Prognostic value of early features in rheumatoid disease.

Extensive data on 102 patients who presented with rheumatoid disease within a year of onset were gathered by a prospective study to assess the prognostic value of early features. Outcome was evaluated at a mean 4-5 years from onset on the basis of functional grade, extent of joint disease, early morning stiffness, and grip strength. Twenty-six patients improved, 14 pursued a mild steady course, and 62 had a persistently severe or deteriorating condition. The features recorded at the first visit were correlated with outcome. Those indicating a poor prognosis were: older age at onset, being underweight, poor grip strength, many affected joints, involvement of wrist or metatarsophalangeal joints, poor functional status, fulfilment of many of the American Rheumatism Association criteria for rheumatoid disease, raised erythrocyte sedimentation rate, seropositivity on sheep cell agglutination or latex tests, low haemoglobin level, raised blood urea level, and early erosions on x-ray films.     

Biliary adenocarcinoma in a stranded northern elephant seal (Mirounga angustirostris)

A stranded adult female northern elephant seal (Mirounga angustirostris) was admitted to a rehabilitation hospital grossly underweight and lethargic in April 2001. The animal was icteric, had severe bilirubinemia, and elevated serum gamma glutamyl transferase concentrations. Laparoscopy under anesthesia revealed multiple masses up to 3 cm diameter throughout the liver and spleen and the animal was euthanized. Abnormal gross postmortem findings included green serous fluid in the abdominal cavity and 0.5 to 3 cm diameter yellow nodules scattered throughout the liver, spleen, and lymph nodes. Histopathology revealed a biliary adenocarcinoma with metastases to the liver, spleen, lymph nodes, adrenal gland, and pancreas. This is believed to be the first reported case of neoplasia in a northern elephant seal.     

Polyarthritis in adults with hypogammaglobulinaemia and its rapid response to immunoglobulin treatment.

Five patients with primary hypogammaglobulinaemia developed a severe polyarthritis that had some features in common with rheumatoid arthritis. Their joint disease could be distinguished from rheumatoid arthritis, however, by the dramatic improvement after gammaglobulin treatment. The arthritis of hypogammaglobulinaemia can, therefore, be included among the few potentially curable polyarthritides.     

Effects of dietary fish oil and corn oil on rat mammary tissue

The effects, on the maternal mammary gland, of diets containing similar lipid percentages but differing in composition of polyunsaturated fatty acids (PUFA) have been assessed in rats during pregnancy and lactation. For this purpose, tuna fish oil (an n-3-PUFA-enriched oil) and corn oil (an n-6-PUFA-enriched oil) were included in diets at ratios such that the caloric inputs were the same as that of the control diet. As expected, the maternal diet affected the tissue composition of dams. Unexpectedly, only the tuna fish oil diet had an effect on pup growth, being associated with the pups being underweight between the ages of 11 and 21 days. The maternal mammary gland of rats fed the tuna fish oil diet displayed two main modifications: the size of cytoplasmic lipid droplets was increased when compared with those in control rats and the mammary epithelium showed an unusual formation of multilayers of cells. These results show that the tuna fish oil diet, during pregnancy and lactation, exerts specific effects on mammary cells and on the formation of lipid droplets. They suggest that this maternal diet affects the functioning of the mammary tissue.     

Fine needle aspiration cytology of parotid sarcoidosis

Granulomatous lesions of the salivary gland are rare; as such, there have been few reports of the cytologic features of granulomatous sialadenitis in general, and salivary gland sarcoidosis in particular. A case of systemic sarcoidosis involving both parotid glands, diagnosed initially by fine needle aspiration (FNA) cytology, is presented. The specific cytologic features included histiocytes of both epithelioid and giant multinucleated types, without background necrosis. The FNA cytologic differential diagnosis of bilateral parotitis is discussed.     

Sj?gren's Syndrome

Sjögren''s syndrome is a common accompaniment of rheumatoid arthritis and other connective-tissue diseases as well as several diseases thought to have an immunological basis. Despite the wide spectrum of clinical features and serological abnormalities the condition is, if anything, underdiagnosed. A clinical subgroup of patients with Sjögren''s syndrome can be distinguished by their pronounced hypergammaglobulinaemia, widespread and prominent immunological abnormalities, severe salivary gland swelling, and mild or absent arthritis. It is in this group that lymphoma development has been a complication.     

