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B-cell proliferation initiated by Ia cross-linking and sustained by interleukins leads to class switching but not somatic mutation in vitro.

Somatic mutations that are acquired by antibody V genes of antigen-stimulated B cells ultimately provide the clonal diversity from which memory B cells are selected during immune responses to T-cell-dependent antigens. Somatic mutations apparently are not acquired when B cells are stimulated by mitogens nor when they participate in immune responses to T-cell-independent antigens. Since the basis of T-cell-dependent humoral immunity is T-cell recognition of processed antigen in the context of class II major histocompatibility glycoproteins (Ia) on the B-cell surface, we sought to determine whether the ligation of Ia on B cells induces somatic mutation. B cells were stimulated in vitro by a procedure in which their proliferation was dependent upon ligation of surface Ia with antibody. Sequences of hybridoma V genes derived from these B cells revealed no somatic mutations despite prolonged stimulation in vitro and the induction of immunoglobulin secretion and switching to isotypes characteristic of T cell-dependent humoral immunity. We infer that Ia-mediated signalling and isotype switching are not causally related to somatic mutation. The avenue of differentiation that leads to somatic mutation in memory B cells is apparently separable from that leading to proliferation, immunoglobulin secretion and switching.

Animals↗

Somatic VHL alteration and its impact on prognosis in patients with clear cell renal cell carcinoma.

Somatic inactivation of the von Hippel-Lindau (VHL) gene is the most frequent genetic event observed in clear cell renal cell carcinoma (CC-RCC). However, the prognostic relevance of somatic VHL alteration and its target, hypoxia inducible factor (HIF)-1alpha has not been defined. We investigated the genetic changes in the VHL gene and HIF-1alpha and studied their clinical implications in patients with sporadic CC-RCC. Patients who underwent nephrectomy were eligible if they had pathologically confirmed CC-RCC not associated with VHL disease or familial RCC. Tumor tissues were selected from paraffin blocks on the basis of hematoxylin and eosin (H&E)-stained sections. Polymerase chain reaction-single strand conformation polymorphism analysis was performed to detect VHL mutations and genetic changes in HIF-1alpha, which were followed by automated direct sequencing. VHL hypermethylation was examined by methylation-specific PCR. A total of 56 patients were enrolled and somatic VHL alterations were detected in 16 patients (29%); intragenic mutation in eight, hypermethylation in five, both alterations in three. The mutation types were missense in five patients, silent in three, nonsense in two, and frameshift in one. Somatic VHL alterations were not significantly associated with progression-free survival (PFS) or overall survival (OS). However, patients with 'loss-of-function' VHL mutation showed significantly decreased PFS (P=0.016) and OS (P=0.046). Although the association between VHL alteration and response to immunotherapy was not significant (P=0.486), patients with missense mutation seem to have better response to immunotherapy. The Pro582Ser change in HIF-1alpha was detected in six patients (11%) and was positively correlated with the development of metastases (P=0.023). This study did not show an association between somatic VHL alteration and prognosis in patients with sporadic CC-RCC. However, it suggests that the therapeutic and prognostic implication of somatic VHL alteration may be different according to the mutational subtype and that the Pro582Ser change in HIF-1alpha may contribute to the development of metastases.

Carcinoma, Renal Cell↗

Osteopathic manipulative treatment of somatic dysfunction among patients in the family practice clinic setting: a retrospective analysis.

CONTEXT: Relatively little has been published about contemporary use of osteopathic manipulative treatment (OMT) in family practice. OBJECTIVE: To provide an "epidemiology" of somatic dysfunction, assessing prevalence and severity of somatic dysfunction encountered in the family practice setting, also characterizing physician use of OMT. DESIGN: Retrospective analysis of Outpatient Osteopathic SOAP Note Form data collected in 1998 and 1999 by 20 osteopathic medical trainee-investigators under the supervision of seven site-based osteopathic physicians. SETTING: Three university-based, osteopathic family practice clinics. RESULTS: The authors analyzed records for 1331 patient encounters and 424 adult patients. The mean (SD) age of patients was 56.9 years (16.2 years), and 71% were women. The median number of days between repeat encounters was 29 days. Somatic dysfunction was diagnosed in 418 (31%) patient encounters, affecting a total of 1199 anatomic regions (2.9+/-1.2 anatomic regions per patient). Investigators used OMT in 335 (25%) patient encounters to treat a total of 952 anatomic regions (2.8+/-1.2 anatomic regions per patient). For women, the odds ratio for receiving OMT was 1.4 (95% confidence interval [CI], 1.0-2.2); for patients using analgesics, anti-inflammatory agents, or muscle relaxants, the odds ratio was 2.2 (95% CI, 1.2-4.1). Immediately after OMT, investigators reported that patients' somatic dysfunction resolved or improved in a total of 747 (96%) anatomic regions and remained unchanged in 32 (4%) anatomic regions (P<.001). The authors used cluster analysis to classify anatomic regions by prevalence and severity of somatic dysfunction. CONCLUSION: Somatic dysfunction was diagnosed in almost one-third of patient encounters. In one-quarter of patient encounters, investigators used OMT.

