Minimally Invasive Approach for Diagnosing TMJ Osteoarthritis

This study's objectives were to test correlations among groups of biomarkers that are associated with condylar morphology and to apply artificial intelligence to test shape analysis features in a neural network (NN) to stage condylar morphology in temporomandibular joint osteoarthritis (TMJOA). Seventeen TMJOA patients (39.9 ± 11.7 y) experiencing signs and symptoms of the disease for less than 10 y and 17 age- and sex-matched control subjects (39.4 ± 15.2 y) completed a questionnaire, had a temporomandibular joint clinical exam, had blood and saliva samples drawn, and had high-resolution cone beam computed tomography scans taken. Serum and salivary levels of 17 inflammatory biomarkers were quantified using protein microarrays. A NN was trained with 259 other condyles to detect and classify the stage of TMJOA and then compared to repeated clinical experts' classifications. Levels of the salivary biomarkers MMP-3, VE-cadherin, 6Ckine, and PAI-1 were correlated to each other in TMJOA patients and were significantly correlated with condylar morphological variability on the posterior surface of the condyle. In serum, VE-cadherin and VEGF were correlated with one another and with significant morphological variability on the anterior surface of the condyle, while MMP-3 and CXCL16 presented statistically significant associations with variability on the anterior surface, lateral pole, and superior-posterior surface of the condyle. The range of mouth opening variables were the clinical markers with the most significant associations with morphological variability at the medial and lateral condylar poles. The repeated clinician consensus classification had 97.8% agreement on degree of degeneration within 1 group difference. Predictive analytics of the NN's staging of TMJOA compared to the repeated clinicians' consensus revealed 73.5% and 91.2% accuracy. This study demonstrated significant correlations among variations in protein expression levels, clinical symptoms, and condylar surface morphology. The results suggest that 3-dimensional variability in TMJOA condylar morphology can be comprehensively phenotyped by the NN.

Online Convective Therapies: Results from a Hemofiltration Trial

With the introduction of the on-line preparation of dialysis fluids, the hemofiltration technique, which has never had a widespread diffusion in its old version with the infusion bags, has gained a new interest. We planned a prospective, randomized, 3-year-long study comparing survival and morbidity in ultrapure bicarbonate dialysis (BD) with on-line predilution hemofiltration (HF). Since comorbidity is one of the main factors limiting survival, the study was addressed to patients with a severe degree of comorbidity. The paper presents the preliminary results of the trial. Sixty-four patients were enrolled and randomized to either BD (N = 32) or HF (N = 32). Mean age and dialysis vintage were comparable. Twenty patients died during the study, 12 in BD and 8 in HF. The relative risk of death was 11% higher in patients treated with BD compared to those in the HF group (p < 0.005). The number of hospitalisation events per single patient was lower, even though not significantly, in HF compared to BD (1.94 + 1.26 in HF vs 2.48 + 1.98 in BD, p = NS). As concerns biochemistry, apart from beta-2-microglobulin, any other substantial difference was not found during the study, though the small solute concentration was generally a little more elevated in HF than in BD. Dialysis hypotension showed a trend to decrease in both the dialysis modalities up to near half of the trial, then, during the last year, it remained quite stable in HF, while, on the contrary, it increased in the BD group. By the end of the protocol, patients in HF showed a 2.5% incidence of acute dialysis hypotension, while patients in BD had 23%.

[Clinical role of interleukin-2 in the surgical treatment of liver metastasis due to colon adenocarcinoma]

