Nailfold capillaroscopy abnormalities and pulmonary hypertension in mixed connective tissue disease and systemic sclerosis patients

OBJECTIVE

Pulmonary arterial hypertension (PAH) represents an important vascular complication of mixed connective tissue disease (MCTD) and systemic sclerosis (SSc). Microvascular involvement in these diseases can be investigated by means of nailfold capillaroscopy (NFC). Microvascular involvement detected in the nailfold bed is the mirror of the microvascular damage occurring in the entire body, further indicating the involvement of the target organs. The aim of this study was to evaluate the microvascular involvement in MCTD patients with or without PAH, compared to that found in SSc patients with or without PAH.

PATIENTS AND METHODS

This cross-sectional study was performed in the Department of Internal Medicine and Department of Rheumatology, Timișoara, Romania, during the time period between January 2017 and December 2022, on a group of 26 patients with MCTD and 26 SSc patients. Antinuclear antibodies, anti-U1-RNP, anti-Scl 70, anti-centromere, anti-cardiolipin antibodies (aCL) (IgM, IgG), anti-β2-glycoprotein I (aβ2GPI) (IgM, IgG) antibodies, and lupus anticoagulant (LAC) were determined in both the groups. PAH was evaluated through cardiac ultrasonography, determining the sPAP (systolic pulmonary artery pressure). Nailfold capillaroscopy was performed using a USB Digital Microscope and 2.0-megapixel digital camera recording capillaries density, giant capillaries, enlarged capillaries, capillaries hemorrhages, avascular areas, ramified/bushy capillaries scores. Data were recorded and presented as mean ± standard deviation. Statistical analyses were performed using the Student's t-test, ANOVA test, and Pearson's correlation. Differences were considered statistically significant if p-value < 0.05.

RESULTS

Among the MCTD patients, PAH was identified in 12 patients (46.15%), while among the SSc patients PAH was identified in 14 patients (53.84%). Development of PAH in MCTD patients was associated with lower capillaries density (p-value < 0.00001), higher scores of giant capillaries, ramified/bushy capillaries, and capillary hemorrhages (p-value < 0.00001, for each of them). Anti-U1-RNP, aCL, aβ2GPI antibodies and LAC were also found to be involved in PAH-associated MCTD development. Unlike MCTD patients, SSc patients with PAH presented with lower capillaries density and ramified/bushy capillaries scores (p-value < 0.05).

CONCLUSIONS

The MCTD patients who presented significant NFC abnormalities (especially active and late scleroderma-like capillaroscopic pattern) are prone to PAH development. Capillary density reduction is the most important factor associated with the occurrence of PAH. Differences in NFC findings (especially capillary density and ramified/bushy capillaries) were detected among patients with MCTD and SSc having PAH.

Reprocessed magnetorheological elastomers with reduced carbon footprint and their piezoresistive properties

Despite the vast amount of studies based on magnetorheological elastomers (MREs), a very limited number of investigations have been initiated on their reprocessing. This paper presents a new type of recyclable MRE which is composed of thermoplastic polyurethane (TPU) and carbonyl iron particles (CI). The chosen TPU can be processed using injection moulding (IM), followed by several reprocessing cycles while preserving its properties. Numerous types of injection moulded and reprocessed MREs have been prepared for various particle concentrations. The effect of thermo-mechanical degradation on the recycled MREs has been investigated while simulating the reprocessing procedure. An apparent decrease in molecular weight was observed for all the examined matrices during the reprocessing cycles. These changes are attributed to the intermolecular bonding between the hydroxyl groups on the surface of the CI particles and the matrix which is studied in depth. The effect of reprocessing and the presence of magnetic particles is evaluated via tensile test, magnetorheology and piezoresistivity. These characterization techniques prove that the properties of our MREs are preserved at an acceptable level despite using 100% of recyclates while in real applications only up to 30% of recycled material is generally used.

