Objective Visfatin is one of the recently discovered adipokines that plays important proinflammatory and catabolic roles in rheumatoid arthritis (RA). Proinflammatory cytokines, such as interleukin (IL)-1, IL-6, IL-15, IL-18, and tumor necrosis factor-a (TNF-α), induce a number of physiological changes that result in the characteristic signs of inflammation. As inflammation is the major factor leading to structural damage, it is critical to achieve rapid suppression of inflammation to maximize disease control. Therefore, early diagnosis and treatment of RA is of paramount importance. As information on the relation between visfatin and disease activity in RA patients is conflicting and little is known about its role in joint damage, the present study was designed to evaluate the role of serum visfatin as a recent proinflammatory marker in RA according to the activity scores of disease to assess the possibility of introducing serum visfatin in the diagnosis and monitoring of RA patients and to determine the correlation between its serum level and other cytokines (IL-6 and TNF-α) and other laboratory biomarkers. Patients and methods This study was carried out on a total of 80 individuals; 60 of these were (48 women, 80%, 12 men, 20%) diagnosed with RA according to the American College of Rheumatology/The European League Against Rheumatism 2010 criteria and 20 healthy individuals were included as controls (10 women, 50%, 10 men, 50%). RA patients were classified into three groups: group I (severe RA) included 20 RA patients, group II (moderate RA) included 20 RA patients, and group III (mild RA) included 20 RA patients according to clinical evaluation for disease activity assessed using a 28 joint disease activity score (DAS-28). Blood samples were obtained from patients and controls for complete blood count and erythrocyte sedimentation rate. The sera of patients were collected for enzyme-linked immunosorbent assay estimation of serum visfatin, IL-6, and TNF-α. C-reactive protein (CRP) and rheumatoid factor (RF) were determined using the turbidimetry quantitative method. Results Comparison of the RA and control groups showed that the mean serum levels of visfatin, platelets (PLT), ESR, IL-6, CRP, and RF were significantly higher in RA patients than in the control group. Comparison of the mild, moderate, and severe RA groups showed that the mean levels of visfatin and IL-6 were significantly higher in the severe RA group than the moderate RA group, which was significantly higher than that of the mild RA group. There was a significant positive correlation between serum visfatin and IL-6, ESR, CRP, TNF-α, and DAS-28 in the RA group. Conclusion Visfatin plays a role in the pathogenesis of RA and could be considered as a disease marker in RA and a marker of joint damage and hence as a potential therapeutic target for RA. The findings of the present study also indicate that serum visfatin and IL-6 might be of diagnostic value for RA; however, the combined diagnosis using serum visfatin, IL-6, and the RF test can improve the diagnosis of RA in the early stage. Further studies are required to determine the possibility of introducing visfatin as a potential therapeutic target especially in early RA to prevent erosions.

Background Systemic lupus erythematosus (SLE) is characterized by exaggerated B cell responses that lead to the production of an array of autoantibodies. The CD27 molecule belongs to the tumor necrosis factor receptor family. The frequency of CD27 ^{+ +} plasma cells has been shown to correlate significantly with SLE disease activity. Objective The aim of this study was to examine the expression of CD27 on B-cell subsets in the peripheral blood of patients with SLE. Participants and methods The expression of CD27 on B-cell subsets was studied in 36 SLE patients (four men, 32 women, mean age 30.08 ΁ 10.35 years, range 14-60) as defined by the American College of Rheumatology criteria; 20 healthy controls (two men, 18 women, mean age 32.70 ΁11.72 years, range 15-62) were included in the study using flow cytometric analysis. Clinical disease activity was assessed according to the systemic lupus erythematosus disease activity index (SLEDAI). SLE patients were divided into two groups: active SLE patients with SLEDAI changes of more than 3 points and inactive SLE patients with SLEDAI changes of 3 or less. Results Active and inactive SLE patients had significantly decreased frequency and absolute number of CD19 ⁺ B cells. The frequency of memory CD19 ⁺ CD27 ⁺ B cells was significantly increased in active SLE patients. A significant increase in both the frequency and the absolute number of CD19 ⁺ CD27 ^high PCs was found in active SLE patients. The frequency and absolute number of CD19+ CD27 ^high PCs were significantly correlated with SLEDAI, anti-dsDNA, and C3 level. Conclusion The higher percentage of CD19 ⁺ CD27 ^high PCs is a promising biomarker for monitoring SLE disease activity.

Background A commonly used method to investigate endurance capacity is measurement of the maximal oxygen uptake by spiroergometry. Objectives The objective of the study was to investigate the effect of a combined training program on endurance capacity as assessed by VO_2max and on serum cardiac troponin T (cTnT) in male volleyball players. Methods This study was conducted on 30 apparently healthy male volleyball players at the beginning of the training cycle. After routine history taking and a general examination, VO_2max was calculated by ergospirometry, and serum cTnT was measured. A combined training program was designed for 12 weeks after which measurement of VO_2max and serum cTnT was repeated. Results We found that a combined training program leads to significant increase in maximal oxygen consumption (VO_2max), but we did not find significant effect of the training program on serum cTnT. Conclusion We concluded that VO_2max increases in response to a combined training program and that serum cTnT does not increase in response to the same training when measured before and after a designed training program.

