Hepatic stellate cells on poly(DL-lactic acid) surfaces control the formation of 3D hepatocyte co-culture aggregates in vitro

Evidence for the functional superiority of cells cultured as 3D aggregates or on 3D scaffolds over conventional 2D monolayer cultures has created interest in material and cell based methods that influence the formation and structure of multicellular aggregates in vitro. We have created a co-culture of primary rat hepatocytes and hepatic stellate cells on a poly(DL-lactic acid) surface, a poor substrate for rat hepatocyte adhesion, to study the dynamics of multicellular spheroid formation and the resultant cell arrangement. The poly(DL-lactic acid) surface allows dynamic and rapid interaction of hepatocytes and stellate cells to form co-culture spheroids in a complex multistage process (shown by time lapse microscopy). This spheroid morphology supports enhanced cell viability relative to a mono-culture mono-layer system (measured by lactate dehydrogenase leakage). The distribution of the aggregating cell type in the final structure is related to the mechanics of formation i.e. mainly central and peripheral. This study provides a unique and generically applicable insight into the dynamics of multicellular spheroid formation where aggregation is induced by one cell type and imposed on another. This has implications for 3D cell culture models and a wide number of currently used stromal co-culture systems.

Cardiac rehabilitation after myocardial infarction: a review to understand barriers to participation and potential solutions

As survival after myocardial infarction (MI) improves, secondary prevention is becoming increasingly important. Cardiac rehabilitation (CR) is one modality for delivery of secondary prevention, whose ultimate goal is to help patients receive appropriate preventive therapies that will help them optimize health and reduce the risk of future cardiac diseases. However, participation rates in CR are less than optimal: in the United States, only 29.5% of MI survivors participated, in Japan 21% of those with acute MI, and in Australia 29% of those eligible were referred, and only 1/3 of those referred acutally attended CR; moreover, there does not appear to be a trend towards increasing participation over time. After reviewing the components of CR and the benefits of participation, this paper will focus on the barriers to participation in CR: from a theoretical framework to consider barriers at patient, provider, health system, and societal levels. We then explore the possible solutions to overcome them and finally propose recommendation for future research.

Low-Concentration Carbon Dioxide is an Effective Adjunct to Positive Airway Pressure in the Treatment of Refractory Mixed Central and Obstructive Sleep-Disordered Breathing

OBJECTIVES

To assess the efficacy of added carbon dioxide as adjunctive therapy to positive airway pressure-refractory mixed obstructive and central sleep-disordered breathing, using a prototype device-the positive airway pressure gas modulator.

DESIGN

Open-label evaluation of low concentrations of carbon dioxide added to a positive airway pressure circuit.

SETTING

Physician-attended polysomnographic titration in a free-standing sleep laboratory with end-tidal and transcutaneous carbon-dioxide monitoring.

PATIENTS

Six adult men (age 54 +/- 5.7 years) with severe poorly controlled mixed sleep-disordered breathing in the absence of renal or heart failure.

INTERVENTIONS

Flow-independent addition of incremental concentrations of carbon dioxide during sleep.

MEASUREMENTS AND RESULTS

The respiratory disturbance index before treatment was 66 +/- 14.5 events per hour of sleep, with a nocturnal desaturation low of 84.6% +/- 10.1%. Residual respiratory disturbance index on best treatment was 43 +/- 9 events per hour of sleep. There was an immediate (<1 minute) response to the addition of 0.5% to 1% carbon dioxide, and minimal changes were required to be made across the night. There was no discomfort, shortness of breath, palpitations, headache, or significant increase in respiratory or heart rate. The residual respiratory disturbance index on carbon dioxide, scored irrespective of desaturations, was in the normal range (< 5 / hour of sleep). Two subjects had a second night at the concentration of carbon dioxide determined to be efficacious, with no required concentration change. No adverse effects on overall sleep architecture were noted.

