Significant Clinical Symptoms Research Articles

Evaluating the role of high-sensitivity C-reactive protein in asthmatic Iraqi patients and its correlation with parameters of patients’ clinical characteristics and pulmonary function tests

Aims and Objectives: To evaluate the relevance of high-sensitivity assays for C-reactive protein (hs-CRP), as a sensitive marker of inflammation in asthmatic Iraqi patients. Additionally, correlations of serum levels of hs-CRP with patients’ clinical characteristics and pulmonary function tests (PFTs) will be studied in a cross-sectional design.Materials and Methods: A random sample of 58 individuals were divided into a healthy (control) group (n = 12) and two groups of adult patients with chronic stable asthma; (n = 22) patients had been receiving inhaled corticosteroids (inhaled corticosteroid-positive, or ICS+VE, group) for the past 2–3 months, and (n = 24) steroid-naive patients (inhaled corticosteroid-negative, or ICS-VE, group). The selected individuals were subjected to hs-CRP measurement and PFTs.Results: The forced expiratory volume in one second (FEV1)/forced vital capacity (FVC), was measured in all subjects. In the ICS+VE and the ICS-VE groups, there was a significant correlation between the level of hs-CRP and FEV1/FVC with r: ?0.891 and a p-value of < 0.0005 for both groups. In the ICS-VE group, 78.5% had significant clinical symptoms, whereas only 22.7% of the ICS+VE group had significant clinical symptoms. This difference (for the prevalence of clinical symptoms) was significant with a chi-square value of 19.59, degree of freedom (df) = 1, and p < 0.0005.Conclusion: In the ICS-VE group, the level of hs-CRP was significantly higher than in both the ICS+VE group and the control group. The values of the PFTs were significantly lower in the ICS-VE group. The prevalence of clinical features was significantly higher in the ICS-VE group.Asian Journal of Medical Sciences Vol. 7(3) 2016 47-53

Endovascular Treatment of Symptomatic Vertebral Artery Dissecting Aneurysms.

ObjectiveVertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs.Materials and MethodsBetween July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture.ResultsClinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either.ConclusionEndovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment.

Programas de ordenador basados en mindfulness. Una revisión de la literatura médica

BackgroundMany studies have evaluated the effects of meditation and have found positive health benefits (Chen, Berger, Manheimer, Forde, Magidson, Dachman, & Lejuez, 2012). Internet has enabled a new way to provide treatment programs (Cuijpers, Driessen, Hollon, van Oppen, Barth, & Andersson, 2012). The main aim of the present study is to conduct a review of the characteristics and the effectiveness of the computer-assisted psychotherapies mindfulnessbased. MethodThe searches were made in the databases, excluding opinion articles and articles where a preand post-treatment evaluation was not included. ResultsA total of 12 articles were found. Most of these studies showed a significant reductionof clinical symptoms. ConclusionsThe application of mindfulness-based therapies over the Internet can help to reduce clinical symptoms and improve the wellness. However, more research in this regard is needed.

HYPOVITAMINOSIS D

Objectives: To determine the frequency of vitamin D deficiency in children under12 years of age in the absence of significant clinical signs and symptoms in an ambulatory caresettings. Study Design: Descriptive study. Settings and duration: This study was conductedin Pediatric Out Patient Department of KAUH from June 2013 to June 2014. Materials andmethods: Patients attending the pediatric clinic in KAUH Riyadh, KSA, from June2013 to June2014, in which 287 healthy children under 12 years were enrolled. Serum calcium, phosphorus,alkaline phosphatase and 25-hydroxyvitamin D [25(OH) D] were measured .X ray wrists weretaken for radiological evidence of rickets. 25(OH) D levels <50 ng/mL and <25 ng/mL weredefined as insufficiency and severe vitamin D deficiency, respectively. Results: A high prevalenceof vitamin D deficiency is observed in healthy children even in absence of clinical signs andsymptoms. The problem should be highlighted and there is a need to create awareness amongpeople about the etiology of vitamin D deficiency and its prevention.There is a strong need forlong term planning including populationscreening, dietary supplementation with vitamin D andfood fortification.

Clinical Correlates of Mass Effect in Autosomal Dominant Polycystic Kidney Disease.

