bluuebunny/crossref_metadata_2025 huggingface dataset:
Modelling ventilation by means of combined mixing and displacement flow
Authors: Waters J R , Simons M W
Published: October 2002

It is convenient to describe the ventilation of an occupied space solely by a single parameter, namely the air change rate, and to characterize air distribution as either mixing or displacement. In practice, distributions which are perfect mixing or displacement are rare, but to analyse air distribution patterns it is usually necessary to use a complex model (e.g., computational fluid dynamics), thus losing the conceptual simplicity of the mixing and displacement models. By combining the mixing and displacement models, a new two-parameter model is proposed which retains the conceptual simplicity of its parents. To the air change rate is added a displacement efficiency parameter which shows the closeness with which the air distribution approaches perfect displacement and gives an overall indication of air distribution sufficient for many applications.
Learner acquaintanceship and oral proficiency test pair-task performance
Authors: O’Sullivan Barry
Published: October 2002

This paper explores the effect on pair-task performance of test-takers’ familiarity with their partner. O’Sullivan (2000a), like McNamara (1996), sees test performance as being affected by a number of factors, related to the test-taker, the interlocutor and the task. Evidence from the psychology literature, and anecdotal evidence from language learners and teachers, suggests that familiarity with one’s partner in an interactive task might positively affect performance, although in the only published study to date, Porter (1991a) found no evidence to support this hypothesis.

A group of 32 Japanese learners performed a series of three tasks (personal information exchange, narrative, and decision making), once with a friend, and again with a person who was not known to them. All performances were video-recorded, awarded scores by trained raters and transcribed for analysis. Results suggest evidence of an `acquaintanceship’ effect, with subjects achieving higher scores when working with a friend. However, analysis of the language suggests that there is no effect on linguistic complexity, and that there is a sex-ofinterlocutor by acquaintanceship interaction effect for accuracy.

These results appear to support findings in the literature on second language acquisition, which suggest that learners vary their language when interacting with familiar or unfamiliar speakers (Plough and Gass, 1993; Tarone and Liu, 1995), although they contradict the findings of Porter (1991a). Despite its limitations, the results of this study confirm that any test format that employs tasks requiring interaction between individuals is in need of urgent and extensive study.
Doctors’ orders for language testers: the origin and purpose of ethical codes
Authors: Boyd Kenneth , Davies Alan
Published: October 2002

Accountability in language testing, as in other professions, requires openness to stakeholders. Professions are increasingly publishing a Code of Ethics which sets out the principles governing the conduct of their members. The long tradition of medicine’s use of a Code of Ethics is discussed and the arguments in that profession with regard to openness is considered. The International Language Testing Association (ILTA) has recently agreed its own Code of Ethics (see Appendix 1). This article considers how far this Code of Ethics makes language testing an open profession and notes the dangers of face validity and of hypocrisy. The article then discusses the need for a Code of Practice to provide detailed guidance to language testers with regard to their professional responsibilities. It is concluded that:

• it is unlikely that an international organization could develop one universal Code of Practice, given the demands of enforceability and relativism; and

• that the way forward may be to encourage local Codes of Practice.

Caution is, however, necessary, given the possibility of tension between relativism and modernity, such that a local Code of Practice could become an alternative Code of Ethics.
Consultation as a model for providing speech and language therapy in schools: a panacea or one step too far?
Authors: Law James , Lindsay Geoff , Peacey Nick , Gascoigne Marie , Soloff Nina , Radford Julie , Band Sue
Published: October 2002

In recent years there has been a pressure to introduce an indirect “consultative model” to working with children with speech and language needs. It is favoured by educationists because it avoids the need to take children out of class and embeds any support children received in the curriculum. This paper reports the results of a recent study which indicates that Speech and Language Therapists are concerned about the universal application of this model of service delivery. It introduces and discusses a number of interrelated factors which need to be in place before the consultative model can be successfully introduced.
Should we rely on nasopharyngeal temperature during cardiopulmonary bypass?
Authors: Johnson R Ian , Fox Mark A , Grayson Antony , Jackson Mark , Fabri Brian M
Published: October 2002

A potential morbidity of incomplete re-warming following hypothermic cardiopulmonary bypass (CPB) is cardiac arrest. In contrast, attempts to fully re-warm the patient can lead to cerebral hyperthermia. Similarly, rigid adherence to 37.0°C during normothermic CPB may also cause cerebral overheating. The literature demonstrates scant information concerning the actual temperatures measured, the sites of temperature measurement and the detailed thermal strategies employed during CPB. A prospective, randomized, controlled study was undertaken to investigate the ability to manage perfusion temperature control in a group of hypothermic patients (28°C) and a group of normothermic patients (37°C). Eighty patients presenting for first-time, elective coronary artery bypass graft surgery (CABG) were randomly allocated to the hypothermic and normothermic groups. All surgery was performed by one surgeon and the anaesthesia managed by one anaesthetist. Temperature measurements were made at the nasopharyngeal (NP) site, as well as in the arterial line of the CPB circuit. The hypothermic group had the arterial blood temperature lowered to 25.0°C to maintain the NP temperature at 28.0-28.5°C. During re-warming, the arterial blood was raised to 38.0°C. Meanwhile, in the normothermic group, the arterial blood temperature was raised to a maximum of 37.0°C to maintain NP temperature at 36.5-37.0°C. Despite strict guidelines, some patients transgressed the temperature control limits. Two patients in the hypothermic group failed to reach an NP temperature of 28.5°C. Twenty-six patients were managed entirely within the control limits. During re-warming in both groups, control of both arterial and NP temperature was well managed with only 25% patients breaching the respective upper control limits. During the re-warming phases of CPB, we were unable to make any correlation between NP temperature and arterial blood temperature, using body weight or body mass index as predictors. Based on the results obtained, we recommend that strict criteria should be implemented for the management of temperature during CPB, in conjunction with more emphasis being placed on monitoring arterial blood temperature as a marker of potential cerebral hyperthermia. We should, therefore, not rely on NP temperature measurement alone during CPB.
Conventional approach to glucose management for diabetic patients undergoing coronary artery bypass surgery
Authors: Gustafson Patricia A , Zarro Debra L , Palanzo David A , Manley Norman J , Montesano Ralph M , Quinn Michael , Elmore Barbara-Anne , Castagna Joseph M
Published: October 2002

