Effects of creatine in a rat intestinal model of ischemia/reperfusion injury.

PURPOSE: Creatine belongs to a buffering system of cellular ATP level and has been reported to display direct antioxidant activity. Aim of this work was to investigate whether creatine treatment could ameliorate the antioxidant response of intestinal cells and limit the oxidative injury induced by anoxia and subsequent reoxygenation. METHODS: Jejunal and ileal tracts of rat intestine were everted and incubated in vitro under normoxic, anoxic and reoxygenation conditions in the absence and in the presence of 10 mM creatine. (Na+, K+)-ATPase, γ-GT and antioxidant enzymes activities were determined in mucosal homogenate, as well as malondialdehyde production and HSP70 expression. RESULTS: Both in jejunum and ileum, creatine treatment increases (Na+, K+)-ATPase activity; γ-GT is unaffected in jejunum but stimulated in ileum. In both tissues, creatine does not alter the antioxidant activities or malondialdehyde level. HSP70 expression is increased only in jejunum. Anoxic conditions stimulate antioxidant activities to a greater extent in jejunum compared to ileum; reoxygenation does not evoke further effects, but enhances malondialdehyde production in both tracts. The protective action of creatine, in reoxygenation, is more marked in jejunum as for its stimulation of antioxidant activities; however, in jejunum, a prooxidant action of creatine is suggested, since malondialdehyde production is enhanced by its presence; on the contrary in ileum, where HSP70 is overexpressed in reoxygenation, peroxidation level is significantly reduced. CONCLUSIONS: The presence of creatine seems to potentiate the defensive response of both tissues, in jejunum by means of cell antioxidant equipment, in ileum by the involvement of HSP70.

Ion transport across the gallbladder epithelium.

The function of the gallbladder is not only to store bile, but also to concentrate it during the interdigestive phase by means of salt-dependent water reabsorption. On the contrary, secretions of water and salt take place during the digestive phase. Dysregulation of ion absorption or secretion are common in many gallbladder diseases, such as colelithiasis. Transepithelial absorptions are determined by the Na+/K+ pump on the basolateral membrane, and by several apical membrane Na(+)-coupled transporters. Among these, some isoforms of Na+/H+ and Cl-/HCO3(-) exchangers have been studied. The presence of a Na(+)-Cl(-) simport has been molecularly and functionally characterized in some animal species. The ion transepithelial secretion is mainly dependent on an apical chloride transport attributable to a CFTR-like cAMP-activated channel with high permeability to HCO3(-). The apical membrane electrical potential is one of the factors influencing anion secretion and is maintained by the activity of cAMP-dependent K+ channels. The regulation of the activity of these channels is complex, because of their sensitivity to voltage, and to intracellular calcium and pH. The coordinated interplay underlying the regulation of transporters and channels needs to be clarified yet, as well as the interactions between transporters, channels and aquaporins.

Jejunal creatine absorption: what is the role of the basolateral membrane?

The mechanism of the intestinal creatine absorption is not well understood. Previous studies have established the involvement of a CT1 carrier system in jejunal apical membrane. The current research was aimed at completing the picture of creatine absorption. To investigate the process supporting creatine exit from enterocyte, basolateral membrane vesicles isolated from rat jejunum were used. The presence of various symport and antiport mechanisms was searched and a NaCl-dependent electrogenic transport system for creatine was evidenced, which shares some functional and kinetic features with the apical CT1. However, Western blot and immunohistochemical experiments ruled out the presence of a CT1 transporter in the basolateral membrane. Further studies are required to identify the basolateral transport mechanism. However, in the in vivo conditions, the NaCl gradient is inwardly directed, therefore such a mechanism cannot energetically mediate the exit of creatine from the cell into the blood during the absorptive process, but rather it may drive creatine into the enterocyte. To shed more light on the creatine absorption process, a possible creatine movement through the paracellular pathway has been examined using the jejunal tract everted and incubated in vitro. A linear relationship between creatine transport and concentration was apparent both in the mucosa-to-serosa and serosa-to-mucosa directions and the difference between the two slopes suggests that paracellular creatine movement by solvent drag may account for transintestinal creatine absorption. As a matter of fact, when transepithelial water flux is reduced by means of a mucosal hypertonic solution, the opposite creatine fluxes tend to overlap. The findings of the present study suggest that paracellular creatine movement by solvent drag may account for transintestinal creatine absorption.

A creatine transporter is operative at the brush border level of the rat jejunal enterocyte.

