bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality-of-Life Concerns of African American Breast Cancer Survivors Within Rural North Carolina: Blending the Techniques of Photovoice and Grounded Theory
Authors: López Ellen D. S. , Eng Eugenia , Randall-David Elizabeth , Robinson Naomi
Published: December 2004

Social norms imposing a prevailing silence around breast cancer in rural African American communities have made it difficult for survivors to express their quality-of-life (QOL) concerns. In this article, the authors describe how they blended the photovoice method (providing participants with cameras so they can record, discuss, and relate the realities of their lives) with grounded theory techniques to assist 13 African American breast cancer survivors from rural eastern North Carolina in (a) exploring how they perceive and address their QOL within their own social context and (b) developing a conceptual framework of survivorship QOL. The framework that emerged reveals that three social forces (racism, stigmas regarding cancer, and cultural expectations of African American women) drive four QOL concerns (seeking safe sources of support, adjusting to the role of cancer survivor, feeling comfortable about the future, and serving as role models) and that survivors address these concerns by relying on spiritual faith and devising strategies to maintain social standing.
Commentary on the Family’s Vitality: Diverse Structures With TV Illustrations
Authors: Pistole M. Carole , Marson Gia
Published: December 2004

There continues to be concern that there is some basic flaw in today’s families. The authors suggest that the family is vital and thriving, although in more diverse structures than were visible previously. The authors use television programming to illustrate the composition and functioning of today’s families and discuss information relevant to professional education and counseling persons/families with developmental issues.
Prevention Work: A Professional Responsibility for Marriage and Family Counselors
Authors: Murray Christine E.
Published: December 2004

Although ethical codes encourage marriage and family counselors to undertake prevention work, many practitioners do not include prevention within the scope of their practice. Prevention work includes a number of professional functions that address multiple family issues. Within a developmental framework, marriage and family counselors can bring a unique set of skills and experience to preventive work, and a family systems theoretical orientation helps to inform the practice of preventive efforts designed to enhance familial relationships. Marriage and family counselors can be involved in the practice, theory development, and research of prevention work. Effective prevention work by marriage and family counselors incorporates a consideration of barriers to effective prevention work, professional collaboration, and ethical considerations.
Diagnosis in Marriage and Family Counseling: An Ethical Double Bind
Authors: Crews Judith A. , Hill Nicole R.
Published: December 2004

The increasing influence of third-party payers over the diagnostic and treatment practices in the field of mental health counseling has created several ethical dilemmas for marriage and family counselors. In particular, the required use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for diagnoses places counselors in the position of misdiagnosing individuals in order to provide counseling for the family. This article is the first of two and overviews some of the primary ethical dilemmas associated with diagnosis in the field of marriage and family counseling. Part 2 will introduce case vignettes and apply an ethical lens to the issues described in the overview.
Fathering Today
Authors: Renshaw Domeena C.
Published: December 2004

Because women literally carry the baby, it has always been possible for men to walk away from sexual intercourse without concern about whether impregnation resulted. With technology today, intercourse is no longer necessary for parenting, but a sperm donor is. However, there is a new awareness of the importance of fathering to a man, his children, and his partner in the parenting role. Men are increasingly concerned and attentive to the pleasures and challenges of fatherhood.
Female Sexual Arousal Disorder and Counseling Deliberations
Authors: Millner Vaughn S.
Published: December 2004

Female sexual arousal disorder, a prevalent sexual problem for women, presents clinical challenges to counselors. The multifactorial etiology of female sexual arousal disorder requires a holistic treatment approach. This article describes both the objective and subjective aspects of the disorder and offers assessment and treatment considerations.
Using the Solving Circle With an Adlerian and Postmodern Twist: Fostering Relationships With Couples and Families
Authors: Lewis Todd F.
Published: December 2004

The solving circle is a technique based on the principles of choice theory designed to help couples and family members communicate more effectively. The central premise is that the relationship takes precedence over individual needs, and couples or family members communicate how each will personally change to make the relationship better. Arguing, blaming, and finger pointing are avoided. This technique is flexible enough to incorporate methods from other therapeutic schools, most notably Adlerian and postmodern approaches. This article describes the solving circle technique and provides a brief case study demonstrating its use.
Gay and Lesbian Families: What We Know and Where to Go From Here
Authors: Lambert Serena
Published: December 2004

The author reviewed the research on gay and lesbian parents and their children. The current body of research has been clear and consistent in establishing that children of gay and lesbian parents are as psychologically healthy as their peers from heterosexual homes. However, this comparison approach to research design appears to have limited the scope of research on gay and lesbian families, leaving much of the experience of these families yet to be investigated.
An Overview of Marriage Enrichment
Authors: Bowling Tiffany K. , Hill Carmella M. , Jencius Marty
Published: December 2004

This article acts as an introduction to the new regular section in The Family Journal called Marriage Education and Enrichment. A brief overview of the history of marriage enrichment is followed by summaries and research associated with five of the leading marriage enrichment programs and research (ACME, TIME, Relationship Enhancement, PREPARE/ENRICH, and PREP). Participants’ views of outcomes and future directions for marriage enrichment are discussed.
The Development of Family Therapy Around the World
Authors: Ng Kit S.
Published: December 2004

