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Fibroblast prostaglandin E2 synthesis. Persistence of an abnormal phenotype after short-term exposure to mononuclear cell products.

Acquired abnormalities of connective tissue metabolism in inflammatory diseases often persist when lesional tissue is maintained in in vitro culture. Although connective tissue cells are exposed to inflammatory cell-derived mediators in vivo and such mediators have been shown to alter connective tissue cell behavior, it is unclear whether the persistence of metabolic defects in vitro could result from remote in vivo exposure to these mediators. An in vitro model was used to test whether transient exposure of normal fibroblasts to inflammatory mediators could lead to metabolic alterations that persist during in vitro culture. Short-term exposure of human foreskin fibroblasts in vitro to supernates of mitogen-activated peripheral blood mononuclear cells led to persistent abnormalities of prostaglandin E2 (PGE2) metabolism. Fibroblasts previously exposed to mononuclear cell products synthesized more than twice as much PGE2 when stimulated compared with similarly stimulated but previously unexposed control fibroblasts of the same strain. The enhanced PGE2 synthesis persisted for as long as 20 wk and 19 cell generations after the original exposure to mononuclear cell products. Exposure of fibroblast populations to mononuclear cell products may, thus, lead to metabolite alterations that are still evident after multiple cell generations.

Cell Division↗

Persistence of regional left ventricular dysfunction after exercise-induced myocardial ischemia.

To determine whether regional myocardial dysfunction occurring after exercise-induced ischemic might be caused by continued abnormalities of myocardial blood flow in the post-exercise period, nine dogs were instrumented with ultrasonic microcrystals for determination of circumferential segment shortening, circumflex artery electromagnetic flow probes, and hydraulic coronary artery occluders. Dogs performed treadmill exercise during partial inflation of the coronary artery occluder. When the stenosis was maintained after exercise (persistent stenosis), subendocardial flow = 0.79 +/- 0.42 ml/min per g vs. 1.39 +/- 0.43 ml/min per g control), and this was associated with continued dysfunction in the ischemic zone (segment shortening 45.4 +/- 36.9% of resting control). When the stenosis was released immediately after exercise (temporary stenosis), however, flow was markedly increased 1 min post-exercise (mean transmural flow 4.24 +/- 1.22 ml/min per g; subendocardial flow 4.18 +/- 1.52 ml/min per g), and this was associated with a transient increase in segment shortening to 104.5 +/- 9.3% of resting control. 5 min after exercise, however, moderate reductions in ischemic segment shortening were noted after both temporary stenosis and persistent stenosis runs, and these persisted for 30 min post-exercise. It is concluded that regional left ventricular dysfunction may persist for a significant period of time after exercise-induced ischemia. Furthermore, early after exercise, dysfunction is related to persistent abnormalities of myocardial blood flow, whereas late after exercise it is independent of primary reductions in myocardial blood flow.

Animals↗

Persistence and remission of depressive symptoms in late life.

OBJECTIVE: The relation of poor health to the onset of depression symptoms in late life is well recognized, but little attention has been given to characteristics that might predict persistence or remission of depressive symptoms. In previous analyses the authors found that increasing disability and declining health preceded the emergence of depressive symptoms in older community residents and accounted for 70% of the variance explained by discriminant analyses. The aim of the present analysis was to examine the relevance of changes in health and disability to the persistence of depressive symptoms. METHOD: A representative sample of 1,855 adults aged 65 or older were assessed with the Center for Epidemiologic Studies Depression Scale at baseline. Twenty-four months later, 1,577 individuals were available for a second assessment of depressive symptoms. The characteristics of the 97 community residents whose depressive symptoms persisted over 24 months were compared to those of the 114 whose symptoms remitted. RESULTS: Changes in health, differences in age, sleep disturbance, and added formal support services accounted for more than 30% of the variance between the persistently depressed and remission groups. Advanced age and worsening health were associated with persistent symptoms, improved health with remission. CONCLUSIONS: Previous studies have indicated that untoward changes in health and disability play a major role in the onset of depressive symptoms. These findings show a substantial contribution to chronicity as well.

Activities of Daily Living↗

Persistence of and changes in neuropsychiatric symptoms in Alzheimer disease over 6 months: the LASER-AD study.

