A Single-Session Process-Based Cognitive-Behavioral Intervention Combined with Multimodal Rehabilitation Treatment for Chronic Pain Associated with Emotional Disorders

BACKGROUND AND OBJECTIVES

Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting.

MATERIALS AND METHODS

A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month.

RESULTS

Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72).

CONCLUSIONS

The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.

THE RESPONSE OF SOME ROMANIAN AND FOREIGN APPLE CULTIVARS TO THE NATURAL INFECTIONS CAUSED BY PODOSPHERA LEUCOTRICHA, IN BISTRIȚA AREA

It is desirable that in the newly established apple orchards to be promoted as many Romanian cultivars that have genetic resistance to diseases. That is why we considered important the evaluation of some Romanian apple varieties whose expansion in culture is desired, in terms of their behaviour to the attack of the fungus Podosphera leucotricha, one of the most harmful pathogens that damage apples. The evaluation of the cultivars was performed in the period 2019 – 2021, in the experimental plots of Research Station for Fruit Growing (RSFG) Bistrita and targeted six Romanian cultivars and five foreign cultivars. Observations were made both in the untreated plots and in the plots where conventional treatment schemes were applied. The results highlight the varieties created at SCDP Bistriţa: 'Bistrițean' and 'Starkprim' which, together with 'Starkrimson', stood out due to the absence of powdery mildew symptoms in the three years of study.The cultivars known to be sensitive to powdery mildew, 'Idared' and 'Jonathan' were most affected, followed by 'Golden Delicious'. The cultivars 'Florina', 'Generos' and 'Auriu de Bistrița' showed a medium to low sensitivity and 'Aura' and 'Salva' very low sensitivity.

High expression of DNA methyltransferases in primary human medulloblastoma

Epigenetic alterations have been implicated in cancer development. DNA methylation modulates gene expression, which is catalyzed by DNA methyltransferases (DNMTs). The objective of our study was to evaluate expression of DNMTs in medulloblastoma and analyze its correlation with clinical features. Nuclear expression of DNMT1, DNMT3A and DNMT3B was analyzed in human primary medulloblastoma of 44 patients using immunohistochemistry. Correlation of expression of DNMT levels with classical histological subtypes, novel molecular subgroups and survival of patients was analyzed. Elevated expression of DNMT1, DNMT3A and DNMT3B was observed in 63.64%, 68.18% and 72.73% of all cases, respectively. None of them showed a correlation with classical histology or survival. Concerning molecular subtypes, significantly higher expression of DNMT1 was observed in the SHH group compared to non-SHH samples (p = 0.02), but without significant difference in DNMT3A or DNMT3B levels between any subtypes. In conclusion, DNMT1, DNMT3A and DNMT3B are highly expressed in human medulloblastoma samples, suggesting that promoter hypermethylation may play a role in medulloblastoma development. Demethylation of tumor suppressor gene promoters may be considered as a possible future target in therapy of medulloblastoma.

Synthesis of a sulfonic acid mimetic of the sulfated Lewis A pentasaccharide

The first sulfonic acid mimetic of the sulfated Lewis A pentasaccharide in which the natural L-fucose unit is replaced by a D-arabinose ring was synthesized. Formation of the sulfonic acid moiety at a pentasaccharide level could be successfully achieved by means of introduction of an acetylthio moiety into the terminal D-galactose residue and subsequent oxidation. The equatorial arrangement of the acetylthio group linked to C-3 of the galactose ring could be obtained by double nucleophilic substitutions; efficient formation of the gulo-triflate derivatives required low-power microwave (MW) activation. Oxidation of the acetylthio group was carried out using Oxone in the presence of acetic acid.

Efficacy and safety of infliximab induction therapy in Crohn's Disease in Central Europe--a Hungarian nationwide observational study

Background

Infliximab (IFX) has proven to be an effective addition to the therapeutic arsenal for refractory, fistulizing, and steroid dependent Crohn's disease (CD), with efficacy in the induction and maintenance of clinical remission of CD. Our objective in this study is to report the nationwide, multicenter experience with IFX induction therapy for CD in Hungary.

