Post-inflammatory Changes Research Articles

Possibilities of using topical retinoids and azelaic acid in acne therapy

Background. Acne is a common, complex and multifactorial inflammatory disease that results from a variety of causes. Acne therapy is an urgent problem of dermatocosmetology. The clinical manifestations of dermatosis can be alleviated, and its long-term consequences can be prevented by early diagnosis and timely initiation of treatment, affecting multifaceted all parts of the pathogenesis.
 Aims. To evaluate the clinical efficacy and safety of the use of monotherapy of 0.1% adapalene cream (Adaclean) with combined external therapy of 0.1% adapalene cream (Adaclean) with 20% azelaic acid cream (Azix-Derm) in the treatment of mild to moderate acne.
 Methods. Under our supervision at the Department of Plastic Reconstructive Surgery, Cosmetology and Regenerative Medicine of the State Budgetary Educational Institution of Higher Professional Education Rost of the State Medical University of the Ministry of Health of Russia, the clinics “Ekaterininskaya” and “MIR-O-MED” there were 50 patients aged 12 to 50 years (18 (36%) men and 32 (64%) women) with mild and moderate acne. Patients with comedonal acne, in the absence of multiple inflammatory elements, which made up group 1 of observation (n = 16), were prescribed Adaclean cream, 1 time per day (evening) against the background of skin care. In the group with mild to moderate papulo-pustular acne and post-inflammatory changes (group 2, n = 34), patients were prescribed a combination of 0.1% adapalene cream and 20% azelaic acid cream (Adaclean (evening) and Azix-Derm (morning)). The follow-up period was 6 months.
 Results. Total clinical remission after 6 months therapy was achieved in 70% of cases, a significant improvement — in 28%, improvement — in 2%. In patients with a comedonal form of acne against the background of monotherapy with Adaclean cream, clinical recovery was obtained in 44% of patients, a significant improvement — in 50%, and an improvement — in 6%. In patients from the group of papulo-pustular acne of mild to moderate severity, after 3 months the use of complex therapy Adaclean and Azix-Derm noted almost complete relief of the inflammatory process; after 6 months therapy clinical recovery was recorded in 58%, significant improvement — in 36%; 6% showed partial improvement, which is associated with irregular use of drugs and skin care products. After 6 months combined treatment was able to achieve regression of dyschromia in 18–46% of patients, atrophic scars — in 5–22%, which significantly improved the results of therapy and made it possible to achieve a good cosmetic effect.
 Conclusion. The combined use of drugs for external use of adapalene (Adaclean) and AK (Azix-Derm) in the treatment of papulo-pustular acne of mild and AK (Azix-Derm) in the treatment of papulo-pustular acne of mild and moderate severity can significantly increase the effectiveness of treatment, achieve a stable clinical effect and remission of the disease, as well as improve the quality of life of patients.

P499 Anorectal Motility Disorders In Inflammatory Bowel Disease Patients

Abstract Background In spite of prolonged disease remission of IBD patients, induced by the new biological molecules, a significant number of them suffer from persistent debilitating symptoms with major impact on the quality of life. Frequently, these symptoms are due to post-inflammatory motility changes and misinterpreted as functional disorders. Our aim is to identify and characterize the anorectal motility dysfunction in IBD patients. Methods We are conducting an ongoing prospective study started in August 2019, which includes the IBD patients admitted in a Tertiary Gastroenterology Centre in Bucharest, with specific symptoms (anorectal pain, incontinence, difficult defecation). We perform high resolution anorectal manometry using Sandhill Scientific systems, the parameters being analysed using InSIGHT software. The manometric testing comprise measurements of anorectal pressure at rest, during squeeze, simulated evacuation, rectoanal inhibitory reflex (RAIR) and rectal sensory testing, in compliance with International Anorectal Physiology Working Group protocol Results We studied 30 patients (18 patients with Ulcerative Colitis and 12 patients with Crohn’s Disease, 18 females and 12 males, mean age 40 (±12.85) years. Only 33% (10 patients) had rectal active involvement. Symptoms were reported by 87% (26) patients: anal incontinence (85%), difficult evacuation (35%) and urgency (46%); rectal inflammation was not correlated with the presence of symptoms in our study group (p=0.28). Perianal surgical interventions didn’t represent a risk factor for fecal incontinence (p=0.18), or for dyssinergic defecation (p=0.1). Modified manometric parameters were found in 23 patients (79%). Low resting pressures were registered in 48% of patients; 55% of them presented low squeeze pressures; during push maneuvers, 34% of patients had insufficient rectal propulsive force, presenting low rectal pressures and 59% of them lacked anal canal relaxation. We performed sensibility testing on 18 patients: 9 patients presented criteria for hypersensitivity, hence reduced rectal compliance; 7 patients presented rectal hyposensitivity, while only 2 patients had normal rectal sensation. Recto-anal inhibitory reflex (RAIR) was present only in 28% of the patients, reflecting the dysfunction of the enteric neural system. Conclusion Patients with inflammatory bowel disease (IBD) have significantly higher rates of functional anorectal disease. Therefore, pelvic floor investigation is an essential tool in the investigation and management of IBD patients with ongoing symptoms not thought to be related to an IBD flare.

