A conceptual model of posttraumatic growth of nursing students with a disabled parent.

OBJECTIVES: To examine a conceptual model of posttraumatic growth (PTG) with the inclusion of family resilience as a mediator, and social support, individual resilience, maternal care, and family members' intimacy after trauma as protective factors. METHODS: A cross-sectional questionnaire survey was carried out in a sample of 134 college nursing students who had a parent with a non-congenital disability. The Socio-demographic Information Questionnaire, the Chinese version of Perceived Social Support Scale (PSSS), 10-item Connor-Davidson Resilience Scale (CD-RISC10), Parental Bonding Instrument (PBI), Family Resilience Assessment Scale (FRAS) and the Posttraumatic Growth Inventory (PTGI) were used to collect data. RESULTS: Results showed that social support, individual resilience, maternal care, and family members' intimacy after trauma positively predicted family resilience (ß = 0.41, 0.20, 0.20, 0.22, all P＜0.01), respectively, and indirectly predicted PTG through family resilience. Family resilience positively predicted PTG (ß = 0.25, P＜0.01). Moreover, individual resilience directly positively predicted PTG (ß = 0.25, P＜0.001). CONCLUSIONS: Family resilience could facilitate PTG in nursing students in the face of parental disability. Interventions to promote PTG among college nursing students who have experienced parental disability should consider individual or family resilience-based intervention.

Vapocoolant spray versus placebo spray/no treatment for reducing pain from intravenous cannulation: A meta-analysis of randomized controlled trials.

BACKGROUND: Intravenous cannulation is a routine procedure in hospitalized patients, and pain can occur during the cannulation process. Vapocoolant spray is an advantageous analgesic alternative for intravenous cannula insertion. OBJECTIVES: The objective of our meta-analysis is to compare the effectiveness of vapocoolant spray and placebo spray/no treatment for pain reduction during intravenous cannulation. DESIGN: A meta-analysis to identify evidence from randomized controlled trials. METHODS: We searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data for publications before January 2018. The outcomes measured included pain during intravenous cannulation, patients' anxiety due to the spray, first attempt success rate, technical ease of the attempt, adverse events, and participant satisfaction. RESULTS: We included 11 studies with 1410 patients. The meta-analysis results showed that vapocoolant spray significantly decreased pain during intravenous cannulation compared with placebo spray or no treatment in both adults and children. In addition, vapocoolant spray significantly increased the technical ease of the attempt and participants' satisfaction. However, patients' anxiety due to spray, first attempt success rate, and adverse events were not associated with vapocoolant spray. CONCLUSIONS: This meta-analysis suggests that vapocoolant spray significantly decreased pain during intravenous cannulation when compared with placebo spray or no treatment in both adults and children. We recommend the use of vapocoolant spray during intravenous cannulation to decrease pain. Future research may help to unify pain measurement standards. Patients' anxiety due to spray and technical ease of the attempt should be explored in future research.

Posttraumatic growth and parental bonding in young adults of parents with physical disabilites: testing mediation model of resilience.

Positive parent-child relationships are associated with positive youth development, but little is known about the relationships between parental bonding, resilience, and posttraumatic growth, which is positive change resulting from the struggle with trauma. This study examined a mediation model among 119 female young adults with disabled parents. The model included resilience as a mediator of the relationship between the paternal Care and posttraumatic growth. The results revealed that resilience did mediate the relationship between the paternal Care and posttraumatic growth. The findings indicate that paternal Care helps to foster female young adults' resilience, which benefits their growth after suffering adversities.

HMGB1 is negatively correlated with the development of endometrial carcinoma and prevents cancer cell invasion and metastasis by inhibiting the process of epithelial-to-mesenchymal transition.

