Characterization of Non-Hodgkin''s Lymphomas Using Multiple Cell Markers: Immunologic, Morphologic, and Cytochemical Studies of 72 Cases

Tissues from 72 cases (87 specimens) of various non-Hodgkin's lymphomas were analyzed for cell markers using multiple techniques. Cell suspensions were evaluated for E, EAC, and IgGEA rosette forming cells; Fc receptor cells; and surface immunoglobulin bearing cells. Cryostat section studies topographically defined EAC binding cells. Cytochemical determinations and immunoperoxidase methods for detection of intracellular immunoglobulin and lysozyme complemented other techniques in evaluating infiltrates containing large neoplastic cells. B-cell malignancies comprised 58 cases (80%) of this series and included well and moderately well differentiated lymphocytic lymphomas (10/10); nodular (23/23) and diffuse (10/18) poorly differentiated lymphocytic lymphomas; and lymphomas of mixed lymphocytic-“histiocytic” (3/3), “undifferentiated” (3/3), and “histiocytic” (9/13) types. Nodular lymphomas were characterized as B-cell neoplasms but also revealed a prominent population of T lymphocytes (39 ± 12%). Alkaline phosphatase activity, a cytochemical marker for lymphoid cells of follicular cuffs, was most consistently observed in B-cell lymphomas of moderately well differentiated lymphocytic type (4/6 cases). In some diffuse lymphomas, cryostat section studies (EAC rosettes) suggested a pre-existing nodular proliferation. One unusual B-cell lymphoma of large cell type exhibited IgGEA rosette formation and a strong receptor for the Fc portion of IgG. Ten lymphomas (14%) were of T-cell type and were represented by cases of diffuse poorly differentiated lymphocytic lymphoma (5/18, including 3 lymphoblastic lymphomas), Sézary syndrome (1), mycosis fungoides (1), and a cytologically distinctive large cell (“histiocytic”) lymphoma (3/13). Acid phosphatase activity was a consistent marker for the T-cell malignancies, some of which also revealed α-naphthyl butyrate esterase activity. No true histiocytic lymphomas were detected. Three cases of diffuse poorly differentiated lymphocytic lymphoma and one “histiocytic” lymphoma were null.     

Serum associated leucocyte locomotion inhibition and leucocyte motility in malignant melanoma: effect of BCG treatment

Serum-associated leucocyte locomotion inhibition (SALLI) and leucocyte motility were investigated in patients with malignant melanoma. Ten days after tumour excision twelve out of eighteen patients' sera exhibited a SALLI exceeding the normal range of 15%. The mean SALLI thus reached was 59·2±5·2%. No correlation was observed between SALLI and the level of invasion or the stage of the disease.

Six patients selected at random who had a mean SALLI of 71·5±5·8% after tumour excision were further treated by BCG immunotherapy and presented after 8·2±2·9 months of therapy with a significantly (P<0·01) lower SALLI of 32·6±8·1%. In eight patients treated exclusively by surgical excision, SALLI remained basically unchanged in the course of 10±2·8 months (29·0±8·0% vs 30·4±12·9%).

The mean index of leucocyte locomotion (LL) of eight melanoma patients who had received BCG for 11·2±2·3 months was 5·9±0·9 cells/field and thus significantly (P<0·01) higher in comparison with the mean index of LL (2·8±0·5) found in eight patients treated by surgical excision only 12·4±2·1 months before testing.

In addition, patients receiving BCG had a significantly higher (P<0·05) mean value of LL than fifteen healthy controls who presented with a mean index of LL of 3·4±0·3 cells/field. Our results permit the suggestion that BCG decreases SALLI and increases LL in melanoma patients.

     

Analysis of time intervals involved in admission to a coronary care unit

Time intervals between the onset of the presenting symptom (chest pain) and arrival in a coronary care unit were studied for 221 admissions arranged by conventional means. The median figure for “patient delay” was 60 minutes, for “general-practitioner delay” 20 minutes, for “ambulance delay” 30 minutes, and for “transit delay” 30 minutes. The median “total delay” was three hours 30 minutes.

