Patient Perceptions of Empowerment Processes,Health Outcomes and Related Factors in Patients Living with Diabetes in Taiwan: A Cross-Sectional Survey

Background: The aim was to examine the associations among empowerment processes, health outcomes, and related factors in patients living with diabetes. Methods: This cross-sectional study analyzed a convenience sample of 144 patients with diabetes in Taiwan. Data were collected with questionnaires, HbA1C, blood pressure, and total cholesterol. Findings: Empowerment processes were significantly associated with health outcomes, including self-care behaviors, quality of life, and HbA1C. Diabetes-related complications and treatment variables were associated with empowerment processes and health outcomes. Conclusions: To optimize the empowerment processes needed to promote the health of patients with diabetes, healthcare professionals should consider patient perceptions of empowerment processes and related factors.     

Digital spot mammography using an add-on upright unit: diagnostic application in daily practice

INTRODUCTION: To present the use of digital spot mammography (DSM) in a diagnostic practice. METHODS AND PATIENTS: Digital spot images of 779 women requiring a spot compression or a spot magnification view were collected. The digital images were acquired on a digital spot upright unit using a 61 mm x 61 mm field of view. Lesions reported included masses, calcifications, and areas of distortions. RESULTS: 1065 lesions required additional views with DSM. Lesions reported included masses (n = 113), masses and microcalcifications (n = 53), spiculated masses (n = 34), architectural distortions (n = 16), and microcalcifications (n = 849). DSMs were considered to be adequate in 97.7% of patients. Unsatisfactory exams resulted from difficulties encountered in targeting the area of interest at the beginning of our experience. CONCLUSION: DSM, most commonly used to perform interventional procedures, can also be used in a diagnostic practice taking advantage of post-processing of images not available with conventional spot compression and magnification.     

Improved renal clearance and tumor targeting of 99mTc-labeled anti-Tac monoclonal antibody Fab by chemical modifications

This study was undertaken to improve the renal clearance and tumor targeting properties of 99mTc-labeled humanized anti-Tac (HuTac) monoclonal antibody Fab fragments using two chemical approaches: 1) labeling with a renal secretion agent 99mTc-mercaptoacetyltriglycine (MAG3) and 2) lowering its isoelectric point (pI) by acylation. HuTac Fab (3.3 mg/mL) was reacted with a trifluorophenyl ester (TFP) of 99mTc-MAG3 alone or was additionally reacted with TFP-glycolate to reduce the pI. In Balb/c mice, 99mTc-MAG3-Fab (pI > 9.3) rapidly accumulated in the kidneys (177% injected dose [ID]/g at 15 min) and then gradually cleared out of the kidneys. In contrast, the glycolation (pI 4.6 approximately 6.6) drastically reduced the renal uptake (31% ID/g) and also the whole-body retention (82% ID vs 101% for the nonglycolated) at 15 min, indicating that the glycolated 99mTc-MAG3-Fab (pI 4.6 approximately 6.6) was rapidly excreted. The glycolated remained in the blood longer than the nonglycolated (1.2% vs 0.3% ID/g at 360 min), but this effect was less drastic than the effect shown on the renal uptake. In nude mice bearing receptor-positive (ATAC4) tumors, the glycolated 99mTc-MAG3-Fab increased the peak tumor uptake to 14.8% ID/g from 8.3% ID/g for 99mTc-MAG3-Fab, whereas the glycolation resulted in a drastic reduction of the renal uptake at 15 min. We demonstrated that the renal clearance and the tumor targeting of Fab could be optimized by chemical modifications.     

Kawasaki disease presenting as cervical lymphadenitis or deep neck infection.

OBJECTIVE: To describe a group of patients with Kawasaki disease who had cervical lymphadenopathy as their dominant initial presentations. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 14 children who were admitted to Chang-Gung Children's Hospital between May 1996 and July 1998 with the initial impression of cervical lymphadenitis, cellulitis, and/or deep neck infection but for which a diagnosis of Kawasaki disease was established later. RESULTS: Five (35.7%) patients were less than 5 months of age, and 8 (57.1%) patients were more than 53 months of age. The mean duration for establishing a diagnosis of Kawasaki disease from the onset of illness was 8.2 (6 to 20) days. Initially, empiric antibiotics were prescribed in each case with unsatisfactory response. Intravenous immune gamma globulin (2 g/kg) was administered in 13 patients. Three (21.4%) patients developed coronary artery lesions. CONCLUSION: If a child less than 6 months or more than 4 years of age has a fever and an enlarged cervical lymph node and is unresponsive to empiric antibiotics, Kawasaki disease should be considered.     

Erythrocyte C3d and C4d for monitoring disease activity in systemic lupus erythematosus

Objective

Disease activity in systemic lupus erythematosus (SLE) is typically monitored by measuring serum C3 and C4. However, these proteins have limited utility as lupus biomarkers, because they are substrates rather than products of complement activation. The aim of this study was to evaluate the utility of measuring the erythrocyte‐bound complement activation products, erythrocyte‐bound C3d (E‐C3d) and E‐C4d, compared with that of serum C3 and C4 for monitoring disease activity in patients with SLE.

