Psychosocial Effects of COVID-19 in the Ecuadorian and Spanish Populations: A Cross-Cultural Study.

The world's population is currently overcoming one of the worst pandemics, and the psychological and social effects of this are becoming more apparent. We will present an analysis of the psychosocial effects of COVID-19: first, a cross-sectional study in an Ecuadorian sample (n = 301) and second, a comparative study between two samples from the Ecuadorian and Spanish populations (n = 83 each one). Participants completed an online survey to (1) describe how they felt (depression, anxiety, and stress) before and after confinement; (2) analyze which emotional and behavioral variables predict depressive symptoms, anxiety, and stress perceived after the confinement; (3) carry out a comparative study in a sample of Ecuadorian and Spanish surveys. Results indicate, first, that Ecuadorians experience significantly more depressive symptoms, anxiety, and stress after confinement. Second, variables which predict depressive symptoms and anxiety are greater public prosocial tendency, less stress as a challenge, and greater stress as a threat, as well as an empathetic tendency that implies greater emotional regulation. Experienced stress after confinement was predicted by a greater public prosocial tendency, as well as an empathetic tendency. Finally, scores for depression, anxiety, and stress are higher after confinement in both countries. However, results reveal the similarity of the psychosocial effects that are being experienced, regardless of the country, and the differences in the variables that can help explain these effects. This can contribute to the constitution of intervention plans which aim to soften and alleviate the effects produced by a situation such as that experienced with COVID-19.

Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study.

Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.

Traditional Masculinity and Aggression in Adolescence: Its Relationship with Emotional Processes.

Traditional masculinity includes norms that encourage many of the aggressive behaviors whereas traditional femininity emphasizes aggression very little. In addition, the lack of emotional regulation as well as a poor impulse control have been related to aggression and, in particular, with reactive and proactive aggression. The objective of this study is to examine the role of gender stereotypes (masculinity/femininity) in reactive and proactive aggression, through regulatory emotional self-efficacy and emotion regulation. A total of 390 adolescents participated in a longitudinal study in Valencia, Spain. Structural equations modeling (SEM) was employed to explore a two-wave longitudinal model. The results show that femininity relates to reactive aggression through regulatory emotional self-efficacy and emotion regulation. This way, both emotional self-efficacy and emotional regulation mediate the relation between femininity and reactive aggression. Furthermore, reactive and proactive aggression relate positively and directly to masculinity and negatively to femininity. Therefore, violence prevention programs with adolescents should incorporate information to break down gender stereotypes and promote strategies to manage emotions. Such efforts may be helpful to reduce aggressive behaviors and violence.

Victimization and Peer and Parents Attachment: The Mediating Effect of Regulatory Emotional Self-Efficacy.

Studies of the Spanish adolescent population has concluded that victimization is related to lack of emotional regulation and impulse control. Therefore, if a victim is unable to recognize, understand and regulate their emotions, this can result in rejection by their peers. A cross-sectional study was conducted to examine regulatory emotional self-efficacy as a possible mediator in the association between peer and parents attachment and victimization. Adolescents (n = 563) completed Regulatory Emotional Self-Efficacy, Inventory of Parents and Peer Attachment and Kid at School questionnaires. Structural equation models (SEMs) were used to predict a latent variable of victimization with parents and peer attachment, emphasizing the mediating role of regulatory emotional self-efficacy, as comprised by a positive and a negative aspect. Results showed that peer attachment had an indirect negative effect, through perceived self-efficacy, in managing a positive effect in victimization, while father attachment had an indirect negative affect, through perceived self-efficacy, in managing a negative affect in victimization, and Mother attachment had no statistically significant indirect effect in victimization. This study suggests that the roles of parents and peers, and also between mothers and fathers, are different in relation to the perception of victimization of adolescents. Findings provide relevant information regarding implications for prevention and intervention in victimization.

Negative emotions and behaviour: The role of regulatory emotional self-efficacy.

