Stability and repeat regeneration potential of the engineered liver tissues under the kidney capsule in mice

Liver tissue engineering using hepatocyte transplantation has been proposed as a therapeutic alternative to liver transplantation toward several liver diseases. We have previously reported that stable liver tissue with the potential for liver regeneration can be engineered at extrahepatic sites by transplanting mature hepatocytes into an extracellular matrix. The present study was aimed at assessing the liver tissue persistence after induced regeneration by hepatectomy and repeat regeneration potential induced by repeat hepatectomy. Mouse isolated hepatocytes mixed in EHS extracellular matrix gel were transplanted under both kidney capsules of isogenic mice. The hepatocyte survival persisted for over 25 weeks. In some of the mice, we confirmed that the grafted hepatocytes developed a thin layer of liver tissues under the kidney capsule, determined by specific characteristics of differentiated hepatocytes in cord structures between the capillaries. We then assessed the regenerative potential and persistence of the exogenous liver tissue. To induce liver regeneration, we performed a two-thirds hepatectomy at 70 days after hepatocyte transplantation. Three weeks after this procedure, the engineered liver tissues showed active regeneration, reaching serum marker protein levels of 261 +/- 42% of the prehepatectomy level. We found that the regenerated liver tissue was stably maintained for 100 days (length of the experiment). Repeat regeneration potential was established by performing a repeat hepatectomy (that had been two-thirds hepatectomized at day 70) 60 days after the initial hepatectomy. Again, the regenerated engineered liver tissues showed active regeneration as there was an approximately twofold increase in the serum marker protein levels. The present studies demonstrate that liver tissue, which was recognized as a part of the host naive liver in terms of the regeneration profile, could be engineered at a heterologous site that does not have access to the portal circulation.     

The effects of patient cost sharing on ambulatory utilization in South Korea

This study focused mainly on the effects of patient cost sharing on the demand for physician service, especially in the low-income people. Patient cost sharing is one of the policies used extensively in the health care financing in Korea, which has been adopted to control the health care cost. It has raised the argument that cost sharing inhibits low-income patients' access to affordable medical care. Data from the National Health and Nutrition Survey conducted 1998 by the Korean Ministry of Health and Welfare was used for this analysis. Multiple regression was done with the dependent variable of the amount of ambulatory utilization and price elasticities are estimated. We obtained significant out-of-pocket price elasticities depending on patient income levels and types of care facilities in the range of -0.21 to -0.07, -0.20 to -0.10, respectively. We found out that low-income patients are more sensitive to cost sharing than high-income patients. Furthermore, we found out that the users of general hospitals are less sensitive to cost sharing than the users of clinics. These results shows that the cost sharing policy in Korea does not efficiently work. Patient cost sharing in Korea induces inequitable medical service utilization and also it does not decrease moral hazard in the sense that the higher cost-sharing sector is less sensitive to cost sharing.     

Analysis of risk factors for the development of gallstones after gastrectomy

BACKGROUND: The incidence of gallstones is higher in people who have undergone gastrectomy than in the general population, but the cause of this is unknown. METHODS: Between January 1992 and January 2003, 749 patients underwent ultrasonography of the gallbladder after gastrectomy for gastric cancer. A total of 2327 examinations were carried out. The incidence of gallstones was compared in subgroups of patients classified according to the type of reconstruction, extent of gastrectomy, whether the duodenum was excluded and type of lymph node dissection. RESULTS: The incidence of gallstones was significantly higher after total compared with partial gastrectomy (27.9 versus 7.8 per cent at 5 years; P < 0.001). Reconstruction with duodenal exclusion was associated with a significantly higher incidence than non-exclusion (25.1 versus 8.2 per cent at 5 years; P < 0.001). Patients who had lymph node dissection in the hepatoduodenal ligament had a significantly higher incidence of gallstones than those who did not (28.2 versus 7.5 per cent at 5 years; P < 0.001). In multivariate analysis that included type of reconstruction and lymph node dissection, lymph node dissection in the hepatoduodenal ligament was identified as the most significant risk factor for gallstone development (odds ratio 3.66 (95 per cent confidence interval 2.16 to 6.22); P < 0.001). CONCLUSION: Lymph node dissection in the hepatoduodenal ligament, total gastrectomy and exclusion of the duodenum are risk factors for gallstones after gastrectomy.     

An improved procedure for catheterization of the thoracic spinal subarachnoid space in the rat

Catheterization of the subarachnoid space provides a convenient means to deliver drugs to, or collect cerebrospinal fluid from, the spinal cord in animal experiments, and has been instrumental to our understanding of spinal mechanisms that underlie anesthesia, analgesia, or cardiovascular regulation. Experience gained over the years has revealed several shortcomings of this technique. We report a procedure that encompasses the benefits of direct subarachnoid catheterization of the rat thoracic spinal cord but circumvents the known shortcomings. An intrathecal catheter was fabricated with a small silicon bead at one end of a PE-10 catheter, which was cannulated with a 4/0 suture that served as a guide. Using the L-shape hook of the suture guide as an anchorage, the catheter was advanced into the subarachnoid space until the silicon bead was lodged on a drilled hole (2 x 2 mm) over the lamina proper on the T13 vertebrae. With less surgical trauma, greater precision of placement and firmer anchorage of the catheter, less leakage of cerebrospinal fluid, and minimal mortality or morbidity, our modified procedure for catheterization of the thoracic spinal subarachnoid space in the rat compared favorably to previously reported methods.     

