Reumasairauksiin liittyvä anemia ja raudanpuute

Anemia on tavallinen ongelma monissa pitkäaikaisissa reumasairauksissa. Tavallisimmat anemian syyt reumasairauksissa ovat tulehdukseen liittyvä raudankäyttöhäiriö sekä ­maha-suolikanavan verenvuodosta johtuva raudanpuute. Raudankäyttöhäiriö johtuu interleukiini 6:n indusoiman hepsidiinin vaikutuksesta raudan kuljetukseen ­suolistossa ja retikuloendoteliaalijärjestelmässä. Tulehduksellista sairautta sairastavan raudanpuute voidaan yleensä tunnistaa määrittämällä seerumin ­ferritiini- ja transferriinireseptoripitoisuus. Tulehdusanemia lievittyy reumasairauden tehokkaalla hoidolla perinteisillä reumalääkkeillä, glukokortikoideilla tai biologisilla lääkkeillä. Itsepintaisen tulehdusanemian hoitoon voidaan harkita rautalääkitystä, jossa parenteraaliset valmisteet ovat etusijalla.Peer reviewe

Paradoksaalisesti käyttäytyvä lasko voi antaa lisävinkkiä hemofagosyyttisestä lymfohistiosytoosista

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Optimising graph codes for measurement-based loss tolerance

Graph codes play an important role in photonic quantum technologies as they provide significant protection against qubit loss, a dominant noise mechanism. Here, we develop methods to analyse and optimise measurement-based tolerance to qubit loss and computational errors for arbitrary graph codes. Using these tools we identify optimised codes with up to 12 qubits and asymptotically-large modular constructions. The developed methods enable significant benefits for various photonic quantum technologies, as we illustrate with novel all-photonic quantum repeater states for quantum communication and high-threshold fusion-based schemes for fault-tolerant quantum computing

Svenska studielinjen i medicin - nuläge och några milstolpar under en 40-årig vandring

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roadmap to vasculitis a rheumatological treasure hunt part iii laboratory evaluation and imaging

Abstract In the third part of this four part review, we already have the stop sign and our three road signs pointing to secondary vasculitides, pseudovasculitides and primary vasculitides behind our back and we have also passed the first milestone, where "patient history and physical examination" was written with large black block letters. GP can get far with simple blood, urine and stool tests and routine X-rays (second milestone). Almost all vasculitides of clinical significance are characterized by increased ESR and raised C-reactive protein levels and often also by normocytic normochromic anaemia, leucocytosis, eosinophilia and thrombocytosis. Urine test may demonstrate haematuria, proteinuria and cylindruria, X-ray of the paranasal cavities chronic sinusitis and chest X-ray shadowing and cavitations. Serological tests may disclose an unexpected hepatitis B or C or perhaps ANCA. The possibilities described form such a cornucopia that we need to have our patient history and physical examination right for the right picks. This is even more pertinent when we take to the sledgehammer in the referral centres (third milestone) and deal with the histopathology of vasculitides as hopefully seen in biopsies rather than autopsies or perform invasive radiology. High resolution colour Doppler ultrasound offers a useful, non-invasive method for the diagnosis and guidance of an eventual biopsy site in temporal arteritis and is helpful in the diagnosis of Takayasu's arteritis and Kawasaki disease. Aortic arch, mesenteric, splanchnic or renal angiographies, MRI, contrast-enhanced CT, gadolinium-enhanced magnetic resonance angiography and positron emission tomography are dealt with but require the right patient and the right "doctor decision maker" not to cause harm and to avoid waste of scant resources

NON-INVASIVE VASCULAR VERY-HIGH RESOLUTION ULTRASOUND TO QUANTIFY ARTERY INTIMA LAYER THICKNESS : VALIDATION OF THE FOUR-LINE PATTERN

Preliminary findings suggest that very-high resolution ultrasound (VHRU, 55 MHz) could differentiate arterial intima layer thickness (IT) non-invasively in vivo. We aimed to validate ultrasound-derived IT measurements and describe a four-line pattern consistent with intimal thickening. VHRU was applied to temporal arteries of 37 patients with suspected giant cell arteritis without inflammation on histology. Anatomically matched ultrasound-derived measurements of arterial layer thickness with the leading-edge method was compared to histology. Intimal thickening (IT >0.06 mm on histology) was identified as a four-line pattern in VHRU with a sensitivity of 96.3% and a specificity of 100%. Histologic and VHRU IT measurement agreement was excellent (mean difference 0.007 mm; 95% limits of agreement, -0.043 to 0.057) and intra-class coefficient (ICC) 0.923 (95% confidence interval [CI], 0.833-0.964). Intra- and inter-observer agreements for VHRU IT were high: ICC 0.946 (95% CI, 0.877-0.976) and 0.872 (95% CI, 0.773-0.943). VHRU utilizing the leading-to-leading edge method allows accurate and reliable measurements of arterial IT in patients with IT >0.06 mm. Measurements of IT will provide the opportunity to explore early subclinical structural intimal changes in the arterial wall increasing with age. (C) 2019 World Federation for Ultrasound in Medicine & Biology. All rights reserved.Peer reviewe

Simulerade patienter är viktiga i kommunikationsundervisningen

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Finländska särdrag i den medicinska svenskan

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Sydänamyloidoosi

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