High-mobility group box protein 1 (HMGB1), a nuclear protein that plays a significant role in DNA architecture and transcription, was correlated with the progression of some types of cancer. However, the role of HMGB1 in endometrial cancer cell invasion and metastasis remains unexplored. HMGB1 expression was initially assessed by immunohistochemistry and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) in normal endometrial tissue and endometrial carcinoma tissue. High expressions of HMGB1 protein were detected in normal endometrial tissues; however, in endometrial cancer tissues, the expressions of HMGB1 were found to be very weak. Furthermore, HMGB1 expressions were negatively correlated with advanced stage and lymph node metastasis in endometrial cancer. Then by RT-qPCR, Western blot and immunocytochemistry, HMGB1 was also detected in primary cultured endometrial cells and four kinds of endometrial cancer cell lines (Ishikawa, HEC-1A, HEC-1B and KLE). We found that the expression of HMGB1 was much higher in normal endometrial cells than in endometrial cancer cells, and reduced expression levels of HMGB1 were observed especially in the highly metastatic cell lines. Using lentivirus transfection, HMGB1 small hairpin RNA was constructed, and this infected the lowly invasive endometrial cancer cell lines, Ishikawa and HEC-1B. HMGB1 knockdown significantly enhanced the proliferation, invasion and metastasis of endometrial cancer cells and induced the process of epithelial-to-mesenchymal transition. These results can contribute to the development of a new potential therapeutic target for endometrial cancer.

Suicidal Ideation and Psychological Strain Among Patients Diagnosed With Stomach Cancer: The Mediation of Psychopathological Factors.

Patients with stomach cancer are at high risk to experience suicidal ideation. Strain theory of suicide assumes that suicide is preceded by psychological strain. Despite wide international acceptance of the theory, its use with a sample of patients with stomach cancer has not previously been reported. The aims were to examine the relationship between psychological strain and suicidal ideation among patients with stomach cancer and to determine whether psychopathological factors act as mediators. A cross-sectional study was undertaken involving subjects with no history of mental disorder, and questionnaires were administered by face-to-face interview. Patients who experienced more psychological strain, especially coping strain, are more likely to experience suicidal ideation. The mediation effects of hopelessness and psychological distress are significant. Psychological strain, hopelessness, and psychological distress may be the vital factors among patients with stomach cancer in the suicide-risk assessment interview and for care planning and psychological intervention.

Job stress and burnout: A comparative study of senior and head nurses in China.

Senior nurses can suffer from high job stress and burnout, which can lead to negative patient outcomes and higher turnover rates; however, few studies have examined this topic. We recruited 224 head and senior nurses from September to December 2015 using convenience and cluster sampling, to compare job stress and burnout levels between the two groups. The Nurse Job Stressors Inventory and Maslach Burnout Inventory scales were used to evaluate job stress and burnout, respectively. Results indicated that job stress scores significantly differed between head and senior nurses. The highest scoring subscales in both groups were time allocation and workload problems. Scores for the three burnout dimensions also significantly differed between the groups. Positive correlations between job stress and burnout were stronger among senior nurses than head nurses. Burnout may be higher among senior nurses given head nurses' potential for greater perceived job control. Our findings suggest that measures need to be taken to reduce burnout and turnover rates among senior nurses.

Professional commitment and attributional style of medical-college nursing students in China: A cross-sectional study.

BACKGROUND: The persistent shortage of nurses has become a common phenomenon around the world. Nursing students' professional commitment affects their decision to choose nursing as a professional career. However, there is little knowledge about the professional commitment of nursing students, especially its relationship with attributional style. OBJECTIVES: To explore the professional commitment of nursing students and to identify the role of attributional style on nursing students' professional commitment. DESIGN: Cross-sectional study design. SETTINGS AND PARTICIPANTS: This study was conducted at three different medical colleges in Jinan, Shandong Province, China and included 1230 nursing students. A total of 1223 valid questionnaires were returned, yielding a response rate of 99%. METHODS: The Professional Commitment Scale and the Multidimensional-Multiattributional Causality Scale (MMCS) were used to investigate nursing students' professional commitment and attributional style. Basic demographic information about the nursing students was collected. Stepwise regression analysis was used to analyze the data. RESULTS: The mean scores on the Professional Commitment Scale were 3.54±5.29 (mean±SD). Professional commitment of first year students was higher than that of second year students. Their residence affected their affective commitment, ideal commitment, and continuance commitment which were the sub-dimensions of professional commitment. Effort and ability attribution positively influenced professional commitment; however, context attribution negatively influenced it. CONCLUSIONS: It is imperative to take effective measures to improve nursing students' professional commitment. Our findings indicated that attributional style had a significant effect on professional commitment; thus, effort and ability attribution need to be emphasized.

5-HTTLPR, victimization and ecological executive function of adolescents.

