bluuebunny/crossref_metadata_2025 huggingface dataset:
A 2‐Year Clinical Report of Patients Treated With Two Loading Protocols for Mandibular Overdentures: Early Versus Conventional Loading
Authors: Turkyilmaz Ilser , Tözüm Tolga F. , Tumer Celal , Ozbek Esma Nida
Published: November 2006

Background: The original Brånemark protocol for dental implant treatment was based on submerged healing prior to loading. In recent years, immediate/early functional loading has been reported to be possible with high success for various indications including two splinted mandibular implants supporting an overdenture. However, there are a limited number of studies regarding the early loading protocol for two unsplinted mandibular implants supporting an overdenture.

Methods: A total of 26 edentulous patients were treated with two unsplinted dental implants supporting mandibular overdentures. All implants were placed in the canine regions of each mandible according to the one‐stage surgery. For the test group, overdentures were connected 1 week after surgery, and for the control group, overdentures were connected 3 months after surgery. Peri‐implant parameters were recorded 1, 6, 12, 18, and 24 months after surgery. Marginal bone levels were evaluated at implant placement and after 6, 12, 18, and 24 months. Clinical stability measurements were performed at surgery, and after 3, 6, 12, 18, and 24 months.

Results: No implant from either group was lost during 2 years. Clinical peri‐implant parameters, clinical implant stability measurements, and marginal bone resorptions showed no statistically significant differences between the two groups during 24 months.

Conclusion: The results of this clinical trial suggest that the early loading approach of two dental implants supporting a mandibular overdenture does not jeopardize peri‐implant soft tissue health, marginal bone resorption, and implant stability.
Gingival Crevicular Fluid Matrix Metalloproteinase (MMP)‐7, Extracellular MMP Inducer, and Tissue Inhibitor of MMP‐1 Levels in Periodontal Disease
Authors: Emingil Gülnur , Tervahartiala Taina , Mãntylã Pãivi , Määttä Marko , Sorsa Timo , Atilla Gül
Published: November 2006

Background: During periodontal inflammation, matrix metalloproteinases (MMPs) are under the control of several regulatory mechanisms including the upregulation of expression by inducers and downregulation by inhibitors. Our study aimed to examine the levels and molecular forms of MMP‐7, tissue inhibitor of MMP (TIMP)‐1, and extracellular matrix metalloproteinase inducer (EMMPRIN) in gingival crevicular fluid (GCF) from patients with different periodontal diseases.

Methods: A total of 80 subjects (20 patients with generalized aggressive periodontitis [GAgP], 20 with chronic periodontitis [CP], 20 with gingivitis, and 20 periodontally healthy subjects) were included in this study. Periodontal status was evaluated by measuring probing depth, clinical attachment loss, presence of bleeding on probing, and plaque. GCF MMP‐7, TIMP‐1, and EMMPRIN levels and molecular forms were analyzed by enzyme‐linked immunosorbent assay (ELISA) and Western immunoblot techniques using specific antibodies.

Results: Total amounts of GCF MMP‐7 were found to be similar between the study groups. GAgP, CP, and gingivitis groups had significantly higher total amounts of GCF EMMPRIN compared to healthy subjects (P <0.008). Among the patient groups, the GAgP group had the highest total amount of GCF EMMPRIN relative to the gingivitis group (P = 0.0004). Soluble EMMPRIN existed in GCF in multiple molecular‐weight species especially in periodontitis‐affected GCF under non‐reducing conditions, i.e., 30‐, ‐5‐, 100‐, 180‐, and 200‐kDa species. All patient groups had significantly elevated total amounts of GCF TIMP‐1 relative to the healthy group (P <0.0001). GAgP and CP groups also had a higher total amount of GCF TIMP‐1 compared to the gingivitis group (P <0.0001 and P <0.0001, respectively). The GAgP group had higher GCF TIMP‐1 and EMMPRIN levels compared to the CP group, but this elevation did not reach statistical significance.

Conclusions: Our data indicate that MMP‐7 is associated with the innate host defense in periodontal tissues. Increased EMMPRIN and TIMP‐1 levels in GCF are associated with the enhanced severity of periodontal inflammation, indicating that these molecules can participate in the regulation of progression of periodontal diseases. To our knowledge, the present study demonstrated the presence of soluble forms of EMMPRIN in GCF of patients with different periodontal diseases for the first time.
The Mental Foramen and Nerve: Clinical and Anatomical Factors Related to Dental Implant Placement: A Literature Review
Authors: Greenstein Gary , Tarnow Dennis
Published: November 2006

Background: The mental foramen is a strategically important landmark during osteotomy procedures. Its location and the possibility that an anterior loop of the mental nerve may be present mesial to the mental foramen needs to be considered before implant surgery to avoid mental nerve injury.

Methods: Articles that addressed the position, number, and size of the mental foramen, mental nerve anatomy, and consequences of nerve damage were evaluated for information pertinent to clinicians performing implant dentistry.

