The Effects of Subjective Cognitive Decline on APOE Genotype Disclosure in the Butler Hospital Alzheimer's Prevention Registry

BACKGROUND

Subjective cognitive decline (SCD) and APOE genotyping are both instrumental in identifying high-risk individuals for Alzheimer's disease (AD) prevention trials.

OBJECTIVE

This study examined the relationship between SCD and the impact of APOE disclosure on the psychological and behavioral health of cognitively unimpaired individuals. Design/Setting/Participant: We recruited 189 trial volunteers (mean age 66, 65% female, 96% White), from the Butler Hospital Alzheimer's Prevention Registry. Participants completed screening for cognitive impairment and a psychological readiness assessment before learning their APOE genotype, and were followed for 6 months after.

RESULTS

SCD had a modest, temporary impact on mood and event-related distress following APOE disclosure, specifically on those who were ε4 carriers. The presence of SCD (SCD+) did not compound the AD genetic test-specific distress related to learning that one was an ε4 carrier. SCD also did not moderate changes in perceived AD risk, with all non-carriers showing a more rapid decrease in perceived risk over time than carriers. Counterintuitively, those without SCD (SCD-) reported taking more steps in future-directives than the SCD+ group at baseline and after disclosure, potentially suggesting that those with SCD may have subtle executive declines that limit future-oriented actions or fear-avoidance behaviors. Further, the SCD- group was more accurate in recalling their APOE status and the recall accuracy correlated with their broad knowledge about APOE as a risk gene for AD.

CONCLUSION

Our findings support the safety and tolerability of APOE disclosure in research volunteers regardless of their SCD statuses, but further studies are warranted to include diverse individuals and those pursuing testing through direct-to-consumer services outside of traditional research settings.

Carrageenan-Based Compounds as Wound Healing Materials

The following review is focused on carrageenan, a heteroglycan-based substance that is a very significant wound healing biomaterial. Every biomaterial has advantages and weaknesses of its own, but these drawbacks are typically outweighed by combining the material in various ways with other substances. Carrageenans' key benefits include their water solubility, which enables them to keep the wound and periwound damp and absorb the wound exudate. They have low cytotoxicity, antimicrobial and antioxidant qualities, do not stick to the wound bed, and hence do not cause pain when removed from the wounded region. When combined with other materials, they can aid in hemostasis. This review emphasizes the advantages of using carrageenan for wound healing, including the use of several mixes that improve its properties.

CLASIC VERSUS NOVEL IN REDUCTION OF ACUTE ANTERIOR DISLOCATION OF THE SHOULDER: A COMPARISON OF FOUR REDUCTION TECHNIQUES

AIM

The purpose of our study is to compare four different techniques for reduction shoulder dislocation in term of efficacy, duration until reduction and pain felt by patient during the procedure.

MATERIAL AND METHODS

During 2015 year, we conducted a study on 50 chronological patients with anterior shoulder dislocation. After exclusion of four patients, the remaining 46 (74% males, mean age 44.6 +/- 20.03 years, range 18 to 89) were randomly assigned in four groups and reduced by Cunningham (C), Kocher (K), Mothes (M) and Hipocrat (H) techniques. All the patients were sedated using Midazolam (2 mg) and Fentanyl (1 microg/kgbw) except patients who underwent Cunningham technique.

RESULTS

The success rate was 76.9% in C group, 98.4% in K group, 90.2% in M group and 87.96% in H group (p>0.05). The level of pain in C group was similar to the other groups in the absence of pain medication (p<0.05).

CONCLUSIONS

Cunningham technique is a simple, single person technique, drug free, less painful and safer, comparable with other "classical" methods.

