Non-inflammatory Disease Research Articles

Faecal sample storage without ethanol for up to 24h followed by freezing performs better than storage with ethanol for shotgun metagenomic microbiome analysis in patients with inflammatory and non-inflammatory intestinal diseases and healthy controls.

The influence of different faecal collection methods on metagenomic analyses remains under discussion, and there is no general agreement on which collection method is preferable for gut microbiome research. We compared faecal samples collected in tubes without preservatives with those containing 10mL of 96% ethanol for gut microbiome research when the timeframe from defecation to freezing at -80°C was up to 24h. We aimed to compare the collection methods on faeces from participants with inflammatory and non-inflammatory gastrointestinal disorders and healthy controls to investigate the most suitable method when considering data yield, human fraction of sequencing reads, and ease of use. We also examined the faecal sample homogeneity. Faeces collected in tubes without preservatives resulted in more sequencing reads compared to faeces collected in tubes with 96% ethanol and were also easier to handle. The human fraction of total reads in faeces collected in ethanol from participants with inflammatory bowel disease was higher than all other samples. DNA extraction and sequencing from two different locations in the same faecal sample gave similar results and showed sample homogeneity.

Pharmacology and Articular Cartilage Regeneration: A New Strategy for Osteoarthritis

ABSTRACT Background: Osteoarthrosis is a slowly progressive, multifactorial, and non-inflammatory degenerative disease affecting synovial joints and is typically associated with aging or previous joint damage. Method: Fifty male Sprague Dawley rats were utilized in the study and divided into five groups, with ten rats in each group. The experiment was divided into two phases: in Phase 1, ten animals received 50 μL of saline in the left tibiotarsal joint and served as the control group (SAL), while the other four groups (n = 40) received a single dose of 50 μL complete Freund’s adjuvant (CFA) to induce monoarthritis. In Phase II, after the induction of monoarthritis, from the fourth week onward, the rats in the four CFA-induced monoarthritis groups were treated with 20 μl of gamma-amino butyric acid (GABA), serotonin (SERO), or a neurotransmitter cocktail (NTC) which were given intra-articularly once for three consecutive weeks, while one group was kept as an experimental control. The animals were monitored throughout the experiment, for ankle diameter, gait, and radiological assessment, and were then euthanized and subjected to histopathological evaluation at the conclusion of the study. Results: The study found that there were statistically significant differences in the degree of inflammation between the CFA group and the groups treated with GABA, SERO, and NTC. The CFA group exhibited the most severe and persistent inflammation, whereas the NTC group showed a milder and shorter inflammatory response than the control group (SAL). In terms of gait score, the NTC treatment resulted in a significant reduction in score compared to the treatments with GABA and SERO administered separately. The radiological scores revealed that NTC was the most effective treatment in mitigating radiographic evidence of joint damage, with a significant decrease in bone destruction. The histopathological examination showed that the NTC group had minimal tissue damage or inflammation and had a regenerative effect compared to the other treatment groups. Conclusions: In conclusion, the local administration of neurotransmitters was found to be effective in reversing inflammation, improving gait score, and mitigating radiological changes in CFA-induced arthritis in the murine model.

Subclinical corneal inflammation and subbasal nerve alterations in keratoconus detected by in vivo confocal microscopy: a cross-sectional study.