CONCLUSIONS

Low concentrations of carbon dioxide added to conventional positive airway pressure effectively control severe treatment-resistant mixed obstructive and central sleep-disordered breathing.

Recognition, diagnosis and management of obesity after myocardial infarction

OBJECTIVE

We investigated the documentation of obesity as a medical problem, and subsequent management recommendations, in patients after myocardial infarction (MI).

DESIGN

We performed a cross-sectional analysis of a randomly selected sample of 627 patients discharged after an MI, from five US teaching hospitals between 1/1/01 and 12/31/02. Information was extracted from clinical notes using standardized definitions.

RESULTS

Mean body mass index (BMI) was 31+/-13 kg/m2, which was documented in only 14% of patients and had to be calculated post hoc in the rest. Waist circumference and waist/hip ratio were not documented at all; 83% of patients were overweight, 55% obese, and 8% morbidly obese. In only 20% of patients with BMI> or =30 kg/m2 was the diagnosis of obesity documented either as a current medical problem, as part of past medical history or as a final diagnosis. A dietary counseling was carried out in 61% of patients with BMI> or =25 kg/m2 and in 61% of patients with BMI<25 kg/m2, P=0.96. Weight loss was described as part of the goals/plan at discharge in 7% of overweight and 9% of obese patients. There was no change in either the level of recognition of obesity (22 vs 19%, P=0.3) or in the proportion of obese patients for whom weight loss was described as part of the goals/plan at discharge (8 vs 10%, P=0.7) before (n=301) compared to after (n=326) the Call to Action in Obesity by the Surgeon General in December 2001.

CONCLUSION

Obesity is underecognized, underdiagnosed and undertreated in persons with acute MI.

Microbiological status of piggery effluent from 13 piggeries in the south east Queensland region of Australia

AIMS

To assist in the development of safe piggery effluent re-use guidelines by determining the level of selected pathogens and indicator organisms in the effluent ponds of 13 south-east Queensland piggeries.

METHODS AND RESULTS

The numbers of thermotolerant coliforms, Campylobacter jejuni/coli, Erysipelothrix rhusiopathiae, Escherichia coli, Salmonella and rotavirus were determined in 29 samples derived from the 13 piggeries. The study demonstrated that the 13 final effluent ponds contained an average of 1.2 x 10(5) colony-forming units (CFU) 100 ml(-1) of thermotolerant coliforms and 1.03 x 10(5) CFU 100 ml(-1) of E. coli. The Campylobacter level varied from none detectable (two of 13 piggeries) to a maximum of 930 most probable number (MPN) 100 ml(-1) (two of 13 piggeries). Salmonella was detected in the final ponds of only four of the 13 piggeries and then only at a low level (highest level being 51 MPN 100 ml(-1)). No rotavirus and no Erysip. rhusiopathiae were detected. The average log10 reductions across the ponding systems to the final irrigation pond were 1.77 for thermotolerant coliforms, 1.71 for E. coli and 1.04 for Campylobacter.

CONCLUSIONS

This study has provided a baseline knowledge on the levels of indicator organisms and selected pathogens in piggery effluent.

SIGNIFICANCE AND IMPACT OF THE STUDY

The knowledge gained in this study will assist in the development of guidelines to ensure the safe and sustainable re-use of piggery effluent.

Helicobacter pylori-induced homotypic phagosome fusion in human monocytes is independent of the bacterial vacA and cag status