Continuous insulin infusion was not an effective mode of treatment in maintaining safe blood glucose levels (<200 mg/dl) during the intraoperative period of diabetic patients requiring open-heart surgery. The two modifications investigated to gain better control of the blood glucose were a change in the base solution of the cardioplegia and the use of a sliding insulin scale. Fifty patients including Type I and Type II diabetics were selected for the purpose of this study. The patients were then randomly divided into two groups categorized by the type of cardioplegic solution administered and the mode of insulin treatment. Group I patients received a dextrose 5%-based cardioplegic solution and blood glucose was treated via continuous intravenous insulin infusion. Group II patients received normal saline 0.9%-based cardioplegic solution and blood glucose was treated via sliding scale. Blood glucose levels were monitored pre- and postcardio- pulmonary bypass (CPB) and every 30 min while on CPB. Glucose values were analyzed by group t test. A p value of < 0.05 was considered statistically significant. When comparing Group I (mean=258 mg/dl) with Group II (mean= 158 mg/dl), there was a statistically significant difference between the glucose values at each of the time intervals when the glucose values were recorded. In conclusion, Group II maintained an acceptable blood glucose level (<200 mg/dl) throughout the entire intra- operative period, which suggests that the combination of the sliding insulin scale and modification of the base cardioplegic solution was an effective mode of treatment.
A 10-year review of pediatric perfusion practice in North America
Authors: Cecere Giovanni , Groom Robert , Forest Richard , Quinn Reed , Morton Jeremy
Published: October 2002

In December 1999, 145 North American pediatric open-heart institutions were mailed an updated survey as a follow-up of two earlier surveys, 1989 and 1994. The survey consisted of 81 questions pertaining to demographics, equipment, techniques and patient monitoring. This survey, following a similar format of the two earlier surveys, provides a 10-year review encompassing both new and founded practices performed during the conduct of pediatric cardiopulmonary bypass. Responses were received from 83 hospitals, for a 57% response rate. Of the respondents, 72 were active pediatric open-heart centers, 67% performing both adult and pediatric cardiac surgery and 33% performing pediatric surgery exclusively. The mean number of pediatric cases performed in 1999 was 169, compared to 101 cases in 1989 and 145 cases in 1993. Of the 72 respondents, 51% were performing greater than 100 cases/year, whereas 3% of centers were performing under 25 cases/year. As the decade progressed, bubble oxygenators were completely replaced by their membrane counterpart. The use of ultrafiltration, reported first in the 1989 survey, has risen by over 30%. The use of colloids in the prime, specifically 25% albumin, has increased in use from 34% in 1989 to 85% in 1999. Rewarming gradients are used by 100% of respondents with a mean gradient of 9.4°C between the patient and water bath. Myocardial protection has seen an increase of close to 20% in the use of blood cardioplegia. The use of safety devices is also on the rise with more centers using level detectors (79%), bubble detectors (88%) and arterial line filters (96%). Centers relying on the use of cardiac assist devices have increased by 25% since 1989. Results of this survey suggest a movement toward a higher volume of cases being performed at fewer centers. While some diversity is seen, movement toward greater homogeneity, first noted in the 1994 survey, continues in 1999.
A review of leukofiltration in cardiac surgery: the time course of reperfusion injury may facilitate study design of anti-inflammatory effects
Authors: Ortolano Girolamo A , Aldea Gabriel S , Lilly Kevin , O’Gara Paul , Alkon Joseph D , Madera Frederick , Murad Tarek , Altenbern Charles P , Tritt Charles S , Capetandes Anthony , Gikakis Nicolas S , Wenz Barry , Shemin Richard J , Downey Francis X
Published: October 2002

