Progression of articular and extraarticular damage in oligoarticular juvenile idiopathic arthritis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A Brazilian registry of juvenile dermatomyositis: onset features and classification of 189 cases

ObjectiveTo describe onset features, classification and treatment of juvenile dermatomyositis (JDM) and juvenile polymyositis (JPM) from a multicentre registry.MethodsInclusion criteria were onset age lower than 18 years and a diagnosis of any idiopathic inflammatory myopathy (IIM) by attending physician. Bohan & Peter (1975) criteria categorisation was established by a scoring algorithm to define JDM and JPM based oil clinical protocol data.ResultsOf the 189 cases included, 178 were classified as JDM, 9 as JPM (19.8: 1) and 2 did not fit the criteria; 6.9% had features of chronic arthritis and connective tissue disease overlap. Diagnosis classification agreement occurred in 66.1%. Medial? onset age was 7 years, median follow-up duration was 3.6 years. Malignancy was described in 2 (1.1%) cases. Muscle weakness occurred in 95.8%; heliotrope rash 83.5%; Gottron plaques 83.1%; 92% had at least one abnormal muscle enzyme result. Muscle biopsy performed in 74.6% was abnormal in 91.5% and electromyogram performed in 39.2% resulted abnormal in 93.2%. Logistic regression analysis was done in 66 cases with all parameters assessed and only aldolase resulted significant, as independent variable for definite JDM (OR=5.4, 95%CI 1.2-24.4, p=0.03). Regarding treatment, 97.9% received steroids; 72% had in addition at least one: methotrexate (75.7%), hydroxychloroquine (64.7%), cyclosporine A (20.6%), IV immunoglobulin (20.6%), azathioprine (10.3%) or cyclophosphamide (9.6%). In this series 24.3% developed calcinosis and mortality rate was 4.2%.ConclusionEvaluation of predefined criteria set for a valid diagnosis indicated aldolase as the most important parameter associated with de, methotrexate combination, was the most indicated treatment.

A new short and simple health-related quality of life measurement for paediatric rheumatic diseases: initial validation in juvenile idiopathic arthritis

Objective. To develop and validate a new short and simple measure of health-related quality of life (HRQL) in children with juvenile idiopathic arthritis (JIA).Methods. The Paediatric Rheumatology Quality of Life Scale (PRQL) is a 10-item questionnaire that explores HRQL in two domains: physical health (PhH) and psychosocial health (PsH). Validation of the parent proxy report and child self-report versions of the instrument was accomplished by evaluating 472 JIA patients and similar to 800 healthy children. Validation analyses included assessment of feasibility, face and content validity; construct and discriminative ability; internal structure and consistency; test-retest reliability; responsiveness to clinical change; and minimal clinically important difference.Results. The PRQL was found to be feasible and to possess both face and content validity. The PRQL score correlated in the predicted range with most of the other JIA outcome measures, thereby demonstrating good construct validity, and discriminated well between different levels of disease severity. Assessment of internal structure (factor analysis) revealed that the PhH and PsH subscales identify two unambiguously separated domains. The internal consistency (Cronbach's alpha) was 0.86. The intraclass correlation coefficient for test-retest reliability was 0.91. The PRQL revealed fair responsiveness, with a standardized response mean of 0.67 in improved patients. Overall, the PRQL appeared to be more able to capture physical HRQL than psychosocial HRQL.Conclusion. The PRQL was found to possess good measurement properties and is, therefore, a valid instrument for the assessment of HRQL in children with JIA. This tool is primarily proposed for use in standard clinical care.

Long-Term Safety and Efficacy of Abatacept in Children With Juvenile Idiopathic Arthritis

Objective. We previously documented that abatacept was effective and safe in patients with juvenile idiopathic arthritis (JIA) who had not previously achieved a satisfactory clinical response with disease-modifying antirheumatic drugs or tumor necrosis factor blockade. Here, we report results from the long-term extension (LTE) phase of that study.Methods. This report describes the long-term, open-label extension phase of a double-blind, randomized, controlled withdrawal trial in 190 patients with JIA ages 6-17 years. Children were treated with 10 mg/kg abatacept administered intravenously every 4 weeks, with or without methotrexate. Efficacy results were based on data derived from the 153 patients who entered the open-label LTE phase and reflect >= 21 months (589 days) of treatment. Safety results include all available open-label data as of May 7, 2008.Results. of the 190 enrolled patients, 153 entered the LTE. By day 589, 90%, 88%, 75%, 57%, and 39% of patients treated with abatacept during the double-blind and LTE phases achieved responses according to the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30), Pedi 50, Pedi 70, Pedi 90, and Pedi 100 criteria for improvement, respectively. Similar response rates were observed by day 589 among patients previously treated with placebo. Among patients who had not achieved an ACR Pedi 30 response at the end of the open-label lead-in phase and who proceeded directly into the LTE, 73%, 64%, 46%, 18%, and 5% achieved ACR Pedi 30, Pedi 50, Pedi 70, Pedi 90, and Pedi 100 responses, respectively, by day 589 of the LTE. No cases of tuberculosis and no malignancies were reported during the LTE. Pneumonia developed in 3 patients, and multiple sclerosis developed in 1 patient.Conclusion. Abatacept provided clinically significant and durable efficacy in patients with JIA, including those who did not initially achieve an ACR Pedi 30 response during the initial 4-month open-label lead-in phase.

