RESUMEN
BACKGROUND: The World Health Organization (WHO) supports the use of Sugar-Sweetened Beverage Taxes (SSBTs) as a fiscal lever to help reduce sugar consumption and tackle obesity. Obesity is associated with a range of adverse health outcomes. In response to increasing levels of obesity in Ireland, an SSBT was introduced in 2018. Previous research in Ireland has noted that the pass-through rate of the SSBT in retail (off-site consumption) settings was poor. However, to date, no research has examined the SSBT pass-through rate in hospitality (on-site consumption) venues in Ireland. METHODS: This research examines the SSBT pass-through rate on Coca-Cola versus diet versions of Coca-Cola in a convenience sample of 100 hospitality venues in two provincial Irish cities. RESULTS: Wilcoxon signed rank test analysis revealed that regular Coca-Cola was significantly more expensive compared to the price charged for diet versions of Coca-Cola. However, in 85.6% of cases the same price was charged for both full-sugar and sugar-free drinks. The mean pass-through rate of the SSBT was 33.8%. CONCLUSION: The effective functioning of the SSBT is premised on persistent price differences between soft drink prices based on sugar content. However, this is barely evident in the hospitality sector in Ireland. A number of recommendations are suggested, including both increasing the SSBT, and increasing it annually in line with inflation.
Asunto(s)
Bebidas Azucaradas , Impuestos , Irlanda , Bebidas Azucaradas/economía , Bebidas Azucaradas/estadística & datos numéricos , Humanos , Bebidas Gaseosas/economía , Bebidas Gaseosas/estadística & datos numéricos , Restaurantes , Comercio/estadística & datos numéricos , Obesidad/prevención & controlRESUMEN
This report presents a case of extensive tophaceous pseudogout involving the temporomandibular joint (TMJ), causing erosion into the middle cranial fossa. Pseudogout is a benign metabolic arthropathy caused by calcium pyrophosphate dihydrate crystal deposition within joints and peri-articular tissue. Pseudogout more frequently occurs in large joints such as the knee, wrist, symphysis pubis, and shoulder. Tophaceous pseudogout involving the TMJ is rare, with only seven cases involving erosion into the middle cranial fossa reported previously. Despite skull base erosion being a rare consequence of this erosive disease, this case highlights the importance of appropriate investigation and multidisciplinary team management.
Asunto(s)
Condrocalcinosis , Condrocalcinosis/complicaciones , Condrocalcinosis/diagnóstico por imagen , Fosa Craneal Media/diagnóstico por imagen , Fosa Craneal Media/cirugía , Diagnóstico Diferencial , Humanos , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugíaRESUMEN
BACKGROUND: Bioreactance is a novel noninvasive method for cardiac output measurement that involves analysis of blood flow-dependent changes in phase shifts of electrical currents applied across the thorax. The present study evaluated the test-retest reliability of bioreactance for assessing haemodynamic variables at rest and during exercise. METHODS: 22 healthy subjects (26 (4) yrs) performed an incremental cycle ergometer exercise protocol relative to their individual power output at maximal O2 consumption (Wmax) on two separate occasions (trials 1 and 2). Participants cycled for five 3 min stages at 20, 40, 60, 80 and 90% Wmax. Haemodynamic and cardiorespiratory variables were assessed at rest and continuously during the exercise protocol. RESULTS: Cardiac output was not significantly different between trials at rest (P=0.948), or between trials at any stage of the exercise protocol (all P>0.30). There was a strong relationship between cardiac output estimates between the trials (ICC=0.95, P<0.001) and oxygen consumption (ICC=0.99, P<0.001). Stroke volume was also not significantly different between trials at rest (P=0.989) or during exercise (all P>0.15), and strong relationships between trials were found (ICC=0.83, P<0.001). CONCLUSIONS: The bioreactance method demonstrates good test-retest reliability for estimating cardiac output at rest and during different stages of graded exercise testing including maximal exertion.
