Prednisolone dose during treatment of tuberculosis might be a risk factor for mortality in patients with systemic lupus erythematosus: a hospital-based cohort study.

Patients with systemic lupus erythematosus (SLE) are at high risk of tuberculosis (TB) because of their immunocompromised status and the use of immunosuppressive drugs. In endemic regions, TB complicates the diagnosis and treatment of SLE, but the risk factors of mortality in these patients have not been investigated. In this study, we reviewed medical records during 2006-2016. Patients who fulfilled the 1997 American College of Rheumatology SLE criteria and presented with definite TB were enrolled. The primary outcome was mortality during TB treatment. There were 5388 SLE patients screened, and 30 patients were enrolled. Seven patients died during follow-up. Compared with the survival group, patients in the mortality group had significantly more central nervous system involvement of TB, higher Systemic Lupus Erythematosus Disease Activity Index-2000 scores and more cyclophosphamide use before TB, and higher prednisolone dose before and during TB treatment. Cox regression showed that prednisolone dose during TB treatment was an independent risk factor for mortality (per 10 mg/day increase, hazard ratio (HR) 1.61, p = .019). For SLE patients, prednisolone dose during TB treatment is an independent risk factor for mortality. Keeping prednisolone dose at less than 25 mg per day during TB treatment might be a reasonable strategy in these patients.

A whole genome methylation analysis of systemic lupus erythematosus: hypomethylation of the IL10 and IL1R2 promoters is associated with disease activity.

The etiology of systemic lupus erythematosus (SLE) involves a complex interaction of genetic and environmental factors. Investigations have shown that environmentally driven epigenetic changes contribute to the etiology of SLE. Here, we hypothesize that aberrant DNA methylation may contribute to the activation of the immune machinery and trigger lupus disease activity. A whole genome methylation array was applied to investigate the DNA methylation changes between 12 pairs of active SLE patients and healthy controls. The results were further confirmed in 66 SLE patients, 102 healthy controls. The methylation statuses of the IL10 and IL1R2 genes were significantly reduced in the SLE patient samples relative to the healthy controls (age-adjusted odds ratios, 64.2 and 16.9, respectively, P<0.0001). There was a trend toward SLE patients having hypomethylated IL10 and IL1R2 genes accompanied by greater disease activity. We observed that the methylation degree of IL10 and IL1R2 genes were reduced in the rheumatoid arthritis (RA) patients as well but the hypomethylation change was more significant in IL1R2 genes than in the IL10 genes in RA patients. This study demonstrated that DNA hypomethylation might be associated with SLE. Hypomethylated IL10 and IL1R2 genes may provide potential epigenetic markers as clinical predictors for autoimmune diseases.

The prognostic values of soft tissue sonography for adult cellulitis without pus or abscess formation.

Abstract The current practice for cellulitis in diagnosis and treatment is mainly based on subjective clinical judgement without validated objective guidance. For patients with non-purulent cellulitis needing intravenous antibiotic treatment in hospital, we found soft tissue sonography performed around 4 days after initiation of antibiotics might have prognostic values. The patients with soft tissue sonographic pattern of subcutaneous thickening alone had shorter duration of antibiotic treatment and higher rate of early treatment response to antibiotics than those with the pattern of cobblestone appearance. Larger-scale research may be warranted to validate the prognostic roles of sonography in cellulitis management.

p53 downstream target DDA3 is a novel microtubule-associated protein that interacts with end-binding protein EB3 and activates beta-catenin pathway.

