bluuebunny/crossref_metadata_2025 huggingface dataset:
Hyperglycemia and Clinical Outcome in Aneurysmal Subarachnoid Hemorrhage
Authors: Kruyt Nyika D. , Biessels Geert Jan , de Haan Rob J. , Vermeulen Marinus , Rinkel Gabriel J.E. , Coert Bert , Roos Yvo B.W.E.M.
Published: April 2009

Background and Purpose—

Hyperglycemia may worsen outcome after aneurysmal subarachnoid hemorrhage. We performed a systematic review to investigate the relation between admission hyperglycemia and outcome after aneurysmal subarachnoid hemorrhage.

Methods—

We included cohort studies or clinical trials of patients with aneurysmal subarachnoid hemorrhage admitted within 72 hours that documented admission glucose levels or the rate of hyperglycemia. Outcome had to be assessed prospectively after 3 or more months. The overall mean glucose level was calculated by weighting for the number of patients included in each study. To calculate the effect size, we pooled the ORs and 95% 95% CIs of poor clinical outcome in patients with or without hyperglycemia.

Results—

We searched MEDLINE, EMBASE, Science Citation Index, and the bibliographies of relevant studies. We included 17 studies totaling 4095 patients. The mean admission glucose level was 9.3 mmol/L (range, 7.4 to 10.9 mmol/L; 14 studies, 3373 patients) and the median proportion of patients with hyperglycemia was 69% (range, 29 to 100; 16 studies, 3995 patients; cutoff levels of hyperglycemia, 5.7 to 12.0 mmol/L). The pooled OR (8 studies, 2164 patients) for poor outcome associated with hyperglycemia was 3.1 (95% CI, 2.3 to 4.3). Cutoff points for defining hyperglycemia varied across studies (6.4 to 11.1 mmol/L), but this had no clear effect on the observed OR for poor outcome.

Conclusions—

After aneurysmal subarachnoid hemorrhage, admission glucose levels are often high and hyperglycemia is associated with an increased risk of poor clinical outcome. A randomized clinical trial is warranted to study the potential benefit of glycemic control after aneurysmal subarachnoid hemorrhage.
Hemodynamic Factors and Perfusion Abnormalities in Early Neurological Deterioration
Authors: Alawneh Josef A. , Moustafa Ramez Reda , Baron Jean-Claude
Published: April 2009

Background and Purpose—

Early neurological deterioration (END) is a relatively common unfavorable course after anterior circulation ischemic stroke that can lead to worse clinical outcome. None of the END predictors identified so far is sufficiently reliable to be used in clinical practice and the mechanisms underlying END are not fully understood. We review the evidence from the literature for a role of hemodynamic and perfusion abnormalities, more specifically infarction of the oligemia, in END.

Summary of Review—

After an overview of the neuroimaging, including perfusion imaging, predictors of END, we review the putative mechanisms of END with a special focus on hemodynamic factors. The evidence relating perfusion abnormalities to END is addressed and potential hemodynamic mechanisms are suggested.

Conclusions—

Hemodynamic factors and perfusion abnormalities are likely to play a critical role in END. Infarction of the oligemic tissue surrounding the penumbra could be the putative culprit leading to END as a result of perfusion, but also physiological and biochemical abnormalities. Further studies addressing the role of the oligemia in END and developing measures to protect its progression to infarction are now needed.
What Are the Social Consequences of Stroke for Working-Aged Adults?
Authors: Daniel Katie , Wolfe Charles D.A. , Busch Markus A. , McKevitt Christopher
Published: April 2009

Background and Purpose—Approximately one fourth of strokes occur in people aged <65 years. UK current policy calls for services that meet the specific needs of working-aged adults with stroke. We aimed to identify the social consequences of stroke in working-aged adults, which might subsequently inform the development and evaluation of services for this group.

Methods—We reviewed quantitative and qualitative studies identifying social consequences for working-aged adults with stroke using multiple search strategies (electronic databases, bibliographic references, hand searches). Social consequences were defined as those pertaining to the World Health Organization International Classification of Functioning, Disability and Health domain “participation.” Two authors reviewed articles using a standardized matrix for data extraction.

Results—Seventy-eight studies were included: 66 were quantitative observational studies, 2 were quantitative interventional studies, 9 were qualitative studies, and one used mixed methods. Seventy studies reported data on return to work after stroke with proportions ranging from 0% to 100%. Other categories of social consequences included negative impact on family relationships (5% to 54%), deterioration in sexual life (5% to 76%), economic difficulties (24% to 33%), and deterioration in leisure activities (15% to 79%).

Conclusions—Methodological variations account for the wide range of rates of return to work after stroke. There is limited evidence of the negative impact of stroke on other aspects of social participation. Robust estimates of the prevalence of such outcomes are required to inform the development of appropriate interventions. We propose strategies by which methodology and reporting in this field might be improved.
The Genetics of Cervical Artery Dissection
Authors: Debette Stéphanie , Markus Hugh S.
Published: April 2009

Background and Purpose—

The pathophysiology of cervical artery dissections (CAD), a major cause of ischemic stroke in young adults, is poorly understood. Several arguments suggest a genetic predisposition.

Methods—

We systematically reviewed all published data on genetic risk factors for CAD and performed a meta-analysis of association studies with the
MTHFR
C677T polymorphism.

