'A level-breaking adventure game': A grounded theory study of postgraduate nurses' academic growth trajectory

OBJECTIVE

This study aims to explore the key experiences in the academic growth trajectory of postgraduate nurses.

DESIGN AND METHODS

A qualitative study was designed using Charmaz's constructivist grounded theory. Semi-structured in-depth interviews were conducted, with all sessions being recorded and transcribed verbatim. Data analysis was performed using initial coding, focused coding, and theoretical coding strategies. Additionally, methods such as constant comparison and memo writing were employed. This study adhered to the Standards for Reporting Qualitative Research.

PARTICIPANTS AND SETTING

A total of 14 postgraduate nurses from comprehensive hospitals in eight cities across China participated in this study.

RESULTS

The postgraduate nurses' academic growth resembles the process of completing 'a level-breaking adventure game,' consisting of four stages: incubation, germination, honeymoon, and plateau. Influenced by the personal factors, organizational factors, and social factors, individuals may diverge towards two paths: metamorphosis or burnout.

CONCLUSIONS

The academic growth trajectory of postgraduate nurses is a multi-stage, evolving process. It should begin during the educational phase in nursing school, relying on support from the workplace and society, and driven by the individuality of the postgraduate nurses.

2214Prevalence and severity of coronary disease in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the RICO survey

Aim

Individuals with heterozygous familial hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI). However, coronary artery disease (CAD) burden of FH remains not well described. From a large database of a regional registry of acute MI, we aimed to address prevalence of FH and severity of CAD.

Methods

Consecutive patients hospitalized with MI in a multicentre database from 2001–2017 were considered. An algorithm, adapted from Dutch Lipid Clinic Network criteria, was built upon 4 variables (LDL-cholesterol (LDL-C) and lipid lowering agents, premature and family history of CAD) to identify FH probabilities.

Results

Among the 11624 patients included in the survey, 249 (2.1%) had probable/definite FH (score ≥6), and 2405 (20.7%) had possible FH (score 3–5). When compared with patients without FH (score 0–2), FH patients (score ≥6) were 20y younger (51 (46–57) vs 71 (61–80) y, p<0.001), with a lower rate of hypertension (47 vs 59%, p<0.001), diabetes (17 vs 25%, p<0.001) and prior stroke (4 vs 8%, p=0.016), but a higher prevalence of smokers (56 vs 23%, p<0.001), personal (20 vs 15%, p=0.02) or familial history of CAD (78 vs 18%, p<0.001). Chronic statin treatment was only used in 48% of FH patients and ezetimibe in 8%. After adjustment for age, sex and diabetes, FH patients were characterized by increased extent of CAD (syntax score 11 (4–19) vs 7 (1–13), p<0.001) and multivessel disease (55 vs 40%, p<0.001).

Conclusion

In this large real world population of acute MI, a high prevalence of FH was found. FH patients were characterized by their young age associated with the severity of CAD burden and limited use of preventive lipid lowering therapy.

Acknowledgement/Funding

University Hospital Center Dijon Bourgogne, Agence Régionale de Santé Bourgogne Franche Comté, France

Abstract P1-16-07: Progression-free survival is a surrogate of survival in maintenance therapy for metastatic breast cancer: Randomized trial level analysis

Background:The validity of progression-free survival (PFS) as a surrogate end point for overall survival (OS) in maintenance therapy trials of metastatic breast cancer (MBC) is uncertain. We aimed to compare treatment effect sizes and the strength of associations between OS and PFS in trials of maintenance therapy for MBC.

Methods: We searched for randomized trials investigating maintenance chemotherapy, endocrine therapy or immunotherapy after first-line chemotherapy in MBC and selected those reporting results for both OS and PFS. Treatment effect size differences between OS and PFS by a ratio of hazard ratios (rHRs) with 95% confidence intervals [CIs] were evaluated using random effects analysis. Surrogacy were analyzed using a weighted linear regression model, correlations were evaluated by squared correlation R2.

