Association Between Hamstring Shortness and Asymmetry, Pain Intensity, Disability Index, and Compensatory Lumbar Movement in 60 Patients with Nonspecific Chronic Low Back Pain

BACKGROUND The correlation between hamstring muscle shortening and nonspecific low back pain and compensatory lumbar movements is still controversial. The purpose of this study was to evaluate the association between hamstring shortness and asymmetry, pain intensity, the disability index, and compensatory lumbar movement in 60 patients with nonspecific chronic low back pain. MATERIAL AND METHODS Sixty patients with nonspecific low back pain participated in this study. The hamstring shortness and asymmetry, pain intensity, the disability index, and compensatory lumbar movement of the patients were assessed. The pain intensity was evaluated using a numeric pain rating scale (NPRS), active knee extension testing was performed to measure the length of the hamstring, and compensatory lumbar movement was assessed using a digital dual inclinometer. Correlation analysis was used for analysis of the obtained data. RESULTS The hamstring length showed a negative correlation with hamstring length asymmetry, NPRS, and disability index (P<0.05). The asymmetry of the hamstring length was positively correlated with NPRS, disability index, and compensatory lumbar rotation (P<0.05). Lumbar flexion was positively correlated with the hamstring muscle length (P<0.05). However, there was a negative correlation between the hamstring length asymmetry, NPRS, and disability index (P<0.05). There was no correlation between the compensatory lumbar rotation, hamstring length, or disability index. CONCLUSIONS Compensatory flexion movements, NPRS, and disability index in patients with nonspecific chronic low back pain were associated with hamstring shortness and asymmetry. These factors should be considered when planning physical therapy for patients with nonspecific low back pain.

Comparison of compensatory lumbar movement in participants with and without non-specific chronic low back pain: A cross-sectional study

BACKGROUND

Many studies have compared muscle length and muscle activity for low back pain. However, compensatory movement for non-specific low back pain has not yet been studied sufficiently.

OBJECTIVE

The purpose of this study was to compare the length of the hip flexor, lumbar extensor endurance and the muscle activity of the erector spinae and gluteus maximus during hip extension, and the compensatory movement of the lumbar in people with or without nonspecific chronic low back pain.

METHODS

In this case-control study, 16 participants with non-specific chronic LBP and 17 without LBP were included. Hip flexor length was assessed by the modified Thomas test. Lumbar extensor endurance was assessed by the modified Biering-Sorensen test. Muscle activity of the erector spinae and gluteus maximus during hip extension was measured using a Delsys-Trigno wireless EMG system. Compensatory lumbar movements during hip extension were measured using a digital inclinometer.

RESULTS

Muscle activity of the erector spinae and compensatory lumbar movements were significantly higher in the LBP group. (p< 0.05). Hip flexor length, muscle activity of the gluteus maximus and endurance of the lumbar extensor were significantly differences in the LBP group (p< 0.05).

CONCLUSIONS

Shortened hip flexors, low gluteus maximus activity, and high erector spinae activity during hip extension, lumbar extensor weak endurance, lumbar compensatory movement are potential factors for non-specific LBP.

Bone mineral density among Korean females aged 20-50 years: influence of age at menarche (The Korea National Health and Nutrition Examination Survey 2008-2011)

To evaluate a possible correlation between bone mineral density (BMD) and age at menarche, the present study used the BMD dataset of the Korea National Health and Nutrition Examination Survey IV-V (KNHANES IV-V). Age at menarche had a small but significant association with BMD of the lumbar spine in premenopausal Korean females, aged 20-50 years.

INTRODUCTION

To investigate any correlation between bone mineral density (BMD) and age at menarche in Korean females using data from the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V; 2008-2011).

METHODS

In total, 37,753 individuals participated in health examination surveys between 2008 and 2011. A total of 5032 premenopausal females aged 20-50 years were eligible. Age, height, weight, and age at menarche were assessed.

RESULTS

Results from the univariate linear regression and analysis of covariance (ANCOVA) indicated that age (per 1 year), height (per 1 cm), weight (per 1 kg), exercise (per 1 day/week), familial osteoporosis history (yes), parity (n = 0 to ≥4), and menarche age distribution were associated with BMD of the total femur, femur neck, and lumbar spine. After stratifying the bone area and adjusting for age, parity, alcohol intake, smoking, exercise, and familial osteoporosis history, no effect was seen for the total femur or femur neck. Age at menarche 16~17 and ≥18 years groups were associated with BMD of the lumbar spine only.

CONCLUSIONS

Age at menarche had a small but significant association with BMD of the lumbar spine in premenopausal Korean females, aged 20-50 years. Females with late menarche may achieve lower peak bone mass at some skeletal sites, which may put them at greater risk for osteoporosis in later life.

Ectopic pregnancy occurring in the remnant tube of a previous adnexectomy: a case report

Ectopic pregnancy occurring in the same region is a comparatively rare disease, but sometimes it is very serious to patients if it is delayed. The authors present a case of spontaneous ectopic pregnancy occurring in the ipsilateral salpingectomy stump of a previous adnexectomy that was successfully removed via laparoscopic surgery without complication. This case may support the idea of intrauterine transmigration of a fertilized egg as an etiology of spontaneous ectopic pregnancy. Thus, the potential for ectopic pregnancy in the tubal remnant in cases of previous salpingectomy or adnexectomy needs to be carefully considered.

