Associations of diagnostic findings with disease activity in primary Sjӧgren's syndrome: a cluster analysis

OBJECTIVE

The diagnosis of primary Sjӧgren's syndrome still relies upon a constellation of clinical, laboratory, imaging, and pathological findings. We aimed to evaluate the relation of the disease activity with the results of diagnostic tests for primary Sjӧgren's syndrome.

METHODS

A principal component with cluster analysis was performed to classify 69 patients with primary Sjӧgren's syndrome based on the results of diagnostic evaluations.

RESULTS

Anti-SSA autoantibody was the most represented feature on the principal components. The anti-SSA and ultrasound score were positively correlated (p=0.001). We identified two distinct clusters of low or high disease activity (p<0.001). Except for disease duration and serum beta2-microglobulin, the clusters were significantly different in salivary flow (p= 0.004), ultrasound findings (p<0.001), IgG (p= 0.001), and salivary beta2-microglobulin (p= 0.048). Also, positive findings were significantly different between the clusters in rheumatoid factor, antinuclear antibody, anti-SSA, and anti-SSB (all p≤0.013).

CONCLUSION

Patients with higher syndrome activity were best recognized with serological and ultrasound assessments. However, patients with lower syndrome activity had a longer disease duration, higher stimulated salivary flow rate, and a positive biopsy of minor salivary glands (56%).

Synthesis and conformational analysis of a potentially super-armed glucuronidation donor

The concise synthesis of a potentially “super-armed” glucuronidation donor is reported. The α-anomer was crystallized and analyzed by single crystal X-ray diffraction. The pyranose ring was found to be in a twist-boat conformation in the solid state. To confirm the relevance of this finding for the solution state, and explain the failure of analysis by NMR, DFT calculations were performed. They revealed the twist-boat to be the dominant among a group of several possible conformers at ambient temperature.

Graphical abstract

Effect of 1-week Calendula officinalis consumption before high-intensity interval exercise on some delayed onset muscle soreness (DOMS) elements in male rowers

Previous studies showed that some medicinal herbs can prevent delayed onset muscle soreness (DOMS). The present study investigates the effect of Calendula officinalis supplementation on DOMS elements on male rowers. Thirty healthy adult male rowers were randomly chosen and equally divided into experimental and control groups. Blood samples, Sargent jumps (SJ), and pain perception tests were measured at the starting point. The experimental group consumed (twice a day, 200 μl each time) C. officinalis extract for a week while the control group received a placebo. After consuming the supplementations for a week, the second samples and tests were taken. All the athletes participated in the high-intensity interval exercise (HIIE – a muscle soreness protocol). Third, fourth, and fifth samples/tests were executed immediately, 24 and 48 h after HIIE. Statistical analysis was conducted and P≤0.05 was considered as the significant level. The results showed that HIIE induced a significant increase in the serum tumour necrosis factor-alpha (TNF-α) and creatine kinase-MB (CK-MB) values as well as the pain perception in both groups. TNF-α and pain perception were significantly lower in the experimental group immediately, 24 and 48 h after HIIE. CK-MB activity was significantly decreased in the experimental group during next 24 and 48 h after HIIE. The muscle soreness protocol and its preceding supplementation had no significant effect on SJ. The present study suggests that the consumption of C. officinalis based on the present study dose and timespan may be effective to attenuate inflammation and pain induced by HIIE in male rowers and probably has no functional impact on muscle.

