Hypothalamic preproghrelin gene expression is repressed by insulin via both PI3-K/Akt and ERK1/2 MAPK pathways in immortalized, hypothalamic neurons.

The gut peptide ghrelin is expressed within neurons of the hypothalamus. Using a hypothalamic cell line, mHypoE-38 neurons, the effect of insulin on preproghrelin gene expression was assayed. These cells contain neuron-specific markers, preproghrelin and the insulin receptor. We determined that insulin has direct effects on preproghrelin gene expression. Insulin (10 nM) stimulated protein kinase B (Akt) and extracellular signal-regulated kinase 1 and 2 (ERK1/2) phosphorylation from 5 to 60 min and 5 min, respectively, and led to repression of preproghrelin gene expression at 2 h. Pharmacological inhibitors to phosphoinositide-3-kinase (PI3-K; LY294002) and MEK (PD98059) demonstrated that basal ghrelin gene expression is regulated by the PI3-K pathway and requires the mitogen-activated protein kinase pathway for insulin-stimulated preproghrelin repression. These results demonstrate that insulin has a direct effect on hypothalamic neurons to decrease preproghrelin gene expression through classic insulin pathways.

Calf management practices and associations with herd-level morbidity and mortality on beef cow-calf operations.

The objective of this study was to investigate calf management practices on beef cow-calf operations and determine associations with herd-level morbidity and mortality of pre-weaned calves. A 40-question survey about management practices, morbidity and mortality was administered to cow-calf producers by distributing paper surveys and by circulating an online link through various media. A total of 267 producers completed the survey. Data were analyzed with descriptive statistics and multivariable linear regression models. Average herd-level treatment risk for pre-weaning calf diarrhea (PCD) and bovine respiratory disease (BRD) were 4.9% and 3.0%, respectively. Average herd-level mortality within the first 24 h of life (stillbirth), from 1 to 7 days and 7 days to weaning were 2.3%, 1.1%, and 1.4%, respectively. Operations that never intervened at parturition had 4.7% higher PCD than those that occasionally did. On operations using small elastrator bands for castration, PCD was 1.9% higher than those using other methods. For every increase of 100 cows in herd size, BRD decreased by 1.1%. The association between BRD and PCD varied by when calving season began. Operations that used off-farm, frozen colostrum had a 1.1% increase in stillbirths. Operations that verified a calf had suckled had 0.7% lower mortality from 1 to 7 days of age. Those that intervened when colostrum was abnormal or that used small elastrator bands for castration had 1.9% and 1.4% higher mortality during the 1st week of life, respectively, compared with other operations. Mortality from 7 days to weaning was lower by 0.7% when calving season started in April compared with January or February and was higher by 1.0% for each additional week of calving season. Operations that intervened with colostrum consumption for assisted calvings had lower mortality from 7 days to weaning by 0.8% compared with those that did not. For every 1.0% increase in BRD, mortality from 7 days to weaning increased by 1.0%. Stillbirths and mortality from 7 days to weaning decreased non-linearly with herd size. Factors related to calving season, herd size, interventions at calving, colostrum management and castration impacted herd-level morbidity and mortality. However, effect size was generally small and causation cannot be determined with a cross-sectional study design. This study identifies several common health management practices associated with calfhood morbidity and mortality that should be further investigated to establish evidence-based management strategies to improve the health and survival of beef calves.

Imagery content during nonpharmacologic analgesia in the procedure suite: where your patients would rather be.

RATIONALE AND OBJECTIVES: Imagery as a hypnotic technique can produce analgesia and anxiolysis, but effective use may be restricted to select, highly hypnotizable individuals. This study assessed (a) whether patients not selected for hypnotizability can produce imagery during interventional radiologic procedures and (b) the type of imagery produced. A secondary goal of the study was to familiarize health care providers with a simple, time-efficient technique for imagery. MATERIALS AND METHODS: Fifty-six nonselected patients referred for interventional procedures were guided to a state of self-hypnotic relaxation by a health care provider according to a standardized protocol and script. Patient hypnotizability was assessed according to the Hypnotic Induction Profile test. RESULTS: Patients as a group had average distribution of hypnotizability. The induction script was started in all patients and completed in 53. All patients developed an imagery scenario. Chosen imagery was highly individual, but common trends were nature and travel, family and home, and personal skills. Being with loved ones was an important element of imagery for 14 patients. Thirty-two patients chose passive contemplation, and 24 were action oriented. CONCLUSION: Average patients who present for interventional radiologic procedures and are not preselected for hypnotizability can engage in imagery. Topics chosen are highly individual, thus making prerecorded tapes or provider-directed imagery unlikely to be equally successful.

