Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: a comparison study with tophaceous gout.

BACKGROUND: Dual-energy computed tomography (DECT) is a new diagnostic tool for gout, but its sensitivity has not been established. Our goal was to assess the sensitivity of DECT for the detection of monosodium urate (MSU) deposits in non-tophaceous and tophaceous gout, both at the level of the patient and that of the individual joint or lesion. METHODS: DECT was performed on 11 patients with crystal-proven non-tophaceous gout and 10 with tophaceous gout and included both the upper and lower extremities in 20/21 patients. DECT images were simultaneously acquired at 80 and 140 kV and then processed on a workstation with proprietary software using a two-material decomposition algorithm. MSU deposits were color coded as green by the software and fused onto grey-scale CT images. The number and location of these deposits was tallied independently by two DECT-trained radiologists blinded to the clinical characteristics of the patient. Sensitivity of DECT was defined as the proportion of patients with a confirmed diagnosis of gout which was correctly identified as such by the imaging technique. All patients provided informed consent to participate in this IRB-approved study. RESULTS: MSU deposits were detected by DECT in ≥1 joint area in 7/11 (64 %) patients with non-tophaceous gout, but were only detected in 3/12 (25 %) joints proven by aspiration to be affected with gout. Inclusion of the upper extremity joints in the scanning protocol did not improve sensitivity. All 10 patients with tophaceous gout had MSU deposits evident by DECT. The sensitivity of DECT for individual gouty erosions was assessed in 3 patients with extensive foot involvement. MSU deposits were detected by DECT within or immediately adjacent to 13/26 (50 %) erosions. CONCLUSIONS: A DECT protocol that includes all lower extremity joints has moderate sensitivity in non-tophaceous and high sensitivity in tophaceous gout. However, DECT has lower sensitivity when restricted to individual crystal-proven gouty joints in non-tophaceous disease or individual erosive lesions in tophaceous gout. The detection of MSU deposits by DECT relates to their size and density and the detection parameters of the DECT scanner and adjustment of the latter might improve sensitivity.

The association of dermatitis herpetiformis and systemic lupus erythematosus.

Dermatitis herpetiformis (DH) is an immune-mediated cutaneous disease occasionally associated with celiac disease, but rarely associated with systemic lupus erythematosus (SLE). The combination of DH and SLE is immunologically mediated and suggests a relationship between the two conditions. We describe a woman with DH and SLE with a novel HLA phenotype.

Structure of the model peptides of Bombyx mori silk-elastin like protein studied with solid state NMR.

The peptides (AG)(6)(VPGVG)(AG)(7) and (AG)(5)(VPGVG)(2)(AG)(5) are models for a new type of protein with both composition and properties such as Bombyx mori silk and elastin. In this paper, we report the solid-state NMR results for these samples and related peptides; the structures after dialysis of the 9 M LiBr aqueous solution and after treatment with formic acid were determined and compared. The detailed structural analyses were performed using deconvolution subroutines assuming Gaussian line shapes for the Ala Cbeta peaks of the (AG)(n) sequences in these peptides. The peptide (AG)(6)(VPGVG)(AG)(7) took the silk II structure after the dialysis, which is in contrast to the silk I form of (AG)(15) after the same treatment. However, a drastic structural change of the (AG)(n) sequences was observed for (AG)(5)(VPGVG)(2)(AG)(5); the fraction of distorted beta-turn was 81% after the dialysis, but the distorted beta-sheet became dominant (84%) after treatment with formic acid. The local structures of the Gly residue of the VG units in the elastin-like subunits, (VPGVG) and (VPGVG)(2), were the distorted structures with a distribution of the torsion angles, which was derived from the 2D spin diffusion NMR spectral pattern of (AG)(5)VPG[1-(13)C]V[1-(13)C]GVPGVG(AG)(5). Observation of this distribution of the Gly residue was independent of the treatment, dialysis or formic acid.

13C CPMAS NMR studies of the elastin-like polypeptide (LGGVG)n.

The elucidation of structure-function relationships in insoluble elastin is often approached using elastin-like polypeptides. In this manner, the characterization of the different regions in this extensive biopolymer may be facilitated in a "piece-wise" manner. Our solid-state NMR experiments indicate that (LGGVG)n has structural similarities to elastin and some elastin peptides, providing support for the utility of the mimetic peptides. Furthermore, previous NMR and CD studies indicated that the structure of the elastin-like polypeptide (LGGVG)n in solution is best described as a "conformational ensemble" with a mixture of type I and II beta-turns, in addition to unfolded regions. Our data indicate that the peptide does not adopt a single conformation in the solid state, lending further support to models for elastin that involve significant conformational heterogeneity.