[Effect of intrafollicular interleukin-6 levels on the secretion of estradiol and progesterone in patients treated with in vitro fertilization and embryo transfer]. / Efecto de los niveles de interleucina-6 intrafolicular en la secreción de estradiol y progesterona de pacientes tratadas con fertilización in vitro y transferencia de embriones.

The objective was to evaluate the relationship between follicular fluid levels of Interleukin-6 (IL-6) and the seric concentrations of estradiol and progesterone during controlled ovarian hyper-stimulation. The levels of IL-6 were measured in follicular fluid of 15 patients undergone to in vitro fertilization and embryo transfer and correlated with the values of seric estradiol and progesterone. There were a negative correlation between follicular levels of IL-6 and either estradiol and progesterone. Four patients achieved pregnancy following embryo transfer (pregnancy rate 26.6%), one of them aborted. As conclusion, the increased levels of IL-6 may be a reaction to controlled ovarian hyper-stimulation and probably a protective response. According to the reduction of estradiol, there may be a subtle reduction in aromatase action by effect of IL-6 and other cytokines.

Early feeding, feeding tolerance, and lactase activity in preterm infants.

OBJECTIVE: We sought to ascertain whether the timing of feeding initiation affected the development of intestinal lactase activity and whether there are clinical ramifications of lower lactase activity. STUDY DESIGN: Preterm infants (26 to 30 weeks' gestation; n = 135) were randomly assigned to begin enteral feedings at either 4 (early group) or 15 days of age (standard group). At 10, 28, and 50 days of age lactase activity was determined by measuring the urinary ratio of lactulose/lactose after the 2 sugars were administered. RESULTS: Lactase activity increased significantly over time. Infants in the early group had greater lactase activity at 10 days of age (by 100%) and 28 days of age (by 60%) than the standard group. At 10 days of age lactase activity was greater in milk- versus formula-fed infants. The time required to achieve full enteral feedings, the number of abnormal abdominal x-ray examinations, and the total number of abdominal x-ray examinations were inversely related to lactase activity. CONCLUSIONS: Early feeding increases intestinal lactase activity in preterm infants. Lactase activity is a marker of intestinal maturity and may influence clinical outcomes. Whether the effects of milk on lactase activity were due to the greater concentration of lactose in human milk compared with that in formula must be determined.

Hepatic Helicobacter species identified in bile and gallbladder tissue from Chileans with chronic cholecystitis.

BACKGROUND & AIMS: Cancer of the gallbladder is the number one cause of cancer mortality in Chilean women. Incidence rates for this tumor vary widely on a worldwide basis, being approximately 30 times higher in high-risk than in low-risk populations, suggesting that environmental factors such as infectious microorganisms, carcinogens, and nutrition play a role in its pathogenesis. Because several Helicobacter sp. colonize the livers of animals and induce hepatitis, the aim of this study was to determine whether Helicobacter infection was associated with cholecystitis in humans. METHODS: Bile or resected gallbladder tissue from 46 Chileans with chronic cholecystitis undergoing cholecystectomy were cultured for Helicobacter sp. and subjected to polymerase chain reaction (PCR) analysis using Helicobacter-specific 16S ribosomal RNA primers. RESULTS: Recovery of Helicobacter sp. from frozen specimens was unsuccessful. However, by PCR analysis, 13 of 23 bile samples and 9 of 23 gallbladder tissues were positive for Helicobacter. Eight of the Helicobacter-specific PCR amplicons were sequenced and subjected to phylogenetic analysis. Five sequences represented strains of H. bilis, two strains of "Flexispira rappini" (ATCC 49317), and one strain of H. pullorum. CONCLUSIONS: These data support an association of bile-resistant Helicobacter sp. with gallbladder disease. Further studies are needed to ascertain whether similar Helicobacter sp. play a causative role in the development of gallbladder cancer.

Analysis of Mauby Bark and its preparations

Mauby Bark, obtained from the plant Colubrina elliptica, is used in the West Indies for medicinal purposes including the treatment of diabetes. It is also sold in small amounts in Afro Caribbean markets in London and an extract of the bark is incorporated into several soft drinks available in the UK which have a reputation as tonics. In common with many such materials, there are no standards for ensuring that the correct bark is sold or used to make commercial preparations. The bark is reported to contain peptide alkaloids and triterpene glycosides but it is not known whether these chemical constituents are responsible for any biological effect. Samples of Mauby bark were obtained from Dominica, Barbados and a sample of authentic Mauby bark from the reference collection of medicinal plants at King's College London. The samples showed no differences in their botanical structure but some differences when examined chromatographically. This underlines the need to standardize herbal material not only botanically but also on the basis of chemical content since chemical variation can be reflected in variation between batches of bark and preparations. As a test for antidiabetic activity, the effect of extracts of the barks on hexokinase was investigated. An increase in activity would lower glucose levels and thus be beneficial in diabetic patients. No such effect was noted. (AU)

Oral feeding in low birth weight infants.

