Local Inflammatory Lesions Research Articles

Rationale for the topical use of a combination of diphenhydramine hydrochloride and lidocaine hydrochloride in the symptomatic treatment of histamine-dependent allergic and inflammatory skin reactions, accompanied by pruritus.

Allergic reactions caused by external factors are treated with medicinal products containing antihistamines, therefore their action is delayed in time. Combination of antihistamines and fast-acting analgesics may help to reduce discomfort associated with cutaneous reactions. To evaluate efficacy and safety of the combination topical gel containing diphenhydramine hydrochloride 20 mg/g and lidocaine hydrochloride 10 mg/g over placebo in the treatment of local skin inflammatory and allergic reactions. A study was a single-centre, single-dose, randomized, double-blind, two-treatment, two-period, two-sequence cross-over clinical trial (n = 44) in healthy subjects. Local skin inflammatory and allergic lesions were induced by the provocative test with histamine in healthy subjects. For all parameters recorded with the Visual Analogue Scale (VAS), the area under the curve (AUC) was calculated and the peak itch intensity was noted for every subject in response to the skin prick test. The primary endpoint of the study was the difference in AUC calculated from the intensity of itch for test product A (diphenhydramine hydrochloride 20 mg/g and lidocaine hydrochloride 10 mg/g, gel) and placebo product B. The results revealed that itching intensity AUC was significantly greater for product B than for product A, on average by 2.05 points. A decrease in itching intensity was observed from the second minute after application of the test product. The study provided evidence for differences in efficacy between the product tested and placebo.

Local skin inflammatory and allergic lesions – a clinician’s perspective

Local skin inflammatory and allergic lesions – a clinician’s perspective

Adverse Events and Vaccination: Extensive Local Reaction after Anatoxin Vaccine—A Case Report

Post-vaccine adverse reactions are unwanted medical events that concern both the public and healthcare professionals. The objective of this paper is to present a detailed analysis of the case of an extensive local adverse reaction after the administration of a vaccine dose containing diphtheria–tetanus anatoxins. A good knowledge of post-vaccine side effects allows for complete and correct diagnosis, as well as appropriate individualized recommendations. Such an approach contributes to restoring public confidence in vaccines and vaccinations. The patient was a 6-year-old boy, with a history of asthma under chronic treatment with corticosteroids. He developed extensive local inflammatory lesions accompanied by functional disorders of the left arm, which began six hours after the administration of the fifth dose of the diphtheria–tetanus–pertussis–poliomyelitis vaccine. The lesions, which extended to the forearm, were locally treated with antiseptics and systemically treated with hydrocortisone hemisuccinate. They completely remitted within 14 days. Laboratory investigations revealed neutrophilia (6,870 neutrophils/µL), which could be related to the long-term treatment with steroids. The investigation needed the plasma concentration of diphtheria and tetanus anatoxins antibodies and the pro-inflammatory cytokines to be complete.

INFLAMMATORY RESPONSE AND METABOLIC ADAPTATION IN CHILDREN WITH ACUTE RESPIRATORY PATHOLOGY.

