bluuebunny/crossref_metadata_2025 huggingface dataset:
ACE Clock Scoring: A Comparison With Eight Standard Correction Methods in a Population of Low Educational Level
Authors: García-Caballero Alejandro , Recimil María José , García-Lado Isabel , Gayoso Pilar , Cadarso-Suárez Carmen , González-Hermida Javier , Area Ramón , Lamas Santiago
Published: November 2006

The authors compared the accuracy of Addenbrooke’s Cognitive Examination Clock Drawing Test scoring method with 8 standard Clock Drawing Test scoring methods in a Spanish speaking population of low educational level. A clinical group composed of 70 patients affected by dementia and 25 patients with memory complaints without dementia was compared with 72 controls matched for gender, age, and educational level. The clinical group was studied with standard neuropsychological instruments and neuroimaging. Clock Drawing Tests extracted from Addenbrooke’s Cognitive Examination were randomly distributed and scored by 2 independent raters. There were statistically significant differences between the different scoring methods. Addenbrooke’s Cognitive Examination Clock Drawing Test scoring method obtained and optimal areas under the curve and interrater reliability, showing no statistical differences with previously standardized systems. In our population, Addenbrooke’s Cognitive Examination and the methods of Cahn, Mendez, Rouleau, Shulman, and Sunderland were of optimal and equivalent usefulness regarding dementia detection.
Workload, Social Support, and Work-School Conflict Among Nigerian Nontraditional Students
Authors: Adebayo D. O.
Published: November 2006

As a result of the increasing number of nontraditional students in Nigerian universities and the consequences associated with combining multiple roles, this study is designed to examine the relationship among nontraditional students with respect to workload, social support, and work-school conflict. Using a cross-sectional survey, data are collected from 126 nontraditional students. Results of the correlational analysis reveals that work-school conflict has a significant positive relationship with perceived workload and a significant inverse relationship with social support. Furthermore, results of the hierarchical multiple regression analysis show that perceived workload, supervisor, and coworker support are found to be significant predictors of work-school conflict after controlling for the possible influence of sociodemographic variables. The discussion of these findings is anchored on multiple roles and social support models. The practical implications for workplace and university flexibility to enhance the educational advancement of nontraditional students are also emphasized.
A Psychometric Evaluation of the Career Decision Self-Efficacy Scale-Short Form in Chinese High School Students
Authors: Hampton Nan Zhang
Published: November 2006

This study explores the reliability and validity of the Career Decision Self-Efficacy Scale-Short Form (CDSES-SF) in Chinese high school students. One hundred and eighty-three high school students from a city in northeastern China participated in the study. The results indicate that scores on the CDSES-SF are reliable (internal consistency reliability = .93) with this sample of Chinese high school students. The convergent validity of the CDSES-SF is supported by a moderate correlation between the CDSES-SF and the general self-efficacy. A principal component factor analysis reveals that the CDSES-SF is a generalized measure of self-efficacy for career decision making. In addition, the CDSES-SF is not related to age, gender, and math achievement, but it is correlated with the Chinese language achievement. The implications of the findings are discussed in the context of the Chinese socioeconomic environment.
Photosensitivity in lupus
Authors: Millard T P , Hawk J L M , Mcgregor J M
Published: November 2006

A wide variety of skin conditions may present in patients with lupus erythematosus (LE). These can be broadly divided into three main groups: cutaneous forms of LE (`LE-specific skin disease'), nonspecific cutaneous manifestations of SLE (`LE non-specific skin disease') and cutaneous complications of drug treatments for LE. This review examines clinical photosensitivity in LE, a trait most commonly associated with cutaneous forms of LE but which may also manifest in SLE. All humans are photosensitive, developing reddening of the skin if exposed to sufficient ultraviolet radiation (UVR). Therefore we define photosensitivity in clinical practice as an abnormal cutaneous response to UVR.

Abnormal photosensitivity in LE may manifest in a number of different forms. The lesions of LE-specific skin disease may be induced or exacerbated by UVR. Patients with LE who are prescribed photosensitizing medications such as thiazide diuretics, neuroleptics and tetracyclines may also develop phototoxic reactions which usually present as easy sunburn. Photosensitivity may also, rarely, manifest as fragile skin and blistering in patients with both LE and porphyria cutanea tarda. Several other photosensitive disorders have been reported in association with LE, including solar urticaria and erythropoetic protoporphyria (EPP), but these appear to be chance associations.

Assessment of patients with LE and photosensitivity requires a careful history and examination. Phototesting and photoprovocation tests may be used to demonstrate photosensitivity in some cases, but these are rarely required for diagnosis. Photosensitive patients should be advised about sun avoidance, photoprotection and sunscreen use as a first line treatment.
Intestinal pseudo-obstruction in systemic lupus erythematosus: an uncommon but important clinical manifestation
Authors: Mok M , Wong R W S , Lau C S
Published: November 2006

Objectives: To document intestinal pseudo-obstruction (IpsO) as a recognised clinical manifestation of systemic lupus erythematosus (SLE) and a possible new clinical entity with its apparent association with ureterohydronephrosis.

