Acquirement and disappearance of HBsAg and anti-HCV in an aged population: a follow-up study in an endemic township

BACKGROUND

HBsAg and anti-hepatitis C virus (anti-HCV) are stable markers and widely used. The seroconversion and seroclearance of HBsAg and anti-HCV are important for disease control and prognosis of diseases.

AIMS

To investigate acquirement and disappearance of HBsAg and anti-HCV in an endemic area.

METHODS

Seven years after a community screening, 1002 of 2909 residents of Tzukuan Township were recruited. HBsAg, anti-HCV and alanine transaminase (ALT) were checked in all who participated and hepatitis B virus (HBV) DNA, anti-HBs, anti-HBc, HCV RNA, anti-HDV and upper abdominal ultrasonography were studied in different groups.

RESULTS

There were 461 male and 541 female residents with a mean age of 66.7 ± 8.6 years. No new HBsAg carrier was noted and the HBsAg clearance rate was 1.58% per year. One of the 17 cases with HBsAg clearance had positive HBV DNA, three had ALT elevation, two had cirrhosis and seven had anti-HBs seroconversion. Quantitative of HBsAg and HBV DNA were concordant and 78.1% subjects had low levels of titration. Anti-HBc alone contributed to 32.1% and was prominent in old age and the anti-HCV-positive group. The anti-HCV seroconversion rate was only 0.74% per year and household transmission was the only risk factor. Only 37.5% of cases with anti-HCV seroconversion had HCV viraemia and the anti-HCV seroreversion rate was 0.63% per year. The anti-HDV seroconversion rate was 0.72% per year and no subject showed anti-HDV clearance.

CONCLUSIONS

Much higher rates of HBsAg seroclearance, anti-HCV seroreversion and anti-HBc alone were noted in this endemic area and no subject showed anti-HDV clearance.

Magnesium sulfate mitigates lung injury induced by bilateral lower limb ischemia-reperfusion in rats

BACKGROUND

Lower limb ischemia-reperfusion (I/R) elicits oxidative stress and causes inflammation in lung tissues that may lead to lung injury. Magnesium sulfate (MgSO(4)) possesses potent anti-oxidation and anti-inflammation capacity. We sought to elucidate whether MgSO(4) could mitigate I/R-induced lung injury. As MgSO(4) is an L-type calcium channel inhibitor, the role of the L-type calcium channels was elucidated.

MATERIALS AND METHODS

Adult male rats were allocated to receive I/R, I/R plus MgSO(4) (10, 50, or 100 mg/kg), or I/R plus MgSO(4) (100 mg/kg) plus the L-type calcium channels activator BAY-K8644 (20 μg/kg) (n = 12 in each group). Control groups were run simultaneously. I/R was induced by applying rubber band tourniquets high around each thigh for 3 h followed by reperfusion for 3 h. After euthanization, degrees of lung injury, oxidative stress, and inflammation were determined.

RESULTS

Arterial blood gas and histologic assays, including histopathology, leukocyte infiltration (polymorphonuclear leukocytes/alveoli ratio and myeloperoxidase activity), and lung water content, confirmed that I/R caused significant lung injury. Significant increases in inflammatory molecules (chemokine, cytokine, and prostaglandin E(2) concentrations) and lipid peroxidation (malondialdehyde concentration) confirmed that I/R caused significant inflammation and oxidative stress in rat lungs. MgSO(4), at the dosages of 50 and 100 mg/kg but not 10 mg/kg, attenuated the oxidative stress, inflammation, and lung injury induced by I/R. Moreover, BAY-K8644 reversed the protective effects of MgSO(4).

CONCLUSIONS

MgSO(4) mitigates lung injury induced by bilateral lower limb I/R in rats. The mechanisms may involve inhibiting the L-type calcium channels.

Limb ischemic preconditioning mitigates lung injury induced by haemorrhagic shock/resuscitation in rats

AIM OF THE STUDY

Haemorrhagic shock and subsequent resuscitation induce acute lung injury. We elucidated whether bilateral lower limb ischemic pre-conditioning (IP) could mitigate lung injury in haemorrhagic shock/resuscitation rats. The role of heme oxygenase-1 (HO-1) was also elucidated.

METHOD

Adult male rats were randomized to receive haemorrhagic shock/resuscitation (HS), HS plus IP, or HS plus IP plus the HO-1 inhibitor tin protoporphyrin (SnPP) (n = 12 in each group). Sham groups were employed simultaneously. For pre-conditioning, 3 cycles of limb IP (10 min ischemia followed by 10 min reperfusion) were performed immediately before haemorrhagic shock. Haemorrhagic shock (mean arterial pressure: 40-45 mmHg) was induced by blood drawing and maintained for 120 min. SnPP was injected 5 min before resuscitation. Shed blood/saline mixtures were re-infused to achieve resuscitation. After monitoring for another 8h, rats were sacrificed. Arterial blood gas and alveolar-arterial oxygen difference (lung function index), histology, polymorphonuclear leukocytes/alveoli ratio (leukocyte infiltration index), wet/dry weight ratio (water content index), inflammatory molecules (e.g., chemokine, cytokine, prostaglandin E(2)), and malondialdehyde (lipid peroxidation index) assays were preformed.

RESULTS

Haemorrhagic shock/resuscitation induced significant lung function alterations and significant increases in leukocyte infiltration, water content, inflammation, and lipid peroxidation in lungs. Histological analysis confirmed that haemorrhagic shock/resuscitation caused marked lung injury. Limb IP significantly mitigated the adverse effects of haemorrhagic shock/resuscitation. Moreover, the protective effects of limb IP were reversed by SnPP.

CONCLUSIONS

Limb IP mitigates lung injury in haemorrhagic shock/resuscitation rats. The mechanisms may involve HO-1.

Reliability and validity of the Chinese Version of the Mood Disorder Questionnaire

The purpose of this study was to examine the reliability, validity, sensitivity, and specificity of the Chinese Version of the Mood Disorder Questionnaire (MDQ-C). A total of 170 patients were administered the Mini International Neuropsychological Interview and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision as criterion standard by on-site psychiatrists. The Cronbach's alpha, test-retest reliability, and the content validity index of the MDQ-C were .83, .76, and .80, respectively. Factor analysis revealed that two factors, elevated mood overactivity and irritable behavior, explained 40.89% of the variance. On the basis of the sensitivity and specificity results, the optimal cutoff point was 6. The MDQ-C is an effective short and comprehensive tool with robust psychometric properties for diagnosis of bipolar disorders, specifically for patients with bipolar I.

