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Background: Providers are currently using surveys designed for cisgender women and/or creating their own questionnaires to evaluate the sexual function and satisfaction (SFS) of transgender women postvaginoplasty (TWPV), despite the marked difference in anatomy and lived experience between these groups., Aim: To evaluate the appropriateness of the current assays that have been validated in cisgender women and to assess their applicability in studying SFS in TWPV., Methods: Surveys assessing female SFS that were validated in English speakers in North America were compiled and reviewed. Percentages reflect the proportion of surveys that asked questions deemed relevant or irrelevant for TWPV. Assessed variables included questions about endogenous lubrication, pain/discomfort with penetration, and other sexual activity., Outcomes: Outcomes of interest were questions that fell into 1 of 2 categories: questions irrelevant to TWPV (present/irrelevant) and those relevant for TWPV (present/relevant)., Results: All surveys contained present/irrelevant questions. Endogenous lubrication-a property of the natal vagina that may not be present in the neovagina-was the primary present/irrelevant question and was asked in 69.2% of the surveys. Vaginal pain, a present/relevant question, was assessed in 46.2% of surveys. Furthermore, questions requiring a partnered relationship to answer were asked in 61.5% of surveys, which may detract from the assessment of SFS in individuals who do not have sexual partners. Notably, there was also a lack of questions important for evaluating SFS in TWPV, such as assessing satisfaction of the caliber and depth of the neovagina, erogenous stimulation of the prostate during insertive intercourse, and cosmetic appearance of the vulva., Clinical Implications: This analysis raises concerns about the clinician's ability to meaningfully assess SFS in TWPV using the tools available., Strengths and Limitations: This article is the first of its kind to qualitatively assess the applicability of currently validated SFS questionnaires in TWPV. Limitations include the inability to draw definitive conclusions due to the qualitative nature of the study and the possibility of missing complex biopsychosocial factors, as trans individuals were not directly involved in the assessments of applicability., Conclusion: Given that the existing surveys are not designed to assess the SFS of TWPV, we call for the development of a validated survey for this population, which is in line with the precedent set by several other questionnaires validated for similarly specific populations., (International Society for Sexual Medicine 2023.)

