Evaluation of Central Sensitisation in Bladder Pain Syndrome: A Systematic Review

INTRODUCTION AND HYPOTHESIS

Bladder pain syndrome (BPS) is a debilitating condition characterised by exaggerated bladder sensations and altered bladder function. It is still unknown whether the condition is a peripheral sensory problem or due to abnormal central sensory processing as seen in central sensitisation. This systematic review, which followed a published and Prospective Register of Systematic Reviews-registered protocol (CRD42021229962), is aimed at establishing the scope of central sensitisation in patients with BPS to aid optimal management and treatment.

METHODS

Four databases were searched, and appraisal of the identified studies was conducted by two independent reviewers based on eligibility criteria: patients with BPS being investigated for central sensitisation with or without comparison of controls, English-language articles, full text and publication in a peer-reviewed journal. The Methodological Index for non-Randomised Studies was used to determine study quality. We identified 763 papers in total, with 15 studies included in the final analysis. All studies were observational and had a low risk of bias. Measures included in the evaluation of CS were questionnaires, urodynamics, and quantitative sensory testing methods.

RESULTS

There was evidence of central sensitisation in patients with BPS in all papers evaluated (15 out of 15). In addition, more significant central sensitisation correlated with severe disease presentation (3 out of 3 papers) and concomitant chronic pain conditions (5 out of 5 papers).

CONCLUSIONS

Central sensitisation plays an integral role in BPS patient pathology. Many secondary measures are used to evaluate this condition. Stratification of patients based on their pathology (peripheral, central or a combination of the two) will aid in implementing an individualised management strategy.

Clinical Trial Endpoints and Their Clinical Meaningfulness in Early Stages of Alzheimer's Disease

As the focus of Alzheimer's disease (AD) therapeutic development shifts to the early stages of the disease, the clinical endpoints used in drug trials, and how these might translate into clinical practice, are of increasing importance. The clinical meaningfulness of trial outcome measures is often unclear, with a lack of conclusive evidence as to how these measures correlate to changes in disease progression and treatment response. Clarifying this would benefit all, including patients, care partners, primary care providers, regulators, and payers, and would enhance our understanding of the relationship between clinical trial endpoints and assessments used in everyday practice. At present, there is a wide range of assessment tools used in clinical trials for AD and substantial variability in measures selected as endpoints across these trials. The aim of this review is to summarize the most commonly used assessment tools for early stages of AD, describe their use in clinical trials and clinical practice, and discuss what might constitute clinically meaningful change in these measures in relation to disease progression and treatment response.

The challenge of using routinely collected data to compare hospital admission rates by ethnic group: a demonstration project in Scotland

BACKGROUND

Recording patients' ethnic group supports efforts to achieve equity in health care provision. Before the Equality Act (2010), recording ethnic group at hospital admission was poor in Scotland but has improved subsequently. We describe the first analysis of the utility of such data nationally for monitoring ethnic variation.

METHODS

We analysed all in-patient or day case hospital admissions in 2013. We imputed missing data using the most recent ethnic group recorded for a patient from 2009 to 2015. For episodes lacking an ethnic code, we attributed known ethnic codes proportionately. Using the 2011 Census population, we calculated rates and rate ratios for all-cause admissions and ischaemic heart diseases (IHDs) directly standardized for age.

RESULTS

Imputation reduced missing ethnic group codes from 24 to 15% and proportionate redistribution to zero. While some rates for both all-cause and IHD admissions appeared plausible, unexpectedly low or high rates were observed for several ethnic groups particularly amongst White groups and newly coded groups.

CONCLUSIONS

Completeness of ethnicity recoding on hospital admission records has improved markedly since 2010. However the validity of admission rates based on these data is variable across ethnic groups and further improvements are required to support monitoring of inequality.

Diagnosis of Early Alzheimer's Disease: Clinical Practice in 2021

Alzheimer's disease is a progressive, irreversible neurodegenerative disease impacting cognition, function, and behavior. Alzheimer's disease progresses along a continuum from preclinical disease, to mild cognitive and/or behavioral impairment and then Alzheimer's disease dementia. Recently, clinicians have been encouraged to diagnose Alzheimer's earlier, before patients have progressed to Alzheimer's disease dementia. The early and accurate detection of Alzheimer's disease-associated symptoms and underlying disease pathology by clinicians is fundamental for the screening, diagnosis, and subsequent management of Alzheimer's disease patients. It also enables patients and their caregivers to plan for the future and make appropriate lifestyle changes that could help maintain their quality of life for longer. Unfortunately, detecting early-stage Alzheimer's disease in clinical practice can be challenging and is hindered by several barriers including constraints on clinicians' time, difficulty accurately diagnosing Alzheimer's pathology, and that patients and healthcare providers often dismiss symptoms as part of the normal aging process. As the prevalence of this disease continues to grow, the current model for Alzheimer's disease diagnosis and patient management will need to evolve to integrate care across clinical disciplines and the disease continuum, beginning with primary care. This review summarizes the importance of establishing an early diagnosis of Alzheimer's disease, related practical 'how-to' guidance and considerations, and tools that can be used by healthcare providers throughout the diagnostic journey.

Addressing the quality of life needs of older patients with cancer: a SIOG consensus paper and practical guide

Around 60% of people living with cancer are aged 65 years or older. Older cancer patients face a unique set of age-associated changes, comorbidities and circumstances that impact on their quality of life (QoL) in ways that are different from those affecting younger patients. A Task Force of the International Society of Geriatric Oncology recommends and encourages all healthcare professionals involved in cancer care to place greater focus on the QoL of older people living with cancer. This paper summarizes current thinking on the key issues of importance to addressing QoL needs of older cancer patients and makes a series of recommendations, together with practical guidance.

