1
|
AB0429 BELFAST TRUST EXPERIENCE OF IDIOPATHIC INFLAMMATORY MYOPATHIES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The Idiopathic Inflammatory Myopathies (IIM) are a heterogeneous group of diseases where there is a growing field of knowledge and experience. Presentation is usually of onset of muscle weakness in combination with typical muscle biopsy findings and specific serum autoantibodies. There is a significant morbidity and mortality associated with IIM, due to its potential systemic nature, associated malignancy risk and side effects of immunosuppressive therapy1. There is no published guideline on management of IIM, with treatment limited to best practice experience.Objectives:Review Belfast Trust experience of Adult IIM from 2009-2020Methods:Review of Electronic Records of 18 patients diagnosed with IIM between 2009-2020Results:18 patients diagnosed with IIM. Mean age at diagnosis is 64, with age range of 46-83. Mean duration of treatment is 4 years. 14 patients are in remission, 2 have active disease and 2 are deceased with cause of death unrelated to IIM.Muscle Biopsy was performed in 17 patients. 11 patients biopsies were diagnostic and 6 were supportive. Of the patients with DM who did not have diagnostic muscle biopsies, all 3 had diagnostic skin biopsies. Of 6 patients with a negative ANA, 5 had a muscle biopsy performed (diagnostic in 4 patients and supportive in 1 patient.)Table 1.Overview of diagnosis and treatment of patients with IIM. PM - Polymyositis DM - Dermatomyositis IBM - Inclusion Body Myositis IMNM Immune Mediated Necrotising Myositis EP - Extended Panel ILD - Interstitial Lung Disease RA - Rheumatoid Arthritis RTx - Rituximab IVIG - Intravenous Immunoglobulin MTx - Methotrexate AZA - Azathioprine MMF - Mycophenolate Mofetil SLZ - Sulphasalazine HLQ - HydroxychloroquineDiagnosisANA/ExtramuscularFailed/IntoleranceRTxIVIGMtxAZAMMFCiclos-porinSLZ/HLQPrednisolone duration (months)PMJo-1 RoAZAX18PMJo-1MyocarditisAZAxxx12PMNegative. No EPAZA/MMF/RTxxMaint. 3mgPMNegative. No EPILDx22PMJo-1ILD, Mechanic HandsMtx/MMFxxMaint. 7mgPMNegative. No EPx36PMNegative. No EPx18, reducing dosePMNegative. No EPxxMaint. 5mgPMRoILD, Dysphagiax6, reducing doseDMMDA5, RoRash, ILDAZAxxX18DMMi2RashMtxxX20DMPM-SCLRashDeceasedDMRo52Siccax6, reducing doseDMMDA5, NXP2RashxxMaint, 12.5mgDM- AmyopathicSAERashMTxxxXDeceasedIBMRo/LaxxxUnknown duration. Now stoppedIMNMHMGCRx12IMNMHMGCRxxx18, reducing doseConclusion:Extended myositis panels have only readily become available in the Belfast Trust in recent years. This has enhanced patients phenotypes and vigilance for extra-muscular complications. There is a recognised elevated risk of cancer in patients with IIM2. In our patients, with a mean disease duration of 4 years, none have developed malignancy. All of our patients had a tissue sample obtained, either muscle or skin. In the Belfast Trust, Rheumatologists perform muscle biopsies and all of the samples contributed to diagnosis. A limitation of diagnostic tests is restricted access to EMGs. We introduced a variety of DMARDs to limit exposure to steroids. 50% of our patients are in remission and off steroids. The only biologic we used was Rituximab. In contrast to other rheumatological conditions, there is no published protocol for administration of Rituximab in IIM. For patients with refractory disease, IVIG was used in the short term to allow for introduction of alternative immunosuppressants to maintain remission. This review highlights the complex nature of this group of diseases, and our experience with a variety of treatment options. We have diagnosed and treated 18 patients, and although we have experience with the medications used to treat IMM further work is needed to establish evidence based treatment.References:[1]Barsotti, Lundberg et al ‘Current Treatment for Myositis’ Curr Treatm Opt Rheumatol vol 4 (4) 2018 p299-315 2. Kang et al ‘Temporal relationship between cancer and myositis identifies two distinctive subgroups of cancers: impact on cancer risk and survival in patients with myositis’ Rheum vol 55 (9) 2016 p1631-1641Disclosure of Interests:None declared
