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The objective of this study was to evaluate the composition of bioactive compounds and the antioxidant activity of virgin olive oil (VOO) from an Algerian variety called «Rougette of Mitidja» from a desert region, as well as its protective effects against titanium dioxide nanoparticles (NPTiO2) induced oxidative stress. The bioactive compounds were analyzed using UV-visible spectrophotometry, while antioxidant activity was tested in vitro using DPPH and in vivo on rats. Twenty-four male Wistar albinos rats were randomly divided into four groups: Control, NPTiO2, NPTiO2 + VOO1 and NPTiO2 + VOO2. The analysis revealed that the VOO contained polyphenols, flavonoids and carotenoids with significant DDPH antioxidant activity at 87.70%. NPTiO2 induced oxidative stress by increasing biochemical parameters and peroxidation of hepatic and renal lipids, as evidenced by a rise in MDA with a decrease in GSH and antioxidant enzyme activities in rats. NPTiO2 also affected the hematological profile with a decrease in red blood cells and hemoglobin. VOO treatment exerted a protective effect by lowering biochemical parameters and increasing antioxidant enzymes compared to the NPTiO2 group. Histological findings confirmed the protective effects of VOO on liver and kidney damages caused by NPTiO2. It can be concluded that monovarietal VOO has a potent protective effect against NPTiO2-induced oxidative stress, which is related to its richness in bioactive compounds. [ABSTRACT FROM AUTHOR]

Introduction and Importance: Desmoid-type fibromatosis is an uncommon tumor characterized by its local invasiveness, with shoulder involvement being notably infrequent. The optimal treatment strategy for this tumor remains a topic of ongoing debate., Case Presentation: A 47-year-old Tunisian woman with a history of hypothyroidism, presented with pain and swelling in her left shoulder for a year. Examination revealed a firm, painful 4 cm mass, and MRI showed a poorly defined intramuscular tumor in the deltoid muscle, initially suspected to be rhabdomyosarcoma. However, surgical biopsy confirmed desmoid-type fibromatosis of the shoulder. The patient underwent surgical wide en-bloc resection of the tumor. The patient's recovery was uneventful, and she received physical therapy. At the three-year follow-up, she reported residual shoulder pain after heavy lifting, improving with analgesics. Examination showed no neurological deficits and a Constant score of 83 out of 100., Clinical Discussion: Due to their deep-seated nature and infiltrative growth patterns into neighboring subcutaneous tissues or muscles, along with the presence of myxoid or fibrotic components, desmoid-type fibromatosis can present challenges in distinguishing them from malignant soft tissue neoplasms based on imaging characteristics., Conclusions: While radiologic evaluations may indicate characteristics suggestive of a malignant soft tissue tumor, histological confirmation is imperative prior to initiating surgical intervention. Continued research into the optimal treatment approaches for desmoid-type fibromatosis is essential for improving future patient outcomes and quality of life., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: We investigated the timing of resistance training (RT) during Ramadan fasting (RF) on muscle strength, hormonal adaptations, and sleep quality., Methods: Forty healthy and physically active male Muslims (age = 25.7 ± 5.6 years, body mass = 85.1 ± 17.5 kg, height = 175 ± 9 cm, BMI = 28.3 ± 5.7 kg/m 2 ) were enrolled in this study and 37 completed pre and post-tests. Subjects were randomly allocated into two experimental groups. Group 1 (FAST, n  = 20) completed an 8-week whole-body RT in the late afternoon (between 16 h and 18 h) while fasting. Group 2 (FED, n  = 20) completed the similar RT protocol compared with FAST at night (between 20 h and 22 h). The following parameters were analyzed at various time-points: 2 weeks before the start of RF (T0), on the 15th day of Ramadan (T1), on the 29th day of Ramadan (T2), and 21 days after the last day of RF (T3) where both groups were in a fed state. One-repetition maximum tests (1-RM) were conducted for the squats (1-RM SQ ), the deadlift (1-RM DL ) and the bench press (1-RM BP ). Sleep quality was assessed using the full Pittsburgh Sleep Quality Index (PSQI). Blood samples were taken to determine cortisol, testosterone and IGF-1 levels. Additionally, acute hormonal responses were evaluated before (BF), immediately after (AF), and 30 min after a RT session (AF-30 min) at T0, T1, T2, and T3., Results: Significant group-by-time interactions were identified for 1-RM SQ ( p  = 0.001; effect size [ES] = 0.43) and 1-RM DL ( p  = 0.001; ES = 0.36). Post-hoc tests indicated significant 1-RM SQ ( p  = 0.03; ES = 0.12) and 1-RM DL ( p  = 0.04; ES = 0.21) improvements from T0-T2 for FED. Additionally, significant group-by-time interactions were observed for the chronic effects on cortisol ( p  = 0.03; ES = 0.27) and testosterone levels ( p  = 0.01; ES = 0.32). Post-hoc tests indicated significant increases of cortisol levels among FAST at T1 and T2 compared to T0 ( p  = 0.05; ES = 0.41, p  = 0.03; ES =  0.34) and a significant increase in cortisol levels in FED at T1 ( p  = 0.05; ES = 0.29) and T2 ( p  = 0.04; ES = 0.25). However, the observed increase was lower compared to FAST. Post-hoc tests also indicated significant increases of testosterone only among FED at T2 ( p  = 0.04; ES = 0.31). A significant group-by-time interaction was found for the acute effect of exercise on cortisol level ( p  = 0.04; ES = 0.34). The cortisol level immediately after RT was higher in FAST only at T1 ( p  = 0.03; ES = 0.39) and T2 ( p  = 0.05; ES = 0.22) compared with T0. No significant group-by-time interactions were identified for sleep quality ( p  = 0.07; ES = 0.43)., Conclusion: Muslims can safely practice RT during RF. However, training in a fed state during Ramadan might be more effective than during fasted state for the enhancement of maximal strength with better hormonal responses observed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer KI declared a past co-authorship with the authors UG and HZ to the handling editor. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Triki, Ben Abderrahman, Salhi, Rhibi, Saeidi, Almaqhawi, Hackney, Laher, Granacher and Zouhal.)

