Relationship between serum lipopolysaccharide binding protein levels, disease activity, and clinical characteristics in Paraguayan patients with systemic lupus erythematosus

INTRODUCTION

Systemic exposure to bacterial components like lipopolysaccharide (LPS) is among the non-genetic factors that could be involved in the onset or progression of systemic lupus erythematosus (SLE). Lipopolysaccharide-binding protein (LBP) participates in the recognition of LPS and in the inflammatory response. Here, we investigated LBP in SLE patients and its relationship with disease activity and SLE phenotypes.

METHODS

Eighty-one adult patients with SLE from IMID-PY biobank (Paraguay) were included in the study. The clinical and laboratory variables were used to determine SLE activity. LBP levels were determined by ELISA in SLE patients and age- and sex-matched population-based controls.

RESULTS

Patients with SLE have lower levels of circulating LBP compared to healthy controls (p = 0.0007). No significant correlation was found between serum LBP levels and disease activity. A significant difference was observed in LBP levels with regard to the presence of arthritis (p = 0.026). No other relation was found with clinical parameters.

CONCLUSIONS

We found low levels of LBP in SLE patients compared to the control group. No correlation was detected between LBP levels and disease activity. It would be interesting for future studies to evaluate the impact of low levels of LBP on lupus immunopathogenesis.

[Accuracy of pedicle screw insertion in the thoracolumbar spine using image-guided navigation]

INTRODUCTION

Computer image guidance is one of the most significant technologic advancements in the spine surgery, because preoperative or intraoperative images can be used for multiplanar, three-dimensional intraoperative navigation.

MATERIAL AND METHODS

We performed a prospective clinical study to assess the accuracy of pedicle screw insertion using an optoelectronic navigation system (SurgiGATE Spine 2.1 Medivision). The study population included 29 patients with diverse disorders of the thoraco- lumbar spine (degenerative 54%, spondylolisthesis 21%, fractures 14%, scoliosis 7% and spondylodiscitis 4%). One patient was excluded from the study because problems with the specific instruments or the computer system. Pre and post-operative axial computed tomography images were obtained for each patient and analyzed by two independent radiologists to placement accuracy. The correct location was defined accord to Heary scale in 5 grades.

RESULTS

163 image-guided thoraco-lumbar pedicle screws were placed 29 in the thoracolumbar spine and 134 in the lumbosacral spine. We achieved a completely intraosseous placement (Grade I) in 99.4% of lumbosacral spine screws and 100% of thoracolumbar spine screws. Only one misplaced screw (Grade III) in the pedicle of L III in the concavity of a scoliosis was reported. No implant related complications were noted.

CONCLUSIONS

The low rate of misplaced screws in this prospective study compares favorably with previously published results. Our initial results indicate that Image-guided spinal surgery is a safe technique which improves surgical performance during posterior transpedicle stabilization.

Transition to irreversibility in sheared suspensions: an analysis based on a mesoscopic entropy production

We study the shear-induced diffusion effect and the transition to irreversibility in suspensions under oscillatory shear flow by performing an analysis of the entropy production associated with the motion of the particles. We show that the Onsager coupling between different contributions to the entropy production is responsible for the scaling of the mean square displacement on particle diameter and applied strain. We also show that the shear-induced effective diffusion coefficient depends on the volume fraction, and use lattice-Boltzmann simulations to characterize the effect through the power spectrum of particle positions for different Reynolds numbers and volume fractions. Our study gives a thermodynamic explanation of the transition to irreversibility through a pertinent analysis of the second law of thermodynamics.

Monitoring utilization and need for obstetric care in the highlands of Guatemala

OBJECTIVE

To monitor changes in the utilization and need for obstetric care between 1995 and 1998 at three hospitals in the highlands of Guatemala.

METHODS

We collected data on 5300 obstetric admissions from maternity registries and selected 10 indicators to measure intermediate outcomes.

RESULTS

Utilization of services increased at some or all hospitals as measured by the number of obstetric admissions, proportion of births in facilities, and cesarean deliveries as a proportion of all births. We observed increases in the proportion of women expected to have obstetric complications who were treated at each hospital and in the proportion of women with obstetric complications who were referrals. The changes in patient profile reflect increased service utilization and accessibility among women who traditionally used the health system the least.

CONCLUSIONS

Positive changes in these indicators are likely to be associated with a reduction in maternal mortality. Without a control area, we cannot be sure of a cause and effect relationship between outcomes and interventions, nevertheless, maternity registry data offer an inexpensive source of information for facilities to monitor changes.

Basal cell carcinoma arising in a fistula-in-ano

Fistula-in-ano can be complicated by malignant degeneration. A case of basal cell carcinoma identified in the curettage specimen of a fistulotomy is reported. The clinicopathologic features of cases reported in the literature are reviewed.

Urgent hemorrhoidectomy for hemorrhoidal thrombosis

Sixty-five patients underwent hemorrhoidectomies for acute thrombosis. All biopsy specimens contained intravascular thrombi. Early postoperative complications included urinary difficulties and bleeding. Late postoperative complications included anal stenosis.