Maduramicin-guided nanotherapy: A polymeric micelles for targeted drug delivery in canine mammary tumors

Canine mammary tumors (CMT) can severely compromise the life quality of the affected dogs through local recurrence, distant metastases and ultimately succumb to death. Recently, more attention has been given to the potential antimetastatic effect of maduramicin (MAD) on breast cancer. However, its poor aqueous solubility and toxicity to normal tissues limit its clinical application. Therefore, to address the drawbacks of MAD and enhance its anticancer and antimetastatic effects, MAD-loaded TPGS polymeric micelles (MAD-TPGS) were prepared by a thin-film hydration technique. The optimized MAD-TPGS exhibited excellent size distribution, stability and improved water solubility. Cellular uptake assays showed that TPGS polymer micelles could enhance drug internalization. Moreover, TPGS synergistically improved the cytotoxicity of MAD by targeting mitochondrial organelles, improving reactive oxygen species levels and reducing the mitochondrial transmembrane potential. More importantly, MAD-TPGS significantly impeded the metastasis of tumor cells. In vivo results further confirmed that, in addition to exhibiting excellent biocompatibility, MAD-TPGS exhibited greater antitumor efficacy than free MAD. Interestingly, MAD-TPGS displayed superior suppression of CMT metastasis via tail vein injection compared to oral administration, indicating its suitability for intravenous delivery. Overall, MAD-TPGS could be applied as a potential antimetastatic cancer agent for CMT.

Luteolin Attenuates Oxidative Stress and Colonic Hypermobility in Water Avoidance Stress Rats by Activating the Nrf2 Signaling Pathway

SCOPE

Irritable bowel syndrome (IBS) is an intestinal disorder, whose symptoms can be alleviated by certain dietary phytochemicals. This study explores the role and potential mechanisms of a natural flavonoid luteolin (LUT) in alleviating the excessive motility of colonic smooth muscles and reducing oxidative stress in IBS with diarrhea (IBS-D) rats.

METHODS AND RESULTS

LUT reduces excessive intestinal motility and lowers reactive oxygen species (ROS) levels in a water avoidance stress (WAS) rat model. Moreover, LUT increases the protein expression levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1), activates the nuclear translocation of Nrf2, and greatly reduces the hydrogen peroxide (H2 O2 )-induced oxidative damage in intestinal epithelial cells.

CONCLUSIONS

LUT, a phyto-active component, protects against excessive intestinal motility and diarrhea by regulating the Nrf2 signaling pathway and effectively reduces oxidative stress damage in the colon.

Apigenin attenuates visceral hypersensitivity in water avoidance stress rats by modulating the microbiota-gut-brain axis and inhibiting mast cell activation

Visceral hypersensitivity (VH) and gut microbiota dysbiosis significantly contribute to the occurrence and development of irritable bowel syndrome (IBS), exacerbated by stress. Apigenin, a natural flavonoid derived from plants, possesses a range of beneficial properties. However, additional research is necessary to investigate its potential in alleviating symptoms of IBS and elucidating its underlying mechanisms of action. Our study confirms that apigenin effectively reverses mast cell and microglial activation, regulates the composition and abundance of the gut microbiota, improves intestinal barrier function in rats induced with water-avoidance stress, and mitigates VH and colonic hypermotility. Furthermore, in vitro studies suggest a potential role of dysbiotic gut microbiota in activating mast cells at the cellular level. Notably, apigenin inhibits mast cell degranulation through the toll-like receptor 4 (TLR4) / myeloid differentiation primary response gene 88 (MyD88) / nuclear factor-kappa B (NF-κB) pathway. In conclusion, this study discusses the potential therapeutic effects of apigenin in alleviating VH and modulating the gut-brain axis in water-avoidance stress rats, providing a novel or alternative treatment approach for IBS.

Effect of the age and sex on growth performance and feather quality of 13 to 25-weeks-old White Roman geese

This study aimed to determine the effect of age and sex in weeks on growth, carcass performances, and feather quality of White Roman geese and analyze the relative effect of age and sex in weeks on feather characteristics in geese. In animal experiments, 120 White Roman geese aged 13 wk were randomly distributed among 12 pens and fed grower diet ad libitum during the growing period, with each pen containing 10 males or 10 females, depending on a completely random design. Ten geese each in their 13, 15, 17, 19, 21, 23, and 25 wk of age were sacrificed. The results showed that the age had no significant effect on the body weight (BW) of geese (P > 0.05). The chest girth was significantly longer in 21 to 25 wk old than in 13- to 19-wk-old geese (P < 0.05). The results reveal no significant change in carcass weight of grower geese among 13- to 25-wk age groups (P > 0.05). The down percentage of the 25-wk-old age group was significantly higher than that of the 13-, 15-, and 17-wk age groups (P < 0.05). The male geese had a higher dry feather weight than the females (P < 0.05). Similarly, the 18-h feed-deprived body weight (18-h FDBW) and 4 to 10 cm feather weight were significantly negatively correlated in grower geese (-0.42). This provides the feather industry an opportunity for the better utilization of grower geese by-products. In conclusion, the age has no influence on BW among 13- to 25-wk-old geese, and a good down percentage and dry weight were observed at 25 wk of age. The 18-h FDBW and down percentage had a significantly negative correlation (-0.55) in grower geese.

Two fragments of HBV DNA integrated into chrX: 11009033 and its genetic regulation in HepG2.2.15

Hepatitis B virus (HBV) integration into human genome causes hepatocellular carcinoma (HCC). The present study used inverse nested PCR; the full sequence of HBV DNA fragments of the chrX: 111009033 integration site was detected (987 bp), containing two fragments of double‑stranded linear DNA with the same orientation (1,744‑1,094 and 1,565‑1,228 nt). By reverse transcription‑quantitative PCR, HBV‑cell fusion transcript was observed in HepG2.2.15 cells. The mean copy number of this site in cells with H₂O₂ treatment (8.73x10^‑2±1.65x10^‑2 copies/cell) was significantly higher than that in the cells without H₂O₂ treatment (3.02x10^‑2±2.33x10^‑2 copies/cell; P<0.0001). The mean levels of P21‑activated kinase 3 (PAK3) were 15.67±5.65 copies/cell in HepG2.2.15 cells with H₂O₂ treatment, significantly higher than in the cells without H₂O₂ treatment (11.34±4.58 copies/cell, P=0.0076) and in HepG2 cells (5.92±1.54 copies/cell, P<0.0001). Significant difference of PAK3 levels was also found between HepG2.2.15 cells without H₂O₂ treatment and HepG2 cells (11.34±4.58 vs. 5.92±1.54 copies/cell, P<0.0001). The average copy numbers of the integration site chrX: 111009033 were positively correlated with the average levels of PAK3 (P=0.0013). The overall trend of PAK3 expression was significantly increased in HepG2.2.15 cells with H₂O₂ treatment compared with that in HepG2.2.15 cells without H₂O₂ treatment (37.63±8.16 and 31.38±7.94, P=0.008) and HepG2 cells (21.67±7.88, P<0.0001). In summary, the chrX: 11009033 integration site may originate from primary human hepatocytes, occurrence and clonal expansion of which may upregulate PAK3 expression, which may contribute to hepatocarcinogenesis.

Relationship between the abdominal sagging index and the reproductive performance of the Roman goose

OBJECTIVE

This research aimed to explore the changes in the observed abdominal sagging index (ASI) and reproductive performance of Roman male and female geese during the breeding period.

METHODS

The 339 six-month-old breeding geese (109 male; 230 female) were used in this study, in which five male and five female geese were slaughtered on a monthly basis to record the ASI.

RESULTS

The short diameter of the testes of the male goose when the female goose lays eggs and in the second, third, and fourth months was significantly wider than in the fifth months (19.0, 20.8, 21.4, and 19.6 vs 12.7 and 14.0 mm/bird; p = 0.0105). On the other hand, the testicular weight of the male goose in the second and third months after the female goose lays eggs was significantly higher than that in the second and fifth months after laying (0.33% and 0.37% vs 0.11% and 0.19%; p = 0.0212). During the exploring period, the length and weight of the fallopian tube, the weight of the ovary, the number of follicles in 2 to 3 cm, the number of follicles in 3 to 4 cm, the fallopian tube weight in the carcass weight percentage, and the ovary weight in the carcass weight percentage all demonstrated a significant curve response. Further, female ASI was positively correlated with reproductive tract length (r = 0.815; p<0.05) and egg production per female (r = 0.790; p<0.05).

