Sleep disturbance in patients taking opioid medication for chronic back pain.

Poor sleep is an increasingly recognised problem with chronic pain and further increases the effect on daily function. To identify the relationship between chronic pain, opioid analgesia and sleep quality, this study investigated activity and sleep patterns in patients taking opioid and non-opioid analgesia for chronic back pain. Thirty-one participants (10 healthy controls, 21 patients with chronic pain: 6 on non-opioid medication; 15 on opioid medication) were assessed using actigraphy, polysomnography and questionnaires. Patients with chronic pain subjectively reported significant sleep and wake disturbances as shown by decreased overall sleep quality (Pittsburgh Sleep Quality Index, p < 0.001), increased symptoms of insomnia (Insomnia Severity Index, p < 0.001) and increased fatigue (Fatigue Severity Scale, p = 0.002). They also spent increased time in bed (p = 0.016), took longer to get to sleep (p = 0.005) and had high interindividual variability in other measures of activity but no overall irregular rest-activity pattern. Patients on high doses of opioids (> 100 mg morphine-equivalent/day) demonstrated distinctly abnormal brain activity during sleep suggesting that polysomnography is necessary to detect sleep disturbance in this population in the absence of irregular rest-activity behaviour. Night-time sleep disturbance is common in individuals suffering from chronic pain and may be further exacerbated by opioid treatment. Considerations must be made regarding the appropriate use of combined actigraphy and miniaturised polysomnography for future population-based studies.

Consent and privacy in pharmacogenetic testing.

The clinical use of pharmacogenetic drugs will require that a sample of a patient's DNA be tested before a drug is prescribed. Although pharmacogenetic tests pose fewer risks than genetic tests for disease mutations, they might still reveal personal information that could be used adversely to a patient's interests. Informed consent and privacy of pharmacogenetic test results may be essential in most clinical uses of pharmacogenetic drugs.

The CANDU Reactor System: An Appropriate Technology.

CANDU power reactors are characterized by the combination of heavy water as moderator and pressure tubes to contain the fuel and coolant. Their excellent neutron economy provides the simplicity and low costs of once-through natural-uranium fueling. Future benefits include the prospect of a near-breeder thorium fuel cycle to provide security of fuel supply without the need to develop a new reactor such as the fast breeder. These and other features make the CANDU system an appropriate technology for countries, like Canada, of intermediate economic and industrial capacity.

Application of electron spin resonance spectroscopy and spin probes to investigate the effect of ingredients on changes in wheat dough during heating.

The change in microviscosity of the aqueous and lipid phases of wheat flour dough, during heating and subsequent cooling, has been measured using novel spin probes based on the isoindolin-yloxyl structure. The spin probes, water and/or lipid soluble, were used with combinations of dough ingredients: diacetyl tartaric acid ester of monoglycerides (DATEM), salt, yeast, and sodium ascorbate. The lipid soluble probe showed that DATEM does not produce a homogeneous phase with endogenous lipids but is found in a separate, less mobile phase. Also, the lipids were shown not to be involved in the baking process, although DATEM may be incorporated into the gelled starch matrix. The water soluble probe enabled starch gelatinization to be investigated in detail and showed that gelatinization produces a reduction of dielectric constant. The technique is appropriate for the detailed examination of the behavior of different ingredients during baking and also potentially to examine interactions between ingredients and flour components in dough.

Increased intestinal uptake of cobalamin in pregnancy does not require synthesis of new receptors.

Increased intrinsic factor cobalamin binding to receptors present in ileal mucosa from mice in the late stages of pregnancy is regulated by placental lactogen. In mice at day 18-20 of pregnancy given an intraperitoneal injection of cycloheximide, 0.5 mg/kg, receptor binding was reduced from 0.42 ng/mg protein to 0.18 ng/mg protein 4 h later. Intestinal mucosal protein synthesis was less than 20% of control values after this dose of cycloheximide. Although this result could be interpreted to mean that the increase in receptors in pregnancy was due to new protein synthesis, cycloheximide-treated mice also had reduced concentrations of placental lactogen in serum. Supplementation with the hormone in cycloheximide-treated mice maintained receptor binding at pregnant levels. Analysis of binding data showed receptor number to be 3.1 X 10(11)/mg protein and the binding constant (Ka) to be 0.5 X 10(12) M-1, which were similar to values found in untreated pregnant mice. It is concluded that, because the increase in receptors cannot be explained on the grounds of new protein synthesis, placental lactogen may recruit cryptic intrinsic factor cobalamin receptors.

