The assessment of denial and physical complaints: the validity of the Hy scale and associated MMPI signs

Little and Fisher (1958) have demonstrated that the MMPI Hysteria (Hy) scale consists primarily of items that address the denial of psychological problems (the DN scale) and items that involve the admission of physical problems (the AD scale). The traditional interpretation of an elevated Hy score implies that both DN and AD subscales are elevated significantly. Using samples of psychiatric (N = 1,246), medical (N = 330), and chronic pain patients (N = 126), the effectiveness of the HY scale and of various combinations of MMPI scales as predictors of the simultaneous occurrence of these two characteristics was evaluated. The results suggest that when the 13 standard MMPI scales were used, simultaneous elevations on scales K, HS, and HY proved to be the best indicator of the denial of psychological factors associated with a physiological disorder. It was found unwarranted to suggest the presence of hysteroid features on the basis of an elevated HY score unless scales K and HS also were elevated. The value of the HY scale as a measure of psychological denial associated with physical complaints must be considered questionable.     

Utility of the MMPI Pain Assessment Index in predicting outcome after lumbar surgery

A Pain Assessment Index (PAI), computed from a weighted combination of MMPI scales scores, has been developed to assess a pain patient's tendency toward continued pain complaints after surgery (Smith & Duerksen, 1979). This study examined the ability of the PAI, determined from presurgery MMPIs, to predict outcome subsequent to lumbar laminectomy and discectomy. One hundred and six chronic low back pain patients (61 males, 45 females) were categorized as having good, fair, or poor outcome 1 year or more postsurgery. Using the cutting score proposed by Smith and Duerksen (1979), the PAI correctly classified 79% of the subjects as having good or fair/poor outcome, and 87% as to whether they were working at follow-up. However, the MMPI Hypochondriasis (HS) scale alone correctly predicted the overall outcome of 83% and the work status of 81% of the subjects. The PAI (and, to a lesser extent, the HS and Hysteria [HY] scales of the MMPI) were found to have good ability to identify patients who were doing well after surgery, but low power in predicting which patients would have a fair or poor surgical result.     

Age differences in MMPI scale scores from 1,189 psychiatric patients

Investigated age-related differences in MMPI scale scores from 1,189 individuals (ages 20 to 64 years) who were applying for psychiatric treatment. All major scales except L, K, D, and SI showed statistically significant age group differences. In general, older patients had higher scores on HS and HY, while younger patients had higher scores on F, PD, PA, PT, SC, MA. These results underscore the importance of the age of the patient in the clinical interpretation of an individual protocol.     

MMPI profiles of closed head trauma patients: impact of neurologic complaints

The MMPI is used commonly with neurologic patients despite concerns about its validity with this population. The basis for this concern--possible artifactual effects due to neurologic-related MMPI items (NRIs)--was assessed in this study of 58 closed head trauma (CHT) patients. The MMPI profiles of these patients were analyzed before and after statistical correction was made for 42 NRIs that were identified by three neurologists. Significant effects occurred on Scales 1 (HS), 2 (D), 3 (HY), 7 (PT), and 8 (SC) in regard to their T scores, frequency of pathological elevation (T greater than 69), and representation in configural codes. The results suggest that MMPI content scales and subscales may help to distinguish the relative contribution of neurologic and emotional complaints on MMPI profiles.     

MMPI correlates of clinical women who report early sexual abuse

It was predicted from Freud's seduction theory that women who experienced sexual assault early in life would be identifiable by the MMPI. Twenty-six of 51 women treated at a psychotherapy clinic during a 2-year period reported experiencing sexual abuse as a child (RA); 25 made no such claim (NRA). Age, income level, years of formal education, marital status, and k-corrected scores of the MMPI were submitted to a stepwise multivariate discriminant analysis. It was found that the HY, MF, HS, and PD scales constituted a linear function that correctly classified 72.55% of the subjects (Wilkes Lambda = .670785, df 4, p = .0009). These scales correctly identified 73.1% of the RA and 72.0% of the NRA clients.     

The level of lipopolysaccharide-binding protein is significantly increased in plasma in patients with the systemic inflammatory response syndrome.

