Adjuvant hepatic intra-arterial iodine-131-lipiodol following curative resection of hepatocellular carcinoma: a prospective randomized trial.

BACKGROUND: The purpose of the present study was to determine whether intrahepatic injection of (131)I-lipiodol (Lipiodol) is effective against recurrence of surgically resected hepatocellular carcinoma (HCC). METHODS: From June 2001 through March 2007, this nationwide multi-center prospective randomized controlled trial enrolled 103 patients 4-6 weeks after curative resection of HCC with complete recovery (52: Lipiodol, 51: Control). Follow-up was every 3 months for 1 year, then every 6 months. Primary and secondary endpoints were recurrence-free survival (RFS) and overall survival (OS), respectively, both of which were evaluated by the Kaplan-Meier technique and summarized by the hazard ratio (HR). The design was based on information obtained from a similar trial that had been conducted in Hong Kong. RESULTS: The Lipiodol group showed a small, and nonsignificant, improvement over control in RFS (HR = 0.75; 95 % confidence interval [95 % CI] 0.46-1.23; p = 0.25) and OS (HR = 0.88; 95 % CI 0.51-1.51; p = 0.64). Only two serious adverse events were reported, both with hypothyroidism caused by (131)I-lipiodol and hepatic artery dissection during angiography. CONCLUSIONS: The randomized trial provides insufficient evidence to recommend the routine use of (131)I-lipiodol in these patients.

Antifungal activity of Cynara scolymus L. extracts.

Chloroform, ethanol and ethyl acetate extracts of Cynara scolymus L. leaves, heads and stems were tested for their antifungal activity using the agar-well diffusion assay technique. The leaves extracts and the ethanol fractions were found to be the most effective extract against all the tested organisms.

Towards development of an edible vaccine against bovine pneumonic pasteurellosis using transgenic white clover expressing a Mannheimia haemolytica A1 leukotoxin 50 fusion protein.

Development of vaccines against bovine pneumonia pasteurellosis, or shipping fever, has focused mainly on Mannheimia haemolytica A1 leukotoxin (Lkt). In this study, the feasibility of expressing Lkt in a forage plant for use as an edible vaccine was investigated. Derivatives of the M. haemolytica Lkt in which the hydrophobic transmembrane domains were removed were made. Lkt66 retained its immunogenicity and was capable of eliciting an antibody response in rabbits that recognized and neutralized authentic Lkt. Genes encoding a shorter Lkt derivative, Lkt50, fused to a modified green fluorescent protein (mGFP5), were constructed for plant transformation. Constructs were screened by Western immunoblot analysis for their ability to express the fusion protein after agroinfiltration in tobacco. The fusion construct pBlkt50-mgfp5, which employs the cauliflower mosaic virus 35S promoter for transcription, was selected and introduced into white clover by Agrobacterium tumefaciens-mediated transformation. Transgenic lines of white clover were recovered, and expression of Lkt50-GFP was monitored and confirmed by laser confocal microscopy and Western immunoblot analysis. Lkt50-GFP was found to be stable in clover tissue after drying of the plant material at room temperature for 4 days. An extract containing Lkt50-GFP from white clover was able to induce an immune response in rabbits (via injection), and rabbit antisera recognized and neutralized authentic Lkt. This is the first demonstration of the expression of an M. haemolytica antigen in plants and paves the way for the development of transgenic plants expressing M. haemolytica antigens as an edible vaccine against bovine pneumonic pasteurellosis.

The effects of Healing Touch on the coping ability, self esteem and general health of undergraduate nursing students.

The study used a mixed methodology to investigate the effects of HealingTouch (HT) on the coping ability, self esteem and general health of undergraduate nursing students to: check the veracity of claims made by HT practitioners that the therapy is effective in reducing stress; monitor the effects of HTon participants' scores using instruments which measure coping, self esteem and general health; and compare objective data with subjective accounts relating to coping, self esteem and general health. Quantitative findings showed no effects of HT on the coping ability, self esteem and general health of first year students, but there were some slight effects for the third year students who were in the experimental group. Qualitative findings showed that all participants in the experimental group found the experience positive. However, conclusions may be drawn tentatively that HT is effective while acknowledging that this project's design may have been ineffective in measuring the effects of HT, as the questionnaire may not have tested the actual effects of the therapy, and objective measures may be inadequate for exploring subjective experiences such as HT.