Anxiety in Patients with Post-COVID Syndrome: Associated Factors.

The term "post-COVID-19 syndrome" describes a range of symptoms persisting beyond the acute phase of the disease. These symptoms predominantly include fatigue, muscle pain, shortness of breath, and psychological issues. Research additionally suggests the possibility of long-term neurological and psychiatric impairment associated with COVID-19. The study included patients who visited the post-COVID outpatient clinic between April 2020 and June 2022. The examination included the detailed history taking, including the COVID-19 course, posteroanterior chest X-ray and pulmonary function tests. Anxiety level was assessed using the Beck Anxiety Inventory (BAI). The relationship between anxiety, demographic data, and course of the disease, need for hospital admission during the acute phase, oxygen therapy, post-inflammatory changes on the chest X-ray and lung function parameters was investigated. This study included 1756 patients who experienced COVID-19 and visited a post-COVID outpatient clinic. The majority of individuals experienced a mild form of the infection. The results showed that younger age and female gender were associated with significantly higher anxiety scores. Inpatients had lower BAI values than those who were not hospitalized during acute phase. Patients with post-inflammatory changes on chest X-ray had surprisingly lower BAI values. Lower values of FEV1 (forced expiratory volume in 1 second), DLCO (diffusing capacity of the lungs for carbon monoxide), and KCO (carbon monoxide transfer coefficient) were associated with significantly higher BAI values. Female gender was associated with higher levels of anxiety. In contrast, higher FEV1 values reduced the risk of a pathological level of anxiety. In our study, the influence of age, gender, inpatient care during the acute phase of infection, the presence of post-inflammatory changes on the chest diagram and selected parameters of lung function (FEV1, DLCO, and KCO) were shown to be important factors in the assessment of anxiety symptoms in post-COVID patients.

Clinical and morphological diagnostics of bening single focal lung lesions without necrotic changes

In recent decades, the problem of accidental detection by radiography or chest computer tomography of solitary focal formations smaller than 3 cm has become relevant. Although the primary task is to find out its benign or malignant nature as soon as possible, the clarification of the etiology of benign formations with non-neoplastic genesis retains an important clinical significance, in particular in cases of their infectious nature. The purpose of the study was to analyze the diagnostic significance of clinical and radiological data and morphological features of benign single focal lung lesions without necrotic changes, taking into account the final clinical diagnosis. The study group consisted of 42 patients with single benign focal lung lesions without necrosis. Among them there were 29 (69.0%) women and 13 (31.0%) men. Average age of the patients was (50.5±2.2) years. The total number of focal formations was 52. According to the number of focal formations, one patient was diagnosed with 1 formation in 34 cases, 2 formations in 6, and 3 formations in 2 cases. The dimensions of each of the formations did not exceed 30 mm. The most common diagnostic measures were direct biopsy at FBS, 10 (23.8%) cases; and transbronchial biopsy of lung under radiological control, 16 (38.1%) cases respectively. Among the operative interventions, lobe resection of the lung with a focus was mainly performed, in 16 (84.2%) cases. According to the results of the histological examination and taking into account the clinical and laboratory data, the following diagnoses were obtained, which corresponded to the final clinical diagnosis of the patients. A lung abscess was established in 4 (9.5%) cases; a chronic inflammatory process of a non-specific nature was diagnosed in 14 (33.3%) cases. Predominantly post-inflammatory changes and local pneumofibrosis were determined in 15 (35.7%) cases. Vascular malformation and pulmonary sarcoidosis were diagnosed once. In another 7 (16.7%) cases, the final clinical diagnosis was based on clinical and laboratory data and patient supervision - in 2 observations, the final diagnosis of chronic non-specific pulmonary disease was made; and in 5 cases, the nature of single focal pulmonary formations was not established. The most numerous subgroups were cases with a chronic nonspecific inflammatory process and with limited post-inflammatory changes (in total, they amounted to 69.0%), so the clinical and radiological indicators of these subgroups were analyzed more detail. Overall clinical data did not differ significantly between both subgroups. Females predominated in the group with post-inflammatory changes. The number of focal lesions in both lungs was equal; the upper lobes were more often affected. The average size of foci was significantly larger in patients with a chronic inflammatory process and was 22.2 mm compared to 16.3 mm in the subgroup with post-inflammatory changes (p<0.05). Single foci with minimal destructive changes were observed only in the subgroup with a chronic inflammatory process. As a result of the research, such findings were obtained. Among benign single non-necrotized focal pulmonary lesions chronic non-specific inflammatory process and post-inflammatory fibrotic changes, including focal pneumofibrosis, predominate in etiology. In our study, they accounted for 69% of all cases. According to the main radiological indicators (localization, size, shape, characteristics of the internal contents) it is impossible correct determination of the benign nature of non-necrotized focal lung lesions in the vast majority of cases. Histological examination of tissue of focal lesions not only determines benign or malignant nature of the formations, but also, in the case of their benign nature, allows clarify their etiology in most cases (83.3%). Keywords: benign non-necrotized focal lung lesions, X-ray indicators, histological diagnostics.

