Classification Criteria (classification + criterion)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Evaluation of the skin sensitizing potency of chemicals by using the existing methods and considerations of relevance for elicitation

David A. Basketter
The Technical Committee of Classification and Labelling dealing with harmonized classification of substances and classification criteria under Directive 67/548/EEC on behalf of the European Commission nominated an expert group on skin sensitization in order to investigate further the possibility for potency consideration of skin sensitizers for future development of the classification criteria. All substances and preparations should be classified on the basis of their intrinsic properties and should be labelled accordingly with the rules set up in the Directive 67/548/EEC. The classification should be the same under their full life cycle and in the case that there is no harmonized classification the substance or preparation should be self-classified by the manufacturer in accordance with the same criteria. The Directive does not apply to certain preparations in the finished state, such as medical products, cosmetics, food and feeding stuffs, which are subject to specific community legislation. The main questions that are answered in this report are whether it would be possible to give detailed guidance on how to grade allergen potency based on the existing methods, whether such grading could be translated into practical thresholds and whether these could be set for both induction and elicitation. Examples are given for substances falling into various potency groups for skin sensitization relating to results from the local lymph node assay, the guinea pig maximization test, the Buehler method and human experience. [source]

Evaluating the severity of dermatologic disorders

Sarah J. Grekin
ABSTRACT Assessment of a patient's disease severity is an essential component of formulating therapeutic strategies. However, disorders of the skin are often not amenable to strict classification criteria, and the dermatologist relies upon personal thresholds of severity when assessing the patient's overall condition. A number of grading systems have arisen, primarily from the need for standardized end points in clinical trials; in some circumstances, these severity assessments may assist the clinician in the evaluation and treatment of dermatologic disease. In this review, we will summarize the results of available severity scores of frequently encountered dermatologic disorders and discuss their utility in the management of disease in a clinician's office. [source]

Macroscopic Classificatrion of Early Colorectal Carcinoma: A Comparison Between Japan and China

Fang-yu Wang
Background: To clarify the similarities and dissimilarities in the macroscopic classification criteria for early colorectal carcinoma (CRC) between Japan and China. Methods: Six early CRC cases were included in this study. Eleven Japanese and Chinese endoscopists were asked to review the colonoscopic pictures of these cases, including before and after indigocarmine spraying. After viewing the pictures, all the endoscopists individually made their classificatory diagnoses of these cases and indicated the findings on which they based each diagnosis. Results: Some lesions diagnosed by Japanese endoscopists as IIa or IIa + IIc, might be classified as Is or Isp by Chinese endoscopists. For superficial lesions consisting of elevation with central depression, IIa + depression, IIa + IIc or IIc + IIa were classified according to the ratio of elevated area/depressed area. However, international as well as interobserver differences still existed in the classification of such lesions. In addition, most Chinese endoscopists overlooked the slightly depressed part on the top of a protruded lesion. Conclusion: Discrepancies on macroscopic classification for early CRC do exist between Japanese and Chinese endoscopists, which were found not only in terminology, but also in recognition of some lesions. In order to develop a universal macroscopic classification, there is a great need for international communication and cooperation. [source]

Detecting the change of customer behavior based on decision tree analysis

EXPERT SYSTEMS, Issue 4 2005
Jae Kyeong Kim
Abstract: Understanding and adapting to changes in customer behavior is an important aspect for survival in a continuously changing environment. This paper develops a methodology based on decision tree analysis to detect the change in classified customer segments automatically between two data sets collected over time. We first define three types of changes as the emerging pattern, the unexpected change and the added/perished rule. Then, similarity and difference measures are developed for rule matching to detect all types of change. Finally, the degree of change is developed to evaluate the amount of change. Our suggested methodology based on decision tree analysis in the change detection problem can be used in more structured situations in which the manager has a specific research question and it also detects the change of classification criteria in a dynamically changing environment. A Korean Internet shopping mall case is evaluated to represent the performance of our suggested methodology, and practical business implications for this methodology are also provided. We believe that the change detection problem and the suggested methodology will become increasingly important as more data mining applications are implemented. [source]

Upper and Lower Cluster Headache: Clinical and Pathogenetic Observations in 608 Patients