The aim: To investigate the parameters change of the general immune responds and endocrine metabolism in the children with Acute Respiratory Pathology and their correlational relationship. Materials and methods: The study group included: school-age children (10-14 years old) with a diagnosis of acute respiratory disease (ARI) as a general group of respiratory tract inflammatory diseases, of viral and bacterial origin (n=40), which included local inflammatory lesions of the respiratory tract and presented with acute pharyngitis (60.0%), acute bronchitis (20%), acute tonsillitis (22%) and a control group (n=25), identical in age and sex. The research was conducted at the clinical base of the CNE «UCChH» of the Uzhhorod City Council. General clinical, immunological studies, inflammatory response of the child's body were conducted. Statistical analysis of the results of the examination of patients was carried out using the Statistics for Windows v.10.0 computer program (StatSoft Inc, USA). The evaluation of the obtained results was carried out using parametric and non-parametric methods. Results: The inflammatory response parameters of the child's organism present indicative increases in the levels of cytokines with a significant predominance in comparison with the data of the children control group: the level of IL-1 increased in 2 times, IL-4 - in10 times, IL-6 - in 1.5 times, γ-IFN - in 3 times, TNFα - in 25 times, Neopterin - in 9 times. The data of the general immune response indicate a 2-times increasing in the level of IgM (3.85 ± 1.89 g/l, p<0.01) and IgG level increased in 10 times (147, 35 ± 56.12 g/l, p< 0.01). The, according to the obtained data but, in comparison with the data of the control group. There are significant differences in the levels of Leptin (р< 0.01), C-peptide (р< 0.01), Thyroid stimulating hormone ( p<0.01), Free thyroxine (p=0.002). The Leptin level, which is at the upper limit of the reference, the level of Thyroid stimulating hormone at the lower limit of the reference, and the slight predomi¬nance of the C-peptide level are noteworthy. Predominance of reliable correlations of pro-inflammatory cytokines IL 1, 4, 6 of varying degrees (r=0.34-0.45) are observed. Only IgG with Free triiodothyronine (r=0.45,p=0.004), IgE with Thyroid peroxidase antibody (r=-0.45,p=0.004) were identified as statistically significant correlations with high reliability. Conclusions: The obtained date presents the increasing of the levels Cytocines (Il -1,4,6) in 2-10 times. The IgG level increased in 10 times and IgM - in 2 times. The indicators of endocrine metabolism are within the reference values. Reliable correlations of pro-inflammatory cytokines IL 1, 4, 6 of varying degrees (r=0.34-0.45) are observed. IgG with Free triiodothyronine (r=0.45,p=0.004) have significant reasonableness.

Rapid vertical flow technique for the highly sensitive detection of Brucella antibodies with Prussian blue nanoparticle labeling and nanozyme-catalyzed signal amplification.

Brucellosis is a chronic infectious disease caused by Brucella, which is characterized by inflammation of reproductive organs and fetal membranes, abortion, infertility, and local inflammatory lesions of various tissues. Due to the widespread prevalence and spread of brucellosis, it has not only caused huge losses to animal husbandry, but also brought serious impacts on human health and safety. Therefore, rapid and accurate diagnosis is of great significance for the effective control of brucellosis. Therefore, we have developed a rapid vertical flow technique (RVFT) using Prussian blue nanoparticles (PBNPs) as a marker material for the detection of brucellosis antibodies. Lipopolysaccharide (LPS) was purified and used to detect brucellosis antibodies to improve the sensitivity of this technique. To enhance the sensitivity of serum antibody detection, a single multifunctional compound buffer was created using whole blood as a biological sample while retaining the advantages of typical lateral flow immunoassays. After signal amplification, standard Brucella-positive serum (containing Brucella antibody at 4000 IU mL-1) could be detected in this system even at a dilution factor of 1 × 10-2. The detection limit was 40 IU mL-1, which is ten times that before signal amplification. This RVFT displayed good specificity and no cross-reactivity. This RVFT effectively avoided the false negative phenomenon of lateral flow immunoassays, was easy to operate, had a short reaction time, has good repeatability, and could elicit results that were visible to the naked eye for 2 ~ 3min without any equipment. Since this method is very important for controlling the prevalence of brucellosis, it holds great promise for application in primary medical units and veterinary brucellosis detection.

A Rare Axillary Cutaneous Squamous Cell Carcinoma: A Case Report and Literature Review

