Negative emotions and behaviour: The role of regulatory emotional self-efficacy.

The objective of this study is to test a longitudinal model that analyses the direct effect of negative emotions (anger, depression and anxiety, wave 1) on prosocial and aggressive behaviour (wave 2) in adolescents. And the indirect effect of negative emotions (wave 1) on prosocial and aggressive behaviour (wave 2) through regulatory emotional self-efficacy. Data was obtained from 417 adolescents in a two-wave longitudinal study (225 girls, M age = 14.70 years) from schools located in Valencia, Spain. SEM was employed to explore longitudinal models. The results showed that anger had a direct relationship with prosocial behaviour and aggression, measured two years later. However, the depression and anxiety states did not predict prosociality and aggressiveness. The mediation role of regulatory emotional self-efficacy between negative emotion and behaviours was only partially confirmed. Finally, only the perception of self-efficacy in expressing positive affect is related to prosociality and aggressiveness.

Differential expression of neurotensin and specific receptors, NTSR1 and NTSR2, in normal and malignant human B lymphocytes.

Neurotensin, a neuropeptide growth factor, and its two specific neurotensin receptors, NTSR1 and NTSR2, were shown to be expressed by human B cell lines. Another NTSR, sortilin, which is common to neurotensin and neurotrophins, was also detected as we have previously described. Neurotensin was functional in B cell lines; it induced their proliferation and inhibited apoptosis induced by serum deprivation or Fas activation. Quantitative study of gene expression in two malignant B cell diseases showed that NTSR2 was overexpressed, NTSR1 decreased, and neurotensin was unexpressed in B cell leukemia patient's cells, as compared with healthy B cells. However, these expressions did not significantly change in large diffuse B cell lymphoma lymph nodes compared with benign ones. This study points out that neurotensin and its two specific receptors are expressed in human B lymphocytes. Such expressions were not described, and their relationship in B cell diseases, especially in chronic B cell leukemia, needs to be considered further in regard to these findings.

[Epidemiology and physiopathogy of Sjögren's syndrome]. / Physiopathologie et épidémiologie du syndrome de Gougerot-Sjögren.

Sjögren's syndrome is defined as an autoimmune disease characterized by a progressive sicca syndrome associated with anti-SSA or SSA positivity and/or significant infiltrate at minor salivary gland biopsy. This autoimmune disease is relatively frequent, with a clinical diagnosis among women after the 5 decade. Its physiopathology, complex, associates the intervention of both environmental and genetic factors. Salivary epithelial cell is at the center of the pathological immune response of primary Sjögren's syndrome, characterized by a chronic B cell polyclonal activation potentially leading to the development of B cell lymphoma.

[Evolutive forms of primary Sjögren's syndrome]. / Formes ëvolutives du syndrome de Gougerot-Sjögren.

Primary Sjogrën's syndrome (pSS) could be restricted in 50% of the cases to glandular involvement with a chronic sicca syndrome, with a considerable alteration of quality of life. It could be complicated by systemic involvements, which are responsible of the visceral severity. Thus systemic complications could appear many years after initial pSS diagnosis and justify long-term surveillance. Initial parotid gland enlargement, Raynaud phenomenon, cutaneous vasculitis and immunological abnormalities (anti-SSA and/or SSB positivity, hypergammaglobulinemia, and cryoglobulinemia) are also implicated in systemic complications.

Psychosocial Effects of COVID-19 in the Ecuadorian and Spanish Populations: A Cross-Cultural Study.