Collapse
|
2
|
Abstract
OBJECTIVE Cutaneous stigmata or congenital anomalies often prompt screening for occult spinal dysraphism (OSD) in asymptomatic infants. While a number of studies have examined the results of ultrasonography (US) screening, less is known about the findings when MRI is used as the primary imaging modality. The object of this study was to assess the results of MRI screening for OSD in infants. METHODS The authors undertook a retrospective review of all infants who had undergone MRI of the lumbar spine to screen for OSD over a 6-year period (September 2006-September 2012). All images had been obtained on modern MRI scanners using sequences optimized to detect OSD, which was defined as any fibrolipoma of the filum terminale (FFT), a conus medullaris ending at or below the L2-3 disc space, as well as more complex lesions such as lipomyelomeningocele (LMM). RESULTS Five hundred twenty-two patients with a mean age of 6.2 months at imaging were included in the study. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in 28 (5%), other isolated cutaneous stigmata (subcutaneous lipoma, vestigial tail, hairy patch, and dysplastic skin) in 31 (6%), several of the above stigmata in 97 (18%), and congenital anomalies in 50 (10%). Twenty-three percent (122 patients) of the study population had OSD. Lesions in 19% of these 122 patients were complex OSD consisting of LMM, dermal sinus tract extending to the thecal sac, and lipomeningocele. The majority of OSD lesions (99 patients [81%]) were filar abnormalities, a group including FFT and low-lying conus. The rate of OSD ranged from 12% for patients with asymmetrically deviated gluteal crease to 55% for those with other isolated cutaneous stigmata. Isolated midline dimple was the most common indication for imaging. Among this group, 20% (46 of 235) had OSD. There was no difference in the rate of OSD based on dimple location. Those with OSD had a mean dimple position of 15 mm (SD 11.8) above the coccyx. Those without OSD had a mean dimple position of 12.2 mm (SD 19) above the coccyx (p = 0.25). CONCLUSIONS The prevalence of OSD identified with modern high-resolution MRI screening is significantly higher than that reported with US screening, particularly in patients with dimples. The majority of OSD lesions identified are FFT and low conus. The clinical significance of such lesions remains unclear.
Collapse
|
3
|
Abstract
Wild-type p53-induced phosphatase 1 (WIP1) is a serine/threonine phosphatase that dephosphorylates proteins in the ataxia telangiectasia mutated (ATM)-initiated DNA damage response pathway. WIP1 may have a homeostatic role in ATM signaling by returning the cell to a normal pre-stress state following completion of DNA repair. To better understand the effects of WIP1 on ATM signaling, we crossed Atm-deficient mice to Wip1-deficient mice and characterized phenotypes of the double knockout progeny. We hypothesized that the absence of Wip1 might rescue Atm deficiency phenotypes. Atm null mice, like ATM-deficient humans with the inherited syndrome ataxia telangiectasia, exhibit radiation sensitivity, fertility defects, and are T-cell lymphoma prone. Most double knockout mice were largely protected from lymphoma development and had a greatly extended lifespan compared with Atm null mice. Double knockout mice had increased p53 and H2AX phosphorylation and p21 expression compared with their Atm null counterparts, indicating enhanced p53 and DNA damage responses. Additionally, double knockout splenocytes displayed reduced chromosomal instability compared with Atm null mice. Finally, doubly null mice were partially rescued from gametogenesis defects observed in Atm null mice. These results indicate that inhibition of WIP1 may represent a useful strategy for cancer treatment in general and A-T patients in particular.
