bluuebunny/crossref_metadata_2025 huggingface dataset:
Feelings of Professional Fulfilment and Exhaustion in Mental Health Personnel: The Importance of Organisational and Individual Factors
Authors: Thomsen Sarah , Soares Joaquim , Nolan Peter , Dallender Janie , Arnetz Bengt
Published: April 2003

Background: Mental health personnel are at high risk for mental illness, burnout and suicide. Previous studies of this group of professionals have indicated the importance of organisational factors in explaining burnout, or exhaustion, and work satisfaction. This study looks more systematically at the contribution of organisational and individual factors to work-related exhaustion and to professional fulfilment, an expanded version of job satisfaction. Methods: A cross-sectional study of 1, 051 psychiatrists and mental health nurses in the city of Stockholm was carried out by postal questionnaire with a previously validated instrument. Multiple and logistic regressions were used to identify predictors of exhaustion and professional fulfilment. Results: Organisational characteristics were found to be more important than individual characteristics in predicting exhaustion and professional fulfilment in mental health professionals. Conclusions: The results indicate that the psychosocial work environment and well-being of mental health professionals can be improved by concentrating on organisational factors such as efficiency, personal development and goal quality.
Evaluation of Some Criteria Used to Select Patients for Brief Psychodynamic Therapy
Authors: Sigal John J. , Paris Joel , Kardos Marianne , Zimmerman Gilbert , Buonvino Michael
Published: April 2003

Background and Objectives: The effectiveness of brief psychotherapy is established, but criteria for the selection of patients remain elusive. This study examines the usefulness of some widely used criteria for the selection of patients for brief psychodynamic therapy (BPT). Methods: A checklist of 39 criteria often used in a teaching hospital to screen patients for BPT was constructed. Scores derived from a principal components analysis of this checklist provided one set of predictor criteria. A second measure was derived from the consensual agreement of the independent ratings by 3 prominent advocates of BPT. A third predictor was derived from a similar analysis of items from the checklist on which consensual agreement for their relevance was obtained from the independent ratings of 23 BPT teachers in 16 university-affiliated hospitals. Reliable chart-based ratings of improvement in symptoms, increased insight, and improvement in general functioning of a convenience sample of 43 patients treated with BPT in the outpatient clinic of a teaching hospital served as outcome measures. Results: No correlation between any of the derived predictors and any of the measures of outcome was significant after a Bonferroni correction. Conclusion: Teachers and clinicians still do not have good criteria for the selection of patients who will benefit from BPT. Exclusion of severe behavior disorders may, however, improve outcome rates by more than 15%.
Factors Associated with Alexithymia in Patients Suffering from Depression
Authors: Honkalampi Kirsi , Saarinen Pirjo , Hintikka Jukka , Virtanen Vuokko , Viinamäki Heimo
Published: April 2003

Background: We studied the factors associated with alexithymia in 137 depressed outpatients. Methods: Diagnosis of depression was confirmed by means of the Structured Clinical Interview for DSM-III-R. Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale. Severity of depression was assessed using the 21-item Beck Depression Inventory, and other psychiatric symptoms with the help of the Symptoms Checklist (SCL-90). Life satisfaction was also assessed with a structured scale. Results: Almost half of the patients were considered alexithymic. They were significantly more often male, unmarried and had a lower education than the nonalexithymic patients. Alexithymic patients more often showed psychiatric symptoms (SCL-90) and were also more often severely depressed and dissatisfied with their life than were the other patients. Logistic regression analyses revealed that four factors were independently associated with alexithymia: male gender, a low level of education, low life satisfaction and severe depression. Sleep disturbances were independently associated with alexithymia in men and severe depression in women. Conclusions: Alexithymia is very common among patients with depressive disorder. An awareness of these risk factors would be useful in improving the efficacy of treatment.
An Exploratory Investigation into Types of Adult Homesickness
Authors: van Tilburg Miranda A.L. , Eurelings-Bontekoe Elisabeth H.M. , Vingerhoets Ad J.J.M. , van Heck Guus L.
Published: April 2003

Background: It is not clear yet whether or not homesickness is a singular syndrome. Some authors have proposed different subtypes or forms of homesickness. Since there may be great differences between various subtypes of homesickness regarding etiology, causes, manifestations and consequences, a distinction of subtypes may have far-reaching implications for research and therapy. This exploratory study was conducted to find out whether homesickness can be considered a homogeneous syndrome, or whether there are distinct subtypes that differ in etiology, severity of the condition and manifestations. Method: Thirty-one individuals, who have had severe homesickness experiences, were interviewed, and verbal scripts were typed out. Twenty-four interviews were suited for analyses. All text related to the topics most relevant to the purpose of the study was extracted. The text was first analyzed searching for meaning and categories and afterwards coded and used in a HOMALS analysis. Results: The HOMALS analysis yielded two dimensions. The first dimension can be described as a dimension of psychopathology differentiating ‘recovered’ and recurrent homesickness. The second dimension was strongly dominated by homesickness during holidays. Conclusions: It seems that there are reasons to presume the existence of at least two subtypes of homesickness: (1) recurrent homesickness related to signs of psychopathology and recurrent homesickness experiences and (2) recovered homesickness, which can be considered as a normal adjustment problem which most people overcome. Very tentatively, a third type of homesickness might be distinguished: holiday homesickness, which is associated with difficulties in breaking with old routines. Consequences for research and therapy are discussed. Furthermore, the need of validation studies is underlined.
Psychological and Physiological Reactivity to Stress: An Experimental Study on Bulimic Patients, Restrained Eaters and Controls
Authors: Tuschen-Caffier Brunna , Vögele Claus
Published: April 2003