Background : There is increasing awareness of the physiological effects of Ramadan intermittent fasting (RIF) in obese subjects. However, there are no data on the effects of RIF on plasma volume changes (ΔPV) in individuals with different body weights. Background and Objectives : This study investigated the effects of RIF on ΔPV in normal-weight (NW) and overweight (OW) adult men, and adult men with obesity (OB) and severe obesity (SO). Materials and Methods : Thirty-two male subjects (32) were divided into four groups ( n = 8 per group) according to their body mass index (BMI): normal weight (NW) (BMI < 25 kg/m 2 ; age = 27.4 ± 3.8), overweight (OW) (BMI between 25 and 29.9 kg/m 2 ; age = 26.8 ± 3.7), obese subjects (OB) (BMI between 30 and 34.9 kg/m 2 ; age = 25.6 ± 2.9), and severely obesity (SO) (BMI between 35 and 40 kg/m 2 ; age = 24.0 ± 4.1). Blood samples were collected for 24 h on 4 different occasions, at T0 before the start of the Ramadan month, at T1 15 days after the start of Ramadan, at T2 one day after the end of Ramadan, and at T3 on the 21st day after the end of Ramadan to determine ΔPV. All groups completed their fasting rituals for the 30 days of Ramadan. Results : A significant group × time effect occurred for body mass ( p = 0.001; ES = 0.53), BMI ( p = 0.001; ES = 0.53), and body fat percentage ( p = 0.001; ES = 0.52). Post hoc tests indicated reductions in body mass in OB and SO at T1 ( p = 0.03; ES = 0.21 and p = 0.002; ES = 0.12) and T2 ( p = 0.03; ES = 0.31 and p = 0.02; ES = 0.23), reductions in BMI in OB and SO at T1 ( p = 0.04; ES = 0.35 and p = 0.03; ES = 0.42) and T2 ( p = 0.03; ES = 0.52 and p = 0.005; ES = 0.48), and reductions in body fat percentage only in OB AT T1 ( p = 0.002; ES = 0.31) and T2 ( p = 0.001; ES = 0.17). A significant group × time effect occurred for hematocrit ( p = 0.02; ES = 0.34), hemoglobin ( p = 0.01; ES = 0.35), and ΔPV ( p = 0.02; ES = 0.18). Post hoc tests indicated increases in hematocrit in OB at T2 ( p = 0.03; ES = 0.36) and hemoglobin in OB and SO at T1 ( p = 0.03; ES = 0.35 and p = 0.002; ES = 0.32) and T2 ( p = 0.003; ES = 0.21 and p = 0.002; ES = 0.33). There were also increases in ΔPV in OB at T1 and T2 ( p = 0.002; ES = 0.25 and p = 0.003; ES = 0.22) and in SO only at T2 ( p = 0.02; ES = 0.37). Contrast analysis indicated that NW was significantly lower than the grand mean of OW, Ob, and SO for all anthropometric and PVV variables (all p < 0.05). Conclusions : The effects of RIF on ΔPV and anthropometric characters was greater in obese individuals compared to normal-weight and overweight participants, suggesting that the improvements in body composition and ΔPV produced by RIF could positively influence obesity.