Structural and regulatory analysis of the male-specific rat liver cytochrome P-450 g: repression by continuous growth hormone administration.

Complementary DNA clones encoding the male-specific rat liver cytochrome P-450 g have been isolated by cross-hybridization with sequences from the female-specific rat liver cytochrome P-450 15 beta. Tissue distribution analysis indicates the liver as the organ with major expression of this cytochrome P-450 gene. Minimal P-450 g expression was also detected in prostate, kidney, heart, and brain. A developmental analysis reveals liver expression in the 8-week-old male and to a lesser extent in the 4-week-old male, but no detectable expression is seen in females of these ages or in 1- and 2-week-old rats from both sexes. Hypophysectomy of female rats dramatically increases hepatic expression of P-450 g, whereas continuous GH administration represses hepatic expression in male or female hypophysectomized rats. In similarity to P-450 15 beta and P-450 16 alpha, therefore, the cytochrome P-450 g gene in liver is GH regulated.

Growth hormone pretranslationally regulates the sexually dimorphic expression of the prolactin receptor gene in rat liver.

The female-specific expression of the rat liver PRL receptor (PRL-R) gene was investigated by Northern analysis of hypophysectomized rats after two alternative human GH treatments that were to mimic either 1) the continuous female-specific or 2) the discontinuous male-specific serum GH patterns. The former (female-specific) pattern was shown to result in a dramatic increase in PRL-R mRNA in both males and females, while the latter (male-specific) pattern failed to evoke this response. A similar inductive effect in hypophysectomized females was shown after continuous administration of bovine GH and was found to constitute an approximately 60-fold increase in PRL-R mRNA levels. This effect by bovine GH, which, unlike the human isoform, is devoid of lactogenic properties, thus indicates the somatogenic origin of the signal resulting in this inductive response. These observations in conjunction with previous data obtained for other GH-regulated nonreceptor genes are interpreted to support the proposal of GH serum patterns being an early signal in a more general mechanism for pretranslational regulation of sex-specific gene expression. In contrast to GH, only a slight elevation of PRL-R mRNA was evoked by the ligand ovine PRL, while coadministration of ovine PRL with bovine GH failed to enhance the mRNA level found with bovine GH alone. The detection of previously unreported PRL-R mRNAs in liver of approximately 3.0, 3.8, and 5 kilobases in addition to the major 2.2-kilobase form was also evident after continuous GH administration.

Estradiol up-regulates estrogen receptor messenger ribonucleic acid in endometrial carcinoma (Ishikawa) cells by stabilizing the message.

Estrogens up-regulate expression of the estrogen receptor alpha (ER) gene in most mammalian tissues studied. Using the ovariectomized ewe as a model, we determined that estradiol (E(2)) acted post-transcriptionally to increase endometrial ER mRNA concentrations by enhancing the stability of the message. The purpose of this study was to determine whether a similar E(2) effect occurs in Ishikawa cells, a well-differentiated human endometrial adenocarcinoma cell line. The presence and function of ER protein in Ishikawa cells was demonstrated by transactivation of a transfected plasmid (ERE(2)tkCAT) in response to 10(-)(9) M E(2), resulting in a 550% increase in reporter gene RNA. Ishikawa cells also responded to E(2) by up-regulating their ER mRNA concentration an average of 100% between 7 and 24 h of treatment. The effect of E(2) on ER mRNA stability was measured after blocking transcription with actinomycin D to find that the half-life increased from 6 to 10 h in control and E(2)-treated cells respectively. These results are consistent with cell-free studies which showed significant enhancement of the half-life of radiolabeled ER 3' untranslated region (3'UTR) RNA in extracts from E(2)-treated cells versus those from control cells. Thus, Ishikawa cells provide a relevant model system for the study of E(2)-regulated endometrial gene expression.

Characterisation of the binding capacities and affinities of wheat bran, fruit and vegetable fibres for MeIQx, before and after fermentation.

Binding capacities and affinities of dietary fibres and fermented fibre residues for MeIQx are much higher for brans than for fruit and vegetable fibres. Bran residues concentrated distally in the colon would provide a substantial binding matrix. Small intestinal conditions are not so conducive to hydrophobic adsorption.

