OBJECTIVE

Alexithymia is a characteristic style of thinking and feeling involving deficits in the recognition of emotions. It is associated with depression onset and severity in younger adults, but researchers have not yet examined the association between alexithymia and depression severity in clinically depressed older adults.

METHODS

Cross-sectional.

METHODS

One hundred thirty-four patients aged 50 years or older with a confirmed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I mood disorder and currently receiving mental health treatment.

METHODS

Alexithymia was measured using the Toronto Alexithymia Scale-20, a 20-item measure with subscales assessing difficulty identifying feelings, difficulty describing feelings (DDF), and externally oriented thinking. Depression symptom severity was measured using the Beck Depression Inventory, Second Edition (BDI-II).

RESULTS

Total alexithymia scores were independently related to depressive symptom severity after controlling for demographics, cognitive functioning, and illness burden. DIF and DDF subscale scores were also independently associated with BDI-II scores.

CONCLUSIONS

The association between alexithymia and depression symptom severity could be attributed to difficulties in recognizing and describing negative emotions and resulting delays in seeking mental health treatment. Future research should focus on modifiable risk factors related to difficulties identifying and describing feelings.

Direct Immunofluorescence (DIF) is invaluable in the diagnosis of cutaneous vesiculobullous lesions (VBL). It is limited by technical factors and disease nature. 1) To record the sensitivity of DIF in VBL 2) To correlate DIF with clinical, histologic findings and analyse discrepancies.

METHODS

A retrospective study of 100 DIFs on suspected VBL of skin. DIF, histology and clinical data were reviewed. 73/100 cases showed DIF patterns concordant with clinical/histologic diagnosis. The sensitivity of DIF was 88% in Pemphigus group (39/ 44), 82% in Bullous Pemphigoid (BP) (23/28), and 20% in Dermatitis Herpetiformis (DH) (1/5).18 cases of histologically proven VBL were negative and of these, 4 had no epidermis. The remaining 9 cases were discordant with clinical/histologic features, including 4 BP and 5 DH, whose histology was non-specific and will be discussed in detail. One case of DH showed an aberrant vasculitic pattern. DIF is of great value in the diagnosis of VBL, specially in clinical/histologic dilemmas. In DH, neither biopsy nor DIF were very useful and response to therapy was the standard. Sampling errors contributed to false negative results. Proper selection of cases and judicious use are mandatory to optimize its' utility.

To evaluate the antitumor and antimetastatic efficacy of oral fluoropyrimidines, alone and combined with taxane on human breast cancer xenografts model, we developed a breast cancer model that spontaneously metastasizes to the lung by orthotopic implantation of MDA-MB-435S-HM tumors into the mammary fat pad (mfp) of SCID mice. The activity of the 5-fluorouracil (5-FU)-degrading enzyme dihydropyrimidine dehydrogenase (DPD) was significantly higher in the metastatic tumors than in the primary tumors. Based on this enzymatic characteristic of pulmonary metastases of breast cancer in regard to 5-FU metabolism, we investigated the antitumor activity of two types of oral 5-FU prodrugs, with and without paclitaxel, on both orthotopically implanted breast tumors and metastatic lung tumors in mice. The drugs and doses used were: S-1, a new oral DPD-inhibiting fluoropyrimidine (DIF) 8.3 mg/kg/day, capecitabine 360 mg/kg/day as a non-DIF, and paclitaxel 50 mg/kg, all of which display minimal toxicity in mice. In the primary tumors, paclitaxel and S-1 displayed a significant antitumor activity, with 57 and 41%, respectively inhibition of tumor growth (p < 0.01), but capecitabine had no effect. When S-1 and paclitaxel were combined, they synergistically caused tumor regression (tumor growth inhibition ratio 94%, p < 0.01) in mice compared to capecitabine plus paclitaxel, without any toxicity. In the pulmonary metastasis model, paclitaxel, and both S-1 alone and combined with paclitaxel, but not capecitabine alone or combined with paclitaxel, diaplayed almost complete antimetastatic activity. These results strongly suggest that combination of S-1, as a DIF with taxanes will show a potent high antitumor and antimetastatic effect on refractory human breast cancers, especially those expressing strong DPD activity.

OBJECTIVE

To determine the percentage of patients with dermatitis herpetiformis (DH) who experience at least 2 years of remission and to identify factors associated with DH remission.