Diagnosis of periarticular osteoporosis in rheumatoid arthritis using digital X-ray radiogrammetry

Osteoporosis can manifest in two ways in rheumatoid arthritis: generalized bone loss, which may result from immobility, the inflammatory process per se and/or treatments such as steroids; and periarticular demineralization, which is probably due to local release of inflammatory agents. Digital X-ray radiogrammetry (DXR) is an effective and sensitive modality for monitoring periarticular osteoporosis, which is among the earliest features of rheumatoid arthritis, preceding bone erosions. DXR is a promising technique, which can provide quantitative data that allow early diagnosis. During the course of rheumatoid arthritis it can be deployed in combination with established X-ray scoring methods to inform decisions regarding the optimal therapy to prevent joint destruction.     

Evidence of a Double Burden of Malnutrition in Urban Poor Settings in Nairobi,Kenya

Background

Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the neighborhood and household level, in an urban poor setting in Nairobi, Kenya.

Methods

Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults.

Results

Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese.

Conclusion

The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.     

Markers of B-lymphocyte activation are elevated in patients with early rheumatoid arthritis and correlated with disease activity in the ESPOIR cohort

Introduction  

Little is known about systemic B-cell activation in early rheumatoid arthritis (RA). We therefore evaluated the serum levels of markers of B-cell activation in patients included in the ESPOIR early arthritis cohort.     

Small cell undifferentiated carcinoma of the parotid gland. Cytologic, histologic, immunohistochemical and ultrastructural features of a neuroendocrine variant

A case of primary small cell undifferentiated carcinoma (SCUC) of the parotid gland, diagnosed initially by fine needle aspiration (FNA) cytology and confirmed by histology, immunohistochemistry and transmission electron microscopy (TEM), is presented. The FNA cytologic features that enabled an accurate diagnosis of this rare salivary gland tumor included nuclear granularity and markedly angular nuclear molding of numerous small cells that were usually present as large syncytia in an inflammatory background. Numerous mitotic figures were also present in this vascular lesion. These features were also evident in the surgical specimens. Immunohistochemistry demonstrated neuron-specific enolase positivity while TEM demonstrated intracytoplasmic neurosecretory granules in this case, indicating a neuroendocrine derivation for this neoplasm instead of the more usual origin of salivary gland SCUCs in ductal epithelial or myoepithelial tissue.     

Presence of antibodies against cyclic citrullinated peptides in patients with 'rhupus': a cross-sectional study

'Rhupus' is a rare condition sharing features of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). If rhupus is a distinctive entity, an overlap between RA and SLE or a subset of SLE is currently debated. This study was performed to explore the prevalence of antibodies against cyclic citrullinated peptides (anti-CCP antibodies) in rhupus. Patients meeting American College of Rheumatology criteria for RA, SLE, or both were included. Clinical and radiographic features were recorded and sera were searched for anti-CCP antibodies, rheumatoid factor, antinuclear antibodies, anti-extractable nuclear antigens, and antibodies against double-stranded DNA (anti-dsDNA antibodies). Seven patients for each group were included. Clinical and serological features for RA or SLE were similar between rhupus and RA patients, and between rhupus and SLE patients, respectively. Values for anti-CCP antibodies obtained were significantly (p < 0.05) higher in RA (6/7) and rhupus (4/7) than in SLE patients (0/7) and healthy subjects (0/7). Our data support the possibility that rhupus is an overlap between RA and SLE, because highly specific autoantibodies for RA (anti-CCP) and for SLE (anti-dsDNA and anti-Sm) are detected in coexistence.     

Characterization of histopathology and gene-expression profiles of synovitis in early rheumatoid arthritis using targeted biopsy specimens

The disease category of early rheumatoid arthritis (RA) has been limited with respect to clinical criteria. Pathological manifestations of synovitis in patients whose disease is clinically classified as early RA seem to be heterogeneous, with regular variations. To clarify the relation between the molecular and histopathological features of the synovitis, we analyzed gene-expression profiles in the synovial lining tissues to correlate them with histopathological features. Synovial tissues were obtained from knee joints of 12 patients with early RA by targeted biopsy under arthroscopy. Surgical specimens of long-standing RA (from four patients) were examined as positive controls. Each histopathological parameter characteristic of rheumatoid synovitis in synovial tissues was scored under light microscopy. Total RNAs from synovial lining tissues were obtained from the specimens selected by laser capture microdissection and the mRNAs were amplified by bacteriophage T7 RNA polymerase. Their cDNAs were analyzed in a cDNA microarray with 23,040 cDNAs, and the levels of gene expression in multilayered lining tissues, compared with those of normal-like lining tissues in specimens from the same person, were determined to estimate gene-expression profiles characteristic of the synovial proliferative lesions in each case. Based on cluster analysis of all cases, gene-expression profiles in the lesions in early RA fell into two groups. The groups had different expression levels of genes critical for proliferative inflammation, including those encoding cytokines, adhesion molecules, and extracellular matrices. One group resembled synovitis in long-standing RA and had high scores for some histopathological features – involving accumulations of lymphocytes and plasma cells – but not for other features. Possible differences in the histopathogenesis and prognosis of synovitis between the two groups are discussed in relation to the candidate genes and histopathology.     