Results: We analyzed data from 16 trials and 3,898 patients that received maintenance chemotherapy, endocrine therapy or immunotherapy for MBC. In the all trial-level analysis, treatment effect sizes were 28% greater for PFS than for OS (combined rHR, 0.72; 95% CI, 0.62 to 0.85, P &lt; 0.001), and the correlation coefficient R2 between PFS and OS was 18% (95% CI, 12% to 26%). Differences were greater with PFS than OS for trials of maintenance chemotherapy compared with observation (rHR, 0.72; 95% CI, 0.59 to 0.80, P &lt; 0.001), and the correlation coefficient R2between treatment effects on PFS and on OS ranged from 12% (95% CI, 8% to 16%) when all trials were considered to 40% (95%CI, 30% to 54%) after exclusion of one highly influential trial by sensitivity analysis. Differences were also great for trials of maintenance endocrine therapy vs. observation (rHR, 0.54; 95% CI, 0.44 to 0.66), and immunotherapy vs. observation (rHR, 0.85; 95% CI, 0.80 to 0.91).

Conclusion: PFS was greater than OS in the treatment effect sizes, which is a valid surrogate end point for OS to assess treatment effect in MBC maintenance therapy trials.

PROSPERO registry: No. CRD42017071858; Support: ChiCTR-IIR-17014036, SYS-C-201801.

Citation Format: Song E, Yao H, Yu Y, Ou Q, Wang Y. Progression-free survival is a surrogate of survival in maintenance therapy for metastatic breast cancer: Randomized trial level analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-16-07.

Ischemia-induced changes in brain monoamine metabolism in aged spontaneously hypertensive rats

Effects of aging on monoamine metabolism in transient cerebral ischemia were studied using adult and aged female spontaneously hypertensive rats (SHRs). Tissue monoamine contents in discrete brain areas were quantified after 20 min of cerebral ischemia with or without 30-min recirculation. Cerebral blood flow (CBF) was determined with a hydrogen clearance method in separate experiments. Dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC) contents in the striatum, nucleus accumbens and septum decreased in ischemic aged SHRs, compared with those in ischemic adult SHRs. After 30-min recirculation, DA contents were actually unchanged with inconsistently increased DOPAC levels. Ischemic CBF decreased to < 20% of the resting CBF in the striatum and cortex, which was not different between the two age groups of SHRs. These results indicate that aging is primarily responsible for more severely impaired DA metabolism during cerebral ischemia in aged SHRs.

Age-related changes in the DNA and RNA content of the brain in spontaneously hypertensive rats

To elucidate the effects of aging accompanied with hypertension on brain nucleic acid, we measured both the DNA and RNA contents of six specific brain regions in adult (5-6 months old) and aged (18-22 months old) female spontaneously hypertensive rats (SHRs). Although no statistical difference was observed in the RNA content, the DNA content did tend to increase in the hippocampal CA1 of aged SHR (4.24 +/- 0.55 ng/microgram protein, mean +/- SD, n = 6) in comparison to that of adult SHR (3.21 +/- 0.71 ng/microgram protein, n = 4). Hence, aged SHRs showed a significant decrease in the RNA to DNA ratio in the CA1 subfield of the hippocampus (3.79 +/- 0.61) compared to adult SHR (5.27 +/- 0.81). On the other hand, no other regions, except for the dorsolateral region of the striatum, showed any difference in the RNA/DNA ratio between aged and adult SHR. We therefore conclude that subtle changes in the nucleic acid occur in vulnerable regions of the brain in aged SHRs.

[The significance of detecting tumor necrosis factor-alpha and its receptors in serum and pleural effusion in differentiating tuberculosis and malignant pleural effusions]

OBJECTIVE

To investigate the significance of TNF-alpha and its soluble receptors (sTNFR-I and sTNFR-II) in differentiating benign and malignant pleural disease.

METHODS

TNF-alpha and its soluble receptors (sTNFR-I and sTNFR-II) were detected using ELISA method in the serum and pleural effusion of 25 cases of tuberculosis pleural effusion and 28 cases of malignant pleural effusion, and in the serum of 32 cases of normal control.

