Cross-sectional characteristics of pediatric-onset discoid lupus erythematosus: Results of a multicenter, retrospective cohort study.

BACKGROUND: The incidence of systemic lupus in children with discoid lupus is unknown. OBJECTIVE: This study assessed the baseline characteristics of patients with pediatric discoid lupus erythematosus (pDLE). METHODS: Medical records at 17 sites were reviewed for pediatric dermatology and rheumatology patients with discoid lupus erythematosus. The inclusion criteria were clinical and/or histopathologic diagnosis of discoid lupus erythematosus with an age at onset of <18 years. Baseline data were collected at the first documented visit. Outcomes included diagnosis of systemic lupus erythematosus (SLE) at the baseline visit using the 1997 American College of Rheumatology (primary) and the 2012 Systemic Lupus International Collaborating Clinics (secondary) criteria. RESULTS: Of the >1500 charts reviewed, 438 patients met the inclusion criteria. The cohort was predominantly female (72%) and racially/ethnically diverse. A diagnosis of SLE at the baseline visit (pDLE + SLE) was rendered in 162 (37%) patients using the American College of Rheumatology and in 181 (41%) patients using the Systemic Lupus International Collaborating Clinics criteria. Patients with pDLE + SLE were older at the time of rash onset (median, 12.9 vs 8.9 years; P < .001), with shorter time from discoid lupus erythematosus onset to diagnosis, compared with patients with pDLE-only (median, 2 vs 7 months; P < .001). Patients with pDLE + SLE were more likely to be female (P = .004), with generalized discoid lupus erythematosus and clinically aggressive disease, including end-organ involvement, positive serologies, and higher- titer levels of antinuclear antibodies (P < .001). LIMITATIONS: Retrospective study. CONCLUSION: A diagnosis of discoid lupus erythematosus in adolescence should prompt thorough screening for SLE.

Rowell syndrome complicated with macrophage activation syndrome in a child.

Rowell syndrome (RS) is a rare disease characterized by the association of systemic lupus erythematosus (SLE) or cutaneous lupus with lesions similar to erythema multiforme and the presence of autoantibodies including ANA, SSA, SSB, or rheumatoid factor. Due to the low incidence of this disease, the epidemiology of RS is not clear. So far there are 95 cases reported in the literature; of these, only seven cases are pediatric patients. Macrophage activation syndrome (MAS) is an increasingly recognized complication of SLE, although its true prevalence in childhood is still unknown. We describe a unique pediatric patient with RS who developed MAS.

Production of HO2 and OH radicals from near-UV irradiated airborne TiO2 nanoparticles.

The production of gas-phase hydroperoxyl radicals, HO2, is observed directly from sub-micron airborne TiO2 nanoparticles irradiated by 300-400 nm radiation. The rate of HO2 production as a function of O2 pressure follows Langmuir isotherm behaviour suggesting O2 is involved in the production of HO2 following its adsorption onto the surface of the TiO2 aerosol. Reduction of adsorbed O2 by photogenerated electrons is likely to be the initial step followed by reaction with a proton produced via oxidation of adsorbed water with a photogenerated hole. The rate of HO2 production decreased significantly over the range of relative humidities between 8.7 and 36.9%, suggesting competitive adsorption of water vapour inhibits HO2 production. From the data, the adsorption equilibrium constants were calculated to be: KO2 = 0.27 ± 0.02 Pa-1 and KH2O = 2.16 ± 0.12 Pa-1 for RH = 8.7%, decreasing to KO2 = 0.18 ± 0.01 Pa-1 and KH2O = 1.33 ± 0.04 Pa-1 at RH = 22.1%. The increased coverage of H2O onto the TiO2 aerosol surface may inhibit HO2 production by decreasing the effective surface area of the TiO2 particle and lowering the binding energy of O2 on the aerosol surface, hence shortening its desorption lifetime. The maximum yield (i.e. when [O2] is projected to atmospherically relevant levels) for production of gas-phase HO2, normalised for surface area and light intensity, was found to be at a RH of 8.7% for the 80% anatase and 20% rutile formulation of TiO2 used here. This yield decreased to as the RH was increased to 22.1%. Using this value, the rate of production of HO2 from TiO2 surfaces under atmospheric conditions was estimated to be in the range 5 × 104-1 × 106 molecule cm-3 s-1 using observed surface areas of mineral dust at Cape Verde, and assuming a TiO2 fraction of 4.5%. For the largest loadings of dust in the troposphere, the rate of this novel heterogeneous production mechanism begins to approach that of HO2 production from the gas-phase reaction of OH with CO in unpolluted regions. The production of gas-phase OH radicals could only be observed conclusively at high aerosol surface areas, and was attributed to the decomposition of H2O2 at the surface by photogenerated electrons.

