The clinical approach to alexithymia: A review

Since development of the concept of alexithymia about a decade ago, there has been considerable discussion of the extent to which it is a medical or a social and cultural phenomenon. However, it becomes a medical problem when it interferes with treatment, especially as alexithymic patients tend to somatize in lieu of experiencing psychic conflict. This review describes the relationship of alexithymia to psychosomatic illness, socioeconomic and cultural factors, and possible anatomicophysiologic features. Alexithymia per se should be distinguished from other conditions, such as simple denial and repression, the psychic numbing that may follow catastrophe, and primary affective disorders. Previous treatment approaches are assessed, and recommended therapeutic strategy is presented.     

The digestive system in psychosomatic perspective

Improved understanding of the digestive organ's various levels of regulation and the neurologic and endocrinologic mechanisms underlying them should be combined with an appreciation of the variability of the individual's view of and hence response to life experiences. This balanced perspective will aid the clinician in his approach to patients with digestive disorders.     

The assessment of personality profiles

A general methodology designated the isographic approach, which searches for similarities of personality profiles among individual persons and similarities of single method profiles within an individual person, is differentiated from traditional nomothetic and idiographic methodologies, all of which are interrelated. The review of methods of profile analysis includes single variable and multivariate differentiation of groups, but focuses on Q correlation, generalized distance function, computer-programmed actuarial analyses of profiles, and clustering techniques. Selected research studies published within the past 15 years in the United States and in other countries, in both clinical and nonclinical areas, and probable directions for future research are discussed.     

The population prevalence of Down's syndrome in England and Wales in 2011

There is uncertainty over the population prevalence of people with Down''s syndrome in England and Wales. This study aimed to estimate the population prevalence of Down''s syndrome in England and Wales in 2011. A meta-analysis of published survival rates of people with Down''s syndrome from 1938 to 2010 was conducted and the results were applied to the estimated numbers of babies born with Down''s syndrome since 1938 in England and Wales. An estimated 37 090 people had Down''s syndrome in England and Wales in 2011, a population prevalence of 0.66 per 1000 people; 650 under 1, 2673 aged 1–5, 7115 aged 5–18, 12819 aged 19–40, 10 626 aged 41–55 and 3207 aged 56 and older. The average life expectancy for babies with Down''s syndrome born in 2011 was 51 years and the median life expectancy was 58 years. This study provides clarity on the number of people with Down''s syndrome in England and Wales. Owing to sudden increases in the survival of babies with Down''s syndrome in the 1950s there are a large proportion of people with Down''s syndrome who are in their 40s. These people have an increased risk of developing dementia in the future and services should be aware of their potential needs.     

Donepezil combined with natural hirudin improves the clinical symptoms of patients with mild-to-moderate Alzheimer's disease: a 20-week open-label pilot study

Aim:To evaluate the efficacy and safety of donepezil plus natural hirudin in patients with mild-to-moderate Alzheimer''s Disease. Methods: In the 20-week, randomized, open-label and controlled study, 84 patients received either donepezil (5 mg/day for the first 4 weeks and 10 mg/day thereafter) or donepezil plus natural hirudin (3 g/day) treatment. Efficacy was reflected by the change of the total scores of Alzheimer''s Disease Assessment Scale cognitive subscale (ADAS-Cog), Activities of Daily Life (ADL) and Neuropsychiatric Inventory (NPI). Results: The patients with the donepezil plus natural hirudin treatment showed more significant improvement in the daily activities and the decline of the cognition than those with donepezil treatment. Significant difference was present in the groups since the 8th week. No group difference was found in the NPI change. However, within the hirudin treatment group, more powerful efficacy including NPI assessment was found in the patients with vascular risk factors (VRF) as comparing to with those without VRF. The combination of donepezil and natural hirudin was well tolerated. The dropout rate was greater in the donepezil and natural hirudin (50%) treatment group than in the donepezil (39%) treatment group. Similar result was found in the incidence of adverse events (23.8% vs 19.0%), but there was no statistical difference between the two groups. Adverse events were the most common reason for the dropout. Although hemorrhage and hypersensitiveness were more common in donepezil plus Maixuekang treatment (11.9% and 7.1%) group than in donepezil treatment (2.4% and 2.4%) group, no significant difference was present between the two groups. Economic problem was another important reason for the patients'' withdrawal. Conclusions: Compared with the donepezil treatment in the patients with mild-to-moderate AD, our results suggest that donepezil combined with natural hirudin may improve the treatment effects in the ADL, BPSD and cognition of the patients. Furthermore, this joint treatment is safe.     

Inhaled verapamil in histamine-induced bronchoconstriction

Fifteen asthmatic subjects participated in a double-blind trial comparing the protective effects of inhaled verapamil, salbutamol, and saline against inhaled histamine. Inhaling verapamil between four repeated histamine inhalation tests produced no significant protection against histamine-induced bronchoconstriction, while there was significant protection with salbutamol (p < 0.001). Inhaling verapamil before a single inhalation test produced limited but significant protection (p < 0.05) compared with a saline control in eight asthmatic subjects. This small protective effect in the two-treatment study of eight asthmatics suggests that either the protective effect of verapamil is variable among subjects or a preceding histamine inhalation test blocks the verapamil effect.     

