Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents.

OBJECTIVE: To estimate the prevalence of psoriatic arthritis (PsA), axial spondyloarthritis (axSpA) and rheumatoid arthritis (RA) and the use of biologic agents in these diseases in Norway. METHODS: From the Norwegian Patient Registry (NPR), we identified as PsA, axSpA and RA patients ≥18 years those with ≥2 recorded episodes with diagnostic coding for index disease (L40.5, M07.0-M07.3 for PsA; M45, M46.0, M46.1, M46.8 and M46.9 for axSpA; M05-M06 for RA). We calculated the point prevalence of PsA, axSpA and RA as per the 1st of January 2017 in the Norwegian adult population (age ≥18). Dispensed disease-modifying antirheumatic drug (DMARD) prescriptions were obtained from the Norwegian Prescription Database and biologic DMARDs given in hospitals from the NPR. RESULTS: The point prevalence of PsA, axSpA, RA, and any of these diseases in total was 0.46%, 0.41%, 0.78%, and 1.56%, respectively. Among women, the prevalence of PsA, axSpA, and RA was 0.50%, 0.37%, and 1.10%, and among men 0.43%, 0.45%, and 0.46%, respectively. In 2017, 27.3% of RA patients, 25.7% of PsA patients and 35.1% of axSpA patients used biologic DMARDs. Treatment with biologics was more frequent in younger age groups in all three diseases, and became more infrequent especially after age ≥55 years. CONCLUSION: In Norway, the combined prevalence of PsA, axSpA, and RA was over 1.5%. Reflecting the good overall access to highly effective but costly biologic treatments, more than a fourth of these patients used biologic agents, which corresponds to over 0.4% of Norwegian adult population.

Effect of probiotic and prebiotic versus placebo on appetite in patients with major depressive disorder: post hoc analysis of a randomised clinical trial.

BACKGROUND: Poor appetite and weight loss are common in melancholic depression. Probiotics and prebiotics have the capacity to affect host behaviour, appetite and weight change by modulating the gut microbiome. The aim of this post hoc analysis was to investigate the effect of supplementation with probiotic and prebiotic on appetite, in parallel with body mass index (BMI), weight and energy intake, in patients with major depressive disorder (MDD). METHODS: We extracted data from a clinical trial with 81 patients. The participants were randomly assigned to receive probiotic (Lactobacillus helveticus and Bifidobacterium longum), prebiotic (galactooligosaccharide) or placebo for 8 weeks. Appetite, weight, BMI, dietary intake, serum leptin and physical activity were measured. Subjective appetite rating was evaluated every 2 weeks using visual analogue scales (VAS) to assess satiety, hunger, fullness and desire to eat. Serum leptin was measured by an enzyme-linked immunosorbent assay. Physical activity was measured using the international physical activity questionnaire. A repeated measures analysis of variance model was used to analyse VAS data and analysis of variance/analysis of covariance models for dietary intake, BMI, weight and leptin data. RESULTS: VAS data analyses indicated no significant intervention-time interactions but did show a significant increase over time for desire to eat within the probiotic group (P = 0.025). No significant difference in either BMI or weight was seen among the groups. Energy intake and leptin were significantly increased in the probiotic group compared to the prebiotic. CONCLUSIONS: Overall, probiotic supplementation for 8 weeks among MDD patients resulted in improvement of appetite, whereas prebiotic administration had no significant effect on appetite.

The effects of weight loss approaches on bone mineral density in adults: a systematic review and meta-analysis of randomized controlled trials.