Background: Lichen sclerosus (LS) is a common autoimmune dermatological condition that is often under-diagnosed in women and has been documented to affect quality of life and sexual function., Aim: To determine the prevalence of sexual dysfunction among women with vulvar lichen sclerosus., Methods: The authors conducted a systematic review and meta-analysis of the existing research on LS and sexual function in database including PubMed using search terms: lichen sclerosus OR vulvar lichen sclerosus OR vulvar lichen sclerosus et atrophicus OR kraurosis vulvae) AND (sexual function OR sexual functions OR sexual disorder OR sexual disorders OR sexual activity OR sexual activities OR sexual dysfunction OR sexual dysfunctions OR dyspareunia OR vaginismus)., Outcomes: Nearly 60% of women with lichen sclerosus suffer from sexual dysfunction., Results: Two hundred and ten studies were initially identified. Twenty-six articles met inclusion criteria and 3 were excluded as they did not relate to sexual function, were regarding a surgical or medical intervention and sexual dysfunction and one was a review article. Therefore, 23 studies were included in the final analysis resulting in a cumulative 486 participants with LS with 208 patients experiencing any kind of sexual dysfunction. Meta-analysis presented prevalence of sexual dysfunction among LS patients as 59% (95% CI: 48 - 70%). Dyspareunia or generalized pain with intercourse was the most commonly reported type of dysfunction., Clinical Implications: Discussing sexual concerns with women with LS could empower them to seek treatment., Strengths and Limitations: Few articles met criteria for inclusion., Conclusion: A large proportion of women with LS experience sexual dysfunction. More research is needed, especially that which includes biopsy-proven LS and validated tools on sexual function. Pope R, Lee MH, Myers A, et al. Lichen Sclerosus and Sexual Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:1616-1624., (Copyright © 2022 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: A clear and well-documented gender bias exists in the evaluation of sexual outcomes for women undergoing urologic surgery. Due to the anatomic template of anterior exenteration, women are commonly left with side effects that include sexual dysfunction and the perpetuated effects of surgical menopause., Objectives: To present evaluation and treatment recommendations for female sexual dysfunction treatment and evaluation, in addition to surgical templates during radical cystectomy (RC)., Methods: This article reviews current literature regarding sexual function and RC with urinary diversion in female bladder cancer patients. Furthermore, this review will provide a review of techniques for organ and neurovascular preservation, along with novel vaginal reconstruction templates. Our review will further focus on emerging technology, including minimally invasive surgery and organ and nerve preservation, directed at preservation of female sexual function., Results: Clinically, studies have demonstrated that females who have undergone genitalia-sparing and neurovascular preservation during RC regained sexual activity earlier than patients undergoing traditional RC. If organ and nerve preservation is not feasible due to involvement of trigone or bladder neck, vaginal reconstruction can mitigate the sexual dysfunction that results from a loss of the anterior vagina during a standard RC., Conclusion: Female sexual dysfunction is associated with high levels of patient distress and is best comanaged with a multidisciplinary treatment approach, including preoperative counseling, intraoperative nerve, and organ preservation, and postoperative interventions to mitigate sexual side effects. Davis L, Isali I, Prunty M, et al. Female Sexual Function Following Radical Cystectomy in Bladder Cancer. Sex Med Rev 2022;10:231-239., (Copyright © 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Background: There are no prospective studies on the association between multimorbidity and urinary incontinence (UI), while mediators in this association are unknown. Thus, we aimed to (i) investigate the longitudinal association between multimorbidity and UI in a large sample of Irish adults aged ≥50 years and (ii) investigate to what extent physical activity, polypharmacy, cognitive function, sleep problems, handgrip strength and disability mediate the association., Methods: Data on 5,946 adults aged ≥50 years old from the Irish Longitudinal Study on Aging were analysed. The baseline survey was conducted between 2009 and 2011 and follow-up after 2 years was conducted. Information on self-reported occurrence of UI in the past 12 months and lifetime diagnosis of 14 chronic conditions were obtained. Multivariable logistic regression and mediation