on lactate metabolism. Thus, we tested the hypothesis that perinatal feeding of omega-3 polyunsaturated fatty acid enriched diet (omega-3PUFA) alters responses to catecholamines and attenuates the stress-induced lactacidemia in 10-day-old rats. METHODS: Ten-day-old rats which perinatally fed omega-3PUFA. Lactacidemia was induced by swimming for 5 min. Ten-day-old rats which perinatally fed omega-6PUFA were controls. Omega-6 fatty acids series are contained in animal fats and corn oil. Adrenergic blockers were used to assess roles of catecholamines in swimming-induced lactacidemia. RESULTS: Swimming increased plasma lactate concentration less (P<0.05) in rats fed omega-3PUFA than rats fed omega-6PUFA. Swimming increased plasma concentrations of glucose and glucagon, cyclic adenosine monophosphate (cAMP) concentration and phosphoenolypruvate carboxykinase mRNA in the liver, and cAMP concentration in the hindlimb muscle more (P<0.05) in rats fed omega-3PUFA than in rats fed omega-6PUFA. Phentolamine and propranolol enhanced swim-induced lactacidemia in the omega-3PUFA group, while they decreased the lactacidemia in the omega-6PUFA group. Propranolol enhanced swimming-induced hyperglycemia in the omega-6PUFA group more than in the omega-3PUFA group. CONCLUSIONS: Omega-3PUFA might increase beta-adrenergic response in the liver and increase gluconeogenesis in response to stress, resulting in decreased lactacidemia.

TNFalpha decreases gluconeogenesis in hepatocytes isolated from 10-day-old rats.

Gluconeogenesis decreases during septic shock, but its mechanism is not well known. Tumor necrosis factor alpha (TNF-alpha), which is a key cytokine in septic shock, can increase GLUT1 gene expression and glucose uptake in muscles and fatty tissues. TNF-alpha does not alter the metabolism of hepatocytes in which GLUT2 is the predominant glucose transporter. However, GLUT1 is the predominant glucose transporter in hepatocytes of 10-d-old rats. Thus, we hypothesized that TNF-alpha might increase glucose uptake and glycolysis in those cells, and decrease gluconeogenesis. In the present study, hepatocytes isolated from 10-d-old rats were incubated with TNF-alpha at the concentrations of 0, 0.98, 9.8, 98, and 980 ng/mL to evaluate TNF-alpha effects on gluconeogenesis and glucose uptake. TNF-alpha increased glucose uptake (41.1 +/- 8 to 114 +/- 21.4 micromol/10(6) cells at the concentration of 980 ng/mL of TNF-alpha) in a dose-dependent manner, and decreased gluconeogenesis (98.2 +/- 8.2 to 1.1 +/- 3.2 micromol/10(6) cells at the concentration of 980 ng/mL of TNF-alpha) in a dose-dependent manner. The decrease of glucokinase mRNA and GLUT1 mRNA abundance correlated with glucose uptake (r = 0.988 and 0.997, respectively), and the decrease of phosphoenolpyruvate carboxykinase mRNA abundance correlated with the decrease of gluconeogenesis (r = 0.972). The decrease of gluconeogenesis by TNF-alpha correlated with the increase of glucose uptake (r = -0.988). We concluded that TNF-alpha reciprocally suppressed gluconeogenesis in hepatocytes isolated from 10-d-old rats.

Insulin tolerance during endotoxic shock in 10-day-old rats.