Background: Non-melanoma skin cancer is the most frequent tumor in Brazil and the world. One of its forms, squamous cell carcinoma (SCC) predominantly affects the old white population in areas of high exposure to the sun. Most SCCs are indolent, evolving with a cure rate higher than 90% within five years. Rarely, metastasis occurs mainly in regional lymph nodes, but it can also happen in the lungs, liver, brain, skin, and bones. There are currently many treatment options; based on the stratification of the neoplasm as high or low risk, an appropriate approach is defined. Case presentation: This report presents the case of a patient with high-risk squamous cell carcinoma affecting an area not exposed to solar radiation and without any other previous triggering factor, which is quite uncommon for this type of tumor. The rarity of the case stems from the lack of scientific reports on the occurrence of SCC in the axillary region, without a history of local chronic inflammatory lesions. The Portuguese, English, and Spanish languages were used to search the database of the main scientific platforms Pubmed, Cochrane Library, Scielo, and Lilacs, with no results similar to the case reported. Conclusion: Despite the fact that the axillary area is not sun-exposed, squamous cell skin cancer manifested as an extensive lesion that required a complex surgical resection with flap repair. Such findings highlight the importance of a thorough physical exam and work-up to diagnose lesions in their early forms which require simple resection procedures and avoid late diagnoses resulting in complex procedures. Such an approach reduces the risk of various complications like wound infection or dehiscence, flap ischemia, or necrosis, among others.

Сучасні аспекти захворюваності гінгівітом та пародонтитом дітей та підлітків України, ефективність лікування та профілактики

The purpose of the work was to study modern aspects of the incidence of gingivitis and periodontitis in children and adolescents in Ukraine and to create an algorithm for treatment and prevention tactics in this pathology. It has been established that the high prevalence of gingivitis and periodontitis among children and adolescents makes this problem one of the most important problems of modern dentistry. The problem of periodontal pathology in children and adolescents is due to both the prevalence of diseases and the fact that poor-quality treatment of diseases in childhood and adolescence will lead to severe irreversible damage to periodontal tissues in adults. Modern prevention of inflammatory periodontal diseases in children and adolescents should be carried out on the basis of an algorithm of therapeutic and preventive measures: elimination of local traumatic factors, restoration of the anatomical shape of the teeth, high-quality treatment of the root system, replacement of defective restorations, professional oral hygiene, selection and correction of means and methods of individual hygiene. Results and discussion. The results of the study of oral hygiene and periodontal condition in patients with chronic limited catarrhal gingivitis and chronic localized periodontitis showed that the average value of most of the studied parameters in patients had significant differences when compared with healthy individuals in the control group, as well as between groups of patients. Index evaluation of the functional state of the peripheral circulation in the periodontal tissues of young patients revealed a significant decrease in capillary resistance. Based on literature data and the results of our own research and an objective method for predicting the localization of inflammatory diseases of periodontitis, a therapeutic and prophylactic tactic was developed in young patients with indications of diseases and risk factors for their development. Evaluation of the effectiveness of the developed method of treatment and prevention of localized periodontal tissue damage in patients of the main group was carried out on the basis of the results of clinical, physicochemical and functional research methods in comparison with groups of patients who underwent therapeutic and preventive measures in the traditional way. The results of treatment of localized inflammatory periodontal diseases were analyzed in 34 patients of the main group with chronic limited catarrhal gingivitis, 26 patients with chronic localized periodontitis of degree I and in a similar number of patients in the comparison group with an identical diagnosis. Conclusion. The results of treatment of 60 patients of the main group showed the high efficiency of the developed method. At the same time, a significant improvement in the subjective and objective symptoms of diseases was found. Complete clinical recovery with the elimination of the inflammatory process in the gums was found in 94.1% of patients with chronic limited catarrhal gingivitis of degree I. The obtained positive results of treatment of the main group of young patients with localized inflammatory lesions of periodontal tissues in terms of hygienic and periodontal indices and the state of peripheral circulation confirm the high efficiency of the developed algorithm for the treatment and prevention of these diseases

Hypothermia and Cold Injury in Children.

Hypothermia and Cold Injury in Children.

Hypoxia-inducible factor-1 drives divergent immunomodulatory functions in the pathogenesis of autoimmune diseases.

