SONOGRAPHIC EVALUATION OF FEMORAL CONDYLAR CARTILAGE IN OSTEOARTHRITIS AND RHEUMATOID-ARTHRITIS

Employing a real-time sonographic scanner with a 5 MHz linear probe, the articular cartilage of the knee was studied in four groups of subjects: normal subjects aged 18-36 years and 50-63 years, patients with rheumatoid arthritis (RA) and patients with osteoarthritis (OA). Cartilage thickness was diminished both in RA and in OA knees compared to the two groups of normal joints, even if in RA the reduction was less. The cartilage surface appeared irregular more frequently in OA than in RA. Our survey suggests that the sonographic technique is a useful, non-invasive diagnostic method to study the articular cartilage of the knee

Nonalcoholic fatty liver disease and increased risk of 1-year all-cause and cardiac hospital readmissions in elderly patients admitted for acute heart failure

Nonalcoholic fatty liver disease (NAFLD) is an emerging risk factor for heart failure (HF). Although some progress has been made in improving survival among patients admitted for HF, the rates of hospital readmissions and the related costs continue to rise dramatically. We sought to examine whether NAFLD and its severity (diagnosed at hospital admission) was independently associated with a higher risk of 1-year all-cause and cardiac re-hospitalization in patients admitted for acute HF. We studied 212 elderly patients who were consecutively admitted with acute HF to the Hospital of Negrar (Verona) over a 1-year period. Diagnosis of NAFLD was based on ultrasonography, whereas the severity of advanced NAFLD fibrosis was based on the fibrosis (FIB)-4 score and other non-invasive fibrosis scores. Patients with acute myocardial infarction, severe valvular heart diseases, endstage renal disease, cancer, known liver diseases or decompensated cirrhosis were excluded. Cox regression was used to estimate hazard ratios (HR) for the associations between NAFLD and the outcome(s) of interest. The cumulative rate of 1-year all-cause re-hospitalizations was 46.7% (n = 99, mainly due to cardiac causes). Patients with NAFLD (n = 109; 51.4%) had remarkably higher 1-year all-cause and cardiac re-hospitalization rates compared with their counterparts without NAFLD. Both event rates were particularly increased in those with advanced NAFLD fibrosis. NAFLD was associated with a 5-fold increased risk of 1-year all-cause re-hospitalization (adjusted-hazard ratio 5.05, 95% confidence intervals 2.78-9.10, p<0.0001) after adjustment for established risk factors and potential confounders. Similar results were found for 1-year cardiac re-hospitalization (adjusted-hazard ratio 8.05, 95% confidence intervals 3.77-15.8, p<0.0001). In conclusion, NAFLD and its severity were strongly and independently associated with an increased risk of 1-year all-cause and cardiac re-hospitalization in elderly patients admitted with acute HF

Ethnic differences in Glycaemic control in people with type 2 diabetes mellitus living in Scotland

Background and Aims: Previous studies have investigated the association between ethnicity and processes of care and intermediate outcomes of diabetes, but there are limited population-based studies available. The aim of this study was to use population-based data to investigate the relationships between ethnicity and glycaemic control in men and women with diabetes mellitus living in Scotland.<p></p> Methods: We used a 2008 extract from the population-based national electronic diabetes database of Scotland. The association between ethnicity with mean glycaemic control in type 2 diabetes mellitus was examined in a retrospective cohort study, including adjustment for a number of variables including age, sex, socioeconomic status, body mass index (BMI), prescribed treatment and duration of diabetes.<p></p> Results: Complete data for analyses were available for 56,333 White Scottish adults, 2,535 Pakistanis, 857 Indians, 427 Chinese and 223 African-Caribbeans. All other ethnic groups had significantly (p<0.05) greater proportions of people with suboptimal glycaemic control (HbA1c >58 mmol/mol, 7.5%) compared to the White Scottish group, despite generally younger mean age and lower BMI. Fully adjusted odds ratios for suboptimal glycaemic control were significantly higher among Pakistanis and Indians (1.85, 95% CI: 1.68–2.04, and 1.62,95% CI: 1.38–1.89) respectively.<p></p> Conclusions: Pakistanis and Indians with type 2 diabetes mellitus were more likely to have suboptimal glycaemic control than the white Scottish population. Further research on health services and self-management are needed to understand the association between ethnicity and glycaemic control to address ethnic disparities in glycaemic control.<p></p&gt

immunohistochemical analysis of the expression of main adhesion molecules and tumor necrosis factors in the synovial membrane of psoriatic arthritis

Objective: To define the expression and pattern of the synovial distribution of adhesion molecules such as E-selectin, ICAM-1 and VCAM-1 and of TNFα and TNFβ cytokines in psoriatic arthritis (PsA), according to the synovitis duration. Methods: Cryostatic sections of the synovial membrane tissue samples were stained for the different antibodies using a standard three-stage-immunoperoxidase-labeling technique. Results: E-selectin grade of staining was higher in those patients with a shorter disease duration compared to longstanding synovitic specimens, as well as ICAM-1 expression. On the contrary a higher VCAM-1 positivity was mainly found in longstanding PsA patients. Anti-TNFa positivity was found almost in all the specimens with no difference among the two groups, while the intensity of anti-TNFβ positivity was globally higher in longstanding cases. Conclusions: Different adhesion molecules may separately participate to the synovitic process in the different phases of PsA, leading to the hypothesis of their different involvement during the disease evolution. Moreover the upregulation of TNFα and TNFβ gives evidence to their local proinflammatory effect within the synovium and to their role in perpetuating the PsA synovitis

