Motivations for Misusing Opioids Among African Americans.

Background: A wide range of opioid misuse motives have been documented in the literature, including to relieve physical pain, feel good/get high, relax, manage feelings/emotions, sleep, and moderate the effects of other substances. Despite a rise in opioid misuse among African Americans over the last 2 decades, their motivations for misuse remain unclear. Much of the research on opioid misuse motivations either rely on samples with little racial diversity or do not stratify their findings by race.

Race and ethnicity define disparate clinical outcomes in chronic rhinosinusitis.

Background: Chronic rhinosinusitis (CRS) is a common upper airways inflammatory disease requiring multidisciplinary care.

Objective: To evaluate if African Americans (AA), Latinxs, and nonLatinx White (White) patients have different chronic rhinosinusitis outcomes and to identify associated factors impacting these outcomes.

Methods: We conducted a large prospective cohort study of CRS patients who were evaluated and followed for several clinical variables at the initial encounter and after continuous management of CRS for a mean of 40 months.

A 2013 Survey on Pressure Monitoring in Adult Cardiopulmonary Bypass Circuits: Modes and Applications.

Pressure data acquired from multiple sites of extracorporeal circuits can be an important parameter to monitor for the safe conduct of cardiopulmonary bypass (CPB). Although previous surveys demonstrate that CPB circuit pressure monitoring is widely used, there are very little data cataloging specific applications of this practice. Therefore, the purpose of this study is to survey the perfusion community to catalog 1) primary CPB circuit site pressure monitoring locations; 2) type of manometers used; 3) pressure monitoring interface and servoregulation with pump console; and 4) the rationale and documentation associated with pressure monitoring during CPB.

A new way of looking at Caesarean section births.

Aims: To implement the Robson Ten Group Classification System (TGCS) at the Royal Women's Hospital (RWH), Melbourne, in order to determine the main contributors to the rising Caesarean section (CS) rate.

Methods: The TGCS divides women into ten groups according to parity, past obstetric history, singleton or multiple pregnancy, fetal presentation, gestational age and mode of onset of labour/delivery. The TGCS was applied retrospectively to the population of women who had a registered birth at the RWH between January 2005 and 31 December 2005.

Modulation of the hyperpolarization-activated current (I(f)) by calcium and calmodulin in the guinea-pig sino-atrial node.

The aim of this study was to investigate possible regulation of the hyperpolarization-activated current (I(f)) by cytosolic calcium in guinea-pig sino-atrial (SA) node cells. Isolated SA node cells were superfused with physiological saline solution (36 degrees C) and the perforated patch voltage-clamp technique used to record I(f) activated by hyperpolarizing voltage steps. A 10-min loading of SA node cells with the calcium chelator BAPTA (using 10 microM BAPTA-AM) significantly reduced the amplitude of I(f) at all potentials studied (69+/-8% at -80 mV, n=6).

NO-cGMP pathway increases the hyperpolarisation-activated current, I(f), and heart rate during adrenergic stimulation.

Objectives: The role of the nitric oxide (NO)-cGMP pathway in the autonomic modulation of cardiac pacemaking is controversial and may involve an interplay between the L-type calcium current, I(CaL), and the hyperpolarisation activated current, I(f). We tested the hypothesis that following adrenergic stimulation, the NO-cGMP pathway stimulates phosphodiesterase 2 (PDE2) to reduce cAMP dependent stimulation of I(f) and heart rate (HR).

Methods: In the presence of norepinephrine (NE, 1 microM), the effects of the NO donor sodium nitroprusside (SNP) were evaluated in sinoatrial node (SAN)/atria preparations and isolated SAN cells from adult guinea pigs.

Nitric oxide does not modulate the hyperpolarization-activated current, I(f), in ventricular myocytes from spontaneously hypertensive rats.

Objective: : In sinoatrial (SA) node cells, nitric oxide (NO) exerts a dual effect on the hyperpolarization-activated current, I(f), i.e. in basal conditions NO enhances I(f) whereas in the presence of beta-adrenergic stimulation it decreases it.

Localisation and functional significance of ryanodine receptors during beta-adrenoceptor stimulation in the guinea-pig sino-atrial node.

Objective: Recent evidence shows that calcium released from the sarcoplasmic reticulum (SR) plays an important role in the regulation of heart rate. The aim of this study was to investigate the subcellular distribution of ryanodine receptors in the guinea-pig sino-atrial (SA) node and to determine their functional role in the regulation of pacemaker frequency in response to beta-adrenoceptor stimulation.

Methods: Monoclonal antibodies raised against the cardiac ryanodine receptor were used with confocal microscopy to investigate ryanodine receptor distribution in single guinea-pig SA node cells.

Role of cGMP-inhibited phosphodiesterase and sarcoplasmic calcium in mediating the increase in basal heart rate with nitric oxide donors.

Nitric oxide (NO) donors increase heart rate (HR) through a guanylyl cyclase-dependent stimulation of the pacemaker current I(f), without affecting basal I(Ca-L). The activity of I(f)is known to be enhanced by cyclic nucleotides and by an increase in cytosolic Ca(2+). We examined the role of cGMP-dependent signaling pathways and intracellular Ca(2+)stores in mediating the positive chronotropic effect of NO donors.

