bluuebunny/crossref_metadata_2025 huggingface dataset:
Cysteinyl‐leukotriene levels in sputum differentiate asthma from rhinitis patients with or without bronchial hyperresponsiveness
Authors: Tufvesson E. , Aronsson D. , Bjermer L.
Published: June 2007

Background
We have previously reported that asthma differs from rhinitis with or without bronchial hyperresponsiveness in the perception and degree of lower airway inflammation.

Objective
The aim of the present study was to investigate whether sputum levels of inflammatory markers could further distinguish these patient groups.

Methods
Patients with seasonal allergic rhinitis with or without asthma or bronchial hyperresponsiveness to methacholine were investigated. Induced sputum was performed during as well as off season, and analysed for cysteinyl‐leukotrienes, hyaluronan, eosinophilic cationic protein (ECP) and other inflammatory markers.

Results
Asthmatic patients differentiated from those with rhinitis with or without bronchial hyperresponsiveness in levels of cysteinyl‐leukotrienes [geometric mean: 3.3 (lower 95%–upper 95% confidence interval (CI) of geometric mean: 1.9–5.1) vs. 1.4 (0.9–2.2) and 0.7 (0.3–1.6) pg/μg total protein] and hyaluronan [0.30 (0.22–0.43) vs. 0.15 (0.10–0.20) and 0.20 (0.12–0.35) ng/μg total protein] in sputum. The levels of cysteinyl‐leukotrienes decreased in sputum from the asthmatic patients, while the levels of hyaluronan remained elevated off‐season. Furthermore, elevated levels of ECP were noticed among both the asthmatic and rhinitis patients with hyperresponsiveness compared with controls [0.022 (0.014–0.033) and 0.015 (0.011–0.021) compared with 0.010 (0.007–0.014) ng/μg total protein]. The level of ECP remained elevated off season.

Conclusion
Cysteinyl‐leukotrienes are possibly more related to mast cell‐mediated inflammation and remodelling, also indicated by increased levels of hyaluronan during and off season. This inflammation may be partly different from the eosinophil‐driven inflammation.
Biological potency of German cockroach allergen extracts determined in an inner city population
Authors: Slater J. E. , James R. , Pongracic J. A. , Liu A. H. , Sarpong S. , Sampson H. A. , Satinover S. M. , Woodfolk J. A. , Mitchell H. E. , Gergen P. J. , Eggleston P. A.
Published: June 2007

Background
Cockroach allergy is an important cause of inner city asthma. To perform valid studies on the diagnosis and treatment of cockroach allergy, biological potencies of test extracts need to be established, and a surrogate in vitro test for biological potency should be chosen.

Methods
Sixty‐two cockroach‐allergic adult subjects were recruited for quantitative skin testing with three commercial German cockroach extracts. The intradermal D50 values were determined using linear interpolation, and the biologic potencies were determined from D50 data. The extracts were also analysed for relative potency, using a competition ELISA, and for specific allergen content, using a two‐site ELISA.

Results
Estimates of each extract's D50 were analysable in 48–55 subjects, with D50s between 10.3 and 11.8. All three extracts were bioequivalent using pre‐set criteria. The biological potencies of the extracts were 1738–8570 bioequivalent allergy units (BAU)/mL (geometric mean=3300), and these relative potencies were similar to those estimated by competition ELISA and specific allergen content. IgE against cockroach allergens were detected in sera from 34 subjects with analysable D50s, and 17 subjects had IgE directed against specific cockroach allergens. Although the presence of anti‐Bla g 5 correlated with the subjects' skin test responses for 2/3 extracts, no single allergen was immunodominant. Antibody responses among the subjects were heterogeneous.

Conclusions
Although commercial cockroach extracts are relatively low in potency, immunotherapeutic doses should be achievable. Biological potency may be estimated using D50 testing, a combination of specific allergen determinations, or by an overall potency assay such as the competition ELISA.

Capsule Summary
The biological potency of three German cockroach allergen extracts, determined in an inner city population, was 1738–8570 BAU/mL. No one allergen was immunodominant, and surrogate in vitro testing methods were examined.
Transformation zone sampling rate is a useful performance indicator for practitioners collecting cervical samples using SurePathTM liquid‐based cytology system
Authors: Narine N. , Young W.
Published: June 2007

An analysis of the reports of 53 982 liquid‐based cytology (LBC) samples processed at the Royal Victoria Infirmary, Newcastle, reveals a significant relationship between the transformation zone (TZ) sampling rate observed in specimens submitted from different practices and their overall detection rate for dyskaryosis. The observed correlation (R = 0.184; P = 0.033, CI = 0.017 to 0.397) is very similar to that described previously using conventional cervical smears and confirms the potential relevance of TZ sampling rates as an indicator of consistently effective specimen collection. The correlation between unsatisfactory sample rates and detection rates for high‐grade dyskaryosis (R = −0.188, P = 0.030, CI = −0.865 to −0.045) also shows a significant relationship for LBC samples which was not previously seen in conventional smears. The essential role of smear taker feedback, the use of transformation zone sampling and unsatisfactory smear rates as key indicators and the practical issues relating to routine reporting of transformation zone components are discussed.
Interaction between cytokines and sCD40L in patients with stable and unstable coronary syndromes
Authors: Tousoulis D. , Antoniades C. , Nikolopoulou A. , Koniari K. , Vasiliadou C. , Marinou K. , Koumallos N. , Papageorgiou N. , Stefanadi E. , Siasos G. , Stefanadis C.
Published: June 2007

Background  Evidence suggests that soluble CD40‐ligand (sCD40L) is elevated in coronary artery disease (CAD) and is released from activated platelets during the acute myocardial infarction (AMI). Although sCD40L is part of immune response, the mechanisms regulating its release in different disease states remain unknown.

