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Interplay of spin conversion and structural phase transformations: re-entrant phase transitions in the 2-propanol solvate of tris(2-picolylamine)iron(II) dichloride.

Crystal structures, magnetic and thermodynamic properties of the spin-crossover compound tris(2-picolylamine)iron(II) dichloride (with 2-propanol solvent molecules) have been measured in the temperature range from 15 to 293 K. X-ray diffraction, SQUID, and calorimetric experiments all showed two first-order phase transitions with hysteresis loops, a narrow one at T(1) approximately 196 K and a broad, triangular one covering the range 153<T(2)<166 K. Crystal structures were analysed at fourteen temperatures in a cooling cycle and at seven temperatures in a heating cycle. They reveal a complex, temperature-dependent ordering behaviour of both the complex cations and the alcohol molecules. A phenomenological model accounting for spin conversion, solvent ordering and coupling between the two processes describes the observed phase transitions and ordering phenomena reasonably well. Similarities and differences in the behaviour of the corresponding ethanol solvate with the same crystal architecture are discussed. It is concluded that spin-crossover behaviour depends as much on molecular properties as it does on intermolecular interactions, both of the spin active and the spin inactive components.

Journal Article↗

Management of cervical disc herniation with upper cervical chiropractic care.

OBJECTIVE: To discuss the chiropractic management of a patient suffering from multiple complaints, including a herniated nucleus pulposus in the cervical spine diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES: A 34-yr-old man suffered from severe neck, lower back and radicular pain of 1 yr duration. He had previously received care from multiple medical specialists, with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. These X-rays were read manually (with a template) and with computer-assisted digitization. Computerized analysis also measured misalignments at the levels of L4-L5. INTERVENTION AND OUTCOME: The patient was managed primarily with the Grostic Procedure of upper cervical adjusting by hand. After a period of about 1 month, a series of re-examinations revealed a dramatic improvement in all subjective and objective findings. A follow-up of > 1 yr has shown that surgery was not necessary. CONCLUSION: This single case study suggests that chiropractic care may be a viable treatment option for patients with cervical disc herniation. Further investigation into chiropractic adjustments as a treatment for this condition should be pursued.

Adult↗

Proof of a gunshot wound and its delayed effects 54 years post injury.

In 1945 a 6-year-old girl received a tangential gunshot injury to the left posterior inferior skull. After hospitalisation because of septicemia she was unable to walk for several months. Since 1967 she had been repeatedly applying for compensation because of pseudoneurasthenia and residual ataxia and many medical examinations were performed including X-ray, CT and MRI. Although certain objective findings (e. g. cerebellar atrophy) could be verified, a causal connection between the gunshot injury and the clinical findings could not be established. Therefore previous investigators concluded on a vascular origin of the disease. During the present re-examination of the patient, the authors found patch-like scars at the left posterior inferior skull base and behind the left ear, a cord-like scar formation in the subcutaneous tissue, connecting both skin scars, a gutter-like defect in the left occipital base of the skull and an indention of the left mastoid process, both again in line between the skin scars and a large defect of the left cerebellar hemisphere. It could be concluded with certainty that the anatomical findings and the clicinal symptoms were the direct result of a gunshot injury. Previous investigations had failed because of deficient investigations and techniques. In addition to an anatomical reconstruction, three dimensional reconstructions from CT scans proved most helpful.

Ataxia↗

First systematic investigation of C-H...Cl hydrogen bonding using inorganic supramolecular synthons: lamellar, stitched stair-case, linked-ladder, and helical structures.

Using a group of six neutral M(II)Cl(2)-containing coordination compounds as building blocks, the first systematic investigation of C-H...Cl hydrogen-bonding interactions was performed. Single-crystal X-ray structural analyses of four new compounds (pseudo-tetrahedral Co(II) and Zn(II); distorted trigonal bipyramidal Zn(II)) authenticate the metal coordination geometry. To provide a unified view of the presence of noncovalent interactions in this class of compounds, we have re-examined the packing diagram of two previously reported compounds (a distorted square-pyramidal Cu(II) complex and a trans-octahedral Co(II) complex). The organic ligands of our choice comprise bidentate/tridentate pyrazolylmethylpyridines and an unsymmetrical tridentate pyridylalkylamine. This systematic investigation has allowed us to demonstrate the existence of versatile C-H...Cl(2)M interactions and to report the successful application of such units as inorganic supramolecular synthons. Additional noncovalent interactions such as C-H...O and O-H...Cl hydrogen bonding and pi-pi stacking interactions have also been identified. Formation of novel supramolecular architectures has been revealed: 2D lamellar (p-cyclophane) and 3D lamellar, 3D "stitched staircase" (due to additional hydrogen-bonding interactions by water tetramers, with an average O-O bond length in the tetramer unit of 2.926 A, acting as "molecular clips" between staircases), 3D linked ladder, and single-stranded 1D helix.