Fish oil augments macrophage cyclooxygenase II (COX-2) gene expression induced by endotoxin.

BACKGROUND: Fish oil-supplemented diets have anti-inflammatory and immunomodulating effects. Although fish oil is readily incorporated into the cell membrane and influences the production of eicosanoids, the exact mechanism is not clear. This study was designed to investigate the effects of eicosapentaenoic acid (EPA), a major component of fish oil, on macrophage (Mphi) cyclooxygenase (COX) gene expression induced by LPS. METHODS: RAW 264.7 cells, a mouse Mphi cell line, were grown in EPA-rich media for 24 h. Mphi were washed and exposed to Escherichia coli LPS (10 microg/ml). Membrane lipid profile was determined by gas chromatographic analysis. COX-1 and COX-2 mRNA expressions were determined by Northern blot assays with mouse-specific cDNA probes. PGE(2) production of Mphi was measured by ELISA. Mphi production of COX-2 protein was determined by Western blot assays with an anti-COX-2 antibody. RESULTS: Incubation in EPA-rich media increased membrane EPA and decreased arachidonic acid (AA) composition. COX-2 mRNA expression was induced by EPA and further augmented by LPS stimulation. EPA also augmented Mphi production of COX-2 protein. In comparison, COX-1 mRNA expression was not affected by either LPS stimulation or EPA incubation. EPA reduced PGE(2) production by LPS-stimulated Mphi. To further support that COX-2 mRNA was regulated by COX product, exogenous PGE(2) was added to Mphi prior to LPS stimulation. PGE(2) reduced COX-2 mRNA of LPS-stimulated Mphi. CONCLUSION: EPA displaces AA and reduces PGE(2) production by LPS-stimulated Mphi. Fish oil inhibition of Mphi PGE(2) production induces COX-2 mRNA expression through a COX-2 product-mediated feedback mechanism.

Fish oil decreases macrophage tumor necrosis factor gene transcription by altering the NF kappa B activity.

BACKGROUND: Fish oil-supplemented diets have anti-inflammatory and immunomodulating effects, though the exact mechanism(s) are unknown. This study investigated the effects of eicosapentanenoic acid (EPA), a major component of fish oil, on transcriptional regulation of tumor necrosis factor (TNF) gene in lipopolysaccharide (LPS)-stimulated macrophages (MO). METHODS: RAW 264.7 cells, a mouse MO cell line, were grown in EPA-rich media for 24-48 h. MO were washed and exposed to Escherichia coli LPS (1 microg/ml) for 2 h. TNF mRNA expression was measured by Northern blot assays. Total nuclear extracts were harvested for the measurement of NF kappa B with electrophoretic mobility shift assays. Supershift assays were performed with anti-P50 or anti-P65 antibodies to show components of NF kappa B dimers. TNF production was determined by L929 bioassays. RESULTS: LPS stimulated RAW cell TNF mRNA expression and NF kappa B activity. In contrast, RAW cells grown in EPA-rich media had less TNF mRNA expression and an altered composition of the NF kappa B subunits (P65/P50 dimers) in the presence of LPS. TNF production by LPS-stimulated MO was reduced by EPA. CONCLUSIONS: The inhibitory effect of EPA on LPS-stimulated MO TNF gene transcription and protein elaboration is, in part, mediated through altering NF kappa B activation by reducing the P65/P50 dimers.

Holistic care and spirituality: potential for increasing spiritual dimensions of nursing.

Holistic care addresses the physical, psychological, social and spiritual dimensions of the client. Health care providers, however, frequently overlook the spiritual dimension. Spiritual care is inseparable from physical, social and psychological care because together they form the whole. Promoting spiritual well-being supports clients in their journey to find meaning and hope in life and peace in death. The preparation of nurses for the spiritual aspects of care deserves much more attention.

Random vs. systematic sampling from administrative databases involving human subjects.

