Ultrasound characterization of the nail bed in patients with systemic lupus erythematosus.

OBJECTIVE: To characterize the ultrasound findings of the nail plate and nail bed in systemic lupus erythematosus (SLE) and its association with nail dystrophy. METHODS: Thirty-two SLE patients, 36 patients with osteoarthritis (OA) and 20 healthy individuals were studied. High-frequency linear ultrasound was performed in nails of the second to fifth fingers in all participants. Disease activity (SLEDAI-2K index), accrued organ damage (SLICC/ACR index), autoantibody profile, and Raynaud's phenomenon were also assessed in SLE patients. RESULTS: Nail bed thickness in SLE patients was higher than in healthy individuals (1.25 ± 0.31 mm vs 1.17 ± 0.29 mm; P = 0.01) but lower than in OA (1.39 ± 0.37 mm; P < 0.001), while nail plate thickness was similar among groups. Nail dystrophy was found more frequently in SLE and OA than in healthy individuals. SLE patients with nail dystrophy were older than their counterparts with no dystrophy (39.4 ± 10.4 years vs 27.8 ± 5.6 years; P = 0.004), although nail dystrophy showed no association with SLICC/ACR, SLEDAI-2K, nail bed vascularity, or autoantibodies. CONCLUSIONS: Nail bed in SLE patients is thicker than in healthy individuals but thinner than in OA patients. Nail dystrophy in SLE is associated with advanced age, but not with accrued organ damage, disease activity, Raynaud's phenomenon, or DIP synovitis assessed by ultrasound.

Effect of Melatonin as an Antioxidant Drug to Reverse Hepatic Steatosis: Experimental Model.

Introduction: The hepatic steatosis of the nonalcoholic origin or NAFLD is increasing at present, particularly in Western countries, parallel to the increase in obesity, constituting one of the most prevalent hepatic processes in the Western society. Melatonin has been successfully tested in experimental models in mice as a drug capable of reversing steatosis. The effect of melatonin on fat metabolism can be summarized as a decrease in lipid peroxidation and a decrease in oxidative stress, biochemical phenomena intimately related to fat deposition in the hepatocyte. There are hardly any studies in large animals. Objective: In this study, we investigate the effects of melatonin administered orally at a dose of 10 mg/kg/day to reverse established hepatic steatosis induced by a special diet in a porcine animal model. Materials and Methods: We analyze the parameters of oxidative stress: malondialdehyde (MDA), 4-hydroxyalkenals (4-HDA), and carbonyls, degree of fat infiltration (analyzed by direct vision by a pathologist and by means of a computer program of image treatment), and serological parameters of lipid metabolism and hepatic damage. These parameters were analyzed in animals to which hepatic steatosis was induced by means of dietary modifications. Results: We have not been able to demonstrate globally a beneficial effect of melatonin in the improvement or reversal of liver steatosis once established, induced by diet in a porcine animal model. However, we have found several signs of improvement at the histological level, at the level of lipid metabolism, and at the level of oxidative stress parameters. We have verified in our study that, in the histological analysis of the liver sample by means of the program image treatment (free of subjectivity) of the animals that continue with the diet, those that consume melatonin do not increase steatosis as much as those that do not consume it significantly (p=0.002). Regarding the parameters of oxidative stress, MDA modifies in a significant manner within the group of animals that continue with the diet and take melatonin (p=0.004). As for lipid metabolism, animals that maintain the steatotic diet and take melatonin lower total and LDL cholesterol levels and increase HDL levels, although these results do not acquire statistical significance. Conclusions: In this study, it has not been possible to demonstrate a beneficial effect of melatonin in the improvement or reversal of liver steatosis once established and induced by diet in the porcine model. It is true that signs of improvement have been found at the histological level, at the level of lipid metabolism, and at the level of oxidative stress phenomena, when comparing animals with established steatosis that are treated with melatonin with those who do not take it. This work is the first study conducted in a large animal model in which the effect of melatonin is studied as a treatment in the reversal of established hepatic steatosis.

Ultrasound in the interstitial pulmonary fibrosis. Can it facilitate a best routine assessment in rheumatic disorders?

Ultrasound (US) is increasing its potential in the assessment of several rheumatic disorders. Recently, different applications of this imaging technique have emerged. Interesting data supporting its utility and validity in the assessment of the lung to detect and quantify interstitial pulmonary fibrosis in rheumatic diseases, even in subclinical phases, have been reported. The main purpose of this review is to provide an overview of the role of US in the assessment of interstitial pulmonary fibrosis in rheumatic disorders and to discuss the current evidence supporting its clinical relevance in daily clinical practice.

Small ablation zones created previous to saline infusion result in enlargement of the coagulated area during perfusion RF ablation: an ex vivo experimental study.

One of the strategies for enlarging coagulation zone dimensions during RF ablation of liver tumours is to infuse saline solutions into the tissue during ablation. The aim of this study was to evaluate experimentally whether the creation of a small coagulation adjacent to a bipolar RF applicator and prior to perfused RF ablation would allow enlargement of the coagulation zone. Thirty bipolar RF ablations (group A, n = 15; group B, n = 15) were performed in excised bovine livers. Additionally, in group B a monopolar RF application (60 W, 20 s) was performed before bipolar ablation using three small additional electrodes. Electrical parameters and dimensions of the ablation zone were compared between groups. Despite the fact that all three ablation zone diameters were greater in group B, only one of the minor diameters was significantly longer (5.52 +/- 0.66 cm versus 4.87 +/- 0.47 cm). Likewise, volume was significantly bigger in group B (100.26 +/- 24.10 cm(3) versus 79.56 +/- 15.59 cm(3)). There were no differences in the impedance evolution, allowing a relatively high constant power in both groups (around 90 W). The efficacy of delivering energy (expressed as the delivered energy per coagulation volume) was significantly better in group B, showing a lower value (578 J cm(-3) versus 752 J cm(-3)). These results suggest that the creation of small ablation zones prior to saline infusion improves the performance of this perfusion system, and hence the total volume.

Improved perfusion system for bipolar radiofrequency ablation of liver: preliminary findings from a computer modeling study.

Current systems for radiofrequency ablation of liver tumors are unable to consistently treat tumors larger than 3 cm in diameter with a single electrode in a single application. One of the strategies for enlarging coagulation zone dimensions is to infuse saline solutions into the tissue through the active electrodes. Nevertheless, the uncontrolled and undirected diffusion of boiling saline into the tissue has been associated with irregular coagulation zones and severe complications, mainly due to reflux of saline along the electrode path. In order to improve the perfusion bipolar ablation method, we hypothesized that the creation of small monopolar coagulation zones adjacent to the bipolar electrodes and previous to the saline infusion would create preferential paths for the saline to concentrate on the targeted coagulation zone. Firstly, we conducted ex vivo experiments in order to characterize the monopolar coagulation zones. We observed that they are practically impermeable to the infused saline. On the basis of this finding, we built theoretical models and conducted computer simulations to assess the feasibility of our hypothesis. Temperature distributions during bipolar ablations with and without previous monopolar coagulation zones were obtained. The results showed that in the case of monopolar coagulation zones the temperature of the tissue took longer to reach 100 degrees C. Since this temperature value is related to rise of impedance, and the time necessary for this process is directly related to the volume of the coagulation zone, our results suggest that monopolar sealing would allow larger coagulation zones to be created. Future experimental studies should confirm this benefit.