Which constructs can predict emotional exhaustion in a working population? A study into its determinants

The main objective of this study was to examine the psychosocial stress model developed by Taylor and Aspinwall with emotional exhaustion as the outcome variable. Respondents, 409 men and 346 women, who had a paid job for at least 20 hours per week, completed questionnaires concerning demographic variables, personality, temperament, work pressure, workload, perceived social support, appraisal, coping, and emotional exhaustion. Structural equation analyses provided only partial support for the validity of the model. First, on theoretical and statistical grounds, one more path linking external resources to social support was added. Second, contrary to expectations, coping styles did not predict emotional exhaustion. To conclude, when coping is measured retrospectively, it does not add to our understanding of emotional exhaustion. It is suggested that future studies should be longitudinal and include objective measures of stressors and psychosocial health outcomes in addition to self‐reports. Copyright © 2007 John Wiley & Sons, Ltd.     

Degenerative arthritis of the knee secondary to fracture malunion

Degenerative arthritis of the knee is a complication of femoral or tibial fractures potentially avoidable by the correction of various degrees of malalignment. To better clarify the malalignment problem, the records of 14 patients (15 limbs), with degenerative arthritis of the knee and a history of tibial or femoral fracture were retrospectively reviewed. The average follow-up was 31.7 years. Static biomechanical frontal plane analyses were evaluated. The calculated increased force on either the medial or lateral tibial plateau, due to the malunion, was strongly associated with presence of a varus or valgus deformity at the knee (p less than 0.0005). A normal tibial plateau force for the malaligned condition multiplied by the time since fracture correlated directly with the amount of subsequent varus or valgus deformity at the knee (p less than 0.01). Lower limb fracture alignment should be restored to as near normal as possible to reduce the likelihood of gonarthrosis.     

Human dolasetron pharmacokinetics: II Absorption and disposition following single-dose oral administration to normal male subjects

Dolasetron is a 5-hydroxytryptamine antagonist active at type III receptors; it is presently undergoing clinical evaluation for the reduction/prevention of cancer chemotherapyinduced nausea and vomiting. A previous study demonstrated that following intravenous administration to healthy male subjects, dolasetron disappeared extremely rapidly from plasma, and less than 1 per cent of the dose appeared in the urine. A major plasma metabolite, reduced dolasetron, peaked rapidly in the plasma. In this study, dolasetron was administered orally to healthy male subjects at doses ranging from 50 to 400 mg (mesylate monohydrate). Plasma concentrations of dolasetron were low and sporadic, and there was little excreted in urine; this prevented dolasetron pharmacokinetic analysis. Reduced metabolite concentrations peaked rapidly, with a median value of 1.00 h. The median terminal disposition half-life was 7.80 h. Median values for fraction of dose excreted in urine and renal clearance were 22.2 per cent and 2.56 ml min^?1 kg^?1. Whereas areas under the plasma concentration—time curves were proportional to dose, renal clearance increased with dose (p < 0.05). However, given dose proportionality to AUC, this is probably of little therapeutic consequence. Since reduced dolasetron has significant anti-emetic activity in the ferret model, it appears that this metabolite may play a significant role in pharmacodynamic activity.     

Degradation of soluble laminin and depletion of tissue-associated basement membrane laminin by Pseudomonas aeruginosa elastase and alkaline protease.

Purified Pseudomonas aeruginosa elastase and alkaline protease rapidly cleaved soluble laminin, with each enzyme yielding different cleavage products. These cleavage fragments were separated from the intact laminin A and B polypeptide chains by sodium dodecyl sulfate-polyacrylamide gradient gel electrophoresis and detected by their characteristic Coomassie blue staining patterns. Pseudomonas elastase produced rapid and extensive degradation of both A and B chains, including the disulfide-rich regions. Apparently complete degradation to limit digests was obtained after 30 min with a substrate/enzyme ratio of 30:0.5. Under similar conditions, alkaline protease rapidly degraded the A chain while slowly degrading the B chain. In addition, immunoreactive laminin was released from authentic basement membranes after incubation with either enzyme as detected by an enzyme-linked immunoabsorption assay and by immunofluorescence. The results from these studies suggest a direct role for elastase and alkaline protease in both tissue invasion and hemorrhagic tissue necrosis in P. aeruginosa infections.     

Food-initiated outbreak of methicillin-resistant Staphylococcus aureus analyzed by pheno- and genotyping.

