Save the children by treating their mothers (PriVileG-M-study) - study protocol: a sequentially randomized controlled trial of individualized psychotherapy and telemedicine to reduce mental stress in pregnant women and young mothers and to improve Child's health.

BACKGROUND: As early as pregnancy, maternal mental stress impinges on the child's development and health. Thus, this may cause enhanced risk for premature birth, lowered fetal growth, and lower fetal birth weight as well as enhanced levels of the stress hormone cortisol and lowered levels of the bonding hormone oxytocin. Maternal stress further reduces maternal sensitivity for the child's needs which impairs the mother-child-interaction and bonding. Therefore, prevention and intervention studies on mental stress are necessary, beginning prenatally and applying rigorous research methodology, such as randomized controlled trials, to ensure high validity. METHODS: A randomized controlled trial is used to assess the impact of psychotherapy and telemedicine on maternal mental stress and the child's mental and physical health. Mentally stressed pregnant women are randomized to an intervention (IG) and a not intervened control group. The IG receives an individualized psychotherapy starting prenatal and lasting for 10 months. Afterwards, a second randomization is used to investigate whether the use of telemedicine can stabilize the therapeutic effects. Using ecological momentary assessments and video recordings, the transfer into daily life, maternal sensitivity and mother-child-bonding are assessed. Psycho-biologically, the synchronicity of cortisol and oxytocin levels between mother and child are assessed as well as the peptidome of the colostrum and breast milk, which are assumed to be essential for the adaptation to the extra-uterine environment. All assessments are compared to an additional control group of healthy women. Finally, the results of the study will lead to the development of a qualification measure for health professionals to detect mental stress, to treat it with low-level interventions and to refer those women with high stress levels to mental health professionals. DISCUSSION: The study aims to prevent the transgenerational transfer of psychiatric and somatic disorders from the mother to her child. The effects of the psychotherapy will be stabilized through telemedicine and long-term impacts on the child's and mothers' mental health are enhanced. The combination of psychotherapy, telemedicine and methodologies of ecological momentary assessment, video recording and bio banking are new in content-related and methodological manner. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00017065. Registered 02 May 2019. World Health Organization, Universal Trial Number: U1111-1230-9826. Registered 01 April 2019.

Conspiracy beliefs and distrust of science predicts reluctance of vaccine uptake of politically right-wing citizens.

It is not uncommon for conspiracy theories to have a political agenda, some conspiracies are more endorsed by the political left-wing than the political right-wing and vice-versa. Conspiracy theories quickly flourished as the COVID-19 pandemic emerged and this may have been an underlying factor in a reluctance by some in following public health policies such as the wearing of face masks. In the present study, we surveyed a community sample of 1358 adults just prior to the COVID-19 vaccine rollout in Aotearoa New Zealand. Our first aim was to determine whether one's political orientation, whether they are politically left- or right-wing, would be predictive of an individual's belief in conspiracy theories and determine whether this relationship can be exacerbated by a distrust in science. The second aim was to determine how such a relationship could explain an individual's vaccine hesitancy. Our results supported that indeed those that identify as right-wing tended to have higher hesitancy associated with taking the COVID-19 vaccine. However, we demonstrated that this association, in part, can be explained by a corresponding belief in COVID-19 related conspiracies. Interestingly, such a relationship only emerged in the presence of a general distrust in science. In other words, if a right-wing individual has at least a moderate trust in science, they demonstrated similarly low endorsement of COVID-19 conspiracies as their left-wing counterparts. Mitigating the right-wing endorsement of COVID-19 conspiracies then aligned with a reduction in vaccine hesitancy. Our findings indicated that public interventions seeking to increase trust in science may mitigate right-wing endorsement of conspiracy theories and thus lead to a more unified and positive response to public health behaviours such as vaccination.

Colonic energy salvage in chronic pancreatic exocrine insufficiency.

