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van den Eijnde W, Heus R, Falcone D, Peppelman M, van Erp P. Skin Barrier Impairment due to the Occlusive Effect of Firefighter Clothing. Ann Work Expo Health 2020; 64:331-337. [PMID: 32016377 PMCID: PMC7571499 DOI: 10.1093/annweh/wxaa005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/09/2019] [Accepted: 01/09/2020] [Indexed: 11/29/2022] Open
Abstract
At fire scenes, firefighters are exposed to potentially harmful substances. Besides inhalation of these products, also skin contamination and the risk of dermal absorption is getting more attention. In this perspective, skin barrier impairment due to the occlusive effect of firefighter clothes could enhance the risk of penetration of hazardous substances. The effect of a firefighter jacket and cellophane on the skin was studied in a paired comparison involving 16 volunteers. Biophysical parameters were measured before, immediately after and 30 min after ending the occlusion. Reflectance confocal microscopy was used to study the skin morphology. Immediately after wearing a firefighter jacket, Transepidermal Water Loss values were significantly increased. This is an indication of an occlusive effect of the firefighter jacket. The skin barrier was fully restored after 30 min after occlusion with cellophane or wearing a firefighter jacket.
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Affiliation(s)
- Wilbert van den Eijnde
- Radboud University Nijmegen Medical Centre, Department of Dermatology, GL Nijmegen, The Netherlands
| | - Ronald Heus
- Institute for Safety, Knowledge Center Occupational Safety, RP Zoetermeer, The Netherlands
| | - Denise Falcone
- Radboud University Nijmegen Medical Centre, Department of Dermatology, GL Nijmegen, The Netherlands
| | - Malou Peppelman
- Radboud University Nijmegen Medical Centre, Department of Dermatology, GL Nijmegen, The Netherlands
| | - Piet van Erp
- Radboud University Nijmegen Medical Centre, Department of Dermatology, GL Nijmegen, The Netherlands
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van Erp PEJ, Peppelman M, Falcone D. Noninvasive analysis and minimally invasive in vivo experimental challenges of the skin barrier. Exp Dermatol 2019; 27:867-875. [PMID: 30019358 DOI: 10.1111/exd.13743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/27/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
In this review, we aim to give a concise and selective overview of noninvasive biophysical analysis techniques for skin barrier analysis (transepidermal water loss, electrical methods, confocal Raman microspectroscopy, sebumeter, reflectance spectrophotometry, tristimulus colorimetry, diffuse reflectance spectroscopy and reflectance confocal microscopy), including advantages and limitations. Rather than giving an exhaustive description of the many techniques currently available, we show the usefulness of a representative selection of techniques in the functional and morphological evaluation of the skin barrier. Furthermore, we introduce human minimally invasive skin challenging models as a means to study the mechanisms regulating skin homoeostasis and disease and subsequently show how biophysical analysis techniques can be combined with these in vivo skin challenging models in the functional and morphological evaluation of the skin barrier in healthy human skin. We are convinced that the widespread application of biophysical analysis techniques in dermatological practice and in cosmetic sciences will prove invaluable in offering personalized and noninvasive skin treatment solutions. Furthermore, combining the human in vivo challenging models with these novel noninvasive techniques will provide valuable methodology and tools for detailed characterization of the skin barrier in health and disease.
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Affiliation(s)
- Piet E J van Erp
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Malou Peppelman
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Denise Falcone
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Falcone D, Uzunbajakava NE, van Abeelen F, van Erp PEJ, van de Kerkhof PCM. Effects of red light on inflammation and skin barrier recovery following acute perturbation. Pilot study results in healthy human subjects. Photodermatol Photoimmunol Photomed 2018; 35:275-276. [PMID: 30520139 DOI: 10.1111/phpp.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/24/2018] [Accepted: 11/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Denise Falcone
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Piet E J van Erp
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
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Falcone D, Uzunbajakava NE, van Abeelen F, Oversluizen G, Peppelman M, van Erp PEJ, van de Kerkhof PCM. Effects of blue light on inflammation and skin barrier recovery following acute perturbation. Pilot study results in healthy human subjects. Photodermatol Photoimmunol Photomed 2017; 34:184-193. [PMID: 29150968 DOI: 10.1111/phpp.12367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE While growing evidence supports the therapeutic effect of 453 nm blue light in chronic inflammatory skin diseases, data on its effects on acutely perturbed human skin are scarce. In this study, we investigated the impact of 453 nm narrow-band LED light on healthy skin following acute perturbation. METHODS Tape stripping and histamine iontophoresis were performed on the forearm of 22 healthy volunteers on 2 consecutive weeks. In 1 week, challenges were followed by irradiation for 30 minutes. In the other week (control), no light was administered. Reactions were evaluated up to 72 hours thereafter by transepidermal water loss (TEWL), diffuse reflectance spectroscopy, and skin surface biomarkers. RESULTS Skin barrier disruption resulted in upregulation of IL-1α at 24 hours after tape stripping (P = .029). In contrast, irradiation abrogated this effect (P > .05). Irradiation also resulted in higher TEWL at 24 hours and in higher b* value at 72 hours after tape stripping compared to the control (P = .034 and P = .018, respectively). At 30 minutes following histamine iontophoresis and irradiation, a trend toward a higher a* value compared to the control was observed (P = .051). CONCLUSION We provide the first in vivo evidence that blue light at 453 nm exerts biological effects on acutely perturbed healthy human skin.
