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.

MedX3D: standards enabled desktop medical 3D.

This paper reports on the work of the Web3D Consortium's Medical Working Group to specify and implement MedX3D -- an extension to the X3D standard that will support advanced medical visualization functionality and medical data exchange. This initiative covers volume rendering, ontology support, and data import/export, for standalone applications and web-based plug-ins. It is our hypothesis that such a 3D medical standard will provide better access to data, and enable improvements in medical care.

Phenotypic effects of short-range and aberrant transposition in Antirrhinum majus.

We describe two novel ways in which changes in gene expression in Antirrhinum majus may arise as a consequence of the Tam3 transposition mechanism. One involves excision of Tam3 from the nivea gene promoter and insertion of two new Tam3 copies 3.4 kb and 2.1 kb away, on either side of the excision site. One of the new insertions is in the nivea coding region and completely blocks production of an active gene product. This allele probably arose by a symmetrical double transposition, following chromosome replication. The second case involves a small deletion at one end of Tam3 in the pallida gene, flanked by a sequence typical of a Tam3 excision footprint. This suggests that the end of Tam3 was cleaved at an early step in an attempted transposition and re-ligated back to its original flanking sequence. The alteration restores some expression to the pallida gene, suggesting that the ends of the intact Tam3 element contain components which can actively inhibit gene expression. The implications of these findings for the mechanism of Tam3 transposition and for the effects of Tam3 on host gene expression are discussed.

Emergency department management of patients with automatic implantable cardioverter-defibrillators.

The case of a patient with idiopathic dilated cardiomyopathy and complex ventricular arrhythmias who underwent placement of an automatic implantable cardioverter-defibrillator (AICD) and experienced inappropriate shocks during atrial fibrillation is presented. On presentation to the emergency department, the patient had experienced approximately ten device discharges over six hours. ECG revealed atrial fibrillation with a rapid, wide complex ventricular response. Initial management consisted of IV verapamil for rate control followed by deactivation of the AICD. The patient was subsequently hospitalized for treatment of atrial fibrillation. Inappropriate device discharges, a frequently reported AICD-associated complication, are discussed.

Herpes simplex virus and CPR training manikins: reducing the risk of cross-infection.

Two disinfecting solutions for removing herpes simplex virus (HSV) from CPR training manikin face skin were investigated. Both 70% ethanol and 70% ethanol plus 0.5% chlorhexidine solutions were effective in reducing recoverable virus at both 10(5) and 10(7) particles per milliliter inoculum concentrations (P less than .01 and P less than .005 versus no decontamination, respectively). The survival characteristics of HSV on manikin skin also were explored, demonstrating greater than four hours of viability.

A hypochlorite solution for removing bacteria from CPR manikins.

To study the effectiveness of a dilute hypochlorite solution in removing bacteria from cardiopulmonary resuscitation (CPR) manikins, cultures from several areas of manikins disinfected with hypochlorite were compared with those from manikins disinfected with another protocol, and bacteria which grew were counted and identified. The use of dilute hypochlorite resulted in significant reduction of bacterial numbers (P less than .0005), without damaging manikin components or provoking unpleasant reaction from trainees. Dilute hypochlorite disinfection of CPR training manikins after each class session might greatly reduce the possibility of transmitting pathogenic bacteria or other microorganisms between participants in resuscitation practice.