BackgroundThe cold-inducible RNA-binding protein (CIRP) is 18 kDa protein of the glycine-rich RNA binding protein (GRP) family, and these proteins function as RNA chaperones to facilitate translation. Extracellular CIRP is a recently identified endogenous proinflammatory mediator and damage-associated molecular pattern molecules (DAMP) that triggers inflammatory responses in sepsis and inflammatory bowel disease.ObjectivesThis study was planned to investigate the relationship between CIRP and rheumatoid arthritis.MethodsPeripheral blood and synovial fluid were collected from 15 patients with rheumatoid arthritis (RA) and 16 patients with osteoarthritis (OA). The concentration of CIRP was measured by sandwich Enzyme-Linked Immunosorbent Assay (ELISA).ResultsThe concentration of serum CIRP was significantly elevated in RA patients group (RA patients=26.39±10.48 pg/ml, OA patients=17.14±7.24 pg/ml, p=0.009). Furthermore, the RA patients group showed significantly higher CIRP concentration than the OA patients group in synovial fluid (153.56±108.93 pg/ml vs. 23.63±16.18 pg/ml, p<0.001) (Fig.1).The mean concentration of synovial fluid CIRP was significantly higher than that of serum in RA patients group (Serum concentration=26.39±10.48 pg/ml, Synovial fluid=153.56±108.93 pg/ml, p<0.001). Also, we found the tendency that the CIRP concentration of synovial fluid was significantly higher than that of serum in same patient (P=0.025) (Fig.2).DAS28-ESR and DAS28-CRP were positively correlated with synovial fluid concentration of CIRP (DAS28-ESR: r=0.582, p=0.023, DAS28-CRP: r=0.541, p=0.037, by correlation analysis).ConclusionsThe serum and synovial concentration of CIRP in RA patients was increased compared to OA patients. Also synovial concentration of CIRP in RA patients correlated well with the disease activity, i.e. the DAS28-ESR/CRP. Based on these results, the CIRP mediates the inflammation and is potential marker for synovial inflammation.ReferencesQiang X, Yang WL, Wu R, Zhou M, Jacob A, Dong W, Kuncewitch M, Ji Y, Yang H, Wang H, Fujita J, Nicastro J, Coppa GF, Tracey KJ, Wang P (2013) Cold-inducible RNA-binding protein (CIRP) triggers inflammatory responses in hemorrhagic shock and sepsis. Nat Med 19:1489–95.Nishiyama H, Higashitsuji H, Yokoi H, Itoh K, Danno S, Matsuda T, Fujita J (1997) Cloning and characterization of human CIRP (cold-inducible RNA-binding protein) cDNA and chromosomal assignment of the gene. Gene 204:115–20.Nishiyama H, Danno S, Kaneko Y, Itoh K, Yokoi H, Fukumoto M, Okuno H, Millán JL, Matsuda T, Yoshida O, Fujita J (1998) Decreased expression of cold-inducible RNA-binding protein (CIRP) in male germ cells at elevated temperature. Am. J. Pathol 152:289–96.Nishiyama H, Xue JH, Sato T, Fukuyama H, Mizuno N, Houtani T, Sugimoto T, Fujita J (1998) Diurnal change of the cold-inducible RNA-binding protein (Cirp) expression in mouse brain. Biochem. Biophys. Res. Commun 245:534–8.Disclosure of InterestNone declared
Background: Topiramate shows excellent reduction in seizure rate and minimal adverse events. However, there is a significant difference about the optimal dose, duration of topiramate management. Thus, we conduct the multi-center retrospective survey to examine the practical using patterns of topiramate in the neurosurgical patients.Objective: This study is to investigate the actual using patterns and clinical effects of topiramate in patients with neurosurgical disease as antiepileptic drugs (AEDs) in 94 korean multi-centers. Patients and methods: A total of 7,152 patients who had taken topiramate for at least 3 months between August 2008 and February 2009 were eligible to participate in this study. We evaluated demographic data, primary diseases, duration of topiramate administration, initial and subsequent dosage adjustment, concomitant AEDs, the frequency of seizure reduction, and adverse events. Results: Topiramate was most commonly prescribed in stroke (38%), and the mean initial dosage was 65 mg/day, and the mean maintenance dosage was 105 mg/day. The mean duration of the initial dosage for topiramate administration was 24 days, and the mean duration of the maintenance dosage was 125 days, respectively. Among groups with prophylactic administration, 98% did not develop convulsion and among groups with therapeutic administration, 2% was ineffective to control seizure. After taking topiramate, 2% patients showed adverse events, that sensory aberration was the most common. Conclusion: These results suggest that topiramate prescribe widely in