High disease activity in ankylosing spondylitis is associated with increased serum sclerostin level and decreased wingless protein-3a signaling but is not linked with greater structural damage

BACKGROUND: Clinical activity of ankylosing spondylitis (AS) predicts the natural course of the disease and the response to treatment. Several molecules are involved in new bone formation resulting in structural damage in patients with AS. However, the link between the clinical and molecular phenomena has not yet been fully established. The aim of the study was to investigate the relation between markers of bone remodeling and inflammation with clinical activity and structural damage in AS. METHODS: We assessed the serum levels of sclerostin, Dickkopf-1 protein, Wingless protein-3a, bone morphogenic protein-7, matrix metalloproteinase-3, osteoprotegerin, bone alkaline phosphatase and inflammatory markers in 50 AS patients with high disease activity (BASDAI ≥ 4), 28 with low disease activity (BASDAI <4), and 23 healthy controls. Cervical and lumbar spine x-rays were performed in 46 patients to measure structural damage (mSASSS). RESULTS: Sclerostin level was significantly greater in high disease activity patients than in controls. Wingless protein-3a and Dikkopf-1 protein levels were significantly lower in high activity group compared to low activity group and controls. Negative correlation was found between sclerostin and Dikkopf-1 protein in high activity group (R = −0.28, P = 0.048). The median mSASSS values were not different between patient groups. CONCLUSIONS: Higher disease activity in AS may not be per se associated with greater new bone formation

Decreased number of regulatory T lymphocytes is related to inflammationand number of CD8+ T cells expressing programmed cell death protein-1 in common variable immunodeficiency

Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder related to recurrent infections, as well as a range of non-infectious manifestations including autoimmune and inflammatory disorders. We hypothesized that patients with CVID and different clinical phenotypes would demonstrate alterations in lymphocyte T subsets, including T lymphocytes expressing programmed cell death protein 1 (PD-1), and regulatory T lymphocytes. We performed flow cytometry in two CVID groups: group 1 with infections only, and group 2 with infections and concomitant noninfectious manifestations. Patients were 18–59 years old (mean 35.8 years of age). Increased proportions of CD8+PD-1+ T cells and reduced regulatory T cells were associated with lymphadenopathy. Amount of regulatory T cells correlated with CD8+PD-1+ T lymphocytes (r = 0.54; p = 0.013), and with CRP (r = –0.64; p = 0.004). Forty percent of patients expressed manifestations in addition to infections (group 2), and they had reduction in number of regulatory T cells [8 (3-12) vs. 24 (11-26)/μl; p = 0.034), naive CD4+ T lymphocytes [36 (27-106) vs. 149 (81-283)/μl; p = 0.034], and elevated C-reactive protein (CRP) [5.33 (3.15-8.82) vs. 1 (1-2.16) mg/l; p = 0.003] in comparison to group 1. In conclusion, the amount of CD8+ T cells expressing PD-1 is associated with lymphadenopathy and number of regulatory T cells in patients with CVID. Patients with CVID and non-infectious complications have increased level of inflammation and alterations in regulatory T cells

Yttrium-90 distribution following radiosynoviorthesis of the knee joint in rheumatoid arthritis patients : a SPECT/CT study

Objective To examine yttrium-90 distribution 1 and 72 h following its injection into a knee joint in patients with rheumatoid arthritis (RA). Methods In 14 RA patients we injected yttrium-90 into the affected knee joint using lateral approach. To assess the radioisotope distribution in the joint, the superimposed sequential SPECT and CT imaging was performed 1 and 72 h after the injection. We analyzed the percentage of radioisotope distribution in three predefined compartments of the knee joint (lower, upper medial, upper lateral). Results After 1 and 72 h, the mean percentage distributions were, respectively, 7.14 and 23.07 % in lower; 21.42 and 15.38 % in upper medial, and 71.42 and 61.53 % in upper lateral compartment. The percentage of isotope deposition did not change significantly with time in any of the compartments (all p > 0.26). The deposition of isotope, both at 1 and 72 h, was significantly greater in upper lateral compartment, where the injection was performed, than in all other compartments (all p < 0.05). Conclusions Using the SPECT/CT hybrid method, we proved that the majority of isotope is located at the compartment adjacent to the injection. Two injections targeting different compartments might improve the clinical efficacy of the procedure

Differential associations of inflammatory and endothelial biomarkers with disease activity in rheumatoid arthritis of short duration

Objectives. To estimate endothelial dysfunction in patients with rheumatoid arthritis (RA) of short duration in relation to disease activity based on the assessment of 28 joints (DAS28). Methods. We studied 29 patients (22 women, mean age 41 (SD, 9) years) with RA of short duration and 29 healthy controls. The RA subjects were divided into those with low (DAS28: 2.6–5.1, n=18) or high (DAS28>5.1, n=11) disease activity. Exclusion criteria included clinically overt atherosclerosis and other coexistent diseases. Biochemical markers of inflammatory activation and endothelial dysfunction were measured. Results. There were no significant intergroup differences in the majority of classical cardiovascular risk factors. High-sensitivity C-reactive protein, tumor necrosis factor-α, and interleukin-6 were increased in RA subjects. Compared to the controls, levels of soluble vascular cell adhesion molecule-1, von Willebrand factor, and pentraxin-3 were significantly elevated in RA subjects with low disease activity, exhibiting no further significant rises in those with high disease activity. Asymmetric dimethyl-L-arginine, soluble E-selectin, monocyte chemotactic protein-1, and osteoprotegerin were increased only in RA patients with high disease activity. Conclusions. Our findings might suggest a dissociation of pathways governing generalized and joint-specific inflammatory reactions from those involved in endothelial activation and inflammation within the vascular wall

