Distribution of Calretinin Immunoreactivity in the Lateral Nucleus of the Bottlenose Dolphin (Tursiops truncatus) Amygdala.

The amgdaloid complex consists of different nuclei, each with unique cytoarchitectonic, chemoarchitectonic and connectional characteristics. Most of the inputs coming from cortical and subcortical areas enter the amygdala via the lateral nucleus, which makes it the main receiving structure of the complex. The activity of its neurons is coordinated and modulated by different inhibitory, GABAergic-interneurons, which can be classified for their expression of various calcium-binding proteins, as well as by morphological characteristics. This research based on the analysis of the amygdala of three bottlenose dolphins, provides the first description of the topography, cytoarchitecture and distribution of calretinin immunoreactivity of the lateral nucleus. Our observations on the bottlenose dolphin confirmed the general topography of the mammalian amygdala and of the lateral nucleus. Notably, we identified six subdivision of the nucleus, more than those reported until now in the rat, monkey and human lateral nucleus. This could reveal an outstanding capability of integration and elaboration of external stimuli. In addition, we observed a strong presence of CR-immunoreactive (-ir) neurons and fibres. CR-ir neurons were mainly non-pyramidal inhibitory neurons; in particular, 80% of IR-cells were represented by large and small polygonal neurons. In the lateral nucleus of the human amygdala, CR-ir neurons form inhibitory synapses on calbindin-D28k-IR inhibitory interneurons. Since calbindin-D28k-ir interneurons make inhibitory synapses on the pyramidal cells, the final goal of the CR-ir interneurons could be the synchronization of cells activity, thus playing an important role in the control of information flow in the lateral amygdalar nucleus. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 300:2008-2016, 2017. © 2017 Wiley Periodicals, Inc.

[Bipartite carpal scaphoid with osteonecrosis of the proximal pole - differential diagnosis of pseudarthrosis]. / Os scaphoideum bipartitum mit Osteonekrose des proximalen Anteils - Differenzialdiagnose zur Pseudarthrose.

We report on the case of a young patient with bipartite carpal scaphoid with osteonecrosis of the proximal pole. The important differentiation of this entity to the pseudarthrosis of the scaphoid is discussed.

Anti-annexins autoantibodies: their role as biomarkers of autoimmune diseases.

Annexins are a group of 12 highly conserved proteins which exert several regulatory functions on cell biology. There are involved in numerous cell processes including vesicle trafficking, calcium signaling, cell growth, division, and apoptosis. Autoantibodies directed toward annexin I, II, V and XI have been reported, but their role and their clinical correlates are controversial. Annexin I exerts an anti-inflammatory effect by suppressing the generation of inflammatory mediators and anti-annexin I antibodies were detected in patients affected with rheumatoid arthritis, systemic (SLE) and cutaneous lupus erythematosus. Annexin II and V have a high affinity for phospholipids playing a pivotal role in the regulation of coagulation cascade. Anti-annexin II and anti-annexin V antibodies were found in patients with arterial or venous thrombosis, especially in those with autoimmune rheumatic diseases (ARD) such as SLE, primary antiphospholipid syndrome (APS) or systemic sclerosis. Anti-annexin V antibodies were also found in patients with pregnancy loss with or without APS. Annexin XI is involved in several biological pathways, particularly apoptosis and cell proliferation. Anti-annexin XI antibodies have been found in patients with SLE, undifferentiated connective tissue disease, rheumatoid arthritis, Sjögren's syndrome and APS. The metanalysis of studies published up to now showed that the Odds Ratio for having an ARD in anti-annexin XI positive patients was 5.08 (95% CI 2.06-12.58).

Infections as triggers and complications of systemic lupus erythematosus.

A growing body of experimental and clinical evidence supports the pivotal role of infections in the induction or exacerbation of systemic lupus erythematosus (SLE). Infections can be responsible for aberrant immune response leading to a loss of tolerance towards native proteins. Molecular mimicry, especially between Sm or Ro autoantigens and EBV Nuclear Antigen-1 response, as well as the over-expression of type 1 INF genes are among the major contributors to SLE development. On the other hand infections are very common in SLE patients, where they are responsible for 30-50% of morbidity and mortality. Several factors, either genetic, including complement deficiencies or mannose-binding lectin deficiency or acquired such as severe disease manifestations or immunosuppressant use, predispose SLE patients to infections. All types of infections, including bacterial, viral and opportunistic infections, have been reported and the most frequently involved sites of infections are the same as those observed in the general population, including respiratory, skin, and urinary tract infections. Some preventive measures could be adopted in order to reduce the rate of infections in SLE patients: i.e. screening for Mycobacterium tuberculosis and for some chronic viral infections before immunosuppressive treatment; adequate prophylaxes or drug adjustments when indicated, and pneumococcal and influenza vaccinations in patients with stable disease.

