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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPrimary cardiac disorders in patients with connective tissue diseases are a consequence of the autoimmune process. Myocarditis evolving into dilated cardiomyopathy is a common complication of many connective tissue disorders, including systemic lupus erythematosus and systemic sclerosis. Other cardiac disorders associated with autoimmune diseases include endomyocarditis and endomyocardial fibrosis, pericarditis, valvulitis, hypertensive cardiomyopathy, and coronary arteritis. This article discusses the characterization, diagnosis, and management of these cardiovascular complications.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESystemic Connective Tissue Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELupus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatological Autoimmune Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESystemic Connective Tissue Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EImaging Modalities\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELupus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInflammatory Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatological Autoimmune Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPrimary cardiac disorders in patients with connective tissue diseases are a consequence of the autoimmune process. Myocarditis evolving into dilated cardiomyopathy (DCM) is a common complication of many connective tissue disorders, including systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Other cardiac disorders associated with autoimmune diseases include endomyocarditis and endomyocardial fibrosis, pericarditis, valvulitis, hypertensive cardiomyopathy, and coronary arteritis. The focus of this session was on the characterization, diagnosis, and management of these cardiovascular complications.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EHEAVY CARDIAC DISEASE BURDEN IN PATIENTS WITH CONNECTIVE TISSUE DISORDERS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIn his presentation, Yannick Allanore, MD, Rene Descartes University, Paris, France, discussed the features and diagnosis of primary cardiac disease in patients with SLE and SSc.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ESLE affects most parts of the heart, including the pericardium, myocardium [Jain D, Halushka MD. \u003Cem\u003EJ Clin Pathol\u003C\/em\u003E 2009] and valves [Zuily S et al. \u003Cem\u003ECurr Rheumatol Rep\u003C\/em\u003E 2013]. Pericardial involvement is found in 40% to 80% of patients with SLE on autopsy. Clinical symptoms manifest at disease onset or during relapse in 25% of patients and include chest pain with or without dyspnea, fever, tachycardia, decreased heart sounds, pericardial rubs, and, rarely, tamponade. Diagnostic tests include echocardiography and chest radiography. The standard treatments are nonsteroidal anti-inflammatory drugs, colchicine, steroids, and chronic immunosuppression [Jain D, Halushka MD. \u003Cem\u003EJ Clin Pathol\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EMyocardial dysfunction is associated with myocarditis, drug-induced injury, or ischemic injury secondary to atherosclerosis. Patients are evaluated with coronary angiography or computed tomography to investigate coronary artery disease; if the results of these tests are negative, patients undergo magnetic resonance imaging (MRI) or endomyocardial biopsy. Patients generally are treated with high-dose corticosteroids and cyclophosphamide [Jain D, Halushka MD. \u003Cem\u003EJ Clin Pathol\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EPulmonary hypertension (PH) in patients with SLE develops as a result of conditions that cause hypoxic vasoconstriction, thromboembolism caused by antiphospholipid antibodies, pulmonary veno-occlusive disease, left heart disease, and noncirrhotic portal hypertension. Similar conditions lead to PH in patients with SSc [Dhala A. \u003Cem\u003EClin Dev Immunol\u003C\/em\u003E 2012]. Conduction defects and arrhythmias are common in patients with SSc; 30% to 50% of patients have abnormal results on resting electrocardiography (ECG). On Holter ECG, 20% have coupled ventricular extrasystoles, and 10% have nonsustained ventricular tachycardia. The risk for conduction defects is higher in patients with muscle and cardiac disease [Vacca A et al. \u003Cem\u003ERheumatology (Oxford)\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EIn summary, patients with SLE and SSc have a heavy burden of primary heart disease. Subclinical cardiac abnormalities are common in these populations.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECARDIAC MRI FOR DIAGNOSIS OF PRIMARY HEART DISEASE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ESven Plein, MD, PhD, University of Leeds \u0026amp; Kings College, London, United Kingdom, discussed the use of cardiac magnetic resonance (CMR) for diagnosing primary cardiac involvement in patients with autoimmune disease. Patients with rheumatoid arthritis (RA), SLE, and SSc are at risk for a variety of cardiovascular pathologies. According to Prof. Plein, CMR is accurate, reproducible, versatile, noninvasive, and mostly quantitative; uses nonionizing radiation; and is useful for tissue characterization. CMR has limitations, including limited availability, a requirement for expertise in acquisition and interpretation, and the mostly visual nature of analysis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EA study of CMR in patients with heart failure reported a marked improvement in reproducibility compared with 2-dimensional echocardiography [Bellenger NG, et al. \u003Cem\u003EJ Cardiovasc Magn Reson\u003C\/em\u003E 2000]. The first study to use CMR to assess cardiac structure and function in patients with RA found that the mean left ventricular mass was much lower in patients with RA compared with controls [Giles JT et al. \u003Cem\u003EArthritis Rheum\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EHachulla et al. [\u003Cem\u003EAnn Rheum Dis\u003C\/em\u003E 