P1679Blood pressure and LDL-cholesterol control in patients with primary hypertension is far from optimal: results from a large observational, multicentric, prospective study

Background

Blood pressure (BP) and LDL-cholesterol control worldwide is still suboptimal. New European and American guidelines have introduced more strict recommendations regarding BP and LDL-cholesterol goals, but data of how difficult is to reach them in routine clinical practice is missing. Triple combination (preferably in a single pill) has been recommended as the 2nd step for the BP control, but data on its efficacy and treatment adherence is limited.

Purpose

To assess BP control at baseline, and after 6 months of optimized treatment with a single pill triple combination (of perindopril, amlodipine, and indapamide), and to assess associated risk factors control and treatment adherence.

Methods

In an observational, multicentric, prospective study, involving 209 investigators, we included 2077 patients (62±10 years; 49% men) with primary hypertension, in sinus rhythm, on current treatment with a single pill triple combination for at least one month prior to inclusion. General characteristics, cardiovascular risk factors, concomitant diseases, concomitant medications, fixed triple combination dosage, and adherence score were collected at baseline (V1), one month (V2), and 6 months (V3). Standardized office BP was measured with a single type sphygmomanometer, at each visit. Lipid profile was collected, if available. At V1 and V2, non-pharmacological and pharmacological treatment was optimized, according to the current guidelines.

Results

At baseline, BP control was suboptimal: only 37% of patients (38% of non-diabetic and 33% of diabetic patients) had optimal BP control as per ESC guidelines 2013, whereas only 10% of patients (11% of non-diabetic and 10% of diabetic patients) had optimal BP control as per ESC guidelines 2018. However, after 6 months of optimized treatment, 75% of patients (78% of non-diabetic and 67% of diabetic patients) had optimal BP control as per ESC guidelines 2013, while 33% of patients (33% of non-diabetic and 33% of diabetic patients) had optimal BP control as per ESC guidelines 2018. At baseline, despite that 52% of patients were on a statin, only 12% of patients at very high cardiovascular risk had an LDL-cholesterol<70 mg/dl, while only 25% of patients at high cardiovascular risk had a LDL-cholesterol<100 mg/dl; at 6 months, 13% of patients at very high cardiovascular risk had an LDL-cholesterol<70 mg/dl, while 30% of patients at high cardiovascular risk had a LDL-cholesterol<100 mg/dl. Single pill triple combination dose was increased at V1 in 29% of patients, and at V2 in 7% of patients. Adherence score increased from 7.0±1.6 at V1 to 7.4±1.1 at V3 (p<0.001).

Conclusion

BP control and LDL-cholesterol control, according to the new guidelines, is far from optimal. However, by optimizing non-pharmacological treatment and increasing dosing and adherence of a single pill triple combination, BP control can be markedly improved.

Acknowledgement/Funding

Servier Pharma

A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds

Burn wounds are a global public health problem, which affects all countries, no matter the development stage and occurs in all age groups, from toddlers to elderly. In spite of burns being the cause of numerous household and work accidents, there are still no clear stated unanimous rules for their treatment. Every day new products appear on the market, each of them trying to prove more effective. Since ancient times, silver has been known for its antimicrobial properties, so it has been used for a long time in the treatment of burns and other types of wounds. One of the relatively modern methods of treatment is applying silver sheets on the scald lesions. In this paper, which was part of a larger study (research for a PhD thesis), concerning prevention and treatment of the post-burn pathological scars, the cases of some patients with burns, who were treated by using the above mentioned method were presented and analyzed. The results obtained by applying silver sheets were then commented and interpreted, pointing out the advantages and disadvantages compared to silver sulfadiazine creams and ointments, which have already been used at a large scale. The prevention and treatment of post-burn pathological (hypertrophic and keloid) scars is a field in which still little is known and in which there are also no clearly set therapy plans. We hope that through this research and the following ones we will manage to establish some major guidelines concerning the prevention of pathological scars, which are not only disabling, but also a major aesthetic issue for any patient, in order to obtain better outcomes.