Currently, there is no way to predict with a high degree of sensitivity and specificity which patients are likely to develop systemic inflammatory response syndrome (SIRS) following systemic infection, trauma, organ rejection, or blood loss. The level of human lipopolysaccharide-binding protein (LBP) was determined in the plasma of 22 patients with a clinical diagnosis of early SIRS. Twenty-nine plasma samples from healthy volunteers were used as controls. The mean level of LBP in the plasma of healthy volunteers was 7.7 micrograms/ml (standard deviation, 6.2 micrograms/ml). Twenty-one of 22 patients (95%) with SIRS had an LBP level on admission at least 2 standard deviations above the mean LBP level for a healthy volunteer control group (range, 4.9 to 114.2 micrograms/ml; mean, 36.6 micrograms/ml; standard deviation, 22.2 micrograms/ml; P < 0.0001). The level of LBP in the plasma of the majority of patients with early SIRS is significantly increased compared to that in healthy controls. The sensitivity, specificity, and predictive value of elevated plasma LBP levels in patients with SIRS remain to be determined.     

Depressive symptoms and disability in acute and chronic back pain patients

Depression and level of disability are evaluated in acute and chronic low back pain (LBP) patients. To assess the possibility that some somatic symptoms are confounded with pain, the items of the Beck Depression Inventory arc divided into a cognitive-affective and somatic subscale. The sample consisted of 37 chronic LBP patients. 41 acute LBP patients, and 28 healthy participants. The level of disability was assessed by the Oswestry Low Back Pain Disability Questionnaire. Chronic LBP patients, but not acute LBP patients, have more depressive symptoms than controls. Additionally, chronic LBP patients report more somatic symptoms of depression (e.g.. emo ltional and self disturbance complaints) than cognitive-affective symptoms. Finally, correlation statistics reveal significant relations between the level of disability and depression scores. Whereas chronic patients show a significant correlation between the somatic subscale and level of disability, in acute patients the cognitive-affective subscale is significantly related to the level of disability. The findings suggest careful consideration of whether somatic symptoms of depression are related to pain when using self-report measurements of depression in pain patients. The separation of cognitive-affective and somatic symptoms of depression to evaluate pain problems seems appropriate.     

Putative consequences of exposure to Helicobacter pylori infection in patients with coronary heart disease in terms of humoral immune response and inflammation

Introduction

Pathogens, including Helicobacter pylori (Hp), have been suggested to contribute to the development of coronary heart disease (CHD), although the evidence still remains insufficient. The study was focused on the exposure of CHD patients to Hp and resulting anti-Hp heat shock protein B HspB antibody production in relation to the level of serum lipopolysaccharide binding protein (LBP) as a marker of inflammation.

Material and methods

One hundred seventy CHD patients and 58 non-CHD individuals participated in this study. Coronary angiography confirmed the atheromatic background of CHD. The panel of classical risk factors included: arterial hypertension, diabetes, total cholesterol, low-density lipoprotein (LDL)/high-density lipoprotein (HDL) cholesterol, triglycerides, obesity and nicotinism. The Hp status was estimated by ¹³C urea breath test and serology. Immunoblot and ELISA were used for screening the sera samples for anti-Hp HspB immunoglobulins (Igs) and LBP.

Results

Coronary heart disease patients were exposed to Hp more frequently than non-CHD individuals. This was associated with increased levels of specific anti-Hp IgG2 and IgA as well as total IgA. Hp infected CHD and non-CHD donors produced anti-Hp HspB IgG cross-reacting with human Hsp 60. In CHD patients the LBP level was significantly higher in comparison to non-CHD donors. This was related to the severity of the disease. Type I Hp strains stimulated higher LBP levels than less pathogenic type II isolates.

Conclusions

Lipopolysaccharide binding protein secreted in excess together with anti-Hp HspB, cross-reacting with human Hsp60, may increase the risk of vascular pathologies in Hp-exposed CHD patients.     