EUROPA DONNA´s First MBC Advocacy Training Course

Background and context: Breast cancer is the most common type of cancer in European women and has the highest mortality of any cancer. Although women with metastatic breast cancer (MBC) are living longer today, in many European countries all their needs and rights to high quality care are not being met. In European countries, MBC services run the gamut from some of the best in the world to services so minimal and basic that most women who present with breast cancer already have MBC. Aim: To impart MBC advocates with the tools and knowledge to initiate and carry out best practice MBC advocacy programmes in their own countries and at the European level. Strategy/Tactics: 1) Provide simple, clear and scientifically sound information to MBC advocates and that ED National Fora can use effectively in their advocacy efforts; 2) Provide a forum in which members from a broad spectrum of European countries learn from one another through the exchange of ideas, experiences and best practices; 3) Provide expert presentations on important MBC topics with the ultimate aim of bringing every country to the level of MBC service described in the EU Guidelines, enhancing the public's knowledge of MBC and therefore reducing stigma surrounding the disease. Programme/Policy process: ED will invite MBC advocates from each of our 47 member countries to attend our 1st MBC Advocacy Training Course and all their expenses will be paid. The 2 1/2 day course will involve: Introductions of ED and participants. Scientific Lectures/Advocacy Skills: Experts will cover such topics as treatment of MBC and the European Commission Initiative on Breast Cancer. Professionals will discuss issues including breast cancer registries and insurance in Europe. ED trainers will share the latest developments from ABC4, the ABC Global Alliance and successful MBC advocacy strategies. A showcase will include MBC related videos and publications. Communication Skills Training Workshops: Three experienced trainers will conduct intensive workshops teaching practical presentation skills and assertiveness techniques. Trainees will be coached individually on handling various situations relevant to MBC advocacy. Participants will role-play to practice these skills. Course materials: A detailed course manual will be developed, distributed and discussed. Follow-up reports will be expected of course attendees to encourage the development of strong and sustainable MBC advocacy programmes. Outcomes: We expect to arm MBC advocates and, through them, ED Fora, with accurate, up-to-date information and proven strategies to lead their countries in advocating for improved MBC services and educating people about MBC. This will lead to improvements in MBC services and public health knowledge, reduce inequalities in MBC services and information provision among European countries, and reduce stigma of the disease at the country- and European-level. What was learned: The course will be held in September 2018.

Abstract P5-14-01: Chemotherapy randomization of the EORTC 10041/ BIG 3-04 MINDACT (microarray in node-negative and 1 to 3 positive lymph node disease may avoid chemotherapy) trial

This abstract was withdrawn by the authors.

Resistance Analyses of Japanese Hepatitis C-Infected Patients Receiving Sofosbuvir or Ledipasvir/Sofosbuvir Containing Regimens in Phase 3 Studies

High rates of sustained virologic response (SVR) has been achieved in Japanese patients with chronic hepatitis C virus (HCV) genotype (GT)1 and GT2 infection treated with ledipasvir/sofosbuvir (LDV/SOF) ±ribavirin (RBV) and SOF+RBV, respectively. We evaluated the effect of baseline HCV NS5A and NS5B resistance-associated variants (RAVs) on treatment outcome and characterized variants at virologic failure. Baseline deep sequencing for NS5A and NS5B genes was performed for all GT1 patients. Deep sequencing of NS5A (GT1 only) and NS5B (GT1 and GT2) was performed for patients who failed treatment or discontinued early with detectable HCV RNA (i.e., >25 IU/mL). In patients with HCV GT1 infection, 22.3% (GT1a: 2/11; GT1b: 74/330) had ≥1 baseline NS5A RAV. The most frequent NS5A RAVs in GT1b were Y93H (17.9%, 59/330) and L31M (2.4%, 8/330). Despite the presence of NS5A RAVs at baseline, 100% and 97% of patients achieved SVR12, compared with 100% and 99% for those with no NS5A RAVs with LDV/SOF and LDV/SOF+RBV, respectively. All patients with NS5B RAVs at baseline achieved SVR12. Of the 153 patients with GT2 infection (GT2a 60.1%, GT2b 39.9%), 3.3% (5/153) experienced viral relapse. No S282T or other NS5B RAVs were detected at baseline or relapse; no change in susceptibility to SOF or RBV was observed at relapse. In conclusion, LDV/SOF and SOF+RBV demonstrate a high barrier to resistance in Japanese patients with HCV GT1 and GT2 infection. The presence of baseline NS5A RAVs did not impact treatment outcome in GT1 Japanese patients treated with LDV/SOF for 12 weeks.

Increasing realism among gay men in Sydney about HIV treatments: changes in attitudes over time

It is important to know if optimism about HIV treatments is widespread and whether it is growing. To this end, cross-sectional surveys of gay men were conducted 6-monthly in Sydney between February 1997 and February 1999 ( n = 3012). Recruitment was consistent at 4 gay community venues. The participants responded True, False or Unsure to 5 statements about the effectiveness of HIV treatments (2 items), and transmission (2 items) and 'worry' (1 item) in the context of treatments. In terms of effectiveness, HIV-positive men were more likely than non-positive men to dismiss 'cure' ( P < 0.05) and more likely to support 'treatments prevent serious illness' ( P < 0.001). Uncertainty about effectiveness decreased over time ( P < 0.001 for each item). In terms of transmission, HIV-positive men were more likely than non-positive men to reject notions of reduced infectivity ( P < 0.001). Over time, there was less uncertainty among non-positive men about undetectable viral load and transmission possibilities ( P < 0.001). Overall, HIV-positive men were less 'worried' than non-positive men ( P < 0.001) but there were no changes over time. On the whole, gay men in Sydney are now less uncertain about highly active antiretroviral therapies (HAART) than at the time of their introduction. Most men remain sceptical that these treatments can cure HIV infection and prevent HIV transmission, but in regard to managing illness among those infected, some initial uncertainty is being replaced by a growing optimism about the efficacy of treatments.

Two Case Reports of Resensitization to Previous Chemotherapy with the Novel Hypoxia-Activated Hypomethylating Anticancer Agent RRx-001 in Metastatic Colorectal Cancer Patients

The development of chemoresistance is a persistent problem during the treatment of cancer. Although reversion or modification of acquired chemoresistance has been previously observed, no systematic exploration has been undertaken. Here, we report a case study of 2 male patients, 62 and 66 years old, both with histologically proven, radiologically progressing, extensively pretreated, metastatic and refractory (≥2 conventional regimens and drug therapy) colorectal adenocarcinoma that was previously treated with FOLFIRI. The patients were resensitized to FOLFIRI after exposure to RRx-001 in the context of a phase-1 study. RRx-001 is a novel, hypomethylating and free-radical-inducing anticancer agent that activates nitrite reduction to NO under hypoxia and has an impact on epigenetic pathways. The repression of DNA methyltransferase 1 by RRx-001 may lead to demethylation and reexpression of silenced tumor suppressor genes, leading to resensitization. These examples provide insight into a nascent strategy to improve the prognosis in heavily pretreated cancer patients and suggest routes for further exploration.