CONCLUSION

The ASI classification method is more objective and easy to distinguish. This scoring method has a high correlation with the number of eggs laid by each goose and the length of the reproductive tract, inferring that the goose observation could take advantage of ASI during egg-laying and can predict the reproductive system development during the laying period and determine when the breeding goose begins to lay eggs.

Nano-encapsulation of halofuginone hydrobromide enhances anticoccidial activity against Eimeria tenella in chickens

Coccidiosis is a worldwide epidemic intestinal disease with high incidence, which causes huge economic losses. Halofuginone hydrobromide (HF) is widely applied as an effective anticoccidial drug in the poultry industry. However, its therapeutic efficacy is severely restrained due to toxic effects, poor aqueous solubility and low permeability. Nanotechnology can improve the biological effect of drugs, and thus, reduce administered doses and toxic effects. The objective of this study was to investigate the therapeutic and preventive potential of novel HF-loaded D-α-tocopherol polyethylene glycol 1000 succinate (TPGS) polymer micelles (HTPM) for preventing coccidiosis in chickens. The HTPM were approximately spherical with a hydrodynamic diameter of 12.65 ± 0.089 nm, a zeta potential of 8.03 ± 0.242 mV, a drug loading of 14.04 ± 0.12%, and an encapsulation efficiency of 71.1 ± 4.15%. HF was encapsulated in the polymer micelles through interactions with TPGS, as characterized by X-ray diffraction (XRD) and Fourier transform infrared (FT-IR) spectroscopy. Cellular take up assays showed that TPGS polymer micelles could enhance drug internalization to alleviate intestinal apoptosis induced by coccidiosis and promote the necrosis of second-generation merozoites of E. tenella. Notably, clinical trials proved that 1.5 mg L^-1 HTPM had a stronger anticoccidial effect on E. tenella than that of 3 mg kg^-1 HF premix. Amplicon sequencing identified that HTPM could alleviate coccidiosis by restoring the structure of the gut microbiome. These findings indicated that the anticoccidial efficacy of HF was significantly enhanced after being encapsulated in polymer micelles, and further demonstrated the potential protective application of nano-encapsulating anticoccidial drugs as a promising approach to control coccidiosis in poultry. In summary, HTPM hold huge potential as an effective therapeutic agent for coccidiosis.

Dysregulated cystathionine-β-synthase/hydrogen sulfide signaling promotes chronic stress-induced colonic hypermotility in rats

BACKGROUND

Hydrogen sulfide (H₂ S), an important endogenous gasotransmitter, is involved in the modulation of gastrointestinal motility, but whether it mediates the intestinal dysmotility in irritable bowel syndrome (IBS) is not known. This study explored the significance of cystathionine-β-synthase (CBS)/H₂ S signaling in stress-induced colonic dysmotility.

METHODS

A rat model of IBS was established using chronic water avoidance stress (WAS). Colonic pathological alterations were detected histologically. Intestinal motility was determined by intestinal transit time (ITT) and fecal water content (FWC). Visceral sensitivity was assessed using the visceromotor response (VMR) to colorectal distension (CRD). Real-time PCR, Western blotting, and immunostaining were performed to identify the expression of CBS in the colon. The contractions of distal colon were studied in an organ bath system and H₂ S content was measured by ELISA. The effects of SAM, a selective CBS activator, on colonic dysmotility were examined. MEK1 was tested as a potential upstream effector of CBS/H₂ S loss.

KEY RESULTS

After 10 days of WAS, the ITT was decreased and FWC was increased, and the VMR magnitude in response to CRD was enhanced. The colonic CBS expression and H₂ S levels were significantly declined in WAS-exposed rats, and the density of CBS-positive enteric neurons in the myenteric plexus in WAS-treated rats was lower than that in controls. SAM treatment relieved WAS-induced colonic hypermotility via increased H₂ S production. AZD6244, a selective inhibitor of MEK1, partially reversed CBS downregulation and colonic hypermotility in WAS-treated rats.

CONCLUSIONS & INFERENCES

Decreased CBS/H₂ S signaling through increased MEK1 signaling might be important in the pathogenesis of chronic stress-induced colonic hypermotility. SAM could be administered for disorders associated with intestinal hypermotility.

An interpretable artificial intelligence system for detecting risk factors of gastroesophageal variceal bleeding

Bleeding risk factors for gastroesophageal varices (GEV) detected by endoscopy in cirrhotic patients determine the prophylactical treatment patients will undergo in the following 2 years. We propose a methodology for measuring the risk factors. We create an artificial intelligence system (ENDOANGEL-GEV) containing six models to segment GEV and to classify the grades (grades 1-3) and red color signs (RC, RC0-RC3) of varices. It also summarizes changes in the above results with region in real time. ENDOANGEL-GEV is trained using 6034 images from 1156 cirrhotic patients across three hospitals (dataset 1) and validated on multicenter datasets with 11009 images from 141 videos (dataset 2) and in a prospective study recruiting 161 cirrhotic patients from Renmin Hospital of Wuhan University (dataset 3). In dataset 1, ENDOANGEL-GEV achieves intersection over union values of 0.8087 for segmenting esophageal varices and 0.8141 for gastric varices. In dataset 2, the system maintains fairly accuracy across images from three hospitals. In dataset 3, ENDOANGEL-GEV surpasses attended endoscopists in detecting RC of GEV and classifying grades (p < 0.001). When ranking the risk of patients combined with the Child‒Pugh score, ENDOANGEL-GEV outperforms endoscopists for esophageal varices (p < 0.001) and shows comparable performance for gastric varices (p = 0.152). Compared with endoscopists, ENDOANGEL-GEV may help 12.31% (16/130) more patients receive the right intervention. We establish an interpretable system for the endoscopic diagnosis and risk stratification of GEV. It will assist in detecting the first bleeding risk factors accurately and expanding the scope of quantitative measurement of diseases.

Repurposing maduramicin as a novel anticancer and anti-metastasis agent for triple-negative breast cancer as enhanced by nanoemulsion

Triple-negative breast cancer (TNBC) is featured by aggression and metastasis and remains an unmet medical challenge due to high death rate. We aimed to repurpose maduramicin (MAD) as an effective drug against TNBC, and develop a nanoemulsion system to enhance anticancer efficacy of MAD. MDA-MB-231 and 4 T1 cells were used as in vitro model, and cell viability was determined by performing cell counting kit-8 and a colony-formation assay. Furthermore, MAD loaded nanoemulsion (MAD-NEs) was manufactured and characterized by a series of tests. The anticancer and anti-metastasis mechanism of MAD-NEs were assessed by performing cell cycle, apoptosis, wound-healing, transwell assay and Western blotting assays. Herein, MAD was firstly demonstrated to be an effective agent to suppress growth of TNBC cells. Subsequently, the optimized MAD-NEs were shown to have stability and high encapsulation efficiency, and could arrested cells in G0/G1 phase and induced apoptosis in TNBC cells. More importantly, MAD-NEs significantly impeded the metastasis of tumor cells, which was further demonstrated by the significant altered expression of epithelial-mesenchymal transition and extracellular matrix markers in vitro and in vivo. Moreover, compared to MAD, MAD-NEs exhibited higher efficacy in shrinking breast tumor size and repressing liver and lung metastasis in vivo, and showed excellent biocompatibility in tumor-bearing mice. The successfully prepared MAD-NEs are expected to be harnessed to suppress tumor growth, invasion and metastasis in the battle against malignant TNBC.

