Etiologies of Bone Metastases at the Rheumatology Department (UTH) of Abidjan

Objectives: The aim of this study was to describe the diagnostic and etiological aspects of bone metastases in the Rheumatology Department of Cocody’s University Teaching Hospital (UTH). Methodology: This was a descriptive, 11-year retrospective study (January 1, 2006 to December 31, 2016) of inpatient records of bone metastases. The diagnosis was made on clinical (bone signs), radiological (osteolysis, bone condensation) and sometimes histological basis. Result: Eighty out of 6, 1111 inpatients suffered from bone metastasis with a hospital frequency of 1.30%. The average age was 60.74 years (range 26 to 81 years). Men were predominant (53 men for 27 women) with a sex ratio of 1.96. The main complaints were pain (97.6%). chronic (90%), severe (73.8%), inflammatory (93.8%). There was sometimes a neurological complication: a motor deficit (21.3%), sensitive (13.8%). These symptoms were associated with fever (56.3%) and altered general state (85%). Bone metastases have been revealing in the vast majority of cases (93.75%);the primary cancer was known only in 5 patients (prostate = 2, breast = 2 and cervix = 1). Bone condensation (61.3%), osteolysis (50%) and mixed lesions (7.5%) where the main radiological lesions observed. The primary tumors were: prostatic (50%), pulmonary (18.8%), mammary (11.3%), uterine (5%), renal (2.5%), hepatic (2.5%), bladder (1.3%) and adrenal (1.3%). Conclusion: Bone metastases affect mostly the elderly;inflammatory spinal pain is the main symptom. Bone condensation is the most common radiologic lesion. The prostate, breast and lungs are the main primary tumors.

Bone Metastases: Experience of Rheumatology Unit of National Hospital University Hubert Koutoukou Maga of Cotonou

Aim: To determine the epidemiological, diagnosis and treatment of secondary bone cancer at the National Hospital University Hubert Koutoukou Maga of Cotonou. Patients and Method: It was a retrospective descriptive cross-sectional study carried out from January 1999 to December 2013 on the records of patients treated in the rheumatology department. The selected files had radiological images of tumor appearance objectified by two radiologists. The diagnosis of secondary bone cancer was confirmed after a bone biopsy or the discovery of a primitive tumor site. Patients with hematologic malignancy and incomplete or insufficiently explored records were excluded. Results: Among 10,292 patients followed in the service, 51 (0.5%) had documented bone metastasis. The sex ratio was 1.83. The mean age of patients was 54 ± 9 [26-85] years, with 53% of those over 60 years old. Secondary cancers were on the spine (74.5%), pelvis (35.3%) and the long bones (39.2%). The primary cancer most frequently found was that of the prostate and breast (45.1% and 27.6%, respectively) followed by genital and digestive cancers (9.8% and 7.8%, respectively). Treatment was dominated by hormone therapy (83%) bisphosphonates (70.5%) and chemotherapy (57%). Conclusion: The profile of bone cancer in Benin hospital is very diverse and dominated by the types and osteolytic ostéocondensant. Primary cancers were dominated by the prostate and breast. Bisphosphonates took an important place in the treatment of the disease.

Etiologies of Arthritis in Sub-Saharan Africa Rheumatology Practice

Objective: To research distribution of etiologies modification of arthritis in Congo-Brazzaville, twenty years after the first reports. Methods: A cross sectional study has been achieved. Medical files of patients admitted for arthritis between 2000 and 2014, in Rheumatology department of Brazzaville university teaching hospital have been included. Among 416 patients listed as cases of arthritis, 201 answered to the inclusion criterias have been kept for analysis. The etiological diagnoses were based on criterias of classification and/or diagnosis used in Rheumatology. Results: 201 patients, 110 men (54.72%) and 91 women (45.28%) were included. The sex-ratio was 1.2, and average age was 45.5 years old (extremes: 8-86 years). Among them, 72 patients had microcrystal arthritis. Septic arthritis and those associated with HIV constituted the second etiological group of 60 patients and respectively, 32 were bacterial and 28 HIV associated arthritis. 58 remaining patients had a chronic inflammatory arthritis. Etiology distribution showed that gout was the most frequent (33.83%), followed by septic arthritis (15.92%), HIV associated arthritis (13.93%) and rheumatoid arthritis (11.94%). In 11 patients (5.5%), etiology was unknown. Conclusion: Three decades after the first publications in Brazzaville, the etiologies of arthritis remain dominated in order of frequency by gout, septic arthritis and HIV associated arthritis and rheumatoid arthritis. The frequency of indeterminate arthritis decreased significantly. Spondy-loarthropathy and autoimmune diseases are more common diagnosis.

