Cardiovascular reactivity in young people

Experimental and clinical evidence has emerged which supports the presence of a stress mediated neurogenic component in the development of essential hypertension (EH). To investigate the relationship of genetic risk for EH and the cardiovascular response to centrally mediated stress in the young, we have studied adolescent offspring of hypertensive and normotensive parents. Compared to the normotensive family history negative controls, those adolescents with mildly elevated blood pressure and at least one parent with RH respond to the central stressor of forced mental arithmetic with a greater and more prolonged elevation in blood pressure (p less than 0.01) and heart rate (p less than 0.1). Those adolescents who were normotensive but also had a parent with EH also had a greater response in the cardiovascular parameters (p less than 0.1) than the family history negative controls. However, this group was mixed with high responders and low responders. Preliminary studies on the effect of sodium on the stress response indicated that salt loading augmented the stress response in family history positive subjects, while no effect was observed in the history negative adolescents. Our studies indicate the presence of an identifiable neurogenic component in early EH. Furthermore, a high sodium intake appears to alter the vascular sensitivity to neurogenic stimuli.     

Young disabled residents in old people's homes.

A survey of the status of residents in aged care facilities in the Auckland region conducted in 1988 indicated that almost 9% (645) of the 7516 people studied were under 65 years of age. Rates were markedly higher for people of Maori descent than for those of European descent in this age group. For nonMaori, the rate for men was higher than that for women, but for Maori the opposite was the case. The majority of these young residents (94%) were being cared for in commercial old people's homes. One half were cared for in just 29 of the 223 homes in the region. While most (59%) were admitted after the age of 50, 15% were admitted before they were 40 and must expect to liver their lives out in institutions primarily housing elderly residents. Almost half of those in old people's homes had been admitted from a psychiatric hospital. The authors are concerned that so many young people appear to be in old people's homes because of a lack of alternative accommodation which is more suited to their care.     

The Impact of Polygraphy on Admissions of Victims and Offenses in Adult Sexual Offenders

Sexual offenders are extremely reluctant to disclose their offending histories for a variety of psychosocial and legal reasons. The polygraph has shown promise as a intervention for eliciting admissions of past sexual offending behaviors. For 60 adult male sexual offender (35 inmates and 25 parolees), the number of victims and offenses were recorded from the Presentence Investigative Report, Sexual History Disclosure form, and 2 consecutive polygraph examination reports. Dramatic increases in the number of admitted victims and offenses were found for inmates, but not for parolees, across each source. However, there was a substantial decline in the number of victim and offense admissions by the second polygraph examination for both groups, even though 80% of the examination results reveled deception about sexual offending behaviors. Standardized use of sanctions and privileges for deceptive and nondeceptive polygraph results, respectively, are proposed as a way of eliciting full disclosure of offending histories for these offenders.     

A developmental psychopathology framework of the psychosocial needs of children orphaned by HIV

In addition to the obstacles to a successful resolution of grief normally faced by children whose parents have died, children orphaned by AIDS may face additional psychological and social challenges. However, limited attention has been paid to psychosocial and developmental needs of children orphaned by HIV/AIDS, particularly in resource-poor countries or regions. In this article the authors review the global literature on child bereavement and AIDS orphan care experiences in developing countries and present a developmental psychopathology model of the psychosocial issues facing AIDS orphans. The authors identify gaps in the literature and provide suggestions for future research on AIDS orphans in resource-poor countries and regions. They emphasize that future studies need to assess the status of behaviors and mental health of children orphaned by AIDS within a developmental framework, identify those individual and social factors associated with grief, and examine the long-term impact of quality of care, developmental maturation, and attachment with caregivers on the psychosocial well-being of AIDS orphans.     

Risk factors for sexually transmitted disease among rural-to-urban migrants in China: implications for HIV/sexually transmitted disease prevention

