Exercise, education, and behavioral modification as alternative therapy for pain and stress in rheumatic disease.

Stress and pain mechanisms are complex and share many central nervous system pathways. Both are critical issues for patients with rheumatoid arthritis and other connective tissue diseases. The link between stress and neuroendoimmune function suggests that alternative therapies focusing on improved psychologic and metabolic function could significantly change patients' pain outcomes. Programs using alternative therapies such as tai chi and meditation in combination with traditional medications appear to be beneficial for patients with arthritis. These individuals appear to live better lives and may have better long-term outcomes.

An examination of individual differences in the relationship between interpersonal stress and disease activity among women with rheumatoid arthritis.

OBJECTIVE: The effects of interpersonal stress on disease activity were examined for married women with rheumatoid arthritis (RA) who differ in the quality of their relationships with their spouses. METHODS: Measures of interpersonal events were collected weekly for 12 weeks and related to disease activity through a comparison of clinician ratings and immune markers taken at baseline and during a highly stressful week for 20 RA patients. Individual differences in marital relationship variables and illness characteristics were used to predict group differences in how stress affected disease activity. RESULTS: Significant elevations in total T cell activation (DR + CD3 cells), soluble interleukin-2 receptor (sIL-2R), and clinician's global ratings of disease activity were found during a week of significant interpersonal stress. However, women with better spousal relationships did not show increases in disease activity following an episode of interpersonal stress. In addition, patients taking low-dose prednisone showed greater reactivity to stress than patients not currently using glucocorticoid treatment. CONCLUSION: The results are consistent with the hypothesis that disease activity in RA increases following increases in interpersonal stress and that women with stronger marital relationships were less vulnerable to those stressors.

Clearance of 125I-labeled interleukin-6 from brain into blood following intracerebroventricular injection in rats.

To test the hypothesis that interleukin-6 (IL-6) induced within the brain can be released into peripheral blood, 125I-labeled IL-6 was injected into the lateral cerebral ventricle of rats, and its concentration in peripheral blood followed serially. Acid-precipitable tracer appeared within 5 min of injection and entered the blood following first-order kinetics (fractional rate, 0.0116 +/- 0.0022/min). Comparison of areas under the curve of intracerebroventricular (icv) vs. iv injection showed that 37.1-46.5% of tracer injected into the lateral cerebral ventricle appeared in the blood over a 4-h period. icv IL-6 exits at least in part via venous drainage (superior sagittal sinus/aortic concentration gradient was 1.47 +/- 0.23 and 3.05 +/- 0.87 in two separate groups). Prior icv injection of human IL-1beta (100 ng) did not alter rate of degradation or of exit ofradioiodine-labeled IL-6 from the brain. These studies indicate that a relatively high proportion of IL-6 that arises in the brain enters the peripheral circulation. Direct secretion of IL-6 from brain to blood may be a mechanism by which the brain modifies peripheral metabolic, endocrine, and immune activity.

Neuroendocrine correlates of separation stress in the Siberian dwarf hamster (Phodopus sungorus).

Siberian dwarf hamsters form monogamous male-female pair bonds. Disruption of the pair bond results in increases in body mass and behavioral alterations similar to profiles seen in human atypical depression. We examined behavioral and neuroendocrine correlates associated with separation of the male from his mate. Animals were paired (n = 28 pairs) for 3 weeks, then 15 pairs were separated and 13 pairs remained as controls. Behaviors of the males were observed in a novel environment following 3 weeks of pairing and 4 weeks of separation. The 5-min behavioral test monitored exploratory, territorial behavior, and locomotor activity. Separated males showed a significant increase in body mass (p < 0.01). paralleled by an increase in food consumption (p < 0.01). Separated males had decreased seminal vesicle mass (p < 0.05) and testicular mass (p < 0.05). Behavioral analysis revealed that separated males showed no significant differences in grooming, scent-marking, alert on 2 feet, or escape behavior when compared to paired males. Separated males did show significant increases in inactivity (p < 0.05). Plasma cortisol levels were significantly increased in separated animals (p < 0.05), but there were no significant effects on testosterone. Resting levels of plasma norepinephrine and epinephrine were less in separated males, but this was significant only for norepinephrine (p < 0.05). In conclusion, separation stress was accompanied by increased hypothalamic-pituitary-adrenal axis function and decreased peripheral sympathetic nervous system activity and decreased reproductive profiles.