Effects of β-Glucan on the Release of Nitric Oxide by Macrophages Stimulated with Lipopolysaccharide

This research analyzed the effect of β-glucan that is expected to alleviate the production of the inflammatory mediator in macrophagocytes, which are processed by the lipopolysaccharide (LPS) of Escherichia. The incubated layer was used for a nitric oxide (NO) analysis. The DNA-binding activation of the small unit of nuclear factor-κB was measured using the enzyme-linked immunosorbent assay-based kit. In the RAW264.7 cells that were vitalized by Escherichia coli (E. coli) LPS, the β-glucan inhibited both the combatant and rendering phases of the inducible NO synthase (iNOS)-derived NO. β-Glucan increased the expression of the heme oxygenase-1 (HO-1) in the cells that were stimulated by E. coli LPS, and the HO-1 activation was inhibited by the tin protoporphyrin IX (SnPP). This shows that the NO production induced by LPS is related to the inhibition effect of β-glucan. The phosphorylation of c-Jun N-terminal kinases (JNK) and the p38 induced by the LPS were not influenced by the β-glucan, and the inhibitory κB-α (IκB-α) decomposition was not influenced either. Instead, β-glucan remarkably inhibited the phosphorylation of the signal transducer and activator of transcription-1 (STAT1) that was induced by the E. coli LPS. Overall, the β-glucan inhibited the production of NO in macrophagocytes that was vitalized by the E .coli LPS through the HO-1 induction and the STAT1 pathways inhibition in this research. As the host immune response control by β-glucan weakens the progress of the inflammatory disease, β-glucan can be used as an effective immunomodulator.

Decreased Bcl-6 and increased Blimp-1 in the peritoneal cavity of patients with endometriosis

PURPOSE OF INVESTIGATION

The authors investigated the expression patterns of interleukin (IL)-lβ and tumor necrosis factor (TNF)-α, cytokines associated with peritoneal inflammatory reactions, and of B cell leukemia lymphoma (Bcl)-6 and B lymphocyte inducer of maturation program (Blimp)-1, transcriptional factors associated with immunoglobulin (Ig) production; the concentrations of Igs, and their correlation, in patients with and without endometriosis.

MATERIALS AND METHODS

The authors analyzed the peritoneal fluid of 98 patients, 46 with endometriosis, and 52 with benign tumors.

RESULTS

IL-1 and TNF-α mRNAs and IgG and IgA concentrations were higher in the endometriosis group, but the differences were not statistically significant. However, Bcl-6 mRNA level was significantly lower and Blimp-1 mRNA level was significantly higher in the endometriosis group with significant correlations among transcriptional factors, Igs, and cytokines (p < 0.05).

CONCLUSION

Peritoneal immune responses in patients with endometriosis may be due to increased IgG and IgA concentrations, as well as to changes in expression of proinflammatory cytokines and transcriptional factors.

Paraneoplastic arthritis mimicking rheumatoid arthritis in cervical cancer

Paraneoplastic arthritis, a subcategory ofparaneoplastic syndrome, presents in a similar manner to rheumatic disorder and usually precedes the detection of the primary tumor by years. Herein, the authors report a case of a patient who was diagnosed with parane- oplastic rheumatoid arthritis (RA)-like arthritis with synchronous cervical cancer. A 38-year-old nulligravida woman was admitted to the gynecology department with a three-month history of irregular vaginal spotting accompanied by severe multiple joint pain. She had a one-year history of RA, for which she had been receiving treatment. During the early stage of treatment, her symptoms were slightly improved by RA treatment; however, after eight months of treatment, she showed absolute resistance to RA treatments and complained of a profuse vaginal discharge with severe foul odor. After colposcopy-directed punch biopsy, she was diagnosed with Stage IIA2 squamous cell carcinoma of the cervix. She underwent radical hysterectomy with lymphadenectomy without complications. After treatment, the multiple joint pain associated with paraneoplastic arthritis spontaneously disappeared. There was no evidence of malignancy according to the follow-up cervical cytology report, magnetic resonance imaging, and positron emission tomography-computed tomography.

Attitudes and practices of Korean gynecologists towards hormone replacement therapy in endometrial cancer survivors

PURPOSE

To investigate the attitudes of Korean gynecologists towards prescribing hormone replacement therapy (HRT) after treatment for endometrial cancer.

MATERIALS AND METHODS

A questionnaire, addressing attitudes towards HRT and treatment strategies for patients previously treated for endometrial cancer, was distributed to 163 Korean gynecologists.

RESULTS

Of the 163 gynecologists that were sent this questionnaire, 98 (60.1%) responded. Among the respondents, 81 (82.7%) had previously prescribed HRT to patients with endometrial cancer. Of the latter, 75 (92.6%) had prescribed HRT to patients with Stage I, and more than half to patients with Stage II, endometrial cancer. Of the respondents who had prescribed HRT, 33 (40.7%) did so without regard for cancer-cell type and 33 (40.7%) began patients on HRT more than two years after endometrial cancer treatment. Tibolone was the most commonly prescribed drug (61.9%). The most common reason not to prescribe HRT was fear of cancer recurrence (38.1%).

CONCLUSION

Most of the Korean gynecologists surveyed had experience prescribing HRT to endometrial cancer patients. Although HRT is not actively recommended, HRT given post-therapy to endometrial cancer patients is considered acceptable.

Cerebral aging: integration of brain and behavioral models of cognitive function

There are substantial declines in behavioral measures of cognitive function with age, including decreased function of executive processes and long-term memory. There is also evidence that, with age, there is a decrease in brain volume, particularly in the frontal cortex. When young and older adults perform cognitive tasks that depend heavily on frontal function, neuroimaging evidence indicates that older adults recruit additional brain regions in order to perform the tasks. This additional neural recruitment is termed “dedifferentiation,” and can take multiple forms. This recruitment of additional neural tissue with age to perform cognitive tasks was not reflected in the behavioral literature, and suggests that there is more plasticity in the ability to organize brain function than was previously suspected. We review both behavioral and neuroscience perspectives on cognitive aging, and then connect the findings in the two areas. From this integration, we suggest important unresolved questions and directions for future research.

β-Amyloid burden in healthy aging: regional distribution and cognitive consequences

OBJECTIVE

Several lines of evidence suggest that pathologic changes underlying Alzheimer disease (AD) begin years prior to the clinical expression of the disease, underscoring the need for studies of cognitively healthy adults to capture these early changes. The overall goal of the current study was to map the cortical distribution of β-amyloid (Aβ) in a healthy adult lifespan sample (aged 30-89), and to assess the relationship between elevated amyloid and cognitive performance across multiple domains.

