bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: A sixteen‐year followup of meniscectomy with matched controls
Authors: Englund M. , Roos E. M. , Lohmander L. S.
Published: August 2003

Objective

To investigate long‐term radiographic and patient‐relevant outcome of isolated limited meniscectomy with regard to type of meniscal tear and extent of surgical resection.

Methods

We studied 155 patients with intact cruciate ligaments (mean ± SD age 54 ± 12 years) who had undergone meniscectomy an average of 16 ± 1 years earlier. The patients were examined using standardized radiography and validated self‐administered questionnaires. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to quantify knee‐related symptoms, and the definition of a symptomatic knee was determined. We used 68 control subjects matched for age, sex, and body mass index to calculate the relative risks (RRs).

Results

Radiographic tibiofemoral osteoarthritis (OA) (Kellgren/Lawrence grade ≥2) was present in 66 index knees (43%), of which 39 (59%) were considered to be symptomatic according to the KOOS. In total, 77 patients (50%) had a symptomatic index knee. In a multivariate model, degenerative meniscal tears were associated with both radiographic OA (P = 0.030) and combined radiographic and symptomatic OA (P ≤ 0.015). The RRs for combined radiographic and symptomatic OA after degenerative and traumatic types of meniscal tear were 7.0 (95% confidence interval [95% CI] 2.1–23.5) and 2.7 (95% CI 0.9–7.7), respectively, compared with matched controls.

Conclusion

An isolated meniscal tear treated by limited meniscectomy is associated with a high risk of radiographic and symptomatic tibiofemoral OA at 16‐year followup. Factors associated with worse outcome were degenerative meniscal lesions and extensive resections. We suggest that degenerative meniscal tears may be associated with incipient OA, and that the meniscal tear signals the first symptom of the disease.
Global surface ultraviolet radiation intensity may modulate the clinical and immunologic expression of autoimmune muscle disease
Authors: Okada Satoshi , Weatherhead Elizabeth , Targoff Ira N. , Wesley Robert , Miller Frederick W.
Published: August 2003

Objective

To determine if geoclimatic factors may influence the nature and frequency of dermatomyositis (DM), polymyositis, and associated autoantibodies around the world.

Methods

We assessed, in the first global evaluation of these conditions, the relationship between 13 geoclimatic variables that may modulate disease and the relative proportion of DM and its associated autoantibody anti–Mi‐2, directed against an SNF2‐superfamily helicase associated with the nucleosome remodeling and histone acetylation and deacetylation complex, in a global myositis population. Altogether, 919 consecutive patients from populations at 15 locations were studied.

Results

Univariate and multivariate analyses demonstrated that of the variables evaluated, surface ultraviolet (UV) radiation intensity (irradiance) most strongly contributed to the relative proportion of DM and was strongly related to the proportion of anti–Mi‐2 autoantibodies (weighted r = 0.939, P < 4 × 10‐7 and weighted r = 0.69, P = 0.02, respectively). Published ethnogeographic immunogenetic allele frequencies imply that the striking differences in the proportion of DM‐ and DM‐specific autoantibodies observed around the world are not the result of inherent global variations in known genetic risk factors.

Conclusion

These data suggest that UV radiation exposure may modulate the clinical and immunologic expression of an autoimmune disease in different populations around the world.
Use of a novel elution regimen reveals the dominance of polyreactive antinuclear autoantibodies in lupus kidneys
Authors: Xie Chun , Liang Zhiyan , Chang Sooghee , Mohan Chandra
Published: August 2003

Objective

The autoantibody specificities that dominate the deposits in lupus kidneys remain unclear. Reasoning that previously utilized elution buffers such as acidic glycine and ammonium thiocyanate may not have been maximally effective in eluting all Ig deposits from the kidneys, this study was conducted to experiment with a stronger dissociating agent, urea‐glycine.

Methods

Seven antinuclear antibody–positive, nephritic female (SWR × NZB)F1 (SNF1) lupus mice were selected for the elution study. Deposited Ig was eluted from their kidneys using 3 different elution buffers: 0.15M glycine‐HCl buffer, 1.3M ammonia thiocyanate/0.15M glycine‐HCl buffer, and 5M urea/0.15M glycine‐HCl buffer. All eluates were tested for specificity against a variety of nuclear and glomerular antigens.

Results

Compared with conventional elution buffers, the urea‐based regimen eluted severalfold more IgG and IgM antinuclear antibodies from the kidneys of nephritic SNF1 lupus mice. IgG anti–double‐stranded DNA (anti‐dsDNA) antibodies were not only the most prevalent species in these renal deposits, they were also heavily enriched in the kidneys, relative to the corresponding serum levels. A substantial fraction of the anti–single‐stranded DNA and antihistone/DNA (but not antihistone) reactivity in these eluates was due to cross‐reactive anti‐dsDNA antibodies. No reactivity with SSA, SSB, Sm, RNP, Jo‐1, Scl‐70, or ribosomal P antigens could be demonstrated in these eluates. Importantly, the urea‐glycine eluates differed from the conventional eluates in having significantly greater reactivity to glomerular substrate and laminin.

Conclusion

This novel urea‐based elution provides further support for the dominance of antibodies in lupus kidneys, with strong polyreactivity to DNA and glomerular substrate.
Inflammation and angiogenesis in osteoarthritis
Authors: Haywood L. , McWilliams D. F. , Pearson C. I. , Gill S. E. , Ganesan A. , Wilson D. , Walsh D. A.
Published: August 2003

Objective

To quantify the relationship between inflammation and angiogenesis in synovial tissue from patients with osteoarthritis (OA).