RESULTS

TNF-alpha level in the serum of tuberculosis patients with pleural effusion is (16.4 +/- 6.2) ng/L, lower than that in the serum of malignant pleural effusion patients (20.5 +/- 10.9) ng/L (P < 0.01), but higher than that in the serum of normal control (11.0 +/- 2.9) ng/L (P < 0.01). TNF-alpha level in the pleural effusion of tuberculosis patients is (29.4 +/- 10.3) ng/L, significantly higher than that of malignant pleural effusion (11.7 +/- 2.0) ng/L (P < 0.01). The sTNFR-I and sTNFR-II level in the serum of malignant pleural effusion is (1,132 +/- 303) ng/L and (1,548 +/- 489) ng/L respectively, significantly higher than that in tuberculosis pleural effusion which is (979 +/- 146) ng/L and (977 +/- 93) ng/L (P < 0.01) respectively. The sTNFR-I and sTNFR-II level in malignant pleural effusion is (1,404 +/- 306) ng/L and (2,195 +/- 418) ng/L respectively, markedly higher than those in tuberculosis pleural effusion which is (1,185 +/- 215) ng/L and (1,195 +/- 300) ng/L (P < 0.01).

CONCLUSION

There are highly elevated TNF-alpha in tuberculosis pleural effusion; The sTNFR-I and sTNFR-II level in the serum and pleural effusion of malignant pleural effusion patients are significantly higher than those in tuberculosis pleural effusion patients, suggesting they may play some role in differentiating benign and malignant pleural diseases.

Amide naphthotube as a novel supramolecular sequestration agent for tetracaine and decamethonium

RATIONALE

Anesthetics are widely used for optimizing surgical conditions, postoperative pain management, and treating various chronic pain conditions. Tetracaine and decamethonium are representative drugs of local anesthetics and neuromuscular blocking agents, respectively. However, overdose and toxicity of the drugs always lead to serious adverse events. Thus, there is a strong demand for effective antidotes.

METHODS

The binding interactions of amide naphthotubes with tetracaine and decamethonium were systematically studied using 1H NMR, ITC, and DFT calculations. The antidotal effects of amide naphthotube to tetracaine toxicity were assessed in vitro and in vivo, and the mechanism of detoxification was explored at a cellular level. Additionally, mouse models were established to evaluate the reversal activities of amide naphthotube on decamethonium-induced mortality and muscle relaxation, and the reversal mechanism was investigated through pharmacokinetic experiments.

RESULTS

We have demonstrated that the anti-isomer of amide naphthotube exhibits significant binding affinities towards tetracaine (K a = 1.89×107 M-1) and decamethonium (K a = 1.01×107 M-1) in water. The host displayed good biocompatibility both in vitro and in vivo. The administration of amide naphthotube following tetracaine overdose in mouse models notably increased the overall survival rate, indicating its effective antidotal properties. The host could reverse the tetracaine-induced Na+ channels blockage at the cellular level. Moreover, the injection of amide naphthotube also reversed the mortality and paralysis induced by decamethonium in mouse models following a pharmacokinetic mechanism.

CONCLUSION

An emerging artificial receptor, amide naphthotube, has strong binding affinities towards tetracaine and decamethonium. It functions as a supramolecular antidote for tetracaine poisoning and a reversal agent for decamethonium by selectively sequestering these compounds in vivo.

[Impact of glycogen synthase kinase-3β (GSK-3β) inhibitor on Wnt and NF-κB signal pathways in a rat model of diabetic nephropathy]

OBJECTIVE

To explore the impact of glycogen synthase kinase-3β (GSK-3β) on Wnt and NF-κB pathways in a rat model of diabetic nephropathy (DN).

METHODS

SD rats were randomly divided into normal control group (NC), DN model group (DM) and GSK-3β inhibitor group (DI). Blood glucose and 24-hour urine protein were monitored in three groups. Renal tissue samples were stained by HE. The expression of GSK-3β and NF-κB proteins was studied by immunohistochemistry. GSK-3β and NF-κB mRNAs were detected by RT-qPCR.

