A multi-site study on the impact of an advance care planning workshop on attitudes, beliefs and behavioural intentions over a 6-month period

BACKGROUND

This study evaluated the impact of the adapted version of the Respecting Choices® The Living Matters Advance Care Planning (ACP) facilitator training programme on trainees' attitudes on facilitation 6 months post-training.

SETTING AND PARTICIPANTS

Two hundred and twenty-one healthcare professionals consisting of doctors, nurses, medical social workers from different training venues in Singapore participated in the first phase of the study (pre- and post) of which 107 participated in the second phase 6 months later (follow-up).

METHODS

Participants self-rated their attitudes, beliefs and behavioural intentions through surveys at three time points in an evaluation design that utilised repeated measures one-way ANOVA (pre-, post-, follow-up). Between-group differences were also examined using independent t-test.

RESULTS

At follow-up, mean scores increased significantly in understanding, confidence, and competence. Changes in effect sizes were large. Although trainees continued to think that ACP is emotionally draining for facilitators, more than before, facilitation experience was considered pleasant for themselves with the positive change significant and moderate in effect size. Those who had experience completing/initiating ACP significantly held more positive views than those who did not.

CONCLUSIONS

The ACP facilitator training programme had lasting effects on enhancing the understanding, competence, and confidence of trainees. Importantly, findings showed that experience in actual facilitation within 6 months after training was important and giving trainees opportunities to facilitate is recommended.

P1604Validating previously reported Brugada syndrome-associated common variants identified in caucasian population in the Han Chinese BrS cohort in Taiwan: SADS-BrS registry

Background

Brugada syndrome (BrS) is a sudden arrhythmic death. The prevalence of BrS is higher in the Southeast Asian populations than that in Caucasian patients. A previous genome-wide association study (GWAS) has reported 13 SNPs significantly associated with BrS. However, no study was performed to validate whether these SNPs are enriched in BrS patients in Han Chinese (HC).

Purpose

Evaluating the common variants previously reported in Caucasian BrS patients could be generalized to HC BrS patients in Taiwan

Methods

We genotyped 200 unrelated BrS patients using Affymetrix TWB Array (N=653,291 SNPs, a customized array for HC in Taiwan). The controls are obtained from the Taiwan Biobank (N ≈ 16,000) using the same array. An imputation workflow was shown in Figure 1. To confirm the accuracy of the imputed genotype of each variant, Sanger sequencing was performed in 10% of randomly selected cases.

Results

Among the 3 most important common variants (rs11708996 in SCN5A, rs10428132 in SCN10A and rs9388451 in HEY2/NCOA7) reported in the previous GWAS mainly conducted in Caucasian BrS patients, 2 of them (rs10428132 and rs9388451) were successfully replicated in the HC population in Taiwan (P<0.01). We also found that the differences of minor allele frequency (dMAF: the MAF of cases minus the MAF of controls) of the two variants were relatively smaller between the BrS cases and healthy controls in HC population compared with that in Caucasian populations (dMAF, rs9388451: 0.15 (Caucasian) vs −0.07 (HC); rs10428132: 0.28 (Caucasian) vs 0.11 (HC)). For the remaining 10 common variants reaching genome-wide significance (P=5×10–8) in Caucasian BrS patients, 9 of them were also significantly enriched in the HC BrS patients after the Bonferroni correction (P<0.05/12=0.0042). We next analyzed the variants identified in the previous GWAS on ECG traits (PR interval, QRS duration, QTc interval, and heart rate) in the Caucasian population. Among the reported 75 variants associated with ECG traits, 5 common variants (rs6798015 (PR), rs1760876 (QRS), rs6795970 (PR/QRS), rs2074238 (QTc) and rs314370 (heart rate)) were significant after Bonferroni correction (P<0.05/75=0.00066).

Figure 1

Conclusions

The preliminary results indicated that 85% of common variants of SCN10A and HEY2/NCOA7 previously reported in Caucasian BrS patients are replicated in BrS patients in the HC population but not the common variant of SCN5A (rs11708996). Furthermore, the common variants of SCN10A and HEY2/NCOA7 related to cardiac depolarization or repolarization may also contribute to the development of BrS.