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Affiliation(s)
- Denise Falcone
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Malou Peppelman
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Piet E J van Erp
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Falcone D, Spee P, van de Kerkhof PCM, van Erp PEJ. Minimally-invasive Sampling of Interleukin-1α and Interleukin-1 Receptor Antagonist from the Skin: A Systematic Review of In vivo Studies in Humans. Acta Derm Venereol 2017; 97:1066-1073. [PMID: 28536733 DOI: 10.2340/00015555-2709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Interleukin-1α (IL-1α) and its receptor antagonist IL-1RA play a pivotal role in skin homeostasis and disease. Although the use of biopsies to sample these cytokines from human skin is widely employed in dermatological practice, knowledge about less invasive, in vivo sampling methods is scarce. The aim of this study was to provide an overview of such methods by systematically reviewing studies in Medline, EMBASE, Web of Science and Cochrane Library using combinations of the terms "IL-1α", IL-1RA", "skin", "human", including all possible synonyms. Quality was assessed using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. The search, performed on 14 October 2016, revealed 10 different sampling methods, with varying degrees of invasiveness and wide application spectrum, including assessment of both normal and diseased skin, from several body sites. The possibility to sample quantifiable amounts of cytokines from human skin with no or minimal discomfort holds promise for linking clinical outcomes to molecular profiles of skin inflammation.
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Affiliation(s)
- Denise Falcone
- Department of Dermatology, Radboud university medical center, 6500HB Nijmegen, The Netherlands
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Falcone D, Uzunbajakava N, van Abeelen F, Oversluizen G, Peppelman M, van Erp P, van de Kerkhof P. 503 Effects of blue light on inflammation and skin barrier recovery following acute perturbation. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Falcone D, Uzunbajakava N, Richters R, van de Kerkhof PC, van Erp PE. Histamine Iontophoresis as in vivo Model to Study Human Skin Inflammation with Minimal Barrier Impairment: Pilot Study Results of Application of the Model to a Sensitive Skin Panel. Skin Pharmacol Physiol 2017; 30:246-259. [DOI: 10.1159/000477416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/09/2017] [Indexed: 11/19/2022]
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Falcone D, Richters RJH, Uzunbajakava NE, van Erp PEJ, van de Kerkhof PCM. Risk factors associated with sensitive skin and potential role of lifestyle habits: a cross-sectional study. Clin Exp Dermatol 2017; 42:656-658. [DOI: 10.1111/ced.13133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2016] [Indexed: 11/28/2022]
Affiliation(s)
- D. Falcone
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
| | - R. J. H. Richters
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
| | - N. E. Uzunbajakava
- Philips Research; Philips Electronics Nederland B.V.; Eindhoven The Netherlands
| | - P. E. J. van Erp
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
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Richters RJH, Falcone D, Uzunbajakava NE, Varghese B, Caspers PJ, Puppels GJ, van Erp PEJ, van de Kerkhof PCM. Sensitive Skin: Assessment of the Skin Barrier Using Confocal Raman Microspectroscopy. Skin Pharmacol Physiol 2017; 30:1-12. [PMID: 28122376 DOI: 10.1159/000452152] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/27/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND/AIMS Sensitive skin (SS), a frequently reported condition in the Western world, has been suggested to be underlined by an impaired skin barrier. The aim of this study was to investigate the skin barrier molecular composition in SS subjects using confocal Raman microspectroscopy (CRS), and to compare it with that of non-SS (NSS) individuals as well as atopic dermatitis (AD) and allergic rhinoconjunctivitis (AR) subjects, who frequently report SS. METHODS Subjects with SS (n = 29), NSS (n = 30), AD (n = 11), and AR (n = 27) were included. Stratum corneum (SC) thickness, water, ceramides/fatty acids, and natural moisturizing factor (NMF) were measured by CRS along with transepidermal water loss and capacitance on the ventral forearm, thenar, and cheek. Sebum levels were additionally measured on the forearm and cheek. RESULTS No differences between SS and NSS subjects were found regarding SC thickness, water, and NMF content, yet a trend towards lower ceramides/fatty acids was observed in the cheek. Compared to AD subjects, the SS group showed higher ceramides/fatty acid content in the forearm, whereas no differences emerged with AR. The correlation of macroscopic biophysical techniques and CRS was weak, yet CRS confirmed the well-known lower content of NMF and water, and thinner SC in subjects with filaggrin mutations. CONCLUSION The skin barrier in SS is not impaired in terms of SC thickness, water, NMF, and ceramides/fatty acid content. The failure of biophysical techniques to follow alterations in the molecular composition of the skin barrier revealed by CRS emphasizes a strong need in sensitive and specific tools for in vivo skin barrier analysis.
