bluuebunny/crossref_metadata_2025 huggingface dataset:
Interleukin‐1 receptor antagonist in patients with active systemic lupus erythematosus: enhanced production by monocytes and correlation with disease activity
Authors: Suzuki Hiroshi , Takemura Hiroyuki , Kashiwagi Heihachiro
Published: February 2007

Objective. To evaluate the relationship between the serum concentration of interleukin‐1 receptor antagonist (IL‐1Ra) and systemic lupus erythematosus (SLE) disease activity, and to investigate the expression of IL‐1Ra messenger RNA (mRNA) and its production by monocytes from patients with SLE.

Methods. Serum IL‐1Ra was measured by enzyme‐linked immunosorbent assay, and expression of IL‐1Ra mRNA was determined by Northern blotting.

Results. Serum IL‐1Ra concentrations were significantly higher in patients with active SLE compared with normal subjects and patients with other rheumatic diseases, and showed a strong correlation with SLE disease activity. IL‐1Ra mRNA expression in freshly isolated monocytes from patients with active SLE was considerably higher than that in normal monocytes. Moreover, monocytes from patients with active SLE produced increased amounts of IL‐1Ra in response to adherent IgG, compared with monocytes from normal subjects.

Conclusion. A high serum concentration of IL‐1Ra is a pathophysiologic feature of active SLE and a good indicator of disease activity. Functional changes of monocytes, such as increased secretion of IL‐1Ra in response to adherent IgG and enhanced expression of IL‐1Ra mRNA in freshly isolated cells, may be involved in the enhanced IL‐1Ra production in active SLE. High concentrations of IL‐1Ra in the circulation and possibly in peripheral lymphoid tissues may influence immunologic and inflammatory features of SLE.
Effects of cyclophosphamide on the development of malignancy and on long‐term survival of patients with rheumatoid arthritis a 20‐year followup study
Authors: Radis Charles D. , Kahl Leslie E. , Baker Gary L. , Wasko Mary Chester Morgan , Cash Joseph M. , Gallatin Aileen , Stolzer Bertrand L. , Agarwal Amrit K. , Medsger Thomas A. , Kwoh C. Kent
Published: February 2007

Objective. To examine the effects of cyclophosphamide (CYC) on the development of malignancies and on the long‐term survival of patients with rheumatoid arthritis (RA).

Methods. We used a longitudinal cohort design in which 119 patients (76 women and 43 men) with refractory RA who were treated with oral CYC between 1968 and 1973 were compared with 119 control patients with RA (matched for age, sex, disease duration, and functional class) who were evaluated during the same time period but did not receive CYC.

Results. There was increased risk of malignancy in the CYC‐treated group, with 50 cancers found in 37 patients in the CYC group compared with 26 cancers in 25 of the control patients (P < 0.05). The relative risk of cancer for those treated with CYC was 1.5 (95% confidence interval 0.93–5.5). Nine of the malignancies in the CYC group were bladder cancers and 19 were skin cancers, compared with no bladder cancers and 6 skin cancers in the control group. The total dose of CYC was higher in those who developed cancer, particularly in those with bladder cancer. Three of the bladder cancers occurred 14, 16, and 17 years after CYC had been discontinued.

Conclusion. The risk of malignancy, particularly bladder cancer, in RA patients treated with oral CYC continues even 17 years after discontinuation of the drug.
Treatment of active refractory rheumatoid arthritis with humanized monoclonal antibody campath‐1h administered by daily subcutaneous injection
Authors: Matteson Eric L. , Yocum David E. , St. Clair E. William , Achkar Antonio A. , Thakor Michael S. , Jacobs Mary R. , Hays Anita E. , Heitman Catherine K. , Johnston Jeffrey M.
Published: February 2007

Objective. To investigate the dose tolerance and potential clinical activity of a humanized antilymphocyte monoclonal antibody, CAMPATH‐1H (C1H), in patients with active, refractory rheumatoid arthritis (RA).

Methods. Thirty adult patients with active, refractory RA were treated in an open‐label, 3‐center, dose‐escalation study of subcutaneously injected C1H. Six patients were assigned to each of 5 dosage groups (0.3, 1.0, 3.0, 10.0 or 30.0 mg/day), and received 10 daily injections of C1H over a 12‐day period.

Results. Side effects occurred primarily during the first 1–2 days of dosing, and included mild fever, chills, nausea, vomiting, headache, and, in a minority of patients, hypotension. All patients developed some discomfort at the injection site. Self‐limited infections occurred in 5 patients during the 6‐month study period. Peripheral blood lymphocyte counts fell promptly after initial dosing and recovered slowly, usually over 2–3 months. Serum antibodies to C1H developed in 54% of patients following treatment. Clinical improvement was observed in 56% of patients, based on the composite Paulus criteria, with a median time‐to‐response of 22 days and a median response duration of 32 days.

Conclusion. C1H is a lymphocyte‐depleting antibody that exhibits biologic potency when administered subcutaneously to patients with refractory RA. Its use is associated with mild to moderate toxicity and short‐term amelioration of disease activity.
Light and electron microscopic analysis of sequential liver biopsy samples from rheumatoid arthritis patients receiving long‐term methotrexate therapy followup over long treatment intervals and correlation with clinical and laboratory variables
Authors: Kremer Joel M. , Kaye Gordon I. , Kaye Nancy W. , Ishak Kamal G. , Axiotis Constantine A.
Published: February 2007

Objective. To describe liver histopathologic features and ultrastructural changes in a prospectively studied cohort of rheumatoid arthritis (RA) patients receiving long‐term methotrexate (MTX) therapy, and to seek correlations between these changes and simultaneously measured laboratory indices of liver function.

