Mortality in rheumatoid arthritis: time to take it seriously

Rheumatoid arthritis (RA) is often regarded as benign and not a serious disease. Yet patients with RA have a substantially reduced life expectancy. Patients with RA are particularly at risk of death from cardiovascular disease, infection and renal disease. A few variables are now recognized as important predictive markers, such as disease duration, severity, sex, educational level and treatment.     

LH PULSE FREQUENCY IN RELATION TO POSITIVE OESTROGEN-GONADOTROPHIN FEEDBACK IN AMENORRHOEA

The relationship between the pattern of pulsatile LH release and the response to oestrogen provocation was studied in twenty amenorrhoeic or oligomenorrhoeic subjects. In 12 subjects with positive oestrogen-gonadotrophin feedback a definite pulsatile pattern of LH release was demonstrated with a pulse frequency of 60--80 min and an increase from nadir to peak ranging between 30 and 58%. The mean basal LH concentration was significantly higher in this group (P less than 0.001). Of eight subjects who had absence of positive feedback, five showed infrequent pulses, 1--2 during the four-hour period. These were of low amplitude and with a percentage increase of 45--70 from nadir to peak. The remaining three did not have a pulsatile pattern of LH release. Positive feedback, as demonstrated by an oestrogen provocation test was thus found only in patient having 3 or more LH pulses in the 4 h study period; an LH pulse frequency similar to that in the early follicular phase in regularly menstruating women.     

Immunoperoxidase staining in the recognition of Aspergillus infections

This study concerns the use of the indirect immunoperoxidase technique for labelling Aspergillus species in infected human and animal tissues in smears taken from cultures. Specific labelling without serious cross-reactivity with Candida species or Zygomycete fungi was demonstrated using antiserum to Aspergillus. However, it was not possible to distinguish between two Aspergillus species. A fumigatus and A. flavus with this technique. Pretreatment of sections with sodium azide and normal swine serum was effective in eliminating background staining. The method can be used to produce permanently stained sections and has applications in the recognition of hyphal fragments in tissue from infected patients.     

应用于卫生害虫防治的昆虫生长调节剂的文献综述

近年来,应用于卫生害虫防治的昆虫生长调节剂的文献大量出现。已研究与应用的昆虫生长调节剂的类型包括昆虫保幼激素及其类似物,几丁质合成抑制剂和其它可改变昆虫生长作用的化合物。在实验室与现场已对许多种化合物防治不同骚扰性与媒介昆虫的作用进行了评价,其中阿尔多息,敌灭灵与灭幼宝等具有较好的防治作用,已在许多国家被注册,并应用于卫生害虫及兽医害虫的防治。自从Mian与Mulla(1982)关于这些化合物的作用以及对环境的影响的文献综述发表以后,已有许多研究和进展。迄今,关于昆虫生长调节剂防治的害虫类群已从叮咬性与骚扰或污染性的几种双翅目昆虫扩大到蚤类、蝉螂、蚂蚁等。本文分析与总结了近十年来关于应用于卫生害虫防治的昆虫生长调节剂的研究概况,并重点放在剂型的评价,新的防治机理,抗性的产生与状况以及对环境中非靶生物的影响。引用的文献为1983年至1994年。     

CUTANEOUS MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS: STUDY FROM LAHORE, PAKISTAN

Background. Systemic lupus erythematosus (SLE) is an autoimmune disorder in which cutaneous lesions occur in 85% of patients. This study from Lahore, Pakistan, was conducted to determine the pattern and incidence of such lesions in SLE. Methods. Forty patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association (ARA) (1982) were examined between October 1992 and September 1993 for the presence of cutaneous manifestations. Results. Skin changes noted were: noncicatricial diffuse alopecia (82.5%), malar rash (60%), mucosal lesions (60%), discoid eruption (57.5%), photosensitivity (60%), nail involvement (55%), vascular lesions (50%), pruritus (45%), and pigmentary changes (37.5%). Peripheral gangrene, chronic ulcers, Raynaud's phenomenon, urticaria, chilblains, thrombophlebitis, palmar erythema, and erythema multiforme were rare. Antinuclear antibody reaction was positive in 80% and anti-dsDNA antibodies in 70%. Conclusion. A different clinical pattern was noted in our patients than reported previously.     