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Affiliation(s)
- Renée J H Richters
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, The Netherlands
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Falcone D, Spee P, Salk K, Peppelman M, van de Kerkhof PCM, van Erp PEJ. Measurement of skin surface biomakers by Transdermal Analyses Patch following different in vivo
models of irritation: a pilot study. Skin Res Technol 2016; 23:336-345. [DOI: 10.1111/srt.12340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 01/01/2023]
Affiliation(s)
- D. Falcone
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
| | - P. Spee
- FibroTX LLC; Tallinn Estonia
| | - K. Salk
- FibroTX LLC; Tallinn Estonia
| | - M. Peppelman
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - P. E. J. van Erp
- Department of Dermatology; Radboud University Medical Center; Nijmegen The Netherlands
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Falcone D, Uzunbajakava N, Peppelman M, Salk K, Spee P, van de Kerkhof P, van Erp P. 112 Assessment of skin perturbation by means of non-invasive in vivo measurement of inflammatiory biomarkers and confocal reflectance microscopy. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Uzunbajakava N, Richters R, Falcone D, Caspers P, Puppels G, van Erp P, van de Kerkhof P. 104 Understanding sensitive skin: a role of inflammation, mast cells, and skin barrier. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Richters RJH, Uzunbajakava NE, Falcone D, Hendriks JCM, Jaspers EJ, van de Kerkhof PCM, van Erp PEJ. Clinical, biophysical and immunohistochemical analysis of skin reactions to acute skin barrier disruption - a comparative trial between participants with sensitive skin and those with nonsensitive skin. Br J Dermatol 2016; 174:1126-33. [PMID: 26595057 DOI: 10.1111/bjd.14307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- R J H Richters
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, the Netherlands
| | - N E Uzunbajakava
- Philips Research, Philips Electronics Nederland B.V., Eindhoven, the Netherlands
| | - D Falcone
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, the Netherlands
| | - J C M Hendriks
- Radboud Institute for Health Sciences (RIHS), Nijmegen, the Netherlands
| | - E J Jaspers
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, the Netherlands
| | | | - P E J van Erp
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, the Netherlands
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Richters RJH, Hendriks JCM, Uzunbajakava NE, Janssen LD, Falcone D, van Erp PEJ, van de Kerkhof PCM. Responses to sodium dodecyl sulphate as an in vivo human model to study the pathomechanisms underlying sensitive skin. Exp Dermatol 2016; 25:407-9. [PMID: 26896835 DOI: 10.1111/exd.12973] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Renée J H Richters
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, The Netherlands
| | - Jan C M Hendriks
- Radboud Institute for Health Sciences (RIHS), Nijmegen, The Netherlands
| | | | - Lisanne D Janssen
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, The Netherlands
| | - Denise Falcone
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, The Netherlands
| | - Piet E J van Erp
- Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, The Netherlands
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Falcone D, Uzunbajakava NE, Varghese B, de Aquino Santos GR, Richters RJH, van de Kerkhof PCM, van Erp PEJ. Microspectroscopic Confocal Raman and Macroscopic Biophysical Measurements in the in vivo Assessment of the Skin Barrier: Perspective for Dermatology and Cosmetic Sciences. Skin Pharmacol Physiol 2015; 28:307-17. [PMID: 26406586 DOI: 10.1159/000439031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022]
Abstract
Skin barrier function, confined to the stratum corneum, is traditionally evaluated using established, noninvasive biophysical methods like transepidermal water loss, capacitance and conductance. However, these methods neither measure skin molecular composition nor its structure, hindering the actual causes of skin barrier change or impairment. At the same time, confocal Raman microspectroscopy (CRS) can directly measure skin molecular composition and structure and has proven itself to be a powerful technique for biomolecular analysis. The aims of this literature review were to evaluate noninvasive biophysical methods in view of CRS and to outline a direction towards more specific and informative skin measurement methods. We address this by investigating, for the first time, the relation between in vivo assessment of the skin barrier using indirect biophysical methods and the actual skin composition and structure as given by CRS, and emphasize the high potential of CRS for dermatology and cosmetic sciences. CRS acceptance in these fields will require close collaboration between dermatologists, skin scientists and spectroscopy experts towards simplifying the technology and creating robust, rapid, easy-to-use and less expensive CRS applications.