Rapid anxiety assessment in medical patients: evidence for the validity of verbal anxiety ratings.

Rapid assessment of patient anxiety is necessary to insure quality care. A number of self-report measures provide valid and reliable measures of anxiety. These measures can be time-consuming to complete, however, and may be burdensome to medical patients who are in pain or acute anxiety states. Many medical procedures are performed in conditions in which written measures are cumbersome (e.g. patient in supine position), and scoring and interpretation of written measures in a busy clinical setting may be difficult for medical personnel. The present study provides validity data for a verbally administered (0-10) anxiety rating. One hundred and ninety-eight adult interventional radiology patients completed standard measures assessing state anxiety, trait Negative and Positive Affect, and the dimensions of the five-factor model of personality. Verbal anxiety rating was highly correlated with Spielberger's State Anxiety Inventory, showed moderate correlations to the related constructs of neuroticism and trait Negative Affect, and was largely unrelated to theoretically distinct constructs. Verbal anxiety ratings made prior to the invasive procedure also predicted pain and anxiety during the procedure. The verbal anxiety rating also demonstrated sensitivity to changes in anxiety that occurred as a result of changes in situation. Findings support the convergent and discriminant validity of verbal anxiety ratings.

Carbon dioxide angiography: effect of injection parameters on bolus configuration.

PURPOSE: Predict the intravascular distribution of carbon dioxide during angiography. MATERIALS AND METHODS: Mathematical modeling was used to predict the flow pattern of CO2 in a pulsatile system as a function of the CO2 flow rate. Findings were validated in an in vitro pulsatile circuit. RESULTS: The annular flow pattern with filling of nearly the entire lumen with CO2 is the most desirable, followed by intermittent bubble flow (provided individual bubbles are large). Stratified flow relates to a continuous floating CO2 bubble. Configuration of the CO2 bolus depends on fluid properties, fluid velocity, flow rates, mean intraluminal pressure, pressure amplitude, pulse rate, and vessel diameter. In vessels with less than 10-mm inner diameter, annular flow can be achieved relatively easily with injection rates above 20-30 mL/sec. Higher rates are not expected to produce superior results. When imaging a 2-cm artery, the best that can be realized clinically is intermittent flow with large bubbles. Bubbles size increases with increasing CO2 flow rate. In aneurysms, only stratified flow can be achieved with reasonable injection rates. Periodicity of the flow patterns is determined by the pulsatile circuit and can produce indentations in the CO2 bolus, which can be mistaken for stenoses. CONCLUSIONS: Flow regime maps can be used to optimize bolus configuration during CO2 angiography.

Determinants of intravenous conscious sedation for arteriography.

PURPOSE: To assess factors that determine the amount of drugs given for intravenous conscious sedation during arteriography. MATERIALS AND METHODS: Data from 254 patients undergoing infradiaphragmatic arteriography at three institutions were evaluated. The effect of age, sex, procedure time, attending physician, and institution on drug use was assessed by analysis of variance and covariance with repeated measures. In a subset of 34 patients, pain and anxiety scores before and after medication were correlated with drug scores. RESULTS: Institution identity and procedure time significantly affected the amount of medication used (both, P = .000). Patient's age and sex, and identity of the physician had no significant effects. While drug use was relatively constant in each institution among different staff physicians, the institutional differences prevailed when the same physicians performed procedures at different institutions. Drug deliveries did not correlate with anxiety and pain scores before or after medication. CONCLUSION: Habits and philosophies of particular institutions, rather than physician guidance or patients' needs, tend to govern the use of intravenous sedatives and analgesics. There is a need for a more patient-oriented standardization of intravenous conscious sedation and analgesia.

Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial.

BACKGROUND: Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study. METHODS: 241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures. FINDINGS: Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min). INTERPRETATION: Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.