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GST Primary GST Primary Best Strategies for Health Care Quality Im... Best Strategies for Health Care Quality Improvement - Diabetes Quality Improvement Strategies for Antibio... Kathryn McDonald, Stanford-UCSF Evidence-b... Systematic review assessing the effect of ... Quality Improvement Strategies for Antibiotics Management Kathryn McDonald, Stanford-UCSF Evidence-based Practice Center, 117 Encina Commons, Stanford, CA 94305-6019, Kathy.mcdonald@stanford.edu Systematic review assessing the effect of quality improvement strategies on appropriate prescribing of antibiotics and appropriate choice of antibiotics. Adherence Adherence Assistive Devices Assistive Devices Childhood Burn Hanson MacMillan Childhood Burn Hanson MacMillan CLSA_9 CLSA_9 Cyberabuse Cyberabuse Cognitive Behavioural Therapy for Violent ... This review included randomized trials abo... Cognitive Behavioural Therapy for Violent Men who Batter Their Partners This review included randomized trials about the effects of cognitive behavioral therapy on domestic violence. The intervention included programs based on the Duluth Model. The violence had to be committed by a male toward his female partner. The violence also had to be physical. The primary outcomes were new arrests and convictions, and new reports of violence. CABG vs PCI CABG vs PCI Quality Improvement Strategies for Prevent... Quality Improvement Strategies for Preventing Nosocomial Infections (Created 17-Feb-06) Quality Improvement Strategies for Asthma ... Quality Improvement Strategies for Asthma Control Erectile Dysfunction (Created 30-Jan-06) Erectile Dysfunction (Created 30-Jan-06) Inequality - Smoking Cessation to Reduce S... This review was the first part of a projec... Inequality - Smoking Cessation to Reduce Socio-Economic Differences This review was the first part of a project about inequality. It included randomized trials about the effect of smoking cessation interventions on reducing socio-economic differences. The studies had to report data either on persons with low socio-economic groups status or, preferably, on both low and high socio-economic groups. Diet and Physical Activity to Reduce Socio... This review was the second part in a proje... Diet and Physical Activity to Reduce Socio-Economic Differences This review was the second part in a project about inequality. It included randomized trials about the effect of interventions on reducing socio-economic differences in diet and physical activity. The studies had to report data either on persons with low socio-economic groups status or, preferably, on both low and high socio-economic groups. Workfare The data in SRS are not identical to the d... Workfare The data in SRS are not identical to the data in the published report. We used SRS only for an updated search. The review included randomized trials about the effect of welfare-to-work programs. Participants were welfare recipients. There were basically two types of programs. The educational type tried to build knowledge and skills in order to help the welfare recipients acquire jobs that could support them economically. The "work first" approach was more aimed at getting the participants quickly into a job. Exercise interventions for the management ... The objective of this systematic review wa... Exercise interventions for the management of frailty The objective of this systematic review was to examine the effectiveness of current exercise interventions on the management of frailty. A comprehensive search of Medline, Embase, Psycinfo, Cinahl, Scopus, Ageline, Eric, and SportDiscus databases was conducted and produced 1808 citations. So far we have completed 2 levels of “title and abstract” screening and we ended up with 262 articles. We have just started the full text screening. Eligibility criteria included original studies whose participants were identified as frail or prefrail with specific criteria and in which structured physical activity was included as at least one component of the intervention. Create a free account, build a dictionary with saved terms to re-use later! Public Domestic Violence - Using Cognitive Behavior Therapy Smoking Cessation to Reduce Socio-Economic Differences Diet and Physical Activity to Reduce Socio-Economic Differences Workfare Exercise Interventions for the Management of Frailty Search     Simple Advanced Refine (4 coded questions)  Any of these:   Exact Phrase: All of these: None of these: Author: Periodical: Projects: No restrictions   Libraries: Public   Select SRS Projects Show Saved Terms Select Library Show articles that do not have abstracts  Humans or Animals Humans Animals Type of Article Clinical Trial Editorial Letter Meta-Analysis Practice Guideline Randomized Controlled Trial Review Addresses Bibliography Biography Case Reports Classical Article Clinical Conference Clinical Trial, Phase I Clinical Trial, Phase II Clinical Trial, Phase III Clinical Trial, Phase IV Comment Comparative Study Consensus Development Conference Consensus Development Conference, NIH Controlled Clinical Trial Corrected and Republished Article Dictionary Directory Duplicate Publication English Abstract Evaluation Studies Festschrift Government Publications Guideline Historical Article Interview In Vitro Journal Article Lectures Legal Cases Legislation Multicenter Study News Newspaper Article Overall Patient Education Handout Periodical Index Published Erratum Retracted Publication Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. 