Patterns of eating and movement that best maintain reduction in overweight.

Two studies of the influences of specific patterns of eating and exercising behaviour on body weight in English Midlands women were re-analysed using correlations as the measure of effect size. As predicted from computational modelling of hunger-sating mechanisms, avoiding energy-containing drinks and foods at the ends of and between meals was the behaviour most influencing year-long weight loss. However, although eating between meals is often called snacking, the term 'snack' appeared to be too ambiguous in this culture for its use in helping efforts to control weight. Avoidance of particular sorts of fat-rich foods was also associated with longer-term weight loss. Attempts at severe restriction of intake at mealtimes were associated with weight loss during a period of intensive dieting, but did not contribute to maintenance of that weight reduction. Using diet formulae to attain rapid weight loss was associated with significant weight gain over a year. These results support the suggestion that the first line of defence against weight gain is avoiding all sources of energy during drink breaks, with personally relevant advice on lower fat versions of particular foods also being important. Continued neglect of the behaviour-specific correlational approach to gaining evidence for less fattening habits does nothing to slow the rise in obesity.

L-carnitine decreases glycolysis in liquid-stored platelets.

BACKGROUND: The platelet storage lesion is characterized metabolically by a pH decrease associated with lactic acid generation; a change in platelet morphology from discoid to spherical; a diminished response to in vitro challenge tests, such as the hypotonic shock response (HSR) and extent of shape change (ESC); increased surface P-selectin expression; and decreased in vivo recovery and survival. Altering storage conditions to improve these measures could allow for extension of the duration of in vitro storage. STUDY DESIGN AND METHODS: ABO-identical paired platelet concentrates were pooled and then equally divided into two plastic bags. Either L-carnitine (LC) or an equal volume of saline (control) was added to one container of each pair. Platelets were stored at 20 to 24 degrees C for 5 to 10 days or at 1 to 6 degrees C for 5 days at various concentrations of LC between 0.1 and 15 mM: At the end of storage, pH, glucose consumption, lactate generation, HSR, ESC, and surface P-selectin expression were measured. In different experiments, paired platelet concentrates were spiked with a Staphylococcus epidermidis suspension in the presence and absence of L-carnitine at a concentration of 5 mM: RESULTS: At 20 to 24 degrees C and concentrations of LC between 0.1 and 5 mM:, there was evidence of better pH preservation, less glucose consumption, and less lactate generation. Only with storage beyond 5 days was a difference present in either surface P-selectin expression or HSR. An L-carnitine concentration of 5 mM: appeared optimal. L-carnitine did not enhance the growth of bacteria after 7 to 8 days of storage. CONCLUSION: LC at 5 mM: may improve the quality of platelet concentrates that are stored beyond 5 days. There was no indication that LC at this concentration would promote bacterial growth. It may be a useful additive to platelet preservation.

Spontaneous venous thrombosis in a young patient with combined factor V Leiden and lupus anticoagulant.

We describe a case of a 28-year-old man who developed an extensive spontaneous deep venous thrombosis. Testing revealed heterozygotic factor V Leiden mutation, and the presence of both lupus anticoagulant (LA) and elevated IgM anticardiolipin antibody (ACA). Several family members were found to be heterozygous for factor V Leiden. A paternal aunt had the factor V Leiden mutation, an elevated plasma homocysteine and a borderline increased IgG ACA level. No other family member had a history of a venous thrombotic event. This case illustrates that evaluation of young patients who present with venous thrombosis should be performed for both hereditary and acquired thrombophilic defects. The family studies suggest that the presence of a lupus anticoagulant may be more clinically significant than elevated ACA in risk assessment. Although screening family members when the proband carries factor V Leiden is controversial, psychological reassurance of those who test negative and simple advice on occupations or social habits (e.g., smoking) for those who test positive may be important benefits.

The results of diagnostic studies for thrombophilia in a large group of patients with a personal or family history of thrombosis.