Methodology: We report six lupus patients who presented with IpsO and review 12 other cases from an English literature search. IpsO is defined as the presence of clinical features suggestive of intestinal obstruction but without organic obstruction, namely absence of bowel sounds, presence of multiple fluid levels on plain abdominal X-rays and exclusion of organic obstruction by imaging or surgical procedure. Other clinical characteristics related to the underlying lupus, serological and histological findings, treatment modalities and outcomes of these patients were reviewed.

Results: All 18 patients fulfilled the ACR revised classification criteria for SLE. None showed any clinical features of scleroderma or overlap syndrome. The mean age of onset of IpsO was 29.0 (15-47) y. The female to male ratio was 16: 2. Nine patients had IpsO as the initial presentation of their underlying lupus. Coexisting lupus involvement of other organ systems included glomerulonephritis (n = 7), thrombocytopenia (n = 5) and cerebral lupus (n = 3). The serology data and autoantibody profile of some of the previously reported patients were incomplete. In our series, anti-Ro antibody was positive in 5=6 while anti-RNP was found in 1=6 patients only. All our patients had active lupus serology at presentation. 17=18 patients required the use of high dose systemic corticosteroid therapy while one patient responded to topical adrenocorticotrophin hormone treatment. Response was good and was observed early after commencement. Azathioprine was used as maintenance therapy in 6=18 patients with good effects. An apparent association with the presence of bilateral ureterohydronephrosis was found in 12=18 patients. These patients presented with dysuria without positive bacterial culture though features of chronic interstitial cystitis were not invariably found in these patients.

Conclusion: IpsO is an uncommon but important manifestation of SLE. The underlying pathology is not fully understood but it may be related to immune complex deposition. The finding of coexisting ureterohydronephrosis suggests that there may also be a central smooth muscle motility problem of neuropathic or myogenic pathophysiology which may or may not be secondary to vasculitis. Early recognition and treatment of IpsO in SLE is important.
Usefulness of detection of complement activation products in evaluating SLE activity
Authors: Nagy G , Brózik M , Varga L , Füst G , Kirschfink M , Kiss E , Gergely P
Published: November 2006

Complement activation products, such as C1rs-C1inh, specific for the activation of the classical pathway, C3b(Bb)P, specific for the activation of the alternative pathway and SC5b-9, specific for common terminal pathway of the complement cascade, were measured in healthy donors and in patients with clinically active and inactive systemic lupus erythematosus (SLE). Plasma levels of C3b(Bb)P and SC5b-9 were moderately, those of C1rs-C1inhibitor (C1rs-C1inh) were markedly elevated in patients with clinically inactive SLE, compared with healthy controls. The difference between active and inactive stages of the disease was best reflected by C3b(Bb)P plasma concentration (P < 0.001), which also showed the highest correlation with the SLEDAI (Rs = 0.41 P < 0.001) and which was the most useful in distinguishing active and inactive sample pairs as well. The difference between SC5b-9 levels in the active and inactive stages was also significant (P = 0.007), while that of C1rs-C1inh did not differ significantly (P = 0.136). The correlation of the SLEDAI with SC5b-9 was 0.3 (P = 0.015), while with C1rs-C1inh it was 0.21 (P = 0.089). These findings suggest that the measurement of complement activation products, especially that of the alternative pathway, are sensitive markers of the activity of SLE and can be used for clinical purposes.
Primary Sjoögren's syndrome in men: clinical and immunological characteristics
Authors: Cervera Ricard , Font Josep , Ramos-Casals Manuel , García-Carrasco Mario , Rosas Joseé , Morlà Rosa , Munóz Francisco J , Artigues Antonia , Pallarés Lucio , Ingelmo Miguel
Published: November 2006

Objective: To determine the clinical and immunological characteristics of primary Sjögren' syndrome (SS) in men from a large series of unselected patients with this condition.

Methods: We studied 223 consecutive patients (204 women and 19 men; mean age at onset 53 y, range 15-87 y, mean disease duration 77 months) with primary SS visited in our units. All these patients fulfilled 4 or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993.

Results: Nineteen (9%) patients were men and they represent the male group described in this paper. Extraglandular manifestations during the course of their disease were present in 10 (53%) of our male patients with primary SS: articular involvement in 4 (21%) patients, interstitial pneumopathy in 3 (16%) and peripheral neuropathy in 2 (11%). ANA were positive in 13 (68%) patients, RF in 5 (31%), anti-Ro/SS-A in 3 (16%) and cryoglobulins in 1/14 (7%). When compared with women, men with primary SS presented a lower prevalence of articular involvement (21% vs 46%, P=0.03, OR 0.32, CI 0.07-0.97).

Conclusion: Although primary SS is typically a disease of middle-aged women, clinicians should note that it may be diagnosed in male patients. Except for a lower prevalence of articular involvement, we could no find any notable differences in clinical and immunological characteristics between male and female patients with primary SS.
Lupus cystitis: A possible additive risk factor for emphysematous cystitis in diabetes mellitus: discussion about one case
Authors: Granel B , Serratrice J , Juhan V , Rey J , Lechevalier E , Disdier P , Weiller P J
Published: November 2006