METHODS

A total of 137 well-screened and cognitively normal adults underwent Aβ PET imaging with radiotracer (18)F-florbetapir. Aβ load was estimated from 8 cortical regions. Participants were genotyped for APOE and tested for processing speed, working memory, fluid reasoning, episodic memory, and verbal ability.

RESULTS

Aβ deposition is distributed differentially across the cortex and progresses at varying rates with age across cortical brain regions. A subset of cognitively normal adults aged 60 and over show markedly elevated deposition, and also had a higher rate of APOE ε4 (38%) than nonelevated adults (19%). Aβ burden was linked to poorer cognitive performance on measures of processing speed, working memory, and reasoning.

CONCLUSIONS

Even in a highly selected lifespan sample of adults, Aβ deposition is apparent in some adults and is influenced by APOE status. Greater amyloid burden was related to deleterious effects on cognition, suggesting that subtle cognitive changes accrue as amyloid progresses.

Aggressive angiomyxoma of the vulva treated by using a gonadotropin-releasing hormone agonist: a case report

A rare case of a 38-year-old woman with progesterone receptor-positive aggressive angiomyxoma is presented. She underwent local excision and was treated with a gonadotropin-releasing hormone agonist as adjuvant therapy, and is free of disease 20 months after.

Antimicrobial resistance of Staphylococcus from otorrhea in chronic suppurative otitis media and comparison with results of all isolated Staphylococci

Staphylococcus is one of the most important pathogenic bacteria in chronic suppurative otitis media (CSOM). The prevalence of pathogenic bacteria in patients with CSOM has not been compared with the prevalence rates in patients from other fields of medicine. We investigated the pathogenic bacteria in CSOM throughout Korea and annual isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) over 6 years. Routine culture results and susceptibility data of CSOM isolated from 2000 to 2005 were collected from six general hospitals in Korea, along with the results of all clinically isolated Staphylococci from one tertiary care teaching hospital. Of the 1,162 bacteria identified in 1,360 CSOM patients, 628 (54.0%) were Staphylococci in CSOM. Of the latter, 288 (45.9%) were MRSA, which accounted for 24.8% of identified bacteria. Of the 5,988 clinically isolated Staphylococci from one tertiary care hospital, 3,712 (61.9%) were MRSA. All MRSA isolated from CSOM patients were sensitive to vancomycin and teicoplanin, and 88.2% were sensitive to sulfamethoxazole/trimethoprim. In contrast, these strains showed little or no sensitivity to oxacillin, clindamycin, penicillin, and erythromycin. Annual MRSA isolation rates showed no tendencies to increase or decrease. MRSA was the most frequently identified Staphylococcus in patients with otorrhea. The isolation rate of MRSA has not changed over 6 years. Continuous and periodic surveillance of MRSA is necessary to reduce the spread of antibiotic-resistant pathogens and to guide appropriate antibacterial therapy.

Weighted centroid neural network for edge preserving image compression

An edge preserving image compression algorithm based on an unsupervised competitive neural network is proposed. The proposed neural network, the called weighted centroid neural network (WCNN), utilizes the characteristics of image blocks from edge areas. The mean/residual vector quantization (M/RVQ) scheme is utilized in this proposed approach as the framework of the proposed algorithm. The edge strength of image block data is utilized as a tool to allocate the proper code vectors in the proposed WCNN. The WCNN successfully allocates more code vectors to the image block data from edge area while it allocates less code vectors to the image black data from shade or non-edge area when compared to conventional neural networks based on VQ algorithm. As a result, a simple application of WCNN to an image compression problem gives improved edge characteristics in reconstructed images over conventional neural network based on VQ algorithms such as self-organizing map (SOM) and adaptive SOM.

Molecular and morphological characterization of Pyricularia and allied genera

The phylogenetic relationships of Pyricularia species and species from related genera were established from sequences of the internal transcribed spacer ribosomal RNA gene. Phylogenetic analysis disclosed a consistent correlation with spore morphology. Most Pyricularia species studied, and two species of Dactylaria that have obpyriform conidia, fell within the Magnaporthaceae cluster with high bootstrap support. Pyricularia variabilis was more related to Dactylaria, Tumularia or Ochroconis species than to the Magnaporthaceae. Dactylaria and species of Nakataea, Ochroconis, Pyriculariopsis and Tumularia were distinct from the Magnaporthaceae, and the genus Dactylaria is polyphyletic. The combination of morphological and molecular characters, such as spore morphology and ITS ribosomal DNA sequences data, suggested that conidial shape could be a primary character to distinguish Pyricularia from related genera.

Cell cycle regulatory protein expression profiles by adenovirus p53 infection in human papilloma virus-associated cervical cancer cells

PURPOSE

The tumor suppressor gene, p53, has been established as an essential component for the suppression of tumor cell growth. In this study, we investigated the time-course anticancer effects of adenoviral p53 (Adp53) infection on human ovarian cancer cells to provide insight into the molecular-level understanding of the growth suppression mechanisms involved in Adp53-mediated apoptosis and cell cycle arrest.

MATERIALS AND METHODS

Three human cervical cancer cell lines (SiHa, CaSki, HeLa and HT3) were used. The effect of Adp53 infection was studied via cell count assay, cell cycle analysis, FACS, Western blot and macroarray assay.

RESULTS

Adp53 exerts a significant role in suppressing cervical cancer cell growth. Adp53 also showed growth inhibitory effects in each cell line, and it induced apoptosis and cell cycle arrest. Adp53 differentially regulated the expression of genes and proteins, and the gene expression profiles in the SiHa cells revealed that the p21, p53 and mdm2 expressions were significantly up-regulated at 24 and 48 hr. Western blot shows that the p21 and p53 expression-levels were significantly increased after Adp53 infection. In addition, in all cell lines, both the CDK4 and PCNA protein expression levels were decreased 48 h after Adp53 infection. Cell cycle arrest at the G1 phase was induced only in the SiHa and HeLa cells, suggesting that exogenous infection of Adp53 in cancer cells was significantly different from the other HPV-associated cervical cancer cells.

