Lupus nephritis and socioeconomic status: Findings from the Southern California lupus registry

OBJECTIVE

Lupus nephritis (LN) is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Despite multiple studies addressing healthcare disparities, disparate outcomes in LN persist. We investigate herein the association between socioeconomic status (SES) and LN as well as the association between SES, SLE disease activity index (SLEDAI), and treatment response.

METHODS

Patients were selected from the Southern California Lupus Registry (SCOLR), a registry enrolling all-comers with SLE. Analysis was completed on individuals with public vs. private insurance. Insurance and ethnicity were used as surrogate variables for SES, and we tested differences in means.

RESULTS

After adjusting for age and sex, public insurance was independently associated with the prevalence of LN. Analysis of 35 patients revealed greater proteinuria and mean SLEDAI in patients with public insurance at baseline and 6 months. Baseline, 6-, and 12-month SLEDAI means were significantly lower in Asian/Pacific Islanders (PI) compared to others. While non-Hispanic Whites demonstrated mean SLEDAI improvement over 6 months, Asians/PI, Blacks, and Hispanics demonstrated worsened disease activity on average.

CONCLUSION

Low SES, when defined by insurance, is associated with greater adverse outcomes in SLE. This is the first regional study that compares differences in treatment response in LN patients with low SES as well as association of SES with long-term outcomes in SLE and LN in southern California.

Validity of Normative Volumetric Estimates from Open Access Software in Amnestic Mild Cognitive Impairment

BACKGROUND

Neurodegeneration in Alzheimer's disease (AD) is typically assessed through brain MRI. Although proprietary software can provide normative estimates of regional atrophy, such tools can be cost-prohibitive for research settings. Free software for generating normative estimates has recently been released but has yet to be validated in the context of amnestic mild cognitive impairment (aMCI).

OBJECTIVES

Determine whether normative morphometric estimates generated from open-source software replicate established patterns of neurodegeneration in aMCI, and whether these metrics correlate with episodic memory performance.

DESIGN

Observational study of brain MRI and cognition in aging and aMCI with two identical study visits occurring approximately 1.2 years apart.

SETTING

Participants were recruited from the local community and outpatient clinical settings.

PARTICIPANTS

Adults ages 60-85 with aMCI (n = 25) and cognitively normal controls (CN; n = 74). A subset returned for follow-up (aMCI n = 11, CN n = 52).

MEASUREMENTS

Participants completed brain MRI and two neuropsychological tests of verbal episodic memory. FreeSurfer v6.0 and Normative Morphometry Image Statistics were used to generate normative morphometric estimates for AD-relevant regions (hippocampus, parahippocampus, entorhinal cortex, amygdala) and control regions (cuneus, lingual gyrus, pericalcarine gyrus), adjusting for age, sex, head size, scanner manufacturer, and field strength. We tested for baseline group differences in ROI volumes and memory and assessed their within-group associations. We also evaluated changes in ROI volumes over time and tested whether these changes corresponded to declines in memory.

RESULTS

At baseline, the aMCI group exhibited poorer memory and smaller volumes in AD-relevant regions than the CN group. There were no group differences in control region volumes. Memory was associated with volumes in AD-relevant regions in the aMCI group only. The aMCI group exhibited greater declines than the CN group in hippocampal volume (17% vs. 8% annual decline) and entorhinal volume (54% vs. 5% annual decline). Decrease in hippocampal volume was marginally associated with decline in memory for the aMCI group.

CONCLUSIONS

Normative morphometric values generated from freely available software demonstrated expected patterns of group differences in AD-related volumes and associations with memory. Significant effects were localized to AD-relevant brain regions and only occurred in the aMCI group. These findings support the validity of these free tools as reliable and cost-effective alternatives to proprietary software for use in research settings.

POS0673 ENDOTHELIAL INFLAMMATION IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TOFACITINIB

Background

Systemic inflammation in rheumatoid arthritis (RA) seems to accelerate atherosclerosis process and increased cardiovascular (CV) events. An adequate joint inflammation control is correlated with endothelial inflammation (EI) improvement. 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG PET/CT) has been shown as a non-invasive, sensitive, and specific tool to show EI. Maximum standardized uptake value (SUV(max)) greater than 1,6 has been correlated with vascular and joint inflammation. Tofacitinib is a Jak inhibitor (JaKi) approved for RA that improves activity and function. The aim of this study is to evaluate the EI outcome by FDG-PET in RA patients treated with tofacitinib.

Objectives

To assess the EI by FDG-PET/CT in RA patients at baseline and after 12 weeks of tofacitinib treatment initiation.

To correlate the vascular findings with disease activity, lipid profile and carotid atherosclerosis by echo Doppler.

Methods

Prospective, observational study. Inclusion criteria: RA (ACR 2010) patients >18 years old, with high activity score (DAS 28 >3,2) and with biologics or synthetic Dmards requirement by Treat to Target strategy and who tofacitinib was prescribed. Exclusion Criteria: Biologics or Jaki previous use or major CV history known.

A baseline Visit evaluating disease activity (DAS 28 and CDAI), functional status by Health Assessment Questionary (HAQ), CV and smoking history, treatments and lipid lab assessment was performed. EI was measured by PET-FDG/CT, showing the SUVmax and target-to-background ratio (TBR) in: right primitive carotid, left primitive carotid, ascendent aorta, descendent aorta and abdominal aorta. Carotid echo Doppler for showing plaque presence was done. During baseline visit tofacitinib was started. After 12 weeks the initial parameters were re-evaluated.

Results

Consecutively, 30 patients were included. Mean age 57 yo (21-79). Female 70%. Mean disease duration 8,3 years (1-40), mean Body mass index (BMI) 24,5. Clinical history: Hypertension 27%, smoking 6,6%, methotrexate treatment 46,6%, methotrexate plus leflunomide 50%, corticosteroids 7,6% (mean dosis 7,6 mg/day).

Mean values of DAS 28, CDAI and HAQ were 5.21, 26,6 y 1,56 in baseline and 3,04, 8,80 y 1,09 in the final visit respectively (p:< 0,001 in all comparations) showing statistical significance activity improvement. Echo doppler showed Carotid plaque in 40% of patients without change between visits. Mean cholesterol levels were 188,5 y 207,53 mg/dl in baseline and final visit respectively (p: 0,0039), showing statistical significance. Endothelial uptake by PET-FDG in the 5 areas measured, considering baseline and final visit was: Right Primitive Carotid: SUV Max 2,03 and 1,93 (p: 0,32) and TRB Max 0,94 and 0,85 (p:1,0); Left Primitive Carotid Suv Max 2,07 and 1,94 (p:1,0) and TRB Max 0,92 and 0,90 (p:0,57); Ascendent Aorta SUV Max 2,63 and 2,57 (p:1,0) and TRB Max 1,18 and 1,15 (p:1,0); Descendent Aorta SUV Max 2,77 and 2,57 (p:0,26) and TRB Max 1,27 and 1,17 (p:0,26) and Abdominal Aorta SUV Max 2,59 and 2,43 (p:0,85) and TRB Max 1,15 y 1,11 (p:0,32). None of the endothelial uptake comparisons showed a significant difference between baseline and final visit after 12 weeks.

Conclusion

This work shows that, despite the significant improvement in joint activity and function values, there was no modification in EI measured by FDG-PET during tofacitinib treatment along 12 weeks. It is noteworthy that all patients initially presented high inflammatory endothelial uptake values, which reinforces the hypothesis of vascular compromise associated with active joint disease. Studies with more observation time and evaluating the role of different treatments related to endothelium will be of clinical utility in the future.

References

[1]Rheumatology (Oxford). 2016 Oct;55(10):1777-85.

[2]Metabolism. 2017 Feb;67:72-79.

[3]Arthritis Res Ther. 2016 May 21;18(1):115.

