published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Medicine / Master / Doctor of Medicine

Introduction: Systemic lupus erythematosus (SLE) is a disabling, chronic, multisystem autoimmune disease that occurs in women of childbearing years (15-40) and spans a lifetime. Little is known about the relevance that social support has in the context of mental health wellbeing for patients with SLE. Physicians may be an adequate source of support when it comes to SLE. Since there are arrays of triggers for depression, there is a need to understand the SLE experience to help with disease management. Objective: To examine the association of social support from a physician and the mental health wellbeing of SLE patients. Methods: We examined 652 SLE patients from the Georgians Organized Against Lupus (GOAL) cohort. Descriptive analysis was performed. Univariate analysis was performed to examine the associations of the main dependent variables (Short Form Health Survey (SF-12) and Patient Health Questionnaire (PHQ-9)) and each independent variable. Both, univariate and multivariate logistic regression analyses were conducted to determine associations between selected characteristics and main independent variables (emotional or social support and social support from a physician) with the categorized mental component score and PHQ9 depression score, individually and together. Ninety-five percent confidence intervals were used to determine statistical significance. Results: SLE patients who perceived having enough emotional/social support were found to have an overall better mental health status than the average American, and 64% less likely to be depressed compared to patients who did not have enough emotional/social support. Patients who were categorized as having social support from a physician were found to be in poorer mental health statuses, as measured by the MCS SF-12 and PHQ9 depression score. Conclusion: The findings of this study show that emotional or social support is associated with a better mental health well-being for SLE patients. SLE patients who have enough emotional or social support were found to have above normal general mental health and less depression. This study did not show any direct associations between physician social support and mental health wellbeing.

Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xviii, 212 p.; also includes graphics (some col.) Includes bibliographical references (p. 185-212). Available online via OhioLINK's ETD Center

Thesis (Ph. D.)--University of Hong Kong, 1998. / Includes bibliographical references (leaves 137-161).

Thesis (doctoral)--Göteborgs Universitet, 1983. / Extra t.p. with thesis statement inserted. Includes the author's published papers. Includes bibliographical references.

Thesis (doctoral)--Göteborgs Universitet, 1983. / Extra t.p. with thesis statement inserted. Includes the author's published papers. Includes bibliographical references.

Resumo: Considerando-se que pacientes com Lúpus Eritematoso Sistêmico são submetidos a tratamento com corticosteróides e imunossupressores, podemos concluir que esta condição pode interferir na presença de microrganismos potencialmente oportunistas na cavidade bucal. Deste modo, o objetivo deste estudo foi avaliar a presença de leveduras do gênero Candida, estafilococos, enterobactérias e Pseudomonas spp. na cavidade bucal de pacientes com LES comparando os resultados com indivíduos controle. Desta forma, foram selecionados 40 pacientes com idades entre 19 e 53 anos com LES e que estavam em tratamento por no mínimo 60 dias. Para o grupo controle foram selecionados 40 indivíduos sistemicamente saudáveis com perfil semelhante (quanto à idade, gênero e condições bucais) aos pacientes do grupo em estudo. Não foram incluídos pacientes diabéticos, portadores de próteses bucais totais e outras doenças sistêmicas e que estavam sob terapia com medicamentos que pudessem interferir com as condições bucais. Foram realizados anamnese, exame clínico e coleta de enxágüe bucal de cada paciente. A amostra de enxágüe bucal foi semeada em meios de cultura específicos para cada microrganismo e após período de incubação foram realizadas contagens de unidades formadoras de colônia (UFC), obtendo-se o número de UFC/mL. A partir dos isolados obtidos, foram realizadas provas de identificação a fim de caracterizar as espécies dos gêneros em estudo. As contagens de microrganismos foram comparadas entre os grupos LES e controle por ANOVA, Mann Whitney (5%). Contagens de microrganismos em indivíduos sob tratamento com fármacos imunossupressores ou não e atividade positiva... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Considering that patients with systemic erithematous lupus are treated with corticoids and immunossuppresive drugs, this condition may interfere in the presence of potentially opportunistic microorganisms in the oral cavity. The aim of this study was to evaluate the presence of Candida spp. staphylococci, enterobacteria and Pseudomonas spp. in the oral cavity of patients with systemic erithematous lupus (LES) comparing the results with control individuals. Forty patients aged 19-53 years with LES and under therapy for at least 60 days were selected. For the control group, 40 healthy individuals paired to the test group in relation to age, gender and oral conditions were selected. Diabetic and other systemic diseases patients, denture users and individuals under therapy with drugs that affect the oral conditions were not included. Clinical examination, anamnesis and oral rinses sampling were performed. Oral rinse samples were plated on specific culture media and after the period of incubation the number of colony forming units were counted, and the value of cfu/ml was obtained. The isolates were identified in order to obtain the species. The counts of microorganisms were compared between LES and control groups by ANOVA, Mann Whitney (5%). Also, counts of microorganisms in patients under treatment with immunossupressive drugs of not and positive or negative activity of the disease (SLEDAI) were compared. No significant differences in the counts of microorganisms between the studied groups were observed (yeasts, p= 0.55; staphylococci, p=0.24; enterobacteria/Pseudomonas spp., p=0.26). No differences in the counts of microorganisms were observed related to the clinical parameters tested. Higher prevalence of Candida albicans and Staphylococcus epidermidis... (Complete abstract click electronic access below) / Orientador: Cristiane Yumi Koga Ito. / Coorientador: Emília Inoue Sato / Banca: Antonio Olavo Cardoso Jorge / Banca: Silvia Maria Rodrigues Querido / Banca: Célia Regina Gonçalves e Silva / Banca: Adriana Aigotti Haberbeck Brandão / Doutor