Background: Binge eating behavior in bulimic patients is thought to play a crucial role in the regulation of psychophysiological arousal in stressful situations. Previous results suggest that interpersonal stress and achievement challenge are perceived as particularly stressful by bulimic individuals. It is not clear, however, whether bulimic individuals respond to stress with an increased desire to binge, and whether this increase is accompanied by higher psychophysiological reactivity compared to healthy controls. Methods: Twenty-seven patients with bulimia nervosa (DSM-IV), 27 restrained eaters, and 27 controls participated in two experimental sessions in which continuous measures of heart rate, blood pressure, respiration rate, and electrodermal activity were monitored under conditions of achievement challenge (mental arithmetic, Stroop test) and interpersonal stress provoking feelings of loneliness and social rejection (film, imagery task). Ratings of desire to binge, negative mood, and hunger were obtained between experimental trials. Groups were matched for age and body mass index. Results: There was a marked difference in subjective ratings during interpersonal stress. Bulimic patients responded to the imagery task with increases in both desire to binge and hunger, whereas restrained eaters and controls showed no change. There were no substantial group differences in psychophysiological reactivity. Conclusions: The dissociation between emotional responses and physiological activation may have important therapeutic implications.
Cognitive Dysfunctions in Bipolar Disorder: Evidence of Neuropsychological Disturbances
Authors: Martínez-Arán Anabel , Vieta Eduard , Colom Francesc , Reinares María , Benabarre Antoni , Gastó Cristòbal , Salamero Manel
Published: April 2003

Although cognitive dysfunctions in psychosis have classically been associated with schizophrenia, there is clinical evidence that some bipolar patients show cognitive disturbances either during acute phases or in remission periods. The authors critically review the data on cognitive impairment in bipolar disorder. The main computerized databases (Medline, Psychological Abstracts, Current Contents) have been consulted crossing the terms ‘cognitive deficits’, ‘neuropsychology’, ‘intellectual impairment’, ‘mania’, ‘depression’ and ‘bipolar disorder’. Changes in the fluency of thought and speech, learning and memory impairment, and disturbances in associational patterns and attentional processes are as fundamental to depression and mania as are changes in mood and behavior. Moreover, a significant number of bipolar patients show persistent cognitive deficits during remission from affective symptoms. However, there are several methodological pitfalls in most studies such as unclear remission criteria, diagnostic heterogeneity, small sample sizes, absence of longitudinal assessment, practice effect and poor control of the influence of pharmacological treatment. Most studies point at the presence of diffuse cognitive dysfunction during the acute phases of bipolar illness. Most of these deficits seem to remit during periods of euthymia, but some of them may persist in approximately one third of bipolar patients. Methodological limitations warrant further research in order to clear up the relationship between neuropsychological functioning and clinical, demographic and treatment variables in bipolar disorder.
Cognitive Behavior Therapy versus Supportive Therapy in Social Phobia: A Randomized Controlled Trial
Authors: Cottraux Jean , Note Ivan , Albuisson Eliane , Yao Saï Nan , Note Brigitte , Mollard Evelyne , Bonasse Françoise , Jalenques Isabelle , Guérin Janine , Coudert André Julien
Published: April 2003

Background: The efficacy of cognitive behaviour therapy (CBT) in social phobia has been demonstrated in several controlled trials and meta-analyses, but no comparison of CBT with supportive therapy (ST) can be found in the literature. Method: The aim of the trial was to study the effectiveness of CBT versus ST carried out ‘as usual’. Sixty-seven DSM-4 social phobic patients (89% generalized subtype, most with avoidant personality) were randomly allocated into two groups. Group 1 (CBT) received 8 1-hour sessions of individual cognitive therapy (CT) for 6 weeks, followed by 6 2-hour sessions of social skills training (SST) in group weekly. Group 2 received ST for 12 weeks (6 half-hour sessions), then the patients were switched to CBT. All patients agreed not to take any medication during the whole trial. In group 1, 29 patients reached week 6, 27 reached week 12, and 24 weeks 36 and 60 (endpoint). In group 2, 29 patients reached week 6, 28 reached weeks 12 and 18, 26 week 24, and 23 reached weeks 48 and 72 (endpoint). Results: At week 6, after CT, group 1 was better than group 2 on the main social phobia measure. At week 12, after SST, group 1 was better than group 2 on most of the measures and demonstrated a significantly higher rate of responders. This finding was replicated after switching group 2 to CBT. Sustained improvement was observed in both groups at follow-up. Compliance with abstinence from medication increased over time. Conclusions: CBT was more effective than ST and demonstrated long-lasting effects. This may suggest that social phobia management requires more than a simple and inexpensive psychological intervention.
Assessing Somatization in Functional Gastrointestinal Disorders: Integration of Different Criteria
Authors: Porcelli Piero , De Carne Massimo , Fava Giovanni A.
Published: April 2003

