Emergency Healthcare Providers' Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department.

This study aimed to explore and compare knowledge levels about advance directives (ADs) and life-sustaining treatment (LST) plans in end-of-life patients between emergency nurses and emergency medical technicians (EMTs). Using a cross-sectional study design and convenience sampling, 96 nurses and 68 EMTs were recruited from 12 emergency medical centers. A survey on knowledge about and attitudes toward ADs was performed using both online and offline methods between November and December 2019. Emergency healthcare providers were conceptually knowledgeable regarding ADs and LST, although approximately half or fewer had knowledge about ADs (such as the legal process for preparation, family or healthcare providers' role, and the healthcare proxy). The knowledge levels of nurses and EMTs were moderate. Nurses had significantly greater knowledge relative to EMTs about ADs and LST. Positive attitudes of emergency healthcare providers were also moderately low, with nurses having less positive views than EMTs. Significant differences regarding ADs were found, with younger emergency healthcare providers having fewer career years, no personal end-of-life experiences, and less need for ADs having less knowledge. Emergency healthcare providers' knowledge about and attitudes toward ADs were moderately low, with EMTs demonstrating a greater knowledge deficit and nurses exhibiting lower positive attitudes. Younger and novice providers had lower knowledge, but younger providers had more positive attitudes, implying that professional education and training should begin early in their careers to enhance their confidence for emergency delivery of advanced care planning.

Alteration of fatty acid oxidation by increased CPT1A on replicative senescence of placenta-derived mesenchymal stem cells.

BACKGROUND: Human placenta-derived mesenchymal stem cells (PD-MSCs) are powerful sources for cell therapy in regenerative medicine. However, a limited lifespan by senescence through mechanisms that are well unknown is the greatest obstacle. In the present study, we first demonstrated the characterization of replicative senescent PD-MSCs and their possible mitochondrial functional alterations. METHODS: Human PD-MSCs were cultured to senescent cells for a long period of time. The cells of before passage number 8 were early cells and after passage number 14 were late cells. Also, immortalized cells of PD-MSCs (overexpressed hTERT gene into PD-MSCs) after passage number 14 were positive control of non-senescent cells. The characterization and mitochondria analysis of PD-MSCs were explored with long-term cultivation. RESULTS: Long-term cultivation of PD-MSCs exhibited increases of senescent markers such as SA-ß-gal and p21 including apoptotic factor, and decreases of proliferation, differentiation potential, and survival factor. Mitochondrial dysfunction was also observed in membrane potential and metabolic flexibility with enlarged mitochondrial mass. Interestingly, we founded that fatty acid oxidation (FAO) is an important metabolism in PD-MSCs, and carnitine palmitoyltransferase1A (CPT1A) overexpressed in senescent PD-MSCs. The inhibition of CPT1A induced a change of energy metabolism and reversed senescence of PD-MSCs. CONCLUSIONS: These findings suggest that alteration of FAO by increased CPT1A plays an important role in mitochondrial dysfunction and senescence of PD-MSCs during long-term cultivation.

Effect of zinc on the collagen degradation in acid-etched dentin.

BACKGROUND/PURPOSE: Matrix metalloproteinases (MMPs) play a crucial role in the pathogenesis of dental caries, collapse of adhesive interface, and chemical erosion of teeth. The objective of this study was to investigate the inhibitory effect of zinc on collagen degradation. MATERIALS AND METHODS: Human dentin was ground and demineralized by citric acid (pH 2.0). The demineralized ground dentin was incubated in six different media: artificial saliva (AS); 5 mg/ml doxycycline in AS; 3.33, 6.82, 13.63, and 27.26 mg/ml of zinc chloride (Zn) in AS. Each group was divided into two subgroups, and active MMP-2 was incorporated into one subgroup. Specimens were incubated for 24 h, 1 week, and 2 weeks. Collagen degradation product was assessed using ELISA. The results were analyzed using repeated measured ANOVA and Duncan's post hoc analysis (α = 0.05). RESULTS: The amount of collagen degradation was the lowest in Doxy group. Zn groups showed a significant inhibitory effect in collagen degradation for all concentrations (P < 0.05). In subgroups without exogenous MMP-2, zinc-mediated inhibition increased in a concentration-dependent manner with increasing zinc concentration. The amount of collagen degradation product slightly increased with increased incubation time from 24 h to 2 weeks. However, in subgroups with exogenous MMP, the inhibitory effect of zinc on collagen degradation did not depend on zinc concentration. CONCLUSION: All Zn groups for the four concentrations tested exhibited statistically significant inhibitory effect on collagen degradation.