The impact of early musical training on striatal functional connectivity

Evidence from language, visual and sensorimotor learning suggests that training early in life is more effective. The present work explores the hypothesis that learning during sensitive periods involves distinct brain networks in addition to those involved when learning later in life. Expert pianists were tested who started their musical training early (<7 years of age; n = 21) or late (n = 15), but were matched for total lifetime practice. Motor timing expertise was assessed using a musical scale playing task. Brain activity at rest was measured using fMRI and compared with a control group of nonmusicians (n = 17). Functional connectivity from seeds in the striatum revealed a striatal-cortical-sensorimotor network that was observed only in the early-onset group. In this network, higher connectivity correlated with greater motor timing expertise, which resulted from early/late group differences in motor timing expertise. By contrast, networks that differentiated musicians and nonmusicians, namely a striatal-occipital-frontal-cerebellar network in which connectivity was higher in musicians, tended to not show differences between early and late musicians and not be correlated with motor timing expertise. These results parcel musical sensorimotor neuroplasticity into a set of musicianship-related networks and a distinct set of predominantly early-onset networks. The findings lend support to the possibility that we can learn skills more easily early in development because during sensitive periods we recruit distinct brain networks that are no longer implicated in learning later in life.

Molecular epidemiology of Mycobacterium tuberculosis isolates in Iran using spoligotyping

Spoligotyping can help assess the transmission of Mycobacterium tuberculosis strains. We aimed to study the genotyping of M. tuberculosis isolated from patients with tuberculosis from the west of Iran by spoligotyping. Forty-seven M. tuberculosis isolates were collected from the west of Iran. All samples were cultured on Löwenstein-Jensen medium incubated at 37°C for 8 weeks. Bacterial isolates were identified as M. tuberculosis using standard biochemical tests. Drug resistance patterns of M. tuberculosis to rifampicin and isoniazid were determined, and multidrug-resistant (MDR) strains were isolated. After DNA extraction, spoligotyping was performed. We found new spoligotypes 4162 and 4163, which correlated with atypical lineage. Atypical and unknown lineages also had correlations with the MDR tuberculosis rate (4%). The most prevalent spoligointernational types were orphan (34%), 2669 (23.4%) and 127 (14.8%) types. The most prevalent clades were Ural-2 (NEW-1) (25.53%) and atypical (23.40%) lineages. The predominant clade was Ural-2 (NEW-1) and an atypical lineage restricted to Iran. The rate of MDR was low. Knowledge of the circulating isolates in the west of Iran will help implement control programmes, so knowledge of the dynamic transmission of local isolates is crucial.

Endodontic Rotary Systems: Comparison between Gentlefile and Pro Taper Universal for removal of Enterococcus faecalis

Background

As a resistant bacterium species in infected root canals, Enterococcus faecalis needs to be removed in any endodontic treatment. So, we aimed to compare the effectiveness of two rotary systems, Gentlefile and Pro Taper Universal, in removing Enterococcus faecalis (E. faecalis) from the infected root canal system.

Material and Methods

Forty single-root premolar teeth were collected and randomly divided into two groups: Gentlefile (n=18) and Pro Taper Universal (n=18). In addition, four teeth were used as a negative control. The root canals were prepared and infected with E. faecalis and incubated for 4 weeks. Samples were obtained from the root canal immediately before and after instrumentation. A reduction in bacteria was determined by the colony count method.

Results

Colony numbers of E. faecalis were significantly different before and after instrumentation in all groups (p<0.001). Furthermore, Gentlefile group illustrated a higher percentage of bacterial reduction (96.1%) compared to Pro Taper Universal group (90%). Accordingly, Gentlefile group was found to be significantly (p<0.001) more effective in decreasing bacterial populations than Pro Taper Universal group.

Conclusions

Although both rotary systems were highly effective in bacterial reduction from root canals, Gentlefile demonstrated better bacterial reduction percentage from root canals than Pro Taper Universal. Key words:Enterococcus faecalis, Gentlefile, Pro Taper Universal, Rotary systems.

Robotic oesophago-gastric cancer surgery

A postoperative complications rate of nearly 50% has compelled oesophago-gastric practice to adopt minimally invasive techniques such as robotic surgery

Combined Phacoemulsification and Ahmed Valve Glaucoma Drainage Implant: A Retrospective Case Series

Purpose

To report on the efficacy and safety of combined phacoemulsification and an Ahmed valve glaucoma drainage implant with respect to visual acuity improvement, intraocular pressure (IOP) control, and requirement for antiglaucoma medication.

