Diagnosis Of Inflammatory Disease Research Articles

ERBANDINGAN NILAI C-REACTIVE PROTEIN METODE aglutinasi Lateks DAN METODE FLUORESCENCE IMMUNOASSAY (FIA) PADA PASIEN PRA SECTIO

Introduction: Examination of C-Reactive Protein (CRP) levels in the blood is a marker of the acute phase in humans which is useful for the diagnosis and monitoring of inflammatory diseases. The Latex Agglutination method is often used to obtain quick and simple results as a screening test for elevated CRP levels. Currently, a quantitative CRP examination is available in order to measure CRP levels more quickly. Fluorescene Immunoassay (FIA) is a method that has improved sensitivity and precision so that it can detect low CRP concentrations. This study aims to determine differences in C-Reactive Protein (CRP) values of the Latex Agglutination method and the FIA method in patients at Bunda Palembang Hospital in 2023. Method: Cross Sectional. The research was conducted in January 2023 at Bunda Palembang Hospital with a total sample of 38 samples. Results: The average value of C-Reactive Protein using the Latex Agglutination method was 6.6 mg/L and the FIA method was 7.0 mg/L. Data analysis of the Latex Agglutination method showed that there were differences between the FIA method and Asymp. Sig. (2-tailed) is 0.029. The sensitivity and specificity were 73.91% and 100% for the Latex Agglutination method, and 100% and 71.43% for the FIA method, respectively. Conclusion: There are differences in the C-Reactive Protein Value examination by the Latex Agglutination Method and the Fluorescene Immunoassay (FIA) Method..

Difficulties in myocarditis diagnosis: a case report

Myocarditis is often difficult to diagnose. The diagnostic difficulties include nonspecific symptoms or a “vague” clinical picture, absence of pathognomonic signs during physical examination, and endomyocardial biopsy, which is the “gold standard” of diagnosis of myocarditis, being an invasive procedure that is performed under strict indications in certain patients. Nevertheless, as radiology is rapidly developing, clinicians are now able to noninvasively diagnose symptoms of inflammatory myocardial damage, including edema and myocardial fibrosis, using cardiac magnetic resonance imaging. This article presents the clinical case of a young patient with symptoms of acute coronary syndrome, who showed no evidence of coronary artery disease. Myocarditis was suspected because of increased activity of cardiospecific enzymes and high levels of inflammatory markers, pronounced electrocardiography changes with positive dynamics, and recent infection. Magnetic resonance imaging was used to confirm myocarditis diagnosis. Thus, this case study demonstrates the role of imaging techniques in the differential diagnosis of ischemic and inflammatory heart diseases.

Predictors of unfavourable outcome in adults with suspected central nervous system infections: a prospective cohort study

Suspected central nervous system (CNS) infections may pose a diagnostic challenge, and often concern severely ill patients. We aim to identify predictors of unfavourable outcome to prioritize diagnostics and treatment improvements. Unfavourable outcome was assessed on the Glasgow Outcome Scale at hospital discharge, defined by a score of 1 to 4. Of the 1152 episodes with suspected CNS infection, from two Dutch prospective cohorts, the median age was 54 (IQR 37–67), and 563 episodes (49%) occurred in women. The final diagnoses were categorized as CNS infection (N = 358 episodes, 31%), CNS inflammatory disease (N = 113, 10%), non-infectious non-inflammatory neurological disorder (N = 388, 34%), non-neurological infection (N = 252, 22%), and other systemic disorder (N = 41, 4%). Unfavourable outcome occurred in 412 of 1152 (36%), and 99 died (9%). Predictors for unfavourable outcomes included advanced age, absence of headache, tachycardia, altered mental state, focal cerebral deficits, cranial nerve palsies, low thrombocytes, high CSF protein, and the final diagnosis of CNS inflammatory disease (odds ratio 4.5 [95% confidence interval 1.5–12.6]). Episodes suspected of having a CNS infection face high risk of experiencing unfavourable outcome, stressing the urgent need for rapid and accurate diagnostics. Amongst the suspected CNS infection group, those diagnosed with CNS inflammatory disease have the highest risk.