Effect of kiwifruit consumption on sleep quality in adults with sleep problems

Numerous studies have revealed that kiwifruit contains many medicinally useful compounds, among which antioxidants and serotonin may be beneficial in the treatment of the sleep disorders. The aim of this study was to evaluate the effects of kiwifruit on sleep patterns, including sleep onset, duration, and quality. In this study, we applied a free-living, self-controlled diet design. Twenty-four subjects (2 males, 22 females) 20 to 55 years of age consumed 2 kiwifruits 1 hour before bedtime nightly for 4 weeks. The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), a 3-day sleep diary, and the Actigraph sleep/activity logger watch were used to assess the subjective and objective parameters of sleep quality, including time to bed, time of sleep onset, waking time after sleep onset, time of getting up, total sleep time, and self-reported sleep quality and sleep onset latency, waking time after sleep onset, total sleep time, and sleep efficiency before and after the intervention. After 4 weeks of kiwifruit consumption, the subjective CPSQI score, waking time after sleep onset, and sleep onset latency were significantly decreased (42.4%, 28.9%, and 35.4%, respectively). Total sleep time and sleep efficiency were significantly increased (13.4% and 5.41%, respectively). Kiwifruit consumption may improve sleep onset, duration, and efficiency in adults with self-reported sleep disturbances. Further investigation of the sleep-promoting properties of kiwifruit may be warranted.

Community-based screening for hepatocellular carcinoma in elderly residents in a hepatitis B- and C-endemic area

BACKGROUND AND AIM

The aim of the present study was to elucidate a reasonable model and the efficacy of hepatocellular carcinoma (HCC) screening on an elderly population.

METHODS

Two-stage HCC screening was conducted in a hepatitis C virus (HCV)-endemic area. First, participants underwent blood tests for hepatitis B surface antigen (HBsAg), anti-HCV antibody, serum α-fetoprotein (AFP), aspartate aminotransferase, alanine aminotransferase, and platelet count. Patients who were abnormal for any of the six markers were enrolled for second-stage ultrasonography. Suspected cases were referred for confirmation. HCC cases were followed for 4 years. All patients were linked to national mortality and cancer register databases to identify newly-developed HCC, 30 months after screening.

RESULTS

A total of 461 males and 541 females were screened for HCC, with 15.1% testing positive for HBsAg and 44.3% positive for anti-HCV. Among them, 619 (61.8%) met the criteria of ultrasonographic screening; 527 (85.1%) responded, and 16 confirmed HCC (male/female = 8/8, 68.8±8 years) cases were detected. All tumor diameters were less than 5 cm, and six were less than 2 cm. AFP and thrombocytopenia were two independent predictive factors of HCC. The overall survival rates of detected cases were 93.8% and 56.3% was 1 and 4 years, respectively. The only good prognostic predictor was "underwent curative treatment". Another seven non-HCC residents developed HCC after screening, and five of these were with either thrombocytopenia or AFP elevation.

CONCLUSION

Under economical consideration, AFP and platelet count should be feasible screening markers of risk identification. Early detection and prompt treatment results in good prognosis in an aged population.

Heme oxygenase-1 mediates the protective effects of ischemic preconditioning on mitigating lung injury induced by lower limb ischemia-reperfusion in rats

BACKGROUND

Lower limb ischemia-reperfusion (I/R) imposes oxidative stress, elicits inflammatory response, and subsequently induces acute lung injury. Ischemic preconditioning (IP), a process of transient I/R, mitigates the acute lung injury induced by I/R. We sought to elucidate whether the protective effects of IP involve heme oxygenase-1 (HO-1).

METHODS

Adult male rats were randomized to receive I/R, I/R plus IP, I/R plus IP plus the HO-1 inhibitor tin protoporphyrin (SnPP) (n = 12 in each group). Control groups were run simultaneously. I/R was induced by applying rubber band tourniquet high around each thigh for 3 h followed by reperfusion for 3 h. To achieve IP, three cycles of bilateral lower limb I/R (i.e., ischemia for 10 min followed by reperfusion for 10 min) were performed. IP was performed immediately before I/R. After sacrifice, degree of lung injury was determined.

RESULTS

Histologic findings, together with assays of leukocyte infiltration (polymorphonuclear leukocytes/alveoli ratio and myeloperoxidase activity) and lung water content (wet/dry weight ratio), confirmed that I/R induced acute lung injury. I/R also caused significant inflammatory response (increases in chemokine, cytokine, and prostaglandin E(2) concentrations), imposed significant oxidative stress (increases in nitric oxide and malondialdehyde concentrations), and up-regulated HO-1 expression in lung tissues. IP significantly enhanced HO-1 up-regulation and, in turn, mitigated oxidative stress, inflammatory response, and acute lung injury induced by I/R. In addition, the protective effects of IP were counteracted by SnPP.

CONCLUSIONS

The protective effects of IP on mitigating acute lung injury induced by lower limb I/R are mediated by HO-1.

Chronic hepatitis C increased the mortality rates of patients with hepatocellular carcinoma and diabetes mellitus in a triple hepatitis virus endemic community

BACKGROUND

To elucidate the factors associated with mortality rates among older subjects with hepatocellular carcinoma (HCC) and diabetes mellitus (DM) in a triple hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV) endemic community.

METHODS

A total of 2,909 residents aged>or=45 years were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV) and alanine aminotransaminase (ALT) in 1997. Anti-HDV was detected in HBsAg-positive subjects. Those who expired from HCC and DM were identified from official mortality data sets (1997-2003). Survival was analyzed using the Kaplan-Meier survival curve with log-rank test and the Cox proportional hazard model.

RESULTS

Forty-one patients died of HCC and 25 of DM during the study period. Multivariate analysis indicated that age>or=65 years (hazard ratio 3.4; 95% confidence interval 1.8-6.4), HBsAg (3.3; 1.7-6.7), anti-HCV (3.8; 1.7-8.5) and ALT>or=40 IU/L (3.7; 1.9-7.0) were independent predictors of HCC mortality, while age>or=65 years (4.8; 2.1-11.0) and anti-HCV (4.2; 1.7-10.6) were two independent predictors of DM mortality. There were synergistic effects of dual viral infections for HCC, but not for DM mortality.

CONCLUSIONS

Old age and chronic HCV infection increase the risk of HCC and DM mortality. HBsAg and ALT levels are also risk factors for HCC mortality, but not DM. The synergistic effects of dual hepatitis viral infections are demonstrable and warrant further investigation.

Home-based deep breathing for depression in patients with coronary heart disease: a randomised controlled trial

OBJECTIVES

The primary aim of this study was to examine the effect of a home-based deep-breathing training programme on depressive symptoms as compared with a control condition (i.e., weekly telephone support) in patients with coronary heart disease (CHD).

DESIGN

This efficacy trial used a randomised controlled, parallel group design.