Methods

Hematoxylin and eosin staining and histologic grading for inflammation were performed for 104 patients who met the American College of Rheumatology criteria for OA and had undergone total joint replacement or arthroscopy. A purposive sample of synovial specimens obtained from 70 patients was used for further analysis. Vascular endothelium, endothelial cell (EC) proliferating nuclei, macrophages, and vascular endothelial growth factor (VEGF) were detected by immunohistochemical analysis. Angiogenesis (EC proliferation, EC fractional area), macrophage fractional area, and VEGF immunoreactivity were measured using computer‐assisted image analysis. Double immunofluorescence histochemical analysis was used to determine the cellular localization of VEGF. Radiographic scores for joint space narrowing and osteophyte formation in the knee were also assessed.

Results

Synovial tissue samples from 32 (31%) of 104 patients with OA showed severe inflammation; thickened intimal lining and associated lymphoid aggregates were often observed. The EC fractional area, EC proliferation, and VEGF immunoreactivity all increased with increasing histologic inflammation grade and increasing macrophage fractional area. In the synovial intimal lining, VEGF immunoreactivity was localized to macrophages and increased with increasing EC fractional area and angiogenesis. No inflammation or angiogenic indices were significantly correlated with radiographic scores.

Conclusion

Inflammation and angiogenesis in the synovium are associated with OA. The angiogenic growth factor VEGF generated by the inflamed synovium may promote angiogenesis, thereby contributing to inflammation in OA.
Rheumatoid arthritis is a heterogeneous disease: Evidence for differences in the activation of the STAT‐1 pathway between rheumatoid tissues
Authors: van der Pouw Kraan Tineke C. T. M. , van Gaalen Floris A. , Kasperkovitz Pia V. , Verbeet Nicolette L. , Smeets Tom J. M. , Kraan Maarten C. , Fero Mike , Tak Paul‐Peter , Huizinga Tom W. J. , Pieterman Elsbet , Breedveld Ferdinand C. , Alizadeh Ash A. , Verweij Cornelis L.
Published: August 2003

Objective

To generate a molecular description of synovial tissue from rheumatoid arthritis (RA) patients that would allow us to unravel novel aspects of pathogenesis and to identify different forms of disease.

Methods

We applied complementary DNA microarray analysis to profile gene expression, with a focus on immune‐related genes, in affected joint tissues from RA patients and in tissues from osteoarthritis (OA) patients as a control. To validate microarray data, real‐time polymerase chain reaction was performed on genes of interest.

Results

The gene expression signatures of synovial tissues from RA patients showed considerable variability, resulting in the identification of at least two molecularly distinct forms of RA tissues. One class of tissues revealed abundant expression of clusters of genes indicative of an involvement of the adaptive immune response. Detailed analysis of the expression profile provided evidence for a prominent role of an activated signal transducer and activator of transcription 1 pathway in these tissues. The expression profiles of another group of RA tissues revealed an increased tissue remodeling activity and a low inflammatory gene expression signature. The gene expression pattern in the latter tissues was reminiscent of that observed in the majority of OA tissues.

Conclusion

The differences in the gene expression profiles provide a unique perspective for distinguishing different pathogenetic RA subsets based on molecular criteria. These data reflect important aspects of molecular variation that are relevant for understanding the biologic dysregulation underlying these subsets of RA. This approach may also help to define homogeneous groups for clinical studies and evaluation of targeted therapies.
Frequency of osteopenia in adolescents with early‐onset juvenile idiopathic arthritis: A long‐term outcome study of one hundred five patients
Authors: Lien Gunhild , Flatø Berit , Haugen Margaretha , Vinje Odd , Sørskaar Dag , Dale Knut , Johnston Virginia , Egeland Thore , Førre Øystein
Published: August 2003

Objective

To determine the frequency of low bone mineral content (BMC) and low bone mineral density (BMD) as long‐term complications in adolescents with early‐onset juvenile idiopathic arthritis (JIA), and to identify disease variables, patient characteristics, and biochemical bone markers related to low bone mass.

Methods

One hundred five (87%) of 121 adolescent patients with early‐onset JIA (ages 13–19 years, 80 girls and 25 boys, mean age at onset of JIA 2.8 years), from a cohort first admitted to the hospital between 1980 and 1985, were assessed after a mean disease duration of 14.2 years. BMC and BMD of the total body, the lumbar spine at L2–L4, and the femoral neck were measured by dual‐energy x‐ray absorptiometry. Age‐ and sex‐specific reference values from a pooled, healthy reference population were used to calculate Z scores. Low bone mass was defined as a Z score less than −1 SD.

Results

Among the 103 adolescent JIA patients who underwent total‐body imaging, 41% had low total‐body BMC and 34% had low total‐body BMD. Compared with adolescent JIA patients who had normal total‐body BMC, those with low BMC had lower mean weight (P < 0.001), height (P < 0.001), lean mass (P < 0.001), and remission rates (P = 0.016), had longer duration of active disease (P = 0.013), had higher numbers of active and mobility‐restricted joints (P < 0.001 and P = 0.001, respectively), had more disability (P = 0.011), had higher frequencies of joint erosions (P < 0.001), and had higher erythrocyte sedimentation rates (P = 0.033). In multiple linear regression analyses of total‐body BMC, 88% of the variance was explained by the duration of active disease, the number of joints with restricted mobility, the bone area, urinary deoxypyridinoline values, age, weight, and height.