Materials and methods  This study enrolled 596 subjects: 201 patients with stable CAD, 109 patients with AMI and 286 healthy controls. Circulating levels of sCD40L, interleukin‐6 (IL‐6), soluble vascular cell adhesion molecule‐a (sVCAM‐1) and soluble intercellular adhesion molecule‐1 (sICAM‐1) were determined by enzyme‐linked immunosorbent assay (ELISA).

Results  Patients with AMI (n = 109) had higher levels of sCD40L and IL‐6 compared to both CAD (n = 201) (P < 0·01) and controls (n = 286) (P < 0·01), while CAD also had higher levels of sCD40L and IL‐6 compared to controls (P < 0·01). Similarly, sICAM‐1 and sVCAM‐1 levels were higher in CAD and AMI compared to controls (P < 0·05). IL‐6 was the only parameter independently associated with sCD40L in healthy individuals [β (SE):0·491(0·096), P = 0·0001]. However, in CAD or AMI, only diabetes mellitus [β (SE): 2·689 (1·082), P = 0·044 and β (SE): 10·406 (3·215), P = 0·002, respectively] and smoking [β (SE): 3·470 (1·111), P = 0·002 and β (SE): 9·694 (2·478), P = 0·0001, respectively] (but not IL‐6), were independently associated with sCD40L levels.

Conclusions  Both CAD and AMI are accompanied by increased levels of sCD40L in parallel with an elevation of proinflammatory cytokine IL‐6 and adhesion molecules sVCAM‐1 and sICAM‐1. Diabetes mellitus and smoking (but not IL‐6 or adhesion molecules) were the only factors independently associated with sCD40L levels in CAD and AMI patients.
Role of hydrology in development of a vernal clear water phase in an urban impoundment
Authors: LEHMAN JOHN T. , PLATTE RACHEL A. , FERRIS JULIE A.
Published: June 2007

1. Grazer control of phytoplankton and water transparency was responsive to interannual variations in river discharge and corresponding water retention time in Ford Lake, Michigan, U.S.A.

2. A simple mathematical model was developed to separate the effects of washout from in situ zooplankton population dynamics. The threshold reservoir flushing time for development of a large Daphnia population and corresponding clear water phase during May was about 20 days. Predation by Leptodora was insufficient to cause the subsequent decline of the Daphnia population.

3. Recruitment success by the zebra mussel Dreissena polymorpha appeared responsive to flushing time indirectly, through hydrological effects on the magnitude of the spring diatom crop.
A review of prison health and its implications for primary care nursing in England and Wales: the research evidence
Authors: Condon Louise , Gill Hek , Harris Francesca
Published: June 2007

Aims and objectives.  To provide a systematic overview of the policy and practice literature concerned with the primary healthcare needs of prisoners in England and Wales and to address the implications of these health needs for nurses working in prisons.

Background.  The recent reorganization of the prison healthcare system, which has brought prison health services in England and Wales within the National Health Service, has major implications for the role of prison nurses. Nurses in prisons are increasingly providing services to promote the health of prisoners, in addition to making assessments of health need and treating health problems.

Methods.  The review examined literature from 1995 to date using standard review techniques adapted to be both sensitive and inclusive and with high recall because of the unexplored nature of primary health care in prisons.

Results.  Findings are identified in three main areas: the general health needs of prisoners, health promotion and chronic disease management. In all these areas, the health needs of the prison population are much greater than the community as a whole, resulting in a high demand for primary care services in prison. However, the prison setting can militate against providing good primary care services in prison.

Conclusions.  More research has been carried out into the health needs of prisoners than into the provision of primary care nursing services in prisons. Further research is needed into primary care nursing in prison to meet the health needs of prisoners effectively.

Relevance to Clinical Practice.  With the reorganization of prison health services, health provision in prisons is increasingly primary care focused. This presents new challenges to nurses working in prison to provide a primary care service, which meets the identified health needs of prisoners.
Effect of the diabetes outpatient intensive management programme on glycaemic control for type 2 diabetic patients
Authors: Song Min‐Sun , Kim Hee‐Seung
Published: June 2007

Aim.  The purpose of this study was to examine the effect of the diabetes outpatient intensive management programme (DOIMP) on glycaemic control over a 12 week follow‐up period for type 2 diabetic patients in Korea.

Background.  Diabetic complications can be prevented if the glycaemic status of diabetes patients is maintained within a nearly normal range. Patient education is critical in controlling blood glucose levels of patients with diabetes within the optimal range.

Methods.  DOIMP was composed of multidisciplinary education, complication monitoring and telephone counselling. Twenty‐five patients in the intervention group participated in the DOIMP and 24 patients in the control group were briefed on the conventional description of diabetes mellitus by diabetes education nurses.

Results.  Patients in the intervention group had a mean decrease of 2·3%, which those in the control group having a mean decrease 0·4% in glycosylated haemoglobin (HbA1c). There was no difference between the two groups in the change in fasting blood glucose (FBG) and two‐hour postprandial blood glucose (2‐h PBG). The proportion of the patients with HbA1c <7% was higher in the intervention group than in the control group at the post‐test compare with the pretest.