BACKGROUND: Chronic pancreatic exocrine insufficiency results in maldigestion. As a result, increased amounts of undigested nutrients reach the colon, providing more substrate for bacterial fermentation to produce short-chain fatty acids, which could therefore provide additional energy supplement. METHODS: This study aimed to assess carbohydrate malabsorption in patients with chronic pancreatic exocrine insufficiency after ingestion of a standard diet and to calculate energy salvaged by colonic bacterial metabolism. A 72-hour stool collection was done on 10 adult patients receiving a 3-day standard diet containing 100 g fat, 329 g carbohydrate, and 154 g protein, and short-chain fatty acids, fat, carbohydrate, and nitrogen excretion were assessed. A breath hydrogen test after ingestion of 200 g (dry weight) cooked maize meal (test meal) and 10 g oral inulin (standard), respectively, was subsequently done on the patients and 15 healthy adult controls. RESULTS: Breath hydrogen production after ingestion of maize meal and inulin, respectively, and calculated carbohydrate malabsorption were significantly greater in patients (21.4% +/- 17%) than in controls (10.2 +/- 1.4%; p < .05). Patients malabsorbed 70.4 g/d (281.6 kcal) carbohydrate in the standard diet. Total carbohydrate loss in stool amounted to 8.1 g/d (2.4%), and 62.3 g/d (19%) was hence salvaged as short-chain fatty acids for energy provision. Colonic bacterial fermentation therefore converted 88.5% of malabsorbed carbohydrate to short-chain fatty acids, 92.8% of which was absorbed and 7.2% excreted. This suggests that 10.2% of energy expenditure/requirement in these patients is derived from salvage of malabsorbed carbohydrate. CONCLUSIONS: Colonic bacterial metabolism is a significant source of energy salvage in patients with pancreatic enzyme deficiency.

Scalp simulation - A novel approach to site-specific biomechanical modeling of the skin.

OBJECTIVES: This study aimed to determine the hardness of the human scalp in vivo in order to identify an appropriate scalp simulant, from a range of commercially available silicone materials, for force impact assessment. Site-dependent variation in scalp hardness, and the applicability of contemporary skin simulants to the scalp were also considered. MATERIALS AND METHODS: A Shore A-type durometer was used to collected hardness data from the scalps of 30 human participants (five males and five females in each of the three age categories: 18-30, 31-40, 41-50) and four commercially available silicones (light, medium, and heavy-bodied PVS, and duplication silicone). One-sample t-tests were used to compare the mean hardness of simulants to that of the scalp. Site-dependent variation in the hardness of the scalp was assessed using a mixed-model repeated measures ANOVA. RESULTS: Mean human scalp hardness derived from participants was 20.6 Durometer Units (DU; SD = 3.4). Analysis revealed only the medium-bodied PVS to be an acceptable scalp simulant when compared to the mean hardness of the human scalp (p = 0.869). Scalp hardness varied significantly anteroposteriorly (with an observable linear trend, p < 0.001), but not mediolaterally (p = 0.271). Comparisons of simulants to site-specific variation in scalp hardness anteroposteriorly found the medium-bodied PVS to be only suitable in the central region of the scalp (p = 0.391). In contrast, the duplication silicone (p = 0.074) and light-bodied PVS (p = 0.147) were only comparable to the posterior region. CONCLUSIONS: Contemporary skin simulants fail to accurately represent the scalp in terms of hardness. There is strong support for the use of medium-bodied PVS as a scalp simulant. Human scalp hardness varies significantly anteroposteriorly, but not mediolaterally, corresponding to regional anatomical variation within the scalp. A number of materials were identified as potential simulants for different regions of the scalp when more site-specific simulant research is required.

Impairment-oriented training and adaptive motor cortex reorganisation after stroke: a fTMS study.

In a sample of 28 subacute anterior circulation ischemic stroke patients with severe arm paresis, reduced motor cortex excitability (increased motor thresholds, reduced MEP amplitudes, reduced number of active points) and a reduced conduction velocity in the corticospinal system were found in the affected hemisphere. At the same time motor cortex topology for the abductor pollicis brevis (APB) representation was comparable for the affected and non-affected hemisphere. Considerable arm motor recovery (Fugl-Meyer test) was observed when assessed four weeks later after a period of rehabilitation intervention. Motor cortex excitability and conduction velocity in the corticospinal system improved in the affected hemisphere. In addition, APB representation showed a medial shift in patients with such a representation at pre test (n=14). Multiple stepwise regression indicated that of all transcranial magnetic stimulation (TMS) parameters only the medial shift of the motor cortex map predicted motor recovery. Assessing the effect of training time (non-intensified vs. intensified therapy) and type of arm training (Bobath approach vs. Arm BASIS training) with a randomised controlled design revealed that the impairment-oriented Arm BASIS training improved motor control more than the control conditions. In addition, patients of the group receiving the Arm BASIS training with an APB representation at pre test showed a medial shift of the motor cortex map and improved conduction times. In conclusion, changes in motor cortex topology were likely to be relevant for motor recovery and might have been induced by the impairment-oriented training.