HEADACHE, Issue 7 2002
Carola Cademartiri MD
Objective, Background, and Methods.,Ever since it was proposed by Ekbom and Kugelberg back in 1968 on the basis of the different location of head pain during attacks, the differentiation of cluster headache into an upper syndrome (US) and a lower syndrome (LS) has been regarded as a purely academic distinction. To evaluate whether this differentiation is indeed well founded and to understand its possible significance in the light of current pathogenetic knowledge, we rigorously applied Ekbom and Kugelberg's classification criteria to a sample of 608 patients with cluster headache (CH; 440 men and 168 women), including 483 with episodic CH, 69 with chronic CH, and 56 with CH periodicity undetermined. Results.,Of these patients, 278 could be classified as US sufferers and 330 as LS sufferers. Our data analysis showed statistically significant clinical differences between the two syndromes: pain location was more common in the ocular, temporal, and nuchal regions among LS sufferers; in addition, patients with LS reported not only a higher rate of autonomic symptoms, but also a higher predominance of nasal congestion, ptosis, and forehead and facial sweating among these symptoms. Conclusions.,Based on current anatomofunctional knowledge and on the most recent pathogenetic findings, we believe that changes in hypothalamic activity posteroinferiorly may lead to activation of the caudal part of the spinal trigeminal nucleus by way of the hypothalamus, midbrain, and trigeminal nerve fibers and consequently to activation of the trigeminovascular system with a different location in the two syndromes. More specifically, there seems to be a larger and more extensive involvement of the subnucleus caudalis in LS compared with US, where only its ventrocaudal portions are likely to be affected. [source]

Epidemiology of primary systemic vasculitis in the Australian Capital Territory and south-eastern New South Wales

A. S. Ormerod
Abstract Background:, The aim of the study was to determine the epidemiology of primary systemic vasculitis in the Australian Capital Territory and the surrounding rural region between 1995 and 2005. Methods:, Cases were ascertained by a medical record search according to international consensus classification criteria. For antineutrophil cytoplasmic antibody-associated vasculitides, ascertainment was corroborated by a search of all positive antineutrophil cytoplasmic antibody serology during the study period. Denominators were obtained from region-specific census data collected during the study period. Prevalence, incidence and patient characteristics for primary systemic vasculitides were determined for two 5-year periods, 1995,1999 and 2000,2004. Results:, We identified 41 cases of primary systemic vasculitides (Wegener's granulomatosis (WG), microscopic polyangiitis (MPA), Churg,Strauss syndrome or polyarteritis nodosa) between 1995 and 1999 and 67 between 2000 and 2004, giving prevalences of 95/million (95% confidence interval (CI) 76.9,116.1) and 148/million (95%CI 125.1,173.9), respectively. Annual incidence was similar in both periods (approximately 17/year per million adult population). Disease-specific incidences (per million per year) for each of the two periods were 8.8 and 8.4 for WG, 2.3 and 5.0 for MPA, 2.3 and 2.2 for Churg,Strauss syndrome and 2.3 and 1.1 for polyarteritis nodosa. The rural incidence of MPA was 13.9 (95%CI 7.7,23.5) compared with 1.6 (95%CI 0.2,7.2) in the city and there was a trend towards a higher incidence of WG in rural than urban areas. Conclusion:, The overall incidence of primary systemic vasculitides is similar to that reported from other developed countries. WG is more common in south-eastern Australia than in southern Europe, whereas MPA is less common. There was a trend towards higher incidence of antineutrophil cytoplasmic antibody-associated vasculitides in rural than urban areas. [source]

Evaluation of the Implementation of Nursing Diagnoses, Interventions, and Outcomes

Maria Müller-Staub PhD
PURPOSE.,This paper aims to provide insight into nursing classifications and to report the effects of nursing diagnostics implementation. This paper summarizes the results of six studies. METHODS.,Two systematic reviews, instrument development and testing, a pre,post intervention study, and a cluster-randomized trial were performed. FINDINGS.,The NANDA International classification met most of the literature-based classification criteria, and results showed the Quality of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) to be a reliable instrument to measure the documented quality of nursing diagnoses, interventions, and outcomes. Implementation of standardized nursing language significantly improved the quality of documented nursing diagnoses, related interventions, and patient outcomes. As a follow-up measure, Guided Clinical Reasoning (GCR) was effective in supporting nurses' clinical reasoning skills. CONCLUSIONS.,Carefully implementing classifications led to enhanced, accurately stated nursing diagnoses, more effective nursing interventions, and better patient outcomes. IMPLICATIONS.,Rethinking implementation methods for standardized language and using GCR is recommended. Based on the results of this study, the inclusion of NANDA International diagnoses with related interventions and outcomes in electronic health records is suggested. [source]

Association of Sjögren's syndrome and rosacea: a diagnostic challenge

Leopoldo Luiz Dos SANTOS-NETO
Abstract Both Sjögren's syndrome and rosacea present clinical manifestations that include ocular involvement. We report a case of a 45-year-old woman with a history of persistent erythematous malar rash, associated with conjunctival hyperemia, xerophthalmia and blefaritis. The patient filled the current classification criteria proposed for Sjögren's syndrome and those for rosacea. The coexistence of these diseases has not been previously described in the literature. Both diseases have similar symptoms and different treatment approaches. We believe that it is important for clinicians to identify this association in order to provide better care for the patient. [source]