Optimization of Maduramicin Ammonium-Loaded Nanostructured Lipid Carriers Using Box–Behnken Design for Enhanced Anticoccidial Effect against Eimeria tenella in Broiler Chickens

Maduramicin ammonium (MAD) is one of the most frequently used anticoccidial agents in broiler chickens. However, the high toxicity and low solubility of MAD limit its clinical application. In this study, MAD-loaded nanostructured lipid carriers (MAD–NLCs) were prepared to overcome the defects of MAD by using highly soluble nanostructured lipid carriers (NLCs). The formulation was optimized via a three-level, three-factor Box–Behnken response surface method. Then, the optimal MAD–NLCs were evaluated according to their hydrodynamic diameter (HD), zeta potential (ZP), crystal structure, encapsulation efficiency (EE), drug loading (DL), in vitro release, and anticoccidial effect. The optimal MAD–NLCs had an HD of 153.6 ± 3.044 nm and a ZP of −41.4 ± 1.10 mV. The X-ray diffraction and Fourier-transform infrared spectroscopy results indicated that the MAD was encapsulated in the NLCs in an amorphous state. The EE and DL were 90.49 ± 1.05% and 2.34 ± 0.04%, respectively, which indicated that the MAD was efficiently encapsulated in the NLCs. In the in vitro study, the MAD–NLCs demonstrated a slow and sustained drug release behavior. Notably, MAD–NLCs had an excellent anticoccidial effect against Eimeria tenella in broiler chickens. In summary, MAD–NLCs have huge potential to form a new preparation administered via drinking water with a powerful anticoccidial effect.

Activation of cannabinoid 2 receptor relieves colonic hypermotility in a rat model of irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a common disease with intestinal dysmotility, whose mechanism remains elusive. The endocannabinoid system is emerging as an important modulator of gastrointestinal (GI) motility in multiple diseases, but its involvement in IBS is unknown. We aimed to determine whether cannabinoid 2 (CB2) receptor modulates intestinal motility associated with stress-induced IBS.

METHODS

A rat IBS model was established by chronic water avoidance stress (WAS). Colonic pathological alterations were detected histologically and intestinal motility was assessed by intestinal transit time (ITT) and fecal water content (FWC). Visceral sensitivity was determined by visceromotor response (VMR) to colorectal distension (CRD). Real-time PCR, western blot, and immunostaining were performed to identify colonic CB2 receptor expression. Colonic muscle strip contractility was studied by isometric transducers and nitric oxide (NO) was detected by the Griess test. The effects of AM1241, a selective agonist of CB2 receptors, on colonic motility were examined.

KEY RESULTS

After 10 days of WAS exposure, ITT was decreased and FWC elevated while VMR magnitude in response to CRD was significantly enhanced. Colon CB2 protein and mRNA levels increased and density of CB2-positive macrophages in the mucosa and enteric neurons in the myenteric plexus was higher than in controls. Pharmacological enhancement of CB2 activity by AM1241 relieved colonic hypermotility in WAS rats in a concentration-dependent manner via inhibition of p38 phosphorylation and elevation of NO production.

CONCLUSION

CB2 receptor may exert an important inhibitory effect in stress-induced colonic hypermotility by modulating NO synthesis through p38 mitogen-activated protein kinase signaling. AM1241 could be used as a potential drug to treat disorders with colonic hypermotility.

[Clinical evaluation of gallbladder and common bile duct stones treated though cholecystostomy tube]

Objective: To investigate the efficacy, feasibility and safety of treatment of gallbladder and common bile duct stones treated through cholecystostomy tube. Methods: The clinical data of 17 patients with gallbladder and common bile duct stones treated through cholecystostomy tube from January 2012 to December 2016 was analyzed retrospectively. Results: Seventeen patients were successfully treated with percutaneous transhepatic gallbladder (PTGD), and 88.2% (15/17) patients had clinical symptom relief. There was no complication happened after PTGD and fistula expansion. All the stones were removed and there was 11.7% (2/17) of gallbladder bleeding, 5.9% (1/17) of pancreatitis, and 5.9% (1/17) of hyperamylasemia after stones extraction. The patients had gone through an average treatment period of 87.8±16.0 days, hospitalization of 5.5±0.6 times and 43.3±4.5 days, cost of 60.0±8.0 thousand, 6.9±0.9 operations, 1.4±0.6 stone extraction operations with the average time of 58.4±21.2 min. The duodenal papillary balloon dilatation rate was 82.4% (14/17). Conclusion: The treatment through cholecystostomy tube is an effective, safe and feasible technique for gallbladder and common bile duct stones. However, there are many shortcomings such as long treatment cycle, large number of hospitalization and operations, difficult operation and high cost.

Colonic Hypermotility in a Rat Model of Irritable Bowel Syndrome Is Associated with Upregulation of TMEM16A in Myenteric Plexus

BACKGROUND

Irritable bowel syndrome (IBS) is a common disease with intestinal dysmotility, whose mechanism remains elusive. TMEM16A is a calcium-activated chloride channel (CaCC) involved in intestinal slow-wave generation.

AIMS

To investigate whether TMEM16A is involved in colonic dysmotility in IBS.

METHODS

A rat model of IBS was established by chronic water avoidance stress (WAS). Colonic pathological alterations were evaluated histologically, and intestinal motility was assessed by intestinal transit time (ITT) and fecal water content (FWC). Visceral sensitivity was determined by visceromotor response (VMR) to colorectal distension (CRD). TMEM16A expression was evaluated by RT-PCR, Western blot, and immunofluorescence. Colonic muscle strip contractility was measured by isometric transducers, and the effect of niflumic acid (NFA), a CaCC antagonist, on colonic motility was examined.

RESULTS

After 10 days of WAS exposure, ITT was decreased and FWC was elevated. Furthermore, VMR magnitude of WAS rats in response to CRD was significantly enhanced. Protein and mRNA levels of TMEM16A in colon were considerably increased after WAS. The percentage of TMEM16A-positive neurons in myenteric plexus (MP) of WAS rats was significantly higher than controls. Pharmacological blockade of TMEM16A activity by NFA considerably enhanced ITT, with concentration-dependent declines in FWC and VMR magnitude in NFA-treated rats. Further, spontaneous contraction of colonic strips of NFA-treated rats was significantly ameliorated in a concentration-dependent manner in vitro.

CONCLUSIONS

Upregulation of TMEM16A in MP neurons may play an important role in chronic stress-induced colonic hypermotility, making CaCC-blocking drugs a putatively effective treatment method for colonic hypermotility in IBS.

Temporal variability of readmission determinants in postoperative vascular surgery patients

Introduction:

Clinical information continues to be limited regarding changes in the temporal risk profile for readmissions during the initial postoperative year in vascular surgery patients. We set out to describe the associations between demographics, clinical outcomes, comorbidity indices, and hospital readmissions in a sample of patients undergoing common extremity revascularization or dialysis access (ERDA) procedures. We hypothesized that factors independently associated with readmission will evolve from “short-term” to “long-term” determinants at 30-, 180-, and 360-day postoperative cutoff points.

Methods:

Following IRB approval, medical records of patients who underwent ERDA at two institutions were retrospectively reviewed between 2008 and 2014. Abstracted data included patient demographics, procedural characteristics, the American Society of Anesthesiologists score, Goldman Criteria for perioperative cardiac assessment, the Charlson comorbidity index, morbidity, mortality, and readmission (at 30-, 180-, and 360-days). Univariate analyses were performed for readmissions at each specified time point. Variables reaching statistical significance of P < 0.20 were included in multivariate analyses for factors independently associated with readmission.

Results:

A total of 450 of 744 patients who underwent ERDA with complete medical records were included. Patients underwent either an extremity revascularization (e.g. bypass or endarterectomy, 406/450) or a noncatheter dialysis access procedure (44/450). Sample characteristics included 262 (58.2%) females, mean age 61.4 ± 12.9 years, 63 (14%) emergent procedures, and median operative time 164 min. Median hospital length of stay (index admission) was 4 days. Cumulative readmission rates at 30-, 180-, and 360-day were 12%, 27%, and 35%, respectively. Corresponding mortality rates were 3%, 7%, and 9%. Key factors independently associated with 30-, 180-, and 360-day readmissions evolved over the study period from comorbidity and morbidity-related issues in the short-term to cardiovascular and graft patency issues in the long-term. Any earlier readmission elevated the risk of subsequent readmission.