The range of tests used in the evaluation of thrombophilia has been altered by the recent recognition of common genetic defects predisposing to thrombosis such as factor VLeiden (FVR506Q), enzyme deficiencies causing hyperhomocysteinemia, and improvement in the sensitivity and utilization of assays for antiphospholipid antibodies. In this study, the outcomes of laboratory evaluation of 402 patients with thrombophilia were reviewed and correlated with clinical data. A predisposing factor was present (positive diagnosis, group A) in 110 patients (27%), the test results of 111 patients (28%) could not be definitively interpreted (equivocal results, group B), and the test results of 181 (45%) were normal (group C). The median age of the group A patients was 48 years (range, 3.7-88 years), suggesting that evaluation of patients over the age of 50 is worthwhile. Of the 110 patients in group A, 84% had single defects and 16% had combined defects. The most common defect was factor VLeiden (44 patients). Equal numbers of patients presenting with arterial and venous thromboses were evaluated. Patients with arterial events were less likely to have a definable laboratory defect (33 of 132 [25%]) than were those with venous events (50 of 136 [37%]). Factor VLeiden was the most frequent finding in patients with venous events, and lupus anticoagulant or anticardiolipin antibodies were the most frequent findings in patients with arterial events. Positive diagnoses were made in patients on anticoagulants, indicating that this should not preclude investigation. Our study confirms the need for thorough evaluation to assess thrombotic risk, and it reflects the impact of newly identified thrombophilic disorders on the expected outcome of laboratory evaluation for thrombophilia.

Whole blood screening test for factor V Leiden using a Russell viper venom time-based assay.

Factor V Leiden (FVR506Q) is a genetic defect in the factor V (FV) molecule that confers resistance to proteolysis by activated protein C (APC) and is the most common abnormality detected in patients studied for hereditary thrombophilia. The initial screening test for this abnormality was a comparison of the activated partial thromboplastin time (APTT) in the presence and absence of APC, expressed as a ratio. But this has been shown to lack sensitivity for the FV mutation. Other clot-based screening tests, such as the modified APTT, using FV-deficient plasma, or the Russell viper venom (RVV) time assay have improved sensitivity. Eighty-seven samples were studied using the RVV-based assay. This assay was performed on platelet-poor plasma (PPP-RVV) and whole blood (WB-RVV). All samples were analyzed by polymerase chain reaction (PCR) for the FV Leiden defect: 77 were PCR negative; 10 were PCR positive. Using a threshold ratio of 1.8, all samples were correctly categorized in the PPP-RVV and the WB-RVV tests, showing an observed sensitivity and specificity of 1.0. These results suggest that an RVV-based assay using whole blood could be an effective screening test for this common abnormality.

Comparison of an activated partial thromboplastin time with a Russell viper venom time test in screening for factor V(Leiden) (FVR506Q).

Factor V(Leiden) is the most common abnormality detected in patients examined because of hereditary thrombophilia. The most widely used clot-based screening test is based on the activated partial thromboplastin (aPTT) time. This test has a low sensitivity. A comparison of the aPTT-based test with a Russell viper venom time test (RVVT) was performed in matched samples. All samples were analyzed by polymerase chain reaction (PCR) for the factor V(Leiden) defect. We studied 139 samples, of which 109 were PCR-negative; 30 were PCR-positive. Using the manufacturer's suggested threshold ratio of 2, the aPTT test showed a sensitivity of 0.43, a specificity of 0.86, and a positive predictive value (PPV) of 0.97. The RVVT test had a sensitivity of 1.0, a specificity of 0.95, and a PPV of 0.91. Segregation of a subpopulation of this study population into ABO group O vs non-group O showed an effect of ABO group on the aPTT test but not on the RVVT test, consistent with an influence of factor VIII clotting (factor VIII:C) on the aPTT test. The RVVT test seems superior to the unmodified aPTT test as a screening test for factor V(Leiden).

Aprotinin, cardiac surgery, and factor V Leiden.