Asunto(s)
Gasto Cardíaco/fisiología , Prueba de Esfuerzo/métodos , Ejercicio Físico/fisiología , Monitoreo Fisiológico/métodos , Descanso/fisiología , Adulto , Femenino , Humanos , Masculino , Consumo de Oxígeno/fisiología , Reproducibilidad de los ResultadosRESUMEN
CONTEXT AND OBJECTIVES: Synthetic cannabinoids are illegal drugs of abuse known to cause adverse neurologic and sympathomimetic effects. They are an emerging health risk: 11% of high school seniors reported smoking them during the previous 12 months. We describe the epidemiology of a toxicologic syndrome of acute kidney injury associated with synthetic cannabinoids, review the toxicologic and public health investigation of the cluster, and describe clinical implications of the cluster investigation. MATERIALS AND METHODS: Case series of nine patients affected by the toxicologic syndrome in Oregon and southwestern Washington during May-October 2012. Cases were defined as acute kidney injury (creatinine > 1.3 mg/dL) among persons aged 13-40 years without known renal disease who reported smoking synthetic cannabinoids. Toxicology laboratories used liquid chromatography and time-of-flight mass spectrometry to test clinical and product specimens for synthetic cannabinoids, their metabolites, and known nephrotoxins. Public health alerts informed clinicians, law enforcement, and the community about the cluster and the need to be alert for toxidromes associated with emerging drugs of abuse. RESULTS: Patients were males aged 15-27 years (median, 18 years), with intense nausea and flank or abdominal pain, and included two sets of siblings. Peak creatinine levels were 2.6-17.7 mg/dL (median, 6.6 mg/dL). All patients were hospitalized; one required dialysis; none died. No alternate causes of acute kidney injury or nephrotoxins were identified. Patients reported easily purchasing synthetic cannabinoids at convenience, tobacco, and adult bookstores. One clinical and 2 product samples contained evidence of a novel synthetic cannabinoid, XLR-11 ([1-(5-fluoropentyl)-1H-indol-3-yl](2,2,3,3-tetramethylcyclopropyl)methanone). DISCUSSION AND CONCLUSION: Whether caused by direct toxicity, genetic predisposition, or an as-yet unidentified nephrotoxin, this association between synthetic cannabinoid exposure and acute kidney injury reinforces the need for vigilance to detect new toxicologic syndromes associated with emerging drugs of abuse. Liquid chromatography and time-of-flight mass spectrometry are useful tools in determining the active ingredients in these evolving products and evaluating them for toxic contaminants.
Asunto(s)
Lesión Renal Aguda/etiología , Cannabinoides/toxicidad , Drogas de Diseño/toxicidad , Drogas Ilícitas/toxicidad , Riñón/efectos de los fármacos , Intoxicación/fisiopatología , Humo/efectos adversos , Lesión Renal Aguda/patología , Lesión Renal Aguda/fisiopatología , Adolescente , Adulto , Cannabinoides/análisis , Drogas de Diseño/análisis , Drogas de Diseño/química , Combinación de Medicamentos , Humanos , Drogas Ilícitas/análisis , Drogas Ilícitas/química , Riñón/patología , Riñón/fisiopatología , Masculino , Oregon , Centros de Control de Intoxicaciones , Intoxicación/terapia , Psicotrópicos/análisis , Psicotrópicos/toxicidad , Resultado del Tratamiento , Washingtón , Adulto JovenRESUMEN
Squamous cell carcinomas (SCCs) of the skin of the scalp have the potential for regional metastases. Microscopically, clearance may be less than the optimal dimensions. We report 101 SCCs of the scalp treated surgically under the care of a single oral and maxillofacial surgeon. Forty-two of the study patients had deep margins that were clear by less than 2mm, of whom five had margins that involved pericranium±skull. Our study demonstrated a local recurrence rate of 6% and a regional recurrence rate of 7%. All patients presented with relapse of the disease within 18 months of primary surgery. The evidence presented in this study suggests that in SCCs of the scalp, less than ideal surgical margin clearance, entirely due to anatomical restrictions, does not appear to substantially affect regional recurrence, but increases the risk of local recurrence.
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Femenino , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Factores de Riesgo , Cuero Cabelludo/anatomía & histología , Cuero Cabelludo/patología , Neoplasias Cutáneas/patología , Resultado del TratamientoRESUMEN
Enteric hyperoxalosis is a recognized complication of bariatric surgery, with consequent oxalate nephropathy leading to chronic kidney disease and occasionally end-stage renal failure. In patients with prior gastrointestinal bypass surgery, renal allografts are also at risk of oxalate nephropathy. Further, transplant recipients may be exposed to additional causes of hyperoxalosis. We report two cases of renal allograft oxalate nephropathy in patients with remote histories of bariatric surgery. Conservative management led to improvement of graft function in one patient, while the other patient returned to dialysis. Interpretation of serologic, urine and biopsy studies is complicated by oxalate accumulation in chronic renal failure, and heightened excretion in the early posttransplant period. A high index of suspicion and careful clinicopathologic correlation on the part of transplant nephrologists and renal pathologists are required to recognize and treat allograft oxalate nephropathy. As the incidence of obesity and pretransplant bariatric surgery increases in the transplant population, allograft oxalate nephropathy is likely to be an increasing cause of allograft dysfunction.
