Increased Sedimentation Rate Research Articles

Use of 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients affected by polymyalgia rheumatica and persistent increase of acute phase reactants.

Polymyalgia rheumatica (PMR) is an inflammatory disease affecting older adults characterized by aching pain and morning stiffness of the shoulder and pelvic girdles. Moreover, PMR can be associated with giant cell arteritis (GCA). Generally, PMR is highly responsive to steroids, reaching complete remission in the majority of cases. However, the possibility of occult diseases, including extra-cranial GCA, should be excluded. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is able to detect the presence of peri-/articular or vascular inflammation, which may be both present in PMR, thus representing a useful diagnostic tool, mainly in presence of extra-cranial GCA. We retrospectively evaluated all consecutive patients who received the diagnosis of PMR in our rheumatology clinic, classified according to the 2012 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria, in the period between April 2020 and May 2022. Among this case series, we selected the patients who underwent 18F-FDG-positron emission tomography (PET) because of the persistent increase of acute phase reactants (APR) besides the steroid therapy. Eighty patients were diagnosed with PMR. Nine out of them also presented arthritis of the wrists during the follow-up, whereas none showed signs of cranial GCA at the diagnosis. Seventeen out of eighty subjects (mean age 71.5 ± 7.5 years; M/F 2/15) presented persistent increase of erythrocyte sedimentation rate (mean ESR 44.2 ± 20.8 mm/h) and/or C-reactive protein (mean CRP 25.1 ± 17 mg/l), thus they underwent total body 18F-FDG-PET/CT. Large vessel 18F-FDG uptake indicating an occult GCA was found in 5/17 (29.4%) cases. Twelve out of seventeen (70.6%) patients showed persistence of peri-/articular inflammation, suggesting a scarce control of PMR or the presence of chronic arthritis. Finally, in 2 cases, other inflammatory disorders were found, namely an acute thyroiditis and a hip prosthesis occult infection. 18F-FDG-PET/CT in PMR patients with persistent increase of APR is a useful diagnostic technique in order to detect occult GCA, persistence of active PMR or other misdiagnosed inflammatory diseases.

Foreland basin response to middle Cretaceous thrust belt evolution, southwestern Montana, USA

Abstract The middle Cretaceous Blackleaf Formation records the first major transgressionregression of the Western Interior Seaway into the southwestern Montana retroforeland basin. Although Blackleaf sedimentology is well documented, sediment provenance and potential linkages with regional tectonics are not. Recent characterization of hinterland tectonics, fold-thrust belt detrital zircon signatures, and advances in high-n detrital zircon analysis allow for significant provenance refinement. We present new detrital zircon ages (n = 5468) from ten samples from the upper Blackleaf Formation (Intervals C and D) in southwestern Montana. Based on maximum depositional ages, sedimentation spanned from 106 to 92 Ma. Jurassic and Cretaceous grains were primarily derived from the older portion of the Cordilleran magmatic arc in western Idaho. Triassic and older grains were recycled from older central Idaho sedimentary strata inboard of the arc. Three depositional stages are identified based on statistical modeling of detrital age distributions. Stage 1 (106–104 Ma) records sourcing from lower Paleozoic strata in central Idaho. Stage 2 (105–101 Ma) records initial unroofing of upper Paleozoic–Triassic strata via propagation of the fold-thrust belt into eastern Idaho, accommodating shortening of Mississippian and younger rocks above the Lemhi Arch. Stage 3 (102–100 Ma) records continued unroofing in central Idaho down to Cambrian stratigraphic levels and distal mixing of sources in the eastern part of the basin. Exhumation in the fold-thrust belt beginning at ca. 105 Ma is coincident with marginwide fault slip-rate increases. We infer that increased sedimentation rates and lowmagnitude flexural loading from shallow thrusting in eastern Idaho drove clastic wedge progradation across the basin.

Effects of frequent debris flows on barrier lake formation, sedimentation and vegetation disturbance, Palongzangbo River, Tibetan Plateau

In incised mountain valleys, debris flows often cause damage to vegetation, especially when debris flows form fans or block receiving rivers. In such contexts, riparian trees may be partially buried in aggrading fans or temporary lakes. The Guxiang gully is the largest debris flow system along the Palongzangbo River on the Tibetan Plateau and at least 13 debris flows (volume > 104 m3) have occurred since 1953. Four of these debris flows (in 1953, 1965, 1975 and 2005) dammed the river forming a barrier lake which is now more than 25 km in length. The repeated damming by debris flows has increased the dam height and thereby affected the sedimentation rates in the barrier lake. The frequent debris flow activity has prevented vegetation recovery on the fan, while sedimentation in the barrier lake has allowed vegetation to colonize the deltas. This study investigated the effects of frequent debris flow damming on sedimentation rates as well as on revegetation and tree disturbance along the river. We documented the landscape evolution and measured the sedimentation thickness and grain size of deposited material at different locations of the barrier lake using cores. We also collected and analyzed growth-ring records from disturbed trees on the fan and the deltas of the barrier lake. We found that frequent debris flows had created a stepped river morphology and greatly increased sedimentation rates in the lake, affecting vegetation on the fan and behind the dam.