RESULTS

Ten weeks after STZ injection, the level of blood glucose increased significantly in DM group [(23.2±5.4) mmol/L] and DI group [(25.0±4.0) mmol/L], compared with NC group, and the level of 24-hour urinary protein increased significantly in DM group [(185.2±35.6) g/24 h] and DI group [(179.6±44.7) g/24 h], compared with NC group. Two weeks after LiCl injection, the level of blood glucose and 24-hour urinary protein decreased in DI group (17.6±2.1) mmol/L, (106.9±30.0) g/24 h], compared with DM Group. Compared with NC group, pathological changes of the kidney of DM group aggravated along with increased mRNA and protein expression of GSK-3β and NF-κB. But the pathological changes of the kidney in DI group alleviated along with declined mRNA and protein expression of GSK-3β and NF-κB as compared with DM group (all P<0.05).

CONCLUSIONS

NF-κB protein expression positively correlates with the GSK3β expression. Wnt and NF-κB signal pathways play an important role in the development of diabetic nephropathy.

Selective adsorption of trace morpholine impurities over N-ethyl morpholine by tetralactam solids

The separation and especially the removal of morpholine (MOR) impurities from N-ethyl morpholine (NEM) is of great significance in the fine chemical industry. Herein, we offer a novel strategy for the selective adsorption of MOR over NEM by tetralactam solids. The adsorbent realized the purification of NEM by adsorbing traces of MOR impurities, such that the purity can be improved from around 98% to over 99.5%. Single crystal structures indicate that N-H⋯O and N-H⋯N hydrogen bonding interactions are essential in the selective separation.

Mutual Associations of Exposure to Ambient Air Pollutants in the First 1000 Days of Life With Asthma/Wheezing in Children: Prospective Cohort Study in Guangzhou, China

BACKGROUND

The first 1000 days of life, encompassing pregnancy and the first 2 years after birth, represent a critical period for human health development. Despite this significance, there has been limited research into the associations between mixed exposure to air pollutants during this period and the development of asthma/wheezing in children. Furthermore, the finer sensitivity window of exposure during this crucial developmental phase remains unclear.

OBJECTIVE

This study aims to assess the relationships between prenatal and postnatal exposures to various ambient air pollutants (particulate matter 2.5 [PM2.5], carbon monoxide [CO], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]) and the incidence of childhood asthma/wheezing. In addition, we aimed to pinpoint the potential sensitivity window during which air pollution exerts its effects.

METHODS

We conducted a prospective birth cohort study wherein pregnant women were recruited during early pregnancy and followed up along with their children. Information regarding maternal and child characteristics was collected through questionnaires during each round of investigation. Diagnosis of asthma/wheezing was obtained from children's medical records. In addition, maternal and child exposures to air pollutants (PM2.5 CO, SO2, NO2, and O3) were evaluated using a spatiotemporal land use regression model. To estimate the mutual associations of exposure to mixed air pollutants with the risk of asthma/wheezing in children, we used the quantile g-computation model.

RESULTS

In our study cohort of 3725 children, 392 (10.52%) were diagnosed with asthma/wheezing. After the follow-up period, the mean age of the children was 3.2 (SD 0.8) years, and a total of 14,982 person-years were successfully followed up for all study participants. We found that each quartile increase in exposure to mixed air pollutants (PM2.5, CO, SO2, NO2, and O3) during the second trimester of pregnancy was associated with an adjusted hazard ratio (HR) of 1.24 (95% CI 1.04-1.47). Notably, CO made the largest positive contribution (64.28%) to the mutual effect. After categorizing the exposure according to the embryonic respiratory development stages, we observed that each additional quartile of mixed exposure to air pollutants during the pseudoglandular and canalicular stages was associated with HRs of 1.24 (95% CI 1.03-1.51) and 1.23 (95% CI 1.01-1.51), respectively. Moreover, for the first year and first 2 years after birth, each quartile increment of exposure to mixed air pollutants was associated with HRs of 1.65 (95% CI 1.30-2.10) and 2.53 (95% CI 2.16-2.97), respectively. Notably, SO2 made the largest positive contribution in both phases, accounting for 50.30% and 74.70% of the association, respectively.

CONCLUSIONS

Exposure to elevated levels of mixed air pollutants during the first 1000 days of life appears to elevate the risk of childhood asthma/wheezing. Specifically, the second trimester, especially during the pseudoglandular and canalicular stages, and the initial 2 years after birth emerge as crucial susceptibility windows.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-ROC-17013496; https://tinyurl.com/2ctufw8n.

