bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of early osteoarthritis of the knee with a Taq I POLYMORPHISM OF THE VITAMIN D RECEPTOR GENE
Authors: Keen R. W. , Hart D. J. , Lanchbury J. S. , Spector T. D.
Published: February 2007

Objective. To determine whether a polymorphism of the vitamin D receptor (VDR) gene, already associated with osteoporosis, might also relate to the risk of osteoarthritis (OA).

Methods. A population cohort of 351 postmenopausal women (ages 45‐64 years) was studied using anteroposterior radiographs of the knee, which were graded for OA according to the Kellgren and Lawrence classification system. The VDR genotype was determined by using polymerase chain reaction and by digestion with the restriction enzyme Taq I.

Results. The VDR allele “T” was associated with an increased risk of knee OA compared with the “t” allele, with an odds ratio of 2.82 (95% confidence interval 1.16‐6.85; P = 0.02). A dominant pattern of risk was suggested. The frequency of the VDR genotype differed significantly between OA cases and controls (P = 0.03 by Fisher's exact test).

Conclusion. A Taq I polymorphism of the VDR gene appears to be associated with an increased risk of knee OA. This is the first genetic locus that has been shown to influence the risk of early knee OA within the general population.
Nitric oxide as s‐nitrosoproteins in rheumatoid arthritis
Authors: Hilliquin P. , Borderie D. , Hernvann A. , Menkes C. J. , Ekindjian O. G.
Published: February 2007

Objective. Nitric oxide (NO) is a free radical involved in inflammation and immune reactions. The presence of NO is usually assessed by assaying its degradation products, nitrite and nitrate. NO binds to thiol‐containing proteins to form S‐nitrosoproteins (S‐NP). The aim of this study was to investigate the presence of S‐NP, together with nitrite and nitrate, in patients with rheumatoid arthritis (RA).

Methods. Forty patients with RA were studied and compared with 24 patients with osteoarthritis (OA) and 21 control subjects. Fourteen patients were treated with 3 consecutive pulses of methylprednisolone for flares of RA. Nitrite was measured by the Griess reaction, and nitrate by a spectrophotometric assay using nitrate reductase. Spectrofluorometry coupled with the inner filter effect was used for the measurement of S‐NP.

Results. S‐NP was detected in all RA samples, both in serum and synovial fluid (SF). Serum and articular S‐NP concentrations were correlated ( P < 0.03). In RA, nitrite and S‐NP levels were higher in SF than in serum; higher SF levels of the 3 compounds were observed in RA than in OA. S‐NP levels in RA patients decreased significantly ( P < 0.03) after pulse methylprednisolone treatment, in parallel with the clinical improvement.

Conclusion. S‐NP, a biologically active form of NO, was consistently present in RA, with higher concentrations within the arthritic joint. S‐NP assays should be added to nitrite and nitrate assays for the evaluation of NO metabolism. S‐NP could be a stable storage form of active NO in RA, and its measurement could be useful in evaluating pharmacologic interventions that modulate NO generation.
Transcriptional regulation of the HOX4C gene by basic fibroblast growth factor on rheumatoid synovial fibroblasts
Authors: Xue Chengsen , Hasunuma Tomoko , Asahara Hiroshi , Yin Weihong , Maeda Toshiro , Fujisawa Koushi , Dong Yi , Sumida Takayuki , Nishioka Kusuki
Published: February 2007

Objective. To examine the expression of genes of the HOX D cluster in the synovial tissue of patients with rheumatoid arthritis (RA), and to determine whether basic fibroblast growth factor (bFGF) influences the expression and transcriptional regulation of the gene.

Methods. The expression of genes of the HOX D cluster, including HOX4C, HOX4D, HOX4H, and HOX4I, was determined in the synovium of 4 patients with RA and 4 with osteoarthritis (OA) by in situ reverse transcription (RT) and RT‐polymerase chain reaction (RT‐PCR). The induction of HOX4C messenger RNA (mRNA) by bFGF was determined by RT‐PCR. The binding activity of a transcriptional regulator of the HOX4C gene, C2, was analyzed by the mobility shift assay. NIH‐3T3 cells transfected with a construct containing C2 binding sequence were incubated with bFGF, and the activity of the reporter was measured by luciferase assay.

Results. Using an in situ RT assay, specific expression of HOX4C mRNA was detected in 3 of 4 RA synovial samples, whereas none of the OA synovia expressed HOX4C. HOX4D, HOX4H, and HOX4I genes were expressed in all synovial samples from RA and OA patients. The presence of HOX4C mRNA was also confirmed by RT‐PCR and Southern blotting. Treatment with bFGF increased the expression of HOX4C mRNA in RA fibroblasts. The mobility shift assay and luciferase assay showed that bFGF enhanced C2 binding activity and significantly increased the transcriptional activity on RA fibroblasts.