CYCLE INITIATION IN AMENORRHOEA; THE EFFECT OF PROGESTERONE AND OESTROGEN ADMINISTRATION ON THE PULSATILE RELEASE OF GONADOTROPHINS

The modulation of pulsatile gonadotrophin release by endogenous ovarian steroids during the normal menstrual cycle may be involved in the initiation of the following menstrual cycle. The absence of this cyclical variation may, in some cases, be the cause of, or contribute to the cause of, amenorrhoea. To assess this the modulatory effect of gonadal steroid administration on the pulsatile release of gonadotrophins was studied in fourteen amenorrhoeic and four oligomenorrhoeic women. Pulsatility was assessed by samples collected at 10 min intervals during a 4 h morning period before and after treatment with either progesterone or micronized oestradiol or a sequential combination of both. Ten patients with intact positive oestrogen-gonadotrophin feedback responded to progesterone treatment by both a significant reduction in LH pulse frequency, from a mean of 4.1 to a mean of 2.1 pulses within the 4 h study period and an increase in pulse amplitude. Progesterone therapy did not affect mean LH concentrations but there was a significant reduction in mean FSH concentrations. In the eight patients with absence of positive feedback, none of the treatment regimes elicited significant changes in LH release. No definable FSH pulses were detected before or after treatment in either group. Both the changes in LH and FSH concentrations and their release observed in this study, support the concept that cycle initiation may be related to a reduced pituitary exposure to LHRH associated with elevated progesterone concentration in the luteal phase of the cycle. This selectively induces FSH synthesis and storage. Release of this stored FSH may occur as a result of failure of the corpus luteum and falling progesterone concentrations.     

Differential maturation of avidity of IgG antibodies to gp41, p24 and p17 following infection with HIV-1

We have evaluated solid-phase ELISA IgG antibody avidity studies as a means of identifying cases of recent HIV-1 infection. Although separate studies on the avidity of anti-gp41 and anti-p24 antibodies in seroconvertors have been reported, a comparison of the ability of patients to simultaneously mature their immune response to more than one HIV antigen immediately following seroconversion appears to be lacking. We have demonstrated a maturation in anti-gp41 avidity which reflects the time since seroconversion in all cases. In contrast, however, only some patients produced high-avidity anti-p24 or anti-p17 antibodies during the same time span. While the avidity of anti-gp41 antibodies remained high in cases of non-recent HIV infection, even in the face of advanced disease, we have confirmed the findings of others that the avidity of anti-p24 falls before the onset of ARC or AIDS. Therefore, whilst the avidity of anti-gp41 antibodies could reliably be of value in identifying cases of recent HIV infection, the avidity of anti-p24 or anti-p17 antibodies could not, but may be of prognostic value, even at an early stage. The time taken to reach maximum anti-p17, anti-p24 and anti-gp41 titres was variable, but anti-gp41 titres, like anti-gp41 avidity, remained high. In contrast, anti-p24 titres fell, even during the early follow-up period in some seroconvertors. Anti-p24 antibody avidity, however, appeared to be a better predictor of disease progression in ‘remote’ cases than anti-p24 titre. The avidity and titres of these antibodies are presented in relation to the clinical details, p24 antigen status, CD4 and CD8 counts where these are known.     

ASSESSMENT OF MOTOR FUNCTION IN STUDIES OF CHRONIC DISABILITY

A method for the assessment of motor function has been developedwhich makes use of tests for individual limb and total bodymovements. While there is a high degree of correlation betweenscores from some tests, others provide independent measuresof disability. There was no significant inter-observer variabilityin the assessment of total body function; assessors disagreedon five out of a total of 480 paired observations. There were,however, some differences in the scores for limb function tests;assessors disagreed on 113 out of a total of 640 paired observations.There were significant associations between disability as indicatedby the Activities of Daily Living index on the one hand, andtotal scores for each limb or total body function on the other.Movements of wrist and hand are a good general index of motordisability in stroke patients. ^*Presented at Annual Scientific Meeting, Society for RehabilitationResearch, Southampton, England, June 1978. Present address: Departments of Rehabilitation, Flinders University,Adelaide, South Australia.