Back pain in relation to pregnancy: a 6-year follow-up

STUDY DESIGN: A prospective randomized controlled 6-year follow-up study of women with back pain during pregnancy. OBJECTIVES: To describe the long-term development of back pain in relation to pregnancy and to identify the effects of a physiotherapy and patient education program attended during pregnancy. SUMMARY OF BACKGROUND DATA: Pain incidence and intensity during pregnancy can be reduced by physiotherapy. No study has described the development of pain experienced for a period of years after delivery or the long-term effect of physiotherapy. METHODS: Pregnant women, registered consecutively, were randomly assigned to one control group and to two intervention groups and were observed throughout pregnancy, with follow-up after 3 months and 6 years. RESULTS: The first phase of the study was completed by 362 women. After 3 months, 351 and after 6 years, 303 women had been observed. Back pain among 18% of all women before pregnancy and among 71% during pregnancy declined to 16% after 6 years. Pain intensity was highest in Week 36 (visual analog score, 5.4) and declined markedly 6 years later (visual analog score, 2.5). Slow regression of pain after partus correlated with having a back pain history before pregnancy, (r = 0.30; P < 0.05), with high pain intensity during pregnancy (r = 0.45; P < 0.01), and with much residual pain 3 months after pregnancy (r = 0.41; P < 0.01). These correlations were not found in the intervention groups. Furthermore, frequency of back pain attacks at 6 years correlated with frequency of attacks during pregnancy (r = 0.41; P < 0.01) and with a vocational factor (r = -0.25; P < 0.01). Physiotherapy and patient education had no effects on back pain development among women without pain during pregnancy. CONCLUSIONS: Back pain during pregnancy regressed spontaneously soon after delivery and improved in few women later than 6 months post partum. Expected correlations between back pain in relation to pregnancy and back pain 6 years later were not present in the intervention groups who had attended a physiotherapy and education program during pregnancy. The program had no prophylactic effects on women without back or pelvic pain during pregnancy.     

Affect intensity: Separating intensity and frequency in repeatedly measured affect.

E. Diener, R. J. Larsen, S. Levine, and R. A. Emmons ( 1985) distinguished between intensity and frequency as separable components in repeatedly measured affect. In this article, an improved way of differentiating intensity and frequency of affect is proposed that permits one to measure affect intensity separately for each emotion of interest. The results of 3 studies using this method provide further support for the affect intensity construct and demonstrate the superiority of the new approach. In addition, a new measure based on intensity ratings of hypothetical scenarios proved to be the best measure of affect intensity when it has to be assessed at I moment in time. Finally, results of 2 diary studies, one sampling emotional events and the other sampling random moments, confirmed the hypothesis that affect intensity is best conceptualized as a disposition to react strongly to emotion-eliciting events rather than to experience intense affect in the absence of goal-relevant situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Laboratory assessment of antithrombotic therapy: what tests and if so why?

A critical review is given of the tests available for the assessment of the action of anticoagulants, such as heparins, oral anticoagulants and direct thrombin inhibitors, in patients under antithrombotic therapy. The principle of action and the performance of the thromboplastin time (PT), the activated partial thromboplastin time (aPTT), the whole blood clotting time, the thrombin time, the ecarin clotting time and the endogenous thrombin potential (ETP) is discussed, as well as the evidence behind the accepted therapeutic ranges. The two most common tests, PT and aPTT, respond in an essentially different way to clinically effective anticoagulation with heparin and with oral anticoagulants. This means that they covariate with, but do not themselves represent the essential parameter influenced by anticoagulation. The experimental basis for the widely accepted two times prolongation of the aPTT as an indicator for adequate anticoagulation is shown to be meagre in the case of unfractionated heparin and lacking for the other anticoagulants. Common sources for error in the interpretation of anti-factor Xa- and anti-thrombin activity of heparins are indicated. Extensive experience with new tests like the ecarin clotting time and the ETP is still lacking. On the basis of preliminary data and in view of the importance of the enzymatic action of thrombin in the pathogenesis of thrombosis, the ETP is considered a possible candidate for a common parameter to assess different types of anticoagulants.     