Treatment of a four-year-old child with destructive pneumonia

BACKGROUND: Treatment of patients with destructive pneumonia remains one of the most difficult problems in pediatric surgery. Modern possibilities of antibacterial and intensive care, minimally invasive endoscopic intraluminal technologies, as well as surgical techniques have reduced the number of adverse outcomes up to 4%. The type of surgical intervention and the time of its performance depend on the disease form, child’s general state, local changes in the bronchi and pleural cavity, as well as on technical capabilities of the clinic.
 CLINICAL CASE DESCRIPTION: The article presents a clinical observation of the complex treatment of a 4-year-old patient with destructive pneumonia complicated by a bronchial fistula. Intensive and antibiotic therapy stabilized the child’s condition, eliminated manifestations of multiple organ failure, and drained the pleural cavity to resolve tension pyothorax. The programmed thoracoscopy provided an adequate sanation of the pleural cavity, assessed dynamics of the inflammatory process and allowed to position drains under visual control. The fistula of the lower lobe bronchus was closed with a valve bronchoblocker after elimination of the local erosive and ulcerative lesion. A clinical success of such management was manifested with inflammatory process remission, bronchopleural fistula closure, pleural empyema removal. Due to this, deblocking was done three months after discharge from the hospital. At the control examination, the patient had no fistula, most part of the affected lung was preserved, post-inflammatory changes in the pleural cavity were minimal.
 CONCLUSION: The favorable outcome after treatment of children with destructive pneumonia depends on personalized and multidisciplinary approach. Minimally invasive endoscopic techniques do contribute to the effective elimination of complications, to effective functional restoration of the affected lung and to better recovery of patients.

Ultrasound imaging in crystal arthropathies: a pictorial review.

The prevalence of crystal arthropathies in the general population is rising. The purpose of this pictorial study is to describe the sonographic elements of the most prevalent crystal arthropathies by emphasizing particular sonographic findings using illustrative images and cases while considering technical details and common pitfalls. Using established recommendations, specialists in the fields of sonography and crystal arthropathies agreed by consensus on the unique ultrasound signs associated with each of the conditions. Gout, calcium pyrophosphate deposition arthropathy, and hydroxyapatite arthropathy are the three most prevalent crystal arthropathies. Today's high-resolution sonography enables reliable evaluation of the underlying crystal deposits, post-inflammatory changes, and a precise description of joint inflammation. High-prevalence crystal arthropathies are reliably detectable by ultrasound with current ultrasound equipment. It is necessary to have extensive ultrasound training, know specific sonographic findings, and understand all possible differential diagnoses for disorders affecting the musculoskeletal system.

Cancer Biology or Ineffective Surveillance? A Multicentre Retrospective Analysis of Colitis-Associated Post-Colonoscopy Colorectal Cancers.

Inflammatory bowel disease [IBD] is associated with high rates of post-colonoscopy colorectal cancer [PCCRC], but further in-depth qualitative analyses are required to determine whether they result from inadequate surveillance or aggressive IBD cancer evolution. All IBD patients who had a colorectal cancer [CRC] diagnosed between January 2015 and July 2019 and a recent [<4 years] surveillance colonoscopy at one of four English hospital trusts underwent root cause analyses as recommended by the World Endoscopy Organisation to identify plausible PCCRC causative factors. In total, 61% [n = 22/36] of the included IBD CRCs were PCCRCs. They developed in patients with high cancer risk factors [77.8%; n = 28/36] requiring annual surveillance, yet 57.1% [n = 20/35] had inappropriately delayed surveillance. Most PCCRCs developed in situations where [i] an endoscopically unresectable lesion was detected [40.9%; n = 9/22], [ii] there was a deviation from the planned management pathway [40.9%; n = 9/22], such as service-, clinician- or patient-related delays in acting on a detected lesion, or [iii] lesions were potentially missed as they were typically located within areas of active inflammation or post-inflammatory change [36.4%; n = 8/22]. IBD PCCRC prevention will require more proactive strategies to reduce endoscopic inflammatory burden, and to improve lesion optical characterization, adherence to recommended surveillance intervals, and patient acceptance of prophylactic colectomy. However, the significant proportion appearing to originate from non-adenomatous-looking mucosa which fail to yield neoplasia on biopsy yet display aggressive cancer evolution highlights the limitations of current surveillance. Emerging molecular biomarkers may play a role in enhancing cancer risk stratification in future clinical practice.