Conclusion.  DOIMP can reduce HbA1c in type 2 diabetes patients.

Relevance to clinical practice.  These findings indicated that DOIMP could be effective in glycaemic control in type 2 diabetes patients.
Group II subfamily secretory phospholipase A2enzymes: expression in chronic rhinosinusitis with and without nasal polyps
Authors: Liu Z. , Lu X. , Wang H. , You X. J. , Gao Q. X. , Cui Y. H.
Published: June 2007

Background: Group II subfamily secretory phospholipases A2(sPLA2s) are the enzymes that can play a major role in inflammation. However, the presence of group II subfamily sPLA2s in human sinonasal mucosa and their roles in chronic rhinosinusitis (CRS) are not well known. The purpose of this study was to investigate the expression of group II subfamily sPLA2s in human sinonasal mucosa from controls and CRS patients with and without nasal polyps (NPs) and the regulation of expression by proinflammatory cytokines.

Methods: Surgical samples were investigated by means of reverse transcriptase polymerase chain reaction (RT‐PCR) for evaluation of group II subfamily sPLA2s mRNA expression, and the presence and location of group II subfamily sPLA2s‐positive cells were analyzed by means of immunohistochemistry. Furthermore, nasal explant culture and quantitative RT‐PCR techniques were used to investigate the effect of interleukin (IL)‐1β and tumor necrosis factor (TNF)‐α on group II subfamily sPLA2s mRNA production in sinonasal mucosa.

Results: Messenger RNA expression of sPLA2‐IIA, ‐IID, and ‐IIE was significantly upregulated in tissues from CRS patients compared with control tissues. Among CRS patients, patients without NPs showed significantly stronger expression in sinonasal mucosa than patients with NPs of sPLA2‐IIA mRNA, and weaker expression of sPLA2‐IIE mRNA. Immunohistochemistry revealed enhanced protein expression of type II sPLA2s and specific type IIA sPLA2in epithelial cells and submucosal glands in samples from CRS patients. Stronger type IIA sPLA2protein expression was found in samples from CRS patients without NPs when compared with NPs. Nasal explant culture experiments demonstrated that mRNA expression of sPLA2‐IIA, ‐IID, and ‐IIE was dramatically induced by IL‐1β and TNF‐α.

Conclusions: The expression of some members of group II subfamily of sPLA2s is upregulated in CRS and it may result from IL‐1β and TNF‐α overexpression. Different individual group II subfamily sPLA2s may play different roles in the pathogenesis of CRS with and without NPs.
The accuracy of symptom‐based definition of chronic rhinosinusitis
Authors: Tahamiler R. , Canakcioglu S. , Ogreden S. , Acioglu E.
Published: June 2007

Objective:  Currently, the diagnosis of chronic rhinosinusitis (CRS) is a symptom‐based definition. This study aims to study, verify and evaluate the predictive value of the symptom‐based definition of CRS and compare this with objective tests.

Methods:  Seven hundred and sixty‐eight adults, who were referred from primary care centers as patients who met the definition of CRS, were enrolled in the study. The patients were divided into two groups according to their allergic status. The patients were subjected to nasal endoscopy and computed tomography (CT) on the same day.

Results:  The results showed 73.15% of the nonallergic patients with symptom‐based diagnosed CRS and 65.34% of the allergic patients with symptom‐based diagnosed CRS had no CT and endoscopic pathology (Endoscopic score 0 + CT score 0). Nasal discharge was the most common major symptom in all patients from both groups who had pathologic endoscopic and/or CT scan scores.

Conclusions:  It is well established that symptoms are very important in the diagnosis of CRS. However, two major symptoms are insufficient for diagnosis. Therefore, endoscopy and CT have important differential diagnostic roles. Our study showed that in patients with three major symptoms, CT pathology may be sufficient for definitive diagnosis. However, in patients with two major symptoms such as nasal discharge and/or low grade nasal polyposis, endoscopy becomes considerably more important due to inspective findings. If no endoscopic findings are found, the importance of the CT scans is increased.
Allergic patients have more numerous and prolonged respiratory infections than nonallergic subjects
Authors: Cirillo I. , Marseglia G. , Klersy C. , Ciprandi G.
Published: June 2007

Background:  Allergic disorders are characterized by type 2 helper T cell (Th2)‐polarization, thus physiological type 1 helper T cell (Th1)‐dependent mechanisms involved in fighting respiratory infections (RI) may be defective. It has previously been reported that allergic children have more numerous and severe RI than nonallergic ones.

Objective:  The aim of the study was to evaluate the number and duration of RI in adult allergic and nonallergic subjects.

Methods:  Six hundred and twenty‐four subjects were studied; 202 of them were allergic (i.e. suffering from allergic rhinitis). The number of RI as well as the duration of the disease were recorded for 2 years.

Results:  Allergic subjects showed a significantly higher rate of RI episodes [adjusted incidence rate ratio (IRR) = 2.16, 95% confidence interval (CI) 1.94–2.41, P < 0.001] than subjects without allergy. The number of mild RI episodes was slightly higher in allergic subjects (IRR = 1.68, 95% CI 1.50–1.89, P < 0.001), while the number of severe episodes was markedly higher (IRR = 15.71, 95% CI 10.35–23.84, P < 0.001) when compared with nonallergic subjects. Moreover, allergic patients showed a longer total duration of RI than nonallergic subjects, with a mean difference of 17.4 days (95% CI 15.5–19.4, P < 0.001).