Improved polarimetric analysis of human skin through stitching: advantages, limitations, and applications in dermatology

Polarimetry is a powerful tool for the analysis of the optical properties of materials and systems, such as human skin. However, in many polarimetric setups, the field of view is limited to a few square centimeters. In these cases, it is possible to resort to stitching techniques, which involve combining multiple Mueller matrix measurements obtained from different overlapping regions of the sample. In this paper, we propose a stitching technique for polarimetric data and discuss its advantages and limitations. We also describe the potential of image stitching for improving the accuracy and robustness of in vivo polarimetry in the presence of random patient movement. We conducted our research using a diverse set of samples which included porcine skin, human skin from arms and fingers, cold cuts of chicken and gelatine, alongside synthetically created sample data. Our results demonstrate the effectiveness of this technique for the application in dermatology. Each additional in vivo measurement enhances the field of view by approximately one third, thereby considerably augmenting the total observation area. We show that stitching enables for the polarimetric assessment of large skin patches which is useful for the diagnosis of inflammatory skin diseases.

Targeted nanotheranostics for the treatment of epilepsy through in vivo hijacking of locally activated macrophages

Epilepsy refers to a disabling neurological disorder featured by the long-term and unpredictable occurrence of seizures owing to abnormal excessive neuronal electrical activity and is closely linked to unresolved inflammation, oxidative stress, and hypoxia. The difficulty of accurate localization and targeted drug delivery to the lesion hinders the effective treatment of this disease. The locally activated inflammatory cells in the epileptogenic region offer a new opportunity for drug delivery to the lesion. In this work, CD163-positive macrophages in the epileptogenic region were first harnessed as Trojan horses after being hijacked by targeted albumin manganese dioxide nanoparticles, which effectively penetrated the brain endothelial barrier and delivered multifunctional nanomedicines to the epileptic foci. Hence, accumulative nanoparticles empowered the visualization of the epileptogenic lesion through microenvironment-responsive MR T1-weight imaging of manganese dioxide. Besides, these manganese-based nanomaterials played a pivotal role in shielding neurons from cell apoptosis mediated by oxidative stress and hypoxia. Taken together, the present study provides an up-to-date approach for integrated diagnosis and treatment of epilepsy and other hypoxia-associated inflammatory diseases. Statement of significanceThe therapeutic effects of antiepileptic drugs (AEDs) are hindered by insufficient drug accumulation in the epileptic site. Herein, we report an efficient strategy to use locally activated macrophages as carriers to deliver multifunctional nanoparticles to the brain lesion. As MR-responsive T1 contrast agents, multifunctional BMC nanoparticles can be harnessed to accurately localize the epileptogenic region with high sensitivity and specificity. Meanwhile, catalytic nanoparticles BMC can synergistically scavenge ROS, generate O2 and regulate neuroinflammation for the protection of neurons in the brain.

Summarizing Evidence of Associations of COVID-19 With a Future Diagnosis of Inflammatory Rheumatic and Musculoskeletal Diseases: A Rapid Review.

Musculoskeletal symptoms are commonly reported following acute COVID-19. It is unclear whether those with musculoskeletal symptoms subsequently develop inflammatory rheumatic musculoskeletal disease (iRMD). This review seeks to identify evidence for an association between acute COVID-19 and subsequent iRMD diagnosis. A rapid review of the literature using a systematic search of Medline, EMBASE and two COVID-19 databases was undertaken until August 2022. Case studies, case series, cross-sectional, case-control, and cohort studies reporting patients with an incident iRMD following COVID-19 were included. Title and abstract screening were conducted by one reviewer and full text screening by two reviewers. Data extraction and quality appraisal were by one reviewer, with a second verifying. Study-type specific critical appraisal tools were used. Results were narratively synthesized. A total of 80 studies were included (69 case reports, 10 case series and 1 cross-sectional study). Commonly reported iRMDs were "reactive arthropathies" (n=47), "inflammatory arthropathies unspecified" (n=18), rheumatoid arthritis (n=12) and systemic lupus erythematosus (n=11). The cross-sectional study reported 37% of those with COVID-19 developed "post COVID arthritis." Time from diagnosis of COVID-19 to iRMD presentation ranged from 0 to 120 days. Several mechanisms were proposed to explain the association between COVID-19 and iRMD development: autoimmune processes, aberrant inflammatory responses, colonization of joint spaces, direct damage from the severe acute respiratory syndrome coronavirus 2 virus and genetic predisposition. The level of evidence of the studies included in this review was low and the quality generally poor. Prospective observational studies are required to confirm associations and likely impact of post COVID-19 iRMDs at a population level.

