bluuebunny/crossref_metadata_2025 huggingface dataset:
From Story to Film: Brokeback Mountain’s “In-Between” Spaces
Authors: Campbell Neil
Published: August 2009

This essay examines the different ways in which Annie Proulx, in her story “Brokeback Mountain,” scriptwriters Larry McMurtry and Diana Ossana, and Ang Lee in his film address the central tensions between desire and social conditioning through a re-exploration of the western genre. Using the concept of ”in-between space,” the article shows how the ”text” (i.e., story/film) is the product of many hands each bringing certain knowledge and approaches to the material and extending outward into new, challenging areas of work. From this mixing of authors there emerges a powerful, tragic story that reveals much about the social conformity of the West embedded in masculinity, patriarchy, and domesticity. This social pressure is examined through the contrasting ”textual” use of space, panopticism, and a constraining sense of family set against the powers of nature, love, and memory.
'A Network of Trust': Measuring and Monitoring Air Pollution in British Cities, 1912-1960
Authors: Mosley Stephen
Published: August 2009

This paper examines the origins and development of the first nationwide air pollution monitoring network of its kind. The Investigation of Atmospheric Pollution was founded in 1912 with less than 30 participating bodies. By the 1960s it had expanded its research activities to involve over 500 cooperating authorities and organisations in almost every major British town and city. The paper is set out in three interrelated parts. Firstly, it explores how central and local government, representatives of industry, and non-governmental organisations worked together to establish an expert body that could gather information on polluted air, despite their different interests and agendas. Secondly, it draws historical attention to the importance (and difficulties) of technical standard-setting in providing reliable and policy-relevant knowledge about environmental pollution. Lastly, it will examine the uses of monitoring in efforts to raise public awareness of the problems caused by coal smoke and its role in supporting action to reduce urban air pollution, particularly after the 1952 London smog disaster.
Campaigning for Street Trees, Sydney Botanic Gardens, 1890s-1920s
Authors: Frawley Jodi
Published: August 2009

Between the 1890s and 1920s street trees became a more prominent feature in streetscapes across New South Wales, Australia. The Sydney Botanic Gardens, with their extensive nursery system, were responsible for supplying seedlings to councils and municipalities for use as street trees. As such, this institution was a primary mover of what a street tree should be, how they should be used and what plants were best suited to this particular use in urban environments. This paper analyses the nurturing of this use of street trees by the Sydney Botanic Gardens and the Director Joseph Maiden. This institution was a place that moved not just stock and seedlings, but ideas about how nature's inclusion into urban environments had the capacity to influence and enhance the cultivation of civilised citizens. This was affected through access to transnational resources available to the Sydney Botanic Gardens.
The Paradox of Discourse Concerning Deforestation in New Zealand: A Historical Survey
Authors: Knight Catherine
Published: August 2009

When the European settlement of New Zealand began in earnest in the mid-nineteenth century, the landscape too underwent a dramatic transformation. Much of the forest was destroyed by milling and fire, and the land converted to pasture for farming. While seen by many as firmly within the prevailing 'doctrine of progress', this transformation was viewed with misgivings by others, who observed how deforestation led to erosion and floods, and advocated more prudent forest management. This paper explores the historical discourse on deforestation around the latter part of the nineteenth and early part of the twentieth centuries and how it contrasts with the recent discourse following major floods in 2004, in which the discussion of deforestation as an underlying cause of floods and erosion is notable in its very absence. This paper will seek to explain the paradox apparent in the development of New Zealanders' understanding of the connection between deforestation and the devastating flood events and severe erosion occurring in New Zealand today. While this is a connection that was repeatedly and cogently expressed by our forebears over one hundred years ago, it is one that most New Zealanders today are ignorant of.
The Fall and Fall in the Legal Status of Mustelids in New Zealand
Authors: Wells Philippa
Published: August 2009

Three species of the family Mustelidae (stoats, weasels and ferrets) were initially introduced into New Zealand (and granted statutory protection) in an attempt to control a burgeoning rabbit population. From that point, scientific, political and social debate centred on both the advisability and efficacy of the introduction. Although their legal protection and support was partially removed in 1903, they were not declared statutory 'vermin' for another 50 years. The long road taken by these predators to political perdition signals shifts in political and economic power and reveals dissension and changes in policy direction.
Breaking New Ground? Gifford Pinchot and the Birth of 'Empire Forestry' in the Philippines, 1900-1905
Authors: Bankoff Greg
Published: August 2009

Professional forest management in the Philippines is largely attributed to the ideas and endeavours of American foresters such as Gifford Pinchot, George Ahern and Henry Graves who were instrumental in establishing the Insular Bureau of Forestry in 1900 and in passing the forestry laws of 1904 and 1905. These men, however, did not so much transfer American forest management directly to the archipelago let alone blindly implement empire forestry policies developed in other colonial settings such as British India. Instead, they pragmatically improvised new methods of forest management that were a blend of European, American and local expertise, 'hybrid practices' more suited to an administratively and scientifically unstable tropical setting.
Book Reviews
Authors: Carruthers Jane , Zeller Suzanne , Showers Kate B. , Chapman J. , Herring Horace
Published: August 2009

Divyabhanusinh (ed.), The Lions of India (JANE CARRUTHERS)
R. Cole Harris, The Reluctant Land: Society, Space, and Environment in Canada before Confederation (SUZANNE ZELLER)
Helen M. Rozwadowski and David K. van Keuren, eds., The Machine in Neptune's Garden (KATE B. SHOWERS)
Marcel Mazoyer and Laurence Roudart, A History of World Agriculture From the Neolithic Age to the Current Crisis (J. CHAPMAN)
Roger Fouquet, Heat, Power and Light: Revolutions in Energy Services (HORACE HERRING)
Explaining phonological conditions on affixation: Evidence from suppletive allomorphy and affix ordering
Authors: Paster Mary
Published: August 2009

