The effect of a double dose of cloprostenol sodium on luteal blood flow and pregnancy rates per artificial insemination in lactating dairy cows.

Inadequate luteolysis in fertility programs is a problem for lactating dairy cows treated with a single dose of PGF2α. The proportion of cows with complete luteolysis can be increased by administering 2 doses of PGF2α 24 h apart. This study hypothesized that a double dose of cloprostenol sodium (1.0 mg) could take the place of 2 doses 24 h apart due to its enhanced half-life. Cows were allocated to receive 1 of 3 treatments: negative controls: 0.5 mg of cloprostenol sodium (single; n = 337); positive controls: two 0.5-mg doses of cloprostenol sodium 24 h apart (two/24; n = 313); and treated: 1.0 mg of cloprostenol sodium (double; n = 298) at the final PGF2α of Double-Ovsynch. Cows received artificial insemination (AI) 16 h after final GnRH of Double-Ovsynch. Pregnancy diagnosis was determined at 24, 34, 62, and 184 d post-AI. Pregnancy loss was categorized in the following periods: between 24 to 34, 34 to 62, and 62 to 184 d post-AI. Ultrasonography (B-mode and color Doppler) was used to assess luteal function pre- and posttreatment with various doses of cloprostenol sodium. Luteal volume and luteal blood flow (LBF) from d 7 and 14 corpora lutea were determined before treatment (d -1), and 2 and 4 d after treatment. No evidence was observed of an effect of treatment on pregnancy rates per AI at 24, 34, or 62 d post-AI. No effect was observed of treatment on pregnancy losses occurring between d 24 and 34, 34, and 62, and between 62 and 184 d post-AI. However, third-plus parity cows treated with the single treatment had greater pregnancy loss compared with two/24 and double between d 24 and 34 post-AI. Third-plus parity cows that received the double treatment had lower LBF 2 and 4 d after treatment compared with cows treated with single. Amount of LBF present 4 d after treatment was not a predictor of pregnancy or pregnancy loss. A double dose (1.0 mg) of cloprostenol sodium may be a feasible alternative for fertility programs based on nondifferent outcomes to the two/24 treatment, lower pregnancy losses, and reduced LBF disappearance following treatment in third-plus parity cows in comparison with the single treatment.

Complexation reduces nickel toxicity to purple sea urchin embryos (Strongylocentrotus purpuratus), a test of biotic ligand principles in seawater.

The potential for Ni toxicity in seawater is of concern because of mining and processing activities in coastal regions. Determining Ni speciation is vital to understanding and predicting Ni toxicity and for bioavailability-based nickel risk assessment. The goal of this study was to characterize the complexation of Ni in relation to toxicity using embryological development of purple sea urchin (S. purpuratus). It was predicted that free ion [Ni2+] would be a better predictor of toxicity than total dissolved Ni concentrations (NiD). Synthetic ligands with known logKf values (Ethylenediaminetetraacetic acid (EDTA), Nitrilotriacetic acid (NTA), tryptophan (TRP), glutamic acid (GA), histidine (HD), and citric acid (CA)) were used to test the assumptions of the biotic ligand model (BLM) for Ni in seawater. [NiD] was measured by graphite furnace atomic absorption spectroscopy (GFAAS) and Ni2+ was first quantified using the ion-exchange technique (IET) and then concentrations were measured by GFAAS; [Ni2+] was also estimated using aquatic geochemistry modelling software (Visual Minteq). The mean EC50 values for [NiD] in unmodified artificial seawater control was 3.6 µM (95% CI 3.0-4.5) [211 µg/L 95% CI 176-264] and the addition of ligands provided protection, up to 6.5-fold higher [NiD] EC50 for EDTA. Compared to the control, measured EC50 values based on total dissolved nickel were higher in the presence of ligands. As predicted by BLM theory, [Ni2+] was a better predictor of Ni toxicity with 17% variability in EDTA and CA media while there was 72% variability in the prediction of Ni toxicity with total dissolved Ni. The results of this research provide support for the application of BLM- based prediction models for estimating Ni impacts in seawater.