Chlorine↗

Benefit of anatomical-functional image fusion in the diagnostic work-up of neuroendocrine neoplasms.

The aim of this prospective study was to evaluate anatomical-functional image fusion using the new technology of combined transmission and emission tomography (SPET/CT) in patients with neuroendocrine tumours (NET). Fifty-four patients with known or suspected NET prospectively underwent both tumour scintigraphy with (111)In-octreotide (n=43) or (123)I-MIBG (n=11) and contrast-enhanced high-end spiral CT. Scintigraphy was performed using a gamma camera (Millennium VG & Hawkeye, GE) with an integrated X-ray tube for combined transmission and emission tomography. SPET and high-end CT were interpreted blinded with regard to localisation and classification of lesions. Analysis of fused images (SPET/CT) was done on a lesion-by-lesion basis, followed by re-evaluation of SPET and high-end CT by consensus. The standard of reference for confirming the presence or absence of malignancy was either histopathology or clinical and imaging follow-up data. A total of 120 lesions were identified by CT and/or scintigraphy. This group included four patients with negative SPET but eight liver lesions on CT that were proven to be metastases. We excluded from the analysis two patients with no evidence of tumour on either modality, two lesions that lacked comparison with the standard of reference and two patients, each with two lesions, who were lost to follow-up. In 56 of the 114 evaluated lesions (49%), the results of SPET and CT were concordant; all lesions were interpreted as malignant. In 58 of 114 lesions (51%), consensus reading of fused images changed the image interpretation of 39 CT scans and 19 SPET studies: 31 lesions previously interpreted as equivocal (n=10) or benign (n=21) were re-classified as malignant and 27 lesions previously interpreted as equivocal (n=19) or malignant (n=8) were re-evaluated as benign. The highest accuracy (99%) in classifying NET lesions was achieved by combined analysis of SPET/CT ("hawkeye") and high-end CT. The specificity of SPET/CT was significantly higher than that of CT alone (P=0.0026) and slightly higher than that of SPET alone, but the accuracy of SPET/CT was inferior to that of side-by-side analysis of SPET and high-end CT (P=0.013) or visual correlation of SPET/CT and high-end CT (P<0.0001). Therapy was changed in 14 of 50 patients (28%) owing to the results of image fusion: in five patients tumour could be excluded, three patients were spared unnecessary surgery because of additional lesions indicating systemic tumour spread, in four patients the surgical approach was changed owing to precise tumour localisation and minimising of the surgical field, and in two patients medical and radiopeptide therapy was changed. Anatomical-functional image fusion allows for improved localisation and characterisation of NET with resultant alteration of the treatment approach in a substantial proportion of patients.

Adult↗

Contrasting oxygen-effects in the inactivation of ribonuclease A by N.3, (SCN).-2 and .OH radicals.

N.3 exhibits higher efficiency than .OH in the inactivation of RNase in de-acerated (neutral) aqueous solution. In O2-saturated solution the .OH-induced inactivation is enhanced, but N.3 and (SCN).-2 become remarkably inefficient. Our results suggest that semi-oxidized tyrosine, the predominant initial defect induced by N.3 and (SCN).-2 but not by .OH2 can be re-reduced upon reaction with O.-2 or cysteine.

Chemical Phenomena↗

Alpha 1-adrenergic receptor antagonist blocks acute cocaine action on the compound action potential of the auditory nerve in the chinchilla.