Conclusion. Our findings suggest that HOX4C is involved in synovial hyperplasia, and that the transcriptional regulation of HOX4C genes by bFGF may play a crucial role in the pathogenesis of RA.
Outcome of rheumatoid arthritis and psoriasis following autologous stem cell transplantation for hematologic malignancy
Authors: Cooley Helen M. , Snowden John A. , Grigg Andrew P. , Wicks Ian P.
Published: February 2007

Based on successful results in animal models, it has been proposed that high‐dose myeloablative therapy followed by autologous bone marrow or stem cell transplantation (ABMT/ASCT) may cure autoimmune disease. The coexistence of autoimmune disease and hematologic malignancy provides an opportunity to examine the response of autoimmune disease to ABMT or ASCT. We describe 4 patients with autoimmune disease (3 with psoriasis and 1 with rheumatoid arthritis) and hematologic malignancy. In each patient, the autoimmune disease remitted posttransplantation, but, in 4 patients with long‐term followup, it recurred at 8–24 months. The earliest relapse occurred in a patient treated with interferon‐α. Our experience suggests that a single autograft with unpurged stem cells is unlikely to cure autoimmune disease, but that other strategies building on this approach are worthy of investigation.
Invasive soft tissue infections with Streptococcls Pneumoniae in patients with systemic lupus erythematosus. Case report and review of the literatur
Authors: Hill Michael D. , Karsh Jacob
Published: February 2007

pneumococcal infections of the soft tissues are uncommon. However, patients with systemic lupus erythematosus(SLE) may be predisposed to this condition,perhaps by virtue of hypocomplementemia and low, nonprotective concentrations of antipneumococcal antibodies. We report a case of severe cellulitis and fasciitis of the anterior neck in a young woman with SLE. The literature on SLE and pneumococcal soft tissue infections is reviewed. A clinical syndrome of SLE and pneumococcal soft‐tissue infections of the neck and pharynx is described.
Antibodies against A peptide sequence located in the linker region of the HMG‐1/2 box domains in sera from patients with juvenile rheumatoid arthritis
Authors: Jung Frank , Neuer Gunter , Bautz Friedlinde A.
Published: February 2007

Objective. To extend our work on the mapping of B cell epitopes on nucleosomal high mobility group (HMG) proteins in the sera of patients with juvenile rheumatoid arthritis (JRA).

Methods. Seventy‐seven pauciarticular‐onset JRA serum samples from antinuclear antibody (ANA)‐ positive patients and 42 polyarticular‐onset JRA patient sera found to react with HMG‐2 by immunoblotting were used in this study. To identify B cell epitopes on HMG‐2, recombinant HMG‐2 protein fragments were used in enzyme‐linked immunosorbent assay (ELISA) and in competition ELISA experiments with a set of overlapping synthetic peptides. Fine epitope mapping was achieved by oligopeptide synthesis, followed by immunoblotting.

Results. Pauciarticular, but not polyarticular, JRA patient sera were found to recognize a lysine‐rich major epitope (KKGKKKDP), which is located in the linker region of the HMG box domains of the HMG‐2 nonhistone chromosomal protein. No significant immunoreactions were observed in sera from ANA‐negative JRA patients and in sera from children with nonrheumatic diseases, indicating that this epitope seems to be specific for pauciarticular‐onset JRA.

Conclusion. In addition to our previous finding that JRA sera will react with a defined epitope on HMG‐17, pauciarticular JRA patient sera were also found to recognize a defined epitope on the HMG‐2 protein, thus suggesting the importance of this epitope in the etiology of JRA.
A phase 1 study to address the safety and efficacy of granulocyte colony‐stimulating factor for the mobilization of hematopoietic progenitor cells in active rheumatoid arthritis
Authors: McGonagle Dennis , Rawstron Andrew , Richards Stephen , Isaacs John , Bird Howard , Jack Andrew , Morgan Gareth , Emery Paul
Published: February 2007

Objective. To examine the safety and efficacy of granulocyte colony‐stimulating factor (G‐CSF) alone for the mobilization of peripheral blood progenitor cells in patients with resistant active rheumatoid arthritis (RA).

Methods. Five patients with resistant active RA were studied. A dose of 5 μg/kg of G‐CSF (Filgrastim) was given subcutaneously each day for 5 days, and the number of stem cells mobilized into the peripheral blood was assessed by daily CD34 counts. RA disease activity was assessed by standard clinical methods.

Results. The absolute numbers of peripheral blood CD34+ cells peaked on day 4, with a mean value of 0.025 × 109/liter (range 0.013–0.048 × 109/liter). There was no significant change in disease activity during the study or in the month following therapy.

Conclusion. Using G‐CSF alone, CD34+ progenitor peripheral blood cells were mobilized in numbers suitable for leukopheresis. G‐CSF therapy was welltolerated in patients with active RA, and was not associated with a flare during treatment or in the month following treatment.
The value of the health assessment questionnaire and special patient‐generated scales to demonstrate change in systemic sclerosis patients over time
Authors: Steen Virginia D. , Medsger Thomas A.
Published: February 2007

Objective. To determine the validity and usefulness of a modified Health Assessment Questionnaire (HAQ) for measurement of disease status and changes in disease status over time in patients with systemic sclerosis (SSc).