To investigate the intracorneal inflammation and subbasal nerve alterations in keratoconus. This prospective cross-sectional study recruited patients with keratoconus, who were diagnosed and graded the severity based on clinical examination and Schiempflug tomography. Laser in vivo confocal microscopy (IVCM) was performed on the corneal subbasal layer centrally to explore the inflammatory cells (ICs), subbasal nerve density (SND), and nerve tortuosity. Keratoconus severity and related factors including ocular allergy, systemic atopy, eye rubbing, floppy eyelids, and contact lens use were recorded. Association between the factors, IC density, SND and keratoconus severity were analyzed. Thirty-four keratoconus eyes were enrolled, and their IVCM findings were compared with those of 20 age-matched normal eyes. Keratoconus showed a significant increase in ICs (44.25 ± 7.01 vs. 13.06 ± 7.51 cells/mm2, p < 0.001) and a significant decrease in SND (16.54 ± 0.79 vs. 20.62 ± 0.72mm/mm2, p < 0.001) when compared to controls. The alterations were pronounced in severe keratoconus as the IC density was significantly higher (p < 0.001), whereas SND was lower (p = 0.001) in high-graded keratoconus than in low-graded keratoconus. However, there was no significant correlation between the number of IC and SND in keratoconus eyes (p = 0.835). Corneal sensitivity and nerve tortuosity were not different between keratoconus and the controls. No keratoconus-related factors were associated with IC density except the severity of keratoconus (p < 0.001, 95% CI [0.70, 0.95]). Keratoconus, a clinically noninflammatory corneal disease, demonstrates subclinical corneal inflammation and subbasal nerve decline as shown by IVCM. These alterations correlate considerably with the severity of keratoconus. What is known Traditionally, Keratoconus is a clinically noninflammatory corneal disease. What is new Our study suspected keratoconus may be subclinical corneal inflammatory disease. In our research, A Keratoconus patient was discovered to have corneal inflammation and a reduction in sub-basal nerve density through the use of In Vivo Confocal Microscopy. Increase in corneal inflammation is considerably correlated with the severity of keratoconus.

Accumulation of endogenous Muse cells in the myocardium and its pathophysiological role in patients with fulminant myocarditis.

Multi-lineage differentiating stress-enduring (Muse) cells, identified as pluripotent surface marker SSEA-3(+) cells, are stress tolerant endogenous pluripotent-like stem cells, and are involved in tissue repair. However, the significance of Muse cells in acute myocarditis has not been evaluated. In the present study, we counted Muse cells/area in biopsied myocardial tissue samples from 17 patients with fulminant myocarditis, and 6 with non-inflammatory myocardial disease as controls. Compared with controls, patients with fulminant myocarditis had significantly more Muse cells (p = 0.00042). Patients with mechanical circulatory support (p = 0.006) and myocardial degeneration (p = 0.023) had significantly more Muse cells than those without them. The Muse cell number was correlated with acute phase CK-MB level (ρ = 0.547, p = 0.029), indicating the severity of myocardial injury, and was also correlatedwith acute/recovery phase ratio of CK-MB (ρ = 0.585, p = 0.023) and cardiac troponin I (ρ = 0.498, p = 0.047) levels, indicating resilience of myocardial injury. In fulminant myocarditis, the Muse cell number was associated with the severity of clinical features in the acute phase, and also with the recovery from myocardial damage in the chronic phase. Endogenous Muse cells might be mobilized and accumulate to the myocardial tissues in fulminant myocarditis, and might participate in the repair of injured myocardium.

Rasch Analysis Of The Dermatology Life Quality Index.

Previous results of the Dermatology-Life-Quality-Index (DLQI) validation in Colombia based on the classical test theory (CTT) perspective have showed the need to delve into its measurement properties. Therefore, we aimed to assess the structural validity, internal consistency and item response analysis of the DLQI through the item response theory (IRT) or the Rasch model. We assessed the dimensionality of the DLQI, determined its difficulty, discrimination and differential functioning and went on to evaluate its internal consistency and discriminative validity among patients with inflammatory and non-inflammatory skin disease. We recruited Colombian patients with different skin diseases. Data of 865 patients (mean age, 49.3 years; 61% females) were included. DLQI-scores ranged from 0 up to 30. Internal consistency for dichotomous item #7 showed a McDonald's Omega coefficient of 0.85 (95%CI, 0.84-0.87) and a Cronbach's α coefficient of 0.86 (95%CI, 0.84-0.88). For ordinal item #7, the McDonald's Omega coefficient was 0.87 (95%IC:0.85-0.89) and Cronbach's α coefficient, 0.84 (95%CI, 0.82-0.87). Horn's parallel analysis revealed the presence of DLQI unidimensionality with a 1-factor solution. Only item #1 fitted the PCM model. The remaining items, including item #9, did not show adequate fit due to overlapping responses and order changes. The validity of DLQI-COL based on Rasch analysis proved not to be a suitable instrument to evaluate QoL in our dermatologic population. A refined version of the scale with an adequate cross-cultural adaptation and validation process is needed to obtain an appropriate and reliable version of the instrument for QOL measuring in Colombian patients with skin diseases.