Expanding the clinical features of autoinflammation and phospholipase Cγ2-associated antibody deficiency and immune dysregulation by description of a novel patient.

BACKGROUND: Autoinflammation and phospholipase Cγ2-associated antibody deficiency and immune dysregulation (APLAID) is an exceedingly rare monogenic autoinflammatory disease. To date, only five cases have been reported with four distinct pathogenic mutations. OBJECTIVES: We present a novel case of APLAID, corroborated by molecular analysis, with newly described clinical findings including central nervous system vasculitis (CNSV); and distinctive histopathological characteristics that may expand our knowledge of this rare disease's phenotype. METHODS: This is a case report presentation of a 3-year-old boy, seen at a reference paediatric hospital in Mexico. His parents authorized the use of his clinical information and photographs. RESULTS: A 3-day-old boy presented to the emergency department with a vesiculo-pustular rash that resolved within 1 week. Two months later, he developed widespread papules and pseudovesicles that evolved into infiltrated plaques. He also had periodical flares of conjunctivitis, diarrhoea and erythematous blistering acral plaques triggered by upper respiratory infections. By the age of 10 months, he experienced seizures and CNSV. Laboratory work-up showed mild neutropenia, decreased serum levels of immunoglobulins and B-cell lymphopenia. A skin biopsy revealed a dense, perivascular and interstitial histiocytic and granulomatous infiltrate, with palisading granulomas, and leucocytoclastic vasculitis with karyorrhexis. APLAID syndrome was confirmed by Sanger sequencing of PLCG2 gene [heterozygous genotype LRG_376t1:c.2543T>C or p.(Leu848Pro)]. CONCLUSIONS: Presence of CNSV has not been previously described in APLAID, however as the number of reported patients with APLAID is very small, it is possible that the overall spectrum of clinical manifestations has not been completely elucidated. The herein identified p.(Leu848Pro) variant was also documented in a Portuguese patient, suggesting that it could be a PLCG2 gene 'hot-spot'.

Subcutaneous immunoglobulin for the treatment of deep morphoea in a child.

Morphoea, also known as localized scleroderma, is a disorder characterized by excessive collagen deposition leading to thickening of the dermis and/or subcutaneous tissues. Intravenous IgG therapy has induced improvement in some fibrotic conditions. The primary indication for subcutaneous IgG (SCIG) is in primary immunodeficiency disorders as replacement therapy; however, recently there has been considerable interest in SCIG as an immunomodulatory agent. We report an 11-year-old girl with deep morphoea who was successfully treated with SCIG.

Measurements of the HO2 uptake coefficients onto single component organic aerosols.

