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Fevers in children are mainly due to infection, malignancy or inflammatory conditions. Rheumatologists have an important role in the care of inflammatory conditions, many of which are associated with fevers. Seven conditions, the hereditary recurrent fever syndromes, have been defined with the presenting symptom of recurring fever, and for which mutation of a single gene has been defined: Chronic infantile neurological articular syndrome (CINCA), Familial cold autoinflammatory syndrome (FACS), Familial Mediterranean fever (FMF), hyperimmunoglobulinemia D (HIDS), Muckle-Wells syndrome (MWS), Pyogenic sterile arthritis and Pyoderma gangrenosum (PAPA) and Tumour necrosis factor receptor-associated periodic syndrome (TRAPS) . These conditions will be discussed in detail in regard to how they fit into the wider picture of pediatric rheumatological conditions, how the diagnoses may be established and the current recommended treatments for each condition.

BACKGROUND: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective contraceptive. However during early months of use unscheduled vaginal bleeding is common sometimes leading to discontinuation. This study aimed to determine whether intermittent administration of progesterone receptor modulator CDB-2914 would suppress unscheduled bleeding during the first 4 months after insertion of the LNG-IUS. METHODS: CDB-2914 150 mg in divided doses or placebo tablets were administered over three consecutive days starting on Days 21 49 and 77 after LNG-IUS insertion in a double-blind randomized controlled trial of women aged 19-49 years newly starting use of LNG-IUS. Daily bleeding diaries were completed for 6 months and summarized across blocks as percentage days bleeding/spotting (BS%). RESULTS: Of 69 women randomized to receive CDB-2914 and 67 placebo 61 and 55 respectively completed the trial. BS% decreased with time in both arms but showed a much steeper treatment-phase gradient in the placebo arm (P < 0.0001) so that a benefit of CDB-2914 in the 28 days after first treatment (-11% points 95% CI -19 to -2) converted to a disadvantage by 64 days after the third treatment (+10% points 95% CI 1-18). CONCLUSIONS: The effect of CDB-2914 on BS% was initially beneficial but then by third treatment was disadvantageous. Nevertheless only 3% (4/136) of all women discontinued LNG-IUS. These findings give insight into possible mechanisms and suggest future research directions. ISRCTN Trial no. ISRCTN58283041; EudraCT no. 2006-006511-72.

Despite recent controversy, hormone replacement therapy remains the mainstay of treatment of menopausal symptoms. Our Drug review considers the risks and benefits of the current treatment options, followed by sources of further information, an analysis of prescription data and the Datafile. Copyright © 2007 Wiley Interface Ltd

Background Acute haematogenous osteomyelitis is a bacterial infection of bone, which occurs most frequently in children. Outcomes are excellent for the majority of children, but a minority develop complicated osteomyelitis. Predicting which children will develop complicated osteomyelitis remains a challenge, particularly in developed countries where most patients are discharged home after a relatively short period in hospital. Methods We conducted a 5-year retrospective case note review of all children aged 3 months to 16 years admitted with a diagnosis of acute haematogenous osteomyelitis. We compared standardized clinical and laboratory parameters in those who developed simple and complicated osteomyelitis. Results Of the 299 children who met inclusion, 241 (80.6%) had simple and 58 (19.4%) had complicated osteomyelitis. The major predictors of complicated disease were older age, a temperature greater than 38.5°C and a higher C-reactive protein at admission. Conclusions A risk prediction model, utilizing information available shortly after hospitalization, allows early identification of children at greatest risk of developing complicated osteomyelitis.

Background and methodology Many women use a variety of contraceptive methods during their reproductive lives. Investigating this exposure is one of the most frequently performed epidemiological investigations. Accurate recall of methods used, as well as validating this information, can be difficult. A pilot study compared recalled contraceptive use over 5 years with that documented in the case notes of 30 women. Results 47% of episodes of method use were accurately recalled to the month of starting method use; this figure rose to 94% when episodes with disagreement within ±12 months were also considered. Similarly, 44% and 91% of episodes were accurately recalled to the month and within ±12 months of stopping method use, respectively. Accuracy of recall for duration of use followed a similar pattern. 7% of users were unable to distinguish between use of a combined pill and a progestogen-only pill and one-third of women using an intrauterine contraceptive were unable to distinguish an intrauterine device (IUD) from the intrauterine system (IUS). Discussion and conclusions Almost all women can recall accurately which contraceptive methods they have used in the past year but are less accurate in respect of exact starting and stopping dates. Some women confuse the combined pill with the progestogen-only pill and others confuse the IUD and the IUS. The findings need to be replicated in other settings and with populations of less well-educated women.

