Ultrasound and MRI of the foot in children and adolescents newly diagnosed with juvenile idiopathic arthritis.

Aim: To evaluate the spectrum of inflammatory features in foot joints which may be detected on routinely performed ultrasound (US) and magnetic resonance imaging (MRI) in children newly diagnosed with juvenile idiopathic arthritis (JIA). Material and methods: Two groups of children hospitalized in a reference center for rheumatology, newly diagnosed with JIA and suspected of foot involvement in the course of JIA were included in this retrospective study. In the first group of 47 patients aged 1-18 years, the imaging was restricted to US. The second group of 22 patients aged 5-18 years underwent only non-contrast MRI of the foot. Results: The most frequent pathologies seen on US included effusion and synovial thickening in the first metatarsophalangeal joint (MTP1), followed by the tibiotalar joint. Synovial hyperemia on color Doppler US images was present most frequently in the Chopart and midtarsal joints (64%; 7/11 cases), followed by the tibiotalar joint (45%; 5/11), and MTP2-5 joint synovitis (40%; 4/10). Grade 3 hyperemia was present only in four cases; grades 1 and 2 were detected in the majority of cases. On MRI, bone marrow edema was the most frequent pathology, found mostly in the calcaneus (45%; 10/22 cases), while alterations of the forefoot were rare. No cases of bursitis, enthesitis, cysts, erosions or ankylosis were diagnosed in either of the analyzed groups. Conclusions: Routine US of the foot is recommended for early detection of its involvement in JIA in daily clinical practice. Although MRI can identify features of various JIA stages, it is particularly useful for the detection of bone marrow alterations.

Recent Developments and Applications of Microbial Levan, A Versatile Polysaccharide-Based Biopolymer.

Polysaccharides are essential components with diverse functions in living organisms and find widespread applications in various industries. They serve as food additives, stabilizers, thickeners, and fat substitutes in the food industry, while also contributing to dietary fiber for improved digestion and gut health. Plant-based polysaccharides are utilized in paper, textiles, wound dressings, biodegradable packaging, and tissue regeneration. Polysaccharides play a crucial role in medicine, pharmacy, and cosmetology, as well as in the production of biofuels and biomaterials. Among microbial biopolymers, microbial levan, a fructose polysaccharide, holds significant promise due to its high productivity and chemical diversity. Levan exhibits a wide range of properties, including film-forming ability, biodegradability, non-toxicity, self-aggregation, encapsulation, controlled release capacity, water retention, immunomodulatory and prebiotic activity, antimicrobial and anticancer activity, as well as high biocompatibility. These exceptional properties position levan as an attractive candidate for nature-based materials in food production, modern cosmetology, medicine, and pharmacy. Advancing the understanding of microbial polymers and reducing production costs is crucial to the future development of these fields. By further exploring the potential of microbial biopolymers, particularly levan, we can unlock new opportunities for sustainable materials and innovative applications that benefit various industries and contribute to advancements in healthcare, environmental conservation, and biotechnology.

Ankle Magnetic Resonance Imaging in Juvenile Idiopathic Arthritis Versus Non-Juvenile Idiopathic Arthritis Patients with Arthralgia.

This retrospective case-control study aimed to evaluate whether Magnetic Resonance Imaging (MRI) enables differentiation of ankle arthritis in Juvenile Idiopathic Afrthritis JIA from ankle arthralgia of unknown aetiology in patients clinically suspected of JIA. Forty-four children, at ages 5-16, who underwent MRI of the ankle from January 2016 to March 2021 for clinically suspected active ankle arthritis in the course of JIA were included. MRI findings in both groups-patients with the final diagnosis of JIA and without final diagnosis of JIA-were compared and scored. The sum of the scores of 22 ankle lesions in an individual patient (active, destructive and developmental), so-called the MRI summarized score, was calculated and tested in terms of the most optimal diagnosis of JIA. Interobserver agreement was calculated. Inflammatory features were seen on MRI in 38 out of all the included patients (86%). The most common lesions in both groups were effusion in the tibio-talar joint (68% in JIA and 64% in the arthralgia group) and effusion in subtalar joint (64% in JIA vs. 59% in the arthralgia group). In general, more lesions were identified in the JIA group than in non-JIA. However, only tenosynovitis was significantly more common in the JIA vs. non-JIA group (p = 0.031). The MRI summarized score did not allow for discrimination between ankle arthritis in JIA from non-JIA patients; the best levels of sensitivity (32%), specificity (91%), positive predictive value PPV (78%) and negative predictive value NPV (57%) were achieved only at the cut-off point of 10.

