Shape reconstruction of subcellular structures from live cell fluorescence microscopy images.

Live imaging of subcellular structures is indispensible to advance our understanding of cellular processes. The blurred digital images acquired in light microscopy are, however, complex to analyze, and identification and reconstruction of subcellular structures from such images remains a major challenge. We present a novel, model-based image analysis algorithm to reconstruct outlines of subcellular structures using a sub-pixel representation. The algorithm explicitly accounts for the optical properties of the microscope. We validate the reconstruction performance on synthetic data and apply the new method to fluorescence microscopy images of endosomes identified by the GTPase EGFP-Rab5. The benefits of the new algorithm are outlined by comparison to standard techniques. We demonstrate that the new algorithm leads to better discrimination between different endosomal virus entry pathways and to more robust, accurate, and self-consistent quantification of endosome shape features. This allows establishing a set of features that quantify endosome morphology and robustly capture the dynamics of endosome fusion.

A six-month randomized controlled trial of exercise and pyridostigmine in the treatment of fibromyalgia.

OBJECTIVE: A subset of fibromyalgia (FM) patients have a dysfunctional hypothalamic-pituitary-insulin-like growth factor 1 (IGF-1) axis, as evidenced by low serum levels of IGF-1 and a reduced growth hormone (GH) response to physiologic stimuli. There is evidence that pyridostigmine (PYD) improves the acute response of GH to exercise in FM patients. The purpose of this study was to evaluate the clinical effectiveness of 6 months of PYD and group exercise on FM symptoms. METHODS: FM patients were randomized to 1 of the following 4 groups: PYD plus exercise, PYD plus diet recall but no exercise, placebo plus exercise, and placebo plus diet recall but no exercise. The primary outcome measures were the visual analog scale (VAS) score for pain, tender point count, and total myalgic score. Secondary outcome measures were the total score on the Fibromyalgia Impact Questionnaire (FIQ) and FIQ VAS scores for individual symptoms (fatigue, poor sleep, stiffness, and anxiety), as well as quality of life (QOL) and physical fitness (lower body strength/endurance, upper and lower body flexibility, balance, and time on the treadmill). RESULTS: A total of 165 FM patients completed baseline measurements; 154 (93.3%) completed the study. The combination of PYD and exercise did not improve pain scores. PYD groups showed a significant improvement in sleep and anxiety in those who completed the study and in QOL in those who complied with the therapeutic regimen as compared with the placebo groups. Compared with the nonexercise groups, the 2 exercise groups demonstrated improvement in fatigue and fitness. PYD was generally well tolerated. CONCLUSION: Neither the combination of PYD plus supervised exercise nor either treatment alone yielded improvement in most FM symptoms. However, PYD did improve anxiety and sleep, and exercise improved fatigue and fitness. We speculate that PYD may have improved vagal tone, thus benefiting sleep and anxiety; this notion warrants further study.

El test de Rorschach en la práctica clínica / The Rorschach test in clinical practice

This article shows the main characteristics of the Rorschach test, as well as the utility of this psychological exam as a clinical diagnostic instrument. It is reviewed the historical evolution and controversy that has grown with it, the clinical dimensions and also, some specific clinical applications. This paper promotes an interdisciplinary concept exchange by providing the language and criterion needed to understand it. It is explained the utility of this test in differential diagnosis between bipolarity, schizophrenia, unipolar depression and personality disorder.

Este artículo expone las principales características del Test de Rorschach en tanto instrumento de apoyo al diagnóstico clínico. Su evolución histórica, los motivos de controversia, las dimensiones que estudia y sus aplicaciones a la práctica clínica. Pretende facilitar el intercambio interdisciplinario, aportando los criterios, lenguaje y conceptos que permitan la adecuada comprensión de esta prueba. Destaca su utilidad en el diagnóstico diferencial de Bipolaridad con respecto a Esquizofrenia, Depresión Unipolar y Trastorno de la Personalidad.

Multidisciplinary approaches for management of fibromyalgia.

