Evidence for the genetic role of human leukocyte antigens in low frequency DRB1*1501 multiple sclerosis patients in Israel

A strong association exists between multiple sclerosis (MS) and the DRB1*1501 haplotype, in most populations. Linkage of Multiple Sclerosis (MS) with the MHC or HLA region on chromosome 6p21 has previously been observed in DRB1*1501 positive MS families. A group of 13 Israeli multiplex MS families with a very low frequency of DRB1*1501 haplotype were examined in this study. Association and a linkage test were performed in order to identify a non-DRB1*1501 effect of HLA on susceptibility for MS. MS multiplex families and healthy controls were molecularly typed for six highly polymorphic markers located within the MHC region: DRB1, DQA1 and DQB1, BAT-2, MIB and D6S248. Data analyses included: (a) an association study comparing the patient group with both healthy relative, and healthy control groups (b) a transmission test for linkage disequilibrium (TDT) of the MS-associated alleles in the multiplex families, and (c) multipoint non-parametric linkage (NPL) and parametric LOD score analyses using the GENEHUNTER program. The DRB1*1303 allele was significantly more frequent among the MS patients. There was a trend towards transmission disequilibrium of DRB1*1303, but was not statistically significant. Allele sharing and LOD score analyses revealed no evidence for linkage. The high frequency of DRB1*1303 observed in our family patients provides evidence to support the association with this allele that previously described in sporadic non-Ashkenazi MS patients. Thus, DRB1*1303 may serve as genetic risk factor for MS. Our study exemplifies the genetic heterogeneity in MS as there is a genetic effect of HLA on MS susceptibility in our low frequency DRB1*1501 patients.     

Immunogenicity of peptides derived from a fibronectin-binding protein of S. aureus expressed on two different plant viruses

The D2 peptide derived from an S. aureus fibronectin-binding protein (FnBP) was expressed on the surface of the icosahedral cowpea mosaic virus (amino acids 1-30 of D2) or on the rod-shaped potato virus X (amino acids 1-38 of D2), termed CPMV-MAST1 and PVX-MAST8, respectively. Mice and rats were immunized subcutaneously with CPMV-MAST1 and mice with PVX-MAST8 in adjuvant and high titres of FnBP-specific antibody were obtained. The mouse IgG was predominantly of the IgG2a and IgG2b isotypes, which strongly bound complement component C1q, suggesting a TH1-bias in the peptide-specific responses. Sera from mice and rats immunized with CPMV-MAST1 and from mice immunized with PVX-MAST8 were shown to completely inhibit the binding of fibronectin to immobilised recombinant FnBP and rat sera against CPMV-MAST1 were able to block adherence of S. aureus to fibronectin. These studies demonstrate that the D2 peptide is highly immunogenic when expressed on 2 different plant viruses and highlight the potential of plant virus-based vaccines to protect against S. aureus infections.     

Time preferences and preventive health behavior: acceptance of the influenza vaccine.

BACKGROUND: Many preventive health behaviors involve immediate costs and delayed benefits. Time preference is the extent to which decision makers value future outcomes relative to immediate ones. Consequently, people with future-oriented time preferences should be more likely to adopt preventive measures. The relationship between time preferences and acceptance of a free influenza vaccination was examined. SAMPLE: The participants were 412 corporate employees who were offered free influenza vaccinations at their workplace. MEASURES: Participants' time preferences were measured in each of two domains: money and health. They also reported on whether they had accepted the influenza vaccination and their beliefs and attitudes about the vaccine. RESULTS: There was a small (OR = 2.38) relationship of vaccination acceptance to monetary time preferences but not to the health time-preference measures. Other variables, such as perceived effectiveness of the vaccine, were more predictive. CONCLUSION: This study provides some evidence of a small relationship between time preferences and preventive health behavior.     

It's better by day

Day surgery has had a slow record f growth in the UK, despite the benefits it offers. Robert Chapman explains the advantages of planning a dedicated unit.     

Psychological aspects of postoperative pain control.

This article examines the biological basis of emotional distress during postoperative pain, discussing the causal links between tissue injury and the mechanisms of centrally mediated emotional arousal. Neurologic signals from injured tissues induce spinoreticular transmission and extensive processing in limbic brain. Pain, as an emotion, shares central noradrenergic mechanisms with vigilance, a biologically important process. The emotional dimension of postoperative pain corresponds to perceived threat. Injury-induced activation of central noradrenergic mechanisms equips the patient for "fight or flight" just as in nature it equips a wounded animal for self-preservation actions. Although the brain chemistry of emotion prepares the postoperative patient to undertake some sort of survival-directed activity, most hospital settings do not permit patients to cope for themselves. This biologically mandated need to cope with injury has no avenue for expression. Several basic concepts from clinical psychology apply to the management of patients after surgery: Control, coping and self-efficacy. In light of the psychobiological nature of emotion in postoperative pain, they explain the benefits of therapies that encourage self-control such as patient controlled analgesia (PCA). PCA changes the role of the postoperative patient from passive to active, permitting patients in pain to cope actively for themselves. Moreover, it demonstrates that an integration of technological advances with psychological principles can improve patient satisfaction with care delivery.     

Cutaneous versus Muscular Perception of Electrically Evoked Tetanic Pain

This work was supported in part by Laval University (sabbatical leave of Dr. A.Y. Bélanger), the School of Kinesiology at Simon Fraser University, and Medtronic of Canada Inc. There is much speculation in athletic, physical therapy, and sports medicine circles about the relative cutaneous (superficial) vs. muscular (deep) perception of pain felt during maximum electrically evoked tetanic muscle contraction. To date, very few studies have addressed the basic question of whether pain perception during electrical stimulation is more superficial (cutaneous) or deep in muscular tissue. The purpose of this study was to determine, in a group of 10 healthy male subjects, the effect of a complete sensory nerve block at the thigh on the qualities (intensity, sensory, affective) of pain (elicited by electrically induced tetanic muscle contraction) as measured by the Short-Form McGill Pain Questionnaire felt during high amplitude, 50-Hz electrical stimulation (ES) of the vastus lateralis muscle. The findings from this study provide clear evidence that a healthy individual's tolerance level to pain induced during electrically evoked maximum tetanic muscle contraction depends as much on deep muscle stimulation as it does on cutaneous or superficial stimulation. Indeed, the results show a statistically significant decrease of approximately 50% in all three qualities of pain (intensity, sensory, and affective) following the elimination of cutaneous pain pathways via the nerve blocking procedure (p < 0.05). Until it is demonstrated that the same results hold for patients who often experience pain prior to ES treatments, any clinical implications would seem to be premature. For now, clinicians must be aware that muscle, as much as skin, may limit one's ability to tolerate high amplitude ES treatments. Further research is needed on the cutaneous vs. muscular perception of electrically evoked pain in healthy and diseased populations as well as on the issue of subject and patient experience vs. nonexperience with ES. J Orthop Sports Phys Ther 1992;16(4):162-168.