Executive function (EF) plays an important role in guiding peer relationship, school performance and behavior control. Children exposed to traumatic environments have been reported to perform poorer in EF tasks. We explored if the relationship between victimization and EF was dependent on the functional variation 5-HTTLPR in a non-clinical sample of adolescents. Data on demographics, victimization and daily life EF were collected from school students (Han Chinese, n=2125). All those reporting executive dysfunction (n=169), and classmate controls (n=208), were genotyped for the 5-HTTLPR. It was shown that the number of victimizations associated positively with executive dysfunction (ED). This association was particularly strong in those homozygous for the short allele of 5-HTTLPR, whilst a statistical 5-HTTLPR×victimization interaction on ED was found. Our findings suggest that adolescents with a genotype conferring a low 5-HTT activity are more vulnerable to a childhood adversity-associated ED in their daily life.

Epidemiology and clinical characteristics of patients with glaucoma: An analysis of hospital data between 2003 and 2012.

PURPOSE: To assess demographic and clinical characteristics of glaucoma patients in an Ophthalmologic Hospital of Jinan, China from 2003 to 2012. MATERIALS AND METHODS: Medical charts of patients with primary open-angle glaucoma (POAG), primary angle closure glaucoma (PACG), and secondary glaucoma (SG) were reviewed. The main outcome measures of patients with glaucoma included basic demographic data (age at presentation, gender, and residence), clinical characteristics (admission date, intraocular pressure, and naked vision), and previous history (injury, cardiovascular disease, diabetes mellitus, hypertension, smoking, and alcohol consumption). RESULTS: Data from 1458 glaucoma patients were reviewed, of which PACG and SG patients accounted for 45.40% and 47.19%, respectively. The average age of all patients with glaucoma increased from 56.05 years in 2003 to 57.83 years in 2012, and the proportion of patients from rural areas rose from 46.43% to 59.13% during 10-year period. Female gender, cardiovascular disease, and hypertension were associated with PACG. POAG was related to smoking and alcohol consumption. There was positive correlation between SG and history of injury and diabetes mellitus. CONCLUSION: PACG and SG are the major types of glaucoma. Gender, injury, diabetes mellitus, cardiovascular disease, hypertension, smoking, and alcohol consumption were associated with different types of glaucoma.

Translation and validation of the Chinese version of the Current Opioid Misuse Measure (COMM) for patients with chronic pain in Mainland China.

BACKGROUND: Management of prescription opioids misuse and abuse problems among chronic pain patients has been increasingly important worldwide and little literature concerning prescription opioids can be found in mainland China so far. METHODS: The Current Opioid Misuse Measure (COMM) was translated into Chinese following Brislin's model of cross-culture translation and was completed by a convenience sample of 180 patients with chronic pain recruited from two major hospitals in Jinan, Shandong province. Data were analyzed using internal consistency, test-retest reliability, exploratory factor analysis and confirmatory factor analysis. RESULTS: The internal consistency coefficient for the total score of the COMM was 0.85 and item-total correlations of all items were above 0.20. Besides, the test-retest reliability was satisfactory with an ICC of 0.91 (95% CI = 0.65-0.98). Four principal components were extracted, accounting for 65.30% of the variance, and the factor loadings of all 17 items were above 0.40. CONCLUSIONS: The Chinese version of COMM showed satisfactory reliability and validity, and could be used as a screening tool to evaluate and monitor current aberrant drug-related behavior among Chinese patients with chronic pain.

Impact of Childhood Adversity and Vasopressin receptor 1a Variation on Social Interaction in Adulthood: A Cross-Sectional Study.

BACKGROUND: Arginine vasopressin (AVP) plays a role in social behavior, through receptor AVPR1A. The promoter polymorphism AVPR1A RS3 has been associated with human social behaviors, and with acute response to stress. Here, the relationships between AVPR1A RS3, early-life stressors, and social interaction in adulthood were explored. METHODS: Adult individuals from a Swedish population-based cohort (n = 1871) were assessed for self-reported availability of social integration and social attachment and for experience of childhood adversities. Their DNA samples were genotyped for the microsatellite AVPR1A RS3. RESULTS: Among males, particularly those homozygous for the long alleles of AVPR1A RS3 were vulnerable to childhood adversity for their social attachment in adulthood. A similar vulnerability to childhood adversity among long allele carriers was found on adulthood social integration, but here both males and females were influenced. LIMITATION: Data were self-reported and childhood adversity data were retrospective. CONCLUSIONS: Early-life stress influenced the relationship between AVPR1A genetic variants and social interaction. For social attachment, AVPR1A was of importance in males only. The findings add to previous reports on higher acute vulnerability to stress in persons with long AVPR1A RS3 alleles and increased AVP levels.

