Increased expression of soluble fractalkine [CX3CL1] in systemic sclerosis - possible role in vascular inflammation

The pathogenesis of systemic sclerosis [SSc] involves interplay between obliterative vasculopathy in multiple vascular beds, inflammation, autoimmunity and progressive fibrosis. Vascular injury and activation are the earliest and possibly primary events in the pathogenesis of SSc. To determine levels of serum soluble fractalkine [sFKN] and its receptor CX3CR1 in peripheral blood mononuclear cells [PBMCs] in systemic sclerosis [SSc] patients and healthy controls. In addition, to assess any possible association between sFKN and clinical features of SSc. Serum levels of soluble fractalkine [sFKN, CX3CL1] assessed by enzyme linked immunosorbent assay [ELISA] and expression of its receptor [CX3CR1] on peripheral blood mononuclear cells by flow cytometric analysis, were measured in 18 systemic sclerosis [SSc] patients and 15 age and sex matched healthy controls. The degree of skin involvement was estimated by modified Rodnan skin thickness score [mRSS], pulmonary involvement was assessed in all patients by high resolution computerized tomography [HRCT] and pulmonary function tests [PFTs]. Serum sFKN levels and expression of its receptor CX3CR1 were significantly elevated in SSc patients than in healthy controls [P < 0.0.05]. SSc patients with pulmonary fibrosis had sFKN levels three times higher than those without PF. Serum sFKN correlated inversely with forced vital capacity of lungs [FVC%] but correlated positively with severity of pulmonary fibrosis, extent of skin fibrosis [mRSS], pitting scars, skin ulcers, anti topo-isomerase 1 antibody and CRP. Serum sFKN may play an important role in the pathogenesis of SSc, including tissue inflammation and vascular injury, hence, its measurement may be a useful serologic marker for the diagnosis and follow up of pulmonary and skin complications. So strategies to target CX3CL1-CX3CR1 interaction could provide a new therapeutic approach in SSc, potentially by blocking endothelial cell injury, leucocyte

Biochemical and genetic risk factors for atherosclerosis in systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is associated with an increase in the risk of premature cardiovascular complications caused by accelerated atherosclerosis which significantly contributes to morbidity and mortality. Carotid ultrasonography is a very sensitive imaging tool to detect premature atherosclerosis and measurements of carotid intima-media thickness [IMT] assess the extent and the severity of systemic atherosclerosis. The pathogenesis of accelerated atherosclerosis in SLE is not clear; inflammation and endothelial dysfunction in addition to genetic risk factors represent important factors in the onset of atherosclerosis. To evaluate the relation between asymmetric dimethylarginine [ADMA], high sensitive C-reactive protein [hs-CRP], monocyte chemoattractant protein-1 [MCP-1] [both serum levels and the genotypes of the MCP-1 A-2518G polymorphism] with the development of carotid atherosclerosis in patients with SLE and their relation to disease activity. In the present study, 30 non-menopause SLE female patients and 20 healthy age-matched females were included. Both patients and controls were subjected to evaluation of body mass index [BMI], IMT, serum glucose, serum lipids, hs-CRP, ADMA, MCP-1 [both serum level and gene polymorphism]. Serum ADMA, hs-CRP, and MCP-1, levels were measured by enzyme-linked immunosorbent assay. MCP-1 genomic variants were detected by polymerase chain reaction followed by restriction enzyme-fragment analysis. Values for IMT, hs-CRP, ADMA and MCP-1 were significantly higher in patients with SLE than in healthy controls with more significant increase in SLE patients with IMT >/=1 mm than in those with IMT <1 mm. Carotid IMT was significantly positively correlated with all the studied variables except for age, BMI and FBS, but significantly negatively correlated with HDL-C in all SLE patients. G/G genotype of MCP-1 A-2518G gene was more frequent in SLE patients than controls. IMT, hs-CRP, ADMA and MCP-1 from patients with G/G phenotypes were markedly higher than those from patients with the A/A genotype. In multiple regression analysis, ADMA and MCP-1 were the strongest independent determinants of IMT in SLE patients. Assessment of high levels of ADMA, hs-CRP, MCP-1, in addition to the MCP-1 A-2518G polymorphism may play a role in the pathogenesis of accelerated atherosclerosis in SLE patients and would be useful in identifying the risk of developing cardiovascular disease. Development of a novel therapy targeting ADMA and MCP-1 may have a potential role in preventing the progression of increased IMT in SLE patients

Can dermatoglyphics be used as an anatomical marker in Egyptian rheumatoid patients?

