Ultrasound in the assessment of musculoskeletal involvement in systemic lupus erythematosus: state of the art and perspectives.

Musculoskeletal manifestations are extremely common in patients with systemic lupus erythematosus. Transient and migratory arthralgia is frequently reported even without clinical signs of joint or tendon inflammation. In less than 15% of patients, joints may be more severely affected by deforming (Jaccoud's arthropathy) and/or erosive arthropathy (Rhupus syndrome). In recent years, ultrasound has emerged as a promising imaging technique for the assessment of musculoskeletal involvement in systemic lupus erythematosus, having demonstrated the ability to detect inflammation and structural damage both at articular and periarticular level. Recent ultrasound studies have also revealed new insights into musculoskeletal involvement in patients with systemic lupus erythematosus, some of them questioning the traditional concepts of systemic lupus erythematosus arthropathy, with potential clinical, prognostic and therapeutic implications. In daily clinical practice, the use of ultrasound in the assessment of joint and tendon involvement in patients with systemic lupus erythematosus is still limited. Several methodological issues encountered in ultrasound studies evaluating musculoskeletal involvement in systemic lupus erythematosus patients need to be addressed in order to improve both the reliability and clinical usefulness of ultrasound findings. This paper reviews ultrasound studies assessing musculoskeletal involvement in patients with systemic lupus erythematosus, highlighting certainty, limits, potential applications and future perspectives of ultrasound use in systemic lupus erythematosus patients.

Validation of the Composite Autonomic Symptom Score 31 (COMPASS 31) for the assessment of symptoms of autonomic neuropathy in people with diabetes.

AIM: To validate the Composite Autonomic Symptom Score (COMPASS) 31, in its Italian version, for the diagnosis of diabetic cardiovascular autonomic neuropathy in a clinic-based, single-centre study. METHODS: A total of 73 participants with diabetes (age 55 ± 14 years) completed the COMPASS 31 questionnaire before undergoing cardiovascular autonomic neuropathy and diabetic polyneuropathy assessment according to cardiovascular reflex tests, neuropathic symptoms and signs, and vibration and thermal thresholds. RESULTS: The COMPASS 31 total weighted score differed between participants with and without cardiovascular autonomic neuropathy (29.9 ± 19.5 vs 16.1 ± 14.7; P = 0.003) and with and without diabetic polyneuropathy (28.9 ± 19.1 vs 12.7 ± 11.3; P < 0.0001). It was related to cardiovascular reflex tests score (rho = 0.38, P = 0.0013) as well as diabetic polyneuropathy symptoms (rho=0.61, P < 0.0001) and signs scores (rho = 0.49, P < 0.0001). Receiver-operating curve analysis showed a fair diagnostic accuracy of total score for cardiovascular autonomic neuropathy (area under the curve 0.748 ± 0.068, 95% CI 0.599-0.861) and diabetic polyneuropathy (area under the curve 0.742 ± 0.061, 95% CI 0.611-0.845). The best score thresholds were 16 for early cardiovascular autonomic neuropathy (sensitivity 75.0%, specificity 64.9%, positive predictive value 37.5% and negative predictive value 90.2%), and 17 for both confirmed cardiovascular autonomic neuropathy and diabetic polyneuropathy (sensitivity 70.0% and 65.5%, respectively; specificity 66.7% and 79.5%, respectively; positive predictive value 25.0% and 67.9%, respectively; and negative predictive value 93.0% and 77.8%, respectively). COMPASS 31 had a good internal consistency according to Cronbach's α coefficient of 0.73. CONCLUSIONS: COMPASS 31 can represent a valid, easy-to-use, quantitative assessment tool for autonomic symptoms in diabetic neuropathy, with a fair diagnostic accuracy for both cardiovascular autonomic neuropathy and diabetic polyneuropathy.

Probing ice VII crystallization from amorphous NaCl-D2O solutions at gigapascal pressures.

We probe the possible inclusion of salt (NaCl) in the ice VII lattice over the pressure range from 2 to 4 gigapascal. We combine data from neutron diffraction experiments under pressure and from computational structure searches based on density functional theory. We observe that the high density amorphous precursor (NaCl·10.2D2O) crystallises during annealing at high pressure in the vicinity of the phase boundary between pure ices VII and VIII. The structure formed is very similar to that of pure ice VII. Our simulations indicate that substituting water molecules in the ice VII lattice with Na+ and Cl- ions would lead to a significant expansion of the lattice parameter. Since this expansion was not observed in our experiments, the ice crystallised is likely to be pure D2O or contains only a small fraction of the ions from the salt solution.

Two structural relaxations in protein hydration water and their dynamic crossovers.