Hormone profile in juvenile systemic lupus erythematosus with previous or current amenorrhea

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Macrophage Activation Syndrome in Juvenile Systemic Lupus Erythematosus A Multinational Multicenter Study of Thirty-Eight Patients

Objective. To describe the clinical and laboratory features of macrophage activation syndrome as a complication of juvenile systemic lupus erythematosus (SLE).Methods. Cases of juvenile SLE-associated macrophage activation syndrome were provided by investigators belonging to 3 pediatric rheumatology networks or were found in the literature. Patients who had evidence of macrophage hemophagocytosis on bone marrow aspiration were considered to have definite macrophage activation syndrome, and those who did not have such evidence were considered to have probable macrophage activation syndrome. Clinical and laboratory findings in patients with macrophage activation syndrome were contrasted with those of 2 control groups composed of patients with active juvenile SLE without macrophage activation syndrome. The ability of each feature to discriminate macrophage activation syndrome from active disease was evaluated by calculating sensitivity, specificity, and area under the receiver operating characteristic curve.Results. The study included 38 patients (20 with definite macrophage activation syndrome and 18 with probable macrophage activation syndrome). Patients with definite and probable macrophage activation syndrome were comparable with regard to all clinical and laboratory features of the syndrome, except for a greater frequency of lymphadenopathy, leukopenia, and thrombocytopenia in patients with definite macrophage activation syndrome. Overall, clinical features had better specificity than sensitivity, except for fever, which was highly sensitive but had low specificity. Among laboratory features, the best sensitivity and specificity was achieved using hyperferritinemia, followed by increased levels of lactate dehydrogenase, hypertriglyceridemia, and hypofibrinogenemia. Based on the results of statistical analysis, preliminary diagnostic guidelines for macrophage activation syndrome in juvenile SLE were developed.Conclusion. Our findings indicate that the occurrence of unexplained fever and cytopenia, when associated with hyperferritinemia, in a patient with juvenile SLE should raise the suspicion of macrophage activation syndrome. We propose preliminary guidelines for this syndrome in juvenile SLE to facilitate timely diagnosis and correct classification of patients.

Differential MMP-2 and MMP-9 Activity and Collagen Distribution in Skeletal Muscle from pacu (Piaractus mesopotamicus) During Juvenile and Adult Growth Phases

Here, we evaluated collagen distribution and matrix metalloproteinases (MMPs) MMP-2 and MMP-9 activities in skeletal muscle of pacu (Piaractus mesopotamicus) during juvenile and adult growth phases. Muscle samples from juvenile and adult fishes were processed by histochemistry for collagen system fibers and for gelatin-zymography for MMP-2 and MMP-9 activities analysis. Picrosirius staining revealed a myosept, endomysium, and perimysium-like structures in both growth phases and muscle types, with increased areas of collagen fibers in adults, mainly in red muscle. Reticulin staining showed that reticular fibers in the endomysium-like structure were thinner and discontinuous in the red muscle fibers. The zymography revealed clear bands of the pro-MMP-9, active-MMP-9, intermediate-MMP-2, and active-MMP-2 forms in red and white muscle in both growth phases. MMP-2 activity was more intense in juvenile than adult muscle fibers. Comparing the red and white muscle types, MMP-2 activity was significantly higher in red muscle in adult phase only. The activity of MMP-9 forms was similar in juvenile red and white muscles and in the adult red muscle, without any activity in adult white muscle. In conclusion, our results show that, in pacu, the higher activities of MMP-2 and -9 are associated with the rapid muscle growth in juvenile age and in adult fish, these activities are related with a different red and white muscle physiology. This study may contribute to the understanding muscle growth mechanisms and may also contribute to analyse red and the white muscle parameters of firmness and softness, respectively, of the commercial product. Anat Rec, 292:387-395, 2009. (C) 2009 Wiley-Liss, Inc.

