Angiogenic gene expression and vascular density are reflected in ultrasonographic features of synovitis in early Rheumatoid Arthritis: an observational study.

INTRODUCTION: Neovascularization contributes to the development of sustained synovial inflammation in the early stages of Rheumatoid Arthritis. Ultrasound (US) provides an indirect method of assessing synovial blood flow and has been shown to correlate with clinical disease activity in patients with Rheumatoid Arthritis. This study examines the relationship of US determined synovitis with synovial vascularity, angiogenic/lymphangiogenic factors and cellular mediators of inflammation in a cohort of patients with early Rheumatoid Arthritis (RA) patients prior to therapeutic intervention with disease modifying therapy or corticosteroids. METHODS: An ultrasound guided synovial biopsy of the supra-patella pouch was performed in 12 patients with early RA prior to treatment. Clinical, US and biochemical assessments were undertaken prior to the procedure. Ultrasound images and histological samples were obtained from the supra-patella pouch. Histological samples were stained for Factor VIII and a-SMA (a-smooth muscle actin). Using digital imaging analysis a vascular area score was recorded. QT-PCR (quantitative-PCR) of samples provided quantification of angiogenic and lymphangiogenic gene expression and immunohistochemistry stained tissue was scored for macrophage, T cell and B cell infiltration using an existing semi-quantitative score. RESULTS: Power Doppler showed a good correlation with histological vascular area (Spearman r--0.73) and angiogenic factors such as vascular endothelial growth factor-A (VEGF-A), Angiopoietin 2 and Tie-2. In addition, lymphangiogenic factors such as VEGF-C and VEGF-R3 correlated well with US assessment of synovitis. A significant correlation was also found between power Doppler and synovial thickness, pro-inflammatory cytokines and sub-lining macrophage infiltrate. Within the supra-patella pouch there was no significant difference in US findings, gene expression or inflammatory cell infiltrate between any regions of synovium biopsied. CONCLUSION: Ultrasound assessment of synovial tissue faithfully reflects synovial vascularity. Both grey scale and power Doppler synovitis in early RA patients correlate with a pro-angiogenic and lymphangiogenic gene expression profile. In early RA both grey scale and power Doppler synovitis are associated with a pro-inflammatory cellular and cytokine profile providing considerable validity in its use as an objective assessment of synovial inflammation in clinical practice

Unguis incarnatus – konservative oder operative Therapie?

Unguis incarnatus, an ingrown toenail, is a common condition in primary care, which is encountered by various medical professions. Inconsistent conservative treatment and nonindicated surgical treatment often result in complications and recurrence of the disease. Patients must be thoroughly informed about the complexity of the nail organ. This is a prerequisite to prevent trivialization of the disease and to achieve appropriate patient compliance for treatment. In this article a practical diagnostic and treatment algorithm for unguis incarnatus is presented. In mild cases of acute unguis incarnatus a consistent conservative treatment is the first-line strategy showing promising results. In cases of moderate to severe forms of acute unguis incarnatus, surgical procedures that preserve the nail matrix should be applied. For cases of chronic unguis incarnatus without an acute infection, elective partial matrixectomy can be indicated. Prior to any surgical intervention, detailed informed consent must be obtained from the patients. ZUSAMMENFASSUNG Der Unguis incarnatus ist ein häufiges Krankheitsbild, mit dem sich Patienten in der Hausarztpraxis, der dermatologischen Klinik oder der chirurgischen Notaufnahme vorstellen. Häufig führt die inkonsequente konservative Therapie oder die falsch-indizierte operative Intervention zu langwierigen und komplikationsreichen Verläufen, inklusive Rezidiven. Die Patienten sollten über die Komplexität des Nagelorgans aufgeklärt werden, um der Banalisierung der Erkrankung vorzubeugen, und eine entsprechende Compliance in der Therapie zu erreichen. In diesem Manuskript wird die sachgerechte Versorgung des Unguis incarnatus im Sinne eines praktischen Behandlungsalgorithmus dargestellt. Die konsequente konservative Therapie ist bei akutem Unguis incarnatus mit milder Ausprägung die Therapie der ersten Wahl mit guten Behandlungsergebnissen. Nagelerhaltende operative Eingriffe kommen bei moderaten/schweren akuten Formen zum Einsatz. Der chronische Unguis incarnatus, ohne floride Infektion, stellt eine elektive Operationsindikation dar. Sowohl bei den nagelerhaltenden Eingriffen als auch bei erweiterten operativen Maßnahmen ist eine chirurgische Operationsaufklärung obligat

Facilitation of information literacy through a multilingual MOOC considering cultural aspects