Profile of Malignant Bone Tumors among Rheumatology Inpatients in Lome (Togo)

Background: The reel impact of malignant bone tumors in adults seems unclear in Black Africa. Aim: The aim of this study is to determine the epidemiological and the semiological profile of malignant bone tumors in rheumatology inpatients at Hospital University Center Sylvanus Olympio in Lome. Methods: It was a retrospective study of recorded cases conducted over a period of 19 years in the rheumatology department at Hospital University center Sylvanus Olympio in Lome, Togo. Results: One hundred and sixty-six patients (68 women and 98 men) suffered from a bone tumor. The average age of patients was 55 years old with some extremes cases of 14 and 98 years old. The most affected age group was the one between 46 and 55 years old (40 cases, 24.1%). The disease’s average duration was 17 months. These tumors were primary in 43 cases (26%) and secondary in 123 (74%). Metastases were those of prostate (44 cases, 35.7%), breast (12 cases, 9.7%), bronchus (7 cases, 5.7%), cervix (5.7%), and liver (2 cases, 1.6%). Myeloma (34 cases;79.0%) and osteosarcoma (9 cases;20.9%) were the main primary malignant bone tumors. However, 41 cases (33.3%) of malignant bone tumors had not been able to label. The spine was the predilection part for all above-mentioned tumors. Conclusion: This study shows the significant part occupied by malignant bone tumors in musculoskeletal diseases within the sub-Saharan population in general and Togo in particular.

Systemic lupus erythematosus in a 15-year-old female with multiple splenic nodules:A case report

BACKGROUND Systemic lupus erythematosus(SLE)is a chronic inflammatory disease primarily affecting young females.SLE can invade any organ,and various forms of splenic invasion have been reported.Manifestations include splenomegaly and splenic infarction,rupture,and calcification.The study encountered a rare case of splenic involvement,with nodules of various sizes without calcifications or ruptures.CASE SUMMARY A 15-year-old girl presented with arthralgia,weight loss,fever,increased levels of inflammatory markers,and positive antinuclear antibody test results.The patient was diagnosed with SLE.She was asymptomatic while taking steroids and hydroxychloroquine.Ten months after discharge,the patient developed a fever and abdominal pain.Lupus enteritis was suspected,and abdominopelvic computed tomography(AP-CT)was performed.There were no specific findings in the gastrointestinal tract,but multiple splenic nodules were observed.Infection or hemangioma was considered;however,no specific radiological findings were observed.A biopsy of the spleen was performed to determine the possibility of malignancy.The histological findings of the spleen included extensive periarteriolar necrosis with hematoxylin bodies and numerous karyorrhectic debris.Based on the biopsy results,the patient was diagnosed with an SLE flare-up and was maintained on high-dose steroids and immunosuppressants.CONCLUSION As disease activity increased,multiple nodules in the spleen that were previously unseen were observed using AP-CT and histologically confirmed.Spleen invasion by SLE can appear in multiple nodular forms and patterns.Therefore,physicians should consider these findings when differentiating these nodules from infections and malignancies.