Conclusion

Forty‐one percent of the adolescents with early‐onset JIA had low bone mass >11 years after disease onset. The development of low total‐body BMC was related to the duration of active disease, disease severity, measures of bone resorption, weight, and height.
Tumor necrosis factor α blockade reduces the synovial cell infiltrate early after initiation of treatment, but apparently not by induction of apoptosis in synovial tissue
Authors: Smeets Tom J. M. , Kraan Maarten C. , van Loon Marieke E. , Tak Paul‐Peter
Published: August 2003

Objective

To determine whether treatment with the chimeric anti–tumor necrosis factor α antibody infliximab could reduce cellularity by the induction of apoptosis in synovial tissue.

Methods

Twenty‐four rheumatoid arthritis patients with active disease were randomized to receive either infliximab (3 mg/kg) (n = 12) or placebo (n = 12) intravenously. All patients were subjected to arthroscopic synovial biopsy directly before initiation of treatment. A second arthroscopic synovial biopsy of the same index joint was performed 48 hours after the first arthroscopy. After the second arthroscopy, the patients who had initially received placebo were also treated with infliximab in an extension study. A third arthroscopy was performed in all patients on day 28. Immunohistologic analysis was performed to characterize the cell infiltrate. In situ detection of apoptotic cells was performed by TUNEL assay and electron microscopy.

Results

At 48 hours after initiation of infliximab treatment, there was a significant reduction in the number of intimal macrophages; this was not observed in the placebo group. The number of sublining macrophages, T cells, and plasma cells also tended to be decreased in infliximab‐treated patients, but not in the placebo group. Of interest, we did not detect any increase in the number of apoptotic cells after infliximab treatment.

Conclusion

Infliximab therapy may reduce the number of inflammatory cells in rheumatoid synovial tissue as soon as 48 hours after initiation of treatment, but apparently not by induction of apoptosis. Conceivably, decreased cell infiltration primarily results from early inhibition of cell migration.
High binding capacity of cyclophilin B to chondrocyte heparan sulfate proteoglycans and its release from the cell surface by matrix metalloproteinases: Possible role as a proinflammatory mediator in arthritis
Authors: De Ceuninck Frédéric , Allain Fabrice , Caliez Audrey , Spik Geneviève , Vanhoutte Paul M.
Published: August 2003

Objective

To study cyclophilin B, a protein newly identified as a secretion product of cultured chondrocytes, in the context of chondrocyte pathobiology.

Methods

Cyclophilin B was purified by sequential chromatographic processing of the secretion medium of cultured guinea pig chondrocytes. Its presence both at the surface of chondrocyte monolayers and in cartilage was demonstrated by immunohistochemistry. Binding sites at the surface of chondrocytes were characterized by Scatchard plot analysis using 125I‐labeled cyclophilin B, and by glycosidase treatments. The release of cyclophilin B from chondrocytes by activated matrix metalloproteinases (MMPs) was studied by Western blot analysis.

Results

Cyclophilin B was present at the surface of cultured chondrocytes and within cartilage, both in cells and in the extracellular matrix, with a particularly intense staining in the superficial layer. It was secreted constitutively by chondrocytes and cartilage explants. Its secretion was enhanced after treatment with its pharmacologic binding partner, cyclosporin A (CSA). Experiments with 125I‐labeled cyclophilin B demonstrated the presence of high‐capacity, low‐affinity, NaCl‐sensitive binding sites at the surface of chondrocytes. Cell‐bound cyclophilin B could be released by heparinase treatment, demonstrating binding to pericellular heparan sulfate proteoglycans (HSPGs). Chondroitinase or keratanase treatments had no effect. MMPs 1, 2, 3, 9, and 13 released intact cyclophilin B from the cell surface, probably by cleavage of HSPGs. This effect was reversed by the broad‐spectrum MMP inhibitor, marimastat.

Conclusion

Cyclophilin B is a secreted CSA‐binding protein involved in inflammatory events. It can induce chemotaxis in human neutrophils and T lymphocytes. The finding that cyclophilin B is an intrinsic component of cartilage and that it can be released by MMPs suggests that it has a role in the pathogenesis of arthritic diseases, even more so since its signaling receptor is present within the inflamed joint both on T cells and in the rheumatoid synovium.
Cytokines elicited by T cell epitopes from a synovial autoantigen: Altered peptide ligands can reduce interferon‐γ and interleukin‐10 production
Authors: Hall Frances C. , Visconti Kevin C. , Ahmad Regina‐Celeste , Parry Sarah L. , Miltenburg André M. M. , McConnell Harden M. , Mellins Elizabeth D. , Sønderstrup Grete
Published: August 2003

Objective

To explore the cytokine responses associated with T cell epitopes from human cartilage glycoprotein 39 (HC gp‐39) and the potential for modifying cytokine secretion using altered peptide ligands (APLs).

Methods

Draining lymph node cells were harvested from HLA–DR*0401 transgenic mice that had been immunized with HC gp‐39. Cytokine responses to 5 previously identified HLA–DR*0401–restricted HC gp‐39 T cell epitopes were studied in vitro. The anchor and T cell receptor (TCR) contact residues of peptide 322–337 were identified, and this information was used to design alanine‐substituted APLs. T cells were primed in vivo with wild‐type peptide 322–337, restimulated with wild‐type peptide or APLs, and the cytokine profiles were compared.

