Low-dose theophylline enhances the anti-inflammatory effects of steroids during exacerbations of COPD

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is characterised by an abnormal inflammatory response mainly to cigarette smoke that flares up during exacerbations of the disease (ECOPD). Reduced activity of histone deacetylases (HDAC) contributes to enhanced inflammation in stable COPD. It was hypothesised that HDAC activity is further reduced during ECOPD and that theophylline, an HDAC activator, potentiates the anti-inflammatory effect of steroids in these patients. A study was performed to investigate HDAC activity during ECOPD and the effects of theophylline on the anti-inflammatory effects of steroids in a randomised single-blind controlled study.

METHODS

35 patients hospitalised with ECOPD and treated according to international guidelines (including systemic steroids) were randomised to receive or not to receive low-dose oral theophylline (100 mg twice daily). Before treatment and 3 months after discharge, HDAC and nuclear factor-kappaB (NF-kappaB) activity in sputum macrophages, the concentration of nitric oxide in exhaled air (eNO) and total antioxidant status (TAS), tumour necrosis factor alpha (TNFalpha), interleukin (IL)-6 and IL8 levels in sputum supernatants were measured.

RESULTS

Patients receiving standard therapy showed decreased NF-kappaB activity, eNO concentration and sputum levels of TNFalpha, IL6 and IL8, as well as increased TAS during recovery of ECOPD, but HDAC activity did not change. The addition of low-dose theophylline increased HDAC activity and further reduced IL8 and TNFalpha concentrations.

CONCLUSIONS

During ECOPD, low-dose theophylline increases HDAC activity and improves the anti-inflammatory effects of steroids.

TRIAL REGISTRATION NUMBER

NCT00671151.

Endothelin 1, its Endothelin Type A Receptor, Connective Tissue Growth Factor, Platelet-Derived Growth Factor, and Adrenomedullin Expression in Lungs of Pulmonary Hypertensive and Nonhypertensive Chickens

Twenty-four 1-d-old broilers were distributed in 2 groups, pulmonary hypertensive broilers (PHB) and pulmonary nonhypertensive broilers (NPHB), to estimate possible differences between them in the expression of endothelin 1 (ET-1) and its type A receptor, connective tissue growth factor, platelet-derived growth factor, and adrenomedullin expression in the lungs. For this purpose, total RNA extraction and real-time PCR analysis were used. Endothelin 1 mRNA levels in the lungs of PHB were significantly higher than the corresponding level in NPHB (P < 0.001). In contrast, the opposite was true for ET-1 type A receptor mRNA levels (P < 0.001). Connective tissue growth factor mRNA levels in the lungs of PHB were significantly higher than in the lungs of NPHB (P < 0.01). However, no differences were encountered between the 2 groups of broilers in platelet-derived growth factor mRNA expression (P > 0.05). Adrenomedullin mRNA levels in the lungs of PHB were significantly higher than in NPHB (P < 0.01). It has been demonstrated for the first time that ET-1, connective tissue growth factor, and adrenomedullin are upregulated in the lungs of PHB. Furthermore, it is suggested that these peptides may play a major role in pulmonary hypertension pathophysiology. Present data might provide clues for future research directions such as genetic selection and therapeutic intervention to revert the process of pulmonary vasoconstriction and vascular remodeling. Major research goals could be to find endothelium-derived factors that probably trigger endothelial dysfunction, as well as possible interactions with already identified molecules which also intervene in the pulmonary response to hypoxia.

[Prototheca Wickerhami peritonitis in patients on peritoneal dialysis]

Prototheca spp exits throughout nature but only infrequently cause infection in humans. Most of the cases of human infection have involved the skin or subcutaneous tissues, but there have been reports of rare cases of protothecosis of the urinary tract, and disseminated disease. The species most commonly isolated is Prototheca wickerhamii. Few cases of peritonitis due to P. wickerhamii in peritoneal dialysis had been reported. We report a successful treatment of Prototheca peritonitis complicating peritoneal dialysis with amphotericin, itraconazole and removal of the catheter.

Quiste aracnoideo complicado con hemorragia intraquística y hematoma subdural espontáneo: hallazgos en resonancia magnética

Arachnoid cysts are collections of cerebrospinal fluid within the arachnoid membrane. They are benign lesions and most are congenital. They are usually asymptomatic; however, they can bleed and become symptomatic. Although arachnoid cyst associated to intracystic hemorrhage and spontaneous subdural hematoma is an uncommon complication, it is a well-known indication for emergency neurosurgery. We present the findings in a ten-year-old boy diagnosed with arachnoid cyst complicated by intracystic hemorrhage and spontaneous subdural hematoma diagnosed by magnetic resonance.

