Self-reported non-adherence to immune-suppressant therapy in liver transplant recipients: demographic, interpersonal, and intrapersonal factors

Adherence to immune suppressants and follow-up care regimen is important in achieving optimal long-term outcomes after organ transplantation. To identify patients most at risk for non-adherence, this cross-sectional, descriptive study explores the prevalence and correlates of non-adherence to immune-suppressant therapy among liver recipients. Anonymous questionnaires mailed consisted of the domains: (i) adherence barriers to immune suppressants, (ii) immune suppressants knowledge, (iii) demographics, (iv) social support, (v) medical co-morbidities, and (vi) healthcare locus of control and other beliefs. Overall response was 49% (281/572). Data analyzed for those transplanted within 10 yr of study reveal 50% (119/237) recipients or 9.2/100 person years reporting non-adherence. Non-adherence was reported highest in the 2-5 yr post-transplant phase (69/123, 56%). The highest immune-suppressant non-adherence rates were in recipients who are: divorced (26/34, 76%, p=0.0093), have a history of substance or alcohol use (42/69, 61%, p=0.0354), have mental health needs (50/84, 60%, p=0.0336), those who missed clinic appointments (25/30, 83%, p<0.0001), and did not maintain medication logs (71/122, 58%, p=0.0168). Respondents who were non-adherent with physician appointments were more than four and a half times as likely (OR 4.7, 95% CI 1.5-14.7, p=0.008) to be non-adherent with immune suppressants. In conclusion, half of our respondents report non-adherence to immune suppressants. Factors identified may assist clinicians to gauge patients' non-adherence risk and target resources.

Parasympathetic and sympathetic control of the pancreas: a role for the suprachiasmatic nucleus and other hypothalamic centers that are involved in the regulation of food intake

To reveal brain regions and transmitter systems involved in control of pancreatic hormone secretion, specific vagal and sympathetic denervation were combined with injection of a retrograde transsynaptic tracer, pseudorabies virus (PRV), into the pancreas. After sympathetic or vagal transsection first-order neurons were revealed in the dorsal motor nucleus of the vagus (DMV) or in preganglionic spinal cord neurons (SPN), respectively. Careful timing of the survival of the animals allowed the detection of cell groups in immediate control of these DMV or SPN neurons. A far larger number of cell groups is involved in the control of DMV than of SPN neurons. Examples are given of a high level of interaction between the sympathetic and parasympathetic nervous system. Several cell groups project to both branches of the autonomic nervous system, sometimes even the same neurotransmitter is used, e.g., oxytocin neurons in the paraventricular nucleus and melanin-concentrating hormone and orexin neurons in the lateral hypothalamus project to both the DMV and SPN neurons. Moreover, the appearance of third-order neurons located in the sympathetic SPN after complete sympathectomy and in the DMV after complete vagotomy illustrates the possibility that motor neurons of the sympathetic and parasympathetic system may exchange information by means of interneurons. The presence of second-order neurons in prefrontal, gustatory, and piriform cortex may provide an anatomic basis for the involvement of these cortices in the cephalic insulin response. The observation that second-order neurons in both vagal and sympathetic control of the pancreas contain neuropeptides that are known to play a role in food intake indicates a direct association between behavioral and autonomic functions. Finally, the observation of third-order neurons in the suprachiasmatic nucleus and ventromedial hypothalamus shows the modulatory action of the time of the day and metabolic state, respectively.

Effect of bilateral lesions of the suprachiasmatic nucleus on hyperglycemia caused by 2-deoxy-D-glucose and vasoactive intestinal peptide in rats

In mammals, the brain usually uses glucose as a sole energy source. Thus, under a central glucopenic condition after intracranial injection of 2-deoxy-D-glucose (2DG), an inhibitor of glucose utilization, it has been shown that rats elevate their blood glucose level through excitation of the sympathetic nerves. Experiments were conducted with rats to examine the role of the hypothalamic suprachiasmatic nucleus (SCN) in the hyperglycemic response to intracerebroventricular injection of either 2DG or vasoactive intestinal peptide (VIP). It was observed that, (1) intracerebroventricular injection of a VIP-antagonist inhibited the hyperglycemic and hyperglucagonemic responses to the intracranial injection of 2DG; (2) bilateral electrolytic lesioning of the SCN suppressed the hyperglycemic and hyperglucagonemic responses to intracranial injection of 2DG, and intracerebroventricular injection of VIP restored these responses to 2DG; and (3) bilateral electrolytic lesioning of the SCN also suppressed the hyperglycemic and hyperglucagonemic responses to the VIP injection, and additional intracerebroventricular injection of 2DG caused hyperglycemia. These findings indicate that in rats with bilateral lesions of the SCN intracranial injection of 2DG is able to elicit hyperglycemia when VIP was administered intracranially, and suggest that neurons containing VIP-like immunoreactive substance (VIP-neurons) in the SCN have an important role in the mechanism of hyperglycemia elicitation following intracranial injection of 2DG. Moreover, these findings show that 2DG and VIP are able to realize their functions through acting on the brain sites outside the SCN.

