Diagnostic and prognostic values of antikeratin antibodies (AKA) and collagen III propeptides (PIIINP) in juvenile rheumatoid arthritis

Background: The need for specific and sensitive diagnostic as well as prognostic markers for juvenile rheumatoid arthritis (JRA) has urged  scientific research toward this field.Objective: We sought to assess the diagnostic and prognostic values of serum and synovial fluid collagen III propeptides (PIIINP) and antikeratin antibodies(AKA) in JRA.Methods :Thirty-one JRA patients with a mean age of 10.6±4.2 years were enrolled in the study. They were compared to 10 SLE patients with arthritis and 15 age and sex matched healthy children as control groups. All  patients were subjected at enrollment to laboratory evaluation by CBC,  ESR, CRP, serum PIIINP and AKA. Patients with knee effusion were  subjected to AKA and PIIINP analysis in their synovial fluid samples. Clinical evaluation was done by examination of joint swelling, tenderness and limitation of movement scores. Also, radiological evaluation by plain X-ray films for hands, knees and feet using modified Larsen score (MLS) was performed. Laboratory, clinical and radiological evaluation methods were re-performed after 3 months of proper treatment. A third radiological evaluation was done one year after the first evaluation.Results: Serum PIIINP was significantly elevated in JRA patients  (12.8±8.7) ìg/L in comparison to healthy controls (7.0±1.9 ìg/L, p<0.05). However, no significant difference was observed when compared to SLE patients. Reduction of serum PIIINP was observed after 3 months of treatment with no significant difference between JRA patients (10.5±8.8 ìg/L) and the healthy controls. Synovial fluid PIIINP (56.4±6.6 ìg/L) was significantly higher than that of the serum (p<0.05). Neither serum nor synovial fluid PIIINP correlated with any of the laboratory, clinical or radiological parameters. The serum AKA positivity rate was significantly higher in JRA patients (77% at the study onset and 90% after three months) as compared to the control group (7%, p<0.001). Serum AKA values recorded a sensitivity, specificity and diagnostic efficiency in JRA patients of 77%, 93% and 83% at the study onset. These values increased after 3 months to 90%, 93% and 91% respectively. Synovial AKA levels displayed no significant difference in comparison to that of the serum.Conclusion :AKA is a specific and sensitive diagnostic marker for JRA. Meanwhile, PIIINP was significantly elevated during JRA disease activity particularly in the synovial fluid. Neither AKA nor PIIINP proved to have prognostic values in JRA.Key words: juvenile rheumatoid, arthritis, antikeratin antibodies, collagen III propeptides, SLE

Effect of pretreatment on the proximate composition, physicochemical characteristics and stability of <em>Moringa peregrina</em> oil

The present research work was intended to study the influence of roasting and germination of the kernel seeds of Sudanese Moringa peregrina on the physicochemical characteristics and the oxidative stability of the extracted oil. Roasting was carried out at 180 ˚C for 25 minutes, whereas germination was done at ambient conditions in a wet jute bag for 5–7 days. The oil was extracted using n-hexane in a Soxhlet extraction apparatus. The results show that the oil contains α-tocopherols (152mg/kg) and oleic acid (above 70%) as the major tocols and fatty acids, respectively. Germination reduced the peroxide value and increased the acid value in a significant way (p < 0.05) whereas the opposite trend was noticed in the case of roasting. It is crucial to note that, with the exception of the acid value of the germinated sample, peroxide and acid values remained below one meq O2/Kg of oil and one mg KOH/g of oil, respectively. The oxidative stability of the oil from the roasted sample was increased almost by 80% compared to the raw one. Roasting of the kernels prior to oil extraction is imperative for improving its oxidation resistance and the physicochemical characteristics

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

TNF\u3b1-induced endothelial activation is counteracted by polyphenol extract from UV-stressed cyanobacterium Arthrospira platensis

The cyanobacterium Arthrospira platensis (A. platensis) has been considered as a potential source of several therapeutic compounds including antioxidant molecules such as phenolics. Several studies have demonstrated that the exposure to a particular stress factor, such as UV-light, is able to modify the quality and the quantity of polyphenols produced by A. platensis. In this study we compare the effect of polyphenol extracts from A. platensis (PEAP) and from UV-stressed A. platensis (PEAPUV) on endothelial cells exposed to TNF\uf061 by evaluating the expression of endothelial Nitric Oxide Synthase (eNOS), of inducible Nitric Oxide Synthase (iNOS), of Vascular Cell Adhesion Molecule 1 (VCAM-1) and of Matrix Metalloproteinase-9 (MMP-9), key markers of endothelial dysfunction. MMP-9 activity was measured by gel zymography. Western Blot analysis was performed to analyze eNOS, iNOS and VCAM-1 expression and signal transduction. The major evidence of this study is that PEAPUV is more efficient than PEAP in counteracting the TNF\u3b1-induced endothelial activation. Treatment with PEAPUV (0.10 mg GAE/ml) restored to basal levels the TNF\u3b1-induced expression of eNOS, iNOS, VCAM-1 and MMP-9 and the TNF\u3b1- triggered activation of Akt. The use of an Akt inhibitor mimicked the inhibitory effects of PEAPUV on eNOS and MMP-9 expression, suggesting that eNOS and MMP-9 induction by TNF\u3b1 depends on Akt activation and that PEAPUV exerts its vaso-protective effect through Akt signalling inhibition. HPLC analysis confirmed a different composition both in polyphenols quality and in quantity of the two extracts. In conclusion, this study shows that a stress factor such as UV light exposure leads to the production by A. platensis of molecules to potentially be used against the onset and progression of vascular diseases associated with endothelial dysfunction