To find out a possible correlation of some quantitative and qualitative dermatoglyphic variables with rheumatoid arthritis [RA] and it's radiological grading. This study was conducted on 60 RA patients and an equal number of controls. Different qualitative dermatoglyphic patterns [ulnar and radial loops, whorls and arches] and quantitative dermatoglyphic measures [total finger ridge count, pattern intensity and a-b ridge count] in addition to palmer creases were studied in both groups. Correlation between significant dermatoglyphic changes in RA patients and radiological changes were studied. Loops were the most common type of the qualitative dermatoglyphic patterns of the fingers, followed by whorls then arches. In both male and female patients, there was significant marked decrease in ulnar loops and increase in arches. Total ridge count and pattern intensity of patients were decreased in both hands of both sexes; however, this decrease was significant in the left hand of males and right hand of females. Moreover, the a-b ridge count was significantly decreased in both hands of female and left hand of male patients. Regarding the unusual palmer flexion creases, there was significant increase only in the Sydney line in female right hands. Significant inverse correlation was noted between total ridge count of the fingers and the radiological erosion in both males and females. Dermatoglyphics can represent an anatomical, non - invasive, inexpensive tool for screening high-risk population, and facilitate early detection and management of RA. Dermatoglyphic variable might also play a significant role not only for screening but also for studying the behavior of the disease

Exercise as a non pharmacological intervention and alternative to oral estrogen therapy in post menopausal women with endothelial dysfunction

Endothelial dysfunction is a key event in the progression of atherosclerosis and heart failure. When the vascular endothelium is healthy it become like Teflon and things don't stick but when it is unhealthy it become like a Velcro attracting blood born junk. Both exercise and postmenopausal estrogen therapy augments endothelial function through increasing bioavailability of nitric oxide [NO] which is a substance that keep your blood vessels opened. Determines the effects of acute bouts of exercise on brachial artery endothelium dependent flow mediated vasodilatation FMD in postmenopausal women. Whether these responses were augmented by the concurrent use of oral estrogen. Whether these two interventions independently or together achieve FMD values observed in pre menopausal women. This study was conducted on 30 apparently healthy post menopausal women their mean age was [54 +/- 4 years old]. FMD was quantified during supine rest and again 60 minutes after treadmill exercise for 45 minute at 60% v02 max - subjects were studied twice, before and after 4 weeks of oral estradiol. The normal reference values was obtained from concurrent determinant of FMD in 30 pre menopausal women their mean age was [28 +/- 2] years old under identical basal conditions. Flow mediated vasodilatation in post menopausal women markedly impaired when compared with pre menopausal women, the mean of absolute diameter change in brachial artery for flow mediated dilatation in post menopausal women was significantly less than premenopausal women [[2.01 +/- 0.2mm [6.1%] Vs 4.1 +/- 0.4mm [12%] P<0.05]. After exercise the absolute change in the brachial artery diameter for FMD in postmenopausal women significantly approximate normal values] [3.8 +/- 0.3mm [11.4%] P<0.05]. In contrast after estrogen therapy the mean of absolute brachial artery diameter change for FMD was augmented at rest [P < 0.01] but was not further enhanced after exercise. [3.7 +/- 0.6 mm [11.5%] VS 3.50 +/- 5mm [10.5%] P > 0.05]. Both interventions increased FMD to values in pre menopausal women. In post menopausal women both acute exercise and oral estrogen normalize FMD. However their effects weren't additive, so these results reinforce the concepts that exercise is an alternative non pharmacological intervention to estrogen in post menopausal women with endothelial dysfunction. For every post menopausal woman regular moderate intensity exercise training must continue to maintain improvement in your endothelial function

