Factors explaining variance in perceived pain in women with fibromyalgia

BACKGROUND

We hypothesized that a substantial proportion of the subjectively experienced variance in pain in fibromyalgia patients would be explained by psychological factors alone, but that a combined model, including neuroendocrine and autonomic factors, would give the most parsimonious explanation of variance in pain.

METHODS

Psychometric assessment included McGill Pain Questionnaire, General Health Questionnaire, Hospital Anxiety and Depression Rating Scale, Eysenck personality Inventory, Neuroticism and Lie subscales, Toronto Alexithymia Scale, and Multidimensional Health Locus of Control Scale and was performed in 42 female patients with fibromyalgia and 48 female age matched random sample population controls. A subgroup of the original sample (22 fibromyalgia patients and 13 controls) underwent a pharmacological challenge test with buspirone to assess autonomic and adrenocortical reactivity to serotonergic challenge.

RESULTS

Although fibromyalgia patients scored high on neuroticism, anxiety, depression and general distress, only a minor part of variance in pain was explained by psychological factors alone. High pain score was associated with high neuroticism, low baseline cortisol level and small drop in systolic blood pressure after buspirone challenge test. This model explained 41.5% of total pain in fibromyalgia patients. In population controls, psychological factors alone were significant predictors for variance in pain.

CONCLUSION

Fibromyalgia patients may have reduced reactivity in the central sympathetic system or perturbations in the sympathetic-parasympathetic balance. This study shows that a biopsychosocial model, including psychological factors as well as factors related to perturbations of the autonomic nervous system and hypothalamic-pituitary-adrenal axis, is needed to explain perceived pain in fibromyalgia patients.

New materials for ESR dosimetry

New materials for electron spin resonance (ESR) dosimetry have been investigated with the aim to find systems more sensitive than L-alanine accepted as a standard for high dose determinations. Among the investigated systems ammonium tartrate, 2-methylalanine, salts of formic acids and dithionates have been found to be more sensitive than alanine by a factor 2-10. The lower limit applies to tissue equivalent materials, while much higher sensitivities were obtained with formates and dithionates containing heavier atoms. The increased sensitivity was mainly attributed to suitable ESR properties of the room temperature stable radicals as regards spectral shape (narrow lines, little or no hyperfine structure) and microwave saturation properties (short relaxation times). The radical structures have when necessary been clarified by ENDOR spectroscopy, while the saturation properties have been screened by pulsed ESR measurements.

EPR dosimetric properties of 2-methylalanine: EPR, ENDOR and FT-EPR investigations

To find an EPR dosimeter material that is sensitive enough for clinical use, the substance 2-methylalanine (2MA) with the chemical structure (CH(3))(2)C(NH(3)(+))COO(-) was tested for its sensitivity to ionizing radiation, dose response, and radical stability over time. At equal and moderate settings of microwave power and modulation amplitude, 2MA was found to be 70% more sensitive than L-alpha-alanine, which is the most common EPR dosimeter material today. The dose response is linear, at least in the dose range of interest (0.5-00 Gy), and the time-dependent variations in signal intensity are very small and may be corrected for easily. The energy dependence of the stopping power and energy absorption was calculated and was found to be similar to that of alanine. The dependence of the signal intensity on microwave power and modulation amplitude was investigated, and the optimal settings were found to be 25 mW (Bruker ER 4102ST) and 12 gauss, respectively. Single crystals of 2MA were analyzed using ENDOR and ENDOR-induced EPR to identify the radiation-induced radicals that formed. Only one radical, in which the amino group is detached from the original molecule, was identified. This radical is obviously dominating and is apparently the only one relevant for dosimetry purposes. The complete set of coupling parameters for three hyperfine couplings is reported. The power saturation properties and spectral line width are ruled by the relaxation times T(1) and T(2). To determine the relaxation times of 2MA, pulsed EPR experiments were performed on single crystals. Two different values of T(1) were obtained, one in the range 1-3 micros, shown to be of importance for the dosimetry properties, and another that is strongly anisotropic with a value between 10 and 35 micros that does not seem to affect the saturation behavior. T(2) was estimated to be of the order of 200-300 ns.

