Biologic Potential of Calcium Phosphate Biopowders Produced via Decomposition Combustion Synthesis.

The aim of this research was to evaluate the biologic potential of calcium phosphate (CaP) biopowders produced with a novel reaction synthesis system. Decomposition combustion synthesis (DCS) is a modified combustion synthesis method capable of producing CaP powders for use in bone tissue engineering applications. During DCS, the stoichiometric ratio of reactant salt to fuel was adjusted to alter product chemistry and morphology. In vitro testing methods were utilized to determine the effects of controlling product composition on cytotoxicity, proliferation, biocompatibility and biomineralization. In vitro, human fetal osteoblasts (ATCC, CRL-11372) cultured with CaP powder displayed a flattened morphology, and uniformly encompassed the CaP particulates. Matrix vesicles containing calcium and phosphorous budded from the osteoblast cells. CaP powders produced via DCS are a source of biologically active, synthetic, bone graft substitute materials.

The adverse effects of diabetes on osteoarthritis: update on clinical evidence and molecular mechanisms.

Projected increases in the prevalence of both diabetes mellitus (DM) and osteoarthritis (OA) ensure their common co-existence. In an era of increasing attention to personalized medicine, understanding the influence of common comorbidities such as DM should result in improved care of patients with OA. In this narrative review, we summarize the literature addressing the interactions between DM and OA spanning the years from 1962 to 2014. We separated studies depending on whether they investigated clinical populations, animal models, or cells and tissues. The clinical literature addressing the influence of DM on OA and its therapeutic outcomes suggests that DM may augment the development and severity of OA and that DM increases risks associated with joint replacement surgery. The few high quality studies using animal models also support an adverse effect of DM on OA. We review strengths and weaknesses of the common rodent models of DM. The heterogeneous literature derived from studies of articular cells and tissues also supports the existence of biochemical and biomechanical changes in articular tissues in DM, and begins to characterize molecular mechanisms activated in diabetic-like environs which may contribute to OA. Increasing evidence from the clinic and the laboratory supports an adverse effect of DM on the development, severity, and therapeutic outcomes for OA. To understand the mechanisms through which DM contributes to OA, further studies are clearly necessary. Future studies of DM-influenced mechanisms may shed light on general mechanisms of OA pathogenesis and result in more specific and effective therapies for all OA patients.

Cyclical articular joint loading leads to cartilage thinning and osteopontin production in a novel in vivo rabbit model of repetitive finger flexion.

OBJECTIVE: An in vivo rabbit model of repetitive joint flexion and loading was used to characterize the morphological effects of cyclical loading on articular cartilage. DESIGN: The forepaw digits of eight anesthetized New Zealand White adult female rabbits were repetitively flexed at 1 Hz with a mean peak digit load of 0.42 N for 2 h per day for 60 cumulative hours. Metacarpophalangeal joints were collected from loaded and contra-lateral control limbs, fixed, decalcified, embedded, and thin-sectioned. Serial sections were stained for histology or for immunohistochemistry. Morphometric data including the mean thicknesses of the uncalcified cartilage and of the calcified cartilage were collected from digital photomicrographs of safranin O-stained sections. The number of cells stained with anti-osteopontin antibody was counted. RESULTS: We observed a decrease in uncalcified cartilage mean thickness with no significant change in calcified cartilage thickness. We also observed a significant increase in the number of cells positive for osteopontin (OPN) in the uncalcified cartilage. These changes occurred without overt cartilage surface degeneration. CONCLUSIONS: Cyclical loading leads to changes at the tissue and cellular levels in articular cartilage. These changes are suggestive of tidemark advancement and may indicate a reactivation of cartilage mineralization steps analogous to endochondral ossification. This novel in vivo rabbit model of repetitive flexion and loading can be used to investigate the effects of cyclical loading on articular joints.

The effects of collagen fragments on the extracellular matrix metabolism of bovine and human chondrocytes.