analysis were conducted., Results: After adjustment for potential confounders, compared to having no chronic conditions at baseline, having three (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.30-2.48) and four or more (OR = 1.86; 95% CI = 1.32-2.60), chronic conditions were significantly associated with incident UI. Mediation analysis showed that polypharmacy, sleep problems and disability explained 22.7, 17.8 and 14.7% of the association between multimorbidity (i.e. two or more chronic conditions) and incident UI, respectively., Conclusion: A greater number of chronic conditions at baseline were associated with a higher risk for incident UI at 2-year follow-up among adults aged ≥50 years in Ireland. Considering the effects of different medications on UI and improving sleep quality and disability among people aged ≥50 years with multimorbidity may reduce the incidence of UI., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: The intense training and occupational demands of military personnel place the individual at risk of serious injury. When they do occur, serious personal injuries (SPIs) can lead to medical discharge, mission compromise, and ongoing recurrence of problems. Prior to the implementation of any minimization strategies, an understanding of the causes of SPIs requires development. The aim of this study was to analyze the incidence rates and patterns of SPIs within the Australian Regular Army (ARA) and Australian Army Reserve (ARES)., Methods: Data for a 2-year period were obtained through the Work Health, Safety, Compensation, and Reporting database of the Australian Department of Defence. Records of SPIs were extracted, with details including: (a) the activity being performed when the injury was suffered; (b) the body location of injury; (c) the nature of injury; and (d) the mechanism of injury. Results were reported as number of SPIs and converted to SPIs/100 full-time equivalent (FTE) years of service., Results: In total, 507 SPIs were reported over the two-year period (ARA = 466; ARES = 41). SPIs most commonly: occurred during combat training (n = 80; 0.13 SPIs/100 FTE years) and physical training (n = 66; 0.10 SPIs/100 FTE years); affected the head (n = 63; 0.10 SPIs/100 FTE years) and shoulders (n = 57; 0.09 SPIs/100 FTE years); and comprised fractures (n = 199; 0.19 SPIs/100 FTE years) and soft-tissue injuries (n = 103; 0.16 SPIs/100 FTE years). The most common mechanism of injury was falls (n = 132; 0.21 SPIs/100 FTE years) or contact with objects (n = 114; 0.18 SPIs/100 FTE years). When adjusted for service time, ARES personnel were found to report SPIs more frequently than ARA personnel (0.87 vs. 0.79/100 FTE years, respectively) giving an injury risk ratio (ARA:ARES) of 0.91 [95% CI = 0.66-1.25]., Conclusions: Despite higher absolute numbers of SPIs occurring in ARA, ARES in fact report similar rates of SPIs when adjusted for service time. The natures and mechanisms of SPIs are also similar for both service types and therefore should be the focus of targeted programs to reduce such injuries., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: For patients with intermediate-thickness melanoma, surveillance of regional lymph node basins by clinical examination alone has been reported to result in a larger number of lymph nodes involved by melanoma than if patients had initial sentinel node biopsy and completion dissection. This may result in worse regional control. A prospective study of both regular clinical examination and ultrasound surveillance was conducted to assess the effectiveness of these modalities., Methods: Between 2010 and 2014, patients with melanoma of thickness 1·2-3·5 mm who had under-gone wide local excision but not sentinel node biopsy were recruited to a prospective observational study of regular clinical and ultrasound nodal surveillance. The primary endpoint was nodal burden within a dissected regional lymph node basin. Secondary endpoints included locoregional or distant relapse, progression-free and overall survival., Results: Ninety patients were included in the study. After a median follow-up of 52 months, ten patients had developed nodal relapse as first recurrence, four had locoregional disease outside of an anatomical nodal basin as the first site of relapse and six had relapse with distant disease. None of the patients who developed relapse within a nodal basin presented with unresectable nodal disease. The median number of involved lymph nodes in patients undergoing lymphadenectomy for nodal relapse was 1 (range 1-2; mean 1·2)., Conclusion: This study suggests that ultrasound surveillance of regional lymph node basins is safe for patients with melanoma who undergo a policy of nodal surveillance., (© 2019 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.)

