Decreased fecal bile acid output in patients with coronary atherosclerosis

In most patients with atherosclerosis, the underlying metabolic derangement remains undefined. Animal experiments have suggested that the ability to produce and excrete large amounts of bile acids may be an adaptation mechanism to cholesterol overload protecting against the atherogenic effects of cholesterol. However, there are very few data on bile acid excretion in human atherosclerosis. In the present study, we have investigated fecal bile acid secretion in subjects with and without coronary artery disease. The target group consisted of 30 patients with proven coronary artery disease and the control group consisted of 27 matched subjects without clinical or laboratory evidence of coronary atherosclerosis. Fecal bile acids were measured by gas-liquid chromatography from 24-hr stool collections under a controlled diet. The patients excreted significantly less bile acids than the controls (325+/-135 vs. 592+/-223 mg/day, respectively, p < 0.0001). The difference was primarily due to a reduced excretion of secondary bile acids. Less than 50% of deoxycholate was excreted by patients (180+/-81 mg/day) as compared to controls (367+/-168 mg/day, p < 0.0002), while lithocholic acid excretion was 111+/-62 mg/day in patients vs. 190 +/-70 mg/day in controls (p < 0.005). The fecal output of the two primary bile acids, cholic and chenodeoxycholic acid, did not differ significantly between patients and controls. The fecal output of total bile acids correlated with that of both secondary bile acids in patients as well as in controls. These findings suggest that patients with coronary heart disease are unable to excrete adequate amounts of bile acids to rid themselves of excess cholesterol, even if they are able to maintain a plasma cholesterol level comparable to that of healthy controls.     

Altered hippocampal kainate-receptor mRNA levels in temporal lobe epilepsy patients

This study determined whether hippocampal kainate (KA) receptor mRNA levels were increased or decreased in temporal lobe epilepsy patients compared with nonseizure autopsies. Hippocampal sclerosis (HS; n = 17), nonsclerosis (non-HS; n = 11), and autopsy hippocampi (n = 9) were studied for KA1-2 and GluR5-7 mRNA levels using semiquantitative in situ hybridization techniques, along with neuron densities. Compared with autopsy hippocampi, HS and non-HS cases showed decreased GluR5 and GluR6 hybridization densities per CA2 and/or CA3 pyramid. Furthermore, HS patients demonstrated increased KA2 and GluR5 hybridization densities per granule cell compared with autopsy hippocampi. These findings indicate that chronic temporal lobe seizures were associated with differential changes in hippocampal KA1-2 and GluR5-7 hybridization densities that vary by subfield and pathology group. In temporal lobe epilepsy patients, these results support the hypothesis that pyramidal cell GluR5 and GluR6 mRNA levels are decreased as a consequence of seizures, and in HS patients granule cell KA2 and GluR5 mRNA levels are increased in association with aberrant fascia dentata mossy fiber sprouting and/or hippocampal neuronal loss.     

Pulmonary and allergy subspecialty care in adults with asthma. Treatment, use of services, and health outcomes

This study examined the relationship of several maternal variables to the duration of exclusive breast-feeding and the total duration of breast-feeding, along with attitudes, perceptions, and beliefs about breast-feeding among women living in poor neighborhoods of Managua, Nicaragua. The field work was carried out in December 1992 and January 1993 using qualitative and quantitative methods. A structured questionnaire was administered in interviews with 556 mothers of children under 12 months of age, and meetings of four directed discussion groups were held, in which a total of 20 women participated. At one week of age, almost all the children of the mothers who were surveyed had been breast-fed, but only 45% had been exclusively breast-fed. At 12 weeks old, 30% were already completely weaned. The discussion groups revealed the coexistence of positive opinions about both breast-feeding and bottle-feeding. However, exclusive breast-feeding was considered harmful for the mother, and breast milk was not thought to be sufficient nourishment for the child. Previous experience was strongly related to the duration of exclusive breast-feeding and to total breast-feeding duration. Attitudes, social support, and work situation were important factors influencing the total length of time women breast-fed a child. In general, the results obtained through the interviews and in the discussion groups were in agreement and showed that the elements needed to promote exclusive breast-feeding were social support, a favorable community environment, and policies that dealt with problems faced by working mothers. The complementary research methods were useful for obtaining information about the relative importance of different factors that determine the duration of breast-feeding and for understanding that practice in greater depth from the mother's point of view.     