Results—

Rarely, CAD is associated with a known monogenic connective tissue disease, mainly vascular Ehlers-Danlos syndrome. However, in the large majority of CAD cases, there is no evidence for a known monogenic disease. Several arguments, including the association of CAD with dermal connective tissue abnormalities that are inherited, suggest that genetic factors also play a role in “sporadic” CAD as part of a multifactorial predisposition. We identified 15 genetic association studies: 10 were negative and 5 reported associations of 3 genetic variants in 3 different candidate genes. Two studies reported associations with polymorphisms in ICAM-1 and COL3A1, but neither has been replicated. Three studies reported an association with the
MTHFR
677TT genotype, but 3 other studies did not replicate this. A meta-analysis of these data identified an overall significant association of the
MTHFR
677TT genotype with CAD (OR, 1.67; 95% CI, 1.21 to 2.31). We also identified 9 studies screening candidate genes for mutations and 4 linkage studies, yielding mostly negative results.

Conclusions—

Although several interesting hypotheses were generated, the majority of genetic studies in CAD have been negative until now, but they were markedly underpowered. Progress in unraveling the genetics of CAD will require the collection of DNA samples from large multicenter series.
Ischemic Stroke in South Asians
Authors: Gunarathne Ashan , Patel Jeetesh V. , Gammon Brian , Gill Paramjit S. , Hughes Elizabeth A. , Lip Gregory Y.H.
Published: April 2009

Background and Purpose—

Within the United Kingdom, mortality from stroke is higher among South Asians compared to European whites. The reasons for this excess cerebrovascular risk in South Asians remain unclear. The aim of this review is to present a comprehensive and systematic overview of the available literature relating to ischemic stroke among South Asian populations identifying distinct features of stroke epidemiology in this group.

Summary of Review—

A high frequency of lacunar strokes is a familiar pattern among South Asians, which suggests a greater prevalence of small-vessel disease in South Asians. This may be a consequence of abnormal metabolic and glycemic processes. In addition, stroke mortality among South Asians appears to be explained by glycemic status, which is an independent predictor of long-term stroke mortality. Within India, there is a perceptible rural–urban gradient in stroke prevalence, underlying the dangers of the rapid transition in socioeconomic circumstances seen across the Indian subcontinent.

Conclusions—

This review emphasizes the importance of further research into ischemic stroke for South Asians given their higher cardiovascular disease burden and necessity for targeted healthcare approaches.
A Randomized Controlled Trial of Mental Imagery Augment Generalization of Learning in Acute Poststroke Patients
Authors: Liu Karen P.Y. , Chan Chetwyn C.H. , Wong Rebecca S.M. , Kwan Ivan W.L. , Yau Christina S.F. , Li Leonard S.W. , Lee Tatia M.C.
Published: April 2009

Background and Purpose—

Our previous studies demonstrated that mental imagery intervention enhanced poststroke patients relearning daily task performance. This study aimed to test the efficacy of mental imagery for promoting generalization of the task skills learned in a training environment to trained and untrained tasks carried out in a novel environment.

Methods—

Thirty-five acute poststroke patients were randomly assigned to the mental imagery (MI; n=18) or conventional functional rehabilitation (FR; n=17) group. The MI intervention was 3-week standardized practices and daily tasks using the chunking-regulation-rehearsal strategies. Outcome measurements were the performances on trained and untrained tasks in the training and novel environments.

Results—

The MI patients showed significantly better performances on 4 of 5 trained tasks (
P
=0.001 to 0.026) versus only 1 task in the FR patients (
P
=0.021). The MI patients also outperformed their FR counterpart on the 3 (of 5) (
P
=0.025 to 0.049) trained and 2 (of 3) untrained tasks (
P
=0.042 to 0.045) carried out in the novel environment.

Conclusions—

The mental imagery intervention was useful for improving patients’ ability on performing the tasks which they did not previously trained on and in places different from the training environments. These involved generalization of the skills learned at the task performance level. Our findings are limited to poststoke patients who share similar characteristics with those in this study.
Mechanical Approaches Combined With Intra-Arterial Pharmacological Therapy Are Associated With Higher Recanalization Rates Than Either Intervention Alone in Revascularization of Acute Carotid Terminus Occlusion
Authors: Lin Ridwan , Vora Nirav , Zaidi Syed , Aleu Aitziber , Jankowitz Brian , Thomas Ajith , Gupta Rishi , Horowitz Michael , Kim Susan , Reddy Vivek , Hammer Maxim , Uchino Ken , Wechsler Lawrence R. , Jovin Tudor
Published: April 2009

Background and Purpose—

Acute stroke attributable to internal carotid artery terminus occlusion carries a poor prognosis. Vessel recanalization is crucial to improve clinical outcome. Historically, pharmacological thrombolysis alone has low recanalization rates. We sought to determine whether adjunctive mechanical approaches achieve better vessel recanalization and functional outcome.

Methods—

We retrospectively reviewed 75 consecutive endovascular cases of acute internal carotid artery terminus occlusions treated at our center between 1998 and 2008. Mechanical approaches (MERCI retrieval/angioplasty/stent) with and without adjunctive intra-arterial pharmacological therapy (urokinase or tissue plasminogen activator) was compared to intra-arterial lytics alone. Univariate and multivariate analyses were performed to determine predictors of recanalization (thrombolysis in myocardial infarction grades 2 to 3) and favorable functional outcome (modified Rankin score ≤2) at 3 months.