Collapse
|
4
|
G.P.5.10 MAPK signaling pathway is commonly activated in hearts of mouse models of autosomal dominant and X-linked Emery–Dreifuss muscular dystrophy. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
5
|
Performance characteristics of an improved version of the ABBOTT IMx HBsAg (V2) MEIA. Clin Lab 2003; 48:359-64. [PMID: 12146568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The ABBOTT IMx HBsAg (V2) microparticle enzyme immunoassay (MEIA) is a fully automated two-step assay for the qualitative determination of hepatitis B surface antigen (HBsAg). HBsAg is the most important serological marker of acute and chronic hepatitis B infection. Therefore, sensitivity of the currently used detection systems for HBsAg is critical to blood screening, diagnosis of HBV infection and therapy monitoring of HBV infected individuals. The design of the assay has been modified and performance characteristics of the modified test were compared to its predecessor. Precision and specificity of the modified assay are comparable to its predecessor. PEI standard subtype ad is detected at 0.026 U/ml versus 0.053 U/ml with the previous assay version. HBsAg subtypes ad and ay are detected at 0.22 ng/ml and 0.17 ng/ml, respectively. The seroconversion window is reduced by 2-28 days versus the predecessor test. The modified assay has the capability to detect HBsAg mutants not detected by some other commercial assays. The modified version of the ABBOTT IMx HBsAg (V2) MEIA provides significantly improved sensitivity combined with the capability to detect prevalent and less prevalent HBsAg mutants.
Collapse
|
6
|
Abstract
Few therapeutic treatment options are available for patients suffering from metastatic androgen-independent prostate cancer. We investigated the ability of the estrogen metabolite 2-methoxyestradiol to inhibit the proliferation of a variety of human prostate cancer cell lines in vitro and to inhibit the growth of androgen-independent prostate cancer in a transgenic mouse model in vivo. Our results showed that 2-methoxyestradiol is a powerful growth inhibitor of LNCaP, DU 145, PC-3, and ALVA-31 prostate cancer cells. Cell flow cytometry of 2-methoxyestradiol-treated DU 145 cells showed a marked accumulation of cells in the G2/M phase of the cell cycle and an increase in the sub-G1 fraction (apoptotic). In addition, staining for annexin V, changes in nuclear morphology, and inhibition of caspase activity support a role for apoptosis. More importantly, we showed that 2-methoxyestradiol inhibits prostate tumor progression in the Ggamma/T-15 transgenic mouse model of androgen-independent prostate cancer without toxic side effects. These results in cell culture and an animal model support investigations into the clinical use of 2-methoxyestradiol in patients with androgen-independent prostate cancer.
Collapse
|
7
|
Integrating the methadone patient in the traditional addiction inpatient rehabilitation program--problems and solutions. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 2001; 68:28-32. [PMID: 11135503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Physicians have reported alcoholism and opioid addiction as co-morbid conditions since the 19th century. From the inception of methadone maintenance treatment, heroin addicts with serious alcohol conditions have enrolled in methadone maintenance programs. Programs that treat alcoholism, including the traditional addiction inpatient rehabilitation programs of the Addiction Treatment Centers (ATCs) operated by New York State, have based their treatment regimen on 12-step abstinence models. Methadone maintenance was considered antithetical to this philosophy. It was regarded as simply substituting one drug for another and not a legitimate treatment for opiate dependence. Therefore, methadone patients were often not accepted into alcohol treatment programs, since they were perceived as active addicts taking a mood-altering drug. Alcohol-related conditions among methadone patients are major causes of liver disease and death, and behavior problems associated with excessive drinking are major reasons for discharging patients. To address these issues and the lack of treatment facilities, the administration of the New York State Office of Alcoholism and Substance Abuse Services (OASAS), which licenses both methadone programs and the ATCs in New York State, realized that many of the methadone patients with alcohol problems are in need of the services provided at the ATCs. They instituted, therefore, a rigorous educational effort for the medical and counseling staffs of the ATCs, designed to integrate methadone treatment into the ATC treatment framework. Eighty percent of the 220 methadone patients who entered the ATCs in a demonstration project during the 1997/1998 state fiscal year have been compliant with the treatment regimen. These results have led to acceptance of methadone patients into the ATCs.
Collapse
|
8
|
Zinc responsive dermatopathy in goats: two field cases. CONTEMPORARY TOPICS IN LABORATORY ANIMAL SCIENCE 2000; 39:32-5. [PMID: 11487227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Two adult female goats presented with symmetrical alopecia, rough hair coats, weight loss, and generalized unthriftiness. In light of the history and clinical signs, we suspected a mineral deficiency or endocrine imbalance. These animals were being fed a diet of alfalfa, a legume high in calcium, which can block zinc uptake. Serum zinc levels were low, and skin biopsies supported the diagnosis of zinc deficiency. Therefore, these findings suggest that the main factor blocking zinc absorption was increased dietary calcium.