Conclusions:  This study provides evidence that adult allergic patients have more numerous and prolonged RI than nonallergic subjects.
Waiting for lung transplantation: quality of life, mood, caregiving strain and benefit, and social intimacy of spouses
Authors: Rodrigue James R. , Baz Maher A.
Published: June 2007

Abstract:  Background:  The emotional and physical well‐being of lung transplant patients is enhanced by the availability and stability of a primary caregiver.

Methods:  We describe the quality of life (QOL), mood, caregiving strain and benefits, and social intimacy of 73 lung transplant caregivers who completed the QOL Inventory, SF‐36 Health Survey, Profile of Mood States, Caregiver Strain Index, Caregiver Benefit Index, and Miller Social Intimacy Scale.

Results:  Clinically low QOL was reported by 17.8–35.6% of spouses. Relative to a normative sample, spouses reported significantly lower physical (z = 4.01, p < 0.001) and emotional (z = 7.01, p < 0.001) QOL. Over half (56.2%) had clinically elevated caregiving strain. Heightened physical strain (80.8%), inconvenience (79.5%), feeling confined (72.6%), feeling upset that patient has changed so much (69.9%) contributed most to caregiver strain, while discovering inner strength (60.3%), support from others (53.4%), and realizing what is important in life (42.5%) were noted caregiving benefits. Higher caregiving strain was associated with more mood disturbance (r = 0.42, p < 0.001), lower emotional QOL (r = −0.39, p < 0.002), lower social intimacy (r = −0.37, p < 0.002), and longer disease duration (r = 0.55, p < 0.001).

Conclusion:  Spouses of patients awaiting lung transplantation may experience QOL deficits and high caregiver strain. Interventions to improve QOL and reduce caregiver strain are needed.
A better yield of islet cell mass from living pancreatic donors compared with cadaveric donors
Authors: Jung Hye Seung , Choi Seong‐Ho , Kim Sung‐Joo , Lee Kyu Taek , Lee Jong Kyun , Jang Kee‐Taek , Lee Byung‐Wan , Jee Jae‐Hwan , Oh Seung‐Hoon , Ahn You‐Ran , Lee Moon‐Kyu , Kim Kwang‐Won
Published: June 2007

Abstract:  Studies in rats have shown that brain death decreases β‐cell function and causes islet cell death during islet isolation and transplantation. Because a direct comparison of human islet cells between living and cadaveric donors has not been reported to date, we studied the effects of brain death on islet cell yield. A total of 36 pancreas specimens from 20 living donors and 16 cadaveric donors were used for analysis. Islets were isolated with a Ricordi chamber, and counted as equivalent islet numbers (EIN). Living donors were predominantly female, and cadaveric donors were mainly male. Although the cold ischemic time, pancreas distensibility and digestion time were not different, islet yield was observed to be higher in living donors compared with cadaveric donors (5800 ± 3500 vs. 1900 ± 2000 EIN/g pancreas). Islet isolation success rates (when defined as more than 2000 EIN/g) were 94.1% and 42.9%, respectively. Post‐Ficoll islet recovery rates and purity were also better in living donors. However, islet viability and in vitro function of isolated islets showed no significant differences between the groups. These results suggested that brain death negatively affected the processes of islet isolation from the pancreas.
Pre‐transplant level of soluble CD30 is associated with infection after heart transplantation
Authors: Nikaein Afzal , Spiridon Camelia , Hunt Judson , Rosenthal Jed , Anderson Allan , Eichhorn Erick , Magee Mitchell , Dewey Todd , Mack Michael
Published: June 2007

Abstract: Background:  One immunologic element of the immune system is the CD30 molecule which belongs to the TNF‐R superfamily. CD30 can serve as a T‐cell signal transducing molecule and is expressed by a subset of activated T lymphocytes, CD45RO+ memory T cells. Augmentation of soluble CD30 during kidney transplant (Tx) rejection has been reported. Our study was to determine if the level of sCD30 prior to heart transplant (HTx) could categorize the patients (pts) into high or low immunologic risk for post‐Tx outcome.

Methods:  Pre‐Tx sera from 100 consecutive HTx recipients were studied. sCD30 was detected by ELISA using the commercially available CD30 monoclonal antibody. Level of sCD30 was correlated with two‐yr Tx outcome.

Results:  Significant correlation was seen between the high level of sCD30 and lower incidence of infection. Four of the 35 pts with pre‐Tx high level of sCD30 level (>90 U/mL) developed infection post‐Tx. However, 31/65 pts who had a low level of sCD30 (<90 U/mL) developed infection post‐transplantation (p < 0.0003). No remarkable differences were noted with the other clinical parameters, including mean hospitalization, 3A biopsy rejection or death.