DEPENDENCE OF THE DEVELOPMENT OF HISTOLOGICAL CHANGES IN THE TISSUES OF THE FALLOPIAN TUBES IN ADOLESCENT GIRLS AND YOUNG WOMEN WITH INFLAMMATORY GENITAL DISEASE ON THE TAXONOMIC AFFILIATION OF PATHOGENS

The aim. To conduct a comparative analysis of the fallopian tubes' clinical, microbiological and histological characteristics in adolescent girls and young women with inflammatory genital disease.
 Materials and methods. The etiological diagnosis of inflammatory disease was established with the help of complex microbiological and cytological studies of biomaterial from the vagina of teenage girls and the cervical canal of young women before hospitalization and histological examination fragments of fallopian tube – after surgery. The microbiological examination included the cultural detection of bacteria of various taxonomic groups, fungi, mycoplasmas, and ureaplasmas from the biomaterial. A set of methods described in the article was used to detect chlamydia [13]. The degree of bacterial infection of the fallopian tube fragments was assessed by determining the microbial count. Histological examination of biopsy specimens of fallopian tube tissues removed during surgery was performed by the conventional method [9].
 Results. In the examination of 29 adolescent girls and young women hospitalized for surgical treatment, a comparative analysis was conducted between the clinical manifestations of inflammatory genital disease, identifiable factors, and histological signs of damaged fallopian tubes.When studying the spectrum of factors in the inflammatory focus (fallopian tube biopsies) in adolescent girls (n=12), enterobacteria (33.3%), staphylococci (33.3%), streptococci (8.35%), and Pseudomonas aeruginosa (8.35%) were detected; in 16.7% of adolescent girls, the cultures were sterile. In young women (n=17), microbiological examination of fallopian tube tissues revealed chlamydia (29.4%), mycoplasma (11.6%), ureaplasma (5.8%), gonococci (5.8%), enterobacteria (5.8%), fungi (5.8%); in 6 (35.8%) of the examined women, no bacterial growth was detected. Among young women who had been operated on for tubo-ovarian inflammatory diseases and ectopic pregnancy, chlamydia were most often (29.4%) found in the tissues of the fallopian tubes.
 Conclusions. The studies have shown that in the development of acute purulent salpingitis in young women, sclerotic changes and signs characteristic of the productive process prevailed in the tissues of the fallopian tubes against the background of genital inflammation, and in adolescent girls, an exudative process was observed against the background of genital inflammation. The peculiarities of the course of genital inflammation depend on the biological properties of pathogens of different taxonomic affiliations.

17. Exploring the clinical utility of the biomarker GPNMB in the diagnosis of hepatic inflammatory diseases

17. Exploring the clinical utility of the biomarker GPNMB in the diagnosis of hepatic inflammatory diseases

T1rho and T2rho based myocardial tissue characterisation in small animals at high-field MRI