Towards an improved understanding of biogeochemical processes across surface-groundwater interactions in intermittent rivers and ephemeral streams

Surface-groundwater interactions in intermittent rivers and ephemeral streams (IRES), waterways which do not flow year-round, are spatially and temporally dynamic because of alternations between flowing, non-flowing and dry hydrological states. Interactions between surface and groundwater often create mixing zones with distinct redox gradients, potentially driving high rates of carbon and nutrient cycling. Yet a complete understanding of how underlying biogeochemical processes across surface-groundwater flowpaths in IRES differ among various hydrological states remains elusive. Here, we present a conceptual framework relating spatial and temporal hydrological variability in surface water-groundwater interactions to biogeochemical processing hotspots in IRES. We combine a review of theIRES biogeochemistry literature with concepts of IRES hydrogeomorphology to: (i) outline common distinctions among hydrological states in IRES; (ii) use these distinctions, together with considerations of carbon, nitrogen, and phosphorus cycles within IRES, to predict the relative potential for biogeochemical processing across different reach-scale processing zones (flowing water, fragmented pools, hyporheic zones, groundwater, and emerged sediments); and (iii) explore the potential spatial and temporal variability of carbon and nutrient biogeochemical processing across entire IRES networks. Our approach estimates the greatest reach-scale potential for biogeochemical processing when IRES reaches are fragmented into isolated surface water pools, and highlights the potential of relatively understudied processing zones, such as emerged sediments. Furthermore, biogeochemical processing in fluvial networks dominated by IRES is likely more temporally than spatially variable. We conclude that biogeochemical research in IRES would benefit from focusing on interactions between different nutrient cycles, surface-groundwater interactions in non-flowing states, and consideration of fluvial network architecture. Our conceptual framework outlines opportunities to advance studies and expand understanding of biogeochemistry in IRES

Inflammation and Progressive Nephropathy in Type 1 Diabetes in the Diabetes Control and Complications Trial

OBJECTIVE—Progressive nephropathy represents a substantial source of morbidity and mortality in type 1 diabetes. Increasing albuminuria is a strong predictor of progressive renal dysfunction and heightened cardiovascular risk. Early albuminuria probably reflects vascular endothelial dysfunction, which may be mediated in part by chronic inflammation

Science and Management of Intermittent Rivers and Ephemeral Streams (SMIRES)

More than half of the global river network is composed of intermittent rivers and ephemeral streams (IRES), which are expanding in response to climate change and increasing water demands. After years of obscurity, the science of IRES has bloomed recently and it is being recognised that IRES support a unique and high biodiversity, provide essential ecosystem services and are functionally part of river networks and groundwater systems. However, they still lack protective and adequate management, thereby jeopardizing water resources at the global scale. This Action brings together hydrologists, biogeochemists, ecologists, modellers, environmental economists, social researchers and stakeholders from 14 different countries to develop a research network for synthesising the fragmented, recent knowledge on IRES, improving our understanding of IRES and translating this into a science-based, sustainable management of river networks. Deliverables will be provided through i) research workshops synthesising and addressing key challenges in IRES science, supporting research exchange and educating young researchers, and ii) researcher-stakeholder workshops translating improved knowledge into tangible tools and guidelines for protecting IRES and raising awareness of their importance and value in societal and decision-maker spheres. This Action is organized within six Working Groups to address: (i) the occurrence, distribution and hydrological trends of IRES; (ii) the effects of flow alterations on IRES functions and services; (iii) the interaction of aquatic and terrestrial biogeochemical processes at catchment scale; (iv) the biomonitoring of the ecological status of IRES; (v) synergies in IRES research at the European scale, data assemblage and sharing; (vi) IRES management and advocacy training

Is exercise a therapeutic tool for improvement of cardiovascular risk factors in adolescents with type 1 diabetes mellitus? A randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Type 1 diabetes mellitus (T1DM) is associated with a high risk for early atherosclerotic complications especially risk of coronary heart disease.</p> <p>Objective</p> <p>To evaluate the impact of six months exercise prgram on glycemic control, plasma lipids values, blood pressure, severity and frequency of hypoglycemia, anthropometric measurements and insulin dose in a sample of adolescents with T1DM.</p> <p>Research design and methods</p> <p>A total of 196 type 1 diabetic patients participated in the study. They were classified into three groups: Group (A) did not join the exercise program(n = 48), group (B) attended the exercise sessions once/week (n = 75), group (C) attended the exercise sessions three times/week (n = 73). Studied parameters were evaluated before and six months after exercise programe.</p> <p>Results</p> <p>Exercise improved glycemic control by reducing HbA1c values in exercise groups (P = 0.03, P = 0.01 respectively) and no change in those who were not physically active (P = 0.2). Higher levels of HbA1c were associated with higher levels of cholesterol, LDL-c, and triglycerides (P = 0.000 each). In both groups, B and C, frequent exercise improved dyslipidemia and reduced insulin requirements significantly (P = 0.00 both), as well as a reduction in BMI (P = 0.05, P = 0.00 respectively) and waist circumference(P = 0.02, P = 0.00 respectively). The frequency of hypoglycemic attacks were not statistically different between the control group and both intervention groups (4.7 ± 3.56 and 4.82 ± 4.23, P = 0.888 respectively). Reduction of blood pressure was statistically insignificant apart from the diastolic blood presure in group C (P = 0.04).</p> <p>Conclusion</p> <p>Exercise is an indispensable component in the medical treatment of patients with T1DM as it improves glycemic control and decreases cardiovascular risk factors among them.</p