Salivary function in patients with reflux esophagitis: effect of cisapride

Saliva plays an important role in esophageal acid clearance. Reduction in salivary function has been considered in the pathogenesis of reflux esophagitis. Cisapride, a prokinetic agent, has been reported effective for treating mild-to-moderate grade gastroesophageal reflux disease. Some studies have shown that cisapride increases saliva volume and acid-buffering capacity. The aim of this study was to evaluate the effect of cisapride on salivary gland function by means of dynamic salivary scintigraphy. METHODS: Fifty-five patients with endoscopic reflux esophagitis (Savary-Miller Grades I-II) were enrolled in this study. In Group 1 (n = 29), patients were evaluated during the fasting state, both before and after cisapride treatment (5 mg, 3 times/day, before meals, for 2 wk). In Group 2 (n = 26), patients were evaluated during the postprandial state, both before and after cisapride treatment. Uptake ratio (UR) and excretion ratio (ER) of the salivary gland in each group were compared using the paired Student's t-test. RESULTS: In Group 1, no significant differences were found in UR or ER after cisapride treatment. However, in Group 2, ER increased significantly after treatment (p < 0.01), but UR did not show any significant change. CONCLUSION: Cisapride can increase the secretion function of salivary glands during the postprandial phase but not the fasting phase.     

Bifurcated endovascular grafting for abdominal aortic aneurysm

Tottering mice inherit a recessive mutation of the calcium channel alpha1A subunit that causes ataxia, polyspike discharges, and intermittent dystonic episodes. The calcium channel alpha1A subunit gene encodes the pore-forming protein of P/Q-type voltage-dependent calcium channels and is predominantly expressed in cerebellar granule and Purkinje neurons with moderate expression in hippocampus and inferior colliculus. Because calcium misregulation likely underlies the tottering mouse phenotype, calcium channel blockers were tested for their ability to block the motor episodes. Pharmacologic agents that specifically block L-type voltage-dependent calcium channels, but not P/Q-type calcium channels, prevented the inducible dystonia of tottering mutant mice. Specifically, the dihydropyridines nimodipine, nifedipine, and nitrendipine, the benzothiazepine diltiazem, and the phenylalkylamine verapamil all prevented restraint-induced tottering mouse motor episodes. Conversely, the L-type calcium channel agonist Bay K8644 induced stereotypic tottering mouse dystonic at concentrations significantly below those required to induce seizures in control mice. In situ hybridization demonstrated that L-type calcium channel alpha1C subunit mRNA expression was up-regulated in the Purkinje cells of tottering mice. Radioligand binding with [3H]nitrendipine also revealed a significant increase in the density of L-type calcium channels in tottering mouse cerebellum. These data suggest that although a P/Q-type calcium channel mutation is the primary defect in tottering mice, L-type calcium channels may contribute to the generation of the intermittent dystonia observed in these mice. The susceptibility of L-type calcium channels to voltage-dependent facilitation may promote this abnormal motor phenotype.     

Use of stomatal conductance and pre-dawn water potential to classify terroir for the grape variety Kékfrankos

