Pico- and femtosecond laser-induced crosslinking of protein microstructures: evaluation of processability and bioactivity.

This study reports the pico- and femtosecond laser-induced photocrosslinking of protein microstructures. The capabilities of a picosecond Nd:YAG laser to promote multiphoton excited crosslinking of proteins were evaluated by fabricating 2D and 3D microstructures of avidin, bovine serum albumin (BSA) and biotinylated bovine serum albumin (bBSA). The multiphoton absorption-induced photocrosslinking of proteins was demonstrated here for the first time with a non-toxic biomolecule flavin mononucleotide (FMN) as the photosensitizer. Sub-micrometer and micrometer scale structures were fabricated from several different compositions of protein and photosensitizer by varying the average laser power and scanning speed in order to determine the optimal process parameters for efficient photocrosslinking. In addition, the retention of ligand-binding ability of the crosslinked protein structures was shown by fluorescence imaging of immobilized biotin or streptavidin conjugated fluorescence labels. The surface topography and the resolution of the protein patterns fabricated with the Nd:YAG laser were compared to the results obtained with a femtosecond Ti:Sapphire laser. Quite similar grain characteristics and comparable feature sizes were achieved with both laser sources, which demonstrates the utility of the low-cost Nd:YAG microlaser for direct laser writing of protein microstructures.

Promoting shorter duration of ventilator treatment decreases the number of painful procedures in preterm infants.

AIM: To investigate whether promoting shorter ventilator treatment decreases the number of painful procedures and the use of analgesics in preterm infants. METHODS: Retrospective patient chart review of all preterm infants in one Neonatal Intensive Care Unit (NICU) was carried out in 2000 (n = 240) and 2005 (n = 206). Between these cohorts, early nasal continuous positive airway pressure (nCPAP) application and early extubation policy were introduced. RESULTS: Fewer infants were intubated (22 vs. 32%, p = 0.03), the duration of ventilator treatment decreased (6.7 SD 11.3 vs. 9.0 SD 11.1 days, p < 0.001) and nCPAP treatment became more common (41 vs. 25%, p < 0.001) in 2005 than in 2000. Similarly, the infants' exposure to painful procedures did not decrease significantly (61.9 SD 98.5 vs. 67.1 SD 104.3 procedures, p = 0.32) but the procedures related to respiratory support were fewer (45.2 SD 79.5 vs. 68.9 SD 91.1 procedures, p < 0.001) in 2005 than in 2000. In addition, the amount of pain medication used was significantly lower in 2005 than in 2000. One day on a ventilator included more painful procedures than a day on nCPAP (11.2 95% CI: 11.0-11.5 vs. 4.2 95% CI: 4.1-4.4 procedures, p < 0.001) during both study years. CONCLUSION: Early nCPAP and early extubation policies were successfully implemented in an NICU resulting in less invasive respiratory support. This was associated with fewer painful procedures and less pain medication in the preterm infants who required respiratory support. Despite this positive effect, the number of painful procedures in all preterm infants stayed at the same level. Our results provide further support for the use of nCPAP in preterm infants.

Strong Stromal Hyaluronan Expression Is Associated with PSA Recurrence in Local Prostate Cancer.

OBJECTIVE: HA (hyaluronan) is involved in cell migration, differentiation and cell proliferation, which all are essential to tumour growth. In addition, the cell surface receptor of HA, CD44, is important in cancer cell adhesion, cell migration and tumour neovascularisation. We studied the expression of HA and CD44 and their relationship with other prognostic factors and prostate-specific antigen (PSA) recurrence in local prostate cancer (PC). MATERIALS AND METHODS: 77 PC patients treated with radical prostatectomy were followed-up for a mean of 4 years. HA was detected by using a HA specific probe and CD44 expression was analysed by conventional immunohistochemistry. RESULTS: All specimens expressed HA in tumour stroma and 78% (60/77) of the tumours showed strong stromal expression of HA. The fraction of positively stained specimens for CD44 was 66% (51/77). The strong stromal HA expression was related to perineural infiltration (p = 0.001) and capsule invasion (p = 0.05). No correlation was demonstrated between the stromal HA expression and CD44 expression, preoperative PSA, clinical or pathological T classification, pN status, Gleason grade, seminal vesicle invasion or surgical margin invasion. Reduced CD44 expression was related only to preoperative PSA level (p = 0.008). The PSA recurrence was predicted by strong stromal HA expression, pT classification, seminal vesicle invasion, capsule invasion and surgical margin invasion (p