BACKGROUND: Aprotinin has been shown to reduce blood transfusion in cardiac surgery. Aprotinin inhibits activated protein C (APC). Patients with factor V (FV) Leiden have an inherited resistance to APC proteolysis. If the inhibition of APC by aprotinin contributes to its beneficial effect in cardiac surgery, then patients with FV Leiden undergoing cardiac surgery might be expected to require less transfusion than patients without FV Leiden. However, the use of aprotinin in such patients also could compromise the protein C regulatory pathway and precipitate a clinical thrombotic event. STUDY DESIGN AND METHODS: Patients undergoing cardiac surgery were studied for the presence of the FV Leiden defect by the use of a Russell's viper venom clot-based assay and polymerase chain reaction. The total amount of blood transfused was recorded for each patient. The effect of aprotinin on the plasma of normal and FV Leiden patients was studied. Further studies were performed on the direct inhibition of APC by aprotinin. RESULTS: Over an 18-month period, 162 patients were studied, of whom 13 (8%; 95% CI, 4.3-13.3%) were positive for FV Leiden. These 13 had a smaller requirement for blood transfusion than the to 13 matched controls. In vitro, aprotinin induced a FV Leiden defect in normal plasma and exacerbated the defect in the plasma of FV Leiden patients. Aprotinin inhibited APC in a dose-dependent manner, and kinetic analysis showed competitive inhibition with an inhibition constant of 4.5 microM (250 Kallikrein inhibitor units/mL). CONCLUSION: The inhibition of APC by aprotinin may contribute to its hemostatic effect. The use of aprotinin in patients with FV Leiden could cause extreme dysfunction of the protein C regulatory pathway, which could result in clinical thrombosis.

MHC (RT1) restriction of the antibody repertoire to infection with the nematode Nippostrongylus brasiliensis in the rat.

It might be expected that infections with transmissible agents will elicit an immune response to all of their exoantigens and that immune response (Ir) gene control of responses to individual epitopes on a given parasite component would be obscured by reaction to the molecule as a whole. Humans infected with parasitic nematodes, however, mount antibody responses which are selective for certain parasite components. This was modelled in inbred rats infected with the parasitic nematode Nippostrongylus brasiliensis and their responses to secreted antigens analysed by immunoprecipitation and SDS-PAGE. No strain responded to all the potential antigens and only those of identical major histocompatibility complex (MHC) had similar recognition profiles. This MHC-restricted response applied to whole molecules synthesized by the parasite, rather than merely to epitopes thereon and is, therefore, contrary to expectation. Moreover, the response patterns of F1 hybrid animals were not merely summations of parental responses. This suggests defective antigen presentation of particular parasite components by certain MHC class II molecules and/or cross-tolerance with background gene products.

Does emotional eating interfere with success in attempts at weight control?

Questionnaire responses from a convenience sample were used to test for hypothesized relationships between changes over time in individuals' reported frequency of emotional eating and estimates of their success in attempts to reduce body weight over periods of at least 1 year. Respondents were 187 English adults, whose distribution of estimated Body Mass Indices (BMI) approximately that of the general population. Initial BMI was significantly (p less than 0.001) positively associated with reported frequency of emotional eating. Moreover, respondents indicating initially relatively high levels of emotional eating who reported a reduction in that level were found to lose significantly (p less than 0.01) more reported weight and to be significantly (p less than 0.05) more successful at approaching target weight over the period of the study than respondents who continued to report high levels of emotional eating. Similarly, respondents who reported an increase from initially relatively low levels of emotional eating, while not losing significantly less reported weight, were significantly (p less than 0.05) less successful at approaching target weight than those respondents who continued to report low levels of emotional eating.

Effect of proximal gastric vagotomy on serum pepsinogen I and II concentrations and acid secretion in duodenal ulcer patients.

Acid secretion and basal serum pepsinogen I and II concentrations were measured in 14 duodenal ulcer patients before and at intervals up to six years after proximal gastric vagotomy. Vagotomy led to significant and long-standing reductions in basal, vagally mediated (induced by sham feeding), and peak pentagastrin-stimulated acid secretion. Serum pepsinogen I concentrations also decreased significantly after vagotomy but to a significantly lesser extent than acid secretion. There was no correlation between serum pepsinogen I concentrations and peak acid secretion, either before or after vagotomy. Serum pepsinogen II concentrations decreased only slightly and transiently after vagotomy. Thus, proximal gastric vagotomy reduces acid hypersecretion and pepsinogen I hypersecretion, but not pepsinogen II hypersecretion, in duodenal ulcer patients.

Effect of GABA on basal and vagally mediated gastric acid secretion and hormone release in dogs.

