Meta-analysis: the significance of screening for JAK2V617F mutation in Budd-Chiari syndrome and portal venous system thrombosis

BACKGROUND

It is important to evaluate whether screening for JAK2V617F mutation should be routinely performed in patients with Budd-Chiari syndrome (BCS) and portal venous system thrombosis (PVST). However, the prevalence of JAK2V617F mutation in such patients is substantially varied, and its association with development of myeloproliferative disorders (MPD) is deficiently identified.

AIMS

To estimate the prevalence of JAK2V617F mutation and to explore the significance of screening for JAK2V617F mutation in these patients.

METHODS

All observational studies regarding the prevalence of JAK2V617F mutation in patients with BCS and PVST were identified via PubMed and MEDLINE databases. Primary items were the proportions of JAK2V617F mutation and MPD.

RESULTS

Twenty-three studies fulfilled the inclusion criteria. Regardless of underlying aetiological factors, the pooled prevalence of JAK2V617F mutation was 37% and 24% in patients with BCS and PVST respectively. After pre-existing MPD was excluded, the pooled prevalence was decreased to 26% and 19%. Heterogeneity among studies was significant for the prevalence of JAK2V617F mutation. Compared with healthy subjects and patients with thrombosis in other sites, the prevalence of JAKV617F mutation was significantly higher in patients with BCS and PVST. The prevalence of MPD was significantly higher in patients with JAK2V617F mutation than those without.

CONCLUSIONS

JAK2V617F mutation is frequently found in patients with BCS and PVST, but there is a huge variation of prevalence among the included studies. Additionally, it is more specific to thrombosis in splanchnic areas and strongly associated with the development of MPD in these patients. Further studies are needed to evaluate whether the screening test should be widely performed in Asian countries and cirrhotic patients.

Cross section and parity-violating spin asymmetries of W± boson production in polarized p + p collisions at sqrt[s] = 500 GeV

Large parity-violating longitudinal single-spin asymmetries A(L)(e+) = -0.86(-0.14) (+0.30) and A(L)(e-) = 0.88(-0.71) (+0.12) are observed for inclusive high transverse momentum electrons and positrons in polarized p+p collisions at a center-of-mass energy of sqrt[s] = 500 GeV with the PHENIX detector at RHIC. These e± come mainly from the decay of W± and Z0 bosons, and their asymmetries directly demonstrate parity violation in the couplings of the W± to the light quarks. The observed electron and positron yields were used to estimate W± boson production cross sections for the e± channels of σ(pp → W+ X) × BR(W+ → e+ ν(e)) = 144.1 ± 21.2(stat)(-10.3) (+3.4) (syst) ± 21.6(norm)  pb, and σ(pp → W- X) × BR(W- → e- ν[over ¯](e)) = 31.7 ± 12.1(stat)(-8.2) (+10.1) (syst) ± 4.8(norm)  pb.

Azimuthal anisotropy of π⁰ production in Au+Au collisions at sqrt((s)NN)=200 GeV: path-length dependence of jet quenching and the role of initial geometry

We have measured the azimuthal anisotropy of π⁰ production for 1<p(T)<18  GeV/c for Au+Au collisions at sqrt((s)NN)=200  GeV. The observed anisotropy shows a gradual decrease for 3≲p(T)≲7-10  GeV/c, but remains positive beyond 10  GeV/c. The magnitude of this anisotropy is underpredicted, up to at least ∼10  GeV/c, by current perturbative QCD (PQCD) energy-loss model calculations. An estimate of the increase in anisotropy expected from initial-geometry modification due to gluon saturation effects and fluctuations is insufficient to account for this discrepancy. Calculations that implement a path-length dependence steeper than what is implied by current PQCD energy-loss models show reasonable agreement with the data.

Elliptic and hexadecapole flow of charged hadrons in Au+Au collisions at sq.rt(s(NN))=200 GeV

Differential measurements of the elliptic (v(2)) and hexadecapole (v(4)) Fourier flow coefficients are reported for charged hadrons as a function of transverse momentum (p(T)) and collision centrality or number of participant nucleons (N(part)) for Au+Au collisions at sq.rt(s(NN))=200  GeV. The v(2,4) measurements at pseudorapidity |η|≤0.35, obtained with four separate reaction-plane detectors positioned in the range 1.0<|η|<3.9, show good agreement, indicating the absence of significant Δη-dependent nonflow correlations. Sizable values for v(4)(p(T)) are observed with a ratio v(4)(p(T),N(part))/v(2)(2)(p(T),N(part))≈0.8 for 50≲N(part)≲200, which is compatible with the combined effects of a finite viscosity and initial eccentricity fluctuations. For N(part)≳200 this ratio increases up to 1.7 in the most central collisions.