Only 4·5 per cent of the patients were under intensive coronary care within one hour, the time of the highest mortality risk. A mobile coronary service should be capable of increasing the proportion of patients brought under special care within the first hour, but the time taken by the patient to realise the nature of the emergency and summon aid is likely to remain the most critical factor.

     

Reliability and Quality of Korean YouTube Videos for Education Regarding Gout

BackgroundYouTube has become an increasingly popular educational tool and an important source of healthcare information. We investigated the reliability and quality of the information in Korean-language YouTube videos about gout.MethodsWe performed a comprehensive electronic search on April 2, 2021, using the following keywords—“gout,” “acute gout,” “gouty arthritis,” “gout treatment,” and “gout attack”—and identified 140 videos in the Korean language. Two rheumatologists then categorized the videos into three groups: “useful,” “misleading,” and “personal experience.” Reliability was determined using a five-item questionnaire modified from the DISCERN validation tool, and overall quality scores were based on the Global Quality Scale (GQS).ResultsAmong the 140 videos identified, 105 (75.0%), 29 (20.7%), and 6 (4.3%) were categorized as “useful,” “misleading,” and “personal experience,” respectively. Most videos in the “useful” group were created by rheumatologists (70.5%). The mean DISCERN and GQS scores in the “useful” group (3.3 ± 1.0 and 3.8 ± 0.7) were higher than those in the “misleading” (0.9 ± 1.0 and 1.9 ± 0.6) and “personal experience” groups (0.8 ± 1.2 and 2.0 ± 0.8) (P < 0.001 for both the DISCERN and GQS tools).ConclusionApproximately 75% of YouTube videos that contain educational material regarding gout were useful; however, we observed some inaccuracies in the medical information provided. Healthcare professionals should closely monitor media content and actively participate in the development of videos that provide accurate medical information.     

Development of an Obesity Management Ontology Based on the Nursing Process for the Mobile-Device Domain

Background

Lifestyle modification is the most important factor in the management of obesity. It is therefore essential to enhance client participation in voluntary and continuous weight control.

Objective

The aim of this study was to develop an obesity management ontology for application in the mobile-device domain. We considered the concepts of client participation in behavioral modification for obesity management and focused on minimizing the amount of information exchange between the application and the database when providing tailored interventions.

Methods

An obesity management ontology was developed in seven phases: (1) defining the scope of obesity management, (2) selecting a foundational ontology, (3) extracting the concepts, (4) assigning relationships between these concepts, (5) evaluating representative layers of ontology content, (6) representing the ontology formally with Protégé, and (7) developing a prototype application for obesity management.

Results

Behavioral interventions, dietary advice, and physical activity were proposed as obesity management strategies. The nursing process was selected as a foundation of ontology, representing the obesity management process. We extracted 127 concepts, which included assessment data (eg, sex, body mass index, and waist circumference), inferred data to represent nursing diagnoses and evaluations (eg, degree of and reason for obesity, and success or failure of lifestyle modifications), and implementation (eg, education and advice). The relationship linking concepts were “part of”, “instance of”, “derives of”, “derives into”, “has plan”, “followed by”, and “has intention”. The concepts and relationships were formally represented using Protégé. The evaluation score of the obesity management ontology was 4.5 out of 5. An Android-based obesity management application comprising both agent and client parts was developed.

Conclusions

We have developed an ontology for representing obesity management with the nursing process as a foundation of ontology.     

Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale

Introduction:

Home-based palliative care is an essential model of palliative care that aims to provide continuity of care at patient''s own home in an effective and timely manner. This study was a pilot test of triage coding system in home-based palliative care using Edmonton Symptom Assessment System (ESAS) scale.