The growth of family work and family therapy has been a slow process outside of America. Family therapists in their homeland have to deal with the lack of training, resources, political red tape, ethnic differences, and language barriers to continue the work of family therapy. This article resolves to help readers to understand the diversity and the impact foreign therapists have in their own country and hopefully gain new respect for family therapy around the globe.
Discovery, Confidentiality, and In Camera Review: Is It Possible to Serve Two Masters?
Authors: Filaccio MaryLynne
Published: December 2004

Discovery is that phase of the litigation process that often involves the exchange of documents between and among parties. Although discovery is meant to be fairly broad as to what must be provided, there are some exceptions. One of these exceptions is psychological records. Psychological records are considered to be of a sensitive and confidential nature, so they are given privilege from the discovery process. Of course, this is not always the circumstance. To avoid confusion regarding when it is or is not proper to turn over psychological records, mental health professionals can request that the court inspect the records privately. This is referred to as “in camera review.” The presiding judge will inspect the records and only give opposing counsel those parts of the record, if any, that may be relevant to the case.
Part of the Package
Authors: Green Jamison
Published: December 2004

Where does masculinity come from? How is masculinity expressed? How is it perceived? What does it mean to be masculine or to have masculinity? The definition of masculinity remains elusive. While typically (though not always), maleness is conferred with the penis—anaccidentof birth—masculinityis often held to be “difficult to achieve.” Rites of passage, behavioral conventions, social roles, and political institutions have all been examined as sources for the production of masculinity. Female-to-male (FTM) transgendered and transsexual individuals, sometimes also called transmen, do not follow the traditional prescriptive paths to maleness, yet they often possess an undeniable masculinity. Through personal observation, literature review, and survey research, this article explores some of the concepts and embodiments of masculinity that are manifest among transmen. Some additional sources are Halberstam (Female Masculinity), Devor (Gender Blending), and Cromwell (Transmen and FTMs). These works are contrasted with that of various masculinity scholars.
Queer Masculinities of Straight Men
Authors: Heasley Robert
Published: December 2004

Many straight men experience and demonstrate “queer masculinity,” defined here as ways of being masculine outside hetero-normative constructions of masculinity that disrupt, or have the potential to disrupt, traditional images of the hegemonic heterosexual masculine. This article proposes language and a typology for such men: (1) straight sissy boys, (2) social justice straight-queers, (3) elective straight-queers, (4) committed straight-queers, and (5) males living in the shadow of masculinity. The benefit of building a typology of straight-queer masculinities is to begin to give voice and legitimacy to the queerness that exists within the straight male world. Naming the diversity of masculinity and its relationship to queerness will ideally provoke greater discourse on the topic and, ideally, extend awareness of the influence of the hegemonically straight masculine context not only over gay men but straight males as well.
Predicting Wife Assault
Authors: Hilton N. Zoe , Harris Grant T.
Published: December 2004

In this review, the authors examine the research evidence for the prediction of wife assault recidivism, lethal wife assault, and wife assault onset. They also review and present original data on the effect of treatment attendance on wife assault risk. Violence does not always become a stable habit, and variables associated with wife assault onset do not necessarily predict recidivism. General antisociality, psychopathy, substance abuse, and a history of assault and psychological abuse in the relationship are the most promising predictors of recidivism. Formal risk assessments, and victims’ predictions, have demonstrated value in predicting recidivism. The authors review existing assessments for wife assault onset and recidivism and explain the relative merits of actuarial tools and structured clinical assessments. Because of statistical and practical limitations to predicting lethal assault, they recommend using an actuarial assessment of wife assault risk, plus attention to the strongest correlates of lethal assault when lethality is a concern.
Family Violence among Adults with Severe Mental Illness
Authors: Solomon Phyllis L. , Cavanaugh Mary M. , Gelles Richard J.
Published: December 2004

Violence against family caregivers by their adult relatives with severe mental illness is a taboo area of public discourse and scientific research because of fears of further stigmatizing this population. Yet, these families experience violence at a rate estimated to be between 10% and 40%, which is considerably higher than the general population. This article reviews the limited research on violence of adults with severe mental illness against their family caregivers and proposes a conceptual framework that can further stimulate study in an area that has been neglected too long by both mental health and family violence investigators. Research on this topic is essential in developing effective policy and practice interventions.
Mediators of the Link between Childhood Sexual Abuse and Emotional Distress
Authors: Whiffen Valerie E. , MacIntosh Heather B.
Published: December 2004

A history of childhood sexual abuse (CSA) is a risk factor for adult emotional distress, including symptoms of depression, anxiety, dissociation, and trauma. However, CSA is likely associated with adult distress indirectly through an impact on mediating variables. In a review of the empirical literature, the authors found support for the roles of shame or self-blame, interpersonal difficulties, and avoidant coping strategies as mediators. In addition, emotional distress appears to mediate links between CSA and other adverse outcomes, such as alcohol abuse and revictimization. The authors conclude with a number of methodological and conceptual recommendations.
Assessment and Screening Tools for Trauma in Children and Adolescents
Authors: Strand Virginia C. , Sarmiento Teresa L. , Pasquale Lina E.
Published: December 2004