Following reports that a VacA+cag+ toxigenic but not a VacA-cag- non-toxigenic Helicobacter pylori strain induced homotypic phagosome fusion in murine macrophages, we addressed that phenomenon in human cells. Mononuclear phagocytes and epitheloid cells were challenged with H. pylori strains of different vacA and cag genotypes and with VacA- and Cag- isogenic mutants, and chased in the absence or presence of signal transduction modulators. Electron microscopy revealed that, in monocytes: (i) homotypic phagosome fusion was frequently induced by all live H. pylori strains investigated but not by exogenous VacA; (ii) phagosomes containing bacteria fused, but not those containing latex beads; (iii) fusion resulted in communal compartments resembling giant multivesicular bodies; and (iv) formation of these compartments was blocked by inhibiting the host cell regulators PI 3-kinase, phospholipase C and p42 MAP kinase. Whereas some internalized bacteria remained viable 1 h after uptake, none survived a 24 h period. In contrast to monocytes, infected epitheloid cells rarely developed communal compartments. In combination, these results demonstrate that, in human monocytes, the H. pylori-induced homotypic phagosome fusion depends on neither the vacuolating cytotoxin VacA nor the cag pathogenicity island of H. pylori and does not result in prolonged intracellular survival.

Cyclic alternating pattern and positive airway pressure titration

OBJECTIVE

To demonstrate that stability of the upper airway during continuous positive airway pressure (CPAP) titration is influenced by the microstructure of sleep as defined by the cyclic alternating pattern (CAP).

METHODS

Retrospective review of 12 CPAP titration records. The patterns of flow-limitation during CPAP at subtherapeutic pressures were characterized as 'stable' (persistent and non-progressive inspiratory flow limitation) or 'unstable' (progressive increase in inspiratory flow-limitation terminating in an arousal), and continuous periods of at least 10 min were identified. Sleep stage scoring by both conventional Rechtshaffen and Kales criteria and the CAP were done. The relationship between flow type and CAP was determined. Responses to an increase in applied pressure on flow-limitation were noted.

RESULTS

There were a total of 50 periods fulfilling the above criteria, totaling 1113 min of titration time. Thirty periods (757 min, 68% of total) showed a stable flow-limitation pattern. A total of 29/30 periods showing a stable flow pattern during sleep was scored as non-CAP, and only a single 18-min period of stable flow was scored as CAP. A total of 19/20 periods showing an unstable flow pattern was in sleep with CAP characteristics, the exception being a single 14-min period where unstable flow was noted in non-CAP. Flow-limitation was stable and non-progressive or absent during non-CAP, even at less than optimal pressures. This was noted irrespective of the presence or absence of delta sleep as scored by conventional criteria. Pressure increases during non-CAP, when the profile of the inspiratory flow was flattened, never resulted in a discernable change in the flow profile, while at least two-thirds of pressure increments during CAP periods improved flow.

CONCLUSIONS

The microstructure of sleep as determined by CAP and non-CAP have practical implications for manual pressure titration algorithms and research on upper airway physiology during sleep. The appearance of a period of non-CAP, irrespective of conventionally scored delta sleep, may falsely suggest that the CPAP is optimal or close to it. Large increases in non-CAP that may be seen during a titration night can reduce the window of opportunity for titration. Increases in CPAP should be avoided in non-CAP.

Arousals in Sleep-disordered Breathing: Patterns and Implications

STUDY OBJECTIVE

To describe the whole spectrum of electroencephalographic (EEG) transients associated with the termination and recovery of obstructed respiratory events and, thus, widen the recognized spectrum of arousal phenomena from sleep.

DESIGN

Retrospective review of diagnostic polysomnograms.

SETTING

American Academy of Sleep Medicine (AASM)-accredited multidisciplinary sleep disorders center.

PATIENTS

17 patents with obstructive sleep-disordered breathing.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Nasal airflow using a nasal-cannula-pressure-transducer system and oral flow by a thermistor were used to score apneas and hypopneas; the latter included flow-limitation events. The EEG patterns that crested or occurred within 2 to 3 seconds of respiratory recovery were recorded, and posthoc categories were created for the purpose of tabulation ranging from an AASM 3-second arousal to a single K-complex with no electromyographic increase. Chi-square statistic was calculated to assess the difference in EEG patterns at event termination between apneas and hypopneas. Score-rescore agreement was tested. Apneas were significantly more likely to be associated with a 3-second arousal than were hypopneas, but all types of EEG change were seen with both types of events. Spindles were rarely seen with arousal-linked K-complexes. The majority of events in rapid eye movement sleep were terminated with visible electromyography tone increase.

