[Concepts of modern gerontology and geriatrics and the role of nutrition in their achievement].

Many factors take part in increasing the healthy period of life - the quality of the environment, drinking water, psychological attitudes in society, dietary patterns, comfort of living, quality of housing, economic relations in the state and society, the degree of landscaping and much more. Collectively, the factors that lead to a healthier and longer life are called the environment that promotes longevity. The scientific study of such an environment, changing everyday life in terms of its quality related to health and increasing duration, is the newest trend in anti-aging medicine. Individual viability (intrinsic capacity) is one of the 4 concepts of geriatrics. The main concept is senile asthenia, the second is premature aging, the third is age viability, which is a psychological state of aging. It seems promising to study the effect of nutrition on individual vitality and longevity. Objective - to study the influence of nutrition on the aging process, to develop further preventive programs based on the data obtained. Methods. Search for literature on nutrition and age problems was held in the databases of RSCI, PubMed, Google Scholar by keywords: aging, ageism, nutrition, individual viability, age-related changes, resilience diet, age-related viability, senile asthenia, domain approach, age. Results. Domain-based assessment is a modern diagnosticis of the condition of people of older age groups, which forms the basis for the development of gerontological preventive programs, in which nutrition plays an important role. Modern studies indicate that the transition in nutrition from «Western¼ patterns to diets with a high content of plant products, as well as fish, vegetable protein (nuts), reduced salt content prevents the development of complications of age-associated diseases by the mechanism of reducing inflammation and hyperinsulinemia, replenishing micronutrient deficiency. Conclusion. Many studies have confirmed the relationship between compliance with optimal nutrition and longevity, as well as a reduced risk of early development of ageassociated diseases. Further research in the field of gerontology will help in the future to develop a comprehensive system of measures aimed at increasing life expectancy and increasing individual viability.

Sigmoid Resection with Primary Anastomosis for Uncomplicated Giant Colonic Diverticulum : a Report of two Cases.

Giant colonic diverticulum (GCD) is a rare complication of colonic diverticulosis. A small number of cases has been reported in the literature. Patients with GCD have often few non-specific symptoms. Unfortunately, severe complications exist and may lead to surgical acute abdomen. Therefore, this complication of the diverticular disease must be known and properly treated. There is no gold standard diagnostic test, but an air-fluid or air-filled, rounded, pseudocystic image in relation with the colonic wall in a patient with colonic diverticula should suggest this diagnosis to the clinician. We report two cases of a 70-year-old male patient and a 44-year-old female patient having a giant sigmoid diverticulum. The treatment of choice of an uncomplicated GCD is an elective colonic resection, including the giant -diverticulum, with primary anastomosis ; while in case of complicated GCD (peritonitis, abscess or complex fistula), a two-stage resection should be considered.

Voiding camp: A successful and unique bladder rehabilitation program for children with urinary incontinence.

INTRODUCTION & BACKGROUND: Standard urotherapy is a well-established treatment for children with incontinence, although it is often challenging for both child and parents, and not always successful. As an alternative, several in- and outpatient bladder training programs have shown positive results on achieving continence. However, the disadvantage is the hospital environment, which can be more stressful for the child, and also quite expensive for society. OBJECTIVE: The aim was to evaluate the outcome on achieving continence following a voiding camp, where standard urotherapy was applied during a one-week stay at a regular summer youth camp, outside the hospital. STUDY DESIGN: Retrospective analysis of 105 children with urinary incontinence, followed in an expert centre for urinary incontinence for at least one year. Data at 7 different time points, before, during and until 6 months after voiding camp were collected. RESULTS: Even though all children had regular follow-up in an expert centre for urinary incontinence for at least one year before participating voiding camp, only 15% of the children reached the recommended amount of daily fluid intake (1.5 L/day). Once minimal daily fluid intake was re-established during the voiding camp, an immediate increase in the maximum voided volume (MVV), and a decrease in the number of wet days and wet nights per week was noted. This effect on a higher MVV remained even 3 months after voiding camp. DISCUSSION: Although sufficient daily fluid intake is a well-established part of standard urotherapy, up until now there was no data that proved the positive impact of sufficient daily fluid intake on bladder volume training and achieving continence in children. CONCLUSION: Voiding camp, as an unique bladder rehabilitation program for children with incontinence, is a successful alternative treatment option. Optimizing the daily fluid intake during voiding camp had a major positive impact on bladder volume training and achieving continence in children.

