Effects of recent and past major depression and distress on self-concept and coping.

The Self-Appraisal Questionnaire (J. C. Coyne & M. M. Calarco, 1995) was used to examine how primary care and psychiatric outpatients with recent or past major depression appraised their prospects and structured their lives. They were compared with nondistressed and distressed primary care patients. Both depressed groups scored higher than the nondistressed patients for Lack of Energy, Management of Burden on Others, Need to Maintain a Balance in Life, Fear of Taking Risks, Imposition of Limitations on Life, and Sense of Stigma. The distressed group fell between the depressed psychiatric and the nondistressed groups, and generally did not differ from the depressed primary care group. Past depression did not explain differences associated with more recent depression and distress. Distress entails a need to manage its effects on others, but depression in psychiatric patients may produce a more profound reorganization of self-concept, relationships, and coping.

Effects of the experience of depression: application of focus group and survey methodologies.

The popularity of cognitive theories of depression has not appreciably increased attention to the effects of depression on how its sufferers subsequently think about themselves and structure their lives. As a first step in a program of systematic research, we recruited recent and former depressed psychiatric patients to participate in focus group discussions of their experience of depression and how it has affected them. Statements elicited in two focus groups were classified into eight categories: lack of energy and the loss of self-efficacy, fear of recurrence, fear of taking risks, inability to trust oneself, self-presentation and concealment, concern about being a burden to others, secondary guilt about having been depressed, and reduced involvement in interpersonal relationships. These results were then used as the basis for the construction of a survey instrument, the Self-Appraisal Questionnaire (SAQ), and strong differences were found between recently recovered depressed women and a sample of women without a history of depression. Taken together, results of the focus groups and the survey study support the utility of a limited "sick role" for recovering depressed persons.

Oxidative stress during reperfusion of human hearts: potential sources of oxygen free radicals.

OBJECTIVE: The aim was to examine the role of neutrophil activation in the genesis of oxidative stress during the early phases of reperfusion after ischaemia in patients subjected to aortocoronary bypass grafting. METHODS: Ten selected patients were studied. All had normal ejection fraction and normal left ventricular end diastolic pressures before operation. Each patient required at least three grafts, so that the duration of aortic crossclamping exceeded 30 min, the minimum ischaemic period required to detect oxidative stress upon reperfusion. Oxidative stress was assessed by measuring the formation and release of oxidised glutathione (GSSG) in the coronary sinus 1 min before and 3 min after the start of the cardiopulmonary bypass, and then 1, 5, 10, and 20 min after removal of the aortic clamp, and again 5 and 10 min after the end of the cardiopulmonary bypass. The arterial-coronary sinus difference for neutrophils, elastase-alpha 1 protease complex (elastase), and creatine phosphokinase was also monitored at the same intervals. RESULTS: Before clamping GSSG was undetectable in arterial and coronary sinus blood. There was no significant arterial-coronary sinus difference for neutrophils or elastase [53(SEM 66) cell.ml-1 and 1.10(2.49) micrograms.litre-1, respectively[. Five minutes after re-establishment of coronary blood flow, there was both a release of GSSG into the coronary sinus [arterial-coronary sinus difference: 11(2.6) nmol.dl-1] and an accumulation of neutrophils in the heart [arterial-coronary sinus difference: 262(33), P < 0.01 cell.ml-1], whereas no elastase release from the heart was measured [arterial-coronary sinus difference 7.6(4.46) microgram.litre-1, NS]. The arterial levels of elastase increased progressively during the operation from 48(5) microgram.litre-1 (preclamping) to 405(62) microgram.litre-1, P < 0.01 (end of the cardiopulmonary bypass). CONCLUSIONS: These data indicate that, in man, neutrophils do accumulate in the myocardium during early reperfusion. However, they are not activated when oxidative stress occurs. It is unlikely that the neutrophil localisation in the heart has pathological significance in the production of oxygen free radicals during early reperfusion. Free radical accumulation in the coronary vessels may contribute to disorders of coronary flow associated with reperfusion.

