Measuring disease activity and response to treatment in rheumatoid arthritis

Introduction: Effective treatment of rheumatoid arthritis (RA) requires suppression of the underlying inflammation. Measurement of such inflammation, the disease activity, is mandatory to target treatment and maximize outcomes. However, this is not as straightforward as it may seem.

Areas covered: The many tools developed to measure disease activity in RA, from composite scores and patient-reported outcomes, to laboratory markers and imaging are discussed, with a focus on their utility in guiding therapy and assessing response. The complex issues in measuring disease activity in RA, whether in clinical trials or normal clinical practice, and in the context of national guidelines and recommendations, available time, and resources are considered.

Expert commentary: The key to effective management of RA is the rapid suppression of inflammation, ideally to remission, with maintenance of such remission. The aim is to prevent disability and maximize quality of life. Central to this is the ability to determine disease activity (potentially open to suppression) as opposed to damage (irreversible). A variety of measures are currently available, allowing better assessment of response to treatment. In the future, the development of predictive biomarkers allowing targeting of drugs may revolutionize this field and render the tools of today redundant.     

心理护理在ICU重症护理中的效果观察

目的探讨心理护理在ICU重症护理中的效果。方法选定本科于2017年6月-2019年8月收诊的ICU重症患者86例,等距抽样法分为对照组(43例,传统式护理)与观察组(43例,心理护理联合传统式护理)2组,比较2组ICU重症患者的护理满意率、情绪评分(SAS/SDS)指标。结果观察组ICU重症患者干预结束后的满意率高于对照组(P<0.05);观察组ICU重症患者干预结束后的SAS评分(32.52±3.26)分、SDS评分(30.09±3.45)分均低于对照组(P<0.05)。结论心理护理应用于ICU重症患者,可对其满意度、安全性进行保证。     

Workplace status and risk of hypertension among hourly and salaried aluminum manufacturing employees

An inverse relationship between workplace status and morbidity is well established; higher job status has been associated with reduced risks of heart disease, hypertension, and injury. Most research on job status, however, has focused on salaried populations, and it remains unclear whether job status operates similarly among hourly workers. Our objectives were to examine whether hourly status itself influences risk of hypertension after adjustment for socioeconomic confounders, and to explore the role of fine-scale job grade on hypertension incidence within hourly and salaried groups. We examined data for 14,999 aluminum manufacturing employees in 11 plants across the U.S., using logistic regression with adjustment for age, sex, race/ethnicity and other individual characteristics. Propensity score restriction was used to identify comparable groups of hourly and salaried employees, reducing confounding by sociodemographic characteristics. Job grade (coded 1 through 30, within hourly and salaried groups) was examined as a more refined measure of job status. Hourly status was associated with an increased risk of hypertension, after propensity restriction and adjustment for confounders. The observed effect of hourly status was stronger among women, although the propensity-restricted cohort was disproportionately male (96%). Among salaried workers, higher job grade was not consistently associated with decreased risk; among hourly employees, however, there was a significant trend, with higher job grades more protective against hypertension. Increasing the stringency of hypertension case criteria also increased the risk of severe or persistent hypertension for hourly employees.     

Labman and Linkman: A data management system specifically designed for genome searches of complex diseases

Two programs have been developed to manage linkage analysis data. The first program, LABMAN, is a comprehensive laboratory data management system organizing pedigrees, blood DNA samples, DNA markers, Southern blot or polyacrylamide gels, autoradiographs, and marker-allele typings generated from these samples. Output includes mendelization checks for genetic incompatibilities in typings and formatted files ready for linkage analysis. LABMAN can also compress highly polymorphic allele systems into smaller allele systems facilitating analysis of large systems. The second program, LINKMAN, provides data management for lod score output from linkage analyses. It reads linkage analysis output files, calculates lod scores by family, associates lod scores with specific marker and family identifiers, and stores these data in a database where they can be combined with lod scores from previous analyses. LINKMAN easily incorporates any of a wide variety of genetic models. It produces formatted output of lod scores by user-specified criteria for reports or as ASCII files for input to other programs. If desired, tests of homogeneity of linkage across families can be run via the HOMOG program [Ott, 1991] and their output included in reports. The programs include features critical for conducting genome searches of complex diseases: They are easy-to-use, well-tested, and reliable. Data from multi-center investigations can be easily combined for analysis. Moreover, they include extensive error-checking capabilities, and they are specifically set up to protect blindness between laboratory workers and data analysts. LABMAN and LINKMAN are currently available free of charge under DOS. © 1994 Wiley-Liss, Inc.     

