Journal of Experimental & Clinical Medicine

JECM: Some Thoughts on Longevity

Edwin L. Cooper — 2010-08-01

The Role of Mitochondria in HIV Infection and Its Treatment

2010-08-01

Mitochondria play a dual role in the life of the cell, being capable of producing either energy (in the form of ATP) or potentially dangerous reactive oxygen species (ROS), and they also contain molecules that, when released into the cytoplasm, cause apoptosis. There is a growing interest in the importance of these organelles during the infection caused by the human immunodeficiency virus (HIV), as well as during its treatment. Indeed, several drugs that are capable of blocking HIV can also interact with the enzyme responsible for the replication of mitochondrial DNA and inhibit its activity. Cytokines produced by the immune system can alter ROS production. Furthermore, the virus as such can trigger different mechanisms that interfere with mitochondrial functionality and induce alterations, ultimately causing cell death. As a result, mitochondria can be severely altered by HIV infection and by its treatment.

Comparing Models of Sleep-dependent Memory Consolidation

Sara C. Mednick, William A. Alaynick — 2010-08-01

The enhancement of normal cognition and breakthrough treatments in cognitive disorders require an improved understanding of memory consolidation. Insights into the mechanisms of memory consolidation have been advanced by the incorporation of a quantifiable variable: sleep. Over the past 20 years, a substantial number of studies have shown that memory performance is facilitated after a bout of sleep, compared with the same period of waking, implicating a slow, offline process during sleep that transforms the memory trace into a more robust form through a consolidation process. Until recently, the majority of these studies have examined cognitive tasks that utilize non-declarative, procedural memory (e.g., knowing “how”, learning actions, habits, perceptual and motor skills, and implicit learning) to show enhanced performance above baseline. Recent attention has turned to studying the relationship between sleep and declarative memory, which refers to consciously accessible memories of fact-based information (i.e., knowing “what”, in terms of events, places, and general knowledge) that are dependent on the hippocampus. Although the exact nature of the relationship between sleep and declarative memory consolidation is hotly debated, there is strong emerging evidence for the importance of slow wave sleep. In contrast with the “enhancement” model of procedural memory, there are two declarative memory models; first, the active model, in which memory depends on sleep specifically; and second, the permissive model, which posits a time-dependent, interference-sensitive process that opportunistically seizes any period of dampened hippocampal input to further process prior, learned information. We review the evidence for the active and permissive models and discuss areas of research that would benefit from future studies. Bridging these scientific fields will impact fundamental research in memory, sleep and pharmacology, as well as have relevance for treatment of memory impairments affecting people with mental illness and age-related cognitive decline.

Effect of Breastfeeding Duration on Infant Growth Until 18 Months of Age: A National Birth Cohort Study

2010-08-01

Background: Optimal nutrition during the 1st year of life is critical to infants' healthy growth and development, and breastfeeding is a key component. However, little is known about the effect of breastfeeding duration on infant growth in Taiwan. Purpose: The aim of this study was to examine the effect of breastfeeding duration on infant growth. Methods: This study was based on questionnaire interviews as part of the Taiwan Birth Cohort Study, which collected information on breastfeeding duration and infant growth among infants aged from 0 to 18 months. Participants were selected from Taiwan birth registry data for 2005, using multistage stratified random sampling. The sample population was 15,868 infants ranging in gestational age between 37 and 41 weeks, excluding those with birth defects or who were hospitalized after birth. The χ2 test, analysis of variance and generalized estimating equations were used to analyze the effects of infant feeding patterns and other factors on infant growth. Results: Breastfeeding duration had no significant effect on infant weight within the first 6 months, but after the 7th month, infants who had been breastfed for ≥6 months were lighter than infants who were not breastfed. Before 18 months of age, infants who had been breastfed for ≥6 months were slightly shorter than infants who had been breastfed for <6 months. From the 7th month onward, breastfed infants were slightly shorter than formula-fed infants. Conclusion: These results show that different infant feeding practices correspond to differences in infant growth from 0 to 18 months, and are consistent with the World Health Organization's new growth standards.

Outcomes of Pharmacy Interventions on Pediatric Medication Prescribing Patterns in Taiwan

You-Meei Lin, Yi-Chun Chiang, Yung-Ting Kuo, Man-Yau Ho, Hsiang-Yin Chen — 2010-08-01

Background/Purpose: The aim of this study was to assess the long-term effect of pharmacy interventions on patients and health care providers, and switching from prescribing extemporaneous powder dosage forms to liquid dosage forms. Methods: An education program for parents was conducted. An attitude, knowledge and behavior questionnaire was employed to measure the efficacy of the education program. Medication management policies were then executed by providing an in-service to pediatricians, establishing dosage-switching guidelines and adding liquid dosage forms of necessary medications into the hospital formulary. Dosage-switching guidelines of pediatric medications were established by surveying the most prescribed extemporaneous powder dosage forms at the Taipei Medical University–Wan Fang Hospital. These guidelines were introduced to every pediatrician, nurse and pharmacist. The prescribing rate of extemporaneous powder prescriptions was monitored to measure the outcomes of the interventions. Results: The mean scores of attitude, knowledge and practice significantly improved towards a positive use of commercially available liquid medications after the patient education program for the parents. Prescriptions for extemporaneous powder dosage forms significantly decreased from 1600 (2.54%) to 13 (0.022%) monthly in the 4th year and were reduced to zero in the 6th year. Conclusion: This study demonstrated that the pharmacists' interventions were able to change the parents' knowledge, attitude and practice towards pediatric drug dosage forms and the prescribing pattern. Effective assurance in children's medication safety can be achieved through collaboration between medical professionals and parents.

