The misogyny of iron deficiency.

Anaemia is common, particularly in women and the commonest underlying cause, iron deficiency, is often overlooked. Anaemia is associated with increased morbidity and mortality in patients undergoing anaesthesia; however, women are defined as being anaemic at a lower haemoglobin level than men. In this narrative review, we present the history of iron deficiency anaemia and how women's health has often been overlooked. Iron deficiency was first described as 'chlorosis' and a cause of 'hysteria' in women and initial treatment was by iron filings in cold wine. We present data of population screening demonstrating how common iron deficiency is, affecting 12-18% of apparently 'fit and healthy' women, with the most common cause being heavy menstrual bleeding; both conditions being often unrecognised. We describe a range of symptoms reported by women, that vary from fatigue to brain fog, hair loss and eating ice. We also describe experiments exploring the physical impact of iron deficiency, showing that reduced exercise performance is related to iron deficiency independent of haemoglobin concentration, as well as the impact of iron supplementation in women improving oxygen consumption and fitness. Overall, we demonstrate the need to single out women and investigate iron deficiency rather than accept the dogma of normality and differential treatment; this is to say, the need to change the current standard of care for women undergoing anaesthesia.

Using cyanide to put noble gases inside C60.

After fullerenes are heated in the presence of a noble gas or an unreactive molecule at 650 degrees C and 3000 atm pressure, a small fraction of the fullerene molecules contain the atom or molecule. The incorporation fraction is greatly enhanced by adding potassium cyanide to the reaction mixture. The details of the preparation are described here.

The effect of maternal prolactin infusion during pregnancy on fetal adipose tissue development.

The present study determines whether maternal administration of prolactin (PRL) to dams promotes the abundance of the brown adipose tissue-specific uncoupling protein-1 (UCP1) in fetal and neonatal rat pups. Recombinant PRL (24 micro g/kg per day), or an equivalent volume of saline, were infused into dams (n=19 per group) throughout pregnancy from 12 h after mating. Interscapular brown adipose tissue was sampled either from fetuses at 19.5 days of gestation (term=21.5 days) or from neonatal rat pups at approximately 18 h after birth. The abundance of UCP1 was determined by immunoblotting on adipose tissue samples from individual pups and pooled from groups of pups. This analysis was complemented by immunocytochemistry on representative adipose tissue samples. Maternal PRL infusion resulted in a greater abundance of UCP1 in fetal rats at 19.5 days of gestation (control: 97.2+/-8.4% reference; PRL: 525.6+/-74.4% reference; P<0.001) and in neonates 18 h after birth. In contrast, the abundance of the outer mitochondrial membrane protein voltage-dependent anion channel was unaffected by PRL. Neonatal adipose tissue sampled from pups born to PRL-infused dams possessed fewer lipid droplets, but more UCP1, as determined by immunocytochemistry. Fetal, but not maternal, plasma leptin concentrations were also increased by maternal PRL administration. In conclusion, as rats are altricial, and the potential thermogenic activity of brown adipose tissue develops over the first few days of postnatal life, these changes prior to, and at the time of, birth implicate PRL in fetal and neonatal adipose tissue maturation.

Formation, isolation, spectroscopic properties, and calculated properties of some isomers of C(60)H(36).

