End Row Research Articles

The emerging role of Growth Differentiation Factor 15 as a potential disease biomarker in juvenile dermatomyositis.

We aimed to investigate the potential of Growth Differentiation Factor 15 (GDF-15) as a novel biomarker for disease activity in Juvenile Dermatomyositis (JDM). We recruited children with juvenile myositis including juvenile dermatomyositis (n = 77), polymyositis (n = 6), and healthy controls (n = 22). GDF-15 levels in plasma were measured using ELISA. Statistical analyses were performed using non-parametric tests. Levels of GDF-15 were significantly elevated in JDM compared with healthy controls (p< 0.001). GDF-15 levels exhibited strong positive correlations with disease activity scores, including the Disease Activity Score (DAS) total score, DAS skin score, DAS muscle score, and Childhood Myositis Assessment Scale (CMAS). Additionally, GDF-15 levels could differentiate between active disease and remission based on the Physician Global Assessment of muscle score. Positive correlations were observed between levels of GDF-15 and creatine kinase, neopterin, and nailfold end row loops, indicating the potential involvement of GDF-15 in muscle damage, immune activation, and vascular pathology. ROC curve analysis showed GDF-15 to be more effective in assessing disease activity in JDM than creatine kinase (AUC 0.77, p= 0.001 and AUC 0.6369, p= 0.0738, respectively). GDF-15 may serve as a valuable biomarker for assessing disease activity in JDM. It exhibits better sensitivity and specificity than creatine kinase, and the levels correlate with various disease activity scores and functional measures. GDF-15 may provide valuable information for treatment decision-making and monitoring disease progression in JDM.

Nailfold capillary dropout precedes the presentation of pneumatosis intestinalis and micro-perforation in juvenile dermatomyositis

Juvenile dermatomyositis (JDM) is a rare autoimmune disease characterized by chronic inflammation of the skin and muscle vasculature. Loss of nailfold capillary end row loops (ERL) is associated with disease activity. We now present the first report of serious gastrointestinal (GI) events in two JDM patients, both preceded by a precipitous drop in their ERL, which contributes to the consideration of JDM as a member of the vasculitis group of myopathies. These cases demonstrate that the sudden and significant loss of ERL density appears to be a novel and reliable indicator of severe systemic microangiopathy, including gastrointestinal vasculopathy, in selected children with JDM.

Juvenile dermatomyositis: association between nail fold capillary end row loop- area under the curve- and disease damage indicators.

Juvenile Dermatomyositis (JDM) is a rare autoimmune disease characterized by skin and muscle inflammation. The loss of nail fold capillary end row loops (ERL) is evidence of small vessel involvement in JDM. This study aimed to examine the specific association of ERL over the disease course with evidence of JDM disease damage. We analyzed data from 68 initially treatment-naïve JDM children who had been observed for at least five years with multiple ERL density assessments. The JDM disease course were categorized into monocyclic short, monocyclic long, polycyclic, and chronic. The ERL capillary count was cumulatively evaluated using the area under the curve (AUC) method. The mean ERL density for the treatment-naive JDM was significantly lower than that of their healthy age-matched controls (4.8 ± 1.6 /mm vs. 7.9 ± 0.9 /mm; p < 0.0001). The ERL AUC was significantly lower in children with a chronic disease course compared to those with a monocyclic short (p = 0.001) or monocyclic long disease course (p = 0.013). JDM patients with lipodystrophy had lower ERL AUC than those without lipodystrophy (p = 0.04). There was no association between ERL AUC and calcifications or fractures. Persistently decreased ERL capillary density, reflected by low ERL AUC, is associated with a chronic disease course and lipodystrophy in JDM. Despite medical therapy, the mean ERL count remained below normal even after five years, particularly in polycyclic and chronic cases. It is not clear that restoring normal capillary density is currently feasible in children with JDM.