Free Immunoglobulin Light Chains in Patients With Myocarditis: a New Biomarker of Inflammation and Heart Failure

To study the concentration of immunoglobulin free light chains (FLCs) in patients with myocarditis in comparison with non-inflammatory heart diseases, their relationship with inflammatory markers and the severity of chronic heart failure (CHF). This study included 77 patients (31 women, mean age 54.1±13.3 years): 41 patients with myocarditis verified by myocardial biopsy (n=18) or using a noninvasive diagnostic algorithm, 31 patients with noninflammatory CHF (comparison group), and 5 patients with monoclonal gammopathy identified during the study (4 of them were diagnosed with AL amyloidosis with heart damage). In the myocarditis group, CHF was diagnosed in 29 patients, mean stage IIA, functional class (FC) 2-3, with a mean left ventricular ejection fraction 43%. In the comparison group, patients had predominantly IIA stage, FC 2-3 CHF without systolic dysfunction. The blood concentration of kappa and lambda FLC types was measured with Cloneus S-FLC-K TIA Kit and Cloneus S-FLC-L TIA Kit. Concentrations were considered normal at FLC-kappa 4.84-14.20 mg/l, FLC-lambda 7.03-22.50 mg/l, and the FLC-kappa/lambda ratio 0.426-1.050. Increased FLC concentrations were found in 58% of patients with myocarditis and in 77% of patients in the comparison group. The FLC-lambda concentration was significantly higher in the comparison group; there were no significant differences between the groups in FLC-kappa and their ratio. The closest significant correlations in both groups and the entire cohort were noted between FLCs of either type and CHF, as well as the requirement for loop diuretics (correlation coefficients, 0.60-0.90), independent on the severity of systolic dysfunction. Myocarditis patients also showed correlations of FLCs with the titer of antibodies to cardiomyocyte nuclear antigens, levels of C-reactive protein, leukocytes, neutrophils, erythrocyte sedimentation rate, and the concentration of N-terminal fragment of brain natriuretic peptide. In a subgroup of 10 myocarditis patients who were treated with immunosuppressants, FLCs of both types were significantly lower than in the comparison group; only with the persistence of severe CHF was an increase in FLCs noted. An increased FLC concentration can be considered as an important pathogenesis component that reflects both the specific mechanisms of myocarditis and the severity of CHF. In the absence of a statistically significant increase in general inflammatory markers in the blood of myocarditis patients, the measurement of FLCs can be used as an additional diagnostic marker and predictor of the decompensated variant of the course of myocarditis. However, the diagnostic and prognostic significance of FLC concentration in patients without CHF requires a further study.

Effectiveness of Ultrasound with Isometric Quadriceps Exercise and Retro walking in Osteoarthritis

Introduction: Knee osteoarthritis is a non-inflammatory, painful and degenerative joint disease; pathologic changes in osteoarthritis involve progressive hyaline joint cartilage loss with concomitant changes in subchondral bone and development of osteophyte. About symptomatic knee osteoarthritis affect 13% of women and 10% of men aged 60 years and older. Men have a lower prevalence of knee osteoarthritis than women. The tool used to measure pain intensity, physical functions in this study is WOMAC scale and to assess the range of motion by Universal goniometer. Aim : To Evaluate the Effectiveness of Ultrasound with Isometric quadriceps exercise and retro walking in osteoarthritis of knee. Method : A Total 30 both male and female participants between 45 to 65 years of age selected from RJS Group of institute of kopargaon , Kothari hospital kopargaon by using purposive sampling method according to the inclusion criteria. The total duration of the study is 3 weeks .total 30 participants allocated into two groups A and B 15 in each group. In group A were intervention Ultrasound with isometric quadriceps exercise and group B Ultrasound with retro walking were given for 3 weeks. Pre intervention and post intervention by WOMAC score and universal goniometer were taken analyzed compared using paired’ test. RESULT: As per statistical analysis both groups shown significant improvement but group B ( Ultrasound with Retro walking )was having most significant improvement as compare to group A ( Ultrasound with Isometric quadriceps exercises). CONCLUSION : This study concluded that Ultrasound with Retro walking was effective in participants with Osteoarthritis of knee .Hence there is reduction of pain, improving range of motion at knee joint and functional mobility, Activity of daily living in participants with osteoarthritis of knee.