The need for thorough and accurate assessment of trauma in the lives of children and adolescents has become extremely important for the implementation of appropriate interventions. This article reviews 35 measures, 25 in depth and 10 in brief, that are currently available for use by researchers and practitioners. Instruments were divided into four domains: those that screen for (1) both a history of exposure to traumatic events and the presence of symptoms of trauma; (2) only a history of exposure; (3) symptoms of posttraumatic stress disorder (PTSD) or Dissociations; and (4) multiple symptoms of trauma (i.e. depressions, anger, sexual concerns, as well as PTSD). Information about the type of instrument, how trauma is constructed, psychometric properties, and practical issues are addressed for each of the 25 measures. A brief analysis is also provided for each measure.
A Conceptual Model of Community Capacity Development for Health Promotion in the Alberta Heart Health Project
Authors: Dressendorfer Rudolph H. , Raine Kim , Dyck Ronald J. , Plotnikoff Ronald C. , Collins-Nakai Ruth L. , McLaughlin W. Keith , Ness Kathleen
Published: December 2004

Purpose. The objective of this study was to derive a conceptual model of community capacity development for health promotion based on the 5-year demonstration phase of the Alberta Heart Health Project. Method. Community actions associated with successful implementation and uptake of initiatives in four diverse target sites were identified by case study evaluation. Results. Thirteen common elements of capacity development were found across the projects and categorized to define three primary dimensions of the process: (a) leadership that provided a driving force for implementation, (b) policy making that ensured diffusion and sustainability, and (c) use of local community resources and infrastructure. A conceptual model was constructed using these 3 dimensions and their interactions. Conclusion. Effective implementation of community health initiatives to promote heart health can be conceptualized as the involvement of local leadership, policy advocacy, and enhancement of existing infrastructure. The model highlights building these dimensions of community capacity development for health promotion.
Sustainability of the Impact of a Public Health Intervention: Lessons Learned From the Laval Walking Clubs Experience
Authors: Nguyên Minh-Nguyêt , Gauvin Lise , Martineau Irène , Grignon Richard
Published: December 2004

To inform health promotion practice regarding the sustainability of public health interventions, the authors interviewed the directors of 13 new communitybased organizations created through a practitioner-initiated public health intervention designed to promote physical activity at the community level. The purpose of the interviews was to uncover the factors that lead organization directors to become involved in the initiative and to maintain their involvement across an extended period of time. Results showed that there were 3 categories of positive outcomes associated with leading a walking club: maintaining and improving health, personal satisfaction, and group motivation. Difficulties associated with directing the club included high participant turnover rates, isolation of club directors, and lack of support from community organizations. Club directors indicated that sustainability would be enhanced through developing individual competencies, becoming more proficient at leading group dynamics, and developing better rootedness in the community. This information is interpreted in light of the six factors associated with sustainability.
Unpacking the Black Box: A Deconstruction of the Programming Approach and Physical Activity Interventions Implemented in the Kahnawake Schools Diabetes Prevention Project
Authors: Lévesque Lucie , Guilbault Gisèle , Delormier Treena , Potvin Louise
Published: December 2004

An ecological lens was used to deconstruct the programming approach and unpack physical activity interventions implemented through the Kahnawake Schools Diabetes Prevention Project. Despite a surge of interest in ecologically based health promotion programming, optimal combinations of interventions and programming approaches to promote community physical activity involvement have not been systematically studied. The authors obtained physical activity intervention descriptions through archive retrieval and face-to-face interviews with intervention staff. Programming approach, intervention targets, strategies for change, and delivery settings were assessed by applying the intervention analysis procedure to intervention descriptions. A complex intervention package was found containing a host of multitarget, multisetting intervention strategies designed and implemented through dynamic exchanges between a diversity of community partners. This study provides a first step toward better understanding community intervention packages and programming strategies for promoting physical activity involvement within a community setting.
Assessment of Public Health Educator Practice: Health Educator Responsibilities
Authors: Johnson Hans H. , Glascoff Mary A. , Lovelace Kay , Bibeau Daniel L. , Tyler Emily T.
Published: December 2004

This study presents a method for better understanding how practicing health educators in local health departments spend their time. The purpose of this study was to document the daily practice of health educators in the 10 areas of responsibility as defined by a competency-based framework for graduate-level health educators. The results of the current study present the average percentage of time health educators spent carrying out each area of responsibility and the percentage of health educators that did not carry out activities related to a specific area of responsibility. For example, the greatest percentage of time was spent implementing programs (21.2%), and approximately 60% of the health educators in the sample did not conduct research nor did they participate in activities to advance the profession. These findings have implications for the professional preparation of health educators and for their continuing education. The current study contains several suggestions for future research in this area.
A Review and Synthesis of Research Evidence for Self-Efficacy-Enhancing Interventions for Reducing Chronic Disability: Implications for Health Education Practice (Part I)
Authors: Marks Ray , Allegrante John P. , Lorig Kate
Published: December 2004

Disability and poor quality of life attributable to chronic diseases such as arthritis, diabetes, and heart disease constitute challenging public health problems for American society. In the absence of any effective cure for these conditions, the secondary prevention of complications and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. The organizing focus of such disease self-management should be on improving coping, communication, and control by enhancing self-efficacy. Part I of this two-part article describes the common clinical features of chronic diseases and the diverse disease management strategies used for alleviating pain and preventing disability associated with these and reviews the role of self-efficacy as a theoretical framework for successful self-management interventions. Part II identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for practice in patient education.
Public Health Informatics: The Nature of the Field and Its Relevance to Health Promotion Practice
Authors: Kukafka Rita
Published: December 2004