MRI Findings in Hip in Juvenile Idiopathic Arthritis.

The aim of this study was to evaluate if magnetic resonance imaging allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology in juveniles clinically suspected for hip arthritis. This was a retrospective observational study which included 97 children with clinically suspected hip arthritis. Each hip was assessed and scored in MRI for signs of active and destructive inflammatory lesions and developmental lesions. MRI findings between JIA-confirmed patients and without final diagnosis of JIA were compared and the MRI summarized score was calculated, as the sum of scorings of all 24 hip lesions in an individual patient (i.a., effusion, synovitis, bone marrow edema, enthesitis). MRI showed at least one lesion in the majority of patients (95 patients; 98%). Effusion was the most common feature, followed by bone marrow oedema and synovitis. All lesions were more common in patients with a final diagnosis of JIA, especially synovitis and enthesitis (p = 0.037 and p = 0.047). The MRI summarized score was significantly higher in the JIA group than the non-JIA group: 3 (2-5) vs. 2 (2-2), respectively, p = 0.002. Using a cut-off score of 6, the MRI summarized score showed 25% sensitivity and 100% specificity indicating a good ability in discriminating hip arthritis during JIA from non-JIA patients. MRI allows hip arthritis in JIA to be differentiated from hip arthralgia of unknown etiology with good specificity, thus, may be helpful in confirming the diagnosis of JIA.

Magnetic resonance imaging of the knee joint in juvenile idiopathic arthritis.

Juvenile idiopathic arthritis (JIA) is an umbrella term for a group of diseases in children younger than 16 years old lasting six weeks or longer. Synovitis may lead to destructive and irreversible joint changes with subsequent functional impairment. Prompt diagnosis is essential to prevent permanent joint damage and preserve joint functionality. In the course of JIA both the axial and peripheral skeleton may be involved in the inflammatory process, but the knee joint is most frequently affected. New drugs and treatment protocols have forced the need for diagnosis at the earliest possible stage. Magnetic resonance imaging (MRI) allows early detection of lesions and constitutes a superior diagnostic imaging method. Synovitis, tenosynovitis, enthesitis, bursitis, osteitis, cartilage loss, bone cysts, and erosions are lesions diagnosed in JIA, and they can be precisely imaged in MRI. This article aims to present MRI inflammatory features of the knee in children with JIA based on the literature.

Cartilage and bone damage in rheumatoid arthritis.

Rheumatoid arthritis (RA), which is a chronic inflammatory disease with a multifactorial aetiology, leads to partial or permanent disability in the majority of patients. It is characterised by persistent synovitis and formation of pannus, i.e. invasive synovial tissue, which ultimately leads to destruction of the cartilage, subchondral bone, and soft tissues of the affected joint. Moreover, inflammatory infiltrates in the subchondral bone, which can lead to inflammatory cysts and later erosions, play an important role in the pathogenesis of RA. These inflammatory infiltrates can be seen in magnetic resonance imaging (MRI) as bone marrow oedema (BME). BME is observed in 68-75% of patients in early stages of RA and is considered a precursor of rapid disease progression. The clinical significance of synovitis and bone marrow oedema as precursors of erosions is well established in daily practice, and synovitis, BME, cysts, hyaline cartilage defects and bone erosions can be detected by ultrasonography (US) and MRI. A less explored subject is the inflammatory and destructive potential of intra- and extra-articular fat tissue, which can also be evaluated in US and MRI. Finally, according to certain hypotheses, hyaline cartilage damage may trigger synovitis and lead to irreversible joint damage, and MRI may be used for preclinical detection of cartilage biochemical abnormalities. This review discusses the pathomechanisms that lead to articular cartilage and bone damage in RA, including erosion precursors such as synovitis and osteitis and panniculitis, as well as the role of imaging techniques employed to detect early cartilage damage and bone erosions.

Magnetic resonance imaging in inflammatory rheumatoid diseases.

