Muscle shear wave elastography in idiopathic inflammatory myopathies: a case–control study with MRI correlation

Objective: To investigate muscle stiffness in patients with idiopathic inflammatory myopathies (IIM) using shear wave elastography (SWE) and to correlate the results with muscle strength and MRI features of myositis. Materials and methods: Muscle shear wave velocity (SWV) was measured in 23 active IIM patients (13 females, mean age 50.4 ± 16.1 years) and 23 matched healthy controls (13 females, mean age 50.7 ± 16.2 years). The investigated muscles included the vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM) vastus intermedius (VI), biceps femoris (BF), semitendinosus (ST), semimembranosus (SM) and the biceps brachii (BB) scanned during relaxed resting and passive stretching positions. Participants performed multiple tests to evaluate their muscle strength. IIM patients had a thigh MRI to assess degrees of oedema, fatty infiltration and atrophy. Results: In the resting position, IIM patients had a 12.9-22.2% significantly lower SWV (p < 0.05) for the quadriceps and hamstrings, but not BB. There was no difference during passive stretching. The SWV for VL, VI and BF showed moderate correlations with the muscle strength tests ranging from r = 0.47 to r = 0.70 (all p < 0.05). Lower SWV was associated with greater MRI scores of oedema (p = 0.001) and atrophy (p = 0.006). However, SWV did not correlate with fatty infiltration (r < 0.3; p = 0.28), creatine kinase (r = 0.28; p = 0.19) or disease duration (r = 0.26; p = 0.24). Conclusion: Shear wave elastography may detect abnormal reduced thigh stiffness in IIM patients. SWE measurements were significantly associated with muscle weakness and MRI signs of oedema and atrophy. Future research should investigate this new technology for monitoring disease activity

Dermatological Emergencies in Family Medicine: Recognition, Management, and Referral Considerations

Numerous people with skin disorders who have real dermatologic crises show up at the emergency room. Family doctors need to be able to identify potentially fatal dermatological disorders quickly since they could be the first to encounter patients with these illnesses. The purpose of this review is to provide guidance for early recognition, help identify distinct symptoms, and enable early diagnosis of emerging dermatological conditions. Necrotizing fasciitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Rocky Mountain spotted fever, and other possible emergencies that might manifest as dermatological symptoms are examples of these conditions. In this article we will be discussing the dermatological emergencies present at primary care settings and encountered by family physician, recognition and management of those emergencies, referral considerations, role of family medicine in dermatological emergencies and other topics

Investigation of the possibility of improving spatial resolution in SPECT with the combination of LaBr3:Ce-based detector and 3D-OSEM reconstruction algorithms

This study investigates the potential of improving spatial resolution in SPECT imaging using a combination of LaBr(3):Ce detectors and 3D-OSEM image reconstruction algorithms. Potential spatial resolution improvement was assessed intrinsically and extrinsically using GATE Monte Carlo simulation. Significantly improved MTF of LaBr(3):Ce detectors suggests better resolution performance at all spatial frequencies. In comparison to conventional Nal(Tl) scintillators, a combination of the LaBr(3):Ce crystal and 3D-OSEM incorporating resolution recovery could significantly improve the extrinsic spatial resolution of SPECT images. (C) 2010 Elsevier B.V. All rights reserved

VITAMIN D PRODUCTION IN UK CAUCASIAN AND SOUTH ASIAN WOMEN FOLLOWING UVR EXPOSURE.

