Milk-derived bioactive peptides protect against oxidative stress in a Caco-2 cell model.

Milk and milk-derived products are a relevant source of bioactive peptides, which are also potential components of functional foods. Bioactive peptides exert multiple actions including an antioxidant role. In the present paper, four synthetic peptides (NPYVPR, AVPYPQR, KVLPVPEK, and ARHPHPHLSFM), corresponding to milk-derived peptides were studied. Although with different features, as revealed by RP-HPLC chromatography and MS analysis, the obtained peptides were shown to be taken up by Caco-2 cells arranged in an epithelial monolayer formation. The four peptides were all able to preserve cell viability against induced oxidative stress indicating that they might have a role in the control of oxidative stress. Therefore, an estimation of total thiols and glutathione content was performed after cell treatment with oxidants like hydrogen peroxide (H2O2) or tert-butyl hydroperoxide (TbOOH). The peptides were able to prevent the decrease of both total thiols and glutathione induced by H2O2 or TbOOH, and, in addition, they showed a protective effect on the thiol-related antioxidant enzymes thioredoxin reductase and glutathione reductase. Finally, they caused a decrease of ROS production induced by TbOOH in Caco-2 cells. The reported results highlight the relevant antioxidant role played by bioactive peptides in cells, which adds to other previously known properties.

Knowledge of Emergency Department Triage nurses in management of patients with mental health needs: comparisons with the Triage Model of Lazio (TLM).

OBJECTIVES: To refer the current competences of Triage Nurses (TRNs) assessing the person with metal health problems in Emergency Departments (ED), and the impact of the Triage Lazio Model (TLM) upon it. MATERIALS AND METHODS: An anonymous questionnaire was administered to ED TRNs of the Lazio Region. Standardized Cronbach's alpha was used for reliability estimation. RESULTS: The Cronbach's alpha was 0.4. Two hundred ninety-nine TRNs were interviewed: 66% women, 47% aged 31-40 years, 60% followed TLM. The consideration of the patient as 'one who comes out of the normal', 'a person with altered functions of mind or mental function' and as 'hostile, aggressive and unpredictable' was reported more by females in comparison to the males (OR=1.76; OR=3.50; OR=1.79); TRNs who have not followed the course on TLM had higher probability to consider 'hostile, aggressive and unpredictable' the psychiatric patients (OR=1.87) in comparison with other Triage courses; those who have taken a course on Triage but at least 3 years ago, had a lower probability to consider as 'one who comes out of the normal' (OR=0.55). CONCLUSIONS: having followed the course TLM, having participated in a recent triage course, male gender, and the seniority in this job appear to be contributing factors for a proper management of psychiatric patients. Continuous improvement of specific knowledge and skills for the management of patients with mental health needs are mandatory.

Speaking the truth: an analysis of gender differences in serostatus disclosure practices among HIV-infected patients in St Petersburg, Russia.

The Russian HIV epidemic is primarily fuelled by injection drug use, but heterosexual spread may be playing an increasing role in transmission. Government-funded AIDS clinics provide most HIV treatment in Russia, and represent an important contact point between the medical community and infected population. Little is known about the population actively seeking HIV treatment. To describe demographics, perceived mode of acquisition and serostatus disclosure practices of HIV-infected individuals seeking treatment in St Petersburg, Russia, we conducted a cross-sectional study of 204 HIV-infected patients presenting to the St Petersburg City AIDS Center between May and June 2007. Mean age of respondents was 28 years old, 51% were women and two-thirds (67%) reported a history of injection drug use. Men were more likely to report injection (62% versus 45%) while women were more likely to identify sexual transmission (45% versus 32%) as their perceived infection route. Predictors of serostatus disclosure were female gender, married status and higher education. Women represent half of all patients seeking HIV treatment in St Petersburg, and are more likely than men to have disclosed their HIV-positive serostatus to sexual partners. While this population may not represent the burden of HIV disease in Russia, it is an important target group for secondary prevention.

Hepatitis B in the United States: ongoing missed opportunities for hepatitis B vaccination, evidence from the Behavioral Risk Factor Surveillance Survey, 2007.

PURPOSE: In the USA, the burden of hepatitis B disproportionately affects high-risk adults who alone account for more than 75% of newly reported hepatitis B virus infections each year. Despite the localization of new infections in identifiable high-risk groups, vaccination rates in this subgroup, with the exception of health care workers, remain consistently low. The purpose of this study was to characterize those at risk for hepatitis B transmission and quantify the association between missed opportunities and hepatitis B vaccination. METHODS: Data from the 2007 Behavioral Risk Factor Surveillance Survey (BRFSS) of adults aged 18 years and older who were at high risk for hepatitis B infection (n = 15,432) were analyzed. Multivariate regression analysis was conducted to determine factors independently associated with vaccination. RESULTS: In a nationally representative sample, 51.4% of high-risk adults remained unvaccinated against hepatitis B and more than 50% had a missed opportunity for vaccination. High-risk adults who were vaccinated against pneumonia and influenza had a higher odds ratio of being vaccinated against hepatitis B than those not vaccinated against pneumonia and influenza (OR 2.27 and 1.67, respectively). Also, high-risk adults tested for human immunodeficiency virus (HIV) at a counseling and testing site or a drug treatment facility had a higher OR of being vaccinated than those who had not been tested for HIV (OR 1.78 and 1.73, respectively). The opposite relationship was true among individuals tested for HIV at a correctional facility (OR 0.60). CONCLUSIONS: The findings of this study underscore the inadequacy of vaccination coverage in high-risk adults and highlight advantageous opportunities to bridge gaps in vaccination coverage.

Gynecologic aspects of Crohn's disease.