The purpose of this article is to introduce the relatively new field of public health informatics and provide examples of how informatics is currently being applied to health promotion activities. Additionally, the article illustrates how informatics is well positioned to play a central role and is likely to be central to disease prevention, health education, and health promotion as it will be practiced in the future.
A Hospital-Based Survey of Risk Factors for Diabetic Foot Ulceration in Northern Thailand
Authors: Rerkasem K. , Kosachunhanum N. , Chongruksut W. , Koiam W. , Limpijarnkit L. , Chimplee K. , Mangklabruks A.
Published: December 2004

Ulceration of the foot is found more commonly in patients with diabetes mellitus than those without it. Foot ulcers affect the lives of patients in many ways, and though good care can be defined, loss of limb is a common occurrence in this patient group. Therefore, early detection of the foot at risk for foot ulceration is of paramount importance. Many risk factors for this type of ulcer have been previously reported such as neuropathy, deformity of the foot, arterial occlusion, and poor glycemic control. The authors conducted a hospital-based survey in patients attending a hospital diabetic clinic to establish a baseline database and found that the percentages of sensory neuropathy, history of claudication and poor glycemic control were 19.2%, 5.7%, and 79.7%, respectively. This suggests the need to establish good diabetic control and health education for our patient population.
The Clinical Evaluation of Pterocarpus santalinus Linn. Ointment on Lower Extremity Wounds—A Preliminary Report
Authors: Biswas Tuhin Kanti , Maity Lakshmi Narayan , Mukherjee Biswapati
Published: December 2004

Pterocarpus santalinus is described in the Ayurveda for its wide spectrum of medicinal properties including wound healing. Previously the authors reported animal studies that demonstrated that an ointment made from the bark of this tree was effective without any toxic effects. They used the same ointment in 6 cases of lower extremity wounds. Healing was observed in all wounds. The study was not controlled, the findings are presented here as case studies. Further studies are planned to develop a wound healing ointment from a locally available and inexpensive plant.
Deep Infection After Ilioinguinal Node Dissection: Vacuum-Assisted Closure Therapy?
Authors: Steenvoorde Pascal , Slotema Eveline , Adhin Santosh , Oskam Jacques
Published: December 2004

Wound infection rates after ilioinguinal node dissection are high; 9% to 16% have been reported. The authors report a patient who underwent an ilioinguinal node dissection for a regional metastasized melanoma. Unfortunately, a deep wound infection occurred with extensive skin necrosis and production of abundant wound fluid (750 cc daily). Despite 6-daily dressings, the wound deteriorated, necessitating further operative debridement. In theatre, the authors failed to identify the lymphatic fistula and therefore were unable to close it. In accordance with literature on treatment of groin infections after vascular prosthesis, vacuum-assisted closure (VAC) therapy was started. After 11 days of VAC therapy, the lymphatic leakage completely stopped. Concurrent successful management of the wound with split skin graft therapy led to a complete closure of the wound. The treatment was not painful, changes of the sponge could be done in the ward, and there were no complications.
Minimally Invasive Treatment for Varicose Veins: A Review of Endovenous Laser Treatment and Radiofrequency Ablation
Authors: Beale Rosie J. , Mavor Andrew I. D. , Gough Michael J.
Published: December 2004

Varicose veins are a common problem, conventionally treated by an operation. Within the last few years, minimally invasive techniques have been developed as alternatives to surgery in an attempt to reduce morbidity and improve recovery time. Radiofrequency ablation and endovenous laser ablation are the most promising of these new techniques. This review article looks at the evidence for these techniques and the clinical experience to date and discusses their role in the future treatment of varicose veins.
A role for bone marrow–derived cells in the vasculature of noninjured CNS
Authors: Galimi Francesco , Summers Robert G. , van Praag Henriette , Verma Inder M. , Gage Fred H.
Published: December 2004

The contribution of hematopoietic cells to the formation of blood vessels is currently the focus of intense scrutiny. Bone marrow–derived endothelial progenitor cells are thought to generate endothelial cells in many tissues, including myocardium, muscle, and certain tumors. In the central nervous system (CNS), however, the possible role of bone marrow–derived angiocompetent cells remains unclear. Here we have investigated the long-term involvement of bone marrow–derived cells in the maintenance of endothelial structures in the brain, spinal cord, and retina. Using hematopoietic chimeras stably expressing green fluorescent protein (GFP) in bone marrow–derived tissues, we found large numbers of hematopoietic cells closely associated with vessels in the CNS. None of these cells, however, showed an endothelial phenotype. They were positive for monocytic and microglial surface markers and demonstrated active phagocytosis of neighboring endothelial elements. Bone marrow–derived, vasculature-associated cells in the noninjured adult CNS are distinct from endothelial cells, but play an active role in vascular structures.
Engraftment and survival following reduced-intensity allogeneic peripheral blood hematopoietic cell transplantation is affected by CD8+ T-cell dose
Authors: Cao Thai M. , Shizuru Judith A. , Wong Ruby M. , Sheehan Kevin , Laport Ginna G. , Stockerl-Goldstein Keith E. , Johnston Laura J. , Stuart Monic J. , Grumet F. Carl , Negrin Robert S. , Lowsky Robert
Published: December 2004