Multidisciplinary approaches to fibromyalgia syndrome (FMS) treatment are advocated for treating the complex symptoms and problems confronting many patients. Exercise and cognitive-behavioral strategies together with patient education commonly comprise the multidisciplinary approach to treatment in clinical trials. A review of the research literature suggests that they are effective for decreasing pain and FMS impact and increasing self-efficacy and physical functioning. Limitations of the current evidence base include a lack of studies that include medication treatment as part of the multidisciplinary approach as well as lack of attention to the diversity of patient psychosocial issues that may interfere with treatment effectiveness. The review recommends that further randomized clinical trials be carried out with subgroups of patients using standardized outcome measurements, adequate treatment length and sufficient length of follow-up to be able to observe and document changes in patient symptoms and behaviors over time.

A comparison of the SF-36 and Nottingham Health Profile in patients with chronic neuropathic pain.

The aim of this study was to evaluate and compare the psychometric properties of two generic health-related quality of life (HRQoL) instruments, the Short Form Health Survey (SF-36) and the Nottingham Health Profile (NHP) in a group of patients with chronic peripheral neuropathic pain (PNP). The sample consisted of 126 adults (56 men and 70 women) with PNP following a lesion of a peripheral nerve, spinal nerve or nerve root or patients with post-herpetic neuralgia. The battery of tests included visual analogue scales (VASs) for pain assessment and global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors. The SF-36 had higher internal consistency reliability coefficients (alpha=0.79, range 0.70-0.90) than the NHP (alpha=0.68, range 0.49-0.79). Correlations between comparable dimensions of the two instruments were significant (range from -0.79 for the physical and mental dimensions to -0.29 for the social dimension) indicating a moderate degree of convergent validity. The study population had significantly worse scores on all dimensions of the two instruments when compared with the general population. Subjects with high VAS scores for pain on movement and those with low global health ratings had poorer scores on the both instruments. Overall, the SF-36 performed somewhat better on psychometric testing than did the NHP. However, the NHP contains dimensions such as sleep and more pain items which might be of particular importance in the PNP population. Since the instruments are short, both could be retained for continued testing in outcome studies of this population.

Exercise for patients with fibromyalgia: risks versus benefits.

Although exercise in the form of stretching, strength maintenance, and aerobic conditioning is generally considered beneficial to patients with fibromyalgia (FM), there is no reliable evidence to explain why exercise should help alleviate the primary symptom of FM, namely pain. Study results are varied and do not provide a uniform consensus that exercise is beneficial or what type, intensity, or duration of exercise is best. Patients who suffer from exercise-induced pain often do not follow through with recommendations. Evidence-based prescriptions are usually inadequate because most are based on methods designed for persons without FM and, therefore, lack individualization. A mismatch between exercise intensity and level of conditioning may trigger a classic neuroendocrine stress reaction. This review considers the adverse and beneficial effects of exercise. It also provides a patient guide to exercise that takes into account the risks and benefits of exercise for persons with FM.

Quality of life of women with systemic lupus erythematosus or rheumatoid arthritis: domains of importance and dissatisfaction.

The aim of this study was to increase understanding of the domains of life that are important to Swedish women with chronic rheumatic disease and to describe their dissatisfaction with these domains. Fifty women with Systemic Lupus Erythematosus (SLE) and 50 with Rheumatoid Arthritis (RA) were interviewed by telephone regarding their quality of life using five open-ended questions. Content analysis of their responses revealed nine categories: Health/wellness, Family/friends, Work, House/home/living environment, Social support/functional services, Hobbies/cultural activities, Sufficient income, Independence, Integrity/identity. Areas of importance correspond closely to those areas with which they were most dissatisfied. Although the domains identified in both groups were the same, SLE patients expressed more dissatisfaction with their perceived control over their bodies and understanding about their condition on the part of physicians and people in general. RA patients were more dissatisfied with areas of their lives that threatened their independence. Health care providers should be aware of these areas of dissatisfaction so that they can plan strategies to maximize patient quality of life.

Conceptualization and measurement of quality of life as an outcome variable for health care intervention and research.