Acute systemic cocaine injection is known to significantly decrease the compound action potential (CAP) amplitude of the auditory nerve. In an attempt to elucidate the mechanism underlying this phenomenon, the present study investigated the influence of prazosin, an adrenergic alpha 1-receptor antagonist, on the effect of cocaine on the CAP. Amplitude-intensity functions at 1 and 8 kHz were obtained before and after treatment with cocaine (experimental group) or saline (control group) in prazosin pretreated subjects. The characteristic reduction in CAP amplitude after an acute cocaine injection was blocked by 0.05 mg/kg prazosin. When subjects were re-injected with cocaine or saline one h after prazosin, the reduction in CAP amplitude following cocaine injection had recovered.

Adrenergic alpha-Antagonists↗

The alcoholic brain: CT scan and psychological findings.

One hundred male alcoholics without overt clinical signs of brain damage were interviewed, psychologically tested and scanned by means of a CT 1010 EMI scanner. Fifty age-matched controls, lifelong abstainers or light drinkers, were used for comparison. Fifty-six alcoholics from the initial sample were followed up after periods varying from 30 to 152 weeks, and radiological changes during the follow-up were assessed. The main results of the study can be summarized as follows: (1) All CT scan indices were significantly different in alcoholics and controls. Alcoholics had larger ventricles, wider cerebral sulci and wider Sylvian and interhemispheric fissures. Cerebellar sulci were visible only in alcoholics. These differences were greater for older alcoholics and controls, but were also present in the younger subjects. (2) In the alcoholic group the size of the ventricular system, and the width of the sulci, Sylvian and interhemispheric fissures were positively and significantly correlated with age. The duration of the drinking history and the age of onset were not significantly correlated with CT scan indices. (3) In those alcoholics whose age was greater than the mean for the whole group, the size of the ventricular system and width of the Sylvian fissure were significantly and negatively correlated with the duration of abstinence prior to scanning. (4) Other features such as decreased tolerance, a positive family history of alcoholism and 'social decline' were not significantly related to the severity of CT scan abnormalities. (5) When the effects of age and premorbid intelligence were controlled, alcoholics showed significant cognitive impairment when compared with controls. The differences in the scores of psychological tests and CT scan indices were greater between alcoholics and controls of high IQ than between those of low IQ. This discrepancy is likely to be due to a selection bias. (6) No significant correlations were found between the degree of cognitive impairment and clinical features. The size of the ventricular system was positively and significantly correlated with the discrepancy between immediate and delayed recall of verbal material. There were no other significant correlations between cognitive impairment and CT scan indices. (7) Those subjects who had remained abstinent during the follow-up period, when considered as a group, showed a significant reduction in the size of the ventricular system. When cortical indices and V/B ratio were combined, patients whose scans had improved at follow-up differed from the rest with regard to the length of abstinence prior to re-scanning.

Adult↗

Trans-regulated silencing and reactivation of TP53 tumor suppressor gene in malignant transformation and its reversion.

Despite growing interest in the methylation-mediated silencing of tumor suppressor genes in the neoplastic process, its signaling mechanism remains largely unknown. Here we show in a cultured murine cell line system that the silencing and reactivation of tumor suppressor gene TP53 were reversibly controlled by a trans-acting regulatory mechanism. The gene product p53, which was constitutively expressed and activated upon X-ray irradiation in non-malignant parental cell line, was undetectable in its X-ray-induced malignant transformants, while they retained a wild-type TP53. The silencing was cancelled by transferring a human chromosome 11 and the expression of p53 was restored. The non-malignant revertants thus obtained were again susceptible to transformation by X-irradiation, giving rise to re-transformants, in which p53 was again repressed while the human chromosome 11 retained the ability to turn on TP53 when it was transferred into other malignant clone. The silent TP53 could be reactivated by treatment with the demethylating agent 5-azadeoxycytidine. These observations indicate the presence of a trans-acting signaling mechanism in the methylation-mediated regulation of TP53 expression which is associated with the acquisition of malignancy.

Animals↗

Tuberculosis--the threat re-emerges.

Tuberculosis remains a significant problem in Australia with five to six new cases per 100,000 of the population per year. The majority of cases occur in individuals born outside Australia. Approximately 70% is pulmonary disease and 30% nonpulmonary. Diagnosis can be made by history, clinical examination, Mantoux testing, chest X-ray plus a thoracic CT scan and sputum analysis. Occasionally bronchoscopy and/or fine needle aspiration biopsy may be indicated. Six months of appropriate supervised chemotherapy achieves a 98% cure. Healthcare workers are at special risk of infection and should have Mantoux testing; if this is negative then either BCG or regular Mantoux surveillance is recommended. Whilst multi-drug resistant tuberculosis is relatively uncommon in Australia, it is a significant problem in the United States and parts of South East Asia and such patients often come to surgical resection of their tuberculous lesions; during such resection healthcare workers are exposed to a potentially lethal infection.

