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Background:Chronic non-bacterial osteomyelitis (CNO) is an immune-mediated disease associated with cytokine dysbalance.Objectives:The aim of our study was to evaluate the cytokines levels in CNO and compare to juvenile idiopathic arthritis (JIA) – disease with immune-mediated mechanism.Methods:The diagnosis of CNO made with criteria, proposed by Jansson (2007, 2009), after the exclusion of other causes of bone disease [1]. We included 42 patients with NBO, 28 patients with non-systemic juvenile idiopathic arthritis (JIA). We evaluated plasma levels of 14-3-3 protein, S100A8/S100A9-protein, interleukine-6 (IL-6), interleukine-18 (IL-18), interleukine-4 (IL-4), interleukine-17 (IL-17), interleukine-1β (IL-1 β) and tumor necrosis factor-α (TNFα) in 2 groups by the ELISA. Statistical analysis was carried out with Statistica 10.0 software. We utilized descriptive statistics (Me; IQR), Mann-Whitney tests.Results:We have found differences in the proinflammatory biomarkers between CNO, JIA. Patients with NBO had lower levels of studied cytokines, exclude14-3-3-protein, S100A8/S100A9 and interleukin-6 compare to JIA patients (table 1).Table 1.Comparison the cytokine levels between CNO, JIA NParameterNBO (n=42)JIA (n=28)pHemoglobin, g/l112 (104; 124)120 (114.5; 126.0)0.02WBC x 109/l7.9 (7.0; 10.5)8.0 (6.7; 10.0)0.86PLT x 109/l347 (259; 408)336.5 (274.0; 390.5)0.98ESR. mm/h25.0 (9.0; 46.0)8.5 (2.5; 13.0)0.013CRP, mg/l6.1 (0.6; 2.4)1.8 (0.4; 11.9)0.02714-3-3, ng/ml21.4 (18.5; 27.1)19.9 (18.0; 27.8)0.77S100A8/S100A9, ng/ml5.9 (5.2; 6.5)5.9 (5.0; 6.2)0.76IL-6, ng/ml126,2 (112.8; 137.5)132.4 (117.4; 142.9)0.16IL-18, ng/ml270.1 (200.1; 316.1)388.3 (373.9; 405.1)0.0000001IL-4, ng/ml15.3 (11.5; 18.2)18.7 (16.2; 20.2)0.003IL-17, ng/ml83.1 (71.1; 97.3)99.2 (87.3; 115.8)0.003IL-1b, ng/ml47.4 (42.0; 51.3)70.8 (65.3; 73.6)0.0000001TNFa, ng/ml19.4 (17.8; 21.3)23.1 (20.2; 25.9)0.0006Conclusion:Patients with CNO had less proinflammatory activity then JIA patients, besides IL-6 and S100A8/S100A9. Further investigations required for finding new more precise biomarkers and finding possible molecular targets for treatment.This work supported by the Russian Foundation for Basic Research (grant № 18-515-57001)References:[1]Jansson AF, et al. Clinical score for nonbacterial osteitis in children and adults. Arthritis Rheum. 2009;60(4):1152-9.Disclosure of Interests:None declared

The sinistral displacement along the Dead Sea Transform (DST), the plate boundary between the African and the Arabian plates, south of the Dead Sea basin, was previously attributed to two main fault zones: the Arava/Araba or Dead Sea fault and the Feinan or Al Quwayra fault zone. This was based on similarities of features on either side of the Araba Valley. In particular, the Timna and the Feinan copper mines, located north of the Themed and Dana faults, and the onlap of the Cambrian formations southward onto the Amram rhyolite and Ahyamir volcanics. To these we add a more accurate offset indicator in the form of an offset Early Cambrian (532 Ma) dolerite dyke previously mapped in Mount Amram (Israel) on the African plate and recently discovered across the Araba Valley in Jabal Sumr al Tayyiba (southwest Jordan) on the Arabian plate. This dolerite dyke is ~ 20 m thick, strikes N50°E and is the only dyke intruding the Jabal Sumr al Tayyiba pink rhyolite flows of the Ahyamir Volcanics. Geochemical and geochronological correlations between the Jabal Sumr al Tayyiba dolerite dyke and the Mount Amram dolerite dyke demonstrate 85 km of sinistral offset across the Arava/Araba fault. Our results also suggest approximately 109 km of combined sinistral displacement across the Arava/Araba and Feinan faults based on petrological correlations between the Timna and Jabal Hanna igneous complexes on the African and Arabian plates, respectively. This constrains the total sinistral displacement of the Feinan fault and its accessory faults to be 24 km.