Results

Restimulation with individual peptides elicited distinct cytokine profiles. HC gp‐39 (peptide 322–337) elicited a dominant interferon‐γ (IFNγ) response. Residues within the core (positions P1–P9) 322–337 peptide sequence were critical for T cell recognition. Surprisingly, the N‐terminal flanking region was also important for recognition by 6 of 10 specific T cell hybridomas. Substitutions of charged TCR contact residues in the 322–337 core epitope (E332A and K335A) were associated with a significant reduction in the IFNγ and interleukin‐10 (IL‐10) stimulation indices. Restimulation with peptides W325A and V326A was also associated with a trend toward reduced IFNγ and IL‐10 secretion. In contrast, restimulation with peptide D330N elicited cytokine profiles more comparable with those resulting from restimulation with wild‐type peptide.

Conclusion

This study indicates that APLs of a proinflammatory HC gp‐39 T cell epitope may be used to alter the cytokine response from a memory T cell population.
Serologic changes following B lymphocyte depletion therapy for rheumatoid arthritis
Authors: Cambridge Geraldine , Leandro Maria J. , Edwards Jonathan C. W. , Ehrenstein Michael R. , Salden Martin , Bodman‐Smith Mark , Webster Anthony D. B.
Published: August 2003

Objective

To explore the changes in serologic variables and clinical disease activity following B lymphocyte depletion in 22 patients with rheumatoid arthritis (RA).

Methods

B lymphocyte depletion was attained using combination therapy based on the monoclonal anti‐CD20 antibody rituximab. Levels of a serologic indicator of inflammation, C‐reactive protein (CRP), of antimicrobial antibodies, of autoantibodies including IgA‐, IgM‐, and IgG‐class rheumatoid factors (RF), and of antibodies to cyclic citrullinated peptide (anti‐CCP) were assayed.

Results

The majority of patients showed a marked clinical improvement after treatment with rituximab, with benefit lasting up to 33 months. Levels of total serum immunoglobulins fell, although the mean values each remained within the normal range. Whereas the IgM‐RF response paralleled the changes in total serum IgM levels, the levels of IgA‐RF, IgG‐RF, and IgG and anti‐CCP antibodies decreased significantly more than did those of their corresponding total serum immunoglobulin classes. The kinetics for the reduction in CRP levels also paralleled the decreases in autoantibody levels. In contrast, levels of antimicrobial antibodies did not change significantly. B lymphocyte return occurred up to 21 months posttreatment. The time to relapse after B lymphocyte return was often long and unpredictable (range 0–17 months). Relapse was, however, closely correlated with rises in the level of at least one autoantibody. Increased autoantibody levels were rarely observed in the absence of clinical change.

Conclusion

Following B lymphocyte depletion in patients with RA, a positive clinical response occurred in correlation with a significant drop in the levels of CRP and autoantibodies. Antibacterial antibody levels were relatively well maintained. B lymphocyte return preceded relapse in all patients. There was also a temporal relationship between clinical relapse and rises in autoantibody levels. Although these observations are consistent with a role for B lymphocytes in the pathogenesis of RA, the precise mechanisms involved remain unclear.
Meta‐analysis of dyspepsia and nonsteroidal antiinflammatory drugs
Authors: Ofman Joshua J. , Maclean Catherine H. , Straus Walter L. , Morton Sally C. , Berger Marc L. , Roth Elizabeth A. , Shekelle Paul G.
Published: August 2003

Objective

Nonsteroidal antiinflammatory drug (NSAID) use is a known risk factor for gastrointestinal (GI) perforations, ulcers, and bleeds, but there are limited data on its association with the very common symptom of dyspepsia. Using published and unpublished data sources, we sought to determine estimates of the risks of dyspepsia associated with NSAIDs.

Methods

We searched computerized databases (1966–1998) for primary studies of NSAIDs reporting on GI complications. We also obtained Food and Drug Administration (FDA) new drug application reviews for the 5 most common NSAIDs. We included studies reporting defined upper GI outcomes among subjects (>17 years old) who used oral NSAIDs for more than 4 days. Two reviewers evaluated 4,881 published titles, identifying 55 NSAID versus placebo randomized controlled trials (RCTs), 37 unpublished (FDA data) placebo‐controlled RCTs; 86 NSAID versus NSAID RCTs (sample size ≥50); and 103 observational studies.

Results

The majority of clinical trials were of good quality. Meta‐regression identified an increased risk of dyspepsia for users of specific NSAIDs (adjusted odds ratio [OR] of indomethacin, meclofenamate, piroxicam = 2.8), and for high dosages of other NSAIDs (OR = 3.1), but not for other NSAIDs regardless of dosage (OR = 1.1). Dyspepsia was not reported as an outcome in the case control or cohort studies.

Conclusions

Clinical trial data indicate that high dosages of any NSAID along with any dosage of indomethacin, meclofenamate, or piroxicam increase the risk of dyspepsia by about 3‐fold. Other NSAIDs at lower dosages were not associated with an increased risk of dyspepsia.
Efficacy of infliximab in resistant psoriatic arthritis
Authors: Salvarani Carlo , Cantini Fabrizio , Olivieri Ignazio , Macchioni Pierluigi , Padula Angela , Niccoli Laura , Catanoso Maria Grazia , Scocco Giovanni Lo , Boiardi Luigi
Published: August 2003

Objective

To evaluate the efficacy and safety of the anti‐tumor necrosis factor α monoclonal antibody infliximab in the treatment of active psoriatic arthritis (PsA) resistant to previous symptom modifying antirheumatic drugs.