Mass effect from polycystic kidney and liver enlargement can result in significant clinical complications and symptoms in autosomal dominant polycystic kidney disease (ADPKD). In this single-center study, we examined the correlation of height-adjusted total liver volume (htTLV) and total kidney volume (htTKV) by CT imaging with hepatic complications (n = 461) and abdominal symptoms (n = 253) in patients with ADPKD. “Mass-effect” complications were assessed by review of medical records and abdominal symptoms, by a standardized research questionnaire. Overall, 91.8% of patients had 4 or more liver cysts on CT scans. Polycystic liver disease (PLD) was classified as none or mild (htTLV < 1,600 mL/m); moderate (1,600 ≤ htTLV <3,200 mL/m); and severe (htTLV ≥ 3,200 mL/m). The prevalence of moderate and severe PLD in our patient cohort was 11.7% (n = 54/461) and 4.8% (n = 22/461), respectively, with a female predominance in both the moderate (61.1%) and severe (95.5%) PLD groups. Pressure-related complications such as leg edema (20.4%), ascites (16.6%), and hernia (3.6%) were common, and patients with moderate to severe PLD exhibited a 6-fold increased risk (compared to no or mild PLD) for these complications in multivariate analysis. Similarly, abdominal symptoms including back pain (58.8%), flank pain (53.1%), abdominal fullness (46.5%), and dyspnea/chest-discomfort (44.3%) were very common, and patients with moderate to severe PLD exhibited a 5-fold increased risk for these symptoms. Moderate to severe PLD is a common and clinically important problem in ~16% of patients with ADPKD who may benefit from referral to specialized centers for further management.

Motion perception deficit in Down Syndrome

It is a well established fact that Down Syndrome (DS) individuals have a tendency to develop Alzheimer's disease (AD) (Lott, I.T., Head, E., 2005. Alzheimer disease and Down syndrome: factors in pathogenesis. Neurobiol. Aging 26, 383–389). They have therefore been proposed as a model to study the pre-dementia stage of Alzheimer's (Mann, D.M., 1988. The pathological association between Down syndrome and Alzheimer disease. Mech. Ageing Dev. 43, 99–136). One of the specific deficits exhibited by AD patients is optic flow motion perception (Tetewsky, S.J., Duffy, C.J., 1999. Visual loss and getting lost in Alzheimer's disease. Neurology 52, 958–965), but there are no corresponding systematic studies in DS individuals. We performed sensitivity measurements to optic flow with Visual Evoked Potentials (VEP) and psychophysical techniques in a group of young DS participants with mild mental retardation and without significant Alzheimer's clinical symptoms. We found a significant reduction in direction discrimination sensitivity to optic flow (random dots moving in radial, rotational and translational trajectories) in DS participants compared to mental age-matched controls, while their sensitivity to direction of control moving stimuli (sinusoidal gratings) was similar to age-matched controls. Measurements of Visual Evoked Potentials (VEP) showed no response to optic flow, although the response to control stimuli (contrast-reversal checkerboard patterns) was significant. Overall, our results show a selective and substantial deficit in the perception of optic flow motion and a corresponding suppression of electroencephalographic activity in DS individuals, thus establishing a further common trait between Down Syndrome and Alzheimer's disease.

Different allergenicity profile of egg white protein extract vs. purified ovalbumin in an adjuvant-free mouse model (HYP7P.267)

Abstract Food allergies are the leading cause of life-threatening allergic reactions with incompletely understood mechanisms. Here we initially evaluated the allergenicity of egg white protein extract (EWPE) in a novel transdermal sensitization model without adjuvants such as alum/cholera toxin/super-antigen that are commonly used in mouse models of egg allergy. Groups of mice received transdermal exposure (TDE) to EWPE (1 mg/exposure/week) for four weeks. Sensitization was measured by specific IgE antibody (SIgE Ab) levels in plasma using ELISA. Systemic anaphylaxis was assessed upon oral challenge (OC) with EWPE using clinical scoring method, and hypothermia reactions. Four TDEs were sufficient to elicit robust SIgE Ab responses. Upon OC (15 mg/mouse), EWPE elicited near-fatal clinical signs of anaphylaxis associated with rapid hypothermia reactions. We then evaluated allergenicity of purified ovalbumin (OVA) using this model. Groups of mice received TDE to OVA at 4 different doses. Robust OVA SpIgE responses were observed upon TDE. Surprisingly, sensitized mice did not exhibit significant clinical symptoms or hypothermia reactions upon OC with a wide dose range. Nevertheless, robust anaphylaxis was evident upon i.p., injection with OVA. These data suggest that mechanisms of oral egg protein-induced reactions in adjuvant-free model likely depends on whether protein extracts or pure protein from the same food source (egg) is used in model development.