Methods. Since 1985,1,250 patients attending the University of Pittsburgh Scleroderma Clinic have completed a modified HAQ annually. In addition to the standard HAQ questions about disability, the questionnaire includes visual analog scales (VAS) to evaluate SSc organ system symptoms, Raynaud's phenomenon, gastrointestinal (GI) tract and lung involvement, pain, and overall disease severity. In this study, the disability index (DI) (from the HAQ) and the VAS scores (on a 0–3 scale) were compared with various clinical and laboratory features recorded within 3 months of administration of the HAQ and VAS, using t‐tests and Spearman's correlation tests.

Results. The HAQ DI correlated directly with skin involvement, scleroderma heart or kidney disease, tendon friction rubs, hand contractures, and proximal muscle strength. Over time, the DI correlated with changes in skin score and was a good predictor of survival. There was a significant improvement in the DI during a 2‐year time period in patients treated with D‐penicillamine. The VAS for digital ulcers, GI symptoms, and lung symptoms correlated very closely with subjective and objective findings for these organ systems. The presence of new digital ulcers or improvement in digital ulcers showed significant associations with the Vascular scale, new GI symptoms or improvement in GI symptoms and institution of H2‐blockers showed appropriate strong correlations with the GI scale, and changes in the forced vital capacity had an excellent correlation with the Lung scale (r = 0.58, P < 0.001). By Cox regression analysis, the HAQ DI was one of the best predictors of survival.

Conclusion. These data provide convincing evidence that a self‐administered questionnaire is an accurate and inexpensive tool to measure disease status changes in SSc. Prospective studies with the HAQ administered at regular intervals, as in controlled trials, should be performed to further assess the benefits and limitations of this instrument.
Human retrovirus‐5 proviral DNA is rarely detected in salivary gland biopsy tissues from patients with Sjögren's syndrome
Authors: Rigby Shirley P. , Venables Patrick J. W. , Griffiths David J. , Weiss Robin A.
Published: February 2007

Objective. To examine whether human retrovirus‐5 (HRV‐5) infection is associated with Sjögren's syndrome.

Methods. Salivary gland DNA was tested by nested polymerase chain reaction (PCR) for HRV‐5 proviral DNA. Rigorous precautions were taken to prevent false‐positive results from PCR contamination. Positive samples were confirmed by testing with an additional independent set of primers and were then sequenced.

Results. Ninety‐two samples were examined (55 from Sjögren's syndrome patients, 37 from non‐Sjögren's syndrome patients), 2 of which were positive. One was from a patient who had sicca symptoms but who did not satisfy the criteria for a diagnosis of Sjögren's syndrome. The other was from a patient with secondary Sjögren's syndrome. Owing to the extremely low virus load in minor salivary glands, the number of HRV‐5—infected patients may be underestimated. In total, 3 different sequences of HRV‐5 were identified which were 98% identical to the original sequence but which displayed variations between and within individuals.

Conclusion. This is the first study to systematically seek a disease association with HRV‐5, although with this method, an association with Sjögren's syndrome was not identified.
Correlation of morphologic and biochemical changes in the natural history of spontaneous osteoarthrosis in guinea pigs
Authors: Wei L. , Svensson O. , Hjerpe A.
Published: February 2007

Objective. To study how the concentrations of proteoglycans (PGs) and collagen change in various parts of tibial articular cartilage during aging, and to evaluate the development of spontaneous osteoarthrosis (OA) in guinea pigs.

Methods. PGs were extracted from guinea pig cartilage samples using 4M guanidine hydrochloride, and the amount of hydroxyproline was determined in the extraction remainder. The molecular size and aggregation of PGs were analyzed by electrophoresis, and the glycosaminoglycan composition was assessed by highperformance liquid chromatography.

Results. The PG concentration was proportional to the load distribution. However, when OA became histologically manifest, the PG concentration decreased by 50% (from a mean of 44 μg to 22 μg per mg fresh tissue) and the collagen level decreased by 40% (from a mean of 17 μg to 10 μg per mg fresh tissue), while the proportion of water increased by 13% (from a mean of 710 mg to 800 mg per mg fresh tissue).

Conclusion. Unmineralized cartilage can, within physiologic load limits, respond to increased mechanical demands by increasing the PG and collagen concentrations. Beyond a certain limit, however, the cartilage can no longer compensate for further increases in stress, which results in cartilage degeneration and losses of matrix constituents. These losses seemed to appear earlier in the disease process than has been described in previous animal models of secondary OA.
Heterogenous nuclear RNP C1 and C2 core proteins are targets for an autoantibody found in the serum of a patient with systemic sclerosis and psoriatic arthritis
Authors: Vencovský Jiří , Kafková Jarmila , Staněk David , Raška Ivan
Published: February 2007

Objective.To determine a target recognized by anti‐Bh autoantibody, found in the serum of a patient with the unusual coexistence of systemic sclerosis (SSc) and psoriatic arthritis (PsA).

Methods. Antigens recognized by the anti‐Bh serum were characterized by indirect immunofluorescence on HeLa cells, by conventional immunoblotting using nuclear extract or partially purified preparation of heterogenous nuclear RNP (hnRNP) proteins, and by 2‐dimensional immunoblotting. For the analysis of cross‐reactivity and immunofluorescence patterns, autoantibodies were affinity‐purified by blot elution and then retested.