To stimulate peripheral gamma-aminobutyric acid (GABA) receptors, GABA, which does not cross the blood-brain barrier, was administered to dogs with vagally innervated gastric fistulas at intravenous doses of 0, 0.66, 2, 6, 18, and 54 micrograms.kg-1.min-1. Mean gastric acid output increased from zero basally to 3.0 +/- 1.4 mmol/h during infusion of 54 micrograms.kg-1.min-1 GABA. Plasma somatostatin-like immunoreactivity decreased significantly below basal levels during infusion of 54 micrograms.kg-1.min-1 GABA (P less than 0.05). To stimulate central nervous system GABA receptors as well as peripheral GABA receptors, progabide, a GABA-receptor agonist, which readily crosses the blood-brain barrier, was injected intravenously. Mean acid output was 3.5 +/- 1.3 mmol/h after 20 mg/kg progabide and 0.6 +/- 0.5 mmol/h after its vehicle (P less than 0.05). Basal serum gastrin concentration increased significantly after progabide injection. Acid output during insulin-induced hypoglycemia was inhibited 59% by 30 mg/kg intravenous progabide. Progabide infusion also diminished or abolished circulating gastrin, somatostatin, and pancreatic polypeptide responses during insulin-induced hypoglycemia (P less than 0.05). Further studies were performed in dogs with a gastric fistula and a vagally denervated Heidenhain pouch to confirm that GABA-receptor stimulation affects acid secretion via peripheral pathways. Intravenous injection of baclofen (0.5 mg/kg), a GABAB-receptor agonist, increased acid secretion significantly from the gastric fistula and the Heidenhain pouch. These studies suggest that GABA may play a role in regulating gastric acid secretion and gastrointestinal and pancreatic endocrine function by both central and peripheral mechanisms.

Gastroduodenal ulceration following active immunization with prostaglandin E2 in dogs. Role of gastric acid secretion.

In this study we present evidence to suggest that gastroduodenal mucosal defects may occur in gastric fistula dogs actively immunized with PGE2-thyroglobulin conjugate. One of four PGE2-immunized dogs developed a chronic pyloroduodenal ulcer with penetration into the pancreas and the other three had endoscopic evidence of gastric and/or duodenal erosions. In contrast, no gastroduodenal mucosal defects were seen in control dogs immunized with thyroglobulin alone. Occurrence of gastroduodenal ulcers or erosions was temporally related to formation of specific antibody to PGE2 suggesting that PGE2 antibody may be responsible for lesion formation. An increase in gastric acid secretion was not observed in PGE2-immunized dogs. Thus, it is likely that mucosal defects occur as a result of an impairment of PGE2-mediated mucosal defense mechanisms. Since gastroduodenal lesions can be visualized by endoscopy, the dog may prove to be useful in studying the role of endogenous PG in ulcer diseases.

Gastrointestinal ulcer formation in rabbits immunized with prostaglandin E2.

Circulating prostaglandin E2 antibodies were produced in 12 rabbits immunized with prostaglandin E2-thyroglobulin conjugate and ulcers occurred in 10, usually in the stomach and less often in the small intestine. Immunization of rabbits with both prostaglandin E2 and 6-keto prostaglandin F1 alpha significantly increased the number of gastric ulcers compared with rabbits immunized with prostaglandin E2 alone. Gastrointestinal ulceration in prostaglandin E2-immunized rabbits was not prevented by oral enprostil. Gastrointestinal ulcers occurred as early as 6 wk after beginning immunization and often perforated with resulting fatality. Neither prostaglandin E2 antibodies nor ulcers developed in rabbits immunized with thyroglobulin vehicle (controls). Passive immunization of unimmunized rabbits with prostaglandin E2-hyperimmune plasma led to acute gastric ulcers within 9 days, whereas passive transfer of nonimmune plasma did not produce ulcers. This latter finding suggests that prostaglandin E2 antibodies per se were responsible for ulcer formation.

Effect of proximal gastric vagotomy on calculated gastric HCO3- and nonparietal volume secretion in man. Studies during basal conditions and gastrin-17 infusion.