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Affiliation(s)
- Denise Falcone
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Richters R, Falcone D, Uzunbajakava N, Verkruysse W, van Erp P, van de Kerkhof P. What Is Sensitive Skin? A Systematic Literature Review of Objective Measurements. Skin Pharmacol Physiol 2014; 28:75-83. [DOI: 10.1159/000363149] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/23/2014] [Indexed: 11/19/2022]
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Gallelli L, Galasso O, Falcone D, Southworth S, Greco M, Ventura V, Romualdi P, Corigliano A, Terracciano R, Savino R, Gulletta E, Gasparini G, De Sarro G. The effects of nonsteroidal anti-inflammatory drugs on clinical outcomes, synovial fluid cytokine concentration and signal transduction pathways in knee osteoarthritis. A randomized open label trial. Osteoarthritis Cartilage 2013; 21:1400-8. [PMID: 23973155 DOI: 10.1016/j.joca.2013.06.026] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 06/20/2013] [Accepted: 06/27/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We investigated the effects of celecoxib, diclofenac, and ibuprofen on the disease-specific quality of life, synovial fluid cytokines and signal transduction pathways in symptomatic knee osteoarthritis (OA). DESIGN Ninety patients scheduled for a total knee arthroplasty (TKA) were randomized to six groups that were treated with low and high dosages of celecoxib, diclofenac or ibuprofen. At the time of the first admission (T0) and at surgery (T1 = 14 days after beginning of the nonsteroidal anti-inflammatory drugs (NSAIDs)), samples of knee synovial fluid were obtained from each patient for analysis. During the surgery the synovial tissue was harvested from the knee of patients. The Western Ontario and McMaster universities (WOMAC) score was used to evaluate the patient disease-specific quality of life at T0 and T1. Microarray tests performed at T0 and T1 were used to evaluate the effects of NSAIDs on Tumor necrosis factor (TNF)-alpha, Interleukin-6 (IL-6), IL8 and Vascular endothelial growth factor (VEGF) concentration in the synovial fluid. Western blot assays evaluated the effects of NSAIDs on MAP kinase (MAPK) signal transduction pathway in the synovial membrane. RESULTS NSAID treatment induced a statistically significant improvement in the WOMAC score and a statistically significant decrease in the IL-6, VEGF and TNF-alpha concentration in the synovial fluid. Higher dosages of NSAIDs provided a greater improvement in the disease-specific quality of life of patients and lower concentrations of pro-inflammatory cytokines in the synovial fluid. Inhibition of MAPKs was noted after NSAID treatment. CONCLUSION Short-term NSAID treatment improves the patient disease-specific quality of life with a parallel decrease in pro-inflammatory synovial fluid cytokine levels in knee OA. Signal transduction pathways may be involved in regulating the anti-inflammatory effects of NSAIDs. ClinicalTrial.gov: NCT01860833.
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Affiliation(s)
- L Gallelli
- Department of Health Science, School of Medicine, Magna Græcia University, Catanzaro, Italy
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Falcone D, Gallelli L, Di Virgilio A, Tucci L, Scaramuzzino M, Terracciano R, Pelaia G, Savino R. Effects of simvastatin and rosuvastatin on RAS protein, matrix metalloproteinases and NF-κB in lung cancer and in normal pulmonary tissues. Cell Prolif 2013; 46:172-82. [PMID: 23510472 DOI: 10.1111/cpr.12018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/17/2012] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES In this study, we have evaluated effects of 24-hour treatments with simvastatin or rosuvastatin on RAS protein, NF-κB and MMP expression in LC tissues obtained from 12 patients undergoing thoracic surgery. MATERIALS AND METHODS Normal and lung tumour tissues obtained from each sample were exposed to simvastatin (2.5-30 μm) or rosuvastatin (1.25-30 μm) and western blot analysis was then performed. RESULTS We documented increased expression of proteins, MMP-2, MMP-9 and NF-κB-p65 in LC tissues, with respect to normal tissues (P < 0.01). In the malignant tissues, simvastatin and rosuvastatin significantly (P < 0.01) and dose-dependently reduced RAS protein, MMP-2/9 and NF-κB-p65 expression. CONCLUSIONS In conclusion, our results suggest that simvastatin and rosuvastatin could play a role in LC treatment by modulation of RAS protein, MMP-2/9 and NF-κB-p65.
