Impact of prenatal and postnatal maternal environment on nephron endowment, renal function and blood pressure in the Lewis polycystic kidney rat.

Maternal insufficiency during fetal development can have long-lasting effects on the offspring, most notably on nephron endowment. In polycystic kidney disease (PKD), variability in severity of disease is observed and maternal environment may be a modifying factor. In this study, we first established that in a rodent model of PKD, the Lewis polycystic kidney (LPK) rat's nephron numbers are 25% lower compared with wildtype animals. We then investigated the effects of prenatal and postnatal maternal environment on phenotype and nephron number. LPK pups born from and raised by homozygous LPK dams (control) were compared with LPK pups cross-fostered onto heterozygous LPK dams to improve postnatal environment; with LPK pups born from and raised by heterozygous LPK dams to improve both prenatal and postnatal environment and with LPK pups born from and raised by Wistar Kyoto-LPK heterozygous dams to improve both prenatal and postnatal environment on a different genetic background. Improvement in both prenatal and postnatal environment improved postnatal growth, renal function and reduced blood pressure, most notably in animals with different genetic background. Animals with improved postnatal environment only showed improved growth and blood pressure, but to a lesser extent. All intervention groups showed increased nephron number compared with control LPK. In summary, prenatal and postnatal environment had significant effect in delaying progression and reducing severity of PKD, including nephron endowment.

Prenatal hypoxia leads to hypertension, renal renin-angiotensin system activation and exacerbates salt-induced pathology in a sex-specific manner.

Prenatal hypoxia is associated with growth restriction and adverse cardiovascular outcomes. Here, we describe renal and cardiovascular outcomes in ageing mouse offspring prenatally exposed to hypoxia (12% O2) from embryonic day 14.5 until birth. At 12 months of age, both male and female offspring exposed to prenatal hypoxia had elevated mean arterial pressure. Glomerular number was reduced by 25% in hypoxia-exposed male, but not female, offspring and this was associated with increased urinary albumin excretion, glomerular hypertrophy and renal fibrosis. Hypoxia-exposed offspring of both sexes were more susceptible to salt-induced cardiac fibrosis, however, renal fibrosis was exacerbated by high salt in males only. In male but not female hypoxia-exposed offspring, renal renin mRNA was increased at weaning. By 12 months, renal renin mRNA expression and concentrations were elevated in both sexes. mRNA expression of At 1a R was also elevated in male hypoxia-exposed offspring at 12 months. These results demonstrate that prenatal hypoxia programs elevated blood pressure and exacerbates salt-induced cardiovascular and renal pathology in a sex specific manner. Given sex differences observed in RAS expression and nephron number, future studies may consider RAS blockade as a therapeutic target in this model.

The effects of gestational age and maternal hypoxia on the placental renin angiotensin system in the mouse.

INTRODUCTION: The renin angiotensin system (RAS) is an important mediator of placental development. However, a comprehensive expression profile for 8 key components of the placental RAS throughout murine gestation has not been performed. Furthermore, maternal hypoxia induces dysregulation of RAS expression in fetal tissues but the effects on the murine placental RAS are less well known. METHODS: Placentas were collected from male and female CD1 mouse fetuses at seven gestational ages for qPCR analysis of Agt, Ren1, Atp6ap2, Ace, Ace2, Agtr1a, Agtr2 and Mas1. mRNA localisation of Agtr1 and Mas1 and protein localisation of ACE and ACE2 was determined at E18.5. To determine the effects of maternal hypoxia on the placental RAS, mice were housed in 12% oxygen from E14.5-E18.5 and placentas examined at E18.5. RESULTS: All RAS genes were expressed in the placenta throughout pregnancy and expression varied with fetal sex and age. Agtr1 was expressed within the labyrinth while Mas1 was expressed within the intraplacental yolk sac. ACE and ACE2 were localised to both labyrinth and junctional zones. In response to maternal hypoxia the expression of Agt, Ace and Ace2 was decreased but expression of Agtr1a was increased. Ace and Agtr1a mRNA levels were affected to a greater extent in females compared to males. DISCUSSION: Collectively, the location within the placenta as well as the expression profiles identified, support a role for the placental RAS in labyrinth development. The placental RAS is disturbed by maternal hypoxia in a sexually dimorphic manner and may contribute to impairment of placental vascular development.

