Balloon kyphoplasty: scintigraphy as the ultimate decision maker?

Balloon kyphoplasty is still controversial as a treatment for vertebral compression fractures (VCFs) due to osteoporosis. Nevertheless, the authors conducted a prospective study in 60 patients about the effectiveness of scintigraphy, after the conventional roentgenographic examination, as an ultimate decision maker for the identification of the levels to be treated. Seventy-one levels were radiographically and scintigraphically positive, were seen as active, and thus treated. Thirty-seven levels were radiographically negative but positive scintigraphically, were considered as imminent fractures, and thus treated. Ten levels were positive radiographically, but negative scintigraphically, and were not treated as they were considered as healed. The Oswestry Disability Score (100% = worst possible condition) improved from 38.8% +/- 39.5% at baseline, to 2.38% +/- 3.99% on the first postoperative day (p < 0.001), to 2.00% +/- 3.40% at 1 month (p < 0.001) and to 1.93% +/- 3.33% at 6 months (p < 0.001). This preliminary study gives a hint that scintigraphy might work as the ultimate decision maker, even when plain radiographs are negative. Further studies will be needed to compare patients with VCFs positive radiographically and scintigraphically, and other patients with VCFs negative radiographically, but positive scintigraphically.     

Hospital-based surveillance of rotavirus gastroenteritis in the era of limited vaccine uptake through the private sector

To investigate possible impact of limited vaccine uptake by the private sector since 2007, a prospective observational study included all children <5 years hospitalized for acute gastroenteritis (AGE) in a Tertiary Care Hospital between 09/2006 and 08/2010. Rotavirus (RV) antigen was detected in stools by a rapid immunochromatographic test and genotype analysis was performed on positive samples by RT-PCR. Compared to 2006-2008, the likelihood of rotavirus infection was significantly reduced among children hospitalized for AGE in 2008-2010 (OR 0.64; 95%CI: 0.49-0.84, p < 0.001). This was mainly due to the reduction of RVGE cases in infants 0-11 months (p = 0.035). Moreover, RVGE cases as well as the rate of RVGE/10,000 hospitalized children significantly decreased (p = 0.009 and p = 0.010 respectively). No children with rotavirus gastroenteritis (RVGE) had received any vaccine dose. G4P [8] was the most common genotype (64/90). In conclusion, this study indicates that even low RV vaccination coverage may have significant effect.     

Air trapping in Wegener��s granulomatosis: an additional finding on expiratory chest HRCT

Purpose

This study was undertaken to assess the presence and extent of air trapping (AT) on high-resolution computed tomography (HRCT) in patients with Wegener??s granulomatosis (WG) and to correlate the finding with the inspiratory pattern and bronchial/bronchiolar involvement.

Materials and methods

Twenty-one patients (7 M/14 F) with WG underwent inspiratory and expiratory HRCT. Images were evaluated for the presence and extent of AT and for airway involvement (bronchi/bronchioles); the predominant HRCT pattern was also documented. The attenuation difference was measured between the areas of AT on expiration and the same areas on inspiration in order to verify the finding of AT. The extent of AT was calculated by visual scoring and correlated with the predominant inspiratory patterns and bronchial/bronchiolar involvement.

Results

AT was found in seven patients (33.3%) and its extent ranged between 3% and 70% (mean 15.8±7). Two patients showed no lesions on inspiratory HRCT, and the only finding was AT on expiration. The attenuation difference between areas of AT on expiration and the same areas on inspiration ranged between 32 and 89 HU. Inspiratory HRCT was pathological in 19 patients (90.4%), and the principal lung patterns were nodular, cavitary or noncavitary (n=7, 38.9%); ground-glass opacities (n=5, 26.3%); masses (n=3, 15.8%); fibrotic (n=3, 15.8%); and consolidation with air bronchogram (n=1, 5.3%). Bronchial and bronchiolar involvement was found in 14 and five patients, respectively. No statistically significant correlation was found between AT extent and the findings on inspiration. In addition, there were no specific patterns that caused higher or lower scores of AT. Moreover, when bronchial or bronchiolar involvement was absent, the mean AT score was statistically significantly higher.

Conclusions

Areas of AT represent a new and indirect HRCT finding, ?? and in rare cases the only finding ?? of pulmonary WG. The nonsignificant correlation between AT extent and inspiratory findings may suggest AT as an additional HRCT finding in patients with WG.     

Association of the nitric oxide synthase (eNOS) gene polymorphism with increased risk for both lupus glomerulonephritis and rheumatoid arthritis in a single genetically homogeneous population

Nitric oxide (NO), a short-lived gaseous free radical, synthesized from L-arginine by NO synthases (NOS), is a potent mediator of biologic responses involved in the pathogenesis of autoimmune rheumatic diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Most biological necessary NO is produced by the family of three NOS. To date, several functionally relevant genetic polymorphisms in the eNOS gene have been associated with various vascular, infectious and autoimmune diseases. To our knowledge, no study has explored these polymorphisms for both SLE and RA in the same population. The objective of this study was to investigate the influence of the eNOS gene intron 4 a/b VNTR polymorphism (a 27-base-pair tandem repeat-based polymorphism) on susceptibility to SLE and RA in patients living in the island of Crete, a genetically homogeneous population. A group of 145 healthy subjects and 190 SLE patients were included in this study. Similarly, a second group of 235 healthy controls and 202 RA patients were analysed. In both cases, patients and controls were sex- and age-matched. Herein we report that the presence of a/b genotype of the eNOS gene may act as a risk factor not for the presence of SLE but for the development of glomerulonephritis (OR 2.71, 95% CI: 1.4-5.2), while it may be a susceptibility gene for RA (OR: 2.005, 95% CI: 1.31-3.07). Thus, in our population, the a/b genotype of the eNOS gene represents a severity rather than a susceptibility genotype for SLE.     