Mid-term outcomes of distal tibial oblique osteotomy in patients with rheumatoid arthritis: a report of three cases.

Although distal tibial oblique osteotomy (DTOO) has usually been indicated for non-inflammatory diseases such as osteoarthritis, we encountered three patients with rheumatoid arthritis (RA) who underwent DTOO. We evaluated radiographic parameters and clinical scores, including self-reported scores for the foot and ankle (SAFE-Q) and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale. In all three cases, radiographic improvements were achieved along with improvements in SAFE-Q and JSSF scores after mid-term follow-up. Supramalleolar osteotomy including DTOO could be indicated even for inflammatory diseases such as RA, if erosive changes are not evident in the ankle joint.

A case report with literature review: long-term follow-up of kidney autotransplantation in fibromuscular dysplasia.

Fibromuscular dysplasia is a rare, idiopathic, systemic, non-inflammatory, and non-atherosclerotic vascular disease that primarily affects young women. It often presents as renal artery stenosis. Fibromuscular dysplasia can induce tissue damage in the post-stenotic kidney. Treatment options include antihypertensive therapy, surgical revascularization, and transluminal angioplasty with stent implantation. However, kidney autotransplantation is an alternative when these treatments are not feasible. This study presents a case report of a 22-year-old woman with fibromuscular dysplasia, highlighting the long-term success of kidney autotransplantation and reviewing the related literature. A multidisciplinary approach was employed in the treatment of this patient presenting with intermittent headaches, hypertension, and acute kidney disease, andwho was diagnosed with fibromuscular dysplasia. She underwent left aorta-renal bypass and right autotransplantation. Following the procedure, her serum creatinine level decreased from 2.74 to 1.1mg/dL, with an eight-year follow-up confirming the favorableoutcome. Renal artery stenosis is a significant contributor to secondary hypertension, with fibromuscular dysplasia being a rarecause. While medical and interventional treatments are usually effective, complex cases may necessitate alternative approaches. Kidney autotransplantation, albeit uncommon, is an effective option for patients who are unresponsive to conventional therapies. This case demonstrates the successful management of fibromuscular dysplasia-associated renovascular hypertension via kidney autotransplantation, resulting in controlled blood pressure and preserved kidney function. In conclusion, kidney autotransplantation represents a valuable therapeutic option for severe renal artery stenosis caused by fibromuscular dysplasia, particularly when percutaneous procedures are impractical.

Increased serum phenylalanine/tyrosine ratio associated with the psychiatric symptom of anti-NMDAR encephalitis.

Encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (NMDAR) results in a distinctive neuro-psychiatric syndrome. It has been reported that the serum phenylalanine-tyrosine (Phe/Tyr) ratio increases during infection. However, the connection between phenylalanine-tyrosine metabolism and psychiatric symptoms remains unclear. We enrolled 24 individuals with anti-NMDAR encephalitis and 18 individuals with non-inflammatory neurological diseases (OND). Chromatography was used to measure serum levels of phenylalanine and tyrosine. Serum and cerebrospinal fluid (CSF) TNF-α levels were obtained from the clinical database. The modified Rankin Scale (mRS) score and Glasgow Coma Scale (GCS) score were recorded during the acute phase. The area under the curve (AUC) of the receiver operating characteristic curve was used to assess prediction efficacy. In NMDAR patients, levels of serum Phe and the ratio of serum Phe/Tyr were higher compared to OND patients. The serum Phe/Tyr ratio was also elevated in NMDAR patients with psychiatric syndrome. Furthermore, serum Phe and Tyr levels were correlated with inflammatory indexes. The serum Phe/Tyr ratio is elevated in NMDAR patients with psychiatric syndrome and is associated with severity. Therefore, the serum Phe/Tyr ratio may serve as a potential prognostic biomarker.