Acknowledgement/Funding

NTUH 106-S3469, NTUH106-S3458 and NTUH 106-018

[Detection and Analysis of the peripheral lymphocytes micronucleus rate of radiation workers in a city]

Objective: To perform lymphocyte micronucleus analysis on radiation workers with long-term exposure to low doses ionizing radiation, Evaluate the health condition of radiation workers, and provide the evidence for strengthening surveillance of radiation workers. Methods: From January 1, 2013 to December 21, 2016, a statistical analysis and evaluation was conducted of the peripheral lymphocytes micronucleus rate in 5 901 radiation workers who had undergone medical examinations of employees at Chinese Academy of Medical Sciences Institute of Radiation Medicine. Results: The micronucleus rates in radiation workers of the on-job group were higher than the pre-job group (P<0.01) . Significant difference was found among the different sex (t=5.97) , different types (χ(2)=378.69) , different levels of work units (χ(2)=115.48) . Significant difference was found among the micronucleus rates of 672 radiation workers of the on-job group from 2013 to 2016 (χ(2)=92.57, P<0.01) . Conclusion: The peripheral lymphocytes micronucleus rate of radiation workers were significantly higher than non-contact workers. Significant increasing trend of micronucleus rates was noted among the radiation worker with increasing exposure time. The peripheral lymphocytes micronucleus rates of interventional therapy workers were highest. The peripheral lymphocytes micronucleus rates of Private hospitals workers were highest. This phenomenon deserves attention. Protection needs to be strengthened to ensure the health of radiation workers.

Genetic analyses of Xianbei populations about 1,500-1,800 years old

To understand the profile of genetic structure of Xianbei and trace its impacts on the formation and development of the minorities from northern China, we analyzed the sequences of the hypervariable segment I (HVS-I, 16.035-16.398) in mtDNA control region of 17 Tuoba Xianbei remains from Shangdu Dongdajing cemetery (Inner Mongolia). Its haplotype diversity and nucleotide diversity were 0.971 ± 0.032 and 0.0184 ± 0.010, respectively, and the haplogroup status presented 29.5% C, 23.5% D4, 17.6% D5, 17.6% A, 5.9% B and 5.9% G. When the data from Qilang Mountain Tuoba remains and other relevant populations were considered, we found that Dongdajing Tuoba Xianbei presented the closest genetic affinity to Qilang Mountain Tuoba Xianbei. Tuoba Xianbei and Murong Xianbei showed a significant differentiation in the maternal lineages. Tuoba Xianbei may contribute to the gene pool of some northern minorities, and it may mix with Xiongnu in northern China.

Adenovirus-mediated siRNA targeting TNF-α and overexpression of bone morphogenetic protein-2 promotes early osteoblast differentiation on a cell model of Ti particle-induced inflammatory response in vitro

Wear particles are phagocytosed by macrophages and other inflammatory cells, resulting in cellular activation and release of proinflammatory factors, which cause periprosthetic osteolysis and subsequent aseptic loosening, the most common causes of total joint arthroplasty failure. During this pathological process, tumor necrosis factor-alpha (TNF-α) plays an important role in wear-particle-induced osteolysis. In this study, recombination adenovirus (Ad) vectors carrying both target genes [TNF-α small interfering RNA (TNF-α-siRNA) and bone morphogenetic protein 2 (BMP-2)] were synthesized and transfected into RAW264.7 macrophages and pro-osteoblastic MC3T3-E1 cells, respectively. The target gene BMP-2, expressed on pro-osteoblastic MC3T3-E1 cells and silenced by the TNF-α gene on cells, was treated with titanium (Ti) particles that were assessed by real-time PCR and Western blot. We showed that recombinant adenovirus (Ad-siTNFα-BMP-2) can induce osteoblast differentiation when treated with conditioned medium (CM) containing RAW264.7 macrophages challenged with a combination of Ti particles and Ad-siTNFα-BMP-2 (Ti-ad CM) assessed by alkaline phosphatase activity. The receptor activator of nuclear factor-κB ligand was downregulated in pro-osteoblastic MC3T3-E1 cells treated with Ti-ad CM in comparison with conditioned medium of RAW264.7 macrophages challenged with Ti particles (Ti CM). We suggest that Ad-siTNFα-BMP-2 induced osteoblast differentiation and inhibited osteoclastogenesis on a cell model of a Ti particle-induced inflammatory response, which may provide a novel approach for the treatment of periprosthetic osteolysis.