Purpose: During Ramadan month, Muslims often continue training to maintain their muscle performance. However, trainers should stress the importance of the time of day chosen for practicing resistance training (RT) during Ramadan fasting to avoid health and performance alteration. Thus, this study aimed to investigate the effects of the timing of RT during Ramadan intermittent fasting (RIF) on muscle strength and hypertrophy in healthy male adults., Methods: Forty men were randomly allocated to 2 matched groups: 20 practicing whole-body RT in the late afternoon in a fasted state and 20 training in the late evening in a fed state (FED). Both groups performed 4 days per week of whole-body RT (∼75%-85% 1-repetition maximum, 12 repetitions/3-4 sets) during RIF. Anthropometric measurements and 1-repetition-maximum test for the squats, deadlift, and bench press were measured. A cross-sectional area of the quadriceps and biceps brachii was examined using ultrasound scans. All measurements were taken at 4 time points: 24 hours before the start of Ramadan, on the 15th day of Ramadan, on the 29th day of Ramadan, and 21 days after Ramadan., Results: Post hoc tests indicated significant preimprovement to postimprovement in FED at the 29th day of Ramadan for the 1-repetition-maximum test for the squats (P = .02; effect size = 0.21) and deadlift (P = .03; effect size = 0.24) when compared to 24 hours before the start of Ramadan. No significant changes were observed in the fasted-state group or for cross-sectional area for both groups., Conclusions: Practicing RT during RIF appears not to have adverse effects on muscle hypertrophy and strength no matter whether it is practiced in FED or fasted state. However, RT had greater effects on muscle strength when applied in FED. Our findings suggest that training sessions should be scheduled after breaking the fast during Ramadan.