Emphysematous cystitis (EC) is a rare condition in which gas-forming organisms are active in the bladder wall and lumen. Most of the cases have been described in patients suffering from diabetes mellitus due to glucosuria and subsequent anaerobic fermentation of glucose. To our knowledge this condition has never been described in association with systemic lupus erythematosus (SLE). We report here the first case of EC during the course of a chronic lupus cystitis (LC) in a woman suffering from SLE and type-I diabetes mellitus.
Liver dysfunction due to apoptosis in a patient with systemic lupus erythematosus
Authors: Mukai Masaya , Bohgaki Toshiyuki , Notoya Atsushi , Kohno Michifumi , Tateno Masatoshi , Kobayashi Seiichi
Published: November 2006

We report on a 23-year-old Japanese female with a 13-year history of systemic lupus erythematosus (SLE), and two episodes of deterioration followed by treatment with high dose prednisolone. Although she had been recently treated with prednisolone (12.5 mg daily), her liver function became worse in July 1998. Results of a liver biopsy revealed multi-focal hepatic cell death in a severe fatty liver, without any inflammatory cell invasion. The biopsy also showed a positive TUNEL (Tdt-catalysed DNA nick end labelling) reaction indicating apoptosis. Her liver function recovered rapidly following steroid pulse therapy. Serum soluble Fas ligand (sFasL) was found to be elevated to a concentration of 0.395 ng/ml at the time of liver damage, but was less than 0.03 ng/ml before liver damage and after prednisolone treatment. The liver damage in this case appeared to be involved with apoptosis induced by sFasL. Although hepatitis associated with SLE is rare, apoptosis directly related to elevated sFasL levels might cause this complication.
Overwhelming septic cavernous sinus thrombosis in a woman after combination of high-dose steroid and intravenous cyclophosphamide therapy for lupus nephritis
Authors: Chen Ying-Chou , Cheng Tiang-Tsai , Lai Hung-Min , Wu Chien-Hui
Published: November 2006

There are many treatment methods for lupus nephritis, including high-dose steroids, pulse methylprednisolone, and cyclophosphamide therapy. In cyclophosphamide therapy, there can be some side effects such as nausea, vomiting, and infection. We report on a case receiving a combination of high dose steroid and intravenous cyclophosphamide. Following this, she developed a fever and a protruding right eye, and septic cavernous sinus thrombosis was diagnosed. This complication had never been reported in a patient with systemic lupus erythematosus, and related literature is reviewed.
Determination of autoantibodies to annexin XI in systemic autoimmune diseases
Authors: Jùrgensen C S , Levantino G , Houen G , Jacobsen S , Halberg P , Ullman S , Khamashta M A , Asmussen K , Oxholm P , Jùrgensen MK , van Venrooij W J , Wiik A
Published: November 2006

Annexin XI, a calcyclin-associated protein, has been shown to be identical to a 56,000 Da antigen recognized by antibodies found in sera from patients suffering from systemic autoimmune diseases. In this work hexahistidine-tagged recombinant annexin XI (His6-rAnn XI) was used as antigen in ELISA experiments for determination of autoantibodies to annexin XI in sera of patients with systemic rheumatic autoimmune diseases. Immunoblotting with HeLa cell extract and with His6-rAnn XI as antigen was used for confirmation of positive ELISA results. We found eleven anti-annexin XI positive sera (3.9%) out of 282 sera from patients with systemic rheumatic diseases. The highest number of annexin XI positive sera were found in primary antiphospholipid syndrome (3=17), and in subacute lupus erythematosus (1=6), while lower frequencies of positive sera were found in patients with systemic sclerosis (5=137), rheumatoid arthritis (1=21), and systemic lupus erythematosus (1=58). Sera from healthy donors and patients with chronic infections were negative, except for one Salmonella typhimurium antibody positive serum. Autoantibodies to annexin XI were found to relate to thrombosis, but not to other clinical or laboratory features. A relation between antibodies to annexins and thrombosis has so far only been known for annexin V.
Mood states and disease activity in patients with systemic lupus erythematosus treated with bromocriptine
Authors: Walker S E , Smarr K L , Parker J C , Weidensaul D N , Nelson W , McMurray R W
Published: November 2006

We tested mood states in patients with systemic lupus erythematosus (SLE) treated with the prolactin-lowering drug, bromocriptine. Bromocriptine was given to seven patients in an open-label study to test its effects on active SLE. Two independent measures of SLE activity, the SLE Activity Measure (SLAM) and the SLE Disease Activity Index (SLEDAI), were scored and the Symptom Questionnaire (SQ) mood survey was administered at entry and at 6 monthly follow-up visits. The SLAM and SLEDAI scores improved significantly during treatment. Two of the four mood scales in the SQ (Anxiety Scale and Anger – Hostility Scale) showed significant improvement compared to the entry value at least once during treatment. Significant improvement was also observed in the Total Distress Score, which is the sum of the four scales and is a more sensitive measure of distress than the score of an individual scale. Depression, anxiety, somatic complaints, and total distress correlated positively with SLAM and/or SLEDAI scores. The Anxiety Scale and the Total Distress Score improved with treatment and did correlate positively with SLE activity. In contrast, the Anger – Hostility Scale improved with treatment but did not correlate with SLE activity.
Illness intrusiveness explains race-related quality-of-life differences among women with systemic lupus erythematosus
Authors: Devins G M , Edworthy S M ,   the ARAMIS Lupus State Models Research Group
Published: November 2006

Our objective was to investigate whether quality of life in systemic lupus erythematosus (SLE) differs across ethnoracial groups and to identify factors that may explain race-related differences.

