Development and clinical application of an evidence-based pharmaceutical care service algorithm in acute coronary syndrome.

WHAT IS KNOWN AND OBJECTIVE: Drug therapies are critical for preventing secondary complications in acute coronary syndrome (ACS). The purpose of this study was to develop and apply a pharmaceutical care service (PCS) algorithm for ACS and confirm that it is applicable through a prospective clinical trial. METHODS: The ACS-PCS algorithm was developed according to extant evidence-based treatment and pharmaceutical care guidelines. Quality assurance was conducted through two methods: literature comparison and expert panel evaluation. The literature comparison was used to compare the content of the algorithm with the referenced guidelines. Expert evaluations were conducted by nine experts for 75 questionnaire items. A trial was conducted to confirm its effectiveness. Seventy-nine patients were assigned to either the pharmacist-included multidisciplinary team care (MTC) group or the usual care (UC) group. The endpoints of the trial were the prescription rate of two important drugs, readmission, emergency room (ER) visit and mortality. RESULTS AND DISCUSSION: The main frame of the algorithm was structured with three tasks: medication reconciliation, medication optimization and transition of care. The contents and context of the algorithm were compliant with class I recommendations and the main service items from the evidence-based guidelines. Opinions from the expert panel were mostly positive. There were significant differences in beta-blocker prescription rates in the overall period (P = .013) and ER visits (four cases, 9.76%, P = .016) in the MTC group compared to the UC group, respectively. WHAT IS NEW AND CONCLUSION: We developed a PCS algorithm for ACS based on the contents of evidence-based drug therapy and the core concept of pharmacist services.

Polyphenol composition and antioxidant capacity from different extracts of Aster scaber.

Phenolic contents and antioxidant capacities from different solvent extracts (petroleum ether, ethyl acetate, methanol, butanol and water) of Aster scaber leaf were investigated. Antioxidant activity was evaluated by three different methods, namely DPPH radical scavenging activity, reducing power assay and phosphomolybdenum activity. A total of twenty-three polyphenolic compounds were identified and quantified from A. scaber leaf extracts, including hydroxybenzoic acids, hydroxycinnamic acids, flavonols and other groups of phenolic compounds. Ultra high performance liquid chromatography (UHPLC) analysis of the leaf extract revealed that myricetin (4850.45 µg/g) was the most dominant flavonols, compared to quercetin and kaempferol. Caffeic acid was the dominant phenolic compound in A. scaber leaf extracts, it constituted about 104.20 µg/g, followed by gentisic acid (84.50 µg/g), gallic acid (61.05 µg/g) and homogentisic acid (55.65 µg/g). The total phenolic and flavonoid content was the highest in ethyl acetate extract (322.43 and 6.51 mg/g). The decreasing order of antioxidant activity among the A. scaber leaf extracts assayed through all the three methods was found to be ethyl acetate > butanol > methanol > petroleum ether > water extract.

Optimization of factors influencing in vitro flowering of gherkin (Cucumis anguria L.).

This study investigated the factors influencing in vitro flowering of gherkin (Cucumis anguria L.). Multiple shoots were efficiently regenerated from cotyledonary node and axillary bud explants of C. anguria within 15 days on MSB5 medium containing 3% sucrose and supplemented with 1.5 mg l-1 6-benzyladinine (BA). The elongated shoots were excised and transferred to MSB5 medium containing 4% sucrose supplemented with 0.5 mg l(-1) gibberellic acid (GA(3)) and 1.0 mg l(-1) indole-3-butyric acid (IBA) induced maximum number of flowers (9.5 flowers/plant) and root induction (16.5 roots/plant). Factors that influence the in vitro flowering were optimizing pH, photoperiod and temperature. In vitro flowering was significantly early and higher number of flowers produced at pH (5.8), photoperiod (12/12 h) and room temperature (28 °C). In vitro developed flowers were less viable (80 ± 1.0%) compared to control plants (90 ± 2.0%). Our in vitro flower induction procedures provide an extremely effective method for further research on flowering regulation mechanisms in C. anguria. These plantlets were successfully transferred to the soil where they grew well for 3 to 5 weeks with 90% survivability. Plants grew normally and produced flowers with viable pollen and fertile seeds.

Coronary heart disease risk assessment and characterization of coronary artery disease using coronary CT angiography: comparison of asymptomatic and symptomatic groups.