Managing adult-onset Still's disease in pregnancy:A case report

BACKGROUND Adult-onset Still’s disease(AOSD)is a rare systemic inflammatory disorder characterized by fever,arthritis,skin rash,and systemic symptoms.The etiology of AOSD is unknown;however,it is thought to be related to immune dysregulation.Although a rare disease,AOSD can significantly impact reproductive health,particularly during pregnancy.This case study assesses the implications of pregnancy in a patient with AOSD,as well as the potential for heredity of the disease.Neonatal hemophagocytic lympho-histiocytosis(HLH)is a rare and lifethreatening disorder characterized by hyperinflammation and uncontrolled activation of immune cells,leading to multiple organ dysfunction.This case report aimed to introduce neonatal HLH from a mother with AOSD.CASE SUMMARY This case study presents a 29-year-old female with AOSD who became pregnant and gave birth to a premature infant who was diagnosed with neonatal HLH.AOSD can significantly impact pregnancy and childbirth,as it may become more severe during pregnancy,with an increased risk of fetal loss and preterm birth.The management of AOSD during pregnancy involves the use of nonsteroidal anti-inflammatory drugs and glucocorticoids,as well as immunosuppressive agents in severe cases.However,the use of immunosuppressive agents during pregnancy may be associated with potential risks to the fetus.The hereditary implications of AOSD are unclear;however,available evidence suggests that genetic factors may play a role in the disease development.CONCLUSION AOSD can have significant implications for pregnancy and childbirth,including an increased risk of fetal loss and preterm birth.Neonatal HLH,a complication of AOSD in pregnancy,requires prompt diagnosis and management.Women with AOSD who are considering pregnancy should discuss their options with their healthcare provider and develop a management plan that addresses the potential risks to both mother and fetus.

The neutrophil–osteogenic cell axis promotes bone destruction in periodontitis

The immune-stromal cell interactions play a key role in health and diseases. In periodontitis, the most prevalent infectious disease in humans, immune cells accumulate in the oral mucosa and promote bone destruction by inducing receptor activator of nuclear factor-κB ligand (RANKL) expression in osteogenic cells such as osteoblasts and periodontal ligament cells. However, the detailed mechanism underlying immune–bone cell interactions in periodontitis is not fully understood. Here, we performed single-cell RNAsequencing analysis on mouse periodontal lesions and showed that neutrophil–osteogenic cell crosstalk is involved in periodontitis-induced bone loss. The periodontal lesions displayed marked infiltration of neutrophils, and in silico analyses suggested that the neutrophils interacted with osteogenic cells through cytokine production. Among the cytokines expressed in the periodontal neutrophils, oncostatin M (OSM) potently induced RANKL expression in the primary osteoblasts, and deletion of the OSM receptor in osteogenic cells significantly ameliorated periodontitis-induced bone loss. Epigenomic data analyses identified the OSM-regulated RANKL enhancer region in osteogenic cells, and mice lacking this enhancer showed decreased periodontal bone loss while maintaining physiological bone metabolism. These findings shed light on the role of neutrophils in bone regulation during bacterial infection, highlighting the novel mechanism underlying osteoimmune crosstalk.

Clinical Profile of Juvenile Idiopathic Arthritis (JIA) in a Semi-Rural Ivorian Environment

Objectives: To describe the clinical profile of juvenile idiopathic arthritis (JIA) in a semi-rural Ivorian setting: the rheumatology department of the Bouaké University Hospital (CHU.B). Patients and methods: This was a descriptive cross-sectional study from January 2018 to December 2023 in the rheumatology department of the CHU.B. The study focused on the epidemiological, diagnostic and therapeutic data of children followed for JIA on the basis of the classification criteria of the International League of Associations for Rheumatology (ILAR). Excel 2019 software was used to analyse the data. Results: Over a 6-year period, JIA represented 0.29% (11/3780) of all rheumatological conditions and 1.40% (11/782) of childhood rheumatic diseases. The mean age of the children at diagnosis was 13.09 ± 3.01 years, and the mean age at onset of the disease was 8.54 years. There were 6 girls and 5 boys. Joint involvement was the main reason for consultation and hospitalisation, accounting for 81.81% (9) of cases. There was a family history in 3 children (27.3%). The clinical forms were as follows: systemic 27.27% (3), oligoarticular 27.27% (3), polyarticular with rheumatoid factor negative 27.27% (3), polyarticular with rheumatoid factor positive 9.09 (1), arthritis with enthesitis 9.09 (1). JIA was discovered at steinbrocker functional stages II and III. Treatment included NSAIDs 72.72% (8), corticosteroid therapy combined with methotrexate and hydroxychloroquine 54.54% (6) and rehabilitation 63.63% (7). Conclusion: JIA is a little-known disease in the semi-rural environment of Côte d’Ivoire. It is characterised by a long delay in diagnosis in relation to poverty and the lack of recourse to alternative medicine in our populations;hence, it is important to raise awareness of the condition among the population and practitioners. Multidisciplinary intervention would improve the diagnosis and management of children with JIA.

