Search

The Chinese diet is low in calcium, including among adolescent girls, with an average intake around 500 mg per day. In this study, we compared the percentage change in bone mineral density and content of the spine and hip region in a 1-year follow-up study between 104 adolescent girls aged 14 to 16 years receiving 375 ml calcium-fortified soymilk supplementation and 95 girls in the control group. The mean percentage changes of bone mineral density/content (BMD/BMC) and standard deviation (SD) at 1 year for the supplementation and control groups were as follows: neck of the femur BMD 2.7+/-2.94%, 1.8+/-3.49% (P = 0.08); trochanter BMD 3.3+/-3.27%, 1.6+/-2.94% (P < or = 0.001); intertrochanter BMD 3.6+/-3.05%, 2.32+/-2.95% (P = 0.002); total hip BMD 3.1+/-2.39%, 2.05+/-2.22% (P = 0.001); total hip BMC 3.8+/-3.05%, 2.6+/-2.96% (P = 0.006). The percent difference between the percentage of bone changes in the supplementation and control groups [100x (soymilk-control)/control] ranged from 45 to 113%. We observed no differences in the spine BMD/C and no differences in changes of height and weight between the soymilk supplementation and control groups, which yielded similar results. Stepwise multivariate regression analysis including height, weight, growth stage, dietary energy, protein, calcium from usual diet and physical activity also showed that supplementation was significantly associated with a percentage increase in BMD/C at the hip. We conclude that 375 ml calcium-fortified soymilk supplementation, or an equivalent of about two glasses, is among the effective strategies for bone acquisition and the optimization of peak bone mass in adolescent girls.

The comet assay is a widely used biomonitoring tool for DNA damage. The most commonly used cells in human studies are lymphocytes. There is an urgent need to find an alternative target human cell that can be collected from normal subjects with minimal invasion. There are some reports of buccal cells, collected easily from the inside of the mouth, being used in studies of DNA damage and repair, and these were of interest. However, our preliminary studies following the published protocol showed that buccal cells sustained massive damage and disintegrated at the high pH [O. Ostling, K.J. Johanson. Microelectrophoretic study of radiation-induced DNA damages in individual mammalian cells. Biochem. Biophys. Res. Commun. 123 (1984) 291-298] used, but that at lower pH were extremely resistant to lysis, an essential step in the comet assay. Therefore, the aims of this study were to develop a protocol than enabled buccal cell lysis and DNA damage testing in the comet assay, and to use the model to evaluate the potential use of the buccal cell model in human biomonitoring and nutritional study. Specifically, we aimed to investigate intra- and inter-individual differences in buccal cell DNA damage (as strand breaks), the effect of in vitro exposure to both a standard oxidant challenge and antioxidant treatment, as well as in situ exposure to an antioxidant-rich beverage and supplementation-related effects using a carotenoid-rich food. Successful lysis was achieved using 0.25% trypsin for 30 min followed by proteinase K (1mg/ml) treatment for 60 min. When this procedure was performed on cells pre-embedded in agarose on a microscope slide, followed by electrophoresis (in 0.01 M NaOH, 1mM EDTA, pH 9.1, 18 min at 12 V), a satisfactory comet image was obtained, though inter-individual variation was quite wide. Pre-lysis exposure of cells to a standard oxidant challenge (induced by H2O2) increased DNA strand breaks in a dose related manner, and incubation of cells in Trolox (a water soluble Vitamin E analogue) conferred significant protection (P<0.05) against subsequent oxidant challenge. Exposure of buccal cell in situ (i.e. in the mouth) to antioxidant-rich green tea led to an acute decrease in basal DNA strand breaks. In a controlled human intervention trial, buccal cells from 14 subjects after 28 days' supplementation with a carotenoid-rich berry (Fructus barbarum L.) showed a small but statistically significant (P<0.05) decrease in DNA strand breaks. These data indicate that this buccal cell comet assay is a feasible and potentially useful alternative tool to the usual lymphocyte model in human biomonitoring and nutritional work.