MANAGEMENT OF BILATERAL FEMORAL NECK FRACTURE IN A NONAGENARIAN PATIENT--CASE REPORT

Simultaneous bilateral femoral neck fracture is rare injury. Cases with this type of fracture have been reported in the literature since the 1950s, following the introduction of electroconvulsive therapy which generates violent hip muscle contractions. In young patients' simultaneous bilateral femoral neck fracture results from high energy trauma (car accident or fall from height) in a normal bone. Pathological changes in bone structure occurring in chronic kidney disease, vitamin D deficiency, osteomalacia, osteoporosis, metabolic imbalances and administration of corticosteroids explain the occurrence of this particular type of fracture following low-energy trauma. We present the case of a 90-year-old female patient who suffered a simple fall from her own height resulting in a Garden IV bilateral femoral neck fracture. Our therapeutic option in this patient was bilateral uncemented bipolar hemiarthroplasty in a single session using a single tray of sterile surgical instruments and two sterile drapes. Postoperative outcome was very good, allowing the initiation of functional recovery on the first postoperative day. Uncemented hemiarthroplasty proved to be a good choice in such a patient in the associated diseases may trigger the risk of cardiovascular disturbances specific to bone cement implantation syndrome.

Proximalize osteotomy of tibial tuberosity (POTT) as a treatment for stiffness secondary to patella baja in total knee arthroplasty (TKA)

INTRODUCTION

Stiffness after a total knee arthroplasty (TKA) is one of the most common post-operative complications. The purpose of this study is the evaluation of the effectiveness of TT proximalization osteotomy of improving a lack of flexion and secondary pain in patella baja (infera) post-TKA.

MATERIALS AND METHODS

Between April 2007 and July 2012, TT proximalization osteotomy was performed on 21 patients. The average preoperative flexion was 70° (in a range of 60-80). Clinical pre- and post-operative evaluations were performed with Knee Society Score, Western Ontario and McMaster Universities Arthritis Index scales and a satisfaction survey. Modified Blackburn-Peel index and Portner angle were used to evaluate patellar height.

RESULTS

After an average follow-up of 35 months (range 18-48), an average flexion of 100° (range 90-100) and an overall satisfaction were obtained. Clinical scores improved significantly. The Blackburn-Peel index and Portner angle improved significantly from 0.3 (range 0.1-0.5) to 0.4 (0.3-0.5) and from 9 (3-15) to 12 (9-18), respectively. Three patients showed no signs of osteotomy consolidation. However, this was not linked to a lack of extension or an increase in local pain.

CONCLUSION

TT proximalization osteotomy provides satisfactory results in improving a lack of flexion and pain in patella baja post-TKR.

The benefits of using Sentinel WebDashboard in medicine: IT solution for monitoring and treatment of patient with liver cirrhosis

The global assessment of the evolution of a disease in a certain geographical area or a specific domain is useful in the medical research for the preparation of practice guidelines/protocols used in the hospitals. Cirrhosis is one of the most common disorders seen today, occupying a significant place in the gastrointestinal pathology. The disease is the final stage of various affections in terms of etiology and morphology. The most frequent subjects treated on this topic are those related to the etiopathology and early diagnosis. Given the current interest in this matter and considering that UGS (upper gastrointestinal bleeding) in liver cirrhosis is a common complication and potentially fatal, the medical research found some very useful conducting retrospective studies in this area. The purpose of our study was to create an IT system implemented with Sentinel WebDashboard, which could increase the medical performances in diagnosis, monitoring and treatment of a disease. We tested our solution on a medical data set containing information about the patients with liver cirrhosis. The solution facilitates the access of the physicians to the databases containing complete information about the patients, offers the possibility to monitor the evaluation of their health and also aids physicians in optimizing the medical procedures and improve the diagnostic methods. It also offers the advantages of a web application: it does not require the installation on the client side, being accessible anytime, anywhere via a web browser, laptop, Smartphone or tablet.

