2,887 research outputs found

    Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

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    <p>Abstract</p> <p>Introduction</p> <p>Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports.</p> <p>Case presentation</p> <p>We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery.</p> <p>Conclusion</p> <p>Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.</p

    Surface-plasmon-polariton wave propagation supported by anisotropic materials: multiple modes and mixed exponential and linear localization characteristics

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    The canonical boundary-value problem for surface-plasmon-polariton (SPP) waves guided by the planar interface of a dielectric material and a plasmonic material was solved for cases wherein either partnering material could be a uniaxial material with optic axis lying in the interface plane.Numerical studies revealed that two different SPP waves, with different phase speeds, propagation lengths, and penetration depths, can propagate in a given direction in the interface plane; in contrast, the planar interface of isotropic partnering materials supports only one SPP wave for each propagation direction. Also, for a unique propagation direction in each quadrant of the interface plane, it was demonstrated that a new type of SPP wave--called a surface-plasmon-polariton-Voigt (SPP-V) wave--can exist. The fields of these SPP-V waves decay as the product of a linear and an exponential function of the distance from the interface in the anisotropic partnering material; in contrast, the fields of conventional SPP waves decay only exponentially with distance from the interface. Explicit analytic solutions of the dispersion relation for SPP-V waves exist and help establish constraints on the constitutive-parameter regimes for the partnering materials that support SPP-V-wave propagation

    Ionization fronts and shocked flows - The structure of the Orion Nebula at 0".1

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    We present HST Wide-Field Camera images of a field in the Orion Nebula obtained in emission from [S II], Hβ, and [O II]. The morphology of the [S II] emission is markedly different from the other lines. While Hβ and [O II] are distributed fairly smoothly, [S II] is dominated by filamentary features with widths between 0".1 and 1" which sharply highlight ionization fronts moving into dense neutral material. These photoionization fronts act as probes of the structure of the cavity walls of this blister H II region. Their morphology indicates that while the surfaces into which they are moving are textured, subarcsecond clumps with high density contrast are uncommon. An exception is a bow shock-shaped ionization front seen along the face of a solar system-sized (0".6 = 270 AU) clump which is itself seen in extinction. The field contains a number of HH objects and related structures, many of which were previously recognized as such, but whose complex structure is revealed here by the resolution of HST. These include M42 HH 1, which is seen to be an intricate structure of knots and filaments with a head-tail morphology. M42 HH 2 shows structure from both the shocked cavity walls and the shocked atomic outflow. M42 HH 5-7 break into numerous condensations with an appearance reminiscent of HH 7-11. All objects with a bow shockshaped structure (i.e., M42 HH 1, 5, 7, and 10) show enhanced Hβ emission at the apex of the structure where the shock should be strongest. M42 HH 8 and 9 may be HH objects viewed face-on, or alternatively condensations photoionized by a nearby A or B star. Emission from [S II] traces shocks at the walls of an ionized jet apparently emanating from a star in a dark cloud. This cloud seen in extinction is coincident with H_2 Peak 1, which we propose is on the near side of the nebula

    Use of risk stratification to target therapies in patients with recent onset arthritis; design of a prospective randomized multicenter controlled trial

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    Background. Early and intensive treatment is important to inducing remission and preventing joint damage in patients with rheumatoid arthritis. While intensive combination therapy (Disease Modifying Anti-rheumatic Drugs and/or biologicals) is the most effective, rheumatologists in daily clinical practice prefer to start with monotherapy methotrexate and bridging corticosteroids. Intensive treatment should be started as soon as the first symptoms manifest, but at this early stage, ACR criteria may not be fulfilled, and there is a danger of over-treatment. We will therefore determine which induction therapy is most effective in the very early stage of persistent arthritis. To overcome over-treatment and under-treatment, the intensity of induction therapy will be based on a prediction model that predicts patients' propensity for persistent arthritis. Methods. A multicenter stratified randomized single-blind controlled trial is currently being performed in patients 18 years or older with recent-onset arthritis. Eight hundred ten patients are being stratified according to the likelihood of their developing persistent arthritis. In patients with a high probability of persistent arthritis, we will study combination Disease Modifying Antirheumatic Drug therapy compared to monotherapy methotrexate. In patients with an intermediate probability of persistent arthritis, we will study Disease Modifying Antirheumatic Drug of various intensities. In patients with a low probability, we will study non-steroidal anti-inflammatory drugs, hydroxychloroquine and a single dose of corticosteroids. If disease activity is not sufficiently reduced, treatment will be adjusted according to a step-up protocol. If remission is achieved for at least six months, medication will be tapered off. Patients will be followed up every three months over two years. Discussion. This is the first rheumatological study to base treatment in early arthritis on a prediction rule. Treatment will be stratified according to the probability of persistent arthritis, and different combinations of treatment per stratum will be evaluated. Treatment will be started early, and patients will not need to meet the ACR-criteria for rheumatoid arthritis. Trial registration. This trial has been registered in Current Controlled Trials with the ISRCTN26791028