The objective of this study is to test a longitudinal model that analyses the direct effect of negative emotions (anger, depression and anxiety, wave 1) on prosocial and aggressive behaviour (wave 2) in adolescents. And the indirect effect of negative emotions (wave 1) on prosocial and aggressive behaviour (wave 2) through regulatory emotional self-efficacy. Data was obtained from 417 adolescents in a two-wave longitudinal study (225 girls, M age = 14.70 years) from schools located in Valencia, Spain. SEM was employed to explore longitudinal models. The results showed that anger had a direct relationship with prosocial behaviour and aggression, measured two years later. However, the depression and anxiety states did not predict prosociality and aggressiveness. The mediation role of regulatory emotional self-efficacy between negative emotion and behaviours was only partially confirmed. Finally, only the perception of self-efficacy in expressing positive affect is related to prosociality and aggressiveness.

Prosocial reasoning and emotions in young offenders and non-offenders / Razonamiento prosocial y emociones en adolescentes delincuentes y no delincuentes

The aim of this study was to analyse the cognitive processes (prosocial moral reasoning, perspective taking) and emotional processes (empathic concern, emotional instability, state-trait anger) which interact in predicting aggressive behaviour and prosocial behaviour of adolescents who have committed a crime and those who have not, for the purpose of establishing the predictor variables in both groups. Participants were 440 adolescents, 220 of them young offenders residing in four youth detention centres in Valencia, in which they were serving court sentences (67.3% men and 32.7% women). The other 220 were enrolled in public and private schools within the metropolitan area of Valencia (65.9% men and 34.1% women). The two subsamples were equated in age (15-18 years) and sex, controlling the representation of social classes. Prosocial moral reasoning, empathy, emotional instability, state-trait anger, prosocial behaviour, and physical and verbal aggression were assessed. Hierarchical regression analyses show the differential weight of positive emotions (empathic concern) and negative emotions (emotional instability and anger) in relation to prosocial moral reasoning in predicting aggressive behaviour in adolescents, especially offenders. The results are discussed in terms of their implications for prevention and re-education oriented to social reinsertion of young offenders (AU)

El objetivo de este estudio ha sido analizar los procesos cognitivos (razonamiento moral prosocial, toma de perspectiva) y los procesos emocionales (preocupación empática, inestabilidad emocional, ira estado-rasgo) que interactúan en la predicción de la conducta agresiva y de la conducta prosocial de los adolescentes que han delinquido y los que no, con la finalidad de establecer las variables predictoras en ambos grupos. La muestra constaba de 440 adolescentes, 220 de los cuales eran adolescentes infractores internos en cuatro centros de menores de la Comunidad Valenciana, en los que estaban cumpliendo medidas judiciales (67.3% varones y 32.7% mujeres) y los 220 restantes estaban escolarizados en centros públicos y concertados dentro del área metropolitana de Valencia (65.9% varones y 34.1% mujeres). Se equipararon las dos submuestras en edad (15-18 años) y sexo, controlando la representación de las clases sociales. Se evaluó el razonamiento moral prosocial, la empatía, la inestabilidad emocional, la ira estado-rasgo, la conducta prosocial y la agresividad física y verbal. Los análisis de regresión jerárquica realizados muestran el peso diferencial de las emociones positivas (preocupación empática) y negativas (inestabilidad emocional e ira) en relación con el razonamiento moral prosocial en la predicción de la conducta agresiva de los adolescentes, especialmente los infractores. Se comentan los resultados en cuanto a sus implicaciones para la prevención y la reeducación orientada a la reinserción social de los jóvenes infractores (AU)

Depression and aggressive behaviour in adolescents offenders and non-offenders / Depresión y agresividad en adolescents delincuentes y no delincuentes

BACKGROUND: Adolescent behaviour is strongly linked to emotions. The aim of this study is 1) analyse the differences between young offenders and non-offenders in emotional instability, anger, aggressive behaviour, anxiety and depression, and also the differences according to sex; and 2) compare the relation between emotional instability and anxiety, depression and aggressive behaviour mediated or modulated by anger in both groups. METHOD: participants are 440 adolescents, both male and female (15-18 years old). 220 were young offenders from four different correctional centres of the Valencia Region. The other 220 participants were randomly chosen from ten public and private schools in the Valencia metropolitan area. In the Schools the instruments were applied collectively in the classroom, with a 50 minutes maximum duration. In the Youth Detention Centre the application was carried out in small groups. RESULTS: The structural equation model (SEM) carried out on each group, young offenders and non-offenders show a relation between the assessed variables. Emotional instability appears strongly related with anger in both samples, but anger just predicts depression and aggressive behaviour in the offender population. CONCLUSIONS: The results give relevant information for treatment and prevention of aggressive behaviour and delinquency in teenagers through emotional regulation

ANTECEDENTES: la conducta adolescente está fuertemente determinada por las emociones. El objetivo es: 1) analizar las diferencias entre los jóvenes infractores y los no infractores en inestabilidad emocional, ira, comportamiento agresivo, ansiedad y depresión, así como las diferencias según el sexo; y 2) comparar la relación entre inestabilidad emocional y ansiedad, depresión y comportamiento agresivo mediado o modulado por la ira en ambos grupos. MÉTODO: participaron 440 varones y mujeres (15-18 años), 220 adolescentes delincuentes procedentes de cuatro Centros de Menores de la Comunidad Valenciana. Los 220 restantes fueron seleccionados aleatoriamente de diez centros públicos y concertados de Valencia. En los centros escolares los instrumentos se aplicaron colectivamente en el aula. En el Centro de Detención Juvenil, la aplicación se realizó en pequeños grupos. RESULTADOS: los Modelos de Ecuaciones Estructurales realizados para cada uno de los grupos muestran que la inestabilidad emocional aparece fuertemente relacionada con la ira en ambas muestras, pero la ira únicamente predice la depresión y la agresividad en la población delincuente. CONCLUSIONES: los resultados aportan información relevante para el tratamiento y la prevención de la agresividad y la delincuencia en la adolescencia a través de la regulación emocional, especialmente el de la ira

Molecular analysis of vascular smooth muscle cells from patients with giant cell arteritis: Targeting endothelin-1 receptor to control proliferation.

OBJECTIVE: The pathophysiology of giant cell arteritis (GCA) and the mechanisms underlying vascular remodeling, are poorly understood. We aimed to compare vascular smooth muscle cells (VSMCs) from patients with GCA and controls by a proteomic and gene expression profile approach and to identify the signaling pathways involved in proliferation. METHODS: VSMCs were cultured from temporal artery biopsies (TABs) from patients with biopsy-proven GCA (TAB+-GCA), biopsy-negative GCA (TAB--GCA), and diagnosis other than GCA (GCA-control). VSMCs from normal human aorta (HAoSMC) were used as controls. 2D-differential in-gel electrophoresis and Affymetrix chips were used to compare proteomes and gene expression profiles of VSMCs. Proliferation was assessed by BrdU incorporation assay. TAB+-GCA and GCA-control TABs underwent immunohistochemistry staining for endothelin-1 (ET-1) and receptors ETAR and ETBR. RESULTS: We identified 16, 30 and 2 protein spots differentially expressed between TAB+-GCA and GCA-control VSMCs, TAB+-GCA and TAB--GCA VSMCs and TAB--GCA and GCA-control VSMCs, respectively (fold change ≥1.5 and p≤0.05). Among the 153 proteins differentially expressed between TAB+-GCA and HAoSMC VSMCs, many were linked with ET-1. Genes differentially expressed between TAB+-GCA and GCA-control VSMCs were involved in proliferation. ET-1 was identified as a link between genes of interest. Proliferation was reduced for TAB+-GCA VSMCs on treatment with the endothelin antagonist macitentan and its active metabolite. Patients showing transmural expression of ET-1 in temporal artery lesions received a significantly higher glucocorticoid daily dose after 6-month follow-up. CONCLUSION: Inhibiting the proliferation with macitentan, combined with glucocorticoids, might be a promising therapeutic approach for patients with GCA.