This paper examines two domains in which phonology may exert an influence on morphology: suppletive allomorph selection and affix ordering. Cross-linguistic facts about both phenomena are examined and ultimately argued to provide evidence for a phonology-morphology interface in which morphology precedes phonology at each level of the grammar in a cyclic-type approach, and phonological conditions on affixation occur when an affix subcategorizes for a particular phonological unit. This is contrasted with an Optimality Theoretic (OT) approach to the phonology-morphology interface in which phonological effects in morphology are modeled by ranking phonological constraints over morphological ones (i.e. ‘P ≫ M’) within a single component of the grammar. It is argued that the former approach makes better predictions for the two phenomena in question as well as for other areas previously discussed in the literature (e.g. infix placement) and that phonological and morphological constraints should not be interranked in an OT grammar.
Assessing Plant Genetic Diversity by Molecular Tools
Authors: Mondini Linda , Noorani Arshiya , Pagnotta Mario  A.
Published: August 2009

This paper is an overview of the diverse, predominantly molecular techniques, used in assessing plant genetic diversity. In recent years, there has been a significant increase in the application of molecular genetic methods for assessing the conservation and use of plant genetic resources. Molecular techniques have been applied in the analysis of specific genes, as well as to increase understanding of gene action, generate genetic maps and assist in the development of gene transfer technologies. Molecular techniques have also had critical roles in studies of phylogeny and species evolution, and have been applied to increase our understanding of the distribution and extent of genetic variation within and between species. These techniques are well established and their advantages as well as limitations have been realized and described in this work. Recently, a new class of advanced techniques has emerged, primarily derived from a combination of earlier, more basic techniques. Advanced marker techniques tend to amalgamate advantageous features of several basic techniques, in order to increase the sensitivity and resolution to detect genetic discontinuity and distinctiveness. Some of the advanced marker techniques utilize newer classes of DNA elements, such as retrotransposons, mitochondrial and chloroplast based microsatellites, thereby revealing genetic variation through increased genome coverage. Techniques such as RAPD and AFLP are also being applied to cDNA-based templates to study patterns of gene expression and uncover the genetic basis of biological responses. The most important and recent advances made in molecular marker techniques are discussed in this review, along with their applications, advantages and limitations applied to plant sciences.
The Relationship Between Positive Psychology and Tourist Behavior Studies
Authors: Pearce Philip L.
Published: August 2009

Positive psychology is an area of study that seeks to highlight the role of positive emotions, character strengths, and positive institutions serving human happiness and well-being. There has been a rapid rise in prominence of this area of psychology since the year 2000 and tourism
studies have not yet made as many connections to the new study area as might be expected. This article reviews the basic concerns in positive psychology and highlights two areas of study in tourist behavior—specifically, the study of optimism and the assessment of positive emotions of
visitors during their experience—to illustrate some of the potential in establishing connections. Further possibilities to build fresh insights for tourist behavior studies are noted, including a richer scrutiny of the underlying dimensions of the experience economy and broader appraisals
of tourists' satisfaction. It is argued further that the direction of influence need not be uniformly one way. For example, tourism research can offer insights into the operation of mindfulness and the assessment of authenticity in different ways from that conceived of by psychologists working
in more constrained experimental settings. Further, the scope and scale of attention to positive psychology themes in tourism settings may also have important consequences for the integration and wellbeing of tourism researchers into broader, very active, and increasingly well-respected academic
communities.
Comparison of Patients with Juvenile Psoriatic Arthritis and Nonpsoriatic Juvenile Idiopathic Arthritis: How Different Are They?
Authors: BUTBUL YONATAN AVIEL , TYRRELL PASCAL N. , SCHNEIDER RAYFEL , DHILLON SANDEEP , FELDMAN BRIAN M. , LAXER RONALD M. , SAURENMANN ROTRAUD K. , SPIEGEL LYNN , CAMERON BONNIE , TSE SHIRLEY M. , SILVERMAN EARL D.
Published: August 2009

Objective.

To compare the clinical features and outcome between patients with juvenile psoriatic arthritis (JPsA) and non-JPsA juvenile idiopathic arthritis (JIA).

Methods.

Fifty-three children with JPsA, 32 with < 5 joints in the first 6 months of disease (oligo–JPsA) and 21 (≥ 5 joints) polyarticular-onset (poly-JPsA) were compared to 53 patients with JIA who were matched by sex, age, date of diagnosis, and articular onset pattern.

Results.

There was no difference in the percentage of patients between the oligoarticular groups who developed extended oligoarthritis or in the percentage of patients who were positive for antinuclear antibodies. The only differences were that 25% of patients with oligo-JPsA had dactylitis compared to 0% of patients with oligo-JIA (p < 0.01) and 50% had nail pitting as compared to 18.7% (p < 0.05). In polyarticular patients the percentages with dactylitis were similar (19% vs 38%; p = 0.25). The frequency of uveitis was identical in the oligoarticular patients but a higher rate was seen in poly-JPsA compared to poly-JIA (23.8% vs 0%; p = 0.02), while contractures were more frequent in poly-JIA compared to poly-JPsA during the course of the illness (47.6% vs 14.3%; p = 0.03) but not at last followup (14.3% vs 4.7%; p = 0.6). At last followup the mean Childhood Health Assessment Questionnaire scores were similar in both the polyarticular and oligoarticular groups.