Charcot-like arthropathy: A newly-recognized subset of psoriatic arthritis

OBJECTIVE

The aim of the study is to describe a group of patients with a highly destructive and asymptomatic form of psoriatic arthritis, mimicking a Charcot-like joint disease.

METHODS

We studied 180 patients with psoriatic arthritis and identified 4 patients with arthritis mutilans mimicking a Charcot-like joint disease. Clinical history, physical exam, and immunological testing were performed as well as X-ray of affected joints. Synovial membrane and sural nerve biopsies were performed and diagnosis of psoriasis was confirmed by skin biopsy.

RESULTS

Four patients with psoriatic arthritis mutilans according to Moll and Wright classification criteria (1) and Charcot-like joint disease were identified and evaluated. There were 2 males and 2 females, all Caucasians. The mean age +/- SD was 57.8 +/- 14.2 years. Mean arthritis duration +/- SD was 6 +/- 4.6 years and mean cutaneous duration +/- SD was 13 +/- 10.4 years. All patients had polyarthritis and a sudden onset of bilateral, painless, and highly destructive arthropathy involving large, non-weight bearing (elbows) and weight bearing (knees), and also small joint of hands and feet. Synovial membrane biopsy showed findings similar to those found in Charcot joint disease, including ischemic neuropathy.

CONCLUSION

A newly-recognized subset of patients with psoriatic arthritis and Charcot-like joint disease according to clinical, radiographic and histological features is described. The proposed neurovascular theory may explain the pathogenesis of this presentation.

Monte Carlo study of Siemens PRIMUS photoneutron production

Neutron production in radiotherapy facilities has been studied from the early days of modern linacs. Detailed studies are now possible using photoneutron capabilities of general-purpose Monte Carlo codes at energies of interest in medical physics. The present work studies the effects of modelling different accelerator head and room geometries on the neutron fluence and spectra predicted via Monte Carlo. The results from the simulation of a 15 MV Siemens PRIMUS linac show an 80% increase in the fluence scored at the isocentre when, besides modelling the components necessary for electron/photon simulations, other massive accelerator head components are included. Neutron fluence dependence on inner treatment room volume is analysed showing that thermal neutrons have a 'gaseous' behaviour and then a 1/V dependence. Neutron fluence maps for three energy ranges, fast (E > 0.1 MeV), epithermal (1 eV < E < 0.1 MeV) and thermal (E < 1 eV), are also presented and the influence of the head components on them is discussed.

Development and operation of a pixel segmented liquid-filled linear array for radiotherapy quality assurance

A liquid isooctane (C(8)H(18)) filled ionization linear array for radiotherapy quality assurance has been designed, built and tested. The detector consists of 128 pixels, each of them with an area of 1.7 mm x 1.7 mm and a gap of 0.5 mm. The small pixel size makes the detector ideal for high gradient beam profiles such as those present in intensity modulated radiation therapy (IMRT) and radiosurgery. As the read-out electronics we use the X-ray Data Acquisition System with the Xchip developed by the CCLRC. Studies concerning the collection efficiency dependence on the polarization voltage and on the dose rate have been made in order to optimize the device operation. In the first tests, we have studied dose rate and energy dependences. Dose rate dependence was found to be lower than 2.1% up to 5 Gy min(-1), and energy dependence lower than 2.5% up to 20 cm depth in solid water. Output factors and penumbras for several rectangular fields have been measured with the linear array and were compared with the results obtained with a 0.125 cm(3) air ionization chamber and radiographic film, respectively. Finally, we have acquired profiles for an IMRT field and for a virtual wedge. These profiles have also been compared with radiographic film measurements. All the comparisons show a good correspondence. The device has proved its capability to verify on-line therapy beams with good spatial resolution and signal-to-noise ratio.

Commissioning of a medical accelerator photon beam Monte Carlo simulation using wide-field profiles

A method for commissioning an EGSnrc Monte Carlo simulation of medical linac photon beams through wide-field lateral profiles at moderate depth in a water phantom is presented. Although depth-dose profiles are commonly used for nominal energy determination, our study shows that they are quite insensitive to energy changes below 0.3 MeV (0.6 MeV) for a 6 MV (15 MV) photon beam. Also, the depth-dose profile dependence on beam radius adds an additional uncertainty in their use for tuning nominal energy. Simulated 40 cm x 40 cm lateral profiles at 5 cm depth in a water phantom show greater sensitivity to both nominal energy and radius. Beam parameters could be determined by comparing only these curves with measured data.