Colorectal neoplasia surveillance in inflammatory bowel disease

Performing colorectal neoplasia surveillance in persons with inflammatory bowel disease (IBD) that is both clinically effective and cost effective is among the greatest challenges facing endoscopists who care for this population. While heightened colorectal cancer (CRC) risk has long been recognized among persons with IBD, this risk has been declining over time, with recent reports suggesting no more than a 1.5–2-fold higher risk compared to age and sex matched members of the general population. Nonetheless, given that CRC still occurs at a higher rate in this population, current surveillance strategies are inadequate for some persons. Conversely, 80–90% of persons with IBD had no neoplastic lesions identified during colonoscopy surveillance, suggesting that many persons with IBD are unnecessarily exposed to the risks of colonoscopy, with society bearing these excess costs.&#x0D; The purpose of colorectal neoplasia surveillance is to reduce the burden of CRC and CRC-related death in the IBD population. Societal guidelines recommend initiating colorectal neoplasia screening with colonoscopy in all persons with colorectal IBD involving at least the rectosigmoid (or at least 1/3 of the colorectum if accompanied by discontinuous inflammation) at 8–10 years following disease diagnosis and continuing lifelong surveillance every 1–5 years. Major factors influencing surveillance frequency include historical disease severity, extent of colorectal inflammation, chronic post-inflammatory changes, family history of CRC, history of colorectal neoplasm, primary sclerosing cholangitis, prior colonoscopy findings, and adequacy of prior surveillance. All guidelines further recommend targeted sampling or resection of suspicious visible abnormalities, and some societies continue to recommend extensive non-targeted biopsies to detect “invisible” neoplasia, particularly if other adjunctive optical modalities, such as dye-spray chromoendoscopy (DCE) or virtual chromoendoscopy (VCE), are not performed, or if the mucosa is poorly visualized, such as in areas of significant inflammation, post-inflammatory polyposis, or poor bowel preparation. Most societies now advocate for DCE or VCE as primary screening tools for IBD neoplasia surveillance or, at a minimum, as alternative modalities to traditional white light colonoscopy with non-targeted biopsies where resources and expertise exists.&#x0D; However, there are no prospective studies demonstrating a reduction in the incidence of CRC or of death from CRC with current surveillance strategies in persons with IBD. Furthermore, observations from large retrospective studies are also conflicting. A Cochrane analysis of 3 studies in persons with UC did not find a significant mortality benefit for current surveillance strategies. Considering that IBD afflicts many persons at a young age, is rising in prevalence in Canada and globally, and requires intensive lifelong surveillance , the amount of endoscopy resources directed toward IBD surveillance is potentially enormous. Increasing demands on colonoscopy resources from expansion of population-based CRC screening programs and an aging population are likely to challenge the ability to continue to provide intensive surveillance to all persons with IBD. Optimizing delivery of limited colonoscopy resources will thus be essential to maintain effective CRC prevention programs in this population.&#x0D; Current standards for neoplasia surveillance in IBD have been recently updated. Shah and Itzkowitz authored a comprehensive review that includes epidemiology, pathogenesis, and management of colorectal neoplasia, along with a chart that compares surveillance recommendations put forward by multiple societies. The present review will highlight new evidence influencing neoplasia surveillance and provide practical approaches for surveillance and management of neoplastic lesions in the IBD population.

The ATTRACT study: screening for the early identification of axial psoriatic arthritis in a cohort of Italian psoriatic patients.

There is growing interest in the early identification of patients with axial PsA (axPsA). We aimed to evaluate whether a dermatology-based screening strategy could help to identify axPsA patients. The dermatologist-centred screening (DCS) questionnaire was administrated by dermatologists to consecutive patients fulfilling the inclusion criteria [(i) age ≥18 years and (ii) clinical diagnosis of psoriasis made by a dermatologist] to identify patients eligible (affirmative answers 1-3c of the DCS) for rheumatological evaluation. Clinical, laboratory, genetic and imaging data were collected from all referred patients. Among the 365 patients screened, 265 fulfilled the inclusion criteria and 124/265 (46.8%) were eligible for rheumatological referral. Diagnosis of axPsA, with or without peripheral PsA (pPsA), was made in 36/124 (29.0%) patients; pPsA without axial involvement was found in 21/124 (16.9%) patients. Back pain at screening was recorded in 174 (66%) patients, with 158 (60%) reporting a back pain duration longer than 3 months and 140 (53%) reporting back pain onset before the age of 45 years. Active inflammatory and/or structural post-inflammatory changes in the sacroiliac joints and/or spine were observed in all axPsA patients. Patients with PsA showed a numerically longer duration of back pain and higher CRP levels in comparison with patients with psoriasis without PsA. The DCS tool proved to be a valuable screening strategy for detecting and characterizing patients with axPsA in a real-life cohort of psoriasis patients in a dermatological setting and helped to identify a substantial number of patients affected by undiagnosed pPsA.