The relation between EEG and mental development following cardiac surgery performed under simple deep hypothermia in children

In order to assess the accuracy of electroencephalography (EEG), in children who have undergone cardiac surgery under simple deep hypothermia, the relation between IQ or schoolwork achievement and the duration of circulatory arrest was investigated in 75 such children. Abnormal preoperative EEG's were found in 16 per cent of the children while abnormal postoperative EEG's were found in 17 per cent. The children were divided into 4 groups, according to pre- and postoperative EEG results. Schoolwork achievement scores ranged between 3.0 and 3.2, the difference among the groups being insignificant. Moreover, no significant shift in IQ was found among the groups. Finally, regarding the number of children who were able to go on to a higher level of education, including high school the college or university, again no significant differences were found among the 4 groups. In a comparison with the number of such children in neighboring Nagasaki prefecture able to continue on to a higher level of education, no significant differences were seen either. The findings and statistics of this investigation therefore indicate that pre- and postoperative EEG's are not always a reliable reference for assessing the prognosis of cerebral activity.     

放松训练对高考学生身心健康的影响

目的　研究放松训练法对高考学生身心健康的影响 ,为考生心理健康水平的提高 ,减轻考前焦虑提供科学措施。方法　选择同一学校两个高中三年级的班级 ,分别作为对照组 ( n=72 )和放松训练组 ( n=70 )。高考前的 3个月开始进行全身放松训练 ,每天约 2 5分钟 ,连续两个半月。比较训练前后两组考生的心理健康水平 ,并评价放松训练法的作用效果。结果　对照组考生在考前半个月 SCL-90的阳性项目数以及焦虑、强迫、躯体化、人际敏感、抑郁等 5项因子分和 SAS总均分均显著高于 3个月前 ;放松训练组考生经 2个半月的放松训练后 ,其 SCL-90的焦虑、强迫、人际敏感、抑郁、躯体化等 5项因子分和 SAS总均分均显著低于放松训练前 ,且阳性项目数、总均分以及焦虑、强迫、抑郁、躯体化、人际敏感等 5项因子分和 SAS总均分均显著低于对照组高考前半月的相应分值。结论　随着高考的临近 ,考生的心身反应增多且加重 ,心理健康水平明显下降 ;全身放松训练法能有效改善考生的各种心身反应和紧张焦虑状况 ,有利于保护考生的心理健康     

神经症的性压抑与心理因素的相关性研究

研究神经症患者潜在人格与性压抑和情绪的相关性.方法:对124例神经症患者进行了婚姻质量问卷(性生活、婚姻质量部份)、抑郁自评量表(以下简称SDS)、焦虑自评量表(以下简称SAS)及自编的性生活调查问卷、主题统觉测验(以下简称TAT)测评.结果:1、神经症伴性障碍组TAT潜在人格与对照组相比,在支配、性、援助、躯体社会攻击、财产破坏欲求、自我攻击、情绪变化欲求和情绪言语攻击性、躯体社会攻击、引诱、缺乏、丧失、灾害、丧失支持、躯体伤害压力上均较对照组显著增高,而成就欲求下降(P<005-001);与神经症无性障碍组相比,神经症伴性障碍组的成就、支配、教养、性欲求得分显著增高,情绪言语攻击欲求得分下降(P<001～005);2、神经症伴性障碍组的性生活质量低,性频度、性后快感均低.3、SDS、SAS与TAT中的负性欲求呈明显的相关性,性行为调查与婚姻质量量表中的性行为呈正相关.结论:神经症的性压抑与其潜在人格有密切的相关性.