The systemic inflammatory response syndrome (SIRS) is a well-recognized phenomenon attending cardiopulmo-nary bypass (CPB) surgery. SIRS leads to costly complications and several strategies intended to ameliorate the symptoms have been studied, including leukocyte reduction using filtration. Although the body of work suggests that leukoreduction attenuates SIRS, discrepancies remain within the literature. The recent literature is reviewed, highlighting the areas where concordance is lacking. Investigations into many promising device-related technologies are often deterred by the high costs of clinical trials. Adding to costs is the fact that clinical end points generally require large sample sizes. An understanding, however, of the pathogenesis of reperfusion injury can guide the investigator to choose physiologic response measures that correlate well with clinical outcome, but feature low inherent variability, allowing for clinical trials with smaller sample sizes. With this goal in mind, a model for the pathogenesis of reperfusion injury is described. Using a model of reperfusion injury as underpinnings for the design of prospective pilot studies, we show that salvaged blood reinfused following CPB elicits time-dependent effects on pulmonary function as predicted by the model. Data are illustrative of principles that could expand the scope of clinical investigations designed to validate the use of physiologic response measures as correlates of clinical outcome. Such investigations would target surrogate markers of clinical outcome, measured at clinically relevant times. Once validated, these surrogate markers would, thereafter, become economical screening tools for clinical studies of device-related or pharmacological anti-inflammatory interventions.
How comparable are tests of apraxia?
Authors: Butler J A
Published: October 2002

Objective: To compare commonly used tests for the diagnosis of apraxia. Measures: People with unilateral left hemisphere lesions, diagnosed with apraxia, were compared in their scoring on commonly used tests for apraxia ( n = 17).

Setting: Rivermead Rehabilitation Centre, Oxford, England, a specialist inpatient neurological unit.

Results: Production moment correlations were low, or did not reach signi”cance level between three tests for ideomotor apraxia ( r = 0.46 p < 0.05 one-tailed test, r = 0.005 NS, r = –0.23 NS, df = 15). Six of the seventeen apraxic patients scored above cut-off point on one test, but below cut-off point on others, indicating that commonly used tests for apraxia may not be reliable for diagnosis if used singly. Internal consistency within tests was also variable (Cronbach’s a 0.72, 0.85, 0.85).

Conclusion: The commonly used tests for apraxia may identify different people as ‘apraxic’, possibly by eliciting different aspects of apraxia and identifying potential subtypes of the condition. The use of multiple tests is, therefore, recommended in order to identify people with apraxia. The need for repeat reliability studies for apraxia assessments, together with a search for a ‘gold standard’ test is apparent.
Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review
Authors: de Kroon J R , van der Lee J H , IJzerman M J , Lankhorst G J
Published: October 2002

Background: Therapeutic electrical stimulation (TES) is a therapeutic strategy aimed at improving impairments of the upper extremity in stroke.

Objective: Assessment of the available evidence on the effect of TES of the affected upper extremity in improving motor control and functional abilities after stroke.

Methods: A systematic literature search was performed to identify randomized controlled trials (RCTs) that have studied the effect of TES on motor control and functional abilities. The methodological quality of the studies was assessed systematically by two raters. The reported outcomes were examined to evaluate the effect of TES and to identify a possible relationship with patient characteristics, method of stimulation and methodological quality. When possible, effect sizes were calculated (Hedges’ g).

Results: Six RCTs were included. The methodological scores ranged from 7 to 16 (maximum 19). All studies assessed the effect on motor control, and four reported a positive effect. Effect sizes calculated in three studies ranged from 0.55 to 1.46. Only two studies assessed the effect on functional ability, one reported a positive effect. Subgroup analyses in two studies suggest a better response to stimulation in less severely affected patients. Apart from this, no relationship between effect and patient characteristics, method of stimulation or methodological quality could be detected.

Conclusions: The present review suggests a positive effect of electrical stimulation on motor control. No conclusions can be drawn with regard to the effect on functional abilities.
Psychosocial— spiritual correlates of death distress in patients with life-threatening medical conditions
Authors: Chibnall John T , Videen Susan D , Duckro Paul N , Miller Douglas K
Published: October 2002

The purpose of this study was to identify demographic, disease, health care, and psychosocial spiritual factors associated with death distress (death-related depression and anxiety). Cross-sectional baseline data from a randomized controlled trial were used. Outpatients (n=70) were recruited from an urban academic medical centre and proprietary hospital. All patients had life-threatening medical conditions, including cancer; pulmonary, cardiac, liver, or kidney disease; HIV/AIDS; or geriatric frailty. Measures of death distress, physical symptom severity, depression and anxiety symptoms, spiritual well-being, social support, patient-perceived physician communication, and patient-perceived quality of health care experiences were administered. In a hierarchical multiple regression model, higher death distress was significantly associated with living alone, greater physical symptom severity, more severe depression symptoms, lower spiritual well-being, and less physician communication as perceived by the patient. Death distress as a unique experiential construct was discriminable among younger patients with specific, diagnosable life-threatening conditions, but less so among geriatric frailty patients. The findings suggest that the experience of death distress among patients with life-threatening medical conditions is associated with the psychosocial spiritual dimensions of the patient's life. Attention to these dimensions may buffer the negative affects of death distress.
How do patients and spouses deal with the serious facts of malignant glioma?
Authors: Salander Pär , Spetz Agneta
Published: October 2002

