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Background Systemic lupus erythematous (SLE) is a systemic autoimmune/inflammatory condition. Approximately 15–20% of patients develop symptoms before their 18th birthday and are diagnosed with juvenile-onset SLE (JSLE). Gender distribution, clinical presentation, disease courses and outcomes vary significantly between JSLE patients and individuals with adult-onset SLE. This study aimed to identify age-specific clinical and/or serological patterns in JSLE patients enrolled to the UK JSLE Cohort Study. Methods Patient records were accessed and grouped based on age at disease-onset: pre-pubertal (≤7 years), peri-pubertal (8–13 years) and adolescent (14–18 years). The presence of American College of Rheumatology (ACR) classification criteria, laboratory results, disease activity [British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) scores] and damage [Systemic Lupus International Collaborating Clinics (SLICC) damage index] were evaluated at diagnosis and last follow up. Results A total of 418 JSLE patients were included in this study: 43 (10.3%) with pre-pubertal disease onset; 240 (57.4%) with peri-pubertal onset and 135 (32.3%) were diagnosed during adolescence. At diagnosis, adolescent JSLE patients presented with a higher number of ACR criteria when compared with pre-pubertal and peri-pubertal patients [pBILAG2004 scores: 9(4–20] vs. 7(3–13] vs. 7(3–14], respectively, p = 0.015] with increased activity in the following BILAG domains: mucocutaneous ( p = 0.025), musculoskeletal ( p = 0.029), renal ( p = 0.027) and cardiorespiratory ( p = 0.001). Furthermore, adolescent JSLE patients were more frequently ANA-positive ( p = 0.034) and exhibited higher anti-dsDNA titres ( p = 0.001). Pre-pubertal individuals less frequently presented with leukopenia ( p = 0.002), thrombocytopenia ( p = 0.004) or low complement ( p = 0.002) when compared with other age groups. No differences were identified in disease activity (pBILAG2004 score), damage (SLICC damage index) and the number of ACR criteria fulfilled at last follow up. Conclusions Disease presentations and laboratory findings vary significantly between age groups within a national cohort of JSLE patients. Patients diagnosed during adolescence exhibit greater disease activity and “classic” autoantibody, immune cell and complement patterns when compared with younger patients. This supports the hypothesis that pathomechanisms may vary between patient age groups.

A pilot study assessed an electronic informed consent model within a randomized controlled trial (RCT). Participants who were recruited for the parent RCT project were randomly selected and randomized to either an electronic consent group ( n = 32) or a simplified paper-based consent group ( n = 30). Results from the electronic consent group reported significantly higher understanding of the purpose of the study, alternatives to participation, and who to contact if they had questions or concerns about the study. However, participants in the paper-based control group reported higher mean scores on some survey items. This research suggests that an electronic informed consent presentation may improve participant understanding for some aspects of a research study.

Objectives To describe the epidemiology of end stage renal disease (ESRD). Design Mixed-methods systematic review. Setting The countries of the Gulf Cooperation Council (GCC) which consist of Saudi Arabia, the United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman. Participants Defined to have ESRD or patients on regular dialysis for a minimum dialysis period of at least three months. Since many outcomes were reviewed, studies that estimated the incidence and prevalence of ESRD as outcomes should not have defined the study population as ESRD population or patients on regular dialysis. Studies where the study population mainly comprised children or pregnant woman were excluded. Main outcome measures The trends of the incidence, prevalence, and mortality rate of ESRD; also, causes of mortality, primary causes and co-morbid conditions associated with ESRD. Results 44 studies included in this review show that the incidence of ESRD has increased while the prevalence and mortality rate of ESRD in the GCC has not been reported sufficiently. The leading primary causes of ESRD recorded in the countries of the GCC is diabetes with the most prevalent co-morbid conditions being Hypertension and Hepatitis C Virus infection; the most common cause of death was cardiovascular disease and sepsis. Conclusions This review highlights that the lack of national renal registries data is a critical issue in the countries of the GCC. The available data also do not provide an accurate and updated estimate for relevant outcomes. Additionally, considering the increasing burden of chronic kidney disease (CKD), these results stressed the needs and the importance of preventative strategies for leading causes of ESRD. Furthermore, more studies are needed to describe the epidemiology of ESRD and for assessing the overall quality of renal care.