Low complications after minimally invasive fixation of calcaneus fracture

Calcaneus fractures are still a delicate point regarding the indication for osteosynthesis. Knowing the skin's poor vascularisation of the back foot, the purpose of this study is to present the benefits of proper surgical options between an open and invasive osteosynthesis with anatomical reduction and internal fixation or minimally invasive approach preserving the quality of the soft parts. 66 interventions that targeted reduction and internal fixation of calcaneus fractures were performed between 2009-2012, in the Orthopaedic and Traumatology Department of Bucharest Emergency University Hospital. 29 cases underwent open reduction and internal fixation with plates and screws or Kirschner wires, and 37 cases underwent a minimally invasive reduction and Essex Lopresti osteosynthesis technique. No patient who underwent a minimally invasive reduction had skin lesions, but showed pain due to osteoarthritis lesions that appeared in the subtalar joint. 4 of them, who underwent open reduction and internal fixation had postoperative wound infections and skin necrosis.

[Use of trabecular metal in total knee arthroplasty in severely and morbidly obese patients (BMI > 35 kg/m2)]

The use of trabecular metal in the tibial surface may increase prosthetic survival in the population with severe or morbid obesity (BMI > 35 kg/m2). A prospective, descriptive study was conducted of patients with a BMI > 35 kg/m2 who underwent total knee replacement with a prosthesis with trabecular metal. Minimal follow-up was two years. The statistical analysis was done with Student's t test; the Knee Society Score and the Western Ontario and McMaster Universities Osteoarthritis Index were applied preoperatively and postoperatively. The chi2 test was applied to the BMI values relating them with more or less radiolucent images. The total number of patients was 39, but three were excluded for not having the radiographic follow-up. Mean follow-up was 34 months (25-43); 35 were females, mean age was 69.4 years (57-81), mean BMI was 39.43 kg/m2 (35-55). All patients had grades 3 and 4 tricompartmental arthrosis. The KSS (R and F) and WOMAC scales, with a 95% confidence interval, showed a statistically significant improvement in the assessment of preoperative results and at the end of the followup. Only a few studies measure long-term implant survival. Most authors define survival as the absence of the need to revise prosthetic implants. The end point of survival is the removal or exchange of prosthetic components. Trabecular metal (TM) is currently used in orthopedic surgery and its clinical applications are increasing more and more with good results.

Secondary patellar resurfacing in the treatment of patellofemoral pain after total knee arthroplasty

PURPOSE

This paper reports a prospective review of patients who, between 2004 and 2007, underwent secondary patellar resurfacing (SPR) due to anterior knee pain after a primary total knee arthroplasty (TKA). The aim was to evaluate the clinical outcomes obtained with the SPR and to compare them with radiological findings.

METHODS

A total of twenty-seven consecutive patients met the inclusion criteria. There were twenty-three (85%) women and four (15%) men with a median age of 70 years. The patients were evaluated before and after the surgery with the same functional scores and radiological parameters. Bone scintigraphy was also used in the assessment, and a CT-scan was performed in order to evaluate the femoral component rotation. The median time between TKA and SPR was 18 months.

RESULTS

With a median follow-up of 23 months, seventeen patients (63%) reported a clear subjective improvement after SPR, and patellofemoral scores (primary outcome measure), KSS and WOMAC (secondary outcome measures) showed a statistically significant improvement following the procedure. There were no significant changes after SPR in the Insall-Salvati ratio, the lateral patellar displacement or the lateral patellar tilt. The mean time between TKA and SPR had no statistically significant effect on outcome. The bone scintigraphy revealed increased patellar uptake in seven cases, but this was not related to subsequent improvement after SPR. Rotational computed tomography showed a median internal rotation of the femoral component of 1º. The complications observed were a patellar component loosening and an acute post-infection.

CONCLUSION

No clinical or radiological parameter was found to be related to the final outcome after SPR. There was a discrepancy between functional scale scores and the patient's subjective satisfaction.

