Matthew Sorenson

Psychological Stress and Cytokine Production in Multiple Sclerosis: Correlation With Disease Symptomatology

Objective: Psychological variables such as perceived stress appear to play a role in symptom onset or disease exacerbation in multiple sclerosis (MS). The authors sought to determine if perceived stress is indeed associated with the expression of pro-inflammatory cytokines and disease symptoms in individuals with MS. To do so, the authors examined the relationships among disease symptomatology, perceived stress, and cytokine production from peripheral blood mononuclear cells in 42 outpatients with MS and 36 normative controls. Method: The authors drew peripheral blood from all subjects prior to the completion of a series of psychological instruments. The authors measured stress using the Perceived Stress scale and negative mood with the Profile of Mood States. Disease symptoms were measured using the Multiple Sclerosis Symptom Checklist. Cytokine production was induced separately by lipopolysaccharide and a combination of phytohemagglutinin and phorbol-12-myristate-13-acetate. Results: In MS subjects, the induced production of interleukin (IL)-6 and IL-10 positively correlated with psychological stress, mood disturbance, and disease symptomatology. In contrast, psychological stress in control subjects significantly correlated with level of tumor necrosis factor-alpha (TNF-α), and mood disturbance correlated with levels of TNF-α and interferon-gamma. As well, compared to controls, MS subjects exhibited a significant fourfold increase in the production of IL-12. Conclusion: There is, in those with MS, a pattern of IL-6 and IL-10 production that correlates significantly with perceived stress and disease symptomatology.

Efficacy and satisfaction rates of oral PDE5is in the treatment of erectile dysfunction secondary to spinal cord injury: A review of literature

Abstract Concept Decreased sexual function is a major concern of men with spinal cord injuries (SCIs). Treatment of erectile dysfunction (ED) through oral pharmacotherapies has been proven to be an effective way to address and treat this concern. Objective To find an efficacious and satisfactory treatment ED secondary to SCI through the compilation of studies that utilized the International Index of Erectile Function (IIEF) when testing phosphodiesterase V inhibitors (PDE5i). Method Ten articles, which used the IIEF to study satisfaction and/or efficacy of PDE5is sildenafil, tadalafil, and vardenafil in the treatment of ED were reviewed and analyzed. Through the use of a self-made grading scale the value of each article was determined for this research. Results Sildenafil, tadalafil, and vardenafil all have been proven to be effective in treating ED in men with SCI. While sildenafil is the most thoroughly studied ED treatment for patients with SCI, tadalafil has a longer time duration effectiveness, which allows for more spontaneity in the sexual experience. Minimal adverse effects have been noted in patients with SCI using these medications; headache, flushing, and mild hypotension are the most common. In articles that study satisfaction, patients show great improvement over baseline with the use of these medications. Conclusion Although there is a need for further research on the safety in long-term use of tadalafil and vardenafil, comparative studies done on all three medications show no statistically significant difference in effectiveness or satisfaction. New medications and treatment options, such as avanafil, are being studied in hope of continued improvement of sexual function in men with SCI.

Increased HDAC in association with decreased plasma cortisol in older adults with chronic fatigue syndrome

Hypocortisolism is a frequent finding in individuals with chronic fatigue syndrome (CFS) with other research findings implying potential dysregulation of glucocorticoid signaling. Glucocorticoid signaling is under the influence of several pathways, several of which are of interest in the study of CFS. Oxidative stress and decreased antioxidant capacity are known to disrupt the hypothalamic-pituitary-adrenal (HPA) axis (Epel et al., 2004) and the presence of histone deacetylases (HDAC) could also impact glucocorticoid signaling. The intent of this pilot study was to investigate the relationship among oxidative stress elements, select HDACs (2/3) and glucocorticoid receptor signaling in an elderly sample with CFS. Findings suggest increased histone deacetylase activity, lower total antioxidant power, in the context of decreased plasma cortisol and increased plasma dehydroepiandrosterone concomitant with decreased expression of the encoding gene for the glucocorticoid receptor. These findings support the presence of HPA axis dysregulation in elderly individuals with CFS.

Baseline Cortisol Levels Predict Treatment Outcomes in Chronic Fatigue Syndrome Nonpharmacologic Clinical Trial

ABSTRACTObjective: Understanding how nonpharmacologic interventions differentially affect the subgroups of patients with chronic fatigue syndrome (CFS) might provide insights into the pathophysiology of this illness. In this exploratory study, baseline measures of normal versus abnormal cortisol were compared on a variety of immune markers and other self-report measures. Normal versus abnormal cortisol ratings were used as predictors in a nurse-delivered nonpharmacologic intervention. Methods: Participants diagnosed with CFS were assigned to 6-month nonpharmacologic interventions. Individuals were classified as having abnormal or normal cortisol levels on the basis of scores over the five testing times. Cortisol levels were considered abnormal if they continued to rise, were flat, or were at abnormally low over time. Results: Across interventions, those with abnormal cortisol at the baseline appeared not to improve over time, whereas those with normal baseline cortisol evidenced improvements on a number o...