Changes in asthma management in Australian general practice

AIMS

To investigate changes in national prevalence, severity and management rates of asthma in Australian general practice from 1990 to 2003.

METHODS

A comparative study of general practitioner (GP) encounters with asthma patients, in cross sectional surveys from 1990-91 and 1998-2003. Main outcome measures were relative rates of asthma management, prevalence and severity of asthma.

RESULTS

The prevalence of asthma remained constant between 1999 and 2002. Prevalence in children was significantly higher (18.4%) than in adults (13.2%) (p < 0.0001). The asthma management rate fell by 0.5 (from 3.7 to 3.2) per 100 encounters between 1990-91 and 1998 (8 years), and by a further 0.5 (from 3.2 to 2.7) per 100 encounters between 1998 and 2003 (5 years) suggesting an accelerating rate of decrease in the general practice asthma management rate over time.

CONCLUSIONS

These findings suggest that Australians attending general practice may be gaining better control of their asthma.

Parasympathetic innervation maintains epithelial progenitor cells during salivary organogenesis

The maintenance of a progenitor cell population as a reservoir of undifferentiated cells is required for organ development and regeneration. However, the mechanisms by which epithelial progenitor cells are maintained during organogenesis are poorly understood. We report that removal of the parasympathetic ganglion in mouse explant organ culture decreased the number and morphogenesis of keratin 5-positive epithelial progenitor cells. These effects were rescued with an acetylcholine analog. We demonstrate that acetylcholine signaling, via the muscarinic M1 receptor and epidermal growth factor receptor, increased epithelial morphogenesis and proliferation of the keratin 5-positive progenitor cells. Parasympathetic innervation maintained the epithelial progenitor cell population in an undifferentiated state, which was required for organogenesis. This mechanism for epithelial progenitor cell maintenance may be targeted for organ repair or regeneration.

Assessing attitudes and behaviours surrounding Alzheimer's disease in Europe: key findings of the Important Perspectives on Alzheimer's Care and Treatment (IMPACT) survey

The Important Perspectives on Alzheimer's Care and Treatment (IMPACT) survey is an assessment in Europe of the attitudes of caregivers, physicians, the general public and payors towards Alzheimer's disease and dementia. This was an Internet-based questionnaire study, which sought to determine the opinion and perception of responders on issues relating to ageing and dementia. There were additional questions for caregivers on the impact of caregiving on their life. Responses were analysed from 949 members of the general public, 500 physicians (generalists and specialists), 250 caregivers and 50 payors from 5 countries--France, Germany, Italy, Spain and the United Kingdom. The survey highlighted the difficulty of diagnosing dementia, especially in the initial stages of the disease. The average time from first noticing symptoms to diagnosis varied from 36 to 63 weeks. Caregivers and the general public felt they had insufficient information about the benefits of treatment and care, although more than half the general public, caregiver and physician responders agreed that early treatment could delay the progression of the disease. The majority of respondents recognised the devastating effects of AD on caregivers and families, and a majority of caregivers, the general public and physicians agreed that their governments fail to view AD as a health care priority. This study occurs roughly 5 years after a similar survey, and provides a timely update. Despite some important differences between the methodologies used in these surveys, diagnosis of dementia is still a key issue, especially amongst generalists, as is the provision of information and support to caregivers. Despite the prevalence of AD in the ageing population of Europe, the perception within each of the 5 countries surveyed is that AD is not viewed as a health care priority.

Screening for cognitive impairment, Alzheimer's disease and other dementias: opinions of European caregivers, payors, physicians and the general public

The IMPACT survey queried physicians, caregivers, payors and members of the general public from 5 European countries (France, Germany, Italy, Spain and the United Kingdom) regarding their opinions towards screening for Alzheimer's disease (AD) as part of a 30-minute Web-based questionnaire conducted between April and May 2009. A larger proportion of caregivers (84%) and members of the general public (80%) than of physicians (56%) or payors (40%) viewed routine screening for AD as extremely or very important (P < 0.001 for caregivers or general public vs physicians or payors). When asked if everyone should be routinely screened for AD at age 65, a smaller proportion of physicians (42%) and payors (44%) than members of the general public (81%) or caregivers (80%) agreed (P < 0.001 for caregivers or general public vs physicians or payors). These opinions were generally consistent across the 5 countries for each respondent group. A notable exception was physician respondents from Italy, where most generalists and specialists actually favoured screening. Overall, generalists had a more positive attitude towards screening than specialists. The most frequently cited reason given by those who did not favour routine screening at age 65 was screening inaccuracy. This article discusses these results in relation to what screening is, when to screen and the barriers to screening. Despite the majority of IMPACT respondents being in favour of screening for AD, the evidence to support the introduction of population screening for cognitive impairment is not available; however, the importance of optimal identification of AD and other dementias in primary care should be a priority for community health professionals and payors. In order to do this effectively, further work is required to identify good assessment guidelines for use during opportunistic screening for cognitive impairment in primary care.

Physicians and caregivers: ready and waiting for increased participation in clinical research

Progressive development of pharmacotherapy for Alzheimer's disease (AD) as well as non-pharmacological treatments is critically dependent on the timely recruitment of appropriate subjects for clinical trials. Accordingly, the IMPACT survey sought to determine the level of awareness of clinical trials and the willingness to foster patient involvement/participation in research studies. IMPACT survey participants were recruited via the Internet in equal numbers from 5 European countries-France, Germany, Italy, Spain and the United Kingdom. During April and May 2009, 250 caregivers and 500 physicians who agreed to participate in this market-based survey completed a 30-minute Web-based questionnaire that included items concerning awareness of clinical research and willingness to facilitate participation of AD patients in such research. Awareness of local clinical trials amongst both caregivers (24% overall; range by country, 14% to 34%) and physicians (19% overall; range by country, 13% to 30%) was found to be low in all countries surveyed. In contrast, the willingness of physicians to refer patients to, and caregivers to support their participation in, clinical trials was extremely high (98% and 81%, respectively). These results strongly indicate that physicians and caregivers are ready and waiting to become more involved in clinical research. Initiatives to increase awareness of clinical trials amongst caregivers and physicians and to conduct clinical trials within the geographical area of as many potential participants as possible should result in much more effective patient recruitment to AD clinical trials.

