The role of endogenous heme oxygenase in the initiation of liver injury following limb ischemia/reperfusion

BACKGROUND/AIMS: Heme oxygenase (HO) derived liver protection was tested in mice following 1 h bilateral hindlimb ischemia and either 1.5 or 3 h reperfusion. METHODS: Groups consisted of limb ischemia/reperfusion (I/R), sham (no I/R), I/R+chromium mesoporphyrin (I/R+CrMP;40 micromol/kg, i.p.), or I/R+hemin (10 mg/kg, i.p.). The vital dye propidium iodide (PI), was used to measure hepatocellular death (#/0.1 mm(3)), while the number of sinusoids perfused by red blood cells (SP(RBC)) were measured from the periportal (Pp) and pericentral (Pc) zones of liver acini using intravital microscopy. Whole organ injury was estimated from serum alanine aminotransferase (ALT). RESULTS: SP(RBC) reduced within 1.5 h with no further decline following 3 h. CrMP resulted in a dramatic loss of SP(RBC) following 3 h only. Hemin restored perfusion in both zones. Hepatocellular death and organ injury increased at 1.5 and 3 h. At 1.5 h, CrMP further increased cell death in the Pc zone, as well as whole organ injury, while hemin restored cell viability. Increased HO mRNA, protein and activity suggested induction within 3 h. CONCLUSIONS: HO does not protect perfusion during the early stage (1.5 h), but becomes increasingly important in preserving liver perfusion and cell viability during the later stage (3 h) of liver injury.     

Tobacco Use Characteristics Among Rural Ohio Appalachians

Appalachians remain at high risk for cancer, heart and lung disease, in part because of their high prevalence of tobacco use; yet, information about their tobacco consumption patterns is limited. The purpose of this study was to describe tobacco consumption variables among rural adult Appalachian tobacco users. Subjects, aged 18 and older (N = 249), participated in a face-to-face interview about tobacco consumption variables and knowledge regarding the health effects of tobacco at fairs in two rural Ohio Appalachian counties. The majority of participants were categorized as precontemplators, although 21 percent were classified in preparation stage of change. Mean age of initiation was 16.6 years and number of cigarettes smoked per day (cpd) was significantly higher for men, as compared to women. One-third of males reported the use of smokeless tobacco. The majority had not tried to quit for more than a year and the average number of previous quit attempts was low. One-half of the sample had been advised in the past to quit by their physician. Few had used nicotine replacement with past quit attempts but greater than half would consider this approach with future attempts. Knowledge about the health effects of smoking indicated that most were aware of the relationship between smoking and cancer but less than one-half recognized its association with heart disease. Those with less education were less informed about the health effects to self and non-smokers. While a sizeable portion expressed interest in quitting, knowledge about the health effects of smoking is lacking, especially with regard to heart disease and among those with less education.     

Assessing child sexual offenders' modus operandi: Accuracy in self-reported use of threats and coercion

Recent evidence suggests that child sexual offenders' self-report can provide a reliable source of information regarding offenders' use of threats and violence. However, the majority of studies in this area have specifically focused on coercion occurring within sexually abusive acts. The current investigation examined the accuracy of offenders' self-report regarding their use of threats and violence with child and adolescent victims during two time periods: (1) while attempting to secure victims' cooperation in sexual activities; and (2) while seeking to maintain victims' silence regarding the abuse. The responses of 16 offenders in an incarcerated treatment setting and 16 in an outpatient treatment program were compared with treatment staff's responses on an anonymous questionnaire. Findings generally indicated a high level of concordance between offender and staff reports. However, both groups of offenders significantly under-reported their use of threats and violence for both time periods. While some of the under-reported items reflected overt forms of violence (e.g., forced participation), the majority represented subtle, manipulative, and/or implied threats. Implications for future studies and clinical applications are discussed.     

Age and ageism: inhabiting the lives of healthy older adults through video narratives

When applied humanities is used as a framework, the educational innovation described in this article provides a more balanced view of aging than occurs in most nursing programs. Five video narratives and focused discussion questions, intended to mitigate the "otherness" of old age, are described. Rationales and sample student responses are provided.     

Physician supply in key medical specialties in West Virginia hospitals, 2001-2004

This article describes the development, implementation and analysis of an ongoing prospective physician supply survey of the largest acute care hospitals in West Virginia. This survey was designed to assess changes in availability of physicians in key specialties from 2001-2004, a period of years that included a "malpractice insurance crisis." The malpractice crisis in this article describes the period of time in 2001-2002 when medical malpractice insurance rates increased abruptly in West Virginia and a number of physicians publicized their departure from practice in the state. We calculated the absolute and relative percentage change in the median number of physicians in each specialty between 2001-2004, calculated percentage change for each specialty by year, and performed univariate analysis on the percentage changes among all hospitals. We also calculated univariate analysis on the percentage changes among all hospitals. The median number of staff physicians in these hospitals declined steadily from 2001-2004. Declines in the number of specialists (some statistically significant) occurred, especially early in the three-year period, notably among surgical specialties. The availability of nephrologists increased significantly from 2003-2004. Decreases in staff physician numbers may have leveled off, but there is no evidence of sustained growth.     

The validity and reliability of chinese frontal assessment battery in evaluating executive dysfunction among Chinese patients with small subcortical infarct

OBJECTIVES: Frontal Assessment Battery (FAB) is a valid and reliable screening test for evaluating executive dysfunction among whites with frontal and subcortical degenerative lesions. We studied the properties of a Chinese version of FAB (CFAB) in evaluating executive dysfunction among Chinese stroke patients with small subcortical infarct. METHODS: Concurrent validity was evaluated using Wisconsin Card Sorting Tst (WCST) and Mattis Dementia Rating Scale-Initiation/Perseveration Subset (MDRS I/P) among 41 controls and 30 stroke patients with small subcortical infarct. Discriminant validities of CFAB and its subitems were compared with those of Mini-Mental State Examination (MMSE). Internal consistency, test-retest, and interrater reliability of CFAB were evaluated. RESULTS: The CFAB had low to good correlation with various executive measures: MDRS I/P (r = 0.63, p < 0.001), number of category completed (r = 0.45, p < 0.001), and number of perseverative errors (r = -0.37, p < 0.01) of WCST. Among the executive measures, only number of category completed had significant but small contribution (6.5%, p = 0.001) to the variance of CFAB. A short version of CFAB using three items yielded higher overall classification accuracy (86.6%) than that of CFAB full version (80.6%) and MMSE (77.6%). Internal consistency (alpha = 0.77), test-retest reliability (rho = 0.89, p < 0.001), and interrater reliability (rho = 0.85, p < 0.001) of CFAB were good. CONCLUSION: Although CFAB is reliable, it is only moderately valid in evaluating executive dysfunction among Chinese stroke patients with small subcortical infarct. The clinical use of CFAB in the evaluation of executive dysfunction among this group of patients cannot be recommended at this stage.