The prevalence of neuromyelitis optica in South East Wales

BACKGROUND AND PURPOSE

Neuromyeltis optica (NMO) is a neuroinflammatory disorder considered rare in Caucasian populations. However, accurate population-based epidemiological data for NMO and NMO spectrum disorder (NMO-SD) from Western populations employing validated diagnostic criteria remain limited. We sought therefore to estimate the prevalence and clinical features of NMO in a north European Caucasian population in South East Wales.

METHODS

Patients were identified by a comprehensive, multistage ascertainment strategy employing a regional neuroinflammatory disease register, hospital diagnostic databases personal physician referrals and regional requests for anti-aquaporin-4 antibodies (anti-AQP4).

RESULTS

Fourteen Caucasian patients (11 patients with NMO and three with NMO-SD) were identified in a population of 712,572 (19.6/million; 95% CIs: 12.2-29.7). There was an excess of females (female:male 12:2), 11/14 were anti-AQP4 positive and 5/14 had disease onset under the age of 20 years.

CONCLUSION

This study suggests that NMO and related spectrum disorders are at least as frequent in Northern European populations as in non-Caucasian populations and that the demographic profile of prevalent patients differs from clinic-based cohorts.

New Measurement of the π0 radiative decay width

High precision measurements of the differential cross sections for π0 photoproduction at forward angles for two nuclei, 12C and 208Pb, have been performed for incident photon energies of 4.9-5.5 GeV to extract the π0→γγ decay width. The experiment was done at Jefferson Lab using the Hall B photon tagger and a high-resolution multichannel calorimeter. The π0→γγ decay width was extracted by fitting the measured cross sections using recently updated theoretical models for the process. The resulting value for the decay width is Γ(π0→γγ)=7.82±0.14(stat)±0.17(syst)  eV. With the 2.8% total uncertainty, this result is a factor of 2.5 more precise than the current Particle Data Group average of this fundamental quantity, and it is consistent with current theoretical predictions.

Efficacy and pharmacokinetics of febantel and ivermectin in red deer (Cervus elaphus)

A trial was conducted to determine the efficacy and pharmacokinetics of fehantel and ivermectin in six month-old red deer calves (C. eluphus). Five calves received febantel by mouth at 7.5 mg/kg, five received a subcutaneous injection of ivermectin at 200 microg/kg and five were controls. All calves were killed seven days later and total lung and gastrointestinal worm counts carried out. Febantel was 85 and 99.8% efficient in removing immature and mature Dictyocaulus viviparus, respectively, and ivermectin was 100% efficient in both cases. There was no gastro-intestinal nematodes in any of the treated calves, compared to an average of 619 in the control calves. The metabolism of febantel resulted in plasma levels of fenbendazole, oxfendazole and sulphone for which the common curves fitted by compartmental model peaked at values (standard errors)-of 0.46 (0.03), 0.41 (0.02) and 1.73 (0.07) mg/l after approximately five, nine, and thirteen hours and were undetectable at 30,72 and 120 hours respectively. There was considerable variation among animals in response to ivermectin. The fitted common curve had a peak plasma level of 15.8 (0.08) microg/l at 20 hours after injection, which had dropped to 7.9 (1.1) microg/l seven days after injection. It was estimated that after 15 days plasma levels of ivermectin would not be detectable. It is concluded that the injectable form of ivermectin tested is a highly efficient anthelmintic in deer, and that plasma levels persist for over a week after subcutaneous injection. Fehantel is very efficient against mature D. viviparus in deer, but its reduced efficiency against immature D. viviparus may relate to the deer;s ability to metabolise and excrete benzimidazoles more quickly than sheep and cattle.

Catalytic Growth of Carbon Nanofibers and Nanotubes

Carbon nanofibers and nanotubes have been prepared from the decomposition of carbon containing gases with the aid of an iron catalyst particle. The physical characteristics as well as the degree of crystalline perfection of the structures were found to be dependent on the nature of the metal particle and the conditions at which the material was grown. Transmission electron microscopy revealed that nanofibers were obtained from large catalyst particles (>20 nm), whereas nanotubes were formed by the aid of smaller particles (<20 nm). The orientation of the graphitc platelets in the carbon nanofibers was dependent on the alignment of the planes at the rear faces of the iron particle that were responsible for the precipitation of carbon. Carbon nanofibers exhibited reactivity in carbon dioxide comparable to that of single crystal graphite under the same conditions.

In-Situ Electron Microscopy Studies of The Behavior of Metal Particles on Ceramic Substrates

This paper is devoted to a discussion of how the information derived from the application of in-situ transmission electron microscopy can be used to gain a unique insight into the manner by which various factors dictate the morphological characteristics of metal particles on a variety of ceramic substrates. In this context, we have used the technique to examine the influence of the strength of the metal-support interaction on the mode of sintering of small particles, and how the chemical nature of the gas environment can induce significant changes in the shapes of the metal particles in a given system. Attention is also focussed on the wetting behavior of metal particles dispersed on graphite when reacted in oxygen and how this aspect impacts on their subsequent mode of catalytic attack.

Relation of synovitis to knee pain using contrast-enhanced MRIs

BACKGROUND

It has been suggested that synovitis causes joint pain. On non-contrast-enhanced MRIs synovial thickening cannot be assessed and on these images synovitis has been inconsistently associated with pain.

