The overall status in rheumatoid arthritis (OSRA) measure--further evidence to support its use in clinical practice

OBJECTIVES

The overall status in rheumatoid arthritis (OSRA) instrument is a simple summary of health status, including disease activity (OSRA-A) and damage (OSRA-D) scores. Despite evidence of the validity of the OSRA, uptake has been low. This study aimed to assess the responsiveness and re-examine the validity of the OSRA using the measures from the British Rheumatoid Outcome Study Group (BROSG) randomized controlled trial of aggressive vs symptomatic treatment of rheumatoid arthritis (RA) patients.

METHODS

466 patients were recruited. Outcome measures included the OSRA, the OMERACT core set and the DAS28, and were collected at baseline and annually for the 3 yrs of the trial. X-rays of the hands and feet were taken at baseline and 3 yrs. Patients were assigned a Townsend score (a measure of social deprivation) according to area of residence. Construct validity was assessed by correlating the OSRA with a range of outcome measures, and testing for the known inequality in RA outcome between patients classified by social deprivation. Responsiveness to change was assessed against self-reported change over the first year of the trial.

RESULTS

The OSRA-A and OSRA-D measures demonstrated construct validity, performing as hypothesized. The OSRA-A was the most responsive measure in the BROSG trial in detecting patient reported improvement and deterioration. The OSRA-D demonstrated similar responsiveness to alternative measures.

CONCLUSIONS

Our results demonstrate the validity and responsiveness of the OSRA, and its potential for inclusion in clinical trials. More important, as the OSRA is quick and easily calculated, uses routinely collected information, and provides useful quantitative information about a patient's status and progress it is suitable for use in the routine clinic.

First Report of Leifsonia xyli subsp. xyli, Causal Agent of Ratoon Stunting of Sugarcane, in Jamaica

To our knowledge, this is the first report that Leifsonia xyli subsp. xyli, previously named Clavibacter xyli subsp. xyli (2), has been detected and identified in sugarcane in Jamaica. Although ratoon stunting (also known as ratoon stunting disease or RSD) has been reported in Jamaica since 1961, presence of the pathogen had never been confirmed in symptomatic tissues. A major industry-wide survey conducted in 1987 using the fluorescent antibody staining technique failed to detect positives in any of the 61 fields sampled in Jamaica. A new survey was conducted in 2004 on eight estates and the Sugar Industry Research Institute (SIRI) in Jamaica. Six arbitrarily selected stalks were sampled from each of 64 fields representing 25 different sugarcane cultivars. A 1-cm diameter core was extracted from the center of the bottom part of the stalk and used to detect the pathogen by tissue blot immunoassay (TBIA) (3). L. xyli subsp. xyli was detected in 26 of 384 samples (7%). At least one positive sample was found in 10 fields and seven cultivars and in one case (sugarcane cv. D14146 at the St Thomas Sugar Estate), all six stalks sampled in a field were positive. The highest number of infected fields (6 of 10) occurred at Worthy Park where cane yield in 2004 was 86.54 tons per ha compared with an average of 68.04 tons per ha for major estates in Jamaica (1). This latter result would indicate that where good quality agronomic practices are maintained, the effect of ratoon stunting might not be substantial or that sugarcane cultivars grown at this location were resistant to ratoon stunting. Pathogen identification was confirmed using nested polymerase chain reaction (PCR) with three samples from a TBIA-positive field of cv. D14146. Primary primers were RSD 33 (CTGGCACCCTGTGTTGTTTTC) and RSD 297 (TTCGGTTCTCATCTCAGCGTC) and secondary, nested primers were RST60 (TCAACGCAGAGATTGTCCAG) and RST59 (CGTCTTGAAGACACAGCGATGAG). The thermocycler parameters were denaturization at 94°C for 4 min, 31 cycles at 94°C for 30 s, 55°C for 30 s, 65°C for 1 min, and final extension at 65°C for 3 min. The nested-PCR product (approximately 230 bp) of each sample was cloned and sequenced. It showed 99 to 100% identity with the 16S-23S intergenic spacer region of L. xyli subsp. xyli, thus confirming occurrence of ratoon stunting in Jamaica. Since this study, the SIRI has installed a hot-water treatment plant and will heat-treat cuttings before planting the nurseries with new sugarcane clones selected for release to growers. The SIRI will also conduct screening for ratoon stunting resistance to ensure that susceptible clones are not released to the industry. Meanwhile, the SIRI will do a more intense survey so that a more comprehensive picture may be obtained of the presence of ratoon stunting in Jamaica. References: (1) Anonymous. Annual Report of the Sugar Industry Research Institute, Jamaica, 2004. (2) L. I. Evtushenko et al. Int. J. Syst. Evol. Microbiol. 50:371, 2000. (3) N. A. Harrison and M. J. Davis. Phytopathology 78:722, 1988.

