In addition, striatal overexpression of pENK

In addition, striatal overexpression of pENK BIBW2992 in MPTP -treated mice led to 52 and 43% higher DA concentrations and DA turnover, respectively, in the GP compared to sham-treated MPTP mice. These observations are in agreement with the idea that increased expression

of pENK at an early stage of disease can improve PD symptoms. “
“Neuronal rhythms are ubiquitous features of brain dynamics, and are highly correlated with cognitive processing. However, the relationship between the physiological mechanisms producing these rhythms and the functions associated with the rhythms remains mysterious. This article investigates the contributions of rhythms to basic cognitive computations (such as filtering signals by coherence and/or frequency) and to major cognitive functions (such as attention and multi-modal coordination). We offer support to the premise that the physiology underlying brain rhythms plays an essential role in how these rhythms facilitate some cognitive operations. “
“Stress-sensitive psychopathologies such as post-traumatic stress disorder are characterized by deficits in fear extinction and dysfunction of corticolimbic circuits mediating extinction. Chronic stress facilitates fear conditioning, impairs JQ1 in vivo extinction, and produces dendritic proliferation in

the basolateral amygdala (BLA), a critical site of plasticity for extinction. Acute stress impairs extinction, alters plasticity in the medial prefrontal cortex-to-BLA circuit, and causes dendritic retraction in the medial prefrontal cortex. Here, we examined extinction learning and

basolateral amygdala pyramidal neuron morphology in adult male rats following a single elevated platform stress. Acute stress impaired extinction acquisition and memory, and produced dendritic retraction and increased mushroom spine density in basolateral amygdala neurons in the right hemisphere. Unexpectedly, irrespective of stress, rats that underwent fear and extinction testing showed basolateral amygdala dendritic retraction Dolutegravir and altered spine density relative to non-conditioned rats, particularly in the left hemisphere. Thus, extinction deficits produced by acute stress are associated with increased spine density and dendritic retraction in basolateral amygdala pyramidal neurons. Furthermore, the finding that conditioning and extinction as such was sufficient to alter basolateral amygdala morphology and spine density illustrates the sensitivity of basolateral amygdala morphology to behavioral manipulation. These findings may have implications for elucidating the role of the amygdala in the pathophysiology of stress-related disorders.

, 2009; Hermida et al, 2014), asthma (Smolensky et al, 1987; Na

, 2009; Hermida et al., 2014), asthma (Smolensky et al., 1987; Nainwal, 2012) and rheumatoid arthritis (Cutolo, 2012). Given that differences in the timing of symptoms for many conditions are similar across individuals, implementing chronotherapeutic strategies for the treatment of some diseases is quite feasible and researchers and pharmaceutical

companies are developing strategies to effectively deliver medications in a time-dependent fashion thorough time-release oral administration, implants, and pumps (reviewed in Maroni et al., 2010). Given the rapid advances in this emerging knowledge and technology, it will be important to educate the medical community in the magnitude of such KPT-330 datasheet effects and practical implementation of chronotherapeutic approaches. The cells of our brains and bodies have evolved in www.selleckchem.com/products/r428.html a 24 h solar system in ways that enable optimal coordination of our internal and external circadian cycles. Transcription–translation feedback loops are modified by post-transcriptional regulatory processes, enabling a central master clock to signal peripheral clocks that then exert local control of cellular function specific to each organ

and gland. Making optimal use of circadian timing mechanisms within specific brain regions and tissues will enable the understanding of interindividual differences and development of pharmacological modulators of circadian timing identified from high-throughput screens. The hope is that the robustness and resilience of circadian oscillation can be enhanced, dysfunctional clocks can be repaired, and personalized treatment regimens

developed for age-related declines and treatment of disease. Further information on mechanisms whereby the SCN signals rhythmic gene expression in the rest of the brain and body requires new genetic, mathematical and statistical tools to understand the spatial and temporal changes in the circadian timing system that underlie its normal and disrupted neural function. We thank Dr Matthew Butler selleck and unidentified reviewers for their comments on earlier drafts of this article. Support during the writing of this review and research from our laboratories reported herein was provided by NSF IOS-1256105 and NIH NS37919 (R.S.), and NIH HD050470 and NSF IOS-1257638 (L.J.K.). Abbreviations Cry cryptochrome DMH dorsomedial hypothalamus FAA food anticipatory activity LD light:dark Per Period ROR retinoid-related orphan receptor SCN suprachiasmatic nucleus VLPO ventrolateral preoptic nucleus “
“Clinical evidence suggests that depression and trauma predispose the subject to panic. Accordingly, here we examined the late effects of uncontrollable stress, a presumptive model of depression and/or traumatic disorder, on panic-like behaviors evoked by electrical stimulation of the dorsal periaqueductal gray (DPAG).

