Variation in prenatal surveillance and management of anti-SSA/Ro autoantibody positive pregnancies

OBJECTIVE

To describe international surveillance and treatment strategies for managing anti-SSA/Ro autoantibody positive pregnancies.

STUDY DESIGN

An electronic REDCap questionnaire was distributed to Fetal Heart Society and North American Fetal Therapy Network members which queried institution-based risk stratification, surveillance methods/frequency, conduction abnormality treatments, and postnatal anti-SSA/Ro pregnancy assessment.

RESULTS

101 responses from 59 centers (59% US, 17% international) were collected. Most (79%) do not risk stratify pregnancies by anti-SSA/Ro titer; those that do use varied cutoff values. Many pregnant rheumatology patients are monitored for cardiac abnormalities regardless of maternal anti-SSA/Ro status. Surveillance strategies were based on maternal factors (anti-SSA/Ro status 85%, titer 25%, prior affected child 79%) and monitoring durations varied. Most respondents treat 2° and 3° fetal atrioventricular block, commonly with dexamethasone and/or IVIG.

CONCLUSIONS

Wide variation exists in current fetal cardiac surveillance and treatment for anti-SSA/Ro autoantibody positive pregnancies, highlighting the need for evidence-based protocols to optimize care.

Continuous Fetal Cardiac Monitoring During Fetoscopic Myelomeningocele Repair and Relationship to Spectral Doppler Changes

INTRODUCTION

No evidence-based protocols exist for fetal cardiac monitoring during fetoscopic myelomeningocele (fMMC) repair and intraprocedural spectral Doppler data is limited. We determined the feasibility of continuous fetal echocardiography during fMMC repair and correlated Doppler changes with qualitative fetal cardiac function during each phase of fMMC repair.

METHODS

Patients undergoing fMMC repair had continuous fetal echocardiography interpreted in real-time by pediatric cardiology. Fetal data included fetal heart rate (FHR), qualitative cardiac function, mitral and tricuspid valve inflow waveforms, and umbilical artery (UA), umbilical vein (UV), ductus arteriosus (DA) and ductus venosus (DV) Dopplers.

RESULTS

UA abnormalities were noted in 14/25 patients, UV abnormalities were observed in two patients, and DV and DA abnormalities were each noted in 4 patients. Qualitative cardiac function was normal for all patients with the exception of one with isolated left ventricular dysfunction during myofascial flap creation, concurrent with an abnormal UA flow pattern. All abnormalities resolved by the first postoperative day.

CONCLUSIONS

Continuous fetal echocardiography was feasible during all fMMC repairs. Spectral Doppler changes in the UA were common during fMMC procedures but qualitative cardiac dysfunction was rare. Abnormalities in the UV, DV and DA Dopplers, FHR, and cardiac function were less common findings.

Diseases of despair in early adulthood: The complex role of social relationships

"Diseases of despair," most prominently depressive and substance-related problems, diminish the prospects of many young adults, especially those with lower levels of education. Yet many young adults in that situation avoid these problems. Close relationships are thought to be a key factor underpinning risk and resilience among this group. To examine this premise, this study explored links, beyond potential confounders assessed in adolescence, between strengths and strains in the social domain and markers of despair in the early and mid-20s in a Canadian sample overrepresenting youth without postsecondary credentials (N = 543, 52% male, 23% non-White). Having a good general ability to maintain supportive relationships was associated with fewer depressive and substance-related symptoms. Furthermore, support and less strain in relationships with parents and friends were associated with fewer depressive symptoms in the early and mid-20s, while for romantic relationships, associations with depressive symptoms became more consistent and robust in the mid-20s. Therefore, support and strains in romantic relationships gradually gained prominence as a determinant of depressive symptoms as youth advanced in adulthood. For substance-related problems, significant associations emerged for strains in friendships only, in both the early and mid-20s. These results suggest that multiple aspects of relationships pose a risk for or protect from the development of diseases of despair in early adulthood and that their relative importance changes depending on outcomes and developmental timing. Thus, facilitating meaningful social connections and reducing the prevalence and impact of relationship strains might contribute to preventing diseases of despair among youth with lower educational attainment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Fetal Non-Ovarian Abdominopelvic Cystic Lesions: A Single-Center Report

INTRODUCTION

There is a paucity of reports describing the clinical course and likely postnatal outcomes of prenatally identified simple cystic abdominopelvic lesions which are not associated with the ovary.

OBJECTIVE

The aim of this study was to describe the natural history and postnatal outcomes of prenatally discovered abdominopelvic cystic lesions seen at our center.