Background: Psychiatric assessment of somatization (the tendency to experience and communicate psychological distress in the form of physical symptoms and to seek medical help for them) currently rests on DSM criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. The aim of this study was to compare these new criteria (Diagnostic Criteria for Psychosomatic Research, DCPR) with DSM-IV in a population where a high prevalence of psychosocial problems is expected (functional gastrointestinal disorders, FGID). Method: One hundred and ninety consecutive patients with FGID in a tertiary care center were assessed according to DSM-IV and DCPR criteria. Results: The number of the 12 DCPR diagnoses was almost double that of DSM diagnoses. Only 9% of the patients were not identified by DCPR criteria, whereas this occurred in 25% of patients using DSM criteria. While patients who were given a DSM diagnosis frequently had additional DCPR diagnoses, many patients with DCPR syndromes did not fulfill any DSM criteria. Four DCPR syndromes appared to be particularly frequent and accounted for almost three quarters of the total diagnoses (alexithymia, persistent somatization, functional symptoms secondary to a psychiatric disorder, demoralization). Conclusions: The joint use of DSM and DCPR criteria was found to improve the identification of psychological factors in FGID. The results may pave the way for changes in DSM classification of somatoform disorders.
Antonovsky’s Sense of Coherence: Trait or State?
Authors: Schnyder Ulrich , Büchi Stefan , Sensky Tom , Klaghofer Richard
Published: April 2003

Background: The aim of this study was first to analyze the stability of Antonovsky’s Sense of Coherence (SOC) as a measure of a person’s world view over time; secondly, to investigate its relationship with depression and anxiety. Methods: Data from two longitudinal studies were used: a study of severely injured accident victims (n = 96), and a study of patients suffering from rheumatoid arthritis (RA, n = 60). The 13 items short version of the SOC scale and measures of depression and anxiety (Symptom Checklist, Hospital Anxiety and Depression Scale) were administered repeatedly over 6–12 months in both studies. Results: In the sample of accident victims, a significant decrease in the SOC mean score was observed during the first half year after the accident. During the same time period, symptoms of anxiety and depression decreased significantly. In the second half year after the accident, SOC as well as measures of psychopathology remained stable. RA patients showed high stability of SOC and measures of anxiety and depression over time. In both samples, between-time correlations of SOC scores were high (r ≥ 0.70, p < 0.01), indicating a high test-retest stability of SOC. Furthermore, in both samples, significant negative correlations of a moderate to high degree (r = –0.28 to –0.73, p < 0.01) were found between SOC and measures of anxiety and depression. Conclusions: SOC can be seen as a relatively stable (trait) measure. However, traumatic events such as life-threatening accidents may change a person’s world view and thus their SOC, even if psychiatric symptoms abate. This suggests that SOC is not merely a proxy measure of psychopathology, but rather a partially independent, general measure of a person’s world view.
Is Alexithymia a Permanent Feature in Depressed Patients?
Authors: Honkalampi Kirsi , Hintikka Jukka , Saarinen Pirjo , Lehtonen Johannes , Viinamäki Heimo
Published: April 2003

Background: A six-month follow-up study was conducted to determine whether alexithymia is a permanent feature in 169 depressed outpatients. Methods: Diagnosis of depression was confirmed by means of the Structured Clinical Interview for DSM-III-R (SCID-I). Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale (TAS-20) and severity of depression was assessed using the 21-item Beck Depression Inventory (BDI). Results: Almost 40% of the patients were considered alexithymic at baseline, but only 23% at follow-up. Alexithymic patients were more often moderately or severely depressed than other patients in both study phases. The BDI scores explained 23% (at baseline) and 42% (at follow-up) of the variation in TAS-20 scores. The decrease in the TAS-20 scores was associated with a concurrent decrease in BDI scores. Conclusions: Alexithymic patients with depressive disorders do not appear to form a stable group. On the contrary, alexithymia seems to change as a function of depression. In the light of these results, alexithymia appears not to be a stable personality trait among depressed patients, and furthermore, it seems possible that alexithymic features respond to psychiatric treatment.
Respiratory Quotient in Patients with Non-Insulin-Dependent Diabetes mellitus Treated with Insulin and Oral Hypoglycemic Agents
Authors: Nakaya Yutaka , Ohnaka Masaharu , Sakamoto Sadaichi , Niwa Yasuharu , Okada Kazuko , Nomura Masahiro , Hara Tsutomu , Kusonoki Masataka
Published: April 2003

The respiratory quotient (RQ) reflects the amount of energy derived from carbohydrate as apposed to fat metabolism. To assess the metabolic state of patients with non-insulin-dependent diabetes mellitus, the RQ was measured five times a day (at 09.00, 11.00, 13.00, 14.00, and 17.00 h) in 20 healthy subjects and 60 diabetic patients. Diabetic patients treated with insulin or sulfonylurea showed significantly higher RQ values than normal subjects and nontreated diabetic patients. Diabetic patients without treatment showed higher glucose levels, and their RQ values were significantly lower than those of treated patients. There was a significant inverse correlation between RQ and blood glucose levels at 11.00 h (r = –0.361, p < 0.01) in diabetic patients, but no significant relation with HbA1c. Treated diabetic patients with a higher body mass index tended to show a higher RQ than those with a lower one (r = –0.269, p = 0.083). Within 1 year, 7 of 13 patients, who had RQ > 1.0, gained more than 3 kg, while only 5 of the remaining 32 treated diabetic patients gained more than 3 kg (p < 0.05). This demonstrates that diabetic patients with a higher RQ tended to gain weight despite the use of insulin or oral hypoglycemia agents. The RQ increased by infusing both insulin and glucose in normal subjects. These results suggest that a high RQ results from excess insulin and excess food. The RQ is a good predictor of weight gain in diabetic patients treated with either insulin or oral hypoglycemic agents.
Low-Density Lipoprotein Size in Primary Hypothyroidism
Authors: Roscini Anna Rita , Lupattelli Graziana , Siepi Donatella , Pagliaricci Sergio , Pirro Matteo , Mannarino Elmo
Published: April 2003