A method for quality assurance in a community mental health center. Community psychiatry in Copenhagen

The purpose was to describe a method for quality assurance in community mental health centres. Three psychiatrists and a multiprofessional treatment team conceived the method. The community mental health center--which was the basis for the work--was the Copenhagen centre for the sectors Vesterbro and Kongens Enghave. The target group for the centre is people with serious mental illness. The work is done according to the principles for clinical case managers. Data are registered in a national database in combination with the centre's own registration system. Eleven indicators for process quality and eight for outcome quality were selected. Measurement parameters for there indicators were defined. Criteria and standard were defined according to existing knowledge and the author's clinical experience. The necessary programs for calculating the value of the chosen standards are constructed. With the use of existing data and a limited extra registration it was possible to evolve a method for quality assurance in a community mental health centre.     

Comparison of sequences for depicting bone marrow alterations in osteomyelitis applied in a low field strength magnetic resonance imaging system

Phenotypes of septal neurons, dissociated from 19-day-old fetal rat brains and then cultured in a medium containing nerve growth factor for 4 weeks, were examined using gamma-aminobutyric acid (GABA), calbindin D-28k, parvalbumin and choline acetyltransferase immunohistochemistry, and acetylcholinesterase histochemistry. There were primarily four groups of neurons identified in this septal culture: the first group (12.7% of 212 neurons examined) displayed a cholinergic, but not GABAergic, phenotype and had an average diameter of 13.6±2.7 μm (mean±S.D.); the second group (31.6%) displayed both cholinergic and GABAergic phenotypes and had a diameter of 12.2±2.8 μm; the third group (31.0%) displayed only a GABAergic phenotype and had a diameter of 10.4±2.3 μm; and the fourth group (24.7%) displayed neither a GABAergic nor cholinergic phenotype and had a diameter of 10.4±2.1 μm. Neurons in the first two groups described were significantly larger than those in the second two groups; neurons in the third and fourth groups were the same size. Calbindin D-28k was expressed in some neurons of each group (31.3%, 18.8%, 9.6% and 15.7%, respectively). These results demonstrate that septal neurons have the ability to express a variety of phenotypes when grown in vitro. This culture will be a useful tool for studying mechanisms of phenotype expression in septal neurons.     

Topical FK506 suppresses cytokine and costimulatory molecule expression in epidermal and local draining lymph node cells during primary skin immune responses

Recently, it has been shown that the immunosuppressive macrolide lactone, FK506, exerts good therapeutic efficacy in inflammatory skin diseases. The aim of this study was to analyze the influence of topical FK506 on molecular (IL-1alpha, IL-1beta, IL-2, IL-4, IL-12 p35, IL-12 p40, macrophage inflammatory protein-2 (MIP-2), granulocyte-macrophage CSF (GM-CSF), TNF-alpha, and IFN-gamma) and cellular (I-A+/CD80+, I-A+/CD54+, I-A+/CD69+, I-A+/B220+, and CD4+/CD25+) events in epidermal (EC) and local draining lymph node (LNC) cells during primary contact hypersensitivity responses. Cytokine mRNA levels for IL-1alpha, IL-1beta, GM-CSF, TNF-alpha, MIP-2, and IFN-gamma in EC and for IL-2, IL-4, IL-12 p35, IL-12 p40, and IFN-gamma in LNC were increased and resulted in significant LNC proliferation during oxazolone-induced contact hypersensitivity. Topical FK506 treatment dose-dependently suppressed oxazolone-induced LNC proliferation. This effect was correlated with decreased IL-1alpha, IL-1beta, GM-CSF, TNF-alpha, MIP-2, and IFN-gamma mRNA expression within the epidermis and decreased IL-12 p35 and p40 mRNA expression in LNC. Further analysis of the LNC cytokine pattern revealed that the production of both Thl (IFN-gamma and IL-2) and Th2 (IL-4) cytokines was dramatically impaired after topical FK506 treatment. Flow cytometric analysis showed that topical FK506 decreased the population of epidermis-infiltrating CD4+ T cells and suppressed the expression of CD54 and CD80 on I-A+ EC and LNC during hapten-induced contact hypersensitivity. Furthermore, topical FK506 profoundly impaired oxazolone-induced up-regulation of CD25 expression on CD4+ LNC and dramatically decreased hapten-induced expansion of I-A+/B220+ and I-A+/CD69+ LNC subsets. In conclusion, these results give new insights into the mechanisms of action of topical FK506 treatment.     