What determines the initiation of the heartbeat?

The origin of the heartbeat in the sino-atrial (SA) node is usually thought to arise from the sequential activation of a variety of ionic currents in pacemaker cells (Irisawa et al. 1993). Recently, the possibility has been considered that heart rate might be influenced by transient changes in cytosolic Ca2+.

Possible role of calcium release from the sarcoplasmic reticulum in pacemaking in guinea-pig sino-atrial node.

Ryanodine and cyclopiazonic acid were used to alter the ability of the sarcoplasmic reticulum (SR) to store calcium. Interventions of this kind significantly reduced the rate of spontaneous beating of guinea-pig sino-atrial node preparations. In addition, both of these drugs decreased the rate of rise and modified other characteristics of the action potentials recorded from this region.

The N-terminal and C-terminal portions of the atrial natriuretic factor prohormone increase during preeclampsia.

The influence of preeclampsia on the circulating concentrations of the 28-amino-acid carboxy terminus (C-terminus) (i.e., atrial natriuretic factor) and the amino terminus (N-terminus) of the 126-amino-acid atrial natriuretic factor prohormone (pro ANF) was studied in the third trimester with the use of three specific radioimmunoassays that recognize: (1) atrial natriuretic factor (i.

125I insulin receptor binding characteristics on umbilical cord blood erythrocytes from normal and diabetic pregnancies.

Umbilical cord blood erythrocyte insulin receptor characteristics of 13 normal and 14 diabetic pregnancies were evaluated to elucidate the effect of maternal diabetes on fetal insulin binding. Specific insulin binding to erythrocytes was similar in the two populations. However, in comparison to infants of nondiabetic women, infants of diabetic mothers exhibited a fourfold decrease in receptor affinity and a fourfold increased number of receptor sites in spite of significant hyperinsulinemia.

Rh isoimmunization complicating a triplet gestation. A case report.

A case occurred of Rh isoimmunization complicating a triplet gestation. Management of that extremely rare situation required careful attention to the problems inherent in both multiple pregnancy and isoimmunization. Amniocentesis and frequent antepartum fetal monitoring were the cornerstones of therapy.

Increase in the plasma levels of the N-terminal and C-terminal portions of the prohormone of atrial natriuretic factor during normal pregnancy.

The influence of pregnancy on the circulating concentrations of atrial natriuretic factor, the 28 amino acid carboxy (C)-terminal end of the 126 amino acid atrial natriuretic factor prohormone, and the amino (N)-terminus of the prohormone was studied with three specific radioimmunoassays recognizing: (1) atrial natriuretic factor (i.e., amino acids 99 through 126), (2) the 98 amino acid N-terminus, and (3) amino acids 31 through 67 from the midportion of the N-terminus of the prohormone.

Constancy of serum angiotensin-converting enzyme activity in normal and complicated pregnancy.

Angiotensin-converting enzyme occupies a central position in the dynamics of the renin-angiotensin system. We prospectively studied serum angiotensin-converting enzyme activity in 112 women at various stages of pregnancy and in the postpartum period because converting enzyme levels have not been well documented in pregnant women with medical disorders which might be expected to influence intravascular volume or blood pressure. Enzyme activity is lower during pregnancy than it is in the same population at 6 weeks postpartum.

Pregnancy and diabetes. Team approach.

Each year, 10,000 babies are born to diabetic women. Gestational diabetes occurs in 2% of all pregnant women, resulting in 60,000 to 90,000 cases of gestational diabetes yearly. Prior to 1922 and the discovery of insulin, fetal mortality for the pregnant diabetic was almost 100%.

Class H diabetes and pregnancy.

Class H diabetes is defined as the presence of diabetes of any duration associated with ischemic myocardial disease. Because of a lack of experience with the coexistence of myocardial ischemic disease and diabetes during pregnancy, it is difficult to offer patients an accurate prognosis for mother and infant during such a gestation. Previous reports suggest that outcomes in this situation are almost routinely poor.

Gestational carcinoma of the female breast.

Few neoplastic diseases can equal the amazing complexity and sheer perversity of carcinoma of the breast. No doubt as many decades of research lie ahead in its study as already have passed. Clinicians have long appreciated the special relationship of the disease to gestation.

Qualitative and quantitative assessment of the circadian rhythm of cortisol in pregnancy.

The effect of pregnancy on the circadian rhythm and diurnal excursion of plasma cortisol and urinary free corticoids was examined in a sequential study during the second and third trimester and 6 to 12 weeks post partum. Hourly blood samples from six subjects and 8-hour urine collections from eight subjects were obtained around the clock. While the circadian rhythm was maintained during gestation, plasma cortisol levels (24-hour mean, nadir, peak, and nadir-peak excursion) increased.

Hypoglycemic coma associated with subcutaneous insulin infusion by portable pump.

The incidence of hypoglycemia in insulin-dependent diabetic patients managed by continuous subcutaneous insulin infusion (CSII) has been reported to be very low. We report a case of hypoglycemia coma occurring in a highly compliant and intelligent patient while on CSII by a portable pump. Factors contributing to this episode included high risk off hypoglycemia due to tight control, failure to recognize early hypoglycemic symptoms, and maintenance of hypoglycemia for over 2 h by the open-loop device.