Antitubercular Agents↗

[The x-ray follow-up study of the cervical spine after anterior fusion with titanium disk implants].

PURPOSE: We examined the postoperative changes of the cervical spine after treatment of cervical nerve root compression with anterior cervical discectomy and fusion with a new titanium intervertebral disc. PATIENTS AND METHODS: 37 patients were examined prior to, as well as 4 days, 6 weeks, and 7 months after surgery. Lateral view X-rays and functional imaging were used to evaluate posture and mobility of the cervical spine, the position of the implants, and the reactions of adjacent bone structures. RESULTS: Implantation of the titanium disc led to post-operative distraction of the intervertebral space and slight lordosis. Within the first 6 months a slight loss of distraction and re-kyphosis due to impression of the implants into the vertebral end-plates were found in all patients. We noted partial infractions into the vertebral end-plates in 10/42 segments and slight mobility of the implants in 14/42 segments. Both groups of patients showed reactive spondylosis and local symptoms due to loosening of the implants. The pain subsided after onset of bone bridging and stable fixation of the loosened discs. CONCLUSIONS: The titanium intervertebral disc provides initial distraction of the fusion segments with partial recurrence of kyphosis during the subsequent course. Loosening of the implants with local symptoms can be evaluated with follow-up X-rays and functional imaging.

Adult↗

A comparison of the gamma component of two high energy neutron therapy beams.

Reciprocal neutron dosimetry intercomparisons have been undertaken between the National Accelerator Centre (NAC), South Africa, and the Université Catholique de Louvain (UCL), Belgium. A comparison of the gamma components measured in the respective therapy beams using the classic twin-detector method formed part of the study. This is important in clinical applications since the biological effects of neutrons and gamma rays are different. The gamma component under various irradiation conditions was derived from pairs of measurements with tissue equivalent ionization chambers and Geiger-Müller counters. The gamma component expressed as a fraction of the gamma dose relative to the total dose agreed within less than 0.01, with the measurements with the NAC Geiger-Müller counters being consistently higher than those with the UCL counter. A re-evaluation of the kU value of the UCL Geiger-Müller counter reduces the differences to less than 0.005 at NAC and less than 0.002 for the measurements at UCL. The results obtained are highly satisfactory in view of the complexity and difficulty of the measurements.

Fast Neutrons↗

13C and (15)N NMR Mechanistic Study of Cyanide Exchange on Oxotetracyanometalate Complexes of Re(V), Tc(V), W(IV), Mo(IV), and Os(VI).

A range of complexes with general formula [MO(X)(CN)(4)](n)()(-) of W(IV), Mo(IV), Re(V), Tc(V), and Os(VI) were prepared and characterized by (13)C, (15)N, (17)O, and (99)Tc NMR, utilizing (13)C- and (15)N-enriched cyano complexes. A correlation between M-O and M-CN bond strength from X-ray crystallographic data and |(1)J((183)W-(13)C)| coupling is reported. The cyanide (HCN/CN(-)) exchange kinetics on the trans-dioxotetracyanometalate complexes and protonated/substituted ([MO(X)(CN)(4)](n)()(-)) forms thereof were studied in aqueous medium. The dioxotetracyano complexes show a trend of reactivity M(IV) > M(V) >M(VI), which is in agreement with the increase in M-L bond strength (L = O(2)(-) or CN(-)) and a dissociative activation for the cyanide and the oxygen exchange in these complexes. Rate constants (X, k(Xc)) in s(-)(1) at 298 K for the [MO(X)(CN)(4)](n)()(-) complexes are as follows for Mo(IV): O(2)(-), >0.4; OH(-), (1.7 +/- 0.1) x 10(-)(2); H(2)O, (1.5 +/- 0.1) x 10(-)(2); CN(-), (9.6 +/- 0.8) x 10(-)(3). For W(IV): O(2)(-), (4.4 +/- 0.4) x 10(-)(3); OH(-), (9.6 +/- 0.9) x 10(-)(5); H(2)O, (1.1 +/- 0.1) x 10(-)(4); CN(-), (1.1 +/- 0.1) x 10(-)(2); N(3)(-), (3.1 +/- 0.2) x 10(-)(4); F(-), (4.8 +/- 0.1) x 10(-)(5). For Tc(V): O(2)(-), (4.8 +/- 0.4) x 10(-)(3); H(2)O, <4 x 10(-)(5); NCS(-), <4 x 10(-)(5). For Re(V): O(2)(-), (3.6 +/- 0.3) x 10(-)(6) and (1.2 +/- 0.1) x 10(-)(4) for CN(-) and HCN, respectively; OH(2), <4 x 10(-)(8). For Os(VI): O(2)(-), <4 x 10(-)(9) and (1.2 +/- 0.1) x 10(-)(4) for CN(-) and HCN, respectively. The cyanide exchange kinetics were correlated with previously determined proton and oxygen exchange, spanning a kinetic domain of more than 12 orders of magnitude for the five metal centers studied.