Effects of Os inserted layers on the microstructures and magnetic properties of the FePt films

The microstructure and magnetic properties of multilayer [Os(t)/FePt(x)]n films on a glass substrate with a 10 nm Os buffer layer by ion beam sputtering have been studied as a function of the annealing temperatures between 300 and 800 degrees C. Here, t = 0.2, 1 or 5 nm and x varied from 10, 20, 25, 50, to 100 nm with its associated n value of 10, 5, 4, 2, and 1, respectively. No diffusion evidence was found in samples with a thin Os layer and t > or = 1 nm. The average grain size of the multilayer films can be well controlled by both annealing temperature and thickness of the FePt layer by a very thin Os space layer with t > or = 1 nm. The enhancement of H(c) can be understood from the fact that for a FePt film with an Os spacer layers, the increasing number of Os layer will inhibit the grain growth of FePt grains and enriches the grain boundary. We have experimentally demonstrated that even with a very thin 1 nm Os spacer layers, the [Os(t)/FePt(x)]n multilayer films can exhibit good hard magnetic properties and are attractive candidates for ultrahigh density magnetic recording media.

Mandible changes evaluated by computed tomography following Botulinum Toxin A injections in square-faced patients

BACKGROUND

A facial contour that is oval is more pleasing in Asian women. Patients with a square face often seek facial contouring procedures to improve their appearance. Treatment often involves various combinations of Botulinum NeuroToxin A (BoNTA) injections into the masseters and/or mandibular angle resection. Many physicians claim that muscle paralysis with injections alone will decrease pulling on the underlying bone and also treat underlying bony flaring when present. Muscular changes after BoNTA injections have been well documented. However, the effect of BoNTA injections on the underlying mandibular bone morphology has not been studied to the best of the authors' knowledge. The goal of this study was to determine whether there are mandibular changes after masseter injection with botulinum toxin.

METHODS

In this retrospective study of ten female patients seeking treatment for a square face, three-dimensional CT scans were taken before and 3 months after standardized BoNTA injections in bilateral masseters. Mandibular cortex thickness, mandibular bone thickness, and mandibular volume were measured.

RESULTS

Soft-tissue changes were observed but no bony changes were observed 3 months after injections.

CONCLUSIONS

In this study of adult patients, there were no statistically significant mandibular changes 3 months after BoNTA injection. The current theory of mandibular flaring resolution after partial muscle paralysis is not supported by our findings. Therefore, a patient presenting both masseteric hypertrophy and bony flaring will most likely require a combined muscular and bony procedure.

Light extraction efficiency enhancement of GaN-based light emitting diodes on n-GaN layer using a SiO2 photonic quasi-crystal overgrowth

In this paper, GaN-based LEDs with a SiO2 photonic quasi-crystal (PQC) pattern on an n-GaN layer by nano-imprint lithography (NIL) are fabricated and investigated. At a driving current of 20 mA on Transistor Outline (TO)-can package, the better light output power of LED III (d = 1.2 microm) was enhanced by a factor of 1.20. After 1000 h life test (55 degrees C/50 mA) condition, Normalized output power of LED with a SiO2 PQC pattern (LED III (d = 1.2 microm)) on an n-GaN layer only decreased by 5%. This results offer promising potential to enhance the light output power of commercial light-emitting devices using the technique of nano-imprint lithography.

Using autocloning effects to develop broad-bandwidth, omnidirectional antireflection structures for silicon solar cells

In this study, we used the autocloning effect on pyramid structures to develop broad-bandwidth, omnidirectional antireflection structures for silicon solar cells. The angular dependence of reflectance on several pyramid structures was systematically investigated. The deposition of three-layer autocloned films reduced the refractive index gap between air and silicon, resulting in an increase in the amount of transmitted light and a decrease in the total light escaping. The average reflectance decreased dramatically to ca. 2-3% at incident angles from 0 to 60° for both sub-wavelength- and micrometer-scale pyramid structures. The measured reflectance of the autocloned structure was less than 4% in the wavelength range from 400 to 1000 nm for incident angles from 0 to 60°. Therefore, the autocloning technique, combined with optical thin films and optical gradient structures, is a practical and compatible method for the fabrication of broad-bandwidth, omnidirectional antireflection structures on silicon solar cells.