Evolving attitudes to Alzheimer's disease among the general public and caregivers in Europe: findings from the IMPACT survey

Understanding and appreciating the awareness of, and attitudes towards, Alzheimer's disease (AD) in the general public is of paramount importance to those charged with the development of health care policy. Furthermore, it is essential that this policy be formulated with consideration given to both the attitudes of the general population and to those within society more directly affected by AD; namely, the caregivers of patients with the disease. In the IMPACT survey, approximately 1000 members of the general public and 250 caregivers in 5 European countries (France, Germany, Italy, Spain, and the United Kingdom) completed a 30-minute, Web-based questionnaire. In this article, we compare and contrast the attitudes and opinions of these populations in an attempt to define specific themes. Indeed, caregivers were more concerned about consequences of growing old and were more fearful of AD than general public respondents, although a high proportion in both groups acknowledged the significant impact of the disease. Similarly, although most respondents in the 2 groups recognised that early signs and symptoms of AD are difficult to detect, caregivers were more skeptical of the abilities of both primary physicians and specialists to detect these early signs and symptoms. In terms of treatment, caregivers were less convinced of the effectiveness of treatment beyond the early stages of AD and more likely to agree that current treatments are associated with side effects. Respondents in both groups had a negative view of their government's investment in AD, but caregivers, particularly those in France, Spain and the United Kingdom, were more likely to feel that their government acts as a barrier to treatment. Some survey respondents from the 2 groups also had a negative view of their governments' attempts to raise awareness of AD and make its treatment a high priority. Overall, comparison of responses from these 2 groups suggests that caregivers' personal experiences of AD profoundly affect their attitudes and perceptions surrounding the disease.

Implications of the Impact Survey for payors across Europe

People involved with development of health care policy must be appreciative of the social and economic challenges that will likely develop as a result of the rise in Alzheimer's disease (AD) as the 21st century progresses. Their attitudes, perceptions and understanding regarding AD were captured in the IMPACT survey, a 30-minute Web-based questionnaire. Fifty health policy managers and decision-makers (payors) were recruited, 10 each from 5 European countries--France, Germany, Italy, Spain and the United Kingdom. Most payors felt that AD was underdiagnosed and undertreated in their country (80% and 68%, respectively). Half of all payors felt that their government did not invest enough in treating AD, and 30% felt their government hindered access to drug therapy. Payors believed that treatment should be initiated as early as possible after a diagnosis of AD (82%), and that early treatment can delay progression of the disease (82%). Even more than caregivers, payors agreed that AD can have devastating effects on the family of the sufferer (90% vs 75%; P<0.05). Payors more often cited cancer, stroke and heart disease than AD as affecting their budgets, but cited AD more often than depression, diabetes, HIV/AIDs and arthritis. Cost savings were seen as the most important factor regarding policy decisions. These attitudes of the surveyed payors towards AD and the patients and caregivers affected by it suggest that they may advocate for national and international policies that will facilitate earlier diagnosis and improved access to treatment.

Clinical practice patterns of generalists and specialists in Alzheimer's disease: what are the differences, and what difference do they make?

Optimising the roles played by both generalists and specialists in the diagnosis and treatment of Alzheimer's disease (AD) could have a major impact on the quality and cost of patient care. Therefore, one aim of the IMPACT survey was to characterise the similarities and differences between these 2 categories of physicians, in 5 different European countries, across a number of domains relevant to the medical care of people at risk for AD and those with the disease. Physician respondents comprised 250 generalists and 250 specialists from 5 European countries--France, Germany, Italy, Spain, and the United Kingdom. A substantial majority of generalists were either general practitioners or family physicians; the majority of specialists were neurologists. In April and May 2009, physician respondents completed a 30-minute, Web-based questionnaire during which they were presented with a number of multiple-choice-type questions concerning their knowledge of AD, approach to diagnosis and treatment of AD and experience of providing care for people with dementia. Generalists reported that 45% of their AD patients had mild symptoms at the initial visit compared with 60% for specialists (P < 0.001). Specialists claimed that they diagnose patients with AD themselves in 65% of cases versus 33% for generalists (P < 0.001). The main prescription treatment options employed were AD-specific medication (90%) and medication for mood or behaviour (78%). A similar percentage of generalists and specialists (77% and 75%) initiate drug treatment within 1 month of diagnosis. Overall, there were more similarities than differences between specialists and generalists regarding a broad spectrum of issues relating to AD; differences between countries appear to be greater than differences between physician groups.

Assessing physician attitudes and perceptions of Alzheimer's disease across Europe

Given the important role that physicians play in clinical care, disease advocacy, national health policy making and clinical research, the IMPACT survey sought to assess the attitudes and perceptions of physicians in 3 general categories: diagnosis and treatment of Alzheimer's disease (AD); caregivers and families of patients with AD; and the role of government in dealing with this disease and its consequences. Survey respondents comprised a total of 250 generalists and 250 specialists (neurologists, geriatricians, neuro-psychiatrists, psychiatrists and psychogeriatricians) from France, Germany, Italy, Spain and the United Kingdom. Physicians were aged 25 to 69 years, in practice for between 5 and 30 years and currently spending more than 50% of their time in direct patient care. Results showed that a sizable majority of physicians throughout Europe, specialists and generalists alike, agree that: 1) AD is underdiagnosed and undertreated; 2) patients and families are not prepared to recognise the early symptoms of the disease; 3) early treatment can help to slow the progression of the disease; and 4) more effective treatments are needed. Attitudes were statistically significantly different between some groups of physicians regarding disclosure of the diagnosis of AD, the benefits of lifestyle modification, and the value of AD-specific medication in patients whose symptoms are worsening. Differences in attitudes and perceptions of AD between specialists and generalists were limited; differences between countries were more common and of greater magnitude, particularly with respect to barriers to the use of prescription medications.

Perlecan from human epithelial cells is a hybrid heparan/chondroitin/keratan sulfate proteoglycan

Perlecan is a multidomain proteoglycan, usually substituted with heparan sulphate (HS), and sometimes substituted with both HS and chondroitin sulphate (CS). In this paper, we describe perlecan purified from HEK-293 cells substituted with HS, CS and keratan sulphate (KS). KS substitution was confirmed by immunoreactivity with antibody 5D4, sensitivity to keratanase treatment, and fluorophore-assisted carbohydrate electrophoresis. HEK-293 perlecan failed to promote FGF-dependent cell growth in an in vitro assay. This study is the first to report perlecan containing KS, and makes perlecan one of only a very few proteoglycans substituted with three distinct types of glycosaminoglycan chains.