Malignant glioma is a severe disease with little chance for recovery. Due to its effect on cerebral function, it is also a disease with an obvious social impact on family life. Brain tumours, therefore, produce much of the anguish associated with cancer diseases. There is a lack of prospective studies concerning how patients and spouses together deal with the serious facts of cancer. In this study, a series of 25 consecutive patients with malignant gliomas and their spouses was followed during the whole course of the disease process by repeated thematic interviews. The spouses were also subjected to a summarizing interview after the patient's death. The interviews were analyzed qualitatively in order to detect the various ways the patient spouse couples dealt with this severe situation and how they discussed it with each other. Four different social processes were detected: 1) the patient does not seem to be aware, the spouse is aware but pretends not to be; 2) both are aware, but the patient does not want to share; they drift apart; 3) both are aware, they do/do not talk openly about the gravity of the situation; nevertheless, there is a joint platform; and 4) neither patient nor spouse seems to be aware; they carry on living as before. The patients, compared to the spouses, seemed content with received information. A few of the couples openly discussed death and dying. More common, and apparently sufficient, was a mutual acknowledgement of the serious facts, without using the words ‘death’ and ‘dying’. In a sense, the present findings challenge the awareness categories suggested by Glaser and Strauss.
Holocene climatic changes and environmental history of Iturup Island, Kurile Islands, northwestern Pacific
Authors: Razjigaeva N. G. , Korotky A. M. , Grebennikova T. A. , Ganzey L. A. , Mokhova L. M. , Bazarova V. B. , Sulerzhitsky L. D. , Lutaenko K. A.
Published: October 2002

The study of Holocene deposits on Iturup Island is very important for understanding palaeolandscape changes on the island. It is separated by deep straits from the neighbouring islands and was isolated during the last glacial maximum. Landscape changes over the last 40000 years and the role of refugia on vegetation development are discussed. Changes in natural processes in this region were controlled both by global climatic changes and by regional factors. Birch forests developed at the warming about 36-37 ka ago, whereas tundrapark landscape developed with the cooling of the last glacial maximum. Holocene environments reflect climatic changes and sea-level oscillations. The fluctuation of warm and cold currents influenced the landscape development. At the Holocene Optimum (about 6 ka) broadleaved forests with Quercus, Phellodendron, Carpinus, Juglans, Fagus, Fraxinus and Syinga occupied the Okhotsk side of central Iturup. Climate was warmer than present and the sum of active tempe]ratures (σ ≥10°C) was not less than 1800°C. The warming was coincident with the transgression with the highest sea level up to 3.5 m above present sea level (PSL). Numerous coastal lakes were formed at this time. A shallow strait occurred on the low Vetrovoy isthmus. The sea-level drop at 4700-4500 radiocarbon years BP led to the development of large dunefields only within bays with a flat coast due to the supply of sandy material from the inshore drainage zone. At the beginning of the late Holocene about 4000 BP the vegetation changed very little due to the warm current influence. Cool-temperate forests with dominant Quercus had a wide distribution, but the diversity of broadleaved genera decreased. A minor transgression occurred about 4100-4000 BP with a sea-level rise on about 2.5 m above PSL. Active accumulation of deposits took place in the coastal zone at this time. Great vegetation changes and climatic deterioration took place in the last 2000 years BP. Cool-temperate broadleaved forests were confined to the Okhotsk side of the central island. Grasslands and swamps also developed in the coastal lowlands at this time. A minor regression led to the formation of large dunefields. Isthmuses increased and coastal wetlands with lakes formed. The presence of marine diatoms in floodplain lake deposits indicates a sea-level rise at about 1060 ± 60 BP. At this time warming was not intensive, but was well pronounced. The last phase of active aeolian accumulation took place during the ‘Little Ice Age’ cooling and regression.
The last 3000 years in the Ría de Vigo (NW Iberian Margin): climatic and hydrographic signals
Authors: Diz Paula , Francés Guillermo , Pelejero Carles , Grimalt Joan O. , Vilas Federico
Published: October 2002

The hydrographic evolution of the Ria de Vigo (NW Spain) during the last 3000 years has been reconstructed using benthic foraminiferal assemblages, stable oxygen isotopes, molecular biomarkers and seasurface temperatures (SST) reconstructed from the UK37 index. Benthic oxygen isotopes and SST records provide evidence of episodic salinity contrasts between surface and bottom waters. The comparison of SSTs with other climate records for the Northern Hemisphere has allowed the inference of oceanographic and climatic signals, which describe the changes in hydrographic conditions of the ría. In general, two different periods can be recognized. From 975 cal. BC to cal. AD 1000, the organic carbon is mainly of continental origin, benthic foraminiferal assemblages are typical of environments that are poorly oxygenated, rich in organic matter and dominated by eurihaline taxa. Percentages of planktonic foraminifera are low and SSTs are warmer than today. These data suggest a restricted environment where the exchange with open ocean waters was diminished. At cal. AD 1000, an important hydrographic change in the ría circulation involved an intensification of coastal upwelling processes as reflected in colder SSTs and increases in the contribution of marine organic carbon and planktonic and opportunistic benthic foraminifera. In these conditions, the sediments of the ría recorded not only local factors but also several well-known Northern Hemisphere climate signals.
Determining the age of the mid-Holocene Tsuga cana densis (hemlock) decline, eastern North America
Authors: Bennett K. D. , Fuller J. L.
Published: October 2002