The prevalence of unrelieved postoperative pain is high and may lead to adverse effects including prolonged hospitalization and delayed recovery. Distraction may be an effective pain-relieving strategy, and can be implemented by several means including affective imaging, games, and possibly music. The aim of this study was to explore the effect of music therapy on postoperative pain. Fifty-seven patients (24 females, 33 males; mean +/- SD age 39.9 +/- 14.35 years [range 15 to 69 years] were matched for age and sex and then nonselectively assigned to either an experimental (n = 27) or a control (n = 30) group. Music was played intermittently to members of the experimental group during the first 24 hour postoperative period. Pain intensity was measured using the Pain Verbal Rating Scales (VRS). Significant decreases in pain intensity over time were found in the experimental group compared to the control group (p < 0.0001). In addition, the experimental group had a lower systolic blood pressure and heart rate, and took fewer oral analgesics for pain. These findings suggest that music therapy is an effective nonpharmacologic approach for postoperative pain management.

For most age-related disorders there is no cure, and treatment is expensive and often ineffective. Thus, disease prevention is an issue of increasing concern and importance. Nurses form the largest professional healthcare group in the world, and the professional code of the modern day nurse advocates health promotion as a primary role. Nurses, by virtue of their close, direct interaction with their community and clients, are in a strong position to disseminate and reinforce the message of health promotion with the aim of achieving functional longevity in our aging population. This requires that nurses themselves increase their awareness, knowledge and understanding of relevant interdisciplinary research findings. In the current review, the influence of diet on the risk of four of the most prevalent age-related diseases (cancer, cardiovascular disease, dementia and diabetes) is presented, and the underlying mechanisms of influence are discussed, with particular focus on antioxidant-rich foods.

Effective pain management requires accurate knowledge, attitudes and assessment skills. To determine the current knowledge level and attitudes of nurses in pain management, 1,604 registered nurses working in three different hospitals in Hong Kong were invited to participate in this study. The sample consisted of 601 registered nurses, 63 nursing officers, and 14 nursing specialists (N = 678). The response rate was 43%. The Nurses' Knowledge and Attitudes Survey Instrument questionnaire developed by McCaffery and Ferrell was translated into Chinese and used with permission. To ensure the contextual relevancy and consistency of the questionnaire, content validity and test-retest reliability tests were performed. The content validity index was 0.87 and the test-retest reliability (Spearman's p coefficient) was 0.812. The percentage of correctly answered questions was 44%. There was statistical significant in educational preparation and clinical experiences with correct scores. The findings of our study support the concern of inadequate knowledge and attitudes in relation to pain management. Further intensive continuing education and staff development is highly indicated for nurses in Hong Kong.

Severe acute respiratory syndrome (SARS) has affected many areas of the world recently and is becoming a global problem. Hong Kong and China have been most severely affected by this new infectious disease. The elderly population is highly vulnerable, and mortality in those older than 65 years is more than 50%. In our study, 27 health care workers and 40 elderly residents in a nursing home were interviewed to investigate their level of knowledge of SARS and its prevention. Most of the elderly residents knew little regarding SARS and prevention strategies, despite access to outside news by TV, radio, and visitors. Also, the worry and fear of an outbreak of SARS among staff working in the nursing home was considered to be high. Tailored education programs to promote awareness and prevention of SARS for the elderly are needed. Also, more in-service training, support, and counseling are strongly indicated for staff to promote disease prevention and improve quality of care.

Analgesic potential of visual stimulation was examined in 33 patients with leg ulcers in a randomized, controlled, crossover clinical trial. Patients were alternating between wearing an eyeglass display with soundless VCD broadcast (V-sessions) and a static blank screen (B-sessions) while receiving superficial debridement and wound dressing for their leg ulcers. A significant reduction in pain scores was found during V-sessions (VAS 67.7 +/- 28.4 vs. 25.6 +/- 29.8 when V-sessions vs. B-sessions, with p < 0.01). Age was positively correlated with the improvement in VAS, whereas gender, residency, and the underlying medical conditions were not correlated with the improvement in pain score. The use of visual stimulation might be beneficial to both genders, in an older age group regardless of the underlying medical conditions. This is the pioneer use of visual stimulation as a non-pharmacological adjuvant to pain relief among a local Chinese population. The study will certainly add knowledge to the existing pain relief methods.