81 Juvenile RHUPUS syndrome: a case reports

BackgroundRHUPUS syndrome is a rare association with rheumatoid arthritis and systemic lupus erythematosus (SLE) in adult patients. Its pediatric presentation is very rare and underdiagnosed. The mechanism is not well understood yet, but most theories accepted a real overlap between SLE and juvenile idiopathic arthritis. In children. Patients with Rhupus have clinical symptoms of SLE with positive ANA, anti-DNA or anti Sm associated with clinical symptoms of JIA.ObjectiveIllustrate an unusual presentation of lupus in childrenMethodswe present a case of juvenile rhupus syndrome; we describe the clinical presentation, the serological results, the diagnostic criteria for SLE (ACR 1997) and JIA (ILLA 2001) and the treatment installed.Case reportsWe recently diagnosed Rhupus syndrome in an 11-year-old girl who presented with polyarthritis deformans of the bilateral joints of the wrists, hands and feet for 24 months. she also had an onset of profound asthenia, recurrent oral aphtosis and massive hair loss over the past few months. Initial investigation showed anaemia, increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Radiographic examinations showed juxtra-articular osteopenia and chronic synovitis of the wrists. The autoimmune assessment was contributory with a positive rheumatoid factor (RF), antinuclear antibodies (ANA) (1/1000) and positive anti-Sm antibodies. Anticardiolipin and anti-RNP antibodies were negative. Our patient met >4 ACR criteria for SLE classification. She was treated with methotrexate and hydroxychloroquine, under close medical supervision in order to watch for the appearance of other organic damage to lupus disease, in particular renal and neurological. This type of joint damage is considered to be either lupus joint damage, lupus with chronic arthritis, or overlapping lupus with JIA. Children with Rhupus initially present with JIA and later develop lupus. Previous reports have shown female predominance, polyarticular involvement, non-erosive arthritis, and years of diagnostic wandering. Our patient had polyarthritis deformans with a two-year delay in diagnosis of SLE.ConclusionAlthough rare, the infantile Rhupus syndrome must be evoked in front of a deforming arthropathy.

Type I interferon signature as a possible new marker for stratification of patients with juvenile idiopathic arthritis.

The interferon score (IS) quantifies the expression of interferon-stimulated genes in peripheral blood, providing an indirect estimate of interferon-mediated inflammation in rheumatological disorders. This study explores the clinical significance of IS among a cohort of patients affected by juvenile idiopathic arthritis (JIA) and its relevance to disease stratification and prognosis. All patients referred to the Rheumatology Service of the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy, with a diagnosis of JIA (2001 ILAR criteria) were consecutively recruited. Systemic JIA was excluded. Demographic, clinical and laboratory data were collected for each patient in a structured database. Categorical variables were expressed as numbers (%) and compared by the χ2 test or Fisher's exact test. Principal Component Analysis (PCA) was performed with clinical and laboratory data. Forty-four patients were recruited (35 F, 9 M): 19 polyarticular, 13 oligoarticular, 6 oligoarticular-extended, 5 psoriatic and 1 enthesitis-related arthritis. Sixteen had a positive IS (≥3). Increased IS correlated with a higher number of involved joints ≥5 (p=0.013), increased erythrocyte sedimentation rate (ESR) (p=0.026) and hypergammaglobulinaemia (p=0.003). PCA highlighted a subgroup of patients who shared high levels of IS, ESR, C-reactive protein, hypergammaglobulinaemia, JADAS-27, polyarticular involvement and family history of autoimmunity. Although based on a small case series, our results may support the role of IS in better defining a subgroup of JIA subjects with stronger autoimmune features. The possible relevance of these results for therapeutic stratification remains to be explored.

Clinical-epidemiologic and serologic characteristics of Lyme disease in the Zaporizhzhia region (a retrospective analysis for 2015–2019 according to the Municipal Institution “Regional Infectious Hospital” of Zaporizhzhia Regional Council)