Family Practice↗

Somatic symptoms in depression.

Both painful and nonpainful somatic symptoms essentially characterize clinical states of depressive mood. So far, this well-established psychopathological knowledge has been appreciated only insufficiently by the official diagnostic systerms of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV TR) and the ICD-10 Classification of Mental and Behavioral Disorders. Clinical Descriptions and Diagnostic Guidelines (ICD-10). From a perspective of primary care services, this unmet diagnostic need is deplorable, as the main mode of presenting a depression is by reporting somatic symptoms. This somatic form of presentation, however, significantly contributes to low rates of recognition in primary care. A diagnostic challenge may be seen in the differentiation of a depression with prevailing somatic symptoms from anxiety, somatoform disorders, and medical conditions. When somatic symptoms, particularly painful physical conditions, accompany the already debilitating psychiatric and behavioral symptoms of depression, the course of the illness may be more severe, implying a higher risk of early relapse, chronicity, suicide, or mortality due to other natural causes, the economic burden increases considerably the functional status may be hampered heavily, and health-related quality of life may be lowered dramatically. The neurobiological underpinnings of somatic symptoms in depression may guide more promising treatment approaches.

Depression↗

[The analysis of somatic antigens extracted from Aspiculuris tetraptera (Oxyuridae) and their role in eliciting immune response in laboratory mice].

BACKGROUND: The aim of this study was isolation and examination of Aspiculuris tetraptera somatic proteins and somatic antigens role in eliciting of immune response in laboratory mice. MATERIAL AND METHODS: In our investigation 40 laboratory mice (BALB/c strain) were used. To extract the somatic proteins Tris-HCl buffer with NaCl and Triton X-100 was used. The analysis of somatic antigens was undertaken by Western blotting. RESULTS: The study showed the presence of 14 protein bands ranging from approximately 82 to 28 kDa. Glicoproteins detection revealed 13 bands in range between approximately 70 to 30 kDa. There was no reaction observed with immunoglobulins IgA. Comparision of these results with earlier studies concerning S. obvelata somatic antigens show that there are proteins and glicoproteins with the same molecular weights for both species. It is also observed that S. obvelata somatic extract is more diversed and have higher antigenicity than A. tetraptera. Hence, we may suppose this fact could favour easier colonization of the host by A. tetraptera.

Animals↗

Nongynecologic somatic pathology in women with chronic pelvic pain and negative laparoscopy.

One hundred eighty-three women with chronic pelvic pain were referred to a multidisciplinary chronic pelvic pain clinic after negative laparoscopy. One hundred twenty-two of them completed a thorough medical and psychologic evaluation and were followed for a minimum of six months after completion of therapy. Occult somatic pathology was diagnosed in 57 women (47%), including 19 in whom coexistent psychopathology was diagnosed. Myofascial pain was the most common somatic diagnosis, followed by atypical cyclic pain (dysmenorrhea or mittelschmerz); gastroenterologic, urologic and infectious diseases; and pelvic vascular congestion. No plausible somatic etiology was apparent in the remaining 65 (53%) of the 122 referrals. Nongynecologic somatic pathology accounted for 34 (29%) and gynecologic pathology for 23 (19%) of the referrals, only 6 (5%) of whom ultimately required hysterectomy. Women with a somatic diagnosis were found to be significantly older than the remainder of the referral population. Long-term symptomatic improvement or resolution of pain was obtained in 43 (75%) of the 57 patients with somatic diagnoses. Coexistent psychopathology was found to correlate with a poorer long-term prognosis. Our findings underscore the importance of a multidisciplinary approach to evaluating and treating chronic pelvic pain in women and confirm that hysterectomy is indicated in this setting only rarely.

Adult↗

The somatic patient.