Fibromyalgia in Maori and European New Zealanders

Patrick Klemp
Abstract Aim:,The objectives of this study were to determine: (i) the prevalence of fibromyalgia (FM) in Maori and European New Zealanders; and (ii) whether an association exists between hypermobility and FM. Methods:,The 1990 American College of Rheumatology classification criteria were used to determine the prevalence of FM (both criteria), widespread pain (WP) only, and a tender point score (TPS) , 11 only, in subjects aged 12 years and older. Beighton's method was used to determine hypermobility. Results:,The prevalence of FM in Maori (1.1%) and European (1.5%) New Zealanders was similar (an overall prevalence of 1.3%); 1.7% Maori and 3.9% Europeans had WP only; and 1.7% Maori and 0.9% Europeans had a TPS of , 11 only. In Maori, the prevalence of WP and a TPS , 11 were the same and similar to the prevalence of FM. In Europeans, WP was 2.6-fold more common than FM. None of the subjects with FM, WP only or a TPS , 11 only was hypermobile. Conclusion:,The prevalence of FM was similar in Maori and European New Zealanders, and similar to most other population studies. In Maori, WP and a TPS , 11 were equally specific for FM whereas in Europeans, WP was more sensitive but less specific for FM than a TPS , 11. There was no association between hypermobility and FM. [source]

Choosing between alternative classification criteria to measure the labour force state

Erich Battistin
Summary., Labour force counting relies on general guidelines that are set by the International Labour Office to classify individuals into three labour force states: employment, unemployment and inactivity. However, the resulting statistics are known to be sensitive to slight variations in operational definitions which are prima facie consistent with the general guidelines. We consider two interpretations of the general guidelines, operationalized by the criterion that is currently followed by Eurostat and a criterion that was followed by the Italian Statistical Office up to 1992. After showing that the labour force statistics resulting from the two criteria differ considerably, we compare individuals whose classification depends on the criterion that is adopted with individuals whose classification is common between criteria to study the boundary between unemployment and inactivity. An application of our strategy is presented using data from the Italian Labour Force Survey, painting a picture neatly against the criterion that is currently followed by Eurostat. [source]

Antimitochondrial antibodies in patients with chronic hepatitis C virus infection: description of 18 cases and review of the literature

M. Ramos-Casals
Summary., To describe the clinical and immunologic patterns of disease expression of patients with chronic hepatitis C virus (HCV) infection and positive antimitochondrial antibodies (AMA). We investigated the presence of AMA in 237 consecutive HCV patients with extrahepatic manifestations from an International Registry. AMA were detected by indirect immunofluorescence in triple rat tissue (liver, stomach and kidney), aceton-fixed criosections and FITC-conjugated rabbit anti-human immunoglobulins. We found positive AMA in 18 (8%) out of 237 HCV patients. All patients were female with a mean age at protocol inclusion of 65.8 years (ranging from 37 to 87 years). Twelve (67%) patients fulfilled classification criteria for systemic autoimmune diseases (SAD), including Sjögren's syndrome (n = 7), systemic sclerosis (n = 3) and systemic lupus erythematosus (n = 2). Fourteen (78%) of the HCV-AMA patients presented at least one of the highly suggestive characteristics of primary biliary cirrhosis (PBC): 9 (50%) had a specific M2 pattern, 6 (33%) had more than twice normal levels of alkaline phosphatase, 5 (28%) had raised IgM levels and 4 (22%) a histological pattern compatible with PBC. Five (28%) patients developed neoplasia after detection of AMA. Seven (39%) patients died, due to neoplasia (n = 4), cirrhotic complications (n = 2) and hepatopulmonary syndrome (n = 1). We describe a subset of HCV patients with positive AMA who presented a broad spectrum of clinical features, including liver, autoimmune and neoplasic manifestations. Two-thirds of these patients presented an associated SAD, mainly Sjögren's syndrome or systemic sclerosis, together with a high frequency of multiple autoantibodies and an increased prevalence of cirrhosis and neoplasia. [source]

Phonological Awareness and Rapid Naming Skills of Children with Reading Disabilities and Children with Reading Disabilities Who Are At Risk for Mathematics Difficulties

Justin C. Wise
Limited research has examined the skills of children with a reading disability (RD) and children with RD and a mathematics disability (MD). Even less research has examined the phonological awareness (PA) and rapid automatized naming (RAN) skills in these two groups of children and how these skills relate to reading and math achievement. Additionally, various classification criteria are frequently implemented to classify children with MD. The purpose of this study, therefore, was to examine the PA and RAN skills in children who met different criteria for RD only and children with RD who are at risk for mathematics difficulties (MDR). Participants were 114 second- or third-grade students with RD from public elementary schools in three large metropolitan areas. Students were classified as at risk for mathematics difficulties utilizing a 25th-percentile cutoff and a 15th-percentile cutoff as assessed by the KeyMath-Revised Test (Connolly, 1988). A series of PA and RAN measures were administered along with a range of reading and mathematics measures. Hierarchical regression analyses indicated that children with RD only evidenced a different pattern of results compared to children with RD + MDR. Additionally, using a more stringent criterion to classify children at risk for mathematics difficulties resulted in a differential pattern of results when compared to a less stringent classification criterion. [source]

Persistent rhinitis , allergic or nonallergic?

