Interstitial Granulomatous Dermatitis: Another Clinical Variant

A 70-year-old female patient presented with an eruption consisting of symmetrically distributed erythematous papules around the umbilicus 1 month after the cessation of adalimumab for the treatment of rheumatoid arthritis. Biopsy of a papule showed an interstitial granulomatous infiltrate in the dermis, without deposition of mucin. The lesions cleared only after re-initiation of treatment 2 months later. Interstitial granulomatous dermatitis is thought to be a distinct histopathological pattern, either drug induced or associated with rheumatoid arthritis or autoimmune collagen diseases. In our case, there was a distinct clinical presentation of interstitial granulomatous dermatitis, composed of symmetrically distributed indurated papules around the umbilicus as well as a mild granulomatous reaction pattern

Right Ventricular Morphology and Function after Exercise Training in People with Systemic Sclerosis: A Randomized Controlled Pilot Study.

Background: Vascular dysfunction and its concomitant multi-organ involvement, including cardiac involvement, affects prognosis in systemic sclerosis (SSc) patients. Regular exercise has demonstrated to be able to improve vascular function in SSc. However, the effects of an exercise program on the heart and specifically in right ventricular (RV) morphology and function in SSc have yet to be explored. The study aimed to examine whether a 3-month combined exercise program can affect RV morphology and function in SSc patients. Methods: Twenty-eight SSc patients were randomly allocated to either the exercise training (ET) or the control (CON) group. Baseline and follow-up assessments consisted of a cardiopulmonary exercise test along with both a conventional and a two-dimensional speckle tracking echocardiography (2DSTE) focused on RV morphology and function. Following the baseline assessments, Group ET participated in a supervised combined exercise program for 12 weeks, while group CON received their usual care. Results: The ET group demonstrated increases in peak oxygen consumption by 25.1% (p < 0.001), global RV free wall longitudinal systolic strain by 6.69% (p < 0.03), RV free wall longitudinal systolic strain of the basal segment by 13.5% (p < 0.001), and global RV four-chamber longitudinal systolic strain by 6.76% (p < 0.03) following the exercise program. No differences were observed in group CON. Conclusions: Combined exercise improved cardiorespiratory efficiency and indices of RV systolic function, as assessed by the 2DSTE, in SSc patients

Flerspråkiga barn i förskolan : En studie om språkutveckling och inkludering

Denna studie fokuserar på hur förskollärare kan arbeta med flerspråkiga barns språkutveckling och inkludering i förskolan. För att få fram ett resultat har jag gjort fyra kvalitativa intervjuer med fyra förskollärare. Genom intervjuerna har jag besvarat mina tre frågeställningar: -Hur uppger förskollärarna att de arbetar för att främja och stimulera språkutvecklingen hos flerspråkiga barn?, -Hur anpassar förskollärarna verksamheten för flerspråkiga barn? och -Hur uppger förskollärarna att de arbetar för att inkludera de flerspråkiga barnen?. Studien grundar sig i det sociokulturella perspektivet och information som har samlats analyseras utifrån dess centrala begrepp: proximala utvecklingszonen, scaffolding, mediering och artefakter. Resultatet visar att förskollärarna som deltog i intervjuerna har en positiv inställning till arbetet med flerspråkiga barn. De belyser bland annat vikten av kommunikation, hur viktigt det är att samtala och ha dialog med barnen. De använder sig av kroppsspråk, pekande och teckenspråk för att främja flerspråkiga barns språkutveckling. Olika material används och olika anpassningar görs för att dessa barn ska bli en del av gruppen och känna sig inkluderade. Förskollärarna uttrycker att det är viktigt att personalen på förskolan accepterar olikheter och visar ett intresse för barnens olika språk

Development and application of diagnostic methods for the identification and characterization of proteins responsible for the various encephalopathies

