A diet enriched in longer chain omega-3 fatty acids reduced placental inflammatory cytokines and improved fetal sustainability of C57BL/6 mice.

Omega (n)-3 polyunsaturated fatty acids (PUFA) are important regulators of inflammatory response that may impact pregnancy outcome. The effects of breeding chow diets containing n-3 PUFA from either fish oil (FO) or soybean oil (SO) were investigated on tissue fatty acid composition, inflammatory cytokines and pregnancy outcome. Female C57BL/6 mice (7 weeks old) were fed FO or SO diets for 2 weeks before mating and throughout pregnancy. Animals were sacrificed before and during pregnancy at day 6.5, 12.5 and 18.5. The FO diet increased the incorporation of n-3 PUFA in placenta, with a concomitant decrease in the concentration of pro-inflammatory cytokines. The FO diet increased the mRNA expression of placental specific PUFA transporter, which coincided with accretion of n-3 PUFA in fetal brain. Sites of fetal resorption were noticeable in the SO group but not in the FO group. N-3 PUFA may improve fetal sustainability via altering cytokine levels.

Fatty acyl composition of lysophosphatidylcholine is important in atherosclerosis.

Atherosclerosis is a major cause of death for mankind. Although the pathophysiology of atherosclerosis is a complex and multifactorial process, growing body of evidence has identified phospholipids-mediated signaling as an important factor in the induction and progression of atherosclerosis. Lysophosphatidylcholine (LPC) is a major phospholipid in oxidized low-density lipoprotein, and is generally considered to be atherogenic. However, some studies have shown anti-atherogenic properties of LPC. The controversial findings surrounding the pro- or anti-atherogenic properties of LPC appear to be due to the chain length and the degree of saturation of the fatty acyl moiety of LPC. Studies have suggested that the presence of omega (n)-polyunsaturated fatty acids (PUFA) at the sn-1 position of LPC modulates the inflammatory response thereby making LPC anti-atherogenic. We have recently shown that feeding a diet high in n-3 PUFA resulted in the enrichment of LPC in both plasma and liver of C57BL/6 mice with n-3 PUFA. Others have also shown that supplementation with fish oil leads to preferential incorporation of n-3 PUFA into LPC. We also found that plasma obtained from mice fed a diet high in n-3 PUFA showed higher cholesterol efflux capacity compared to animals fed a low n-3 PUFA diet, despite no changes in high-density lipoprotein concentrations. We are therefore hypothesizing that n-3 PUFA enriched LPC has anti-atherogenic properties by promoting cholesterol efflux from macrophages and by reducing inflammation. Our anticipated long term objective is to establish that the fatty acyl moiety of LPC can be used as a potential biomarker for the risk of developing atherosclerosis. Validating this hypothesis would have a substantial impact on the public health with respect to early diagnosis of cardiovascular risks, and designing dietary based therapeutic strategies for the prevention and management of atherosclerosis and other heart related diseases.

Anaesthetists' attitudes to intraoperative death.

BACKGROUND AND OBJECTIVES: A recent survey in the British Medical Journal reported the attitudes of orthopaedic surgeons towards the intraoperative death of a patient. Several replies to this article were from anaesthetists, who pointed out that other staff might be affected by 'death on the table'. We designed a questionnaire survey to assess the attitudes of anaesthetists, concerning intraoperative death. METHODS: Three hundred anonymized questionnaires were distributed to 12 anaesthetic departments throughout England. RESULTS: Two hundred and fifty-one replies were received (84% response rate); 92% of respondents had experienced an intraoperative death, the majority of deaths being expected (60%) and non-preventable (77%), occurring mainly during emergency surgery (80%), particularly involving vascular surgery (41% of cases); 87% had administered another general anaesthetic in the following 24 h, most without their professional ability being compromised (77%). CONCLUSIONS: This survey shows that anaesthetists are highly likely to experience intraoperative death, the consequences of which can be extremely stressful. Although the majority of anaesthetists (71%) agreed that it was reasonable for medical staff not to take part in operations for 24 h after an intraoperative death, fewer (25%) thought the proposal practicable. Nevertheless, all departments should provide for the discontinuation of further operations, if the circumstances require it. Consideration should be given by all departments of anaesthesia towards the prevention of intraoperative death, and the management of its aftermath, including the provision of support for psychologically traumatized staff.

Nature's medicinal bounty: don't throw it away.

Plant-derived drugs have an important place in both traditional and modern medicine. For this reason a special effort to maintain the great diversity of plant species would undoubtedly help to alleviate human suffering in the long term. Proven agroindustrial technologies should be applied to the cultivation and processing of medicinal plants and the manufacture of herbal medicines.

