Interleukin levels and depressive symptoms in psoriatic arthritis patients: insights from a case-control study on socio-demographic factors and disease perception.

In the course of psoriatic arthritis (PsA), depression occurs much more often than in the general population. Depression can be considered a poor prognostic factor. The aim of the study was to assess the relationships between the occurrence of depression and the levels of proinflammatory cytokines in patients with PsA. The study included 86 (47F/39M) patients with PsA. Only patients with high disease activity (DAPSA > 28) were enrolled in the study. The severity of depressive symptoms was assessed using the Beck Depression Inventory II (BDI-II) for all patients. Additionally, sociodemographic data were collected. All patients were also assessed for the levels of interleukins (IL): IL-1, IL-6, IL-17A, IL-23, and tumor necrosis factor alpha (TNF-α) using the enzyme-linked immunosorbent assay (ELISA) test. In the study group, depression (BDI-II ≥ 14) was diagnosed in 45 patients (52%). Patients with coexisting depression reported higher levels of pain and disease activity on the visual analogue scale compared to patients without depression (8.5 vs. 7.7, p < 0.001 and 9.3 vs. 8.4, p < 0.001, respectively). The mean levels of proinflammatory cytokines [pg/ml], IL-1 and IL-6, were also higher in the group of patients with depression (46.4 vs. 4.7, p < 0.001 and 10.5 vs. 4.9, p < 0.001, respectively). The coexistence of depression in the course of Psoriatic Arthritis (PsA) is associated with higher levels of IL-1 and IL-6. Depression has a negative impact on the perception of the underlying disease and is linked to reduced social and occupational activity.

Mechanical Thrombectomy in Stroke-Retrospective Comparison of Methods: Aspiration vs. Stent Retrievers vs. Combined Method-Is Aspiration the Best Starting Point?

Background: There are three main methods of mechanical thrombectomy (MT): using a stent retriever (SR) only (SO), aspiration catheter (AC) only (AO) and the combined method (CM) using both the SR and AC. This paper describes a real-life, single-center experience using SO, AO and CM during 276 consecutive MTs. Methods: The primary endpoint was the frequency of first-pass complete (FPE TICI3). The secondary endpoints were final mTICI 2b-3, procedure duration, clinical outcome and the total number of device passes. The third aim of this study was to test the association between the clinical outcomes in patients treated with each method and various factors. Results: There was a significant difference (p = 0.016) between the groups' FPE TICI3 rates with 46% mTICI 3 in the AO group, 41% in the CM group and 21% in the SO group. AO resulted in procedure time shortening to a mean duration of 43 min, and the scores were 56 min for CM and 63 min for SO (p < 0.0001). There were no significant differences in clinical outcomes or in-hospital mortality. The analysis showed a correlation between good clinical outcomes and the administration of IVT: OR 1.71 (1.03-2.84) p = 0.039. Patients ≥66 years old had higher odds of a bad outcome compared to younger patients in general (OR, 1.99 95% CI, 1.17-3.38; p = 0.011). FPE TICI3 was associated with good functional outcomes in the whole treated cohort (OR, 1.98; 95% CI, 1.21-3.25; p = 0.006). Conclusions: In our series, AO proved to be the best starting point in most cases. It demonstrates good technical efficacy regarding FPE, it is fast and clinical outcomes seem to be the least age- and FPE TICI3-dependent. It can be easily converted into the combined method, which had the second-best outcomes in our cohort.

Comparison of advanced glycation end products concentration in the skin among patients with rheumatic diseases, with and without comorbid depression: a case-control study.

Patients with rheumatic diseases suffer depression at a far greater rate than the general population. Aside from evident mental health degradation, in this group of patients depression can often lead to failures in the treatment of the basic disease. The aim of the study was to assess the concentration of advanced glycation end-products (AGE) in the skin autofluorescence (SAF) exam in patients with select rheumatic diseases depending on depression concomitance. 139 patients with rheumatic diseases were enrolled into the study-43 (39F/4 M) patients with RA, 31 (24F/7 M) patients with PsA, 27 (22F/5 M) patients with SLE and 38 (33F/5 M) patients with SSc. In all patients, the concentration of AGE was assessed using the AGE Reader device (DiagnOptics BV Groningen, The Netherlands). The Beck Depression Inventory II was used to assess depression in the patients. Patients who scored 14 points or more in the BDI-II were diagnosed with depression. In the studied group, depression was identified in 73 (53%) patients-25 with RA, 21 with PsA, 11 with SLE and 16 with SSc. Mean SAF in patients with depression was 2.8 ± 0.4, and in the group with no depression-2.2 ± 0.5 (p < 0.001). The study results indicate that in the course of rheumatic diseases, the presence of depression may influence the increase in AGE concentration in the skin. Therefore, evaluating AGE levels in the skin may be clinically relevant as it can help identify patients who may be at risk of developing depression.