The conversion of a normal g;ycoprotein, prion protein (PrPC) to its abnormal isoform (PrPSc) seems to be the main factors underlying the pathogenesis of spongiform encephalopathies. There are many studies indicating that PrP interacts with glycosaminoglycans (GAGs) and we exploited this interaction to develop a sensitive solid phase assay for detection of both PrP isoforms. GAGs were immobilized by theis negative charge to ELISA plate wells activated by the sequential reaction of glutaraldehyde and spermine. Recombinant PrP and tissue homogenate extracted PrP were used for this study. In addition and taking into account that glycosylation of PrP is species specific, similarly activated ELISA plate wells were used to determine different PrP glycoforms. The most interesting outcome of the second part of the study is the differential binding of RCA to the normal and scrapie brain homogenates. DSL and WGA seems to bind almost equally to both samples, and all three have an increased sensitivity to PrPSc after proteinase K digestion.Τα prions είναι ο μολυσματικός παράγοντας, πρωτεϊνικής φύσης, που προκαλεί μια κατηγορία θανατηφόρων νευροεκφυλιστικών ασθενειών μέσω ενός πρωτόγνωρου μηχανισμού. Οι πιο γνωστές ασθένειες της κατηγορίας αυτής είναι η Bovine Spongiform Encephalopathy (BSE) στα βοοειδή, η scrapie στα αιγοπρόβατα και η Creutzfeldt-Jakob disease (CJD) στους ανθρώπους. Στις ασθένειες αυτές εμπλέκεται διαμορφωτική τροποποίηση της εν λόγω πρωτεΐνης. Αντικειμενικός σκοπός της διατριβής είναι η ανάπτυξη μεθοδολογίας, τόσο για τον εμπλουτισμό των βιολογικών δειγμάτων σε prion, όσο και για τον προσδιορισμό τους γρήγορα και αξιόπιστα, σε ιστούς που είναι εύκολα προσβάσιμοι, όπως είναι οι αμυγδαλές. Για τον λόγο αυτό, αναζητήθηκαν μόρια με τα οποία η συγκεκριμένη πρωτεΐνη αναφέρεται ότι αλληλεπιδρά και χρησιμοποιήθηκε η αλληλεπίδραση αυτή για τον προσδιορισμό της. Ανάμεσα στα μόρια αυτά είναι οι GAGs, για τις οποίες αναφέρεται ότι συμμετέχουν στον μηχανισμό μετατροπής της PrPC σε PrPSc. Για τη διεκπεραίωση της μελέτης αναπτύχθηκαν συστήματα σε στερεά φάση που έφεραν ακινητοποιημένες διάφορες GAGs και αφήνονταν προς αλληλεπίδραση με πρότυπο PrP, με ομογενοποιήματα διαφόρων ιστών, φυσιολογικών και παθολογικών. Τα συστήματα αυτά χρησιμοποιήθηκαν είτε για τον έλεγχο διαχωρισμού των δύο μορφών της PrP είτε για τον προσδιορισμό των δύο μορφών της

Association Between Uric Acid and Worsening Peripheral Microangiopathy in Systemic Sclerosis

Objective: The key element in the pathogenesis of systemic sclerosis (SSc) is microcirculatory changes in several vascular beds. Uric acid is associated with endothelial dysfunction and therefore, microvascular damage. The aim of this study was to examine the association between uric acid (UA) and peripheral microvascular involvement in patients with SSc.Methods: We included consecutive, consenting patients with SSc. Serum UA, urea and creatinine were measured, and glomerular filtration rate (GFR) was calculated with CKD-EPI. All participants underwent nailfold video-capillaroscopy (NVC) to evaluate the microcirculation.Results: A total of 64 patients (95.3% women) were included in the study. UA levels were significantly associated with the number of avascular areas (r = 0.290; p = 0.020), whereas no correlation was shown for the GFR (r = -0.065; p = 0.609). A significant trend of UA in the three capillaroscopic patterns was shown (3.90 +/- 1.52 vs. 4.15 +/- 0.98 vs. 5.38 +/- 2.26; for early, active, and late patterns respectively, p = 0.028). Multivariate analysis showed that male gender (beta = 3.049; 95% CI = 0.997-5.101) and UA (beta = 0.352; 95% CI = 0.117-0.588) were independently associated with the number of avascular areas.Conclusion: These data suggest that UA levels are significantly associated with the capillaroscopic patterns, reflecting a progressive microvasculopathy

