Troglitazone and Delta 2Troglitazone Enhance Adiponectin Expression in Monocytes/Macrophages through the AMP-Activated Protein Kinase Pathway

Accumulating evidence indicates that the regimen to increase adiponectin will provide a novel therapeutic strategy for inflammation and cardiovascular disorders. Here, we tested the effect of troglitazone (TG) and its newly synthesized derivative, 5-[4-(6-hydroxy2,5,7,8-tetramethyl-chroman-2-yl-methoxy)-benzylidene]-2,4-thiazolidinedione (Delta 2troglitazone, (Delta 2TG)), on the adiponectin expression in monocytes/macrophages and the relative mechanisms. The expression of adiponectin was located in macrophages of atherosclerotic lesions from patients and cholesterol-fed rabbits. TG and Delta 2TG enhanced adiponectin mRNA and protein expression in THP-1 cells by quantitative real-time PCR, Western blot, and immunocytochemistry. TG induced adiponectin mRNA expression through a PPAR gamma-dependent pathway whereas Delta 2TG enhanced adiponectin mRNA expression through a PPAR gamma independent pathway in THP-1 cells. Both TG and Delta 2TG enhanced adiponectin mRNA expression through AMP-activated protein kinase (AMPK) activation. TG and Delta 2TG decreased the adhesion of THP-1 cells to TNF-alpha-treated HUVECs and the inhibitory effect was abolished by specific antiadiponectin antibodies. TG- and Delta 2TG-induced suppression on monocyte adhesion were inhibited by a selective AMPK inhibitor compound C. Our data suggest that the inhibitory effect of TG and Delta 2TG on monocyte adhesion might be at least in part through de novo adiponectin expression and activation of an AMPK-dependent pathway, which might play an important role in anti-inflammation and antiatherosclerosis

Symptom Patterns of Advanced Cancer Patients in a Palliative Care Unit

This study involved longitudinal evaluations of symptom severity and describes the symptom patterns of 77 terminal cancer patients (median age: 62 years; 61% female), selected from 537 consecutive patients admitted to the Palliative Care Unit of the National Taiwan University Hospital. The most common primary cancer sites in these patients were lung (23.4%), liver (15.6%), and stomach (13%). Nineteen physical and psychological symptoms were assessed using different scales. The median number of symptoms was 11 ( range: 1-18) on admission, among which weakness, fatigue , anorexia, pain, and depression were the most common. A comparison of the initial symptom severity scores with those at one week after admission and two days before death suggested six symptom change patterns: A: continuous static(restless/heat, abdominal fullness, constipation, dizziness, and insomnia); B: static-increase (fatigue, weakness, nausea/ vomiting, taste alteration, dysphagia, diarrhea, dry mouth, and night sweats); C: decrease-static (pain and depression); D: decrease-increase ( anorexia and dyspnea); E: static-decrease (aggression); and F: gradually decrease ( anxiety). These six symptom patterns can be divided into two categories on the basis of the relative severity of symptoms between one week after admission and two days before death. The first category included patterns A, C, E and F and the symptoms improved with palliative care. However, the symptoms in the second category (patterns B and D), which were associated with the anorexia-cachexia syndrome and dyspnea, did not show improvement. As symptom management is an essential component of palliative care, holistic care, which encompasses physical, psychosocial and spiritual aspects, represents a rational approach for the relief of these incurable symptoms at the end stage of life for these patients

Fear of Death and Good Death among the Young and Elderly with Terminal Cancers in Taiwan

譫妄為一老年住院病患常見的問題，本研究之目的在瞭解對譫妄病患之護理過程之經 驗，以開放性面談方式，共收集四位元曾照顧過譫妄病患的護理人員之護理過程並將 所得資料加以分析，結果發現整個護理經驗是—“尋求平衡”的過程，護理人員在平 日沈重工作負擔及病患發性譫妄之不確定性二者間，試圖採取最佳措施來平衡此二種 壓力，其所採取措施包括依賴家屬或其他病患的協助、確保病患安全、報告醫師處理 、及同儕間相互支持。瞭解護理人員的經驗能讓護理管理者在在職教育及人力分配等 各方面訂定措施，經由提升護理人員對譫妄之認知、評估、及處理技能，一方面能達 到早期偵測譫妄之目的，另一方面能減輕基層護理人員壓力，以提升病患之護理品質 。 This qualitative research was aimed at under standing nursesdegree of death fear and the total good death score in both groups at two days before death (P < 0.05). The comprehensive care in the palliative care unit might relate to the relief of the death fear of terminal cancer patients. There is a need for psychological and spiritual care in elderly patients

Changes of serum adiponectin and soluble intercellular adhesion molecule-1 concentrations after smoking cessation

[[abstract]]Background: This study aims to investigate the effect of increased serum adiponectin concentration during smoking cessation on soluble intercellular adhesion molecule-1 (sICAM-1) concentration. Methods: One hundred and sixty-six eligible smokers were assessed at baseline and were followed up at the 1st, 5th, and 9th weeks after smoking cessation. Demographic data, body weight and blood pressure of these participants were obtained; serum glucose biochemical data, sICAM-1 and adiponectin concentrations were measured. Repeated measures analysis paired t-tests and generalized estimating equations for balanced repeated measures were used for statistical analyses. Results: Forty-one individuals completed the 2-month smoking cessation program. The mean cigarette consumption dramatically decreased (p<0.0001) and the cotinine concentration also decreased significantly (p<0.0001) among the quitters. Serum adiponectin concentration significantly increased (p=0.0186) and sICAM-1 significantly decreased (p<0.0001) in quitters after smoking cessation. The elevation of serum adiponectin concentration significantly correlated with lowering of sICAM-1 (p=0.0001) concentration. Body weight changes at the end of 2-month smoking cessation was inversely correlated with adiponectin increment from baseline (p=0.0003). Conclusions: An increase in serum adiponectin concentration is an independent factor correlated with lowering of sICAM-1 concentration during smoking cessation