If health care providers are to be able to document effective outcomes resulting from their interventions, they must first develop clear conceptual definitions for the outcomes, and then select measures that represent these concepts. No consensus exists in the health care disciplines about what quality of life is or how it should be measured. This paper presents historical and conceptual arguments in favour of a particular definition of quality of life, and distinguishes between quality of life and concepts often confused with it in the literature: symptoms, mood, functional status, and general health status. Whether quality of life is actually amenable to change as a result of health care interventions, and whether we ought to be trying to influence clients' quality of life is also discussed. We conclude that quality of life is an important outcome of health care intervention. However, traditional approaches to influencing quality of life may be misdirected, and the relative importance of our interventions to clients--whose opinions matter the most--ought to be put into perspective.

Validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index.

The purpose of this study was to examine the validity and reliability of the Norwegian version of the Ferrans and Powers Quality of Life Index in a sample of 131 men and women with newly diagnosed cancer. The Quality of Life Index was translated into Norwegian using a standardized international approach, including back-translation. The findings showed high internal consistency reliability for the global score (alpha = 0.93 (test)) as well as for the following domains: health and functioning (alpha = 0.88), socio-economic (alpha = 0.82), psychological/spiritual (alpha = 0.82) and family (alpha = 0.79). The test-retest reliability after 3-4 weeks was 0.78 for the global score. A factor analysis partially confirmed the different subscales. In conclusion, the Quality of Life Index was found to be reliable and had sufficient validity to be used for measuring quality of life in Norwegian cancer patients.

Soft tissue problems associated with rheumatic disease.

Rheumatic disease and associated soft tissue problems encompass a large number of syndromes and account for a high percentage of visits to primary care practitioners. This article describes the symptoms, causes, and treatments for five of the problems most commonly encountered: bursitis, tendinitis, carpal tunnel syndrome, myofascial pain syndrome, and fibromyalgia. Effective management requires a structured history, physical examination, and definitive diagnosis that distinguishes the soft tissue problem from a joint problem and an inflammatory syndrome from a noninflammatory syndrome. The overriding principle is self-management of treatments that focuses on relief of pain, maintenance of function, and avoidance of factors that cause recurrence or exacerbation of the problem. Medications, physical therapies, biomechanical aids, and exercise strategies, along with cognitive-behavioral techniques for the more chronic problems, are all known to decrease symptoms and to assist patients in returning to normal functioning.

The Norwegian version of the Quality of Life Scale (QOLS-N). A validation and reliability study in patients suffering from psoriasis.

The aim of this study was to adapt, validate, and test for reliability the Quality of Life Scale in Norwegian (QOLS-N) for patients suffering from psoriasis. Two hundred and eighty-two patients with psoriasis were included in the study. Self-reported health was measured using the SF-36. Disease severity was also measured in 95 patients using the Psoriasis Area and Severity Index (PASI). The reliability of the QOLS-N was computed using the internal consistency reliability (Cronbach's alpha) and the test-retest reliability test. Face and content validity and construct discriminant ability of the QOLS-N were assessed. The results indicated that the QOLS-N has highly satisfactory rates of test-retest reliability (r = 0.83) and internal consistency reliability (alpha 0.86). As expected, the QOLS-N had a lower correlation with physical health (r = 0.24, p < 0.000) and self-reported symptoms (r = -0.20, p < 0.001), and a higher correlation with mental health (r = 0.52, p < 0.000). The correlation with disease severity was not significant (-0.06). The results reported in the present paper are in accordance with those derived in other validation studies. The QOLS-N seems to be a reliable and valid measure of global quality of life in patients suffering from psoriasis.

Hypothalamic-pituitary-insulin-like growth factor-I axis dysfunction in patients with fibromyalgia.