Magnetic resonance (MR) is used more and more frequently to diagnose changes in the musculoskeletal system in the course of rheumatic diseases, at their initial assessment, for treatment monitoring and for identification of complications. The article presents the history of magnetic resonance imaging, the basic principles underlying its operation as well as types of magnets, coils and MRI protocols used in the diagnostic process of rheumatic diseases. It enumerates advantages and disadvantages of individual MRI scanners. The principles of MRI coil operation are explained, and the sequences used for MR image analysis are described, particularly in terms of their application in rheumatology, including T1-, T2-, PD-weighted, STIR/TIRM and contrast-enhanced T1-weighted images. Furthermore, views on the need to use contrast agents to optimise diagnosis, particularly in synovitis-like changes, are presented. Finally, methods for the assessment of MR images are listed, including the semi-quantitative method by RAMRIS and quantitative dynamic examination.

Catalase activity in blood fractions of patients with sporadic ALS.

BACKGROUND: Oxidative stress may be a key element in pathogenesis of sporadic amyotrophic lateral sclerosis (sALS). Several studies proved that markers of peroxidation of lipids, proteins or nucleic acids are increased in postmortem tissue of sALS patients. However, much less is known about enzymatic antioxidant defense mechanism in sALS. OBJECTIVES: The aim of the study was to assess catalase (CAT) activity that is implicated in the defense against oxidative stress, in three blood fractions, i.e. erythrocytes, plasma and serum of sALS patients and healthy controls. METHODS: Altogether 46 sALS patients and 54 controls were enrolled in the study. CAT activity was estimated using a commercially available assay kit. RESULTS: CAT activity in erythrocytes of sALS patients was significantly decreased compared to neurologically healthy controls (p=0.04), whereas CAT activity in plasma and serum was similar in both studied groups. CONCLUSIONS: CAT activity in erythrocytes, in contrast to other blood fractions is reduced in sALS cases as compared to controls, which may indirectly indicate that antioxidant defense system in erythrocytes is involved in pathogenesis of sALS.

Shoulder joint tuberculosis.

BACKGROUND: Despite the fact that joint tuberculosis is one of the most common forms of extrapulmonary tuberculosis, it is a disease entity that is very rare in Poland (less than 100 cases a year in the last 10 years). The symptoms are non-specific, and thus the disease is rarely taken into account in preliminary differential diagnosis. CASE REPORT: A 68-year-old female patient was admitted to the Internal Diseases Clinic due to oedema and pain of the right shoulder joint. The pain has been increasing for about 8 months. Physical examination revealed increased circumference and elevated temperature of the right shoulder joint. Limb function was retained. The full range of radiological and laboratory diagnostic examinations was performed, including the biopsy of the affected tissue which revealed the presence of Mycobacterium tuberculosis in the bacterial culture. Clinical improvement was obtained after introduction of TB drugs. CONCLUSIONS: Radiological diagnostic methods (X-ray, CT scans, MRI scans) provide high precision monitoring of articular lesions. However, the decisive diagnosis requires additional laboratory tests as well as histopathological and bacteriological assays.

Brainstem ischemic stroke without permanent sequelae during the course of spontaneous internal carotid artery dissection - case report.

BACKGROUND: Internal carotid artery dissection (ICAD) is a frequent cause of a stroke in young patients. Risk factors which can lead to dissection include neck injury and diseases of the inner wall of the artery. Common symptoms in ICAD are cervical pain and headache, Horner's syndrome, paralysis of the cranial nerves and subsequently cerebral and retinal ischemia. MR angiography in TOF technique and brain MRI in T1- and T2-weighted images, FLAIR and DWI sequences are the method of choice in patients with ICAD but contrast-enhanced multislice computed tomography remains the fastest and the most available diagnostic method. CASE REPORT: A 39-year old woman, previously healthy, presented to the Hospital Emergency Department because of increasing neck pain on the right side and difficulty in swallowing. The neurological examination revealed: drooping of the right eyelid with narrow palpebral fissure, dysarthria, anisocoria (narrower pupil on the right side), unilateral hypoesthesia on the left side, weak palatal and pharyngeal reflexes on both sides, paresthesia within the left half of the body. Seven days before, the patient felt a sudden, severe neck pain radiating to the temporal apophysis. CT angiography revealed a defect in contrast filling within the left internal carotid artery and right vertebral artery. MRI of the head with MR angiography showed internal carotid artery dissection on the left side and dissection of the right vertebral artery and no ischemic changes within the brain. CONCLUSIONS: CT and MR angiography are methods characterized by high sensitivity in detecting dissection of the cervical arteries.