Are children with clefts underweight for age at the time of primary surgery?

Children with clefts, especially those with a cleft palate, have an impaired sucking mechanism and are therefore prone to nutritional problems. This study was undertaken to determine whether children with clefts of the lip and/or palate are underweight for age at the time of primary surgery. Underweight for age was defined as being less than 80 percent of expected weight for age or below the 3rd percentile as plotted on standard percentile charts. The records of all children with clefts seen at the Red Cross Children's Hospital between 1976 and 1996 were reviewed. Of these 740 records, 100 were excluded for inadequate data (47), severe systemic syndrome (27), no operation done (22), or craniofacial cleft (4). The records of 640 children were thus included; 195 (30.5 percent) were underweight for age. By comparison, only 13.7 percent of a similar group of noncleft controls (n = 872) were underweight for age. The difference between these two groups was highly significant (p < 0.01). Factors that influenced weight at the time of primary surgery were type of cleft and age at the time of surgery. Children with cleft palate, whether associated with a cleft lip or not, were found to be more underweight for age than those with an isolated unilateral cleft lip (p = 0.008). Children who had surgery after the age of 1 year were 1.5 times more likely to be underweight for age than children who had surgery under 1 year of age (p < 0.01). Children with isolated cleft palates who were underweight for age had a tendency toward a higher fistula rate (36 percent) than those of normal weight (24 percent) (p = 0.18).     

Ultrastructure of the cells of the ovarian interstitial gland in hypophysectomized rats

Summary The fine structure of the interstitial gland of the ovary was studied in hypophysectomized rats and in hypophysectomized rats after denervation of the ovary or stimulation of the ovarian plexus. Hypophysectomized rats were used to eliminate gonadotropic influences on interstitial cells. In hypophysectomized rats, there was a large amount of intercellular space and cells had irregularly shaped nuclei and a large nuclear-cytoplasmic ratio. Prominent cytoplasmic features included small mitochondria with an electron-dense matrix, rough and smooth endoplasmic reticulum, polysomes and large osmiophilic lipid droplets. Interstitial cells from stimulated ovaries had reduced intercellular space and a reduced nuclear-cytoplasmic ratio. Mitochondria had tubular cristae; smooth endoplasmic reticulum-surrounded lipid droplets, and large polysomes were present. After section of the ovarian plexus, intercellular space was increased and filopodia were numerous. Cytoplasmic features included mitochondria with a dense matrix and indistinct cristae, large electronlucent lipid droplets, and variously sized multivesicular structures. These observations suggest that stimulation of the ovarian plexus in hypophysectomized rats causes regressed cells to assume the fine structural features of active steroidogenic cells. In contrast, interruption of the ovarian nerve supply causes a qualitative and quantitative increase in ultrastructural features characteristic of regressed steroidogenic cells. These responses of interstitial gland cells to denervation and stimulation provide morphological evidence for a functional role for the adrenergic nerves to this ovarian compartment.     

Dosiomics-based prediction of radiation-induced hypothyroidism in nasopharyngeal carcinoma patients

PurposeTo predict the incidence of radiation-induced hypothyroidism (RHT) in nasopharyngeal carcinoma (NPC) patients, dosiomics features based prediction models were established.Materials and methodsA total of 145 NPC patients treated with radiotherapy from January 2012 to January 2015 were included. Dosiomics features of the dose distribution within thyroid gland were extracted. The minimal-redundancy-maximal-relevance (mRMR) criterion was used to rank the extracted features and selected the most relevant features. Machine learning (ML) algorithms including logistic regression (LR), support vector machine (SVM), random forest (RF), and k-nearest neighbor (KNN) were utilized to establish prediction models, respectively. Nested sampling and hyper-tuning methods were adopted to train and validate the prediction models. The dosiomics-based (DO) prediction models were evaluated through comparing with the dose-volume factor-based (DV) models in terms of the area under the receiver operating characteristic (ROC) curve (AUC). The demographics factors (age and gender) were included in both DO model and DV model.ResultsAge, V45 and 37 dosiomics features exhibited significant correlations with RHT in univariate analysis. For prediction performance, DO prediction models exhibited better results with the best AUC value 0.7 while DV prediction models 0.61. In DO prediction models, the AUC values displayed a trend from ascending to descending with the increasing of selected features. The highest AUC value was achieved when the number of selected features was 3. In DV prediction model, similar trend was not observed.ConclusionThis study established a prediction model based on the dosiomics features with better performance than conventional dose-volume factors, leading to early predict the possible RHT among NPC patients who had received radiotherapy and take precaution measures for NPC patients.     

