Disruption of the A 3 Adenosine Receptor Gene in Mice and Its Effect on Stimulated Inflammatory Cells

The A(3) adenosine receptor (A3AR) is one of four receptor subtypes for adenosine and is expressed in a broad spectrum of tissues. In order to study the function of A3AR, a mouse line carrying a mutant A(3) allele was generated. Mice homozygous for targeted disruption of the A3AR gene, A3AR(-/-), are fertile and visually and histologically indistinguishable from wild type mice. The lack of a functional receptor in the A3AR(-/-) mice was confirmed by molecular and pharmacological analyses. The absence of A3AR protein expression in the A3AR(-/-) mice was demonstrated by lack of N(6)-(4-amino-3-[(125)I]iodobenzyl)adenosine binding to bone marrow-derived mast cell membranes that were found to express high levels of A3AR in wild type mice. In A3AR(-/-) mice, the density of A(1) and A(2A) adenosine receptor subtypes was the same as in A3AR(+/+) mice as determined by radioligand binding to brain membranes. Additionally, A(2B) receptor transcript expression was not affected by ablation of the A3AR gene. A3AR(-/-) mice have basal heart rates and arterial blood pressures indistinguishable from A3AR(+/+) mice. Functionally, in contrast to wild type mice, adenosine and the A3AR-specific agonist, 2-chloro-N(6)-(3-iodobenzyl)-adenosine-5'-N-methyl-carboxamide (2-Cl-IB-MECA), elicit no potentiation of antigen-dependent degranulation of bone marrow-derived mast cells from A3AR(-/-) mice as measured by hexosaminidase release. Also, the ability of 2Cl-IB-MECA to inhibit lipopolysaccharide-induced tumor necrosis factor-alpha production in vivo was decreased in A3AR(-/-) mice in comparison to A3AR(+/+) mice. The A(2A) adenosine receptor agonist, 2-p-(2-carboxyethyl)phenylamino)-5'-N-ethylcarboxamidoadenosine, produced inhibition of lipopolysaccharide-stimulated tumor necrosis factor-alpha production in both A3AR(-/-) and A3AR(+/+) mice. These results show that the inhibition in vivo can be mediated by multiple subtypes, specifically the A(3) and A(2A) adenosine receptors, and A3AR activation plays an important role in both pro- and anti-inflammatory responses

Household exposure to pesticides and bladder exstrophy in a newborn baby boy: a case report and review of the literature

© 2009 Martin et al; licensee Cases Network Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Kunskap - leder det till attitydförändringar? En litteraturstudie om vårdpersonalens kunskap om och attityder till HIV-positiva homosexuella

Hiv/aids är i dagsläget en ökande epidemi som drabbar hela världen. Homosexualitet har länge förknippats med sjukdomen vilket med stor sannolikhet bidragit till fördomar och negativa attityder till denna redan utsatta minoritet. Syftet med examensarbetet var att genom en systematisk litteraturstudie undersöka vårdpersonalens kunskaper om och attityder till hiv-positiva homosexuella. Ytterligare ett syfte var att undersöka om attityder kunde skiljas åt beroende på kategorier av vårdpersonal vilket avser all personal inom vården samt sjuksköterske- och undersköterskestuderande. De viktigaste resultaten som framkom i studien var att de generella attityderna till hiv-positiva homosexuella övervägande var positiva och att de negativa attityderna till hiv/aids och homosexualitet ter sig kunna bero på en bristande kunskap och erfarenhet. Likaså kan rädsla för att bli smittad ses som ett resultat av bristande kunskap och som även bidrar till minskad vilja att vårda de hiv-positiva patienterna. Av de olika kategorierna av vårdpersonal visade undersköterskestudenterna minst positiva attityder och mest rädsla. Inom hälso- och sjukvården är det viktigt med ett jämlikt bemötande och att alla oavsett diagnos eller sexuell läggning känner sig trygga och blir respekterade för den de är. De kliniska implikationerna som torde kunna dras av dessa resultat torde kunna vara att utbildning och ökad kunskap är den grundläggande faktorn för ett kvalitativt bemötande och attitydförändring.Today hiv/aids is a continounessly growing epidemic around the world. For a long time homosexuality has been associated with the disease which probably has contributed to prejudice and negative attitudes towards this already vulnerable minority. The purpose of this degree project was through a systematic literature review examine health care personnel´s knowledge about and attitudes towards hiv-positive homosexuals. Another purpose was to examine if the were any differences in attitudes between the different categories of health care personnel wich includes all health care personnel´s and nursing- and assistant nursing students. The most important findings were that the general attitudes towards hiv-positive homosexuals were mostly postive and that the negative attitudes towards hiv/aids and homosexuality were characterized by lack of knowledge and of experience. Likewise the fear of being infected can be seen as a consequence of a lacking knowledge which may contribute to the unwillingness to care for hiv-positive patients. The assistant nursing students were shown to be the category of health care personnel´s who had least positive attitudes and most fear. It is important with an equal treatment within the health care system and for everyone regardless of diagnosis and sexual orientation to feel safe and respected. The clinical implications from these findings may perhaps be that education and an increased knowledge seems to be needed to alter attitudes towards this group of patients

