Effects of tacrolimus on an organotypic raft-culture model mimicking oral mucosa.

BACKGROUND: Tacrolimus ointment has shown efficacy in treating T-cell-mediated inflammatory oral mucosal diseases, including lichen planus. However, the safety of topical tacrolimus has been questioned, based on its possible association with malignant transformation. AIM: To evaluate the safety aspects of tacrolimus in a three-dimensional in vitro model of oral mucosa containing both multilayered epithelium and connective tissue (raft culture). METHODS: Raft cultures mimicking oral mucosa were topically exposed to tacrolimus, and the effects on cell proliferation and adhesion, epidermal growth factor receptors (EGFR, ERBB2, ERBB3, ERBB4), and apoptosis were evaluated with immunohistochemistry and terminal dUTP nick-end labelling, respectively. Results. The epithelium of the cultures was found to be slightly thinner, but no changes in cell proliferation or adhesion, apoptosis, or expression of epidermal growth factor receptors were detected. CONCLUSIONS: Our results suggest that short-term topical tacrolimus exposure of in vitro constructed oral mucosa does not induce changes in a number of factors known to be involved in malignant transformation.

Gelatine matrix with human thrombin decreases blood loss in adolescents undergoing posterior spinal fusion for idiopathic scoliosis: a multicentre, randomised clinical trial.

AIMS: In a multicentre, randomised study of adolescents undergoing posterior spinal fusion for idiopathic scoliosis, we investigated the effect of adding gelatine matrix with human thrombin to the standard surgical methods of controlling blood loss. PATIENTS AND METHODS: Patients in the intervention group (n = 30) were randomised to receive a minimum of two and a maximum of four units of gelatine matrix with thrombin in addition to conventional surgical methods of achieving haemostasis. Only conventional surgical methods were used in the control group (n = 30). We measured the intra-operative and total blood loss (intra-operative blood loss plus post-operative drain output). RESULTS: Each additional hour of operating time increased the intra-operative blood loss by 356.9 ml (p < 0.001) and the total blood loss by 430.5 ml (p < 0.001). Multiple linear regression analysis showed that the intervention significantly decreased the intra-operative (-171 ml, p = 0.025) and total blood loss (-177 ml, p = 0.027). The decrease in haemoglobin concentration from the day before the operation to the second post-operative day was significantly smaller in the intervention group (-6 g/l, p = 0.013) than in the control group. CONCLUSION: The addition of gelatine matrix with human thrombin to conventional methods of achieving haemostasis reduces both the intra-operative blood loss and the decrease in haemoglobin concentration post-operatively in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. TAKE HOME MESSAGE: A randomised clinical trial showed that gelatine matrix with human thrombin decreases intra-operative blood loss by 30% when added to traditional surgical haemostatic methods in adolescents undergoing posterior spinal fusion for idiopathic scoliosis.

Inflammatory response and apoptosis in newborn lungs after meconium aspiration.

An important feature of meconium-instilled newborn lungs is an inflammatory response and apoptotic cell death. It was recently demonstrated by our group and supported by several other investigators in a relatively short period of time. Apoptosis exists also in healthy lungs, but in meconium-instilled lungs its level is usually dramatically higher. Apoptosis is characterized by loss of cell function, decrease in cell size, and its morphology. Apoptosis plays an important role in normal cell life, but increased levels of apoptosis induce great damage for any tissues. Apoptosis in the lungs has been greatly overlooked for the past decade, and meconium-induced apoptosis is a relatively new event and not effectively studied at the present time. This Review summarized current knowledge regarding meconium-induced inflammation and apoptosis in newborn lungs.

Assessment of quality of life with the Nottingham Health Profile among women with coronary artery disease.

OBJECTIVE: To examine the differences in the health-related quality of life (HRQOL) of Finnish women with coronary artery disease (CAD) (n = 91) in comparison with Finnish men with CAD (n = 189). Healthy women (n = 990) served as a control group. DESIGN: Prospective, cross-sectional survey. SETTING: Surgical and medical clinics at the University of Oulu, Finland. PATIENTS: Twenty-one women underwent coronary artery bypass grafting (CABG), 40 women underwent percutaneous transluminal coronary angioplasty (PTCA), and 30 women received medication for treatment of CAD. The patients in the medication group were taking beta blockers (81%), long-acting nitrates (86%), calcium channel blockers (43%), aspirin (79%), and lipid-lowering drugs (18%). OUTCOME MEASURES: The Nottingham Health Profile (NHP), which consists of six dimensions: energy, sleep, pain, emotional reactions, social isolation, and physical mobility. Higher mean indexes signify lower HRQOL. INTERVENTION: The patients referred to CABG and PTCA procedures were interviewed and asked to fill in the questionnaire on the day before the operation. They were instructed to describe their HRQOL over the preceding 3 months. The patients in the medication group were mailed the NHP questionnaire. RESULTS: Women with CAD reported significantly poorer HRQOL than age-matched women in the healthy sample, as measured by the following dimensions of the NHP: energy, sleep, pain, emotional reactions, and physical mobility. This indicates the NHP dimensions affected by CAD among women. HRQOL for women with CAD was lower than that of men with CAD. The mean indexes of four of the six NHP dimensions, energy, sleep, emotional reactions, and physical mobility were higher for women with CAD than men with CAD in the two youngest age groups. Social isolation was most common in the youngest age group among both women and men with CAD. In women with CAD, emotional reactions and social isolation were most clearly related to demographic characteristics such as traumatic life experiences, depression, financial situation, and smoking. CONCLUSIONS: These findings suggest that the subjective HRQOL should be considered along with the clinical severity of the disease in the evaluation of CAD. The findings further shed light on the HRQOL of especially young women with CAD, the female and male patients' referral for treatment, and the use of the NHP instrument among patients with CAD.