Methods

Sixteen patients with peripheral active PsA with at least 6 months of methotrexate (MTX) therapy at a stable dosage were treated with infliximab administered at a dosage of 3 mg/kg at 0, 2, 6, 14, 22, and 30 weeks while continuing to receive MTX. Intake of nonsteroidal antiinflammatory drugs and corticosteroids was stable during the study period. Standard clinical assessments, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) were determined at baseline and at weeks 2, 6, 14, 22, and 30.

Results

By week 2, significant improvements were registered in the number of swollen and tender joints, visual analog scale for pain, patient and doctor global disease assessment scores, Health Assessment Questionnaire, Dougados functional index, ESR, and CRP. At week 30, the percentages of patients satisfying American College of Rheumatology (ACR) 20%, ACR 50%, and ACR 70% response rates were 64%, 57%, and 57%, respectively. In the 3 patients with active axial disease, spinal stiffness and pain resolved almost completely at week 2 and the improvement did not diminish over time. Psoriasis Area Severity Index improvement was 37% at week 2 and 86% at week 30. No patients dropped out for treatment failure. Side effects were observed in 4 of 16 patients, 2 of whom suspended the therapy due to a severe allergic reaction.

Conclusion

In patients with resistant PsA, infliximab is an effective therapy without major side effects.
Tumid lupus erythematosus: Criteria for classification with immunohistochemical analysis
Authors: Alexiades‐Armenakas Macrene R. , Baldassano Marisa , Bince Benji , Werth Victoria , Bystryn Jean‐Claude , Kamino Hideko , Soter Nicholas A. , Franks Andrew G.
Published: August 2003

Objective

To define comprehensive criteria for the classification and differential diagnosis of tumid lupus erythematosus (LE).

Methods

A prospective study of patients fulfilling the classical description of tumid LE was performed. Clinical evaluation, histopathologic and direct immunofluorescence analyses of skin specimens, and serologic evaluation were conducted. The inflammatory cell infiltrate was quantitatively investigated by immunohistochemical analysis of fresh frozen skin specimens using multiple lymphocytic markers.

Results

Fifteen patients were followed for a mean of 7 years. Smooth, indurated, nonscarring, pink to violaceous papules, plaques, or nodules, devoid of surface changes were distributed on sun exposed sites. The mean lesion duration was 2 years, female:male ratio was 8:7, and racial distribution was 11 white, 2 Hispanic, and 2 African American patients. Histopathologic findings included a superficial and deep, perivascular, and frequently periadnexal infiltrate of lymphocytes, mucin deposition throughout the dermis, and absent to focal dermal‐epidermal junctional involvement. Direct immunofluorescence immunoreactants and low titer antinuclear antibodies were variably present. Immunohistochemical findings included a predominance of pan‐T cell marker CD3‐expressing (78.0% ± 6.3%) T lymphocytes. Most were CD4 expressing (82.7% ± 8.0%) helper T cells; a minority were CD8 expressing (31.3% ± 14.0%) cytotoxic T cells. The CD4:CD8 ratio was 3.1 (±1.3):1. One patient developed systemic LE and one a discoid LE lesion.

Conclusion

Comprehensive clinical, histopathologic, and immunohistochemical criteria for the classification of tumid LE are proposed that differentiate tumid LE from other cutaneous disorders that may be clinically and histologically indistinguishable. The chronic, benign course indicates that tumid LE be classified as a form of chronic cutaneous LE, although it may be a cutaneous feature of systemic LE.
Group education for patients with rheumatoid arthritis and their partners
Authors: Riemsma Robert P. , Taal Erik , Rasker Johannes J.
Published: August 2003

Objective

To determine the effects of group education followed by booster sessions for people with rheumatoid arthritis (RA), and to determine whether participation of a significant other influenced the effects.

Methods

A total of 218 RA patients, each of them with a partner, took part in the study. Two‐thirds of the patients received a 5‐week group self‐management education program, with booster sessions after 3, 6, and 9 months; half of them received the intervention with a partner, and half without. One‐third of the patients received the same educational materials without group sessions. Data were collected 1 week before the group sessions began and 2, 6, and 12 months later. The assessments included health behavior, arthritis self‐efficacy, health status, and social interactions.

Results

After 12 months, self‐efficacy scores for coping with other symptoms were significantly higher for patients participating in the group education without a partner and significantly lower for patients participating in the group education with a partner. Fatigue increased in patients participating in the group education with a significant other and decreased in patients participating in the group education without a significant other. No other effects were found on health status, health behavior, or social interactions.

Conclusion

Our findings suggest that participation of a significant other in psychoeducational programs does not have only positive effects. Instead of stimulating patients to adopt beneficial health behaviors and increase their self‐efficacy expectations, participation of a significant other led in our program to decreases in self‐efficacy and increased fatigue, whereas patients participating in group education without partners showed increases in self‐efficacy and decreased fatigue. Booster sessions did not seem to influence results.
Influence of suture material and surgical technique on risk of reoperation after non-mesh open hernia repair
Authors: Nordin P , Haapaniemi S , Kald A , Nilsson E
Published: August 2003

Background

Although mesh techniques are used with increasing frequency, sutured repair still has a place in groin hernia surgery. Studies relating suture material to recurrence rate have yielded conflicting results. The aim of the present study was to analyse the influence of suture material and sutured non-mesh technique on the risk of reoperation in open groin hernia repair using data from the Swedish Hernia Register.

