Chimeric calicivirus-like particles elicit specific immune responses in pigs.

Virus-like particles (VLPs) have received considerable attention due to their potential application in veterinary vaccines and, in particular, VLPs from rabbit haemorrhagic disease virus (RHDV) have successfully shown to be good platforms for inducing immune responses against an inserted foreign epitope in mice. The aim of this study was to assess the immunogenicity of chimeric RHDV-VLPs as vaccine vectors in pigs. For this purpose, we have generated chimeric VLPs containing a well-known T epitope of 3A protein of foot-and-mouth disease virus (FMDV). Firstly, RHDV-VLPs were able to activate immature porcine bone marrow-derived dendritic cells (poBMDCs) in vitro. Secondly, pigs were inoculated twice in a two-week interval with chimeric RHDV-VLPs at different doses intranasally or intramuscularly. One intramuscularly treated group was also inoculated with adjuvant Montanide™ ISA 206 at the same time. Specific IgG and IgA antibodies against RHDV-VLPs were induced and such levels were higher in the adjuvanted group compared with other groups. Interestingly, anti-RHDV-VLP IgA responses were higher in groups inoculated intramuscularly than those that received the VLPs intranasally. Two weeks after the last immunisation, specific IFN-γ-secreting cells against 3A epitope and against RHDV-VLPs were detected in PBMCs by ELISPOT. The adjuvanted group exhibited the highest IFN-γ-secreting cell numbers and lymphoproliferative specific T cell responses against 3A epitope and RHDV-VLP. This is the first immunological report on the potential use of chimeric RHDV-VLPs as antigen carriers in pigs.

Impact of lupus on school attendance and performance.

Cognitive impairment in children and adolescents with systemic lupus erythematosus (SLE) can affect intelligence, academic achievement, arithmetic, reading comprehension, learning, visual memory and complex problem solving ability. In this prospective two-center study, we examined children's (and adolescents') and parents' perception of the impact of SLE on school; the relationship between child and parent reports on school-related issues; and the relationship between health-related quality of life (HRQOL) and school-related issues. Patients aged 9-18 years with SLE and their parents completed corresponding child and parent reports of the SLE-specific HRQOL scale, Simple Measure of Impact of Lupus Erythematosus in Youngsters (SMILEY), and PedsQL(TM) generic and rheumatology modules. Patients also completed questions related to school attendance and performance. Qualified physicians assessed SLE activity, damage and severity. Forty-one patients (73% girls) with SLE with mean age of 15 +/- 3 years and 32 parents participated. Mean school domain scores for child and parent reports of the PedsQL( TM) generic report were lower compared with total and subscale scores. Patients reported difficulty with schoolwork, had problems with memory and concentration, and were sad about the effect of SLE on schoolwork and attendance. Moderate to strong correlations were found between child and parent reports on school-related items from all questionnaires. Eighty-three percent of patients felt that they would have done better in school if they did not have SLE. Moderate correlations (r = 0.3-0.4) were found between SMILEY total score and the following items: satisfaction with school performance, interest in schoolwork, remembering what was learned, and concentrating in class. Patients on intravenous chemotherapeutic medications missed more school days (p < 0.05) compared with patients on oral medications. Also, patients with a greater number of missed school days had increased disease activity (p = 0.008). SLE and activities related to caring for the disease clearly impose a burden on children's school attendance and performance. School-related activities can have a significant impact on HRQOL in children and adolescents with SLE. Detailed examination of the impact of SLE on attendance and the various aspects of school performance will enable us to formulate interventions in school for these children and adolescents.

Preliminary cross-cultural adaptation of a new pediatric health-related quality of life scale in children with systemic lupus erythematosus: an international effort.