UNLABELLED: We assessed the impact of weight loss strategies including calorie restriction and exercise training on BMD in adults using a systematic review of randomized controlled trials. Weight reduction results in reduced BMD at the hip, but has less effect on the spine. Both calorie restriction and a combination of calorie restriction and exercise result in a decrease in hip bone density, whereas weight loss response to exercise training without dietary restriction leads to increased hip BMD. INTRODUCTION: Findings are not consistent on the effect of weight loss on bone mineral density (BMD). We conducted a systematic review on the randomized controlled trials to assess the effect of weight loss strategies, including calorie restriction and exercise programs on BMD in adults. METHODS: A structured and comprehensive search of MEDLINE and EMBASE databases was undertaken up to March 2016. Study-specific mean differences (MD) were pooled using a random-effects model. Subgroup analysis and meta-regression were used to find possible sources of between-study heterogeneity. RESULTS: Thirty-two randomized controlled trials met predetermined inclusion criteria. The meta-analysis revealed no significant difference on total BMD (MD 0.007, 95 % CI -0.020-0.034, p = 0.608). In contrast, the pooled data of studies showed a significant effect of weight loss on hip BMD (MD -0.008, 95 % CI -0.09 to -0.006 g/cm(2), p < 0.001) and also lumbar spine BMD (MD -0.018 g/cm(2), 95 % CI -0.019 to -0.017, p < 0.001). BMD in the hip site decreased after more than 4 months, especially in those who were obese. Moreover, calorie restriction interventions longer than 13 months showed a significant decreased in lumbar spine BMD. CONCLUSION: Weight loss led to significant decreases at the hip and lumbar spine BMD but not at the total. Weight loss response following calorie restriction resulted in a decrease in hip and lumbar spine bone density especially more than 1 year; whereas an exercise-induced weight loss did not.

Dieulafoy lesion: CT diagnosis of this lesser-known cause of gastrointestinal bleeding.

A Dieulafoy lesion describes a tortuous, submucosal artery in the gastrointestinal tract--most commonly the posterior stomach--that penetrates through the mucosa over time, eventually perforating to cause severe gastrointestinal bleeding. Due to its insidious onset, tendency to cause intermittent but severe bleeding, and difficulty of endoscopic diagnosis, Dieulafoy lesion has a very high mortality rate. Although originally thought not to be a radiologically diagnosable entity, Dieulafoy lesions can be seen at enhanced CT of the abdomen. The purpose of this review is to summarize the pathophysiology, epidemiology, diagnosis, and management of Dieulafoy lesions with a focus on diagnostic findings at enhanced CT imaging.

Influence of non-uniform magnetic field on the thermal efficiency hydrodynamic characteristics of nanofluid in double pipe heat exchanger.

Enhancement of the heat transfer rate inside the double pipe heat exchangers is significant for industrial applications. In present work, the usage of non-uniform magnetic field on the heat transfer rate of the nanofluid flow streamed inside double pipe heat exchangers are comprehensively studied. Computational technique of CFD is used for the visualization of the nanofluid hydrodynamic in existence of the magnetic source. Influences of the magnetic intensity and nanofluid velocity on the heat transfer are also presented. Simple algorithm is used for the modeling of the incompressible nanofluid flow with addition of magnetic source. Presented results show that magnetic source intensifies the formation of the circulation in the gap of the inner tube and consequently, heat transfer is enhanced in our domain. Comparison of different geometries of tube reveals that the triangle tube is more efficient for improvement of the heat transfer of nanofluid flow. Our results indicate that heat transfer in the tube with triangular shape is more than other configurations and its performance is 15% more than smooth tube.

An Efficient Capsule-based Network for 2D Left Ventricle Segmentation in Echocardiography Images.

The segmentation of cardiac chambers is essential for the clinical diagnosis and treatment of cardiovascular diseases. It is demonstrated that in cardiac disease, the left ventricle (LV) is extensively involved. Therefore, segmentation of the LV in echocardiographic images is critical for the precise evaluation of factors that influence cardiac function such as LV volume, ejection fraction, and LV mass. Although these measurements could be obtained by manual segmentation of the LV, it would be time-consuming and inaccurate because of the poor quality and low contrast of these images. Convolutional neural networks, commonly referred to as CNNs, have emerged as a highly favored deep learning technique for medical image segmentation. Despite their popularity, the pooling layers in CNNs ignore the spatial information and do not consider the part-whole hierarchy relationships. Furthermore, they require a large training dataset and a large number of parameters. Therefore, Capsule Networks are proposed to address the CNNs limitations. In this study, for the first time, an optimized capsule-based network for object segmentation called SegCaps is proposed to achieve accurate LV segmentation on echocardiography images applied to the CAMUS dataset. The result was compared against the standard 2D-UNet. The modified SegCaps and 2D-UNet achieved an average Dice similarity coefficient (DSC) of 84.48% and 83.28% on LV segmentation, respectively. The capabilities of the CapsNet led to an improvement of 1.44% in DSC with 92.77% fewer parameters than the U-Net. The results indicate that the proposed method leads to accurate and efficient LV segmentation.Clinical Relevance- From a clinical point of view, our findings lead to more precise evaluations of critical cardiac parameters, including ejection fraction as well as left ventricle volume at end-diastole and end-systole.

