A case of reactive arthritis secondary to sexually acquired Shigella flexneri.

We present the first documented case of reactive arthritis (ReA) secondary to sexually acquired Shigella flexneri infection. The case occurred in the context of a recent change in Shigella epidemiology in England where non-travel associated cases are now contributing the majority of diagnoses. Such non-travel associated cases are occurring predominantly in men who have sex with men with high sexual risk taking behaviour reflecting the importance of the sexual history when assessing a man with Shigella infection who has not travelled. We suggest Shigella can be thought of as a cause of sexually acquired ReA and not just a form of enteric ReA. Referral to sexual health services for further management is essential.

An integrated approach to osteoarthritis pain.

Informed therapeutic choices can help patients with osteoarthritis pain in 2 common locations-the hand and the knee-stay active.

Yoga as the "next wave" of therapeutic modalities for treatment of insomnia.

Insomnia rates continue to rise, especially among specific populations. Current nonpharmacological treatments rely primarily upon cognitive behavioral therapy for insomnia (CBT-I), which was introduced in the 1970s. Newer treatments have incorporated CBT "third wave" techniques, including mindfulness and acceptance techniques. Yoga practice is well suited to complement existing therapies and to address sleep problems in a more holistic way. Current theoretical and empirical approaches to treating insomnia are discussed, with an emphasis on the role of yoga in addressing precipitating and perpetuating factors in insomnia that have previously been largely overlooked.An estimated one-third of U.S. adults suffer from insomnia (Chen, Gelaye, & Williams, 2013; Mellinger, Balter, & Uhlenhuth, 1985; Ohayon, 2002), and the problem appears to be growing. While treatment for insomnia has helped to alleviate the problem for some (Irwin, Cole, & Nicassio, 2006; Morin et al., 2009), prevalence of insomnia is on the rise, especially among certain groups, including elderly and military populations (Morin, 2009; Mysliwiec et al., 2013). Rising rates of insomnia have been attributed to changes in lifestyle and environmental factors, including increased reliance on technology and decreased synchrony with natural wake-sleep rhythms (Brahinsky, 2013; Wallace-Guy et al., 2002; Yun, Bazar, Gerber, Lee, & Daniel, 2005).

Role of central beta-adrenergic receptors in regulating proinflammatory cytokine responses to a peripheral bacterial challenge.

Elevation of proinflammatory cytokines in the brain have potent effects on altering physiological, behavioral, and cognitive processes. The mechanism(s) by which brain cytokines are induced during a peripheral immune challenge remains unclear since microorganisms/cytokines do not cross the blood-brain barrier (BBB). Recent studies indicate that central beta-adrenergic receptors (beta-ADRs) may mediate brain interleukin-1beta (IL-1) production. This has direct implications for the production of brain cytokines during a peripheral immune response since peripheral pathogens and cytokines rapidly stimulate brainstem catecholamine neurons via peripheral nerves and circumventricular pathways. Studies here examine the role of central beta-ADRs in regulating brain cytokine production following peripheral Escherichia coli (E. coli) challenge. Rats were centrally administered propranolol (beta-ADR antagonist) or vehicle followed by peripheral E. coli or saline and sacrificed 6h later for measurement of cytokines. Pre-treatment with propranolol completely blocked the induction of brain IL-1 following E. coli. Surprisingly, central propranolol also attenuated E. coli-induced peripheral cytokines. To examine whether the attenuated peripheral cytokine response following central propranolol administration was due leakage of propranolol into the general circulation and blockade of peripheral beta-blockade, nadolol (beta-ADR antagonist that does not cross the BBB) was administered peripherally prior to E. coli. Nadolol administration did not block central cytokine production following E. coli, but instead enhanced both peripheral and central proinflammatory cytokine production. Furthermore, central administration of isoproterenol (beta-ADR agonist) results in a time-dependent increase in brain IL-1 production. These data demonstrate central beta-ADRs may play a critical role to induce brain IL-1, while peripheral beta-ADRs inhibit cytokine response to bacterial challenge.

Physiological improvements and health benefits during an exercise-based comprehensive rehabilitation program in medically complex patients.

OBJECTIVES: To determine the effects of an exercise-based comprehensive rehabilitation program on the physiological, health, and cost benefit in medically complex patients. DESIGN: Case series SETTING: Comprehensive rehabilitation centers. PARTICIPANTS: Elderly chronically ill men (n = 39, age = 75.3 +/- 1.4) and women (n = 74, age = 76.5 +/- 0.9 years). INTERVENTION: Patients participated in individualized physical therapy with therapeutic exercises (stretching, strengthening, endurance, balance, sitting and standing dynamic exercises) three times/week for three months under the supervision of a physician. MEASUREMENTS: Upper (back) and lower (leg flexors) extremity strength, aerobic power as measured by metabolic equivalents (METS) at 80% of age predicted maximal heart rate (APMHR), physical functioning and mental health as assessed by the Short Form-36 (SF-36) questionnaire, and medical events (falls, physician visits, and hospitalizations) questionnaire was collected at baseline and after three months of the program. RESULTS: Strength measures improved by approximately 30% (P < 0.05) as well as aerobic power improved by approximately 25% (P < 0.05) over the three-month period. There were significant improvements in two of the SF-36 Physical Component Scales: Physical Functioning (P < 0.05) and Role Physical (P < 0.05); plus, there were significant improvements in all four of the Mental Component Scales: Vitality (P < 0.05), Social Functioning (P < 0.05), Role Emotional (P < 0.05), and Mental Health (P < 0.05). There were significant reductions in fall rate (P < 0.05), physician visits (P < 0.05), and hospitalizations (P < 0.05). CONCLUSION: Patients improve physical capacity, which result in improvements in health status with concurrent reductions in healthcare utilization during a comprehensive rehabilitation program.

