B-cell activating factor and A proliferation-inducing ligand in relation to intima-media thickness as biomarkers of premature atherosclerosis in systemic lupus erythematosus patients

BACKGROUND

The aim of this study was to assess the correlation of the serum B-cell activating factor (BAFF), A proliferation-inducing ligand (APRIL) and interleukin (IL)-21 with carotid intima-media thickness (cIMT) to evaluate their efficacy as non-invasive biomarkers for the risk of premature development of atherosclerosis.

METHODS

ELISA test was used to quantify serum BAFF, APRIL and IL-21 in 40 patients with systemic lupus erythematosus (SLE) and 20 healthy controls (HCs). The obtained results were correlated with disease duration, anti-double stranded DNA, complement proteins levels, lipid profile, cIMT and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).

RESULTS

Serum BAFF, APRIL and IL-21 were significantly increased in SLE compared to HCs. Positive correlation was recorded between BAFF (r = 0.51) and APRIL (r = 0.52) with the cIMT. IL-21 correlated positively with SLEDAI (r = 0.33) and negatively with BAFF (r = -0.37) and APRIL (r = -0.44). According to the multiple logistic regression analysis, we found that low-density lipoprotein, serum BAFF and APRIL values were independent factors for cIMT in SLE. To discriminate premature atherosclerosis in patients with SLE, BAFF ≥455 pg/ml yielded 88.9% sensitivity with 100% specificity while APRIL ≥600 pg/ml yielded 95% sensitivity with 100% specificity. IL-21 ≥240 pg/ml yielded 66.7% sensitivity and 100% specificity.

CONCLUSIONS

Circulating BAFF and APRIL in patients with SLE were correlated to disease activity and cIMT, suggesting that they could be used as a peripheral blood biomarker for the occurrence of premature atherosclerosis in SLE.

The potential use of serum interleukin-21 as biomarker for lupus nephritis activity compared to cytokines of the tumor necrosis factor (TNF) family

OBJECTIVE

Lupus nephritis (LN) is a significant consequence of systemic lupus erythematosus (SLE). To the best of our knowledge, this is the first work that focuses on evaluation of serum interleukin (IL-) 21 as a diagnostic biomarker of LN activity, compared to B lymphocyte stimulator (BlyS), tumor necrosis factor ligand superfamily member 13 (TNF-SF13), and traditional techniques of active LN attempting to compare their diagnostic usefulness.

METHODS

Serum levels of IL-21, BlyS, and TNF-SF13 during LN were investigated. Twenty-five biopsy-proven, active LN female patients and 15 SLE patients without active LN and 20 healthy controls (HCs) joined this work.

RESULTS

Serum IL-21 level was significantly higher in active LN group than in inactive LN group. Correlation analysis showed that serum IL-21 levels were significantly correlated with total SLEDAI (r = 0.41, p = 0.03), renal-SLEDAI (r = 0.48, p = 0.04), renal activity index (AI) (r = 0.93; p < 0.001), and 24-h proteinuria (r = 0.51; p > 0.008). Receiver operating characteristic curve (ROC) revealed the ability of serum IL-21 to discriminate between active and inactive LN with 70% sensitivity at >240 pg/ml cutoff point (AUC 0.809).

CONCLUSION

For Egyptian SLE patients, serum levels of IL-21 were superior to TNF-SF13 and BlyS and correlated significantly with the activity indexes of LN, indicating a promising role as a potential biomarker of active LN.

Automatic thresholding from the gradients of region boundaries

We present an approach for automatic threshold segmentation of greyscale images. The procedure is inspired by a reinterpretation of the strategy observed in human operators when adjusting thresholds manually and interactively by means of ‘slider’ controls. The approach translates into two methods. The first one is suitable for single or multiple global thresholds to be applied globally to images and consists of searching for a threshold value that generates a phase whose boundary coincides with the largest gradients in the original image. The second method is a variation, implemented to operate on the discrete connected components of the thresholded phase (i.e. the binary regions) independently. Consequently, this becomes an adaptive local threshold procedure, which operates relative to regions, rather than to local image subsets as is the case in most local thresholding methods previously published. Adding constraints for specifying certain classes of expected objects in the images can improve the output of the method over the traditional ‘segmenting first, then classify’ approach.

Enteric disease surveillance under the AFHSC-GEIS: current efforts, landscape analysis and vision forward

The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.