Electron emissions in InAs quantum dots containing a nitrogen incorporation induced defect state: the influence of thermal annealing

With the incorporation of nitrogen (N) into InAs quantum dots (QDs), the carrier distribution near the QD displays electron emissions from a localized N-induced defect state at 0.34 eV and a weak emission at 0.15 eV from the QD. This defect state causes drastic carrier depletion in the neighboring GaAs bottom layer near the QD, which can effectively suppress tunneling emission for the QD excited states. As a result, electrons escape from the QD ground state through thermal emission to near the GaAs conduction band, rather than through thermal emission to the QD first excited state and a subsequent tunneling to the GaAs conduction band, as observed in InAs QDs without N incorporation. Thermal annealing can weaken the defect emission and enhance the QD emission, suggesting a removal of the defect state and a recovery of carriers in the QD. Increasing annealing temperature can significantly decrease the emission time and energy of the QD emission, which is explained by a weakening of tunneling suppression due to the removal of the defect state.

Enhanced light output from a nitride-based power chip of green light-emitting diodes with nano-rough surface using nanoimprint lithography

Enhanced light extraction from a GaN-based power chip (PC) of green light-emitting diodes (LEDs) with a rough p-GaN surface using nanoimprint lithography is presented. At a driving current of 350 mA and with a chip size of 1 mm × 1 mm packaged on transistor outline (TO)-cans, the light output power of the green PC LEDs with nano-rough p-GaN surface is enhanced by 48% when compared with the same device without a rough p-GaN surface. In addition, by examining the radiation patterns, the green PC LED with nano-rough p-GaN surface shows stronger light extraction with a wider view angle. These results offer promising potential to enhance the light output powers of commercial light-emitting devices by using the technique of nanoimprint lithography under suitable nanopattern design.

Survey of computed tomography scanners in Taiwan: Dose descriptors, dose guidance levels, and effective doses

The IAEA and the ICRP recommended dose guidance levels for the most frequent computed tomography (CT) examinations to promote strategies for the optimization of radiation dose to CT patients. A national survey, including on-site measurements and questionnaires, was conducted in Taiwan in order to establish dose guidance levels and evaluate effective doses for CT. The beam quality and output and the phantom doses were measured for nine representative CT scanners. Questionnaire forms were completed by respondents from facilities of 146 CT scanners out of 285 total scanners. Information on patient, procedure, scanner, and technique for the head and body examinations was provided. The weighted computed tomography dose index (CTDI(w)), the dose length product (DLP), organ doses and effective dose were calculated using measured data, questionnaire information and Monte Carlo simulation results. A cost-effective analysis was applied to derive the dose guidance levels on CTDI(w) and DLP for several CT examinations. The mean effective dose +/- standard deviation distributes from 1.6 +/- 0.9 mSv for the routine head examination to 13 +/- 11 mSv for the examination of liver, spleen, and pancreas. The surveyed results and the dose guidance levels were provided to the national authorities to develop quality control standards and protocols for CT examinations.

Protein phosphatase inhibitor cantharidin inhibits steroidogenesis and steroidogenic acute regulatory protein expression in cultured rat preovulatory follicles

The effect of cantharidin, a natural toxicant of blister beetles and a strong inhibitor of protein phosphatases types 1 and 2A, on luteinizing hormone (LH)-induced synthesis of steroidogenic acute regulatory (StAR) protein was studied in a serum-free culture of preovulatory follicles. StAR protein is a steroidogenic tissue-specific, hormone-induced, rapidly synthesized protein previously shown to be involved in the acute regulation of steroidogenesis, probably by promoting the transfer of cholesterol to the inner mitochondrial membrane and the cytochrome P450 side-chain cleavage (P450scc) enzyme. Treatment of preovulatory follicles dissected from ovaries of immature rats primed with pregnant mares' serum gonadotropin (10 IU) with LH for 24 h resulted in a dose-dependent increase in the level of StAR protein that reached a maximum at 100 ng LH/ml. This increase was associated with an increase in progesterone production. Treatment of follicles with increasing concentrations (10 - 1000 ng/ml) of cantharidin suppresssed LH (100 ng/ml)-induced StAR protein levels and progesterone production in a dose-dependent manner. The amount of P450scc protein and the conversion of 22R-hydroxycholesterol to progesterone were not affected by cantharidin. This indicates that cantharidin did not interfere with the activity of P450scc. Cantharidin also decreased StAR protein levels and progesterone production induced by the adenylate cyclase activator forskolin (10(-5) M) or a cAMP analog 8-Br-cAMP (0.5 mM). These results demonstrate that cantharidin inhibits the LH-induced StAR protein levels, and, thus, suggest that phosphoprotein phosphatase activity is required for the cAMP-protein kinase A-stimulated steroidogenic activity of the preovulatory follicle.