AIM: To evaluate the prevalence of coronary artery disease (CAD) in relation to risk of coronary heart disease (CHD) and assess plaque characteristics from coronary computed tomography (CT) angiography in asymptomatic and symptomatic patients. MATERIALS AND METHODS: Three hundred and ninety consecutive patients [asymptomatic group, n=138; symptomatic group (atypical or non-anginal chest pain), n=252] were retrospectively enrolled. They were subsequently classified into three CHD risk categories, based on the National Cholesterol Education Program guidelines, and 10 year risks of coronary events were calculated using Framingham risk score. CT was evaluated for stenosis, plaque composition, and coronary calcium scores. RESULTS: CAD was observed in 42% of the asymptomatic group and 62% of the symptomatic group. In the former, the prevalence of CAD in low-, moderate- and high-risk subgroups was 21.4, 47.4 and 65%, respectively, and was 33.3, 74.4, and 72.4% in the symptomatic group. Framingham 10-year risks of coronary events were significantly higher in patients with CAD than in normal participants, and receiver operating characteristics curves showed that discriminatory power was poor in the asymptomatic group and symptomatic men, and good in symptomatic women. Of the participants in the asymptomatic group, 12% exhibited only non-calcified plaques and of the symptomatic group, 7% exhibited only non-calcified plaques. The coronary calcium score was significantly higher for significant stenosis than for non-significant stenosis in both groups. CONCLUSIONS: The prevalence of CAD was not negligible even in subgroups with low-to-moderate CHD risk. Additionally, the Framingham risk score was effective for predicting CAD only in symptomatic women. Coronary calcium scores correlated with significant stenosis; however, a sizeable percentage of both groups had only non-calcified plaques.

Intraspecific relationship analysis by DNA markers and in vitro cytotoxic and antioxidant activity in Eleutherococcus senticosus.

To analyse genetic relationships and intraspecific variation within Eleutherococcus senticosus, the polymerase chain reaction (PCR) was performed on total genomic DNAs of 10 Eleutherococcus collections. Ten primers were used for amplification, yielding 106 bands, of which 87 were polymorphic. The genetic diversity and genetic distance among 10 collections of Eleutherococcus species were used to describe the dendrogram showing the phylogenic relationship. The 10 collections were classified into two groups (groups I and II) at a similarity coefficient of 0.50. Group I included E. senticosus from Bukhaedo (Japan), E. sessliliflorus from Youngwal (Korea), E. seoulense and E. chiisanesis, while group II included several internal and Russian collections. The range of polymorphism was from 66.7 to 90.9% in the 87 amplified polymorphic DNA fragments. The similarity value of all collections ranged from 0.41 to 0.92, and the average genetic distance was 0.61. Thus, RAPD analysis was useful in determining genetic relatedness among collections and in identifying different genotypes of E. senticosus and other Eleutherococcus species. Also, the biological activity on DPPH radical scavenging, antilipid peroxidation in rat liver microsomes and cytotoxic sulforhodamine B (SRB) assay was evaluated using root extracts of E. senticosus, Odaesan, Korea. Ethyl acetate and n-butanol fractionation revealed strong antioxidant against scavenging on DPPH free radical and also ethyl acetate fractionation exhibited high antilipid peroxidative activities. In the cytotoxic effects were evaluated on seven human cancer cell lines, the values of 50% growth inhibition (GI(50)) were mostly below 30 microg/ml for crude extracts to be considered as significantly active.

Feasibility study of treated sewage irrigation on paddy rice culture.

A feasibility study was performed to examine the agronomic application of the treated sewage on paddy rice culture through field experiment. The domestic sewage was treated using a constructed wetland system, a subsurface flow type consisting of sand and macrophyte. The effluent of the wetland system was diluted to maintain the total nitrogen concentration below 25 mg/L and was used as irrigation water. Addition of the treated sewage to the irrigation water showed no adverse effect on the paddy rice culture; in fact some enhancement was noticed in both growth and yield. Irrigation with the treated sewage after the concentration was adjusted accompanied by conventional fertilization showed a better result, with the yield exceeding that of the control where clean water was used, thus suggesting that reuse of the treated sewage as supplemental irrigation water could be a feasible and practical alternative. For a full-scale application, however, further study is recommended on the specific guideline for controlling the major water quality components in the treated sewage.

Molecular cloning and characterization of a tobacco leaf cDNA encoding a phosphate transporter.

Phosphate acquired by roots is translocated to and utilized by the upper part of the plant, where the phosphate transport in the cell is also important in the phosphate metabolism. In order to study the role of the phosphate transporter in the regulation of the phosphate movement across the membranes in leaf cells, we isolated and characterized a 2,059 bp tobacco leaf cDNA clone, NtPT1. The 537 amino acid sequences, deduced from NtPT1, exhibited 93 and 91% identites to one of the high affinity phosphate transporters constitutively expressed in potato and tomato roots, respectively. The NtPT1 contains 12 membrane-spanning domain with a central hydrophilic region. The expression of NtPT1 in the yeast high affinity phosphate transporter mutant strain, NS219, complemented the mutant and promoted cell growth significantly. These results strongly suggest that NtPT1 encodes a functional phosphate transporter and that one of the high affinity phosphate transporters expressed in roots is also expressed in leaves. Southern analysis indicated that tobacco phosphate transporter genes are low copy number genes and members of a small multi-gene family.

