Overexpressing endothelial cell protein C receptor alters the hemostatic balance and protects mice from endotoxin

Previous studies have shown that blocking endothelial protein C receptor (EPCR)-protein C interaction results in about an 88% decrease in circulating activated protein C (APC) levels generated in response to thrombin infusion and exacerbates the response to Escherichia coli. To determine whether higher levels of EPCR expression on endothelial cells might further enhance the activation of protein C and protect the host during septicemia, we generated a transgenic mouse (Tie2-EPCR) line which placed the expression of EPCR under the control of the Tie2 promoter. The mice express abundant EPCR on endothelial cells not only on large vessels, but also on capillaries where EPCR is generally low. Tie2-EPCR mice show higher levels of circulating APC after thrombin infusion. Upon infusion with factor Xa and phospholipids, Tie2-EPCR mice generate more APC, less thrombin and are protected from fibrin/ogen deposition compared with wild type controls. The Tie2-EPCR animals also generate more APC upon lipopolysaccharide (LPS) challenge and have a survival advantage. These results reveal that overexpression of EPCR can protect animals against thrombotic or septic challenge.

Genetic effects of rainforest fragmentation in an early successional tree (Elaeocarpus grandis)

Rainforests in Australia and around the world have been extensively cleared and degraded. It is essential to recognize the changes in population diversity and dynamics that follow habitat fragmentation if better conservation and management strategies are to be developed. This study is an investigation of the medium term (over 100 years) effects of rainforest fragmentation on a long-lived, early successional tree species within a habitat matrix that includes various types of fragmented and undisturbed sites. Five microsatellite loci were used to assess the level and distribution of genetic variation across the southern range of Elaeocarpus grandis (Elaeocarpaceae). In all, 21 sites were sampled to provide a direct comparison between fragmented and undisturbed populations. Overall levels of diversity (A=3.4, He=0.568, f=0.094) were higher than those of closely related endemic species, but lower than those recorded across other rainforest trees. No significant genetic structure was detected across this species, suggesting the existence of efficient dispersal and colonization mechanisms responsible for the maintenance of gene flow. Rainforest fragments, and in particular those within the extensively cleared Big Scrub, show a trend for increased inbreeding levels caused by a loss of heterozygosity within juvenile cohorts. However, the overall rate of genetic decline within fragmented rainforests appears to be more subtle in E. grandis than across other species. A combination of ecological attributes and evolutionary history is likely to have contributed to this outcome and need to be considered in future rainforest restoration projects.

Measurement of intra-abdominal pressure in intensive care units in the United Kingdom: a national postal questionnaire study

BACKGROUND

To explore the attitudes of intensivists in the UK to intra-abdominal pressure (IAP) measurement and abdominal compartment syndrome (ACS) and to determine current practice.

METHODS

A postal questionnaire study addressed to the lead clinician in the intensive care unit was sent to hospitals in the UK with a general surgical service.

RESULTS

Completed questionnaires were received from 137 of the 207 hospitals surveyed (66.2% response rate). Only 1.5% of the respondents (n=2) had no prior knowledge of intra-abdominal hypertension and ACS. IAP had been measured on some occasion by 75.9% (n=104) of the respondents, always by the intravesical route. Among those intensive care units that measured IAP, in 93.2% (n=97) it was only measured when there was a suspicion of the development of ACS; 3.8% of units (n=4) measured IAP on all patients who had undergone an emergency laparotomy, and 2.9% (n=3) measured IAP only in those who had undergone emergency laparotomy associated with massive fluid resuscitation. There was major disparity in the frequency of IAP measurement and when to recommend abdominal decompression.

CONCLUSIONS

Despite widespread awareness of IAH and the ACS, many intensive care units never measure the IAP. When it is measured, the intravesical route is used exclusively. No consensus exists on optimal timing of measurement or when decompressive laparotomy should be performed.

RS-100642-198, a novel sodium channel blocker, provides differential neuroprotection against hypoxia/hypoglycemia, veratridine or glutamate-mediated neurotoxicity in primary cultures of rat cerebellar neurons