The impact of emotional intelligence on work engagement of registered nurses: the mediating role of organisational justice.

AIMS AND OBJECTIVES: To explore the impact of emotional intelligence and organisational justice on work engagement in Chinese nurses and to examine the mediating role of organisational justice to provide implications for promoting clinical nurses' work engagement. BACKGROUND: The importance of work engagement on nurses' well-being and quality of care has been well documented. Work engagement is significantly predicted by job resources. However, little research has concentrated simultaneously on the influence of both personal and organisational resources on nurses' work engagement. DESIGN: A descriptive, cross-sectional design was employed. METHODS: A total of 511 nurses from four public hospitals were enrolled by multistage sampling. Data collection was undertaken using the Wong and Law Emotional Intelligence Scale, the Organizational Justice questionnaire and the Utrecht Work Engagement Scale-9. We analysed the data using structural equation modelling. RESULTS: Emotional intelligence and organisational justice were significant predictors and they accounted for 44% of the variance in nurses' work engagement. Bootstrap estimation confirmed an indirect effect of emotional intelligence on work engagement via organisational justice. CONCLUSIONS: Emotional intelligence and organisational justice positively predict work engagement and organisational justice partially mediates the relationship between emotional intelligence and work engagement. RELEVANCE TO CLINICAL PRACTICE: Our study supports the idea that enhancing organisational justice can increase the impact of emotional intelligence. Managers should take into account the importance of emotional intelligence and perceptions of organisational justice in human resources management and apply targeted interventions to foster work engagement.

Promoter polymorphism in the serotonin transporter (5-HTT) gene is significantly associated with leukocyte telomere length in Han Chinese.

The serotonin transporter gene (5-HTT)-linked polymorphic region (5-HTTLPR) plays an important role in modulating mood and behavior by regulating 5-HTT expression and thereby controlling the concentration of serotonin (5-HT) in brain synapses: The homozygous shorter allele (S/S) in 5-HTTLPR results in lower 5-HTT expression coupled with stronger psycho-pathological reactions to stressful experiences compared to the homozygous long (L/L) and heterozygous (S/L) alleles. Psychological insults and mood disorders have been shown to cause accelerated telomere shortening, a marker of biological aging, however, it is currently unclear whether the allelic variants of 5-HTTLPR affect telomere length (TL) in the healthy population without mood disorders. In the present study, we determined the relationship between TL and the 5-HTTLPR variants in healthy Han Chinese. The 5-HTTLPR genotyping and leukocyte TL analysis of 280 young female Han Chinese freshmen showed a significantly shorter TL in 149 of them carrying the 5-HTTLPR S/S version compared to those (131) with the L/S or L/S plus L/L genotypes (mean ± SD, 0.533±0.241 for S/S vs 0.607±0.312 for L/S, P  =  0.034; or vs 0.604±0.313 for L/S plus L/L, P  =  0.038). Similar results were achieved in the other cohort including 220 adult healthy individuals of different age, gender and profession (0.691±0.168 for S/S vs 0.729±0.211 for L/S, P  =  0.046, or vs 0.725±0.213 for L/S plus L/L, P  =  0.039). Taken together, shorter leukocyte TL is significantly associated with the 5-HTTLPR S/S allelic variant, which may be implicated in psychological stress-related health problems.

The Edinburgh Feeding Evaluation in Dementia scale (EdFED): cross-cultural validation of the simplified Chinese version in mainland China.

AIMS AND OBJECTIVES: To translate the Edinburgh Feeding Evaluation in Dementia scale (EdFED) into simplified Chinese and to comprehensively evaluate its reliability and validity. BACKGROUND: The EdFED, the only validated instrument at present for assessing feeding difficulty in older people with dementia, is available in the original English and traditional Chinese versions, but not available in simplified Chinese. The traditional Chinese version may not be applicable in Mainland China because of linguistic and cultural differences. DESIGN: Survey. METHODS: The scale was translated into simplified Chinese by the cross-culture translation method, and 102 participants with dementia were assessed. Data were collected by comprehensive methods and analysed by correlation, Mokken scaling and exploratory factor analysis. RESULTS: Reliability and validity were demonstrated for the scale, and a strong and reliable Mokken scale was formed by six items. A three-factor structure was illustrated by exploratory factor analysis, and construct validity was further demonstrated by good convergent and discriminant validity. CONCLUSIONS: The simplified Chinese version shows good reliability and validity and can be applicable to measure feeding difficulty in people with dementia in Mainland China and other Chinese cultural groups. More work is required on Mokken scaling, and a confirmatory factor analysis is needed to confirm the three-factor structure. RELEVANCE TO CLINICAL PRACTICE: The validation of Ch-EdFED has provided a validated instrument for measuring feeding difficulty in people with dementia in Chinese culture; thus, early recognition of feeding difficulty in older people with dementia can be achieved and proper interventions could be designed. Moreover, with the availability of the three different validated versions of the EdFED, research into cross-cultural comparisons could be conducted.