Environmental pollution impact on the severity of some rheumatic diseases: a comparative analytical study on inflammatory and non-inflammatory samples

ObjectiveEnvironmental pollution of heavy metals is increasingly a problem and has become of great concern due to the adverse effects it causes worldwide. Heavy metal exposure has been implicated in health problems, including fibromyalgia and rheumatoid arthritis. We aim to evaluate the rule of chronic heavy metals toxicity on the induction of vitamin D3 (VD) deficiency and parathyroid hormone (PTH) disturbances in an inflammatory disease like rheumatoid arthritis (RA) and non-inflammatory disease like fibromyalgia syndrome (FMS).MethodsThis comparative analytical study was conducted on sixty adults (age ≥ 18 years). Participants were divided into three groups. Group I: twenty patients diagnosed with RA according to the specific ACR/EULAR criteria for RA. Group II: twenty patients diagnosed with FMS according to the specific 2010 (ACR) criteria for FMS. Group III: twenty healthy adults. All patients and controls were subjected to routine laboratory tests as well as the measurement of PTH, VD and estimation of serum levels of lead, cadmium, and chromium.ResultsVD was significantly inversely correlated to PTH, lead, cadmium, chromium, and activity scores in the RA and FMS groups. Lead, Cadmium and Chromium had a significant independent risk on the VD level in RA patients, while lead had a significant independent risk on the VD level in FMS patients.ConclusionHeavy metals may affect VD synthesis, leading to hypovitaminosis D and secondary hyperparathyroidism in RA and FMS patients. Heavy metals play a key role in the pathogenesis of RA, FMS, and their disease activity.

Patient-Reported Outcomes of Depression and Fibromyalgia Symptoms Do Not Predict Non-Inflammatory versus Inflammatory Diagnoses at Initial Rheumatology Consultation.

The objective of this study was to assess the potential value of patient-reported outcomes (PROs) of depression, fibromyalgia symptoms, and pain in predicting non-inflammatory vs. inflammatory diagnoses in rheumatology patients. This retrospective, single-center study evaluated electronic health record (EHR) data from adults who were seen for their first rheumatology consultation and subsequently received a diagnosis of an inflammatory (e.g., rheumatoid arthritis or spondyloarthritis) or non-inflammatory (e.g., osteoarthritis or fibromyalgia) condition. The PROs evaluated included depressive symptoms (Patient Health Questionnaire-2 [PHQ-2]), fibromyalgia symptom severity (FM SS), and pain. A total of 3669 patients were evaluated, including patients with (n = 984; 26.82%) and without (n = 2685; 73.18%) inflammatory rheumatologic disease, of whom 141 (3.8%) had fibromyalgia. The non-inflammatory subgroup reported higher FM SS scores, and the inflammatory subgroup had higher pain and inflammatory markers. Bivariate models based on PHQ-2 and FM SS had a very low specificity (0.3%) for predicting non-inflammatory conditions, resulting in the misclassification of >99% of inflammatory cases. Adding pain, inflammatory markers, and other relevant EHR variables increased specificity but still resulted in a high level of misclassification. The PROs evaluated in this study are not suitable for predicting non-inflammatory vs. inflammatory rheumatologic disease, even when combined with other EHR variables.

Features of the course of external genital endometriosis due to cervical pathology