Methods:

Objective of the study was to evaluate if the triage coding system in home-based palliative care: (a) Facilitated timely intervention, (b) improved symptom control, and (c) avoided hospital deaths. Homecare services were coded as high (Group 1 - ESAS scores ≥7), medium (Group 2 - ESAS scores 4–6), and low (Group 3 - ESAS scores 0–3) priority based on ESAS scores. In high priority group, patients received home visit in 0–3 working days; medium priority group, patients received home visit in 0–10 working days; and low priority group, patients received home visit in 0–15 working days. The triage duration of home visit was arbitrarily decided based on the previous retrospective audit and consensus of the experts involved in prioritization and triaging in home care.

Results:

“High priority” patients were visited in 2.63 ± 0.75 days; “medium priority” patients were visited in 7.00 ± 1.5 days, and “low priority” patients were visited in 10.54 ± 2.7 days. High and medium priority groups had a statistically significant improvement in most of the ESAS symptoms following palliative home care intervention. Intergroup comparison showed that improvement in symptoms was the highest in high priority group compared to medium and low priority group. There was an 8.5% increase in home and hospice deaths following the introduction of triage coding system. There was a significant decrease in deaths in the hospital in Group 1 (6.3%) (χ² = 27.3, P < 0.001) compared to Group 2 (28.6%) and Group 3 (15.4%). Group 2 had more hospital deaths. Interval duration from triaging to first intervention was a significant predictor of survival with odds ratio 0.75 indicating that time taken for intervention from triaging was more significantly affecting survival than group triaging.

Conclusion:

Pilot study of testing triaging coding system in home-based palliative care showed, triage coding system: (a) Facilitated early palliative home care intervention, (b) improved symptom control, (c) decreased hospital deaths, predominantly in high priority group, and (d) time taken for intervention from triaging was a significant predictor of survival.     

Empirical Evidence for “Syndrome Z”: A Hierarchical 5-Factor Model of the Metabolic Syndrome Incorporating Sleep Disturbance Measures

Study Objective:

Sleep disturbances have been associated with individual components of the metabolic syndrome (“syndrome X”), and, although the concept has been proposed, it is not known whether sleep disturbances actually cluster with features of the metabolic syndrome to produce a unifying trait, “syndrome Z”. Therefore, we evaluated a second-order factor model, whereby syndrome Z was described by 5 first-order factors – insulin resistance, obesity, hypertension, dyslipidemia, and sleep disturbance – with the sleep disturbance factor defined using the apnea-hypopnea index, arousal index, percentage of sleep time with oxygen saturation less than 90%, and percentage of slow wave sleep.

Design:

Observational, cross-sectional study.

Setting:

Clinical research center.

Participants:

Five hundred thirty-three adults from the Cleveland Family Sleep Study who underwent polysomnography and were not treated by continuous positive airway pressure.

Measurements and Results:

When modeling syndrome Z as a second-order factor unifying 5 first-order factors, we observed good overall model fit (χ²/df = 3.20; CFI = 0.96; RMSEA = 0.06; SRMR = 0.05) and found that obesity was the most important determining factor (standardized loading = 0.85 ± standard error = 0.02; P < 0.01) followed by sleep disturbance (0.82 ± 0.03; P < 0.01), insulin resistance (0.67 ± 0.03; P < 0.01), hypertension (0.64 ± 0.04; P < 0.01), and dyslipidemia (0.60 ± 0.05; P < 0.01). Simultaneous multiple group analyses revealed that this model was essentially generalizable across age, race, and sex subgroups.

Conclusions:

Our results demonstrate that sleep disturbance co-aggregates with other metabolic features to represent a single unifying trait, syndrome Z. Although our model awaits validation in other populations, it provides a tool for better understanding the synergistic risk of syndrome Z, compared with syndrome X, on type 2 diabetes and cardiovascular disease in future studies.

Citation:

Nock NL; Larkin EK; Patel SR; Redline S. Empirical evidence for “Syndrome Z”: a hierarchical 5-factor model of the metabolic syndrome incorporating sleep disturbance measures. SLEEP 2009;32(5):615-622.     

Double contrast-enhanced ultrasonography evaluation of preoperative Lauren classification of advanced gastric carcinoma

Introduction

The clinical value of double contrast-enhanced ultrasonography (DCUS) in determining the Lauren classification of advanced gastric carcinoma needed investigation.