Infections, connective tissue diseases and vasculitis.

In genetically predisposed individuals, viruses, bacteria, or parasitic infectious agents are suspected of inducing autoimmunity and/or exacerbating autoimmune rheumatic diseases (ARD) once self-tolerance is broken. Although direct evidence for this association is still lacking, numerous data from animal models as well as from humans support the hypothesis of a direct contribution of pathogens to the induction of several ARD. This review focuses on the possible role of infectious agents as triggers of autoimmunity in systemic lupus erythematosus, polymyositis-dermatomyositis, antiphospholipid antibody syndrome, and primary vasculitis. Indeed, vasculitis may be a clinical manifestation of an infectious disease (secondary vasculitis). In addition, immune response abnormalities and immunosuppressive medications may be responsible for the high percentage of infectious complications in ARD patients. Recent therapeutic approaches aimed at lowering doses of cytotoxic agents and shortening duration of treatment with the most toxic drugs, have proved to be as effective as conventional regimens. New drugs and strategies aimed at preventing infections could further improve the outcome of ARD patients.

[Results after simple trapeziectomy and capsular fixation for osteoarthritis of the trapeziometacarpal joint]. / Ergebnisse nach alleiniger Trapezektomie und Kapselraffung bei der Behandlung der Rhizarthrose.

BACKGROUND: Resection arthroplasty of the carpometacarpal joint of the thumb is considered to be the most frequently used surgical treatment for osteoarthritis of the trapeziometacarpal joint. Although simple trapeziectomy and fixation of the capsular tissue have been found to be an easy, successful treatment, the ligament reconstruction and tendon interposition in different techniques is still widely used. We evaluate the results of our patients after simple trapeziectomy. PATIENTS AND METHODS: Thirty-four thumbs were treated by simple trapeziectomy and fixation of the dorsal capsular tissue. If the dorsal capsular tissue seemed to be weak, it was fixed with a mitek anchor (Minilok Quickanchor, De Puy Mitek, Raynham, USA) to the distal scaphoid pole. Assessment included patient satisfaction, pain measurement, range of motion and tip, key and grip strength. RESULTS: After a mean follow-up of 26.9 (8-61) months, 91% were satisfied with the outcome, 94.1% would undergo the procedure again. 41% of the patients reported complete pain relief, 44% had pain only with large mechanical load. At follow-up, the mean DASH score was 29.2 (+/-21.7). We noticed in 29% paraesthesia at the back of the thumb, suggesting damage to branches of the superficial radial nerve. Furthermore, we tried two easy functional tests: 91% of the patients could hold a cup of coffee without any pain, 76.4% could hold a one-litre bottle without pain. CONCLUSION: The collected data confirm that the simple trapeziectomy is a safe and relative simple procedure for treatment of carpometacarpal osteoarthritis of the thumb.

Scleroderma-like disorders.

Fibrosing disorders comprise a wide spectrum of heterogeneous diseases characterized by sclerosis of the dermis, subcutis, and sometimes the underlying soft tissues and bone. The hallmark of this group of diseases is skin thickening as in systemic sclerosis with a different distribution pattern and for this reason they have also been referred to as "scleroderma-like" disorders. These diseases may have a different clinical course ranging from a benign disease with a localized cutaneous involvement, to a widespread, systemic, life-threatening disease. Some of them are associated with autoantibodies and/or autoimmune conditions. An accurate recognition of these scleroderma-like diseases is important for the institution of the most appropriate treatment.

Long-term follow-up after finger and upper-limb replantation: clinical, angiologic, and lymphographic studies.

This 10-year follow-up study evaluates 25 patients with a total of 57 successfully replanted fingers and six successfully replanted upper limbs. The global functional loss, including loss of range of motion, sensibility, and strength of the hand, was determined using the "Millesi score." The hemodynamic parameters of replanted and control fingers under resting and stress conditions were measured using a laser Doppler flowmeter. The lymphatic system at the site of replantation was examined by fluorescence microlymphography. All patients showed a considerable functional loss, according to the Millesi score, that averaged 56 percent of the normal function of the hand. In order to overcome functional deficit, many patients had developed successful compensatory mechanisms. In general, the patients themselves subjectively rated their functional deficits lower than indicated by the Millesi score. Laser Doppler flowmetry at rest and after arterial occlusion, and capillaroscopy before, during, and after a cold provocation test, revealed subnormal resting flow conditions and significantly decreased vascular capacity in the replanted fingers. Lymphatic drainage capacity was also significantly reduced despite documented reanastomosis between the skin microlymphatic network distal and proximal to the scar (fluorescence microlymphography). The coexistence of functional loss with compensatory mechanisms, decreased reactive hyperemia, and deficit in lymphatic drainage, present in all patients, must be considered as definitive sequelae of the initial injury.