Nailfold capillary density in 140 untreated children with juvenile dermatomyositis: an indicator of disease activity

BackgroundWe lack a reliable indicator of disease activity in Juvenile Dermatomyositis (JDM), a rare disease. The goal of this study is to identify the association of nailfold capillary End Row Loop (ERL) loss with disease damage in children with newly diagnosed, untreated JDM.FindingsWe enrolled 140 untreated JDM and 46 age, race and sex matched healthy controls, ages 2–17. We selected items from the Juvenile Myositis Registry for analysis. Variables include average ERL density of 8 fingers, average capillary pattern, hemorrhages, and clinical and laboratory correlates. Laboratory data includes Myositis Specific Antibodies (MSA), disease activity scores (DAS), Childhood Myositis Assessment Scale (CMAS), and standard clinical serologic data. The reduced mean ERL density is 5.1 ± 1.5/mm for untreated JDM vs 7.9 ± 0.9/mm for healthy controls, p < 0.0001, and is associated with DAS-skin, r = -0.27 p = 0.014, which did not change within the age range tested. Untreated JDM with MSA Tif-1-γ had the lowest ERL density, (p = 0.037); their ERL patterns were primarily “open” and the presence of hemorrhages in the nailfold matrix was associated with dysphagia (p = 0.004).ConclusionsDecreased JDM ERL density is associated with increased clinical symptoms; nailfold hemorrhages are associated with dysphagia. Duration of untreated disease symptoms and MSA, modify NFC shape. We speculate nailfold characteristics are useful indicators of disease activity in children with JDM before start of therapy.

Computational investigation for reduction in auxiliary energy consumption with different cell spacing in battery pack

The need for battery storage systems is expected to grow quickly in the coming decade for a variety of applications, including electric vehicles, stationary storage and off-grid applications. Internal heat production in the lithium-ion battery chemistry is substantial in high-power applications, which is adverse to battery efficiency, long-term performance, and battery safety. Maintaining the battery temperature in the range of 15–45 °C is required for improved performance and safety of lithium-ion battery modules. The cooling methods consist of active and passive cooling, in which active cooling needs of additional power such as liquid cooling, forced air cooling, whereas in passive cooling, there is no need of additional power and employs phase change material cooling, and heat pipe, which require no additional power in the design of Battery thermal management systems. We focused on a designing of a forced-air cooling system for a battery module in this research. A Numerical model of a battery module has been developed in ANSYS Fluent software consist of ECM battery model and validated using the data of the previous study. The novelty of this work is that the subgrouping of the cells in the pack creates turbulence in the flow of heat extracting air. Ability of inlet air to extract heat at an end rows is increased and due to this, the end rows in the pack cool effectively. The modified design shows the improved cooling performance by 21.2 %. The reduced temperature rise in battery pack is achieved without using extra auxiliary power and extra volume. Modified design gives reduction in power consumption by 12.7 %.

Association of p155/140 Autoantibody With Loss of Nailfold Capillaries but not Generalized Lipodystrophy: A Study of Ninety-Six Children With Juvenile Dermatomyositis.

Myositis-specific antibodies (MSAs) facilitate grouping children with juvenile dermatomyositis (DM) into distinct phenotypes. The first aim of this study was to investigate the link between anti-p155/140 and lipodystrophy as determined by dual x-ray absorptiometry (DXA) assessment of fat distribution. The second aim was to examine the relationship between anti-p155/140 and damage to the nailfold capillary system. Children with juvenile DM followed for a minimum of 5 years were included. The study population was divided into 3 groups (anti-p155/140, other MSA, and MSA negative). Lipodystrophy was assessed by physician assessment and DXA fat distribution (trunk-to-leg fat ratio). Documentation of nailfold capillary end row loops (ERLs) was obtained at diagnosis. A total of 96 subjects (44% anti-p155/140, 23% other MSA, 33% MSA negative) were included. There was no significant difference in age, disease activity scores, or lipodystrophy between the 3 groups. The trunk-to-leg fat ratios were similar among the 3 groups at different time points. However, the anti-p155/140 group had significantly decreased ERL counts (P=0.006) at baseline as well as a prolonged duration of untreated disease at diagnosis (P=0.027). Also, the anti-p155/140 group had fewer patients with a monophasic disease course than the other 2 groups (P=0.008). Generalized lipodystrophy frequency was equivalent in all 3 groups based on physician assessments and trunk-to-leg fat ratios. The anti-p155/140 group had a greater loss of ERLs, suggesting that this MSA may impact the vascular component of juvenile DM.