Asunto(s)
Oxalato de Calcio/metabolismo , Hiperoxaluria/terapia , Fallo Renal Crónico/terapia , Trasplante de Riñón/métodos , Anciano , Cirugía Bariátrica , Biopsia , Cristalización , Femenino , Tracto Gastrointestinal/metabolismo , Rechazo de Injerto , Humanos , Hiperoxaluria/complicaciones , Riñón/fisiopatología , Fallo Renal Crónico/complicaciones , Trasplante de Riñón/efectos adversos , Masculino , Nefrología , Obesidad/complicaciones , Obesidad/cirugía , Trasplante HomólogoRESUMEN
BACKGROUND: Membranous glomerulonephritis (MGN) may develop in the renal allograft either de novo or as a recurrence. These 2 forms of MGN may have different pathogenic mechanisms, with different IgG subclass profiles in the immune deposits. This study examined IgG subclass distributions in recurrent and de novo MGN in allograft kidneys. METHODS: We identified allograft kidneys with MGN, including 7 with recurrent MGN, 2 with de novo MGN, and 2 atypical/indeterminate, and determined the relative intensity of IgG1, IgG2, IgG3, and IgG4 staining in capillary wall deposits by immunofluorescence microscopy. RESULTS: IgG4 was the dominant or codominant IgG subclass in capillary loop deposits in all 7 cases of recurrent MGN. IgG1 staining was dominant in 3 of 4 de novo or atypical MGN cases and codominant with IgG4 in the fourth. CONCLUSIONS: Although pretransplantation kidney biopsies were not available for comparisons, these findings suggest that all allograft recurrences represent idiopathic MGN and that de novo MGN cases had a different pathogenic mechanism.
Asunto(s)
Glomerulonefritis Membranosa/inmunología , Inmunoglobulina G/análisis , Trasplante de Riñón/inmunología , Riñón/inmunología , Adolescente , Adulto , Anciano , Biopsia , Niño , Humanos , Trasplante de Riñón/efectos adversos , Microscopía Fluorescente , Persona de Mediana Edad , Oregon , Recurrencia , Trasplante Homólogo , Resultado del TratamientoRESUMEN
BACKGROUND: Neutrophil predominant capillaritis and interstitial inflammation is an uncommon renal biopsy finding, with a broad differential diagnosis. CASE: A 77-year-old woman presented with a complicated history including vasculitis, cryoglobulinemia, malaise, and systemic symptoms, which progressed to acute kidney injury. Renal biopsy demonstrated prominent neutrophilic capillaritis with interstitial inflammation, and fibrinoid deposits in medullary capillaries and interstitium. Glomeruli showed membranoproliferative glomerulonephritis, but no crescents or necrosis. DISCUSSION: We interpret the capillary and interstitial changes as evidence of cryoglobulin-associated vasculitis, and discuss the differential diagnosis of this uncommon histologic pattern of renal pathology, including other vasculitides, infection, ischemia-infarction, collagen vascular disease, and antibody-mediated allograft rejection, among others.