Cartilage matrix degradation generates collagen type II fragments. The objective of this study is to explore the possibility that these collagen fragments may be part of an endogenous metabolic feedback. Initially, collagen fragments were extracted from normal or osteoarthritic cartilage, as part of a matrix fragment preparation. Later, collagen fragments were generated by digestion of bovine collagen type II with bacterial collagenase (col2f). These fragments were added to cultures of isolated chondrocytes (bovine and human) and cartilage explants (human). In a dose-dependent manner, col2f caused inhibition of cell attachment to collagen, inhibition of collagen synthesis, and induction of matrix degradation. In addition, when col2f were added to human cartilage explants, an induction of gelatinase activity was detected in the media. These data sets present first evidence that degradation products of collagen may be directly involved in the regulation of cartilage homeostasis.

Emotional and functional outcomes in women with coronary heart disease.

Instruments used to measure emotional and functional outcomes of coronary heart disease show a fairly high level of consistency. Scores on depression scales are typically higher in women than men, yet this finding must be balanced with data showing that mean scores for depression are low. Both sexes report moderate levels of anxiety after a cardiac event; however, global mental health is rated as relatively high. Women report lower levels of physical activity and higher levels of disruption in functional activities than men. Women also report resuming household activities early in their recovery, a finding most likely reflective of traditional role responsibilities. Last, for both sexes, emotional distress and functional disability decrease over time and appear to be stable by 6 months after the event.

Concerns and risk factor modification in women during the year after coronary artery surgery.

BACKGROUND: Future plans or return to a usual lifestyle has been shown to be of concern to persons recovering from coronary artery surgery. However it is not clear whether early concerns remain stable or evolve over time. OBJECTIVE: To examine women's concerns about having coronary artery surgery and living with coronary artery disease after surgery over time. METHODS: Concerns and risk factor modification strategies were measured in 55 women at 1, 6, and 12 months after coronary artery surgery. The Carr and Powers Stressor Scale and an investigator-developed interview were used. RESULTS: Women's primary concerns shifted over the year from surgical recovery to living with coronary heart disease. At 1 month after surgery, issues related to future plans, such as progress in recovery and resuming lifestyle, were rated as causing the most concern. Concern about diet was the highest rated concern 1 year after surgery. More than half of the women reported exercising more, and approximately three fourths reported eating a better diet 1 year after surgery. CONCLUSIONS: The findings demonstrate that women are concerned about diet and exercise, and many women attempt to change their behavior. Capitalizing on women's concerns about living with coronary artery disease may help address risk factors. However, specialized interventions may be needed that focus on women who are not concerned about and/or not engaged in risk reduction behaviors.

Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. American Heart Association Women's Heart Disease and Stroke Campaign Task Force.

CONTEXT: One of 2 women in the United States dies of heart disease or stroke, yet women are underdiagnosed and undertreated for these diseases and their risk factors. Informed decisions to prevent heart disease and stroke depend on awareness of risk factors and knowledge of behaviors to prevent or detect these diseases. OBJECTIVE: Assess (1) knowledge of risks of heart disease and stroke and (2) perceptions of heart disease and its prevention among women in the United States. DESIGN AND SETTING: Telephone survey conducted in 1997 of US households, including an oversample of African American and Hispanic women. PARTICIPANTS: One thousand respondents 25 years or older; 65.8% white, 13.0% African American, and 12.6% Hispanic. MAIN OUTCOME MEASURES: Knowledge of heart disease and stroke risks, perceptions of heart disease, and knowledge of symptoms and preventive measures. RESULTS: Only 8% of the respondents identified heart disease and stroke as their greatest health concerns; less than 33% identified heart disease as the leading cause of death. More women aged 25 to 44 years identified breast cancer as the leading cause of death than women 65 years or older. Women aged 25 to 44 years indicated they were not well informed about heart disease and stroke. Although 90% of the women reported that they would like to discuss heart disease or risk reduction with their physicians, more than 70% reported that they had not. CONCLUSIONS: Most women do not perceive that heart disease is a substantial health concern and report that they are not well informed about their risk. Age influenced knowledge to a greater extent than ethnicity. Programs directed at young women that address the effects of lifestyle behaviors on long-term health are needed. Better communication between physicians and patients is also warranted.