Background/Aim: Hypothyroidism is associated with abnormalities in lipid metabolism but its effect on LDL size is not known. This study identified the LDL particle size (pattern ‘A’ or ‘B’) in a group of 50 postmenopausal women with primary hypothyroidism before and after 2 months of hormone replacement therapy (HRT) with the aim of establishing whether hypothyroidism is associated with an increased frequency of pattern B LDL compared with healthy controls, and whether euthyroid recovery modified LDL size. Methods: Lipid parameters (total cholesterol, triglycerides, HDL- and LDL-cholesterol, apoprotein AI and B and lipoprotein(a)) were determined in a blood sample from each patient and control. LDL size was determined by gradient gel electrophoresis. Determinations were done before and after 2 months of HRT (75–150 μg L-tiroxina/daily) in patients and once in controls. Results/Conclusions: No significant difference emerged in pattern B LDL distribution: 16% in patients and 18% in controls (p = NS). After HRT no statistical variations were observed in LDL size. HRT normalized all other lipid parameters except lipoprotein(a). In conclusion, the increased risk of coronary heart disease assumed to be associated with hypothyroidism is not linked with the presence of pattern B LDL, but rather with concomitant metabolic abnormalities.
Substituting Enzymatically Interesterified Butter for Native Butter Has No Effect on Lipemia or Lipoproteinemia in Man
Authors: Christophe Armand B. , De Greyt Wim F. , Delanghe Joris R. , Huyghebaert André D.
Published: April 2003

The aim of this study was to determine whether substituting enzymatically interesterified butter for native butter in the usual diet affects lipid and lipoprotein levels in man. Parameters studied were serum total cholesterol, LDL-cholesterol, HDL-cholesterol, free cholesterol, phospholipids, triglycerides, apoA1 and apoB and the fatty acid composition of serum triglycerides, free fatty acids, phospholipids and cholesterol esters. Subjects were healthy volunteers and a controlled design was used. The only mathematically significant difference found when interesterified butter was substituted for butter was an about 7% lower fraction of oleic acid in the serum cholesterol esters (p = 0.005). In contrast to an earlier study where chemically interesterified butter fat was substituted for native butter, no indications are found in this study that replacing native butter by enzymatically interesterified butter, in amounts normally consumed, may have any beneficial effect on health.
Lower Absorption of Cholesteryl Oleate in Rats Supplemented with Areca catechu L. Extract
Authors: Jeon Seon-Min , Kim Hee-Sook , Lee Taehoon G. , Ryu Sung-Ho , Suh Pann-Ghill , Byun Sung-June , Park Yong Bok , Choi Myung-Sook
Published: April 2003

Areca catechu L. extracts I and II, prepared using two different solvent systems, exhibited strong inhibitory activities against pancreatic cholesterol esterase (pCEase) in vitro. To determine their cholesterol-lowering effects, these two extracts were investigated by analyzing plasma lipid levels, intestinal enzyme activities, and the absorption of cholesteryl oleate. For 6 days, male rats were fed a diet containing cholesteryl oleate (0.5 g/100 g of body weight) either with or without the Areca nut extract supplements. The supplementation of the two Areca nut extracts significantly lowered the concentrations of plasma cholesterol by 13.4 and 11.7% and plasma triglycerides by 35.0 and 36.9%, respectively, compared with the pre-experimental values. However, when the cholesteryl oleate diet was fed without any Areca nut extract in high-cholesterol control, the plasma cholesterol and triglyceride concentrations significantly increased by 13.6 and 15.9%, respectively, compared with the pre-experimental values. After 6 days of treatment, the intestinal pCEase activities were significantly lower in the groups supplemented with the Areca nut extracts (37.8 and 26.5%) than in the group with no extract supplement (83.2%). The supplements also significantly elevated the excretion of [1,2(n)-3H]cholesteryl oleate administered orally, when determined by the large intestinal contents, 930.5 Bq/day (Areca I) and 1,766.3 Bq/day (Areca II) vs. 98.1 Bq/day (high-cholesteryl oleate (CO) control). The inhibition of pCEase activity with the supplementation of the Areca nut extracts could account for the decrease in [1,2(n)-3H]cholesteryl oleate absorption that resulted in decreased radioactivity in blood.
Remarkable Removal of Beta-2-Microglobulin by On-Line Hemodiafiltration
Authors: Lornoy Willy , Becaus Ignace , Billiouw Jean-Marie , Sierens Luc , van Malderen Paul
Published: April 2003