CONCLUSION

Adp53 can inhibit cervical cancer cell growth through induction of apoptosis and cell cycle arrest, as well as through the regulation of the cell cycle-related proteins. The Adp53-mediated apoptosis can be employed as an advanced strategy for developing preferential tumor cell-specific delivery.

Relationships within the Proteobacteria of plant pathogenic Acidovorax species and subspecies, Burkholderia species, and Herbaspirillum rubrisubalbicans by sequence analysis of 16S rDNA, numerical analysis and determinative tests

Sequence data for 16S rDNA of the type strains of Acidovorax avenae subsp. avenae, A. avenae subsp. cattleyae, A. avenae subsp. citrulli, A. konjaci and Herbaspirillum rubrisubalbicans were compared with GenBank library accessions of Burkholderia spp., Comamonas sp., Ralstonia solanacearum and Variovorax sp. Maximum Parsimony analysis produced two clusters: 1. Acidovorax spp., Comamonas sp., and Variovorax sp. (all in the Comamonadaceae), and 2. Burkholderia spp., Ralstonia solanacearum, and Herbaspirillum rubrisubalbicans. Maximum Likelihood analysis produced only one cluster (of the Comamonadaceae). Using nutritional and laboratory tests, all Acidovorax spp., Burkholderia spp., and Herbaspirillum rubrisubalbicans were discriminated in distinct clusters at the species level, and could be identified by selected determinative tests. There were no phenotypic tests constituted as a circumscription of the genera and which permitted the allocation of strains to genera. Strain identification as species allowed allocation to genera only by inference. The nomenclatural implications of these data are discussed.

Implementation intentions and facilitation of prospective memory

Forming detailed implementation intentions for a future behavior can increase the probability that the behavior is actually completed. We investigated whether this intention effect could be used to improve prospective memory in older adults. As expected, participants who formed an implementation intention were more than twice as likely to self-initiate the intended behavior (writing down the day of the week on every sheet of paper received during the experiment) compared with participants who either were merely instructed to do so or actively rehearsed the instruction. Forming an implementation intention, however did not improve performance on a task that required a response to salient cues. We conclude that detailed implementation intentions facilitate prospective memory on tasks that lack salient cues and require self-initiation.

Effects of seasoning and heating device on mutagenicity and heterocyclic amines in cooked beef

Pan-roasted beef showed a lower mutagenicity after various degrees of cooking than charcoaled one. The high mutagenicity of charcoaled beef was due to the formation of more heterocyclic amines, especially AalphaC (2-amino-9H-pyrido- [2,3-b]indole) and PhIP (2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine) because of rapid and direct heating on the surface of the meat at a high temperature. Seasoning decreased mutagenicity of pan-roasted beef except the very well done sample with unchanged heterocyclic amine contents, but increased mutagenicity of charcoaled beef with decreased levels of AalphaC and PhIP, probably due to the change of heterocyclic amine precursors or alternatively to the occurrence of other mutagens.

Cognitive function in fibromyalgia patients

OBJECTIVE

To evaluate fibromyalgia (FM) patients for the presence of cognitive deficits and to test the hypothesis that abnormalities would fit a model of cognitive aging.

METHODS

We studied 3 groups of patients: FM patients without concomitant depression and in the absence of medications known to affect cognitive function (n = 23), age- and education-matched controls (n = 23), and education-matched older controls who were individually matched to be 20 years older (+/- 3 years) than the FM patients (n = 22). We measured speed of information processing, working memory function, free recall, recognition memory, verbal fluency, and vocabulary. We correlated performance on cognitive tasks with FM symptoms, including depression, anxiety, pain, and fatigue. We also determined if memory complaints were correlated with cognitive performance.

RESULTS

As expected, older controls performed more poorly than younger controls on speed of processing, working memory, free recall, and verbal fluency. FM patients performed more poorly than age-matched controls on all measures, with the exception of processing speed. FM patients performed much like older controls, except that they showed better speed of processing and poorer vocabulary. Impaired cognitive performance in FM patients correlated with pain complaints, but not with depressive or anxiety symptoms. FM patients reported more memory problems than did the older and younger controls, and these complaints correlated with poor cognitive performance.

CONCLUSION

Cognitive impairment in FM patients, particularly memory and vocabulary deficits, are documented in the study. Nevertheless, the intact performance on measures of information processing speed suggests that the cognitive deficits are not global. FM patients' complaints about their memory are likely to be legitimate, since their memory function is not age appropriate.

Cognitive dysfunction in fibromyalgia

Fibromyalgia is a puzzling syndrome of widespread musculoskeletal pain. In addition to pain, patients with fibromyalgia frequently report that cognitive function, memory, and mental alertness have declined. A small body of literature suggests that there is cognitive dysfunction in fibromyalgia. This article addresses several questions that physicians may have regarding cognitive function in their patients. These questions concern the types of cognitive tasks that are problematic for patients with fibromyalgia, the role of psychological factors such as depression and anxiety, the role of physical factors such as pain and fatigue, the nature of patients' perceptions of their cognitive abilities, and whether patients can be tested for cognitive dysfunction. Critical areas for further investigation are highlighted.