Acknowledgements

Pfizer´s unrestricted grant

Disclosure of Interests

None declared

AB0736 ASSOCIATION BETWEEN ERYTHROCYTE DISTRIBUTION WIDTH AND SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

Background

Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) account for 60% of deaths related to scleroderma (SSc). The erythrocyte distribution width (RDW) has been used as a marker of poor prognosis in different pathologies. In SSc, RDW has been found to be elevated in PAH and has been proposed as a predictor of cardiorespiratory compromise.

Objectives

The aim of this study is to evaluate the association between increased RDW and the presence of EPI in patients with SSc.

Methods

This is a multicenter, retrospective, cross-sectional study of patients diagnosed with SSc (ACR/EULAR 2013) from January 2011 to August 2021. Other concomitant autoimmune diseases, malignancy, active infections, iron-deficiency or pernicious anaemia and transfused patients were excluded. The diagnosis of PID was made by high-resolution computed tomography (HR-CT) and the extension evaluated by Goh criteria. A review of medical records was conducted, collecting clinical and demographic characteristics, interstitial pattern by HR-CT, assessed, acute phase reactants, capillaroscopy, functional respiratory tests (PFT) and echocardiographic resolution. Patients diagnosed with PAH by right heart catheterization were not excluded in this study but recorded.

Results

Seventy-five patients were included, with a mean age of 59.4 (SD 14.1 CI95% 56-6), from which 67 (89%) were women. A median of 8 years of disease evolution was observed RIC 8). Limited SS was observed in 50 (66%) and diffuse SS in 24 (32%). EPI was observed in 50 (66%) of which NSIP 25 (33%), NSIP-f 15 (20%) and UIP 10 (13%). The extension of the disease was limited in 25 (33%) and extensive in 19 (25%). Capillaroscopic findings were normal in 2 (3.4%), nonspecific in 1 (1.7%), early SD in 9 (15.3%), active SD in 22 (37.3%), and late SD in 25 (42.4%); in sixteen patients there was no capillaroscopy.

We observed an increase in RDW in the EPI group with a statistically significant difference OR 6.06 CI95% 2-17 (p 0.001).

The median RDW is higher in patients with ILD and PAH than in healthy people (p<0.0001).

We found a low negative correlation between RDW / FVC r (63) -.25 p 0.042 and RDW / FEV1 r (63) .30 p 0.015.

Conclusion

In the present study we have been able to evidence that there is a statistically significant relationship between the percentage of RDW and the presence of PID. When analysing the association between patients without pulmonary compromise, ILD and PAH and the percentage of RDW, we were able to find a statistically significant difference between the three groups. It is necessary to continue with studies with a larger number of patients to grant robustness to the results.

References

[1]Muangchan, et al: 15% rule in SSc. The Journal of Rheumatology 2013; 40; 9; doi:10.3899/jrheum.121380.

[2]Cottin and Brown. Interstitial lung disease associated with systemic sclerosis (Ssc-ILD) Respiratory Research (2019) 20:13

[3]Thayer, T. E. et al. Unbiased Phenome-wide Association Studies of Red Cell Distribution Width Identifies Key Associations with Pulmonary Hypertension. Annals of the American Thoracic Society. doi:10.1513/annalsats.201809-594oc.

[4]Zhao J,Mo H, Guo X,Wang Q, Xu D, Hou Y, Tian Z, Liu Y,Wang H, Lai J, Li M, ZengX (2018) Red blood cell distribution width as a related factor of pulmonary arterial hypertension in patients with systemic sclerosis. Clin Rheumatol 37:979–985.

[5]Goh NSL, Desai SR, Veeraraghavan S, et al. Interstitial Lung Disease in Systemic Sclerosis: A Simple Staging System. American Journal of Respiratory and Critical Care Medicine. 2008. June;177(11):1248–54.

[6]Hax V, Bredemeier M, Didonet Moro AL, et al. Clinical algorithms for the diagnosis and prognosis of interstitial lung disease in systemic sclerosis. Seminars in Arthritis and Rheumatism. 2017. October;47(2):228–34.

[7]Peralta S. Guías Argentinas De Consenso En Diagnóstico Y Tratamiento De La Hipertensión Pulmonar. Sociedad Argentina de Cardiología. Área de Consensos y Normas. Vol 85 Suplemento 3. Octubre 2017.

Acknowledgements

Participating centers

Disclosure of Interests

None declared

POS0312 HOW DOES THE PRESENCE OF DEPRESSION IMPACT ON DISEASE ACTIVITY SCORES IN PATIENTS WITH RHEUMATOID ARTHRITIS?

Background:

Depression is present in up to half of patients with Rheumatoid Arthritis (RA). The association between this mood disorder and disease activity scores, including DAS28, SDAI and CDAI, has previously been described by various authors.

Objectives:

The aim of our study was assessed the effect of depression on the components of different disease activity scores.

Methods:

We performed a cross-sectional study of consecutive adults with RA, according to ACR/EULAR 2010 criteria. Sociodemographic data, comorbidities and current treatment were recorded. Disease activity was evaluated using DAS28-ESR, DAS28-CRP, SDAI and CDAI. Depression was assessed using PHQ-9 questionnaire. The PHQ-9 values were categorized in 4 groups as follows: 5 to 9, 10 to 14, 15 to 19, 20 or greater, represents mild, moderate, moderate/severe, and severe depression, respectively. A cutoff value of 10 or greater was set to define major depression. Statistical analysis: Student´s T, ANOVA and Chi2 tests. Multiple logistic regression.

Results:

Two hundred fifty eight patients were included, with a median (m) disease duration of 9 years (IQR 3.6-16.7). The m PHQ-9 score was 6 (IQR 2-12.3) and the prevalence of major depression was 33.7%. Patients with major depression had more tender and swollen joint count (TJC and SJC) (mean 4.9±4.3 vs 2.3±3.7, p<0.0001 and 2.9±3.3 vs 1.7±3.4, p=0.009), more pain (VAS [cm] mean 5.6±2.7 vs 3.3±2.6, p<0.0001), higher patient and physician global assessment (PGA and PhGA) (VAS [cm] mean 5.4±2.9 vs 3.1±2.5, p<0.0001 and 4.4±2.7 vs 2.4±2.4, p<0.0001) and CRP (mean 1.7±3.3 vs 0.7±1.1 mg/dl, p=0.01). ESR values were higher in the group with major depression, but the difference did not reach significance. Disease activity was higher in the depression group by all scores: DAS28-ESR (mean 4.3±1.4 vs 3.3±1.3, p<0.0001), DAS28-CRP (mean 3.9±1.4 vs 2.8±1.7, p<0.0001), SDAI (mean 19.2±12.7 vs 10.3±10.1, p<0.0001) and CDAI (mean 17.6±10.9 vs 9.6±9.9, p<0.0001). While 41 (15.9%) patients had high disease activity according to DAS28-ESR, only 34 (13.2%) had SDAI>26.

In the multivariate analysis, evaluating the association of major depression with the different components of DAS28-ESR, DAS28-CRP, SDAI and CDAI, we observed that the presence of this mood disorder remained significantly associated with higher PGA in all the scores. In addition, a significant association was seen with higher TJC in both DAS28 scores.

Conclusion:

Patients with major depression had higher disease activity. It´s presence has a significantly association with the subjective items of the disease activity scores, particularly PGA. CRP value was the only objective component associated with depression.