Mid- to late term hypoxia in the mouse alters placental morphology, glucocorticoid regulatory pathways and nutrient transporters in a sex-specific manner.

Maternal hypoxia is a common perturbation that can disrupt placental and thus fetal development, contributing to neonatal impairments. Recently, evidence has suggested that physiological outcomes are dependent upon the sex of the fetus, with males more susceptible to hypoxic insults than females. This study investigated the effects of maternal hypoxia during mid- to late gestation on fetal growth and placental development and determined if responses were sex specific. CD1 mice were housed under 21% or 12% oxygen from embryonic day (E) 14.5 until tissue collection at E18.5. Fetuses and placentas were weighed before collection for gene and protein expression and morphological analysis. Hypoxia reduced fetal weight in both sexes at E18.5 by 7% but did not affect placental weight. Hypoxia reduced placental mRNA levels of the mineralocorticoid and glucocorticoid receptors and reduced the gene and protein expression of the glucocorticoid metabolizing enzyme HSD11B2. However, placentas of female fetuses responded differently to maternal hypoxia than did placentas of male fetuses. Notably, morphology was significantly altered in placentas from hypoxic female fetuses, with a reduction in placental labyrinth blood spaces. In addition mRNA expression of Glut1, Igf2 and Igf1r were reduced in placentas of female fetuses only. In summary, maternal hypoxia altered placental formation in a sex specific manner through mechanisms involving placental vascular development, growth factor and nutrient transporter expression and placental glucocorticoid signalling. This study provides insight into how sex differences in offspring disease development may be due to sex specific placental adaptations to maternal insults.

Prostaglandin F2alpha-induced nest-building behaviour is associated with increased hypothalamic c-fos and c-jun mRNA expression.

Intramuscular injection of the naturally occurring prostaglandin F2alpha (PGF2alpha) to sexually mature female pigs induces luteolysis and rapidly elicits a behavioural response consistent with pre-partum nest-building. Intramuscular injection of the synthetic prostaglandin F2alpha (cloprostenol) also induces luteolysis but no nest-building behaviour is observed. The effects of PGF2alpha, but not cloprostenol, on nest-building behaviour may be mediated via peripheral PGF2alpha receptors (FP) or via direct action on central FP receptors. We have previously shown FP receptor mRNA to be localized in porcine paraventricular nucleus (PVN), supraoptic nucleus (SON) and pars dorso-medialis of the suproptic nucleus (SOD), suprachiasmatic nucleus, choroid plexus and anterior and intermediate pituitary lobes. In this experiment, we examined hypothalamic expression of the immediate early genes c-fos and c-jun mRNA after treatment with PGF2alpha or cloprostenol. Twenty-one 8-month-old nulliparous female pigs (gilts) were injected intramuscularly with a luteolytic dose of PGF2alpha (15 mg), cloprostenol (175 microg) or saline control, their behaviour was recorded and they were killed 60 min later. Coronal hypothalamic sections and control ovarian tissues were incubated with 45-mer oligonucleotide probes complementary to porcine c-fos and c-jun genes using standard in situ hybridization histochemistry techniques. Significantly higher c-fos and c-jun mRNA expression was found in PGF2alpha-treated compared to saline or cloprostenol-treated pigs in the PVN, SON and SOD. Significantly higher c-fos and c-jun mRNA expression was found in corpus lutea of PGF2alphaand cloprostenol-treated pigs compared to saline controls. Treatment with PGF2alpha induced nest-building behaviour whereas treatment with cloprostenol and saline did not. This suggests that PGF2alpha, or one of its metabolites, and not cloprostenol, crosses the blood-brain barrier and acts directly on hypothalamic receptors to mediate its effect on nest-building behaviour.

Indomethacin blocks pre-partum nest building behaviour in the pig (Sus scrofa): effects on plasma prostaglandin F metabolite, oxytocin, cortisol and progesterone.

