Docosahexaenoic acid restores endothelial function in children with hyperlipidemia: results from the EARLY study.

OBJECTIVE: The primary objective of this study was to determine whether the National Cholesterol Education Program Step II (NCEP-II) diet or supplementation with docosahexaenoic acid (DHA) with the diet, affects endothelial function in children with familial hypercholesterolemia (FH) or the phenotype of familial combined hyperlipidemia (FCH). As secondary endpoints, the influence of diet and DHA supplementation on lipid profiles as well as biomarkers for oxidative stress and inflammation, and asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, were all evaluated. METHODS: In a double-blind, placebo-controlled, randomized, crossover study design, 20 children (ages 9-19 years) with FH (n = 12) and FCH (n = 8) received nutritional counseling based on the National Cholesterol Education Program Step II (NCEP-II) and food guide pyramid dietary guidelines for 6 weeks. They were then randomly assigned to supplementation with docosahexaenoic acid (DHA 1.2 g/d) or placebo for 6 weeks, followed by a washout phase of 6 weeks and crossover phase of 6 weeks while continuing the NCEP-II diet. Endothelium-dependent flow-mediated dilation (FMD) of the brachial artery was determined by high-resolution ultrasound. Plasma levels of total cholesterol, triglycerides and lipoprotein classes (LDL, HDL, VLDL) were measured by ultracentrifugation and enzymatic methods, plasma F2 isoprostanes by gas chromatography/mass spectrometry, urinary 8-OH-2' deoxyguanosine by liquid chromatography, high sensitivity C-reactive protein by immunonephelometry and ADMA by liquid chromatography. RESULTS: FMD increased significantly after DHA supplementation compared to baseline (p < 0.001), diet alone (p < 0.002), placebo (p < 0.012) and washout (p < 0.001) phases of the study without affecting biomarkers for oxidative stress, inflammation or ADMA. DHA supplementation was associated with increased levels of total cholesterol (p < 0.01), LDL- and HDL cholesterol concentrations (p < 0.001) compared to the NCEP-II diet. CONCLUSION: This study demonstrates that DHA supplementation restores endothelial-dependent FMD in hyperlipidemic children. The endothelium may thus be a therapeutic target for DHA. This is consistent with a hypothesis of increasing NO bioavailability, with the potential for preventing the progression of early coronary heart disease in high-risk children.

Environmental endocrine disruption in decapod crustacean larvae: hormone titers, cytochrome P450, and stress protein responses to heptachlor exposure.

A variety of enzymes and other proteins are produced by organisms in response to xenobiotic exposures. Cytochrome P450s (CYP) are one of the major phase I-type classes of detoxification enzymes found in terrestrial and aquatic organisms ranging from bacteria to vertebrates. One of the primary functions of stress proteins (HSPs) is to aid in the recovery of damaged proteins by chaperoning their refolding. These and other biomarkers of xenobiotic exposure and resulting effects have not been studied in crustacean larvae. This information is of potential importance for environmental management and risk assessment. In this work, we have given Homarus americanus larvae single 24 h exposures to the cyclodiene pesticide heptachlor, a known environmental endocrine disruptor (EDC) on different days of the 1st larval instar. We followed these larvae during the first larval stage for effects on timing of ecdysis to 2nd stage, ecdysteroid molting hormone titers, and alterations in the levels of cytochrome P450 CYP45 and HSP70 proteins. Delays in ecdysis were correlated with alterations in ecdysteroid levels. This result provides clues that this pesticide may function as an environmental endocrine disruptor in crustaceans. CYP45 and HSP70 levels were significantly elevated for several days following heptachlor exposure. The elevation in HSP70 was prolonged depending on the day of pesticide exposure and this was directly related to the increase in mortality. These results demonstrate the utility of these measurements as potential biomarkers in crustacean larval developmental toxicology and EDC effects research.

Neuroactive steroids modulate crustacean locomotor activity.