In this way, circadian clocks exert regulatory control over almos

In this way, circadian clocks exert regulatory control over almost every aspect of physiology, with disruptions leading to disease states, and their understanding lending opportunities for the analysis of novel mechanisms of diagnosis and Selleck Buparlisib treatment. An aspect of the circadian regulation of genetic, metabolic and cytosolic clocks that has received relatively little attention is how these processes might be affected by sex differences. Also, sex differences may confound the results of studies in which the sex of the animal or cell is not taken

into account. Within the brain, widespread sex differences in gene expression and splicing have been detected in all major brain regions and involve 2.5% of all expressed genes (Trabzuni et al., 2013). Furthermore, a diffusion tensor imaging study indicates widespread sex differences in regional and global network characteristics of the brains of youths (Ingalhalikar et al., 2014). The sparsity of circadian studies may be attributed in part to the expense and work load associated with undertaking studies of both males and females, especially when PI3K Inhibitor Library cell assay ovulatory cycle-associated changes must also be taken into account (Morin et al.,

1977). That said, there are tremendous sex differences in the circadian timing system (reviewed in Bailey & Silver, 2013). A salient example is seen in sleep regulation. Women go to sleep later and later until the age of around 19.5 years, whereas men continue to delay their sleep until around the age of 21 years (Roenneberg et al., 2007). Furthermore, throughout adulthood, men tend to go to sleep later than women. This sex difference disappears at around the age of 50, at around the time of menopause. A key symptom of major depressive disorder is the disruption of circadian patterns. In a study applying time-of-death analysis to gene expression DNA ligase data from postmortem brains, cyclic patterns

of gene expression were much weaker in the brains of patients with major depressive disorders due to shifted peak timing and potentially disrupted phase relationships between individual circadian genes (Li et al., 2013). As noted above, sleep disturbance is associated with major depressive disorders. Turning to the question of sex differences, Plante et al. (2012) found that women, but not men, with major depressive disorders demonstrate significant increases in slow wave activity in multiple cortical areas relative to control subjects. In conclusion, sex differences become important when they can provide clues to the mechanisms conferring protection to one sex or susceptibility to the other, and in those research areas where sex differences are salient, attention to the underlying mechanisms is especially warranted.

Rather than relying on molecular diagnosis based on RNA detection

Rather than relying on molecular diagnosis based on RNA detection, the point-of-care test selleck compound for dengue NS1 antigen would be appropriate for travelers’ screen. NS1 sensitivity is highest between the 2nd and 4th

day of illness and would be useful early in acute phase in non-endemic countries.3 Extreme utility of NS1 antigen assay was witnessed in travelers at airports in Taiwan. By NS1 antigen detection, 19 RT-PCR negative travelers could be labeled dengue positive. Two such travelers turned out to be IgM positive on day 17 or 18 of illness.4 Subhash C. Arya 1 and Nirmala Agarwal 1 “
“Cardiovascular disease is an increasing concern among HIV-infected persons and their providers. We determined if fatty liver disease is a marker for underlying coronary atherosclerosis among HIV-infected persons. We performed a cross-sectional study in HIV-infected adults to evaluate the prevalence of and factors, including fatty liver disease, associated with subclinical coronary atherosclerosis. All participants underwent computed tomography for determination of coronary artery calcium (CAC; positive defined as a score >0) and fatty liver disease (defined BGB324 ic50 as a liver-to-spleen ratio <1.0). Factors associated with CAC were determined using multivariate logistic regression

models. We included in the study 223 HIV-infected adults with a median age of 43 years [interquartile range (IQR) 36–50 years]; 96% were male and 49% were Caucasian. The median CD4 count was 586 cells/μL and 83% were receiving antiretroviral medications. Seventy-five (34%) had a positive CAC score and 29 (13%) subjects had fatty liver disease. Among those with CAC scores of 0, 1–100 and >100, the percentage with concurrent fatty liver disease was 8, 18 and 41%, respectively (P=0.001). In the multivariate model, CAC was associated with increasing age [odds ratio (OR) 4.3 per 10 years; P<0.01], hypertension (OR 2.6; P<0.01) and fatty liver disease (OR 3.8; P<0.01). Coronary atherosclerosis as detected using CAC is prevalent among young HIV-infected persons. The detection of fatty