The effect of severe undernutrition and subsequent refeeding on whole-body metabolism and protein synthesis in human subjects.

BACKGROUND: To determine the consequences of severe undernutrition and refeeding on whole-body metabolism and protein synthesis. METHODS: Respiratory quotient (RQ), resting energy expenditure (REE), and whole-body protein synthesis (WBPS) were assessed in undernourished patients, with anorexia nervosa (n = 8) or with coexistent disease (n = 17). Results were compared with 17 healthy controls. Six anorexic patients and 13 disease patients consented to study after nutrition support. RESULTS: Mean body mass index was 12.46 +/- 0.53 kg/m2 in the anorexia patients and 13.81 +/- 0.40 kg/m2 in the disease patients (controls 23.71 +/- 0.72 kg/m2; p < .001). Compared with controls, RQ was similar in anorexia patients (0.85 +/- 0.05 vs 0.90 +/- 0.05) but lower in the disease patients (0.76 +/- 0.03 vs 0.90 +/- 0.05; p = .02). REE was lower in the patients (anorexia 1058 +/- 134.0 kcal/d, disease 1189 +/- 101.4 kcal/d vs 1828 +/- 89.76 kcal/d; p < .001); however, expressed as kcal/kg/d, it was higher (anorexia 32.17 +/- 4.25, disease 31.30 +/- 2.14 vs 25.07 +/- 1.00; p < .05). WBPS was lower in the patients (anorexia 140.9 +/- 10.54 g/d, disease 119.8 +/- 8.57 g/d vs 305.0 +/- 21.64 g/d; p < .001); however, when expressed as g/kg/d, the anorexia patients were similar to controls, whereas the disease patients were lower (3.11 +/- 0.24 vs 4.27 +/- 0.32; p < .05). Refeeding increased RQ in the disease patients (0.84 +/- 0.03 vs 0.76 +/- 0.03; p < .05), and normalized REE (anorexia 27.65 +/- 3.05 kcal/kg/d, disease 28.90 +/- 1.85 kcal/kg/d). WBPS increased in the disease patients (173.6 +/- 16.38 g/d vs 116.5 +/- 10.15 g/d; p < .01). CONCLUSIONS: Undernutrition is associated with increased REE (kcal/kg/d). Reduction in RQ and protein synthesis (g/kg/d) was evident in those patients with coexistent disease. Refeeding resulted in normalization of RQ, REE (kcal/kg/d), and protein synthesis (g/kg/d).

Quantification of subconcussive impact forces to the head using a forensic model.

Concussive and subconcussive head injury is a global phenomenon that affects millions of people each year. Concussive injury has been extensively studied in sport, which has led to a greater understanding of the biomechanical forces involved and guidelines aimed at preventing athletes from playing while concussed. Subconcussive forces by definition do not meet the threshold for concussion but nonetheless may have significant long term consequences due to the repetitive pattern of injury to the head. Quantifying these impact forces using a forensic head model provides the groundwork for future studies by establishing a range or threshold of subconcussive impact forces that could be correlated with clinical assessments. The use of a forensic head model has distinct advantages in terms of ethics and safety.

Impaired gastric acid and pancreatic enzyme secretion in patients with Crohn's disease may be a consequenece of a poor nutritional state.

