Clinical study on the flow murmurs at the defect area of atrial septal defect by means of intracardiac phonocardiography.

In order to study flow murmurs through atrial septal defects, right heart catheterization was performed on 48 patients of secundum type, four of primum type, and five of probe-patent foramen ovale, with the double-lumen phonocatheter of Lewis, at the tip of which barium titanate was mounted. The flow murmurs at the defect area were classified into three patterns: v murmur, atriosystolic murmur, and mid-diastolic murmur. V murmur was continuous, extending from late systole to diastole, of low to medium pitch, closely related to atrial v wave and augmenting with expiration. It had no significant correlation to the ratio of left-to-right shunt. It was recorded in 32 out of 48 cases of secundum type and one of primum type, but not observed in probe-patent foramen ovale. Atriosystolic murmur was noted in 17 of 48 cases of secundum type and one of primum type. It was connected with atrial a wave. Mid-diastolic murmur was found at the defect area in four subjects of secundum type. It was thought to be an independent entity from v murmur and to be another one due to shunt flow through the septal defect, since it had no relation to v wave but it was localized between v and a waves in the pressure curve of the right atrium. It is different in localization from mid-diastolic murmur due to relative tricuspid stenosis at the inflow tract of right ventricle.     

An Evaluation on Levels of Knowledge,Attitude and Behavior of People at 65 Years and Above About Alternative Medicine Living in Ankara

The aim was to determine the knowledge, attitude and behavioral levels of people at and above 65 years of age, living in Ankara (Turkey) about alternative medicine. The study was carried out between March – April 2010 through survey application of 200 participants by selective random sampling from the population. Data obtained as a result of the survey were analyzed by SPSS program. The study revealed that 83.5% of the participants believed in alternative therapy methods but 16.5% of them did not. It is concluded that herbal therapy methods are the most frequently used methods with a 63% rate among other alternative therapy methods. When status of the participants was analyzed it was found that it was found that 69% received the information about alternative medicines from their family while 53.5% received it from television This study revealed that alternative medicine is profoundly used by people above 65 years of age in Ankara.     

Downregulation of TGF-βRII in T effector cells leads to increased resistance to TGF-β-mediated suppression of autoimmune responses in type I diabetes

Tregs play an important role in controlling immune responses, particularly autoimmunity. In NOD mouse model, an excellent model for autoimmune diabetes, transfer of Tregs was shown to prevent diabetes, whereas depletion of Tregs in vivo enhanced disease progression, suggesting that Treg dysfunction contributes to the pathogenesis of diabetes. However, the mechanisms leading to Treg dysfunction and their role in diabetes progression has remained unclear. In this study we assessed quantitative and qualitative changes in Tregs during the development of autoimmune diabetes in NOD. We compared female NOD with males that have similar predisposition to but a lower incidence of diabetes and found that Treg numbers remained unchanged between 6 to 16 weeks of age in both groups. Although female Tregs produced lower TGF-β compared to male, regulatory function of female Tregs was only marginally inferior to male upon GAD65 autoantigen stimulation. GAD65-reactive female Teffectors were more responsive and progressively became refractory to regulation compared to male effectors, in part due to lower expression of TGF-β RII, accounting for reduced sensitivity to Tregs. Moreover, we unexpectedly found that TGF-β suppressed IFN-γ production to GAD65 antigen in male, not in female responders. These data suggest that TGF-β plays a major role in Teff resistance to regulation and Treg dysfunction, and may account for autoimmune diabetes. Our study implies that development of a successful supplemental Treg therapy for halting autoimmunity may require further understanding of Teff responses to regulation in order to generate highly effective Tregs.     

Rebamipide potentially mitigates methotrexate-induced nephrotoxicity via inhibition of oxidative stress and inflammation: A molecular and histochemical study

Methotrexate (MTX) is a widely used chemotherapeutic agent; nevertheless, the nephrotoxicity associated with its use has limited its clinical use. Rebamipide (REB) is a gastro-protective agent with diverse promising biological activities. Here, we investigated the renoprotective effects of REB against MTX-induced nephrotoxicity in rats. Male Wistar rats were allocated into four groups: the normal control group, the REB group (100 mg kg⁻¹ day⁻¹, PO, for 12 days), the MTX group (which received a single injection of 20 mg/kg, ip), and the REB + MTX group (which received 100 mg kg⁻¹ day⁻¹ REB for 7 days before and 5 days after being injected with 20 mg/kg MTX). Interestingly, MTX triggered kidney injury, characterized by renal dysfunction along with histopathological alterations. Moreover, increased reactive oxygen species level and inflammatory response were detected in the kidney of MTX-treated rats. However, REB prevented MTX-induced oxidative kidney injury and boosted an antioxidant balance. Mechanistically, REB markedly activated the NRF-2 protein and upregulated the expression of both SIRT-1 and FOXO-3 genes. Additionally, REB administration strongly inhibited the inflammatory response by downregulating both NF-κB-p65 and TLR-4. Finally, the coadministration of REB and MTX activated the mTOR/PI3K/AKT signaling pathway. Simultaneously, REB treatment attenuated the reduction in glomerular size, the widening of the capsular spaces, and the tubular cell damage due to MTX administration. Taken together, these results indicate the potential of REB as adjuvant therapy to prevent nephrotoxicity in patients receiving MTX treatment.     