Acetylpuerarin increases cell viability and reduces apoptosis in rat hippocampal neurons following oxygen­glucose deprivation/reperfusion.

The effects of acetylpuerarin treatment following oxygen-glucose deprivation/reperfusion (OGD/R) were examined in rat hippocampal neurons in vitro and compared with the effects of acetylpuerarin in normoxic cells to confirm acetylpuerarin's potential neuroprotective effects, including apoptosis inhibition. Wistar rat embryo hippocampal cells (day 18, E18) cultured for 8 days were subjected to 3 h OGD treatment, followed by reperfusion for 12, 24 or 36 h. For each time interval, a group of cells was left untreated (OGD/R-only groups) and treated with 0.1, 0.4 and 1.6 µM acetylpuerarin (OGD/R+acetylpuerarin). Neuron viability, apoptosis and caspase-8 and -3 activities were assessed by the reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), 4',6-diamidino-2-phenylindole (DAPI) and terminal deoxynucleotidyl-transferase-mediated dUTP nick end labeling (TUNEL) and spectrophotometric assays, respectively. Fas-ligand (Fas-L), Fas-associated death domain (FADD) and tumor necrosis factor-α (TNF-α) were determined by western blot analysis. Compared with control cells, OCD/R+acetylpuerarin cells treated with 0.1, 0.4 and 1.6 µM doses showed a concentration-dependent increase in hippocampal cell survival and viability by 69.93 ± 2.28%, 81.49 ± 2.13% and 85.28 ± 2.38% at 12 h, 68.59 ± 3.02%, 77.85 ± 2.84% and 85.64 ± 4.39% at 24 h and 69.70 ± 1.70%, 77.21 ± 3.21% and 83.90 ± 2.12% at 36 h (P<0.05). Furthermore, OCD/R+acetylpuerarin cells exhibited a dose-dependent decrease in caspase-8 and -3 activation, TUNEL and DAPI-positive neurons and Fas-L, FADD and TNF-α expression. In conclusion, acetylpuerarin protects against OGD/R-induced neuronal apoptosis predominantly in the first 24 h following ischemia, which may be useful in mediating neuronal apoptosis in ischemic stroke patients.

The comparison of dementia patient's quality of life and influencing factors in two cities.

AIMS AND OBJECTIVES: To determine the current status of dementia patient's quality of life and compare influencing factors in China and Japan to inform nursing care and potentially improve the patient's quality of life. BACKGROUND: The prevalence of dementia is increasing related to lack of a cure, thus prompting some researchers and clinicians to focus on patient's quality of life. DESIGN: A cross-sectional study. METHODS: A convenience sample of 200 mild-to-moderate dementia patients was obtained in Jinan city and 205 ones in Wakayama city. Then, we measured patient's quality of life and analysed the relation between general demographic information, cognitive function, activities of living, behavioural and psychological symptoms, and the patient's quality of life. RESULTS: The total score of Dementia Quality of Life in Jinan city was 89·82 ± 15·11; multiple linear regression showed that the influencing factors of quality of life were marital, economics, characteristics, activities of living, hypertension and irritability. And the total score in Wakayama city was 118·30 ± 14·56; the influencing factors were education, body mass index, activities of living and depression. CONCLUSIONS: The total score of Dementia Quality of Life in Jinan city was significantly lower than Wakayama city. The same influencing factor between these two cities was activities of living. RELEVANCE TO CLINICAL PRACTICE: Nurses could implement interventions to focus on many of the patient's influencing factors, so that to improve their mental and physical health, which may slow the disease process and further improve the patient's quality of life. In addition, Chinese government could learn some experience from Japanese government, such as perfect the system of nursing insurance for elderly and introduce professional geriatric nursing talents to provide better service for the elderly.