P18 Bullous leukocytoclastic vasculitis in a patient with known undifferentiated autoimmune rheumatic disease

P18 Bullous leukocytoclastic vasculitis in a patient with known undifferentiated autoimmune rheumatic disease

The Psychosocial Burden of Skin Disease and Dermatology Care Insights Among Skin of Color Consumers.

Skin conditions are associated with psychological symptoms and may be particularly distressing for skin of color (SoC) individuals. SoC consumers' decisions to pursue dermatology care may be negatively impacted by the scarcity of skin tone diversity in dermatology. This survey explored SoC consumers' perspectives on dermatologic care to provide insight into the psychosocial burden of skin disease. Beacon Science conducted an anonymous web-based survey in August 2022 among self-selected consumers. Demographics, bothersome skin condition effects on mental health, insights about skincare products, and dermatologists&rsquo; ability to address SoC were captured. Descriptive statistics were performed. 775 responded, 64.6% (n=501) with SoC. Among these, 94.2% (472/501) were female, 76.6% (384/501) Black/African American, and 48.9% (245/501) 18-24 years. 79.6% (399/501) reported a bothersome skin condition that was moderate to extremely bothersome (85.2%, 340/399). 57.4% (229/399) reported skin condition(s) affected mental health. Discoloration/acne-related post-inflammatory pigmentation changes (69.5%, 348/501), acne (58.5%, 293/501), and ingrown hairs (48.1%, 241/501) were most common. The face was most frequently affected (93.6%, 469/501). 40.9% (205/501) believed available skin products do not address their specific skin needs; 44.8% (179/399) have consulted a dermatologist; 46.4% (185/399) felt like the dermatologist did not know how to treat their skin; and 92.5% (369/399) did not believe most dermatologists or aestheticians are trained to treat darker skin tones. The survey was not validated and may not be generalizable. SoC consumers experience skin-condition psychosocial distress and may hesitate to seek dermatology care. Dermatology products, services, and education tailored to SoC consumers is needed. J Drugs Dermatol. 2023;22(10):1027-1033 doi:10.36849/JDD.7713.

Treatment of mild to severe acne with 1726 nm laser: A safe alternative to traditional acne therapies.

Acne is the most common reason for dermatology consultation in adolescents and young adults. Consultation is often delayed despite unsuccessful self-treatment. Postponing effective treatment places acne sufferers at higher risk for permanent acne scars and post-inflammatory pigment changes. This review discusses clinical challenges with present therapeutic options for acne treatment and the role of a 1726 nm laser for acne. Current acne treatment guidelines were reviewed. A literature review was conducted for trials of light-based acne therapy. The selectivity of previous light-based therapies was reviewed. Available acne therapy is effective, but treatment-related side effects are common. Acne treatment guidelines do not include recommendations for light-based treatments. Different types of light-based treatments have been tried but until now no wavelength specifically targeted sebaceous glands. The 1726 nm laser is safe and effective for treating mild to severe acne in all Fitzpatrick skin types. Acne resolution is apparent within the first month and improves for up to 2 years beyond treatment.

DP14 Going against the grain: eosinophilic dermatosis presenting as erythema gyratum repens

Abstract Erythema gyratum repens (EGR) is a rare, paraneoplastic rash with a characteristic woodgrain appearance. It is heavily associated with malignancies, including lung, oesophageal and breast cancers. However, other conditions can mimic EGR, including leucocytoclastic vasculitis, immunobullous and papulosquamous conditions. We report an unusual presentation of eosinophilic dermatosis with an EGR-like pattern, not associated with malignancy. A 67-year-old woman presented with a 2-week history of a pruritic eruption on her legs. It initially started with three small circular erythematous macules on the right leg and one on the left leg. Over the course of a few days, the three macules evolved into large concentric annular patches simulating woodgrain, which raised the clinical suspicion of EGR. After a week, the patches began to blister with accentuation of some of the blisters on the edge of the annular patches. She denied any previous history of skin problems or changes in medication and was otherwise well with no systemic symptoms, including fever. In view of the almost 70% chance of an underlying malignancy, she was thoroughly investigated. Her full blood count, eosinophil count, liver function test, renal profile and serum C3 and C4 were normal. Skin basement membrane/desmosome antibodies and Borrelia burgdorferi IgG and IgM antibodies were also negative. Histology revealed prominent epidermal spongiosis with some corneal and intraepidermal vesicles that were cell-poor and contained only red blood cells. The underlying dermis showed prominent papillary dermal oedema with a brisk interstitial and superficial/deep perivascular mixed inflammatory infiltrate containing numerous eosinophils but no obvious flame figures. There was also eosinophil infiltration into the underlying subcutaneous fat. Direct immunofluorescence was negative. The histological pattern was that of an eosinophil-rich dermatitis with vesiculation; the history and morphology of the eruption were not compatible with bullous insect bites. An eosinophilic dermatosis such as eosinophilic cellulitis presenting with an EGR-like pattern was considered to be the most likely possibility for her presentation. Computed tomography of the neck, thorax, abdomen and pelvis, bidirectional endoscopy and mammography revealed no malignancies. She was treated with prednisolone 30 mg daily for 10 days with Elocon® ointment, and the eruption improved remarkably leaving postinflammatory colour changes that subsequently resolved. We would like to raise the awareness that an EGR-like pattern can be found in several other dermatoses, including eosinophilic dermatosis, and woodgrain pattern is not always equivalent to EGR or a high risk of associated malignancies (Table 1).Table 1Erythema gyratum repens-like dermatosesLeucocytoclastic vasculitisImmunobullousPapulosquamousBullous pemphigoidPsoriasisEpidermolysis bullosa acquisitaPityriasis rubra pilarisLinear IgA dermatoses