Results.Comparison of the reactivity of the anti‐Bh antibody with the monoclonal antibody 4F4 against both the hnRNP C proteins, together with the determination of biochemical properties of the autoantigens, led to the identification of C1 and C2 core proteins as the targets for the anti‐Bh autoantibody.

Conclusion. Several essential components of the spliceosome are targeted by autoantibodies that are present in the sera of patients with systemic rheumatic diseases. We also found that the hnRNP core proteins C1 and C2 are recognized by the autoantibody present in the serum of a patient with SSc and PsA. C1 and C2 hnRNP proteins should be added to the several intracellular autoantigens recently shown to be cleaved by interleukin‐1β‐ converting enzyme‐like enzymes during apoptosis.
Increased phosphate content in complement component C3, fibrinogen, vitronectin, and other plasma proteins in systemic lupus erythematosus. Covariation with platelet activation and possible association with thrombosis
Authors: Ekdahl Kristina Nilsson , Rönnblom Lars , Nilsson Bo , Sturfelt Gunnar
Published: February 2007

Objective. To investigate whether extracellular phosphorylation of plasma proteins takes place in vivo in patients with systemic lupus erythematosus (SLE), to determine possible correlations between phosphate levels and clinical and/or laboratory parameters, and to identify individual phosphorylated plasma proteins.

Methods. Sera from SLE patients were analyzed for total amounts of protein‐bound phosphate by a colorimetric technique, and for levels of β‐thromboglobulin by radioimmunoassay. In addition, the ability of these sera to activate platelets, resulting in the release of protein kinase, was tested using an assay in which platelet‐rich plasma from healthy blood donors was incubated with sera or immune complexes from SLE patients. In this assay, [γ‐32P]ATP was added, and 32P‐labeled C3 was quantified. Phosphate in individual proteins was detected by Western blot analysis.

Results. 32P‐labeled, activated platelets were able to phosphorylate exogenously added proteins, without the addition of ATP or cations. Platelet‐rich plasma from healthy blood donors became activated by sera or by polyethylene glycol‐precipitated immune complexes from patients with SLE, which led to the extracellular phosphorylation of plasma proteins, exemplified in the C3 assay. The phosphate content in plasma proteins was increased in SLE patients with previous thrombosis. The degree of phosphorylation increased up to 3‐fold in serial samples obtained from 2 SLE patients during periods of disease exacerbation. Substantial phosphate increases were seen in C3 and fibrinogen. The changes were linked to platelet activation because of the observed covariation with the levels of β‐thromboglobulin.

Conclusion. In SLE patients, the phosphate content in plasma proteins (including C3 and fibrinogen) increases due to platelet activation.
Social support and psychosocial adjustment to rheumatoid arthritis quantitative and qualitative findings
Authors: Affleck Glenn , Pfeiffer Carol , Tennen Howard , Fifield Judith
Published: February 2007

One hundred twenty‐nine individuals with rheumatoid arthritis were interviewed, and their satisfaction with several aspects of social support was rated. Quantitative analyses showed that patients' overall support satisfaction was related to health care providers' ratings of their psychosocial adjustment, independent of patients' demographic characteristics, illness duration, disease activity, and functional disability. Furthermore, the relation between support satisfaction and psychosocial adjustment increased as a function of patients' level of disability, suggesting a stress‐buffering function of support. Among the important qualitative findings emerging from content analyses of interview material was that disruptions in relationships with actual and potential support providers constituted a source of stress. However, several participants stated that the illness had actually strengthened valued relationships. Patients' views of helpful and unhelpful support gestures are also classified and discussed. Directions for future research on the support process are suggested.
The importance of aspects of treatment for fibromyalgia (Fibrositis): Differences between patient and physician views
Authors: Potts Marilyn K. , Silverman Stuart L.
Published: February 2007

Thirty‐five individuals with fibromyalgia (fibrositis), 22 of their physicians, and 49 rheumatologists on an Arthritis Foundation referral list rated the importance of 24 aspects of fibromyalgia treatment. These encompassed symptom control, psychosocial factors, information, and physical therapy. Respondents with fibromyalgia rated their satisfaction with the way each aspect of treatment had been managed by their physician, and each completed a health status questionnaire. Fibromyalgia patients viewed 8 of the 24 aspects of treatment as significantly more important than did their own physician, and 18 of the 24 as significantly more important than did area rheumatologists. Satisfaction with the way treatment had been managed was generally low. Some evidence suggested that patients' health status was affected positively by the extent to which their physician viewed certain aspects of treatment as important. The results are expected to be useful in the design of fibromyalgia education programs for both lay and health professional audiences.
Four psychosocial theories and their application to patient education and clinical practice
Authors: Gonzalez Virginia M. , Goeppinger Jean , Lorig Kate
Published: February 2007