Epidemiological, Clinical and Paraclinical Profile of Osteoarthritis of the Lower Limbs in Obese Patients at the Cocody University Teaching Hospital

Objective: To describe the epidemiological, clinical and paraclinical characteristics of osteoarthritis of the lower limbs in obese patients at the Cocody University Teaching Hospital. Methodology: This was an analytical cross-sectional study carried out in the rheumatology department of the Cocody UTH in Abidjan (Ivory Coast) from March 1 to April 30 2023. Patients who came for rheumatology consultation presenting with mechanical arthralgia of the lower limbs, who were obese, had radiographic images were included. All patients without radiographic images were excluded. Obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m. The Chi2 test was used to compare proportions and determine the existence of associations between osteoarthristis and obesity, obesity severity and radiographic stage of osteoarthritis as well as the functional impact. A p-value below a predefined threshold (p = 0,05) indicates a significant relationship between the variables. Result: Out of 185 patients received for osteoarthritis of the lower limbs during the study period, 136 were obese (74%). There were 115 women (84.6%) with an average age of 56.03 with a standard deviation of 12.72 years (extremes: 22 and 84 years). The main socio-professional category was the informal sector (30%). The majority of patients had a low socio-economic level (80.2%) and lived in urban areas (92.6%). The most common past medical history was hypertension (33.08%) followed by peptic ulcer disease (16.91%). Patients had a body mass index class 1 (81.6%), class 2 (15.40%) and class 3 (2.90%). The average duration of symptom progression until diagnosis was 11 months. Genu varum was the main static disorder (56.10%) and the knee joint was the dominant topography (90.4%) with a bilateral localization (80%). The average Lequesne index was greater than 8 (59.5%). The Kellgren and Lawrence radiographic stages were stage 1 (9.20%), stage 2 (46.90%), stage 3 (29.20%) and stage 4 (6.90%). The Obesity severity was significantly associated with osteoarthritis of the knee (p = 0.042). There was no statistically significant association between obesity severity and radiographic stage of osteoarthritis (p = 0.163) or functional impact (p = 0.180). Conclusion: Osteoarthritis of the lower limbs affected obese women and was dominated by stage 2 osteoarthritis of the knee (Kellgren and Lawrence). There is an association between the severity of obesity and osteoarthritis of the knee.

Lupus and Pregnancy

Introduction: Systemic lupus erythematosus is a multifactorial autoimmune disease characterised by its clinical polymorphism and its course in flares. The aim of our study was to determine the effects of pregnancy on lupus and vice versa. Material and Methods: This is a retrospective study conducted over a period of 14 years from 2002 to 2015. We included cases of systemic lupus erythematosus associated with pregnancy followed at the obstetrics and gynecology department “C” of the Ibn Rochd University Hospital in Casablanca. Results: The mean age of our parturients was 31.4 years. All our patients were known to have lupus and were followed up. Pregnancy was terminated in six (20%) cases. We noted one (3%) case of intrauterine fetal death, four (13%) cases of intrauterine growth retardation, and five (16%) cases of prematurity. Lupus flare during pregnancy occurred in 16 (52%) cases, including one (3%) patient who developed superimposed pre-eclampsia, had a renal relapse in the third trimester requiring an abortion at 32 weeks of gestation with three sessions of hemodialysis, and another patient who developed eclampsia. Conclusion: A better understanding of the aggravating factors and compatible treatments has led to a more widespread authorization of pregnancy.