Tissue specific and inducible expression of resveratrol synthase gene in peanut plants.

The expression of resveratrol synthase (RS) genes is induced by biotic and abiotic factors in peanut cell cultures. However, little is known about the regulation of the RS gene expression in peanut plants. The expression of RS genes was investigated in peanut plants with a peanut RS clone, pPRS3C, which encodes two polypeptides that show about a 96% amino acid sequence identity to peanut RS2 and RS3, respectively. A low level of RS mRNA was detected in the roots of peanut plants grown aseptically in vitro. In mature peanut plants that were grown in the field, however, RS mRNAs were present at relatively high levels in both the roots and pods, but at below the detection limit in leaves. RS mRNAs were abundant in young pods and decreased dramatically in mature pods. The RS mRNA expression was induced by yeast extract and UV in leaves and roots, and also by wounding in leaves. Stress hormones, such as ethylene, jasmonic acid, and salicylic acid, induced RS mRNA accumulation in leaves. These results indicate that the RS gene expression is induced by biotic and abiotic stresses through the stress hormones in peanut plants. The induction of the RS gene expression by biotic and abiotic stresses could provide peanut plants with protection from microbial infections through resveratrol synthesis. The RS gene expression in developing pods has significant implications in terms of the role of resveratrol as a phytochemical for human health.

Application of flow injection--chemiluminescence to the study of radical scavenging activity in plants.

Chemiluminescence (CL) was observed during the oxidation of luminol (2 mg/L). mediated by 0.06% hydrogen peroxide (H(2)O(2)) and cytochrome c (10 mg/L). CL intensity was decreased by the presence of radical scavengers and the reduction was linearly proportional to the concentration and ability of scavengers; butylated hydroxytoluene (BHT), caffeic acid and gallic acid. The order of effectiveness as radical scavengers was gallic acid > caffeic acid > BHT, which shows that the number of hydroxyl groups (OH) in the B-ring of flavonoids plays a key role in a good radical scavenging activity. Of eight catechins obtained from green tea extracts, (-)-catechin was the least effective and (-)-epigallocatechin gallate (EGCg) showed the strongest activity. This result indicates that the stereoscopic structure between the C-3 group and the B ring of flavonoids as well as substituents at the C-3 position make a contribution to radical scavenging activity. Of the tested Chinese herbal ingredients, five species of ingredients represented more than 90% of the radical scavenging activity.

Clonal architecture of normal and atherosclerotic aorta: implications for atherogenesis and vascular development.

X chromosome inactivation studies indicate that smooth muscle cells in human atherosclerosis are monoclonal. Monoclonality could arise either by 1) proliferation of a single cell in the adult intima, eg, by selection or mutation, or 2) proliferation of many cells within a large, pre-existing clonal patch that formed during development. To determine whether clonal expansion occurs concomitantly with plaque growth or as part of normal development, X chromosome inactivation patterns were mapped in microdissected samples of aortic smooth muscle, using the human androgen receptor locus as a marker. As expected, 43% of plaque samples were skewed toward one X chromosome, indicating a monoclonal population. Surprisingly, 25% of normal medial samples and 31% of diffuse intimal thickening samples also were skewed toward one X chromosome, indicating a relatively large patch size. Furthermore, 30% of diffuse intimal thickening and 22% of medial samples showed contiguous regions of 4 mm skewed to the same allele, showing that patch length often exceeded 4 mm. Intima and overlying media typically were skewed to the same allele (73% concordance), suggesting common cells of origin. Because patch size is large in normal arteries, X-inactivation analysis cannot discriminate between a monoclonal and a polyclonal origin of plaque smooth muscle cells. We propose that human arteries grow by expanding coherent smooth muscle clones, with little mixing of adjacent clones. Determining whether plaques arise by clonal expansion will require other approaches, such as analysis of somatic mutations; the finding of large X-inactivation patches raises the possibility that plaques arise from a pre-existing (developmental) clone.

'Bad trips'.

This article attempts to convey the experiences of a medical team at a 'rock' music festival involving 45,000 people. An important impression was the complexity of drug combinations used experimentally and the demands on the therapist of detoxification without use of other drugs.