The objective of the study was to identify risk factors associated with sexually transmitted diseases (STDs) among rural-to-urban migrants in Beijing in 2002. Migrants with STDs consisted of 432 migrants who sought STD care in two public STD clinics. Migrants without STDs included 892 migrants recruited from 10 occupational clusters. Multiple logistic regression was used for data analysis. Compared to migrants without STDs, migrants with STDs were more likely to report having engaged in commercial sex (selling or buying sex) (odds ratio [OR] = 2.70, 95% confidence interval [CI]: 1.71-4.25), multiple sex partners in the previous month (OR = 6.50, 95% CI: 3.73-11.32) and higher perceived HIV-related stigma (OR = 1.89, 95% CI: 1.30-2.75). Being a migrant with an STD was also associated with female gender (OR = 4.10, 95% CI: 2.89-5.82), higher education (OR = 2.92, 95% CI: 1.40-6.06), and higher monthly salary (OR = 1.68. 95% CI: 1.23-2.29). Migrants with STDs visited their hometowns more frequently and had more stable jobs than migrants without STDs. Approximately 10% of the migrants with STDs and 7.7% of the migrants without STDs always used condoms. This study suggests that among migrants, acquisition of an STD is associated with higher participation in risk behaviors as would be expected, but also with higher perceived stigma, education, stable jobs, salary, and with female gender. Appropriate behavioral intervention programs are advocated to reduce the risk and stigma among the special population.     

Valvular Heart Disease in Osteogenesis Imperfecta: Presentation of a Case and Review of the Literature

Osteogenesis imperfecta (OI) is a rare inheritable disorder of connective tissue. While musculoskeletal abnormalities are well known, cardiovascular involvement is rare. Aortic root dilation is the most common cardiovascular manifestation. OI preferentially affects the left-sided heart valves, for unclear reasons, leading to aortic and mitral regurgitation. Valve replacement surgery carries a unique set of issues in this population, and fewer than 40 cases have been reported. We report a case of chronic severe aortic regurgitation in a patient with OI complicated by the development of a flail aortic valve leaflet and presenting with a transient ischemic attack. The patient subsequently underwent successful combined bioprosthetic aortic valve replacement and coronary artery bypass grafting. We review the literature on valvular disease and other cardiovascular manifestations in OI and the related surgical considerations relevant to this patient population. (Echocardiography 2010;27:69-73)     

Coupling of Aggregation and Immunogenicity in Biotherapeutics: T- and B-Cell Immune Epitopes May Contain Aggregation-Prone Regions

Biotherapeutics, including recombinant or plasma-derived human proteins and antibody-based molecules, have emerged as an important class of pharmaceuticals. Aggregation and immunogenicity are among the major bottlenecks during discovery and development of biotherapeutics. Computational tools that can predict aggregation prone regions as well as T- and B-cell immune epitopes from protein sequence and structure have become available recently. Here, we describe a potential coupling between aggregation and immunogenicity: T-cell and B-cell immune epitopes in therapeutic proteins may contain aggregation-prone regions. The details of biological mechanisms behind this observation remain to be understood. However, our observation opens up an exciting potential for rational design of de-immunized novel, as well as follow on biotherapeutics with reduced aggregation propensity.     

Recommendations for the validation of cell-based assays used for the detection of neutralizing antibody immune responses elicited against biological therapeutics

The administration of biological therapeutics may result in the development of anti-drug antibodies (ADAs) in treated subjects. In some cases, ADA responses may result in the loss of therapeutic efficacy due to the formation of neutralizing ADAs (NAbs). An important characteristic of anti-drug NAbs is their direct inhibitory effect on the pharmacological activity of the therapeutic. Neutralizing antibody responses are of particular concern for biologic products with an endogenous homolog whose activity can be potentially dampened or completely inhibited by the NAbs leading to an autoimmune-type deficiency syndrome. Therefore, it is important that ADAs are detected and characterized appropriately using sensitive and reliable methods. The design, development and optimization of cell-based assays used for detection of NAbs have been published previously by Gupta et al. 2007 [1]. This paper provides recommendations on best practices for the validation of cell-based NAb assay and suggested validation parameters based on the experience of the authors.     

Preventing stroke: saving lives around the world

Stroke caused an estimated 5.7 million deaths in 2005, and 87% of these deaths were in low-income and middle-income countries. Without intervention, the number of global deaths is projected to rise to 6.5 million in 2015 and to 7.8 million in 2030. The rising burden of stroke, especially in low-income and middle-income countries, leads us to propose a worldwide goal for stroke: a 2% reduction each year over and above that which may happen as a result of better case management and treatment. The experience of high-income countries indicates that sustained interventions can achieve at least the required 4% annual average decline in stroke mortality for people age 60-69 years. Achieving this goal for stroke would result in 6.4 million fewer deaths from stroke from 2005 to 2015. More of these deaths will be averted in low-income and middle-income countries than in high-income countries.