Short communication: Blood samples before and after embryonic attachment accurately determine non-pregnant lactating dairy cows at 24 d post-artificial insemination using a commercially available assay for pregnancy-specific protein B.

Early pregnancy diagnosis is critical to reproductive success on dairy farms. Reproductive success depends on cows becoming pregnant before 130 d in milk and then maintaining that pregnancy. The earlier non-pregnant cows are identified, the sooner they can be reinseminated, thus reducing days to pregnancy. Assays for pregnancy-specific protein B (PSPB) and pregnancy-associated glycoproteins can be used to diagnose pregnancy >28 d post-artificial insemination (AI) in lactating cows. The objective of this study was to determine whether percentage change in serum levels of PSPB within cow from d 17 to 24 can be used to identify non-pregnant cows using a commercially available assay. This study was performed on a large commercial dairy. Blood samples were taken at d 17 and 24 post-AI. The d 17 sample served as a baseline based on previous data. Cows with a 10% increase in serum PSPB levels from d 17 to 24 were considered pregnant. Lactating dairy cows (n = 206; 39% primiparous and 61% multiparous) were synchronized using G6G-Ovsynch. The PSPB diagnosis was compared with the herd veterinarian's diagnosis via ultrasound on d 34. The sensitivity for a 10% cutoff as a non-pregnant diagnosis was 100%, and the specificity was 93.58%. The positive predictive value was 93.27%, and the negative predictive value was 100%. Low PSPB levels at d 24 were predictive of early pregnancy loss by 60 d post-AI. To our knowledge no other method can diagnose non-pregnancy with 100% accuracy and predict pregnancy loss earlier than 24 d post-AI. Using comparative PSPB samples at d 17 and 24 post-AI provides an accurate non-pregnancy diagnosis earlier than any other pregnancy diagnosing method.

The high-fertility cycle: How timely pregnancies in one lactation may lead to less body condition loss, fewer health issues, greater fertility, and reduced early pregnancy losses in the next lactation.

Body condition loss during early lactation varies among cows in the herd and is associated with future health and reproductive outcomes. The objective of this study was to gain a greater understanding of the relationship between previous calving interval and body condition change during the first 30 d in milk (DIM) and their relationship to subsequent fertility and health variables and sex ratio at birth. Dry cows and heifers (n = 851) from a single farm entered the study approximately 25 d before the due date. They were evaluated and given a body condition score on a 1-to-5 scale with 0.1-point increments weekly until parturition. Body condition score was assessed within 1 wk of parturition and then again 27 to 33 DIM. Previous calving interval, gestation length, periparturient health events (giving birth to twins, dystocia, retained placentas, ketosis, metritis, and displaced abomasum), sire net merit ($), and milk data were used for each cow as recorded in PCDART (Dairy Records Management Systems, Raleigh, NC) by the herd managers. Longer previous calving intervals were related to greater body condition at parturition and body condition loss during the first 30 DIM. A 75% greater proportion of cows with a calving-to-pregnancy interval shorter than 130 d maintained or gained body condition during the first 30 DIM compared with cows with calving-to-pregnancy intervals longer than 130 d. Multiparous cows that maintained or gained body condition (n = 144) had greater pregnancies per AI following first service compared with cows that lost body condition (n = 577) during the first 30 DIM when health events were considered or removed. When cows with health events were considered, multiparous cows that maintained or gained body condition had a greater percentage pregnant by 130 DIM compared with cows that lost body condition (67 vs. 55%; n = 522). Cows that lost body condition during the first 30 DIM regardless of health events experienced greater pregnancy loss (n = 224) between 35 and 60 d after first AI (0.0 vs. 6.7%) compared with cows that maintained or gained body condition (n = 69) during that period. Based on data in this study from a single herd, maintaining a cycle of pregnancy before 130 DIM may reduce the amount of body condition lost after the next parturition, enhance subsequent pregnancies per AI, and reduce the possibility of early pregnancy loss. We refer to this phenomenon as the high-fertility cycle.

The effect of prior bisphosphonate therapy on the subsequent therapeutic effects of strontium ranelate over 2 years.