Targeted deletion of adenosine A(3) receptors augments adenosine-induced coronary flow in isolated mouse heart.

To determine whether adenosine A(3) receptors participate in adenosine-induced changes in coronary flow, isolated hearts from wild-type (WT) and A(3) receptor knockout (A(3)KO) mice were perfused under constant pressure and effects of nonselective and selective agonists were examined. Adenosine and the selective A(2A) agonist 2-[p-(2-carboxyethyl)]phenylethylamino-5'-N-ethylcarboxamidoadenosine (CGS-21680) produced augmented maximal coronary vasodilation in A(3)KO hearts compared with WT hearts. Selective activation of A(3) receptors with 2-chloro-N(6)-(3-iodobenzyl)-adenosine-5'-N-methyluronamide (Cl-IB-MECA) at nanomolar concentrations did not effect coronary flow, but at higher concentrations it produced coronary vasodilation both in WT and A(3)KO hearts. Cl-IB-MECA-induced increases in coronary flow were susceptible to both pharmacological blockade and genetic deletion of A(2A) receptors. Because deletion or blockade of adenosine A(3) receptors augmented coronary flow induced by nonselective adenosine and the selective A(2A) receptor agonist CGS-21680, we speculate that this is due to removal of an inhibitory influence associated with the A(3) receptor subtype. These data indicate that the presence of adenosine A(3) receptors may either inhibit or negatively modulate coronary flow mediated by other adenosine receptor subtypes.Journal ArticleResearch Support, U.S. Gov't, P.H.S.info:eu-repo/semantics/publishe

Adenosine kinase inhibition promotes survival of fetal adenosine deaminase–deficient thymocytes by blocking dATP accumulation

Thymocyte development past the CD4(–)CD8(–) stage is markedly inhibited in adenosine deaminase–deficient (ADA-deficient) murine fetal thymic organ cultures (FTOCs) due to the accumulation of ADA substrates derived from thymocytes failing developmental checkpoints. Such cultures can be rescued by overexpression of Bcl-2, suggesting that apoptosis is an important component of the mechanism by which ADA deficiency impairs thymocyte development. Consistent with this conclusion, ADA-deficient FTOCs were partially rescued by a rearranged T cell receptor β transgene that permits virtually all thymocytes to pass the β-selection checkpoint. ADA-deficient cultures were also rescued by the adenosine kinase inhibitor 5′-amino-5′-deoxyadenosine (5′A5′dAdo), indicating that the metabolite responsible for the inhibition of thymocyte development is not adenosine or deoxyadenosine, but a phosphorylated derivative of an ADA substrate. Correction of ADA-deficient FTOCs by 5′A5′dAdo correlated with reduced accumulation of dATP, implicating this compound as the toxic metabolite. In ADA-inhibited FTOCs rescued with a Bcl-2 transgene, however, dATP levels were superelevated, suggesting that cells failing positive and negative selection continued to contribute to the accumulation of ADA substrates. Our data are consistent with dATP-induced mitochondrial cytochrome c release followed by apoptosis as the mechanism by which ADA deficiency leads to reduced thymic T cell production