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Coping strategies and individual meanings of illness.

Every person has a subjective understanding of their own illness. The personal attitude towards disease and the corresponding coping mechanisms go beyond biomedical factors to influence the course of the disease. Lipowski described eight different disease concepts which were supplemented by the theory of control conviction (external-internal control). Several hypotheses about disease concepts, coping strategies and psychopathology were globally confirmed in a study of 205 chronic patients: Ability to control and acceptance lead to a more active and problem-related coping, whereas emotional coping modi occur more often in persons who do not accept their illness or do not consider it to be controllable. Results confirm the necessity of a differentiated analysis.

Adaptation, Psychological↗

Depth distribution of frontal cortical field potential to acoustic stimulation in unrestrained non-anaesthetized rats.

Intracortical depth profiles of acoustically evoked potentials (AEP) through the frontal cortex were studied with moveable electrodes in 5 freely behaving rats to identify the generators of the AEP components with current source-density analysis in pharmacologically uninfluenced relaxed wakefulness. The main negative AEP components (N21 and N38) which change their polarity across the cortical depth are generated by extracellular current sinks within the V cortical lamina. Since both components were polarity reversed in different cortical depths and have their current sources in different laminae, the participation of different generation modi are assumed for both AEP components.

Acoustic Stimulation↗

Hepatocyte nuclear factor 1 negatively regulates amylin gene expression.

Maturity-onset diabetes of the young (MODY) is a monogenic subtype of Type 2 diabetes, defined as having an early age of onset, with a dominant inheritance pattern. Hepatocyte nuclear factor 1 (HNF1), which is encoded by the MODY3 gene, has been shown to bind the insulin promoter. Since the promoters of three pancreas-specific genes involved in glucose homeostasis-insulin, glucokinase, and amylin bind similar transcription factors, we were interested in whether HNF1 could also regulate amylin expression. In the present study, we used the electrophoretic mobility shift assay, to demonstrate that the HNF1 transcription factor can specifically bind to the amylin promoter. Moreover, co-transfection of an HNF1 expression vector with an amylin-CAT reporter plasmid decreased the activity of the amylin promoter by 85%. These data support the hypothesis that the amylin gene is regulated by HNF1 in a negative manner and may explain partially how HNF1 mutations result in diabetes.

Amyloid↗

Effect of mutations in HNF-1alpha and HNF-1beta on the transcriptional regulation of human sucrase-isomaltase in Caco-2 cells.

Mutations in transcription factors hepatocyte nuclear factors (HNF)-1alpha and HNF-1beta cause maturity-onset diabetes of the young (MODY) types 3 and 5, respectively. HNF-1alpha and HNF-1beta mutations are well studied in some tissues, but the mechanism by which HNF-1alpha and HNF-1beta mutations affect sucrase-isomaltase (SI) transcription in the small intestine is unclear. We studied the effects of 13 HNF-1alpha mutants and 2 HNF-1beta mutants on human SI gene transcription, which were identified in subjects with MODY3 and MODY5, respectively. Transactivation activity of 11 HNF-1alpha and 2 HNF-1beta mutants was significantly lower than that of wild (wt)-HNF-1alpha and wt-HNF-1beta. Furthermore, in co-expression studies with mutant (mu)-HNF-1alpha/ wt-HNF-1beta and wt-HNF-1alpha/mu-HNF-1beta, the combination of mu-HNF-1alpha (P379fsdelCT and T539fsdelC)/wt-HNF-1beta impaired SI transcription, but the others were not remarkably different from wt-HNF-1alpha/wt-HNF-1beta. Although wt-HNF-1beta inhibited the transactivation activity of wt-HNF-1alpha on SI transcription, the inhibitory effect was reduced by 2 HNF-1beta mutants. These results suggest that SI transcription might tend to be unchanged or lower in MODY3, while occurring more in MODY5.

Animals↗

The role of phenylalanine 483 in cytochrome P450 2D6 is strongly substrate dependent.