Disclosure of Interests:

Carolina Ayelen Isnardi Speakers bureau: Bristol Myers Squibb, Janssen, Grant/research support from: Pfizer, Emilce Edith Schneeberger Speakers bureau: Abbvie, Amgen, Bristol Myers Squibb, Janssen, Eli Lilly, Boehringer Ingelheim, Pfizer, Genzyme, Grant/research support from: Pfizer, Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Grant/research support from: Pfizer, Marcela Bazzarelli: None declared, Laura Barloco: None declared, Eliana Soledad Blanco: None declared, Alejandro Benitez Speakers bureau: Abbvie, Novartis, Amgen, Federico Benavidez: None declared, SANTIAGO SCARAFIA: None declared, María Alicia Lazaro Speakers bureau: Abbvie, Rodolfo Perez Alamino Speakers bureau: Pfizer, Abbvie, Amgen, Bristol-Myers-Squibb, Lilly, Janssen, Novartis, Federico Colombres: None declared, María Paula Kohan: None declared, Julia Sosa: None declared, Luciana Gonzalez Lucero: None declared, Ana Lucía Barbaglia: None declared, Hernan Maldonado Ficco Speakers bureau: Pfizer, Abbvie, Jansen, Novartis, Bago, Bristol, Eli Lilly., Consultant of: Pfizer, Abbvie, Novartis, Jansen, Bago, Eli Lilly., Gustavo Citera Speakers bureau: Abbvie, Bristol-Myers-Squibb, Lilly, Jansen, Gema, Pfizer, Roche, Grant/research support from: Pfizer

POS1005 ASSESSMENT OF DAREA AND MODIFIED DAREA IN AN ARGENTINIAN-GUATEMALAN REACTIVE ARTHRITIS COHORT

Background:

Reactive Arthritis (ReA) is an inflammatory joint disease and, as in rheumatoid or psoriatic arthritis, composite indices are the most useful tools to measure disease activity. The Disease Activity Index for Reactive Arthritis (DAREA) is the only developed index for ReA, which requires a 66/68 joint count and CRP for its assessment, the latter being difficult to acquire in our setting. Therefore, we developed a simplified index, the modified DAREA (DAREAm), with a lower joint count and ESR for its evaluation.

Objectives:

1) To evaluate the DAREA and the DAREAm in a cohort of patients with diagnosis of ReA and post-infectious arthritis 2) To assess the correlation of the DAREA and DAREAm with several clinical variables, functional capacity and quality of life in a cohort of patients with ReA.

Methods:

Patients with diagnosis of ReA (Calin’79) and post-infectious arthritis were included. Demographic data were collected, patient´s pain and global assessment were evaluated through a visual analog scale (VAS) and a 3-point scale (no pain = 0, mild = 1, moderate = 2, severe = 3), physician´s global assessment, morning stiffness (MS) and VAS fatigue. Functional capacity was assessed by HAQ and quality of life according to EuroQol-5 dimensions (EQ-5D), and the activity indices DAS28, DAREA and DAREAm were calculated. Statistical analysis: a descriptive analysis of the variables and correlation between numerical variables with Spearman rank correlation were performed.

Results:

57 patients were included, 53 with diagnosis of ReA, the majority post urogenital (63%) and gastrointestinal (17%), and 4 with diagnosis of post-infectious arthritis. Fifty six percent were male, mean age: 40 years old (SD ± 14) and median ReA duration: 15 months (IQR 2-45). The number of painful and swollen joints in a 66/68 joint count showed a median of 2 (IQR 0-3) and 1 (IQR 1-2) respectively. Median VAS pain 43 (IQR 15-70), patient´s disease activity 40 (IQR 20-60) and physician´s 40 (IQR 20-60), MS 10 (IQR 0-50) and fatigue 30 (IQR 0-80). Median DAS28 3.6 (IQR 2.3-4.3), DAREA 7.4 (IQR 2.5-10.6), DAREAm 8.6 (IQR 4.6-12.7), HAQ 0.625 (IQR 0.125-1). The dimensions with the greatest compromise in the EQ-5D were pain/discomfort (63%) and anxiety/depression (51%), and the median VAS EQ-5D was 60 (IQR 32-80). DAREA correlated with DAREAm (rs= 0.89; p <0.001), DAS28 (rs= 0.84; p <0.001), medical VAS (rs= 0.60; p <0.001), MS (rs= 0, 50; p <0.001), HAQ (rs= 0.53; p <0.001), VAS fatigue (rs= 0.57; p <0.001) and mobility subscales of the EQ5D (rs= 0.56; p <0.001), pain/discomfort (rs= 0.49; p <0.001) and anxiety/depression (rs= 0.61; p <0.001). The DAREAm correlated with DAS28 (rs= 0.93; p <0.001), physician VAS (rs= 0.58; p <0.001), fatigue VAS (rs= 0.53; p <0.001), HAQ (rs= 0 .51; p <0.001) and the EQ5D subscales: mobility (rs= 0.64; p <0.001), pain/discomfort (rs= 0.56; p <0.001) and anxiety/depression (rs= 0.66; p <0.001)

Conclusion:

This is the first study that assess activity indices in a cohort of patients with ReA. The DAREAm demonstrated a very good correlation with both DAREA and DAS28. We encourage the use of this simplified index in daily practice to evaluate patients with ReA.

Disclosure of Interests:

None declared.

FRI0607-HPR FREQUENCY AND PATIENTS BELIEFS ON VACCINATION IN RHEUMATIC DISEASES

Background:

Infectious diseases are increased in patients with rheumatic disorders; vaccination improves morbidity and mortality

Objectives:

The aim of this study was to describe the frequency of vaccination in patients with rheumatic disorders and to compare the results with those obtained in 2009 and 2013 in a similar population. We also identified factors leading to lack of vaccination and patients beliefs on vaccines.

Methods:

Multicentric cross sectional study in patients with autoinmune diseases from external rheumatology offices. Evaluation of vaccination status and patients´ knowledge about vaccines were studied. A comparative analysis was carried out with the series registered in 2009 and 2013 in a similar population.

Results:

179 patients (158 female, 88.3% and 21 male, 11.7%) were evaluated. Median age was 52 years. Main pathologies were: Rheumatoid Arthritis 65.9% (n:118), Systemic Lupus Erythematosus 11.7% (n:21), Systemic Sclerosis 3.9% (7), Sjogren Syndrome n = 3.4% (n:6), other diseases 15% (n: 27). Median disease duration: 8.87 years. Ninety three percent of patients (n:167) were taking inmunomodulators and 36.8% (n: 66) were using oral corticosteroids (20mg/day or less); 26,8% patients (n: 48) were receiving biological therapies. Vaccination frequency in the population was: Influenza 82% (147); 13-valent conjugate pneumococcal 69.3% (124), 23-valent pneumococcal 64.2% (115) and hepatitis B 62% (111). Comparative with 2009 and 2013 series there was an increase in the rate of vaccinated patients: influenza (82% vs. 39,1% and 74,2% respectively), antineumococcal (64% vs. 17% and 29%) and hepatitis B (62% vs. 6,7% and 26,7%).

Reasons for non-vaccination were absence of medical indication (41% of patients for hepatitis B; 32% for 23-valent pneumococcal; 38% for 13-valent pneumococcal and 34% for influenza).

139 patients (77, 7%) knew the benefits of vaccines, 164 (91, 6%) thought vaccines are useful; 134 (74,9%) reported that vaccines may decrease dying probability, 155 (86,5%) thought that vaccines are effective to prevent diseases and 149 patients (83,2%) believed that they prevent serious infections. 71 patients (39%) believed that vaccines can lead to serious consequences and 99 (55,3%) that they are more likely to acquire infections than the rest of the population.

Conclusion:

Frequency of vaccination has increased since 2009 but there is still misinformation regarding vaccines risks and benefits. Promotion and information is essential to improve adherence.

References:

[1]2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Furer V, et al. Ann Rheum Dis 2020;79:39–52

[2] Vaccines and Disease-Modifying Antirheumatic Drugs: Practical Implications for the Rheumatologist. Friedman MA et al. Rheum Dis Clin North Am. 2017 Feb; 43 (1):1-13.

[3] Recommendations and barriers to vaccination in systemic lupus erythematosus. Garg M et al. Autoimmun Rev. 2018 Oct; 17 (10):990-1001.

[4] Comparison of national clinical practice guidelines and recommendations on vaccination of adult patients with autoimmune rheumatic diseases. Papadopoulou D. et al. Rheumatol Int. 2014 Feb;34 (2):151-63.