Detection of EWS/FLI-1 fusion in non-Ewing soft tissue tumors

OBJECTIVES

EWS/FLI-1 fusion mainly appears in Ewing's sarcoma or the primitive neuroectodermal tumors and represents a genomic marker for these tumors. However, it can appear with lower frequency in other soft tissue tumors. The paper investigates the presence of EWS/FLI-1 fusion in clinically diagnosed sarcoma belonging to different non-Ewing connective tissue tumors in order to search for a possible new biomarker valuable for investigators.

METHODOLOGY

20 patients with soft tissue tumors, who underwent surgery, were tested. Intra-operative samples of normal and tumor tissue were collected for histopathological diagnosis and genetics determinations. The patients' RNA from tumor and normal peritumoral tissue was extracted and EWS/FLI-1 fusion screened by quantitative real-time PCR. The relative expression of the fusion in the tumor sample was compared to the similar expression in normal tissue.

RESULTS

The amplification in the threshold zone was shown by 5 samples (25%): 2 clear cell sarcoma, 1 fibrosarcoma, 1 malignant tumor of nerve sheath, 1 metastatic adenocarcinoma. We differentiated between the unspecific amplification and concluded that these are weak positive results.

CONCLUSIONS

Genomic investigation may establish the tumor malignancy and its possible affiliation earlier than histopathology. It can support the screening of EWS/FLI-1 fusion in a larger variety of clinically diagnosed soft tissue tumors.

Detection of EWS/FLI-1 fusion in non-Ewing soft tissue tumors

OBJECTIVES

EWS/FLI-1 fusion mainly appears in Ewing's sarcoma or the primitive neuroectodermal tumors and represents a genomic marker for these tumors. However, it can appear with lower frequency in other soft tissue tumors. The paper investigates the presence of EWS/FLI-1 fusion in clinically diagnosed sarcoma belonging to different non-Ewing connective tissue tumors in order to search for a possible new biomarker valuable for investigators.

METHODOLOGY

20 patients with soft tissue tumors, who underwent surgery, were tested. Intra-operative samples of normal and tumor tissue were collected for histopathological diagnosis and genetics determinations. The patients' RNA from tumor and normal peritumoral tissue was extracted and EWS/FLI-1 fusion screened by quantitative real-time PCR. The relative expression of the fusion in the tumor sample was compared to the similar expression in normal tissue.

RESULTS

The amplification in the threshold zone was shown by 5 samples (25%): 2 clear cell sarcoma, 1 fibrosarcoma, 1 malignant tumor of nerve sheath, 1 metastatic adenocarcinoma. We differentiated between the unspecific amplification and concluded that these are weak positive results.

CONCLUSIONS

Genomic investigation may establish the tumor malignancy and its possible affiliation earlier than histopathology. It can support the screening of EWS/FLI-1 fusion in a larger variety of clinically diagnosed soft tissue tumors.

Listeria monocytogenes - characterization of strains isolated from clinical severe cases

Listeria monocytogenes became an increasing pathogen involved more frequently in sporadic severe illnesses and outbreaks of foodborne infections. This study investigates in vitro susceptibility of 26 strains of Listeria monocytogenes isolated from the clinical specimens collected between March 2009 and November 2013, from 24 patients hospitalized in three medical institutions in Bucharest. All isolates were tested by disk diffusion method to 15 antimicrobial agents, by using disk diffusion tests. Among the 26 clinical L. monocytogenes isolates tested, no multidrug resistant strains were detected, but 18 (72%) were found to be resistant to at least one clinically relevant antibiotic. Among them, 18 clinical isolates were resistant against ciprofloxacin also. Resistance to Ciprofloxacin was particularly noticed to the strains in Romania. Serological and molecular typing by Multiplex PCR method detected two molecular types 1/2 a, 3a and 1/2 b, 3b, as to the more frequent isolated among studied cases. These types of L. monocytogenes could be associated to the higher pathogenic activity of immunodeficient patients.