An integrated nursing model of depressive behavior in adults. Theory and implications for practice.

Accumulating evidence suggests that cognitive processes or stimuli associated with a stressor may influence the neurochemical state. In addition, it has been suggested that a person's coping responses may protect him or her from the biologic dysregulations implicated in depression. From a nursing care perspective, the proposed model suggests the following practice components. First, assessment not only should include the symptom profiles of each client but should address both physical and psychosocial stressors. Second, once identified, individualized care needs to incorporate a variety of interventions that focuses on the target components (i.e., cognitive interventions for negative thought patterns, interventions to build interpersonal skills, sleep hygiene principles, pharmacologic interventions, and so forth). Finally, one needs to address how having experienced episodes of depression may influence the client's self-perception and ongoing quality of life. Nurses must begin to understand how the experience of having a depressive episode itself may serve as an ongoing stressor for the client. The factors that maintain depressive behavior and influence recurrence need to be the central focus of mental health nursing from a research and clinical perspective. It is this attention to integration and recurrence that will define nursing's unique contributions to this important area of mental health.

Serum isoforms of creatine kinase MM and MB in myocardial infarction. An appraisal of quantitative, clinical and pathophysiological information.

Using an electrophoretic method, the changes in the catalytic activities of three CK-MM isoforms (MM1, MM2, MM3) and two CK-MB isoforms (MB1, MB2) in the serum of 13 patients with acute myocardial infarction (AMI) have been monitored for 3 days after the onset of chest pain. In post-AMI period, MM3 reaches a peak first, 17 h after infarction (394 U/l), followed by MB2 (17.3 h, 190 U/l), MB1 (20.6 h, 82 U/l), MM2 (28.7 h, 637 U/l), and MM1 (32 h, 780 U/l). According to their faster decay from circulation, MB2 and MM3 have higher fractional disappearance rates (-0.035 and -0.026 per hour, respectively). The MM3/MM1 activity ratio rises beyond the upper limit found in healthy subjects within about 3 h after onset of symptoms and peaks 9.3 h after AMI, even earlier than peaks of isoforms. These characteristics make the ratio an earlier and more sensitive indicator of acute enzyme release from necrotic myocardium.

Serum enzymes in acute myocardial infarction after intracoronary thrombolysis.

Serum kinetics of total creatine kinase (CK), CK-MB isoenzyme, aspartate aminotransferase (AST), lactate dehydrogenase (LD) and alpha-hydroxybutyrate dehydrogenase (HBD) activities were studied in twenty patients with acute myocardial infarction randomly assigned to receive either intracoronary urokinase (group A) or conventional (control) therapy (group B). The temporal characteristics of enzyme changes described were the time lag from onset of chest pain until maximum catalytic concentration value, the rate at which enzymes are released into blood, the peak value of the serum enzyme curves and (d) the fractional disappearance rate (Kd) for each enzyme considered. Thrombolytic treatment induced earlier peak times in group A: for CK, 10.8 vs 27.0 h, for CK-MB, 10.4 vs 23.1, for AST, 13.9 vs 31.3, for LD, 24.4 vs 49.1, and for HBD, 20.5 vs 48.5 (for all enzymes, p less than 0.001). The maximal rate of release for the enzymes was at least twofold greater in group A. Enzyme peak activities and Kd were not significantly different between the groups. The most significant discrimination between the two groups was obtained with AST peak time (Hartz overlap index (Oi) = 0.11) and CK-MB peak time (Oi = 0.12).

Isoforms of creatine kinase MM and MB in acute myocardial infarction: a clinical evaluation.