The polymorphic cytochrome P450 2D6 (CYP2D6) is involved in the metabolism of 30% of the drugs currently prescribed, and is thus clinically relevant. Typical CYP2D6 substrates generally contain a basic nitrogen atom and an aromatic moiety adjacent to the site of metabolism. Recently, we demonstrated the importance of active site residue F120 in substrate binding and catalysis in CYP2D6. On the basis of protein homology models, it is claimed that another active site phenylalanine, F483, may also play an important role in the interaction with the aromatic moiety of CYP2D6 substrates. Experimental data to support this hypothesis, however, is not yet available. In fact, in the only study performed, mutation of F483 to isoleucine or tryptophan did not affect the 1'-hydroxylation of bufuralol at all [Smith G, Modi S, Pillai I, Lian LY, Sutcliffe MJ, Pritchard MP, et al., Determinants of the substrate specificity of human cytochrome P-450 CYP2D6: design and construction of a mutant with testosterone hydroxylase activity. Biochem J 1998;331:783-92]. In the present study, the role of F483 in ligand binding and metabolism by CYP2D6 was examined experimentally using site-directed mutagenesis. Replacement of F483 by alanine resulted in a 30-fold lower V(max) for bufuralol 1'-hydroxylation, while the K(m) was hardly affected. The V(max) for 3,4-methylenedioxy-methylamphetamine O-demethylenation on the other hand decreased only two-fold, whereas the effect on the K(m) was much larger. For dextromethorphan, in addition to dextrorphan (O-demethylation) and 3-methoxymorphinan (N-demethylation), two other metabolites were formed that could not be detected for the wild-type. The substrate 7-methoxy-4-(aminomethyl)-coumarin was not metabolised at all by CYP2D6[F483A], a phenomenon that was reported also for CYP2D6[F120A]. The presented data show that next to F120, residue F483 plays a very important role in the metabolism of typical CYP2D6 substrates. The influence of F483 on metabolism was found to be strongly substrate-dependent.

Cytochrome P-450 CYP2D6↗

The HNF-1 target collectrin controls insulin exocytosis by SNARE complex formation.

Defective glucose-stimulated insulin secretion is the main cause of hyperglycemia in type 2 diabetes mellitus. Mutations in HNF-1alpha cause a monogenic form of type 2 diabetes, maturity-onset diabetes of the young (MODY), characterized by impaired insulin secretion. Here we report that collectrin, a recently cloned kidney-specific gene of unknown function, is a target of HNF-1alpha in pancreatic beta cells. Expression of collectrin was decreased in the islets of HNF-1alpha (-/-) mice, but was increased in obese hyperglycemic mice. Overexpression of collectrin in rat insulinoma INS-1 cells or in the beta cells of transgenic mice enhanced glucose-stimulated insulin exocytosis, without affecting Ca(2+) influx. Conversely, suppression of collectrin attenuated insulin secretion. Collectrin bound to SNARE complexes by interacting with snapin, a SNAP-25 binding protein, and facilitated SNARE complex formation. Therefore, collectrin is a regulator of SNARE complex function, which thereby controls insulin exocytosis.

Animals↗

Clinical characteristics of Japanese youth-onset type 2 diabetes with ketonuria.

The study analyzed the clinical background and eating habits of Japanese youth-onset type 2 diabetes. Thirty-six patients with type 2 diabetes (22 males, 14 females) with onset in less than 20-year-old were studied. All patients were negative for anti-glutamic acid decarboxylase (GAD) antibody and islet cell antibody. Cases diagnosed as having abnormalities in the mitochondrial gene, maturity onset diabetes of the young (MODY), and apparent type 1 diabetes were excluded from the study. Urinary ketone was detected positive in 11 cases among 36 patients at the onset of diabetes. We compared the clinical characteristics and food compositions between the patients with ketonuria and those without ketonuria. Age and urinary C-peptide secretion did not show any significant difference between both groups. In the patients with ketonuria, male to female ratio was remarkably high (10:1) compared with the group without ketonuria (12:13). Positive diabetic family history was predominantly higher in the group with ketonuria (11/11) than that in the group without ketonuria (17/25). All these were identical to previously reported characteristics of soft-drink ketosis. However, we in this study, revealed the difference of total calorie intake and dietary composition between youth-onset type 2 diabetes with and without ketonuria. As a result dietary contents such as carbohydrate, fat and confectionery in the former group were also 1.5, 1.4-2.4 times higher, respectively, than those in the latter group.