Surveys on therapeutic effects of "halotherapy chamber with artificial salt-mine environment" on patients with certain chronic allergenic respiratory pathologies and infectious-inflammatory pathologies

Halotherapy (HT), derived from speleotherapy in salt mines, is also a drug-free therapeutic method. HT effects vary depending on the therapeutic method and the structure of halotherapy environment. The purpose of this article is to show the HT effects of "halotherapy chamber with artificial salt-mine environment" of the National Institute of Rehabilitation, Physical Medicine and Balneoclimatology (INRMFB), on patients with bronchial asthma and other chronic, infectious-inflammatory and allergic respiratory diseases, describing the clinical effects on certain nonspecific resistance factors, on markers of inflammatory processes and on certain immunological changes. Patients were clinically assessed, with the application of hematologic investigations, analysis of nonspecific resistance to infection and of inflammatory process markers, immunologic assessments, analysis of sodium and potassium concentrations, of mineralocorticoid function and other biochemical tests. For the experimental HT therapy performed in the "halotherapy chamber with artificial salt-mine environment" of INRMFB, 15 patients suffering from bronchial asthma, allergic rhinitis, chronic bronchitis, chronic obstructive bronchopneumopathy were selected, based on specific medical indications and contraindications and applying ethical principles, as well as 4 patients with similar pathologies for the control group, who underwent in-home drug treatment. After the specific halotherapy treatment on patients with bronchial asthma, chronic bronchitis and chronic obstructive bronchopneumopathy, which also showed other chronic, infectious-inflammatory and allergic respiratory pathologies, triggering of anti-inflammatory (and also anti allergic) mechanisms and healing effects on inflammatory process were noted. Data acquired also proved the halo therapeutic effect causing the reduction of sensitiveness of body in patients with bronchial asthma.

Effects of aldehydes on CD36 expression

INTRODUCTION

During the oil frying process lipid peroxidation compounds are formed. These products can modulate gene expression and alter cellular behaviour. The cellular uptake of oxidized LDL, a key step in the development of atherosclerosis, is mediated by the CD36 scavenger receptor, whose expression is down-regulated by alpha-tocopherol.

OBJECTIVE

To determine the effects of water-soluble aldehydes, obtained from thermally oxidized sunflower oil on the expression of CD36 scavenger receptor in human monocytes (THP-1 cells). We also wanted to study the effects of alpha-tocopherol on CD36 expression in the presence of water-soluble aldehydes.

MATERIALS AND METHODS

Sunflower oil was heated in a frying pan, at 180--200 degrees C for 40 min, water-soluble aldehydes were isolated, and the content of thiobarbituric acid reacting substances (TBARS) was determined. THP-1 monocytes were cultured in RPMI medium during 24 h and incubated with increasing concentrations of the water-soluble aldehydes (ranging from 0.05 to 1 microM) and with or without 50 microM of alpha-tocopherol. In parallel, THP-1 cells were cultured with the same volume of an extract obtained from non-oxidized oil or distilled water. The CD36 expression at the cell surface was studied with fluorescence-activated cell sorting (FACS).

RESULTS

Monocytes incubated in a medium containing water-soluble aldehydes, showed a dose dependent increase in the expression of the CD36 protein on the cell surface, compared to with the control groups. When the cells were treated simultaneously with 50 microM of alpha-tocopherol a significant reduction in the expression of the CD36 protein was observed.

CONCLUSION

Water-soluble aldehydes, extracted from thermally oxidized culinary oil, increase the expression of CD36. This effect is partially decreased by the presence of alpha-tocopherol.

An outbreak of gastroenteritis in a campsite in Romania, July 2007

Between 8 and 13 July 2007, an outbreak of acute gastroenteritis involving 117 holiday-makers (children and adults) at a campsite in Romania was investigated by the Constanta District Public Health Authority (CDPHA). The camp complex has a capacity for 4,200 people and includes four canteens.

Ten years of cyclosporine use in renal transplantation: a single-center experience with 479 renal transplants

INTRODUCTION

From 1983 to 1996 therapy with cyclosporine in association with low-dose azathioprine and prednisone has been used for transplantation immunosuppression. The aim of our study was to present 10 years experience with cyclosporine.

