Predisposing, Reinforcing, and Enabling Factors of Nicotine Dependence Among Young Adults in a Rural Community.

OBJECTIVES: The aim of this study was to determine the influence of predisposing, reinforcing, and enabling factors of nicotine dependence among young adults in a rural community. STUDY DESIGN: A quantitative, predictive-correlational cross-sectional study was done among 190 young adults in a rural community utilizing compact segmental sampling. METHODS: Data were collected from August to October 2018 utilizing a validated robotfoto, adapted determinants of smoking questionnaire, and Fagerström test to assess nicotine dependence. Stepwise multiple linear regression was used in predicting the relationship between the predictors and nicotine dependence. RESULTS: Reinforcing and enabling factors influenced nicotine dependency. The influence of other relatives (ß = .179, p = .023) and radio advertisements (ß = -.224, p = .008) as well as availability (access) to cigarettes (ß = .228, p = .003) were significant predictors of nicotine dependency in the rural community. CONCLUSION: Identified predictors can help form policies that can help address the availability of cigarettes and advertisements (radio) that can influence nicotine dependence among young adults in a rural community. Furthermore, the influence of other relatives (extended family) can be a factor that can increase the development of nicotine dependence.

A comparative study on depression and anxiety of mice (Mus musculus) on a prebiotic-supplemented diet versus a standard diet during Unpredictable Chronic Mild Stress (UCMS)

@#<p style="text-align: justify;"><strong>Background.</strong> Anxiety and depression are becoming increasingly prevalent today and are often aggravated by day-to-day stresses. Because current management strategies are usually accompanied by unpleasant side effects, there is a need to look into alternative treatment regimens - such as prebiotics - that may provide equally effective anxiolytic and antidepressant effects.</p><p style="text-align: justify;"><strong>Objective.</strong> Therefore, the study aims to determine the effect of a combined fructooligosaccharide (FOS) and galactooligosaccharide (GOS) supplemented diet on anxiety and depression levels in mice subjected to Unpredictable Chronic Mild Stress (UCMS).</p><p style="text-align: justify;"><strong>Methods.</strong> Forty male BALB/C mice were subjected to UCMS under a pretest-posttest control group design where the treatment group received prebiotic supplementation throughout the study. Repeated measures ANOVA was run to evaluate between, within, and time interactions of the measured anxiety parameters using the light-dark box test, and depression parameter using the fur coat state assessment.</p><p style="text-align: justify;"><strong>Results.</strong> Results show that (1) the FOS + GOS treatment did not give the treatment group an advantage over the control group during UCMS, (2) both groups grew more anxious and depressed over time, and (3) the treatment group grew more anxious with time in relation to control in terms of the total time spent in the light side.</p><p style="text-align: justify;"><strong>Conclusion.</strong> These imply that the UCMS protocol was successful in inducing stress in mice, but the FOS + GOS regimen failed to provide anxiolytic and antidepressant effects on male BALB/C mice exposed to UCMS.</p>

3D cross sectional view to investigate the morphology of internal carotid artery plaques. Is 3D ultrasound superior to 2D ultrasound?

PURPOSE: Previous studies have demonstrated that plaques from the internal carotid artery with lower median grayscale values are associated with higher complication rates in the perinterventional course. A repeatedly cited limitation of ultrasound is that the single plane used to calculate the median grayscale value is only two dimensional. The goal of this study was to compare the median grayscale value as determined using two dimensional cuts versus three dimensional data sets. MATERIALS AND METHODS: Seventy-one cuts of 24 thromboendarterectomy samples from 19 patients were analyzed using 3D data sets. The ultrasound data sets were obtained using a 10 MHz probe in 3D mode in a special chamber and were evaluated by two investigators. Additionally, a longitudinal view of the samples was made using B mode according to a standardized protocol. RESULTS: There was a significant correlation between the 2D and 3D data as assessed by two observers (p < 0.001, intraclass correlation [ICC] > 0.895) and at different times (p < 0,001, ICC > 0.935). Comparison of the 3D transverse cuts with the longitudinal B mode cuts also showed a highly significant association between the two methods (p < 0.001, R = 0.800). 97.2 % of the measured values were within the limits of agreement, reflecting the concordance of the both methods. CONCLUSION: The superiority of three dimensional ultrasound with respect to two dimensional ultrasound was not able to be demonstrated using this standardized in vitro procedure to examine the echolucency in extracranial internal carotid artery plaques.

[Critical limb ischemia]. / Kritische Extremitätenischämie.

