Tight glycemic control during diabetic pregnancy has been shown to significantly reduce the occurrence of congenital malformations and other effects of maternal diabetes on the offspring. However, intensive insulin therapy often causes recurring acute maternal hypoglycemia, which has been found to be harmful to the developing fetus, although the mechanisms involved are not clear. The aim of our work was to study the effect of acute insulin-induced maternal hypoglycemia on glucose metabolism in the fetal brain. To this end, near-term pregnant New Zealand rabbits were rendered hypoglycemic, and [U-(13)C]glucose was infused into maternal circulation. The metabolic fate of the (13)C-labeled glucose was then studied in fetal brain extracts by (13)C NMR isotopomer analysis, together with conventional biochemical assays of glucose and lactate levels in both plasma and brain. For comparison [U-(13)C]glucose was also administered to insulin-induced hypoglycemic young adult rabbits. Our results showed that while plasma glucose levels were significantly reduced (approximately 70%) relative to controls, no changes in cerebral glucose levels could be detected. Lactate levels were found to be significantly decreased in hypoglycemic fetal plasma and brain. No differences in lactate levels between control and hypoglycemic young rabbit plasma and brain were observed. These differences were attributed to the utilization of lactate as an energy substrate in the fetal brain, but not in the adult brain. Higher relative (13)C enrichments of most glucose metabolites, except lactate, in the hypoglycemic fetal and young rabbit brains, observed by (13)C NMR, stem from reduced endogenous plasma glucose pools, thereby diluting the labeled glucose to a lower extent. The relative glucose (or glucose-derived lactate) flux via the pyruvate carboxylase and pyruvate dehydrogenase pathways (PC/PDH ratio) was not altered under hypoglycemic conditions in the fetal brain for both glutamine and glutamate, but significantly increased in the adult brain for both glutamine and glutamate. The presented data indicate the ability of the fetal brain to maintain energy metabolism during acute hypoglycemia, via lactate utilization. The increase in the adult PC/PDH ratio was suggested by us to stem from increased PC activity, in order to replenish TCA cycle intermediates.

Amino Acids↗

PubMedDate not supplied

[Screening mammography of women with a hereditary predisposition to cancer of the breast].

Explore the source record for details and available documents.

Breast Neoplasms↗

PubMedDate not supplied

Epidemiology, health policy, and resource allocation: the Israeli perspective.

Israel represents a developed country as far as demand and consumption of health services are concerned. The analysis of the Israeli health system reveals a significant trend of expansion in the intensity and the utilization of health services as well as an accelerated development of sophisticated technology, while the percentage of Gross National Product used for health expenditure remained constant and even decreased. Competing needs, reflecting population growth, a rapid aging process, new areas of treatment, and changes in use of health services, illustrate the aggravating issue of setting priorities. The permanent dilemma of the health system is oscillation between opposite trends: enlargement of public eligibility and technological capabilities and economic reduction and budget limitations. Is there a possibility that the insufficiencies of the system are built into patterns of thinking of those in the system, into its structure, and into its organization of health services delivery? Does the formulation of health policy influence, in terms of the outcomes of the system, priorities and allocation of resources? Does the process of decisionmaking reflect in an appropriate manner the epidemiologic data? Under the objective constraints, decisionmaking and health policy formulation become critical determinants of the ability to cope more efficiently and effectively with growing and changing needs. The authors suggest an alternative strategy of health decisionmaking that is more instrumental in order to prevent setbacks and to open new horizons for the future.

Epidemiology↗