Tailgut cyst. A case report.

Tailgut cysts, also called retro-rectal cystic hamartomas or mucin-secreting cysts, are uncommon vestigial masses. They can become complicated with infection or neoplastic degeneration. Surgery is the only treatment. We report here a case of a tailgut cyst in a 60-year-old female, that was discovered 10 years ago but not investigated.

Exposure to nuclear antigens contributes to the induction of humoral autoimmunity during tumour necrosis factor alpha blockade.

OBJECTIVE: Type I interferons and apoptotic particles contribute to antinuclear autoimmunity in experimental models. This study assessed whether similar mechanisms contribute to break peripheral B-cell tolerance in humans by studying the induction of antinuclear antibodies by tumour necrosis factor blockade in spondyloarthritis. METHODS: 40 spondyloarthritis patients treated with infliximab or etanercept and 20 renal cell carcinoma patients treated with sorafenib were studied. Serum antinucleosome IgM and nucleosomes were measured by ELISA. Type I interferon serum activity was measured using a functional reporter cell assay. Synovial apoptosis was assessed by terminal transferase nick end-labelling (TUNEL) assay and anti-active caspase-3 immunostaining. Complement was measured by nephelometry. RESULTS: Despite a similar clinical improvement and reduction of synovial inflammation, antinucleosome IgM were induced by infliximab but not etanercept. This induction did not correlate with type I interferon activity, which was transiently downmodulated by infliximab but persistently upregulated by etanercept. In contrast, antinucleosome IgM levels did correlate with serum nucleosome levels, which were significantly upregulated by infliximab but not by etanercept treatment. This increase in serum nucleosome levels was not directly related to massive cell death, but rather to a decrease of complement 3 and 4 serum levels during infliximab treatment. CONCLUSION: Infliximab and etanercept have a differential effect on both type I interferon activity and nucleosome levels. Only elevated serum nucleosomes relate to the induction of antinucleosome antibodies after infliximab treatment.

Melanoma inhibitory activity, a biomarker related to chondrocyte anabolism, is reversibly suppressed by proinflammatory cytokines in rheumatoid arthritis.

OBJECTIVE: In mice, melanoma inhibitory activity (MIA) is a chondrocyte-specific molecule with similar regulation to collagen type II. As MIA is a small secreted protein, its value as cartilage biomarker in human inflammatory arthritis was assessed. METHODS: MIA tissue distribution was studied by quantitative PCR and immunohistochemistry. The regulation of MIA production was studied in vivo in rheumatoid arthritis (RA) (n = 37) and spondyloarthritis (SpA) (n = 30) synovial fluid (SF), and in vitro in alginate embedded human chondrocytes. Therapeutic modulation of serum MIA was evaluated during tumour necrosis factor (TNF)alpha and interleukin (IL)1 blockade in RA. RESULTS: MIA was primarily expressed by chondrocytes in the human joint. SF MIA levels were lower in RA than in SpA despite similar levels of overall synovial inflammation. Further analysis indicated that these levels were inversely correlated with the degree of joint inflammation in RA, but not in SpA, and that the levels of TNFalpha and IL1beta were significantly increased in RA versus SpA. Accordingly, these proinflammatory cytokines suppressed MIA mRNA and protein in cultured chondrocytes. This suppression was paralleled by suppression of cartilage anabolism as assessed by collagen type 2 and aggrecan mRNA. Treatment of patients with RA with TNF blockade or IL1 blockade induced an increase of serum MIA levels. CONCLUSION: The decreased levels of MIA in the inflamed RA joint and the coregulation of MIA and cartilage matrix molecules by proinflammatory cytokines indicate that joint inflammation in RA not only drives accelerated cartilage degradation but also suppresses cartilage anabolism. This inflammation-driven suppression is reversible in vivo.

Anti-citrullinated protein/peptide antibodies (ACPA) in rheumatoid arthritis: specificity and relation with rheumatoid factor.

Anti-citrullinated protein/peptide antibodies (ACPA) are highly specific and sensitive markers for rheumatoid arthritis (RA). For instance, for the anti-CCP2 assay, sensitivities ranging from 55% to 80% and specificities ranging from 90% to 98% have been reported. Despite their high specificity, recent reports have suggested that ACPA may be found in some patients with other rheumatic autoimmune diseases, including psoriatic arthritis, systemic lupus erythematosus and Sjögren's syndrome. Also, the differences between the classical rheumatoid factor (RF) and ACPA, as well as the complementarity between both tests have recently been demonstrated more clearly. Indeed, both antibody systems have a different association with specific RA features like extra-articular manifestations, a different association with the HLA shared epitope and, behave differently following anti-TNF therapy.

