Severity Of Inflammatory Activity Research Articles

Skin Homeostasis is Impaired in Hidradenitis Suppurativa Lesions: A Comparative Study

IntroductionHidradenitis suppurativa (HS) is a chronic skin disease whose impact on skin homeostasis has not been adequately studied at present. Knowledge about how skin function changes in these patients, and could be of interest not only to improve the topical management of the disease, but also as an objective measure of disease activity. The aim of this study was to compare skin homeostasis and the epidermal barrier function in lesional and healthy skin areas of patients with HS. MethodsWe conducted a cross-sectional study. Skin homeostasis and the epidermal barrier function of lesions were assessed in HS patients using validated tools. A healthy perilesional skin control was assigned to each lesion to compare skin homeostasis parameters. ResultsA total of 43 patients were included: 22 nodules, 10 abscesses and 25 draining tunnels were measured. The male-to-female ratio was 20:23, and the mean age, 35.95 years (SD, 14.82). Increased transepidermal water loss (TEWL) and erythema were found in nodules, abscesses and draining tunnel vs healthy skin. A direct association was observed between inflammatory nodules TEWL and IHS4 stage. In draining tunnels, a direct association was observed between TEWL and smoking. A trend of increasing TEWL values was observed as a function of Hurley stage. ConclusionHS lesions exhibit epidermal barrier dysfunction that depends on the severity of inflammatory activity. These results could be useful to develop objective classification systems for the severity and degree of involvement of HS or help in the development of vehicles for specific drugs, antiseptics and dressings for the management of this disease.

Diversion colitis in inflammatory bowel disease (IBD) is distinct from that in non-IBD: Reappraisal of diversion colitis

The significant histologic overlap between diversion colitis and inflammatory bowel disease (IBD) poses a diagnostic challenge. We aimed to identify histologic features that are characteristic of diverted colon segments among patients with IBD and compare them with histologic features identified in IBD colectomies. Archived slides from resected diverted colon segments from patients with (n=79) and without (n=80) IBD and the corresponding prior colectomies (n=52) of the IBD patients were reviewed. Clinical and endoscopic data were collected, and a series of histologic features were evaluated and graded. Compared to the non-IBD group, IBD patients were more likely to be symptomatic and present with abnormal endoscopic findings (P<.05). The severity of inflammatory activity, crypt architectural distortion, mucosal atrophy, transmural inflammation, intramucosal lymphoid aggregates (IMLAs), and transmural lymphoid aggregates (TMLAs) were significantly greater in diverted segments in IBD cases than controls (P<.001). The severity of inflammatory activity, IMLAs, TMLAs, and transmural inflammation and the presence of ulcer(s) in the diverted colon segments of IBD patients were associated with the histologic features reflective of IBD activity such as inflammatory activity, transmural inflammation and ulcer(s) in the preceding colectomies (P<.05). Diversion colitis developing in the setting of IBD is endoscopically and histologically distinct from that observed among individuals without IBD. Inflammatory activity, presence of ulcer(s), IMLAs, TMLAs, and transmural inflammation in diverted colon segments of IBD patients may, in part, reflect the severity of underlying IBD rather than pure diversion colitis.

