Study of liver transplant rejection in alcoholism-induced cirrhosis.

Rejection is the most usual cause of primary dysfunction of hepatic allograft transplants. Acute rejection (AR) often occurs in the early post-transplantation weeks, with an incidence of 12%-19%. Chronic rejection (CR) is less usual (2.5%-17%) and irreversible. Our aim was to determine the incidence of AR and CR in patients who underwent transplantaton due to alcoholism-induced cirrhosis and the survival of these groups. We undertook a retrospective study of the 93 patients who received a liver transplant due to hepatic cirrhosis between 2005 and 2012. AR occurred in 23.7% of cases, and CR in 11.8%. The median time from implantation to the appearance of AR was 34.5 days, and for CR it was 334 days. The survival of the patients with AR and CR showed no significant differences as compared with the control group (P = .77). From our clinical appraisal, symptoms of previous AR may lead to CR, although the relationship was not significant.

Second trimester maternal plasma levels of cytokines IL-1Ra, Il-6 and IL-10 and preterm birth.

OBJECTIVE: To examine the interaction of the cytokines interleukin-1 receptor antagonist (IL)-1Ra, IL-6 and IL-10 to predict preterm birth (PTB) in pregnant Hispanic women (n=470). STUDY DESIGN: In this prospective study, demographic data were obtained prenatally and birth outcome data were obtained from the medical chart. Cytokines were measured from plasma obtained at 22 to 24 weeks gestation. Data analysis utilized logistic regression. RESULT: PTB was predicted by level of IL-1Ra (odds ratio (OR)=2.55; 95% confidence interval (CI)=1.24, 5.24). The interaction between IL-1Ra and IL-6 and between IL-1Ra and IL-10 was significant (Wald=4.01, P=0.04 and Wald=8.84, P<0.003, respectively) and was also predictive of PTB. As IL-1Ra levels increased while IL-10 levels were low, the probability of PTB greatly increased. CONCLUSION: The interactions of select cytokines and cytokine receptor antagonists were associated with PTB. Future research should focus on the changes in cytokines during pregnancy to identify critical periods of change, and examine predictors of the cytokine response.

Specialized care for twin gestations: improving newborn outcomes and reducing costs.

OBJECTIVE: To compare newborn outcomes and costs of hospital stays for twins born to mothers receiving care in a specialized twin clinic with a research-based care protocol and one consistent caregiver versus twins whose mothers received standard prenatal care. DESIGN AND SETTING: A retrospective, historical cohort study conducted in a high-risk obstetric clinic in central Texas. PATIENTS: Thirty women pregnant with twins received specialized care. The comparison group consisted of 41 women pregnant with twins who received standard care. INTERVENTIONS: An advanced practice nurse provided prenatal care, which included weekly clinic visits, home visits, and 24-hour availability for phone support. OUTCOME MEASURES: Gestational age at birth, birth weight, length of stay in the neonatal intensive-care unit (NICU), and hospital charges for the newborns. RESULTS: No newborns of less than 30 weeks gestation were born to women in the specialized care group, the mean birth weight was 249 g (SD +/- 77) higher, days in the NICU were reduced from a mean of 17 to 7, and hospital charges were $30,000 less per infant. CONCLUSIONS: Newborn outcomes were improved and length of stay and hospital charges were significantly reduced for newborns whose mothers had received care in the specialized twin clinic.

Determination of allicin, S-allylcysteine and volatile metabolites of garlic in breath, plasma or simulated gastric fluids.

Various components of garlic and aged garlic extract, including allicin, S-allylcysteine (SAC) and volatile metabolites of allicin were determined in breath, plasma and simulated gastric fluids by HPLC, gas chromatography (GC) or HPLC- and GC-mass spectrometry (MS). Data indicate that allicin decomposes in stomach acid to release allyl sulfides, disulfides and other volatiles that are postulated to be metabolized by glutathione and/or S-adenosylmethionine to form allyl methyl sulfide. SAC can be absorbed by the body and can be determined in plasma by HPLC or HPLC-MS using atmospheric pressure chemical ionization (APCI)-MS.

Relationships of cortisol, perceived stress, genitourinary infections, and fetal fibronectin to gestational age at birth.