Conclusion.

There were only a few differences between patients with JPsA and JIA regarding disease onset, disease course, and outcome. We suggest that large, longterm prospective studies are required to accurately determine whether subdividing JIA according to psoriasis is worthwhile.
Clinical Usefulness of a Prognostic Score in Histological Analysis of Renal Biopsy in Patients with Lupus Nephritis
Authors: KOJO SHOICHIRO , SADA KEN-EI , KOBAYASHI MIZUHO , MARUYAMA MIE , MAESHIMA YOHEI , SUGIYAMA HITOSHI , MAKINO HIROFUMI
Published: August 2009

Objective.

To evaluate active and chronic lesions in association with renal outcome according to the International Society of Nephrology/Renal Pathology Society classification in patients with lupus nephritis.

Methods.

A retrospective analysis of 99 biopsy-proven subjects with lupus nephritis from 1990 to 2006 was performed in our center using the new classification. Each histological lesion was evaluated by multivariate survival analysis as predictive factor for renal insufficiency in patients with lupus nephritis, and independent predictors were graded to develop the prognostic score based on the regression coefficient. A receiver operating-characteristic curve based on the prognostic score was plotted to determine the most appropriate cutoff point.

Results.

In class IV, the IV-G group tended to exhibit a worse renal outcome compared with the IV-S group, but the difference was not significant (log-rank test, p = 0.4330). Independent histological predictors of poor renal outcome were extracapillary proliferation, glomerular sclerosis, and fibrous crescents analyzed by Cox proportional hazards model, while predictors of favorable renal outcome were hyaline thrombi and fibrous adhesions. By the prognostic score, renal outcome was significantly worse in the group with the higher score (≥ 0.25) than in the group with the lower score (< 0.25) in class IV patients (log-rank test, p < 0.001).

Conclusion.

These results demonstrate the advantage of our prognostic score compared to subclasses in predicting the renal outcome of class IV patients [University Hospital Medical Information Network (UMIN) clinical trials registry, number UMIN 000001943].
Urine Osteoprotegerin and Monocyte Chemoattractant Protein-1 in Lupus Nephritis
Authors: KIANI ADNAN N. , JOHNSON KRISTEN , CHEN CATHERINE , DIEHL EDWARD , HU HUAIZHONG , VASUDEVAN GANESH , SINGH SUKHMINDER , MAGDER LAURENCE S. , KNECHTLE STUART J. , PETRI MICHELLE
Published: August 2009

Objective.

Renal biopsy is the “gold standard” to determine renal activity in systemic lupus erythematosus (SLE), but it is expensive, invasive, and carries risk. Osteoprotegerin (OPG) is produced by the heart, lungs, kidney, and bone. Monocyte chemoattractant protein-1 (MCP-1), a chemotactic cytokine, is involved in the progression of glomerular and tubulointerstitial injury. We investigated both urine OPG and MCP-1 as potential biomarkers for lupus nephritis.

Methods.

Our subjects, 87 patients with SLE (88% women; 48% African American, 41% Caucasian, 11% other), mean age 44 years, were followed monthly to quarterly. Urinary OPG (pg/ml) and MCP-1 (pg/ml) were measured (Luminex MAP bead assay).

Results.

OPG concentrations were strongly associated with global disease activity and with both renal activity on a visual analog scale (VAS) (p = 0.0006) and renal disease activity descriptors of the SELENA SLEDAI, including hematuria (p = 0.001) and a positive anti-dsDNA (p = 0.013). MCP-1 was also associated with the renal VAS (p = 0.032), renal disease activity descriptors of SELENA SLEDAI, including hematuria (p = 0.027), and with a positive anti-dsDNA (p = 0.016). We also examined the relationship between the biomarkers and having a urine protein to creatinine ratio (pr/cr) ≥ 0.5. Among patients with medium or high OPG, 46% had urine pr/cr ≥ 0.5, compared to only 23% among those with low OPG (p = 0.032). The 2 biomarkers were strongly correlated with each other (Spearman correlation coefficient 0.77, p < 0.0001).

Conclusion.

The lack of availability of urine biomarkers has hampered development of new therapies for lupus nephritis. Urine MCP-1 and OPG were both associated with measures of lupus renal disease activity. Medium or high levels of OPG were predictive of a urine protein/creatinine ratio of ≥ 0.5. Further study, including longitudinal assessment and correlation with concurrent renal biopsies, is necessary before this assay can be used in the routine clinic setting.
Vitamin D Deficiency and Insufficiency in 2 Independent Cohorts of Patients with Systemic Sclerosis
Authors: VACCA ALESSANDRA , CORMIER CATHERINE , PIRAS MARTINA , MATHIEU ALESSANDRO , KAHAN ANDRE , ALLANORE YANNICK
Published: August 2009

Objective.

To investigate 25-OH vitamin D concentrations in 2 independent systemic sclerosis (SSc) populations from France and Italy.

Methods.

We studied 156 consecutive SSc patients comparable for demographic characteristics: 90 from Northern France and 66 from Southern Italy. 25-OH vitamin D, intact parathyroid hormone, and serum total calcium and phosphorus were measured in all patients. Vitamin D concentrations < 30 ng/ml were considered insufficiency, while values < 10 ng/ml were classified as deficiency.

Results.