Proinflammatory cytokine profile in children with neonatal sepsis

Research objective . Evaluation of inflammatory activity of the blood of newborns with various forms of bacterial infectious diseases with the determination of the diagnostic significance of various inflammatory markers. Materials and methods . The study includes 50 newborns with various forms of infectious diseases: 31 newborns with neonatal sepsis (group 1) and 19 newborns with localized variants of bacterial infection. The severity of inflammatory activity was assessed by the level of C-reactive protein, the number of peripheral blood leukocytes, the level of cytokines-tumor necrosis factor-α (TNF-α), interleukins IL-2, IL-6, IL-8, IL-10, interferon-ɣ (IFN-ɣ), granulocyte-macrophage colony-stimulating factor (GM-CSF). Results. In the group of children with neonatal sepsis, the first 2 days of the disease occur against the background of an increase in the concentration of TNF-α, IL-6, IL-8 and IFN-ɣ in the blood, the indices of which differed significantly (p &lt;0.05) from the control group. Significant markers of inflammation were high concentrations in the blood of the C-reactive protein (RR-3.7, CI 1.7-8.1), IL-6 (RR-2.0, CI 1.4–3.0), and IL -8 (RR-1.5, CI 1.1–2.2). In the group of children with localized forms of bacterial infection, the first 2 days of the disease were accompanied by an increase in the concentration in the blood of TNF-α, IL-6 and IFN-ɣ (p &lt;0.05). Moreover, the degree of increase of IL-6 was less pronounced than in the 1st group (p=0.007), and the median IL-8 did not differ from the control group (p=0,7). Conclusion. The immune response for neonatal sepsis and localized forms of bacterial infection is characterized by an increase in the level of proinflammatory cytokines in the blood. Reliable markers of inflammation in sepsis are IL-6, IL-8 and C-reactive protein, the values of which were significantly high in the group of children with neonatal sepsis.

Vitamin D status and serum ferritin concentration in chronic hepatitis C virus type 1 infection

The circulating 25-hydroxylated form of vitamin D(3), 25(OH)D, and serum ferritin concentrations have been described to be associated with disease progression in chronic hepatitis C. Both parameters also have been assessed with regard to treatment outcome, however, with divergent results. This study examined both the pre- and posttreatment serum concentrations of 25(OH)D and ferritin in 191 patients infected chronically with hepatitis C virus (HCV) type 1 with regard to liver inflammatory activity (grading), disease progression in terms of fibrosis (staging) and an antiviral treatment outcome. Mean pretreatment serum 25(OH)D and ferritin concentrations were 18 ± 10 ng/ml and 280 ± 225 µg/L, respectively. Multivariate analysis revealed lower pretreatment serum 25(OH)D and higher ferritin concentrations to be significantly related to both severity of inflammatory activity and of fibrotic alterations. Pretreatment serum ferritin concentration, furthermore, unlike 25(OH)D concentration, was found to be associated with a sustained virological response by uni- and multivariate analyses. A sustained virological response was featured by a significant increase in serum 25(OH)D levels (18 ± 10 ng/ml vs. 22 ± 11 ng/ml; P < 0.01), a reduction of serum ferritin concentration (191 ± 156 µg/L vs. 103 ± 63 µg/L; P < 0.001) and a normalization of serum alanine aminotransferase (ALT) and γ-glutamyl-transferase (γ-GT) activities. Taken together, decreased 25(OH)D and increased ferritin serum levels indicate the severity of hepatic inflammation and fibrosis in patients infected chronically with HCV type 1. Elevated ferritin, furthermore, was found to be an independent predictor for standard IFN-based therapy responsiveness.

Retinal Thickening in HLA-B27–Associated Acute Anterior Uveitis: Evolution with Time and Association with Severity of Inflammatory Activity

To describe the evolution of retinal thickness in eyes affected with acute anterior uveitis (AAU) in the course of follow-up and to assess its correlation with severity of inflammatory activity in the anterior chamber. 72 eyes (affected and fellow eyes) of 36 patients presenting with HLA-B27-related acute anterior uveitis were included in a prospective, institutional, cohort study. Patients were followed daily until beginning of resolution of inflammatory activity and weekly thereafter. Optical coherence tomography and laser flare photometry were performed at each visit. Treatment consisted of topical corticosteroids. Main outcome measures were retinal thickness of affected eyes, difference in retinal thickness between affected and fellow eyes and their evolution in time, association between maximal retinal thickness, and initial laser flare photometry. Difference in retinal thickness between affected and fellow eyes became significant on average 7 days from baseline and remained so throughout follow-up (P < 0.001). There was a steep increase in retinal thickness of affected eyes, followed by a progressive decrease after reaching a peak value. Maximal difference in retinal thickness between affected and fellow eyes was observed between 17 and 25 days from baseline and exhibited a strong, positive correlation with initial laser flare photometry values (P = 0.015). Retinal thickness in eyes affected with AAU presents a steep increase over 3 to 4 weeks and then gradually decreases. Severity of inflammation at baseline predicts the amount of retinal thickening in affected eyes. A characteristic pattern of temporal response of retinal anatomy to inflammatory stimuli seems to arise.