[5] Guías de recomendaciones de prevención de infecciones en pacientes que reciben modificadores de la respuesta biológica. Jordán R. Et al. Rev Arg Reumatol. 2014; 25 (2): 08-26.

Disclosure of Interests:

Malena Viola: None declared, Alejandro Benitez: None declared, Cecilia Garbarino: None declared, Gonzalo Rodriguez: None declared, Federico Benavidez: None declared, Claudia Peon: None declared, Eliana Soledad Blanco: None declared, Hernan Molina: None declared, Gimena Gómez: None declared, griselda redondo: None declared, Maria DeLaVega: None declared, Dario Mata: None declared, Augusto Riopedre: None declared, Osvaldo Messina Speakers bureau: Amgen; Americas Health Foundation; Pfizer

FRI0056 LUNG COMPROMISE SCREENING IN PATIENTS WITH EARLY RA. A MULTICENTRIC CROSS SECTIONAL STUDY

Background:

Rheumatoid arthritis (RA) affects 0.4-1.3% of general population (1). It can affect lungs in different ways, with interstitial lung disease (ILD) as the most severe. Clinically evident ILD has been reported in 10-42% of patients, with a great impact in prognosis (2).

Objectives:

Toidentify the prevalence of lung involvement in early rheumatoid arthritis patients (ERA) without previous known lung disease and describe the association between high resolution computed tomography (HRCT), lung functional tests (LFT) and clinical findings.

Methods:

Cross sectional multicentric study. We included ERA patients (1 year or less since diagnose) consecutively. Patients with previous RA related lung disease or biologic/targeted synthetic Dmard treatment were excluded. HRCT, immunological tests (rheumatoid factor, anti-CCP, ANA), LFT and clinical evaluation were performed.

Results:

We included 74 patients, 63 (85,1%) woman, mean (SD) of 47 (17,7) years. Thirty-seven patients (50%) were current or former smokers. Abnormal findings in HRCT were found in 62 patients (88,6%): ILD in 6 (8,6%), airway involvement in 40 (70%) and emphysema in 7 (10%). Ten patients (13,5%) had abnormal auscultation (2 sibilances, 2 roncus, and 6 crackles). Six patients (8,1%) had digital clubbing. Regarding immunological tests, 54/61 (88,5%) patients were positive for Anti CCP, and 53/61 (86,9%) were positive for FR. We compared features of patients with findings related to RA in HRCT (interstitial and/or airway) with those without them. We found no differences in the mean (SD) of DAS-28 [4,74 (1,38) vs 4,32 (1,39); p= 0,27]. The prevalence of anti- CCP was not higher in patients with abnormal HRCT [38/44 (86,3%) vs 16/17 (94,1%); p=0,39]. Patients with abnormal HRCT were older [median (IQR) 50,5 years (44,5-59,5) vs 43 years (32-51); p=0,008) and showed higher VSG values [mean (SD) 39,09 (24,03) vs 27,38 (17,6); p= 0,043]. Abnormal physical examination or dyspnea (class 2 mMRC or higher) was significantly associated with HRCT abnormalities [26 (50%) vs 3 (13,6%); p=0.003) and the presence of ILD on HRCT was significantly associated with crackles on the auscultation [4/68(6,25%) vs 2/6 (33,33%); p 0,023].

Conclusion:

This study shows a high prevalence of lung involvement in ERA patients of less 1 year from diagnosis. Also, we showed a significant association between HRCT and physical examination findings. This data highlights the importance of the clinical examination in Rheumatoid Arthritis patients. More studies with bigger samples and longitudinal follow up are needed to confirm and complete our results.

References:

[1]Rooney BK, Silman AJ. Epidemiology of the rheumatic diseases. Curr Opin Rheumatol [Internet]. 1999 Mar [cited 2016 Jul 19];11(2):91–7. Available from:http://www.ncbi.nlm.nih.gov/pubmed/10319210.

[2]Antin-Ozerkis D, Evans J, Rubinowitz A, Homer RJ, Matthay RA. Pulmonary Manifestations of Rheumatoid Arthritis. Clin Chest Med [Internet]. 2010;31(3):451–78. Available from:http://dx.doi.org/10.1016/j.ccm.2010.04.003.

Disclosure of Interests:

None declared

Belimumab alters transitional B-cell subset proportions in patients with stable systemic lupus erythematosus

OBJECTIVE

We evaluated the effects of the B-cell activating factor (BAFF)-targeting antibody Belimumab on human nonmemory B-cell pools. Human B-cell pools were identified using surface markers adapted from mouse studies that specifically assessed reductions in immature B cells due to BAFF depletion. Patients with systemic lupus erythematosus (SLE) have high levels of both BAFF and immature B cells. Mechanistic mouse studies provide a framework for understanding human responses to therapies that target B cells.

METHODS

Peripheral blood mononuclear cells were isolated from healthy donors and SLE patients on Belimumab or standard-of-care therapy (SCT). Cells were stained for flow cytometry to identify B-cell subsets based on CD21/CD24. Differences in subset proportions were determined by one-way ANOVA and Tukey's post hoc test.

RESULTS

Patients treated with Belimumab show alterations in the nonmemory B-cell pool characterized by a decrease in the Transitional 2 (T2) subset (p = 0.002), and an increase in the proportion of Transitional 1 (T1) cells (p = 0.005) as compared with healthy donors and SCT patients. The naïve B-cell compartment showed no significant differences between the groups (p = 0.293).

CONCLUSION

Using a translational approach, we show that Belimumab-mediated BAFF depletion reduces the T2 subset in patients, similar to observations in mouse models with BAFF depletion.

Differential Impact of Index Stroke on Dementia Risk in African-Americans Compared to Whites

OBJECTIVE

To compare whites and African-Americans in terms of dementia risk following index stroke.

METHODS

The data consisted of billing and International Classification of Diseases, Ninth Revision diagnosis codes from the South Carolina Revenue and Fiscal Affairs office on all hospital discharges within the state between 2000 and 2012. The sample consisted of 68,758 individuals with a diagnosis of ischemic stroke prior to 2010 (49,262 white [71.65%] and 19,496 African-Americans [28.35%]). We identified individuals in the dataset who were subsequently diagnosed with any of 5 categories of dementia and evaluated time to dementia diagnosis in Cox Proportional Hazards models. We plotted cumulative hazard curves to illustrate the effect of race on dementia risk after controlling for age, sex, and occurrence of intervening stroke.

RESULTS

Age at index stroke was significantly different between the 2 groups, with African-Americans being younger on average (70.0 [SD 12.5] in whites versus 64.5 [SD 14.1] in African-Americans, P < .0001). Adjusted hazard ratios revealed that African-American race increased risk for all 5 categories of dementia following incident stroke, ranging from 1.37 for AD to 1.95 for vascular dementia. Age, female sex, and intervening stroke likewise increased risk for dementia.

CONCLUSIONS

African-Americans are at higher risk for dementia than whites within 5 years of ischemic stroke, regardless of dementia subtype. Incident strokes may have a greater likelihood of precipitating dementia in African-Americans due to higher prevalence of nonstroke cerebrovascular disease or other metabolic or vascular factors that contribute to cognitive impairment.

Nanowire Y-junction formation during self-faceting on high-index GaAs substrates

In this contribution, we report on the observation of high-order and bi-dimensional surface mechanisms that allows the self-assembling of an alternating array of straight and bifurcated nanowires.