Aim The aim of this study was to evaluate the efficacy of botulinum toxin-A (BTX-A) therapy compared with stabilization occlusal splint in treatment against temporomandibular disorders clinically and by electromyographic quantitative interference pattern analysis (QIPA). Patients and methods Twenty-four female patients with temporomandibular disorder symptoms and signs were enrolled in the study. The patients were randomly assigned into two groups. Patients in group 1 were injected with BTX-A in the affected masseter and temporalis muscles, whereas patients in group 2 were treated with occlusal splint therapy. Patients were evaluated at baseline and at 8 and 12 weeks using the anamnestic dysfunction index, measurement of maximum mouth opening, and surface electromyographic QIPA. Results On follow-up, anamnestic dysfunction index improvement and maximum mouth opening were significantly larger in the BTX-A group than in the splint group. BTX-A injections produced a general reduction in the QIPA parameters of masseter and temporalis muscles at the first follow-up, which increased slightly on the second assessment. In group 2, QIPA parameters were seen to have increased significantly at both assessments. Conclusion BTX-A injection is more advantageous than stabilization splint, provided it is administrated at appropriate doses.

Introduction The spinal (N22) wave is generated postsynaptically in the gray matter of the lumbar cord. Short-latency somatosensory-evoked responses to tibial nerve stimulation were recorded simultaneously over the spinous processes of the lumbar vertebrae and scalp. This noninvasive test yielded values that are highly reproducible and could be correlated closely with patient-related variables such as height and leg length. Most studies on somatosensory-evoked potentials (SEPs) in cases of lumbosacral radiculopathy routinely analyze scalp (cortical) responses, depending mainly on the evaluation of P40 and the dermatomal somatosensory-evoked potential (DSEP) whose origin is the primary somatosensory cortex. It was suggested that a selective study of the N22 potential might be a useful technique to improve both the accuracy and the sensitivity of the diagnosis of lumbosacral radiculopathy. Aim The aim of this study was to test the reliability of the spinal N22 potential in uncovering lesions of lumbosacral roots and its sensitivity verses DSEP and mixed somatosensory-evoked potential (MSEP). Patients and methods Fifty patients with a clinical suspicion of a lumbosacral root lesion were recruited. Twenty normal individuals constituted the control group to determine the cut-off points for the electrophysiological parameters. MRI of the lumbosacral spine was performed for all patients to detect lumbosacral root compression if present. For all patients, motor (peroneal and tibial nerves) and sensory (sural and superficial peroneal) nerve conduction studies were carried out in lower limbs using standard techniques. MSEP of the tibial nerve, DSEP studies of the affected lower limb, and spinal N22 SEP study of the tibial nerve were carried out. Results There was a positive correlation of statistical significance between the MSEP and the DSEP (P= 0.001) and between the MSEP and N22 (P= 0.001); however, there was a positive correlation of statistical significance between the DSEPs and the N22 (P = 0.001). There was a positive correlation of statistical significance between the MRI and the MSEP (P =0.004), the DSEP (P =0.001), and the N22 (P =0.002), respectively. The sensitivity and specificity of N22, DSEP, and MSEP were determined using MRI as a gold standard. N22 was the most sensitive (72.5%), followed by the DSEP (62.5%) and the least sensitive was the MSEP (42.5%). They were all specific (100%), with a high positive predictive value (100%). The N22 had the highest negative predictive value (47.6%), followed by the DSEP (40%), and the MSEP had the least negative predictive value (30%). Conclusion From this study, N22 was found to be a sensitive technique that is correlated with the MRI findings and is sensitive and specific with a high positive predictive value that is suitable for the diagnosis of early and minor cervical root lesions with manifest sensory complaints.

Aim of the work The aim of the study was to compare the outcome of early surgical intervention in recently diagnosed cases of neurogenic thoracic outlet syndrome (NTOS) with late surgical treatment after a trial of conservative management. Patients and methods The study included 35 patients with NTOS (25 women and 10 men; aged 20-52 years) who were classified into two groups. Patients in the first group (15 patients) were operated upon 6 months after medical and physical therapy; patients in the second group were operated upon within 3 months of onset. All patients were operated upon using the supraclavicular surgical approach. They were evaluated clinically and neurophysiologically and they answered the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire preoperatively and 6 months postoperatively for assessment of functional outcome. Results Paresthesia and pain were seen to have improved significantly in group II compared with group I. Muscle weakness was nonsignificantly less frequent in group II compared with group I. Group II showed a significantly better sensory nerve action potential of the ulnar nerve and less denervation in electromyography compared with group I. The postoperative DASH score improved in both groups but it was less statistically significant in group I compared with group II (P<0.05 in group I and P<0.001 in group II). Conclusion We suggest that early surgical treatment for NTOS will improve functional disability, stop degeneration of nerves, and decrease the occurrence of muscle wasting and denervation of nerves compared with late surgery.