Magnetic resonance imaging characteristics in patients with psoriatic arthritis and axial manifestations from the MAXIMISE cohort.

The current analysis of the MAXIMISE trial was conducted to investigate the presence of post-inflammatory and degenerative spinal changes and inflammatory changes in spinal processes identified in baseline MRIs and their potential for predicting differential treatment effects in a cohort of PsA patients with axial manifestations. Baseline spinal MRIs from the MAXIMISE trial were re-read to identify additional inflammatory (spinal process), post-inflammatory, and degenerative changes, and investigate the differential treatment effect of these imaging features using logistic regression modelling. In addition to bone marrow oedema assessed at primary analysis, spinal process inflammation and post-inflammatory changes evaluated by FAt Spondyloarthritis Spine Score were documented in 11.1% and 20.2% patients, respectively. At least one type of degenerative change was noted in 64% patients, with Pfirrmann grade ≥3 (51.1%) being the most common. Combining primary and re-read MRI findings, 67.1% of patients presented with inflammatory or post-inflammatory changes while 21.2% had degenerative changes alone. Although not statistically significant, post-inflammatory changes were associated with a trend for better efficacy outcomes in terms of ASAS20, ASAS40 and BASDAI50 responses; a trend for worse outcomes was observed in the presence of degenerative changes. The current analysis revealed the occurrence of additional inflammatory and post-inflammatory changes suggestive of axial PsA (axPsA) and a trend for better clinical outcomes for patients treated with secukinumab. These results elucidate the imaging characteristics and improve our current understanding of axPsA thereby supporting the interpretation of future trials. ClinicalTrials.gov, NCT02721966.

Prospective study of efficacy and safety of non-ablative 1927 nm fractional thulium fiber laser in Asian skin photoaging.

Photoaging manifests as deeper wrinkles and larger pores. It has been tried to rejuvenate photoaging skin using a variety of lasers, including fractionated lasers, which are a popular photorejuvenation treatment. A new breakthrough for skin rejuvenation is the 1927 nm fractional thulium fiber laser (FTL), a laser and light-based treatment option. Clinical data regarding the FTL for treating photoaging are limited despite its effectiveness and safety. This study is aim to evaluate FTL' clinical effectiveness and safety. Fitzpatrick skin types II-IV subjects with mild to moderate photoaging signs were enrolled in this prospective study. At intervals of one month, patients received three full face treatments. Wrinkles, spots, texture, pores, melanin index, erythema index (MI and EI), skin elasticity and hydration were measured with non-invasive tool. The epidermal thickness and dermal density on ultrasonography were compared between baseline and one month after all treatment sessions. The Global Score for Photoaging scale (GSP) was rated by two independent evaluators at the baseline and final follow-up visit. Secondary outcomes included patient-rated pain on a 10-point visual analog scale (VAS), as well as overall satisfaction. Following each treatment, adverse events were noted. Totally 27 subjects (24 females and 3 males) with Fitzpatrick skin types II to IV and a mean age of 44.41 (range33-64) were enrolled. Results suggests that the epidermal thickness has significantly improved after treatment. Statistically significant improvements in melanin index, skin elasticity and wrinkles were noted. An analysis of 12 subjects' reports (44%) suggested their skin felt brighter. No post-inflammatory hyperpigmentation changes or adverse events were observed. 70% patients reporting "satisfied" or "extremely satisfied". In this study, FTL was found to be a safe and effective treatment option for treating photoaging.