椎间盘突出临近退变节段是否导致腰痛

背景：椎间盘突出症患者腰痛原因很难判断,一直以来,认为突出的椎间盘是椎间盘突出症患者腰痛及腿痛重要原因,椎间盘突出临近退变节段是否导致腰痛需进一步研究证实。 目的：通过椎间盘造影判断突出临近退变节段是否是椎间盘突出症患者腰痛原因,并报告经椎间盘镜摘除椎间盘后残留腰痛在临近退变疼痛椎间盘经亚甲蓝注射治疗的效果。 方法：20例同时具有腰痛和腿痛椎间盘突出症患者行椎间盘造影检查,这些患者腰椎MRI表现为有1个突出椎间盘外至少合并1个或1个以上的临近退变的椎间盘,全部患者均经椎间盘镜摘除椎间盘切除突出的椎间盘,5例临近退变椎间盘造影阳性患者在椎间盘镜切除后经椎间盘内注射亚甲蓝治疗。腰痛、腿痛采用目测类比评分评定。 结果与结论：20例患者总共64个椎间盘行椎间盘造影,共11个椎间盘造影阳性,其中6个位于椎间盘突出临近退变节段,5个位于引起神经根性痛的椎间盘突出节段。全部病例腿痛行椎间盘镜切除突出椎间盘后明显缓解,腰痛有部分缓解,6例临近椎间盘造影阳性患者经椎间盘镜摘除椎间盘后腰痛明显,影响日常生活,其中5例行临近疼痛椎间盘亚甲蓝注射后腰痛缓解,1例患者拒绝亚甲蓝注射治疗仍有明显腰痛。结果显示椎间盘突出症患者腰痛可能来源于突出临近退变节段。     

Hopelessness at the end of life: The utility of the hopelessness scale with terminally ill cancer patients

Objectives. We sought to investigate the utility of the Beck Hopelessness Scale (HS) in a sample of terminally ill cancer patients by examining the scale properties. Moreover, we sought to identify and remove potentially problematic items in order to ascertain a “purer” index of hopelessness for this population. Design. A cross‐sectional study of 200 hospice inpatients with a life expectancy of less than 6 months. The HS, as well as several other distress measures, were administered to patients at bedside by trained clinicians. Methods. An item analysis of the HS was conducted, looking specifically at item endorsement and item‐total correlations. Three abbreviated versions (3‐item 7‐item, 13‐item) were developed based on certain denoted item‐total correlation cut‐offs. Reliability and validity of the original 20‐item HS was then compared to that of the newly developed abbreviated version. Results. All scales were found to be reliable and valid measures of hopelessness. The three abbreviated versions were more highly correlated with the distress measures than the original version, and the 7‐item and 13‐item subscales outperformed the original HS in the prediction of suicidal ideation and desire for hastened death. Conclusion. The data suggest that the HS may be improved, when applied to a terminally ill sample, by the elimination of problematic items. The development of a shorter, purer measure of hopelessness for this population is crucial given the need to reduce the burden placed on those who participate in end‐of‐life studies, and the important role of hopelessness in the prediction of suicide and desire for hastened death.     

疑病性神经症患者个性特征分析

目的 探讨疑病性神经症患者的人格特征,为临床心理干预提供参考依据.方法 采用MMIP量表对46例疑病性神经症患者进行测试,与中国常模比较.结果 疑病性神经症患者的MMPI分值以Hs、D、Hy、Pt最高,呈1-2-3-7型图形(P＜0.05～0.01);另有Pd、Pa和Sc量表也明显高于常模(P＜0.05～0.01).男女之间比较女性Hs、D、Hy、Mf和Pt显著高于男性组(P＜0.05～0.01).结论 疑病性神经症的发生与个性基础有关,MMIP对辅助评价疑病性神经症患者的人格特征有重要意义.     

The effect of alginate and hyaluronate on the viability and function of immunoisolated neonatal rat islets.

Recent observations suggest that the extracellular matrix plays a role as regards the viability and morphological integrity in long-term culture of Langerhans islets. For the present study we encapsulated neonatal rat islets without extracellular matrix (WEM), with alginate solution (AL) and with hyaluronate solution (HY) into cuprophane hollow fibers. Function was tested after week 1 and 5. The insulin release of WEM encapsulated islets decreased significantly during the culture period. In contrast to this, AL and HY embedded islets had stable secretion values throughout the whole cultivation. Histological examination confirmed that viability of HY and of AL embedded islets differed significantly from that of WEM encapsulated islets. Furthermore, HY seems to be a more advantageous environment to immunoisolated islets than AL. Both the insulin secretion values and the viability of HY embedded islets were higher than of AL embedded islets. We conclude that an extracellular matrix is important for immunoisolated islets, to maintain their function and morphological integrity and that HY is especially suitable for this application.     