UNLABELLED: Many osteoporotic women prescribed strontium ranelate have previously received bisphosphonates. Prior bisphosphonate use blunted the spinal bone mineral density (BMD) response for 6 months. Hip BMD was blunted to a degree for 2 years, although there was an overall increase in hip BMD in contrast to the heel where BMD did not increase. INTRODUCTION: Many osteoporotic women commenced on strontium ranelate have already received treatment with bisphosphonates. This study investigates whether prior bisphosphonate use impairs the subsequent therapeutic response to strontium ranelate. METHODS: Women were recruited who were either bisphosphonate naïve or currently receiving a bisphosphonate. All women received strontium ranelate and were followed up for 2 years. RESULTS: One hundred and twenty women were recruited. After 2 years, the bisphosphonate-naïve group had significant BMD increases of 8.9%, 6.0% and 6.4% at the spine, hip and heel, respectively. In the prior bisphosphonate group, BMD increased significantly at the spine (4.0%) and hip (2.5%) but not at the heel. At all time points at all sites, the BMD increase was greater in the bisphosphonate-naïve group. BMD at the spine did not increase during the first 6 months in the prior bisphosphonate group but then increased in parallel with the bisphosphonate-naïve group. In contrast, the difference between the two groups in hip BMD continued to increase throughout the 2 years. P1NP was suppressed in the prior bisphosphonate group for the first 6 months. CONCLUSIONS: After bisphosphonate exposure, the BMD response to strontium ranelate is blunted for only 6 months at the spine. At the hip, a degree of blunting was observed over 2 years, although there was an overall increase in hip BMD in contrast to the heel where no increase in BMD was observed.

Dairy heifers have an earlier increase in serum pregnancy-specific protein B compared with lactating dairy cows. Is this an indicator of earlier conceptus attachment?

This study was designed to use within-individual daily increases in circulating pregnancy-specific protein B (PSPB) to determine time to increase in serum PSPB in nulliparous heifers and multiparous dairy cows following artificial insemination (AI). Weekly cohorts of lactating Holstein cows (n = 56) averaging 122 ± 7 d in milk at AI and nulliparous Holstein heifers (n = 23) averaging 16 ± 0.24 mo old at AI were used in this study. Lactating cows received AI to either Ovsynch (n = 38) or at ~12 h following observed standing estrus (n = 18). All heifers were inseminated ~12 h after observed standing estrus. Blood samples for measurement of PSPB were collected daily from d 15 through d 35 postovulation. Nulliparous heifers had increases in serum PSPB earlier compared with both primiparous and multiparous cows. Day of increase in serum PSPB was defined as the day serum PSPB optical density levels initially increased ≥10% from baseline and continued to increase from baseline of ≥10% the following 2 d. Average PSPB were greater in pregnant heifers compared pregnant cows from d 23 through 29. Early lactation nonpregnant cows maintained greater average optical density of serum PSPB from 15 to 35 d postovulation compared with nonpregnant heifers (n = 38). In summary, fertility differences in heifers versus lactating cows may be due to the differences in timing of increases in serum PSPB. This appears to be one of the first publications that used daily PSPB sampling to investigate possible differences in fertility in heifers versus lactating cows.

Contribution of chlorophyll fluorescence to the apparent vegetation reflectance.

