Autoantibodies in psoriasis as predictors for loss of response and anti-infliximab antibody induction

BACKGROUND

Infliximab is successfully used to treat psoriasis and psoriatic arthritis. However, some patients lose therapeutic response after several cycles. Antibodies to infliximab (infliximab-Abs) are induced during treatment in a subgroup of patients and are thought to be associated with loss of response (LOR). Routine screening for infliximab-Abs is expensive and not regularly performed. A reliable and affordable method for identifying patients who are at risk for LOR to infliximab is desirable.

OBJECTIVES

To analyse the development of antinuclear antibodies (ANA)/antidouble-stranded DNA antibodies (anti-dsDNA) over time in patients with psoriasis receiving infliximab. To analyse if there is an association between ANA titres/anti-dsDNA concentrations, infliximab-Ab status and LOR.

METHODS

A retrospective data analysis of 29 patients with psoriasis receiving infliximab was carried out. ANA titres and anti-dsDNA concentrations were regularly monitored in these patients and sera were tested for infliximab-Abs by enzyme-linked immunosorbent assay.

RESULTS

Median ANA titres increased from 1 : 80 [interquartile range (IQR) 0 to 1 : 320, n = 29] pretreatment, to 1 : 1280 (IQR 1 : 640 to 1 : 1920, n = 15) after infusion 10, and 1 : 1920 (IQR 1 : 1280 to 1 : 2560, n = 10) after infusion 20. Infliximab-Abs were found in 21% of patients. Infliximab-Ab-positive patients and patients with LOR had significantly higher pretreatment anti-dsDNA concentrations and higher pretreatment ANA titres than infliximab-Ab-negative and responsive patients, respectively.

CONCLUSIONS

The results of this study suggest a role for autoantibodies in the identification of patients with psoriasis at higher risk of developing infliximab-Abs and of LOR under treatment with infliximab.

Acute left ventricular failure in a patient with hydroxychloroquine-induced cardiomyopathy

We present the case of a 75-year-old woman with a medical history of rheumatoid arthritis treated with hydroxychloroquine, who was admitted with acute left-sided heart failure due to a hydroxychloroquine-induced cardiomyopathy as supported by endomyocardial biopsy.

Microbiological stability of solutions containing local anesthetics and opioids in closed infusion systems used for epidural analgesia

Nine solutions containing opiod analgesics and local anesthetics as typically use in epidural catheters were tested for antimicrobial stability. Administration via a pefusor syringe requires several refill processes. It was shown that repetitive refilling of the syringes did not result in any microbiological contamination.

Efficacy and safety of a new 450 mg/ml florfenicol formulation administered intramuscularly in the treatment of bacterial bovine respiratory disease

The objective of the study was the safety and efficacy evaluation of a new 450 mg/ml florfenicol formulation in the treatment of naturally occurring respiratory disease when administered intramuscularly, compared with a positive control group treated with the well-established 300 mg/ml formulation. A total of 174 calves, selected from five sites in France and Spain, aged from 1 to 17 months, showing severe signs of respiratory disease, were randomly assigned to treatment with either the 300 mg/ml (3 ml/45 kg; Nuflor; MSD Animal Health) or 450 mg/ml (2 ml/45 kg; Nuflor Minidose; MSD Animal Health) florfenicol formulation, both administered intramuscularly twice, two days apart. Animals were clinically observed daily for 14 days following treatment initiation. The predominant pathogens present in pretreatment respiratory tract samples were Mannheimia haemolytica and Pasteurella multocida. Mycoplasma bovis and Histophilus somni were also present. All isolates were subjected to in vitro sensitivity testing and found susceptible to florfenicol. In both treatment groups, rectal temperature dropped and clinical index (depression and respiratory signs) significantly improved (P<0.05) after treatment. As a result, 97.7 per cent of the 450 mg/ml florfenicol formulation-treated animals were considered treatment successes on day 5. On day 14, 67.82 per cent of the animals were classified as treatment successes and among them 63.22 per cent were cured. The intramuscular injection of the new 450 mg/ml florfenicol formulation was found equally efficacious as the original 300 mg/ml formulation.

Stent placement for flow restoration in acute ischemic stroke: a single-center experience with the Solitaire stent system

BACKGROUND AND PURPOSE

In acute thromboembolic stroke, mechanical recanalization with stents may result in immediate flow restoration. The Solitaire stent can be used both for flow restoration and thrombectomy. In this single-center experience, we report safety and efficacy data on the application of the Solitaire stent.

MATERIALS AND METHODS

Between March 2009 and July 2010, 18 patients were treated with the Solitaire stent. To evaluate perfusion of the occluded vessel segment before and after the intervention, the TICI score was used (0-3). Clinical outcome was assessed by using the mRS at discharge.

RESULTS

Overall, recanalization was successful in 16 of 18 patients (88.8%). There were no procedure-related complications. Mean TICI score after the intervention was 2.3 ± 0.8. In 5 patients, reocclusion of the treated vessel occurred immediately after retrieval of the temporarily opened stent, and permanent stent deployment was performed to maintain stable perfusion. In 3 patients, hemorrhage occurred after successful recanalization. Five patients died (infarction, n = 3; hemorrhage, n = 1; organ failure, n = 1). A good clinical outcome (mRS ≤2) was achieved in 33.3% of the patients, 5.5% had a moderate outcome (mRS, 3/4), and 61.2% had a poor outcome or died (mRS, 5/6).