We study the translational single particle dynamics of hydration water of lysozyme upon cooling by means of molecular dynamics simulations. We find that water close to the protein exhibits two distinct relaxations. By characterizing their behavior upon cooling, we are able to assign the first relaxation to the structural α-relaxation also present in bulk water and in other glass-forming liquids. The second, slower, relaxation can be ascribed to a dynamic coupling of hydration water motions to the fluctuations of the protein structure. Both relaxation times exhibit crossovers in the behavior upon cooling. For the α-process, we find upon cooling a crossover from a fragile behavior to a strong behavior at a temperature which is about five degrees higher than that of bulk water. The long-relaxation time appears strictly connected to the protein motion as it shows upon cooling a temperature crossover from a strong behavior with a lower activation energy to a strong behavior with a higher activation energy. The crossover temperature coincides with the temperature of the protein dynamical transition. These findings can help experimentalists to disentangle the different information coming from total correlators and to better characterize hydration water relaxations in different biomolecules.

The Widom line and dynamical crossover in supercritical water: Popular water models versus experiments.

In a previous study [Gallo et al., Nat. Commun. 5, 5806 (2014)], we have shown an important connection between thermodynamic and dynamical properties of water in the supercritical region. In particular, by analyzing the experimental viscosity and the diffusion coefficient obtained in simulations performed using the TIP4P/2005 model, we have found that the line of response function maxima in the one phase region, the Widom line, is connected to a crossover from a liquid-like to a gas-like behavior of the transport coefficients. This is in agreement with recent experiments concerning the dynamics of supercritical simple fluids. We here show how different popular water models (TIP4P/2005, TIP4P, SPC/E, TIP5P, and TIP3P) perform in reproducing thermodynamic and dynamic experimental properties in the supercritical region. In particular, the comparison with experiments shows that all the analyzed models are able to qualitatively predict the dynamical crossover from a liquid-like to a gas-like behavior upon crossing the Widom line. Some of the models perform better in reproducing the pressure-temperature slope of the Widom line of supercritical water once a rigid shift of the phase diagram is applied to bring the critical points to coincide with the experimental ones.

Superficial radiotherapy for multiple keratoacanthomas.

We report the case of a 76-year-old Caucasian woman who attended our clinic with multiple keratoacanthomas. Radiotherapy was considered a viable and effective option in such an old patient, who could not be a good surgical candidate for number and distribution of the lesions, and for the age. After a 12-month follow-up, we observed the complete and global disappearance of the lesions; the patient was therefore very satisfied especially in view of the clinical outcome. According to our point of view, radiotherapy allows the physician to obtain a good oncological radicality and excellent cosmetic results too.

Fragile to strong crossover at the Widom line in supercooled aqueous solutions of NaCl.

We study by molecular dynamics simulations the dynamical properties of an aqueous solution of NaCl at a concentration of 0.67 mol/kg upon supercooling. In a previous study of the same ionic solution, we have located the liquid-liquid critical point (LLCP) and determined the Widom line connected to the liquid-liquid transition. We present here the results obtained from the study of the self-intermediate scattering function in a large range of temperatures and densities approaching the LLCP. The structural relaxation is in agreement with the mode coupling theory (MCT) in the region of mild supercooling. In the deeper supercooled region the α-relaxation time as function of temperature deviates from the MCT power law prediction showing a crossover from a fragile to a strong behavior. This crossover is found upon crossing the Widom line. The same trend was found in bulk water upon supercooling and it appears almost unchanged by the interaction with ions apart from a shift in the thermodynamic plane toward lower pressures and higher temperatures. These results show that the phenomenology of supercooled water transfers from bulk to solution where the study of the supercooled region is experimentally less difficult.

Ion hydration and structural properties of water in aqueous solutions at normal and supercooled conditions: a test of the structure making and breaking concept.

We study with the method of molecular dynamics simulation the structural properties of aqueous solutions of NaCl, KCl and KF salts at ambient conditions and upon supercooling at constant pressure. The calculations are performed at increasing concentration of the salt starting from c = 0.67 mol kg(-1) up to 3.96 mol kg(-1). We investigate the modifications of the hydration shells and the changes in the water structure induced by the presence of the ions. The oxygen-oxygen structure is strongly dependent on the ionic concentration while it is almost independent from the cation. The hydrogen bonding is preserved at all concentrations and temperatures. The main effect of increasing the ionic concentration is the tendency of the water structure to assume the high density liquid form predicted for pure water upon supercooling. An important consequence of our analysis is that the concept of an ion as a structure maker or a structure breaker must be revisited to take into account the other ionic species, the ionic concentration and more generally the thermodynamic conditions of the solutions.

A route to explain water anomalies from results on an aqueous solution of salt.