The transcriptional landscape of the mammalian genome

This study describes comprehensive polling of transcription start and termination sites and analysis of previously unidentified full-length complementary DNAs derived from the mouse genome. We identify the 5' and 3' boundaries of 181,047 transcripts with extensive variation in transcripts arising from alternative promoter usage, splicing, and polyadenylation. There are 16,247 new mouse protein-coding transcripts, including 5154 encoding previously unidentified proteins. Genomic mapping of the transcriptome reveals transcriptional forests, with overlapping transcription on both strands, separated by deserts in which few transcripts are observed. The data provide a comprehensive platform for the comparative analysis of mammalian transcriptional regulation in differentiation and development.

Quality of life, morbidity, and mortality after low trauma hip fracture in men

BACKGROUND

Osteoporotic hip fractures have been extensively studied in women, but they have been relatively ignored in men.

OBJECTIVE

To study the mortality, morbidity, and impact on health related quality of life of male hip fractures.

METHODS

100 consecutive men aged 50 years and over, with incident low trauma hip fracture, admitted to Royal Cornwall Hospital, UK during 1995-97, were studied. 100 controls were recruited from a nearby general practice. Mortality and morbidity, including health status assessed using the SF-36, were evaluated over a 2 year follow up period.

RESULTS

Survival after 2 years was 37% in fracture cases compared with 88% in controls (log rank test 62.6, df = 1, p = 0.0001). In the first year 45 patients died but only one control. By 2 years 58 patients but only 8 controls had died. Patients with hip fracture died from various causes, the most common being bronchopneumonia (21 cases), heart failure (9 cases), and ischaemic heart disease (8 cases). Factors associated with increased mortality after hip fracture included older age, residence before fracture in a nursing or residential home, presence of comorbid diseases, and poor functional activity before fracture. Patients with fracture were often disabled with poor quality of life. By 24 months 7 patients could not walk, 12 required residential accommodation, and the mean SF-36 physical summary score was 1.7SD below the normal standards.

CONCLUSIONS

Low trauma hip fracture in men is associated with a significant increase in mortality and morbidity. Impaired function before fracture is a key determinant of mortality after fracture.

A longitudinal study of disease activity and functional status in a hospital cohort of patients with ankylosing spondylitis

OBJECTIVE

To evaluate changes in functional status and disease activity and their determinants in patients with ankylosing spondylitis (AS) attending hospital, using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI).

METHODS

Patients completed BASDAI and BASFI questionnaires annually from 1996 to 2001. Demographic and clinical data were collected. The mean first and last recorded scores were compared. The change per year and area under the curve per year for the BASDAI and BASFI were calculated. Relationships between demographic, clinical and longitudinal BASDAI/BASFI data were examined. Subgroup analyses were performed using the cross-sectional and longitudinal data.

RESULTS

Two hundred and seventy-nine BASDAI and 322 BASFI questionnaires were analysed. The BASFI increased [mean change 6.15, 95% confidence interval (CI) 1.9, 10.3, P = 0.005] but the BASDAI did not (mean change 0.87, 95% CI -3.96, 5.7, P = 0.71). First recorded scores were the best predictors of the cumulative scores per year. Patients with peripheral joint (P = 0.01) and hip (P<0.001) disease had higher mean BASFI scores. Males (P<0.001) and patients with spinal disease alone (P = 0.0014), iritis (P = 0.005) and late-onset AS (P = 0.002) became more functionally impaired over time.