Background Diabetes mellitus is the most common cause of urinary and sexual dysfunction. Although diabetes mellitus can be diagnosed clearly and simply, diabetic neuropathy and diabetic cystopathy (DC) can progress insidiously over time without any symptoms, manifesting itself at a later stage, which increases the risk of secondary complications. Therefore, early diagnosis in the asymptomatic stage of DC with a simple noninvasive method is of utmost importance. Aim of the work To evaluate the different electrophysiological studies [including genital sympathetic skin response (SSR), somatosensory-evoked potential (SSEP) of the tibial nerve] in the early detection of urinary and sexual dysfunction in diabetic women. Patients and methods This study was carried out on 30 diabetic women and 10 healthy women served as a control group. All patients were divided into two groups (group I and group II) with respect to lower urinary tract symptoms and signs. They were subjected to a full assessment of medical history, full neurological examination, and assessment by the female sexual function index questionnaire. Urodynamic studies including: uroflowmetry and cystometry were carried out for all patients. Electrophysiological studies were carried out for both patients and controls and included nerve conduction studies of both tibial and peroneal nerves, sensory nerve conduction studies of both sural nerves, SSEP of the tibial nerve and genital, hand, and foot SSR. Results In group I: Abnormal findings of motor studies were recorded in 1/15 (6.6%) patients, prolonged genital SSR in one patient (6.6%) and absent in two patients 2/15 (13.3%). Prolonged SSEP were recorded in 2/15 (13.3%) of patients. As regards urodynamic study, abnormal findings were detected in 3 patients (20%). In group II: Abnormal findings of motor studies were recorded in 8/15 (53.3%) patients, absent foot SSR in four patients (26.6%), absent genital SSR in seven (46.6%) patients. Prolonged SSEP P40 were recorded in 6/15 (40%). As regards urodynamic study, abnormal findings were detected in 12 patients (80%). There was statistically significant difference between both groups as regards all electerophysiologic parameters except foot latency. There was a statistically highly significant difference between urodynamic diagnosis and genital SSR and SSEP P40 of tibial nerve. Conclusion Although urodynamic is essential for the actual diagnosis and the detection of variable pathophysiological changes, electrophysiological studies represent an easy, valid, and noninvasive objective method for the evaluation of DC and sexual dysfunction.

Background Long-term athletic training is associated with cardiac changes including increased left ventricular cavity dimension and wall thickness; these changes have been described as 'athlete's heart'. Objectives The aim of this investigation was to study the ability of diastolic function measured by echocardiography to reflect changes in endurance as assessed by maximal oxygen consumption (VO_2max) in response to combined strengthening and endurance training in male volleyball players. Materials and methods This study was conducted on 30 apparently healthy male volleyball players at the beginning of the training cycle. After routine history taking and a general examination, echocardiography was performed for all players, during which the cardiac structure was assessed and systolic and diastolic functions were measured. VO_2max was also calculated by ergospirometry. A combined training program was designed for 12 weeks after which echocardiography and measurement of VO_2max were repeated. Results We found that a combined training program leads to significant increase in cardiac wall thickness, diastolic function of the heart [mainly propagation velocity (Vp)], and VO_2max. Further, we found that there is a close relationship between changes in VO_2max and changes in all indices of diastolic function studied (Vp, E wave/A wave ratio, and deceleration time). Conclusion We concluded that diastolic function measured by echocardiography can reflect changes in endurance as previously assessed by VO_2max only, in response to a combined strengthening and endurance training program. Moreover, Vp is a better indicator of diastolic function in athletes compared with E wave/A wave ratio and deceleration time. Also, echocardiographic parameters of cardiac hypertrophy increase in response to the combined training program.

Objective The aim of this study was to assess the presence of subclinical atherosclerosis in Egyptian rheumatoid arthritis (RA) patients and its correlation to disease activity. Patients and methods Thirty RA patients and 20 control individuals matched for age and sex were subjected to a full clinical assessment and laboratory investigations, including rheumatoid factor, erythrocyte sedimentation rate, C-reactive protein, total lipid profile, ECG, conventional radiography of the hands to detect joint erosion, and high-resolution B-mode ultrasound of the common carotid arteries for intima-media thickness (IMT) and carotid plaques. Results Patients with RA had increased carotid artery IMT compared with matched healthy controls. There were statistically significant differences between the studied RA patients and controls in serum cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein (P<0.001), but the selected patients with RA were not diagnosed as hyperlipidemic as their lipid profile level still did not exceed the normal average limits. In terms of carotid duplex parameters, there were significantly higher carotid IMT, interluminal diameter (ILD), and interadventetial diameter (IAD) in the 30 RA patients than in the 20 control participants (P<0.001); a higher prevalence of carotid atherosclerosis in the studied RA patients was found by measuring IMT more than 1.1mm and IAD more than 8.00 mm. There was a statistically significant positive correlation between disease activity score and carotid IMT (P<0.05), whereas no correlation was detected between disease activity score and carotid interluminal diameter or IAD in the RA patients studied. Conclusion RA is associated with accelerated atherosclerosis. Thus, aggressive treatment of RA patients and better monitoring of atherosclerotic risk factors are required to reduce cardiovascular morbidity and mortality.