Thyroid Disease and the Heart

Thyroid hormones have an intimate relationship with cardiac function. Some of the most significant clinical signs and symptoms of thyroid disease are the cardiac manifestations. In both hypothyroidism and hyperthyroidism, the characteristic physiological effects of thyroid hormone can be understood from the actions at the molecular and cellular level. Here we explore topics from the metabolism and cellular effects of thyroid hormone to special considerations related to statin and amiodarone therapy for the alterations in thyroid hormone metabolism that accompany heart disease.

Asymptomatic Middle East respiratory syndrome coronavirus infection in rabbits.

The ability of Middle East respiratory syndrome coronavirus (MERS-CoV) to infect small animal species may be restricted given the fact that mice, ferrets, and hamsters were shown to resist MERS-CoV infection. We inoculated rabbits with MERS-CoV. Although virus was detected in the lungs, neither significant histopathological changes nor clinical symptoms were observed. Infectious virus, however, was excreted from the upper respiratory tract, indicating a potential route of MERS-CoV transmission in some animal species.

A new paradigm in treatment of brain metastases

Dada la escasez de directrices abordando este tema y con motivo de la futura creación de la Unidad de Cuidados Paliativos (CP) en nuestro centro de neurorrehabilitación, los miembros del equipo médico de la Clínica San Vicente hemos decidido proponer una serie de sugerencias sobre el empleo de fármacos antiepilépticos (FAEs) en el manejo de las crisis epilépticas (CEs) en CP.Búsqueda de artículos en PubMed, últimos libros y recomendaciones de las guías de práctica clínica y sociedades científicas publicadas más relevantes, referentes al manejo de las CEs en CP.La confección de este tipo de guías, además de identificar pacientes candidatos a recibir CP, es fundamental para garantizar un buen control sintomático de las CEs y evitar el sufrimiento innecesario de estos enfermos y sus familiares. Dadas las características de estos pacientes, se recomienda usar FAEs con presentación vía parenteral (preferiblemente intravenosa) y un perfil bajo de interacciones. Diazepam y/o midazolam serían los más idóneos para la fase aguda, y levetiracetam, ácido valproico y/o lacosamida para casos refractarios y/o como tratamiento crónico.Estas recomendaciones deben considerarse una guía de abordaje integral, debiendo adaptarse a la idiosincrasia de cada caso clínico en particular. Sin embargo, se necesitan ensayos clínicos controlados, aleatorizados, bien diseñados, que incluyan muestras amplias de pacientes subsidiarios de CP, para redactar un documento de consenso que permita recomendar con un mayor nivel de evidencia y de forma generalizada, la utilización adecuada, racional y efectiva de FAEs en este ámbito médico-asistencial de elevada complejidad.Very little has been written on seizure management in palliative care (PC). Given this situation, and considering the forthcoming setting up of the Palliative Care Unit at our neurorehabilitation centre, the Clínica San Vicente, we decided to establish a series of guidelines on the use of antiepileptic drugs (AEDs) for handling seizures in PC.We conducted a literature search in PubMed to identify articles, recent manuals, and clinical practice guidelines on seizure management in PC published by the most relevant scientific societies.Clinical practice guidelines are essential to identify patients eligible for PC, manage seizures adequately, and avoid unnecessary distress to these patients and their families. Given the profile of these patients, we recommend choosing AEDs with a low interaction potential and which can be administered by the parenteral route, preferably intravenously. Diazepam and midazolam appear to be the most suitable AEDs during the acute phase whereas levetiracetam, valproic acid, and lacosamide are recommended for refractory cases and long-term treatment.These guidelines provide general recommendations that must be adapted to each particular clinical case. Nevertheless, we will require further well-designed randomised controlled clinical trials including large samples of patients eligible for PC to draft a consensus document recommending adequate, rational, and effective use of AEDs, based on a high level of evidence, in this highly complex area of medical care.