PARTICIPANTS AND METHODS

A total of 62 CHD patients with a Beck Depression Inventory-II (BDI-II) >10 were randomised to receive either home-based deep-breathing training (experimental group, n=28) or weekly telephone support (control group, n=34). Both participants and data assessors were blinded to the study hypothesis. The primary outcome measure was the change in the self-reported depressive symptom severity, measured by the BDI-II. The secondary outcome was the change in the Patient Health Questionnaure-9 (PHQ-9)-assessed depressive symptom severity. Depressive symptoms were assessed at baseline and post-test in both groups. For the experimental group, depressive symptoms were also assessed at the end of the first 2 weeks of training.

RESULTS

The post-test BDI-II and PHQ-9 were significantly lower in the experimental group than in the control group (p<0.001 and p<0.001, respectively). The decreases in BDI-II, from baseline, at post-test were significantly greater in the experimental group as compared with the control group (95% confidence interval (CI): -12.554 to -5.408, p<0.001). Similarly, the pre-test-to-post-test change in PHQ-9 scores was significantly greater in the experimental group as compared with the control group (95% CI: -5.59 to -0.092, p=0.007). Examining the changes in BDI-II and PHQ-9 within the experimental group by the repeated-measures analysis of variance (ANOVA) revealed that both measures of depressive symptoms decreased significantly over time (both p<0.001). The percentage of participants with a BDI-II >or=17 decreased over time from 28.6% at baseline, and 17.9% during treatment, to 10.7% post-test.

CONCLUSIONS

Home-based deep-breathing training is effective in reducing depressive symptoms as compared with telephone support in patients with CHD.

Platonin mitigates acute lung injury induced by bilateral lower limb ischemia-reperfusion in rats

BACKGROUND

Oxidative stress and inflammatory response are crucial in mediating the development of acute lung injury induced by bilateral lower limb ischemia-reperfusion (I/R). Platonin, a potent antioxidant, possesses anti-inflammation capacity. We sought to elucidate whether platonin could mitigate acute lung injury induced by lower limb I/R.

MATERIALS AND METHODS

Forty-eight adult male rats were allocated to receive I/R, I/R plus platonin (100 μg/kg intravenous injection immediately after reperfusion), sham instrumentation, or sham instrumentation plus platonin (denoted as the I/R, I/R-platonin, Sham, or Sham-platonin group, respectively; n = 12 in each group). Bilateral hind limb I/R was induced by applying rubber band tourniquets high around each thigh for 3 h followed by reperfusion for 3 h. After sacrifice, the degree of lung injury was determined.

RESULTS

Histologic findings revealed moderate inflammation in lung tissues of the I/R group and mild inflammation in those of the I/R-platonin group. Total cell number and protein concentration in bronchoalveolar lavage fluid as well as the leukocyte infiltration and myeloperoxidase activity in lung tissues of the I/R group were significantly higher than those of the I/R-platonin group. The pulmonary concentrations of macrophage inflammatory protein-2, interleukin-6, and prostaglandin E(2) of the I/R group were significantly higher than those of the I/R-platonin group. Moreover, the plasma nitric oxide concentration as well as the nitric oxide and malondialdehyde concentrations in lung tissues of the I/R group were significantly higher than those of the I/R-platonin group.

CONCLUSIONS

Platonin mitigates acute lung injury induced by bilateral lower limb I/R in rats.

Protective effects of dexmedetomidine-ketamine combination against ventilator-induced lung injury in endotoxemia rats

BACKGROUND

Pulmonary inflammatory response is crucial in mediating the development of ventilator-induced lung injury (VILI) in animals experiencing endotoxemia. Dexmedetomidine and ketamine are two sedative agents with potent anti-inflammatory capacity. We sought to elucidate the anti-inflammatory effects of dexmedetomidine-ketamine combination against VILI in endotoxemia rats.

MATERIALS AND METHODS

Eighty-four adult male rats were allocated to receive normal saline, VILI, VILI plus dexmedetomidine-ketamine combination (D+K), lipopolysaccharide (LPS), LPS plus D+K, LPS plus VILI, or LPS plus VILI plus D+K (designated as the NS, V, V-D+K, LPS, LPS-D+K, LPS/V, and LPS/V-D+K group, respectively; n = 12 in each group). VILI was induced by high-tidal volume ventilation (tidal volume 20 mL/kg; respiratory rate 50 breath/min; FiO(2) 21%). After being mechanically ventilated for 4 h, rats were sacrificed and the levels of pulmonary inflammatory response were evaluated.

RESULTS

Histologic findings revealed severe, moderate, and mild inflammation in lung tissues of the LPS/V, LPS, and V groups, respectively, whereas those of the LPS/V-D+K, LPS-D+K, and V-D+K groups revealed moderate, mild, and normal to minimal inflammation, respectively. Moreover, the total cell number and the concentrations of macrophage inflammatory protein-2 and interleukin-1β in bronchoalveolar lavage fluid as well as the lung water content, leukocyte infiltration, myeloperoxidase activity, and the concentrations of inducible nitric oxide synthase/nitric oxide, and cyclooxygenase 2/prostaglandin E(2) in lung tissues of the LPS/V, LPS, and V groups were significantly higher than those of the LPS/V-D+K, LPS-D+K, and V-D+K groups, respectively.

CONCLUSIONS

Dexmedetomidine-ketamine combination could mitigate pulmonary inflammatory response induced by VILI in endotoxemia rats.

Prevention of arterial stiffening by pyridoxamine in diabetes is associated with inhibition of the pathogenic glycation on aortic collagen

BACKGROUND AND PURPOSE

Our team previously demonstrated that diabetes induces a deterioration in vascular dynamics, in parallel with the enhanced formation of advanced glycation end products. The aim of this study was to determine whether prevention of the arterial stiffening by pyridoxamine in diabetes is associated with inhibition of the pathogenic glycation on aortic collagen.

EXPERIMENTAL APPROACH

Diabetes was induced in rats by a single tail vein injection with 55 mg.kg(-1) steptozotocin (STZ). After induction of hyperglycaemia, animals were treated for 8 weeks with pyridoxamine (1 g.L(-1) in drinking water) and compared with the age-matched untreated diabetic controls. Pulse wave reflection along the vasculature was derived using the impulse response function of the filtered aortic input impedance spectra.

KEY RESULTS

Treatment of this experimental diabetes with pyridoxamine resulted in a significant increase in wave transit time and a decrease in wave reflection factor, indicating that pyridoxamine attenuates the diabetes-induced augmentation in systolic load of the left ventricle coupled to its arterial system. Meanwhile, pyridoxamine therapy ameliorated the diabetes-related cardiac hypertrophy, as evidenced by the reduction in ratio of the left ventricular weight to body weight. Glycation-derived modification of aortic collagen was also found to be attenuated by administration of pyridoxamine to the STZ-induced diabetic rats.