OBJECTIVE

To assess synovial thickening in relation to knee pain severity among subjects in the Multicenter Osteoarthritis Study (MOST) using contrast-enhanced (CE) MRI.

METHODS

MOST is a cohort study of people who have, or are at high risk of, knee osteoarthritis (OA). An unselected subset of 535 participants who volunteered underwent CE 1.5 T MRI of one knee. Synovitis was scored in six compartments and a summary score was created. Knee pain severity was assessed using the maximum item score on the Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain scale. The association between synovitis and pain severity was examined using a logistic regression model adjusting for age, sex, body mass index (BMI), MRI bone marrow lesions and effusions in the whole sample and in a subgroup without radiographic OA.

RESULTS

454 of the 535 subjects undergoing CE MRI had complete data on synovitis and WOMAC pain. Mean age was 59 years, mean BMI 30 and 48% were women. In knees with moderate pain, 80% had synovitis. For knee pain, synovitis conferred a 9.2-fold increased odds compared with those without synovitis. In knees without radiographic OA (n=329), there was also an association of synovitis with an increased prevalence of pain.

CONCLUSION

Synovitis has a strong relation with knee pain severity, an association detected more clearly with CE MRI than suggested by previous studies using non-CE MRI measures of synovitis.

Timely Troponins Avoid Admissions: Clinical Assessment of Undifferentiated Chest Pain

Background

Undifferentiated chest pain is a common presentation to acute medicine units. Targeted appropriately timed troponin analysis may reduce unnecessary admissions and relieve bed shortages. We investigated how reliably cardiac chest pain was identified clinically, whether patients had appropriately timed cardiac enzyme analysis, and implications upon rates of admission.

Method

A prospective data collection was completed on 100 consecutive patients admitted with undifferentiated chest pain to an acute receiving unit over 41 days. We excluded patients with acute coronary syndrome or myocardial infarction already confirmed or excluded. Troponin results were retrospectively documented.

Results

Of 100 patients admitted, 67 were thought to have cardiac type chest pain as their only or significant differential diagnosis, and 10 were subsequently confirmed as ACS or MI. Not all patients with cardiac type chest pain were assessed in accordance with SIGN guidelines. 38 patients were admitted overnight solely to await the result of troponin analysis, with a total of 411.5 hours spent waiting at an estimated cost of over £7400.

Conclusion

This study supports the extension of hours of troponin analysis or instant point of care (bedside) cardiac enzyme testing as a cost effective measure, warranting further examination in terms of laboratory service provision.

Histopathological and neurological features of Atg4b knockout mice

This investigation found that genetic inactivation of mouse Atg4b, 1 of the 4 mammalian homologs of the autophagy-related gene Atg4, resulted in amorphous globular bodies in the neuropil of the deep cerebellar nuclei and adjacent vestibular nuclei but nowhere else in the brain or other tissues. The spheroid-like bodies in the deep cerebellar and vestibular nuclei showed heterogeneous composition, reactivity with anti-ubiquitin antibody, and staining characteristics of proteinaceous material. Atg4b-deficient (Atg4b (-/-)) mice also showed a mild but measurable impairment of motor performance on the Rotarod. Atg4b (-/-) mice produced by breeding heterozygous parents were produced at a slightly lower than expected ratio to heterozygous and wild-type siblings but showed no other clear abnormalities in a battery of screening tests. These findings appear to be different than those reported for inactivation of other Atg4 homologs, suggesting that these homologs have tissue-specific functions beyond redundancy.

Work disability in systemic lupus erythematosus is prevalent and associated with socio-demographic and disease related factors

Our objectives were to examine the prevalence of work disability (WD) and factors associated with job loss in systemic lupus erythematosus (SLE) in a large, multi-centered Canadian sample to determine the current prevalence of WD and identify the contribution of disease activity, damage, and co-morbidities with respect to WD in this cohort. Cross-sectional data on WD status from the 1000 Canadian Faces of Lupus database (a multi-center multi-ethnic cohort of SLE patients) along with clinical measures (number of ACR criteria ever, SLICC Damage Index, SLAM, SLEDAI, SF-36 and Charlson Co-morbidity Index scores), demographic features (age, sex, high school education, household income, marital status, disease duration, employment status) and co-morbidities (including self-reported fibromyalgia, arthralgias, depression and fatigue) were used in bivariate and logistic regression analyses. The 1137 SLE patients had a mean age of 50 years (SE 0.75) and mean disease duration was 18 years (SE 0.70); 19.09% were work disabled and 49.78% were employed. Those with WD were more likely than non-WD SLE patients to have: a higher number of ACR criteria for SLE; not completed high school; older age; single marital status; a lower household income; longer disease duration; higher SLICC Damage Index and SLAM scores; lower SF-36 PCS and SF-36 MCS scores; less vigorous activity per week; and fibromyalgia, arthralgias, fatigue and depression (p < 0.05). This contemporary rate of WD is lower than many past reports. Socio-demographic factors, co-morbidities (fibromyalgia and fatigue) and disease related factors were strongly associated with WD. We cannot determine cause and effect as the study was cross-sectional.