liver disease among HIV-infected adults should prompt consideration of assessment for underlying cardiovascular disease and risk factor reduction. As HIV-infected persons are experiencing longer life expectancies, there is increasing concern regarding non-AIDS-defining conditions, including cardiovascular Meloxicam disease [1,2]. HIV-infected persons appear to have a higher risk of coronary artery atherosclerosis compared with the general population, which may be a result of HIV-induced inflammation, antiretroviral medications, or concurrent medical conditions, such as insulin resistance, dyslipidaemia, hypertension, visceral fat deposition and tobacco abuse [1–10]. Elevated prevalence rates of subclinical cardiovascular disease among HIV-infected persons have recently been demonstrated using computed tomography (CT) coronary artery calcium (CAC) scores [9,11–18].

coli clones unable to grow into colonies after transformation In

coli clones unable to grow into colonies after transformation. In contrast, asRNA clones in which highly expressed genes are being targeted would

be able to grow into colonies and selected during the subsequent phenotypic (+IPTG) screens. This hypothesis is supported by data from DNA array-based E. coli gene expression profiling (Tao et al., 1999). For example, 53 of the 79 essential genes (67%) targeted by asRNA constructs (Table S1) are within the top 10% highly expressed genes among the 4290 ORFs examined when E. coli cells were grown exponentially in LB broth plus glucose (Tao et al., 1999). To increase the diversity of asRNA clones identified, possible technical improvements include replacing Ptrc with a more stringent promoter element on the cloning vector or employing a number of plasmid vectors each containing a promoter with different range of activities (Nakashima et al., 2006; Xu et al., 2010). The recovery of 18 asRNA constructs derived Akt inhibitor from 10 nonessential genes which share operons with essential genes provides strong support for a hypothesis that expressed asRNAs silence gene function in E. coli at Cobimetinib datasheet the operon level. The mechanism of asRNA inhibition in S. aureus was examined previously by Young and coworkers (Young et al., 2006) who demonstrated that asRNAs exert their inhibition by eliciting degradation of mRNAs upstream (5′) of the regions where the asRNAs bind, which lends support to

our hypothesis. If the hypothesis is confirmed, an asRNA construct or synthetic oligonucleotide could inhibit as many as 11 essential

genes simultaneously on the rplN operon (Fig. 2a), rendering it difficult for multiple resistant mutations to occur in multiple genes. If such multigene mechanism of gene silencing turns out to be prevalent among bacteria, it will facilitate design and development of antisense-based antimicrobial therapeutics which are ‘polypharmaceutical’ (Good & Stach, 2011) or ‘multitargeting’ (Silver, 2007): antibiotics (e.g. most of the successful antibiotics in clinical use) target or interact with two or more bacterial target proteins. In this study, two genomic libraries were constructed successfully and screened for inducible Clomifene growth inhibitory asRNA clones. The asRNA constructs discovered could knock-down or silence the expression of 79 E. coli essential genes. While the genes being targeted are not yet comprehensive, likely due to a leaky Ptrc promoter of pHN678, this communication represents a first published report to successfully apply regulated asRNA technology to discover E. coli asRNA clones at the genome level. Such conditional asRNA clones will not only stimulate studies of global functions of genes and operons in E. coli but also facilitate discovery and development of novel antimicrobial agents to combat multidrug-resistant pathogens. Funding for this project has been provided by NIH grant SC3GM083686 (to H.H.X.).