OBJECTIVE: Two sampling techniques, simple random sampling (SRS) and systematic sampling (SS), were compared to determine whether they yield similar and accurate distributions for the following four factors: age, gender, geographic location and years in practice. METHOD: Any point estimate within 7 yr or 7 percentage points of its reference standard (SRS or the entire data set, i.e., the target population) was considered "acceptably similar" to the reference standard. The sampling frame was from the entire membership database of the Canadian Chiropractic Association. The two sampling methods were tested using eight different sample sizes of n (50, 100, 150, 200, 250, 300, 500, 800). From the profile/characteristics, summaries of four known factors [gender, average age, number (%) of chiropractors in each province and years in practice], between- and within-methods chi 2 tests and unpaired t tests were performed to determine whether any of the differences [descriptively greater than 7% or 7 yr] were also statistically significant. The strengths of the agreements between the provincial distributions were quantified by calculating the percent agreements for each (provincial pairwise-comparison methods). Any percent agreement less than 70% was judged to be unacceptable. RESULTS: Our assessments of the two sampling methods (SRS and SS) for the different sample sizes tested suggest that SRS and SS yielded acceptably similar results. Both methods started to yield "correct" sample profiles at approximately the same sample size (n > 200). CONCLUSION: SS is not only convenient, it can be recommended for sampling from large databases in which the data are listed without any inherent order biases other than alphabetical listing by surname.

Combinatorial expression patterns of individual TLE proteins during cell determination and differentiation suggest non-redundant functions for mammalian homologs of Drosophila Groucho.

The Drosophila protein Groucho is involved in the regulation of cell-determination events during insect neurogenesis and segmentation. A group of mammalian proteins, referred to as transducin-like Enhancer of split (TLE) 1 through 4, share with Groucho identical structures and molecular properties. The aim was to determine whether individual TLE proteins participate in the regulation of cell determination in mammals like their Drosophila counterpart. It is here reported that TLE family members are expressed in combinatorial ways during the in vitro differentiation of mouse P19 embryonic carcinoma cells (a model for neural determination) and rat CFK2 cells (a model for chondrocytic determination). TLE1 is up-regulated and TLE2 and TLE4 are down-regulated to different extents during early stages of differentiation. In contrast, later stages correlate with up-regulation of TLE2 and TLE4, and decreased expression of TLE1. Individual TLE proteins are also expressed in combinatorial as well as complementary patterns during the development of the cerebral cortex and spinal cord of mouse embryos. In particular, TLE1 is robustly expressed in both neural progenitor cells and postmitotic neurons of the outer layers of the cortical plate, whereas TLE4 expression marks preferentially postmitotic neurons of the inner layers. Taken together, these results strongly suggest non-redundant roles for individual TLE proteins during both cell-determination and cell-differentiation events.

A holistic approach in facilitating adherence in people with diabetes.

The issue of adherence is a multidimensional one, with a complex set of factors that affect the behaviour of people with chronic illness. This article draws on some of the results of a recent study which explored the psychosocial factors affecting adherence to self-care behaviours in people with diabetes mellitus (DM).

Evolution of methotrexate resistance of human acute lymphoblastic leukemia cells in vitro.

A human acute lymphoblastic T-cell line, MOLT-3, was fed with Roswell Park Memorial Institute Medium 1640 supplemented with 10% fetal bovine serum and antibiotics which contained increasing concentrations of methotrexate (MTX). The development of drug resistance was associated initially with progressive decrease in MTX transport. When the cells became 200-fold resistant, a rise in the dihydrofolate reductase was noted which was short-lived in the absence of the drug. A 10,000-fold increase in MTX resistance was accompanied, in addition to further decrease in MTX transport, by a 10-fold increase in the dihydrofolate reductase activity. While the purely transport-related resistant cell lines had a collateral sensitivity to lipid-soluble antifols, the sublines which had both transport- and enzyme-related MTX resistance contained a subpopulation highly resistant to these antifols. Chromosome analysis of the subline with increased dihydrofolate reductase activity showed an expanded abnormally banded region in chromosome 5.

Predeposit autologous blood transfusions in patients undergoing irradiation and radical cystectomy.

We have used blood withdrawn electively and frozen for later use by the donor in 25 patients with bladder cancer who were treated by preoperative irradiation and radical cystectomy. Patients donated 1 to 5 units of blood (average 3.4 per patient). We transfused 10 patients with only autologous blood, whereas 15 required some homologous blood in addition to their own banked blood. The program was well tolerated and repeated blood donation did not compromise the effectiveness of preoperative irradiation. Our preliminary data show that this program reduces the dependence on volunteer donor homologous blood transfusions for cystectomy, thus, decreasing the potential risk of an adverse reaction and avoiding seasonal blood bank shortages.