Transition in yield and azimuthal shape modification in dihadron correlations in relativistic heavy ion collisions

Hard-scattered parton probes produced in collisions of large nuclei indicate large partonic energy loss, possibly with collective produced-medium response to the lost energy. We present measurements of π^{0} trigger particles at transverse momenta p{T}{t}=4-12  GeV/c and associated charged hadrons (p{T}{a}=0.5-7  GeV/c) vs relative azimuthal angle Δϕ in Au+Au and p+p collisions at sqrt[s{NN}]=200  GeV. The Au+Au distribution at low p{T}{a}, whose shape has been interpreted as a medium effect, is modified for p{T}{t}<7  GeV/c. At higher p{T}{t}, the data are consistent with unmodified or very weakly modified shapes, even for the lowest measured p{T}{a}, which quantitatively challenges some medium response models. The associated yield of hadrons opposing the trigger particle in Au+Au relative to p+p (I{AA}) is suppressed at high p{T} (I{AA}≈0.35-0.5), but less than for inclusive suppression (R{AA}≈0.2).

DUSP16 is an epigenetically regulated determinant of JNK signalling in Burkitt's lymphoma

Background:

The mitogen-activated protein kinase (MAPK) phosphatases or dual specificity phosphatases (DUSPs) are a family of proteins that catalyse the inactivation of MAPK in eukaryotic cells. Little is known of the expression, regulation or function of the DUSPs in human neoplasia.

Methods:

We used RT–PCR and quantitative PCR (qPCR) to examine the expression of DUSP16 mRNA. The methylation in the DUSP16 CpG island was analysed using bisulphite sequencing and methylation-specific PCR. The activation of MAPK was determined using western blotting with phospho-specific antibodies for extra-cellular signal-related kinase (ERK), p38 and c-Jun N-terminal kinase (JNK). The proliferation of cell lines was assessed using the CellTiter 96 Aqueous One assay.

Results:

The expression of DUSP16, which inactivates MAPK, is subject to methylation-dependent transcriptional silencing in Burkitt's Lymphoma (BL) cell lines and in primary BL. The silencing is associated with aberrant methylation in the CpG island in the 5′ regulatory sequences of the gene blocking its constitutive expression. In contrast to BL, the CpG island of DUSP16 is unmethylated in other non-Hodgkin's lymphomas (NHLs) and epithelial malignancies. In BL cell lines, neither constitutive nor inducible ERK or p38 activity varied significantly with DUSP16 status. However, activation of JNK was increased in lines with DUSP16 methylation. Furthermore, methylation in the DUSP16 CpG island blocked transcriptional induction of DUSP16, thereby abrogating a normal physiological negative feedback loop that limits JNK activity, and conferred increased cellular sensitivity to agents, such as sorbitol and anthracycline chemotherapeutic agents that activate JNK.

Conclusion:

DUSP16 is a new epigenetically regulated determinant of JNK activation in BL.

The role of psychological distress and personality variables in the disablement process in rheumatoid arthritis

OBJECTIVE

To test whether psychological distress and personality variables mediate or moderate physical health-related quality of life (HRQOL) in rheumatoid arthritis (RA) patients.

METHODS

In 168 RA patients the following self-report instruments were administered: the Health Assessment Questionnaire (HAQ), the General Health Questionnaire (GHQ), the Defence Style Questionnaire (DSQ), the Hostility and Direction of Hostility Questionnaire (HDHQ), and the Sense of Coherence (SOC) scale. A total of 152 patients with several rheumatological disorders [56 with systemic sclerosis (SSc), 56 with systemic lupus erythematosus (SLE) and 40 with Sjögren's syndrome (SS)] served as disease controls. The outcome measure was the physical scale of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF). We used hierarchical regression to determine whether our data were consistent with the disablement process model.

RESULTS

In RA patients, sense of coherence was associated with physical HRQOL but the relationship was mediated by psychological distress. Self-sacrificing defence style moderated the relationship between pain and physical HRQOL: pain was associated with impaired physical HRQOL only in patients with predominant self-sacrificing defence style. Although psychological distress and personality variables were also associated with physical HRQOL in the disease control group, the moderating effects of personality on physical HRQOL were unique to RA. Thus, in RA, psychological distress, functional disability, and the interaction term between pain and self-sacrificing defence style were independently associated with physical HRQOL.