The world's population is currently overcoming one of the worst pandemics, and the psychological and social effects of this are becoming more apparent. We will present an analysis of the psychosocial effects of COVID-19: first, a cross-sectional study in an Ecuadorian sample (n = 301) and second, a comparative study between two samples from the Ecuadorian and Spanish populations (n = 83 each one). Participants completed an online survey to (1) describe how they felt (depression, anxiety, and stress) before and after confinement; (2) analyze which emotional and behavioral variables predict depressive symptoms, anxiety, and stress perceived after the confinement; (3) carry out a comparative study in a sample of Ecuadorian and Spanish surveys. Results indicate, first, that Ecuadorians experience significantly more depressive symptoms, anxiety, and stress after confinement. Second, variables which predict depressive symptoms and anxiety are greater public prosocial tendency, less stress as a challenge, and greater stress as a threat, as well as an empathetic tendency that implies greater emotional regulation. Experienced stress after confinement was predicted by a greater public prosocial tendency, as well as an empathetic tendency. Finally, scores for depression, anxiety, and stress are higher after confinement in both countries. However, results reveal the similarity of the psychosocial effects that are being experienced, regardless of the country, and the differences in the variables that can help explain these effects. This can contribute to the constitution of intervention plans which aim to soften and alleviate the effects produced by a situation such as that experienced with COVID-19.

Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study.

Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.

Active immunological profile is associated with systemic Sjögren's syndrome.

BACKGROUND: The aim of this paper was to study the evolution of primary Sjögren's syndrome (pSS) immunological profile, its impact on pSS activity and long-term evolution in a bicentric cohort of French patients with pSS (n = 445, mean age 53.6 ± 14 years, mean follow-up 76.1 ± 51 months). METHODS: This is a retrospective cohort study. RESULTS: Two hundred twelve patients were Sjögren's syndrome A (SSA) positive, and 131 were both SSA and Sjögren's syndrome B (SSB) positive. Sixty-eight patients (15%) had cryoglobulinemia. Active systemic profile (i.e., hypergammaglobulinemia, rheumatoid factor (RF), and anti-Sjögren's syndrome A (anti-SSA), anti-Sjögren's syndrome B (anti-SSB) positivity), associated with multisystemic involvement, leads to an increased utilization of corticosteroid and hydroxychloroquine. Multivariate analysis pointed out independent statistical association between hypergammaglobulinemia, anti-SSA, anti-SSB, and RF. Cryoglobulinemia is associated with multi-systemic involvement, lymphoma, and pSS-related death. CONCLUSION: The subset of patients with active immunological profile is characterized by systemic complications leading to immunosuppressive drug utilization and polyclonal B-cell activation profile.

Traditional Masculinity and Aggression in Adolescence: Its Relationship with Emotional Processes.

Traditional masculinity includes norms that encourage many of the aggressive behaviors whereas traditional femininity emphasizes aggression very little. In addition, the lack of emotional regulation as well as a poor impulse control have been related to aggression and, in particular, with reactive and proactive aggression. The objective of this study is to examine the role of gender stereotypes (masculinity/femininity) in reactive and proactive aggression, through regulatory emotional self-efficacy and emotion regulation. A total of 390 adolescents participated in a longitudinal study in Valencia, Spain. Structural equations modeling (SEM) was employed to explore a two-wave longitudinal model. The results show that femininity relates to reactive aggression through regulatory emotional self-efficacy and emotion regulation. This way, both emotional self-efficacy and emotional regulation mediate the relation between femininity and reactive aggression. Furthermore, reactive and proactive aggression relate positively and directly to masculinity and negatively to femininity. Therefore, violence prevention programs with adolescents should incorporate information to break down gender stereotypes and promote strategies to manage emotions. Such efforts may be helpful to reduce aggressive behaviors and violence.

Victimization and Peer and Parents Attachment: The Mediating Effect of Regulatory Emotional Self-Efficacy.