A significant proportion of patients seen in the Emergency Department will present with somatic complaints for which there is no apparent physiologic cause. Such patients may be divided into two broad categories: (1) those with symptoms and signs consciously synthesized by the patient, either for obvious secondary gain (malingering) or as a result of more subtle and complex motivations (factitious disorders); and (2) those patients with symptoms that are the unconscious expression of psychological stress (somatoform disorders). The somatoform disorders include (1) somatization disorder (characterized by a chronic history of numerous and widely divergent somatic complaints), (2) psychogenic pain disorder (somatization expressed in terms of persistent pain), (3) hypochondriasis (a conviction that one is diseased and disabled in conjunction with a well-focused constellation of supporting symptoms), and (4) conversion disorder (a single, usually nonpainful neurologic symptom, often with identifiable coping value for the patient). The first three disorders have been aggregately termed the "common somatization syndrome." Management of the somatically focused patient includes the communication of a caring attitude to the patient in conjunction with a cautious and diligent search for treatable medical or psychiatric illness. Resocialization and development of patient links with ongoing, nurturing nonmedical as well as medical support systems is of benefit.

Emergency Service, Hospital↗

[Missed somatic disease: justified fear or chimera?].

The fear to miss the diagnosis of somatic processes in "functional" disorders and the ignorance of the positive criteria for the diagnosis of conversion (physical expression of conflicts) and of psychophysiological disorder (somatic symptoms and signs, accompanying affectivity) lead to diagnosing by exclusion of somatic disorders. Its consequences are extensive, damaging procedures and a postponement of a diagnosis which integrates somatic, psychic and social components by seven to eight years. Based on positive criteria, which had been collected by means of a bio-psycho-social approach to the patient, ten were diagnosed as suffering from conversion and 22 from psychophysiological disorders. Five years later the patients were reassessed. In none of the cases a somatic diagnosis emerged, which would have been responsible for the initial complaints five years earlier. The diagnoses "conversion" and "psychophysiological disorder" proved to be reliable over five years, if they were based on positive criteria. The fear to miss a somatic process turns thus into a chimera.

Adult↗

Homozygous deficiency at autosomal locus aprt in human somatic cells in vivo induced by two different mechanisms.

Associations between germinal and somatic mutations at autosomal loci play an important role in the development of some tumors, including retinoblastoma. In an attempt to determine whether equivalent events occur in vivo at other loci, we cloned and enumerated somatic T-cells with mutations at the aprt locus, by taking advantage of both the presence of a human disease caused by genetic defects at this locus and an effective selection procedure for the deficient mutants. T-cells homozygously deficient at this locus (aprt-/-) were found in all four heterozygotes (aprt+/-) studied, at an average frequency of 1.3 x 10(-4). From 310 normal individuals, we identified only one aprt-/- clone, and the calculated frequency of aprt-/- T-cells in aprt+/+ individuals was 5.0 x 10(-9). These results confirm that a two-step process (aprt(+/+)----aprt(+/-)----aprt-/-) is functional through two different mechanisms (germinal-somatic and somatic-somatic) in vivo. Our data suggest that the two-step mutations leading to homozygous deficiencies at the somatic cell level, as proposed for the carcinogenic mechanisms for retinoblastomas and other human tumors, generally occur at rather high frequencies at various autosomal loci in humans.

2-Aminopurine↗

[Somatic disease at a department for acute psychiatric disease].

All of the patients admitted to the psychiatric inpatient department of the Municipal Hospital in Copenhagen during a period of three months were, on discharge, registered as regards somatic disease. 70% (95% confidence limits 66-75%) had somatic disease (38% of these were newly diagnosed). Treatment of these was carried out by the medical staff of the department and in 46% of the cases this was carried out in cooperation with the medical staffs of somatic departments. The close geographic contact with the departments for somatic diseases facilitated this cooperation. The staff in departments for emergency inpatient treatment of psychiatric disease should be able to observe and treat somatic disease on account of the high incidence of this. A psychiatric/medical special department could probably provide optimal treatment in cases of combined psychiatric and somatic disease.

Acute Disease↗

Somatization disorder in a family practice.