Conclusions:

We noted important patterns in the temporal behavior of hospital readmission risk in patients undergoing ERDA. Although factors independently associated with readmission were not surprising (e.g. comorbidity profile, cardiovascular status, and graft patency), the knowledge of temporal trends described in this study may help determine clinical risk profiles for individual patients and guide readmission reduction strategies. These considerations will be increasingly important in the evolving paradigm of value-based healthcare.

[Value of integrated pancreatic and biliary stents for prevention of post-ERCP pancreatitis]

Objective: To investigate the value of integrated pancreatic and biliary stents for prevention of post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis. Methods: The clinical data of patients whom had pancreatic stents for prevention of post-ERCP pancreatitis from December 2013 to October 2015 were retrospectively analyzed. The clinical effect and complication were compared between straight pancreatic stents group and integrated pancreatic and biliary stents group. Results: A total of 214 patients had pancreatic stents for prevention of post-ERCP pancreatitis. Among them, 139 of the patients received a straight pancreatic stents with the average operation time of 62.1±9.8 min and 75 patients received the integrated pancreatic and biliary stents with the average operation time of 67.2±12.7 min. The average operation time was statistically significantly different (P=0.001). Straight stents group was found to have higher incidence of pancreatic stents proximal migration and spontaneous abscission than integrated pancreatic and biliary stents group (8.6% vs 0, P=0.009; 12.9% vs 1.3%, P=0.004). There was no significant difference in the incidence of acute pancreatitis or hyperamylasemia between the two groups (3.6% vs 2.7%, P=1.000; 5.0% vs 4.0%, P=1.000). A total of 123 patients in the straight stents group received a second ERCP to remove the pancreatic stents in 1 to 8 weeks after ERCP, and 2 patients had acute pancreatitis and 3 patients had high amylase, while there was no complication happened after the remove of integrated pancreatic and biliary stents in one week after ERCP. Conclusion: The clinical effect of integrated pancreatic and biliary stents for the prevention of post-ERCP pancreatitis is better than straight pancreatic stents.

The Role of Interstitial Cells of Cajal in Acute Cholecystitis in Guinea Pig Gallbladder

Background/Aims: Acute cholecystitis is common in gallbladder motility disorder. Interstitial cells of Cajal (ICCs) in the gallbladder are involved in the regulation of gallbladder motility. The aim of this study was to explore the change of gallbladder ICCs in acute cholecystitis. Methods: Thirty adult guinea pigs were randomly divided into 3 groups: a sham-operated group (healthy controls) and 2 study groups. The animals in the study group were subjected to bile duct ligation and then to laparotomy and cholecystectomy at 24 and 48 hours after surgery. Immunohistochemistry, immunohistofluorescence, and laser confocal microscopy were performed to observe the shape, size, morphology, and density of gallbladder ICCs. Western blot and real-time PCR were performed to detect stem cell factor and c-kit protein and mRNA expression, respectively. Results: There were no differences in the shape, size, and morphology of the gallbladder ICCs in the control and the two acute cholecystitis groups. Density of gallbladder ICCs, SCF level, and c-kit protein and mRNA expression all decreased in the acute cholecystitis groups. Further, SCF level and c-kit protein and mRNA expression decreased with progress of acute cholecystitis (all P < 0.05). Conclusion: Acute cholecystitis can decrease ICCs through repression of SCF and c-kit expression and that ICCs loss play a role in acute cholecystitis.

Effects of dietary garlic scape meal on the growth and meat characteristics of geese

This study evaluated the growth performance and meat characteristics of grower geese whose diets included garlic scape meal (GSM), a by-product of garlic production. Scape is the leaf-less flower stem of garlic. Garlic scape (GS) extracts contained 84.7 ± 3.8 μg/g dry weight (DW), 81.4 ± 8.2 μg/g DW, 0.78 ± 0.05 mg gallic acid equivalent/g DW and 31.67 ± 2.25 μg/g DW of allicin, alliin, total phenolics and flavonoid contents, respectively. In total, 120 White Roman geese aged 5 weeks were randomly distributed among 12 pens and fed on a grower diet ad libitum during the growth period. Employing a completely random design, 5 males and 5 females were placed in each pen. Each treatment was applied to three pens (in total 30 birds) and the treatments comprised the following: 1) control (maize-soybean meal), 2) 5% of maize replaced with 5% of GSM (5% GSM), 3) 10% of maize replaced with 10% of GSM (10% GSM) and 4) 15% of maize replaced with 15% of GSM (15% GSM). Each group of 30 birds was treated for 8 weeks. The results revealed that the 15% GSM group was characterised by a lower feed conversion ratio than the control group; however, these groups did not differ significantly in their body weights (BWs). In addition, the 10% GSM group did not differ in both the feed conversion ratio and consumption. The flavour intensity score of meats in the 10% GSM group was significantly lower than those of meats in the 5% GSM and control groups. The general acceptability scores of meats in the 5% GSM and control groups were higher than those of meat in the 10% GSM group. The study concluded that 5% dietary GSM in the feed did not adversely affect the growth performance, meat characteristics or sensory evaluation of grower geese. Hence, the environment can be protected by including agricultural waste in goose diets.

Factors Affecting the Incidence of Angel Wing in White Roman Geese: Stocking Density and Genetic Selection

The present study investigated stocking density and genetic lines, factors that may alter the severity and incidence of angel wing (AW), in White Roman geese. Geese (n = 384) from two genetically selected lines (normal- winged line, NL, and angel-winged line, AL, respectively) and one commercial line (CL) were raised in four pens. Following common commercial practice, low-stocking-density (LD), medium-stocking-density, and high-stocking-density treatments were respectively administered to 24, 32, and 40 geese per pen at 0 to 3 weeks (1.92 m²/pen) and 4 to 6 weeks (13.2 m²/pen) of age and to 24, 30, and 36 geese at 7 to 14 weeks (20.0 m²/pen) of age. The results revealed that stocking density mainly affected body weight gain in geese younger than 4 weeks, and that geese subjected to LD had a high body weight at 2 weeks of age. However, the effect of stocking density on the severity score of AW (SSAW) and incidence of AW (IAW) did not differ significantly among the treatments. Differences were observed among the genetic stocks; that is, SSAW and IAW were significantly higher in AL than in NL and CL. Genetic selection generally aggravates AW, complicating its elimination. To effectively reduce IAW, stocking density, a suspected causal factor, should be lower than that presently applied commercially.

The working experiences of novice psychiatric nurses in Taiwanese culture: a phenomenological study

Novice psychiatric nurses experience heavy workloads, insufficient training and support in Taiwan. The aim of this study was to understand the working experiences of novice psychiatric nurses during their first year in a clinical setting. A qualitative phenomenological approach, using semi-structured face-to-face interviews was used. Narratives were analyzed using Colaizzi's seven-step method. Data saturation was reached after interviews were conducted with 15 nurses based on the purposive sampling. Four themes and eight sub-themes were identified: struggling (lacking a sense of security and competency), emulating (learning the process of interaction with clients and families, learning an appropriate role from nursing staff), prevailing (developing core competency, creating a therapeutic environment) and belonging (coping with the job, becoming a part of the psychiatric nursing staff). The findings from this study demonstrate that nurses are often inadequately prepared for psychiatric nursing. They have little understanding of mental illness, are unable to communicate appropriately with clients and struggle to cope with the conditions. Our study supports the importance for helping nurses to improve their essential knowledge and skills for coping with the job and providing good quality care, particularly in the first year.