We calculated gastric HCO3- and H+ secretion, as well as nonparietal and parietal volume secretion, in 15 duodenal ulcer patients who had previously undergone successful proximal gastric vagotomy, 15 unoperated duodenal ulcer patients, and 15 normal control subjects. Basal HCO3- secretion was not significantly altered after vagotomy, while basal H+ secretion, parietal volume and nonparietal volume secretion were reduced significantly. Intravenous gastrin-17 infusion reduced gastric HCO3- secretion by approximately 50% in both unoperated ulcer patients and normal subjects (P less than 0.05). Gastrin-17 infusion did not inhibit gastric HCO3- secretion after vagotomy. In fact, mean gastric HCO3- secretion increased to a nearly significant extent in response to gastrin (P = 0.06). These findings indicate that gastrin inhibits gastric HCO3- secretion in humans and that the gastrin-induced reduction in gastric HCO3- secretion is dependent upon intact vagal innervation to the oxyntic mucosa.

Variable contribution of gastrin to gastric acid secretion after a meal in humans.

The purpose of these experiments was to determine the contribution of gastrin to the acid secretory response to eating in healthy human subjects. To simulate the gastric and intestinal phases of eating, a meal was homogenized and then infused into the stomach through a nasogastric tube. At the same time, the cephalic phase of acid secretion was activated by sham feeding. With this simulated meal, mean serum gastrin concentration increased from a basal value of 43 +/- 9 pg/ml to an average postprandial gastrin concentration over 2 h of 121 +/- 25 pg/ml. Gastrin release after this simulated meal was similar to gastrin release after a normally eaten meal in the same 12 subjects. Gastric acid secretion in response to the simulated meal, which was measured by in vivo intragastric titration, averaged 24.2 +/- 2.4 mmol/h. To determine how much of this postprandial acid secretion could be attributed to gastrin, gastrin 17 I was infused intravenously in the same subjects on a separate day and acid secretion and serum gastrin concentrations were measured. By relating serum gastrin concentration during gastrin 17 infusion to concomitant acid secretion, we determined that an average postprandial serum gastrin concentration of 121 pg/ml could result in an acid secretion rate of 21.5 mmol/h, 89% of the actual acid secreted after the simulated meal in these subjects. However, in individual subjects, the amount of gastrin released after a meal could produce as little as 51% or as much as 162% of actual postprandial acid secretion. Thus, in individual human subjects the contribution of gastrin to acid secretion after a meal is variable.

Detailed comparison of basal and food-stimulated gastric acid secretion rates and serum gastrin concentrations in duodenal ulcer patients and normal subjects.

We measured basal and peak acid outputs, food-stimulated acid secretion, and basal and food-stimulated serum gastrin concentrations in a large group of duodenal ulcer patients and normal subjects. Basal and peak acid outputs were significantly higher in ulcer patients. In contrast, acid secretion was similar in the groups when food was infused into the stomach and when sham feeding was combined with meal infusion to simulate normal eating. Meal-stimulated acid secretion, expressed as a percentage of peak acid output to correct for differences in secretory capacity, was lower in ulcer patients (P less than 0.002). Basal serum gastrin concentrations were higher in ulcer patients, which may have contributed to higher basal acid output. However, increases in serum gastrin after food were similar in the groups. Duodenal ulcer patients, as a group, have increased basal and maximal acid secretion, but the amount of acid secreted and gastrin released after eating is normal.

Comparison of acid secretory responsiveness to gastrin heptadecapeptide and of gastrin heptadecapeptide pharmacokinetics in duodenal ulcer patients and normal subjects.

Serum gastrin concentrations and gastric acid secretion were measured during intravenous infusion of gastrin heptadecapeptide (G-17) (0, 7, 22.1, 70, 221, and 700 pmol/kg X h) in 15 duodenal ulcer patients and 15 healthy controls. Ulcer patients developed higher serum gastrin concentrations during G-17 infusion due to nearly twofold slower clearance of gastrin (8.8 vs. 15.7 ml/kg X min; P less than 0.01). Despite slower clearance of G-17, ulcer patients had plasma elimination half-times for G-17 similar to controls (6.0 vs. 6.1 min, respectively). Thus, calculated volume of distribution for G-17 was lower in ulcer patients than controls (78.5 vs. 140.7 ml/kg; P less than 0.025). For any serum gastrin during gastrin-17 infusion, acid secretion (millimoles per hour) was higher in ulcer patients than in controls. However, when acid secretion was expressed as a percentage of peak acid output to G-17 (to correct for differences in parietal cell mass), curves relating acid secretion to serum gastrin were identical in ulcer patients and controls.