Serous cutaneous glands in the paludiculine frog Physalaemus biligonigerus (Anura, Leptodactylidae): patterns of cytodifferentiation and secretory activity in premetamorphic specimens

The development of serous cutaneous glands is described in tadpoles of the leptodactylid frog Physalaemus biligonigerus , with attention to the cytodifferentiation processes of the secretory unit (adenomere). Secretory differentiation causes the adenomere to assume the structure of a syncytium and triggers biosynthesis of the serous product (poison), consisting of granules with peculiar repeating substructure. The secretory granules resemble glomerular-like aggregates of randomly orientated tubular subunits. This complex substructure derives from the rearrangement of the dense, compact material released by the Golgi apparatus in the form of small, membrane-bounded particles. Both early and advanced features of P. biligonigerus poison closely resemble those found during serous gland development in the Italian treefrog Hyla intermedia . The similar aspects described during serous biosynthesis in these leptodactylid and hylid frogs suggest they are phylogenetically informative. On the other hand, the peculiar features of their poisons may reflect the differential patternings of their secretory repertories along the divergent phylogenetic paths, which led these frogs to be currently included in different families.     

瘤背石磺产卵前后生殖系统的组织学变化

瘤背石磺(Onchidium struma)是雌雄同体、异体交配的腹足纲贝类,其生殖系统较为复杂,通过解剖学和组织切片技术对成体瘤背石磺的生殖系统及产卵前后的组织学变化进行了系统的研究.结果表明:(1)雄性生殖系统主要南阴茎囊、阴茎、雄性附性腺、两性腺(早期主要产生精于)和储精囊等部分组成,而雌性生殖系统则由两性腺(后期主要产生卵子)、生殖细胞输送管、蛋白腺、黏液腺、受精囊和阴道等组成;(2)雄性生殖系统的组织学结构在产卵前后变化较小,但两性腺、卵蛋白腺和黏液腺的组织学在产卵前后变化显著;(3)产卵后的两性腺由于成熟卵子的排放,整体结构松散,部分腺泡中有少量未排出的成熟卵细胞和卵黄合成早期的卵母细胞;(4)产卵前的卵蛋白腺中含有许多强嗜碱性的小颗粒(组织学结构类似于卵鞘中的胚胎外周蛋白),产卵后腺体中的颗粒相对较大,且呈嗜酸性;(5)产卵前的黏液腺中存在嗜碱性区、嗜酸性区和混杂区三种区域,但是产卵前黏液腺以嗜酸性细胞为主,而产卵后的黏液腺中以嗜碱性细胞区域为主,且分泌管道中有一些嗜碱性物质.由此可见,卵蛋白腺的主要功能是分泌卵蛋白包裹受精卵形成卵外周蛋白层,而黏液腺则在产卵过程中分泌黏液物质形成卵鞘结构及链状的卵带.     

Homeobox Genes in the Rodent Pineal Gland: Roles in Development and Phenotype Maintenance

The pineal gland is a neuroendocrine gland responsible for nocturnal synthesis of melatonin. During early development of the rodent pineal gland from the roof of the diencephalon, homeobox genes of the orthodenticle homeobox (Otx)- and paired box (Pax)-families are expressed and are essential for normal pineal development consistent with the well-established role that homeobox genes play in developmental processes. However, the pineal gland appears to be unusual because strong homeobox gene expression persists in the pineal gland of the adult brain. Accordingly, in addition to developmental functions, homeobox genes appear to be key regulators in postnatal phenotype maintenance in this tissue. In this paper, we review ontogenetic and phylogenetic aspects of pineal development and recent progress in understanding the involvement of homebox genes in rodent pineal development and adult function. A working model is proposed for understanding the sequential action of homeobox genes in controlling development and mature circadian function of the mammalian pinealocyte based on knowledge from detailed developmental and daily gene expression analyses in rats, the pineal phenotypes of homebox gene-deficient mice and studies on development of the retinal photoreceptor; the pinealocyte and retinal photoreceptor share features not seen in other tissues and are likely to have evolved from the same ancestral photodetector cell.