A novel xenograft model to study the role of TSLP-induced CRLF2 signals in normal and malignant human B lymphopoiesis

Thymic stromal lymphopoietin (TSLP) stimulates in-vitro proliferation of human fetal B-cell precursors. However, its in-vivo role during normal human B lymphopoiesis is unknown. Genetic alterations that cause overexpression of its receptor component, cytokine receptor-like factor 2 (CRLF2), lead to high-risk B-cell acute lymphoblastic leukemia implicating this signaling pathway in leukemogenesis. We show that mouse thymic stromal lymphopoietin does not stimulate the downstream pathways (JAK/STAT5 and PI3K/AKT/mTOR) activated by the human cytokine in primary high-risk leukemia with overexpression of the receptor component. Thus, the utility of classic patient-derived xenografts for in-vivo studies of this pathway is limited. We engineered xenograft mice to produce human thymic stromal lymphopoietin (+T mice) by injection with stromal cells transduced to express the cytokine. Control (-T) mice were produced using stroma transduced with control vector. Normal levels of human thymic stromal lymphopoietin were achieved in sera of +T mice, but were undetectable in -T mice. Patient-derived xenografts generated from +T as compared to -T mice showed a 3-6-fold increase in normal human B-cell precursors that was maintained through later stages of B-cell development. Gene expression profiles in high-risk B-cell acute lymphoblastic leukemia expanded in +T mice indicate increased mTOR pathway activation and are more similar to the original patient sample than those from -T mice. +T/-T xenografts provide a novel pre-clinical model for understanding this pathway in B lymphopoiesis and identifying treatments for high-risk B-cell acute lymphoblastic leukemia with overexpression of cytokine-like factor receptor 2.

Surface APRIL Is Elevated on Myeloid Cells and Is Associated with Disease Activity in Patients with Rheumatoid Arthritis

OBJECTIVE

To assess surface APRIL (a proliferation-inducing ligand; CD256) expression by circulating myeloid cells in rheumatoid arthritis (RA) and to determine its relationship to disease activity.

METHODS

Peripheral blood mononuclear cells (PBMC) and plasma were obtained from patients with RA and healthy donors. PBMC were stained for flow cytometry to detect surface APRIL and blood cell markers to identify circulating myeloid cell subsets. Based on CD14 and CD16 phenotypes, monocyte subsets described as classical (CD14+CD16-), intermediate (CD14+CD16+), and nonclassical (CD14loCD16+) were identified. Levels of surface APRIL expression were measured by flow cytometry and median fluorescence intensity was used for comparisons. Levels of soluble APRIL in the plasma were determined by ELISA. Disease activity was measured by the Disease Activity Score in 28 joints.

RESULTS

In patients with RA, total myeloid cells showed expression of surface APRIL that correlated with disease activity and with plasma APRIL levels observed in these patients. In healthy donors, classical monocytes were composed of > 80% of circulating monocytes. However, in patients with RA, the intermediate and nonclassical subsets were elevated and made up the majority of circulating monocytes. In contrast to healthy donors, where high levels of surface APRIL were only observed in nonclassical monocytes, patients with RA showed high levels of surface APRIL expression by all circulating monocyte subsets.

CONCLUSION

Surface APRIL is elevated in circulating myeloid cells in patients with RA where it is highly correlated with disease activity. Patients with RA also showed skewing of monocytes toward subsets associated with secretion of tumor necrosis factor-α and/or interleukin 1β.

Differences in mouse and human nonmemory B cell pools

Identifying cross-species similarities and differences in immune development and function is critical for maximizing the translational potential of animal models. Coexpression of CD21 and CD24 distinguishes transitional and mature B cell subsets in mice. In this study, we validate these markers for identifying analogous subsets in humans and use them to compare the nonmemory B cell pools in mice and humans, across tissues, and during fetal/neonatal and adult life. Among human CD19(+)IgM(+) B cells, the CD21/CD24 schema identifies distinct populations that correspond to transitional 1 (T1), transitional 2 (T2), follicular mature, and marginal zone subsets identified in mice. Markers specific to human B cell development validate the identity of marginal zone cells and the maturation status of human CD21/CD24 nonmemory B cell subsets. A comparison of the nonmemory B cell pools in bone marrow, blood, and spleen in mice and humans shows that transitional B cells comprise a much smaller fraction in adult humans than mice. T1 cells are a major contributor to the nonmemory B cell pool in mouse bone marrow, in which their frequency is more than twice that in humans. Conversely, in spleen, the T1:T2 ratio shows that T2 cells are proportionally ∼ 8-fold higher in humans than in mice. Despite the relatively small contribution of transitional B cells to the human nonmemory pool, the number of naive follicular mature cells produced per transitional B cell is 3- to 6-fold higher across tissues than in mice. These data suggest differing dynamics or mechanisms produce the nonmemory B cell compartments in mice and humans.

Novel white matter tract integrity metrics sensitive to Alzheimer disease progression

BACKGROUND AND PURPOSE

Along with cortical abnormalities, white matter microstructural changes such as axonal loss and myelin breakdown are implicated in the pathogenesis of Alzheimer disease. Recently, a white matter model was introduced that relates non-Gaussian diffusional kurtosis imaging metrics to characteristics of white matter tract integrity, including the axonal water fraction, the intra-axonal diffusivity, and the extra-axonal axial and radial diffusivities.

MATERIALS AND METHODS

This study reports these white matter tract integrity metrics in subjects with amnestic mild cognitive impairment (n = 12), Alzheimer disease (n = 14), and age-matched healthy controls (n = 15) in an effort to investigate their sensitivity, diagnostic accuracy, and associations with white matter changes through the course of Alzheimer disease.

RESULTS

With tract-based spatial statistics and region-of-interest analyses, increased diffusivity in the extra-axonal space (extra-axonal axial and radial diffusivities) in several white matter tracts sensitively and accurately discriminated healthy controls from those with amnestic mild cognitive impairment (area under the receiver operating characteristic curve = 0.82-0.95), while widespread decreased axonal water fraction discriminated amnestic mild cognitive impairment from Alzheimer disease (area under the receiver operating characteristic curve = 0.84). Additionally, these white matter tract integrity metrics in the body of the corpus callosum were strongly correlated with processing speed in amnestic mild cognitive impairment (r = |0.80-0.82|, P < .001).

CONCLUSIONS

These findings have implications for the course and spatial progression of white matter degeneration in Alzheimer disease, suggest the mechanisms by which these changes occur, and demonstrate the viability of these white matter tract integrity metrics as potential neuroimaging biomarkers of the earliest stages of Alzheimer disease and disease progression.

Isometric knee extensor fatigue following a Wingate test: peripheral and central mechanisms

Central and peripheral fatigue have been explored during and after running or cycling exercises. However, the fatigue mechanisms associated with a short maximal cycling exercise (30 s Wingate test) have not been investigated. In this study, 10 volunteer subjects performed several isometric voluntary contractions using the leg muscle extensors before and after two bouts of cycling at 25% of maximal power output and two bouts of Wingate tests. Transcranial magnetic stimulation (TMS) and electrical motor nerve stimulation (NM) were applied at rest and during the voluntary contractions. Maximal voluntary contraction (MVC), voluntary activation (VA), twitch amplitude evoked by electrical nerve stimulation, M wave and motor potential evoked by TMS (MEP) were recorded. MVC, VA and twitch amplitude evoked at rest by NM decreased significantly after the first and second Wingate tests, indicating central and peripheral fatigue. MVC and VA, but not the twitch amplitude evoked by NM, recovered before the second Wingate test. These results suggest that the Wingate test results in a decrease in MVC associated with peripheral and central fatigue. While the peripheral fatigue is associated with an intramuscular impairment, the central fatigue seems to be the main reason for the Wingate test-induced impairment of MVC.