Die effiziente Organisation

Definition of the problem The hospital as an organization has undergone substantial changes during recent decades due to reforms in the health care system. There have been necessary and quite helpful modifications; however, some modifications raise the question: what public tasks should hospitals fulfill in the future? The following question, thus, arises: what kind of effectiveness, besides cutting costs, should be achieved by the permanent increase of efficiency in hospitals? Paradoxically spoken, the change of the organization hospital seems to be entailed by economization which at the same time is meant to be a remedy for change. Arguments This article reflects on the process of economization from an ethical perspective using patterns from organizational and institutional theory, e.g., a model to evaluate levels of economization contributed by the French sociologist Pierre Bourdieu, applied in this case to German hospitals. Conclusion Market-driven incentives are no answer to the question which goals (i.e., morally, socially, and legally) the health care system should meet. Therefore, public deliberation and performance-orientated shaping of the institutions is required.     

Empirische Methodologien und Methoden der angewandten und der empirischen Ethik

Definition of the problem This paper deals with the question of adequate methodologies and methods to conduct empirical research and integrate empirical knowledge in the field of biomedical ethics. Arguments It starts with reflections about the main subject matter of ethics, the human being as a bio-psycho-social creature and its morals, and argues that social sciences are the adequate basic empirical science in the field of ethics in general. The next paragraph considers theory of science perspectives of the relationship of ethics, empirical findings, methodologies and theories and examples of the integration of empirical findings into ethical deliberations. Reasons for the tension between social science and ethics are scrutinized which are different in the yet to be defined field of empirical ethics compared to traditional applied ethics. Conclusion How a bio-psycho-social ethics that incorporates these criteria into its own body of work could look like is finally depicted.     

Die therapeutische Interaktion als moralische Vorgabe

Definition of the problem

Hospitals serve the general purpose to improve the health of patients. Health care professionals are a necessary means to achieve that end but have their own more specific professional ends. What is the due relationship between those kinds of ends with respect to the organisation of hospitals?

Arguments

Individual health care in hospitals is delivered by professionals who are dependent upon the hospital??s human, administrative and technical facilities. As organised social entities, hospitals use professionals as the means to an end we normally call health of patients. More precisely, the professional task consists in a specific, namely, therapeutic interaction, an asymmetric relationship between morally equals. Professionals have to explore, interpret and pursue patients?? interests according to their consent. From a moral perspective, this interaction should be kept free from distortion through external incentives which divert the professional??s intrinsic motivation. Although a professional responsibility, the individual professional would be overcharged with this organisational task.

Conclusion

The profession has a responsibility to protect and foster professional behaviour of its members including participation in organising hospitals and the individual professional should engage in organising the profession as a collective agent.     

Fabrication of oriented electrospun cellulose nanocrystals–polystyrene composite fibers on a rotating drum

Nitrobenzene (CNC-1), trifluoromethyl benzene (CNC-2) modified and polystyrene-grafted (CNC-g) cellulose nanocrystals in polystyrene (PS)-N,N dimethylformamide (DMF) solutions were electrospun and collected as stretched and aligned fibers on a rotating drum. Scanning electron microscope pictures showed significant alignment in the case of unmodified and nitrobenzene-modified CNC-1/PS nanocomposite fibers once the linear speed of rotor reached to 15 m s⁻¹. Fiber diameter decrease was more strong with rotor speed increase in the case of trifluoromethyl benzene modified (CNC-2) and polystyrene-grafted (CNC-g) cellulose nanocrystals/PS systems. Dynamic mechanical analysis including storage and elastic modulus of electrospun-oriented fibers were performed on surface-modified and polymer-grafted CNC/PS samples. According to α transition peak, the increase in the glass-transition temperature with filler concentration was the highest in polymer-grafted CNC-g/PS composite fibers. It was due to the interpenetration of grafted polymer brushes and free polymer chains in continuous phase and resulted in restrictions of motions of polymer chains in the PS matrix. The elastic moduli of nitrobenzene (CNC-1) and trifluoromethyl benzene (CNC-2)-modified CNC-filled PS composite fibers agreed well with percolation model, which indicates the CNC–CNC interactions and network formation with an increase in concentration. Magnitude of the elastic modulus of polymer grafted CNC-g at 0.33 vol % in PS was significantly higher than the prediction from percolation theory. It was due the immobilized polymer chains around CNC-g particles. However, grafted polymer chains, at higher CNC concentrations acted like stickers among CNC particles and caused CNC agglomerates with entrapped free polystyrene from the matrix, thus caused a decrease in the elastic modulus. © 2020 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2020 , 137, 48942.