Methods

A retrospective chart review was conducted of 41 eyes (31 patients) with coexisting visually significant cataracts and uncontrolled glaucoma who had combined phacoemulsification and Ahmed valve implantation. The outcome measures were: visual acuity, IOP, antiglaucoma medication requirements, and intra- and post-operative complications. Success was categorized as absolute (IOPp<21 mmHg without the need for antiglaucoma medication) and relative (IOPp<21 mmHg with one or more antiglaucoma medications). Failure was considered to be an IOPp<6 mmHg or IOP>21 mmHg on maximally tolerated medications or any devastating complication.

Results

The mean patient age was 67.3±5.9 years old. The mean visual acuity improved from 0.73±0.5 to 0.16±0.16 (p=0.000). The mean IOP decreased from 28.2±3.1 to 16.8±2.1 (p=0.000, 40.4%), while the number of antiglaucoma medication decreased from 2.6±0.66 to 1.2±1.4 (p=0.000). The absolute and relative success rates were 56.1% and 31.7%, respectively; 5 eyes (12.2%) were considered failures. There were no intraoperative complications; postoperative complications occurred in 8 eyes (19.5%). A hypertensive phase was detected in 12 (29.3%) eyes.

Conclusions

Combined phacoemulsification and Ahmed valve glaucoma drainage implantation is a safe and effective alternative to phacotrabeculectomy in patients with coexisting cataract and refractory glaucoma.

A Three-Component Reaction for the Synthesis of 1-Azabicyclo[3.1.0]hexane-3-enes

A novel and simple synthesis of 1-azabicyclo[3.1.0]hexane-3-ene derivatives is described. The synthesis is carried out via a simple three-component reaction between aryl aldehydes, malononitrile, and hydroxylamine hydrochloride in water. Eco-friendliness, excellent product yields, short reaction time, inexpensive and readily available starting materials, and interesting reaction and products are the main advantages of this method.

Polymorphism of the IL-18 and CD40 genes and Liver Transplant Outcome in Iranian Patients

BACKGROUND

Cytokines and co-stimulatory molecules are important factors determining the outcome of transplantation.

OBJECTIVE

To investigate the effect of IL-18 and CD40 gene polymorphisms on the outcome of liver transplantation.

METHODS

150 liver transplant recipients were included in this study. Alleles and genotypes frequencies for IL-18 (rs1946519) and CD40 (rs1883832) were determined in 28 acutely rejected (AR group) and 122 non-acutely rejected (non-AR group) liver transplant recipients. IL-18 and CD40 gene polymorphisms were evaluated by PCR-RFLP methods.

RESULTS

There were no significant associations between IL-18 and CD40 polymorphism with acute rejection in liver transplant patients. IL-18TT and TG genotypes had a significant association with rejection in women compared to men. After grouping the liver recipients according to living vs cadaver donors, a significant association was found between CC genotype of CD40 and rejection in male living donor recipients. IL-18 TG genotype had a significant association with rejection in female cadaver donor recipients.

CONCLUSION

There is no correlation between all genotype and alleles of IL-80 and CD40 polymorphism and the outcome of liver transplantation. However, gender and type of donor affect the correlation between all genotype and alleles of IL-18 and CD40, and the outcome of liver transplantation.

Tracking post-error adaptation in the motor system by transcranial magnetic stimulation