Carolina Foxtail (Alopecurus carolinianus): Susceptibility and Suitability as an Alternative Host to Rice Blast Disease (Magnaporthe oryzae [formerly M. grisea])

Carolina foxtail (Alopecurus carolinianus) has not been reported to host Magnaporthe oryzae. A collection of Carolina foxtail obtained from several Arkansas locations over a 4-year period was inoculated with four races of the fungus under greenhouse conditions and, in all cases, inoculation resulted in the formation of irregular, yellow and brown lesions without obvious gray centers that are characteristic for blast on rice. Differences in these lesions were not observed among our collection. These lesions appeared to differ from typical blast lesions on inoculated rice leaves but were evident following artificial inoculation of Carolina foxtail in the greenhouse. M. oryzae races that differed in pathogenicity toward rice cultivars also displayed differences in lesion development on Carolina foxtail. The most virulent race on rice cultivars also produced lesions most rapidly on Carolina foxtail. These lesions developed more quickly on Carolina foxtail than on the most susceptible rice cultivars tested, including a susceptible California cultivar, M202. M. oryzae isolates cultured from these lesions in the infected Carolina foxtail caused typical disease symptoms of blast on inoculated rice cultivars. We suggest that Carolina foxtail is a new and previously unrecognized host for the blast pathogen.

Geographic variability in access to primary kidney transplantation in the United States, 1996-2005

This article focuses on geographic variability in patient access to kidney transplantation in the United States. It examines geographic differences and trends in access rates to kidney transplantation, in the component rates of wait-listing, and of living and deceased donor transplantation. Using data from Centers for Medicare and Medicaid Services and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients, we studied 700,000+ patients under 75, who began chronic dialysis treatment, received their first living donor kidney transplant, or were placed on the waiting list pre-emptively. Relative rates of wait-listing and transplantation by State were calculated using Cox regression models, adjusted for patient demographics. There were geographic differences in access to the kidney waiting list and to a kidney transplant. Adjusted wait-list rates ranged from 37% lower to 64% higher than the national average. The living donor rate ranged from 57% lower to 166% higher, while the deceased donor transplant rate ranged from 60% lower to 150% higher than the national average. In general, States with higher wait-listing rates tended to have lower transplantation rates and States with lower wait-listing rates had higher transplant rates. Six States demonstrated both high wait-listing and deceased donor transplantation rates while six others, plus D.C. and Puerto Rico, were below the national average for both parameters.

Administration of triiodothyronine and dopamine to broiler chicks increases growth, feed conversion and visceral organ mass

The influences of triiodothyronine (T3) or dopamine (DA) administration on growth, feed conversion, and visceral weights in broiler chicks between the ages of 6 and 12 d posthatch were investigated. In Trial 1, six chicks at age 6 d were randomly administered one of the following treatments: 0.37, 0.74, 1.48, and 2.96 micromol T3/kg BW or 0.07, 0.14, 0.28, and 0.56 micromol DA/kg BW. Both T3 and DA were administered via intraperitoneal injections between the end of sternum and the ends of os pubis, with 0.9% saline as the excepient. In addition, two groups of six birds each were either not injected or injected with excepient only, as controls. Four replications were carried out with a total of 264 chicks. Heart weight as a percentage of feed-deprived body weight (FDBW) of the chicks injected with 2.96 micromol T3/kg BW was heavier than that of controls. Other variables measured were not significantly different between treatments. In trial 2, six chicks at age 6 d were randomly administered, one of the following treatments: 0.56, 1.12, 2.24, and 4.48 micromol T3/kg diet or 0.40, 0.80, 1.60, and 3.20 micromol DA/kg diet as well as a nonsupplemented control. Four replications were carried out with 216 chicks. The results in Trial 2 showed that the effects of T3 (X, micromol/kg diet) on body weight gain (Y1, g) and feed consumption (Y2, g) were linear (Y1 = 310 - 21.5X, R2 = 0.868, P < 0.001 and Y2 = 398 - 22.3X, R2 = 0.765, P < 0.001, respectively). The feed conversion ratio, the weight of liver, the weights of various intestinal segments, the lengths of the duodenum, jejunum and the ileum, as well as weight per centimeter jejunal length, gizzard weight as percentage of FDBW, and the duodenal length per kilogram FDBW all had linear responses (P < 0.05) to the level of dietary supplementation of T3. The effect of dietary supplementation of T3 on the heart weight was quadratic (Y16 = 2.58 + 0.89X - 0.17 X2, R2 = 0.526, P < 0.01). Similarly, the weights of pancreas and gizzard, the heart weight as a percentage of FDBW and the pancreas weight as a percentage of FDBW all had second-order curve responses. Dietary DA supplementation exerted no effect on the variables measured except that the regression of the heart weight as a percentage of FDBW on dietary DA supplementation (X1, micromol/kg diet) existed, namely, Z1 = 0.64 + 0.24 X1 - 0.23 X1(2) + 0.05 X1(3) (R2 = 0.868, P < 0.05).

Suramin protects the murine motor nerves from the toxic effects of presynaptic Ca(2+) channel inhibitors

The purpose of this study is to investigate whether suramin is capable of preventing the neurotoxic effects of Ca(2+) channel inhibitors at the presynaptic sites. Mouse diaphragm and triangularis sterni preparations were used for this study in order to measure the muscle tension and nerve terminal Ca(2+) current, respectively. Both omega-conotoxin MVIIC and omega-agatoxin IVA markedly inhibit the nerve-evoked muscle contractions as well as the nerve terminal Ca(2+) current respectively. Pretreatment with suramin (0.3 mM) significantly reduced the inhibitory effect of nerve-evoked muscle contractions and Ca(2+) current induced by either omega-conotoxin MVIIC or omega-agatoxin IVA but not that induced by the non-selective Ca(2+) channel blocker, Cd(2+). Neither suramin nor Ca(2+)-channel toxins significantly affect Na(+)- and K(+) currents of the nerve terminals. These findings indicate that suramin selectively interferes the action of presynaptic Ca(2+) channel neurotoxins and thus reduces their depressant effects on the muscle contractions. The implication of these findings is that suramin and its derivatives may potentially become useful agents in management of intoxication of Ca(2+) channel neurotoxins.

Effects of Scutellarein on diabetic rat aorta

AIM

To study the effect of Scutellarein (Scu) on the diabetic rat aorta.

METHODS

Contractile responses to phenylepherine and endothelium-dependent relaxation responses to acetylcholine (ACh) in rat aorta were investigated after streptozocin-induced 6-wk diabetes, Scu-treated streptozocin-induced diabetes, and in age-matched control in vitro.

RESULTS

1) Endothelium-dependent relaxation to ACh in diabetic rats was decreased (P < 0.01) compared with age-matched control. 2) Contractile responses to phenylepherine were increased (P < 0.01) in diabetic rats. 3) The dietary supplement of 0.5% Scu starting from 1-wk diabetes induction prevented endothelial dysfunction (P < 0.01), but the contractile responses to phenylepherine were further increased.

CONCLUSION

Scu prevented vascular endothelial dysfunction in diabetic rats, and also potentiated the contraction induced by phenylepherine.

One-codon alternative splicing of the CpG MTase Dnmt1 transcript in mouse somatic cells

The genomic methylation patterns in the mammalian somatic cells are presumably maintained by a single enzyme, dnmt1. In mouse, this DNA (cytosine-5)-methyltransferase, or CpG MTase, is encoded by the Dnmt1 gene. We now present evidence that in different tissues and cell types, the primary transcript of mouse dnmt1 is alternatively spliced to generate two poly-(A) RNAs of approximately similar abundance. This alternative splicing most likely originates from the existence of two tandemly arranged acceptor sites separated by only 3 nt. The two Dnmt1 mRNAs thus encode two CpG MTases differing by two amino acids. We discuss the implications of the discovery of two dnmt1 isozymes, instead of one enzyme as previously thought, in the somatic cells of both mouse and human.