Critical limb ischemia can be divided into acute and chronic forms. All patients suspected of the acute form should be evaluated immediately, as urgent revascularization is usually necessary. Chronic critical limb ischemia is the most complicated type of peripheral artery disease (PAD). Typical for it are pain at rest and necrosis or gangrene. The most important known risk factors are nicotine, hypertension, diabetes, and hyperlipoproteinemia. Patients suffering from PAD run a significantly higher risk of cardiovascular or cerebrovascular events and therefore should be on permanent antithrombotic therapy as secondary prophylaxis. Besides clinical examination and determination of the ankle/brachial index, complementary imaging is mandatory. Here angiography is the gold standard. For therapy surgical and other interventional procedures are available. The decision on individual therapy follows an interdisciplinary approach based on an international consensus (TASC classification).

[Imaging techniques for showing the morphology and surface structure of extracranial internal carotid artery plaques]. / Diagnostik der Morphologie und Oberflächenstruktur von Plaques der Arteria carotis interna. Vergleich von Sonographie, Computertomographie und Kernspintomographie.

Methods of determining plaques in the extracranial internal carotid artery are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). The goal of this overview is to introduce these methods and discuss their diagnostic and clinical significance. Ultrasound has the capability of showing the echogenity of the plaques. This method seems to demonstrate a relationship with the incidence of hemispheric symptoms. A histological association could only rarely be seen. The surface structure can only be clearly and correctly evaluated in individual cases under optimal circumstances. Computed tomography is capable of showing the calcium content and specific site of the plaques. However, lipid content and fibrous tissue cannot be deduced reliably. The currently available image resolutions limit a detailed imaging of surface characteristics. Magnetic resonance imaging provides, in vitro, a correct rendering of plaque composition and endoluminal surface structure. In vivo it is possible to recognize both the fibrous cap and necrotic core as well as intraplaque hemorrhage. Because of certain artefacts more detailed images are difficult to interpret. In conclusion, further clinical trials should reveal, whether these methods can be set in clinical routine to detect plaque surface and morphology for stratifying patients at risk of hemispheric symptoms during the spontaneous course as well as during carotid interventions.

Carotid artery calcium: accuracy of a calcium score by computed tomography-an in vitro study with comparison to sonography and histology.

OBJECTIVES: The aim of this study was to compare methods of quantifying calcification of the internal carotid artery. MATERIALS AND METHODS: We examined 92 internal carotid artery endarterectomy specimens. Grey scale median (GSM) values were calculated from optimized B-mode scans. The degree of calcification was assessed using radiographic calcification grading. Plaques were processed histologically, and classified into: (1) calcium-rich hard plaques, (2) lipid-rich soft plaques, and (3) combined plaques. The specimens were scanned in CT-scanner. The calcium score was determined as described by Agatston. RESULTS: Histopathology and GSM results concurred in 39 out of 92 cases (kappa=0.088). There was no significant correlation between the calcium score and the median GSM value (R=0.005; P=0.959). Histology and CT morphology showed a significant concordance (P<0.001). Also CT and radiomorphological classification showed close agreement (R=0.628, P<0.001). CONCLUSIONS: Calcium scores calculated using CT morphology enable precise in vitro evaluation of the calcium content of plaques in the internal carotid. In contrast, grey scale median values do not adequately reflect calcification of plaques.

[Diagnosis and therapy of progressive thrombophlebitis of epifascial leg veins]. / Die Diagnostik und Therapie der progressiven Thrombophlebitis epifaszialer Beinvenen.

INTRODUCTION: The thrombophlebitis is generally regarded as a harmless disease. However, the progressive varicophlebitis represents a subgroup of thrombophlebitis in which the proximal portion of the thrombus can ascend into the deep vein system with the complication of deep vein thrombosis or pulmonary embolism. PATIENTS AND METHODS: In a period of 15 months ten patients were operated upon in whom a progressive varicophlebitis was diagnosed with color-flow duplex scanning. Eight of them were men, two were women. The average age was 56 years. RESULTS: Nine patients had an ascending thrombosis of the greater saphenous vein. One patient had the origin of the thrombus in the shorter saphenous vein. In one patient the ascending thrombosis of the greater saphenous vein was the reason for a segmental pulmonary embolism. The indication for operation was given when the proximal portion of the thrombus was within 10 cm of the confluence to the deep vein system. The operative procedure comprised the ligature of the epifascial vein. CONCLUSION: The diagnosis of thrombophlebitis should not be restricted only to clinical examination. Color-flow duplex scanning is preferred to compression venous ultrasonography. The ascending contrast venography as invasive diagnostic procedure should only be performed for the clarification of further questions. In ascending varicophlebitis ligature of the confluence from the superficial to the deep vein system is a safe procedure to avoid a progression of the disease or embolism. In case of postoperative recanalisation of the superficial varicose vein a second operation with stripping of the vein can be performed.