CONCLUSIONS AND IMPLICATIONS

Pyridoxamine imparts significant protection against the diabetes-induced deterioration in pulsatile arterial load imposed on the heart, at least partly through inhibition of the formation of advanced glycation end products and their accumulation on aortic collagen of the STZ-treated rats.

[Noninvasive measurement of cardiovascular functions: blood pressure reactivity to stress]

Advances in medical engineering have introduced novel tools to monitor changes in hemodynamics in a continuous and non-invasive manner. Blood pressure or cardiovascular reactivity to laboratory-induced mental stresses in individuals with certain traits or diseases differs from that of healthy controls. Therefore, blood pressure reactivity to stress can be used as an index of cardiovascular function. It can also be used in research to elucidate linkages between exaggerated blood pressure response and cardiovascular disease. This paper introduces the stress response and its physiologic mechanisms, blood pressure reactivity, short-term regulation of blood pressure, and blood pressure reactivity assessment methods.

Dexmedetomidine-ketamine combination mitigates acute lung injury in haemorrhagic shock rats

AIM OF THE STUDY

Upregulation of pulmonary inflammatory molecules is crucial in mediating the development of acute lung injury induced by haemorrhagic shock. Dexmedetomidine and ketamine possess potent anti-inflammatory capacity. We sought to elucidate whether dexmedetomidine, ketamine, or dexmedetomidine-ketamine combination could mitigate acute lung injury in haemorrhagic shock rats.

METHODS

Fifty adult male Sprague-Dawley rats were randomized to the sham-instrumented, haemorrhagic shock (HS), HS plus dexmedetomidine (HS-D), HS plus ketamine (HS-K), or HS plus dexmedetomidine-ketamine (HS-D+K) group (n=10 in each group). Haemorrhagic shock was induced by blood withdrawing and the mean blood pressure was maintained at 40-45mmHg for 120min. Resuscitation was then performed by infusion of shed blood/saline mixtures. After monitoring for another 8h, rats were sacrificed.

RESULTS

Histology findings and lung injury score analysis revealed moderate lung injury in rats of the HS, HS-D, and HS-K groups, whereas those of the HS-D+K group revealed mild lung injury. The effects of haemorrhagic shock on increasing cell number and protein concentration in bronchoalveolar lavage fluid as well as water content, leukocyte infiltration, and myeloperoxidase activity of lung tissues were significantly attenuated by dexmedetomidine-ketamine combination but not by dexmedetomidine or ketamine alone. Dexmedetomidine-ketamine combination, but not dexmedetomidine or ketamine alone, also significantly inhibited haemorrhagic shock-induced upregulation of pulmonary inflammatory molecules, including nitric oxide, prostaglandin E(2), chemokine (e.g., macrophage inflammatory protein-2), and cytokines [e.g., interleukin (IL)-1beta, and IL-6].

CONCLUSIONS

Dexmedetomidine-ketamine combination mitigates acute lung injury in haemorrhagic shock rats.

Reproducibility of Morning Blood Pressure Surge and Its Relation to Blood Pressure Reactivity

This study examined the stability of the morning blood pressure surge (MBPS) and its relation to blood pressure (BP) reactivity in untreated hypertensives. Thirty-six participants completed a stress task at baseline. Ambulatory BP monitoring was carried out three times on a weekday. The MBPS demonstrated small reproducibility and large coefficient of variation. The MBPS correlated with nighttime BP (p = 0.001) but not morning BP or BP reactivity. Dippers had greater MBPS than did nondippers (p < 0.05). The MBPS provides distinct information that is different from the BP response to mental stress.

Demographics, training, and practice patterns of practitioners of folk medicine in Taiwan: a survey of the Taipei metropolitan area

OBJECTIVES

The purpose of this study was to investigate the demographics, training, and practice patterns of folk medicine practitioners, their opinions toward statutory regulation of folk medicine, and the formal education and credentialing for folk medicine providers in the metropolitan Taipei area.

DESIGN

A cross-sectional survey design was used.

SUBJECTS

Included in the survey were 200 folk medicine practitioners in Taipei city and 200 folk medicine practitioners in Taipei county.

INSTRUMENT

The survey questionnaire consisted of 3 domains including demographics and training; practice patterns; and opinions toward statutory regulation of folk medicine and formal education and credentialing for Tuina, Ba Guan, Gua Sha, and reflexology providers.

RESULTS

The response rates ranged from 86.3% to 99.5%. A typical folk medicine provider in the Taipei metropolitan area was a middle-aged man with a high school degree who worked about 50 hours a week. The majority of the providers in the Taipei metropolitan area received their training through apprenticeship. Years of training and experience varied widely among these practitioners. About 80% had received more than one year of training prior to starting their practice. Adult men and women were their major clientele. The major treatment modalities they offered were Tuina, Gua Sha, Ba Guan, reflexology, and meridian massage. The majority of the respondents agreed that practitioners should receive formal education and training and agreed that certifying the qualifications of folk medicine practitioners is necessary.

CONCLUSION

Findings from the present survey provide an understanding of the training and practice patterns of Taiwanese folk medicine practitioners, highlight folk medicine practitioners' needs for formal education and training, and stress the importance of statutory regulation of folk medicine in Taiwan.

Effects of dexmedetomidine on regulating pulmonary inflammation in a rat model of ventilator-induced lung injury

BACKGROUND

We sought to elucidate the effects of dexmedetomidine, a selective alpha2-adrenergic receptor agonist, on the regulation of pulmonary inflammation in ventilator-induced lung injury (VILI) in a rat model.

METHODS

A total of 64 adult male Sprague-Dawley rats were assigned to receive either standard ventilation (tidal volume 10 mL/kg; respiratory rate 50 breaths/minute), high-tidal volume ventilation (HVT: tidal volume 20 mL/kg; respiratory rate 50 breaths/minute), HVT plus dexmedetomidine (0.5, 2.5 or 5.0 microg/kg per hour), or HVT plus dexmedetomidine (0.5, 2.5 or 5.0 microg/kg per hour) and yohimbine (the alpha2-adrenergic receptor antagonist) (n = 8 in each group). The doses of dexmedetomidine were chosen to correspond to 1, 5 and 10 times the clinical dose (0.5 microg/kg per hour). After maintaining ventilation for 4 hours, rats were sacrificed and pulmonary inflammatory changes as well as the upregulation of pulmonary inflammatory molecules were evaluated.

