Medications received by patients with juvenile dermatomyositis.

OBJECTIVE: Few controlled studies are available to guide treatment decisions in juvenile dermatomyositis (JDM). This study evaluated therapies received, changes of treatment over time, and factors associated with medication choices in JDM. METHODS: We performed a retrospective analysis of the number and type of therapies and duration of treatment for 320 patients with JDM enrolled in a North American registry. Kaplan-Meier and logistic regression analysis were used to assess the association of demographic and clinical features and autoantibodies with medication usage. RESULTS: High-dose oral prednisone was the primary therapy given to 99% of patients. 1997 was determined to be a threshold year for increasing usage of medications other than prednisone. The median time to half the initial oral prednisone dose was shorter in patients diagnosed after vs. before 1997 (10 vs. 19 months, P < 0.01). Patients received intravenous methylprednisolone (IVMP), methotrexate, intravenous immunoglobulin, antimalarial drugs, and combination therapy more frequently when diagnosed after 1997. IVMP was frequently received by patients with severe illness onset, anti-p155/140 (anti-TIF1) and anti-MJ (anti-NXP2) autoantibodies. Treatment with methotrexate was associated with older age at diagnosis and anti-MJ autoantibodies, while antimalarial therapy was associated with anti-p155/140 autoantibodies and mild onset severity. CONCLUSION: Oral prednisone has been the mainstay of therapy in JDM, and prednisone was reduced faster in patients diagnosed after 1997 when there was also an increase in other medications. Specific medications received by patients with JDM correlated with year and age at diagnosis, myositis autoantibodies, onset severity, and illness features.

Assessment of aquatic ecological risk and site-specific criteria of copper in San Francisco Bay, California, USA.

A new regression-based copper toxicity model was applied in a case study of San Francisco Bay, California, USA, to demonstrate its utility in estimating risk and site-specific water quality criteria. This was accomplished using probabilistic techniques and a simple model relating dissolved organic carbon (DOC) concentrations with the toxicity of dissolved copper to embryos of the most copper sensitive taxon (Mytilus) in the US Environmental Protection Agency's (USEPA) water quality criteria database. Similar probabilistic techniques were applied to data developed for San Francisco Bay using the USEPA's water-effect ratio (WER) methods for comparison with the DOC-based method. Based on 595 site- and date-specific DOC model observations at 26 sites in San Francisco Bay, none suggested risk of chronic toxicity. Safety factors (1/risk quotient) on average across all sites ranged from 2.4 to 9.1. Comparisons were made between 1) estimates of site-specific criteria made using the DOC method, 2) estimates of site-specific criteria made using the WER method, 3) USEPA national and California Toxics Rule criteria, and 4) region-specific criteria recommended for regulatory implementation by the Clean Estuary Partnership. The DOC- and WER-based methods indicated that copper criteria for San Francisco Bay could be increased above USEPA and California Toxics Rule criteria and will retain the level of protection (> or =97%) embodied in the USEPA copper saltwater water quality criteria. The DOC method overall was more conservative (i.e., implies the need for lower criteria in the Bay) than the WER method. The DOC method suggests that the region-specific criteria being recommended for regulatory implementation would be underprotective in some areas and yet could be increased and remain protective in other areas of San Francisco Bay.

Probability-based estimates of site-specific copper water quality criteria for the Chesapeake Bay, USA.

The object of this study was to estimate site- and region-specific dissolved copper criteria for a large embayment, the Chesapeake Bay, USA. The intent is to show the utility of 2 copper saltwater quality site-specific criteria estimation models and associated region-specific criteria selection methods. The criteria estimation models and selection methods are simple, efficient, and cost-effective tools for resource managers. The methods are proposed as potential substitutes for the US Environmental Protection Agency's water effect ratio methods. Dissolved organic carbon data and the copper criteria models were used to produce probability-based estimates of site-specific copper saltwater quality criteria. Site- and date-specific criteria estimations were made for 88 sites (n = 5,296) in the Chesapeake Bay. The average and range of estimated site-specific chronic dissolved copper criteria for the Chesapeake Bay were 7.5 and 5.3 to 16.9 microg Cu/L. The average and range of estimated site-specific acute dissolved copper criteria for the Chesapeake Bay were 11.7 and 8.3 to 26.4 microg Cu/L. The results suggest that applicable national and state copper criteria can increase in much of the Chesapeake Bay and remain protective. Virginia Department of Environmental Quality copper criteria near the mouth of the Chesapeake Bay, however, need to decrease to protect species of equal or greater sensitivity to that of the marine mussel, Mytilus sp.