P027 Anorectal Motility Disorders in Inflammatory Bowel Disease patients

Abstract Background In spite of prolonged disease remission of IBD patients, induced by the new biological molecules, a significant number of them suffer from persistent debilitating symptoms with major impact on the quality of life. Frequently, these symptoms are due to post-inflammatory motility changes and misinterpreted as functional disorders. Our aim is to identify and characterize the anorectal motility dysfunction in IBD patients. Methods We are conducting an ongoing prospective study started in August 2019, which includes the IBD patients admitted in a Tertiary Gastroenterology Centre in Bucharest, with specific symptoms (anorectal pain, incontinence, difficult defecation). We perform high resolution anorectal manometry using Sandhill Scientific systems, the parameters being analysed using InSIGHT software. The manometric testing comprise measurements of anorectal pressure at rest, during squeeze, simulated evacuation, rectoanal inhibitory reflex (RAIR) and rectal sensory testing, in compliance with International Anorectal Physiology Working Group protocol. Results We studied 21 patients (12 patients with Ulcerative Colitis and 9 patients with Crohn’s Disease, 15 females and 6 males, mean age 40 (±11.43) years. Only 23.1% (5 patients) had rectal active involvement. Symptoms were reported by 81.0% (17) patients: pain (57.1%), anal incontinence (94.1%), difficult evacuation (29.4%), urgency (64.7%) and intolerance of rectal therapies (35.3%); rectal inflammation was not correlated with the presence of symptoms in our study group (p= 0.53). Modified manometric parameters were found in 81.0% patients and were associated with previous pelvic surgical interventions (p&amp;lt;0.05); although, the latter does not seem to increase the risk of incontinence (p=0.33). In 61.9% cases the manometric measurements correlated with the symptoms. 85% of the patients with passive incontinence presented lower resting pressure and 57.1% of those with active incontinence were found with lower squeeze pressures. Changes compatible with dyssynergia were detected in 61.9% of the cases. Sensory testing revealed alterations in 46.2% of patients, and RAIR was negative in 33.3% of the cases. Conclusion There is a considerable number of patients with anorectal motility changes. Therefore, pelvic floor investigation is an essential tool in the management of IBD patients with anorectal symptoms.

Catechol-O-Methyltransferase Loss Drives Cell-Specific Nociceptive Signaling via the Enteric Catechol-O-Methyltransferase/microRNA-155/Tumor Necrosis Factor α Axis

The etiology of abdominal pain in postinfectious, diarrhea-predominant irritable bowel syndrome (PI-IBS-D) is unknown, and few treatment options exist. Catechol-O-methyltransferase (COMT), an enzyme that inactivates and degrades biologically active catecholamines, plays an important role in numerous physiologic processes, including modulation of pain perception. Our objective was to determine the mechanism(s) of how decreased colonic COMT in PI-IBS-D patients contributes to the chronic abdominal pain phenotype after enteric infections. Colon neurons, epithelial cells, and macrophages were procured with laser capture microdissection from PI-IBS-D patients to evaluate cell-specific colonic COMT, microRNA-155 (miR-155), and tumor necrosis factor (TNF) α expression levels compared to recovered patients (infection cleared: did not develop PI-IBS-D) and control individuals. COMT-/-, colon-specific COMT-/-, and miR-155-/- mice and human colonoids were used to model phenotypic expression of COMT in PI-IBS-D patients and to investigate signaling pathways linking abdominal pain. Citrobacter rodentium and trinitrobenzene sulfonic acid animal models were used to model postinflammatory changes seen in PI-IBS-D patients. Colonic COMT levels were significantly decreased and correlated with increased visual analog scale abdominal pain ratings in PI-IBS-D patients compared to recovered patients and control individuals. Colonic miR-155 and TNF-α were increased in PI-IBS-D patients with diminished colonic COMT. COMT-/- mice had significantly increased expression of miR-155 and TNF-α in both colon tissues and dorsal root ganglia. Introduction of cV1q antibody (anti-TNF-α) into mice reversed visceral hypersensitivity after C rodentium and trinitrobenzene sulfonic acid. Decreased colonic COMT in PI-IBS-D patients drives abdominal pain phenotypes via the COMT/miR-155/TNF-α axis. These important findings will allow new treatment paradigms and more targeted and personalized medicine approaches for gastrointestinal disorders after enteric infections.