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) involving 27 patients and 14 health-care workers (HCW) was studied. The outbreak started in the hematology unit of the University Hospital Rotterdam, Dijkzigt, The Netherlands, and spread to the surgical unit. Twenty-one patients (77.8%) developed clinical disease, and five died. Subsequently, MRSA was detected in food and in the throat of one of the HCW who prepared food for hematology patients. Food contaminated by an HCW most likely caused the first case of MRSA septicemia. This route of transmission has not been described before. The outbreak strain was probably transmitted to the surgical unit by a colonized nurse, where it caused an explosive outbreak. Airborne probably transmitted to the surgical unit by a colonized nurse, where it caused an explosive outbreak. Airborne MRSA transmission played an important role in disseminating the organism. The outbreak was controlled within 6 months by intensifying surveillance, temporarily closing the affected wards, treating carriers, and instituting an MRSA ward outside the hospital. Phage typing, insertion sequence probing, protein A gene typing, and DNA fingerprinting by PCR revealed that all outbreak-related isolates were identical. By pulsed-field gel electrophoresis, all but one of the outbreak-related isolates were determined to be identical. Protein A gene typing identified numerous (11) repeat units in all outbreak-related isolates, which supports the suggestion that the outbreak strain may have been more virulent and more transmissible than other MRSA strains. Pheno- and genotyping studies underlined the value of DNA fingerprinting methods for investigation of MRSA epidemiology. Optimal discriminatory power was achieved by combining the results of four genotyping methods.     

Antigenic and molecular analyses of different Chlamydia pneumoniae strains.

Chlamydia pneumoniae is an important human respiratory pathogen. Classification of C. pneumoniae isolates into distinguishable serovars or genotypes has not yet been reported. To determine whether antigenic or molecular variants among C. pneumoniae isolates exist, six strains were studied via immunoblot analysis and DNA sequence determination of the entire major outer membrane protein (MOMP) gene omp1. The strains included four prototype strains and two clinical isolates from our laboratory. Immunoblot analysis of sera from patients infected with C. pneumoniae revealed antigenic differences between the C. pneumoniae strains. Strong reactivity of one serum sample with a 65-kDa protein in two C. pneumoniae strains which was not observed with the other strains was the most prominent finding. All sera reacted with the 40-kDa MOMP. Comparison of the omp1 DNA sequences revealed that the omp1 genes of all strains were identical and were 100% identical to the sequence of the omp1 gene of C. pneumoniae AR-39. The results of this study demonstrate that unlike C. trachomatis, the omp1 gene is conserved in C. pneumoniae. Furthermore, it was shown that C. pneumoniae strains are antigenically different. This finding indicates that more than one serovar of C. pneumoniae exist.     

*NO, RSNO, ONOO-, NO+, *NOO, NOx--dynamic regulation of oxidant scavenging, nitric oxide stores, and cyclic GMP-independent cell signaling

Following its release from nitric oxide synthase, nitric oxide seldom perfuses the cytosol; rather this reactive mediator quickly interacts with available target molecules proximate to its site of release. Within the cell, virtually every component, low-molecular-weight oxidants and reductants, proteins, lipids, sugars, and nucleic acids can be modified by nitrogen oxides thus acting as potential targets for reactive nitrogen oxides. Adducts formed by nitrogen oxides often modulate the cellular activities of the target molecules, and these modified molecules may be differentially metabolized or localized. The formation of nitrogen oxide adducts can be a reversible process, and the reactive nitrogen species released may be specifically oxidized or reduced during the process. Recently, numerous studies have demonstrated that reversible nitration of cellular proteins acts to transduce molecular signals regulating such diverse processes as muscle contraction, neurotransmission, protein metabolism, and apoptosis. The vast numbers of molecules that undergo biologically relevant interactions with nitrogen oxides imply that the cellular concentration of nitrosated and nitrated species may effectively comprise a reserve or cellular store. Potentially, these nitroso reserves function as critical components of the overall redox status of the intracellular environs. Understanding the dynamic regulation of nitric oxide/nitrogen oxides release from these stores is likely to provide clues important in resolving the complex pathophysiology of poorly understood multifactorial disorders, including neurodegeneration, multiorgan failure, cardiomyopathy, and septic shock.     

Verhandlungen ärztlicher Gesellschaften

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Synaptic integration in rat frontal cortex shaped by network activity

Neocortical neurons in vivo are embedded in networks with intensive ongoing activity. How this network activity affects the neurons' integrative properties and what function this may imply at the network level remain largely unknown. Most of our knowledge regarding synaptic communication and integration is based on recordings in vitro, where network activity is strongly diminished or even absent. Here, we present results from two complementary series of experiments based on intracellular in vivo recordings in anesthetized rat frontal cortex. Specifically, we measured 1) the relationship between the excursions of a neuron's membrane potential and the spiking activity in the surrounding network and 2) how the summation of several inputs to a single neuron changes with the different levels of its membrane potential excursions and the associated states of network activity. The combination of these measurements enables us to assess how the level of network activity influences synaptic integration. We present direct evidence that integration of synaptic inputs in frontal cortex is linear, independent of the level of network activity. However, during periods of high network activity, the neurons' response to synaptic input is markedly reduced in both amplitude and duration. This results in a drastic shortening of its window for temporal integration, requiring more precise coordination of presynaptic spike discharges to reliably drive the neuron to spike under conditions of high network activity. We conclude that ongoing activity, as present in the active brain, emphasizes the need for neuronal cooperation at the network level, and cannot be ignored in the exploration of cortical function.