The aim of the work is to clarify the clinical and laboratory features of Lyme disease in the Zaporizhzhia region on the basis of a retrospective clinical, epidemiological and serological analysis of this disease cases in the period from 2015 to 2019. Materials and methods. A retrospective analysis of 62 medical cards of stationary patients with Lyme disease for the period from 2015 to 2019 was carried out. The age of the patients ranged from 18 to 79 years. There were 38 men and 24 women. All the patients were given a traditional complex clinical-laboratory examination; ELISA was used to defined serum IgM and IgG to Borrelia burgdorferi. Results. According to the study results it was found that Lyme disease in the Zaporizhzhia region had a clear seasonal prevalence in summer (56.5 %) and spring (25.8 %). The vast majority of patients (80.6 %) clearly indicated the tick bite. The disease was mostly acute (90.3 %) with a predominance of erythema (94.6 %). In the acute course of the disease, patients were seropositive in 75.0 % of cases with simultaneous detection of both IgM and IgG to Borrelia burgdorferi, and positive IgM in the absence of IgG. Seronegative 25.0 % of patients required clear clinical and epidemiological data to confirm the diagnosis. Under prolonged and chronic conditions, patients had positive IgG to Borrelia burgdorferi (100 %) and IgM (50.0 %). Certain clinical and laboratory features at different course of Lyme disease were revealed. So, the acute course was characterized by the predominance of erythema (94.6 %), mild or no manifestations of general intoxication syndrome, lack of pathological changes in the hemogram in most patients (80.4 %). In the prolonged and chronic course, there was no history of erythema, clinical symptoms were polymorphic, half of the patients had increased erythrocyte sedimentation rate in the absence of changes in blood count, mild cytolytic syndrome and hyperbilirubinemia. Conclusions. As a result of the retrospective analysis of Lyme disease cases in the period from 2015 to 2019, certain patterns of epidemiological, clinical and serological changes in different courses of this infection in the Zaporizhzhia region were revealed, namely the clear seasonality of the disease, in the acute course – the predominance of erythema and different variants of serological profile in patients, and in prolonged and chronic course – polymorphism of all clinical symptoms and no history of erythema.

Postglacial shelf erosion, riverine input and lake drainage in the eastern Kara Sea, Russia

Marine sediment core PS2719-1 represents a key sedimentary record for the reconstruction of the postglacial shelf evolution of the eastern Kara Sea west of the entrance to the Vilkitsky Strait. Sedimentological, chronological, geochemical, mineral magnetic and micropaleontological data were used to investigate the sedimentary evolution of the area in unprecedented detail. Four phases of sedimentation were identified, which are closely related to sea-level rise and input from the Yenisei and Taymyr Rivers. Sedimentation likely commenced directly after regional deglaciation prior to 13.6 cal ka BP. Basal sediments are coarse grained and rich in terrestrial organic matter, which points to shelf erosion as the dominating sedimentation process. Around 13.6 cal ka BP Yenisei River water masses reached the area, causing a shift in heavy mineral assemblages and a distinct peak in magnetic susceptibility. This phase was followed by increased sedimentation rates during the early Holocene, which were related to high sediment supply from Lake Taymyr, possibly due to the opening of an ice dam in the Lower Taymyra River area. These sediments are characterized by high terrestrial organic matter accumulation, a fine-grained composition, and a heavy mineral assemblage reflecting the sediment source on the Taymyr Peninsula. High burial rates are reflected by high Mn contents. The transition to modern conditions commenced already around 8.5 cal ka BP and were fully established at ca. 5 cal ka BP, being documented in mineral magnetic evidence and foraminiferal assemblages and are characterized by more marine conditions and a strong influence of the Yenisei River.

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Morphoevolution of the Seymareh landslide-dam lake system (Zagros Mountains, Iran): Implications for Holocene climate and environmental changes

The Seymareh landslide is the largest rock slope failure (44 Gm3) ever recorded on the exposed Earth surface. It detached at ∼10 ka from the northeastern flank of the Kabir-Kuh anticline (Zagros Mountains, Iran) creating a natural dam responsible for the formation of a lake system that persisted for ∼3 kyr during the early and mid-Holocene before its emptying phase caused by overflow. The chronology of its demise and connection to the Holocene climate variations have been barely studied. To reconstruct the influence of local vs. regional environmental changes upon the lake history and unravel their contribution on the lake overflowing phase, we analyzed 13 samples extracted from a 30-m-thick lacustrine succession belonging to Seymareh Lake. We performed grain size analysis, carbon and oxygen stable isotopes of carbonate-bearing sediments, and X-ray diffraction analysis of clay minerals, in addition to the geomorphological analysis to reconstruct the lake system morphoevolution. Main results highlight that the lake infilling phase was characterized by a first period (from 9.73 ± 0.13 to 7.37 ± 0.73 ka) with a median sedimentation rate of ~2 cm yr−1 and a second period (from 7.37 ± 0.73 to 6.98 ± 0.39 ka) marked by an increased sedimentation rate up to ~10 cm yr−1. The age of 6.98 ± 0.39 ka is here considered as the termination of lacustrine sedimentation and the beginning of lake emptying and new valley entrenchment. Stable isotope and X-ray diffraction analyses confirm a stable humid interval after the early-mid Holocene arid to humid transition, consistent with other regions of the Middle East. During this transition, rainfall seasonality and its inter-annual irregularity may have prevented the development of a widespread vegetation cover that likely favored the increase of denudation rates on hillslopes and sediment supply along connected channels network. Therefore, the sedimentation rate increased within the downstream lake basin. However, in the late infilling phase from ~7.6–7.32 ka, local high energy hydroclimatic events, characterized by high sand content and low δ18O concentration, were recorded more frequently. This could justify a sudden increase in the tributaries' discharge that culminated at ~7.3 ka because of the complete overflow of Jaidar Lake into Seymareh Lake likely causing the overflowing of the entire Seymareh landslide-dam lake system.