Pleurisy and pericarditis as a cause of atypical chest pain in patients with in early post-COVID-19 period

During the pandemic COVID-19, there has been an increase in the number of patients with non-anginal chest pain at cardiologist appointments.Objective. To assess the incidence of signs of pleurisy and pericarditis after COVID-19 in non-comorbid patients with atypical chest pain and describe their characteristics according to echocardiography and magnetic resonance imaging.Materials and methods. From February 2021 to January 2022, 200 outpatients were prospectively enrolled in the study, all of them suffered from a discomfort in the heart region for the first time after SARS-CoV-2 infection. Inclusion criteria: 18–50 years old, 5–12 weeks after SARS-CoV-2 infection, non-anginal chest pain. Exclusion criteria: pneumonia or signs of pulmonary thromboembolism, coronary heart disease, congestive heart failure or kidney disease, clinical or laboratory signs of myocarditis, oncopathology, radiation or chemotherapy of the chest in past medical history. A survey was conducted (yes/no) for the presence of general malaise, quality of life deterioration, hyperthermia, cough. Ultrasound examination of the pericardium and pleura to detect effusion or postinflammatory changes was performed in accordance with the recommendations. Magnetic resonance imaging was performed if ultrasound imaging was poor or there was no evidence of pericardial or pleural involvement in patients with typical symptoms.Results. 82 women and 118 men were included. Median of age 39 [28–46] years old. Pericarditis was diagnosed in 152 (76%) patients, including effusive pericarditis in 119 (78%), myocarditis in 6 (3%) and myopericarditisin 49 (25%) patients, pleurisy was detected in 22 (11%) patients, exudative pleurisy – in 11 (5.5%) patients with a predominant unilateral lesion of the mediastinal-diaphragmatic region adjacent to the heart. Hyperthermia was recorded in 2.5% of cases, general malaise – in 60% and a decrease in the quality of life – in 84%.Conclusion. Serositis as a cause of atypical chest pain among young non-comorbid patients in early postCOVID was identified in 87% of patients. In the coming years, it is probably worthwhile to perform ultrasound of the pericardium and pleura in all patients with chest pain.

СЕЛЕКТИВНОЕ ПРОФИЛАКТИЧЕСКОЕ ФЛЮОРОГРАФИЧЕСКОЕ ОБСЛЕДОВАНИЕ СОЦИАЛЬНО-ДЕЗАДАПТИРОВАННОЙ ГРУППЫ НАСЕЛЕНИЯ г. ЯКУТСКА

The article analyzes the effectiveness of a selective preventive fluorographic examination of a socially maladjusted group of the population, conducted in Yakutsk in 2018-2021. The socially maladjusted groups of the population include persons without a fixed place of residence and work (homeless), suffering from alcohol addiction, persons released from places of the penitentiary system. The analysis of data from field fluorographic examinations of 667 persons from a socially maladjusted group who found themselves in difficult life situations was carried out. The examination revealed 114 fluoropositive individuals with various radiographic changes in the chest organs. As a result of additional examination of fluoropositive persons in the anti-tuberculosis dispensary, active tuberculosis of the chest organs was detected in 7 persons, metatuberculous changes in the lungs - in 28, oncological and non-specific inflammatory diseases, as well as post-inflammatory changes in the lungs - in 41. The group of the population amounted to 10.5 per 1,000 examinations, which is significantly higher than the similar indicator of mass continuous examination of the entire population of the republic for 2012-2019, which amounted to 0.57 per 1,000 examinations. Thus, persons from the socially maladjusted group of the population remain one of the main risk groups for tuberculosis. Tuberculosis remains largely a social disease and requires special attention not only from healthcare organizations, but also from social protection authorities, administrations of municipal institutions, public organizations, law enforcement and justice agencies.

A novel magnetic resonance imaging scoring system for active and chronic changes in children and adolescents with juvenile idiopathic arthritis of the hip

BackgroundHip involvement predicts severe disease in juvenile idiopathic arthritis (JIA) and is accurately assessed by MRI. However, a child-specific hip MRI scoring system has not been validated.ObjectiveTo test the intra- and interobserver agreement of several MRI markers for active and chronic hip changes in children and young adults with JIA and to examine the precision of measurements commonly used for the assessment of growth abnormalities.Materials and methodsHip MRIs from 60 consecutive children, adolescents and young adults with JIA were scored independently by two sets of radiologists. One set scored the same MRIs twice. Features of active and chronic changes, growth abnormalities and secondary post-inflammatory changes were scored. We used kappa statistics to analyze inter- and intraobserver agreement for categorical variables and a Bland–Altman approach to test the precision of continuous variables.ResultsAmong active changes, there was good intra- and interobserver agreement for grading overall inflammation (kappa 0.6–0.7). Synovial enhancement showed a good intraobserver agreement (kappa 0.7–0.8), while the interobserver agreement was moderate (kappa 0.4–0.5).Regarding acetabular erosions on a 0–3 scale, the intraobserver agreement was 0.6 for the right hip and 0.7 for the left hip, while the interobserver agreement was 0.6 for both hips. Measurements of joint space width, caput–collum–diaphyseal angle, femoral neck–head length, femoral width and trochanteric distance were imprecise.ConclusionWe identified a set of MRI markers for active and chronic changes in JIA and suggest that the more robust markers be included in future studies addressing clinical validity and long-term patient outcomes.