ScribeMD: Mixed-methods analysis of a pen pal program in undergraduate medical education.

Introduction: A growing emphasis on humanistic medical care has led to the development of programs to imbue more humanistic values into training physicians. The ScribeMD intra-class pen pal program is a narrative medicine tool designed to meet this need with a focus on the journey through medical education. This study intends to evaluate the efficacy of this novel program on the participants' professional identity formation (PIF), emotional intelligence development (EID), and narrative competency improvement (NCI).Methods: This program evaluation involved quantitative and qualitative survey solicitations from first and second-year medical student participants and controls. An efficacy-triangulation model was developed as a quantitative outcome-measuring tool linking objective, writing prompts, and survey data.Results: The quantitative results showed statistically significant improvements in line with the Efficacy Triangulation Model in the participant group. Qualitatively, reflective and insight-driven gains were elicited, as were notable themes of personal and community improvements.Conclusion: ScribeMD poses a unique avenue for the development of more humanistic physicians during their medical education. We recommend additional development of the Efficacy Triangulation Model as well as the program design itself. We also recommend the piloting of this program in other healthcare-education settings both with medical education and other health professions.

Patient-reported outcomes among patients with type 2 diabetes mellitus treated with dapagliflozin in a triple-therapy regimen for 52 weeks.

Patients with type 2 diabetes (T2DM) and inadequate glycaemic control on combination metformin (MET) and sulphonylurea (SU) were enrolled in a 24-week, double-blind, randomized, placebo-controlled study with a 28-week extension. The five-dimension EuroQol questionnaire (EQ-5D), SHIELD Weight Questionnaire-9 (WQ-9), Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) were used to evaluate health status and health-related quality of life (HRQoL) at baseline and week 52. Patients with dapagliflozin 10 mg + MET + SU (n = 108) were compared with patients treated with placebo + MET + SU (n = 108), using a repeated-measures mixed model. EQ-5D visual analogue scale scores, IWQOL-Lite and DTSQ scores improved in the dapagliflozin and placebo groups from baseline to week 52; however, there was no significant difference between groups (p > 0.20). EQ-5D index scores remained the same from baseline to week 52 for dapagliflozin and placebo (p = 0.54). A numerically greater proportion of the dapagliflozin group reported improvement in all nine SHIELD WQ-9 items compared with placebo, and the difference was statistically significant for physical health (p = 0.017). Over 52 weeks of therapy, patients maintained their health status and HRQoL when dapagliflozin was added to the treatment.

Gender differences in symptoms in partial responders to proton pump inhibitors for gastro-oesophageal reflux disease.

BACKGROUND: Gender differences may exist in the symptom experience of patients with gastro-oesophageal reflux disease (GERD) who have a partial response to proton pump inhibitors (PPIs). OBJECTIVE: The purpose of this study was to analyse gender differences in partial responders to PPIs. METHODS: Patients with GERD who responded partially to PPIs (n = 580; NCT00703534) completed the Reflux Symptom Questionnaire 7-day recall (RESQ-7) and the Gastrointestinal Symptom Rating Scale (GSRS). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. RESULTS: Women had significantly higher RESQ-7 domain scores than men for Heartburn (frequency: 4.3 vs 3.9; intensity: 3.1 vs 2.8), Burping (frequency: 4.9 vs 4.4; intensity: 3.1 vs 2.8) and Hoarseness, cough and difficulty swallowing (frequency: 2.6 vs 2.2; intensity: 1.8 vs 1.5), and had higher GSRS domain discomfort scores than men for Abdominal pain (3.51 vs 3.23), Indigestion (3.80 vs 3.45) and Constipation (2.69 vs 2.17) (all p < 0.05). Anxiety and depression were significantly more prevalent in women than in men. CONCLUSION: In this population of partial responders, women had more frequent/intense heartburn and extra-oesophageal symptoms and more discomfort from abdominal pain, indigestion and constipation than men. Comorbid anxiety and depression may contribute to the increased symptom burden in women.