Conclusions:  We report for the first time that the high level of sCD30 prior to the HTx may be associated with a higher immunologic ability of the pts and therefore, may have a protective effect in the development of infection post‐Tx.
Renal transplantation outcomes: a comparative analysis between elderly and younger recipients
Authors: Mendonça Helena Moisés , Reis Marlene Antônia dos , De Cintra Sesso Ricardo de Castro , Câmara Niels Olsen Saraiva , Pacheco‐Silva Alvaro
Published: June 2007

Abstract:  Renal transplantation is presently the best treatment for end‐stage renal disease, although considered contraindicated for elderly patients. However, more investigation is needed due to higher life expectancy rates of the general population and the increasing number of over 60‐yr‐old patients with chronic renal failure dependant upon dialysis. This study aims to determine graft and patient survival rates of renal transplant patients 60 yr and older compared to a younger group (50–59 yr old). Relevant pre‐ and post‐transplant clinical data related to graft and patient survival in both groups were also investigated. Three‐hundred and twenty consecutive renal transplant patients were enrolled in this study and grouped based on age at the time of the transplantation: one‐hundred and ten patients at or over 60 yr old (elderly group) and 210 patients ranging from 50 to 59 yr old (younger group). There were no statistical differences in either group regarding clinical characteristics and immunological risk factors. The incidence of acute rejection was higher in the younger group (37.6%) than in the elderly (22.7%) (p = 0.01). Censored to death graft survivals at five yr were respectively 86.7% for patients ≥ 60 yr and 82.1% for patients 50–59 yr old (p = 0.49). Patient survival rates at five yr were respectively 76.2% for patients ≥ 60 yr and 81.6% for patients 50–59 yr old (p = 0.33). Our data show that renal transplantation for elderly patients has similar results to those found in younger individuals, which does not make age, in and of itself, a contraindication for transplantation.
Successful treatment of small‐for‐size syndrome in adult‐to‐adult living‐related liver transplantation: single center series
Authors: Gruttadauria Salvatore , Mandala’ Lucio , Miraglia Roberto , Caruso Settimo , Minervini Marta Ida , Biondo Domenico , Volpes Riccardo , Vizzini Giovanni , Marsh J. Wallis , Luca Angelo , Marcos Amadeo , Gridelli Bruno
Published: June 2007

Abstract:  The portal hyperperfusion, or small‐for‐size syndrome (SFSS), is a widely recognized clinical complication that may occur after segmental liver transplantation. Several surgical strategies have been proposed to reduce portal blood inflow and portal pressure after partial liver transplantation. In particular, splenic artery ligation and splenectomy have been used without a firm hemodynamic basis for these procedures. Our group recently demonstrated that, in patients with cirrhosis and portal hypertension, the occlusion of the splenic artery causes a significant reduction in the portal pressure gradient, which is directly related to the spleen volume and indirectly related to the liver volume. This concept is at the center of our strategy for performing early splenic artery embolization (SAE) for the treatment of SFSS after living‐related liver transplantation (LRLT). Six patients developed small‐for‐size syndrome, defined as: onset within the first week after LRLT of progressive hyperbilirubinemia without mechanical cause; marked cholestasis; centrilobular sinusoidal dilatation and hepatocyte atrophy at liver biopsy; and refractory ascites in the absence of vascular complications. All six patients who underwent SAE rapidly improved their clinical condition, with an evident decrease in the value of bilirubin in the serum, in the production of ascites, and improvement in condition of pancytopenia. Coagulopathy expressed by the international normalized ratio value (INR) was not a reliable early marker of SFSS in this series; in fact a slight improvement in the result of this test was already present immediately after LRLT and before SAE. Because splenic flow clearly contributes to portal hyperperfsion, an early SAE can relieve the partial graft from the deleterious effect of this portal overflow.
Glutathione peroxidase protein expression and activity in human islets isolated for transplantation
Authors: Tonooka Naoko , Oseid Elizabeth , Zhou Huarong , Harmon Jamie S. , Robertson R. Paul
Published: June 2007

Abstract:  Background:  Overexpression of antioxidant enzymes has been reported to protect rodent beta cells from oxidative stress. However, very little is known about protein expression and activity of antioxidant enzymes in human islets.

Method/Results:  Human islet protein levels by Western analysis and enzymatic activity for the key antioxidant enzymes superoxide dismutases (SODs), catalase, and glutathione peroxidase‐1 (GPx) were examined. Enzyme protein expression and activity were in the order SODs > catalase > GPx. Human islet GPx protein expression was significantly less than that found for catalase (p < 0.0001) and levels of GPx activity were virtually undetectable. As glucose and estrogens have been proposed to alter antioxidant enzyme levels, we examined islet data from male and female donors separately and under varying glucose concentrations. We found significantly less (p < 0.001) GPx protein expression in islets from females compared to males, but no significant regulation by glucose in either gender.

Conclusions:  Human islets have very low protein and activity levels for GPx, the essential enzyme for protection against excessive levels of intracellular lipid peroxides. GPx mimetics may be especially valuable in providing human islets with the broadest spectrum of protection against oxidative stress during isolation and transplantation.
Calcineurin inhibitor‐sparing regimens in solid organ transplantation: focus on improving renal function and nephrotoxicity
Authors: Flechner Stuart M , Kobashigawa Jon , Klintmalm Goran
Published: June 2007

Abstract:  Background:  The calcineurin inhibitors (CNIs), cyclosporine and tacrolimus, have had a revolutionary effect on the overall success of renal transplantation through reduction in early immunologic injury and acute rejection rates. However, the CNIs have a significant adverse impact on renal function and cardiovascular disease, and extended long‐term graft survival has not been achieved. The recognition of these effects sparked interest in CNI‐sparing strategies. Strategies to limit CNI exposure include CNI minimization, avoidance, and withdrawal. We sought to review the impact of CNI‐sparing strategies in kidney, liver, and heart transplantation.

Materials and methods:  A PubMed search 1966 to August 2006 was conducted to identify relevant research articles, and the references of these articles as well as the authors’ personal files were reviewed.