Background: falls rates in older people continue to rise despite concerted efforts to manage falls risks. As more effective strategies to reduce falls in older people may arise from better understanding their perspectives on falls risk, this study aimed to explore perceptions and behavioural decisions that may affect risk of falling among older people living in regional Australia., Method: this qualitative research, informed by hermeneutics, explored older people's perspectives on decisions they made that could affect their falls risk. The study involved 26 participants (21 females) aged 65-84 years, residing in regional Australia. In total, 13 participated in semi-structured focus groups and 13 in semi-structured, in-depth interviews., Results: six key themes illuminated the challenges older people faced in relation to falls risk. These were: the role that independence played in decision making regarding risk; the influence of previous falls experience; older people's level of understanding of risks; ability and willingness to engage with support; the need or desire to cover up a fall history; and the influence of finances in managing risk. Older people's accounts demonstrated they experienced competing influences that impacted upon decisions they made with respect to falls risks. Most significantly, the complex interplay of these influences drove the decisions older people made, sometimes placing them at greater risk of falling., Conclusion: consideration of the multifaceted issues older people face when managing falls risk, and the influence these factors have on their behaviours, is vital to successfully reducing rates of fall related injuries in this population.

Introduction: Women with vesicovaginal fistulas often experience a disruption in their normal lives, including sexual relationships, because of urinary incontinence., Aim: Although surgery repairs the urinary leakage, it is not known how surgery might affect sexual function positively or negatively., Methods: 119 women were enrolled before surgery and interviewed including a revised Female Sexual Distress Scale (FSDS-R) score and examined for vaginal length, caliber, and pelvic floor strength., Main Outcome Measures: Approximately one third of women return to normal sexual function after repair, although a minority experience de novo dysfunction., Results: 115 women completed follow-up 6 to 12 months after surgery. Approximately one third (35.6%, n = 41) stated that intercourse had returned to the way it was before a fistula. Forty-four women (40%) report sexual problems after the fistula developed; 15% due to incontinence and 23.5% due to pain. Fourteen women (12.2%) stated that they experienced problems with intercourse since surgery; 50% due to incontinence during intercourse and 50% due to pain. Nineteen of the participants (16.5%) scored in the range of dysfunction as assessed by the FSDS-R tool after surgery. Fibrosis did not significantly change and was not found to be associated with sexual function. Vaginal length was found to decrease on average by 5 mm. Of the variables examined, the factors statistically significantly associated with dysfunction included a larger-size fistula as determined by the Goh classification (> 3 cm diameter) and decreased vaginal caliber. FSDS-R scores drastically decreased from before to after surgery and the reason for problems with intercourse changed from leaking urine before surgery to lack of partner and concern for HIV infection., Clinical Implications: Women with large fistulas and decreased vaginal calibers are at high risk for sexual dysfunction and should be counseled appropriately preoperatively and offered surgical and medical interventions., Strengths & Limitations: Physical parameters were combined with qualitative interviews and FSDS-R scores to contextualize sexual health before and after surgery. Limitation is the brief follow-up of 6-12 months after surgery as many women were still abstaining from sexual activity., Conclusion: Sexual dysfunction is a complex issue for women with obstetric fistulas; although many women do not continue to experience problems, several need ongoing counseling and treatment. Pope R, Ganesh P, Chalamanda C, et al. Sexual Function Before and After Vesicovaginal Fistula Repair. J Sex Med 2018;15:1125-1132., (Copyright © 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate telomere length (TL) between patients with SLE and healthy controls and to test if TL is associated with carotid plaque., Methods: A pilot study of 154 patients with SLE and 152 controls was performed from the SOLVABLE (Study of Lupus Vascular and Bone Long-Term Endpoints) cohort. Demographic and cardiovascular disease (CVD) factors were collected at baseline. The presence or absence of plaque was evaluated by B-mode US. Genomic DNA was isolated from whole peripheral blood. TL was quantified using real-time quantitative PCR., Results: SLE women had a short TL compared with healthy controls (4.57 vs 5.44 kb, P = 0.03). SLE women showed shorter TL than controls across all age groups: <35 years (4.38 vs 6.37 kb), 35-44 years (4.52 vs 5.30 kb), 45-54 years (4.77 vs 5.68 kb) and ≥55 years (4.60 vs 4.71 kb). Among patients with SLE and carotid plaque there was a trend towards shorter TL at a younger age and it was significantly lower in the 35- to 44-year age group when compared with controls (P = 0.025). Multiple logistic regression analysis indicated a risk of carotid plaque with older age [odds ratio (OR) 1.09; 95% CI 1.06, 1.12] but not with TL (OR 1.05; 95% CI 0.97, 1.13)., Conclusion: SLE women had significantly shorter TL than controls. SLE women trended towards shorter TL at a younger age. When carotid plaque was identified, the younger SLE women had shorter TL. Only older age but not shorter TL was independently associated with carotid plaque. Additional studies are needed to confirm if TL is a novel biomarker for cardiovascular disease in SLE.

Injury prevention guided by robust injury surveillance systems (ISS's) can effectively reduce military injury rates, but ISS's depend on human interaction. This study examined experiences and requirements of key users of the Australian Defence Force (ADF) ISS to determine whether the operation of the ISS was optimal, whether there were any shortcomings, and if so, how these shortcomings might be addressed. Semistructured interviews were conducted with 18 Australian Defence Department participants located throughout Australia. Grounded theory methods were used to analyze data by developing an understanding of processes and social phenomena related to injury surveillance systems within the military context. Interviews were recorded and professionally transcribed and information contained in the transcripts was analyzed using NVivo. Key themes relating to the components of an injury surveillance system were identified from the analysis. A range of processes and sociocultural factors influence the utility of military ISS's. These are discussed in detail and should be considered in the future design and operation of military ISS's to facilitate optimal outcomes for injury prevention.