Low expression of CD39(+) /CD45RA(+) on regulatory T cells (Treg ) cells in type 1 diabetic children in contrast to high expression of CD101(+) /CD129(+) on Treg cells in children with coeliac disease.

Type 1 diabetes (T1D) and coeliac disease are both characterized by an autoimmune feature. As T1D and coeliac disease share the same risk genes, patients risk subsequently developing the other disease. This study aimed to investigate the expression of T helper (Th), T cytotoxic (Tc) and regulatory T cells (Treg ) in T1D and/or coeliac disease children in comparison to healthy children. Subgroups of T cells (Th : CD4(+) or Tc : CD8(+) ); naive (CD27(+) CD28(+) CD45RA(+) CCR7(+) ), central memory (CD27(+) CD28(+) CD45RA(-) CCR7(+) ), effector memory (early differentiated; CD27(+) CD28(+) CD45RA(-) CCR7(-) and late differentiated; CD27(-) CD28(-) CD45RA(-) CCR7(-) ), terminally differentiated effector cells (TEMRA; CD27(-) CD28(-) CD45RA(+) CCR7(-) ) and Treg (CD4(+) CD25(+) FOXP3(+) CD127(-) ) cells, and their expression of CD39, CD45RA, CD101 and CD129, were studied by flow cytometry in T1D and/or coeliac disease children or without any of these diseases (reference group). Children diagnosed with both T1D and coeliac disease showed a higher percentage of TEMRA CD4(+) cells (P < 0·05), but lower percentages of both early and late effector memory CD8(+) cells (P < 0·05) compared to references. Children with exclusively T1D had lower median fluorescence intensity (MFI) of forkhead box protein 3 (FoxP3) (P < 0·05) and also a lower percentage of CD39(+) and CD45RA(+) within the Treg population (CD4(+) CD25(+) FOXP3(+) CD127(-) ) (P < 0·05). Children with exclusively coeliac disease had a higher MFI of CD101 (P < 0·01), as well as a higher percentage of CD129(+) (P < 0·05), in the CD4(+) CD25(hi) lymphocyte population, compared to references. In conclusion, children with combined T1D and coeliac disease have a higher percentage of differentiated CD4(+) cells compared to CD8(+) cells. T1D children show signs of low CD39(+) /CD45RA(+) Treg cells that may indicate loss of suppressive function. Conversely, children with coeliac disease show signs of CD101(+) /CD129(+) Treg cells that may indicate suppressor activity.

Insulin treatment of streptozotocin-induced diabetes re-establishes the patterns in carbohydrate, fat and amino acid metabolisms in growing pigs.

The effects of streptozotocin (STZ) were studied in eight high-health herd-certified Yorkshire × Swedish Landrace pigs (32.5 ± 2.6 kg initial body weight [BW]), and an insulin treatment protocol was developed to re-establish their metabolisms. A single intravenous dose of 150 mg STZ/kg BW successfully induced hyperglycaemia and alterations in their fat and protein metabolisms. Within 13 h post-STZ treatment blood glucose concentration had fallen to a range of 1.3 to 4.7 mmol/L. Hypoglycaemia was promptly treated with 0.5 g glucose/kg BW intravenously. All the pigs became hyperglycaemic with blood glucose concentrations >23 mmol/L within 48 h post-STZ. Two days post-STZ serum C-peptide concentrations fell below 60 ρmol/L in all the pigs and remained below 96 ρmol/L for five weeks until the end of the study. The pigs were left untreated for one week after STZ injection. At the end of this week 13-fold and nine-fold increases in serum concentrations of triglycerides and non-esterified fatty acids, respectively, were observed. Also, at this time-point a three-fold increase in the concentration of branched-chain amino acids (BCAA) was observed, and alanine and taurine were decreased by approximately 70% and 40%, respectively. During the week when the pigs were untreated, a reduced weight gain was observed, but after the onset of insulin treatment the daily weight gain was at least as good as that of conventional high-health pigs. Then a subcutaneous treatment with short-acting insulin was initiated. The initial dose of 2/3 IU/kg BW daily, divided between two doses, was gradually increased to 1 IU/kg BW. Within three weeks, the insulin treatment restored the metabolic changes in carbohydrate, fat and protein metabolisms produced by the STZ. In conclusion, the results underscore the usefulness of this animal model in translational research as insulin treatment re-establishes the changes in carbohydrate, fat and amino acid metabolisms observed in STZ-diabetic pigs and resolves clinical signs of disease similar to those in humans.

Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study.

OBJECTIVE: To examine trends and effects of weight loss treatment on health-related quality of life (HRQL) in the severely obese over 10 years. DESIGN: Swedish obese subjects (SOS) intervention study is a controlled, longitudinal trial of the health effects of weight loss in the severely obese. SUBJECTS: A total of 655 of 851 surgically treated and 621 of 852 conventionally treated obese men (body mass index, BMI>or=34) and women (BMI>or=38) who completed 10 years of the study. MEASUREMENTS: HRQL was assessed before treatment and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years. RESULTS: HRQL change during the 10-year observation period largely followed phases of weight loss, weight regain and weight stability. Improvements and deteriorations in HRQL were associated with the magnitude of weight loss or regain, except regarding anxiety. Peak improvements in the surgical group were observed during the first year of weight loss, whereas the weight regain phase (mainly between 1- and 6-year follow-up) was accompanied by a gradual decline in HRQL. The period from 6- to 10-year follow-up was characterized by relatively stable observations in both weight and HRQL. At 10 years, net gains were noted in all HRQL domains compared to baseline. Comparisons of treatment effects on HRQL in the surgical vs conventional group after 10 years showed significantly better outcome in the surgical group on current health perceptions, social interaction, psychosocial functioning and depression, whereas no significant differences were found for overall mood and anxiety. Long-term results of the study suggest that a maintained weight loss of about 10% is sufficient for positive long-term effects on HRQL, a limit that was reached in about two-thirds of the surgically treated patients who completed 10 years of the study. CONCLUSION: Long-lasting weight reduction in the severely obese has a general long-standing positive outcome on HRQL. Bariatric surgery is a favorable option for the treatment of severe obesity, resulting in long-term weight loss and HRQL improvements in a majority of patients. However, difficulties among some surgical patients to control and maintain weight loss over time should not be ignored. Future research should study if the long-term efficacy of bariatric surgery may be further enhanced by implementing lifestyle modification techniques in the postoperative management of patients.

A comparative controlled study of personality in severe obesity: a 2-y follow-up after intervention.

OBJECTIVE: The primary purpose was to examine 2-y effects of weight change on personality traits in severely obese subjects treated conventionally or surgically. We also assessed differences between the severely obese patients and a primarily normal-weight reference group. METHOD: Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychasthenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. A total of 1380 surgical candidates, 1241 conventionally treated patients and 1135 subjects from the SOS (Swedish Obese Subjects) reference study, representing the general population, completed the KSP. Data presented in this study were gathered twice from the patients (prior to treatment and after 2 y) and once from the reference subjects. Significance tests and effect sizes (ES) were calculated. RESULTS: At baseline, the obese were characterised as more anxiety prone, impulsive, irritable and less monotony avoiding than the reference group; surgery patients more so than the conventionally treated. At follow-up, it was found that anxiety proneness decreased and Monotony Avoidance increased with increasing weight loss. The conventionally treated were, on average, weight stable and, hence, only a small decrease was noted regarding Somatic Anxiety. The surgery group lost on average 28 kg, and differences between surgically treated and the reference group decreased on all scales except Impulsiveness, which remained unchanged. The largest improvement was in relation to Psychasthenia. CONCLUSIONS: Weight reduction maintained for 2 y was associated with changes on practically all personality traits in proportion to the magnitude of weight loss. In particular, Psychasthenia seemed to be alleviated, while Impulsiveness was unaffected.

Severe obesity and personality: a comparative controlled study of personality traits.