Adolescent↗

Conversion efficacy of intravenous ibutilide compared with intravenous amiodarone in patients with recent-onset atrial fibrillation and atrial flutter.

AIM: The aim of our study was to compare the efficacy and safety of ibutilide and amiodarone (intravenously) in converting recent-onset atrial fibrillation (AF) and atrial flutter (Af) to sinus rhythm (SR). METHODS: The study was prospective, randomized and included 152 (103 men and 49 women) consecutive patients with AF or Af of 3-48 h duration. Ibutilide is a selective class III antiarrhythmic agent which when administered intravenously can terminate AF and Af. Amiodarone is also a class III antiarrhythmic agent that when given intravenously or orally has proved to be more effective than other agents in terminating AF and Af [B.N. Singh, F.V. Mody, B. Lopez, J.S. Sarma. Antiarrhythmic agents for atrial fibrillation: focus on prolonging atrial repolarization. Am J Cardiol 1999 Nov 4; 84: 161R-173R.]. Seventy-nine patients (56 with AF and 23 with Af) that consisted group A were treated with ibutilide. Seventy-three (52 with AF and 21 with Af) consisted group B and were treated with intravenous infusion of amiodarone. RESULTS: The conversion rate of group A (ibutilide) was significantly higher than the conversion rate of group B (amiodarone) (80% vs. 57%, p=0.0054). As regards the kind of arrhythmia separately, for AF there wasn't significant difference (77% vs. 69%, p=ns) whereas for Af ibutilide was superior to amiodarone (87% vs. 29%, p=0.003). The conversion rates of ibutilide didn't differ for AF and Af (77% vs. 87%, p=ns). CONCLUSIONS: Ibutilide is more effective than amiodarone in converting recent-onset Af to SR whereas both drugs are equally effective in converting recent-onset AF to SR.

Acute Disease↗

Observation and simulation of net primary productivity in Qilian Mountain, western China.

We modeled net primary productivity (NPP) at high spatial resolution using an advanced spaceborne thermal emission and reflection radiometer (ASTER) image of a Qilian Mountain study area using the boreal ecosystem productivity simulator (BEPS). Two key driving variables of the model, leaf area index (LAI) and land cover type, were derived from ASTER and moderate resolution imaging spectroradiometer (MODIS) data. Other spatially explicit inputs included daily meteorological data (radiation, precipitation, temperature, humidity), available soil water holding capacity (AWC), and forest biomass. NPP was estimated for coniferous forests and other land cover types in the study area. The result showed that NPP of coniferous forests in the study area was about 4.4 tCha(-1)y(-1). The correlation coefficient between the modeled NPP and ground measurements was 0.84, with a mean relative error of about 13.9%.

Altitude↗

Vagal nerve stimulation technique: enhancing its efficacy and acceptability by augmentation with auto activation and deactivation mode of operation.

The purpose of this article is to search for an additional modus operandi to improve the functioning of currently deployed vagal nerve stimulation (VNS) technique that is being used as an adjunctive therapy for intractable epilepsy, mainly complex partial seizures (partial onset with secondary generalization). The efficacy and success of current VNS technique is variable and limited, which can be attributed (to a considerable extent) to its present modi operandi. The mechanism of anti-epileptic action of VNS that has been hypothesized in the article is found to conform to observations and results in a large number of studies including those on VNS itself. Based on this mechanism in controlling seizures, the author proposes an additional mode of operation of the VNS device, (an auto activation and deactivation mode), designed to work on a feedback mechanism, which would deliver VNS as and when the brain requires it to abort/arrest the impending focal attack and/or its generalization, thus eliminating the limitations associated with the current VNS device. This mode should enhance its acceptability, efficacy and success.