MRI features of infarcts with potential cardiac source of embolism in the Yonsei Stroke Registry (YSR), Korea

The determination of the embolic source is crucial to understanding the pathogenesis of ischemic stroke, the initiation of appropriate therapy, and the prevention of recurrent infarctions. In this study we undertook to identify the characteristic features on magnetic resonance images of patients who had suffered from stroke due to cardiac embolism (CE), as classified by TOAST (possible and probable). We retrospectively studied magnetic resonance imaging (MRI) findings of patients with ischemic stroke from the Yonsei Stroke Registry (YSR). On the basis of the TOAST classification, 92 patients were identified to have a potential cardiac source of embolism (PCSE), in which 69 patients were found to have high-risk PCSE and 23 patients medium-risk PCSE. To compare their imaging characteristics, another group of 49 patients who were found to have had a stroke due to large artery-to-artery (ATA) embolism-common or internal carotid artery (CCA, ICA)-were identified. Involvement of the simultaneous superficial and deep territories (58.7%; 6.1%, p < 0.001), and combined new anterior and old posterior circulation (15.2%; 2.0%, p = 0.016) were more frequent in PCSE than ATA embolism. Bilateral anterior hemispheric involvement was also more frequent in the PCSE group, but it did not reach statistical significance (13.0%; 4.1%, p = 0.090). ATA embolism tended to involve only superficial territories compared to PCSE (71.4%; 28.3%, p < 0.001). There were no topographic differences between the high-risk and medium-risk groups. With respect to the etiology of PCSE in our population, atrial fibrillation was the most common. Characteristic MRI features of patients with PCSE, which were not documented previously by computed tomography (CT) included: old and new, involvement of multiple different vascular territories, bilateral anterior hemisphere, as well as anterior and posterior circulation. These MRI features, together with simultaneous superficial and deep territorial involvement, help to differentiate the underlying embolic sources, whether they are cardiac or ATA in origin.

Do cognitive processes predict mental health in individuals with rheumatoid arthritis?

The purpose of the present study was to assess the hypothesis that intellectual functioning affects the mental health of individuals with rheumatoid arthritis. Structural equation modeling techniques were used to assess the relative contributions of age, education, intellectual functioning, self-efficacy, and pain to mental health. It was hypothesized that individuals with rheumatoid arthritis who had higher intellectual functioning and higher self-efficacy would report better mental health than those with lower intellectual functioning and self-efficacy. One hundred twenty-one adults aged 34 to 84 with rheumatoid arthritis completed a battery of cognitive tasks, and multiple measures of self-efficacy, pain, and mental health, twice in 1 month. The data provided a good fit to the hypothesized model. Intellectual functioning was directly related to mental health and, also, indirectly related to mental health through self-efficacy and pain. Older individuals who performed poorly on cognitive tasks reported less self-efficacy, more pain, and poorer mental health than those individuals who performed well on cognitive tasks.

Judgments about estrogen replacement therapy: the role of age, cognitive abilities, and beliefs

This study investigated age, cognitive abilities, health beliefs, and other factors in women's judgments about effective treatments for menopause. Women (N = 102) ranging in age from 20 to 79 read a vignette about a woman facing a decision about Estrogen Replacement Therapy (ERT) and then made judgments about what should be done. Participants also completed a battery of questions pertaining to ERT and cognitive abilities. Path-analytic techniques were used to determine the role of specific cognitive abilities and the representation of menopause and its treatment in making judgments about ERT treatments. Cognitive abilities had direct effects on treatment decisions. Education affected the number of perceived options for treatment. Age and education indirectly affected treatment decisions, operating through cognitive abilities. Factors related to the mental representation of menopause had no direct effects and few indirect effects on treatment decisions. Potential mechanisms that can help older adults compensate for declines in cognitive abilities in medical decisions are discussed.

Antitumor effect of GnRH agonist in epithelial ovarian cancer

OBJECTIVE

The effects of the gonadotropin releasing hormone (GnRH) agonist (D-Trp(6)) were examined in two human ovarian cancer cell lines and in severe combined immune deficiency (SCID) mice to evaluate its potential as a cytocidal, cytostatic, or differentiating antitumor agent.

METHODS

We treated the human ovarian cancer cell lines OVCAR-3 and SKOV-3 for 5 or 7 days and sex-matched SCID mice with GnRH agonist for 29 days. The antitumor effect of GnRH agonist were studied in various aspects. To confirm the antiproliferative effect, we used 3-(4,5-dimethylthiazol-2-yl) -2,5-diphenyltetrazolium bromide colorimetric assay, in vitro, and a serial measurement of tumor growth in vivo. The disturbances of progression in the cell cycle and the changes of cyclin-dependent kinase 1 following treatment with GnRH agonist were evaluated with flow cytometric analysis in vitro. The induction of apoptosis following treatment with GnRH agonist was studied using in situ terminal deoxyribonucleotidyl transferase (Tdt) and further quantitated with ELISA in vitro. The presence of telomerase activity following treatment with GnRH agonist was measured by PCR-based telomeric repeat amplification protocol and ELISA detection in cell lines and xenografts in vitro and in vivo.

RESULTS

Continuous exposure of cell lines and xenografts to GnRH agonist resulted in growth inhibition of cancer cells in a dose- and time-dependent manner. In cultured cells, the GnRH agonist blocked cell cycle progression in G0/G1 phase and thus reduced the number of cells in S and G2/M phases. The phenomenon of apoptosis was documented in cultured cells treated with GnRH agonist by in situ Tdt assay. The frequency of apoptotic cells in the in situ Tdt assay was 5-6% compared with control, 4-5%. Apoptosis quantified by ELISA revealed a high incidence in cultured cells treated with GnRH agonist. The activities of telomerase in cell lines and xenografts were not decreased by GnRH agonist. There were not any significant changes of expression of CA-125 by flow cytometry and of the cellular morphology observed with light microscopy.

CONCLUSIONS

Our results indicate that the antiproliferative effect of GnRH agonist in epithelial ovarian cancer cells may be mainly attributed to cytostatic activities resulting in blocking of cell cycle progression in the G0/G1 phase and minimally related to the induction of apoptosis.

Memory for news in young and old adults

Memory for news stories was studied in 48 young and 48 old adults (20-40 and 60-80 years of age, respectively). Three stories selected from actual news programs were presented in print, audio, and TV formats for study. Young adults recalled a higher proportion of news content than old adults and performed better on source recognition tests. Presentation of the information in a TV format led to better performance than in an audio format for both young and old adults. Hierarchical regression analysis revealed that approximately 86% of the age-related variance in news recall was mediated by measures of sensory acuity and processing speed, and commonality analysis revealed that 75% of the age-related variance was mediated jointly by acuity and speed. Findings support common-cause and generalized slowing views of memory impairment in old age.