The effect of gender on outcome in digitalis-treated heart failure patients

BACKGROUND

The use of digitalis is recommended for the treatment of heart failure to reduce hospitalization. Recent data suggest that digitalis treatment may adversely affect survival in women but not in men. We studied patients with left ventricular dysfunction enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) to determine whether there was a gender-based survival difference in patients treated with digitalis.

METHODS AND RESULTS

Symptomatic (n = 2569) and asymptomatic (n = 4228) patients with left ventricular ejection fraction < or = 0.35 were studied. Digitalis use was assessed at baseline and baseline demographic variables were catalogued and compared. A multivariate analysis, incorporating known covariates of risk for adverse cardiovascular events, was used to examine the association of digitalis with all-cause mortality, cardiovascular death, death from heart failure, and arrhythmic death, with, or without, worsening heart failure in women compared with men. Analysis for an interaction between digitalis and gender on mortality was also performed. No interaction between gender and digitalis treatment on survival was found, and there was no significant difference in the hazard ratios for men and women on digitalis either with respect to all-cause mortality, cardiovascular mortality, heart failure mortality, or arrhythmic death with worsening heart failure. When mortality for arrhythmic death without worsening heart failure was adjusted for the probability of being treated with digitalis (propensity analysis), women fared better than men.

CONCLUSION

Data from the SOLVD trials suggest that digitalis treatment of heart failure does not result in a difference in survival between men and women. Because a randomized trial to definitively answer the question is unlikely, and perhaps inappropriate, examination of other heart failure populations for a gender-digitalis interaction is indicated.

General practice encounters for psychological problems in rural, remote and metropolitan areas in Australia

OBJECTIVE

Previous Australian research suggests there is very little difference in the prevalence of mental health disorders across rural, remote and metropolitan areas. However, mental health specialists are particularly scarce in rural and remote areas and some researchers have argued that non-metropolitan residents rely heavily on general practitioners (GPs) for mental health care. This article investigated rates of GP services for psychological problems across rural, remote and metropolitan areas.

METHOD

The Bettering the Evaluation and Care of Health (BEACH) program, Medicare and Pharmaceutical Benefits Scheme data were used in this report. Data included all psychological, depression and anxiety problems reported as managed by GPs and prescriptions for mental health medications (written and filled). Problem and medication rates are given per 100 patient encounters and per 1000 population.

RESULTS

Only a few regional differences were evident in the rate of psychological problems and prescriptions for mental health medications per 100 GP-patient encounters. However, rural and remote residents visited GPs less frequently than their metropolitan counterparts. Lower rates of GP encounters for psychological problems were evident for residents of most non-metropolitan areas (per 1000 population). Additionally, GPs prescribed mental health medications at half the rate for residents of remote areas than capital cities.

CONCLUSIONS

General practitioners provide fewer mental health services per capita in non-metropolitan areas. This difference could represent completely untreated psychological problems or fewer follow-up consultations. While non-metropolitan residents have limited access to specialists, rates of GP encounters for psychological problems are also very low.

Electrophoretic, biosensor, and bioactivity analyses of perlecans of different cellular origins

Three cellular sources of perlecan were examined in this study, namely human umbilical arterial endothelial cells (HUAEC), a transformed human umbilical venous endothelial cell line (C 1 1 STH) and a human colon carcinoma cell line (WiDr). Perlecans were immunopurified from conditioned media of the above cells and the purity of the perlecan preparations was examined by composite agarose polyacrylamide gel electrophoresis (CAPAGE) and semi-dry immunoblotting with monoclonal antibodies directed to either the perlecan core protein (mAb A76) or heparan sulphate (HS) side-chain (mAb10E4). The ability of each perlecan species to bind fibroblast growth factor-l (FGF-1) was examined using a biosensor (BIAcore). The bioactivity of perlecan FGF-1 interactions was also analysed using BaF3 cells transfected with fibroblast growth factor receptors FGFR1b and 1c. CAPAGE demonstrated subtle differences between the perlecans, indicating they had differing charge to mass ratios with C 11 STH perlecan being slightly more mobile in CAPAGE than the HUAEC and WiDr sample. BIAcore biosensor analysis demonstrated distinct differences in the ability of perlecan preparations to bind FGF-1; HUAEC and C 11 STH perlecan showed similar high binding responses as compared to WiDr perlecan, which bound FGF-1 very poorly. Binding of FGF-1 to endothelial perlecans was shown to be HS-dependent. Interestingly, HUAEC perlecan stimulated the growth of FGFR1b and FGFR1c expressing cells in the presence of FGF-1 comparable to heparin, whereas C 11 STH perlecan showed only very limited stimulation of FGFR 1b cells and was incapable of stimulating FGFR1c cells. WiDr perlecan exhibited no stimulation of growth in either cell line. Collectively the data presented herein indicate that. different cell types express perlecans which vary in the growth factor binding capabilities, which may suggest differences in their HS chain substructure. This may represent a subtle mechanism whereby cells can modulate the responsiveness of perlecan to a range of biologically important ligands and thus in a broader context may have important implications for cell signalling.

The nursing shortage--it's back!

Nursing shortages have been cyclic events during the 1970s, 1980s, and early 1990s. Recent downsizings and reengineerings have witnessed professional nurses in reduction of workforce actions. Acute-care settings, with goals of increased productivity and cost reduction, have decreased ratios of professional to nonlicensed staff frequently forcing nurses to practice with fewer resources and in diverse healthcare settings. As inpatient settings find a higher acuity level of patients receiving care from a "leaner" high-percentage agency workforce, many experts believe we are beginning to experience a new wave of shortages that will be more critical than those of the past. Hospitals and other healthcare practice sites will experience a shortage of professionals necessary to provide care to patients and will be competing for those scarce resources. This article presents a discussion of the important factors of supply and demand related to the shortage and possible strategies for hospitals to use when approaching the large and complex challenge.

Low proliferative rate of invasive node-negative breast cancer predicts for a favorable outcome: a prospective evaluation of 669 patients

This study was designed to compare outcome in terms of disease-free survival (DFS) in women with histologically negative axillary lymph nodes and documented low proliferative rate cancer to other well-defined prognostic factors including type of adjuvant treatment. Between 1988 and 1998, we studied 669 patients with invasive node-negative breast cancer up to 5 cm in size and low proliferative rate measured by flow cytometry to determine S-phase fraction (SPF) or by histochemistry (Ki67/MIB1). At a median follow-up of 53 months, 5-year DFS for the entire group was 94% and did not differ significantly by type of systemic adjuvant treatment: none (133 patients, 95% DFS), tamoxifen (441 patients, 94% DFS), or chemotherapy with doxorubicin and cyclophosphamide (95 patients, 92% DFS). In a multivariate prognostic factor analysis, only tumor size was significant; 5-year DFS was 96% for T1N0 cancer versus 89% for T2N0 cancer (P = 0.01). We have prospectively confirmed that a low rate of proliferation as measured by SPF or MIB1 determination confers an excellent prognosis in invasive node-negative breast cancer up to 5 cm in size, regardless of adjuvant treatment.

