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The ability of ultrasound (US) to identify subclinical joint inflammation in rheumatoid arthritis (RA) patients in remission has been already reported. Nonetheless, current studies present a lack of homogeneity in patient's characteristics and number of joints assessed by US. The aim of this study was to identify a reduced set of target joints to be scanned in RA patients in clinical remission in order to detect subclinical synovitis.Forty RA patients in clinical remission (DAS28 ≤2.6) for at least 3 months underwent an US examination of 18 joints: wrist, II-III-IV-V metacarpophalangeal (MCP) and II-III-IV-V metatarsophalangeal joints bilaterally. The presence of synovial hypertrophy (SH) and power-Doppler (PD) signal was registered following the OMERACT definitions and was graded according to a 4-point scale (0-3). Then, by applying a process of data reduction based on the frequency of joint involvement, a reduced assessment was obtained.Twenty (50%) subjects had at least one joint affected by active synovitis; 17.5% presented grade 1 PD and 32.5% grade 2 PD. The joints most frequently affected by active synovitis were the wrists (75%) and the II MCP joints (55%). After data reduction, the evaluation of 3 joints (both wrists and the II MCP of the dominant hand) obtained a sensitivity of 90% for the detection of subclinical synovitis.The US scan of 3 target joints showed a high sensitivity in detecting subclinical active synovitis in RA patients in clinical remission and can be feasible in the routine assessment of these patients.

A 30-year-old woman affected by Mixed Connective Tissue Disease with scleroderma spectrum developed a facial eruption, a clinical and histological characteristic of subacute cutaneous lupus erythematosus (SCLE). Speckled anti-nuclear antibodies, high-titer anti-ribonucleoprotein1, anti-Sm, anti-Cardiolipin (aCL) IgG/IgM, and anti-Ro/SSA antibodies were positive. SCLE was resistant to Azathioprine, Hydroxychloroquine, and Methotrexate while Mycophenolate Mofetil was suspended due to side effects. Subsequently, the patient was treated with three cycles of therapeutic plasma exchange (TPE) followed, one month after the last TPE, by the anti-CD20 antibody Rituximab (RTX) (375 mg/m2 weekly for 4 weeks). Eight and 16 months later the patient received other two TPE and RTX cycles, respectively. This therapeutic approach has allowed to obtain a complete skin healing persistent even after 8-month follow-up. Moreover, mitigation of Raynaud's phenomenon, resolution of alopecia, and a decline of aCL IgG/IgM and anti-Ro/SSA antibodies were observed.

Pilots are exposed to the "stress of flight" and the chronically activated stress response may play an important role in circulatory system disease progression. We studied the effect of an experimental mental stress on cardiovascular and neuroendocrine activity, in Air Force Academy cadets, before and after one month intensive course.Nine cadets were submitted to a psychometric evaluation before Stroop test (ST), including Minnesota Multiphasic Personality Inventory, State and Trait Anxiety Inventory (STAI X1 and X2 form) and Reaction Scheme Test. After ST, subjects completed a STAI X1 form. Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP) were monitored and serum prolactin (PRL), growth hormone (GH), adrenocorticotropin (ACTH) and cortisol levels were determined, during ST. The protocol was repeated at the end of the course.No significant differences were evident in PRL, GH and ACTH levels. Cortisol concentrations were significantly higher before the course. ST did not modify hormone secretion. ST induced a significant and reproducible elevation of HR and SBP. Basal HR, SBP and DBP values were significantly elevated after the course. Two subjects presented a particular psychometric profile, a different cardiovascular response to ST and did not pass the course.acute mental stress significantly activated cardiovascular response without modifying endocrine responses, in relation to the psychological profiles. A significant increase of cardiovascular parameters was present after the course, with enhanced dichotomy between the endocrine and sympathetic system, suggesting a careful evaluation and follow-up for circulatory system diseases in cadets.