The influence of graft composition on clinical outcomes after reduced-intensity conditioning is not well-characterized. In this report we prospectively enumerated CD34+, CD3+, CD4+, and CD8+ cell doses in granulocyte colony-stimulating factor–mobilized peripheral blood mononuclear cell (G-PBMC) allografts in 63 patients who received transplants following non-myeloablative conditioning with total body irradiation 200 cGy plus fludarabine as treatment for malignant diseases. Donors were HLA-identical siblings (n = 38) or HLA-matched unrelated individuals (n = 25). By univariate analyses G-PBMC CD8+ T-cell dose in at least the 50th percentile favorably correlated with full donor blood T-cell chimerism (P = .03), freedom from progression (P = .001), and overall survival (P = .01). No G-PBMC cell dose influenced grade II to IV acute or extensive chronic graftversus-host disease. In multivariate analysis only G-PBMC CD8+ T-cell dose (P = .003; RR = 0.2, 95% CI = 0.1-0.6) was associated with improved freedom from progression. Infusion of low G-PBMC CD8+ T-cell dose for reduced-intensity allografting may adversely affect T-cell engraftment and survival outcome.
Regulation of human auto- and alloreactive T cells by indoleamine 2,3-dioxygenase (IDO)–producing dendritic cells: too much ado about IDO?
Authors: Terness Peter , Chuang Jing-Jing , Bauer Thomas , Jiga Lucian , Opelz Gerhard
Published: December 2004

Although dendritic cells (DCs) strongly stimulate the immune response, they can also induce unresponsiveness. Recently, a human monocyte-derived DC subpopulation was described that constitutively expresses indoleamine 2,3-dioxygenase (IDO). These DCs were defined as nonadherent CD123+/CC chemokine receptor 6+ (CCR6+) cells that suppress the allogeneic T-cell response. In the present study, we generated nonadherent, mature DCs from human blood monocytes. As expected, in addition to the classic markers, these cells expressed CD123 and CCR6. Reverse transcription–polymerase chain reaction (RT-PCR), however, did not show IDO gene transcription, nor did we detect enzymatic IDO activity. Treating the cells with interferon-γ (IFN-γ) resulted in significant IDO production. Subsequently, we studied the regulatory properties of IDO-producing DCs on autologous and allogeneic T-cell responses. Neither OKT3-stimulated T cells of healthy donors nor myelin basic protein (MBP)–specific T cells of patients with multiple sclerosis (MS) were suppressed by autologous IDO DCs. However, whereas IDOneg DCs supported further stimulation of preactivated MBP-specific T cells of an MS patient, IDOpos DCs had lost this capacity. The allogeneic T-cell response was only marginally suppressed by IDO DCs. Our findings show that nonadherent CD123+/CCR6+ human DCs do not constitutively express IDO, and, even if they express the enzyme after IFN-γ treatment, they possess only limited T-cell regulatory function.
Imatinib mesylate therapy may overcome the poor prognostic significance of deletions of derivative chromosome 9 in patients with chronic myelogenous leukemia
Authors: Quintas-Cardama Alfonso , Kantarjian Hagop , Talpaz Moshe , O'Brien Susan , Garcia-Manero Guillermo , Verstovsek Srdan , Rios Mary Beth , Hayes Kimberly , Glassman Armand , Bekele B. Nebiyou , Zhou Xian , Cortes Jorge
Published: December 2004

Deletions of derivative chromosome 9 [der(9)] can be identified by fluorescence in situ hybridization (FISH) in 10% to 15% of patients with chronic myeloid leukemia (CML). Patients with der(9) deletions have been reported to have an adverse outcome when treated with chemotherapy, interferon, and possibly imatinib mesylate. We investigated the frequency and prognostic significance of der(9) deletions among 352 patients with CML treated with imatinib mesylate at our institution, in whom a deletion status of der(9) was determined. Thirty-three patients (9%; 95% CI 0.07, 0.13) (30 in chronic phase, 3 in accelerated phase) had der(9) deletions. The rates of major (82% vs 79%, P = 0.82) and complete cytogenetic response (76% vs 66%, P = .33) with imatinib mesylate therapy were similar in patients with and without der(9) deletions, respectively. After a median follow-up of 28 months, there was no difference in overall survival (P = .30) or response duration (P = .49) in patients with and without deletions. In a multivariate analysis, der(9) deletions had no significant impact on response, survival, or response duration. We conclude that treatment with imatinib mesylate overcomes the adverse prognostic significance of der(9) deletions in patients with CML.
Isolation and characterization of human antigen-specific TCRαβ+ CD4-CD8- double-negative regulatory T cells
Authors: Fischer Karin , Voelkl Simon , Heymann Jana , Przybylski Grzegorz K. , Mondal Krishna , Laumer Monika , Kunz-Schughart Leoni , Schmidt Christian A. , Andreesen Reinhard , Mackensen Andreas
Published: December 2004