Brain↗

Inhibitory interactions of calcineurin (phosphatase 2B) and calmodulin on rat hippocampal NMDA receptors.

Calcineurin, protein phosphatase 2B, is a calcium-binding protein that has been shown to modulate NMDA receptor activity (Regulation of NMDA channel function by endogenous Ca(2+)-dependent phosphatase. Nature 369 (1994) 235; Regulation of glycine-insensitive desensitisation of the NMDA receptor in outside-out patches. J. Neurophysiol. 71 (1994) 754; Calcineurin acts via the C-terminus of NR2A to modulate desensitization of NMDA receptors. Neuropharmacology 42 (2002) 593) and synaptic transmission (Synaptic desensitization of NMDA receptors by calcineurin. Science 267 (1995) 1510; beta-adrenergic regulation of synaptic NMDA receptors by cAMP-dependent protein kinase. Neuron 16 (1996) 415). Calmodulin, a necessary co-factor for calcineurin (Calmodulin binding by calcineurin. J. Biol. Chem. 262 (1987) 15062), has also been shown to inhibit NMDA receptor activity (Inactivation of NMDA receptors by direct interaction of calmodulin with the NR1 subunit. Cell 84 (1996) 745; Direct effects of calmodulin on NMDA receptor single-channel gating in rat hippocampal granule cells. J. Neurosci. 22 (2002) 8860) in a calcium dependent manner (Calmodulin mediates calcium-dependent inactivation of N-methyl-d-aspartate receptors. Neuron 21 (1998) 443; Interactions of calmodulin and alpha-actinin with the NR1 subunit modulate calcium-dependent inactivation of NMDA receptors. J. Neurosci. 19 (1999) 1165). In order to gain insight into the likely actions and interactions of calcineurin and calmodulin at excitatory synapses, we have investigated the effects of these two proteins on single NMDA receptor channel activity. Calcineurin and calmodulin are both known to reduce channel open time (Regulation of NMDA channel function by endogenous Ca(2+)-dependent phosphatase. Nature 369 (1994) 235; Inactivation of NMDA receptors by direct interaction of calmodulin with the NR1 subunit. Cell 84 (1996) 745), and the duration of receptor activations or superclusters. They are, therefore, predicted to shorten the synaptic current decay (Regulation of NMDA channel function by endogenous Ca(2+)-dependent phosphatase. Nature 369 (1994) 235; Direct effects of calmodulin on NMDA receptor single-channel gating in rat hippocampal granule cells. J. Neurosci. 22 (2002) 8860). In agreement with Lieberman and Mody (Regulation of NMDA channel function by endogenous Ca(2+)-dependent phosphatase. Nature 369 (1994) 235), the results of this study indicate calcineurin plus calmodulin reduces channel open time. However, this effect is not as pronounced as that observed in the presence of calmodulin alone. Calcineurin plus calmodulin was also found to increase single channel shut time. We conclude that in addition to its direct effects on single channel activity, calcineurin regulates the effects of calmodulin on NMDA receptor activity.

Animals↗

[Clinical, metabolic, immunologic and genotypic characteristics in non-pediatric patients with type 1A diabetes mellitus. Onset and short-term prognosis].