[Superficial siderosis of the central nervous system: report of two new cases]

INTRODUCTION

Superficial siderosis of the central nervous system (CNS) is a rare disease characterized by deafness, ataxia and pyramidal dysfunction. It is due to hemosiderin deposition in the subpial membranes of the brain, spinal cord and cranial nerves. Most cases are secondary to chronic or recurrent bleeding into the subarachnoid space. Diagnosis is permitted by magnetic resonance imaging (MRI).

CASE REPORTS

We report two patients with a chronic, slowly progressive cerebellar ataxia and hearing loss. MRI showed T2 hypointense signals in the brain, cerebellum and spinal cord diagnostic of superficial siderosis of the CNS. Xanthochromia was present in one patient. Evoked potentials showed retrochoclear hearing loss. Extensive vascular studies were negative for bleeding sources. One patient, treated with oral anticoagulants, benefited from reduction of the International Normalized Ratio.

CONCLUSION

Due to its rarity, clinical suspicion is essential for diagnosis of superficial siderosis of the CNS.

Free ion yield observed in liquid isooctane irradiated by rays. Comparison with the Onsager theory

We have analysed data on the free ion yield observed in liquid isooctane irradiated by 60Co gamma rays within the framework of the Onsager theory about initial recombination. Several distribution functions describing the electron thermalization distance have been used and compared with the experimental results: a delta function, a Gaussian-type function and an exponential function. A linear dependence between the free ion yield and the external electric field has been found at low-electric-field values (E < or = 1.2 x 10(3) V mm(-1)) in excellent agreement with the Onsager theory. At higher electric field values, we obtain a solution in power series of the external field using the Onsager theory.

Localized nodular vasculitis: a new variant of localized cutaneous polyarteritis nodosa?

Cutaneous polyarteritis nodosa (PAN) was first described by Lindberg in 1931. This initial description was followed by many case reports and series, including those of Díaz-Pérez and Winkelmann, who used a strict definition based on cutaneous involvement, and Chen and Daoud who classified the condition into three well differentiated groups. The cutaneous form of PAN is distinct from the systemic form due to its chronic, recurrent, benign nature, the absence of internal organ involvement, and the presence of inflammation in medium and small vessels of the deep dermis and panniculus. In the present article we report our findings for 12 patients with a variant of cutaneous PAN consisting of painful erythematous nodular lesions not preceded or followed by livedo reticularis, that were located exclusively on the lower third of the legs and responded slowly to treatment with corticosteroids and immunosuppressants.

Analysis of copper and calcium-fulvic acid complexation and competition effects

The binding of Cu2+ and Ca2+ to a fulvic acid (FA), simulating naturally occurring conditions, was studied. Furthermore, copper-FA complexation in the presence and absence of calcium was compared. For this, potentiometric titrations were carried out using a solution of FA at a concentration of 100 mgL(-1), and of ionic strength 0.1M. The Ca(2+)-FA complexation reaction was carried out at pH 6.5, 7.5 and 8.5 and the Cu(2+)-FA complexation reaction at pH 5.5 and 6.5, in both the presence and absence of calcium ion. The calcium ion had a significant effect on copper binding at [Ca2+]> or =2.5x10(-3)M. The experimental binding curves were analyzed using non-electrostatic discrete site and continuous distribution models. Competition by the calcium ion mainly affected the maximum binding capacity of the Cu(2+)-FA complexation, whereas the slight effect observed on the binding constant appears to indicate that calcium only competes for specific copper sites, thus modifying the binding sites distribution function. It was also found that the number of sites occupied by the copper ion represented only 20% of the total concentration of acid groups ionized on FA at the pH values studied.

Tumoral calcinosis presenting as an extradural mass: MR findings and pathological correlation

Two cases of idiopathic tumoral calcinosis presenting as an extradural mass are reported. There are few reports in the literature of this pathological process presenting as extradural masses, so both cases represent very unusual locations for tumoral calcinosis. Magnetic resonance imaging features and pathological correlation of these two cases are presented. Tumoral calcinosis might be considered as a rare but possible cause of extradural mass.

Unusual presentation of a pancreatic insulinoma in helical CT and dynamic contrast-enhanced MR imaging: case report

Insulinomas are pancreatic neoplasms that can be radiologically characterized typically because of their tendency to present intense and early contrast enhancement with a wash-out phenomenon. In this sense, we report an unusual case of a hypovascular solid pancreatic insulinoma confirmed with surgery and pathologic analysis, in a patient with normal serum insulin levels. In the two-phase helical CT, the mass behaved as a hypodense lesion with respect to the surrounding pancreatic parenchyma during the arterial phase and as a hypointense lesion during the dynamic contrast-enhanced MR imaging. Pathologic examination demonstrated a hypercellular tumor with poor vascularization of intervening stroma which showed prominent amyloid deposits.