Down-regulation of immune responses by regulatory T (Treg) cells is an important mechanism involved in the induction of tolerance to allo-antigens (Ags). Recently, a novel subset of Ag-specific T-cell receptor (TCR)αβ+ CD4-CD8- (double-negative [DN]) Treg cells has been found to be able to prevent the rejection of skin and heart allografts by specifically inhibiting the function of antigraft-specific CD8+ T cells. Here we demonstrate that peripheral DN Treg cells are present in humans, where they constitute about 1% of total CD3+ T cells, and consist of both naïve and Ag-experienced cells. Similar to murine DN Treg cells, human DN Treg cells are able to acquire peptide–HLA-A2 complexes from antigen-presenting cells by cell contact-dependent mechanisms. Furthermore, such acquired peptide-HLA complexes appear to be functionally active, in that CD8+ T cells specific for the HLA-A2–restricted self-peptide, Melan-A, became sensitive to apoptosis by neighboring DN T cells after acquisition of Melan-A–HLA-A2 complexes and revealed a reduced proliferative response. These results demonstrate for the first time that a sizable population of peripheral DN Treg cells, which are able to suppress Ag-specific T cells, exists in humans. DN Treg cells may serve to limit clonal expansion of allo-Ag–specific T cells after transplantation.
The origins of age-related proinflammatory state
Authors: Ferrucci Luigi , Corsi Annamaria , Lauretani Fulvio , Bandinelli Stefania , Bartali Benedetta , Taub Dennis D. , Guralnik Jack M. , Longo Dan L.
Published: December 2004

We hypothesized that the rising levels of inflammatory markers with aging is explained by cardiovascular risk factors and morbidity becoming progressively more prevalent in older persons. Information on inflammatory markers, cardiovascular risk factors, and diseases was collected in 595 men and 748 women sampled from the general population (age, 20-102 years). In both men and women, older age was associated with higher levels of interleukin-6 (IL-6), IL-1 receptor antagonist (IL-1ra), IL-18, C-reactive protein (CRP), and fibrinogen, while soluble IL-6 receptor (sIL-6r) increased significantly with age only in men. Adjusting for cardiovascular risk factors and morbidity, the age regression coefficients became substantially smaller in models predicting IL-6, IL-1ra, IL-18, and fibrinogen and larger in the model predicting sIL6r. Adjustment for cardiovascular morbidity substantially reduced the effect of age on CRP in men but not in women. Findings were confirmed in a subgroup of 51 men and 45 women with low risk profile and no cardiovascular morbidity. Part of the “proinflammatory state” in older persons is related to the high prevalence of cardiovascular risk factor and morbidity.
z-VAD-fmk augmentation of TNFα-stimulated neutrophil apoptosis is compound specific and does not involve the generation of reactive oxygen species
Authors: Cowburn Andrew S. , White Jessica F. , Deighton John , Walmsley Sarah R. , Chilvers Edwin R.
Published: December 2004

In most cell types constitutive and ligand-induced apoptosis is a caspase-dependent process. In neutrophils, however, the broad-spectrum caspase inhibitor z-VAD-fmk enhances tumor necrosis factor-α (TNFα)-induced cell death, and this has been interpreted as evidence for caspase-dependent and -independent cell death pathways. Our aim was to determine the specificity of the effect of z-VAD-fmk in neutrophils and define the potential mechanism of action. While confirming that z-VAD-fmk (> 100 μM) enhances TNFα-induced neutrophil apoptosis, lower concentrations (1-30 μM) completely blocked TNFα-stimulated apoptosis. Boc-D-fmk, a similar broad-spectrum caspase inhibitor, and z-IETD-fmk, a selective caspase-8 inhibitor, caused a concentration-dependent inhibition of only TNFα-stimulated apoptosis. Moreover, the caspase-9 inhibitor, Ac-LEHD-cmk, had no effect on TNFα-induced apoptosis, and z-VAD-fmk and Boc-D-fmk inhibited TNFα-stimulated reactive oxygen species (ROS) generation. These data suggest that TNFα-induced apoptosis in neutrophils is fully caspase dependent and uses a mitochondrial-independent pathway and that the proapoptotic effects of z-VAD-fmk are compound specific and ROS independent.
Transfusion-related acute lung injury
Authors: Silliman Christopher C. , Ambruso Daniel R. , Boshkov Lynn K.
Published: December 2004

Transfusion-related acute lung injury (TRALI) is a life-threatening adverse effect of transfusion that is occurring at increasing incidence in the United States and that, in the past 2 reporting years, has been the leading cause of transfusion-related death. TRALI and acute lung injury (ALI) share a common clinical definition except that TRALI is temporally and mechanistically related to the transfusion of blood/blood components. In prospective studies, 2 patient groups, 1 requiring cardiac surgery and 1 with hematologic malignancies and undergoing induction chemotherapy, were predisposed. Two different etiologies have been proposed. The first is a single antibody-mediated event involving the transfusion of anti-HLA class I and class II or antigranulocyte antibodies into patients whose leukocytes express the cognate antigens. The second is a 2-event model: the first event is the clinical condition of the patient resulting in pulmonary endothelial activation and neutrophil sequestration, and the second event is the transfusion of a biologic response modifier (including lipids or antibodies) that activates these adherent polymorphonuclear leukocytes (PMNs), resulting in endothelial damage, capillary leak, and TRALI. These hypotheses are discussed, as are the animal models and human studies that provide the experimental and clinical relevance. Prevention, treatment, and a proposed definition of TRALI, especially in the context of ALI, are also examined.
The combination of thalidomide and intermediate-dose dexamethasone is an effective but toxic treatment for patients with primary amyloidosis (AL)
Authors: Palladini Giovanni , Perfetti Vittorio , Perlini Stefano , Obici Laura , Lavatelli Francesca , Caccialanza Riccardo , Invernizzi Rosangela , Comotti Benedetto , Merlini Giampaolo
Published: December 2004