Methods. This was a long‐term, prospective, open observational study. Twenty‐seven outpatients with RA who began therapy with MTX and continued treatment for extended periods underwent baseline and followup liver biopsies. One hundred seventy liver biopsy specimens were analyzed by light microscopy (LM) and assessed according to a modified Roenigk score and a newly devised numerical grading system. Ninety‐three biopsy specimens were also analyzed by electron microscopy (EM). Blood samples were obtained at 4–6‐week intervals for determination of bilirubin, alkaline phosphatase, aspartate aminotransferase (AST), and albumin levels, and the weekly dosage of MTX was adjusted if there were abnormalities in the AST or albumin level. A mean of 6.3 liver biopsies per patient were obtained over a mean followup period of 8.2 years (range 2–13 years).

Results. The modified Roenigk score was significantly different from baseline at year 3, when it increased from a mean of 1.8 to 2.3 (P = 0.05) and at year 6, when it increased to 2.4 (P = 0.04), but this was not considered clinically meaningful. No other significant changes from baseline were observed by either LM grading system. No significant progression was observed by EM over the course of the investigation. Increases in serial measurements of AST correlated with both the modified Roenigk score (r = 0.21, P = 0.016) and the numerical rating score (r = 0.19, P = 0.027).

Conclusion. Patients with RA who are receiving weekly single‐dose oral MTX therapy exhibit little deterioration in hepatic architecture by LM or EM when the dosage of the drug is adjusted for abnormalities in AST and serum albumin, monitored at frequent intervals.
Incidence of systemic lupus erythematosus race and gender differences
Authors: Mccarty Daniel J. , Manzi Susan , Medsger Thomas A. , Ramsey‐Goldman Rosalind , Laporte Ronald E. , Kwoh C. Kent
Published: February 2007

Objective. To examine racial differences in the incidence of systemic lupus erythematosus (SLE).

Methods. A population‐based registry of SLE patients in Allegheny County, Pennsylvania, was used to identify incident cases of SLE diagnosed between January 1, 1985 and December 31, 1990, from 3 sources, by medical record review (University of Pittsburgh Lupus Databank, rheumatologists, and hospitals). Capture‐recapture methods using log‐linear models were used to estimate the level of case‐finding and to calculate 95% confidence intervals (CI). Incidence rates were calculated per 100,000 population.

Results. A total of 191 definite and 78 probable incident cases of SLE were identified, and the overall annual incidence rates were 2.4 (95% CI 2.1–2.8) and 1.0 (95% CI 0.8–1.3), respectively. The crude incidence rates of definite SLE were 0.4 for white males, 3.5 for white females, 0.7 for African‐American males, and 9.2 for African‐American females. The annual incidence rates of definite SLE remained fairly constant over the study interval. African‐American females with definite SLE had a younger mean age at diagnosis compared with white females (P < 0.05). Since the overall ascertainment rate was high (85%; 95% CI 78–92%), the ascertainment‐corrected incidence rate for definite SLE, 2.8 (95% CI 2.6–3.2), was similar to the crude rate.

Conclusion. Our rates clearly confirm previous reports of an excess incidence of SLE among females compared with males and among African‐Americans compared with whites. We have used capture–recapture methods to improve the accuracy of SLE incidence rates, and we advocate their use to facilitate comparisons across studies.
Characterization of the binding region for the yersinia enterocolitica adhesin yada on types i and ii collagen
Authors: Schulze‐Koops Hendrik , Burkhardt Harald , Heesemann JÜRgen , Mark Klaus Von Der , Emmrich Frank
Published: February 2007

Objective. The plasmid‐encoded adhesin YadA confers pathogenic functions on Yersinia enterocolitica, a microorganism associated with reactive arthritis. While emerging evidence has indicated that the persistence of the bacteria in individuals with reactive arthritis is a prerequisite for the development of the disease, the tissue specificity of this immunologic disease sequela remains elusive. The present study was undertaken to investigate YadA‐mediated binding of Y enterocolitica to the most abundant collagens in joints, types I and II collagen.

Methods. Binding studies were performed with recombinant Y enterocolitica strains and highly purified type II collagen and the α1(I) chain of type I collagen, or fragments of these collagens generated by various enzymatic and nonenzymatic cleavage procedures. Interactions of bacteria with the proteins were determined in binding assays with radiolabeled proteins.

Results. Binding regions for YadA were identified at the 181–amino acid fragment α1(I)78CBN of type I collagen and the CB10 fragment of type II collagen. From binding and blocking experiments with α1(I) fragments, cyanogen bromide–derived or mammalian collagenase–derived type II collagen fragments, and synthetic peptides with collagen‐like structures, it was concluded that the binding site for YadA on collagen is determined by a restricted amino acid sequence and is defined within a highly homologous 134–amino acid region. Furthermore, the binding site is not affected by mammalian collagenase digest. Binding of YadA‐positive yersiniae to collagen could be inhibited by an antiserum specific for YadA.