Prevention of heart disease in women: recommendations for management of risk factors.

Coronary heart disease is the leading cause of death and disability in women in the U.S. Unfortunately, efforts for primary and secondary prevention of coronary heart disease are less than optimal. The need to emphasize prevention of coronary heart disease in women in important because first events are often fatal in women. Factors that are unique in terms of their influence on risk for coronary heart disease in women include age, reproductive and hormonal status, high density lipoprotein cholesterol and triglyceride levels, and the presence of diabetes. A consistent plan to address risk factor management of each woman is the key to long term risk reduction. Nurses and nurse practitioners, working in any setting, can use the recommendations presented in this paper to help women reduce their risk for coronary heart disease.

Reasons for use of hormone replacement therapy in women undergoing coronary angiography.

The recommendation has been made that all women be counseled about the risks and benefits of hormone replacement therapy (HRT). Use of HRT among women undergoing coronary angiography was explored to assess whether patterns of use were similar to data drawn from community samples. Using a descriptive design, a convenience sample of 414 postmenopausal women was interviewed. Fifty-eight percent had never used HRT, 18.3% were past users, and 23.7% were currently using HRT. The primary reason given for ever using HRT was for symptoms of menopause. Less than 14% of women cited coronary heart disease (CHD) or osteoporosis as their primary reason for using HRT. The most common reasons for stopping HRT were side effects and fear of cancer. The most common reasons given for never having used HRT were that their healthcare provider had never talked about it and that they had never thought about it. Use of HRT among women undergoing coronary angiography is similar to that found in community samples. The challenge is to promote patient-provider interactions that include information about HRT based on the scientific model as well as attention to women's individual concerns.

Social comparisons and temporal comparisons after coronary artery surgery.

OBJECTIVE: To examine the use and efficacy of social and temporal comparisons used before and after coronary artery surgery. DESIGN: Secondary analysis of data from a prospective study designed to examine social support. PATIENTS: 141 subjects undergoing surgery. RESULTS: One third of subjects made spontaneous social comparisons. Most who made a social comparison before and 1 month after surgery viewed themselves as similar to others. Social comparisons were related to mood states only before surgery. The majority of subjects made temporal comparisons 1 year after surgery. Subjects generally saw themselves as the same or better than they were before surgery. Temporal comparisons were related to both emotional and functional outcomes. CONCLUSIONS: Social comparisons were not consistently related to emotional and functional status; thus whether they can be used to formulate interventions needs further exploration. On the other hand, use of temporal comparisons was related to better mood state and functional status. Enhancing an individual's ability to view self as stable or improved compared with before surgery may be beneficial. Results are discussed in terms of how social comparison theory fits within the overall context of coping with physical illness.

Expression of anchorin CII (cartilage annexin V) in human young, normal adult, and osteoarthritic cartilage.

In its tissue-specific function as a collagen receptor of chondrocytes, cartilage annexin V (anchorin CII) occupies a key position in the organization of the cell-extracellular matrix (ECM) junction for the tissue. The general role of annexin V (Anx V) in other tissues suggests involvement in cellular secretory processes and in regulation of apoptosis. Immunohistochemical analysis of Anx V in growth plate cartilage, confirmed by in situ hybridization, suggests that Anx V is prominently expressed and forms a major constituent of growth plate chondrocytes. Anx V epitopes are also located in the pericellular matrix of hypertrophic cartilage. In adult articular cartilage the expression is downregulated, with the highest levels of immunostaining found in the upper third of the articular cartilage layers and almost no antigen found in the deep layers. Osteoarthritic (OA) cartilage is characterized by a significant upregulation of message and protein throughout the entire depth of the tissue, an accumulation of cytoplasmic annexin V epitopes, and a release of epitopes into the pericellular and interterritorial matrix, in part co-localized with granular structures. Therefore, Anx V expression and tissue distribution may serve as a histological marker for metabolic alterations and for changes in the cellular phenotype associated with OA.