Chemical agents and enzymes used for the extraction of gut lymphocytes influence flow cytometric detection of T cell surface markers.

Chemical agents (DTT, EDTA) and enzymes (collagenase, DNAse) are often used for the generation of a single cell suspension from tissue samples. In this study, flow cytometry was used to examine the effect of chemical agents and enzymes on the expression of cell membrane markers of T lymphocytes from tonsils and peripheral blood. Expression of CD4, CD8, CD25, CD38, L-selectin, CD44, alphaEbeta7 and alpha4beta7 were studied. Incubation of lymphocytes with DTT and EDTA resulted in a decrease of CD38, alphaEbeta7 and alpha4beta7 expression. Incubation with collagenase A and DNAse resulted in a decrease of CD25, L-selectin, alphaEbeta7 and alpha4beta7. The results of this study indicate that a careful interpretation is necessary for phenotypic descriptions of lymphocyte populations obtained by enzymatic isolation techniques.

Review article: bone and joint diseases in inflammatory bowel disease.

The intestinal and articular systems are closely linked in inflammatory bowel disease. Clinical and immunological studies support an important aetio-pathogenetic link between intestinal and articular inflammation. There is increasing evidence for a negative link between bone mass density and intestinal inflammation. This paper will focus on the prevalence, aetio-pathogenesis and treatment of arthritis (peripheral, sacroiliitis and spondylitis) and osteoporosis in inflammatory bowel disease.

Focal up-regulation of E-cadherin-catenin complex in inflamed bowel mucosa but reduced expression in ulcer-associated cell lineage.

The E-cadherin-catenin complex is important for the maintenance of epithelial architecture. We studied its expression in Crohn disease, ulcerative colitis, acute ileitis, and controls. Immunohistochemical stainings for E-cadherin, alpha-catenin, beta-catenin and gamma-catenin were performed. E-cadherin messenger RNA (mRNA) was detected using riboprobes. In active inflammation, there was up-regulation of the complex. In particular, epithelium adjacent to ulcers showed increased expression of protein and mRNA, but in ulcer-associated cell lineage, the intensity of staining was weak to negative. In focal inflammation, up-regulation was found in affected areas. Reparative epithelium growing over denuded areas showed weaker expression. Since structural or functional perturbation in any of the molecules of the E-cadherin-catenin complex results in loss of intercellular adhesion, the preexistent epithelium may benefit from up-regulation to try to maintain its normal architecture under inflammatory conditions. Reduced expression in reparative epithelium and ulcer-associated cell lineage could facilitate the motility of these cells.

Bowel inflammation and the spondyloarthropathies.

The concept of spondyloarthropathies gathers together a group of chronic diseases in which not only the locomotor system is involved but also other organs, especially the gastrointestinal tract. In humans, ileocolonoscopic studies demonstrated the presence of inflammatory gut lesions in all the diseases in the spondyloarthropathy group; their presence varied in the different diseases between 20% and 70%. The inflammation could be related to specific disease features in the spondyloarthropathies. Further research supports the hypothesis of subclinical inflammatory bowel disease in some patients with spondyloarthropathy, in which the locomotor inflammation was the only clinical manifestation. The link between gut inflammation and arthropathy has also been demonstrated in animal models, notably the human leukocyte antigen B27 transgenic rats. The temporal relationship between activity and severity of colonic involvement and flares of peripheral arthritis directs treatment of choice. For all forms of enterogenic arthropathies, nonsteroidal anti-inflammatory drugs remain the acute treatment form. Caution is in order, however, because of their possible harmful effects on intestinal integrity, permeability, and even on gut inflammation.

Double-blind comparison of etodolac and piroxicam in the treatment of rheumatoid arthritis.

