Heading Toward a Modern Imaging Approach in Juvenile Idiopathic Arthritis

MR imaging and musculoskeletal ultrasound are expanding their utility in the assessment of patients with chronic inflammatory arthritis. These imaging techniques, by providing additional and more sensitive information over clinical examination and conventional radiographs, are promising tools for the diagnosis, prognosis and assessment of treatment efficacy in patients with juvenile idiopathic arthritis (JIA). Owing to the peculiarities of the growing skeleton, knowledge of imaging in healthy children is of high priority. A sound understanding of growth-related changes is of foremost value in establishing whether the apparent changes on joint surface reflect real damage or are actually part of normal development. This review explores current evidence and suggests a new workflow for imaging in JIA, in which conventional and modern imaging modalities can be integrated for optimal management.     

Predictability of pharyngeal airway space dimension changes after orthognathic surgery in class II patients: A mathematical approach

IntroductionAngle Class II malocclusion due to mandibular retrognathia is a common dentofacial deformity. It is well known that mandibular advancement increases pharyngeal airway dimensions. The aim of this study was to evolve a mathematical method for predicting posterior pharyngeal airway space (PAS) changes based on 2D lateral cephalographic radiographs (LCRs) and expected extent of mandibular advancement prior to BSSO.Materials and methodsLinear regression analyses were performed in order to investigate the relation between the posterior airway space and mandibular advancement. LCRs where carried out to assess skeletal landmarks and pharyngeal airway space pre- (T0) and postoperatively (T1). To detect changes postoperatively, the posterior airway space was divided into three units: nasopharyngeal airway space (superior airway space — SPAS), oropharyngeal airway space (mid airway space — MAS) and hypopharyngeal airway space (inferior airway space — IAS). The differences between the distances of distinct measurement points (DIFF) were measured pre- and postoperatively. DOA referred to the distance of mandibular advancement and DP to the distance between the measurement points preoperatively. The parameters a, b₁ and b₂ were the regression coefficients that were determined separately for each unit (SPAS, MAS, and IAS).Results49 patients (16 male and 33 female) with a mean age of 27.2 years (SD: 10.09), ranging from 18 to 51 years, who underwent mandibular advancement surgery (BSSO) were enrolled in this study. The mean distance of mandibular advancement was 5.05 mm (SD: 1.63). Regarding SPAS and IAS, mandibular advancement did not affect dimensions significantly: SPAS DIFF, 0.33 mm ± 1.13 mm (b₁, p = 0.0881; b₂, p = 0.087); IAS DIFF, 0.66 mm ± 2.45 mm (b₁, p = 0.342; b₂, p = 0.765). DOA and DP did not influence DIFF significantly in both sections. Regarding MAS, the mean effect of mandibular advancement was an expansion of 2.47 mm ± 2.24. The linear regression model showed a statistically significant (b₁, p = 0.0064; b₂, p = 0.0240) influence of DOA and DP on DIFF in posterior airway dimensions pre- and postoperatively.DiscussionBased on preoperative LCR imaging data, a linear regression model was developed as a mathematical approach to allow prediction of PAS development in patients with Angle Class II malocclusions of different degrees. Increasing mandibular advancement was shown to be linked to increasing PAS, while a greater distance between the measuring points preoperatively led to smaller predicted PAS increases postoperatively.ConclusionPredicting pharyngeal airway space (PAS) development after mandibular advancement by analysing lateral cephalometric radiographs (LCR) may be useful in the screening and treatment of obstructive sleep apnea syndrome (OSAS) patients. Our mathematical approach is a simple and sustainable prediction tool based on LTR data for patients with Class II malocclusions.     