Although the development of theoretically based and empirically verified practice guidelines is now possible, some health education practice still remains uninformed by this research‐based knowledge. This article describes four psychosocial theories that have been useful in our practices: self‐efficacy, stress and coping, learned helplessness, and social support. The theories are introduced and compared; practical suggestions for their use in the development of health education interventions are then discussed. Skills mastery, modeling, reinterpretation of physical signs and symptoms, and persuasion are presented as ways of enhancing self‐efficacy. Some similar strategies are presented as examples of coping techniques, including positive reappraisal or reinterpretation. Other coping strategies such as confronting, distancing, self‐care, seeking social support, accepting responsibility, escape avoidance or ignoring, problem solving, activity, distraction, self‐talk, and prayer are also introduced. Cognitive restructuring is examined most fully as an example of an intervention strategy derived from learned helplessness theory. And finally, five strategies for fostering positive social support are presented: enhancing personal networks, linking volunteers, establishing mutual aid networks, identifying and supporting neighborhood helpers, and community empowerment.
Dietary and allergic associations with rheumatoid arthritis: Self‐report of 704 patients
Authors: Tanner S. Bobo , Callahan Leigh F. , Panush Richard , Pincus Theodore
Published: February 2007

A survey of 704 rheumatoid arthritis (RA) patients was performed to analyze responses of patients reporting favorable or unfavorable effects of specific foods on clinical status. Overall, 28% of patients reported some association between a specific food and clinical status. Patients reporting food associations tended to report higher levels of allergies and family history of allergies, but did not differ importantly in clinical status or demographic variables from patients reporting no associations of foods and clinical status. These data suggest that a subset of RA patients might have food sensitivity as a component of clinical activity, but most patients find no associations between foods and clinical status.
The efficacy of the back school: A randomized trial
Authors: Keijsers Jolanda F. E. M. , Steenbakkers Mieke W. H. L. , Meertens Ree M. , Bouter Lex M. , Kok Gerjo
Published: February 2007

Although the back school is a popular treatment for patients with low back pain, especially in Scandinavian countries, very few well‐designed studies into the effectiveness of this type of treatment have been performed. Back schools are programs in a group setting, directed toward pain management and consisting of elements of education and/or training of skills. The Maastricht Back School is designed to be a combination of all those elements about which we consider a back school should give information and training. In order to determine the effectiveness of the Maastricht Back School, we conducted a randomized trial (n = 77) comparing a group that attended back school with a waiting list control group. The most important measures of effect were pain management, pain, medical consumption, and absenteeism from work. The overall response was 85.5%. The results of an intention‐to‐treat analysis of the data collected 2 and 6 months after randomization consistently suggested inefficacy of the Maastricht Back School for all effect parameters (except for the effect parameter knowledge). Though the present study certainly had some limitations, we question the clinical relevancy of back schools.
Nonsurgical management of the boutonniere deformity
Authors: Palchik Nancy S. , Mitchell Douglas M. , Gilbert Naomi L. , Schulz Amy J. , Dedrick Robert F. , Palella Thomas D.
Published: February 2007

The present study examined the effectiveness of a 6‐week experimental program of splinting and joint protection education in reducing the progression of the early boutonniere deformity. Nine patients with mild or moderately reducible boutonniere deformities were randomized into experimental and control groups and followed for 1 year. Improvements in active extension of the proximal interphalangial joint for patients in the experimental program suggest that early initiation of a nonsurgical intervention can reduce or reverse progression of the boutonniere deformity in some patients with rheumatoid arthritis. Although the number of patients was small, we conclude that early splinting and joint protection education may limit the anatomical and functional derangements of boutonniere deformity in the rheumatoid hand.
The social network characteristics of fibromyalgia patients compared with healthy controls
Authors: Bolwijn Paulien H. , Baars Herman M. J. , Kaplan Charles D. , van Santen‐Hoeufft Marijke H. S. , van der Linden Sjef
Published: February 2007

Objective. To assess structural social network characteristics and perceived loneliness in fibromyalgia syndrome (FMS) patients and healthy controls.

Methods. A cross‐sectional, retrospective, case‐control design was employed using a structured interview and a self‐report questionnaire. We studied 25 female FMS patients and 25 matched healthy female controls.

Results. FMS patients had statistically significantly (P < 0.05) more intimate friends (mean 4.5) and more health care providers (mean 1.5) than did controls (2.3 and 0.0, respectively). The FMS patients more often initiated the contact with family members (mean 2.1) than did controls (mean 0.8). FMS patients did not perceive themselves as lonelier than controls perceived themselves. While there was a significant negative correlation between loneliness and social network variables among the controls, this relationship was not significant among the FMS patients. Among the patients, there was a strong correlation between the total social network size and the number of intimate friends, whereas in controls, the mean number of acquaintances was strongly correlated with the total network size.

Conclusion. Compared to healthy controls, the social networks of FMS patients presented more linkages with intimate friends, family members, and health care providers. The lack of correlation between loneliness and social network variables for FMS patients is not what might be expected from social support theory. The assessment of structural social network characteristics along with social support variables may add to our understanding of the social functioning of FMS patients.
Ethnicity and access to care in systemic lupus erythematosus
Authors: Waters Teresa M. , Chang Rowland W. , Worsdall Ellen A. , Ramsey‐Goldman Rosalind
Published: February 2007

Objective. To define access to care and to examine the relationship between ethnicity and access to care in systemic lupus erythematosus (SLE).

Methods. A review of published literature was supplemented with preliminary data from a pilot study. Data from patient interviews, chart reviews, and insurer surveys were collected at 2 sites and used to develop several measures of access. The relationship between ethnicity and access was examined through chi‐square analyses, difference of means testing, and multivariate regression.