BACKGROUND AND OBJECTIVE: Around 50% of new cases of type 1 diabetes mellitus (DM1) are seen in subjects aged above 15 years. It is of particular interest the characterization of such a population. THE AIMS OF OUR STUDY WERE: a) to characterize a group of non-pediatric subjects with DM1 at the onset of the disease; b) to evaluate the prognosis of the disease under conventional intensive insulin therapy, and c) to investigate the presence of mutations in the HNF-1* gene in those subjects who did not display pancreatic autoimmune markers. SUBJECTS AND METHOD: All subjects with an age >= 15 and 35 years recently diagnosed DM1 (1998-2001) were included in the study. Pancreatic cell function was assessed by glucagon test (at onset and at 12 months). The presence of pancreatic autoantibodies, GAD, IA2 and IAA was evaluated. HLA class II genes and the 10 exons of HNF-1* gene were analyzed from genomic DNA. RESULTS: We studied 86 subjects (32 women, 23.9 [5.3] year-old). Eighty percent of subjects were positive for any of the studied autoantibodies. Alone or in combination, GAD was positive in 68.6% of subjects, IA2 in 45.3% and IAA in 27.9% of them. Most frequent haplotype was DRB1*0301-DQA1*0501-DQB*0201. There were no differences with regard to clinical, metabolic or genetic characteristics among those subjects with or without presence of pancreatic autoantibodies (at onset and at 12 months). We did not find mutations in the HNF-1* gene in any of the subjects included in our study. After 12 months of follow-up, cell function remained unaltered in comparison with that observed at the onset of the disease. CONCLUSIONS: Clinical, immunological and HLA characteristics of a non-pediatric DM1 population are in agreement with expected results. The absence of pancreatic autoimmune markers neither rules out the existence of type 1A diabetes mellitus nor is associated with mutations in the MODY-3 gene. A therapeutic programme using conventional intensified insulin treatment prevents the impairment of insulin secretory capacity for a short-term follow-up.

Adolescent↗

Detection of water quality using simulated satellite data and semi-empirical algorithms in Finland.

The aim of the study was to test the feasibility of the band combination of the TERRA MODIS and ENVISAT MERIS instruments for operational monitoring of lakes and coastal waters in Finland. Also simulated LANDSAT TM data were tested. Satellite bands were simulated using airborne measurements with AISA imaging spectrometer. Semi-empirical algorithms with simulated satellite data were tested against field observations using regression analysis. Interpretation of chlorophyll a, suspended matter, turbidity and secchi-disk depth was included in the analyses. The data for this study were gathered in campaigns carried out in May and August 1997 and August 1998 both for lakes in southern Finland and coastal waters of the Baltic Sea. The data set included 85 in situ observations for lakes and 107 for coastal waters. Our results show that the band combination to be included in the ENVISAT MERIS instrument enables the interpretation of water quality, including chlorophyll a concentration using semi-empirical algorithms both for lakes and coastal waters. MERIS band 9 centred at 705 nm is proven to be of vital importance for the detection of chlorophyll a in local surface waters.

Algorithms↗

The epidemiology and management of diabetes mellitus in Indonesia.

Predications indicate a potentially explosive increase in the prevalence of diabetes worldwide, especially in developing countries such as Indonesia. Studies of people living in rural areas of East Java and Bali show a prevalence rate of 1.5% in 1982 to 5.7% in 1995 among the urban population. Ujung Pandnag also experienced an increase, and recent studies in Manado found a dramatically high rate of 6.1% in urban areas. Preliminary results indicate varying prevalence between those living in urban and rural areas. Currently, Indonesia has an estimated 1.2-2.3% prevalence among people over 15 years. Geographically variation appears to be an influential factor, due to differences in ethnics, race, culture and lifestyle. Studies of diabetic families show a significantly high prevalence and, clinically speaking, the mode of treatment indicates the type of diabetes. Those who respond well to OHA among young diabetics (<40) are assumed to have the MODY variation of the disease. The level of obesity among the general population has increased, due partly to increased calorie intake and is a significant factor in the increased rate of diabetes. It is also more common among the elderly, as our results will show. The new types of the disease are clinically more difficult to assess than the classical types 1 and 2, as they require relatively costly genetic and immunological studies. The rate of LADA type diabetes was found to be relatively high (>20% for ICA and IAA and 2.3% for GAOA). A concensus on diabetes management has now been formulated in Indonesia and these guidelines are now used by all Indonesian health care professionals.

Adolescent↗

Mutation screening of the hepatocyte nuclear factor (HNF)-6 gene in Japanese subjects with diabetes mellitus.

