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Adenosine and the regulation of cerebral blood flow.

OBJECTIVES: This review summarizes the 30 year effort of my collaborator and mentor Dr J. W. Phillis to establish the role of adenosine in the regulation of cerebral blood flow. METHODS: While most of the experiments described utilized the rat cerebral cortex as a model, several different and complementary methodologies were employed. Superfusate samples were collected from the cortical surface and analysed for purines using HPLC. Laser-Doppler flowmetry was utilized to measure blood flow in the pial vasculature, while pial diameters were monitored by videomicroscopy. An additional series of experiments looked at coronary blood flow in a Langendorff preparation. RESULTS: Adenosine is released from the cortex in response to decreased nutrient supply (hypoxia/ ischemia) and during conditions that mimic alterations in the extracellular environment associated with increased metabolism. The application of pharmacological agents that alter adenosine metabolism resulted in the appropriate alterations in ECF adenosine levels and also in blood flow. Selective blockade of the adenosine A(2A) receptor reduced the pial vasodilation evoked by hypercapnoea. Results from the isolated rat heart, utilizing similar agents, support a role for adenosine in the regulation of coronary blood flow during respiratory and metabolic acidosis. DISCUSSION: Adenosine is released when there is a mismatch between supply and demand. If the effects of adenosine are blocked with receptor antagonists, the vasodilation is also reduced. However, the effects of adenosine on the hyperemia evoked by hypercapnoea are complicated by the arousal evoked by adenosine receptor antagonists and the effects of upstream regulation.

Adenosine↗

The qualitative experience of Chinese parents with children diagnosed of cancer.

AIM: The present study aimed to describe the coping experiences of Chinese parents with children diagnosed as having cancer during the treatment stage. BACKGROUND: Cancer is the second major cause of death among children in Hong Kong, it claims the lives of 60-70 children per year. Childhood cancer has tremendous impact on the family, especially the parents. It is, therefore, important to understand parents' psychological functioning and coping experience. METHODS: A phenomenological approach was used. Data were collected by qualitative interviews and analysed following Colaizzi's phenomenological methodology. A purposive sample of nine parents whose children were diagnosed of having childhood cancer was recruited from a regional hospital in Hong Kong. RESULTS: Four themes emerged describing parents' coping experiences: shock and denial, establishing the meaning or the situation, confronting the reality and establishing a new perspective. The initial reactions of the parents to the diagnosis were shock, denial and worry. However, they quickly accepted the reality and regarded their child's illness as their 'fate' that they had to accept. They were committed to the care of the sick child and seek informational and emotional support to cope with the situation. All of them were able to identify positive aspects from the illness experience and establish hope for the future. Chinese cultural beliefs might help the parents cope positively and avoid negative emotions. CONCLUSION: This study found some commonalities of coping experience in both Western and Chinese culture. It adds knowledge to the coping experience of Chinese parents at the treatment phase of their children's illness and highlighted the need for emotional and information support for parents. RELEVANCE TO CLINICAL PRACTICE: Education programme and mutual support group would be helpful to parents. Nurses have to learn how different cultural groups and subcultural groups in the society cope to provide competent cultural care.

Adaptation, Psychological↗

The need for accurate nutrition survey methodology: the South Carolina experience.

Assessment of two nutrition-related risk factors, obesity and fat intake, was completed on a representative sample of South Carolina adults. Obesity estimates determined from self-reported heights and weights were less than prevalences determined from direct measurements (white males 21.4% vs. 28.2%; white females 20.8% vs. 24.5%; black males 29.2% vs. 30.1%; black females 43.6% vs. 50.6%; and total 24.9 vs. 29.8%). Nine fat-intake habits were identified from dietary mannerisms involving the consumption of red meat, fat on meat, fried fish/chicken, butter, eggs, whole milk, bacon/sausage, and cheese and the use of solid fats when cooking vegetables. The mean number of the nine habits exhibited was four. The total number of habits did not correlate well with serum cholesterol, as 27% of the individuals with none of the nine fat intake habits had blood cholesterol values greater than 6.2 mmol/L (239 mg/100 mL), while only 17% of the individuals with seven habits had the high level of cholesterol. These nine habits explained less than 10% of the variability of serum cholesterol values.