In the pig, nest building occurs in the day preceding parturition (gestation=114--116 days). Nest building behaviour can be induced in pregnant, pseudopregnant and cyclic female pigs following injection of prostaglandin F2alpha. Here we investigated behaviour and endocrine changes after the administration of indomethacin, which inhibits cyclo-oxygenase enzymes and thus prostaglandin synthesis. In experiment 1, pregnant primiparous pigs (gilts) were blood sampled through jugular vein catheters every 20 min from 1000 h on day 113 of pregnancy and behaviour was recorded until birth. Two hours after pre-partum nest building began, animals received 4 mg/kg indomethacin (n=7) or control vehicle (n=8) intramuscularly. Indomethacin-treated animals showed less nest building than controls between 1 and 5 h after injection (P<0.05), during which time they were mostly inactive and lay down for longer than controls. From 5 h before birth until birth there was no significant treatment difference in nest building behaviour. There was a tendency for the start of birth to be delayed in indomethacin-treated animals. Plasma 13,14-dihydro-15-keto-prostaglandin F2 alpha (a major metabolite of prostaglandin F2 alpha) rose during pre-injection nest building and then fell following indomethacin treatment, but was not significantly different between groups when behaviour differed. Plasma oxytocin, cortisol and progesterone were not significantly affected by treatment. In experiment 2, indomethacin-treated non-pregnant gilts (n=7) did not show any changes in activity or posture compared with vehicle-treated controls (n=6) between 90 and 150 min after treatment. These results suggested that indomethacin treatment reversibly and specifically inhibits porcine pre-partum nest building by a mechanism that may involve endogenous prostaglandin F2 alpha synthesis inhibition but is independent of circulating oxytocin, cortisol and progesterone concentrations.

Urine calcium and urine sodium concentrations are not related, after adjustment for urine magnesium.

BACKGROUND AND OBJECTIVES: Urine calcium correlates with urine sodium. The aims of this study were to investigate whether the urine sodium-calcium relationship persists into old age and whether it holds after adjustment for urine magnesium. DESIGN: Cross-sectional descriptive analysis. PATIENTS: Residents of two aged care institutions (median age 84 years) who were not taking diuretics, calcium or vitamin D supplements. MEASUREMENTS: Early morning urine calcium, sodium and magnesium, plasma creatinine and serum 25-hydroxyvitamin D and parathyroid hormone. RESULTS: Urine calcium correlated with urine sodium (r = 0.29, P < 0.01) and with urine magnesium (r = 0.56, P < 0.001). After adjustment for urine magnesium, the relationship between urine sodium and urine calcium was no longer significant. Forty-five percent of the interindividual variation in urine calcium was explained by a linear model on the basis of urine magnesium and plasma creatinine. CONCLUSION: The data indicate that a correlation between urine sodium and calcium persists in very old age. However, this correlation no longer holds after adjustment for urine magnesium. Further studies examining urine calcium excretion should also consider urine magnesium.

Hyaluronidases of Gram-positive bacteria.

Bacterial hyaluronidases, enzymes capable of breaking down hyaluronate, are produced by a number of pathogenic Gram-positive bacteria that initiate infections at the skin or mucosal surfaces. Since reports of the hyaluronidases first appeared, there have been numerous suggestions as to the role of the enzyme in the disease process. Unlike some of the other more well studied virulence factors, much of the information on the role of hyaluronidase is speculative, with little or no data to substantiate proposed roles. Over the last 5 years, a number of these enzymes from Gram-positive organisms have been cloned, and the nucleotide sequence determined. Phylogenetic analysis, using the deduced amino acid sequences of the Gram-positive hyaluronidases, suggests a relatedness among some of the enzymes. Molecular advances may lead to a more thorough understanding of the role of hyaluronidases in bacterial physiology and pathogenesis.

The extracellular hyaluronidase gene (hylA) of Streptococcus pyogenes.