癌末病人的疲倦控制

雖然醫療科技日新月異，癌症末期病人並沒有因為現代醫學的進步而減少，反而有增 加的趨勢。因為末期病人對治癒性的治療已經沒有反應，病人會因癌症的持續進展及 抗癌治療過程產生的副作用，使整體器官功能逐漸衰退，除了身體的痛苦外，更有心 理、社會及靈性上的痛苦與需求。因此發展整體性的照顧模式，給予癌末病人身、心 、靈的全人照顧，全力提昇癌末病人的生活品質實為當務之急。根據過去的研究，疲 倦是癌末病人最常見的症狀。疲倦是一種主觀的症狀，其原因是多方面的，包括身體 、心理、社會、文化、靈性等因素。所以要改善癌末病人的疲倦症狀，必須對其相關 因素、形成機轉及評估方法有深入的瞭解，才能給予病人藥物及非藥物的整體照顧， 讓病人即使在器官功能逐漸衰退的情況下，也能擺脫疲倦的困擾，獲得生活品質的提 昇。 The terminal cancer patients, refractory to curative treatment, are increasing in number, even though medical technology has made a rapid progress. During the terminal phase of cancer, not only general condition is deteriorated gradually because of advanced malignancy and side effect from anticancer treatment but also associtates with psychosocial and spiritual sufferings. It is very urgent to establish a hospice palliative care model for terminal cancer patients to promote their quality of life. Fatigue is the most common symptom of terminal cancer patients. It is a subjective symptom caused by physical, psychological, social, and spiritual factors. To improve patients' fatigue, we should have a comprehensive understanding of its associated factors, mechanism, and clinical assessment. To provide terminal cancer patients with total care is the way to improve their quality of life, even if their physical performance is deteriorated gradually

Significance of Symptom Clustering in Palliative Care of Advanced Cancer Patients

Patients with advanced cancer often experience multiple concurrent symptoms. To explore this symptom clustering and its associated parameters , we prospectively surveyed 427 consecutive patients on admission to the Palliative Care Unit. There were 222 males (52.0%) and 205 females (48.0%) , with a median age of 66 years (range: 27-93 years). The main tumor sites were lung (19.9%), liver (18.0%), and colorectum (11.0%). The median survival was 13 days (1-418 days). Symptoms were assessed using a face- valid Symptom Reporting Form. We identified five symptom clusters by exploratory factor analysis. Clusters were named &quot;loss of energy,&quot; &quot;poor intake,&quot; &quot;autonomic dysfunction,&quot; &quot; aerodigestive impairment,&quot; and &quot;pain complex.&quot; We used nonhierarchical cluster analysis to divide the 394 patients with complete data into six groups. Each group was characterized by a particular pattern that was composed of different symptom clusters. Survival functional performance, bone metastasis, and fluid accumulation were significantly associated with symptom clustering in six groups of patients . The severity of psychological distress also related to their physical deterioration. These data suggest that different underlying mechanisms associate with symptom clustering. Further elucidation of these processes may assist in. symptom management

Rosiglitazone Inhibits Monocyte/Macrophage Adhesion through De Novo Adiponectin Production in Human Monocytes

Rosiglitazone (RSG) has a variety of actions on both insulin sensitization and anti-atherogenic effects. The molecular effect of RSG on monocyte/macrophage function in terms of de novo synthesis of adiponectin is not fully understood. Here , we examined the regulation of adiponectin expression in human monocytes/macrophages by RSG and its function on monocyte adhesion during initiation of atherosclerosis. Adiponectin expression in monocytes and macrophages was studied by RT-PCR, quantitative real-time PCR, Western blot, and immunocytochemistry. Signal transduction and adhesion molecules were studied in order to describe the function of de novo synthesized adiponectin in monocyte adhesion. Adiponectin was expressed and upregulated during monocyte differentiation. The expression of adiponectin was enhanced, albeit at a much lesser degree, by a peroxisome proliferator-activated receptor gamma (PPAR gamma) agonist RSG, which was similar to what was found in adipocytes. Monocyte adhesion was remarkably reduced when the cells were treated with RSG for 12 h. This inhibitory effect of RSG was abolished by specific anti- adiponectin antibodies but not by non-immune immunoglobulin G in a serum- free condition . Adiponectin-induced suppression on monocyte adhesion was inhibited by a selective AMP-activated protein kinase (AMPK) inhibitor compound C. The reduced expression and/or function of adhesion molecule integrins may underlie the mechanism contributing to reduced monocyte adhesion upon AMPK activation. Our data suggest that the inhibitory effect of RSG on monocyte adhesion might be at least in part through de novo adiponectin expression and activation of an AMPK-dependent pathway, which might play an important role in atherogenesis