PURPOSE: The purpose was to investigate insulin tolerance during endotoxic shock in 10-day-old rats. MATERIALS AND METHODS: [(14)C]Deoxy-glucose (2DG) with or without insulin (1 unit/kg) was injected to 10-day-old and 6-week-old rats 3 h after an injection of endotoxin (lipopolysaccharide: LPS). Plasma concentrations of glucose and 2DG were serially measured for 45 min. Gluconeogenesis was measured in hepatocytes isolated from control and endotoxic 10-day-old rats to evaluate effects of insulin on gluconeogenesis. RESULTS: In endotoxic 10-day-old rats, plasma glucose concentration at 45 min was 48 +/- 3% (P < 0.05) of value at 0 min, and when insulin was injected with 2DG, it was 29 +/- 4% (P < 0.05) after insulin injection. Plasma 2DG disappearance was enhanced by insulin injection in the control (t(1/2) = 17.9 vs 20.5 min, P < 0.05), but not in the endotoxic rats (t(1/2) = 17.9 vs 18.4 min), indicating the presence of insulin tolerance in septic rats. Insulin decreased gluconeogenesis (P < 0.05) in hepatocytes from both control and endotoxic 10-day-old rats. In endotoxic 6-week-old rats, plasma glucose concentration was decreased to 46 +/- 10% at 45 min and further decreased to 38 +/- 4% (P < 0.05) by insulin injection. Plasma 2DG disappearance was enhanced by insulin injection in the control (t(1/2) = 11.8 vs 17.4 min, P < 0.05) and in the septic rats (t(1/2) = 14.8 vs 12.2 min). However, the enhancement of plasma 2DG disappearance by insulin was less (P < 0.05) in the septic rats than in the control, confirming reports of other investigators which showed insulin tolerance in septic shock. CONCLUSION: Although hepatocytes from endotoxic rats retained insulin sensitivity, insulin tolerance which was evaluated by 2DG disappearance occurred during septic shock in newborn rats.

Anti-Müllerian hormone is a specific marker of sertoli- and granulosa-cell origin in gonadal tumors.

Sex cord stromal tumors are gonadal neoplasms containing Sertoli, granulosa, Leydig, or thecal cells, which originate from cells derived from either the sex cords (Sertoli and granulosa cell tumors) or the specific mesenchymal stroma (Leydig and thecal cell tumors) of the embryonic gonad. Only granulosa and Sertoli cells produce anti-Müllerian hormone (AMH). Our purpose was to investigate whether AMH can be used as a specific marker of human granulosa or Sertoli cell origin in gonadal tumors, to distinguish them from other primary or metastatic neoplasms, using immunohistochemistry. We studied 7 juvenile and 6 adult-type granulosa cell tumors of ovarian localization and 3 extraovarian metastases, 20 other ovarian tumors, 6 testicular Sertoli cell tumors, 2 gonadoblastomas, and 13 extragonadal tumors. Granulosa cell tumors, both juvenile- and adult-type of either ovarian or metastatic localization, showed an heterogeneous pattern of AMH immunoreactivity: Areas containing intensely or weakly AMH-positive cells were intermingled with AMH-negative areas. Although in most cases AMH-positive areas represented a minor proportion of tumor cells, we found a positive reaction in all the cases examined. In testes, although normal prepubertal Sertoli cells were intensely positive, testicular Sertoli cell tumors showed large areas of negative reaction, with few positive cells scattered throughout the tumor. AMH was also reactive in most of the cells of sex-cord origin in gonadoblastomas. No AMH immunoreaction was observed in other gonadal and extragonadal tumors. We conclude that AMH expression is conserved in only a small proportion of tumor cells of granulosa or Sertoli cell origin; however, a positive reaction in a few cells helps to distinguish between granulosa or Sertoli cell tumors or gonadoblastomas and other gonadal tumors of different origin.

A mechanism for shock following stomach rupture in the newborn.

BACKGROUND: Stomach rupture often leads to shock and death within a short period, but the mechanism for this is not well-known. Shock may be due, in part, to endotoxin translocation and endotoxemia. METHODS: Sterile, endotoxin-free HCl (0.1 mol/L), with or without endotoxin-feeding, was injected intraperitoneally into 10-day-old rats, simulating stomach rupture in the newborn. The plasma endotoxin concentration was measured. Plasma glucose and lactate concentrations were monitored to assess physiologic response to endotoxemia and shock. RESULTS: Endotoxin feeding alone caused endotoxemia (0.49 +/- 0.12 ng/mL; P < 0.05) in 10-day-old rats, while plasma endotoxin concentration in controls was less than 0.04 ng/mL. However, the endotoxemia did not cause disruption of glucose regulation or death. Injection of HCl alone did not increase plasma endotoxin concentrations and did not alter glucose regulation. However, HCl injection into endotoxin-fed rats induced endotoxemia (211.1 +/- 70.5 ng/mL; P < 0.05), hypoglycemia, lactacidemia and mortality (45%; P < 0.05). CONCLUSION: Early development of shock following stomach rupture may be in part due to endotoxin translocation and endotoxemia.

