Associations of serum uric acid levels with arterial wave reflections and central systolic blood pressure

Background

Uric acid may be involved in the pathogenesis of hypertension. We investigated the roles of four major hemodynamic parameters of blood pressure, including arterial stiffness, wave reflections, cardiac output (CO), and total peripheral resistance (TPR), in the association between uric acid and central systolic blood pressure (SBP-c).

Methods

A sample of 1303 normotensive and untreated hypertensive Taiwanese participants (595 women, aged 30–79 years) was drawn from a community-based survey. Study subjects' baseline characteristics, biochemical parameters, carotid-femoral pulse wave velocity (cf-PWV), amplitude of the backward pressure wave decomposed from a calibrated tonometry-derived carotid pressure waveform (Pb), CO, TPR, and SBP-c were analyzed.

Results

In multi-variate analyses adjusted for age, waist circumference, body mass index, creatinine, total cholesterol, smoking, and heart rate, uric acid significantly correlated with Pb and cf-PWV in men, and Pb and TPR in women. The correlation between uric acid and Pb remained significant in men and women when cf-PWV was further adjusted. In the final multi-variate prediction model (model r² = 0.839) for SBP-c, the significant independent variables included uric acid (partial r² = 0.005), Pb (partial r² = 0.651), cf-PWV (partial r² = 0.005), CO (partial r² = 0.062), TPR (partial r² = 0.021), with adjustment for age, sex, waist circumference, body mass index, creatinine, total cholesterol, smoking, and heart rate.

Conclusions

Uric acid was significantly independently associated with wave reflections, which is the dominant determinant of SBP-c. Uric acid was also significantly associated with SBP-c independently of the major hemodynamic parameters.     

老年胃癌术后早期联合肠内营养的临床观察

目的探讨老年胃癌术后早期联合肠内营养支持对术后恢复的作用。方法随机将86例老年胃癌患者分为肠外营养联合早期肠内营养组(parenteral and early enteral nutrition,PAEEN)和全肠外营养组(total parenteral nutrition,TPN),对比其术后恢复情况、并发症发生率和平均住院费用。结果 86例患者均康复出院,PAEEN组术后最早第2天肛门排气,3例患者肺部感染,10例患者出现恶心,2例腹胀,8例有腹泻表现;TPN组术后最早第6天排气,9例患者肺部感染,1例全胃患者有吻合口瘘出现,全肠外营养支持后治愈,5例患者有不同程度的反流,7例排气前有明显的腹痛腹胀。结论老年胃癌术后早期联合肠内营养能明显改善患者的营养状况,减少术后并发症的发生,符合患者的病理生理需求,具有安全、有效、合理的特点。     

非小细胞肺癌中Per2的表达及其与预后的关系

目的：研究生物钟基因Per2在非小细胞肺癌（NSCLC）中的表达及其与预后的关系。方法：采用免疫组织化学染色法检测60例NSCLC组织和20例正常肺组织中Per2的表达,结合临床病理和随访资料进行分析。结果：在NSCLC组织和正常肺组织中Per2的阳性表达率分别为71.7%（43/60）和95.0%（19/20）,差异有统计学意义（P〈0.05）。NSCLC中Per2的表达缺失与分化程度及TMN分期相关（P〈0.05）,单因素分析结果表明Per2的表达状态与NSCLC的预后相关（P〈0.05）,多因素分析结果显示分化程度、TNM分期、淋巴结转移情况及Per2的表达状态均非影响NSCLC预后的独立危险因素（P〉0.05）。结论：Per2在NSCLC中表达降低,其阴性表达在NSCLC的发生和发展中起重要作用,影响NSCLC的预后。     

Selective cyclooxygenase-1 inhibition improves collateral vascular reactivity in biliary cirrhotic rats

BackgroundEvidence has demonstrated that overproduction of prostacyclin (PGI₂) is critical in the pathogenesis of splanchnic hyposensitivity to vasoconstrictors in the cirrhotic state. The biosynthesis of PGI₂ is through cyclooxygenase (COX). This study evaluated which isoform of COX is dominant in the mechanism of collateral vascular reactivity of biliary cirrhotic rats.MethodsThree groups of formalin-injected common bile duct-ligated (FBDL) induced cirrhotic rats received two doses of: (1) selective COX-1 inhibitor (SC-560 2 mg/kg); (2) COX-2 inhibitor (NS-398 2 mg/kg); (3) dimethyl sulfoxide (control). Subsequently, the rats were kept in metabolic cages for 24 hours to collect urine. Thereafter, the systemic and portal hemodynamics and renal function were measured. In another series, using in-situ collateral perfusion model, the collateral vascular responses to arginine vasopressin (AVP) were measured in the subject rats after preincubation of vehicle (Krebs solution), SC-560 (5 μM) or NS-398 (10 μM).ResultsThe mean arterial pressure, heart rate, and portal pressure were similar among SC-560-treated, NS-398-treated, and control groups. Additionally, there was no significant difference in the calculated creatinine clearance rates among these three groups. SC-560 preincubation significantly enhanced the pressor effect of AVP at the concentration of 3M × 10^?9 M (11.0 ± 1.0 mmHg vs. 6.4 ± 0.6 mmHg, p = 0.002) in the cirrhotic rats.ConclusionThere was no significant hemodynamic change and renal toxicity after acute administration of COX inhibitor in the FBDL-induced cirrhotic rats. Preincubation of selective COX-1, but not COX-2, inhibitor could enhance collateral vascular response to AVP, indicating that COX-1 plays a major role in the collateral vascular reactivity.     