Eight chronic, anuric hemodialysis patients were randomly treated with a high-flux polysulphone dialyzer (F80), using 6 different modes: conventional bicarbonate hemodialysis (HD), hemodiafiltration (HDF) with a replacement solution at 40, 60, 80 or 100 ml/min in postdilution and 80 ml/min in predilution. The differences in β2-microglobulin (β2M) reduction ratio and clearance were evaluated statistically by analysis of variance (ANOVA). Both studies revealed no significant difference between HD and HDF40 in postdilution, but an increasing significant difference from HDF60 to HDF100 in postdilution and with HDF80 in predilution. The mean reduction ratio ranged from 49.7 (HD) to 72.7% (HDF 100 ml/min), showing an overall statistically significant difference (p = 0.0000). For the clearance, the range was between 63.8 (HD) and 116.8 ml/min (HDF 100 ml/min) (p = 0.0000). β2M in the effluent dialysate with HDF100 ml/min reached up to a mean of 258 mg/session. Concerning small molecules (BUN, creatinine and P), there was a statistically significant different clearance for creatinine and especially for P with HDF 100 ml/min. Conclusion: HDF with an on-line replacement solution at 100 ml/min and a high-flux and biocompatible polysulphone membrane represents a new tool for enhanced removal of β2M. Besides a significant increase in creatinine and especially in phosphorus clearance is noted.
Predictive Value of Functional Status for Mortality in Patients on Maintenance Hemodialysis
Authors: Ifudu Onyekachi , Paul Henry R. , Homel Peter , Friedman Eli A.
Published: April 2003

In patients receiving maintenance hemodialysis, laboratory indices (such as serum albumin concentration) are predominantly utilized to assess well-being, while measures of functional status are rarely applied. However, the serum albumin concentration declines with advancing age, and the mean age of patients starting maintenance hemodialysis is now over 63 years. Using a 14-level modified Karnofsky activity scale, we measured baseline functional status in 522 randomly selected hemodialysis patients and prospectively monitored them for 3 years to determine the predictive value of our modified Karnofsky score for mortality. At onset of study, serum albumin and creatinine concentrations as well as hematocrit were measured and the comorbid conditions documented. At baseline, the 522 subjects (270 women and 252 men) included 327 blacks (63%), 154 whites (29%), 31 Hispanics (6%), and 10 Asians (2%) of mean age 59 ± (SD) 15 years. The mean duration of end-stage renal disease was 4 ± 3.6 years, and the mean serum albumin concentration was 3.7 ± 0.4 g/dl. 166 (32%) of the patients died during the observation period. Cox regression analysis revealed inverse relations between mortality and both our modified Karnofsky score (p = 0.0001) and serum albumin concentration (p = 0.001). The predictive value of a low modified Karnofsky score for mortality persisted after analysis of subjects stratified according to serum albumin concentration (<4 g/dl, n = 382, p = 0.0001 vs. ≥4 g/dl, n = 140, p = 0.008). With a modified Karnofsky score (<70 vs. ≥70), the relative risk of death during the 3-year follow-up period was 1.44 (95% confidence interval 1.236, 1.675; p < 0.0001). Forward stepwise Cox regression analysis showed that advanced age (p = 0.0005), white race (p = 0.0009), diabetes mellitus (p = 0.01), and a low serum albumin concentration (p = 0.003) were independently associated with an increased risk of mortality during follow-up after adjustment for other factors. A modified Karnofsky score (p = 0.14) did not predict survival in the Cox model when other independent variables were included. We conclude that in patients with end-stage renal disease sustained on maintenance hemodialysis, a poor functional status (measured on a modified Karnofsky activity scale) is associated with early mortality. Periodic measurement of modified Karnofsky score is a simple, low-cost, and reliable means of identifying patients on dialysis at risk for early death.
Metalloproteinase-9 mRNA Expression in Monocytes from Patients with Chronic Renal Failure
Authors: Ebihara Isao , Nakamura Tsukasa , Tomino Yasuhiko , Shimada Noriaki , Koide Hikaru
Published: April 2003

Long-term dialysis patients suffer from various complications including atherosclerosis. It has been suggested that metalloproteinases (MMPs) contribute to vascular remodeling during the development and progression of human atherosclerosis. Activated human monocytes have been demonstrated to secrete MMPs.In the present study, we measured levels of MMP mRNA in peripheral blood monocytes obtained from patients on continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD) and chronic-renal-failure patients not undergoing dialysis. Twenty patients with chronic renal failure were not undergoing dialysis, 20 patients were on CAPD, 40 patients were on chronic HD and 20 healthy volunteers served as controls. We used cDNA probes encoding for MMP-1, MMP-2, MMP-3 and MMP-9 and glyceraldehyde phosphate dehydrogenase. Higher levels of MMP-9 mRNA in the peripheral blood monocytes were observed in HD patients than in CAPD patients, undialyzed chronic renal failure patients or healthy controls. MMP-9 mRNA levels at the end of HD were not significantly higher than those at the start of HD. MMP-9 mRNA levels from HD patients did not differ among the types of membranes. We could detect minimal MMP-1, MMP-2 and MMP-3 mRNA expression in monocytes from all groups. Serum gelatinase activity was detectable in all samples; however, no significant differences existed among the groups.In summary, MMP-9 mRNA expression is enhanced in monocytes from HD and CAPD patients, and the enhancement may be, in part, associated with cardiovascular complications, including atherosclerosis, in dialysis patients. This increase in monocyte MMP-9 mRNA levels is lower in CAPD patients that it is in HD patients.
Plasma Homocysteine, Vitamin B6, Vitamin B12 and Folic Acid in End-Stage Renal Disease during Low-Dose Supplementation with Folic Acid
Authors: Hong Sae-Yong , Yang Dong-Ho , Chang Sung-Keun
Published: April 2003

