Serum cytokine levels related to multiple dimensions of fatigue in patients with primary Sjogren's syndrome

Methods: Sixty female patients with pSS filled out a questionnaire to assess multiple dimensions of fatigue. Scores were compared with values in a population based control group (n = 139). Levels of interleukin (IL)1ß, IL2, IL6, IL10, and tumour necrosis factor α were measured in serum with commercial sandwich ELISAs. The relationship between self reported dimensions of fatigue and these serum cytokine levels was determined. Results: Patients with pSS had high scores at all dimensions of fatigue (p<0.001): general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue. Fatigue levels were not related to serum cytokine levels. The incidental finding that reduced motivation was higher in patients with detectable serum levels of IL10 (p = 0.04) disappeared after correction for multiple testing. Conclusion: Fatigue is prominent in patients with pSS and involves all dimensions of fatigue. The findings do not suggest a widespread effect of circulating cytokines on multiple aspects of fatigue.     

Air Pollution and Mortality in Seven Million Adults: The Dutch Environmental Longitudinal Study (DUELS)

Background

Long-term exposure to air pollution has been associated with mortality in urban cohort studies. Few studies have investigated this association in large-scale population registries, including non-urban populations.

Objectives

The aim of the study was to evaluate the associations between long-term exposure to air pollution and nonaccidental and cause-specific mortality in the Netherlands based on existing national databases.

Methods

We used existing Dutch national databases on mortality, individual characteristics, residence history, neighborhood characteristics, and national air pollution maps based on land use regression (LUR) techniques for particulates with an aerodynamic diameter ≤ 10 μm (PM₁₀) and nitrogen dioxide (NO₂). Using these databases, we established a cohort of 7.1 million individuals ≥ 30 years of age. We followed the cohort for 7 years (2004–2011). We applied Cox proportional hazard models adjusting for potential individual and area-specific confounders.

Results

After adjustment for individual and area-specific confounders, for each 10-μg/m³ increase, PM₁₀ and NO₂ were associated with nonaccidental mortality [hazard ratio (HR) = 1.08; 95% CI: 1.07, 1.09 and HR = 1.03; 95% CI: 1.02, 1.03, respectively], respiratory mortality (HR = 1.13; 95% CI: 1.10, 1.17 and HR = 1.02; 95% CI: 1.01, 1.03, respectively), and lung cancer mortality (HR = 1.26; 95% CI: 1.21, 1.30 and HR = 1.10 95% CI: 1.09, 1.11, respectively). Furthermore, PM₁₀ was associated with circulatory disease mortality (HR = 1.06; 95% CI: 1.04, 1.08), but NO₂ was not (HR = 1.00; 95% CI: 0.99, 1.01). PM₁₀ associations were robust to adjustment for NO₂; NO₂ associations remained for nonaccidental mortality and lung cancer mortality after adjustment for PM₁₀.

Conclusions

Long-term exposure to PM₁₀ and NO₂ was associated with nonaccidental and cause-specific mortality in the Dutch population of ≥ 30 years of age.

Citation

Fischer PH, Marra M, Ameling CB, Hoek G, Beelen R, de Hoogh K, Breugelmans O, Kruize H, Janssen NA, Houthuijs D. 2015. Air pollution and mortality in seven million adults: the Dutch Environmental Longitudinal Study (DUELS). Environ Health Perspect 123:697–704; http://dx.doi.org/10.1289/ehp.1408254     

Charges for Criminal Exposure to HIV and Aggravated Prostitution Filed in the Nashville, Tennessee Prosecutorial Region 2000–2010

This paper examines comprehensive data on arrests for HIV-specific crimes within a single jurisdiction, the Nashville Tennessee prosecutorial region, over 11 years. There were 25 arrests for HIV exposure and 27 for aggravated prostitution. Eleven of the arrests for HIV exposure involved nonsexual behaviors; none alleged transmission. Sixteen of the arrests for HIV exposure involved sexual behavior; three alleged transmission. Aggravated prostitution cases (i.e. prostitution while knowing one has HIV) often involved solicitation of oral sex; none alleged transmission. Maximum sentences for HIV-specific crimes ranged from 5 to 8 years. We conclude that enforcement of US HIV-specific laws is underestimated. Fifty-two arrests over 11 years were recorded in one jurisdiction. Over half of the arrests involved behaviors posing minimal or no HIV transmission risk. Despite concerns about malicious, intentional HIV transmission, no cases alleged malice or intention.     