Vitamin D insufficiency and deficiency rates were very high and comparable between the 2 populations: 74/90 (82%) versus 57/66 (86%) for insufficiency and 29/90 (32%) versus 15/66 (23%) for deficiency, respectively, in the French and Italian patients. They were not influenced by vitamin D supplementation, which was not statistically different in the 2 groups. In the combined populations, a significant negative correlation was found between low vitamin D levels and European Disease Activity Score (p = 0.04, r = −0.17) and an even more significant correlation was found with acute-phase reactants (p = 0.004, r = −0.23 for erythrocyte sedimentation rate), and low levels of vitamin D were associated with the systolic pulmonary artery pressure (sPAP) estimated by echocardiography (p = 0.004). In multivariate analysis, vitamin D deficiency was associated with sPAP (p = 0.02).

Conclusion.

Vitamin D deficiency was very common in the 2 SSc populations, independent of geographic origin and vitamin D supplementation. This suggests that common vitamin D supplementation does not correct the deficiency in SSc patients, and that a higher dose is probably needed, especially in those with high inflammatory activity or severe disease.
Comparison of Screening Procedures for Mycobacterium tuberculosis Infection Among Patients with Inflammatory Diseases
Authors: SOBORG BOLETTE , RUHWALD MORTEN , HETLAND MERETE LUND , JACOBSEN SØREN , ANDERSEN AASE BENGAARD , MILMAN NILS , THOMSEN VIBEKE OSTERGAARD , JENSEN DORTE VENDELBO , KOCH ANDERS , WOHLFAHRT JAN , RAVN PERNILLE
Published: August 2009

Objective.

To test if Mycobacterium tuberculosis screening results differ among patients with inflammatory disease depending on whether the QuantiFeron TB-Gold test (QFT) or tuberculin skin test (TST) is used; and to evaluate if a possible difference is influenced by the presence of risk factors or immunosuppression.

Methods.

The interferon-γ response to in vitro stimulation of M. tuberculosis-specific antigens was measured with QFT and results were compared with TST. Associations to bacillus Calmette-Guerin (BCG) vaccination, risk factors, and immunosuppression were analyzed for both tests.

Results.

QFT and TST results were available for 294/302 and 241/302 patients, respectively; 234 had results from both tests. Twenty-one (7%) tested positive with QFT and 45 (19%) with TST. A positive QFT was associated with risk factors for M. tuberculosis infection: i.e., birth or upbringing in a TB-endemic area [risk ratio (RR) = 7.8, 95% CI 1.5–18.2, p < 0.001], previous TB treatment (RR 4.7, 95% CI 1.6–13.5, p = 0.005), and any latent TB infection risk factor (RR 4.7, 95% CI 2.1–11.0, p = 0.0002). Treatment with corticosteroids increased the risk for an inconclusive QFT result (RR 4.2, 95% CI 1.6–10.7, p = 0.04) and decreased the risk for a positive TST result (RR 0.4, 95% CI 0.1–1.0, p = 0.04). Agreement between the tests was low (kappa 0.2, 95% CI 0.02–0.3, p = 0.002).

Conclusion.

The study documented a high degree of discordant positive QFT and TST results. A positive QFT was more closely associated with risk factors for M. tuberculosis infection than the TST. The use of corticosteroids affected test outcome by increasing the risk for an inconclusive QFT result and decreasing the risk for a positive TST result.
Diclofenac Sodium Gel in Patients with Primary Hand Osteoarthritis: A Randomized, Double-blind, Placebo-controlled Trial
Authors: ALTMAN ROY D. , DREISER RENÉE-LILIANE , FISHER CHESTER L. , CHASE WALTER F. , DREHER DONATUS S. , ZACHER JOSEF
Published: August 2009

Objective.

To measure the efficacy and safety of diclofenac sodium gel in patients with primary hand osteoarthritis (OA).

Methods.

In a randomized, double-blind, placebo-controlled trial, men and women aged ≥ 40 years diagnosed with primary OA in the dominant hand were randomly assigned to self-apply topical 1% diclofenac sodium gel (Voltaren® Gel) (n = 198) or vehicle (n = 187) to both hands 4 times daily for 8 weeks. Primary outcome measures included OA pain intensity (100-mm visual analog scale), total Australian/Canadian Osteoarthritis Hand Index (AUSCAN) score, and global rating of disease activity at 4 and 6 weeks. Secondary outcomes included onset of efficacy in Weeks 1 and 2, durability of efficacy at 8 weeks, measures of disease activity in the dominant hand, pain intensity in the non-dominant hand, AUSCAN subindices, end of study rating of efficacy, and Osteoarthritis Research Society International response criteria.

Results.

Diclofenac sodium gel decreased pain intensity scores by 42%–45%, total AUSCAN scores by 35%–40%, and global rating of disease by 36%–40%. Significant differences favoring diclofenac sodium gel over vehicle were observed at Week 4 for pain intensity and AUSCAN, with a trend for global rating of disease activity. At Week 6, diclofenac sodium gel treatment significantly improved each primary outcome measure compared with vehicle. Secondary outcomes generally supported the primary outcomes. The most common treatment-related adverse event (AE) was application-site paresthesia. Most AE were mild. No cardiac events, gastrointestinal bleeding, or ulcers were reported.

Conclusion.

Topical diclofenac sodium gel was generally well tolerated and effective in primary hand OA. (NCT ID: NCT00171665)
Can Magnetic Resonance Imaging Differentiate Undifferentiated Arthritis Based on Knee Imaging?
Authors: EMAD YASSER , RAGAB YASSER , SHAARAWY AHMED , ABOU-ZEID ALAA , SAAD AHMED , FAWZY MAGDY , JOKHDAR HANI , RASKER JOHANNES J.
Published: August 2009

Objective.

To compare findings as observed on enhanced magnetic resonance imaging (MRI) of the knee joints, in oligoarticular-undifferentiated arthritis (UA) in those with established rheumatoid arthritis (RA) and spondyloarthropathy (SpA).