Ultrasound contrast-enhanced study as an imaging biomarker for anti-cancer drug treatment: preliminary study with paclitaxel in a xenograft mouse tumor model (secondary publication).

PURPOSE: The purpose of this study was to assess tumor angiogenesis using contrast-enhanced ultrasonography (CEUS) of human prostate cancer cells (PC3) that were implanted in mice before and after paclitaxel injection. METHODS: Twelve mice were injected with human PC3. The mice were grouped into two groups; one was the paclitaxel-treated group (n=6) and the other was the control group (n=6). Before administering paclitaxel into the peritoneal cavity, baseline CEUS was performed after the administration of 500 µL (1×108 microbubbles) of contrast agent. The area under the curve (AUC) up to 50 seconds after injection was derived from the time-intensity curves. After injection of paclitaxel or saline, CEUS studies were performed at the 1-week follow-up. Changes in tumor volume and the AUC in both two groups were evaluated. After CEUS, the microvessel density (MVD) was compared between the groups. RESULTS: In the paclitaxel-treated group, the AUC from CEUS showed a significant decrease 1-week after paclitaxel administration (P=0.030), even though the tumor volume showed no significant changes (P=0.116). In the control group, there was no significant decrease of the AUC (P=0.173). Pathologically, there was a significant difference in MVD between both groups (P=0.002). CONCLUSION: The AUC from the time intensity curve derived from CEUS showed an early change in response to the anti-cancer drug treatment that preceded the change in tumor size. The findings of CEUS could serve as an imaging biomarker for assessing tumor responses to anti-cancer drug treatment.

Evaluation of tumor angiogenesis in a mouse PC-3 prostate cancer model using dynamic contrast-enhanced sonography.

OBJECTIVES: The purpose of this study was to evaluate tumor angiogenesis in a mouse xenograft model injected with human PC-3 prostate cancer cells using contrast-enhanced sonography. METHODS: Sixteen nude mice were injected with human prostate cancer cells on the back or the flank. Contrast-enhanced sonography was performed with a 5- to 12-MHz broadband linear transducer after a 500-µL bolus injection of a sonographic contrast agent composed of lipid shells and sulfur hexafluoride. Contrast-enhanced sonograms were obtained by the pulse inversion coded harmonic technique with a low mechanical index of 0.07. A region of interest was drawn to encompass the tumor, and time-intensity curves were acquired. After fitting the curve by a gamma variate function, the maximum intensity, area under the curve for up to 50 seconds, time to peak, shape parameter, and scale parameter were derived. The tumor volume, percentage of vascular endothelial growth factor expression, and CD31-positive vessel count (microvessel density) were correlated with the parameters derived from the time-intensity curve. RESULTS: The maximum intensity was positively correlated with the microvessel density with statistical significance (r = 0.552; P = .03). The percentage of vascular endothelial growth factor expression did not have any correlation with the parameters from the curve. CONCLUSIONS: Contrast-enhanced sonography can reflect tumor vascularity in a prostate cancer animal model. Sonography of tumor angiogenesis may permit functional assessment of the tumor vasculature and provide an imaging biomarker for tumor responses to antiangiogenic therapies.

Preparation, characterization, cytotoxicity and drug release behavior of liposome-enveloped paclitaxel/Fe3O4 nanoparticles.

Phospholipid vesicles encapsulating magnetic nanoparticles (liposome complexes) have been prepared for targeting a drug to a specific organ using a magnetic force, as well as for local hyperthermia therapy. Liposome complexes are also an ideal platform for use as contrast agents of magnetic resonance imaging (MRI). We describe the preparation and characterization of liposomes containing magnetite. These liposomes were obtained by thin film hydration method and Fe3O4 nanoparticles were synthesized by coprecipitation method. They were characterized by an electrophoretic light scattering spectrophotometer, the liposome complexes were subsequently coated using chitosan. We have further investigated the ability of the above formulation for drug delivery and MRI applications. We are specifically interested in evaluating our liposome complexes for drug therapy; hence, we selected paclitaxel for the combination study. The amount of paclitaxel was measured at 227 nm using a UV-Vis spectrophotometer. Cytotoxicity of liposome complexes was treated with the various concentrations of paclitaxel in PC3 cell lines. The structure and properties of liposome complexes were analyzed by FT-IR, XRD and VSM. The particle size was analyzed by TEM and DLS.