Black People↗

Prevalence of and factors affecting post-obturation pain in patients undergoing root canal treatment.

AIM: This longitudinal, prospective study (1) investigated the prevalence of post-obturation pain after root canal treatment and (2) evaluated the influence of factors affecting the pain experience. METHODOLOGY: Twenty practitioners, comprising general dental practitioners, MSc graduates and Endodontists, participated in this study. The patient sample (n = 415) was derived from consecutive patients attending the practitioners' surgeries for root canal treatment on a single tooth. Demographic, medical history, preoperative and intra-operative data as well as pain experience on day 1 and day 2 after root canal obturation were recorded. Intensity of pain experienced was recorded on a visual analogue scale (VAS) of 0-5. The data were analysed using logistic regression models. RESULTS: The prevalence of post-obturation pain within 48 h after treatment was 40.2% (n = 167) but less than 12% of patients experienced severe pain (VAS 4 or 5) on either day 1 or day 2. The factors that significantly influenced post-obturation pain experience were: gender (OR = 0.434, P < 0.001), tooth type (OR = 1.733, P = 0.007), size of periapical lesion (OR = 0.493, P = 0.004), history of post-preparation pain (OR = 4.110, P = <0.001) or generalized swelling (OR = 3.435, P = 0.005) and number of treatment visits (OR = 2.604, P < 0.001). CONCLUSIONS: The prevalence of post-obturation pain was high (40.2%). The important prognostic determinants of post-obturation pain were female, molar tooth, size of periapical lesion smaller than 3 mm, history of post-preparation pain or generalized swelling and single-visit treatment.

Adult↗

Prevalence of and factors affecting postpreparation pain in patients undergoing two-visit root canal treatment.

AIM: This longitudinal, prospective study (i) investigated the prevalence of postpreparation pain during root canal treatment and (ii) evaluated the influence of factors affecting the pain experience. METHODOLOGY: Twenty practitioners, comprising general dental practitioners, MSc graduates and endodontists, participated in this study. The patient sample (n=272) was derived from consecutive patients attending the practitioners' surgeries for a two-visit root canal treatment on a single tooth. Demographic, medical history, preoperative and intraoperative data as well as pain experience on days 1 and 2 after root canal preparation were recorded. Intensity of pain experienced was recorded on a visual analogue scale (VAS) of 0-5. The data were analysed using logistic regression models. RESULTS: The prevalence of postpreparation pain within 48 h after treatment was 64.7% (n=176), but less than 10% of patients experienced severe pain (VAS 4 or 5) on either day 1 or day 2. The presence of preoperative pain (OR=2.841, P<0.001), tooth type (OR=2.008, P=0.009), systemic steroid therapy for other medical reasons (OR=0.181, P=0.023) and preoperative swelling (OR=2.433, P=0.040) were the only factors to significantly influence postpreparation pain experience. CONCLUSIONS: The prevalence of postpreparation pain was high, and the important prognostic determinants were presence of preoperative pain, tooth type, systemic steroid therapy and preoperative swelling.

Adult↗

Application of microarray technology in primate behavioral neuroscience research.

Gene expression profiling of brain tissue samples applied to DNA microarrays promises to provide novel insights into the neurobiological bases of primate behavior. The strength of the microarray technology lies in the ability to simultaneously measure the expression levels of all genes in defined brain regions that are known to mediate behavior. The application of microarrays presents, however, various limitations and challenges for primate neuroscience research. Low RNA abundance, modest changes in gene expression, heterogeneous distribution of mRNA among cell subpopulations, and individual differences in behavior all mandate great care in the collection, processing, and analysis of brain tissue. A unique problem for nonhuman primate research is the limited availability of species-specific arrays. Arrays designed for humans are often used, but expression level differences are inevitably confounded by gene sequence differences in all cross-species array applications. Tools to deal with this problem are currently being developed. Here we review these methodological issues, and provide examples from our experiences using human arrays to examine brain tissue samples from squirrel monkeys. Until species-specific microarrays become more widely available, great caution must be taken in the assessment and interpretation of microarray data from nonhuman primates. Nevertheless, the application of human microarrays in nonhuman primate neuroscience research recovers useful information from thousands of genes, and represents an important new strategy for understanding the molecular complexity of behavior and mental health.