Brain Derived Neurotrophic Factor is Decreased in Chronic Fatigue Syndrome and Multiple Sclerosis

Objective: This study examined the levels of a major regulator of neuronal survival, brain derived neurotrophic factor (BDNF) in two populations: individuals with multiple sclerosis and chronic fatigue syndrome. BDNF is a protein involved in the maintenance and maturation of both peripheral and central neurons. In patients with multiple sclerosis, BDNF expression is often decreased and believed to reflect ineffective repair mechanisms. s a reliminary exploration, we examined the production of BDNF on the part of peripheral blood mononuclear cells in three groups: patients with Chronic Fatigue Syndrome (CFS [n=15]), patients with multiple sclerosis n=57), and a set of putatively healthy controls (n=37). Methods: Mononuclear cells were extracted from peripheral blood samples and cultured for 48 hours. Production of BDNF was evaluated from phyto-aemagglutinin (PHA) and phorbol-12-myristate-13-acetate (PMA) stimulated and unstimulated cells. BDNF levels were determined using a commercially available enzyme linked immuno absorbent assay (sensitivity: 2.5-4,000 pg/mL). Results: Both CFS and MS samples displayed nearly identical levels of BDNF, levels that were 25 percent of that displayed by the healthy control sample. For unstimulated cells, the BDNF values ere 404.71 pg/ml for the CFS sample, 573.33 pg/ml for the MS sample and 1,114.15 pg/ml for the control sample. For stimulated cells, the BDNF values were 442.55 pg/ml for the CFS sample, 367.33 pg/ml for the timulated MS sample, and 1432.24 pg/ml for the stimulated control sample. Conclusion: The decreased production of BDNF on the part of MS patients is consistent with the literature. However, the decreased roduction in those with CFS was unexpected and a novel finding. This finding could reflect a reduced ability to maintain neuronal structure and function in those with CFS. Future studies are needed to evaluate for neuronal damage in those with CFS

Dysregulation of the HPA Axis in Chronic Fatigue Syndrome

A wide array of physiologic mechanisms has been proposed to explain the symptomatology and pathogenesis of chronic fatigue syndrome. One consistent finding points to potential disruptions of hypothalamic-pituitary-adrenal (HPA) axis functioning concomitant with hypocortisolism. While there are divergent theories, evidence has been found for a possible lack of responsiveness on the part of the HPA axis to challenge, a pattern of glucocorticoid resistance, and disruption or dysregulation of the expected diurnal cortisol pattern among patients with CFS. Some authors offer that CFS is the result of a maladaptive stress response, one that is under the influence of genetic variance or epigenetic influences. Recent research demonstrates a lack of messenger RNA encoding for the glucocorticoid receptor, with evidence pointing toward histone deacetylases. The intent of this review is to highlight these findings supporting dysregulation of the HPA axis in CFS.

“Clinical Chatter” Every Nurse Informed

AIMS AND OBJECTIVES To assess the acceptability and usability of a standardised communication tool for nurses. BACKGROUND AND SIGNIFICANCE Communication is key in health care. On a daily, if not hourly, basis, nursing staff is inundated with new information regarding tools and resources, practice changes and the work environment. However, there is currently no standardised messaging or delivery method to effectively communicate new information. Even with a plethora of communication tools such as flyers, posters, emails, unit huddles and unit meetings, there is no means to guarantee attendance to crucial information. DESIGN Descriptive, cross-sectional online survey, implemented at a nonacademic, suburban hospital with 280 nurses. METHODS The Clinical Chatter, an online tool developed by nursing leadership to standardise messages regarding the organisation, new tools and resources, professional development, recognition and unit updates, was delivered to each nurse on a weekly basis followed by administration of Acceptability and Usability scales. RESULTS The Clinical Chatter tool has adequate acceptability and usability as a method of communication among nurses in a hospital organisation. Sociodemographic variables of age and years of experience had no statistically significant association with perceived acceptance and usefulness of the tool. CONCLUSION The findings indicate that the Clinical Chatter tool can be used as a standardised communication tool to deliver key information among nurses working in a hospital organisation. Nursing leadership must establish and support a clear communication system to enhance patient care and outcomes and improve nursing job satisfaction. RELEVANCE TO CLINICAL PRACTICE Communication is vital to advancing health care. Lack of communication among nursing has been linked to unsafe patient care: medication errors, unhealthy work environments and decreased nurse retention rates. Clinical Chatter is an effective communication tool for presentation of institutional information to nursing personnel.