The present study investigated the effects of RS-100642-198 (a novel sodium channel blocker), and two related compounds (mexiletine and QX-314), in in vitro models of neurotoxicity. Neurotoxicity was produced in primary cerebellar cultures using hypoxia/hypoglycemia (H/H), veratridine or glutamate where, in vehicle-treated neurons, 65%, 60% and 75% neuronal injury was measured, respectively. Dose-response neuroprotection experiments were carried out using concentrations ranging from 0.1-500 micro M. All the sodium channel blockers were neuroprotective against H/H-induced injury, with each exhibiting similar potency and efficacy. However, against veratridine-induced neuronal injury only RS-100642-198 and mexiletine were 100% protective, whereas QX-314 neuroprotection was limited (i.e. only 54%). In contrast, RS-100642-198 and mexiletine had no effect against glutamate-induced injury, whereas QX-314 produced a consistent, but very limited (i.e. 25%), neuroprotection. Measurements of intraneuronal calcium [Ca(2+)]i) mobilization revealed that glutamate caused immediate and sustained increases in [Ca(2+)]i which were not affected by RS-100642-198 or mexiletine. However, both drugs decreased the initial amplitude and attenuated the sustained rise in [Ca(2+)]i mobilization produced by veratridine or KCl depolarization. QX-314 produced similar effects on glutamate-, veratridine- or KCl-induced [Ca(2+)]i dynamics, effectively decreasing the amplitude and delaying the initial spike in [Ca(2+)]i, and attenuating the sustained increase in [Ca(2+)]i mobilization. By using different in vitro models of excitotoxicity, a heterogeneous profile of neuroprotective effects resulting from sodium channel blockade has been described for RS-100642-198 and related drugs, suggesting that selective blockade of neuronal sodium channels in pathological conditions may provide therapeutic neuroprotection against depolarization/excitotoxicity via inhibition of voltage-dependent Na(+) channels.

A report on the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Initiative: what have we learned and what is its potential?

INTRODUCTION

The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Initiative established a national database in 1999. The goal was to provide a vehicle whereby surgeons could accumulate meaningful data about their surgical activity and procedure outcomes.

METHODS

Through a secure Internet site, participants entered core data at the time of operation on all patients undergoing any laparoscopic or open procedure. Procedure-specific data was accumulated for cholecystectomy, inguinal hernia, and fundoplication. A second data set was collected at the time of follow-up evaluation. Individual data and a summary of national data were available through the Web site for contemporaneous review.

RESULTS

Between May 1999 and December 2001, 4,100 cases were entered by 73 surgeons, including data for 1070 cholecystectomies, 1,070 antireflux procedures, and 300 hernias. The remaining cases encompassed all other procedures. Perioperative and follow-up data showed many interesting findings. For example, 30% of cholecystectomies were first-assisted by a nonphysician. The rate of conversion from laparoscopic cholecystectomy to open surgery was 3%. In the gastroesophageal reflex disease (GERD) report on fundoplications, 21% of the patients had a previous fundoplication. This report contains a summary of the data collected during this period in the national database.

CONCLUSIONS

The SAGES Outcomes Initiative allows surgeons to be involved in data collection about their practice. It provides data on the general practice of surgery, which are more useful for setting benchmarks than published data from the surgical elite.

Computerisation and decision making in neonatal intensive care: a cognitive engineering investigation

This paper reports results from a cognitive engineering study that looked at the role of computerised monitoring in neonatal intensive care. A range of methodologies was used: interviews with neonatal staff, ward observations, and experimental techniques. The purpose was to investigate the sources of information used by clinicians when making decisions in the neonatal ICU. It was found that, although it was welcomed by staff, computerised monitoring played a secondary role in the clinicians' decision making (especially for junior and nursing staff) and that staff used the computer less often than indicated by self-reports. Factors that seemed to affect staff use of the computer were the lack (or shortage) of training on the system, the specific clinical conditions involved, and the availability of alternative sources of information. These findings have relevant repercussions for the design of computerised decision support in intensive care and suggest ways in which computerised monitoring can be enhanced, namely: by systematic staff training, by making available online certain types of clinical information, by adapting the user interface, and by developing intelligent algorithms.

Volume-activated Cl− secretion and transepithelial vinblastine secretion mediated by P-glycoprotein are not correlated in cultured human T84 intestinal epithelial layers

The relationship between the P-glycoprotein-mediated vinblastine secretion and cell-swelling activated Cl- secretion (conductance) in intact epithelial layers of human colonic adenocarcinoma T84 cells has been investigated. Whereas vinblastine secretion is effectively inhibited by 100 microM 1,9-dideoxy-forskolin, volume-stimulated Cl- secretion is unaffected. In contrast, 100 microM 4,4'-diisothiocyanostilbene-2,2'-disulphonic acid (DIDS) inhibited the volume-stimulated Cl- secretion, but was without effect upon transepithelial vinblastine secretion. In addition, it was noted that some epithelial layers failed to express a volume-stimulated Cl- secretion but maintained a normal level of secretory vinblastine flux.

The effect of group psychosocial support on survival in metastatic breast cancer

BACKGROUND

Supportive-expressive group therapy has been reported to prolong survival among women with metastatic breast cancer. However, in recent studies, various psychosocial interventions have not prolonged survival.

METHODS

In a multicenter trial, we randomly assigned 235 women with metastatic breast cancer who were expected to survive at least three months in a 2:1 ratio to an intervention group that participated in weekly supportive-expressive group therapy (158 women) or to a control group that received no such intervention (77 women). All the women received educational materials and any medical or psychosocial care that was deemed necessary. The primary outcome was survival; psychosocial function was assessed by self-reported questionnaires.