Self-administered questionnaire data from 335 White, 40 Black, and 30 Asian women with SLE were obtained from a multi-center database. Measures assessed illness intrusiveness, psychological well-being, depressive symptoms, musculoskeletal pain, and learned helplessness. Extent of SLE disease activity was indexed by self-reported functional-system involvement. Educational attainment was indicated by number of years in school.

Principal-components analysis reduced the four psychosocial measures to a single factor score. This represented psychosocial well-being in path analysis. Psychosocial well-being differed significantly across the three groups, with Whites reporting the highest, and Blacks the lowest, levels. Path analysis indicated that illness intrusiveness accounted for this race-related difference. Although disease activity was significantly associated with psychosocial well-being, it did not differ across ethnoracial groups. Illness intrusiveness and educational attainment emerged as independent mediators of the race-related difference in psychosocial well-being.

We conclude that race-related quality-of-life differences exist among women with SLE and are mediated independently by illness intrusiveness and educational attainment.
Altered Bax expression and decreased apoptosis in bone marrow cells of lupus-susceptible NZB/W mice
Authors: Nazareth M , Fanti P , Schwach C , Poppenberg K , Janis K , Aronica S M
Published: November 2006

Estrogen is believed to contribute to the development of the autoimmune disorder systemic lupus erythematosus (SLE) (lupus) in women. We hypothesized that estrogen might promote the development of lupus by altering apoptosis of bone marrow cells, perhaps through regulation of the apoptotic proteins Bax and Bcl-2. We compared the effects of estrogen (E2) and thrombopoietin (TPO) on the expression of Bax or Bcl-2 in bone marrow cells isolated from female non-lupus (NZW or NZBparental strains) or lupus-prone (NZBand NZW cross; NZB =W) mice. We report that the basal level of Bax in parental bone marrow cells was significantly greater than that of cells from NZB/W animals. Treatment of NZBor NZW marrow cells with E 2 resulted in a significant decrease in Bax expression,which was completely reversed upon co-treatment with TPO. Bax expression was not significantly altered by E2 and/or TPO in NZB/W cells. Bcl-2 levels didnot differ between murine strains under basal or hormone-treated conditions. Lower basal expression of Bax protein was associated with significantly less apoptosis for NZB/W marrow cells. In addition, there were significantly greater numbers of cells in bone marrow of lupus-susceptible animals. Our results indicate that bone marrow cells of NZB/W animals differ physiologically from those of NZW or NZBmice, and suggest that decreased expression of Bax in bone marrow precursors may lead to decreased apoptosis of mature blood cells in lupus-susceptible mice.
Anti-prolactin autoantibodies in paediatric systemic lupus erythematosus patients
Authors: Blanco-Favela F , Quintal Ma G , Chavez-Rueda A K , Leaños-Miranda A , Berron-Peres R , Baca-Ruiz V , Lavalle-Montalvo C
Published: November 2006

The aim of this study was to determine the frequency of anti-prolactin autoantibodies and the relationship among anti-prolactin autoantibodies, serum prolactin (PRL) levels and lupus activity in paediatric patients with systemic lupus erythematosus (SLE) using a transversal study. One-hundred and three consecutive paediatric SLE patients were tested for serum anti-PRL autoantibodies and PRL levels. Clinical disease activity was scored using the SLEDAI index. Anti-PRL autoantibodies were measured by means of gel filtration. The frequency of anti-PRL autoantibodies was 6.7% (7=103), on the basis of the amount of immunoreactive PRL eluted in molecular weight fraction corresponding to IgG (150 kDa). No anti-PRL autoantibodies were found in normoprolactinaemic patients. By contrast, 21.8% (7=32) hyperprolactinaemic patients (hPRL) had anti-PRL autoantibodies. There was a correlation between anti-PRL autoantibody and serum levels of PRL (rs1/4 0.98, P 1/4 0.0001). Lupus activity was present in 64=103(62.1%) patients, without a significant difference in the frequency of anti-PRL autoantibodies when compared to inactive lupus (7.8 vs5.1%, P > 0.05). Higher levels of serum PRL were associated with lupus activity regardless of other variables (39.6% vs 17.9%, P 1/4 0.05). Patients with anti-PRL autoantibodies had higher levels of serum PRL than those without anti-PRL autoantibody (41.85 vs 17.77 ng/ml, P 1/4 0.01) and significantly different frequency of hPRL (100 vs 26%, r 1/4 0.4531, P< 0.001). We have identified a subset of paediatric SLE patients with hPRL and anti-PRL autoantibodies. Anti-PRL autoantibodies were associated with hPRL state and antibody titres correlated positively with serum PRL levels. These data suggest that anti-PRL autoantibodies could be responsible for hPRL in a subset of SLE patients. An increase in serum PRL levels proved to be related to lupus activity, but there was no statistical relationship between anti-PRL autoantibodies and lupus activity.
Pemphigus vulgaris and systemic lupus erythematosus in a 46-y-old man
Authors: Hidalgo-Tenorio C , Sabio-Sánchez J M , Tercedor-Sánchez J , León-Ruíz L , Pérez-Alvarez F , Jiménez-Alonso J
Published: November 2006

