The Psychosomatic Practice.

There is increasing awareness of the limitations of the disease-oriented approach in medical care. The primary goal of psychosomatic medicine is to correct this inadequacy by incorporation of innovative operational strategies into clinical practice. Psychosomatic practice can be recognized by 2 distinctive features: the holistic approach to patient management (encompassing psychosocial factors) and the clinical model of reasoning (which reflects a multifactorial frame of reference). A basic psychosomatic assumption is the consideration of patients as partners in managing disease. The partnership paradigm includes collaborative care (a patient-physician relationship in which physicians and patients make health decisions together) and implementation of self-management (a plan that provides patients with problem-solving skills to enhance their self-efficacy). Pointing to strategies that focus on individual needs may improve patient quality of life and final outcomes

Definition of Naturally Processed Peptides Reveals Convergent Presentation of Autoantigenic Topoisomerase I Epitopes in Scleroderma.

ObjectiveAutoimmune responses to DNA topoisomerase I (topo I) are found in a subset of scleroderma patients who are at high risk for interstitial lung disease (ILD) and mortality. Anti-topo I antibodies (ATAs) are associated with specific HLA-DRB1 alleles, and the frequency of HLA-DR-restricted topo I-specific CD4+ T cells is associated with the presence, severity, and progression of ILD. Although this strongly implicates the presentation of topo I peptides by HLA-DR in scleroderma pathogenesis, the processing and presentation of topo I has not been studied.MethodsWe developed a natural antigen processing assay (NAPA) to identify putative CD4+ T cell epitopes of topo I presented by monocyte-derived dendritic cells (mo-DCs) from 6 ATA-positive patients with scleroderma. Mo-DCs were pulsed with topo I protein, HLA-DR-peptide complexes were isolated, and eluted peptides were analyzed by mass spectrometry. We then examined the ability of these naturally presented peptides to induce CD4+ T cell activation in 11 ATA-positive and 11 ATA-negative scleroderma patients.ResultsWe found that a common set of 10 topo I epitopes was presented by Mo-DCs from scleroderma patients with diverse HLA-DR variants. Sequence analysis revealed shared peptide-binding motifs within the HLA-DRβ chains of ATA-positive patients and a subset of topo I epitopes with distinct sets of anchor residues capable of binding to multiple different HLA-DR variants. The NAPA-derived epitopes elicited robust CD4+ T cell responses in 73% of ATA-positive patients (8 of 11), and the number of epitopes recognized correlated with ILD severity (P = 0.025).ConclusionThese findings mechanistically implicate the presentation of a convergent set of topo I epitopes in the development of scleroderma

Leveraging browse and grazing forage estimates to optimize index-based livestock insurance

African pastoralists sufer recurrent droughts that cause high livestock mortality and vulnerability to climate change. The index-based livestock insurance (IBLI) program ofers protection against drought impacts. However, the current IBLI design relying on the normalized diference vegetation index (NDVI) may pose limitation because it does not consider the mixed composition of rangelands (including herbaceous and woody plants) and the diverse feeding habits of grazers and browsers. To enhance IBLI, we assessed the efcacy of utilizing distinct browse and grazing forage estimates from woody LAI (LAIW) and herbaceous LAI (LAIH), respectively, derived from aggregate leaf area index (LAIA), as an alternative to NDVI for refned IBLI design. Using historical livestock mortality data from northern Kenya as reference ground dataset, our analysis compared two competing models for (1) aggregate forage estimates including sub-models for NDVI, LAI (LAIA); and (2) partitioned biomassmodel (LAIP) comprising LAIH and LAIW. By integrating forage estimates with ancillary environmental variables, we found that LAIP, with separate forage estimates, outperformed the aggregate models. For total livestock mortality, LAIP yielded the lowest RMSE (5.9 TLUs) and higher R2 (0.83), surpassing NDVI and LAIA models RMSE (9.3 TLUs) and R2 (0.6). A similar pattern was observed for species-specifc livestock mortality. The infuence of environmental variables across the models varied, depending on level of mortality aggregation or separation. Overall, forage availability was consistently the most infuential variable, with species-specifc models showing the diferent forage preferences in various animal types. These results suggest that deriving distinct browse and grazing forage estimates from LAIP has the potential to reduce basis risk by enhancing IBLI index accurac

Spin-polarized oxygen hole states in cation deficient La(1-x)CaxMnO(3+delta)

When holes are doped into a Mott-Hubbard type insulator, like lightly doped manganites of the La(1-x)CaxMnO3 family, the cooperative Jahn-Teller distortions and the appearance of orbital ordering require an arrangement of Mn(3+)/Mn(4+) for the establishment of the insulating canted antiferromagnetic (for x<=0.1), or of the insulating ferromagnetic (for 0.1<x<= 0.2) ground state. In the present work we provide NMR evidence about a novel and at the same time puzzling effect in La(1-x)CaxMnO(3+delta) systems with cation deficience. We show that in the low Ca-doping regime, these systems exhibit a very strong hyperfine field at certain La nuclear sites, which is not present in the stoichiometric compounds. Comparison of our NMR results with recent x-ray absorption data at the Mn K edge, suggests the formation of a spin-polarized hole arrangement on the 2p oxygen orbitals as the origin of this effect.Comment: 10 pages, 4 Figures, submitted to PR

The microenvironment’s role in mycosis fungoides and sézary syndrome: From progression to therapeutic implications

Background: Mycosis fungoides (MF) and Sezary Syndrome (SS) are the most common cutaneous T-cell lymphomas. It has been hypothesized that the interaction between the immune system, cutaneous cells, and neoplastic elements may play a role in MF/SS pathogenesis and progression. Methods: This paper aims to revise in a narrative way our current knowledge of the microenvironment’s role in MF/SS. Results and Conclusions: Literature data support a possible implication of microenvironment cells in MF/SS pathogenesis and progression, opening up new therapeutic avenues

Examining a staging model for anorexia nervosa: empirical exploration of a four stage model of severity.