Hypoxia-inducible factor-1 (HIF-1) is a heterodimeric (HIF-1α/ HIF-1β) transcription factor in which the oxygen-sensitive HIF-1α subunit regulates gene transcription to mediate adaptive tissue responses to hypoxia. HIF-1 is a key mediator in both regulatory and pathogenic immune responses, because ongoing inflammation in localized tissues causes increased oxygen consumption and consequent hypoxia within the inflammatory lesions. In autoimmune diseases, HIF-1 plays complex and divergent roles within localized inflammatory lesions by orchestrating a critical immune interplay sponsoring the pathogenesis of the disease. In this review, we have summarized the role of HIF-1 in lymphoid and myeloid immunomodulation in autoimmune diseases. HIF-1 drives inflammation by controlling the Th17/Treg /Tr1 balance through the tipping of the differentiation of CD4+ T cells in favour of pro-inflammatory Th17 cells while suppressing the development of anti-inflammatory Treg /Tr1 cells. On the other hand, HIF-1 plays a protective role by facilitating the expression of anti-inflammatory cytokine IL-10 in and expansion of CD1dhi CD5+ B cells, known as regulatory B cells or B10 cells. Apart from lymphoid cells, HIF-1 also controls the activation of macrophages, neutrophils and dendritic cells, thus eventually further influences the activation and development of effector/regulatory T cells by facilitating the creation of a pro/anti-inflammatory microenvironment within the autoinflammatory lesions. Based on the critical immunomodulatory roles that HIF-1 plays, this master transcription factor seems to be a potent druggable target for the treatment of autoimmune diseases.

KCa3.1 Inhibition of Macrophages Suppresses Inflammatory Response Leading to Endothelial Damage in a Cell Model of Kawasaki Disease.

PurposeMacrophages-mediated inflammation is linked with endothelial damage of Kawasaki disease (KD). KCa3.1, a calcium-activated potassium channel, modulates inflammation of macrophages. However, little is known about the role of KCa3.1 in inflammation by macrophages involved in KD. Hence, this study is aimed to explore the potential role of KCa3.1 in regulating inflammatory response by macrophages and subsequent vascular injury in an in vitro model of KD.MethodsRAW264.7 cells were stimulated with Lactobacillus casei cell wall extract (LCWE) with or without TRAM-34 or PDTC or AG490. Subsequently, mouse coronary artery endothelial cells (MCAECs) were incubated with RAW264.7 cells-conditioned medium to mimic local inflammatory lesions in KD. CCKi8 assay was used to evaluate cell viability. The mRNA levels of inflammatory mediators were detected by qRT-PCR. Expressions of KCa3.1, MCAECs injury-associated molecules, proteins involved in signal pathways of nuclear factor-κB (NF-κB), signal transducers and activators of transcription (STAT) 3 and p38 were evaluated by Western blot.ResultsOur study showed that LCWE increased KCa3.1 protein level in RAW264.7 macrophages and KCa3.1 inhibition by TRAM-34 notably suppressed the expression of pro-inflammatory molecules in LCWE-treated macrophages via blocking the activation of NF-κB and STAT3 pathways. Besides, the inflammation and damage of MCAECs were attenuated in the TRAM-34-treated group compared with the KD model group. This vascular protective role was dependent on the down-regulation of NF-κB and STAT3 signal pathways, which was confirmed by using inhibitors of NF-κB and STAT3.ConclusionThis study demonstrates that KCa3.1 blockade of macrophages suppresses inflammatory reaction leading to mouse coronary artery endothelial cell injury in a cell model of KD by hampering the activation of NF-κB and STAT3 signaling pathway. These findings imply that KCa3.1 may be a potential therapeutic target for KD.

