Relationship between self-rated functional status and psychosocial stress in patients suffering from rheumatoid arthritis

BACKGROUND: To assess relationship between psychosocial factors and self-rated functioning in rheumatoid arthritis (RA). METHODS: In 66 RA patients (mean age +/- SD = 50.8 +/- 12.6 years, women 49 (74%), illness duration mean +/- SD = 13.4 +/- 10.5 years) aspects of developmental psychosocial stress thought to influence human behavior were assessed in an in depth interview using structured biographical history. Furthermore evaluation included Trait anxiety, global functional status according to the ACR criteria, radiological staging of illness and patients' self-ratings of functioning obtained by the Health Assessment Questionnaire (HAQ). Bivariate correlations were performed using psychosocial and somatic factors and self-rated functional status. RESULTS: Scores of developmental psychosocial stress significantly correlated with interviewers scoring of nurture (r = -0.722, p < 0.001) indicating good internal consistency of interview data. Significant correlations were found between patients' scoring of functional status (HAQ) and (i) ACR criteria (r = 0.490, p < 0.0001) and (ii) score of Trait anxiety (r = 0.367, p < 0.003). There was no significant correlation between developmental psychosocial stress and HAQ score. CONCLUSION: Developmental psychosocial stress does not significantly contribute as to how RA patients perceive their functional ability. In a proportion of RA patients self-rated functional status may depend on the patients disposition (e.g. neuroticism) probably promoting impaired illness behavior (e.g. regressive tendencies) which should be considered in assessing treatment procedures.     

Effects of detraining subsequent to strength training on neuromuscular function in patients with inflammatory arthritis

The effects of detraining subsequent to strength training on neuromuscular function were examined in 39 recent-onset rheumatoid arthritis (RA) patients. Eighteen age- and sex-matched healthy people (H) served as controls. Patients were randomly allocated either to the experimental group (PE), who carried out progressive strength training for 6 months, or to the control group (PC), who maintained only their habitual physical activities. After 6 months, PE returned to their earlier physical activities and strength training was terminated. At baseline, the maximal strength of the trunk extensors (not significant), grip strength and maximal dynamic strength and the shape of the force-time curve of the knee extensors were lower in PE and PC (P < 0.05-0.001) than in H. Strength training in PE led to remarkable increases (P < 0.05-0.001) in the maximal strength of all muscle groups without changes in the shape of the force-time curve. The increases in muscle strength in PE obtained by strength training were lost to a great degree during the detraining period for the isometric trunk extension (P < 0.01) and flexion (P < 0.01) strength and for the dynamic knee extension strength (P < 0.05), but not for the grip strength. In PC, trunk extension and flexion strength decreased significantly throughout the study period. At the post-test, all the strength values in both patient groups were much lower than in H. RA is a chronic disease which seems to need continuous physical exercise with sufficient intensity to minimize/prevent the loss of muscle strength and functional capacity.     

Increased levels of lipid oxidation products in rheumatically destructed bones of patients suffering from rheumatoid arthritis

The new indicator for lipid peroxidation (LPO) processes--9-hydroxy-10,12-octadecadienoic acid (9-HODE)--was used to investigate, whether LPO processes are increased in destructed bone material of patients suffering from rheumatoid arthritis (RA) in comparison to surrounded non destructed bone material. The HODE content in destructed bones exceeded that of non destructed ones of the same patient for a factor of about 3. In addition similar increases in leukotoxines and epoxy oleic acid in the destructed bone material were observed, indicating an increase of LPO processes in affected bone parts of patients.     

Study of lithogenicity of bile among patients suffering from cholecystolithiasis and among patients not suffering from this disease

On the basis of biochemical and morphological research, the authors decided to attempt to determine the degree of lithogenicity of the bile among patients suffering from cholecystolithiasis (100 patients) and those not suffering from this disease (31 patients). Having analyzed the obtained data, it can be concluded that the degree of lithogenicity of bile is influenced by the concentration of cholesterol, bile acids and phospholipids as well as the damage of the liver and of the wall of the gallbladder as well as its kinetics. Lithogenic bile was noticed in 84% of the patients of group I and in 54% in group II. However, the degree of lithogenicity was significantly higher in patients suffering from cholecystolithiasis. According to the authors, the degree of lithogenicity is the deciding factor in the creation of bile stones.     