In order to see whether conventional low-dose folic acid supplement along with vitamin B6 and B12 reduces hyperhomocysteinemia in patients with ESRD, we compared the levels of homocysteine, vitamin B6, B12 and folic acid among 3 groups of patients: 44 ESRD patients on hemodialysis with replacement of folic acid, vitamin B6, and B12 (dialysis group); 27 chronic renal failure patients without vitamin replacement (predialysis group); and 17 hypertensive patients without vitamin replacement (control group). Mean plasma total homocysteine concentration was higher in the dialysis (15.5 ± 6.6 µmol/l) and the predialysis groups (15.7 ± 4.2 µmol/l) than in the control group (6.2 ± 1.5 µmol/l) (p < 0.001). However, there was no difference in homocysteine concentrations between the dialysis and predialysis groups. In the control and predialysis groups, the homocysteine concentration showed a reverse correlation with the concentrations of folic acid (r = 0.584, p = 0.014 for the control group; r = 0.431, p = 0.247 for the predialysis group) and vitamin B12 (r = 0.485, p = 0.049 for the control group; r = –0.562, p = 0.023 for the predialysis group) but not with vitamin B6. In conclusion, plasma folic acid concentrations were 3–4 times higher in the dialysis than in the predialysis group. But these levels of folic acid are not enough to reduce hyperhomocysteinemia in ESRD.
Continuous Venovenous Hemodiafiltration in the Treatment of Acute Hyperammonemia
Authors: Braun Michael C. , Welch Thomas R.
Published: April 2003

Acute hyperammonemia is an emergent cause of central nervous system dysfunction for which renal replacement therapy is advocated. We report the successful use of continuous venovenous hemodiafiltration in this metabolic emergency, and report the calculated ammonia clearances for both continuous venovenous hemofiltration and hemodiafiltration.
Voluntary Ingestion of Cortinarius Mushrooms Leading to Chronic Interstitial Nephritis
Authors: Calviño Jesus , Romero Rafael , Pintos Elena , Novoa Daniel , Güimil Dolores , Cordal Teresa , Mardaras Javier , Arcocha Victor , Lens XoseM. , Sanchez-Guisande Domingo
Published: April 2003

‘Magic mushrooms’ ingestion among the drug-using population has become a popular cheap way to get hallucinogenic effects which is not free of complications. One of these is acute renal failure related to Cortinarius genus intake. This one greatly resembles ‘magic mushrooms’ and confusion is possible for inexperienced collectors. We report the case of a young male ex-drug addict who developed acute tubulointerstitial nephritis after voluntary ingestion of Cortinarius orellanus. The clinical picture was preceded by a long latency period, had an insidious course without any data of hepatoxicity and evolved to a chronic state. Renal biopsy showed nonspecific histopathological findings. In summary, it is important to bear this possibility in mind when facing an acute tubulointerstitial nephritis of unknown origin in a drug-taking patient.
Prevalence of Microalbuminuria and Relationship to the Risk of Cardiovascular Disease in the Japanese Population
Authors: Tomura Shigeo , Kawada Kenichi , Saito Keiko , Lin Yu-Lin , Endou Kazue , Hirano Chiaki , Yanagi Hisako , Tsuchiya Shigeru , Shiba Kiyoko
Published: April 2003

The prevalence of microalbuminuria and its relationship to cardiovascular disease risk factors were examined in subjects participating in an annual physical and laboratory examination program. The urinary albumin concentration and the urinary albumin/creatinine ratio were determined in morning urine specimens. A turbidimetric immunoassay was used for the measurement of urinary albumin. Of the 731 subjects, 41 (5.6%) who were weakly positive or positive on a routine dipstick test for protein were excluded from the final analysis of data. Microalbuminuria was present in 14.5% of the men, in 12.4% of the women, and in 13.2% of the entire subject population when defined as a urinary albumin concentration of 30–299 μg/ml. The prevalence of microalbuminuria was significantly higher in subjects with a high normal blood pressure (15.0%) or hypertension (26.2%) as compared with normotensive subjects (6.5%). Subjects with impaired glucose tolerance (24.3%) or hyperglycemic subjects (50.0%) had a significantly higher prevalence of microalbuminuria than normoglycemic subjects (11.3%). The prevalence of microalbuminuria was significantly higher in subjects with left ventricular hypertrophy (47.1%) as compared with those with normal electrocardiograms (11.3%). A good correlation was observed between urinary albumin concentration and albumin/creatinine ratio, and both showed a significant positive correlation with age, systolic and diastolic blood pressures, and fasting plasma glucose, total serum protein, albumin, and triglyceride levels, but not with angiotensin-converting enzyme activity. Multiple regression analysis demonstrated that both the urinary albumin concentration and the albumin/creatinine ratio show a significant positive correlation with systolic blood pressure and fasting plasma glucose. The prevalence of microalbuminuria was about 13% in this Japanese cohort, and the systolic blood pressure and the fasting plasma glucose level were demonstrated as independent risk indicators for both urinary microalbumin level and urinary microalbumin/creatinine ratio.
Plasma Immunoreactive Leptin and Neuropeptide Y Levels in Kidney Transplant Patients
Authors: Kokot Franciszek , Adamczak Marcin , Wiecek Andrzej , Spiechowicz Urszula , Mesjasz Jacek
Published: April 2003