Comparison of oil emulsion, mannosylated chitosan, and Bacillus vector adjuvants for vaccination against influenza in chickens

Summary Vaccination against influenza continues to be the primary method of control in many countries, but there is still a strong reliance on autogenous vaccines adjuvated with mineral oil emulsions known to induce overly high local inflammatory responses and lesions at the site of injection. The studies presented herein investigate various combinations of mannosylated chitosan adjuvant (MCA) and/or recombinant Bacillus construct adjuvant (BCA) containing highly conserved influenza antigens to assess their ability to function as an effective alternative adjuvant in influenza vaccination. In experiment 1, broilers were vaccinated via subcutaneous and/or drinking water application with an inactivated swine influenza in combination with MCA or commercial oil emulsion adjuvant. Subcutaneous or oral prime, followed by oral boost, resulted in the highest improvement in day 21 serum IgG hemagglutination inhibition (HI) titer, compared to the non-vaccinated control group. Experiment 2 tested BCA and MCA adjuvants, mixed with inactivated avian influenza virus in broilers. The group receiving combined subcutaneous and oral prime, followed by an oral boost containing both MCA and BCA adjuvants, exhibited significantly improved tracheal IgA HI titers. Experiment 3 investigated the ability of these adjuvated vaccines to protect against both homologous and heterologous highly pathogenic avian influenza challenge in layers. Groups receiving a subcutaneous prime followed by either subcutaneous or oral boost survived at 100%. Groups receiving only oral vaccine administrations did not exhibit improved survival. MCA and BCA adjuvants were found to improve immune responses in both broiler and layer-type chickens, equivalently matching immunogenicity and protection to the traditional mineral oil emulsion adjuvant. These studies suggest protective mucosal immunity can be achieved with vaccination strategies that incorporate MCA or BCA, but primary parenteral administration remains an important component of the vaccination strategy to achieve protective immunity.

Odontogenic Infections with Cutaneous Involvement in Children: a Case Series

Cutaneous involvement of dental sepsis is a rare occurrence in children. It often presents as a diagnostic dilemma, especially in the absence of oral symptoms, with initial presentation to non-dental professionals. This article discusses three cases of children presenting with cutaneous involvement of odontogenic origin to two paediatric dentistry departments in the UK. All cases had delayed presentations and were initially submitted to ineffective treatment, with significant impact on the children’s well-being. Final management included antibiotic therapy, drainage and extraction of the septic tooth. These three cases highlight the importance of considering a dental aetiology for localized inflammatory and purulent skin lesions of the mandible. Prompt diagnosis and early treatment are determinant for early resolution and avoidance of systemic or psychological complications. CPD/Clinical Relevance: This article discusses diagnosis and management of three different presentations of odontogenic sepsis with cutaneous involvement in children.

The Effect of Panoramic Radiography on the Diagnosis of Lesions in Dentistry and Its Effect on Cumulative Dose

Introduction: One of the most commonly used radiography methods for the diagnosis of oral and dental diseases is the panoramic radiography technique. This technique is widely used due to ease of implementation, extensive coverage, time and cost savings. Dental radiography, as a routine and appropriate test, accounts for about 33% of the total radiographic examination. However, information derived from radiography plays a major role in detecting lesions in dentistry, but it puts the patient at risk from the effects of ionizing radiation. This study was designed and implemented with the aim of investigating the lesions found in panoramic radiographies in patients referred to the Kermanshah Imaging Centers. Materials and Methods: In this retrospective-descriptive cross-sectional study, 378 panoramic images were collected from Kermanshah Imaging Centers and assessed by the dentist. Data collection was done by completing a two-part checklist, consisting of 46 questions including demographic information, questions about the relative frequency of lesions found in panoramic images, including the existence, characteristics, and pathology types of lesion. Results: According to the findings of this study, 56.6% of patients had a lesion. The most commonly found lesion was tooth decay (194 cases), which 92.4% of total radiographies with lesion and 51.3% of the total radiographs. The least damage was also in the case of tumoral jaw lesions (4 cases), which contained 1.9% of radiography with lesion and 1.1% of total radiographs. The highest rates of decay lesions, periodontal lesions, dwindle of bone crest and localized inflammatory lesions of the jaw lesions unilaterally and with a certain margin. Conclusion: Altogether, the findings of this study showed that nearly half of the panoramic images did not show any lesion. This suggests that dentists should be more concerned about the unnecessary use of panoramic images about the overall assessment of the condition of the teeth and the evaluation of dental caries.