MATERIAL AND METHOD

Among 479 renal transplants performed since 1992, 61 were performed with cadaver donor grafts and 58 in pediatric recipients. From 1992 to 1998, the immunosuppressive protocol included CsA, azathioprine, and prednisone. Since 1998, mycophenolate mofetil (MMF) replaced azathioprine. In 2002, tacrolimus and rapamycin were introduced into our protocols. The patients were assessed in terms of serum creatinine, incidence of acute rejection, cyclosporine side effects, and graft and patient survivals.

RESULTS

Five-year patient and graft survivals were higher among recipients receiving CsA-MMF-prednisone when compared with CsA-azathioprine-prednisone. The incidence of acute rejection episodes during the first year after transplantation was less frequent among recipients receiving MMF compared to those treated with azathioprine. The overall 5-year survivals for patients was 86.29% and for grafts 74.04%.

CONCLUSION

Cyclosporine remains a useful immunosuppressive drug, which represents a major step toward efficient renal transplantation. The availability of multiple effective immunosuppressive agents allows individualized protocols to reduce toxic effects. The advent of new induction regimens offers more opportunities to prolong graft life.

Wavelet image compression--the quadtree coding approach

Perfect reconstruction, quality scalability, and region-of-interest coding are basic features needed for the image compression schemes used in telemedicine applications. This paper proposes a new wavelet-based embedded compression technique that efficiently exploits the intraband dependencies and uses a quadtree-based approach to encode the significance maps. The algorithm produces a losslessly compressed embedded data stream, supports quality scalability, and permits region-of-interest coding. Moreover, experimental results obtained on various images show that the proposed algorithm provides competitive lossless/lossy compression results. The proposed technique is well suited for telemedicine applications that require fast interactive handling of large image sets, over networks with limited and/or variable bandwidth.

Wavelet-based lossless compression of coronary angiographic images

The final diagnosis in coronary angiography has to be performed on a large set of original images. Therefore, lossless compression schemes play a key role in medical database management and telediagnosis applications. This paper proposes a wavelet-based compression scheme that is able to operate in the lossless mode. The quantization module implements a new way of coding of the wavelet coefficients that is more effective than the classical zerotree coding. The experimental results obtained on a set of 20 angiograms show that the algorithm outperforms the embedded zerotree coder, combined with the integer wavelet transform, by 0.38 bpp, the set partitioning coder by 0.21 bpp, and the lossless JPEG coder by 0.71 bpp. The scheme is a good candidate for radiological applications such as teleradiology and picture archiving and communications systems (PACS's).

The impact of laparoendoscopic surgery on the training of surgical residents

Laparoscopic cholecystectomy is an accepted part of the training of surgical residents at present. Further procedures performed by residents include laparoscopic appendectomy, herniorrhaphy and others. This report analyzes the first 22 months of operative laparoscopy in Bakes Surgical Hospital and the impact on the training of residents. From September 1993 through May 1995 four residents performed 179 laparoscopic operations. Their operative experience has been shifted especially towards laparoscopic cholecystectomy but education in open cholecystectomy and open biliary tract procedures has not been jeopardized. It may be concluded that surgical residents can master essential laparoscopic operations without additional complications in a manner standard for training of other procedures.

Blood coagulation and fibrinolysis in hyperthermic rats

Exposure of rats to an environment of +40 degrees C that increases central (rectal) temperature to about 40 degrees C, importantly decrease the number of thrombocytes, the blood coagulation (the Quick time and Howel time) and euglobulin lysis time (ELT). In order to search for the mechanism responsible for coagulability and fibrinolysis we studied the relations of these changes with the sympatheticoadrenergic system and with the adrenal hormonal secretion. Some parameters were thus explored after adrenalectomy and under the influence of a beta-blocking agent, Eraldin. Adrenalectomy moderately reduced these decreasing effects, excepting the ELT. Eraldin has a contrary effect. Adrenalectomy acts by suppressing the corticoid reaction and by diminishing the catecholamineones. Since Eraldin influences coagulation and fibrinolysis in an opposite sense than adrenalectomy, it may be concluded that catecholamines do moderate the effect of heating, inhibiting and not stimulating circulation, as assumed. On the contrary, corticoids (gluco- or mineralo-) contribute to the effect, influencing coagulation in hyperthermia. Both influences are slight, not determinant. Supplementary explorations revealed that repeated daily exposure for 1-2 or 3 weeks, simply in the cages in which hyperthermia was subsequently produced, decreased also the number of thrombocites, the QT and the ELT, especially the last one. The HT was less influenced. It results that these exposures, produced effects similar with hyperthermia. Heating rats after these daily repeated exposures does not influence these already changed parameters.