Systemic lupus erythematosus (SLE) is an autoimmune disease that may affect many organs in the body. Skin manifestations are frequent and sometimes vesiculobullous lesions may apper such as in bullous lupus erythematosus. SLE may also be exceptionally associated with other blistering diseases such as pemphigus vulgaris (PV). We describe the case of a male diagnosed as having SLE, who one year later developed PV. Only three cases (all in women) of SLE associated with PV have been reported in the literature. Our case is noteworthy in that this exceptional association developed in a middle-aged male.
External influences on the fetus and their long-term consequences
Authors: Phillips D IW
Published: November 2006

The observation that low birth weight is associated with cardiovascular disease and its risk factors has formed the basis for the ‘developmental origins' hypothesis. This hypothesis suggests that the operation of adverse influences during intrauterine life leads to permanent alterations in structure and physiology of the adult phenotype which predispose to a range of common adult diseases. The process is known as developmental plasticity or programming and is strongly supported by studies in experimental animals. Recent evidence suggests that the same processes may affect the development of the immune system and play a part in the pathogenesis of autoimmune disease. Animal studies show that the intrauterine environment has powerful and long-lasting effects on many aspects of immune function. The corresponding human evidence, though preliminary, suggests that birth weight or other markers of the early environment are associated with a range of autoimmune diseases.
Drug-induced lupus: an update
Authors: Vasoo S
Published: November 2006

Drug-induced lupus erythematosus (DILE) is a lupus-like illness that has been recognized as an entity under environmentally-induced lupus erythematosus, where other agents such as physical (ultra-violet irradiation), chemical (heavy metals, aromatic amines) and food products (alfalfa sprouts) have been implicated. DILE has been accepted as a side effect of therapy with over 80 drugs since its first description in association with sulfadiazine in 1945. The epidemiology and clinical course of SLE and DILE differ markedly and prognosis is generally favourable in the latter although occasional lifethreatening cases have been reported in the literature. Constant pharmacovigilance is crucial for prompt diagnosis and cessation of offending therapy offers the best outcome. This review discusses the clinical presentation, diagnosis of DILE as well as provides an update on postulated pathogenic mechanisms and an overview of implicated drugs.
Diet and the developing immune system
Authors: Langley-Evans S C , Carrington L J
Published: November 2006

Undernutrition during fetal life is known to have programming effects upon tissue morphology and function. This generally promotes poor health in adult life, with increased risk of metabolic syndrome and cardiovascular mortality noted among individuals whose growth was constrained in utero. Undernutrition in early life impacts upon the development of the immune organs and appears to diminish cellular immunity and increase the risk of atopic disorders during childhood. A limited body of evidence implicates fetal programming in the development of autoimmune disorders. This area represents an interesting target for further research and preventive medicine.
Environment versus genetics in autoimmunity: a geneticist's perspective
Authors: Mohan C
Published: November 2006

Both environmental as well as genetic factors have been documented to contribute to autoimmunity, as is evident from the accompanying articles in this journal. This raises an important question–which of these two elements plays a more important role in the genesis of autoimmunity? This report encapsulates a geneticist's perspective on this interesting question. Though lupus is used as an example in this essay, the proposed model is envisaged to operate in other autoimmune diseases as well.
The environment and antiphospholipid syndrome
Authors: Levy Y , Almog O , Gorshtein A , Shoenfeld Y
Published: November 2006

The etiology of autoimmune diseases is multifactorial. The degree to which genetic and environmental factors influence susceptibility to autoimmune diseases is poorly defined. It is believed that versatile clinical presentations of autoimmune diseases stem from various combinations of the genetic and environmental factors. One of the newly diagnosed autoimmune diseases is the antiphospholipid syndrome (APS). APS is characterized by vascular thrombosis, and/or pregnancy morbidity associated with anticardiolipin (aCL), anti-β2-glycoprotein-I (anti-β2GPI) and lupus anticoagulant (LAC).
Impact of in utero environment on the offspring of lupus patients
Authors: Tincani A , Danieli E , Nuzzo M , Scarsi M , Motta M , Cimaz R , Lojacono A , Nacinovich R , Taddei F , Doria A , Brucato A , Meroni P , for the Pregnancy Study Group of Italian Society of Rheumato
Published: November 2006

The number of patients affected by systemic lupus erythematosus (SLE) that decide to have children has greatly increased probably because of recent improvements in the diagnosis and management of the disease. This has stimulated our interest in defining the outcome of children, focusing both on neonatal problems and long term development. SLE patients still carry a risk of pregnancy loss. However, due to careful monitoring and treatment by a multidisciplinary team, the number of losses has dramatically decreased, but an increased number of preterm deliveries is still a problem. Neonatal lupus is linked to the presence of anti-Ro/SS-A and anti-La/SS-B antibodies in the mother, although other factors probably of fetal origin are important. Neonatal lupus is a complex condition whose most serious manifestation is the congenital heart block (CHB). Usually, children with complete CHB need permanent pacing, but apparently do not have neuropsychological problems. Studies focusing on the neuropsychological development of SLE offspring show an increased number of learning disabilities in children with normal intelligence levels. Fetal consequence of maternal treatment need to be considered choosing non teratogenic drugs, but the withdrawal of medications just because the patient is pregnant should be avoided to avoid SLE flares.
Sex differences in the epidemiology and outcomes of heart disease: population-based trends
Authors: Roger V Vl , Jacobsen S J , Weston S A , Gabriel S E
Published: November 2006