Efficacy and side effects of intermittent intravenous and oral doxercalciferol (1alpha-hydroxyvitamin D(2)) in dialysis patients with secondary hyperparathyroidism: a sequential comparison.

Most reports on the effectiveness and side effects of oral versus parenteral calcitriol or alfacalcidol in hemodialysis patients with secondary hyperparathyroidism show no advantage of parenteral treatment. The efficacy and safety of intravenous doxercalciferol (1alphaD(2)) were studied in hemodialysis patients with secondary hyperparathyroidism (plasma intact parathyroid hormone [iPTH]: range, 266 to 3,644 pg/mL; median, 707 pg/mL). These results were compared with those of a previous trial using intermittent oral 1alphaD(2); the same 70 patients were entered onto both trials, and 64 patients completed both trials per protocol. Twelve weeks of open-label treatment in both trials were preceded by identical 8-week washout periods. Degrees of iPTH suppression from baseline were similar in the two trials, with iPTH level reductions less than 50% in 89% and 78% of patients during oral and intravenous treatment, respectively. Grouping patients according to entry iPTH levels (<750 and >/=750 pg/mL) showed similar but more rapid iPTH suppression in the low-iPTH groups, whereas longer treatment and larger doses were required by the high-iPTH groups. Highest serum calcium levels averaged 9.82 +/- 0.14 and 9.67 +/- 0.11 mg/dL during oral and intravenous 1alphaD(2) treatment, respectively (P: = not significant [NS]). Prevalences of serum calcium levels greater than 11.2 mg/dL during oral and intravenous treatment were 3.62% and 0.86% of calcium measurements, respectively (P: < 0.001). Highest serum phosphorus levels during oral and intravenous treatment averaged 5.82 +/- 0.21 and 5.60 +/- 0.21 mg/dL, respectively (P: = NS). The percentage of increments in serum phosphorus levels during oral treatment exceeded that during intravenous treatment during 5 of 12 treatment weeks. Thus, intermittent oral and intravenous therapy with 1alphaD(2) reduced iPTH levels effectively and similarly, hypercalcemia was less frequent, and serum phosphorus levels increased less during intravenous than oral 1alphaD(2) therapy, suggesting that intravenous 1alphaD(2) therapy may be advantageous in patients prone to hypercalcemia or hyperphosphatemia.

Intermittent doxercalciferol (1alpha-hydroxyvitamin D(2)) therapy for secondary hyperparathyroidism.

Hypercalcemia and hyperphosphatemia frequently necessitate vitamin D withdrawal in hemodialysis patients with secondary hyperparathyroidism. In short-term trials, doxercalciferol (1alpha-hydroxyvitamin D(2) [1alphaD(2)]) suppressed intact parathyroid hormone (iPTH) effectively with minimal increases in serum calcium and phosphorus (P) levels. This modified, double-blinded, controlled trial examined the efficacy and safety of 1alphaD(2) use in 138 hemodialysis patients with moderate to severe secondary hyperparathyroidism by using novel dose titration; 99 patients completed the study. Hemodialysis patients with secondary hyperparathyroidism were enrolled onto this study, consisting of washout (8 weeks), open-label 1alphaD(2) treatment (16 weeks), and randomized, double-blinded treatment with 1alphaD(2) or placebo (8 weeks). Oral 1alphaD(2) was administered at each hemodialysis session, with doses titrated to achieve target iPTH levels of 150 to 300 pg/mL. Baseline iPTH levels (897 +/- 52 [SE] pg/mL) decreased by 20% +/- 3.4% by week 1 (P: < 0.001) and by 55% +/- 2.9% at week 16; iPTH levels returned to baseline during placebo treatment but remained suppressed with 1alphaD(2) treatment. In 80% of the patients, iPTH level decreased by 70%, reaching the target level in 83% of the patients. Grouping patients by entry iPTH level (<600, 600 to 1,200, and >1,200 pg/mL) showed rapid iPTH suppression in the group with the lowest level; greater doses and longer treatment were required in the group with the highest level. During open-label treatment, serum calcium and P levels were 9.2 +/- 0.84 (SD) to 9.7 +/- 1.05 mg/dL and 5.4 +/- 1.10 to 5.9 +/- 1.55 mg/dL, respectively. During double-blinded treatment, serum calcium levels were slightly greater with 1alphaD(2) than placebo, but P levels did not differ. During double-blinded treatment, 3.26% and 0.46% of serum calcium measurements exceeded 11.2 mg/dL with 1alphaD(2) and placebo, respectively (P: < 0.01); median level was 11.6 mg/dL during hypercalcemia. Intermittent oral 1alphaD(2) therapy effectively suppresses iPTH in hemodialysis patients with secondary hyperparathyroidism, with acceptable mild hypercalcemia and hyperphosphatemia.