We have previously identified mouse DDA3 as a p53-inducible gene. To explore the functional role of DDA3, we screened a mouse brain cDNA library by the yeast two-hybrid assay, and identified the microtubule plus-end binding protein EB3 as a DDA3-interacting protein. Binding of DDA3 to EB3 was verified by glutathione S-transferase (GST) pull-down assay and subcellular colocalization; co-immunoprecipitation further indicated that interaction of these two proteins within cells required intact microtubules. Domains of DDA3-EB3 interaction were mapped by GST pull-down assay to amino acids 118-241 and 242-329 of DDA3 and the N- and C-termini of EB3. Immunofluorescence analysis revealed colocalization of DDA3 with microtubules in various cell phases, and regions encompassing aa 118-241 and 242-329 contained microtubule-interacting and bundling activities. In vitro microtubule-binding assay showed that DDA3 and EB3 associated directly with microtubules, and cooperated with each other for microtubule binding. In addition, DDA3 bound to the EB3 interacting partner adenomatous polyposis coli 2 (APC2), a homolog of the tumor suppressor APC, which is a component of the beta-catenin destruction complex. Ectopic expression of DDA3 and EB3 enhanced beta-catenin-dependent transactivation and cyclin D1 production, whereas knockdown of endogenous DDA3 or EB3 inhibited beta-catenin-mediated transactivation and the ability of cells to form colonies. Together, our results identify DDA3 as a novel microtubule-associated protein that binds to EB3, and implicate DDA3 and EB3 in the beta-catenin-mediated growth signaling.

Abnormal in vitro CXCR2 modulation and defective cationic ion transporter expression on polymorphonuclear neutrophils responsible for hyporesponsiveness to IL-8 stimulation in patients with active systemic lupus erythematosus.

OBJECTIVE: To elucidate the molecular basis of hyporesponsiveness of polymorphonuclear neutrophils (PMN) to interleukin-8 (IL-8) stimulation in patients with active SLE. METHODS: PMN obtained from active SLE and well-matched healthy individuals were studied. The expression of two IL-8 receptors, CXCR1 and CXCR2, in PMN were detected by flow cytometry and reverse transcriptase-polymerase chain reaction. The binding affinity of PMN with IL-8 was calculated by Scatchard plotting. Soluble CXCR2 level in IL-8-stimulated PMN culture supernatant was measured by sandwich enzyme-linked immunosorbent assay. The resting and IL-8-stimulated membrane potential (MP) changes, and membrane expression of cationic ion transporters including Na+-K+-ATPase, renal epithelial Na+ channel (ENaC) and renal outer medullary epithelial K+ channel 1 (ROMK1) on PMN were detected by flow cytometry. RESULTS: Compared with normal PMN, decreased CXCR2 gene expression, but normal IL-8-binding affinity of SLE-PMN, was found. For exploring the molecular basis of the defect, the modulation of CXCR2 in SLE-PMN was intensively investigated. We found that increased cytosolic CXCR2 expression in SLE-PMN was due to defective surface translocation, increased spontaneous internalization and/or increased spontaneous synthesis. The IL-8-induced CXCR2 down-regulation in SLE-PMN was also impaired due to decreased proteolytic cleavage of IL-8-IL-8 receptor complexes from the cell surface whereas IL-8-induced internalization of the complexes was normal. In addition, we originally found that increased resting but decreased IL-8-stimulated MP in SLE-PMN was relevant to defective expression of Na+-K+-ATPase, ENaC and ROMK1 on the cell surface. CONCLUSION: The abnormal CXCR2 modulation and impaired cationic ion transporter expression cause SLE-PMN hyporesponsiveness to IL-8 stimulation in vitro.

Increased multidrug resistance-associated protein activity in mononuclear cells of patients with systemic lupus erythematosus.

UNLABELLED: Multidrug resistance-associated proteins (MRPs, ATP binding cassette sub-family C), P-glycoprotein (P-gp) and ATP binding cassette (ABC) sub-family G member 2 (ABCG2) are important drug efflux pumps emerging after long-term medications. We intended to detect whether these molecules are expressed in immune-related cells of patients with systemic lupus erythematosus (SLE) on long-term immunosuppressants. METHODS: Mono nuclear cells (MNC) and polymorphonuclear neutrophils (PMN) were isolated from healthy volunteers and SLE patients. The MPR-mediated transport activity of these cells was measured by using carboxy-2',7'-dichlorofluorescein diacetate (CFDA) efflux assay. P-gp-mediated transport activity of cells was detected by rhodamine 123 efflux assay. ABCG2-mediated transport assay was evaluated by mitoxantrone efflux assay. The intracellular expression of MRP1, MRP2, and MRP3 molecules in MNC was detected by flow cytometry. The results were compared between MNC and PMN derived from normal and SLE groups. RESULTS: The specific dye-efflux function of MRPs in SLE-MNC is significantly higher than normal MNC. However, the expression of MRP1, MRP2, and MRP3 molecules in SLE-MNC was not different from normal MNC. We also noted that only the duration of corticosteroid treatment in different clinical/laboratory parameters was significantly correlated with the increased activity of MRPs in SLE-MNC. CONCLUSIONS: These results suggest that increased activity of MRPs in SLE-MNC is elicited by long-term corticosteroid therapy.