INTRODUCTION: Impaired pancreatic function has been reported in Crohn's disease, the cause of which is uncertain. This study investigated the effect of malnutrition, and subsequent re-feeding, on digestive function and protein synthesis in Crohn's disease patients. METHODS: Gastric acid and pancreatic secretion studies were performed on malnourished Crohn's patients before, and after a period of intensive nutritional support. Whole body, as well as pancreatic enzyme protein synthesis was investigated by [14C]leucine isotope incorporation studies. Results were evaluated in comparison to normal healthy volunteers. RESULTS: The mean body mass index (BMI) of the Crohn's patients was 14.14 kg/m2. The Crohn's patients had reduction in the secretion of gastric acid (7.36 versus 25.53 mEq/h; P < 0.01), and the pancreatic enzymes, amylase (759.6 versus 2305 U/h; P < 0.01), lipase (33.01 versus 118.6 U/h; P < 0.01) and trypsin (97.43 versus 341.4 U/h; P < 0.01). Resting energy expenditure (REE), expressed in relation to body mass, was greater in the malnourished Crohn's disease patients (38.25 versus 25.36 kcal/kg/d; P = 0.01). Total body protein synthesis was reduced (2.82 versus 4.39 g protein/kg/d; P < 0.05), with significant impairment in the synthesis of pancreatic enzymes, and reduction of zymogen stores. Following re-feeding, the BMI of the Crohn's patients improved to 16.80 +/- 0.66 kg/m2. Pancreatic enzyme synthesis improved, with significant increase in pancreatic enzyme stores and secretion, to levels similar to control values. Gastric acid secretion also improved, although still lower than the control value. CONCLUSION: Malnutrition may play a significant role in the impairment of gastric acid and pancreatic secretion in Crohn's disease patients.

Intravenous CDP870, a PEGylated Fab' fragment of a humanized antitumour necrosis factor antibody, in patients with moderate-to-severe Crohn's disease: an exploratory study.

BACKGROUND: CDP870 is a PEGylated Fab' fragment of a humanized monoclonal antibody that neutralizes tumour necrosis factor-alpha. AIM: To evaluate the safety and efficacy of a single intravenous dose of CDP870 or placebo over a 12-week period in patients with moderate-to-severe Crohn's disease. METHODS: Ninety-two adult patients with Crohn's disease (Crohn's Disease Activity Index: 220-450 points) were randomized to receive CDP870 [1.25 (n = 2), 5 (n =26), 10 (n = 17) or 20 mg/kg (n = 23)] or placebo (n = 24). Crohn's Disease Activity Index scores were determined at weeks 0, 2, 4, 8 and 12. The primary end-point was the percentage of patients achieving clinical response [i.e. a decrease in Crohn's Disease Activity Index score > or = 100 points or remission (Crohn's Disease Activity Index score: < or =150 points)] at week 4 in the intent-to-treat population. RESULTS: The percentage of patients achieving the primary end-point was comparable across all treatment groups (56.0%, 60.0%, 58.8% and 47.8% for placebo, CDP870 5, 10 and 20 mg/kg, respectively). The remission rate at week 2 was 47.1% with CDP870 10 mg/kg vs. 16.0% for placebo (P = 0.041). All treatments were well-tolerated: adverse events, reported by 43 patients treated with CDP870 and 15 patients treated with placebo, were mainly mild-to-moderate in intensity. There were no infusion reactions. CONCLUSIONS: A single intravenous dose of CDP870 was well-tolerated by patients with Crohn's disease. While no statistically significant difference in clinical response rates between CDP870 and placebo was observed, clinical benefit in terms of remission was demonstrated.

Coexistence of cholinergic and somatostatin receptors on astrocytes of rat CNS.

Electrophysiological studies have shown that somatostatin (SOM; 10(-8) and 10(-7) M) causes a hyperpolarization of the majority of astrocytes in explant cultures of rat spinal cord and cortex. When SOM and the cholinergic agonists muscarine and nicotine (10(-6) M) were tested on the same cell, all three compounds produced hyperpolarizations, suggesting a colocalization of functional cholinergic and SOM receptors on the glial membrane. Combined immunohistochemical and autoradiographic binding studies demonstrating that almost all astrocytes which were immunostained by the monoclonal muscarinic or nicotinic antibodies were also intensely labelled by 125I-SOM, provide further evidence for the coexistence of cholinergic and SOM receptors on astrocytes.

Electrophysiological evidence for the presence of receptors for cholecystokinin and bombesin on cultured astrocytes of rat central nervous system.

The action of cholecystokinin (CCK) and bombesin (Bom) was studied on the membrane potential of astrocytes in explant cultures of rat cortex, cerebellum, brain stem and spinal cord. Both peptides (10(-8) and 10(-7) M) caused a hyperpolarization of most astrocytes studied. The hyperpolarization by CCK was markedly reduced or blocked by the CCKB-antagonist L-365,260 whereas addition of the Bom-antagonist [D-Phe12,Leu14]-Bom antagonized the effects of Bom, suggesting a specific action of these peptides. When CCK and Bom were tested on the same cell, both peptides were effective, indicating a colocalization of receptors for CCK and Bom on the glial membrane. Our electrophysiological investigations provide strong evidence for the existence of functional CCK and Bom receptors on astrocytes.

