ABSTRACT
BACKGROUND: Prior research has established that anxiety and depression, as measured by the Hospital Anxiety Depression Score (HADS), are strongly correlated with disease-specific quality of life (Rhinosinusitis Disability Index - RSDI) in chronic rhinosinusitis (CRS). We hypothesized that anxiety and depression would decrease after functional endoscopic sinus surgery (FESS), and furthermore that HADS would predict improvement in RSDI following surgery. METHODOLOGY: The study cohort from 2014 consisted of 99 CRS patients who underwent nasal endoscopy, RSDI, and HADS evaluation. The cohort was segregated by whether or not they underwent FESS and an updated HADS was administered. For 44 surgical patients, pre- and post-operative RSDI (n=38), Lund-Kennedy (LK) (n=34) and HADS (n=18) scores were compared. Delta RSDI was compared between patients with varying levels of anxiety and depression. RESULTS: Lund-Kennedy scores improved from 5.8 ± 4.1 to 3.2 ± 2.6 following surgery, as did total RSDI (39.3 ± 26.8 to 24.6 ± 29.2). Total HADS (9.8 ± 6.4 to 11.3 ± 7.4) and depression and anxiety subscores were unchanged. Linear regression did not reveal a correlation between HADS and change in RSDI following FESS. Delta RSDI was not significantly different between patients with varying levels of anxiety and depression. CONCLUSIONS: Despite improvements in objective evidence of sinonasal inflammation (LK) and disease-specific quality of life (RSDI), neither depression nor anxiety improved after FESS, nor did the magnitude of psychological comorbidity predict post-operative improvement in quality of life. Improvement in RSDI was not different among patients with varying levels of anxiety and depression. Levels of depression and anxiety may be hard-wired, and therefore not influenced by changes in objective or perceived sinonasal disease burden.
Subject(s)
Anxiety/psychology , Depression/psychology , Endoscopy/methods , Rhinitis/surgery , Self Report , Sinusitis/surgery , Chronic Disease , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Quality of LifeABSTRACT
High avidity anti-dsDNA IgG antibodies are believed to play an important role in the pathogenesis of the autoimmune disease systemic lupus erythematosus (SLE) and therefore attempts have been made to reduce the concentration of these antibodies in the bloodstream of SLE patients. Previously we reported the development of an antigen based heteropolymer (AHP), a bispecific complex prepared by using the avidin-biotin system to crosslink dsDNA to a mAb specific for the human erythrocyte (E) complement receptor. Our studies indicated that this AHP could bind anti-dsDNA antibodies to E and facilitate clearance of these autoantibodies from the circulation of a monkey without E destruction. Here we report an improved covalent crosslinking procedure and purification scheme in which the AHP construct is isolated by precipitation in 50% saturated ammonium sulfate. We used a dsDNA binding dye, PicoGreen, to demonstrate specificity of binding of dsDNA to E via the AHP. The efficacy of the AHP in binding IgG anti-dsDNA antibodies to E was demonstrated in a sensitive and quantitative assay, based on the time resolved fluorescence properties of europium-labeled anti-human IgG mAbs used to probe the E. We also used this assay to screen SLE patient and normal plasmas for levels of anti-dsDNA IgG. The results of this assay correlate very well with the Farr assay, and therefore this approach may be useful in the development of informative and specific assays for a variety of autoantibodies. Treatment of SLE plasmas with E-AHP under conditions close to physiological led to substantial reductions (> or = 90%) in anti-dsDNA titers. It should be possible to test these new AHP for their ability to target and safely remove IgG anti-dsDNA antibodies from the circulation in animal models.
Subject(s)
Antibodies, Antinuclear/analysis , Antibodies, Bispecific/therapeutic use , Antibodies, Monoclonal/therapeutic use , DNA/immunology , Immunoglobulin G/analysis , Lupus Erythematosus, Systemic/therapy , Receptors, Complement 3b/immunology , Antibodies, Antinuclear/immunology , Antibodies, Antinuclear/metabolism , Antibodies, Bispecific/isolation & purification , Antibodies, Monoclonal/isolation & purification , Dose-Response Relationship, Immunologic , Erythrocytes/metabolism , Humans , Immunoglobulin G/immunology , Immunoglobulin G/metabolism , Lupus Erythematosus, Systemic/immunologyABSTRACT
Three hundred twelve surgical procedures in patients with chronic renal failure have been characterized. There is a high incidence of operation in this expanding population. Multiple procedures for each patient were found in our 10 year study. Operative mortality was 1 percent and late mortality was about 10 percent per year. The survival curve predicted an 81 percent 2 year rate and a 60 percent 5 year survival rate. The high late mortality was likely related to the underlying disease process and the high proportion of complicating associated illnesses. The gross complication rate was high (64 percent), with the most frequent one being hyperkalemia. Other frequent complications were hemodynamic instability, infections, and fluid overload. A pattern of postoperative time to onset for the various complications was identified. Perioperative management requires aggressive, but appropriate metabolic, hematologic, and pharmaceutical intervention.