Asunto(s)
Lesión Renal Aguda/patología , Crioglobulinemia/patología , Riñón/patología , Vasculitis/patología , Anciano , Capilares/patología , Crioglobulinemia/terapia , Femenino , Humanos , Riñón/irrigación sanguíneaRESUMEN
BACKGROUND: Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare form of uveitis. Previously, the authors had demonstrated a strong association of human leukocyte antigen (HLA) DRB1*0102 with TINU. Here, the authors performed HLA analysis on subjects with isolated bilateral sudden-onset uveitis (as in the TINU subtype) or with isolated tubulointerstitial nephritis (TIN). METHODS: Patients with sudden onset, anterior, bilateral uveitis not fulfilling a diagnosis of TINU were identified. Pathology reports were reviewed to identify subjects with biopsy-proven TIN. Molecular typing of the HLA-DRB1 gene was performed by the Luminex technology-based sequence-specific oligonucleotide (SSO) hybridisation method (One Lambda, Canoga Park, California). HLA-DRB1 allele frequencies were compared with normal published controls (http://www.ncbi.nlm.nih.gov/projects/gv/mhc/ihwg.cgi dbMHC Europe cohort) and the published TINU cohort (n=18). RESULTS: The authors included 28 subjects with uveitis and 14 with TIN. There was a significantly higher frequency of DRB1*0102 in the isolated uveitis cohort versus in normal controls (10.7% vs 0.6%, respectively, p<0.0001; RR 14.3 (6.9-29.8)). None of the nephritis patients showed this HLA subtype. Another association with HLA-DRB1*08 was seen in the isolated uveitis cohort with an allele frequency of 10.7% versus 2.7% in normal controls (p=0.0019; RR 4.0 (1.8-9.0)). In contrast, the HLA-DRB1*08 was not different from controls in the TINU cohort (allele frequency 2.8%, p=not significant). CONCLUSION: The incidence of HLA-DRB1*0102 is increased in sudden-onset bilateral anterior uveitis, as seen in patients with TINU. The same allele does not appear to occur in increased frequency in patients with isolated TIN. HLA DRB1*0102 might predispose to this subset of uveitis.
Asunto(s)
Antígenos HLA-DR/genética , Uveítis Anterior/genética , Enfermedad Aguda , Adolescente , Adulto , Anciano , Niño , Femenino , Frecuencia de los Genes , Ligamiento Genético , Genotipo , Antígenos HLA-DR/metabolismo , Cadenas HLA-DRB1 , Prueba de Histocompatibilidad , Humanos , Masculino , Persona de Mediana Edad , Tipificación Molecular , Nefritis Intersticial/genética , Síndrome , Uveítis/genética , Adulto JovenRESUMEN
Pre-tracheal air cysts or aeroceles are rare complications of tracheostomy. This is believed to be the first reported case in an adult presenting with a pre-tracheal air cyst 12 years after a tracheostomy. Only three case reports in children have been reported to date. The pathogenesis and treatment options are discussed and a method of managing this condition is suggested.
Asunto(s)
Quistes/etiología , Enfisema/etiología , Enfermedades de la Tráquea/etiología , Traqueostomía/efectos adversos , Adulto , Quistes/diagnóstico por imagen , Enfisema/diagnóstico por imagen , Femenino , Humanos , Tomografía Computarizada por Rayos X , Enfermedades de la Tráquea/diagnóstico por imagenRESUMEN
The elucidation of the tissue-specific profile of expression of the prolactin (PRL) and growth hormone (GH) receptors during embryonic and fetal development in a range of species has provided a new impetus for the delineation of the specific roles of the hormone ligands for these receptors in development. During late gestation, there is a requirement to shift from a phase of predominant cellular proliferation, where placental nutrient supply is a dominant influence on organ and body growth, to one of functional differentiation, which is required for independent homoeostasis after birth. In this review we discuss the interactions between the pre-partum increases in cortisol and thyroid hormones and the synthesis, secretion and actions of fetal PRL and GH. We also review the changes that occur in the tissue-specific expression of the PRL and GH receptors before birth which may play an important role in precocial species in the successful transition of the fetus to extra-uterine life.
Asunto(s)
Feto/metabolismo , Trabajo de Parto/metabolismo , Receptores de Prolactina/metabolismo , Receptores de Somatotropina/metabolismo , Animales , Femenino , Hormona del Crecimiento/metabolismo , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Fotoperiodo , Placenta/metabolismo , Embarazo , Prolactina/biosíntesis , Prolactina/metabolismo , Receptores de Prolactina/genética , Receptores de Somatotropina/genéticaRESUMEN
Membranous nephropathy has been associated with many autoimmune diseases. We describe a child with membranous nephropathy associated with chronic immune thrombocytopenic purpura (ITP) and Coombs'-positive hemolytic anemia. After 3 years of ITP, the patient developed nephrotic syndrome during a flare of ITP. A biopsy specimen showed membranous nephropathy. Treatment with corticosteroids led to improvement of the thrombocytopenia and resolution of the proteinuria. Two years later, the patient again developed thrombocytopenia and proteinuria. Both conditions resolved after treatment with corticosteroids. This case suggests that ITP can cause membranous nephropathy.