Results: The mental foramen may be oval or round and is usually located apical to the second mandibular premolar or between apices of the premolars. However, its location can vary from the mandibular canine to the first molar. The foramen may not appear on conventional radiographs, and linear measurements need to be adjusted to account for radiographic distortion. Computerized tomography (CT) scans are more accurate for detecting the mental foramen than conventional radiographs. There are discrepancies between studies regarding the prevalence and length of the loop of the mental nerve mesial to the mental foramen. Furthermore, investigations that compared radiographic and cadaveric dissection data with respect to identifying the anterior loop reported that radiographic assessments result in a high percentage of false‐positive and ‐negatives findings. Sensory dysfunction due to nerve damage in the foraminal area can occur if the inferior alveolar or mental nerve is damaged during preparation of an osteotomy.

Conclusions: To avoid nerve injury during surgery in the foraminal area, guidelines were developed based on the literature with respect to verifying the position of the mental foramen and validating the presence of an anterior loop of the mental nerve. These guidelines included leaving a 2 mm zone of safety between an implant and the coronal aspect of the nerve; observation of the inferior alveolar nerve and mental foramen on panoramic and periapical films prior to implant placement; use of CT scans when these techniques do not provide clarity with respect to the position of the nerve; surgical corroboration of the mental foramen's position when an anterior loop of the mental foramen is suspected of being present or if it is unclear how much bone is present coronal to the foramen to establish a zone of safety (in millimeters) for implant placement; once a safety zone is identified, implants can be placed anterior to, posterior to, or above the mental foramen; and prior to placing an implant anterior to the mental foramen that is deeper than the safety zone, the foramen must be probed to exclude the possibility that an anterior loop is present. In general, altered lip sensations are preventable if the mental foramen is located and this knowledge is employed when performing surgical procedures in the foraminal area.
A National Survey of Tobacco Cessation Programs for Youths
Authors: Curry Susan J. , Emery Sherry , Sporer Amy K. , Mermelstein Robin , Flay Brian R. , Berbaum Michael , Warnecke Richard B. , Johnson Timothy , Mowery Paul , Parsons Jennifer , Harmon Lori , Hund Lisa , Wells Henry
Published: December 2006

Objectives. We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics.

Methods. We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified.

Results. We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was $2000. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment.

Conclusions. There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths’ smoking prevalence.
Characteristics of Persons With Heterosexually Acquired HIV Infection, United States 1999–2004
Authors: Espinoza Lorena , Hall H. Irene , Hardnett Felicia , Selik Richard M. , Ling Qiang , Lee Lisa M.
Published: December 2006

Objectives. In the United States a growing proportion of cases of heterosexually acquired HIV infections occur in women and in persons of color. We analyzed the association between race/ethnicity, whether diagnoses of HIV infection and AIDS were made concurrently, and the survival after diagnosis of heterosexually acquired AIDS.

Methods. We used data from 29 states that report confidential name-based HIV/AIDS cases to the Centers for Disease Control and Prevention to calculate estimated annual percentage change in the number of actual diagnoses and analyzed the association between race/ethnicity and concurrent diagnoses of HIV and AIDS. We adjusted for reporting delays and absence of information about HIV risk factors.

Results. During 1999 to 2004, diagnoses of heterosexually acquired HIV were made for 52 569 persons in 29 states; 33 554 (64%) were women. Among men and women, 38 470 (73%) were non-Hispanic Black; 7761 (15%), non-Hispanic White; and 5383 (10%), Hispanic. The number of persons with heterosexually acquired HIV significantly increased: 6.1% among Hispanic men (95% confidence interval=2.7, 9.7) and 4.5% among Hispanic women (95% confidence interval=1.8, 7.3). The number significantly decreased (–2.9%) among non-Hispanic Black men. Concurrent HIV and AIDS diagnoses were slightly more common for non-Hispanic Whites (23%) and Hispanics (23%) than for non-Hispanic Blacks (20%).

Conclusions. To decrease the incidence of heterosexually acquired HIV infections, prevention and education programs should target all persons at risk, especially women, non-Hispanic Blacks, and Hispanics.
The Impact of Cost on the Availability of Fruits and Vegetables in the Homes of Schoolchildren in Birmingham, Alabama
Authors: Ard Jamy D. , Fitzpatrick Stephanie , Desmond Renee A. , Sutton Bryce S. , Pisu Maria , Allison David B. , Franklin Frank , Baskin Monica L.
Published: December 2006

Objectives. Fruit and vegetable cost is a presumed barrier to intake. We sought to determine whether fruit and vegetable cost and consumers’ race and income would predict availability of fruits and vegetables in homes of schoolchildren in the Birmingham, Ala, area.

Methods. Data on availability of 27 fruit and vegetable items were obtained from homes of 1355 children (32% African American) in the Birmingham area. Fruit and vegetable costs were obtained from the US Department of Agriculture. We used discrete choice analysis with the dependent variable represented as presence or absence of the fruit or vegetable item. Explanatory variables included fruit and vegetable price per serving; child’s gender, race, and age; and parent’s body mass index and income.

