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While the burden of HIPAA implementation and compliance rests with healthcare providers, payors and information clearing-houses, many experts believe that behavioral health and human service organizations will face additional scrutiny […]

The energy-rich substrates available to the fasting stressed baboon neonate and infant are quantitatively similar to the metabolic fuels presented to the stressed low birth weight human newborn. Within a few hours after birth, fasting arterial plasma glucose levels in the baboon neonate approximate those of 4–6-week-old baboon infants after a 20-hr fast. Lactate levels are high and comparable for both age groups. In contrast, β-hydroxyburyrate is quite low in the immediate neonatal period, but rises to significantly higher levels (P< 0.001) after a fast at 4–6 weeks. In addition, glycerol levels are higher (P< 0.02) in the fasted older infant compared with the fasting neonate.

Estimates of splanchnic energy substrate exchange in the primate infant have been obtained using a baboon model. The splanchnic bed of the fasting baboon newborn released glucose at an estimated rate of 14.5 ± 5.0 µmol/min·kg body weight. Splanchnic glucose release in the fasting 5-7-wk old baboon infant proceeded similarly at an estimated rate of 15.5 ± 4.5 µmol/min·kg body weight. The principal precursors taken up by the splanchnic bed were lactate, glycerol, and alanine. Uptake of alanine correlated in a linear fashion with glucose release. Lactate was the most important precursor in both age groups. Glucose recycling through lactate is an active mechanism in the primate fetus as well as in the young of other species.

Extract: Measurement of intrarenal distribution of renal blood flow by injection of radionuclides in 3—5-day-old infant monkeys showed a preponderance of outer cortical over inner cortical flow with flow rates of 4.23 and 2.54 ml/min/g, respectively. Intermittent positive pressure ventilation (IPPV) causes a reversal of this flow pattern. The theoretical difference in nephron function in these two areas suggests that this reversal in intrarenal flow induced by IPPV may have important clinical implications.Speculation: Extrarenal stimuli such as IPPV causes a redistribution of intrarenal blood flow in infant primates. Any stimuli that results in increased production of epinephrine or similar compounds may be responsible for this redistribution by a local effect on outer cortical blood vessels. Our data further suggest that antidiuretic hormone may influence intrarenal blood flow in addition to altering tubular membrane permeability.

A study of the chromous chloride promoted addition of various N-chloro- and N-bromoamides (ZCONHX) to a variety of olefins shows that two types of addition products can be obtained, namely N-(2-haloalkyl)amides (1,2-adducts) which generally predominate and N-alkylamides (1,H-adducts). The total yield of addition products, the relative proportion of N-(2-haloalkyl)amide(s) and N-alkylamide, and the stereochemistry of 1,2-addition to cyclic olefins vary with the N-haloamide, that is with both Z and X, and also with the olefin. The best yields of 1,2-adducts were obtained with N-chlorocarbamates (Z = O-alkyl) and the proper choice of Z (e.g., 2,2,2-trichloroethoxy, benzyloxy) shows the potential of this method for the synthesis of N-protected β-chloro primary amines where the amino group is attached to the less substituted carbon atom. The use of an excess of N-haloamide results in high yields (>90%) of 1,2-addition based on the olefin, the excess of N-haloamide being simply reduced to the corresponding amide. N-Chloro-N-alkylamides (ZCONRCl) do not add to cyclohexene and are simply reduced to the corresponding amides.

The age-related changes in fasting arterial levels of energy substrates and insulin were studied at birth and/or 6 wk in eleven baboon infants. In addition, the renal contribution to glucose release in the primate infant was estimated. Arterial blood glucose levels were similar in six fasted newborns and in nine fasted 6-wk-old infants. Arterial blood lactate, alanine, pyruvate, glutamate, and glutamine levels were significantly higher (P< 0.01) in the new born animals, and β-hydroxybutyrate was significantly higher in the older animals (P< 0.001). Arterial plasma insulin levels were low in both groups. Levels of blood glucose in the inferior vena cava below the renal vein were significantly lower than levels in the aorta (P< 0.01). In contrast, levels of blood glucose in the inferior vena cava above the renal vein were significantly higher than in the aorta (P< 0.05). Computed renal vein glucose levels were higher than those in the aorta (P< 0.01). In the newborn infants, there was significant renal uptake of lactate, pyruvate, glycerol, and glutamine (P< 0.01), and release of β-hydroxybutyrate (P< 0.05). In the older animals, there was renal uptake of alanine, lactate, pyruvate, and glycerol (P0.01). Mean cardiac output per kg body weight did not differ significantly in the newborn and 6-wk-old infants.

We examined the effects of maternal sodium ß-hydroxybutyrate (NaBOHB) on the primate fetus to investigate the impact of ketosis not associated with acidosis on fetal metabolism. After a loading dose (600 mg/ kg), NaBOHB was infused for 70 min (300 mg/kg hr) into the maternal femoral vein of eight pregnant baboons, and placental transfer and fetal and maternal metabolic changes were observed during an acute experimental protocol. Maternal arterial levels rose from 0.70 ± 0.21 to 5.42 ± 0.93 mM (p<0.001), and fetal arterial levels from 0.34 ± 0.09 to 2.76 ± 0.64 mM (p<0.01). A maternalfetal gradient of approximately 21 was observed in both baseline and steady-state infusion conditions and is similar to the human maternal-fetal ketone gradient. This is in contrast to the sheep where significantly higher gradients have been described. The elevated lactate, from 1.90 ± 0.34 to 2.88 ± 0.54 mM (p<0.05) and somewhat decreased pO2values in the fetus from 54.8 ± 8.9 to 45.0 ± 3.8 mm Hg (p>0.05<0.1), without change in oxygen consumption (2.00 ± 0.28 versus 1.73 ± 0.15 mM/min) are features common to conditions of increased levels of fetal energy substrate. NaBOHB does not appear to contribute to oxidative energy metabolism of the whole fetus but may contribute to lipid stores. The significance of higher levels of BOHB in the primate fetus compared to the sheep fetus remains to be elucidated