Prognosis of phrenic nerve injury following thoracic interventions: four new cases and a review.

INTRODUCTION: Phrenic nerve lesion is a known complication of thoracic surgical intervention, but it is rarely described following thymectomy and lung surgery. OBJECTIVE: To review the literature on thoracic intervention and phrenic nerve lesion and to describe four new cases, in which regular neurophysiological studies were performed. METHODS: We reviewed the literature concerning phrenic nerve lesion after cardiac, lung and thymus surgical interventions. We described four cases of phrenic nerve lesion, three associated with thymectomy and one in lung surgery. RESULTS: The review shows that cryogenic or thermal injuries during cardiac surgeries are associated with good prognosis. The information on the outcome of phrenic nerve lesion in thymectomy or lung surgery is insufficient. Our cases and this review suggest that phrenic lesion in the last two interventions are associated with a poor recovery. CONCLUSION: Our data suggests that the prognosis of phrenic nerve lesion following thoracic intervention depends on the nature of the damage. Probably, in thymectomy and lung surgery, nerve stretch or laceration are involved, consequently the outcome is poorer in comparison with cardiac surgery, where cold lesion is more frequent. Neurophysiological tests give a direct, quantified and reliable assessment of nerve regeneration.

[Vanguard Signature TKR--first experiences]. / Alloplastyka stawu kolanowego Vanguard Signature --pierwsze doswiadczenia.

On 15th May 2010 in Poland first computer planned total knee arthroplasty Vanguard Signature was performed and until now, including Orthopedic Traumatology Department of Central Clinical Hospital Ministry of Interior and Administration in Warsaw and Orthopedic Surgery Department of Promienista Clinic in Poznan, 65 patients have been operated with this method. The new system includes programming technical parameters of operation on the basis of diagnostic analysis of lower extremity using CT or MRI scans. Data are transmitted on Signature Positioning Guides (SPG) which implements function of navigation during surgery. Minimal bone resection, implants sizing and placement with reconstruction of mechanical axis of the limb provides proper functioning of the knee joint and reduces the risk of implants loosening. Further benefits include: instrument reduction, lower degree of femur trauma and reduction of average postoperative blood transfusion volume. The operator using Signature technology is required to have advanced knowledge in the conventional method TKR and medium level computer skills. Access to the program and materials and online communication with the Signature team in the USA allows the surgeon to modify the parameters of the operation and the necessary expert feedback. The rapid increase in the number of registered surgeons in Signature system shows a considerable interest in this technology.

Cerebrotendinous xanthomatosis: a rare cause of spinocerebellar syndrome.

A 34-year-old patient demonstrating pyramidal and cerebellar signs, accompanied by epilepsy, peripheral neuropathy, mental retardation and bilateral cataract was diagnosed with cerebrotendinous xanthomatosis based on the clinical picture, magnetic resonance imaging of the brain and serum sterol analysis. Tendon xanthomas were not observed in this case. After establishing the diagnosis, treatment with chenodeoxycholic acid and statin was introduced. During the next two years of the follow-up, serum cholestanol and 7α-hydroxycholesterol levels decreased in response to the therapy, but this was not reflected in the patient's neurological condition, which was slowly progressing. Treatment effectiveness in cerebrotendinous xanthomatosis is variable, notably better in patients who had started therapy before the injury to the nervous system took place. The present case report points to cerebrotendinous xanthomatosis as a rare cause of spinocerebellar syndrome, which might be treatable if diagnosed in early life.

The -A162G polymorphism of the PON1 gene and the risk of sporadic amyotrophic lateral sclerosis.