Comparison of anti-agalactosyl IgG antibodies, rheumatoid factors, and anti-cyclic citrullinated peptide antibodies in the differential diagnosis of rheumatoid arthritis and its mimics.

OBJECTIVE: Anti-agalactosyl IgG antibodies [anti-Gal(0) IgG] have been regarded as a useful serological marker for rheumatoid arthritis (RA). Our aim was to evaluate the clinical usefulness of anti-Gal(0) IgG in the differential diagnosis of rheumatic disorders that mimic RA compared to rheumatoid factors (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP). METHODS: Sera were collected from 39 patients with RA, 49 patients with primary Sjögren's syndrome (pSjS), 47 patients with systemic lupus erythematosus (SLE), 65 patients with chronic hepatitis B viral infection (HBV), 68 patients with chronic hepatitis C viral infection (HCV) and 19 normal individuals. RF-IgM was measured by the nephelometeric method, and RF-IgA, anti-Gal(0) IgG and anti-CCP were measured by the respective ELISA assays. RESULTS: Anti-Gal(0) IgG titers were remarkably elevated in patients with RA (191.0 +/- 250.8 AU/ml) compared to pSjS (37.9 +/- 42.6 AU/ml), SLE (10.3 +/- 13.6 AU/ml), chronic HBV with (36.1 +/- 38.4 AU/ml) or without rheumatic symptoms (9.6 +/- 19.4 AU/ml), RF(+) chronic HCV without rheumatic symptoms (19.0 +/- 14.8 AU/ml), chronic HCV with rheumatic symptoms (15.2 +/- 17.4 AU/ml) and healthy individuals (2.6 +/- 0.7 AU/ml). The specificity of anti-Gal(0) IgG could be greatly enhanced by elevating the cut-off value from 12 AU/ml to 40 AU/ml (68.6% vs. 85.6%, p < 0.001) without significantly compromising its sensitivity (76.9% vs. 61.5%, p > 0.05). CONCLUSION: The serum titer of anti-Gal(0) IgG is much higher in rheumatoid arthritis than in mimicking diseases. The specificity of anti-Gal(0) IgG is enhanced when the cut-off value is raised. However, anti-CCP remains the most specific biomarker for RA.

Anti-myeloperoxidase antibodies enhance phagocytosis, IL-8 production, and glucose uptake of polymorphonuclear neutrophils rather than anti-proteinase 3 antibodies leading to activation-induced cell death of the neutrophils.

Anti-neutrophil cytoplasmic antibodies (ANCA) not only are triggered by target protein myeloperoxidase (MPO) and proteinase 3 (PR3) of polymorphonuclear neutrophil (PMN) but also react with primed PMN to exert the inflammatory process in vasculitis syndrome. To clarify the crucial role of PMN in ANCA-associated vasculitis and the related mechanism, PMN was cultured with monoclonal antibody MPO-ANCA and PR3-ANCA to determine the function of phagocytosis, Interleukin- 8 (IL-8) production, glucose uptake, and TNF-related apoptosis induced ligand (TRAIL) production. The spontaneous membrane expression of MPO and PR3 on PMN could be significantly increased by lipopolysaccharide (LPS) and TNF-alpha, but not by IL-8 or GRO-alpha. The PMN-stimulating activity of ANCA was demonstrated by enhancing phagocytosis, IL-8 production, and glucose uptake that was more prominent by MPO-ANCA. The PMN stimulation by ANCA was not through protein kinase, H2O2, or superoxide anion radicals as their inhibitors exerted no effect on ANCA-mediated activation. On the other hand, ANCA also accelerated PMN apoptosis and increased TRAIL production. These results demonstrate that activation-induced cell death (AICD) mechanism could be initiated in PMN with existence of ANCA. In conclusion, MPO-ANCA is more potent in stimulating PMN than PR3-ANCA. ANCA-activated PMN is not only responsible for the amplified inflammatory process in blood vessel but also initiates immune circuit via triggered macrophage/monocyte by apoptotic PMN through the mechanism of AICD elicited by ANCA.