METHODS

Retrospective cohort study.

METHODS

National Institutes of Health (NIH).

METHODS

Patients seen at the NIH during the 1972-2010 period who had clinical findings consistent with DH, whose normal skin showed the presence of granular IgA deposits at the dermoepidermal junction on direct immunofluorescence (DIF) examination, whose age of disease onset was known, who had DH for at least 2 years, and who were followed up for at least 3 years after the initial NIH visit.

METHODS

Remission, defined as absence of skin lesions and symptoms of DH for more than 2 years while not taking sulfones (dapsone or sulfoxone), sulfapyridine, anti-tumor necrosis factor agents, or oral steroids and not adhering to a gluten-free diet.

RESULTS

Among 86 patients, in 10 (12%) the disease underwent remission (95% confidence interval, 6%-20%). Factors associated with DH remission included DH age of onset at 39 years or older vs onset at ages 8 to 38 years (unadjusted P = .02; adjusted P = .07) and DH onset year between 1960 and 1972 vs onset between 1935 and 1959 or after 1972 (P = .02 for global comparison of 4 onset-year groups).

CONCLUSIONS

Dermatitis herpetiformis can go into remission. Clinicians should attempt to wean patients with well-controlled DH from a gluten-free diet and/or use of sulfones or other therapies to determine if the DH might have remitted. Our findings provide insight into the pathogenesis and course of this disease and may serve to guide long-term management of patients with DH.

Cell death in the model organism Dictyostelium, as studied in monolayers in vitro, can be induced by the polyketide DIF-1 or by the cyclical dinucleotide c-di-GMP. c-di-GMP, a universal bacterial second messenger, can trigger innate immunity in bacterially infected animal cells and is involved in developmental cell death in Dictyostelium. We show here that c-di-GMP was not sufficient to induce cell death in Dictyostelium cell monolayers. Unexpectedly, it also required the DIF-1 polyketide. The latter could be exogenous, as revealed by a telling synergy between c-di-GMP and DIF-1. The required DIF-1 polyketide could also be endogenous, as shown by the inability of c-di-GMP to induce cell death in Dictyostelium HMX44A cells and DH1 cells upon pharmacological or genetic inhibition of DIF-1 biosynthesis. In these cases, c-di-GMP-induced cell death was rescued by complementation with exogenous DIF-1. Taken together, these results demonstrated that c-di-GMP could trigger cell death in Dictyostelium only in the presence of the DIF-1 polyketide or its metabolites. This identified another element of control to this cell death and perhaps also to c-di-GMP effects in other situations and organisms.

Dam methylates GATC sequences in γ-proteobacteria genomes, regulating several cellular functions including replication. In Vibrio cholerae, which has two chromosomes, Dam is essential for viability, owing to its role in chr2 replication initiation. In this study, we isolated spontaneous mutants of V. cholerae that were able to survive the deletion of dam. In these mutants, homologous recombination and chromosome dimer resolution are essential, unless DNA mismatch repair is inactivated. Furthermore, the initiator of chr2 replication, RctB, is no longer required. We show that, instead, replication of chr2 is insured by spontaneous fusion with chr1 and piggybacking its replication machinery. We report that natural fusion of chr1 and chr2 occurred by two distinct recombination pathways: homologous recombination between repeated IS elements and site-specific recombination between dif sites. Lastly, we observed a preferential fusion of the two chromosomes in their terminus of replication.

The terminus region of the Caulobacter crescentus chromosome and the dif chromosome dimer resolution site were characterized. The Caulobacter genome contains skewed sequences that abruptly switch strands at dif and may have roles in chromosome maintenance and segregation. Absence of dif or the XerCD recombinase results in a chromosome segregation defect. The Caulobacter terminus region is unusual, since it contains many essential or highly expressed genes.