Abstract Introduction Cardiac tissue characterisation using T2-based MRI promises non-invasive diagnosis or monitoring of inflammatory heart disease, toxic heart damage after chemotherapy and myocardial infarction or post-infarction patients. T2 relaxation is also an indicator for the detection of myocardial oedema or intramyocardial haemorrhage [1]. However, accurate T2 quantification is challenging due to motion, blood flow and field inhomogeneities, especially in high-field MRI [2]. In this work, we present an alternative to T2 imaging that uses spin-locking (SL) to provide a robust measurement of T2ρ relaxation. It is known from relaxation theory that T2ρ has a sensitivity almost identical to T2 [3]. In the small animal study presented here, cardiac T2ρ quantification is tested for the first time using a newly developed pulse sequence and compared with established methods. Methods All measurements were performed on a preclinical 7T MRI. T2 contrast was prepared using a CPMG (Carr-Purcell-Meiboom-Gill) sequence. T2ρ contrast was conventionally generated by a balanced-SL (BSL) preparation [4]. Furthermore, a new approach for T2ρ was developed based on a MLEV sequence (Malcolm-Levitt, [2]). In contrast to [2], all pulse delays were minimised here, producing pure T2ρ contrast (Fig. 1). The new method was first validated in phantom experiments and then tested in three mice with radial image acquisition accelerated for cardio-MRI. Results The results of the phantom study are shown in figure 2. No significant differences were found between BSL and MLEV for T2ρ quantification (mean deviation 0.74%). In vivo, significant artefacts were observed for T2 (Fig. 3), while both T2ρ methods showed improved image quality. For the evaluation of relaxation times in the left ventricle, the mean across all animals was: T2=22.9±2.6ms (R2=0.979), BSL-T2ρ=51.4±5.4ms (R2=0.983) and MLEV-T2ρ=60.0±3.4ms (R2>0.99). Thus, the MLEV-T2ρ method achieves the most robust quantification with a mean R2>0.99 and provides relaxation time maps with diagnostic image quality. Discussion: In the present study, myocardial T2ρ mapping was tested at 7T. While no significant differences between BSL and MLEV appeared in phantom experiments, significant difference was found in vivo. Here, only the MLEV technique could achieve robust quantification. One reason for the improved performance is the continuous refocusing and minimisation of free dephasing of the transverse magnetisation. The results also show that MLEV-T2ρ has improved image quality and more robust quantification compared to CPMG-T2. Conclusion Cardiac T2ρ quantification is a robust alternative to established T2 imaging and can be applied under high-field conditions. A combined measurement of T1ρ and T2ρ relaxation time could be used for native detection of myocardial fibrosis and oedema.Figure 1)Comparison of image qualityFigure 2)Results in a knockout model

Abstract 14158: Ceria/Iron Oxide and Silver/Iron Oxide Nanohybrids: New Classes of Materials for Theranostics of Cardiovascular Diseases

Introduction: The need for efficient and biocompatible treatment methods that can simultaneously deliver imaging and therapeutic agents for combined diagnosis and therapy have resulted in the development of theranostic nanoparticles in recent times. Nanotheranostics represent one of the last frontiers in precision medicine and provide real-time information about drug biodistribution, release, and targeted treatment in vivo. Hypothesis: Here we aim to develop biocompatible smart nanomaterials for efficient theranostics of cardiovascular diseases. Methods: We have developed various hybrid materials based on metal and metal oxide such as iron oxide, ceria, and silver for diagnosis and treatment of thrombosis, atherosclerosis and inflammatory diseases. Iron oxide offers magnetic resonance imaging (MRI) capability. Ceria provides antioxidant and anti-inflammatory effects. The incorporation of silver onto the particles not only provides photoacoustic imaging capability but also allows photothermal therapy. The developed nanohybrids were labelled with fluorescence molecules to enable optical imaging, and also tagged with targeting ligands for targeted delivery of the materials. Results: The ceria/iron oxide nanohybrids showed excellent theranostic property in a liver inflammation mouse model, and in an atherosclerosis model. MRI was successfully employed to monitor the delivery of the materials and detect the inflammation, and atherosclerosis. The particles could reverse liver inflammation and inhibit atherosclerosis progression while did not show any adverse effects systemically. The other nanohybrids, silver/iron oxide, exhibited multimodal imaging capability where both MRI and photoacoustic imaging could be used to image the materials and thus allowed the detection of thrombosis in mouse models. Triggered by 808nm light, the nanoparticles could induce excellent thrombolysis effect and completely restored blood flow in the clotted arteries. Interestingly, this material did not show any systemic adverse effect. Conclusions: Our data show that these new classes of materials are promising theranostic approaches for imaging and treating thrombosis and inflammation diseases such as atherosclerosis and liver inflammation.