Intracranial epidermoid cyst with hemorrhage: MR imaging findings.

We present a case of a 28-year-old woman with a cerebellopontine angle and prepontine cistern epidermoid cyst with unusual signal intensity. She presented with cranial nerve neuropathy and unsteady gait. MR imaging showed a tumor mass with central area of hemorrhage and a focal area of heterogeneous signal intensity with spotty enhancement, which correlated histologically to old blood in a cystic lumen and granulation of a cystic wall, with a large area of hemorrhage and mild vascularity.

An evaluation of drug treatments for adolescents in 4 US cities.

BACKGROUND: Little is known about outcomes of community-based treatment programs for adolescents with drug problems. METHODS: We studied 1167 adolescents (age range, 11-18 years; 368 females, 799 males) from 4 US cities (Pittsburgh, Pa; Minneapolis, Minn; Chicago, Ill; and Portland, Ore) using a naturalistic, nonexperimental evaluation design. These adolescents were consecutive admissions during the period from 1993 to 1995 at 23 community-based treatment programs in the Drug Abuse Treatment Outcome Studies for Adolescents. Included were 418 admissions to 8 residential programs, 292 admissions to 9 outpatient drug-free programs, and 457 admissions to 6 short-term inpatient programs. RESULTS: Adolescents in treatment typically had multiple problems (eg, 58.4% of them were involved in the legal system, and 63.0% met diagnostic criteria for a mental disorder). Nevertheless, less than half (43.8%) of all patients reported weekly marijuana use in the year following treatment (dropping from 80.4% in the year before admission). Similarly, there were decreases in heavy drinking (dropping from 33.8% to 20.3%), use of other illicit drugs (dropping from 48.0% to 42.2%), and criminal involvement (dropping from 75.6% to 52.8%). Additionally, patients reported better psychological adjustment and school performance after treatment. Longer stays in treatment were positively associated with several favorable outcomes, although length of time in treatment was generally short. CONCLUSIONS: Substance abuse treatment for adolescents is effective in achieving many important behavioral and psychological improvements. Strategies specific to adolescents to improve their treatment retention and completion are needed to maximize the therapeutic benefits of drug treatment.

Endometrial stromal sarcoma mimicking submucosal myoma protruding to the vagina: MRI findings.

A 46-year-old woman complained of persistent abnormal vaginal bleeding over ten days. Her intrauterine device had been removed two years before. Soon after, she suffered from menorrhagia and metrorrhagia. An incidental finding of severe anemia was also noted. In this admission, our initial T2-weighted magnetic resonance imaging (MRI) revealed a well-demarcated mass predominantly in the uterine cavity. The mass was depicted by an isointense signal relative to the myometrium on T1-weighted images, high signal intensity on T2-weighted images, and slightly heterogeneous enhancement on post-contrast images. The patient refused surgery. After two years, follow-up MRI showed a pedunculated mass protruding into the upper third of the vagina with a stalk connecting to the posterior wall of the uterine cavity, simulating submucosal myoma. Histological diagnosis was compatible with low-grade endometrial stromal sarcoma.

Unrecognized cocaine use among schizophrenic patients.

OBJECTIVE: Unrecognized stimulant use could lead to the misdiagnosis of schizophrenia or the misunderstanding of its course and prognosis. This study was conducted to determine the prevalence of unrecognized stimulant use among patients with a clinical diagnosis of schizophrenia. METHOD: The subjects were 108 schizophrenic patients admitted consecutively to a Veterans Affairs psychiatric hospital. Admitting psychiatrists supplemented routine clinical evaluations with a semistructured interview regarding recent and lifetime use of alcohol, cocaine, amphetamine, marijuana, and opiates. A urine specimen was assayed for the four illicit drugs. RESULTS: Of the 103 patients who provided a urine specimen, 37 (36%) used cocaine during the 6 months before admission, including 31 who used the drug in the week before admission. Because of the poor reliability of negative self-reports of recent cocaine use, clinicians failed to recognize cocaine use in one-third of the patients with a urine toxicology positive for cocaine metabolites. Two other groups of patients were identified; schizophrenic patients without substance abuse (including alcohol) and schizophrenic patients with substance abuse other than stimulants. Both substance-abusing groups were younger than the nonabusing group, but the three groups had similarly high rates of recent psychotic symptoms, homelessness, and unemployment. CONCLUSIONS: Among schizophrenic patients who require hospitalization, clinicians should not rely solely on self-reported stimulant use. Recognition of stimulant use could be improved through routine urine toxicologies for all psychotic patients. The authors suggest that recognition of stimulant use among schizophrenic patients may identify a population with a better prognosis for schizophrenia and different treatment needs.

