Training of patients for self-management of oral anticoagulant therapy: standards, patient suitability, and clinical aspects.

Self-control and self-management of oral anticoagulant therapy have become more and more attractive for patients undergoing long-term treatment. In our training center, we examined 50 patients who took part in a standardized training course for self-management. Patients (36 men, 14 women) were preselected according to the guidelines of the German Association for Self-management of Oral Anticoagulation (ASA e.V.) and were all trained by the same physician. The complete course took an average of eight sessions. Patients older than 59 years needed significantly more training time in theoretical advising than younger patients; they did not need more training time in practical matters. The values between International Normalized Ratio (INR) measured in venous blood samples and by self-assessment were comparable for both groups. There was a good overall correlation between self-controlled INRs and laboratory assays, however, the self-assayed INRs were significantly lower than those from the venous blood samples.

Female circumcision.

The practice of female genital mutilations is widespread in many developing countries, yet health care professionals typically know little about the care of circumcised women. With the influx of immigrants and refugees from developing countries into Western cultures, it's important for nurses to understand some of the customs, beliefs, and traditions surrounding female circumcision (Calder, et al., 1993; McCleary, 1994). It's estimated that approximately 2 million procedures are performed annually (WHO, 1997).

Increased amount of a mitochondria-associated 21 x 10(3) dalton protein in human gastrointestinal tumors.

Differences in the structure and number of mitochondria in tumor cells were found. Using isoelectrofocusing two-dimensional polyacrylamide gel electrophoresis which allows detection of alterations in the protein pattern of tumor mitochondria, we studied both quantitative and qualitative changes in the mitochondrial protein pattern of human gastrointestinal tumors and corresponding normal matrix tissues. One low molecular protein spot was found to be quantitatively changed in the tumors. The approximate molecular weight was 21 x 10(3) daltons and the pI value 5.7.

Enhanced casein kinase II activity during mouse embryogenesis. Identification of a 110-kDa phosphoprotein as the major phosphorylation product in mouse embryos and Krebs II mouse ascites tumor cells.

Mouse embryos at various stages of development were used to study the relationship of protein kinase activities with normal embryogenesis. Casein kinase II (CKII) activity in developing mouse embryos shows a 3-4-fold activity increase at day 12 of gestation. Together with the CKII activity, increased phosphorylation of a 110-kDa protein is observed. Treatment of the embryo extracts with heparin, a highly specific inhibitor of CKII activity, results in a drastic reduction of the 110-kDa protein phosphorylation indicating that the protein might be a CKII-specific substrate. Rapidly proliferating mouse tumour cells also show an enhanced CKII activity. Here too, a 110-kDa phosphoprotein was the major phosphoryl acceptor. Partial proteolytic digestion shows that both proteins are identical. Other protein kinases tested (cAMP- and cGMP-dependent protein kinases) only show a basal level of enzyme activity with minor alterations throughout the different stages of embryogenesis investigated.

Two-dimensional gel analysis of proteins from human trisomy 21 fetal liver tissue after DEAE-Sepharose chromatography.

Isoelectrofocusing two-dimensional polyacrylamide gel electrophoresis (IEF-2D-PAGE) offers the opportunity to detect typical alterations in the protein pattern from directly prepared liver tissue of fetuses with trisomy 21 and normal controls. The fractionation of the cell lysate by differential centrifugation into various subcellular components (nuclei, membranes, polyribosomes, cytoplasmic proteins) and fractionation of the proteins through DEAE-Sepharose chromatography allows detection of protein differences. In the 19th week of pregnancy it is possible to establish only three differences in the protein patterns between liver tissue from trisomy 21-fetuses and normal controls. All three proteins are synthesized in euploid controls at a higher level than in trisomy 21-liver tissue and are supposed to be consequences of primary gene dosage effects. The molecular mass of the individual proteins ranges from 14 kdaltons to 31 kdaltons. The data reported here raise the question whether some of the differences found by others represent different gene expression of cells under tissue culture conditions and/or of cells derived from different tissues, or developmental stages.

In vitro study of the biological activity of RNAs after incubation of hog liver, heart and brain tissue at room temperature.

The biological activity of RNA, isolated from tissue which was incubated for 1, 3, or 6 hours at room temperature (simulation of post-mortem conditions), was preserved. However, the different organs used differ from each other. When liver is used, qualitative differences in the in vitro translation products are observed, after one hour incubation at room temperature, whereas when heart and brain are used these differences are not observed. We have also shown that relatively small amounts of post-mortem tissue is sufficient for RNA extraction. When using frozen tissue it is absolutely necessary to add RNase inhibitors during thawing to reduce the loss of biological activity.