The rapid and progressive deterioration of soft tissue during S 

The rapid and progressive deterioration of soft tissue during S. aureus and C. perfringens coinfections is due to analogous necrotic alpha toxins produced by the two organisms. The aim of this study was to determine the alpha toxins of S. aureus and C. perfringens by duplex PCR. The PCR assay employed two sets of primers: hlaf/r to amplify staphylococcal alpha toxin gene hla (274 bp) and cpaf/r to amplify clostridial alpha toxin gene cpa (398 bp) along with a competitive internal amplification control (608 bp), simultaneously. Optimization

of the duplex PCR assay was achieved by a modified Taguchi method, an engineering optimization process, in a nine-tube combinatorial array. The detection level of the duplex PCR was found to be 10 pg of purified DNA or 103 CFU mL−1 of S. aureus and 100 pg of purified DNA or 104 CFU mL−1 of C. perfringens. Other bacteria routinely found in tissue infections were tested for cross-reactivity and the duplex PCR turned Caspase inhibitor TSA HDAC mouse out to be highly specific. This duplex PCR assay provides a rapid, robust and reliable alternative to the existing conventional techniques in

establishing the aetiology of S. aureus and C. perfringens in soft tissue infections. “
“Division of Environmental and Biomolecular Systems, Oregon Health and Science University, Beaverton, OR, USA Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR, USA ORF40 (named fatE) in the Vibrio anguillarum pJM1 plasmid-encoding anguibactin iron transport systems is a homolog of ATPase genes involved in ferric-siderophore transport. Mutation of fatE did not affect ferric-anguibactin transport, indicating that there must be other ATPase gene(s) in addition to fatE. By searching the genomic sequence of V. anguillarum 775(pJM1), we identified a homolog of fatE named fvtE on chromosome 2. It is of interest that in this locus, we also identified homologs of fatB, fatC, and fatD that we named fvtB, fvtC and fvtD, respectively. The these fvtE mutant still showed ferric-anguibactin transport,

while the double fatE and fvtE mutation completely abolished the ferric-anguibactin transport indicating that fatE and fvtE are functional ATPase homologs for ferric-anguibactin transport. Furthermore, we demonstrate that fvtB, fvtC, fvtD, and fvtE are essential for ferric-vanchrobactin and ferric-enterobactin transport. “
“Bacillus anthracis, the etiological agent of anthrax, is a gram-positive, spore-forming rod, with colonies exhibiting a unique ground-glass appearance, and lacking hemolysis and motility. In addition to these phenotypes, several others traits are characteristic of B. anthracis such as susceptibility to gamma phage, the presence of two virulence plasmids (pX01 and pX02), and specific cell wall and capsular antigens that are commonly detected by direct fluorescent-antibody assays. We report on the identification and characterization of 14 Bacillus megaterium and four Bacillus sp.

Microplusin completely altered the respiratory profile of C neof

Microplusin completely altered the respiratory profile of C. neoformans. The basal oxygen consumption in MP-treated cells was approximately 40% lower ATM/ATR inhibitor review than that in non-MP treated cells. In treated fungi, AA or KCN did not further disturb the rate of oxygen consumption, while SHAM fully impaired respiration, which implies that the classical electron transport pathway was either damaged

or absent and that respiration of C. neoformans is entirely driven by the alternative pathway. As laccase is a copper-dependent oxidase responsible for melanization (Zhu & Williamson, 2004) in C. neoformans, we investigated whether the copper-chelating properties of microplusin might have a negative effect on this process. Microplusin inhibited melanization of the strains H99 and B3501 at concentrations ≥3.12 μM (Fig. 4a). When we supplemented a culture of C. neoformans strain Selleckchem Hydroxychloroquine B3501 with 2.5 μM of CuCl2.6H2O, we observed that the presence of this metal caused a twofold reduction

in the antimelanization activity of microplusin (Fig. 4b). Similar results were obtained with C. neoformans strain H99 (data not shown). Moreover, we observed that microplusin reduced the laccase activity of C. neoformans strain H99 by almost 50% (Fig. 4c). In parallel, we evaluated whether microplusin could reduce l-dopa autopolymerization in a manner similar to glyphosate, a compound whose antimelanization activity in C. neoformans has been described (Nosanchuk et al.,