Diagnosis and treatment of focal nodular hyperplasia

Objective To summarize the diagnosis and treatment experiences of focal nodular hyperplasia (FNH) . Methods The clinical data of 48 patients with FNH who were admitted to the Xiangya Hospital from February 2010 to August 2014 were retrospectively analyzed. All the patients received complete serologic tests, abdomen B ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) examinations. The pathological examinations were done on the patients undergoing surgical treatment. The surgical treatment was done on the unconfirmed FNH patients according to location of space-occupying lesions. The conservative treatment was done on the confirmed FNH patients without clinical symptoms. All the patients were followed up via outpatient examination and telephone interview up to September 2014, and the follow-up included the history review, clinical symptoms and medical examinations. Results Forty-seven patients had normal liver function and 1 had high level of total bilirubin (TBil) . The serum tumor markers including AFP, CEA and CA19-9 in all the patients were negative. Fifty-five foci were detected by imaging examination, 41 foci were single mass and 7 foci were multifocality. Forty-eight patients were definitively unconfirmed with FNH by B ultrasound. The results of CT examinations in 38 patients showed as follows: low density was in 31 patients and isodensity in 7 patients, including striped and radiated low density showing in the center of tumor in 20 patients and 3 patients with the confirmed FNH. The results of MRI examinations in 10 patients showed as follows: 3 patients were confirmed as with FNH; all the 10 patients showed rather homogeneous enhancement in arterial phase; 5 patients were accompanied with radiated foci in the center of tumor, and showed high signal on T2WI, no enhancement in early arterial phase and enhancement in delayed arterial phase. The central scar showed low signal on T1WI and high signal on T2WI. Two patients were confirmed as with FNH by percutaneous trans-hepatic histopathological examinations. Forty patients without the confirmed FNH underwent surgical treatment, including 31 undergoing open hepatectomy and 9 undergoing laparoscopic hepatectomy. No patients had cirrhosis of liver. During operation, 47 foci were detected, 16 of which located at the left lobe of liver and 31 of which located at the right lobe of liver. Local tumor resection of liver was carried out on 30 patients, right hemihepatectomy or extended right hepatectomy on 7 patients, left hemihepatectomy on 3 patients and combined treatment of cholecystectomy on 12 patients. The operation time, volume of blood loss and diameter of foci were (78-255) minutes, (80-720) mL and (4. 6 ±1. 6) cm (range, 1. 5-11. 5 cm) . Forty patients were confirmed as with FNH by pathological examination, and 8 patients were cured by conservative treatment. All the 48 patients were followed up for 21 months (range, 1-56 months) and survived well without recurrence and complications. Conclusions The clinical symptoms of FNH are atypical and unobvious. The preoperative enhanced CT and MRI examinations can help improve the diagnosis and differential diagnosis of FNH. The surgical treatment could be performed on the patients with significant clinical symptoms and without definitive diagnosis, and the patients with definitive diagnosis should be treated by conservative treatment with the good prognosis. Key words: Focal nodular hyperplasia; Hepatectomy; Diagnosis; Therapy

Asymptomatic idiopathic right atrial rupture: An unusual presentation

Introduction: Atrial rupture is a very rare and fatal condition and has been only scantily reported in the past. Patients with this condition present with significant clinical symptoms requiring an urgent medical management. case report: A case of spontaneous idiopathic right atrial rupture detected on routine physical examination in a completely asymptomatic active young male. A defect of 18 mm in the right atrial wall just above the level of tricuspid valve was revealed in the transthoracic echocardiogram. Patient denied the option of surgical repair and remains asymptomatic during a two-year follow-up. conclusion: Very rarely, patients with spontaneous idiopathic right atrial rupture may remain asymptomatic for a long period and can live a normal life without any active surgical intervention. However, the patient may develop severe right heart failure followed by death if the medical condition is left untreated. In view of the long-term complications, it is advisable to treat this condition with immediate surgical intervention.