For many hospital patients, the experience brings pain and anxiety. Unfamiliar surroundings, various diagnostic and therapeutic procedures, and the sight and sounds of medical procedures exacerbate pain and anxiety. To block off the anxiety-inducing sights and sounds of hospital surroundings and create a pleasing environment, the therapeutic potential of visual stimulation as a nursing intervention was investigated. In a randomized, controlled, cross-over study, pain was produced by a modified tourniquet technique in 46 healthy volunteers. Subjects were randomly allocated to two groups (Group V and Group B) with subsequent cross-over. Those in Group V watched a soundless video display of natural scenery during tourniquet inflation, whereas in Group B subjects watched a static blank screen. Pain threshold was defined as the time when subjects reported the first detectable pain, whereas pain tolerance was the time the pain was reported to be intolerable and deflation of the tourniquet was requested. With the use of visual stimuli, there was a significant increase in pain threshold (P < 0.05) and pain tolerance (P < 0.01). Gender and the sequence of visual stimuli did not have any significant effect on pain threshold and pain tolerance. Further studies specifically addressing level of anxiety and physiological data correlated with pain scores and visual stimuli are needed. The findings have implications for nurses and other healthcare professionals to use various visual stimuli as positive adjuncts to other methods of pain relief and for different pain conditions in clinical areas.

Hospitalization involves anxiety and pain for many people. Unfamiliar hospital settings, various diagnostic and therapeutic procedures, and the sight and sounds of medical procedures exacerbate pain and anxiety. By blocking off the anxiety-inducing sights and sounds of the hospital surroundings and creating a pleasant environment, an eyeglass display might be able to change the sensation and perception of pain. In this randomized, controlled, crossover study, 72 healthy university student volunteers were asked to wear a light-weight eyeglass that projected a feeling of watching a 52-inch television screen at 6 1/2 feet in distance while pain was produced by a modified tourniquet technique. Subjects were randomly assigned to participate in a V-session or B-session first, with subsequent cross-over. In a V-session, subjects were instructed to wear the eyeglass and watch the soundless display of natural scenery during the inflation. In a B-session, the eyeglass that subjects wore would project a static blank screen. During V-sessions, there was a significant increase in pain threshold (p < 0.001) and pain tolerance (p < 0.001). The degree of immersion was positively correlated with improvement in pain threshold, whereas the anxiety level was negatively correlated with improvement in pain threshold. These findings have implications for using visual stimulation as a positive adjunct to other methods of pain relief and for different pain conditions. This study was considered to be the pioneer use of visual stimulation in the local Chinese community as an adjunct to pain relief.

We have been examining the potential value of visual stimulation via the eyeglass displays in changing the perception of pain. In this randomized, controlled, cross-over study, 72 healthy university student volunteers were asked to wear a light-weighted eyeglass projecting a feeling of watching a fifty-two-inch television screen in a close distance while pain was produced by a modified tourniquet technique. There is a significant increase of pain threshold and pain tolerance with the effect of visual stimulation. These findings having implications of using visual stimulation as positive adjunct to other methods of pain relief and to different pain conditions in clinical areas.

After birth, the full-term ductus arteriosus actively constricts and undergoes extensive histologic changes that prevent subsequent reopening. These changes are thought to occur only if a region of intense hypoxia develops within the ductus wall after the initial active constriction. In preterm infants, indomethacin-induced constriction of the ductus is often transient and is followed by reopening. Prostaglandins and nitric oxide both play a role in inhibiting ductus closure in vitro. We hypothesized that combined inhibition of both prostaglandin and nitric oxide production (with indomethacin and N-nitro-L-arginine (L-NA), respectively) may be required to produce the degree of functional closure that is needed to cause intense hypoxia. We used preterm (0.67 gestation) newborn baboons that were mechanically ventilated for 6 d: 6 received indomethacin alone, 7 received indomethacin plus L-NA, and 16 received no treatment (control). Just before necropsy, only 25% of control ductus and 33% of indomethacin-treated ductus were closed on Doppler examination; in contrast, 100% of the indomethacin-plus-L-NA-treated ductus were closed. Control and indomethacin-treated baboons developed negligible-to-mild ductus hypoxia (EF5 technique). Similarly, there was minimal evidence of ductus remodeling. In contrast, indomethacin-plus-L-NA-treated baboons developed intense hypoxia in regions where the ductus was most constricted. The hypoxic muscle strongly expressed vascular endothelial growth factor, and proliferating luminal endothelial cells filled and occluded the lumen. In addition, cells in the most hypoxic regions were undergoing DNA fragmentation. In conclusion, preterm newborns are capable of remodeling their ductus, just like the full-term newborn, if they can reduce their luminal blood flow to a point that produces intense ductus wall hypoxia. Combined prostaglandin and nitric oxide inhibition may be necessary to produce permanent closure of the ductus and prevent reopening in preterm infants.