The prevalence of childhood abuse and neglect (CAN) histories and their associations with alexithymia among male substance-dependent inpatients were studied. Participants were 159 consecutively admitted male substance dependents (115 alcohol and 44 other drugs). Substance dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. Patients were investigated with the Toronto Alexithymia Scale (TAS-20) and Childhood Abuse and Neglect Questionnaire. Among substance-dependent patients, 57.0% had at least one type of CAN and 45.3% were considered as alexithymic since they had a score greater than 60 on the TAS-20. Rate of unemployment, low educational status, emotional abuse and history of suicide attempts were higher in alexithymic substance dependent patients. Those who had histories of two or more types of childhood abuse or neglect had also higher mean score on TAS-20, particularly on the item "difficulty in identifying feelings-DIF." Also, the number of childhood trauma types was positively correlated with TAS-20 and DIF and the "difficulty in describing feelings-DDF" items of TAS-20. History of childhood emotional abuse was the only determinant for alexithymia. Childhood emotional abuse might be a risk factor for alexithymia among inpatient substance dependents.

The Aspergillus nidulans acuH gene, required for growth on acetate and long-chain fatty acids, was cloned by complementation of the acuH13 mutation. Northern blotting analysis showed that transcription of the acuH gene occurs in acetate-grown mycelium and at higher levels in oleate-grown mycelium, but not during growth on glucose minimal medium. The acuH gene encodes a protein of 326 amino acids that belongs to the mitochondrial carrier family. The ACUH protein contains three related segments of approximately 100 amino acids in length, each segment comprising two hydrophobic domains that are probably folded into two transmembrane alpha-helices linked by an extensive polar region. Sequence comparisons suggest that the acuH gene of A. nidulans encodes the homologue of the carnitine/acylcarnitine carrier of rat and man. The uncharacterised proteins YOR100C of Saccharomyces cerevisiae, COLT of Drosophila melanogaster, and DIF-1 of Caenorhabditis elegans also seem to be homologues of ACUH. In addition to the motifs present in all members of the mitochondrial carrier family, we propose the highly conserved motif R(A,S)(V,F)PANAA(T,C)F within the sixth hydrophobic domain of these proteins as the characteristic feature of the carnitine carrier subfamily. The proposed function of the ACUH protein is the transport of acetylcarnitine molecules from the cytosol to the mitochondrial matrix, a process required during growth on acetate or on long-chain fatty acids.

BACKGROUND

An increasing number of research designs are using text messaging (SMS) as a means of self-reported symptom and outcome monitoring in a variety of long-term health conditions, including severity ratings of depressed mood. The validity of such a single item SMS score to measure latent depression is not currently known and is vital if SMS data are to inform clinical evaluation in the future.

METHODS

A sub-set of depressed participants in the UK ACUDep trial submitted a single SMS text score (R-SMS-DS) between 1 and 9 on how depressed they felt around the same time as completing the PHQ-9 depression questionnaire on paper at 3 months follow-up of the trial. Exploratory categorical data factor analysis (EFA) was used to ascertain the alignment of R-SMS-DS scores with the factor structure of the PHQ-9. Any response bias with regard to age or gender was assessed by differential item functioning (DIF) analysis.

RESULTS

Depression scores based on the PHQ-9 and R-SMS-DS at 3 months were available for 337 participants (74 % female; mean age: 42 years, SD = 11.1), 213 of which completed the two outcomes within 6 days of each other. R-SMS-DS scores aligned with the underlying latent depression of the PHQ-9 (factor loading of 0.656) and in particular its affective rather than somatic dimension. The R-SMS-DS score was most strongly correlated with depressed mood (r = 0.607), feeling bad about oneself (r = 0.588) and anhedonia (r = 0.573). R-SMS-DS responses were invariant with respect to gender (p = 0.302). However, there was some evidence for age related response bias (p = 0.031), with older participants being more likely to endorse lower R-SMS-DS scores than younger ones.

CONCLUSIONS

The R-SMS-DS used in the ACUDep trial was found to be a valid measure of latent affective depression with no gender related response bias. This text message item may therefore represent a useful assessment and monitoring tool meriting evaluation in further research. For future study designs we recommend the collection of outcome data by new health technologies in combination with gold standard instruments to ensure concurrent validity.

BACKGROUND

Direct immunofluorescence (DIF) of perilesional skin is the gold standard in the diagnosis of pemphigus. Since the outer root sheath (ORS) of anagen hair is structurally analogous to epidermal keratinocytes, pemphigus specific immunofluorescence pattern may be present in the ORS.