In this paper we investigate the possibility to detect the hypothesized liquid-liquid critical point of water in supercooled aqueous solutions of salts. Molecular dynamics computer simulations are conducted on bulk TIP4P water and on an aqueous solution of sodium chloride in TIP4P water, with concentration c=0.67 mol/kg. The liquid-liquid critical point is found both in the bulk and in the solution. Its position in the thermodynamic plane shifts to higher temperature and lower pressure for the solution. Comparison with available experimental data allowed us to produce the phase diagrams of both bulk water and the aqueous solution as measurable in experiments. Given the position of the liquid-liquid critical point in the solution as obtained from our simulations, the experimental determination of the hypothesized liquid-liquid critical point of water in aqueous solutions of salts appears possible.

Effect of concentration on the thermodynamics of sodium chloride aqueous solutions in the supercooled regime.

Molecular dynamics simulations are performed on two sodium chloride solutions in TIP4P water with concentrations c=1.36 mol/kg and c=2.10 mol/kg upon supercooling. The isotherms and isochores planes are calculated. The temperature of maximum density line and the limit of mechanical stability line are obtained from the analysis of the thermodynamic planes. The comparison of the results shows that for densities well above the limit of mechanical stability, the isotherms and isochores of the sodium chloride aqueous solution shift to lower pressures upon increasing concentration while the limit of mechanical stability is very similar to that of bulk water for both concentrations. We also find that the temperature of maximum density line shifts to lower pressures and temperatures upon increasing concentration. Indications of the presence of a liquid-liquid coexistence are found for both concentrations.

Thermodynamic behavior and structural properties of an aqueous sodium chloride solution upon supercooling.

We present the results of a molecular dynamics simulation study of thermodynamic and structural properties upon supercooling of a low concentration sodium chloride solution in TIP4P water and the comparison with the corresponding bulk quantities. We study the isotherms and the isochores for both the aqueous solution and bulk water. The comparison of the phase diagrams shows that thermodynamic properties of the solution are not merely shifted with respect to the bulk. Moreover, from the analysis of the thermodynamic curves, both the spinodal line and the temperatures of maximum density curve can be calculated. The spinodal line appears not to be influenced by the presence of ions at the chosen concentration, while the temperatures of maximum density curve displays both a mild shift in temperature and a shape modification with respect to bulk. Signatures of the presence of a liquid-liquid critical point are found in the aqueous solution. By analyzing the water-ion radial distribution functions of the aqueous solution, we observe that upon changing density, structural modifications appear close to the spinodal. For low temperatures, additional modifications appear also for densities close to that corresponding to a low density configurational energy minimum.

Parasites of the digestive tract in beef cattle imported from France to Italy.

Beef cattle heads (195 heads, 6 batches) imported for fattening from France to Italy were examined. Coprological qualitative and quantitative tests were performed, and the results analysed in relation to sex, breed, age, date of arrival, geographical origin (French department in which the animal was bred), and gathering centre (French department in which the animal was grouped with the others before travelling to Italy). The following parasites were identified: Eimeriidae (overall prevalence 60.5%); Strongyles (59%); Nematodirus spp. (14.3%); Trichuris spp. (4.1%); Capillaria spp. (2.0%); Paramphistomum spp. (27.6%); Dicrocoelium spp. (3.0%); Moniezia spp. (8.7%). All the observed parasites are widely reported in beef cattle either in Italy or in France. However, the seeming absence of Fasciola hepatica was unexpected, as well as the high prevalence of Paramphistomum spp. The variables that appeared to be more linked to parasite epidemiology were sex, altitude of the geographical origin and season.

Effect of mobile phase additives on peptide retention in reversed-phase chromatography with pellicular and totally porous sorbents.

The effect of two mobile phase additives, trifluoroacetic acid and phosphoric acid, on the energetics of peptide retention in reversed-phase chromatography was investigated using Hy-Tach C18 micropellicular and Vydac C4 and C18 totally porous stationary phases. The effect of the relatively low phase ratio of columns packed with micropellicular sorbents was also examined. The logarithmic retention factors, of two model peptides, Ac-RGGGGLGLGK-amide and Ac-RGAGGLGLGK-amide, were evaluated with different columns and additives in a practical range of eluent strength. The dependence of the logarithmic retention factor on the concentration of acetonitrile in the mobile phase was linear in all cases. The higher sensitivity of the retention to the organic modifier concentration in the case of the Hy-Tach C18 column is attributed to the relatively low phase ratio of this column. Pairwise plots of the logarithmic retention factors were linear. The plots of data obtained with the two additives has unit slopes and thus reveal homoenergetic retention behavior. On the other hand data obtained on two different columns manifest homeoenergetic retention, the slopes of plots are different from unity. The analysis has yielded consistent results and validated the assumption that the retention free energy can be divided into two components arising from mobile phase and stationary phase contributions. The approach also allowed an estimation of the relative phase ratios of the columns and the Vydac C18 column was found to have an 3 and 8 times higher phase ratio than the Vydac C4 and the Hy-Tech C18 column, respectively.