Effect of intravenous administration of melatonin on the efferent activity of the adrenal nerve

The effect of intravenous administration of melatonin on the efferent activity of the adrenal nerve was investigated in the rat. Intravenous infusion of 1 or 2 ng melatonin resulted in a decrease, and 10 or 20 ng or larger amount of melatonin caused an increase in the efferent activity of the adrenal nerve. The least effective dose for the suppressive activity of melatonin was 100 pg and the response is dose-related. Administration of either 1 ng or 10 ng of melatonin did not change the plasma glucose concentration until 30 min after the administration. Hepatic vagotomy eliminates the inhibitory effect of melatonin. These results suggest that melatonin sensors in the hepato-portal region and melatonin receptors in the SCN play important roles in the regulation of sympathetic outflow to the adrenal medulla.

Melatonin suppresses hyperglycemia caused by intracerebroventricular injection of 2-deoxy-D-glucose in rats

To elucidate the role of melatonin (MT), we examined the effects of intracranial injection of MT and an MT-antagonist (S20928) on the hyperglycemic response to intracranial injection of 2-deoxy-D-glucose (2DG) in rats. The hyperglycemic and hyperglucagonemic responses caused by intracerebroventricular injection of 2DG were inhibited by intracerebroventricular co-injection of MT, but enhanced by co-injection of the MT-antagonist. Intraperitoneal injection of MT also inhibited the hyperglycemic response, though the inhibition seemed to be less than that after intracranial injection of MT. These results suggest that MT plays an endogenously suppressive role in the hyperglycemia caused by 2DG, possibly through a brain site.

Inheritance of dsRNAs in the rice blast fungus, Magnaporthe grisea

The 1.6 and 1.8 kbp dsRNAs have been found in the rice blast fungus, Magnaporthe grisea strain MG01. These dsRNA molecules are located in cytoplasm of the fungal cells and maintained stably during vegetative growth. Three crosses between dsRNA free and dsRNA containing strains including a parental cross, sib-mating and back cross were made to follow the inheritance of dsRNAs during sexual reproduction. Approximately 10% of ascospore progenies (11 out of 105) contained dsRNAs from all three crosses. These data indicate that dsRNAs of M. grisea are inherited at a low frequency and not in a Mendelian fashion.

Roles of the suprachiasmatic nucleus and vasoactive intestinal peptide in the response of plasma arginine vasopressin to osmotic challenge

To clarify the role of neurons containing a vasoactive intestinal peptide (VIP)-like substance (VIP neurons) in the hypothalamic suprachiasmatic nucleus (SCN) in regulation of the plasma arginine vasopressin (AVP) concentration, we examined the effects of bilateral lesions of the SCN and intracranial injection of VIP on the increase in the plasma AVP concentration caused by ip injection of hypertonic (3.6%) saline in rats. The increase in the plasma AVP concentration after ip injection of hypertonic saline was significantly suppressed in rats with bilateral lesions of the SCN. Furthermore, the increase in the plasma AVP concentration elicited by ip injection of hypertonic saline was enhanced by intracerebro-ventricular injection of VIP and suppressed by a VIP antagonist, [Lys1,Pro2,5,Arg3.4,Tyr6]VIP. However, the same dose of VIP injected into the heart had no effect on the increase in the plasma AVP concentration caused by ip injection of hypertonic saline. These results suggest that the SCN and intracranial VIP play important roles in the regulation of the plasma AVP concentration and support the possibility that VIP neurons in the SCN enhance the response of plasma AVP to osmotic challenge.