METHODS

This study is a retrospective review of all newborns with prenatally discovered non-ovarian simple cystic abdominal or pelvic lesions (September 2012-December 2018). Prenatal solid organ involvement, lesion size, and postnatal clinical outcomes are described.

RESULTS

Sixty-six patients with 68 cystic lesions were identified; 22 patients with 24 lesions met the defined study criteria and were included. Eleven (46%) resolved prenatally, while 5 (21%) resolved by 18 months of age. Of the 10 lesions associated with an organ, 4 (40%) resolved prenatally. Of the remaining 14 lesions not associated with a solid organ, 7 (50%) resolved prenatally. Seven lesions (29%) required postnatal surgical intervention. Larger maximum prenatal lesions tended toward postnatal surgical intervention (one-way ANOVA: p = 0.072).

CONCLUSIONS

The majority of simple non-ovarian cystic abdominopelvic lesions at our center resolved in the perinatal period. Due to the low frequency of these lesions at fetal centers, a larger multicenter study based on a consistent monitoring protocol should be undertaken to better describe the resolution patterns of simple non-ovarian cystic lesions for improved prenatal counseling.

Gender Differences in Adolescents' Exposure to Stressful Life Events and Differential Links to Impaired School Functioning

Gender differences in exposure and reactivity to specific stressful life events (SLE) contribute to explaining adolescent boys' and girls' differential susceptibility to common adjustment difficulties like depression and behavioral problems. However, it is unclear whether these gender differences are also relevant to understanding another key marker of adolescent maladjustment: high school dropout. A state-of-the-art interview protocol was used to assess recent SLE in a sample of academically vulnerable Canadian adolescents (N = 545, 52% boys). The sample was comprised of three groups in approximately equal proportions: 1) students who had recently dropped out; 2) matched students at risk of dropping out but who persevered nevertheless; and 3) "normative" students with an average level of risk. When SLE of all types were considered together, overall exposure was similar for adolescent boys and girls, and the SLE-dropout association did not vary as a function of gender. However, gender differences emerged for specific events. Boys were especially exposed to SLE related to performance (e.g., school failure, suspension) and conflicts with authority figures (e.g., with teachers or the police), whereas girls were particularly exposed to SLE involving relationship problems with family members, peers, or romantic partners. In terms of specific SLE-dropout associations, one consistent result emerged, showing that performance/authority-related SLE were significantly associated with dropout only among boys. It therefore seems that considering gendered exposure and sensitivity to SLE is important for understanding the emergence of educational difficulties with long-ranging consequences for future health and well-being.

School-based extracurricular activity involvement and high school dropout among at-risk students: Consistency matters

Encouraging involvement in school-based extracurricular activities (ECA) may be important for preventing high school dropout. However, the potential of these activities remains underexploited, perhaps because studies linking ECA involvement and dropout are rare and based on decades-old data. Previous studies also ignore key parameters of student involvement. The present study expands and updates this limited literature by using recent data from a high-risk Canadian sample (N = 545) and by considering a range of involvement parameters. Results showed that consistent involvement in the past year was associated with lower odds of dropout (OR = 0.32; 95% CI = 0.17-0.61). However, adolescents who interrupted their involvement during this period (e.g., because of cancelations or exclusions) were as much at risk of dropout as those who were not involved at all. Findings notably imply that excluding students from ECA (e.g., because of No Pass/No Play policies) may heighten their dropout risk.

Dynamic discriminant model for predicting respiratory distress at birth based on mass volume ratio in fetuses with congenital lung malformation

OBJECTIVES

The congenital lung malformation volume ratio (CVR) is a prenatal ultrasound measurement that parameterizes congenital lung malformation (CLM) size. The aims of this study were to use serial measurements to create estimated growth curves of fetal CVR for asymptomatic and symptomatic neonates with CLM and to investigate whether a discriminant prognostic model based on these measurements could predict accurately which fetuses with CLM will require invasive respiratory support at delivery and should therefore be delivered at a tertiary-care facility.

METHODS

This was a retrospective study of fetuses diagnosed prenatally with CLM at three tertiary-care children's hospitals between 2009 and 2016. Those with two or more sonographic measurements of CVR were included. Serial fetal CVR measurements were used to create estimated growth curves for neonates with and those without respiratory symptoms at delivery, defined as requiring invasive respiratory support for the first 24 h after delivery. A discriminant model based on serial CVR measurements was used to calculate the dynamic probability of the need for invasive respiratory support. The performance of this model overall and in preterm and term neonates was compared with those using maximum CVR thresholds of 1.0 and 1.6.