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Retraction of Publication Scientific Integrity Review Support of Research Technical Report Twin Study Validation Studies Not a Primary Study or Review Unknown Primary Study Case Series Case Control Cohort Study Observational Study Qualitative Research CBA or ITS Registry Double Blind Controlled before after study Quasi-randomized trial Simple before after study Cluster-RCT Non-Randomized Study Report Book Book chapter Dissertation Conference procedings Secondary Research Not RCT Ages All Infant: birth-23 months All Child: 0-18 years All Adult: 19+ years Newborn: birth-1 month Infant: 1-23 months Preschool Child: 2-5 years Child: 6-12 years Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Middle Aged + Aged: 45+ years Aged: 65+ years 80 and over: 80+ years Undetermined Language English French German Italian Japanese Russian Spanish Afrikaans Albanian Unknown Arabic Armenian Azerbaijani Bosnian Bulgarian Catalan Chinese Croatian Czech Danish Dutch Esperanto Estonian Finnish Georgian Greek, Modern Hebrew Hindi Hungarian Icelandic Indonesian Kinyarwanda Korean Latin Latvian Lithuanian Macedonian Malay Malayalam Maori Multiple Languages Norwegian Persian Polish Portuguese Pushto Romanian Sanskrit Scottish gaelic Serbian Slovak Slovenian Swedish Thai Turkish Ukrainian Vietnamese Not English Not French Results(1-25 of 190) Sort By: Publication Date Relevance Took: 0.248 seconds to search 17,750,454  Action: Copy Results to new Clipboard Build Search Link Page 1 of 8 1 2 3 4 > Last >> (190 articles found) Illusory contours and surfaces without amodal completion and depth stratification. 2004 Baingio Pinna,Walter H Ehrenstein,Lothar Spillmann Cognitive and figural cues were studied in modified Ehrenstein figures made from letters of the alphabet instead of radial lines. Capital letters with and without terminators (L, J vs O, D) were used, oriented towards or away from the central gap. Three groups, of 14 subjects each, estimated the ma... ( view more )gnitude of either (i) the illusory contour, (ii) brightness enhancement, or (iii) apparent depth. Strong illusory contour formation and brightness enhancement, but no depth stratification, were perceived in figures devoid of apparent occlusion and amodal completion. These results demonstrate that the Ehrenstein illusion can arise from line ends--with no need for perceptual completion, showing that illusory boundaries and surfaces can be dissociated from apparent depth. Results support a bottom-up explanation in terms of end-stopped neurons in the visual cortex. Conversely, top-down processes appear to be responsible for depth stratification. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Scintillating lustre and brightness induced by radial lines. 2002 Baingio Pinna,Lothar Spillmann,Walter H Ehrenstein Gray disks inserted into the central gaps of an Ehrenstein pattern appear to lighten up and scintillate with each movement of the eye or stimulus pattern. We call this phenomenon scintillating lustre. Both phenomena-illusory brightness and scintillating lustre-depend on the presence of the radial i... ( view more )nducing lines converging onto the gaps. Without the radii the gray disks appear matte. Using parametric stimulus variation, we show that the strength of scintillating lustre covaries with line-induced brightness enhancement when the length, width, number, and contrast of the radial lines, as well as the size of the gaps in the Ehrenstein figure, are varied. Following the proposal by Anstis (2000, Vision Research 40 2551-2556), we suggest that lustre results from a competition between the ON and OFF visual pathways. Whereas Helmholtz's binocular gloss is elicited by stereoscopically fused incremental and decremental stimuli, the present study demonstrates that lustre can also arise from the interaction between line-induced brightness (illusory increment) and a dark gray disk (physical decrement). ( view less ) View Full Abstract View Article Details View Coded Data Related Articles The role of domestic hygiene in inflammatory bowel diseases: hepatitis A and worm infestations. Jun 2008 Stefan Hafner,Antje Timmer,Hans Herfarth,Gerhard Rogler,Jürgen Schölmerich,Andreas Schäffler,Boris Ehrenstein,Wolfgang Jilg,Claudia Ott,Ulrike G Strauch,Florian Obermeier BACKGROUND: Environmental factors are likely to be involved in the pathogenesis of inflammatory bowel disease (IBD), as the incidence of both Crohn's disease (CD) and ulcerative colitis (UC) increased with improved living standards in Europe after World War II. On the basis of earlier reports sugge... ( view more )sting that hygienic standards may also play a role in the pathogenesis of IBD, we investigated the influence of hepatitis A seroprevalence as an indicator for poorer hygienic conditions and worm infestations in IBD. METHODS: Hepatitis A seroprevalence was examined in patients with UC and CD. Patients with minor endocrinological disorders served as controls. All patients were questioned about immunizations, parasitic infections (worms), contact with animals, living on a farm, and ever traveling abroad. Patients were excluded for active hepatitis A immunization or recent passive immunization. Results are presented as Mantel-Haenszel odds ratios with 95% confidence interval, adjusted for age group. RESULTS: The sample included 307 patients (73 CD, 48 UC, and 186 controls). Hepatitis A seroprevalence was strongly associated with age older than 50 years. Age adjusted Mantel-Haenszel odds ratios were 0.25 (0.09-0.71) for UC and 0.75 (0.38-1.46) for CD versus controls. For parasitic infections, the odds ratios were 1.15 (0.52-2.53) for UC and 0.34 (0.13-0.89) for CD. CONCLUSION: We were able to demonstrate a negative association of hepatitis A infection with UC only. In contrast, a novel finding was a strong protective effect of worm infestations for the occurrence of CD, but not UC. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Noise generation in an unstable boundary-layer flow over a flexible wall. May 2008 Marie-Laure Gobert,Uwe Ehrenstein,Jacques Andre Astolfi,Patrick Bot,Jean Audet,Guillaume Oudot The boundary-layer flow, for instance along a sonar dome, gives rise to hydrodynamic noise due to the pressure fluctuations. The prediction of the resulting self-noise received by the sonar antenna is based on models, which in general take only partially into account the flexibility of the dome wal... ( view more )l. The present work readdresses the problem of hydrodynamic noise, considering the geometrically simplified model of a two-dimensional unstable boundary-layer flow along an elastic plate with clamped ends. The incompressible Navier-Stokes equations are fully coupled to the elastic plate model and the system is numerically solved for various plate materials. The unstable flow dynamics is analyzed with respect to the wall properties. The Fourier-transformed stress tensor is then used in the framework of Lighthill's analogy to determine the generated radiative sound, emphasizing the effect of wall-flexibility. This work is supported by Thales Underwater System and DCNS. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Restoring the balance: harnessing regulatory T cells for therapy in rheumatoid arthritis. Apr 2008 Fabian Flores-Borja,Claudia Mauri,Michael R Ehrenstein Treg play a vital role in the maintenance of tolerance to self antigens, thereby preventing disease through the active suppression of proliferation and pro-inflammatory cytokine production by autoreactive T cells. Here we discuss strategies aimed at enhancing Treg function in patients with rheumato... ( view more )id arthritis with the ultimate aim of restoring lasting tolerance but without increasing the risk of infections or cancer. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles [Vaccination of healthcare workers against influenza] Feb 2008 B Salzberger,B Ehrenstein Vaccination of healthcare workers (HCW) against influenza is strongly recommended due to its positive effects on elderly patients. In randomized studies vaccination of healthcare workers resulted in lower overall mortality of patients in the winter period. Still, vaccination rates of healthcare wor... ( view more )kers remain low in many countries, especially in Europe. The rationale for the current recommendations, vaccination rates of healthcare workers, factors influencing these rates, and strategies to improve vaccination rates are discussed. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles The 'short' history of regulatory B cells. Jan 2008 Claudia Mauri,Michael R Ehrenstein The maintenance of tolerance is the sine qua non of a sophisticated regulatory apparatus to prevent or dampen overzealous immune responses. In addition to the ability of B cells to prime and activate the immune system, B cells with regulatory function (Bregs) have been identified in experimental mo... ( view more )dels of autoimmunity, infections, and cancer, supporting the notion that, similar to regulatory T cells (Tregs), Breg-mediated suppression is an important means for the maintenance of peripheral tolerance. This regulatory function appears to be directly mediated by the production of IL-10 and/or TGFbeta and by the ability of B cells to interact with pathogenic T cells to inhibit harmful immune responses. The identification of their existence is of great relevance to the understanding of autoimmune diseases and to the development of new therapeutic strategies. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles If the treatment works, do we need to know why?: the promise of immunotherapy for experimental medicine. Oct 1, 2007 Michael R Ehrenstein,Claudia Mauri There has been much fanfare, and rightly so, heralding a revolution in the treatment of autoimmune disease using biologic agents-antibodies or other molecules that specifically target known mediators of disease. But not all patients respond to even the most successful biologic agent, which may prov... ( view more )ide clues about alternate disease mechanisms. Studies aimed at understanding the mechanism of action of biologic agents will yield significant benefits for experimental medicine. ( view less ) View Full Abstract View Article Details   Related Articles B cell depletion therapy in systemic lupus erythematosus: long-term follow-up and predictors of response. Sep 2007 Kristine P Ng,Geraldine Cambridge,Maria J Leandro,Jonathan C W Edwards,Michael Ehrenstein,David A Isenberg OBJECTIVES: To describe the long-term clinical outcome and safety profile of B cell depletion therapy (BCDT) in patients with systemic lupus erythematosus (SLE). It was also determined whether baseline parameters can predict the likelihood of disease flare. METHODS: 32 patients with refractory SLE ... ( view more )were treated with BCDT using a combination protocol (rituximab and cyclo-phosphamide). Patients were assessed with the British Isles Lupus Assessment Group (BILAG) activity index, and baseline serology was measured. Flare was defined as a new BILAG 'A' or two new subsequent 'B's in any organ system. RESULTS: Of the 32 patients, 12 have remained well after one cycle of BCDT (median follow-up 39 months). BCDT was followed by a decrease of median global BILAG scores from 13 to 5 at 6 months (p = 0.006). Baseline anti-extractable nuclear antigen (ENA) was the only identified independent predictor of flare post-BCDT (p = 0.034, odds ratio = 8, 95% CI 1.2 to 55) from multivariable analysis. Patients with low baseline serum C3 had a shorter time to flare post-BCDT (p = 0.008). Four serious adverse