Conclusion. This study provides the first evidence of a binding site for bacterial proteins on collagens which is not determined by the repetitive sequence Gly‐X‐Y of collagens. We speculate that the binding region is conserved between types I and II collagen, the most abundant collagens in the joints. Specific binding of Yersinia products to joint collagens might contribute to the arthritogenic potential of enteropathogenic yersiniae.
Progressive joint destruction in a human immunodeficiency virus‐infected patient with rheumatoid arthritis
Authors: Müller‐Ladner ULF , Kriegsmann JÖRg , Gay Renate E. , Koopman William J. , Gay Steffen , Chatham W. Winn
Published: February 2007

This article reports the case of a 63‐year‐old patient with rheumatoid arthritis (RA) whose symptoms of RA improved after the occurrence of a secondary human immunodeficiency virus (HIV) infection; however, the HIV infection did not affect the histologic parameters of joint destruction to the same extent as it did the clinical symptoms. Histologic and immunohistologic joint examinations of this patient revealed an ongoing production of cartilage‐ and bone‐degrading enzymes by macrophages and fibroblasts, without the presence of T cells. These findings demonstrate that progressive joint destruction in RA can occur in the absence of T cells. Moreover, our results support the hypothesis that both T cell‐dependent and T cell‐independent pathways play a significant role in the pathogenesis of RA.
Peripheral neuropathy with necrotizing vasculitis in rheumatoid arthritis
Authors: Puéchal Xavier , Said Gerard , Hilliquin Pascal , Coste Joel , Job‐Deslandre Chantal , Lacroix Catherine , Menkès Charles J.
Published: February 2007

Objective.To examine the clinicopathologic features of the noncompressive neuropathies in rheumatoid arthritis (RA).

Methods.We studied 32 patients with RA and peripheral neuropathy whose nerve and/or muscle biopsy specimens exhibited necrotizing vasculitis. Morphologic analysis of nerve specimens included light and electron microscopy studies and teased fiber preparation. Survival was evaluated, and the prognostic values of clinical, biologic, and pathologic features were assessed by Cox proportional hazards model. A prognostic assessment based on the significant variables was devised to estimate the probability of survival of any individual patient.

Results.Epi and/or perineurial vasculitis was observed with the same frequency in the 17 patients with sensory and motor deficit and the 15 patients with sensory neuropathies and was associated with axonal degeneration of an average of 77.7% of the nerve fibers. The mean followup was 7.2 years, and the overall survival rate at 5 years was 57%. A full prolonged remission of the vasculitis was observed in 53% of the patientsrelapse occurred in 25%. The factors correlated with mortality, in decreasing order of significance, were clinical cutaneous vasculitis (P= 0.0003), neuropathy affecting 3 or 4 limbs (P= 0.03), and depressed level of C4 (P< 0.05). The prognostic assessment indicated a wide range of 5‐year probabilities of survival, from <1% to 93%.

Conclusion.Necrotizing vasculitis is responsible for the different patterns of noncompressive neuropathies in RA, including mononeuritis multiplex and distal symmetric sensory or sensorimotor neuropathy. Cutaneous vasculitis, multifocal neuropathy, and depressed C4 level were the 3 independent variables which best predicted mortality. We propose a prognostic assessment according to these variables, to stratify patients to receive more aggressive or less aggressive therapy.
Selection of a gene for apolipoprotein a1 using autoantibodies from a patient with systemic lupus erythematosus
Authors: Merrill Joan T. , Rivkin Eugene , Shen Christine , Lahita Robert G.
Published: February 2007

Objective. To investigate immunoreactivity of systemic lupus erythematosus (SLE) sera with apolipoprotein A1, (Apo A1), the major lipid‐binding protein of high‐density lipoprotein (HDL).

Methods. Since early attempts to identify Apo A1 autoantibodies using standard enzyme‐linked immunosorbent assay (ELISA) and immunoblotting techniques had been unsuccessful, a mouse complementary DNA lambda phage expression library was screened.

Results. A selected clone (MA1) was found to have 82% DNA sequence homology to a segment of human Apo A1. Since there were nonconservative substitutions in the MA1 protein and lack of a complete sequence, it was possible that the SLE patient'S antibodies were binding MA1 epitopes that were shared by the complete human protein but had not been conformationally accessible using the earlier techniques. Thus, gamma‐irradiated ELISA plates were used as an alternative antigen‐binding surface for intact human Apo A1, and high‐titer anti‐human Apo A1 autoantibodies were then identified in the sera of 5 more SLE patients.

Conclusion. These findings show that Apo A1 is immunogenic. Apo A1 antibodies may play a role in the decreased HDL levels and Apo A1:Apo B ratios previously reported to occur in subgroups of SLE patients.
Carpal tunnel syndrome due to t cell lymphoma
Authors: Chevalier Xavier , Hermine Olivier , Authier Francois‐Jerome , Gaulard Philippe , Gherardi Romain K.
Published: February 2007

In 2 patients, carpal tunnel syndrome was one of the presenting manifestations of a noncutaneous T cell lymphoma. Infiltration of the carpal tunnel by neoplastic T cells was proven by biopsy in both patients. In 1 case, the carpal tunnel syndrome was associated with eosinophilic fasciitis. These observations emphasize the importance of histologic examination of annular ligaments removed during surgical decompression procedures.
Regression of the nephrotic syndrome in rheumatoid arthritis and amyloidosis treated with azathioprine
Authors: Shapiro Deborah L. , Spiera Harry
Published: February 2007

