Melanocortin 4 receptor sequence variations are seldom a cause of human obesity: the Swedish Obese Subjects,the HERITAGE Family Study,and a Memphis cohort

The prevalence of mutations within and in the flanking regions of the gene encoding the melanocortin 4 receptor was investigated in severely obese and normal-weight subjects from the Swedish Obese Subjects study, the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) Family study, and a Memphis cohort. A total of 433 white and 95 black subjects (94% females) were screened for mutations by direct sequencing. Three previously described missense variants and nine novel (three missense, six silent) variants were detected. None of them showed significant association with obesity or related phenotypes. In addition, two novel deletions were found in two heterozygous obese women: a -65_-64delTG mutation within the 5' noncoding region and a 171delC frameshift mutation predicted to result in a truncated nonfunctional receptor. No pathogenic mutations were found among obese blacks or nonobese controls. Furthermore, none of the null mutations found in other populations was present in this sample. In conclusion, our results do not support the prevailing notion that sequence variation in the melanocortin 4 receptor gene is a frequent cause of human obesity.     

Fibromyalgia’s Key Symptoms in Normal-Weight,Overweight, and Obese Female Patients

Factors affecting the symptomatology of fibromyalgia (FM) are not fully understood. The aim of the present study was to analyze the relationship of weight status with pain, fatigue, and stiffness in Spanish female FM patients, with special focus on the differences between overweight and obese patients. The sample comprised 177 Spanish women with FM (51.3 ± 7.3 years old). We assessed tenderness (using pressure algometry), pain and vitality using the General Health Short-Form Survey (SF36), and pain, fatigue, morning tiredness, and stiffness using the Fibromyalgia Impact Questionnaire (FIQ). The international criteria for body mass index was used to classify the patients as normal weight, overweight, or obese. Thirty-two percent were normal-weight, 35% overweight, and 32% obese. Both overweight and obese patients had higher levels of pain than normal-weight patients, as assessed by FIQ and SF36 questionnaires and tender point count (p < .01). The same pattern was observed for algometer score, yet the differences were not significant. Both overweight and obese patients had higher levels of fatigue, and morning tiredness, and stiffness (p < .05) and less vitality than normal-weight patients. No significant differences were observed in any of the variables studied between overweight and obese patients. In conclusion, FM symptomatology in obese patients did not differ from overweight patients, whereas normal-weight patients significantly differed from overweight and obese patients in the studied symptoms. These findings suggest that keeping a healthy (normal) weight is not only associated with decreased risk for developing FM but might also be a relevant and useful way of improving FM symptomatology in women.     

Back to work – a two-year outcome of a multidisciplinary rehabilitation programme focused on physical function and pain

Purpose. To analyze why some responded positively to rehabilitation and why some did not.

Method. Sixty participants with musculoskeletal disorders, mainly neck and back pain participated in a 7-week rehabilitation programme which was based on a combination of theoretical and practical education and physical activities. Before and after the programme and 6, 12 and 24 months after completion of the programme all participants were evaluated with the Disability Rating Index (DRI) and Pain Intensity Rating on a Visual analogue scale (VAS).

Results. In the participants who had full-time sick leave from the start of the programme to the 2-year follow-up (Group I) self-experienced physical disability and pain ratings were high and showed no decrease and were maintained up until the 2-year follow-up. For the participants who had part-time sick leave or no sick leave (Group II) physical disability and pain ratings were initially lower than in Group I and decreased gradually, (p < 0.01) and (p < 0.05), respectively throughout the 2-year follow-up period.

Conclusion. Participants in Group I did not benefit from the rehabilitation programme and did not show improvement in their physical disability and pain rating. Group II showed decreased physical disability and pain rating. The decrease was gradual and was maintained up until the 2-year follow-up period. These results may indicate that persons with musculoskeletal pain with severe disability and pain require other rehabilitation programmes than those with moderate symptoms. This research has highlighted the need for development of such programmes.     

Back to work – evaluation of a multidisciplinary rehabilitation programme with emphasis on musculoskeletal disorders. A two-year follow-up

Purpose. The aim of this study was to evaluate the 2-year outcome of a multidisciplinary rehabilitation programme for working-age people, regarding sick leave and mental health.

