Assessment of two screening tools to identify psoriatic arthritis in patients with psoriasis

BACKGROUND

Many patients with psoriasis have undiagnosed psoriatic arthritis. Low specificity is found with many PsA screening tools. A new instrument, the CONTEST questionnaire, was developed utilizing the most discriminative items from existing instruments.

OBJECTIVE

The aim of this study was to compare the CONTEST and PEST screening tools.

METHODS

People attending secondary care clinics with psoriasis, but not PsA, completed the questionnaires, were assessed for function and quality of life, and had a physical examination. Patients thought to have PsA were compared to those without. The performance of CONTEST and PEST was compared using area under the receiver operating curve (AUC), and sensitivity and specificity at the previously published cut-offs.

RESULTS

A total of 451 dermatology patients were approached, 35% were reviewed and 27 (17%, 95% CI 12.3-21.7) had unidentified psoriatic arthritis. The sensitivity and specificity (95% CI) of PEST were 0.60 (0.42-0.78)/0.76 (0.69-0.83) and for CONTEST 0.53 (0.34-0.72)/0.71 (0.63-0.79). The confidence limits for the AUC overlapped (AUC for PEST 0.72 (0.61-0.84), for CONTEST 0.66 (0.54-0.77).

CONCLUSIONS

PEST and CONTEST questionnaires performed equally well, with no superiority of the new CONTEST tool.

Surface Characterization and Thermodynamics of Adsorption of Pr, Nd and Er on Alumina from Aqueous Solution

The porous nature of alumina has been investigated using various techniques. The values obtained for moisture content, surface area, pore volume, average particle size and porosity were 22%, 116 m2/g, 0.76 cm3/g, 17.0±0.5 μm and 68.0%, respectively. The adsorption isotherms of NdIII, PrIII and ErIII on alumina from aqueous solution have been obtained at different temperatures. All these adsorption isotherms obey the Langmuir, Freundlich and Dubinin-Radushkevich isotherm equations. Thermodynamic parameters such as the free energy, entropy and enthalpy of adsorption have been computed and interpreted. It is noteworthy that the adsorption of PrIII and NdIII increases with decreasing temperature while the reverse is observed for ErIII.

Adsorption Characteristics of Organic Dyes on Alumina Powder from Aqueous Solutions

Adsorption of industrially important dyes (Acid Red 88, Acid Orange 8 and Bismark Brown R) on alumina from aqueous media has been investigated as a function of shaking time, amount of adsorbent, concentration of adsorbate and temperature. It is noted that the adsorption of Acid Red 88, Acid Orange 8 and Bismark Brown R on alumina decreases with an increase in temperature. The results obtained show that the adsorption isotherms at different temperatures are S-type and obey the Freundlich type of adsorption equation. Isosteric heats of adsorption (qst) have also been calculated at different coverages from the adsorption isosters and have been interpreted. The qst values for all the adsorption systems decrease with increasing surface coverage indicating that the alumina used possessed a heterogeneous surface with sites of different activities. The results also indicate that initial adsorption, whether by chemical or physical means, occurs first on the most active sites and then, as the concentration of adsorbate is increased, on sites of lesser activity.

Change in serum CXCL10 levels during anti-tuberculosis treatment depends on vitamin D status [Short Communication]

Serum levels of the inflammatory C-X-C motif chemokine 10 (CXCL10) are raised in tuberculosis (TB). CXCL10 gene expression is downregulated in monocytes by metabolically active vitamin D3 (1,25dihydroxy vitamin D). Stratification of patients by serum 25hydroxyvitamin D (25[OH]D) levels at baseline showed that treatment-induced decrease in CXCL10 occurred in those with 'insufficient' and 'deficient' but not in those with 'optimal' levels. In the deficient group, 25(OH)D showed an inverse correlation with CXCL10 levels. CXCL10 may thus be a useful biomarker for the follow-up of response to treatment. However, CXCL10 levels should be interpreted taking into account the baseline serum vitamin D levels of the TB patients.