Self-care agency and factors related to this agency among patients with coronary heart disease.

The aim of this study was to assess the self-care agency and factors related to this agency among patients with coronary heart disease (N = 250) measured with a self-care inventory (Self-as-Carer Inventory, SCI). A secondary aim was to analyze the ability of the SCI inventory based on Orem's self-care deficit theory to measure the self-care agency of patients with coronary heart disease. Factor analysis yielded four factors which represent the key aspects of self-care, such as evaluation, implementation, decision-making, significance of knowledge, attitudes, motivation and physical prerequisites of self-care. The most important precondition for self-care in our study was 'appreciation and motivation to self-care'. This factor had numerous correlations with the background factors. Age, sex, socioeconomic status, employment status, health behavior, such as alcohol use and smoking, other diseases, such as diabetes, and satisfaction with sex life were related to the patients' self-care agency. It can be concluded that the self-care agency of our patients was moderate and many background factors were related to it. The SCI inventory seems to cover the self-care requirements of these patients, but the clinical use of SCI is precarious. The items are still too abstract and the questionnaire is therefore too difficult to fill in for many patients.

Quality of life in coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) constitutes a considerable financial burden on society in Finland; it is the cause of death of approximately 7,500 men and 6,500 women annually in a population of 5 million. OBJECTIVES: The purpose of this study was to assess the changes in the quality of life (QOL) of patients with CAD treated by medication, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass surgery (CABS) during 1 year. METHOD: The study population consisted of 280 patients with CAD. One hundred patients had been referred to CABS and another 100 to PTCA, whereas 80 patients were on drug therapy. The patients assessed their health status and QOL in terms of functional capacity and aspects of distress using self-completed questionnaires with the Nottingham Health Profile (NHP) instrument before the operation and 6and 12 months afterwards. RESULTS: The QOL of the patients who had undergone CABS and PTCA was significantly better on the dimensions of energy, pain, and mobility 1 year after the intervention. In the medication group, the only improvement took place on the dimension of social isolation, whereas both energy and mobility deteriorated. CONCLUSIONS: The results on QOL obtained in this study support the notion that patients continue to have many problems even after medical treatment with a good outcome. The problems occur in different areas compared with the pretreatment situation as on the dimensions of social isolation and emotional reaction. The rehabilitation of CAD patients is therefore important because the new problems are manifested differently from those seen before the illness or the treatment. The patient's QOL and personal preference for a treatment modality should be important criteria in the choice of treatment.

Life course of people with coronary artery disease.

The purpose of this study was to describe the life course of coronary artery disease patients from their own perspective at the onset of coronary artery disease and during both the in-patient period and the one-year period of aftercare. Nineteen people selected from a population of 200 patients who had undergone either coronary artery bypass surgery or percutaneous transluminal coronary angioplasty were available for thematic interviews. Interviews were conducted one year after the treatment in the subject's homes. Analyses revealed two distinct types of life course; accepting and progressive, as opposed to non-accepting and regressive. Participants who represented an accepting and progressive life course achieved a better level of rehabilitation than those with a non-accepting and regressive life course. If health care personnel are able to identify the problems related to a non-accepting, regressive life course, they will be better able to support patients' individual life course planning. According to the present findings, a rehabilitation programme is particularly needed for patients with acute onset of coronary artery disease at a relatively early age, disruption of an active working career, financial problems, dissatisfaction with outcome of treatment, family problems and a dismal view of the future. The findings challenge health care personnel to listen to coronary patients' own experiences.

Assessment of quality of life with the Nottingham Health Profile among patients with coronary heart disease.

The aim was to describe the quality of life of people suffering from coronary artery disease. The patients had been treated with medication (n = 80), percutaneous transluminal coronary angioplasty (n = 100) and coronary artery bypass surgery (n = 100). Of the 280 patients, 189 were men and 91 women. The patients who participated in this study were seriously ill, as nearly half of them had three or more stenosed coronary arteries. Male patients were most numerous in the bypass surgery group and female patients in the angioplasty group. The quality of life was evaluated using the Nottingham Health Profile (NHP) instrument relation to an age- and sex-matched general population, the background factors and the severity of the coronary disease. The NHP questionnaire consists of 38 statements on health problems, making up six dimensions of subjective health: physical mobility, pain, sleep, energy, emotional reactions and social isolation. The health-related quality of life of coronary patients before the invasive procedures was significantly poorer on all the six dimensions than the quality of life in an age- and sex-matched general population. The most obvious differences were seen on the following dimensions: energy, pain, emotional reactions, sleep and physical mobility. The smallest differences occurred in social isolation. Both males and females had the lowest value for energy and social isolation in the youngest age group (35-54 years). The index values of emotional reactions in the two youngest groups were significantly higher among females than males, which reflects poor quality of life. The women in the age group of 35-54 years found the manifestation of a serious disease extremely hard to face. Our findings clearly suggest that while choosing the mode of treatment, the patient's quality of life should be considered along with the clinical severity of the disease, especially in the case of young women. From the societal and social points of view, the patient's symptoms and quality of life are even more important than the objective medical outcome. In clinical decision-making, the goal is to integrate the results of health-related quality of life assessments with clinical decisions, and this underlines the need to evaluate whether the treatment given is congruent with the patient's quality of life. On the basis of the present findings, the NHP instrument seems to be applicable to quality of life measurements among coronary patients. It does not, however, necessarily give an accurate and profound view of an individual's overall quality of life.