OBJECTIVES: Neuropsychiatric symptoms (NPS) are common in Alzheimer disease (AD). It is important in terms of management to know their natural history and their effects on service use. The authors aimed to determine the persistence and change in severity of NPS over 6 months in participants with AD, and the relationship to initial severity, drug management, use of services, and cost of care. METHODS: NPS scores and data on cognition, psychotropic medication, service use, and costs of care were collected on 224 participants at baseline and on 198 at 6-month follow-up. RESULTS: Of 224 patients, 210 (93.8%) had NPS at baseline; 168 (75.0%) had at least one clinically significant symptom, 118 (80.4%) of whom had persistent significant symptoms at 6-month follow-up. There was no significant change in mean NPS score for any symptom over 6 months, but many individuals became better or worse; 61.2% of those with at least one significant baseline symptom in any domain improved. Those with persistent symptoms had more severe baseline symptoms. Deterioration in NPS was predicted by deterioration in MMSE. Those with at least one clinically significant symptom had higher care costs than those without. CONCLUSIONS: NPS were highly persistent overall, but many individuals became better or worse. Persistence was predicted by having more severe symptoms at baseline. Clinically significant levels of NPS were associated with greater costs of care. The relatively few associations found between specific psychiatric treatments and changes in NPS reflect both undertreatment and the complexity of symptoms.

Aged↗

Depressive symptoms in elderly patients after a somatic illness event: prevalence, persistence, and risk factors.

Elderly patients with somatic illness are at increased risk of depression. The authors studied the prevalence and persistence of depressive symptoms during the first year after the events of myocardial infarction, congestive heart failure, fall-related injury, and the diagnosis of cancer and their putative pre-event risk factors. The GLAS study contains data from 614 patients who experienced post-baseline myocardial infarction, cancer, heart failure, or fall-related injury of the extremities within 5 years after the baseline assessment. Follow-up was conducted 8 weeks, 6 months, and 1 year after the somatic event. The authors studied the relative importance of 21 baseline risk factors for experiencing significant depressive symptoms during follow-up and the persistence of depression. Depressive symptoms were prevalent in 38.3% of the subjects during the post-event year; in about 19.1%, symptoms were mild. For a majority of patients (67.5%), symptoms persisted until the next assessment. Significant pre-event risk factors were depressive symptoms at baseline, age, smoking, poor general health, poor well-being, and neuroticism. Within the depressed group, only neuroticism was related to the persistence of symptoms. Neuroticism increases the risk of experiencing post-event depressive symptoms and is related to their persistence, which suggests the existence of a depression-prone personality.

Accidental Falls↗

Persistence of the stapedial artery: a histopathologic study.

Persistence of the stapedial artery is a rare event. Fewer than 30 cases have been reported since the discovery of this artery in 1836. We carried out a histopathologic study on three temporal bones from two patients who had this anomaly, and were able to trace the full course of the artery. In two specimens a large stapedial artery persisted and substituted for the middle meningeal artery. In the third, a small, persistent stapedial artery ended in the arterial plexus surrounding the facial nerve. Persistence is discussed in terms of embryogenesis, developmental theories, histologic findings, and clinical significance. The material suggests that the stapedial artery can persist to varying degrees.

Arteries↗

Pharmacologic reversion of persistent atrial fibrillation with amiodarone predicts long-term sinus rhythm maintenance.