Inflammation Sub-Group Analysis in Pediatric HA-VTE Cases: A Report from the Children's Hospital Acquired Thrombosis Registry (CHAT) Registry

Introduction: Hospital-Acquired venous thromboembolism (HA-VTE) is becoming an increasingly more common complication in children that may result in mortality, short- and long-term morbidity, and increased healthcare costs. To inform HA-VTE risk mitigation strategies, clinical research efforts have been undertaken to determine the precipitating causes of pediatric HA-VTE. Many of these studies have identified inflammation as an important underlying risk factor. We aimed to determine the association between HA-VTE and any clinical inflammatory state among a hospitalized pediatric patient population within the Children's Hospital Acquired Thrombosis (CHAT) Registry, with the hypothesis that inflammation increases the risk of HA-VTE among hospitalized children. Methods: Institutional review boards at all centers approved the protocol. Children aged 0-21 years admitted to a hospital at one of 8 U.S. pediatric healthcare institutions centers were enrolled in the study. Participants with VTE at admission were excluded. Electronic health records for enrolled subjects were reviewed for the development of a HA-VTE throughout their hospitalization and up to 30 days post discharge to identify cases. Control subjects were hospitalized patients without VTE on admission, during their hospital stay, or within 30 days of discharge. Controls were matched to cases by admission year and admitting institution. Acute inflammation was defined as notation of an inflammatory disease diagnosis (as defined by consensus of the physicians on the study team) as an admitting or discharge diagnosis but not in past medical history (PMH). Inflammatory disease diagnosis in PMH but not in admission/discharge diagnosis was denoted as chronic inflammation. Acute on chronic inflammation was identified in subjects having inflammatory disease diagnoses in both the PMH and admission/discharge diagnosis, while subjects without inflammation had no inflammatory diseases in either PMH or admission/discharge diagnoses. Inflammation was further categorized by consensus of the physicians on the study team as either systemic, regional, or local based on degree of organ system involvement. Results: From January 1, 2012 to December 31, 2021, 2164 subjects were enrolled. Complete data were available for 1218 HA-VTE cases and 946 controls. Median age for HA-VTE cases was 2.1 years compared to 5.8 years for controls without HA-VTE, with 56% of cases and 51% of controls being males. Cases were more likely than controls to have had surgery, ICU admission/transfer, intubation with mechanical ventilation, and central venous catheter placement, as well as to have received mechanical, pharmacological, or combined thromboprophylaxis while hospitalized. Among controls, 24 (2.5%) carried PMH diagnoses of inflammatory diseases, while 47 (3.9%) of the HA-VTE cases did (p=0.087). Among cases, 643 (52.8%) had infections either present on admission or develop while hospitalized, compared to 178 (18.8%) of controls (p<0.01). Steroids were administered to 677 (55.6%) of cases compared to 276 (29.2%) of controls (p<0.01). Interestingly, 42.5% of cases and 55.6% of controls were noted to exhibit any type of inflammation (p<0.01), while 39.2% of cases demonstrated systemic inflammation compared to only 26.5% of controls (p<0.01). Of the 1043 children with inflammation, systemic inflammation yielded an odds ratio (OR) of 1.78 (95% confidence interval [CI], 1.37-2.32) for HA-VTE development in univariate analysis. Four hundred eighty-six (39.9%) HA-VTE cases exhibited acute inflammation, 16 (1.3%) had chronic, 31 (2.6%) had acute-on-chronic, and 685 (56.2%) had no inflammation, compared to 513 (54.2%), 11 (1.2%), 13 (1.4%), and 409 (43.2%) for controls, respectively. Compared to no inflammation, acute-on-chronic inflammation demonstrated increased risk for HA-VTE development with OR 1.42 (95% CI 0.74-2.75). Conclusion: The present work demonstrates the importance of clinical inflammation subcategories when determining HA-VTE risk. Initial analysis of these data demonstrated that systemic inflammation, especially of the acute-on-chronic variety, conveys the highest risk for HA-VTE in children. Ongoing work will determine how to incorporate these concepts into clinical practice as well as clinical trials of HA-VTE prevention in children.