RESULTS

Of the 147 neonates meeting the inclusion criteria, 16 (10.9%) required postnatal invasive respiratory support. The estimated CVR growth curve models showed different growth trajectories for asymptomatic and symptomatic neonates, with significantly higher CVR in symptomatic neonates, and values peaking late in the second trimester at around 25 weeks' gestation in asymptomatic neonates. All prognostic methods had high accuracy for the prediction of the need for invasive respiratory support in term neonates, but the discriminant model had the best performance overall (area under the receiver-operating characteristics curve (AUC) = 0.88) and in the preterm population (AUC = 0.85).

CONCLUSIONS

The estimated CVR growth curves showed different growth patterns in asymptomatic and symptomatic neonates with CLM. The dynamic discriminant model performed well overall and particularly in neonates that were carried to term. Development of an externally validated clinical tool based on this analysis could be useful in determining the site of delivery for fetuses with CLM. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Parenting practices during middle adolescence and high school dropout

INTRODUCTION

Despite inconclusive findings, educational researchers have long considered adequate parenting practices instrumental in preventing high school dropout among adolescents. The present short-term retrospective study focuses on parenting practices during middle adolescence when dropout typically occurs.

METHODS

The culturally diverse, high-risk sample of Canadian adolescents (N = 108; M_age = 16.0 years) from low-income neighborhoods included very recent dropouts and matched still-in-school students. A global score reflecting the quality of parenting practices during the period preceding dropout (or comparable period) was derived from adolescents' answers to a well-established structured interview protocol. Transcripts of interviews were also used to identify the potentially disruptive challenges (e.g., parental incarceration) that families faced.

RESULTS

Results show a robust relationship between current parenting practices and dropout that was not moderated by challenging family circumstances or immigration history. Descriptive findings indicate that extreme and relatively rare cases of parental neglect were associated with a high dropout risk, but that most dropouts lived in families where communication and supervision, although not entirely absent, were minimal.

CONCLUSION

Offering systematic support to parents of middle adolescents could help to prevent dropout in high-risk communities.

Circumstances Preceding Dropout Among Rural High School Students: A Comparison with Urban Peers

This study examined whether recent disruptive events would increase the likelihood of high school dropout among both rural and urban youths, and whether the types of disruptive events preceding dropout would be different in rural vs. urban environments. Based on interviews conducted with early school leavers and matched at-risk schoolmates (N = 366) in 12 disadvantaged Canadian high schools, recent disruptive events appeared to generally trigger dropout. However, the prevalence of some types of events associated with dropout varies according to the environment. In agreement with social disorganization and formal/informal social control models, crises involving child welfare services or the juvenile justice system (e.g., an arrest after a fight) represented a lower share of triggering events among rural than urban leavers (8% vs. 26%, respectively), whereas those involving peer conflicts and rejection (e.g., exclusion from one's peer group) were overrepresented among rural compared to urban leavers (26% vs. 10%, respectively). These differences are thought to represent upsides and downsides associated with the relative density, stability, and overlapping nature of rural adolescents' social networks. Practical implications are discussed, notably regarding the relevance and contextual adaptation of prevention programs as a function of place.

High School Dropout in Proximal Context: The Triggering Role of Stressful Life Events

Adolescents who drop out of high school experience enduring negative consequences across many domains. Yet, the circumstances triggering their departure are poorly understood. This study examined the precipitating role of recent psychosocial stressors by comparing three groups of Canadian high school students (52% boys; Mage  = 16.3 years; N = 545): recent dropouts, matched at-risk students who remain in school, and average students. Results indicate that in comparison with the two other groups, dropouts were over three times more likely to have experienced recent acute stressors rated as severe by independent coders. These stressors occurred across a variety of domains. Considering the circumstances in which youth decide to drop out has implications for future research and for policy and practice.

Revisiting the Link Between Depression Symptoms and High School Dropout: Timing of Exposure Matters

PURPOSE

Recent reviews concluded that past depression symptoms are not independently associated with high school dropout, a conclusion that could induce schools with high dropout rates and limited resources to consider depression screening, prevention, and treatment as low-priority. Even if past symptoms are not associated with dropout, however, it is possible that recent symptoms are. The goal of this study was to examine this hypothesis.

METHODS

In 12 disadvantaged high schools in Montreal (Canada), all students at least 14 years of age were first screened between 2012 and 2015 (N_screened = 6,773). Students who dropped out of school afterward (according to school records) were then invited for interviews about their mental health in the past year. Also interviewed were matched controls with similar risk profiles but who remained in school, along with average not at-risk schoolmates (N_interviewed = 545). Interviews were conducted by trained graduate students.