2009] demonstrated that CMR is reliable and sensitive for diagnosing cardiac involvement in patients with SSc and for analyzing inflammatory, microvascular, and fibrotic components. CMR provided more information than echocardiography by visualizing inflammation and fibrosis. A study using T2-weighted CMR identified clinically unsuspected acute ischemic and inflammatory injury in patients with resuscitated sudden cardiac death and sustained monomorphic ventricular tachycardia [White JA et al. \u003Cem\u003ECirc Cardiovasc Imaging\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EAnother study used CMR with T1 mapping and extracellular volume quantification to visualize subclinical myocardial inflammation and diffuse fibrosis in patients with SSc [Ntusi NAB et al. \u003Cem\u003EJ Cardiovasc Magn Reson\u003C\/em\u003E 2014]. Native T1 and extracellular volume were significantly higher in patients with SSc versus controls (p\u0026lt;0.001) and were significantly correlated with disease activity and severity (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/9\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Correlation of Myocardial T1 and ECV to Peak Circumferential Systolic Strain and Peak Diastolic Circumferential Strain Rate\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-463649996\u0022 data-figure-caption=\u0022Correlation of Myocardial T1 and ECV to Peak Circumferential Systolic Strain and Peak Diastolic Circumferential Strain Rate\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/9\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/9\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/17\/9\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14618\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003ECorrelation of Myocardial T1 and ECV to Peak Circumferential Systolic Strain and Peak Diastolic Circumferential Strain Rate\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EECV=extracellular volume\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EBlue dot indicates systemic sclerosis; gray dot indicates control.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced from Ntusi NA et al. Diffuse myocardial fibrosis is subclinical and is associated with impaired myocardial deformation characteristics in systemic lupus erythematosus: a cardiovascular magnetic resonance study. \u003Cem\u003EJ Cardiovasc Magn Reson\u003C\/em\u003E 2014;16(Suppl 1):P307.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-13\u0022\u003E\n            \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E lists the uses for the different CMR protocols in patients with autoimmune disease.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14619\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14619\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14619\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003ECMR Protocols and Their Uses\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EProf. Plein concluded that CMR is a validated quantitative method for performing multiparametric assessment of cardiovascular morphology and function. Early data suggest a role for CMR in assessing cardiovascular involvement in autoimmune disease, but the studies have been small, and no outcomes data are available. Furthermore, many study results are nonspecific, and the potential exists for misinterpretation of data by inexperienced observers.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMANAGING CARDIAC COMPLICATIONS OF AUTOIMMUNE DISEASES\u003C\/h2\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EAlida L. P. Caforio, MD, PhD, University of Padova, Padova, Italy, reviewed the features, diagnosis, and management of cardiac involvement in patients with autoimmune connective tissue disorders. Autoimmune myocarditis is common among patients with these disorders and is defined as histologic myocarditis with negative viral polymerase chain reaction, with or without serum cardiac autoantibodies [Caforio ALP et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EClinically suspected myocarditis is diagnosed by new abnormalities on ECG, Holter ECG, or stress testing; elevated myocardiocytolysis markers (troponin T or troponin I); functional and structural abnormalities on cardiac imaging; or tissue characterization by CMR [Caforio ALP et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2013]. The European Society of Cardiology recommends treatment with immunosuppression for proven forms of autoimmune myocarditis, including giant cell myocarditis, cardiac sarcoidosis, and myocarditis associated with known extracardiac autoimmune disease [Caforio ALP et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003E\n            \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E shows the cardiac complications associated with autoimmune diseases and their treatments.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14620\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14620\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14620\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003ECardiac Complications of Autoimmune Diseases\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EMany patients with systemic immune-related disorders develop inflammatory cardiomyopathy with or without a DCM phenotype. Clinically overt myocardial involvement confers a negative prognosis and may be life threatening. Subclinical inflammatory cardiomyopathy is likely to be underdiagnosed and inadequately treated. Furthermore, there is a lack of prospective studies using current cardiac imaging to define the frequency of inflammatory cardiomyopathy in the various autoimmune diseases. Prof. Caforio concluded that a multidisciplinary approach that includes a cardiologist is needed in the management of systemic immune-related disorders.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/17\/9.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp35p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp35p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp35p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}