Identifying the substance abuse treatment needs of caregivers involved with child welfare

Parental substance use significantly increases risk of child maltreatment, but is often under-identified by child protective services. This study examined how agency use of standardized substance use assessments and child welfare investigative caseworker education, experience, and caseload affected caseworkers' identification of parental substance abuse treatment needs. Data are from a national probability sample of permanent, primary caregivers involved with child protective services whose children initially remained at home and whose confidential responses on two validated instruments indicated harmful substance use or dependence. Investigative caseworkers reported use of a formal assessment in over two thirds of cases in which substance use was accurately identified. However, weighted logistic regression indicated that agency provision of standardized assessment instruments was not associated with caseworker identification of caregiver needs. Caseworkers were also less likely to identify substance abuse when their caseloads were high and when caregivers were fathers. Implications for agency practice are discussed.     

Thioredoxin Mediates Remodeling Factors of Human Bronchial Epithelial Cells upon Interaction with House Dust Mite-Stimulated Eosinophils

Bronchial epithelial cells exposed to allergens typically secrete chemokines to recruit eosinophils. Persistent inflammation and repair responses result in airway remodeling and irreversible airflow limitation. House dust mite (HDM) is a common allergen causing allergic disorders. Thioredoxin (TRX) is a redox protein that scavenges reactive oxygen species (ROS). This study was to elucidate how TRX mediates gene expression of remodeling factors of human bronchial epithelial cells in response to HDM stimuli interacting with eosinophils. This study cultured normal human bronchial epithelial (BEAS-2B) cells with eosinophils exposed to 0.5?μg/ml recombinant Dermatophagoides pteronyssinus 1 (rDer p1) protease to mimic the allergen-immune reaction. Eosinophils were induced by rDer p1 protease to secrete tumor necrosis factor (TNF)-α and generate ROS. When cultured with rDer p1-stimulated eosinophils, BEAS-2B cells released interleukin-6 and underwent apoptosis. The HDM-stimulated eosinophils applied oxidative stress and apoptosis to BEAS-2B cells through the release of mediators. Damaged BEAS-2B cells interfered with gene expression of remodeling factors, such as transforming growth factor (TGF)-β 1, epidermal growth factor receptor (EGFR), cyclin dependent kinase inhibitor (p21^waf) and matrix metalloproteinase (MMP) 9, relevant to inflammatory response and epithelial repair in airway remodeling. Notably, BEAS-2B cells over-expressing TRX reduced eosinophil-derived apoptosis and suppressed underlying airway remodeling via attenuation of TGF-β1, EGFR and p21^waf and up-regulation of MMP9 expression. Results of this study indicated TRX-over-expressing bronchial epithelial cells attenuated TGF-β1 and activated MMP9 expression to prevent airway remodeling from HDM-induced inflammation. The finding can be as a reference for further therapeutic studies of TRX.     

Emergency medical technicians' disaster training by tabletop exercise

The objective of this study was to assess the attitudes of emergency medical technicians (EMTs) toward tabletop drills to determine the effect of tabletop simulation on the EMT student perception of disaster preparedness and management. In November 1998 and April 1999, 59 firefighters underwent 260 hours of EMT intermediate level training at the National Cheng Kung University Hospital in Tainan, Taiwan. All participants had experience in field disaster exercise training before they attended this EMT training course. The EMT courses included a disaster and mass-casuality incident program. A 9-item questionnaire was completed by the 59 EMTs before (for field exercise) and after undergoing the tabletop drills. The results of the survey revealed that the field operation exercise could not provide adequate provisions to link the results of disaster exercises to appropriate changes in terms of training, equipment, supplies, and plans. Field operation failed to show the ability of others to fill in during the absence of key officials. Tabletop drilling provided better performance for these 2 issues. Tabletop exercise also provided a better chance than field exercise to evaluate the response without the use of telephones, which are not always reliable in real emergency situation. For disaster exercises, limitations of field operation drills such as communications, coordination, assignment of responsibilities, and postevent mitigation priorities were noted, and tabletop drills provided additional benefits for these settings. Large-scale effect evaluation of different drills may be necessary to design future disaster preparedness programs.