RESULTS

Almost one dropout out of four had clinically significant depressive symptoms in the 3 months before leaving school. Adolescents with recent symptoms had an odd of dropping out more than twice as high as their peers without such symptoms (adjusted odds ratio = 2.17; 95% confidence interval = 1.14-4.12). In line with previous findings, adolescents who had recovered from earlier symptoms were not particularly at risk.

CONCLUSIONS

These findings suggest that to improve disadvantaged youths' educational outcomes, investments in comprehensive mental health services are needed in schools struggling with high dropout rates, the very places where adolescents with unmet mental health needs tend to concentrate.

Adaptation and Validation of the Life Events and Difficulties Schedule for Use With High School Dropouts

The Life Events and Difficulties Schedule (LEDS) is considered the standard for measuring psychosocial stressor exposure, but it has not been used with academically at-risk adolescents, including high school dropouts. The goal of this study was to (1) adapt the LEDS for use with this population, and (2) examine the reliability (interrater) and validity (concurrent and predictive) of this adaptation among a sample of vulnerable adolescents (N = 545). Good reliability coefficients (.79-.90) were obtained, and stressor exposure was associated with concurrent criteria indexing mental health outcomes (depression) and major risk factors for dropout (administratively recorded and self-reported). Also, LEDS scores predicted dropout beyond these risk factors. The adapted LEDS appears useful for describing academically struggling adolescents' stressor exposure.

Targeting the specific vocabulary needs of at-risk preschoolers: a randomized study of the effectiveness of an educator-implemented intervention

This randomized study examined the effectiveness of a preschool stimulation program created to teach words that had been selected by considering the needs of the target population of children. Twenty-two educators and their group of at-risk preschoolers (N = 222, M age = 4.27 years) were assigned to one of two conditions: control or intervention. In the latter condition, educators had to read specifically developed storybooks to their group and conduct stimulation activities. Despite the training and support they received, educators implemented the intervention with varying degrees of fidelity. Nonetheless, intent-to-treat comparison of the two conditions indicates that children in the intervention condition learned the meaning of a much greater number of words than their peers in the control condition. In addition, efficacy subset analyses that took into account fidelity of implementation show that the greatest gains were made by children who had an educator who had implemented the intervention reliably. Strategies for scaling up the intervention and optimizing its implementation are discussed.

Understanding the positive role of neighborhood socioeconomic advantage in achievement: the contribution of the home, child care, and school environments

The goal of this study was to examine the mechanisms underlying associations between neighborhood socioeconomic advantage and children's achievement trajectories between ages 54 months and 15 years. Results of hierarchical linear growth models based on a diverse sample of 1,364 children indicate that neighborhood socioeconomic advantage was nonlinearly associated with youths' initial vocabulary and reading scores, such that the presence of educated, affluent professionals in the neighborhood had a favorable association with children's achievement among those in less advantaged neighborhoods until it leveled off at moderate levels of advantage. A similar tendency was observed for math achievement. The quality of the home and child care environments as well as school advantage partially explained these associations. The findings suggest that multiple environments need to be considered simultaneously for understanding neighborhood-achievement links.

Differentiating Emery-Dreifuss muscular dystrophy and collagen VI-related myopathies using a specific CT scanner pattern

Bethlem myopathy and Ullrich congenital muscular dystrophy are part of the heterogeneous group of collagen VI-related muscle disorders. They are caused by mutations in collagen VI (ColVI) genes (COL6A1, COL6A2, and COL6A3) while LMNA mutations cause autosomal dominant Emery-Dreifuss muscular dystrophy. A muscular dystrophy pattern and contractures are found in all three conditions, making differential diagnosis difficult especially in young patients when cardiomyopathy is absent. We retrospectively assessed upper and lower limb muscle CT scans in 14 Bethlem/Ullrich patients and 13 Emery-Dreifuss patients with identified mutations. CT was able to differentiate Emery-Dreifuss muscular dystrophy from ColVI-related myopathies in selected thigh muscles and to a lesser extent calves muscles: rectus femoris fatty infiltration was selectively present in Bethlem/Ullrich patients while posterior thigh muscles infiltration was more prominently found in Emery-Dreifuss patients. A more severe fatty infiltration particularly in the leg posterior compartment was found in the Emery-Dreifuss group.

Development and validation of the RQC: a daily contact log for ACT and ICM teams

AIM

Instruments to measure the process--the daily activities of home care workers--have received little attention and may impede research in refining the active ingredients, the clientele best served and continuous quality improvement. We developed a decade ago in Quebec, Canada, a new daily contact log (relevé quotidien des contacts or RQC) that has now reached in practice 1 million entries.

