Multidimensionality of the PROMIS self-efficacy measure for managing chronic conditions

Quality of Life Research - This study investigated the PROMIS Self-Efficacy Measure for Managing Chronic Conditions (PROMIS-SE) domain distributions and examined the factor structure of the...     

Potential therapeutic effect of Allium cepa L. and quercetin in a murine model of Blomia tropicalis induced asthma

Background

Asthma is an inflammatory condition characterized by airway hyperresponsiveness and chronic inflammation. The resolution of inflammation is an essential process to treat this condition. In this study we investigated the effect of Allium cepa L. extract (AcE) and quercetin (Qt) on cytokine and on smooth muscle contraction in vitro and its therapeutic potential in a murine model of asthma.

Methods

AcE was obtained by maceration of Allium cepa L. and it was standardized in terms of quercetin concentration using high performance liquid chromatography (HPLC). In vitro, using AcE 10, 100 or 1000 μg/ml or Qt 3.5, 7.5, 15 μg/ml, we measured the concentration of cytokines in spleen cell culture supernatants, and the ability to relax tracheal smooth muscle from A/J mice. In vivo, Blomia tropicalis (BT)-sensitized A/J mice were treated with AcE 100, 1000 mg/kg or 30 mg/kg Qt. We measured cell influx in bronchoalveolar lavage (BAL), eosinophil peroxidase (EPO) in lungs, serum levels of Bt-specific IgE, cytokines levels in BAL, and lung histology.

Results

We observed a reduction in the production of inflammatory cytokines, a relaxation of tracheal rings, and a reduction in total number of cells in BAL and EPO in lungs by treatment with AcE or Qt.

Conclusion

AcE and Qt have potential as antiasthmatic drugs, as they possess both immunomodulatory and bronchodilatory properties.     

Macrophage impairment underlies airway occlusion in primary respiratory syncytial virus bronchiolitis

Although respiratory syncytial virus (RSV) infection is the most important cause of bronchiolitis in infants, the pathogenesis of RSV disease is poorly described. We studied histopathologic changes in a panel of lung tissue specimens obtained from infants with fatal cases of primary RSV infection. In these tissues, airway occlusion with accumulations of infected, apoptotic cellular debris and serum protein was consistently observed. Similar observations were found after RSV infection in New Zealand black (NZB) mice, which have constitutive deficiencies in macrophage function, but not in BALB/c mice. A deficiency in the number of alveolar macrophages in NZB mice appears to be central to enhanced disease, because depletion of alveolar macrophages in BALB/c mice before RSV exposure resulted in airway occlusion. In mice with insufficient numbers of macrophages, RSV infection yielded an increased viral load and enhanced expression of type I interferon-associated genes at the height of disease. Together, our data suggest that innate, rather than adaptive, immune responses are critical determinants of the severity of RSV bronchiolitis.     

Tooth autotransplantation using an interdisciplinary approach to rehabilitation in a young patient: Case report with 7-year follow-up

This case report demonstrates the possibility of functional and aesthetic rehabilitation using an interdisciplinary approach in a child following avulsion of a tooth. Autotransplantation after the development of calcific metamorphosis of the pulp and acute apical periodontitis provided satisfactory repair after root canal treatment. A 7-year-old white boy avulsed the right maxillary central incisor (tooth 11). The extra-alveolar time exceeded 60 minutes, and this triggered external replacement resorption of the avulsed tooth. At 11 years of age, the child underwent tooth autotransplantation. After 4 years of follow-up, intraoral clinical and radiographic examination led to the diagnosis of calcific metamorphosis of the pulp and acute apical periodontitis. The patient had minimally invasive root canal treatment, orthodontic treatment and esthetic rehabilitation with a porcelain crown. Control periapical radiography and tomography of the autotransplanted tooth after 7 years revealed bone repair in the periapical region. This case report indicates that tooth autotransplantation can be used to replace anterior teeth after avulsion followed by replacement resorption. Interdisciplinary management helped to maintain the esthetics and function of the rehabilitated area.     

Dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity

OBJECTIVE: To investigate the dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity by using Rasch analysis. DESIGN: Secondary analysis of pooled data from 2 existing datasets: a randomized therapeutic exercise clinical trial and a cohort longitudinal study of stroke recovery. SETTING: University research center. PARTICIPANTS: A total of 512 subjects, ages 69.8+/-11.1 years, who were 0 to 145 days poststroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dimensionality was examined with principal components analysis and Rasch item-fit statistics. The Rasch-derived item hierarchy was examined for consistency with the expected course of poststroke upper-extremity recovery suggested by the reflex-hierarchical conceptual model underlying the assessment. RESULTS: Factor loadings and item infit statistics suggested that the 3 reflex items were empirically disconnected from other assessment items. The reflex items were removed. The modified 30-item assessment showed a unidimensional structure. The Rasch-item-difficulty order was not consistent with the expected item order. CONCLUSIONS: The items testing resting-state reflexes may threaten the assessment's dimensionality. With reflex items removed, the assessment is a unidimensional measure of volitional movement. The Rasch-generated item-difficulty order challenges the hierarchical structure implied by the instrument's underlying conceptual framework.     