Bilateral lesions of the hypothalamic suprachiasmatic nucleus eliminated sympathetic response to intracranial injection of 2-deoxy-D-glucose and VIP rescued this response

We previously found that bilateral lesions of the suprachiasmatic nucleus abolished hyperglycemic response to intracranial injection of 2-deoxy-D-glucose in rats. Because the hyperglycemia due to 2-deoxy-D-glucose was shown to be dependent on the functions of the adrenal medulla and sympathetic nervous system, the effect of bilateral lesions of the suprachiasmatic nucleus on changes in the nervous activity of sympathetic efferents to the adrenal after intracranial injection of 2-deoxy-D-glucose was examined in rats. It was found that bilateral lesions of the nucleus eliminated the increase in neural activity of the sympathetic efferent that occurred after the injection of 2-deoxy-D-glucose. Because the suprachiasmatic nucleus possesses neurons containing a vasoactive intestinal polypeptide-like substance, the effects of vasoactive intestinal polypeptide and 2-deoxy-D-glucose, administered alone or in combination, on the sympathetic activity were examined in intact control rats and in rats with bilateral lesions of the suprachiasmatic nucleus. It was found that in the normal control rats, vasoactive intestinal polypeptide alone increased the sympathetic activity, whereas it dramatically enhanced the sympathetic response to 2-deoxy-D-glucose. However, in rats with bilateral lesions of the suprachiasmatic nucleus, vasoactive intestinal polypeptide alone elicited no increase in the nervous activity of the sympathetic efferents to the adrenal, but combined administration of vasoactive intestinal polypeptide and 2-deoxy-D-glucose caused an increase in the nervous activity of sympathetic efferents to the adrenal. These findings suggest that the suprachiasmatic nucleus is involved in the enhancement of sympathetic activity caused by intracranial injection of 2-deoxy-D-glucose, and that neurons containing a vasoactive intestinal polypeptide-like substance in the suprachiasmatic nucleus play an important role in the sympathetic enhancement that occurs after intracranial injection of 2-deoxy-D-glucose. This role might be a permissive and facilitative one.

Involvement of cerebral neurotensin in hyperglycemic response caused by 2-deoxy-D-glucose in rats

Previous studies have indicated that neurons containing a vasoactive intestinal polypeptide (VIP)-like immunoreactive substance (VIP neurons) in the suprachiasmatic nucleus (SCN) are involved in regulating glucose metabolism in rats. In this connection, it has been suggested that in rats, VIP neurons in the SCN have neurotensin (NT) receptors. To clarify the role of NT, we examined the effects of intracranial injection of NT and an NT-antagonist on the hyperglycemic response to intracranial injection of 2-deoxy-D-glucose (2DG) in rats. The hyperglycemic and hyperglucagonemic responses caused by intracerebroventricular injection of 2DG were significantly enhanced by intracerebroventricular co-injection of NT, but suppressed by co-injection of the NT-antagonist. Intraperitoneal injection of the NT-antagonist did not affect the hyperglycemic and hyperglucagonemic responses to 2DG. These results suggest that intracranial NT plays an endogenously enhancive role in the hyperglycemic and hyperglucagonemic responses caused by 2DG.

Suppressive effect of vasopressin on the hyperglycemic response to intracranial injection of 2-deoxy-D-glucose

Vasopressin (VP) is a peptide consisting of 9 amino acids which acts as a neurotransmitter or neuromodulator in the central nervous system. Neurons containing VP project to some nuclei in the hypothalamus that have a role in energy metabolism. To clarify the possible role of VP on glucose metabolism in the brain, we examined the effect of intracranial injection of VP on the hyperglycemia induced by 2-deoxy-D-glucose (2DG) and obtained the following results. The hyperglycemic and hyperglucagonemic responses induced by 2DG were significantly suppressed and enhanced by co-injections of VP and a VP-antagonist with 2DG, respectively. However, co-injections of either VP or a VP-antagonist with 2DG had no effect on the change in plasma insulin concentration. These findings suggest that central VP plays a suppressive role in the hyperglycemic and hyperglucagonemic responses to 2DG.

A synthetic study on cyclic phosphate derivatives of seconucleosides as potential antiviral agents (I). Synthesis of 3',5'-cyclic phosphates of 2'-substituted secouridines and secoribavirins

The synthetic study of 3',5-cyclic phosphates of 2'-substituted 2',3'-secouridines and 2',3'-secoribavirins toward development of new antiviral agents is described. These cyclic phosphates were synthesized from their respective 4-nitrophenyl 3',5'-cyclic phosphate triesters. These triesters were prepared from the corresponding 2'-azido and 2'-bromo 2',3'-seconucleosides.