Results:  Calcineurin inhibitor minimization using mycophenolate mofetil or sirolimus may be associated with a modest increase in creatinine clearance (CrCl) and a decrease in serum creatinine (SCr) in the short term. Despite improvement in CrCl or SCr, CNI nephrotoxicity and chronic allograft nephrotoxicity are progressive over time when CNI exposure is maintained. In kidney transplantation, the tubulo‐interstitial and glomerular damage are irreversible. Mycophenolate mofetil may improve renal outcomes during CNI minimization more than sirolimus, and antibody induction may be effective to limit CNI exposure, but longer‐term follow‐up data are required. Use of sirolimus with mycophenolate mofetil or azathioprine to avoid CNI exposure de novo has improved glomerular filtration rate for at least two yr in most studies in kidney transplantation; however, experience is limited in liver and heart transplantation, and reports of delayed graft function and wound healing with sirolimus may have dampened enthusiasm for de novo use. Late CNI withdrawal has achieved variable results, possibly because withdrawal was attempted after the kidney damage was too extensive. Early CNI withdrawal, prior to significant graft damage, has generally improved CrCl and markers of fibrosis and decreased chronic allograft lesions, a finding also observed with sirolimus in most CNI avoidance studies. Successful withdrawal appears to be more effective than CNI minimization.

Conclusions:  Calcineurin inhibitors are associated with significant nephrotoxicity and chronic kidney damage. Minimization is associated with a modest increase in renal function, but persistent damage is observed on biopsies as long as the CNIs are continued. Avoidance is hampered by lack of experience and possible sirolimus‐induced side effects. CNI withdrawal may be the best option by delivering CNIs during the early period of immunologic graft injury and then converting them to less nephrotoxic agents before significant renal damage occurs.
Effects of hyperoncotic or hypertonic–hyperoncotic solutions on polymorphonuclear neutrophil count, elastase‐ and superoxide‐anion production: a randomized controlled clinical trial in patients undergoing elective coronary artery bypass grafting
Authors: Molter G. P. , Silomon M. , Bauer C. , Ziegeler S. , Soltesz S.
Published: June 2007

Background:  Hypertonic–hyperoncotic solutions may be an effective treatment for systemic inflammatory response syndrome (SIRS). With regard to the immunomodulatory effects of these drugs, previous studies demonstrated controversial results. Therefore, the present study investigated the influence of different hyperoncotic and hypertonic–hyperoncotic solutions on polymorphonuclear neutrophil leukocyte (PMNL) count, elastase and superoxide‐anion production in patients undergoing elective coronary artery bypass grafting (CABG) with cardiopulmonary bypass.

Methods:  Fifty patients scheduled for elective CABG with cardiopulmonary bypass were randomly assigned to five groups: (i) NaCl 0.9%, 750 ml/m2 body surface area (BSA); (ii) hydroxyethylic starch 10%, 250 ml/m2 BSA and NaCl 0.9%, 400 ml/m2 BSA; (iii) dextran 10%, 250 ml/m2 BSA and NaCl 0.9%, 300 ml/m2 BSA; (iv) hypertonic sodium chloride 7.2%/hyperoncotic hydroxyethylic starch 10%, 150 ml/m2 BSA; and (v) hypertonic sodium chloride 7.2%/hyperoncotic dextran 10%, 150 ml/m2 BSA. Blood samples were drawn from arterial, central venous and coronary artery sinus catheters peri‐operatively. PMNL count, superoxide‐anion production and elastase were recorded.

Results:  PMNL counts and elastase activity increased in all groups after reperfusion. Superoxide‐anion production showed only minor changes. Between groups, no significant differences were demonstrated.

Conclusions:  Infusion of clinically relevant doses of hypertonic–hyperoncotic solution did not affect PMNL count, elastase‐ or superoxide‐anion production during elective CABG with cardiopulmonary bypass.
Cardioprotective effects of cyclosporine A in an in vivo model of myocardial ischemia and reperfusion
Authors: Xie J.‐R. , Yu L.‐N.
Published: June 2007

Background:  Recent evidence indicates that reperfusion of the heart after a period of ischemia leads to the opening of the mitochondrial permeability transition pore (MPTP). The aim of this study was to investigate cardioprotective effects of cyclosporine A (CsA), an inhibitor of the MPTP, in an in vivo model of myocardial ischemia and reperfusion.

Methods:  Male Sprague–Dawley rats were subjected to occlusion of the left anterior descending coronary artery for 30 min followed by 180 min of reperfusion. CsA (10 mg/kg) or vehicle was given 10 min prior to ischemia via the femoral vein. Sham myocardial ischemia–reperfusion rats (sham‐operation group) were used as controls. Infarct size was measured using the staining agent TTC (2,3,5‐triphenyl tetrazolium chloride) and myocardial apoptosis by caspase‐3 activity was determined by fluorescent assay. The myocardium mitochondria ultrastructure was observed through a transmission electron microscope.

Results:  CsA significantly reduced infarct size (48.8 ± 5.8% of left ventricle in vehicle + I/R group and 30.3 ± 2.7% of left ventricle in CsA + I/R, respectively) and decreased caspase‐3 activity in the myocardium [(0.62 ± 0.17)/μg of protein and (0.42 ± 0.15)/μg of protein, respectively] and relieved the injury of mitochondria.