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Affiliation(s)
- D Falcone
- Department of Health Science, School of Medicine, University of Catanzaro, Catanzaro, Italy
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Pelaia G, Gallelli L, Renda T, Fratto D, Falcone D, Caraglia M, Busceti MT, Terracciano R, Vatrella A, Maselli R, Savino R. Effects of statins and farnesyl transferase inhibitors on ERK phosphorylation, apoptosis and cell viability in non-small lung cancer cells. Cell Prolif 2012; 45:557-65. [PMID: 23045963 DOI: 10.1111/j.1365-2184.2012.00846.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/19/2012] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) can affect post-translational processes, thus being responsible for decreased farnesylation and geranylgeranylation of intracellular small G proteins such as Ras, Rho and Rac, essential for cell survival and proliferation. In this regard, recent in vitro and in vivo studies suggest a possible role for both statins and farnesyl transferase inhibitors in the treatment of malignancies. Within such a context, the aim of our study was to investigate effects of either simvastatin (at concentrations of 1, 15, and 30 μm) or the farnesyl transferase inhibitor R115777 (at concentrations of 0.1, 1, and 10 μm), on two cultures of human non-small lung cancer cells, adenocarcinoma (GLC-82) and squamous (CALU-1) cell lines. In particular, we evaluated actions of these two drugs on phosphorylation of the ERK1/2 group of mitogen-activated protein kinases and on apoptosis, plus on cell numbers and morphology. MATERIALS AND METHODS Western blotting was used to detect ERK phosphorylation, and to assess apoptosis by evaluating caspase-3 activation; apoptosis was also further assessed by terminal deoxynucleotidyl-mediated dUTP nick end labelling (TUNEL) assay. Cell counting was performed after trypan blue staining. RESULTS AND CONCLUSION In both GLC-82 and CALU-1 cell lines, simvastatin and R115777 significantly reduced ERK phosphorylation; this effect, which reached the greatest intensity after 36 h treatment, was paralleled by a concomitant induction of apoptosis, documented by significant increase in both caspase-3 activation and TUNEL-positive cells, associated with a reduction in cell numbers. Our results thus suggest that simvastatin and R115777 may exert, in susceptible lung cancer cell phenotypes, a pro-apoptotic and anti-proliferative activity, which appears to be mediated by inhibition of the Ras/Raf/MEK/ERK signalling cascade.
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Affiliation(s)
- G Pelaia
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
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Gallelli L, Pelaia G, Fratto D, Muto V, Falcone D, Vatrella A, Curto LS, Renda T, Busceti MT, Liberto MC, Savino R, Cazzola M, Marsico SA, Maselli R. Effects of budesonide on P38 MAPK activation, apoptosis and IL-8 secretion, induced by TNF-alpha and Haemophilus influenzae in human bronchial epithelial cells. Int J Immunopathol Pharmacol 2010; 23:471-9. [PMID: 20646342 DOI: 10.1177/039463201002300209] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Non-typeable Haemophilus influenzae (NTHi) is one of the most frequently involved pathogens in bacterial exacerbations of chronic obstructive pulmonary disease (COPD). In the airways, the main tissue target of NTHi is bronchial epithelium, where this pathogen can further amplify the inflammatory and structural changes induced by proinflammatory cytokines such as tumour necrosis factor-alpha (TNF-alpha). Therefore, the aim of this study is to investigate, in primary cultures of human bronchial epithelial cells, the effects of NTHi on signal transduction pathways, apoptotic events and chemokine production activated by TNF-alpha. Moreover, we also evaluated the effects exerted on such cellular and molecular phenomena by a corticosteroid drug. p38 mitogen-activated protein kinase (MAPK) phosphorylation was analyzed by Western blotting, using an anti-phospho-p38 MAPK monoclonal antibody. Apoptosis was assayed by active caspase-3 expression. Interleukin-8 (IL-8/CXCL8) was detected in cell-free culture supernatants by ELISA. TNF-alpha induced a significant increase in p38 MAPK phosphorylation. NTHi was able to potentiate the stimulatory actions of TNF-alpha on caspase-3 expression and, to a lesser extent, on IL-8 secretion. These effects were significantly (P less than 0.01) inhibited by a pharmacological pre-treatment with budesonide. These results suggest that TNF-alpha is able to stimulate, via activation of p38 MAPK signalling pathway, IL-8 release and airway epithelial cell apoptosis; the latter effect can be markedly potentiated by NTHi. Furthermore, budesonide can be very effective in preventing, through inhibition of p38 MAPK phosphorylation, both structural and proinflammatory changes elicited in bronchial epithelium by TNF-alpha and NTHi.
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Affiliation(s)
- L Gallelli
- Department of Experimental and Clinical Medicine, University Magna Grecia of Catanzaro, Catanzaro, Italy
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Gallelli L, Falcone D, Pelaia G, Renda T, Terracciano R, Malara N, Vatrella A, Sanduzzi A, D'Agostino B, Rossi F, Vancheri C, Maselli R, Marsico SA, Savino R. Interleukin-6 receptor superantagonist Sant7 inhibits TGF-beta-induced proliferation of human lung fibroblasts. Cell Prolif 2008; 41:393-407. [PMID: 18435790 DOI: 10.1111/j.1365-2184.2008.00538.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Both interleukin-6 (IL-6) and transforming growth factor-beta (TGF-beta) are crucially involved in fibrotic events that characterize interstitial lung diseases (ILD). Therefore, the aim of this study was to investigate in primary cultures of normal and fibrotic human lung fibroblasts (HLF), exposed to either IL-6 or TGF-beta1, the effects on phosphorylation of mitogen-activated protein kinases (MAPK) and cell growth of IL-6 signalling inhibition, performed by the IL-6 receptor superantagonist Sant7. MATERIALS AND METHODS MAPK phosphorylation was detected by Western blotting, HLF viability and proliferation were evaluated using the trypan blue staining and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, respectively. RESULTS Sant7, at a concentration of 1 microg/mL, was capable of significantly inhibiting HLF proliferation and MAPK phosphorylation induced by cell exposure to IL-6 (100 ng/mL) or TGF-beta1 (10 ng/mL), whose actions were more evident in fibrotic cells. CONCLUSIONS These findings suggest that, in HLFs derived from patients with ILDs, the proliferative mechanisms activated by TGF-beta1 are at least in part mediated by an increased release of IL-6, leading to phosphorylation-dependent MAPK activation. Such preliminary findings may thus open new therapeutic perspectives for fibrogenic ILDs, based on inhibition of signal transduction pathways stimulated by the IL-6 receptor.