Cell cycle arrest in endometrial carcinoma cells exposed to gonadotropin-releasing hormone analog

Gonadotropin-releasing hormone (GnRH) has been shown to have an inhibitory effect on the growth of several hormone-dependent human tumors. We have treated a human endometrial cancer cell line which expresses GnRH receptor with GnRH analog, D-Trp6-LHRH, in order to study whether there are differences in cell cycle kinetic response. Flow cytometric analysis revealed that cultured carcinoma cells showed a cell cycle arrest at the G1-S transition after treatment with 10 microM D-Trp6-LHRH for 36 h. Western blot analysis showed that the level of p16 protein was obvious following 24 h of D-Trp6-LHRH treatment. These results suggest that the mechanism by which GnRH inhibits the growth of endometrial carcinoma cells may include effects on cell cycle arrest.

Judgments about estrogen replacement therapy: the role of age, cognitive abilities, and beliefs

This study investigated age, cognitive abilities, health beliefs, and other factors in women's judgments about effective treatments for menopause. Women (N = 102) ranging in age from 20 to 79 read a vignette about a woman facing a decision about Estrogen Replacement Therapy (ERT) and then made judgments about what should be done. Participants also completed a battery of questions pertaining to ERT and cognitive abilities. Path-analytic techniques were used to determine the role of specific cognitive abilities and the representation of menopause and its treatment in making judgments about ERT treatments. Cognitive abilities had direct effects on treatment decisions. Education affected the number of perceived options for treatment. Age and education indirectly affected treatment decisions, operating through cognitive abilities. Factors related to the mental representation of menopause had no direct effects and few indirect effects on treatment decisions. Potential mechanisms that can help older adults compensate for declines in cognitive abilities in medical decisions are discussed.

Aging, culture, and cognition

There is evidence that East Asians are biased to process information in a holistic, contextual fashion, whereas Western Europeans process information in an analytic, feature-based style. We argue that these cultural differences in information-processing styles are so pervasive that they affect cognitive function at the most basic levels, including the mechanics of cognition. However, as individual age, it is not always the case that culture effects on cognitive processes magnify, despite many additional years of exposure to the culture. Neurobiological decline in cognitive function that occurs with age is a cognitive universal and can limit the strategies used in late adulthood, resulting in more similarity in cognitive function in late adulthood across cultures than is observed in young adulthood. We present a theoretical framework for understanding the impact of aging on cognitive function cross-culturally. The importance of developing culture-invariant measures of processing resources is emphasized and methodological issues associated with the cross-cultural study of aging are addressed.

Memory for news in young and old adults

Memory for news stories was studied in 48 young and 48 old adults (20-40 and 60-80 years of age, respectively). Three stories selected from actual news programs were presented in print, audio, and TV formats for study. Young adults recalled a higher proportion of news content than old adults and performed better on source recognition tests. Presentation of the information in a TV format led to better performance than in an audio format for both young and old adults. Hierarchical regression analysis revealed that approximately 86% of the age-related variance in news recall was mediated by measures of sensory acuity and processing speed, and commonality analysis revealed that 75% of the age-related variance was mediated jointly by acuity and speed. Findings support common-cause and generalized slowing views of memory impairment in old age.

Medication adherence in rheumatoid arthritis patients: older is wiser

OBJECTIVES

To create a profile of individuals nonadherent to their medications in an age-stratified sample (ages 34-84) of community-dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed.

DESIGN

A direct observation approach was used in conjunction with structural equation modeling. All participants were administered a preliminary assessment battery. Medications were then transferred to vials with microelectronic caps that recorded medication events for all medications for the next 4 weeks.

PARTICIPANTS AND SETTING

A volunteer sample of 121 community-dwelling rheumatoid arthritis (RA) patients were recruited from newspaper ads, posters, and via informal physician contact from private rheumatology practices in Atlanta and Athens, Georgia. Written verification of the RA diagnosis and a disease severity rating were obtained from personal physicians before patients were enrolled in the study. Patients were tested in a private physician's office, and their medication adherence was monitored electronically for a month in their every-day work and home settings.

MEASUREMENTS AND RESULTS

Structural equation modeling techniques were used to develop a model of adherence behavior. Cognitive and psychosocial measures were used to construct latent variables to predict adherence errors. The model of medication adherence explained 39% of the variance in adherence errors. The model demonstrated that older adults made the fewest adherence errors, and middle-aged adults made the most. A busy lifestyle, age, and cognitive deficits predicted nonadherence, whereas coping with arthritis-related moods predicted adherence. Illness severity, medication load, and physical function did not predict adherence errors. Omission of medication accounted for nearly all errors.

CONCLUSION

Despite strong evidence for normal, age-related cognitive decline in this sample, older adults had sufficient cognitive function to manage medications. A busy lifestyle and middle age were more determinant of who was at risk of nonadherence than beliefs about medication or illness. Thus, practicing physicians should not assume that older adults have insufficient cognitive resources to manage medications and that they will be the most likely to make adherence errors. Very busy middle-aged adults seem to be at the greatest risk of managing medications improperly.

Subsequent reproductive experience after treatment for gestational trophoblastic disease

PURPOSE

The purpose of this study was to evaluate reproductive performance of patients with gestational trophoblastic disease (GTD) after completion of treatment and follow-up periods.

PATIENTS AND METHODS

Subjects comprised 115 patients who became pregnant after having been judged completely cured after a follow-up period of at least 1 year. There were 77 hydatidiform-mole patients who had a natural cure and 38 gestational trophoblastic tumor patients who were cured after chemotherapy. We studied these patients with respect to parameters concerning pregnancy outcome.

RESULTS

Average age at first pregnancy was 28.0 and average number of past deliveries was 1.3. After a 1-year contraception period, the average time to the next pregnancy was 0.8 year, with 59 of 115 (51.3%) women becoming pregnant within 1 year after pregnancy was permitted and 98 women (85.2%) conceiving within 3 years. Results of the pregnancies after cure of GTD did not deviate from normal ranges in separated analyses of complete mole (CM), partial mole (PM), and gestational trophoblastic tumor. Rate of repeat mole was found to be high, occurring in 5 of 115 (4.3%) cases. Rates of antepartum and postpartum complications did not deviate from normal ranges, and there was nothing peculiar about the neonatal sex and weight.