Methods

The relative risk of reoperation after sutured repair using non-absorbable, late absorbable and early absorbable sutures was compared in multivariate analyses, taking into account known confounding factors.

Results

Between 1992 and 2000, 46 745 hernia repairs were recorded in the Swedish Hernia Register. Of these, 18 057 repairs were performed with open non-mesh methods and were included in the analysis. Using non-absorbable suture as reference, the relative risk of reoperation after repair with early absorbable suture and late absorbable suture was 1·50 (95 per cent confidence interval (c.i.) 1·22 to 1·83) and 1·03 (95 per cent c.i. 0·83 to 1·28) respectively. Using the Shouldice repair as reference, other sutured repairs were associated with a significantly higher relative risk of reoperation (1·22, 95 per cent c.i. 1·03 to 1·44).

Conclusion

A non-absorbable or a late absorbable suture is recommended for open non-mesh groin hernia repair. The Shouldice technique was found to be superior to other open methods.
Simultaneous resection of colorectal primary tumour and synchronous liver metastases
Authors: Weber J C , Bachellier P , Oussoultzoglou E , Jaeck D
Published: August 2003

Background

The surgical strategy for treatment of synchronous colorectal liver metastases remains controversial. The outcome and overall survival of patients presenting with such metastases, treated either by simultaneous resection or by delayed resection, were evaluated.

Methods

From 1987 to 2000, 97 patients presented with synchronous colorectal liver metastases, of whom 35 (36 per cent) underwent a simultaneous resection and 62 patients (64 per cent) a delayed resection. Simultaneous resection was considered prospectively for patients with fewer than four unilobar metastases.

Results

Age, blood transfusion requirements, operating time, duration of inflow occlusion, hospital stay and mortality rate were similar in the two groups. The morbidity rate did not differ significantly (23 per cent after simultaneous resection and 32 per cent after delayed resection). The location of the primary tumour and extent of liver resection did not influence the morbidity rate significantly in the simultaneous resection group. The overall survival rate was 94, 45 and 21 per cent at 1, 3 and 5 years respectively after simultaneous resection, and 92, 45 and 22 per cent after delayed resection.

Conclusion

In selected patients, simultaneous resection of the colorectal primary tumour and liver metastases does not increase mortality or morbidity rates compared with delayed resection, even if a left colectomy and/or a major hepatectomy are required.
Fibrosis-associated gene expression in renal transplant glomeruli after acute renal allograft rejection
Authors: Brook N R , White S A , Waller J R , Bicknell G R , Nicholson M L
Published: August 2003

Background

Acute allograft rejection is thought to be a risk factor for chronic allograft nephropathy, the cardinal features of which are vasculopathy, interstitial fibrosis and glomerulosclerosis. Fibrosis-associated genes might act as ad interim surrogate markers for chronic allograft nephropathy. The aim of this study was to determine mRNA expression of fibrosis-associated genes in glomeruli plucked from protocol renal transplant biopsies, in patients with or without a history of acute rejection.

Methods

A consecutive series of 52 patients (31 male, 21 female) was assessed. Donor categories were cadaveric, living related or asystolic. Transplant recipients received either cyclosporin- or tacrolimus-based immunosuppression. Patients routinely underwent percutaneous needle-core renal transplant biopsy at 1 week, and 3 and 6 months. Acute rejection episodes were confirmed histologically and treated with intravenous methylprednisolone, or antithymocyte globulin if steroid resistant. Individual glomeruli were plucked and total mRNA was extracted. Fibrosis-associated genes were amplified by reverse transcriptase–polymerase chain reaction (PCR) and quantified by enzyme-linked immunosorbent assay.

Results

The expression of both collagen type III (mean 0·42 versus 0·31 arbitrary units of PCR products corrected for a housekeeping gene) and collagen IV (mean 0·46 versus 0·42 arbitrary units) at 6 months did not differ between recipients who experienced acute rejection episodes and those who were free from rejection. There was also no significant difference between groups in terms of mRNA expression of collagen IVα2, matrix metalloproteinase 2, tissue inhibitor of matrix metalloproteinases 1 and 2, transforming growth factor β or tenascin.

Conclusion

These results suggest that acute rejection episodes do not increase the expression of fibrosis-associated genes in glomeruli from renal transplant biopsies.
Recurrence and survival after mesorectal excision for rectal cancer
Authors: Bülow S , Christensen I J , Harling H , Kronborg O , Fenger C , Nielsen H J
Published: August 2003

Background

Mesorectal excision for rectal cancer has resulted in local recurrence rates of 3–11 per cent compared with up to 38 per cent after conventional methods. The results of a prospective Danish study with a historical control group are presented.

Methods

Three hundred and eleven patients with a mobile rectal cancer had mesorectal excision with curative intent performed by certified surgeons and were followed for 3 years. Demographic, perioperative and follow-up data were recorded prospectively. A series of patients who had conventional operations for rectal cancer served as a control group.