events were observed. CONCLUSION: Autoantibody profiling may help identify patients who will have a more sustained response. Although the long-term safety profile of BCDT is favourable, ongoing vigilance is recommended. ( view less ) View Full Abstract View Article Details   Related Articles Fifty years of anti-ds DNA antibodies: are we approaching journey's end? Jul 2007 D A Isenberg,J J Manson,M R Ehrenstein,A Rahman The year 2007 marks the 50th anniversary of the identification of antibodies to double-stranded (ds) DNA. Whilst widely regarded as synonymous with patients who have systemic lupus erythematosus (SLE), doubts have been raised about their significance and the extent to which they are genuinely part ... ( view more )of the pathogenesis of the disease rather than being mere bystanders. Problems with assays used to detect them are still evident but they remain widely utilized both to help establish the diagnosis of SLE and to monitor the progress of the disease. This review explores each of these aspects and concludes that whilst some way short of ideal, their measurement remains a useful criterion for the disease and some of these antibodies do appear to be genuinely pathogenic. However, further research is needed to establish beyond 'reasonable doubt' whether they are merely part of the spectrum of anti-nucleosome antibodies, the precise mechanisms by which they 'exert' their pathogenic effects and to what extent blocking them would be a useful therapeutic goal. ( view less ) View Full Abstract View Article Details   Related Articles Novel suppressive function of transitional 2 B cells in experimental arthritis. Jun 15, 2007 Jamie G Evans,Karina A Chavez-Rueda,Ayad Eddaoudi,Almut Meyer-Bahlburg,David J Rawlings,Michael R Ehrenstein,Claudia Mauri The immune system contains natural regulatory cells important in the maintenance of tolerance. Although this suppressive function is usually attributed to CD4 regulatory T cells, recent reports have revealed an immunoregulatory role for IL-10-producing B cells in the context of several autoimmune d... ( view more )iseases including collagen-induced arthritis. In the present study, we attribute this suppressive function to a B cell subset expressing high levels of CD21, CD23, and IgM, previously identified as transitional 2-marginal zone precursor (T2-MZP) B cells. T2-MZP B cells are present in the spleens of naive mice and increase during the remission phase of arthritis. Following adoptive transfer to immunized DBA/1 mice, T2-MZP B cells significantly prevented new disease and ameliorated established disease. The suppressive effect on arthritis was paralleled by an inhibition of Ag-specific T cell activation and a reduction in cells exhibiting Th1-type functional responses. We also provide evidence that this regulatory subset mediates its suppression through the secretion of suppressive cytokines and not by cell-to-cell contact. The ability to regulate an established immune response by T2-MZP B cells endows this subset of B cells with a striking and previously unrecognized immunoregulatory potential. ( view less ) View Full Abstract View Article Details   Related Articles Environmental exposure to confined animal feeding operations and respiratory health of neighboring residents. May 2007 Katja Radon,Anja Schulze,Vera Ehrenstein,Rob T van Strien,Georg Praml,Dennis Nowak BACKGROUND: Despite public concern about potential adverse health effects of concentrated animal feeding operations, objectively assessed data on environmental exposure to concentrated animal feeding operations and respiratory health are sparse. We aimed to assess respiratory health in neighbors of... ( view more ) confined animal feeding operations. METHODS: A survey was done in 2002-2004 among all adults (18-45 years old) living in 4 rural German towns with a high density of confined animal feeding operations. Questionnaire data were available for 6937 (68%) eligible subjects. In a random sample we measured the following outcomes: specific IgE to common and farm-specific allergens, lung function, and bronchial hyperresponsiveness to methacholine. Exposure was measured by collecting data on odor annoyance and geo-coded data on the number of animal houses within 500 m of the home. Locally optimal estimating and smoothing scatter plots were used to model the association between exposure and outcome. Analyses were restricted to subjects without private or professional contact with farming environments. RESULTS: The prevalence of self-reported asthma symptoms and nasal allergies increased with self-reported odor annoyance. The number of animal houses was a predictor of self-reported wheeze and decreased forced expiratory volume in 1 second, but not allergic rhinitis or specific sensitization. Self-reported exposure and results of clinical measurements were poorly correlated. CONCLUSIONS: Confined animal feeding operations may contribute to the burden of respiratory disease among their neighbors. Our findings underline the importance of objective assessment of exposure and outcome in environmental epidemiology. ( view less ) View Full Abstract View Article Details   Related Articles [Nocardia farcinica infection of a vascular prosthesis] Apr 2007 P Babilas,K Scherer,M Landthaler,B Ehrenstein,R-M Szeimies A 61-year-old woman presented with purple-red subcutaneous nodules on her right leg. She had experienced fever up to 40 degrees C for the past 10 days and felt generally weak over the last two months. Four months earlier, a vascular graft had been implanted in her right femoral artery. Based on the... ( view more ) diagnosis of skin infection due to implantation of an infected prosthesis, she was hospitalized