Purpose: To determine the relationship between gastrointestinal hormones (leptin, glucagon-like peptide-1), ghrelin, cholecystokinin, peptide YY, morphological characteristics, and physical performances in elite soccer players., Methods: Q2 Twenty-two elite male soccer players (age = 23.1 [2.7] y, height = 177.0 [0.1] cm, weight = 70.2 [2.9] kg, body mass index = 22.1 [1.8] kg/m2) completed 3-day food records each week during the 5-week training period. Blood samples were drawn after an overnight fast before and after preseason training to assess gastrointestinal hormones (leptin, glucagon-like peptide-1, ghrelin, cholecystokinin, and peptide YY). Continuous analysis of the training load was used during the training period. Preintervention and postintervention tests assessed jumping (countermovement jump), sprinting (10, 20, and 30 m), and endurance fitness (the Yo-Yo Intermittent Recovery Test Level 1 [YYIRT1]) levels., Results: Preseason training decreased body mass index (P = .001; effect size [ES] = 0.183) and body fat percentage (P = .001; ES = 0.516). There were increases in countermovement jump (P = .032; ES = 0.215), 20- (P = .016; ES = 0.195) and 30-m sprints (P = .001; ES = 0.188), and YYIRT1 performance (P = .001; ES = 0.9). Levels of cholecystokinin, peptide YY, and ghrelin did not change during preseason training, although changes in leptin (P = .001; ES = 0.41) and glucagon-like peptide-1 levels (P = .039; ES = 0.606) were recorded. Leptinemia correlated with anthropometric parameters (body mass index, r = .77, P = .001; percentage of body fat,r = .67, P = .006) and the total distance covered during the YYIRT1 (r = -.54; P = .03)., Conclusion: Changes in morphological parameters and physical performance in elite-level male soccer players are related to variations in selected gastrointestinal hormones.

This research paper attempts to investigate both the long-run and causality relationship among electric power consumption (EPC), technological transfer, financial development (FD), and environmental quality for the Saudi Arabia (KSA) economy from 1980 to 2019. In doing so, we propose a carbon emission function tested by incorporating multi-steps techniques such as autoregressive distributed lag (ARDL) has been exploited to determine the existence of cointegration or no; while vector error correction model (VECM) has been applied to decide the direction of causality. In this paper we have proposed two proxies of technological transfer, namely imported technology (MT) and Technical cooperation grants (TCG). The results indicate the existence of cointegration between the concerned series. Besides, the existence of a feed-back effect among variables (except TCG) in the long-run. However, in the short run feed-back effect exists among EPC and Environmental Quality (EnvQ); MT and EnvQ; EPC and MT. Thus, the paper provides original visions for policy makers to encourage the technological transfer by financing and supporting the electric energy sector which constitutes the main locomotive to improve the environment quality for the KSA., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: To determine the effects of Ramadan intermittent fasting (RIF) on inflammatory (C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)) and biochemical markers of liver-renal function (aspartate aminotransferase (AST), alanine amino transferase (ALT), bilirubin, lactate dehydrogenase (LDH), urea and creatinine) in males with obesity., Materials and Methods: Twenty-eight males with obesity were randomly allocated to an experimental group (EG, n = 14) or a control group (CG, n = 14). The EG group completed their fasting rituals for the entire month of Ramadan (30 days) whereas the CG group continued with their normal daily habits. Blood samples were collected 24 h before the start of Ramadan (T0), on the 15th day of Ramadan (T1), the day after the end of Ramadan (T2), and 21 days after the end of Ramadan (T3). Resting plasma volume variation between pre and post-RIF (ΔPV) was calculated., Results: Decreases were noted for interleukin-6 (p = 0.02, d = 1.4) and tumor necrosis factor-alpha (p = 0.01, d = 0.7), with no changes for C-reactive protein (p = 0.3; d = 0.1) in the EG compared to CG group. There were no changes (P > 0.05) in ΔPV recorded after RIF for either EG (-0.035 ± 0.02%) and CG (0.055 ± 0.06%)., Conclusion: This study demonstrates that RIF improves systemic inflammation biomarkers in males with obesity. Moreover, RIF did not negatively affect biomarkers of liver and renal function., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)

We studied the effects of Ramadan intermittent fasting (RIF) on gut hormones (leptin, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), cholecystokinin (CCK), and ghrelin) in males with obesity. Thirty sedentary males were randomly allocated to either an experimental group (EG, n = 15) or a control group (CG, n = 15). The EG group completed their Ramadan fasting rituals (30 days), whereas the CG continued with their normal daily habits. Blood samples were collected at four time points: 24 h before the start of Ramadan (T0), on the 15th day of Ramadan (T1), the day after the end of Ramadan (T2) and 21 days after Ramadan (T3). There were significant pre-to-post improvements for leptin ( p = 0.01, d = 1.52), GLP-1 ( p = 0.022, d = 0.75), PYY ( p = 0.031, d = 0.69) and CCK ( p = 0.027, d = 0.81) in the EG, with no interaction effect for ghrelin ( p = 0.74; d = 0.008). No significant changes ( p > 0.05) occurred in plasma volume variations (ΔPV) after RIF in both EG (-0.03 ± 0.01%) and CG (0.06 ± 0.07%). RIF represents an effective strategy to modify appetite-regulating hormones, leading to improved body composition indices and reduced obesity.