Isomers of C(60)H(36) and He@C(60)H(36) have been synthesized by the Birch or dihydroanthracene reduction of C(60) and isolated by preparative high-pressure liquid chromatography. (3)He, (13)C, and (1)H NMR spectroscopic properties were then determined. A comparison of experimental chemical shifts against those computed using density functional theory (B3LYP) with polarized triple- and double-zeta basis sets for He and C,H, respectively, allowed provisional assignment of structure for several isomers to be made. Theoretical calculations have also been carried out to identify low-energy structures. The transfer hydrogenation method using dihydroanthracene gives a major C(60)H(36) isomer and a minor C(60)H(36) isomer with C(3) symmetry as determined by the (13)C NMR spectrum of C(60)H(36) and the (3)He NMR spectrum of the corresponding sample of (3)He@C(60)H(36). In view of the HPLC retention times and the (3)He chemical shifts observed for the Birch and dihydroanthracene reduction products, the two isomers generated by the latter procedure can be only minor isomers of the Birch reduction. A significant energy barrier apparently exists in the dihydroanthracene reduction of C(60) for the conversion of the C(3) and C(1) symmetry isomers of C(60)H(36) to the T symmetry isomer previously predicted by many calculations to be among the most stable C(60)H(36) isomers. Many of the (1)H NMR signals exhibited by C(60)H(36) (and C(60)H(18), previously reported) are unusually deshielded compared to "ordinary" organic compounds, presumably because the unusual structures of C(60)H(36) and C(60)H(18) result in chemical shift tensors with one or more unusual principal values. Calculations clearly show a relationship between exceptionally deshielded protons beta to a benzene ring in C(60)H(18) and C(60)H(36) and relatively long C-C bonds associated with these protons. The additional information obtained from 1D and 2D (1)H NMR spectra obtained at ultrahigh field strengths (up to 900 MHz) will serve as a critical test of chemical shifts to be obtained from future calculations on different C(60)H(36) isomers.

ATP transduces signals from ASGM1, a glycolipid that functions as a bacterial receptor.

The flagella of the Gram-negative bacterium Pseudomonas aeruginosa serve not only for motility but also to bind bacteria to the host cell glycolipid asialoGM1 (ASGM1) through the protein flagellin. This interaction triggers defensive responses in host cells. How this response occurs is unclear because ASGM1 lacks transmembrane and cytoplasmic domains and there is little information about the downstream effectors that connect ASGM1 ligation to the initiation of host defense responses. Here, we show that ASGM1 ligation promotes ATP release from the host cell, followed by autocrine activation of a nucleotide receptor. This response links ASGM1 to cytoplasmic signaling molecules and results in activation of phospholipase C, Ca(2+) mobilization, phosphorylation of a mitogen-activated protein kinase (Erk 1/2), and activation of mucin transcription. These results indicate that bacterial interaction with host cells can trigger autocrine nucleotide signaling and suggest that agents affecting nucleotide receptors may modulate host responses to bacteria.

Synthesis of fluorous fullerene adducts: reversible solubilization of fullerenes in perfluorinated solvents

Fullerene (C60) Diels-Alder adducts with perfluoroalkylated 1,3-cyclopentadiene (1a,b) were synthesized and studied. The perfluoroalkylated cyclopentadiene was found to be less reactive toward C60 than cyclopentadiene itself, possibly because of the electron-withdrawing effect of the side chain. Because of the same effect, the temperature of the retro-Diels-Alder reaction for the fluorinated adducts was lower (70 degrees C) than the reported value (95 degrees C) for the cyclopentadiene adducts of C60. Higher adducts of the fluorous diene and C60 were found to be soluble in perfluorohexane and to show visible partitioning between organic (toluene) and fluorous phases. Also, the Diels-Alder addition of the fluorous diene was accompanied by extensive oxidation of the fullerene core, as revealed by MALDI-TOF data.

The clamshell incision for bilateral pulmonary artery reconstruction in tetralogy of Fallot with pulmonary atresia.

