Health care in the new Russia: a western perspective

OBJECTIVE: To evaluate the growth and insulin secretion from microencapsulated beta TC6-F7 cells in vitro and to assess the in vivo function of microencapsulated cells transplanted in rats with steptozotocin (STZ)-induced diabetes. METHOD: Alginate-poly-L-lysine encapsulated beta TC6-F7 cells were exposed to glucose, isobutylmethylxanthine (IBMX) and glucagon-like peptide I (7-36 amide) in a static in vitro challenge. In vivo, 2.5-3.5 x 10(7) encapsulated cells were implanted into diabetic rats. Graft function was evaluated by monitoring blood glucose concentrations and by an intraperitoneal glucose tolerance test. RESULTS: The cell density (number of cells per capsule) of cultured microencapsulated beta TC6-F7 cells increased almost 35-fold over a 55 day observation period to reach a plateau of approximately 3500 cells/capsule. While insulin secretion per capsule remained unchanged over the first 21 days of culture, a 7-fold increase was observed during the last 14 days of the 55 day observation period. Intraperitoneal transplantation of 3.5 x 10(7) encapsulated cells into diabetic rats resulted, within 24 hours, in reversal of hyperglycemia for up to 60 days. Post-transplantation blood glucose concentrations varied between 2 and 4 mM. Glucose clearance rates evaluated by an intraperitoneal glucose tolerance test at 30 days post-transplantation resulted in a markedly flat glucose clearance curve with blood glucose never rising above 4 mM. The glucose challenge of microencapsulated cells recovered 30 days post-transplantation resulted in a 2-fold increase in insulin response at glucose concentrations greater than 5.5 mM as compared to glucose-free media. In addition, immunostaining of recovered grafted tissue for insulin, reveals a strong presence of the peptide within the cell population. CONCLUSIONS: These data demonstrate the potential use of an immunoisolated beta-cell line for the treatment of diabetes.     

Mitral regurgitation: a new clinical perspective

Mitral regurgitation is a common valvular heart disease, particularly in the elderly population. The timing of surgical repair is controversial, but recent literature suggests a new clinical perspective on the management of this disease. Despite receiving medical treatment and having few initial symptoms, patients with mitral regurgitation due to flail leaflets have an excess mortality rate (6.3% per year) and high morbidity. Ten years after mitral regurgitation has been diagnosed, 90% of the patients have either died or undergone an operation. After surgical correction of mitral regurgitation, left ventricular dysfunction is a frequent complication and is the cause of excess heart failure and mortality. This complication is due to preoperative left ventricular dysfunction but is incompletely predictable with use of current methods. Conversely, considerable progress in surgery has resulted in an extremely low operative mortality rate (about 1% in patients younger than 75 years of age) and high feasibility of valve repair, even in patients with anterior leaflet prolapse. These facts have led to the new perspective that early surgical correction (before occurrence of overt symptoms or left ventricular dysfunction) should be considered when patients are diagnosed with severe mitral regurgitation.     

Personality disorders in sociocultural perspective

In this paper we take as a starting point the perceived high prevalence of domestic violence in marriages between Filipino women and Australian men. In in-depth interviews and structured questionnaires with service providers and with Filipinas married to Anglo-Australian and Filipino men the issue of underreporting physical and emotional violence was a recurring theme. We explore the relationships of power that characterize these marriages, the changes in balance of power that result from the externalization of anger, physical and verbal violence, and stigmatization of domestic violence experienced by Filipinas individually and in the community. We suggest that social disapproval and stereotypical representations of Filipina-Australian marriages in Australian society, and the consequent shame experienced by Filipinas, has led to underreporting of emotional and physical abuse.     

The mammalian Y chromosome: a new perspective

If pityriasis lichenoides et varioliformis acuta (PLAVA) exists in the vagina or cervical os of the uterus, it may cause premature labor and premature rupture of the membranes.     

Exercise and cardiovascular disease: a new perspective

The oxidation of low density lipoprotein (LDL) has been suggested as a key event in atherogenesis. Paradoxically, exercise, which imposes an oxidative stress, is an important deterrent of cardiovascular disease. In study 1 the oxidizability of LDL was enhanced in exercisers compared with sedentary controls. The lag time of isolated LDL subjected to copper-induced in vitro oxidation was significantly shortened in the exercisers compared with sedentary subjects. This increased sensitivity was not due to a decreased presence of vitamin E. Instead, these findings suggested that the LDL of exercisers may contain increased amounts of preformed lipid peroxides, which account for the increased oxidizability. In study 2, a group x sex ANOVA revealed that male exercisers had a significantly longer mean lag time than male sedentary subjects and that females had similar mean lag times regardless of exercise group. This remained the case when statistical adjustment was made for age, body mass index, blood lipid levels, LDL, and plasma alpha-tocopherol levels. Study 1 exercisers had been in training for a shorter time (< 1 year) than study 2 exercisers (> 2 years). These findings suggest that truly "chronic" exercise (aerobic intensity over several months) decreases the susceptibility of a male exerciser's LDL to undergo oxidation. Conversely, regular aerobic stress during an overall shorter time span creates a more oxidative environment in the body, thus increasing the susceptibility of LDL to undergo oxidation. The oxidative stress of aerobic exercise does not appear to adversely affect the oxidizability of LDL in women.     