Measurements of HO2 uptake coefficients (γ) were made onto a variety of organic aerosols derived from glutaric acid, glyoxal, malonic acid, stearic acid, oleic acid, squalene, monoethanol amine sulfate, monomethyl amine sulfate, and two sources of humic acid, for an initial HO2 concentration of 1 × 10(9) molecules cm(-3), room temperature and at atmospheric pressure. Values in the range of γ < 0.004 to γ = 0.008 ± 0.004 were measured for all of the aerosols apart from the aerosols from the two sources of humic acid. For humic acid aerosols, uptake coefficients in the range of γ = 0.007 ± 0.002 to γ = 0.09 ± 0.03 were measured. Elevated concentrations of copper (16 ± 1 and 380 ± 20 ppb) and iron (600 ± 30 and 51 000 ± 3000 ppb) ions were measured in the humic acid atomizer solutions compared to the other organics that can explain the higher uptake values measured. A strong dependence upon relative humidity was also observed for uptake onto humic acid, with larger uptake coefficients seen at higher humidities. Possible hypotheses for the humidity dependence include the changing liquid water content of the aerosol, a change in the mass accommodation coefficient or in the Henry's law constant.

On the mechanism of iodine oxide particle formation.

The formation of atmospherically relevant iodine oxides IxOy (x = 1,…,3, y = 1,…,7) has been studied experimentally using time-of-flight mass spectrometry combined with a soft ionisation source, complemented with ab initio electronic structure calculations of ionisation potentials and bond energies at a high level of theory presented in detail in the accompanying paper (Galvez et al., 2013). For the first time, direct experimental evidence of the I2Oy (y = 1,…,5) molecules in the gas phase has been obtained. These chemical species are observed alongside their precursors (IO and OIO) in experiments where large amounts of aerosol are also generated. The measured relative concentrations of the IxOy molecules and their dependence on ozone concentration have been investigated by using chemical modelling and rate theory calculations. It is concluded that I2O4 is the most plausible candidate to initiate nucleation, while the contribution of I2O5 in the initial steps is likely to be marginal. The absence of large I3Oy (y = 3,…,6) peaks in the mass spectra and the high stability of the I2O4-I2O4 dimer indicate that dimerisation of I2O4 is the key step in iodine oxide particle nucleation.

Measurements of uptake coefficients for heterogeneous loss of HO2 onto submicron inorganic salt aerosols.

Laboratory studies were conducted to investigate the kinetics of HO2 radical uptake onto submicron inorganic salt aerosols. HO2 reactive uptake coefficients were measured at room temperature using an aerosol flow tube and the Fluorescence Assay by Gas Expansion (FAGE) technique that allowed for measurements to be conducted under atmospherically relevant HO2 concentrations ([HO2] = 10(8) to 10(9) molecule cm(-3)). The uptake coefficient for HO2 uptake onto dry inorganic salt aerosols was consistently below the detection limit (γ(HO2) < 0.004). The mass accommodation coefficient of HO2 radicals onto Cu(II)-doped (NH4)2SO4 aerosols was measured to be α(HO2) = 0.4 ± 0.3 representing the kinetic upper limit to γ. For aqueous (NH4)2SO4, NaCl and NH4NO3 aerosols not containing traces of transition metal ions, a range of γ(HO2) = 0.003-0.02 was measured. These values were much lower than γ values previously measured on aqueous (NH4)2SO4 and NaCl aerosols and also those typically used in atmospheric models (γ(HO2) = 0.1-1.0). Evidence is presented showing that the HO2 uptake coefficients onto aqueous salt aerosol particles are dependent both on the exposure time to the aerosol and on the HO2 concentration used.

Analysis of genetic polymorphism of the HLA-B and HLA-DR loci in patients with dermatophytic onychomycosis and in their first-degree relatives.

Onychomycosis is known to have predisposing factors and a high prevalence within families that cannot be explained by within-family transmission. We determined the frequency of HLA-B and HLA-DR haplotypes in 25 families of Mexican patients with onychomycosis in order to define the role of the class II major histocompatibility complex (MHC) in genetic susceptibility to this infection. Seventy-eight subjects participated in the study, 47 with onychomycosis and 31 healthy individuals. The frequencies of the HLA-B and HLA-DR haplotypes were compared with those found in first-degree relatives without onychomycosis and in a historic control group of healthy individuals. The frequencies in the controls were similar to those of the healthy relatives of the patients. However, on comparison of the patients with historic controls, we detected a higher frequency of the HLA-DR8 haplotype (P=.03; odds ratio, 1.89; 95% confidence interval, 0.98-36). These findings suggest that there are polymorphisms in genes of the MHC that increase susceptibility to onychomycosis, particularly haplotype HLA-DR8.