Results. Although African‐American SLE patients appear less likely to be privately insured and more likely to be uninsured, no significant differences in utilization rates were detected between ethnic groups. Uninsured patients, however, had significantly fewer physician visits than both the Medicaid and the privately insured patients. Multivariate regression results confirm a strong and negative relationship between physician visits and patient coinsurance rates.

Conclusion. Careful examination of multiple dimensions of access may highlight differences between ethnic groups. Further research is necessary to document these differences and explore their relationships to outcomes.
Commercial wrist extensor orthoses: A descriptive study of use and preference in patients with rheumatoid arthritis
Authors: Stern Erica B. , Ytterberg Steven R. , Krug Hollis E. , Larson Lea M. , Portoghese Caroline Parke , Kratz William N. R. , Mahowald Maren L.
Published: February 2007

Objective. To describe patients' functional uses of 3 commercial wrist orthoses, to describe patients' preference patterns for the orthoses, and to clarify orthotic attributes that are viewed positively and negatively.

Methods. Using a cross‐over design, 42 patients with definite rheumatoid arthritis used each of 3 commercial orthoses for one week. There was a one‐week washout between each week of use. At the end of the study, private semi‐structured interviews were conducted with each participant. Data from close‐ended questions were tabulated. Open‐ended data were analyzed using qualitative methods.

Results. Patients reported that the 3 commercial wrist orthoses reduced wrist pain similarly, but that comfort and a sense of security during functional tasks were only found if the orthoses were comfortable and well‐fitting. Most subjects preferred the padded, short forearm orthosis, though a small number found it uncomfortably warm, and many complained that it was difficult to use when wearing long‐sleeved garments. Common complaints about the two elastic orthoses included chafing at the thumb webspace and chafing at the proximal closures. Longer forearm length was often perceived as providing unnecessarily high levels of wrist support.

Conclusions. No single orthosis suited all subjects. Satisfaction with an orthosis appears to be based not only on its therapeutic effect, but also the comfort and ease of its use. To maximize patient satisfaction and improve the likelihood of appropriate fit and comfort, several styles of commercial orthoses should be available. The current trend toward restricted clinic stocks appears contrary to both therapeutic goals and patient satisfaction.
The feasibility and validity of studies comparing orthopedists and non‐orthopedists caring for musculoskeletal injuries: Results of a pilot study
Authors: Gabriel Sherine E. , Amadio Peter C. , Ilstrup Duane
Published: February 2007

Objective. To review care provided by orthopedists and non‐orthopedists for a variety of common acute injuries to the shoulder, knee, and ankle; and to evaluate the difficulties in assessing results from diagnostic data collected for administrative reporting by comparing these data with data collected by medical record abstraction for the same patients.

Methods. The Rochester Epidemiology Project database was used to identify new cases of Colles fracture, knee sprain, ankle sprain, and shoulder sprain/rotator cuff injury among Olmsted county residents >18 years of age, who were evaluated between January 1, 1990 and December 31, 1992. Data were collected from an administrative database and medical records.

Results. Although the diagnoses recorded in the administrative database and those obtained from medical record review were the same in 94% of the 500 cases reviewed, only 270 (67.7%) actually represented acute injuries. Medical record review showed that (for the shoulder and ankle) injury severity was highly correlated with treatment specialty: 13 of 15 severe injuries were cared for by orthopedists, while 64 of 68 mild injuries were treated by non‐orthopedists. Diagnostic uncertainty was more common among non‐orthopedists; in 21 of the 149 patients treated by non‐orthopedists (15.1%), the final (i.e., recorded for coding) diagnosis was different from the initial diagnosis. In 14 of these cases, an orthopedist made the final diagnosis. None of the diagnoses made by orthopedists were revised.

Conclusion. Current diagnostic coding does not capture injury acuity, severity, or diagnostic uncertainty. Studies that limit themselves to such data for diagnostic information are likely to suffer from biases which can skew results in unpredictable ways. Conclusions drawn from such studies are likely to be flawed.
In vivo hip pressures during cane and load‐carrying gait
Authors: McGibbon Chris A. , Krebs David E. , Mann Robert W.
Published: February 2007

Objective. To test the hypotheses that carrying a load reduces hip contact pressure ipsilateral to the load and that using a cane when carrying a load further reduces hip contact pressure.

Methods. A Moore‐type endoprosthesis with 13 femoral‐head pressure transducers was implanted in a human subject following a Garden III fracture. Hip contact pressures were measured during unaided, cane‐aided, and load‐carrying gait over two years.

Results. Relative to unloaded gait, contact pressures increased significantly when ipsilateral to the carried load. Using a contralateral cane when carrying the load reduced ipsilateral posterior‐superior contact pressure; however, the hip contralateral to the load experienced significantly higher than normal pressures.

