Telephone assistance for smoking cessation: one year cost effectiveness estimations

A randomised trial evaluated the American Cancer Society's telephone counselling service to assist smoking cessation. Counselling nearly doubles a smokers' odds of quitting and maintaining cessation for one year. The estimated cost for each case of maintained smoking cessation attributable to counselling availability is approximately 1300 dollars.

Water in nanopores. I. Coexistence curves from Gibbs ensemble Monte Carlo simulations

Coexistence curves of water in cylindrical and slitlike nanopores of different size and water-substrate interaction strength were simulated in the Gibbs ensemble. The two-phase coexistence regions cover a wide range of pore filling level and temperature, including ambient temperature. Five different kinds of two-phase coexistence are observed. A single liquid-vapor coexistence is observed in hydrophobic and moderately hydrophilic pores. Surface transitions split from the main liquid-vapor coexistence region, when the water-substrate interaction becomes comparable or stronger than the water-water pair interaction. In this case prewetting, one and two layering transitions were observed. The critical temperature of the first layering transition decreases with strengthening water-substrate interaction towards the critical temperature expected for two-dimensional systems and is not sensitive to the variation of pore size and shape. Liquid-vapor phase transition in a pore with a wall which is already covered with two water layers is most typical for hydrophilic pores. The critical temperature of this transition is very sensitive to the pore size, in contrast to the liquid-vapor critical temperature in hydrophobic pores. The observed rich phase behavior of water in pores evidences that the knowledge of coexistence curves is of crucial importance for the analysis of experimental results and a prerequiste of meaningful simulations.

Phase coexistence and dynamic properties of water in nanopores

The dynamical properties of a confined fluid depend strongly on the (spatially varying) density. Its knowledge is therefore an important prerequisite for molecular-dynamics (MD) simulations and the analysis of experimental data. In a mixed Gibbs ensemble Monte Carlo (GEMC)/MD simulation approach we first apply the GEMC method to find possible phase states of water in hydrophilic and hydrophobic nanopores. The obtained phase diagrams evidence that a two-phase state is the most probable state of a fluid in incompletely filled pores in a wide range of temperature and level of pore filling. Pronounced variations of the average and local densities are observed. Subsequently, we apply constant-volume MD simulations to obtain water diffusion coefficients and to study their spatial variation along the pore radius. In general, water diffusivity slightly decreases in a hydrophilic pore and noticeably increases in a hydrophobic pore (up to about 40% with respect to the bulk value). In the range of gradual density variations the local diffusivity essentially follows the inverse density and the water binding energy. The diffusivity in the quasi-two-dimensional water layers near the hydrophilic wall decreases by 10 to 20% with respect to the bulk value. The average diffusivity of water in incompletely filled pore is discussed on the basis of the water diffusivities in the coexisting phases.

Definition of risk factors for death, end stage renal disease, and thromboembolic events in a monocentric cohort of 338 patients with systemic lupus erythematosus

BACKGROUND

The survival rate in patients with systemic lupus erythematosus (SLE) has improved dramatically during the past four decades to 96.6% (five year) in the Erlangen cohort, but it is nearly three times as high as in an age and sex matched control population. Reasons for death are mainly cardiovascular diseases (37%) and infections (29%).

OBJECTIVE

To find risk factors existing at disease onset for a severe outcome in the Erlangen cohort.

PATIENTS AND METHODS

By using a database of 338 patients with SLE from a single centre, documented at least one to 15 years and including Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage score data and index (SDI) and an activity score (European Consensus Lupus Activity Measurement (ECLAM)), a retrospective search was made for risk factors for a severe outcome like death, end stage renal disease (ESRD), and thromboembolic events (TE) in SLE. For this purpose, multivariable Cox regression models were analysed using the statistical package SPSS 10.0 for Windows.

RESULTS

The following were defined as risk factors for death at disease onset: male sex (p<0.001, relative risk (RR)=3.5), age >40 at disease onset (p<0.0001, RR=19.9), nephritis (p<0.05, RR=1.6), a reduction of creatinine clearance (p<0.001, RR=1.8), heart disease (p=0.05, RR=1.5), and central nervous system (CNS) disease (p=0.06, RR=1.6). An increase in the SDI of two or more points from the first to the third year of disease was the worst prognostic factor (p<0.0001, RR=7.7). The existence of Ro or nRNP antibodies, or both, was protective (p<0.05, RR =0.1). A low C3 (p<0.01 RR=3.0) and splenomegaly (p<0.01 RR=2.7) at disease onset turned out to be risk factors for ESRD besides a nephritis. In patients with hypertension (p<0.05) and/or high titres of dsDNA antibodies (>70 U/l) (p<0.01) and/or a mean ECLAM score of 4 (p<0.01) in the course of disease, a prevalence of ESRD was recorded in 9% (p<0.05) and 10% (p<0.01), and 8% (p<0.01) v 4% in the whole group. Analysis of risk factors at disease onset for TE identified positive lupus anticoagulant (p=0.17, RR=1.6), cryoglobulins (p<0.05, RR=1.8), and nephritis (p=0.05, RR=1.4), in addition to an age >40 at disease onset.

