Comparison of radiographic scoring methods in a cohort of RA patients treated with anti-TNF therapy

OBJECTIVE

To compare the ability of the simple erosion narrowing score (SENS) to classify radiographic progression relative to the Sharp/van der Heijde score (SHS) in a prospective cohort of anti-TNF-treated RA patients.

METHODS

Radiographs of the hands, wrists and feet of patients enrolled in a pharmacovigilance programme are performed every 2 years. These radiographs were read in chronological order by three rheumatologists and scored using the SHS. SENS scores were derived from the SHS. Additionally, one rheumatologist scored the radiographs using the SENS method only. Patients with radiographic progression in excess of the smallest detectable change were classified as progressors. The probability of agreement and κ-value between the SHS and SENS methods for determining progression was calculated.

RESULTS

A sample of 25 patients was selected from the database. The annualized mean (s.d.) change in SHS score was 6.61 U (7.48 U) and in SENS score was 2.27 U (2.17 U). Five patients were classified as progressors using SHS and seven using SENS, with a probability of agreement of 84% (κ = 0.565).

CONCLUSION

The SENS method captures radiographic progression reliably compared with the more detailed SHS method. SENS is suitable for application in clinical practice or in observational cohorts.

Novel GLIS3 mutations demonstrate an extended multisystem phenotype

INTRODUCTION

Mutations in the GLI-similar 3 (GLIS3) gene encoding the transcription factor GLIS3 are a rare cause of neonatal diabetes and congenital hypothyroidism with six affected cases from three families reported to date. Additional features, described previously, include congenital glaucoma, hepatic fibrosis, polycystic kidneys, developmental delay and facial dysmorphism.

SUBJECTS

We report two new cases from unrelated families with distinct novel homozygous partial GLIS3 deletions. Both patients presented with neonatal diabetes mellitus, severe resistant hypothyroidism in the presence of elevated thyroglobulin and normal thyroid anatomy, degenerative liver disease, cystic renal dysplasia, recurrent infections and facial dysmorphism. These novel mutations have also resulted in osteopenia, bilateral sensorineural deafness and pancreatic exocrine insufficiency, features that have not previously been associated with GLIS3 mutations. Gene dosage analysis showed that the parents were carriers of a deletion encompassing exons 1-2 (case 1) or exons 1-4 (case 2) of the 11 exon gene. Genome-wide SNP analysis did not reveal a common ancestral GLIS3 haplotype in patient 2.

CONCLUSIONS

Our results confirm partial gene deletions as the most common type of GLIS3 mutations, accounting for four of five families identified to date. We propose that mutations in GLIS3 lead to a wider clinical phenotype than previously recognised. We also report the first case of a recessive GLIS3 mutation causing neonatal diabetes and congenital hypothyroidism in a child from a non-consanguineous pedigree, highlighting the importance of molecular genetic testing in any patient with this phenotype.

Suggested baseline ranges for performance testing of the Fujifilm FCR Capsula XL computed radiography system

Due to the difficulty in obtaining expected baseline values from the supplier for the performance testing of the Fujifilm FCR Capsula XL computed radiography system, performance test results from the acceptance testing of 42 Capsula systems were reviewed. Guidance ranges are provided for nine system performance tests which can be applied to future testing of calibrated systems.

Patterning of novel breast implant surfaces by enhancing silicone biocompatibility, using biomimetic topographies

INTRODUCTION AND AIMS

Silicone biocompatibility is dictated by cell-surface interaction and its understanding is important in the field of implantation. The role of surface topography and its associated cellular morphology needs investigation to identify qualities that enhance silicone surface biocompatability. This study aims to create well-defined silicone topographies and examine how breast tissue-derived fibroblasts react and align to these surfaces.

METHODS

Photolithographic microelectronic techniques were modified to produce naturally inspired topographies in silicone, which were cultured with breast tissue-derived human fibroblasts. Using light, immunofluorescent and atomic force microscopy, the cytoskeletal reaction of fibroblasts to these silicone surfaces was investigated.

RESULTS

Numerous, well-defined micron-sized pillars, pores, grooves, and ridges were manufactured and characterized in medical grade silicone. Inimitable immunofluorescent microscopy represented in our high magnification images of vinculin, vimentin, and the actin cytoskeleton highlights the differences in fibroblast adhesion between fabricated silicone surfaces. These unique figures illustrate that fibroblast adhesion and the reactions these cells have to silicone can be manipulated to enhance biointegration between the implant and the breast tissue. An alteration of fibroblast phenotype was also observed, exhibiting the propensity of these surfaces to induce categorical remodeling of fibroblasts.

CONCLUSIONS

This unique study shows that fibroblast reactions to silicone topographies can be tailored to induce physiological changes in cells. This paves the way for further research necessary to develop more biocompatible constructs capable of eliminating capsular contracture by subverting the foreign body response.

