Assessing Illness Representations of Chronic Illness: Explorations of Their Disease-Specific Nature

Elaborating on the five-dimensional structure of illness representation, as described in the self-regulation model of Leventhal (1980), the present study is aimed at identifying the relevance of this generic structure for two chronic illnesses: chronic fatigue syndrome (CFS) and Addison's disease (AD). Factor analyses showed the importance of the five dimensions identity, time-line, control/cure, cause, and consequences to differ according to the type of disease. That is, the items representing the five dimensions merged together for CFS patients and AD patients in a different manner and thereby produced different factor solutions for the two patient groups. In CFS patients, a four-factor solution was identified with manageability, seriousness, personal responsibility, and external cause as the factors. In AD patients a four-factor solution was also identified but with seriousness, cause, chronicity, and controllability as the factors. The value of these findings for our understanding of the disease-specific nature of illness representation is discussed.     

血清Ⅳ型胶原测定对慢性肝病中医证型的诊断作用及临床意义

采用放射免疫法测定160例慢性肝病患者血清肝纤维化标志物Ⅳ型胶原（Ⅳ-C）,以探讨在血清中Ⅳ-C的质量浓度ρⅣ-C与中医证型的关系及临床意义。结果显示,各中医证型组的ρⅣ-C均较对照组明显升高,其升高程度依次为肝郁脾虚＜瘀血阻络＜肝肾阴虚＜湿热中阻＜脾肾阳虚。统计分析表明,湿热中阻和脾肾阳虚组ρⅣ-C的升高与肝郁脾虚组比较存在显著性差异（P＜0．01）。提示：（1）测定ρⅣ-C对慢性肝病中医分型有一定指导意义;（2）肝纤维化在肝郁脾虚阶段已启动,但相对静止;（3）湿热中阻和脾肾阳虚是肝纤维化的活跃期,后者的病情尤其严重。     

Leukemoid reaction and chronic lung disease in infants with very low birth weight

Objectives: To analyze the relationship between the leukemoid reaction and chronic lung disease in very-low-birth-weight (VLBW) infants. Methods: Neonates born weighing less than 1500 g without evidence of congenital anomalies and admitted to our hospital from October 1985 to December 1999 comprised our study. Leukemoid reaction was defined as a peripheral white blood cell (WBC) count of ≥ 50 × 10³/μl. The infants who demonstrated a leukemoid reaction formed the study group, while the remainder formed the control group. The relationship between neonatal variables and WBC counts was studied. Results: Fourteen of the 486 infants demonstrated WBC counts of ≥ 50 × 10³/μl, with an incidence of 2.9%. Univariate analysis demonstrated a significant association between a leukemoid reaction and chronic lung disease following intrauterine infection. Conclusion: A leukemoid reaction was observed in 2.9% of VLBW infants in our neonatal intensive care unit. A significant association was demonstrated between the leukemoid reaction and chronic lung disease following intrauterine infection.     

Hepatitis G and C Viruses Respond to Interferon-α with Different Virologic Kinetics

The aim of this work was to specify the timecourse of response to interferon (IFN) of hepatitis Gvirus (HGV) and hepatitis C virus (HCV) in coinfectedindividuals. A group of 33 patients, undergoing 12 months of IFN therapy for chronic hepatitis C,was screened for the presence of both HGV and HCV RNAsto select seven coinfected patients. Spontaneousrecovery from HGV infection was excluded through the detection of antibodies to the envelope-2protein of HGV and HCV isolates were genotyped. Withinthree months of treatment, we found that HGV RNA wastransiently cleared in 6/7 patients, but the rate of long-term favorable response was very low(1/7). In addition, considering the same individualsseparately, it was shown that HGV and HCV responded toIFN with different kinetics in 5/7 patients. Takentogether, these results underscore the importance of thevirological basis of the resistance to IFNtreatment.     

Trypsinogen Activation Peptides (TAP) in Peritoneal Fluid as Predictors of Late Histopathologic Injury in Necrotizing Pancreatitis of the Rat

The levels of trypsinogen activation peptides(TAP) were quantified by ELISA immunoassay in acutepancreatitis of the rat and compared to the degree oflate histopathological sequelae and exocrine functional impairment 4 and 12 weeks after the acute phaseof the disease. For this purpose acute pancreatitis ofdifferent severity was induced using a suitable ratmodel recently described. Forty five surviving animals were studied. The level of TAP inperitoneal exudate measured 3 and 6 hr afterpancreatitis induction correlated well with the amountof the late histopathological injury at the end of thecorresponding observation period (at 4 weeks after 3 hr: r =0.75, P = 0.003, after 6 hr: r = 0.72, P = 0.005,Pearson; and at 12 weeks after 3 hr: r = 0.86, P =0.0001, after 6 hr: r = 0.84, P = 0.0001, Pearson). A negative correlation of TAP with the impairmentof exocrine function was found only at 4 weeks for thesecretion of total protein (r = –0.76 after 3 hr;r = –0.62 after 6 hr) and for exocrine function (r = –0.67 after 3 hr, r = –0.57 after6 hr), but not at 12 weeks after acute pancreatitis. Nocorrelation with plasma amylase and lipase was found. Weconclude that quantitation of TAP in ascites provides an accurate prediction of late histopathologicsequelae. Pancreatic exocrine function could bepredicted by TAP assay only in the early stage afterpancreatitis induction (eg, four weeks). In later stages of the disease (eg, 12 weeks) remainingpancreatic tissue seems to compensate for any exocrinedeficits that have occurred.     

