Epidemiologic/prognostic study, level III.

Objective The diagnosis of Sjögren's Syndrome (SS) in routine practice is largely a clinical one and requires a high index of suspicion by the treating physician. This great dependence upon clinical judgment frequently leads to delayed diagnosis or misdiagnosis. Tear protein profiles have been proposed as simple and reliable biomarkers for SS diagnosis. Given that cathepsin S activity is increased in the lacrimal glands and tears of NOD mice (a murine model of SS), we explored the clinical utility of using tear cathepsin S (CTSS) activity as a biomarker for SS. Methods A method to measure CTSS activity in tears eluted from Schirmer's strips was developed and validated. Schirmer's tests and CTSS activity measurements were performed on 278 female subjects, including patients with SS (n=73), rheumatoid arthritis (n=79), systemic lupus erythematosus (n=40), blepharitis (n=10), non-specific dry eye (n=31), or other autoimmune diseases (n=12), along with 33 healthy controls. Results Median tear CTSS activity in SS patients was 4.1-fold higher than in patients with non-SS autoimmune diseases, 2.1-fold higher than in patients with non-specific dry eye, and 41.1-fold higher than in healthy controls. Tear CTSS levels were equally elevated in primary and secondary SS independent of the Schirmer's strip values or of circulating anti-SSA or anti-SSB autoantibodies. Conclusion Markedly high levels of tear CTSS activity are suggestive of SS. CTSS activity in tears can be measured in a simple, quick, economical, and non-invasive fashion and may serve as a novel biomarker and indicator of autoimmune dacryoadenitis during the workup for SS.

This was a prospective, non-randomized, multicentre study of rocuronium (Org 9426) in 40 elective Caesarean section patients at full term without fetal distress. Anaesthesia was induced with thiopentone 4-6 mg kg-1 i.v. and rocuronium 0.6 mg kg-1 and maintained with isoflurane and nitrous oxide in oxygen. Monitors included ECG, arterial pressure, pulse oximeter and train-of-four (TOF) produced by ulnar nerve stimulation. In all patients, full neuromuscular block at the hand indicating the maximum effect of rocuronium (T1 = 0) occurred at a mean time of 98.1 (SE 9.4) s. However, after 79.3 (2.9) s, excellent to good intubating conditions were achieved in 90% of patients. Injection to delivery time was 12.7 (0.9) min and the surgical procedure lasted 53.1 (3.5) min. After administration of rocuronium, T2 appeared after 32.7 (1.8) min (indicating duration of effect). At the end of the surgical procedure in 39 patients, glycopyrronium 0.2 mg and neostigmine 1 mg were given every 5 min to antagonize residual neuromuscular effect. The mean dose of neostigmine required was 1.54 (0.1) mg. Rocuronium had no clinically significant effect on maternal heart rate or arterial pressure. After administration of thiopentone and rocuronium in two patients, temporary erythema occurred, one along the site of injection and the other on the chest wall. Rocuronium had no untoward effects on the neonates, evaluated by 1- and 5-min Apgar scores, time to sustained respiration, total and muscular neuroadaptive capacity scores, acid-base status and blood-gas tensions in umbilical arterial and venous blood.(ABSTRACT TRUNCATED AT 250 WORDS)