Current strategies for monitoring the physiologic status of terrestrial vegetation rely on remote sensing reflectance data, which provide estimates of vigor based primarily on chlorophyll content. Chlorophyll fluorescence (ChlF) measurements offer a non-destructive alternative and a more direct approach for diagnosis of vegetation stress before a significant reduction in chlorophyll content has occurred. Thus, technology based on ChlF may allow more accurate carbon sequestration estimates and earlier stress detection than is possible when using reflectance data alone. However, the observed apparent vegetation reflectance (Ra) in reality includes contributions from both the reflected and fluoresced radiation. The aim of this study is to determine the relative contributions of reflectance and ChlF fractions to Ra in the red to near-infrared region (650-800 nm) of the spectrum. The practical objectives of the study are to: 1) evaluate the relationship between ChlF and reflectance at the foliar level for corn, soybean and maple; and 2) for corn, determine if the relationship established for healthy vegetation changes under nitrogen (N) deficiency. To obtain generally applicable results, experimental measurements were conducted on unrelated crop and tree species (corn, soybean and maple) under controlled conditions and a gradient of inorganic N fertilization levels. Optical reflectance spectra and actively induced ChlF emissions were collected on the same foliar samples, in conjunction with measurements of photosynthetic function, pigment levels, and carbon (C) and N content. The spectral trends were examined for similarities. On average, 10-20% of Ra at 685 nm was actually due to ChlF. The spectral trends in steady state and maximum fluorescence varied significantly, with steady state fluorescence (especially red, 685 nm) showing higher ability for species and treatment separation. The relative contribution of ChlF to Ra varied significantly among species, with maple emitting much higher fluorescence amounts, as compared to corn and soybean. Steady state fluorescence from individual red and far-red emission bands (F685 and F740, respectively) and their ratio consistently enabled species separation. For corn, the relative ChlF fraction increased in concert with the nutrient stress levels from <2% for non-stressed foliage to >7% for severely N deficient plants. Steady state ChlF at 685 nm provided optimal N treatment separation. This study confirms the trends in the steady state red/far-red ratio (F685s/F740s) associated with N deficiency and vegetation stress, previously established using active single narrow band excitation.

The safety and efficacy of vertebroplasty using Cortoss cement in a newly established vertebroplasty service.

Vertebroplasty provides an effective means of treating painful vertebral lesions although the majority of the literature relates to vertebroplasty using PMMA cement. The purpose of this study is to assess the safety and efficacy of vertebroplasty using Cortoss, a recently developed bis-GMA resin. Our newly established vertebroplasty service exclusively uses Cortoss cement and has a patient database which is updated on a regular basis using the medical records. To date, there are 34 patients on this database, mean age 66, in whom a vertebroplasty has been performed on 42 vertebral lesions with a mean of 2.2 ml of Cortoss injected into each lesion. The mean duration of follow up was 9.5 months. Eighty-two per cent of patients reported an improvement in their symptoms, while 79% required less analgesia post vertebroplasty. A total of 88.2% experienced no significant complications. In 38% there was an asymptomatic leakage of Cortoss. Four patients (11.8%) experienced significant complications: one asymptomatic PE, one episode of transient radicular leg pain, one generalized rash and one patient suffered retropulsion of the Cortoss due to further vertebral malignancy. Cortoss vertebroplasty provides comparable efficacy and safety to the published literature for PMMA.

PDK1 governs thromboxane generation and thrombosis in platelets by regulating activation of Raf1 in the MAPK pathway.

Essentials Phosphoinositide 3-kinase and MAPK pathways crosstalk via PDK1. PDK1 is required for adenosine diphosphate-induced platelet activation and thromboxane generation. PDK1 regulates RAF proto-oncogene Ser/Thr kinase (Raf1) activation in the MAPK pathway. Genetic ablation of PDK1 protects against platelet-dependent thrombosis in vivo. SUMMARY: Background Platelets are dynamic effector cells with functions that span hemostatic, thrombotic and inflammatory continua. Phosphoinositide-dependent protein kinase 1 (PDK1) regulates protease-activated receptor 4-induced platelet activation and thrombus formation through glycogen synthase kinase3ß. However, whether PDK1 also signals through the ADP receptor and its functional importance in vivo remain unknown. Objective To establish the mechanism of PDK1 in ADP-induced platelet activation and thrombosis. Methods We assessed the role of PDK1 on 2MeSADP-induced platelet activation by measuring aggregation, thromboxane generation and phosphorylation events in the presence of BX-795, which inhibits PDK1, or by using platelet-specific PDK1 knockout mice and performing western blot analysis. PDK1 function in thrombus formation was assessed with an in vivo pulmonary embolism model. Results PDK1 inhibition with BX-795 reduced 2-methylthio-ADP (2MeSADP)-induced aggregation of human and murine platelets by abolishing thromboxane generation. Similar results were observed in pdk1-/- mice. PDK1 was also necessary for the phosphorylation of mitogen-activated protein kinase kinase 1/2 (MEK1/2), extracellular signal-regulated kinase 1/2, and cytosolic phospholipase A2, indicating that PDK1 regulates an upstream kinase in the mitogen-activated protein kinase (MAPK) pathway. We next determined that this upstream kinase is Raf-1, a serine/threonine kinase that is necessary for the phosphorylation of MEK1/2, as pharmacological inhibition and genetic ablation of PDK1 were sufficient to prevent Raf1 phosphorylation. Furthermore, in vivo inhibition or genetic ablation of PDK1 protected mice from collagen/epinephrine-induced pulmonary embolism. Conclusion PDK1 governs thromboxane generation and thrombosis in platelets that are stimulated with 2MeSADP by regulating activation of the MAPK pathway.