Comparison of speech results after Furlow palatoplasty and von Langenbeck palatoplasty in incomplete cleft of the secondary palate

BACKGROUND

Due to many confounding factors, it is not easy to answer which method of cleft repair is superior to others. The purpose of this study is to try to compare the treatment result of different types of palatoplasty in patients who had the same cleft type and same treatment protocol besides the method of cleft repair. We selected nonsyndromic patients with incomplete cleft of the secondary palate. The speech results after the two palatoplasties were compared.

METHODS

Ninety-six children with nonsyndromic incomplete clefts of the secondary palate who received palatoplasty at the Craniofacial Center of Chang Gung Memorial Hospital from 1989 to 1997 were studied. Forty-six patients received Furlow palatoplasty and 50 patients received von Langenbeck palatoplasty. Velopharyngeal function was evaluated by speech pathologists periodically after the patient was two and half years old. Adequacy of velopharyngeal function was used as a measurement of speech outcome.

RESULTS

The Furlow palatoplasty group showed excellent results with 98% (45/46) adequacy in velopharyngeal function. In the von Langenbeck palatoplasty group, only 70% (35/50) of the patients had adequate velopharyngeal function. Statistical analysis with Fisher's exact test showed a significant difference (p < 0.0001, p < 0.05). Only one patient had an oronasal fistula after Furlow palatoplasty. After von Langenbeck palatoplasty, one patient had an oronasal fistula and one had wound dehiscence.

CONCLUSION

In this study, there was a better speech outcome after Furlow palatoplasty than von Langenbeck palatoplasty for repair of incomplete cleft of the secondary palate. Also, the number of complications after a Furlow palatoplasty was low. It should be a recommended treatment.

Dexamethasone enhances follicle stimulating hormone-induced P450scc mRNA expression and progesterone production in pig granulosa cells

The effect of dexamethasone on follicle-stimulating hormone (FSH)-stimulated expression of cholesterol side-chain cleavage (P450scc) enzyme and production of progesterone by ovarian granulosa cells was studied in vitro. Granulosa cells from 3- to 5-mm pig antral follicles were cultured for 48 h in the presence or absence of FSH and/or dexamethasone. Treatment with FSH resulted in a dose-dependent increase in the level of P450scc mRNA that reached a submaximum at 100 ng FSH/ml. This increase was associated with an increase in progesterone production. Treatment of the cells with increasing concentrations (10(-9)-10(-6) M) of dexamethasone for 48 h increased constitutive and potentiated FSH-stimulated P450scc mRNA levels and progesterone production in a dose-dependent manner. Increasing duration (12-48 h) of treatment with dexamethasone (100 nM) led to a time-dependent increase in basal and FSH-stimulated progesteorne production, achieving statistical significance by 48 and 24 h, respectively. Dexamethasone also increased P450scc mRNA level and progesterone production induced by the adenylate cyclase activator forskolin (10 microM) or a cAMP analog 8-Br-cAMP (1 mM). The effects of dexamethasone on FSH-induced progesterone production were blocked by cotreatment of the cells with glucocorticoid receptor antagonist RU-486. These results demonstrate that dexamethasone potentiates FSH actions on steroidoogenesis in the pig ovary. Possible mechanisms for this potentiation include the ability of dexamethasone to stimulate P450scc gene expression.

Comparison of protein loaded poly(epsilon-caprolactone) microparticles prepared by the hot-melt technique