Serum creatine kinase (CK, EC 2.7.3.2) isoenzymes MM and MB were resolved, respectively, into three (MM1, MM2, MM3) and two (MB1, MB2) isoforms (subforms derived from the same isoenzyme) by electrophoresis and the isoform patterns were determined in multiple sequential serum samples, timed from the onset of chest pain, from 58 patients with acute myocardial infarction (AMI). During the first 3 h after the onset of chest pain, the serum isoform activity resembled the pattern seen in normal volunteers. Specimens obtained 6 h after AMI showed predominantly MM3 and MB2 (45% and 11% of the total CK activity, respectively). Between 10 and 72 h, there was a gradual shift in which MM3, MM2 and MB2 decreased, while MM1 and MB1 increased. MB2 and MB1 disappeared from the pattern for samples collected after 24-48 h, while MM1 was always the most prominent band at the end of the observation period (66%, range 41-77%, at 48 h). These data suggest that a single determination of CK isoform pattern, drawn between 6 and 48 h after AMI, may provide an effective means of predicting the time of onset of necrosis. There were no significant differences in the CK isoform patterns according to infarct location and functional status of patients.

Evaluation of the direct potentiometric method for serum chloride determination--comparison with the most commonly employed methodologies.

A new instrument (NOVA 4 + 4) designed to measure serum chloride by ion-selective electrode (ISE)-direct potentiometry (without sample dilution) was evaluated and compared with two widely used methodologies for chloride determination. Mean values obtained with the Nova were significantly higher than those obtained by a colorimetric method and by coulometric titration. Unlike these procedures, which are performed after sample dilution, direct potentiometry was unaffected by changes in plasma water caused by hyperlipemia and/or high protein concentrations. The only important interference was falsely high choride caused by administered bromide or iodide. Therefore, the direct potentiometric method should be more accurate than the colorimetric or coulometric procedures, especially when plasma lipids or proteins are very high.

Evaluation of a commercial immunoenzymometric assay kit for creatine kinase MB isoenzyme determination using monoclonal antibodies.

A simultaneous two-site immunoenzymometric assay for creatine kinase MB determination (Hybritech Tandem-E CK-MB) using monoclonal antibodies was evaluated and compared with cellulose acetate electrophoresis using fluorometric scanning densitometry. The assay has satisfactory precision (between-day analysis gives a coefficient of variation between 2.1 and 9.4%) and is not susceptible to interference by concentrations of creatine kinase MM up to 5000 micrograms/l (3400 U/l) and creatine kinase BB up to 1000 micrograms/l (1085 U/l). The upper limit of MB isoenzyme concentration in 250 apparently healthy people was 5.5 micrograms/l. Comparison between the immunoenzymometric assay (y) and electrophoresis (x) yielded the following linear regression equation: y = 0.37x + 1.9, with a correlation coefficient of 0.828. The characteristics of the temporal kinetics of MB isoenzyme, calculated by two methods, in 49 patients with acute myocardial infarction, were nearly identical in terms of the rate of creatine kinase MB release and the time at which the peak value is obtained, but not in terms of the rate of elimination of the isoenzyme. The fractional disappearance rate of MB isoenzyme from the circulation was significantly higher if calculated with Tandem-E results rather than with electrophoresis results (-0.035 vs -0.028, p less than 0.001). Whereas in the first day after infarction immunoenzymometric assay and electrophoresis had the same clinical sensitivity for identifying patients with acute myocardial infarction, in specimens collected more than 24 hours after the onset of the chest pain, the clinical sensitivity of the immunoenzymometric method was lower. Our results show that it is still premature to draw definitive clinical conclusions from the immunoassay results.

Clinical and diagnostic significance of aspartate aminotransferase isoenzymes in sera of patients with liver diseases.

Serum aspartate aminotransferase isoenzymes were measured in 123 hospital patients with various liver diseases, using a new and simple immunochemical method. Our findings show the usefulness of this determination in estimating the severity of hepatic damage, especially if accompanied by the measurement of other mitochondrial enzymes. During hepatic damage, the cytoplasmic isoenzyme is found in greater quantities than the mitochondrial isoenzyme, but the level of the latter increases to a greater extent in acute liver diseases. Moreover, the values of mitochondrial aspartate aminotransferase activity and the ratio of mitochondrial to total aspartate aminotransferase in alcoholic hepatitis are higher than expected if so-called hepatic enzymes commonly measured in serum are considered. These results indicate that there is significant mitochondrial damage in alcoholic hepatitis.