Circadian changes in body temperature during the menstrual cycle of healthy adult females and patients suffering from premenstrual syndrome

The biological rhythm of females is closely related to the menstrual cycle, and this rhythm is believed to influence circadian changes in body temperature. This study investigated and compared the patterns of circadian changes in the body temperature of healthy adult females and patients suffering from premenstrual syndrome or major depression. Body temperature was measured both rectally and sublingually in healthy subjects, and only sublingually in the patients. During the luteal phase in healthy adult females, both the average and lowest nocturnal body temperatures increased, the amplitude of the circadian changes decreased, and the times of the lowest and highest temperatures within a 24-hour period were delayed by 2-3 h. In the patients, the amplitude decreased during disease periods, especially in the follicular phase, whereas in the luteal phase, circadian changes showed great variation each day, although the decrease in amplitude was not as remarkable. The results show that (i) the biological rhythm of females is intrinsically unstable in the luteal phase, although this rhythm is stable in the follicular phase; and, (ii) symptoms were often aggravated with the decreases in amplitude experienced in the luteal phase.     

Cochlear implantation in patients suffering from Cogan's syndrome

Among patients who receive cochlear implants, those with Cogan's syndrome make a unique group. On one hand they are part of the post-lingual patients and good results can be anticipated. On the other hand, their basic illness is thought to have an autoimmune aetiology and for that reason more susceptible to complications, especially flap problems. In a series of 60 patients who were implanted at the Sheba Medical Center, three had Cogan's syndrome. No post-operative complications, including flap problems, were observed (followed-up for at least 18 months). Subjective and objective hearing results were very good.     

Aldosterone synthase gene in patients suffering from hyperaldosteronism

In this study the known promoter region of P450aldo gene (CYP11B2) was investigated in patients with idiopathic hyperaldosteronism, a disease characterised by hypertension due to aldosterone oversecretion. We amplified the 2.2 kb promoter region of 6 patients and 7 controls from the same ethnic population by PCR and sequenced the product. Thirteen polymorphic sites were found. Of the most significant, one was within a predicted CRE and another previously described polymorphic site was located in a putative SF-1 binding site. To elucidate the allelic distribution of the polymorphisms, the PCR products were cloned and both alleles for each patient were sequenced. As the same alleles and allele combinations were found in hypertensive patients as well as in normal subjects, it was concluded that none of the polymorphisms was responsible for hyperaldosteronism.     

Interactions of lymphocytes from patients with psoriatic arthritis or healthy controls and cultured endothelial cells