This study was systematically designed to compare bovine serum albumin (BSA) loaded poly(epsilon-caprolactone) (PCL) microparticles based on a 2(3) factorial experiment. The microparticles were prepared by the holt-melt technique without using an organic solvent for polymer solubilization. The influence of the particle size of protein, protein/polymer ratio, and hydrophilic PEG on the surface morphology, particle size as well as the yield of PCL microparticles, encapsulation efficiency of BSA, and in vitro release properties were investigated. The structure of BSA remained its integrity using this technique. The mean particle size of BSA-loaded microparticles were in the range of 12.7 +/- 0.1-16.9 +/- 0.8 microm, and all of the particles were smooth on the surface. The production yield of microparticles and the encapsulation efficiencies were high, and the values were in the range of 94.8 +/- 1.6%-98.1 +/- 1.0% and 94.9 +/- 9.6%-98.6 + 0.3%, respectively. The burst release of BSA was in the range of 8.2 +/- 0.4%-61.0 +/- 0.8%, which strongly depended on the formulation. None of three variables affected the yield of microparticles prepared from eight formulations (p > 0.05). However, the particle size of BSA significantly affected the size and the burst release as well as the cumulative release of protein in these microparticles (p < 0.05). The initial loading of BSA in terms of BSA/PCL ratio and the amount of PEG blended with PCL significantly affected all of the properties, except the yield (p < 0.05). The smaller the particle size of the BSA, the smaller the size of the resulting microparticles. Since the total surface area of the small particles was larger than that of the large particles, this accounted for the high burst release of protein from the microparticles encapsulating triturated-BSA.

Dual effect of the antianginal drug fendiline on bladder female transitional carcinoma cells: mobilization of intracellular CA2+ and induction of cell death

The effect of fendiline, an antianginal drug, on cytosolic free Ca2+ levels ([Ca2+]i) in populations of bladder female transitional carcinoma (BFTC) cells was explored using fura-2 as a Ca2+ indicator. Fendiline at concentrations between 3 and 200 micromol/l increased [Ca2+]i in a concentration-dependent manner and the signal saturated at 100 micromol/l. The [Ca2+]i signal was biphasic, with an initial rise and a slow decay. Ca2+ removal inhibited the Ca2+ signal by about half in peak amplitude. Adding 3 mmol/l Ca2+ increased [Ca2+]i in cells pretreated with 100 micromol/l fendiline in Ca2+ -free medium, suggesting that fendiline induced Ca2+ influx via capacitative Ca2+ entry. In Ca2+ -free medium, pretreatment with 1 micromol/l thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor) to deplete the endoplasmic reticulum Ca2+ store inhibited most of the 100 micromol/l fendiline-induced internal Ca2+ release; and conversely, pretreatment with 100 micromol/l fendiline partly inhibited 1 micromol/l thapsigargin-induced Ca2+ release. This indicates that the major internal Ca2+ store of fendiline-induced [Ca2+]i increases is located in the endoplasmic reticulum. The Ca2+ release induced by 100 micromol/l fendiline may be partly mediated by inositol 1,4,5-trisphosphate, because the [Ca2+]i increase was inhibited by 50% by inhibiting phospholipase C with 2 micromol/l U73122. Fendiline (100 micromol/l) decreased cell viability by 12-44% after being added to cells for 2- 30 min. Together, the findings indicate that in BFTC cells, fendiline exerts a dual effect: mobilization of intracellular Ca2+ and induction of cell death.

Fendiline, an anti-anginal drug, increases intracellular Ca2+ in PC3 human prostate cancer cells

BACKGROUND

The effects of the anti-anginal drug fendiline on intracellular Ca2+ concentrations ([Ca2+]i) in human PC3 prostate cancer cells were examined.

METHODS

[Ca2+]i was measured using the fluorescent dye fura-2.

RESULTS

Fendiline (0.5-100 microM) increased [Ca2+]i in a concentration-dependent manner. Ca2+ removal partly inhibited the Ca2+ signals. In Ca2+-free medium, pretreatment with 100 microM fendiline inhibited most of the [Ca2+]i increase induced by 1 microM thapsigargin (an endoplasmic reticulum Ca2+ pump inhibitor), and pretreatment with thapsigargin abolished the fendiline-induced [Ca2+]i increases. Adding 3 mM Ca2+ increased [Ca2+]i in cells pretreated with 0.5-200 microM fendiline in Ca2+-free medium. Pretreatment with 1 microM U73122 to block the formation of inositol-1.4.5-trisphosphate (IP3) did not alter fendiline-induced internal Ca2+ release.

CONCLUSIONS

The anti-anginal drug fendiline induced internal Ca2+ release and external Ca2+ entry. Because prolonged increases in [Ca2+]i may lead to cell injury and death, the long-term effect of fendiline on the function of prostate cancer cells should be investigated.