CONCLUSIONS

A subgroup of patients in the Erlangen cohort with a typical clinical and serological phenotype at disease onset that is at high risk for a worse outcome was identified. Identification of these white patients at risk at disease onset will enable treatment to be intensified and thereby possibly prevent or better control late stage manifestations.

Role of the Sp family of transcription factors on glucagon receptor gene expression

The glucagon receptor mediates the actions of glucagon on carbohydrate metabolism by the liver and on insulin release by the pancreatic beta-cell, which are key processes in the control of glucose homeostasis. The 5'-region of the mouse glucagon receptor gene has been recently cloned and two functional promoters were characterized. In the present study, we show that most of the glucagon receptor mRNA was transcribed from the distal promoter, in the mouse liver. In the distal promoter region, a GC-rich sequence with five putative binding sites for the Sp family of transcription factors was localized. To elucidate the role of these Sp1-binding sites in the mouse MIN6 beta-cell line, the expression of reporter gene constructs containing deletion or point mutation of each site was carried out. Selective mutation of the second Sp1-binding site decreased the activity of the distal promoter. Electrophoretic mobility shift assay with a DNA fragment spanning the three first Sp1 sites confirmed that the second site bound specifically MIN6 nuclear proteins, and supershift using specific Sp antibodies demonstrated that it interacted with Sp3 but not Sp1 transcription factors. These data illustrate that the basal expression of the mouse glucagon receptor gene, driven by the distal promoter, requires an Sp1-binding site that binds Sp3 proteins.

Characterization of an enhancer element in the proximal promoter of the mouse glucagon receptor gene

The 5'-flanking region of the mouse glucagon receptor has been previously cloned and two promoter regions were characterized. Functional analysis of the proximal promoter was now performed to characterize cis-acting element(s) regulating basal gene expression. Promoter analysis using deletion constructs in a rat cell line (CA-77) expressing the glucagon receptor, showed that the region from -64 to +127 relative to the proximal transcription start site was sufficient for maximal proximal promoter activity. A DNA sequence spanning the -28 to -16 region organized as an imperfect palindrome was demonstrated to be functional as a cis-acting enhancer. Constructs including several copies of this motif strongly increased activity of the heterologous thymidine kinase promoter. Gel mobility shift assays performed with different DNA fragments spanning this region confirmed that it specifically bound nuclear protein(s) from CA-77 cells, mouse MIN-6 cells or mouse liver. Mutations in the core sequence of this site impaired both reporter gene activity and nuclear protein binding. The palindrome is a novel DNA sequence with no homology to existing transcription factor binding site database. This is the first characterization of a functional cis-acting sequence into the proximal promoter of the mouse glucagon receptor that may support constitutive expression of the gene.

Inhibition of protein synthesis by didemnins: cell potency and SAR

Synthetic and naturally occurring didemnins are potent and specific inhibitors of protein synthesis in vitro. Structure-activity analysis indicates a requirement for the intact macrocycle; however, the smaller ring size represented by the didemnin analogue, tamandarin A, is equipotent to didemnin B. Replacement of the N,O-dimethyltyrosine by a N-methylphenylalanine or N-methylleucine residue is also well-tolerated. The rank order for inhibition of protein synthesis in vitro appears to be retained in MCF-7 cells, albeit at much higher potency. This increase in potency is explained for the first time by data indicating that MCF-7 cells can accumulate didemnin B up to 2-3 orders of magnitude compared to the growth medium.

Concept of and preliminary trial protocol for adjuvant treatment of mediastinitis with immunoglobulins after cardiac surgery (ATMI): response to comments and criticism

During the consensus-based process of protocol development external experts were invited to comment on a proposal for a trial protocol on adjuvant immunotreatment of patients with wound infection after median sternotomy (ATMI). Controversies and arguments can be divided into five main areas: 1) rationale and objectives; 2) criteria for patient selection; 3) adjuvant treatment; 4) measures of efficacy; and 5) course and timetable of the study. We present and summarise the experts comments and criticism as well as the result of the final discussion of the study group with respect to these areas.