C/EBPε Plays a Role in Immunity By Regulating Trem-1 Expression in Granulocytes

C/EBPepsilon (C/EBPε) knock-out (KO) mice have defects in granulocytic development and increased susceptibility to infection. We also observed a unique phenotype of C/EBPε KO mice showing prolonged lower grade, mild skin problems such as hair loss that progressed to severe wound problems; abdominal wall perforation to the peritoneum as well as mandibular skin perforation to the oral cavity, without significant clinical symptoms. The observation suggests inappropriate response to inflammation by loss of C/EBPε. To understand the functional defects of these granulocytes, we performed a systematic approach with ChIP-seq and microarray of bone marrow cells from C/EBPε KO mice.Duplicate ChIP-seq libraries were prepared from bone marrow cells of wild type and C/EBPε KO mice using two different C/EBPε specific antibodies. Analysis of pooled data identified 14,253 C/EBPε binding sites, and 12,865 of these binding sites overlapped with the two antibodies. Sixteen percent of C/EBPε binding sites were in the promoter regions within 1 kb of the transcriptional start sites. Direct canonical C/EBPε target genes were defined by 1.5 log2 fold or greater increase in expression in the Gr-1+/Mac-1+ cells of wild type bone marrow cells compared to those of the KO mice. 2,224 genes met this criteria including previously identified target genes, such as ltf, camp, ngp, of which 988 genes were bound by C/EBPε. C/EBPε bound to the promoter sites of 150 genes and the enhancer region of 838 genes. The other 1,236 up-regulated genes did not have binding of C/EBPε, suggesting their up-regulation was a secondary event during terminal granulocytic differentiation. Electromobility shift assay followed by antibody supershift confirmed that C/EBPε was able to bind to upstream regions of target genes such as lft, ngp, il-1b.Trem-1 is an amplifier of inflammatory response. Increased expression/activation of Trem-1 on neutrophil membranes takes part in cytokine production, phagocytosis, apoptosis, oxidative burst by cooperating with TLR4 in response to environmental conditions. Soluble TREM1 levels increase even in neutopenic patients, suggesting it is associated with emergent granulopoiesis in response to infection or inflammation. The expression of Trem-1 is regulated by NF-kB and PU.1. Trem-1 KO mice have reduced inflammation without defects in clearance of pathogens in mice. Considering previous reports demonstrating TLR4 increases transcription of C/EBP and potentiates transcriptional activity of C/EBP via NF-kB, regulatory loops between TLR4/NF-kB/C/EBP/Trem-1 may exist and regulate inflammatory response.ChIP-seq illustrated a C/EBPε binding site located 92 bp upstream from transcription start site of Trem-1 (GTTGTGAAAC). Microarray comparison of Trem-1 expression in Gr-1+/Mac-1+ bone marrow cells showed 5.3 log2 fold decreased gene expression in C/EBPε KO versus wild type mice. To confirm microarray data, quantitative PCR were performed with sorted Gr-1+ bone marrow cells from wild type and KO mice. The qPCR demonstrated that trem-1 expression of C/EBPε KO cells was 60% of wild type (p=0.001). A pGL3 basic luciferase vector with the first 291bp upstream of trem-1containing a putative C/EBPε binding site was cloned and co-transfected with 2 ug of C/EBPε expressing vector into 293T cells. The dual luciferase assay, normalized by renilla luciferase, showed 8 fold increase by C/EBPε (p<0.0001).In conclusion, we identified trem-1 as a downstream target of C/EBPε, which completes a positive regulatory loop of TLR4-NF-kB-C/EBPε-Trem1-TLR4 in response to inflammatory signal. Therefore, C/EBPε KO mice have an inappropriate inflammatory response by loss of the positive amplificatory loop, in addition to previously known defective clearance of pathogen by their inability to produce secondary granules. DisclosuresNo relevant conflicts of interest to declare.

Multilevel Anterior Cervical Discectomy and Fusion With Plate Fixation for Juvenile Unilateral Muscular Atrophy of the Distal Upper Extremity Accompanied by Cervical Kyphosis

A retrospective clinical study was conducted and related literatures were reviewed. This study aimed to evaluate outcome of multilevel anterior cervical discectomy and fusion with plate fixation for juvenile unilateral muscular atrophy of the distal upper extremity accompanied by cervical kyphosis. Juvenile unilateral muscular atrophy of the distal upper extremity is a rare disease. Traditional treatment uses a neck collar to immobilize neck motion. However, if the disease is accompanied by cervical kyphosis, conservative treatment is difficult to correct cervical kyphosis and the prognosis is worsened. Therefore, it is important to initially apply surgical treatment for juvenile unilateral muscular atrophy accompanied with cervical kyphosis. From March 2008 to May 2010, 4 patients were transferred to our spine medical center because of a history of slowly progressive distal weakness and atrophy of their hands and forearms. Four patients were diagnosed with Hirayama disease accompanied with cervical kyphosis based on their clinical representations and radiologic findings. After conservative treatment failed, these patients underwent multilevel anterior cervical discectomy and fusion with plate fixation. The clinical outcomes were retrospectively evaluated with follow-up ranging from 1.5 to 3 years. The clinical and radiologic follow-up indicated satisfactory clinical relief from symptoms, cervical sagittal alignment and cervical spinal canal volume, for all the patients. Within 6 months after surgery, the JOA score improved from a preoperative average of 14 to a postoperative average of 16.3; JOA recovery rates of all patients were more than good level. The muscle strengths of intrinsic muscles, wrist flexors and extensors, and biceps and triceps muscle improved on average by 1 grade. No complications occurred. Hirayama disease is a rare disease, a proper diagnosis of which can be made based on significant clinical symptoms and neurological imaging (dynamic MRI). The primary results from this study showed the tendency that multilevel anterior cervical discectomy and fusion with plate fixation is a preferred treatment for patients showing anterior effacement and apparent cervical kyphosis.