Anti-inflammatory properties of the extract of maruna virgin (Tanacetum parthenium L.) on the model of chronic inflammation modeled by the Freund’ adjuvant in rats

Еhe aim of the study was to investigate the effectiveness of a thick extract of feverfew (Tanacetum parthenium L.) herb in chronic inflammation (adjuvant arthritis) in rats.
 The anti-inflammatory properties of the water-alcohol thick extract of feverfew (Tanacetum parthenium L.) herb (ETP) were studied in the model of adjuvant arthritis (ADA) (0.1 ml of Freund's adjuvant (PAF), once subcutaneously at the base of the tail of white nonlinear male rats (body weight 200–220 g). After 7 days, the introduction of PAF was repeated (subcutaneously in the right hind paw of rats). The animals were divided into 4 groups of 9 rats each, in the intact group – 6 animals. Distilled water (1 ml/100 g) was administered to positive control animals (PCs) on the background of pathology. An aqueous solution of ETP (50 mg/kg) and diclofenac sodium (1% starch suspension, 8 mg/kg) were administered from day 1 of the experiment and for four weeks daily intragastrically once daily. The volume of the affected foot (V) was measured using a LE7500 plethysmometer (PANLAB, Italy) in dynamics – at 1, 5, 10, 15, 20, 25 and 30 days after administration of a permissive dose of PAF. The intensity of inflammation in rats was assessed by peripheral blood parameters, biochemical indicators - markers of the inflammatory process. Statistical analysis of data was performed using the standard software package «Statistica v. 6.0». Differences between groups were considered statistically significant at p <0.05.
 The course of ADA was characterized by the development of systemic inflammation, as evidenced by an increase in the number of leukocytes, increased erythrocyte sedimentation rate (ESR) and the content of C-reactive protein (CRP). A statistically significant increase in the level of LF and sialic acids indicates membrane-destructive processes in connective tissue. Against the background of ETP significantly decreased the level of the main indicator of inflammation CRP 2 times, the content of markers of destruction of joint tissue – sialic acid and LF decreased by 1.9 times relative to PC animals, indicating a positive effect on local and systemic manifestations of inflammation in ADA. The effectiveness of ETP was not inferior to diclofenac sodium (DS).
 Based on the data obtained, it can be concluded that the studied ETP at a dose of 50 mg/kg in the ADA model in rats has a pronounced anti-inflammatory effect and is not inferior to diclofenac sodium, which makes it promising further research as an effective anti-inflammatory agent.

Changes in coral reef community structure along a sediment gradient in Fouha Bay, Guam

High sedimentation rates have well-documented, deleterious impacts on coral reefs. However, few previous studies have attempted to quantitatively describe a coral reef community across a large continuous sediment gradient. In this study distinct benthic assemblages in Fouha Bay, Guam, were identified using a Moving Window Analysis conducted along a two-order of magnitude sediment gradient, with transition boundaries that were generally consistent with sediment thresholds identified in the literature. Coral richness dropped exponentially with increasing sedimentation rate. Richness was nearly three times greater in assemblages with sedimentation rates <10 mg cm−2 d−1 compared to assemblages experiencing rates between 10 and 50 mg cm−2 d−1, and nearly 30 times greater than assemblages experiencing rates between 50 and 100 mg cm−2 d−1. No corals were found in assemblages with sedimentation rates >110 mg cm−2 d−1. Reducing sedimentation in this area could result in a shift of more diverse and abundant coral assemblages toward the head of the bay.

Selected hematological abnormalities and their associated factors among asthmatic patients in Northwest Ethiopia: a cross-sectional study

BackgroundAsthma is a chronic inflammatory disease that affects the lungs. Variation in whole blood cell lines is caused by the progression and severity of asthma. Common hematological abnormalities encountered during asthma include eosinophilia, neutrophilia, leukocytosis, and increased erythrocyte sedimentation rate. The main aim of this study was to assess the selected hematological abnormalities and their associated factors among asthmatic patients in Northwest Ethiopia from March to May 2021.MethodologyA hospital-based cross-sectional study was conducted on a total of 320 asthmatic patients in Northwest Ethiopia. A simple random sampling technique was employed to select study participants. A pre-tested structured questionnaire and a checklist were used to collect data. Blood samples were collected from asthmatic patients for complete blood count and erythrocyte sedimentation rate determination. Hematological profiles were analyzed by Unicel DxH 800 (Beckman Coulter, Ireland). The erythrocyte sedimentation rate was determined by using the Westergren method. The data were entered into EpiData version 3.0.4 and analyzed with a statistical package for social science version 20 software. The bi-variable and multi-variable binary logistic regression models were used to assess the factors associated with hematological abnormalities. A p value of less than 0.05 in the multivariable logistic regression analysis was considered statistically significant.ResultsThe overall prevalence of neutrophilia, eosinophilia, thrombocytopenia, leukocytosis, and basophilia was 35.3%, 20%, 11.9%, 10.3%, and 4.1%, respectively. Neutrophilia was associated with a lack of physical activity (AOR = 3.25; 95% CI 1.43–7.37) and a history of taking non-asthmatic drugs within the previous three months (AOR = 2.63; 95% CI 1.22–5.65). Being admitted to the emergency department (AOR = 0.27; 95% CI 0.11–5.67) was found to be associated with eosinophilia. In addition, being admitted to the emergency department (AOR = 5.44; 95%CI: 2.6–11.3) was associated with thrombocytopenia.ConclusionThe current study demonstrated the predominant prevalence of neutrophilia, followed by eosinophilia, among asthma patients. Therefore, hematological abnormalities should be taken into account for proper monitoring and management of asthmatic patients.