Methods.

A total of 55 patients with knee arthritis were consecutively recruited for the study, including 25 with undifferentiated oligoarthritis of the knee joint(s), 15 fulfilling the American College of Rheumatology criteria for RA and 15 with SpA. Laboratory investigations included erythrocyte sedimentation rate, C-reactive protein, complete blood count, aspartate aminotransferase, alanine aminotransferase, serum creatinine, and urine analysis. In all patients in the UA and in the RA group, rheumatoid factor and anti-CCP2 antibody (ELISA) were tested. All patients underwent enhanced MRI of the more symptomatic knee. All groups were compared in terms of demographics, laboratory investigations, and MRI findings.

Results.

Synovial thickness differed significantly in the RA group compared to UA and SpA groups (p < 0.001). The RA group showed a higher rate of bony and cartilaginous erosions and bone marrow edema compared to UA and SpA groups (p < 0.001). Enthesitis was found in all patients in the SpA group (100%) and differed from RA and UA groups (p < 0.001).

Conclusion.

Patients with RA showed more destructive changes in terms of synovial thickening, bone marrow edema, cartilaginous and bone erosions compared to UA and SpA groups. Enthesitis is a common feature on MRI in SpA, while absent in the RA and UA groups. This latter finding may have important clinical implications for classification purposes, and can help to determine the evolving pattern of patients with UA of the knee joint.
Do Rheumatoid Arthritis Patients Have a Higher Risk for Sleep Apnea?
Authors: READING STEPHANIE R. , CROWSON CYNTHIA S. , RODEHEFFER RICHARD J. , FITZ-GIBBON PATRICK D. , MARADIT-KREMERS HILAL , GABRIEL SHERINE E.
Published: August 2009

Objective.

Patients with rheumatoid arthritis (RA) have an increased risk for developing cardiovascular disease (CVD) compared to subjects in the general population. The development of CVD has also been linked to chronic sleep apnea. The purpose of this study was to examine the risk for sleep apnea in patients with RA compared to subjects without RA.

Methods.

We recruited RA patients and non-RA subjects who were age and sex matched from the same population. These persons completed the Berlin Sleep Questionnaire, which evaluated their level of risk (high or low) for sleep apnea. In addition, there were 3 subscales evaluating snoring, fatigue, and relevant comorbidities [i.e., high blood pressure and obesity [body mass index (BMI) ≥ 30 kg/m2)]. Chi-squared tests were used for comparisons.

Results.

The study population consisted of 164 patients with RA and 328 patients without RA. Age, sex and BMI were similar for both groups. There was no difference in snoring (p = 0.31) or in the comorbidities subscale (p = 0.37). However, RA patients reported more fatigue (38%) than subjects without RA (13%; p < 0.001). Overall, the risk for sleep apnea was significantly higher for the RA patients (50%) than the non-RA subjects (31%; p < 0.001).

Conclusion.

Patients with RA may be at a higher risk for sleep apnea compared to non-RA subjects. This apparent risk difference may be attributed to reports of fatigue in RA patients, which may be associated with sleep apnea or RA disease itself.
Increased Cardiovascular Disease in Patients with Inflammatory Arthritis in Primary Care: A Cross-sectional Observation: Table 1.
Authors: PETERS MIKE J.L. , NIELEN MARK M.J. , RATERMAN HENNIE G. , VERHEIJ ROBERT A. , SCHELLEVIS FRANCOIS G. , NURMOHAMED MICHAEL T.
Published: August 2009

Objective.

To compare the prevalence of cardiovascular disease (CVD) in patients with inflammatory arthritis and control subjects registered in primary care.

Methods.

Conditional logistic regression analyses were used to compare the CVD prevalence in patients and controls, aged 50–75 years.

Results.

Overall, the CVD prevalence was 66.1 per 1000 patients in inflammatory arthritis and 37.3 per 1000 patients in controls, resulting in an odds ratio of 1.83 (95% confidence interval 1.33–2.51).

Conclusion.

Inflammatory arthritis patients registered in primary care are associated with an increased cardiovascular burden, which emphasizes the need for cardiovascular risk management in the primary care setting.
Does Sonographic Needle Guidance Affect the Clinical Outcome of Intraarticular Injections?
Authors: SIBBITT WILMER L. , PEISAJOVICH ANDRES , MICHAEL ADRIAN A. , PARK KYE S. , SIBBITT RANDY R. , BAND PHILIP A. , BANKHURST ARTHUR D.
Published: August 2009

Objective.

This randomized controlled study addressed whether sonographic needle guidance affected clinical outcomes of intraarticular (IA) joint injections.

Methods.

In total, 148 painful joints were randomized to IA triamcinolone acetonide injection by conventional palpation-guided anatomic injection or sonographic image-guided injection enhanced with a one-handed control syringe (the reciprocating device). A one-needle, 2-syringe technique was used, where the first syringe was used to introduce the needle, aspirate any effusion, and anesthetize and dilate the IA space with lidocaine. After IA placement and synovial space dilation were confirmed, a syringe exchange was performed, and corticosteroid was injected with the second syringe through the indwelling IA needle. Baseline pain, procedural pain, pain at outcome (2 weeks), and changes in pain scores were measured with a 0–10 cm visual analog pain scale (VAS).

Results.