ALLERGY, Issue 2004
C. Bachert
Summary Although rhinitis has been classified as being either allergic, noninfectious, or ,,other forms'' (nonallergic noninfectious), these categories lack strict classification criteria and often overlap. The term ,,nonallergic noninfectious rhinitis'' is commonly applied to a diagnosis of any nasal condition, in which the symptoms are similar to those seen in allergic rhinitis but an allergic aetiology has been excluded. This group comprises several subgroups with ill-defined pathomechanisms, and includes idiopathic rhinitis, irritative-toxic (occupational) rhinitis, hormonal rhinitis, drug-induced rhinitis, and other forms (non-allergic rhinitis with eosinophilia syndrome [NARES], rhinitis due to physical and chemical factors, food-induced rhinitis, emotion-induced rhinitis, atrophic rhinitis). Unlike allergic rhinitis, there are no specific diagnostic tests and diagnosis is primarily based on a history of reaction to specific irritant-toxic triggering agents (either general or occupational), drugs, infections, and hormonal status, coupled with exclusion of allergic rhinitis and other forms of non-allergic rhinitis by skin prick testing. Accordingly, from a clinical standpoint NARES, irritative-toxic, hormonal, drug-induced and idiopathic rhinitis are possibly the least difficult forms of nonallergic rhinitis to diagnose. [source]

Neurochemical biomarkers in the differential diagnosis of movement disorders,

Brit Mollenhauer MD
Abstract In recent years, the neurochemical analysis of neuronal proteins in cerebrospinal fluid (CSF) has become increasingly accepted for the diagnosis of neurodegenerative dementia diseases such as Alzheimer's disease and Creutzfeldt,Jakob disease. CSF surrounds the central nervous system, and in the composition of CSF proteins one finds brain-specific proteins that are prioritized from blood-derived proteins. Levels of specific CSF proteins could be very promising biomarkers for central nervous system diseases. We need the development of more easily accessible biomarkers, in the blood. In neurodegenerative diseases with and without dementia, studies on CSF and blood proteins have investigated the usefulness of biomarkers in differential diagnosis. The clinical diagnoses of Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration still rely mainly on clinical symptoms as defined by international classification criteria. In this article, we review CSF biomarkers in these movement disorders and discuss recent published reports on the neurochemical intra vitam diagnosis of neurodegenerative disorders (including recent CSF ,-synuclein findings). © 2009 Movement Disorder Society [source]

Assessing obesity: are ethnic differences in body mass index and waist classification criteria justified?

W. P. T. James

Current issues in Sjögren's syndrome

ORAL DISEASES, Issue 3 2002
Roland Jonsson
Sjögren's syndrome is a chronic autoimmune and rheumatic disorder with prominent sicca complaints from the mucous membranes because of lack of proper exocrine secretions. There is no straightforward and simple diagnostic test for Sjögren's syndrome, although several classification criteria have been designed including several oral diagnostic tests. A new set of classification criteria in a joint effort by research groups in Europe and USA has recently been presented. A large number of autoantibodies have been reported in Sjögren's syndrome where, in some cases, the antibodies are correlated with the extent and severity of disease. The finding of serum autoantibodies directed against the muscarinic M3 receptor is an important advance in understanding the pathogenesis of not only the impaired glandular function but also associated features of autonomic dysfunction in some patients. The treatment of primary Sjögren's syndrome is still mainly symptomatic. [source]

2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative,

Daniel Aletaha
Objective The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA. Methods A joint working group from the ACR and the European League Against Rheumatism developed, in 3 phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease,this being the appropriate current paradigm underlying the disease construct "rheumatoid arthritis." Results In the new criteria set, classification as "definite RA" is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0,5), serologic abnormality (score range 0,3), elevated acute-phase response (score range 0,1), and symptom duration (2 levels; range 0,1). Conclusion This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct "rheumatoid arthritis." [source]

The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report

Tuhina Neogi
Objective The American College of Rheumatology and the European League Against Rheumatism have developed new classification criteria for rheumatoid arthritis (RA). The aim of Phase 2 of the development process was to achieve expert consensus on the clinical and laboratory variables that should contribute to the final criteria set. Methods Twenty-four expert RA clinicians (12 from Europe and 12 from North America) participated in Phase 2. A consensus-based decision analysis approach was used to identify factors (and their relative weights) that influence the probability of "developing RA," complemented by data from the Phase 1 study. Patient case scenarios were used to identify and reach consensus on factors important in determining the probability of RA development. Decision analytic software was used to derive the relative weights for each of the factors and their categories, using choice-based conjoint analysis. Results The expert panel agreed that the new classification criteria should be applied to individuals with undifferentiated inflammatory arthritis in whom at least 1 joint is deemed by an expert assessor to be swollen, indicating definite synovitis. In this clinical setting, they identified 4 additional criteria as being important: number of joints involved and site of involvement, serologic abnormality, acute-phase response, and duration of symptoms in the involved joints. These criteria were consistent with those identified in the Phase 1 data-driven approach. Conclusion The consensus-based, decision analysis approach used in Phase 2 complemented the Phase 1 efforts. The 4 criteria and their relative weights form the basis of the final criteria set. [source]