A randomised comparison of bicalutamide ('Casodex') 150 mg versus placebo as immediate therapy either alone or as adjuvant to standard care for early non-metastatic prostate cancer. First report from the Scandinavian Prostatic Cancer Group Study No. 6.

OBJECTIVES: To assess the efficacy and tolerability of bicalutamide 150 mg ('Casodex'(1)) as immediate therapy, either alone or as adjuvant to treatment of curative intent, in patients with early (T1b-T4, any N, M0) prostate cancer. METHODS: This randomised, double-blind study was conducted in the Nordic countries as part of the 'Casodex' Early Prostate Cancer programme. Patients received bicalutamide 150 mg (n=607) or placebo (n=611) in addition to standard care. RESULTS: More than 80% of patients had not received therapy of primary curative intent. Median follow-up in both groups was 3 years. Median exposure to study treatment in the bicalutamide and standard care alone groups was 2.5 and 2.3 years, respectively. Bicalutamide reduced the risk of objective disease progression by 57% compared with standard care alone (HR 0.43; 95% CI 0.34, 0.55; p<<0.0001). Survival data were immature (11.4% deaths) with no difference between the two treatment groups. CONCLUSIONS: Bicalutamide 150 mg as immediate therapy, either alone or as adjuvant to treatment of curative intent, significantly reduces the risk of disease progression in patients with early prostate cancer. The trial is ongoing to assess whether the reduction in risk of objective progression translates into an overall survival benefit.

Functional long-term changes in patients with spondylarthropathy.

The objective of the study was to determine the long-term functional outcome of chronic spondylarthropathy (SpA) when measured by various functional indices. This information is important in the planning of long-term intervention studies and selection of the best follow-up methods. The study group consisted of 65 patients (21 women and 44 men) with SpA. Their mean age was 49 years and the mean age from diagnosis was 12 years. They completed several questionnaires (developed for the evaluation of functional capacity or the state of health of patients with SpA) at the beginning of the study and 3 years later. The questionnaires were: the Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), the Health Assessment Questionnaire for Spondylarthropathies (HAQ-S), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Patient Global Assessment (BAS-G) and Stiffness-VAS (on a visual analogue scale). We also asked the patients to inform us if something had occurred in their lives during the follow-up that might have affected their health. Most of the indices (BASFI, DFI, BASDAI, BAS-G and Stiffness-VAS, but not HAQ-S) showed a statistically significant reduction in the functional capacity or state of health of the patients during the follow-up. Many factors occurring during the 3-year period may have influenced the results of the indices. The natural course of the functional capacity of patients with SpA appears to be one of impairment, when evaluated using these indices. Our experience also showed that it is very difficult to separate any effect of a single treatment intervention (e.g. rehabilitation) in a long-term follow-up study, as so many interfering factors, e.g. life events and health-related factors, may affect the follow-up population over several years.

Feasibility of fitness tests in subjects with chronic pain (fibromyalgia): discordance between cycling and 2-km walking tests.