CONCLUSIONS

In RA patients, psychological distress mediated the association of personality variables with physical HRQOL but personality moderated the effects of pain on physical HRQOL and this could be relevant to psychological interventions.

Structure and phase transitions of monolayers of intermediate-length n-alkanes on graphite studied by neutron diffraction and molecular dynamics simulation

We present evidence from neutron diffraction measurements and molecular dynamics (MD) simulations of three different monolayer phases of the intermediate-length alkanes tetracosane (n-C(24)H(50) denoted as C24) and dotriacontane (n-C(32)H(66) denoted as C32) adsorbed on a graphite basal-plane surface. Our measurements indicate that the two monolayer films differ principally in the transition temperatures between phases. At the lowest temperatures, both C24 and C32 form a crystalline monolayer phase with a rectangular-centered (RC) structure. The two sublattices of the RC structure each consists of parallel rows of molecules in their all-trans conformation aligned with their long axis parallel to the surface and forming so-called lamellas of width approximately equal to the all-trans length of the molecule. The RC structure is uniaxially commensurate with the graphite surface in its [110] direction such that the distance between molecular rows in a lamella is 4.26 A=sqrt[3a(g)], where a(g)=2.46 A is the lattice constant of the graphite basal plane. Molecules in adjacent rows of a lamella alternate in orientation between the carbon skeletal plane being parallel and perpendicular to the graphite surface. Upon heating, the crystalline monolayers transform to a "smectic" phase in which the inter-row spacing within a lamella expands by approximately 10% and the molecules are predominantly oriented with the carbon skeletal plane parallel to the graphite surface. In the smectic phase, the MD simulations show evidence of broadening of the lamella boundaries as a result of molecules diffusing parallel to their long axis. At still higher temperatures, they indicate that the introduction of gauche defects into the alkane chains drives a melting transition to a monolayer fluid phase as reported previously.

Measurement of bottom versus charm as a function of transverse momentum with electron-hadron correlations in p + p collisions at square root of s = 200 GeV

The momentum distribution of electrons from semileptonic decays of charm and bottom quarks for midrapidity |y|<0.35 in p+p collisions at square root of s=200 GeV is measured by the PHENIX experiment at the Relativistic Heavy Ion Collider over the transverse momentum range 2<pT<7 GeV/c. The ratio of the yield of electrons from bottom to that from charm is presented. The ratio is determined using partial D/D-->e(+/-)K(-/+)X (K unidentified) reconstruction. It is found that the yield of electrons from bottom becomes significant above 4 GeV/c in pT. A fixed-order-plus-next-to-leading-log perturbative quantum chromodynamics calculation agrees with the data within the theoretical and experimental uncertainties. The extracted total bottom production cross section at this energy is sigma(bb)=3.2(-1.1)(+1.2)(stat)(-1.3)(+1.4)(syst)mub.

Gluon-spin contribution to the proton spin from the double-helicity asymmetry in inclusive pi0 production in polarized p+p collisions at [sqrt]s=200 GeV

The double helicity asymmetry in neutral pion production for pT=1 to 12 GeV/c was measured with the PHENIX experiment to access the gluon-spin contribution, DeltaG, to the proton spin. Measured asymmetries are consistent with zero, and at a theory scale of micro2=4 GeV2 a next to leading order QCD analysis gives DeltaG[0.02,0.3]=0.2, with a constraint of -0.7<DeltaG[0.02,0.3]<0.5 at Deltachi2=9 (approximately 3sigma) for the sampled gluon momentum fraction (x) range, 0.02 to 0.3. The results are obtained using predictions for the measured asymmetries generated from four representative fits to polarized deep inelastic scattering data. We also consider the dependence of the DeltaG constraint on the choice of the theoretical scale, a dominant uncertainty in these predictions.

Descriptive epidemiology of cerebral gliomas in northwest Greece and study of potential predisposing factors, 2005-2007

BACKGROUND

To investigate the epidemiologic and clinical characteristics (age, sex, tumor location, socioeconomic status) and potential predisposing factors (alcohol, tobacco, mobile phone use, severe head trauma) of cerebral gliomas in a defined area of Northwest Greece.