Evaluation of portable radionuclide method for measurement of left ventricular ejection fraction and cardiac output.

Seventeen patients with coronary artery, valvular, or myopathic heart disease were studied to determine correlations of the cardiac output and ejection fraction when comparing the results obtained with a portable probe technique using 113mIn with those obtained with standard methods (cineangiographic, Fick, and dye dilution). With ejection fractions ranging from o.10 to 0.85, the coefficient of correlation was 0.90 when comparing cineangiographic and radionuclide techniques. Cardiac output determinations by the radionuclide technique also correlated well with standard methods (r equals 0.88). The radionuclide method shows promise as an accurate, safe, and simple method in the evaluation of cardiac function at the bedside.

Usefulness of electron beam computed tomography in children with heterotaxy syndrome.

Children with heterotaxy syndrome frequently have complex cardiac and noncardiac malformations requiring detailed diagnostic evaluation for management planning. Direct delineation of these structures by electron beam computed tomography (EBCT) is validated as a means of diagnosis. From July 1995 to March 1997, 32 patients (16 girls, 16 boys) with clinically impressed heterotaxy syndrome were enrolled in this study. After evaluation by echocardiography, EBCT studies were performed. Interpretation of cardiac anomalies was performed by sequential analysis based on these cross-sectional images. The diagnoses were subsequently confirmed by angiocardiography and surgical findings. Twenty-eight patients had bilateral trifurcated bronchi, and most of these (24 of 28) did not have a spleen. Four patients had bilateral bifurcated bronchi, 2 patients had polysplenia, and the other 2 patients had a lobulated single spleen. We found that laterality could be identified by EBCT in all patients. Comparison of diagnostic yield between echocardiography, catheterization, and EBCT showed that EBCT is superior to echocardiography and catheterization in demonstration of pulmonary venous anatomy and presence of a very small rudimentary ventricle. In addition, associated visceral, bronchopulmonary, mediastinal, and intracardiac anomalies could all be clearly delineated by EBCT at the same time. Thus, EBCT is a promising complementary modality for an overall understanding of heterotaxy syndrome.

The effect of increased mastication by daily gum-chewing on salivary gland output and dental plaque acidogenicity.

The effect of increased mastication on plaque metabolism and salivary gland function was determined in 11 human subjects who chewed a sugarless gum for ten minutes of each waking hour for two weeks. Prior to and at the conclusion of the gum-chewing regimen, unstimulated whole saliva and 2% citric-acid-stimulated parotid saliva were collected. Flow rates, pH, and buffer capacity were determined on all saliva samples. In addition, parotid saliva was analyzed for protein concentration and the proteins further studied by SDS-PAGE. The plaque pH response to a 10% sucrose rinse was also measured before and after the regimen. Significant increases were observed in the pH and buffer capacity of unstimulated whole saliva as were similar increases in the flow rate, pH, and buffer capacity of stimulated parotid saliva. Protein concentrations and profiles remained unaffected. In addition, the resting plaque pH and minimum plaque pH reached after a sucrose challenge were both raised significantly, with a significant reduction in the cH area. The results of this study indicate that increased masticatory effort by frequent consumption of sugar-free chewing gum over a prolonged time period resulted in a functional increase in the output of stimulated parotid saliva, as well as in increases in pH and buffer capacity of whole and parotid saliva, which may help to reduce plaque acidogenicity.

Prior treatment experience related to process and outcomes in DATOS.

