Role of ultrasonography in diagnosing early rheumatoid arthritis and remission of rheumatoid arthritis - a systematic review of the literature

Introduction

Ultrasonography (US) might have an added value to clinical examination in diagnosing early rheumatoid arthritis (RA) and assessing remission of RA. We aimed to clarify the added value of US in RA in these situations performing a systematic review.

Methods

A systematic literature search was performed for RA, US, diagnosis and remission. Methodological quality was assessed; the wide variability in the design of studies prohibited pooling of results.

Results

Six papers on the added value of US diagnosing early RA were found, in which at least bilateral metacarpophalangeal (MCP), wrists and metatarsophalangeal (MTP) joints were scanned. Compared to clinical examination, US was superior with regard to detecting synovitis and predicting progression to persistent arthritis or RA. Eleven papers on assessing remission were identified, in which at least the wrist and the MCP joints of the dominant hand were scanned. Often US detected inflammation in patients clinically in remission, irrespective of the remission criteria used. Power Doppler signs of synovitis predicted X-ray progression and future flare in patients clinically in remission.

Conclusions

US appears to have added value to clinical examination for diagnosing of RA when scanning at least MCP, wrist and MTP joints, and, when evaluating remission of RA, scanning at least wrist and MCP joints of the dominant hand. For both purposes primarily power Doppler US might be used since its results are less equivocal than those of greyscale US.     

Forest Elephants: Tree Planters of the Congo

The abundance of large vertebrates is rapidly declining, particularly in the tropics where over-hunting has left many forests structurally intact but devoid of large animals. An urgent question then, is whether these 'empty' forests can sustain their biodiversity without large vertebrates. Here we examine the role of forest elephant ( Loxodonta africana cyclotis ) seed dispersal in maintaining the community structure of trees in the Ndoki Forest, northern Congo. Analysis of 855 elephant dung piles suggested that forest elephants disperse more intact seeds than any other species or genus of large vertebrate in African forests, while GPS telemetry data showed that forest elephants regularly disperse seeds over unprecedented distances compared to other dispersers. Our analysis of the spatial distribution of trees from a sample of 5667 individuals showed that dispersal mechanism was tightly correlated with the scale of spatial aggregation. Increasing amounts of elephant seed dispersal was associated with decreasing aggregation. At distances of<200 m, trees whose seeds are dispersed only by elephants were less aggregated than the random expectation, suggesting Janzen–Connell effects on seed/seedling mortality. At the landscape scale, seed dispersal mode predicted the rate at which local tree community similarity decayed in space. Our results suggest that the loss of forest elephants (and other large-bodied dispersers) may lead to a wave of recruitment failure among animal-dispersed tree species, and favor regeneration of the species-poor abiotically dispersed guild of trees.     

Immunoglobulin G galactosylation and sialylation are associated with pregnancy-induced improvement of rheumatoid arthritis and the postpartum flare: results from a large prospective cohort study

Introduction  

Improvement of rheumatoid arthritis (RA) during pregnancy has been causatively associated with increased galactosylation of immunoglobulin G (IgG) N-glycans. Since previous studies were small, did not include the postpartum flare and did not study sialylation, these issues were addressed in the present study.     

Surveillance of Arboviruses in Primates and Sloths in the Atlantic Forest,Bahia, Brazil

From 2006 through 2014, we conducted seroepidemiological surveys on non-human primates and sloths to investigate the possible circulation of arboviruses in Bahia Atlantic Forest, Brazil. We collected a total of 196 samples from 103 Leontopithecus chrysomelas, 7 Sapajus xanthosternos, 22 Bradypus torquatus and 7 Bradypus variegatus. Serum samples were tested using neutralization test and hemagglutination inhibition test to detect total antibodies against 26 different arboviruses. The overall prevalence of arboviruses was 36.6% (51/139), with the genus Flavivirus having the highest prevalence (33.1%; 46/139), followed by Phlebovirus (5.0%; 7/139), Orthobunyavirus (4.3%; 6/139) and Alphavirus (0.7%; 1/139). Monotypic reactions suggest that the wild animals were exposed naturally to at least twelve arboviruses. Added results from the neutralization test, animals were exposed to thirteen arboviruses. Most of these viruses are maintained in transmission cycles independent of human hosts, although antibodies against dengue virus serotypes 1, 2 and 3 were found in this study. To our knowledge, this is the first study reporting exposure to arboviruses in L. chrysomelas, S. xanthosternos and B. torquatus. Our results also highlight that the Southern Bahia Atlantic Forest has a variety of vertebrate hosts and potential vectors, which may support the emergence or re-emergence of arboviruses, including those pathogenic to humans.     

Health evaluation of Galapagos Hawks (Buteo galapagoensis) on Santiago Island, Galapagos

Galapagos Hawks (Buteo galapagoensis), the only endemic, diurnal raptor species in Galapagos, are currently distributed on eight Galapagos Islands having been extirpated from three of the human-inhabited islands. In January 2009, we performed health assessments of 89 Galapagos Hawks on Santiago Island, Galapagos. Four of the 89 Galapagos Hawks (4%) evaluated had physical abnormalities. Blood parameters did not differ between males and females, except for aspartate transaminase values, which were significantly higher in females than males. No Galapagos Hawks tested positive for antibodies to avian encephalitis virus, Marek virus, and paramyxovirus-1 or to haemosporidian antigen. Chlamydophila psittaci antigen was detected in 2 of 86 Galapagos Hawks (2%), with 24 of 43 Galapagos Hawks (56%) antibody-positive for avian adenovirus-1 and 1 of 48 Galapagos Hawks (2%) antibody positive for Toxoplasma gondii. There were no significant differences in infectious disease results based on sex. This study contributes to the understanding of the health status of the Galapagos Hawk and to the establishment of baseline information for the species.     