Conformational preference and remote (1,10) stereocontrol in biphenyl-2,2'-dicarboxamides

The double ortholithiation and electrophilic quench of N,N,N'N'-tetraisopropylbiphenyl-2,2'-dicarboxamide 1 is diastereoselective, giving the chiral, C(2)-symmetric atropisomers of the 3,3'-disubstituted products 3. These chiral atropisomers can be converted with moderate to good stereoselectivity to their achiral, centrosymmetric epimers by heating. The stereoselectivity of the double lithiation-quench reaction is determined by the stereochemistry of the intermediate doubly lithiated species 2, either diastereoisomer of which may be formed stereospecfically from the corresponding atropisomeric dibromo compounds.[reaction: see text]

Honig's model of working memory and brain activation: an fMRI study

The present study investigated changes in neuronal activation with fMRI related to Honig's model of working memory, which is much less studied compared with other working memory models. In contrast to other studies which have applied recognition procedures, the primary aim with the present study was to examine brain activation when subjects had to continuously recall and forget items held in working memory. The results showed that the mid-ventrolateral frontal cortex was particularly activated in the left hemisphere, whereas the mid-dorsolateral frontal cortex was particularly activated in the right hemisphere during execution of the working memory task. The findings are discussed in relation to process- and domain-specific accounts of working memory.

Prognostic factors in major depression: a long-term follow-up study of 323 patients

BACKGROUND

Optimal long-term treatment of major depression should assess the background factors affecting remission and recurrent episodes. The duration and number of previous depressive episodes has been shown to be important for recurrence. This long-term prospective study of patients with major depression assessed the prognostic effect of variables related to childhood, social life and occupation.

METHODS

The study examined 323 patients in two follow-up examinations 12-25 years from the initial examination to the second follow-up. Stepwise logistic regression was used to evaluate the prognostic effect for depression at the second follow-up.

RESULTS

The risk of depression at the second follow-up was associated with several psychosocial factors in childhood, female gender, social isolation and a negative attitude towards one's own occupation.

LIMITATIONS

The patient group was selected from the practice of only one psychiatrist.

CONCLUSIONS

Several psychosocial factors in childhood, female gender, social isolation and a negative attitude towards one's own occupation have previously been shown to be associated with the risk of depression. The results in this study suggest that these factors are also important in predicting the outcome of a major depressive episode and the risk of recurrent episodes.

Staphylococcus aureus capsular polysaccharide type 5 conjugate and whole cell vaccines stimulate antibody responses in cattle

Dairy heifers were immunized subcutaneously with one of four different vaccines which contained preparations of Staphylococcus aureus capsular polysaccharide type 5 (CP5) and a mineral oil adjuvant, or received a placebo containing saline and adjuvant. The vaccine containing a CP5-human serum albumin conjugate (CP5-HSA) and the vaccine with formaldehyde inactivated whole cells expressing CP5, both elicited strong anti-CP5 antibody responses. After two injections three weeks apart and a third injection 10 months later, the mean level and duration of the anti-CP5 antibody response was significantly higher in the whole cell group. No differences were found between the two groups with regard to the relative proportion of IgG subclasses, and the antibody responses to the polysaccharide were composed of both the IgG1 and IgG2. Vaccines containing only free CP5 or CP5 mixed with HSA produced weak and transient humoral immune responses. Only animals vaccinated with the whole cell vaccine or the conjugate vaccine showed responses to CP5 in a lymphocyte proliferation assay conducted one year after the third vaccination. This study indicates that CP5 expressed on the surface of formaldehyde inactivated whole cells, emulsified in an oil adjuvant, gives a strong and long lasting immune response in cattle. The use of conjugation technology, although effective, might not be necessary in order to achieve an immune response against S. aureus CP5 in cattle.