Animals↗

Potential contribution of the microbiota-gut-brain axis to doxorubicin-associated cognitive impairment: Mechanisms, evidence, and therapeutic opportunities.

Chemotherapy-induced cognitive impairment (CICI), often termed chemobrain, is a clinically important complication of cancer treatment that can affect memory, attention, executive function, and processing speed during and after therapy. Doxorubicin is of particular mechanistic interest because brain parenchymal exposure is limited, yet preclinical studies consistently identify neuroinflammatory, oxidative, vascular, and synaptic abnormalities after treatment. This critical narrative review evaluates whether intestinal injury and disruption of the microbiota-gut-brain axis may contribute to these central effects. Preclinical evidence indicates that doxorubicin can alter microbial community structure, injure the intestinal barrier, modify SCFA-associated taxa or predicted functions, alter selected metabolite profiles, and promote systemic inflammatory and metabolic signaling. These peripheral changes could interact with brain endothelial cells, glia, mitochondria, hippocampal neurogenesis, and synaptic-plasticity pathways. However, the proposed doxorubicin-gut-brain pathway remains a predominantly preclinical and incompletely tested framework. No longitudinal human study has yet established, within the same patients, the temporal sequence linking doxorubicin exposure, microbiome or metabolome changes, systemic inflammation, and objective cognitive outcomes. Existing animal studies also vary in dose, regimen, tumor context, sampling time, microbiome methodology, and control of behavioral or microbiological confounders, while causal rescue experiments remain limited. Key priorities are therefore longitudinal human cohorts with pretreatment baselines and repeated multi-omics and cognitive assessments; animal studies that test temporal precedence and causal rescue or pathway blockade in the same model; mediation analyses that determine whether microbial or metabolic changes lie between treatment and cognitive dysfunction; and mechanism-informed clinical trials that demonstrate target engagement, cognitive benefit, oncology safety, and preservation of antitumor efficacy. Microbiome-directed interventions are promising but remain investigational for doxorubicin-associated CICI.

blood&#x2013;brain barrier↗

Applicability of a cryogradient technique for the enrichment of PAH from automobile exhausts: demonstration of methodology and evaluation experiments.

A cryogradient system for the enrichment of polycyclic aromatic hydrocarbons from gasoline and diesel powered vehicles is described. The sampling involves particle trapping on a filter followed by gas phase enrichment in three separate condensers. The filter is extracted with dichloromethane (DCM). For the extraction of the condensers three different solvents have been used; cyclohexane, acetone and DCM. The latter has also been used together with three buffers, pH 3, pH 7 and pH 11. Analyses of polynuclear aromatic hydrocarbons were performed by means of glass capillary gas chromatography and mass spectrometry. These analyses of diluted gasoline exhausts show that of the phenanthrene/anthracene, fluoranthene/pyrene and their monoalkylated forms found, between 90 and 30% are present in the gas phase. For diesel emissions, corresponding values are between 50% and 5%, respectively. However, the distribution of PAH between gas phase and particles is dependent on dilution ratio and filter temperatures. The addition of NO2 (approximately 7 ppm) prior to filter sampling involves degradation of cyclopenteno(cd)pyrene (CPedP) and benzo(a)pyrene (BaP) on the particles from diluted gasoline exhausts. This also occurs with BaP on diesel particles sampled under equivalent conditions. Mutagenicity data from these experiments support the theory of formation of direct-acting mutagens, probably due to nitration. Parallel sampling of particles with Teflon-coated and glass fiber filters does not show that components which are reactive to NO2, e.g., CPcdP, are degraded to a lower extent when glass fiber filters are used.

Air Pollutants↗

Paving the way: training the influentials in population education.