OBJECTIVE: The study analyzed the role of different variables that determine long-term sinus rhythm maintenance in patients with persistent atrial fibrillation who are treated with amiodarone. BACKGROUND: It has been recognized that different factors influence long-term sinus rhythm preservation after the conversion of persistent atrial fibrillation. Although the duration of the arrhythmia appears to be the most important factor, consistent information regarding the role of the mode of arrhythmia conversion (pharmacologic or electric) is still lacking. METHODS: One hundred and forty one anticoagulated patients with persistent atrial fibrillation (median duration 8 months, percentiles 25 and 75: 2-24) were treated for 4 weeks with oral amiodarone (600 mg/day). Those in whom the arrhythmia persisted underwent electric cardioversion. After restoration of normal sinus rhythm (either pharmacologic or electric), all patients received a daily dose of amiodarone (200 mg) and were followed for a median of 19 months (percentiles 25 and 75: 8-34 months). RESULTS: Sixty eight patients (48.22%) regained sinus rhythm during the initial period of amiodarone treatment with 600 mg/day (Group I) and 73 (51.78%) required electric cardioversion (Group II). During the entire follow-up, atrial fibrillation relapsed in 63 patients: 17 (25%) in Group I and 46 (63%) in Group II. Recurrences of the arrhythmia were strikingly less frequent in patients whose atrial fibrillation lasted 12 months or less (33/103, 32.3%) than in those whose atrial fibrillation lasted more than 12 months (30/38, 78.94%). In the multivariate analysis, the mode of reversion (HR, 0.37; CI, 0.21-0.65) and the duration of the arrhythmia (HR, 2.55; CI, 1.54-4.20) were the determinants for long-term sinus rhythm maintenance. Age, sex, left atrium size, left ventricle diameter, and the shortening fraction did not significantly influence the rate of arrhythmia recurrence. Among the 141 patients included in the study, 113 patients were followed for at least 1 year, and cardiac rhythm was assessed at this time. Of these, only 1 of 48 patients (2.1%) in Group I was in atrial fibrillation, in marked contrast with 18 of 65 patients (27.8%) in Group II (RR, 0.075; 95% CI, 0.01-0.54). CONCLUSIONS: In patients with persistent atrial fibrillation, long-term preservation of sinus rhythm under chronic amiodarone treatment may be anticipated when the arrhythmia lasts 12 months or less and/or its reversion is obtained pharmacologically. We may confidently assume that these two factors have a beneficial additive influence on the outcome.

Adult↗

Persistent medical problems and permanent impairment five years after occupational injury.

In a comprehensive, one year material of 1,785 occupational injuries in the township of Umeå, Sweden. 1985-04-01/1986-03-31, the proportion of persons with persistent medical problems, two years after the event, was 39%. These were investigated again in 1990, five years after the event, and the proportion of persons with persistent medical problems had dropped to 23%. Around 4% of the injured had a definable permanent medical impairment, most often caused by a fracture, luxation or amputation of an upper extremity. Back injuries, however, were the most frequent cause for persistent medical problems, mostly in the form of ache and pain. Persons in health care, social and nursing occupations had a twice as high proportion of persistent problems as the average in the material. Of the persons that reported persistent medical problems when interviewed in 1990, one in three had changed his leisure time activities, one in five had changed jobs, and one in ten had retired early or was on long term sick leave. The group of early retired and persons on long term sick leave had a large proportion of young females and old males. The reader is reminded that conclusions and comparisons must be made with reference to the assessment and benefit structure in the particular systems of social insurance and workers' compensation.

Adult↗

Clonal persistence of oral Fusobacterium nucleatum in infancy.

Once established, early-colonizing bacterial species tend to persist in the mouth. To obtain detailed information on the population dynamics of early-colonizing oral anaerobes, we examined the clonal diversity and persistence of clones among oral Fusobacterium nucleatum populations during the first 2 yrs of life. Consecutive salivary samples from 12 infants, collected at 2, 6, 12, 18, and 24 mos of age, yielded a total of 546 F. nucleatum isolates for clonal typing with arbitrarily primed PCR (AP-PCR). Up to 7 AP-PCR types were simultaneously detected in each sample. In 11 out of the 12 infants examined, AP-PCR types persisted for up to 1 yr. Strain turnover rate was high during the first year of life, but then the occurrence of persistent clones increased. This study indicates a wide genetic diversity within the species and provides evidence for the increasing persistence of F. nucleatum clones in the oral cavity with age.

Chi-Square Distribution↗

Tuning the volume of the immune response: strength and persistence of stimulation determine migration and cytokine secretion of dendritic cells.