Juvenile idiopathic arthritis and HLA Class I and Class II interactions and age-at-onset effects

Jill A. Hollenbach
Objective The aim of this study was to quantitate risk and to examine heterogeneity for HLA at high resolution in patients with the most common subtypes of juvenile idiopathic arthritis (JIA), IgM rheumatoid factor,negative polyarticular JIA and oligoarticular JIA. Use of 4-digit comprehensive HLA typing enabled great precision, and a large cohort allowed for consideration of both age at disease onset and disease subtype. Methods Polymerase chain reaction,based high-resolution HLA typing for class I and class II loci was accomplished for 820 patients with JIA and 273 control subjects. Specific HLA epitopes, potential interactions of alleles at specific loci and between loci (accounting for linkage disequilibrium and haplotypic associations), and an assessment of the current International League of Associations for Rheumatology classification criteria were considered. Results An HLA,DRB1/DQB1 effect was shown to be exclusively attributable to DRB1 and was similar between patients with oligoarticular JIA and a younger subgroup of patients with polyarticular JIA. Furthermore, patients with polyarticular JIA showed age-specific related effects, with disease susceptibility in the group older than age 6 years limited to an effect of the HLA,DRB1*08 haplotype, which is markedly different from the additional susceptibility haplotypes, HLA,DRB1*1103/1104, found in the group with oligoarticular JIA and the group of younger patients with polyarticular JIA. Also in contrast to findings for oligoarticular JIA, patients with polyarticular arthritis had no evidence of an HLA class I effect. Markers associated with a reduced risk of disease included DRB1*1501, DRB1*0401, and DRB1*0701. DRB1*1501 was shown to reduce risk across the whole cohort, whereas DRB1*0401 and DRB1*0701 were protective for selected JIA subtypes. Surprisingly, the disease predisposition mediated by DPB1*0201 in individuals without any disease-predisposing DRB1 alleles was great enough to overcome even the very strong protective effect observed for DRB1*1501. Conclusion Inherited HLA factors in JIA show similarities overall as well as differences between JIA subtypes. [source]

Antimalarial treatment may have a time-dependent effect on lupus survival: Data from a multinational Latin American inception cohort

Samuel K. Shinjo
Objective To evaluate the beneficial effect of antimalarial treatment on lupus survival in a large, multiethnic, international longitudinal inception cohort. Methods Socioeconomic and demographic characteristics, clinical manifestations, classification criteria, laboratory findings, and treatment variables were examined in patients with systemic lupus erythematosus (SLE) from the Grupo Latino Americano de Estudio del Lupus Eritematoso (GLADEL) cohort. The diagnosis of SLE, according to the American College of Rheumatology criteria, was assessed within 2 years of cohort entry. Cause of death was classified as active disease, infection, cardiovascular complications, thrombosis, malignancy, or other cause. Patients were subdivided by antimalarial use, grouped according to those who had received antimalarial drugs for at least 6 consecutive months (user) and those who had received antimalarial drugs for <6 consecutive months or who had never received antimalarial drugs (nonuser). Results Of the 1,480 patients included in the GLADEL cohort, 1,141 (77%) were considered antimalarial users, with a mean duration of drug exposure of 48.5 months (range 6,98 months). Death occurred in 89 patients (6.0%). A lower mortality rate was observed in antimalarial users compared with nonusers (4.4% versus 11.5%; P< 0.001). Seventy patients (6.1%) had received antimalarial drugs for 6,11 months, 146 (12.8%) for 1,2 years, and 925 (81.1%) for >2 years. Mortality rates among users by duration of antimalarial treatment (per 1,000 person-months of followup) were 3.85 (95% confidence interval [95% CI] 1.41,8.37), 2.7 (95% CI 1.41,4.76), and 0.54 (95% CI 0.37,0.77), respectively, while for nonusers, the mortality rate was 3.07 (95% CI 2.18,4.20) (P for trend < 0.001). After adjustment for potential confounders in a Cox regression model, antimalarial use was associated with a 38% reduction in the mortality rate (hazard ratio 0.62, 95% CI 0.39,0.99). Conclusion Antimalarial drugs were shown to have a protective effect, possibly in a time-dependent manner, on SLE survival. These results suggest that the use of antimalarial treatment should be recommended for patients with lupus. [source]

Classification, presentation, and initial treatment of Wegener's granulomatosis in childhood