    XIPE: the X-ray Imaging Polarimetry Explorer

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    X-ray polarimetry, sometimes alone, and sometimes coupled to spectral and temporal variability measurements and to imaging, allows a wealth of physical phenomena in astrophysics to be studied. X-ray polarimetry investigates the acceleration process, for example, including those typical of magnetic reconnection in solar flares, but also emission in the strong magnetic fields of neutron stars and white dwarfs. It detects scattering in asymmetric structures such as accretion disks and columns, and in the so-called molecular torus and ionization cones. In addition, it allows fundamental physics in regimes of gravity and of magnetic field intensity not accessible to experiments on the Earth to be probed. Finally, models that describe fundamental interactions (e.g. quantum gravity and the extension of the Standard Model) can be tested. We describe in this paper the X-ray Imaging Polarimetry Explorer (XIPE), proposed in June 2012 to the first ESA call for a small mission with a launch in 2017 but not selected. XIPE is composed of two out of the three existing JET-X telescopes with two Gas Pixel Detectors (GPD) filled with a He-DME mixture at their focus and two additional GPDs filled with pressurized Ar-DME facing the sun. The Minimum Detectable Polarization is 14 % at 1 mCrab in 10E5 s (2-10 keV) and 0.6 % for an X10 class flare. The Half Energy Width, measured at PANTER X-ray test facility (MPE, Germany) with JET-X optics is 24 arcsec. XIPE takes advantage of a low-earth equatorial orbit with Malindi as down-link station and of a Mission Operation Center (MOC) at INPE (Brazil).Comment: 49 pages, 14 figures, 6 tables. Paper published in Experimental Astronomy http://link.springer.com/journal/1068

    Autoantibody Epitope Spreading in the Pre-Clinical Phase Predicts Progression to Rheumatoid Arthritis

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    Rheumatoid arthritis (RA) is a prototypical autoimmune arthritis affecting nearly 1% of the world population and is a significant cause of worldwide disability. Though prior studies have demonstrated the appearance of RA-related autoantibodies years before the onset of clinical RA, the pattern of immunologic events preceding the development of RA remains unclear. To characterize the evolution of the autoantibody response in the preclinical phase of RA, we used a novel multiplex autoantigen array to evaluate development of the anti-citrullinated protein antibodies (ACPA) and to determine if epitope spread correlates with rise in serum cytokines and imminent onset of clinical RA. To do so, we utilized a cohort of 81 patients with clinical RA for whom stored serum was available from 1–12 years prior to disease onset. We evaluated the accumulation of ACPA subtypes over time and correlated this accumulation with elevations in serum cytokines. We then used logistic regression to identify a profile of biomarkers which predicts the imminent onset of clinical RA (defined as within 2 years of testing). We observed a time-dependent expansion of ACPA specificity with the number of ACPA subtypes. At the earliest timepoints, we found autoantibodies targeting several innate immune ligands including citrullinated histones, fibrinogen, and biglycan, thus providing insights into the earliest autoantigen targets and potential mechanisms underlying the onset and development of autoimmunity in RA. Additionally, expansion of the ACPA response strongly predicted elevations in many inflammatory cytokines including TNF-α, IL-6, IL-12p70, and IFN-γ. Thus, we observe that the preclinical phase of RA is characterized by an accumulation of multiple autoantibody specificities reflecting the process of epitope spread. Epitope expansion is closely correlated with the appearance of preclinical inflammation, and we identify a biomarker profile including autoantibodies and cytokines which predicts the imminent onset of clinical arthritis
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