We developed a brief, new health-related quality of life measure for children with systemic lupus erythematosus that is valid in English for the United States, called Simple Measure of Impact of Lupus Erythematosus in Youngsters (SMILEY). The United States-English language questionnaire may not be applicable to most of the countries in the world and several United States population subgroups, such as Hispanics. In order to measure the impact of morbidity of systemic lupus erythematosus on the lives of children, adolescents, and their parents and assess the outcome of new therapies, it is critical to have a uniform measure of systemic lupus erythematosus-specific health-related quality of life that is valid for different cultures. We report the translation and cultural adaptation process undertaken by our team with the goal of cross-cultural validation of SMILEY in the following thirteen languages: Danish, Dutch, French (France), German (Germany), Hebrew, Italian, Portuguese (Brazil), Slovene, Spanish (USA and Puerto Rico), Spanish (Spain), Spanish (Argentina), Spanish (Mexico), and Turkish. We employed the following steps: establishing collaborative relationships with institutions across the globe; forward and back translation of SMILEY text; and cultural adaptation of SMILEY content. We are in the process of enrolling patients and conducting validation of the translated and adapted versions of SMILEY.

Relationship between health-related quality of life and SLE activity and damage in children over time.

We previously described the development and validation of the 'Simple Measure of the Impact of Lupus Erythematosus in Youngsters' (SMILEY) for the reliable assessment of health-related quality of life (HRQOL) in children with systemic lupus erythematosus (SLE). The objectives of this new study were to determine the relationship of SMILEY scores to patient's/parent's assessment of HRQOL and SLE status, and physician's assessment of disease activity and damage over time. In this multicentre study, 68 children with SLE and parents completed SMILEY including the global HRQOL and SLE status assessments, physicians completed disease activity and damage tools at two time-points. Spearman rho was calculated between SMILEY scores and other scales, and between interval changes in SMILEY scores and other scales. SMILEY scores correlated with patient/parent assessments of global HRQOL and SLE status, disease activity and damage, confirming previous findings. The change in disease activity and damage measures correlated most strongly with the changes in SMILEY domains, Limitation and Burden of SLE. Results provide preliminary evidence that Limitation and Burden of SLE domains of SMILEY reflect the impact of disease activity and damage on HRQOL.

Pharmacokinetic study of cefodizime and ceftriaxone in sera and bones of patients undergoing hip arthroplasty.

The study was carried out to determine the concentrations of cefodizime (single 2-g intravenous [i.v.] dose) and ceftriaxone (single 2-g i.v. dose) in the sera and bones of 42 patients (18 women and 24 men) undergoing hip arthroplasty. The concentrations of cefodizime and ceftriaxone in cancellous and cortical bone appear to be related to the free levels in serum but not to the total levels in serum, so the concentrations of cephalosporins in bone must be compared with the free concentrations in serum. Both drugs diffuse well into bone, with concentrations exceeding the MIC at which 90% of the major pathogenic infecting organisms are inhibited.

[Late results of replantation of the upper extremity]. / Otdalennye rezul'taty replantatsii verkhnei konechonosti.

The authors present the long-term results observed in 82 patients after replantations of various segments of the upper extremity which were performed at centres of microsurgery of in Italy. A number of tests of prac- four towns tical importance aimed at the evaluation of the recovery of the extremity and the fingers sensitivity has been used during the examination. The authors have come to the conclusion that the success of the operations of replantation of various moments of the extremities is determined not only by the technical aspect of the surgery, but to a greater degree by correct implementation of the system of rehabilitation treatment aimed at the extremity sensitivity recovery.

Ultrasound examination of haematomas after total hip replacement.

We have used ultrasound after 84 total hip replacements to define the site and size of any haematoma present. Repeated examination after operation indicated when the haematoma had occurred. We have demonstrated that two suction drains were more effective than one in preventing haematomas around the prosthesis in the first week after operation. The early detection of a haematoma allows rational treatment which should reduce the risk of deep infection.

Ultrasonography in the study of pathological conditions of the hip.