CONCLUSIONS

The spectrum of EEG change associated with the termination of respiratory events identified by using a nasal-cannula-pressure-transducer system is wider than that recognized as arousal phenomena by the 1992 AASM criteria. Scoring arousals with the 3-second rule may falsely minimize the apparent impact of abnormal breathing on sleep. The time may be right to update arousal recognition rules.

Helicobacter pylori upregulates matrilysin (MMP-7) in epithelial cells in vivo and in vitro in a Cag dependent manner

BACKGROUND AND AIMS

Matrix metalloproteinase-7 (MMP-7) is important in normal and pathological remodelling of epithelial-matrix interactions, and is upregulated in gastric cancer. Helicobacter pylori infection is the first stage in gastric carcinogenesis, and therefore our aim was to determine if H pylori upregulated gastric MMP-7 expression and if this was affected by strain virulence.

METHODS

We took gastric biopsy specimens at endoscopy from H pylori infected (n = 17) and uninfected (n = 18) patients and assessed MMP-7 expression by ELISA, real time polymerase chain reaction (PCR), and immunohistochemistry (concentrating on epithelial cells in the proliferative zone). We PCR typed H pylori for cagE and vacA. We performed H pylori/cell line coculture studies with wild-type pathogenic and non-pathogenic H pylori strains and with CagE(-) and VacA(-) isogenic mutants.

RESULTS

Gastric biopsy specimens from H pylori+ patients expressed higher levels of MMP-7 at the protein and mRNA levels in the antrum and corpus (for example, by ELISA: H pylori+ 0.182 OD units vH pylori- 0.059; p = 0.009 antrum). Epithelial cells from H pylori+ patients stained more intensely for MMP-7 than those from uninfected patients, including in the proliferative zone containing pluripotent cells (p<0.03 antrum, p<0.04 body). Upregulation of MMP-7 in epithelial cells was confirmed at the protein and mRNA levels by H pylori/cell line coculture. These experiments also showed that MMP-7 upregulation was dependent on an intact H pyloricag pathogenicity island but not on the vacuolating cytotoxin.

CONCLUSION

We speculate that increased expression of MMP-7 in H pylori gastritis may contribute to gastric carcinogenesis.

Lessons learned from raltitrexed--quality assurance, patient education and intensive supportive drugs to optimise tolerability

Although recent trials have raised concerns about the toxicity of raltitrexed monotherapy in patients with advanced colorectal cancer (aCRC), similar concerns have also been raised with other chemotherapy regimens in aCRC. The lessons learnt form our previous experiences with raltitrexed are, therefore, still important as they offer practical guidances to optimise tolerability of chemotherapy for CRC in general. The aims of the study were to report the low-toxicity profile in 58 patients receiving raltitrexed when a rigorous patient information and education strategy was implemented together with an intensive supportive adjuvant drugs regimen from the start. After a discussion with the consultant, all patients received a further consultation with a specialist nurse, a series of bespoke information tools, including an information video and written guidelines on how to avoid, prevent and deal promptly with the side-effects of raltitrexed. They all received intravenous adjuvant ondansetron and dexamethasone, then oral domperidone, ranitidine and nystatin from cycle one. The dose intensity was 98% over 307 cycles. Toxicity associated with raltitrexed comprised grade 1/2 diarrhoea (31.6% of treatment cycles), nausea (12.4%) and vomiting (8.4%), with no grade 3/4 events; grade 1/2 alopecia (17.9%); grade 1 (only) stomatitis (2.3%) and grade 1/2/3 lethargy (70.3%, only 2.3% grade 3), anaemia (14.3%, only 0.3% grade 3) and neutropenia (3.3%, only 0.3% grade 3). There were no treatment-related deaths. The low toxicity, despite high-dose intensity, suggests that intensive supportive education and drugs should have a role in the future design of regimens containing raltitrexed and other chemotherapy regimens for colorectal carcinoma.