Background and Aims: A 3‐year study was carried out in order to evaluate the ecophysiology, yield and quality characteristics of Vitis vinifera L. cv. Kékfrankos (syn. Limberger) at Eger‐Nagyeged hill (steep slope) and at Eger‐K?lyuktet? (flat) vineyard sites located in the Eger wine region, Hungary. The aim of this paper was to analyse the effect of ‘vintage’ and ‘terroir’ on the seasonal changes of Kékfrankos ecophysiology and its possible relationship with yield and wine composition. Methods and Results: Grapevine physiological responses (midday‐ and pre‐dawn water potential, pressure–volume analysis and gas‐exchange), growing stages, yield and wine composition of each vineyard were studied. Lower grapevine water supply was detected at Eger‐Nagyeged hill in each season due to its steep slope and soil characteristics. Pressure‐volume curves indicated that there was no osmotic adjustment in the leaves of this variety. Higher osmotic concentration was measured at turgor loss and full turgor in the leaves of the unstressed vineyard (Eger‐K?lyuktet?) presumably due to higher photosynthetic activity. Differences in soil water content of the vineyards resulted in a slightly altered cell wall elasticity. Stomatal conductance, transpiration rate and photosynthetic production per unit leaf area were affected by water availability. Lower yield in Eger‐Nagyeged hill was partly associated with decreased photosynthetic production of the canopy. Improved wine quality of Eger‐Nagyeged hill was due to moderate water stress which induced higher concentration of anthocyanins and phenolics in the berries. The duration of the phenological stages was dependent on vintage temperature characteristics rather than on vineyard site. Conclusion: There was a close relationship between environmental conditions, Kékfrankos gas‐exchange, water relations, yield and wine composition. Water deficit plays an important role in creating a terroir effect, resulting in decreased yield, better sun exposure of leaves and clusters and thus higher concentration of phenolics and anthocyanins. Although quality is mainly influenced by vintage differences, vineyard characteristics are able to buffer unfavourable vintage effects even within a small wine region. Significance of the Study: Stomatal conductance, pre‐dawn water potential and climatic data may be reliable parameters for terroir classification, although variety–terroir interactions must always be considered.     

Distribution of 127 edible plant species for antioxidant activities by two assays

Epidemiological studies have demonstrated the protective effects of fruit and vegetable consumption on human health. A total of 150 edible plants representing 127 species were evaluated for Trolox equivalent antioxidant capacity (TEAC) and superoxide scavenging (SOS) activity. Distributions of vegetables for TEAC and SOS were not continuous but highly skewed. TEAC values on a dry weight basis ranged from 0 to 2105 µmol TE g⁻¹ and SOS values ranged from 0 to 6206 µmol ascorbate equivalent (AE) g⁻¹. The majority of vegetables clustered within 200 µmol TE g⁻¹ and 400 µmol AE g⁻¹. Vegetable species were grouped into six classes after natural logarithm transformation of TEAC and SOS values. Most highly consumed vegetables fell in the very low to medium classes. Species in the very high class for both TEAC and SOS included leaves of Cedrela sinensis (Chinese cedar), Oroxylum indicum (Damocles tree), Cassia siamea (cassod tree) and Cassia tora (sickle senna). Edible plants high in antioxidant activity (AOA) were mostly perennial and underutilised crops, while commonly consumed vegetables were generally low in AOA. There is great potential to increase dietary antioxidants and improve human health through consumption of diverse vegetable species, especially those high in AOA. Copyright © 2006 Society of Chemical Industry     

Red cell folate in elderly patients with myelodysplastic syndrome

Diabetes mellitus is a lifelong condition which requires acceptance, understanding and some degree of lifestyle discipline in order to maintain glycaemic equilibrium. The situation is complicated by the fact that poor glycaemic control is not necessarily symptomatic. Routines recommended by health professionals may not always be acceptable to the recipients or may be difficult to translate into the individual's framework of daily living. Dramatic emergencies may arise from a complex interrelated multiplicity of actions or omissions, or for reasons outside the control of the patient. Most emergencies are technically preventable. An attempt should be made by Accident and Emergency (A & E) staff to determine the cause. Referral to the diabetes specialist team is usually indicated.     

Improving functional outcomes in older patients: lessons from an acute care for elders unit