Psoriatic arthritis (PA) is an inflammatory rheumatic disease that can concomitantly occur in patients with psoriasis vulgaris. Psoriatic synovitis shows alterations of the synovial microvasculature. Inflammatory cells adhere to endothelial cells (EC) and migrate through the vascular wall of postcapillary venules located in the subintimal layer of the synovial membrane. The aim of our study was to investigate, first, the phenotype of lymphocytes (LC) of PA patients using flow cytometry (FC) with regard to activation antigens and adhesion molecules; second, the adhesion of LC of PA patients on cultivated resting or activated (with thrombin, LPS, IFN-gamma, or TNF-alpha) human umbilical vein endothelial cells (HUVEC) by counting the Feulgen-stained nuclei of both adherent LC and HUVEC using image analysis; and third, the synthesis of IL-6 and IL-8 in both LC and HUVEC 24 hr after cell contact. These cytokines were determined qualitatively by immunofluorescence and quantitatively at the single-cell level by FC as well as in the supernatants of the cultures using commercial cytokine ELISAs. Fourth, we investigated whether or not the LC adhesion on HUVEC as well as the cytokine production could be inhibited by monoclonal antibodies against LC- or EC-specific adhesion molecules. In contrast to controls PA patients showed an increased surface expression of CD11a, b, and c as well as of CD44 but a reduced surface expression of CD49d/CD29, and CD49e/CD29, and cell-bound fibronectin on CD3+ LC. The activation markers CD25 and HLA-DR were found to be slightly enhanced in PA. The cell adhesion was generally enhanced in PA patients vs controls. It could be reduced with monoclonal antibodies (MoAbs) against CD11a and CD18 on IFN-gamma- or TNF-alpha-activated HUVEC but was generally enhanced after treatment of HUVEC with MoAbs against CD54, CD62E, or CD106. Due to LC adhesion on HUVEC IL-6 and IL-8 were produced in significantly higher amounts in PA patients compared to controls. This effect occurred already in resting but was enhanced in activated HUVEC. While IL-6 is mainly produced by HUVEC but also in smaller quantities by LC, IL-8 is synthesized only by HUVEC and could be modified by preincubation with MoAbs against LC- or EC-specific adhesion molecules in parallel to the cell adhesion. The experiments show that the main adhesion pathway in LC homing of PA patients is the interaction of the LC adhesion molecule CD11a/CD18 with CD54 on EC followed by an enhanced synthesis of proinflammatory and chemotactic cytokines. These results favor the hypothesis that the pathological alterations of the microvasculature in PA patients are generated by altered homing processes.     

Open heart operation in patients suffering from hereditary spherocytosis

Hereditary spherocytosis is a clinically heterogeneous, genetically determined red blood cell membrane disorder resulting in hemolytic anemia. Structural or functional disorders of the cytoskeletal proteins result in the formation of spherocytes, which lack the strength, durability, and flexibility to withstand the stresses of the circulation. This problem can be accentuated by the deleterious effects of the heart-lung machine. Three patients with hereditary spherocytosis underwent open heart operation with no deaths and no serious complications resulting from the hematologic defect. Splenectomy is recommended, although not essential, before a cardiac operation, and mechanical valves should perhaps be avoided.     

A role for the nurse in caring for the individual suffering from rheumatoid arthritis

A review was made of the medical records of pregnant patients who had myomas that were documented by ultrasonographic studies. Only 42% of the myomas were diagnosed by physical examination. In most instances the clinical diagnosis was made when the neoplasm was large. However, when the myoma was 3 cm to 5 cm in diameter, the rate of detection on physical examination was only 12.5%. The relationship between the location of the myomas and the placental site emerged as a significant prognostic clue to the outcome of the pregnancy. Ten of 13 patients in whom there was contact between the two presented with complications of pregnancy, mainly antepartum bleeding and premature rupture of membranes. A prospective study is currently in progress.     

肝内胆管细胞癌预后因素分析

Objective:The outcome of surgical treatment of patients with intrahepatic cholangiocarcinoma (ICC) is poor.This study was designed to analyze prognostic factors after surgical procedure for ICCs.Methods:A retrospective clinical analysis was made in 183 cases of ICC,admitted to Department of Hepatic Surgery,Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai,China,from December 1996 to July 2003.Fifteen clinicopathologic factors that could possibly influence survival were selected.A multivariate analysis of these individuals was performed using the Cox Pro-portional Hazards Model.Results:The accumulative 1-,3- and 5-year survival rates of the patients were 51.3%,21.6% and 11.8% respectively.The statistical analysis showed that surgical procedure,lymph node metastasis,serum level of CA19-9 and pathological differentiation grade affected postoperative survival significantly,but transfusion,postoperative radiotherapy and chemotherapy,diameter of tumor,serum level of AFP,cirrhosis,preoperative total serum bilirubin level (TBIL),ratio of albumin to globulin (A/G),sex and age were not significant factors influencing postoperative survival.Conclusion:Major hepatectomy with systematic lymph node dissection may be recommended for the surgical treatment of ICC.Aggressive treat-ment and prevention on postoperative intrahepatic recurrence and lymph node metastasis are important strategy to improve the survival for ICC.     