Studies of the Spanish adolescent population has concluded that victimization is related to lack of emotional regulation and impulse control. Therefore, if a victim is unable to recognize, understand and regulate their emotions, this can result in rejection by their peers. A cross-sectional study was conducted to examine regulatory emotional self-efficacy as a possible mediator in the association between peer and parents attachment and victimization. Adolescents (n = 563) completed Regulatory Emotional Self-Efficacy, Inventory of Parents and Peer Attachment and Kid at School questionnaires. Structural equation models (SEMs) were used to predict a latent variable of victimization with parents and peer attachment, emphasizing the mediating role of regulatory emotional self-efficacy, as comprised by a positive and a negative aspect. Results showed that peer attachment had an indirect negative effect, through perceived self-efficacy, in managing a positive effect in victimization, while father attachment had an indirect negative affect, through perceived self-efficacy, in managing a negative affect in victimization, and Mother attachment had no statistically significant indirect effect in victimization. This study suggests that the roles of parents and peers, and also between mothers and fathers, are different in relation to the perception of victimization of adolescents. Findings provide relevant information regarding implications for prevention and intervention in victimization.

Articular manifestations in primary Sjögren's syndrome: clinical significance and prognosis of 188 patients.

OBJECTIVES: Articular manifestations (AMs) occurred in approximately 30-60% of patients with primary SS (pSS). We conducted the current study to describe clinical presentation, specific treatment and to report clinical outcome of pSS patients with AM in a large bicentric French cohort. METHODS: Clinical, biological and immunological features of 419 consecutive patients with pSS were recorded in order to describe the clinical and immunological course of pSS AM and to point out the impact of those rheumatological features on pSS evolution. RESULTS: A total of 188 patients with pSS (172 women, 16 men) exhibited AM. They preceded sicca symptoms in 32, were simultaneous to pSS diagnosis in 98 and followed diagnosis in 59 patients. Clinical presentation was polyarticular and concerned mostly peripheral joints (synovitis, n = 66). Symptoms responded readily to symptomatic treatment in 45 cases (24%). DMARDs or immunosuppressive treatments were introduced in 133 patients: HCQ (n = 111), corticosteroid (n = 53), MTX (n = 12), SSZ (n = 6), AZA (n = 3), LEF (n = 1), etanercept (n = 1) and allochrysine (n = 1). Only one case of RA was diagnosed during the evolution. Statistical analysis identified clinical and biological factors associated with AM (P < or = 0.05): RP, muscular manifestations, renal involvement, peripheral neuropathy, cutaneous vasculitis, and positivity of RF, anti-SSB antibodies and cryoglobulinaemia. Patients with AM at diagnosis were characterized by a multisystemic involvement at the end of the follow-up period (P < 0.001). CONCLUSION: Although AMs are frequent and usually mild in pSS, these manifestations are associated with a pluri-systemic involvement of pSS.

Role of endogenous brain-derived neurotrophic factor and sortilin in B cell survival.

Brain-derived neurotrophic factor (BDNF), a major neuronal growth factor, is also known to exert an antiapoptotic effect in myeloma cells. Whereas BDNF secretion was described in B lymphocytes, the ability of B cells to produce sortilin, its transport protein, was not previously reported. We studied BDNF production and the expression of its receptors, tyrosine protein kinase receptor B and p75 neurotrophin receptor in the human pre-B, mature, and plasmacytic malignant B cell lines under normal and stress culture conditions (serum deprivation, Fas activation, or their combination). BDNF secretion was enhanced by serum deprivation and exerted an antiapoptotic effect, as demonstrated by neutralization experiments with antagonistic Ab. The precursor form, pro-BDNF, also secreted by B cells, decreases under stress conditions in contrast to BDNF production. Stress conditions induced the membranous expression of p75 neurotrophin receptor and tyrosine protein kinase receptor B, maximal in mature B cells, contrasting with the sequestration of both receptors in normal culture. By blocking Ab and small interfering RNA, we evidenced that BDNF production and its survival function are depending on sortilin, a protein regulating neurotrophin transport in neurons, which was not previously described in B cells. Therefore, in mature B cell lines, an autocrine BDNF production is up-regulated by stress culture conditions and exerts a modulation of apoptosis through the sortilin pathway. This could be of importance to elucidate certain drug resistances of malignant B cells. In addition, primary B lymphocytes contained sortilin and produced BDNF after mitogenic activation, which suggests that sortilin and BDNF might be implicated in the survival and activation of normal B cells also.

