Sex-specific diagnostic efficacy of MRI in axial spondyloarthritis: challenging the 'One Size Fits All' notion.

OBJECTIVES: Sex-specific differences in the presentation of axial spondyloarthritis (axSpA) may contribute to a diagnostic delay in women. The aim of this study was to investigate the diagnostic performance of MRI findings comparing men and women. METHODS: Patients with back pain from six different prospective cohorts (n=1194) were screened for inclusion in this post hoc analysis. Two blinded readers scored the MRI data sets independently for the presence of ankylosis, erosion, sclerosis, fat metaplasia and bone marrow oedema. Χ2 tests were performed to compare lesion frequencies. Contingency tables were used to calculate markers for diagnostic performance, with clinical diagnosis as the standard of reference. The positive and negative likelihood ratios (LR+/LR-) were used to calculate the diagnostic OR (DOR) to assess the diagnostic performance. RESULTS: After application of exclusion criteria, 526 patients (379 axSpA (136 women and 243 men) and 147 controls with chronic low back pain) were included. No major sex-specific differences in the diagnostic performance were shown for bone marrow oedema (DOR m: 3.0; f: 3.9). Fat metaplasia showed a better diagnostic performance in men (DOR 37.9) than in women (DOR 5.0). Lower specificity was seen in women for erosions (77% vs 87%), sclerosis (44% vs 66%), fat metaplasia (87% vs 96%). CONCLUSION: The diagnostic performance of structural MRI markers is substantially lower in female patients with axSpA; active inflammatory lesions show comparable performance in both sexes, while still overall inferior to structural markers. This leads to a comparably higher risk of false positive findings in women.

L1 Reading Experience Influences L2 Lexical Learning: Spanish Learning in Chinese Speakers and English Speakers.

L2 processing is shaped by L1 experience; however, it is not completely understood whether L1 reading experience also influences how the brain learns L2 under different learning conditions. In this study, we compare brain mechanisms of Spanish word learning in Chinese and English speakers using two learning conditions: speech-based learning and handwriting-based learning. The behavioral data suggest an advantage for learning that uses handwriting over speech-based learning across all participants. Furthermore, brain imaging data reveal that English speakers show greater functional connectivity among phonological regions in the handwriting condition than the speech-based condition during a silent phonological recall task. This suggests that, for English speakers specifically, handwriting further enhanced the phonological network. Interestingly, Chinese speakers showed an opposite pattern, with greater functional connectivity among phonological regions in the speech-based condition than the handwriting condition. Moreover, it was found that Chinese speakers with higher reading skills in their native L1 tended to engage the right fusiform to a greater degree by connecting to phonological regions in the handwriting condition. Thus, the handwriting-based learning engaged visuo-orthographic regions to a greater degree in highly skilled Chinese speakers. In summary, the current findings suggest that handwriting facilitates lexical learning by enhancing orthographic involvement in Chinese speakers, while the handwriting condition enhanced phonological involvement in English speakers. This difference between Chinese and English speakers might be due to different L1 learning experience.

Different mechanisms in learning different second languages: Evidence from English speakers learning Chinese and Spanish.

Word reading has been found to be associated with different neural networks in different languages, with greater involvement of the lexical pathway for opaque languages and greater invovlement of the sub-lexical pathway for transparent langauges. However, we do not know whether this language divergence can be demonstrated in second langauge learners, how learner's metalinguistic ability would modulate the langauge divergence, or whether learning method would interact with the language divergence. In this study, we attempted to answer these questions by comparing brain activations of Chinese and Spanish word reading in native English-speaking adults who learned Chinese and Spanish over a 2 week period under three learning conditions: phonological, handwriting, and passive viewing. We found that mapping orthography to phonology in Chinese had greater activation in the left inferior frontal gyrus (IFG) and left inferior temporal gyrus (ITG) than in Spanish, suggesting greater invovlement of the lexical pathway in opaque langauges. In contrast, Spanish words evoked greater activation in the left superior temporal gyrus (STG) than English, suggesting greater invovlement of the sublexical pathway for transparant languages. Furthermore, brain-behavior correlation analyses found that higher phonological awareness and rapid naming were associated with greater activation in the bilateral IFG for Chinese and in the bilateral STG for Spanish, suggesting greater language divergence in participants with higher meta-linguistic awareness. Finally, a significant interaction between the language and learning condition was found in the left STG and middle frontal gyrus (MFG), with greater activation in handwriting learning than viewing learning in the left STG only for Spanish, and greater activation in handwriting learning than phonological learning in the left MFG only for Chinese. These findings suggest that handwriting facilitates assembled phonology in Spanish and addressed phonology in Chinese. In summary, our study suggests different mechanisms in learning different L2s, providing important insights into neural plasticity and important implications in second language education.

Association of biomarkers of inflammation, cartilage and bone turnover with gender, disease activity, radiological damage and sacroiliitis by magnetic resonance imaging in patients with early spondyloarthritis.

To assess the association between biomarkers of inflammation, cartilage and bone turnover with gender, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Spondylitis Disease Activity Score (ASDAS) and bone marrow oedema in resonance magnetic imaging (MRI) of sacroiliac joints (SIJs) and radiological damage in early spondyloarthritis (SpA). Cross-sectional study of 60 patients (56.7 % females; mean age, 32.4 years) with early SpA. Sociodemographic data, clinical features, serum matrix metalloproteinase 3 (MMP-3), high sensitivity C-reactive protein (hsCRP), C-terminal cross-linking telopeptides of type I collagen (CTX-I) and urinary deoxypyridinoline, ASDAS, BASDAI, BASFI, BASRI and MRI of the SIJs were collected. The mean (SD) disease duration was 12.4 (6.8 months). Twenty-two (68.7 %) of the 32 patients had active sacroiliitis by MRI. MMP-3 and CTX I correlated with swollen joint (r = 0.515, r = 0.386, p = 0.01). hsCRP correlated with ESR (r = 0.303, p = 0.05), with CRP (r = 0.455, p = 0.01) and with total BASRI (r = 0.95, p = 0.05). Biomarkers were unrelated with the rest of variables. Levels of MMP-3 (44.3 ± 52.4 vs 24.7 ± 33.4, p < 0.05) and CTX-I (0.53 ± 0.45 vs 0.24 ± 0.38; p < 0.05) were higher in men. Our study shows that CTX-I and MMP-3 are a marker of peripheral disease activity in early SpA. Male gender had higher levels of CTX-I and MMP-3, which may indicate higher disease activity. Higher hsCRP levels trended towards correlation with more baseline radiographic damage. Therefore, these biomarkers may help identify a subgroup of patients who will need closer monitoring and more intensive treatment.