Arsenic trioxide concentration determines the fate of Ewing's sarcoma family tumors and neuroblastoma cells in vitro.

Arsenic trioxide (As(2)O(3)) induces both the differentiation and apoptosis of acute promyelocytic leukemia cells in a concentration dependent manner. We assessed the effects of As(2)O(3) in CADO-ES Ewing's sarcoma (ES), JK-GMS peripheral primitive neuroectodermal tumor (PNET), and SH-SY5Y neuroblastoma cells, as they share common histogenetic backgrounds. As(2)O(3) at low concentrations (0.1-1 microM) induced SH-SY5Y differentiation, and whereas PNET cells acquired a slightly differentiated phenotype, change was minimal in ES cells. Extracellular signal-regulated kinase 2 (ERK2) was activated at low As(2)O(3) concentrations, and PD98059, an inhibitor of MEK-1, blocked SH-SY5Y cell differentiation by As(2)O(3). High concentrations (2-10 microM) of As(2)O(3) induced the apoptosis in all three cell lines, and this was accompanied by the activation of c-jun N-terminal kinase. The generation of H(2)O(2) and activation of caspase 3 were identified as critical components of As(2)O(3)-induced apoptosis in all of the above cell lines. Fibroblast growth factor 2 enhanced As(2)O(3)-induced apoptosis in JK-GMS cells. The overall effects of As(2)O(3) strongly suggest that it has therapeutic potential for the treatment of ES/PNET.

Proteome analysis of human amnion and amniotic fluid by two-dimensional electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

Proteome analysis by 2-DE and PMF by MALDI-TOF MS was performed on human amnion and amniotic fluid at term. Ninety-two soluble and nineteen membrane proteins were identified from amnion. Thirty-five proteins were identified from amniotic fluid. Calgranulin A and B were found in all patients infected with Ureaplasma urealyticum, but not in any of the patients without infection, indicating that they are potential markers of intrauterine infection. Identity of calgranulin A and B was confirmed by MALDI-TOF/TOF MS. This study represents the first extensive analysis of the human amnion and amniotic fluid proteome at term and demonstrates that 2-DE and MALDI-TOF MS is a useful tool for identifying clinically significant biomarkers of problematic pregnancies.

Crushing the circumflex stent arm in a case of proximal peristent restenosis after kissing stent for the distal left main disease.

We present a case of proximal peristent restenosis after kissing stenting in the distal left main lesion. The patient was treated by crushing the proximal portion of the circumflex stent after passing through the stent arm in the left anterior descending.

Feasibility of the radial artery as a vascular access route in performing primary percutaneous coronary intervention.

We aimed to evaluate the feasibility of transradial primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI) by comparing the procedural results and complications with those of transfemoral intervention. From April 1997 to October 2004, we enrolled 352 consecutive cases of STEMI who underwent primary PCI. The femoral route was used in 132 cases (TFI group) and the radial route was used in 220 cases (TRI group). Cases with Killips class IV, a negative Allen test or a non-palpable radial artery were excluded from our study. Baseline clinical and angiographic profiles were comparable in both groups. Vascular access time was 3.8 +/- 3.5 min in the TFI group and 3.6 +/- 3.1 min in the TRI group, and cath room to reperfusion time was 25 +/- 11 min in the TRI group and 26 +/- 13 min in the TRI group. The procedural success rate was 89% in the TFI group and 88% in the TRI group. Crossover occurred in 9 cases (4%) due to approaching vessel tortuosity in the TRI group. Major access site complications occurred in 7 cases (5%) in the TFI group, and there were no complications in the TRI group (p < 0.001). Although radial occlusion occurred in 5 cases of the TRI group, there was no evidence of hand ischemia. The total hospital stay was significantly shorter in TRI group than in TFI group. In conclusion, use of the radial artery might be a potential vascular access route in performing primary PCI in selected cases.

Percutaneous coronary stenting in guide-induced aortocoronary dissection: angiographic and CT findings.

We report here on a case of accidental aortocoronary dissection that occurred during the engagement of a guiding catheter. This resulted in an antegrade dissection into the right coronary artery, and a retrograde extension of the dissection into the Sinus of Valsalva and the ascending aorta up to the aortic arch. It was successfully treated with a stent deployment at the RCA ostium; this restored optimal coronary blood flow and there was a complete resolution of the aortic dissection as was documented by coronary angiography and the follow-up CT scan.