Administration of chemically ripened banana (Musa acuminate) juice to male Wistar rats depletes blood cells via impaired hematopoiesis

The use of chemicals such as calcium carbide to ripen fruits instigates toxicity; inclusion of the chemically ripened fruits in the preparation of juices may induce blood cells depletion by altering hematopoiesis via declined functionality of erythropoietin, leukopoietin, thrombopoietin, interleukin-3, prostaglandins, hematopoietic stem cells; resulting to reduction in cellular components of blood. The blood cell depletion potentials of chemically ripened banana juice were investigated in 20 male Wistar rats categorized into four; Group A (control), Group B (administered naturally ripened banana juice), Group C &amp; D (administered juices composed of 15mg/kg and 25mg/kg of calcium carbide ripened banana) (n=5). Following the administration protocol of the banana juice for 28days, data was obtained and statistically analyzed using GraphPad prism (version 8). Chemically ripened banana juices significantly decreased erythropoietin, leukopoietin, thrombopoietin, interleukin-3, prostaglandins (PGE2), hematopoietic stem cells and cellular components of blood in a dose-dependent manner. Reduction in packed cell volume (PCV), hemoglobin concentration and increase in erythrocyte sedimentation rate (ESR); which suggests indication of anemia and red blood cell inflammation were also observed. The study suggests that chronic consumption of calcium carbide ripened banana juices induces alteration of hematopoiesis which results to depletion of blood cells.

Serology and Comorbidities in Patients With Fracture Nonunion: A Multicenter Evaluation of 640 Patients.

This multicenter cohort study investigated the association of serology and comorbid conditions with septic and aseptic nonunion. From January 1, 2011, to December 31, 2017, consecutive individuals surgically treated for nonunion were identified from seven centers. Nonunion-type, comorbid conditions and serology were assessed. A total of 640 individuals were included. 57% were male with a mean age of 49 years. Nonunion sites included tibia (35.2%), femur (25.6%), humerus (20.3%), and other less frequent bones (18.9%). The type of nonunion included septic (17.7%) and aseptic (82.3%). Within aseptic, nonvascular (86.5%) and vascular (13.5%) nonunion were seen. Rates of smoking, alcohol abuse, and diabetes mellitus were higher in our nonunion cohort compared with population norms. Coronary artery disease and tobacco use were associated with septic nonunion (P < 0.05). Diphosphonates were associated with vascular nonunion (P < 0.05). Serologically, increased erythrocyte sedimentation rate, C-reactive protein, parathyroid hormone, red cell distribution width, mean platelet volume (MPV), and platelets and decreased absolute lymphocyte count, hemoglobin, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and albumin were associated with septic nonunion while lower calcium was associated with nonvascular nonunion (P < 0.05). The presence of four or more of increased erythrocyte sedimentation rate, C-reactive protein, or red cell distribution width; decreased albumin; and age younger than 65 years carried an 89% positive predictive value for infection. Hypovitaminosis D was seen less frequently than reported in the general population, whereas anemia was more common. However, aside from hematologic and inflammatory indices, no other serology was abnormal more than 25% of the time. Abnormal serology and comorbid conditions, including smoking, alcohol abuse, and diabetes mellitus, are seen in nonunion; however, serologic abnormalities may be less common than previously thought. Septic nonunion is associated with inflammation, younger age, and malnourishment. Based on the observed frequency of abnormality, routine laboratory work is not recommended for nonunion assessment; however, specific focused serology may help determine the presence of septic nonunion.

Quantitative assessment of left ventricular systolic function in patients with systemic lupus erythematosus: a non-invasive pressure-strain loop technique.