The association of pulmonary tuberculosis and Behçet's disease revealed by an aneurysm of the humeral artery is exceptional with a complicated management. We report a case in which the two conditions occurred concomitantly with the vascular complication, apart from any use of immunosuppressive therapy, something that has never been reported in the literature. We report an extremely rare case of a spontaneous rupture of an aneurysm of the humeral artery of a 29-year-old woman with no history. The patient underwent axillo-humeral bypass. Investigations concluded the diagnosis of Behçet's disease associated with pulmonary and lymph node tuberculosis. Antituberculous chemotherapy followed by corticosteroids, immunosuppressants, and colchicine has been administrated. Based on this observation, we insist on the necessity of searching the symptoms of Behçet's disease in the presence of arterial involvement when having a young patient. Therapeutic management must include medical treatment to control inflammation and limit the risk of recurrence. Endovascular or surgical treatment is necessary if the arterial involvement is threatening. The association with tuberculosis complicates management and requires close monitoring., Competing Interests: None

A series of novel-sulfonated furanic polyesteramides have been synthesized by polycondensation in the melt-phase. The copolymers were obtained with reasonable molecular weights and high inherent viscosities between 0.2 and 0.4 dL/g. The hydrolytic degradability of polyesteramides was enhanced by the increasing of amide units in the copolymers backbone., (© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objective: We examined Theory of Mind (ToM) abilities in adolescents with early-onset schizophrenia (EOS) and their correlation with clinical findings and Executive Functions (EF)., Methods: The ToM abilities of 12 adolescents with EOS were compared with those of healthy participants matched in age and educational level. The Moving Shapes Paradigm was used to explore ToM abilities in three modalities: random movement, goal-directed movement and ToM - scored on the dimensions of intentionality, appropriateness and length of each answer. EF was tested using Davidson's Battery and the clinical psychopathology with the Positive and Negative Syndrome Scale (PANSS)., Results: Adolescents with EOS were significantly more impaired than controls in the three dimensions evaluated for the goal-directed and ToM modalities. Regarding the random movement modality, the only difference was in appropriateness (p<0.01). No correlation with age or level of education was evident for ToM skills. Total PANSS score was negatively correlated with appropriateness score for the goal-directed (p=0.02) and ToM modalities (p=0.01). No correlation existed between performance in the ToM Animated Tasks and positive, negative or disorganisation PANSS subscores. No correlations were found among the three scores in the Moving Shapes Paradigm and any measures of the accuracy of the three tasks assessing EF., Conclusion: Our results confirm previous findings of ToM deficits in adult individuals with schizophrenia and attest the severity of these deficits in patients with EOS.

Antinuclear antibodies (ANAs) are significant biomarkers in the diagnosis of autoimmune diseases in humans, done by mean of Indirect ImmunoFluorescence (IIF) method, and performed by analyzing patterns and fluorescence intensity. This paper introduces the AIDA Project (autoimmunity: diagnosis assisted by computer) developed in the framework of an Italy-Tunisia cross-border cooperation and its preliminary results. A database of interpreted IIF images is being collected through the exchange of images and double reporting and a Gold Standard database, containing around 1000 double reported images, has been settled. The Gold Standard database is used for optimization of a CAD (Computer Aided Detection) solution and for the assessment of its added value, in order to be applied along with an Immunologist as a second Reader in detection of autoantibodies. This CAD system is able to identify on IIF images the fluorescence intensity and the fluorescence pattern. Preliminary results show that CAD, used as second Reader, appeared to perform better than Junior Immunologists and hence may significantly improve their efficacy; compared with two Junior Immunologists, the CAD system showed higher Intensity Accuracy (85,5% versus 66,0% and 66,0%), higher Patterns Accuracy (79,3% versus 48,0% and 66,2%), and higher Mean Class Accuracy (79,4% versus 56,7% and 64.2%).