IL-7 Dependence in human B lymphopoiesis increases during progression of ontogeny from cord blood to bone marrow

IL-7 is critical for B cell production in adult mice; however, its role in human B lymphopoiesis is controversial. One challenge was the inability to differentiate human cord blood (CB) or adult bone marrow (BM) hematopoietic stem cells (HSCs) without murine stroma. Here, we examine the role of IL-7 in human B cell development using a novel, human-only model based on coculturing human HSCs on primary human BM stroma. In this model, IL-7 increases human B cell production by >60-fold from both CB and adult BM HSCs. IL-7-induced increases are dose-dependent and specific to CD19(+) cells. STAT5 phosphorylation and expression of the Ki-67 proliferation Ag indicate that IL-7 acts directly on CD19(+) cells to increase proliferation at the CD34(+) and CD34(-) pro-B cell stages. Without IL-7, HSCs in CB, but not BM, give rise to a small but consistent population of CD19(lo) B lineage cells that express EBF (early B cell factor) and PAX-5 and respond to subsequent IL-7 stimulation. Flt3 ligand, but not thymic stromal-derived lymhopoietin (TSLP), was required for the IL-7-independent production of human B lineage cells. As compared with CB, adult BM shows a reduction of in vitro generative capacity that is progressively more profound in developmentally sequential populations, resulting in an approximately 50-fold reduction in IL-7-dependent B lineage generative capacity. These data provide evidence that IL-7 is essential for human B cell production from adult BM and that IL-7-induced expansion of the pro-B compartment is increasingly critical for human B cell production during the progression of ontogeny.

Human cord blood, but not adult bone marrow, gives rise to IL-7-independent B cell production (138.5)

IL-7 is critical for B cell production in adult mice, however its role in human B lymphopoiesis is controversial. Using a novel, human-only culture model we show that IL-7 increases human B cell production by &gt;60-fold from hematopoietic stem cells (HSCs) in both cord blood (CB) and adult bone marrow (BM). IL-7-induced increases are dose-dependent and specific to CD19+ cells. STAT5 phosphorylation and expression of the Ki-67 proliferation antigen indicate that IL-7 acts directly on CD19+ cells to increase proliferation at the CD34+ and CD34- pro-B cell stages, but not among CD19- B lineage precursors. As compared to CB, adult BM shows a reduction of in vitro generative capacity that is progressively more profound in developmentally sequential B cell precursor populations, resulting in a ~50-fold reduction in IL-7-dependent B lineage generative capacity. Without IL-7, HSCs in CB, but not BM, give rise to a small but consistent population of CD19LO B lineage cells that express EBF and PAX-5 and respond to subsequent IL-7 stimulation. Flt3 ligand, but not TSLP, was required for the IL-7-independent production of human B lineage cells. These data provide evidence that human B cell production from adult BM is dependent on IL-7 and suggest that a mechanism in addition to the "developmental switch" observed in the mouse model may be responsible for IL-7 dependency in adult human B lymphopoiesis. Supported by NIH K01 DK066163 (KJP).

Alterations in glutamate uptake in NT2-derived neurons and astrocytes after exposure to gamma radiation

Currently, the cellular and molecular mechanisms that underlie radiation-induced damage in the CNS are unclear. The present study began investigations of the underlying mechanism(s) for radiation-induced neurotoxicity by characterizing glutamate transport expression and function in neurons and astrocytes after exposure to gamma rays. NTera2-derived neurons and astrocytes, isolated as pure cultures, were exposed to doses of 10 cGy, 50 cGy and 2 Gy gamma rays, and transporter expression and function were assessed 3 h, 2 days and 7 days after exposure. In neurons, at 7 days after exposure, a significant increase was detected in EAAT3 after 50 cGy (P < 0.05) and a dose-dependent increase in GLT-1 expression was seen between doses of 10 and 50 cGy (P < 0.05). Functional assays of glutamate uptake revealed that neurons and astrocytes respond in a reciprocal manner after irradiation. Neurons responded to radiation exposure by increased glutamate uptake, an effect still evident at our last time (7 days) after exposure (P < 0.05). The astrocyte response to gamma radiation was an initial decrease in uptake followed by recovery to baseline levels at 2 days after exposure (P < 0.05). The observations made in this study demonstrate that neurons and astrocytes, while part of the same multifunctional unit, have distinct functional and reciprocal responses. The response in neurons appears to indicate a protracted response with potential long-term effects after irradiation.

Outcomes associated with retinoblastoma and c-myc gene expression in patients with testicular cancer: A ten-year experience

14656

Purpose: To determine and correlate the protein and mRNA expression of c-myc and Rb genes in normal testicular tissue and testicular cancer as possible markers of pharmacological response. Methods: Eleven fresh testicular cancer surgical specimens were obtained from untreated patients with histological diagnosis of seminoma (9/11) and non seminoma (2/11) during the period of 1992 to 1995. Age patient average was 35 (16–74). Two normal human testicular tissues also were evaluated as control. Single and double immunohistochemical assay was performed with peroxidase anti-peroxidase system using polyclonal antibody anti-pRb C-15 and monoclonal antibody anti- c-myc 1. Non radioactive in situ hybridization with cRNA probes was performed with cDNA from Rb (exons 2–27) and c-myc (exons 2,3). All seminomas were stage I and were treated with radiotherapy. Non-seminomas were stage III and were treated with chemotherapy. Results: Histological findings: Rb protein was expressed in mature cells toward the lumen of normal testicular tissue while c-myc was located in basal cells but decreasing the expression toward the lumen. High correlation between mRNA and protein levels for both genes was observed in normal testicular tissue. Rb protein and mRNA was absent in 6/11 (55%) tumors while the remaining showed a low level expression (45%). A high c-myc expression was observed in 6/11 (55%) seminomas specimens correlating in a few cases with absent Rb expression. Percentage of positive cells to c-myc gene expression (mRNA and protein) was highly increased in tumoral samples. Clinical findings: All patients with seminoma (9/11) and one of non seminoma (1/11) are alive and without tumoral activity a ten years of the diagnosis. A non-seminoma patient (1/11) have 11-year survival, a high expression of c-myc gene and absent retinoblastoma expression was observed in this case. Conclusion: The semiquantitative differences observed on c-myc and Rb gene expression in seminoma and non-seminoma tumors might correlate with the biological behavior including their high proliferation rate and the chemosensitivity.

No significant financial relationships to disclose.

Labeling of antibiotics for infection diagnosis

The high impact of infection on daily clinical practice has promoted research into better and more accurate diagnostic and therapeutic

METHODS

Localizing inflammation/infection with nuclear medicine techniques began over 40 years ago. Today, (67)Ga-scintigraphy, (99m)Tc-nanocolloid, (111)In and (99m)Tc in vitro labeled leukocytes, and monoclonal antigranulocyte antibodies are widely available for this purpose. While these methods are useful for localizing inflammation, they cannot always differentiate septic from aseptic processes. The ideal properties of an agent for diagnosing infection include: high specificity, early diagnosis, rapid blood clearance, ease of preparation, low toxicity, biodistribution appropriate for the disease under study, absence of immunologic response and low cost. A novel approach to infection diagnosis is the use of radiolabelled antibiotics. Antibiotics localize in the infectious focus, where they are frequently taken up and metabolized by microorganisms. The majority of the various antibiotics studied so far are those of the quinolones group (ciprofloxacin, sparfloxacin, enrofloxacin, levofloxacin, norfloxacin and ofloxacin). More recently, the labeling of ceftizoxime, a semisynthetic third generation cephalosporin, has been reported. The relevant features of labeled antibiotics in research and/or clinical infection diagnosis are the focus of this article.

Prostaglandins E(2) and F(2alpha) enhance differentiation of cementoblastic cells

BACKGROUND

The prostaglandins (PG) E(2) and PGF(2alpha) are important cytokines in periodontal physiology and pathology. PGE(2) and PGF(2alpha) alter cell function by binding and activating the plasmamembrane G-protein-coupled PG receptors. In this study, we examined the PGE(2) and PGF(2alpha) effects on the immortalized cementoblastic OCCM cells.

METHODS

Confluent OCCM cells were treated with PGE(2), PGF(2alpha), specific activators/inhibitors of the EP prostanoid receptors, a specific activator of the FP prostanoid receptor, and direct activators/inhibitors of the protein kinase C (PKC) signaling pathway. Mineral nodule formation was assessed by the von Kossa stain.