High prevalence of serum antibodies reacting with simian virus 40 capsid protein mimotopes in patients affected by malignant pleural mesothelioma

Human malignant pleural mesothelioma (MPM) is considered a rare tumor, but recent estimations indicate that one-quarter million people will die of this neoplasm in Europe in the next three decades. The mineral asbestos is considered the main causative agent of this neoplasm. MPM is largely unresponsive to conventional chemotherapy/radiotherapy. In addition to asbestos exposure, genetic predisposition to asbestos carcinogenesis and to simian virus (SV)40 infection has also been suggested. SV40 is a DNA tumor virus found in some studies to be associated at high prevalence with MPM. SV40 sequences have also been detected, although at a lower prevalence than in MPM, in blood specimens from healthy donors. However, some studies have failed to reveal SV40 footprints in MPM and its association with this neoplasm. These conflicting results indicate the need for further investigations with new approaches. We report on the presence of antibodies in serum samples from patients affected by MPM that specifically react with two different SV40 mimotopes. The two SV40 peptides used in indirect ELISAs correspond to viral capsid proteins. ELISA with the two SV40 mimotopes gave overlapping results. Our data indicate that in serum samples from MPM-affected patients (n = 97), the prevalence of antibodies against SV40 viral capsid protein antigens is significantly higher (26%, P = 0.043) than in the control group (15%) represented by healthy subjects (n = 168) with the same median age (66 y) and sex. Our results suggest that SV40 is associated with a subset of MPM and circulates in humans.     

Hypoactive sexual desire disorder: can we treat it with drugs?

Hypoactive sexual desire disorder (HSDD) is a common multidimensional condition which is characterized by a decrease in sexual desire that causes marked personal distress and/or interpersonal difficulty. There are a number of potential causes and contributing factors to HSDD and a balanced approach comprising both biological and psycho-relational factors is mandatory for accurate diagnosis and tailored management in clinical practice. It is clearly evident that sex hormones play a crucial role in modulating sexual response during the entire reproductive life span of women. On the other hand, a better understanding of the neurobiological basis of sexual desire supports the idea that selective psychoactive agents may be proposed as non-hormonal treatments to restore the balance between excitatory and inhibitory stimuli leading to a normal sexual response cycle. However, there are currently no approved pharmacological treatments for premenopausal women with HSDD, while transdermal testosterone is approved in Europe for post-menopausal women who experience HSDD as a result of a bilateral oophorectomy. That being so, the ideal clinical approach remains to be established in term of efficacy and safety and further research is needed to develop specific pharmacotherapies for individualized care of women with sexual dysfunction of any age.     

Identification of a Prognostic Signature Based on the Expression of Genes Related to the Insulin Pathway in Early Breast Cancer

IntroductionInsulin and the insulin-like growth factor (IGF) family play a key role in breast cancer (BC).ObjectiveIn this study, we evaluated on a genomic scale the potential prognostic value of insulin signaling in early BC.MethodsCandidate genes were selected from the published literature and gene expression profiling experiments. Three publicly available BC datasets, containing gene expression data on 502 cases, were used to test the prognostic ability of the score. The gene signature was developed on {"type":"entrez-geo","attrs":{"text":"GSE1456","term_id":"1456"}}GSE1456, containing microarray data from 159 patients, split into a training set (102 breast tumors) and a validation set (n = 57). {"type":"entrez-geo","attrs":{"text":"GSE3494","term_id":"3494"}}GSE3494 and {"type":"entrez-geo","attrs":{"text":"GSE2990","term_id":"2990"}}GSE2990 (350 patients) were used for external validation. Univariate Mann-Whitney test was used to identify genes differentially expressed between relapsed and nonrelapsed patients. Expression of genes significantly correlated with relapse was combined in a linear score. Patients were classified as low or high risk with respect to the median value.ResultsOn the training set, 15 genes turned out to be differentially expressed: 8-year disease-free survival (DFS) was 51 and 91% in the high- and low-risk group (p < 0.001), respectively. In the validation set, DFS was 97 and 54% (p = 0.009), respectively. External validation: 8-year DFS was 72 and 61%, respectively, in {"type":"entrez-geo","attrs":{"text":"GSE3494","term_id":"3494"}}GSE3494 (p = 0.03) and 74 and 55% in {"type":"entrez-geo","attrs":{"text":"GSE2990","term_id":"2990"}}GSE2990 (p = 0.03). By multivariate analyses, the insulin signature was significantly associated with DFS, independently of age, hormone receptor status, nodal status, and grade.ConclusionsOur findings indicate that the insulin pathway is involved in BC prognosis at a genomic level and provide a window of selectivity for preventive and treatment strategies targeting the insulin/IGF pathway in BC patients.