To gain a better understanding of the development of sucking behavior in low birth weight infants, the aims of this study were as follows: (1) to assess these infants' oral feeding performance when milk delivery was unrestricted, as routinely administered in nurseries, versus restricted when milk flow occurred only when the infant was sucking; (2) to determine whether the term sucking pattern of suction/ expression was necessary for feeding success; and (3) to identify clinical indicators of successful oral feeding. Infants (26 to 29 weeks of gestation) were evaluated at their first oral feeding and on achieving independent oral feeding. Bottle nipples were adapted to monitor suction and expression. To assess performance during a feeding, proficiency (percent volume transferred during the first 5 minutes of a feeding/total volume ordered), efficiency (volume transferred per unit time), and overall transfer (percent volume transferred) were calculated. Restricted milk flow enhanced all three parameters. Successful oral feeding did not require the term sucking pattern. Infants who demonstrated both a proficiency > or = 30% and efficiency > or = 1.5 ml/min at their first oral feeding were successful with that feeding and attained independent oral feeding at a significantly earlier postmenstrual age than their counterparts with lower proficiency, efficiency, or both. Thus a restricted milk flow facilitates oral feeding in infants younger than 30 weeks of gestation, the term sucking pattern is not necessary for successful oral feeding, and proficiency and efficiency together may be used as reliable indicators of early attainment of independent oral feeding in low birth weight infants.

Controle de arrtmias atriais com período refratário atrial controlado por sensor e mudança automática de modo em pacientes portadores de marcapasso dupla-câmara com sensor de ventilação por minuto / Atrial arrhythmia management with sensor controlled atrial refractory period and automatic mode switching in patients with minute ventilation sensing dual chamber rate adaptive pacemakers

Apesar de um longo período refratário atrial pós evento ventricular (PVARP) pode prevenir a ocorrência de taquicardias mediadas pelo marcapasso e também o sincronismo inapropriado com arrtmias atriais na estimulação dupla-câmara(DDD) a limitação da freqüência máxima será necessariamente comprometida. Testamos a possibilidade de utilizar um marcapasso dupla-câmara com sensor de ventilação por minuto (DDDR) e com capacidade de encurtar o PVARP durante o exercício em 13 pacientes com bradicardia (PVARP em repouso = 463 + - 29 ms) a fim de prevenir a limitação prematura da freqüência máxima. O teste de esforço em esteira nos modos DDD e DDDR com este PVARP resultou em freqüências máximas de 98 bpm + - 8 bpm e 142 bpm + - 3 bpm respectivamente (P < 0,0001). Estes resultados foram obtidos graças à incompetênciacronotrópica e à limitação da freqüência máxima no modo DDD, ambas contornadas pelo uso do sensor. Com a finalidade de simular arritmias atriais, foi aplicada estimulação na parece torácica por 30 segundos, a uma freqüência de 250 bpm e com uma sensibilidade atrial unipolar média de 0,82 mV. No modo DDD, ocorreu uma resposta ventricular irregular (as freqüências com um PVARP de 280 ms e 463 ms + - 29 ms foram respectivamente 92 bpm + - 5 bpm e 66 bpm + - 3 bpm (P < 0,0001). No modo DDDR, com PVARP de 463 ms + - 29 ms, ocorreu uma estimulação ventricular regular a 53 bpm + - 2 bpm devida à mudança de modo para VVIR, na presença de eventos repetitivos captados dentro do PVARP. Um paciente desenvolveu fibrilação atrial espontânea durante o seguimento, que foi corretamente identificada pelo algoritmo do marcapasso, resultando na mudança de modo DDDR para VVIR e na preservação da resposta em freqüência. Em conclusão, o PVARP controlado pelo sensor permite a utilização de um PVARP mais longo durante o repouso, sem comprometer a freqüência máxima durante o exercício. Adicionalmente, ao oferecer em proteção contra retrógrada, o PVARP longo e a mudança automática de modo também limitam a freqüência durante as arritmias atriais, permitindo uma resposta ventricular de acordo com a demanda fisiológica...