RESULTS

PGE(2) and PGF(2alpha) significantly increased mineralization of OCCM cells. The EP1 and EP3 PG receptor activators 16,16-dimethyl-prostaglandin E(2) and sulprostone, also increased mineralization. In contrast, specific activators of the EP2 or the EP2/EP3/EP4 receptors did not have any effect. Fluprostenol, a specific activator of the FP receptor, significantly increased mineralization of OCCM cells. FP and EP (1 or 3) receptors signal through activation of the protein kinase C (PKC) pathway. Indeed, phorbol 12-myristate 13-acetate (PMA), a direct activator of the PKC pathway, significantly increase OCCM mineralization, while pre-treatment of OCCM cells with the PKC inhibitor GF109203x (bisindolylmaleimide) significantly decreased mineralization.

CONCLUSION

We conclude that PGE(2) and PGF(2alpha) exert an anabolic effect on OCCM mineralization through activation of PKC signaling.

Neurodevelopment of neonates in neonatal intensive care units and growth of surviving infants at age 2 years

SUMMARY

The presence of development disorders in neonates attended in a Neonatal Intensive Care Unit (NICU) is highly variable; the aim of this study, therefore, was to determine the evolution of somatic and neurosensory development in a group of neonates requiring treatment in the NICU and to analyse the perinatal and developmental aspects of children presenting abnormalities.

PATIENTS AND METHODS

A total of 492 neonates (275 premature, 106 with birthweight < or =1500 g), who were treated in the NICU between January 1994 and December 1997, were followed-up until the age of 2 years. Data were obtained concerning birthweight, body length, head circumference, gestational age, normality of weight for gestational age, single/multiple birth, duration of stay in the NICU and the hospital, duration of mechanically assisted respiration and evolutive somatometry, neurological examination and the Brunet-Lezine development test, adjusted for the gestational age of the neonates, at 6, 12, 18 and 24 months. When abnormal results were detected, Early Attention (EA) programmes were applied.

RESULTS

Somatometry at birth in relation to gestational age revealed a weekly weight gain of 8.6%, an increase in body length of 1% and in head circumference of 1% (p<0.001). The evolution of somatic development to the age of 2 years showed that neonates with a birthweight < or =1500 g did not reach the values of neonates with a greater birthweight. The prevalence of cerebral palsy among all neonates was 6.8%, 14.6% among those weighing < or =1500 g, 4% among those weighing 1501-2500 g and 5% among those weighing >2500 g. The overall rate of neurosensory injury was 10.5%. These neonates presented less somatic development than those did with no neurologic disorder. To sum up, most of the neonates attended in the NICU during the 1990s presented a normal pattern of development. Nevertheless, they should be the object of special attention during the first years of life, particularly those neonates with a birthweight < or =1500 g and those presenting neurosensory risk.

Evaluation of tumor marker S-100 in cerebrospinal fluid from subjects with nonischemic brain pathologies

In order to evaluate the S-100 concentration in cerebrospinal fluid from subjects with nonischemic brain damage, a total of 33 samples were analyzed: 11 from subjects in whom no organic disease could be found; 14 from patients with a diagnosis of lymphocytic or bacterial-fungal meningitis, and 8 from patients with acute lymphatic leukemia but no demonstrable signs of meningeal involvement. In all cases, the subjects considered had no previous history of melanoma or ischemic brain damage. The mean levels +/- SEM found for each study group were 1.00 +/- 0.11, 1.67 +/- 0.23 and 1.17 +/- 0.14 microg/l, respectively. Significant differences appeared between the groups when applying the Kruskal-Wallis nonparametric test (p = 0.035). The highest levels were found in the meningitis group and were significantly different from those of the control group (p = 0.015). No significant differences were found with regard to age or sex. Based on the pathophysiology of meningitis and on previous studies, the results suggest the existence of brain damage caused by an infection as a possible cause of increased S-100 levels.

Evaluation of dream content in combat-related PTSD

Nightmares that replicate traumatic events are among the criteria that define posttraumatic stress disorder (PTSD); however, there has been limited systematic assessment of the content of dreams in PTSD. A PTSD dream rating instrument was developed to operationalize features attributed to dreams associated with combat-related PTSD that incorporated dimensions from the dream content analysis literature, and its reliability was assessed. Then the instrument was used to characterize dream reports in 18 Vietnam combat veterans diagnosed with PTSD. Approximately half of the group's target dreams contained features characteristic of combat, and all but 3 (17%) were moderately to highly threatening. Fifty-three percent were set at least partially in the present and 79% contained distorted elements. We therefore conclude that target dreams of combat veterans with PTSD vary with regard to replication of trauma and elements normally associated with dreaming, but typically are threatening.

[Efficiency of oxidant gas generator cells powered by electric or solar energy]

Diseases caused by microbial contaminants in drinking water continue to be a serious problem in countries like Mexico. Chlorination, using chlorine gas or chlorine compounds, is one of the best ways to treat drinking water. However, difficulties in handling chlorine gas and the inefficiency of hypochlorite solution dosing systems--due to sociopolitical, economic, and cultural factors--have reduced the utility of these chlorination procedures, especially in far-flung and inaccessible rural communities. These problems led to the development of appropriate technologies for the disinfection of water by means of the on-site generation of mixed oxidant gases (chlorine and ozone). This system, called MOGGOD, operates through the electrolysis of a common salt solution. Simulated system evaluation using a hydraulic model allowed partial and total costs to be calculated. When powered by electrical energy from the community power grid, the system had an efficiency of 90%, and in 10 hours it was able to generate enough gases to disinfect about 200 m3 of water at a cost of approximately N$8 (US $1.30). When the electrolytic cell was run on energy supplied through a photoelectric cell, the investment costs were higher. A system fed by photovoltaic cells could be justified in isolated communities that lack electricity but have a gravity-fed water distribution system.

Prevalence of malaria parasitemia and accuracy of microscopic diagnosis in Haiti, October 1995

In October 1995 the Ministry of Public Health and Population in Haiti surveyed 42 health facilities for the prevalence and distribution of malaria infection. They examined 1,803 peripheral blood smears from patients with suspected malaria; the overall slide positivity rate was 4.0% (range, 0.0% to 14.3%). The rate was lowest among 1- to 4-year-old children (1.6%) and highest among persons aged 15 and older (5.5%). Clinical and microscopic diagnoses of malaria were unreliable; the overall sensitivity of microscopic diagnosis was 83.6%, specificity was 88.6%, and the predictive value of a positive slide was 22.2%. Microscopic diagnoses need to be improved, and adequate surveillance must be reestablished to identify areas where transmission is most intense. The generally low level of malaria is encouraging and suggests that intensified control efforts targeted to the areas of highest prevalence could further diminish the effect of malaria in Haiti.

Sequential computerized tomography changes and related final outcome in severe head injury patients

The authors analysed the serial computerized tomography (CT) findings in a large series of severely head injured patients in order to assess the variability in gross intracranial pathology through the acute posttraumatic period and determine the most common patterns of CT change. A second aim was to compare the prognostic significance of the different CT diagnostic categories used in the study (Traumatic Coma Data Bank CT pathological classification) when gleaned either from the initial (postadmission) or the control CT scans, and determine the extent to which having a second CT scan provides more prognostic information than only one scan. 92 patients (13.3% of the total population) died soon after injury. Of the 587 who survived long enough to have at least one control CT scan 23.6% developed new diffuse brain swelling, and 20.9% new focal mass lesions most of which had to be evacuated. The relative risk for requiring a delayed operation as related to the diagnostic category established by using the initial CT scans was by decreasing order: diffuse injury IV (30.7%), diffuse injury III (30.5%), non evacuated mass (20%), evacuated mass (20.2%), diffuse injury II (12.1%), and diffuse injury I (8.6%). Overall, 51.2% of the patients developed significant CT changes (for worse or better) occurring either spontaneously or following surgery, and their final outcomes were more closely related to the control than to the initial CT diagnoses. In fact, the final outcome was more accurately predicted by using the control CT scans (81.2% of the cases) than by using the initial CT scans (71.5% of the cases only). Since the majority of relevant CT changes developed within 48 hours after injury a pathological categorization made by using an early control CT scan seems to be most useful for prognostic purposes. Prognosis associated with the CT pathological categories used in the study was similar independently of the moment of the acute posttraumatic period at which diagnoses were made.