Secondary or reactive (AA) amyloidosis is a well‐known complication of certain rheumatic diseases, particularly rheumatoid arthritis (RA). This case report describes a patient with RA complicated by amyloidosis and the nephrotic syndrome, which regressed after treatment with azathioprine. The AA amyloidosis was documented by renal and lymph node biopsies and by the presence of proteinuria. Evaluation for other etiologies of proteinuria was negative. After treatment with azathioprine, the proteinuria resolved and the serum albumin level increased from 1.9 mg/dl to normal. This is the first published report of azathioprine therapy resulting in a reversal of the nephrotic syndrome in a patient with RA and secondary amyloidosis.
Effect of the arthritis health professional on compliance with use of resting hand splints by patients with rheumatoid arthritis
Authors: Feinberg Judy
Published: February 2007

This study examined the effects of an occupational therapist's approach during the initial splinting session on the subsequent use of resting hand splints by patients with rheumatoid arthritis. Forty subjects were randomly assigned either to a standard treatment (control) group or to a compliance‐enhancement (experimental) group, for whom the use of learning principles, sharing of expectations, use of a positive affective tone and behaviors by the therapist, and the assumption of responsibility by the patient were eMPHasized. During the 28‐day period after splinting, patients in the experimental and control groups wore their splints an average of 23.3 and 18.1 days, respectively (p = 0.056). Nine subjects in the experimental group, but only four in the control group used their splints every day (p = 0.035). Knowledge of splint use correlated with actual use, regardless of the group assignment (p = 0.035). Change in the amount of wrist and hand pain was not significant in either group; however, the experimental group experienced a decrease in the duration of morning stiffness (p = 0.013). This intervention provides health professionals with a pragmatic and effective method to enhance compliance.
Activity‐induced pain in rheumatoid arthritis functional class II and its relations with demographic, medical, functional, psychosocial, and work variables. Result of a survey in bollnäs medical district, Sweden, II
Authors: Stenström Christina H. , Lindell Bengt , Swanberg Peter , Nordemar Rolf , Harms‐Ringdahl Karin
Published: February 2007

One aim of this study was to describe inflammatory activity, joint destruction, work status, and demographic factors in a group of 69 American Rheumatism Association functional class‐II rheumatoid arthritis patients: 56 women and 13 men, mean age 54 years (SD 11), mean symptom duration 14 years (SD 11). Another aim was to determine correlations between activity‐induced pain and other variables. Patients were assessed with Ritchie's articular index, Larsen's radiologic index, and laboratory tests. Deformity in hands and knee joints, and grip strength, were determined. Results from earlier investigations of functional impairment and psychosocial capacity were also used. Of the patients, 4% had high inflammatory activity. Joint erosions were found in between 4% (knee joints) and 55% (wrists) of the joints examined. Of the patients aged <65, 43% were working. Activity‐induced pain was related with work status (p = 0.0002). It also correlated significantly (p ⩽ 0.01) with inflammatory activity (rs = 0.34), but not with joint destruction (rs = 0.21).
Comparison and sensitivity to change of self‐report scales to assess difficulty, dissatisfaction, and pain in performing activities of daily living over one and five years in rheumatoid arthritis
Authors: Callahan Leigh F. , McCoy Annette , Smith Wendy
Published: February 2007

We analyzed the longitudinal sensitivity to change of three self‐report activities of daily living (ADL) scales over 1 and 5 years in 982 patients with rheumatoid arthritis (RA) from 15 private practices. Over 1 year, the ADL difficulty status worsened in 28.3% of the patients, remained the same in 50.2%, and improved in 21.5%. Over 5 years, 41.3% worsened, 38.8% stayed the same, and 19.9% were improved. Similar percentages for 1‐ and 5‐year changes were found for the ADL dissatisfaction and pain scales. The effect sizes for change over 1 and 5 years for the ADL difficulty, dissatisfaction, and pain scales were −0.05, 0.01, and −0.02, and −0.28, −0.20, and −0.14, respectively, indicating small to moderate declines. These data indicate that the three ADL scales are sensitive to change in status, and ADL change status scores after 1 and 5 years were significantly correlated with each other (r = 0.49–0.68, all p < 0.001). Monitoring of these three constructs may be helpful in the longitudinal evaluation of some patients with RA.
Randomized, controlled trial of compression gloves in rheumatoid arthritis
Authors: McKnight Peggy T. , Kwoh C. Kent
Published: February 2007

A randomized, controlled trial was conducted to determine efficacy of the Isotoner and the Futuro compression gloves in 39 patients with hand syn‐ovitis secondary to rheumatoid arthritis. After 7 days of nighttime treatment, both brands of gloves were found to decrease subjective symptoms of pain and stiffness (p < 0.05). In addition, swelling of the proximal interphalangeal joints decreased, while range of motion, rate of finger motion, and grip strength all increased (p < 0.05). Compression gloves should be used with caution in patients with bilateral carpal tunnel syndrome, because 12 of 13 such patients experienced worsening of their symptoms following one nighttime wearing of compression gloves. While both gloves were found to be efficacious in improving the signs and symptoms of hand synovitis, neither glove was found to be superior to the other. Patient preferences related to glove composition and fit may ultimately determine which glove to prescribe.
Comparison of selected health behavior variables in elderly women with osteoarthritis in different environments
Authors: Lee Helen Jacobsen
Published: February 2007