Metabolic syndrome is common among middle-to-older aged Mediterranean patients with rheumatoid arthritis and correlates with disease activity: a retrospective, cross-sectional, controlled, study

OBJECTIVES: Patients with rheumatoid arthritis have an increased risk for cardiovascular disease (CVD). The prevalence of metabolic syndrome (MetS)-a major contributor to CVD-in a cohort of patients with rheumatoid arthritis and its relationship with rheumatoid arthritis related factors is investigated here. METHODS: 200 outpatients with rheumatoid arthritis (147 women and 53 men), with a mean (standard deviation (SD)) age of 63 (11) years, and 400 age and sex-matched controls were studied. MetS was assessed according to the adult treatment panel III criteria and rheumatoid arthritis disease activity by the disease activity score of 28 joints (DAS28). A standard clinical evaluation was carried out, and a health and lifestyle questionnaire was completed. RESULTS: The overall prevalence of MetS was 44% in patients with rheumatoid arthritis and 41% in controls (p = 0.5). Patients with rheumatoid arthritis were more likely to have low high-density lipoprotein cholesterol compared with controls (p = 0.02), whereas controls were more likely to have increased waist circumference or raised blood pressure (p = 0.001 and 0.003, respectively). In multivariate logistic regression analysis adjusting for demographics and rheumatoid arthritis treatment modalities, the risk of having moderate-to-high disease activity (DAS28>3.2) was significantly higher in patients with MetS compared with those with no MetS components (OR 9.24, 95% CI 1.49 to 57.2, p = 0.016). CONCLUSION: A high, albeit comparable to the control population, prevalence of MetS was found in middle-to-older aged patients with rheumatoid arthritis. The correlation of rheumatoid arthritis disease activity with MetS suggests that the increased prevalence of coronary heart disease in patients with rheumatoid arthritis may, at least in part, be attributed to the inflammatory burden of the disease.     

The paf gene product modulates asexual development in Penicillium chrysogenum

Penicillium chrysogenum secretes a low molecular weight, cationic and cysteine-rich protein (PAF). It has growth inhibitory activity against the model organism Aspergillus nidulans and numerous zoo- and phytopathogenic fungi but shows only minimal conditional antifungal activity against the producing organism itself. In this study we provide evidence for an additional function of PAF which is distinct from the antifungal activity against putative ecologically concurrent microorganisms. Our data indicate that PAF enhances conidiation in P. chrysogenum by modulating the expression of brlA, the central regulatory gene for mitospore development. A paf deletion strain showed a significant impairment of mitospore formation which sustains our hypothesis that PAF plays an important role in balancing asexual differentiation in P. chrysogenum.     

The small molecular mass antifungal protein of Penicillium chrysogenum--a mechanism of action oriented review

The β-lactam producing filamentous fungus Penicillium chrysogenum secretes a 6.25 kDa small molecular mass antifungal protein, PAF, which has a highly stable, compact 3D structure and is effective against a wide spectrum of plant and zoo pathogenic fungi. Its precise physiological functions and mode of action need to be elucidated before considering possible biomedical, agricultural or food technological applications. According to some more recent experimental data, PAF plays an important role in the fine-tuning of conidiogenesis in Penicillium chrysogenum. PAF triggers apoptotic cell death in sensitive fungi, and cell death signaling may be transmitted through two-component systems, heterotrimeric G protein coupled signal transduction and regulatory networks as well as via alteration of the Ca(2+) -homeostasis of the cells. Possible biotechnological applications of PAF are also outlined in the review.     

A case of non-malignant multifocal lesions on the methyl diphosphonate technetium-99m bone scan with enteropathy. SAPHO syndrome

This is a case of a 24-year-old man with non-malignant multifocal bone lesions on the methyl diphosphonate technetium-99m bone scan, that may represent a variant of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. The patient complained for diffuse osseous pain, focused mainly in the hip joints. X-rays of the hips were normal but X-rays of the shoulders showed hyperostosis of the right clavicle with no erosions. SAPHO is a rare syndrome of unknown aetiology with no more than a hundred cases reported during the last 10 years. Its typical form consists of characteristic painful osteoarticular manifestations and dermatological findings. In a variant of this syndrome, such as in our case, dermatological manifestations may be absent, but hyperostosis with osseous hypertrophy and enteropathy are present. No other malignant or benign disease was diagnosed. All routine laboratory tests for an inflammatory rheumatoid disease were negative. Treatment with non steroid anti-inflammatory agents was successful and after six months, there were no clinical symptoms and lesions on the bone scan faded. Four years later the patient remained free from symptoms. We discuss the scintigraphic, radiological laboratory clinical findings, the therapeutic criterion and the exclusion of any malignant or other benign bone disease that suggest the diagnosis of SAPHO syndrome. In conclusion, although we were unable to perform a bone biopsy, we suggest that no other diagnosis but an enteropathic variant of SAPHO syndrome may better describe the above clinical and laboratory findings. Bone scan findings have a principal diagnostic role in SAPHO syndrome.