Gay men in Australia who do not have HIV test results

Whereas most gay men in Australia know their HIV test result, a consistent minority do not. From Gay Community Periodic Surveys (n=6831) conducted during 1998 in the 5 largest cities, those who did not have HIV test results (13.3% overall) comprised 10.0% in Sydney, 15.7% in Melbourne, 13.6% in Brisbane, 15.2% in Perth and 14.0% in Adelaide, representing a significant difference between cities (P < 0.001). Gay men who did not have HIV test results differed from those who did in several ways. They were on average younger (31 vs 35 years, P<0.001) and less likely to be in professional occupations (P<0.001). They were less likely to identify themselves as 'gay' (P<0.001), spent less time with other gay men (P<0.001) and had fewer gay friends (P<0.001). They had sex with fewer different men 'in the previous 6 months' (P<0.001) and were more likely to be in a monogamous relationship or without sexual partners at the time of the survey (P<0.001). With respect to both regular and casual partners, they were more likely (P<0.001) to have 'no such partner'/'no anal intercourse' rather than 'anal intercourse' (either always protected or sometimes unprotected). These differences between gay men who did and did not have HIV test results were confirmed in a logistic regression (apart from 'amount of free time spent with gay men' and 'relationship status' which were accounted for by closely correlated variables in the reduced logistic model). Social and sexual environment appears to exert an influence on HIV testing rather than sexual risk per se.

A scale of optimism-scepticism in the context of HIV treatments

The aim of this research was to develop a brief scale of gay men's optimism-scepticism in the context of new HIV treatments. Following comprehensive literature search and communication with other researchers, 34 items about viral load testing, HIV therapies and concern about HIV infection were generated. By way of anonymous, self-complete questionnaires, these items were put to 532 gay men recruited at the Sydney Gay and Lesbian Mardi Gras Fair Day in February 1999. Principal axes factor analysis and item refinement yielded an optimism-scepticism scale based on 12 items (range 12-48, with higher scores indicating greater optimism). The sample mean was 19.8 (SD = 4.7). The scale had high internal consistency reliability (Cronbach's alpha = 0.79). Providing preliminary evidence of validity, men who reported unprotected anal intercourse with a causal partner 'in the past six months' had a significantly higher mean score (21.3) than those who did not report this risk practice (19.5, p < 0.001). Similar validation was provided from separate samples of gay men in Queensland and Sydney. Our scale of optimism-scepticism in the context of new HIV therapies is a brief, reliable instrument which can be incorporated within broader questionnaires and interview schedules. It is a useful tool to monitor attitudes toward HIV therapies and possible associations with risk practices.

Condom use and 'withdrawal': exploring gay men's practice of anal intercourse

Some gay men who have unprotected anal intercourse avoid ejaculation-they practise 'withdrawal'. Using data collected in 1997 from a sample of Sydney gay men (n=625), we explored the relation between men's practice of ejaculation and their use of condoms. We also investigated whether men who had unprotected withdrawal but not unprotected ejaculation were more likely to think unprotected withdrawal was safe, liked condoms less, liked anal intercourse more, or were more sexually adventurous. Considering separately insertive and receptive anal intercourse with regular and with casual partners, we found that the majority of men who practised unprotected withdrawal also practised unprotected ejaculation. Of those whose only unprotected sex was withdrawal ('true withdrawers'), most never used condoms (they did not also have protected sex with ejaculation). True withdrawers were compared with men who had unprotected ejaculation, who always used condoms, who had no anal sex and who had no partners. Those who were true withdrawers with casual partners were more likely to believe withdrawal was safe; no group effects were found with regular partners. No significant differences in condom attitudes were found. True withdrawers with regular partners liked anal intercourse less than other men, but true withdrawers with casual partners were indistinguishable from those who had unprotected ejaculation. True withdrawers did not differ in sexual adventurousness from other men who had anal intercourse. Most withdrawers avoided anal sex with ejaculation rather than use condoms. Converting them into reliable condom users may be a considerable challenge for health promotion.

HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne

OBJECTIVES

To investigate associations between gay men's optimism and sexual behaviour in the context of new HIV treatments.

METHODS

Cross-sectional surveys (using anonymous, self-completed questionnaires) were conducted in Sydney during February 1998 (n = 2200) and in Melbourne during January 1998 (n = 1891). Gay men were recruited at social and sex-on-premises venues, clinics and fair days/carnivals.

RESULTS

In a multivariate analysis, unprotected anal intercourse with casual partners (UAIC) was associated with being recruited at a sex-on-premises venue (rather than a clinic or fair day/carnival), HIV positivity, having been tested for HIV less than 6 months ago (rather than over 2 years ago or never having been tested), and not having a regular partner. Over and above these factors, UAIC was associated with agreement with the statements 'An HIV-positive person who is on combination therapy is unlikely to transmit HIV' and 'I'm less worried about HIV infection than I used to be'.

CONCLUSIONS

The data reveal a significant relationship between UAIC and certain aspects of optimism in the context of new HIV treatments. Whereas the direction of causality cannot be specified, there is a clear need for HIV and sexual health education programmes to clarify issues of viral load, new and drug resistant strains of HIV, and other infectious agents.