The mediating effect of 'bothersome' urinary incontinence on help-seeking intentions among community-dwelling women.

To explore the mediating effect of bother of urinary incontinence between urinary incontinence severity and help-seeking intentions and detect whether the International Consultation on Incontinence Questionnaire-UI Short Form could be a valid measure to delineate bothersome urinary incontinence. Urinary incontinence is a common condition among women, which has a profound adverse effect on quality of life. However, many of them experiencing significant clinical symptoms do not seek medical help. A cross-sectional survey design. Women with urinary incontinence (N = 620) from three randomized selected community health service centres from May-October 2011 participated in the study. Data were collected using a pencil-and-paper questionnaire. Multivariate regression models were used to test the role of bother as a mediator in the relation between urinary incontinence severity and help-seeking intentions. Receiver operating characteristic analysis was used to find the best cut-off International Consultation on Incontinence Questionnaire-UI Short Form score (range: 0-21) to delineate the bother of urinary incontinence. Bothersome urinary incontinence mediated the relationship between urinary incontinence severity and help-seeking intentions. Age and duration of urine leakage had a negative association on help-seeking intentions, while educational level and previous help-seeking behaviours had a positive association. Bother was a mediator in the relation between urinary incontinence severity and help-seeking intentions. The International Consultation on Incontinence Questionnaire-UI Short Form was a discriminative measure to delineate the bothersome urinary incontinence.

Kinematic analysis of diseased and adjacent segments in degenerative lumbar spondylolisthesis

Background contextDegenerative spondylolisthesis is a common pathologic condition that leads to lumbar instability and significant clinical symptoms. The effect of this pathology on adjacent lumbar motion segments, however, has not yet been studied. PurposeTo characterize the motion characteristics of lumbar degenerative spondylolisthesis at both the diseased and adjacent levels in patients with low-grade, single-level lumbar degenerative spondylolisthesis using kinetic magnetic resonance imaging (kMRI). Study designRetrospective study of patient kMRIs. Patient sampleOne-hundred twelve patient MRIs with low-grade, single-level lumbar spondylolisthesis were included. Outcome measuresAngular and translational motion. MethodsThis study compared 112 patients diagnosed with low-grade (Grade 1 or 2), single-level lumbar degenerative spondylolisthesis at L3–L4, L4–L5, or L5–S1 with 296 control patients without spondylolisthesis. Angular and translational motion were measured using patient kMRIs. The level of slip was graded according to the Meyerding classification system, and disc degeneration was classified according to the Pfirrmann system. Instability was defined as translational motion greater than 4 mm. ResultsLumbar hypomobility was often present regardless of the level of degenerative spondylolisthesis. A slip at L3–L4 resulted in the largest decrease in lumbar range of motion. Instability at the diseased level was most common at L3–L4 (36%), followed by L5–S1 (31%) and L4–L5 (30%). Instability at the adjacent segments was most frequent at L4–L5 (49%), followed by L5–S1 (34%) and L3–L4 (23%). Patients with stable spondylolisthesis generally had decreased angular motion at all lumbar levels. Translational motion at the diseased level was consistently increased. Disc degeneration was significantly greater at the level of slip for the L3–L4 and L4–L5 spondylolisthesis groups and equal to the control group in the L5–S1 group. There was no significant difference in disc degeneration at adjacent segments in L3–L4 and L4–L5 degenerative spondylolisthesis patients, but there was a significant decrease with an L5–S1 slip. ConclusionsThere were a similar percentage of patients in each degenerative spondylolisthesis group with lumbar instability. Angular motion decreased at the diseased level with L3–L4 and L5–S1 spondylolisthesis, but increased with L4–L5 spondylolisthesis. Translational motion, however, increased at the diseased level in all three groups. There was compensatory hypermobility at adjacent levels in patients with unstable spondylolisthesis at L3–L4 and L4–L5, but not at L5–S1.