[Analysis of genetic polymorphism of the HLA-B and HLA-DR loci in patients with dermatophytic onychomycosis and in their first-degree relatives]. / Análisis del polimorfismo genético de los loci HLA-B y HLA-DR en pacientes con onicomicosis dermatofítica y familiares en primer grado.

Onychomycosis is known to have predisposing factors and a high prevalence within families that cannot be explained by within-family transmission. We determined the frequency of HLA-B and HLA-DR haplotypes in 25 families of Mexican patients with onychomycosis in order to define the role of the class II major histocompatibility complex (MHC) in genetic susceptibility to this infection. Seventy-eight subjects participated in the study, 47 with onychomycosis and 31 healthy individuals. The frequencies of the HLA-B and HLA-DR haplotypes were compared with those found in first-degree relatives without onychomycosis and in a historic control group of healthy individuals. The frequencies in the controls were similar to those of the healthy relatives of the patients. However, on comparison of the patients with historic controls, we detected a higher frequency of the HLA-DR8 haplotype (P=.03; odds ratio, 1.89; 95% confidence interval, 0.98-36). These findings suggest that there are polymorphisms in genes of the MHC that increase susceptibility to onychomycosis, particularly haplotype HLA-DR8.

Effect of the barometric phase transition of a DMPA bilayer on the lipid/water interface. An atomistic description by molecular dynamics simulation.

Understanding the structure and dynamics of phospholipid bilayers is of fundamental relevance in biophysics, biochemistry, and chemical physics. Lipid Langmuir monolayers are used as a model of lipid bilayers, because they are much more easily studied experimentally, although some authors question the validity of this model. With the aim of throwing light on this debate, we used molecular dynamics simulations to obtain an atomistic description of a membrane of dimyristoylphosphatidic acid under different surface pressures. Our results show that at low surface pressure the interdigitation between opposite lipids (that is, back-to-back interactions) controls the system structure. In this setting and due to the absence of this effect in the Langmuir monolayers, the behavior between these two systems differs considerably. However, when the surface pressure increases the lipid interdigitation diminishes and so monolayer and bilayer behavior converges. In this work, four computer simulations were carried out, subjecting the phospholipids to lateral pressures ranging from 0.17 to 40 mN/m. The phospholipids were studied in their charged state because this approach is closer to the experimental situation. Special attention was paid to validating our simulation results by comparison with available experimental data, therebeing in general excellent agreement between experimental and simulation data. In addition, the properties of the lipid/solution interface associated with the lipid barometric phase transition were studied.

Retinal innervation of calbindin-D28K cells in the hamster suprachiasmatic nucleus: ultrastructural characterization.

The authors have described a subregion of the hamster hypothalamic suprachiasmatic nucleus (SCN) containing cells that are immunopositive for the cytosolic calcium-binding protein, Calbindin-D28K (CaBP). Several lines of evidence indicate that this region may constitute the site of the pacemaker cells that are responsible for the regulation of circadian locomotor rhythms. First, 79% of the CaBP-immunoreactive (ir) neurons express Fos in response to photic stimulation, indicating that they are close to or part of the input pathway to pacemakers. Second, at the light microscopy level, retinal terminals innervate the CaBP subnucleus. Finally, destruction of this subnucleus renders animals arrhythmic in locomotor activity. In this study, the authors examined the ultrastructural relationship between cholera toxin (CTbeta) labeled retinal fibers and the CaBP-ir subregion within the hamster SCN. CTbeta-ir retinal terminals make primarily axo-somatic, symmetric, synaptic contacts with CaBP-ir perikarya. In addition, retinal terminals form synapses with CaBP processes as well as with unidentified profiles. There are also complex interactions between retinal terminals, CaBP perikarya, and unidentified profiles. Given that axo-somatic synaptic input has a more potent influence on a cell's electrical activity than does axo-dendritic synaptic input, cells of the CaBP subregion of the SCN are ideally suited to respond rapidly to photic stimulation to reset circadian pacemakers.