Imaging the surface of Staphylococcus aureus by atomic force microscopy

The surfaces of four strains of Staphylococcus aureus, which differed in their expression of capsular polysaccharides, were examined using atomic force microscopy. The images show that it is possible to get information about surface characteristics of S. aureus using atomic force microscopy (AFM) following simple preparation. Strains Smith Diffuse (serotype 2), Reynolds (serotype 5), Wood-46 (capsule negative) and JL243 (capsule negative) were grown on medium known to promote the expression of capsular polysaccharides. The bacteria were air-dried prior to being imaged using tapping-mode AFM. Differences in the appearance of the bacterial surfaces were evident between the strains. The two capsule-negative strains exhibited a smooth regular surface, as opposed to the mucoid appearance of the two strains having polysaccharide capsules. Moreover, comparison of images of the heavily encapsulated serotype 2 strain and the serotype 5 strain indicates that a type 2 capsule can be distinguished from a type 5 microcapsule.

General practitioners' reactions to non-compliant patients

OBJECTIVE

To examine how general practitioners (GPs) respond to patients who are non-compliant with medical advice and who doctors believe act irresponsibly towards their health.

DESIGN

Quantitative analysis of responses to questionnaire with case histories.

SETTING AND SUBJECTS

93 questionnaires completed by a random stratified sample of Norwegian GPs.

MAIN OUTCOME MEASURES

Scores relating to GPs' feelings and choice of main and sub-strategies for further treatment of patients.

RESULTS

The respondents typically felt discouraged or unaffected by non-compliant patients, younger doctors more often felt helpless while older ones were more content, and female doctors more often than male doctors felt irritated or angry. The main strategy preferred was to give the patient a new appointment. The young, the inexperienced, and females tended more often to ask a colleague for advice or refer to a specialist. Patient-centred sub-strategies were generally preferred, especially by younger doctors.

CONCLUSION

GPs' feelings towards and strategies for dealing with non-compliant patients vary, and the doctor's age, sex and clinical experience are central variables.

Multiple founder effects in spinal and bulbar muscular atrophy (SBMA, Kennedy disease) around the world

SBMA (spinal and bulbar muscular atrophy), also called Kennedy disease, is an X-chromosomal recessive adult-onset neurodegenerative disorder caused by death of the spinal and bulbar motor neurones and dorsal root ganglia. Patients may also show signs of partial androgen insensitivity. SBMA is caused by a CAG repeat expansion in the first exon of the androgen receptor (AR) gene on the X-chromosome. Our previous study suggested that all the Nordic patients with SBMA originated from an ancient Nordic founder mutation, but the new intragenic SNP marker ARd12 revealed that the Danish patients derive their disease chromosome from another ancestor. In search of relationships between patients from different countries, we haplotyped altogether 123 SBMA families from different parts of the world for two intragenic markers and 16 microsatellites spanning 25 cM around the AR gene. The fact that different SBMA founder haplotypes were found in patients from around the world implies that the CAG repeat expansion mutation has not been a unique event. No expansion-prone haplotype could be detected. Trinucleotide diseases often show correlation between the repeat length and the severity and earlier onset of the disease. The longer the repeat, the more severe the symptoms are and the onset of the disease is earlier. A negative correlation between the CAG repeat length and the age of onset was found in the 95 SBMA patients with defined ages at onset.

In vitro release of interferon-gamma by trichophytin-stimulated whole blood cell cultures from ringworm-vaccinated and control calves experimentally inoculated with Trichophyton verrucosum

Of a group of seven calves, four were vaccinated against bovine ringworm with the vaccine Ringvac bovis LTF-130 (Alpharma, Oslo, Norway), while three calves were left unvaccinated. All calves were inoculated epicutaneously with a virulent strain of Trichophyton verrucosum. Clinical signs were recorded. In response to stimulation with trichophytin, in vitro interferon-gamma (IFN-gamma) production in whole blood cell cultures was assessed in samples obtained pre- and post-vaccination and pre- and post-inoculation. A commercial enzyme immunoas say kit was used to measure IFN-gamma levels (Bovigam, CSL, Victoria, Australia). Control calves developed typical ringworm lesions, whereas vaccinated calves did not. Following vaccination, release of IFN-gamma in whole blood cell cultures indicated the presence of circulating trichophytin-specific lymphocytes. After inoculation with T. verrucosum, IFN-gamma production was demonstrated in samples from both vaccinated and control calves. This study showed that vaccination with Ringvac bovis LTF-130 elicits a protective immune response suggesting involvement of the cellular branch of the immune system. Experimental infection of naïve nonvaccinated calves with T. verrucosum, also indicated stimulation of a cell-mediated immune response essential for resolution of lesions.

