Endocan: A biomarker for endothelial dysfunction and inflammation, linking maternal obesity and pediatric obesity in a cohort of preterm neonates.

OBJECTIVES: Numerous animal and epidemiologic studies have demonstrated a positive association between maternal obesity in pregnancy and obesity in offspring. The biologic mechanisms of this association remain under investigation. One proposed mechanism includes fetoplacental endothelial dysfunction secondary to inflammation. Endocan is a relatively new biomarker for endothelial dysfunction and inflammation. Our objectives were to examine (1) the association between maternal obesity and neonatal serum endocan at birth, and (2) the association between neonatal serum endocan at birth and pediatric obesity at 24-36 months of age. STUDY DESIGN: This was a secondary analysis of a prospective cohort of neonates born < 33 weeks gestation. Serum endocan was collected within 48 hours of birth. Serum endocan levels were compared in neonates born to obese mothers vs. those born to non-obese mothers. BMI data were retrospectively collected from cohort neonates between 24 and 36 months of age. RESULTS: The analysis included 120 mother/neonate dyads. Neonates born to obese mothers had higher median serum endocan at birth compared to neonates born to non-obese mothers (299 ng/L [205-586] vs. 251 ng/L [164-339], p = 0.045). In a linear regression modeled on neonatal serum endocan level, maternal obesity had a statistically significant positive association (p = 0.021). Higher mean serum endocan level at birth was associated with pediatric obesity between 24 and 36 months (obese vs. non-obese offspring; 574 ng/L (222) vs. 321 ng/L (166), p = 0.005). CONCLUSIONS: In our cohort of preterm neonates, elevated serum endocan at birth was associated with both maternal obesity and downstream pediatric obesity. More research is needed to understand intergenerational transmission of obesity. A large focus has been on epigenetic modification. Endothelial dysfunction and inflammation may play important roles in these pathways. Effective biomarkers, including endocan, may also serve as intermediate outcomes in future pregnancy research.

The effect of health status on patients' satisfaction with out-of-hours care provided by a family doctor co-operative.

BACKGROUND: Systems for providing primary care outside normal hours have changed significantly in Europe over the last 20 years. The impetus for this change has come almost entirely from the medical profession, and it is important to consider the patients' perspective. Although patient's satisfaction with out-of-hours care has been studied extensively, the effect of patient's health status on satisfaction level has not been examined previously. OBJECTIVES: The primary objective of this study was to investigate whether health status has an influence on patient satisfaction with out-of-hours care provided by a family doctor co-operative. The secondary objective of this study was to investigate the impact of age, gender, socio-economic status and call outcome on patients' satisfaction with out-of-hours care. METHODS: All patients contacting the service over a designated 24 day period were forwarded a postal questionnaire. Health status was recorded using the Short Form-12 (SF-12) health survey. Patients' satisfaction was measured by using a version of the McKinley questionnaire. RESULTS: The response rate was 55% (531 out of 966). Overall satisfaction levels were high, with 88% of patients rating the service as either excellent or good. Logistic regression, modelling for the simultaneous effects of age, gender, socio-economic status, call outcome and health status on overall satisfaction, found that patients with lower physical and mental health status scores were significantly less likely to be satisfied with their out-of-hours care [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07, P = 0.017; and 1.03, 95% CI 1.00-1.06, P = 0.046, respectively]. Patients with higher socio-economic status were also significantly less likely to be satisfied (OR 0.25, 95% CI 0.11-0.55, P = 0.001). Patient's age and gender, and call outcome did not significantly affect overall satisfaction levels. CONCLUSION: Family doctor co-operatives have significantly altered the way out-of-hours care is delivered. Patients with lower health status are significantly less likely to be satisfied with this new form of out-of-hours care. This finding has important implications for the future planning of out-of-hours primary care services.

The influence of medical and legal authorities on deaths facilitated by physicians.