Microsatellite instability in gastrointestinal tract tumours

Although a number of studies have documented microsatellite instability (MSI) in gastrointestinal tumours, the clinical significance is uncertain. In this study the MSI status and clinicopathological features were examined in gastric and colorectal tumours. Eighty-four gastrointestinal tumours were examined for MSI. Normal and tumour DNA isolated from the same patients were analysed at five different microsatellite loci. Clinical features of these patients were also collated and compared with MSI status. High level MSI (MSI-H) (as defined by instability in 2 or more microsatellites) was detected in 6 out of 47 (13%) colon tumours and 6 of 37 (16%) gastric tumours. The frequency of MSI-H between these groups was not statistically significant (P = 0.36). There was no significant correlation with patient age or gender, UICC stage, or degree of differentiation of the tumour. This was true both when analysed as a group, as well as when divided into colon and gastric sites. Our results confirm that a proportion of sporadic tumours from the colon and stomach exhibit an MSI-H phenotype. However, there was no significant relationship between the presence of MSI and any of the clinicopathological characteristics studied.

Parathyroid hormone-related protein (PTHrP)-(1-139) isoform is efficiently secreted in vitro and enhances breast cancer metastasis to bone in vivo

Parathyroid hormone-related peptide (PTHrP) is a mediator of local osteolysis due to breast cancer. Three isoforms of PTHrP, (1-139), (1-141), and (1-173), are products of alternative splicing in humans, but the specific contribution of each of these isoforms to osteolytic metastasis caused by breast cancer has not been evaluated. To determine the role of PTHrP isoforms in breast cancer metastasis to bone, the human breast cancer cell line MDA-MB-231 (MDA-231) was stably transfected with cDNAs for human prepro PTHrP-(1-139), -(1-141), or -(1-173). Stable MDA/PTHrP-(1-139) clones expressed more PTHrP mRNA and secreted more PTHrP protein, compared with MDA/PTHrP-(1-141), -(1-173), or parental MDA-231. Parental MDA-231 cells and clones expressing each isoform had similar growth rates in vitro. In a mouse model of bone metastases, the osteolytic lesion area of radiographs was greatest in mice bearing MDA/PTHrP-(1-139) compared with those bearing MDA/PTHrP-(1-141), -(1-173), or parental MDA-231. Ca(++) and plasma PTHrP concentrations were significantly higher in the MDA/PTHrP-(1-139) compared with the MDA/PTHrP-(1-141), -(1-173), or parental MDA-231 groups. These data demonstrate that the PTHrP-(1-139) isoform was produced to a greater extent than PTHrP-(1-141) or -(1-173), and in vivo enhanced osteolysis with increased plasma PTHrP concentrations and hypercalcemia compared with overexpression of PTHrP-(1-141) or -(1-173).

Does type of surgeon matter in rectal cancer surgery? Evidence, guideline consensus and surgeons' views

One of the most obvious but controversial trends in contemporary surgical practice is that of subspecialization. There is a lack of definitive evidence that subspecialization improves cancer outcomes largely because previous research is compromised by confounding variables of referral practice, lack of standardized definitions of surgical skills and selection bias. Randomized controlled trials of generalized versus subspecialist surgical care are unlikely ever to be performed. The present study of surgeons' views about the role of subspecialization in the care of colorectal cancer patients demonstrates partisan reactions among surgeons themselves (89% response rate). Results of national audits will contribute to wider debate about surgical subspecialization in colorectal cancer.

