Fatigue after traumatic brain injury and its impact on participation and quality of life

OBJECTIVES: To examine the relationships between post-TBI fatigue (PTBIF) and comorbid conditions, participation in activities, quality of life, and demographic and injury variables. PARTICIPANTS: 223 community-dwelling individuals with mild to severe TBI and 85 noninjured controls. MEASURES: Global Fatigue Index (GFI), Beck Depression Inventory (BDI-II), McGill Pain Questionnaire (MPQ), Pittsburgh Sleep Quality Inventory (PSQI), Participation Objective Participation Subjective (POPS), SF-36, Life-3. METHOD: Data were collected through interviews and administration of self-report measures as part of a study of PTBIF. RESULTS: Fatigue was more severe and prevalent in individuals with TBI, and more severe among women. It was not correlated with other demographic and injury variables. Once overlap in measurement instruments' content was removed, depression, pain, and sleep problems accounted for approximately 23% of the variance in fatigue in those with TBI compared to 58% of the variance in the control group. PTBIF was correlated with health-related quality of life and overall quality of life, but was not generally related to participation in major life activities. CONCLUSIONS: PTBIF has significant impact on well-being and quality of life and cannot be accounted for by comorbid conditions alone, suggesting that it is related to brain injury itself. It appears to be unrelated to demographic and injury variables other than gender. PTBIF does not limit the quantity and frequency of participation. Future research should focus on the relationship between fatigue and the quality of participation.     

Nerve growth factor (NGF) and NGF-receptor expression in diseased human kidneys

BACKGROUND: Nerve growth factor (NGF) has been indicated to be critical to normal renal development in rodents. However, little is known about the expression of NGF and the high-affinity NGF receptors in human kidneys which is essential for promoting the biological and functional activities of NGF. The present study examined the presence of NGF, low-affinity (p75) and high-affinity tyrosine kinase A (TrkA) NGF receptor (NGFR) immunoreactivity in diseased human kidneys. METHODS: Renal biopsies were performed in 24 patients (11 females and 13 males, ranging from 12 to 78 years of age), with various renal diseases. Kidney biopsy samples were fixed in Bouin fluid for 24 hours, washed, dehydrated, embedded in paraplast sections (3-micron thick) and immunostained for NGF, TrkA and p75 localization. Immunostained sections were evaluated under a Nikon Eclipse E600 microscope equipped with a x20 objective and a Nikon DMX 1200 digital camera connected to a PC computer, with the aid of a computerized image analysis system. RESULTS: The results demonstrate the existence of NGF and TrkA in tubular and glomerular cells and of p75-positivity in the interstitial and mesangial cells. It also shows colocalization of TrkA and NGF, but not TrkA and p75 in tubular and glomerular cells, implying that the synthesis and utilization of NGF might be autocrinally regulated. CONCLUSIONS: These findings suggest that NGF signaling may be important in human kidney and glomerular response to injury, though to understand the precise functional significance of these NGF elements in the human kidney, further studies need to be done.     

Tumor-released microvesicles as vehicles of immunosuppression

Tumor-released microvesicles, or exosomes, which are abundant in the body fluids of patients with cancer, are likely to be involved in tumor progression. We recently showed that microvesicles released by human melanoma and colorectal carcinoma cells can promote the differentiation of monocytes to myeloid-derived suppressor cells which support tumoral growth and immune escape. These findings underscore an important role for these extracellular organelles in remodeling tumor-stromal interactions to promote malignancy.     

A multivariable analysis of patient dental satisfaction and oral health-related quality-of-life. A cross-sectional study based on DVSS and OHIP-14

Objective. The aim of this paper was to study the association between dental satisfaction and oral health-related quality-of-life (OHRQoL) when controlling for individual, clinical and psychological factors. Materials. Secondary analysis was conducted using data from a large study carried out in the Swedish region of Värmland in 2004. The questionnaire included demographic variables, clinical assessment and the following instruments: the Dental Visit Satisfaction Scale (DVSS), the short version of Oral Health Impact Profile (OHIP-14) and a modified version of the revised helping alliance questionnaire. Internal consistency analysis was undertaken on the instruments to assess reliability; bivariate comparisons were assessed to compare DVSS scores with individual factors (age, gender and education). In addition, a three step hierarchical multiple regression analysis was performed with DVSS as a dependent variable. Results. Data were completed for 485 randomly selected patients. The mean age of participants was 43.5 years, 54.6% were women,and 41.2% had high education. The median DVSS score was 48 (range 10–50) and the median OHIP was 3.0 (range 0–56). All the instruments showed good reliability. Bivariate analysis showed that females were more satisfied than males (p ≤ 0.01) and patients of 50 years or older were more satisfied than the younger ones (p ≤ 0.05). Finally, the following variables explained 31% of the variance of being very satisfied with dental visit: a good OHRQoL and patients' positive perceptions of the relationship with their care provider. Conclusion. This study showed positive associations between dental satisfaction and OHRQoL when controlling for related factors. The result suggests that care providers should take into account the various dimensions of OHRQoL rather than use only clinical measurements when they evaluate patient satisfaction.