Adrenergic receptors mediate stress-induced elevations in extracellular Hsp72.

Heat-shock protein concentrations in the blood increase after exposure to a variety of stressors, including trauma and psychological stress. Although the physiological function of extracellular heat shock protein remains controversial, there is evidence that extracellular heat shock protein 72 (Hsp72) can facilitate immunologic responses. The signal(s) that mediate(s) the in vivo elevation of extracellular Hsp72 in the blood after stressor exposure remain(s) unknown. Here we report that Hsp72 increases in the circulation via an alpha1-adrenergic receptor-mediated signaling pathway. Activation of alpha1-adrenoceptors results in a rapid increase in circulating Hsp72, and blockade of alpha1-adrenoceptors prevents the stress-induced rise in circulating Hsp72. Furthermore, our studies exclude a role for beta-adrenoceptors, glucocorticoids, and ACTH in mediating stress-induced elevations in circulating extracellular Hsp72. Understanding the signals involved in elevating extracellular Hsp72 could facilitate the use of extracellular Hsp72 to bolster immunity and perhaps prevent exacerbation of inflammatory diseases during stress.

Resting cellular and physiological effects of freewheel running.

INTRODUCTION/PURPOSE: Exercise modulates many aspects of physiology. The purpose of the current experiment was to characterize the impact of regular, moderate physical activity on resting, baseline measures of cellular immunity blood lipids, and muscle enzyme. METHODS: Male Fischer 344 rats were housed with either mobile (run, N = 10) or immobile (sedentary, N = 10) running wheels. After 4 wk of running, rats were sacrificed. Blood and muscle (long and medial heads of the triceps) were collected. From blood, white blood cell (WBC) differentials, red blood cell (RBC) count, hemoglobin, hematocrit, and lipid profiles were measured. Muscle citrate synthase (CS) activity was measured by spectrophotometric analysis. RESULTS: Rats ran an average of 9.89 +/- 0.79 km.wk(-1). There were no differences in the total number of circulating WBC, RBC, or eosinophils. Freewheel running decreased the number of circulating neutrophils (P < 0.001), monocytes (P < 0.01), and basophils (P < 0.01), while increasing the number of lymphocytes (P < 0.001), when compared with sedentary animals. Mean corpuscular content of hemoglobin was elevated in the freewheel group (P < 0.01). Physically active animals had slightly lower triglycerides and LDL, and elevated HDL. These changes resulted in a significant improvement in LDL/HDL ratio (P < 0.05). Muscle CS activity was unchanged between groups. CONCLUSION: Both the alterations in the RBC hemoglobin and lipid proteins are positive health changes associated with exercise training. The impact of the alterations in WBC differentials remains unknown but could indicate a reduction in inflammatory load. In conclusion, freewheel running provides sufficient exercise stimulus to produce some, but not all, training associated physiological adaptations.

Influence of age and physical activity on the primary in vivo antibody and T cell-mediated responses in men.

The aging immune system is characterized by the progressive decline in the antibody and T cell-mediated responses to antigen. Little is known, however, about the benefits of exercise in aging on the generation of a primary immune response to antigen and the subsequent antibody and memory T cell-mediated response. Most in vivo immune research to date has utilized vaccines or recall antigens to elicit an immune response. Therefore, the purpose of this experiment was to examine the association of aging and physical activity on the primary antibody and T cell response to the novel protein antigen keyhole-limpet hemocyanin (KLH). Forty-six physically active and sedentary, young (20-35 yr) and older (60-79 yr) men were recruited. Subjects were intramuscularly immunized with 100 microg of KLH, and blood samples were collected at days 0, 7, 14, 21, and 28. Samples were measured for anti-KLH IgM, IgG, IgG1, and IgG2 by ELISA. On day 21 after intramuscular KLH administration, subjects received an intradermal injection with 1 microg of KLH of inflammation recorded at 24, 48, 72, 96, and 120 h to assess anti-KLH delayed-type hypersensitivity response. There was a significant reduction in all anti-KLH measures with aging except for anti-KLH IgG2. The physically active older group had significantly higher anti-KLH IgM, IgG, IgG1, and delayed-type hypersensitivity responses, but not IgG2 compared with the sedentary older group. In conclusion, regular physical activity in older men is associated with a more robust immune response to novel antigenic challenge.