Central mechanisms in human enhanced physiological tremor.

The sites of the central nervous structures involved in enhanced physiological tremor (EPT) are still unclear. The syndrome of persistent mirror movements (PMM) is characterized by abnormal bilateral corticospinal projections. If a supraspinal mechanism is involved in EPT, the activity of EPT should be coherent between both sides in subjects with this abnormality. We investigated three PMM subjects and three normal controls. Focal transcranial magnetic stimulation (TMS) resulted in contralateral hand muscle responses in the controls. The PMM subjects, in contrast, had bilateral responses. Similarly, long-latency reflexes (LLR) in PMM could be recorded bilaterally, while the control subjects showed responses only on the stimulated side. EPT was evoked by intravenous salbutamol. EMG time series were recorded bilaterally from the wrist extensor muscles and cross spectra were calculated. If there was a significant right-left-coherence, phase analysis was performed. No control subject showed a significant right-left-coherence of tremor activity. In contrast, a significant coherence was found in PMM between 8 and 12 Hz. When the mechanical tremor frequency of one hand was reduced by loading, coherences and phase spectra of the EMGs remained unchanged. By comparing the results from TMS, LLR and cross spectral analysis we come to the conclusion, that the 8 to 12 Hz component of EPT is transmitted transcortically, most likely originating from two separate generators for both sides.

Musculoskeletal ultrasound: an update.

In summary, musculoskeletal sonography is a rapidly growing field of interest around the world. Outside of America, it is often the first and definitive imaging modality fordisorders of the musculoskeletal system. Musculoskeletal ultrasound offers rapid, inexpensive, real-time examination of the structures of interest with easy comparison to the contralateral side. Principles of one area of musculoskeletal sonography easily generalize to other areas.

Influence of blockade of alpha 1-adrenoceptors, beta 1-adrenoceptors and vasopressin V1A receptors on the cardiovascular effects of gamma 2-melanocyte-stimulating hormone (gamma 2-MSH).

gamma 2-Melanocyte-stimulating hormone (gamma 2-MSH) and related melanotropins have been shown to have various cardiovascular effects, including acute, short-lasting increases in blood pressure (MAP) and heart rate (HR). gamma 2-MSH, administered intravenously, dose-dependently increased MAP and HR with an ED50 of approximately 30 nmol/kg and a maximal effect on MAP of approximately 55 mm Hg and on HR of around 70 beats per minute. Intravenous (i.v.) pretreatment with the alpha 1-adrenoceptor antagonist, prazosin, caused the dose-response curve for the effect of gamma 2-MSH on MAP to shift to the right with a decrease in slope, whereas it had no effect on the dose-response curve for the effect on HR. I.v. pretreatment with the beta 1-adrenoceptor antagonist, metoprolol, had no effect on the dose-response curve for the effect of gamma 2-MSH on MAP, but it caused the dose-response curve for the effect of the peptide on HR to shift to the right with a decrease in slope. Neither i.v. nor intracerebroventricular (i.c.v.) administration of the vasopressin V1A receptor antagonist, SR 49059 ((2S) 1-[(2R 3S)-5-chloro-3-(2-chlorophenyl)-1-(3,4-dimethoxy-benzene-sulfonyl)- 3-hydroxy-2,3-dihydro-1H-indole-2-carbonyl]-pyrrolidine-2-carboxamide), had significant effects on the dose-response curves for the effects of the peptide on either MAP or HR. The doses of prazosin, metoprolol and SR 49059 were found to be effective in counteracting the effects of agonists for these receptors (phenylephrine, isoprenaline and [Arg8]vasopressin, respectively). Taken together, these results support the postulate that the effects of gamma 2-MSH are, at least partially, due to an increase in sympathetic outflow to the periphery (Gruber and Callahan (1989), Am J Physiol 257: R681-R694), and that this increase leads to increased activation of vascular alpha 1-adrenoceptors and cardiac beta 1-adrenoceptors. If, as was suggested by these authors, gamma 2-MSH acts via activation of a central vasopressin system, it is via a vasopressin receptor subtype other than the vasopressin V1A receptor, since i.c.v. administration of a selective vasopressin V1A receptor antagonist failed to interfere with the pressor and cardioaccelerator effects of gamma 2-MSH.