Comparison of Physical Fitness, Self-Assessed Resilience, and Self-Assessed Character Traits between Elite Polish Obstacle Course Racers and Polish Special Operations Force Personnel.

INTRODUCTION: Some of the obstacle Course Race (OCR) competitions are co-organized by military units that are seeking candidates for service in special operations forces (SOFs). The aim of the study was to compare psycho-physical characteristics between Polish OCR athletes and SOF soldiers, in order to assess the possibility of recruiting future SOF soldiers from the OCR community. MATERIALS AND METHODS: The study included 23 OCR competitors, and 17 soldiers from JW Formoza were used as the comparative group. The psychological measure of resilience was assessed using the Connor-Davidson Resilience Scale. Participants also completed a survey in which they had to rank character strengths. Physical fitness was assessed on the basis of a 3000-m run and the maximum number of sit-ups and straight pull-ups. RESULTS: There were significant differences between OCR participants and JW Formoza soldiers: body mass index, 24.1 ± 1.5 vs. 25.9 ± 1.9 (P = .002); 3000-m run, 11:59 ± 0:49 vs. 12:11 ± 0:28 (P = .024); and straight pull-ups, 19 ± 3 vs. 15 ± 3 (P = .001). The most commonly chosen character strengths in both groups were self-control, team worker, and optimism. CONCLUSIONS: OCR competitors show psychophysical characteristics similar to those expected from actual SOF personnel.

Towards a Computational Approach for the Assessment of Compliance of ALCOA+ Principles in Pharma Industry.

The pharmaceutical industry is a data-intensive environment and a heavily-regulated sector, where exhaustive audits and inspections are performed to ensure the safety of drugs. In this context, processing and evaluating the data generated in the manufacturing lines is a relevant challenge since it requires compliance with pharma regulations. This work combines data integrity metrics and blockchain technology to evaluate the compliance-degree of ALCOA+ principles among different levels of drug manufacturing data. We propose the DIALCOA tool, a software to assess the compliance-degree for each ALCOA+ principle, based on the assessment of data from manufacturing batch reports and its different levels of information.

The applicability of trabecular bone score for osteoporosis diagnosis in ankylosing spondylitis.

Ankylosing spondylitis (AS) patients have a high risk of osteoporotic fractures. The aim of this study was to evaluate the usefulness of trabecular bone score (TBS) in assessing fracture risk in patients with AS. 67 patients meeting the ASAS classification criteria were enrolled in the study. Fracture risk for each patient was assessed based on a lumbar spine exam encompassing bone mineral density (BMD), and TBS through a dual-energy X-ray absorptiometry (DXA) exam. In addition, each patient had an X-ray taken of their lumbar and thoracic spine to determine the presence of syndesmophytes and bony bridges, as well as spinous process and vertebral body fractures. Moreover, each patient's medical history was analyzed for other osteoporotic fractures. A major osteoporosis fracture (MOF) was found in 11 (16%) patients in total, of which 7 (10%) were vertebral body fractures. The mean TBS in patients with MOF and no MOF were, respectively, 1.12 and 1.29 (p < 0.001). No significant differences were found in BMD scores between the two groups. Syndesmophytes and bony bridges occurred more frequently in patients with MOF (p = 0.02). Age of 50 or more (RR = 9.86, p = 0.002), TBS score ≤ 1.31 (RR = 2.07, p < 0.0001), and presence of syndesmophytes and bony bridges (RR = 2.14, p = 0.04) were considered a relative risk (RR) increasing factors. TBS is a markedly more sensitive method of identifying patients with a high fracture risk compared to BMD measurement in a DXA exam in patients with AS.

A 39-Year-Old Woman with Cervicofacial and Mediastinal Emphysema 10 Hours After an Elective Lower Molar Dental Extraction.