We examined trends in heart disease (HD) mortality and the delivery of cardiac in Olmsted County, MN. Between 1979 and 1994, women experienced 51% of the total number of HD (ICD9 codes 390 — 398,402,404 — 429) deaths (3095). Age-adjusted HD mortality rate declined from 123 per 100,000 (95%CI 102, 144) in 1979 to 81 (67,95) in 1994. The risk ratio (RR) of HD death in 1994 compared to 1979 was 0.69 for women vs 0.53 for men (P = 0.06). This equates to a decline in HD mortality of 2.5%=y in women and 4.2%=y in men. The decline in HD mortality was less pronounced in older age groups (P < 0.001), reflecting a shift of the burden of HD towards women and the elderly. Compared to men, there was less use of stress tests among women, of cardiology visits after stress testing, and of cardiac procedures among women presenting to the emergency room with unstable angina. Further studies are needed to examine causal links between these trends.
Sex-based differences in gene transmission and gene expression
Authors: Ostrer H
Published: November 2006

The higher prevalence of certain diseases among women suggests involvement of genetic mechanisms linked to the sex chromosomes or of sex-limited gene expression that may be developmentally or hormonally regulated. Analysis of genetic markers and gene expression patterns provides the means for testing hypotheses related to these mechanisms.
Microchimerism: implications for autoimmune disease
Authors: Nelson J L
Published: November 2006

Recent studies indicate cells traffic between the fetus and mother during normal human pregnancy and that fetal cells persist in maternal peripheral blood for decades after childbirth. The long-term persistence of fetal cells, when considered together with clinical similarities of chronic graft-vs-host disease and autoimmune disease and the female predilection to autoimmunity, led to the hypothesis that microchimerism is involved in some autoimmune diseases. Sources of engraftment applicable to men and to women who have never been pregnant include from a blood transfusion, a twin sibling, or mother. Initial studies lend support to the hypothesis. A role in disease pathogenesis has not been demonstrated, however, and microchimerism is also common in healthy normals. If microchimerism is involved in the pathogenesis of some autoimmune diseases further understanding potentially may lead to new therapeutic strategies.
Gender differences in cellular response
Authors: Nikezic-Ardolic M , Lin L , Milcevic M , Zakeri Z
Published: November 2006

Autoimmune and other diseases frequently manifest a sexual discordance that cannot be explained by hormonal differences. Although there is evidence for gender skewing being caused by gonadal hormones, such skewing does not explain an increase of frequency rather than of severity of such diseases in women. To examine if skewing might have a genetic explanation, we have asked how male and female cells devoid of hormonal differences respond to challenges. We used mouse embryonic cells from heart, liver and brain and assessed cellular responsiveness by cell survival. We find that female cells in general show more sensitivity to challenges, such as ethanol, hydrogen peroxide, and camptothecin. Our findings indicate that there is a differential behavior to challenges, in male vs female cells, which may be due to differences in the biological make-up of the cells with regard to gender, and provide preliminary information regarding the feasibility of this type of approach.
Gender differences in some host defense mechanisms
Authors: Spitzer J A
Published: November 2006

Sexual dimorphism exists in the immune response. Both humoral and cell-mediated immunity are more active in females than in males, and steroid gonadal hormones may play an important role in regulating this response.

We have documented gender differences in several aspects of neutrophil and macrophage functions elicited by lipopolysaccharide (LPS) (endotoxin) treatment and/or acute ethanol intoxication. In LPS-treated female rats, circulating neutrophils and alveolar macrophages are resistant to the deleterious effects of surgery and anesthesia on phagocytosis observed in male rats. The generation of cytokine-induced neutrophil chemoattractant (CINC) by hepatocytes and Kupffer cells of LPS-treated rats, as well as TNF-a secretion by Kupffer cells and alveolar macrophages of acutely ethanol intoxicated rats are also gender dependent.

The effects of alcohol on the immune response are expressed differently in males and females. In LPS plus ethanol-treated rats gender differences were noted in terms of adhesion molecule (CD11b/c) expression on circulating neutrophils, and cytoskeletal reorganization in blood-recruited neutrophils and Kupffer cells.

Nitric oxide (NO) plays an important role in inflammatory processes. We found gender differences in NO production by alveolar macrophages of LPS-treated rats; this difference was abrogated by ethanol treatment. LPS tolerance and ethanol treatment modulate hepatic NO production in rats in a cell and gender-dependent fashion, which may exert a protective influence against oxidative injury in the female liver.
Estradiol prevents and testosterone promotes Fas-dependent apoptosis in CD4+ Th2 cells by altering Bcl 2 expression
Authors: Huber S A , Kupperman J , Newell M K
Published: November 2006

Coxsackievirus B3 (CVB3) induces myocarditis in male BALB/c mice. Female mice are resistant to viral myocarditis, except in the third trimester of pregnancy and postpartum. Cardiac damage is mediated by T lymphocytes activated during virus infection. Th1 (interferon-gamma +) cell responses promote cardiac injury, while disease resistance correlates to preferential activation of Th2 (interleukin-4 +) cell responses. CVB3-specific Th1 and Th2 cell clones were established, treated with between 0 and 100 ng/ml 17β estradiol and 4-androsten-17β-ol-one (testosterone) for two days, 51Cr-labeled and cultured on FasL-transfected 3T3 cells to determine susceptibility to Fas-dependent apoptosis. Testosterone treatment enhanced Th2 cell lysis while estradiol treatment was protective. Staining of Th2 cells for Bcl 2, an anti-apoptotic factor, indicates that Bcl 2 expression increased in these cells with estradiol but decreased with testosterone exposure. Hormone-induced changes in Bcl 2 expression likely explain the selective survival of Th2 cells in females and prevention of viral myocarditis.
Osteoporosis: gender differences and similarities
Authors: Khosla S , Melton L J , Riggs B L
Published: November 2006

