Elevated calprotectin levels reveal bowel inflammation in spondyloarthritis.

INTRODUCTION: Microscopic bowel inflammation is present in up to 50% of patients with spondyloarthritis (SpA) and is associated with more severe disease. Currently no reliable biomarkers exist to identify patients at risk. Calprotectin is a sensitive marker of neutrophilic inflammation, measurable in serum and stool. OBJECTIVES: To assess whether serum and faecal calprotectin in addition to C-reactive protein (CRP) can be used to identify patients with SpA at risk of microscopic bowel inflammation. METHODS: Serum calprotectin and CRP were measured in 125 patients with SpA. In 44 of these patients, faecal samples were available for calprotectin measurement. All 125 patients underwent an ileocolonoscopy to assess the presence of microscopic bowel inflammation. RESULTS: Microscopic bowel inflammation was present in 53 (42.4%) patients with SpA. Elevated serum calprotectin and CRP were independently associated with microscopic bowel inflammation. Faecal calprotectin was also significantly higher in patients with microscopic bowel inflammation. Patients with CRP and serum calprotectin elevated had a frequency of bowel inflammation of 64% vs 25% in patients with low levels of both. When either CRP or serum calprotectin was elevated, the risk was intermediate (40%) and measuring faecal calprotectin provided further differentiation. Hence we suggest a screening approach where initially serum calprotectin and CRP are assessed and, if necessary, faecal calprotectin. The model using this scenario provided an area under the ROC curve of 74.4% for detection of bowel inflammation. CONCLUSIONS: Calprotectin measurements in stool and serum, in addition to CRP, may provide a promising strategy to identify patients with SpA at risk of bowel inflammation and could play a role in overall patient stratification.

A functional genomics approach to the study of avian innate immunity.

A second-generation 4,959 element cDNA microarray has been created and evaluated for its potential use in examining the avian innate immune response. The elements in this array were obtained from EST libraries of stimulated avian PMNC-derived monocytes/macrophages and supplemented by genes of interest from several specific innate immune pathways. The elements are spotted in triplicate resulting in 14,877 total spots per slide. The avian innate immunity microarray (AIIM) contains 25 avian interleukin, chemokine, and cytokine elements. The array also contains elements for several innate immune pathways, including genes involved in the Toll-like receptor (TLR) pathway (including six of the currently known avian TLR receptors), avian interferon/antiviral response pathway genes, and genes involved in apoptosis, antigen presentation and the oxidative burst. The AIIM can be used to evaluate global gene expression patterns in a number of immunologically relevant tissues and in chickens, turkeys and ducks. The array has also been evaluated for its ability to monitor the avian immune response to both bacterial (avian pathogenic Escherichia coli) and viral (avian influenza) avian pathogens.

[Laparoscopic sterilization using the tubal ring]. / Laparoskopska sterilizacija prstenovima.

Interval ring laparoscopic sterilization, in line with law, was in the last four years performed in 103 women on the principles applied to other laparoscopic operations. There were ten immediate complications (7 technical and 3 surgical). One patient was subfebrile following surgery and one became pregnant a few months after sterilization.

PIP: The tubal ring was described in 1972, and in 1974 Yoon applied it in a multicentric trial. The ring consists of silicone rubber impregnated with 5% barium sulfate. Since 1986 a total of 103 laparoscopic sterilizations were performed in women over 35 in accordance with legal stipulations. The operation was done under endotracheal anesthesia. 1 1/min carbon dioxide was insufflated, usually 3-5 liters, via a needle umbilically under control of intraabdominal pressure. The uterus was manipulated transvaginally by means of a vacuum portio adapter. The laparoscope was also introduced umbilically and under laparoscopic control the ring applicator suprapubically medially. The ring was fixed onto the isthmic portion of the tube 2-3 cm from the uterus. The pierced wound was closed with a metal clasp. The operation lasted 15-30 minutes. The patients received routine analgesics, antiprostaglandins, rectally or im, then according to need. Hospitalization lasted 4-5 days. There were 7 complications ascribed to technique: in 2 instances pneumoperitoneum made the operation difficult, in 2 cases the ring was lost in the abdomen, and in 3 cases the slipped ring was successfully removed. There were 3 surgical complications: 2 instances of cutting the tube necessitating laparotomy in 1 case, and in the other the ring was attached to the cut end of the tube. In 1 case a hematoma of 2-3 cm size formed under the ring at mesosalpinx that did not require surgical intervention. 1 woman with a perigenital wound healing was subfebrile for a few days after the operation, and another woman became pregnant a few months after sterilization. 1 woman underwent sterilization while pregnant and abortion was performed later. Another woman underwent simultaneous abortion and sterilization following 2 cesarean sections. Pregnancy (sometimes extrauterine) occurs in .1-1.5% after this simple, safe, long-lasting procedure, mainly in the 1st year.

[Simultaneous interstitial and intrauterine pregnancy: successful completion of the intrauterine pregnancy]. / Istovremena intersticijska i intrauterina trudnoca: uspjesan svrsetak intrauterine trudnoce.

The authors describe an extremely rare combination of simultaneous intrauterine and interstitial pregnancy. In spite of the rupture of interstitial pregnancy in the 13th week and cornual resection, it was possible to restrain the intrauterine pregnancy under careful control until the 38th week, when a healthy mature baby was delivered by elective Caesarian section. The cicatrix of the uterus after cornual resection held the pregnancy well. Severe anaemia as a consequence of the bleeding before and during operation was quickly corrected and did not harm the further development of the child.

[Human milk - variations in lactose, potassium, sodium and total lipid concentrations and in fatty acids composition of lactating women in early puerperium]. / Zensko mlijeko - promjene u koncentracijama laktoze, kalija, natrija i cjelokupnih lipida te u sastavu masnih kiselina u ranom puerperiju dojilja

Some biochemical components were studied in the milk of 16 lactating women during the first six postpartum days. A gradual increase in the lactose and potassium concentration and a decrease in the sodium concentration were observed, as well as an increase in the total lipids concentration and a significant shifting in the fatty acids composition where the biosynthesis of the fatty acids with a lower number of C atoms (C 10:0, C12:0, C 14:0) at the expence of the fatty acids with higher C atoms number was intensified.

Nonpuerperal breast secretion. Its relation to the use of oral contracetpives.

The occurrence of breast secretion more than 1 year postpartum was studied in 800 healthy, parous women of childbearing age. Among of 418 women who were using a combination-type oral steroid contraceptive, the incidence of breast secretion was lower than among the nonusers. The incidence of bilateral secretion decreased with increasing duration of use of the oral contraceptives. Statistical material is presented for the incidence of breast secretion as related to age. time elapsed since last delivery, and duration of nursing the last child. Brownish secretion rather than white or yellowish is seen more often in women over 30 years of age. Various menstrual irregularities (excluding amenorrhea) do not appear to be associated with an increased incidence of breast secretion.

The effects of lavour time on neonatal depression.

The effects of labour time on neonatal depression were investigated in 1072 cases. It was found that the everage Apgar score assessed at one minute post-parturition decreased significantly as a function of duration of labour. Additionally, the incidence of neonatal depression (Apgar indes of 7 or less) was found to increase significantly with increase significantly with increases in labour duration. Apgar indices taken five minutes after birth did not reveal any significant effects related to duration of labour. Further analysis of the labour conditions indicated that the effects of labour time on the condition of the infant was greater in spontaneius labours than induced or stimulated labours. In spotanious labours, the five-minute Apgar score continued to be influenced by duration of labour. After five minutes individual differences were clearly observable in all labours.