Relative to conventional palpation-guided methods, sonographic guidance resulted in 43.0% reduction in procedural pain (p < 0.001), 58.5% reduction in absolute pain scores at the 2 week outcome (p < 0.001), 75% reduction in significant pain (VAS pain score ≥ 5 cm; p < 0.001), 25.6% increase in the responder rate (reduction in VAS score ≥ 50% from baseline; p < 0.01), and 62.0% reduction in the nonresponder rate (reduction in VAS score < 50% from baseline; p < 0.01). Sonography also increased detection of effusion by 200% and volume of aspirated fluid by 337%.

Conclusion.

Sonographic needle guidance significantly improves the performance and outcomes of outpatient IA injections in a clinically significant manner.
Palindromic Rheumatism: Longterm Outcomes of 60 Patients Diagnosed in 1967–84
Authors: KOSKINEN ESSI , HANNONEN PEKKA , SOKKA TUULIKKI
Published: August 2009

Objective.

To study longterm outcomes of 60 patients with palindromic rheumatism (PR) diagnosed in 1967–1984.

Methods.

A cohort of patients with PR was identified in Jyväskylä Central Hospital in 1967–84, and reexamined in 1984–86. In 2006, medical records of the patients were reviewed to analyze the proportion of patients who had developed chronic rheumatoid arthritis (RA), had joint replacement surgery, or had died. Patients’ health status was reviewed by mail questionnaires including functional status on the Health Assessment Questionnaire (HAQ), pain, and the number of painful joints.

Results.

Forty patients developed chronic RA over the observation period of over 20 years, among whom 38 patients within 10 years and 2 patients after 10 years. Twenty-four patients had died by 2006, 17 (42%) in the RA group and 7 (35%) in the non-RA group. Nine patients, all in the RA group (23%), had received 1 or more joint replacements. The mean HAQ score was 0.57 in the non-RA survivors (mean age 70 yrs), compared to 0.89 in the RA group (mean age 66 yrs) (p = 0.020, adjusted for age). Pain scores and the number of painful joints were similar between the groups.

Conclusion.

Two-thirds of the patients with PR developed chronic arthritis. The risk to develop chronic arthritis remained over 10 years. The RA group was characterized with functional declines and having joint replacements as longterm outcomes of the disease.
Arterial Events in Persons with Dermatomyositis and Polymyositis
Authors: TISSEVERASINGHE ANNALIESE , BERNATSKY SASHA , PINEAU CHRISTIAN A.
Published: August 2009

Objective.

To assess arterial events in dermatomyositis (DM) and polymyositis (PM), and associated factors.

Methods.

We studied a cohort of persons with DM and PM, assembled from provincial administrative databases. New cases of ischemic heart disease, cerebrovascular accidents (CVA), and peripheral arterial disease were ascertained from billing and hospitalization data. We performed case-control analyses to assess the effects of clinical factors and medication exposures.

Results.

Incident arterial events occurred in 80 subjects, including 34 acute myocardial infarctions (13.8/1000 person-years) and 13 CVA (5.1/1000); these rates are higher than available Canadian figures. Nested case-control analyses, with risk-set sampling, revealed an increased incidence of arterial events associated with hypertension [adjusted rate ratio (RR) 2.6; 95% confidence interval (CI) 1.2–5.5] and lipid disorders (adjusted RR 2.6, 95% CI 1.0–6.5), whereas nonsteroid immunomodulators (methotrexate, azathioprine, antimalarial agents, or cyclophosphamide) were inversely associated with arterial events (adjusted RR 0.5, 95% CI 0.2–1.0).

Conclusion.

We found a high incidence of arterial events in this cohort of persons with inflammatory myopathy. Traditional risk factors, particularly hypertension and lipid disorders, were predictors of arterial events, while nonsteroid immunomodulators were inversely associated. Our work suggests a rationale for aggressive risk reduction strategies in persons with inflammatory myopathies.
Th17 Transcription Factor RORC2 Is Inversely Correlated with FOXP3 Expression in the Joints of Children with Juvenile Idiopathic Arthritis
Authors: OLIVITO BIAGIO , SIMONINI GABRIELE , CIULLINI SARA , MORIONDO MARIA , BETTI LETIZIA , GAMBINERI ELEONORA , CANTARINI LUCA , DE MARTINO MAURIZIO , AZZARI CHIARA , CIMAZ ROLANDO
Published: August 2009

Objective.

To investigate the relationship between interleukin 17 (IL-17) producing T cells (Th17) and CD4+CD25+FOXP3+ regulatory T cells (Tregs) in blood and synovial fluid (SF) of patients with juvenile idiopathic arthritis (JIA).

Methods.

Sixty-five children with JIA (18 males and 47 females, median age 6.2 yrs; 45 with oligoarticular and 20 with polyarticular course) and 75 age- and sex-matched healthy controls were studied. Flow cytometry was used to analyze the forkhead box P3 (FOXP3)-positive Treg cells in peripheral blood (PB) and synovial fluid mononuclear cells (SFMC). FOXP3 and retinoic-acid related orphan receptor C isoform 2 (RORC2) messenger RNA (mRNA) were assessed by real-time polymerase chain reaction analysis. Cytokines (IL-17 and Th1/Th2 related cytokines) were measured in culture supernatants of 11 paired PBMC and SFMC activated with PMA and ionomycin.

Results.

FOXP3+ T cells and FOXP3 mRNA amounts were significantly lower in PB of children with JIA as compared with controls (p = 0.0002 and p = 0.001, respectively) and a higher percentage of Treg cells with concomitant higher level of FOXP3 transcript levels were observed in SF when compared with their PB counterparts (both p < 0.0001). SF CD4+FOXP3+ T cells were characterized by higher amounts of FOXP3 protein per cell when compared with peripheral CD4+FOXP3+ T cells, as revealed by the difference in FOXP3 median fluorescence intensity (median ± SD, arbitrary units, 54 ± 22.6 vs 19.5 ± 4.2; p < 0.001). RORC2 transcript levels were higher in JIA joints when compared with matched PB samples (median fold increase 3.9, p < 0.0001) but negatively correlated with FOXP3 mRNA levels (r = −0.623, p = 0.04). Stimulated SFMC displayed an impaired ability to produce IL-17 when compared with PBMC and, interestingly, an inverse relationship between IL-17 levels and the percentage of CD4+CD25+FOXP3+ SF T cells (r = −0.510, p = 0.047) was seen.