METHODS

The prospective study was conducted in patients with gliomas referred to all 7 hospitals of a study area with a population of 488,435 inhabitants, from June 1, 2005, to May 31, 2007. Incidence rates (IR) were calculated as new cases diagnosed among residents of the study area during the study period per 100,000 inhabitants. A case-control study was carried out in order to study the possible association of the risk of glioma with smoking, alcohol, use of mobile phone, and severe cranial trauma.

RESULTS

A total of 56 glioma incident cases were identified with IRs of glioma and glioblastoma (GBM) at 5.73/10(5)/year and 3.69/10(5)/year, respectively. A male to female ratio of 1.25 was obtained in the GBM group. IRs of glioma and GBM for both males and females were higher in the age group 60-79. The most frequent anatomic location was the frontal lobe. 46.5% of the patients originated from the low, 25% from the middle and 28.5% from the high socioeconomic class. There was no significant association between glioma and alcohol consumption, smoking and mobile phone use. A trend for a positive association between the risk of glioma and a history of severe cranial trauma was observed, but this association was not statistically significant.

CONCLUSION

The estimated IR of glioma and GBM in this study was higher compared with data from other studies carried out on European, Asian and US populations. Further studies may be needed to assess the possible association of genetic, environmental and lifestyle factors with the high occurrence of gliomas observed in this study.

Diagnostic value of vascular endothelial growth factor and endostatin in malignant pleural effusions

OBJECTIVE

To assess the value of vascular endothelial growth factor (VEGF) and endostatin in the differential diagnosis of malignant and tuberculous pleural effusions (PE).

METHODS

Effusion samples were collected from 62 patients with malignant PE caused by lung cancer and from 64 patients with tuberculous pleurisy. Concentrations of pleural fluid VEGF and endostatin were measured simultaneously using enzyme-linked immunosorbent assay (ELISA) and enzyme immunoassay, respectively. The sensitivity, specificity and accuracy were calculated.

RESULTS

PE levels of VEGF and endostatin were found to be significantly elevated in effusions with malignancy rather than in those of tuberculous origin (both P < 0.01). For VEGF, the sensitivity, specificity and accuracy in diagnosing malignant pleural effusions were respectively 71%, 61% and 66%, while for endostatin the values were respectively 69%, 83% and 76%. A combination of VEGF and endostatin can increase these to respectively 81%, 97% and 89%.

CONCLUSIONS

Elevated levels of VEGF and endostatin in pleural effusions may be helpful in diagnosing malignant pleural effusions, while a combination of VEGF and endostatin can increase the sensitivity, specificity and accuracy of differentiating malignant from tuberculous pleural effusions.

Onset of pi(0) suppression studied in Cu+Cu collisions at sqrt S NN=22.4, 62.4, and 200 GeV

Neutral pion transverse momentum (p(T)) spectra at midrapidity (|y| less than or approximately 0.35) were measured in Cu+Cu collisions at sqrt[s(NN)]=22.4, 62.4, and 200 GeV. Relative to pi_(0) yields in p+p collisions scaled by the number of inelastic nucleon-nucleon collisions (N(coll) the pi_(0) yields for p(T) more than or approximately 2 GeV/c in central Cu+Cu collisions are suppressed at 62.4 and 200 GeV whereas an enhancement is observed at 22.4 GeV. A comparison with a jet-quenching model suggests that final state parton energy loss dominates in central Cu+Cu collisions at 62.4 and 200 GeV, while the enhancement at 22.4 GeV is consistent with nuclear modifications in the initial state alone.

Radical therapy for muscle-infiltrating bladder cancer (cystectomy or radiotherapy): does age affect the final therapeutic benefit for the patient?

PURPOSE

To evaluate the therapeutic outcome of radical cystectomy and radical radiotherapy in patients with T2N0M0 clinical stage bladder cancer in relation to their age.

PATIENTS AND METHODS

Between 1995-2006, 119 patients with clinical stage T2N0M0 bladder cancer were treated with radical radiotherapy (group A) and were divided in 2 subgroups: >70 years old (A1) and <or=70 years old (A2). Between 1998-2006, 26 patients with the same clinical stage were treated with radical cystectomy (group B) (>70 years old/B1 subgroup and <or=70 years old/B2 subgroup). The following parameters were evaluated in both groups and subgroups: therapeutic outcome (overall survival/OS, local control, development of metastases) and tolerance (side effects and complications of each method). Kaplan-Meier method and log-rank test were used for statistical analyses.