Les chimiokines (CK) et leurs récepteurs (RCK) régulent l’homéostasie leucocytaire et sont également des partenaires actifs dans la physiopathologie du syndrome WHIM et du lupus systémique (LS).Le syndrome WHIM est un déficit immuno-hématologique rare qui se caractérise notamment par une profonde lympho-neutropénie périphérique. Ce déficit est expliqué par un gain de fonction du RCK CXCR4, qui entraîne un défaut de désensibilisation du récepteur et une hyper-sensibilité à son ligand CXCL12. Malgré la lymphopénie caractéristique, les patients parviennent à générer une réponse immune humorale mais celle-ci n’est pas maintenue dans le temps. Afin de mieux comprendre la physiopathologie du syndrome WHIM, notre laboratoire a développé le modèle murin Cxcr4+/1013 qui présente une mutation gain de fonction de Cxcr4 similaire à celle observée chez certains patients. La première partie de ma thèse s’est intéressée à l’impact de ce gain de fonction de Cxcr4 sur la réponse immune. L’immunisation des souris Cxcr4+/1013 a permis de montrer que la désensibilisation de Cxcr4 limitait la différenciation des cellules productrices d’anticorps (Ac) appelées plasmocytes (PC). De plus, le gain de fonction de Cxcr4 est associé à une migration aberrante des PC et un défaut de leur maintien au long cours dans la moelle osseuse, pouvant ainsi expliquer la réponse vaccinale défectueuse observée chez les patients.La seconde partie de ma thèse a été consacrée à la caractérisation du profil migratoire des PC dans le LS. Le LS est une maladie auto-immune systémique, qui évolue par poussées et rémissions, et qui affecte plusieurs organes (peau, rein, système nerveux central…). L’initiation et l’exacerbation du LS sont médiées par les auto-Ac sécrétés par les PC autoréactifs. A ce jour, de par l’absence d’identification de marqueur spécifique de cette population, aucune thérapie ne parvient à cibler spécifiquement ces cellules. Une stratégie alternative consiste en la dérégulation de la domiciliation des PC autoréactifs dans les tissus enflammés, à l’origine même des dommages tissulaires. Ce projet s’est intéressé à l’identification du code migratoire des PC circulants de patients lupiques. J’ai cherché à savoir si les PC circulants de patients lupiques présentaient un profil d’expression de RCK distinct de ceux d’individus sains, pouvant ainsi expliquer le recrutement aberrant de ces cellules dans les tissus enflammés. Ces études ont été effectuées chez des patients en phases de poussée et de rémission mais également dans le modèle murin lupique NZB/W F1. Ces travaux suggèrent que les patients peuvent être stratifiés selon les RCK exprimés par les PC circulants. / The chemokines (CK) and their receptors (CKR) are essential for leukocyte homeostasis. They are also involved in the pathophysiology of several diseases including the WHIM syndrome and systemic lupus erythematosus (SLE).The WHIM syndrome is a rare immunodeficiency characterised by a severe peripheral lympho-neutropenia. It is caused by a gain-of-function of the CKR CXCR4, leading to a defect in desensitization of this receptor and a hyper-responsiveness to its ligand CXCL12. To better understand the pathophysiology of the WHIM syndrome, our laboratory developed the mouse model Cxcr4+/1013 harboring a natural mutation observed in some patients. Despite the lymphopenia, WHIM patients can mount a potent humoral immune response but that is not sustained over time. The maintenance of long-term antibody (Ab) titers is guaranteed by plasma cells (PCs) in the bone marrow (BM). The first part of my thesis was thus dedicated to the analysis of the role of a gain-of-function of Cxcr4 on PC differentiation and migration. The analysis of humoral response of Cxcr4+/1013 mice revealed a defect in the persistence of specific antibody titres in the absence of Cxcr4 desensitization. Furthermore, this was associated with an abnormal accumulation of a population of immature PCs in the BM.The second part of my work aimed to characterize the migratory potential of circulating PCs from SLE patients. SLE is a systemic autoimmune disease which can affect several organs like the skin, the kidneys or the central nervous system. SLE evolves in flare and remission phases and auto-Ab secreted by autoreactive PCs contribute to its pathophysiology and severity. Today, no specific treatment against autoreactive PCs exist. Targeting their migratory capacity to the inflamed tissues could be an alternative strategy. The objective of this project was to identify the migratory potential of SLE PCs. These studies were processed on samples from SLE patients during flare or remission, and on the lupus mouse model, the NZB/W F1 mice. We observed that the expression of different combinations of surface CKR may stratify several groups of SLE patients.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20270号 / 医博第4229号 / 新制||医||1021(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 山田 亮, 教授 福原 俊一, 教授 小川 修 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM