Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part I: Active lesions.

Magnetic resonance imaging (MRI) is an increasingly important tool for identifying involvement of the sacroiliac joints (SIJ) in juvenile idiopathic arthritis (JIA). The key feature for diagnosing active sacroiliitis is bone marrow edema (BME), but other features of active arthritis such as joint space inflammation, inflammation in an erosion cavity, capsulitis and enthesitis can be seen as well. Structural changes may also be seen. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the disease course, choice of therapeutics and evaluating treatment response. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of SIJ inflammation. This atlas demonstrates fundamental MRI disease features of active inflammation in a format that can serve as a reference for assessing SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 2, Structural Lesions.

Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part II: Structural damage lesions.

Magnetic resonance imaging (MRI) is the imaging modality of choice for identifying sacroiliitis in juvenile idiopathic arthritis (JIA). Besides active lesions of sacroiliitis, of which bone marrow edema (BME) is the key feature, structural damage lesions can also be detected. Structural changes include erosion, sclerosis, fat lesion, backfill and ankylosis, and are more common at later stages. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the course of the disease and evaluating treatment options. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of structural damage of sacroiliitis. This atlas can serve as a reference for assessing structural lesions of SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 1, Active Lesions.

Proteins in the tensile region of adult bovine deep flexor tendon.

Tendon proteoglycans and proteins (other than Type I collagen) were solubilized by sequential extraction of powdered adult bovine deep flexor tendon. Only the proximal (tensile) region of this tendon was used. The experiments involved 24-hour extraction with phosphate buffered saline (to remove components that are readily soluble), followed by repeated extraction with 4 mol/L guanidine (to break noncovalent bonds holding components into the tissue), and then extraction with 4 mol/L guanidine containing dithiothreitol (to dissociate components held by disulfide bonds). Proteins accounting for approximately 5% of the tissue dry weight could by removed by the extraction protocol. Proteins were identified by Western blotting and correlation with stained gels. The major extracted components were identified as decorin, Type VI collagen, fibromodulin and a member of the leucine rich repeat protein family (PRELP). In addition an oligomeric matrix protein initially identified in cartilage (COMP), aggrecan, and biglycan were present. Most of these proteins were entirely extracted in cold 4 mol/L guanidine. However, some Type VI collagen and cartilage oligomeric matrix protein could not be removed unless the tissue was reduced with dithiothreitol. Many of these proteins have been considered as molecules that are primarily or exclusively components of cartilage. Cartilage and tendon are tissues with different histologic appearance and different function. However, the fact that the same biochemical components are found in cartilage and tendon shows the relatedness of these connective tissues and the cells that produce them. Tissue engineering attempts to reconstruct tendon using only its major or unique components may omit significant aspects of the tissue's structure.

Oral contraceptive use among African American adolescents: individual and community influences.

Side effects of oral contraceptives are a noteworthy problem, particularly among low-income young women who reside in inner-city communities. The problem may be compounded by inadequate family planning services, particularly when such services are provided by general medical practices with high volumes of clients. This study examined the prevalence and correlates of pill-related side effects, with particular attention to the role of clinic characteristics. Participants were 177 pregnant and parenting African American adolescents and young women (average age = 18.34). The experience of a pill-related side effect was the most frequently cited barrier to birth control use, and it was significantly related to contraceptive behavior. Finally, although participants attending comprehensive clinics experienced more barriers to medical service use than those attending neighborhood clinics, they reported fewer problems with pill-related side effects and better psychological functioning. Implications for future research and policy are discussed.

PIP: In Study 1 the prevalence and correlates of pill-related side effects were examined among 177 pregnant and parenting African American adolescents and young women from 2 social service settings. They were recruited between December 1989 and January 1991 in the inner city of a large US midwestern city. They were 14-22 years old with a mean age of 18.34. 27.1% were pregnant and 54% had 1 child, 22.2% had 2 children, 8% had 3 children, and 0.6% had 4 children. 96% of them had never been married, and 64.4% were not in school. 90.8% were receiving public assistance. They were interviewed about background demographic variables as well as scales of stress, psychological functioning, and social support. Pregnancy and birth control histories were also assessed along with patterns of medical and social service utilization. 107 of the participants were potential birth control users because they had been recently sexually active. 35 of these participants (32.7%) said that they had not used any contraceptives at last intercourse. 44 women (61%) using contraceptives at the time of their last intercourse were using oral contraceptives. Condoms accounted for 27.8% of those who used contraception at that time. Those who indicated that pill-related side effects interfered with birth control were significantly less likely to use any form of birth control than those who did not complain of such side effects (p 0.05). Study 2 involved 31 participants, a subset of the Study 1 sample, who were 14-21 years old. 40% were pregnant and 76.7% were not in school. 15 clinics attended by the participants were identified. 15 women had attended 1 or more comprehensive clinics and 15 had attended 1 or more neighborhood clinics. Among 5 comprehensive clinic users who cited barriers, 60% cited long lines, 20% cited rude staff, and 20% cited cost. Participants who used comprehensive clinics were less likely to report side effects as a problem than were participants who used neighborhood clinics (p 0.05).

Patterns of service utilization among pregnant and parenting African American adolescents.

PIP: Adolescent childbearing is associated with a host of social and public health problems. For example, pregnant and parenting adolescents are at comparatively higher risk for dropping out of school, welfare dependency, and repeated early pregnancies, while their offspring are more likely to be born prematurely and have low birth weights. While social and health services will not summarily resolve all of these circumstances and problems, they may nonetheless help to reduce the incidence of these negative outcomes. The authors explored factors associated with differential patterns of social and health service use among 177 pregnant and parenting female African-American adolescents aged 14-22 years; participants were of mean age 18.34 years. 90.8% received welfare benefits and 96% had never been married. The researchers were able to distinguish between women who used available services either frequently, moderately, or inconsistently. These groups were distinct in terms of their frequency of service usage, perceptions of barriers to usage, and psychological and social functioning. The relatively higher levels of psychological functioning observed among moderate users suggests that they are healthier than either the frequent or inconsistent users. Inconsistent users were distinguished by their high rates of sexual victimization, low use of medical services, and their perceptions of programmatic and personal barriers to use. Suggestions are offered for research and interventions appropriate to the needs of this study population.^ieng

Sexual victimization in young, pregnant and parenting, African-American women: psychological and social outcomes.

The influence of sexual victimization on the psychological and social adjustment of 177 pregnant and parenting African Americans was examined. Compared with those who had not been victimized, young women with a history of sexual victimization were more symptomatic, had lower self esteem, and had a more external locus of control than the non-victimized women. In addition, women who were sexually victimized at some time in their lives reported higher levels of economic strain. Victimized young women were less satisfied with their social support than their non-victimized peers. Taken together, these findings suggest that the link between sexual victimization and psychological distress in pregnant and parenting adolescents may be mediated through young women's interpersonal resources.