Hardiness, social support, perceived health, functional independence, and use of healthcare facilities were compared in this descriptive study of 45 elderly women with osteoarthritis living in three different environments‐urban, rural, and frontier. All participants were between the ages of 65 and 75 years and were residing in their own homes. Statistical differences were found between groups in overall perceived health and functional independence; the frontier sample perceived their health as better and themselves as more functionally independent than the urban or the rural sample. No statistical differences were found in levels of hardiness or perceived social support between the three groups. Use of health care facilities varied among participant groups by environmental context; the urban group made more use of facilities than the rural or frontier group, and the rural group used more facilities than the frontier group.
The effect of isometric quadriceps strength training in mid‐range for osteoarthritis of the knee
Authors: Marks Ray
Published: February 2007

This case report describes the effect of strengthening the quadriceps of an effused osteoarthritic knee joint of a 53‐year‐old man isometrically in mid‐range. The instruments included an isokinetic dynamometer, a knee scoring inventory, and a visual analog scale. The outcomemeasures of isometric quadriceps torque and work, clinical status, and pain were recorded before andafter the exercise intervention. The exercises were carried out three times per week for a 6‐week period with the subject seated on an exercise chair. Following training, quadriceps torque increased, clinical status improved, and pain with walking decreased. Subject to further investigation, isometric training of the quadriceps in mid‐range could prove useful for improving the function of persons with painful or effused knees who might otherwise experience muscle inhibition by exercising in the more traditional inner ranges of knee extension.
Pain measurement in arthritis
Authors: Bradley Laurence A
Published: February 2007

Objective. This paper reviews the major pain measurement methods used with adult patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia.

Methods and Results. The most frequently used measures are numerical and verbal rating (category) scales of pain intensity and affect. However, visual analogue scales and composite measures are preferable to category scales because they may be subjected to parametric statistical analyses and may be associated with greater sensitivity to treatment‐related changes over time. Measurement of overt motor behaviors and pain threshold levels provides important information that cannot be assessed with rating scales. It also allows one to determine whether there are discrepancies between patients' ratings of their pain experiences and their behaviors. Measurement ofpsychophysio‐logic parameters are used to understand better how markers of immune system activity may mediate the relationships between psychological and environmental factors and patients' pain experiences.

Conclusions. It is necessary to use multiple pain measurement methods for clinical and research purposes. These should include at least two measures of pain intensity and affect as well as a measure of pain behavior.
Social support, social disability, and psychological well‐being in rheumatoid arthritis
Authors: Doeglas Dirk , Suurmeijer Theo , Krol Boudien , Sanderman Robbert , van Rijswijk Martin , van Leeuwen Miek
Published: February 2007

Purpose. Rheumatoid arthritis (RA) is a disease that may lead to social disability. As a consequence, the psychological well‐being of RA patients can be strained. Social support is a possible moderator of the relation between social disability and psychological well‐being. The focus of the present study is on the main effect versus the buffering effect of social support.

Methods. Data on 54 RA patients were gathered by means of a 2‐hr interview at the patient's home.

Results. Receiving more daily emotional support positively related to greater psychological well‐being; whereas problem‐oriented emotional support negatively related to some aspects of psychological well‐being. People receiving more social companionship turned out to be less depressed.

Conclusion. The assumption was confirmed that social support has a major effect on psychological well‐being. A buffering effect of social support was not demonstrated.
Social network characteristics in fibromyalgia or rheumatcid arthritis
Authors: Bolwijn Paulien H. , van Santen‐Hoeufft Marijke H. S. , Baars Herman M. J. , van der Linden Sjef
Published: February 2007

Purpose. To describe trends in the personal social network characteristics of the fibromyalgia patients compared with the network of patients with another chronic disorder such as rheumatoid arthritis (RA).

Methods. A structured interview was applied to 10 fibromyalgia patients and 10 matched RA patients.

Results. The networks of the 10 fibromyalgia and 10 RA patients were comparable in most respects, namely: the small number of intimate friends, the reliance for support on the spouse and the physician, and the relative lack of new social contacts. Furthermore, the fibromyalgia networks were closed networks within a small geographic area. These networks lacked initiative to establish and maintain relations, and can hardly fulfill the patients' psychosocial needs.

Conclusion. Based on small numbers, the study provides some evidence that social networks of patients with fibromyalgia are more restricted than those of RA patients. Further studies should include larger numbers of patients to clarify cause and effect relationships and to suggest new directions in the treatment of chronic disorders such as fibromyalgia.
Continuation of group physical therapy is necessary in ankylosing spondylitis results of a randomized controlled trial
Authors: Hidding Alita , van der Linden Sjef , Gielen Xandra , de Witte Luc , Dijkmans Ben , Moolenburgh Daniël
Published: February 2007

Purpose. Group physical therapy in patients with ankylosing spondylitis was studied to determine whether beneficial effects persisted after cessation of the intervention.

Methods. After a 9‐month period of supervised group physical therapy, 68 patients were randomized for another 9 months to unsupervised daily exercises at home (discontinuation group) or continuation of weekly sessions of supervised group physical therapy (continuation group). Endpoints were spinal mobility (thoracolumbar flexion and extension, chest expansion, cervical rotation), fitness (maximum work capacity), functioning (Sickness Impact Profile (SIP), Health Assessment Questionnaire for the Spondylarthropathies (HAQ‐Sl, Functional Index [FI]), and patient's global health assessment on a visual analogue scale.

Results. Time for exercises at home was significantly higher in the continuation than in the discontinuation group (mean duration 1.9 versus 1.2 hr per week, P < 0.05). The continuation group improved in global health (mean improvement 1.6; 32%) and in SIP score. Scores for thoraco‐lumbar mobility and HAQ‐S did not change very much, whereas chest expansion, cervical rotation, fitness, and FI deteriorated. The average attendance for group therapy sessions was 62%. The discontinuation group improved only marginally (0.2; 4%) in global health, whereas all other endpoints decreased. Only for global health and HAQ‐S were the differences statistically significant in favor of the continuation group.