Results—

Lowest recanalization rates were observed with intra-arterial lytics alone (3/17, 17.6%). MERCI embolectomy combined with intra-arterial lytics was associated with the highest recanalization rates (18/21, 85.7%;
P
<0.0001). MERCI embolectomy alone achieved 46.2% recanalization rates (6/13;
P
=0.23). Angioplasty or stenting and intra-arterial lytics achieved 25% (2/8;
P
=0.65) and 40% (4/10;
P
=0.085) recanalization, respectively. In multivariate analysis, combination of MERCI embolectomy with intra-arterial lytics (OR, 16.2; CI, 4.6–77.6), or any mechanical technique with intra-arterial lytics (OR, 6.7; CI, 2.5–19.5) independently predicted thrombolysis in myocardial infarction 2 to 3 recanalization. Clinically significant parenchymal hemorrhage rates were 7.5% with combination (3/38) and 12.5% with pharmacological therapies (2/16;
P
=0.46). Using stepwise logistic regression, age (OR, 0.95; CI, 0.90–0.995), baseline NIHSS (OR, 0.82; CI, 0.70–0.96), and thrombolysis in myocardial infarction 2 to 3 recanalization (OR, 4.0; CI, 1.1–14.4) were associated with favorable functional outcome.

Conclusions—

Combined mechanical and intra-arterial pharmacological therapy is associated with higher recanalization rates than either intervention alone in acute internal carotid artery terminus occlusion revascularization.
Political Ideology and Psychological Symptoms Following Terror
Authors: Laufer Avital , Solomon Zahava
Published: April 2009

The article examines the associations between political ideology and level of psychological symptoms in youth exposed to terror attacks. The study included 2,999 7th to 10th graders from various parts of Israel. Political ideology was examined in two ways: (a) as a content dimension: “political stand”—holding right, centrist, or left wing views and (b) as a content-free dimension: “ideological commitment”—which measured the strength of the political ideology regardless of its content. Findings indicated that youth holding right wing beliefs reported less distress. However, strong ideological commitment was associated with higher levels of symptoms, regardless of the political stand. The discussion concerns the differentiated role of content and content-free dimensions of a political ideology and its implication in psychological distress in the wake of political terror.
Molecular Expression Analysis of β-Naphthoflavone-induced Hepatocellular Tumors in Rats
Authors: Dewa Yasuaki , Nishimura Jihei , Jin Meilan , Kawai Masaomi , Saegusa Yukie , Harada Tomoaki , Shibutani Makoto , Mitsumori Kunitoshi
Published: April 2009

The present study was performed to characterize molecular expression levels of preneoplastic and neoplastic lesions induced by β-naphthoflavone (BNF), an aryl hydrocarbon receptor (AhR) agonist in rat hepatocarcinogenesis. Male F344 rats were initiated with an intraperitoneal injection of 200 mg/kg N-diethylnitrosamine, and two weeks later, they were fed a diet containing 0% or 1% BNF for twenty-eight weeks. All animals were subjected to a two-thirds partial hepatectomy at week 3 and sacrificed at week 30. Histopathologically, BNF increased the incidence and multiplicity of altered foci (1.7-fold and 3.3-fold) and hepatocellular adenomas (HCAs) (4.0-fold and 4.7-fold). Immunohistochemically, BNF increased the number of proliferating cell nuclear antigen (PCNA)-positive cells in altered foci (2.3-fold) and HCAs (6.7-fold) compared with the surrounding tissue and decreased the staining of cell cycle regulators (P21, C/EBPα). In addition, loss of reactivity for AhR-regulated (CYP1A1, CYP1B1) molecules and increased reactivity of Nrf-2-regulated (AKR7, GPX2) molecules were also observed in proliferative lesions. Furthermore, increased staining of histone deacetylase (HDAC1) in the nucleus was prominent in HCAs. The differential expression patterns were confirmed at mRNA levels by real-time reverse transcription-polymerase chain reaction (RT-PCR) analysis. These results suggest that enhanced cell proliferation and protection against oxidative stress play an important role in BNF-induced hepatocarcinogenesis in rats.
γ-Tocopherol Attenuates Ozone-induced Exacerbation of Allergic Rhinosinusitis in Rats
Authors: Wagner James G. , Harkema Jack R. , Jiang Qing , Illek Beate , Ames Bruce N. , Peden David B.
Published: April 2009

Compared to healthy subjects, individuals with allergic airway disease (e.g., asthma, allergic rhinitis) have enhanced inflammatory responses to inhaled ozone. We created a rodent model of ozone-enhanced allergic nasal responses in Brown Norway rats to test the therapeutic effects of the dietary supplement γ-tocopherol (γT). Ovalbumin (OVA)-sensitized rats were intranasally challenged with 0% or 0.5% OVA (in saline) on Days 1 and 2, and then exposed to 0 or 1 ppm ozone (eight hours/day) on Days 4 and 5. Rats were also given 0 or 100 mg/kg γT (p.o., in corn oil) on days 2 through 5, beginning twelve hours after the last OVA challenge. On Day 6, nasal tissues were collected for histological evaluation and morphometric analyses of intraepithelial mucosubstances (IM) and eosinophilic inflammation. Nasal septal tissue was microdissected and analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) for mucin glycoprotein 5AC (MUC5AC) expression levels. Histological analysis revealed mild to moderate eosinophil influx in the mucosa lining the nasal airways and maxillary sinus of OVA-challenged rats (eosinophilic rhinosinusitis). Ozone exposure of allergic rats further increased eosinophils in the maxillary sinus (400%), nasolacrimal duct (250%), and proximal midseptum (150%). Storage of intraepithelial mucosubstances (IM) was not significantly affected by OVA challenge in filtered air-exposed rats, but it was increased by ozone in the septum (45%) and maxillary sinus (55%) of allergic compared to control rats. Treatment with γT attenuated the ozone/ OVA-induced synergistic increases in IM and mucosal eosinophils in both nasal and paranasal airways. γ-Tocopherol also blocked OVA and ozone-induced MUC5AC gene expression. Together, these data describe a unique model of ozone enhancement of allergic rhinosinusitis and the novel therapeutic efficacy of a common supplement, γT, to inhibit ozone exacerbation of allergic airway responses.
Participation of Functionally Different Macrophage Populations and Monocyte Chemoattractant Protein-1 in Early Stages of Thioacetamide-induced Rat Hepatic Injury
Authors: Mori Yoko , Izawa Takeshi , Takenaka Shigeo , Kuwamura Mitsuru , Yamate Jyoji
Published: April 2009