An underestimated old friend: Serum protein electrophoresis in the differential diagnosis of glomerulopathies

Background: Serum protein electrophoresis (SPEP) is an easy test separating serum proteins based on their physical and chemical properties. Although it is frequently used in the differential diagnosis of multiple myeloma and various chronic inflammatory diseases, its value in the etiologic classification of glomerular diseases has yet to be studied.
 Material and Methods: We retrospectively reviewed the medical records of patients who underwent renal biopsy from 2008 to 2016 at our institution. We excluded patients who can not be classified as primary (PGn) or secondary glomerulonephritis (SGn). Univariate and multivariate logistic regression analyses were performed for the prediction of SGn. 
 Results: Four hundred thirty-two patients were included in the study. Of those, 57.9% had PGn. Rheumatological diseases, malignancies, and infections were the most common etiologic causes of SGn, accounting for nearly 75%. Univariate analysis revealed that alpha-1 (α1), gamma (Ɣ), and albumin fractions significantly differ between PGn and SGn groups. ROC curve analysis determined the cut-off value of (α1*Ɣ)/albumin ratio as 1.48. Multivariate analysis revealed that total serum protein and (α1*Ɣ)/albumin ratio were significantly independent predictors for SGn (p=0.020 and p

Characteristics and course of patients with AA amyloidosis: single centre experience with 174 patients from Turkey.

This study aimed to evaluate the clinical, laboratory and genetic characteristics and outcomes of patients with AA amyloidosis. Patients followed up in a tertiary referral centre in Turkey with the diagnosis of inflammatory rheumatic diseases and immunohistologically proven AA amyloidosis were included in the study and retrospectively analysed. Among 184 patients with the diagnosis of AA amyloidosis, 174 (83 female, 91 male) were included in the analysis. The most common cause of AA amyloidosis was FMF (78.7%), and 91% of FMF-AA amyloidosis patients were carrying the p.M694V variant (74.1% homozygous). AA amyloidosis was identified earlier in patients with homozygous or compound heterozygous MEFV exon 10 variants compared with the heterozygous patients (27, 30 and 41 years, respectively). Patients with an estimated glomerular filtration rate <60 ml/min at admission had a higher frequency of progression to end-stage renal disease (P < 0.001). The overall mortality rate was 15.3% and it increased gradually in association with the amyloid burden (10% in patients with renal, 15% in renal + gastrointestinal and 43% in those with additional cardiac involvement). Renal findings responded completely to treatment in 31% of the patients, a partial response was observed in 4%, a stable course in 23.6% and progression in 38.5%. Amyloid storm was identified in nine patients and was found to be associated with increased mortality within 1 year. FMF patients still constitute the majority of AA amyloidosis patients in Turkey. The MEFV genotype and associated inflammatory load may affect the age of onset of AA amyloidosis, and earlier diagnosis and stricter follow-up and treatment may delay progression of the disease.

Recurrent superior orbital fissure syndrome associated with VEXAS syndrome

PurposeTo describe a case of recurrent orbital inflammation and superior orbital fissure syndrome associated with VEXAS (vacuoles, E1 enzyme, X-linked, auto-inflammatory, somatic) syndrome.Case presentationVEXAS syndrome is a recently identified multi-system inflammatory disease of late adult onset. The authors describe the case of a 76-year-old man who presented with recurrent episodes of orbital inflammation, with superior orbital fissure syndrome, dacryoadenitis and orbital myositis. He had a constellation of systemic disorders including recurrent chest infections, congestive cardiac failure, pulmonary emboli and skin rashes. The underlying diagnosis of VEXAS syndrome was confirmed by genetic testing, which revealed the UBA1 mutation.ConclusionVEXAS syndrome should be considered in the differential diagnosis of orbital inflammatory disease associated with multi-system inflammatory disorders.

Effects of Azatioprine in Patients with Diagnosis of Intestinal Inflammatory Disease: A Systematic Review

Effects of Azatioprine in Patients with Diagnosis of Intestinal Inflammatory Disease: A Systematic Review

Research progress of exosomes in the diagnosis and treatment of sepsis

Sepsis is a life-threatening organ dysfunction caused by infection that lead to dysregulation of the host response. Sepsis and septic shock with a high mortality threaten human health at present, which are important medical and health problems. Early diagnosis and treatment decision-making for sepsis and septic shock still need to be improved. Exosomes are extracellular vesicles with a diameter of 30-150 nm formed by the fusion of multi-vesicle bodies and cell membranes. Exosomes can effectively transport a variety of bioactive substances such as proteins, lipids, RNA, DNA, and participate in the regulation of inflammatory response, immune response, infection and other pathophysiological processes. In recent years, exosomes have become one of the important methods for the diagnosis and treatment of systemic inflammatory diseases. This article will focus on the basic and clinical research of sepsis, and focus on the research progress of exosomes in the diagnosis and targeted therapy of sepsis.