Evaluation of a new night nursing service for elderly people suffering from dementia

A new night hospital nursing service was developed for older people with dementia. A case study approach to evaluation was adopted using a structure-process-outcome quality assurance cycle. The effects and attendance of patients are reported and discussed. Discussion relating to care provision for the future is presented. The effects on carers of patients' attendance are briefly discussed.     

Magical thinking in healthy people and in schizophrenia

Different conditions of magical thinking have been analyzed. A formation of the proportion "realistic thinking - magical thinking" in paranoid schizophrenia has been discussed and the characteristic features of magical thinking in schizophrenia have been indicated.     

Connective tissue in skin biopsies from patients suffering systemic sclerosis

We describe the complete beta-tubulin folding pathway. Folding intermediates produced via ATP-dependent interaction with cytosolic chaperonin undergo a sequence of interactions with four proteins (cofactors A, D, E, and C). The postchaperonin steps in the reaction cascade do not depend on ATP or GTP hydrolysis, although GTP plays a structural role in tubulin folding. Cofactors A and D function by capturing and stabilizing beta-tubulin in a quasi-native conformation. Cofactor E binds to the cofactor D-beta-tubulin complex; interaction with cofactor C then causes the release of beta-tubulin polypeptides that are committed to the native state. Sequence analysis identifies yeast homologs of cofactors D (cin1) and E (pac2), characterized by mutations that affect microtubule function.     

Trend of circulating eosinophils in healthy children and children suffering from infectious diseases. A retrospective study

INTRODUCTION: Acute bacterial and viral infections are accompanied by a marked diminution in circulating eosinophils in the blood. This forms part of the host's physiological response to acute infection and was first studied in adults early this century. The aims of this study were to check whether eosinopenia during acute phlogosis is a phenomenon present in pediatric patients, and whether the trend is comparable to the experimental models reported; to describe the trend of circulating eosinophils in the remission process. METHODS: A retrospective study was performed in 34 children hospitalised in the Pediatric Hospital of AUSL 2-Lucca (Italy) for bacterial or viral infective diseases documented by cell culture or presumed diagnosed. Children with the following characteristics were excluded from the study: 1) blood samples collected for hemochrome analysis at times other than normal (7-8 a.m.); 2) cortisone treatment administered up to 5 days prior to blood sample and/or during hospitalisation; 3) positive personal anamnesis for manifest allergic diseases. On admittance (children during acute phase) and at the start of remission, an absolute count of circulating eosinophils was performed in these children using an automatic globule counter. Sixty-six children with non evident infective and/or inflammatory diseases were included in the study as a control group. This group was also selected in the same way as infective subjects. RESULTS: The mean number of circulating eosinophils was 288 (+/- 248) in the control group, 46 (+/- 58) in subjects at the acute phase of infective pathology and 252 (+/- 162) in infective patient during the remission phase. The difference between the two means was statistically significant. This characteristic falling and rising trend of circulating eosinophils was found in 33 of the 34 infective subjects examined. CONCLUSIONS: Eosinophil values found in control subjects are broadly in line with those reported in the literature. Eosinopenia during the course of acute infection and the early rise during remission represent a characteristic phenomenon indicating the body's "normal" response to a non-parasitic infection. Both eosinophil levels, namely in the control group (288/mm3) and in acute-phase subjects (46/mm3), should be regarded as "normal" provided they refer to the appropriate situation. The precocity and precision with which the eosinophil trend follows the phases of the infection underlines the value of the assay of these cells as a reliable parameter for monitoring acute infection. There are also indications that, in an inflammatory situation, the behaviour of circulating eosinophils may provide a practical clinical marker of the predominant lymphocyte pattern (Th1 or Th2), as well as the phase of phlogosis, active or remission.