Characterization of native 40 S particles from Krebs II mouse ascites tumor cells: resolution, nomenclature and molecular weights of the nonribosomal proteins.

Native 40 S particles from Krebs II mouse ascites tumor cells were isolated on a large scale. A nonribosomal protein moiety of about 30 proteins could be removed from the ribosomal particles by treatment with 250 mM KCl. These proteins were analysed by two-dimensional polyacrylamide gel electrophoresis and turned out to be mostly acidic in nature. The molecular weights of about 17 proteins were determined by three-dimensional gel electrophoresis. Radioactively labelled nonribosomal protein spots were excised from two-dimensional gel electrophoresis. Radioactively labelled nonribosomal protein spots were excised from two-dimensional gels and transferred directly or after electrodialysis onto the third dimension gel. The proteins fell into a molecular weight range from about 20,000 to 300,000.

Phosphorylation in vivo of non-ribosomal proteins from native 40 S ribosomal particles of Krebs II mouse ascites-tumour cells.

Four non-ribosomal proteins from native 40 S ribosomal subunits with mol.wts. of 110 000, 84 000, 68 000 and 26 000 were phosphorylated in vivo when ascites cells were incubated in the presence of [32P]Pi. The 110 000-, 84 000- and 26 000-dalton proteins are identical with phosphorylated products from native 40 S subunits after phosphorylation in vitro by a cyclic nucleotide-independent protein kinase. Phosphoserine was the major phosphorylated amino acid of the proteins phosphorylated in vivo and in vitro.

Comparison of alterations in the histamine-diamine oxidase system during acute intestinal ischaemia in pigs, dogs and rabbits; evidence for a uniform pathophysiological mechanism?

Among various vasoactive substances histamine was also suggested to induce circulatory arrest following superior mesenteric artery occlusion. Thus the involvement of the histamine-diamine oxidase system was studied in intestinal ischaemia using three animal species. In pigs, dogs and rabbits aminoguanidine, the specific inhibitor of diamine oxidase, shortened the survival time after mesenteric infarction. Under these conditions the diamine oxidase activity in the intestinal wall was reduced in animals treated by saline whereas the histamine content was not altered significantly. Plasma histamine levels were increased considerably in the portal vein of pigs during the revascularization period if the animal were pretreated by aminoguanidine. Similar findings were obtained in dogs. It was concluded that in all three species investigated the diamine oxidase protects the organism against the deleterious effects of at least one of its vasoactive substrates-histamine.

Diamine oxidase activity in gastric and duodenal mucosa of man and other mammals with special reference to the pyloric junction.

In the gastric mucosa of human subjects and of various mammals methylation was accepted as the main pathway of histamine catabolism. However, augmentation of gastric acid secretion by aminoguanidine, the strong inhibitor of diamine oxidase, indicated an influence of diamine oxidase activity on this secretory process. Therefore a careful reinvestigation of the occurrence of diamine oxidase activity was started from the distal duodenum in the direction of the cardia. In all species studied, diamine oxidase activity decreased from distal duodenum towards the pylorus. In dogs, landrace pigs and in human subjects the diamine oxidase activity clearly exceeded the pyloric borderline gradually becoming zero in corpus or fundus. In rabbits, however, and especially in mini-pigs no diamine oxidase activity was found beyond the pylorus. Among individuals gastric diamine oxidase activity showed a variable prevalence and could not be found regularly in all the subjects. In one patient with prepyloric ulcer a strong influence of pathophysiological processes on gastric diamine oxidase activity could be suspected. Thus, in every alteration of the gastric mucosa under experimental or clinical conditions also an alteration of gastric diamine oxidase activity should be taken into account.

Diamine oxidase activity and histamine release in dogs following acute mesenteric artery occlusion.

Following superior mesenteric artery occlusion and revascularization in dogs all animals died in a circulatory collapse state. However, pretreatment by aminoguanidine, the strong and specific inhibitor of diamine oxidase, accelerated the circulatory break-down significantly and increased the venous plasma histamine concentrattions up to levels which also in normal dogs are effective in the circulatory system. Furthermore, the haematocrit increased significantly more in the aminoguanidine-treated animals than in the dogs treated by saline. No changes in plasma diamine oxidase activity were observed in saline-treated animals during intestinal ischemia and following revascularization. In aminoguanidine-treated animals no enzymic activity could be measured. The results were interpreted by a protective role of intestinal diamine oxidase in intestinal ischemia. Enhancement of the enzymic activity in patients, for instance by heparin, may be helpful in mesenteric infarction disease.