[Children with psoriasis in secondary care: Clinical aspects and comorbidities diverge from the generally published data]. / Psoriasis de l'enfant vu en milieu libéral : les aspects cliniques et épidémiologiques diffèrent des données habituellement publiées.

BACKGROUND: Psoriasis affects 0.2-0.7 % of children and is associated with obesity. Published studies have been conducted in hospital settings (tertiary care). The PsoLib study evaluated childhood psoriasis in private practice (secondary care) in terms of epidemiology, clinical aspects and comorbidities. PATIENTS AND METHODS: This was a non-interventional, cross-sectional, multicenter study of children with psoriasis performed by 41 dermatologists working in private practice. The clinical and therapeutic aspects and comorbidities were systemically evaluated. We compared data to the χ-Psocar study performed in hospitals using the same methodology. RESULTS: In all, 207 children (girls: 60.4 %; mean age: 10.5±4.2 years) were included. Scalp psoriasis (40.6 %) was the most frequent clinical type, while plaque psoriasis represented 26 % of cases. Nail, tongue, and arthritic involvement were rare. Less than 1 % of children suffered from hypertension, diabetes or dyslipidemia, but 16.4 % were overweight and 7.0 % were obese. Severity (PG≥4 at peak) was associated with excess weight (P=0.01). CONCLUSION: Scalp psoriasis is the most frequent clinical type of psoriasis in childhood. Comorbidities and extracutaneous localization are rare. Even in private practice, the severity of the disease is associated with excess weight.

Verbal memory decline in Alzheimer's disease: a multiple-processes deficit.

Memory dysfunction is a primary diagnostic criterion and one of the earliest clinical manifestations of dementia of the Alzheimer type (DAT). The profile of progression of this memory deficit is assumed to represent a unitary decline. We studied the profile of verbal memory decline using an immediate free recall learning task in 18 DAT patients judged to be at 3 different stages of severity (mildly, moderately, and severely affected), using the serial-position function as the dependent measure. Results showed that the pattern of performance of DAT patients depended upon the severity of the disease. With mild dementia, the U-shaped curve was qualitatively similar to that observed in normals (presence of primacy and recency effects). With increasing severity of dementia, there was a consistent modification of the serial-position function with, in moderately affected subjects, a progression toward a unimodal curve devoid of a primacy effect and, later on, a decrease of the recency effect. These findings suggest that the serial-position function shows dynamic changes across stages of DAT. These dynamic changes may imply distinct disturbances of 2 or more learning-memory processes in this condition. The processes involved presumably reflect the temporal nature of the pathologic involvement of distinct neural systems, both structural and neurochemical.

Selective dorsolateral frontal lobe dysfunction associated with diencephalic amnesia.

We report three cases with unilateral thalamic ischemic lesions that resulted in lasting material-specific memory impairments and concomitant selective frontal lobe-related cognitive deficits. In two cases the lesions were limited to the left thalamus, and in the third the right thalamus was involved. These deficits were associated with ipsilateral diencephalic, striatal, and dorsolateral prefrontal hypoperfusion. The damage implicated the ventral anterior nucleus, the mamillothalamic tract, and the rostroventral internal medullary lamina. These findings suggest that medial thalamic damage involving the ventral and rostral sector of the dorsal thalamus will concurrently affect functionally and neurally distinct limbodiencephalic pathways and diencephalic connections with the frontal cortex. A review of the neuropsychological and neuroimaging findings from previously reported cases with vascular lesions of the thalamus further supports this contention. The presence of frontal lobe-related cognitive deficits, though not obligatorily related to the memory problems, may contribute to some aspects of the memory deficits and affect the nature of the memory disorder observed in some cases with diencephalic amnesia.

Cardiorespiratory alterations consequent to endurance exercise training during chronic beta-adrenergic blockade with atenolol and propranolol.

A study was undertaken to determine if normal healthy subjects can increase their endurance capacity consequent to endurance training during chronic beta-adrenergic blockade. Forty-seven subjects, 17 to 34 years of age, were randomly assigned to 1 of 3 treatments (placebo, propranolol, 160 mg/day, and atenolol, 100 mg/day) and then completed a 15-week aerobic exercise training program. All groups reduced their submaximal steady-state heart rates consequent to training; submaximal oxygen uptake was slightly reduced; submaximal stroke volume was increased only in the placebo and atenolol groups; submaximal cardiac output was generally lower; and arterial-mixed venous oxygen difference was increased after training in all 3 groups, suggesting decreased muscle blood flow and increased oxidative capacity. Maximal oxygen uptake and maximal treadmill time were increased in all 3 groups after training. However, while still on medication the atenolol group had significantly greater increases in maximal oxygen uptake and maximal treadmill time compared with the propranolol group. Because most patients will remain on medication, these results suggest a distinct advantage for cardioselective blocking agents. It is concluded that beta-adrenergic blockade does not reduce the ability of normal healthy subjects to gain the benefits associated with cardiorespiratory endurance training.