RESULTS

All group B patients tolerated their treatment very well, without interruptions. The 3-year OS of groups A and B was 39 and 69%, respectively (p=0.032). The 3-year OS of subgroups A1 and A2 was 37.3 and 43.3%, respectively (p=0.085). In the cystectomy group B, 3-year OS of the subgroups was the same (B1: 68.6% and B2: 69.3%; p=0.10). Local control rate for the subgroups A1, A2, B1, B2 was 43, 40, 90 and 84%, respectively. Distant metastatic rate was 14.1, 20, 7.6 and 7.4% for subgroups A1, A2, B1, B2, respectively.

CONCLUSION

The results of both therapeutic methods in both age groups seem satisfactory. Very good tolerance was also observed. It seems that if a patient is not completely suitable for radical cystectomy or radical radiotherapy age should not be considered as an exclusion factor.

Emissions of the indirect greenhouse gases NH3 and NOx from Australian beef cattle feedlots

Emissions of indirect greenhouse gases, notably the nitrogen gases ammonia (NH3) and the odd oxides of nitrogen (NOx), play important roles in the greenhouse story. Feedlots are intense, but poorly quantified, sources of atmospheric NH3 and although production of NOx is to be expected in feedlots, rates of NOx emission are virtually unknown. In the atmosphere, these gases are involved in several transformations, but eventually return to the earth in gaseous or liquid form and can then undergo further transformations involving the formation and emission of the direct greenhouse gas nitrous oxide (N2O). The IPCC Phase II guidelines estimate that indirect N2O emissions due to atmospheric deposition of N compounds formed from NH3 and NOx could be ~14% of the direct emissions from agricultural soils or from animal production systems. IPCC recommends that these indirect emissions be accounted for in making inventory estimates of N2O emission. This paper is a preliminary report of emissions of NH3 and NOx from two Australian feedlots determined with micrometeorological techniques. Emissions of nitrogen gases from both feedlots were dominated by emissions of NH3. The average NH3 emission rate over both feedlots in winter was 46 g N/animal.day, while that of NOx was less than 1% of that rate at 0.36 g N/animal.day. It was apparent that NH3 release was governed by the wetness of the surface. Rates of emission from the feedlot with the wetter surface were almost three times those from the other. The IPCC default emission factor for the combined emission of NH3 and NOx from livestock is 0.2 kg N/kg N excreted, but in our work, the emission factor was 0.59 kg N/kg N excreted. Potential emissions of N2O due to NH3 and NOx deposition were estimated to be of the same magnitude as the direct N2O emissions, the sum of direct and potential indirect amounting to ~3 g N2O-N/animal.day. If applied nationally, this would represent a contribution of N2O from Australian feedlots of 533Gg CO2-e or 2.2% of all Australian N2O emissions.

Overcoming depolarizing resonances with dual helical partial Siberian snakes

Acceleration of polarized protons in the energy range of 5 to 25 GeV is challenging. In a medium energy accelerator, the depolarizing spin resonances are strong enough to cause significant polarization loss but full Siberian snakes cause intolerably large orbit excursions and are also not feasible since straight sections usually are too short. Recently, two helical partial Siberian snakes with double pitch design have been installed in the Brookhaven Alternating Gradient Synchrotron (AGS). With a careful setup of optics at injection and along the energy ramp, this combination can eliminate the intrinsic and imperfection depolarizing resonances otherwise encountered during acceleration to maintain a high intensity polarized beam in medium energy synchrotrons. The observation of partial snake resonances of higher than second order will also be described.

Air quality improvement estimation and assessment using contingent valuation method, a case study in Beijing

The aim of the paper is to estimate and assess residents' willingness to pay to improve air quality in the urban area of Beijing using the Contingent Valuation Method (CVM). The mean willingness to pay (WTP) for a 50% reduction of harmful substances in the air was 143 CNY per household per year, and the total WTP of the residents in the study area was 336 million CNY per year. As a proportion of household annual income, the mean WTP amounted to 0.7%. Four socio-economic variables were found to have significant impacts on residents' willingness to pay. The analysis results illustrated that WTP increases with income and education level, and decreases with household population and age. The willingness was larger for residents in the urban districts than those in the suburban districts. It was found that most of the protest bids lay on interviewees' incomplete perception of the values of environmental amenity. The influence of household income on people's willingness to pay illustrated in this study reflects a causal force of Beijing's transition to market economy that households created to have disposable income are more likely to care about environmental quality. The results of this study strike an optimistic note on the possibility of measuring the total economic value of environmental quality improvement by using the CVM in China. Suggestions on implication of the CVM for both academics and policy makers are provided in the paper.

