1,3,5,8‐Tetrahydroxy‐9H‐xanthen‐9‐one exerts its antiageing effect through the regulation of stress‐response genes and the MAPK signaling pathway

The antioxidative effects of 30 xanthone derivatives (XDs) ( XD‐ n , n = 1–30) in HepG2 cells were evaluated by the cellular antioxidant activity assay. Results showed that all XDs were antioxidants and 1,3,5,8‐tetrahydroxy‐9H‐xanthen‐9‐one ( XD‐2 ) was the most active antioxidant. The all‐oxygenated substituted xanthones extended the lifespan of wild‐type N2 nematodes under normal culture conditions and XD‐2 was the best one. XD‐2 eliminated excessive intracellular reactive oxygen species and enhanced the expression levels and activities of the antioxidant enzymes superoxide dismutase, catalase, and glutathione peroxidase. XD‐2 inhibited the H₂O₂‐increased phosphorylation levels of c‐JUN N‐terminal kinase, extracellular signal‐regulated kinase, and p38 in HepG2 cells. In vivo, XD‐2 also extended the lifespan of wild‐type N2 nematodes under oxidative stress induced by paraquat, but failed in extending the lifespan of CF1038 (daf‐16 deletion) and AY102 (pmk‐1 deletion) mutant nematodes. It was revealed by real‐time polymerase chain reaction that the genes daf‐16, sir‐2.1, akt‐1, and age‐1 were all inhibited by paraquat stimuli, while XD‐2 reversed these inhibitions; in contrast, paraquat stimuli upregulated both the skn‐1 and pmk‐1 genes. However, treatment by  XD‐2 further increased the levels of both genes. These pieces of evidence implied that XD‐2 promotes longevity through endogenous signaling pathways rather than through the antioxidative activity alone. Taken all together, it may be concluded that XD‐2 is a promising antiageing agent.     

中国六岁以下儿童维生素A缺乏情况调查

目的　了解中国 6岁以下儿童维生素A(VA)缺乏的患病率及地区分布特点。方法　采用分层整群随机抽样方法 ,抽取中国 14个省 (沿海 4个省、内地 5个省、边远 5个省 )的 14个市及 2 8个县进行调查。调查内容包括家庭和儿童营养问卷 ,收集儿童血清。儿童血清VA标本全部在首都儿科研究所用荧光分析仪检测。结果　 14个省共调查 6岁以下 86 6 9人 (城市 2 877人 ,农村 5 792人 ) ,男 4 6 2 9人 ,女 4 0 4 0人。 2～ 5岁儿童夜盲症 8例 ,结膜干燥症 7例 ,母亲夜盲症 6 1人 ,均为农村人口。血清VA检测结果 :≤ 0 70 μmol/L的 10 18例 (11 7% ) ,其中城市 15 0例 ,占 5 2 % ,农村 86 8例 ,占 15 0 % (贫困县占 2 3 3% ) ;沿海、内地、边远分别为 14 5例 (5 8% )、35 5例 (11 5 % )、5 18例 (16 8% )。平均VA浓度 :全国为 1 0 6 μmol/L ,城乡分别为 1 2 0和 0 99μmol/L。 <6个月婴儿平均VA浓度≤0 70 μmol/L的为 33 4 % ,4～ 5岁儿童为 8%。性别差异无显著性 ,但年龄的差异有显著性。 结论　中国儿童存在VA缺乏 ,特别是在农村贫困地区 ,需要对这些地区的儿童补充VA。     

Family functioning in the caregivers of patients with dementia

BACKGROUND: Caregiver burden has been extensively studied in the dementia population. The marital relationship has been suggested as a mediational model through which variables influence the caregiver and contribute to the experience of burden or reward. OBJECTIVES: This study examines family functioning, caregiver burden and reward and quality of life in 38 family members caring for a relative with dementia. METHODS: Caregivers of out-patients with dementia completed self report questionnaires. RESULTS: 63% of caregivers were female with a mean age of 62 years. Patient mean age was 73 years. The average number of caregiving years was 3.1. Caregivers were more likely to be spouses (61%) than children (29%) or other relatives (11%). Despite the fact that caregivers reported that their relatives were moderately disabled, they perceived more reward than burden. Caregivers who reported poor family functioning had higher ratings of strain and burden. Family functioning in these caregivers was poorest in the dimensions of affective responsiveness, problem solving and communication but it was also impaired in roles and affective involvement. CONCLUSIONS: Assessing a family's functioning may be an important factor in the care of the dementia patient and his/her family.     