Resurfacing total hip replacement--a therapeutical approach in postmenopausal women with osteoporosis and hip arthrosis

AIM

Patients with incipient hip arthrosis may benefit from a relatively new therapeutical approach using resurfacing total hip replacement, but in those with associated osteoporosis, this type of surgical intervention is contraindicated, given the poor quality of osteoporotic bones. We assessed the efficacy of the antiosteoporotic pharmacological therapy to improve bone quality and bone strength in postmenopausal women diagnosed with hip arthrosis and osteoporosis thus facilitating the hip surgical intervention.

METHODS

We evaluated 20 postmenopausal women aged between 53-60 years diagnosed with osteoporosis according to the WHO criteria, by using dual-energy X-ray absorptiometry (DXA) for bone mineral density measurements. All these patients had low hip T score (osteopenia/ osteoporosis) and also incipient hip arthrosis. The surgical approach was delayed for 12 months and all the patients received bisphosphonate therapy with calcium and vitamin D supplements. DXA scans were performed after 12 months of therapy in all the patients.

RESULTS

A surgical intervention with resurfacing total hip replacement was performed in 12 of the 16 patients presenting with increasing BMD, 4 of them showing elements of rapidly advancing hip arthrosis to a stage that made this type of intervention impossible. We chose not to use this technique in the group with stable BMD (4 patients). All 12 women surgically treated had a favorable post-operative outcome without experiencing a femoral neck fracture during the surgical intervention or during the twelve-month follow-up. All 20 patients continued to receive bisphosphonate therapy.

CONCLUSION

In postmenopausal women with osteoporosis and associated hip arthrosis, improving bone mass and bone quality with bisphosphonate therapy is necessary and important in order to allow hip arthroplasty, by using the technique of resurfacing, avoiding the risk of intra-operative fractures and with a favorable post-operative long-term outcome.

Long-standing pain in a 25-year-old patient with a non-diagnosed cervical osteoblastoma: a case report

Benign osteoblastomas are infrequent tumors, representing less than 1% of all bone tumors. The spinal location accounts for 40-50% of all osteoblastomas from which only 20% are located in the cervical spine. The majority of the spinal osteoblastomas arise from the posterior elements: pedicles, laminas, transverse or spinous processes. We present a case report of a young male that due to the lack of specific symptoms was diagnosed of a cervical osteoblastoma 14 months after the first symptoms. The tumor was located in the right C7 pedicle. We then operated, resected the tumor and a posterior C6-T1 bilateral instrumentation was performed to stabilize the spine. Nowadays, this delay in diagnosis may be avoided by the routine use of MRI or CT for unspecific cervical symptoms. The treatment of this lesion is the complete surgical resection based on a correct preoperative planning with CT and MRI in order to define precisely the location, size and extension of the tumor. Currently, percutaneous or minimally invasive surgery is not commonly used in the treatment of this lesion.

Usefulness of teicoplanin for preventing methicillin-resistant Staphylococcus aureus infections in orthopedic surgery

In order to gather more data on the use of teicoplanin for reducing MRSA infections in high-risk populations, the present study was conducted. At a hospital in Barcelona, Spain, there was a high prevalence of MRSA infections among patients who underwent surgery for femoral neck fracture during the first 5 months of 2002 (period A) when cefuroxime was the antibiotic prophylaxis. During the following 12 months (period B) 600 mg of teicoplanin was added to cefuroxime. The rates of overall and MRSA infection during period A were 5.07 and 2.73%, respectively. Pulsed-field gel electrophoresis demonstrated there was no clonal relationship among MRSA strains. No nasal carriers of MRSA were detected among health workers. During period B the rates of overall and MRSA infection were 2.36 and 0.19%, respectively. Both rates were statistically significantly lower than those in period A (p<0.05). These results suggest teicoplanin may be useful in patients undergoing orthopedic surgery when the prevalence of MRSA is high.