CONCLUSION

GTD and chemotherapy rarely affect later pregnancies; however, the rate of repeat mole is relatively high.

Age differences in context integration in memory

This research examined the role of contextual integration in memories of younger and older adults. In 2 experiments, recall of a target picture to a context picture cue was better when sentences were generated that integrated the picture pair and when the picture pairs were already related to each other. Age differences were smallest when sentences were generated for semantically related pairs. Older adults generated the same type sentences as younger adults, although they generated fewer integrations for unrelated pairs. In a 3rd experiment, younger adults could not differentiate between younger- and older-generated sentences from Experiment 1, and the sentences did not differentially affect recall performance. The results are discussed in terms of age differences in self-initiated processing when using context.

HPV-16-related proteins as the serologic markers in cervical neoplasia

OBJECTIVE

Recently, a variety of HPV-related proteins have been synthesized and their utility as diagnostic and prognostic markers in cervical cancers needs to be assessed. The ability to generate preparative amounts of HPV-16 L1/L2 VLPs and E6, E7 proteins may have implications for the development of a serologic assay to detect anti-HPV-16 virion immune responses. The purpose of the study is to improve the way of proper management of the cervical cancer by investigating the utility of the recently developed HPV-16 L1/L2 VLPs, HPV-16 E6, E7 proteins as the clinical serologic markers through antibody reactions by comparison with those of SCCA and CEA which have been used as tumor markers for cervical cancer.

METHODS

The serologic responses in Korean women with cervical neoplasia by ELISA using HPV-16 L1/L2 VLPs and radioimmunoprecipitation assay (RIPA) using in vitro translated HPV-16 E6, E7 proteins were investigated. PCR using E6 type-specific primers for HPV-16/18 was used to determine the presence and type of HPV infection (normal controls, 15 cases; preinvasive lesions, 28 cases; invasive cervical cancers, 124 cases).

RESULTS

The sera of 34% (42/124) of cervical cancers were positive for SCCA and the sera of 18% (22/124) of cervical cancers were positive for CEA. The positivity of SCCA was increased with advancing clinical stages, but the antibody levels were not correlated with clinical stage of disease. The sera of 7% (1/15) of normal controls, 39% (11/28) of preinvasive lesions, and 56% (70/124) of patients with cervical cancer were ELISA positive for HPV-16 L1/L2 VLPs (P < 0.05). The sera of 7% (2/28) of preinvasive lesions and 51% (63/124) of cervical cancers were positive for in vitro translated HPV-16 E6 protein (P < 0.05) and the sera of 11% (3/28) of preinvasive lesions and 33% (41/124) of cervical cancers were positive for in vitro translated HPV-16 E7 protein (P < 0.05). The antibody levels to HPV-16 E7 protein were correlated to clinical stage and tumor burden in a significant number of cervical cancers.

CONCLUSIONS

These data suggest that a considerable number of patients with cervical neoplasia generated positive antibody response to L1/L2 VLPs and in vitro translated E6, E7 proteins of HPV-16. These HPV-16-associated proteins might be disease-specific markers which could be useful in an adjunctive diagnostic assay and a seroepidemiologic study of HPV-related cervical neoplasia. In particular, the monitoring of antibody to HPV-16 E7 protein seems to be valuable in the proper management of cervical cancers for specific tumor markers.

Age differences in context integration in memory

This research examined the role of contextual integration in memories of younger and older adults. In 2 experiments, recall of a target picture to a context picture cue was better when sentences were generated that integrated the picture pair and when the picture pairs were already related to each other. Age differences were smallest when sentences were generated for semantically related pairs. Older adults generated the same type sentences as younger adults, although they generated fewer integrations for unrelated pairs. In a 3rd experiment, younger adults could not differentiate between younger- and older-generated sentences from Experiment 1, and the sentences did not differentially affect recall performance. The results are discussed in terms of age differences in self-initiated processing when using context.

Interrelations of age, self-reported health, speed, and memory

Contributions of self-reported health to adult age differences in perceptual speed and memory were assessed for 301 adults ages 20-90. Participants were asked 4 health status questions, given 3 perceptual speed tests, 2 working memory tests, and 2 memory tests. Self-reported health was found to predict speed better than it predicted memory. Covariance structural equation modeling was used to assess the relations among age, self-reported health, perceptual speed, working memory, and memory. The results support the hypothesis that any effects of self-reported health on age differences in memory are mediated by perceptual speed.

Adherence to antihypertensive medications across the life span

Although treatment for hypertension is readily available, poor control of hypertension is a major health problem frequently manifested in late life. Researchers believe that one of the major causes of uncontrolled hypertension is failure to take medication as directed. In this preliminary study, the medication-taking behaviors of 48 adults diagnosed with hypertension, ranging in age from 35 to 87, were recorded for 2 months with credit card-sized bar-code scanners. The social-cognitive model (Park, 1992) for understanding medication adherence, which proposes that medication adherence is governed by both beliefs and cognitive factors, was used as a basis for this research. Therefore, measures of health behaviors, attitudes about health and medication taking, and cognitive function were recorded, as well as blood pressure readings. The main findings were that (a) the oldest-old and groups of middle-aged adults were the most nonadherent, whereas the young-old were more likely to adhere than the other age groups; (b) high blood pressure readings predicted adherence to antihypertensive medications; and (c) medication beliefs influenced adherence in some situations.

Effect of age on event-based and time-based prospective memory

The magnitude of age differences on event- and time-based prospective memory tasks was investigated in 2 experiments. Participants performed a working memory task and were also required to perform either an event- or time-based prospective action. Control participants performed either the working memory task only or the prospective memory task only. Results yielded age differences on both prospective tasks. The age effect was particularly marked on the time-based task. Performance of the event-based prospective task, however, had a higher cost to performance on the concurrent working memory task than the time-based task did, suggesting that event-based responding has a substantial attentional requirement. The older adults also made a significant number of time-monitoring errors when time monitoring was their sole task. This suggests that some time-based prospective memory deficits in older adults are due to a fundamental deficit in time monitoring rather than to prospective memory.