CONCLUSIONS

Disease activity in this AS cohort remained relatively constant but there was functional decline. Initial BASDAI/FI can predict a severe disease course. PJD patients with peripheral joint disease were more functionally impaired, but deteriorated less than spinal disease alone patients. Iritis and late onset disease may be severity markers for functional impairment.

Growth of Bose-Einstein condensates from thermal vapor

We report on a quantitative study of the growth process of (87)Rb Bose-Einstein condensates. By continuous evaporative cooling we directly control the thermal cloud from which the condensate grows. We compare the experimental data with the results of a theoretical model based on quantum kinetic theory. We find quantitative agreement with theory for the situation of strong cooling, whereas in the weak cooling regime a distinctly different behavior is found in the experiment.

Determinants of cardiac function: simulation of a dynamic cardiac pump for physiology instruction

A computer model is described that simulates the cardiac cycle of a mammalian heart. The model emphasizes the pressure-volume plot as a teaching tool to explain the behavior of the heart as a pump. It exhibits realistic responses to changes in preload, afterload, contractility, and heart rate while displaying time-dependent changes in pressure and volume in addition to the pressure versus volume plot. It differs from previous models by graphing these parameters on a beat-to-beat basis, allowing visualization of the dynamic adaptation of the pumping heart to various stimuli. A system diagram is also included to further promote student understanding of the physiology of cardiac function. The model is useful for teaching this topic to medical, graduate, or undergraduate students. It may also be used as a self-directed computer laboratory exercise.

Basic principles of synaptic physiology illustrated by a computer model

A computer model is described that simulates many basic aspects of chemical synapse physiology. The model consists of two displays, the first being a pictorial diagram of the anatomical connections between two presynaptic neurons and one postsynaptic neuron. Either or both of the presynaptic cells can be stimulated from a control panel with variable control of the number of pulses and firing rate; the resulting presynaptic action potentials are animated. The second display plots the membrane potential of the postsynaptic cell versus time following presynaptic stimulation. The model accurately simulates temporal and spatial summation when the presynaptic cells are arranged and stimulated in parallel and simulates presynaptic inhibition when they are arranged and stimulated in series. Excitatory and inhibitory postsynaptic potentials can be demonstrated by altering the nature of the ionic conductance change occurring on the postsynaptic cell. The effects on summation of changing length constant or time constant of the postsynaptic cell can also be illustrated. The model is useful for teaching these concepts to medical, graduate, or undergraduate students and can also be used as a self-directed computer laboratory exercise. It is available for free download from the internet.

Regulation of ion channels by protein tyrosine phosphorylation

Ion channels are regulated by protein phosphorylation and dephosphorylation of serine, threonine, and tyrosine residues. Evidence for the latter process, tyrosine phosphorylation, has increased substantially since this topic was last reviewed. In this review, we present a comprehensive summary and synthesis of the literature regarding the mechanism and function of ion channel regulation by protein tyrosine kinases and phosphatases. Coverage includes the majority of voltage-gated, ligand-gated, and second messenger-gated channels as well as several types of channels that have not yet been cloned, including store-operated Ca2+ channels, nonselective cation channels, and epithelial Na+ and Cl- channels. Additionally, we discuss the critical roles that channel-associated scaffolding proteins may play in localizing protein tyrosine kinases and phosphatases to the vicinity of ion channels.

Ca(4)IrO(6), Ca(3)MgIrO(6) and Ca(3)ZnIrO(6)

Single crystals of tetracalcium iridium hexaoxide, Ca(4)IrO(6), tricalcium magnesium iridium hexaoxide, Ca(3)MgIrO(6), and tricalcium zinc iridium hexaoxide, Ca(3)ZnIrO(6), were prepared via high-temperature flux growth and structurally characterized by single-crystal X-ray diffraction. The three compounds are isostructural and adopt the K(4)CdCl(6) structure type, comprised of chains of alternating face-shared [CaO(6)], [MgO(6)] or [ZnO(6)] trigonal prisms and [IrO(6)] octahedra, surrounded by columns of Ca(2+) ions.