Numerical and Experimental Modal Analysis of Go Kart Chassis

Abstract: Structural analysis of GO KART chassis is significant in design and development stage. Since, it holds all the essential components, understanding the dynamic behavior is necessary to understand how vibrations are transferred to the end rows from any vibration sources. This project presents the modal properties of Go-Kart chassis calculated by means of finite element analysis (FEA) and experimental modal analysis (EMA). The purpose of this study is to find the modal properties like natural frequency and mode shapes. The correlation between experimental results and theoretical results was observed. Keywords: Experimental modal analysis, natural frequency, chassis

Transcriptomes of peripheral blood mononuclear cells from juvenile dermatomyositis patients show elevated inflammation even when clinically inactive

In juvenile dermatomyositis (JDM), the most common pediatric inflammatory myopathy, weakness is accompanied by a characteristic rash that often becomes chronic and is associated with vascular damage. We hoped to understand the molecular underpinnings of JDM, particularly when untreated, which would facilitate the identification of novel mechanisms and clinical targets that might disrupt disease progression. We studied the RNA-Seq data from untreated JDM peripheral blood mononuclear cells (PBMCs; n = 11), PBMCs from a subset of the same patients when clinically inactive (n = 8/11), and separate samples of untreated JDM skin and muscle (n = 4 each). All JDM samples were compared to non-inflammatory control tissues. The untreated JDM PBMCs showed a strong signature for type1 interferon response, along with IL-1, IL-10, and NF-κB. Surprisingly, PBMCs from clinically inactive JDM individuals had persistent immune activation that was enriched for IL-1 signaling. JDM skin and muscle both showed evidence for type 1 interferon activation and genes related to antigen presentation and decreased expression of cellular respiration genes. Additionally, we found that PBMC gene expression correlates with disease activity scores (DAS; skin, muscle, and total domains) and with nailfold capillary end row loop number (an indicator of microvascular damage). This included otoferlin, which was significantly increased in untreated JDM PBMCs and correlated with all 3 DAS domains. Overall, these data demonstrate that PBMC transcriptomes are informative of molecular disruptions in JDM and provide transcriptional evidence of chronic inflammation despite clinical quiescence.

Nailfold Capillaroscopy as a Biomarker in the Evaluation of Pediatric Inflammatory Bowel Disease.

BackgroundNoninvasive screening and disease monitoring are an unmet need in pediatric inflammatory bowel disease (IBD). Nailfold capillaroscopy (NFC) is a validated technique for microvascular surveillance in rheumatologic diseases. NFC uses magnified photography to examine nail bed capillaries called end row loops (ERL). We aimed to identify variations in NFC in pediatric IBD patients and their associations with disease activity.MethodsPediatric patients with Crohn’s disease (CD) or ulcerative colitis (UC) and healthy controls were recruited. NFC was performed on patients with newly diagnosed IBD prior to initiating therapy, patients with established IBD, and controls. ERLs were quantified along with a 3mm distance on 8 nailfolds. Serum biomarker levels of disease activity and symptoms activity indexes were correlated with average ERL density digits on both hands. Statistics were performed using chi-squared, ANOVA, and linear regression.ResultsFifty-one IBD patients and 16 controls were recruited. ERL density was significantly decreased in IBD (Control: 19.2 ERL/3mm vs UC: 15.6 ERL/3mm vs CD: 15.4 ERL/3mm; P < .0001). ERL density was lower in UC patients with lower albumin levels (P = .02, r2 = 0.29).The change in ERL density over time predicted the change in pediatric CD activity index among CD patients (P = .048, r2 = 0.58) with treatment.ConclusionsOur data demonstrate ERL density is reduced in IBD compared to controls. Lower albumin levels correlated with lower ERL density in UC. In newly diagnosed CD, ERL density increases over time as disease activity improves with therapy. NFC may be a feasible biomarker of disease activity and utilized for monitoring IBD.