Using data collected from cocaine-abusing patients who participated in the Drug Abuse Treatment Outcome Studies (DATOS), we contrasted patients in treatment for the first time and patients having extensive histories of prior treatment to identify factors associated with better outcomes in each group. Compared with first-timers, treatment-experienced patients had less favorable post-treatment outcomes. Indicators of early engagement in DATOS treatment predicted post-treatment abstinence for both groups. Importantly, the interaction of treatment history and several process measures affected post-treatment abstinence. For example, individual counseling and program compliance had greater impacts on abstinence among treatment repeaters in outpatient drug-free programs than for first-timers. Social support and environmental context were significantly related to abstinence. These findings confirm the importance of considering treatment process and aftercare in developing and implementing strategies to optimize treatment for patients with different treatment histories.

Cell cations and blood pressure in US whites, US blacks, and west African blacks.

Differences in cell cation metabolism have been previously demonstrated between blacks and whites in the US. To investigate a potential racial/genetic basis for these differences we studied red cell sodium content (Nai) and platelet cytosolic calcium (Cai) in a group of US whites (n = 26), US blacks (n = 20) and West African blacks (n = 26) residing in Chicago, IL. Participants in all groups were primarily health professionals. The West Africans had lived in Africa until at least age 21 and subsequently resided in the US for an average of 19 months. Immunological markers were used to estimate European gene admixture among the US blacks. Red cell Nai was significantly lower in US whites (7.72 +/- 2.49 mEq/l cells) compared to both the US blacks and West African blacks (9.98 +/- 2.36 and 10.60 +/- 2.80, respectively; P less than 0.01) and Cai was higher in whites than among US blacks (P less than 0.05). No differences were noted in blood pressure (BP) levels among the three racial groups. A linear correlation existed between Nai and both systolic (SBP) and diastolic (DBP) (r = 0.378 and 0.339, respectively; P less than 0.01), which was strongest among the blacks, particularly the US blacks (SBP vs. Nai, r = 0.716, P less than 0.01). Approximately 20% European gene admixture was present among the US blacks. Based on these findings, it would appear that, compared to US whites, higher levels of RBC Nai are common to black persons native to the US and West Africa.(ABSTRACT TRUNCATED AT 250 WORDS)

Decreased spontaneous and lipopolysaccharide stimulated production of interleukin 8 by polymorphonuclear neutrophils of patients with active systemic lupus erythematosus.

OBJECTIVE: Interleukin 8 (IL-8) acts as a potent chemotactic cytokine and also as an autocrine factor for polymorphonuclear neutrophils (PMN), thus amplifying the acute inflammatory reaction. We undertook to study the IL-8 producing capacity of PMN in patients with systemic lupus erythematosus (SLE). METHODS: PMN from twelve patients with active SLE, from fifteen patients with inactive disease and from sixteen healthy individuals were incubated for 24 hours in medium alone, or in medium with lipopolysaccharide (LPS) or TNF-alpha. The IL-8 concentration in the culture supernatants was measured by an enzyme linked immunosorbent assay. RESULTS: We found that the spontaneous and LPS-stimulated, but not TNF-alpha-stimulated, production of IL-8 by the PMN of active SLE patients were significantly lower than that of healthy individuals. The impaired IL-8 production by SLE-PMN was linked to disease activity but not to the administration of steroid, because incubation of normal PMN or inactive SLE-PMN with prednisolone (1 microgram/ml and 5 micrograms/ml) for 24 hours did not affect IL-8 production. In addition, IL-8 production increased in three active SLE patients after effective treatment with immunosuppressants but not in two cases of ineffective treatment, in the follow-up study. CONCLUSION: These results suggest that decreased IL-8 production is one of the defects of PMN in patients with active SLE, which might predispose SLE patients to infection.

The reactivity of sera from patients with systemic lupus erythematosus to seven different species of single and double stranded deoxyribonucleic acids.