Endovascular treatment of symptomatic intracranial atheromatous stenosis: a single center study of 21 consecutive cases.

OBJECTIVES: This retrospective single-center study evaluated the technical success as well as the periprocedural and long-term complications of angioplasty with stenting of symptomatic intracranial atheromatous stenosis. PATIENTS AND METHODS: From January 2005 to December 2010, 21 patients were treated by angioplasty with stent implantation for symptomatic atheromatous intracranial stenosis greater or equal to 50% at least 7 days after a stroke. RESULTS: The median population age was 65 years (range: 41-88 years), and 76% (16/21) of the candidates had a history of transient ischemic attack (TIA) or stroke before the event qualifying them for an endovascular procedure. In addition, 86% (18/21) were taking antithrombotic medication at the time of the qualifying event. Technical success was obtained in all cases. The periprocedural stroke or death rate was 9.5% (2/21), and there was no other stroke or death after 30 days during the mean follow-up of 1.4 years. CONCLUSION: Endovascular treatment of symptomatic intracranial atherothrombotic stenosis can lead to severe complications, particularly during the periprocedural period, but it also represents the only alternative treatment for patients who fail with medical therapy. Future studies need to focus on improvement of periprocedural complications. Essentially, this should include more rigorous selection of candidates as well as a better understanding of the pathophysiological mechanism(s) of the ischemic phenomenon related to stenosis.

Classification of Iranian patients with Glanzmann's Thrombasthenia using a flow cytometric method.

Glanzmann's Thrombasthenia (GT) is a rare inherited autosomal recessive platelet disorder caused by a deficiency or dysfunction of the GPIIb-IIIa receptor on platelets, which is characterized by a lack of platelet aggregation in response to multiple physiologic agonists and a life-long bleeding disorder. Flow cytometry is a rapid and highly sensitive method that can detect reduced levels of receptors, as well as absolute deficiency. The aim of this study was to classify Iranian GT patients by a flow cytometric method, and to correlate these findings with the severity of clinical bleeding. The expression of GPIIb-IIIa on the platelet surface was assessed in 123 GT patients using quantitative flow cytometry to determine the most common subtype among these patients. We used a panel of antibodies to detect the expression of glycoproteins GPIb, GPIIb, GPIIIa, as well as Integrin αv. Patients were also interviewed with regard to the severity and frequency of bleeding, according to history and gender, in order to evaluate the nature of their bleeding phenotype, and classify them as mild, moderate or severe bleeders, in accordance with the Glanzmann's Thrombasthenia Italian Team (GLATIT) protocol. In the detailed analysis of the results of our investigation, 95 out of 123 (77.5%) were classified as type I; 20 (16%) as type II with residual GPIIb-IIIa, and eight (6.5%) as GT variants. The variant type was diagnosed by the inability of GPIIb-IIIa to bind fibrinogen, as evidenced by the absence of platelet aggregation in response to physiologic agonists. There was no significant correlation between bleeding severity and different subtypes of GT. This study demonstrates that GT type I is the most common subtype among Iranian patients. There was no correlation between severity of symptoms and cytometric phenotype of the disease. The identification of families at risk may significantly decrease the incidence of the severe form of the disorder if genetic counseling is provided.

The effect of lipid emulsion on depth of anaesthesia following thiopental administration to rabbits.