Conclusion.

We demonstrated for the first time an increased synovial expression of the transcription factor of Th17, RORC2, in JIA, and its inverse relationship with FOXP3 mRNA. These results extend research on “Th17” and Tregs in JIA.
Noninfectious Ascending Aortitis: A Case Series of 64 Patients
Authors: LIANG KIMBERLY P. , CHOWDHARY VAIDEHI R. , MICHET CLEMENT J. , MILLER DYLAN V. , SUNDT THORALF M. , CONNOLLY HEIDI M. , CROWSON CYNTHIA S. , MATTESON ERIC L. , WARRINGTON KENNETH J.
Published: August 2009

Objective.

To identify the clinical presentation and histopathologic characteristics of noninfectious ascending aortitis.

Methods.

A retrospective medical record and histopathology review was performed of patients with histologic evidence of active noninfectious aortitis who underwent ascending aortic aneurysm resection at Mayo Clinic between January 1, 2000, and February 28, 2006. Clinicopathologic features were recorded, including demographics, clinical presentation, laboratory, imaging findings, histopathology, complications, treatment, and outcome.

Results.

Sixty-four patients (50% women) were identified; the majority were Caucasian (83%) and elderly (mean age 69.1 yrs). Upon initial presentation, 45% had aneurysm-related symptoms, 33% were asymptomatic, 12.5% had constitutional symptoms, 4.7% had symptoms referable to cranial arteries, and 9.4% had polymyalgia rheumatica (PMR) symptoms. The majority (81%) were of “isolated” variant, with no rheumatologic history. Mean preoperative erythrocyte sedimentation rate was 16.2 ± 23.3 mm/h (n = 20). Additional vascular imaging abnormalities were present in 72% of patients, including stenoses and/or ectasia of major aortic branches and descending thoracic or abdominal aneurysms. Giant cells were seen in 71.9%. Median followup time was 15.4 months, during which 6 (9.4%) patients died. Only 22 (34%) patients received corticosteroids, with uncertain effect on development of recurrent aneurysms, rupture, or dissections.

Conclusion.

Noninfectious ascending aortitis frequently occurs even in the absence of history, symptoms, or signs of giant cell arteritis (GCA) or PMR. When discovered, such patients should be followed closely, as a majority have additional vascular abnormalities. More studies are needed to determine optimal strategies for surveillance, detection, and treatment of ascending aortitis, which may represent a clinical entity distinct from classical GCA.
Purified Protein Derivative Response in Juvenile Idiopathic Arthritis
Authors: KIRAY EVRIM , KASAPCOPUR OZGUR , BAS VEDAT , KAMBUROGLU-GOKSEL AYLA , MIDILLI KENAN , ARISOY NIL , TASTAN YUCEL
Published: August 2009

Objective.

To examine the purified protein derivative (PPD) response that develops depending upon Th1 immune response in children with juvenile idiopathic arthritis (JIA).

Methods.

PPD skin test was performed in 115 children with JIA who were vaccinated with bacillus Calmette-Guerin (BCG), and then they were compared to the PPD response of 45 healthy children of the same age who were vaccinated with BCG. Children with a PPD induration ≥ 5 mm were accepted as PPD-positive. PPD induration ≥ 10 mm was accepted as a limit for suspecting tuberculosis.

Results.

PPD induration size and PPD positivity rates (PPD ≥ 5 mm) of children with JIA were significantly lower than those of healthy children. The mean of PPD induration size was significantly lower (p < 0.0001) in patients with either 1 BCG vaccine (3.7 ± 3.6) or more than 1 BCG vaccine than controls with either 1 BCG vaccine (7.10 ± 3.2) or more than 1 BCG vaccine (10.05 ± 4.1). PPD was positive in 35.9% of patients with JIA vaccinated once (n = 32), in 50% of patients with JIA vaccinated more than once (n = 13), in 82.1% of controls vaccinated once (n = 23), and in 88.2% of controls vaccinated more than once. This result was statistically significant (patients, p = 0.03; controls, p = 0.039). It was determined that neither the activity of the disease nor the use of corticosteroid and methotrexate affected the PPD response.

Conclusion.

The response to PPD, which is one of the Th1 cell-type responses, was significantly lower in BCG-vaccinated children with JIA compared to healthy children.
Design and Verification of Application Specific Integrated Circuits in a Network of Online Labs
Authors: Garbi Zutin Danilo , Auer Michael E. , Al-Zoubi A.Y.
Published: August 2009

A solution to implement a remote laboratory for testing and designing analog Application-Specific Integrated Circuits of the type (ispPAC10) is presented. The application allows electrical engineering students to access and perform measurements and conduct analog electronics experiments over the internet. PAC-Designer software, running on a Citrix server, is used in the circuit design in which the signals are generated and the responses are acquired by a data acquisition board controlled by LabVIEW. Three interconnected remote labs located in three different continents will be implementing the proposed system.
A Remote Laboratory for a Basic Course on Control Engineering
Authors: Calvo Isidro , Zulueta E. , Oterino F. , Lopez-Guede J. M.
Published: August 2009