The commission of an error triggers cognitive control processes dedicated to error correction and prevention. Post-error adjustments leading to response slowing following an error ("post-error slowing"; PES) might be driven by changes in excitability of the motor regions and the corticospinal tract (CST). The time-course of such excitability modulations of the CST leading to PES is largely unknown. To track these presumed excitability changes after an error, single pulse transcranial magnetic stimulation (TMS) was applied to the motor cortex ipsilateral to the responding hand, while participants were performing an Eriksen flanker task. A robotic arm with a movement compensation system was used to maintain the TMS coil in the correct position during the experiment. Magnetic pulses were delivered over the primary motor cortex ipsilateral to the active hand at different intervals (150, 300, 450 ms) after correct and erroneous responses, and the motor-evoked potentials (MEP) of the first dorsal interosseous muscle (FDI) contralateral to the stimulated hemisphere were recorded. MEP amplitude was increased 450 ms after the error. Two additional experiments showed that this increase was neither associated to the correction of the erroneous responses nor to the characteristics of the motor command. To the extent to which the excitability of the motor cortex ipsi- and contralateral to the response hand are inversely related, these results suggest a decrease in the excitability of the active motor cortex after an erroneous response. This modulation of the activity of the CST serves to prevent further premature and erroneous responses. At a more general level, the study shows the power of the TMS technique for the exploration of the temporal evolution of post-error adjustments within the motor system.

Rapid and sensitive high performance liquid chromatographic determination of zonisamide in human serum application to a pharmacokinetic study

An accurate and very rapid method for determination of zonisamide an antiepileptic drug, in human serum is described. The analytical procedure involves liquid-liquid extraction of the analyte and an internal standard (vanillin) from human serum by ethyl acetate as extracting solvent. Chromatographic separation was achieved using a monolithic C18 analytical column and a mixture of 0.05 M phosphate buffer containing triethylamine (1 ml/l; pH 2.7) and methanol (83:17 v/v) was used as the mobile phase. The detection wavelength was set at 240 nm. The calibration curve was linear over a concentration range of 0.015-6.4 μg/ml of zonisamide in human serum. The total run time of analysis was 3.5 min and the lower limits of detection and quantification were 0.005 and 0.015 μg/ml, respectively. The method validation was carried out in terms of specificity, sensitivity, linearity, precision, accuracy and stability. The validated method was applied in a randomised crossover bioequivalence study of two different zonisamide preparations in 24 healthy volunteers, and the assay was sensitive enough to measure drug levels up to 8 days following a single dose administration of zonisamide.

The molecular prevalence of viral infections in transplant candidates with bone marrow suppression, shiraz, southern iran, 2010

BACKGROUND

Transient bone marrow suppression, characterized by acute inability of the bone marrow to produce circulating blood cells, may strongly relate to the pathogenesis of some viral infections.

OBJECTIVE

To study the prevalence of some DNA and RNA viruses in patients with transient bone marrow suppression.

METHODS

EDTA-treated blood samples were collected from 27 patients with clinically- and laboratory-confirmed transient bone marrow suppression. The genomic DNA of hepatitis B virus, adenovirus, polyomavirus BK, and parvovirus B19, and genomic RNA of hepatitis C and G viruses were extracted and amplified by sensitive and specific in-house simple and nested PCR and RT-PCR protocols, respectively. The risk factors that might be related to the studied viral infections were analyzed.

RESULTS

Hepatitis B virus infection was diagnosed in 9 (33%) of 27 patients; adenovirus infection in 2 (7%); and parvovirus B19 infection in 7 (26%) of 27 patients. The genomic DNA of polyomovirus BK was not detected in any patients. Both hepatitis C and G viruses were found in 3 (11%) of 27 patients.

CONCLUSION

Diagnosis of the high prevalence of hepatitis B virus, and parvovirus B19 in patients with transient bone marrow suppression, reflects the importance of these viral infections in introducing bone marrow suppression. This hypothesis should be confirmed in further studies.

Maladaptive connectivity of broca’s area in schizophrenia during audiovisual speech perception: an FMRI study

Introduction

Natural speech perception relies on both, auditory and visual information. Both sensory channels provide redundant and complementary information, such that speech perception is enhanced in healthy subjects, when both information channels are present.

Objectives

Patients with schizophrenia have been reported to have problems regarding this audiovisual integration process, but little is known about which neural processes are altered.

Aims

In this study we investigated functional connectivity of Broca’s area in patients with schizophrenia.

Methods

Functional magnetic resonance imaging (fMRI) was performed in 15 schizophrenia patients and 15 healthy controls to study functional connectivity of Broca’s area during perception of videos of bisyllabic German nouns, in which audio and video either matched (congruent condition) or die not match (incongruent; e.g. video = hotel, audio = island).