Background. In modern literature, there is a limited number of publications devoted to the characteristics of the course of endometriosis in patients with cervical diseases (CD), the choice of management tactics for cervical diseases and the prevention of relapses of these diseases.Objective. To analyze clinical, anamnestic and laboratory data in patients of reproductive age with a combination of benign cervical diseases and external genital endometriosis.Materials and methods. A retrospective cohort study was conducted that included 100 women of reproductive age with external genital endometriosis. The main group consisted of 56 patients with a combination of benign cervical diseases and external genital endometriosis. The comparison group consisted of 44 patients with external genital endometriosis without cervical cancer. An assessment was made of clinical and anamnestic data, the results of a cytological examination of a cervical smear, extended colposcopy and the level of hormones AMH, FSH, estradiol, performed by enzyme immunoassay on days 2-5 of the menstrual cycle. Statistical analysis was carried out using the SPSS Statistics 26.0 program.Results. External genital endometriosis in 56% of cases is associated with benign cervical diseases, in the structure of which non-inflammatory diseases predominate (63%). Inflammatory diseases of the cervix were observed in 16% of patients, and combined pathology of the cervix was observed in 21% of women with external genital endometriosis. The presence of concomitant cervical pathology in 83.3% of cases is accompanied by endometriosis-associated infertility, this is significantly more common than in patients with inflammatory (22.2%) and non-inflammatory (42.9%) cervical diseases, p &lt; 0.05. Surgical treatment of endometriosis did not lead to pregnancy within one year after surgery in any planning patient with concomitant cervical pathology (0/11); this figure in women with non-inflammatory cervical diseases was 14.3% (4/32), whereas in 75.0% (3/4) with inflammatory diseases of the cervix, pregnancy occurred within a year after surgery, p&lt;0.05. In turn, the presence of inflammatory cervical diseases was associated with a significantly lower level of AMH (1.4±0.5 ng/ml) compared to patients with non-inflammatory cervical diseases (3.0±0.4 ng/ml) and combined cervical cancer pathology (3.4±0.5 ng/ml), p&lt;0.017. A significant decrease in ovarian reserve in the future can also lead to impaired fertility in this category of patients.Conclusion. The results of the study indicate the need for a comprehensive assessment of the condition of the cervix in patients with genital endometriosis, including a thorough history taking, cytological examination and extended colposcopy in combination with determination of HPV virus carriage. Timely measures for the diagnosis and treatment of cervical diseases in patients with endometriosis-associated infertility will improve fertility rates in this category of patients.

Comprehensive microRNA analyses using vitreous humor of ocular sarcoidosis.

MicroRNAs (miRNAs) are non-coding RNAs which have attracted attention as biomarkers in a variety of diseases. However, extensive unbiased analysis of miRNA in vitreous humor of sarcoidosis patients has not been reported. In the present study, we comprehensively analyzed the dysregulated miRNAs in ocular sarcoidosis to search for potential biomarkers. This study included seven patients diagnosed with ocular sarcoidosis (five definite and two presumed). Five patients with unclassified uveitis and 24 with non-inflammatory diseases served as controls. MicroRNA expression levels in vitreous humor samples were measured by microarray, and differentially expressed miRNAs between sarcoidosis and other diseases were explored. Next, pathway enrichment analysis was performed to evaluate the functions of the dysregulated miRNAs, and machine learning was used to search for candidate biomarkers. A total of 614 upregulated miRNAs and 8 downregulated miRNAs were detected in vitreous humor of patients with ocular sarcoidosis compared with patients with unclassified uveitis and non-inflammatory diseases. Some dysregulated miRNAs were involved in the TGF-β signaling pathway. Furthermore, we identified miR-764 as the best predictor for ocular sarcoidosis using Boruta selection. In this study, comprehensive miRNA analysis of vitreous humor samples identified dysregulated miRNAs in ocular sarcoidosis. This study suggests new insights into molecular pathogenetic mechanisms of sarcoidosis and may provide useful information toward developing novel diagnostic biomarkers and therapeutic targets for sarcoidosis.

Different Complement Activation Patterns Following C5 Cleavage in MOGAD and AQP4-IgG+NMOSD.