Nonselective cyclooxygenase (COX) inhibitors are potent tocolytic agents; however, they also have adverse fetal effects such as constriction of the fetal ductus arteriosus. Recently, selective COX-2 inhibitors have been used in the management of preterm labor in the hope of avoiding fetal complications. However, both COX-1 and -2 are expressed by cells of the ductus arteriosus. We used fetal lambs (0.88 gestation) to assess the ability of selective COX-2 inhibitors celecoxib and NS398 to affect the ductus arteriosus. Both selective COX-2 inhibitors decreased PGE(2) and 6ketoPGF(1alpha) production in vitro; both inhibitors constricted the isolated ductus in vitro. The nonselective COX-1/COX-2 inhibitor indomethacin produced a further reduction in PG release and an additional increase in ductus tension in vitro. We used a prodrug of celecoxib to achieve 1.4 +/- 0.6 microg/ml, mean +/- standard deviation, of the active drug in vivo. This concentration of celecoxib produced both an increase in pressure gradient and resistance across the ductus; celecoxib also decreased fetal plasma concentrations of PGE(2) and 6ketoPGF(1alpha). Indomethacin (0.7 +/- 0.2 microg/ml) produced a significantly greater fall in ductus blood flow than celecoxib and tended to have a greater effect on ductus resistence in vivo. We conclude that caution should be used when recommending COX-2 inhibitors for use in pregnant women, because COX-2 appears to play a significant role in maintaining patency of the fetal ductus arteriosus.

Twelve healthy volunteers were given ibuprofen racemate in two different dosage forms, a suspension and a tablet. The plasma concentration-time profiles of S- and R-ibuprofen were determined and the R-ibuprofen inversion clearance was calculated. Although the area under the curve was almost the same in both the suspension and tablet studies, the inversion clearance was larger in the suspension study than in the tablet study (1.18+/-0.65 and 0.72+/-0.63 l/h, shown as the mean+/-S.D.). The Michaelis-Menten parameters for this inversion process were then determined in vitro with human liver microsomes (1.3+/-0.2 mM for Km and 3.1+/-0.3 nmol/min/mg protein for Vmax, shown as the mean+/-S.D.). These parameters indicated that the stereoisomeric inversion of R-ibuprofen in the liver was not likely to be saturated at the plasma concentrations measured in the volunteer study. The profile of the plasma concentration ratio between S-ibuprofen and R-ibuprofen revealed a difference in the early phase of these two studies. Therefore the inversion difference between those two studies probably resulted from the difference in the absorption phase of each dosage form. Our study demonstrated that R-ibuprofen inversion could be affected by alteration of dosage form.

A sensitive HPLC assay utilising a simple fluorescence pre-column labelling technique was developed for plasma level monitoring of different types of mono- and dicarboxylic acids. Carboxylic acids form mixed anhydrides with ethyl chloroformate in the presence of triethylamine; the mixed anhydrides further react with L-leucine-4-methyl-7-coumarinylamide, forming highly fluorescent and stable amides. Drugs with no chromophore (azelaic acid, and its longer carbon chain analogues) or week UV absorption (artelinic acid, enalaprilat) were used as model compounds. The plasma samples were extracted using ion exchange solid phase cartridges. The separation was performed on an Axxiom C18 (5 microns, 4.6 x 250 mm) column. The detector wavelengths were set at 330 nm for excitation and 390 nm for emission.