Can rheuma be scanned? : Review of the current study situation on fluorescence optical imaging

The novel technique of indocyanine green (ICG)-based fluorescence optical imaging (FOI) using the Xiralite® system (Rheumascan) has been the subject of many different studies worldwide since approval for clinical use in the European Union (2009), USA (2014) and Asia. The FOI depicts the disturbed microcirculation in the joints of both hands caused by inflammation. The aim of this article is to provide an overview of the current state of studies on ICG-based FOI in different rheumatologic indications. Anarrative literature review of publications on ICG-based FOI in the diagnosis of various inflammatory rheumatic joint diseases since 2010 is presented, its use in treatment monitoring is explained, and its value in systemic sclerosis is outlined. In summary, studies have extensively demonstrated the accuracy of FOI in inflammation detection. Therefore, it can be concluded that FOI is agood supplement to existing imaging modalities. Due to characteristic patterns of both skin and nails, FOI is an indicated procedure especially in psoriatic arthritis and can be very helpful in the diagnostic process in early undifferentiated arthritis. The FOI has shown its usefulness in children (juvenile idiopathic arthritis), for monitoring the course of treatment, and for demonstrating disturbed microcirculation in patients with systemic sclerosis. The presented data imply that FOI should be considered as avaluable complementary imaging tool in the diagnostic algorithm of daily rheumatologic practice, both for diagnosis and for follow-up monitoring. In particular, the automated analyses should be able in the future to objectify measurements of inflammatory activity as well as monitoring the response to treatment.

Enhanced production and single step purification of biologically active recombinant anti-IL6 scFv from Escherichia coli inclusion bodies

Interleukin 6 (IL-6) is a proinflammatory cytokine that plays a critical role in immune responses and inflammation. Overexpression of IL-6 serves as a biomarker for various diseases. Therefore, it is vital to develop IL-6-specific antibodies for the diagnosis and treatment of inflammatory diseases. Alternatively, high-yield production of single-chain variable fragments (scFv) in prokaryotes reduces the time and cost required while attaining a similar specificity. However, overexpression of eukaryotic proteins in bacterial expression systems often leads to the formation of inclusion bodies. Here, a codon-optimized anti-IL6 scFv was expressed in the E. coli SHuffle strain, and the effects of inclusion body solubilisation methods on the product yield were investigated. A high concentration (23 mg/L) of biologically active and pure (>95 %) scFv was obtained without any need for a refolding step following solubilisation with a non-denaturing solubilisation agent, N-lauroyl sarcosine. Activity assays showed that anti-IL6 scFv could specifically bind to its antigen. Overall, we present reproducible and efficient production of anti-IL6 scFv in E. coli by using a one-step purification method. While the biologically active and pure antibody fragment can be used for diagnostic studies of the IL-6 cytokine, the developed method can be applied to other recombinant proteins expressed in E. coli.