OBJECTIVE: The primary purpose was to assess personality trait differences between the severely obese seeking treatment and a mainly non-obese reference group. We also investigated gender differences and differences between obese patients and obese not seeking treatment. METHOD: Personality traits were assessed using 7 of 15 scales from the Karolinska Scales of Personality (KSP): Somatic Anxiety, Muscular Tension, Psychastenia, Psychic Anxiety, Monotony Avoidance, Impulsiveness, and Irritability. Patients from the Swedish Obese Subjects (SOS) intervention study (n=3270, ages 37-57, 71% women) and the SOS reference study (n=1135, 54% women) completed the survey. Data presented in this study were gathered prior to treatment. Significance tests and effects sizes were calculated. RESULTS: Although statistically significant differences were found between obese patients and reference subjects on nearly all personality traits, effect sizes were at most moderate. Of the three scales with moderate effects sizes, differences on Somatic Anxiety and Psychastenia could be traced to items tapping condition-specific symptoms, e.g., problems with sweating and breathing as indicators of Somatic Anxiety. Moderate differences on the Impulsiveness scale (men alone) could not be explained by item composition. Further, the obese patients differed from obese in the reference group, and both obese and reference women reported significantly higher levels on Somatic Anxiety, Muscular Tension and Psychic Anxiety compared to men (effect size: small). CONCLUSIONS: Our results provided no evidence of a general obese personality profile, instead considerable heterogeneity in personality traits was observed across our obese samples (treatment seekers vs non-seekers, men vs women) and generally only small differences were noted compared to a reference study population. Further research is needed to investigate if the somewhat elevated levels of Impulsiveness, particularly among male obese patients, is affected by weight loss. When assessing personality traits in diseased groups consideration should be given to possible confounding from, e.g., somatic symptoms.

Effects of coping on psychological outcome when controlling for background variables: a study of traumatically spinal cord lesioned persons.

STUDY DESIGN: Cross-sectional. OBJECTIVES: In a previous study we found spinal cord lesion (SCL)-related coping factors to be distinctly related to levels of SCL-related psychological outcome. However, we did not control for other potentially confounding variables. In this study we investigated effects of coping strategies on psychological outcome reactions in traumatically spinal cord lesioned persons controlling for sociodemographic, disability-related and social support variables. SETTING: The Gothenburg Spinal Injuries Unit in Sweden. METHODS: The study sample comprised 255 persons and a subsample of 157 persons. A series of stepwise multiple regression analyses were performed. RESULTS: SCL-related coping factors clearly predicted psychological outcome even when background variables were controlled. Higher levels of acceptance coping predicted decreased psychological distress and increased positive morale. Elevated social reliance coping predicted heightened distress. Higher levels of social support predicted lower feelings of helplessness. Sociodemographic and disability-related variables were weak predictors of psychological outcome with one exception: higher education predicted less bitterness and brooding. CONCLUSION: SCL-related coping remained the most important predictor of psychological outcome even when a wide range of variables was controlled. Thus we conclude that psychosocial interventions aimed at helping individuals develop their coping strategies might be of substantial value in their adjustment to SCL.

Linkages between coping and psychological outcome in the spinal cord lesioned: development of SCL-related measures.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To investigate relationships between coping and mental well-being with clinical relevance to spinal cord lesion (SCL). SETTING: The Gothenburg Spinal Injuries Unit in Sweden. METHODS: The study sample comprised 274 persons. From in-depth interviews, literature reviews, and the transactional theory of stress and coping, items reflecting coping and psychological outcome, respectively were generated. Principal components factor analysis, multi-trait analysis, and structural equation modelling were used. RESULTS: The coping scale comprised three factors: Acceptance (i.e. revaluation of life values); Fighting spirit (i.e. efforts to behave independently); Social reliance (i.e. a tendency towards dependent behaviour). The outcome scale included the factors: Helplessness (i.e. feeling perplexed, out of control and low self-esteem); Intrusion (i.e. bitterness and brooding); Personal growth (i.e. positive outcomes of life crisis). Acceptance showed a positive relation to Personal growth and was inversely related to both Helplessness and Intrusion. Fighting spirit had a weak negative association to Helplessness and a weak positive association to Personal growth. Social reliance was positively related to Helplessness and Intrusion. Only Social reliance showed any association to neurological status. Those lesioned 1-4 years reported more Helplessness, Intrusion, Social reliance, and less Acceptance than those lesioned >or=5 years. CONCLUSION: Coping is related to psychological outcome in SCL. Our situational coping measure may be a candidate to assess intervention effects.