Magnetic resonance imaging signal changes in denervated muscles after peripheral nerve injury.

The evaluation of peripheral nerve disorders has traditionally relied on a clinical history, physical examination, and electrodiagnostic studies. Recent studies have used magnetic resonance imaging (MRI) to evaluate a variety of both nerve and muscle disorders. In this article, we describe the use of MRI, using short-tau inversion recovery (STIR) sequences, to evaluate muscle signal characteristics in a variety of peripheral nerve disorders. A total of 32 patients were studied, and 12 representative cases are discussed in detail. Increased STIR signal in muscle was seen in cases of severe axonotmetic injuries involving the transection of axons producing severe denervation changes on electromyography. The increased STIR signal in denervated muscles was seen as early as 4 days after the onset of clinical symptoms, which is significantly earlier than changes detected on electromyography. The MRI signal changes were reversible when the recovery of motor function occurred as a result of further muscle innervation. In cases of neurapraxic nerve injuries, characterized by conduction block without axonal loss, the STIR signal in muscle was normal. These findings show that MRI using STIR sequences provides a panoramic visual representation of denervated muscles useful in localizing and grading the severity of peripheral nerve injury secondary to either disease or trauma. MRI using STIR sequences may therefore play an important role in the prediction of clinical outcome and the formulation of appropriate therapy early after peripheral nerve injury.

The effect of severe undernutrition, and subsequent refeeding on digestive function in human patients.

BACKGROUND: Severe undernutrition may adversely affect gut function. AIMS: To investigate the effects of severe undernutrition and subsequent refeeding on human digestive function. METHODS: Severely undernourished patients (body mass index (BMI) < 17 kg/m2) were studied before, and after a period of intensive nutritional support. Standard intestinal absorption tests (faecal fat and urinary xylose excretion), pentagastrin-stimulated acid secretion, and cholecystokinin octapeptide (CCK-8)-stimulated pancreatic enzyme secretion tests were performed. In addition, duodenal biopies were taken to assess gut mucosal morphology. Findings were evaluated in comparison to a group of normal healthy volunteers. RESULTS: Mean BMI of the patients prior to nutritional support was 13.41 kg/m2, with improvement to 16.12 kg/m2 after. Duodenal histology showed evidence of villous atrophy in six of 14 (43%) undernourished patients. Mean xylose excretion following a 5 g oral dose was 0.62 g/5 h in the group of undernourished patients prior to nutritional support (normal > 1 g/5 h), with improvement to 1.40 g/5 h (P < 0.01) after feeding. Maximal gastric acid output was significantly impaired in the undernourished group, as compared to the controls (6.94 mEq/l vs 25.53 mEq/l, P < 0.02), with a significant improvement to 12.30 mEq/l (P < 0.05) following nutritional support. Pancreatic enzyme output was significantly reduced (amylase 830.9 U/h vs 2304 U/h, P < 0.01; lipase 38.0 U/h vs 118.6 U/h, P < 0.01; trypsin 119.7 U/h vs 341.4 U/h, P < 0.01). Following a period of nutritional support there was a significant improvement in amylase and lipase outputs to 1819 U/h and 85.5 U/h, respectively (P < 0.01). These levels were not significantly different from the normal controls. Trypsin output, however, remained significantly impaired at 174.3 U/h (P < 0.01). CONCLUSIONS: Severe undernutrition is associated with significant impairment of digestive function, with improvement occurring following nutritional support. These changes may affect initial tolerance to enteral feeding, particularly in those patients with co-existent gut disease.

Impaired pancreatic secretion in severely malnourished patients is a consequence of primary pancreatic dysfunction.