Pollen counts and radiocarbon age determinations from 60 sites in eastern North America are used to determine the age of the mid-Holocene T.ugai canadensis decline, and to analyse the errors associated with such age estimation. The age is determined as 4750 14C yr BP with a standard error of the mean of about 50 years. Despite the quantity of data available, large uncertainties in the choice of age-depth model make it impossible to determine a more precise age for this event. It is likely that there are similar problems, or worse, with attempts to determine the age of other Holocene events. Within the limitations of the available data set, the Tsuga canadensis decline was synchronous across the whole of its range.
Induction of oxidative stress and acetylcholinesterase inhibition in organophosphorous pesticide manufacturing workers
Authors: Ranjbar A , Pasalar P , Abdollahi M
Published: October 2002

Oxidative stress status and acetylcholinesterase (AChE) activity were studied in blood samples obtained from 45 organophosphorous (OP)-formulating pesticide workers with a minimum work history of 1 year in the age range of 23–55. Controls were age-matched workers of a food-making factory. They were evaluated for oxidative stress markers, including thiobarbituric acid-reactive substances (TBARS) indicator of lipid peroxidation (LPO), ferric-reducing ability of plasma (FRAP) indicator of total anti-oxidant capacity, total thiol (SH) groups and gamma glutamyl transpeptidase (GGT) levels in blood and AChE activity in erythrocytes. The results show marked inhibition of AChE activity, increased TBARS, decreased FRAP and decreased thiol group levels in workers. The reduction in activity of AChE correlated well with increased TBARS and decreased FRAP in OP formulators. It is concluded that OP-formulating workers are exposed to more oxidative stress. The measurement of erythrocyte AChE activity in pesticide workers who formulate OPs can be a good monitoring factor and is recommended to be performed in a regular manner.
Statistical evaluation of the revised fixed-dose procedure
Authors: Stallard N , Whitehead A , Ridgway P
Published: October 2002

The fixed-dose procedure (FDP) was introduced as OECD Test Guideline 420 in 1992, as an alternative to the conventional median lethal dose (LD50) test for the assessment of acute oral toxicity (OECD Test Guideline 401). The FDP uses fewer animals and causes less suffering than the conventional test, while providing information on the acute toxicity to allow substances to be ranked according to the EU hazard classification system. Recently the FDP has been revised, with the aim of providing further reductions and refinements, and classification according to the criteria of the Globally Harmonized Hazard Classification and Labelling scheme (GHS). This paper describes the revised FDP and analyses its properties, as determined by a statistical modelling approach. The analysis shows that the revised FDP classifies substances for acute oral toxicity generally in the same, or a more stringent, hazard class as that based on the LD50 value, according to either the GHS or the EU classification scheme. The likelihood of achieving the same classification is greatest for substances with a steep dose–response curve and median toxic dose (TD50) close to the LD50. The revised FDP usually requires five or six animals with two or fewer dying as a result of treatment in most cases.
Reactivation of systemic lupus erythematosus in a dialysis patient after tuberculous peritonitis
Authors: Lui S L , Lam M F , Tse K C , Lo W K
Published: October 2002

The disease activity of patients suffering from lupus nephritis usually becomes quiescent after the onset of end stage renal failure. Reactivation of lupus activity, especially after a long period of dialysis, is uncommon. Factors that might trigger off lupus reactivation after dialysis have not been well defined. We report a case of a 43-year-old Chinese woman on long-term peritoneal dialysis, who developed lupus reactivation with cerebral involvement 2 weeks after she was diagnosed to have tuberculous peritonitis. The close temporal relationship between the tuberculous peritonitis and the lupus reactivation raise the possibility that the tuberculous infection might have triggered off the lupus reactivation.
Lung cavitation in primary antiphospholipid syndrome
Authors: Bertoli A M , Tabares A H , Casas J P , Saurit V , Caeiro F , Alvarellos A
Published: October 2002

Pulmonary complications of primary antiphospholipid syndrome are common and diverse, with thromboembolic events counting as the most frequent manifestation. We present the case of a female patient with a diagnosis of primary antiphospholipid syndrome, pulmonary thromboembolism and infarction followed by lung cavitation.
Purified protein derivative reaction in systemic lupus erythematosus patients. Indirect study of cellular immunity
Authors: Pascual-Ramos V , Hernández-Cruz B , Villalobos I , Sifuentes-Osornio J , Alcocer-Varela J
Published: October 2002

Cutaneous anergy in SLE patients results from disease activity and/or immunosuppressive treatment (IT). The aim of this study was to evaluate purified protein derivative (PPD) reaction in SLE patients. A total of 145 patients and 20 controls were studied. Five units of PPD were applied on day 0, and skin reaction was measured after 3 (PPD1) and 6 (PPD2) days. A booster was applied (day 14), and the reaction was measured after 3 (PPD3) and 6 (PPD4) days.

Non-parametricANOVA test and unpaired Student's t-test were performed. Forty patients (group I) were inactive (MexSLEDAI 3), receiving no IT (at least 3 months previous to the PPD test); 39 (group II) were inactive receiving IT; 24 (group III) were active without IT, and 42 (group IV) were active with IT. Active patients had lower PPD1 (group III, 1.4 ± 0.9; group IV, 0.6 ± 0.5) than inactive patients (group I, 8.4 ± 2.3; group II, 5.1 ± 1.9) and than controls (9.4 ± 3; P ≤ 0.001). Group IV had lower delayed response (PPD2 = 0.3 ± 0.3) than inactive groups (group I, 2.6 ± 0.9; group II, 3.1 ± 0.8) and than controls (7.9 ± 2.5; P ≤ 0.001). Group III had lower delayed reaction P ≤ 0.001).