Although ergogenic effects and health benefits have been reported for creatine used as nutritional supplement, to date little is known about the mechanism of creatine absorption in the small intestine. Thus the current study was undertaken to elucidate the mechanism of creatine intake in rat jejunum with the use of well-purified brush border membrane vesicles, isolated from jejunal enterocyte. Creatine uptake was found markedly stimulated by inwardly directed Na(+) and Cl(- )gradients, potential-sensitive, strongly reduced by the substitution of Na(+) and Cl(-) with various cations and anions and positively affected by intravesicular K(+). Moreover, creatine uptake is: 1) significantly inhibited by creatine structural analogs, 2) abolished by low concentrations of 2-aminoethyl methanethiosulfonate hydrobromide (MTSEA), 3) saturable as a function of creatine concentration with an apparent Michaelis-Menten constant of 24.08 +/- 0.80 muM and a maximal velocity of 391.30 +/- 6.19 pmoles mg protein(-1) 30 s(-1). The transport is electrogenic since at least two Na(+) and one Cl(-) are required to transport one creatine molecule. Western blot analysis showed the same amount of creatine transport protein in the jejunal apical membrane when compared to ileum. Thus, these data demonstrate the existence of a Na(+)- and Cl(-)-dependent, membrane potential-sensitive, electrogenic carrier-mediated mechanism for creatine absorption in rat jejunal apical membrane vesicles, which is biochemically and pharmacologically similar to those observed in other tissues. However, in other cell types the stimulatory effect of intravesicular K(+) was never detected.

[Proposal for first level nursing degree]. / Una proposta per la laurea di primo livello degli infermieri.

A project for the organisation of the new nursing degree program starting in Italy in 2001/02 is presented (national regulation published 5 June 2001). It is the fruit of the work of a group of nursing professors of the University of Insubria (Varese, Italy). After the explanation of the criteria which have led to the educative objectives construction, the choice of the scientific disciplines necessary to reach them has been made. The same educative objective have guided the amount of working hours assigned to each discipline and formative activity (according to the European credit transfer system). The characteristic elements of the project are: the presence of an introductory module among the so called "professionalising formative activities"; the centrality of these professionalising formative activities; the constant reference to a conceptual nursing model; the decision to keep the integrated courses modality beginning from the experience gained since 1992; the reduction in number of the integrated courses and therefore of the exams.

Increase in intrinsic anion conductance upon inhibition of the electroneutral Cl(-)/HCO(3)(-) exchanger: effect of CO(2)/HCO(3)(-).

The electroneutral Cl(-)/HCO(3)(-) exchange, present at the apical membrane of rabbit gallbladder epithelium, apparently is converted into a stilbene- and dipyridamole-sensitive, nonrectifying, approximately 5-pS anion channel after the exchange is directly inhibited (inhibitors tested: hydrochlorothiazide (HCTZ), phlorizin, phenylglyoxal and diphenylamine-2-carboxylic acid (DPC)). In intact tissue, in the absence of CO(2)/HCO(3)(-) in the media, the opening of these channels causes an approximately 7-mV depolarization of the apical membrane. This has been shown to be a constant index of the total Cl(-) conductance (G(Cl)) activated. The effect of exogenous and endogenous CO(2)/HCO(3)(-) on the depolarization has now been investigated in the intact tissue by conventional microelectrodes. The anion exchange has been measured radiochemically. The presence of exogenous or endogenous CO(2)/HCO(3)(-) reduces the depolarization induced by HCTZ, phlorizin and DPC from approximately 7 to 3 mV, but 10(-4) mol/l acetazolamide restores the full depolarization. Response time, S(0.5) and Hill number are unchanged in each case. The way of bicarbonate replacement is irrelevant. The depolarization generated by phenylglyoxal, which covalently binds to the transport site of the exchanger and prevents HCO(3)(-) binding, is unaffected by CO(2)/HCO(3)(-) presence. HCO(3)(-) binding to the transport site is suggested to partially hinder the conversion of the exchanger into the channel.

Diphenylamine-2-carboxylic acid (DPC), Usually an inhibitor of Cl- and non-selective cation channels, inhibits Cl-/HCO3- exchange and opens Cl- and cation conductances in rabbit gallbladder epithelium.

In the apical plasma membrane of rabbit gallbladder epithelium various drugs (hydrochlorothiazide, phlorizin, phenylglyoxal) inhibit Cl-/HCO3- exchange and probably enhance the almost negligible intrinsic anion conductance of the exchanger. By radiochemical measurements of apical Cl- influx, the anion exchange is shown here to be directly and immediately inhibited by diphenylamine-2-carboxylic acid (DPC) too. Using conventional microelectrode techniques in intact tissue, DPC, with same dose/response curve, is shown to activate an apical anion conductance (GCl) that has similar properties and amplitude to the GCl activated by the other exchange inhibitors so far tested; the actions are not additive. Patch-clamp methods (cell-attached and excised inside-out patch configurations) reveal that GCl is due to anion channels that are non-rectifying, cytoplasm independent, sensitive to stilbene and dipyridamole and have conductance of a few picosiemens. All this strengthens the correlation between inhibition of anion exchange and the activation of GCl and channels with features similar to those of the almost negligible intrinsic anion conductance of the exchanger. Among the drugs tested, the effects of DPC and hydrochlorothiazide are even more similar, such that even their dose/response curves overlap. Moreover, both drugs also directly activate some verapamil-sensitive Ca2+ channels and consequently apamin-sensitive, Ca2+-activated K+ channels. Thus DPC, usually an inhibitor of Cl- and non-selective cation channels, is shown here to be capable of activating Cl- and cation conductances.