Polarized proton collisions at 205 GeV at RHIC

The Brookhaven Relativistic Heavy Ion Collider (RHIC) has been providing collisions of polarized protons at a beam energy of 100 GeV since 2001. Equipped with two full Siberian snakes in each ring, polarization is preserved during acceleration from injection to 100 GeV. However, the intrinsic spin resonances beyond 100 GeV are about a factor of 2 stronger than those below 100 GeV making it important to examine the impact of these strong intrinsic spin resonances on polarization survival and the tolerance for vertical orbit distortions. Polarized protons were first accelerated to the record energy of 205 GeV in RHIC with a significant polarization measured at top energy in 2005. This Letter presents the results and discusses the sensitivity of the polarization survival to orbit distortions.

Psychological distress and personality traits in early rheumatoid arthritis: a preliminary survey

OBJECTIVES

To investigate psychiatric manifestations, personality traits, and ego mechanisms of defense involved in early rheumatoid arthritis (RA).

METHODS

Twenty-two unselected early RA outpatients with disease duration less than 1 year participated in the study. The majority of participants were females (72.7%), married (81.8%), aged 51.0+/-14.6 years. Thirty-four subjects matched for age, sex and educational level served as "healthy" controls. General Heath Questionnaire, Symptom Distress Checklist, Defense Style Questionnaire and Hostility and Direction of Hostility Questionnaire were used; disease activity was estimated by disease activity for 28-joint indices score.

RESULTS

Seven patients (31.8%) presented psychological distress scores indicative of possible psychiatric caseness, expressing obsessive-compulsive symptoms and depression, as compared to six (17.6%) of controls. Social dysfunction distress and somatization were prominent psychiatric manifestations in early RA group. Early RA patients tend to adopt a less adaptive defense style than controls. Although disease activity was not correlated to psychological distress, a significant association between disease activity and patients' defensive style was observed: as the disease is exacerbated, there was a shift from "non-adaptive" to "immature image distorting or borderline" defense style, suggesting a rather fragile underlying personality structure.

CONCLUSION

Psychological distress is a relatively common experience in early RA. Social dysfunction, along with the less adaptive defense style, which under the stress of the disease exacerbation turns to "borderline", underlines the importance of a careful assessment and consultation in early RA patients in order to face the distress shortly after diagnosis and highlights potential risk factors for future adaptation to exacerbations of the disease.

Clinical correlation of bone marrow microvessel density in essential thrombocythemia

The aim of this study was to investigate the prognostic relevance of angiogenesis expressed as bone marrow microvessel density (MVD) in 40 patients with essential thrombocythemia (ET). Bone marrow MVD was visualized in paraffin tissue sections using immunohistochemical staining for CD34 protein. Increased MVD of bone marrow specimens was not significantly correlated with clinical (sex, age, microvascular disturbances, liver and spleen size, complications, treatment or no before biopsy), laboratory (peripheral blood count), bone marrow histopathological parameters (cellularity, megakaryocyte clumping and reticulin fibrosis) and overall survival. These preliminary findings suggest that angiogenesis has no prognostic value in patients with ET.

Multiple brown tumors of the ribs simulating malignancy

Bone disease associated with primary hyperparathyroidism, known as osteitis fibrosa cystica, is now very rarely encountered, since the parathyroid disorder is most often diagnosed at the early stage of asymptomatic hypercalcemia. Here, we report the case of a patient with multiple pleural-based masses and hypercalcemia, which led to the presumptive diagnosis of malignancy. However, histological and laboratory data were consistent with the development of brown tumors of the ribs due to underlying severe hyperparathyroidism.

Laryngeal involvement in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovial membrane, which causes joint damage and bone destruction. Extra-articular manifestations are numerous, involving multiple organ systems. Rheumatoid nodules are common extra-articular findings occurring in 20% RA patients. They develop most commonly in pressure areas (elbows and finger joints) and may occasionally affect internal organs including pleura, lungs, meninges, larynx, and others. Furthermore, RA affects the ear, nose, and throat, causing various otorhinolaryngological symptoms. In this report we describe two patients with RA and laryngeal involvement, mostly rheumatoid nodule formation, with a review of the literature.