METHODS

Three features distinguish the RQC development, namely, practical ergonomics, a clear logic, and response categories easy to understand and retain. The instrument is filled following any 10-minute or more contact with or about the client, and covers the location, time and actors of the episode of care, and the nature of the intervention (crisis, representing, accompanying, discussing) in 10 areas (i.e. medication, daily living activities, housing, relationships, substance abuse, legal, etc.). Inter-rater agreement for each RQC response category and rater agreement with a criterion measure (coded vignettes) were evaluated.

RESULTS

Kappa coefficients and intra-class correlation coefficients yielded results ranging from at least moderate to generally substantial agreement for all 77 response categories.

CONCLUSIONS

The new RQC may support international studies of the implementation and application of various forms of intensive home care, refining its indications, and serves as a clinical and managerial tool to ensure quality of the interventions.

The Arabidopsis DNA mismatch repair gene PMS1 restricts somatic recombination between homeologous sequences

The eukaryotic DNA mismatch repair (MMR) system contributes to maintaining the fidelity of genetic information by correcting replication errors and preventing illegitimate recombination events. This study aimed to examine the function(s) of the Arabidopsis thaliana PMS1 gene (AtPMS1), one of three homologs of the bacterial MutL gene in plants. Two independent mutant alleles (Atpms1-1 and Atpms1-2) were obtained and one of these (Atpms1-1) was studied in detail. The mutant exhibited a reduction in seed set and a bias against the transmission of the mutant allele. Somatic recombination, both homologous and homeologous, was examined using a set of reporter constructs. Homologous recombination remained unchanged in the mutant while homeologous recombination was between 1.7- and 4.8-fold higher than in the wild type. This increase in homeologous recombination frequency was not correlated with the degree of sequence divergence. In RNAi lines, a range of increases in homeologous recombination were observed with two lines showing a 3.3-fold and a 3.6-fold increase. These results indicate that the AtPMS1 gene contributes to an antirecombination activity aimed at restricting recombination between diverged sequences.

An Arabidopsis MLH1 mutant exhibits reproductive defects and reveals a dual role for this gene in mitotic recombination

The eukaryotic DNA mismatch repair (MMR) system contributes to maintaining genome integrity and DNA sequence fidelity in at least two important ways: by correcting errors arising during DNA replication, and also by preventing recombination events between divergent sequences. This study aimed to investigate the role of one key MMR gene in recombination. We obtained a mutant line in which the AtMLH1 gene has been disrupted by the insertion of a T-DNA within the coding region. Transcript analysis indicated that no full-length transcript was produced in mutant plants. The loss of a functional AtMLH1 gene led to a significant reduction in fertility in both homozygotes and heterozygotes, and we observed a strong bias against transmission of the mutant allele. To investigate the role of AtMLH1 in mitotic recombination, the mutant was crossed to a series of recombination reporter lines. A strong decrease (72%) in the frequency of homologous recombination was observed in the mutant. However, the decline in recombination due to homeology was less severe in the Atmlh1 mutant than in a wild-type control. These data demonstrate a dual role for AtMLH1 in recombination: it is both required for recombination and acts to limit recombination between diverged sequences.

Imagerie de la pathologie iatrogène médicamenteuse

Iatrogenic drug disorders should be considered when presented with a number of imaging findings mainly involving the nervous, musculoskeletal, gastrointestinal or genitourinary system. Care should be used when differentiating between imaging findings related to the underlying pathology and imaging findings related to drug-related complications: examples include the impact of steroid therapy on bones and the impact of triple-drug anti-HIV therapy and its impact of fatty tissue. Knowledge of the necessary imaging surveillance protocol is implied.

Familial inflammatory inclusion body myositis

OBJECTIVE

To compare familial inflammatory inclusion body myositis (IBM) with hereditary inclusion body myopathies and sporadic IBM.

PATIENTS AND METHODS

Clinical, biological, MRI, and histological data were analysed in two siblings with inflammatory IBM and compared with those of patients with sporadic and hereditary IBM.

RESULTS

Both patients had a clinical phenotype of sporadic IBM, which differs from hereditary myopathies because of late age of onset--respectively 65 and 66 years, and different pattern of muscular involvement--asymmetric, mainly distal but also involving quadriceps. MRI showed selective fatty infiltration and oedema in the extensor compartment of thigh muscles. The diagnosis of IBM was confirmed by muscle biopsy, showing muscle fibres containing numerous rimmed vacuoles, a characteristic shared by all types of IBM. In contrast with hereditary IBM, histological analysis also showed inflammatory mononuclear infiltrate invading non-necrotic fibres, ragged red and oxidase c negative fibres, and positive Congo red staining. Moreover, HLA class II typing disclosed DR beta 1 0301 haplotype, which is significantly related to sporadic but not to hereditary IBM. With steroid treatment and monthly intravenous immunoglobulins, the disease was stabilised in both patients at protracted follow up.