Results

There were differences in connectivity between experimental groups and between conditions. Broca’s area of the patient group showed connections to more brain areas than the control group. This difference was more prominent in the incongruent condition, for which only one connection between Broca's area and the supplementary motor area was found in control participants, whereas patients showed connections to 8 widely distributed brain areas.

Conclusions

The findings imply that audiovisual integration problems in schizophrenia result from maladaptive connectivity of Broca's area in particular when confronted with incongruent stimuli and are discussed in light of recent audio visual speech models.

Long-term treatment of spasticity with botulinum toxin type A: an analysis of 1221 treatments in 137 patients

OBJECTIVES

Spasticity is a complex disorder that causes significant disability in affected patients. We here present long-term results of botulinum toxin type A (BoNT-A) treatment in spasticity of various etiologies in the upper and lower limbs.

PATIENTS AND METHODS

We evaluated long-term results of BoNT-A treatment with Dysport and Botox for up to 12 years in 137 patients with spasticity of various etiologies. The focus was laid on efficacy, dosage, safety and side effects over time in a retrospective analysis of the database of our movement disorder clinic.

RESULTS

The mean clinical benefit, latency and duration of response were comparable for both products. Side effects were generally mild and comparable for the two products. We found a significant negative correlation between time from onset of spasticity to start of BoNT-A treatment and degree of improvement after treatment.

CONCLUSION

Our data confirm the safety and efficacy of BoNT-A treatment of spasticity of different etiologies over a long period of time. Furthermore, the data imply that BoNT-A treatment should be started early after appearance of spasticity to obtain better treatment response.

Audiovisual integration of speech is disturbed in schizophrenia: an fMRI study

Speech perception is an essential part of social interaction. Visual information (lip movements, facial expression) may supplement auditory information in particular under inadvertent listening situations. Schizophrenia patients have been shown to have a deficit in integrating articulatory motions with the auditory speech input. The goal of this study was to investigate the neural basis of this deficit in audiovisual speech processing in schizophrenia patients by using fMRI. Disyllabic nouns were presented in congruent (audio matches visual information) and incongruent conditions in a slow event related fMRI design. Schizophrenia patients (n=15) were compared to age and gender matched control participants. The statistical examination was conducted by analysis of variance with main factors: audiovisual congruency and group membership. The patients' brain activity differed from the control group as evidenced by congruency by group interaction effects. The pertinent brain sites were located predominantly in the right hemisphere and comprised the pars opercularis, middle frontal sulcus, and superior temporal gyrus. In addition, we observed interactions bilaterally in the fusiform gyrus and the nucleus accumbens. We suggest that schizophrenia patients' deficits in audiovisual integration during speech perception are due to a dysfunction of the speech motor system in the right hemisphere. Furthermore the results can be also seen as a reflection of reduced lateralization of language functions to the left hemisphere in schizophrenia.

A long-term follow-up of botulinum toxin A in cervical dystonia

OBJECTIVE

Cervical dystonia (CD) is the most common form of adult-onset focal dystonia, and botulinum toxin A (BoNT-A) has become the first-line treatment for this condition.

METHODS

In this work, we present data of 207 CD patients treated with BoNT-A for 6.7 +/- 3.5 years. One hundred and sixty-three patients were treated with Dysport (mean dose, 389 +/- 144 U) and 44 with Botox (mean dose, 145 +/- 44 U).

RESULTS

The mean clinical benefit, based on a 0-3 scale (0=no effect, 1=slight, 2=moderate and 3=marked improvement) was similar for Dysport (2.5 +/- 0.3) and Botox (2.2 +/- 0.4). Adverse events were mild and similar for both products. Fewer than 2% of the patients developed neutralizing antibodies.

DISCUSSION

These data confirm the efficacy and safety of BoNT-A treatment in CD over an extended period of up to 14 years.