Systemic lupus erythematosus (SLE) is associated with a variety of cardiovascular diseases, even in the early stage of disease development. The purpose of this study was to quantitatively evaluate left ventricular (LV) systolic function in patients with SLE using a novel non-invasive pressure-strain loop (PSL) technique. This prospective case-control study included 132 patients with SLE and 99 normal controls, all of whom underwent traditional transthoracic echocardiography. The LV myocardial work was evaluated with the PSL technique based on speckle tracking and brachial artery blood pressure. The differences among groups were compared, and the correlations between myocardial work, laboratory data, and disease activity were analyzed in the SLE group. Compared with the normal group, SLE patients had significantly higher global wasted work {GWW; SLE: 109 [82-150] mmHg%; controls: 66 [45-109] mmHg%; P<0.001} and impaired global work efficiency [GWE; SLE: 95% (94-97%); controls: 97% (96-98%); P<0.001]. Global work index (GWI) and global constructive work (GCW) did not show significant differences (P>0.05). Further subdivision analysis found that the increase of GWW and the damage of GWE were more obvious in SLE patients with high disease activity or severe diastolic dysfunction. Multivariate analysis revealed that increased erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-phospholipid antibodies, peak strain dispersion, and SLE Disease Activity Index (SLEDAI) were independently associated with increased GWW (β=0.189, 0.230, 0.444, 0.111, and 0.180, respectively; all P<0.05) and damaged GWE (β=-0.184, -0.130, -0.468, -0.149, and -0.191, respectively; all P<0.05). The non-invasive PSL can quantitatively evaluate the LV systolic function in SLE patients. This technique may provide a new method for monitoring cardiac function in chronic diseases.

Structure of cardiac pathology and some comorbidities, clinical, anamnestic, laboratory and functional characteristics of patients with СOVID-19 (own experience)

Objective. Ɍo study clinical, anamnestic, laboratory and functional indices of patients (pts) with COVID-19 who hospitalized in the transformed unit on the basis of the department of myocardial infarction (MI) and cardiac rehabilitation (CR). Materials and methods. The study included 36 pts with COVID-19: the 1 st group (n = 19) consisted of pts ≤ 65 (57.8 ± 7.8) years, the 2nd group (n = 16) -&gt; 65 (72.5 ± 7.0) years. 4 pts were transferred to the intensive care (2 of them died). Biochemical data, blood samples, indices of ECG, EchoCG, blood oxygen saturation were analyzed. 25 pts underwent computed tomography (ɋɌ). Ferritin, procalcitonin and troponin levels were determined according to indications. In addition to cardiac drugs, medications to treat COVID-19 were prescribed. All pts received pronoposition, oxygen support, exercise therapy, apparatus breathing exercises with resistance on inhalation and exhalation as CR. Results. Arterial hypertension (AH) was diagnosed in 15 (78.9%) pts in the 1st group and in 14 (87.5%) pts in the 2nd group, diabetes mellitus (DM) - in 3 (15.8%) and 5 ( 31.3%) pts, atrial fibrillation (AF) - in 10 (52.6%) and 14 (87.5%) (ɪ=0.03), heart failure (HF) above stage I - in 7 (36.8 %) and in 13 (81.2%) pts (ɪ=0.01), respectively. There was a slight increase in erythrocyte sedimentation rate, growth of stab leukocytes and platelets up to (277,8±102,3 and 182,0±55,8)·109/l (ɪ=0,002) in 1st and 2nd group with decrease of lymphocytes. The CRP level increased almost in two times (9.2 ± 6.1 mg / ml) in 1st group and up to (15,6±7,6 mg / ml) in 2nd group (ɪ=0.01) with values of D-dimer 0,29 ± 0.13 and 0,85±0,23 ng / ml (ɪ=0.09), respectively. At the CT scan lung lesions was 27% and 41% (ɪ=0.06), respectively, without clear relationship with blood oxygen saturation: SpO2 at admission was 92% in both groups with an increase of more than 95% at discharge in patients of 1st group and in the majority of patients in 2nd group (ɪ=0,07). The patients were treated in accordance to the current protocols. The stay in clinic was 11.4 and 15.4 days in 1st in 2nd group. Conclusions1. At admission 30.6% of patients were in a serious condition, while a prehospital diagnosis of COVID-19 was established in 57.7%. 2. In the structure of cardiac pathology and comorbidity, acute infection with SARS COV-2 occurred on the background of AH in 82.9% of patients, AF - in 25.7%, heart failure stage IIA - in 57.1%, diabetes - 22.9%. Except of AH, these conditions were significantly more frequent in the group of older patients and were accompanied with higher levels of CRP (3 times higher than normal) and D-dimer, as well as the area of lung lesions according to CT (41% compared to 27% in the first group) in the absence of a relationship with the index of blood oxygen saturation, which increased from ≤92.0% to 94.9% in the older group and up to 97.6% in the group of patients ≤ 65 years of age at discharged.3. COVID-19 therapy was carried out due to current protocols in 2021. All patients received anticoagulants, 60% - dexamethasone (twice as often in group of older patients), 74.3% - vitamin D, 77.1% - antibiotics, with a longer stay (at 3 days) in the clinic in older patients.

Multiple Strictures of Small Intestine: Is It Crohn’s Disease?