Method. The test persons consisted of 40 women and 20 men (mean age 46.8 ± SD 7.9) with musculoskeletal disorders, mainly neck and back pain. The rehabilitation programme was individually adapted and consisted of physical activity in several forms, relaxation, theoretical and practical education and individual guidance. Before, during and after the programme all participants were evaluated with the Global Self-Efficacy Index, Hospital Anxiety and Depression Scale, and stress test.

Results. At the 2-year follow-up full-time sick leave had decreased by 37% (p < 0.0001) in the women, and by 25% (p < 0.05) in the men. Both women and men showed an increased quality of life (QoL) and decreased anxiety, depression and self-experienced stress at the 2-year follow-up compared with the start of the rehabilitation programme.

Conclusions. The most important conclusion was that the effects of the rehabilitation programme persisted for up to 2 years. At 2 years the majority of the participants were still physically active, their QoL was increased, and most participants had returned to work.     

Response to furosemide during dehydration with and without naproxen pretreatment of kidney donors and renal transplant recipients

Summary The response to 40 mg furosemide p.o. in 6 healthy kidney donors and 6 renal transplant recipients with and without naproxen pretreatment has been studied. No volume replacement was given in order to study the development of tolerance. The subjects showed an average dehydration of 1.5 kg · 6 h^–1.While mean creatinine clearance was equal in patients and donors (76 vs 80 ml/min), renal furosemide clearance was significantly lower in the patients (47 vs 81 ml/min; P<0.05). The patients also excreted a smaller fraction of the dose in the urine (5.7 vs 7.8 mg/6 h; P<0.05). As the overall renal sensitivity was similar in the two groups, the natriuretic response was correspondingly smaller in transplant recipients as compared to donors.Within the observation period of 6 h after dosing, acute tolerance developed in the donors and in 4 of the 6 patients, as shown by clockwise hysteresis in the dose (urine furosemide excretion rate)-response (natriuresis) curves. Pretreatment with naproxen reduced renal sensitivity to furosemide (right shift of the dose response curve) in all the donors but in only 2 of the patients.In both groups acute tolerance was less pronounced after naproxen, which may indicate involvement of the prostaglandin system in the development of acute tolerance. The results may also indicate regeneration of sympathetic nerves with functional capacity in at least some renal transplants, or that other mechanisms of salt regulation compensate for loss of sympathetic nerve activity.     

EXTREMELY HIGH FREQUENCY (EHF) PUNCTURE THERAPY AND SYNDROMES OF TRADITIONAL CHINESE MEDICINE

ExtremeIy high frequency (EHF) puncture is a new method of treatment based uponbiological effects of low power electromagnetic waves of millimetric band and acupuncture theory oftraditional Chinese medicine (TCM). It is non-invasive, painless and effective. Extensiveness and variety of the specific sensations (Deqi phenomenon) during EHF-puncture re-flect intensive reactions of the patient's organism and provide individualization of therapy. EHF-puncture is a step of integration of traditional Chinese with modern Western medicines.     

Combined effects of tri-n-butyl tin (TBT) and diuron on marine periphyton communities detected as pollution-induced community tolerance

The effects of combined toxicity were studied, using marine periphyton communities exposed to mixtures of tri-n-butyl tin (TBT) and diuron (3-(3,4-dichlorophenyl)-1,1-dimethylurea, DCMU) in indoor aquaria during four weeks. The experimental design of the study followed a central composite design (CCD) and utilized dose-response surface methodology for evaluation of the results. The detection of pollution-induced community tolerance (PICT) was accomplished by short-term (1 h) tests on inhibition of photosynthesis. Both single-toxicant and two-toxicant short-term tests were used. Two tentative measures of tolerance are proposed to achieve convenient comparisons of the tolerances from the two-toxicant tests. With the detection of PICT, effects of the long-term exposure were recorded on diatom species richness, chlorophyll a accumulation and copepod abundance. The decrease of diatom species richness was accompanied by an increased tolerance (PICT), which was detectable by all tolerance measures used. Primary effects on microalgae were recorded as a decrease in chlorophyll a at higher toxicant concentrations. At lower concentrations, primary effects on copepods were found, which resulted in reduced grazing and increased chlorophyll a content.