Evolución de pacientes adultos tratados con técnica de arco recto / Evolution of Adult Patients Treated with Straight Wire Technique

Introducción: la técnica de arco recto produce una revolución en la aparatología fija ortodóncica y su uso en pacientes adultos representa una herramienta para el especialista. Objetivo: describir la evolución de los pacientes adultos tratados con la técnica de arco recto después del tratamiento. Métodos: se realizó un estudio cuasi experimental, en el período de septiembre de 2014 a septiembre de 2015. El universo quedó constituido por 60 pacientes, en las edades de 19 a 59 años, que fueron atendidos en el Servicio de Ortodoncia de la Clínica Estomatológica Docente Mario Pozo. El examen y el estudio de los casos se realizó en el sillón dental con luz artificial por los autores de la investigación, utilizando set de clasificación, pie de rey, regla milimetrada, modelos de estudio, radiografías periapicales y panorámicas. Resultados: en los pacientes estudiados prevaleció la evolución favorable en el 88,33%, y de ellos, el sexo masculino con el 94,44%. El grupo de edad de 19 a 34 años predominó en el 95,34% de los casos y el tipo facial euriprosopo que representó el 100%. No hubo diferencias significativas en cuanto al estado del periodonto de inserción en los pacientes antes y después del tratamiento con esta técnica. Conclusiones: la mayoría de los pacientes adultos tratados con técnica de arco recto tuvieron una evolución favorable, sin alteraciones periodontales.

Introduction: the Straight Archwire Technique has caused a true revolution in fixed orthodontic appliances and its use in adults represents an important tool for the specialists. Objective: to describe the evolution of adult patients treated with straight wire technique after treatment. Method: a quasi-experimental study was conducted in the period from September 2014 to September 2015. It included 60 patients, aged 19-59 years, who were treated at Orthodontics Department of at the “Mario Pozo” Teaching Odontology Clinic. The examination and study of cases was performed in the dental chair with artificial light by the authors of the research, using a classification set, caliper, millimeter ruler, study models, and periapical and panoramic radiographs. Results: in the studied patients with positive developments prevailed 88.33%, specifically the age group of 19-34 years with 94.44% and the euriprosopic facial type with 100%. There were no significant differences in the condition of the insertion periodontium in patients before and after the Straight Archwire treatment. Conclusion: the majority of adult patients treated with the straight archwire technique showed a satisfactory progress without periodontal alterations.

Evolución de pacientes adultos tratados con técnica de arco recto / Evolution of Adult Patients Treated with Straight Wire Technique

Introducción: la técnica de arco recto produce una revolución en la aparatología fija ortodóncica y su uso en pacientes adultos representa una herramienta para el especialista.Objetivo: describir la evolución de los pacientes adultos tratados con la técnica de arco recto después del tratamiento.Métodos: se realizó un estudio cuasi experimental, en el período de septiembre de 2014 a septiembre de 2015. El universo quedó constituido por 60 pacientes, en las edades de 19 a 59 años, que fueron atendidos en el Servicio de Ortodoncia de la Clínica Estomatológica Docente Mario Pozo. El examen y el estudio de los casos se realizó en el sillón dental con luz artificial por los autores de la investigación, utilizando set de clasificación, pie de rey, regla milimetrada, modelos de estudio, radiografías periapicales y panorámicas.Resultados: en los pacientes estudiados prevaleció la evolución favorable en el 88,33%, y de ellos, el sexo masculino con el 94,44%. El grupo de edad de 19 a 34 años predominó en el 95,34% de los casos y el tipo facial euriprosopo que representó el 100%. No hubo diferencias significativas en cuanto al estado del periodonto de inserción en los pacientes antes y después del tratamiento con esta técnica.Conclusiones: la mayoría de los pacientes adultos tratados con técnica de arco recto tuvieron una evolución favorable, sin alteraciones periodontales.(AU)