Conclusions. Global health and functioning are sustained or even improved further if group physical therapy is continued. Spinal mobility decreased slightly in both groups.
Therapeutic exercise in rheumatoid arthritis
Authors: Stenström Christina H.
Published: February 2007

Although about 80% of individuals with rheumatoid arthritis (RA) are functionally independent on any given occasion [1], substantial functional disability is often observed over time in the average patient [2]. One important goal in rehabilitation of individuals with RA is the prevention of functional decline, and therapeutic exercise is frequently used for this purpose. The target population for therapeutic exercise consists mainly of functionally independent persons with RA [3]. For these individuals, aerobic exercise seems superior to nonaerobic methods of exercise [4]. Likewise, dynamic exercise, requiring muscle work during joint motion, appears to be superior to static or isometric exercises [5].
Physician visits by rheumatoid arthritis patients: A prospective analysis
Authors: Berkanovic Emil , Hurwicz Margo‐Lea
Published: February 2007

Obejective. To examine prospectively, using the behavioral model of health service utilization, patient‐initiated physician visits, physician‐requested visits, and visits for disease flares by 270 patients with rheumatoid arthritis (RA).

Methods. Four waves of telephone interviews were conducted over 2 years. Hierarchical regression analyses were used to assess the relative contributions to variance explained by blocks of variables indicating need for care and predisposing and enabling factors.

Results. Predisposing and enabling factors accounted for 50–67% of the explained variance in the 3 types of visits, while need accounted only for 33–50%.

Conclusions. Studies seeking to identify factors other than need for care that facilitate or inhibit physician visits among RA patients are essential to analyzing the costs of care.
The impact of arthritis in rural populations
Authors: Jordan Joanne M. , Linder G. Fletcher , Renner Jordan B. , Fryer John G.
Published: February 2007

Objective. Rural residents may experience more arthritis and disability than urban dwellers. This paper reviews data on arthritis in rural areas and describes a new study, the Johnston County Osteoarthritis Project, a population‐based study of osteoarthritis (OA) of the knee and hip in rural North Carolina.

Methods. Published reports of urban and rural comparisons of arthritis were reviewed. Data from the first 1,432 African‐American and Caucasian participants in the Johnston County Osteoarthritis Project were analyzed. Radiographic knee and hip OA were defined as a Kellgren‐Lawrence grade ≥2. Functional ability was assessed by the Health Assessment Questionnaire, timed chair stands, and 8‐foot walk time. Unweighted prevalences of knee and hip OA were calculated for age, sex, and racial groups. Associations between hip and knee OA, and hip and knee pain and functional ability were examined.

Results Hip OA was present in 27.9% and knee OA in 38.4% of participants. Both were strongly related to age (P < 0.0001), but only knee OA to female sex (odds ratio = 1.33, 95% confidence interval 1.05, 1.68). Neither hip OA nor knee OA was related to race. Hip OA, hip pain, knee OA, and knee pain was each associated with self‐reported and observed functional ability.

Conclusion. Residents in rural areas may experience more arthritis and disability than previously expected. Contrary to other studies, African‐American and Caucasian residents of rural Johnston County, North Carolina, have similar high rates of knee and hip OA. Further study is needed to address urban/rural differences in arthritis and its impact, with adequate control of confounders, standard definitions of rural/urban and of disease, and assessment of multiple arthritis outcomes.
The implications of depression for pain and disability in rheumatoid arthritis
Authors: Parker Jerry C. , Wright Gail E.
Published: February 2007

Depression in rheumatoid arthritis (RA) affects many, but by no means all, persons with the disease. There is evidence that depression bears a significant relationship to pain in RA, although the causal direction is not entirely clear. Likewise, there is strong evidence that depression is a major contributor to the RA disability. Therefore, prevention, early diagnosis, and aggressive treatment of depression are needed to minimize the disability associated with RA.
Multinuclear Silver Ethynide Supramolecular Synthons for the Construction of Coordination Networks
Authors: Mak Thomas C. W. , Zhao Liang
Published: February 2007

The invariant appearance of the μ8 coordination mode for the C42− dianion in its silver(I) complexes, with four silver(I) atoms attached to each terminal ethynide moiety, implies that the Ag4⊂CCCC⊃Ag4 species may be considered as a new type of supramolecular synthon for the construction of 1D, 2D, and 3D coordination polymers. This Focus Review covers recent results on the synthesis and structural characterization of silver(I) arylethynide and alkylethynide complexes, which established the existence and utility of analogous polynuclear supramolecular synthons RCC⊃Agn (R=aryl or alkyl; n=4, 5) and Agn⊂C2RC2⊃Agn (R=p‐, m‐, o‐C6H4; n=4, 5). The interplay of silver–ethynide bonding, which can be classified into σ, π, and mixed (σ,π) types, with argentophilicity, π–π stacking, and other weak interactions highlights the complexity and challenge in building coordination networks of silver ethynide complexes.
Crosslinking of casein by microbial transglutaminase and its resulting influence on the stability of micelle structure
Authors: Partschefeld Claudia , Schwarzenbolz Uwe , Richter Sven , Henle Thomas
Published: February 2007