Altogether, 69 out of 98 fibromyalgia (FMS) patients who attended a 2-week multidisciplinary inpatient course and a 1-week control period 3 months later completed 2-km walking tests and stepwise-increased cycling tests at entry and after 3 months. The purpose was to compare the feasibility of the two fitness tests for assessment of FMS patients. The results showed a substantially lower fitness level in the results of the 2-km walking test than in the cycling test in the same patients: mean maximum VO2 was 28.5 ml/kg per min vs 34.6 ml/kg per min, respectively. At entry and after the 3-month training period, the correlations between the two tests were very poor, i.e., with Spearman's r coefficients of 0.37 and 0.34, respectively (P < 0.01), intraclass correlation coefficients (ICC) 0.20 (95% CI -0.29 to 0.50) and 0.47 (95% CI 0.15 to 0.67), reliability coefficients (alpha) 0.54 and 0.47, and Kendal-T coefficients 0.32 and 0.41 for ordinal correlation of the test results. The results did not correlate with pain, which remained at initial levels for the 3 months of follow-up. Principally, these tests should both measure the same property, i.e., the fitness of fibromyalgia syndrome (FMS) patients, but the results differed substantially. The 2-km walking test showed a markedly lower fitness level than the cycling test in the same patients. The primary explanation for this difference might be difficulties in controlling test performance. especially in walking. The 2-km walking test would not appear recommendable for subjects with chronic pain syndrome, e.g., fibromyalgia.

Functional changes in patients with spondylarthropathy. A controlled trial of the effects of short-term rehabilitation and 3-year follow-up.

A cohort of 25 patients with spondylarthropathy (SpA) participated in a 3-year follow-up study of functional changes before and after an intensive 3-week inpatient course. They answered questions in the following functional status/disability indices: Bath ankylosing spondylitis functional index (BASFI), Dougados functional index (DFI), health assessment questionnaire for spondylarthropathy (HAQ-S), Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis patient global assessment (BAS-G), and horizontal visual analogue scale for stiffness (stiffness VAS) before and after the course and 3 years later by mail. A control group of 18 consecutive SpA patients from the waiting list for an inpatient course filled in the same questionnaires as study patients 3 months before entry and again 3 weeks later at home without rehabilitation. During the waiting time for the inpatient course, control group global assessments (BASDAI, BAS-G, and stiffness-VAS) worsened slightly, and BASFI but not HAQ-S and DFI scores remained unchanged in the 3 weeks without treatment. The results of the 25 study patients showed small and not significant improvements in all functional index scores (BASFI -0.5 points, DFI -1.1, and HAQ-S 0.17), whereas improvements were significant in BAS-DAI, BAS-G, and stiffness-VAS (-13 mm, 13 mm, and -11 mm, respectively) after the 3-week inpatient course. At 3-year follow-up, these small changes had disappeared and the changes were not significant. The global indices and BASFI worsened slightly (0.4) from baseline results, while DFI was slightly better (-0.4) and HAQ-S remained at the post-treatment level after 3 years. Thus, BASFI was the most sensitive to changes, whereas DFI and HAQ-S were relatively insensitive. All six indices correlated highly significantly with each other (ICC 0.53-0.94). The natural course of spondylarthropathy leads to progression of functional impairments, which seems to be preventable with intensive rehabilitation, at least in the short term. Among the three functional indices, BASFI seems to be the most sensitive tool.

Analysis of false-positive BTA STAT test results in patients followed up for bladder cancer.

OBJECTIVES: To evaluate the role of a positive BTA stat Test result in patients with negative cystoscopic findings. METHODS: Five hundred one consecutive patients in follow-up for bladder cancer were studied. A voided urine sample was obtained before cystoscopy and split for culture, cytology, and BTA stat testing. In the case of a positive BTA stat Test, but negative cystoscopic findings, patients underwent additional investigations. RESULTS: Of 501 patients, 133 (26.5%) had bladder cancer recurrence at cystoscopy, of which the BTA stat Test detected 71 (53.4%); only 21 of the cases (17.9%) were detected by cytologic examination. Of the remaining 368 patients with no visible tumor at cystoscopy, 96 (26.1%) had a positive BTA stat Test result. Fifty-five of those (57.3%) underwent intravenous urography or renal ultrasound and random biopsies, and an additional 9 recurrences (16.4%) were detected. Of those 46 patients who had a true false-positive BTA stat Test, 3 (3 of 43, 7.0%) had recurrence at the next follow-up cystoscopy, 4 (8.7%) had a urine infection, and 8 (17.4%) had ongoing intravesical instillations; the latter two percentages were significantly higher than among those with true-negative BTA stat Test results (0% and 6.8%, respectively). CONCLUSIONS: Patients with a positive BTA stat Test result but negative cystoscopic findings have about a 16% risk of an undetected recurrence. False-positive results may be due to present instillation treatment and urine infection, and the predictive value of a BTA stat Test for subsequent recurrence seems relatively low.