Bilateral Cervical Ribs Fusing or Naffziger Syndrome: About an Observation in Guinea and Literature Review

Thoraco-brachial outlet syndrome (TDSD) or cervical rib brings together all the clinical symptoms (arterial, neurological and/or venous) due to extrinsic, intermittent or permanent compression of the vascular-nervous elements of the root of the upper limb during cervico-thoraco-brachial crossing syndrome. This pathology is relatively common but often overlooked;it affects women more often (between 4/1 and 2/1) and is rare in children. We report the case of a 59-year-old female patient seen in the department for paresthesia and muscular weakness of the upper limbs rated 3/5 on the right and 4/5 on the left progressively evolving over 39 years, electromyography (EMG) showed indicated compression of the brachial plexus and the CT scan confirmed the presence of bilateral cervical ribs fused with the first on the left. She benefited from physiotherapy while awaiting her surgery, and unfortunately, she died of a stroke in the traumatology department. This pathology is the first in our department to be supported by a review of the literature.

Osgood Schlatter Disease: Study of 2 Observations in Conakry, Guinea

Introduction: OSD is a growth osteochondrosis affecting the apophyseal cartilage of the anterior tibial tuberosity of the knee, 20 to 30% of young growing athletes suffer from this pathology, described by Osgood and Schlatter in 1903. Objective: To report 2 observations and review the literature. Observation 1: This was a 14-year-old Guinean teenager, Halpoular, living in Conakry, a right-handed footballer who presented with a painful swelling of the right knee that looked mechanical, whose father had HLA B27 positive ankylosing spondylitis. X-ray of the right knee showed fragmentation of the anterior tibial tuberosities, and ossicle with edema of the patellar tendons at stage 4 according to Ehrenbord and Lagergren (1961). Thus, the disease of OSD is retained, He received 120 mg of diclofenac, 20 mg omeprazole for 1 month and the cessation of sports activity, the evolution was favorably marked by the regression of pain. Observation 2: A 16-year-old girl, initials M.L.T, Guinean, residing in Coyah (Republic of Guinea), a handball player, consulted for intense pain (VAS: 8/10) in her knees after a violent shock received when she hit the post. The physical examination found a painful, soft swelling at the anterior tibial tuberosity of the right knee, the rest of the examination was normal. The X-ray of the right knee shows fragmentation of the anterior tibial tuberosity, and ossicle with edema of the patellar tendon at stage 4 according to Ehrenbord and Lagergren 1961, thus the OSD disease is retained, the treatment instituted was 120 mg of diclofenac, the cessation of sports activity which gives a good evolution (EVA at 2/10). Conclusion: OSD is a growth osteochondrosis affecting the apophyseal cartilage of the anterior tibial tuberosity of the knee in young growing athletes, resolving at rest.

Etanercept-synthesizing adipose-derived stem cell secretome:A promising therapeutic option for inflammatory bowel disease

BACKGROUND Inflammatory bowel disease(IBD)is a chronic inflammatory condition of the gastrointestinal tract,with tumor necrosis factor(TNF)-αplaying a key role in its pathogenesis.Etanercept,a decoy receptor for TNF,is used to treat inflammatory conditions.The secretome derived from adipose-derived stem cells(ASCs)has anti-inflammatory effects,making it a promising therapeutic option for IBD.AIM To investigate the anti-inflammatory effects of the secretome obtained from ASCs synthesizing etanercept on colon cells and in a dextran sulfate sodium(DSS)-induced IBD mouse model.METHODS ASCs were transfected with etanercept-encoding mini-circle plasmids to create etanercept-producing cells.The secretory material from these cells was then tested for anti-inflammatory effects both in vitro and in a DSS-induced IBD mouse model.RESULTS This study revealed promising results indicating that the group treated with the secretome derived from etanercept-synthesizing ASCs[Etanercept-Secretome(Et-Sec)group]had significantly lower expression levels of inflammatory mediators,such as interleukin-6,Monocyte Chemoattractant Protein-1,and TNF-α,when compared to the control secretome(Ct-Sec).Moreover,the Et-Sec group exhibited a marked therapeutic effect in terms of preserving the architecture of intestinal tissue compared to the Ct-Sec.CONCLUSION These results suggest that the secretome derived from ASCs that synthesize etanercept has potential as a therapeutic agent for the treatment of IBD,potentially enhancing treatment efficacy by merging the anti-inflam-matory qualities of the ASC secretome with etanercept's targeted approach to better address the multifaceted pathophysiology of IBD.