Identification and quantification of ureaplasmas colonizing the respiratory tract and assessment of their role in the development of chronic lung disease in preterm infants.

BACKGROUND: The role of Ureaplasma urealyticum in the development of chronic lung disease (CLD) in preterm infants continues to be disputed. Recently U. urealyticum has been found to consist of two species, U. urealyticum and Ureaplasma parvum, a finding that has not been considered in previous studies of CLD. This study examined the possible relationships between development of CLD and respiratory colonization by these newly redefined species, their concentrations in lower respiratory secretions and the effect of pulmonary surfactant treatment on these relationships in preterm infants with birth weights < 1500 g. METHODS: Endotracheal aspirates (ETA) were collected from intubated infants when airway suctioning was medically required. ETA were stored at -80 degrees C until quantitative cultures for ureaplasmas and Mycoplasma hominis were performed. Culture results were correlated with development of CLD. RESULTS: Of 475 infants (birth weights < 1500 g) admitted during the 2-year study period, 272 were excluded because they were not intubated or were extubated before ETA could be obtained. An additional 28 infants died, were discharged or were transferred before they could be assessed for CLD. From the remaining 175 infants ureaplasmas were isolated from 66 (38%). No statistically significant associations were identified between development of CLD and the Ureaplasma species isolated, or concentration of ureaplasmas in lower respiratory secretions. These findings were not altered by treatment with pulmonary surfactant (Survanta). CONCLUSION: Lower respiratory colonization by ureaplasmas does not appear to be a contributory cause of CLD in preterm infants.

Tamoxifen up-regulates oestrogen receptor-alpha, c-fos and glyceraldehyde 3-phosphate-dehydrogenase mRNAs in ovine endometrium.

Tamoxifen, the antiestrogen most widely used in medicine, was tested in ewes to determine whether it antagonizes oestradiol up-regulation of ER, PR, and other genes reported to be oestrogen-modulated (c-fos, oxytocin receptor (OTR), glyceraldehyde phosphate dehydrogenase (GAPDH), and apolipoprotein AI (apo AI)) in endometrium and liver. Ovariectomized ewes (n = 6 ewes per group) were injected with 20 mg tamoxifen (Tam) 24 h prior to tissue collection, 50 microg oestradiol (E2) 18 h prior to tissue collection, both drugs (T + E2) or drug vehicle (Con). E2 treatment resulted in 857 +/- 93 pg oestradiol/g endometrium. Gross uterine characteristics of Tam- and T + E2-treated ewes were intermediate to those in Con and E2 groups. In endometrium, Tam treatment mimicked E2 treatment in up-regulating ER, c-fos, and GAPDH mRNAs two- or three-fold. However, neither E2 nor Tam treatments affected concentrations of OTR mRNA in endometrium, or ER, c-fos, GAPDH, OTR and apo AI mRNAs in liver. Like oestradiol, tamoxifen stabilized endometrial ER mRNA more than 3-fold in endometrial explants cultured with the transcription inhibitor 5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole (DRB). Thus, tamoxifen acts as an oestradiol agonist in ovine endometrium and shares a posttranscriptional mechanism with oestradiol in the up-regulation of ER gene expression.

ICI 182,780 acts as a partial agonist and antagonist of estradiol effects in specific cells of the sheep uterus.