and treated with an antibiotic regime. During the initial antibiotic treatment, the symptoms deteriorated, and she developed joint, hepatic and CNS abscesses. Finally, a microbiologic culture with an extended incubation time revealed the diagnosis of an infection with the slowly growing bacterium Nocardia ssp. Hereupon the patient was treated purposefully with Meropenem over six months. This treatment resulted in complete recovery. ( view less ) View Full Abstract View Article Details   Related Articles Perinatal risk factors for hospitalization for pneumococcal disease in childhood: a population-based cohort study. Apr 2007 Barbara E Mahon,Vera Ehrenstein,Mette Nørgaard,Lars Pedersen,Kenneth J Rothman,Henrik T Sørensen OBJECTIVE: The objective of this study was to examine the relation of factors that are present at birth to subsequent hospitalization for childhood pneumococcal disease. METHODS: We conducted a cohort study of all singletons born in 3 counties in western Denmark from 1980 through 2001, using popula... ( view more )tion-based registries to obtain data on pregnancy- and birth-related variables and hospitalizations through age 12. We calculated incidence rates of pneumococcal disease hospitalization overall and within strata of study variables and used Poisson regression to estimate rate ratios for pneumococcal disease hospitalization while accounting for other birth characteristics. RESULTS: Among 338,504 eligible births, 1052 children were later hospitalized for pneumococcal disease. Pneumonia accounted for most hospitalizations (81.9%). The pneumococcal disease hospitalization rate was highest among 7- to 24-month-olds, followed by 0- to 6-month-olds and 25- to 60-month-olds. The highest rates, typically over 200 hospitalizations per 100,000 person-years, were in 0- to 6- and 7- to 24-month-old children who were born preterm or with low birth weight, a low 5-minute Apgar score, or birth defects. The hospitalization rate was lower for first-born children at 0 to 6 months but not at older ages. At older ages, hospitalization rates were not substantially different for children whose mothers smoked during pregnancy, but at 0 to 6 months, the rate was higher for children of multiparous nonsmokers than for others. Adjusted rate ratios were elevated across all age categories for several variables, including low birth weight, presence of birth defects, and low 5-minute Apgar. For several others, including preterm birth, maternal multiparity, age < or = 20 years, and non-Danish/European Union citizenship, adjusted rate ratios were elevated only for 0- to 6-month-olds. CONCLUSIONS: This large cohort study of hospitalization for childhood pneumococcal disease clarifies the roles of some gestation and birth factors while raising new questions about how these factors work. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles [Epidemiology of severe sepsis at a German university hospital] Mar 15, 2007 Franz X Audebert,Frank Hanses,Arne Schneidewind,Boris Ehrenstein,Stefan Blaas,Bernd Salzberger,Jürgen Schölmerich,Dieter Fröhlich,Rainer H Straub,Thomas Glück BACKGROUND AND PURPOSE: Sepsis still represents a major medical challenge despite several advances in therapy. Most published data on sepsis have been derived from clinical trials evaluating new drugs and from international cohort studies. The aim of this study was to analyze risk factors, mortalit... ( view more )y and causative pathogens in a cohort of unselected patients with severe sepsis at a German university hospital and to compare the data with international cohorts and recently published therapeutic trials. PATIENTS AND METHODS: Between May 1999 and December 2002, all patients of the surgical and internal medicine intensive care units of a university medical center with newly manifested severe sepsis and at least one organ failure were recruited into the prospective observational study "Unicenter Sepsis Survey Regensburg" (USSR). RESULTS: 182 patients were included. The median age of the patients studied was 58 years, the median SAPS II amounted to 42, mortality at day 14 and day 30 was 25% and 34%, respectively. 48% of the patients developed sepsis due to an internal disease, 33% after surgical emergency interventions, and 19% after planned surgical interventions. Patients with surgical emergencies had higher SAPS II values and a worse outcome. 35% of all patients developed acute renal failure. 85% of the patients were treated with vasopressors, and 90% had to be ventilated mechanically. 58% of the patients had a probable and 38% a confirmed focal infection; in the final retrospective analysis, an infectious genesis proved to be unlikely in 4% of the patients. CONCLUSION: The characteristics of unselected patients with severe sepsis at the authors' institution are comparable to data from recently published sepsis studies with respect to mortality, severity of disease, and range of causative pathogens. ( view less ) View Full Abstract View Article Details   Related Articles Increased positive selection of B1 cells and reduced B cell tolerance to intracellular antigens in c1q-deficient mice. Mar 1, 2007 Helen Ferry,Paul K Potter,Tanya L Crockford,Anastasia Nijnik,Michael R Ehrenstein,Mark J Walport,Marina Botto,Richard J Cornall Inherited deficiency of early components of the classical complement pathway is strongly associated with the targeting of intracellular self Ags in systemic lupus erythematosus, but the reasons for this association are debated. In this study, we show that C1q deficiency increases the positive selec... ( view more )tion of B1b B cells and IgM autoantibodies by an intracellular self Ag, which is exposed on dying cells, and decreases the negative