Methods

During a 6-year-period, beginning in 2000, a total of 363 CD patients were treated with IFX as induction therapy (5 mg/kg IFX infusions given at week 0, 2 and 6) at eleven centers in Hungary in this observational study. Data analysis included patient demographics, important disease parameters and the outcome of IFX induction therapy.

Results

Three hundred and sixty three patients (183 women and 180 men) were treated with IFX since 2000. Mean age was 33.5 ± 11.2 years and the mean duration of disease was 6.7 ± 6.1 years. The population included 114 patients (31.4%) with therapy-refractory CD, 195 patients (53.7%) with fistulas, 16 patients (4.4%) with both therapy-refractory CD and fistulas, and 26 patients (7.2%) with steroid dependent CD. Overall response rate was 86.2% (313/363). A higher response rate was observed in patients with shorter disease duration (p = 0.05, OR:0.54, 95%CI:0.29-0.99) and concomitant immunosuppressant therapy (p = 0.05, OR: 2.03, 95%CI:0.165-0.596). Concomitant steroid treatment did not enhance the efficacy of IFX induction therapy. Adverse events included 34 allergic reactions (9.4%), 17 delayed type hypersensitivity (4.7%), 16 infections (4.4%), and 3 malignancies (0.8%).

Conclusion

IFX was safe and effective treatment in this cohort of Hungarian CD patients. Based on our experience co-administration of immunosuppressant therapy is suggested in patients receiving IFX induction therapy. However, concomitant steroid treatment did not enhanced the efficacy of IFX induction therapy.

Tuberculosis in the European Union – ongoing commitment needed to control the disease

World TB day on 24 March commemorates this event and is an opportunity for a critical appraisal of the TB situation, for raising awareness and for joining forces in order to control the disease.

Tackling tuberculosis: progress made and challenges remaining for the European Union

World Tuberculosis Day on 24 March commemorates the date in 1882 when Robert Koch presented his findings on the causing agent of tuberculosis (TB) - Mycobacterium tuberculosis. This celebration provides a good opportunity to take stock of the achievements in controlling the disease so far - and the remaining challenges at global, regional, national and local level.

Why a burden of disease study?

From the time I was appointed as Director of the European Centre for Disease Prevention and Control (ECDC) in 2005, I and the ECDC Governing and Advisory Bodies faced the task of tackling the 46 diseases under mandatory notification in the European Union (EU), as well as severe acute respiratory syndrome (SARS), avian influenza and West Nile virus.

Successful transfer of Eurosurveillance to ECDC

One of the first things the new European Centre for Disease Prevention and Control (ECDC) had to address in 2005 when the Centre was just being set up and operational was the requirement in its Work Plan 2005-2006 to issue a “weekly epidemiological report”.

Leukaemia incidence and survival in children and adolescents in Europe during 1978–1997. Report from the Automated Childhood Cancer Information System project

Leukaemias constitute approximately one-third of cancers in children (age 0-14 years) and 10% in adolescents (age 15-19 years). Geographical patterns (1988-1997) and time trends (1978-1997) of incidence and survival from leukaemias in children (n=29,239) and adolescents (n=1929) were derived from the ACCIS database, including data from 62 cancer registries in 19 countries across Europe. The overall incidence rate of leukaemia in children was 44 per million person-years during 1988-1997. Lymphoid leukaemia (LL) accounted for 81%, acute non-lymphocytic leukaemia (ANLL) for 15%, chronic myeloid leukaemia (CML) for 1.5% and unspecified leukaemia for 1.3% of cases. Adjusted for sex and age, incidence of childhood LL was significantly lower in the East and higher in the North than in the British Isles. The overall incidence among adolescents was 22.6 per million person-years. The incidence of LL was rising in children (0.6% per year) and adolescents (1.9% per year). During 1988-1997 5-year survival of children with leukaemias was 73% (95% CI 72-74) and approximately 44% for infants and adolescents. Similar differences in survival between children and adolescents were observed for LL, much less so for ANLL. Survival differed between regions; prognosis was better in the North and West than the East. Remarkable improvements in survival occurred in most of the subgroups of patients defined by diagnostic subgroup, age, sex and geographic categories during the period 1978-1997. For children with ANLL most improvements in survival were observed in the 1990s.