Conclusions. Ipsilaterally carried loads may not always provide stress protection of the arthritic hip. Using a cane opposite to the load may aid in restoring normal pressures to the ipsilateral hip, but may expose the contralateral hip to a significant stress burden.
Biofeedback/relaxation training and exercise interventions for fibromyalgia: A prospective trial
Authors: Buckelew Susan P. , Conway Robert , Parker Jerry , Deuser William E. , Read Joan , Witty Thomas E. , Hewett John E. , Minor Marian , Johnson Jane C. , Van Male Lynn , McIntosh Matthew J. , Nigh Margaret , Kay Donald R.
Published: February 2007

Objective. To compare the effectiveness of biofeedback/relaxation, exercise, and a combined program for the treatment of fibromyalgia.

Methods. Subjects (n = 119) were randomly assigned to one of 4 groups: 1) biofeedback/relaxation training, 2) exercise training, 3) a combination treatment, or 4) an educational/attention control program.

Results. All 3 treatment groups produced improvements in self‐efficacy for function relative to the control condition. In addition, all treatment groups were significantly different from the control group on tender point index scores, reflecting a modest deterioration by the attention control group rather than improvements by the treatment groups. The exercise and combination groups also resulted in modest improvements on a physical activity measure. The combination group best maintained benefits across the 2‐year period.

Conclusion. This study demonstrates that these 3 treatment interventions result in improved self‐efficacy for physical function which was best maintained by the combination group.
Coping with pain in the hip or knee in relation to physical disability in community‐living elderly people
Authors: Hopman‐Rock M. , Kraaimaat F. W. , Odding E. , Bijlsma J. W. J.
Published: February 2007

Objective. To investigate the use of pain coping strategies by community‐living older people with pain in the hip or knee and the mediating role of coping with pain in the relationship between the chronicity of pain and physical disability.

Methods. A group of 157 people with pain “in the last month” was identified. Coping with pain was assessed with the Pain Coping Inventory, physical disability with the Sickness Impact Profile, and household and sport activities with a validated structured interview method.

Results. People with chronic pain used relatively more “resting,” and “reducing demands” as pain coping strategies. Pain chronicity made a significant contribution to physical disability; however, when corrected for other variables in a regression model, no significant partial correlation was found.

Conclusion. We conclude that pain coping has a mediating role in the relationship between pain chronicity and physical disability. Less use of “resting” and a physically active lifestyle are independently associated with less physical disability.
Predictors of functional disability in patients with rheumatoid arthritis
Authors: Holm Margo B. , Rogers Joan C. , Kwoh C. Kent
Published: February 2007

Objective. Using the World Health Organization's classification system of the consequences of disease, this study sought to examine the impact of physical and psychological impairment variables, beyond that contributed by social, demographic, and disease variables, on the functional disability of a rheumatoid arthritis (RA) sample. Data collected during an acute episode were used to predict concurrent and future disability status.

Method. A secondary data analysis of 85 adults hospitalized for exacerbations in arthritis was undertaken. Disability was assessed with the Health Assessment Questionnaire. Physical impairment was measured with the Keitel Function Test and Pain Analog Scales, and psychological impairment was measured with the Center for Epidemiologic Studies Depression Scale and the Perceived Self‐Efficacy Scale for People with Arthritis.

Results. Our findings indicated that physical impairment, demographic, and disease variables accounted for 64% of the explained variance in disability during the concurrent episode. Psychological impairment as well as demographic and disease variables accounted for 49% of the explained variance in future disability status.

Conclusion. The combined influence of demographic characteristics and the consequences of the pathology of RA experienced as physical and psychological impairments contributed differentially to disability during concurrent and future time periods.
A comparison of three types of neck support in fibromyalgia patients
Authors: Ambrogio Nancy , Cuttiford Joanne , Lineker Sydney , Li Linda
Published: February 2007

Objective. To determine the effectiveness of 3 types of neck support for patients with fibromyalgia (FMS) and their preference for the type of support.

Methods. Thirty‐five patients with FMS chose the order of application and used each type of neck support for a 2‐week period, followed by a 2‐week washout. The same schedule was repeated a second time. The neck supports included a Shape of Sleep pillow, two neck ruffs with one standard pillow, and a single standard pillow. All subjects received a physiotherapy treatment and educational program in the home. Outcome measures included visual analog scales (VAS) for neck pain and quality of sleep, the Fibromyalgia Impact Questionnaire (FIQ), and a neck and shoulder pain distribution diagram.

Results. Analysis using Friedman's 2‐way analysis of variance revealed no significant differences in any outcome measure, although there was a trend towards improvement in the FIQ and VAS neck pain and quality of sleep scores for some patients. Most participants (62.9%) preferred the Shape of Sleep pillow, 20.0% preferred cervical ruffs with one standard pillow, and 17.1% preferred a single standard pillow.