A number of countries in Far East Asia are in the process of launching national population education programs. To get them off the ground and to keep them working needs the support of key personnel in the program. This means that basic training in population education should be given to key personnel to enable them to promote and efficiently run the population education programs. The Sub-Regional Group Training Course in Population Education organized by the Mobile Team of the Unesco Regional Office for Education in Asia and Oceania to be held in Bangkok from 18 August to 5 September is a response to this need. Training will be given to key personnel from Afghanistan, India, Nepal, and Pakistan. The specific objectives of the course are to provide the participants with: 1) opportunities for exchanges of information and experience; exposure to and involvement in developing population education curricula, teaching units and sample instructional materials; 2) an understanding of various strategies for curriculum development and methodologies used for designing and implementing programs; and 3) preparation as teams from each Member State able to contribute to the promotion of population education in school and out of school in their countries. The training course has 5 main thrusts, namely: 1) sharing of experiences and clarification of the concepts of population education; 2) development of population education curriculum; 3) development of teaching units; 4) development of sample alternative instructional materials; and 5) field visit to ongoing population education programs in Thailand. The content will cover: 1) the knowledge base which includes concepts, nature, issues and status of population education; demographic concepts, population and development; and 2) strategies and approaches such as those used in curriculum development and teaching units, methods of teaching, and instructional materials development. The training methodologies will include lecture and panel discussions, film shows, and practicum.

Community Health Workers↗

A qualitative inquiry of Taiwanese children's pain experiences.

Little information was found in studying Taiwanese children's pain experiences. Because pain is culturally shaped, health care providers should not assume Taiwanese children's pain to be identical to those of children in the US. Thus, a qualitative descriptive study with semi-structured interview of 90 hospitalized Taiwanese children with acute pain was conducted to understand Taiwanese children's pain experiences. Krippendorff's (1980) content analysis was used to guide the data analysis. Seven themes from the interview data were presented, including definition of pain, quality of pain, previous pain experiences, pain expectation, pain acceptance, causes of pain and meaning of pain. Surprisingly, the results of this study revealed few differences in the experiences and meanings of pain. Most results are consistent with the studies done in the US. Differences are minor, including the interpretation of children's crying and how Taiwanese parents talk with their children about pain, and are probably related to the sample sizes and methodology of the studies. Further research is necessary about the influence of culture upon children's pain experiences.

Acute Disease↗

Overcoming strangeness and communication barriers: a phenomenological study of becoming a foreign nurse.

BACKGROUND: This paper presents a study that explored the lived experience of foreign nurses working at hospitals in Iceland. AIM: The aim was to generate an understanding of this experience both for local and international purposes. METHOD: The methodology that guided the study was the Vancouver school of doing phenomenology. Sampling was purposeful and consisted of 11 registered nurse from seven countries. The data were collected in dialogues; the analyses were thematic. FINDINGS: The findings are presented in five main themes that describe the essence of the experience with the overall theme of 'Growing through experiencing strangeness and communication barriers'. The first theme portrays how the nurses met and tackled the multiple initial challenges. One of the challenges, described in the second theme, was becoming outsiders and needing to be let in. The third theme explores the language barrier the nurses encountered and the fourth theme the different work culture. The fifth then illuminates how the nurses finally overcame these challenges and won through. CONCLUSION: The findings and their international context suggest the importance of language for personal and professional well-being and how language and culture are inseparable entities.

Acculturation↗

Characterisation of the xenobiotic-metabolizing Cytochrome P450 expression pattern in human lung tissue by immunochemical and activity determination.

The lung represents an important target for the toxic effects of chemicals. Many of the chemicals require enzymatic activation to exert their adverse effects, which is mostly catalysed by Cytochrome P450 (CYP) enzymes. Although there is considerable evidence that individual members of the xenobiotic-metabolizing P450 family are expressed in human lung tissue at the mRNA level, there is conflicting evidence concerning the following issues: (I) the qualitative expression pattern of CYP isoenzymes; (II) CYP expression at the protein and/or activity level; and (III) interindividual variability of CYP enzymes in human lung. The latter can be the basis for individual susceptibility towards the adverse effects of lung toxicants. In preparing for studying factors to explain interindividual variability of CYP expression in lung tissue, we investigated the qualitative pulmonary expression pattern of xenobiotic-metabolizing CYP enzymes and elaborated the optimal conditions for quantification at the protein and activity level. By using either individual human lung samples or pooled microsomes from different individuals, immunoreactive bands specific for the following CYP enzymes could be determined by Western blotting: CYP1A1, CYP1A2, CYP2E1 and CYP3A5. Western blotting experiments were also supportive of the presence of CYP2A, CYP2B6, CYP2D6 and CYP3A4 in human lung. By using antibodies specific for CYP2C enzymes and CYP1B1, respectively, immunoreactive bands, which differed slightly in mobility from corresponding standards, were detectable. In addition, we measured methoxy- and ethoxyresorufin dealkylase activities and chlorzoxazone (CLX)-hydroxylase activity in human lung and confirmed the specifities of the latter two activities by inhibition experiments. In summary, we have established methodologies to quantify a panel of CYP enzymes in human lung samples among which there are CYP enzymes whose expression at the protein and activity level has not been evidenced so far.