A Comparison of the Ability of Two Upper Extremity Assessments to Measure Change in Function

Study DesignRetrospective Measurement Comparison.IntroductionUpper extremity musculoskeletal disorders affect millions, thus, discerning optimal assessments for measuring change in upper extremity function is critical.Purpose of the StudyTo compare responsiveness (ability to measure change) of the Disabilities of Arm, Shoulder, and Hand (DASH) and Upper Extremity Functional Index (UEFI).MethodsStatistical analyses included Rasch analysis to place the instruments on the same scale, analysis of variance to compare change scores, correlations to compare change scores with global ratings, and the use of receiver operating characteristic (ROC) curves to determine meaningful change scores and overall error.ResultsChange scores on the DASH and UEFI and correlations between change scores and global ratings were similar. Areas under the ROC curves for the DASH and UEFI were 67% and 65%, respectively.ConclusionsNeither assessment has a clear advantage over the other when measuring clinical change.Level of EvidenceNot applicable.     

Severe human lower respiratory tract illness caused by respiratory syncytial virus and influenza virus is characterized by the absence of pulmonary cytotoxic lymphocyte responses

BACKGROUND: Respiratory syncytial virus (RSV) and influenza virus are common causes of infantile lower respiratory tract infection (LRTI). It is widely believed that both viral replication and inappropriately enhanced immune responses contribute to disease severity. In infants, RSV LRTI is known to be more severe than influenza virus LRTI. METHODS: We compared cytokines and chemokines in secretions of infants surviving various forms of respiratory illness caused by RSV or influenza viruses, to determine which mediators were associated with more-severe illness. We analyzed lung tissue from infants with fatal cases of RSV and influenza virus LRTI to determine the types of inflammatory cells present. Autopsy tissues were studied for the lymphotoxin granzyme and the apoptosis marker caspase 3. RESULTS: Quantities of lymphocyte-derived cytokines were minimal in secretions from infants with RSV infection. Concentrations of most cytokines were greater in influenza virus, rather than RSV, infection. Lung tissues from infants with fatal RSV and influenza virus LRTI demonstrated an extensive presence of viral antigen and a near absence of CD8-positive lymphocytes and natural killer cells, with marked expression of markers of apoptosis. CONCLUSIONS: Severe infantile RSV and influenza virus LRTI is characterized by inadequate (rather than excessive) adaptive immune responses, robust viral replication, and apoptotic crisis.     

Translating measures across the continuum of care: using Rasch analysis to create a crosswalk between the Functional Independence Measure and the Minimum Data Set

Setting-specific outcome measures present a major barrier to monitoring patient progress across the continuum of care. This study demonstrated Rasch analysis for the creation of a crosswalk between the Functional Independence Measure (FIM), which is used in inpatient rehabilitation, and the Minimum Data Set (MDS), which is used in skilled nursing facilities. To create the crosswalk, we used data from a sample of 236 patients from four Department of Veterans Affairs' facilities who had had both the FIM and the MDS administered within 7 days. The combined FIM-MDS analysis showed good internal consistency (Cronbach alpha = 0.94), with 21 of the 26 items showing acceptable fit statistics. FIM and MDS raw scores correlated at -0.81 and the measures, corrected for scale direction, correlated at 0.78. Future validity testing will be necessary to determine the accuracy and applicability of the crosswalk.     

Prior psychiatric problems in rehabilitation clients with work-related injuries

Psychiatric histories were obtained in 56 patients beginning rehabilitation following a work-related injury in order to establish the temporal relationship between the onset of psychiatric problems and the date of the work injury. The presence of major depression and alcohol abuse was determined using structured, directed interviews and the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders. A history of either alcohol abuse or depression was found in 36 (64.3%) of the 56 subjects. Of these 36 subjects, 32 (88.9%) reported a history of psychiatric problems that antedated the work injury. These data suggest that, in injured workers, the conceptualization of psychiatric problems solely as reactive illnesses in otherwise psychiatrically healthy persons is often inaccurate. Furthermore, these data suggest the hypothesis that the presence of clinical depression or alcohol abuse may increase the risks of a work-related injury.     

Circulating immune complexes in the blood and anterior chamber fluid in patients with glaucoma and diabetic angioretinopathy complicated by myopia and senile cataract

Circulating immune complexes (CIC) in the serum and anterior eye chamber were simultaneously measured by 4% polyethylene glycol in 23 ophthalmologic patients. The patients with noncomplicated cataracts were found to have elevated serum levels of CIC (175 +/- 8.1 opt. units, p less than 0.001), whereas the patients with glaucoma, diabetic angioretinopathy, and complicated myopia had even higher CIC levels in the serum (247 +/- 7.1 opt. units, p less than 0.001) together with the increased CIC levels in the anterior eye chamber fluid (29.43 +/- 0.88 opt. units, p less than 0.001), which fact is indicative of the augmentation of the autoimmune component it the progress of the dystrophic changes in the eye tissues.