Migration to lymph nodes and secretion of cytokines are critical functions of mature dendritic cells (DCs); however, these 2 functions are not necessarily linked. This is the first report showing that quantitative differences in identical signaling pathways determine DC migration and cytokine secretion. Using different polymerized forms of CD40 ligand, we demonstrate that the strength and persistence of CD40 signaling can induce either function. Induction of monocyte-derived DC (MoDC) migration required a weak and transient CD40 signal, whereas strong and persistent CD40 signaling blocked migration and biased toward cytokine secretion. In contrast to MoDCs, CD40 activation of CD1c+ peripheral blood DCs (PBDCs) induced a nonpersistent, intracellular signaling profile resulting in migratory-type DCs unable to secrete interleukin-12p70 (IL-12p70). Extracellular signal-regulated kinase 1/2 (ERK1/2) and p38K activation synergistically mediated cytokine secretion, whereas migration was enhanced by p38K activation but reduced by persistent ERK1/2 activity. This model of signal strength and persistence also applied when stimulating DCs with intact microbes. Thus, a novel concept emerges in which the type of immune response induced by DCs is tuned by the strength and persistence of DC activating signals.

CD40 Antigens↗

Persistent preswitch clonotypic myeloma cells correlate with decreased survival: evidence for isotype switching within the myeloma clone.

Multiple myeloma (MM) is identified by unique immunoglobulin heavy chain (IgH) variable diversity joining region gene rearrangements, termed clonotypic, and an M protein termed the "clinical" isotype. Transcripts encoding clonotypic pre and postswitch IgH isotypes were identified in MM peripheral blood mononuclear cells (PBMCs), bone marrow (BM), and mobilized blood. For 29 patients, 38 BM, 17 mobilized blood, and 334 sequential PBMC samples were analyzed at diagnosis, before and after transplantation for 2 to 107 months. The clinical clonotypic isotype was readily detectable and persisted throughout treatment. Eighty-two percent of BM and 38% of PBMC samples also expressed nonclinical clonotypic isotypes. Clonotypic immunoglobulin M (IgM) was detectable in 68% of BM and 25% of PBMC samples. Nonclinical clonotypic isotypes were detected in 41% of mobilized blood samples, but clonotypic IgM was detected in only 12%. Patients with persistent clonotypic IgM expression had adverse prognostic features at diagnosis (lower hemoglobin, higher beta(2)-microglobulin) and higher numbers of BM plasma cells compared with patients with infrequent/absent clonotypic IgM. Patients with persistent clonotypic IgM expression had significantly poorer survival than patients with infrequent IgM expression (P <.0001). In a multivariate analysis, persistent clonotypic IgM expression in the blood correlated independently with poor survival (P =.01). In nonobese diabetic severe combined immunodeficiency mice, xenografted MM cells expressed clinical and nonclinical postswitch clonotypic isotypes. MM expressing clonotypic IgM engrafted both primary and secondary mice, indicating their persistence within the murine BM. This study demonstrates that MM clonotypic cells expressing preswitch transcripts are tied to disease burden and outcomes. Because MM pathology involves postswitch plasma cells, this raises the possibility that IgH isotype switching in MM may accompany worsening disease.

Adult↗

The impact of dosing frequency on compliance and persistence with bisphosphonates among postmenopausal women in the UK: evidence from three databases.

BACKGROUND: Bisphosphonates are currently among the most effective therapies for the treatment of osteoporosis and provide one of the mainstays of treatment in the UK. However studies in several countries have all reported sub-optimal compliance and persistence with treatment. OBJECTIVE: To examine the impact of dosing frequency on compliance and persistence with bisphosphonates in the UK. METHODS: Three UK General Practitioner sourced databases, the General Practice Research Database (GPRD), IMS Disease Analyzer (MEDIPLUS) and the Doctors Independent Network Database (DIN-LINK) were used to identify bisphosphonate naïve postmenopausal women. In each of the three retrospective analyses women were grouped into weekly or daily cohorts and followed for 12 months from an initial prescription. Compliance was measured as a Medication Possession Ratio (MPR), defined as the proportion of days for which patients had prescription coverage. Persistence was measured as the number of continuous days of treatment from the initial prescription to the end of the last prescription issued in the follow-up period. RESULTS: GPRD, MEDIPLUS and DIN-LINK provided access to 7567, 5962 and 1801 women, respectively. All three analyses consistently demonstrated that those on weekly regimens had a higher MPR than those on daily regimens (GPRD 76.2%, CI(95%,) 75.4-77.0 vs. 63.5%, CI(95%) 61.2-65.8, MEDIPLUS 70.3%, CI(95%) 69.3-71.2 vs. 56.3%, CI(95%) 53.8-58.9, DIN-LINK 59.5%, CI(95%) 59.4-59.6 vs. 46.3%, CI(95%) 45.9-46.7) (p < 0.0001) and persisted longer with treatment (GPRD 249, CI(95%) 246-253 vs. 208, CI(95%) 199-217, MEDIPLUS 228, CI(95%) 224-231 vs. 186, CI(95%,) 176-196, DIN-LINK 235, CI(95%) 234-236 vs. 189, CI(95%) 187-191) days respectively), (p < 0.0001). CONCLUSIONS: Although this study only provided an indirect measure of medication usage, it demonstrated that a less frequent dosing regimen significantly improved levels of both compliance and persistence; however, even on weekly regimens bisphosphonate usage remains sub-optimal thereby reducing the clinical benefits.