CONCLUSION

Sporadic and familial inflammatory IBM share the same clinical, biological, MRI, and histological features.

The normal hip joint space: variations in width, shape, and architecture on 223 pelvic radiographs

OBJECTIVES

To determine the range of normal radiographic joint space width (JSW) values and the shape of the normal hip, and the influence of age, sex, dysplasia, coxa profunda, and acetabular roof curve abnormalities on these values.

METHODS

On routine conventional pelvic radiographs taken in the supine position in patients with no history of hip or lumbar pain, JSW was measured at three points (superolateral, apical, superomedial), together with the VCE, HTE, and neck shaft angles; acetabular depth; and femoral head diameter.

RESULTS

223 radiographs (446 hips) from 127 women and 96 men (mean age 51.3 years) were examined. Interindividual variations in JSW were large (apical site: 4.19 (0.92) mm; range 2-7). Mean JSW values were higher at the superolateral site than at the apical and superomedial sites in nearly 80% of cases. Women had lower JSW values than men. JSW values did not fall with age. Marked right/left JSW asymmetry was seen in 13/221 (5.9%) subjects. Eight cases of acetabular dysplasia (7 unilateral) and 16 cases of coxa profunda were found, but no cases of acetabular protrusion. The JSW was thicker in dysplastic hips, and thinner in hips with coxa profunda. A roof curve abnormality was found in 96/446 (21.5%) hips.

CONCLUSIONS

Normal JSW values vary widely; the JSW is commonly narrower at the superomedial site than at the apical site, and is sometimes asymmetric. The roof curve is dysmorphic in about 20% of patients. These findings may have important implications for epidemiological studies and early diagnosis of osteoarthritis of the hip.

Apport de l'IRM musculaire dans les myopathies inflammatoires

PURPOSE

Inflammatory myopathies include polymyositis (PM), dermatomyositis (DM) and inclusion body myositis (IBM) which differ in terms of clinical, immuno-histological presentations, evolution and treatment. Diagnosis is based on the muscular biopsy but histological distinction between PM and IBM can be difficult; biopsies can be insufficient as well as during follow-up to detect active areas within the muscle.

CURRENT KNOWLEDGE AND KEY POINTS

Muscular MRI is an important tool both in the diagnosis and the follow-up of IMM in the following circumstances: Distinction between PM and IBM: fatty infiltration and involvement of the anterior group of the thighs are characteristic of IBM whereas isolated inflammation and involvement of the three thighs or posterior muscle groups are characteristic of PM. Biopsy guidance on the inflammatory lesions depicted on the STIR sequence either initially or after a non-conclusive biopsy. To differentiate, active disease from steroid myopathy.

FUTURE PROSPECTS AND PROJECTS

Several multicentric trials are in development both in spectro and morphologic MRI to study hypoxic phenomenon in early course of IMM and muscular volume evaluation both in normal subjects, congenital or acquired myopathies.

Toward benchmarks for tertiary care for adults with severe and persistent mental disorders

BACKGROUND

Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities.

OBJECTIVES

To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks.

METHODS

Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey ascertained the number of places utilized and of those needed for residential care among all long-stay inpatients and all adults in supervised residential facilities. A second survey identified the need for such long-stay hospitalization, nursing homes, and supervised facilities as an alternative or as a complement to hospitalization among acute care inpatients.

RESULTS

The actual ratio of places in long-stay hospital units, nursing homes, and supervised residential facilities was 150:100,000 inhabitants. The ideal ratio, according to estimated needs, is 171:100,000. The figure breakdown is as follows: 20:100,000 for long-stay hospital units, 20:100,000 for nursing homes, 40:100,000 for group homes, 40:100,000 for private hostels or foster families, and 51:100,000 for supervised apartments. The needs of this urban, blue-collar population for supervised residential places hovered in the upper range of utilization and standards for European countries and within the proposed standards for Canadian provinces.

DISCUSSION

Needs for long-stay hospitalization or for supervised residential facilities cannot be treated as absolute. For example, evaluation conducted in this hospital-led system of psychiatric care may produce higher estimates of institutional care. Comparing actual utilization and projected needs in this urban catchment area with current utilization in other jurisdictions in Canada and Europe should contribute to establishing sound national benchmarks within ranges.

CONCLUSIONS

It is possible to establish benchmarks that guide the development of supervised residential settings to best meet the needs of the population of adults with severe and persistent mental disorders. The methods used here to assess needs should serve as guidelines for future research, because they were designed to contain the bias of over- or underprovision of care in the current utilization.