Results

The cumulative 3-year local recurrence rate was 11 per cent after mesorectal excision compared with 30 per cent after conventional surgery (hazard ratio (HR) 0·33 (95 per cent confidence interval (c.i.) 0·21 to 0·52); P < 0·001). Multivariate regression analysis showed that only advanced age (HR 0·97 (95 per cent c.i. 0·94 to 1·00); P = 0·048) and tumour in the lower third of the rectum (HR 0·21 (95 per cent c.i. 0·04 to 1·97); P = 0·075) were marginal independent predictors of local recurrence after mesorectal excision. The cumulative crude 3-year survival rate was 77 per cent after mesorectal excision and 62 per cent after conventional surgery (HR 0·58 (95 per cent c.i. 0·43 to 0·77); P < 0·001). Age was the only independent predictor of death after mesorectal excision (HR 1·04 (95 per cent c.i. 1·02 to 1·07); P = 0·001).

Conclusion

Mesorectal excision is associated with a considerably lower risk of local recurrence and a better survival rate than conventional surgery, and is the optimum method for rectal cancer resection.
Spatial relations of the angular vein, an important landmark in axillary nodal dissection
Authors: Chan C-Y , Tan M
Published: August 2003

Helpful anatomy for the breast surgeon
Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver
Authors: Tanaka K , Adam R , Shimada H , Azoulay D , Lévi F , Bismuth H
Published: August 2003

Background

The role of neoadjuvant chemotherapy for patients with multiple (five or more) bilobar hepatic metastases irrespective of initial resectability is still under scrutiny. The purpose of this study was to compare the outcome of hepatectomy alone with that of hepatectomy after neoadjuvant chemotherapy for multiple bilobar hepatic metastases from colorectal cancer.

Methods

Retrospective data were collected from 71 patients after hepatectomy for five or more bilobar liver tumours. The outcome of 48 patients treated by neoadjuvant chemotherapy followed by hepatectomy was compared with that of 23 patients treated by hepatectomy alone.

Results

Patients who received neoadjuvant chemotherapy had better 3- and 5-year survival rates from the time of diagnosis than those who did not (67·0 and 38·9 versus 51·8 and 20·7 per cent respectively; P = 0·039), and required fewer extended hepatectomies (four segments or more) (39 of 48 versus 23 of 23; P = 0·027). Multivariate analysis showed neoadjuvant chemotherapy to be an independent predictor of survival.

Conclusion

In patients with bilateral multiple colorectal liver metastases, neoadjuvant chemotherapy before hepatectomy was associated with improved survival and enabled complete resection with fewer extended hepatectomies.
Long-term results of the Lyons R90-01 randomized trial of preoperative radiotherapy with delayed surgery and its effect on sphincter-saving surgery in rectal cancer
Authors:   Lyons Oncology Group, Glehen O , Chapet O , Adham M , Nemoz J C , Gerard J P
Published: August 2003

Delayed surgery does not reduce local recurrance or improve survival
Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy
Authors: Simunovic M , Sexton R , Rempel E , Moran B J , Heald R J
Published: August 2003

Background

Radiation is being used increasingly in the management of patients with rectal cancer. Over the past decade the Basingstoke Colorectal Research Unit has combined precision total mesorectal excision with the highly selective use of preoperative radiotherapy.

Methods

One hundred and fifty consecutive patients who underwent major surgical excision for cancers of all stages comprised the study group. Preoperative clinical assessment was based largely on tumour size, fixation and distance from the anal verge. Only preoperative radiotherapy was considered and this only for tumours judged to be at high risk of mesorectal fascia involvement.

Results

During a 5-year period 35 of 150 patients were selected for preoperative irradiation. In the non-irradiated patients the local recurrence rate after a median follow-up period of 870 (range 51–1903) days was 2·6 per cent (three of 115 patients), compared with 17·1 per cent (six of 35 patients) in those chosen for irradiation. Sixty patients (52·2 per cent) who were not irradiated were node positive. The local recurrence rate for the whole group was 6·0 per cent.

Conclusion

The great majority of patients undergoing major excision for rectal cancer can be managed without radiation therapy if the preoperative assessment of the mesorectal fascia and surgery are performed optimally.
Salvage surgery after restorative proctocolectomy
Authors: Tulchinsky H , Cohen C R G , Nicholls R J
Published: August 2003

Background and method

Restorative proctocolectomy is now the elective surgical procedure of choice for most patients with ulcerative colitis or familial adenomatous polyposis. Complications may lead to failure, defined as removal of the reservoir with establishment of a permanent ileostomy or long-term diversion. Failure may be avoided for some patients by salvage surgery. The causes of failure are identified in this article and the procedures adopted to treat them are defined; a review of the literature was carried out to determine the effectiveness of the procedures.

Results

Failure after restorative proctocolectomy results from complications, which may occur indefinitely during follow-up to a cumulative rate of about 15 per cent at 10–15 years. Sepsis accounts for over 50 per cent of these complications. Abdominal salvage procedures are successful in 20 to over 80 per cent of patients but the rate of salvage is dependent on the duration of follow-up, which might explain this variance. Local procedures are successful in 50–60 per cent of patients with pouch–vaginal fistula. Poor function accounts for about 30 per cent of failures. Abdominal salvage for outlet obstruction and low pouch capacitance results in satisfactory or acceptable function in up to 70 per cent of patients. There is no effective surgical salvage for pouchitis.