Production of IL-6 and MCP-1 by the human peritoneum in vivo during major abdominal surgery.

Both inflammatory and anti-inflammatory mediators are released into the circulation during major abdominal surgery. In addition, some of these mediators have been detected postoperatively in peritoneal fluids. Thus, it appears that the peritoneum may be a potential source of circulating immunomodulators following major abdominal surgery. With this in mind, we quantified the intraoperative production of interleukin (IL)-6 and monocyte chemoattractant protein-1 (MCP-1) by human peritoneum. A small chamber was sewed to the parietal peritoneum of 19 patients at the beginning of the operation. This chamber was perfused with buffered salt solution, and the perfusate was collected hourly and assayed for IL-6 and MCP-1 concentrations by enzyme-linked immunosorbent assay. Expression of the corresponding mRNAs was determined by reverse-transcription polymerase chain reaction from additional peritoneal biopsies taken at the beginning and at the end of operation. Peritoneal production of IL-6 and MCP-1 started within the first hour of operation and continued with increasing amounts of up to 435 (43-1925) pg/cm2/h [median (range)] of IL-6 and 435 (59-1930) pg/cm2/h of MCP-1. There was induction of peritoneal IL-6 and MCP-1 mRNA expression. A suppressed MCP-1 production was seen only in one patient who suffered from severe septic complications in the postoperative course. Using a new technique that allows for the quantification of local cytokine production in vivo, we demonstrated that the peritoneum rapidly reacts to abdominal surgery with increased production of IL-6 and MCP-1. Early detection of impaired production may help to identify patients at risk of postoperative septic complications.

Fluoroscopically triggered contrast-enhanced 3D MR DSA and 3D time-of-flight turbo MRA of the carotid arteries: first clinical experiences in correlation with ultrasound, x-ray angiography, and endarterectomy findings.

The aim of this article was to obtain initial experiences with fluoroscopically triggered contrast-enhanced (CE) 3D MR DSA with elliptical centric k-space order and 3D time-of-flight (TOF) turbo MRA of the carotid arteries. In this prospective study we examined 16 consecutive patients with suspicion of atherosclerotic disease involving the carotid arteries. Ultrasound was available in all, x-ray angiography in 12, surgical correlation in 9, and intraoperative x-ray angiography in 4 patients. All examinations were done on a 1.5 T unit applying: transverse plain 3D TOF turbo MRA and coronal CE MRA with fluoroscopic triggering. Combining head and neck array coils allowed the visualization of supraaortic arteries from the aortic arch to the circle of Willis. MRA results (maximum intensity projections) were compared with x-ray angiography, ultrasound, and inspection of endarterectomy specimens. Volume rendering was performed in selected cases additionally. Agreement between CE MRA, 3D TOF turbo MRA and x-ray angiography regarding stenoses of the internal and external carotid artery was very good. CE MRA was able to detect correctly intracranial stenoses, but delineation of the aortic arch and proximal common carotid arteries was sometimes reduced. Volume rendering was suited for visualization of MRA images providing a realistic three-dimensional impression. In conclusion, high-resolution fluoroscopically triggered CE MRA as non-invasive technique is another important step on the way to replace invasive x-ray angiography for the evaluation of atherosclerotic carotid artery disease. High resolution 3D TOF turbo MRA might be a helpful adjunct to increase the diagnostic reliability for the carotid bifurcation.

The diminished postoperative capacity of blood leukocytes to produce IL-6 is associated with high concentrations of IL-6 in the circulation.

Surgical trauma is followed both by a transient increase of interleukin 6 (IL-6) concentrations in the serum and impaired function of circulating leukocytes. Perioperatively, we investigated the relationship of IL-6 concentrations in the serum with lipopolysaccharide (LPS)-stimulated cytokine production in the whole blood of patients undergoing elective major abdominal operations. In 50 patients, we found a transient increase of IL-6 concentrations in the serum. Six hours after skin incision, in vitro stimulated production of IL-6 and TNFalpha was diminished by 72% (P<0.05). A significant increase in cytokine production was observed three days postoperatively, however this was 63% below the preoperative values. Patients with high concentrations of circulating IL-6 showed a significantly lower stimulated IL-6 production than patients with low serum concentrations of IL-6. We conclude, that two opposing effects are associated with surgery: an activation leading to IL-6-release into the circulation, and a prolonged hyporesponsiveness of circulating leukocytes. These reactions are positively related.

