Three decades after Baby Doe: how neonatologists and bioethicists conceptualize the Best Interests Standard.

OBJECTIVE: The objective of this study is to determine how neonatologists and bioethicists conceptualize and apply the Best Interests Standard (BIS). STUDY DESIGN: Members of the American Society for Bioethics and Humanities and the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine were surveyed to determine how they conceptualized the BIS and ranked the appropriateness of forgoing life-sustaining therapy (LST). RESULTS: Neonatologists' median response supported an infant-specific BIS conceptualization that linked the infant's and family's interests. They did not support allowing limitations on the family's obligations. Ethicists' supported a conceptualization that linked the infant's and family's interests and limitations on the family's obligations, a less infant-specific conceptualization. Ethicists were less or equally likely to agree with forgoing LST in seven of eight cases. CONCLUSIONS: Ethicists endorsed a conceptualization of the BIS that includes the effects on the family and rejected an infant-specific one. Neonatologists split between these two and rejected limiting the family's obligations. Critical appraisal of the BIS is needed in neonatal ethics.

The effects of Ramadan fasting on endothelial function in patients with cardiovascular diseases.

BACKGROUND/OBJECTIVES: Endothelial dysfunction, which can be manifested by loss of nitric oxide bioavailability, is an increasingly recognized cause of cardiovascular diseases. Previous studies showed that diets affect endothelial function and modify cardiovascular risks. This study aimed to assess the effects of Ramadan fasting, as a diet intervention, on endothelial function. SUBJECTS/METHODS: The study population consisted of 21 male patients (mean age: 52±9 years) with cardiovascular risks (coronary artery disease, cerebrovascular or peripheral arterial diseases). The biochemical variables in serum of patients were measured 2 days before and after Ramadan fasting. The levels of asymmetric dimethylarginine (ADMA) and vascular endothelial growth factor (VEGF) were evaluated using the enzyme-linked immunosorbent assay. Nitric oxide (NO) and Malondialdehyde (MDA) levels were measured by the Griess and thiobarbituric acid reaction substances assay, respectively. RESULTS: NO levels in patients after Ramadan fasting were significantly higher compared with the baseline value (85.1±11.54 vs 75.8±10.7 µmol/l) (P<0.05). Post-Ramadan levels of ADMA decreased significantly in comparison with pre-Ramadan levels (802.6±60.9 vs 837.6±51.0 nmol/l) (P<0.05). In addition, the levels of VEGF and MDA changed during Ramadan fasting, but these changes were not statistically significant (228.1±27.1 vs 222.7±22.9 pg/ml and 3.2±0.7 vs 3.6±1.1 µmol/l, respectively). CONCLUSIONS: Ramadan fasting may have beneficial effects on endothelial function and can modulate cardiovascular risks. Further studies are needed to confirm the clinical significance of Ramadan fasting on cardiovascular health.

Von Meyenburg complexes of the liver: imaging findings.

PURPOSE: Our purpose was to present imaging findings of six cases proven or supposed to be von Meyenburg complexes (VMCs) with a basis of reviewing the pathologic literature and to describe imaging points for the diagnosis of typical VMC along with its differential diagnosis. METHOD: Six cases were diagnosed as VMC of the liver with imaging modalities (one had histopathologic proof). Both ultrasound (US) and CT were available for all cases, and MRI was used for three cases. Follow-up with US, CT and/or MRI was performed in five cases. RESULTS: US detected varying abnormalities of the livers in four cases. CT and MRI revealed multiple or numerous intrahepatic tiny (usually < 5 mm) cystoid lesions in all of the cases. The lesions were scattered throughout the livers, and some of them were located more frequently adjacent to the medium-sized portal veins than to the hepatic veins of similar size on CT. Moreover, some lesions were apparently located in the subcapsular areas (up to the hepatic capsules). They were usually irregular in shape and showed no enhancement but increased in number by approximately 80-150% after administration of intravenous contrast medium. The T2-weighted MR images and MR cholangiopancreatography showed the lesions to be much more apparent and to be more numerous than T1-weighted images did. Follow-up of five cases with imaging modalities did not show remarkable change of the lesions. CONCLUSION: Despite our limited experience, VMC lesions seem to show some CT and MR features different from those of other multiple small hepatic lesions. They presented as multiple or numerous intrahepatic tiny cystoid lesions usually with irregular contour, scattered throughout the liver up to the subcapsular areas, and were detected in far greater number by enhanced CT or T2-weighted MR images than by unenhanced CT or T1-weighted images. They showed no remarkable change on long term follow-up imaging. We propose that a diagnosis of typical VMC could be made after analyzing CT or MR images carefully with good understanding of its pathologic basis, but imaging follow-up is necessary in oncology patients.