OBJECTIVE: To investigate the serum levels of insulin-like growth factor-I (IGF-I) in patients with fibromyalgia (FM) compared to healthy controls and patients with other rheumatic diseases, and to explore possible etiologic mechanisms of low IGF-I levels in patients with FM. METHODS: Five hundred patients with FM and 152 controls (74 healthy blood donors, 26 myofascial pain patients and 52 patients with other rheumatic diseases) were studied. All had measurements of acid extracted serum IGF-I. A subset of 90 patients with FM were evaluated for clinical features that might explain low IGF-I levels. Twenty-five patients with FM underwent growth hormone (GH) provocation testing with l-dopa and clonidine. RESULTS: The mean serum IGF-I level in patients with FM was 138 +/- 56 ng/ml and in controls 215 +/- 86 ng/ml (p = 0.00000000001). Low levels of IGF-I were not due to depression, tricyclic medications, nonsteroidal antiinflammatory drugs, poor aerobic conditioning, obesity, or pain level. Patients with focal myofascial pain syndromes had normal IGF-I levels (236 +/- 68), as did most patients with other rheumatic disorders, unless they had concomitant FM. Patients with FM with initially normal levels often had a rapid decline of IGF-I over 1 to 2 years. Most patients with FM with low IGF-I levels failed to secrete GH after stimulation with clonidine and l-dopa. CONCLUSION: Many, but not all, patients with FM have low levels of IGF-I that cannot be explained by clinical associations. These results suggest that low IGF-I levels in patients with FM are a secondary phenomenon due to hypothalamic-pituitary-GH axis dysfunction.

Impact of fibromyalgia on everyday life: a study of women in the USA and Sweden.

The study investigated how 39 women with fibromyalgia (FM), living in two countries (USA or Sweden), report the consequences of fibromyalgia on everyday life activities. Data were collected using questionnaires, diaries and interviews. The result showed that the impact on everyday life was considerable. The majority of the women experienced pain and fatigue for more than 90% of their time awake. There were no significant differences between the national groups in time use, problems with everyday activities, or quality of life. Overall, the differences between individuals were greater than between the national groups. The majority of the employed patients in the Swedish group had reduced their working time, while the employed patients in the USA group worked mainly full-time. Patients who were able to reduce their working hours to fit their perceived capacity were less exhausted during their leisure, and reported higher satisfaction with daily activities.

Group treatment of fibromyalgia: a 6 month outpatient program.

OBJECTIVE: To evaluate the impact of a 6 month group therapy program on the treatment of patients with fibromyalgia (FM). Since FM is a common problem in rheumatology practice, a program was designed to treat patients in a group setting using allied health professionals. METHODS: The FM group (15 to 25 patients) met once a week for 6 months. The average session lasted 90 min and consisted of formal lectures, group sessions emphasizing behavior modification, stress reduction techniques, strategies to improve fitness and flexibility and support sessions for spouses/significant others. The 2 major outcome measures were the fibromyalgia impact questionnaire (FIQ) and the total tender point score. Secondary outcome measures were the quality of life scale, questionnaires to assess coping strategies and attitudes to illness, an index of aerobic conditioning, flexibility, distance walked in 6 min., Beck depression and Beck anxiety questionnaires. Patients were followed 2 years and compared to a group of patients outside the program. RESULTS: Between 1989 and 1993 170 patients were evaluated and 104 patients completed the program. At the end of the 6 months 73 (70%) of patients had <11 tender points and FIQ improved 25%. Having a pain profile on MMPI or having major depression, did not predict poorer outcome. Thirty-three patients followed for 2 years after the program continue to show improvement. A control group of 29 patients who never entered the program showed no significant improvement. CONCLUSION: The group treatment of patients with FM in an outpatient setting shows promise; a more formal controlled study is needed to confirm this impression.

Perceived control: a comparison of women with fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus using a Swedish version of the Rheumatology Attitudes Index.

This study compared the attitudes of women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or fibromyalgia (FM) regarding their perceptions of control and ability to cope with their disease. We also report the validation of a Swedish version of the Rheumatology Attitudes Index (RAI). One hundred thirty-nine women participated in the study by completing the RAI two or three times along with several other self-report and disease severity measures. The Swedish version RAI was found to have acceptable reliability, evidence of validity, sensitivity to change, and two distinct factors of internality and helplessness. In general, patients with RA or SLE perceived higher control over their symptoms than those with FM. FM patients who participated in a self-management experimental program significantly changed their scores on the RAI in a positive direction.

Predictors of hand function in patients with rheumatoid arthritis.