Because Crohn's disease has a tendency to be transmural and to form fistulas, it may involve contiguous organs. Gynecologic involvement is frequent, diverse and often difficult to diagnose. Inflammation involving adjacent structures has been reported in as many as one third of patients. Enteric fistulas to the vagina, uterus, ovaries, perineum and vulva also have been reported. Diagnosis may not be obvious if pelvic involvement precedes active bowel disease, or if drainage is clear or mucoid. Abscesses, draining sinuses, edema and ulceration of the perineum or vulva are common, and are caused by direct extension from the involved bowel or by granulomas separated from the bowel by normal tissue. Lesions presenting with vulvar hypertrophy, a fluctuant mass or ulceration are easily misdiagnosed. Menstrual abnormalities are reported in more than one half of patients. Pelvic manifestations of Crohn's disease can be psychologically crippling. Patients or physicians may be hesitant to address serious psychosocial morbidity. To optimize management, physicians must be aware of the diverse manifestations, confusing presentations and psychologic morbidity of Crohn's disease.

A backbone-cyclic, receptor 5-selective somatostatin analogue: synthesis, bioactivity, and nuclear magnetic resonance conformational analysis.

Cyclo(PheN2-Tyr-D-Trp-Lys-Val-PheC3)-Thr-NH2 (PTR 3046), a backbone-cyclic somatostatin analogue, was synthesized by solid-phase methodology. The binding characteristics of PTR 3046 to the different somatostatin receptors, expressed in CHO cells, indicate high selectivity to the SSTR5 receptor. PTR 3046 is highly stable against enzymatic degradation as determined in vitro by incubation with rat renal homogenate and human serum. The biological activity of PTR 3046 in vivo was determined in rats. PTR 3046 inhibits bombesin- and caerulein-induced amylase and lipase release from the pancreas without inhibiting growth hormone or glucagon release. The major conformation of PTR 3046 in CD3OH, as determined by NMR, is defined by a type II' beta-turn at D-Trp-Lys and a cis amide bond at Val-PheC3.

Intestinal endometriosis masquerading as common digestive disorders.

Intestinal endometriosis mimics a wide variety of inflammatory, infectious, or neoplastic digestive diseases. To alert clinicians to its diverse manifestations, we describe nine patients who required laparotomy. The underlying diagnosis was elusive initially. In no case were symptoms clearly cyclic or temporally related to phases of the menstrual cycle. Presenting complaints included acute or subacute lower abdominal pain (three patients), hematochezia (two patients), signs or symptoms of small-bowel obstruction (two patients), peritonitis (one patient), and a partially obstructing sigmoid lesion (one patient). The findings of barium enema were nondiagnostic in the five cases in which it was performed. Surgery was needed in each case; indications included inability to exclude carcinoma (two patients), small-bowel obstruction (two patients), diffuse peritonitis (one patient), persistent colonic obstruction (one patient), pericolonic abscess (one patient), and intractable pain (one patient). Intestinal endometriosis has a diverse clinical spectrum, with nonspecific features in many patients. This disease should be considered during the evaluation of unexplained digestive complaints in women of childbearing years.

Progenitor recruitment and in vitro expansion of immunostimulatory dendritic cells from human CD34+ bone marrow cells by c-kit-ligand, GM-CSF, and TNF alpha.

Several cytokines have been identified that support the development of dendritic cells from murine and human precursor populations, most notably GM-CSF, TNF alpha, and IL-4. We have been interested in human bone marrow as a source of defined CD34+ progenitors to generate large numbers of autologous dendritic cells for use as adjuvants in immune based therapy. In serum-replete conditions with c-kit-ligand, GM-CSF, and TNF alpha, dendritic cells constitute approximately 10-15% of the myeloid progeny (equivalent to approximately 1.7 x 10(6) dendritic cells per single ml of starting bone marrow); and they develop together with granulocytic intermediates and monocytes in the same cultures. CD14- dendritic cells share expression of class II MHC and costimulatory ligands with CD14+ monocyte progeny, but only the CD14- HLA-DR+ dendritic cells are highly stimulatory of resting unprimed T cells. We have further identified a novel colony that develops in the presence of GM-CSF and TNF alpha alongside typical CFU-GM, which is comprised of dendritic cells mixed with < or = 15% monocytes (CFU-DC/mono). c-kit-ligand recruits and expands early progenitors responsive to the dendritic cell-differentiating effects of GM-CSF and TNF alpha, effecting a 100- to 1000-fold greater expansion of CFU-DC/mono by 14d and 21d respectively than does the combination of GM-CSF and TNF alpha without c-kit-ligand.(ABSTRACT TRUNCATED AT 250 WORDS)

Massive gastrointestinal bleeding as the initial manifestation of pancreatic carcinoma.

Pancreatic carcinoma is a rare cause of GI bleeding. We have studied eight patients in whom major digestive hemorrhage was the first sign of a subsequently proven pancreatic malignancy. Bleeding was characteristically severe and unremitting, including hematochezia (four), melena (three), and hematemesis (one). In seven cases, direct tumor invasion into a contiguous portion of the GI tract was present. Tumor erosion occurred into the third portion of the duodenum (three) descending (two), stomach (one), and transverse colon (one). In one patient, a metastatic bleeding lesion was present in the sigmoid colon. The four patients who required urgent laparotomy for control of major hemorrhage died during the initial hospitalization. Conventional diagnostic evaluation by endoscopic and roentgenographic techniques was commonly unsuccessful. Our retrospective analysis suggested that a more aggressive approach, including early angiography in unrelenting and undiagnosed bleeding, might have aided diagnosis and averted laparotomy in a population with dismal prospects for a surgical solution. Clinicians should be aware that pancreatic malignancy may present with a varying spectrum of GI bleeding ranging from occult to potentially exsanguinating hematemesis, hematochezia, or melena.