Asunto(s)
Anemia Hemolítica Autoinmune/complicaciones , Enfermedades Autoinmunes/complicaciones , Glomerulonefritis Membranosa/etiología , Púrpura Trombocitopénica/complicaciones , Corticoesteroides/uso terapéutico , Anemia Hemolítica Autoinmune/inmunología , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/patología , Biopsia , Niño , Femenino , Glomerulonefritis Membranosa/inmunología , Glomerulonefritis Membranosa/patología , Humanos , Riñón/inmunología , Riñón/patología , Púrpura Trombocitopénica/inmunología , Púrpura Trombocitopénica/patologíaAsunto(s)
Amputación Traumática/complicaciones , Aspergilosis/complicaciones , Fungemia/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/microbiología , Adulto , Aspergilosis/diagnóstico , Aspergilosis/terapia , Resultado Fatal , Fungemia/diagnóstico , Fungemia/terapia , Humanos , Masculino , Síndrome de Respuesta Inflamatoria Sistémica/terapiaRESUMEN
BACKGROUND: Resistance to the action of parathyroid hormone (PTH) has been demonstrated in end-stage renal failure and is considered to be important in the pathogenesis of secondary hyperparathyroidism. The mechanism of resistance is unknown. However, altered regulation of cellular PTH/PTH-related protein (PTH/PTHrP) receptor (PTH1R) has been assumed to be important. METHODS: We have used in situ hybridization to examine PTH1R mRNA expression by osteoblasts in human bone and have compared the expression in high- and low-turnover renal bone disease, high-turnover nonrenal bone disease (healing fracture callus and Pagetic bone), and normal bone. Bone biopsies were formalin fixed, ethylenediaminetetraacetic acid decalcified, and paraffin wax embedded. A 1.8 kb PTH1R cDNA probe, labeled with 35S, was used, and the hybridization signal was revealed by autoradiography. The density of signal over osteoblasts was quantitated using a semiautomated Leica image analysis software package. RESULTS: The mean density of PTH1R mRNA signal over osteoblasts in renal high-turnover bone was only 36% of that found in nonrenal high-turnover bone (P < 0.05) and 51% of that found in normal bone (P < 0.05). Osteoblast PTH1R mRNA signal in adynamic bone from individuals with diabetes mellitus was 28% of normal bone (P < 0.05) and 54% of that found in renal high-turnover bone (P < 0.05). CONCLUSIONS: These results demonstrate a down-regulation of osteoblast PTH1R mRNA in end-stage renal failure in comparison to normal and high-turnover bone from otherwise healthy individuals, and provide an insight into the mechanisms of "skeletal resistance" to the actions of PTH.
Asunto(s)
Fallo Renal Crónico/metabolismo , Fallo Renal Crónico/fisiopatología , Osteoblastos/metabolismo , Receptores de Hormona Paratiroidea/genética , Adulto , Huesos/metabolismo , Callo Óseo/metabolismo , Callo Óseo/fisiopatología , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/metabolismo , Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/fisiopatología , Nefropatías Diabéticas/metabolismo , Nefropatías Diabéticas/fisiopatología , Regulación hacia Abajo/genética , Femenino , Expresión Génica/fisiología , Humanos , Hibridación in Situ , Masculino , Persona de Mediana Edad , Osteítis Deformante/metabolismo , Osteítis Deformante/fisiopatología , Osteoclastos/metabolismo , ARN Mensajero/metabolismo , Receptor de Hormona Paratiroídea Tipo 1 , Receptores de Hormona Paratiroidea/metabolismo , Uremia/metabolismo , Uremia/fisiopatologíaRESUMEN
An underlying assumption of the WHO orthogonal regression model for prothrombin time standardisation is that a single line describes the relationship between PT of abnormal and normal plasmas. The aim was to evaluate Tomenson's correction for lack of coincidence using the model of the ECAA human reagent with lyophilized plasma calibrations. Local ISI calibrations using ECAA lyophilized normal and abnormal plasmas were performed on coagulometers with the ECAA human thromboplastin. They gave a high incidence of non-linearity of the two calibration slopes. The mean percentage deviation from assigned values of the target coumarin plasmas coagulometer INR at 45 centres before local ISI correction was 16.6% and 11.9% respectively in two studies. After local ISI calibration. the unsigned deviation was reduced to 5.54% and 6.61% respectively. Tomenson's correction for non-linearity further reduced the mean deviation to 3.08% and 2.96% respectively in the two studies demonstrating the value of the procedure.