The importance of social condition in the hormonal and behavioral responses to an acute social stressor in the male Siberian dwarf hamster (Phodopus sungorus).

Social condition is an important factor in determining the behavioral and hormonal responses to a social stressor in the Siberian dwarf hamster (Phodopus sungorus). We predict that males housed with a female or a family (female and pups) will show an increase in the magnitude of the behavioral and hormonal responses to a male intruder compared to those of individually housed males. Three treatment groups were studied: individually housed males that had been previously group-housed in same-sex colonies (males, n = 10), males housed with a female (male + female, n = 9), and males housed with their female and pups (male + family, n = 12). Males were monitored for aggressive behavior toward an intruder male for 10 min. Blood samples were taken at baseline and after the encounter. Male + female and male + family groups spent more time in aggressive behavior (P < 0.05), such as attacking (P < 0.05) and fighting (P < 0.05), than did individually housed males. These same groups showed significant increases in plasma cortisol after the encounter (P < 0.01) whereas there were no significant increases in plasma cortisol in solitary males. All groups showed significantly lower levels of plasma testosterone (male, P < 0.001, male + female, P < 0.05; male + family, P < 0.01) whereas a significant increase in prolactin occurred only in the male + family group (P < 0.05). There was a significant positive correlation between postencounter cortisol levels and total number of minutes spent in aggressive behavior (P < 0.05). These results demonstrate that the introduction of a novel intruder male results in an activation of the hypothalamic-pituitary-adrenocortical axis and a suppression of the reproductive axis. Furthermore, pairing of a male with a female alters the behavioral and hormonal responses to an intruder male.

Comparison of types of pulmonary stenosis with the state of the ventricular septum in complete transposition of the great arteries.

The pulmonary valve and left ventricular outflow tract of 214 hearts with d-transposition of the great arteries (d-TGA) were visually inspected (126 of 214 with intact ventricular septum and 88 of 214 with ventricular septal defect [VSD]). Pulmonary stenosis (PS), either valvular, subvalvular, or in combination, was present in 26 cases and was found to be more common in the presence of a VSD (20.5%) than intact ventricular septum (6.3%). PS occurred more commonly in the presence of a supracristal VSD than an infracristal VSD (70%, 7 of 10 vs 15%, 10 of 66). Further, infracristal or supracristal VSDs were associated with different types of pulmonary obstruction. In seven of ten cases with infracristal VSD and PS, the stenosis was caused by an anomaly of an atrioventricular valve. In six of seven cases with supracristal VSD and PS, the latter was caused by membranous encirclement of the left ventricular outflow tract.

Traumas oculares causados por agressoes em 70 pacientes. / Ocular traumas caused by personal attack in 70 patients

Num estudo realizado em 307 pacientes com traumatismos oculares, internados no servico de oftalmologia do Hospital Municipal Souza Aguiar no periodo de 15 meses, foram registrados 70 casos de agressoes. O agente causal mais frequente do trauma ocular foi a pedrada seguida do projetil da arma de fogo (PAF), ocasionando graves ferimentos perfurantes de globo ocular. O estudo das causas que levam a agressao implica numa profunda analise do comportamento humano e social, nao sendo esse o nosso proposito. Consideracoes sobre alguns aspectos estatisticos sao aqui abordados visando possiveis medidas preventivas, que possam contribuir para diminuir as agressoes ou os seus efeitos