Influence of exercise training on resting blood pressures of Dahl rats.

To determine whether female Dahl salt-sensitive (SS) hypertensive rats would adapt to chronic treadmill exercise by exhibiting lower resting systolic blood pressures (RSBP), a 12-wk training program was undertaken. Female Dahl salt-resistant (SR) rats were also trained for the same time period a a similar intensity [40-70% maximal O2 consumption (VO2max)] and duration (55 min). Postexperimental treadmill run times and VO2max values [SR: nontrained (NT) 87 +/- 1, trained (T) 97 +/- 2; SS: NT 82 +/- 2, T 92 +/- 3 ml.min-1 X min-1 X kg-1] indicated that the prescribed program had produced a trained state. However, the training program caused no group differences between the SR or the SS and their nontrained controls in measurements associated with sodium chloride intake, fluid consumption, urine production, 24-h sodium excretion, plasma volumes, plasma insulin, or blood volumes. Chronic exercise did significantly lower RSBP in the SR subgroup after 6 wk (NT 123 +/- 4, T 110 +/- 3 mmHg) and 8 wk (NT 120 +/- 4, T 106 +/- 2 mmHg) and remained lower throughout the remaining weeks of the experiment. On the other hand, the RSBP results of the trained SS rats were significantly higher than the nontrained SS rats after 6 wk (NT 155 +/- 8, T 191 +/- 7 mmHg) and were never significantly different than the controls for the remainder of the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Reliability of a handgrip test for evaluating heart rate and pressor responses in multiple sclerosis.

PURPOSE: The purpose of this study was to determine the test-retest reliability of an isometric handgrip exercise protocol designed to evaluate heart rate and arterial pressure responses in individuals with multiple sclerosis (MS). METHODS Three males and eleven females, aged 24 through 51, performed isometric handgrip contractions at 30% of maximal voluntary contraction (MVC) to the point of fatigue (defined as inability to maintain the target force for three consecutive seconds). During this exercise, rate of perceived exertion (RPE) was recorded every 30 s. Heart rate and beat-to-beat systolic, diastolic, and mean arterial pressures were recorded continuously throughout the duration of exercise. Surface EMG was monitored continuously via loudspeaker to provide feedback on extraneous muscular activity. Each subject performed three trials. A repeated measures ANOVA was used to calculate interclass reliability estimates for each dependent variable. RESULTS: Reliability estimates for MVC and time to fatigue were 0.98 and 0.84, respectively. Reliability estimates for the following dependent variables at the point of fatigue were: RPE, 0.90; delta HR, 0.97; delta systolic pressure, 0.92; delta diastolic pressure, 0.87; and delta MAP, 0.88. CONCLUSIONS: We conclude that this isometric handgrip protocol is a reliable method for evaluating heart rate and blood pressure responses in MS patient.

Pressor response to isometric exercise in patients with multiple sclerosis.

The purpose of this study was to determine whether patients with multiple sclerosis (MS) would show attenuated heart rate and/or pressor responses to isometric handgrip exercise. Patients with MS (30 males, 74 females, aged 23-61 yr) and control subjects (9 males, 16 females, aged 25-47 yr) performed isometric handgrip exercise at 30% of maximal voluntary contraction (MVC) to fatigue. Systolic, diastolic, and mean arterial pressure (MAP) increased linearly in both groups, but were significantly lower (P < 0.05) in patients with MS at 20%, 40%, 60%, 80%, and 100% of exercise duration. Mean change in MAP at fatigue was +47.9 mm Hg for controls and +28.2 mm Hg for patients with MS, with 18 patients with MS between -6 mm Hg and +15 mm Hg. Heart rate increased normally in patients with MS. To predict change in MAP at fatigue in patients with MS, stepwise regression analysis using six variables yielded an R2 of 0.26. These data suggest that in some patients MS lesions exist in areas of autonomic cardiovascular control that result in attenuated pressor responses to exercise. In 17% of patients tested, attenuation was profound. Data also suggest an abnormal dissociation between the heart rate and pressor response to static work in patients with MS.