We examined the effects of neuroactive steroids known to modulate gamma-aminobutyric acid(A) (GABA)(A) receptor activity, on locomotor activity in a submerged circular open-field apparatus. Juvenile male lobsters, Homarus americanus, were treated with a single administration of an agonist, 3alpha-hydroxy-5alpha-pregnan-20-one (allopregnanolone, 3alpha,5alpha-TH PROG), an antagonist, pregnenolone sulfate (PREGS), or vehicle alone. 3alpha,5alpha-TH PROG treatment (125 and 250 microg) significantly reduced while PREGS significantly elevated locomotor activity in a dose-dependent manner similar to diazepam. PREGS increased locomotor activity at 30 and 60 microg, while diminishing such activity and altering locomotor patterns at 120 microg. These results suggest that neuroactive steroids may affect crustacean GABA receptors in a fashion similar to the GABA(A) type found in the vertebrates, and that they may be involved in the regulation of locomotor behavior.

Clinical use of tai chi in elderly populations.

Tai chi, a type of low-intensity exercise, has received growing attention in both eastern and western cultures, especially its use with the most rapidly increasing segment of the population-elders. Previous research findings further supported the idea that tai chi is appropriate for elderly populations and helps promote their well-being. In this article, the beneficial effects of tai chi for elders are summarized, resources to increase awareness about the exercise are provided, and ways to promote tai chi in elderly populations are suggested.

Issues in complementary therapies: how we got to where we are.

Consumer interest in and use of complementary/alternative therapies has increased exponentially in the past decades. Although many of the over 1800 therapies have not been used in the delivery of nursing care, a number of these therapies have a long tradition of use in nursing. Additionally, nurses have conducted research on selected complementary therapies. Nursing is in an excellent position to be a leader in integrating these therapies into the Western biomedical health model and in continuing the research that will provide a better scientific base for the use of complementary therapies.

Challenges of implementing intervention research in persons with dementia: example of a glider swing intervention.

Intervention studies for persons with dementia present many challenges. This article describes challenges encountered in conducting a glider swing intervention study for persons with dementia and the strategies used to manage the problems encountered. The overall purpose of a quasi-experimental study was to explore the effects of a glider swing intervention on emotions, relaxation, and aggressive behaviors in nursing home residents with dementia. Suggestions for investigators conducting intervention studies for persons with dementia are provided.

A glider swing intervention for people with dementia.

The soothing, repetitive movement of rocking and swinging is well known to anyone who has enjoyed a porch swing or rocking chair. Positive effects of rocking have been reported. However, investigations on its effect in people with dementia are limited. The purposes of this quasi-experimental, repeated-measures design study were to measure the effects of a glider swing on emotions, relaxation, and aggressive behaviors in a group of nursing home residents with dementia (n = 30). Data were obtained during a 5-day baseline phase, a 10-day intervention phase, and a 5-day posttreatment phase. Subjects were placed on the glider for 20 minutes each day during the intervention phase. The results of the study indicate that the glider intervention significantly improved emotions and relaxation. The most noted changes were found after 10 minutes of swinging. However, no differences were found in aggressive behaviors.

Facilitators and barriers to elders' practice of t'ai chi. A mind-body, low-intensity exercise.

Research has documented the positive effects that t'ai chi has on the well-being of elders. However, the reasons that elders practice t'ai chi have not been explored. The purpose of this study was to describe the facilitators and barriers to t'ai chi practice in elderly populations. Taiwanese community-dwelling elders (40 of whom practiced t'ai chi and 40 who did not) aged 65 and older, matched on age and gender, were interviewed. Results showed that encouragement from others was the most important factor for elders to practice t'ai chi, whereas positive health outcomes were the reason they continued to practice it. Most of the non-t'ai chi group participants had never thought about practicing t'ai chi because they felt they were too weak to practice. Because t'ai chi can be helpful in promoting the well-being of elders, it is essential for health care professionals to overcome the barriers to its uses in elderly populations.

Use of presence in the critical care unit.

