A scoping Review of tools used to assess patient Complexity in rheumatic disease

ObjectivePatients with rheumatic diseases often have multiple comorbidities which may impact well‐being leading to high psychosocial complexity. This scoping review was undertaken to identify complexity measures/tools used in rheumatology that could help in planning and coordinating care.MethodsMEDLINE, EMBASE and CINAHL were searched from database inception to 14 December 2019 using keywords and Medical Subject Headings for “care coordination”, “complexity” and selected rheumatic diseases and known complexity measures/tools. Articles describing the development or use of complexity measures/tools in patients with adult rheumatologic diagnoses were included regardless of study design. Included articles were evaluated for risk of bias where applicable.ResultsThe search yielded 407 articles, 37 underwent full‐text review and 2 were identified during a hand search with 9 included articles. Only 2 complexity tools used in populations of adult patients with rheumatic disease were identified: the SLENQ and the INTERMED. The SLENQ is a 97‐item patient needs questionnaire developed for patients with systemic lupus (n = 1 study describing tool development) and applied in 5 cross‐sectional studies. Three studies (a practice article, trial and a cross‐sectional study) applied the INTERMED, a clinical interview to ascertain complexity and support coordinated care, in patients with rheumatologic diagnoses.ConclusionsThere is limited information on the use of patient complexity measures/tools in rheumatology. Such tools could be applied to coordinate multidisciplinary care and improve patient experience and outcomes.Patient contributionThis scoping review will be presented to patient research partners involved in co‐designing a future study on patient complexity in rheumatic disease.     

Associations of Sleep With Sedentary Behavior and Physical Activity Patterns Across Pregnancy Trimesters

IntroductionSleep, sedentary behavior, and moderate-to-vigorous physical activity (MVPA) are altered in pregnancy and may affect pregnancy health; however, how these behaviors are associated with each other is unclear.MethodsPregnant women (N = 120) completed the Pittsburgh Sleep Quality Index and wore an activPAL3 micro and ActiGraph GT3X for 7 days in each trimester to assess sleep, sedentary behavior, and MVPA, respectively. Latent trajectories described patterns of sleep duration, efficiency, and quality as well as sedentary behavior and MVPA. Multinomial logistic regression examined associations of sleep patterns with sedentary behavior and MVPA patterns and, in exploratory analyses, with adverse pregnancy outcomes.ResultsTrajectories were identified for sleep duration (consistently short, 20.7% of sample; consistently adequate, 79.3%), efficiency (consistently low, 17.5%; consistently high, 82.5%), and quality (consistently poor, 15.1%; worsening, 23.5%; and consistently good, 61.5%). Compared with those in more optimal sleep groups, women in the short duration, low efficiency, and worsening quality groups had lower odds of being in the moderate and/or high sedentary behavior group (odds ratio range, 0.21–0.31; 95% confidence interval range, 0.09–0.65). Women in the worsening quality group had greater odds of being in the low MVPA group (odds ratio, 2.51; 95% confidence interval, 1.18–5.38). Trends were observed with women in less optimal sleep groups having greater odds of adverse pregnancy outcomes and lower odds of excessive gestational weight gain.ConclusionsLess optimal sleep patterns in pregnancy are associated with less sedentary behavior and MVPA; additional research is needed to confirm associations between sleep and pregnancy outcomes.     

Agreement between proxy- and self-report scores on PROMIS health-related quality of life domains in pediatric burn survivors: a National Institute on Disability,Independent Living,and Rehabilitation Research Burn Model System Study

Quality of Life Research - To examine agreement between pediatric burn survivor self- and caregiver proxy-report on multiple PROMIS domains and examine factors associated with differences between...     