BACKGROUND: Patients with tetralogy of Fallot/pulmonary atresia often have bilateral pulmonary artery lesions, including diminutive central and peripheral vessels, major aortopulmonary collaterals, and distortion from previous operations. Staged procedures through lateral thoracotomies and median sternotomies have traditionally been used for repair. METHODS: Between October 1993 and December 1995, 10 patients 3 months to 15 years old with complex tetralogy of Fallot/pulmonary atresia underwent repair via a clamshell approach. Nine had undergone a mean of 2.8 +/- 0.8 previous operations (range 1 to 4). Indications for operation were repair of pulmonary artery arborization anomalies in 10 (4 unilateral, 6 bilateral), with unifocalization in 6 (2 unilateral, 4 bilateral). RESULTS: Eight of 10 patients had concomitant complete repair. There were no deaths at a mean follow-up of 17.1 +/- 4.0 months (range 12 to 26). Mean ventilation time was 3.7 +/- 2.1 days (range 1 to 14) and hospital stay 8.7 +/- 4.6 days (range 4 to 19). At follow-up, the peak right ventricular/left ventricular pressure ratio in patients who received complete repair was 0.44 +/- 0.13 (0.30 to 0.67). One patient (10%) required reoperation because of pseudoaneurysm of the main pulmonary artery 14 months after repair, and one had successful stent placement because of recurrent left and right pulmonary artery stenosis 8 months after repair. Two infants who underwent complete unifocalization and central pulmonary artery reconstruction are awaiting completion of repair. CONCLUSIONS: The clamshell approach to complex tetralogy of Fallot/ pulmonary atresia provides simultaneous exposure of bilateral central and peripheral pulmonary artery lesions and intracardiac pathologic conditions. This procedure appears safe and may decrease the number of operations required to complete repair of tetralogy of Fallot/pulmonary atresia in selected patients.

Short-wavelength automated perimetry in low-, medium-, and high-risk ocular hypertensive eyes. Initial baseline results.

OBJECTIVE: To examine the relationship between the prevalence of short-wavelength sensitivity losses in the central 30 degrees visual field and risk factors for development of glaucomatous visual field loss in ocular hypertension. DESIGN: A modified Humphrey Field Analyzer was used to perform standard automated perimetry and short-wavelength automated perimetry (SWAP), which is a technique that isolates the activity of short-wavelength-sensitive ("blue") mechanisms. In addition, an assessment of the risk of developing glaucomatous visual field loss was determined, based on a validated model that utilized intraocular pressure, a family history of glaucoma, age, and the vertical cup-to-disc ratio. PATIENTS: Both eyes of 232 ocular hypertensive patients were examined and compared with results from an age-matched control group of normal subjects. Both ocular hypertensive patients and normal subjects had to have normal visual fields on standard automated perimetry, good visual acuity, and no evidence of other ocular or neurologic disease or surgery. Intraocular pressure in the ocular hypertensive patients was 21 mm Hg or greater OU (without medication), and it was less than 20 mm Hg OU in normal control subjects. RESULTS: Less than 10% of the low-risk ocular hypertensive eyes had a SWAP deficit, as compared with 20% of the moderate-risk and 33% of the high-risk ocular hypertensive eyes. Intraocular pressure and a family history of glaucoma showed no meaningful relationship with the prevalence of SWAP deficits, but both age and the vertical cup-to-disc ratio demonstrated a strong association with the SWAP abnormalities. CONCLUSIONS: The SWAP results that were found in the ocular hypertensive eyes were associated with other risk factors that have been reported to be predictive of the development of glaucomatous visual field loss, especially the vertical cup-to-disc ratio and age. These findings support the notion that the SWAP deficits represent early glaucomatous damage and may be related to early changes that occur at the optic nerve head.

Computerized topographic analysis of the healing graft after penetrating keratoplasty for keratoconus.

After penetrating keratoplasty, visual rehabilitation can be slow and is largely a function of corneal surface configuration. Computerized topographic analysis allows the detailed study of corneal surface factors that determine the optical function of the graft. We performed a prospective, longitudinal study of eight patients with keratoconus by using computerized topographic analysis to determine the rate and pattern of postoperative surface normalization and stabilization. Study data included Snellen visual acuity, contrast sensitivity function, central keratometry, photokeratoscopy, and computerized topographic analysis. Data were collected preoperatively and at one week, one month, two months, three months, and six months postoperatively. Results demonstrate that the greatest configurational changes both topographically and functionally occur in the first month after keratoplasty. The computer-generated surface asymmetry index and the surface regularity index correlated well with improvement in Snellen visual acuity measurements. Contrast sensitivity function was depressed initially but improved to well above preoperative values by one month postoperatively and paralleled the improvement in the surface indices and visual acuity. The axis of astigmatism stabilized by one month postoperatively. Our data indicate that topographic analysis provides a good indication of the rate and course of optical stabilization during the early healing process after keratoplasty and correlates well with visual function in the otherwise normal eye.