Differential activation of mitogen activated protein kinases and nuclear factor-kappaB in lipopolysaccharide-treated term and preterm amnion cells.

Intrauterine exposure to amniotic sac infection elicits an inflammatory response from the fetus, which is associated with elevated levels of fetal plasma proinflammatory cytokines, i.e. interleukin-6 (IL-6). We have recently demonstrated that the severity of fetal inflammatory response in terms of gestation period is greater in preterm fetuses than in term fetuses. The activation of mitogen activated protein kinases (MAPKs) and nuclear factor kappa B (NF-kappaB) is known to be associated with up-regulation of proinflammatory cytokine gene expression in many cell types. In the present study, therefore, we studied patterns of MAPK and NF-kappaB activation following treatment with bacterial lipopolysaccharide (LPS) in amnion cells obtained from placentas of varying gestational ages to assess whether or not MAPKs and NF-kappaB are differentially regulated during gestation. MAPK phosphorylation was investigated by immunoblot analysis with phosphospecific antibodies. Transient phosphorylations of extracellular signal-regulated kinase (ERK) 1/2 and c-Jun N-terminal kinase (JNK) were observed in LPS-treated amnion cells, with the degree of phosphorylation being more pronounced in preterm cases. The results of NF-kappaB-dependent reporter gene expression and electrophoretic mobility shift assay (EMSA) of NF-kappaB were similar to those of ERK 1/2 and JNK activity. To assess whether the results of in vitro observations reflected in vivo results, we further analyzed amniotic fluid and cord blood IL-6 levels in preterm deliveries with placental inflammation. The analysis also revealed a significantly higher level of IL-6 in cases of

Broken guidewire fragment in the radio-brachial artery during transradial sheath placement: percutaneous retrieval via femoral approach.

A case in which a 0.014" wire was broken during the sheath placement in the radial artery for transradial coronary procedure is described here, and a successful retrieval of it using conventional methods is also described. Through the left femoral artery, the 6 Fr guiding catheter was advanced down to the tip of the broken wire at the brachial artery, and the distal part of the broken guidewire was captivated into the guiding catheter. By inflating the balloon catheter inside of the guiding catheter, seized broken guidewire between the inflated balloon and the guiding catheter was removed successfully by withdrawing the whole system en bloc.

Fibroblast growth factor 2 induces differentiation and apoptosis of Askin tumour cells.

Peripheral primitive neuroectodermal tumour (PNET)/Ewing's sarcoma (ES) and neuroblastoma (NB) are related tumours of neural crest origin with primitive neural characteristics. Fibroblast growth factor 2 (FGF2) is a critical signalling molecule for primitive neural crest cells. The treatment of NB cells with FGF2 variably affects biological characteristics such as growth and differentiation, while in PNET/ES, FGF2 predominantly induces apoptosis. The JK-GMS Askin tumour cell line can be induced to differentiate upon treatment with nerve growth factor (NGF), indicating the integrity of the cellular machinery necessary for differentiation. The present study assesses whether FGF2 can induce differentiation in JK-GMS cells. JK-GMS cells expressed high-affinity FGF receptors (FGFRs), and treatment with FGF2 induced phosphorylation of FGFR1 together with activation of extracellular signal-regulated kinases (ERK1/ERK2) and c-Jun N-terminal kinase (JNK). Subsequent biological effects were growth inhibition, neuronal differentiation, and apoptosis, and these changes were associated with increased expression of neurofilaments, reduction of c-myc and bcl-2 expression, and activation of caspase 3. Treatment of the cells with a specific inhibitor of the MAPK/extracellular signal-regulated kinase (MEK)-1, PD98059, predominantly inhibited the effects of FGF2 on growth, differentiation, and apoptosis, while an inhibitor of JNK reduced apoptosis, indicating that the ERK1/2 and JNK pathways are critical components of FGF2-mediated effects in JK-GMS cells. Additional comparative analyses of FGF2-mediated effects in two ES cell lines (CADO-ES, RD-ES) and a PNET cell line (SK-N-MC) showed pronounced differentiation in SK-N-MC, but not in CADO-ES or RD-ES cells. This study demonstrates that FGF2 can induce neuronal differentiation of PNET including Askin tumour. These findings clearly indicate that the FGF2-mediated signalling pathway plays a critical role in controlling the major properties of PNET cells and may provide a potential therapeutic target for PNET.