MEN1 is an autosomal dominant disorder characterized by parathyroid, pituitary, and pancreatic tumors. The MEN1 gene is located on chromosome 11q13 and encodes a 610-amino acid protein. MEN1 mutations are of diverse types and are scattered throughout the coding region, such that almost every MEN1 family will have its individual mutation. To further characterize such mutations we ascertained 34 unrelated MEN1 probands and undertook DNA sequence analysis. This identified 17 different mutations in 24 probands (2 nonsense, 2 missense, 2 in-frame deletions, 5 frameshift deletions, 1 frameshift deletional-insertion, 3 frameshift insertions, 1 donor splice site mutation, and a g-->a transition that resulted in a novel acceptor splice site in intron 4). The intron 4 mutation was found in 7 unrelated families, and the tumors in these families varied considerably, indicating a lack of genotype-phenotype correlation. However, this intron 4 mutation is the most frequently occurring germline MEN1 mutation ( approximately 10% of all mutations), and together with 5 others at codons 83-84, 118-119, 209-211, 418, and 516, accounts for 36.6% of all mutations, a finding that indicates an approach for identifying the widely diverse MEN1 mutations.

The purpose of this study was to determine if the parachutist ankle brace (PAB) decreases the number and severity of ankle injuries in an airborne Ranger battalion. A retrospective study was performed covering a 38-month period. A computer database was used to track all jump injuries with a diagnosis of ankle pain, sprain, or fracture. The frequency was calculated for ankle injuries per 1,000 jumps and the average length of medically restricted duty per ankle injury. A total of 13,782 static line parachute jumps were conducted during the study period. Without the PAB, 35 ankle injuries were seen (4.5/1,000 jumps), with 9 fractures and 316 days of medical restriction per 1,000 jumps. Using the PAB, 9 ankle injuries were seen (1.5/1,000 jumps), with 3 fractures and 71 days of medical restriction per 1,000 jumps. The correct use of the PAB appeared to significantly decrease the incidence of ankle injuries in this battalion.

This cohort study investigated whether the risk of attrition during Australian Army recruit training was predicted by the fitness, age, date of enlistment, or injury status of recruits. Subjects were 1,317 male Australian Army recruits undertaking 12 weeks of intensive training. Fitness was measured using a 20-m progressive shuttle run test (20 mSRT) in which higher scores reflected higher fitness. A total of 184 subjects failed to complete training. Two hundred seventy-six disabling lower limb training injuries were recorded; 100 were stress fractures or periostitis. Scores on the 20 mSRT ranged between 3.5 and 13.5. Multivariate survival analysis revealed a strong negative association between 20 mSRT score and risk of attrition (p < 0.001) and a positive association between sustaining a lower limb injury and risk of attrition (p < 0.001). These effects were additive. Age and enlistment date were not significantly associated with risk of attrition. Fitness and training procedures may be important, modifiable risk factors for attrition.

In 1991-1992, a pelvic stress fracture incidence of 11.2% was recorded in a cohort of 143 female Australian Army recruits. An incidence of 0.1% was recorded in a cohort of male recruits trained in the 1992-1993 year using a nearly identical program. A number of preventive strategies were instituted in an attempt to reduce the high incidence of injury in female recruits. Route march speed was reduced from 7.5 to 5 km/h, running occurred on softer surfaces, individual step length was promoted instead of marching in step, march and run formations were more widely spaced, and interval-running training replaced traditional middle-distance runs. Pelvic stress fracture incidence decreased significantly to 0.6% in an immediately subsequent cohort of 161 female recruits (chi 2 = 15.12 for 1 df; p < 0.001). It is likely that the preventive strategies reduced bone strain by reducing the frequency and forces of impact during the training period.