METHODS

Twenty consecutive patients of pemphigus were enrolled in the study, irrespective of any other inclusion or exclusion criteria. Hairs were plucked in a similar fashion to that of trichogram. Approximately 5 anagen hairs were selected processed and stained with fluorescein isothiocyanate (FITC) conjugates. DIF of perilesional skin and indirect immunofluorescence (IIF) were carried out simultaneously. DIF of hair was also done in equal numbers of controls with other dermatoses.

RESULTS

Intercellular deposition of IgG was seen in the ORS of anagen hair in 85% of patients (n = 17). The test was positive in all patients who had scalp lesions (n = 10); however, it was also positive in 7 patients (77.7%) who did not have scalp lesions. The test was negative in 3 patients; two of whom were elderly and had sparse scalp hair. The other patient only had mucosal lesion. The test was negative in the control group.

CONCLUSIONS

DIF of hair is a simple, non-invasive test. In future, it may alleviate the need for skin biopsies, in patients with pemphigus.

BACKGROUND

To analyse the cross-diagnostic validity of the Functional Independence Measure (FIM) motor items in patients with spinal cord injury, stroke and traumatic brain injury and the comparability of summed scores between these diagnoses.

METHODS

Data from 471 patients on FIM motor items at admission (stroke 157, spinal cord injury 157 and traumatic brain injury 157), age range 11-90 years and 70 % male in nine rehabilitation facilities in Scandinavia, were fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIM motor items was made prior to testing fit to the model. Categories were re-scored where necessary. Fit to the model was assessed initially within diagnosis and then in the pooled data. Analysis of Differential Item Functioning (DIF) was undertaken in the pooled data for the FIM motor scale. Comparability of sum scores between diagnoses was tested by Test Equating.

RESULTS

The present seven category scoring system for the FIM motor items was found to be invalid, necessitating extensive rescoring. Despite rescoring, the item-trait interaction fit statistic was significant and two individual items showed misfit to the model, Eating and Bladder management. DIF was also found for Spinal Cord Injury, compared with the other two diagnoses. After adjustment, it was possible to make appropriate comparisons of sum scores between the three diagnoses.

CONCLUSIONS

The seven-category response function is a problem for the FIM instrument, and a reduction of responses might increase the validity of the instrument. Likewise, the removal of items that do not fit the underlying trait would improve the validity of the scale in these groups. Cross-diagnostic DIF is also a problem but for clinical use sum scores on group data in a generic instrument such as the FIM can be compared with appropriate adjustments. Thus, when planning interventions (group or individual), developing rehabilitation programs or comparing patient achievements in individual items, cross-diagnostic DIF must be taken into account.

The dif locus (deletion-induced filamentation) of Escherichia coli is a resolvase site, located in the terminus region of the chromosome, that reduces chromosome multimers to monomers. In strains in which this site has been deleted, a fraction of the cells is filamentous, has abnormal nucleoid structure, and exhibits elevated levels of the SOS repair system. We have demonstrated that a 33-bp sequence, which is sufficient for RecA-independent recombination and which shows similarity to the cer site of pColE1, suppresses the Dif phenotype when inserted in the terminus region. Flanking sequences were not required, since suppression occurred in strains in which dif as well as 12 kb or 173 kb of DNA had been deleted. However, location was important, and insertions at a site 118 kb away from the normal site did not suppress the Dif phenotype. These sites were otherwise still functional, and they exhibited wild-type levels of RecA-independent recombination with dif-containing plasmids and recombined with other chromosomal dif sites to cause deletions and inversions. It is proposed that the functions expressed by a dif site depend on chromosome location and structure, and analysis of these functions provides a way to examine the structure of the terminus region.

Tests with untreated and trypsin-treated red cells (rbc) from a variety of species showed that anti-Ig-coupled pig RBC are good indicator cells for the study of ruminant blood sIg + lymphocytes by the DARR test; coupled donkey and rabbit RBC are suitable for investigating pig lymphocytes. The different species showed the following percentages of sIg + lymphocytes (M +/- SE) by direct immunofluorescence (DIF) and the direct antiglobulin rosetting reaction (DARR) respectively:pigs 9.2 +/- 0.7% and 16.3 +/- 1.2%; sheep 20.2 +/- 1.2% and 33.1 +/- 1.6%; Cattle 13.5 +/- 1.4% and 28.9 +/- 3.5%. The mean ratio of sIg + lymphocytes shown by the two tests (DARR/DIF) for each species was 1.80 +/- 0.08 for pigs, 1.73 +/- 0.7 for sheep and 2.15 +/- 0.18 for cattle. Preincubation of pig and sheep lymphocytes at 37 degrees for 1 h did not alter the proportion of sIg + lymphocytes detected by either test. Thus the DARR test reveals a further population of sIg + lymphocytes in addition to that detected by immunofluorescence, whose number is proportional to the B population as measured by DIF and whose sIg is intimately associated with the membrane.