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Affiliation(s)
- L Gallelli
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Italy
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Legate KR, Falcone D, Andrews DW. Nucleotide-dependent binding of the GTPase domain of the signal recognition particle receptor beta-subunit to the alpha-subunit. J Biol Chem 2000; 275:27439-46. [PMID: 10859309 DOI: 10.1074/jbc.m003215200] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The signal recognition particle (SRP) receptor (SR) is a heterodimer of two polypeptides (SRalpha and SRbeta) that each contain a GTP-binding domain. The GTP-binding domain in the peripheral membrane SRalpha subunit has a well defined role in regulating targeting of SRP-ribosome-nascent chain complexes to the translocon. The only well established function for the transmembrane SRbeta subunit is anchoring SRalpha on the endoplasmic reticulum membrane. Deletion of the amino-terminal transmembrane domain of SRbeta did not affect receptor dimerization, but revealed a cryptic translocation signal that overlaps the GTPase domain. We demonstrate that the domain of SRalpha that binds SRbeta does so by binding directly to the nucleotide-bound form of the GTPase domain of SRbeta. An SRbeta mutant containing an amino acid substitution that allows the GTPase domain to bind XTP dimerized with SRalpha most efficiently in the presence of XTP or XDP, but not ATP. Our results suggest an additional level of regulation of SRP receptor function based on regulated dissociation of the receptor subunits.
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Affiliation(s)
- K R Legate
- Department of Biochemistry, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
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Falcone D, Do H, Johnson AE, Andrews DW. Negatively charged residues in the IgM stop-transfer effector sequence regulate transmembrane polypeptide integration. J Biol Chem 1999; 274:33661-70. [PMID: 10559255 DOI: 10.1074/jbc.274.47.33661] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A non-hydrophobic sequence that contributes to the biogenesis of a transmembrane protein is termed a stop-transfer effector (STE). To examine the mechanism of STE-mediated stop-transfer, a series of fusion proteins were constructed containing variants of a putative STE from murine IgM fused to an otherwise translocated hydrophobic sequence. Unexpectedly, the fraction of molecules adopting transmembrane topology was insensitive to many amino acid substitutions within the STE sequence but varied directly with the number of negative charges. Furthermore, when present at the amino terminus of a reporter, mutants were observed that adopted type I (amino terminus lumenal) and type II (amino terminus cytoplasmic) transmembrane topologies, demonstrating that the STE sequence can be located at either side of the endoplasmic reticulum membrane. Our results suggest that recognition of a broad structural feature formed primarily by negatively charged residues within the STE halts translocation and triggers membrane integration, even when the negative charges end up on the cytoplasmic side of the membrane. Since functional STE sequences photocross-link to two membrane proteins not previously identified at the translocon, these unique proteins are presumably involved in recognizing STE sequences and/or facilitating STE function.
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Affiliation(s)
- D Falcone
- Department of Biochemistry, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
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Kim SP, Bennett CL, Chan C, Chmiel J, Falcone D, Knight SJ, Kuzel T, Davis TC, Elstein AS, Moran E, Robertson CN, Smith JS. QOL and outcomes research in prostate cancer patients with low socioeconomic status. Oncology (Williston Park) 1999; 13:823-32; discussion 835-8. [PMID: 10378220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate cancer are included in the study, most of whom are of low socioeconomic status and over half of whom are African-American. Quality-of-life responses were most favorable for newly diagnosed patients, intermediate for those with stable metastatic disease, and poorest for those with progressive metastatic disease. Patients could not provide reliable estimates of their own preferences for future QOL states but responded reliably to questions phrased as a comparison of the preferences of two hypothetical patients. High out-of-pocket costs for hormonal therapies, lack of health insurance, and a belief that the non-VA system offered poorer services were the most common reasons for patient transferral to the VA system. Satisfaction with medical care was generally high. While African-American patients were more likely to have advanced prostate cancer at diagnosis, after adjustment for differences in health literacy, race was no longer a significant predictor of advanced disease. The VA CaPOS provides useful information on health status and patient satisfaction of VA prostate cancer patients. Long-term evaluations are needed to detect clinically meaningful QOL information as the disease progresses.