Perceived side effects and benefits of coronary angioplasty in the early recovery period.

OBJECTIVE: To examine patients' perceptions of the side effects and the treatment benefit of percutaneous transluminal coronary angioplasty (PTCA) in the early postdischarge recovery period, and to determine whether selected demographic and clinical variables were associated with perceptions of side effects and treatment benefit. DESIGN: Descriptive, correlational study. SAMPLE: Convenience sample of 62 subjects, with a mean age of 62 years (SD 11 years), 77% of whom were men, who had undergone successful, elective PTCA. RESULTS: Fifty-two percent of subjects reported side effects 2 weeks after PTCA. The most frequently reported side effect (22.5%), was discomfort in the groin site. Seventy-nine percent of subjects reported PTCA made things better, and 5% reported that PTCA made things worse. The most commonly reported benefit of PTCA was relief of chest pain. Age, sex, and a history of previous PTCA were not related to reported side effects or reported benefits. Subjects who experienced chest pain since the time of hospital discharge were less likely to report that PTCA was beneficial. CONCLUSION: More emphasis should be placed on helping patients who are candidates for a PTCA to predict and to manage treatment side effects and to have realistic expectations concerning the trajectory of recovery from PTCA. Further research is needed to examine the impact of patients' uncertainty concerning treatment benefit or perceptions of no treatment benefit in the early recovery period on intermediate and long-term PTCA recovery outcomes.

Long-term chest wall discomfort in women after coronary artery bypass grafting.

OBJECTIVE: The purpose of the study was to determine the occurrence of long-term chest wall discomfort in women after coronary artery bypass grafting. DESIGN: Prospective repeated-measures design. SETTING: Posthospitalization. SAMPLE: Fifty-one women who had undergone coronary artery bypass grafting. Data were collected at 12 and 18 months by self-report and data collection instruments. INSTRUMENTS: Life Orientation Test, Satisfaction with Life Scale, Profile of Mood States, Sickness Impact Profile, interview schedule, and discomfort scale 0 to 10. RESULTS: Women who had an internal mammary artery graft had significantly (p = 0.003) more discomfort. Most discomforts were intermittent and did not interfere with daily activities. However, the feelings of numbness and itchiness tended to be continuous.

Optimism, coping and long-term recovery from coronary artery surgery in women.

Optimism, coping strategies, and psychological and functional outcomes were measured in 55 women undergoing coronary artery surgery. Data were collected in-hospital and at 1, 6, and 12 months after surgery. Optimism was related to positive moods and life satisfaction, and inversely related to negative moods. Few relationships were found between optimism and functional ability. Cognitive coping strategies accounted for a mediating effect between optimism and negative mood. Optimists were more likely to accept their situation, and less likely to use escapism. In turn, these coping strategies were inversely related to negative mood and mediated the relationship between optimism and this outcome. Optimism was not related to problem-focused coping strategies; this, these coping strategies cannot explain the relationship between optimism and outcomes.

Empowering staff nurses to participate in the American Nurses Association's call for quality indicators research.

The American Nurses Association (ANA) advocates establishment of a national database, which can collect, aggregate, and analyze patient data to link nursing activities to 10 quality of care outcomes. These outcomes, developed through extensive research, can highlight the essential nature of nursing, demonstrate institutional compliance with external standards, and justify registered nurse staffing patterns. Staff nurses collect and record the data that provide the foundation for the quality nursing indicators research initiative. This paper focuses on the important and unique role that staff nurses can play in advancing this agenda.

Psychologic and social aspects of cardiovascular disease.