Impact de la modification des prescriptions chez les sujets âgés hospitalisés en service de court séjour gériatrique en termes de coût

Purpose

Polypharmacy in the elderly increases the risk of adverse drug reactions and leads to increased medical costs. There is little data currently available on drug modification and cost reduction during hospitalization in a geriatric unit. The aims of this study were to analyse drug modification during hospitalization in a geriatric care unit and to evaluate the repercussions in terms of cost reduction.

Methods

This monocentric study included 691 patients over a period of 3.5 years. The drugs and their daily costs were counted and classified (10 classes, 37 subclasses) upon admission and upon discharge. The modifications in the number of drugs in each class and subclass, as well as their costs, were analysed. Predictive factors in drug modification between admission and discharge were investigated.

Results

Our study showed a significant decrease in the number of drugs (mean  ±  standard error [SE], 5.2 ± 0.11 to 4.5 ± 0.07), as well as in the daily medical costs (4.4 ± 0.18 to 3.67 ± 0.12 €) between admission and discharge. The higher the number of drugs was upon admission, the greater the reduction was upon discharge. Cardiovascular, metabolic, analgesic and pulmonary drugs were significantly reduced, whereas gastrointestinal and anti-osteoporotic treatments increased. Diabetes, adverse drug events and the one-leg balance were predictive factors in drug modification.

Conclusion

Hospitalization in a geriatric unit allows a re-evaluation of drug management with a significant reduction in the number and cost of treatments between admission and discharge. Given the multiple consequences of polypharmacy and its serious financial impact, research to develop optimal care of the elderly and to improve medication intervention is warranted.     

Validation of the Greek version of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+, version 3)

Objectives: There is a growing need for evaluation of the results of mental health services and clinical treatment in older people, but evidence for effectiveness is limited in Greece. The Health of the Nations Outcome Scales for Elderly People (HoNOS65+) are promising instruments for the assessment of mental, physical and social health in older persons. They have been translated into the Greek language but have not been validated. The aim was to assess the inter-rater reliability, intraclass correlation, concurrent validity, internal consistency and sensitivity to change of HoNOS65+ in a Greek sample of older people with mental health problems.

Method: Two samples, one of inpatients in a psychiatric hospital and the other of older people living in the community were used. In order to test the extent to which the HoNOS65+ were sensitive to change the first sample was reassessed after two months and the second after three months. For each participant HoNOS65+ were completed by two independent raters, and the clinician rated blindly each participant on the Stockton Geriatric Rating Scale and a scale which measured behavioural, physical, cognitive and emotional status.

Results: In both groups (inpatients n?=?50, community n?=?65), the inter-rater reliability, intraclass correlation and concurrent validity were high while internal consistency of the scales taken together was low. At reassessment in 98 participants, HoNOS65+ showed changes comparable to clinician ratings.

Conclusion: The Greek version of HoNOS65+ can achieve high levels of reliability, validity and sensitivity to change for measuring outcomes in older people with mental health problems.     

塞来昔布联合p65miRNA抑制人乳腺癌移植瘤的生长

目的探讨下调核因子NF-κB p65亚基的表达联合塞来昔布对人乳腺癌裸鼠移植瘤生长的协同抑制效应及其机制。方法建立人乳腺癌裸鼠移植瘤模型,随机将裸鼠分为6组,control组、Neg-miRNA组、p65miRNA组、塞来昔布组、塞来昔布+Neg-miRNA组、塞来昔布+p65miRNA组。观察治疗前后裸鼠的一般状态、肿瘤体积和瘤重,计算平均抑瘤率。免疫组化法检测p65miRNA干扰后肿瘤组织中p65蛋白的表达。RT-PCR、Western印迹法检测肿瘤组织中血管内皮生长因子(VEGF)、金属基质蛋白酶(MMP-2)基因mRNA及蛋白表达的变化。结果塞来昔布组、p65miRNA组和塞来昔布+p65miRNA组肿瘤生长受到明显抑制,抑瘤率分别为43.23%、40.72%及61.69%。p65miRNA组较对照组p65蛋白表达明显减少。塞来昔布组、p65miRNA组和塞来昔布+p65miRNA组VEGF、MMP-2 mRNA及蛋白表达受到不同程度地抑制。结论塞来昔布及p65miRNA均具有明显的抗肿瘤作用,联合应用时具有一定的协同作用,可显著抑制人乳腺癌裸鼠移植瘤的生长,并可显著下调VEGF、MMP-2的表达。