Based on the efficacy of thalidomide in multiple myeloma and on its synergy with dexamethasone on myeloma plasma cells, we evaluated the combination of thalidomide (100 mg/d, with 100-mg increments every 2 weeks, up to 400 mg) and dexamethasone (20 mg on days 1-4) every 21 days in 31 patients with primary amyloidosis (AL) whose disease was refractory to or had relapsed after first-line therapy. Eleven (35%) patients tolerated the 400 mg/d thalidomide dose. Overall, 15 (48%) patients achieved hematologic response, with 6 (19%) complete remissions and 8 (26%) organ responses. Median time to response was 3.6 months (range, 2.5-8.0 months). Treatment-related toxicity was frequent (65%), and symptomatic bradycardia was a common (26%) adverse reaction. The combination of thalidomide and dexamethasone is rapidly effective and may represent a valuable second-line treatment for AL.
Systemic lupus erythematosus and pemphigus vulgaris: association or coincidence
Authors: Calebotta A , Cirocco A , Giansante E , Reyes O
Published: December 2004

Few cases have been published relating systemic lupus erythematosus (SLE) and pemphigus vulgaris (PV). We describe a patient with this association. A 35-year old woman who started to develop persistent pain and morning stiffness of proximal inter and metacarpo-phalangeal joints. During the following year, the patient recalled the onset of blisters on both legs, face, arms and thorax, as well as erosions appearing on oral mucous membranes. We observed generalized multiple erosions on her trunk and legs, flaccid bullae located on her right thigh and multiple erosions on oral mucous membranes. A skin biopsy reported PV. Direct immunofluorescence on the perilesional skin specimen, showed beehive intercellular IgG deposits in the epidermis (+++), suggesting PV; granular discontinuous IgM and C3 deposits in the dermal-epidermal union (+++), suggesting SLE. Direct immunofluorescence of the healthy unexposed skin specimen, reported granular discontinuous IgG deposits in the dermal-epidermal union and beehive intercellular IgG deposits in the lower levels of the epidermis (+++); granular continuous IgM deposits in the dermal-epidermal union (+++). The results of rheumatic studies were obtained as follows: ANA: 3 +, Anti-DNA, Anti-Sm, Anti-Ro and Anti-La: 4 +. The definite diagnosis was PVand SLE. Treatment with 50 mg of prednisone daily with good evolution.
The prevalence of dyslipoproteinemia in Thai patients with systemic lupus erythematosus
Authors: Siripaitoon B , Osiri M , Vongthavaravat V , Akkasilpa S , Deesomchok U
Published: December 2004

Fasting blood samples taken from 93 pairs of outpatient systemic lupus erythematosus (SLE) women and matched controls were assessed for total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL)- and low-density lipoprotein (LDL)-cholesterol. The demographic data, clinical manifestations, Mexican-SLE Disease Activity Index (MEX-SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index and medication prescribed in the SLE patients were reviewed. A significant elevation of TG levels was observed in the SLE patients compared to controls (mean ±SD 113.3 ±59.5 versus 77.7 ±45.7 mg/dL, P < 0.001). The HDL-c level was also significantly lower in SLE patients than controls (mean ±SD 49.7 ±12.7 versus 65.0 ±14.8 mg/dL, P < 0.001). The percentage of samples with low HDL-c (<35 mg/dL) was higher in the SLE group (9.7%) than controls (0%; P = 0.002). The LDL-c and TC levels were comparable in both groups. The use of antimalarial drugs was negatively associated with TC (OR 0.22, 95%CI 0.08-0.61) and LDL-c levels (OR 0.27, 95%CI 0.09-0.80). The increased prevalence of dyslipoproteinemia in SLE patients in this report has confirmed the results of previous studies and emphasized the importance of controlling this modifiable cardiovascular risk factor by the combination of lifestyle modification and medical treatments.
Decreased number of T cells bearing TCR rearrangement excision circles (TREC) in active recent onset systemic lupus erythematosus
Authors: Kayser C , Alberto F L , da Silva N P , Andrade L EC
Published: December 2004

