bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

AbstractObjectiveTo 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.MethodsOne 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.ResultsAmong 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.ConclusionForty‐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

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

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

AbstractObjectiveTo 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).MethodsDraining 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.ResultsRestimulation 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.ConclusionThis 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

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

AbstractObjectiveNonsteroidal 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.MethodsWe 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.ResultsThe 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.ConclusionsClinical 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

AbstractObjectiveTo 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.MethodsSixteen 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.ResultsBy 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.ConclusionIn 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

AbstractObjectiveTo define comprehensive criteria for the classification and differential diagnosis of tumid lupus erythematosus (LE).MethodsA 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.ResultsFifteen 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.ConclusionComprehensive 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

AbstractObjectiveTo 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.MethodsA 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.ResultsAfter 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.ConclusionOur 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

AbstractBackgroundAlthough 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.MethodsThe 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.ResultsBetween 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).ConclusionA 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

Abstract

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.