Material and methods

Fifty-eight patients with gastric cancer proved by endoscopic biopsy underwent preoperative DCUS examination in which an oral contrast agent was combined with an intravenous agent, and the findings were compared with the postoperative pathological findings using haematoxylin-eosin and Alcian Blue-Periodic Acid Schiff (AB-PAS) staining.

Results

Of 58 patients, 34 (59%) were the intestinal type and 24 (41%) the diffuse type on pathological examination of resected specimens. Among intestinal type patients, 30 (88%) showed homogeneous vascular enhancement and 4 (12%) heterogeneous enhancement with the “sandwich” pattern in 2 patients (50%) and “barrier” pattern in 2 patients (50%). In the diffuse type, 22 of 24 patients (92%) enhanced heterogeneously, with stippled and peripheral enhancement in 9 (41%), the “sandwich” pattern in 8 (36%) and “barrier” pattern in 5 (23%). Two of 24 patients (8%) with the diffuse type enhanced homogeneously. The proportion of heterogeneous enhancement was significantly different between the 2 subtypes of tumour (p = 0.0001). The sensitivity and specificity of heterogeneous enhancement in diagnosing the diffuse type of advanced gastric cancer were 92% and 88%, respectively. Youden’s index was 0.8.

Conclusions

Double contrast-enhanced ultrasonography is a new and useful method to determine Lauren classification in patients with gastric carcinoma.     

Accuracy of 2D CT-Based Measurements of Rotational Alignment of the Femoral Component for Total Knee Arthroplasty

PurposeWe aimed to investigate the accuracy of two-dimensional computed tomography (2D-CT)-based methods for measuring rotational alignment of the femoral component during total knee arthroplasty in comparison to reference values for three-dimensional (3D) reconstruction.Materials and MethodsWe selected the “most protruding transepicondylar axis section,” “most protruding posterior condylar line section,” and “distal femoral cut section” on 2D-CT images for 100 knees. We investigated posterior condylar angle (PCA) and condylar twist angle (CTA) values using three different methods on 2D-CT and compared to these values to those obtained using a 3D model.ResultsThe mean PCA and CTA values were 2.8° and 7.0° on the 3D model and 2.0° to 2.1° and 5.9° to 6.0° on 2D-CT, respectively. Errors in PCA and CTA measurement included internal rotation of 0.8° and 1.1° with the 1-plane and 2-plane methods and 0.9° and 1.0° with the assumed resection method, respectively.ConclusionMean errors in PCA and CTA values measured using three different methods on 2D-CT were not significantly different. However, PCA and CTA values measured on 2D-CT were approximately 1° smaller than their 3D values. Thus, we suggest that adding 1° to the mean PCA and CTA values obtained from a single plane of 2D-CT would provide values similar to those obtained from 3D reconstruction.     

Significance for the diagnosis of iron overload of histochemical and chemical iron in the liver of control subjects

Storage iron was examined in surgical liver biopsy specimens in 43 haematologically normal and otherwise healthy adult individuals. These patients had no history of unphysiological iron losses nor of unphysiological iron intake. Histochemical iron was estimated in parenchymal and Kupffer cells and graded from 0 to 4+. Stainable iron of grade 1+ or more was present in parenchymal cells in 23 of the 27 men. Six of them had a 3+ grade. In nine cases iron was also visible in Kupffer cells. Visible iron was absent in most of the menstruating women. The mean total nonhaemin iron concentration for the male group was 80·2 (19·4 to 227·0), for the postmenopausal women 50·7 (19·3 to 106·6), and for the menstruating women 23·5 (5·5 to 65·9) mg./100 g. dry weight. The mean value for the women was significantly lower than the mean value for the men. There was a significant correlation between the histochemical grades of iron and chemically determined nonhaemin iron, but the degree of overlapping was considerable.     

Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study

Introduction

The effect of cardiovascular disease (CVD) prevention measures aimed at elderly patients requires further evidence. We investigated the effect of statin treatment (targeted to achieve guideline goals) on CVD outcomes in different age groups to determine whether statins are more beneficial in the elderly.

Material and methods

The primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study (n = 1,600 patients with established coronary heart disease (CHD), mean follow-up 3 years) was the absolute and relative CVD event (a composite of death, myocardial infarction, revascularization, unstable angina, heart failure and stroke) risk reduction in age quartiles (each n = 200). Patients on “structured care” with atorvastatin (n = 800) followed up by the university clinic and treated to lipid goal were compared with the corresponding quartiles on “usual care” (n = 800) followed up by specialists or general practitioners of the patient''s choice outside the hospital.

Results

In the elderly (mean age 69 ±4 and 70 ±3 years in the “structured” and “usual care”, respectively) the absolute CVD event reduction between “structured” and “usual care” was 16.5% (p < 0.0001), while in the younger patients (mean age 51 ±3 years and 52 ±3 years in the “structured” and “usual care”, respectively) this was 8.5% (p = 0.016); relative risk reduction (RRR) 60% (p < 0.0001) vs. 42% respectively (p = 0.001). The elderly had higher rates of chronic kidney disease and higher uric acid levels, plus an increased prevalence of diabetes, metabolic syndrome and non-alcoholic fatty liver disease. These factors might contribute to the increased CVD risk in older patients.

Conclusions

All age groups benefited from statin treatment, but the elderly on “structured care” had a greater absolute and relative CVD risk reduction than the younger patients when compared with the corresponding patients assigned to “usual care”. These findings suggest that we should not deprive older patients of CVD prevention treatment and lipid target achievement.     

Effects of ad libitum food intake,insufficient sleep and weekend recovery sleep on energy balance

Study ObjectivesInsufficient sleep is believed to promote positive energy balance (EB) and weight gain. Increasing weekend sleep duration to “recover” from weekday sleep loss is common, yet little is known regarding how weekend recovery sleep influences EB. We conducted a randomized controlled trial to assess how: (1) 2 days and 8 days of insufficient sleep and (2) ad libitum weekend recovery sleep impact EB (energy intake [EI] – energy expenditure [EE]).MethodsFollowing ten baseline days with 9 h per night sleep opportunities, participants completed one of three 10-day experimental protocols with ad libitum EI: control (9 h sleep opportunities; n = 8; 23 ± 5 years [mean ± SD]); sleep restriction (SR; 5 h sleep opportunities; n = 14; 25 ± 5 years); sleep restriction with weekend recovery sleep (SR + WR; 5 days insufficient sleep, 2 days ad libitum weekend recovery sleep, 3 days recurrent insufficient sleep; n = 14; 27 ± 4 years).ResultsTwenty-four hour EB increased (p < 0.001; main effect) by an average of 797.7 ± 96.7 (±SEM) kcal during the 10-day experimental protocol versus baseline with no significant differences between groups. Percent change from baseline in 24 h-EE was higher (p < 0.05) on day 2 of insufficient sleep (SR and SR + WR groups; 10 ± 1%) versus adequate sleep (control group; 4 ± 3%).ConclusionsIn this between-group study, the effects of adequate sleep and insufficient sleep, with or without or weekend recovery sleep, on 24 h-EB were similar. Examining EB and body weight changes using within-subject cross-over designs and “free-living” conditions outside the laboratory (e.g. sleep extension) are needed to advance our understanding of the links between insufficient sleep, weekend recovery sleep and weight-gain.     