[Genetics of renal tumors]

The quintessence of malignant transformation is the genetic alteration of the tumor progenitor cell, i.e. somatic mutation. The genetic change appearing at chromosome and/or gene level results in the disturbance of the balance of cell proliferation and differentiation. In solid tumors, including renal tumors, the basic genetic mechanism proved to be the loss of function of a specific gene pair caused by loss of the particular chromosome or chromosomal region (monosomy, deletion) or by mutation of the gene. In the well studied Wilms' tumor-aniridia-syndrome the distal part of 11p13 region is deleted. The responsible gene is the WT-1 tumor suppressor gene, a Zn finger type transcription factor. In the majority of cases the mutation of this gene leads to the tumor formation without cytogenetically detectable deletion. For manifestation of the tumor the functional damage of both alleles is needed. In other histological types of renal tumors a great variation of chromosome losses and gains, as well as translocations can be identified. In Wilms tumor of embryonic origin, tumor suppressor genes located on the short arms of chromosomes 16 and 17 play a role in the pathogenesis. Besides, the significance of abnormal genomic imprinting of IGF2 and H19 genes located on 11p15 has also been confirmed. If a part of the embryonic cells do not regress, they may develop to papillary carcinoma together with the appearance of trisomies of chromosomes 7 and 17 and loss of Y. In the transformation process from papillary adenoma to carcinoma, duplication of several chromosomal regions is involved (3q+, +8, +12, +16, +20). The origin of renal carcinoma developing from normal nephron cells is associated with a deletion of 3p and 5q+, while during the progression of the disease further variable chromosome losses appear (6q-, 8p-, 14q-, -9). Tumor-specific cytogenetic and molecular genetic changes confirm the morphological classification of epithelial renal tumors pointing at the relation of the various entities or their independence. Based on cytogenetic alterations, a sequential predictive model of renal tumors can be developed. Individual types, together with joining and sequential appearance of aberrations are in line with the multistep mechanism of carcinogenesis. At the same time, the specific cytogenetic and molecular genetic changes confirm the diagnosis, provide further information about the histological type and progression of the disease. In hereditary cases, the members of the family at risk can be identified by recognizing the possibly associating clinical symptoms and/or by detecting the constitutional mutation of the gene using molecular genetic methods. Consequently, the genetic study of renal tumors plays important role not only in diagnosis and choosing adequate therapy but also in prevention of the disease.

Ineffability of qualia: a straightforward naturalistic explanation

In this paper I offer an explanation of the ineffability (linguistic inexpressibility) of sensory experiences. My explanation is put in terms of computational functionalism and standard externalist theories of representational content. As I will argue, many or most sensory experiences are representational states without constituent structure. This property determines both the representational function these states can serve and the information that can be extracted from them when they are processed. Sensory experiences can indicate the presence of certain external states of affairs but they cannot convey any more information about them than that. So, format- or code-conversion mechanisms that link different systems of representation (linguistic and perceptual) to each other will fail to extract any relevant information from sensory experiences that could be coded in language. They only way to establish specific roles for sensory experiences in communication and the organization of behavior is to attach to them, by associative links, words, or other behavioral responses. If a sensory experience has no linguistic label associated to it in a particular subject, then no linguistic description can token, or activate, that state in the subject. In other words, no linguistic description can cause a subject to undergo an unlabeled perceptual state. On the contrary, complex, or syntactically structured perceptual states can be built up, on the basis of descriptions, by mechanisms of constructive imagination (conceived here as one sort of format conversion). It is this difference between complex and unstructured representational states that gives us an understanding of the phenomenon we call the ineffability of qualia.

