Rheumatic diseases in the elderly: assessing chronic pain

This article will discuss the assessment of chronic pain in older patients. First, the epidemiology and impact of chronic pain in the elderly will be addressed. Next, common barriers to pain assessment will be reviewed. An effective approach to pain assessment in the older patient will then be described, including important pearls for history-taking and the physical examination, as well as recommendations for the evaluation of functional status and psychosocial well-being. The article will conclude with a review of multidimensional and unidimensional pain assessment tools and a discussion of methods for pain assessment in the cognitively impaired.     

Gender differences in regional cutaneous microcirculatory responses to capsaicin

Vascular responsiveness between healthy male and female subjects to capsaicin, an agent promoting neuropeptide release, was compared. Changes in skin perfusion were measured non-invasively using laser Doppler imaging. Topical application of a 3% solution of capsaicin to the dorsum of the hand resulted in vasodilatation in nine of 10 male subjects, but in less than half of the female subjects. Responses to capsaicin at the shin were smaller but did not show gender differences. Fingertip temperature was significantly lower in females compared with males and this correlated (r = 0.54, P < 0.01) with the maximum response to capsaicin. These effects were specific to capsaicin as endothelium-dependent and -independent vasodilator mechanisms, assessed non-invasively by iontophoresis of acetylcholine and sodium nitroprusside, respectively, showed no gender differences. These findings suggest a specific anomaly in capsaicin-sensitive vasodilator mechanisms in some subjects, perhaps indicative of subclinical expression of Raynaud's phenomenon.     

Association between body fat response to exercise training and multilocus ADR genotypes

OBJECTIVE: To examine the contribution of adrenergic receptor (ADR) gene polymorphisms and their gene-gene interactions to the variability of exercise training-induced body fat response. RESEARCH METHODS AND PROCEDURES: This was an intervention study that used a volunteer sample of 70 healthy, sedentary men (n = 29) and postmenopausal women (n = 41) 50 to 75 years of age, with a BMI < or = 37 kg/m2, from the Washington, DC, metropolitan area. Participants completed 6 weeks of dietary stabilization (American Heart Association diet) before 24 weeks of supervised aerobic exercise training. Diet was maintained throughout the intervention. Change in percent total body fat, percent trunk fat, and fat mass by DXA in ADR genotype groups (Glu12/Glu9 alpha2b-ADR, Trp64Arg beta3-ADR, and Gln27Glu beta2-ADR) at baseline and after 24 weeks of aerobic exercise training was measured. RESULTS: In multivariate analysis (covariates: age, gender, and baseline value of phenotype), best fit models for percent total body and trunk fat response to exercise training retained main effects of all three ADR gene loci and the effects of each gene-gene interaction (p = 0.009 and 0.003, respectively). Similarly, there was a trend for the fat mass response model (p = 0.03). The combined genetic factors explained 17.5% of the overall model variability for percent total body fat, 22% for percent trunk fat, and 10% for fat mass. DISCUSSION: The body fat response to exercise training in older adults is associated with the combined effects of the Glu12/Glu9 alpha2b-, Trp64Arg beta3-, and Gln27Glu beta2-ADR gene variants and their gene-gene interactions.     

Prevalence of SDHB, SDHC, and SDHD germline mutations in clinic patients with head and neck paragangliomas

Background: Paragangliomas are rare and highly heritable tumours of neuroectodermal origin that often develop in the head and neck region. Germline mutations in the mitochondrial complex II genes, SDHB, SDHC, and SDHD, cause hereditary paraganglioma (PGL).

Methods: We assessed the frequency of SDHB, SDHC, and SDHD gene mutations by PCR amplification and sequencing in a set of head and neck paraganglioma patients who were previously managed in two otolaryngology clinics in the USA.

Results: Fifty-five subjects were grouped into 10 families and 37 non-familial cases. Five of the non-familial cases had multiple tumours. Germline SDHD mutations were identified in five of 10 (50%) familial and two of 37 (~5%) non-familial cases. R38X, P81L, H102L, Q109X, and L128fsX134 mutations were identified in the familial cases and P81L was identified in the non-familial cases. Both non-familial cases had multiple tumours. P81L and R38X mutations have previously been reported in other PGL families and P81L was suggested as a founder mutation. Allelic analyses of different chromosomes carrying these mutations did not show common disease haplotypes, strongly suggesting that R38X and P81L are potentially recurrent mutations. Germline SDHB mutations were identified in two of 10 (20%) familial and one of 33 (~3%) non-familial cases. P131R and M71fsX80 were identified in the familial cases and Q59X was identified in the one non-familial case. The non-familial case had a solitary tumour. No mutations could be identified in the SDHC gene in the remaining four families and 20 sporadic cases.

Conclusions: Mutations in SDHD are the leading cause of head and neck paragangliomas in this clinic patient series. SDHD and SDHB mutations account for 70% of familial cases and ~8% of non-familial cases. These results also suggest that the commonness of the SDHD P81L mutation in North America is the result of both a founder effect and recurrent mutations.

     

An overview of palliative nursing care

Studies tell us that most people fear a protracted, painful death; unfortunately, this is what many experience. Palliative nursing care seeks to change this. This new series challenges nurses to think differently about caring for people when cure isn't possible.     

Physical activity,hormone replacement therapy and plasma lipoprotein-lipid levels in postmenopausal women

We assessed the cross-sectional associations between hormone replacement therapy (HRT), habitual physical activity levels and plasma lipoprotein-lipid levels in postmenopausal women. Sedentary (n = 19), active nonathlete (n = 20) and endurance-trained (n = 21) postmenopausal women, with half of each group on and half not on HRT, underwent assessments of plasma lipids, VO2max, body composition, diet and common genetic variants. The groups' physical characteristics were generally similar though body weight was higher in the active nonathletes, and body fat was lower and VO2max higher in the athletes. HRT was associated with beneficial total cholesterol, LDL-C and HDL-C levels in sedentary and active nonathlete women. Plasma lipoprotein-lipid profiles were similar in women athletes on and not on HRT, with their profiles being only slightly better than sedentary and physically-active women on HRT. After controlling for HRT status, VO2max was correlated with total cholesterol (r = -0.51, p = 0.0001), LDL-C (r = -0.52, p = 0.0001), HDL-C (r = 0.25, p = 0.055), HDL 2 -C (r = 0.24, p = 0.08) and TG levels (r = -0.46, p = 0.0001). After controlling for HRT status, % body fat was correlated with total cholesterol (r = 0.43, p = 0.001), LDL-C (r = 0.38, p = 0.003), HDL-C (r = -0.29, p = 0.025), HDL 2 -C (r = -0,26, p = 0.07) and TG levels (r = 0.40, p = 0.002). Dietary fat intake was similar among the groups. APO E genotype was only associated with plasma lipid profiles in athletes, as those with at least one APO E2 allele tended to have better lipid profiles than those with only APO E3 or E4 alleles. Thus, HRT, exercise training and body composition are associated with plasma lipid levels in postmenopausal women; common polymorphic variations at key lipid metabolism-related gene loci also may interact with exercise training to affect their plasma lipid profiles.