RESULTS

Histological and arterial blood gas analyses confirmed that HVT induced significant lung injury. HVT also significantly increased the pulmonary concentrations of chemokines (e.g. macrophage inflammatory protein-2), cytokines (e.g. tumor necrosis factor-alpha, interleukin [IL]-1beta, and IL-6), inducible nitric oxide synthase/nitric oxide, cyclooxygenase-2/prostaglandin E2. Dexmedetomidine at the dose of 5.0 microg/kg per hour, but not at 0.5 and 2.5 microg/kg per hour, significantly attenuated the effects of HVT. Moreover, these effects of dexmedetomidine were significantly attenuated by yohimbine.

CONCLUSION

Dexmedetomidine at clinically relevant doses had no significant effect in attenuating VILI. In contrast, dexmedetomidine at a dose approximately 10 times higher than the clinical dose significantly attenuated VILI. These effects of dexmedetomidine were mediated, at least in part, by the alpha2-adrenergic receptor.

Molecular kinetics of proteins at the surface of porcine sperm before and during fertilization

Fertilization is a decisive moment in life and enables the combination of the DNA from two gametes to ultimately form a new organism. The sperm surface, especially the head area, has distinguishable subdomains that are involved in distinct fertilization processes. It is known that the sperm head surface undergoes constant remodelling during epididymal maturation and migration in the male and female genital tract. But intriguingly, the identity, origin and spatial ordering of proteins at the sperm surface that are involved in mammalian fertilization are essentially unknown. This review deals with sperm surface protein modifications that are under somatic cell control. As soon as the sperm is released from the seminiferous tubules it is subjected to these modifications. These surface reorganisations continue until the sperm reside in the fallopian tube where they meet the oocyte and may fertilize it. Most likely, a selective process allows only functionally mature and intact sperm to optimally interact and fertilize the oocyte. Recent data suggest that even the perivitelline fluid is involved in sperm surface remodelling as it contains factors which could facilitate the first penetrating sperm to fertilize the oocyte. In this contribution, the kinetics of proteins at the sperm surface will be overviewed. Better understanding of this would help to design strategies to improve male fertility or to devise novel contraceptives.

Preparation of silica microspheres encapsulating phase-change material by sol-gel method in O/W emulsion

Spherical silica microcapsules containing phase-change material (PCM) were prepared by the sol-gel method in O/W emulsion. This is the first time that inorganic encapsulation of PCM with core/shell structure has been studied. The results of this synthesis revealed that micron size (4 - 8 microm) silica microspheres encapsulating n-pentadecane can be successfully created from acidic solutions ([H+] > or = 1.44 N) by using cationic surfactants as the emulsifiers. The identification of the mechanisms for the formation of silica shell at the oil-water interface indicates that it should be the charge-controlled mechanism through S+X-I+ (positively charged surfactant-halide ion-positively charged silica species) electrostatic interactions or the reaction rates-controlled mechanism working on cationic emulsifiers.

[Insomnia: concept analysis]

Sleep performs an essential function in humans. Insomnia is one of the common phenomena in a poor sleep pattern. Long-term suffering can result in somatic symptoms and the development of diseases. It can even induce diseases with a mental dimension. Insomnia causes indications of poor health. No systematic analysis of insomnia has been performed, however. The purpose of this study, therefore, was to describe the concept of insomnia. In accordance with Walker and Avant's (2005) methodology of concept analysis, this paper presents a review of the conceptual definitions, characteristics, antecedents and consequences, constructing examples, and empirical references of insomnia. The results indicate that: (1) Insomnia's defining attributes are recognized as an insufficient of quality and quantity for sleep for more than one month. (2) Antecedents of insomnia include changes in life habits, physiological demands caused by sleep time changes, and the experience of uncomfortable sensations. (3) Consequences of insomnia include a poor condition, with physical, psychological, social, and global dimensions. (4) There are many instruments that can be used to inspect insomnia, including questionnaires and tools for physiological measurement. Insomnia is a serious problem with various facets. An understanding of the concept of insomnia will help nurses to perceive this problem in caring for subjects.

Clonidine enhances type-2 cationic amino acid transporter transcription in endotoxin-activated murine macrophages

BACKGROUND

We sought to evaluate the effects of clonidine on type-2 cationic amino acid transporter (CAT-2) transcription in endotoxin-activated murine macrophages.

METHODS

To determine the effects of clonidine on CAT-2 transcription, confluent murine macrophages (RAW264.7 cells) were treated with 1x phosphate buffered saline, clonidine (1000 microM), lipopolysaccharide (LPS, 100 ng/mL), or LPS plus clonidine (10, 100, or 1000 microM). After reacting with LPS for 18 hours or a comparable duration in groups without LPS, cell cultures were harvested and the CAT-2 mRNA concentration was assayed. To determine the stability of CAT-2 mRNA, confluent macrophages were treated with LPS or LPS plus clonidine (100 microM). After reacting with LPS for 6 hours, CAT-2 transcription was terminated and the stability of CAT-2 mRNA was determined.

RESULTS

The CAT-2 mRNA concentration of cell cultures receiving LPS plus clonidine (100 microM) or LPS plus clonidine (1000 microM) were significantly higher than that of the cell cultures receiving LPS alone, whereas the CAT-2 mRNA concentrations of cell cultures receiving LPS plus clonidine (10 microM) was comparable to that of cell cultures receiving LPS alone. The data indicated that clonidine significantly enhanced LPS-induced CAT-2 transcription. The estimated half-life of CAT-2 mRNA of cell cultures receiving LPS was similar to that of cell cultures receiving LPS plus clonidine. These results indicated that clonidine did not affect CAT-2 mRNA stability.

CONCLUSION

Clonidine enhances CAT-2 transcription in endotoxin-activated murine macrophages.

Heart rate variability and daytime functioning in insomniacs and normal sleepers: preliminary results

OBJECTIVES

This study examined the differences in heart rate variability (HRV) and daytime functioning between insomniacs and normal sleepers.

METHODS

All participants underwent an interview, a medical examination, and a sleep measurement protocol during which they wore an actigraph and logged a sleep diary for a 7-day period to verify their eligibility. Included in the study were 18 insomniacs and 21 normal sleepers. During a laboratory session, these participants completed four paper-pencil tests of sleepiness, anxiety, fatigue, and concentration difficulty and the Wisconsin Card Sorting Test. Resting HRV was recorded under paced breathing.

RESULTS

Neither did insomniacs experience cognitive impairment nor did they experience excessive daytime sleepiness compared with normal sleepers. However, insomniacs experienced higher frequency of fatigue [effect size (ES)=1.14, P=.002] compared with normal sleepers. There was also a trend toward higher trait anxiety score (ES=0.62) and concentration difficulty (ES=0.59) in insomniacs than in normal sleepers. Although a tendency toward lower resting high- frequency (HF) HRV (ES=-0.57) in insomniacs than in normal sleepers was noted, neither the resting low-frequency (LF) HRV nor the LF/HF ratio were different between groups. Subjective sleep estimates correlated to self-reported daytime consequences such as fatigue and concentration difficulty but not cognitive function. On the contrary, objective sleep estimates correlated to problem-solving/conceptualization and learning but not self-reported daytime consequences.