Diminished expression of the α5β1 integrin (fibronectin receptor) by invasive clones of a human follicular thyroid cancer cell line

Altered adhesion plaques have been observed in transformed cell lines and are associated with enhanced metastatic potential. The prototypical adhesion plaque is formed by 51 fibronectin receptors (FnRs) interacting with the cellular actin network. We have found differences in the actin networks of noninvasive (FTC-133) and invasive (FTC-236, FTC-238) clones of a human follicular thyroid cancer cell line. Furthermore, thyroid-stimulating hormone (TSH) induces stress fibers in FTC-133. In order to investigate differences in adhesion plaques, expression of fibronectin (FN) and its receptor by these cells was analyzed. For these studies FTC-133, FTC-236, and FTC-238 were cultured in serum-depleted DME-H21 medium for 24 hours before the addition of TSH 30 mU/ml. No quantitative differences were noted in FN expression on Western blot in either the conditioned medium or cellular extracts. Western blots and immunohistochemical studies indicated that TSH induced secretion of FN only in FTC-133. Flow cytometry with an 5 antibody demonstrated a 52% and 45% reduction (p<0.01) in expression of FnR by FTC-236 and FTC-238, respectively, compared to FTC-133; this finding was supported by immunohistochemistry results. TSH treatment did not alter FnR expression. From these studies, we conclude that invasive clones of FTC decrease their expression of FnRs without changing their expression of FN. Furthermore, TSH treatment may promote FN secretion by FTC-133, although it does not seem to affect FnR or absolute FN expression. The diminished expression of FnR adhesion plaques may enhance metastatic potential in some follicular thyroid cancers.

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Resumen Se han observado placas adhesivas alteradas en líneas celulares transformadas en asociación con un potencial metastásico incrementado. La prototípica placa adhesiva se forma por la interacción de receptores 5-1 con la trama celular de actina. Hemos encontrado diferencias en las tramas de actina en clones no invasivos (FTC-133) e invasivos (FTC-236, FTC-238) de una línea celular de cáncer folicular de tiroides.Además, la TSH induce líneas de estrés en FTC-133. Con el objeto de investigar las diferencias en las placas adhesivas, se hizo el análisis de la expresión de fibronectina (FN) y sus receptores en tales células.Para estos estudios se hizo el cultivo de FTC-133, FTC-236 y FTC-238, en sueros depletados de DME-H21 por 24 horas anteriores a la adición de 30 mU/ml TSH por 24 horas. No se observaron diferencias cuantitativas en la expresion de FN o en el Western blot ni en los medios condicionados ni en los extractos celulares. Los Western blots y los estudios inmunohistoquímicos indicaron que la TSH induce la secreción de FN sólo en FTC-133. La citometría de flujo con un anticuerpo 5 demostró una reducción de 52% y 45% (p<0.01) en la expresión de FnR por FTC-236 y FT-238, respectivamente, en comparación con FTC-133; este hallazgo fue verificado por inmuno-histoquímica. El tratamiento con TSH no alteró la expresón FnR. Con base en estos estudios, es nuestra conclusión que los clones invasivos de FTC disminuyen la expresión de FnR sin cambiar su expresión de FN. Además, el tratamiento con TSH puede promover la secreciòn de FN por FTC-133, aunque no parece afectar la expresión de FnR o la expresión absoluta de FN. Esta expresión disminuída de las placas adhesivas FnR puede incrementar el potencial metastásico en algunos cánceres foliculares de tiroides.

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Résumé On a observé des altérations des plaques d'adhésion dans certaines lignées cellulaires transformées, et celles-ci semblent être associées à un potentiel métastatique augmenté. La plaque d'adhésion prototypique est formée par des récepteurs 51 de fibronectine (FnR) qui agissent sur le réseau cellulaire d'actine. Nous avons trouvé une différence entre les réseaux d'actine des clones noninvasifs (FTC-133) et invasifs (FTC-236, FTC-238) des lignées cellulaires dans le cancer folliculaire de la thyroïde chez l'homme. La TSH induit des fibres de stress dans le FTC-133. Afin d'évaluer les différences dans les plaques d'adhésion, l'expression de la fibronectine (FN) et de son récepteur ont été analysées. Pour ces études, les clones FTC-133, FTC-236 et FTC-238 ont été mis en culture dans le milieu DME-H21 dépourvu en sérum pendant 24 heures avant l'addition de 30 mU/ml de TSH/24 heures. II n'y avait aucune différence quantitative dans l'expression FN sur Western blot que ce soit sur le milieu ainsi conditionné ou sur les extraits cellulaires. Les Western blots et les études immunohistochimiques ont indiqué que la TSH n'induisait la sécrétion de FN que dans la lignée FTC-133. La cytométrie de flux avec l'anticorps 5 a démontré une réduction respectivement de 52% et de 45% (p<0.01) dans l'expression de FnR par les clones FTC-236 et FTC-238, comparé au FTC-133. Cette donnée a été confirmée par l'immunohistochimie. A partir de ces études, nous concluons que les clones d'invasion de FTC diminuent leur expression en FnR sans changer leur expression de FN. De plus, un traitement par la TSH peut induire la sécrétion de FN par le clone FTC-133 alors qu'il ne semble pas influencer le FnR ou l'expression FN. L'expression diminuée des plaques d'adhésion FnR semble potentialiser les métastases dans certains cancers de la thyroïde.