The influence of enzymatic crosslinking by microbial transglutaminase (mTG) on the stability of casein micelles of ultrahigh temperature (UHT)‐treated milk in the presence of EDTA (0–0.45 mM) or ethanol (0–74 vol%) as well as under high hydrostatic pressures up to 400 MPa was investigated. Disintegration of micelles and changes in micelle size were monitored by the measurement of turbidity as well as by dynamic light scattering. The results show that the incubation of UHTtreated milk with mTG resulted in an improved micelle stability toward disintegration on addition of EDTA, ethanol, or pressure treatment. Intramicellar formed isopetides significantly enhanced the stability of casein micelles. It is supposed that net‐like crosslinks are formed within the external region of the micelles and they adopt the stabilizing role of colloidal calcium phosphate within the micelles, thus making the micelles less contestable for disrupting influences.
Enhancement of cell growth in tissue‐engineering constructs under direct perfusion: Modeling and simulation
Authors: Chung C.A. , Chen C.W. , Chen C.P. , Tseng C.S.
Published: February 2007

Perfusion bioreactors improve mass transfer in cell‐scaffold constructs. We developed a mathematical model to simulate nutrient flow through cellular constructs. Interactions among cell proliferation, nutrient consumption, and culture medium circulation were investigated. The model incorporated modified Contois cell‐growth kinetics that includes effects of nutrient saturation and limited cell growth. Nutrient uptake was depicted through the Michaelis–Menton kinetics. To describe the culture medium convection, the fluid flow outside the cell‐scaffold construct was described by the Navier–Stokes equations, while the fluid dynamics within the construct was modeled by Brinkman's equation for porous media flow. Effects of the media perfusion were examined by including time‐dependant porosity and permeability changes due to cell growth. The overall cell volume was considered to consist of cells and extracellular matrices (ECM) as a whole without treating ECM separately. Numerical simulations show when cells were cultured subjected to direct perfusion, they penetrated to a greater extent into the scaffold and resulted in a more uniform spatial distribution. The cell amount was increased by perfusion and ultimately approached an asymptotic value as the perfusion rates increased in terms of the dimensionless Peclet number that accounts for the ratio of nutrient perfusion to diffusion. In addition to enhancing the nutrient delivery, perfusion simultaneously imposes flow‐mediated shear stress to the engineered cells. Shear stresses were found to increase with cell growth as the scaffold void space was occupied by the cell and ECM volumes. The macro average stresses increased from 0.2 mPa to 1 mPa at a perfusion rate of 20 µm/s with the overall cell volume fraction growing from 0.4 to 0.7, which made the overall permeability value decrease from 1.35 × 10−2cm2 to 5.51 × 10−4cm2. Relating the simulation results with perfusion experiments in literature, the average shear stresses were below the critical value that would induce the chondrocyte necrosis. Biotechnol. Bioeng. 2007; 97: 1603–1616. © 2007 Wiley Periodicals, Inc.
Quantitative image analysis as a diagnostic tool for monitoring structural changes of anaerobic granular sludge during detergent shock loads
Authors: Costa J.C. , Abreu A.A. , Ferreira E.C. , Alves M.M.
Published: February 2007

Two shock loads of a commercial detergent (I—150 mg chemical oxygen demand (COD)/L, fed for 56 h; II—300 mg COD/L fed for 222 h) were applied in a lab‐scale Expanded Granular Sludge Blanket (EGSB) reactor, fed with 1,500 mg COD/L of ethanol. The impact of the surfactant was assessed in terms of granular sludge morphology, specific methanogenic activity (SMA) in the presence of individual substrates, and reactor performance. COD removal efficiency remained unaffected in the shock I, but 80 h after starting exposure to the shock II, the COD removal efficiency decreased drastically from 75 to 17%. In the first 8 h of operation of shock I, the SMA was stimulated and decreased afterwards, being recovered 5 days after the end of exposure time. Concerning to shock II, the SMA was immediately and persistently reduced during the exposure time, although, the inhibition of SMA in presence of H2/CO2 showed a trend to increase after the exposure time. Acetoclastic bacteria were observed as the most sensitive to the toxic effects of surfactant whereas the hydrogenotrophic bacteria were less affected. The inhibitory effects were dependent on surfactant concentration and exposure time. The ratio filaments length per total aggregates area (LfA) was an early‐warning indicator of biomass washout, since it increased 3 and 5 days before effluent volatile suspended solids (VSS) rise, respectively, in shocks I and II. Biotechnol. Bioeng. 2007; 98: 60–68. © 2007 Wiley Periodicals, Inc.
Crossed renal ectopia with fusion: Report of two patients
Authors: Boyan Neslihan , Kubat Huseyin , Uzum Ayse
Published: February 2007

Crossed renal ectopia is one of the rarest urinary system anomalies. It is more often seen at autopsy than in clinical practice. Most cases of renal ectopia remain asymptomatic during life and are diagnosed incidentally. Renal ultrasonography, intravenous pyelography, computerized tomography, and renal scintigraphy (technetium‐based tests) are the imaging methods used for diagnosis. Demonstration of crossed renal ectopia is important because it is a predisposing factor for obstruction, infection, and neoplasia of the urinary system. We report two male patients who had unremarkable clinical findings. Both had left‐to‐right inferior crossed renal ectopia with fusion. Additionally, the first patient had a history of surgery for a recurrent inguinal hernia, whereas the second had crossed fused renal ectopia associated with nephroptosis. Surgeons should be aware of ectopic and fused kidneys to minimize perioperative complications because of the uncertain anatomy. Clin. Anat. 20:699–702, 2007. © 2007 Wiley‐Liss, Inc.
Relationship between the Zuckerkandl's tubercle and entrance point of the inferior laryngeal nerve
Authors: Bülent Yalçlın , Ozan Hasan
Published: February 2007