Id2 is a target of the beta-catenin/T cell factor pathway in colon carcinoma

Activation of beta-catenin/T cell factor (TCF) transcription as a result of mutations in the adenomatous polyposis coli (APC) and/or beta-catenin genes occurs in the majority of colon tumors. An increasing number of genes, including c-myc and cyclin D1, have been implicated as targets of this pathway. We now report that the dominant negative helix-loop-helix regulator Id2 is also a target of the beta-catenin/TCF transcription pathway in colon adenocarcinoma. Investigation of the mechanism for the overexpression of Id2 in colon carcinoma cells demonstrated that the Id2 promoter is activated, and the Id2 protein is up-regulated by beta-catenin. Conversely, reducing free beta-catenin blocked this induction of promoter activity. We have also used an electrophoretic mobility shift assay and supershift to identify a motif in the Id2 promoter that binds to TCF4 protein. Site-directed mutagenesis of this motif abolished promoter reporter activity. Both transfection of Id2 into SW480 cells and induction of Id2 in HT29 colon cells was found to increase anchorage-independent survival of these cells. Growing evidence associates disruption to Id2 expression with tumorigenesis, and our findings suggest that this dysregulation of Id2 expression is due to the activation of the beta-catenin/TCF pathway.

The phosphatidylinositol 3'-kinase p85alpha gene is an oncogene in human ovarian and colon tumors

Phosphatidylinositol 3'-kinases (PI3ks) are a family of lipid kinases that play a crucial role in a wide range of important cellular processes associated with malignant behavior including cell growth, migration, and survival. We have used single-strand conformational polymorphism/heteroduplex analysis to demonstrate the presence of somatic mutations in the gene for the p85alpha regulatory subunit of PI3k (PIK3R1) in primary human colon and ovarian tumors and cancer cell lines. All of the mutations lead to deletions in the inter-SH2 region of the molecule proximal to the serine608 autoregulatory site. Expression of a mutant protein with a 23 amino acid deletion leads to constitutive activation of PI3k providing the first direct evidence that p85alpha is a new oncogene involved in human tumorigenesis.

Sodium butyrate-induced differentiation of human LIM2537 colon cancer cells decreases GSK-3beta activity and increases levels of both membrane-bound and Apc/axin/GSK-3beta complex-associated pools of beta-catenin

Analysis of the glycogen synthase kinase-3beta (GSK-33) activity in several colon cancer cell lines suggested a correlation between comparatively low enzyme activity and moderate to high differentiation status. Treatment of LIM2537 cells, a poorly differentiated colon cancer cell line, with the potent differentiating agent sodium butyrate resulted in 34% reduction in GSK-3beta activity in the treated cells (P < 0.028, n = 3). Decreases in GSK-3beta activity were paralleled by stabilization of cytoplasmic beta-catenin, a hallmark of Wnt signaling. However, in contrast to Wnt signaling, expression of the beta-catenin/ TCF target genes c-myc and cyclin D1 did not appear to be increased in the sodium butyrate-treated cells. Interestingly, expression of membrane-bound beta-catenin was increased in the sodium butyrate-treated cells. This suggests that, in the context of cellular differentiation, increases in beta-catenin expression may be sequestered at the cell membrane and suggests that a possible role of sodium butyrate in promoting differentiation may be via increasing the levels of beta-catenin available for cell adhesion.

Expression of interleukin-6, leukemia inhibitory factor and their receptors by colonic epithelium and pericryptal fibroblasts

BACKGROUND AND AIM

The cellular configuration of the human colon suggests a predetermined organization that creates specific microenvironments. The role of pericryptal fibroblasts in this microenvironment has been the subject of considerable speculation. This study examined the expression of growth factors and their receptors by colonic crypt epithelium and pericryptal fibroblasts.

METHODS AND RESULTS

Pericryptal fibroblast cells were isolated and cultured from decrypted human colonic mucosa. The pericryptal fibroblast cells expressed messenger RNA (mRNA) for interleukin-6 (IL-6), leukemia inhibitory factor (LIF), LIF receptor alpha, and the common coreceptor glycoprotein 130 (GP130), but not the IL-6 receptor alpha. Interleukin-6 protein expression was confirmed by the analysis of conditioned medium and immunohistochemistry. In comparison, normal colonic epithelial cells express mRNA for LIF but not IL-6 as well as the receptors for GP-130, IL-6 receptor alpha but not LIF receptor alpha. As cultures of normal human colonic epithelial cells were not available, the conditioned medium was assayed from established colon carcinoma cell lines and demonstrated a secretion of LIF but not IL-6 protein.