Conclusion:  CsA reduced the cardiac damage associated with ischemia–reperfusion injury of the heart. The cardioprotective effects of CsA might be associated with the protection of mitochondria and the inhibition of caspase‐3 activity. It also suggests that the MPTP might play an important role in cardiomyocytes death after ischemia–reperfusion injury.
Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists
Authors: Lindfors P. M. , Meretoja O. A. , Töyry S. M. , Luukkonen R. A. , Elovainio M. J. , Leino T. J.
Published: June 2007

Background:  Organizational changes and relative growth of the ageing population together with related health problems seem to have increased stressfulness in the work of anaesthesiologists. However, little is known about their work‐related well‐being and the factors through which their situation could be improved.

Methods:  A cross‐sectional questionnaire study of the level and the determinants of job satisfaction, work ability and life satisfaction among female and male anaesthesiologists involved 258 Finnish anaesthesiologists working full time (53% men).

Results:  The respondents had fairly high job satisfaction, work ability and life satisfaction. No gender differences appeared in these well‐being indicators, but their determinants differed by gender. Job satisfaction was only associated with work‐related factors in both genders: with job control in women and with job control and organizational justice in men. Work ability correlated with job control and health in both genders and with family life in women. Life satisfaction correlated with individual‐ and family related factors such as social support and family problems in both genders. Life satisfaction correlated with physical workload in men and health in women. Women had less job control, fewer permanent job contracts and more domestic workload than men.

Conclusions:  Job control and organizational justice were the most important determinants in work‐related well‐being. Work‐related factors were slightly more important correlates of well‐being in males, and family life seems to play a larger role in the well‐being of female anaesthesiologists. Organizational and gender issues need to be addressed in order to maintain a high level of well‐being among anaesthesiologists.
THE WAGNER–NELSON METHOD MAKES THE [13C]‐BREATH TEST COMPARABLE TO RADIOSCINTIGRAPHY IN MEASURING GASTRIC EMPTYING OF A SOLID/LIQUID MIXED MEAL IN HUMANS
Authors: Sanaka Masaki , Nakada Koji , Nosaka Chihiro , Kuyama Yasushi
Published: June 2007

Scintigraphy is the gold standard for measuring gastric emptying, but the use of radioactive isotopes can produce substantial irradiation. The [13C]‐acetate/octanoic acid breath test is widely used as a non‐radioactive alternative.

The half [13CO2] excretion time () is closely correlated with the scintigraphic half‐emptying time (). However, is consistently remote from , because the distribution of [13CO2] into the bicarbonate pool delays the respiratory excretion of the [13C] marker, which has already been emptied from the stomach. The time for the distribution process should be adjusted to diminish the discrepancy between the results of the scintigraphic and breath tests.

The Wagner–Nelson method provides an accurate profile of drug absorption. We have recently applied the Wagner–Nelson method to breath testing to adjust the time for [13CO2] distribution. In the present study, the [13C]‐breath test with Wagner–Nelson analysis was compared with scintigraphy.

Six female volunteers simultaneously underwent scintigraphy and the breath test on two occasions, either to measure gastric emptying of the liquid phase (16 kcal) or for that of the solid phase (214 kcal). Time–percentage gastric retention curves were generated by scintigraphy and the breath test with Wagner–Nelson analysis. The half‐emptying times were determined by interpolation from the scintigraphic curve () and the Wagner–Nelson curve (). was calculated by conventional curve‐fitting techniques.

For liquid and solid emptying, the gastric retention curves generated by the Wagner–Nelson method were comparable to the scintigraphic retention curves. For the liquid, was significantly longer than (93.8 ± 7.3 vs 14.2 ± 9.3 min, respectively; P < 0.0001), as was also observed for the solid phase (147.8 ± 34.4 vs 35.3 ± 11.2 min, respectively; P < 0.0001). In contrast, no significant differences were found between and for the liquid (13.5 ± 5.0 vs 14.2 ± 9.3 min, respectively; P = 0.734) and the solid (45.8 ± 10.2 vs 35.3 ± 11.2 min, respectively; P = 0.051) phase.

In conclusion, Wagner–Nelson analysis makes the [13C]‐breath test comparable to scintigraphy.
ATP MODULATES THE RELEASE OF NORADRENALINE THROUGH TWO DIFFERENT PREJUNCTIONAL RECEPTORS ON THE ADRENERGIC NERVES OF RAT PROSTATE
Authors: Morikawa Tsugumi , Tanaka Naoko , Kubota Yoko , Mizuno Hideya , Nakamura Kazuki , Kunitomo Masaru , Shinozuka Kazumasa
Published: June 2007

The effects of adenosine and ATP receptor agonists on the release of endogenous noradrenaline from electrically stimulated (2 Hz, 0.1 msec) rat prostate were examined in order to clarify the pharmacological properties of prejunctional receptors for adenosine and ATP on the adrenergic nerve varicosities in the prostate. Noradrenaline was quantified by HPLC coupled with electrochemical detection techniques.

Both adenosine and ATP receptor agonists (1 µmol/L) inhibited noradrenaline release and the relative order of inhibitory effect wasN6‐cyclopentyl‐adenosine (CPA) > 5′‐N‐ethylcarboxamidoadenosine > 2‐chloroadenosine > adenosine > 2‐methylthio‐ATP (2mSATP) > AMP > ATP.

The adenosine receptor agonist CPA (1 nmol/L–1 µmol/L) and the ATP receptor agonist 2mSATP (100 nmol/L–100 µmol/L) inhibited the stimulation‐induced release of noradrenaline in a concentration‐dependent manner. The concentrations of CPA and 2mSATP that produced 50% inhibition of noradrenaline release were 9.6 nmol/L and 1.4 µmol/L, respectively.