Intravenous lipid emulsion has proven benefit in lipophilic drug-induced cardiotoxicity. Its effect in reversal of central nervous system depression secondary to overdose with lipophilic psychotropic agents remains uncertain. Twenty adult New Zealand White rabbits were anaesthetised with 20 mg.kg(-1) thiopental and randomised to receive either 4 ml.kg(-1) saline 0.9% or 4 ml.kg(-1) lipid emulsion 20% immediately afterwards. Depth of anaesthesia was monitored using bispectral index (BIS) at 1-min intervals. Duration of anaesthesia was measured as time to regain the righting reflex (ability of the animal to right spontaneously from dorsal recumbency to sternal recumbency). The BIS was greater in the control group (p = 0.011). The greatest BIS differential was observed immediately following treatment (mean (SD) BIS 75.0 (9.5) for saline vs 58.6 (10.4) for lipid, 95% CI 5.75-27.1; p < 0.001). No difference was observed in duration of anaesthesia (mean (SD) 15.5 (0.8) min for saline vs 15.6 (0.7) min for lipid, p = 0.86). Lipid emulsion administration may serve to increase central nervous system depression in the early phase of lipophilic toxin distribution.

Serum lipid and lipoprotein patterns of Iranian horses.

Patterns of serum biochemical parameters vary among horse breeds. The objective of the present study was to compare serum lipoproteins of Iranian Caspian ponies with those of other horses (Arabs and Thoroughbreds) in the Iranian region. Serum lipoprotein values were determined by agar-agarose gel electrophoresis and measured by scan densitometry. Moreover, serum triglyceride and cholesterol concentrations were determined and the results were analysed by one-way analysis of variance. Serum triglyceride and cholesterol values were 1.13 +/- 0.23 and 2.38 +/- 0.18 mmol/l in Caspian ponies, 1.96 +/- 0.49 and 1.92 +/- 0.25 mmol/l in Arab horses and 1.38 +/- 0.26 and 2.17 +/- 0.53 mmol/l in Thoroughbred horses. The relative percentages of alpha- (72.63 +/- 17.76%) and beta-lipoproteins (29.10 +/- 5.49%) in serum electrophoretic tracings from Caspian ponies were not significantly different from those of other horses (p > 0.05). The lipoprotein phenotype in Caspian ponies may be useful for evaluating metabolic diseases.

COVID-19, Scarce Resources and Priority Ethics: Why Should Maximizers Be More Conservative?

Background: The principle of maximization, which roughly means that we should save more lives and more years of life, is usually taken for granted by the health community. This principle is even more forceful in crises like the COVID-19 pandemic, where we have scarce resources which can be allocated only to some patients. However, the standard consequentialist version of this principle can be challenging particularly when we have to reallocate a resource that has already been given to a patient. Methodology: Engaging in thought experiments, conceptual analysis, providing counterexamples, and appealing to moral intuitions, we challenge the standard consequentialist version of the maximization principle and make a case for adopting an alternative deontological version. Discussion: In certain cases, the standard consequentialist version of the maximization principle is shown to yield intuitively immoral results. The deontological version of this principle is preferable because it can retain the merits of the standard consequentialist version without falling prey to its problems. Conclusion: Compared to the standard consequentialist version, the deontological version of the maximization principle can better guide the ethical decisions of the health community, even in cases where we face a scarcity of resources.

Effect of Fe2+ and Fe3+ ions on human plasma cholinesterase activity.

OBJECTIVES: Metals such as iron are needed for physiological functions of the body. However, their excess may cause serious damage including poisoning. The effects of Fe2+ and Fe3+ ions on human plasma cholinesterase activity were investigated. MATERIAL AND METHODS: Plasma were obtained (n = 24) from healthy male volunteers, and treated with five various concentrations of Fe2+ and Fe3+ ions. Activity of butyryl cholinesterase (BChE) was assayed according to colorimetric EIIman procedure. The activity was calculated as micromole of hydrolyzed substrate, per minute in each ml. RESULTS: Both ferric (Fe3+) and ferrous (Fe2+) ions significantly decreased the BChE activity in all tested concentrations. The effect of ferric (Fe3+) ions on the reduction of plasma enzyme activity was more pronounced than ferrous (Fe2+) ions (p < 0.001, respect to control group). CONCLUSIONS: The present paper represents the effect of Fe2+ and Fe3+ ions on ButyrylChE activity in human plasma. It reveals that both ions suppress BChE activity.