Active SLE patients, receiving or not receiving IT, had lower skin response to PPD than inactive patients and controls.
Conservation of FceRI gamma chain coding region in normals and in SLE patients
Authors: Wu J , Edberg J C , Gibson A W , Kimberly R P
Published: October 2002

High-frequency single nucleotide polymorphism (SNP) alleles are useful in mapping genes responsible for disease susceptibility. Functionally, Fcg receptors (FcgR) have been implicated in autoimmune disease, and the gene encoding the signaling element for several FcgR, Fc-epsilon-receptor gamma-chain (FceRIg), has several SNPs in the immunoreceptor tyrosine activation motif (ITAM) recorded in GenBank. Direct sequencing of the FceRIg coding region found potentially polymorphic sites in the 50?30 direction in control donors, which were not confirmed in the reverse direction (n 66), and further exploration of 80 SLE patients revealed no non-synonymous SNPs. One normal donor was heterozygous for a non-synonymous SNP at nt 38 which changed the fifth codon from valine (GTG) to methionine (ATG). Although the EST databases suggest candidate SNPs, insertions and deletions, these appear to be artifacts, most probably due to secondary structure. The coding region of FceRIg shows a remarkable absence of nucleotide diversity. Either as yet unidentified regulatory elements of FceRIg or other genes in the region of human chromosome 1q23 are likely to be systemic lupus erythematosus disease susceptibility and severity genes.
Reporting consistency in systemic lupus erythematosus patients: how reliable are patient histories?
Authors: Yazici Y , Erkan D , Harrison M J , Peterson M G , Yazici H
Published: October 2002

Systemic lupus erythematosus (SLE) patients are frequently seen by multiple physicians and at multiple times. In each instance, most of the information important in clinical decision-making is gathered from the patient. There are no studies looking at reporting consistency of certain aspects of SLE patients' history. We studied this by administering the same nine-item questionnaire 4 months apart to the same cohort of SLE patients. In addition, a retrospective chart review was done to correlate the information obtained by prospective questioning and with that on the charts. Our results showed overall good consistency in the areas of general medical history, SLE-specific history and social history. The information gathered by the chart review, in general, went in parallel with that obtained by prospective questioning. This was also true for the poor correlation observed in the family history questions. Many studies and databases depend rather heavily on patient reporting and the quality of this information is usually not substantiated. Our study suggests that, even though SLE patients are generally consistent reporters of certain aspects of their histories, family history information provided is frequently not consistent with previous reporting.
Classes, activity and chronicity indices, and α-smooth muscle actin expression as prognostic parameters in lupus nephritis outcome
Authors: Ravinal R Cuan , Costa R S , Coimbra T M , Pastorello M T , Coelho E B , Dantas M , dos Reis M A
Published: October 2002

Renal biopsies of 86 patients with lupus nephritis were assessed according to the WHO classification, and according to activity and chronicity indices. The aim of the present study was to correlate clinical, and histological features (WHO class, activity and chronicity indices, and a-SM actin expression)with the progression of lupus nephritis, and identify the pathologicalrole of a-SM actin in lupus nephritis. The median follow-up time was 75.5§ 57.3 months. Two patients were grouped as WHO class IIa lupus nephritis, eight patients as class IIb, 16 patients as class III, 25 patients as class IV, 15 patients as class V, and 19 patients as mixed pattern lupus nephritis. Sex, age, race, and the a-SM actin expression in glomeruli and tubulo-interstitialarea in WHO class III and IV showed no correlation with clinical follow-up outcome of lupus nephritis. Unfavorable clinical outcome of lupus nephritis was correlated with WHO class IV compared to the other classes, and with the chronicity index in WHO class III patients.
A Chinese version of the Rheumatology Attitudes Index is a valid and reliable measure of learned helplessness in patients with SLE
Authors: Thumboo J , Feng P-H , Chan S-P , Boey M-L , Thio S-t , Fong K-Y
Published: October 2002

Despite the prognostic importance of learned helplessness (LH) in rheumatic diseases, there are no validated measures of LH in Chinese or other Asian languages. We therefore assessed the validity of a Chinese translation of the Rheumatology Attitudes Index (CRAI; a widely used measure of LH) and its Helplessness (CHS) and Internality (CIS) subscales in patients with SLE. Chinese-speaking SLE patients (n = 69) completed identical, self-administered questionnaires containing the CRAI and assessing demographic/socio-economic variables twice within 2 weeks. SLE activity, damage and quality of life were assessed using the BILAG, SLICC/ACR Damage Index and SF-36 respectively. Scale psychometric properties were assessed through Cronbach's α, intra-class correlations, quantifying test–retest differences, factor analysis and known-groups construct validity. Internal consistency and reliability were acceptable, with Cronbach's α for the CHS, CIS and CRAI being 0.70, 0.69 and 0.74, respectively. Mean differences in test–retest scores spanned 1.6–2.4% of possible scale ranges and intra class correlations ranged from 0.72 to 0.88. Factor analysis identified two major factors corresponding to the CHS and CIS subscales of the CRAI. Eight of 10 a priori hypotheses relating the CRAI and CHS to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales.