In myelin oligodendrocyte glycoprotein IgG-associated disease (MOGAD) and aquaporin-4 IgG+ neuromyelitis optica spectrum disorder (AQP4+NMOSD), the autoantibodies are mainly composed of IgG1, and complement-dependent cytotoxicity is a primary pathomechanism in AQP4+NMOSD. We aimed to evaluate the CSF complement activation in MOGAD. CSF-C3a, CSF-C4a, CSF-C5a, and CSF-C5b-9 levels during the acute phase before treatment in patients with MOGAD (n = 12), AQP4+NMOSD (n = 11), multiple sclerosis (MS) (n = 5), and noninflammatory neurologic disease (n = 2) were measured. CSF-C3a and CSF-C5a levels were significantly higher in MOGAD (mean ± SD, 5,629 ± 1,079 pg/mL and 2,930 ± 435.8 pg/mL) and AQP4+NMOSD (6,017 ± 3,937 pg/mL and 2,544 ± 1,231 pg/mL) than in MS (1,507 ± 1,286 pg/mL and 193.8 ± 0.53 pg/mL). CSF-C3a, CSF-C4a, and CSF-C5a did not differ between MOGAD and AQP4+NMOSD while CSF-C5b-9 (membrane attack complex, MAC) levels were significantly lower in MOGAD (17.4 ± 27.9 ng/mL) than in AQP4+NMOSD (62.5 ± 45.1 ng/mL, p = 0.0019). Patients with MOGAD with severer attacks (Expanded Disability Status Scale [EDSS] ≥ 3.5) had higher C5b-9 levels (34.0 ± 38.4 ng/m) than those with milder attacks (EDSS ≤3.0, 0.9 ± 0.7 ng/mL, p = 0.044). The complement pathway is activated in both MOGAD and AQP4+NMOSD, but MAC formation is lower in MOGAD, particularly in those with mild attacks, than in AQP4+NMOSD. These findings may have pathogenetic and therapeutic implications in MOGAD.

Lower total cholesterol and triglyceride levels in ankylosing spondylitis than non-inflammatory rheumatic disease controls in a 1978-98 study: a potential effect of increased physical energetics in manual occupations in the pre-2000 chronologic era.

No article on serum lipids in ankylosing spondylitis (AS) and control subjects has been reported from USA. The primary aim of this study was to determine if any difference occurred in serum lipid levels in AS and control rheumatic disorders in two time periods, 1978-98 and 2000-10. The secondary aim was to investigate variables associated with lipid levels and if a difference was found between AS and control disorders. The AS patients were compared to non-inflammatory rheumatic disorders (NIRDs) in 1978-98 and 2000-10 surveys and to rheumatoid arthritis (RA) in the 2000-10 survey. Patients were matched within 5 years of age, sex, and clinic or hospital source. In the 1978-98 survey, entry mean (SEM) serum cholesterol level [mg/dL] was highly (p<0.001) significantly lower in 69 AS [179.0 (4.8)] than 69 matched NIRD controls [208.0 (5.6)]. In 29 pairs of AS and NIRD subjects having manual labour occupations, mean (SEM) cholesterol level was additionally lower in AS [156.7 (5.9)] and higher in 29 NIRD controls [213.3 (8.6)] (p<0.001). In manual labour workers, mean (SEM) serum triglyceride was significantly lower (p=0.004) in 15 AS [110.3 (14.1)] than 14 NIRD controls [185.2 (19.3)]. In the 2000-10 survey, no lipid difference was found between AS vs. NIRD control patients. In the 1978-98 survey, AS had significantly lower mean serum cholesterol and triglyceride levels than NIRD control patients. Associated manual labour occupations may have significantly contributed to results, possibly related to increased energy expenditures from physical activity in the pre-2000 era.

Abstract P439: An Uncommon and Missed Diagnosis of Hypertension: Fibromuscular Dysplasia

Introduction: Fibromuscular dysplasia is a noninflammatory vascular disease most commonly affecting carotid and renal arteries, especially in young to middle aged women. Renal artery stenosis may cause refractory and severe hypertension in these patients without traditional risk factors. Case: A 58-year-old woman with uncontrolled hypertension on calcium channel and angiotensin receptor blocker and history of left carotid artery stenosis, and carotid endarterectomy at the age of 48 years, was referred cardiac evaluation. Patient’s twin sister had a diagnosis of fibromuscular dysplasia (FMD). Her blood pressure was 190/90 mmHg at presentation. Computed Tomography Angiography (CTA) of the abdomen/pelvis showed a typical nodular stenosis of the mid renal artery consistent with FMD. Patient underwent renal angiogram and successful percutaneous transluminal angioplasty. She still required medical therapy but her BP significantly improved. Discussion: Our patient had severe hypertension, carotid artery stenosis and even surgery but had missed FMD diagnosis for &gt; 10 years. Physicians should have a high level of clinical suspicion for young and middle aged women with refractory hypertension and/or artery stenosis, aneurysm, or dissection in any vascular bed. CTA should be performed for renal and carotid artery imaging looking for typical “string of beads” appearance. Cerebral artery aneurysm should also be evaluated. The inheritance pattern for FMD such as PHACTR1 is most consistent with an autosomal dominant trait with variable penetrance. Renal artery angioplasty may lessen the degree of refractory or severe hypertension.

Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study

BackgroundPilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT).MethodsWe describe our preliminary experience with PiLaT performed in adolescents aged 10–17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed.ResultsA total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients’ mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m−2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6–60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients’ evaluation) and 11.4 ± 4.7 (observers’ evaluation).ConclusionThe a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.

Distribution of Serum Testosterone Concentrations in IBD Males and Associations With Inflammatory Bowel Disease Activity.

An inverse relationship exists between inflammation and testosterone concentrations in non-inflammatory bowel disease (IBD) immune conditions but has not been objectively explored in the IBD male population. We aimed to characterize the distribution of testosterone concentrations in a cohort of males with IBD and identify any relationship between testosterone levels and disease activity. We conducted a prospective cross-sectional study of male IBD patients. Demographics, disease characteristics, sex-hormone concentration, gonadotropins, C-reactive protein, fecal calprotectin, and patient-reported outcomes on quality of life and erectile function were collected. Relationships between disease activity, biomarkers, patient-reported outcome scores, and testosterone levels were analyzed using univariate and multivariate linear regression analyses. A total of 85 male IBD patients were included with a mean age 44±14.1 years, of which 49.4% had Crohn's disease. Mean testosterone concentration was 15.4±5.2 nmol/L and 17.6% had a serum testosterone <10.4 nmol/L. Active disease was associated with lower testosterone concentrations in univariate analysis (β ± SE = -0.25 ± -1.99, P = .02) but not in multivariate analysis (β -0.18±1.75, P = .06). Testosterone concentrations were independently associated with sex hormone-binding globulin levels (β ± SE = 0.45±0.04, P < .0001) and a younger age (β ± SE = -0.32±0.04, P <.0001). Erectile function scores (5-item International Index of Erectile Function) were lower in IBD patients with a longer duration of disease (β ± SE = -0.24±0.006, P = .04). Lower testosterone concentrations in men with IBD may reflect confounding from other factors and are not independently associated with disease activity. Greater awareness and screening for sexual dysfunction should occur in males with IBD, particularly in those with a longer disease duration.

Challenges in the Diagnosis of SARS-CoV-2 Infection in the Nervous System.

Neurological involvement has been widely reported in SARS-CoV-2 infection. However, viral identification in the cerebrospinal fluid (CSF) is rarely found. The aim of this study is to evaluate the accuracy of virological and immunological biomarkers in CSF for the diagnosis of neuroCOVID-19. We analyzed 69 CSF samples from patients with neurological manifestations: 14 with suspected/confirmed COVID-19, with 5 additional serial CSF samples (group A), and as a control, 50 non-COVID-19 cases (group B-26 with other neuroinflammatory diseases; group C-24 with non-inflammatory diseases). Real-time reverse-transcription polymerase chain reaction (real-time RT-PCR) was used to determine SARS-CoV-2, and specific IgG, IgM, neopterin, and protein 10 induced by gamma interferon (CXCL-10) were evaluated in the CSF samples. No samples were amplified for SARS-CoV-2 by real-time RT-PCR. The sensitivity levels of anti-SARS-CoV-2 IgG and IgM were 50% and 14.28%, respectively, with 100% specificity for both tests. CXCL-10 showed high sensitivity (95.83%) and specificity (95.83%) for detection of neuroinflammation. Serial CSF analysis showed an association between the neuroinflammatory biomarkers and outcome (death and hospital discharge) in two cases (meningoencephalitis and rhombencephalitis). The detection of SARS-CoV-2 RNA and specific immunoglobulins in the CSF can be used for neuroCOVID-19 confirmation. Additionally, CXCL-10 in the CSF may contribute to the diagnosis and monitoring of neuroCOVID-19.