The current work presents a remote laboratory for a basic course in control engineering over which several experiments may be performed. The proposed experiments have been carefully selected in order to illustrate the maximum number of concepts learnt in the classroom over a unique plant, a Ball & Hoop system. In this work, Labview has been used to acquire and handle process data whereas OPC technology is used to connect remote servers with web-integrated front-end applications. This choice has been made on the basis that these tools do not require very advanced skills and may be a reasonable approach for a wide range of simple remote laboratories.
TLR Triggering on Tolerogenic Dendritic Cells Results in TLR2 Up-Regulation and a Reduced Proinflammatory Immune Program
Authors: Chamorro Sonia , García-Vallejo Juan J. , Unger Wendy W. J. , Fernandes Rosette J. , Bruijns Sven C. M. , Laban Sandra , Roep Bart O. , 't Hart Bert A. , van Kooyk Yvette
Published: August 2009

Tolerogenic dendritic cells (TDC) offer a promising therapeutic potential to ameliorate autoimmune diseases. Reported to inhibit adaptive immune responses, little is known about their innate immunity receptor repertoire. In this study, we compared three types of human TDC (IL-10-DC, dexamethasone (DX)-DC, and 1,25(OH)2D3-DC) by their TLR expression and response to a set of TLR ligands. TDC are endowed with the same TLR set as standard monocyte-derived dendritic cells but respond differentially to the TLR stimuli Pam3CSK4, polyinosinic-polycytidylic acid, LPS, and flagellin. TDC expressed low or no IL-12-related cytokines and remarkably elevated IL-10 levels. Interestingly, only TDC up-regulated the expression of TLR2 upon stimulation. This boosted the tolerogenic potential of these cells, because IL-10 production was up-regulated in TLR2-stimulated, LPS-primed DX-DC, whereas IL-12 and TNF-α secretion remained low. When comparing the TDC subsets, DX-DC and 1,25(OH)2D3-DC up-regulated TLR2 irrespective of the TLR triggered, whereas in IL-10-DC this effect was only mediated by LPS. Likewise, DX-DC and 1,25(OH)2D3-DC exhibited impaired ability to mature, reduced allostimulatory properties, and hampered capacity to induce Th1 differentiation. Therefore, both DX-DC and 1,25(OH)2D3-DC display the strongest tolerogenic and anti-inflammatory features and might be most suitable tools for the treatment of autoimmune diseases.
C3 Promotes Expansion of CD8+ and CD4+ T Cells in a Listeria monocytogenes Infection
Authors: Nakayama Yumi , Kim Shin-Il , Kim Eui Ho , Lambris John D. , Sandor Matyas , Suresh M.
Published: August 2009

It is known that C3 is required for optimal expansion of T cells during acute viral infections. However, it is not yet determined whether T cell responses to intracellular bacterial infections require C3. Therefore, we have investigated the requirement for C3 to elicit potent T cell responses to Listeria monocytogenes (LM). We show that expansion of Ag-specific CD8 and CD4 T cells during a primary response to LM was markedly reduced in the absence of C3 activity. Further studies indicated that, unlike in an influenza virus infection, the regulation of LM-specific T cell responses by C3 might not involve the downstream effector C5a. Moreover, reduced T cell responses to LM was not linked to defective maturation of dendritic cells or developmental anomalies in the peripheral T cell compartment of C3-deficient mice. Experiments involving adoptive transfer of C3-deficient CD8 T cells into the C3-sufficient environment of wild-type mice showed that these T cells do not have intrinsic proliferative defects, and a paracrine source of C3 will suffice for clonal expansion of CD8 T cells in vivo. However, stimulation of purified C3-deficient CD8 T cells by plastic-immobilized anti-CD3 showed that C3 promotes T cell proliferation directly, independent of its effects on APC. On the basis of these findings, we propose that diminished T cell responses to LM in C3-deficient mice might be at least in part due to lack of direct effects of C3 on T cells. These studies have furthered our understanding of C3-mediated regulation of T cell immunity to intracellular pathogens.
The Binding of Antigenic Peptides to HLA-DR Is Influenced by Interactions between Pocket 6 and Pocket 9
Authors: James Eddie A. , Moustakas Antonis K. , Bui John , Nouv Randi , Papadopoulos George K. , Kwok William W.
Published: August 2009

Peptide binding to class II MHC protein is commonly viewed as a combination of discrete anchor residue preferences for pockets 1, 4, 6/7, and 9. However, previous studies have suggested cooperative effects during the peptide binding process. Investigation of the DRB1*0901 binding motif demonstrated a clear interaction between peptide binding pockets 6 and 9. In agreement with prior studies, pockets 1 and 4 exhibited clear binding preferences. Previously uncharacterized pockets 6 and 7 accommodated a wide variety of residues. However, although it was previously reported that pocket 9 is completely permissive, several substitutions at this position were unable to bind. Structural modeling revealed a probable interaction between pockets 6 and 9 through β9Lys. Additional binding studies with doubly substituted peptides confirmed that the amino acid bound within pocket 6 profoundly influences the binding preferences for pocket 9 of DRB1*0901, causing complete permissiveness of pocket 9 when a small polar residue is anchored in pocket 6 but accepting relatively few residues when a basic residue is anchored in pocket 6. The β9Lys residue is unique to DR9 alleles. However, similar studies with doubly substituted peptides confirmed an analogous interaction effect for DRA1/B1*0301, a β9Glu allele. Accounting for this interaction resulted in improved epitope prediction. These findings provide a structural explanation for observations that an amino acid in one pocket can influence binding elsewhere in the MHC class II peptide binding groove.