Erigeron breviscapus prevents defective endothelium-dependent relaxation in diabetic rat aorta

We examined the endothelium-dependent relaxation response to acetylcholine (Ach) in streptozotocin-induced diabetic rat aorta at the stages of 2- and 6-wks' duration in vitro, and compared with another two groups which were treated with dietary supplement of 0.1% Aminoquanidine (AG) and 0.5% Erigeron breviscapus (EB) from 1-week of diabetes induction. At the stage of 2-wks' duration of diabetes, relaxation responses to lower concentrations of Ach in 0.3 uM phenylepherine-precontracted aortas were diminished significantly (P<0.05) compared with age-matched control, but the maximal relaxation of Ach remained unchanged. At the stage of 6-wks' duration, diabetes caused an approximately 60% (P<0.001) deficit in maximum relaxation, and this was significantly (P<0.001) prevented in AG and EB treated groups. There was an approximately 40% enhancement in the maximum contractile response to phenylepherine with diabetes (P<0.05), which was unaffected significantly by AG and EB treatments. The data suggest that the defective endothelium-dependent relaxation in diabetic rat aorta occurred as early as 2-wks' duration of diabetes, and the treatments of AG and EB could protect vascular endothelium although the deficits in vascular smooth muscle contractile responses were not protected.

Suramin inhibits the toxic effects of presynaptic neurotoxins at the mouse motor nerve terminals

Clinically available chemical antagonists of snake neurotoxins still await to be identified. In this study, we demonstrate that an anti-trypanosomiasis agent, suramin, is an effective inhibitor of beta-bungarotoxin isolated from the venom of Formosan Krait snake. Following intraperitoneal injection (12 ng/g) of beta-bungarotoxin in mice, the time to paralysis (loss a limb withdrawal reflex, 21. 8+/-3.4 h, n=4) was significantly prolonged after intravenous injection (16 microg/g) of suramin (35.9+/-4.0 h, n=4, P<0.05). The mechanism of this inhibitory effect of suramin was analyzed at the mouse nerve terminals. beta-Bungarotoxin (1 microg/ml) produces an irreversible blocking effect of nerve-evoked muscle contractions of mouse phrenic nerve-diaphragm (blocking time 135+/-6 min, n=6). Pretreatment with suramin (0.3 mM) significantly prolonged the blocking time by three-fold. This selective inhibitory effect of suramin was further confirmed when suramin was shown to delay the neuromuscular blocking effect of another presynaptic neurotoxin, crotoxin (from American rattlesnake venom), but not that of the postsynaptic neurotoxin, alpha-bungarotoxin. Furthermore, suramin inhibited beta-bungarotoxin in blocking transmitter release as revealed by prolonging the time to abolish the end-plate potential amplitude (with suramin, 391+/-8 min; without treatment, 141+/-5 min). K(+) current was measured in the mouse triangularis sterni preparation; suramin (0.3 mM) had no significant effect on beta-bungarotoxin in inhibiting K(+) current (77+/-3% of control; with suramin 75+/-3% of control, respectively). These findings clearly show that suramin is an inhibitor of presynaptic neurotoxins, mediated by interrupting the toxins in blocking the releasing mechanism of transmitter at the motor nerve terminals. The implication of these findings is that suramin and related compounds can become useful agents in management of snakebites.

Two major forms of DNA (cytosine-5) methyltransferase in human somatic tissues

Thus far, only one major form of vertebrate DNA (cytosine-5) methyltransferase (CpG MTase, EC 2.1.1.37) has been identified, cloned, and extensively studied. This enzyme, dnmt1, has been hypothesized to be responsible for most of the maintenance as well as the de novo methylation activities occurring in the somatic cells of vertebrates. We now report the discovery of another abundant species of CpG MTase in various types of human cell lines and somatic tissues. Interestingly, the mRNA encoding this CpG MTase results from alternative splicing of the primary transcript from the Dnmt1 gene, which incorporates in-frame an additional 48 nt between exons 4 and 5. Furthermore, this 48-nt exon sequence is derived from the first, or the most upstream, copy of a set of seven different Alu repeats located in intron 4. The ratios of expression of this mRNA to the expression of the previously known, shorter Dnmt1 mRNA species, as estimated by semiquantitative reverse transcription-PCR analysis, range from two-thirds to three-sevenths. This alternative splicing scheme of the Dnmt1 transcript seems to be conserved in the higher primates. We suggest that the originally described and the recently discovered forms of CpG MTase be named dnmt1-a and dnmt1-b, respectively. The evolutionary and biological implications of this finding are discussed in relation to the cellular functions of the CpG residues and the CpG MTases.

[Role of caudal pressor area of medulla oblongata in vasomotor tone of peripheral vessels]

To study the role of the caudal pressor area (CPA) on the ventral surface of medulla oblongata in vasotonia of the skeletal muscles and kidneys, perfusion pressures of vessels in skeletal muscles and kidneys were recorded to observe effects of microinjection of L-glutamate (L-glu) into CPA. The results are as follows. L-glu induced a significant increase of artery pressure (AP), perfusion pressure of muscles (PPm) and perfusion pressure of kidney (PPk), which was markedly attenuated by prior injection of phentolamine or propranolol to the bilateral pressor area. These results indicate that the vascular roles of CPA were mainly mediated via alpha- and/or beta-receptors.

Enhanced spontaneous transmitter release at murine motor nerve terminals with cyclosporine

Cyclosporine, a calcineurin inhibitor, significantly enhances spontaneous acetylcholine release after a brief tetanus and potentiates the effect of phorbol 12,13-dibutyrate. Both actions are prevented by the protein kinase C inhibitor, bisindolylmaleimide iodide. Protein kinase C and calcineurin thus play important roles in the balance between phosphorylation and dephosphorylation regulating spontaneous transmitter release at motor nerve terminals.

Inhibitory effects of S-nitrosocaptopril on vasomotor tone

AIM

To study effects of captopril (Cap) and S-nitrosocaptopril (CapNO) on vascular tension.

METHODS

Tension of rabbit aortic rings and perfusion pressure of rat renal artery (PPr) were examined to evaluate the effects of CapNO.

RESULTS

CapNO (3 nmol.L-1-10 mumol.L-1) produced concentration-dependent vasorelaxation response in the rings of rabbit thoracic aortas. Endothelium denudation did not alter the relaxations to CapNO. In contrast, Cap had no vasorelaxing effect on the rings precontracted with phenylephrine. CapNO (10 nmol.L-1) decreased rat PPr in vivo (P < 0.01), and the effect was concentration-dependent and reversible. Cap showed a reduction in rat PPr only at the concentration 1000 nmol.L-1 (P < 0.05). The relaxing potency of CapNO was 100 times higher than that of Cap in this respect. Pre-perfusion of rat renal arteries with NG-monomethyl-L-arginine monoacetate (L-NMMA, 0.03 nmol.L-1) or L-arginine (3 nmol.L-1) did not significantly blocked the relaxing effect induced by CapNO.

CONCLUSION

CapNO had a direct vasodilatory effect.

Phorbol ester-induced contractions of mouse detrusor muscle are inhibited by nifedipine

The effects of phorbol esters on contractions of detrusor strips isolated from mouse urinary bladder were studied. Beta-phorbol-12,13-dibutyrate (beta-PDBu, 10 nM) significantly enhances both the neurogenic and myogenic detrusor contractions to a similar extent. By contrast, an inactive isoform of protein kinase C (PKC) stimulation, alpha-phorbol-12,13-dibutyrate (100 nM) has no such enhancing effect on the muscle contraction. The effect of beta-PDBu was dependent on the extracellular Ca2+ concentration. Nifedipine (0.3 microM, a L-type Ca2+ channel blocker), staurosporine (1 microM) and bisindolylmaleimide I (microM, a selective PKC inhibitor) but not omega-conotoxin GVIA (an N-type Ca2+ channel blocker) abolished the enhancing effect of beta-PDBu. In other words, beta-PDBu failed to augment the nifedipine-insensitive component of the muscle contraction. Moreover, beta-PDBu not only enhances the muscle response induced by exogenous agonists (acetylcholine or ATP) and KCl but also increases the resting tone of detrusor muscle, an effect which is also inhibited by nifedipine and bisindolylmaleimide I. From these findings, it is concluded that the enhancing effect of beta-PDBu is due to activation of the L-type Ca2+ channel through phosphorylation by protein kinase C. This allows more Ca2+ influx from the extracellular medium, leading to an increase in the contractions of the mouse detrusor muscle.