selection of autoreactive conventional B cells by the same Ag. These effects are specific to intracellular Ag because C1q deficiency does not affect negative selection by extracellular self Ag or increase the positive selection of naive B cells. The B1-derived IgM autoantibody binds to the intracellular Ag when it is expressed on dying cells, leading to fixation of C1q and clearance of cells by phagocytosis. These findings suggest that the positive selection of autoreactive B1 cells by self Ags may contribute to the IgM and C1q-dependent clearance of dying cells in a feedback loop that limits exposure of conventional B cells to immunogenic self Ags. We show that exposure of intracellular Ag leads to the activation of conventional B cells, when there is a source of T cell help in vivo. ( view less ) View Full Abstract View Article Details   Related Articles Postterm delivery and risk for epilepsy in childhood. Mar 2007 Vera Ehrenstein,Lars Pedersen,Vibeke Holsteen,Helle Larsen,Kenneth J Rothman,Henrik T Sørensen OBJECTIVE: Postterm delivery is a risk factor for perinatal complications, some of which increase risk for neurologic morbidity. We aimed to examine the association between postterm delivery and risk for epilepsy in childhood. METHODS: We conducted a cohort study of singleton children who were born... ( view more ) in 3 Danish counties from 1980 to 2001. Birth registry data were linked with hospital records to identify cases of epilepsy in the first 12 years of life. We included children who were born at > or = 39 gestational weeks and computed crude, age-specific, and birth weight standardized incidence rates of epilepsy. We estimated adjusted incidence rate ratios according to mode of delivery by Poisson regression. RESULTS: Among the 277,435 nonpreterm births, 32,557 were at > or = 42 weeks, including 3396 at > or = 43 weeks. Nearly one fourth of the 2805 epilepsy cases occurred in the first year of life. In that period, birth weight standardized incidence rate ratios for epilepsy were 1.3 for birth at 42 weeks and 2.0 for birth at > or = 43 weeks, compared with birth at 39 to 41 weeks. Among children who were delivered by cesarean section, incidence rate ratios adjusted for birth weight, presentation, malformations, and county were 1.4 for birth at 42 completed weeks and 4.9 for birth at > or = 43 weeks, compared with term vaginal births. There was a similar tendency among children who were delivered with the assistance of instruments. We found no evidence for the association between postterm delivery and risk for epilepsy beyond the first year of life. CONCLUSIONS: Prolonged gestation is a risk factor for early epilepsy; the added increase in risk for instrument-assisted and cesarean deliveries could be attributable to factors that are related to both birth complications and epilepsy. ( view less ) View Full Abstract View Article Details   Related Articles Improvement in the routine diagnostic assessment of the liver by high-resolution sonography: an analysis of 999 cases. Mar 2007 Doris Schacherer,Carola Schuh,Ulrike Strauch,Boris Ehrenstein,Reiner Wiest,Juergen Schölmerich,Klaus Schlottmann,Frank Klebl OBJECTIVE: High-frequency ultrasound transducers have been helpful in certain settings of transabdominal ultrasound examination, and their role in the evaluation of the liver surface in patients with cirrhosis is well documented. However, their value in the routine assessment of the liver has not y... ( view more )et been analysed systematically. The aim of this pilot study was to clarify whether the additional use of high-frequency ultrasound as compared to the standard 3.5 MHz-transducer is of any benefit. MATERIAL AND METHODS: A total of 999 patients from a tertiary care medical centre were examined with a wideband 3.5 MHz- and a high-frequency transducer (band width 4.5 to 10 MHz) with tissue harmonic imaging using one of two high-end ultrasound machines (Siemens Sonoline Elegra or Hitachi EUB-8500). Findings on hepatic pathologies were collected on a standardized documentation sheet and were evaluated using descriptive statistics. RESULTS: In all, 948 patients showed a plain liver surface when the 3.5 MHz transducer was used, whereas this was only true for 862 patients examined with the high-frequency probe. Using the 7.5 MHz probe, the structure of the liver parenchyma appeared to be homogeneous (n=800; 80.1%) less often than when the 3.5 MHz probe (n=822; 82.3%) was used. More cases of liver cirrhosis were suspected with the high-frequency probe (n=66; 6.6% as compared with n=49; 4.9%). In 85 patients (8.5%) new hepatic pathologies were described which had not been detected with the 3.5 MHz probe. The examiners judged the high-frequency examination to be helpful in 284 cases. The time needed for the additional examination ranged between 0.5 and 10 min (mean: 2.2 min). CONCLUSIONS: This study demonstrates that the additional use of a high-frequency transducer during routine abdominal examinations reveals new hepatic pathologies in a significant proportion of examined patients, without substantial prolongation of the overall examination period. ( view less ) View Full Abstract View Article Details   Related Articles Anti-TNF-alpha therapy induces a distinct regulatory T cell population in patients with rheumatoid arthritis via TGF-beta. Jan 22, 2007 Suchita Nadkarni,Claudia Mauri,Michael R Ehrenstein The induction of regulatory T (T reg) cells holds considerable potential as a treatment for autoimmune diseases. We have previously shown that CD4+CD25hi T reg cells isolated from patients with active rheumatoid arthritis (RA) have a defect in their ability to suppress proinflammatory cytokine prod... ( view more )uction by CD4+CD25- [corrected] T cells. This defect, however, was overcome after anti-tumor necrosis factor (TNF)-alpha antibody (infliximab) therapy. Here, we demonstrate that infliximab therapy gives rise to a CD4+CD25hiFoxP3+ T reg cell population, which mediates suppression via transforming growth factor (TGF)-beta and interleukin 10, and lacks CD62L expression, thereby distinguishing this T reg cell subset from natural T reg cells present in healthy individuals and patients with active RA. In vitro, infliximab induced the differentiation of CD62L- T reg cells from CD4+CD25- T cells isolated from active RA patients, a process dependent on TGF-beta. In spite of the potent suppressor capacity displayed by this CD62L- T reg cell population, the natural CD62L+ T reg cells remained defective in infliximab-treated patients. These results suggest that anti-TNF-alpha therapy in RA patients generates a newly differentiated population of T reg cells, which compensates for the defective natural T reg cells. Therefore, manipulation of a proinflammatory environment could represent a therapeutic strategy for the induction of T reg cells and the restoration of tolerance. ( view less ) View Full Abstract View Article Details   Related Articles Children's intellectual function in relation to arsenic exposure. Jan 2007 Ondine S von Ehrenstein,Shalini Poddar,Yan Yuan,Debendra Guha Mazumder,Brenda Eskenazi,Arin Basu,Meera Hira-Smith,Nalima Ghosh,Sabari Lahiri,Reina Haque,Alakendu Ghosh,Dave Kalman,Subankar Das,Allan H Smith BACKGROUND: Very little evidence exists concerning the possible impairment of children's intellectual function in relation to arsenic exposure in utero and during childhood. METHODS: We conducted a cross-sectional study among 351 children age 5 to 15 years who were selected from a source population... ( view more ) of 7683 people in West Bengal, India, in 2001-2003. Intellectual function was assessed with 6 subtests from the Wechsler Intelligence Scale for Children as well as with the Total Sentence Recall test, the Colored Progressive Matrices test, and a pegboard test. Arsenic in urine and lifetime water sources (including during the pregnancy period) were assessed using measurements of samples from 409 wells. The test scores were analyzed with linear regression analyses based on the method of generalized estimating equations incorporating relevant covariates. RESULTS: Stratifying urinary arsenic concentrations into tertiles, we found associations between arsenic and reductions in the adjusted scores of the vocabulary test (0, -0.14, -0.28; P for trend = 0.02), the object assembly test (0, -0.16, -0.24; P for trend = 0.03), and the picture completion test (0, -0.15, -0.26; P for trend = 0.02). These findings correspond to relative declines of 12% (95% confidence interval =0.4% to 24%) in the vocabulary test, 21% (-0.8% to 42%) in the object assembly test, and of 13% (0.3% to 24%) in the picture completion test in the upper urinary arsenic tertile. However, we did not find evidence of an association between test results and arsenic water concentrations during pregnancy or childhood. CONCLUSIONS: Current arsenic concentrations in urine, which reflect all sources of recent exposure, including water and food, were associated with small decrements in intellectual testing in school-aged children in West Bengal. We did not see associations between long-term water arsenic concentrations and intellectual function. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Cells of the synovium in rheumatoid arthritis. B cells. 2007 Claudia Mauri,Michael R Ehrenstein There is significant evidence arising from experimental models that autoantibodies play a key role in the pathogenesis of inflammatory arthritis. In addition to autoantibody production, B cells efficiently present antigen to T cells, produce soluble factors, including cytokines and chemokines, and ... ( view more )form B cell aggregates in the target organ of rheumatoid arthritis. In this review we analyze the multifaceted role that B cells play in the pathogenesis of rheumatoid arthritis and discuss how this information can be used to guide more specific targeting of B cells for the therapy of this disease. ( view less ) View Full Abstract View Article Details   Related Articles Bone marrow B-lineage cells in patients with rheumatoid arthritis following rituximab therapy. Jan 2007 M J Leandro,N Cooper,G Cambridge,M R Ehrenstein,J C W Edwards OBJECTIVE: To assess the presence and phenotype of B-lineage cells in the bone marrow (BM) of rheumatoid arthritis (RA) patients after rituximab therapy. METHODS: Six patients were studied. BM aspirates were collected 3 months after the treatment and analysed using the four-colour flow cytometry. R... ( view more )ESULTS: CD19+ (B-lineage) cells in BM samples varied from 0.1 to 3.25% in the lymphoid gate. CD34+ cells varied from 1.23 to 4.86%. The proportion of CD34+ cells committed to the B-lineage varied between 0 and 42.19%. Pro-B-cells were undetectable in one case. The majority of B-cell precursors were pro-B-cells in Patients 5 and 6 (50 and 62% of CD19+ cells, respectively), pre-B-cells in Patients 3 and 4 (64 and 70%) and immature B-cells in Patient 1 (44%). Detectable CD20 expression on CD19+ cells was either low or absent. Plasma cells varied from 0.01 to 0.36% of the total nucleated cells. There was a trend towards longer duration of clinical response in patients with evidence of more complete depletion in BM. CONCLUSION: In this small cohort of RA patients treated with rituximab, differences in proportion and phenotype of CD19+ BM cells were detected. These differences suggest variation in the degree of depletion achieved and