Results. Higher cost was inversely related to fruit and vegetable availability. Higher income, African American race, and female gender were positively related to availability. Cost per serving was stratified into 3 categories—low, medium, and high. Relative to low-cost items, only high-cost items decreased the odds of availability significantly.

Conclusions. Fruit and vegetable cost does impact availability and has the greatest impact for high-cost items. Although cost was inversely related to availability, African Americans reported higher fruit and vegetable availability than Whites. Additional studies are needed to determine whether food items of lower nutritive value and comparable cost impact availability.
Strategic Responses to Deregulation and Their Performance Implications in the U.S. Airline Industry
Authors: Goll Irene , Johnson Nancy Brown , Rasheed Abdul A.
Published: December 2006

This study examines the relationships between deregulation, business strategy (low cost, differentiation, and scope), size, and firm performance in the U.S. airline industry based on archival data for the Major, National, and Large Regional air carriers in the U.S. from 1972 to 1995. Cross-sectional time series regression analysis shows that deregulation had a significant impact on the strategic choices made by airlines. Results also support a significant relationship between business strategy and firm performance. Further, the study found that firm size moderates the environment-business strategy relationship and the business strategy-firm performance relationship, thereby supporting the salience of firm size as a contingency variable in strategy studies.
Limited Observation in Mutual Consent Networks
Authors: McBride Michael
Published: December 2006

This paper studies mutual consent social networks in which individuals imperfectly monitor others' network ties and have incomplete information about the benefits of network participation. I introduce the Conjectural Pairwise Stability concept, which generalizes Jackson and Wolinsky's (1996) Pairwise Stability concept to allow for limited observation, and apply it to a specific mutual consent network formation game. While limited observation generally leads to the existence of less efficient stable networks, I find that it can also lead to the existence of efficient stable networks. Moreover, stability restrictions considered in previous work lose their refining power as observation becomes more limited.
New Approaches to Ranking Economics Journals
Authors: Kodrzycki Yolanda K. , Yu Pingkang
Published: December 2006

We develop a flexible, citations- and reference-intensity-adjusted ranking technique that allows a specified set of journals to be evaluated using a range of alternative criteria. We also distinguish between the influence of a journal and that of a journal article, with the latter concept arguably being more relevant for measuring research productivity. The list of top economics journals can (but does not necessarily) change noticeably when one examines citations in the social science and policy literatures, and when one measures citations on a per-article basis. The changes in rankings are due to the broad interest in applied microeconomics and economic development, to differences in citation norms and in the relative importance assigned to theoretical and empirical contributions, and to the lack of a systematic effect of journal size on influence per article. We also find that economics is comparatively self-contained but nevertheless draws knowledge from a range of other disciplines.
Designing Auctions in R&D: Optimal Licensing of an Innovation
Authors: Brocas Isabelle
Published: December 2006

We study an R&D game in which a research unit undertakes a (non-observable) research effort and, if an innovation is obtained, auctions licenses to a pool of producers. Each producer has a private valuation for the license and suffers a negative externality when a competitor becomes a licensee. We compare the optimal rule for the allocation of licenses and the level of research effort implemented by the innovator in two scenarios: free licensing by the innovator vs. optimal regulation. As long as the cost of public intervention is sufficiently low, free licensing induces two different types of inefficiencies: an excessively high price for licenses and a suboptimal dissemination of knowledge, and an excessively low research effort. This indicates that public intervention should combine the following measures: (i) an antitrust agency which limits the royalties that innovators can ask for a license, and (ii) a direct subsidy to research activity.
Increasing Returns, Input-Output Linkages, and Technological Leapfrogging
Authors: Gallo Fredrik
Published: December 2006

Firms agglomerate in one region due to increasing returns, input-output linkages and transportation costs. In the de-industrialised region factor prices are lower and a new technology may be profitable to adopt in that region instead, inducing a change in the technological leadership. This paper shows that the risk of locking in to an old technology is monotonically increasing in the benefits of agglomeration. Greater incompatibility between technologies also increases the risk of rejecting potentially superior manufacturing processes.
Transmission System Upgrading - Analyzing the Alternatives for Final Decision Making
Authors: Chinnasamy Palanichamy , Nadarajan Sundar Babu
Published: December 2006

At present the Indian Power Sector is seriously considering the optimization of their existing inter-regional transmission links, and also planning to form new inter-regional links. As one of the options, Thyristors Controlled Series Compensation (TCSC) scheme has been implemented recently in the Uttar Pradesh State, in the 400 kV links between Anpara and Unnao, and further efforts have not been made yet. At this stage, as a helping hand to the Power Sector in its decision-making, this paper explores the need for further transmission system upgrading, and based on a prototype transmission system study, it identifies a few more inter-regional transmission links for TCSC implementation.
Higly fusogenic cationic liposomes transiently permeabilize the plasma membrane of HeLa cells
Authors: Stebelska Katarzyna , Wyrozumska Paulina , Gubernator Jerzy , Sikorski Aleksander
Published: December 2006