Lead chelation therapy and urate excretion in patients with chronic renal diseases and gout

BACKGROUND

It is known that chronic renal insufficiency (CRI) patients with gout may have subtle lead poisoning. In addition, gout episodes frequently aggravate progressive renal insufficiency because of the use of nephrotoxic drugs and urate deposition. Our study was arranged to evaluate the causal effect of environmental lead exposure on urate excretion in CRI patients.

METHODS

A cross-section study and a randomized, controlled trial were performed. Initially, 101 patients with CRI and without a history of previous lead exposure received ethylenediaminetetraacetic acid mobilization tests to assess body lead stores (BLS). Then, a clinical trial was performed; 30 CRI patients with gout and high-normal BLS and the changes of urate excretion in these patients were compared before and after lead chelating therapy. The treated group received four-week chelating therapy, and the control group received a placebo therapy.

RESULTS

The BLS of patients with CRI and gout was higher than that of patients with CRI only, and none had subtle lead poisoning. The BLS, not the blood lead level (BLL), significantly correlated to indices of urate excretion in all CRI patients after related factors were adjusted. In addition, after lead chelating therapy, urate clearance markedly improved after a reduction of the BLS of patients with CRI and gout (study group 67.9 +/- 80.0% vs. control group 1.2 +/- 34.0%, P = 0.0056).

CONCLUSION

Our findings suggest that the chronic low-level environmental lead exposure may interfere with urate excretion of CRI patients. Importantly, the inhibition of urate excretion can be markedly improved by lead chelating therapies. These data shed light on additional treatment of CRI patients with gout; however, more studies are needed to confirm our findings.

Mycophenolate mofetil reduces renal cortical inducible nitric oxide synthase mRNA expression and diminishes glomerulosclerosis in MRL/lpr mice

Overexpression of inducible nitric oxide synthase (iNOS) has been implicated in the pathogenesis of lupus glomerulonephritis. Mycophenolate mofetil (MMF), a novel immunosuppressive agent, is currently used in organ transplantation and under evaluation for treatment of autoimmune disorders. Mycophenolic acid, the active metabolite of MMF, has been shown to suppress cytokine-induced nitric oxide production in vitro. The aim of this study was to evaluate the effect of MMF on the expression of renal cortical iNOS mRNA and protection against glomerulonephritis in MRL/lpr mice. Three-month-old MRL/lpr mice (n = 6) displaying clinical symptoms of glomerulonephritis were treated for 3 months with MMF (90 mg/kg/day) dissolved in a vehicle. Controls were age- and sex-matched mice (n = 6) that received the vehicle alone. By reverse-transcription competitive polymerase chain reaction, we found that the renal cortical iNOS/beta-actin mRNA ratio was reduced by 30.8% (P <.05) in MMF-treated mice. Furthermore, MMF significantly reduced urinary nitrite production and degree of glomerulosclerosis. The glomerular volume was reduced by 17.5% (P <.001). Proteinuria was also significantly reduced in the MMF-treated group. However, by electrophoretic mobility shift assay, the nuclear binding of nuclear factor-kappaB (NF-kappaB) was not affected by MMF treatment. We conclude that in addition to its immunosuppressive action, MMF may reduce renal cortical iNOS mRNA expression and diminish glomerulosclerosis in MRL/lpr mice independent of modulation of the NF-kappaB pathway.

In vivo pressure-flow curve in unilateral rat lung ischemia-reperfusion injury

The pressure-flow (P-Q) curve has been widely used in many studies to describe the effects of various factors on vascular hemodynamics. It is not clear, however, whether unilateral ischemia-reperfusion (IR) alters the P-Q curve of the rat lung. In this study, we developed an in vivo P-Q curve using the unilateral (left) rat lung before and after IR. Animals were divided into two groups: sham and IR. The protocol of the IR group consisted of three periods: baseline, ischemia, and reperfusion. P-Q curves were obtained by altering blood flow of the left lung during the baseline and the reperfusion periods. The sham group received the same operation without IR procedure. An additional group was used to compare pulmonary blood flow measured by the microsphere and the ultrasonic methods. IR treatment rotated the P-Q curve toward the left, indicating an increase in resistance in the left lung. However, this rotation was not found in the sham group. A significant correlation (r = 0.87, P < 0.01) between percentages of blood flow obtained by the microsphere and ultrasonic methods in both right and left lungs was demonstrated. Therefore, we demonstrated a simple and useful technique to evaluate changes in the P-Q curves caused by IR in the unilateral rat lung model.