Intrapelvic protrusion of a dynamic hip screw

The sliding hip screw, sometimes called the dynamic hip screw (DHS) has been a successful method for treating hip fractures. Nevertheless, mechanical complications of this system have been reported from time to time. They are mainly the result of instability of the fracture, bone quality and technical errors occurring during surgery. We report a case of an intrapelvic protrusion of a sliding screw after a basicervical fracture was treated with a DHS and a 6.5 mm cannulated screw, and its surgical solution using a hybrid total hip arthroplasty. In our case we think the mechanical failure was due mainly to technical errors during surgery. Despite that, we believe the sliding hip screw is the implant of choice for basicervical fractures. Using an additional K-wire during the technique is sufficient to avoid rotation of the proximal fragment and no additional fixation is necessary.;

[How can we improve mortality records in primary care?]

OBJECTIVE

To calculate whether the introduction for systematic use of an epicrisis form for deaths improved the quality of mortality records in a primary care centre (PCC).

DESIGN

Before and after study.

SETTING

Urban, with a population of 31 000. Patients and other participants. All the deaths recorded at the PCC before 1996 (N=396) and in the period from January 1999 to August 2000 (N=160).

MAIN MEASUREMENTS AND RESULTS

The number of deaths recorded at the PCC represents only 32.5% of the official data obtained from the municipal registry in the 1996 evaluation, and 51.5% in the 2000 evaluation. In 2000 the epicrisis forms were filled out in 76.8% (95% CI, 65.0-88.6%) of all deaths. In the 1996 evaluation the place of death was not recorded in 65.5% (95% CI, 59.0-71.8%) of cases, but in 2000 this figure was 22.5% (95% CI, 19-26%). Undefined causes of death dropped from 37% (95% CI, 33.4-40.6%) in 1996 to 30.5% (95% CI, 25.8-35.2%) in 2000. Recording of cause of death rose from 64% (95% CI, 57.8-70.4%) in 1996 to 73% (95% CI, 61.8-84.4%) in 2000.

CONCLUSIONS

Official data reveal under-recording of mortality at the PCC. The introduction of an epicrisis form for deaths has improved the quality of the centres mortality records.

Hydrodynamic effects on the solute transport across endothelial pores and hepatocyte membranes

In this short note we propose a simple and rapid procedure to calculate the net quantity of metabolites absorbed by hepatocytes from blood plasma. The blood movement through sinusoids determines an opposed circulation of plasma through the space of Disse. Hydrodynamic considerations lead to the conclusion that hepatocytes absorb for their own synthesis processes a quantity of metabolites in a volume flow of the order of 10(-12) nl s(-1) through a sieve plate surface with an area of 1 microm2. At pathological temperature (40 degrees C), the excess of the net absorbed volume flow for the entire sinusoidal surface of the mammalian liver may be as high as 1.9 nl s(-1). Some observations on the effect of red and white blood cells on the chylomicron traffic through endothelial pores are made.

Esophageal porto-caval anasthomosis. Critical view of the hypothesis of F.C. Carvalho

The apparition and the breakage of esophageal varices et the level of cardioesophageal junction in the portal hypertension still represents a problem of pathological surgery. The presence of these varicose dilatations in this region is due to an important zone of porto-caval anastomoses. Angioarhitectonical study of lower abdominal esophagus represents a disputed problem in the specialty literature. The hypothesis of south American anatomist F. C. Carvalho (1966) looks to be the best model that could explain the appear of cardioesophageal varices. Studies realized in the past within the Anatomy Department of Medicine "Carol Davila" Bucharest tried to demonstrate the validity of Carvalho's theory, and the results of these researches are exposed in the present paper.