Numerical Analysis of Flow across Brush Elements Based on a 2-D Staggered Tube Banks Model

In order to improve efficiency in turbomachinery, brush seal replaces labyrinth seals widely in the secondary air system. A 2-d staggered tube bank model is adopted to simulate the gas states and the pressure character in brush seal, and computational fluid dynamics (CFD) is used to solve the model in this paper. According to the simulation results, the corrected formula of the Euler number and dimensionless pressure are given. The results show that gas expands when flow through the bristle pack, and the gas expansion closes to an isotherm process. The dynamic pressure increases with decreasing static pressure. The Euler number can reflect the seal performance of brush seals in leakage characteristics. Compared with increasing the number of rows, the reduction of the gap is a higher-efficiency method to increase the Euler number. The Euler number continually increases as the gap decreases. However, with the differential pressure increasing, Euler number first increases and then decreases as the number of rows increases. Finally, the pressure distribution on the surface of end rows is asymmetric, and it may increase the friction between the bristles and the back plate.

Classifying the near-equality of ribbon Schur functions

We consider the problem of determining when the difference of two ribbon Schur functions is a single Schur function. We fully classify the five infinite families of pairs of ribbon Schur functions whose difference is a single Schur function with corresponding partition having at most two parts at least 2. We also prove an identity for differences of ribbon Schur functions and we determine some necessary conditions for such a difference to be Schur-positive, depending on the distribution of 1’s and the end row lengths.

Structural performance of large-scale dowelled CLT connections under monotonic and cyclic loading

This paper presents an experimental study on 12 large-scale dowelled CLT connections under monotonic and cyclic loading. The connection design was inspired by hold-downs in tall CLT shear wall systems, however, the connections were loaded uniaxially to assess the accuracy of the strength prediction with Eurocode 5 and to evaluate the connection behavior in terms of strength, stiffness, ductility, energy dissipation, and overstrength based on the load–displacement relationship. Two different connection layouts and two different panel layups were considered in the testing. The test results suggested that the tested connections had on average medium to high ductility (4.8–6.3) without the introduction of an excessive amount of overstrength (1.10–1.63) and the connections were able to dissipate a significant amount of energy.It was also found that connection strength can be significantly improved by replacing the outer timber laminations with Laminated Veneer Lumber (LVL) laminations or by using a wider dowel spacing. Furthermore, the LVL laminations also increased the connection’s ductility by a factor of 1.3 under cyclic loading and a factor of 1.4 under monotonic loading. Based on test observations, for dowelled connections it is recommended to use bolts or dowels with threaded ends with nuts and washers in the end row of the connection to avoid opening up of the laminations, thus improving the overall connection behavior.

Planter Technology to Reduce Double‐Planted Area and Improve Corn and Soybean Yields

Core Ideas Corn yield was more proportionally reduced for double‐planted area as yield level decreased.Soybean yield presented similar behavior for both double‐planted area and automatic section control at varying yield levels.ROI for the ASC technology is recovered with lower planted area when corn is the main crop.Overall DPA% was 5.5%, but for irregular fields double‐planted area increased faster as planted area rose. Double‐planted area (DPA) on end rows commonly occurs in corn (Zea mays L.) and soybean (Glycine max L.) fields. Economic and yield losses from DPA can be reduced by using the automatic section control (ASC) technology on planters. However, the effects of DPA on crop yield within different yield levels (yield potentials) as well as different DPA proportion within Brazilian fields are not yet quantified. Using two datasets, the objectives of this study were: dataset I‐ (a) quantify yield losses from DPA in corn and soybean; (b) calculate the planting area necessary to recover the investment from ASC for Brazil and U.S. farmers when considering: (i) yield loss, (ii), DPA proportion, (iii) corn/soybean ratio in the rotation, and (iv) planted area; dataset II‐ (c) estimate DPA proportion at a regional‐scale using data from 128 Brazilian fields. The main results were: dataset I‐ (1) corn yield losses linearly increased due to DPA as yield level decreased; (2) soybean yields were less sensitive to DPA; (3) when only corn was considered, economic returns from using ASC was recovered with a smaller planted area; and dataset II‐ (4) overall DPA proportion was 5.5% of the total field area, increasing proportionally for irregular shaped fields. Use of ASC technology benefited soybeans via seed savings, while for corn, via both seed savings and superior yields. Future research focused on the ASC benefits should consider potential interactions between crop genotypes, field management, and environments.