Ribavirin exposure after the first dose is predictive of sustained virological response in chronic hepatitis C.

UNLABELLED: The impact of ribavirin exposure on sustained virological response (SVR) in patients with chronic hepatitis C is unknown. Preliminary studies showed marked inter-individual variability of ribavirin concentrations despite dose adjustment for body weight (BW) and suggested there was a correlation between single time point concentrations and SVR. None of them evaluated the global exposure to ribavirin. This study was conducted to determine whether early ribavirin global exposure is related with SVR. An exploratory pharmacokinetic-pharmacodynamic (PK-PD) study was conducted in genotype 1 hepatitis C patients treated with peginterferon alfa-2a and ribavirin (dose-adjusted for BW) for 12 weeks, to which amantadine was added for the following 36 weeks. Full and abbreviated ribavirin area under the concentration time curves (AUC(0-12h), AUC(0-4h)) were derived from plasma concentration profiles at day 0 (D0), week 12 (W12), W12 + 1 day, and W24. Virological follow-up was performed at D0 (0, 12, and 24 hours), W2, W4, W6, and monthly until W72 (TaqMan polymerase chain reaction, cut-off 15 international units/mL). Twenty-eight patients were enrolled in the study and 24 completed it. Patients with a SVR had a significantly higher D0 AUC(0-12h) (3695 [1571-6916] versus 2937 [1266-4913] microg/hour/L, P = 0.03) and D0 AUC(0-4h) (2010 [615-3175] versus 1340 [622-2246] microg/hour/L, P = 0.03). Patients with D0 AUCs above the cut-off values defined by receiver operating characteristic curves (3014 microg/hour/L and 1755 microg/hour/L for AUC(0-12h) and AUC(0-4h), respectively) had a significantly better chance of achieving an SVR than patients with AUCs under the thresholds (odds ratio = 16.0, 95% confidence interval 1.54-166.6, P = 0.02 and odds ratio = 8.9, 95% confidence interval, 1.4-56.6; P = 0.02). CONCLUSION: Ribavirin exposure at D0 is significantly related to SVR. To our knowledge, this is the first study to give an early pharmacokinetic predictor of SVR. We propose a minimum AUC(0-4h) threshold of 1755 microg/hour/L at D0 as a target for ribavirin dose adjustment.

Predictive clinical features of eczema craquelé associated with internal malignancy.

OBJECTIVE: To describe a series of hospitalized patients with eczema craquelé (EC) and the possible correlations between clinical features of EC and cancer in an open prospective observational study. PATIENTS AND INTERVENTIONS: The study population comprised 68 consecutive patients included between January 1, 1999 and December 31, 2000 who were followed up through December 2004. All patients who had localized or generalized EC were included. Patients underwent complete clinical examinations, routine laboratory tests, chest x-rays, abdominal ultrasound, and cutaneous biopsies performed on EC. MAIN OUTCOME MEASURES AND RESULTS: Rates of EC associated with cancer, clinical features of eczema, rate of recalcitrant eczema, relationship to other clinical prognostic factors, and paraneoplastic evolution were evaluated. Cancer was diagnosed in 32 patients (47%). We observed a significant difference in the presenting clinical signs of EC between patients with malignant tumors and patients without cancer. In patients with malignancies, EC was widespread on the trunk and we noted deep red and inflammatory fissures. In all cases, EC led to the discovery of malignancy or recurrence of cancer. CONCLUSION: Widespread EC, topical corticosteroid resistance, and deep red and inflammatory fissures were significantly correlated with neoplasia.

Molecular analysis of vascular smooth muscle cells from patients with giant cell arteritis: Targeting endothelin-1 receptor to control proliferation.

