"This Life is Normal for Me": A Study of Everyday Life Experiences and Coping Strategies of Live-in Carers in Taiwan.

Recruiting migrant live-in carers has become the main strategy to address the rapid increase in the number of older persons with intensive care needs in many parts of the developed world. This is also the case in northern Taiwan, where this study took place. Thirteen live-in carers from Indonesia and the Philippines were interviewed in the fall of 2019. In this article, we discuss their two main coping strategies: a) "accepting destiny", which refers to carers accepting their life and viewing their role as a live-in carer as a job that allowed them to meet their parents' expectations of financial support; and b) "connecting to significant others", which is the most important way carers found motivation to keep going. However, despite their coping strategies, working as a live-in carer was experienced as a challenging and precarious lifestyle. In the conclusion, we discuss how professional social workers in collaboration with decision-makers and non-governmental organizations in Taiwan could contribute to fostering a system that would support live-in carers in ways that allow them, and the older persons they care for, to thrive.

Eight versus 16-week re-evaluation period in rheumatoid arthritis patients treated with leflunomide or methotrexate accompanied by moderate dose prednisone.

In a step-up approach of DMARD treatment of RA a fast response and an early DMARD switch in the case of non-response is important. Therefore, we performed an open trial in which we compared an 8-week and a 16-week observation period during treatment of RA with MTX or LEF, both given in intensified starting doses and accompanied by moderate dose prednisone. MTX and LEF naïve patients with RA (mean time since diagnosis: 2.3 years) were randomised to receive either LEF in a 3-day-loading dose of 100 mg/day followed by 20 mg/day (n = 19) or MTX intramuscularly in a dose of 25 mg once weekly (n = 21). All patients received concomitant treatment with oral prednisone in an initial dose of 20 mg/day with weekly dose reductions of 5 mg/day. The disease activity was re-evaluated 8 and 16 weeks after the start of the treatment. Mean DAS28 before the start of treatment was 5.36 +/- 0.8 for the MTX-group and 5.46 +/- 0.8 for the LEF-group. After 8 weeks of treatment the DAS28 in the MTX-group was 2.59 +/- 1.0 and 3.16 +/- 0.8 in the LEF group (difference not significant). The mean DAS28 at re-evaluation 16 weeks after the starting of treatment (2.58 +/- 1.5 for the MTX-group and 3.25 +/- 1.16 for the LEF-group) was significantly different neither in between the both treatment groups nor in comparison to the week 8 evaluation. Efficiency of RA treatment with MTX or LEF in intensified doses and in combination with moderate dose prednisone can be sufficiently judged 8 weeks after its initiation.

[Present importance of direct immunologically based intervention strategies using anticytokines in rheumatoid arthritis]. / Gegenwärtige Bedeutung der direkten immunologischen Interventionstherapie durch Antizytokine bei der Rheumatoiden Arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory multisystemic autoimmune disease of unknown origin. RA is clinically characterized by recurrent inflammation of joints, synovialitis, progressive destruction of cartilage or bone tissue and multiorgan involvement. Today all established therapies of RA are still unable to stop or even cure the disease. In most cases these therapies can only reduce progression. Furthermore, these therapies have substantial side effects, which can contribute to the increased mortality of disease. Therefore more effective therapies with fewer side effects are needed. In this context direct immunological intervention strategies increasingly gained interest to inhibit proinflammatory cytokines. In vivo and in vitro studies as well as experimental therapies documented the important role of the proinflammatory cytokines TNFalpha and IL-1 in RA. The therapy with TNFalpha-antibodies or receptor fusion proteins as well as IL-1 receptor antagonists proved to be clinically as well as immunologically highly effective as therapy of RA. The single dose treatment is associated with mild side effects only. In addition, trials using combined TNFalpha-antibody and methotrexate therapy gave promising results. However, potential severe side effects may occur after repeated therapy cycles or may be discovered after prolonged time of observation only (e.g., allergic reactions, induction of autoantibodies or malignancies). Therefore, at present these therapy options can only be recommended for selected patients, who are included into controlled clinical trials. In addition, repeated courses of therapy seem to lead to reduced therapeutical efficacy (especially in TNFalpha-antibody therapy). Further controlled studies with cytokine antagonists should especially address these problems and focus in particular on potential inductions of autoantibodies or malignancies as well as on additional long-term side effects. In contrast to direct inhibition of TNFalpha or IL-1 several further therapies indirectly influence these cytokines by interference with their synthesis or by alteration of the respective receptors. The importance of these therapeutical options has to be determined as well as the possibility of combination of established therapies with immunological intervention strategies.