Selective association of phospholipids as a clue for the passive flip-flop diffusion through bilayer lipid membranes

We showed that the investigation of the selective association of phospholipids might contribute to the insight of the flip-flop diffusion processes. The process of selective association was studied quantitatively by testing the association probabilities for both parallel and anti-parallel orientations of the polar headgroups. The model of double chain binary mixture confirms a high capacity of phospholipids for self-association in parallel configuration of the electric dipole moments whether the cross-sectional area of the polar headgroups are in an usual range of 25-55 A2. It is demonstrated that the aggregation of a class of phospholipids from a binary mixture is strongly dependent on the dipole-dipole interaction between the same phospholipids and is modulated by the magnitude of the electric dipole moment of the other phospholipids from that binary mixture. There are a great number of mechanisms involved in the transbilayer movement of phospholipids. We referred here only to the passive transport of lipids from one monolayer to the other. The flip-flop mechanisms raised in this paper are the breakdown of bilayer due to the increase of the packing density and the inversion of the coupled phospholipids from the opposite monolayers of the same bilayer. Thus, the pair formation promoting a drop in occupied volume decreases the packing pressure in the respective monolayer and consequently triggers a flip-flop into the other direction since the packing pressure in the other monolayer has not dropped. According to the present model for the binary mixtures of double-chain lipids, the rate of the flip-flop diffusion decreased by increasing the number of the methylene groups added to the acyl chain. This dependence may be perturbed whether the phospholipids possesses a very high cross-section area of the polar headgroups (a > 55 A2). We think that the selective association of phospholipids is neither exclusively, nor only involved in promoting the transbilayer diffusion of phospholipids. Most probably, the selective association determines some phospholipid domains that attract certain particular proteins so that it can modulate the protein activity.

Experimental studies on bacterial product CANTASTIM derived from Pseudomonas aeruginosa. II. Protective effect in Salmonella typhimurium infection

Stimulation of the host defense system in a nonspecific way may provide effective treatment of recurrent infections. CANTASTIM is a bacterial product that has been successfully used in cancer immunotherapy as well as in chronic infections treatment. The nonspecific protective effect of CANTASTIM was investigated in two models of experimental infection with Salmonella typhimurium in mice. Prophylactic administration of CANTASTIM (three days before challenge) enhanced peritoneal macrophages bactericidal activity and significantly increased survival of treated mice. When CANTASTIM was administered 72 h after bacterial challenge, in a sublethal infection model with Salmonella typhimurium, by activating macrophages, NK and T cells, it increased the survival rate. The cell populations and molecular mechanisms involved in the prophylactic and therapeutic protective effect CANTASTIM seem to be partially different.

Aspects of self- and cross-association hydrophobicity in a single chain binary mixture. A computer study

The differential scanning calorimetry (DSC) traces for binary mixtures of single chain amphiphiles present more than one transition temperature, while the traces for pure single chain amphiphiles have a single (or at most two) transition temperature(s). These secondary transition temperatures can appear owing to the selective association processes between the components of the lipid mixtures. This paper presents an attempt to examine theoretically the association of single chain amphiphiles between (a) two identical molecules (self-association) and (b) two different molecules (cross-association). Association probabilities, the mean association probabilities and the overall ratio of efficiency, were evaluated for 36 binary mixtures of single chain amphiphiles. A test system for evaluation of differential effects of the hydrophobic chain length on the mean association probabilities was considered. Self-association of longer hydrophobic chains and cross-association phenomena show a high probability compared with the self-association of shorter hydrophobic chains. We found that "the efficacious length of association" in a binary mixture of single chain amphiphiles is 8 methylene groups.

Differential length effects in a binary mixture of single chain amphiphiles in planar monolayers. A three-dimensional approach

The purpose of this work was to investigate the selective association into a binary lipid mixture having the acyl chain lengths of the two components as variables. A more adequate parameter that can describe the selectivity of the association processes into a binary lipid mixture is the mean association probability. In the present paper, we used a three-dimensional approach by evaluating the mean probabilities of association of single chain amphiphile molecules for a group of 36 binary mixtures. The possible correlations between the hydrophobic chain lengths and the association processes have been carried out by using the differential mean association probabilities. These results allowed us to uncover some significant rules that govern the selective association between the two components from a single chain binary mixture. We have found that in a binary mixture of single chain amphiphiles, the distance where the dispersion forces become effective during association processes is about 8.89 A.

