Gestational diabetes alters the fetal heart rate variability during an oral glucose tolerance test: a fetal magnetocardiography study.

OBJECTIVE: Gestational diabetes mellitus (GDM) potentially harms the child before birth. We previously found GDM to be associated with developmental changes in the central nervous system. We now hypothesise that GDM may also impact on the fetal autonomic nervous system under metabolic stress like an oral glucose tolerance test (OGTT). DESIGN: We measured heart rate variability (HRV) of mothers and fetuses during a three-point OGTT using fetal magnetocardiography (fMCG). SETTING: Measurements were performed in the fMEG Centre in Tübingen. POPULATION: After exclusion of 23 participants, 13 pregnant women with GDM and 36 pregnant women with normal glucose tolerance were examined. METHODS: All women underwent the same examination setting with OGTT during which fMCG was recorded three times. MAIN OUTCOME MEASURE(S): Parameters of heart rate variability were measured. RESULTS: Compared with mothers with normal glucose regulation, mothers with GDM showed increased heart rate but no significant differences of maternal HRV. In contrast, HRV in fetuses of mothers with GDM differed from those in the metabolically healthy group regarding standard deviation normal to normal beat (SDNN) (P = 0.012), low-frequency band (P = 0.008) and high-frequency band (P = 0.031). These HRV parameters exhibit a decrease only in GDM fetuses during the second hour of the OGTT. CONCLUSIONS: These results show an altered response of the fetal autonomic nervous system to metabolic stress in GDM-complicated pregnancies. Hence, disturbances in maternal glucose metabolism might not only impact on the central nervous system of the fetus but may also affect the fetal autonomic nervous system. TWEETABLE ABSTRACT: Metabolic stress reveals a different response of fetal autonomic nervous system in GDM-complicated pregnancies.

A comparison of SNAP II and bispectral index monitoring in patients undergoing sedation.

Clinical signs and patients' verbal responses have traditionally been used to assess patients' comfort and the depth of sedation. Recently, level-of-consciousness monitors have been used to guide sedation. The SNAP II(c) is a single-lead electroencephalogram device that displays a SNAP(c) Index - a derived value based on both high and low frequency electroencephalogram signals. Much of the current clinical research on monitoring during sedation involves the bispectral index monitor. We compared simultaneous readings recorded by the SNAP II and bispectral index during sedation in 51 consecutive patients undergoing surgery. The anaesthesia team was blinded to the SNAP II and bispectal index values. Concurrent SNAP II and bispectral index readings displayed similarly-shaped trajectories during sedation, but further studies are needed to establish the routine clinical utility of both these monitors.

A flow cytometric immune function assay for human peripheral blood dendritic cells.

CD11c+ and CD11c- (CD123+) dendritic cells (DCs) have been described in blood. Both cell types express high levels of HLA-DR and lack the lineage markers CD3, CD14, CD19, CD20, CD16, and CD56. These immunophenotypic properties were used along with analysis of activation-related surface antigens and intracellular staining of cytokines to characterize functional responses of these DC subsets to stimuli in whole human blood (WB). Samples from healthy donors were activated with lipopolysaccharide (LPS) or phorbol 12-myristate 13-acetate plus ionomycin (PMA+I). The only distinct response in CD11c- DCs was the expression of CD25 upon PMA+I activation. CD11c+ cells responded to LPS stimulation by producing high levels of interleukin-1beta (IL-1beta) and tumor necrosis factor alpha (TNF-alpha), and lower levels of IL-6, IL-1Ra, and IL-8 and an increased expression of accessory molecules (CD25, CD40, CD80, CD86, HLA-DR, and HLA-DQ). PMA+I activation of CD11c+ cells resulted in high levels of IL-1beta and lower levels of IL-8, IL-1Ra, and TNF-alpha and up-regulation of CD80, CD86, HLA-DR, and HLA-DQ. Our data support prior observations of functional differences between peripheral blood DC subsets and demonstrate the power of multiparameter flow cytometry to characterize the pleiotropic responses of these cells to various stimuli.

Exercise in rats with liver injury induced by carbon tetrachloride or bile duct obstruction. Blood cholic acid and liver histology.

UNLABELLED: Tolerance of exercise in rats with liver injury was evaluated by the response of plasma cholylglycine (CG) and by liver histology in two experiments with CCl4 hepatocellular damage and in two other experiments with cholestatic liver injury induced by obstruction of the common bile duct. (1) Rats swimming daily for 1 h while exposed to five successive doses of CCl4 and studied at rest, had a trend (P less than 0.06) to higher CG and a higher plasma SGPT (P less than 0.05) than sedentary CCl4 rats. (2) In rats recovering from four successive doses of CCl4 there were no differences between CG curves before, during, and after exercise, except at 48 h of recovery when exercise elevated CG (P less than 0.05). (3) Sixteen days after ligation of the bile duct CG was high but not affected by exercise, 45 days after ligation exercise resulted in further increase of CG (P less than 0.05). (4) When ligation of the bile duct lasted only 24 h, exercise prior to release of the obstruction did not affect CG. Exercise 8 h and 27 h after release of ligation resulted in an increase in CG (P less than 0.05). Return to pre-exercise CG occurred 30 min after exercise. CONCLUSION: CG was a useful indicator of liver injury showing a positive correlation with the CCl4 dose and a negative correlation with recovery from CCl4. Exercise had only mildly adverse effect in hepatotoxic and cholestatic liver injury. CG appeared to respond more sensitively to exercise after release of bile duct obstruction than in CCl4 hepatocellular injury.