Duchenne muscular dystrophy remains an untreatable genetic disease that severely limits motility and life expectancy in affected children. The only animal model specifically reproducing the alterations in the dystrophin gene and the full spectrum of human pathology is the golden retriever dog model. Affected animals present a single mutation in intron 6, resulting in complete absence of the dystrophin protein, and early and severe muscle degeneration with nearly complete loss of motility and walking ability. Death usually occurs at about 1 year of age as a result of failure of respiratory muscles. Here we report that intra-arterial delivery of wild-type canine mesoangioblasts (vessel-associated stem cells) results in an extensive recovery of dystrophin expression, normal muscle morphology and function ( confirmed by measurement of contraction force on single fibres). The outcome is a remarkable clinical amelioration and preservation of active motility. These data qualify mesoangioblasts as candidates for future stem cell therapy for Duchenne patients. ispartof: Nature vol:444 issue:7119 pages:574-579 ispartof: location:England status: published

Adhesive mechanisms are considered to be of crucial importance for blastocyst adherence to the uterine wall, as well as for the interactions between embryonal and decidual tissues during hemochorial placenta formation. Epithelial V-like Antigen (Eva) is a novel homophilic adhesion molecule of the immunoglobulin superfamily, which during mouse embryonic development is expressed by various differentiating epithelia. In the present paper we describe Eva expression during mouse trophoblast invasion and placental morphogenesis, analysing day 5.5 to 18.5 postcoitum (p.c.) placentas and deciduomas by in situ hybridization. Eva transcripts were detected in spongiotrophoblast cells from 7.5 to 18.5 days p.c. Expression was uniform at early stages, but after day 11.5, p.c. became limited to the invasive subpopulation of spongiotrophoblasts (known as glycogen cells). Trophoblast giant cells did not express Eva in any of the stages analysed. Besides trophoblasts, also early postimplantation decidua was positive for Eva transcripts. In decidual tissue, Eva expression was present at day 5.5 p.c., peaked at day 7.5 p.c., and declined on successive days. The expression pattern of Eva transcripts suggests that during mouse placenta formation, its protein product may play a role in the processes of trophoblast invasion, decidual response, and trophoblast-decidual interaction.

Local intrauterine delivery of levonorgestrel (LNG) results in extensive decidualization of endometrial stromal cells, atrophy of the glandular and surface epithelium and changes in vascular morphology (suppression of spiral artery formation and presence of large dilated vessels). With endometrial exposure to LNG, there is down-regulation of sex steroid receptors in all cellular components. As a consequence of endometrial sex steroid receptor down-regulation, there is perturbation of progesterone-regulated locally acting mediators, and the integrity of blood vessel walls is disturbed. Thus, intrauterine LNG administration results in modulation of local mediators regulating endometrial function. To date, no single factor has been identified where the expression correlates closely with unscheduled breakthrough bleeding (BTB). BTB is a common side effect and reason for discontinuation of LNG-IUS use. Much remains to be determined about the mechanisms involved in suppression of menstruation, BTB episodes and the local endometrial environment with local LNG administration.

Canine retinal S antigen has been purified to study the retinal progressive atrophy of the dog. The purified antigen will be used to detect, by the ELISA technique, specific autoantibody in dogs with ocular diseases.

Since January 1994, heroin-assisted treatment for opiate addicts has been available in Switzerland. This is the first report of the long-term effects of this form of treatment. The report examines subjects who entered a study involving medical prescription of opiates (Projekt zur ärztlichen Verschreibung von Betäubungsmitteln; PROVE) in Switzerland between January 1994 and March 1995 (n = 366). Opiates were dispensed in eight treatment centres. A follow-up was conducted 6 years after treatment entry. Two groups were assessed: clients who have continuously been on heroin-assisted treatment since entry into the PROVE study or who re-entered this treatment, and ex-clients who had discontinued heroin-assisted treatment at the time of follow-up. Two kinds of comparisons were conducted. Firstly, conditions at treatment entry were compared to 6-year follow-up outcomes, and secondly, outcomes were compared between clients still on heroin-assisted treatment and those who had been discharged. It was found that 46% of the clients still alive were on heroin-assisted treatment at the time of follow-up. A comparison of the present living conditions showed very little difference between those in treatment and those who had terminated treatment. Compared to the situation at entry, the results of the follow-up showed a significant decrease in the use of illegal substances, illegal income and most other variables concerning social conditions, but they also showed an increase in unemployment and reliance on social benefits. Heroin-assisted treatment is thus efficacious in the long-term course of treatment and is still effective after termination of treatment with respect to living conditions and use of illicit substances.