Characterization of the two-component abortive phage infection mechanism AbiT from Lactococcus lactis

During the production of fermented dairy products, virulent bacteriophages infecting Lactococcus lactis can delay or stop the milk acidification process. A solution to this biological problem consists of introducing natural phage barriers into the strains used by the dairy industry. One such hurdle is called abortive infection (Abi) and causes premature cell death with no or little phage progeny. Here, we describe the isolation and characterization of a novel Abi mechanism encoded by plasmid pED1 from L. lactis. The system is composed of two constitutively cotranscribed genes encoding putative proteins of 127 and 213 amino acids, named AbiTi and AbiTii, respectively. Site-directed mutagenesis indicated that a hydrophobic region at the C-terminal extremity of AbiTi is essential to the antiphage phenotype. The AbiT system is effective against phages of the 936 and P335 species (efficiency of plaquing between 10(-5) and 10(-7)) and causes a 20-fold reduction in the efficiency to form centers of infection as well as a 10- to 12-fold reduction in the burst size. Its efficacy could be improved by raising the plasmid copy number, but changing the intrinsic ratio of AbiTi and AbiTii did not greatly affect the antiphage activity. The monitoring of the intracellular phage infection process by DNA replication, gene expression, and electron microscopy as well as the study of phage mutants by genome mapping indicated that AbiT is likely to act at a later stage of the phage lytic cycle.

Epithelioid sarcoma mimicking abscess: review of the MRI appearances

A case of epithelioid sarcoma involving the soft tissues of the ankle is presented. The tumor was a hemorrhagic, fluid-filled, multiloculated lesion with inflammatory changes in the surrounding planes. Tuberculous abscess was diagnosed on the basis of the clinical picture, ultrasound and MRI findings. Surgical exploration of the ankle mass was carried out because of lack of local healing while the patient's general and pulmonary status improved on antituberculosis treatment. This was an unusual case of epithelioid sarcoma mimicking a multilocular abscess.

A novel missense mutation (C30S) in the gene encoding tumor necrosis factor receptor 1 linked to autosomal-dominant recurrent fever with localized myositis in a French family

OBJECTIVE

To characterize both phenotypic (clinical features and magnetic resonance imaging [MRI] findings) and genotypic aspects of autosomal-dominant recurrent fever, also known as tumor necrosis factor receptor (TNFR)-associated periodic syndrome (TRAPS), in a French family and to investigate the role of the mutated 55-kd tumor necrosis factor alpha (TNFalpha) receptor (TNFR1) in the pathogenesis of the disease.

METHODS

The coding region of TNFR1 was sequenced in 2 individuals with TRAPS (the propositus and her grandfather) and in 3 clinically unaffected relatives. Expression of soluble TNFR1 (sTNFR1) was investigated in 3 of the family members carrying a C30S mutation in TNFR1, and was compared with the levels of soluble TNFR2 (sTNFR2) by enzyme-linked immunosorbent assay. The membrane TNFR1 expression was then compared with membrane TNFR2 levels at the surface of peripheral blood mononuclear cells by flow cytometric analysis. The clinical heterogeneity in this French family was investigated by searching polymorphic variants in the TNFalpha promoter by DNA sequencing.

RESULTS

Both the disease course and the clinical presentation in the propositus were highly indicative of TRAPS. MRI study of the segmental inflammatory process in the limbs showed abnormal signals in the muscle and subcutaneous tissue without involvement of adjacent joints or fascia. A novel missense mutation, C30S, in the first extracellular N-terminal cysteine-rich domain (CRD1) of TNFR1 was characterized in the propositus, her affected grandfather, and her clinically unaffected father. Expression of membrane TNFR1 at the surface of monocytes and polymorphonuclear leukocytes, as well as the levels of sTNFR1 in serum when the disease was not active were not modified in the 3 individuals carrying the TNFR1 C30S mutation. In contrast, during attacks, sTNFR1 levels remained abnormally low, as compared with the levels in unrelated patients with active adult-onset systemic Still's disease. The clinical heterogeneity could not be explained by a polymorphic variant in the TNFalpha promoter.

CONCLUSION

TRAPS is a distinct clinical and radiologic disease entity that is responsible for recurrent fever and migratory cellulitis-like processes with localized myositis. We have identified a novel TNFR1 mutation, C30S, that is located in the CRD1 domain in a French family affected by the disease. This mutation seems to affect the level of sTNFR1, which did not increase in the propositus during inflammatory attacks.