Biclonal chromosomal aberrations in a child with myelodysplastic syndrome

Hematological malignancies and premalignant diseases are generally of monoclonal origin. The prognostic and therapeutic significance of finding two genetically independent clones remains to be determined. We followed a case of childhood myelodysplastic syndrome showing biclonal chromosomal abnormalities (+8, -7) by conventional cytogenetic examination and double target fluorescence in situ hybridization (FISH). A 7-year-old girl presented with Plaut-Vincent angina and leukopenia. The cytogenetic aberration of +8 was the first sign to suggest MDS. Serial bone marrow controls, prompted by a progressive clinical course detected myelodysplastic changes and a new clonal aberration (-7). The presence of -7 and +8 in two independent clones was verified by double-target FISH. While at diagnosis and during cytokine treatment more cells showed +8, after successful all-trans retinoic acid (ATRA) therapy, the clone with -7 predominated. Following allogeneic bone marrow transplantation the patient displayed donor-derived hematopoesis. Our data stress the significance of cytogenetic and FISH examinations in detecting specific genetic abnormalities and progressive clonal changes as an indicator and guideline for therapy. Different cell clones characterized by different genetic changes might be associated with different biologic features reflected in their response to treatment.

Supraclavicular abscess caused by Salmonella enteritidis in patient without gastrointestinal symptoms

Soft tissue infections are among the rare manifestations of extra intestinal salmonellosis and occur more frequently in immunocompromised patients. Herein we report a case of a 51-year-old white male with type II. diabetes mellitus, diagnosed with supraclavicular abscess caused by Salmonella enteritidis. The patient denied any gastrointestinal symptoms, and stool cultures were negative. After incision, drainage, and administration of intravenous ampicillin (4 x 1.5 g/day for two weeks) the patient recovered completely. To our knowledge, this is the first reported case of cervical soft tissue abscess caused by Salmonella enteritidis without preceding gastrointestinal symptoms. We feel that the presence of diabetes was a risk factor for developing the infection.

[Epidemiology of non-variceal upper gastrointestinal hemorrhage in Vas County in Western Hungary]

Data of 3014 patients with nonvariceal upper gastrointestinal bleeding were retrospectively evaluated in county Vas between 1984 and 1995. The annual incidence of bleeding increased progressively in this period. In this change the role of nonsteroidal antiinflammatory drugs in questionable, because in the investigated period the sale of these drugs decreased, although the purchase of oxicame, one of this drug-group associating with higher risk for bleeding increased. The risk of bleeding enhanced with ageing that can be explained by higher rate of Helicobacter pylori infection, by the greater consumption of nonsteroidal antiinflammatory drugs and by the more frequent serious concomitant diseases in elderly age. The risk of bleeding in males proved to be higher than in females, the frequency of bleeding in men was twice as much as it could be expected according to the sex rate of the peptic lesions. Their results concerning the reduction of mortality underline the importance of the early endoscopic diagnosis and therapy.

[Efficiency of electro-hydrothermal coagulation in the management of non-variceal upper gastrointestinal bleeding]

The data of 596 electro-hydrothermal coagulations in nonvariceal acute gastrointestinal bleeding were retrospectively evaluated and the results were compared to a previous period in which the endoscopic hemostasis was not regularly applied. Initial hemostasis was achieved in 96.1%, the rebleeding rate was 20.5%, perforation occurred in 0.5%. Comparing the two period the need of urgent surgery decreased from 9.2% to 3.4% (p < 0.05) and the mortality from 25.4% to 12% (p < 0.01).

CONCLUSION

The electro-hydro-thermal coagulation is a safe and effective method in the treatment of nonvariceal gastrointestinal bleeding.