Modal properties investigation of car body-in-white with attached windscreen and rear screen

Vibration analysis of car body in white (BIW) is crucial during design stage. Car BIW holds all the essential components; therefore, analysing its dynamic behaviour is necessary to understand how vibrations are transferred to the end rows from any vibration sources. This paper presents the modal properties of car BIW with attached windscreen and rear screen calculated by means of finite element analysis (FEA) and experimental modal analysis (EMA). The aim for the analysis is to observe the effect of windscreen and rear screen to the dynamic properties of car BIW. Detailed CAD models of BIW for both schemes were used for normal modes calculation in FEA, therefore providing the finest prediction of its modal properties. Actual car BIW was hanged on a metal frame to imitate free-free boundary condition as in FEA; prior to EMA. The EMA was done for both schemes, whereby the results for FEA were confirmed with EMA, at least for the first five modes with errors below 15%. It can be concluded from the analysis that the attached windscreen and rear screen is significantly affects the first five modes of the BIW. However, other higher frequencies remain unchanged.

Endothelial progenitor cell number is not decreased in 34 children with Juvenile Dermatomyositis: a pilot study

ObjectiveA pilot study to determine endothelial progenitor cells (EPC) number in children with Juvenile Dermatomyositis (JDM).MethodsAfter obtaining informed consent, the EPC number from 34 fasting children with definite/probable JDM at various stages of therapy—initially untreated, active disease on medication and clinically inactive, off medication—was compared with 13 healthy fasting pediatric controls. The EPC number was determined by fluorescence activated cell sorting (FACS), CD34+/VEGFR2+/CD45dim−, and assessed in conjunction with clinical variables: disease activity scores (DAS), duration of untreated disease (DUD), TNF-α allelic polymorphism (A/G) at the promoter region of −308, number of nailfold capillary end row loop (ERL) and von Willebrand factor antigen (vWF:Ag). Correlations of the EPC numbers with the clinical and demographic variables, including DAS Skin (DAS SK), DAS Weakness (DAS WK), DAS Total Score, DUD, Cholesterol, triglycerides, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL), and ERL were calculated using the Pearson correlation coefficient. Tests of associations of EPC with gender (boy vs girl), TNF-α-308A allele (GA/AA vs GG), vWF:Ag (categorized by specific ABO type) as normal/abnormal were performed, using two-sample T- tests.ResultsThe EPC number for JDM was not significantly different from the healthy controls and was not associated with any of the clinical or cardiovascular risk factors tested.ConclusionThe EPC for JDM were in the normal range, similar to adults with DM. These data support the concept that the normal EPC numbers in DM/JDM, irrespective of age, differs from adult PM, where they are decreased, perhaps reflecting a different pathophysiology.

MicroRNA-10a Regulation of Proinflammatory Mediators: An Important Component of Untreated Juvenile Dermatomyositis.

To identify differentially expressed microRNA (miRNA) in muscle biopsies (MBx) from 15 untreated children with juvenile dermatomyositis (JDM) compared with 5 controls. Following MBx miRNA profiling, differentially expressed miRNA and their protein targets were validated by quantitative real-time PCR (qRT-PCR) and immunological assay. The association of miRNA-10a and miRNA-10b with clinical data was evaluated, including Disease Activity Score (DAS), von Willebrand factor antigen (vWF:Ag), nailfold capillary end row loops, duration of untreated disease, and tumor necrosis factor (TNF)-α-308A allele. In JDM, 16/362 miRNA were significantly differentially expressed [false discovery rate (FDR) < 0.05]. Among these, miRNA-10a was the most downregulated miRNA in both FDR and ranking of fold change: miRNA-10a = -2.27-fold, miRNA-10b = -1.80-fold. Decreased miRNA-10a and miRNA-10b expressions were confirmed using q -4.16 and -2.59 fold, respectively. The qRT-PCR documented that decreased miRNA-10a expression was related to increased vascular cell adhesion molecule 1 in 13 of these JDM cases (correlation -0.67, p = 0.012), unlike miRNA-10b data (not significant). Concurrent JDM plasma contained increased levels of interleukin (IL) 6 (p = 0.0363), IL-8 (p = 0.0005), TNF-α (p = 0.0011), and monocyte chemoattractant proteins 1 (p = 0.0139). Decreased miRNA-10a, but not miRNA-10b, was associated with the TNF-α-308A allele (p = 0.015). In the 15 JDM, a trend of association of miRNA-10a (but not miRNA-10b) with vWF:Ag and DAS was observed. MiRNA-10a downregulation is an important element in untreated JDM muscle pathophysiology. We speculate that muscle miRNA expression in adult dermatomyositis differs from muscle miRNA expression in untreated childhood JDM.