Although osteoporosis has traditionally been considered a disease of women, men also incur substantial bone loss with aging, and elderly men have age-specific hip fracture incidence rates and vertebral fracture prevalence rates that are at least half those in women. Early postmenopausal bone loss (which results in the syndrome of type I osteoporosis) is due to the direct skeletal consequences of estrogen deficiency, manifested by an increase in bone resorption without an adequate increase in bone formation. Recent evidence indicates that even late postmenopausal bone loss (type II or ‘senile’ osteoporosis) in women may be due to estrogen deficiency. In particular, the late consequences of estrogen deficiency in elderly women result in abnormalities in calcium homeostasis and increases in parathyroid hormone secretion, leading to increased bone resorption and bone loss. The etiology of bone loss in aging men has remained relatively unclear. Recent evidence from a male deficient in estrogen receptor-alpha and in two males with aromatase deficiency indicate that estrogen may play a significant role in bone metabolism in men. Moreover, several large epidemiologic studies have found that bone mineral density correlates better with serum estrogen than testosterone in aging men. Thus estrogen deficiency may lead to bone loss in men.
Gender-related differences in vascular smooth muscle cell proliferation: implications for prevention of arteriosclerosis
Authors: Fitzpatrick L A , Ruan M , Anderson J , Moraghan T , Miller V
Published: November 2006

Premenopausal women have a significant reduction in coronary artery disease compared to age matched males. Little is known about the mechanism underlying this cardio protective effect of estrogen. Contradictory evidence has been published and our lack of basic understanding of hormone interactions and bioavailability of different estrogens prevents definitive interpretation of these data. We demonstrate gender-specific effects in the proliferation of coronary artery vascular smooth muscle cells obtained from a sexually mature animal model. Vascular smooth muscle cells are an integral component of the atherosclerotic plaque, and inhibition of cell proliferation by estrogen may be one mechanism by which estrogen exerts its cardio protective effect. Various types of estrogen may also have different mechanistic actions on the vascular system. No differences are demonstrated in overall estradiol binding in vascular smooth muscle cells obtained from male or female animals; however, differences in c-jun, c-fos and TIEG gene expression were gender related. Inhibition of vascular smooth muscle cell proliferation may have important implications in the prevention of atherosclerotic disease and these studies may provide evidence for the cardio protective effect of estrogen.
Prevalence of soft tissue calcifications in patients with SLE and effects of alfacarcidol
Authors: Okada J , Nomura M , Shirataka M , Kondo H
Published: November 2006

Objective: To clarify the prevalence and etiology of ectopic calcification in patients with systemic lupus erythematosus (SLE), especially under the active vitamin D3 administrations and to reveal the risk factors of ectopic calcification.

Methods: Sixty patients with SLE, excluding the patients on dialysis were studied. We examined radiographs of hands, forearms, upper and lower extremities, and pelvises of all patients to evaluate ectopic calcification.

Results: The prevalence of ectopic calcification in SLE was 40% (24 out of 60 patients), found in 6.7% (4 patients) in peripheral arteries, 33.3% (20 patients) in periarticular area and 16.7% (10 patients) in other soft tissues. The incidence of lupus nephritis and nephrotic syndrome were significantly higher (respectively: P = 0.0144 and P = 0.0348) in the calcification-positive than negative group. Total protein levels (7.04 0.6 g =dl) of patients in the calcification-positive group were decreased significantly (P = 0.0056) compared with 7.48 0.55 g =dl in the negative group. However, other biochemical parameters were not significantly different between the two groups. Sixty-three percent of the SLE patients with ectopic calcification received alfacarcidol, which is significantly (P = 0.0007) higher than the 19% in patients without calcification.

Conclusion: It is suggested that the alfacarcidol therapy and lupus nephritis could increase the risk of ectopic calcification in SLE patients.
Mild presentation of systemic lupus erythematosus in elderly patients assessed by SLEDAI
Authors: Formiga F , Moga I , Pac M , Mitjavila F , Rivera A , Pujol R
Published: November 2006

Objective: Systemic lupus erythematosus (SLE) predominantly affects young patients. SLE starting in later life has a clinical presentation different than in younger patients. We have used the SLE Disease Activity Index (SLEDAI) to explore the relationship between age of onset and disease activity.

Methods: We selected all patients controlled in our hospital at the moment of clinical diagnosis of SLE (100 patients; 85 females and 15 males). They were classified in two groups: those with early onset (<50 y) and those with late onset (>50 y) based on their age at the moment of clinical diagnosis of SLE.

Results: In 12 patients the onset of SLE was > 50 y (10 females and two males; mean age 59 y). The early onset patients had significantly higher SLEDAI values at the presentation and during the first year of disease with respect to elderly patients. Antibodies to DNA and hypocomplementemia were detected more often in younger patients.