Injuries of the terminal branches of the infraclavicular brachial plexus

We reviewed 101 patients with injuries of the terminal branches of the infraclavicular brachial plexus sustained between 1997 and 2009. Four patterns of injury were identified: 1) anterior glenohumeral dislocation (n = 55), in which the axillary and ulnar nerves were most commonly injured, but the axillary nerve was ruptured in only two patients (3.6%); 2) axillary nerve injury, with or without injury to other nerves, in the absence of dislocation of the shoulder (n = 20): these had a similar pattern of nerve involvement to those with a known dislocation, but the axillary nerve was ruptured in 14 patients (70%); 3) displaced proximal humeral fracture (n = 15), in which nerve injury resulted from medial displacement of the humeral shaft: the fracture was surgically reduced in 13 patients; and 4) hyperextension of the arm (n = 11): these were characterised by disruption of the musculocutaneous nerve. There was variable involvement of the median and radial nerves with the ulnar nerve being least affected.

Surgical intervention is not needed in most cases of infraclavicular injury associated with dislocation of the shoulder. Early exploration of the nerves should be considered in patients with an axillary nerve palsy without dislocation of the shoulder and for musculocutaneous nerve palsy with median and/or radial nerve palsy. Urgent operation is needed in cases of nerve injury resulting from fracture of the humeral neck to relieve pressure on nerves.

Selective probing of photoinduced charge and spin dynamics in the bulk and surface of a topological insulator

Topological insulators possess completely different spin-orbit coupled bulk and surface electronic spectra that are each predicted to exhibit exotic responses to light. Here we report time-resolved fundamental and second harmonic optical pump-probe measurements on the topological insulator Bi(2)Se(3) to independently measure its photoinduced charge and spin dynamics with bulk and surface selectivity. Our results show that a transient net spin density can be optically induced in both the bulk and surface, which may drive spin transport in topological insulators. By utilizing a novel rotational anisotropy analysis we are able to separately resolve the spin depolarization, intraband cooling, and interband recombination processes following photoexcitation, which reveal that spin and charge degrees of freedom relax on very different time scales owing to strong spin-orbit coupling.

Estimation of atrazine in the stratum corneum and its toxic effects in skin following topical application to rabbits

ABSTRACT For risk assessment, a workable non-invasive method for the estimation of atrazine in skin was needed. Moreover, the dermato-toxic effects of different concentrations of atrazine have not been studied so far. Fifteen milligrams of 35% solution of atrazine in ethanol was topically applied to each of six different clipped sites on the back of rabbits (n = 6). Each site was tape-stripped with 10 consecutive adhesive tapes at 0.5, 1, 2, 3, 4, and 6 h of topical dosing to remove the stratum corneum (SC). Atrazine in tapes was extracted with methanol and analyzed with HPLC. The amount of atrazine detected in the SC at 6 h (1955.79 +/- 47.22 mug) is equivalent to 13.03% of the total applied dose. In dermal toxicity studies, 500 mul of 35%, 70% atrazine in ethanol and a commercial preparation of atrazine (Balance(R)) was dosed on clipped backs of rabbits (n = 4) for 4 days under occluded vs non-occluded conditions. Ethanol alone served as control. On the 5th day, rabbits were euthanized and skin was scored for erythema and then examined microscopically. Significant differences (p < 0.05) in erythema scores were observed with 70% atrazine and Balance(R) as compared to the control under occluded conditions. Significant differences in epidermal thickness and cell layers were observed with Balance(R) and 74% atrazine as compared to control in both dosing conditions. There were non-significant differences in erythema, epidermal thickness, or cell layers in occluded vs non-occluded applications of atrazine in ethanol, indicating that atrazine is equally toxic regardless of its application procedures. Moreover, under non-occluded application, very slight erythema was observed but microscopically significant epidermal hyperplasia was noticed. This indicates that even if there are no significant gross skin manifestations of atrazine this can still produce significant damage to the epidermal barrier and hence can result in increase in penetration of self or other toxic substances.

A blinded, randomised, controlled trial of stapled versus tissue glue closure of neck surgery incisions

INTRODUCTION

Cosmetic acceptability of scar and neck mobility are important outcomes after collar line incision for neck surgery. This randomised, controlled trial compares these parameters in closures using tissue glue (Dermabond, Ethicon, UK) and skin staples.