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Affiliation(s)
- S P Kim
- Northwestern University Medical School, Chicago, Illinois, USA
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Brandt EN, Broyles RW, Falcone D. Health maintenance organizations in Oklahoma. J Okla State Med Assoc 1996; 89:197-9. [PMID: 8691297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- E N Brandt
- Center for Health Policy, OUHSC College of Public Health, Oklahoma City 73190, USA
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Abstract
During the cotranslational integration of a nascent protein into the endoplasmic reticulum membrane, the transmembrane (TM) sequence moves out of an aqueous pore formed by Sec61alpha, TRAM, and other proteins and into the nonpolar lipid bilayer. Photocross-linking reveals that this movement involves the sequential passage of the TM domain through three different proteinaceous environments: one adjacent to Sec61alpha and TRAM and two adjacent to TRAM that place different restrictions on TM domain movement. In addition, the TM sequence is not allowed to diffuse into the bilayer from the final TRAM-proximal site until translation terminates. Cotranslational integration is therefore linked to translation and occurs via an ordered multistep pathway at an endoplasmic reticulum site that is multilayered both structurally and functionally.
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Affiliation(s)
- H Do
- Department of Medical Biochemistry & Genetics, Texas A&M University Health Science Center, College Station 77843-1114, USA
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Falcone D, Fewtrell C. Ca(2+)-ATPase inhibitor, cyclopiazonic acid, releases Ca2+ from intracellular stores in RBL-2H3 mast cells and activates a Ca2+ influx pathway that is permeable to sodium and manganese. J Cell Physiol 1995; 164:205-13. [PMID: 7790392 DOI: 10.1002/jcp.1041640125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cyclopiazonic acid has been reported to inhibit the Ca(2+)-ATPase of intracellular calcium stores in some nonexcitable cell types, such as myeloid cells and lymphocytes. The present study examines the effects of cyclopiazonic acid on rat basophilic leukemia (RBL) cells, a mucosal mast cell line. Addition of cyclopiazonic acid to fura-2-loaded RBL cells evoked a biphasic increase in free ionized intracellular calcium. Release of stored calcium accounted for the first phase of this response. The second phase was determined to be calcium entering through an influx pathway activated by cyclopiazonic acid. The influx pathway was selective for calcium, but was somewhat permeable to manganese. However, in a Ca(2+)-free solution containing EGTA, sodium ions permeated freely. This influx pathway appears to be identical to that which is activated by antigen, the physiological stimulus to the cells. Cyclopiazonic acid also induced secretion when combined with the phorbol ester 12-O-tetradecanoyl phorbol 13-acetate, which activates protein kinase C.
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Affiliation(s)
- D Falcone
- Department of Pharmacology, Cornell University, Ithaca, New York 14853-6401, USA
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Brandt EN, Broyles RW, Demps B, Falcone D. Medicaid in Oklahoma. J Okla State Med Assoc 1994; 87:231-4. [PMID: 8051582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Medicaid expenditures in Oklahoma increased 98.2% from 1986 through 1991 while those of the United States went up 111.0%. Of this increase, 21.6% was due to inpatient care and 25.9% to nursing home care. With respect to beneficiaries, 34.9% of the increase was attributable to the aged and 31.4% to the disabled. AFDC recipients accounted for only 19.1% of the increase.
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Affiliation(s)
- E N Brandt
- Center for Health Policy Research and Development, University of Oklahoma Health Sciences Center, Oklahoma City 73190
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Abstract
Race continues to impede access to health services, for acute as well as long-term care. Whites, for example, use disproportionately more days of nursing home care than nonwhites, not simply because they are more likely to be private payers and, therefore, are preferred over nonwhites: the difference in utilization persists even among those whose nursing home stays are covered by Medicare. Using data from a study of patients awaiting alternative placement in North Carolina acute care general hospitals in 1991, this article examines racial differences in discharge delay, that is, in the time between when a patient is medically ready for discharge to another form of care and when he or she actually is discharged. Logistic regression and ordinary least squares are used heuristically to identify patient characteristics associated with delay, and two-way analyses of variance are used to document the independent effect of race. The results indicate that race has substantial independent explanatory power. This finding is reinforced by the analysis of variance with controls for the patient's payment source for long-term care, chronic condition or special care requirements, demographic attributes, family cooperativeness, whether the patient had a behavior problem that impeded the discharge planning process, and whether there was a financial problem in arranging for the patient's discharge. The inescapable conclusion is that nursing homes discriminate on the basis of race in admitting patients. This practice is patently objectionable; it also is costly to hospitals, thus to society, since hospitals bear the direct costs of delayed discharges and hospitals do not keep costs to themselves. While research is needed to determine whether the North Carolina findings are replicable in other states, past research suggests that the problem is not confined to this state.