The purpose of this study was to assess whether a computerized battery of neuropsychological tests could produce similar results as the conventional forms. Comparisons on 77 volunteer undergraduates were carried out with two neuropsychological tests: Line Orientation Test and Enhanced Cued Recall Test. Firstly, students were assigned randomly across the test medium (paper-and-pencil versus computerized). Secondly, the groups were given the same test in the other medium after a 30-day interval between tests. Results showed that the Enhanced Cued Recall Test–Computer-based did not correlate with the Enhanced Cued Recall Test-Paper-and-pencil results. Line Orientation Test–Computer-based scores, on the other hand, did correlate significantly with the Line Orientation Test–Paper-and-pencil version. In both tests, scores were higher on paper-and-pencil tests compared to computer-based tests. Total score difference between modalities was statistically significant for both Enhanced Cued Recall Tests and for the Line Orientation Test. In both computer-based tests, it took less time for participants to complete the tests.

Low vitamin D levels have been found in patients with autoimmune diseases, including type I diabetes, rheumatoid arthritis, multiple sclerosis and systemic lupus erythematosus. The main source of vitamin D is exposure to sunlight, but the same solar radiation is known to exacerbate lupus erythematosus. We investigated the prevalence of vitamin D insufficiency in patients with cutaneous lupus erythematosus (CLE). We designed a cross-sectional study including 55 patients with CLE to measure their serum 25-hydroxyvitamin D (25(OH)D) by chemiluminescence immunoassay and compare it with a control group consisting of 37 healthy sex and age-matched subjects recruited from the patients' relatives as well as healthcare workers. Correlations with clinical and demographic variables were determined. Approximately 95% of patients with CLE had less than 30 ng/ml of serum 25(OH)D, which is accepted as the lower limit for vitamin D adequacy. Mean serum vitamin D values were significantly lower than controls (p = 0.038) and were associated with higher levels of parathyroid hormone (p = 0.050). A history of CLE was a strong predictor of insufficiency of vitamin D (odds ratio 4.2; 95% confidence interval 1.0-17.4). The results suggest a role of CLE in the metabolism of the vitamin and provide guidance for future studies looking at a potential role for vitamin D in the prevention and treatment of CLE. Lupus (2010) 19, 810-814.

Background: The toes play an important stabilizing role in weightbearing activities. However, the factors that influence toe plantarflexion strength are poorly understood, and there are no validated measures for assessing toe weakness in the clinical setting. Therefore, the objectives of this study were to determine whether plantarflexion strength of the toes differs according to age and gender and to evaluate the validity of a clinical screening test for assessing toe plantarflexor weakness (the paper grip test). Methods: Plantarflexion strength of the hallux and lesser toes was measured in 40 young participants (20 men and 20 women, mean age 20.8 ± 2.2 years) and 40 older participants (20 men and 20 women, mean age 74.6 ± 5.7 years) using a pressure platform in conjunction with clinical assessment using the paper grip test. Results: Older participants exhibited 32% less plantarflexion strength of the hallux and 27% less plantarflexion strength of the lesser toes compared to younger participants, and women exhibited 42% less hallux plantarflexor strength than men. Gender did not influence lesser toe plantarflexor strength. Participants who failed the paper grip test exhibited significantly reduced plantarflexion strength for both the hallux and lesser toes. The sensitivity and specificity of the paper grip test of the hallux to predict plantarflexor strength less than 2.6 kg was 80% and 79%, respectively, and the sensitivity and specificity of the paper grip test of the lesser toes to predict plantarflexor strength less than 2.2 kg was 75% and 74%, respectively. Conclusions: These findings indicate that aging is associated with reduced plantarflexion strength of the toes. The paper grip test may be a useful screening tool to detect toe weakness in the clinical setting.