N-aminomorpholine-functionalized bromine-doped carbon dots for hypochlorous acid detection in foods and imaging in live cells

Hypochlorous acid (HClO) is used in food preservation. However, excessive HClO can deteriorate nutritional composition of food, compromise its quality, and potentially induce various diseases. Consequently, the development of multifunctional fluorescent probes for the sensitive and selective detection of HClO is highly anticipated for food safety. In this work, we designed a nanoprobe using N-aminomorpholine (AM)-functionalized bromine-doped carbon dots (Br-CDs-AM) for sensing HClO. This nanoprobe exhibits pH stability, strong resistance to photobleaching, superior long-term photostability (12 weeks), high sensitivity (19.3 nM), and an ultrarapid response (8 s) for detecting HClO residues in food matrices with percentage recovery (96.5 %-108 %) and RSDs less than 5.34 %. In addition, extremely low cytotoxicity and outstanding biocompatibility enable the nanoprobe to be used primarily for lysosome tracking and rapidly visualizing HClO in live cells. Thus, this study provides a new pathway to design unconventional nanoprobes for food safety assessment and subcellular organelle-specific imaging HClO.

The association of dysglycaemia metrics over the first 7 days of ICU stay with ICU mortality among patients with and without diabetes

BACKGROUND

Dysglycaemia metrics, defined as hyperglycaemia, increased glucose variability, hypoglycaemia and reduced time in the targeted blood glucose range (TIR), are linked to higher mortality. The relationship between dysglycaemia metrics and intensive care unit (ICU) mortality over time for patients with and without diabetes remains inconclusive, posing challenges for ICU medical staff in accurately identifying and distinguishing various risk factors and taking timely and appropriate responses.

AIM

To explore which dysglycaemia metrics within the first 7 days of ICU stay are associated with ICU mortality among patients with and without diabetes.

STUDY DESIGN

This retrospective cohort study included 712 patients without diabetes and 222 patients with diabetes. Clinical data were collected within the first 7 days of ICU stay. Binary logistic regression models were built to analyse which dysglycaemia metrics (hyperglycaemia, coefficient of variation [CV], hypoglycaemia and TIR) on the first day, over the first 3, 5 and 7 days of ICU stay were associated with ICU mortality.

RESULTS

In patients with diabetes, hyperglycaemia on the first day (OR: 4.90, 95% CI: 1.51-15.90, p = .008) and TIR <70% during the first 7 days of ICU stay (OR: 16.31, 95% CI: 1.50-176.89, p = .022) were associated with increased ICU mortality. In patients without diabetes, CV >20% on the first day (OR: 1.46, 95% CI: 1.03-2.07, p = .035), and TIR <70% during the first 3 (OR: 2.01, 95% CI: 1.35-2.98, p < .001) and 5 days (OR: 1.66, 95% CI: 1.09-2.54, p = .019) were associated with increased ICU mortality (p < .05). The proportion of hypoglycaemia did not significantly correlate with ICU mortality in patients with or without diabetes (p > .05).

CONCLUSIONS

Specific dysglycaemia metrics are associated with ICU mortality between patients with and without diabetes. In patients with diabetes, hyperglycaemia on the first day and TIR <70% on the first 7 days with higher mortality. In patients without diabetes, CV >20% on the first day and TIR <70% in the first 3 and 5 days are associated with higher mortality. Monitoring these metrics may potentially help develop strategies to decrease ICU mortality through individualized glycaemic management.

RELEVANCE TO CLINICAL PRACTICE

Close monitoring of dysglycaemia metrics, especially TIR, and personalized glucose management based on diabetic status may help identify high-risk ICU patients and improve targeted care strategies.