Inhibitors of the Cl-/HCO3- exchanger activate an apical anion conductance with similar features in the epithelial cells of rabbit gallbladder: analysis in intact epithelium.

In the apical plasma membrane of rabbit gallbladder epithelium, hydrochlorothiazide (HCTZ), besides its inhibiting action on Na+-Cl- symport and some side-effects, opens a SITS-sensitive Cl- conductance (Gcl), resulting in depolarization of the membrane due to a cell-to-lumen Cl- backflux. Some previous indications suggest that GCl is someway related to the Cl-/HCO3- exchanger. Thus the actions on the apical membrane of HCTZ and two inhibitors of the exchanger mainly studied in erythrocytes, namely phlorizin and phenylglyoxal (PG), have been compared. The transapical Cl- influx was measured radiochemically and the anion exchange fraction identified. The apical and transepithelial membrane potentials (Vm, Vm), the apical/basolateral membrane resistance ratio (Rm/Rs) and the transepithelial resistance (Rep) were measured with conventional microelectrodes and the changes in apical electromotive force and conductance were calculated. It has been shown that: (1) 2.5 x 10(-4) mol/l HCTZ abolishes Cl-/HCO3- exchange in a few seconds, (2) exchanger inhibition by HCTZ is direct and not mediated by carbonic anhydrase inhibition, (3) 2 mmol/l phlorizin and 4 mmol/l PG also inhibit the exchanger in a few seconds or at least rapidly and in parallel activate a depolarization of 6-7 mV, like HCTZ, (4) dose/response curves of the three drugs for depolarization activation and anion exchange inhibition overlap, (5) depolarization time courses are similar for the three drugs, (6) a decrease in the Rm/Rs ratio occurs in the presence of the three drugs, with a significant change in apical electromotive force when the luminal Cl- concentration is reduced, all this indicating the appearance of a substantial, quantifiable GCl which is absent in the absence of incubation with the drugs, (7) GCl values are similar, regardless of the drug which generates them, (8) the effects of the three drugs are not additive, and (9) stilbenes and dipyridamole abolish GCl (but not DPC) as well as the basal intrinsic conductance of the exchanger. On this basis it is concluded that some inhibitors of the Cl-/HCO3- exchanger either turn it into an anion channel or, less probably, activate a parallel GCl, as a consequence of the exchanger inhibition.

[Accreditation of the nursing service at the Varese Hospital, Italy]. / L'accreditamento di un servizio infermieristico di una azienda ospedaliera.

The article presents the results of a project carried out by a group of four nurse managers of the Hospital "Ospedale di Circolo e Fondazione Macchi" in Varese, Italy, in order to accreditate the Nursing Service. After its constitution and formalization in 1994 and the definition of the goals of the Service, the process of continuous improvement of quality has been described. The accreditation process has led to the compilation of the Quality handbook. The Authors describe all the phases and the contents of each Manual chapter with explicative tables enclosed. The conclusions summarize the positive aspects at this point of the never ending work of continuous improvement of Quality.

[The nursing service at the enterprise: "Ospedale di Circolo e Fondazione Macchi" in Varese]. / Il servizio infermieristico dell'azienda "Ospedale di Circolo e Fondazione Macchi" di Varese.

The article present the results of a project carried out by a group of four nurse managers of the Hospital "Ospedale di Circolo Fondazione Macchi" in Varese, Italy, in order to constitute the "Nursing Service". The Authors have described the initial situation with the traditional leading nursing roles in the Hospital (Nursing Officer and Director of the Nursing School) defining the objectives of the project. The goal of the Service has been identified, the organizational structure has been chosen and the different line and staff functions described. The conclusions inform on the current situation and work for the accreditation of the Service according to the mission of the Hospital managers and the announced changes in Lombardy health policy.

[Tutors and assistants for apprenticeship for students in the university diploma course in nursing science]. / I tutor e gli assistenti di tirocinio degli studenti del corso di diploma universitario in scienze infermieristiche.

The article presents the results of a work carried out by a group of nurses dealing with nursing education, both graduate (Hospital School and then University) and post graduate, since about ten years. The Authors have defined role, functions, spheres of activity, hierarchic and functional relationships, qualifications and abilities of the two new professional figures quoted in the document agreed between Lombardia Region and Lombardia Universities about the new university diploma courses in Nursing Sciences: the tutor and the clinical instructor. In order to do such a work the Authors started from the literature review. They also tried to use the didactic and teaching experience gained by the nursing School of Varese since 1956 and the contemporary beginning of the University course since 1992.

[Heart sarcoidosis. A case of mitral and ascending aorta involvement]. / Sarcoidosi cardiaca. Un caso di coinvolgimento mitralico e dell'aorta ascendente.

We describe a case of cardiac sarcoidosis manifested by arrhythmias, shock, chest pain, mitral valve prolapse and incompetence, aortic vascular involvement. Steroid therapy corrected shock and arrhythmias, but was unable to prevent the progression of the mitral valve insufficiency. Subsequently pulmonary and tricuspid valve incompetence were also observed.