Does tenosynovitis of the hand detected by B-mode ultrasound predict loss of clinical remission in rheumatoid arthritis? Results from a real-life cohort.

Objective The role of US-detected tenosynovitis (USTS) in the management of rheumatoid arthritis remains controversial. The aim of this study was to investigate whether tenosynovitis can predict a flare in rheumatoid arthritis patients in remission in a real-life cohort. Methods Rheumatoid arthritis patients from the Swiss Clinical Quality Management cohort were included in this study if they were in clinical remission, defined by 28-joint disease activity score (DAS28-ESR) <2.6, and had an available B-mode tenosynovitis score. The patients were stratified according to the presence or absence of tenosynovitis (USTS+ vs. USTS-). Cox proportional hazard models were used for time-to-event analysis until the loss of remission, after adjustment for multiple confounders. The impact of baseline US performed early in remission and the advent of flares at different fixed time periods after baseline were investigated in sensitivity analysis. Results Tenosynovitis was detected in 10% of 402 rheumatoid arthritis patients in remission. At baseline, USTS+ patients in remission had significantly higher DAS28-ESR (mean (SD): USTS- 1.8 (0.5) versus USTS+ 2.0 (0.5); p = 0.0019) and higher additional disease activity parameters, such as physician global assessment, and simplified- and clinical-disease activity index. Joint synovitis detected by B-mode US was associated with tenosynovitis (mean (SD) 7.2 (6.3) in USTS- versus 9.0 (5.4) in USTS+, respectively; p = 0.02). A disease flare was observed in 69% of remission phases, with no differences in the time to loss of remission between USTS+ and USTS- groups. Conclusion While US-detected tenosynovitis was associated with higher disease activity parameters in rheumatoid arthritis patients in clinical remission, it was not able to predict a flare

Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease

The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63 +/- 11 years, 77 (35%) female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions. Patients were followed-up for the occurrence of the following clinical endpoints: death, nonfatal myocardial infarction, unstable angina, and coronary revascularization. During a mean follow-up of 14 +/- 4 months, 59 patients (27%) reached at least one of the predefined clinical endpoints. Patients with abnormal coronary arteries on CTA (i.e., presence of coronary plaques) had a 1st-year event rate of 34%, whereas in patients with normal coronary arteries no events occurred (event rate, 0%, p or =50% luminal narrowing) on CTA were associated with a high first-year event rate (59%) compared to patients without stenoses (3%, p < 0.001). The presence of obstructive lesions was a significant independent predictor of an adverse cardiac outcome. Sixty-four-slice CTA predicts cardiac events in patients with known or suspected CAD. Conversely, patients with normal coronary arteries on CTA have an excellent mid-term prognosis

Sulphur and zinc abundances in galactic halo stars revisited

Aims. Based on a new set of sulphur abundances in very metal-poor stars and an improved analysis of previous data, we aim at resolving current discrepancies on the trend of S/Fe vs. Fe/H and thereby gain better insight into the nucleosynthesis of sulphur. The trends of Zn/Fe and S/Zn will also be studied. Methods. High resolution VLT/UVES spectra of 40 main-sequence stars with -3.3 < [Fe/H] < -1.0 are used to derive S abundances from the weak λ8694.6 S I line and the stronger λλ9212.9, 9237.5 pair of S I lines. For one star, the S abundance is also derived from the S I triplet at 1.046μm recently observed with the VLT infrared echelle spectrograph CRIRES. Fe and Zn abundances are derived from lines in the blue part of the UVES spectra, and effective temperatures are obtained from the profile of the Hβ line. Results. Comparison of sulphur abundances from the weak and strong S I lines provides important constraints on non-LTE effects. The high sulphur abundances reported by others for some metal-poor stars are not confirmed; instead, when taking non-LTE corrections into account, the Galactic halo stars distribute around a plateau at [S/Fe] ∼ +0.2 dex with a scatter of 0.07 dex only. [Zn/Fe] is close to zero for metallicities in the range -2.0 < [Fe/H] < -1.0 but increases to a level of [Zn/Fe] ∼ +0.1 to +0.2 dex in the range -2.7 < [Fe/H] < -2.0. At still lower metallicities [Zn/Fe] rises steeply to a value of [Zn/Fe] ∼ +0.5 dex at [Fe/H] = -3.2. Conclusions. The trend of S/Fe vs. Fe/H corresponds to the trends of Mg/Fe, Si/Fe, and Ca/Fe and indicates that sulphur in Galactic halo stars has been made by α-capture processes in massive SNe. The observed scatter in S/Fe is much smaller than predicted from current stochastic models of the chemical evolution of the early Galaxy, suggesting that either the models or the calculated yields of massive SNe should be revised. We also examine the behaviour of S/Zn and find that departures from the solar ratio are significantly reduced at all metallicities if non-LTE corrections to the abundances of these two elements are adopted. This effect, if confirmed, would reduce the usefulness of the S/Zn ratio as a diagnostic of past star-formation activity, but would bring closer together the values measured in damped Lyman-alpha systems and in Galactic stars

Earliest evidence for social endogamy in the 9,000-year-old-population of Basta, Jordan.

The transition from mobile to sedentary life was one of the greatest social challenges of the human past. Yet little is known about the impact of this fundamental change on social interactions amongst early Neolithic communities, which are best recorded in the Near East. The importance of social processes associated with these economic and ecological changes has long been underestimated. However, ethnographic observations demonstrate that generalized reciprocity - such as open access to resources and land - had to be reduced to a circumscribed group before regular farming and herding could be successfully established. Our aim was thus to investigate the role of familial relationships as one possible factor within this process of segregation as recorded directly in the skeletal remains, rather than based on hypothetical correlations such as house types and social units. Here we present the revealing results of the systematically recorded epigenetic characteristics of teeth and skulls of the late Pre-Pottery Neolithic community of Basta in Southern Jordan (Figure S1). Additionally, mobility was reconstructed via a systematic strontium (Sr) isotope analysis of tooth enamel of the Basta individuals. The frequency of congenitally missing maxillary lateral incisors in the 9,000-year-old community of Basta is exceptionally high (35.7%). Genetic studies and a worldwide comparison of the general rate of this dental anomaly in modern and historic populations show that the enhanced frequency can only be explained by close familial relationships akin to endogamy. This is supported by strontium isotope analyses of teeth, indicating a local origin of almost all investigated individuals. Yet, the accompanying archaeological finds document far-reaching economic exchange with neighboring groups and a population density hitherto unparalleled. We thus conclude that endogamy in the early Neolithic village of Basta was not due to geographic isolation or a lack of exogamous mating partners but a socio-cultural choice