PATIENTS AND METHODS

Patients requiring a collar line incision were randomised to receiving tissue glue or staples for skin closure. Time for closure to be completed was recorded. Mobility of the neck was assessed using a visual analogue scale at 48 h and 1 week after surgery. At 6 weeks, cosmetic appearance was assessed using a linear 1-10 visual analogue scale by the patient, surgeon and an independent blinded assessor. Results were compared using appropriate statistical tests.

RESULTS

Glued (n = 14) and stapled (n = 15) closures were performed for hemithyroidectomy (n = 8 versus 6), sub-total thyroidectomy (n = 2 versus 4), total thyroidectomy (n = 1 versus 4) and parathyroidectomy (n = 3 versus 1). Closure with tissue glue took significantly longer than with staples (mean, 95 versus 28 s; P < 0.001). Neck mobility scores were comparable at 48 h and 1 week (mean, 4.8 versus 4.4; P = 0.552: and 2.7 versus 2.6; P = 0.886). Cosmetic appearance at 6 weeks was comparable when patient (mean, 1.7 versus 1.8; P = 0.898), surgeon (mean, 2.6 versus 2.3; P = 0.633) and independent assessment (mean, 1.4 versus 1.9; P = 0.365) was performed.

CONCLUSIONS

The use of glued skin closure may increase the duration of surgery but acceptable neck mobility and wound cosmesis can be achieved by the more rapid application of stapled skin closure in cervicotomy incisions.

Pathological effects of formalin (37% formaldehyde) feeding in female Japanese quails (Coturnix coturnix japonica)

The aim of this study was to determine the pathological effects of formalin on female quails. Seventy-five 1-day-old female Japanese quails (Coturnix coturnix japonina) were divided into five equal groups (A-E) and fed formalin daily at dose levels of 20, 10, 5, 2.5 and 0 mL/ kg feed, respectively. All birds were slaughtered at the end of the experiment -- the eighth week. No clinical signs were observed in quails fed 2.5 mL formalin/kg feed. Depression, dullness and anorexia were prominent in quails fed 20 mL formalin/kg feed. Feed intake, body weight, egg production and egg weight together with absolute and relative weight of organs, erythrocyte and leukocyte counts, hemoglobin concentration and hematocrit were decreased at higher doses, i.e., 10 and 20 mL formalin/kg feed. Total serum proteins and globulin significantly increased (P <0.05) in all formalin fed quails compared to control birds. No gross lesions were observed in the 2.5 mL formalin/kg fed group. At higher doses (10 and 20 mL formalin/kg feed) hemorrhages on the thigh muscles, decreased weight and reduction in area and folds of different segments of oviduct were recorded. Reduced size of liver, heart and kidneys was recorded in quails fed 20mL formalin/kg feed compared to controls and other birds. The histopathological changes in oviduct consisted of degeneration of mucosal glands characterized by vacuolation of nuclei of cells. It was concluded from the study that formalin feeding to female quails at 2.5 mL/kg feed is without harmful effects, however, higher doses are not without health risks.

Ruptured abdominal aortic aneurysm presenting as buttock pain

This is the first case report of a ruptured aortic aneurysm presenting with acute right buttock pain. The patient was an 80 year old man. A literature search revealed one report of ruptured internal iliac artery aneurysm presenting with acute hip pain and another of an unruptured aortic aneurysm presenting with chronic hip pain. Thus the present case is another unusual presentation of ruptured abdominal aortic aneurysm and highlights the importance of careful history taking and clinical examination. A high index of clinical suspicion of aneurysm rupture should be maintained in elderly patients presenting with a history of collapse.