PIP: About 80% of the world's people depend largely on traditional plant-derived drugs for their primary health care (PHC). Medicinal plants serve as sources of direct therapeutic agents and raw materials for the manufacture of more complex compounds, as models for new synthetic products, and as taxonomic markers. Some essential plant-derived drugs are atropine, codeine, morphine, digitoxin/digoxin, and quinine/artemisinin. Use of indigenous medicinal plants reduces developing countries' reliance on drug imports. Costa Rica has set aside 25% of its land to preserve the forests, in part to provide plants and other materials for possible pharmaceutical and agricultural applications. The Napralert database at the University of Illinois establishes ethnomedical uses for about 9200 of 33,000 species of monocotyledons, dicotyledons, gymnosperms, lichens, pteridophytes, and bryophytes. Sales of crude plant drugs during 1985 in China equaled US$1400 million. Even though many people use medicinal plants, pharmaceutical firms in industrialized nations do not want to explore plants as sources of new drugs. Scientists in China, Germany, and Japan are doing so, however. Screening, chemical analysis, clinical trials, and regulatory measures are needed to ensure safety of herbal medicines. WHO has hosted interregional workshops to address methodologies for the selection and use of traditional medicines in national PHC programs. WHO, the International Union for the Conservation of Nature and Natural Resources, and the World Wide Fund for Nature developed guidelines for conservation of medicinal plants. Their 2-pronged strategy includes prevention of the disappearance of forests and associated species and the establishment of botanical gardens. WHO's Traditional Medicine Programme hopes that people will apply known and effective agroindustrial technologies to the cultivation and processing of medicinal plants and the production of herbal medicines and the creation of large-scale networks for the distribution of seeds and plants.

WHO and the development of acupuncture nomenclature: overcoming a Tower of Babel.

At present, WHO does not have an official policy on acupuncture. The Organization's policies are usually developed after a debate has taken place on a particular health issue. There has not yet been a debate on acupuncture. This paper reviews WHO's efforts to produce a standard acupuncture nomenclature as a first step towards ensuring that a debate on acupuncture takes place in an atmosphere of greater understanding of the contribution that acupuncture can make in the delivery of health care. Activities that the programme for traditional medicine hopes to implement in the coming years are outlined.

The best of both worlds: bringing traditional medicine up to date.

If there is to be any real improvement in the health of the underserved populations of the world, there will have to be full utilization of all available resources, human and material. This is fundamental to the primary health care approach. Traditional practitioners constitute the most abundant and, in many cases, valuable health resources present in the community. They are important and influential members of their communities who should be associated with any move to develop health services at the local level. There have been varying responses to a number of key WHO resolutions that call on Member States to develop traditional medicine activities as part of their national health services. Some aspects of the work of WHO Collaborating Centres for Traditional Medicine and some current activities of the traditional medicine programme are described. A number of guiding principles which may help the Organization and other international and donor agencies working in this area are also suggested.

Medicinal plants in therapy.

One of the prerequisites for the success of primary health care is the availability and use of suitable drugs. Plants have always been a common source of medicaments, either in the form of traditional preparations or as pure active principles. It is thus reasonable for decision-makers to identify locally available plants or plant extracts that could usefully be added to the national list of drugs, or that could even replace some pharmaceutical preparations that need to be purchased and imported. This update article presents a list of plant-derived drugs, with the names of the plant sources, and their actions or uses in therapy.

WHO's traditional medicine programme: progress and perspectives.

PIP: An early objective of the World Health Organization's (WHO) traditional medicine program was to promote a realistic approach to the subject. The realism with which countries around the world, both developed and developing, examine their own traditional practices suggests that progress is being made towards this goal. The current challenge is to pursue action along 3 lines: evaluation, integration, and training. In traditional medicine it is necessary to separate myth from reality so that valid practicies and remedies can be distinguished from those that are patently ineffective and/or unsafe. Thus, WHO will continue to promote the development, teaching, and application of analytical methods that can be used to evaluate the safety and efficacy of various elements of traditional medicine. Action need not await the results of formal evaluation. Efforts can be initiated now to synthesize traditional and modern medicine. Several countries have attempted such a synthesis. For example, medical curricula in China include elements of Chinese medicine such as acupuncture, moxibustion, manipulation and massage, relaxation, and herbal medicine. A critical training need is to incorporate in the curricula of conventional health workers certain traditional practices and remedies that have been evaluated and proven safe and effective. Traditional practitioners also require training. They need to be provided with additional skills. It is essential to make practitioners of traditional medicine allies rather than competitors. The training of traditional birth attendants in aseptic delviery techniques and simple antenatal and postpartum care provides a good example of the possibilities that exist for collaboration between the traditional and modern health care sectors. In the past 2 years WHO has carried out numerous activities in the field of traditional medicine. For example, among the activities coordinated by WHO headquarters was the continuing search for indigenous plants for fertility regulation in men and women. In 1983, WHO collaboration centers for traditional medicine continued to strengthen national efforts in research and development. A prerequisite for the success of primary health care is the availability and use of suitable drugs. It is reasonable for decision makers to identify locally available plants or plant extracts that could usefully be added to the national list of durgs or that could even replace some pharmaceutical preparations that need to be purchased and imported. NAPRALERT (for national products alert) is a computerized database derived primarily from scientific information gathered from the world literature on the chemistry, pharmacology, and ethnopharmacology of natural plant products. It can provide both a general profile on a designated plant and a profile on the biological effects of a chemical constituent thereof. A valuable feature of the NAPRALERT database is its ability to generate information on plants from a given geographical area.^ieng