BACKGROUND Mediastinal emphysema, also called pneumomediastinum, is a very infrequent condition in patients reporting to an Emergency Department. Mediastinal emphysema is the pathologic presence of free air enclosing the mediastinal structures. In the case of chest pain in a young healthy adult, pneumomediastinum as a differential diagnosis will undoubtedly be omitted. This would be especially likely if the symptoms are not preceded by an injury, intense vomiting, or an infection in this area. CASE REPORT We present a case in which a previously healthy 39-year-old woman experienced painless progressive face and neck swelling, dyspnea, and retrosternal pain several hours after a dental procedure. Physical examination revealed crackles on palpation of the skin on the right part of the face, neck, and chest. Neck and chest computed tomography confirmed subcutaneous neck and upper chest emphysema and pneumomediastinum. The patient was transferred to the thoracic surgery ward. After 2 days of prophylactic intravenous administration of antibiotics, she was discharged for further scheduled treatment at the Maxillofacial Surgery Clinic. CONCLUSIONS This report presented a rare case of a woman who reported to the Emergency Department with subcutaneous and mediastinal emphysema following routine molar dental extraction. Emergency Department physicians should be aware of the possibility of delayed complications after standard dental procedures. A detailed medical history and clinical examination will enable making a correct diagnosis so as not to jeopardize the health of a patient, and in the case of the development of mediastinitis, even the patient's life.

Tractography-Based Analysis of Morphological and Anatomical Characteristics of the Uncinate Fasciculus in Human Brains.

(1) Background: The uncinate fasciculus (UF) is a white matter bundle connecting the prefrontal cortex and temporal lobe. The functional role of the uncinate fasciculus is still uncertain. The role of the UF is attributed to the emotional empathy network. The present study aimed to more accurately the describe anatomical variability of the UF by focusing on the volume of fibers and testing for correlations with sex and age. (2) Material and Methods: Magnetic resonance imaging of adult patients with diffusion tensor imaging (DTI) was performed on 34 patients. The total number of fibers, volume of UF, and number of tracts were processed using DSI studio software. The DSI studio allows for mapping of different nerve pathways and visualizing of the obtained results using spatial graphics. (3) Results: The total number of UF tracts was significantly higher in the right hemisphere compared to the left hemisphere (right M ± SD = 52 ± 24; left: 39 ± 25, p < 0.05). A hook-shaped UF was the most common variant (91.7%). The UF volumes were larger in men (1410 ± 150.7 mm3) as compared to women (1325 ± 133.2 mm3) (p < 0.05). The mean fractional anisotropy (FA) values of the UF were significantly larger on the left side 0.597, while the right UF had an average of 0.346 (p < 0.05). Patients older than 50 years old had a significantly higher value of mean diffusivity (MD) (p = 0.034). In 73.5% of patients, a greater number of fibers terminated in the inferior part of the inferior frontal gyrus. (4) Conclusions: The morphological characteristics of the UF, unlike the shape, are associated with sex and are characterized by hemispheric dominance. These findings confirm the results of the previous studies. Future research should examine the potential correlation among the UF volume, number of fibers, and total brain volume in both sexes and patient psychological state.

The changing role of ultrasonography examination in patients with rheumatoid arthritis in light of recent studies.

For many years, ultrasonography (US) has been a widely accepted modality used for joint assessment in patients with rheumatoid arthritis (RA). Given the efficacy of present day therapies, there is scepticism whether it is required in the first place. The most recent clinical Targeting synovitis in Early Rheumatoid Arthritis (TaSER) and Clinical Tight Control Therapy (ARCTIC) trials' results appear to contradict it, yet this does not necessarily mean ultrasound has no place in modern rheumatology. The possibility of detecting inflammation at a subclinical level carries a tremendous predictive value, enabling identification of patients likely to experience an exacerbation in the coming months. Therefore, US should be a part of the decision-making process regarding treatment modification or introduction of any additional interventions, such as glucocorticosteroid injections. The results of the most recent clinical trials do not negate the usefulness of US, but merely suggest that it ought to be used in moderation.

The role of ultrasonography in the diagnostic criteria for rheumatoid arthritis and monitoring its therapeutic efficacy.

Rheumatoid arthritis (RA) is a chronic systemic disease of connective tissue. It is characterized by symmetrical multiple joint involvement and extra-articular symptoms. Modern RA treatment methods place a particular emphasis on the earliest possible diagnosis and initiation of appropriate treatment. Currently, ultrasonography (US) is the key imaging test performed in RA patients. However, despite the general acknowledgement of its role in the assessment of disease activity, US was not included in the applicable ACR/EULAR criteria. This is due to the lack of strictly defined criteria for US evaluation and the interpretation of test results. In addition, the absence of a correlation between the common DAS/DAS28 disease activity score and ultrasound assessment of joints makes developing new diagnostic criteria difficult. The objective of this article is to review recent scientific reports on the use of ultrasonography in the diagnosis and monitoring of RA and to indicate current problems associated with the interpretation of test results and the comparison with applicable scores of disease activity.

The role of ultrasonography in monitoring long-standing rheumatoid arthritis: a pilot study.