The involvement of multipotential progenitor cells in Mooren's ulcer

The aim of this study was to assess the involvement of multipotential progenitor cells in the pathogenesis of Mooren's ulcer using immunohistochemical staining techniques. Tissue specimens were collected from 3 Mooren's ulcer patients who underwent lamellar keratectomy. Immunohistochemical staining patterns were analyzed using antibodies: CD34, c-kit, STRO-1, CD45RO, VEGF and a-SMA. Strong positive CD34, c-kit and STRO-1 cells were revealed in Mooren's ulcer specimens, especially in the superficial stroma. A few weakly expressed CD34 stroma cells were seen in normal limbal cornea but no immunoreactivity for c-kit and STRO-1 could be found. CD45RO positive T cells were found to have infiltrated in Mooren's ulcer. The immunostaining pattern of VEGF and a- SMA was closely correlated with the degree of expression and the number of CD34 positive cells. Bone marrow-derived multipotential progenitor cells may be involved in the pathogenesis of Mooren's ulcer by synergizing with other factors to amplify autoimmune destructive reactions and to contribute to the regeneration process. Specific therapeutic strategies that target the role of these cells in the disease are warranted.     

The role of the resistive index in Hashimoto's thyroiditis: a Sonographic pilot study in children

OBJECTIVE:

The role of Doppler ultrasonography in the diagnosis of diffuse thyroid diseases is not well established. In particular, Doppler ultrasonography findings in children with Hashimoto''s thyroiditis are very limited. We examined gray-scale and Doppler ultrasound findings in Hashimoto''s thyroiditis in children in an attempt to understand the feasibility of future prospective controlled studies.

MATERIALS AND METHODS:

Twenty-one children with newly diagnosed Hashimoto''s thyroiditis were recruited in the study. The patients were euthyroid or had subclinical hypothyroidism at the time of the ultrasonography examination. According to the color Doppler scale developed by Schulz et al., thyroid glands were classified into four patterns based on visual scoring and the mean resistive index (RI), which was calculated via measurements from both lobes, and these results were compared with gray-scale findings.

RESULTS:

The mean RI value, calculated as the mean of the RI values of both lobes obtained from each patient, was found to be 0.57±0.05 (range 0.48-0.67) cm/sn. The distribution of thyroid classifications was as follows: Pattern 0, n = 7; Pattern I, n = 6; Pattern II, n = 4; and Pattern III (“thyroid inferno”), n = 4. The mean RI values in patients with normal or near-normal gray-scale findings (n = 10) and patients with more substantial gray-scale changes (n = 11) were not significantly different and were lower than the values in normal children previously presented in the literature.

CONCLUSION:

The results indicated that the RI may be more sensitive than other ultrasound parameters for the diagnosis of Hashimoto''s thyroiditis.     

The importance of vitamin D in the pathology of bone metabolism in inflammatory bowel diseases

Etiological factors of bone metabolism disorders in inflammatory bowel diseases have been the subject of interest of many researchers. One of the questions often raised is vitamin D deficiency. Calcitriol acts on cells, tissues and organs through a vitamin D receptor. The result of this action is the multi-directional effect of vitamin D. The reasons for vitamin D deficiency are: decreased exposure to sunlight, inadequate diet, inflammatory lesions of the intestinal mucosa and post-gastrointestinal resection states. This leads not only to osteomalacia but also to osteoporosis. Of significance may be the effect of vitamin D on the course of the disease itself, through modulation of the inflammatory mechanisms. It is also necessary to pay attention to the role of vitamin D in skeletal pathology in patients with inflammatory bowel diseases and thus take measures aimed at preventing and treating these disorders through the supplementation of vitamin D.     

The use of proteomics in biomarker discovery in neurodegenerative diseases

Biomarkers for neurodegenerative diseases should reflect the central pathogenic processes of the diseases. The field of clinical proteomics is especially well suited for discovery of biomarkers in cerebrospinal fluid (CSF), which reflects the proteins in the brain under healthy conditions as well as in several neurodegenerative diseases. Known proteins involved in the pathology of neurodegenerative diseases are, respectively, normal tau protein, beta-amyloid (1-42), synaptic proteins, amyloid precursor protein (APP), apolipoprotein E (apoE), which previously have been studied by protein immunoassays. The objective of this paper was to summarize results from proteomic studies of differential protein patterns in neurodegenerative diseases with focus on Alzheimer's disease (AD). Today, discrimination of AD from controls and from other neurological diseases has been improved by simultaneous analysis of both beta-amyloid (1-42), total-tau, and phosphorylated tau, where a combination of low levels of CSF-beta-amyloid 1-42 and high levels of CSF-tau and CSF-phospho-tau is associated with an AD diagnosis. Detection of new biomarkers will further strengthen diagnosis and provide useful information in drug trials. The combination of immunoassays and proteomic methods show that the CSF proteins express differential protein patterns in AD, FTD, and PD patients, which reflect divergent underlying pathophysiological mechanisms and neuropathological changes in these diseases.     

Absence of a clastogenic factor in ataxia telangiectasia lymphoblastoid cells

Based on the observation of a diffusable “clastogenic factor” in the plasma of ataxia telangiectasia (AT) patients and the medium used to culture their skin fibroblasts, studies were performed to discern its possible presence in AT long-term lymphoblastoid cell lines. Cocultivation of normal and AT lymphoblasts showed no increase in chromosome damage in the normal cells. Additionally, tissue culture medium, used for the propogation of the AT lymphoblasts, demonstrated no damaging effect on the chromosomes of normal phytohemagglutinin-stimulated lymphocytes. Therefore, contrary to the findings in other cell types (T lymphocytes and skin fibroblasts), the AT B cell apparently does not produce this clastogenic factor.