Group A streptococci produce an extracellular hyaluronidase (hyaluronate lyase) which may be associated with the spread of the organism during infection. The gene for this hyaluronidase (hylA) encodes an 868 amino acid protein with a molecular size of 99636 Da. Cleavage of the proposed signal peptide results in an extracellular protein of 95941 Da. Comparison with other bacterial hyaluronidases indicates strong similarities to the genes from Streptococcus pneumoniae, Streptococcus agalactiae and Staphylococcus aureus. A region internal to the hylA gene was amplified from all 175 strains of Streptococcus pyogenes tested suggesting a widespread distribution of the gene.

Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel.

OBJECTIVES: To determine whether falling relates to serum levels of vitamin D and parathyroid hormone. DESIGN: A cross-sectional study with retrospective analysis. SETTING: An aged-care institution in Melbourne Australia. PARTICIPANTS: Ambulant nursing home and hostel residents (n = 83). MEASUREMENTS: Frequency of falling, frequency of going outdoors, use of cane or walker, age, sex, weight, type of accommodation, and duration of residence. Serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and parathyroid hormone (PTH). Plasma concentrations of albumin, calcium, phosphate, and creatinine. Use of furosemide or non-benzodiazepine anticonvulsants. RESULTS: Median age of residents was 84 years. The cohort was vitamin D deficient with a median (interquartile range) 25-hydroxyvitamin D level of 27 (18-37) nmol/L (one-third the reference range median), P < .001. The median (interquartile range) PTH of 5.2 (3.8-7.7) pmol/L exceeded the reference range median, P < .001. Residents who fell (n = 33) had lower serum 25-hydroxyvitamin D levels than other residents (medians 22 vs 29 nmol/L, P = .02) and higher serum PTH levels (medians 6.2 vs 4.8 pmol/L, P < .01). Sixty residents lived in the hostel (72%), and 41 (49%) walked without any walking aid. In a multiple logistic regression for falling, higher serum PTH remained independently associated with falling, with an odds ratio (95% confidence interval) for falling of 5.6 (1.7-18.5) per unit of the natural logarithm of serum PTH. Other terms in the regression were hostel accommodation, odds ratio .04 (.01-.25), and ability to walk without aids, odds ratio .07 (.01-.37). CONCLUSIONS: In ambulant nursing home and hostel residents, residents who fall have lower serum 25-hydroxyvitamin D and higher serum parathyroid hormone levels than other residents. The association between falling and serum PTH persists after adjustment for other variables.

Postextubation foreign body aspiration: a case report.

Endoscopic sinus surgery performed on a healthy young male could have resulted in a fatal outcome when a surgically placed nasal pack became dislodged upon extubation and unknowingly was aspirated. Unlike the "missing" nasal packs or posterior pharyngeal packs placed intraoperatively, this particular pack was to remain in place 12 to 24 hours postoperatively, status postseptoplasty. At the conclusion of the case and after extubation, all visible knots, ties, and steri-strips appeared to be intact. However, the patient displayed signs of hypoxia and stridor. Excessively high ventilating pressures were required to oxygenate the patient with the subsequent need for an emergency reintubation. A diagnosis of foreign body aspiration was made. Using the fiberoptic bronchoscope, it was discovered that one of the packs placed intraoperatively had indeed become dislodged and aspirated into the tracheal bronchial tree. This became a life-threatening situation with the patient showing signs of compromised oxygenation, hypercarbia, tachycardia, and hypertension. The combined efforts of the surgeon, the anesthesia team, and the operating room personnel allowed for the prompt retrieval of the foreign body using the fiberoptic bronchoscope equipment.

Risk factors for secondary hyperparathyroidism in a nursing home population.

