Antiphospholipid syndrome in northwest Italy (APS Piedmont Cohort): demographic features, risk factors, clinical and laboratory profile

We report the experience from the Antiphospholipid Antibodies (aPL) Regional Consortium in northwest Italy, meant to support clinical research and foster collaboration among health professionals regarding the diagnosis and management of antiphospholipid syndrome (APS) patients. This cohort-study (APS Piedmont Cohort) was designed to register the clinical characteristics at inception and associated immunological manifestations at diagnosis (if any) of patients who strictly fulfilled the current criteria for APS, all recruited at the Piedmont and Valle d'Aosta regions. Clinical and laboratory data from 217 APS patients (171 with vascular events, 33 with pregnancy morbidity and 13 with both), from 16 centres within the geographical area were collected. Venous thrombosis was recorded in 45.6% of patients, arterial thrombosis in 35%, small-vessel thrombosis in 1.12% and mixed arterial and venous thrombosis in the remaining 19.4% of the cases. Pregnancy morbidity included 19 patients with unexplained fetal death beyond the 10th week of pregnancy, 17 with premature birth before the 34th week and 10 with three or more unexplained spontaneous abortions before the 10th week of gestation. This consortium represents an instrument by which to audit clinical practice, to provide counselling to local centres and to sustain future basic and clinical APS research.     

Glenohumeral internal rotation deficit: pathogenesis and response to acute throwing

Overhand throwing places high loads and stresses on the joints and tissues of the shoulder and arm. As a result, throwing athletes regularly demonstrate altered shoulder internal and external ranges of motion where internal rotation (IR) is decreased and external rotation is increased in the dominant arm when compared with the nondominant arm. This alteration can exist as a result of alterations to the bones (humeral retroversion), capsule (posterior thickening), or muscle (passive stiffness known as thixotropy). When the amount of IR or total arc of motion difference reaches a certain threshold (typically 20 or more degrees of IR or 8 degrees total arc difference), it is known as glenohumeral internal rotation deficit or total arc of motion deficit. Glenohumeral internal rotation deficit and total arc of motion deficit can cause alterations in biomechanics such as scapular "wind-up" or alteration of glenohumeral joint kinematics, which can in turn lead to clinical findings of impingement and labral pathology. This study will review the causes of motion alteration, effects of altered motion on the throwing motion, provide definitions for the various types of rotation deficits, and how to evaluate and treat rotational deficits.     

Long-term effects of intensive B cell depletion therapy in severe cases of IgG4-related disease with renal involvement

Immunologic Research - IgG4-related disease (IgG4-RD) is an immune-mediated disorder often showing elevated serum IgG4 concentrations, dense T and B lymphocyte infiltration, and IgG4-positive...     

An Acute Throwing Episode Decreases Shoulder Internal Rotation

Background  

Glenohumeral internal rotation (GIR) and total arc of motion (TAM) decrease, whereas external rotation (GER) may increase in throwing. Although decreased GIR has been documented after throwing, its time course for recovery and the effect of pitching role have not.     

Comparative radiologic study of bone localizations of malignant lymphomas

The radiological features of bone lesions in patients affected by malignant lymphoma (Hodgkin's lymphoma, non-Hodgkin's lymphoma and primary non-Hodgkin's lymphoma of bone) were studied. For each bone lesion the site and type of alteration, the involvement of the cortex and adjacent soft tissue, the periosteal reaction and the presence of a pathological fracture were considered. The radiological aggressiveness of bone lesions in malignant lymphoma was assessed on the basis of these data according to Lodwick criteria; the lower aggressiveness of bone lesions of Hodgkin's than in non-Hodgkin's lymphoma is stressed.     

Oxidative stress and airway inflammation after allergen challenge evaluated by exhaled breath condensate analysis

Background Allergen exposure may increase airway oxidative stress, which causes lipid membrane peroxidation and an increased formation of 8‐isoprostane. Objective The aim of the study was to investigate oxidative stress induced by allergen challenge in mild asthmatics, by measuring 8‐isoprostane in exhaled breath condensate (EBC), and to examine their relationship with mediators derived from arachidonic acid. Methods 8‐isoprostane, cysteinyl leukotrienes (cys‐LTs) and prostaglandin E2 (PGE₂) concentrations in EBC were measured at baseline and after allergen challenge in 12 patients with mild allergic asthma sensitized to cat allergen. Results At 24 h after allergen challenge, compared with baseline values, EBC 8‐isoprostane increased [48.64 pg/mL (44.14–53.61) vs. 21.56 pg/mL (19.92, 23.35), P<0.001], cys‐LTs increased [27.37 pg/mL (24.09–31.10) vs. 13.28 pg/mL (11.32, 15.57), P<0.001] and PGE₂ decreased [18.69 pg/mL (12.26, 28.50) vs. 39.95 pg/mL (34.37, 46.43), P<0.001]. The trend of increasing 8‐isoprostane after allergen challenge was significantly correlated with the trend of increasing cys‐LTs (R²=0.85, P<0.001) whereas the trend of decreasing PGE₂ after allergen challenge was significantly correlated with the trend of increasing cys‐LTs (R²=0.52, P=0.001). Conclusions and Clinical Relevance The increase in EBC 8‐isoprostane observed after allergen challenge indicates that allergen exposure increases airway oxidative stress in allergic asthma. The strict correlation between cys‐LTs and 8‐isoprostane underlines the relationship between allergic inflammation and oxidative stress. A shift of arachidonic acid metabolism towards lipoxygenase pathway is induced by the allergen challenge. Airway oxidative stress occurs after allergen challenge even in patients with mild intermittent allergic asthma. Cite this as: L. Brussino, I. Badiu S. Sciascia, M. Bugiani, E. Heffler G. Guida, A. Malinovschi, C. Bucca and G. Rolla, Clinical & Experimental Allergy, 2010 (40) 1642–1647.     