Cholesteryl ester transfer protein I405V polymorphism influences apolipoprotein A-I response to a change in dietary fatty acid composition.

The aim of the present study was to investigate whether the cholesteryl ester transfer protein (CETP) I405V polymorphism modifies the response to changes in the dietary ratio of polyunsaturated to saturated fat (P:S). The population included 85 healthy subjects with the different I405V genotypes (35 II, 36 IV, and 14 VV) assigned to two consecutive 28-day experimental period. All subjects consumed a high-P:S with P:S of 1.2 for the first period and a low-P:S with a P:S of 0.3 for the next 28-day period. At the first and end of each dietary period, serum lipid, lipoprotein, and CETP concentrations were measured. At screening, lipid or lipoprotein concentrations were not significantly different among CETP I405V genotype groups. After the low-P:S diet, subjects carrying V allele had greater reduction in apoA-I and HDL cholesterol (HDL-C) than subjects with II genotype. A genotype-by-diet interaction effect was observed on apoA-I (p=0.016) concentrations. In conclusion, the CETP I405V polymorphism contributes to the unfavorable changes of apoA-I and HDL-C when a high-P:S diet was replaced with a low-P:S diet.

pH of pus collected from periapical abscesses.

AIM: To determine the pH of pus collected from periapical abscesses. METHODOLOGY: Forty patients (Male = 17/Female = 23) between the ages 17 and 37 years, each with a periapical abscess and with no relevant medical history, were recruited. All the participants had moderate-to-severe pain on percussion accompanied by localized or generalized swelling. At least 1 mL of pus was aspirated from each participant using a No 20 gauge needle. A pH meter was used to define the pH of the pus immediately following aspiration. RESULT: The mean pH of pus from the periapical abscesses of patients was 6.68 +/- 0.324 with a range between 6.0 and 7.3. There was no statistically significant difference in pH by gender or age. CONCLUSION: The mean pH of pus from periapical abscesses was generally acidic, but some samples (two female and three male) were neutral and some samples (four female and one male) were alkaline.

Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gastric cardia cancer.

INTRODUCTION: Atrophic gastritis is a risk factor for non-cardia gastric cancer, and gastro-oesophageal reflux disease (GORD) for oesophageal adenocarcinoma. The role of atrophic gastritis and GORD in the aetiology of adenocarcinoma of the cardia remains unclear. We have investigated the association between adenocarcinoma of the different regions of the upper gastrointestinal tract and atrophic gastritis and GORD symptoms. METHODS: 138 patients with upper GI adenocarcinoma and age- and sex-matched controls were studied. Serum pepsinogen I/II was used as a marker of atrophic gastritis and categorised to five quintiles. History of GORD symptoms, smoking and H pylori infection were incorporated in logistic regression analysis. Lauren classification of gastric cancer was used to subtype gastric and oesophageal adenocarcinoma. RESULTS: Non-cardia cancer was associated with atrophic gastritis but not with GORD symptoms; 55% of these cancers were intestinal subtype. Oesophageal adenocarcinoma was associated with GORD symptoms, but not with atrophic gastritis; 84% were intestinal subtype. Cardia cancer was positively associated with both severe gastric atrophy [OR, 95% CI: 3.92 (1.77 to 8.67)] and with frequent GORD symptoms [OR, 95% CI: 10.08 (2.29 to 44.36)] although the latter was only apparent in the non-atrophic subgroup and in the intestinal subtype. The association of cardia cancer with atrophy was stronger for the diffuse versus intestinal subtype and this was the converse of the association observed with non-cardia cancer. CONCLUSION: These findings indicate two distinct aetiologies of cardia cancer, one arising from severe atrophic gastritis and being of intestinal or diffuse subtype similar to non-cardia cancer, and one related to GORD and intestinal in subtype, similar to oesophageal adenocarcinoma. Gastric atrophy, GORD symptoms and histological subtype may distinguish between gastric versus oesophageal origin of cardia cancer.