Maintenance of beta-endorphin analgesia across age cohorts.

Age-related decreases occur in analgesic responses following morphine, 2-deoxy-D-glucose, inescapable foot shock and cold-water swims. Decreased affinity and concentration of opiate receptors and levels of endogenous opioids are also observed. The present study evaluated the dose-dependent (0.1, 0.5, 1.0, 5.0 micrograms, ICV) and time-dependent (15, 30, 45, 60 min) properties of beta-endorphin analgesia on the jump test across three age cohorts of rats (8, 18 and 30 months of age). The different age cohorts failed to display differences in the magnitude of beta-endorphin analgesia across doses and times, except for a transient (30 min) decrease in the 30-month group following the 0.5 microgram dose. This maintenance of beta-endorphin analgesia across age cohorts stands in marked contrast to the age-related decrements in morphine and opiate-sensitive environmental analgesia and occurs despite decreased levels of beta-endorphin. These data are discussed in terms of differential alterations in opiate receptor subpopulations, and represent the first instance of maintained opioid analgesia across cohorts.

Comparison of ultrastructural characteristics of gonadotropin-releasing hormone neurons in prepubertal and adult male rats.

Gonadotropin-releasing hormone neurons from prepubertal (29-day-old) and adult (three-month-old) male rats were demonstrated immunocytochemically using the LR1 antibody, and prepared for electron microscopic examination. Gonadotropin-releasing hormone neurons were equally immunoreactive in the two age groups, but there were heavy deposits of reaction product in the outer nuclear envelope of these neurons in prepubertal animals. Point count stereology on electron micrographic montages of gonadotropin-releasing hormone neurons at x25,000 was used to compare the relative proportion of cytoplasm containing various subcellular organelles. More of the cytoplasm was occupied by Golgi apparatus and secretory vesicles in the prepubertal animals. The representation of mitochondria was equal in the two age groups, while there were more lysosomes in the gonadotropin-releasing hormone neurons from adult animals. The density of synaptic input to the neurons was estimated using quantitative morphometrics on electron micrographs of three levels of section through the neuron, magnified x25,000. The percentage of the perikaryal membrane with synaptic contacts was greater in the gonadotropin-releasing hormone neurons from adults. Most strikingly, there were gonadotropin-releasing hormone terminals on gonadotropin-releasing hormone soma of these neurons in prepubertal animals, but not in the adults. The highly immunoreactive outer nuclear envelope and relative larger representation of Golgi and secretory vesicles in gonadotropin-releasing hormone neurons in prepubertal animals suggest that these cells are actively synthesizing peptides, including gonadotropin-releasing hormone. The large representation of Golgi apparatus may also reflect the active biosynthesis of membrane in association with the elaboration of neuronal processes.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrastructural changes in gonadotropin-releasing hormone neurons as a function of age and ovariectomy in rats.

In this study we examined the effects of aging on various aspects of the ultrastructure of gonadotropin-releasing hormone neurons in female rats, including the density of synaptic input and the volume fraction of various subcellular organelles. In addition, we explored the possibility that removal of estrogen might provide a protective effect on the aging of the gonadotropin-releasing hormone neuron as exposure to gonadal steroids alters the time course of reproductive aging. Our experimental groups included four- and 18-20-month-old virgin female rats divided as follows: young intact, young short-term ovariectomized, old intact, old short-term ovariectomized and old long-term ovariectomized. Brain tissue was processed for immunocytochemical detection of gonadotropin-releasing hormone neurons and selected cells from the preoptic area were chosen for electron microscopic examination. The percentage of plasma membrane containing synaptic modification was quantified using a morphometrics program, and the volume fraction of lysosomes/lipofuscin, rough endoplasmic reticulum and Golgi apparatus were estimated using point count stereology. Whereas we had previously found a significant increase in the density of synaptic input to gonadotropin-releasing hormone neurons in aged virgin male rats, the density of synaptic input to gonadotropin-releasing hormone cells in the virgin female was not affected by age. The volume fraction of lysosomes/lipofuscin was increased in all age groups. Aging produced a dramatic decrease in the volume fraction of rough endoplasmic reticulum as well as a decrease in Golgi, suggesting a general decrease in biosynthetic activity of the cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Selective potentiations in opioid analgesia following scopolamine pretreatment.