In 1990, the prevalence of antibodies to hepatitis C virus (anti-HCV) was assessed among 4,978 Air Force recruits aged 18-26 years coming from all regions of Italy. Positivity to anti-HCV was found by both IIIrd generation EIA and RIBA in 24 (0.48%) study participants. The prevalence was twice as high in Southern Italy and the islands as in Northern and Central Italy (0.76% vs. 0.35%), a difference which was not statistically significant. The results of multiple logistic regression showed that no sociodemographic variable (region of birth, father's years of education, number of siblings) was associated with anti-HCV positivity. No anti-HCV-positive individual was positive for HBsAg. Anti-HCV positivity was found in 0.8% (2/236) of the participants who were positive for anti-HBc and in 0.5% (22/4742) of those who were anti-HBc negative, also a difference which was not statistically significant. Thus no association was found between HCV and HBV infections. These findings indicate that in Italy, HCV infection is an uncommon event among young adult males.

The aim of our study was to verify the efficacy of transvaginal ultrasound scanning as an indicator of the endometrial status in healthy menopausal women. One hundred eighty five healthy women in natural menopause were examined by vaginal sonography; the endometrial patterns were analyzed and the influence on it of body weight, menopausal age, and hormonal therapy was considered. The presence of irregular and the endometrial histology were related to the ultrasound findings. 38% of the women assumed estrogen plus progestin replacement treatment since one-two years, for menopausal complaints. 17% of all patients reported irregular bleeding during the last month. The majority of women (90%), regardless of the hormone assumption, presented en endometrial thickness less than 10 mm. 10% of untreated and treated women had an endometrial thickness between 10 and 20 mm. Among the subjects with elevated menopausal age is more frequent the imaging of endometrial layer minor than 5 mm in comparison with women in early menopause. 4% of untreated and 10% of treated women without irregular bleeding had an endometrial thickness higher than 10 mm, while 67% of women with irregular bleeding presented an endometrial layer higher than 10 mm. In treated group all women with endometrial thickness greater than 10 mm had amenorrhoea. 86% of patients had endometrial atrophy detected by biopsy; hyperplastic endometrium or endometrial cancer was not demonstrated. In conclusion, vaginal sonography is a simple and reliable method in the study of the endometrial pattern in healthy menopausal women.

Acute hypoxia stimulates the release of atrial natriuretic factor (ANF) from isolated rat and rabbit hearts. Increased ANF plasma levels have been found in rats exposed to chronic hypoxia and recently some studies have been conducted on men, with discordant results. The aim of the present study was to verify changes in ANF plasma levels during acute and prolonged hypoxia in young healthy men. We studied 22 subjects (aged 20-28 years, mean 22.7 years) during a simulated exposure to altitude (5000 m) in a hypobaric chamber for 3 hours (A), and 6 subjects (aged 24-51 years, mean 36.5 years) during the scientific expedition to mount Poumori (Nepal 4930 m altitude) with an exposure at maximum altitude for 20 days (B). ANF was measured by the radioimmunoassay method. Results (pg/ml): (A) baseline: 29.4 +/- 18.6; 120 min: 32.0 +/- 17.4 (NS); 180 min: 35.4 +/- 17.1 (p less than 0.05). (B) baseline: 39.6 +/- 13.3; third day: 38.2 +/- 14.1; fifth day: 31.3 +/- 11; seventh day: 29.1 +/- 13.5; tenth day: 32.2 +/- 20.8; fifteenth day: 37.9 +/- 20.2; twentieth day: 34.6 +/- 23.7 (all differences were not significant). In (B) we observed a higher dispersion of values perhaps due to individual variability. The different behaviour of ANF plasma levels in acute and chronic conditions might be due to the adaptive modification of different physiological parameters as loss of plasma volume, natriuresis and attenuation of tissue hypoxia by enhanced erythropoiesis, observed more evidently during prolonged exposure.

It has been demonstrated that peripheral blood lymphocytes, particularly the ‘atypical’ ones, are predominantly of the T type in infectious mononucleosis (IM). This is based on membrane marker studies (E rosettes, receptor for complement, receptor for Fc fragment of immunoglobulins (Ig), and membrane Ig) and by anti-T lymphocyte serum. On the other hand, lymphoblastoid cell lines derived from IM patients show the characteristics of B lymphocytes. This permits the supposition that EBV infects B lymphocytes and stimulates them to proliferate. The cell proliferation is unlimited in vitro and is probably controlled in vivo by T cells. The reduction of cellular immunity in vivo, which contrasts with the high number of T cells in peripheral blood, could be explained by the fact that T cells are engaged in the regulation of B cell proliferation.