Planum temporale, planum parietale and dichotic listening in dyslexia

A reduction or reversal of the normal leftward asymmetry of the planum temporale (PT) has been claimed to be typical of dyslexia, although some recent studies have challenged this view. In a population-based study of 20 right-handed dyslexic boys and 20 matched controls, we have measured the PT and the adjacent planum parietale (PP) region in sagittal magnetic resonance images. For the PT, mean left and right areas and asymmetry coefficients were compared. Since a PP area often could not be identified in one or both hemispheres, a qualitative comparison was used for this region. The total planar area (sum of PT and PP) was also compared between the two groups. A dichotic listening (DL) test with consonant-vowel syllables was administered to assess functional asymmetry of language. The results showed a mean leftward PT asymmetry in both the dyslexic and the control group, with no significant difference for the degree of PT asymmetry. Planned comparisons revealed however, a trend towards smaller left PT in the dyslexic group. In control children, but not in the dyslexic children, a significant correlation between PT asymmetry and reading was observed. A mean leftward asymmetry was also found for the total planar area, with no difference between the groups for the degree of asymmetry. Significantly fewer dyslexic children than control children showed a rightward asymmetry for the PP region. Both groups showed a normal right ear advantage on the DL task, with no significant difference for DL asymmetry. No significant correlation was observed between PT asymmetry and DL asymmetry. The present population-based study adds to recent reports of normal PT asymmetry in dyslexia, but indicates that subtle morphological abnormalities in the left planar area may be present in this condition.

Case-control study of risk factors for clinical mastitis in postpartum dairy heifers

A case-control study was carried out to evaluate risk factors for clinical mastitis occurring in dairy heifers between 1 and 14 d postpartum. Case and control heifers were matched on herd; the control was the heifer that calved closest in time, before or after, the particular case. Data were analyzed by conditional logistic regression. The final multivariate model included 339 case-control pairs. Blood in the milk, udder edema, teat edema, and milk leakage, all recorded at the time of parturition, were significant risk factors. Purchased heifers and heifers with skin lesions between udder and thigh were not at increased risk of clinical mastitis. Separate analysis of a subgroup of case-control pairs identified teat edema, blood in the milk, and milk leakage at calving as risk factors for clinical mastitis caused by Staphylococcus aureus.

The effects of UV-irradiation on the ESR-dosimetry of tooth enamel

Tooth enamel has been shown to be an excellent dosimeter material for retrospective dosimetry. A complication is that it is sensitive to ultraviolet light (UV), creating a signal that interferes with the dosimetric signal. Irradiation of tooth enamel by UV-light induces a mixture of stable and unstable free radicals. The unstable radicals disappear in about three weeks. Stable radicals are created both at the dosimetric peak and at the same g-value as the native peak. The stable peak coinciding with the native peak shows saturation behavior both for UVA/B- and UVC-light. The signal intensity from the sun is roughly estimated to induce a signal comparable to 15 mGy/h from 60 kV X-rays. The blue lamps used by dentists when hardening plastic repairs contain a narrow tail in the UVA/B-region, and it is shown here that these lamps also contribute to the stable peak coincident with the native peak. The contribution to the dosimetry peak, though negligible, at least for the irradiation times is used in this work. Most of the problems with UVA/B-induced signal contributions can probably be avoided by not using front teeth and teeth close to plastic repairs.

Behaviour problems in children with dyslexia

The association between behaviour problems and dyslexia was assessed in a population sample of 10- to 12-year-old children. Twenty-five dyslexic children and a matched control group were recruited through a screening in primary schools in the city of Bergen, Norway. For the assessment of behaviour problems the Child Behavior Checklist (CBCL), Teacher Self Report (TRF), and Youth Self Report (YSR) were filled out by parents, teachers, and children, respectively. Information on health and developmental factors were obtained from parents on a separate questionnaire designed for the study. The dyslexic group had significantly more behaviour problems than the control group according to both the CBCL and the TRF. On the YSR there was no significant difference between the groups. Dyslexic children had higher CBCL and TRF scores on the Total Behaviour Problem scale, the Internalizing and Externalizing subdomains, and the Attention problem subscale. The groups differed in social background, prenatal risk factors, birth weight, preschool language problems, and IQ, but these variables showed no relationship to the level of behaviour problems in the present sample. We conclude that pre-adolescent dyslexic children show a wide range of behaviour problems that cannot be attributed to social or developmental background variables.

Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders. A study of women with random sample population controls

BACKGROUND

We compared ICD-10 psychiatric disorders in female patients with fibromyalgia (n=45) or functional dyspepsia (n=18) with age-matched random sample controls (n=49).

METHOD

Version 2 of The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used for present state examination and lifetime diagnoses.

RESULTS

Current psychiatric disorders (somatoform pain disorder and specific phobia omitted) were diagnosed in 80% of fibromyalgia patients (OR=8.3), 83% of functional dyspepsia patients (OR=10.3) and 33% controls. Among fibromyalgia patients 27% had lifetime panic disorder. Lifetime mood disorders were found in 83% of functional dyspepsia patients. First-degree relatives with psychiatric disorder were found in 16% of the fibromyalgia patients, 50% of functional dyspepsia patients and 20% of controls.

CONCLUSIONS

Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders in substantial subgroups. Psychiatric symptoms and somatic complaints are closely related in these disorders.

Characterisation of isolates of Staphylococcus aureus from acute, chronic and subclinical mastitis in cows in Norway

Eighty-six Staphylococcus aureus isolates from cases of bovine mastitis were characterised biochemically and with respect to serotype, multilocus enzyme electrophoresis genotypes, antibiotic sensitivity, and production of enterotoxins A through D (SEA-D) and toxic shock syndrome toxin-1 (TSST-1). The samples were obtained from 81 different cows from 79 Norwegian dairy herds in 10 different counties in southern Norway. There was an equal representation of isolates from cases of acute, chronic and subclinical mastitis. Multilocus enzyme electrophoresis using 13 genetic loci showed that 69 of 86 isolates had the same electrophoretic type. This common electrophoretic type comprised isolates that differed in the expression of other phenotypical characteristics studied. Fifty-eight percent of the isolates produced one or more enterotoxins, predominantly a combination of SEC and TSST-1. Capsular serotyping revealed that 95% of the isolates belonged to serotype 8. No correlation was found between the factors studied and the clinical classification of mastitis. It appears that the majority of S. aureus isolates recovered from cases of bovine mastitis in Norway are genetically closely related and express common phenotypical characteristics.

The human elongation factor 1 A-2 gene (EEF1A2): complete sequence and characterization of gene structure and promoter activity

The eukaryotic elongation factor 1 A (eEF1A, formerly EF1alpha) is a key factor in protein synthesis, where it promotes the transfer of aminoacylated tRNAs to the A site of the ribosome. Two differentially expressed isoforms of eEF1A, designated eEF1A-1 and eEF1A-2, are found in mammals. Here we report the isolation and sequencing of the gene (HGMW-approved symbol EEF1A2) coding for the human eEF1A-2 isoform. Furthermore, we characterize the gene structure and the activity of the promoter. Isolation of overlapping clones from human libraries revealed that the human eEF1A-2 gene spans approximately 10 kb and consists of eight exons. The intron-exon boundaries of human EEF1A2 and EEF1A1 are conserved, yet the gene of the eEF1A-2 isoform is larger than the eEF1A-1 gene because of enlarged introns. Primer extension analysis identified the predominant transcription start site 166 bp upstream of the AUG codon. The start site maps to an adenine located within a consensus initiator element. Sequencing of a 2-kb 5'-flanking promoter region revealed no TATA element. However, several putative cis-regulatory elements were discovered. The 5'-promoter activity was characterized by transient transfection experiments. Progressive deletions of the upstream promoter region defined a minimal promoter region, ranging from -16 to +92, that is sufficient to drive transcription.