Collapse
|
9
|
Stereotactic uses beyond core biopsy: model development for minimally invasive treatment of breast cancer through interstitial laser hyperthermia. Am Surg 1996; 62:117-8. [PMID: 8554188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Light of a Nd:YAG laser presented through a fiberoptic cable to a diffusing tip can be adapted to mammographic stereotactic instruments now used for core biopsy in the hyperthermic endoablation of breast cancer. This approach to cancer destruction extends breast preservation to the point of no observable surface skin change. The initial analysis characterizes the effects of laser endohyperthermia in a physical model as well as in tissue, both ex vivo and in vivo, to create a reliable technique that will lead to human trials. A fiberoptic cable with a diffusing quartz tip placed deep within soft tissue can pass light of a neodymium laser and consequent thermal energy for the destruction of surrounding soft tissues. Because breast cancer occurs with greatest frequency in the involuted breasts of women more than 50 years of age and because this tissue is predominantly fibro-fatty in nature, our work has concentrated on model development and the determination of heat distribution and destruction of fat and fibro-fatty tissue. Following the development of a physical model, time-temperature courses were found to be similar in ex vivo human breast tissue and subcutaneous porcine fat. This led to in vivo porcine studies that confirmed similar time-temperature courses. For tissues brought to a range of 60 degrees C to 80 degrees C and sustained for the better part of 20 minutes, gross and histological analyses reveal complete destruction over a 1 1/2 cm radial region around the laser tip. This approach offers great promise for the treatment of stereotactically biopsied small T1 breast carcinomas.
Collapse
|
10
|
Continuing medical education in ontario: a primary care perspective. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 1982; 28:1327-1333. [PMID: 21286128 PMCID: PMC2306452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A major study of continuing medical education practices, needs and problems in Ontario showed that the primary care physician is very active in maintaining his clinical skills and knowledge. Compared to his other specialty colleagues he utilizes more resources in his own community, depending less on formal programs. Members of the College of Family Physicians of Canada tend to be more like their other specialty colleagues than other primary care physicians.
Collapse
|
11
|
Influenza vaccination in patients with rheumatic diseases. Safety and efficacy. JAMA 1979; 242:53-6. [PMID: 312949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The safety and efficacy of influenza vaccination were studied in 32 healthy volunteers and in 62 patients with systemic lupus erythematosus (SLE), rheumatoid arthritis, degenerative joint disease, and other rheumatic diseases. These individuals, none of whom was acutely ill, were examined at the time of immunization and one week, three weeks, and four months later. Flare-ups of rheumatic disease following immunization were infrequent and usually minor. Seroconversion to A/New Jersey/76 developed in 62% to 87% of all individuals and to A/Victoria/75 in 62% to 69%. Antibody responses to A/New Jersey/76 were significantly lower in young patients taking glucocorticoids compared to those not taking glucocorticoids. The antibody responses to A/New Jersey/76 and A/Victoria/75 in patients with SLE were not different from normal responses. Administration of these vaccines was safe in these patients with stable disease and induced antibody responses in most individuals.
Collapse
|
12
|
Abstract
Eosinophilic fasciitis is a recently described rheumatic disease, some 20 cases having been reported in abstract form. Previous descriptions have stressed the localized nature of skin involvement, the absence of visceral changes or Raynaud's phenomenon, an association with hypergammaglobulinaemia and eosinophilia, and a good response to corticosteroid therapy. The most conspicuous feature of this entity has been a massive thickening of the subcutaneous fascia, when an adequate (skin down to muscle) biopsy has been performed. We report another case conforming to these general features, with the exception that Raynaud's phenomenon was a prominent symptom. A critical review of the literature suggests that eosinophilic fasciitis should tentatively be regarded as a variant of scleroderma.
Collapse
|
13
|
Blood flow through surgically produced arterio-venous fistulae in the human forearm. Clin Sci (Lond) 1971; 41:7P-8P. [PMID: 5564324 DOI: 10.1042/cs041007pb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
14
|
Evidence for a non-specific sensitizing action of physostigmine (eserine) on constrictor responses of smooth muscle in the rabbit ear artery. J Physiol 1971; 216:61P-62P. [PMID: 5559636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
15
|
Forearm blood flow in patients with an arterio-venous fistula. Ir J Med Sci 1970; 3:436. [PMID: 5517054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|