CONCLUSION

The expression of reciprocal cytokine and receptor expression suggest that there is a paracrine relationship between pericryptal fibroblasts and colonic epithelium.

Activation of nuclear factor-kappa B by podocytes in the autologous phase of passive Heymann nephritis

BACKGROUND

The present study examined whether activation of nuclear factor-kappa B (NF-kappa B) occurs within podocytes in passive Heymann nephritis (PHN) and contributes to the pathogenesis of proteinuria.

METHODS

Electrophoretic mobility shift assays (EMSAs) were used to detect NF-kappa B activation, and supershift assays were used to determine the subunits involved. Localization of the activated NF-kappa B subunit p50 was performed by immunohistochemistry. Expression of the NF-kappa B-dependent genes interleukin-1 beta (IL-1 beta) and matrix metalloproteinase-9 (MMP-9) were determined by reverse transcription-polymerase chain reaction and, for IL-1 beta, immunohistochemistry. To inhibit activation of NF-kappa B in vivo, pyrrolidone dithiocarbamate (PDTC) was administered for 10 days following induction of PHN.

RESULTS

Glomerular nuclear extracts from rats with PHN showed increased NF-kappa B binding activity in comparison to normal rats. The major Rel/NF-kappa B proteins in these activated complexes were p65 and p50. Immunohistochemistry showed that nuclear translocation of p50 occurred predominantly within podocytes. IL-1 beta mRNA was increased in the PHN rats, and increased IL-1 beta protein was localized predominantly to podocytes by immunohistochemistry. To investigate whether activation of NF-kappa B is involved in the pathogenesis of proteinuria, PDTC was administered to rats with PHN. Electrophoretic mobility shift assays of glomerular nuclear extracts showed a significant reduction in NF-kappa B binding activity in the PDTC-treated rats with a striking reduction in MMP-9 mRNA. Compared with control rats, there was a significant reduction in albuminuria at days 15 (P < 0.001) and 20 (P < 0.001) when PHN was induced with a suboptimal dose of anti-Fx1A antiserum. There was no detectable difference in the systemic immune response to sheep Ig in the treated rats.

CONCLUSIONS

These data show that NF-kappa B is activated within podocytes in PHN and suggest that it contributes to autologous phase proteinuria. The critical genes regulated by NF-kappa B in the podocyte have not yet been determined, but may include MMP-9.

Attitudes of Olmsted County, Minnesota, residents about tobacco smoke in restaurants and bars

OBJECTIVE

To determine the attitudes of Olmsted County, Minnesota, adults about environmental tobacco smoke in restaurants, bars, and nightclubs.

SUBJECTS AND METHODS

In this population survey,2014 adults were contacted by random digit dial methods between February 28 and May 5, 2000, and asked to participate in a telephone survey; 1224 (61%) consented.

RESULTS

For the 57% (95% confidence interval [CI], 54%-60%) of the study population that reported exposure to environmental tobacco smoke, the most frequently reported sites of exposure were restaurants (44% [95% CI, 41%-48%]), work (21% [95% CI, 18%-24%]), and bars (19% [95% CI, 16%-22%]). Seventy-two percent (95% CI, 69%-74%) of respondents said that they would select a smoke-free restaurant over one where smoking is permitted, and 70% (95% CI, 67%-72%) said that they would select a smoke-free bar over one where smoking is permitted. The majority of respondents said that they would not dine out or visit bars or nightclubs more often or less often if all restaurants, bars, and nightclubs were smoke-free.

CONCLUSIONS

Olmsted County residents prefer smoke-free restaurants, bars, and nightclubs.