Macrophages are crucial in hepatic fibrogenesis. In acute hepatic necrosis induced in rats by a single injection of 300 mg/kg body weight (BW) of thioacetamide (TAA), macrophage properties were investigated using single or double immunohistochemistry. Macrophages reacting with anti-CD68, anti-CD163, or major histocompatibility complex (anti-MHC) class II antibody appeared in injured centrilobular areas on days 1-5 after injection. Increased expression of CD68 and CD163 reflect phagocytosis and production of pro-inflammatory factors, respectively. There were also macrophages double-positive to CD68/CD163, CD68/MHC class II, or CD163/MHC class II; of these, macrophages double-positive to CD68/MHC class II were most frequent, indicating that macrophages with enhanced phagocytic activity came to express MHC class II. The appearance of these macrophages corresponded to increased expression of mRNAs of monocyte chemoattractant protein-1 (MCP-1), a chemokine, on day 1, and TGF-β1, a fibrogenic factor, on day 3. Some hepatic stellate cells (HSCs) in injured areas reacted with anti-MCP-1 antibody. To investigate the effects of MCP-1, we added MCP-1 to HS-P, a rat macrophage line. Addition of MCP-1 increased immunoexpression for CD68 and CD163 and up-regulated TGF-β1 mRNA expression. Collectively, macrophages in acute hepatic necrosis may express different properties such as phagocytosis, MHC class II expression, and TGF-β1 production; such expression may be influenced by MCP-1 produced by HSCs.
Health Literacy Self-Management by Patients With Type 2 Diabetes and Stage 3 Chronic Kidney Disease
Authors: Sakraida Teresa J. , Robinson Marylou V.
Published: April 2009

This is a qualitative study report from a parent study that used a concurrent mixed methods design whose aim was to describe the transition and self-management experiences of patients diagnosed with type 2 diabetes mellitus (T2DM) and stage 3 chronic kidney disease (CKD). Six adult men and women recruited from outpatient clinics completed two focus group interviews. Discerned in the ethnographic analysis of interviews and field notes using ATLAS/ti was a pattern of Health Literacy Self-Management with two major threads: (a) transition experience to self-advocacy characterized as seeking useful resources and difficulties in resource use and (b) partnering with the health care provider (HCP) characterized as helpful messaging and messaging confusion. Self-management support includes a shared responsibility and developmental process by the patient and the HCP to achieve quality care. Description of behavioral factors and self-management processes provides a foundation for future study.
Safety of botulinum toxin type A among children with spasticity secondary to cerebral palsy: a systematic review of randomized clinical trials
Authors: Albavera-Hernández Cidronio , Rodríguez Jorge M , Idrovo Alvaro J
Published: April 2009

Objective: To assess the safety of botulinum toxin type A for children with cerebral palsy using data from randomized clinical trials.

Data sources: A search was conducted of MEDLINE database for the period January 1990 to February 2008. A complementary search was carried out of references from previous reviews. From 122 articles, 20 randomized clinical trials were selected for the review.

Review methods: Two authors independently assessed eligibility of the studies and methodological quality of those according to CONSORT guidelines. For each adverse effect, relative risk was calculated, and when more than one study reported adverse effects, a meta-analysis was carried out. Sensitivity analyses with different continuity corrections factors were performed when zero cases were reported in a study arm.

Results: There were 882 participants in the 20 studies included in the meta-analysis. Six studies reported zero adverse effects. Thirty-five different adverse events were reported. Botulinum toxin type A use was related to respiratory tract infection, bronchitis, pharyngytis, asthma, muscle weakness, urinary incontinence, falls, seizures, fever and unspecified pain. Two deaths were reported in the study with higher person-time follow-up (relative risk (RR) 4.69, 95% confidence interval (CI) 0.23—95).

Conclusions: Botulinum toxin type A has a good safety profile during the first months of use. However the occurrence of adverse events is more frequent among children with cerebral palsy than individuals with other conditions. Severe adverse events are potentially related with the use of botulinum toxin type A, but data are sparse and additional study is required to clarify the causal relation.
A computerized visual perception rehabilitation programme with interactive computer interface using motion tracking technology — a randomized controlled, single-blinded, pilot clinical trial study
Authors: Si Hyun Kang  , Kim Don-Kyu , Kyung Mook Seo  , Kwang Nam Choi  , Jin Yong Yoo  , Sang Yoon Sung  , Heon Jong Park
Published: April 2009

Objective: To assess the effectiveness of a computerized visual perception rehabilitation programme using motion tracking technology for visual perception impairment.