The surgical treatment of liver metastasis due to colorectal cancer can substantially modify the natural history of the disease, mainly when it is associated with effective medical treatment. Chemotherapy, via systemic or locoregional (intrahepatic) administration, has 2 possible objectives: as adjuvant treatment, to prevent or delay disease recurrence; as neo-adjuvant treatment, mainly interesting for the surgeon, to allow resective surgery in responding patients previously considered not-operable. Unfortunately, the severe immune deficiency associated with the advanced cancer negative impact on long-term outcome after any treatment (surgery, chemotherapy) is a limit for the clinical application of multidisciplinary treatments. Aim of this study is to review the possible different approaches to improve the clinical results, either as tumour response or overall survival, using an association of IL-2 with different chemotherapy procedures, in order to recover the locoregional and/or systemic immunodeficency. Several literature studies are worth of consideration not only for the biological activity reported, but also for the preliminary clinical results. At our Department, we have started a clinical experience in order to verify and confirm the results reported in these studies. The preliminary results seem to confirm an increase of chemotherapy activity obtained with an association of IL-2 immunotherapy with systemic therapy procedures and mainly with locoregional therapeutic programs.

Immunomodulation with granulocyte–macrophage colony-stimulating factor and interleukin 2 in an experimental model of sepsis

Background

Previous studies have demonstrated that immunomodulation with granulocyte–macrophage colony-stimulating factor (GM-CSF) reduces the mortality rate in an experimental model of sepsis, decreases levels of tumour necrosis factor in the serum and in the liver, and enhances neutrophil activity. It was also demonstrated recently that immunoprophylaxis with interleukin (IL) 2 can reduce the mortality rate in rats that have undergone caecal ligature and puncture (CLP). In fact, IL-2 is the major activator of the specific immune response (B and T lymphocytes). The aim of this study was to investigate whether IL-2 and GM-CSF together might further decrease the mortality rate in an experimental model of peritonitis in rats, which resembles the clinical situation of bowel perforation and mixed bacterial peritonitis.

Methods

Peritonitis was induced by CLP in four groups of Sprague–Dawley male rats (250 g). Each group included 30 rats. Group 1 underwent CLP and postoperative antibiotic therapy with tobramycin and clindamycin (12·5 μg g−1 day−1 and 4 mg g−1 day−1 respectively for 72 h after operation). Group 2 underwent preoperative intraperitoneal IL-2 injection (1.000.000 units), then CLP and postoperative antibiotic therapy with the same regimen. Group 3 underwent CLP and intraperitoneal GM-CSF injection (l ng g−1 day−1 for 48 h after operation). Group 4 received IL-2, CLP and GM-CSF with the same regimen and antibiotic therapy. Deaths were recorded within 72 h after CLP.

Results

After CLP group 1 (antibiotics) had a mortality rate of 70 per cent; group 4 (IL-2, GM-CSF, antibiotics) had a mortality rate of only 3 per cent which was significantly lower than in that in group 2 (IL-2 and antibiotics) and group 3 (GM-CSF and antibiotics), 33 and 25 per cent respectively (P &lt; 0·0001).

Conclusion

Only one of 30 rats that had CLP and were treated with IL-2, GM-CSF and antibiotics died. Immunomodulation offers a new option in the treatment of sepsis related to peritonitis; in this experimental model treatment with IL-2 and GM-CSF enhanced host resistance to sepsis and decreased the mortality rate.

Endotoxemia, encephalopathy, and mortality in cirrhotic patients

Endotoxemia without sepsis was detected with a chromogenic Limulus assay in 36 of 39 (92.3%) cirrhotic patients and was absent in seven healthy volunteers. In 11 patients who underwent elective portasystemic shunt, portal vein endotoxemia was higher than inferior vena caval: p less than 0.05, systemic endotoxin levels did not change, compared to preoperative levels, on the 1st, 2nd, and 3rd postoperative days, attendant to an uneventful recovery. In 21 patients in hepatic encephalopathy after esophagogastric hemorrhage, systemic endotoxemia was higher than in well-compensated cirrhotics: p less than 0.001; it was higher in deep than in light coma: p less than 0.05; it was higher in those who died than in those who survived: p less than 0.001. Endotoxin levels showed a positive correlation with serum bilirubin: r = 0.59, p less than 0.001, and a negative correlation with prothrombin activity: r = -0.59, p less than 0.001. These data show endotoxemia without sepsis is a constant finding in cirrhosis and increasing levels of endotoxemia are associated with hepatic failure, encephalopathy, and death.