A community-based study of acute respiratory tract infections in children in Uruguay

Acute respiratory tract infection (ARI) was investigated in children less than 5 years old in a longitudinal community-based study of 166 families living in a socioeconomically depressed area in Montevideo, Uruguay. Pediatricians made home visits every 10 days from May 1985 to December 1987, and symptoms and signs of ARI were recorded. The incidence of ARI was 5.8 episodes per child-year during the first 12 months of life and decreased with increasing age of the index children; the rate was highest in children 1-5 months old. Children observed from birth were ill during 21% of the visits. According to the definitions of the study, the incidence of lower respiratory tract infection was 11.6% higher than the incidence of upper respiratory tract infections. The rates of ARI were higher during the colder months. Most risk factors for ARI were only marginally statistically significant.

Effect of streptozotocin-diabetes and insulin treatment on regulation of Leydig cell function in the rat

The present study was performed to further clarify the possible role played by insulin deficiency on the steroidogenic capacity of the rat testis. Sprague-Dawley rats weighing 250-300 g were used in all experiments. Diabetes was induced by i.p. injection (40 mg/kg b.w.) of streptozotocin and was monitored at 2-day intervals by measuring body weight and serum glucose, glucosuria and ketonuria levels. The effect of insulin therapy on pituitary LH content and plasma LH concentrations, as well as on the cyclic AMP level in interstitial cell incubation medium and plasma testosterone concentrations, was measured 30 days after the induction of diabetes by radioimmunoassay. Streptozotocin-induced diabetes resulted in significantly reduced pituitary LH (16%, P less than 0.025) and plasma LH (34%, P less than 0.02); insulin treatment completely restored these levels. Similarly, the cyclic AMP content of interstitial cell incubation medium and the plasma testosterone concentrations were dramatically decreased in the diabetic state (50%, P less than 0.005 and 63%, P less than 0.025, respectively) and combined treatment with insulin plus hCG appeared slightly more effective than treatment with either of these hormones alone, suggesting a possible synergistic action. It is concluded that decreased testicular steroidogenesis in the diabetic rat may represent, at least in part, a direct consequence of insulin deficiency at the hypothalamic and/or pituitary levels. However, our findings would also be consistent with other reports suggesting that insulin may play a direct role in the rat testis.

Effect of streptozotocin diabetes on the pituitary-testicular axis in the rat

The pituitary-testicular axis was investigated in the streptozotocin diabetic male rat to determine the relationship between hormonal alterations and steroidogenic activity. Male Sprague-Dawley rats weighing 250-300 g were used in all experiments. Diabetes was induced by intraperitoneal injection (40 mg/kg body wt.) of streptozotocin and they were studied with non-diabetic controls. The observations on these animals were compared to those from diabetic rats treated with 1-5 IU protamine zinc insulin. Steroidogenic activity was determined by measuring the per cent of [4-14C]-cholesterol converted to [4-14C]-pregnenolone and [4-14C]-progesterone. Plasma concentrations of LH, FSH and prolactin were measured by RIA. Streptozotocin induced diabetes resulted in significantly reduced plasma LH (34%, p less than 0.20) and prolactin (53%, p less than 0.001) but did not modify FSH concentrations. Insulin treatment completely and partially restored abnormal LH and prolactin release. The activity of the enzyme cleaving the side-chain of cholesterol (rate limiting step in steroidogenesis) was considerably reduced in the diabetic state (59%, p less than 0.002) and insulin treatment restored it to even supranormal levels (not significant). Our findings suggest that insulin may play a physiological and differential role in regulating the secretory activity of the anterior pituitary. The insulin is needed for normal LH and prolactin release and Leydig cells function but its role in FSH release and Sertoli cells function is not clear.

Atypical interstitial pneumonia in yearling feedlot cattle

During each week of 1974, we surveyed, for illnesses and deaths, a constantly changing population of yearling feedlot cattle that, for the year, totaled 407,000 animals. From 3,943 fatalities, 1,988 necropsies were made; of this number, 106 (5.3%) had atypical interstitial pneumonia. The death rate was higher during summer and fall than during the other seasons and was evenly distributed throughout each of the 4 stages of fattening. Gross pulmonary lesions involved both lungs and were prominent throughout the caudal (diaphragmatic) lobes. Epithelialization, hemorrhage, fibrin, hyaline membranes, emphysema, bronchiolitis, and interstitial edema were common, whereas chromatin strands, bronchiolar edema, interstitial emphysema, and obliterating bronchiolitis were less common histopathologic features.

Shipping fever pneumonia in yearling feedlot cattle

During each week of 1974, we surveyed, for illnesses and deaths, a continually changing population of yearling feedlot cattle that, for the year, totaled 407,000 animals. About 5.1% of the cattle sickened and, of these, 18.9% died. From the 3,943 fatalities, 1,988 necropsies were made. About 75% of the clinical diagnoses and 64% of the necropsy diagnoses were respiratory tract diseases; of the fatalities from respiratory tract diseases, 75% were attributed to shipping fever pneumonia. Nearly 72% of fatal cases of shipping fever pneumonia occurred during the first 45 days on feed. In the lungs of most cattle with shipping fever pneumonia, bronchiolitis, fibrinous exudate, colonies of microorganisms, lymphatic clots, intravascular clots, thromboses, and foci of necrosis were found. Pasteurella spp, Mycoplasma spp, and infectious bovine rhinotracheitis virus were isolated from pneumonic tissues. It was hypothesized that pathogenic Pasteurella spp and other microorganisms in nasal secretions transfer from the nasopharynx into the lungs by draining along the tracheal floor into ventral bronchi, bronchioles, and alveoli, and that pasteurella endotoxin, formed in infected lobules, thromboses and occludes lymphatics, capillaries, and veins and thereby causes ischemic necrosis.

Fetal abomasal ulcers in yearling feedlot cattle

During all of 1974, we surveyed, for illnesses and deaths, about 407,000 yearling feedlot cattle. From the 3,943 dead cattle, 1,988 necropsies were made; of this number, 31 (1.6%) had ulcers with fatal perforations or hemorrhages; a similar additional number of necropsied cattle had innocuous ulcers as incidental findings. Ulcers developed during all seasons and all stages of fattening, but were more common during the first 45 days of winter-initiated fattening than during other times. Perforations of the abomasal wall resulted in spillage of abomasal contents into the abdominal cavity and the development of peritonitis.

Brisket disease in yearling feedlot cattle

During all of 1974, we surveyed, for illnesses and deaths, about 407,000 yearling feedlot cattle maintained at 1,600 m altitude. Of 1,988 cattle necropsied, 116 (5.8%) had brisket disease. The malady occurred during all seasons but was most common throughout fall and winter. The gross changes were hypertrophy and dilatation of the right ventricle and generalizaed passive congestion. The postulated causative factors were high genetic susceptibility, rapid growth rate, previous mountain grazing, and hypoventilation with airway hypoxia.

Bronchiectasis in yearling feedlot cattle

Thoughout all of 1974, we surveyed, for illnesses and deaths, about 407,000 yearling feedlot cattle. From the 3,943 dead cattle, 1,988 necropsies were made; of the cattle necropsied, 32 (1.6%) had bronchiectasis. In this disease, the permanently dilated small bronchi and bronchioles, located in ventral parts of the lungs, were filled with accumulations of exudate and microorganisms, including Pasteurella hemolytica, Pasteurella multocida, Corynebacterium pyogenes, Escherichia coli, Salmonella anatum, Staphylococcus spp, and Mycoplasma arginini.