Somatization disorder is a condition characterized by multiple unexplained complaints. This study was done to determine the prevalence of somatization disorder in a family practice office setting, to characterize the patients so affected, and to assess their impact on the practice. A sample of ill patients was interviewed, of whom 6 (5 percent) had definite somatization disorder and another 4 (4 percent) had borderline somatization disorder (ten or more symptoms). All were women, and they were more likely than controls to live in households with children but no spouse (P less than .01). They were also more likely than their unaffected counterparts to be from the lowest two social classes (P less than .01). Compared with matched controls, their rate of office visits and charges incurred was about 50 percent greater (.58 visits per month vs .41 visits per month; $23.28 per month vs $14.44 per month). Their charts were thicker (7 cm vs 3.6 cm) and heavier (3076 g vs 1843 g) and had more diagnoses (85 vs 51) than controls. The physicians of the somatizers were significantly less satisfied with the care rendered to them than to the controls (P less than .01). This study demonstrates that somatization disorder is a prevalent, expensive, and difficult problem for family physicians.

Adult↗

Somatization disorder in a university hospital.

Somatization disorder is a condition characterized by multiple unexplained complaints. To characterize this disorder as it occurs in a university hospital, a sample of 213 patients admitted to adult medical and surgical services was studied. Nineteen of these patients (9 percent) met the Diagnostic and Statistical Manual of Mental Disorders, ed 3, criteria for somatization disorder. A significantly higher proportion of the women compared with the men interviewed had the disorder (14 percent vs 3 percent, P less than .01). Fourteen percent of the divorced, separated, or widowed subjects qualified for the diagnosis, compared with 7 percent of the married subjects and 5 percent of the never-married subjects (P less than .05). Likewise, 32 percent of single patients with children at home had somatization disorder, compared with 4 percent of subjects in all other household configurations (P less than .001). When compared with matched controls, patients with somatization disorder had hospitalizations of roughly equal duration and expense, but had a much higher proportion of negative findings on workup for their presenting complaints (74 percent vs 21 percent, P less than .01). Nevertheless, these patients perceived their health as significantly worse than those without the disorder (P less than .001). None of the patients enrolled in this study had the diagnosis of somatization disorder at admission or discharge. This study documents that patients with somatization disorder are common, are unrecognized, and are admitted to the hospital for nonproductive workups.

Alabama↗

[Somatic radiation risk in roentgen-diagnosis].

The authors give a survey of the somatic radiation risk in X-ray diagnostics. A somatic dose index is calculated for different examination methods containing the organ doses to the red bone marrow, the lung, the female breast, and the thyroid gland and evaluating their somatic significance. If this somatic dose index by which the individual radiation risk is described, is multiplied by the examination frequencies per year in the German Federal Republic, one gets the somatically significant dose index, which is a measure of the collective somatic radiation risk. In this sense, mammography has the highest, and dental radiography the lowest collective radiation risk.

Bone Marrow↗

Standardization of the hospital record for osteopathic structural examination: recording of musculoskeletal findings and somatic dysfunction diagnosis.

The diagnosis of somatic dysfunction is supported by the recording of positive musculoskeletal findings (altered structure, motion, tissue). We conducted a national survey to assess the status of the documentation of this relationship in the hospital setting. The 26 participating osteopathic training hospitals submitted 719 admitting physical examination forms, of which 417 (58%) met study criteria (adult patients on medicine or surgical service with a musculoskeletal examination documented on the chart). On 234 charts (56%), at least one positive finding was recorded but no diagnosis of somatic dysfunction was stated. Of 14 charts with a diagnosis of somatic dysfunction, 10 had a positive musculoskeletal finding recorded. The relationship between positive musculoskeletal findings and somatic dysfunction is not being documented on osteopathic training hospital admitting physical examination forms. Proper documentation of a somatic dysfunction diagnosis and related positive musculoskeletal findings will enable multisite research on the relationship between somatic dysfunction and other health problems documented on the hospital medical record. A multiple data collection system that is workable, reliable, and reproducible was developed as a result of this study.

Hospital Records↗

Somatization and medicalization in the era of managed care.

Somatization, the reporting of somatic symptoms that have no pathophysiological explanation, appears to be increasing as sociocultural currents reduce the public's tolerance of mild symptoms and benign infirmities and lower the threshold for seeking medical attention for such complaints. These trends coincide with a progressive medicalization of physical distress in which uncomfortable bodily states and isolated symptoms are reclassified as diseases for which medical treatment is sought. Somatization and medicalization are likely to become more problematic in the era of managed care. Under capitation, providers will have greater incentives to reduce utilization, and somatizing patients may feel forced to express their "disease" in more urgent and exaggerated terms in order to gain access to the physician. In addition, prepaid subscribers will suffer little financial disincentive to seek medical attention for relatively minor complaints; therefore, they are likely to increase the demand for physician consultation. This situation suggests an urgent need to improve the management of somatizing patients. Innovative consultative, behavioral, and educational interventions are now available. In addition, medical professionals should greet the process of medicalization with considerable caution and educate the public more about the normative presence of symptoms and bodily distress in healthy people. Additional research is needed into somatization and its relationship to the demand for medical care. In an era of managed care, increased attention should be devoted to understanding and controlling the demand for care, a large portion of which is symptom driven.