This study investigated whether two widely publicized cases of deaths facilitated by physicians were followed by significant peaks in mortality. In March, 1991, Timothy Quill, MD, published a controversial editorial describing the physician-assisted suicide (PAS) of his 45-year-old, female leukemia patient. In a landmark decision in December 1990, the Missouri Supreme Court allowed removal of life support for Nancy Cruzan, a comatose accident victim. Correcting for trends and seasonal fluctuations, the authors examined: (1) U.S. leukemia mortality in the period centered on Quill's editorial, and (2) mortality from accident/coma combinations in the period centered on the Missouri Supreme Court's decision on Cruzan. Female leukemia deaths rose 11.3% above the expected rate (p < .01) just after Quill's article was published. The more closely the decedent matched Quill's patient, the greater the peak, with the largest peak (33.9%) evident for female leukemia patients in their 40s, who were long-term residents of smaller communities (p < .05). Five possible explanations for the findings were assessed, leading to the conclusion that Quill's editorial elicited an increase in mortality. The involvement of physicians in this increase is supported by analysis of the Cruzan case. This showed a mortality peak of 57% for accident/coma patients following the court decision.

Ping-pong ball plombage for right postpneumonectomy syndrome in children.

BACKGROUND/PURPOSE: Right postpneumonectomy syndrome is a rare complication of pneumonectomy characterized by exertional dyspnea resulting from mediastinal shift into the empty hemithorax. Historically, this problem has been treated with thoracoplasty, muscle flap transposition, pericardial fixation, and plombage using a variety of materials. Significant postoperative complications have been reported with each of these methods. In an effort to avoid the problems known to be associated with other plombage materials, we have used sterilized ping-pong balls as plombage to treat the postpneumonectomy syndrome. METHODS: Two children with pneumonectomy syndrome were treated with ping-pong ball plombage. RESULTS: Symptoms improved immediately in both patients and postoperative chest x-rays in each showed a normal cardiac position. Neither child had a postoperative complication. Six-year follow-up chest films in both children have demonstrated some fluid filling of the ping-pong balls, but no clinical problems attributable to them have been noted. CONCLUSION: The authors conclude that ping-pong ball plombage appears to be a viable management option in children with right postpneumonectomy syndrome.

Cell-mediated and humoral immunity to chick type II collagen and its cyanogen bromide peptides in guinea-pigs.

Cell-mediated immunity (CMI) to chick type II collagen and its cyanogen bromide (CB) peptides was studied in guinea-pigs using cutaneous delayed hypersensitivity reactions. Responses were largely independent of molecular conformation in animals immunized with either native or denatured collagen, and reactions obtained with CB peptides 8, 9, 10 and 12 suggested that sites in the central regions of collagen chains were recognized in CMI. Antibodies to collagen were detected by haemagglutination and immunofluorescence only in animals immunized with native molecule and not in animals immunized with denatured or CB-digested material. Humoral and CMI responses were similar in that neither recognized the pepsin-labile non-helical regions of the molecule. The responses differed in that humoral reactions were conformation-dependent and type-specific and CMI reactions were not.

Effect of excising Freund's adjuvant granuloma on subsequent development of experimental allergic arthritis.

Rabbits were immunized with antigen in Freund's complete adjuvant. Several weeks later the granuloma which developed was excised one day before joint challenge with antigen. The subsequent development of experimental allergic arthritis (EAA) was not affected, which argues against the chronicity of the disease being maintained by continuous recruitment of mycobacterial debris to EAA joints.

The non-passage of mycobacteria from Freund's complete adjuvant granuloma depots to arthritic joints.

The intra-articular injection of antigen after immunization with that antigen in FCA, the mycobacterial component of which consisted of live M. avium or dead 125I-M. tuberculosis, resulted in identical chronic disease, experimental allergic arthritis. In the former case live mycobacteria could be isolated from the subcutaneous granuloma which developed at the injection site, and from arthritic joints into which 10 mug wet weight (equivalent of 2 mug dry weight) had been injected with this antigen. However, no mycobacteria could be isolated from other inflamed or normal joints. With 125I-labelled mycobacteria radioactive counting and radioautography clearly showed M. tuberculosis present in the subcutaneous granuloma but not in either injected or uninjected joints. The quantity of mycobacteria which could have been detected if present was estimated to be less than 1 mug dry weight. These results strongly suggest that mycobacteria do not travel from the granuloma depot to the arthritic joint, and that any mechanism one may consider to explain the chronicity of EAA cannot involve the physical presence of mycobacteria in the knee joint.