Leptin and neuropeptide Y (NPY) seem to play an important role in food intake and energy expenditure. Leptin is secreted by adipose tissue in proportion fo fat stores and is presumed to be an important anorectic hormone. NPY is produced by the hypothalamus, and in contrast to leptin, is one of the most potent appetite stimulants yet demonstrated. On the other hand, in most patients increased appetite is present after successful kidney transplantation. Finally, a stimulatory effect of glucocorticoids on leptin secretion was reported. The present study aimed to assess the relationship between plasma leptin and NPY levels and body mass index (BMI) in haemodialyzed patients (HDP) with chronic renal failure and in kidney transplant patients (KTP). In both groups, BMI was of the same magnitude as in healthy controls. Despite the presence of a normal BMI, leptin levels in KTP (25.2 ± 3.6 ng/ml) and in HDP with chronic renal failure (25.3 ± 4.2 ng/ml) were higher than in controls (11.7 ± 1.8 ng/ml). The mean plasma NPY level in KTP (168.0 ± 10.3 pg/ml) was significantly higher (p < 0.01) than in controls (70.7 ± 5.9 pg/ml) and in HDP (77.0 ± 5.7 pg/ml). In all examined groups, a significant positive correlation was found between leptinaemia and BMI. Conclusions: (1) KTP are characterized by significantly elevated leptinaemia in spite of a normal BMI. In KTP this increased leptinaemia does not seem to be dependent only upon the fat mass and the kind and dosis of immunosuppressive therapy. (2) Similarly to healthy subjects, female KTP and HDP show markedly higher leptinaemia than males. (3) In contrast to healthy subjects and HDP, KTP are characterized by significantly elevated plasma NPY levels.
Nephrotic Syndrome with Mesangial Proliferative Glomerulonephritis Induced by Multiple Wasp Stings
Authors: Tauk Bill , Hachem Hassan , Bastani Bahar
Published: April 2003

We report the case of a young male who developed severe nephrotic syndrome within 2–3 weeks after being stung by 3 wasps. A percutaneous kidney biopsy specimen revealed mesangioproliferative glomerulonephritis with occasional subepithelial deposits suggestive of early membranous nephropathy. The patient was treated with oral prednisone 60 mg/day with no significant clinical response after 4 weeks, at which point he was started on oral cyclophosphamide, 100 mg/day, while the prednisone dose was tapered to 20 mg every other day over a 2-week period. Six months after initiation of cyclophosphamide, he still has severe nephrotic syndrome. We also briefly review the literature on Hymenoptera sting associated nephrotic syndrome.
Malignant Hypertension with a Rare Complication of Pulmonary Alveolar Hemorrhage
Authors: Hida Kazuyuki , Wada Jun , Odawara Masahiro , Kunitomi Mie , Hayakawa Nobuhiko , Kashihara Naoki , Makino Hirofumi
Published: April 2003

A 34-year-old Japanese male was admitted to Okayama University Hospital with severe hypertension, rapidly progressive renal failure, blurred vision, dyspnea and hemoptysis. Clinical diagnosis of malignant hypertension was given and antihypertensive therapy and hemodialysis were immediately started. Renal biopsy was performed on the sixth day in hospital to examine the underlying disease, such as microscopic form of polyarteritis, since the complaint of hemoptysis and pulmonary alveolar hemorrhage was noted by computed tomography of the lungs. Typical pathological changes of malignant hypertension, i.e. fibrinoid necrosis of the afferent arterioles and proliferative endoarteritis at the interlobular arteries were observed. There was no evidence of active necrotizing glomerulonephritis and crescent formation. Renal function was gradually recovered and pulmonary hemorrhage completely disappeared by treatment with antihypertensive agents. The authors report a case of malignant hypertension with a rare complication of pulmonary alveolar hemorrhage and speculate that it may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.
Anticardiolipin Antibodies in South African Patients with Lupus Nephritis: A Clinical and Renal Pathological Study
Authors: Naiker Indiran P. , Rughubar Karuna N. , Duursma June , Pudifin Dennis J. , Seedat Yakoob K.
Published: April 2003

Aims: This study was conducted prospectively to ascertain the prevalence of anticardiolipin antibodies (ACAs) in patients with lupus nephritis and to determine whether this subgroup of patients differed clinically and histologically from patients without the antibody. Patients and Methods: 40 SLE patients (26 Blacks, 14 Indians, 37 females, 3 males) with evidence of renal involvement underwent clinical assessment and percutaneous renal biopsy. Special investigations included: urinary protein quantitation; radioisotope glomerular filtration rate (GFR); complement levels, and antinuclear antibodies and ACAs. Histology was reviewed by a single senior pathologist blinded to the ACA results. In addition to the standard WHO classification, specimens were examined for intrarenal thrombosis. Results: The prevalence of ACA was 45% (18 of 40 patients). Thrombocytopenia was more frequent in patients with ACA (33 vs. 13.6%, p = 0.015). Patients with ACA did not differ from controls with regard to the incidence of thrombosis, neurological disorders, recurrent fetal loss, active disease and hypertension. Mean GFR and 24-hour urine protein (ACA vs. controls) were 51.3 versus 67 ml/min (NS) and 2.4 versus 3.7 g (NS), respectively. Intrarenal microvascular thrombosis (glomerular and arteriolar) occurred in 27.7% of ACA patients versus 9% of controls (p = 0.025). Apart from a higher incidence of class-III nephritis in the controls, standard histology (WHO classification) did not differ between the 2 groups. Conclusion: The prevalence of ACA in our patients with lupus nephritis was 45%. This subgroup did not differ from patients without the antibody apart from a higher incidence of thrombocytopenia and intrarenal microvascular thrombosis.
Learning-Induced Physiological Memory in Adult Primary Auditory Cortex: Receptive Field Plasticity, Model, and Mechanisms
Authors: Weinberger Norman M. , Bakin Jonathan S.
Published: April 2003