OBJECTIVE: The pathophysiology of giant cell arteritis (GCA) and the mechanisms underlying vascular remodeling, are poorly understood. We aimed to compare vascular smooth muscle cells (VSMCs) from patients with GCA and controls by a proteomic and gene expression profile approach and to identify the signaling pathways involved in proliferation. METHODS: VSMCs were cultured from temporal artery biopsies (TABs) from patients with biopsy-proven GCA (TAB+-GCA), biopsy-negative GCA (TAB--GCA), and diagnosis other than GCA (GCA-control). VSMCs from normal human aorta (HAoSMC) were used as controls. 2D-differential in-gel electrophoresis and Affymetrix chips were used to compare proteomes and gene expression profiles of VSMCs. Proliferation was assessed by BrdU incorporation assay. TAB+-GCA and GCA-control TABs underwent immunohistochemistry staining for endothelin-1 (ET-1) and receptors ETAR and ETBR. RESULTS: We identified 16, 30 and 2 protein spots differentially expressed between TAB+-GCA and GCA-control VSMCs, TAB+-GCA and TAB--GCA VSMCs and TAB--GCA and GCA-control VSMCs, respectively (fold change ≥1.5 and p≤0.05). Among the 153 proteins differentially expressed between TAB+-GCA and HAoSMC VSMCs, many were linked with ET-1. Genes differentially expressed between TAB+-GCA and GCA-control VSMCs were involved in proliferation. ET-1 was identified as a link between genes of interest. Proliferation was reduced for TAB+-GCA VSMCs on treatment with the endothelin antagonist macitentan and its active metabolite. Patients showing transmural expression of ET-1 in temporal artery lesions received a significantly higher glucocorticoid daily dose after 6-month follow-up. CONCLUSION: Inhibiting the proliferation with macitentan, combined with glucocorticoids, might be a promising therapeutic approach for patients with GCA.

Treatment of cutaneous calcinosis in CREST syndrome by extracorporeal shock wave lithotripsy.

We describe the unusual case of a 78-year-old woman consulting for extensive and painful wound leg ulcerations and calcifications secondary to CREST syndrome that was treated by extracorporeal shock wave lithotripsy. This treatment was considered because of the severity of our patient's symptoms and her failure to respond to various medical and surgical treatment.

Routine vs extensive malignancy search for adult dermatomyositis and polymyositis: a study of 40 patients.

OBJECTIVE: To identify potential risk factors and the yield of routine screens for early detection of malignancy associated with dermatomyositis (DM) and polymyositis (PM). DESIGN: Retrospective study of malignancies in all patients with DM or PM followed up between the years 1981 and 2000 and a review of the relationship of DM and PM to malignancy, the usefulness of various tests or examinations for malignancy search, and the patients' course. SETTING: Departments of internal medicine and dermatology in a teaching hospital. PATIENTS: Forty consecutive adult patients with DM (33 cases) or PM (7 cases). MAIN OUTCOME MEASURES: (1) Rate of false-negative results of routine workup and yield (percentage of positive results) of blind malignancy search and (2) comparison of 16 characteristics in patients with malignancy vs those without. RESULTS: Malignancy occurred in 16 patients: 13 with DM and 3 with PM. In all cases, the diagnosis of malignancy was made concurrently with or shortly after the diagnosis of DM or PM. Factors associated with malignancy were recruitment in the internal medicine department (P =.02), constitutional symptoms (P<.01), a rapid onset of DM or PM (P =.02), the lack of Raynaud phenomenon (P<.01), and a higher mean erythrocyte sedimentation rate (P<.01) and creatine kinase level (P<.01). Initial routine search failed to discover 4 malignancies, 3 of which were discovered at an advanced stage by more extensive investigations. The positive result yield of blind malignancy search was only 13% (11 of 87), but reached 28% (5 of 18) for blind abdominal-pelvic and thoracic computed tomographic scans. CONCLUSION: Extensive search for malignancy, particularly computed tomographic scans, may be warranted in at least a subset of patients with DM or PM and risk factors of malignancy.

[Management of intermittent fever in the adult]. / Prise en charge d'une fièvre intermittente chez l'adulte.