diverse neurosurgical disorders, and effective in reduction of seizure frequency, and does not cause serious adverse effects comparable with old AEDs.Purpose: To demonstrate demographics of patients with new onset transient loss of consciousness (TLOC) and clinical characteristics useful in distinguishing causes of TLOC. Methods: We retrospectively enrolled 158 patients aged ≥18 years who visited the emergency rooms of 5 tertiary referral hospitals because of new onset TLOC. Clinical characteristics including symptoms, concurrent medical conditions, comorbidities, and laboratory findings were investigated. Calgary Syncope Seizure Score (CSSS) was measured according to medical records. Results: Among 158 patients, 80 (50.6) were diagnosed as syncope and 62 (39.2%) as epileptic seizures. Tongue biting, head turning, unresponsiveness, unusual posturing and jerking limbs during the TLOC, emotional stress before the TLOC, and no memory of a spell and confusion after the TLOC were associated with epileptic seizures. Lightheadedness, sweating, micturition, and prolonged standing or sitting before the TLOC were associated with syncope. Past history of cerebrovascular disease, concurrent metabolic derangement, sleep deprivation and withdrawal from alcohol were associated with epileptic seizures. EEG abnormalities were associated with the diagnosis of epileptic seizures while MRI abnormalities were not. Discrimination between epileptic seizures and syncope by CSSS was concordant wit...
BackgroundMyositis-specific antibodies in patients with inflammatory myopathies are known to be associated with various clinical manifestations, classifications and diagnosis. Among them, recently found anti-transcriptional intermediary factor 1 (TIF1) α, β, or γ antibodies, has been reported to be associated with dermatomyositis (DM) accompanied by cancer.ObjectivesAlthough previous studies have evaluated the association of the antibodies in serum and clinical subtypes, the information about the target antigen is insufficient. The purpose of this study was to confirm the overexpression of TIF1s in the muscle and skin tissues of patients with inflammatory myopathies.MethodsFrom February 2004 to November 2014, skin and muscle biopsies were performed on 45 patients diagnosed with dermatomyositis and polymyositis. We stained skin and muscle tissue by immunohistochemistry using anti-TIF1α, β, or γ and compared with the results of healthy control. We analyzed the association between the clinical manifestations and protein expression in each tissue.ResultsWhen compared with the control group, any antigens showed no significant overexpression in the muscle. However, TIF1α showed higher positive rate in the skin of DM (12/15 [80%]) than in the skin of healthy control (0/7 [0%]) (p=0.001). TIF1γ expression was higher in the muscle of patients with DM while there was no expression in the muscle of healthy controls (DM, 8/19 [80%] vs. healthy control 0/7 [0%], p=0.039).In the tissues of inflammatory myopathies, TIF1α and TIF1γ demonstrated higher positive rates in the skin than in the muscle (TIF1α, muscle, 4/35 [11%] vs. skin, 12/15 [80%], p<0.001; TIF1γ, muscle, 10/35 [29%] vs. skin, 13/15 [87%], p<0.001). When analyzing DM patients only, the result was similar (TIF1α, muscle, 1/19 [5%] vs. skin, 12/15 [80%], p<0.001; TIF1γ, muscle, 8/19 [42%] vs. skin, 13/15 [87%], p=0.013). TIF1β showed strong positivity in all tissues of myositis or healthy control.Analyzing the association with TIF1s expression and cancer, there was no significant difference in the positive rate of TIF1α or γ in the muscle or skin between the myositis patient with or without cancer.ConclusionsTIF1α was expressed more in the skin of DM patients than that in that of control group and TIF1γ in the muscle of DM patients than in that of control. The expression of TIF1α in the skin and TIF1γ in the muscle of cancer associated DM was not higher than those of DM without cancer. Thus the expression levels of TIF1α in the skin and TIF1γ in the muscle may be associated with myositis rather than with cancer.ReferencesHoshino K, et al. Anti-MDA5 and anti-TIF1-gamma antibodies have clinical significance for patients with dermatomyositis. Rheumatology (Oxford) 2010;49(9):1726–1733.Fiorentino D. Casciola-Rosen L, Autoantibodies to transcription intermediary factor 1 in dermatomyositis shed insight into the cancer-myositis connection. Arthritis Rheum 2012;64(2):346–349.Disclosure of InterestNone declared
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