Background: An illness staging model for anorexia nervosa (AN) has received increasing attention, but assessing the merits of this concept is dependent on empirically examining a model in clinical samples. Building on preliminary findings regarding the reliability and validity of the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN), the current study explores operationalising CASIAN severity scores into stages and assesses their relationship with other clinical features. Method: In women with DSM-IV-R AN and sub-threshold AN (all met AN criteria using DSM 5), receiver operating curve (ROC) analysis (n = 67) assessed the relationship between the sensitivity and specificity of each stage of the CASIAN. Thereafter chi-square and post-hoc adjusted residual analysis provided a preliminary assessment of the validity of the stages comparing the relationship between stage and treatment intensity and AN sub-types, and explored movement between stages after six months (Time 3) in a larger cohort (n = 171). Results: The CASIAN significantly distinguished between milder stages of illness (Stage 1 and 2) versus more severe stages of illness (Stages 3 and 4), and approached statistical significance in distinguishing each of the four stages from one other. CASIAN Stages were significantly associated with treatment modality and primary diagnosis, and CASIAN Stage at Time 1 was significantly associated with Stage at 6 month follow-up. Conclusions: Provisional support is provided for a staging model in AN. Larger studies with longer follow-up of cases are now needed to replicate and extend these findings and evaluate the overall utility of staging as well as optimal staging models

Improving road safety knowledge in Africa through crowdsourcing. The African Road Safety Observatory

Africa is the worst performing continent in road safety: the fatality rate, 26.6 per 100.000 inhabitants, is almost three times that of Europe's and fatalities per capita are projected to double from 2015 to 2030 (WHO, 2015). This is mainly due to the fact that Emerging Economies are experiencing increases in traffic, for which their traffic systems are not sufficiently prepared. On one hand, there is a significant demand for data and knowledge to be used for road safety-related decision making. On the other hand, there is a substantial lack of a reliable and detailed knowledge on road casualties in terms of the number of road accidents and fatalities occurring and, on the factors, leading to road accidents or affecting their consequences. When official data are poor or missing these could be integrated with other sources. The objective of this paper is to describe the African Road Safety Observatory (African RSO), a participative web portal developed in the field of the "SaferAfrica-Innovating dialogue and problems appraisal for a safer Africa" project, funded by the European Union's Horizon 2020 program. The African RSO combines traditional functions of analyzing and sharing road safety performance data and provide knowledge and information, with the more innovative ones: a Dialogue Platform and the crowdsourcing tool. The Dialogue Platform is dedicated to experts and stakeholders and aims at encouraging and facilitating a constructive engagement and dialogue on road safety in Africa, producing knowledge to inspire road safety funding, policies and interventions in Africa and providing recommendations to update the African Road Safety Action Plan and the African Road Safety Charter. The crowdsourcing tool allows African citizens to report and highlight road safety needs, to share opinions as well as to discuss solutions in their own Countries

Role of ADAMTS (A Disintegrin and Metalloproteinase With Thrombospondin Motifs)-5 in Aortic Dilatation and Extracellular Matrix Remodeling.

OBJECTIVE: Thoracic aortic aneurysm (TAA), a degenerative disease of the aortic wall, is accompanied by changes in the structure and composition of the aortic ECM (extracellular matrix). The ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) family of proteases has recently been implicated in TAA formation. This study aimed to investigate the contribution of ADAMTS-5 to TAA development. APPROACH AND RESULTS: A model of aortic dilatation by AngII (angiotensin II) infusion was adopted in mice lacking the catalytic domain of ADAMTS-5 (Adamts5Δcat). Adamts5Δcat mice showed an attenuated rise in blood pressure while displaying increased dilatation of the ascending aorta (AsAo). Interestingly, a comparison of the aortic ECM from AngII-treated wild-type and Adamts5Δcat mice revealed versican as the most upregulated ECM protein in Adamts5Δcat mice. This was accompanied by a marked reduction of ADAMTS-specific versican cleavage products (versikine) and a decrease of LRP1 (low-density lipoprotein-related protein 1). Silencing LRP1 expression in human aortic smooth muscle cells reduced the expression of ADAMTS5, attenuated the generation of versikine, but increased soluble ADAMTS-1. A similar increase in ADAMTS-1 was observed in aortas of AngII-treated Adamts5Δcat mice but was not sufficient to maintain versican processing and prevent aortic dilatation. CONCLUSIONS: Our results support the emerging role of ADAMTS proteases in TAA. ADAMTS-5 rather than ADAMTS-1 is the key protease for versican regulation in murine aortas. Further studies are needed to define the ECM substrates of the different ADAMTS proteases and their contribution to TAA formation