Question: A previously healthy 43-year-old woman presented with epigastric pain and intermittent postprandial vomiting for 1 year. The patient denied any fever, night sweats, extraintestinal symptoms, and perianal disease. Physical examination was unremarkable. Initial laboratory values were within normal limits except for increased erythrocyte sedimentation rate (46 mm/h) and positive fecal calprotectin. Ileocolonoscopy revealed erosions in the terminal ileum. Biopsy specimens showed unspecific alterations with acute and chronic inflammation. Computed tomography enterography showed circumferential thickening and enhancement of the multiple segmental small intestinal walls, with luminal stricture and enlarged peripheral lymph nodes (Figure A). Subsequent interferon-γ release assay for Mycobacterium tuberculosis was negative and no tuberculous lesions were found on a computed tomography scan of the chest. What is the most likely diagnosis? See the Gastroenterology web site () for more information on submitting your favorite image to Clinical Challenges and Images in GI. Owing to the symptoms of mechanical obstruction and diagnostic uncertainty, a decision was made to undertake a surgical approach. Laparoscopy confirmed 8 segments of thickened intestinal wall between 5 and 200 cm proximal to the ileocecal valve, accompanied by numerous white, miliary nodules on the mesenterium and intestinal wall (Video). Focally stenosis was found (Figure B) and partial intestinal resection was obtained followed by end-to-side anastomosis. Macroscopic examination showed a circumferential ulcer (Figure C, arrows). Pathology revealed numerous caseating granulomas throughout intestinal tissue, characterized by confluent granuloma, large granuloma, and granuloma with surrounding cuffing lymphocytes (Figure D). Additionally, the results of acid-fast staining (Figure E, circle) and polymerase chain reaction testing for M tuberculosis were positive. Hence, a firm diagnose of intestinal tuberculosis was made. HIV testing was negative. The patient is on a 1-year course of antituberculosis treatment with good response. Multiple diagnostic models have been developed regarding the differentiation of intestinal tuberculosis from Crohn’s disease.1He Y. Zhu Z. Chen Y. et al.Development and validation of a novel diagnostic nomogram to differentiate between intestinal tuberculosis and Crohn's disease: a 6-year prospective multicenter study.Am J Gastroenterol. 2019; 114: 490-499Crossref PubMed Scopus (33) Google Scholar An interferon-γ release assay is the most commonly used tool. Although this assay has very high specificity (>95%), the sensitivity is only approximately 80%, as in our case.2Pai M. Zwerling A. Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update.Ann Intern Med. 2008; 149: 177-184Crossref PubMed Scopus (1150) Google Scholar Persons with tuberculosis in high incidence countries (like China) often have advanced disease and are likely to be malnourished or infected with HIV. Anergy owing to advanced disease (which may be applicable to our patient), malnutrition, and HIV-associated immune suppression may decrease the sensitivity of interferon-γ release assays. Hence, it is a challenge to make the differential diagnosis between intestinal tuberculosis and Crohn’s disease. Multiple segmental involvement at small intestine, especially with a normal-appearing ileocecal valve are very unusual in intestinal tuberculosis.3Bae J.H. Park S.H. Ye B.D. et al.Development and validation of a novel prediction model for differential diagnosis between Crohn's disease and intestinal tuberculosis.Inflamm Bowel Dis. 2017; 23: 1614-1623Crossref PubMed Scopus (24) Google Scholar It is frequently misdiagnosed as Crohn’s disease preoperatively. As seen in this patient, exploratory abdominal surgery was usually required for the final diagnosis. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3MmVmM2EzMDEyNjRiZGU1NmI2Y2JmZDZiZGQ5NTliOSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcwOTExMjExfQ.isWS2Gk2qOguY5qIEWij4OJBJJuDXzRct5FoY4d49ZTUqfOvNyjzd1PuZwASlAVJpvWR_qEgLYpzjYhehlCMN4gTvH8mTzg_UwEDnoLexdCTsH7vGKnT_xuoZGKwhtNfM0gn4I4Egq4qkollG2UzWKHjesnMvmGKA4ConZhyqLtNlvkqdKFhWR5lW_6KLRIGLvHJqjRC6CcZlJyw1eaIBWQIyTRIqRLoQptMipd4z30ZuvX4XeDx6KNv8KIovkFSqXtDAPflPunRAUETprl6ZY0Gsakyh79bWf9_SLhN1jIiQnIqC_4AAE-EolCxqQA-zFICCCfw8QlB48Y4ITISHA Download .mp4 (16.47 MB) Help with .mp4 files Video

Clinical and Laboratory Parameters of Autoinflammatory Disorders in Single Tertiary Care Center.