Blotting, Western↗

Patients' experiences of hip fracture.

BACKGROUND: Hip fracture is a major cause of mortality and morbidity, particularly among older people, but there is little information on how individuals experience this. AIMS: This study was conducted to explore the experiences of individuals who had suffered a hip fracture. The aim was not to produce generalizable findings but, rather, to generate a rich description of the experience of incurring and recovering from a hip fracture, to inform nursing practice. METHOD: Phenomenological methodology was used. A purposeful sample of five older patients was interviewed, following a stay in a community hospital for rehabilitation after surgical repair of a hip fracture. The unstructured interviews were tape-recorded, transcribed verbatim and analysed for significant statements and meanings. FINDINGS: Four major themes emerged: the injury experience, the pain experience, the recovery experience and the disability experience. The injury experience consisted of storytelling, recalling the experience of the injury itself. The pain experience consisted of coping with the pain. The recovery experience involved the operation, beginning the struggle of recovery, and regaining independence. The disability experience consisted of the disability itself, depending on others, and being housebound. CONCLUSIONS: Pain management, meeting psychological and physical needs for nursing care, planning for discharge, and ensuring a reasonable quality of life are areas for nursing care development. Consideration of appropriate settings for rehabilitation is needed and there should be further investigation into improving quality of life after discharge.

Aged↗

Being a parent of the adolescent with complex chronic pain: an interpretative phenomenological analysis.

BACKGROUND: Previous quantitative research has shown that parents of adolescents with chronic pain report elevated levels of emotional distress in addition to limitations in social and family functioning. AIM: This study aimed to further explore this parental impact by employing qualitative methodology to investigate parental experiences of caring for an adolescent with chronic pain. METHODS: A sample of 17 parents/carers of adolescents with chronic pain was selected from two UK tertiary clinic sites. Participants were 11 mothers, five fathers, and one grandmother (primary caregiver). Four focus groups with parents/carers were conducted to discuss the impact of caring for an adolescent with chronic pain on the parent/carer. Transcripts were analysed using interpretative phenomenological analysis (IPA). FINDINGS: Data analysis revealed two superordinate themes that captured the extensive, and largely negative, impact of being a parent of an adolescent with chronic pain. These themes were labelled 'struggle for control and coherence' and 'a very different life'. Both themes represent a fundamental parental struggle to adapt to a life very different than expected, a life fraught with uncertainty, fear, distress and loss. CONCLUSIONS: Parents who are unable to achieve the relief of their adolescent's chronic pain and suffering report significant personal distress that is exemplified by the repetitive search for legitimacy of their child's pain in 'diagnosis'. In the absence of diagnosis parents reported an unwelcome suspension in an unusual pattern of parenting, resembling the infant phase of parenting.

Activities of Daily Living↗

Design and results of the Women's Health Study.

The Women's Health Study was a methodological experiment carried out in Chicago. More than 1,000 women took part; a comparison sample of 100 men was also included. The sample was selected from two sources. Most of the women and all of the men were selected from an area probability sample that had been screened to identify women in the eligible age range; the rest of the women were selected from rosters at cooperating abortion clinics and were known to have had an abortion. Questionnaires based on the one used in the National Survey of Family Growth were administered to the sample; the questionnaire included items on abortion, sexual behavior, and illicit drug use. The experiment examined five variables: whether the questionnaire began with a series of medical questions or with questions on pregnancy; whether the interview was conducted by a nurse or field interviewer; whether the interview was done at the respondent's home or outside the home; whether the interviewer or respondent administered the questions; and whether the data were collected on paper or via computer. Of the five experimental factors, the one with the most consistent effect was the method of administering the questions. Self-administration significantly increased the reported number of sexual partners, sexually transmitted diseases, and the level of condom use compared to administration by an interviewer. Computer assistance occasionally interacted with the site of the interview to effect reporting. The other two experimental variables-the version of the questionnaire and the data collection staff-had few discernible effects. None of the variables affected reported drug use over the lifetime.