Betulinic acid mitigates lipopolysaccharide-induced intestinal injury of weaned piglets through modulation of the mitochondrial quality control

Intestinal injury of weaned piglets often leads to reduced immunity, diarrhea and growth retardation, resulting in significant economic losses to agriculture. Betulinic acid (BA) is a natural plant-derived active ingredient with multiple pharmacological activities including immune modulation and anti-inflammatory. This study was aimed to investigate the potential mechanism that BA as a feed additive mitigated lipopolysaccharide (LPS)-induced intestinal injury in piglets. The results indicated that BA pretreatment improved the morphology and structure of the intestine, enhanced intestinal mucosal barrier function, and activated the PPAR signaling pathway to reduce the mRNA levels of intestinal CD40 and CXCL13. Meanwhile, BA pretreatment improved the LPS-induced disruption of intestinal microbiota by increasing the abundance of the Firmicutes and decreasing the abundance of the Bacteroidota and Proteobacteria. Furthermore, BA pretreatment activated the AMPK/SIRT1/PGC-1α signaling pathway to enhance mitochondrial biogenesis, restored a balance to mitochondrial dynamics, and modulated the PINK1/Parkin, BNIP3 and FUNDC1 signaling pathways to activate mitophagy, thereby alleviating LPS-induced intestinal injury. Overall, the present study elucidated that dietary supplementation with BA could alleviate LPS-induced intestinal injury in weaned piglets by regulating mitochondrial quality control, which provided a novel approach for alleviating intestinal stress in weaned piglets.

Intelligent decoding platform for peptide sequences: SERS detection via high affinity self-assembled silver nanoparticles and machine learning analysis

BACKGROUND

Peptides are compounds formed by the dehydration-condensation reaction of two or more amino acids which play an important role in the life functions of the organism. Changes in the structure of amino acids and peptides are vital for elucidating the process of disease development. However, the existing methods make it difficult to accurately recognize slight variations in peptide sequences, which becomes a difficult detection task. Therefore, the necessity of novel, accurate, comprehensive and deep strategies for peptide sequence identification is imperative.

RESULTS

Here, an intelligent decoding system was developed, which synthesized a substrate (Ag/BDHA) with high affinity and self-assembly capabilities by double reduction method and utilized surface-enhanced Raman scattering (SERS) to achieve label-free, high-affinity and accurate capturing of peptide sequences. The platform can recognize peptide chains with the same molecular weight but different amino acid sequences, filling the loopholes of mass spectroscopy. Interestingly, it can also distinguish peptide chains with different amino acid lengths, different amino acid positions and different amino acid mutations. And further combined with machine learning methods to simplify the output of detection results, including thermogram, confusion matrix, principal component analysis and hierarchical cluster analysis, which was more suitable for practical applications. More importantly, to explore the potential for application, real influenza A viruses were selected and analyzed and successfully identifying mutations and subtypes of viruses.

SIGNIFICANCE

In sum, the original, versatile and intelligent detection system based on surface-enhanced Raman scattering we proposed provides a promising method and strategy for the precise and valid analysis of different variations of peptide sequences, which is of great significance for explaining life processes, exploring disease pathogenesis, and developing innovative drugs.

Application of multidisciplinary in situ simulation training in the treatment of acute ischemic stroke: a quality improvement project

BACKGROUND

Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity, mortality, and disability. Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke. The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time.

METHODS

This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise. A total of 53 participants completed the two-day in situ simulation training. The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training. A 5-point Likert scale was used to measure participant comfort. A paired-sample t-test was used to compare the mean self-reported comfort scores of participants, as well as the endotracheal intubation time and door-to-image time on the first and second days of in situ simulation training. The door-to-image time before and after the training was also recorded.

RESULTS

The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time. For the emergency management of hypoxemia or tracheal intubation, the mean post-training self-reported comfort score was significantly higher than the mean pre-training comfort score (hypoxemia: 4.53±0.64 vs. 3.62±0.69, t= -11.046, P<0.001; tracheal intubation: 3.98±0.72 vs. 3.43±0.72, t= -6.940, P<0.001). We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time, which continued after the training.

CONCLUSION

Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confidence of stroke team members, optimize the first-aid process, and effectively shorten the door-to-image time of stroke patients with emergency complications.