Aged↗

Tissue MicroArray (TMA) analysis of normal and persistent Chlamydophila pneumoniae infection.

BACKGROUND: Chlamydophila pneumoniae infection has been implicated as a potential risk factor for atherosclerosis, however the mechanism leading to persistent infection and its role in the disease process remains to be elucidated. METHODS: We validated the use of tissue microarray (TMA) technology, in combination with immunohistochemistry (IHC), to test antibodies (GroEL, GroES, GspD, Ndk and Pyk) raised against differentially expressed proteins under an interferon-gamma (IFN-gamma) induced model of chlamydial persistence. RESULTS: In the cell pellet array, we were able to identify differences in protein expression patterns between untreated and IFN-gamma treated samples. Typical, large chlamydial inclusions could be observed in the untreated samples with all antibodies, whereas the number of inclusions were decreased and were smaller and atypical in shape in the IFN-gamma treated samples. The staining results obtained with the TMA method were generally similar to the changes observed between normal and IFN-gamma persistence using proteomic analysis. Subsequently, it was shown in a second TMA including archival atheromatous heart tissues from 12 patients undergoing heart transplantation, that GroEL, GroES, GspD and Pyk were expressed in atheromatous heart tissue specimens as well, and were detectable morphologically within lesions by IHC. CONCLUSION: TMA technology proved useful in documenting functional proteomics data with the morphologic distribution of GroEL, GroES, GspD, Ndk and Pyk within formalin-fixed, paraffin-embedded cell pellets and tissues from patients with severe coronary atherosclerosis. The antibodies GroEL and GroES, which were upregulated under persistence in proteomic analysis, displayed positive reaction in atheromatous heart tissue from 10 out of 12 patients. These may be useful markers for the detection of persistent infection in vitro and in vivo.

Cell Line↗

Psychiatric illness in patients with persistent somatisation.

BACKGROUND: This study explores the incidence and nature of mental illness among persistent somatisers, and analyses their use of mental health services. METHOD: Individuals with at least ten admissions to non-psychiatric departments during an 8-year period were studied. Persistent somatisers (n = 56) were compared with other frequent users (n = 57) of non-psychiatric services. RESULTS: Of the persistent somatisers, 82% had been examined by a psychiatrist at least once (median, 3 times). Sixteen per cent were mentally retarded, 48% were dependent on alcohol or drugs, and 48% had DSM-III-R personality disorder. The most prevalent ICD-10 diagnoses were anxiety states (54%), depressions (30%), phobias (18%) and psychoses (20%). CONCLUSIONS: Persistent somatisation is associated with severe mental illness and a broad spectrum of heterogeneous psychiatric diagnoses and syndromes. Persistent somatisers impose a serious burden on the mental health care system.

Adolescent↗

Detection of recurrent or persistent nasopharyngeal carcinomas after radiotherapy with 18-fluoro-2-deoxyglucose positron emission tomography and comparison with computed tomography.

PURPOSE: The effectiveness of positron emission tomography (PET) with 1 8-fluoro-2-deoxyglucose (FDG) for detecting suspected recurrence of nasopharyngeal carcinomas (NPC) was evaluated and compared with computed tomography (CT). PATIENTS AND METHODS: FDG-PET studies were performed on 36 NPC patients 4 months after radiotherapy. The images were interpreted visually and quantitatively by calculating standardized uptake values (SUVs). RESULTS: The sensitivity, specificity, and accuracy of visually interpreted FDG-PET images, for differentiation of recurrent or persistent NPC from benign lesions, were 100%, 96%, and 97%, respectively. Cases with recurrent or persistent NPC (1.6 to 5.8) had significantly higher SUVs than cases with benign lesions (0.8 to 1.5). The sensitivity, specificity, and accuracy of CT for detecting recurrent or persistent NPC were 72%, 88%, and 83%, respectively. CONCLUSION: FDG-PET is a better tool than CT for the detection of recurrent or persistent NPC. Either visual interpretation or SUV can be used to differentiate benign lesions from recurrent or persistent NPC.