Etodolac is the first of a new class of nonsteroidal anti-inflammatory drugs--the pyranocarboxylic acids--and has potent analgesic and anti-inflammatory properties. Etodolac and piroxicam were compared in the treatment of patients with active rheumatoid arthritis. A total of 118 patients entered this double-blind parallel study and were randomly assigned to receive 200 mg of etodolac twice a day (60 patients) or 20 mg of piroxicam once a day (58 patients) for 12 weeks. After the baseline evaluation, efficacy and tolerability evaluations were made at 2, 4, 6, 8, and 12 weeks. Significant improvement from baseline was noted in both treatment groups in the patient's and physician's global evaluations, in the number of swollen and tender joints, and in the pain intensity scores. Improvement was noted at the first visit (week 2) and continued through week 12. Based on changes in the patient's global evaluation, 56% of the etodolac-treated patients and 47% of the piroxicam-treated patients showed improvement at the final evaluation. Based on changes in the physician's global evaluation, 47% of the etodolac-treated patients and 42% of the piroxicam-treated patients showed improvement at the final evaluation. Eight (13%) patients in the etodolac group and 7 (12%) patients in the piroxicam group withdrew from the study because of adverse events. Most adverse events were mild to moderate; gastrointestinal complaints were the most prevalent adverse events in both treatment groups. No clinically significant changes were seen in laboratory test results or vital signs. These results demonstrate that etodolac is well tolerated and effective in the treatment of the signs and symptoms of rheumatoid arthritis and compares favorably to piroxicam in safety and efficacy.

Short term variation of human immunoglobulin levels with an estimation of the day to day physiological variability.

In this work serum Ig levels were determined daily for 14 days in 12 subjects, every two days for 14 days in 19 subjects, every week for 1 month in 11 subjects and fortnightly in 11 subjects for 6 months. The serum IgG, IgM and IgA levels were quantitated by the linear plate method. The day-to-day reproducibility of the technique was checked for a period of one months on seven different samples. The mean coefficient of variation in the reproducibility experiments was found to be 4.8% for IgG, 8.2% for IgM and 5.2% for IgA. Since the observed variation in all groups of subjects was found to be higher than the methodological variation, it appears that physiological variability occurs in the serum Ig levels of an individual. No difference was found between the physiological variances of IgG, IgM and IgA observed in the group with daily analysis and those with determinations every two days. The physiological variations increase when longer periods are considered between consecutive determinations, but the variability of IgG and IgA in the group with fortnightly determinations is less important than that observed in the group with weekly analyses. Some evidence is presented indicating a periodic fluctuation of serum IgG and IgA levels with an amplitude of nearly 20% and with a recurrence rate of two weeks.

Intra-articular injection pentosanpolysulphate results in increased hyaluronan molecular weight in joint fluid.

The influence of an oversulphated glycosaminoglycan, pentosanpolysulphate, on hyaluronan metabolism of the synovial lining cell was studied in vivo in human volunteers. Significant increases in the mean degree of polymerisation of the hyaluronan chains were observed after a series of four to six intra-articular injections of this glycosaminoglycan. No increases in hyaluronan synthesis rates were observed. Repeated administration of the drug did not cause any inflammation or bleeding in the joint cavity.

Osteomyelitis in a patient with a chronically infected arterial graft and longstanding hypertrophic osteoarthropathy of the leg.

A patient is reported with hypertrophic osteoarthropathy of the right leg who developed an osteomyelitis; this appeared to be related to an infected aortic bifurcation prosthesis with increased uptake on leukocyte scan and chronic gas formation at the proximal aortic anastomosis on computed tomography. There have been previous reports of hypertrophic osteoarthropathy as a sign of arterial prosthesis infection. In this patient antibiotic therapy was successful in controlling the osteomyelitis but eradication of the arterial prosthesis infection could not be confirmed and an elective arterial operation involved too great a risk.

Goldsalts, levamisole and D-penicillamine as first choice slow-acting antirheumatic drugs in rheumatoid arthritis--a long-term follow-up study.

In the present study, 345 rheumatoid arthritis patients were treated using goldsalts, D-Penicillamine or levamisole as the slow-acting antirheumatic drug of first choice. Goldsalts were given to 182 patients, levamisole to 139 and D-Penicillamine to 24. At the time of the present evaluation, 83 patients were still on goldsalts (44.6%), 63 on levamisole (45.2%) and 11 on D-Penicillamine (45.9%). Adverse reactions required interruption of treatment in 64 patients on goldsalts (35.2%), in 44 on levamisole (31.7%) and in 5 on D-Penicillamine (20.8%). Inefficacy was responsible for withdrawal of 33 patients receiving goldsalts (18.1%), 30 receiving levamisole (21.6%) and 8 receiving D-Penicillamine (33.3%). The duration of treatment was 4.6 years for goldsalts, 3.6 years for levamisole and 3.6 years for D-Penicillamine. In the present analysis none of the compounds was found to have a definite advantage over the others. The rather favourable treatment continuation rates in this study can be attributed to the fact that the slow-acting antirheumatic drugs were given at an early stage of the disease, preferably before the occurrence of radiological lesions.

