Individual-level behavioral interventions to support optimal development of children with sickle cell disease: A systematic review

This review aimed to identify and describe individual-level behavioral interventions for children 0–18 years of age with sickle cell disease (SCD). PRISMA guidelines were followed at each stage of this review. Twenty-seven studies were included, representing six intervention types: disease knowledge (n = 7), self-management (n = 7), pain management (n = 4), school functioning (n = 4), cognitive health (n = 4), and mental health (n = 2). Most interventions targeted older children (5+ years), while only two examined interventions for children 0–3 years. This review suggests that offering education about disease knowledge, self-management, and pain management interventions can be beneficial for this population. Future research is needed to understand interventions to support young children and the impact of SCD on development.     

Erythromycin modulates eosinophil chemotactic cytokine production by human lung fibroblasts in vitro

Recent studies suggest that erythromycin can suppress the production of some cytokines and may be an effective treatment for asthma. Eosinophil chemotactic cytokines have been suggested to contribute to the pathogenesis of asthma by the recruitment of eosinophils. We hypothesized that erythromycin modulates eosinophil chemotactic cytokine production. To test the hypothesis, we evaluated the potential of erythromycin to modulate the release of eosinophil chemoattractants from the human lung fibroblast cell line HFL-1. HFL-1 released eotaxin, granulocyte-macrophage colony-stimulating factor, and regulated and normal T-cell expressed and presumably secreted (RANTES) in response to interleukin-1beta or tumor necrosis factor alpha. Erythromycin attenuated the release of these cytokines and eosinophil chemotactic activity by the HFL-1. The suppressive effect on eotaxin was the most marked of these cytokines. Erythromycin therapy also suppressed eotaxin mRNA significantly. These results suggest a mechanism that may account for the apparent beneficial action of macrolide antibiotics in the treatment of allergic airway disorders.     

Impaired biliary excretion of taurocholate associated with increased biliary tree permeability in mirex- or chlordecone-pretreated rats

Impaired biliary excretion of exogenously provided xenobiotic metabolites was demonstrated previously after pre-exposure of rats to mirex (MX) or chlordecone (CD). This toxicity was studied further in pentobarbital-anesthetized rats, cannulated at the common bile duct. We found reduced biliary excretion rates for exogenous [14C]taurocholic acid (3 or 10 mumol/kg bolus) after 15-day dietary pretreatment of male rats with 20 or 100 ppm of MX or CD. Hepatobiliary dysfunction was dose-dependent. Maximal reduction in excretory rate on a per gram of liver basis (50%) followed treatment with 100 ppm of MX. Biliary tree permeability was estimated to ascertain whether efflux of canalicular bile into the hepatic circulation explained hepatobiliary dysfunction. Bile-to-plasma concentration ratios for [3H]sucrose increased in parallel with MX- and CD-impaired biliary excretion. Modeling the relationship between bile flow and bile-to-plasma [3H]sucrose ratio indicated the site of increased permeability involved a paracellular pathway. Bile flow (on a per gram of liver basis) and biliary clearance of [14C]erythritol were both reduced by 100 ppm of these toxicants. The above effects occurred in the absence of substantial hepatocellular necrosis, whereas liver enlargement increased in a dose-dependent manner. Maximal liver enlargement (doubling of liver weight) resulted from 100 ppm of MX treatment. These results indicated that hepatobiliary dysfunction induced by MX and CD was at least partially explained by increased permeability of the biliary tree.     

Hypertonic saline resuscitation reduces apoptosis and tissue damage of the small intestine in a mouse model of hemorrhagic shock

The effect of hypertonic saline resuscitation on intestinal damage and the incidence of apoptosis after hemorrhagic shock were investigated. After anesthesia, male BALB/c mice weighing 24-34 g were hemorrhaged to the mean arterial pressure of 40 +/- 5 mmHg for 90 min. Animals were randomly assigned to four groups: 1) resuscitation with 4 mL/kg of 7.5% NaCl (hypertonic saline; HS) + shed blood (SB); 2) resuscitation with two times the volume of shed blood of lactated Ringer's solution (2LR) + SB; 3) sham (catheter only); or 4) control (no treatment). Intestinal damage was graded based on the extent of the vacuolation at the basal area of the intestinal villi. Apoptosis of the small intestines was examined with the terminal deoxynucleotidyl transferase-mediated deoxyuridine 5-triphosphate nick-end labeling method and with DNA laddering. Caspase-3 activation, heat shock protein (HSP) 70, and HSP40 were assessed by western blotting. Apoptosis of the small intestine and intestinal damage were significantly lower (P < 0.01) in the HS+SB group compared with the 2LR+SB group 2 h and 6 h after hemorrhagic shock and resuscitation, respectively. This corresponded with more DNA fragmentation in the small intestine of the 2LR+SB group compared with the HS+SB group 2 h after hemorrhage and resuscitation. In addition, we observed less caspase-3 activation in the small intestine of the HS+SB group compared with the 2LR+SB group at 2 h after resuscitation. The content of HSP40 and HSP70 in the HS+SB group was similar to that in controls, but slightly decreased in the 2LR+SB group. HS resuscitation reduced intestinal damage and apoptosis after hemorrhagic shock, suggesting that HS resuscitation may improve the outcome after hemorrhagic shock by reducing apoptosis and damage to the small intestine.     

Identification and treatment of mental and substance use conditions: health plans strategies

BACKGROUND: Mental health and substance use conditions are under-recognized and under-treated. Private health plans may be able to affect the extent of screening and, thus, identification of enrollees who need treatment. OBJECTIVES: The goals of this study were to determine strategies used by health plans to identify mental health and substance use conditions; and describe the characteristics of health plans associated with use of these strategies. METHODS: In 2003, we conducted a nationally representative survey of private health plans regarding behavioral health services. A total of 368 health plans (83% response rate) provided information about their managed care products: health maintenance organization (HMO), point-of-service (POS), or preferred provider organization (PPO) products (812 in total). MEASURES: We asked whether plans verify primary care providers' screening for mental health or substance use conditions, screen outside of primary care, and distribute practice guidelines. We characterized each product in terms of "carve-out" to a specialty behavioral health vendor, tax status, and region and market area population. RESULTS: Thirty-four percent of products verify primary care providers' screening for mental health, but only 8% verify alcohol or drug screening. Outside of primary care, 31% conduct screening through the mail, phone, or internet. Depression guidelines are distributed to primary care providers by 78% of managed care products: alcohol or drug guidelines are distributed by 33%. In multivariate analyses, specialty contracting was positively associated, and PPO product type was negatively associated with these strategies. CONCLUSIONS: Most health plans use multiple strategies to improve identification of behavioral health conditions, but use of such strategies was greater for mental health than for substance use conditions.     

织构复合水凝胶体系的假说

生物软组织可视为具有多层次结构的织构复合水凝胶体系(TCHS)、以水凝胶复合元件(HCE)为基本的构件(CP),通过一定的组合、排列方式构筑一系列多层次结构的不同软组织。软组织中任何层次的结构单元既可视为织构复合水凝胶体系又可视为构件。任何层次的TCHS中,构件的结构及其组合排列方式决定着该层次单元的功能。以织构复合水凝胶体系的观点考察了真核细胞、角膜和骨骼肌的多层次结构。双层网络水凝胶、皮芯复合水凝胶纤维人工肌肉模型、时空匹配可降解细胞支架等研究成果初步地证明了提出织构复合水凝胶体系观点的合理性。