Cationic liposomes can efficiently carry nucleic acids into mammalian cells. This property is tightly connected with their ability to fuse with negatively charged natural membranes (i.e. the plasma membrane and endosomal membrane). We used FRET to monitor and compare the efficiency of lipid mixing of two liposomal preparations — one of short-chained diC14-amidine and one of long-chained unsaturated DOTAP — with the plasma membrane of HeLa cells. The diC14-amidine liposomes displayed a much higher susceptibility to lipid mixing with the target membranes. They disrupted the membrane integrity of the HeLa cells, as detected using the propidium iodide permeabilization test. Morphological changes were transient and essentially did not affect the viability of the HeLa cells. The diC14-amidine liposomes were much more effective at either inducing lipid mixing or facilitating transfection.
Controlling fine particle formation processes using a concentric microreactor
Authors: Nagasawa Hideharu , Tsujiuchi Tatsuya , Maki Taisuke , Mae Kazuhiro
Published: November 2006

To clarify the mechanism of fine‐particle formation processes in a multilamination type microreactor that proceeds mainly due to molecular‐diffusion‐induced mixing, the relation between the size and distribution, and reaction‐operation condition in experimental and numerical approaches is investigated. For experimental study, a concentric microreactor was used, and titania fine‐particle formation was examined as a model reaction. Based on the hypothesis on the fine‐particle formation mechanism, from the experimental results derived, a relatively simple calculation model was made, and validity demonstrated by showing the coincidence of the calculation results and the experimental results. Also, the calculation model was used to establish a technique for predicting the reactant concentration profiles in the microchannel, particle‐growth rate, number of formed particles, and nucleation region. Thus, the proposed analysis method will be useful as a guideline for designing microreactors to form fine particles, and will provide industrially information. © 2006 American Institute of Chemical Engineers AIChE J, 2007
Understanding and revamping of industrial scale SMB units for p‐xylene separation
Authors: Minceva Mirjana , Rodrigues Alírio E.
Published: November 2006

One of the first applications of Simulated Moving Bed (SMB) technology was in p‐xylene recovery from mixed xylenes. The three main industrial processes for p‐xylene separation from mixed xylenes based on SMB technology are: UOP's Parex, IFP's Eluxyl, and Toray's Aromax. These units operate in liquid phase (T = 180°C and P = 9 bar), achieving high recovery of almost pure p‐xylene with high on‐stream efficiency and extended adsorbent life. In this work, the industrial scale SMB process is investigated from modeling, simulation, and optimization points of view, using experimentally measured xylene adsorption equilibrium and kinetics data on ion exchanged faujasite zeolite. The aim is to develop tools for training of SMB unit operators and choice of the best operating conditions. Useful studies for better understanding of the influence of the operating parameters, adsorbent packing, and separation requirements on unit productivity are presented. SMB unit revamping strategies and operative actions are proposed. The practical application of “separation volume” methodology in the selection of optimum operating conditions that lead to maximum p‐xylene productivity with minimal desorbent consumption is described. © 2006 American Institute of Chemical Engineers AIChE J, 2007
Control of gradient copolymer composition in ATRP using semibatch feeding policy
Authors: Wang Rui , Luo Yingwu , Li Bo‐Geng , Zhu Shiping
Published: November 2006

Controlled/living radical copolymerization (CLRcoP) operated in a batch process is subject to composition drifting and thus produces spontaneous gradient copolymer. The composition distribution along the chain length of individual chains is solely determined by the reactivities of comonomers and the as‐synthesized product is uncontrolled. Design of the composition vs. chain length profile provides a new route for developing polymer materials with tailor‐made properties. Presented in this article is a theoretical mainframe used for the control over composition distribution along the chain length in atom transfer radical copolymerization. The control is based on a semibatch reactor technology with programmed comonomer feeding rates. Illustrated are three copolymerization model systems with representative reactivity ratios. The targeted composition distribution profiles are uniform, linear gradient, parabolic gradient, hyperbolic gradient, and di‐block and tri‐block distributions. © 2006 American Institute of Chemical Engineers AIChE J, 2007
Domain 1 of the urokinase‐type plasminogen activator receptor is required for its morphologic and functional, β2 integrin–mediated connection with actin cytoskeleton in human microvascular endothelial cells: Failure of association in systemic sclerosis endothelial cells
Authors: Margheri Francesca , Manetti Mirko , Serratì Simona , Nosi Daniele , Pucci Marco , Matucci‐Cerinic Marco , Kahaleh Bashar , Bazzichi Laura , Fibbi Gabriella , Ibba‐Manneschi Lidia , Rosso Mario Del
Published: November 2006

Objective

In systemic sclerosis (SSc) microvascular endothelial cells (MVECs), angiogenesis is blocked by matrix metalloproteinase 12–dependent cleavage of domain 1 of the urokinase‐type plasminogen activator receptor (uPAR). Since integrins are associated with the invasive activity of uPAR in angiogenesis, this study was undertaken to show whether full‐size and truncated uPAR are differentially associated with integrins and with motor components of the cytoskeleton.