Prognostic value of CD44 standard, variant isoforms 3 and 6 and -catenin expression in local prostate cancer treated by radical prostatectomy.

OBJECTIVE: The clinical and histological data of prostate cancer patients were compared with the expression of CD44 standard (CD44s), variant isoforms CD44v3, CD44v6 and alpha-catenin. The prognostic value of these adhesion molecules was also analysed. PATIENTS AND METHODS: We analysed the clinical and histological data of 87 prostate cancer patients treated by radical prostatectomy in two Finnish hospitals. The mean (SD) age of the patients at diagnosis was 64 years (6) and the mean follow-up was 3 years (8). Immunohistochemistry was used to detect the expression of CD44s and its v3 (CD44v3) and v6 (CD44v6) isoforms and alpha-catenin. RESULTS: The mean (SD) fractions of positively stained cancer cells were 38 (38), 10 (22), 56 (41) and 93% (17) for CD44s, CD44v3, CD44v6 and alpha-catenin, respectively. Low fractions of CD44s- and CD44v6-positive cancer cells were related to high preoperative prostate-specific antigen (PSA) levels (p<0.05 for both). Low fraction of CD44s positive cancer cells was linked with presence of seminal vesicle invasion (p = 0.07), surgical margin positivity (p = 0.09), high Gleason score (p = 0.04) and high mitotic index (p = 0. 02). Low fraction of CD44v3-positive cancer cells was related to positive surgical margins (p = 0.05), high Gleason score (p = 0.04), presence of perineural infiltration (p = 0.02) and absence of tumour-infiltrating lymphocytes (p = 0.02). Low fraction of CD44v6-positive cancer cells was related to high pT classification (p = 0.07), capsule invasion (p = 0.03), positive surgical margins (p = 0.05), high Gleason score (p = 0.008), perineural infiltration (p = 0.0001) and high mitotic index (p = 0.001). alpha-Catenin expression was not related to any of the clinicopathological variables included in this study. Gleason score (p = 0.001), pT classification (p = 0.007), perineural infiltration (p = 0.01) and the fraction of CD44v3-positive cancer cells (p = 0.04) were predictors of PSA failure in univariate analysis. pT category (p = 0. 012), Gleason score (p = 0.02) and expression of CD44v3 (p = 0.0003) were independent predictors of PSA failure. CONCLUSIONS: The expression of CD44s, CD44v3 and CD44v6 is related to tumour differentiation. The expression of CD44v3 independently predicts PSA failure in addition to Gleason score and pT category during a short-term follow-up.

The prognostic value of inducible nitric oxide synthase in local prostate cancer.

OBJECTIVE: To compare the clinical and histological data from patients with prostate cancer with the results of the immunohistochemical analysis of inducible nitric oxide synthase (iNOS), and thus determine the prognostic value of iNOS. PATIENTS AND METHODS: The study included 82 patients (mean age 64.6 years, SD 6.1) with local prostate cancer treated by radical prostatectomy in two Finnish hospitals. Their mean (SD) follow-up was 3.3 (2.2) years. An immunohistochemical method was used to detect the expression of iNOS in these specimens, and the expression graded according to staining intensity as none, weak or strong. RESULTS: There was weak or strong expression of iNOS in 25 (31%) and 56 (68%) of the patients, respectively, and one specimen was negative for iNOS. Strong expression of iNOS was related to high a preoperative prostate specific antigen (PSA) level (P = 0.006) and high pT classification (P < 0.001), but not to nodal status, grade, seminal vesicle or capsular invasion, surgical margin status, perineural infiltration, tumour infiltrating lymphocytes or proliferation rate of cancer cells. A PSA failure was detected in 29 patients but was not predicted by iNOS expression. A Cox multivariate analysis showed that surgical margin positivity, seminal vesicle involvement and number of tumour infiltrating lymphocytes predicted the PSA failure. CONCLUSION: A high expression of iNOS was related to a high pT classification and the preoperative PSA level but not to other established prognostic factors; iNOS expression was not a predictor of PSA failure in patients with local prostate cancer.