Diarrheal illness among deployed U.S. military personnel during Operation Bright Star 2001—Egypt

In the fall of 2001, approximately 15,000 U.S. military personnel participated in a military exercise in the northwestern Egyptian desert. To assess the prevalence and impact of diarrhea and enteropathogen distribution, we conducted a post-deployment survey and a case series study. A departure convenience sampling (n = 3725) was used in the post-deployment survey. Overall, 9.3% reported diarrhea, 2.6% sought medical care, and 2.8% stopped or decreased their work for at least a day. Among those reporting diarrhea, 41.7% had symptoms for less than 2 days, 43.5% had symptoms from 2-5 days, and 14.8% had symptoms for more than 5 days. In the case series study, pathogens were identified in 53.6% of the 129 cases enrolled. Pathogens identified included enterotoxigenic E. coli (n = 53), enteroaggregative E. coli (n = 13), Cryptosporidium (n = 9), Campylobacter jejuni (n = 7), noroviruses (n = 7), Shigella flexneri (n = 2), rotavirus (n = 2), and Entamoeba histolytica (n = 2). Among those seeking care for diarrhea, two thirds reported a decreased ability or inability to perform their jobs for at least one day, but overall, diarrhea was much less prevalent than in past surveys in this region, with minimal impact on the mission.

Limited ovarian stimulation (LOS), prevents the recurrence of severe forms of ovarian hyperstimulation syndrome in polycystic ovarian disease

OBJECTIVES

We aimed to test the possibility that LOS could be used to avoid the risk of occurrence of severe OHSS in PCOD patients with past history of severe OHSS in their previous IVF treatment.

STUDY DESIGN

A prospective study, with patients stood as their own controls. Twenty patients with history of severe OHSS in their previous IVF treatment were included in the study. The patients received LOS cycles during the six months period commencing January 1998, a full dose of human chorionic gonadotropin (10,000 IU) was administered when the leading follicle reached a mean diameter of 12 mm, and oocytes retrieval 36 h later was followed by intracytoplasmic sperm injection (ICSI) and embryo transfer. Signs and symptoms of severe OHSS were recorded.

RESULTS

All patients produced mature oocytes, achieved fertilisation and eight clinical pregnancies were diagnosed. None of the patients re-experienced the symptoms of severe OHSS, and none required hospitalisation.

CONCLUSION

We confirm that, in the studied group of patients, LOS helped in the prevention of the severe forms of OHSS in PCOD patients with past history of severe OHSS.

Limited ovarian stimulation results in the recovery of mature oocytes in polycystic ovarian disease patients: a preliminary report

This pilot study including five patients, examined the feasibility of obtaining oocytes from partially stimulated ovarian follicles in patients with polycystic ovarian disease (PCOD). We evaluated oocyte maturity, and fertilization potentials. The diagnosis of PCOD was based on ultrasound findings and endocrine criteria. The long protocol of pituitary ovarian axis down-regulation was used and follicles were stimulated with daily injections of human menopausal gonadotropin (HMG), until the mean diameter of the leading follicle reached 12 mm. A full dose of HCG (10000 I.U.) was administered and oocytes were collected 36 h later. The mean number of oocytes collected per patient was 12.6+/-4.9, the mean number of MII oocytes was 8.8+/-4.4, with fertilization rate of 70.5% following intracytoplasmic sperm injection (ICSI). To our knowledge this is the first report in the literature documenting the recovery of mature oocytes following limited stimulation of the ovaries. The potentials of this novel approach open a new dimension in the management of patients with PCOD.

Immunological response to diphtheria/tetanus vaccine in Schistosomiasis mansoni patients

The cellular and humoral immune responses of patients with S. mansoni infection were evaluated before and one month after each of two intramuscular doses of diphtheria/tetanus toxoid vaccine. Patients were divided into "responder" and "non-responder" groups based on anti-tetanus toxoid (anti-TT) IgG levels after vaccination. The specific anti-TT IgG1 response of the responder group was predominantly in the IgG, subclass. The lymphoproliferative response to PHA was also significantly higher in the responder group; this elevation was detectable before and after each vaccination. The responses to PWM and SPL were comparable in the two groups before vaccination, although the responder group had a higher response to SPL after vaccination. IgG antibodies for schistosome adult worm and egg antigens were significantly lower in the responder group prior to vaccination but not thereafter. Anti-diphtheria IgG antibodies were comparable in the two groups after vaccination at all times. Clinically, the non-responder patients had a higher incidence of splenomegaly (84.6% vs 44.8%) and were significantly older than the responder patients (mean 34.1 yrs vs 18.7 yrs). The cause for the reduced anti-tetanus IgG response in schistosomiasis patients is believed to be multifactorial. T cell or antigen presenting cell dysfunction, high levels of IgG antibodies specific for schistosome antigens, splenomegaly and age are factors that might lead to reduced anti-TT IgG response.