Secretion of IL-6, monocyte chemoattractant protein-1, macrophage inflammatory protein-1alpha, and TNFalpha by cultured intact human peritoneum.

The peritoneum is an important site of host defence. The mesothelial cells, lining the peritoneum, and the fibroblasts found in the layers below are potent sources of a variety of mediators. Furthermore, granulocytes, mast cells, and macrophages, either resident or attracted by inflammatory processes, are interspersed within the tissue. We investigated the production of mediators by samples of fresh human peritoneum. The method described here has the advantage that the cellular composition of the human peritoneum remains intact. Samples of peritoneum were excised at the beginning of elective abdominal operations in infection-free patients. The tissue was placed across the wells of a microtitre plate, fixed in place by the plate cover and incubated with culture medium with or without lipopolysaccharide (LPS) for up to 5 h. The accumulation of IL-6, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1alpha (MIP-1alpha) and TNFalpha in culture supernatants was measured by ELISA. Production of MCP-1 and IL-6 occurred spontaneously during incubation and was enhanced by as much as 4-fold in the presence of different concentrations of LPS (0. 5-500 ng/ml) in a dose-dependent manner. MIP-1alpha and TNFalpha were detected in culture supernatants of LPS-stimulated samples with concentrations about 8 times as high as those of samples cultured with no such stimulus. The addition of IL-1beta resulted in an increase in the release of IL-6 and MCP-1, similar to that observed with LPS stimulation, but failed to increase the production of TNFalpha. MIP-1alpha production was only marginally enhanced by IL-1beta. In conclusion, our experimental system is suitable for the investigation of chemokine and cytokine production by the human peritoneum, with the aim of assessing aspects of local immunocompetence.

[Production of chemokines by the human peritoneum]. / Das humane Peritoneum als Produzent von Chemokinen.

AIM OF THE STUDY: Peritonitis is characterised by a continued infiltration of the peritoneal cavity with leukocytes, attracted by chemotactic mediators. The aim of this study was to demonstrate the capacity of the human peritoneum to secrete chemokines and to show a therapeutic option by impairing the proinflammatory function of the peritoneum. METHODS: Peritoneum was obtained from 12 consenting patients undergoing abdominal surgery for noninflammatory diseases. After opening the peritoneal cavity a piece of the parietal peritoneum was excised and subsequently incubated with lipopolysaccharide (LPS, 50 ng/ml) +/- interleukin-10 (IL-10, 100 U/ml) for five hours in vitro. The culture supernatants were assayed for concentrations of interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1) and monocyte inflammatory protein-1 alpha (MIP-1 alpha) by using the ELISA. RESULTS: The cultured peritoneum secreted MCP-1 (mean (SEM): 3416 (659) pg/ml) and IL-8 (2946 (894) pg/ml). The presence of LPS resulted in a fourfold enhancement of this secretion (MCP-1: 13563 (1613), IL-8: 9854 (1305) pg/ml) and led to the production of MIP-1 alpha (1476 (240) pg/ml). The LPS-stimulated production of all of these chemokines was significantly diminished by the presence of IL-10. CONCLUSION: The reaction of the peritoneum to LPS indicates its proinflammatory function in the context of peritonitis caused by gram-negative bacteria. This inflammatory reaction might be diminished by application of IL-10.

Culture of human peritoneum--a new method to measure the local cytokine response and the effect of immunomodulators.

The production of cytokines and chemokines, which are involved in cell activation and cell migration in native pieces of peritoneum, was measured to investigate immune regulatory reactions in the human peritoneum. The samples were obtained during abdominal surgery and cultured immediately afterwards. In order to test therapeutic options in vitro, the effect of IL-10 and IFN-gamma on the cytokine and chemokine production was also studied. The chemokine monocyte chemotactic protein-1 (MCP-1) was produced and released spontaneously. When lipopolysaccharide (LPS) was added, MCP-1 production increased. In addition, TNF-alpha production was induced by LPS. When IL-10 was added, LPS-stimulated TNF-alpha production was reduced towards baseline levels, LPS-induced MCP-1 production was reduced by 37%. IFN-gamma did not affect LPS-induced TNF-alpha and MCP-1 production, but increased baseline MCP-1 production. It can be concluded that short-time culture of native human peritoneum is a method to investigate peritoneal chemokine and cytokine production in patients undergoing abdominal surgery. Further studies are intended to detect cytokine patterns which identify patients at risk of developing peritonitis. In addition, the effects of medications may be tested in vitro in order to investigate options for preventive modulation of the peritoneal immune response in such patients.