伯氏疏螺旋体传播过程中病原体、媒介、宿主间的相互作用(英文)

莱姆病是一种蜱媒传播的人兽共患病,在北半球广泛流行。其病原体是伯氏疏螺旋体,具有极为复杂的传播机制和过程。在过去20多年中,科学家们对此进行了广泛而深入的探索。本综述拟对近5年这方面的研究进展,尤其是Fikrig实验室的工作进行总结。内容主要包括:证明伯氏疏螺旋体外膜蛋白OspA是一种粘附素(adhesion) ,对螺旋体在硬蜱中肠(midgut)定居至关重要,并发现硬蜱中肠肠腔表面蛋白TROSPA是OspA的受体;发现蜱唾液腺蛋白Salp15协助伯氏疏螺旋体感染哺乳类动物;发现伯氏疏螺旋体膜蛋白bmpA和bmpB介导螺旋体在关节的定居及关节炎的发生。这些发现有助于我们深入了解莱姆病的传播特征和致病机制。

玉屏风散对气道变态反应性小鼠IL-17和IL-6的影响

目的通过建立系统性气道变态反应性小鼠模型,观察玉屏风散对小鼠肺部IL-17和IL-6的影响。方法40只Balb/c小鼠随机分成正常对照组、哮喘模型组、地塞米松治疗组和玉屏风散治疗组。建立用OVA诱导激发的上、下呼吸道变态反应性炎症模型,采用ELISA和免疫组织化学标记法分别测定和标记肺部IL-17和IL-6,治疗组在激发同时分别给予地塞米松(2mg/kg,7d)或玉屏风散(771mg/kg,7d)腹腔注射。结果哮喘动物模型激发同时给予玉屏风散治疗后,肺匀浆IL-17和IL-6均下降(P≤0.05)。模型组肺部免疫组化标记IL-17显著表达在小支气管柱状上皮,经治疗后表达下降;IL-6免疫组化也表达在支气管柱状上皮,较IL-17低。各实验组IL-6测定和表达结果类似于IL-17。结论Th17细胞参与了哮喘发病的病理过程,玉屏风散对小鼠系统性气道变态反应模型IL-17和IL-6在激发期有治疗作用,即玉屏风散对Th17细胞参与哮喘的病理过程有抑制作用。

Hand bone mass in rheumatoid arthritis:A review of the literature

Rheumatoid arthritis(RA) is a common chronic inflammatory disease and periarticular osteoporosis or osteopenia of the inflamed hand joints is an early feature of RA Quantitative measurement of hand bone loss may be an outcome measure for the detection of joint destruction and disease progression in early RA. This systematic review examines the published literature reporting hand bone mass in patients with RA, particularly those using the dual X-ray absorptiometry(DXA) methods The majority of the studies reported that hand bone loss is associated with disease activity, functional statusand radiological progression in early RA. Quantitative measurement of hand bone mineral density by DXA may be a useful and practical outcome measure in RA and may be predictive for radiographic progression or functional status in patients with early RA.

Do neutrophil extracellular traps contribute to the heightened risk of thrombosis in inflammatory diseases?