Voids in the H-bonded network of water and their manifestation in the structure factor

The main peak of the oxygen-oxygen structure factor S(OO)(Q) of liquid water shows an unusual doublet structure. The low-Q feature of the doublet shifts appreciably with pressure, between limits which correspond to the position of the first peak in the low- and high-density forms of amorphous ice. This pressure dependence has been cited as evidence of polyamorphism in water. It is shown that this feature is analogous to the "prepeak," or "first-sharp-diffraction peak" which is well known in network-forming ionic liquids, like SiO2, and that its position is determined by the nearest-neighbor separation of voids in the spatial distribution of oxygen atoms.

Structural and functional characterizations of the 5'-flanking region of the mouse glucagon receptor gene: comparison with the rat gene

A putative proximal promoter was defined previously for the mouse glucagon receptor (GR) gene. In the present study, a distal promoter was characterized upstream from a novel non-coding exon revealed by the 5'-rapid amplification of cDNA ends from mouse liver tissue. The 5'-flanking region of the mouse GR gene was cloned up to 6 kb and the structural organization was compared to the 5' untranslated region of the rat gene cloned up to 7 kb. The novel exon, separated by an intron of 3.8 kb from the first coding exon, displayed a high homology (80%) with the most distal of the two untranslated exons found in the 5' region of the rat GR gene. The mouse distal promoter region, extending up to -1 kb from the novel exon, displayed 85% identity with the rat promoter. Both contain a highly GC-rich sequence with five putative binding sites for Sp1, but no consensus TATA or CAAT elements. To evaluate basal promoter activities, 5'-flanking sequences of mouse or rat GR genes were fused to a luciferase reporter gene and transiently expressed in a mouse and in a rat cell line, respectively or in rat hepatocytes. Both mouse and rat distal promoter regions directed a high level of reporter gene activity. Deletion of the Sp1 binding sites region or mutation of the second proximal Sp1 sequence markedly reduced the distal promoter activity of the reporter gene. The mouse proximal promoter activity was 2- to 3-fold less than the distal promoter, for which no functional counterpart was observed in the similar region of the rat gene.

Palliative treatment of a secondary aortoduodenal fistula by stent-graft placement

A 64-year-old male was admitted with suspected aortoduodenal fistula 16 years after transabdominal aortic reconstruction for aortoiliac occlusive disease. Computed tomography (CT) and angiography revealed an aortoduodenal fistula and a suture-line aneurysm at the proximal anastomosis. Due to the patient's poor general condition at the time of diagnosis, endoluminal stent-graft implantation was chosen rather than conventional surgery. Successful placement of the stent graft without leakage of contrast medium and with complete exclusion of the fistula was demonstrated by CT. The patient recovered uneventfully and was discharged 10 days after the intervention. Five months later contrast CT indicated a recurrence of the aortoduodenal fistula. Since the patient was now in good general condition the stent graft was removed surgically and an extra-anatomic axillofemoral bypass was implanted. Endoluminal stent-graft Implantation is effective as palliative therapy for aortoduodenal fistulas and is especially valuable in patients with high risk for conventional surgery.

Effects of venlafaxine on extracellular concentrations of 5-HT and noradrenaline in the rat frontal cortex: augmentation via 5-HT1A receptor antagonism

Venlafaxine is a novel serotonin/noradrenaline reuptake inhibitor (SNRI) which has been shown clinically to be an effective antidepressant (AD) with a faster onset of action than serotonin specific reuptake inhibitors (SSRI). Preclinically, venlafaxine has been shown to potently inhibit dorsal raphe neuronal (DRN) firing through a 5-HT1A mediated mechanism, in a similar manner to SSRIs. Here we demonstrate the acute neurochemical effects of venlafaxine on extracellular concentrations of 5-HT and noradrenaline (NA) from the rat frontal cortex using in vivo microdialysis. Administration of venlafaxine (3-50 mg/kg s.c.) resulted in a significant dose-dependent increase in extracellular NA, but produced no significant increase in 5-HT concentrations. Combination treatment with the selective 5-HT1A antagonist WAY100635 produced a dose-dependent augmentation of venlafaxine-induced (3-30 mg/kg s.c) extracellular 5-HT concentrations, but had no further effect on NA above that produced by venlafaxine alone. WAY100635, at doses as low as 0.03 mg/kg s.c., maintained this potentiation effect. The beta-adrenergic/5-HT1A receptor antagonist (+/-)pindolol and the selective 5-HT1B/D antagonist GR127935 produced no significant augmentation of venlafaxine-induced changes in either 5-HT or NA. Using the alpha1 and alpha2-adrenoceptor antagonists, prazosin and idazoxane, we also demonstrate the role of the alpha-adrenoceptors in the augmentation of venlafaxine-induced changes. The possible mechanisms underlying venlafaxines improved clinical AD action and the potential for further enhancement of this SNRIs clinical effects are discussed.