Prognostic relevance of adding MRI data to WHO 2016 and cIMPACT‐NOW updates for diffuse astrocytic tumors in adults. Working toward the extended use of MRI data in integrated glioma diagnosis

Assess the contribution of preoperative MRI data in improving grading of adult astrocytomas reclassified according to the WHO 2016 and cIMPACT‐NOW update 3. Retrospective unicentric cohort study of 679 adult patients treated for newly diagnosed diffuse astrocytic and oligodendroglial tumors (January 2006–December 2016). We first systematically compared radiological (contrast enhancement present [CE+] vs. absent [CE−]) and histopathological findings (microvascular proliferation present [MPV+] vs. absent [MPV−]) to validate whether this comparing step of neoangiogenesis represents an efficient method to appreciate the representativity of the tumoral sampling. We focused on 629 cases of astrocytomas for radio‐histological integrated analyses. In 598 cases (95.1%), neoangiogenesis evaluated by MRI or histology (CE+/MPV+ or CE−/MPV−) was identical. For the CE+/MPV− and CE−/MPV+ groups (23 cases), the radio‐histological face‐to‐face evaluation allowed us to assess that for 13 cases (56.5%) the reason for this discrepancy was an undersampled tumor. We analyzed the group of CE+/MPV− (n = 8) and CE−/MPV+ (n = 2) in verified image‐guided tumoral samples. Finally, we identified three new prognostic subgroups for molecular glioblastomas: (1) “non‐representative sampling” (n = 9), (2) “Non neoangiogenic glioblastoma at the time of diagnosis, without contrast enhancement and microvascular proliferation” (n = 8), and (3) “contrast enhancing glioblastoma but without microvascular proliferation in a representative sample” (n = 4). Neoangiogenesis processes should be assessed to improve the prognosis accuracy of the current integrated diagnosis. We suggest adding imaging analyses during the neuropathological analysis of astrocytomas in adults.     

Prone versus Barts “flank-free” modified supine percutaneous nephrolithotomy: a match-pair analysis

Background/aimIn this study, we aimed to compare the results of prone and Barts “flank-free” modified supine percutaneous nephrolithotomy (PCNL) operations in our clinic.Materials and methods The data from patients that underwent Barts “flank-free” modified supine PCNL (BS-PCNL) (n = 52) between June 2018 and July 2020 and prone PCNL (P-PCNL) (n = 286) between April 2014 and June 2018 were retrospectively evaluated. Of those 286 patients, 104 patients whose sex, age, body mass index, American Society of Anesthesiology score, stone localization, stone size, and hydronephrosis matched the BS-PCNL group in a 1:2 ratio were included in the study. The groups were compared in terms of intraoperative outcome, complication rates, and stone-free rates.Results The mean age of all patients (58 females, 98 males) included in the study was 41.8 ± 15.2 years, and the mean body mass index (BMI) was 24.7 ± 2.9 kg/m2. The mean operation time was significantly shorter in the BS-PCNL group than in the P-PCNL group (80.2 ± 15.1 min vs. 92.4 ± 22.7 min and p = 0.01). There was no significant difference between the two groups in terms of fluoroscopy time, intraoperative complications, postoperative complications, and stone-free rates.Conclusion Our study shows that BS-PCNL is an effective and safe method that significantly reduces the operation time and should be considered as one of the primary treatment options for patients scheduled for PCNL.     

A Topographic Study of Minicolumnar Core Width by Lamina Comparison between Autistic Subjects and Controls: Possible Minicolumnar Disruption due to an Anatomical Element In‐Common to Multiple Laminae

Radial cell minicolumns are basic cytoarchitectonic motifs of the mammalian neocortex. Recent studies reveal that autism is associated with a “minicolumnopathy” defined by decreased columnar width and both a diminished and disrupted peripheral neuropil compartment. This study further characterizes this cortical deficit by comparing minicolumnar widths across layers. Brains from seven autistic patients and an equal number of age‐matched controls were celloidin embedded, serially sectioned at 200 µm and Nissl stained with gallocyanin. Photomicrograph mosaics of the cortex were analyzed with computerized imaging methods to determine minicolumnar width at nine separate neocortical areas: Brodmann Area''s (BA) 3b, 4, 9, 10, 11, 17, 24, 43 and 44. Each area was assessed at supragranular, granular and infragranular levels. Autistic subjects had smaller minicolumns whose dimensions varied according to neocortical area. The greatest difference between autistic and control groups was observed in area 44. The interaction of diagnosis × cortical area × lamina (F _16,316 = 1.33; P = 0.175) was not significant. Diminished minicolumnar width across deep and superficial neocortical layers most probably reflects involvement of shared constituents among the different layers. In this article we discuss the possible role of double bouquet and pyramidal cells in the translaminar minicolumnar width narrowing observed in autistic subjects.     