Obesity-related coping and distress and relationship to treatment preference.

OBJECTIVES: The primary purpose was to define obesity-related strategies for coping with psychological problems connected with obesity. We also wanted to identify obesity-related distress and explore the effect of coping on distress. Thirdly, we wanted to investigate differences in coping and distress related to choice of surgery or conventional treatment. DESIGN: Cross-sectional data from patients in the Swedish Obese Subjects (SOS) intervention study. METHODS: An obesity-related questionnaire concerning coping and distress was created and evaluated in 2510 patients from the SOS study, using multitrait, exploratory and confirmatory factor analysis procedures. RESULTS: Three coping factors were defined. Social Trust and Fighting Spirit were problem-focused, whereas Wishful Thinking was emotion-focused. Surgical candidates displayed lower levels of problem-focused and higher levels of emotion-focused coping. We also identified two distress factors: Intrusion and Helplessness. Wishful Thinking was positively related to distress, and Social Trust and Fighting Spirit were inversely related, thus explaining the higher levels of distress reported by the surgical candidates. CONCLUSIONS: In our sample, emotion-focused coping proved maladaptive and was associated with increased distress. Problem-focused coping, however, was adaptive and associated with reduced distress. These findings partly explain psychological morbidity and should be taken into consideration in the treatment of obese people.

Serum eosinophil cationic protein (ECP) as a mediator of inflammation in acute asthma, during resolution and during the monitoring of stable asthmatic patients treated with inhaled steroids according to a dose reduction schedule.

OBJECTIVE AND DESIGN: The main objective was to establish the level of serum ECP in a group of adult asthmatic patients with acute exacerbation and the following resolution and in another group of adult, stable asthmatic patients during reduction of inhaled steroids. SUBJECTS AND TREATMENT: Acute group: Twenty-one asthmatic patients admitted to the asthma clinic with acute deterioration of their asthma were set on oral steroids which were reduced to 0 within one week. Reduction group: Forty-four stable asthmatic patients on maintenance inhaled steroids were included and, on the basis of their peak expiratory flow (PEF) values, adjustments in the doses of steroids were made. CONTROL GROUP: Twenty stable asthmatics on a constant dose of inhaled steroids were enrolled as controls. METHODS: All patients registered daily PEF measurements and spirometry was performed at each visit. Blood samples were drawn and analysed for eosinophil cationic protein (ECP), myeloperoxidase (MPO), eosinophils and neutrophils. RESULTS: ECP was low and within the normal range for all three groups at study entry. (Acute group = 8.4 microg/l, reduction group = 3.7 microg/l and control group = 4.6 microg/l). Nevertheless, the value in the acute group was significantly higher than in the control group (p=0.005). The levels in the acute group decreased significantly (p=0.004) after one week on oral steroids. No significant changes in ECP were observed in the reduction group or in the control group during the follow-up period. The lung function was low in the acute group at inclusion, forced expiratory volume in one second (FEV1)=47.1% of predicted, and increased significantly during the treatment period (p = 0.006). The patients in the reduction- and control group showed small variations in lung function during the whole study, FEV1 >70% and PEF > 80% of predicted, respectively. No correlation between atopy and ECP was found in the patients irrespective of the stage of disease. CONCLUSIONS: This study suggests that the resolution of acute asthma exacerbations during treatment could be followed using ECP determinations. In stable asthmatics on inhaled steroids and with normal ECP levels, a dose reduction could be indicated. A longer period after tapering off steroids is proposed to confirm the benefit of ECP measurements for controlling asthma.

Systemic effects of a short course of betamethasone compared with high-dose inhaled budesonide in early childhood asthma.