It is known that skin pigmentation reduces the penetration of ultraviolet radiation (UVR) and thus photosynthesis of 25-hydroxvitamin D (25(OH)D). However ethnic differences in 25(OH)D production remain to be elucidated.The aim of this study was to investigate differences in vitamin D production between UK South Asian and Caucasian postmenopausal women, in response to a defined and controlled exposure to UVR.Seventeen women; 9 white Caucasian (skin phototype II and III), 8 South Asian women (skin phototype IV and V) participated in the study, acting as their own controls. Three blood samples were taken for the measurement of vitamin D status during the run in period (9 days, no sunbed exposure) after which, all subjects underwent an identical UVR exposure protocol irrespective of skin colour (9 days, 3 sun bed sessions, 6, 8 and 8minutes respectively with approximately 80% body surface exposed). Skin tone was measured four times during the study.Despite consistently lower 25(OH)D levels in South Asian women, they were shown to synthesise vitamin D as efficiently as Caucasians when exposed to the same dose of UVR. Interestingly, the baseline level of vitamin D rather than ethnicity and skin tone influenced the amount of vitamin D synthesised.This study have found no ethnic differences in the synthesis of 25(OH)D, possibly due to the baseline differences in 25(OH)D concentration or due to the small population size used in this study. Applying mixed linear model, findings indicated no effect of ethnicity and skin tone on the production of vitamin D; baseline level and length of exposure were the critical factors. To confirm that ethnicity and skin tone has no effect on 25(OH)D production, a larger sample size study is required that considers other ethnic groups with highly pigmented skin. Initial vitamin D status influences the amount of UVB needed to reach equal serum concentrations

Bioethanol Production from Lignocellulosic Biomass Using <i>Aspergillus niger</i> and <i>Aspergillus flavus</i> Hydrolysis Enzymes through Immobilized <i>S. cerevisiae</i>

Lignocellulose, the main component of a plant cell wall, is a potential renewable bioenergy source. It is composed of cellulose, hemicellulose, and lignin structures. Cellulose is a linear polysaccharide that is hydrolyzed chemically or enzymatically by cellulase. The addition of lignocellulosic biomass, such as wheat bran and coffee pulp, into the fermentation culture, induces the production of cellulases. Cellulose accounts for 20% of the enzyme market worldwide, demonstrating benefits in diverse applications, especially bioethanol and biogas generation. The aim is to evaluate the optimal condition for bioethanol production by previously isolated fungal species from different soil types in the eastern region of the Kingdom of Saudi Arabia. This study attempts to evaluate and optimize the culture conditions of lignocellulosic biomass under SSF using the highest cellulases-producer strains in the region: Aspergillus niger and Aspergillus flavus (GenBank Accession No. MT328516 and MT328429, respectively) to produce raw sugar that consequently is used in the next step of bioethanol production. This process has two parts: (1) hydrolyze lignocellulosic biomass to obtain raw sugar using A. niger and A. flavus that produce cellulase, and (2) produce bioethanol through the conversion of the raw sugar produced from the cellulolysis into ethanol using Saccharomyces cerevisiae. The optimal conditions under SSF were seven days of incubation, 5% glucose as a carbon source, 1% ammonium sulfate as a nitrogen source, and 80% moisture for both isolates. Biochemical characterization showed stability for the immobilized enzyme in all temperature ranges (from 20 °C to 70 °C), while the free enzyme exhibited its maximum at 20 °C of 1.14 IU/mL. CMCase production was the highest at pH 4.0 (1.26 IU/mL) for free enzyme and at pH 5.0 (2.09 IU/mL) for the immobilized form. The CMCase activity increased steadily with an increase in water level and attained a maximum of 80% moisture content. The maximum enzyme activity was with coffee pulp as a substrate of 7.37 IU/mL and 6.38 IU/mL for A. niger and A. flavus after seven days of incubation, respectively. The Carboxymethyl Cellulase (CMCase) activity in immobilized enzymes showed good storage stability under SSF for six weeks, maintaining 90% of its initial activity, while the free enzyme retained only 59% of its original activity. As a carbon source, glucose was the best inducer of CMCase activity with coffee pulp substrate (7.41 IU/mL and 6.33 IU/mL for A. niger and A. flavus, respectively). In both fungal strains, ammonium sulfate caused maximum CMCase activities with coffee pulp as substrate (7.62 IU/mL and 6.47 IU/mL for A. niger and A. flavus, respectively). Immobilized S. cerevisiae showed an increase in ethanol production compared to free cells. In the case of immobilized S. cerevisiae cells, the concentration of ethanol was increased steadily with increasing fermentation time and attained a maximum of 71.39 mg/mL (A. niger) and 11.73 mg/mL (A. flavus) after 72 h of fermentation