Nicotine, lung and cancer

The respiratory epithelium expresses the cholinergic system including nicotinic receptors (nAChRs). It was reported that normal human bronchial epithelial cells (BEC), which are the precursor for squamous cell carcinomas, and small airway epithelial cells (SAEC), which are the precursor for adenocarcinomas, have slightly different repertoires of nAChRs. Studies shown that nAChRs expressed on lung carcinoma or mesothelioma form a part of an autocrine-proliferative network facilitating the growth of neoplastic cells; others demonstrated that nicotine can promote the growth of colon, gastric, and lung cancers. Nicotine and structurally related carcinogens like NNK [4-(methylnitrosoamino)- 1-(3-pyridyl)-1-butanone] and NNN (N'-nitrosonornicotine) could induce the proliferation of a variety of small cell lung carcinoma cell lines and endothelial cells and nicotine in non-neuronal tissues -including lung- induces the secretion of growth factors (bFGF, TGF-alpha, VEGF and PDGF), up regulation of the calpain family proteins, COX-2 and VEGFR-2, causing the eventual activation of Raf/MAPK kinase/ERK (Raf/MEK/ERK) pathway contributing to the growth and progression of tumors exposed to nicotine through tobacco smoke or cigarette substitutes. It has been demonstrated that nicotine promotes the growth of solid tumors in vivo, suggesting that might induce the progression of tumors already initiated. While tobacco carcinogens can initiate and promote tumorigenesis, the exposure to nicotine could confer a proliferative advantage to early tumors but there is no evidence that nicotine itself provokes cancer. This is supported by the findings that nicotine can prevent apoptosis induced by various agents - such as chemotherapeutic in NSCLC, conferring a survival advantage as well.     

Cor Triatriatum

Cor triatriatum is defined as a membrane within the left atrium, which might lead to restricted pulmonary venous return. Diagnosis is usually achieved by echocardiography, therapy of choice is excision of the membrane. Upon ten new cases, the association with other congenital heart diseases (CHDs), clinical symptoms and the surgical approach are discussed. Eight of ten patients were children, six of them aged<1 year. Additional CHDs included atrial and ventricular septal defects, partial anomalous pulmonary venous return and complex CHD. Surgery was performed in all cases. Prognosis is related to associated CHD.     

Projections of primary afferent fibers to last-order premotor interneurons in the lumbar spinal cord of rats

It is well established that last-order premotor interneurons in the spinal cord have crucial importance in the integration of activities generated by the spinal motor apparatus, sensory information and volleys arising from higher motor centers, indicating that they play a substantial role in spinal motor functions. Despite extensive studies, synaptic input systems of these neurons have not been investigated in detail up to now with morphological approaches. On this basis, the present experiments were aimed at the visualization of possible contacts between primary afferents and last-order premotor interneurons in the lumbar spinal cord of rats using double label neural tracing methods in light microscopy. The findings show that terminal puncta of primary afferents do establish indeed appositions on last-order premotor interneurons. From the quantitative point of view, these appositions occur, however, in limited numbers. The study also shows that last-order premotor interneurons contacted by primary afferents tend to be concentrated at the segmental level of the innervated motoneurons, and are evenly distributed along the mediolateral extent of laminae V-VI and in the dorsal portion of lamina VII.     

The 2020 reform of the employment status of Hungarian health workers: Will it eliminate informal payments and separate the public and private sectors from each other?

Hungary, like many countries, features a complex mix of the public and private sector in the financing and provision of health care services. At the same time, the health system also faces challenges related to shortages of health professionals, low public financing, and informal payments. With the added pressure from the COVID-19 pandemic, Hungarian policymakers acted rapidly to pass a sweeping regulation aimed at these issues. Over two days, the Hungarian parliament introduced and unanimously approved a new regulation, Act C of 2020 on the Employment Status of Health Workers, that replaces the existing public employment relationship between health professionals, public providers and their controlling authorities. The Act, passed on 6 October 2020, brings the employment of health workers under strict central control by introducing a new employment status similar to that of the armed forces. The Act also provides doctors with an unprecedented 120% salary increase and criminalizes informal payments. The reception has been overwhelmingly negative, with thousands of health professionals indicating that they would not sign the new contracts, and the policy also contains serious technical and feasibility concerns. Although the first statistics show that only about 3-5% of the active workforce did not sign the contract by 1 March 2021, the implementation of the reform still faces serious challenges.