Aurora A kinase is overexpressed in many cancers but the status of this protein in the breast cancer often varies. We investigate the expression and localization of Aurora A protein in relation with tumor emergence and progression in breast cancer. Aurora A kinase status was evaluated in 107 patients using immunohistochemistry. The experimental findings showed that high expression of the Aurora A protein was correlated with elevated nuclear grade, low expression of progesterone receptor and positive nodal status. The experimental results showed also that the localization of this kinase shifts from cytoplasm in non malignant adjacent tissue to both cytoplasmic and nuclear compartments in tumoral tissue, suggesting an oncogenic role of the nuclear accumulation. We have, furthermore, detected the overexpression of this protein in non malignant adjacent tissue. The expression of the Aurora A kinase in non malignant tissue may represent an earlier diagnosis tool for breast cancer.

Purpose: To retrospectively determine sensitivity and specificity of four findings for distinguishing pulmonary infarction from other causes of peripheral pulmonary consolidations on multidetector computed tomographic (CT) images, with other CT and clinical findings as reference., Materials and Methods: Institutional review board approved the study and waived informed consent. Three independent radiologists blindly analyzed selected multisection CT images of 50 pulmonary infarctions-not showing direct arterial signs of pulmonary embolism-and 100 peripheral consolidations of other origins. Readers analyzed four findings: triangular shape, vessel sign (defined as presence of an enlarged vessel at the apex of consolidation), central lucencies, and air bronchograms. Interobserver agreement; frequency on CT images with and without infarct; and sensitivity, specificity, and positive likelihood ratio (LR) for diagnosis of pulmonary infarction were assessed for each finding., Results: One hundred fifty peripheral consolidations were analyzed in 134 (75 men, 59 women) patients (mean age, 55.9 years+/-17.4 [standard deviation] vs 54.7+/-19.9; P=.71). Interobserver agreement was good for central lucencies and air bronchograms and poor to moderate for the other two findings (kappa<0.61). Compared with CT images without infarct, CT images with infarct had a higher frequency of vessel sign (32% [16 of 50] vs 11% [11 of 100], P=.029) and central lucencies (46% [23 of 50] vs 2% [two of 100], P<.001) and a lower frequency of air bronchograms (8% [four of 50] vs 40% [40 of 100], P=.003). Frequency of triangular shape was similar in both groups (52% [26 of 50] vs 40% [40 of 100], P=.17). Positive LR was 23.0 for central lucencies, 2.9 for vessel sign, 1.3 for triangular shape, and 0.2 for air bronchograms. Presence of central lucencies had 98% specificity and 46% sensitivity for pulmonary infarction. When the vessel sign and negative air bronchogram were combined with central lucencies, specificity increased to 99% but sensitivity decreased to 14%., Conclusion: Central lucencies in peripheral consolidations are highly suggestive of pulmonary infarction., (Copyright (c) RSNA, 2007.)