Dedicated extremity MR imaging of the foot and ankle

The purpose of this review is to provide illustrative examples of diseases of the foot and ankle when imaged with a low-field MR imaging system. A retrospective review of 268 foot and ankle examinations, performed in our institution within the past 3 years with a 0.2-T (Artoscan Esaote, Genoa, Italy) dedicated extremity MR system was done. Additionally, illustrative comparison with conventional radiography and high-field MR imaging is presented in patients in whom these examinations were also performed. Although motion artifact limited the value of a few studies, in the majority of examinations low-field MR imaging provided diagnostic image quality for the full spectrum of disorders affecting the foot and ankle and seemed to be a feasible alternative to high-field MR imaging in establishing an accurate diagnosis.

AbiQ, an abortive infection mechanism from Lactococcus lactis

Lactococcus lactis W-37 is highly resistant to phage infection. The cryptic plasmids from this strain were coelectroporated, along with the shuttle vector pSA3, into the plasmid-free host L. lactis LM0230. In addition to pSA3, erythromycin- and phage-resistant isolates carried pSRQ900, an 11-kb plasmid from L. lactis W-37. This plasmid made the host bacteria highly resistant (efficiency of plaquing <10(-8)) to c2- and 936-like phages. pSRQ900 did not confer any resistance to phages of the P335 species. Adsorption, cell survival, and endonucleolytic activity assays showed that pSRQ900 encodes an abortive infection mechanism. The phage resistance mechanism is limited to a 2.2-kb EcoRV/BclI fragment. Sequence analysis of this fragment revealed a complete open reading frame (abiQ), which encodes a putative protein of 183 amino acids. A frameshift mutation within abiQ completely abolished the resistant phenotype. The predicted peptide has a high content of positively charged residues (pI = 10.5) and is, in all likelihood, a cytosolic protein. AbiQ has no homology to known or deduced proteins in the databases. DNA replication assays showed that phage c21 (c2-like) and phage p2 (936-like) can still replicate in cells harboring AbiQ. However, phage DNA accumulated in its concatenated form in the infected AbiQ+ cells, whereas the AbiQ- cells contained processed (mature) phage DNA in addition to the concatenated form. The production of the major capsid protein of phage c21 was not hindered in the cells harboring AbiQ.

Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis

OBJECTIVE

To compare magnetic resonance (MR) imaging, computed tomography (CT), and radiography in the detection of sacroiliitis accompanying ankylosing spondylitis (AS).

DESIGN AND SUBJECTS

Nine volunteers and 24 patients were recruited. Radiography, CT, and MR imaging were completed within a 1-week period in 24 patients with AS. In precontrast MR examination, spin-echo T1, fast spin-echo T2, and gradient echo with rephasing T2* images were obtained without fat saturation using a 0.3-T imager for all volunteers and patients. Postcontrast MR examination was performed using the same precontrast SE T1 sequence for patients with AS.

RESULTS AND CONCLUSIONS

MR imaging directly showed the normal cartilage in all 16 sacroiliac joints of the 8 volunteers. In the 24 patients with AS, cartilage abnormalities were observed in 42 sacroiliac joints. More diagnoses of sacroiliitis were made using MR and CT imaging than using radiography (P < 0.001). Therefore, low-field-strength MR can be useful in detecting early sacroiliitis in patients with AS. MR imaging was able to reveal early cartilage changes and bone marrow edema, which could not be found by either CT or radiography.

Temporal linkages between wives' pursuit and husbands' withdrawal during marital conflict

This study examined the association between wives' pursuit and husbands' withdrawal during marital conflict discussions, and the affects associated with these behaviors. Ten distressed and 10 nondistressed couples completed a videotaped interaction in which the wives requested changes in husbands' behaviors. Results showed sequential dependencies between wives' pursuit and husbands' withdrawal, but distressed couples, as compared to nondistressed couples, did not engage in stronger pursuit/withdrawal patterns. Distressed husbands showed the highest proportions of anxious affects. The findings are discussed with reference to the affective context of the pursuit/withdrawal pattern.

Cryocrystalglobulinemia as a cause of systemic vasculopathy and widespread erosive arthropathy

This report describes the case of woman who was admitted to the hospital for highly destructive axial and peripheral arthropathy in association with acute malignant hypertension and skin purpura. Type I IgGkappa serum cryoglobulinemia was identified and was classified as a monoclonal gammopathy of unknown significance. Cryoglobulin was shown to crystallize in the serum and synovium fluid and was responsible for both granulomatous microcrystalline synovial inflammation and occlusive vasculopathy in the kidneys and skin. Cryocrystalglobulinemia pathogenicity and therapeutic implications are discussed.