Cell cycle proteins preceded neuronal death after chronic cerebral hypoperfusion in rats

Abstract

Objectives: To explore the re-expression of cell cycle related proteins and delayed neuronal death after chronic cerebral hypoperfusion in rats and to investigate the relationship between aberrant expression of cell cycle proteins and apoptotic cell death.

Methods: Rat model of chronic cerebral hypoperfusion was established by permanent bilateral common carotid arteries occlusion (2VO) in the retired rats. The apoptotic cells were assessed by TUNEL method. The expression of cell cycle related proteins, i.e. CDK4 and cyclin B1, were detected by immunohistochemical staining and Western blotting. A cyclin-dependent kinases (CDKs) inhibitor, roscovitine, was intracerebroventricularly administered 1 day before 2VO insult. Spatial learning behavior was assessed by the Morris water maze 7, 14 and 21 days after the surgery.

Results: Aberrant expression of CDK4 and cyclin B1 became present 7 days after 2VO insult surgery and last for a long period. On the other hand, TUNEL positive cells appeared as early as 14 days after the surgery and peaked at day 21. Furthermore, roscovitine significantly improve behavioral deficit in the Morris water maze test 7 and 14 days after the surgery.

Conclusion: These findings indicated that aberrant expression of CDK4 and cyclin B1 takes place in the brain after chronic cerebral hypoperfusion in retired rat, and aberrant expression of cell cycle proteins preceded neuronal death in this model. Our data also suggest that the CDK inhibitor, roscovitine, has therapeutic potential for the treatment of dementia caused by chronic cerebral hypoperfusion.     

Serial MRI findings in patient with chronic cryptococcus meningo-encephalitis

Abstract

We describe the serial changes of magnetic resonance imaging (MRI) in a patient with chronic cryptococcus meningo-encephalitis. In the subacute phase, MRI revealed a focal lesion with hyperintensity on T2-weighted image (WI) in the left thalamus. At 11 months after the onset, MRI showed a focal lesion with hyperintensity on T2-WI in the right pons that was enhanced with gadolinium (Gd). At 13 months after the onset, the lesion in the left thalamus became rim enhanced with Gd. After antifungal therapy (amphotericin B and 5-flucytosine), the rim enhancement in the left thalamus and the high signal intensity area in the right pons decreased. Cryptococcoma should be in the differential from other ring enhancing lesions. [Neurol Res 2001; 23: 810-812]     

Comparison of Fracture Prediction Tools in Individuals Without and With Early Chronic Kidney Disease: A Population-Based Analysis of CARTaGENE

Whether fracture prediction tools developed for the management of osteoporosis can be used in chronic kidney disease (CKD) is poorly known. We aimed to compare the performance of fracture prediction tools in non-CKD and CKD. We analyzed CARTaGENE, a population-based survey of 40-year-old to 69-year-old individuals recruited between 2009 and 2010. Renal function was assessed using baseline creatinine and categorized according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines (non-CKD, stage 2, stage 3). Individuals without creatinine measurements or with advanced CKD (stage 4 or 5; prevalence <0.25%) were excluded. Predicted 5-year fracture probabilities (using Fracture Risk Assessment Tool [FRAX], QFracture, and Garvan) were computed at baseline. Fracture incidence (major fracture [MOF] or any fracture) was evaluated in administrative databases from recruitment to March 2016. Discrimination (hazard ratios [HRs] per standard deviation [SD] increase in Cox models; c-statistics) and calibration (standardized incidence ratios [SIRs] before and after recalibration) were assessed in each CKD strata. We included 19,393 individuals (9522 non-CKD; 9114 stage 2; 757 stage 3). A total of 830 patients had any fracture during follow-up, including 352 MOF. FRAX (HR = 1.89 [1.63–2.20] non-CKD; 1.64 [1.41–1.91] stage 2; 1.76 [1.10–2.82] stage 3) and QFracture (HR = 1.90 [1.62–2.22] non-CKD; 1.57 [1.35–1.82] stage 2; 1.86 [1.19–2.91] stage 3) discriminated MOF similarly in non-CKD and CKD. In contrast, the discrimination of Garvan for any fracture tended to be lower in CKD stage 3 compared to non-CKD and CKD stage 2 (HR = 1.36 [1.22–1.52] non-CKD; 1.34 [1.20–1.50] stage 2; 1.11 [0.79–1.55] stage 3). Before recalibration, FRAX globally overestimated fracture risk while QFracture and Garvan globally underestimated fracture risk. After recalibration, FRAX and QFracture were adequately calibrated for MOF in all CKD strata whereas Garvan tended to underestimate any fracture risk in CKD stage 3 (SIR = 1.31 [0.95–1.81]). In conclusion, the discrimination and calibration of FRAX and QFracture is similar in non-CKD and CKD. Garvan may have a lower discrimination in CKD stage 3 and underestimate fracture risk in these patients. © 2020 American Society for Bone and Mineral Research.