Effects of similarities in lifestyle habits on familial aggregation of high density lipoprotein and low density lipoprotein cholesterol: the NHLBI Family Heart Study

It is generally assumed that familial aggregation of lipids relates to both genetic and shared environmental factors. To determine the degree to which familial similarities in lifestyle habits explain familial aggregation of high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, the authors analyzed 1994-1996 data from 2,284 US adult participants in the National Heart, Lung, and Blood Institute Family Heart Study. For men and women, respectively, HDL cholesterol correlated with alcohol consumption (r = 0.27, p < 0.001; r = 0.21, p < 0.001), exercise (r = 0.06, p = 0.05; r = 0.10, p = 0.002), and smoking (r = -0.09, p = 0.005; r = -0.13, p < 0.001). There was strong familial aggregation of HDL cholesterol (parent-child, r = 0.32; sibling-sibling, r = 0.29), but less than 10% was explained by lifestyle habits. For LDL cholesterol, weak correlations were found for intake of total fat (r = 0.06, p = 0.07) and fruits/vegetables (r = -0.09, p = 0.005) among men and for smoking (r = 0.10, p = 0.002) among women. LDL cholesterol correlated strongly among family members (parent-child, r = 0.24; sibling-sibling, r = 0.31), but essentially none of this aggregation related to the lifestyle factors studied. This study suggests that lifestyle factors have little effect on the familial aggregation of HDL and LDL cholesterol.

Radiation absorbed dose estimation for 90Y-DOTA-biotin with pretargeted NR-LU-10/streptavidin

Pretargeted radioimmunotherapy permits the administration of doses of 90Y five times higher than is possible with antibodies directly labeled with 90Yttrium (90Y). These high doses of 90Y introduced new issues for dosimetry that were not encountered in prior studies using conventional radioimmunotherapy. We have addressed these issues here and correlated dosimetry estimates with observed toxicity and tumor responses.

METHODS

The pretargeted radioimmunotherapy (PRIT) system employed the antibody NR-LU-10 conjugated with streptavidin, a glycoprotein clearing agent and 90Y-DOTA-biotin. A single dose of 90Y was escalated to 140 mCi/m2. Indium-111(111In) (3-5 mCi) DOTA-biotin was co-injected for gamma camera imaging and dosimetry assessment. The effect of bremsstrahlung radiation from increasing 90Y activity levels with a constant dose of 111In was studied using a phantom. Patient images identified the intestinal tract and the kidneys as potential organs at risk of clinically significant radiation toxicity. A method of measuring the activity localized in the intestinal tract was developed, and S values were calculated to estimate intestinal wall dose from radioactivity present in the intestine. Intestinal, bone marrow and renal toxicity were observed. Coefficients were derived for correlating the relationships between observed intestinal and marrow toxicity and the estimated radiation absorbed doses.

RESULTS

At an 90Y:111In ratio of 50:1, bremsstrahlung radiation accounted for 12% of the counts in the images. Grade IV diarrhea was observed in patients estimated to have received 6850-14,000 cGy to the large intestinal wall. The correlation coefficient of intestinal toxicity with absorbed dose was 0.64. Myelotoxicity (measured as grade of suppression of absolute neutrophil count) correlated better with marrow dose (r = 0.72) than with the whole body dose, (r = 0.44). Delayed renal toxicity was observed in two patients 8 and 11 months following therapy. Tumor response was seen in the two patients with the highest estimated dose to tumor, 4,000-6,000 cGy.

CONCLUSION

Dosimetry is feasible using 111In as a tracer in the presence of high 90Y activity. The absorbed dose estimates derived in the PRIT schema correlated moderately well with clinically observed toxicity and response.

Increase in unprotected anal intercourse with casual partners among Sydney gay men in 1996-98

We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly with a view to investigating any behavioural changes after the recent improvements in antiretroviral therapies. Trends in unprotected anal intercourse were monitored through the Sydney Gay Community Periodic (cross-sectional) Surveys which were conducted at six-monthly intervals between February 1996 and February 1998. Gay men (n = 2,863) were recruited and self-completed a short questionnaire at three gay venues and a sexual health clinic. There was a significant increase in unprotected anal intercourse with casual partners (but not with regular partners), applicable to both HIV positive and HIV negative men. Sexual practice was generally unrelated to ideas about recent advances in viral load testing and combination therapies.

Cultures of sexual adventurism as markers of HIV seroconversion: a case control study in a cohort of Sydney gay men

A case control analysis within an ongoing cohort study was used to examine differences between seroconverters and men who remained HIV-negative. The cases were interviewed within one to 13 months prior to their seroconversion. Their responses to a structured questionnaire were compared with those of HIV-negative controls drawn from the same time period and from the same longitudinal study, Sydney Men and Sexual Health. Data collected from both cases and controls included: demographic and contextual variables, knowledge of HIV transmission, sexual practices, drug and alcohol use and attitudinal factors. The aim was to compare the sexual behaviours, and the social and cultural contexts of such behaviours, of men prior to their HIV seroconversion with men who did not seroconvert. Twenty-three men had seroconverted within the cohort. Cases were identified by a positive HIV antibody test or self-report of positive HIV status following a previous negative HIV test. Three-hundred-and-sixty-nine controls were selected on the basis of being HIV negative at interview in 1994, and having at least one subsequent medically-confirmed negative HIV antibody test. Univariate predictors of seroconversion were: being in a regular relationship with a known HIV-positive partner, drug use, and engaging in a range of anal and esoteric sexual practices. Practices commonly used to enhance sexual pleasure, such as group sex, watching and being watched having sex, the use of sex toys and dressing up/fantasy, were engaged in more frequently by seroconverters. Engaging in these esoteric sexual practices was highly correlated with drug use, involvement in the gay community and engagement in a wide range of anal practices. In the multivariate analysis independent predictors of seroconversion were: younger age; being in a regular relationship with a known HIV-positive partner; believing withdrawal to be safe with regard to HIV transmission; and range of esoteric practices. These results indicate the importance of the social and cultural contexts of particular sexual practices and consequent HIV transmission. Sexually adventurous men may be at increased risk for HIV because they seek sex within particular sexual sub-cultures.

Gay men who engage repeatedly in unprotected anal intercourse with casual partners: the Sydney Men and Sexual Health Study

We set out to determine the frequency and correlates of gay men's repeated unprotected anal intercourse with casual partners (UAI-C), defined as UAI-C reported at each of 3 annual interviews. By May 1997, 659 men had completed 3 annual interviews for the Sydney Men and Sexual Health (SMASH) cohort study. For the 3 6-month periods prior to each interview, 127 men reported UAI-C during one period only; 45 reported it during 2 periods; and 20 men reported it during all 3 periods. These 20 men who had repeated UAI-C were compared with 497 men who had anal intercourse with casual partners but did not report on all 3 occasions that they had UAI-C. Logistic regression revealed that repeated UAI-C was associated with HIV-positive status, more casual partners, less favourable attitudes toward condoms and greater recreational drug use. Few gay men have repeated UAI-C but those who do run greater risk of HIV transmission.