Comparison of serum fructosamine vs glycohemoglobin as measures of glycemic control in a large diabetic population

In diabetic patients, measurement of glycohemoglobin (HbA1C) is widely accepted as the standard method for determining long-term glycemic control. Another test, the serum fructosamine test, has been suggested as a less costly alternative. To compare these two tests, we evaluated how well each correlated with fasting blood glucose and how well each could predict the degree of glycemic control perceived by treating physicians. Among 222 diabetic subjects, fructosamine (r=0.74) and fructosamine corrected for serum albumin (c-fructosamine) (r=0.79) correlated better with fasting blood glucose than did HbA1C (r=0.68) (P<0.05). Among 450 diabetic subjects, fructosamine, c-fructosamine, and HbA1C showed similar error rates (23%-26%) when discriminating between subjects who had either poor vs not-poor control or poor-to-fair versus good-to-excellent control. However, receiver operating characteristic curves for these tests indicated that HbA1C was the best discriminator because it showed a 9% to 10% greater area under the curve (P<0.05).

Studies on curare-like action of the tripeptide carbobenzoxy-Gly-Gly-Arg-beta-naphthylamide in mouse diaphragm

The effects of several protease substrates or protease inhibitors on neuromuscular transmission in the isolated mouse phrenic nerve-diaphragm were studied. N-Carbobenzoxy-Gly-Gly-Arg-beta-naphthylamide (Z-GGR-N) but none of the other agents inhibited the nerve-evoked muscle contractions. By means of electrophysiological studies, Z-GGR-N was found to inhibit the amplitudes of both end-plate potentials (epps) (IC50 approximately 50 microM) and miniature end-plate potentials (mepps) but to increase the frequencies of mepps. This tripeptide could protect the nicotinic acetylcholine receptor from the irreversible inhibitory action of alpha-bungarotoxin on the mouse diaphragm. Similar to D-tubocurarine, Z-GGR-N induced tetanic fading both of nerve-evoked muscle contractions and of the amplitude of epps. Furthermore, Z-GGR-N exhibited a greater depression of the amplitudes of train-epps than those of mepps, similar to that of hexamethonium and D-tubocurarine, indicating an effect on presynaptic autoreceptors. Suramin, which could competitively reverse the inhibitory effects of non-depolarizing relaxants, acted in this study as an antagonist of all the effects of Z-GGR-N, especially those at the presynaptic site. All of these findings suggest that Z-GGR-N is a novel tripeptide possessing curare-like actions at both presynaptic and postsynaptic sites and that these actions are independent of its protease substrate property.

'Best clinical practice': assessment of processes of care and of outcomes in the US Military Health Services System

The National Quality Management Program of the Military Health Services System of the United States has undertaken a series of projects whose objective is the active, on-going monitoring and improvement of the effectiveness and efficiency of the care provided to a broad population that encompasses troops on active duty, retirees and dependents. The analytic activities consist of (1) identification by clinical panels of conditions and procedures of interest; (2) collection of data from electronic repositories and from charts to characterize the patients, how they are managed, the clinical outcomes they experience, the resource costs their care entails, and, from questionnaires, their functional status and level of satisfaction, and (3) generation of 'report cards' that inform organizational units down to the level of the hospital of the characteristics of their patients, their practices, and the risk-adjusted outcomes they achieve. The patterns of care employed by the hospitals that obtain the best risk-adjusted outcomes and resource utilization ('best clinical practice') are identified and made known. In addition, (4) a systematic process of developing outcomes-based practice guidelines has been devised. It intent is to serve as a decision-support tool for clinicians. Initial estimates have been obtained of the probable consequences of the application of this tool to operative interventions in childbirth. Use of the tool would result in a higher occurrence of elective Caesarean sections, a reduced rate of emergency Caesarean sections and much lower use of forceps, with an overall improvement in outcomes and lower resource costs. This program is currently in the early phases of implementation. The two principal requirements for the immediate future are (1) education of the clinical and administrative communities in the use of the data and the decision-support tools and (2) evaluation of the consequences of the use of the data by the clinical and administrative communities.

Involvement of nitric oxide in the in vivo effects of lipopolysaccharide on the contractile and electrical properties of mouse diaphragm

The contractile and electrical properties of the mouse diaphragm during endotoxemia were studied, and the possible role of nitric oxide (NO) on these changes was investigated. The mice were injected intraperitoneally with E. coli. lipopolysaccharide (endotoxin, LPS) at various times before isolation of the diaphragm to induce endotoxemia. It was observed that direct twitch tension was slightly increased, and that there was a significant increase in tetanic tension when compared with controls. The potentiation of direct twitch tension induced by a Cl--channel blocker (9-anthracene carboxylic acid), but not the potentiation by a Na+-channel activator (veratridine) or by K+-channel blockers (uranyl ion, 4-aminopyridine and tetraethylammonium ion), was attenuated in the diaphragm of LPS-treated mice. Moreover, the resting membrane potential was significantly reduced and the membrane input resistance was significantly increased, largely due to a decrease in Cl--conductance. However, the membrane K+-conductance remained unaltered. These results imply that the sarcolemmal Cl--channel is markedly affected in the mouse diaphragm during endotoxemia. These changes of contractile and electrical characteristics of the mouse diaphragm during endotoxemia could be reversed by treatment with dexamethasone and N(G)-nitro-L-arginine (NO synthase inhibitors). On the other hand, in in vitro studies, LPS (20 microg/ml), by itself, applied directly to the diaphragm, did not alter the muscle contractions or the membrane potentials. A NO donor, added to the diaphragm bath, increased the tetanus/twitch ratio and induced a transient depolarization. All of these findings suggest that LPS may, at least in part, affect the sarcolemmal electrical properties and muscle contractions during endotoxemia through the L-arginine:NO pathway.

A potential determinant of enhanced crystallization of Hbc: spectroscopic and functional evidence of an alteration in the central cavity of oxyHbC

The structural basis of the crystallizing tendencies of oxyHbC (beta 6Glu-->Lys), that produces haemolytic anaemia in homozygotes, is unknown. Using a fluorescent organic phosphate analogue (8-hydroxy-1,3,6-pyrenetrisulphonate), and conventional oxygen equilibrium studies, data suggest that the binding of inositolhexaphosphate (IHP) to oxyHbC differs from HbA, indicating perturbations of the oxyHbC central cavity, which was predicted from our earlier spectroscopic findings. To define the relationship between this conformational change in oxyHbC and its tendency to crystallize, the effect of four central cavity ligands on the crystallization rate was studied: a peptide containing 11 residues from the N-terminal portion of band 3, the full cytoplasmic domain of band 3, 2,3-diphosphoglycerate and IHP. OxyHbC crystallization was accelerated by all these central cavity ligands and not by the appropriate controls. These central cavity changes become an excellent candidate for the dramatic increase in the crystallization rate of oxyHbC.

HbC compound heterozygotes [HbC/Hb Riyadh and HbC/Hb N-Baltimore] with opposing effects upon HbC crystallization

Compound heterozygotes of variant haemoglobins (Hbs) with HbC, with or without novel phenotypic changes, have provided insight into the molecular basis of the interacting haemoglobins and information concerning the role of specific residues in the crystallization of oxy HbC. A high phosphate buffer system has proved useful for studying the effects of variant haemoglobins (naturally co-existing with HbC in the red cell) on the oxy HbC crystallization process and has led us to conclude that beta87 and beta73 are contact sites of the oxy HbC crystal. We now present investigations from two HbC compound heterozygotes which exhibit opposing effects upon HbC crystallization: HbC/Hb N-Baltimore (beta95 Lys-->Glu) and HbC/Hb Riyadh (beta120 Lys-->Asn). The latter inhibits the in vitro crystallization of HbC, explaining the lack of erythrocyte abnormalities (with the exception of microcytosis) in the doubly heterozygous infant. In contrast, Hb N-Baltimore accelerates the crystallization of HbC, contributing to multiple abnormalities in red cell morphology, albeit in the absence of morbidity. We conclude that (1) beta120 and beta95 are additional contact sites in the crystal, and (2) the HbC/Hb Riyadh haemoglobinopathy demonstrates that crystallization may not be required for the generation of the observed microcytosis and increased red cell density in HbC-containing red cells.