Tumor necrosis factor-alpha alters glucose metabolism in suckling rats.

Tumor necrosis factor-alpha (TNF-alpha), an important mediator of endotoxic shock, induces hypoglycemia and shock in adult animals. Indomethacin ameliorates TNF-alpha-induced hypoglycemia in the adult. However, effects of TNF-alpha on glucose metabolism in the newborn have not been well documented. The present study showed that in 10-day-old rats injected with TNF-alpha (4.5 x 10(7) U/kg, intraperitoneally) the plasma glucose concentration increased from 4.1 +/- 0.3 mmol/L to 6.9 +/- 0.5 mmol/L (P < .05) at 2 hours and subsequently decreased to 1.4 +/- 0.5 mmol/L (P < .05) at 6 hours, although plasma lactate concentration increased from 1.1 +/- 0.1 mmol/L to 5.5 +/- 0.3 mmol/L (P < .05) at 6 hours. Plasma insulin concentration remained unchanged throughout the experiment. TNF-alpha increased GLUT 1 messenger RNA (mRNA) abundance in the brain, liver, muscle, and fatty tissue (P < .05). Glucose uptake increased in association with the increase of GLUT1 mRNA abundance. TNF-alpha decreased mRNA abundance of GLUT 2 and phosphoenolpyruvate carboxykinase (PEPCK) in liver, suggesting decreased gluconeogenesis. Indomethacin (1.5 mg/kg 20 minutes before TNF-alpha, intraperitoneally) attenuated the hypoglycemia, the lactacidemia, and the increase of GLUT1 mRNA abundance and glucose uptake. Indomethacin attenuated the decrease of PEPCK mRNA abundance. We concluded that TNF-alpha induced hypoglycemia, increasing GLUT1 mRNA abundance and glucose uptake and decreasing PEPCK mRNA abundance in 10-day-old rats. Indomethacin attenuated the TNF-alpha-induced glucose dyshomeostasis.

Effects of hydrazine sulfate on galactosamine-sensitized endotoxic shock in ten-day-old rats.

Patients who have liver diseases are susceptible to septic shock. Galactosamine induces liver damage and increases endotoxin-sensitivity. Hydrazine stimulates pituitary-adrenal axis and decreases mortality in galactosamine-sensitized endotoxic shock in the adult. However, as pituitary-adrenal function in the newborn is immature, the effects of hydrazine on galactosamine-sensitized endotoxic shock in the newborn remained unclear. In the present study, galactosamine-sensitized endotoxic shock was induced and treated with hydrazine in ten-day-old rats. Galactosamine (600 mg/kg) plus Salmonella enteritidis lipopolysaccharide (LPS; 0.01 mg/kg) induced hypoglycemia, lactacidemia and resulted in high mortality. Hydrazine at the dose of 20, 50 or 80 mg/kg did not alter the hypoglycemia, lactacidemia or morality. Dexamethasone ameliorated the hypoglycemia and lactacidemia (p < 0.05) and decreased the morality (p < 0.05). The lack of beneficial effects of hydrazine in galactosamine-sensitized endotoxic shock in ten-day-old rats may be related to immature pituitary-adrenal function and suppression of gluconeogenesis by hydrazine.

Endotoxemia following enteral refeeding in children.

Plasma endotoxin-like activity, tumor necrosis factor alpha (TNFalpha) concentrations, core body temperature, and liver functions were measured before and after enteral feeding in children who had been deprived of enteral feeding for 5 days because of their illness. Transient endotoxemia and elevations in plasma TNFalpha concentrations occurred. Core body temperature, aspartate aminotransferase, alamine aminotransferase, and bilirubin concentrations were normal in patients who had elevated plasma endotoxin-like activity. Transient endotoxemia following enteral feeding may be due to the translocation from the gastrointestinal (GI) tract as a result of increased mesenteric circulation and peristalsis. No clinical consequences were noted despite transient endotoxemia. The transient endotoxemia is not due to the immature GI tract; instead, it results from enteral feeding following the deprivation of enteral feeds.