Prescribing physical activity for older patients.

Regular exercise is an effective nonpharmacologic therapy for stress, sleep disorders, depression, and anxiety, as well as such chronic conditions of aging as hypertension, obesity, diabetes mellitus, coronary artery disease, hyperlipidemia, and constipation. Pre-exercise office assessment of cardiac risk, possible limitations, and contraindications is advised. A balanced fitness training program includes activities to increase flexibility, strength, and cardiovascular endurance. The most effective exercise prescription begins with a type of aerobic activity the patient enjoys. A prescribed schedule of stepwise increments in frequency, duration, and intensity gradually leads to a maintenance level of fitness.

Complement C3b fragment covalently linked to tetanus toxin increases lysosomal sodium dodecyl sulfate-stable HLA-DR dimer production.

Processing and presentation of covalently linked C3b-tetanus toxin (TT) complexes, as compared to unlinked C3b + TT, lead to increased T cell proliferation. The aim of this study was to analyze the effect of coupling C3b to TT on the efficiency of TT peptide loading on HLA-DR1 molecules. In the Epstein-Barr virus-transformed B cell line HOM 2, we detected a significant increase of sodium dodecyl sulfate (SDS)-stable major histocompatibility complex (MHC) class II molecules after exposure to C3b-TT as compared to unlinked C3b and TT. The ratio of compact form/unbound form (C/U ratio) obtained with C3b-TT as antigen (Ag) is about twice that obtained with uncomplexed TT + C3b as Ag. Similar results were obtained using HLA-DR1-transfected fibroblasts that do not express C3b complement receptors, indicating that the SDS-stable HLA-DR1 increase did not result simply from C3b opsonization but rather from a direct effect of C3b-TT linkage on peptide generation. Exposure of HOM 2 cells to C3b-TT resulted in an increase in concentration of SDS-stable HLA-DR molecules in lysosomes but not in endosomes. Thus, C3b attachment to Ag induces a redistribution of peptide/MHC complex which results in a higher efficiency of Ag presentation by MHC class II molecules.

Heat shock increases antigenic peptide generation but decreases antigen presentation.

The heat shock response is a universal and highly conserved cellular response to stress. We describe here the effect of elevated temperature on the capacity of B cells to present antigen. Heat shock markedly affects the ability of these cells to process and present tetanus toxin to class II-restricted T cell clones. Inhibition of antigen presentation is due neither to a modification of antigen capture nor to a variation of major histocompatibility complex (MHC) class II molecule synthesis and cell surface expression. Stressed and nonstressed B cells are able to present peptides loaded at the cell surface with the same efficiency. Nevertheless, heat shock leads to an increase of antigen peptide generation in subcellular compartments; an enhancement of cathepsin B activity is also observed. These data suggest that such a stress induces a failure in the intracellular peptide loading onto MHC class II molecules.

Response of hypertensive rats to acute and chronic conditions of static exercise.

To determine whether chronic static exercise would alter resting caudal artery systolic blood pressure (RSBP) in stroke-prone hypertensive rats (SP-SHR), a 20- to 21-wk experimental study was initiated with 24 male and 16 female rats. In addition, eight rats were cannulated for heart rate and blood pressure measurements and implemented with Doppler flow probes (mesenteric and iliac arteries) for determination of the acute responses. The rats were trained to perform static exercise by forelimb hanging over an electrical grid (3-5 mA) activated with a high-frequency sound (2.5-10kHz) of 60 dB. Acute forelimb hanging by nontrained rats caused a 70-mmHg elevation in mean blood pressure, 115-beat/min increase in heart rate, and 71% decrease in mesenteric blood flow. The procedure for chronic forelimb hanging included increasing the number of sets per session from one to three, maintaining the number of repetitions between 6 and 10 and the hang time within 7-10 s/hang, while increasing the amount of weight supported per set from 0 to 12% of body weights for males and 30% for females. Two performance tests, one for endurance (no weights) and one for "strength" (weights), demonstrated that the hanging animals increased their endurance ability by 103% and their strength by 115%. RSBP was not significantly increased in either the male or female trained populations when evaluated by analysis of variance or trend-analysis procedures. Food and water consumption, sodium and potassium excretion, and blood volume measurements exhibited no group differences that had statistical significance. Five animals had evidence for previous strokes, with four being associated with the nonhanging animals.(ABSTRACT TRUNCATED AT 250 WORDS)