It is well established that the functional organization of adult sensory cortices, including the auditory cortex, can be modified by deafferentation, sensory deprivation, or selective sensory stimulation. This paper reviews evidence establishing that the adult primary auditory cortex develops physiological plasticity during learning. Determination of frequency receptive fields before and at various times following aversive classical conditioning and instrumental avoidance learning in the guinea pig reveals increased neuronal responses to the pure tone frequency used as a conditioned stimulus (CS). In contrast, responses to the pretraining best frequency and other non-CS frequencies are decreased. These opposite changes are often sufficient to shift cellular tuning toward or even to the frequency of the CS. Learning-induced receptive field (RF) plasticity (i) is associative (requires pairing tone and shock), (ii) highly specific to the CS frequency (e.g., limited to this frequency ± a small fraction of an octave), (iii) discriminative (specific increased response to a reinforced CS+ frequency but decreased response to a nonreinforced CS– frequency), (iv) develops extremely rapidly (within 5 trials, the fewest trials tested), and (v) is retained indefinitely (tested to 8 weeks). Moreover, RF plasticity is robust and not due to arousal, but can be expressed in the deeply anesthetized subject. Because learning- induced RF plasticity has the major characteristics of associative memory, it is therefore referred to as ‘physiological memory.’ We developed a model of RF plasticity based on convergence in the auditory cortex of nucleus basalis cholinergic effects acting at muscarinic receptors, with lemniscal and nonlemniscal frequency information from the ventral and magnocellular divisions of the medial geniculate nucleus, respectively. In the model, the specificity of RF plasticity is dependent on Hebbian rules of covariance. This aspect was confirmed in vivo using microstimulation techniques. Further, the model predicts that pairing a tone with activation of the nucleus basalis is sufficient to induce RF plasticity similar to that obtained in behavioral learning. This prediction has been confirmed. Additional tests of the model are described. RF plasticity is thought to translate the acquired significance of sound into an increased frequency representation of behaviorally important stimuli.
Classification of Patients with Ménière’s Disease Using Otoacoustic Emissions
Authors: van Huffelen Wim M. , Mateijsen Nies J.M. , Wit Hero P.
Published: April 2003

Otoacoustic emissions (OAEs) were studied in patients with Ménière’s disease in order to assess their usefulness for distinguishing between different stages of the disease. An accurate classification of Ménière’s patients is expected to allow optimalization of the treatment for each particular stage. Click-evoked and distortion product OAEs were evaluated in both ears for 70 Ménière’s patients. Based on these measurements, Ménière’s patients can be divided into four different categories. In patients with small hearing losses OAEs are found, whereas patients with pure-tone thresholds larger than 60 dB exhibit no OAEs at all. In the intermediate range (30- to 60-dB thresholds) two categories of patients are distinguished: patients with relatively large emissions and patients without measurable emissions. These findings suggest the presence of various stages in the pathophysiological mechanism involved in Ménière’s disease. Additionally, Ménière’s patients with contralateral ears with normal thresholds have significantly smaller emissions than normal-hearing adults. This observation could represent a very early manifestation of bilateral Ménière’s disease, which cannot be detected by other diagnostic methods.
Elevation of Reactive Oxygen Species following Ischemia-Reperfusion in Mouse Cochlea Observed in vivo
Authors: Ohlemiller Kevin K. , Dugan Laura L.
Published: April 2003

An in vivo method for assessment of changes in hydroxyl radical levels in cochlear perilymphatic spaces is described and applied to cochlear ischemia-reperfusion in the mouse. Cochlear blood flow was reversibly reduced by compression of the anterior inferior cerebellar arterial network. Changes in the production of hydroxyl radicals, used as an index of tissue production of reactive oxygen species (ROS), were determined by measuring the conversion of salicylate to 2,3-dihydroxybenzoic acid. Low levels of salicylate (0.1 mM) in artificial perilymph were applied by perfusion of the cochlea using a round window entry and apical exit. Perfusate was collected and analyzed by high-performance liquid chromatography. Forty minutes of partial ischemia led to a > 10-fold average increase over baseline in the concentration of hydroxyl radical, which increase persisted for at least 40–80 min following reperfusion. Our observations support previous results obtained using less direct methods, indicating that cochear ischemia-reperfusion and related damage is associated with elevated ROS levels. Development of an in vivo method for assessing changes in cochlear ROS in mice will facilitate the study of the relation between deafness genes, vulnerability to insults and dynamics of cellular processes that produce and regulate ROS.