A sublethal dose of LPS to pregnant rats induces TNF-alpha tolerance in their 0-day-old offspring.

The newborn has high mortality in septic shock. Induction of endotoxin tolerance may prevent endotoxic shock in the newborn. The present study showed that a small dose of Salmonella enteritidis lipopolysaccharide (S. ent. LPS), Rc mutant Escherichia coli lipopolysaccharide (J5 LPS), or tumor necrosis factor-alpha (TNF-alpha) given to pregnant rats on the 19th day of gestation induced endotoxin tolerance in their 0-day-old offspring. S. ent. LPS or J5 LPS injected into pregnant rats increased plasma endotoxin-like activity in dams, although not in their fetuses, and increased plasma TNF-alpha concentration in both dams and their fetuses. The endotoxin-tolerant newborn rats were also resistant to TNF-alpha. In those newborn rats, an LPS injection increased plasma TNF-alpha concentration and liver TNF-alpha mRNA abundance. These experiments showed that the endotoxin tolerance could be due to TNF-alpha tolerance. In conclusion, prenatal treatment of dams with a small dose of S. ent. LPS, J5 LPS, or TNF-alpha was beneficial in preventing endotoxic shock in the newborn.

Tissue glucose transport and glucose transporters in suckling rats with endotoxic shock.

Hypoglycemia occurs without hyperinsulinemia in suckling rats with endotoxic shock. However, tissue glucose uptake during endotoxic shock is not well known in the newborn. GLUT1 is insulin insensitive and is the predominant glucose transporter in 10 day old rats. In the adult with endotoxic shock, noninsulin-mediated glucose uptake and GLUT1 gene expression increase. Therefore, we hypothesized that tissue glucose uptake and GLUT1 mRNA abundance increased in 10 day old rats with endotoxic shock. The present study showed that whole body glucose disposal increased 3 h after a Salmonella enteritidis lipopolysaccharide injection (LD90 at 72 h). Plasma insulin concentration was not altered. Tissue glucose uptake increased in liver (2.4-fold) and fat (2.6-fold). However, changes of GLUT1 protein concentration were not detected in liver. GLUT1 mRNA abundance increased in liver (9-fold) and fat (4-fold). GLUT1 mRNA abundance but not glucose uptake increased in muscle. Neither glucose uptake or GLUT1 mRNA abundance was altered in brain. The mRNA abundance of tissue-specific glucose transporters (GLUT2 and GLUT4) was not altered. Thus, tissue glucose uptake and GLUT1 mRNA abundance increased without hyperinsulinemia during endotoxic shock in 10 day old rats.

Perinatal nutrition enriched with omega-3 polyunsaturated fatty acids attenuates endotoxic shock in newborn rats.

Sepsis and septic shock continue to have a high mortality and morbidity in the newborn. Eicosanoids are important mediators in Gram negative septic shock. Omega-3 polyunsaturated fatty acids (omega-3) decrease production of biologically active 2-series eicosanoids. Therefore, we hypothesized that omega-3-enriched diet could decrease 2-series eicosanoids and attenuate endotoxic shock in newborn rats. Sprague-Dawley rat dams were fed with either omega-3 polyunsaturated fatty acid-enriched diet (omega-3 PURA) or omega-6 polyunsaturated fatty acid enriched diet (omega-6PUFA; controls) from the 16th day of gestation until 10 days after parturition. In 10 day old rats, shock was induced by an intraperitoneal injection of Salmonella enteritidis lipopolysaccharide. The omega-3PUFA decreased the mortality of endotoxic shock. In omega-6PUFA, lipopolysaccharide induced hyperglycemia at 2 h and hypoglycemia thereafter without an elevation in plasma insulin concentration, omega-3PUFA attenuated the hyperglycemia and hypoglycemia. omega-3PUFA attenuated the decrease of liver phosphoenolpyruvate ca-boxykinase mRNA abundance, suggesting preserved gluconeogenesis. Therefore, perinatal feeding with omega-3PUFA was beneficial in attenuating glucose dyshomeostasis in newborn rats with endotoxic shock and may be a novel approach to the prevention of endotoxic shock in the newborn.