In summarizing the evidence, it becomes apparent that several psychologic and social variables are related to coronary heart disease (CHD). Coronary prone behavior pattern, in particular the hostility component, appears to be related to the development and perhaps expression of CHD, whereas it is not reliably related to outcomes after CHD is manifest. Depression clearly has been shown to be related to outcomes after CHD has declared itself. Lack of social ties appears to be related to mortality, whereas emotional social support has been shown to be related to recovery from coronary events. It also seems apparent that there are subsets of vulnerable individuals who might be best served by targeted interventions. Interventions are proposed as suggested by the prevailing evidence.

Absence of cell-surface annexin V is accompanied by defective collagen matrix binding in the Swarm rat chondrosarcoma.

Annexin V has been characterized as a major collagen type II binding cell-surface component of normal chondrocytes and is also called anchorin CII in chondrogenic populations. Herein we present evidence that in vitro cultured Swarm rat chondrosarcoma cells are not capable of binding collagen type II in significant quantities to their surfaces, as compared to normal rat chondrocytes. This finding coincides with a deficiency of annexin V on the surface of these cells. A small quantity of an intracellular polypeptide could be detected which is immunologically cross-reactive with annexin V but displayed a mobility in SDS-PAGE of less than 34 kD compared to the M(r) 36 kD of intact rat annexin V. By immunohistochemistry the protein could be localized in the cytoplasm of in vitro and in vivo grown tumor cells. By reverse transcription-polymerase chain reaction and Northern blot analysis, a regular-sized mRNA for annexin V could be detected in the chondrosarcoma cells that is expressed in only slightly lower quantities than in normal chondrocytes. Taken together, the data suggest a modified processing or turnover for annexin V in the chondrosarcoma excluding it from being a functionally active collagen type II binding protein. The findings support the hypothesis of cell-surface annexin V as a key component for the formation of the pericellular matrix of chondrocytes.

Perceptions of patients with cardiovascular disease about the causes of coronary artery disease.

This study was an examination of perceptions about the causes of coronary artery disease and the timeline of the disease among 105 patients hospitalized because of myocardial infarction or for coronary angiography and receiving the diagnosis of coronary artery disease. Although 79% of subjects named at least one of three modifiable risk factors (smoking, hypertension, elevated cholesterol), only 7% identified all three. Subjects known to have risk factors varied in their recognition of those risks as a cause of their coronary artery disease. Sixty-four percent of smokers recognized smoking as a personal cause of their coronary artery disease, whereas only 15% of subjects with hypertension recognized hypertension as a cause. The majority of subjects (55%) believed that coronary artery disease was a chronic disease. The other subjects were unsure (13%) or believed the situation would be short term (28%). Despite general knowledge about coronary artery disease, individuals with known risk factors continue to be largely ignorant of their personal risks and to some extent of the course of the disease.

Correlates of fatigue in older women with heart failure.

OBJECTIVE: To examine the relative contribution of psychologic factors and physical symptoms to the variance in fatigue in older women with heart failure. METHODS: Eighty women who had been hospitalized in the previous 12 months for heart failure were interviewed. Fifty-seven women completed second interviews 18 months after the first interview. RESULTS: Fatigue was the most frequently occurring physical symptom at both measurement times, and it significantly increased with time. Other physical symptoms contributed uniquely to the variance in fatigue at both measurement times, but psychologic factors did not. At time 1, sleep difficulties, chest pain, and weakness each explained unique variance in fatigue. At time 2, dyspnea was the only variable that explained unique variance in fatigue (9%). Dyspnea also explained a significant portion of the variance (7%) in time 2 fatigue, when time 1 fatigue was controlled. CONCLUSIONS: Fatigue in older women with heart failure is related more to other physical symptoms than psychologic factors.

An educational model for the acute care nurse practitioner.

As new opportunities for acute care nurse practitioners (ACNP) evolve, there is increasing recognition of the need to distinguish between the knowledge base and the role functions generic to all advanced practice nurses, and the knowledge base specific to different areas of clinical specialization. This necessitates differentiating between converging core curriculum elements and merging the roles of advanced practice nurses. This article presents an educational model for the ACNP.