BACKGROUND

Recent neurobiological studies have reported that alexithymia may result from altered brain function related to emotional processing. Serotonin (5-hydroxytryptamine, 5-HT) has been shown to regulate central nervous system development associated with psychological processing. We investigated the possibility that polymorphism of the 5-HT transporter-linked promoter region (5-HTTLPR) is associated with alexithymia.

METHODS

This study included 304 healthy Japanese volunteers (148 males, 156 females). The subjects were categorized according to genotype (L/L, L/S, S/S) and results of the 20-item Toronto Alexithymia Scale (TAS-20), State-Trait Anxiety Inventory (STAI) and Self-Rating Depression Scale (SDS).

RESULTS

Subjects with the L/L genotype showed significantly higher TAS-20 scores, as well as significantly higher scores on the difficulty identifying feeling (DIF) subscale, than those with the L/S or S/S genotype (p < 0.05). There was a gender difference in the association between 5-HTTLPR genotype and DIF score. Female subjects with the L/L genotype showed significantly higher DIF scores than those with the L/S or S/S genotype (p ≤ 0.001). Neither STAI nor SDS was significantly associated with the 5-HTTLPR genotype.

CONCLUSIONS

These results suggest a link between low synaptic 5-HT and alexithymia.

Resolution of chromosome dimers, by site-specific recombination between dif sites, is carried out in Escherichia coli by XerCD recombinase in association with the FtsK protein. We show here that a variety of altered FtsK polypeptides, consisting of the N-terminal (cell division) domain alone or with deletions in the proline-glutamine-rich part of the protein, or polypeptides consisting of the C-terminal domain alone are all unable to carry out dif recombination. Alteration of the putative nucleotide-binding site also abolishes the ability of FtsK to carry out recombination between dif sites.

Insects resist bacterial infections through the induction of both cellular and humoral immune responses. The cellular response involves the mobilization of hemocytes, whereas the humoral response utilizes antibacterial peptides that are synthesized in the fat bodies and secreted into the circulating hemolymph. Recent studies suggest that the induction of the humoral response involves Rel-containing regulatory proteins, Dif and dorsal, which are related to mammalian NF-kappa B. These regulatory proteins function as sequence-specific transcription factors that induce the expression of immunity genes, including cecropin and diptericin. In mammals, NF-kappa B has been implicated in both lymphocyte differentiation and the acute-phase response. The finding that insect and mammalian immunity involve related transcription factors offers the promise that genetic studies in Drosophila might lead to the identification of novel components mediating mammalian immunity.

The separation and segregation of newly replicated bacterial chromosomes can be constrained by the formation of circular chromosome dimers caused by crossing over during homologous recombination events. In Escherichia coli and most bacteria, dimers are resolved to monomers by site-specific recombination, a process performed by two Chromosomally Encoded tyrosine Recombinases (XerC and XerD). XerCD recombinases act at a 28 bp recombination site dif, which is located at the replication terminus region of the chromosome. The septal protein FtsK controls the initiation of the dimer resolution reaction, so that recombination occurs at the right time (immediately prior to cell division) and at the right place (cell division septum). XerCD and FtsK have been detected in nearly all sequenced eubacterial genomes including Proteobacteria, Archaea, and Firmicutes. However, in Streptococci and Lactococci, an alternative system has been found, composed of a single recombinase (XerS) genetically linked to an atypical 31 bp recombination site (difSL). A similar recombination system has also been found in 𝜀-proteobacteria such as Campylobacter and Helicobacter, where a single recombinase (XerH) acts at a resolution site called difH. Most Archaea contain a recombinase called XerA that acts on a highly conserved 28 bp sequence dif, which appears to act independently of FtsK. Additionally, several mobile elements have been found to exploit the dif/Xer system to integrate their genomes into the host chromosome in Vibrio cholerae, Neisseria gonorrhoeae, and Enterobacter cloacae. This review highlights the versatility of dif/Xer recombinase systems in prokaryotes and summarizes our current understanding of homologs of dif/Xer machineries.