Design: Randomized controlled, single-blinded, pilot clinical trial study.

Setting: Inpatient rehabilitation hospital.

Subjects: Sixteen left hemiplegic patients with visual perceptional impairment.

Intervention: Subjects were randomly assigned to receive either (1) participation in a computerized visual perception rehabilitation programme with an interactive patient—computer interface applying motion tracking technology based on the CAMSHIFT algorithm or (2) use of the PSS CogRehab program for three sessions per week, 30 minutes per session for four weeks. There were eight patients in each group.

Main measures: Mini-Mental Status Examination, Motor-free Visual Perception Test and Modified Barthel Index were assessed at the beginning and end of the training. A survey was conducted to evaluate the degree of patients' interest using an interest scale.

Results: After training, the mean (SD) Motor-free Visual Perception Test score increased significantly in both experimental group (from 65.8 (19.5) to 77.8 (28.7)) and control group (from 68.3 (11.4) to 74.1 (14.8)) (P<0.01). Modified Barthel Index score increased significantly in both groups, with the experimental group recording a higher increase. Mean (SD) interest scale score was greater in the experimental group (2.2 (0.8)) than in the control group (1.3 (0.7)) (P<0.01).

Conclusions: A computerized visual perception rehabilitation programme with interactive computer interface using motion tracking technology could be considered as a treatment option for stroke patients with visual perception impairment.
A clinical practice guideline for physiotherapists treating patients with chronic obstructive pulmonary disease based on a systematic review of available evidence
Authors: Langer D. , Hendriks EJM , Burtin C. , Probst V. , van der Schans CP , Paterson WJ , Verhoef-de Wijk MCE , Straver RVM , Klaassen M. , Troosters T. , Decramer M. , Ninane V. , Delguste P. , Muris J. , Gosselink R.
Published: April 2009

Purpose: Update of a clinical practice guideline for the physiotherapy management of patients with chronic obstructive pulmonary disease supporting the clinical decision-making process.

Methods: A systematic computerized literature search was performed on different modalities for improving physical exercise capacity, reducing exertional dyspnoea, improving airway clearance and encouraging changes in physical activity behaviour. Methodological quality was scored with the PEDro Scale. Scientific conclusions were graded according to the criteria of the `Dutch Evidence Based Guideline Development Platform'. These, together with practical considerations, were used to formulate recommendations for clinical practice.

Results: A total of 103 studies were included in the systematic review, consisting of five meta-analyses of randomized controlled trials, 84 randomized controlled trials and 14 uncontrolled studies. Twenty scientific conclusions supported six recommendations on physical exercise training. Nineteen scientific conclusions supported eight recommendations on interventions for reducing dyspnoea. Five scientific conclusions supported seven recommendations concerning treatment modalities to improve mucus clearance, and two scientific conclusions supported two recommendations on strategies for encouraging permanent changes in physical activity behaviour.

Conclusions: Strong recommendations support the use of physical exercise training to improve health-related quality of life and functional exercise capacity. Future research should investigate whether additional interventions for reducing exertional dyspnoea have a place as adjuncts to physical exercise training in selected patients. In addition, treatment of impaired mucus clearance, especially during acute exacerbations, requires further research. With the advance of new technologies for objective measurements of physical activities in daily life more research is needed concerning interventions to initiate and maintain physical activity behaviour change during and after supervised physical exercise training programmes
Sexual History Disclosure Polygraph Examinations With Cybercrime Offences
Authors: Buschman Jos , Bogaerts Stefan , Foulger Sarah , Wilcox Daniel , Sosnowski Daniel , Cushman Barry
Published: April 2009

This article presents the first study on post-conviction polygraphy in the Netherlands. Importantly, it exclusively focuses on cybercrime offenders. The study is designed to systematically address the different child sexual behaviours exhibited by 25 participants who are in treatment for possessing child abuse images. The results indicate that post-conviction polygraphy can provide additional data to inform the development of theory in this area and contribute to the treatment, supervision, and more effective containment of offending behaviour and the reduction of future victimization.
Acute acalculous cholecystitis in juvenile systemic lupus erythematosus
Authors: Mendonça JA , Marques-Neto JF , Prando P , Appenzeller S
Published: April 2009

Small- and medium-vessel vasculitis is a common manifestation in systemic lupus erythematosus (SLE) and may occur in any organ. However, acute acalculous cholecystitis is a rare abdominal manifestation in SLE, especially in children. We report a case of a 12-year-old patient who initially presented with AAC and seizure. Follow-up investigation diagnosed SLE, and brain magnetic resonance imaging had hyperintense white matter lesions in cortico-subcortical regions. The patient was successfully treated with pulse methylprednisolone and cyclophosphamide without surgical intervention.
Twenty-year follow-up: an unusual case of nephropathy of antiphospholipid syndrome
Authors: Lin YQ , Lakshminarayanan S , Yamase H , Palmisano J , Parke A
Published: April 2009

Nephropathy of antiphospholipid antibody syndrome (NAPS) is an increasingly well-recognized aspect of antiphospholipid syndrome. The most characteristic histopathology is that of thrombotic microangiopathy, and thrombosis occurring in the renal vasculature is thought to be the initiating event. Other less common pathologies have been reported, and the mechanisms of these are unclear. Therapy has been largely empiric. We report a case of NAPS in a patient with atypical pathology, who has declined therapy with immunosuppressive agents and anticoagulants and who has maintained normal renal function in 20 years of follow-up.
Renal Limited Wegener’s granulomatosis
Authors: Del Porto F , Proietta M , Stoppacciaro A , Trappolini M , Menè P , Aliberti G
Published: April 2009