Dexamethasone attenuates hypoglycemia in ten day old rats treated with TNF alpha.

Hypoglycemia during septic shock is a common and life-threatening sign in the newborn. TNF alpha is an important cytokine in endotoxic shock. The present study was performed to investigate if TNF alpha induces hypoglycemia and if dexamethasone ameliorates the TNF alpha effects in 10 day old rats. TNF alpha induced hypoglycemia and lactacidemia without altering plasma insulin concentration in 10 day old rats. TNF alpha increased GLUT1 mRNA abundance in brain, liver, muscle and fatty tissue, and decreased liver phosphoenolpyruvate carboxykinase (PEPCK) mRNA abundance. Dexamethasone attenuated the hypoglycemia and lactacidemia. Dexamethasone blunted the increase of GLUT1 mRNA abundance and increased the liver PEPCK mRNA abundance. Dexamethasone may be beneficial by promoting gluconeogenesis.

Galactosamine alters glucose regulation in ten-day-old rats treated with a low dose of endotoxin.

Hypoglycemia develops rapidly during septic shock and is a common and life-threatening problem in the human newborn. In adult animals, galactosamine alter glucose metabolism and increases mortality of endotoxic shock. Galactosamine may alter tissue glucose uptake and induce hypoglycemia in ten-day-old rats. The present study showed that galactosamine induced hypoglycemia and a high mortality without an increase in plasma insulin concentration in ten-day-old rats treated with a low dose of endotoxin. Galactosamine decreased tissue glucose uptake in endotoxin-treated animals. Hypoglycemia induced by galactosamine could be due to decreased gluconeogenesis.

The emergency management of hyperglycemic-hyperosmolar nonketotic coma in the pediatric patient.

We recommend consideration of HHNK in comatose pediatric patients and advocate the prompt institution of fluid therapy. Insulin is not required during the initial course of treatment and potentially can have adverse effects. Compared to adults, pediatric patients appear to be at a greater risk of developing potentially fatal cerebral during the course of treatment. In order to prevent complications associated with the rapid decrease in serum tonicity the initial management should consist of fluid therapy directed toward repleting the intravascular volume, correcting electrolyte abnormalities, and slowly returning serum tonicity to normal.

How accurate is glucose analysis in the presence of multiple interfering substances in the neonate? (glucose analysis and interfering substances).

Whole blood glucose testing by reagent sticks is inaccurate at low plasma glucose concentrations and with varying hematocrit. Both conditions are frequently seen in newborn infants. Therefore plasma glucose analysis is the preferred method for newborn glucose monitoring. We encountered unanticipated difficulties in plasma glucose measurement by the automated hexokinase method caused by the combinations of plasma free hemoglobin, bilirubin, and plasma triglycerides, which are frequently elevated in newborn plasma. We determined the adverse effects of various combinations of these interfering substances on glucose analysis by the hexokinase method and demonstrated that accurate analysis is possible by a 1:1 plasma dilution only at high plasma glucose levels but not at the more critical low plasma glucose concentration. The dilution reduced the number of repeat specimens required in newborns. But 1:1 plasma dilution overestimated the glucose levels at low plasma glucose values, and therefore this automated hexokinase method is not suitable for glucose analysis in the newborn. Glucose-oxidase remains the method of choice for plasma glucose analysis in neonates. This information is important because using this hexokinase methodology, one might miss hypoglycemia in the newborn.

Feminizing Sertoli cell tumors in boys with Peutz-Jeghers syndrome.