Capitation Fee↗

Di- and trinucleotide target preferences of somatic mutagenesis in normal and autoreactive B cells.

During Ag-driven development of memory B cells, Ab V genes are modified by somatic mutagenesis. Although V gene somatic mutations have important biologic consequences in both physiologic and autoimmune Ab responses, little is known about the mechanism of mutation, or whether it operates normally in autoreactive B cells. To approach these issues, we analyzed somatic mutations in Ab genes for evidence of sequence-specific target preferences. Our analysis was confined to noncoding segments of V genes so that the intrinsic characteristics of the somatic mutation process could be reliably dissociated from the indirect but substantial influences of cellular selection. We consistently observed that some dinucleotides, GC and TA in particular, mutated at frequencies that were higher than expected based on their frequency of occurrence. Most of the dinucleotide mutation preferences could not be extrapolated directly from mononucleotide mutation preferences. Specific trinucleotides, including AGC, TAC, and their inverse repeats (GCT, GTA), also mutated more frequently than expected. These and other mutation characteristics were virtually indistinguishable in V genes of normal and autoreactive B cells. An analysis of mutations in published flanking sequences confirmed the target preferences, as did an examination of reported "hot spots" within coding V sequences. The shared preferences in coding and noncoding regions of V genes suggests that somatic mutations are generated de novo. Collectively, our findings indicate that the somatic mutation process exhibits sequence-specific preferences, consistent with an untemplated mechanism, and appears to operate similarly in normal and autoreactive B cells.

Animals↗

[The reason for medical consultations in patients with psychiatric diseases: somatization phenomena and suicide attempts].

BACKGROUND: The objectives of the study are to document the frequency of use of the general medical services by psychiatric patients, to measure how many consultations are due to somatization and suicide attempts and to know the existence of possible differences between psychiatric inpatients and outpatients in relation to the reason of medical consultation. MATERIAL AND METHODS DESIGN: retrospective study. Site: Manchester Royal Infirmary, a university third level hospital in Manchester (United Kingdom). PATIENTS: patients from the psychiatric department seen during the period from July 1st to December 31st in 1992 (n = 1,012 patients). RESULTS: The percentage of patients that consults a medical/surgical department in one year is 27.5%, 25.2% of outpatients and 36.3% of inpatients. Non-medical reasons are 42.3% of these consultations: 30.4% somatization phenomena and 10.8% suicide attempts. The frequency of somatization in psychiatric patients (30.4%) is similar to that described in non-psychiatric patients. The psychiatric inpatients that are referred to a medical department as inpatients show a significant lower rate of somatization (2.2%) and a higher rate of suicide (35.5%). CONCLUSIONS: On fourth of psychiatric patients consult a medical department in one year and more than 40% of these consultations are not due to somatic diseases. The frequency of somatization in psychiatric patients is similar to the observed in other patients. Psychiatric inpatients that are also medical inpatients in one year constitute a specific high risk group.

Adult↗

Somatic hypermutation: mutations 3' of rabbit VDJ H-chain genes.

VDJ genes of rabbit B cells are diversified by a somatic gene conversion-like mechanism in which V(H) gene segments 5' of the VDJ gene serve as donors. To assess whether somatic mutation also contributes to Ab diversification in the rabbit, we searched for mutations 3' of VDJ genes because mutations in this region presumably result from somatic mutation rather than gene conversion. We PCR-amplified and cloned the region extending 534 bp 3' of VDJ genes from splenic DNA of young and adult rabbits. Results of nucleotide sequence analysis of the clones revealed a high mutation frequency (2.4%) within the first 120 bp downstream of VDJ genes. This frequency decreased rapidly with increasing distance 3' of the VDJ genes. The mutations demonstrated both strand bias and dinucleotide preferences characteristic of somatic hypermutation. We conclude that Ab diversity in rabbit is generated not only by somatic gene conversion but also by somatic hypermutation.

Amino Acid Sequence↗