Tumor necrosis factor alpha (TNF-alpha) has been shown to induce the production of interstitial collagenase by fibroblasts and chondrocytes. We investigated the role of TNF-alpha in collagenase gene expression by U937 monocyte/macrophage cells. Transcription of the TNF-alpha gene was observed after 0.5 h of phorbol myristate acetate (PMA) stimulation. Collagenase mRNA expression was not observed until 5-7 h of activation with PMA. TNF-alpha was detected in the culture supernatants 2-3 h before transcription of the collagenase gene. Neutralization of TNF-alpha protein with anti-TNF-alpha antibodies significantly reduced collagenase mRNA expression. Protein kinase C (PKC) and protein tyrosine kinase (PTK) inhibition essentially abolished both PMA-induced TNF-alpha protein secretion and collagenase mRNA expression. Collagenase gene expression induced by exogenous TNF-alpha in U937 cells stimulated with a suboptimal concentration of PMA was suppressed by PTK, but not PKC, inhibition. The pyrrolidine derivative of dithiocarbamate, a potent inhibitor of nuclear factor-kappa B (NF-kappa B) activation, resulted in a marked reduction in collagenase gene transcription, however, no reduction of TNF-alpha secretion was noted. Anti-TNF-alpha antibodies inhibited PMA-induced NF-kappa B activation. These observations demonstrate an important role for TNF-alpha in the autocrine regulation of collagenase gene expression by U937 cells. Additionally, TNF-alpha-induced PTK and NF-kappa B activation were important in collagenase gene expression in this cell line.

A case of contact urticaria to a compound used in the production of the M17 protective mask is reported. The new M40/42 series protective mask has a different composition, and should be tried as an alternative to the M17 mask in service members with black rubber allergies.

In patients receiving long-term therapeutic or replacement corticosteroids, delayed or inappropriate adjustment of steroid dosage during intercurrent illness may be fatal. We used a questionnaire to assess current levels of patient knowledge, awareness of the need for action during intercurrent illness and the frequency with which steroid warning cards and Medic Alert pendants were carried, in 61 patients on long-term replacement corticosteroids and in 40 patients receiving long-term therapeutic corticosteroids. Only 67 of the 101 patients taking corticosteroids were carrying a steroid warning card. Eleven of the 21 Medic Alert owners wore their pendants. Only 18 of the 41 patients in the therapeutic group and 41 of the 60 patients in the replacement group would take appropriate action during an intercurrent illness (P < 0.001). Lack of patient knowledge in this important area emphasizes the need for continuing and effective education of these groups of patients during follow-up. An information sheet detailing the exact changes to be made during intercurrent illness may help reinforce verbal advice.

Isoprinosine (IPS) is a new anti-viral agent which appears to have immunomodulatory activities which include its ability to enhance the in vitro blastogenic responses of normal lymphocytes to mitogens. The present study compares the effects of IPS on the in vitro immune functions of peripheral blood mononuclear cells (PBMC) from systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients with its effects on PBMC from normal controls. Each mitogen (Con A, PHA or PWM) was used at its optimal concentration with a range of IPS concentrations (0-25 micrograms/ml). PHA-induced blastogenesis by PBMC from all three groups was enhanced by IPS at or above 5 micrograms/ml. The Con A-induced responses of SLE lymphocytes were significantly enhanced over controls by IPS (P less than 0.02 at 5 micrograms/ml) while those of RA lymphocytes were not. IPS had little effect on PWM-induced blastogenesis by RA lymphocytes but did enhance the blastogenic responses of SLE lymphocytes (P less than 0.01 at 5 micrograms/ml). In contrast, the characteristically high immunoglobulin synthesis by SLE lymphocytes was decreased by IPS. The mechanism responsible for these effects is not known but IL-2 production by patient lymphocytes in vitro which was low for both RA (P less than 0.01) and SLE (P less than 0.02) increased significantly (P less than 0.05) when SLE lymphocytes were cultured with IPS. These data identify IPS as an agent for the study of aberrant immune regulation in autoimmune diseases and suggest that it may have potential therapeutic value in SLE.

In order to characterize the immune complexes detected in patients with Sjogren's syndrome (SS) and with rheumatoid arthritis (RA), the sera of 19 patients with SS alone and 11 with SS plus RA were examined. Elevated quantities of circulating immune complexes (CIC) were detected in 67% by the C1q-binding assay (C1q-BA), 73% by the C1q-solid phase (C1q-SP) assay, 43% by the monoclonal rheumatoid factor solid phase assay (mRF-SP) and 33% by the mRF-inhibition assay (MRF-Inh). Elevated concentrations of IgM RF were detected in 83% and of IgG RF in 73% of the sera by radioimmunoassay. Strong correlations existed between RF of the IgM and IgG classes and both the C1q-BA and the C1q-SP. Three lines of evidence indicated that RF were important components of the immune complexes detected by these radioimmunoassays. These results indicated that in those patients with RA plus SS, as well as those with SS alone, both IgM and IgG RF made substantial contributions to immune complexes detected both by C1q-BA and C1q-SP.