David A. Cabral
Objective To compare the criteria for Wegener's granulomatosis (WG) of the American College of Rheumatology (ACR) with those of the European League Against Rheumatism/Pediatric Rheumatology European Society (EULAR/PRES) in a cohort of children with WG and other antineutrophil cytoplasmic antibody (ANCA),associated vasculitides (AAVs), and to describe the interval to diagnosis, presenting features, and initial treatment for WG. Methods Eligible patients had been diagnosed by site rheumatologists (termed the "MD diagnosis") since 2004. This diagnosis was used as a reference standard for sensitivity and specificity testing of the 2 WG classification criteria. Descriptive analyses were confined to ACR-classified WG patients. Results MD diagnoses of 117 patients (82 of whom were female) were WG (n = 76), microscopic polyangiitis (n = 17), ANCA-positive pauci-immune glomerulonephritis (n = 5), Churg-Strauss syndrome (n = 2), and unclassified vasculitis (n = 17). The sensitivities of the ACR and EULAR/PRES classification criteria for WG among the spectrum of AAVs were 68.4% and 73.6%, respectively, and the specificities were 68.3% and 73.2%, respectively. Two more children were identified as having WG by the EULAR/PRES criteria than by the ACR criteria. For the 65 ACR-classified WG patients, the median age at diagnosis was 14.2 years (range 4,17 years), and the median interval from symptom onset to diagnosis was 2.7 months (range 0,49 months). The most frequent presenting features by organ system were constitutional (89.2%), pulmonary (80.0%), ear, nose, and throat (80.0%), and renal (75.4%). Fifty-four patients (83.1%) commenced treatment with the combination of corticosteroids and cyclophosphamide, with widely varying regimens; the remainder received methotrexate alone (n = 1), corticosteroids alone (n = 4), or a combination (n = 6). Conclusion The EULAR/PRES criteria minimally improved diagnostic sensitivity and specificity for WG among a narrow spectrum of children with AAVs. Diagnostic delays may result from poor characterization of childhood WG. Initial therapy varied considerably among participating centers. [source]

The shared epitope hypothesis in rheumatoid arthritis: Evaluation of alternative classification criteria in a large UK Caucasian cohort

Ann W. Morgan
Objective Many classification systems for the HLA,DRB1 allelic association with rheumatoid arthritis (RA) have been reported, but few have been validated in additional populations. We sought to evaluate 3 different DRB1 allele classification systems in a large cohort of Caucasian RA patients and control subjects in the UK. Methods HLA,DRB1 typing was undertaken in 1,325 Caucasian RA patients and 462 healthy Caucasian controls who were residents of the UK. Logistic regression analyses were performed to investigate the different classification systems. Results We confirmed the association between the susceptibility alleles S2 and S3P, as proposed by Tezenas du Montcel, and the presence of RA in UK Caucasians. A significant hierarchy of risk was observed within the S3P allele group. There was no evidence of a significant association between DRB1*1001 and RA. Our data did not support the hypothesis that an isoleucine at position 67 conferred protection against RA, other than in contrast to the susceptibility alleles. However, the presence of an aspartic acid at amino acid 70 did appear to confer some degree of protection. Conclusion We were unable to fully substantiate any of the 3 recent revisions of the shared epitope hypothesis in this large cohort of Caucasian RA patients and control subjects in the UK. This reinforces the importance of evaluating disease susceptibility alleles in different Caucasian populations as well as in other ethnic groups. In particular, it will be important to clarify the precise DRB1 association in a given population before DRB1 genotyping is incorporated into clinical diagnostic or treatment algorithms. [source]

Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: A double-blind, randomized, placebo-controlled trial

Henrike van Dongen
Objective To determine whether patients with undifferentiated arthritis (UA; inflammatory, nontraumatic arthritis that cannot be diagnosed using current classification criteria) benefit from treatment with methotrexate (MTX). Methods The PRObable rheumatoid arthritis: Methotrexate versus Placebo Treatment (PROMPT) study was a double-blind, placebo-controlled, randomized, multicenter trial involving 110 patients with UA who fulfilled the American College of Rheumatology (ACR) 1958 criteria for probable RA. Treatment started with MTX (15 mg/week) or placebo tablets, and every 3 months the dosage was increased if the Disease Activity Score was >2.4. After 12 months, the study medication was tapered and discontinued. Patients were followed up for 30 months. When a patient fulfilled the ACR criteria for RA (primary end point), the study medication was changed to MTX. Joint damage was scored on radiographs of the hands and feet. Results In 22 of the 55 patients (40%) in the MTX group, UA progressed to RA compared with 29 of 55 patients (53%) in the placebo group. However, in the MTX group, patients fulfilled the ACR criteria for RA at a later time point than in the placebo group (P = 0.04), and fewer patients showed radiographic progression over 18 months (P = 0.046). Conclusion This study provides evidence for the efficacy of MTX treatment in postponing the diagnosis of RA, as defined by the ACR 1987 criteria, and retarding radiographic joint damage in UA patients. [source]

Prevalence of rheumatoid arthritis in persons 60 years of age and older in the United States: Effect of different methods of case classification