Xer site-specific recombination functions in the stable inheritance of circular plasmids and bacterial chromosomes. Two related recombinases, XerC and XerD, mediate this recombination, which 'undoes' the potential damage of homologous recombination. Xer recombination on natural plasmid sites is preferentially intramolecular, converting plasmid multimers to monomers. In contrast, recombination at the Escherichia coli recombination site, dif, occurs both intermolecularly and intramolecularly, at least when dif is inserted into a multicopy plasmid. Here the DNA sequence features of a family of core recombination sites in which the XerC- and XerD-binding sites, which are separated by 6 bp, were analysed in order to ascertain what determines whether recombination will be preferentially intramolecular, or will occur both within and between molecules. Sequence changes in either the XerC- or XerD-binding site can alter the recombination outcome. Preferential intramolecular recombination between a pair of recombination sites requires additional accessory DNA sequences and accessory recombination proteins and is correlated with reduced affinities of recombinase binding to recombination core sites, reduced XerC-mediated cleavage in vitro, and an apparent increased overall bending in recombinase-core-site complexes.

The major inducers of cell differentiation in Dictyostelium appear to be cyclic AMP and DIF-1. Recently we have chemically identified DIF-1, together with the closely related DIF-2 and -3. They represent a new chemical class of potent effector molecules, based on a phenyl alkanone with chloro, hydroxy, and methoxy substitution of the benzene ring. Previous work has shown that DIF-1 can induce prestalk-specific gene expression within 15 min, whereas it suppresses prespore differentiation. Hence, DIF-1 can control the choice of pathway of cell differentiation in Dictyostelium and is therefore likely to be involved in establishing the prestalk/prespore pattern in the aggregate. In support of this, we show that DIF treatment of slugs results in an enlarged prestalk zone. Cyclic AMP seems less likely to have such a pathway-specific role, but later in development it becomes inhibitory to stalk cell differentiation. This inhibition may be important in suppressing terminal stalk cell differentiation until culmination. Spore differentiation can be induced efficiently by high levels of Br-cyclic AMP, a permeant analogue of cyclic AMP. In this, it phenocopies certain spore-maturation mutants, and we propose that during normal development spore differentiation is triggered by an elevation in intracellular cyclic AMP levels. How this elevation in cyclic AMP levels is brought about is not known. The experiments with Br-cyclic AMP also provide the first direct evidence that elevated levels of intracellular cyclic AMP induce differentiation in Dictyostelium.

The summating potentials (SP) to free-field 1-, 2-, 4-, and 8-kHz, 90-dB HL tone bursts were recorded by means of transtympanic electrocochleography in 45 patients divided into three groups: those with Meniere's disease, those whose diagnosis was uncertain, and control subjects. The similarities across frequencies between the human SP (promontory) and the experimental SP (DIF component from basal turn) suggest that the SP recorded in electrocochleography originates mostly from the base of the cochlea; negative values were observed at low frequencies (1 to 2 kHz), positive values at high frequencies (8 kHz). Patients with Meniere's disease showed significantly larger SP values than control subjects. The effect of orally administered glycerol on the SP and action potential amplitudes was evaluated by means of automated recordings repeated every 5 minutes. Summating potential values were remarkably constant in the control group. A decrease in SP absolute amplitude was observed in most patients with Meniere's disease and some subjects with uncertain diagnoses, specifically at low frequencies. These changes were frequently associated with action potential amplitude and auditory threshold improvements at low frequencies. It is assumed that the glycerol-induced SP changes at low frequencies are related to modifications in the low frequency mechanical response of the basilar membrane at the basal turn.