Nurses have used the intervention of presence for centuries, but only recently has attention been given to defining and describing this intervention that conveys much of the caring aspect of nursing. Presence is more than a nurse's being with a patient physically. Researchers have found that patients recognize and value nurses who are present with their whole beings and are attuned to patients' needs and concerns. When critical care nurses use the intervention of presence, findings have shown that they make a connection with the patient that can lead to earlier identification of patients' problems. Further, critical care nurses can use presence in interactions with patients to avoid the perception by patients and their families that the nurse is emotionally distant or is there just to do a job. By incorporating presence as an integral part of all patient interactions, critical care nurses have the privilege of transforming a technical, potentially impersonal setting into a humane, healing place.

New antimicrobial flavanones from Physena madagascariensis.

Two new flavanones (1 and 2) with antibacterial activity were isolated from the methanolic extract of the dried leaves of Physena madagascariensis using activity against Staphylococcus aureus to guide the isolation. A third flavonoid, a flavanone dimer linked by a methylene group (3) was also isolated and proved to be inactive. The structures of 1 and 2 were established primarily from NMR studies, while that of 3 required more extensive mass spectrometric analysis. All three flavanones had lavandulyl units in the limonene form. Flavanones 1 and 2 were active against several bacteria at concentrations as low as 4 microM.

Music therapy.

Nurses have used music as an intervention for many years. A sizeable number of investigations to determine the efficacy of music in managing pain, in decreasing anxiety and aggressive behaviors, and in improving performance and well-being have been conducted by nurses and other health professionals. Nursing and non-nursing research reports published between the years 1980-1997 were reviewed. Great variation existed in the type of musical selection used, the dose of the intervention (number of sessions and length exposure), the populations studied, and the methodologies used. Overall, music was found to be effective in producing positive outcomes.

A research-based use of Tai Chi/movement therapy as a nursing intervention.

Tai Chi has been widely practiced in China for centuries as an art form, religious ritual, relaxation technique, exercise, and a method of self-defense for people of all ages. It has been used to improve balance; promote postural stability; decrease falls; enhance cardiovascular and ventilatory functions; rehabilitate persons with acute myocardial infarction and rheumatoid arthritis; and reduce pain, stress, and nightmares. The purpose of this article is to summarize, synthesize, and critically evaluate the research-based use of Tai Chi presented in the current literature and give implications and directions for future research. Additional studies about the effects of Tai Chi from a nursing perspective are needed to make clear when it is beneficial as a nursing intervention.

Identification of a new cytochrome P450 family, CYP45, from the lobster, Homarus americanus, and expression following hormone and xenobiotic exposures.

A new cytochrome P450, the first member of the CYP45 family, was identified from the hepatopancreas of the American lobster, Homarus americanus. The lobster CYP45 shares significant sequence homologies to the vertebrate CYP3 and the invertebrate CYP6, CYP9, CYP28, and CYP30 families, perhaps indicating a common ancestor of these P450s. Of seven tissues examined, CYP45 was expressed only in the hepatopancreas, the crustacean equivalent of the vertebrate liver, pancreas, and intestine. Over the course of the lobster molt cycle, CYP45 expression mirrored the hemolymph titer of ecdysteroids, suggesting its potential involvement in molting hormone dynamics. This idea was strengthened further by ecdysteroid treatment of intermolt-stage lobsters during the lowest hemolymph titers and CYP45 expression levels. Significant elevations in hepatopancreas CYP45 mRNA levels were elicited by such injections over a 2- to 4-day interval. Similar experiments were performed by intubating juvenile lobsters with various xenobiotics. Induction of CYP45 expression occurred following phenobarbital and heptachlor administration, but not by beta-naphthoflavone. Hormonal and xenobiotic modulation of lobster CYP45 expression provides a potential pathway for endocrine disruption in lobsters.

Endothelial dysfunction occurs in children with two genetic hyperlipidemias: improvement with antioxidant vitamin therapy.