Saccharomyces boulardii prevention of the hepatic injury induced by Salmonella Enteritidis infection.

Salmonella enterica subsp. enterica serovar Enteritidis (Salmonella Enteritidis) is the predominant cause of serovar-associated food-borne outbreaks in many countries and causes significant clinical symptoms of liver injury, enteritis, and diarrheal diseases. Saccharomyces boulardii is used in clinical application for prophylaxis and the treatment of a variety of diseases caused by bacterial infection. We used a mouse model of Salmonella Enteritidis infection, which included pretreatment with S. boulardii, to reveal the protection mechanisms of S. boulardii against Salmonella Enteritidis infection, including the translocation of Salmonella Enteritidis to the liver 10 days after Salmonella Enteritidis challenge, and the colonisation of Salmonella Enteritidis and the formation of hepatic tissue lesions in mice after Salmonella Enteritidis challenge on the 10th day. Compared with Salmonella Enteritidis infection in mice, S. boulardii decreased Salmonella Enteritidis translocation to the liver by 96%, and 99% of Salmonella Enteritidis colonised the cecum on the 10th day. Saccharomyces boulardii also abated hepatic tissue injury caused by the infiltration of neutrophilic granulocytes, lymphocytes, and plasmocytes by decreasing the translocation of Salmonella to the liver. These findings demonstrated that S. boulardii is an effective agent in the prevention of the hepatic injury induced by Salmonella Enteritidis infection in a mouse model.

Single session robotic radiosurgery for a patient with low risk prostate cancer

Here, we describe the first patient treated by single session robotic radiosurgery for low risk prostate cancer. The initial PSA of this 70-year-old patient was 5.05 ng/dl and transrectal biopsy confirmed a Gleason score 3+3=6 tumor. The patient refused a standard surgical and conventional radiation treatment. The combined choline PET/CT before treatment did not show any additional tumor locations and MRI excluded prostate capsule infiltration. Robotic radiosurgery was offered upon the patient's request as an individual treatment attempt. After ultrasound-guided transrectal fiducial implantation, a highly conformal treatment plan was generated and the patient was treated in April 2008 with 19 Gy to the 70% isodose in a single session. The treatment was tolerated very well with the minor dysuretic symptoms during the first two weeks after the procedure. The PSA continuously dropped in the following years and measured 0.07 ng/dl in July 2014. During this period, no significant clinical symptoms were detected, and the patient experienced no rectal or urinary toxicity. This is the first published patient treated with single session prostate radiosurgery, and we believe a prospective trial is warranted to investigate further the options of this attractive treatment concept for low-grade prostate cancer patients.

Infliximab for treatment of granulomatous disease in patients with common variable immunodeficiency.

Eight to 22 % of common variable immunodeficiency (CVID) patients exhibit granulomas of the lungs, spleen, liver, and/or skin. Granulomas can be the most medically significant day-to-day problem for CVID patients. Currently, there are limited options for treatment of granulomas associated with CVID. We treated five patients with CVID who exhibited significant clinical symptoms secondary to granulomas with infliximab. The patients were selected and treated based solely on clinical need and were not otherwise controlled or blinded to the therapy. After obtaining baseline studies (labs, spirometry, radiology) and excluding infection, they were treated with infliximab 5 mg/kg at week 0, 2, 6 and every 4 weeks thereafter. Post treatment improvements were seen in all 5 patients with significant clinical responses observed for both visceral and cutaneous granulomata. Four of the five patients were maintained on infliximab for 5 to 18 months (mean 9.4 months) without adverse reaction or increased susceptibility to infection. One patient completed 6 months of therapy with improvement of respiratory parameters but discontinued infliximab due to joint stiffness and rash that she attributed to the medication. In our series, infliximab (5 mg/kg monthly) was an effective treatment for cutaneous and visceral granulomas in patients with CVID.

AB0938 Cluster of Patients with Familial Mediterranean Fever and Heterozygous Carriers of Mutations in MEFV Gene in the Czech Republic - Update

BackgroundFamilial Mediterranean Fever (FMF) is a well-described monogenic autosomal recessive disorder with highest occurrence in the Mediterranean region. It is very rare in other areas, although with the increase of...