Focal palatine erosion in captive and free-living cheetahs (Acinonyx jubatus) and other felid species

We examined 1,092 skulls of captive and free-living individuals, representing 33 felid species, to determine the prevalence of focal palatine erosion (FPE). FPE was detected in 3.2% of cats evaluated, including cheetah (Acinonyx jubatus) and 14 other felid species. The prevalence of FPE between cheetah (9.4%; n = 64) and non-cheetah species (2.8%; n = 1,028) (χ(2) test; P = 0.004) and between captive (5.7%; n = 246) and free-living (2.4%; n = 824) individuals (χ(2) test; P = 0.010) were significantly different, with prevalence between captive (19%; n = 21) and free-living (2.9%; n = 34) cheetahs approaching significance (Fisher's exact test; P = 0.064). FPE was diagnosed with equal prevalence in skulls from individuals in which the lower molars did not meet the palatine bone (60.6%) and individuals in which it did (39.4%; n = 33) (χ(2) test; P = 0.139). In cheetahs with FPE, one was a captive animal in Germany, one a free-living cheetah from Mali, one captive cheetah from Kenya, and three captive cheetahs of unknown origin. Additionally, we evaluated the medical records of 49 captive cheetahs in Namibia. Of these cheetahs, 48 (98.0%) had clinical signs consistent with FPE, although only 16 of these 48 (39.6%) had perforation of the palatine bone. Based on physical examinations, FPE was diagnosed in two caracals (Caracal caracal) and one fishing cat (Prionailurus viverrinus) from a North American Zoo. Results from this study confirm FPE in cheetahs outside of Namibia, in a minimum of 15 felid species, and a higher FPE prevalence in captive individuals than free-living ones. Clinical implications of these findings and recommendations for future studies are provided.     

Intrinsic electric fields and proton diffusion in immobilized protein membranes. Effects of electrolytes and buffers.

We present a theory for proton diffusion through an immobilized protein membrane perfused with an electrolyte and a buffer. Using a Nernst-Planck equation for each species and assuming local charge neutrality, we obtain two coupled nonlinear diffusion equations with new diffusion coefficients dependent on the concentration of all species, the diffusion constants or mobilities of the buffers and salts, the pH-derivative of the titration curves of the mobile buffer and the immobilized protein, and the derivative with respect to ionic strength of the protein titration curve. Transient time scales are locally pH-dependent because of protonation-deprotonation reactions with the fixed protein and are ionic strength-dependent because salts provide charge carriers to shield internal electric fields. Intrinsic electric fields arise proportional to the gradient of an "effective" charge concentration. The field may reverse locally if buffer concentrations are large (greater to or equal to 0.1 M) and if the diffusivity of the electrolyte species is sufficiently small. The "ideal" electrolyte case (where each species has the same diffusivity) reduces to a simple form. We apply these theoretical considerations to membranes composed of papain and bovine serum albumin (BSA) and show that intrinsic electric fields greatly enhance the mobility of protons when the ionic strength of the salts is smaller than 0.1 M. These results are consistent with experiments where pH changes are observed to depend strongly on buffer, salt, and proton concentrations in baths adjacent to the membranes.     

Modulation of Base-Specific Mutation and Recombination Rates EnablesFunctional Adaptation Within the Context of the Genetic Code

The persistence of life requires populations to adapt at a rate commensurate with the dynamics of their environment. Successful populations that inhabit highly variable environments have evolved mechanisms to increase the likelihood of successful adaptation. We introduce a 64 × 64 matrix to quantify base-specific mutation potential, analyzing four different replicative systems, error-prone PCR, mouse antibodies, a nematode, and Drosophila. Mutational tendencies are correlated with the structural evolution of proteins. In systems under strong selective pressure, mutational biases are shown to favor the adaptive search of space, either by base mutation or by recombination. Such adaptability is discussed within the context of the genetic code at the levels of replication and codon usage.Supplementary material to this paper is available in electronic form.Reviewing Editor: Dr. Edward Trifonov     

Endoparasites of western lowland gorillas (Gorilla gorilla gorilla) at Bai Hokou, Central African Republic

A coprologic study of free-ranging western lowland gorillas (Gorilla gorilla gorilla) at Bai Hokou, Dzangha-Ndoki National Park, Central African Republic (2 degrees 51'34'N, 16 degrees 28'03'E) was conducted from October 1999 to November 2000. All 75 fecal samples examined were positive for endoparasites, and each contained at least two species. Parasites present included two genera of amoebae, entodiniomorph ciliates, including Prototapirella gorillae, Troglodytella spp., and Gorillophilus thoracatus, a Balantidium-like organism, strongyle/trichostrongyle eggs (including a presumptive Mammomonogamus sp. and several other genera), Strongyloides sp., Probstmayria sp., a spirurid, a trichuroid, and several unidentified trematodes. Flagellates and cestodes were not found. Despite the presence of a variety of parasite genera, in general, levels of parasitism were low. These data provide baseline parasitologic data for this population as part of a comprehensive health-monitoring program. With the advent of ecotourism in this study area, continued monitoring is indicated for insuring the health of both gorillas and humans in the Bai Hokou study area.