Endovascular Stroke Therapy with a Novel 6-French Aspiration Catheter.

BACKGROUND AND PURPOSE: Direct thrombus aspiration is increasingly used as a first-line therapy in acute ischemic stroke with large vessel occlusion. We assessed the performance and safety of a novel aspiration catheter available: the 6-French AXS Catalyst catheter. MATERIALS AND METHODS: We conducted a cohort study from a prospective clinical registry of consecutive stroke patients treated by mechanical thrombectomy between March 2016 and July 2016. Baseline clinical and imaging characteristics, recanalization rates, complications, and clinical outcomes were analyzed. RESULTS: Among the 60 patients included, 30 were treated using aspiration alone, 14 were treated using aspiration and then stent retriever as a rescue therapy, and 16 were treated using aspiration combined with a stent retriever straightaway. Successful recanalization (mTICI2b/3) was achieved in 85% patients and functional independence in 48.3%. We observed one intracranial perforation and one vertebral artery dissection. Symptomatic intracranial hemorrhage occurred in 5% and mortality in 21.7%. CONCLUSION: Endovascular stroke therapy using the AXS Catalyst catheter seems safe and effective, with similar performance than other reperfusion catheters.

Serum level of anti-hepatitis B surface antigen 6-8 years after hepatitis B vaccination at birth.

The duration of protection after hepatitis B vaccination in children is unknown. We determined the serum level of antibody to hepatitis B surface antigen (anti-HBsAg) in 273 randomly selected 7-9-year-old schoolchildren from Zanjan City, Islamic Republic of Iran, who had been fully vaccinated against hepatitis B starting at birth. Titres < or = 10 mlU/mL were considered unprotective. Just over half of the children (52%) had titres < or = 10 mlU/mL with no difference between the sexes, while 81 (29.7%) had no anti-HBsAg (0 mlU/mL). Three of the children had antibodies to hepatitis B core protein. More studies are needed to determine the necessity for or timing of booster doses.

Childhood Pre-B acute lymphoblastic leukemia and glutathione S-transferase omega 1 and 2 polymorphisms.

INTRODUCTION: Acute lymphoblastic leukemia (ALL) is the most prevalent malignancy among children and makes up 23% of total childhood cancers worldwide. Pre-B ALL is one of the most common ALLs, comprising about 80% of childhood cases. A variety of genes are involved in metabolizing carcinogens. These gene polymorphisms can result in less efficient or overly-down metabolic pathways, which may contribute to the susceptibility to develop cancer. Glutathione S-transferase omega (GSTO) is a new known class among GSTs superfamily. GSTO1 and GSTO2 polymorphisms have been reported to be related to several types of disease. We assessed the association between GSTO1 and GSTO2 polymorphisms and childhood pre-B ALL risk in Iran. METHODS: This case-control study analyzed GSTO1 A140D (rs. 4925) and GSTO2 N142D (rs. 156697) gene polymorphisms using a polymerase chain reaction-restriction fragment length polymorphism method, in 100 patients and 120 healthy controls. RESULTS: The genotype frequencies were not significantly different between patients and healthy controls. Odds ratio (95% confidence intervals) for mutant homozygotes were 1.54 (0.628-3.778) and 0.791 (0.349-1.793) for GSTO1 A140D and GSTO2 N142D, respectively. CONCLUSION: This study found no significant association between Pre-B ALL and GSTO1 A140D and GSTO2 N142D polymorphisms.

Endocarditis associated with Erysipelothrix rhusiopathiae in a fat-tailed ram.

Endocarditis is rarely reported in sheep and information presented for ovine endocarditis is based mostly on comparative findings in the cattle. Infective vegetative endocarditis of the right heart was diagnosed in a 3-year-old fat-tailed ram. Clinical findings included tachycardia, marked brisket edema, jugular veins distention and pulsation and pale mucous membranes. Hematologic abnormality included neutrophilic leukocytosis. Necropsy confirmed severe right atrioventricular and pulmonary valves vegetative endocarditis with evidence of right heart failure. Erysipelothrix rhusiopathiae was isolated from those vegetative lisions.