Methods

The levels of E‐C3d and E‐C4d were measured by flow cytometry in 157 patients with SLE, 290 patients with other diseases, and 256 healthy individuals. The patients with SLE were followed up longitudinally. Disease activity was measured at each visit, using the validated Systemic Lupus Activity Measure (SLAM) and the Safety of Estrogens in Lupus Erythematosus: National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).

Results

At baseline, patients with SLE had higher median levels of E‐C3d and E‐C4d (P < 0.0001) in addition to higher within‐patient and between‐patient variability in both E‐C3d and E‐C4d when compared with the 2 non‐SLE groups. In a longitudinal analysis of patients with SLE, E‐C3d, E‐C4d, serum C3, and anti–double‐stranded DNA (anti‐dsDNA) antibodies were each significantly associated with the SLAM and SELENA–SLEDAI. In a multivariable analysis, E‐C4d remained significantly associated with these SLE activity measures after adjusting for serum C3, C4, and anti‐dsDNA antibodies; however, E‐C3d was associated with the SLAM but not with the SELENA–SLEDAI.

Conclusion

Determining the levels of the erythrocyte‐bound complement activation products, especially E‐C4d, is an informative measure of SLE disease activity as compared with assessing serum C4 levels and should be considered for monitoring disease activity in patients with SLE.

     

Mycobacterium avium-intracellulare pulmonary infection in HIV-negative patients without preexisting lung disease: diagnostic and management limitations

STUDY OBJECTIVES: To review the experience of an outpatient pulmonary clinic with Mycobacterium avium-intracellulare (MAI) pulmonary disease in the HIV-negative population without preexisting lung disease. DESIGN: Retrospective clinical series. SETTING: University medical center. PATIENTS: The clinic charts of all patients who fulfilled the current American Thoracic Society criteria for MAI pulmonary infection and who had no preexisting lung disease or immunosuppression were reviewed. MEASUREMENTS AND RESULTS: Of 31 patients identified, 94% were female, 90% were white, and the median age at diagnosis was 63 years. The median time interval from symptom onset to diagnosis was 10 months. Bronchiectasis or small nodules without predilection for any lobe was found in 93%. Bronchoscopy or open lung biopsy for diagnosis was required in 45% because of nondiagnostic sputum cultures. At > or = 12 months, 50% failed therapy, 86% continued to be symptomatic, and 58% did not tolerate their initial multidrug regimen. CONCLUSIONS: These results emphasize the observed chronic nature of MAI pulmonary disease in this population, both before diagnosis and despite therapy. The sensitivity of sputum culture in this population is low, so an aggressive diagnostic approach, including bronchoscopy, should be considered if sputum cultures are negative. Current treatments are suboptimal because of poor drug tolerance and significant failure rates. Last, the preponderance of disease in older white women argues for a genetic or acquired immune deficiency to explain disease susceptibility.     

Impact of Residual Stretch and Remodeling on Collagen Engagement in Healthy and Pulmonary Hypertensive Calf Pulmonary Arteries at Physiological Pressures

Understanding the mechanical behavior of proximal pulmonary arteries (PAs) is crucial to evaluating pulmonary vascular function and right ventricular afterload. Early and current efforts focus on these arteries' histological changes, in vivo pressure-diameter behavior and mechanical properties under in vitro mechanical testing. However, the in vivo stretch and stress states remain poorly characterized. To further understand the mechanical behavior of the proximal PAs under physiological conditions, this study computed the residual stretch and the in vivo circumferential stretch state in the main pulmonary arteries in both control and hypertensive calves by using in vitro and in vivo artery geometry data, and modeled the impact of residual stretch and arterial remodeling on the in vivo circumferential stretch distribution and collagen engagement in the main pulmonary artery. We found that the in vivo circumferential stretch distribution in both groups was nonuniform across the vessel wall with the largest stretch at the outer wall, suggesting that collagen at the outer wall would engage first. It was also found that the circumferential stretch was more uniform in the hypertensive group, partially due to arterial remodeling that occurred during their hypoxic treatment, and that their onset of collagen engagement occurred at a higher pressure. It is concluded that the residual stretch and arterial remodeling have strong impact on the in vivo stretch state and the collagen engagement and thus the mechanical behavior of the main pulmonary artery in calves.     

Biomechanical and histological studies of particulate hydroxylapatite implanted in femur bone defects of adult dogs

The purpose of this study was to investigate the biomechanical behavior and the histology of particulate hydroxylapatite (HA) implanted in bone defects created in femurs of 48 adult mongrel dogs. The bone defects, measuring 10 x 10 x 25 mm with or without HA implantation, were allowed to heal until the end of the 1st, 2nd, 3rd, 6th, 9th and 12th months after surgery. The harvested tissue specimens from the implant sites were processed into long cubic or rectangular prismatic forms. Their mechanical strengths were assessed using compression and shearing tests to measure the maximal compressive and shear stress by force loading on the middle portions of the specimens. Histological sections of each stage were processed with both decalcified and nondecalcified methods. The results showed that the mechanical strength of the tested specimens was closely related to the tissue regeneration within the bone defect. Progressive regeneration of new bone was observed at each stage, with complete bone formation at the 9-month period. A consistent increase in both maximal compressive stress and maximal shear stress was noted at each stage, responsive to the ossification and maturation of the regenerating tissue within the bone defect. This animal model provides a novel approach to directly estimate the tissue strength of the HA-implanted bone defect.