Validity of a back pain classification scale for detecting psychological disturbance as measured by the MMPI

Constructed a Back Pain Classification Scale (BPCS) to detect serious psychological disturbance in low back pain patients, validated against the MMPI. One hundred and twenty patients with low back pain were classified as functional or organic on the basis of BPCS scores. The group identified as psychologically disturbed (functional) had significantly higher MMPI elevations on Scales F, HS, D, HY, PD, MF, PA, PT and SC. None of their scale scores was significantly lower than the group identified as organic. T-scores above 70 were present only on Scales 1 and 3, which suggests a high incidence of essentially neurotic disorders in patients classified as functional. The use of the BPCS as a viable alternative to the MMPI in the medical setting was discussed.     

Modification of the late asthmatic reaction by hyposensitization in asthmatic children allergic to house dust mite (Dermatophagoides pteronyssinus) or grass pollen

The frequency and severity of the late asthmatic reaction (LAR) was studied in asthmatic children allergic to house dust mite (HDM) or grass pollen (GP) with and without hyposensitization (HS). The four groups were comparable according to their severity of asthma. All children were allergic to HDM (Dermatophagoides pteronyssinus) or GP according to history, skin testing and specific IgE determination via the RAST. The LAR occurred less frequently (29% versus 73%) (P less than 0.001) and was less severe in children receiving HS. The difference was significant between the children allergic to HDM as well as between children allergic to GP. The immediate asthmatic reaction (IAR) was also less severe in children allergic to HDM who received HS, compared to those who never received HS, (P = 0.033) although the PD20 of the HDM challenge (PD20HDM) was not different between the two groups. In children allergic to GP, there was no difference in PD20 of the GP challenge (PD20GP) or in severity of the IAR, whether the children received HS or not. There was no difference between the PD20HDM in patients who developed a LAR and in patients who did not. There was no relation between the type of asthmatic reaction following the allergen provocation test and the level of circulating immune complexes (CIC) and the level of house dust mite-specific IgG (IgGHDM) or grass pollen-specific IgE (IgGGP) in the different groups, determined before the challenge. There was a decrease in the level of IgG containing CIC (IgGCIC) during the LAR. It is concluded that the LAR occurs less frequently and is less severe in asthmatic children who receive HS.     

Plasmids and serogroups in Campylobacter jejuni

For epidemiological purposes identification of Campylobacter strains is usually based on surface antigen characteristics. Two different systems, one for heat-stable (HS) and one for heat-labile (HL) antigen have dominated. In earlier studies we found a great variability in the two antigen systems. The aim of the present investigation was to analyse the frequency of plasmids in Campylobacter strains in the light of their possible use as an epidemiological tool as well as the relation between the presence of plasmids and surface antigens (HS and HL). Two hundred and forty-two strains from the same number of patients with diarrhea were analysed. In 70 (28.9%) plasmid(s) were found, in general one or two. Most of the plasmids were found in the molecular weight interval between 21-40 Md. There was no relation between the presence or size of plasmids and serogroup. We conclude that plasmid determination can be used as a complement to serotyping in epidemiological studies.     

Cell culture medium composition and translational adult bone marrow-derived stem cell research

For most therapeutic strategies using MSC, the preliminary amplification is carried out in media containing fetal calf serum (FCS). The theoretical health risk of using a xenogenic serum, a recent practice for which we have limited data, cannot be underestimated, while amplification using human serum (HS) remains controversial. At present, the available information on multipotentiality, self-renewal, and transplantability does not permit the selection of FCS rather than HS. Cellular modifications observed during cell passage seem to indicate a gradual impairment of cells in relation to native MSC, suggesting the making of short cell cultures without necessarily trying to reinfuse a high number of MSC in patients. With this approach, the volume of HS required would remain limited. While clinical studies have already started, many problems remain, such as evaluating the quality of the initial mesenchymal compartment and the biological properties of the cell suspension with FCS compared to those with HS, and depending on culture time.     

Low back pain and psychological factors. A social psychiatric study of the population of working age.