Effect of chronic heat stress on some physiological and immunological parameters in different breed of broilers.

ABSTRACTThe differences in physiological and immunological parameters and pathological damage to organ tissues exposed to chronic heat stress provide the basis for evaluating heat resistance of different chicken breeds (white recessive rock [WRR] and The Lingshan [LS]). Ninety broilers of each breed were divided equally into a chronic heat stress group and a no heat stress group. The effects of chronic heat stress on the physiological and immunological parameters of broilers were analyzed using flow cytometry, ELISA, RT-qPCR, etc. Under heat stress conditions: (1) H and H/L values were significantly increased (P < 0.01) in the 2 breeds, and were higher in the WRR broilers than in the LS broilers at a late stage (P < 0.05). Although the corticosterone levels were also significantly increased (P < 0.01) in both breeds, they were lower in the 49 d WRR broilers than in the LS broilers (P < 0.01). The number of leukocytes were significantly increased in the 49 d WRR broilers (P < 0.01), whereas the number of CD3+, CD8+ cells, and erythrocytes were significantly reduced (P < 0.05). A significantly (P < 0.01) lower number of CD3+, CD4+ T-lymphocytes, and CD4+/CD8+ were present in WRR compared to that in the LS broilers. (2) The HSP70 transcript was significantly increased in the WRR broilers (P < 0.01), and was higher than the level in the LS broilers. The expression level of HSP70 protein was significantly (P < 0.05) increased in WRR broilers. (3) The WRR broilers developed cardiac and leg muscle inflammatory cellular hyperplasia and local inflammatory lesions, as well as cerebral meningitis and inflammatory hyperplasia of the brain tissue. The LS broilers developed mild cerebral inflammatory hyperplasia and mild inflammatory cellular proliferation in the leg muscle. In conclusion, under heat stress conditions, the relative physiological and immunological parameters were worse in the WRR broilers than in the LS broilers. The WRR broilers showed poor heat tolerance as evidenced from the expression of HSP70 and the extent of histopathological damages.

Mediation of the single-walled carbon nanotubes induced pulmonary fibrogenic response by osteopontin and TGF-β1

ABSTRACTPurpose of the study: A number of in vivo studies have shown that pulmonary exposure to carbon nanotubes (CNTs) may lead to an acute local inflammatory response, pulmonary fibrosis, and granulomatous lesions. Among the factors that play direct roles in initiation and progression of fibrotic processes are epithelial-mesenchymal transition and myofibroblasts recruitment/differentiation, both mediated by transforming growth factor-β1 (TGF-β1). Yet, other contributors to TGF-β1 associated signaling, such as osteopontin (OPN) has not been fully investigated. Materials and Methods: OPN-knockout female mice (OPN-KO) along with their wild-type (WT) counterparts were exposed to single-walled carbon nanotubes (SWCNT) (40 µg/mouse) via pharyngeal aspiration and fibrotic response was assessed 1, 7, and 28 days post-exposure. Simultaneously, RAW 264.7 and MLE-15 cells were treated with SWCNT (24 hours, 6 µg/cm2 to 48 µg/cm2) or bleomycin (0.1 µg/ml) in the presence of OPN-blocking antibody or isotype control, and TGF-β1 was measured in supernatants. Results and Conclusions: Diminished lactate dehydrogenase activity at all time points, along with less pronounced neutrophil influx 24 h post-exposure, were measured in broncho-alveolar lavage (BAL) of OPN-KO mice compared to WT. Pro-inflammatory cytokine release (IL-6, TNF-α, MCP-1) was reduced. A significant two-fold increase of TGF-β1 was found in BAL of WT mice at 7 days, while TGF-β1 levels in OPN-KO animals remained unaltered. Histological examination revealed marked decrease in granuloma formation and less collagen deposition in the lungs of OPN-KO mice compared to WT. RAW 264.7 but not MLE-15 cells exposed to SWCNT and bleomycin had significantly less TGF-β1 released in the presence of OPN-blocking antibody. We believe that OPN is important in initiating the cellular mechanisms that produce an overall pathological response to SWCNT and it may act upstream of TGF-β1. Further investigation to understand the mechanistic details of such interactions is critical to predict outcomes of pulmonary exposure to CNT.