Objective: The purpose of our study was to evaluate the reliability of software-calculated doubling times for discerning malignant versus benign nodules., Materials and Methods: CT lung analysis volumetric software was used to retrospectively calculate the doubling times of 63 solid noncalcified nodules by comparing nodule volumes on baseline and follow-up CT scans obtained a median of 3.7 months apart. A final diagnosis based on validated criteria was available for all 63 nodules. All CT examinations were performed with 1.25-mm-thick slices on a four-detector unit. Taking 500 days as the upper value for malignancies, we evaluated whether the software-calculated doubling times could be used to distinguish malignant from benign solid nodules. We also examined whether the relative volume variation of benign nodules correlated with initial nodule size, interscan interval, or differences in contrast administration or exposure parameters between baseline and follow-up CT., Results: There were 52 benign and 11 malignant nodules. Benign nodules had a median doubling time of 947 days and a mean relative volume variation of -4.4% (range, -50% to 38%). Malignant nodules had a median doubling time of 117 days and a mean relative volume variation of 102% (22-462%). The sensitivity, specificity, and negative and positive predictive values of the volumetric software for diagnosing malignancy were 91% (95% confidence interval [CI], 0.59-1.00), 90% (95% CI, 0.79-0.97), 98% (95% CI, 0.89-1.00), and 67% (95% CI, 0.38-0.88), respectively. No correlation was found between the relative volume variation of benign nodules and their initial size, the interscan interval, or differences in contrast administration or exposure parameters between the two CT examinations., Conclusion: Software-calculated pulmonary nodule doubling times of more than 500 days have a 98% negative predictive value for the diagnosis of solid malignant pulmonary nodules. This method may be useful for diagnosing malignant pulmonary nodules on follow-up CT.

Objective: To measure serum levels of tumor necrosis factor alpha (TNF alpha) and interleukin-6 (IL-6) in patients with rheumatoid arthritis (RA) and age-matched control subjects and to study how these correlate with serum levels of hyaluronan (HA) and antigenic keratan sulfate (KS) and other biochemical as well as clinical indicators of disease activity., Methods: Immunoassays were used to measure levels of TNF alpha, IL-6, HA, and antigenic KS in the serum of 35 patients with RA and a group of age- and sex-matched control subjects. Clinical disease activity in the RA group was assessed using the Lansbury index. Drug intake was recorded and the erythrocyte sedimentation rate, and levels of fibrinogen, creatinine, bilirubin, alkaline phosphatase, lactate dehydrogenase, and aminotransferase were measured., Results: Serum levels of TNF alpha, IL-6, and HA were significantly higher in the RA population than in the control group. In patients with RA, serum levels of HA correlated positively with serum levels of TNF alpha and with clinical joint scores, but only weakly with other laboratory parameters of inflammation. Serum levels of antigenic KS correlated negatively with levels of circulating TNF alpha, but much more weakly with other clinical and biochemical parameters of disease activity., Conclusion: These in vivo data support in vitro studies which have shown that TNF alpha is a potent stimulator of HA synthesis by synovial lining cells. The results strengthen the contention that serum HA may be a unique marker of synovial involvement and inflammation, rather than of only inflammation, in RA.

Five cases of Aspergillus discitis in male patients are reported. Three patients had impaired immune responses as a result of immunosuppressive therapy following a heart transplant (two cases) or hairy cell leukemia (one case). Two patients had a recent history of mycobacterial infection. All five patients were hospitalized for severe spinal pain suggestive of an inflammatory disease with no neurological abnormalities. Erythrocyte sedimentation rate was elevated in every case. The diagnosis of discitis was suspected on spinal roentgenograms and established by computed tomography and/or magnetic resonance imaging. In three patients the spine was the only site of Aspergillus infection (lumbar discitis in two cases and thoracic discitis in one case). One patient developed Aspergillus infection of several disks (L1-L2, L2-L3, and L4-L5) after Aspergillus endocarditis with embolization to the left lower limb. Another patient developed discitis after an Aspergillus lung infection. In every case, Aspergillus fumigatus was recovered in cultures of specimens harvested by a percutaneous needle biopsy of the intervertebral disk. All five patients were treated by itraconazole which was given as single drug therapy in one case and in combination with 5-flucytosine and amphotericin B in four cases. Recovery was achieved in every case after four to six months of this drug therapy. In contrast to most previously reported cases, none of the five patients reported herein required surgical treatment. Efficacy of conservative treatment in this study may be related to the use of itraconazole in every case.(ABSTRACT TRUNCATED AT 250 WORDS)