Chicago↗

A repeated sampling bone chamber methodology for the evaluation of tissue differentiation and bone adaptation around titanium implants under controlled mechanical conditions.

A repeated sampling bone chamber methodology was developed for the study of the influence of the mechanical environment on skeletal tissue differentiation and bone adaptation around titanium implants. Via perforations, bone grows into the implanted outer bone chamber, containing an inner bone chamber with a central test implant. An actuator--easily mounted on the outer bone chamber--allows a controlled mechanical stimulation of the test implant. After each experiment, the inner bone chamber--with its content--can be harvested and analysed. A new inner bone chamber with a central implant can be inserted consecutively in the outer bone chamber and a new experiment can start. Pilot studies led to a reliable surgical protocol and showed the applicability of the methodology, offering the possibility to study skeletal tissue differentiation and adaptation around implants under well-controlled mechanical conditions, and this protected from external loading. Repeated sampling of the bone chamber allows conducting several experiments within the same animal at the same site, thereby excluding subject- and site-dependent variability and reducing the amount of experimental animals.

Adaptation, Physiological↗

The influence of the site of sampling and assay medium upon the measurement and interpretation of blood lactate responses to exercise.

UNLABELLED: This paper reports the findings of two investigations into methodological problems associated with the interpretation of blood lactate (BLa) in the sports sciences. In Experiment 1, brachial artery (A), antecubital venous (V) and fingertip capillary (C) blood samples were drawn simultaneously from nine subjects (mean age 21.1 +/- 1.3 years) during an incremental treadmill protocol and immediately assayed for BLa concentration. Experiment 2 investigated the extent of lactate concentration differences in whole blood (WB), lysed blood (LB) and plasma (P) measured using a YSI 23 AM analyser. In Experiment 1, a comparison of the mean BLa concentrations obtained from the three sites revealed no significant differences (P greater than 0.05). Correlations between BLa samples from different sites were very high, with r values ranging from 0.858 to 0.983. In Experiment 2, the mean lactate concentrations were: WB, 4.7 +/- 2.7 mM; LB, 5.0 +/- 3.0 mM; P, 7.0 +/- 3.8 mM. Plasma (P) values were significantly higher than WB and LB. Values from all sites were highly correlated with coefficients ranging from 0.963 to 0.987. IN CONCLUSION: (1) Significant arterial and venous BLa concentration differences do not exist during incremental treadmill exercise. (2) As capillary BLa concentrations reflect arterial values, their use in laboratory and field settings is recommended. (3) Lactate concentration differences in whole blood, lysed blood and plasma will influence the assessment of performance at fixed lactate reference values. (4) If the inter-laboratory test procedures are to be standardized and results compared, precise reporting of lactate sampling and assay techniques is critical.

Adult↗

A qualitative study of the experiences during radiotherapy of Swedish patients suffering from lung cancer.

PURPOSE/OBJECTIVES: To describe experiences during radiotherapy of patients suffering from lung cancer. DESIGN: Inductive, qualitative. SETTING: A radiotherapy department in the south of Sweden. SAMPLE: 15 patients with lung cancer undergoing their second week of radiotherapy. METHODOLOGIC APPROACH: Interviews were conducted in a hospital setting, transcribed, and content analyzed. MAIN RESEARCH VARIABLES: Experiences during radiotherapy. FINDINGS: The patients' experiences fall into four categories: fatigue, physical distress, managing disease- and treatment-related issues, and obstacles to managing. Fatigue was a major experience expressed in terms of low energy levels and low fitness, sometimes leading to social isolation. CONCLUSIONS: Nurses need to implement interventions to minimize side effects of radiotherapy and maximize patients' abilities to manage the disease and the treatment. INTERPRETATION: Informing and educating patients about pretreatment and assessing fatigue as well as implementing interventions (e.g., nurse-patient interaction, support, information, encouragement, focus on the patients' own resources) may lead to improved comprehensive care during radiation therapy.

Aged↗