Comparative Effectiveness of Behavioral Interventions to Prevent or Delay Dementia: One-Year Partner Outcomes.

BACKGROUND/OBJECTIVE: Various behavioral interventions are recommended to combat the distress experienced by caregivers of those with cognitive decline, but their comparative effectiveness is poorly understood. DESIGN/SETTING: Caregivers in a comparative intervention study randomly had 1 of 5 possible interventions suppressed while receiving the other four. Caregivers in a full clinical program received all 5 intervention components. Care partner outcomes in the study group were compared to participants enrolled in a full clinical program. PARTICIPANTS: Two hundred and seventy-two dyads of persons with amnestic mild cognitive impairment (pwMCI) and care partners enrolled in the comparative intervention study. 265 dyads participated in the full clinical program. INTERVENTION: Behavioral intervention components included: memory compensation training, computerized cognitive training, yoga, support group, and wellness education. Each was administered for 10 sessions over 2 weeks. MEASUREMENTS: A longitudinal mixed-effect regression model was used to analyze the effects of the interventions on partner burden, quality of life (QoL), mood, anxiety, and self-efficacy at 12 months follow-up. RESULTS: At 12 months, withholding wellness education or yoga had a significantly negative impact on partner anxiety compared to partners in the clinical program (ES=0.55 and 0.44, respectively). Although not statistically significant, withholding yoga had a negative impact on partner burden and mood compared to partners in the full clinical program (ES=0.32 and 0.36, respectively). CONCLUSION: Our results support the benefits of wellness education and yoga for improving partner's burden, mood, and anxiety at one year. Our findings are the first to provide an exploration of the impact of multicomponent interventions in care partners of pwMCI.

Expression of transglutaminase-2 isoforms in normal human tissues and cancer cell lines: dysregulation of alternative splicing in cancer.

The multiple enzymatic activities and functions of transglutaminase type 2 (TG2) may be attributed to alternative TG2 molecules produced by differential splicing of TG2 mRNA. Different RNA transcripts of the human TG2 gene (TGM2) have been identified, but the expression of TG2 multiple transcripts has never been systematically addressed. We have confirmed and rationalized the main TG2 variants and developed a screening assay for the detection of alternative splicing of TG2, based on real-time reverse-transcription PCR. We have quantified the multiple TG2 transcripts in a wide range of normal tissues and in cancer cell lines from four different sites of origin. Our data show a significant correlation in the expression of canonical and alternative TG2 isoforms in normal human tissue, but differences in alternative splicing of TG2 in cancer cell lines, suggesting that in cancer cells the alternative splicing of TG2 is a more active process.

Microbes and sequestered substances as mechanisms for disease: Bartonella and L-forms as common global etiological agents.

The pathogenicity of microbes may be determined by substances sequestered from blood and bound to their constituent lipid. The brain may not perceive substances sequestered by microbes, to interfere with control to maintain normal levels. Pathological conditions can be induced as organisms exposed to antimicrobial substances/conditions and/or deprived of nutrients essential to cell wall synthesis, disintegrate to free lipid-bound compounds and produce L-forms that can deplete nutrients as they revert to bacteria. Microbes may act as active carriers for the continuing interaction of sequestered substances. Changes in the molecular structure of substances effected during sequesteration could cause them to be seen as substances 'synthesized' by an organism. In media that contain substances to inhibit 'contaminants', L-forms can be seen as mycoplasma. Elementary bodies of L-forms with a specific substance or tissue affinity may be seen as 'receptors'. Bartonella are global agents for disease--pleomorphic organisms (description suits Proteus)--and they can be seen as 'contaminants'.

Bartonellosis and human immunodeficiency disease (AIDS): L-forms as persisters, activating factors, and mechanism of disease.

Bartonella, genus Proteus, can cause immunodepressive disease. The organisms, in parasitized red blood cells, may invade the brain and every other system and space in the human body. Bartonella henselae is proposed to have a role in the pathogenesis of acquired immunodeficiency syndrome (AIDS) encephalopathy. Bartonella bacilliformis produces two known toxins that can induce spasm and angiomatosis, respectively, and manifest as diseases associated with symptomatic AIDS. The skin lesions of bartonellosis may be mistaken clinically and histologically for Kaposi's sarcoma. Bacteria of the genus Proteus produce L-forms: their elementary bodies may be mistaken for what are called the 'human immunodeficiency viruses' (HIV). Antibiotics, especially penicillin, induce bacteria to produce L-forms. Air pollution and high sugar, salt and fat diets are factors that may increase the lipid content of microbes that produce toxins and L-forms that may persist or revert to bacterial form.

Mediastinal bronchogenic cysts.

It was observed from the literature that the incidence, clinical and radiological features of the mediastinal bronchogenic cysts are different in adults than in infant population. Five cases of bronchogenic cysts in the middle mediastinum were studied over a period of 22 years. The cysts were carina-based in four cases and paratracheal in one case. The airway compression was observed in four cases due to cysts. In case one the cyst compressed the right pulmonary artery and vein as well as both mainstem bronchi causing their stenosis and bulged into the left atrial chamber.