Thrombotic events,both arterial and venous,are a major health concern worldwide. Further,autoimmune diseases,such as systemic lupus erythematosus,anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis,and antiphospholipid syndrome,predispose to thrombosis,and thereby push the risk for these morbid events even higher. In recent years,neutrophils have been identified as important players in both arterial and venous thrombosis. Specifically,chromatin-based structures called neutrophil extracellular traps(NETs) play a key role in activating the coagulation cascade,recruiting platelets,and serving as scaffolding upon which the thrombus can be assembled. At the same time,neutrophils and NETs are emerging as important mediators of pathogenic inflammation in the aforementioned autoimmune diseases. Here,we first review the general role of NETs in thrombosis. We then posit that exaggerated NET release contributes to the prothrombotic diatheses of systemic lupus erythematosus,ANCA-associated vasculitis,and antiphospholipid syndrome.

Helicobacter pylori-associated immune thrombocytopenia:Clinical features and pathogenic mechanisms

Immune thrombocytopenia (ITP) is an autoimmune disease mediated by anti-platelet autoantibodies. There is growing evidence that the eradication of Helicobacter pylori (H. pylori) effectively increases platelet count in a considerable proportion of ITP patients infected with this bacterium. In the majority of ITP patients responding to H. pylori eradication therapy, the anti-platelet autoantibody response is completely resolved with no relapse for more than 7 years, indicating that the disease is cured. Therefore, adult patients with suspected ITP should be examined for H. pylori infection, and eradication therapy is recommended if the infection is present. Notably, however, the efficacy of H. pylori eradication therapy in ITP patients varies widely among countries, with a higher response rate in Japan compared with the United States and European countries other than Italy. The pathogenesis of H. pylori-associated ITP is still uncertain, although the mechanisms are known to involve multiple factors. H. pylori may modulate the Fcγ-receptor balance of monocytes/macrophages in favor of activating Fcγ receptors, and H. pylori components may mimic the molecular makeup of platelet antigens. Further studies of the pathogenic process of H. pylori-associated ITP may be useful for the development of new therapeutic strategies for ITP.

Perioperative management of the patient with rheumatoid arthritis

A multidisciplinary approach is required to care for patients with rheumatoid arthritis(RA)in the perioperative period.In preparation for surgery,patients must have a cardiovascular risk assessment performed due to the high risk of heart disease in patients with RA.Treatment of RA is with immunomodulatory medications,which present unique challenges for the perioperative period.Currently,there is no consensus on how to manage disease modifying antirheumatic drug(DMARD)therapy in the perioperative setting.Much of the data to guide therapy is based on retrospective cohort data.Choices regarding DMARDs require an individualized approach with collaboration between surgeons and rheumatologists.Consensus regarding biologic therapy is to hold the therapy in the perioperative period with the length of time dictated by the half-life of the medication.Special attention is required at the time of surgery for potential need for stress dose steroids.Further,there must be close communication with anesthesiologists in terms of airway management particularly in light of the risk for cervical spine disease.There are no consensus guidelines regarding the requirement for cervical spine radiographs prior to surgery.However,history and exam alone cannot be relied upon toidentify cervical spine disease.Patients with RA who undergo joint replacement arthroplasty are at higher risk for infection and dislocation compared to patients with osteoarthritis,necessitating particular vigilance in postoperative follow up.This review summarizes available evidence regarding perioperative management of patients with RA.

Gene therapy for gastric cancer:Is it promising?

Gastric cancer is one of the most common tumors worldwide. The therapeutic outcome of conventional therapies is inefficient. Thus, new therapeutic strategies are urgently needed. Gene therapy is a promising molecular alternative in the treatment of gastric cancer, including the replacement of defective tumor suppressor genes, the inactivation of oncogenes, the introduction of suicide genes, genetic immunotherapy, anti-angiogenetic gene therapy, and virotherapy. Improved molecular biological techniques and a better understanding of gastric carcinogenesis have allowed us to validate a variety of genes as molecular targets for gene therapy. This review provides an update of the new developments in cancer gene therapy, new principles, techniques, strategies and vector systems, and shows how they may be applied in the treatment of gastric cancer.