The CRAI and its helplessnesssubscale are valid and reliable measures of learned helplessness in Chinese-speaking SLE patients.
Increased bioactive TNF in human systemic lupus erythematosus: associations with cell death
Authors: Aringer M , Feierl E , Steiner G , Stummvoll G H , Höfler E , Steiner C W , Radda I , Smolen J S , Graninger W B
Published: October 2002

In systemic lupus erythematosus (SLE) serum TNF is increased and correlates with its soluble receptors and with disease activity. We therefore investigated (i) whether the TNF in SLE serum is bioactive, (ii) whether SLE cells react to TNF and (iii) whether there are associations with cell death, which is regarded as pathogenic in SLE. Sera from active SLE patients induced an increase in fibroblast CD54, which was abolished by blocking antibodies against TNF, suggesting TNF bioactivity. SLE lymphocytes had a similar surface expression of TNF-R I as healthy lymphocytes, their expression of TNF-R II was slightly increased. Recombinant TNF induced cell death in PBMC of SLE patients, suggesting functional receptors. Serum levels of sTNF-RII (as a surrogate marker for TNF activity) correlated with sTNF-RI and disease activity, as expected, and also correlated with the percentage of dying lymphocytes and with lymphocytic CD95. SLE sera contain increased amounts of biologically active TNF. Peripheral blood lymphocytes of SLE patients express functional TNF receptors. Finally, associations with cell death and CD95 receptors suggest that TNF may be pathogenic in SLE.
Significance of magnetic resonance imaging in the diagnosis of nodular regenerative hyperplasia of the liver complicated with systemic lupus erythematosus: a case report and review of the literature
Authors: Horita T , Tsutsumi A , Takeda T , Yasuda S , Takeuchi R , Amasaki Y , Ichikawa K , Atsumi T , Koike T
Published: October 2002

Nodular regenerative hyperplasia of the liver (NRH), characterized by multiple hepatic nodules in the absence of fibrosis, is a rare but important complication of systemic lupus erythematosus (SLE) associated with non-cirrhotic portal hypertension. The diagnosis of NRH is based on the pathological examination, and radiological findings of NRH are poorly documented. We report a case of a 40-year-old woman with SLE complicated with NRH. Sixteen years after diagnosis of SLE, esophageal varices were incidentally found and diagnosis of portal hypertension due to NRH was made by magnetic resonance imaging (MRI) and confirmed by needle liver biopsy. Although MRI showed the lesions as significant nodules, neither computed tomography nor ultrasonography could demonstrate the nodules. However, serial MRI showed significant enlargement of the nodules for 2 years Because NRH may lead to portal hypertension with life-threatening variceral haemorrhage in patients with SLE, MRI is a useful, non-invasive examination to screen the patients for its presence and follow-up. We reviewed the literature regarding NRH in SLE and discuss the management of the affected patients.
Anticardiolipin antibody titre and plasma homocysteine level independently predict intima media thickness of carotid arteries in subjects with idiopathic antiphospholipid antibodies
Authors: Ames P R J , Margarita A , Alves J Delgado , Tommasino C , Iannaccone L , Brancaccio V
Published: October 2002

This study evaluated whether IgG anticardiolipinantibody (aCL) titre and traditional risk factors for atherosclerosis bore any relationship to the intima media thickness (IMT) of carotid arteries of patients with idiopathic antiphospholipid antibodies (aPL). IMT was assessed by high-resolution sonography at the common carotid, carotid bifurcation and internal carotid in 42 (13 male, 29 female, mean age 31§ 10 years) aPL subjects, 29 with primary thrombotic antiphospholipid syndrome and 13 with persistence of aPL in the absence of any underlying disorder. In the same subjects the following were measured: plasma fibrinogen (FNG), von Willebrand factor (vWF), plasminogen activator inhibitor (PAI), homocysteine (HC), total cholesterol (CHO), triglycerides (TG), high density and low density lipoprotein (HDL and LDL), platelet numbers and aCL of IgG and IgM isotype. IMT of the internal carotid was greater in males than females (0.48±0.03 vs 0.39±0.01 mm, P = 0.02). IMT of the carotid bifurcation was greater in thrombotic than nonthrombotic subjects (0.50§ 0.02 vs 0.42§ 0.02 mm, P = 0.04). By simple regression, IMT of the common carotids correlated with age (P < 0.0001) IgG aCL titre (P = 0.001), FNG (P = 0.006), LDL (0.01), CHO (0.02) and PAI (P = 0.02). IMT of the carotid bifurcation correlated with age (P = 0.002), IgG aCL titre (P = 0.0002), FNG (P = 0.0001), HC (P = 0.009), CHO (P = 0.02), vWF (P = 0.01) and number of thrombotic events (P = 0.03). IMT of the internal carotids correlated with age (P = 0.002), IgG aCL titre (P = 0.0001), FNG (P = 0.0008), PAI (P = 0.002) and HC (P = 0.01). By stepwise multiple regression analysis, IgG aCL titre independently predicted IMT at all carotid segments examined (P always < 0.005). In addition, plasma FNG and HC also resulted independent predictors of IMT at the carotid bifurcation (P = 0.001 and P < 0.0001, respectively) and internal carotid (P = 0.03 and P < 0.0001, respectively). These data strongly support an atherogenic role for IgG aCL in patients with aPL. Measurement of plasma HC and FNG may help define aPL subjects at higher vascular risk who may require lowering of HC and FNG by vitamin and/or pharmacologic intervention. Lupus (2002) 11, 208–214.
Ultraviolet light exposure is not a requirement for the development of cutaneous neonatal lupus
Authors: Cimaz R , Biggioggero M , Catelli L , Muratori S , Cambiaghi S
Published: October 2002