Asunto(s)
Relación Normalizada Internacional , Tiempo de Protrombina , Humanos , Organización Mundial de la SaludRESUMEN
The possibility of reduction of numbers of fresh coumarin and normal plasmas has been studied in a multicentre manual prothrombin (PT) calibration of high international sensitivity index (ISI) rabbit and low ISI human reference thromboplastins at 14 laboratories. The number of calibrant plasmas was reduced progressively by a computer program which generated random numbers to provide 1000 different selections for each reduced sample at each participant laboratory. Results were compared with those of the full set of 20 normal and 60 coumarin plasma calibrations. With the human reagent, 20 coumarins and seven normals still achieved the W.H.O. precision limit (3% CV of the slope), but with the rabbit reagent reduction < 50 coumarins with 17 normal plasmas led to unacceptable CV. Little reduction of numbers from the full set of 80 fresh plasmas appears advisable. For maximum confidence, when calibrating the ISI of a new reagent, it would always seem worthwhile to use the full number of patients' and normal plasmas at each centre for the initial calibration, i.e. 60 fresh coumarin and 20 fresh normal plasmas. Smaller numbers should achieve the required precision with the lower ISI reagent.
Asunto(s)
Tromboplastina/normas , Animales , Calibración , Humanos , Relación Normalizada Internacional , Conejos , Tamaño de la Muestra , Sensibilidad y EspecificidadRESUMEN
We have investigated the separate actions of hypothalamo-pituitary disconnection (HPD), with or without cortisol administration, and changes in the external photoperiod on the regulation of the levels of messenger RNA (mRNA) encoding long (PRLR1) and short (PRLR2) forms of PRL receptor in the liver of the fetal lamb. In pregnant Merino ewes (n = 20), the hypothalamus and pituitary were surgically disconnected in 13 fetuses (HPD group), and fetal vascular catheters were implanted in the HPD group and in an additional 7 fetuses (intact + saline group) between 104-120 days gestation (d). Fetal sheep in the HPD group were infused with either cortisol (3.5 mg/4.8 ml saline/24 h; HPD + F; n = 5) or saline for 5 days between 134-141 d, and saline was also infused in the intact group within the same gestational age range. A second group of pregnant ewes (n = 12) was kept in a 12-h light, 12-h dark cycle from 70 d until implantation of fetal vascular catheters between 106-120 d, after which ewes were allocated to either a long photoperiod (16 h of light, 8 h of darkness; LL group; n = 6) or a short photoperiod (8 h of light, 16 h of darkness; SL group; n = 6) regimen. Circulating cortisol concentrations were higher (P < 0.05) in the intact fetal sheep (18.7 +/- 3.8 nmol/liter) than in the HPD + saline group (1.5 +/- 0.6 nmol/liter), and were further increased (P < 0.05) in the HPD + cortisol group (97.4 +/- 23.7 nmol/liter). Fetal PRL concentrations were lower (P < 0.05) in the HPD + saline (10.6 +/- 4.3 ng/ml) and HPD + cortisol (5.6 +/- 2 ng/ml) groups compared with those in the intact group (38.9 +/- 6.8 ng/ml). The levels of hepatic PRLR mRNA were higher (P < 0.05) in the intact (PRLR1, 27.4 +/- 6.1; PRLR2, 17.7 +/- 2.5) and HPD + cortisol (PRLR1, 23.4 +/- 0.4; PRLR2, 15.3 +/- 3.0) groups than in the HPD + saline group (PRLR1, 10.6 +/- 1.8; PRLR2, 8.9 +/- 1.8) at 140/141 d. The mean plasma PRL concentration in the LL group (70 +/- 9 ng/ml) was higher (P < 0.05) than that in the SL group (34 +/- 15 ng/ml), whereas the levels of hepatic PRLR1 mRNA (LL group, 4.6 +/- 0.9; SL group, 4.3 +/- 0.8) and PRLR2 mRNA (LL group, 3.4 +/- 0.4; SL group, 3.0 +/- 0.5) at 140-141 d were not different. These data indicate that cortisol acts directly or indirectly to maintain hepatic PRLR mRNA levels in the sheep fetus during late pregnancy. In contrast, changes in the external photoperiod and circulating PRL concentrations in the sheep fetus do not directly alter PRLR expression in the fetal liver. These studies provide further insight into the role that the PRL axis may play in the transduction of signals about the external environment to the fetus as it prepares for the transition to extrauterine life.