OBJECTIVE: To measure endothelium-dependent vascular relaxation in children with two genetic hyperlipidemias and to assess the effect of antioxidant vitamins on endothelial dysfunction. STUDY DESIGN: Vascular reactivity in the brachial artery was measured in 45 individuals between 6 and 21 years of age (18 with familial hypercholesterolemia [FH], 15 with familial combined hyperlipoproteinemia [FCH], 12 control subjects) with the use of high-resolution two-dimensional ultrasonography. Follow-up studies were done for 11 children after 6 weeks of treatment with tocopherol (400 IU twice a day) and ascorbic acid (500 mg twice a day). RESULTS: The mean percent change in diameter during reactive hyperemia was 2.1 +/- 2.2 (SD) and 2.7 +/- 4.4, in FH and FCH, respectively, compared with 12. +/- 4.9 among control subjects (p < 0.001 in each case). The mean percent dilation was significantly increased (2.8 +/- 1.6 to 9.1 +/- 2.3) (p < 0.001) after antioxidant therapy. CONCLUSIONS: Impaired endothelium-dependent vasoregulation occurs in children with FCH as well as in those with FH. The improvement in vascular reactivity observed during supplementation with antioxidant vitamins suggests that reactive oxygen species derived from oxidized lipoproteins may be responsible for the impairment of vasoregulation in subjects with hyperlipidemia.

Interventions for decreasing agitation behaviors in persons with dementia.

1. High stress is one of the possible causes of agitation behaviors in persons with dementia; use of stress management interventions may be helpful in reducing the stress level. 2. Two nursing interventions, hand massage and therapeutic touch, were effective in producing a relaxation response in persons with dementia who had a history of agitation behaviors; they did not, however, decrease agitation behavior. 3. Hand massage was more effective in producing relaxation than was therapeutic touch.

Role of the midgut gland in metabolism and excretion of ecdysteroids by lobsters, Homarus americanus.

The chromatographic profile of ecdysteroids (Ecds) from the midgut gland (MG) of juvenile female lobsters, Homarus americanus, was examined using high-performance liquid chromatography (HPLC) and radioimmunoassay (RIA) over four stages of the molt cycle. Upon initial examination, highly polar Ecd conjugates appeared to be the principal metabolites found in all molt stages. HPLC fractions containing apolar Ecds initially exhibited low RIA activity. Upon hydrolysis with a Helix pomatia enzyme preparation and reanalysis, significant amounts of other Ecds were released. Amounts of apolar Ecd conjugates were estimated, at their highest levels, to be at least 50% of the total Ecds in MGs of molt stage D3 lobsters. Only the MG formed significant amounts of apolar Ecds upon in vitro culture with [3H]ecdysone ([3H]E). Epidermis and antennal gland significantly increased their rates of [3H]E metabolism in vitro between molt stages C4 and D1. This result further supports the idea that regulation of ecdysteroid metabolism, at least in selected tissues, may be important in the molt cycle regulation of hormone titers. Using gel filtration column chromatography and sucrose density gradient centrifugation analyses, evidence was found for association of apolar Ecds with a protein(s) from MG cytosol. The protein was estimated to have a molecular weight of 180,000-200,000 and specifically bound apolar Ecds.

Ecdysteroids in relation to the molt cycle of the American lobster, Homarus americanus. II. excretion of metabolites.

Ecdysteroid (Ecd) excretion patterns were followed during the molt cycle of adult male and female lobsters. Homarus americanus. Urine was the major route of Ecd elimination, amounting to greater than or equal to 96% of the excreted radioimmunoassay activity for all molt stages. The other identified route of Ecd elimination from the hemolymph was the feces, which accounted for the remaining 4% of the total Ecd excretion. High polarity metabolites (HP), including 20,26-dihydroxyecdysone (2026E) and 20-hydroxyecdysonoic acid (20EA), were the major types of Ecds found in the urine. Other urinary Ecd components included 20-hydroxyecdysone (20E), ecdysone (E), and ponasterone A (P). The major portion of urinary HP was composed of conjugates of 2026E, 20E, E, P, and other unidentified metabolites. The fecal Ecds were predominately HP and apolar metabolites. Apolar fecal Ecds were hydrolyzable to release 20EA, 2026E, 20E, E, P, and other metabolites. By means of intubation, [3H]E was placed directly into the cardiac stomach of lobsters. The gut pathway formed an apolar conjugate of [3H]E which was found exclusively in the feces. Lobsters are therefore capable of excreting ingested Ecds without absorption.