The work presented in this paper details the design and performance characteristics of a new hyperspectral visible imaging technique. Rather than using optical filters or a dispersing element, this design implements Fourier transform spectroscopy to achieve spectral discrimination. One potentially powerful application of this new technology is the nondestructive analysis and authentication of written and printed documents. Document samples were prepared using red, blue, and black inks. The samples were later altered using a different ink of the same color. While the alterations are undetectable to the naked eye, the alterations involving the blue and black inks were easily detected when the spectrally resolved images were viewed. Analysis of the sample using the red inks was unsuccessful. A 2004 series $20 bill was imaged to demonstrate the application to document authentication. The results argue that counterfeit detection and quality control during printing are plausible applications of Fourier transform hyperspectral visible imaging. All of the images were subjected to fuzzy c-means cluster analysis in an effort to objectively analyze and automate image analysis. Our results show that cluster analysis can distinguish image features that have remarkably similar visible transmission spectra.

Reading from a visual display terminal (VDT) has increased enormously with widespread computer use. Whether such reading affects higher cognitive processes requires study so the effect of display medium (LCD screen vs paper) and luminance contrast (1:3, 1:7, 1:11) on concept-formation performance and EEG responses was investigated. 96 men and 24 women participated in two concept-formation tasks (rule learning vs attribute and rule learning). Concept-formation performance and EEG responses were similar for stimuli displayed on paper or LCD screen. The concern that the screen may be detrimental to conception-formation performance was not confirmed; however, luminance contrast significantly affected time to complete a concept-formation task and EEG response. The middle contrast (1:7) had the smallest mean EEG power, so this contrast might be appropriate for cognitive performance. Participants' performance was significantly faster and EEG power lower for the rule-learning task than for an attribute and rule-learning task.

Artefacts in dental radiographs are not uncommon findings. In some cases, however, such film faults might lead to difficult or even wrong diagnoses. In this brief report, the authors present a case where a small piece of paper cast a foreign body-like image onto a panoral radiograph. The importance of proper techniques and film handling when taking radiographs cannot be over-emphasised.

The reactivity of rabbit antisera to rat lung secretory proteins with other rodent species was evaluated by immunocytochemistry. Rabbit anti-rat surfactant apoprotein antiserum reacts with the cytoplasm of rat, mouse, and hamster type II pneumocytes and is specific for these cells. Rabbit antiserum to rat Clara cell secretory proteins stains rat, mouse, and hamster Clara cells. Rabbit antisera specific to the two antigenic types of rat Clara cell antigens were also both reactive with rat, mouse, and hamster Clara cells. An antiserum to the non-serum proteins of hamster lung lavage was also prepared and shown to be specifically reactive with hamster Clara cells. The availability of specific reagents for secretory proteins of rodent lungs is expected to facilitate studies of the respective cell types in various pathologic states.

The radioimmunoassay described measures TSH in dried whole blood spots collected from neonates onto filter paper Guthrie cards. Microgranular cellulose is added to the precipitating reagent at the critical separation stage of the assay to overcome imprecision caused by the presence of the filter paper sample disc in the tube. The method was developed for a regional neonatal screening unit and has been found to be very reliable during ten months' routine use. It was required to be as precise, sensitive, accurate, rapid, simple, and inexpensive as possible and suitable for use with automatic diluting equipment in order to process large numbers of samples. Other methods were examined for their suitability and found not to fulfil one or more of the above criteria.

A multicentre study for the detection of congenital hypothyroidism by enzyme-immunoassay of thyrotropin in filter paper blood spots is described. The method is accurate, with good precision and adequate sensitivity. No interference due to common blood constituents has been observed. Moreover, the TSH determination can easily be performed by photometric measurement of enzyme activity. Large series of samples can be processed by automation using common laboratory analysers. Values show good agreement with those obtained by RIA methods. We present a method for screening for congenital hypothyroidism which can be performed in all clinical laboratories.

Previous methods for assessing the control of diabetes at home have concentrated on the measurement of glucose concentrations in urine and, more recently, blood. These levels reflect only one aspect of deranged metabolism in the disease. A technique is described whereby glucose, lactate, and 3-hydroxybutyrate can be measured in capillary blood samples dried on boric acid impregnated filter paper. The technique is sufficiently sensitive to measure 0·05 mmol/l glucose, 0·02 mmol/l lactate, and 0·004 mmol/l 3-hydroxybutyrate with precisions of 4·0%, 4·5%, and 8·0%, respectively. This method could prove useful in the broader metabolic assessment of the diabetic state.