Conclusion: Our results confirm using SLEDAI, that the lupus of the elderly patients is a distinct clinical subgroup with a milder course of disease.
Disease expression and class II HLA antigens in systemic lupus erythematosus
Authors: Gladman D D , Urowitz M B , Darlington G A
Published: November 2006

The aim of this investigation was to examine the relationship between Class II HLA antigens and disease expression in systemic lupus erythematosus (SLE). HLA-DR and DQ antigen frequency was studied serologically in 217 SLE patients followed prospectively and compared to 320 healthy controls. The relationship between HLA antigens and the presence of disease manifestations, as well as death was investigated in 117 SLE patients enrolled within the first year of their disease. A univariate analysis confirmed the association between HLA-DR3 and SLE. HLA antigen DR1, DR6, DR7, DQw1 and DQw3 were decreased in patient group compared to the controls. A logistic regression model showed a significantly negative association with HLA-DR1, DR6 and DR7, and a positive association with HLA-DR3. The reduced frequency of HLA-DQw1 and DQw3 was maintained using a logistic procedure. Cox Proportional Hazards models revealed no association between HLA-Class II antigens and death. Logistic regression models revealed no associations between central nervous system (CNS) disease nor musculoskeletal manifestations with any of the DR antigens. There was a trend towards a lower frequency of HLA-DR6 in patients with renal involvement and lower prevalence of HLA-DR1 and HLA-DR7 in patients with vasculitis.
Reflex sympathetic dystrophy in a patient with the antiphospholipid syndrome
Authors: Tsutsumi A , Horita T , Ohmuro J , Atsumi T , Ichikawa K , Tashiro K , Koike T
Published: November 2006

We describe a 50-year-old woman who developed severe pain of the left lower limb after an episode of thrombophlebitis. Bone scintigraphy and thermography showed results indicative of reflex sympathetic dystrophy. Laboratory analysis revealed the presence of the lupus anticoagulant. The patient was diagnosed as antiphospholipid syndrome complicated with reflex sympathetic dystrophy of the left lower limb. To our knowledge, this is the first report of a patient with reflex sympathetic dystrophy with underlying antiphospholipid syndrome.
Relapsing catastrophic antiphospholipid antibody syndrome: a mimic for thrombotic thrombocytopenic purpura?
Authors: Cerveny K C , Sawitzke A D
Published: November 2006

The catastrophic antiphospholipid antibody syndrome (CAPS) is an uncommon disorder characterized by widespread micro and macrovascular changes due to intravascular thrombosis. This complication of the antiphospholipid antibody syndrome is often fatal and recurrences are very rare. The differential diagnosis of CAPS includes thrombotic thrombocytopenic purpura (TTP) and this distinction may be difficult, but essential, for appropriate therapy. Plasmapheresis is effective in both conditions, but anticoagulation, a mainstay in the treatment of CAPS, could be disastrous in TTP. We present the case of an elderly woman who survived two episodes of CAPS four years apart and whose clinical findings were also suggestive of TTP. The characteristics of TTP and CAPS are compared and the importance of accurate diagnosis is emphasized.
Magnetic Resonance Imaging Volumetric Analysis of the Putamen in Children With ADHD
Authors: Wellington Tasha McMahon , Semrud-Clikeman Margaret , Gregory Amanda Louise , Murphy Jennifer Mary , Lancaster Jack Lynn
Published: November 2006

Objective: Volumetric differences in the putamen of boys with ADHD combined subtype with psychopathic traits and controls are investigated.

Method: The putamen in 24 archival magnetic resonance imaging scans of 12 boys in residential treatment with symptoms of ADHD and psychopathic traits and 12 community control boys are analyzed using Display software.

Results: There are no differences found in the total, left, and right putamen volumes across the ADHD or control group. A significant reversal of asymmetry across groups is found; children with ADHD more frequently have a smaller left putamen than right. In contrast, the control group more frequently has a smaller right than left putamen.

Conclusion: A reversal of symmetry in the putamen (as found in the caudate) may relate to ADHD symptomology as well as to psychopathic traits.
Case Series: Evaluation of a Behavioral Sleep Intervention for Three Children With Attention-Deficit/Hyperactivity Disorder and Dyssomnia
Authors: Mullane Jennifer , Corkum Penny
Published: November 2006

Objective: The authors conducted a preliminary evaluation of a behavioral sleep intervention for children with attention-deficit/hyperactivity disorder (ADHD) and dyssomnia delivered via distance treatment.

Method: Three children (1 male, 2 females; aged 6-10 years) with ADHD and dyssomnia participated in a 5-week manualized intervention. Using a non-concurrent multiple baseline design, the children were randomly assigned to a 1-, 2-, or 3-week baseline and then received the 5-week intervention. Sleep problems were assessed daily by both objective and subjective measures. Measures of problematic nighttime behaviors and daytime ADHD symptoms were also obtained weekly.

Results: After 5 weeks, a clinically significant decrease was found in the severity of the children’s dyssomnia. No changes in ADHD symptoms were noted. Gains were generally maintained at the 3-month follow-up. Parents perceived the intervention as being “helpful” to “very helpful.”

Conclusion: Based on the initial data, this intervention shows promise as an effective and feasible treatment.