Increased adenosine triphosphatase in leukocytes of asthmatic children.

Adenosine triphosphatase (ATPase) activities were compared in leukocytes of asthmatic and nonasthmatic children. Both Mg(2+)- and Ca(2+)-dependent ATPase activities were significantly elevated in two membrane fractions (59 to 66%) and in a superntant fraction (68 to 72%) prepared from sonicated leukocytes of asthmatic subjects. Intact cell surface or ecto ATPase was also elevated (67 to 76%) in asthmatic leukocytes. Alternate day glucocorticosteroid therapy was associated with leukocyte ATPase activities intermediate between those for asthmatics not receiving steroids and for nonasthmatic control subjects. Incubation of normal leukocytes with 10(-8) M hydrocortisone or leukocyte membranes with 10(-4)-10(-3) M hydrocortisone in vitro also resulted in decreased ATPase activities. The elevated leukocyte ATPase activities appear to relate to the adrenergic imbalance in asthma previously characterized by reduced beta adrenergic responsiveness of adenylate cyclase and suggest the possibility of more than one enzymatic abnormality intrinsic to the asthmatic condition.

Assessment of vegetation stress using reflectance or fluorescence measurements.

Current methods for large-scale vegetation monitoring rely on multispectral remote sensing, which has serious limitation for the detection of vegetation stress. To contribute to the establishment of a generalized spectral approach for vegetation stress detection, this study compares the ability of high-spectral-resolution reflectance (R) and fluorescence (F) foliar measurements to detect vegetation changes associated with common environmental factors affecting plant growth and productivity. To obtain a spectral dataset from a broad range of species and stress conditions, plant material from three experiments was examined, including (i) corn, nitrogen (N) deficiency/excess; (ii) soybean, elevated carbon dioxide, and ozone levels; and (iii) red maple, augmented ultraviolet irradiation. Fluorescence and R spectra (400-800 nm) were measured on the same foliar samples in conjunction with photosynthetic pigments, carbon, and N content. For separation of a wide range of treatment levels, hyperspectral (5-10 nm) R indices were superior compared with F or broadband R indices, with the derivative parameters providing optimal results. For the detection of changes in vegetation physiology, hyperspectral indices can provide a significant improvement over broadband indices. The relationship of treatment levels to R was linear, whereas that to F was curvilinear. Using reflectance measurements, it was not possible to identify the unstressed vegetation condition, which was accomplished in all three experiments using F indices. Large-scale monitoring of vegetation condition and the detection of vegetation stress could be improved by using hyperspectral R and F information, a possible strategy for future remote sensing missions.

The Role of Flavonol Glycosides and Carotenoids in Protecting Soybean from Ultraviolet-B Damage.