Autoinflammatory diseases (AIDs) are disorders with an inborn error of innate immunity, characterized by recurrent episodes of fever and inflammatory attacks. The spectrum of AIDs is expanding, but there are no standardized clinical criteria for the diagnosis of the patients. This study aims at establishing the first autoinflammatory registry of an Iranian population focusing on the clinical and laboratory features that may help clinicians for a better understanding and diagnosis of these disorders. Clinical and laboratory characteristics of patients who were clinically and or genetically diagnosed with AIDs were collected during 15 years. The updated version of classification criteria from the Eurofever Registry was used for the clinical diagnosis. Twenty-eight patients (16 males and 12 females) with the mean±SD age of 28.03±14.49 years (from 2 to 68 years) were entered this study. About 29% were genetically diagnosed. Familial Mediterranean fever (FMF) was the most common diagnosis of the patients. Fever duration episodes were between 1-10 days. Some of the clinical manifestations from the most to the least common were as follows: arthralgia and arthritis (80%), myalgia (76%), coughs and shortness of breath (68%), fatigue (60%), abdominal pain (56%), increased erythrocyte sedimentation rate(ESR) (48%), and splenomegaly (24%). Here, we presented the most common clinical manifestations of Iranian AIDs who have registered in our AID registry which would be a useful guide for managing the same patients and also designing the future studies.

Mid to late Holocene sea-level rise and precipitation variability recorded in the fringe mangroves of the Caribbean coast of Panama

Throughout the Holocene, two of the most important factors involved in the evolution of tropical coastlines have been fluctuations in sea level and regional climates. The geological record provides insightful realizations of the complex interaction between these two factors, improving our understanding of the evolution of littoral zones. Here we present the sedimentary record of a mangrove swamp located in Punta Galeta, Caribbean coast of Panama. Through the conjunction of geochemical and biological sedimentary indicators, we reconstruct environmental dynamics of the area for the last ~5200 years. Between ~5200 and ~1800 cal yr B.P., the progressive dominance of carbonates and a decrease of mangrove pollen indicate increasing marine influence in the area, probably facilitated by a progressively drier climate. Between 3100 and 1800 cal yr B.P., the embayment was flooded by marine water resulting in a landward migration of mangroves. From ~1800 cal yr B.P. to present, the pollen and organic matter records indicate that mangrove vegetation belt recovered, contributing a large proportion of organic matter to the sediment and advancing the shoreline seaward. The maturation of the mangrove forest has resulted in a progradation process that offsets between 4 and 5 m of sea level rise occurred through the last ~5000 years. This process was facilitated by the progressive decrease in rates of sea level rise and by increasing sedimentation rates resulting from a higher accumulation of organic matter from the more vigorous vegetation and more terrigenic input associated with higher regional precipitation. The record of Punta Galeta demonstrates that the evolution of fringe mangroves throughout the Holocene has been mostly driven by sea level rise, which effects are potentially offset by erosion during times of high precipitation. Thus, across the Caribbean coast, precipitation regimes have played a pivotal role at defining the structure and function of mangrove communities. • Sea level rise has dominated coastal dynamics in Punta Galeta through the Holocene. • Mangroves have played a central role at counteracting sea level rise. • Precipitation variability has modulated the effect of sea level rise on the regional coastline.

Interleukin-6 at the Host-Tumor Interface: STAT3 in Biomolecular Condensates in Cancer Cells.

It was recognized over 30 years ago that the polyfunctional cytokine interleukin-6 (IL-6) was an almost invariant presence at the host-tumor interface. The IL-6 in the tumor microenvironment was produced either by the cancer cell or by host stromal cells, or by tumor-infiltrating immune cells, or all of them. IL-6 effects in this context included local changes in tumor cell-cell and cell-substrate adhesion, enhanced motility, epithelial to mesenchymal transformation (EMT), and changes in cell proliferation rates in both solid tumors as well as hematologic dyscrasias. Locally produced IL-6 enhanced cancer-targeting functions of tumor-infiltrating macrophages and immune cells. Additionally, the sex-biased phenotype of certain cancers [e.g., hepatocellular carcinoma (HCC) which is 3-5-fold more common in men] was related to the inhibition of macrophage-derived IL-6 production by estradiol-17β (E2). In many circumstances, locally produced IL-6 reached the peripheral circulation and elicited systemic effects such as cachexia and paraneoplastic syndrome (including fever, increased erythrocyte sedimentation rate, increased levels of C-reactive protein in serum, hypoalbuminemia). This review highlights the EMT produced by IL-6 in cancer cells, as well as mechanisms underlying sex bias in HCC, enhanced IL-6 expression in cancer cells resulting from mutations in p53, consequent alterations in STAT3 transcriptional signaling, and the newer understanding of STAT3 nuclear bodies in the cancer cell as phase-separated biomolecular condensates and membraneless organelles (MLOs). Moreover, the perplexing issue of discrepant measurements of IL-6 in human circulation using different assays, especially in patients undergoing immunotherapy, is discussed. Additionally, the paradoxical chaperone (enhancing) effect of anti-IL-6 “neutralizing” antibodies on IL-6 in vivo and consequent limitations of immunotherapy using anti-IL-6 mAb is considered.