Blood coagulation and fibrinolysis in rats after hypokinesia and hyperthermia

Coagulation and fibrinolysis were studied in rats exposed to hypokinesia (HK) obtained by including rats (for 1, 2 and 3 weeks) in small cages designed to limit their movements, permitting only spontaneous feeding (a method widely used for mimicking space flight conditions). The number of thrombocytes, the Quick time, the Howell time and the euglobulinlysis time (ELT) decreased after 1 and 2 weeks of HK; however, after 3 weeks, the parameters of coagulation approached normal control levels, while ELT was still significantly under the control values. An increased blood level of corticosterone in animals subjected to HK suggested that changes observed in the blood coagulation could be linked with it. After exposing rats to heat, similar changes were noticed, i.e. thrombocytopenia and an increase in the speed of coagulation and fibrinolysis. When hyperthermia was induced in hypokinetic animals (after 1 and 2 weeks of HK), the association of exposure to HLK and heat was not followed by a cumulative response.

Changes in some digestive enzymes after a seven-day orbital flight

Changes in some digestive enzymes (amylase, lipase, uropepsinogen) were studied in the serum and urine of one of the participants in the Soviet-Romanian seven-day space flight on the Soyuz 40-Saliut 6 complex. On the first day after landing it was found an increased total serum and urinary amylase, resulting from the separate increase of pancreatic and salivary amylase, determined by Skude and Ihse's method [14]. In both serum and urine, pancreatic amylase was found in higher amounts than the salivary one. Lipase was also increased. These modifications are in general in keeping with those recorded after different flights of similar duration and are part of the anabolic response. The pancreatic and salivary amylase were first investigated separately. Under the same conditions uropepsinogen was decreased, an unexpected result. Serum gastrin was increased, in agreement with a generally increased digestive activity.

The influence of magnetic fields on some humoral parameters and on resistance to hyperthermia in rats

The influence of magnetic fields of moderate intensities (50 and 120 Oe) was studied in rats after single or repeated exposures with or without a rise in environmental temperature. The following parameters were investigated: the number of erythrocytes and leucocytes, the percentage of different varieties of leucocytes, serum Na+ and K+, plasma corticosterone, ascorbic acid in adrenals, blood catecholamines, plasma fibrinolytic activity, plasma antidiuretic hormone. The resistance to hyperthermia was tested after single exposures to magnetic fields and the survival time was measured. The only significant change recorded in the number of blood cells was a leucopenia after single exposures to 50 Oe for 4 hrs. The parameters indicating the activity of the adrenal cortex were not altered significantly. A moderate rise in blood noradrenaline suggested a possible mild stimulation of the adrenergic system. The plasma fibrinolytic activity was significantly stimulated after single exposures, but no change in fibrinolysis could be recorded after repeated exposures to magnetic fields. Changes observed in plasma ADH were not conclusive. The resistance of animals to hyperthermia - as a general test of reactivity - showed minimal changes in the survival time, loss of weight, and rectal temperature in animals exposed to hyperthermia (40 degrees C) under the influence of the magnetic fields.

Retrospective data on the pituitary gland response during immune and neoplastic processes

A synthesis of many experimental works performed during the last ten years regarding the nonspecific response of the pituitary gland during some immune and neoplastic processes is presented. Different modalities of the response of pituitary gland cell that vary depending on the antigen type were observed. The TAB vaccine inducing a humoral immune response determined an increased secretory activity of STH and FSH cells which are involved by their secretions in the activation of protein synthesis also including antibodies. The tumoral antigens also representing a stressing factor brought about a more intense activity besides the FSH cells, the ACTH and TSH cells.