RESULTS

Women assigned to supportive-expressive therapy had greater improvement in psychological symptoms and reported less pain (P=0.04) than women in the control group. A significant interaction of treatment-group assignment with base-line psychological score was found (P</=0.003 for the comparison of mood variables; P=0.04 for the comparison of pain); women who were more distressed benefited, whereas those who were less distressed did not. The psychological intervention did not prolong survival (median survival, 17.9 months in the intervention group and 17.6 months in the control group; hazard ratio for death according to the univariate analysis, 1.06 [95 percent confidence interval, 0.78 to 1.45]; hazard ratio according to the multivariate analysis, 1.23 [95 percent confidence interval, 0.88 to 1.72]).

CONCLUSIONS

Supportive-expressive group therapy does not prolong survival in women with metastatic breast cancer. It improves mood and the perception of pain, particularly in women who are initially more distressed.

Medical history and chronic pain

OBJECTIVE

Can either a history of previous similar injury, including recurrence of injury, or an individual's symptoms, including time off work, predict chronic pain and/or chronic pain disability?

METHODOLOGY

The literature search identified one systematic review and six observational studies (5 low back pain and 1 chronic shoulder pain) to provide evidence about these questions.

RESULTS

Only one study evaluated subjects before a painful event. Other studies evaluated subjects over a range of time from onset of pain, including some selected for clinic treatment. This variability as well as the use of different outcome measures without blinding limited the quality of the evidence.

CONCLUSIONS

The studies provide moderate evidence (level 2) that a history of previous similar pain predicts subsequent reports of pain and limited evidence (level 3) that a history of similar pain predicts poorer outcomes after recurrent injury. The studies also provide moderate evidence (level 2) that longer duration of pain predicts the occurrence of subsequent reports of pain and limited evidence (level 3) that longer time off work before treatment predicts poorer activity and poorer participation outcomes after recurrent injury.

Physical symptoms and signs and chronic pain

OBJECTIVE

Do physical findings that are used to indicate location and extent of tissue damage and a measure of the severity of initial pain predict subsequent reports of pain and of disability?

METHODOLOGY

A standardized literature search identified one systematic review and 12 observational studies (9 low back pain, 2 neck pain, and 1 carpal tunnel syndrome) to provide evidence about these questions.

RESULTS

Most studies were of specific populations. These studies were useful studies of predictors, but they have limited generalizability. Exclusions and loss of subjects at follow-up in some studies also limited generalizability. Conclusions were made cautiously, because some factors with statistical correlations with chronic pain were not plausible predictors.

CONCLUSIONS

The studies provide moderate evidence (level 2) that reports of the intensity of pain in acute musculoskeletal injury predict subsequent reports of pain. There is limited evidence (level 3) that the location and extent of injury predict reports of pain and poor functional activity outcomes. There is moderate evidence (level 2) that physical symptoms and signs cannot be considered individual predictors of chronic pain disability as measured by participation outcomes. Instead, in the transition from subacute to chronic pain disability, functional disability and psychological distress play a more important role than pain intensity.

Demographic variables and chronic pain

OBJECTIVE

Are demographic variables (age, gender, sex, and marital status) predictors of chronic pain and chronic pain disability?

METHODOLOGY

The literature search identified one systematic review plus 12 observational studies (11 back or spinal pain and 1 whiplash) to provide evidence about this question.

RESULTS

The role of predictive factors varied with different patient groups, settings, and interventions. Analytic methods also varied. Most studies evaluated age, sex, and marital status with other nondemographic variables.

CONCLUSIONS

The studies provided limited and conflicting evidence (level 4b) that either increasing age or sex correlates with chronic pain and chronic pain disability. Marital status and education both showed conflicting evidence (level 4b) of a correlation with chronic pain. Age and sex express different risks for disease, severity of injury, and occupational opportunities and choices. Demographic factors can modify the effect of other factors with which they interact. Future identification of predictors of chronic pain should include control for age and gender (level 3).

Demonstration of a neonlike argon soft-x-ray laser with a picosecond-laser-irradiated gas puff target

We demonstrate a neonlike argon-ion x-ray laser, using a short-pulse laser-irradiated gas puff target. The gas puff target was formed by pulsed injection of gas from a high-pressure solenoid valve through a nozzle in the form of a narrow slit and irradiated with a combination of long, 600-ps and short, 6-ps high-power laser pulses with a total of 10 J of energy in a traveling-wave excitation scheme. Lasing was observed on the 3p (1)S(0)?3s (1)P(1) transition at 46.9 nm and the 3d (1)P(1)?3p (1)P(1) transition at 45.1 nm. A gain of 11 cm(-1) was measured on these transitions for targets up to 0.9 cm long.