Inhibition of interleukin-8 synthesis by intraarticular methotrexate therapy in patients with rheumatoid arthritis.

5 Patients with definite RA and knee effusions under constant doses of DMARD therapy were treated with up to 6 intraarticular injections of 10 mg methotrexate (MTX) every 3 to 7 days. A matched randomized control group who received a single i.a. injection of 40 mg triamcinolone hexacetonide (TC) was monitored according to the same protocol. The intraarticular granulocyte counts and IL-8 levels decreased in all MTX treated patients on day 10-13 and stayed low in those patients who could be re-evaluated after 13 weeks. Compared to the IL-8 levels, the other tested cytokine levels showed only minor changes on day 10-13. There was no need for re-injection in the TC group during the 13 week study phase. We conclude that intraarticular MTX therapy results in a strong decrease of SF-granulocyte counts. This effect may be due to the impairment of IL-8 mediated chemotaxis by decreased IL-8 synthesis in synovial fluid mononuclear cells. Clinically, repeated intraarticular MTX therapy results in a worse 13 week outcome than i.a. steroid treatment measured in an intention-to-treat analysis.

Characterization of YB2/0 cell line by counterflow centrifugation elutriation.

The non-secreting rat myeloma cell line YB2/0 could be separated into different cell fractions by counterflow centrifugal elutriation. The obtained fractions are analyzed by morphology studies, morphometrics, clonogenic assays and flow cytometry. The methodology is extensively described. A separation of different cell fractions according to cell cycle stages was achieved. This implies further application possibilities for clinical use like the in vitro fractionation of autologous bone marrow prior to transplantation in patients with multiple myeloma.

Lymphocyte depletion of donor bone marrow by counterflow centrifugal elutriation: results of a phase I clinical trial.

We report here the results of a phase I clinical trial using counterflow centrifugal elutriation (CCE) for the removal of donor T lymphocytes before allogeneic bone marrow transplantation (BMT). Thirty-eight patients received lymphocyte-depleted allografts from HLA-identical, MLR-nonreactive sibling donors. The patients entered onto the study were either at high risk on the basis of age (median, 39 years) or disease status (acute leukemia in early relapse [ER], chronic myelogenous leukemia [CML] in accelerated phase [AP], or therapy resistant [RES] lymphoma). All patients received a standard lymphocyte dose of 1 x 10(6) morphologic lymphocytes per kilogram ideal body weight (BW) and were maintained on cyclosporine A (CsA) for 170 days after BMT. Prompt engraftment occurred in 37 of 38 patients with a median time to absolute neutrophil count (ANC) greater than 500/microL of 18 days. Although acute graft-v-host disease (GVHD; clinical stage I or greater) was observed in 45%, it was limited to the skin in all but five patients. Survival was related to disease status at the time of BMT. Among patients with acute leukemia in first or second remission, CML in chronic phase (CP) or lymphoma in partial remission (PR), 64% are currently alive, in contrast to 31% of patients with acute leukemia in third remission or early relapse, CML in second CP or AP, or RES lymphoma. Median follow-up for all patients was 351 days (range, 105 to 711 days). We conclude that this procedure is safe and warrants further evaluation in a randomized efficacy trial.

Implementation of a semiclosed large scale counterflow centrifugal elutriation system.

A semiclosed counterflow centrifugal elutriation system that minimizes the risks of contamination and cell loss is presented. A detailed description of the configuration of the system and its sterilization and assembly is provided along with examples of its application to large-scale separation of leukapheresis buffy coat and cadaveric bone marrow. We are currently using this system to deplete lymphocytes from human bone marrow prior to use in allogeneic bone marrow transplantation. The implementation of a semiclosed system increases the safety, ease of operation, and reproducibility of a technique that has the potential for a wide range of clinical applications.