We report the pathology findings in two cases of multicentric Sertoli cell testicular tumors in two young boys with probable Peutz-Jeghers syndrome. Four cases of such tumors occurring in boys with Peutz-Jeghers syndrome were previously reported. Each of the two boys reported in this paper had prominent gynecomastia, rapid growth, and advanced bone age. Serum levels of estradiol were markedly elevated. Anti-müllerian hormone was measured in the serum of one of the boys and was in the normal range for age. Bilateral orchiectomy was performed in each case because the neoplastic growth would most likely result in sterility, and curtailment of height potential was threatened from continued elevation of estradiol levels. Microscopically, greatly enlarged seminiferous tubules packed with ovoid Sertoli-like cells were present. Prominent eosinophilic basement membrane surrounded the tubules and intersected between the cells, forming hyalinized ovoid globules and microcalcifications. Ultrastructure revealed lamination of basement membranes surrounding adjacent cells, ovoid cells with abundant cytoplasm, and limited smooth endoplasmic reticulum. Studies of testicular tumor tissue from both cases revealed increased transcription of the aromatase cytochrome P450 gene using promoter II, the promoter directing aromatase expression in the normal ovary and testis. The levels of transcripts were comparable to corpus luteum, thus resulting in increased estrogen synthesis. Transcripts specific for placental-type aromatase promoters (I.1 and I.2) were not detected in significant levels in these tumors.

Evaluation of short stature.

Patients with short stature may go unrecognized if routine, accurate growth measurements are not performed by primary care physicians: This cannot be overemphasized. An accurate assessment of growth requires reliable growth measurements and proper plotting of growth data on correct growth charts. This should be done by the primary care physician yearly and at every office visit. When evaluating a child for short stature, previous growth data, diet history, birth history, the parents' heights, and parents' pubertal history are extremely important. Most children with short stature do not have endocrine abnormalities. Instead, variations of normal or chronic, nonendocrine illnesses may be present. In many nonendocrine conditions poor growth may be the only presenting problem. If the diagnosis is not readily discernible by history and physical examination, screening laboratory studies individualized for each patient may provide diagnostic clues. In some children other specialized testing is required, such as chromosomal analysis or GH testing. The therapy, if any, of short stature will of course depend on the underlying etiology. Often reassurance is all that is necessary.

Anti-lipid A monoclonal antibodies and anti-LPS antiserum effects on limulus activity of LPS.

Anti-lipid A monoclonal antibodies (A78S1 and A523) and anti-LPS antiserum can decrease the mortality due to endotoxic shock in the newborn rat. However, in vitro LPS detoxification of anti-lipid A monoclonal antibodies is not known. Thus, we studied in vivo effects of A78S1 (IgG), A523 (IgM), and anti-LPS antiserum on Limulus activity. Anti-LPS antiserum decreased Limulus activity of S. enteritidis, E. coli and S. typhosa LPS. However, neither A78S1 nor A523 decreased the Limulus activity of E. coli and S. typhosa LPS. A78S1 or A523 incubation with S. enteritidis LPS at different doses (0.1 to 100 ng/ml) did not alter the Limulus activity. Perchloric acid treatment after LPS incubation with A78S1 or A523 significantly decreased Limulus activity. Therefore, antilipid A monoclonal antibodies (A78S1 and A523) can bind LPS, but do not decrease Limulus activity.

Testing for thyroid function recovery in children and adolescents with Hashimoto thyroiditis.

Thyroid function in children and adolescents with primary hypothyroidism owing to Hashimoto thyroiditis was studied to evaluate criteria for the discontinuation of thyroxine therapy. A cohort of 29 children and adolescents was prospectively studied for one year. A thyrotropin-releasing hormone stimulation test with measurements of basal and stimulated thyrotropin and thyroxine was performed at the beginning of the study and 6 and 12 months later. In 59 percent of patients, persistent biochemical evidence of hypothyroidism was observed. Interindividual variations and variations among measurements in individual patients were much greater than those reported for healthy individuals. In one patient, all measured values were consistently normal, and the therapy was successfully discontinued. No single measurement or test could predict the natural course of disease. In summary, children and adolescents with hypothyroidism owing to Hashimoto thyroiditis can not have discontinued replacement thyroxine therapy on the basis of any single evaluation of thyroid function, as proposed for adults. If the decision to discontinue the therapy in this age group is made on the basis of previous follow-up, a substantial possibility of relapse remains and continuous follow up is necessary.