Methods

SSc and normal MVECs were isolated from human skin biopsy specimens and studied by confocal laser scanning microscopy and immunoprecipitation to assess the mechanisms of association of truncated and full‐size uPAR with integrins and the actin cytoskeleton. The integrin composition of the MVECs was studied by reverse transcription–polymerasechain reaction. Cell migration and capillary morphogenesis were studied on fibrinogen substrates. Involvement of Rac and Cdc42 was evaluated by Western blotting.

Results

Only full‐size uPAR showed a connection with the actin cytoskeleton in ECs. This connection was mediated by the uPAR‐associated αM‐ and αX‐subunits of β2 integrin, and was absent from SSc MVECs. The cleaved uPAR was not associated with β2 integrins or with actin. β3 integrins were associated with both the full‐size and cleaved uPAR at focal contacts. The uncoupling of uPAR from β2 integrins in SSc MVECs impaired the activation of Rac and Cdc42 (thus inhibiting their mediation of uPAR‐dependent cytoskeletal rearrangements and cell motility) and blocked the integrin‐engagement–delivered signals to the actin cytoskeleton. Invasion and capillary morphogenesis on fibrinogen‐coated substrates indicated that ligation of uPAR by uPA empowers the β2/β3 integrin–dependent invasion of fibrinogen, and that this system is impaired in SSc MVECs.

Conclusion

The reduced angiogenic properties of SSc MVECs can be explained by the effects of uPAR truncation and the subsequent loss of the β2 integrin–mediated connection of uPAR with the actin cytoskeleton in these ECs.
“What do you expect? You're just getting older”: A comparison of perceived osteoarthritis‐related and aging‐related health experiences in middle‐ and older‐age adults
Authors: Gignac Monique A. M. , Davis Aileen M. , Hawker Gillian , Wright James G. , Mahomed Nizar , Fortin Paul R. , Badley Elizabeth M.
Published: November 2006

Objective

To compare the health experiences of middle‐ and older‐age adults with moderate osteoarthritis (OA) symptoms with experiences of individuals with no chronic health conditions. Similarities and differences in health changes, the meaning of these changes, and their impact were examined.

Methods

Sixteen focus groups (10 OA, 6 control) were conducted with 53 women and 37 men (age 39–88 years). OA participants were recruited from practitioners' offices and The Arthritis Society, Ontario Division. Additional OA participants and controls were recruited from community centers and newspaper advertisements. All participants were asked about changes in health, the impact of these changes, and self‐management strategies. Participants also completed standardized measures including demographic information; the Short Form 36; Western Ontario and McMaster Universities Osteoarthritis Index; and Disabilities of the Arm, Shoulder and Hand questionnaire.

Results

Differences in the depth, breadth, and meaning of symptoms such as pain, stiffness, and fatigue were reported with little overlap between OA and control groups. OA was often seen as part of a normal aging process requiring acceptance, not treatment. However, younger OA participants reported more distress and frustration managing the disease. OA participants reported an impact of their health on work, leisure, social activities, and relationships that was described as upsetting compared with controls.

Conclusion

This study illuminates personal and social factors associated with OA by comparing health experiences of individuals with OA and controls. It highlights directions for future research that can improve our understanding of the needs of individuals with OA and can help link individuals' health status to the broader framework of their lives.
Using internet technology to deliver a home‐based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial
Authors: Van Den Berg M. H. , Ronday H. K. , Peeters A. J. , Le Cessie S. , Van Der Giesen F. J. , Breedveld F. C. , Vliet Vlieland T. P. M.
Published: November 2006

Objective

To compare the effectiveness of 2 Internet‐based physical activity interventions for patients with rheumatoid arthritis (RA).

Methods

A total of 160 physically inactive patients with RA who had a computer with Internet access were randomly assigned to an Internet‐based physical activity program with individual guidance, a bicycle ergometer, and group contacts (individualized training [IT] group; n = 82) or to an Internet‐based program providing only general information on exercises and physical activity (general training [GT] group; n = 78). Outcome measures included quantity of physical activity (questionnaire and activity monitor), functional ability, quality of life, and disease activity (baseline, 3, 6, 9, and 12 months).

Results

The proportion of physically active patients was significantly greater in the IT than in the GT group at 6 (38% versus 22%) and 9 months (35% versus 11%; both P < 0.05) regarding a moderate intensity level for 30 minutes in succession on at least 5 days a week, and at 6 (35% versus 13%), 9 (40% versus 14%), and 12 months (34% versus 10%; all P < 0.005) regarding a vigorous intensity level for 20 minutes in succession on at least 3 days a week. In general, there were no statistically significant differences regarding changes in physical activity as measured with an activity monitor, functional ability, quality of life, or disease activity.