Association probabilities between the single-chain amphiphiles into a binary mixture in plan monolayers (II)

A test system of homologous binary mixtures of single-chain amphiphiles was considered. The dependence of the association probabilities on the hydrophobic chain length, and on the dipole moment of the shorter chain component when the longer chain component has a low dipole moment, was studied. The free-end effect of each hydrophobic chain on the association probability was also analysed. Generally, both the shorter chain end effect and the longer chain end effect on the association process are independent of their own initial chain length, but are dependent on the chain length of the other component and dipole moment. The changes in every association probability produced by the addition of one methylene group to the shorter chain and to the longer chain are unequal and opposite. For this reason the efficiency ratios were defined and analysed. The thermotropic behaviour of lipid mixtures can be related to association processes.

Calculation of the optimal surface area for amphiphile molecules using the hard core method

In this work, we have calculated the optimal surface area per amphiphile molecule using a two-dimensional gas of electric dipoles interacting with hard The optimal surface area can be evaluated according to a formula (in the two-body approximation) or as a root of an equation (in the three-body approximation). If the equation has more than one positive root, which is greater than the hard core area, then a polydisperse dimensional distribution of supramolecular aggregates is possible.

Association probabilities between the single chain amphiphiles into a binary mixture in planar monolayers

In this work, we have calculated the probabilities of selfassociation of single chain amphiphile molecules for 36 binary mixtures of molecules having an even number of carbon atoms (from 8 to 24 carbon atoms). The association probabilities depend on the dipole moment of head groups, the length of chains and the mole fraction of the mixture of both types of amphiphile. These calculations are useful for the quantitative and qualitative explanation of the cluster formation on the surface of the mono- or bilayers.

[Immunologic anomalies in inflammatory diseases of connective tissue in children]

A comparison was made between the results of an analysis of humoral immunological changes in 64 cases of inflammatory diseases of the connective tissue of children (32 cases of ACJ, 5 cases of systemic lupus erythematosus, 2 cases of polymyositis, and 25 cases of systemic vasculitis), and data reported in recent literature, the authors conclude as follows:--changes of the immunological parameters that were tested support the hypothesis of a humoral immunopathogenic mechanism in systemic lupus erythematosus, in some of the manifestations of ACJ, and in systemic vasculitis;--of particular value for the immunological diagnosis of ACJ is the detection of FR in the patients' serum (and especially of FR from the IgG and the IgA class), as well as changes of immunological parameters of the articular fluid (the presence of FR, of immune complexes, a reduction of the titer intra-articular complement, the presence of ragocytes);--demonstration of humoral immunological changes (polyclonal hypergammaglobulinemia, the presence in the serum of circulating immune complexes, and of cryoglobulins, the low titer of serum complement in active stages, the presence of antinuclear antibodies, and especially of antinative DNA, the presence of LE cells in peripheral blood, and of a varied range of autoantibodies) is mandatory for the diagnosis of systemic lupus erythematosus;--in the present stage of our knowledge humoral immunologic changes are not an absolutely certified criterion for the diagnosis of polymyositis, and of some cases of systemic vasculitis (Henoch-Schoenlein purpura).

Plasma fibronectin level in patients with connective tissue diseases

The level of plasma fibronectin (Fn) was studied in 40 patients with connective tissue diseases. Fn concentration was found increased in patients with rheumatoid arthritis (mean +/- SE, 560 +/- 30 micrograms/ml, p less than 0.01) decreased in patients with mixed connective tissue disease (337 +/- 12 micrograms/ml, p less than 0.05) and was not significantly different from controls in systemic lupus erythematosus, scleroderma, polymyositis. The value of plasma Fn level was found increased in active diseases and decreased in the cases, with presence of cryoprecipitates. The factors which might influence the level of plasma Fn and the possibility of using the changes of Fn concentration in the estimation of the evolution of connective tissue diseases are discussed.