The authors investigated the role of stress and cortisol with patients having preterm labor (PTL) and preterm birth (PTB). The relationships of maternal cortisol, perceived stress, fetal fibronectin (fFN), and genitourinary infections to PTL and PTB were studied. A prospective, longitudinal, observational study (n = 78) was conducted in a private practice in central Texas. Subjects had 4 blood draws for cortisol measurements grouped by 15-19, 20-22, 23-26, 27-30, and 31-35 weeks of gestation. Subjects had 2 vaginal swabs forfFN, chlamydia, and bacterial vaginosis screens at 23-26 and 27-30 weeks with assessment of psychosocial stress at 23-26 and 31-35 weeks. Statistical analysis was by analysis of variance, Pearson correlations, Fisher exact test, and logistic regression. There were no significant differences between the PTB, PTL, and term groups on cortisol levels at any of the gestational periods. Cortisol concentrations at any gestational stage did not correlate with gestational age at birth. A relationship of cortisol to race was observed when comparing Caucasians to other ethnic groups. A correlation (r = 0.42, P < 0.001) between the change in Perceived Stress Scale (PSS) score and gestational age was observed. The greater the decrease in PSS scores, the longer was the gestational age. A significant increase in cortisol at 19-21 weeks (P < 0.04), 23-26 weeks (P < 0.05), and 31-35 weeks (P < 0.01) was observed in patients having genitourinary infection. PTL was also significantly increased in subjects having positive genitourinary infections at either 23-26 weeks or 27-30 weeks (P < 0.01). The sensitivity of fFN to predict PTL collected at 27-30 weeks was 40%, specificity 86%, positive predictive value 55%, and negative predictive value 83%. These results indicate that cortisol is a poor predictor of either PTL or PTB. A decrease in perceived stress during the 2nd trimester was associated with an increase in length of gestation, suggesting the possibility of stress reduction as an appropriate intervention for lengthening gestational age.

The determination of metabolites of garlic preparations in breath and human plasma.

Gas Chromatography-Mass Spectrometry (GC-MS) was the major technique used to determine various metabolites after consumption of dehydrated granular garlic and an enteric-coated garlic preparation, in breath, plasma, and simulated gastric fluids. A special short-path thermal desorption device was used as an introduction technique for the gas chromatograph for the determination of volatiles. These garlic preparations release allicin, which decomposes in stomach acid or with time in the intestine to release allyl sulfides, disulfides and other volatiles, some of which are postulated to be metabolized by glutathione and/or S-adenosylmethionine to form allyl methyl sulfide, the main sulfur containing volatile metabolite. S-Allylcysteine, a non-volatile bioactive component of aged garlic preparations, was determined in human plasma and urine by HPLC-MS using the negative ion atmospheric pressure chemical ionization mode (APcI)- MS. The technique of selected ion monitoring was used for quantitation. A synthetic internal standard of deuterated S-allylcysteine was added to the plasma or urine to ensure recovery and to obtain reliable quantitative data.

Psychoneuroimmunology and preterm birth. A holistic model for obstetrical nursing practice and research.

This article presents a framework through which nurses can conceptualize premature labor and birth for both practice and research. Use of the psychoneuroimmunology (PNI) model may guide the study of the problem of preterm birth in a more holistic manner, discovering relationships between the body and the mind that may affect how nurses can intervene to prevent premature birth. Nursing assessment of risk needs to include those situations that may lead to increased stress or anxiety, as is supported by research based on the PNI model. Reduction of stressors that lead to physiological changes related to the stress response can affect the incidence of preterm labor. Interventions to decrease stress and poor coping behaviors need to be tested and integrated into practice.

The measurement of stress in pregnancy.

Stress is thought to be one of the biopsychosocial factors that contribute to adverse pregnancy outcomes, such as preterm labor and low birthweight. Identification of these factors (as in total number), and measurement of their individually perceived importance (severity) could lead to opportunities for intervention, and improved pregnancy outcome. A pilot study of the Daily Hassles Scale, was conducted in order to determine the appropriateness of its use among pregnant women. Daily hassles were thought to be a valid proxy for prenatal stress. Content and construct validity were determined among a sample of four content experts and 30 pregnant women. The Daily Hassles Scale proved to be a reliable (internally consistent) measure of stress (alpha reliability coefficient of 0.90). Further adaptation of the scale to include hassles specific to pregnancy and further testing of its usefulness among diverse multicultural and ethnic populations is warranted.

Mechanisms of full-term and preterm labor: factors influencing uterine activity.

OBJECTIVE: To review factors influencing uterine activity leading to delivery. DATA SOURCES: A search was conducted on MEDLINE and CINAHL under the terms "preterm labor," "preterm delivery," and "physiology of labor and preterm labor." STUDY SELECTION: One-hundred fifty articles were reviewed, with selection based on physiologic concepts judged to be most relevant to nursing practice. DATA SYNTHESIS: In this review, factors initiating labor and preterm labor (PTL) are identified, along with areas for further research. CONCLUSIONS: Despite research on what initiates labor, it is unknown how the various mechanisms are integrated. Nurses are in a position to conduct research to help further the understanding of the labor and PTL processes. Nurses can use their assessment skills to help identify women at risk for PTL and delivery.

The research basis for prevention of preterm delivery in twin gestations.

The purpose of this review is to explore interventions to improve the preterm delivery (PTD) rate in twin gestations. The increased mortality rate of twin gestations is strongly associated with low birth weight and PTD. Current evidence-based interventions such as specialized, comprehensive care by a consistent provider (such as an advanced practice nurse) should be implemented. Research is still needed for improved early detection and interventions to decrease risk factors for PTD. Nursing research is challenged to further develop interventions to improve perinatal outcomes in twin gestations and to decrease the burdens of premature delivery for our nation.