The increase in ultraviolet-B (UV-B; 0.290-0.320 [mu]m) radiation received by plants due to stratospheric ozone depletion heightens the importance of understanding UV-B tolerance. Photosynthetic tissue is believed to be protected from UV-B radiation by UV-B-absorbing compounds (e.g. flavonoids). Although synthesis of flavonoids is induced by UV-B radiation, its protective role on photosynthetic pigments has not been clearly demonstrated. This results in part from the design of UV-B experiments in which experimental UV-A irradiance has not been carefully controlled, since blue/UV-A radiation is involved in the biosynthesis of the photosynthetic pigments. The relationship of flavonoids to photosynthetic performance, photosynthetic pigments, and growth measures was examined in an experiment where UV-A control groups were included at two biologically effective daily UV-B irradiances, 14.1 and 10.7 kJ m-2. Normal, chlorophyll-deficient, and flavonoid-deficient pigment isolines of two soybean (Glycine max) cultivars that produced different flavonol glycosides (Harosoy produced kaempferol, Clark produced quercetin and kaempferol) were examined. Plants with higher levels of total flavonoids, not specific flavonol glycosides, were more UV-B tolerant as determined by growth, pigment, and gas-exchange variables. Regression analyses indicated no direct relationship between photosynthesis and leaf levels of UV-B-absorbing compounds. UV-B radiation increased photosynthetic pigment content, along with UV-B-absorbing compounds, but only the former (especially carotenoids) was related to total biomass (r2 = 0.61, linear) and to photosynthetic efficiency (negative, exponential relationship, r2 = 0.82). A reduction in photosynthesis was associated primarily with a stomatal limitation rather than photosystem II damage. This study suggests that both carotenoids and flavonoids may be involved in plant UV-B photoprotection, but only carotenoids are directly linked to photoprotection of photosynthetic function. These results additionally show the importance of UV-A control in UV-B experiments conducted using artificial lamps and filters.

Priority issues for hospital boards.

Governing a hospital or healthcare system is a difficult and demanding job. If done properly, the organization can operate well. If the board is inept or incompetent, the organization will suffer. In this article I discuss those functions of board governance that I think are among the most important, along with some recommendations for implementing them.

Inhibition by quercetin of thyroid hormone stimulation in vitro of human red blood cell Ca2+-ATPase activity.

Human red blood cell membrane Ca2+-ATPase activity is stimulated in vitro by physiological concentrations of thyroid hormone. Quercetin, a flavonoid that inhibits several membrane-linked ATPases, suppressed thyroid hormone action on red cell Ca2+-ATPase activity and also interfered with binding of the hormone by red cell membranes. These effects of quercetin were dose-dependent over a range of concentrations (1-50 microM). In contrast, in the absence of thyroid hormone, quercetin at low concentrations stimulated Ca2+-ATPase activity and at 50 microM inhibited the enzyme. The effects of quercetin at low concentrations (1-10 microM), namely, stimulation of Ca2+-ATPase and inhibition of membrane-binding of thyroid hormone, mimic those of thyroid hormone and are consistent with the thyronine-like structure of quercetin. At high concentrations, quercetin is generally inhibitory of Ca2+-ATPase activity. Chalcone, fisetin, hesperetin and tangeretin are other flavonoids shown to reduce susceptibility of membrane Ca2+-ATPase to hormonal stimulation.

Lack of pharmacokinetic and pharmacodynamic interactions between ketoconazole and prednisolone.

The effects of ketoconazole on the pharmacokinetics and pharmacodynamics of intravenous prednisolone (14.8 mg) were assessed in six healthy volunteers. Subjects were studied with and without receiving ketoconazole, 200 mg orally for 6 days. The addition of ketoconazole did not significantly change the clearance (96 +/- 11 versus 90 +/- 11 ml/hr/kg), mean residence time (4.29 +/- 0.43 versus 4.45 +/- 0.59 hours), volume of distribution (0.41 +/- 0.02 versus 0.40 +/- 0.02 L/kg), or plasma protein binding characteristics of prednisolone. The suppressive effects of prednisolone on serum cortisol, blood basophil, and helper T lymphocyte values, assessed by the ratio of the area under the curve (AUC) after prednisolone administration to the baseline AUC, was not altered significantly by ketoconazole. The 50% inhibitory concentration values derived from pharmacodynamic models developed to describe the direct suppressive effects of corticosteroids indicated no alteration in intrinsic sensitivity in the presence of ketoconazole. Ketoconazole does not appear to alter the pharmacokinetics or the pharmacodynamic response patterns of selected direct suppression effects of single low doses of prednisolone.

Effects of hydralazine, nitroglycerin, and food on estimated hepatic blood flow.