Cutaneous neonatal lupus erythematosus (NLE) is a rare disorder, linked to the presence of transplacentally acquired maternal autoantibodies (anti-ENA). NLE skin lesions frequently appear in the second or third month of life, and ultraviolet exposure is thought to be an initiating factor since it can externalize intranuclearautoantigens at the cell surface. We report a baby who was born already with an extensive NLE rash, suggesting that sun exposure is not a requirement for the development of NLE skin lesions.

A 31-year-old woman affected with mixed connective tissue disease gave birth to a female after 38 weeks of gestation. Pregnancy was uneventful and no perinatal complications were seen. The mother was positive for anti-RNP, but negative for anti-SSA/Ro and SSB/La autoantibodies. Already at birth, an extensive scarring rash with a few erythematosus lesions was present on the baby's face and scalp; this progressed over the following months, and subsequentlystabilized. Anti-RNP were present in the baby's serum. Due to the unusual features of the disease expression, a skin biopsy was performed at age 5 months; results were consistent with the diagnosis of NLE, showing mononuclear cell infiltration and immunoglobulin deposition. No other features of NLE were detected.

This observation is unusual for: (1) the presence of an NLE rash in the absence of anti-SSA/Ro;(2) the scarring and atrophic characteristicsof the lesions; and (3) the development already in utero. This latter finding argues against sun exposure being necessary for lesion induction.
Spectrum and progression of conduction abnormalities in infants born to mothers with anti-SSA/Ro-SSB/La antibodies
Authors: Askanase A D , Friedman D M , Copel J , Dische M R , Dubin A , Starc T J , Katholi M C , Buyon J P
Published: October 2002

The classic cardiac manifestation of neonatal lupus is congenitalheart block, attributed to antibodymediated inflammation and subsequent fibrosis of the atrioventricular(AV) node. In consideringthe pathologic process of injury it may be that tissue damage results in a range of conduction abnormalities. Identification of less-advanced degrees of block or of fibrosis around the AV node without any conduction abnormality on EKG would support this pathologic model, and serve as a potential marker for treatment if the conduction defect could be shown to progress. To ascertain the spectrum of arrhythmias associated with maternal anti-SSA/Ro-SSB/La antibodies, records of all children enrolled in the Research Registry for Neonatal Lupus were reviewed. Of 187 children with congenital heart block whose mothers have anti-SSA/Ro-SSB/La antibodies, nine had a prolonged PR interval on EKG at birth, four of whom progressed to more advanced AV block. A child whose younger sibling had third degree block was diagnosed with first degree block at age 10 years at the time of surgery for a broken wrist. Two children diagnosed in utero with second degree block were treated with dexamethasone and reverted to normal sinus rhythm by birth, but ultimately progressed to third degree block. Four children had second degree block at birth: of these, two progressed to third degree block. Sinus bradycardia (< 100 bpm) was present in three (3.8%) of 78 fetuses for whom atrial rates were recorded by echocardiogram. Of 40 neonates for whom EKGs were available, the mean atrial rate was 137± 20 bpm (range 75–200). These data have important research and clinical implications. In contrast to the AV node, permanent sinoatrial nodal involvement is not clinically apparent. Perhaps many fetuses sustain mild inflammation, but resolution is variable, as suggested by the presence of incomplete AV block. Since subsequent progression of less-advanced degrees of block can occur, an EKG should be performed on all infants born to mothers with anti-SSA/Ro-SSB/La antibodies.
Elevated IL-16 levels in patients with systemic lupus erythematosus are associated with disease severity but not with genetic susceptibility to lupus
Authors: Lard L R , Roep B O , Verburgh C A , Zwinderman A H , Huizinga T W J
Published: October 2002

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by several immunological abnormalities. The pathogenic importance of T cells in this disease is well established. Interleukin-16 (IL-16) is a cytokine which is mainly produced by CD8+ T cells and induces chemotaxis of CD4+ T cells and monocytes. IL-16 levels have been shown to be elevated in SLE patients in a cross-sectional study, but the mechanism is unknown. To explore whether the increased IL-16 levels are associated with genetic background or the disease itself, we investigated the IL-16 level in healthy first-degree family members of SLE patients and SLE patients who were followed over time with regard to disease activity. We observed high IL-16 levels in SLE patients with severe disease compared to SLE patients with non-severe disease and healthy controls. Furthermore, IL-16 levels in first-degree relatives were not different from those in healthy controls. These results suggest that high IL-16 levels are associated with severity of SLE, but not with genetic susceptibilityto SLE. Finally, we followed the disease activity of SLE patients over time, which showed significant correlation between the SLE disease activity index and IL-16, ESR and the complement components C3, C4 and CH50. In conclusion, these results implicate an association of IL-16 with SLE.