Sensitivity to change of mobility tests; effect of short term intensive physiotherapy and exercise on spinal, hip, and shoulder measurements in spondyloarthropathy.

OBJECTIVE: To assess the sensitivity to change of 13 spinal, shoulder, and hip measurements and determine correlation between age, disease duration, and radiologic findings in ankylosing spondylitis (AS) and other spondyloarthropathies (SpA). METHODS: We assessed 112 patients with various types of SpA as changes before and after an intensive inpatient course. RESULTS: The most sensitive spinal measurements were finger to floor distance, chest expansion. thoracolumbar rotation (TLR), and lateral flexion, in that order. Cervical rotation, lateral flexion, and intermalleolar distance might also be useful in short term clinical trials, while the Schober tests, thoracolumbar flexion, and occiput-wall distance were not sufficiently sensitive. Hip internal rotation (HRi), shoulder flexion, and abduction measurements were also sensitive, though possibly more suitable for patients with articular symptoms. TLR and HRi were the only measurements that correlated markedly with disease duration, but not with age. Changes in the measurements correlated significantly with radiological spinal changes. CONCLUSION: Finger to floor distance, TLR, and thoracolumbar lateral flexion were the most sensitive to detect improvements in short term clinical trials, while the Schober test, thoracolumbar flexion, and occiput-wall distance were insensitive.

Clinical assessment of spinal mobility measurements in ankylosing spondylitis: a compact set for follow-up and trials?

Different spinal ranges of motion (ROM) were measured and the results of 17 repeated tests correlated with spinal radiological changes in 52 male patients with ankylosing spondylitis (AS). Both Schober tests and measurements of lumbar and cervical rotations (TRi, TR, CR, CRt) and lateral flexions (LFLf, LFLx, CLFLt, CLFLm), together with thoracolumbar flexion (ThFL), cervical flexion-extension measurements (CFL, CExt), and tragus - wall and occiput - wall distances (OWD,TWD), showed significant correlations with detailed radiological spinal changes. Cervical rotation (CRm, CRt) and flexion (CFLm) correlated only with cervical changes, and thoracolumbar rotation as assessed by instrument (TRi) correlated only weakly with lumbar changes, while chin-chest distance (CCD) and chest expansion (CE) showed no correlation. Inter- and intratester reliability was good in all tests (the intraclass correlation coefficients ranged from 0.84 to 0.98). Three new tape methods for measuring thoracolumbar and cervical rotations and cervical lateral flexion also proved to be valid and reliable, as did the Schober-S1 modification. We conclude that the thoracolumbar segment (Schober), whole (ThFL) and lateral (LFL) flexions and rotation (TR), and chest expansion (CE) (after careful standardisation) together with cervical rotation (CR), extension (CExt) and/or lateral flexion (CLFL) comprise the set of mobility tests for the follow-up and assessment of disease progression in AS. On the other hand, cervical (forward) flexion (CFL), chin-chest distance (CCD) and an instrument method for thoracolumbar rotation (TRi) are not approaches to be recommended.

Evaluation of the Finnish versions of the functional indices BASFI and DFI in spondylarthropathy.