Elizabeth K. Rasch
Objective To determine prevalence estimates for rheumatoid arthritis (RA) in noninstitutionalized older adults in the US. Prevalence estimates were compared using 3 different classification methods based on current classification criteria for RA. Methods Data from the Third National Health and Nutrition Examination Survey (NHANES-III) were used to generate prevalence estimates by 3 classification methods in persons 60 years of age and older (n = 5,302). Method 1 applied the "n of k" rule, such that subjects who met 3 of 6 of the American College of Rheumatology (ACR) 1987 criteria were classified as having RA (data from hand radiographs were not available). In method 2, the ACR classification tree algorithm was applied. For method 3, medication data were used to augment case identification via method 2. Population prevalence estimates and 95% confidence intervals (95% CIs) were determined using the 3 methods on data stratified by sex, race/ethnicity, age, and education. Results Overall prevalence estimates using the 3 classification methods were 2.03% (95% CI 1.30,2.76), 2.15% (95% CI 1.43,2.87), and 2.34% (95% CI 1.66,3.02), respectively. The prevalence of RA was generally greater in the following groups: women, Mexican Americans, respondents with less education, and respondents who were 70 years of age and older. Conclusion The prevalence of RA in persons 60 years of age and older is ,2%, representing the proportion of the US elderly population who will most likely require medical intervention because of disease activity. Different classification methods yielded similar prevalence estimates, although detection of RA was enhanced by incorporation of data on use of prescription medications, an important consideration in large population surveys. [source]

Temporal arteritis and Chlamydia pneumoniae: Failure to detect the organism by polymerase chain reaction in ninety cases and ninety controls

Michael J. Regan
Objective To examine the reported correlation between the presence of Chlamydia pneumoniae in temporal artery biopsy specimens and the diagnosis of temporal arteritis (TA). Methods Among 90 possible cases of TA identified at our institution between 1968 and 2000, 79 of the positive biopsy specimens (88%) demonstrated giant cells and the other 11 cases (12%) had other histopathologic features compatible with TA; by chart review, all 90 patients were confirmed to have met the American College of Rheumatology classification criteria for TA. Controls had negative temporal artery biopsy specimens during the same 32-year time period and their postbiopsy disease courses were not compatible with TA. Controls were matched with each case by sex, year of biopsy, and age within 10 years. The biopsy specimens from all cases and controls were reevaluated and readings were confirmed in a masked manner by an experienced eye pathologist. Polymerase chain reaction (PCR) analyses for C pneumoniae were performed on the 180 samples using 2 different sets of PCR primers (which target 2 different genes). A primer set targeting the ompA gene (CP1-CP2/CPC-CPD) was used to perform a nested PCR, followed by confirmation of the findings with primers targeting the 16S ribosomal RNA (rRNA) gene (Cpn90/Cpn91) in a touchdown-enzyme time-release PCR. We used positive and negative controls, as well as controls made from infected and noninfected HEp-2 cells, suspended in a formalin-fixed, paraffin-embedded matrix. Results Seventy-six percent of the 180 cases and controls were women. The mean age of the cases was 72.0 years (range 53,90), and that of the controls was 70.4 years (range 51,86). Eighty percent of the control samples were obtained by temporal artery biopsy performed within 1 year of the biopsies performed on the matched cases. Using the CP1-CP2/CPC-CPD primer set, only 1 TA case sample (1% of all case samples) was positive for the ompA gene. One control sample was also positive using these primers. With the Cpn90/Cpn91 primers, none of the cases and none of the controls were positive for the 16S rRNA gene. Conclusion The results of this study using sensitive and specific PCR analyses do not support a role for C pneumoniae in the pathogenesis of TA. [source]

How to diagnose rheumatoid arthritis early: A prediction model for persistent (erosive) arthritis

Henk Visser
Objective To develop a clinical model for the prediction, at the first visit, of 3 forms of arthritis outcome: self-limiting, persistent nonerosive, and persistent erosive arthritis. Methods A standardized diagnostic evaluation was performed on 524 consecutive, newly referred patients with early arthritis. Potentially diagnostic determinants obtained at the first visit from the patient's history, physical examination, and blood and imaging testing were entered in a logistic regression analysis. Arthritis outcome was recorded at 2 years' followup. The discriminative ability of the model was expressed as a receiver operating characteristic (ROC) area under the curve (AUC). Results The developed prediction model consisted of 7 variables: symptom duration at first visit, morning stiffness for ,1 hour, arthritis in ,3 joints, bilateral compression pain in the metatarsophalangeal joints, rheumatoid factor positivity, anti,cyclic citrullinated peptide antibody positivity, and the presence of erosions (hands/feet). Application of the model to an individual patient resulted in 3 clinically relevant predictive values: one for self-limiting arthritis, one for persistent nonerosive arthritis, and one for persistent erosive arthritis. The ROC AUC of the model was 0.84 (SE 0.02) for discrimination between self-limiting and persistent arthritis, and 0.91 (SE 0.02) for discrimination between persistent nonerosive and persistent erosive arthritis, whereas the discriminative ability of the American College of Rheumatology 1987 classification criteria for rheumatoid arthritis was significantly lower, with ROC AUC values of 0.78 (SE 0.02) and 0.79 (SE 0.03), respectively. Conclusion A clinical prediction model was developed with an excellent ability to discriminate, at the first visit, between 3 forms of arthritis outcome. Validation in other early arthritis clinics is necessary. [source]