OBJECTIVE: Anti-DNA antibodies are frequently found in the serum of patients with systemic lupus erythematosus (SLE). To understand whether the avidity of SLE sera to different species of single-stranded (ss) and double-stranded (ds) DNA is different or not, the reactivity of active SLE sera to seven species of DNA from viral, bacterial, piscine, and mammalian sources was compared. METHODS: Nineteen sera from patients with active SLE were studied for their reactivity to different ssDNA and dsDNA from Escherichia coli (EC), Micrococcus lysodeikticus (ML), Clostridium perfringens (CP), calf thymus (CT), salmon testis (ST), human placenta (HP) and lambda phage by ELISA. The dsDNA was purified by treating it with S1 nuclease and proteinase K, followed by Sephacryl S-300 gel filtration. The ssDNA was purified by absorption on a hydroxyapatite column after heat-cleavage of the dsDNA. RESULTS: The reactivity of SLE sera to 7 species of dsDNA was not significantly different and they recognized a more widely shared epitope. In contrast, the reactivity of these sera to 7 species of ssDNA was erratic and the antigens could be grouped into high (CP and HP), medium (EC, ML, CT, and ST) and low (lambda-phage) antigenicities. CONCLUSION: The anti-ssDNA and anti-dsDNA antibodies of SLE patients recognize more widely shared determinants on the DNA of seven different species. Lambda-phage DNA shows the poorest immunogenicity among them.

AIDS knowledge and attitudes among injection drug users: the issue of reliability.

Among injection drug users (IDUs), AIDS-related knowledge and attitudes have not consistently predicted AIDS risk behavior. This may be due in part to the limited reliability of indexes used to measure drug users' AIDS knowledge and attitudes. In addition, the substantive interpretation of findings is confounded if index reliability is lower for particular demographic groups (e.g., ethnic populations and women). This report is based on 8 measures of AIDS-related knowledge and attitudes in a sample of 332 injection drug users in Los Angeles. The reliability of knowledge and attitude indexes for the overall sample is generally acceptable for the purpose of group comparison (average alpha = .60). But reliability is consistently lower for respondents who are Hispanic (average alpha = .49) and respondents with less formal education (alpha = .56). The reliability of 2 measures of sex-related attitudes is lower for female respondents. It is therefore important that the reliability of knowledge and attitude indexes be assessed not just for drug-user samples as a whole, but also within demographic groups of substantive interest.

PIP: This study pertains to a survey of 365 injection drug users (IDUs) in Los Angeles County from methadone maintenance/detoxification or residential drug free programs and earlier studies of AIDS risk reduction. The sample was stratified by ethnicity and gender and appeared to represent the local IDU population with treatment experience. There were 129 whites, 118 Hispanics, and 85 blacks; 174 were women and 158 men. 189 had completed high school and 143 had not. The purpose of the study was to investigate the reliability of indexes measuring AIDS-related knowledge and attitudes. Background information is provided on AIDS risk demographics and measurement, AIDS knowledge and attitudes, and summary of prior research. The instrument was newly designed to measure general knowledge about AIDS, perceived susceptibility to HIV infection and to self-efficacy regarding drug, and sex related risk reduction techniques and response efficacy of those techniques, and drug and sex-related risk reduction norms. 45 questions were asked by trained interviewers and answered by respondents in English in a Likert agree/disagree format. The results showed that knowledge, susceptibility, self-efficacy/drugs, self efficacy/sex, and norms/sex had the highest alphas ranging from .64 to .78. The minimum acceptable level is .50. The response norm/drugs is barely acceptable at .56. In the demographic analysis, alphas are the lowest for Hispanics in 7 out of 8 indexes, and with statistically significant differences in 4 indexes: response efficacy/drugs, response efficacy/sex, self-efficacy/sex, and norms/drugs. Response efficacy/sex and norms/drugs reach the acceptable minimum of .50 for blacks and whites only. Self-efficacy/sex for total does not reach a minimum acceptable level, however, it does for white at .58 and almost reaches acceptability for blacks at .43. There are inconsistent patterns by sex. In general, men are less reliable on the susceptibility index and women on the response efficacy/sex and self-efficacy/sex indices. Respondents with a high school education had alphas of .61 compared with .56 for low education respondents. There is lower reliability among lower educated respondents on self-efficacy/drugs and norms/drugs. The implications are that subgroup reliability is related to responses, such that low education and Hispanics score lower. Inconsistency of response may be due to methodological problems, which may be corrected statistically or by asking open-ended questions, and affect the effectiveness of interventions.