Ocena przydatności hepatotropowego środka kontrastowego Teslascan (Mn-DPDP) w wykrywaniu zmian ogniskowych w wątrobie

Background: The purpose of our study was to evaluate the usefulness of the hepatotropic contrast agent Teslascan (Mn-DPDP) in the detection of focal hepatic lesions. Material/Methods: A prospective study was performed in 24 patients (12 men, 12 women) with 82 confirmed focal hepatic lesions, in whom the hepatotropic contrast agent Mn-DPDP (Teslascan) was administered. The examinations were performed on a 1.5T unit (Philips Gyroscan). The sensitivity of hepatic lesions detection were compared in T2W, TSE, T2W STIR, T1W GRE, and T1W GRE sequences, 15-30 minutes after intravenous administration of Mn-DPDP. Results: In T2W TSE sequences 64 focal lesions were detected (sensitivity 78%); in T2W STIR sequences, 70 lesions (sensitivity 85%); in T1W GRE sequences, 65 lesions (sensitivity 79%); in T1W GRE sequences after Mn-DPDP administration, 77 lesions (sensitivity 94%). The combined sensitivity of evaluation using all the sequences obtained before Mn-DPDP administration (T2W TSE, T2W STIR, T1W GRE) was 88%. Conclusions: MR examination with the use of MN-DPDP yielded higher sensitivity in hepatic lesion detection compared to unenhanced T2W TSE, T2W STIR and T1W GRE sequences

Differentiation of focal hepatic lesions in MR imaging with the use of combined quantitative and qualitative analysis

Background: To evaluate the efficacy of the protocol of combined quantitative-qualitative analysis for the differentiation of focal hepatic lesions. Material/Methods: The study group included 168 patients with 292 hepatic lesions confirmed by histology (n =138) or follow-up (n =154). Lesions were divided into: benign lesions treated conservatively (group A, 120 lesions), malignant tumors and benign lesions treated surgically (group B, 172 lesions). MR imaging (1.5-T) consisted of sequences: T2 double-echo TSE, T2 STIR, T1 GRE and of dynamic study. During the first part of differentiation process, quantitative analysis, based on lesions T2 relaxation times (derived from T2 double-echo TSE sequence), was performed in order to discriminate non-solid lesions (hemangiomas, cysts, abscesses; n = 88) from solid tumors (n = 204). Subsequently, all tumors defined as solid underwent qualitative evaluation based on visual assessment of lesions signal intensities in all sequences and patterns of their contrast enhancement. The aim of this part of analysis was to discriminate benign lesions (FNH and focal fatty infiltration) from other solid tumors. The remaining tumors were characterized as group B lesions. Results: Statistically significant difference between mean T2 relaxation time of solid tumors (84.1 ms) and non-solid lesions (250.5 ms) was noted, allowing diagnosis of solid tumors with sensitivity of 96% and specificity of 93% (at the threshold of 116 ms). Overall 202 lesions were defined as solid (196 true positive, 8 false negative, 6 false positive results). Qualitative analysis of these lesions was performed allowing correct characterization of all 7 focal fatty infiltrations and 21 of 24 FNH. Six lesions were falsely diagnosed as FNH. Remaining 168 lesions were defined as group B lesions. Both parts of differentiation protocol yielded sensitivity and specificity of 92%, allowing correct characterization of 158 of 172 group B lesions. Fourteen false negative and 10 false positive results (3 FNH, 1 focal inflammation, 6 hemangiomas) were obtained. Conclusions: Combined protocol of quantitative and qualitative analysis enabled discrimination of group B lesions (malignant tumors and benign lesions treated surgically) with high sensitivity and specificity of 92%

Recommendations on the use of innovative medical technologies in cardiology and cardiac surgery and solutions leading to increased availability for Polish patients

There is a great need for innovative technologies that will improve the health and quality of life (QoL) of Polish patients with cardiac problems. It is important that the safety and effectiveness of the technology are confirmed by scientific evidence on which guidelines and clinical recommendations are based. Scientific evidence for medical devices is also increasingly important for decision-making in finance approval from public funds. New technologies in cardiology and cardiac surgery contribute to improved patient QoL, increased treatment effectiveness and facilitated diagnosis. Hence, it is necessary to increase accessibility to such technologies, primarily through the development of clinical recommendations, and education of medical personnel in conjunction with public funding. The aim of this publication is to present the recommendations of leading experts in the field of cardiology and cardiosurgery, supported by clinical research results, regarding the use of the cited innovative medical technologies and solutions leading to their increased availability for Polish patients.