Immunohistochemical staining reveals C-reactive protein existing predominantly as altered conformation forms in inflammatory lesions.

C-reactive protein (CRP) is an established marker of inflammation and has been proposed to play a proinflammatory role in pathologies of several diseases. CRP is primarily produced by the liver and released into circulation as a pentameric molecule composed of five identical subunits. It has been suggested that the activation of the proinflammatory actions of CRP requires sequential conformational changes triggered by local inflammatory conditions. These include the dissociation into the subunit form (monomeric CRP, mCRP) and further reduction of the intra-subunit disulfide bond of mCRP. This model predicts that mCRP is the primary isoform present in inflamed but not healthy tissues, however the supporting evidence is lacking. Herein, we stained tissue samples across multiple anatomical locations from several types of human diseases with highly selective monoclonal antibodies that can differentiate CRP and mCRP. The results indicated that mCRP is the predominant form existing in the lesions. Further immunoblotting of the patient tissue samples revealed the potential presence of reduced mCRP. Together, we conclude that mCRP but not CRP is the major isoform present in local inflammatory lesions, supporting the so-called cascading model of CRP function and regulation.

Focal bone lesions in hiv-positive patient treated with tenofovir

BackgroundTenofovir is a widely used antiviral drug for the treatment of HIV and HBV infection. Although its side effects on renal function and bone metabolism are well known, there are no reports on focal bone lesions caused by this drug. Our case suggests this new, unusual but important scenario.Case presentationWe report on a 46-year-old HIV-positive man treated with an antiretroviral regimen containing tenofovir who suddenly developed localized inflammatory bone lesions. The examinations performed ruled out all the disorders commonly associated with this clinical pattern, and the patient’s conditions improved only after the suspension of tenofovir.ConclusionsThe case study suggests a rare but severe adverse event, which should be taken into account when physicians treat HIV-positive patients with focal inflammatory bone lesions

Pentraxin 3 is a local inflammatory marker in atrial fibrillation

Increasing evidence indicates that inflammation contributes to the pathogenesis of atrial fibrillation (AF). Pentraxin 3 (PTX3) is produced abundantly in local inflammatory lesions while C-reactive protein (CRP) is produced mainly in the liver. In this study, we investigated whether a local level of PTX3 might be a sensitive marker for the local inflammation of AF. Blood from the periphery and left atrial appendage (LAA) was sampled from 23 patients with AF undergoing pulmonary vein isolation, and from 10 control subjects with Wolff-Parkinson-White syndrome. We measured peripheral and LAA plasma concentrations of CRP, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and PTX3. Plasma PTX3 concentrations in both locations were higher in patients with AF than in control subjects. PTX3 concentrations were significantly higher in the LAA than the periphery in patients with AF (3.7 ± 1.4 vs 3.3 ± 1.2 ng/ml, P < 0.01), but not in control subjects (2.4 ± 0.5 vs 2.4 ± 0.5 ng/ml, not significant). Patients and controls showed no significant differences in CRP, IL-6, or TNF-α concentrations between the periphery and LAA. Interestingly, there was a significant positive correlation between LAA plasma concentrations of PTX3 and left atrial volume (r = 0.55, P < 0.01). These data demonstrate that local PTX3 production in the left atrium might reflect the local inflammation of AF.