The aim of the study was to compare and evaluate the usefulness of Finnish versions of two functional indices used in spondylarthropathies. Seventy consecutive inpatients with different kinds of spondylarthropathies filled in self-administered questionnaires: the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index for spondylarthropathies (DFI). Cronbach's alpha as a coefficient of internal consistency was analysed for BASFI and DFI. Test-retest reliability was evaluated in 30 patients. For validity the functional indices were compared with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), spinal movement measures of chest expansion (CE), Schober S1 test and occiput-to-wall distance (OWD), and radiological changes in the lumbar spine (RTGLS) and sacroiliac joints (RTGSI). The reproducibility of the indices BASFI and DFI was good; the intraclass correlation coefficient (ICC) for reliability was 0.99 and 0.98, and the coefficient of internal consistency (Cronbach's alpha) was 0.94 for both BASFI and DFI. The functional indices correlated well with each other, r = 0.85 (95% CI 0.78-0.90). Validity in terms of correlation coefficients between disease activity index BASDAI and functional indices BASFI and DFI was 0.74 (95% CI 0.60-0.84) and 0.69 (95% CI 0.53-0.80), respectively. BASFI and DFI correlated with spinal mobility measurements and RTGLS, but DFI did not correlate with RTGSI. Neither BASFI nor DFI correlated with ESR and disease duration, and only DFI correlated with age. In conclusion, BASFI and DFI are reliable and valid for Finnish inpatients with spondylarthropathies. It is important to know that cultural differences do not reduce the usefulness of these indices.

Assessment of thoracolumbar rotation in ankylosing spondylitis: a simple tape method.

Results of a 'new' method for thoracolumbar rotation by tape (TRPav), simple instrumental rotation (TRi), the modified Schober test and thoracolumbar flexion (ThFL) were correlated with radiological changes in patients with ankylosing spondylitis (AS). TRPav showed a significant radiological correlation (Ls-r: 0.38; Th-r: 0.31), while the instrument method (TRi) did not; both the Schober test and ThFL, again, correlated fairly highly (Ls-r: 0.71, 0.62; Th-r: 0.49, 0.42). Both inter- and intratester reliability of the tests was good (Bland and Altman plots). Thoracolumbar rotation is one of the three principal levels of spinal motion and seems to be less affected by age. TRPav proved a valid and reliable method for measuring thoracolumbar rotation and clinically is a non-invasive, quick and easy complement to AS measurement methodologies.

Do pathological opposites cancel each other out? Do all patients with both hypermobility and spondylarthropathy fulfill a criterion of any disease?

When a patient with hypermobility syndrome suffers from ankylosing spondylitis or seronegative spondylarthropathy with spinal stiffness, a part of the mobility criterion of the one disease may be "eliminated" due to the other illness. These two cases may represent typically such opposite effects on mobility.

Neck mobility assessment in ankylosing spondylitis: a clinical study of nine measurements including new tape methods for cervical rotation and lateral flexion.

The objective was to carry out a clinical assessment of different cervical mobility measurements in ankylosing spondylitis (AS), including two new tape methods for measuring cervical rotation and lateral bending. A range of cervical movements was measured in 52 consecutive male AS patients and the results correlated with detailed radiological changes in the whole spine and sacroiliac joints. Occiput- and tragus-to-wall distance (OWD/TWD), cervical rotation (CR) and lateral flexion (CLF) using a Myrin inclinometer (My) and a tape method (t), cervical flexion-extension (CFl-CExt/My) motion and chin chest distance (CCD) measurements were taken and repeated (test-retest). The results showed a highly significant correlation of all measurements with cervical radiological changes, except for CCD, and also those of OWD/TWD with lumbar changes. CLF and CExt also correlated significantly with lumbar changes, other measurements did not, and only TWD and CExt correlated with thoracic changes. All measurements showed good reliability, intra-class correlation coefficients (ICC) ranging from 0.89 to 0.98. Occiput- or tragus-to-wall distance, cervical extension and lateral flexion proved to be valid and reliable measurements in AS, but cervical rotation also appeared to be a clinically relevant method. Cervical lateral flexion is a recommendable measurement for clinical trials in AS. The two new tape methods for measuring cervical rotation and lateral bending were as valid and reliable as the inclinometer method (Myrin), but also quick and easy. Chin-to-chest distance was not among the most valid tests in AS.