The authors describe the use of real-time ultrasonography in the investigation of the hip joint. The study involved 25 patients with traumatic, inflammatory or degenerative lesions. It was possible to evaluate effusion and capsular changes in 13 cases and to correlate these findings with the type of pathology involved. The ultrasonographic findings in the patients with degenerative or inflammatory joint disease were confirmed at operation. The method described is simple, quick and devoid of risk to the patient. It is therefore a useful investigation in the study of disorders of the hip joint.

Ultrasonography in the investigation of loose hip prostheses.

Twenty-two patients with severe pain in the hip on weight-bearing after prosthetic replacement were investigated by radiography, arthrography, scintigraphy and ultrasonography to determine the accuracy of these diagnostic methods in detecting loosening of infective or mechanical origin. In two cases, ultrasonography revealed superficial infections that were resolved with antibiotic therapy. Of the remaining 20 cases, 12 involved a deep infection and in 8 the loosening was of mechanical origin. In the deep infections, standard radiography provided a diagnosis in 66% of cases, arthrography in 75% and scintigraphy in 83%, while ultrasonography detected the deep infection in all 12 cases. In the patients with mechanical mobilization, arthrography and ultrasonography were 100% accurate. Since ultrasonography is able to detect discrete or diffuse lesion of the soft tissues around a prosthesis it should be included among the methods used to screen patients with painful hips after prosthetic replacement.

[Ultrasonography and computerized tomography in the determination of the femoral angle of anteversion. Experimental and clinical comparative study]. / Ultrasonografia e TC nella determinazione dell'angolo di antiversione femorale. Studio comparativo sperimentale e clinico.

A comparative study of the femoral neck anteversion angle as determined by ultrasonography and CT was conducted on 40 unpaired dry bone specimens and 5 normal subjects. Since ultrasound cannot penetrate bone, the anterior surface femoral neck orientation was determined and correlated well (r = 0,95) with the corresponding measurements as imaged by CT. However, a weaker correlation (= 0,76) existed between it and the true femoral neck axis, as measured on CT display. The latter is a function of the posterior surface femoral neck orientation as well, since the two femoral surface are rarely parallel, but converge at the femoral shaft. It is concluded that the ultrasonographic modality will overestimate the true femoral neck anteversion beyond the 5-degree error acceptable for clinical purposes.

The calcaneal index in the determination of osteoporosis.

The authors tested the reliability of a new method of evaluating osteoporosis and osteopenia radiographically. This is based on the calcaneal index, which can be correlated directly with Singh's femoral neck index and is inversely proportional to the age of the subjects tested.

[Role of computerized tomography in the evaluation of the stability of the glenohumeral articulation]. / Ruolo della tomografia computerizzata nella valutazione della stabilità dell'articolazione gleno-omerale.

CT scans of the shoulder were performed on 30 normal subjects. The bony architecture of the glenohumeral joint and of the shoulder as described by definite angles and index was determined. Attention was primarily drawn upon the parameters often implicated in the mechanism of glenohumeral stability, namely: the glenoid antero-posterior tilt and the anteversion angle of the scapula. While the former is a static determinant, the latter is a dynamic determinant of joint stability. An inversely proportional relationship was found to exist between these two components of glenohumeral stability. It may be speculated that an high glenoid tilt, which is unstable, may be counterbalanced by a functional reduction in anteversion of the scapula, thus improving the joint stability.

[Osteogenesis imperfecta and calcitonin. Considerations on 10 years of clinical experimentation]. / Osteogenesis imperfecta e calcitonina. Considerazioni su 10 anni di sperimentazione clinica.

Salmon and porcine calcitonin has been used in the drug treatment of Osteogenesis Imperfecta for ten years. The evaluation of its therapeutic efficacy is complex and inaccurate because of difficulty in clinical and pathogenetic classification of the disease and impossibility to standardize and evaluate the patients. Calcitonin therapy showed no capacity to modify the degree of osteoporosis and the incidence of pathological fracture and bone deformities, because it does not affect the underlying biochemical defect. Calcitonin may be useful only in selected patients and in addition to physiotherapeutic, orthopaedic and surgical measures.