Conclusions. The results of this study are inconclusive due to the small sample size. However, from a patient's perspective, neck support is an important part of a comprehensive physiotherapy program. Most participants preferred the more rigid support of a Shape of Sleep pillow. Further research into the efficacy of the use of neck support in people with FMS is warranted.
Case of the hidden assumptions
Authors: Koshland Daniel E.
Published: February 2007

The Ogston “three point attachment” model to explain how proteins discriminate between d and l isomers was originally proposed to explain the asymmetric distribution of isotopes that passed through a symmetric intermediate. It has been a standard in textbooks and the literature until the recent finding of Mesecar and Koshland [6] that it could not explain data of isocitrate dehydrogenase and other enzymes and must be replaced by a “four location model.” The hidden assumptions that are part of the Ogston model are seen to be an interesting feature of the scientific method that can both advance and hinder scientific progress.
Detection of genetically modified organisms in food by DNA extraction and PCR amplification
Authors: Thion Laurent , Vossen Christine , Couderc Bettina , Erard Monique , Clemençon Blandine
Published: February 2007

A practical class experiment based on the extraction/purification of DNA from soybeans and the identification of exogenous DNA sequences amplified by PCR is described. This is used in a biochemistry and molecular biology course for advanced science undergraduate students. Students are given small amounts of soybean powder, and they practice a DNA extraction, purification, and a PCR with a set of different specific primers followed by an electrophoresis to determine whether the sample is transgenic. A major aim is to provide experience in the use of common techniques such as DNA extraction/purification and PCR and their interpretation.
Introducing problem‐based learning into a traditional lecture course
Authors: Johnson Elizabeth , Herd Susanna , Andrewartha Kathy , Jones Steve , Malcolm Susan
Published: February 2007

We have developed a short program of problem‐based learning (PBL) sessions for third year nutrition science, integrated within a traditional lecture and practical format. This course was designed to develop additional generic skills without losing the benefits of the existing course. The inherent flexibility of problem‐based sessions allows the time to both reinforce and expand the original course material. PBL has proved popular with our students, and we have measured a high degree of satisfaction with the format. Many students have requested an extension of the PBL program throughout the year.
A simple question to think about when considering the hemoglobin function
Authors: Ruiz‐Larrea M. Begoña
Published: February 2007

Hemoglobin is a complex protein formed by various subunits interacting with each other. These non‐covalent interactions, quaternary structure, are responsible for hemoglobin functioning as an excellent oxygen transporter, loading up with oxygen in the lungs and delivering it to tissues, where the oxygen pressure is lower. The communications between subunits make hemoglobin bind oxygen in a cooperative way, displaying sigmoidal saturation curves. In addition to oxygen, hemoglobin also transports H+, CO2, and 2,3‐bisphosphoglycerate, and these molecules regulate the transport of oxygen. The quaternary structure of hemoglobin accounts for the different behavior with respect to another oxygen‐binding protein, myoglobin, a monomeric protein, thus lacking quaternary structure, whose function is mainly to store oxygen. A simple question, “What consequences would the loss of the hemoglobin quaternary structure have on oxygenation?” helps the student to think about the behavior of hemoglobin and to integrate and relate all the elements affecting its binding with oxygen.
A Professor's Pathway through problem‐based learning
Authors: Hodges Linda C.
Published: February 2007

Numbers of articles document the power of problem‐based learning in promoting various facets of student learning, yet many faculty are still hesitant to use this pedagogy. Balancing the complexity of the classroom dynamic in student‐centered strategies and the content demands of our discipline with our personal philosophy of teaching is a challenging task. In this article I share my personal insights in adopting problem‐based learning in an undergraduate survey course in biochemistry and the rewards and challenges that this pedagogy posed for my students and for me. I offer a rationale for adopting a holistic model of teaching that takes into account both our students' and our own intellectual and personal growth in the classroom.
Random amplified polymorphic DNA PCR in the microbiology teaching laboratory: Identification of bacterial unknowns*
Authors: Baker Jason C. , Crumley Richard E. , Eckdahl Todd T.
Published: February 2007

There continues to be a need for authentic and engaging undergraduate teaching laboratory investigations that reflect modern molecular biological research methods. We adapted random amplified polymorphic DNA (RAPD) analysis for the microbiology laboratory as a practical activity that allowed students to generate and analyze data for the identification of bacterial unknowns. The activity gave students an appreciation of the value of applying a molecular biological method to a discipline‐specific question.

The abbreviation used is: RAPD, random amplified polymorphic DNA.
Visualization of aligned genomic open reading frame data*
Authors: Boyle Alan P. , Boyle John A.
Published: February 2007

Students can better appreciate the value of genomic data if they are asked to use the data themselves. However, in general the enormous volume of data involved makes detailed examination difficult. Here we present a web site that allows students to study one particular aspect of sequenced genomes. They are able to align the open reading frames (ORFs) of any available genome that is of reasonable size. The ORFs may be aligned using either the start codon or the stop codon as the starting points. Results will readily show the presence of common ribosome binding sites as well as reveal interesting order within the ORFs that is nonexistent outside of them. Students will be able to ask various questions involving comparisons of genomes and see the results presented in both a tabular and graphic format. An example problem is presented under “Results.”
Teaching receptor theory to biochemistry undergraduates
Authors: Benore‐Parsons Marilee , Sufka Kenneth J.
Published: February 2007

Receptor:ligand interactions account for numerous reactions critical to biochemistry and molecular biology. While students are typically exposed to some examples, such as hemoglobin binding of oxygen and signal transduction pathways, the topic could easily be expanded. Theory and kinetic analysis, types of receptors, and the experimental assay techniques should be included to properly prepare students for careers in research, medicine, or professional programs. In this article we offer a range of material for teaching these concepts to students.