The relationship between sleep quality and dyspnoea severity in patients with COPD

ObjectivesThis study aimed to determine sleep quality, frequency and severity of dyspnoea in COPD patients and to evaluate the relationship between dyspnoea severity and sleep quality.MethodThe sample of the study consisted of 110 patients admitted to the Chest Diseases polyclinic of a private hospital and diagnosed as COPD for at least one year. The data of the study were collected using the “Individual Information Form”, “COPD and Asthma Sleep Scale (CASIS)” and “Medical Research Council (MRC) Dyspnoea Scale”.ResultsIt was found that 6.4% of the patients did not experience dyspnoea, 34.5% had mild, 40.9% had moderate, and 18.2% had severe dyspnoea. The mean CASIS score of the patients without dyspnoea was 29.08±7.83, with mild dyspnoea was 40.22±9.30, with moderate dyspnoea was 50.31±8.97 and with severe dyspnoea was 56.96±13.13. There was a statistically significant difference between dyspnoea severity and mean CASIS score (p=0.001). Correlation analysis between MRC dyspnoea scale and CASIS score showed a significant positive correlation (r=0.61 p=0.001).ConclusionIt was concluded that the majority of COPD patients had moderate or poor sleep quality and dyspnoea. As dyspnoea severity increases, sleep quality decreases.     

Blood monocyte activation in rheumatoid arthritis: increased monocyte adhesiveness, integrin expression, and cytokine release

Infiltration of the synovium by mononuclear cells, namely lymphocytes and monocytes, is one of the main features of rheumatoid arthritis (RA) and is considered to be responsible for the development of the disease. In this study in 31 consecutive patients with RA, we investigated whether peripheral blood monocytes exhibited markers of cellular activation related to cell migration. Using flow cytometry with the respective specific antibodies, we studied the expression of integrins CD11a, CD11b, CD11c, CD49d (VLA-4), and CD49e (VLA-5) on monocytes from patients with RA and from normal (N) subjects. IL-1β, IL-6, and tumour necrosis factor-alpha (TNF-α) production by cultured monocytes was measured by immunoassay. Adhesiveness of monocytes was studied on various surfaces (plastic, human fibronectin, gelatin-coated plasma, subendothelial matrix) and on cultured endothelial cells under basal conditions or after stimulation by IL-1β. An increased number of CD14⁺ monocytes (Mo) from RA patients expressed the CD11b molecule (RA Mo = 90·3%, N Mo = 83·4%, P < 0·005). The expression of CD11b on CD14⁺ monocytes was significantly increased in RA patients (median fluorescence intensity (FI): RA Mo = 145 (range 80–466) units; normal Mo = 95 (range 24–164) units; P < 0·003). Production of extracellular IL-1β and IL-6 by RA monocytes was significantly enhanced compared with monocytes from normal subjects (IL-1β: RA = 2·65 ± 0·91 ng/ml versusN = 1·35 ± 0·85 pg/ml, P < 0·05; IL-6: RA = 4·83 ± 0·90 ng/ml versusN = 2·40 ± 0·95 ng/ml, P < 0·05). Compared with normal monocytes, RA monocytes exhibited increased adhesion to the various surfaces studied (plastic, P < 0·01; fibronectin, P < 0·01; and gelatin-coated normal or RA plasma, P < 0·01) as well as to unstimulated (P < 0·01) and IL-1β-stimulated endothelial cells (IL-1β for 4 h, P < 0·05; IL-1β for 24 h, P < 0·05). In our study, blood monocytes from RA patients exhibited features of activation related to cell adhesion.     