Differential expression of myogenic regulatory factor MyoD in pacu skeletal muscle (Piaractus mesopotamicus Holmberg 1887: Serrasalminae, Characidae, Teleostei) during juvenile and adult growth phases

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Population size and survivorship for juvenile lemon sharks (Negaprion brevirostris) on their nursery grounds at a marine protected area in Brazil

Os tubarões enfrentam muitos obstáculos para sobreviver nos primeiros anos de vida e muitas espécies ocupam áreas de berçário. Embora estimativas de sobrevivência, particularmente para jovens, sejam essenciais para acessar, monitorar e manejar efetivamente populações animais, existem poucos cálculos destas estimativas para populações de tubarões e poucas estimativas baseadas em métodos diretos para estes animais em suas áreas de berçário. Métodos de marcação e recaptura foram utilizados no presente estudo para estimar o tamanho populacional e a sobrevivência de jovens tubarões-limão (Negaprion brevirostris) em uma área de berçário na Reserva Biológica do Atol das Rocas, Brasil. Os indivíduos foram amostrados entre 1999 e 2003 e as estimativas de tamanho populacional variaram entre 12 a 100 indivíduos jovens e a taxa de sobrevivência entre 24 e 54%, com média de 44,6% durante o período de amostragem mais robusto. A população destes tubarões jovens diminuiu ao longo de nosso estudo, ainda que as taxas de sobrevivência tenham aumentado durante o mesmo período. Mesmo um nível moderado de pesca e a remoção de fêmeas maduras em áreas adjacentes podem afetar dramaticamente pequenas populações de tubarões num berçário pequeno e isolado como o Atol das Rocas. As taxas de sobrevivência e tamanho populacional relativamente mais baixos em Rocas podem ser resultado das diferenças nas características físicas deste berçário, comparadas a outros utilizados pela espécie no Atlântico norte-ocidental. Tais parâmetros comparativamente mais baixos no Atol das Rocas sugerem a fragilidade da população jovem de tubarões-limão neste berçário.

B lineage acute lymphoblastic leukemia transformation in a child with juvenile myelomonocytic leukemia, type 1 neurofibromatosis and monosomy of chromosome 7 - Possible implications in the leukemogenesis

This report describes the case of an 8-month-old infant with a diagnosis of juvenile myelomonocytic leukemia (JMML) and type I neurofibromatosis that presented progression to B lineage acute lymphoid leukemia (ALL). The same rearrangement of gene T-cell receptor gamma (TCRgamma) was detected upon diagnosis of JMML and ALL, suggesting that both neoplasias may have evolved from the same clone. Our results support the theory that JMML may derive from pluripotential cells and that the occurrence of monosomy of chromosome 7 within a clone of cells having an aberrant neurofibromatosis type 1 (NFI) gene may be the cause of JMML and acute leukemia. (C) 2002 Elsevier B.V. Ltd. All rights reserved.

Persistent organic pollutants in juvenile Magellan penguins (Spheniscus magellanicus) found on the northern shore of the state of São Paulo and southern shore of the state of Rio de Janeiro, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Early juvenile development of Armases rubripes (Rathbun 1897) (Crustacea, Brachyura, Sesarmidae) and comments on the morphology of the megalopa and first crab

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Juvenile development and growth patterns in the mud crab Eurytium limosum (Say, 1818) (Decapoda, Brachyura, Xanthidae) under laboratory conditions

The post-larval development of the mud crab Eurytium limosum was studied under laboratory conditions by using the offspring of ovigerous females collected at the Comprido River mangrove, SP, Brazil. The first crab stage is fully described and the juvenile development, until crab stage 10, is examined with emphasis on morphological change, sexual differentiation and growth patterns. The carapace of the first crab stage is nearly square as observed in other xanthids, becoming similar to adults only at stage 15. The sexes can be distinguished from stage four, based on the number of pleopods and their morphology. While the intermoult period increases, the moult percentage decreases at each stage. The abdominal allometric growth is sex-dependent, with males showing a negative (b=0.71) and females an isometric (b=0.95) relative growth pattern. Male gonopods undergo a positive allometric growth, and their shape changes remarkably until sexual maturity. The cheliped dentition can be observed after stage 4. Regardless of sex, most crabs have a molariform right cheliped, which is thought to aid the handling of asymmetric prey such as gastropods.

The megalopa and juvenile development of Pachygrapsus transversus (Gibbes, 1850) (Decapoda, Brahyura) compared with other grapsid crabs

Megalopae were reared in the laboratory to the 7(th) crab stage. The megalopa and 1(st) crab stage are described and juvenile development was studied with emphasis on pleopodal differentiation. The megalopal phase, is easily identified, and shares with those of other Grapsinae and Plagusiinae big size, the presence of many natatory setae, and a series of conspicuous teeth on the inner margin of the dactyli from the 2(nd) to 4(th) walking leg. These features are regarded as adaptive for settlement in a wave-swept environment, such as the rocky marine intertidal where most of those species live. Fast development of juvenile pleopods is another characteristic of these subfamilies. In Pachygrapsus transversus, the sexes can be distinguished from the 2(nd) crab stage. Gonopod differentiation in males and the basic segmentation of all four pleopod pairs in females are already concluded at the 5(th) instar. A review of the available information indicated that settlement of large megalopae and fast juvenile development, preceding a precocious sexual maturity, are trends in Grapsinae and Plagusiinae. on the other hand, the Sesarminae pass through a more extensive juvenile instar sequence and presumably a delayed maturity.

The megalopa and early juvenile development of Hepatus pudibundus (Crustacea: Brachyura: Aethroidea) reared from neuston samples

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)