Simulations of Bose fields at finite temperature

We introduce a time-dependent projected Gross-Pitaevskii equation to describe a partially condensed homogeneous Bose gas, and find that this equation will evolve randomized initial wave functions to equilibrium. We compare our numerical data to the predictions of a gapless, second order theory of Bose-Einstein condensation [S. A. Morgan, J. Phys. B 33, 3847 (2000)], and find that we can determine a temperature when the theory is valid. As the Gross-Pitaevskii equation is nonperturbative, we expect that it can describe the correct thermal behavior of a Bose gas as long as all relevant modes are highly occupied. Our method could be applied to other boson fields.

Military assistance in complex emergencies: what have we learned since the Kurdish relief effort?

After the success of relief efforts to the displaced Kurdish population in northern Iraq following the Gulf War, many in the US military and the international relief community saw military forces as critical partners in the response to future complex emergencies (CEs). However, successes in subsequent military involvement in Somalia, Rwanda, the former Yugoslavia, and other CEs proved more elusive and raised many difficult issues. A review of these operations reinforces some basic lessons that must be heeded if the use of military forces in humanitarian relief is to be successful. Each CE is unique, thus, each military mission must be clearly defined and articulated. Armed forces struggle to provide both security and humanitarian relief, particularly when aggressive peace enforcement is required. Significant political and public support is necessary for military involvement and success. Military forces cannot execute humanitarian assistance missions on an ad hoc basis, but must continue to develop doctrine, policy and procedures in this area and adequately train, supply, and equip the units that will be involved in humanitarian relief. Militaries not only must cooperate and coordinate extensively with each other, but also with the governmental and non-governmental humanitarian relief organizations that will be engaged for the long term.

Regulation of the L-type calcium channel by alpha 5beta 1 integrin requires signaling between focal adhesion proteins

The L-type calcium channel is the major calcium influx pathway in vascular smooth muscle and is regulated by integrin ligands, suggesting an important link between extracellular matrix and vascular tone regulation in tissue injury and remodeling. We examined the role of integrin-linked tyrosine kinases and focal adhesion proteins in regulation of L-type calcium current in single vascular myocytes. Soluble tyrosine kinase inhibitors blocked the increase in current produced by alpha(5) integrin antibody or fibronectin, whereas tyrosine phosphatase inhibition enhanced the effect. Cell dialysis with an antibody to focal adhesion kinase or with FRNK, the C-terminal noncatalytic domain of focal adhesion kinase, produced moderate (24 or 18%, respectively) inhibition of basal current but much greater inhibition (63 or 68%, respectively) of integrin-enhanced current. A c-Src antibody and peptide inhibitors of the Src homology-2 domain or a putative Src tyrosine phosphorylation site on the channel produced similar inhibition. Antibodies to the cytoskeletal proteins paxillin and vinculin, but not alpha-actinin, inhibited integrin-dependent current by 65-80%. Therefore, alpha(5)beta(1) integrin appears to regulate a tyrosine phosphorylation cascade involving Src and various focal adhesion proteins that control the function of the L-type calcium channel. This interaction may represent a novel mechanism for control of calcium influx in vascular smooth muscle and other cell types.

Invited review: arteriolar smooth muscle mechanotransduction: Ca(2+) signaling pathways underlying myogenic reactivity

The smooth muscle of arterioles responds to an increase in intraluminal pressure with vasoconstriction and with vasodilation when pressure is decreased. Such myogenic vasoconstriction provides a level of basal tone that enables arterioles to appropriately adjust diameter in response to neurohumoral stimuli. Key in this process of mechanotransduction is the role of changes in intracellular Ca(2+). However, it is becoming clear that considerable complexity exists in the spatiotemporal characteristics of the Ca(2+) signal and that changes in intracellular Ca(2+) may play roles other than direct effects on the contractile process via activation of myosin light-chain phosphorylation. The involvement of Ca(2+) may extend to modulation of ion channels and release of Ca(2+) from the sarcoplasmic reticulum, alterations in Ca(2+) sensitivity, and coupling between cells within the vessel wall. The purpose of this brief review is to summarize the current literature relating to Ca(2+) and the arteriolar myogenic response. Consideration is given to coupling of Ca(2+) changes to the mechanical stimuli, sources of Ca(2+), involvement of ion channels, and spatiotemporal aspects of intracellular Ca(2+) signaling.