Exercise as a non pharmacological intervention and alternative to oral estrogen therapy in post menopausal women with endothelial dysfunction

Both exercise and postmenopausal estrogen therapy augment endothelial function through increasing bioavailability of nitricoxide [NO]. The aim of this study was to: 1- determine the effects of acute bouts of exercise on brachial artery endothelium dependent flow mediated vasodilatation FMD in postmenopausal women. 2- Whether these responses were augmented by the concurrent use of oral estrogen. 3- Whether these two interventions independently or together achieve FMD values observed in pre menopausal women. This study was conducted on 30 apparently healthy post menopausal women their mean of age was [54 +/- 4 years old]. FMD was quantified during supine rest and again 60 minutes after treadmill exercise for 45 minute at 60% v[02] max - subjects were studied twice, before and after 4 weeks of oral estradiol. The normal reference values was obtained from concurrent determinant of FMD in 30 pre menopausal women their mean of age was [28 +/- 2] years old under identical basal conditions. flow mediated vasodilatation in post menopausal women markedly impaired when compared with pre menopausal women. The mean of absolute diameter change in brachial artery for flow mediated dilatation in post menopausal women was significantly less than premenopausal women [2.01 +/- 0.2mm [6.1%] Vs 4.1 +/- 0.4mm [12%] P<0.05]. After exercise the absolute change in the brachial artery diameter for FMD in postmenopausal women significantly approximate normal values [3.8 +/- 0.3mm [11.4%] P<0.05]. In contrast after estrogen therapy the mean of absolute brachial artery diameter change for FMD was augmented at rest [P < 0.01] but was not further enhanced after exercise. [3.7 +/- 1.32 mm [11.5%] VS 3.5 +/- 1.4mm [10.5%] P > 0.05]. Both interventions increased FMD to values in pre menopausal women. in post menopausal women both acute exercise and oral estrogen normalize FMD. However there effects weren't additive so these results reinforce that exercise is an alternative non pharmacological intervention to estrogen in post menopausal women with endothelial dysfunction

Backpack use and other risk factors for low back pain in young adolescents

Background: An earlier onset of low back pain is often predictive of future back problems. This implies that prevention of low back pain in adolescence may have a positive impact in adulthood. Aim of work: The study aimed at assessing the frequency of occurrence of low back pain in young adolescents and to ascertain some risk factors

Subjects and methods: A longitudinal prospective study of 882 preparatory school students with mean age 13.03 +/- 1.09 in Tanta City and a close rural area was conducted during the scholastic year 2003-2004. Schools were selected randomly [one out of seven schools for boys, one out of eight schools for girls and one Mixed rural school] to participate in the study. From each school; two classes in each grade [first, second and third grade] were selected randomly. Frequency of low back pain during the period of the study was reported through monthly visits. Anthropometric measurements were assessed twice; one at the start of the study and the second six months Iater. The risk factors for low back pain were studied. These included demographic, anthropometric, lifestyle, mechanical and psychosocial factors. Also, clinical assessment of muscular flexibility and its relation to low back pain was done

Results: Of young adolescents, 17.23% reported low back pain that tasted one day or more at least once a week during the follow up period [6 months]. Risk factors associated with the development of low back pain were female sex, high growth spurt [Odds Ratio =2.48, Confidence Interval =1.41-4.34] rapid-weight gain [Odds Ratio=1.86, Confidence Interval =1.07-3.22], carrying heavy backpack [Odds Ratio=1.93, Confidence Interval =1.30-2.86] and adverse psychosocial factors

Conclusion and recommendation: Low back pain is a common problem in young adolescents. It was associated with high growth spurt, rapid weight gain, heavy backpacks and adverse psychosocial factors. Modifying some risk factors through school health education and extracurricular physical and social activities may potentially serve to provont the development of low back pain in young adolescents