Pathogenesis of middle-ear effusion in nasopharyngeal carcinoma: a new perspective

The theory that middle-ear effusion (MEE) associated with nasopharyngeal carcinoma (NPC) is merely the result of tensor veli palatinus destruction is deficient because recent studies have shown that many patients with NPC have MEE but no tensor veli palatinus dysfunction. The present study evaluates the relationship between MEE and Eustachian cartilage erosion by NPC and examines the pathogenesis of NPC-associated MEE from a new perspective. Thirty-five patients with NPC were studied by magnetic resonance scans taken along the lengths of the Eustachian tubes. Twenty-four patients had tumour involvement of both sides of the nasopharynx so that 59 ears were available for study. Eighteen ears had MEE of which 12 had Eustachian cartilage erosion (p < 0.00001), Fischer's Exact Test). In ears with MEE, Eustachian cartilage erosion was frequently but not necessarily associated with tensor veli palatinus destruction. We postulate that altered Eustachian tubal compliance as a result of cartilage erosion by tumour is an important reason why middle-ear effusions develop in patients with NPC.     

Psychoeducational assessment: A broader perspective.

The fields of mental health and education have mutual ties. When the resources and knowledge from both are pooled, as in some psychoeducational practices, comprehensive diagnostic and treatment programs become possible. While many assessment procedures have been labeled "psychoeducational," they vary from each other in significant ways to the extent that some even ignore or minimize the importance of affective behaviors during the evaluation. This article outlines a psychoeducational assessment approach for use with children and adolescents who display learning and adjustment problems. This approach stresses (a) affective as well as cognitive functioning and the intimate and dynamic relation between them, and (b) "process" rather than "achievement" test variables. Specific process variables pertaining to affective behaviors are described, and case material is included. (69 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The aging lung: an epidemiological perspective

There is no specific association established between colorectal cancer and blood group type. In this study, the distribution of ABO and Rh blood groups was studied in 838 patients with colorectal cancer. There was no difference in distribution of ABO blood groups between patients who were Rh+ and Rh-. There was no difference in ABO blood group or Rh factor and tumor location. The highest A/O ratio was found in rectal cancer. Although there was no difference in stage distribution for each ABO blood group, there was a significant difference between the Rh+ and Rh- groups (P < 0.037). It is not clear, however, whether the prognosis is different between the two groups since there were more early tumors as well as incurable tumors in the Rh- group. All patients with synchronous cancer were Rh+. Further studies on blood group antigens are needed to elucidate the relationship between these antigens and colorectal cancer.     

Temporomandibular disorders: a critical review of the nature of pain and its assessment

Temporomandibular disorders is a common form of chronic pain affecting the head, face, and jaw. The distinguishing symptoms of this disorder include pain and impairment of the masticatory function, and frequent display of symptoms, ranging from aches in the head, neck, ears, and eyes, to atypical toothaches, throat symptoms, and occlusal changes. It is recognized that pain is a complex, multifactorial experience including not only sensory dimensions, but also affective and cognitive factors. Recent recommendations regard temporomandibular disorders as a dual-axis disorder with physical and psychologic dimensions, but little research has incorporated measures of multidimensional pain characteristics in the assessment of temporomandibular disorders. This article is a review of the literature on the psychophysiologic factors contributing to temporomandibular disorders and its limitations. Recommendations for future research are also given.     

Naive objectivism in the assessment of behavioral disorders

Naive objectivism is a widespread attitude in human and social science research, although it disregards important principles of the theory of cognition. In the history of philosophy two naive approaches to the understanding of the world were continually disputed; 1. rationalism which purports unlimited cognitive power of the human mind, 2. a kind of empiricism which denies subjective elements in the process of cognition. Today the overestimation of human understanding is reflected in a dogmatic adherence to specific professional or idealogically biased doctrines and in the dubious ideal of a purely empirical science with its limited applicability to mankind. The exaggerated expectations regarding the inherent lawfulness of the empirical research field is demonstrated by excessive data collection and by the useless attempt to define behavioral disorders as deviation from the statistical norm. However, behavior disorders can only be understood, if the totality of being human is considered. They are to be seen as failing attempts to give and to maintain a meaning to life.     