Resolution and identification of the protein components of the photosystem II antenna system of higher plants by reversed-phase liquid chromatography with electrospray-mass spectrometric detection.

Reversed-phase liquid chromatography (RPLC) was interfaced to mass spectrometry (MS) with an electrospray ion (ESI) source for the separation and accurate molecular mass determination of the individual intrinsic membrane proteins that comprise the photosystem II (PS II) major light-harvesting complex (LHC II) and minor (CP24, CP26 and CP29) antenna system, whose molecular masses range between 22,000 and 29,000. PS II is a supramolecular complex intrinsic of the thylacoid membrane, which plays the important role in photosynthesis of capturing solar energy, and transferring it to photochemical reaction centers where energy conversion occurs. The protein components of the PS II major and minor antenna systems were extracted from spinach thylacoid membranes and separated using a butyl-silica column eluted by an acetonitrile gradient in 0.05% (v/v) aqueous trifluoroacetic acid. On-line electrospray MS allowed accurate molecular mass determination and identification of the protein components of PS II major and minor antenna system. The proposed RPLC-ESI-MS method holds several advantages over sodium dodecyl sulfate-polyacrylamide gel electrophoresis, the conventional technique for studying membrane proteins, including a better protein separation, mass accuracy, speed and efficiency.

Breast cancer patients: long-term relapses.

The authors evaluated 200 cases of long-term relapses in patients subjected to mastectomy at least 8 years before and not given any hormonal or other therapy that would have significantly affected the course of the disease. A group of 200 mastectomy patients with early relapses (within 3 years) was used as a control. The following parameters were compared: histologic type, singularity or multiplicity of the relapses at the time of the diagnosis, the patient's age at the time of the mastectomy, the presence of metastatic lymphnodes at the axilla, the clinical course of the disease after the diagnosis of relapse, and the presence of estrogen receptors in the primary tumor. There was a significant higher incidence of lobular histologic type in the group of patients with long-term relapses (p < 0.001). The cases with long-term relapses showed a relatively lower number of relapses in local-region lymphnodes (p < 0.005) a higher number of cases with metastases to the axillary lymphnodes at the time of mastectomy (p < 0.001), a better clinical course (survival) after the diagnosis (mean 3 vs 2.6 years), and more cases with estrogen receptors (p < 0.001) than controls. Premenopausal or postmenopausal status at the time of mastectomy was not significant. After a review of the literature, the authors conclude that relapses that appear after 8 years from the mastectomy occur almost exclusively in patients with a cancer for which the hormonal factor is very important. They hypothesize that even the 18 cases of the series who were without estrogen receptors in reality had receptors saturated by circulating estrogens or receptors for other hormones.

Rapid analysis of somatostatin in pharmaceutical preparations by HPLC with a micropellicular reversed-phase column.

A rapid high-performance liquid chromatography method for the analysis of somatostatin in pharmaceutical preparations is described. A commercially available column packed with 2 microns spherical non-porous silica-based reversed-phase sorbent is used, along with a mobile phase consisting of acetonitrile and aqueous phosphoric acid, adjusted to pH 2.8 with sodium hydroxide. The effect of the organic modifier content and column temperature on the retention behaviour of somatostatin is reported. The method is found to be highly selective and specific, as indicated by the baseline separation of a mixture containing somatostatin and two analogue peptides, which differ from the analyte for one and two amino acids, respectively. Down to 10 ng of somatostatin can be detected and the detector response is linear over the concentration range from 4.14 to 20.75 micrograms ml-1. The application of this method to two commercial pharmaceutical formulations of somatostatin is found to give a mean percentage recovery from each of the two commercial samples, subjected to multiple injection analysis (n = 5), of 100.9% with a RSD of 0.92%, and 102.6% with a RSD of 1.56%, respectively.

Chondroprotective action of chondroitin sulfate. Competitive action of chondroitin sulfate on the digestion of hyaluronan by bovine testicular hyaluronidase.

Lysosomal hyaluronidase is responsible for the degradation of hyaluronan, a component of the extracellular matrix, in degenerative disorders of the joints. It has been hypothesized that the administration of chondroitin sulfate (both a component of the extracellular matrix and a substrate for hyaluronidase) could compete for this enzyme and reduce the degradation process. The present study shows that a mixture of chondroitin 4-sulfate and chondroitin 6-sulfate is a good competitor of hyaluronan for hyaluronidase. The digestion of hyaluronan is reduced in proportion to the amount of competing chondroitin. The competitive ability is dependent on the 4-sulfate, 6-sulfate composition of the chondroitin mixture. Mixtures richer in the 4-sulfate isomer are more effective. The enzymatic reactions have been monitored by HPLC and PAGE.