BACKGROUND AND PURPOSE: Sporadic amyotrophic lateral sclerosis (sALS) is a devastating neurodegenerative disease, which results from complex genetic and environmental interactions. Recent studies have reported an association between several polymorphisms of the PON1 and PON2 genes and risk of sALS. The aim of the present study was to identify an association between the -A162G polymorphism of the promoter region of the human PON1 gene and the risk of sALS in a Polish population. MATERIAL AND METHODS: We included 259 patients with a diagnosis of definite or probable sALS (76 bulbar onset, 183 limb onset) and 694 healthy controls matched for age and sex. The diagnosis of ALS was established according to El Escorial criteria. The polymorphism was studied by Single Nucleotide Polymorphism Real-Time Polymerase Chain Reaction analysis. RESULTS: No overall difference in the PON1 -A162G geno-type and allele distribution was seen between cases and controls (all p > 0.05). There was, however, a difference in the A allele frequency when the bulbar onset group was compared to the controls (p = 0.03), but this significance disappeared after the Bonferroni correction. CONCLUSIONS: The results did not show that the -A162G polymorphism of the PON1 gene is a risk factor of sALS in a Polish population; it may affect, however, bulbar onset of the disease.

A phenotypic-genetic study of a group of Polish patients with spinal and bulbar muscular atrophy.

We studied phenotype-genotype correlation in a group of Polish males with spinal and bulbar muscular atrophy (SBMA) and in female carriers. Eleven males with suspected SBMA phenotype and three suspected female carriers were examined. Male patients presented with the predominant signs of progressive, symmetrical distal limb weakness with amyotrophy, facial muscular weakness with orofacial fasciculations, nasal voice and slight dysphagia, gynaecomastia, decreased potency, as well as hand tremor and distal peripheral sensory disturbances in a few cases. One of the carriers presented with a 30-year history of fasciculations and minimal distal weakness and cramps in the legs, while the other two were asymptomatic. DNA analysis revealed expanded size of CAG repeats in Xq11-12 in the AR gene in 10 out of 11 men (range 45-52 CAG repeats) and in the women (range 46-48 CAG repeats). There was no correlation between CAG repeat size and the age of disease onset and duration of the disease. A rare, predominantly distal distribution of weakness and amyotrophy was found in our group of the SBMA patients (8 out of 11 cases) from three unrelated kindreds and also in the remaining two sporadic cases. The extended CAG repeats within families were stable.

[Stromal tumor of the stomach in a 14 year old girl]. / Nowotwór stromalny zoladka u 14-letniej dziewczynki.

We present a case of a 14 year old girl with gastrointestinal stromal tumor (GIST) of the stomach. The patient discovered epigastric tumor on palpation. CT and ultrasound revealed tumor arising from the gastric wall, biopsy suggested GIST. Gastroscopically 6 cm policyclic lesion covered by unchanged mucosa has been visualized. Patient was submitted to operative management. There were no features of dissemination or invasion of surrounding structures. Stomach resection according to the Rydygier procedure has been performed. Histologically tumor arose from the muscularis propria. Mitotic activity was high 8/50. Immunohistochemical reaction against CD-117 was positive and in some parts against CD-34 which confirmed GIST. SMA and ALK were negative which excluded myogenic or inflammatory myofibroblastic tumor. Postoperative course was uneventful. There were no indications for adjuvant therapy. No recurrences were observed during follow-up.

[Assessment of nutritional status of prepubertal students in Southeast Poland]. / Ocena stanu odzywienia dzieci szkolnych w wieku przedpokwitaniowym w Malopolsce.

The aim of the investigation was to estimate the prevalence of malnutrition, overweight and obesity in prepubertal schoolchildren from Southeast Poland and to obtain information on obesity risk factors in children. A representative national sample of 480 school children (252 girls and 228 boys) between 8-9 years old was selected from 23 schools from Southeast Poland. Examinations included anthropometric measurements (weight and height) and questionnaires covering familial, socioeconomic and psychosocial factors. Body mass index (BMI) was calculated and used as an indicator of overweight. As a statistical method a cross-sectional, three-stage, probability-proportionate-to-size cluster sampling method was used. The prevalence of malnutrition was: 8%, the prevalence of overweight: 6.7% and of obesity 1.9%. A statistical significance between parenteral obesity and obesity of their offspring was found. The mothers obesity represented a higher risk of the condition for girls (p = 0.001), and obesity in fathers represented a higher risk for boys (p = 0.016) than girls. We found the association between obesity in children and physical activity (odds ratio: 2.55; 95% CI: 1.12 5.8). A greater number of obese children skip breakfast as compared with other children (p = 0.058).