Determination of SK&F 108566 (Teveten) in human plasma by reversed-phase high-performance liquid chromatography

A sensitive, selective and rugged analytical method was developed for the determination of SK&F 108566 (eprosartan, Teveten) in human plasma. The new method employs a simple solid-phase extraction procedure to isolate the drug and its internal standard (SB-200062) from plasma samples. The assay is based on analysis by reversed-phase high-performance liquid chromatography with ultraviolet absorbance detection. The dynamic range of the assay is from 10.0 to 5000 ng/ml, based on 0.5-ml aliquots of plasma. No interference from the endogenous components of plasma, the anticoagulant, or sample collection devices have been noted. The assay has been fully validated. The mean within-run precision (6.5%), between-run precision (4.0%), accuracy (106%) and recovery (71.8%) of the method were considered acceptable. Additionally, SK&F 108566 was found to be stable in plasma under the storage and sample preparation conditions used. This assay has been successfully employed to provide pharmacokinetic data from clinical trials.

Nurse manager perceptions of healthcare executive behaviors during organizational change

Nurse managers have a large responsibility in implementing healthcare organizational change. To be effective, they need support from healthcare executives. The authors report on a study in which nurse managers described behaviors that facilitated the quality of their work life. Nurse managers in a large (700+ bed) hospital undergoing organizational change were asked to rank behavior of healthcare executives perceived as supportive to a successful transition process and related to maintaining quality of work life. The nurse managers in this study ranked frequent communication about the goals and progression of the organizational change by healthcare executives as most important during a time of organizational change. High visibility and verbalized commitment to the organizational change being implemented were indicated as important by the managers responsible for the operation and realization of the desired vision and goals. Behaviors exhibited by healthcare executives during a time of organizational change may be supportive to nurse managers.

Cluster of wound botulism in California: clinical, electrophysiologic, and pathologic study

Over a period of 15 months we have seen 6 patients with long-standing history of subcutaneous heroin injections who experienced acute blurred vision, dysphagia, dysarthria, and generalized weakness. Decreased or absent deep tendon reflexes, pupillary abnormalities, incremental responses to fast repetitive nerve stimulation, and positive serology for Clostridia botulinum toxin A were found, but not in all cases. Muscle biopsies showed variable signs of neurogenic atrophy. In vitro electrophysiology studies revealed decreased end-plate potentials quantal content, confirming the presynaptic nature of the disorder. Mechanical ventilation was required in 5 patients. Half of the patients were treated with polyvalent antitoxiin. Prognosis was favorable, though recovery was slow. In conclusion, acute bulbar weakness with visual symptoms in patients with subcutaneous heroin abuse strongly suggets the possibility of wound botulism. High diagnostic suspicion combined with histology and in vitro electrophysiology confirmation of presynaptic failure, especially in seronegative cases, may significantly improve morbidity.

Lack of relations of hostility, negative affect, and high-risk behavior with low plasma lipid levels in the Coronary Artery Risk Development in Young Adults Study

BACKGROUND

Previous studies have suggested that low plasma cholesterol levels or cholesterol lowering may increase the risk of suicide and violent death. Increased aggression, risk-taking behavior, or depression has been associated with low cholesterol levels in some studies.

METHODS

A total of 4240 subjects of the Coronary Artery Risk Development in Young Adults study, aged 23 to 35 years, were included in the study. Analyses were stratified by race (black or white) and sex. Persons in the lowest 10% of plasma total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were compared with the other participants in each race/sex group, using standardized measures of hostility, anger suppression, depressive symptoms, and anxiety. The relations between 5-year change in hostility and 5-year change in lipid levels also were examined. The relations between lipid levels and high-risk behavior (e.g., violent arguments or having a gun at home) were examined in a subset of subjects. All analyses were adjusted for relevant covariates.

RESULTS

In cross-sectional analyses, low total cholesterol levels were not related to any of the psychological measures in any race/sex group. Among black women only, low low-density lipoprotein cholesterol was related to greater anxiety, and low triglycerides were related to lower anger suppression (P < or = .002). Among white men only, increases in hostility during the 5-year follow-up were related to increases in triglycerides (P < .01), but changes in hostility were unrelated to changes in cholesterol levels. Among a subset of 371 subjects with initially elevated total cholesterol (> or = 5.17 mmol/L [> or = 200 mg/dL]) and a non-medicated decrease of 0.52 mmol/L (> or = 20 mg/dL) or more during 5 years, hostility decreased in a univariate analysis (P < .001). High-risk behaviors also were not associated with low lipid levels.

CONCLUSION

The results do not support a consistent relation between hostility, negative affect, or high-risk behaviors with low lipid levels or lipid-lowering among young adults.

Influence of Bcl-2 overexpression on Na+/K(+)-ATPase pump activity: correlation with radiation-induced programmed cell death

Bcl-2 overexpression in transfected PW cells is associated with inhibition of radiation-induced programmed cell death (PCD). We have previously reported that there is a relationship between inhibition of radiation-induced PCD and membrane hyperpolarization in these cells. In this article, we report that Na+/ K(+)-ATPase pump activity, as measured by the uptake of Rubidium-86 (86Rb+), is significantly higher in Bcl-2 overexpressing PW cells than in control PW cells, and that pump activity following irradiation with doses > or = 500 cGy was reduced to a lesser extent in the Bcl-2 transfectants than in the control cells. When PW-Bcl-2 cells were incubated with a dose of ouabain (1 microM) that decreased pump activity significantly, but did not induce PCD, the previously reported protection from radiation-induced PCD associated with overexpression of Bcl-2 no longer existed. In order to demonstrate that reactive oxygen species (ROS) affected Na+/ K(+)-ATPase pump activity, cells were incubated with N-acetyl cysteine (NAC) prior to irradiation, or treated with the ROS generating drug buthionine sulphoxamine (BSO). 86Rb+ uptake was significantly higher in irradiated cells incubated with NAC compared to cells irradiated in the absence of NAC, while BSO resulted in lower levels of 86Rb+ uptake, suggesting that the effects of radiation on the Na+/K(+)-ATPase pump were due to ROS. Furthermore, the resting cell membrane potential of cells exposed to NAC were slightly hyperpolarized compared to control PW cells, whereas cells exposed to BSO were depolarized in comparison to control PW cells. In summary, this data suggests that Bcl-2 affects Na+/K(+)-ATPase pump activity, which is associated with the resting membrane potential and the level of susceptibility to radiation-induced PCD.