Flat galaxies in the SDSS DR6

S.J. Kautsch
Abstract This study presents the fractions of different spiral galaxy types from a complete and homogeneous sample of 15 127 edge-on disk galaxies extracted from the sixth data release from the Sloan Digital Sky Survey. The sample is divided in broad morphological classes and sub types consisting of galaxies with bulges, intermediate types and galaxies which appear bulgeless. A small fraction of disky irregulars is also detected. The morphological separation is based on automated classification criteria which resemble the bulge sizes and the flatness of the disks. Each of these broad classes contains about 1/3 of the total sample. Using strict criteria for selecting pure bulgeless galaxies leads to a fraction of 15 % of simple disk galaxies (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Edge-on disk galaxies in the SDSS DR6: Fractions of bulgeless and other disk galaxies

S.J. KautschArticle first published online: 2 JAN 200
Abstract The aim of this study is to determine the fractions of different spiral galaxy types, especially bulgeless disks, from a complete and homogeneous sample of 15 127 edge-on disk galaxies extracted from the sixth data release from the Sloan Digital Sky Survey. The sample is divided in broad morphological classes and sub types consisting of galaxies with bulges, intermediate types and galaxies which appear bulgeless. A small fraction of disky irregulars is also detected. The morphological separation is based on automated classification criteria which resemble the bulge sizes and the flatness of the disks. Each of these broad classes contains about 1/3 of the total sample. Using strict criteria for selecting pure bulgeless galaxies leads to a fraction of 15% of simple disk galaxies. We compare this fraction to other galaxy catalogs and find an excellent agreement of the observed frequency of bulgeless galaxies. Although the fraction of simple disk galaxies in this study does not represent a "cosmic" fraction of bulgeless galaxies, it shows that the relative abundance of pure disks is comparable to other studies and offers a profound value of the frequency of simple disks in the local Universe. This fraction of simple disks emphasizes the challenge for formation and evolution models of disk galaxies since these models are hard pressed to explain the observed frequency of these objects (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source]

Differences between subtypes of children with ADHD and simple attentional difficulties during an initial assessment

Peter Weber
Abstract Objective: To examine differences between subtypes of children with attention-deficit/hyperactivity disorder (ADHD), simple attentional difficulties and situational ADHD during an initial assessment. Method: In a single-centre study examination data of 205 children who had an initial assessment between January 1, 2002 and December 31, 2003 were retrospectively analyzed. The groups of children were compared with respect to their history features, neuromotor deficits, neuropsychological performance, and comorbid behavioural and developmental deficits by standardized test procedures and questionnaires. Results: Children with ADHD more frequently have a positive family history of attentional symptoms than non-ADHD children. There is no difference between these groups with respect to the associated behavioural problems. Children classified as ADHD show more neuromotor problems and neuropsychological deficits than children with non-ADHD attentional problems. Children with ADHD subtype hyperactive/impulsive demonstrate better neuropsychological performance than children with subtypes inattentive and combined. Children with situational home-only or school-only ADHD show no clear differences in neuromotor behaviour, comorbid problems or neuropsychological performance. Conclusions: There are clear neuropsychological differences between children who fulfil the classification criteria of The Diagnostic and Statistical Manual of Disease, Fourth Revision (DSM-IV) for ADHD and children who are confronted daily with attentional difficulties, but do not fulfil the criteria for ADHD. In contrast, differences in behavioural comorbidities were not found, nor were differences found between home-only and school-only ADHD children. [source]

Strategies of emotion regulation in adolescents and young adults with substance dependence or eating disorders

Blaise Pierrehumbert
Some authors argue that both substance dependence and eating disorders should be considered as dependent behaviours. Similarities and differences between these disorders, however, remain unclear. This study compares processes of emotion regulation in adolescents and young adults (15 to 25 years old) with substance dependence (SD) or eating disorders (ED). One hundred and thirteen SD, 50 ED and 86 non-clinical subjects (NC), recruited in four French and Swiss locations, completed a self-report questionnaire of emotion regulation strategies. This questionnaire addresses the subjects' relationships, concerning past and present family, and refers to Main's (1990) concept of primary strategy (balanced activation and deactivation of attachment behaviours), and of secondary strategies (hyperactivation or excessive deactivation of the attachment system). Participants were also questioned in structured interviews, about life events and DSM-IV classification criteria. SD reported more adverse events than ED and NC. SD and ED reported using fewer primary strategies than NC, and SD had secondary strategies that were different from those of ED. Patients with eating disorders reported more hyperactivation, and SD reported more deactivation of the attachment system. It is hypothesized that while subjects with SD and ED have in common poorly regulated strategies, they differ in the way they process emotion or relationship-related information. Copyright © 2002 John Wiley & Sons, Ltd. [source]