Sarcoidosis (SA) and diffuse interstitial fibrosis (DIF) are characterized by alveolitis, mast cell hyperplasia and increased fibroblast proliferation. Stem cell factor (SCF) stimulates proliferation of hematopoietic progenitor cells involved in mast and stromal cell interaction. We assessed the role of SCF secreted by alveolar fibroblasts (AFb) in the development of fibrosis of DIF and SA in six patients with SA and six patients with DIF. Bronchoalveolar lavage (BAL) was performed by conventional methods. A total of 500 cells were differentially counted from Giemsa-stained cytopreps. AFb and supernatants were recovered from long-term cultures of BAL cells and from 24 h cultures of confluent AFb. Levels of SCF were measured by ELISA. Alpha actin content of AFb was characterized by immunohistochemistry. The expression of AFb mRNA for IL1-alpha and beta, TGF-beta, IFN-gamma, IL-2, IL-4, IL-5 and IL-6 was determined by RT-PCR. There was a lymphocytic predominance in the SA patients and an increase in neutrophils and eosinophils in DIF. SCF secreted by AFb from DIF was significantly higher than in SA. TNF + IL-1 significantly decreased the secretion of SCF by AFb. There was a positive correlation between SCF levels and the percentage eosinophils but not for metachromatic cells. Alpha-actin expression of AFb in DIF was significantly higher than in SA. Cytokine mRNA was extracted from AFb of two SA and two DIF patients. The profile showed that only in stimulated AFb isolated from the DIF patients can IL-5 transcripts be visualized. In conclusion, AFb can contribute to the onset of fibrosis by secreting SCF and IL-5 which, in turn, may recruit eosinophils.

BACKGROUND

Linear IgA bullous dermatosis (LAD) of children is relatively frequent in Africa. We undertook this study to evaluate the frequency of this disease among autoimmune bullous diseases (AIBD) in Tunisian children.

METHODS

We present a 32-year retrospective study (January 1976 to December 2007). Children with chronic acquired bullous diseases seen at the Charles Nicolle Hospital of Tunis and for whom direct immunofluorescence (DIF) of the perilesional skin demonstrated linear IgA immunoglobulin deposits were included in the study population.

RESULTS

Thirty-one children with LAD were collected representing 65.9 percent of all AIBD of children collected in the same period, with a mean age of 5.5 years and a sex ratio M/F of 2.4. Most of the children had a generalized eruption (28/31) but more profuse on the face, pelvic region, buttocks, and limbs. Mucosal lesions were present in only 4 children (12.9%). The mean duration of the disease was 14 months. Direct immunofluorescence demonstrated predominantly linear IgA deposits along the dermal-epidermal junction in all patients. Faint IgG, IgM, and complement were also seen (20/31). Indirect immunofluorescence was negative in 67 percent of cases. Eight patients responded to Dapsone, but prednisone had to be added in 7 children and erythromycin in 4 others to control the disease. A long term remission period (34 months) was achieved in 61.9 percent of patients.

CONCLUSIONS

This study confirms that LAD is the most common AIBD in children in Tunisia and it frequently occurs in preschool-aged males. Independently of the medication chosen for treatment, a long term remission is frequently observed.

OBJECTIVE

To examine the psychometric properties of the Visual Activities Questionnaire (VAQ) and each of its subscales in a modern cataract population using Rasch analysis and if flawed, to revise the VAQ and create a valid measure that maximizes its measurement properties.

METHODS

Flinders Eye Centre, Flinders Medical Centre, Adelaide, Australia.

METHODS

Patients with cataract in 1 or both eyes drawn from the surgical waiting list were mailed the 33-item VAQ for self-administration. The following were examined for the entire questionnaire and each subscale: whether items measured a single construct (unidimensionality), the behavior of response categories, the ability to differentiate between patients' visual abilities (person separation), matching of item difficulty to participant ability (targeting), and whether items function similarly across subgroups of participants (differential item functioning [DIF]).

RESULTS

The VAQ was completed by 561 patients. Response categories were used as intended. The VAQ discriminated the visual ability of the population (person separation, 4.88) but had suboptimum targeting, misfitting items, significant multidimensionality, DIF, and 4 dysfunctional subscales. Elimination of items causing multidimensionality resulted in a reduced 13-item VAQ that met all validity criteria for satisfactory instrument performance. Only 1 valid subscale (peripheral vision) could be preserved in the 13-item VAQ.

CONCLUSIONS

The VAQ in its native form was multidimensional and contained subscales with poor psychometric properties. The revised unidimensional 13-item VAQ was more appropriate for application in cataract outcomes assessment. Ideally, more items should be included to improve the targeting of item difficulty to more able cataract patients.