Self-monitoring in the assessment of eating disorders.

Self-monitoring is a key feature of cognitive behavioral therapy (CBT) for eating disorders. It provides a detailed measure of eating problems and the circumstances under which they occur, but it does not yield precise estimates of amount of caloric intake. It indexes the progress of treatment and helps guide the focus of each therapy session. Adherence to self-monitoring is good provided that therapists implement it skillfully within a collaborative therapeutic alliance. Anorexia nervosa patients may pose a particular challenge in this respect. Self-monitoring may play an important role in the rapid effects of CBT for bulimia nervosa. Preliminary data indicate that self-monitoring of binge eating and purging may provide a valid measure of treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PSRO: a new direction for quality assessment in Otolaryngology

At the present time, the University of Michigan Hospital Department of Otorhinolaryngology has an 18-month experience in a quality assessment program directed toward compliance with PSRO legislation. This experience, we hope, provides an approach to the continuing assessment of medical care, whether it is for conforming to a particular legislative action or for the evaluation of patient care. It has been encouraging to the physicians involved that this is a program which is organized at the local level. It is oriented toward the local physician and in most instances will be administered by local physicians. The process of quality assessment has provided a milieu for educational experience and positive action toward correction of medical care problems. It has been said before that this may be the last opportunity for the physician to maintain control at the local level. This may be the opportunity for the profession to proceed with controlled quality assessment before outside agencies intercede.     

A Chinese perspective of somatoform disorders

The role of altered gastric motor functions for the development of obesity is still unclear. In this study, we investigated whether severe obesity is related to gastric dysfunctions or to abnormal perception in response to distension. 31 obese patients and 20 healthy volunteers were studied using an electronic barostat. Basal gastric tone, gastric accommodation, and perception in response to distension were not altered in obese patients. The median minimal distending pressure, reflecting the intra-abdominal pressure, was significantly elevated in obese patients, being 12 versus 7 mm Hg, respectively (p < 0.0001). We conclude that the proximal gastric motility, including perception and accommodation in response to intragastric distension, is not impaired in severe obesity. Whether disturbances of gastric reflex relaxation in response to a meal are involved in the pathogenesis of obesity remains to be established.     

Catharsis in psychotherapy: A new perspective.

Reviews contemporary thinking about catharsis in psychotherapy, which is still dominated by J. Breuer and Freud's work with the cathartic method. Psychoanalysts view the fact that Freud abandoned catharsis as evidence of its ineffectiveness, while the emotive therapies developed in the 1960's returned to Freud's earliest view that neurosis results from repressed affect and can be cured by cathartic uncovering. Emotional memories continue to be thought of as foreign bodies lodged in the human psyche and requiring purgation. It is argued that this view divorces people from responsibility for their conduct and encourages a fractionation of human experience into feeling, thought, and action. It is proposed that catharsis is, instead, a label for completing a previously restrained or interrupted sequence of self-expression. It is accompanied by recovery manifestations of some sort, for example, tears or angry shouting. Implications of this view for psychotherapeutic practice are proposed, using examples of patients going through catharsis. It is concluded that therapists should allow catharsis as a means of helping patients discover their predilections, but should recognize this as a preliminary step. After blocked aspects of self have been discovered, then the patient must begin to claim responsibility for choosing more congruent actions and appropriate social expressions, thereby defining a richer, more satisfying existence. (60 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learned helplessness in the perspective of the depressive disorders: Conceptual and definitional issues.

Examines 3 issues that are important in extending the learned helplessness model to clinical depressive disorders. First, the nature of the heterogeneity of clinical manifestations of depression is examined within several clinical frameworks, and the role that learned helplessness may play in each is discussed. Second, the problems in constructing models for clinical populations are explored through the examination of several parallels between learned helplessness and clinical depression put forth by M. E. Seligman (1975). Third, problems involved in defining and identifying depressed college student Ss in analog research are discussed. Integral to the latter issue is an evaluation of the assumption that depressed college student Ss differ from clinical depressives only quantitatively but not qualitatively. Suggestions are made for research aimed at extending the learned helplessness model to other clinical problem areas. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorders: National Institute of Mental Health's perspective.

The mission of the National Institute of Mental Health (NIMH) is to reduce the burden of mental and behavioral disorders through research, and eating disorders embody an important fraction of this burden. Although past and current research has provided important knowledge regarding the etiology, classification, pathophysiology, and treatment of the eating disorders, there are still significant challenges that need to be addressed. This article briefly describes some of these challenges, recent NIMH-supported research and research-related activities directed at addressing these challenges, and approaches and areas of research that hold promise for furthering the understanding and treatment of eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)