Integrins and mechanotransduction of the vascular myogenic response

This review summarizes what is currently known about the role of integrins in the vascular myogenic response. The myogenic response is the rapid and maintained constriction of a blood vessel in response to pressure elevation. A role for integrins in this process has been suggested because these molecules form an important mechanical link between the extracellular matrix and the vascular smooth muscle cytoskeleton. We briefly summarize evidence for a general role of integrins in mechanotransduction. We then describe the integrin subunit combinations known to exist in smooth muscle and the vascular wall matrix proteins that may interact with these integrins. We then discuss the effects of integrin-specific peptides and antibodies on vascular tone and on calcium entry mechanisms in vascular smooth muscle. Because integrin function is linked to the cytoskeleton, we discuss evidence for the role of the cytoskeleton in determining myogenic responsiveness. Finally, we analyze evidence that integrin-linked signaling pathways, such as those involving protein tyrosine phosphorylation cascades and mitogen-activated protein kinases, are required for myogenic tone.

Characterization of stretch-activated cation current in coronary smooth muscle cells

Stretch-activated ion currents were recorded from vascular smooth muscle (VSM) after enzymatic isolation of single cells from porcine coronary arterioles. Patch pipettes were used to record whole cell current and control cell length. Under voltage clamp in physiological saline solution, an inward cation current (I(CAT)) was activated by 105--135% longitudinal stretch. I(CAT) coincided with an increase in intracellular Ca(2+) concentration. Under current clamp, membrane depolarization was induced by stretch. The magnitude of I(CAT) varied from -0.8 to -6.9 pA/pF at a holding potential of -60 mV. I(CAT) was graded with stretch, inactivated on release, and could be repeatedly induced. A potassium current (I(K)) activated in unstretched cells by depolarization was also enhanced by stretch. In Ca(2+)-free bath solution, stretch-induced enhancement of I(K) was blocked, but I(CAT) was still present. Hexamethyleneamiloride (50 microM), a reputed inhibitor of mechanosensitive channels, blocked I(CAT) and the stretch-induced increase in I(K) but not basal I(K). Grammostolla spatulata venom (1:100,000) blocked basal I(K), blocked stretch-induced increases in I(K), and blocked I(CAT). Iberiotoxin, a specific Ca(2+)-activated K(+) channel blocker, did not alter I(CAT) but blocked the stretch-induced increase in I(K) and increased the magnitude of stretch-induced depolarization. We concluded that longitudinal stretch directly activates a cation current and secondarily activates a Ca(2+)-activated K(+) current in isolated coronary myocytes. Although these two currents would partially counteract each other, the predominance of I(CAT) at physiological potentials is likely to explain the depolarization and contraction observed in intact coronary VSM during pressure elevation.

Trauma systems

Trauma is one of the major causes of death and disability in modern society, particularly for the young. Organized trauma systems reduce mortality and morbidity from trauma. An effective trauma system addresses all aspects of trauma care, from prevention to rehabilitation. Well-developed trauma systems are currently available only to a minority of the world's population. Trauma systems in developed nations have much potential for improvement.

Fluorides in the new millennium

Water fluoridation is known to be the most successful public health measure of the 20th century. More than half a century later, we are still reaping the benefits of fluoridation. We now know that the most important mechanism of fluoride action occurs through daily low-dose exposures. The battle between demineralization and remineralization occurs constantly, and fluoride shifts the balance to the latter. This dynamic, daily process far supersedes the pre-eruptive fluoride incorporation in importance. Fluoride, however, is now available in a variety of very different forms, useful in waging the war on caries. Nevertheless, opponents of this therapeutic agent maintain that its widespread use should be curtailed. Although the benefits of fluoride can no longer be disputed, fluoride supplementation must be supported and approached with consideration of total fluoride exposure.