Gender and the renin–angiotensin–aldosterone system

Premenopausal women are protected to some extent from cardiovascular and kidney diseases. Because this protection weakens after menopause, sex hormones are believed to play an important role in the pathogenesis of cardiovascular and kidney diseases. The cardiovascular system and the kidneys are regulated by the renin–angiotensin–aldosterone system (RAAS), which in turn, appears to be regulated by sex hormones. In general, oestrogen increases angiotensinogen levels and decreases renin levels, angiotensin‐converting enzyme (ACE) activity, AT₁ receptor density, and aldosterone production. Oestrogen also activates counterparts of the RAAS such as natriuretic peptides, AT₂ receptor density, and angiotensinogen (1‐7). Progesterone competes with aldosterone for mineralocorticoid receptor. Less is known about androgens, but testosterone seems to increase renin levels and ACE activity. These effects of sex hormones on the RAAS can explain at least some of the gender differences in cardiovascular and kidney diseases.     

Maternal–fetal attachment: Influence of mother–daughter and husband–wife relationships

Intergenerational attachment relationships between the pregnant woman and her mother, her husband, and her fetus were examined. Self-completed instruments were used to measure the attachment variables for a convenience sample of 115 middle-class mothers who attended urban prenatal classes. Results supported the hypothesis that mother–daughter and husband–wife attachment were correlated positively. Contrary to study predictions, maternal–fetal attachment scores were not related to mother–daughter and husband–wife attachment scores. Maternal–fetal attachment was related to length of gestation. Results provide only partial support for the intergenerational model of attachment relationships.     

Patient–patient interaction – caring and sharing

Aim: The aim of this study is to provide an understanding of the significance of hospitalized patients’ interpersonal interaction with fellow patients in an infectious disease ward in a large Danish hospital. Method: A qualitative approach was selected using participant observation and semi‐structured qualitative interviews. Six female participants at the age of 32–81 years with different types of infectious diseases accepted to participate in interviews. The analysis was carried out using Kvales’ three levels of qualitative data analysis. Data were catalogued into two main categories with several subcategories representing significance of patients’ interaction with fellow patients. Results: The qualitative analysis resulted in two main categories: (i) Caring for fellow patients and (ii) Sharing illness information with fellow patients. Each of the main categories was elucidated through several subcategories. Our findings clearly showed that interpersonal interaction with fellow patients was of utmost importance when it came to care and support and when they needed information about their illness. Typically, the interpersonal interaction was experienced as giving and referred to in positive terms, but occasionally, the opposite was experienced too. Less typically, the patients experienced interaction with fellow patients as a burden and referred to it in negative terms. Conclusions: Patients’ interaction resembled care as well as self‐care. Patient–patient interaction was an important part of the social support system during hospitalization.     

Lipidfiltration––safe and effective methodology to perform lipid-apheresis

Familial hypercholesterolemia (FH) not adequately responding to diet and drug therapy represents an indication for extracorporeal lipid-apheresis, which has become an highly effective and approved therapy for those patients in several countries. Based on different methodology, five treatment options of lipid-apheresis exist and are in widespread practical use covered by regular reimbursement in Germany. All methods are safe and demonstrate equivalent efficacy of reducing LDL cholesterol with respect to the single apheresis session as well as during long-term treatment. Therefore German reimbursement guidelines leave the choice of the method to the discretion of the apheresis center. Related to properties of the used technology all methods exhibit characteristic patterns of additional plasma protein elimination, which do not impair, but in part may increase the therapeutic benefit of lipid-apheresis. Fibrinogen reduction has to be mentioned as an example. The Lipidfiltration system is based on plasmafiltration previously referred to as membrane differential filtration (MDF), synonymous with double filtration plasmapheresis (DFPP). The new term Lipidfiltration was the result of technological progress in the manufacturing process of the plasmafilter resulting in enhanced sieving characteristics and capacity. The Lipidfiltration system is completed by a specifically designed therapy machine with optimised performance characteristics.     

Collagen–chitosan–laminin hydrogels for the delivery of insulin‐producing tissue

Islet transplantation is an emerging strategy for treating patients with type 1 diabetes mellitus. Although the proof of concept for cellular replacement therapy in diabetes has been firmly established, vascularity of the transplant site and the long‐term survival and function of transplanted islets remains suboptimal. In the present study, human circulating angiogenic cells (CACs) and porcine islet cells embedded in collagen–chitosan hydrogels, with and without laminin, were investigated as potential engineered biomaterials for the treatment of type 1 diabetes. Hydrogels were evaluated in vitro for their physical properties (compression, degradation, porosity and wettability) and cell compatibility. Increasing the chitosan content in the collagen‐based hydrogel resulted in increased stiffness (p ≤ 0.04) and time to gelation (p < 0.001), but reduced porosity (from 22–28% to 16–19%). The material design formulations (10:1 vs 20:1 collagen:chitosan ratio) directly affected the cell properties. The viability of both human CACs and porcine islets embedded in the 20:1 collagen–chitosan matrix was higher at 24 h compared to the 10:1 formulation. For islet function, glucose stimulation indices for the 20:1 formulation at 24 h compared favourably with values reported in the literature, more so than the 10:1 formulations. While laminin improved the short‐term viability of CACs, its presence did not confer any benefit to islet viability or function. Overall, the design features outlined in this study provided the degree of control required to establish viable tissue with potential for islet transplantation and neovascularization. Copyright © 2013 John Wiley & Sons, Ltd.     

Performing arts medicine – Instrumentalist musicians Part I – General considerations

Performing arts medicine is a relatively new specialty addressing the medical needs of dancers, musicians, ice skaters, and gymnasts. This paper focuses on the role of healthcare providers in the diagnosis and therapeutic management of instrumentalist musicians. Musicians are at high risk for developing painful musculoskeletal problems, including pain and overuse injuries, entrapment and peripheral neuropathies, and focal dystonias. Musicians' careers are threatened, when they are no longer able to play their instrument because of pain and dysfunction. To appreciate music-related injuries, it is important that clinicians are familiar with the context of musicians' injuries and disorders.This is the first paper in a series of three. This paper discusses the importance of taking an extended history. The typical history procedures need to be broadened when interviewing musicians, and should include instrument-specific questions, and questions regarding practice habits, education, repertoire, and employment. The second article addresses the physical examination, while the third article provides three case reports of musicians with hand problems, which serve to illustrate the points made in the first two articles. The articles are illustrated with several tables and photographs of musicians to assist the reader in assessing instrumentalist musicians and determining the most appropriate course of action.