Differential diagnosis in patients presenting with fever of unknown origin (FUO) is often difficult because infectious diseases, neoplasms, infective endocarditis or systemic autoimmune diseases may all be responsible for the condition. Furthermore, vasculitis may generate typical, atypical or limited syndromes depending on the extent of vascular involvement. Here, we report the case of a 73-year-old man with FUO and renal failure due to a rare variant of Wegener’s granulomatosis, limited to the kidneys.
Onset of autoimmune glomerulonephritis derived from the telomeric region of MRL-chromosome 1 is associated with the male sex hormone in mice
Authors: Ichii O , Konno A , Sasaki N , Endoh D , Hashimoto Y , Kon Y
Published: April 2009

Female B6.MRLc1(82–100) congenic mice develop more severe autoimmune glomerulonephritis (AGN) than males. We assessed the effects of gonadectomy on the pathogenesis of AGN in these mice. One-month-old male and female mice were divided into sham-operated group (SG) and gonadectomized group (GG), and the pathological changes were investigated at 8 months. SG females showed higher spleen and thymus weights, serum total IgG and autoantibody levels, glomerular damage scores and percent IgG- and CD3-positive glomeruli as compared with SG males. Gonadectomy showed more remarkable effects in males than in females. Spleen and thymus weights, urinary albumin excretion, glomerular damage scores, percent IgG- and CD3-positive glomeruli, and CD3-positive areas in the spleen were significantly higher in GG males than in SG males. CD3-positive cells were observed in both the thymic cortex and medulla in all animals except SG males. The expression ratio of active Fc gamma receptor ( Fcgr) 3 to inhibitory Fcgr2b in the kidneys, which we have previously demonstrated to have a great impact on pathogenesis in B6.MRLc1(82–100), was significantly higher in GG males than in SG males. These results suggested that the differences in the pathogenesis of AGN are primarily because of the inhibitory roles of the male sex hormones.
Increased expression of soluble inducible costimulator ligand (ICOSL) in patients with systemic lupus erythematosus
Authors: Her M , Kim D , Oh M , Jeong H , Choi I
Published: April 2009

To investigate the level of costimulating molecules in systemic lupus erythematosus (SLE), we assessed the plasma concentrations of soluble forms of costimulatory molecules such as programmed death-1 (PD-1), B7-H1 (also called PD-L1 or CD274) and inducible costimulator ligand (ICOSL) in patients with SLE. Plasma concentrations of soluble PD-1, B7-H1 and ICOSL were measured by ELISA using plasma samples from 57 SLE patients with or without the active disease, 21 rheumatoid arthritis (RA) patients and 35 healthy subjects. We also evaluated surface ICOSL expression on B cells using flow cytometry to gain a better understanding of ICOSL expression. To compare the level of ICOSL mRNA expression, reverse transcriptase-polymerase chain reaction (RT-PCR) was performed using total RNA from peripheral blood mononuclear cells (PBMCs) isolated from eight healthy subjects and 11 patients with SLE. The concentration of plasma ICOSL was significantly higher in patients with SLE compared with healthy subjects ( P = 0.005). Plasma ICOSL concentrations in patients with active SLE were also significantly higher than those of either patients with inactive SLE or patients with RA ( P = 0.001, P = 0.015, respectively). Plasma ICOSL concentrations in patients with SLE correlated modestly with the SLE disease activity index score ( r = 0.298, P = 0.024). We also found a significant inverse correlation between the soluble ICOSL expression and the surface ICOSL expression on B cells ( r = −0.690, P = 0.001). However, ICOSL mRNA levels of patients with SLE were comparable with those of the control subjects. There was also no significant difference in plasma B7-H1 concentrations between groups, and plasma PD-1 was not detectable in any of the groups. The plasma concentration of soluble ICOSL might be correlated to the disease severity of lupus. The increased levels of ICOSL in active lupus suggest that this pathway is involved in the pathogenesis of SLE. The mechanism and physiological role of soluble ICOSL in the pathogenesis of SLE, however, remains to be investigated.
Prevalence, predictors and outcome of vascular damage in systemic lupus erythematosus
Authors: Becker-Merok A , Nossent JC
Published: April 2009

Despite improved prognosis, patients with systemic lupus erythematosus (SLE) remain at increased risk for early death. Vascular events (VE) occur with increased frequency and contribute to premature death in SLE patients. As conventional cardiovascular risk factors do not fully explain this hazard, this study investigated the contribution of disease-specific features to VE development. Documented VE were classified as atherothrombotic, venous thrombotic, arterial thrombotic or tissue loss inducing vasculitis during a mean follow-up of nearly 12 years in the Tromsø Lupus cohort ( n = 158). The impact of disease-specific factors (organ manifestations, laboratory findings, drug treatment, weighted average SLE Disease Activity Index (WAS) and cumulative Damage Index) was assessed by odds ratios for VE in multivariate analysis. A total of 41 patients (26%) developed VE, and atherothrombotic events were most common (73%). Overall, VE prevalence was 3.5/100 patient years, and VE risk increased linearly over time, reaching 35% after 20 years. WAS scores >3 increased, and use of hydroxychloroquine and antihypertensive medication reduced overall VE risk. Age >40 years was the main risk factor for atherothrombotic events. VE nearly quadrupled the risk of death. VE occurred in 26% of SLE patients, predominantly as atherothrombotic disease. VE prevalence increased linearly over time leading to a four-fold risk of mortality. Strategies for reducing disease activity, including treatment with antimalarials and antihypertensive drugs, are most likely to reduce the risk associated with VE in SLE.
Does mycophenolate mofetil prevent extra-renal flares in systemic lupus erythematosus? Results from an observational study of patients in a single practice treated for up to 5 years
Authors: Posalski JD , Ishimori ML , Wallace DJ , Weisman MH
Published: April 2009