Drug management of low back pain

NSAIDs and muscle relaxants effectively reduce acute nonspecific low back pain (LBP), different types of both drugs being equally effective. In general, there is no strong evidence for the effectiveness of medication for chronic nonspecific LBP. However, there is a possibility that administration of antidepressants is an intervention worthy of consideration in cases of LBP with no identifiable organic cause and resistant to other treatments.     

Leptospirosis

PURPOSE OF REVIEW: Leptospirosis, a spirochaetal zoonotic disease, has been recognized as an important emerging infectious disease in the last 10 years. This review addresses the issues in the epidemiology, diagnosis and clinical management which confront public health responses, and highlights the progress made towards understanding the Leptospira genome, biology and pathogenesis. RECENT FINDINGS: Leptospirosis has spread from its traditional rural base to become the cause of epidemics in poor urban slum communities in developing countries. Mortality from severe disease forms, Weil's disease and severe pulmonary haemorrhage syndrome, is high (>10% and >50%, respectively) even when optimal treatment is provided. Moreover, the overall disease burden is underestimated, since leptospirosis is a significant cause of undifferentiated fever and frequently not recognized. Barriers to addressing this problem have been the lack of an adequate diagnostic test and effective control measures. China and Brazil, countries in which leptospirosis is a major health problem, have completed the sequence of the Leptospira interrogans genome. Together with new genetic tools and proteomics, new insights have been made into the biology of Leptospira and the mechanisms used to adapt to host and external environments. Surface-exposed proteins and putative virulence determinants have been identified which may serve as sub-unit vaccine candidates. SUMMARY: Major progress has been made in the basic research of leptospirosis. Future challenges will be to translate these advances into public health measures for developing countries. Yet the most effective responses may be interventions that directly address the determinants of poverty, such as poor sanitation, which are often responsible for transmission.     

Amelioration of experimental colitis by Astragalus membranaceus through anti-oxidation and inhibition of adhesion molecule synthesis

AIM: To investigate the protective effects of Astragalus membranaceus(Am) against hapten-induced colitis in male Sprague-Dawley rats as well as its underlying mechanism. METHODS: Experimental colitis was induced in rats by enema administration of 2,4-dinitrobenzene sulfonic acid(DNBS). Rats were either pretreated with Am extract(2 or 4g/kg, p.o. once daily) starting from 10 d before DNBS enema, or received Am post-treatment(2 or 4 g/kg, p.o. twice daily) on the three consecutive days following DNBS administration. Colonic lesion area and histological damage were determined, while the activities of myeloperoxidase(MPO) and xanthine oxidase, as well as reduced glutathione(GSH) content were measured in the excised colonic tissues. Besides, protein expression of inducible nitrite oxide synthase(iNOS), intercellular adhesion molecule-1(ICAM-1) and P-selectin was also detected by Western blot analysis. RESULTS: Our findings had shown that both macroscopic lesion area and histological colonic damage induced by DNBS were significantly reduced by both Am pre- and post-treatments. These were accompanied by attenuation of the elevated colonic MPO activity and downregulation of the iNOS, P-selectin, and ICAM-1 protein expression. Besides, deprivation of colonic GSH level under colitis condition was also preserved. CONCLUSION: These results demonstrate that Am possesses both preventive and therapeutic potential in experimental colitis. The anti-inflammatory actions involve anti-oxidation along with inhibition of adhesion molecule synthesis in the colonic tissues.     

The metabolic syndrome and insulin resistance

The frequency of cardiovascular disease associated with metabolic disorder is increasing rapidly worldwide. The metabolic syndrome, a concurrence of glucose intolerance, obesity, dyslipidemia, and hypertension that are risk factors for atherosclerosis, accounts for a large proportion of cardiovascular morbidity and mortality. Exceeding energy intake coupled with high fat diet, sedentary lifestyle, and multiple genetic factors interact to produce the metabolic syndrome, and insulin resistance and visceral adiposity have been suggested to be the common pathophysiological basis of the metabolic syndrome. Adiposity is correlated with altered production of so-called adipocytokines that play a role on the atherosclerotic angiopathy. At the cellular level, excess insulin is involved in VLDL-triglycerides production, decreased HDL, and various elements of atherogenesis. Detecting the metabolic syndrome and implementing preventive lifestyle interventions--diet education, physical activity, and weight control--is a high clinical priority.     

Development and psychometric properties of the Chinese language version of the TAPQOL: a health-related quality of life instrument for preschool children

The objectives of this study were to assess psychometric properties of the Mandarin version of the TZO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire in Taiwanese preschool children. Two groups of children, a very low birthweight group (n=118) and a not-very low birthweight group (n=170), were recruited. The internal consistency was acceptable and the correlation coefficients between the 12 subscales were low. Confirmatory factor analysis supported the 12-factor structure. Children with very low birthweight had significantly lower quality of life scores. This instrument may be used in clinical and research applications to investigate quality of life among preschool children.