[A case of a two-chambered right ventricle associated with aneurysm of the sinus of Valsalva]

A 51-year-old male with a two-chambered right ventricle associated with an aneurysm of sinus of Valsalva, who underwent successful surgical repair without ventriculotomy, is reported. Preoperative right ventriculogram revealed that the right ventricle was divided by the anomalous muscle bundle, and the aneurysm of sinus of Valsalva growing from the right coronary sinus protruded just below the pulmonary valve. The right ventricular pressure was 107/10 mmHg and the pressure gradient between the right ventricle and the pulmonary artery was 88 mmHg. Trans-pulmonary arterial resection of the aneurysm of Valsalva sinus was performed and the anomalous muscle bundle was successfully removed through the pulmonary arteriotomy and the right atrial incision. Post-operative right ventricular pressure dropped to 42 mmHg, and there was no stenosis in the right ventricle.

[Effects of interleukin-1 and interleukin-2 on electrophysiological characteristics of rat hippocampal neurons in culture]

The effects of recombinant human interleukin-1 beta (rhIL-1 beta) and interleukin-2 (rhIL-2) on the cultured rat hippocampal neurons were investigated with intracellular recording and extracellular micropressure ejection techniques. Experimental results showed that all of the neurons tested with rhIL-1 beta (100 U/ml) exhibited a 4.20 +/- 1.86 mV membrane hyperpolarization. 50% of the neurons treated with rhIL-2 (100 U/ml) showed a depolarization of 11.12 +/- 3.71 mV accompanied by bursting activity, while in a still higher concentration (1,000 U/ml) a 3.25 +/- 0.63 mV hyperpolarization was observed. All the above effects of rhIL-1 beta and rhIL-2 on the hippocampal neurons were completely reversible. The membrane resistance of the neurons was not significantly affected by these cytokines. These results suggest that the effects of cytokines IL-1 and IL-2 on the excitability of hippocampal neurons may be a way by which the immune system exerts a regulatory action on hippocampal function.

[Cavoatrial bypass in obstruction of the inferior vena cava in the hepatic portion through the posterior route of the hepatic caudate lobe]

In a 32-year-old Japanese female who had a history of Sjögren's syndrome, the obstruction of the inferior vena cava in the hepatic portion was found associated with Budd-Chiari syndrome. The obstruction of the inferior vena cava was about 6 cm in length by cavography. Cavoatrial bypass grafting was successfully performed with a 16 mm ring reinforced expanded polytetrafluoroethylene graft, which ran behind the caudate lobe of the liver and connected to the right atrium via right pleural cavity. This may be the first report of the posterior route of the hepatic caudate lobe in cavoatrial bypass grafting in Japanese and English literature.

Expression of mitogen-activated protein kinase phosphatase-1 in the early phases of human epithelial carcinogenesis

Many mitogens and human oncogenes activate extracellular regulated kinases (ERKs), which in turn convey proliferation signals. ERKs or mitogen-activated protein (MAP) kinases are inactivated in vitro by MAP kinase phosphatases (MKPs). The gene encoding one of these MKPs, MKP-1, is a serum-inducible gene and is transcriptionally activated by mitogenic signals in cultured cells. As MKP-1 has been shown to block DNA synthesis by inhibiting ERKs when expressed at elevated levels in cultured cells, it has been suggested that it may act as a tumor suppressor. MKP-1 mRNA and MAP kinase (ERK-1 and -2) protein expression was assessed in 164 human epithelial tumors of diverse tissue origin by in situ hybridization and immunohistochemistry. MKP-1 was overexpressed in the early phases of prostate, colon, and bladder carcinogenesis, with progressive loss of expression with higher histological grade and in metastases. In contrast, breast carcinomas showed significant MKP-1 expression even when poorly differentiated or in late stages of the disease. MKP-1, ERK-1, and ERK-2 were co-expressed in most tumors examined. In a subset of 15 tumors, ERK-1 enzymatic activity as well as structural alterations that might be responsible for loss of function of MKP-1 during tumor progression, were examined. ERK-1 enzymatic activity was found to be elevated despite MKP-1 overexpression. No loss of 5q35-ter (containing the MKP-1 locus) was detected by polymerase chain reaction in metastases compared with primary tumors. Finally, no mutations were found in the catalytic domain of MKP-1. These data indicate that MKP-1 is an early marker for a wide range of human epithelial tumors and suggest that MKP-1 does not behave as a tumor suppressor in epithelial tumors.