Severe undernutrition has been associated with reduced secretions of gastric acid and pancreatic enzymes. This may be the result of an impaired gut mucosal response to food and primary gastric parietal and pancreatic acinar cell secretory dysfunction as a consequence of the poor nutritional state. To investigate the relative contributions of these factors, severely undernourished patients underwent enteral-meal-stimulated (ES; n = 7) or intravenous hormone (pentagastrin and cholecystokinin-8)-stimulated (HS; n = 12) gastric acid and pancreatic enzyme secretion before and after a period of nutritional support. Results were evaluated in comparison with normal healthy control subjects (ES = 7, HS = 10). In the control subjects, enteral-meal and cholecystokinin-8 stimulation resulted in similar outputs of the pancreatic enzymes amylase (2213 versus 2305 U/h), lipase (84.93 versus 118.6 U/h), and trypsin (498.9 versus 341.4 U/h), whereas acid output was significantly lower in the ES group (10.90 versus 25.53 mEq/h; P < 0.01). Compared with controls, malnourished groups had significantly reduced secretions of amylase (ES = 870.1 U/h, HS = 686.5 U/h; P < 0.02), lipase (ES = 30.68 U/h, HS = 25.96 U/h; P < 0.02), and trypsin (ES = 175.6 U/h, HS = 109.3 U/h; P < 0.01). The response to enteral-meal or CCK-8 stimulation was comparable. Gastric acid was similarly reduced in the undernourished patients (ES = 4.39 mEq/h, HS = 5.04 mEq/h; P < 0.01). After refeeding, secretion of amylase (ES = 2351 U/h, HS = 2228 U/h) and lipase (ES = 58.83 U/h, HS = 84.91 U/h) improved to levels not significantly different from controls, whereas trypsin (ES = 226.4 U/h, HS = 213.1 U/h; P < 0.03) and acid secretion (ES = 3.52 mEq/h, HS = 11.85 mEq/h; P < 0.01) remained significantly impaired. Severe undernutrition was associated with primary gastric parietal and pancreatic acinar cell dysfunction, which, at least in the case of pancreatic enzymes, appeared to be the determining factor controlling secretion in these patients.

Utility of magnetization prepared GRE MRI for the detection of focal liver lesions.

We compared the efficacy of rapidly acquired magnetization prepared gradient-echo (MP-GRE) sequences with CT and standard MRI pulse sequences for the detection of focal liver lesions. Fourteen patients with 28 focal liver lesions were scanned. TI times of 300, 450, and 600 ms were used. MP-GRE lesion conspicuity was compared to corresponding CT, T1, T2, T2-post-superparamagnetic-iron-oxide (SPIO), and STIR images. It was found that the differences between MP-GRE and CT and MP-GRE and T1 MRI were not significant. However, overall anatomic detail was better with CT and T1 MRI than MP-GRE. Lesion conspicuity was significantly worse with the MP-GRE than with the T2, T2-post-SPIO, and STIR sequences (all p values = 0.00). Maximal liver signal nulling occurred at TI = 300 ms in 13 out of 14 patients. However, the T1 for optimal focal liver lesion conspicuity varied widely and could not be predicted before scanning. No new lesions were seen on the MP-GRE sequence that could not be seen on the CT or standard MRI sequences. As currently implemented, MP-GRE imaging offers no advantage in the detection of focal liver lesions over CT and standard MRI pulse sequences.

Familial and socioregional environmental effects on abstinence from alcohol at age sixteen.

OBJECTIVE: This study identifies, in genetically informative data, familial and socioregional environmental influences on abstinence from alcohol at age 16. METHOD: Data are from FinnTwin 16, a population-based study of five consecutive birth cohorts of Finnish twins (N = 5,747 twin individuals), yielding 2,711 pairs of known zygosity. Measures of alcohol use, embedded into a health-habits questionnaire, were taken from earlier epidemiological research with nontwin Finnish adolescents. The questionnaire was administered sequentially to all twins as they reached age 16. Separate questionnaires, including measures of alcohol use and screening questions for alcohol problems, were received from 5,243 of the twins' parents. RESULTS: Abstinence from alcohol to age 16 exhibits very significant familial aggregation, largely due to nongenetic influences. Abstinence rates are influenced by socioregional variation, sibling interaction effects and parental drinking patterns. Sibling and parental influences are greater in some regional environments than in others: the relative likelihood that a twin abstains, given that the co-twin does, or that both parents do, is shown to be modulated by socioregional variation. CONCLUSION: Environmental contexts affect the likelihood of maintaining abstinence from alcohol to midadolescence, and socioregional variation modulates influences of siblings and parents. The results illustrate how genetically informative data can inform prevention research by identifying target variables for intervention efforts.