Conclusion

An Internet‐based physical activity intervention with individually tailored supervision, exercise equipment, and group contacts is more effective with respect to the proportion of patients who report meeting physical activity recommendations than an Internet‐based program without these additional elements in patients with RA. No differences were found regarding the total amount of physical activity measured with an activity monitor.
Comparison of efficacy of arthroscopic lavage plus administration of corticosteroids, arthroscopic lavage plus administration of placebo, and joint aspiration plus administration of corticosteroids in arthritis of the knee: A randomized controlled trial
Authors: Van Oosterhout M. , Sont J. K. , Bajema I. M. , Breedveld F. C. , Van Laar J. M.
Published: November 2006

Objective

To compare the efficacy of arthroscopic lavage plus administration of corticosteroids (ALC), arthroscopic lavage plus administration of placebo (ALP), and joint aspiration plus administration of corticosteroids (JAC) in knee arthritis, and to evaluate whether clinical or histologic characteristics determine outcome.

Methods

Patients with knee arthritis (not due to gout, osteoarthritis, or septic arthritis) were randomized over 3 treatment arms: ALC, ALP, and JAC. The primary end point was event‐free survival, with events defined as 1) recurrence or persistence of symptomatic knee swelling necessitating local re‐treatment, or 2) nonimprovement of the knee joint score. Synovial tissue specimens were collected and analyzed histologically to identify predictive factors of responsiveness.

Results

A total of 78 patients were enrolled; 3 patients did not receive their allocated therapy and 3 were lost to followup. The median time until recurrence was 9.6 months after ALC, 3.0 months after JAC, and 1.0 month after ALP, corresponding to a relative risk (RR) of arthritis recurrence of 2.2 for JAC (95% confidence interval [95% CI] 1.2–4.2, P = 0.02) and 4.7 for ALP (95% CI 2.3–9.4, P < 0.0001) compared with ALC. A high versus low synovial extent of fibrosis conferred an RR for recurrence of 5.7 (95% CI 1.6–20.5, P < 0.01) after ALC.

Conclusion

Arthroscopic lavage plus administration of corticosteroids was more effective than arthroscopic lavage plus administration of placebo or joint aspiration plus injection of corticosteroids. The absence of fibrosis was a histologic predictor of a beneficial response.
Prevalence of conventional and lupus‐specific risk factors for cardiovascular disease in patients with systemic lupus erythematosus: A case–control study
Authors: Bessant Rupa , Duncan Rachel , Ambler Gareth , Swanton Jo , Isenberg David A. , Gordon Caroline , Rahman Anisur
Published: November 2006

Objective

Patients with systemic lupus erythematosus (SLE) are significantly more likely to experience a myocardial infarction or a stroke than age‐matched controls. We compared the prevalence of conventional and lupus‐specific risk factors in patients with SLE just before a cardiovascular event and in matched controls with SLE but no cardiovascular disease (CVD).

Methods

Twenty‐nine patients with SLE and CVD were enrolled. For each patient, 2 ethnically‐ and sex‐matched controls were obtained, 1 matched for age and 1 for SLE duration. Data regarding risk factors were collected for the time immediately preceding the relevant cardiovascular event, or at an equivalent time for controls.

Results

Patients' median age at event was 49 years (interquartile range 43–54 years) and mean disease duration was 12.0 ± 7.1 years. Patients with SLE and CVD were more likely than both age and duration controls to be treated for hypertension (P = 0.01 and P = 0.001, respectively) and to have elevated triglyceride levels (P = 0.05 and P = 0.01, respectively). Compared with duration controls, CVD patients were more likely to have lupus anticoagulant (P = 0.03), but less likely to be receiving treatment with hydroxychloroquine (P = 0.003). Compared with age controls, patients were more likely to be current smokers (P = 0.03), to have taken a mean dosage >7.5 mg/day of prednisolone (P = 0.04), and to have been treated with pulsed methylprednisolone (P = 0.03). In multivariable analysis, only hypertension treatment was an independent risk factor for CVD.

Conclusion

We identified significantly increased prevalence of some conventional and lupus‐specific risk factors in patients with SLE immediately before a CVD event compared with controls matched for age or disease duration.
Joint laxity and the relationship between muscle strength and functional ability in patients with osteoarthritis of the knee
Authors: Van Der Esch M. , Steultjens M. , Knol D. L. , Dinant H. , Dekker J.
Published: November 2006

Objective

To establish the impact of knee joint laxity on the relationship between muscle strength and functional ability in osteoarthritis (OA) of the knee.

Methods

A cross‐sectional study of 86 patients with OA of the knee was conducted. Tests were performed to determine varus‐valgus laxity, muscle strength, and functional ability. Laxity was assessed using a device that measures the angular deviation of the knee in the frontal plane. Muscle strength was measured using a computer‐driven isokinetic dynamometer. Functional ability was assessed by observation (100‐meter walking test) and self report (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Regression analyses were performed to assess the impact of joint laxity on the relationship between muscle strength and functional ability.

Results

In regression analyses, the interaction between muscle strength and joint laxity contributed to the variance in both walking time (P = 0.002) and WOMAC score (P = 0.080). The slope of the regression lines indicated that the relationship between muscle strength and functional ability (walking time, WOMAC) was stronger in patients with high knee joint laxity.