Autologous growth factors used for the treatment of recurrent fistula-in-ano preliminary results

Dear Sir, The risk of postoperative complications such as fistula recurrence or incontinence increases in patients with recurrent fistulas and high transsphincteric and suprasphincteric fistulas [1, 2]. Due to the large number of postoperative complications, in recent years, there have been some attempts to treat this disease conservatively. Methods of treatment include tissue adhesives and plugs that close the internal orifice as well as autologous growth factors that are present in the platelet-rich plasma and used as “natural glue” to close the lumen of the fistula. Autologous platelet-rich plasma (APRP) is platelet concentration derived from centrifuged full blood collected from a patient right before surgery. The platelet-rich plasma (PRP) obtained using the Gravitational Platelet Separation III System (GPS® III, Biomet Merck, UK) constitutes 10 % of the original volume of the collected blood and more than 90 % of its mass is made of platelets. Platelet-rich plasma preparation is administered to the fistula tract following curettage (Fig. 1). We report our experience with the GPS® System in 2 patients with anal fistula. Fig. 1 Autologous platelet-rich plasm administration to fistula tract A 50-year-old male underwent surgery for recurrent suprasphincteric posterior horseshoe fistula at our unit. At a time of surgery curettage of the fistula tract was performed, and then a GPS® III preparation was administered to the fistula tract. The patient was discharged home 2 days after surgery. Fourteen days after surgery, the patient presented at the ward due to an inflammatory infiltration. Two months after surgery, a follow-up examination revealed fistula recurrence. A 37-year-old male with recurrent intersphincteric anterior fistula-in-ano, and with a narrow, transsphincteric branch running towards the puborectalis loop also underwent surgical treatment at our unit. At a time of surgery, the main tract of the fistula was removed and APRP (GPS® III) was administered to the narrow lateral tract following curettage. The patient was discharged home on postoperative day 3. No recurrence of the fistula was reported within the 6-month follow-up period. The first experiences with using growth factors were related to the treatment of patients with chronic skin ulcers [3]. At present, indications for using APRP therapy are being expanded. APRP is used in burn units and for the treatment of non-healing wounds. There are also reports of using APRP for the treatment of tendon injuries, muscle injuries, degenerative lesions of tendons and joints and bone voids, mainly in maxillofacial surgery. APRP therapy is also offered by aesthetic surgery centres, where it is used to fill deep wrinkles. In the healing process, thrombin stimulates platelet alpha-granules to release growth factors which, through appropriate stem cell receptors, stimulate stem cell differentiation. Reports of using autologous growth factors for the treatment of fistula-in-ano date back to the late 1990s. In 1999, a paper on the treatment of patients with recurrent fistula-in-ano was published [2]. It described a group of 30 patients with complex fistulas, rectovaginal fistulas and vesicorectal fistulas. The cure rate was 60 %. A similar cure rate was reported by Cintron et al. [1]. In the literature, there are reports of using APRP as an element of multi-stage treatment of fistula-in-ano. The first stage involves inserting a loose seton through the fistula tract in order to drain and heal any local inflammatory lesions. The second stage involves APRP administration, which resulted in fistula healing in as many as 75 % of patients [4]. Hagen et al. [5] used the two-stage method, and in 2009 they published the results of administering APRP to 10 patients with high transsphincteric fistulas. The first stage of treatment involved draining the fistula tract and then closing the internal opening with a patch of mucous membrane and filling the tract with APRP. After almost 2 years of follow-up, fistula recurrence was observed in 10 % of the patients. Available publications include papers that present small groups of patients, different types of fistulas qualified for APRP treatment and different methods of surgery. However, the results are encouraging since this method has no negative effect on anal sphincter function.

Role for magnetic resonance imaging in coccydynia with sacrococcygeal dislocation

Sacrococcygeal dislocation is among the many causes of coccydynia. The etiological diagnosis of this fairly rare condition is difficult. Dynamic imaging is the only means of documenting the dislocation. We describe two cases of sacrococcygeal dislocation in patients presenting with coccydynia. Both patients reported a history of trauma in the more or less remote past, with no clear correlation with pain onset. Magnetic resonance imaging (MRI) of the sacrococcygeal junction showed local inflammatory lesions (bursitis, sacrococcygeal arthritis), providing a rationale for a local procedure. Analgesic therapy was inadequately effective and a local glucocorticoid injection into the sacrococcygeal junction was therefore recommended. One of the patients accepted this procedure and subsequently reported complete resolution of the symptoms.