OBJECTIVE: Rheumatoid arthritis (RA) is a condition that poses many diagnostic problems. As a result, it is often diagnosed too late, which makes effective treatment more difficult. The course of the disease is chronic, and it causes irreversible changes in the musculoskeletal system, as well as bone destruction, and this in turn impairs the proper monitoring of the treatment. Therefore, in order to assess the treatment's efficacy, as well as a clinical examination of the patient and laboratory tests, diagnostic imaging is being used more frequently in routine practice. The aim of this paper is to assess the usefulness of power Doppler ultrasonography in the assessment of MCP joints in patients with chronic RA (LSRA), in comparison with DAS28, X-ray, and MRI. MATERIAL AND METHODS: The study involved 26 patients with LSRA, treated with biologics. It lasted for a year. At the moment of enrolment, the condition had lasted for a minimum of 5 years, and DAS28 was > 5.1. The patients had visits every three months. During every visit, a PDUS test was performed and the DAS28 was determined. In the first and last month of the study the patients underwent X-ray and MRI tests. RESULTS: At the end of the study, the DAS28 of 26 (100%) patients was lower or equal to 3.2. Based on PDUS and MRI tests, no synovitis was found in 21 (81%) and 18 (69%) patients, respectively. According to the MRI results, radiological changes progressed in 5 (19%) of them. All patients who showed progress of radiological changes also had visible synovitis during their PDUS test. CONCLUSIONS: PDUS in patients with LSRA can be helpful in selecting patients, who are likely to develop a progression of radiological changes.

Osteoporosis diagnostics in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease. The development of comorbidities often occurs in the course of RA. One of them is osteoporosis, which has serious social and economic effects and may contribute to the increase in the degree of disability and premature death of the patient. Due to the young age in which RA disease occurs, densitometry (DXA) of the lumbar spine is the basic examination in osteoporosis diagnostics. In the course of RA, much more frequently than in healthy persons of the same age, osteoporotic fractures of vertebral bodies occur, which hinder a correct assessment in the DXA test. Rheumatoid arthritis patients often undergo computed tomography (CT) examination of the abdominal cavity for other medical indications than suspected spinal injury. Then, CT examination may also serve for the assessment of bone density, especially in patients with osteoporotic fractures.

DAS28 score vs. ultrasound examination for assessment of rheumatoid arthritis disease activity: comparison and discussion of pros and cons.

Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease which is characterized by symetrical multiple joints involvement and extra-articular symptoms. Current EULAR diagnostic criteria for RA include disease activity parameters, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are used to calculate disease activity scores, including DAS and DAS28. Recently attempts have been made to assess disease activity using imaging diagnostic modalities, such as magnetic resonance imaging (MRI) and ultrasonography (US). Due to significant progress in therapy effectiveness and early RA diagnosis possibility, imaging modalities become increasingly meaningful and many clinical trials confirm their usefulness. However, there are no consistent criteria for objective assessment of therapy effectiveness based on US. Moreover, it is not US availability that limits its common use, but rather significant variability between operators. This is why US remains only an additional tool to assess therapy efficacy with regard to DAS/DAS28 index.

Coexistence of rheumatoid arthritis and ankylosing spondylitis.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic progressive inflammatory diseases, leading to joint damage and reducing the physical fitness of patients. They are among the most common rheumatic diseases. However, their etiology and symptomatology are different. Formerly, AS was often wrongly diagnosed as RA. Today there are no major diagnostic difficulties in differentiation between these diseases, thanks to modern laboratory tests and imaging. However, a problem may arise when the patient has symptoms typical for both diseases simultaneously. Cases of coexistence of RA with AS - according to our best knowledge - are rare. This study aims to compare our experience in diagnosis and treatment of concomitant RA and AS with the experience of other researchers. Implementation of the proper diagnostic algorithm, allowing for correct diagnosis of both diseases in one patient, may be useful for differential diagnosis of similar cases in the future.

[Modern ultrasonographic techniques for the study of the synovial membrane in rheumatic diseases]. / Nowoczesne techniki ultrasonograficzne blony maziowej w chorobach reumatycznych.

In recent years ultrasonography has become one of basic imaging techniques used by radiologists, orthopedists, and rheumatologists for the study of the musculoskeletal system, particularly in patients with rheumatic diseases. This position of ultrasonography is the result of rapid technical advances. Contemporary ultrasound scanners have little in common with those used when ultrasonography was introduced into medicine. Modern ultrasound scanners offer additional options like tissue harmonic imaging, power color Doppler, volumetric ultrasonography (3D/4D imaging), and contrast-enhanced ultrasonography. Moreover, image resolution during examination has significantly been improved thanks to high-resolution transducers and software for image analysis. This article discusses modern ultrasonographic techniques and their use.