The effect of methylprednisolone pulse treatment on cytokine network in Graves ophthalmopathy

The etiology of Graves ophthalmopathy (GO), representing the most common extrathyroidal manifestation of Graves disease, is multifactorial. Among multiple genetic, environmental, and endogenous factors, cytokines play a critical role in its etiopathogenesis. We studied an effect of glucocorticoid therapy on the serum IL-6, IL-4, and IL-13 levels in 18 GO patients. All the patients presented euthyroid GO with over 4 points according to the CAS classification (range 4-6; mean 4.94). The patients were treated with methylprednisolone (1 g every second day for three times) followed by 6 months oral prednisone (60 mg/day, with gradual reduction). The clinical examination (Clinical Activity Score and the GO severity by modified NOSPECS classification) and measurement of anti-TPO, anti-TG, anti-TSHR (TRAK), IL-6, IL-4, as well as IL-13 serum levels were performed before, after 2 weeks, and after 6 months of the glucocorticoid therapy. Significant serum IL-6 increases (p < 0.001) and moderate serum IL-4 and IL-13 increases (p < 0.05) were found in GO patients compared with healthy controls. After 2 weeks of the therapy, the serum IL-6 levels decreased in majority of the patients, however after 6-month observation, lower serum IL-6 levels were only in 8 patients who seemed to respond clinically to the therapy (mean value of the Clinical Activity Score decreased from 4.5 before the therapy initiation to 1.25 after 6 months of the glucocorticoid therapy). No changes in IL-4 and IL-13 serum levels during the therapy were observed. Statistical analysis revealed a good correlation between serum IL-6 level and the Clinical Activity Score (p < 0.01). Based on the obtained data, we conclude that IL-6 plays an important role in GO. It seems that IL-6 may serve as a useful factor in the inflammatory events of GO.     

Distribution of CTLA-4 polymorphisms in allergic asthma

BACKGROUND: The CTLA-4 molecule is an important negative regulator of T cell activation. It is encoded on chromosome 2q33 and found to be associated with several allergic phenotypes including asthma. However, the association of CTLA-4 gene polymorphisms with allergic asthma is still controversial and therefore was the subject of this study. METHODS: By PCR-RFLP, the distribution of three single nucleotide polymorphisms (SNPs), -1147 C/T, -318 C/T, and +49 A/G, was examined in 219 Polish Caucasoid patients diagnosed with allergic asthma and in 102 ethnically matched healthy control individuals. (AT)(n) microsatellite polymorphism was also tested in the same individuals. RESULTS: No statistically significant differences in SNPs or microsatellite allele, genotype or haplotype frequencies between patients and controls were found. CONCLUSION: CTLA-4 polymorphisms do not seem to be a risk factor for allergic asthma in Poles.     

Determinants of Bullying at School Depending on the Type of Community: Ecological Analysis of Secondary Schools in Poland

Ecological studies, when the school is the unit of analysis, may help to design and evaluate school intervention programs. The paper discusses selected contextual determinants of bullying, using data collected in Poland in 2015 and aggregated to school level (4085 students; 70 junior high schools). The main hypothesis is related to the neighborhood social capital as protective factor and the type of community as a modifier. The main dependent variable was the combined index of bullying which included three perspectives (victim, perpetrator, bystander). Student delinquent behavior was taken into account as potential determinant, along with selected characteristics of the school and neighborhood. The analyses were adjusted for the percentage of the surveyed boys. The overall bullying index ranged, depending on the school, from 0.88 to 4.07 points (out of 12 possible); intraclass coefficient ICC = 2.8%. In the entire sample, the main predictors of bullying were student delinquent behaviors as a risk factor and the school social climate as a protective factor (R ² = 56.3%). The stratification of schools due to their location influences the inference regarding those main determinants. The dominating influence of delinquent behavior is visible only in big cities where bullying index showed the highest dispersion. In smaller towns and rural areas, the neighborhood social capital becomes an important protective factor; highly correlated with the school climate. We can conclude that strong social bonds in the community are supportive for school climate and can reduce the level of bullying at schools.     

The use of radiosynovectomy in patients with juvenile idiopathic arthritis. Assessment of treatment efficacy and safety

ObjectivesThe aim of the study was to evaluate the usefulness of knee joint radiosynovectomy (RS) in patients suffering from juvenile idiopathic arthritis (JIA).Material and methodsOne hundred RS procedures performed in 58 patients with JIA in average age 10.4 years were evaluated.ResultsAfter 6 weeks, a decrease in the number of cases with joint pain from 90.3% to 29%, with joint oedema from 100% to 74.5%, with joint exudate from 100% to 60.6%, with gait disorders from 19.4% to 3.2%, with joint mobility disorders from 51.1% to 26.6% in the RS cases was observed. A reduction of the score in the Colorado scale from 10.9 to 4.66, in the pain visual analogue scale (VAS) from 50 to 10, in the illness VAS assessed by the patient/parent from 69.9 to 32.4, in the illness VAS assessed by the physician from 68.8 to 36.9 was observed. Six months after the RS procedure, a reduction in the number of cases with joint pain from 89.5% prior to the procedure to 29.5%, with oedema from 100% to 58.3%, with exudate from 100% to 46.9%, with gait disorders from 20% to 2.1%, with joint motility disorders from 51.1% to 26.1% was achieved. The score in the Colorado scale was reduced from 10.9 to 4.04, in the pain VAS from 40 to 0, in the illness VAS assessed by the patient/parent from 69.7 to 27.9, in the illness VAS assessed by the physician from 68.8 to 32.4. In ultrasound examinations, the greatest improvement compared to the initial condition was recorded in the 6^th month after the RS. Radiosynovectomy was positively evaluated by parents and patients in 34 anonymous surveys. Early and late observations (average 1473 days) did not show lesions at the isotope injection site, and no neoplastic lesions were observed.ConclusionsRadiosynovectomy is a valuable therapeutic option for local treatment in patients with JIA.