Episodic fever is a difficult diagnostic challenge, more enigmatic than prolonged fever of unknown origin. Patients are younger, and have longer history of fever before admission. Despite the use of extensive diagnostic procedures 50% of the cases remain undiagnosed. A meticulous physical examination and history remains an important tool for registering potentially diagnostic clues useable in the diagnostic process. In the absence of clues, a staged diagnostic protocol can be used to search elements contributing to the diagnosis (laboratory investigations including chest X-ray and ultrasonography of upper abdomen, imaging techniques, endoscopies and histologic investigations. When diagnosis is not established and patient deteriorate, empiric therapeutic trial is started to presumptive diagnoses. If not, patient must be carefully followed as an out patient basis and symptomatically treated, periodic reassessment will in time reveal the development of overt disease.

Immunological profiles determine neurological involvement in Sjögren's syndrome.

BACKGROUND: Up to 68% of patients with primary Sjögren's syndrome (pSS) undergo neurological complications, and evidence for distinct immunological subgroups is emerging. We sought to determine systemic and immunological profiles associated with neurological manifestations. METHODS: 420 patients fulfilling the 2002 American-European pSS criteria were retrospectively analyzed. Neurological manifestations were diagnosed through clinical, biological, electrophysiological, and imaging findings. Biographical, clinical, and laboratory data were compared. RESULTS: Within 93 (22%) patients with neurological manifestations, peripheral and central nervous systems were involved in 66% and 44%, respectively. Raynaud's phenomenon, cutaneous vasculitis, renal involvement, and cryoglobulinemia were associated with sensorimotor neuropathy and mononeuritis multiplex (p<0.05). Conversely, pure sensory neuropathy occurred without extraglandular manifestation, and without anti-Ro/SSA antibodies (p<0.05). All neurological manifestations were associated with increased use of corticosteroids and immunosuppressive drugs (p<0.05). CONCLUSIONS: In pSS, patients with sensorimotor neuropathies and pure sensory neuropathies have distinct extraglandular and immunological profiles.

Neurotrophins are expressed in giant cell arteritis lesions and may contribute to vascular remodeling.

INTRODUCTION: Giant cell arteritis (GCA) is characterized by intimal hyperplasia leading to ischaemic manifestations that involve large vessels. Neurotrophins (NTs) and their receptors (NTRs) are protein factors for growth, differentiation and survival of neurons. They are also involved in the migration of vascular smooth muscle cells (VSMCs). Our aim was to investigate whether NTs and NTRs are involved in vascular remodelling of GCA. METHODS: We included consecutive patients who underwent a temporal artery biopsy for suspected GCA. We developed an enzymatic digestion method to obtain VSMCs from smooth muscle cells in GCA patients and controls. Neurotrophin protein and gene expression and functional assays were studied from these VSMCs. Neurotrophin expression was also analysed by immunohistochemistry in GCA patients and controls. RESULTS: Whereas temporal arteries of both GCA patients (n = 22) and controls (n = 21) expressed nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), tropomyosin receptor kinase B (TrkB) and sortilin, immunostaining was more intense in GCA patients, especially in the media and intima, while neurotrophin-3 (NT-3) and P75 receptor (P75NTR) were only detected in TA from GCA patients. Expression of TrkB, a BDNF receptor, was higher in GCA patients with ischaemic complications. Serum NGF was significantly higher in GCA patients (n = 28) vs. controls (n = 48), whereas no significant difference was found for BDNF and NT-3. NGF and BDNF enhanced GCA-derived temporal artery VSMC proliferation and BDNF facilitated migration of temporal artery VSMCs in patients with GCA compared to controls. CONCLUSIONS: Our results suggest that NTs and NTRs are involved in vascular remodelling of GCA. In GCA-derived temporal artery VSMC, NGF promoted proliferation and BDNF enhanced migration by binding to TrkB and p75NTR receptors. Further experiments are needed on a larger number of VSMC samples to confirm these results.