Renal protection from ischemia mediated by A2A adenosine receptors on bone marrow-derived cells

Activation of A2A adenosine receptors (A2ARs) protects kidneys from ischemia-reperfusion injury (IRI). A2ARs are expressed on bone marrow-derived (BM-derived) cells and renal smooth muscle, epithelial, and endothelial cells. To measure the contribution of A2ARs on BM-derived cells in suppressing renal IRI, we examined the effects of a selective agonist of A2ARs, ATL146e, in chimeric mice in which BM was ablated by lethal radiation and reconstituted with donor BM cells derived from GFP, A2AR-KO, or WT mice to produce GFP-->WT, A2A-KO-->WT, or WT-->WT mouse chimera. We found little or no repopulation of renal vascular endothelial cells by donor BM with or without renal IRI. ATL146e had no effect on IRI in A2A-KO mice or A2A-KO-->WT chimera, but reduced the rise in plasma creatinine from IRI by 75% in WT mice and by 60% in WT-->WT chimera. ATL146e reduced the induction of IL-6, IL-1beta, IL-1ra, and TGF-alpha mRNA in WT-->WT mice but not in A2A-KO-->WT mice. Plasma creatinine was significantly greater in A2A-KO than in WT mice after IRI, suggesting some renal protection by endogenous adenosine. We conclude that protection from renal IRI by A2AR agonists or endogenous adenosine requires activation of receptors expressed on BM-derived cells.     

The use of epidural and intrathecal analgesia in palliative care

Oral analgesics and adjunctive medicines will be used to meet the needs of most palliative care patients in terms of pain relief. However, for a small number of patients, this will not be adequate for satisfactory relief from pain, resulting in a lower quality of life. For such patients, using some of the more 'technical approaches' to pain relief, e.g. epidural or intrathecal analgesia, can prove beneficial. Taking the anatomy of the spinal space into consideration, this article will present the indications and contraindications for spinal analgesia, as well as drugs used and the most appropriate methods of drug administration.     

Sperm-related antigens, antibodies, and circulating immune complexes in sera of recently vasectomized men.

Sera from 35 men were collected before and at timed intervals subsequent to vasectomy and examined for the presence of (a) antibody reactive with human spermatozoa, (b) sperm-related antigen, and (c) circulating immune complexes (CIC). Fewer than 10% of the men examined were ever positive for antisperm antibodies. However, sperm-related antigens were elevated in the sera of 18, 18, and 26% of the mean at 2 wk, 2 mo, and 4 mo postvasectomy, respectively. CIC were detected in the sera of some vasectomized men by three different assays. The CIC in patients' sera were precipitated with polyethylene glycol, dissociated, and the individual CIC components identified by an enzyme-linked immunosorbent assay. Most, but not all, of the CIC contained antigen reactive with antisperm immunoglobulin (Ig)G and some also contained complement components C3 and/or Clq. IgA was identified in some of the CIC positive for IgG and sperm antigen and two men had IgM-containing CIC. Analysis of the CIC by sucrose gradient centrifugation revealed them to be heterogeneous in size.     

Students’ evolving beliefs about nursing: From entry to graduation in a four-year baccalaureate programme

Students become socialised into nursing during an educational programme through interaction with faculty members, classes and seminars, and by the experience of practicing nursing. In this paper, some results from a qualitative study that examined the socialisation of nursing students from one four-year baccalaureate programme are described. The changes in the students’ attitudes and values are presented. Fred Davis theory of doctrinal conversion is used to examine progress in the process of socialisation. There is evidence that students moved from a lay to a professional image of nursing over the course of their four-year programme. While they tended to remain idealistic, elements of realism were evident in the final year as they looked toward their role as a registered nurse and recognised the constraints inherent in the hospital system.     

Are unplanned readmissions to hospital really preventable?

All John Hunter Hospital readmission data for October 1998 were examined. Twenty-four readmissions out of 3081 total admissions (0.8%) were defined as adverse events (unplanned readmissions) being nominally due to inappropriate medical management. The 24 adverse events comprised 5.5% of the 437 readmissions. A further five readmissions occurred because scheduled theatre was cancelled. Remaining readmissions were due to the condition of the patient in each case. Of the 16 highly preventable adverse events, 10 were allocated to the minor temporary category of severity. It is difficult to evaluate these readmission rates because there are no comparable findings in other Australian studies. The adverse events showed no particular association with patient age, sex, hospital of original admission or hospital specialty. While they were technically preventable, after medical record review a senior clinician identified these as extremely difficult cases, indicating that better outcomes may not have been possible.     

Zebrafish: a genetic model for hemostasis and thrombosis.

Here we review the zebrafish hemostatic system, its relevance to mammalian hemostasis, and its efficacy as a vertebrate genetic model to further the understanding of hemostasis and thrombosis.     

Complications of insulin-dependent diabetes mellitus: management of insulin reactions and acute illness

Occasional mild hypoglycemia is an unavoidable and usually acceptable side effect of intensive insulin therapy. Patients with insulin-dependent diabetes mellitus may have impaired glucose counterregulation, which may increase the risk of hypoglycemia and justify less ambitious glycemic goals. A conservative but flexible approach to the treatment of insulin reactions is appropriate in order to avoid hyperglycemia. Insulin requirements are often increased during acute illness, and frequent self-monitoring of blood glucose concentrations is necessary to determine the need for supplementation with regular insulin. Frequent supplementation, together with modification of diet and maintenance of fluid intake, should not only minimize the need for hospitalization but also prevent severe deterioration in glycemic control.     

Clinical use and pharmacology of amiodarone

Amiodarone, an investigational drug in the United States, has had considerable use in this country and worldwide in the treatment of cardiac arrhythmias. This article reviews the clinical pharmacology of this potentially useful antiarrhythmic agent.