The essential oil of Hyptis crenata Pohl ex Benth. presents an antiedematogenic effect in mice

Hyptis crenata, commonly known as “salva-do-Marajó”, “hortelã-do-campo”, and “hortelãzinha”, is used in folk medicine in Northeast Brazil as tea or infusion to treat inflammatory diseases. Due to the pharmacological efficacy and the low toxicity of the essential oil of Hyptis crenata (EOHc), we decided to investigate the EOHc antiedematogenic effect in experimental models of inflammation. EOHc was administrated orally at doses of 10-300 mg/kg to male Swiss albino mice. Paw edema was induced by subcutaneous injection in the right hind paw of inflammatory stimuli (carrageenan, dextran, histamine, serotonin, and bradykinin) 60 min after administration of EOHc. EOHc significantly inhibited the induced edema. The inhibitory effect of EOHc on dextran-induced edema extended throughout the experimental time. For the 30, 100, and 300 mg/kg doses of EOHc, the inhibition was of 40.28±1.70, 51.18±2.69, and 59.24±2.13%, respectively. The EOHc inhibitory effect on carrageenan-induced edema started at 10 mg/kg at the second hour (h) and was maintained throughout the observation period. At 30, 100, and 300 mg/kg doses the inhibition started earlier, from 30 min. At the edema peak of 180 min, 56, 76, and 82% inhibition was observed for 30, 100, and 300 mg/kg doses, respectively. Additionally, the effect of EOHc on carrageenan-induced paw edema was influenced by the time of administration. The EOHc also inhibited myeloperoxidase activity. In conclusion, the EOHc showed a potent effect, both preventing and reversing the edema, consistent with its anti-inflammatory use in folk medicine.     

Prediction of lymphovascular space invasion in patients with endometrial cancer

Objective: Predict the presence of lymphovascular space invasion (LVSI), using uterine factors such as tumor diameter (TD), grade, and depth of myometrial invasion (MMI). Develop a predictive model that could serve as a marker of LVSI in women with endometrial cancer (EC).Methods: Data from 888 patients with endometrioid EC who were treated between January 2009 and December 2018 were reviewed. The patients'' data were retrieved from six institutions. We assessed the differences in the clinicopathological characteristics between patients with and without LVSI. We performed logistic regression analysis to determine which clinicopathological characteristics were the risk factors for positive LVSI status and to estimate the odds ratio (OR) for each covariate. Using the risk factors and OR identified through this process, we created a model that could predict LVSI and analyzed it further using receiver operating characteristic curve analysis.Results: In multivariate logistic regression analysis, tumor size (P = 0.027), percentage of MMI (P < 0.001), and presence of cervical stromal invasion (P = 0.002) were identified as the risk factors for LVSI. Based on the results of multivariate logistic regression analysis, we developed a simplified LVSI prediction model for clinical use. We defined the “LVSI index” as “TD×%MMI×tumor grade×cervical stromal involvement.” The area under curve was 0.839 (95% CI= 0.809-0.869; sensitivity, 74.1%; specificity, 80.5%; negative predictive value, 47.3%; positive predictive value, 8.6%; P < 0.001), and the optimal cut-off value was 200.Conclusion: Using the modified risk index of LVSI, it is possible to predict the presence of LVSI in women with endometrioid endometrial cancer. Our prediction model may be an appropriate tool for integration into the clinical decision-making process when assessed either preoperatively or intraoperatively.     

Reduction of serum cholesterol and blood pressure in hypertensive patients by behaviour modification

In a pilot study, 14 pharmacologically treated hypertensive patients were given training in psychophysical relaxation exercises, reinforced by biofeedback instruments, for six weeks. The patients were asked to practise twice a day and also incorporate the exercises into everyday activities. In spite of their unchanged drug schedule, their mean blood pressure (B.P.) was reduced from 170·6/102·5 to 147·9/89·14 (P = < ·001) while their mean (± S.D.) serum cholesterol level was reduced from 241·6 ± 39·19 to 217·1 ± 38·12 mg/100 ml (P = < ·001). I believe the possibility of one therapy which can reduce two risk factors at the same time should be explored further in a controlled study.