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Falcone D, Lasser A. Rural hospitals: challenges & opportunities. Adm Radiol 1994; 13:44. [PMID: 10132013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- D Falcone
- Department of Health Administration and Policy, Oklahoma University Health Sciences Center
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Falcone D, Bolda E, Leak SC. Waiting for placement: an exploratory analysis of determinants of delayed discharges of elderly hospital patients. Health Serv Res 1991; 26:339-74. [PMID: 1869444 PMCID: PMC1069829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This article examines the causes of delayed hospital discharge for 3,111 patients waiting for alternative placement in 80 North Carolina acute care general hospitals during May 1989. Almost all of the patients were elderly: their average age was 77. Delay is defined as the period between the day a patient was judged medically ready for discharge by a discharge planner and the day the patient was discharged (or May 31 if unplaced). The average delay was 16.7 days. The policy-relevant patient characteristics associated with delay are requirement for heavy care, race, source of reimbursement, and whether or not there was a financial problem in arranging discharge. The patient's age and whether or not a problem with behavior or family cooperativeness was noted also were predictors. Along with patient characteristics, hospital features such as bed size, occupancy rate, and total revenues were correlated with delay. Local nursing and rest home (domiciliary) bed supply were insignificant predictors, possibly because of their limited variance: the number of nursing home beds in all North Carolina counties is below the national mean; the number of rest home beds exceeds it. The conclusion reached is that the delay problem warrants more intensive analysis, particularly regarding financial problems encountered at discharge, and race. Guidelines for such an endeavor are provided. Further, there is a need to recognize the increasing preponderance of a new type of heavy care patient via more appropriate reimbursement levels and "transitional care" services.
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Affiliation(s)
- D Falcone
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710
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Falcone D, Andrews DW. Both the 5' untranslated region and the sequences surrounding the start site contribute to efficient initiation of translation in vitro. Mol Cell Biol 1991; 11:2656-64. [PMID: 2017171 PMCID: PMC360035 DOI: 10.1128/mcb.11.5.2656-2664.1991] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The role of RNA sequences in the 5' leader region between the cap site and initiating AUG in mediating translation was examined in vitro. Hybrid mRNAs were synthesized in which the cognate leader sequence was replaced with either optimized or compromised leader sequences, and translational efficiency was measured for six different coding regions. Translation was most efficient with a leader containing the 5' untranslated region from Xenopus beta-globin and an optimized initiation sequence. Compared with the cognate leaders, this hybrid was observed to increase translation of the various coding regions as much as 300-fold. The translational efficiencies of the different coding regions also varied substantially. In contrast to earlier suggestions that increased leader efficiency results from higher affinity of the leader for a limiting factor, our experiments suggest that increased translation from the beta-globin hybrid leader sequence results from more rapid initiation of translation.
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Affiliation(s)
- D Falcone
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
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Amato R, Celestino D, Brilli M, Falcone D, Tullio A. [Muco-epidermoid carcinoma of the minor salivary glands. A case localized in the palate]. Minerva Stomatol 1988; 37:975-80. [PMID: 3241618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Kay DC, Pickworth WB, Neidert GL, Falcone D, Fishman PM, Othmer E. Opioid effects on computer-derived sleep and EEG parameters in nondependent human addicts. Sleep 1979; 2:175-91. [PMID: 232563 DOI: 10.1093/sleep/2.2.175] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
After one adaptation night, intramuscular doses of methadone (7.5, 15, 30 mg/70 kg), morphine (10 or 20 mg/70 kg), or placebo were given to seven male nondependent opiate addicts at weekly intervals in a randomized cross-over design. After three adaptation nights, heroin (3, 6, 12 mg/70 kg) was compared with morphine and placebo by means of a similar design in seven other subjects. Using electroencephalogram (EEG) bisector analysis, tape recordings of sleep were analyzed for two beta, three alpha, three theta, and two delta EEG patterns, as well as for detections of sleep spindles, K-complexes, eye movements, body movements, average electromyogram (EMG), and calculation of seven sleep-waking stages. All three opioids produce a dose-related arousal: they increase EMG and EEG measures of muscle activity, as well as body movements and EEG alpha, while decreasing EEG theta and spindling. These opioids also increase measures of waking state and decrease measures of spindle sleep and REM sleep. Although the 1974 version of the EEG bisector analysis is not exactly comparable to visual analysis, in this design it defined significant drug effects on sleep and EEG. Distinctive bisector analysis patterns are positively correlated with each sleep--waking stage.
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Abstract
It has often been asserted that health services research (HSR) has been either epiphenomenal or entirely ineffectual in influencing the formation of policy. In this examination of the HSR-policy relationship that assertion is contested; the authors conclude that there has been a relationship between HSR and policy, at least public policy. A diagrammatic framework is presented to describe the HSR-policy nexus in an attempt to facilitate an understanding of how future efforts in the conduct of HSR might be most effective.
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