Implication of low level inflammation in the insulin resistance of adipose tissue at late pregnancy

Insulin resistance is a characteristic of late pregnancy, and adipose tissue is one of the tissues that most actively contributes to the reduced maternal insulin sensitivity. There is evidence that pregnancy is a condition of moderate inflammation, although the physiological role of this low-grade inflammation remains unclear. The present study was designed to validate whether low-grade inflammation plays a role in the development of insulin resistance in adipose tissue during late pregnancy. To this end, we analyzed proinflammatory adipokines and kinases in lumbar adipose tissue of nonpregnant and late pregnant rats at d 18 and 20 of gestation. We found that circulating and tissue levels of adipokines, such as IL-1β, plasminogen activator inhibitor-1, and TNF-α, were increased at late pregnancy, which correlated with insulin resistance. The observed increase in adipokines coincided with an enhanced activation of p38 MAPK in adipose tissue. Treatment of pregnant rats with the p38 MAPK inhibitor SB 202190 increased insulin-stimulated tyrosine phosphorylation of the insulin receptor (IR) and IR substrate-1 in adipose tissue, which was paralleled by a reduction of IR substrate-1 serine phosphorylation and an enhancement of the metabolic actions of insulin. These results indicate that activation of p38 MAPK in adipose tissue contributes to adipose tissue insulin resistance at late pregnancy. Furthermore, the results of the present study support the hypothesis that physiological low-grade inflammation in the maternal organism is relevant to the development of pregnancy-associated insulin resistance.

Epitope mapping of the U1 small nuclear ribonucleoprotein particle in patients with systemic lupus erythematosus and mixed connective tissue disease

Systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD) are autoimmune illnesses characterized by the presence of high titers of autoantibodies directed against a wide range of 'self ' antigens. Proteins of the U1 small nuclear ribonucleoprotein particle (U1 snRNP) are among the most immunogenic molecules in patients with SLE and MCTD. The recent release of a crystallized U1 snRNP provides a unique opportunity to evaluate the effects of tertiary and quaternary structures on autoantigenicity within the U1 snRNP. In the present study, an epitope map was created using the U1 snRNP crystal structure. A total of 15 peptides were tested in a cohort of 68 patients with SLE, 29 with MCTD and 26 healthy individuals and mapped onto the U1 snRNP structure. Antigenic sites were detected in a variety of structures and appear to include RNA binding domains, but mostly exclude regions necessary for protein-protein interactions. These data suggest that while some autoantibodies may target U1 snRNP proteins as monomers or apoptosis-induced, protease-digested fragments, others may recognize epitopes on assembled protein subcomplexes of the U1 snRNP. Although nearly all of the peptides are strong predictors of autoimmune illness, none were successful at distinguishing between SLE and MCTD. The antigenicity of some peptides significantly correlated with several clinical symptoms. This investigation implicitly highlights the complexities of autoimmune epitopes, and autoimmune illnesses in general, and demonstrates the variability of antigens in patient populations, all of which contribute to difficult clinical diagnoses.

Aspiration and swallowing in Parkinson disease and rehabilitation with EMST: a randomized trial

OBJECTIVE

Dysphagia is the main cause of aspiration pneumonia and death in Parkinson disease (PD) with no established restorative behavioral treatment to date. Reduced swallow safety may be related to decreased elevation and excursion of the hyolaryngeal complex. Increased submental muscle force generation has been associated with expiratory muscle strength training (EMST) and subsequent increases in hyolaryngeal complex movement provide a strong rationale for its use as a dysphagia treatment. The current study's objective was to test the treatment outcome of a 4-week device-driven EMST program on swallow safety and define the physiologic mechanisms through measures of swallow timing and hyoid displacement.

METHODS

This was a randomized, blinded, sham-controlled EMST trial performed at an academic center. Sixty participants with PD completed EMST, 4 weeks, 5 days per week, for 20 minutes per day, using a calibrated or sham, handheld device. Measures of swallow function including judgments of swallow safety (penetration-aspiration [PA] scale scores), swallow timing, and hyoid movement were made from videofluoroscopic images.

RESULTS

No pretreatment group differences existed. The active treatment (EMST) group demonstrated improved swallow safety compared to the sham group as evidenced by improved PA scores. The EMST group demonstrated improvement of hyolaryngeal function during swallowing, findings not evident for the sham group.

CONCLUSIONS

EMST may be a restorative treatment for dysphagia in those with PD. The mechanism may be explained by improved hyolaryngeal complex movement.

CLASSIFICATION OF EVIDENCE

This intervention study provides Class I evidence that swallow safety as defined by PA score improved post EMST.

Role of aeroallergen nasal challenge in asthmatic children

BACKGROUND

The majority of allergic asthmatic patients are sensitised to several aeroallergens. Discrimination of the clinically relevant allergen is essential for the correct use of immunotherapy.

OBJECTIVE

To investigate nasal challenge and its role in screening clinically relevant allergens in asthmatic children.

METHODS

Aeroallergen nasal challenge was performed in five different groups of patients (asthma; asthma & rhinitis; rhinitis; atopic controls; and non-atopic controls). Differences between groups after challenge were evaluated by means of spirometry and acoustic rhinometry.

RESULTS

Nasal challenge was performed in 125 patients, 25 per group. The positive nasal response of immediate type was recorded in 21 patients with asthma only (P<0.001), 18 with asthma and rhinitis (P<0.001), 19 with rhinitis (P<0.001), two atopic control patients and in no healthy control patients. However, no differences were observed between the asthma group and the groups with rhinitis symptoms. The risk of a positive challenge was much higher in the asthma without rhinitis group compared to atopic controls (OR 29.57; 95%CI: 5.47-159.97).

CONCLUSION

Aeroallergen nasal challenge is a safe technique in asthmatic children and could be useful in establishing the clinically relevant allergen even in the absence of rhinitis.

Cuban healthcare providers in Venezuela: a case study

Approximately 31,000 Cuban healthcare providers reside in Venezuela as part of an initiative to increase Venezuelans' access to health care. The concept began in 1999 as part of the new constitution, and has grown steadily to include 6000 clinics, health promotion and prevention programmes, an integrated healthcare system, and a vision to train and deploy community public health physicians selected from and trained within the neighbourhood. In the case study described herein, physician-patient consultations increased from 3.5 million to 17 million, and the numbers of primary care physicians, nurses and dentists increased dramatically. Furthermore, in Caracas, there has been a 30% reduction in the use of emergency rooms at public hospitals. Estimates are provided for preventive services and potential lives saved. As health care is a politically-laden issue in many countries, all approaches to reducing healthcare disparities are worth analysing for their potential contributions to population health improvement.

An MMPI-Based Behavior Descriptor/Personality Trait List

Descriptive terms associated with elevated MMPI scales were abstracted from 10 MMPI reference works. Those corresponding to the 300-word Gough Adjective Check List were retained to construct a new behavior descriptor/personality trait list.