2001). Microplusin did not inhibit the autopolymerization of l-dopa and even Fludarabine research buy increased this process at concentrations ≥6.25 μM (Fig. 4d). Several enzymes are involved in the formation of the polysaccharide capsule in C. neoformans (reviewed in Zaragoza et al., 2009) and microplusin might affect this process by copper depletion, as copper is a co-factor for some of these enzymes. Our results revealed that microplusin impeded capsule enlargement of C. neoformans (strain T1444) in a dose-dependent manner (Fig. 5a). We also observed that 25 μM of microplusin significantly inhibited the capsular enlargement of H99 and B3501 (Fig. 5b and c). Our main hypothesis was that microplusin could negatively affect C. neoformans by copper depletion, which would be consistent with the importance of copper homeostasis for this fungus (Davis-Kaplan et al., 1998; Cox et al., 2003; Zhu et al., 2003; Waterman et al., 2007; Jiang et al., 2009) and the copper-chelating property of microplusin at a MP : copper II molar ratio of 1 : 1 (Silva et al., 2009). We have shown that microplusin at concentrations ≥1.56 μM significantly affected the growth of C. neoformans, similar to the activity of the peptide against M. luteus (Silva et al., 2009). Moreover, the anticryptococcal effect was considerably reversed when 2.5 μM of copper was added.

Embryonic dopamine neuron transplantation has provided symptomati

Embryonic dopamine neuron transplantation has provided symptomatic benefit for some individuals with Parkinson’s disease (PD). However, the efficacy of grafting is variable and less than would be predicted from the degree of dopamine replacement provided in many individuals (Freed et al., 2001; Olanow et al., 2003). While results from recent grafting trials for PD are disappointing, the rationale of replacing selleck screening library cells lost in PD remains sound and interest in this approach is regaining popularity. Thus, the question remains why this potentially viable therapeutic approach has not yet fully succeeded.

One factor thought to underlie this lack of success is pathology within the parkinsonian striatum, the region of graft placement. It has been shown in patients with PD and animal models of the disease that dopamine depletion is associated with a host of plastic changes in the striatum (Brown & Gerfen, 2006; Deutch, 2006; Collier et al., 2007; Meurers et al., 2009). One such change involves the primary synaptic target of afferent nigral dopaminergic neurons and descending cortical glutamate neurons, the medium spiny neuron (MSN). Normal MSNs have an abundance of dendritic spines, critical sites for synaptic integration of striatal dopamine and glutamate. In advanced PD there is a marked atrophy of dendrites and spines on these

neurons selleck kinase inhibitor (McNeill et al., 1988; Stephens et al., 2005; Zaja-Milatovic et al., 2005). Similar pathology is observed in mice and rats with severe dopamine depletion (Day et al., 2006; Neely et al., 2007). While the impact of this altered morphology on dopamine cell replacement is unclear, it would be anticipated Anidulafungin (LY303366) that an absence of these critical input sites would make it difficult for grafted dopamine neurons to re-establish normal connections needed for therapeutic

benefit. It is also possible that the structural abnormalities of MSNs in the dopamine-depleted striatum could result in inappropriate graft–host contacts leading to abnormal behaviors (e.g. graft-induced dyskinesias; GIDs). While little is known about the etiology of GIDs, we recently reported (Soderstrom et al., 2008) that in a rat model of PD aberrant synaptic features following dopamine cell grafting are associated with the expression of graft-mediated motor dysfunction. These data support the idea that abnormal synaptic reorganization within the grafted striatum contributes to the evolution of aberrant motor behaviors; however, the biological contributor(s) to aberrant graft–host connectivity remains uncertain. The current study was designed to test the hypothesis that preventing MSN dendritic spine loss would allow for more appropriate integration of grafted neurons into the host striatum, thus resulting in increased behavioral efficacy and preventing the development of abnormal motor behaviors.

2%), neurological manifestations (153%), gastrointestinal manife

2%), neurological manifestations (15.3%), gastrointestinal manifestations (6.3%) and epididymitis (7.2%). Some manifestations are rarely seen, such as pleuropulmonary (1.8%), and cardiac manifestations (1.8%). Diagnosis is mainly clinical, on the association of symptoms, but diagnosis/classification

criteria may help. Sixteen sets of criteria were created for BD. The first was in 1946 and the last in 2010. The International Study Group (ISG) criteria, created by seven countries in 1990, had a low sensitivity and accuracy. The ICBD was created by 27 countries in 2006. It was revised in 2010.[5] In ICBD, skin lesions, vascular lesions, neurological manifestations and positive pathergy tests each get one point. Oral aphthosis, genital aphthosis and ocular lesions each get two points. To be classified/diagnosed as BD, a patient has to get four points (or more). Behcet’s disease manifestations are self-limiting, but recurrent. selleck kinase inhibitor PI3K inhibitor Some heal without a sequelae, but others are the main cause of morbidity, such as ophthalmological manifestations which may cause blindness if not aggressively treated. Some may cause mortality, as in some of the vascular, neurological, cardiac or pulmonary involvements. The first group of manifestations (healing without sequelae) may need no treatment if the frequency of their recurrence is low and

the burden acceptable when the lesion is active.[4] In the others colchicine is the main treatment, given at 1 mg daily, at night. If not effective in reducing the frequency of attacks, or their severity, low-dose methotrexate (MTX) with low-dose prednisolone can be given. The same will be given for genital aphthoses.