Heterozygous mutations in the genes encoding transcription factors (HNF-1alpha, HNF-1beta and HNF-4alpha) in the hepatocyte nuclear factor (HNF) network are associated with maturity-onset diabetes of the young (MODY). We screened HNF-6 gene for mutations in 34 Japanese subjects with MODY/early-onset diabetes mellitus and 56 subjects with late-onset diabetes mellitus. One single nucleotide polymorphism (SNP) at codon 287 (GGG to GGT) was found in the gene and the frequency was similar among MODY/early-onset diabetes, late-onset diabetes and control subjects. Genetic variations in the HNF-6 gene are not likely to contribute to the susceptibility to diabetes mellitus in Japanese.

Adolescent↗

A set of polyclonal and monoclonal antibodies reveals major differences in post-translational modification of the rat HNF1 and vHNF1 homeoproteins.

The related homeodomain-containing transcription factors HNF1 (HNF1 alpha) and vHNF1 (HNF1 beta) recognise common target DNA sequences in the regulatory regions of many genes and are expressed in several parenchymal cell types, predominantly in liver, kidney, intestine and pancreas. HNF1-null mutant mice, with a wild-type vHNF1 gene, develop normally, but die within a few weeks of birth with severe liver and kidney failure. Humans with a mutation in the HNF1 alpha gene develop non-insulin dependent diabetes on maturity (MODY 3). To determine distinctive roles for each of these proteins we produced a set of polyclonal sera and monoclonal antibodies, directed against different parts of the rat HNF1 and vHNF1 proteins. These antibodies reveal that HNF1 is present in vivo as a heterogeneous mixture of 92-98 kDa molecular mass polypeptides, a mass higher than that expected from its amino acid sequence. vHNF1 is present in the form of two isoforms of roughly the expected molecular masses, 65 and 68 kDa. In addition, some antibodies prepared against bacterially-produced HNF1 recognise vHNF1 but not HNF1, in liver and kidney extracts. Hence, we present the first evidence for differential post-translational modification of HNF1 and vHNF1 proteins.

Animals↗

Use of DNA polymorphisms for genetic analysis of non-insulin dependent diabetes mellitus.

Polymorphisms occur on the average of one out of every 500 base pairs of DNA, and these polymorphisms provide useful markers for genetic analysis. Hundreds of RFLP markers have been mapped at regular intervals throughout the human genome. Diabetes genes have not been mapped with these markers, however, only one MODY family has been partially evaluated. This type of analysis is further complicated if NIDDM is multigenic and/or polygenic. RFLPs have been used to evaluate specific candidate loci for NIDDM, e.g. the insulin, insulin receptor and glucose transporter genes. For these analyses, population and family studies (limited in number) have suggested that none of these loci are major contributors to the genetic susceptibility to NIDDM. In no case, however, could a contribution of 10% or less of these loci be confidently excluded, because of variable penetrance, different degrees of linkage disequilibrium between RFLPs and putative mutations, the frequencies of the RFLPs in non-diabetic populations, and inadequate sample size. The conclusions are clear: either (1) the correct candidate gene(s) has not been found, or (2) sample sizes need to be increased by at least an order of magnitude, or (3) newer methods of analysis must be adopted (e.g. use of extended haplotypes and associations with subphenotypes, or screening with allele specific oligonucleotide probes, denaturing gradient gel electrophoresis or direct genomic sequencing of polymerase chain reaction amplified DNA).

Animals↗

Searching for type 2 diabetes genes in the post-genome era.

The discovery of genes encoding maturity onset diabetes of the young (MODY) type 2 diabetes mellitus (T2DM) represents a milestone in the study of the genetics of complex diseases. The genes were revealed, in large part, through positional cloning and linkage analysis in families. The genes are relatively rare and have strong genotype-phenotype correlations. Based on the results of several genome scans for genes encoding T2DM in various racial-ethnic groups, it appears that, as in other complex diseases, multiple genes are involved, each contributing a small amount to the overall risk. New strategies for patient sampling, phenotyping, genotyping technologies and genetic analysis must be employed to further define the genetic basis of this disease.

Animals↗