Conclusion

Patients with knee OA and high knee joint laxity show a stronger relationship between muscle strength and functional ability than patients with OA and low knee joint laxity. Patients with OA, high knee joint laxity, and low muscle strength are most at risk of being disabled.
Impact of osteoarthritis on rehabilitation for persons with hip fracture
Authors: Nguyen‐Oghalai Tracy U. , Ottenbacher Kenneth J. , Granger Carl V. , Smith Sarah Toombs , Goodwin James S.
Published: November 2006

Objective

To determine the impact of osteoarthritis (OA) on length of rehabilitation stay, Functional Independence Measure (FIM Instrument) ratings at discharge and followup, functional gain, and percentage of patients discharged home.

Methods

We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients. We obtained standardized data for all patients admitted after a hip fracture between 1994 and 2001. Our primary analytical method was multiple regression analysis. Outcome variables were length of stay, FIM Instrument ratings at discharge and followup, functional gain, and percentage of patients discharged home. The predictor variable was the presence of OA. Covariates were age, sex, race/ethnicity, other comorbidity, admission FIM ratings, total hip replacement, and time to followup.

Results

We studied 1,953 patients with OA and 11,441 patients without OA admitted to inpatient rehabilitation facilities after hip fracture. Mean ± SD length of stay for patients with OA was 18.1 ± 10.0 days versus 16.5 ± 8.9 days for those without OA (P < 0.01). After adjusting for age, sex, race/ethnicity, comorbidity, admission FIM ratings, and total hip replacement, OA was associated with a longer rehabilitation stay (1.4 days; P < 0.01) and slightly higher discharge FIM ratings; however, OA was not associated with lower weekly rehabilitation gain, followup FIM ratings, and percentage discharged home.

Conclusion

Persons with hip fracture and OA had longer inpatient rehabilitation length of stay than persons without OA, but there were similarities in weekly rehabilitation gain and percentage discharged home.
Muscle strength, functional performance, and self‐reported outcomes four years after arthroscopic partial meniscectomy in middle‐aged patients
Authors: Ericsson Ylva B. , Roos Ewa M. , Dahlberg Leif
Published: November 2006

Objective

To examine thigh muscle strength, functional performance, and self‐reported outcome in patients with nontraumatic meniscus tears 4 years after operation, and to study the impact of a strength deficit on self‐reported outcome and evaluate the feasibility of 3 performance tests in this patient group.

Methods

The study group comprised 45 patients (36% women, mean age 46.7) who had an arthroscopic partial meniscectomy a mean of 4 years (range 1–6 years) previously. Main outcome measures included isokinetic strength of knee extensors and flexors, functional performance (1‐leg hop, 1‐leg rising, and square‐hop tests), and a self‐reported questionnaire (Knee Injury and Osteoarthritis Outcome Score).

Results

We found lower knee extensor strength and worse 1‐leg rising capacity in the operated leg, but no difference between operated and nonoperated leg for knee flexors (P≤ 0.004 andP> 0.3, respectively). Patients with a stronger quadriceps of the operated leg compared with the nonoperated leg had less pain and better function and quality of life (r = 0.4–0.6,P≤ 0.010). We found the 1‐leg rising and 1‐leg hop tests to be suitable performance tests in middle‐aged meniscectomy patients.

Conclusion

Quadriceps strength is reduced in the meniscectomized leg compared with the nonoperated leg 4 years after surgery. This relative quadriceps weakness significantly affects objective and self‐reported knee function, pain, and quality of life, indicating the importance of restoring muscle function after meniscectomy in middle‐aged patients.
Availability of pediatric rheumatology training in United States pediatric residencies
Authors: Mayer Michelle L. , Brogan Laura , Sandborg Christy I.
Published: November 2006

Objective

To characterize the availability of pediatric rheumatology training in general pediatric residencies.

Methods

We surveyed 195 pediatric residency program directors in the US using a combined Web‐based and paper‐based survey format. The survey asked directors about the availability of an on‐site pediatric rheumatologist in their institution, the availability of formal pediatric rheumatology rotations, and the types of physicians involved in teaching curriculum components related to pediatric rheumatology. Survey responses were analyzed using descriptive and bivariate statistics.

Results

Of the 195 program directors surveyed, 127 (65%) responded. More than 40% of responding programs did not have a pediatric rheumatologist on site. Programs with on‐site pediatric rheumatologists were significantly more likely than those without on‐site pediatric rheumatologists to have an on‐site pediatric rheumatology rotation available (94% versus 9%; P < 0.001). Although pediatric rheumatologists' involvement in 4 curriculum areas relevant to pediatric rheumatology is nearly universal in programs with on‐site pediatric rheumatologists, nearly two‐thirds of programs without on‐site pediatric rheumatologists rely on internist rheumatologists, general pediatricians, or other physicians to cover these areas.