Abstract 505: Young Adults With Juvenile Dermatomyositis Have Endothelial Dysfunction: Studies of Brachial Artery Reactivity and Oxidized Lipids

Objective: Older patients with Juvenile Dermatomyositis (JDM) have increased carotid wall thickness and decreased nailfold capillary end row loops (ERL). This study tested young adults with JDM and decreased ERL for brachial artery reactivity (BAR) and HDL antioxidant function. Methods: 20 adults, 14 F, mean age 21.8± 4.2 yrs; mean age at JDM onset 7.6 ± 3.7 years, mean duration of untreated disease (DUD) at diagnosis 5.4 ± 4.8 months, and mean total duration of disease 14.2 ±3.9 years. JDM adults had a mean Total Disease Activity Score (DAS) 1.9 ± 2.5 and were medication free. They were matched by age, race, sex and BMI with 20 healthy controls (mean age 23.8 ± 4.2 years). All subjects were tested for: BAR, ERL number, height and weight. The antioxidant function of HDL was evaluated by the change in fluorescence intensity caused by oxidation of dichlorfluorescein-diacetate by oxidized LDL ±HDL was measured (mean HDL function in healthy controls ranges from 0.44 - 0.66).For BAR, individuals were fasting and rested supine for 10 minutes before ultrasound imaging. Brachial artery diameter was measured at rest and one minute after 4.5 minutes of supra-systolic forearm occlusion. BAR was expressed as the percent diameter change from baseline in response to increased sheer stress [(post-deflation - baseline diameter)/baseline diameter] x100. Results: The # of ERL were significantly lower in the JDM group, 6.35 ± 1.29 vs the controls, 7.4±0.58, p=0.003. The TNF-α -308A allele in the JDM group was 40% vs. 15% in controls. JDM were shorter than their controls, for JDM women, 159.7 ±8.8cm vs. 165.6 ±5.4cm, p=0.048, and for JDM men, 172.7±3.6cm compared to controls, 181.5 ±4.6cm, p=0.0046, perhaps a consequence of steroid administration. BAR in JDM was 3.35±3.06%, and 5.22±3.07% in normal controls (p=0.068). After adjusting for height, age, sex, and BA diameter, the BAR in JDM adults was significantly lower than controls by 2.31% (p=0.04). There were no associations of BAR with ERL, DUD, or DAS or oxidized lipids. Conclusion: BAR is decreased in young adults off medication for JDM, indicating endothelial cell dysfunction. Larger studies in young adults with JDM are needed to validate this finding

The economics of automatic section control technology for planters: A case study of middle and west Tennessee farms

Reducing double-planted area in row crop production fields where planter overlap is unavoidable, such as end rows, point rows, and areas around internal field obstacles, can improve net returns by reducing seed costs and increasing revenue. The objective of this case study was to present a summary of results from 52 fields that highlight potential losses from double-planted areas and therefore potential savings associated with an investment in an Automatic Section Control system (ASC) for planters. Percentage of double-planted area ranged from 0.1% to 15.5% depending on field size and shape. Fields were classified into low, moderate and high double-planted fields, based on percentage of double planted area. Potential savings from adopting ASC system for planters were evaluated using this information. Savings from the adoption of this technology ranged from $4 per ha to $26 per ha depending on the distribution of field types in a farming operation. The results indicated that savings and the minimum period of time over which an investment in ASC on planters would have to be finance to guarantee a positive net cash flow every year was determined by farm size and distribution of field types in a farming operation.