Spiral CT evaluation of pulmonary emphysema using a low-dose technique

PURPOSE: To evaluate the diagnostic accuracy and clinical acceptability of low-dose spiral CT for determining pulmonary volumes and emphysema extension in patients with pulmonary emphysema, in comparison with studies based on spiral CT at conventional dose. MATERIALS AND METHODS: We prospectively evaluated eighteen patients, current or former smokers, with a clinical diagnosis of chronic obstructive pulmonary disease. All the patients underwent: HRCT with three scans at predetermined levels; quantitative spiral CT, with two inspiratory scans, one conventional scan at 240 mA, and the second one a low-dose scan at 80 mA. We used the following parameters: 120 kV, rotation time 0.8", scan time less than 20" (single inspiratory breath-hold), layer thickness 7.5 mm, pitch 6 (high speed), interpolation algorithm at 180 degrees. A 3D reconstruction was performed, with segmentation of the lungs and automatic quantification of pulmonary volumes. We compared the volumes of absolute and percent emphysema and the ratings of the dose delivered to the patient (CTDIw and DLP) obtained with the two spiral CT scans with each other and with the respiratory function tests. RESULTS: The average total lung capacity (TLC) obtained by conventional-dose spiral CT (CTs1) was 6889.4 cc (SD +/-1813.2), and the capacity with low-dose spiral CT (CTs2) was 6929.4 cc (SD +/-1811.6). The percentage of emphysema was 39.7% (range: 2.2-63.5%; SD: +/-19.9) for the CTs1 and 41.1% (range: 2.1-66.4%; SD: +/-20). The CTDIw corresponding to CTs1 was 12.2 mGy (range: 11.9-16.4; SD: +/-1), the one corresponding to CTs2, 3.6 mGy (range: 3.6-4.9; SD: +/-0.3). The DLP corresponding to CTs1 was 391.7 mGy x cm (range: 333.3-518.9; SD: +/-46.7), the one corresponding to CTs2 was 117.8 mGy x cm (range: 100.3-156; SD: +/-14). As for the respiratory function tests, the total lung capacity (TLC) obtained by body plethysmography was 7061 cc (SD: +/-2029.7); the percent TLC was 115.9 (range: 66-165; SD: +/-27.6), the forced expiratory volume at one second (FEV1%, percentage of predicted value) was 46.7% (range: 17-123; SD: +/-27.3), residual volume (RV%) as a percentage of predicted value was 186.3 (range: 84-359; SD: +/-80.7), the Tiffeneau index (TI) was 46% (range: 25-71; SD: +/-15.7). We observed a very significant correlation between radiological and functional TLC for both CT methods. The percentage scores for emphysema obtained with the two methods correlated significantly with the functional indexes. The pixel index of CTs1 correlated with TLC% (r=0.87; p<0.0001), FEV1% (r=-0.53; p<0.02), RV% (r=0.76; p=0.004), TI (r=-0.79; p=0.0001). The pixel index of CTs2 correlated with TLC% (r=0.87; p<0.0001), FEV1% (r=-0.56; p=0.01), RV% (r=0.78; p=0.003), TI (r=-0.8; p=0.0001). The adoption of the method with low tube current entailed a highly significant reduction in the estimated dose delivered to patients (CTDIw and DLP) with r=0.9 and p < 0.0001. DISCUSSION AND CONCLUSIONS: Quantitative low-dose spiral CT is a very good method to quantify pulmonary volumes and calculate the extension of the anatomic emphysema. The reduction of mA from 240 to 80 lowers the estimated dose by 30%, without compromising the accuracy of the results. Our study achieved a highly significant correlation between the results obtained with the two spiral CT techniques and between these results and the respiratory function tests. In clinical practice, the easiest way to reduce the dose in spiral CT of the lung is to reduce the tube current. The low-dose method allows a significant reduction in radiation exposure. Further studies are required to establish to what extent the dose can be reduced without increasing in quantum noise and thereby compromising the quality of the study.     

Epidermal growth factor and proliferation in rat hepatocytes in primary culture isolated at different times after partial hepatectomy

Primary hepatocyte cultures have been prepared from normal adult rat liver and from rat liver at 4, 8, 12, 24, and 48 h following partial hepatectomy (removal of 70% of the liver). Cells were maintained in minimal essential medium alone or supplemented with hormones. Comparing DNA synthesis in normal adult rat hepatocytes with DNA synthesis in hepatocytes isolated from regenerating livers, we found with minimal essential medium alone little DNA synthesis in normal adult rat hepatocytes and in hepatocytes isolated 4, 8, or 12 h after 70% hepatectomy. In hepatocytes isolated 24 h after partial hepatectomy, however, the incorporation of [3H]thymidine was 3 times the rate of normal hepatocytes. The addition of insulin to minimal essential medium had minimal effect on DNA synthesis in all hepatocytes. Addition of epidermal growth factor alone or in combination with insulin resulted in a dramatic increase in DNA synthesis in hepatocytes from regenerating rat liver. Increased incorporation was detectable as early as 4 h after partial hepatectomy and reached a maximum at 24 h after the operation. Results obtained with [3H]thymidine incorporation were confirmed by autoradiography and by direct DNA determinations in hepatocyte cultures. Epidermal growth factor binding to the hepatocytes was determined and agreed with previously reported binding studies. Binding of epidermal growth factor in hepatocytes isolated at 4 h after partial hepatectomy was the same as in normal hepatocytes but was undetectable in hepatocytes isolated from rats at 12 and 24 h after partial hepatectomy.