     

A combined method for estimating ventilatory threshold

BACKGROUND: The aims of this study were to compare two new methods (Dmax and CUSUM) for determination of the ventilatory threshold and to examine the consequences of estimation by application of these methods in combination. METHODS: Experimental design: a comparative design was used. Setting: the study was performed in the Exercise Physiology Laboratory in the Faculty of Medicine, Sel?uk University. Participants: thirty-two untrained males (20.6 +/- 1.2 yrs) performed an incremental exercise test on a cycle ergometer. Interventions: there is no intervention. Measures: ventilatory and gas exchange variables were measured breath-by-breath. The ventilatory thresholds were detected by conventional linear regression, CUSUM, Dmax and combined CUSUM-Dmax methods. RESULTS: The ventilatory thresholds determined by Dmax method gave the highest r-values compared to the criterion method. There was no statistical difference between thresholds determined by all methods or by the same method using different variables. Ventilatory thresholds could not be determined by the conventional linear regression method in three subjects but were determined in all subjects by the other three methods. CONCLUSIONS: Although all methods presented in this study can be used in the determination of ventilatory threshold, the Dmax method was found to be the most valid one. When using the CUSUM method, combining it with the Dmax method increases the validity of the measurement.     

Cryptorchidism as a result of burn injury

Thermal injury of the genitalia usually occurs as part of larger body surface burns. The most common sequelae of burns of the penoscrotal region are contractures of penile shaft, but we did not encounter any reported cases in English Literature with cryptorchidism as a sequel of burn injury. A 7 year old boy with cryptorchidism as a component of extensive perineal and inguinal burn deformity is reported to indicate the role of burn injury in cryptorchidism. Cryptorchidism as a component of perineal burn injury may be caused by the attachment of the cremaster muscle or fascia to the abdominal wall during the process of wound healing. As healing process of wounds on inguinal region by contraction may cause testis entrapment and cryptorchidism, a careful genital examination bears a great importance in inguinal burn deformities in order not to miss any trapped testis and replace it as early as possible before degenerative changes begin.     

The Efficacy of Fluoxetine in the Treatment of Premature Ejaculation: A Double-Blind Placebo Controlled Study

Purpose

The efficacy of the selective serotonin re-uptake inhibitor fluoxetine in the treatment of premature ejaculation was examined.

Materials and Methods

The study comprised 17 patients with premature ejaculation who presented to the urology clinic of our medical school. In this double-blind study the patients were randomized into treatment groups receiving 20 mg. fluoxetine daily for 1 week and 40 mg. daily afterward (group 1) or 1 capsule placebo daily for 1 week and 2 capsules daily afterward (group 2). The groups were evaluated according to the latent period of intravaginal ejaculation.

Results

The latent period of intravaginal ejaculation in group 1 was significantly longer than that in group 2. Nausea, headache and insomnia were reported side effects.

Conclusions

Fluoxetine may be regarded as a safe and effective alternative in the treatment of premature ejaculation.     