Adolescent↗

Bound lectins that mimic insulin produce persistent insulin-like activities.

Short preincubation of rat adipocytes with wheat germ agglutinin, followed by removal of unbound lectin, resulted in persistent activation of lipogenesis, which lasted at least 3 h. The bound lectin also inhibited lipolysis initiated by isoproterenol 1 or 2 h after the removal of the free lectin. This property was also shared by other insulinomimetic lectins, such as Concanavalin A and wax bean agglutinin. Persistent bioactivation is the consequence of lectin adsorbed to external cell surface determinants in a permanent fashion. This fraction is not internalized, processed, or appreciably dissociated from the cells, since the addition of N-acetyl-D-glucosamine at any time after the onset of wheat germ agglutinin-induced persistent lipogenesis leads to termination. The property of producing persistent bioactivation is not shared by insulin itself, since removal of the unbound hormone results in termination of bioactivation. This study indicates the existence of externally located fat cell surface determinants, which, upon being occupied continuously, produce persistent insulin-like activities. The study also strongly supports the notion that the initial perturbation is sufficient to activate the insulin machinery system, and that internalization and processing of hormone-receptor complexes are the sole pathway for termination.

Acetylglucosamine↗

Persistent viral infection of the thyroid gland: alteration of thyroid function in the absence of tissue injury.

The possible role of viruses as the cause of some thyroid disorders was evaluated in three strains of mice neonatally infected with lymphocytic choriomeningitis virus. We report the first definitive evidence that viruses can persist in the thyroid gland, particularly thyroid epithelial cells in which thyroglobulin is synthesized. Concomitant with the infection of these cells was a significant reduction in the level of thyroglobulin mRNA and circulating thyroid hormones. Another virus that causes persistent infection but does not replicate in the thyroid gland failed to alter serum levels of thyroid hormones, indicating the thyroid dysfunction was not a generalized result of stress accompanying a persistent infection. This alteration in thyroid homeostasis during persistent infection with lymphocytic choriomeningitis virus is not caused by autoantibodies to the thyroid. Moreover, despite infection of the thyroid gland, neither necrosis nor inflammation occurs. Thyroid dysfunction was noted both when persistence was initiated at birth and in utero during congenital infection. These observations in an experimental model raise the issue that viruses may play a role in the pathogenesis of some thyroid disorders in man.

Animals↗

Immunotherapeutic relief from persistent infections and amyloid disorders.

Persistent infections and amyloid disorders afflict a significant number of people worldwide. It would appear at first glance that the treatment of these afflictions should be entirely unrelated; however, in both cases components of the adaptive immune system have been harnessed in an attempt to provide some therapeutic relief. Given that the ability of a pathogen to establish persistence often depends in part on a shortcoming of the adaptive immune response, it seems logical to devise immunotherapies with the intention of supplementing (or replacing) the insufficient immunologic element. A case in point is an intervention referred as immunocytotherapy, which relies upon the adoptive transfer of pathogen-specific T lymphocytes into a persistently infected host. Remarkably, the adoptively transferred T lymphocytes not only have the capacity to clear the persistent infection, but can also provide the recipient with protection against subsequent rechallenge (i.e., immunologic memory). Treatment of amyloid disorders (e.g., Alzheimer disease, sporadic inclusion-body myositis) with a similar therapeutic approach is complicated by the fact that the aberrant protein accumulations are self-derived. Focusing the adaptive response on these aberrant self-proteins has the potential to result in autoimmune pathology. This review critically evaluates the importance of immunotherapeutic approaches for the treatment of persistent infections and amyloid disorders, and attempts to delineate the interventions that are most likely to succeed in an exceedingly complex disorder such as sporadic inclusion-body myositis.

Alzheimer Disease↗