The effects of the muscarinic receptor antagonist scopolamine upon analgesia induced by D-ala-D-leu-enkephalin (DADL), beta-endorphin (BEND) and morphine were examined. While scopolamine (10 mg/kg, IP) significantly potentiated the analgesic responses following DADL (40 micrograms, ICV) and morphine (5 mg/kg, SC) on the jump test, it failed to alter significantly BEND (1 microgram, ICV) analgesia.

Reduction in 2-deoxy-D-glucose analgesia following acute, but not chronic antidepressant treatment.

Acute, but not chronic, antidepressant treatment potentiates the analgesic responses following cold-water swims. The present study evaluated the effects of acute (10 mg/kg) and chronic (10 mg/kg, twice daily over 7 days) pretreatment with desipramine (DMI) upon the analgesic response following 2-deoxy-D-glucose (2DG) in rats as measured by the jump test. Acute, but not chronic, DMI pretreatment significantly reduced 2DG analgesia. These effects are discussed in terms of the heterogeneity of pain-inhibitory responses.

Differential sensitivity of opioid-induced feeding to naloxone and naloxonazine.

The high-affinity mu-1 opioid binding site has been implicated in some opioid responses (e.g., supraspinal analgesia) but not others (e.g., respiratory depression) by comparing the actions of naloxone, a short-acting, non-selective antagonist, and naloxonazine, an irreversible and selective mu-1 antagonist. The mu-1 site has been implicated in the opioid component modulating free feeding and deprivation-induced feeding, but not glucoprivic feeding. The present study compared naloxone and naloxonazine antagonism of hyperphagia induced by morphine, ethylketocyclazocine (EKC), dynorphin and d-ala2,d-leu5-enkephalin (DADL) in rats. Morphine produced a dose-dependent (0.01-5 mg/kg) hyperphagia in mildly food-deprived rats that was blocked by naloxone (0.01-10 mg/kg). Naloxonazine (10 mg/kg) shifted the morphine hyperphagia dose-response curve to the right. These effects could not be fully accounted for by the intrinsic hypophagic properties of these antagonists. EKC produced a dose-dependent (0.5-5 mg/kg) hyperphagia which was blocked by naloxone (10 mg/kg) only at low effective EKC doses. Naloxonazine (10 mg/kg) failed to affect EKC hyperphagia. Naloxone, but not naloxonazine also blocked dynorphin and DADL hyperphagia. These results indicate that feeding induced by opiate and opioid agonists are differentially mediated by the mu-1 and other opioid binding sites; these data contrast with the modulation by the mu-1 site of the supraspinal analgesia induced by each of these agonists.

Calbindin-D28K cells in the hamster SCN express light-induced Fos.

Although the suprachiasmatic nuclei (SCN) have been intensively analyzed, they contain a population of cells that has not yet been characterized. In this study, we examined the distribution of cells immunoreactive (ir) for calbindin-D28K (CaBP), calretinin (CR), parvalbumin, vasopressin-associated neurophysin (NP), substance P (SP), vasoactive intestinal peptide (VIP), and light-induced Fos-like protein. Previously unidentified cells in the core of the hamster SCN contained CaBP. Photic stimulation during the night induced Fos expression in about 75% of the CaBP-positive SCN cells, and about 50% of the Fos-positive cells in the core region expressed CaBP. These findings provide new information in the search for the cellular localization of pacemaker cells in the SCN, as photic input entrains the circadian system, and cells that receive photic input must be either part of the clock itself, or an upstream component of the clock.