OBJECTIVE: Secondary hyperparathyroidism may cause bone loss and structural deterioration of bone and may thus be a cause of fracture in the elderly. Vitamin D deficiency, renal impairment and medications are potential causes of hyperparathyroidism and may also directly predispose to fracture. We present the first findings of an ongoing study of hip fracture, vitamin D deficiency and hyperparathyroidism in a large Australian nursing home. DESIGN: Descriptive prevalence study. PATIENTS: Two hundred and fifty-one nursing home residents were eligible for inclusion. Informed consent and successful venepuncture were obtained for 99. Residents were of median age 83 years with interquartile range (IR) 77-89 years. MEASUREMENTS: 25-Hydroxyvitamin D (25OHD), intact parathyroid hormone (PTH), creatinine and biochemistry, demographic data and current medications. RESULTS: Fifty-two per cent of 99 subjects had 25OHD below the reference range of 28-165 nmol/l and 96.5% were below the reference range mean. Those with low 25OHD had lower plasma calcium corrected for albumin than those with normal 25OHD (medians 2.34 vs 2.41 mmol/l, 95% confidence interval for the difference between medians (CI) -0.10 to -0.04 mmol/l, P = 0.0001) and higher PTH (medians 5.8 vs 3.9 pmol/l, CI 0.10-2.6 pmol/l, P = 0.0360). Twenty-eight per cent of 97 residents had PTH above the upper reference range limit of 6.5 pmol/l. Residents receiving frusemide had higher PTH than other residents (medians 6.95 vs 3.45 pmol/l, CI 1.9-4.2 pmol/l, P < 0.0001). In linear modelling, the most important predictor of the natural logarithm of PTH was daily frusemide dose, adjusted R2 (Ra2) = 31.8%, F = 39.3, P < 0.001. Creatinine and the reciprocal of 25OHD were other significant predictors with the final Ra2 = 39.4%, F = 17.7, P < 0.001. CONCLUSIONS: Vitamin D deficiency is a common risk factor for secondary hyperparathyroidism in nursing home residents despite a climate in which vitamin D nutrition is thought to be ample. However, the daily frusemide dose is a more important predictor of PTH in this population.

Out-of-hospital cardiac arrest: a six-year experience in a suburban-rural system.

All out-of-hospital cardiac arrest advanced life support (ALS) trip sheets were collected from January 1980 through December 1985 for this suburban-rural system. Information was extracted according to a uniform reporting format. In our study, 18% of patients with early CPR (less than four minutes) and early ALS (less than ten minutes) survived to hospital discharge, compared with 7% with early CPR and late ALS, 6% with late CPR and early ALS, and 3% with both occurring late. Although 75% of the survivors had ventricular tachyarrhythmias as initial rhythms, bradyasystolic arrests were not uniformly lethal, even with long CPR and ALS times. This study supports the need for early CPR in the prehospital care of potential sudden-death victims. We recommend, with qualification, this reporting format to emergency medical services systems to describe their cardiac arrest experience.

Noninvasive transcutaneous cardiac pacing in prehospital cardiac arrest.

This study evaluated the efficacy of prehospital external cardiac pacing in cardiac arrest patients. From October 1984 to June 1985, 91 patients were paced. Mean time from cardiac arrest to advanced life support (ALS) intervention in this metropolitan-rural ALS system was 14.5 minutes. Electrical capture occurred in 85 (93%), mechanical capture (pulses) occurred in ten (11%), and a measurable blood pressure occurred in three (3%) of the 91 patients. Despite a high rate of electrical capture, palpable pulses were produced only in 11%, and no patients survived to be discharged from the hospital. There was no difference in the frequency of electrical capture, palpable pulses, or outcome for patients receiving pharmacologic intervention before or after pacing. Likewise there was no difference in the frequency of electrical capture, palpable pulses, or outcome for patients receiving ALS therapy within or after ten minutes of their arrest. Although we found that external cardiac pacing was easily used in the prehospital setting, pacing did not result in any increase in survival in cardiac arrest patients.

Prehospital use of intravenous verapamil.

Verapamil was introduced into a hospital-based urban/rural advanced life support (ALS) system for intravenous (IV) use in patients with symptomatic supraventricular tachyarrhythmias. During this trial period, IV verapamil was given to 24 patients, 12 (50%) of which benefited from its use. IV verapamil produced no harmful effects, and there was only one reported adverse effect (nausea) related to its administration. IV verapamil may be useful in the prehospital care of patients with symptomatic supraventricular tachyarrhythmias.