Journal Article↗

Dichroic, dinuclear mu2-(eta2-NO)-nitrosoaniline-bridged complexes of rhenium of the type [[(CO)3Re(mu-X)]2ONC6H4NR2] (X = Cl, Br, I; R = Me, Et).

A series of unusual dinuclear mu2-(eta2-NO)-nitrosoaniline-bridged complexes [[(CO)3Re(mu-X)]2ONC6H4NR2] (X = Cl, Br, I; R = Me, Et) with dichroic properties have been synthesised by reaction of pentacarbonylhalogenorhenium(I) [(CO)5ReX] (X = Cl, Br, I) with the corresponding nitrosoaniline derivatives R2NC6H4NO (R = Me, Et). The deeply coloured solutions in CH2Cl2 show broad UV/Vis absorptions from 595 to 620 nm depending on the halogen bridges and N substituents. Single crystals of all six compounds exhibit a pronounced linear dichroism. The molecular structures have been determined by single-crystal X-ray analyses. All the compounds contain two face-shared octahedra, with two halogens and one NO ligand as bridges. The NO ligand coordinates in a nonsymmetrical eta2-like fashion with N or O coordination to each Re centre. Therefore, the C-nitroso group and the planar NC2 moiety of NR2 both lie almost exactly within the symmetry plane of the dinuclear complexes. These complexes belong to the novel and simple class of neutral dinuclear C-nitroso complexes that include the rare, non-assisted mu2-(eta2-NO) ligand function and have only single halogen atoms in bridging positions.

Journal Article↗

Rhenium tricarbonyl core complexes of thymidine and uridine derivatives.

Thymidine and uridine were modified at the C2' and C5' ribose positions to form amine analogues of the nucleosides (1 and 4). Direct amination with NaBH(OAc)3 in DCE with the appropriate aldehydes yielded 1-{5-[(bis(pyridin-2-ylmethyl)amino)methyl]-4-hydroxytetrahydrofuran-2-yl}-5-methyl-1H-pyrimidine-2,4-dione (L1), 1-{5-[(bis(quinolin-2-ylmethyl)amino)methyl]-4-hydroxytetrahydrofuran-2-yl}-5-methyl-1H-pyrimidine-2,4-dione (L2), and 1-[3-(bis(pyridin-2-ylmethyl)amino)-4-hydroxy-5-(hydroxymethyl)tetrahydrofuran-2-yl]-1H-pyrimidine-2,4-dione (L5), while standard coupling procedures of 1 and 4 with 5-(bis(pyridin-2-ylmethyl)amino)pentanoic acid (2) and 5-(bis(quinolin-2-ylmethyl)amino)pentanoic acid (3) in the presence of HOBT-EDCI in DMF provided a second novel series of bifunctional chelators: 5-(bis(pyridin-2-ylmethyl)amino)pentanoic acid [(3-hydroxy-5-(5-methyl-4-oxo-3,4-dihydro-2H-pyrimidin-1-yl)tetrahydrofuran-2-yl)methyl] amide (L3), 5-(bis(quinolin-2-ylmethyl)amino)pentanoic acid [(3-hydroxy-5-(5-methyl-4-oxo-3,4-dihydro-2H-pyrimidin-1-yl)tetrahydrofuran-2-yl)methyl] amide (L4), 5-(bis(pyridin-2-ylmethyl)amino)pentanoic acid [2-(2,4-dioxo-3,4-dihydro-2H-pyrimidin-1-yl)-4-hydroxy-5-(hydroxymethyl)tetrahydrofuran-3-yl] amide (L6), and 5-(bis(quinolin-2-ylmethyl)amino)pentanoic acid [2-(2,4-dioxo-3,4-dihydro-2H-pyrimidin-1-yl)-4-hydroxy-5-(hydroxymethyl)tetrahydrofuran-3-yl] amide (L7). The rhenium tricarbonyl complexes of L1-L4, L6, and L7, [Re(CO)3(LX)]Br (X=1-4, 6, 7: compounds 5-10, respectively), have been prepared by reacting the appropriate ligand with [NEt4][Re(CO)3Br3] in methanol. The ligands and their rhenium complexes were obtained in good yields and characterized by common spectroscopic techniques including 1D and 2D NMR, HRMS, IR, cyclic voltammetry, UV, and luminescence spectroscopy and X-ray crystallography. The crystal structure of complex 6.0.5NaPF6 displays a facial geometry of the carbonyl ligands. The nitrogen donors of the tridentate ligand complete the distorted octahedral spheres of the complex. Crystal data: monoclinic, C2, a = 24.618(3) A, b = 11.4787(11) A, c = 15.5902(15) A, beta = 112.422(4) degrees , Z = 4, D(calc) = 1.562 g/cm3.

