Health status and medical expenditures: more evidence of a link

The hypothesis that one must include life-style changes in order to accurately capture the true relationship between medical expenditures and health status is explored, using data from 22 countries over a 20-year period. A simultaneous model is estimated using a variety of indicators for life style as well as health status. Changes in life style, aging of the population and changes in occupational risk are modeled as influences on medical expenditures: medical expenditures and changes in life style are modeled as having direct influences on health status. The results are consistent with the existence of a positive link between medical expenditures and health status.     

ELEVATED SERUM LEVELS OF INTERLEUKIN-1 RECEPTOR ANTAGONIST IN POLYMYOSITIS/DERMATOMYOSITIS. A Biologic Marker of Disease Activity with a Possible Role in the Lack of Acute-Phase Protein Response

Objective. To determine whether the lack of acute-phase protein (APP) response in numerous patients with polymyositis/dermatomyositis (PM/DM) is related to an imbalance between cytokines and cytokine inhibitors. Methods. Levels of C-reactive protein (CRP), interleukin-1β (IL-1β), tumor necrosis factor α (TNFα), IL-6, IL-1 receptor antagonist (IL-1ra), TNF soluble receptor 55 kd (sTNFR 55 kd), and sTNFR 75 kd were tested in the serum of 15 patients with PM/DM, 14 patients with spondylarthropathies (SPA), and 12 healthy blood donors. Serum IL-1β, TNFα, IL-6, IL-1ra, sTNFR were measured by specific immunoassays. Results. Serum levels of CRP were lower in PM/DM patients than in SPA patients. Normal or slightly elevated CRP values were found in 10 of the 15 PM/DM patients, 7 of whom had active myositis. Serum IL-6 levels were significantly higher in SPA patients than in PM/DM patients, whereas serum IL-1ra and sTNFR levels were significantly higher in PM/DM than in SPA patients. IL-1ra levels were particularly elevated in patients with active myositis and decreased in response to treatment. Conclusion. These differences in cytokine levels, particularly IL-1ra, between PM/DM and SPA patients are indicative of distinct pathogenic mechanisms. High levels of IL-1ra may account for the weak APP response in some PM/DM patients. Our results suggest that measurement of IL-1ra, together with clinical examination, may provide useful information for the followup of PM/DM patients.     

Infantile Sweet syndrome following MMRV vaccine

Sweet syndrome (SS), also called acute febrile neutrophilic dermatosis, is rare in the pediatric population, especially in infants and neonates. We present a case of infantile SS that developed 1 day after the MMRV vaccine; we suggest a possible causal relationship between the MMRV vaccine and SS.     

α-SMA positive vascular mural cells suppress cyst formation in hemangioblastoma

Brain Tumor Pathology - Approximately 60% of hemangioblastomas (HBs) have peritumoral cysts adjacent to the tumor, which can cause neurological deficits due to the mass effect, and the management...