Peripheral microcirculatory abnormalities are associated with cardiovascular risk in systemic sclerosis: a nailfold video capillaroscopy study

Introduction Microvascular dysfunction is the key element in the pathogenesis of systemic sclerosis (SSc), whereas the contribution of large and medium size vessel abnormalities is yet to be established. The aim of the present study is to assess the association between micro- and macrovascular function by utilizing a broad spectrum of assessments of vascular performance. Methods We included consecutive, consenting SSc patients who underwent nailfold video capillaroscopy (NVC) for microcirculation evaluation. Peripheral and central systolic and diastolic blood pressure, carotid intima-media thickness (cIMT), aortic augmentation index (AIx) corrected for a heart rate of 75 beats per minute (AIx-75), and carotid-femoral pulse wave velocity (PWV) were also performed to assess macrovascular function. Cardiovascular risk disease (CVD) algorithms were also calculated and included in the analysis. Results A total of 81 patients (6 males) were studied with mean age 55.44 +/- 13.40 years. Reduced capillary density was inversely correlated with arterial stiffness (Alx-75) and augmentation pressure (r = - 0.262, p = 0.018, and r = - 0.249, p = 0.025 respectively). Alx was significantly lower in the early compared to late pattern (28.24 +/- 11.75 vs 35.63 +/- 10.47, p = 0.036). A significant trend was found among NVC patterns with Alx-75 values being higher with the progression of microangiopathy towards the “late” group (26.36 +/- 10.90 vs 30.81 +/- 11.59 vs 35.21 +/- 7.90, p = 0.027 for trend). Similarly, Framingham risk score and Atherosclerotic Cardiovascular Disease score were progressively higher across the worsening NVC patterns (4.10 +/- 4.13 vs 2.99 +/- 2.72 vs 6.36 +/- 5.65, p = 0.023, and 6.99 +/- 7.18 vs 5.63 +/- 4.41 vs 12.09 +/- 9.90, p = 0.019, respectively, for trends). Finally, QRISK3 (10-year cardiovascular disease risk) and ASCVD (Atherosclerotic Cardiovascular Disease) scores were inversely correlated with the number of capillaries (r = - 0.231, p = 0.048, and r = - 0.260, p = 0.038 respectively). Conclusion These data suggest that CVD risk scores and macrovascular parameters are strongly correlated with microvasculopathy in patients with SSc

Right Ventricular Morphology and Function after Exercise Training in People with Systemic Sclerosis: A Randomized Controlled Pilot Study

Background: Vascular dysfunction and its concomitant multi-organ involvement, including cardiac involvement, affects prognosis in systemic sclerosis (SSc) patients. Regular exercise has demonstrated to be able to improve vascular function in SSc. However, the effects of an exercise program on the heart and specifically in right ventricular (RV) morphology and function in SSc have yet to be explored. The study aimed to examine whether a 3-month combined exercise program can affect RV morphology and function in SSc patients. Methods: Twenty-eight SSc patients were randomly allocated to either the exercise training (ET) or the control (CON) group. Baseline and follow-up assessments consisted of a cardiopulmonary exercise test along with both a conventional and a two-dimensional speckle tracking echocardiography (2DSTE) focused on RV morphology and function. Following the baseline assessments, Group ET participated in a supervised combined exercise program for 12 weeks, while group CON received their usual care. Results: The ET group demonstrated increases in peak oxygen consumption by 25.1% (p p p p < 0.03) following the exercise program. No differences were observed in group CON. Conclusions: Combined exercise improved cardiorespiratory efficiency and indices of RV systolic function, as assessed by the 2DSTE, in SSc patients