For resistant cases, pimecrolimus, an ointment for local application, may be effective. Skin manifestations may respond to colchicine. If they do not, non-steroidal anit-inflammatory PDK4 drugs (NSAIDs) or MTX with low-dose prednisolone will suffice in the majority of cases. Joint manifestations are usually transient and NSAIDs will work. In cases of chronic arthritis, the patient can be treated as with rheumatoid arthritis or seronegative sponyloarthritis. The second group, those with high morbidity or mortality, need aggressive treatment with cytotoxic drugs and medium- to high-dose steroids.[4] Pulse cyclophosphamide,[6] azathioprine, cyclosporine A, chlorambucil[7] and MTX[8] can be used, depending on the severity of lesions. Prednisolone has to be associated at 0.5 mg to 1 mg/kg of body weight. In resistant cases to cytotoxic drugs and prednisolone, a combination of cytotoxics can be used.[6] Another choice is the addition of biologic agents,[4],whether anti-tumor necrosis factor-α or anti-CD20. There are still no long-term reports or control studies for cytotoxic drugs or biologic agents. In this issue of the International Journal of Rheumatic Diseases, six papers on BD are presented.

2%), neurological manifestations (153%), gastrointestinal manife

2%), neurological manifestations (15.3%), gastrointestinal manifestations (6.3%) and epididymitis (7.2%). Some manifestations are rarely seen, such as pleuropulmonary (1.8%), and cardiac manifestations (1.8%). Diagnosis is mainly clinical, on the association of symptoms, but diagnosis/classification

criteria may help. Sixteen sets of criteria were created for BD. The first was in 1946 and the last in 2010. The International Study Group (ISG) criteria, created by seven countries in 1990, had a low sensitivity and accuracy. The ICBD was created by 27 countries in 2006. It was revised in 2010.[5] In ICBD, skin lesions, vascular lesions, neurological manifestations and positive pathergy tests each get one point. Oral aphthosis, genital aphthosis and ocular lesions each get two points. To be classified/diagnosed as BD, a patient has to get four points (or more). Behcet’s disease manifestations are self-limiting, but recurrent. AZD9668 mw Ibrutinib order Some heal without a sequelae, but others are the main cause of morbidity, such as ophthalmological manifestations which may cause blindness if not aggressively treated. Some may cause mortality, as in some of the vascular, neurological, cardiac or pulmonary involvements. The first group of manifestations (healing without sequelae) may need no treatment if the frequency of their recurrence is low and

the burden acceptable when the lesion is active.[4] In the others colchicine is the main treatment, given at 1 mg daily, at night. If not effective in reducing the frequency of attacks, or their severity, low-dose methotrexate (MTX) with low-dose prednisolone can be given. The same will be given for genital aphthoses.

For resistant cases, pimecrolimus, an ointment for local application, may be effective. Skin manifestations may respond to colchicine. If they do not, non-steroidal anit-inflammatory STK38 drugs (NSAIDs) or MTX with low-dose prednisolone will suffice in the majority of cases. Joint manifestations are usually transient and NSAIDs will work. In cases of chronic arthritis, the patient can be treated as with rheumatoid arthritis or seronegative sponyloarthritis. The second group, those with high morbidity or mortality, need aggressive treatment with cytotoxic drugs and medium- to high-dose steroids.[4] Pulse cyclophosphamide,[6] azathioprine, cyclosporine A, chlorambucil[7] and MTX[8] can be used, depending on the severity of lesions. Prednisolone has to be associated at 0.5 mg to 1 mg/kg of body weight. In resistant cases to cytotoxic drugs and prednisolone, a combination of cytotoxics can be used.[6] Another choice is the addition of biologic agents,[4],whether anti-tumor necrosis factor-α or anti-CD20. There are still no long-term reports or control studies for cytotoxic drugs or biologic agents. In this issue of the International Journal of Rheumatic Diseases, six papers on BD are presented.