In this study, the clinical course and change in extra-renal manifestations of patients with SLE taking mycophenolate mofetil (MMF) were evaluated. The charts of 75 consecutively identified patients on MMF from a single practice were reviewed for demographics, dates of SLE diagnosis, initiation, indication or discontinuation of MMF and other medications. British Isles Lupus Assessment Group (BILAG) organ system data were identified for 3 months prior to MMF and then for the subsequent 5 years. BILAG scores for each organ system and an overall score were calculated for intervals of 6 months. The mean age of 75 subjects was 35.8 years with SLE mean disease duration of 99.2 months. Indications for starting MMF were renal (70.7%), musculoskeletal (10.6%), mucocutaneous (9.3%), cardiorespiratory (5.3%), haematologic (4%), vasculitic (2.7%), neurologic (1.3%) and other (18.7%). The mean duration of treatment was 3.3 years; 22 discontinuations occurred. Overall, there was a >50% improvement in composite BILAG scores for 49.3% (37/75) of patients in the first year of treatment and in 20% (15/75) of patients who were still on MMF at ≥5 years. Most flares occurred at second and third year of treatment. The general and renal systems have the most improvement and clinical remissions; the musculoskeletal, mucocutaneous and haematological systems have the most recurrences. Approximately, 50% and 20% of patients taking MMF showed improvement in overall lupus disease activity at both 1 and 5 years, respectively. When evaluating organ system subsets separately, MMF improved disease activity in the first year, but had little effect in preventing new organ-specific flares, with most flares taking place in second and third year of treatment.
Arterial wall dysfunction in systemic lupus erythematosus
Authors: Cypiene A , Kovaite M , Venalis A , Dadoniene J , Rugiene R , Petrulioniene Z , Ryliskyte L , Laucevicius A
Published: April 2009

Carotid-radial pulse wave velocity (PWV), aortic augmentation index (AIx) and endothelium-dependent flow-mediated dilatation (FMD) have been repeatedly showed to be related to premature atherosclerosis and cardiovascular diseases in different settings of population. The increased arterial stiffness and endothelium dysfunction may add to premature aging of the arteries in systemic lupus erythematosus (SLE) patients. Still data about arterial stiffness and endothelium function in inflammatory rheumatic diseases are not well described. The aim of this study was to determine the PWV, its derivate marker AIx and FMD and factors possibly influencing them in young SLE women without significant organ damage. Thirty women between 23 and 55 years with an established SLE diagnosis and 66 healthy women were consequently included in the study and both groups were comparable according to age, body mass index (BMI), serum lipid profile and creatinine. PWV was determined by measuring carotid-radial pulse wave transit time with the help of applanation tonometry and AIx, its derivate marker, was calculated as a difference between two waveform peaks expressed as a percentage of the pulse pressure. The FMD was performed by obtaining the repeated scans of the brachial artery at rest and during reactive hyperemia. In SLE women, PWV and AIx were significantly higher and FMD was not different from controls. In linear multiple stepwise regression analysis if patients and controls were both considered, PWV was weakly related to mean blood pressure (MBP), AIx was mostly predicted by age and MBP and FMD was predicted by the diameter of blood vessel, BMI, high density lipoproteins. If the sole SLE setting was analyzed, PWV was not related to any of the pending parameters, AIx turned out to be related to organ damage measured by Systemic Lupus International collaborative Clinics (SLICC) index and age, and FMD obtained strong and significant relation with vessel diameter, and BMI, and disease duration. Regardless of the small number of study group patients, we can state that controlling for MBP and taking measures towards organ damage prevention can partially slow down the process of early atherosclerosis in SLE patients.
Serum complement activation on heterologous platelets is associated with arterial thrombosis in patients with systemic lupus erythematosus and antiphospholipid antibodies
Authors: Peerschke EIB , Yin W , Alpert DR , Roubey RAS , Salmon JE , Ghebrehiwet B
Published: April 2009

Complement plays a major role in inflammation and thrombosis associated with systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). A cross-sectional retrospective analysis was performed to evaluate serum complement fixation on platelets and thrombotic incidence using banked sera and clinical data from patients with SLE ( n = 91), SLE with antiphospholipid antibodies (aPL) or APS ( n = 78) and primary aPL ( n = 57) or APS ( n = 96). In-situ complement fixation was measured as C1q and C4d deposition on heterologous platelets using an enzyme-linked immunosorbent assay approach. Platelet activation by patient serum in the fluid phase was assessed via serotonin release assay. Enhanced in-situ complement fixation was associated with the presence of IgG aPL and IgG anti-β2 glycoprotein 1 antibodies ( P < 0.05) and increased platelet activation ( P < 0.005). Moreover, enhanced complement fixation, especially C4d deposition on heterologous platelets, was positively associated with arterial thrombotic events in patients with SLE and aPL ( P = 0.039). Sera from patients with aPL possess an enhanced capacity for in-situ complement fixation on platelets. This capacity may influence arterial thrombosis risk in patients with SLE.
Fulminant leucocytoclastic brainstem vasculitis in a patient with otherwise indolent systemic lupus erythematosus
Authors: Kleinig TJ , Koszyca B , Blumbergs PC , Thompson P
Published: April 2009