Effect of aluminum adjuvants on safety and immunogenicity of Haemophilus influenzae type b-CRM197 conjugate vaccine

OBJECTIVE: The present study was carried out to evaluate the safety and immunogenicity of the Haemophilus influenzae type b-CRM197 (Hib-CRM197) conjugate vaccine in relation to the change of adjuvant from aluminum hydroxide to aluminum phosphate (AlPO4). METHODS: The present study was a clinical phase II, observer-blind, randomized, multicenter, controlled study. Subjects were healthy infants aged 6-12 weeks, eligible for expanded program of immunization (EPI) routine vaccination and admitted to Hacettepe University Department of Social Pediatrics and Gülveren Health Center, Ankara. A total of 520 healthy infants were randomized in a 2:2:1 ratio to receive at either Chiron Hib/AlPO4 vaccine or VaxemHib (aluminum hydroxide adjuvant) vaccine or HibTiter (no adjuvant). Vaccines were administered simultaneously with routine diphtheria, tetanus and pertussis (DTaP) and oral polio vaccine (OPV) vaccines at 2, 4 and 6 months of age. Blood samples for anti-plain polysaccharide (PRP) antibody measurement were collected before the first vaccination and 1 month after the last vaccination. After each vaccination parents filled out a diary for 7 days. RESULTS: Out of 520 subjects enrolled, 514 received three doses and were included for safety analysis. Local and systemic reactions occurred with low and similar frequencies in all groups. Only erythema was more common in Chiron Hib/AlPO4 vaccine (19, 10, 11% in Chiron Hib/AlPO4, VaxemHib and HibTiter, respectively, P < 0.05). Nine serious adverse events were reported in seven cases of which none were related to vaccines. A total of 504 subjects were included in the immunogenicity analysis. The three vaccines were highly immunogenic and equivalent in terms of percentage of acquisition of long-term protective levels. The anti-PRP geometric mean titers were 9.9, 8.3 and 5.14 micro g/mL, respectively (P < 0.05). CONCLUSIONS: The use of aluminum compounds adjuvants in Hib-CRM197 conjugate vaccines does not impact the safety profile, while it does increase the magnitude of anti-PRP antibody titers.     

Correlation of cytochrome P450 (CYP) 1A2 activity using caffeine phenotyping and olanzapine disposition in healthy volunteers.

Olanzapine has previously been shown to have predominant metabolism by cytochrome (CYP) P450 1A2. Caffeine has been shown to provide an accurate phenotypic probe for measuring CYP1A2 activity. The purpose of this study is to determine if a significant correlation exists between olanzapine disposition and caffeine metabolic ratios. Subjects were phenotyped for CYP1A2 activity with caffeine probe methodology. After 200-mg caffeine administration, blood (4 h), saliva (6 and 10 h), and urine (8 h total) were collected for high-performance liquid chromatography (HPLC) analysis of caffeine and its metabolites.CYP1A2 activity was measured as plasma (PMR(4 h)), saliva (SMR(6 h) and SMR(10 h)), and three urinary metabolic (UMR1(8 h), UMR2(8 h), and UMR3(8 h)) ratios. Each of the 14 healthy nonsmokers (13 male) received a single 10 mg olanzapine dose after which blood was collected for HPLC determination of olanzapine concentrations at predose and at 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 10, 12, 24, 48, 72, 96, and 120 h postdose. Olanzapine pharmacokinetic parameters in this study were similar to those previously published. All caffeine metabolic ratios (PMR(4 h), SMR(6 h), SMR(10 h), UMR1(8 h), and UMR2(8 h)) significantly correlated with each other (p <0.001) except for UMR3(8 h), which did not correlate. A significant correlation (p <0.05) was also found between olanzapine clearance and PMR(4 h) (r=0.701), SMR(6 h) (r=0.644), SMR(10 h) (r=0.701), UMR1(8 h) (r=0.745), and UMR2(8 h) (r=0.710). A negative correlation was observed between olanzapine clearance and UMR3(8 h) (r=-0.029, p=NS). A significant correlation was found between olanzapine clearance and various caffeine metabolic ratios. Interpatient variability in CYP1A2 activity may explain the wide interpatient variability in olanzapine disposition. Compounds that modulate CYP1A2 activity may be expected to alter olanzapine pharmacokinetics accordingly.