Forty children aged 1-3 y completed a placebo-controlled study on the effects of 10 d of inhaled budesonide for asthma caused by respiratory tract infection. The effects on symptoms were significantly better in the active than in the placebo group. In 20 of these children the systemic effects of high-dose inhaled budesonide for 10 d and the effect of a 3-d course of oral betamethasone on asthma exacerbation were evaluated. Systemic effects were evaluated by measuring morning cortisol in serum and urine, and the bone markers osteocalcin, ICTP (the C-terminal telopeptide region of type I collagen) and PIIINP (an N-terminal propeptide of type III procollagen) in serum before and at the end (d 7-10) of treatment (1600 microg budesonide d(-1) for 3 d and 800 microg for 7 d). In 9 children, measurements were taken on d 3 of a 3-d course of betamethasone (6, 4 and 2 mg) for asthma exacerbation and 14 d later. There were no signs of systemic effects after 7-10 d of budesonide. After 3 d of betamethasone, serum cortisol decreased from a median of 263 to 26 nmol l(-1), urine cortisol/creatinine from 19.9 to 7.2 nmol l(-1), osteocalcin from 31.4 to 5.5 microg l(-1), ICTP from 19.4 to 8.5 microg l(-1) and PIIINP from 12.3 to 5.9 microg l(-1). Two weeks later, the levels were back to normal. In conclusion, short courses of oral betamethasone have pronounced systemic effects, whereas 10 d of high doses of budesonide do not produce significant systemic effects.

Importance and attainment of life values among disabled and non-disabled people.

How do disabled persons evaluate their life situation? To address this issue, importance and attainment ratings of 82 different life values as well as mood ratings were collected from 325 chronically ill and/or disabled persons and 504 non-disabled persons. Both groups largely agreed on what is important in life. The disabled persons, however, gave lower importance ratings on functions related to health and mobility. The attainment and mood ratings were in general slightly lower for the disabled persons. The attainment ratings for health and mobility were markedly lower. The concordance between rated importance and attainment across different life values was positive in both groups. This measure was also positively related to mood in both samples. It was suggested that disabled persons adjust to their life situation by de-emphasizing the importance of the physical functions affected by the disability and through habituation.

Functional status and well being in chronic obstructive pulmonary disease with regard to clinical parameters and smoking: a descriptive and comparative study.

BACKGROUND: Self-assessment questionnaires which measure the functional and affective consequences of chronic obstructive pulmonary disease (COPD) give valuable information about the effects of the disease and may serve as important tools with which to evaluate treatment. METHODS: A cross sectional comparative study was performed between patients with COPD (n = 68), stratified according to pulmonary function, and a healthy control group (n = 89). A battery of well established clinical and quality of life measures (the Sickness Impact Profile (SIP), Mood Adjective Check List (MACL), and Hospital Anxiety and Depression scale (HAD)) was used to examine in which functional and affective aspects the patient group differed from the control group and how these measures related to pulmonary function and smoking habits. RESULTS: Compared with the controls, COPD affected functional status in most areas, not just those requiring physical activity. Forty six patients with forced expiratory volume in one second (FEV1) below 50% predicted showed particularly high levels of dysfunction in ambulation, eating, home management, and recreation/ pastimes (SIP). Despite this, their level of psychosocial functioning and mood status was little different from that of the healthy controls. Among the patients, a subgroup reported substantial psychological distress, but mood status was only weakly, or not at all, related to pulmonary function. Smoking habits did not affect functional status or well being. CONCLUSIONS: Quality of life is not significantly affected in patients with mild to moderate loss of pulmonary function, possibly due to coping and/or pulmonary reserve capacity. This suggests that generic self-assessment questionnaires are of limited value for detecting the early consequences of COPD. However, in later stages of the disease they are sensitive enough to discriminate between patients with different levels of pulmonary dysfunction. The low correlations between the indices of pulmonary function and the indices of affective status suggest that well being depends, to a large extent, on factors outside the clinical domain.

Circadian rhythm of serum interleukin-6 in rheumatoid arthritis.

