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INTRODUCTION: Several studies have shown an association of anti-C1q antibodies (abs) with systemic lupus erythematosus (SLE) nephritis and disease activity. The aim of this study is to determine the relevance of the anti-C1q abs and the C1q levels, in Black South Africans with SLE and their relevance to disease activity and/or organ damage, specifically renal disease. METHODS: Serum anti-C1q abs and C1q levels were measured in 96 SLE patients who were also assessed for disease activity, using the SELENA Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and organ damage as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC) Damage Index. Furthermore patients were assessed for the presence of an active urine sediment as evidenced by otherwise unexplained proteinuria, haematuria or cellular casts. Serum anti-C1q abs was measured by a commercial Elisa kit and serum C1q by immunoelectrophoresis. RESULTS: Of the 96 patients; the majority, 87 were female (90.65%), with a mean (SD) age and disease duration (SD) of 38.1 (13.0) years and 4.2 (4.4) years respectively. An active urine sediment was found in 21 (21.88%) patients. Elevated anti-C1q abs were present in 12 (12.50%) of the patients and 7 (14.29%) of the patients with renal involvement. Serum anti-C1q abs levels correlated significantly with SELENA SLEDAI scores (p=0.004, r =0.41).Anti-C1q abs levels were significantly higher in patients with an active urine sediment (p= 0.007). C1q levels were decreased in 17/96 (17.71%) patients and 11/49 (22.45%) patients with renal involvement. No associations with any other clinical features were observed. CONCLUSION: The findings indicate that in Black South Africans with SLE, although elevated anti-C1q abs levels were present in only a small minority of patients, the abs were associated with SLE global activity as determined by the SELENA SLEDAI and to the presence of an active urine sediment. These findings suggest that anti-C1q abs are a potential bio-marker of disease activity, especially active renal disease.

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by disease flares and damage accrual. The increased longevity allows SLE patients to accrue damage which has retarded their survival improvement since the 1980s. In the first study of this thesis, meta-analyses of observational studies revealed that renal and neuropsychiatric damage has been adversely affecting the survival of lupus patients in the past fifty years. While confirmatory studies are required, targeting at renal and neuropsychiatric involvement early might hopefully further improve the survival of SLE patients. As the survival of SLE patients improves, their psychosocial well-being becomes increasingly important. In the second study, anxiety symptoms were found to be significantly more frequent in lupus patients than those with other common inflammatory rheumatic conditions. Additionally, damage accrual and cumulative glucocorticoids accurately predicted anxiety in SLE patients. Related to neuropsychiatric damage, event-related functional brain imaging in the third study showed that new-onset SLE patients had poorer strategic planning skill that required compensatory cortical recruitment for executing comparable cognitive function as in healthy subjects. Even after sufficient control of SLE, they remained to demonstrate inferior strategic planning skill which necessitated compensatory recruitment of cortical areas to boost their executive function. These findings illustrated that cognitive dysfunction persists even after adequate control of SLE. Early recognition of the prognostically challenging renal, cardiovascular and musculoskeletal damage and their predictors is imperative. The fourth study revealed that failure to achieve complete renal remission 12 months after renal presentation predicted renal damage, irrespective of age and the choice of immunosuppressants. As to whether mycophenolate (MMF) or cyclophosphamide (CYC) is better; by meta-analysis, the fifth study concluded that MMF offers similar efficacy as CYC in inducing renal remission and preventing renal damage. As for the cardiovascular system, endothelial dysfunction exerts its impact very early during atherogenesis. As shown in the sixth study, SLE patients na?ve for cardiovascular disease had significantly poorer endothelial function than demographically and anthropometrically matched healthy controls. Higher serum high-sensitivity C-reactive protein level independently predicted poorer endothelial function in SLE patients. Osteoporotic fracture is a major lupus musculoskeletal damage which occurred in 9% of SLE patients as found in the seventh study. Increasing age and duration of corticosteroid use independently predicted osteoporotic fracture. While hormonal replacement therapy appeared fracture protective, its unfavorable long-term consequences limit its indication for fracture prevention. Mitigating fracture risk before fractures occur is the current management strategy. The eighth study found that the significantly higher FRAX? 10-year risk of major osteoporotic and hip fractures amongst SLE patients na?ve for clinical fracture compared with their demographically and anthropometrically matched healthy counterparts was driven by chronic glucocorticoid use and premature menopause. Modifiable factors including low hip bone mineral density (BMD), cumulative glucocorticoids and higher serum anti-dsDNA level independently predicted higher fracture risks. Finally, the relationship between lumbar bone loss and endothelial dysfunction was hitherto identified. Although potential drivers of this relationship remain to be identified, our findings serve to alert physicians to early atherosclerosis in lupus patients particularly in those with low lumbar BMD. / published_or_final_version / Medicine / Master / Doctor of Medicine

This multi-method study presents an exercise in applied discourse analysis conducted within the broad framework of systemic-functional linguistics. The theoretical part of the work explores the relationship between one functional component of language, Halliday's notion of Theme, and the characterisation of a particular genre, the scientific research article (RA). Relevant literature on a variety of views of genre and Theme in the traditions of English for Academic Purposes (FAP) and systemic-functional linguistics is reviewed. The integration of these two levels of functional description is used as a basis for exploring the way in which Theme and generic structure relate to 'successful' processes and products of scientific research communication. The particular educational setting for the applied part of this work is the writing of first scientific RAs in English by NNS (non-native speaker) novice researchers. The primary method of study adopted here is corpus-based and initial discourse-functional analysis and description of marked and unmarked thematic choices are based on a corpus of 36 published RAs in the physical and life sciences written by 'experienced' NSs. This corpus represents a base 'norm' of thematic usage against which other corpora are compared, namely, published RAs written by 'experienced' NNS scientists and unpublished first and final RA drafts written by NNS novices. Major findings indicated that 'appropriate' thematic selections in the RA genre are constrained by the changing rhetorical purposes, signalled by means of moves, which operate throughout the different stages of scientific RA discourse; thus, the textual metafunction of Theme plays a significant role in the characterisation and dynamic wi thin-text structuring of the scientific RA genre. Furthermore, background surveys by means of questionnaires and interviews of the participants in the process of international research communication, in particular, of 'expert' NS journal editors, confirmed that 'appropriate' thematic control was clearly associated with the judgement of the merits of NNSs' RAs, and thereby, their 'successful' publication. With the pedagogical application of such theoretical insights in mind, the use of the teaching/research tool of Propositional Clusters (PCs) was explored in the EAP classroom as a heuristic for raising NNS novices' awareness about the manipulation of Theme in drafting and redrafting RA sections. Data collected from PCs exercises indicated their potential to raise awareness about the role of 'appropriate' thematic control in helping to create 'successful' texts. This study contributes to our understanding of aspects of the functional relationship between elements of discourse structure and lexica-grammatical components such as Theme/Subject. In addition, reflecting the social-semiotic perspective of a systemic-functional framework, this work strongly emphasises the social-constructionist nature of the processes involved in international research communication through the medium of the scientific research article.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 5 uppsatser.

Thesis (M. Ag. Sci.)--University of Adelaide, 1957. / Spine title: Systemic insecticides in grape vines. Typescript (copy). Includes bibliographical references (leaf . 82-84).

Thesis (M. Phil.)--University of Hong Kong, 2009. / Includes bibliographical references (leaves 61-82) Also available in print.