Anaphylaxis: lesson learned from five cases

Anaphylaxis is a severe hypersensitivity reaction. Its clinical manifestations vary, affecting several organs at once. Skin symptom is the most frequent manifestation; however, diagnosis of anaphylaxis will only be established when involving one or both vital organs, which are cardiovascular and respiratory system. Other symptom, such as that involving central nervous system or gastrointestinal tract, may accompany. We present five cases of anaphylaxis which vary in onset of symptoms, allergen, degree of severity, therapeutic response and clinical manifestation. Anaphylactic reaction to drugs in these cases is mainly manifested as anaphylactic shock and reaction to food allergen causing obstruction of respiratory tract. Four anaphylactic events occurred at home and only one occurred in a hospital, thus education on anaphylaxis to general community is very important, especially for the patients and their families. Prompt medical assistance in patients with anaphylactic symptoms determines their therapeutic response. Skin test prior to administration of cephalosporin does not give negative predictive value toward anaphylactic event.     

Quantity and quality profiles of antibiotics pre,on, and post surgery in a hospital setting

International Journal of Clinical Pharmacy - Background Providing proper antibiotics is undoubtedly crucial to prevent infections during surgery. Objective This study set out to evaluate the...     

Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis

BACKGROUND

Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy.

OBJECTIVE

To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services.

DESIGN

Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3 % (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS).

PATIENTS

U.S. transgender population starting before transitional therapy.

INTERVENTIONS

No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both.

MAIN MEASURES

Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost.

KEY RESULTS

Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000–22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints —HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85 % of simulations.

CONCLUSIONS

Health insurance coverage for the U.S. transgender population is affordable and cost-effective, and has a low budget impact on U.S. society. Organizations such as the GIC should consider these results when examining policies regarding coverage exclusions.

     

Identification and characterization of novel hepatitis B virus subgenotype C10 in Nusa Tenggara, Indonesia

Six novel subgenotypes (B7, B8, C6, C8, C9, and D6) within three hepatitis B virus (HBV) genotypes (B–D) were recently identified in Indonesia. To further characterize HBV in this country, 18 HBV-viremic samples obtained from blood donors in Nusa Tenggara, Indonesia, were subjected to phylogenetic analysis of an 1.6-kb partial or full-length sequence. Thirteen HBV isolates were classified into genotype B with four distinct subgenotypes [B3 (n = 2), B5 (n = 1), B7 (n = 4), and B8 (n = 6)], followed by 4 HBV isolates of genotype C (HBV/C); the remaining one isolate was of D (D1). As for the four HBV/C isolates, one isolate segregated into subgenotype C1, and two into C2. The remaining HBV/C isolate [C0901177(NT3)] differed from reported HBV/C isolates (C1–C9) by 4.6–7.7% over the entire genome and did not show evidence of recombination with any of the known HBV genotypes/subgenotypes, justifying its conclusive assignment into a novel subgenotype (C10) within genotype C.     

Family functioning in the caregivers of patients with dementia: one-year follow-up

Caregivers for relatives with dementia can maintain their quality of life without specific intervention. It is unclear which variables are protective and which variables are aggravating for the caregiver. To assess the impact of family functioning on caregiver burden over time, the authors had caregivers of out patients with dementia complete self-report questionnaires at recruitment and at 1 year. At recruitment, 63% of caregivers were female, with a mean age of 62 years. Mean patient age was 73 years. The average number of caregiving years was 3.1. Caregivers were more likely to be spouses (61%). After 1-year, caregivers who stayed in the study reported no change in burden, reward, quality of life, or overall family functioning, although the patient's activities of daily living and level of disability were perceived to have significantly deteriorated. Caregivers who reported poor family functioning at initial assessment had higher ratings of strain and burden.     

Family-oriented patient care through the residency training cycle.

OBJECTIVE: Because family oriented patient care improves patient outcome and reduces family burden, clinical family skills of communication, assessment, alliance, and support are part of core competencies required of all residents. Teaching residents to "think family" as part of core competencies and to reach out to families requires change in the teaching environment. METHODS: This article advocates teaching residents family skills throughout the training years as an integrated part of routine patient care rather than in isolated family clinics or a course in "family therapy." It reviews family skills required of residents in all treatment settings and family skills that are specific to inpatient, emergency room, outpatient, and consultation-liaison services. RESULTS: Families can be seen in multiple treatment settings throughout resident training using recent research to support appropriate interventions for patients and caregivers. CONCLUSION: The process of establishing change in the training environment requires a commitment on the part of the training faculty to include families, but is possible within the current training framework.