CONCLUSIONS

Insomniacs are not sleepier during the day than normal sleepers. However, they may experience such a daytime symptom as fatigue although cognitive function remains unimpaired.

Bupivacaine inhibits COX-2 expression, PGE2, and cytokine production in endotoxin-activated macrophages

BACKGROUND

Upregulation of cyclooxygenase-2 (COX-2) and resultant prostaglandin E(2) (PGE(2)) overproduction has been shown to play a crucial role in initiating a systemic inflammatory response during sepsis. Sepsis also induces robust production of pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and IL-6 as well as anti-inflammatory cytokine IL-10. We sought to elucidate the effects of bupivacaine on COX-2 expression and production of PGE(2) and cytokines using an endotoxin-activated murine macrophages model.

METHODS

Confluent murine macrophages (RAW264.7 cells) were treated with lipopolysaccharide (LPS, 100 ng/ml) or LPS plus bupivacaine (1, 10, or 100 microM). Bupivacaine was added immediately after LPS. After reacting for 18 h, cell cultures were harvested for subsequent analysis.

RESULTS

LPS significantly upregulated COX-2 transcription and PGE(2) production in macrophages. LPS also significantly increased the production of TNF-alpha, IL-1beta, IL-6 and IL-10 in macrophages. Bupivacaine significantly inhibited the effects of LPS on COX-2 transcription and PGE(2) production in a dose-dependent manner. In a dose-dependent manner, bupivacaine also significantly inhibited the effects of LPS on the production of TNF-alpha, IL-1beta, and IL-6. However, bupivacaine exerted no significant effects on LPS-induced IL-10 production.

CONCLUSION

Bupivacaine significantly inhibited COX-2 expression, PGE(2) and cytokine production in endotoxin-activated macrophages.

Effects of Electromyography Biofeedback-Assisted Relaxation on Pain in Patients With Advanced Cancer in a Palliative Care Unit

Most patients with advanced cancer experience pain. However, many cancer patients do not find satisfaction with conventional treatment of pain relief. This study examined the effect of electromyography (EMG) biofeedback-assisted relaxation on cancer-related pain in advanced cancer patients. We hypothesized that changes in EMG activity in frontal muscles underlie the efficacy of EMG biofeedback-assisted relaxation. This was a randomized control study. The experimental group (n = 12) received 6 EMG biofeedback-assisted relaxation sessions over a 4-week period, whereas the control group (n = 12) received conventional care. The primary efficacy measure was the level of pain, measured by the Brief Pain Inventory. Findings from this study show that relaxation training supplemented with visual and auditory EMG biofeedback signals is effective in reducing cancer-related pain in advanced cancer patients, possibly through a mechanism of attenuation of physiological arousal. Electromyography biofeedback-assisted relaxation training may be used along with medications for effective pain management in patients with advanced cancer.

Tubulozole-induced G2/M cell cycle arrest in human colon cancer cells through formation of microtubule polymerization mediated by ERK1/2 and Chk1 kinase activation

Our studies demonstrated that human colon cancer cells (COLO 205), with higher expression level of check point kinase 1 (Chk1), were more sensitive to microtubule damage agent Tubulozole (TUBU) induced G2/M phase arrest than normal human colon epithelial (CRL) cells. TUBU (10 microM, for 3h) treatment resulted in rapid and sustained phosphorylation of Cdc25C (Ser-216) leading to increased 14-3-3beta binding. This resulted in increased nuclear translocation. In addition, TUBU induced phosphorylation of the Cdc25C (Ser-216) and Bad (Ser-155) proteins were blocked by Chk1 SiRNA-transfection. Surprisingly, cellular apotosis was observed in cells treated with TUBU after Chk1 SiRNA inhibition. We further demonstrated that extracellular signal-regulated kinase (ERK) activation by TUBU was needed for Chk1 kinase activation and microtubule formation as shown by the attenuation of these responses by the ERK1/2 specific inhibitor PD98059. However, TUBU induced ERK1/2 phosphorylation was not blocked in the Chk1 SiRNA-transfected COLO 205 cells. These results imply that ERK1/2 mediated Chk1 activation may be play an important role in determining TUBU induced G2/M arrest or apoptosis in COLO 205 cells.

HO-1 overexpression attenuates endotoxin effects on CAT-2 isozymes expression

BACKGROUND

l-arginine transport mediated by type-2 cationic amino acid transporter (CAT-2) isozymes is one crucial mechanism that regulates nitric oxide (NO) production via inducible nitric oxide synthase (iNOS). We sought to investigate the effects of heme oxygenase-1 (HO-1) overexpression on CAT-2 isozymes, e.g., CAT-2, CAT-2A, and CAT-2B.

MATERIALS AND METHODS

Adult male Sprague Dawley rats were allocated to receive lipopolysaccharide (LPS), normal saline, hemin (a HO-1 inducer), tin protoporphyrin (SnPP, a HO-1 inhibitor), LPS plus hemin, or LPS plus hemin plus SnPP. After maintaining for 6 h, rats were sacrificed and the expression and activity of individual enzyme was evaluated.

RESULTS

LPS increased HO activity, HO-1 concentration, NO production, l-arginine transport, and concentrations of iNOS, CAT-2, and CAT-2B in rat lungs and kidney. LPS also increased HO activity, HO-1 concentration, NO production, l-arginine transport, and iNOS concentration but decreased CAT-2 and CAT-2B concentrations in rat liver. LPS increased CAT-2A concentration in rat liver but did not affect CAT-2A concentration in rat lungs and kidney. Hemin further increased HO activity and induced HO-1 overexpression in the lungs, kidney, and liver from LPS-treated rats. In addition, the effects of LPS on NO production, l-arginine transport, and concentrations of iNOS and CAT-2 isozymes were significantly attenuated by hemin. SnPP, on the other hand, reversed the effects of hemin.

CONCLUSIONS

HO-1 overexpression significantly attenuates endotoxin-induced increases in NO production and l-arginine transport. Induction of HO-1 overexpression also significantly attenuates the effects of endotoxin on the expression of iNOS and CAT-2 isozymes in septic rats.

Blood Pressure Biofeedback Exerts Intermediate-Term Effects on Blood Pressure and Pressure Reactivity in Individuals with Mild Hypertension: A Randomized Controlled Study

OBJECTIVE

This randomized controlled study examined whether a 4-week blood pressure (BP) biofeedback program can reduce BP and BP reactivity to stress in participants with mild hypertension.