Pathological Effects of Formalin (37% Formaldehyde) Mixed in Feed or Administered into the Crops of White Leghorn Cockerels

This study compared the adverse effects of formalin administered by two different methods. Formalin mixed with the feed (2.5, 5.0 and 10 ml/kg) was given to 10-week-old White Leghorn cockerels for a period of 8 weeks. Simultaneously in other groups, a 3% solution of formalin was administered into the crops (5, 10, 15 and 20 ml/bird/day). Total amount of formalin utilized during the experiment in the feed of individual bird of groups given 2.5, 5 and 10 ml/kg was 6.25, 3.9 and 1.6% higher than those administered 5, 10 and 20 ml of 3% formalin into crop, respectively. Body mass and feed intake in all feed-mixed groups and those given 5 and 10 ml formalin (3%) into the crop were not significantly different from control. Administration of 15 and 20 ml formalin (3%) into crop resulted in depression, delayed onset of crowing, significantly decreased feed intake, lower body mass, decreased mass and volume of testes, ulceration in crops, sloughing of mucosa and petechial haemorrhages in proventriculus. All the groups given formalin had significantly smaller diameters of seminiferous tubules. Kidneys of the birds administered formalin into crop exhibited pyknotic nuclei of epithelial cells in proximal tubules. Non-significant differences in different parameters and lesser degree of pathological changes in birds given formalin-mixed feed than their corresponding crop-administered groups suggested that formalin present in the feed had partially evaporated. Therefore, birds ingested less amount of formalin than that originally mixed in the feed.

Previous infection protects house finches from re-infection with St. Louis encephalitis virus

Antibody titers against St. Louis encephalitis virus (SLE) measured by a plaque reduction neutralization test (PRNT) decreased rapidly in house finches (Capodacus mexicanus) after initial infection, whereas antibodies measured by enzyme immunoassay (EIA) remained detectable in all birds for the length of the experiment, indicating long-term persistence and greater assay sensitivity of the EIA. After 52 wk, birds were challenged by subcutaneous inoculation with the same strain of SLE virus. Virus was not detected for 1-4 d postchallenge in blood samples tested by plaque assay and RT-PCR or by xenodiagnosis in Culex tarsalis fed concurrently and then held for 11 d at 26 degrees C. Virus was detected by all three methods in control birds infected concurrently for the first time. Challenge with SLE produced a rapid and marked ananmestic rise in both neutralizing and EIA antibody titers that exceeded the primary response in the same birds or in concurrently inoculated control birds. At necropsy 4 wk postchallenge, 3 of 7 challenged and 1 of 2 positive control birds were chronically infected, with viral RNA detected by RT-PCR in brain, spleen, lung, and/or kidney tissues. Our results indicated that persistence of protective antibody prevents reinfection during the following season and may prevent the recrudescence of infectious virus in chronically infected birds.

Altered myosin light-chain phosphorylation in resting platelets from premenopausal women with diabetes

Gender-related differences in the rate of coronary heart disease (CHD) between premenopausal women and men are greatly diminished in women with diabetes mellitus (DM). This may be related, in part, to altered platelet function in premenopausal diabetic women. Hyperglycemia may contribute to increase platelet aggregation through enhancement of oxidative stress, increased nitric oxide (NO) destruction, and increased myosin light-chain (MLC) phosphorylation (MLC-P). Accordingly, we investigated functional and biochemical parameters of platelet function in 32 women (14 premenopausal and postmenopausal controls and 18 age-matched patients with DM); platelet MLC-P and cyclic guanosine monophosphate ([cGMP] reflecting NO) were assessed. Other parameters including age, body mass index (BMI), waist to hip ratio, total cholesterol, and platelet count were not different in the control and diabetic groups. In the premenopausal women, baseline MLC-P was lower in women with DM versus the control group (P = .02). GMP levels were similar in the two groups at baseline (22.7 +/- 3 fmol/mL in controls v 23.1 +/- 3 fmol/mL in diabetic subjects) and 3 minutes after insulin exposure. The platelet content of ascorbic acid (AA), an endogenous antioxidant compound, was elevated in premenopausal women with DM (P = .02) compared with the controls. Despite similar estradiol (beta,E2) levels, platelets of premenopausal women with DM exhibited reduced MLC-P. This paradoxic difference may be accounted for by an increase in platelet AA, as this suggests decreased platelet oxidative stress in this patient population. These observations indicate that an altered redox state and associated MLC-P of platelets does not contribute to enhanced platelet aggregation and CHD in premenopausal women with DM.