BACKGROUND: Hospitalization often marks the beginning, and may be partially responsible for, a downward trajectory characterized by declining function, worsening quality of life, placement in a long term care facility, and death. At the University Hospitals of Cleveland, an Acute Care for Elders (ACE) unit that reengineered the process of caring for older patients (> or = 70 years of age) to improve functional outcomes was established in September 1990. DESCRIPTION OF INTERVENTION: The general principles of ACE included an approach to care guided by the biopsychosocial model and recognition of the importance of fitting the hospital environment to the patient's needs. The design of the intervention was consistent with principles of comprehensive geriatric assessment and continuous quality improvement. Care, which focused on maintaining function, was directed by an interdisciplinary team that considered the patient's needs both at home and in the hospital. The major components of the ACE Unit intervention included patient-centered nursing care (daily assessment of functional needs by nursing, nursing-based protocols to improve outcomes, daily rounds by a multidisciplinary team), a prepared environment, planning for discharge, and medical care review. RESULTS: In a randomized trial comparing ACE with usual care, patients receiving ACE had improved functional outcomes at discharge. The costs to the hospital for ACE unit care were less than for usual care. The functional status of ACE and usual care patients was similar 90 days after discharge. FUTURE DIRECTIONS: The ACE unit intervention is being expanded to preserve the improvements observed during the hospitalization in the outpatient setting. In addition, needs other than function which are critical to patients' long-term quality of life are being considered.     

Dopaminergic modulation of early signs of excitotoxicity in visualized rat neostriatal neurons

Cell swelling induced by activation of excitatory amino acid receptors is presumably the first step in a toxic cascade that may ultimately lead to cell death. Previously we showed that bath application of N-methyl-D-aspartate (NMDA) or kainate (KA) produces swelling of neostriatal cells. The present experiments examined modulation of NMDA and KA-induced cell swelling by dopamine (DA) and its receptor agonists. Nomarski optics and infra-red videomicroscopy were utilized to visualize neostriatal medium-sized neurons in thick slices from rat pups (12-18 postnatal days). Increase in somatic cross-sectional area served as the indicator of swelling induced by bath application of glutamate receptor agonists. NMDA induced cell swelling in a dose-dependent manner. Activation of DA receptors in the absence of NMDA did not produce swelling. DA and the D1 receptor agonist SKF 38393, increased the magnitude of swelling produced by NMDA. This effect was reduced in the presence of the D1 receptor antagonist, SCH 23390. In contrast, activation of D2 receptors by quinpirole decreased the magnitude of NMDA-induced cell swelling. DA slightly attenuated cell swelling induced by activation of KA receptors. Quinpirole produced a significant concentration-dependent reduction in KA-induced swelling while SKF38393 increased KA-induced swelling, but only at a low concentration of KA. Together, these results provide additional support for the hypothesis that the direction of DA modulation depends on the glutamate receptor subtype, as well as the DA receptor subtype activated. One possible consequence of these observations is that endogenous DA may be an important contributing factor in the mechanisms of cell death in Huntington's disease.     

A nonparametric bootstrap method for testing close linkage vs. pleiotropy of coincident quantitative trait loci

A novel method using the nonparametric bootstrap is proposed for testing whether a quantitative trait locus (QTL) at one chromosomal position could explain effects on two separate traits. If the single-QTL hypothesis is accepted, pleiotropy could explain the effect on two traits. If it is rejected, then the effects on two traits are due to linked QTLs. The method can be used in conjunction with several QTL mapping methods as long as they provide a straightforward estimate of the number of QTLs detectable from the data set. A selection step was introduced in the bootstrap procedure to reduce the conservativeness of the test of close linkage vs. pleiotropy, so that the erroneous rejection of the null hypothesis of pleiotropy only happens at a frequency equal to the nominal type I error risk specified by the user. The approach was assessed using computer simulations and proved to be relatively unbiased and robust over the range of genetic situations tested. An example of its application on a real data set from a saline stress experiment performed on a recombinant population of wheat (Triticum aestivum L. ) doubled haploid lines is also provided.     

Medical education change: a detailed study of six medical schools

This article reports a comparative case study of six selected USA medical schools, undertaken to identify factors that facilitate or obstruct innovation in medical education. The findings suggest that the culture of each medical school results from a combination of intra-institutional and external factors. Together these forces influence substantially the fate of educational innovations. The institutional culture influences critical elements such as educational philosophy, leadership and resources provided in support of innovation. Equally important, the culture shapes the level and type of change a school considers and implements. The findings also suggest that the availability of resources and the creative impetus present in schools giving priority to research can benefit the educational goals and facilitate educational change.