METHODS

Participants in the active biofeedback group (n=20) were trained in 4 weekly laboratory sessions to self-regulate their BP with continuous BP feedback signals, whereas participants in the sham biofeedback group (n=18) were told to manipulate their BP without feedback signals. BP, skin temperature, skin conductance, BP reactivity to stress, body weight, and state anxiety were assessed before training and repeated at the eighth week after the training.

RESULTS

The decreases in systolic (12.6 +/- 8.8 versus 4.1 +/- 5.7) and mean BP (8.2 +/- 6.9 versus 3.3 +/- 4.9) from baseline at week 12 follow-up were significantly greater in the active biofeedback group compared with the sham biofeedback group (p=0.001 and 0.017, respectively). Results from analysis of covariance with the follow-up systolic blood pressure (SBP) (or mean arterial pressure [MAP]) as the dependent variable, baseline SBP (or MAP) as the covariate, and group as the independent variable showed that biofeedback training effectively lowered SBP and MAP (p=0.013 and 0.026, respectively). The pre-to-post differences in skin conductance and SBP reactivity were statistically significant for the biofeedback group (p=0.005 and 0.01, respectively), but not for the control group. For the sample as a whole and for the biofeedback group, the state anxiety score and body weight remained unchanged.

CONCLUSIONS

BP biofeedback exerts a specific treatment effect in reducing BP in individuals with mild hypertension, possibly through reducing pressor reactivity to stress.

The protective role of heme oxygenase-1 induction on testicular tissues after testicular torsion and detorsion

PURPOSE

Testicular torsion-detorsion has been identified as an ischemia-reperfusion type of injury. We elucidated the protective role of heme oxygenase-1 super induction on testicular torsion-detorsion injury.

MATERIALS AND METHODS

Adult male Sprague-Dawley rats were randomly allocated to undergo testicular torsion-detorsion, immediately followed by injection of normal saline, the heme oxygenase-1 inducer hemin or hemin plus the heme oxygenase-1 inhibitor tin protoporphyrin. Another set of rats that underwent sham operation, immediately followed by injection of normal saline, hemin or hemin plus tin protoporphyrin, served as controls. Testes were harvested 4 and 24 hours after detorsion, respectively, in the experimental groups or at comparable time points in the control groups.

RESULTS

Histological evaluation confirmed that torsion-detorsion caused significant testicular tissue injury. Torsion-detorsion also caused significant increases in the testicular levels of nitric oxide, malondialdehyde, myeloperoxidase activity and heme oxygenase-1. The heme oxygenase-1 inducer hemin significantly enhanced the heme oxygenase-1 expression induced by torsion-detorsion and in turn attenuated testicular injury, and increases in nitric oxide, malondialdehyde and myeloperoxidase activity. In addition, the protective effects of hemin were significantly offset by the heme oxygenase-1 inhibitor tin protoporphyrin.

CONCLUSIONS

Super induction of heme oxygenase-1 protects testes from torsion-detorsion injury.

Acupuncture stimulation of ST36 (Zusanli) attenuates acute renal but not hepatic injury in lipopolysaccharide-stimulated rats

BACKGROUND

We sought to determine the effects of ST36 acupuncture on sepsis-induced kidney and liver injuries.

METHODS

A total of 120 rats were randomized into 10 groups: 1) lipopolysaccharide (LPS), 2) normal saline (N/S), 3) LPS + ST36, 4) ST36, 5) LPS + P-ST36, 6) P-ST36, 7) LPS + Sham, 8) Sham, 9) LPS + P-Sham, and 10) P-Sham groups. Rats in the LPS + ST36, ST36, LPS +Sham, and Sham groups received ST36 (designated as "ST36") or a nonacupoint (designated as "Sham") acupuncture for 30 min followed by LPS or N/S injection. Rats in the LPS + P-ST36, P-ST36, LPS + P-Sham, and P-Sham groups received LPS or N/S injection for 3 h followed by a 30 min of ST36 or a "nonacupoint" acupuncture. Rats were killed at 6 h after LPS injection.

RESULTS

LPS caused prominent kidney and liver injuries. The renal and hepatic nitric oxide (NO) concentrations and inducible NO synthase (iNOS) expression were also increased by LPS. ST36 acupuncture pretreatment significantly attenuated the LPS-induced kidney injury and the increases in renal NO concentration and iNOS expression. However, ST36 acupuncture pretreatment did not affect the LPS-induced liver injury and increases in hepatic NO concentration or iNOS expression. Furthermore, ST36 acupuncture performed after LPS did not affect the LPS-induced organ injuries or increases in NO concentration and iNOS expression.

CONCLUSIONS

ST36 acupuncture pretreatment significantly attenuated sepsis-induced kidney, but not liver, injury in rats, whereas ST36 acupuncture performed after sepsis induction had no protective effects against sepsis-induced organ injuries.

Postoperative delayed respiratory failure caused by Guillain-Barré syndrome--a case report

Postoperative respiratory failure caused by Guillain-Barré syndrome (GBS) is a rare complication after general anesthesia. We report a GBS patient who after receiving an operation for polycystic liver disease under general anesthesia developed weakness of upper and lower extremities on the 3rd postoperative day, with decreased deep tendon reflex, which ultimately evolved into respiratory failure. Slurred speech and bilateral ptosis were also noted. All these manifested an acute peripheral polyneuropathy combined with bulbar involvement. According to the clinical picture, CSF examination and results of nerve conduction tests, Guillain-Barré syndrome was diagnosed. Plasmapheresis was immediately arranged and her motor weakness problem was soon improved after treatment. No neurological sequelae were found two months after discharge. Postoperative muscle weakness is usually caused by residual effects of anesthetic agents or surgical complications. But it may sometimes be related to some rare neurological diseases. To prompt an accurate diagnosis of Guillain-Barré syndrome is important because it can help forestall fatal complications. In addition, the prognosis will be encouraging with early treatment.

Perioperative vasovagal syncope with focus on obstetric anesthesia

Vasovagal syncope refers to a reflex cardiovascular depression that gives rise to loss of consciousness with bradycardia and profound vasodilatation. This response commonly occurs during regional anesthesia, hemorrhage or supine inferior vena cava compression in pregnancy. The changes in circulatory response from the normal maintenance of arterial pressure to parasympathetic activation and sympathetic inhibition may cause severe hypotension. This change is triggered by reduced cardiac venous return as well as episodes of emotional stress, excitement or pain. Occasionally, these vasovagal responses may be unpredictable and may dramatically proceed to asystole with circulatory collapse, and may even result in death. In these circumstances, hypotension may be more severe than that caused by bradycardia alone, because of unappreciated vasodilatation. Regional anesthesia, decreased venous return, hemorrhage and abnormal fetal presentation cumulatively increase the risk of vasovagal syncope in cesarean section patients. When a vasovagal response occurs, ephedrine is the drug of first choice because of its combined action on the heart and peripheral blood vessels. Epinephrine must be used early in established cardiac arrest, especially after high regional anesthesia.