OBJECTIVES: The aims of this study were to determine: (1) what factors predict patient self-estimated hand function; (2) what factors predict actual hand function; and (3) the relationship among actual hand function, patient estimates of hand function, and self-assessed activities of daily living (ADL). METHODS: Fifty-two patients with rheumatoid arthritis completed wrist and hand mobility measures, grip strength, pain, stiffness, and estimated hand function tests, along with the Sollerman Grip Function Test (actual hand function), Health Assessment Questionnaire (HAQ), and subscales of the Arthritis Impact Measurement Scales (AIMS). RESULTS: Grip strength and stiffness were the strongest predictors of self-estimated hand function. Flexion and extension deficits in digits II through V were the strongest predictors of actual hand function. Actual hand function and self-estimated hand function were significantly correlated with each other and with the HAQ and AIMS subscales. CONCLUSIONS: Measures of deficit are the most useful in predicting actual hand function, whereas measures of strength and flexibility are most useful for estimated hand function.

Evaluation of a Swedish version of the arthritis self-efficacy scale in people with fibromyalgia.

The major purpose of this study was to determine the utility and construct validity of the Swedish version of the Arthritis Self-Efficacy Scale (ASES-S). Ninetynine women with fibromyalgia (FS) were included in a randomized, controlled trial of fibromyalgia efficacy-based self-management education and physical training. Several self-report instruments were used to evaluate the outcome of the intervention. Evidence of construct validity of the ASES-S was revealed in the factor analysis which produced a three factor solution similar to previous results. Significant correlations between ASES-S and pre and post health status measures were consistent with theoretically derived hypotheses, further testifying to construct validity. Multiple regression analyses confirmed that pretest ASES-S was the strongest predictor of posttest ASES-S. The results indicated that the intervention had produced a significant change in ASES-S and that this positive change in self-efficacy was associated with changes in health status. In conclusion, this study has shown the ASES-S to be a valid measure of treatment effects also for patients with FS.

The Fibromyalgia Impact Questionnaire, a Swedish translation of a new tool for evaluation of the fibromyalgia patient.

The American Fibromyalgia Impact Questionnaire (FIQ) was translated into Swedish. The FIQ is a brief 10-item self-administered instrument designed to evaluate the special problems bothering fibromyalgia patients. After the translation procedure, 73 Swedish women fibromyalgia patients answered the translated FIQ. The questionnaire was fast and simple to handle both for the patients and the investigators. There was a good level of correspondence between FIQ items and related items in the Health Assessment Questionnaire, the Nottingham Health Profile and the Psychological General Well-Being Index. There were no significant differences in a test-retest analysis. The study has provided evidence that the translated and slightly modified Swedish version of the American Fibromyalgia Impact Questionnaire has the validity and sensitivity to be able to function as a relevant and comprehensible tool to monitor FMS-patients.

Exercise tests as outcome measures.

Outcome assessments of physical fitness attributes such as endurance, strength, and flexibility are not measured routinely in clinical trials or clinical practice in either adults or children with rheumatic diseases. Although physical fitness is not a measure of disease severity, it can be a critical indicator of capacity to function. Adequate fitness is necessary for the performance of positive health behaviors that enhance health status and wellness in spite of chronic disease. The purpose of this paper is to explore the conceptual, methodologic, and analytic issues related to the use of exercise tests as outcome measurements of physical functioning in persons with rheumatic disease.

Education programmes for fibromyalgia patients: description and evaluation.

A firm theoretical basis for patient education in rheumatic disease care has been built up over the past 10 to 15 years. Education in self-management has enabled patients to control symptoms and become partners in care with their health providers. Education for fibromyalgia patients has come to the foreground during the last 5 years as health professionals have come to understand the syndrome better and recognize the role that stress plays in the exacerbation of symptoms. A few controlled trials of various strategies, such as aerobic conditioning and cognitive-behavioural techniques, have been reported recently. All have shown significant benefits to patients with fibromyalgia. Only one controlled trial has studied the effects of a self-management education programme alone. The results of this programme were positive. Self-efficacy and life quality were enhanced. This programme and an uncontrolled programme that integrated many strategies have shown some of the first positive long-term indications that patients who are treated intensively for even a short time can continue to improve as they practice self-management techniques. There is still a need for further documentation of non-drug treatment strategies and especially further research into who is helped by which strategies, the optimal length of time for a programme, and the need for ongoing treatment.