The objective of the study was to find out how low back pain (LBP) and psychological factors are interrelated in the adult population. The study dealt with 220 individuals suffering from LBP and with a control group (n = 101). The method used was a psychiatric interview. Mental disorders were more prevalent in the LBP group than in the control group. A clinical disorder was diagnosed for 31% in the LBP group and they had many mild mental disturbances, too. The association between LBP and mental disorders was not as clear as found in previous studies with patient populations. The LBP group was divided according to the etiology of pain into functional and organic groups. No significant differences were found between the groups with regard to mental disturbance.     

Spectral analysis of electromyogram in lumbar muscles: fatigue induced endurance contraction

In the last few years, epidemiological studies have shown correlations between the low endurance capacity of the erector spinae muscle and low back pain (LBP). In this study, the function of the erector spinae muscle and localized muscle fatigue in LBP were investigated in both LBP patients and control subjects without LBP, using surface multi-channel electromyograms (EMG). Four positions (L1, L2, L4, L5) were chosen as representative locations for the different functions of the erector spinae muscle. Median frequency (f _m) parameters of an EMG power density spectrum were monitored to quantify localized muscle fatigue. This research indicated a statistically significant difference (P < 0.05) in f _m, parameters between the LBP patients and the control subjects. The integrated electromyogram (iEMG) signals of LBP patients were considerably higher than for the control subjects during endurance isometric contraction. Our research suggested that human fatiguing erector spinae muscle, in submaximal voluntary contractions tests, induced a different firing order of motor unit spikes between two groups.     

Elevated levels of lipopolysaccharide-binding protein and soluble CD14 in plasma in neonatal early-onset sepsis

No data on lipopolysaccharide-binding protein (LBP) in newborns with sepsis have been available up to now. We therefore determined levels of LBP and soluble CD14 (sCD14) in plasma of healthy and septic neonates in order to evaluate their potential diagnostic role. The study included prospectively collected patient samples of two recently published studies on cytokine expression in neonatal sepsis. Twenty-nine septic patients were enrolled in the present analysis. Samples--either cord blood or peripheral blood--from patients admitted within the first 24 h of life for suspicion of sepsis and cord blood samples of a control group of 40 healthy mature infants delivered spontaneously were analyzed. For seven patients of the septic group, a second sample collected between 24 and 48 h of life was available. Levels of sCD14 and LBP in plasma were determined by an enzyme immunoassay using recombinant CD14 and LBP as standards. LBP and sCD14 were correlated to cytokine plasma levels. In septic neonates, LBP (median, 36.6 versus 7.8 microg/ml; P < 0.001) and sCD14 (median, 0.42 versus 0.28 microg/ml; P < 0.001) levels were highly elevated when compared to those of healthy neonates and strongly correlated to granulocyte colony-stimulating factor (G-CSF), interleukin-1beta (IL-1beta), IL-6, and IL-8 levels. LBP levels in septic neonates analyzed between 24 and 48 h of life even increased when compared to samples obtained at or shortly after delivery (median, 36.6 versus 60 microg/ml; P = 0.038). In summary, levels of LBP in plasma of neonates with early-onset sepsis are significantly elevated; the elevated plasma levels seem to persist for more than 24 h, which could provide the clinician with a prolonged time period to identify the newborn with bacterial sepsis.     

Prevalence of facet joint arthrosis in lumbago patients–CT scan evaluation

IntroductionThere are multiple causes of low back pain (LBP), the leading ones being degeneration of intervertebral disc, lumbar spinal stenosis(LSS) and facet joint arthrosis(FJA). There are number of studies done earlier on disc degeneration and LSS, however the studies on facet joint arthrosis are limited and incomplete. Hence the present study was undertaken to assess the prevalence of FJA of lumbar spine in lumbago patients of Delhi NCR region of India.MethodThe present study was conducted in the Departments of Radiodiagnosis of Santosh Medical College, Ghaziabad and Safdarjung Hospitals, New Delhi. Thirty eight patients were selected for CT scan imaging after pre-defined questionnaire and informed consent. The images were assessed on Philips Dicom viewer for facet joint arthritic changes.ResultsA high prevalence of 52.6% was seen in cases of LBP. FJA was seen in 80% of female cases and the highest prevalence of arthrosis was seen at lumbar spinal level of L4-L5.DiscussionFacet joint arthrosis plays an important role in low back pain. The prevalence of FJA increases caudally from L1 to L5, with the highest incidence being at the L4–L5 spinal level. The prevalence of FJA is seen more in females than males.