Several recent studies have shown that hydralazine and nitroglycerin may increase the apparent oral bioavailability of high-clearance drugs. It has been postulated that the mechanism responsible may be a vasodilator-induced transient increase in hepatic blood flow with an associated reduction in first-pass metabolism. To test this hypothesis, we examined the effect of hydralazine (25 mg) and sublingual nitroglycerin (2 doses of 0.6 mg separated by 30 minutes) on indocyanine green (ICG) blood clearance (ClB). Forty minutes after the start of nitroglycerin therapy, ICG ClB fell from a baseline of 648 +/- 98 to 607 +/- 151 ml/min, and was further decreased to 578 +/- 98 ml/min 80 minutes after dosing. Hydralazine induced no consistent effect on ICG ClB. ICG ClB was 744 +/- 376, 721 +/- 218, and 763 +/- 195 ml/min at baseline, 40 minutes, and 80 minutes after dosing. As a positive control, ICG ClB was assessed after a high-protein meal. After this meal, ICG ClB increased from 656 +/- 107 to 811 +/- 141 and 801 +/- 132 ml/min at 40 and 80 minutes after dosing. These data suggest that one or more mechanism(s) other than changes in hepatic blood flow are involved in the vasodilator-induced increase in the apparent oral bioavailability of high-clearance drugs.

Effect of carbohydrates on estimated hepatic blood flow.

Recent experiments suggest that propranolol taken orally with a carbohydrate-rich meal increases its apparent bioavailability by reducing first-pass metabolism. It has been postulated that this increase in bioavailability may be secondary to a transient increase in hepatic blood flow (QH). To examine this hypothesis, we examined the effect of one of the carbohydrate meals (potato) tested in other propranolol studies on QH by measuring blood clearance (ClB) of indocyanine green (ICG). Ten minutes after eating 200 gm cooked potato, mean ICG blood clearance (ClB) in six subjects rose by 12% (range -13% to +41%). There also was a 10% mean increase (range -13% to +23%) in ICG ClB 60 min after the meal. It was then postulated that a larger carbohydrate meal might induce a more consistent and substantial increase in ICG ClB; therefore, five of the subjects were restudied after 400 gm potato. The increase in ICG ClB was of the order of that after 200 gm. Changes in QH of this magnitude would be expected to make a negligible contribution to the mean 50% increase in propranolol bioavailability reported by several investigators. It thus appears that factors other than change in QH play a dominant role in the reduced first-pass metabolism of propranolol after a meal rich in carbohydrates.

Gender-based effects on methylprednisolone pharmacokinetics and pharmacodynamics.

The pharmacokinetics and selected pharmacodynamic responses to methylprednisolone were investigated in six men and six premenopausal women after a dose of 0.6 mg/kg ideal body weight. Women (luteal phase) exhibited a greater methylprednisolone clearance (0.45 versus 0.29 L/hr/kg) and shorter elimination half-life (1.7 versus 2.6 hours) than men. The volume of distribution of methylprednisolone was similar when normalized for ideal body weight. Pharmacodynamic models were used to examine the methylprednisolone suppressive effects on cortisol secretion and basophil and helper T lymphocyte trafficking. A significantly smaller 50% inhibitory concentration (IC50) value (0.1 versus 1.7 ng/ml) was seen in the women for suppression of cortisol secretion, indicating increased sensitivity. However, the area under the concentration-time curve of effect was similar for both groups. The IC50 values for effects of methylprednisolone on basophil trafficking related to estradiol concentrations in a log-linear fashion in women, with increased sensitivity found at higher estradiol concentrations. Men displayed a greater 24-hour net suppression in blood basophil numbers, but no difference was observed in net cortisol and helper T lymphocyte suppression between the sexes. These findings suggest that methylprednisolone dosages should be based on ideal body weight. Although women are more sensitive to methylprednisolone as measured by cortisol suppression, they eliminate the drug more quickly, generally producing a similar net response.

Oral contraceptive effects on methylprednisolone pharmacokinetics and pharmacodynamics.