The spectrum of central nervous system (CNS) vascular pathology in systemic lupus erythematosus (SLE) includes small vessel vasculopathy, thromboembolism, perivascular lymphocytic infiltration and, rarely, overt transmural vasculitis. We present the case of a patient, who experienced three CNS relapses over total disease duration of 26 years, with otherwise indolent disease. The first two relapses were suspicious of vasculitis and the last was proven at autopsy. The short duration between final relapse onset and death in this SLE CNS vasculitis case was, to our knowledge, unique. Histopathological investigation demonstrated multiple confluent areas of haemorrhage in the medulla due to an acute small vessel leucocytoclastic vasculitis.
Ultraviolet light output of compact fluorescent lamps: comparison to conventional incandescent and halogen residential lighting sources
Authors: Nuzum-Keim AD , Sontheimer RD
Published: April 2009

Patients with photosensitive dermatologic and systemic diseases often question the ultraviolet light (UVL) output of household lighting sources. Such individuals have increasing concern about potential UVL exposure from energy-efficient compact fluorescent lamps (CFL), as little data have been presented concerning their UVL output. The objective was to compare, via pilot study, the levels of ultraviolet A (UVA) and ultraviolet B (UVB) leak between residential lighting sources. Equivalent wattage CFL, incandescent and halogen bulbs were purchased from local retailers in Oklahoma City, Oklahoma, USA. The UVA and UVB outputs of these sources were measured under controlled conditions at 10, 25, 50, 100 and 150 cm away from the light source using an IL-1700 research radiometer equipped with UVA and UVB detectors. Negligible UVB and UVA was detected at 100 and 150 cm. Therefore, data were analysed from measurements at 10, 25 and 50 cm only. The results demonstrated UVA leak highest from incandescent and halogen bulbs, and UVB leak highest from CFL. The overall UVA/UVB leak was lowest from CFL shielded during the manufacturing process. In conclusion, patients with photosensitivity have choices depending on their relative risk from different UVL wavelength spectra. UVB exposure risk may be reduced the greatest by utilising CFL with manufacturer-provided shields.
Ethnographic Insights into Enduring Inequalities
Authors: Gorringe Hugo , Jeffery Roger , Sariola Salla
Published: April 2009

This is a country where the poor fear tuberculosis, which kills 1,000 Indians a day, but people like me—middle-class people with access to health services that are probably better than England's—don't fear it at all. It's an unglamorous disease, like so much of the things that the poor of India endure (Adiga in Jefferies 2008).
Adivasi Mobilisation
Authors: Steur Luisa
Published: April 2009

In August 2001 there was widespread protest in Kerala, a state otherwise known for its remarkable achievements in ‘human’ development, at the starvation deaths that had occurred in a number of adivasi colonies. This prompted a continuing debate on the meaning of the Kerala ‘model’ of development for adivasis, in which a consensus seems to have risen that adivasis are the victims of Kerala's development experience and in which their current mobilisation is seen as the first time in history that their interests are being politically articulated. This article argues that such an interpretation is unwarranted and dangerous in that it ignores the present limitations of neo-liberalism on initiatives for the emancipation of subaltern groups and prevents them from using their historical political experience to dynamise their present political initiatives.
In the Name of ‘Poor and Marginalised’? Politics of NGO Activism with Dalit Women in Rural North India
Authors: Govinda Radhika
Published: April 2009

Assertion by the Dalits or ex-untouchables is one of the most significant developments in contemporary India. Dalit women have actively participated in Dalit movements and in women's and development NGOs activism. However, their voices and perspectives are said to have been marginalised by movements and NGOs alike. This article unpacks the complexities, contradictions and challenges that are produced, reproduced and subverted in NGO activism with Dalit women by examining a women's NGO and its relations with Dalit women, the state and international donors in rural Uttar Pradesh in north India. Which factors contribute to an NGO choosing to work with Dalit women? Specifically, what implications does having roots in a state-sponsored initiative have for the NGO under study? Does external funding necessarily change the character of activism with Dalit women? CanDalit women take on leadership roles in NGO activism with other Dalit women? The article explores these questions using interviews, observations and documentation collected and analysed in my doctoral research.
Performing Global HIV Prevention
Authors: Sariola Salla
Published: April 2009

Sex workers in India are central to HIV prevention programmes, yet the relationships of sex workers with those who conduct HIV prevention have not been studied. In this article I describe and analyse the relationships between four sets of very different social actors: global funding bodies; the Indian government; non-governmental organisations (NGOs) and; sex workers who are involved in HIV prevention in Chennai, India. Using ethnographic data derived from fieldwork conducted in 2004–5, I show that HIV prevention is a performance, rhetoric and a resource available to sex workers as well as to the NGOs. HIV prevention programmes create opportunities for sex workers for social mobilisation and offer them ways of subverting stigma, but these programmes are insufficient because they produce and reproduce existing power hierarchies. Thus when analysing inequality in sex workers’ lives, the influences of local power asymmetries as well as the global dimensions of international HIV prevention policies need to be considered.