Purpose The purpose of this paper is to demonstrate the rationale, technical framework, content creation workflow and evaluation for a multilingual massive open online course (MOOC) to facilitate information literacy (IL) considering cultural aspects. Design/methodology/approach A good practice analysis built the basis for the technical and content framework. The evaluation approach consisted of three phases: first, the students were asked to fill out a short self-assessment questionnaire and a shortened adapted version of a standardized IL test. Second, they completed the full version of the IL MOOC. Third, they were asked to fill out the full version of a standardized IL test and a user experience questionnaire. Findings The results show that first the designed workflow was suitable in practice and led to the implementation of a full-grown MOOC. Second, the implementation itself provides implications for future projects developing multilingual educational resources. Third, the evaluation results show that participants achieved significantly higher results in a standardized IL test after attending the MOOC as mandatory coursework. Variations between the different student groups in the participating countries were observed. Fourth, self-motivation to complete the MOOC showed to be a challenge for students asked to attend the MOOC as nonmandatory out-of-classroom task. It seems that multilingual facilitation alone is not sufficient to increase active MOOC participation. Originality/value This paper presents an innovative approach of developing multilingual IL teaching resources and is one of the first works to evaluate the impact of an IL MOOC on learners' experience and learning outcomes in an international evaluation study

School nurses' experiences of delivering the UK HPV vaccination programme in its first year

Background: In the United Kingdom (UK) in September 2008, school nurses began delivering the HPV immunisation programme for girls aged 12 and 13 years old. This study offers insights from school nurses' perspectives and experiences of delivering this new vaccination programme. Methods: Thirty in-depth telephone interviews were conducted with school nurses working across the UK between September 2008 and May 2009. This time period covers the first year of the HPV vaccination programme in schools. School nurses were recruited via GP practices, the internet and posters targeted at school nurse practitioners. Results: All the school nurses spoke of readying themselves for a deluge of phone calls from concerned parents, but found that in fact few parents telephoned to ask for more information or express their concerns about the HPV vaccine. Several school nurses mentioned a lack of planning by policy makers and stated that at its introduction they felt ill prepared. The impact on school nurses' workload was spoken about at length by all the school nurses. They believed that the programme had vastly increased their workload leading them to cut back on their core activities and the time they could dedicate to offering support to vulnerable pupils. Conclusion: Overall the first year of the implementation of the HPV vaccination programme in the UK has exceeded school nurses' expectations and some of its success may be attributed to the school nurses' commitment to the programme. It is also the case that other factors, including positive newsprint media reporting that accompanied the introduction of the HPV vaccination programme may have played a role. Nevertheless, school nurses also believed that the programme had vastly increased their workload leading them to cut back on their core activities and as such they could no longer dedicate time to offer support to vulnerable pupils. This unintentional aspect of the programme may be worthy of further exploratio

Multiple shades of grey: Opening the black box of public sector executives' hybrid role identities

Public sector reforms of recent decades in Europe have promoted managerialism and aimed at introducing private sector thinking and practices. However, with regard to public sector executives' self-understanding, managerial role identities have not replaced bureaucratic ones; rather, components from both paradigms have combined. In this article, we introduce a bi-dimensional approach (attitudes and practices) that allows for different combinations and forms of hybridity. Empirically, we explore the role identities of public sector executives across Europe, building on survey data from over 7,000 top public officials in 19 countries (COCOPS survey). We identify country-level profiles, as well as patterns across countries, and find that administrative traditions can account for these profiles and patterns only to a limited extent. Rather, they have to be complemented by factors such as stability of the institutional environment (indicating lower shares of hybrid combinations) or extent of reform pressures (indicating higher shares of hybrid combinations)

Fighting Conflict: Violent Splits or Healthy Divides?

In this study, we develop a theory to understand how groups with strong divisions may, paradoxically, help members to cope with conflict and injustice. We test our theoretical predictions using a survey methodology and the data from 72 work groups across different industries. Consistent with our hypotheses, we found that group faultlines weakened the positive relationships between injustice and psychological health

Monocyte Scintigraphy in Rheumatoid Arthritis: The Dynamics of Monocyte Migration in Immune-Mediated Inflammatory Disease

Background: Macrophages are principal drivers of synovial inflammation in rheumatoid arthritis (RA), a prototype immune-mediated inflammatory disease. Conceivably, synovial macrophages are continuously replaced by circulating monocytes in RA. Animal studies from the 1960s suggested that macrophage replacement by monocytes is a slow process in chronic inflammatory lesions. Translation of these data into the human condition has been hampered by the lack of available techniques to analyze monocyte migration in man. Methods/Principal Findings: We developed a technique that enabled us to analyze the migration of labelled autologous monocytes in RA patients using single photon emission computer tomography (SPECT). We isolated CD14+ monocytes by CliniMACS in 8 patients and labeled these with technetium-99m (99m-Tc-HMPAO). Monocytes were re-infused into the same patient. Using SPECT we calculated that a very small but specific fraction of 3.4x10(-3) (0.95-5.1x10(-3)) % of re-infused monocytes migrated to the inflamed joints, being detectable within one hour after re-infusion. Conclusions/Significance: The results indicate monocytes migrate continuously into the inflamed synovial tissue of RA patients, but at a slow macrophage-replacement rate. This suggests that the rapid decrease in synovial macrophages that occurs after antirheumatic treatment might rather be explained by an alteration in macrophage retention than in monocyte influx and that RA might be particularly sensitive to treatments targeting inflammatory cell retention