Telomere dysfunction induced by chemotherapeutic agents and radiation in normal human cells.

The number of long-term survivors of patients with various malignancies (>5 years) is increasing mainly owing to advances in cancer therapeutics, but long-term side effects of the cancer treatment in this population have emerged as an important health and socio-economical issue. Telomeres and telomerase are known to be essential for regulation of cellular life-span and maintenance of genomic stability, and earlier studies have demonstrated that cancer patients who receive chemotherapy have shorter telomeres in their blood cells, indicating accelerated telomere erosion and a potential contribution of telomere loss to late side-effects. Little is currently known about the effect of chemotherapeutic agents and radiation on telomere dynamics including potential effects on telomere length, structure, function, telomerase activity, and telomere shelterin proteins in normal human cells. In the present study, we had addressed this issue experimentally. The treatment of normal human T lymphocytes and fibroblasts with chemotherapeutic agents doxorubicin (DOX) or etoposide (VP16) led to significant shortening of telomeres, down-regulation of telomerase activity, and diminished expression of telomerase reverse transcriptase (hTERT) and the telomere binding proteins TPP1 and POT1. More importantly, telomere dysfunction was observed in cells treated with DOX or VP16. Furthermore, all the above alterations were similarly found in the cells receiving γ-irradiation. Taken together, both chemotherapy and radiotherapy significantly impair telomere maintenance and function in normal human cells. Conceivably telomere dysfunction causes shortened life-span and genomic instability of normal human cells, and thereby contributes to tissue/organ damage and secondary malignancies in long-term survivors of cancer.

Activation of telomerase by seminal plasma in malignant and normal cervical epithelial cells.

Seminal fluids are involved in the development of cervical cancer but the underlying mechanism is unclear. Because cellular transformation requires telomerase activation by expression of the telomerase reverse transcriptase (hTERT) gene, we examined the role of seminal fluids in telomerase activation. Significantly elevated hTERT mRNA and telomerase activity were observed in cervical cell lines (HeLa, SiHa and Caski) treated with seminal plasma. Normal cervical epithelial cells expressed minimal levels of hTERT mRNA and telomerase activity, and seminal plasma substantially enhanced both expression and activity. The hTERT promoter activity was similarly increased in seminal plasma-treated HeLa cells and this effect was closely correlated with increased Sp1 expression and binding to the hTERT promoter. Cyclooxygenase-2 (COX-2) was simultaneously increased in HeLa cells exposed to seminal plasma, and blockade of COX-2 induction abolished seminal plasma stimulation of the hTERT promoter activity, hTERT expression and telomerase activity. Prostaglandin E2 (PGE2) mimics the effect of seminal plasma, stimulating Sp1 expression, enhancing Sp1 occupancy on the hTERT promoter and promoter activity. Moreover, tumour growth was robustly enhanced when HeLa cells together with seminal plasma were injected into nude-mice. Taken together, seminal plasma stimulates COX-2-PGE2-Sp1-dependent hTERT transcription, which provides insights into the putative mechanism underlying telomerase activation in cervical epithelial and cancer cells.

Premature senescence of T cells in long-term survivors of renal transplantation.

Prevention of graft rejection in renal transplant recipients depends on chronic treatment with immunosuppressive agents. However, impaired immune functions and immunosurveillance may cause infection, cancer and many other problems, which subsequently compromise quality of life and survival of patients. In the present study, we assessed potential premature immune-senescence in long-term survivors of kidney transplant patients receiving immunosuppressive agents. Peripheral blood lymphocytes derived from patients had significantly shorter telomeres than those from age- and sex-matched healthy individuals. Consistent with this, lower expression of telomerase reverse transcriptase (hTERT) and telomerase activity was observed in patients' lymphocytes. The level of p16(ink4A) expression was elevated in patients' cells. Moreover, the CD8(+)/CD28(-) fraction of late-stage differentiated T cells was significantly increased in the patients. In vitro studies further showed that cyclosporine A, a widely used immunosuppressive drug in transplant patients, attenuated induction of hTERT and telomerase activation in T cells treated with the mitogenic agent concanavalin A. Taken together, immunosuppressant-mediated premature senescence of T lymphocytes occurs in renal transplant recipients.