Multiple types of Ca2+ channels in mouse motor nerve terminals

We measured neurotransmitter release and motor nerve terminal currents in mouse phrenic nerve-diaphragm and triangularis sterni preparations, to evaluate the role of Ca2+-channel subtypes in regulating transmitter release. Saturated concentrations of either omega-agatoxin IVA [omega-Aga-IVA (0.3 microM), a blocker of P-type Ca2+ channels] or omega-conotoxin MVIIC [omega-CTx-MVIIC (2 microM), a P- and Q-type Ca2+-channel blocker], inhibited nerve-evoked muscle contractions and the amplitude of endplate potentials respectively. In contrast, combined treatment with nifedipine (50 microM, a blocker of L-type Ca2+ channels) plus omega-conotoxin GVIA [omega-CTx-GVIA (2 microM), a blocker of N-type Ca2+ channels] did not elicit inhibitory effects on nerve-evoked muscle contractions, endplate potentials or nerve terminal waveforms. Because of the non-linear relationship between endplate potentials and Ca2+ signals, a small decrease in presynaptic Ca2+ entry can significantly reduce the amplitude of the endplate potential. Thus, we applied 3,4-diaminopyridine (3,4-DAP, a K+-channel blocker) or high Ca2+ (10 mM) to accelerate and amplify the endplate potentials and Ca2+ currents. The endplate potentials amplified by 3,4-DAP or by high Ca2+ correspondingly proved to be quite resistant to both omega-Aga-IVA and omgea-CTx-MVIIC; omega-Aga-IVA exerted only a partial inhibitory effect on endplate potentials, and the omega-Aga-IVA-resistant component was further inhibited by omega-CTx-MVIIC. The component that was resistant to the two toxins could be completely blocked by the non-selective Ca2+ channel blocker Cd2+ (300 microM). A combination of the two toxins had no significant effects on either spontaneous transmitter release or postsynaptic resting membrane potentials of the diaphragm preparation and the Na+ and K+ waveforms of the triangularis sterni preparations. This finding suggests a preferential inhibitory effect at a presynaptic site. Measuring the Ca2+ currents in the triangularis sterni also revealed partial inhibition by omega-CTx-MVIIC with further incomplete inhibition by omega-Aga-IVA. Cd2+ (300 microM) abolished the toxin-resistant component of the Ca2+ current. In contrast, a combination of nifedipine (50 microM) with omega-CTx-GVIA (2 microM) was without inhibitory effect. We conclude that multiple types of Ca2+ channels, i.e. omega-Aga-IVA-sensitive, omega-CTx-MVIIC-sensitive and toxin-resistant Ca2+ channels, coexist in mouse motor nerve terminals.

Hb Montefiore (126(H9)Asp-->Tyr). High oxygen affinity and loss of cooperativity secondary to C-terminal disruption

Hb Montefiore was found, in the heterozygous state, in a Puerto Rican female who had a slightly elevated total Hb level. Structural analysis revealed that Asp-alpha126 was replaced by Tyr. Hb Montefiore migrates close to HbF (at pH 8.6) and accounts for 20.3% of the hemolysate. Oxygen binding of red blood cells revealed a 40% decrease in the P50 (pH 7.4) and a low n value of 1.6 (normal: 2.6). Depletion of red blood cell 2,3-DPG did not change the results. Stripped Hb Montefiore at pH 7.2 showed an 8-fold reduction in P50 (0.6 versus 4.6 mm Hg) and very low cooperativity (n = 1.2 versus 2.9 for the control). Heterotopic effectors, as 2,3-diphosphoglycerate and inositol hexaphosphate had a normal effect and in addition, they increased cooperativity. The chloride ion effect and the Bohr effect were moderately reduced. A bezafibrate derivative (L345), known to bind alpha126, increases the P50 of HbA by 9-fold, but only by 1. 5-fold that of Hb Montefiore. Combining these functional studies with intrinsic fluorescence and Resonance Raman spectroscopy, we interpret the very low n value and the high oxygen affinity for Hb Montefiore as a result of both a destabilized T state that switches to R upon ligand binding and a deoxy T state that binds ligands with higher affinity than that of deoxy HbA. Hb Montefiore still binds ligands cooperatively, but the difference in ligand binding properties of the two quaternary states has been drastically reduced.

Ruthenium red, a novel enhancer of K+ currents at mouse motor nerve terminals

The effects of ruthenium red (RR) on transmitter release and pre-synaptic currents were studied in the mouse neuromuscular junction. The action of RR (10 microM) was shown not only in the complete suppression of nerve-evoked muscle contractions associated with the depression of endplate potential amplitude but also in the partial inhibition of the amplitude of miniature-endplate potentials. However, the other ruthenium compounds, ruthenium chloride and tris (2,2-bipyridyl) ruthenium chloride did not significantly affect the neuromuscular transmission. In pre-synaptic waveform studies, the fast K(+)-current [IK(f)] as well as the ca(2+)-activated K(+)-current [IK(ca)] was significantly enhanced by 10 microM RR. Furthermore, 10 microM RR antagonized the action of beta-bungarotoxin (a blocker of slow K(+)-channel [IK(s)] in enhancing pre-synaptic Ca2+ currents. In contrast, the typical Ca(2+)-channel blockers, omega-agatoxin (0.5 microM), Gd3+ (0.5 mM) and CD2+ (0.3 mM) all suppressed the IK(ca). Although RR (1-30 microM) inhibited the Ca(2+)-currents of the nerve terminals induced by the combined treatment with the K(+)-channel blockers, 3,4-diaminopyridine plus tetraethylammonium chloride in a concentration-dependent manner, it is considered that RR-enhanced K+ currents were responsible for, at least in part, the observed inhibition of the Ca(2+)-current which led to the blockade of transmitter release.

Technical performance evaluation of BM/Hitachi 747-200 serum fructosamine assay

The technical performance of serum fructosamine assay as a short-term index of diabetic control was evaluated by using the BM/Hitachi 747-200 Automatic Analyzer (Boehringer Mannheim Corp). Intra- and interassay precisions (CV) were <2%. Linearity was confirmed up to 1000 micromol/L. Lipemia, produced artificially or from hypertriglyceridemia in vivo, did not interfere with measurement of serum fructosamine concentration. However, hemoglobin (Hb) interfered with measurement substantially at concentrations >15.5 micromol/L, and bilirubin interfered substantially at concentrations >68.4 micromol/L. A normal reference range of up to 282 micromol/L (mean +/- 2SD = 242 +/- 40) was derived from results obtained from 228 nondiabetic subjects. In 222 diabetic subjects, serum fructosamine concentration correlated well with fasting glucose concentration (r = 0.74) and with Hb A1c concentration (r = 0.80). This automated fructosamine assay has the advantages of technical simplicity, low cost, and reduced analytical time compared with the Hb A1c method.

Technical performance evaluation of BM/Hitachi 747-200 serum fructosamine assay

The technical performance of serum fructosamine assay as a short-term index of diabetic control was evaluated by using the BM/Hitachi 747-200 Automatic Analyzer (Boehringer Mannheim Corp). Intra- and interassay precisions (CV) were &lt;2%. Linearity was confirmed up to 1000 micromol/L. Lipemia, produced artificially or from hypertriglyceridemia in vivo, did not interfere with measurement of serum fructosamine concentration. However, hemoglobin (Hb) interfered with measurement substantially at concentrations &gt;15.5 micromol/L, and bilirubin interfered substantially at concentrations &gt;68.4 micromol/L. A normal reference range of up to 282 micromol/L (mean +/- 2SD = 242 +/- 40) was derived from results obtained from 228 nondiabetic subjects. In 222 diabetic subjects, serum fructosamine concentration correlated well with fasting glucose concentration (r = 0.74) and with Hb A1c concentration (r = 0.80). This automated fructosamine assay has the advantages of technical simplicity, low cost, and reduced analytical time compared with the Hb A1c method.