OBJECTIVE: Oral contraceptive (OC) steroids alter the disposition of numerous drugs, including corticosteroids. We investigated the pharmacokinetics and pharmacodynamics of methylprednisolone. METHODS: Twelve women (six women used OC steroids and six women did not) received intravenous methylprednisolone (0.6 mg/kg ideal body weight). Methylprednisolone disposition was assessed from plasma concentrations. Pharmacodynamic parameters measured were plasma cortisol, whole blood histamine (reflecting basophils), and blood helper T lymphocytes. RESULTS: Methylprednisolone clearance was significantly decreased in the women who used OC steroids (0.298 versus 0.447 L/hr/kg), resulting in a longer elimination half-life (2.20 versus 1.72 hours). With use of indirect response models, significant differences were observed with the cortisol and basophil responses. A larger value for the concentration that inhibits the zero-order production rate by 50% (0.37 versus 0.11 ng/ml) was observed in the women who used OC steroids for suppression of cortisol secretion, indicating less sensitivity to the suppressive effects of methylprednisolone. Greater net suppression of basophils was observed in the users of OC steroids (area under the response curve, 694 versus 401 ng x hr/ml). No differences were observed for helper T-cell responses. CONCLUSION: OC steroids appear to inhibit methylprednisolone metabolism. However, mixed changes in several responses occur, indicating that women can probably receive similar doses of methylprednisolone irrespective of OC steroid use.

PIP: At the Buffalo General Hospital in New York, researchers randomly assigned 6 healthy, nonobese women, 30-36 years old and using a triphasic oral contraceptive (OC) (Triphasil 28, Wyeth-Ayerst Laboratories), to either the baseline phase group or the group receiving an intravenous bolus of methylprednisolone sodium succinate at a dose of 0.6 mg/kg ideal body weight during the 2-week period after ovulation (i.e., luteal phase). These women were compared with 6 other women who did not use OCs but did receive the same dose of methylprednisolone. The purpose was to determine whether the adrenosuppressive, anti-inflammatory, and immunosuppressive effects of methylprednisolone differ in OC users. OC users experienced slower clearance of methylprednisolone (33% slower) than controls. This slower clearance rate contributed to a longer elimination half-life for methylprednisolone (2.2 vs. 1.72 hours; p 0.05). OC users also had a rate of slower elimination of cortisol than controls (0.180 vs. 0.276 hr-1; p 0.05). They had higher mean cortisol levels than controls (136 vs. 65 ng/ml). Women who used OCs for suppression of cortisol secretion had a larger value for the concentration of cortisol that suppresses the zero-order production rate by 50% (0.37 vs. 0.11 ng/ml; p 0.05), suggesting a decreased sensitivity to the effects of methylprednisolone on cortisol suppression. OC users experienced a greater net suppression of basophils at drug effect than at baseline. Methylprednisolone appeared to have no effect on helper T-cell responses. These findings suggest that OCs inhibit methylprednisolone metabolism. Since there were inconsistent changes in several responses, women can likely receive similar doses of methylprednisolone irrespective of OC use.

Pharmacokinetics and pharmacodynamic modeling of direct suppression effects of methylprednisolone on serum cortisol and blood histamine in human subjects.

Pharmacodynamic models for "directly suppressive" effects of methylprednisolone are based on the premise that receptor interactions of steroids are followed by immediate suppression of either the circadian secretion of cortisol or the constant rate recirculation of histamine-containing basophils that persists until inhibitory concentrations of methylprednisolone disappear. Methylprednisolone doses of 0, 10, 20, and 40 mg were given as the 21-succinate sodium salt in a balanced crossover study to six normal men. Plasma steroid concentrations and blood histamine were measured simultaneously. Both forms of methylprednisolone exhibited linear kinetic parameters. One dynamic model quantitates the baseline circadian pattern and the decline and return of cortisol with similar parameter estimates for all three dose levels. A similar model describes the monoexponential decline and the log-linear return to steady-state baseline of blood histamine. Similar inhibitory concentration values for both effects approximated the equilibrium dissociation constant of in vitro steroid receptor binding. The new models are more physiologically appropriate for these steroid effects than three other models that are commonly employed in pharmacodynamics. Steroid effects generally appear to be receptor mediated with either nongene immediate responses or gene-mediated delayed effects. These models allow quantitation of the rapid effects of steroids with simple equations and common fitted parameters for all steroid dose levels.