Chelating Agents↗

Preparation and structural characterization of polymer-supported methylrhenium trioxide systems as efficient and selective catalysts for the epoxidation of olefins.

Novel heterogeneous compounds of methylrhenium trioxide (MTO) were prepared with poly(4-vinylpyridine) and polystyrene as polymeric supports. The wide-angle X-ray diffraction (WAXS.) analysis, performed by the application of the difference method, showed, in a representative case of the poly(4-vinylpyridine)/MTO derivatives, a slightly distorted octahedral conformation on the metal's primary coordination sphere. The Re-O and Re-C bond distances were not influenced by the polymeric nature of the ligand, while the Re-N bond distance was abnormally shorter than those previously observed for homogeneous MTO/L(n) complexes, showing a strong coordination of the rhenium atom to the support. A set of scanning electron microscopy (SEM) photographs showing the morphology of the surface of particles of poly(4-vinylpyridine)/MTO and polystyrene/MTO systems are reported. The reticulation grade of the polymer was a crucial factor for the morphology of the particles surface. Poly(4-vinylpyridine) 2% cross-linked systems were characterized by particles with very irregular shape and surface. Poly(4-vinylpyridine) 25% cross-linked systems showed particles with regular spherical shape, which morphology was similar to microcapsules obtained with polystyrene. All novel MTO compounds were efficient and selective heterogeneous catalysts for the epoxidation of olefins using environmentally friendly H2O2 as oxygen atom donor. The catalyst activity was maintained for at least five recycling experiments.

Journal Article↗

The mechanical joint score: a new clinical index of joint damage in rheumatoid arthritis.

OBJECTIVES: To evaluate the mechanical joint score (MJS) in terms of its reliability between observers and over time, its ease of use and its relationship with conventional measures of rheumatoid arthritis (RA) disease activity, severity and functional outcome. METHODS: The MJS was evaluated in 103 patients with reference to the following joints: total proximal interphalangeal (PIP) joints, total metacarpophalangeal (MCP) joints, wrists, elbows, shoulders, hips, knees, ankles and total metatarsophalangeal (MTP) joints. The score was based on the appearance of the joints on a scale of 0-3, 0 representing no abnormality and 3 severe abnormality or previous surgery. The MJS was evaluated in terms of its intra- and inter-observer variability and its content, construct and criterion validities. A subset of 29 patients were re-evaluated after 5 yr to examine change in MJS over time. RESULTS: The MJS performed well in terms of inter-observer and intra-observer reliability. The MJS showed strong correlation with the Larsen X-ray score of hands and feet (Spearman correlation coefficient 0.74) and with the modified Health Assessment Questionnaire (Spearman correlation coefficient 0.56) and only weak correlation with indices of disease activity, such as the Ritchie index and erythrocyte sedimentation rate. The MJS showed highly significant positive change over time. CONCLUSION: The MJS is a reliable clinical index of joint damage and may be a useful new outcome measure in RA.

Adult↗