Founder effect in spinal and bulbar muscular atrophy (SBMA) in Scandinavia

We haplotyped 13 Finnish, 10 Swedish, 12 Danish and 2 Norwegian SBMA (spinal and bulbar muscular atrophy, Kennedy disease) families with a total of 45 patients and 7 carriers for 17 microsatellite markers spanning a 25.2 cM region around the androgen receptor gene on chromosome Xq11-q12 in search of a genetic founder effect. In addition, the haplotypes of 50 Finnish, 20 Danish and 22 Swedish control males were examined. All the Scandinavian SBMA families shared the same 18 repeat allele for the intragenic GGC repeat, which was present in only 24% of the controls. Linkage disequilibrium was also seen for the closest microsatellite markers. In addition, extended haplotypes of the Finnish, Swedish and Danish SBMA families revealed country-specific common founder haplotypes, which over time became gradually shortened by recombinations. No common haplotype was found among the controls. The data suggest that the SBMA mutation was introduced into western Finland 20 generations ago. Haplotype analysis implies a common ancestor for the majority of Scandinavian SBMA patients.

Development of ammonium tartrate as an ESR dosimeter material for clinical purposes

The crystalline substance ammonium tartrate is investigated with respect to its suitability as a clinical dosimetry material. The properties investigated are: the radical stability for absorbed doses relevant for clinical use, the improvement in sensitivity when the crystals are deuterated and the linear electron transfer (LET)-dependence. After photon irradiation to an absorbed dose of 20 Gy, the signal increases rapidly during the first 6 h. After this period, the changes are more moderate and can be corrected for. The signal-to-noise ratio of irradiated ammonium tartrate is twice the corresponding value of alanine. By deuterating the crystals, the sensitivity can be further improved by a factor of 1.4. As expected, the signal decreases with increasing LET of the radiation, but no changes in the spectrum shape was observed.

Central auditory processing, MRI morphometry and brain laterality: applications to dyslexia

We review data from our laboratory related to a view of dyslexia as a biological disorder, or deficit, caused by both structural and functional brain abnormalities. The review is focused on central auditory processing in dyslexia, and the possibility that impairments in the auditory or acoustic features of the phonological code may be at the heart of the impairments seen in dyslexia. Three methodological approaches by which to investigate central auditory processing deficits are outlined: dichotic listening (DL) to consonant-vowel syllables; magnetic resonance imaging (MRI), and the use of event-related potentials (ERPs). Consonant-vowel syllable DL is a technique for probing the functional status of phonological processing areas in the superior temporal gyrus, particularly in the left hemisphere. MRI is a corresponding structural, or morphological, measure of anatomical abnormalities in the same brain region, particularly covering the planum temporale area. The ERP technique, and particularly the mismatch negativity (MMN) component, reveals cortical dysfunctions in sensory processing and memory related to basic acoustic events. For all three approaches, the dyslexic children were seen to differ from their control counterparts, including absence of modulation of the right ear advantage (REA), in DL through shifting of attention, smaller left-sided planum temporale asymmetry, and prolonged latency in the MMN ERP complex, particularly in the time-deviant stimulus condition.

Spin concentration in a possible ESR dosimeter: An electron spin echo study on X-irradiated ammonium tartrate

Several single crystals and powder samples of ammonium tartrate, recently proposed as a possible ESR dosimeter, have been X-irradiated with different doses. The total radical concentration has been determined by quantitative cw ESR, by comparison with a standard. The samples have been studied by electron spin echo spectroscopy. The two-pulse echo decay has been obtained and simulated by a single exponential function for different values of the microwave power of the pulses and for different pulse lengths. The dependence of the phase memory time TM on the microwave power has been exploited to get information on the contribution of the instantaneous diffusion to spin dephasing. At room temperature in the range of radical concentrations of 10(18)-10(19) spins/cm3 the instantaneous diffusion is the dominant spin dephasing mechanism. The linear dependence of the instantaneous diffusion on the total concentration of the radicals is in agreement with the theory. From the latter result we conclude that the average radical-radical distance corresponds to a random distribution of the radicals in the matrix. A simple method of measuring the radical concentration by the ESE decays in powder samples of irradiated ammonium tartrate is described.