Effect of age on event-based and time-based prospective memory

The magnitude of age differences on event- and time-based prospective memory tasks was investigated in 2 experiments. Participants performed a working memory task and were also required to perform either an event- or time-based prospective action. Control participants performed either the working memory task only or the prospective memory task only. Results yielded age differences on both prospective tasks. The age effect was particularly marked on the time-based task. Performance of the event-based prospective task, however, had a higher cost to performance on the concurrent working memory task than the time-based task did, suggesting that event-based responding has a substantial attentional requirement. The older adults also made a significant number of time-monitoring errors when time monitoring was their sole task. This suggests that some time-based prospective memory deficits in older adults are due to a fundamental deficit in time monitoring rather than to prospective memory.

Mediators of long-term memory performance across the life span

An individual-differences approach was used to examine the component processes that predict episodic long-term memory performance. A total of 301 participants ages 20-90 received a 7-hr cognitive battery across 3 days. Key constructs hypothesized to affect long-term memory function were assessed, including multiple measures of working memory and perceptual speed. Latent-construct, structural equation modeling was used to examine the relationship of these measures and age to different types of long-term memory tasks. Speed was a key construct for all 3 types of memory tasks, mediating substantial age-related variance; working memory was a fundamental construct for free and cued recall but not spatial memory. The data suggest that both speed and working memory are fundamental to explaining age-related changes in cognitive aging but that the relative contributions of these constructs vary as a function of the type of memory task.

Mediators of long-term memory performance across the life span

An individual-differences approach was used to examine the component processes that predict episodic long-term memory performance. A total of 301 participants ages 20-90 received a 7-hr cognitive battery across 3 days. Key constructs hypothesized to affect long-term memory function were assessed, including multiple measures of working memory and perceptual speed. Latent-construct, structural equation modeling was used to examine the relationship of these measures and age to different types of long-term memory tasks. Speed was a key construct for all 3 types of memory tasks, mediating substantial age-related variance; working memory was a fundamental construct for free and cued recall but not spatial memory. The data suggest that both speed and working memory are fundamental to explaining age-related changes in cognitive aging but that the relative contributions of these constructs vary as a function of the type of memory task.

Adult age differences in the effects of environmental context on memory performance

In two experiments, we examined the hypotheses that the memory performance of older adults is more dependent than that of younger adults on environmental context, and that the integration of to-be-remembered items with contextual cues benefits older more than younger adults. When younger and older adults were shown simple line drawings that were not explicitly associated with the external environment, there was no effect on recall of a change in environmental context for either age group. However, when subjects heard sentences that connected the simple drawings with environmental cues, an environmental context effect was observed. Both age groups recalled more in the same than in a different environment, and the magnitude of the facilitation effect of the familiar context was equal for younger and older adults. However, the integration of the to-be-remembered items with the context facilitated recall regardless of the context present at retrieval, and this effect was larger for younger adults, suggesting that the younger adults were better able to use the provided integrations than were the older adults.

Cloning and characterization of a Schizophyllum gene with A beta 6 mating-type activity

The A-pathway of development in the basidiomycete fungus Schizophyllum commune may be activated by either of two mating-type loci, A alpha and A beta. A alpha consists of two multiallelic genes, Y and Z. Y contains a putative homeodomain; Z contains a homeodomain-related region. Non-self combinations of Y and Z form heteromultimers which are thought to be transcription factors of developmental genes. To more completely understand A-regulated development it is necessary to address the issue of functional redundancy, i.e., how do two different mating loci, A alpha and A beta, both manage to regulate the same pathway. Here we report the structure of a gene with A beta 6 activity. This gene, denoted A beta V6, encodes a deduced polypeptide of 640 amino-acids with a homeodomain motif. V6 also contains a 20-amino acid sequence that is conserved in A alpha Y1, Y3 and Y4. Except for the homeodomain and the conserved sequence, the deduced V6 polypeptide shows no significant identity to A alpha Y, A alpha Z, or other known proteins. The presence of a homeodomain suggests that V, like Y and Z, may be a regulatory protein for genes in the A-pathway. Thus while A alpha and A beta encode different proteins, the general mechanism by which A alpha and A beta components signal A-regulated development may be similar.

The A alpha mating-type transcripts of Schizophyllum commune

A alpha 1, A alpha 3, and A alpha 4 ds- and ss-DNA probes from the polymorphic A alpha mating-type locus of Schizophyllum commune were used to probe Northern blots of poly(A+) RNA extracted from strains of various A alpha mating types. The purpose of these experiments was to identify, map, and characterize the transcripts produced from the regions of the A alpha locus. The transcripts unique to A alpha mating type map colinear with the open reading frames identified from DNA sequence and are encoded within the fragments which activate the A developmental pathway in transformation. These data confirm the existence and structure of the previously hypothesized Y and Z A alpha mating-type genes. Transcripts from the Y and Z genes are present in vegetative cells of homokaryons and dikaryons and in cells of the fruiting bodies. The presence of the transcripts throughout the life cycle is consistent with the model of Y and Z proteins as "master switches" of A-regulated development.

Implementation and impact of the Patient Self-Determination Act

The Patient Self-Determination Act became effective in December 1991 and mandates that patients be given information about legal rights regarding living wills and durable powers of attorney for health care. We investigated the impact this law has had on hospitals, medical personnel, and patients. We conducted a survey of all hospitals in the state of Georgia, collecting data regarding implementation and knowledge of the law, as well as effects of the law and beliefs about it. The data indicated that hospitals relied primarily on the Georgia Hospital Association for implementation policy, that "minimalist" implementation of the law occurs in most hospitals, and that the biggest perceived problem with the law was the inappropriateness of presenting this information at hospital admission and problems patients had in comprehending the materials presented. Despite these concerns, most respondents did not want the law repealed.