Biomarkers in Nonalcoholic Fatty Liver Disease: A New Era in Diagnosis and Staging of Disease in Children

Biomarkers in Nonalcoholic Fatty Liver Disease: A New Era in Diagnosis and Staging of Disease in Children

Aberrant methylation of DAPK in long-standing ulcerative colitis and ulcerative colitis-associated carcinoma

Death-associated protein kinase (DAPK) has pro-apoptotic functions and participates in various apoptotic systems. DAPK acts as a tumor suppressor, and its inactivation by promoter hypermethylation has been frequently observed in various human cancers. As alterations of pro-apoptotic genes might cause instability in the balance of cell-turnover during chronic inflammatory processes, epigenetic silencing of DAPK might be involved in the carcinogenesis of ulcerative colitis-associated carcinoma (UCC). To evaluate the role of DAPK in the inflammation-driven carcinogenesis of ulcerative colitis (UC), we analyzed promoter hypermethylation and protein expression of DAPK using methylation-specific PCR and immunohistochemistry in 43 UCCs and paired UC-background mucosa, as well as in UC-background mucosa of 50 patients without UCC. The frequency of methylation of DAPK in UCCs was low (27.6%) compared to overall non-neoplastic UC-background mucosa (48.3%; p = 0.02) and sporadic colorectal carcinoma (57.4%, p = 0.019). The difference in the methylation frequency in UC-background mucosa in patients without UCC (54.2%), compared to those with UCC (40.0%), was not significant ( p = 0.141). Promoter methylation correlated significantly with decreased DAPK protein expression ( p < 0.001) and severity of inflammatory activity ( p = 0.024). In unmethylated UC-background mucosa, DAPK protein expression increased with activity of UC-associated inflammation, suggesting a protective role of the pro-apoptotic DAPK during the chronic inflammatory process of UC. Thus, inactivation of DAPK by promoter hypermethylation might be crucial for accumulation of DNA damage in inflamed mucosa of UC, and might therefore contribute to the initiation of the neoplastic process and development of UC-associated carcinoma.

Chromoendoscopy and ulcerative colitis

Background and aimsTimely diagnosis of intraepithelial neoplasias (IN) and colitis-associated colon carcinomas (CRC) is crucially important in the treatment of ulcerative colitis (UC). We performed a randomized, controlled trial to test whether chromoendoscopy (CE) can facilitate early detection of IN and CRC in ulcerative colitisMethodsA total of 263 patients with long-standing UC (8 years or more) were screened for inclusion in the study, 165 of whom were randomized at a 1:1 ratio to undergo conventional colonoscopy or colonoscopy with CE using 0.1% methylene blue. Five mucosal biopsy specimens were taken every 10 cm between the rectum and caecum. Circumscript lesions in the colon were evaluated according to a modified pit pattern classification.ResultsIn the CE group, there was a significantly higher correlation between the endoscopic assessment of degree (P = 0.0002) and extent (89 vs 52%; P < 0.0001) of colonic inflammation and the histopathologic findings, compared with the conventional colonoscopy group. More targeted biopsies resulted in the detection of significantly more IN in the CE group (32 vs 10; P = 0.003). Using a modified pit pattern classification, both the sensitivity and specificity for differentiation between non-neoplastic and neoplastic lesions measured 93%.ConclusionsBased on our prospective, randomized trial, CE permits more accurate diagnosis of the extent and severity of inflammatory activity in UC compared with conventional colonoscopy. In addition, CE with methylene blue provides a novel tool for the early detection of IN and CRC in patients with UC. These findings have important implications for medical and surgical interventions.