Demographic characteristics and perceived health status of users of folk therapies in Taiwan

OBJECTIVES

This study examined the prevalence of folk therapy use among Taiwanese adults and factors associated with such use.

SUBJECTS AND METHODS

The data used in this study were from the 2001 National Health Interview Survey in Taiwan, which utilized a multistaged stratified systematic sampling scheme. Included in the current analysis were 11,290 individuals from 20 to 65 years.

RESULTS

Only 1.3% of those surveyed were classified as users of folk therapy. Users of folk therapies were older (p = 0.002), had higher annual incomes (p < 0.001), and experienced more health problems (p = 0.006) than nonusers. The two groups were comparable in the areas of marital status, employment status, gender, and educational level. Users had lower scores in the physical functioning (p < 0.001), role physical (p = 0.041), general health perception (p = 0.002), and bodily pain (p < 0.001) domains of the Medical Outcome Studies 36-Item Short-Form Health Survey. The two groups were not significantly different regarding the utilization and satisfaction with conventional medical resources and the domain scores of the brief version of the World Health Organization Quality of Life (QOL) questionnaire.

CONCLUSIONS

Less than 2% of adult Taiwanese population reported relying primarily on folk therapies for their common physical discomfort. Users of folk therapies are older, have higher incomes, and have more health problems and poorer health-related QOL, but they neither make more frequent use of conventional medical services nor are they dissatisfied with the available services.

Heme Oxygenase 1, Nuclear Factor E2–related Factor 2, and Nuclear Factor κB Are Involved in Hemin Inhibition of Type 2 Cationic Amino Acid Transporter Expression and l-Arginine Transport in Stimulated Macrophages

Background

L-Arginine transport mediated by type 2 cationic amino acid transporter (CAT-2) is one crucial mechanism that regulates nitric oxide production mediated by inducible nitric oxide synthase. Heme oxygenase (HO)-1 induction has been reported to significantly attenuate inducible nitric oxide synthase expression and nitric oxide production. The authors sought to explore the effects of HO-1 induction on CAT-2 expression and L-arginine transport. The effects of HO-1 induction on nuclear factor E2-related factor 2 (Nrf2) and nuclear factor kappaB (NF-kappaB) were also investigated.

Methods

Murine macrophages (RAW264.7 cells) were randomized to receive lipopolysaccharide, lipopolysaccharide plus hemin (an HO-1 inducer; 5, 50, or 500 microm), lipopolysaccharide plus hemin (5, 50, or 500 microm) plus tin protoporphyrin (an HO-1 inhibitor), or lipopolysaccharide plus hemin (5, 50, or 500 microm) plus hemoglobin (a carbon monoxide scavenger). Then, cell cultures were harvested and analyzed.

Results

Lipopolysaccharide significantly induced Nrf2 activation and HO-1 expression. Lipopolysaccharide also significantly induced NF-kappaB activation, CAT-2 expression, and L-arginine transport. In a dose-dependent manner, hemin enhanced the lipopolysaccharide-induced Nrf2 activation and HO-1 expression. In contrast, hemin, also in a dose-dependent manner, significantly attenuated the lipopolysaccharide-induced NF-kappaB activation, CAT-2 expression, and L-arginine transport. Furthermore, the effects of hemin were significantly reversed by both tin protoporphyrin and hemoglobin.

Conclusions

HO-1 induction significantly inhibited CAT-2 expression and L-arginine transport in lipopolysaccharide-stimulated macrophages, possibly through mechanisms involved activation of Nrf2 and inhibition of NF-kappaB. In addition, carbon monoxide mediated, at least in part, the effects of HO-1 induction on CAT-2 expression and L-arginine transport.

HO-1 Mediates the Effects of HBO Pretreatment Against Sepsis

BACKGROUND

We have recently shown that attenuation of sepsis-induced lung injury by hyperbaric oxygen (HBO) pretreatment involves expression regulation of inducible nitric oxide synthase (iNOS) and heme oxygenase (HO)-1. This study was performed to determine the effects of HBO pretreatment on acute kidney and liver injuries in septic rats and the roles of iNOS and HO-1.

MATERIALS AND METHODS

One group of adult male rats (n = 48) were pretreated with HBO. The other group of rats (n = 48) breathed air at normal atmospheric pressure instead. Rats in each group were randomly allocated to receive injection of lipopolysaccharide (LPS), normal saline (N/S), LPS plus hemin (a HO-1 inducer), hemin, LPS plus SnPP (a HO-1 inhibitor), SnPP, LPS plus hemin plus SnPP, or hemin plus SnPP. Hemin and SnPP were injected at 1 h before HBO or air pretreatment. Rats were maintained for 6 h before sacrifice.

RESULTS

LPS caused prominent kidney and liver injuries as well as iNOS and HO-1 expression in stimulated rats. HBO pretreatment significantly attenuated LPS-induced kidney but not liver injury. However, in conjunction with hemin (a HO-1 inducer), HBO pretreatment did attenuate LPS-induced liver injury. In addition, the inhibition of iNOS expression by HBO pretreatment was associated with "super-induction" (i.e., further enhancement) of LPS-induced HO-1 expression. Furthermore, the therapeutic effect of HBO could be counteracted by SnPP (a HO-1 inhibitor).

CONCLUSIONS

HBO pretreatment significantly attenuates LPS-induced acute organ injuries in septic rats. The beneficial effect of HBO pretreatment against sepsis is mediated, at least in part, by "super-induction" of HO-1.

Thermal Biofeedback for Primary Raynaud’s Phenomenon: A Review of the Literature

The clinical presentation of primary Raynaud's phenomenon (RP) derives from various pathogenic triggers. The use of thermal biofeedback (TBF) may be of benefit in reducing the severity and frequency of attacks. This article summarizes the relevant research regarding the pathophysiology of primary RP and mechanism of TBF for RP. Systematic reviews of the efficacy of TBF for RP and treatment guidelines for clinicians are provided. The panel concludes that the level of evidence for TBF efficacy is categorized as Level IV: efficacious. The rationale, based on three randomized controlled trials conducted in independent laboratories, demonstrated "superiority or equivalence" of treatments that include TBF. However, randomly controlled trials (RCT) with positive clinical outcomes tended to be small. A large RCT with negative results did not effectively teach handwarming skills. Procedures for reviewing and rating of the levels of evidence of efficacy of studies was based on the Template for Developing Guidelines for the Evaluation of the Clinical Efficacy of Psychophysiological Interventions developed by the joint task force of the AAPB and the Society for Neuronal Regulation (SNR).