CONCLUSIONS

Application of the Solitaire stent in acute stroke results in a high recanalization rate (88.8%) without procedural complications and with a good outcome in one-third of patients. These results encourage further evaluation of the stent in larger patient populations.

[Chronic Strongyloides stercoralis infection. Larva currens as skin manifestation]

Strongyloidiasis is a nematode infection that can persist asymptomatically for years. Pathognomonic skin manifestation is the larva currens. A human immunodeficiency virus-infected patient native from an endemic area presented with pruritus, an urticarial serpiginous rash and eosinophilia. The histology was not helpful. Strongyloidiasis was confirmed on the basis of stool and serum examination. He was treated successfully with Ivermectin.

Flexible and monolithically integrated CIGS-Modules

Monolithically integrated Cu(In,Ga)Se2-mini-modules (CIGS) have been fabricated on polymer as well as on metal foils. Preferred foils with view on costs and physical properties were ferritic steel, titanium, Fe/Ni-alloys (e.g. Kovar®) and polyimide as the only appropriate low temperature candidate. The metal substrates were isolated by multiple layers of SiOx and Al2O3 which served both as diffusion barrier against substrate elements and dielectric barrier. Small area cell efficiencies of 13.8% on ferritic steel foils and 10.6% on polymer foils (both without antireflective coating) were obtained. First monolithically integrated submodules of up to 10×10cm2 substrate area were fabricated both on ferritic steel and polyimide substrates. Different patterning methods have been applied and matched to the respective substrate materials.

Fabrication and Properties of Syntactic Magnesium Foams

Syntactic magnesium foams which consist of thin-walled hollow alumina spheres embedded in a magnesium matrix were fabricated by infiltrating a three-dimensional array of hollow spheres with a magnesium melt by using a gas pressure-assisted casting technique.

The resulting composite contains closed cells of homogeneous and isotropic morphology. The densities of the syntactic magnesium foams were between 1.0 and 1.4 g/cm3. The densities were controlled by variations in the bulk density of the hollow spheres with the volume fraction of spheres kept constant at approximately 63 %.

Compressive deformation characteristics of the composites were evaluated with respect to the influence of matrix strength and sphere wall thickness on characteristic variables such as compressive strength, plateau stress and energy absorption efficiency. Differences in the strength of the magnesium-based matrix materials investigated (cp-Mg, AM20, AM50, AZ91) had little influence on the compressive strength of the syntactic foam. However, an increasing relative wall thickness of the hollow ceramic spheres led to a significant strength enhancement. In all cases the ratio between compressive and plateau strength rose with increasing composite strength resulting in decreasing energy absorption efficiency.

Venous air embolism and intracardiac thrombus after pressurized fibrin glue during liver surgery

After segmental liver resection, a fibrin glue aerosol was used to stop diffuse bleeding from the liver resection site. Immediately after pressurized administration, severe hypotension and bradycardia occurred, requiring cardiopulmonary resuscitation and inotropic support. Transoesophageal echocardiography demonstrated air in both ventricles deriving from the inferior vena cava; contractility of both ventricles was markedly reduced. In addition, a 3 cm floating thrombus was detected in the right ventricle. This case demonstrates that sprayed fibrin glue can cause life-threatening air embolism and intracardiac thrombus formation in liver surgery.

Reduction of regulatory T cells in skin lesions but not in peripheral blood of patients with systemic scleroderma

OBJECTIVE

To determine the frequency and suppressive capacity of regulatory T cells (T(reg)) and their association with clinical parameters in patients with systemic scleroderma (SSc).

METHODS

Peripheral blood from 25 patients with SSc, 15 patients with localised scleroderma (LS) and 29 healthy controls (HC) was studied. Analysis of CD4(+) forkhead box P3 (Foxp3)(+) and CD4(+)CD25(++)Foxp3(+) T(reg) subpopulations was carried out by flow cytometry and cell proliferation was quantified by (3)H-thymidine incorporation. Quantitative analysis of T(reg) was further performed in skin biopsies from 17 patients with SSc and 21 patients with LS using anti-CD4 and anti-Foxp3 monoclonal antibodies for immunohistochemistry.

RESULTS

The frequency of CD4(+)Foxp3(+) and CD4(+)CD25(++)Foxp3(+) T(reg) in peripheral blood from patients with SSc was not significantly different from that of patients with LS or HC. The suppressive capacity of CD4(+)CD25(++) T(reg) in SSc was also found to be similar to that of HC. Phenotypic and functional data revealed no significant difference between the limited or diffuse form of SSc. Moreover, therapy with bosentan showed no significant effect on the frequency of T(reg) during the course of the disease. However, the frequency of T(reg) in skin lesions from patients with SSc or LS, determined as the percentage of CD4(+) cells expressing Foxp3 in the inflammatory infiltrate, was significantly reduced compared with other inflammatory skin diseases.

CONCLUSION

These results indicate that although the authors found no defect in the frequency or function of peripheral T(reg) subpopulations, the reduction of CD4(+)Foxp3(+) T(reg) in the skin of patients with SSc may be important in the pathogenesis of the disease.