1,3‐Dipropyl‐8‐cyclopentylxanthine, an adenosine A1receptor antagonist, significantly reduced the inhibitory effects of not only CPA, but also 2mSATP.

Suramin, an ATP receptor antagonist, significantly reduced the inhibitory effects of 2mSATP, but not those of CPA.

Pyridoxalphosphate‐6‐azophenyl‐2′,4′‐disulphonic acid, another ATP receptor antagonist, had no effect on the inhibitory action of either agonist.

These results suggest that, in the sympathetic nerve terminals of rat prostate, adenosine and ATP induce inhibition of noradrenaline release via the activation of adenosine A1and/or xanthine‐sensitive ATP receptors, which play an inhibitory regulatory role in adrenergic neurotransmission in the prostate.
GENETIC INFLUENCES ON THE ARTERIAL WALL
Authors: Kingwell Bronwyn , Boutouyrie Pierre
Published: June 2007

Arterial stiffness, which has independent predictive value for cardiovascular events, seems to have a genetic component, largely independent of the influence of blood pressure and other cardiovascular risk factors.

In animal models of essential hypertension (stroke‐prone spontaneously hypertensive rats and spontaneously hypertensive rats), structural modifications of the arterial wall include an increase in the number of elastin–smooth muscle cell connections and smaller fenestrations of the internal elastic lamina, possibility leading to redistribution of the mechanical load towards elastic materials. These modifications may give rise to mechanisms explaining why changes in arterial wall material accompanying wall hypertrophy in these animals are not associated with an increase in arterial stiffness.

In monogenic connective tissue diseases (Marfan, Williams and Ehlers–Danlos syndromes) and the corresponding animal models, precise characterization of the arterial phenotype makes it possible to determine the influence of abnormal, genetically determined, wall components on arterial stiffness.

Such studies have highlighted the role of extracellular matrix signalling in the vascular wall and have shown that elastin and collagen not only display elasticity or rigidity, but are also involved in the control of smooth muscle cell function.

These data provide strong evidence that arterial stiffness is affected by the amount and density of stiff wall material and the spatial organization of that material.
GLUCOSE, INSULIN, DIABETES AND MECHANISMS OF ARTERIAL DYSFUNCTION
Authors: Cameron James D , Cruickshank J Kennedy
Published: June 2007

This commentary reviews and discusses the association between increased arterial stiffness and indices of glucose and insulin metabolism and diabetes mellitus (DM).

Diabetes mellitus is associated with increased cardiovascular events, is an established major independent risk factor for cardiovascular disease and is included in current risk assessment algorithms. Based on Framingham risk assessment, the incremental risk due to DM, at a given level of baseline risk in non‐diabetics, is approximately equivalent to 10 years and, at any given level of other major risk factors, DM increases risk three‐ to fourfold.

Increased aortic stiffness has been shown to be an independent risk factor for both cardiovascular and overall mortality in high‐risk groups and recently in the general population. Both DM1 and DM2 are associated with accelerated stiffening of the elastic arteries, over and above that associated with normal ageing, and DM can be considered as imparting added biological age and, thus, added cardiovascular risk.

Aortic stiffness provides a plausible mechanism relating diabetes to increase cardiovascular disease.

A proportion of the increased risk of cardiovascular events in DM is a sequel of stiff arteries. Direct measures of arterial stiffness, such as aortic pulse wave velocity, are likely to be better candidates than pulse wave analysis for refining interventions to improve outcomes in diabetes.
ARTERIAL CALCIFICATION AND STIFFNESS IN CHRONIC KIDNEY DISEASE
Authors: Kerr PG , Guerin AP
Published: June 2007

Patients with chronic kidney disease (CKD) demonstrate a high burden of vascular disease. This vascular disease is unusual by way of a preponderance of medial calcification. Further, traditional cardiovascular risk factors fail to fully explain the high cardiovascular event rate in this population.

The present review examines the problem of medial calcification and arterial stiffness evident in patients with CKD and explores evidence for its existence and the potential pathological process involved. Many factors are emerging as potential culprits in this disease entity, although the specific roles of components such as fetuin‐A, matrix Gla protein, osteopontin and fibroblast growth factor‐23 have yet to be determined. Calcium and phosphate balance remains integral to the pathological process.

Pulse wave velocity has proven to be a useful tool to assess and follow arterial stiffness in CKD patients and is discussed.

Finally, techniques aimed at reducing or reversing arterial calcification and stiffness are discussed, with as yet no definitive answers available.
DRUG EFFECTS ON THE MECHANICAL PROPERTIES OF LARGE ARTERIES IN HUMANS
Authors: Hope Sarah A , Hughes Alun D
Published: June 2007

Arteries become stiffer with increasing age and various disease states. A complete description of arterial mechanical properties in vivo is not possible, although a number of methods have been used.

Detailed discussion in the present review is limited to pulse wave velocity and estimates of central waveform morphology derived by the application of a generalized arterial transfer function.

Many drugs affect these parameters, either increasing or decreasing apparent stiffness. However, the extent to which changes reflect changes in blood pressure rather than more fundamental vessel wall properties remains unclear. Similarly, it is as yet unknown whether determining the need for, or assessing the effectiveness of, drug treatment by the assessment of arterial mechanical properties will offer any advantage and the usefulness of these techniques as routine clinical tools remains to be established.