We assessed the ability of ICI 182,780 (ICI) to block the estradiol (E2) responses of genes within the sheep uterus. Ovariectomized ewes in the 'ICI+E2' treatment group received a uterine infusion with 10(-7) M ICI for 14 h, an injection of 50 microg E2 6 h after the infusion started, and were hysterectomized 18 h postinjection. Other groups received only ICI or E2, or neither treatment ('Con'). Both E2 and ICI increased the wet weight of dissected endometrium: averaging 10.0+/-1.2 g for ICI+E2, ICI, and E2 groups compared to 6.8+/-0.6 g for Con. Slot blot analyses of endometrial RNA showed that estrogen receptor-alpha (ER), progesterone receptor (PR), glyceraldehyde 3-phosphate dehydrogenase (GAPDH), cyclophilin, actin and c-fos mRNAs responded to E2 treatment: the first five increased an average of 60% while the last decreased 38%. In situ hybridization identified more subtle ICI effects: agonistic up-regulation of GAPDH mRNA in superficial endometrial cells, and antagonistic down-regulation of ER and PR mRNAs in the inner layer of the myometrium. Thus, we conclude that the agonist versus antagonist effects of ICI relative to those of E2 are a function of the gene examined as well as the specific cell within the uterus.

Problems associated with serotyping strains of Ureaplasma urealyticum.

We sought to identify problems associated with serotyping Ureaplasma urealyticum, a human genital tract mycoplasma. We examined the results of serotyping isolates from cases of nongonococcal urethritis and asymptomatic controls and found no indication of correlation between serotype(s) and pathogenic potential. Reproducibility in serotype determination was generally good, i.e., overall agreement of 83% between primary and secondary plating and 87% on multiple, secondary cultures. We examined the reasons for variation in reproducibility and also the selection of a minor antigenic component in a culture. We provide no evidence of changes in the antigenicity of an isolate. We have indicated the means for standardizing reagents and the interpretation of results and have suggested improvements in methodology to allow more objective serotype determination.

Ethical and legal issues in human embryo donation.

OBJECTIVE: To identify main ethical and legal issues that arise with donation of embryos left over from IVF treatments of infertility or created from separate gamete donations. DESIGN: Analysis of ethical commentary, advisory committee reports, statutes, court cases, and legal commentary relating to gamete and embryo donation and assisted reproduction to assess their effect on donation of created or leftover embryos. RESULTS: Donation of surplus embryos or embryos created from separate gamete donations would help a subset of infertile couples to form families. A program undertaking embryo donation will have to coordinate the donation of embryos from its own patients or other programs or arrange for separate gamete donations to form embryos. The main ethical issues concern the effect on offspring, consent and counseling of donors and recipients, avoidance of mixing embryos or gametes from different sources, and payment of donor expenses. The main legal issues concern whether embryo donation is viewed as gamete donation or adoption; the rearing rights and duties of donors and recipients in resulting offspring; liability; and compensation issues; and the legality of monetary compensation for donors. Donation of embryos for research raises separate issues. CONCLUSION: Human embryo donation is an ethically and legally acceptable way for infertile couples to form families.

Alcohol, sex and risks of HIV infection.

A complex association between alcohol consumption and sexual behaviour has long since been established. During 1985 a survey of 335 young adults was conducted in South East Scotland. Information was elicited about sexual behaviour, alcohol and other psychoactive drug use. The results indicate that amongst both males and females, age of first sexual intercourse was positively associated with age of first alcohol use, as well as with current use of tobacco and illicit drugs. Respondents who had consumed alcohol immediately prior to first sexual intercourse were markedly less likely than others to have used condoms or other forms of contraception. It is concluded that the use of alcohol and other drugs has clear relevance to unprotected sexual activities and the spread of HIV infection. Future health education should give due weight to this connection.

The growth response of Mycoplasma hyopneumoniae and Mycoplasma flocculare based upon ATP-dependent luminometry.

Cultures of Mycoplasma hyopneumoniae and M. flocculare in Friis' broth grew faster and to higher titers in air than in 8% CO2; cultures in air grew better when shaken than when stationary. Under the optimal conditions, both species have generation times of about 10 h and achieve maximum titers of at least 10(9) organisms per ml. Maximum growth was reached near pH 7.0, before the phenol red indicator had noticeably changed colour. Changes in growth were readily detected by an ATP assay based upon the luciferin-luciferase reaction. Concentrations of ATP fell rapidly after peak growth. Although the addition of 27 mM glucose to the medium did not change the pattern of growth and gas chromatography gave no evidence of the production of volatile or non-volatile end-products, washed harvested cells of both species metabolized [14C]-glucose. The addition of 29 mM arginine to the medium inhibited growth.