Dysregulation of cytokine pathways in chronic fatigue syndrome and multiple sclerosis

ABSTRACT Background: Cytokine studies in chronic fatigue syndrome (CFS) have yielded mixed findings. Purpose: This investigation evaluated whether network analysis of cytokine production differs between patients with CFS and multiple sclerosis (MS) as compared to a reference group of healthy controls. Methods: Three subgroups (N = 109) were included: 15 participants who met diagnostic criteria for CFS, 57 participants meeting criteria for MS, and 37 controls. Peripheral blood was obtained and production of a select cytokine profile was determined from stimulated and unstimulated mononuclear cells. Data were generated through the use of a multi-analyte bead suspension array. Pairwise associations were determined for each group, and these associations were used to create a graphical representation of the data. The graph was clustered using an eigenvector community algorithm and results visualized using edges to model the correlations by color and thickness to show direction and strength. Results: The control and MS groups produced a three-neighborhood relationship regardless of cell condition. While producing a three-neighborhood relationship, the MS group differed significantly from the control group as it displayed stronger relationships among pro-inflammatory cytokines. In contrast, the CFS group displayed a three-neighborhood solution when unstimulated. However, when cells from the CFS group were stimulated, a two-neighborhood model was found that exhibited stronger inter-cytokine correlations. The model found in CFS was significantly different from that found in the control and MS groups. Conclusion: CFS was characterized by a pattern of global immunologic activation using network analysis, fundamentally different from those found for either MS or control groups.

Editorial: Body composition of women and men with complete motor paraplegia

Over the past several years, numerous news articles and media presentations have depicted concern over the increased rate of obesity in the USA. Increased waist circumference and body mass index (BMI) are associated with metabolic syndrome and the development of type II diabetes along with other adverse health risks. In the obese, the risk of acute coronary syndrome is increased, along with the incidence of hypertension. Increased waist circumference alone has been found associated with increased mortality.1 Of interest are findings demonstrating that increased waist circumference and BMI are associated with decreased levels of physical activity and not caloric intake per se.2 This presents a potential negative overtone for those with spinal cord injury (SCI). Individuals with SCI are at increased risk for the development of adverse consequences known to be associated with immobility. Immobility leads to a decrease in lean muscle mass, and an increase in adipose tissue. In turn, metabolic disruptions associated with SCI are tied in with an increase in insulin resistance and apparent dyslipidemia.3 There is evidence that individuals with SCI present a unique risk for the development of coronary heart disease.4 In the face of this risk, it is apparent that measures of waist circumference and BMI would be helpful in evaluating patients with SCI due to decreased activity level concomitant with a loss of lean muscle mass.5 Yet, questions remain as to whether these parameters are appropriate for evaluating health in those with SCI.6 It is possible that BMI may even underestimate the degree of adipose tissue in those with tetraplegia.7 There is then a need to further understand issues of body composition in those with SCI. In this issue, Beck et al.8 provide such clarification in the article entitled “Body Composition of Women and Men with Complete Motor Paraplegia”. The findings of Beck et al. demonstrate that body composition in those with SCI is a more complex parameter than it appears at first blush. While there was an increase in total body fat mass in those with paraplegia in comparison to controls, the BMI of those with a SCI was actually less that of controls. The decrease in total lean mass in the lower extremities was somewhat offset by an increase in upper body lean mass. The authors provide a conclusion that the daily use of manually propelled wheelchairs provides a level of activity that contributes to the development of upper body lean muscle mass. This is supported by other work demonstrating that upper body exercise appears to have a beneficial effect on body composition in those with SCI.9 Any physical exercise may be beneficial to those with SCI, and can add in reducing insulin resistance and the risk of developing type II diabetes.10 In this study, the authors found that BMI may well underestimate obesity in those with complete motor paraplegia. A case is made for the reevaluation of the cut scores used to establish a respective BMI score. It is possible that such scores need to be established for those with SCI. As a potential weakness, the participation in upper extremity activity was not directly measured, rather inferred from the use of manual wheelchairs. These findings when taken into consideration with other literature on the topic demonstrate that the most common parameters of obesity, waist circumference, and BMI area is at present of limited utility in the study of adiposity in those with SCI. Alternative measures of body composition require consideration and future research. It is hoped that this study can see replication with a larger sample. The development of clinical and research measures specific to the SCI population can help further the development of both research and care interventions. This study provides a further step in identifying factors that need to be considered in studying SCI. In a separate note, the primary author of the study is a registered nurse. The Journal of Spinal Cord Medicine has long sought to increase representation from the nursing section, and is pleased to note the submission of this manuscript. There are a number of nursing researchers engaged in work within the field of SCI, and it is hoped that this publication is but one of many from the nursing perspective.