Conclusion

Programs without pediatric rheumatologists on site are less likely to have pediatric rheumatology rotations and are more likely to rely on internist rheumatologists and nonrheumatologists to address rheumatology‐related curriculum components. Lack of exposure to pediatric rheumatology during residency may impede general pediatricians' ability to identify and treat children with rheumatic diseases, undermine resident interest in this field, and perpetuate low levels of supply.
Osteoporosis management in patients with rheumatoid arthritis: Evidence for improvement
Authors: Solomon Daniel H. , Katz Jeffrey N. , Cabral Danielle , Patrick Amanda R. , Bukowski Jack F. , Coblyn Jonathan S.
Published: November 2006

Objective

Osteoporosis in patients with rheumatoid arthritis (RA) is increasingly recognized as a major comorbidity. We examined past management patterns for glucocorticoid‐induced osteoporosis and attempted to improve care through an educational intervention. The goal was to examine the frequency of osteoporosis management in patients with RA treated at a large academic rheumatology practice.

Methods

We performed a structured chart review on randomly selected patients seen during 2004 for RA. Osteoporosis management was defined as a bone mineral density test or receipt of a medication for osteoporosis in the prior 24 months. The frequency of osteoporosis management among our study group was assessed. We also examined how glucocorticoid dosage affected osteoporosis management in adjusted models.

Results

We reviewed the records for 193 patients, 99 had not used glucocorticoids in the prior 24 months, and 94 had used them. Of the total study population, 48% had received a bone mineral density test or medication for osteoporosis. Some form of osteoporosis management was present for 64% of patients taking ≥5 mg prednisone for ≥3 months compared with 38% for patients taking none (P = 0.002). Predictors of osteoporosis management included older age, female sex, glucocorticoid dosage, and prior osteoporosis diagnosis or fracture.

Conclusion

The frequency of osteoporosis management appears to have increased compared with a prior chart review.
Long‐term impact of early treatment on radiographic progression in rheumatoid arthritis: A meta‐analysis
Authors: Finckh Axel , Liang Matthew H. , van Herckenrode Carmen Mugica , de Pablo Paola
Published: November 2006

Objective

Although early initiation of disease‐modifying antirheumatic drugs (DMARDs) is effective in controlling short‐term joint damage in individuals with rheumatoid arthritis (RA), the long‐term benefit in disease progression is still controversial. We examined the long‐term benefit of early DMARD initiation on radiographic progression in early RA.

Methods

We identified published and unpublished clinical trials and observational studies from 1966 to September 2004 examining the association between delay to treatment initiation and progressive radiographic joint damage. We included studies of persons with RA disease duration <2 years and DMARD therapy of similar efficacy during followup. The differences in annual rates of radiographic progression between early and delayed therapy were pooled as standardized mean differences (SMDs).

Results

A total of 12 studies met the inclusion criteria. The pooled estimate of effects from these studies demonstrated a significant reduction of radiographic progression in patients treated early (−0.19 SMD, 95% confidence interval [95% CI] −0.34, −0.04), which corresponded to a −33% reduction (95% CI −50, −16) in long‐term progression rates compared with patients treated later. Patients with more aggressive disease seemed to benefit most from early DMARD initiation (P = 0.04).

Conclusion

These results support the existence of a critical period to initiate antirheumatic therapy, a therapeutic window of opportunity early in the course of RA associated with sustained benefit in radiographic progression for up to 5 years. Prompt initiation of antirheumatic therapy in persons with RA may alter the long‐term course of the disease.
Association of antinucleosome antibodies with disease flare in serologically active clinically quiescent patients with systemic lupus erythematosus
Authors: Ng K. P. , Manson J. J. , Rahman A. , Isenberg D. A.
Published: November 2006

Objective

To identify the prevalence of serologically active clinically quiescent (SACQ) patients in a cohort of 290 patients with systemic lupus erythematosus (SLE). We investigated if the presence of anti–double‐stranded DNA (anti‐dsDNA) or antinucleosome (anti‐NCS) antibodies during the SACQ period was associated with future flares.

Methods

SACQ patients defined as clinically inactive for 6 months (global British Isles Lupus Activity Group index [BILAG] scores <6) and serologically active (anti‐dsDNA antibodies >50 units/ml on at least 2 occasions by enzyme‐linked immunosorbent assay [ELISA]) were identified. Patient sera collected during the defined SACQ period were also tested for anti‐NCS antibodies (ELISA). We retrospectively reviewed patient clinical details and episodes of flare using the BILAG activity index.

Results

Twenty‐seven (9%) patients were SACQ. Seventeen (81%) patients experienced a flare (total of 91 flares, up to 12 flares per person) in the next 5 years. Median duration to first flare was 15 months (range 2–46). Time to first flare after SACQ period was significantly correlated with the presence of anti‐NCS (P = 0.0012), high anti‐NCS antibody titers (P = 0.0006), and anti‐dsDNA titers 5 times above the normal limit (P = 0.02). Patients with higher absolute anti‐NCS antibody titers showed a significant correlation with the number of flares (r = 0.57, P = 0.007).

Conclusion

A minority of patients with SLE are SACQ. The majority of these patients experience a flare in the next 5 years and close followup is recommended. Anti‐NCS antibodies may be a better predictor than anti‐dsDNA antibodies for future flares.