Systemic lupus erythematosus (SLE) is characterized by several T lymphocyte abnormalities. An indirect assessment of recent thymus emigrants (RTE) has been recently been made available by measuring the number of TCR recombination excision circles (TREC) in peripheral T cells. We studied TREC levels in peripheral blood mononuclear cells (PBMC) of 32 SLE patients with active disease and 32 normal age- and sex-matched controls. Signal-joint TREC concentration was determined by real-time quantitative-PCR as the number of TREC copies/μg PBMC DNA. SLE patients had lower TREC levels (4.1 ±3.9 ×104 TREC/μg DNA) than controls (8.9 ±7.9 ×104/μg DNA) ( P = 0.004). There was an inverse correlation between age and TREC levels in controls ( r = 20.41, P = 0.02) but not in SLE patients. No clinical association was observed between TREC levels and clinical and laboratory SLE manifestations. TREC levels tended to be lower in patients with SLEDAI above 20 than in the rest of the patients ( P = 0.08). The decreased PBMC TREC levels is indicative of a low proportion of RTE in SLE and could be caused by decreased RTE output and/or by increased peripheral T cell proliferation in this disease. The under-representation of RTE in the peripheral T cell pool may play a role in the immune tolerance abnormalities observed in SLE.
Effects of fludarabine treatment on murine lupus nephritis
Authors: Jones O Y , Alexander P J , Lacson A , Gok F , Feliz A , Marikar Y , Madivi C , Jones J M , Good R A
Published: December 2004

BXSB mice, a murine model of systemic lupus erythematosus (SLE), were treated with two different doses of fludarabine for a four-week period and examined two weeks after the final dose. Control mice were treated with saline or cyclophosphamide. Mice treated with fludarabine had a significant reduction in renal pathology compared to control mice. Fludarabine-treated mice also had an almost 10-fold increase in percentile of CD8+CD25+ T cells in the spleen and a smaller but significant increase in CD4+CD25+ cells. Mice treated with cyclophosphamide had a greater leucopenia compared to the other groups and a significant reduction in percentile of B220+ cells in peripheral blood and spleen. Serum autoantibody levels to dsDNA did not differ significantly among the groups, but were higher in 4/10 mice treated with fludarabine. Although few trials of fludarabine for human SLE have been conducted, additional studies may be warranted.
Abnormal mechanical properties of larger arteries in postmenopausal women with systemic lupus erythematosus
Authors: Brodszki J , Bengtsson C , Länne T , Nived O , Sturfelt G , Maršál K
Published: December 2004

There is limited knowledge of potential defects in arterial wall properties in female systemic lupus erythematosus (SLE) patients without manifest cardiovascular disease (CVD) and significant atherosclerotic lesions. The aim of the present study was to investigate the mechanical properties of larger vessels in these patients and to compare them with healthy controls. B-mode ultrasound was used to assess vessel wall structure and to exclude presence of plaque. The ankle/brachial pressure index was measured to exclude occlusive arterial disease. An ultrasound echo-tracking system was used to determine stiffness of the abdominal aorta, common carotid artery (CCA) and popliteal artery (PA) in 39 female patientswith SLE and 55 female, healthy controls. SLE had an independent effect on stiffening of the CCA ( P = 0.01) and PA ( P = 0.005). In addition, larger vessel diameters were observed in the CCA (P = 0.002) after adjustments for the effects of mean arterial pressure and age. Thus, this investigation demonstrated an increased arterial stiffness and signs of premature vascular ageing in the SLE patients without manifest cardiovascular disease and without significant atherosclerotic lesions. The results of this study indicate that other mechanisms besides atherosclerosis might be involved in the pathogenesis of arterial stiffening in SLE patients.
Can disease specific measures for systemic lupus erythematosus predict patients health related quality of life?
Authors: Jolly M , Utset T O
Published: December 2004

Disease specific measures like systemic lupus erythematosus (SLE) Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics (SLICC) and Systemic Lupus Activity Measure (SLAM) are primarily based on physician assessment of disease severity along with blood tests pertinent to SLE. These are primarily used for research purposes and do not quantify the social impact of the disease or measure function and well being from the patients perspective. We wish to study the degree of correlation between the SLEDAI, SLICC and patient reported health related quality of life (HRQOL), to see if these measures can be used to gauge the disease impact from the patient’s perspective. The aim of the study was, therefore, to assess the correlation between SLICC, SLEDAI and HRQOL in patients with systemic lupus erythematosus. We utilized the University of Chicago SLE database to obtain SLEDAI, SLICC and MOS SF-36 scores. A physician not directly involved in their care assessed SLEDAI, SLICC and SF-36 at the same visit. STATA-7SE software was used to obtain the two summary scores [physical component summary (PCS) and mental component summary (MCS)]. Multiple linear regression and correlation coefficients were obtained to assess the direction and relationship between HRQOL and these disease specific measures. On multivariate regression models, both SLICC and SLEDAI were predictive of the PCS scores (βSLICC = -1.036, P = 0.025, 95% CI -1.9, -0.13: βSLEDAI = -0.322, P = 0.012, 95% CI -0.57, -0.07. R2 = 0.14). Neither SLICC nor SLEDAI were predictive of MCS scores (βSLICC = -0.015, P = 0.97, 95% CI -1.03, 1.001: βSLEDAI = -0.19, P = 0.174, 95% CI -0.47, 0.08. R2 = 0.02). The correlation coefficients between SLEDAI and PCS, MCS were -0.29 and -0.15, respectively. The correlation coefficients between SLICC and PCS, MCS were -0.27 and -0.02, respectively. The conclusions are that SLEDAI and SLICC are poor indicators of HRQOL of patients with SLE.