E55 Macrophagic activation syndrome in pediatric rheumatology: about 12 cases

Abstract Introduction Macrophage activation syndrome (MAS) is a serious clinical condition due to inappropriate stimulation of macrophages. It can be primary or secondary to underlying neoplastic, infectious or autoimmune diseases. Some pediatric inflammatory diseases are highly complicated by MAS with a higher incidence in systemic juvenile idiopathic arthritis (SJIA) or systemic lupus erythematosus (SLE). Objective We aim to highlight the features of MAS occurring in the context of pediatric inflammatory diseases according to our epidemiology and local conditions. Materials and methods This is a retrospective, descriptive and analytical study seen over a period of 4 years (from January 2019 to December 2022). The diagnosis of MAS was confirmed according to Ravelli criteria published in 2016 in the presence of mandatory persistent fever and at least four of the following abnormalities: hyperferritinemia&amp;gt; 684 ng/ml, platelet count &amp;lt; 181x103/mm3, liver cytolysis aspartate amino transferase (AST) &amp;gt; 48UI/l, triglyceridemia &amp;gt; 1.56 g/l, fibrinogenemia &amp;lt; 3.6 g/l, after having ruling out infections. The presence of hemophagocytes in the bone marrow aspiration was considered sufficient for the diagnosis in presence of long lasting fever. Results Among 70 patients followed for inflammatory disease, 12 presented with MAS. The age of the patients ranged from 8 months to 17 years during the MAS episode, with a mean age of 8 years 9 months and male: female ratio was 1.4 (7 boys/5 girls). All patients had fever and altered general condition, two had associated hemorrhagic syndrome. On clinical examination, 3 patients had splenomegaly, 3 had hepatomegaly, 2 of which combined splenomegaly and hepatomegaly. Adenopathies were reported in 3 patients. No patient had jaundice or neurological signs. Biological parameters revealed a platelet count&amp;lt; 181 000/mm3 in 58.3% (7 cases), an AST level &amp;gt; 48IU/l in 91,6% (11 cases), hypertriglyceridemia &amp;gt; 156mg/l in 69.2% (9 cases), hypofibrinogenemia &amp;lt; 360 mg/dl in 66.6% (8 cases), and hyperferritinemia &amp;gt;684 ng/ml in 91,6% (11 cases). Eight had bone marrow aspiration, which was inflammatory in 37.5%, normal in 37.5% and hemophagocytosis in 25%. In our series, MAS preceeded the diagnosis of paediatric inflammatory disease in 9 patients, and complicating the evolution of an inflammatory disease in 3 patients. The main aetiology was SLE in 58.3% (7 cases). Other causes were reported such as SJIA in 1, NLRC 4 deficiency without genetic confirmation in 1, PIMS in 1, primary immune deficiency with hypogammaglobulinemia and sarcoidosis like picture in 1 and one case of primary MAS. Recurrence was noted in 3 patients, including 1 SLE, 1 primary MAS and the NLRC 4 deficiency. All patients received bolus intravenous corticosteroids, followed by oral corticosteroids which was weaned off over a period of four months if no disease progression. Ciclosporin A was added to corticosteroids in 4 (33,3%). Biotherapy was administered to 2 patients, the first with NLRC4 deficiency, who received Tocilizumab and infliximab before responding favorably to anakinra 10 mg/kg/d. The second for a PIMS complicated by severe MAS, who received Tocilizumab once without any improvement before switching to anakinra 2 mg/kg/day for 4 months with complete remission. Conclusion and Discussion MAS is a severe syndrome, characterized by non-specific clinical and biological signs, making the diagnosis very difficult. Recently, clinical and biological criteria have been proposed according to the disease, however, the most discriminating biological parameter is hyperferritinemia. This condition must be detected and treated without delay to avoid death. Our series is characterized by the predominance of SLE as the major aetiology of MAS, by its inaugural presentation worsening the prognosis of the underlying inflammatory disease probably related to a delay in consultation, by the low percentage of hemophagocytes in bone marrow aspiration, which could be explained by a lack of knowledge on the part of our cytologists and by a low use of biotherapies.

Advancing Precision Medicine in Myocarditis: Current Status and Future Perspectives in Endomyocardial Biopsy-Based Diagnostics and Therapeutic Approaches.

The diagnosis and specific and causal treatment of myocarditis and inflammatory cardiomyopathy remain a major clinical challenge. Despite the rapid development of new imaging techniques, endomyocardial biopsies remain the gold standard for accurate diagnosis of inflammatory myocardial disease. With the introduction and continued development of immunohistochemical inflammation diagnostics in combination with viral nucleic acid testing, myocarditis diagnostics have improved significantly since their introduction. Together with new technologies such as miRNA and gene expression profiling, quantification of specific immune cell markers, and determination of viral activity, diagnostic accuracy and patient prognosis will continue to improve in the future. In this review, we summarize the current knowledge on the pathogenesis and diagnosis of myocarditis and inflammatory cardiomyopathies and highlight future perspectives for more in-depth and specialized biopsy diagnostics and precision, personalized medicine approaches.