Conclusion

Salvage surgery must be discussed carefully with the patient, who should be made aware of the possible complications and the prospect of success, which is less than that in the general population of patients undergoing ileoanal pouch surgery.
Controlling the expansion of abdominal aortic aneurysms
Authors: Thompson M M
Published: August 2003

Pharmacotherapy holds promise for the future
Use of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery
Authors: Tei T M , Stolzenburg T , Buntzen S , Laurberg S , Kjeldsen H
Published: August 2003

The original article to which this Erratum refers was published in British Journal of Surgery  90: 575–580.
An Alternative Efficient Redox Couple for the Dye‐Sensitized Solar Cell System
Authors: Nusbaumer Hervé , Zakeeruddin Shaik M. , Moser Jacques‐E. , Grätzel Michael
Published: August 2003

A series of new cobalt complexes [Co(LLL)2X2] were synthesized and evaluated as redox mediators for dye‐sensitized nanocrystalline TiO2 solar cells. The structure of the ligand and the nature of the counterions were found to influence the photovoltaic performance. The one‐electron‐transfer redox mediator [Co(dbbip)2](ClO4)2 (dbbip = 2,6‐bis(1′‐butylbenzimidazol‐2′‐yl)pyridine) performed best among the compounds investigated. Photovoltaic cells incorporating this redox mediator yielded incident photon‐to‐current conversion efficiencies (IPCE) of up to 80 %. The overall yield of light‐to‐electric power conversion reached 8 % under simulated AM1.5 sunlight at 100 W m−2 intensity and more than 4 % at 1000 W m−2. Photoelectrodes coated with a 2 μm thick nanoporous layer and a 4 μm thick light‐scattering layer, sensitized with a hydrophobic ruthenium dye, gave the best results.
Cytokeratin intermediate filament organisation and dynamics in the vegetal cortex of living Xenopus laevis oocytes and eggs
Authors: Clarke Emma J. , Allan Victoria J.
Published: August 2003

Cytokeratin intermediate filaments are prominent constituents of developing Xenopus oocytes and eggs, forming radial and cortical networks. In order to investigate the dynamics of the cortical cytokeratin network, we expressed EGFP‐tagged Xenopus cytokeratin 1(8) in oocytes and eggs. The EGFP‐cytokeratin co‐assembled with endogenous partner cytokeratin proteins to form fluorescent filaments. Using time‐lapse confocal microscopy, cytokeratin filament assembly was monitored in live Xenopus oocytes at different stages of oogenesis, and in the artificially‐activated mature egg during the first cell cycle. In stage III to V oocytes, cytokeratin proteins formed a loose cortical geodesic network, which became more tightly bundled in stage VI oocytes. Maturation of oocytes into metaphase II‐arrested eggs induced disassembly of the EGFP‐cytokeratin network. Imaging live eggs after artificial activation allowed us to observe the reassembly of cytokeratin filaments in the vegetal cortex. The earliest observable structures were loose foci, which then extended into curly filament bundles. The position and orientation of these bundles altered with time, suggesting that forces were acting upon them. During cortical rotation, the cytokeratin network realigned into a parallel array that translocated in a directed manner at 5 μm/minute, relative to stationary cortex. The cytokeratin filaments are, therefore, moving in association with the bulk cytoplasm of the egg, suggesting that they may provide a structural role at the moving interface between cortex and cytoplasm. Cell Motil. Cytoskeleton 56:13–26, 2003. © 2003 Wiley‐Liss, Inc.
Chromatic changes in relation to binocular summation determined with contrast thresholds
Authors: Jiménez J. R. , Valero E. , Anera R. G. , Martínez J. A. , Salas C.
Published: August 2003

We measured binocular summation for the detection of red–green chromatic, blue–yellow chromatic, and luminance contrast. The results indicated a higher degree of binocular summation for luminance contrast (reaching the level of neural summation) than for chromaticity contrast (probability summation), showing that the former is more effective than the latter for the binocular visual system, in agreement with studies on stereopsis and binocular summation for visual reaction time. © 2003 Wiley Periodicals, Inc. Col Res Appl, 28, 366–370, 2003; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/col.10179
The role of copper and silver in the colouration of metallic luster decorations (Tunisia, 9th century; Mesopotamia, 10th century; Sicily, 16th century): A first approach
Authors: Bobin O. , Schvoerer M. , Ney C. , Rammah M. , Pannequin B. , Platamone E. Cilia , Daoulatli A. , Gayraud R. P.
Published: August 2003

The metallic luster of glazed ceramics is a very special type of decoration. Its optical properties are characterized by a change of colour according to the observation conditions. In diffuse light, these decorations are often green, brown, or ochre‐yellow. In specular reflection, they show an associated coloured metallic reflection (blue, golden‐yellow, orange, etc.). Metallic copper and/or silver colloids almost always compose the metallic luster decorations. We wish to define the role of these two metals in the colouration observed both in diffuse light and in specular reflection. Our investigations show that a relationship exists between the proportions of copper and silver, and the diffuse colour. The green decorations contain more silver than copper, and the ochre‐yellow and brown decorations contain more copper than silver. This specific correlation only exists if the samples have the same type of glaze and, especially, a similar chemical composition. This means that the composition of the glaze has an important influence in the colouration process. Moreover, our investigations show that there is no relationship between the specular colour and the overall concentration of copper and silver. © 2003 Wiley Periodicals, Inc. Col Res Appl, 28, 352–359, 2003; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/col.10183