Introduction: the Straight Archwire Technique has caused a true revolution in fixed orthodontic appliances and its use in adults represents an important tool for the specialists.Objective: to describe the evolution of adult patients treated with straight wire technique after treatment.Method: a quasi-experimental study was conducted in the period from September 2014 to September 2015. It included 60 patients, aged 19-59 years, who were treated at Orthodontics Department of at the “Mario Pozo” Teaching Odontology Clinic. The examination and study of cases was performed in the dental chair with artificial light by the authors of the research, using a classification set, caliper, millimeter ruler, study models, and periapical and panoramic radiographs.Results: in the studied patients with positive developments prevailed 88.33%, specifically the age group of 19-34 years with 94.44% and the euriprosopic facial type with 100%. There were no significant differences in the condition of the insertion periodontium in patients before and after the Straight Archwire treatment.Conclusion: the majority of adult patients treated with the straight archwire technique showed a satisfactory progress without periodontal alterations.

Neurotrophins are expressed in giant cell arteritis lesions and may contribute to vascular remodeling.

INTRODUCTION: Giant cell arteritis (GCA) is characterized by intimal hyperplasia leading to ischaemic manifestations that involve large vessels. Neurotrophins (NTs) and their receptors (NTRs) are protein factors for growth, differentiation and survival of neurons. They are also involved in the migration of vascular smooth muscle cells (VSMCs). Our aim was to investigate whether NTs and NTRs are involved in vascular remodelling of GCA. METHODS: We included consecutive patients who underwent a temporal artery biopsy for suspected GCA. We developed an enzymatic digestion method to obtain VSMCs from smooth muscle cells in GCA patients and controls. Neurotrophin protein and gene expression and functional assays were studied from these VSMCs. Neurotrophin expression was also analysed by immunohistochemistry in GCA patients and controls. RESULTS: Whereas temporal arteries of both GCA patients (n = 22) and controls (n = 21) expressed nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), tropomyosin receptor kinase B (TrkB) and sortilin, immunostaining was more intense in GCA patients, especially in the media and intima, while neurotrophin-3 (NT-3) and P75 receptor (P75NTR) were only detected in TA from GCA patients. Expression of TrkB, a BDNF receptor, was higher in GCA patients with ischaemic complications. Serum NGF was significantly higher in GCA patients (n = 28) vs. controls (n = 48), whereas no significant difference was found for BDNF and NT-3. NGF and BDNF enhanced GCA-derived temporal artery VSMC proliferation and BDNF facilitated migration of temporal artery VSMCs in patients with GCA compared to controls. CONCLUSIONS: Our results suggest that NTs and NTRs are involved in vascular remodelling of GCA. In GCA-derived temporal artery VSMC, NGF promoted proliferation and BDNF enhanced migration by binding to TrkB and p75NTR receptors. Further experiments are needed on a larger number of VSMC samples to confirm these results.

Immunological profiles determine neurological involvement in Sjögren's syndrome.

BACKGROUND: Up to 68% of patients with primary Sjögren's syndrome (pSS) undergo neurological complications, and evidence for distinct immunological subgroups is emerging. We sought to determine systemic and immunological profiles associated with neurological manifestations. METHODS: 420 patients fulfilling the 2002 American-European pSS criteria were retrospectively analyzed. Neurological manifestations were diagnosed through clinical, biological, electrophysiological, and imaging findings. Biographical, clinical, and laboratory data were compared. RESULTS: Within 93 (22%) patients with neurological manifestations, peripheral and central nervous systems were involved in 66% and 44%, respectively. Raynaud's phenomenon, cutaneous vasculitis, renal involvement, and cryoglobulinemia were associated with sensorimotor neuropathy and mononeuritis multiplex (p<0.05). Conversely, pure sensory neuropathy occurred without extraglandular manifestation, and without anti-Ro/SSA antibodies (p<0.05). All neurological manifestations were associated with increased use of corticosteroids and immunosuppressive drugs (p<0.05). CONCLUSIONS: In pSS, patients with sensorimotor neuropathies and pure sensory neuropathies have distinct extraglandular and immunological profiles.