The Zuckerkandl's tubercle (ZT) is a lateral or posterior projection from the lateral thyroid lobe. It has been used as an anatomical landmark for location of the inferior laryngeal nerve (ILN). Because most nerve injuries occurred just below that point where the ILN passed under the inferior constrictor muscle, we aimed to investigate the relationship between the ZT and entrance point (EP) of the ILN. Forty‐five specimens taken from 26 male and 19 female cadavers were dissected. We found Grade 2 and Grade 3 ZTs in 58 sides (64% of 90 sides). The ZT was situated at the middle third of lateral lobe of the thyroid gland in 48 sides (82.7% of 58 sides). This group had three subgroups: (I) the ZTs indicated EPs of the ILN or the anterior laryngeal branch, (II) the ZTs covered the EPs of the ILN or the laryngeal branches or only the anterior laryngeal branch, and (III) the ZTs were below or above the EPs of the laryngeal branches. In conclusion, the ZTs pointed the EPs of the ILN or the laryngeal branches in 32 of 58 sides (55.2%). For this reason, we imagine that the ZT may be used as a landmark by surgeon to locate the EPs of the ILN or the laryngeal branches. Clin. Anat. 20:640–643, 2007. © 2007 Wiley‐Liss, Inc.
Isolated deep peroneal (fibular) nerve palsy in association with primary total hip arthroplasty
Authors: Ahmad I. , Patil S.
Published: February 2007

We present two patients sufffering isolated deep peroneal (fibular) nerve (DPN) palsies post primary total hip arthroplastry. The consistent factor in both patients was difficulty with initial dislocation and subsequent relocation. Both developed immediate isolated DPN palsies, with loss of dorsiflexion and paraesthesia over the first web space. The superficial peroneal nerve was intact in both. Depsite intensive physiotherapy neither patient regained a return to pre‐morbid motor or sensory function. Common peroneal nerve (CPN) palsy is common than due to a number of important anatomical factors. It is thought that the deep and superficial branches of this nerve also exist as discrete fascicles and these same factors make the deep division more frequently affected. Recovery is prolonged and incomplete despite intensive physiotherapy, thus putting emphasis on prevention. Clin. Anat. 20:703–704, 2007. © 2007 Wiley‐Liss, Inc.
A Two‐Photon Fluorescent Probe for Lipid Raft Imaging: C‐Laurdan
Authors: Kim Hwan Myung , Choo Hyo‐Jung , Jung Soon‐Young , Ko Young‐Gyu , Park Won‐Hwa , Jeon Seung‐Joon , Kim Chul Hoon , Joo Taiha , Cho Bong Rae
Published: February 2007

The lipid‐rafts hypothesis proposes that naturally occurring lipid aggregates exist in the plane of membrane that are involved in signal transduction, protein sorting, and membrane transport. To understand their roles in cell biology, a direct visualization of such domains in living cells is essential. For this purpose, 6‐dodecanoyl‐2‐(dimethylamino)naphthalene (laurdan), a membrane probe that is sensitive to the polarity of the membrane, has often been used. We have synthesized and characterized 6‐dodecanoyl‐2‐[N‐methyl‐N‐(carboxymethyl)amino]naphthalene (C‐laurdan), which has the advantages of greater sensitivity to the membrane polarity, a brighter two‐photon fluorescence image, and reflecting the cell environment more accurately than laurdan. Lipid rafts can be visualized by two‐photon microscopy by using C‐laurdan as a probe. Our results show that the lipid rafts cover 38 % of the cell surface.
Synthesis, Structures, and Stability of N‐Donor‐Stabilized N‐Silylphosphoranimine Cations
Authors: Huynh Keith , Rivard Eric , Lough Alan J. , Manners Ian
Published: February 2007

A series of DMAP‐stabilized (DMAP=4‐dimethylaminopyridine) N‐silylphosphoranimine cations [DMAP⋅PR2NSiMe3]+, bearing R=Cl ([8]+), Me ([10 a]+), Me/Ph ([10 b]+), Ph ([10 c]+), and OCH2CF3 ([10 d]+) substituents, have been synthesized from the reactions of the parent phosphoranimines Cl3PNSiMe3 (3) and XR2PNSiMe3 (X=Cl (9), Br (11); R=Me (9 a and 11 a), Me/Ph (9 b and 11 b), Ph (9 c and 11 c), and OCH2CF3 (9 d and 11 d)) with DMAP and silver salts as halide abstractors. Reactions in the absence of silver salts yield the corresponding cations, with halide counterions. The stability of the salts is highly dependent on the phosphoranimine substituent and the nature of the counteranion, such that electron‐withdrawing substituents and non‐coordinating anions yield the most stable salts. X‐ray structural determination of the cations reveal extremely short phosphoranimine PN bond lengths for the cations [8]+ and [10 d]+ (1.47–1.49 Å) in which electron‐withdrawing substituents are present and a longer phosphoranimine PN length for the cation [10 a]+ (1.53 Å) in which electron‐donating substituents are present. Very wide bond angles at nitrogen are observed for the salts containing the cation [10 d]+ (158–166°) and indicate significant sp hybridization at the nitrogen centre.