Prognostic value and clinicopathological profile of microsatellite instability in gastric cancer

In this study, microsatellite instability (MI) was investigated in 126 gastric carcinomas and correlated with clinicopathological features and prognosis; at least 5-10 microsatellite loci were analyzed. MI was identified in 56 (44.5%) of all investigated carcinomas, one locus being affected in 40 (31.7%) carcinomas, two loci being affected in 6 (4.8%) carcinomas, and more than two loci being affected in 10 (8.0%) carcinomas. MI was correlated with neither age and sex of the patients nor with depth of invasion, lymph node metastasis, tumor differentiation, or histological type according to WHO and Laurén classification. The frequency of MI was the same in early gastric carcinomas as it was in advanced gastric carcinomas, suggesting that MI arises early during the tumorigenesis of gastric cancer. No significant differences in survival could be demonstrated between patients with MI-negative and MI-positive gastric carcinomas.     

The nonrandom binding distribution of Streptococcus pneumoniae to type II pneumocytes in culture is dependent on the relative distribution of cells among the phases of the cell cycle

The adherence of Streptococcus pneumoniae to epithelial (A549) lung cells was studied and the bacterial binding distribution was found to be nonrandom (non-Gaussian). Analysis of the dependency of bacterial binding on the cell cycle of A549 cells revealed that approximately 1.8 times more bacteria bind to G2 cells than to G0-G1 phase cells. Furthermore, bacterial binding curves exhibited a plateau of binding to G2 cells at a normalized bacteria to cell ratio approximately 1.8 times larger than that at which the plateau of binding to G0-G1 cell was observed. Since G2 cells are on average 1.4-1.8 times larger than G0-G1 cells, the results indicate that bacterial binding is proportional to cell size and not to the preferential binding (higher affinity) of bacteria to A549 cells in the G2 phase. Finally, the non-Gaussian distribution of bacterial binding could be mathematically modeled by a linear combination of three Gaussian distributions each representing bacterial binding to cells in a particular phase of the cell cycle (G0-G1, S, and G2-M). Because the Gaussian function contains a term that takes into account the relative number of cells in each of the phases, this last result implies that the overall (non-Gaussian) binding distribution (and hence the median of bacterial binding) can be highly sensitive to the relative proportion of cells in the various phases of the cell cycle.     

Information processing in schizophrenia and bipolar disorder: a discriminant analysis

Schizophrenia and bipolar disorder are two distinct categories of mental disorders in the DSM-IV. However, it is often difficult to make a differential diagnosis because of the overlapping symptoms. A potential adjunct in the classification of schizophrenia and bipolar disorder is the application of information processing models, as patients with schizophrenia and possibly those with bipolar disorder have information processing deficits. A study was conducted in which a computerized battery of information processing tasks (called COGLAB) was administered to three participant groups: patients with schizophrenia, patients with bipolar disorder, and normal controls. The tasks included the Mueller-Lyer illusion, reaction time, size estimation, a variant of the Wisconsin Card Sorting Test, backward masking, and Asarnow continuous performance. Discriminant analyses were used to investigate the differences among the three groups. Results indicated that COGLAB correctly classified 75.5% of the cases of schizophrenia and bipolar disorder. The Mueller-Lyer illusion and the number of perseverative errors on the card sort most powerfully discriminated the two groups.