Reparative response of human articular cartilage in tissue culture. Comparison between a normal and an osteoarthritic knee of the same donor.

Some evidence is presented that the metabolism of visually intact cartilage taken from a knee with focal osteoarthritic lesions, may already be affected. Proteoglycan metabolism of articular cartilage from the macroscopically unaffected right knee and the osteoarthritic left knee of the same donor was assayed in long-term tissue culture. A good reparative response was found in the right knee with an increase in the relative amount of radiolabelled proteoglycan and proteoglycan aggregates, and in the total amount of labelled proteoglycan per mg dry tissue. No significant differences were found when the anteromedial, anterolateral and posterolateral areas were compared. Visually intact samples taken from the left knee, with a deep osteoarthritic cartilage erosion on the medial condyle, showed no accumulation of radiolabel into proteoglycan and proteoglycan aggregates for the enzymatically pretreated samples. This was interpreted as a repair failure.

Pigmented villonodular synovitis of the hip--association with osteochondromatosis.

Pigmented villonodular synovitis, diffuse or nodular in nature, is most commonly seen in the knee but occasionally involves the hip. The authors reviewed the medical records of seven patients with a pathological diagnosis of unilateral pigmented villonodular synovitis of the hip. Characteristic findings were proliferation of the synovial lining cells and subsynovial invasion of fibroblast or polyhedral mesenchymal cells in a nodular pattern. Multiple initiating factors have been advanced to account for the occurrence of this monoarticular chronic arthritis, but the etiology and pathogenesis still remain obscure. On three occasions the authors found an association with free floating osteochondromas and well-delineated foci of metaplastic cartilage under the synovial lining cells. Two benign lesions may occur simultaneously and are possibly related entities involving the synovial membranes as a reaction to a common etiologic factor. Although the histopathology of pigmented villonodular synovitis of the hip and the knee is identical, localization in the former joint has its typical clinical, radiological, differential diagnostic and therapeutic aspects.

Subclinical involvement of the gut in undifferentiated spondylarthropathies.

In order to evaluate the frequency of subclinical gut involvement in the seronegative spondylarthropathies, ileocolonoscopy with biopsies of the colon, ileocecal valve and ileum were performed on 211 patients with ankylosing spondylitis (AS), reactive arthritis (ReA) and undifferentiated spondylarthropathies. Inflammatory gut lesions were detected in a large number of these patients. It was concluded that the group of undifferentiated spondylarthropathies could be split into fairly equal subgroups: one subgroup suffering from subclinical inflammatory bowel disease associated with peripheral joint symptoms, a second subgroup presenting a form of enterogenic ReA, and a third subgroup in which no relation with the gut could be demonstrated. Ankylosing spondylitis, which has to be considered as a form of undifferentiated seronegative spondylarthropathy, could be subdivided into the same subgroups. These findings confirm the existence of subclinical gut involvement in patients with seronegative spondylarthropathies.

Prevalence of inflammatory rheumatic diseases in an adolescent urban student population, age 12 to 18, in Belgium.

In order to determine the prevalence of inflammatory rheumatic diseases in an urban secondary school student population, a questionnaire dealing with past or present joint, tendon, axial, gastrointestinal, ocular and dermatological symptoms was completed by 2,990 students of secondary schools in Antwerp and Ghent. The parents were asked to complete a questionnaire regarding the family medical history. From these 2,990 students, 524 were selected for further investigation by a rheumatology resident, who checked the answers to the first questionnaire and performed a clinical examination. Forty-one adolescents with a presumptive history or present symptoms of inflammatory rheumatic diseases were retained. These students were examined by the medial staff of the rheumatology department; if necessary, a complementary biochemical and radiological examination was performed. Five cases of definite juvenile chronic arthritis (JCA) (with polyarticular onset in 1 case and late pauciarticular onset in 4 cases) and 4 cases of presumptive late pauciarticular onset JCA were detected, resulting in a prevalence of 167 per 100,000 for definite JCA and of 301 per 100,000 for possible JCA. This prevalence rate is higher than that generally described. This method of investigation effectively allows the detection of milder and spontaneously remitting cases of JCA. It further enabled us to definite case and 4 presumptive cases of various previously undiagnosed forms of JCA.