Serum and lymphocytic neurotrophins profiles in systemic lupus erythematosus: a case-control study.

BACKGROUND: Neurotrophins play a central role in the development and maintenance of the nervous system. However, neurotrophins can also modulate B and T cell proliferation and activation, especially via autocrine loops. We hypothesized that both serum and lymphocytic neurotrophin levels may be deregulated in systemic Lupus erythematosus (SLE) and may reflect clinical symptoms of the disease. METHODS: Neurotrophins in the serum (ELISA tests) and lymphocytes (flow cytometry) were measured in 26 SLE patients and 26 control subjects. Th1 (interferon-γ) and Th2 (IL-10) profiles and serum concentration of BAFF were assessed by ELISA in the SLE and control subjects. FINDINGS: We have demonstrated that both NGF and BDNF serum levels are higher in SLE patients than healthy controls (p=0.003 and p<0.001), independently of Th1 or Th2 profiles. Enhanced serum NT-3 levels (p=0.003) were only found in severe lupus flares (i.e. SLEDAI ≥ 10) and significantly correlated with complement activation (decreased CH 50, Γ=-0.28, p=0.03). Furthermore, there was a negative correlation between serum NGF levels and the number of circulating T regulatory cells (Γ=0.48, p=0.01). In circulating B cells, production of both NGF and BDNF was greater in SLE patients than in healthy controls. In particular, the number of NGF-secreting B cells correlated with decreased complement levels (p=0.05). One month after SLE flare treatment, BDNF levels decreased; in contrast, NGF and NT-3 levels remained unchanged. CONCLUSION: This study demonstrates that serum and B cell levels of both NGF and BDNF are increased in SLE, suggesting that the neurotrophin production pathway is deregulated in this disease. These results must be confirmed in a larger study with naive SLE patients, in order to avoid the potential confounding influence of prior immune-modulating treatments on neurotrophin levels.

Study of anti-Müllerian hormone and its relation to the subsequent probability of pregnancy in 112 patients with systemic lupus erythematosus, exposed or not to cyclophosphamide.

CONTEXT: Cyclophosphamide is used for renal and major extrarenal involvement in systemic lupus erythematosus (SLE) and is associated with a risk of premature ovarian failure. There are no data available about the relation between anti-Müllerian hormone (AMH) serum levels and the probability of subsequent pregnancy in SLE patients. OBJECTIVE: We analyzed AMH levels and the probability of pregnancy in SLE women exposed to cyclophosphamide. DESIGN AND SETTING: We conducted a matched cohort study in referral centers for SLE. PATIENTS: Fifty-six cyclophosphamide-exposed SLE women younger than 40 years of age and 56 control SLE women matched for age within 6 months participated in the study. MAIN OUTCOME MEASURES: AMH was measured in samples from the PLUS study (ClinicalTrials.gov no. NCT00413361). All patients were interviewed in May 2012 regarding their obstetric status. RESULTS: The mean age ± SD of the 112 patients was 31.6 ± 5.8 years. The mean AMH level was low (1.21 ± 1.01 ng/mL) and was significantly lower in patients exposed to cyclophosphamide (P = .03) and in patients older than 30 years (P = .02). During a median follow-up (interval between sampling and the interview) period of 4.2 (range, 2.5-4.8) years, 38 patients sought to become pregnant, and 32 (84.2%) succeeded. In the univariate analysis, the risk of failure was associated with cumulative cyclophosphamide dose (P = .007) and older age (P = .02), but not with AMH. CONCLUSION: We confirmed that AMH levels are low in SLE patients and decrease significantly with age and cyclophosphamide exposure. Nonetheless, the risk of failure to conceive was low and was predicted by cyclophosphamide exposure and age, but not by AMH levels.

Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study.

OBJECTIVES: Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency. SUBJECTS AND DESIGN: 150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared. RESULTS: At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05). CONCLUSION: Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.

Differential expression of neurotensin and specific receptors, NTSR1 and NTSR2, in normal and malignant human B lymphocytes.

Neurotensin, a neuropeptide growth factor, and its two specific neurotensin receptors, NTSR1 and NTSR2, were shown to be expressed by human B cell lines. Another NTSR, sortilin, which is common to neurotensin and neurotrophins, was also detected as we have previously described. Neurotensin was functional in B cell lines; it induced their proliferation and inhibited apoptosis induced by serum deprivation or Fas activation. Quantitative study of gene expression in two malignant B cell diseases showed that NTSR2 was overexpressed, NTSR1 decreased, and neurotensin was unexpressed in B cell leukemia patient's cells, as compared with healthy B cells. However, these expressions did not significantly change in large diffuse B cell lymphoma lymph nodes compared with benign ones. This study points out that neurotensin and its two specific receptors are expressed in human B lymphocytes. Such expressions were not described, and their relationship in B cell diseases, especially in chronic B cell leukemia, needs to be considered further in regard to these findings.

Central and peripheral neurological complications of primary Sjögren's syndrome.

Primary Sjögren's syndrome (pSS) is an autoimmune inflammatory disorder characterized by lymphocytic infiltration of exocrine glands, mainly the lacrimal and salivary glands leading to a chronic sicca syndrome. However, extraglandular organ systems may frequently be involved, including both central and peripheral nervous systems. Clinically significant neurologic manifestations affect approximately 20% of patients and may be the first manifestation of the disease in at least 25% of the cases. The spectrum of pSS-related neuropathies is wide including sensory neuropathies, neuronopathies, sensory-motor neuropathies, mononeuritis multiplex related to vasculitis… Central nervous system involvement is composed by multiple sclerosis-like manifestations including acute and chronic myelopathies and by more diffuse manifestations (cognitive dysfunction, subacute aseptic meningitis, encephalopathy, psychiatric symptoms, chorea, seizures…). The diagnosis and treatment of such pSS-related manifestations must be optimized in order to avoid severe disability.

[Epidemiology and physiopathogy of Sjögren's syndrome]. / Physiopathologie et épidémiologie du syndrome de Gougerot-Sjögren.

Sjögren's syndrome is defined as an autoimmune disease characterized by a progressive sicca syndrome associated with anti-SSA or SSA positivity and/or significant infiltrate at minor salivary gland biopsy. This autoimmune disease is relatively frequent, with a clinical diagnosis among women after the 5 decade. Its physiopathology, complex, associates the intervention of both environmental and genetic factors. Salivary epithelial cell is at the center of the pathological immune response of primary Sjögren's syndrome, characterized by a chronic B cell polyclonal activation potentially leading to the development of B cell lymphoma.

[Evolutive forms of primary Sjögren's syndrome]. / Formes ëvolutives du syndrome de Gougerot-Sjögren.

Primary Sjogrën's syndrome (pSS) could be restricted in 50% of the cases to glandular involvement with a chronic sicca syndrome, with a considerable alteration of quality of life. It could be complicated by systemic involvements, which are responsible of the visceral severity. Thus systemic complications could appear many years after initial pSS diagnosis and justify long-term surveillance. Initial parotid gland enlargement, Raynaud phenomenon, cutaneous vasculitis and immunological abnormalities (anti-SSA and/or SSB positivity, hypergammaglobulinemia, and cryoglobulinemia) are also implicated in systemic complications.