Transurethral prostatectomy in patients with preoperative bacteriuria: double-blind study with oral fleroxacin and cefalexin.

We compared oral fleroxacin and cefalexin in the prevention of postoperative infectious complications after transurethral prostatectomy (TURP) in patients with preoperative bacteriuria. 95 patients underwent TURP due to benign prostatic hyperplasia with preoperative bacteriuria. The therapy consisted of 7 days of oral fleroxacin 400 mg once a day or cefalexin 500 mg three times daily. After 2 weeks, 62% of the urine samples were sterile in the fleroxacin groups but only 37% in the cefalexin group (p = 0.047). Patients in the cefalexin group had also statistically significantly more symptoms of urinary tract infections. After 6 weeks, the bacterial eradication rate was 53% in the fleroxacin group and 37% in the cefalexin group. There were no septicemias. TURP can be performed with reasonable safety with this oral antibiotic therapy.

Fifteen months' follow-up of intensive inpatient physiotherapy and exercise in ankylosing spondylitis.

Long-term effects of three or four-week inpatient physiotherapy and exercise courses were studied in 141 adult patients with ankylosing spondylitis (AS). Eight cervical and thoracolumbar range of motion (ROM) measurements and straight leg raise test, vital capacity (VC) and fitness index were measured at the beginning and end of an intensive course and 15 months later. All nine mobility measurements, vital capacity and fitness index were significantly improved after the course. Fifteen months later only chest expansion and vital capacity had significantly deteriorated from the baseline, while CR, FFD and fitness index were still significantly better. Disease duration did not influence treatment results. We conclude that it is possible by means of intensive rehabilitation courses to prevent for more than one year deterioration of spinal function and fitness in AS patients irrespective of disease duration.

Correlation between mobility restrictions and radiologic changes in ankylosing spondylitis.

STUDY DESIGN: In 151 adult patients with ankylosing spondylitis who participated in an inpatient rehabilitation program of 3-4 weeks, 10 different range of motion (ROM) values were measured, and their lumbar spine and sacroiliac joints were radiographed. OBJECTIVES: To determine whether a correlation obtained between restriction of ROM and progression of radiologic findings in ankylosing spondylitis, together with a high enough reliability level in measurements. SUMMARY OF BACKGROUND DATA: A significant correlation was observed between the restriction of eight ROMs: the Schober test, thoracolumbar rotation, thoracolumbar flexion, cervical rotation, occiput-wall distance, chin-chest distance, chest expansion, finger-floor distance, and overall radiologic changes in both lumbar spine and sacroiliac joints; straight leg raise did not correlate, and vital capacity only with sacroiliac joint changes. Spearman's correlation coefficients for ROMs were slightly higher to lumbar spine changes than to sacroiliac joint changes. A corresponding correlation was also observed between spinal mobility restrictions and six detailed changes in lumbar roentgenogram: syndesmophytes, apophyseal arthritis, sclerotic anterior borders of vertebrae, straightened anterior surface of vertebrae, and ossification of interspinous and anterior longitudinal ligaments. Other detailed lumbar spine findings did not correlate. As assessed by erythrocyte sedimentation rate values the disease activity increased in the course of radiologic progression, decreasing again, however, to the end stage. METHODS: Conventional methods with a tape and (Myrin) inclinometer were used to measure thoracolumbar flexion, cervical rotation, occiput-wall distance, chin-chest distance, finger-floor distance, chest expansion, vital capacity, and straight leg raise. In addition, a new method of thoracolumbar rotation and a new modification of the Schober test were introduced. Thirty-nine patients were randomized for a reliability assessment using repeated measurements of ROMs. Radiologic changes were evaluated (in a masked fashion) using the method of Dale and Vinje. RESULTS: The reliability of all ROMs was good (except for interrater intraclass correlation coefficients of chest expansion: 0.53). CONCLUSIONS: The clear correlation between radiologic sacroiliac joint and lumbar spine progression and eight ROMs showed that these are useful noninvasive measurements of disease progression and severity in ankylosing spondylitis that can be used in daily practice.