Dietary patterns in Canadian men and women ages 25 and older: relationship to demographics, body mass index, and bone mineral density

BACKGROUND

Previous research has shown that underlying dietary patterns are related to the risk of many different adverse health outcomes, but the relationship of these underlying patterns to skeletal fragility is not well understood. The objective of the study was to determine whether dietary patterns in men (ages 25-49, 50+) and women (pre-menopause, post-menopause) are related to femoral neck bone mineral density (BMD) independently of other lifestyle variables, and whether this relationship is mediated by body mass index.

METHODS

We performed an analysis of 1928 men and 4611 women participants in the Canadian Multicentre Osteoporosis Study, a randomly selected population-based longitudinal cohort. We determined dietary patterns based on the self-administered food frequency questionnaires in year 2 of the study (1997-99). Our primary outcome was BMD as measured by dual x-ray absorptiometry in year 5 of the study (2000-02).

RESULTS

We identified two underlying dietary patterns using factor analysis and then derived factor scores. The first factor (nutrient dense) was most strongly associated with intake of fruits, vegetables, and whole grains. The second factor (energy dense) was most strongly associated with intake of soft drinks, potato chips and French fries, certain meats (hamburger, hot dog, lunch meat, bacon, and sausage), and certain desserts (doughnuts, chocolate, ice cream). The energy dense factor was associated with higher body mass index independent of other demographic and lifestyle factors, and body mass index was a strong independent predictor of BMD. Surprisingly, we did not find a similar positive association between diet and BMD. In fact, when adjusted for body mass index, each standard deviation increase in the energy dense score was associated with a BMD decrease of 0.009 (95% CI: 0.002, 0.016) g/cm(2) for men 50+ years old and 0.004 (95% CI: 0.000, 0.008) g/cm(2) for postmenopausal women. In contrast, for men 25-49 years old, each standard deviation increase in the nutrient dense score, adjusted for body mass index, was associated with a BMD increase of 0.012 (95% CI: 0.002, 0.022) g/cm(2).

CONCLUSIONS

In summary, we found no consistent relationship between diet and BMD despite finding a positive association between a diet high in energy dense foods and higher body mass index and a strong correlation between body mass index and BMD. Our data suggest that some factor related to the energy dense dietary pattern may partially offset the advantages of higher body mass index with regard to bone health.

One scan for all: extended role of cardiac CT angiography in acute myocardial infarction

BACKGROUND

Cardiac computed-tomographic angiography (CTA) has gained widespread acceptance as a useful non-invasive technique in the assessment of coronary artery disease. Although most interest has focused on coronary vessels, analysis of myocardial perfusion, left ventricular wall motion, ejection fraction and left ventricular structure can easily be performed at the same time allowing comprehensive assessment of anatomy and function in a single examination. We present a case of acute ST elevation myocardial infarction where cardiac catheterization was deferred, but assessment by CTA permitted a management plan to be constructed using rest perfusion and blood pool inversion analyses of the dataset obtained during the coronary artery study.

CONCLUSION

Coronary CT angiography can provide a comprehensive assessment of coronary arteries, myocardial perfusion and structural features in those not suitable for coronary angiography after myocardial infarction.

Current implant surface technology: an examination of their nanostructure and their influence on fibroblast alignment and biocompatibility

Systematic reviews indicate that breast implant texture confers a protective effect on capsular contracture. Fibroblasts are affected by micro- and nanotopographies. Few previous studies have investigated the inherent topographies of existing breast implants and the surfaces with which body tissue is exposed.

AIMS

To examine currently available breast implant surfaces at high resolution and evaluate features within their surface that have been demonstrated to influence fibroblast alignment.

METHODS

Using scanning electron and light microscopy, 5 distinct smooth and textured silicone implants including the Mentor Siltex (Mentor Corporation, Santa Barbara, Calif) and Allergan Biocell (Allergan Medical Corporation, Santa Barbara, Calif) surfaces were investigated at high magnification to illustrate their intrinsic surface topographies.

RESULTS

The images obtained illustrate remarkable micro- and nanoscale topographies. Each surface produced a distinctive microenvironment capable of influencing cell shape and thus biointegration. These features are illustrated by our unique, high-magnification images. The smooth surface exhibits a shallow, regular, 5-microm period rippled texture that may explain higher reported contracture rates, while the Biocell and Siltex surfaces show 100- to 200-microm deep but random features that have been shown to anchor the implant to breast tissue and reduce contracture. Results allow a cell's eye view of these implants, with an explanation of why these types of topographies influence the success of these implants.

CONCLUSIONS

We assessed commonly available silicone implants and offer a unique overview into their surface topographies and how they are manufactured. We conclude that these surfaces require modernization. Our findings provide further insight into potential interactions between cellular assemblies and artificial surfaces and may contribute to the development of improved implant surfaces.

Elective primary cesarean section: weighing the risks and benefits

The increasing understanding of the nature and extent of pelvic floor injury during childbirth, coupled with an increasing medico-legal demand to present a flawless baby at the completion of the birth process, has helped fuel the rising cesarean section rate. As more women become educated in the controversies surrounding the protective benefits of cesarean, they may increasingly elect to undergo cesarean delivery primarily. Evidence concerning maternal, fetal, and ethical considerations in this decision is presented.