This report describes an unusual case of pseudotumour of muscle caused by an eosinophilic myositis associated with peripheral blood eosinophilia, systemic illness and a pericardial effusion. The relationship of this case to other reported cases of eosinophilic myositis and the hypereosinophilic syndrome is discussed briefly.

The sera of patient with adult rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD) were employed together with sensitive radioimmunoassays to examine the relationship between immune complexes detected by three methods and the IgM, IgA and IgG classes of rheumatoid factors (RF). Compared to the controls, significantly increased concentrations of RF and immune complexes were detected for every patient group except JRA. Increased concentrations of IgA RF, IgG RF and immune complexes detected by the C1qBA and the C1qSP were strongly associated with the presence of IgM RF. Significant correlations were noted between RF (especially IgG and IgM) and immune complexes (detected by both the C1qBA and the C1qSP) for patients with RA, SLE and MCTD. These studies suggest that RF may be partially involved in the formation of the immune complexes detected by C1q-binding assays and demonstrate the need for further clarification of the constituents of the immune complexes detected in each disease.

Several aspects of interleukin-2 (IL-2) generation and function were studied employing mononuclear cells from synovial fluid (SF), synovial tissue (ST) and peripheral blood (PB) of patients with rheumatoid arthritis (RA). Decreased PHA stimulated IL-2 production by lymphocytes from rheumatoid ST, SF (P less than 0.02), and PB (P less than 0.01) was observed when compared to normal blood and SF of patients with gout. The proliferative response of rheumatoid lymphocyte blasts exposed to exogenous IL-2 was also defective (P less than 0.05-0.001). This defect was greater in SF than in rheumatoid PB (P less than 0.05-0.001). In addition to the proliferative response, the effect of IL-2 on interferon-gamma (IFN-gamma) production was also examined. Rheumatoid lymphocytes from both PB and SF produced less IFN-gamma after overnight treatment with IL-2 than did normal PB lymphocytes. This decreased IFN-gamma induction was discordant with the excellent enhancement by IL-2 of natural killer activity. Removal of adherent cells in synovial fluid did not correct this deficit. Abnormalities in the biology of IL-2 and IFN-gamma suggest that impaired T cell function could contribute to the immunopathogenesis of RA.

We have investigated the T-cell antigen receptor constant beta and alpha chain genes (TCR-C beta, -C alpha) and the immunoglobulin (Ig) heavy chain switch regions of patients with Graves' disease (GD) using restriction fragment length polymorphism (RFLP) analysis. No significant associations were found with RFLPs of either the TCR-C beta, -C alpha or Ig heavy chain switch region loci and GD. However, a significant association was found between the presence of anti-thyroglobulin (anti-Tg) antibodies in the serum of patients and the 10.0; 9.2 kb TCR-C beta genotype (P less than 0.02). Also, those patients with anti-Tg antibodies had an increased frequency of HLA-DR3 (P less than 0.025). These results suggest that genes residing in the TCR chain and major histocompatibility complex loci may be important in determining the immune response to thyroglobulin but not to the disease itself.

The determination of levels of IgM antibody to Epstein-Barr virus (EBV) capsid antigen was improved by absorbing unfractionated test serum with Staphylococcus aureus cells containing protein A. Nonspecific background fluorescence was significantly decreased, thus facilitating the reading of slides and the detection of specific fluorescent reactions in serum with low levels of this IgM antibody. Moreover, the inclusion of the absorption step eliminated false-positive reactions caused by the presence of rheumatoid factor in serum and shortened the time needed for the incubation of test serum with the EBV-infected cell smear. This improved antibody test should facilitate the laboratory diagnosis of acute EBV infections, including unaccompanied by a heterophil antibody response.