OBJECTIVES: To test the hypothesis of a diurnal variation in circulating levels of interleukin-6 (IL-6) and/or tumour necrosis factor-alpha (TNF-alpha) in rheumatoid arthritis and other inflammatory connective tissue diseases. METHODS: Serum levels of IL-6 and TNF-alpha were measured at three hour intervals from 7:30 to 22:30 in 48 patients with different rheumatic diseases as well as ten healthy controls. In four of the patients with rheumatoid arthritis, serum IL-6 levels were measured before and after one week of treatment with prednisolone 15-20 mg daily. RESULTS: IL-6 and TNF-alpha could not be detected in serum from healthy controls. However, serum IL-6 levels were substantially increased in patients with rheumatoid arthritis. Furthermore, patients with rheumatoid arthritis showed a statistically significant circadian variation in levels of IL-6. Peak values appeared in the morning and low values in the afternoon and evening. In contrast, levels were low and stable in other connective tissue diseases. Levels of TNF-alpha were low in patients with rheumatoid arthritis and high in patients with other connective tissue diseases, but without circadian rhythm. After treatment with prednisolone, levels of serum IL-6 decreased significantly, but the circadian rhythm remained. CONCLUSIONS: The circadian rhythm of circulating IL-6 might correspond to the circadian rhythm of symptoms in rheumatoid arthritis. The diurnal variation of IL-6, and possibly other cytokines, might explain the conflicting results previously reported on the inter-relationship between circulating IL-6 levels and disease activity in rheumatoid arthritis.

Non-invasive measurement of pulsatile vessel diameter change and elastic properties in human arteries: a methodological study.

A recently developed ultrasound phase-locked echo-tracking system makes it possible to measure non-invasive pulsatile vessel diameter changes, and, in combination with blood-pressure measurement, to calculate pressure strain elastic modulus (Ep) and stiffness (beta). The reproducibility in measurements of pulsatile diameter changes with this system was evaluated. Also the precision of indirect blood-pressure measurements, as compared to the simultaneously measured intra-arterial blood pressure was tested. The resulting reproducibility in pressure strain elastic modulus (Ep) and stiffness (beta) was evaluated. Intra-observer variabilities in measuring pulsatile diameter changes were 16% for the abdominal aorta, 10% for the common carotid artery, and 15% for the common femoral artery, respectively. Intra-observer variabilities for Ep and beta were 21% for both in the abdominal aorta, 17% for both in the common carotid artery, and 18% for both in the common femoral artery, respectively. There were only small differences in indirect and direct measurement of systolic blood pressure, whereas indirect blood pressure measurement systematically overestimated the diastolic blood pressure, on average by 20%. The variabilities in indirect blood pressure measurements were 2% for the systolic and 3% for the diastolic blood pressure, respectively. Inter-observer variability in the investigation of the common carotid artery was 10% for the pulsatile diameter changes, and 21% and 23% for Ep and beta, respectively. Thus, the echo-tracking system represents a reliable system for estimation of pressure strain elastic modulus and stiffness. However, Ep and beta are systematically underestimated by 25-30%, when used in combination with indirect blood pressure measurements.

The aerobic and anaerobic microflora of the gastric remnant more than 15 years after Billroth II resection.

The bacteriology of the gastric remnant contents was examined in 150 patients 15-20 years after Billroth II resection for duodenal ulcer disease. Samples of gastric contents were aspirated through a gastroscope, and aerobic and anaerobic microflora were cultured and analyzed semiquantitatively. All patients but one had bacterial growth, with a mean number of 6.8 strains per remnant. One third of the bacterial strains were anaerobic, and many of them had their normal habitat in the colon. The role played by bacteria of the gastric remnant in the etiology of mucosal pathology and gastric remnant disease is discussed.

Fecal bacterial flora of four nordic population groups with diverse incidence of large bowel cancer.

Fecal samples were collected and biologically examined from 4 population groups, exhibiting a 3-fold range in colon cancer incidence, in Denmark and Finland. Carrier rates and counts per gram feces of several aerobic as well as anaerobic genera, including nuclear dehydrogenase-producing clostridia, were calculated. The results obtained with the described method did not confirm a relationship between colon cancer incidence and carrier rates of intestinal bacteria.