correlate with time to relapse. Although pro-B-cells are not targeted directly by rituximab as they do not express CD20, the levels were unexpectedly low. ( view less ) View Full Abstract View Article Details   Related Articles Arsenic concentrations and bacterial contamination in a pilot shallow dugwell program in West Bengal, India. Jan 2007 Meera M Hira-Smith,Yan Yuan,Xavier Savarimuthu,Jane Liaw,Alpana Hira,Cynthia Green,Timir Hore,Protap Chakraborty,Ondine S von Ehrenstein,Allan H Smith Project Well has developed a pilot self-supporting community-based mitigation program to provide arsenic-safe water to the villagers of North 24 Parganas, West Bengal, India. Shallow concrete dugwells, less than 25 feet deep, that tap into an unconfined aquifer are constructed following stipulated ... ( view more )guidelines. The design differs from the traditional dugwell in two major ways: (i) there is a layer of coarse sand in the annular space enveloping the outer wall of the concrete cylinder; and (ii) handpumps are used for water extraction to reduce the potential for bacterial contamination. Monitoring programs for arsenic and coliform bacteria in selected dugwells have been completed. In summer, when the water levels were low, the arsenic concentrations were measured. In 11 wells, measured over three years, the average water arsenic concentration was 29 micro gL-1. Two dugwells had high concentrations of arsenic (average 152 micro gL-1 and 61 micro gL-1), but the remaining nine dugwells had an overall average of 11 micro gL-1. Seasonal variation was assessed in five wells with monthly measurements and there was a direct relationship between increases in arsenic concentrations and decreases in the volume of water in the dugwells in the dry summer season. To control bacterial contamination, sodium hypochlorite solution containing 5% chlorine was applied once a month. In 2005, fecal coliform was undetected in 65% (n = 13) of the dugwells but detected at high levels in 35% (n = 7) of the dugwells. The program clearly reduced exposure to arsenic, but we conclude that further study of increases in arsenic concentrations in the dry season are warranted, as well as assessment of ways to more effectively control bacterial contamination such as more frequent chlorination, perhaps with lower doses on each occasion. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Atorvastatin restores Lck expression and lipid raft-associated signaling in T cells from patients with systemic lupus erythematosus. Nov 15, 2006 Elizabeth C Jury,David A Isenberg,Claudia Mauri,Michael R Ehrenstein Loss of tolerance to self-Ags in patients with systemic lupus erythematosus (SLE), a prototypic autoimmune disease, is associated with dysregulation of T cell signaling, including the depletion of total levels of lymphocyte-specific protein kinase (Lck) from sphingolipid-cholesterol-enriched membra... ( view more )ne microdomains (lipid rafts). Inhibitors of 3-hyroxy-3-methylgluteryl CoA reductase (statins) can modify the composition of lipid rafts, resulting in alteration of T cell signaling. In this study, we show that atorvastatin targets the distribution of signaling molecules in T cells from SLE patients, by disrupting the colocalization of total Lck and CD45 within lipid rafts, leading to a reduction in the active form of Lck. Upon T cell activation using anti-CD3/anti-CD28 in vitro, the rapid recruitment of total Lck to the immunological synapse was inhibited by atorvastatin, whereas ERK phosphorylation, which is decreased in SLE T cells, was reconstituted. Furthermore, atorvastatin reduced the production of IL-10 and IL-6 by T cells, implicated in the pathogenesis of SLE. Thus, atorvastatin reversed many of the signaling defects characteristic of SLE T cells. These findings demonstrate the potential for atorvastatin to target lipid raft-associated signaling abnormalities in autoreactive T cells and provide a rationale for its use in therapy of autoimmune disease. ( view less ) View Full Abstract View Article Details   Related Articles Seasonal variation of arsenic concentrations in tubewells in west Bengal, India. Sep 2006 Xavier Savarimuthu,Meera M Hira-Smith,Yan Yuan,Ondine S von Ehrenstein,Subhankar Das,Nilima Ghosh,D N Guha Mazumder,Allan H Smith This study was conducted to monitor the changes in arsenic concentration during different seasons in a one-year period during 2002-2003 in selected tubewells in an arsenic-affected area in the district of South 24 Parganas in West Bengal, India, and to map the location of the wells. Seasonal variat... ( view more )ions in concentrations of arsenic in water were measured from 74 selected tubewells, ranging in depth from 40 to 500 feet. Water samples were collected from these wells during winter, summer, monsoon, and the following winter in 2002-2003. A global positioning system was used for locating the tubewells, and a geographic information system was used for mapping. There was evidence of seasonal variation in concentrations of arsenic in water (p=0.02) with the minimum average concentration occurring in the summer season (694 microg/L) and the maximum in the monsoon season (906 microg/L). From the winter of 2002 to the winter of 2003, arsenic concentrations increased, irrespective of the depth of the tubewells, from an average of 464 microg/L to 820 microg/L (p<0.001). This extent of variation in arsenic concentration, if confirmed, has important implications for both epidemiological research and mitigation programmes. ( view less ) View Full Abstract View Article Details View Coded Data Related Articles Page 1 of 8 1 2 3 4 > Last >> (190 articles found)

      
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