Interview: Does Complex Trauma Exist? A “Long View” Based on Science and Service in the Trauma Field

I’m very happy to share some thoughts about this topic. For a long time I have been following the professional dialogue about posttraumatic stress disorder (PTSD), psychological trauma, domestic violence, interpersonal violence, and then the emergence of a condition called complex trauma. I believe that one of the very first places that Judy Herman discussed complex trauma was in my living room in Brookline, as part of the Harvard Study Group on Trauma. That group comprised 25 to 30 people who consistently attended a monthly meeting in Boston, starting in the mid-1980s and continuing until my sabbatical year in 1993 when, for a variety of reasons, it never picked up again. This group gathered people who were doing some of the foundational work on psychological trauma. It included colleagues in Boston at many of the key academic and clinical institutions, some who were visiting Boston for one reason or another, and some whom we would invite from elsewhere in the country to talk with our group about concepts of psychological trauma. Over time the people who comprised the Harvard Study Group on Trauma and those who presented to that group emerged as some of the leading figures in the field, including some who defined key concepts related to psychological trauma. Initially, the group met at the home of Henry Murray’s1 wife (Nina). Their home was in the shadows of Harvard’s William James Hall–a particularly wonderful place to have a conversation about a disorder that was not well-accepted by mainstream psychology and psychiatry. Bessel van der Kolk also hosted the group at times in his beautiful South End row house. One evening Judy Herman spoke about her concerns about the issues of PTSD and the very different patient population she was seeing at the Victims of Violence program at Cambridge Hospital. Her take on it was that many of the people who were given diagnoses of personality disorders were really people who suffered considerable domestic violence, child physical abuse, child sexual abuse, and neglect in ongoing ways. The nature of the distinction was that these were ongoing psychological traumas–ongoing oppression, ongoing stress associated with living in abusive situations, whether it was the spouse, or the parents, or the uncle, or whomever. It was this ongoing nature of it, the sense that “there is no safety,” “no place where anything is safe,” that I think led her to think a bit differently about what conventionally was called personality disorders (borderline being one, but not the only one). She gave birth to the notion of complex trauma and it received a great deal of attention from lots of people at the time who were seeing patients with this same set of problems. I would characterize the patients being discussed as those with dysregulated emotion, cognition, and behavior. The common thread was the existence of this background of ongoing, abusive environments. Interestingly, the syndrome

Clinical Status and Cardiovascular Risk Profile of Adults with a History of Juvenile Dermatomyositis

A pilot study of adults who had onset of juvenile dermatomyositis (JDM) in childhood, before current therapeutic approaches, to characterize JDM symptoms and subclinical cardiovascular disease. Eight adults who had JDM assessed for disease activity and 8 healthy adults (cardiovascular disease controls) were tested for carotid intima media thickness and brachial arterial reactivity. Adults who had JDM and 16 age-, sex-, and body mass index-matched healthy metabolic controls were evaluated for body composition, blood pressure, fasting glucose, lipids, insulin resistance, leptin, adiponectin, proinflammatory oxidized high-density lipoprotein (HDL), and nail-fold capillary end row loops. Adults with a history of JDM, median age 38 years (24-44 years) enrolled a median 29 years (9-38 years) after disease onset, had elevated disease activity scores, skin (7/8), muscle (4/8), and creatine phosphokinase (2/8). Compared with cardiovascular disease controls, adults who had JDM were younger, had lower body mass index and HDL cholesterol (P = .002), and increased intima media thickness (P = .015) and their brachial arterial reactivity suggested impairment of endothelial cell function. Compared with metabolic controls, adults who had JDM had higher systolic and diastolic blood pressure, P = .048, P = .002, respectively; lower adiponectin (P = .03); less upper arm fat (P = .008); HDL associated with end row loops loss (r = -0.838, P = .009); and increased proinflammatory oxidized HDL (P = .0037). Adults who had JDM, 29 years after disease onset, had progressive disease and increased cardiovascular risk factors.