Effects of Medication and Pathophysiology on 12-lead Electrocardiograms in Bipolar Disorder and Schizophrenia

Pao-Huan Chen, Shang-Ying Tsai, Kuo-Hsuan Chung — 2010-08-01

Background: Cardiovascular disease is the principal cause of death among patients with bipolar disorder and schizophrenia. We hypothesized that a combination of psychophysiology and the use of lithium, along with antipsychotics, alter electrocardiophysiological activity in bipolar and schizophrenic patients. Purpose: The goal of this study was to evaluate the effects of psychotropic agents and the pathophysiology using 12-lead electrocardiograms (EKGs) in bipolar and schizophrenic patients. Methods: The study involved three groups of patients: (1) 30 lithium/haloperidol-treated patients with bipolar mania (15 males, 15 females); (2) 33 lithium-free patients with bipolar mania (21 males, 12 females); and (3) 31 lithium-free schizophrenic patients (15 males, 16 females). Clinical data were obtained through a retrospective review of the medical records of all subjects. Results: The mean PQ interval, QRS complex, and corrected QT (QTc) intervals did not differ among the three groups. Among those in the lithium/haloperidol-treated bipolar mania group, the QTc interval demonstrated a marginally significant correlation with serum lithium levels (r = 0.373; p = 0.05). Conclusion: Pathophysiological changes or minor abnormalities of electrocardiophysiological activity in schizophrenia and bipolar disorder patients might not be displayed by routine 12-lead EKGs. Because of the limitations of 12-lead EKGs, bipolar manic patients who have higher serum lithium levels might have increased risks for QTc prolongation, and thus QTc intervals should be carefully followed-up in these patients.

Depiction of Bowel Wall Visualization and Dilation in Abdominopelvic MDCT: Comparison of High-attenuation Contrast Medium, Water and Whole Milk

2010-08-01

Background: High-attenuation oral contrast agents in the form of iodine solutions or barium suspensions have been used traditionally and effectively for abdominal computed tomography (CT) examinations. Apart from the unpleasant taste, there are relatively few disadvantages that may affect interpretation, such as pseudotumor formation due to incomplete mixing of contrast material with the bowel contents and poor mural discrimination. Thus, low-attenuation oral contrast materials are needed. Purpose: The aim of this study was to evaluate the efficiency of whole milk as a low-attenuation contrast agent compared with water-soluble contrast medium and water for abdomi-nopelvic CT. Methods: A total of 152 patients were randomly assigned to receive whole milk (4%), water or water-soluble contrast medium (Optiral). All CT scans were performed using a 64-multidetector CT scanner with a 0.35-second rotation time. Two radiologists were responsible for reviewing the images to assess bowel wall enhancement and bowel dilation. Results: There were no differences in average dilation scores among the three groups for duodenum and jejunum. The average dilation score in the milk group was higher than that in the water-soluble contrast medium group in the antrum, and there was no difference between water and milk. For the ileum, there were no differences in the average dilation scores in the milk and water-soluble contrast medium groups, and milk produced better dilation compared with water. Bowel enhancement in the water and milk groups was stronger than that in the water-soluble contrast medium group. The major side effects of milk were nausea and flatulence. Conclusion: We concluded that abdominopelvic multidetector CT with whole milk provides better bowel dilation and wall visualization compared with high-attenuation contrast medium. Whole milk and water have potential as good oral contrast materials for bowel discrimination. However, whole milk should be considered as an alternative to water in cases of disease suspected in the pelvis.

Propofol Infusion Syndrome Leads to Severe Right Heart Injury and Lethal Arrhythmias

Yuan-Teng Tseng, Wen-Rui Hao, Ju-Chi Liu, Ming-Hsiung Hsieh — 2010-08-01

Propofol-related infusion syndrome (PRIS) has a high mortality with myocardial failure and dysrhythmias. However, there is no detailed description of the serial cardiac conditions presenting during the critical and recovery periods during PRIS. We report the case of a 24-year-old man with a traumatic head injury who developed PRIS after propofol infusion. Cyanosis, hypotension, neck vein distension, cardiac arrest and ventricular tachycardia occurred. The patient survived PRIS by prompt cessation of propofol, the use of inotropic agents, and short-term hemofiltration. A timely Holter electrocardiogram (ECG) recording, serial echocardiograms and 12-lead ECGs revealed isolated right heart failure, sequential bradycardia, arrest, left bundle branch block-like ventricular tachycardia, and varied coved-type ST elevation in the right precordial leads. All these clinical abnormalities (symptoms, echocardiograms, and ECGs) subsided within a few hours after treatment. The patient was eventually discharged with clear consciousness and without any cardiopulmonary sequelae. Our cardiac survey implied that in PRIS, the right heart is severely injured, both mechanically and electrophysiologically. Injured right hearts can completely and rapidly recover if recognition and treatment are timely.