On 6 April 2009, a moderate earthquake (Mw = 6.3; Ml = 5.8) struck the Abruzzo region in central Italy, causing more than 300 fatalities and heavy damage to L'Aquila and surrounding villages. Coseismic surface effects have been thoroughly documented by timely field surveys as well as by remote sensing analyses of satellite images. The outstanding quality of geological, seismological, geodetic, and interferometric synthetic aperture radar (InSAR) information arguably represents the best ever data set made available immediately after a moderate seismic event. Based on this data set, we aim at testing the capability of coupled geological and InSAR data to map surface faulting patterns associated with moderate earthquakes. Coseismic ground ruptures have been mapped at a scale of 1:500 in the whole epicentral area. Traces of surface ruptures have been inferred from linear phase discontinuities identified in the interferogram. A very good agreement between the two methods resulted in the characterization of the main surface rupture along the Paganica fault. The same approach applied to ground ruptures hypothesized along other capable fault segments provided more questionable results. Thus, the combined field and InSAR approach appeared useful for detecting continuous surface ruptures exceeding 1 km in length and showing displacements greater than a few centimeters. These are the typical faulting parameters for moderate earthquakes (6.0 < Mw < 6.5) in central Apennines. For continuous ground cracks shorter than a few hundred meters and/or that show displacements smaller than 1–2 cm, the described approach may be less helpful, most probably due to the limited resolution of the data.

Purpose To describe the clinical and radiological characteristics of uncommon upper cervical spine abnormality in children. Methods Clinical and diagnostic characteristics of three patients aged 6–12 years with a similar uncommon type of occipital anomaly are described. The patients were admitted in 2007, 2009, and 2014, respectively. Results All patients were clinically and radiologically examined. In each case the massive, additional unilateral outgrowth of the occipital bone (os occipitale) was visualized. The signs and symptoms included torticollis, acute brain ischemia, and limited head motion. Two of the three patients underwent surgical treatment: an occipital–cervical fusion was performed in the first patient, and the outgrowth was removed in the second patient. After 1 year of follow-up the results were estimated as good for both patients, with better functional outcome for the second patient. The parents of the third patient did not consent for the surgical treatment. Conclusions The unique features of this abnormality distinguish it from previous descriptions of the manifestation of pro-atlas, atlas, or atlanto–occipital synostosis. The presented abnormality had different manifestation of various severity in each case, from torticollis to acute vascular disorder. Study design Clinical case series. Level of evidence IV.

BackgroundChronic non-bacterial osteomyelitis (CNO) is a heterogenous group of immune-mediated inflammatory bone diseases, often co-exist with other rheumatic diseases. There are no approved treatments for CNO except non-steroid anti-inflammatory drugs (NSAID). The efficacies of methotrexate (MTX), sulfasalazine, pamidronate (PAM), anti-IL1 and TNFα-inhibitors (TNFα-inh) were shown in different reports.ObjectivesThe aim of study: to compare the efficacy of non-randomized different treatment approaches in pediatric patient CNO cohort.Methods52 children (25 M and 27 F) with CNO has average age at the onset of disease 8.4 years (5.4÷11.0), the number of foci - 3.0 (2.0÷6.0, incl. multifocal cases in 80.8%), fever at the onset – 38.5%, spine involvement - 34.6%, positive family autoimmune diseases (AID) history - 7.7%, concomitant AID - 67.3%. NSAID was the first-line treatment for non-vertebral cases, as well as PAM for vertebral involvement. Second-line treatment includes MTX, PAM and TNFα-inh. Dynamics of pain, patient's (PVAS) and physician's (MDVAS) assessment and ability to each medication to achieve remission of CNO activity we evaluated.ResultsAccording to the NSAID, MTX, SSZ, PAM and TNFα-inh groups next data were registered: PVAS: -14.2% (p=0.05), -50.0% (p=0.04), -23.1 (p=0.89), -83.3% (p=0.0001), -73.6% (p=0.0007); pain: -21.9% (p=0.01), -18.6% (p=0.13), +36,4 (p=0.89), -79.7% (p=0.00016), -74.1%, (p=0.0015);MDVAS: -13.8% (p=0.13); -56.4% (p=0.09), +30.8% (p=0.89), -74.7%, (p=0.0001), -82.1 (p=0.0015) respectively.The ability of each treatment strategy to achieve the CNO remission was 52.6%, 44.4%, 57,1%, 88.8% and 73.3% respectively (log-rank test, p=0,001, figure). TNFα-inh usually used as second-third line treatment in cases where other options, especially PAM were fall.ConclusionsThe most effective treatment approaches for CNO were PAM and TNFα-inh. The randomized controlled trials for assessment efficacy and safety of these medications is mandatory to confirm these results.Disclosure of InterestNone declared

Case report. The combination of severe post-infectious kyphosis and diaphragm relaxation is extremely rare in patient early than 1 year old. Its no publications concerning their simultaneous surgical treatment. 7-Month-old girl had simultaneous spinal reconstruction with anterior and posterior instrumentation and plastic of diaphragm because of sequelae of non-granulenatous spondylitis complicated by severe kyphosis (54°) and diaphragm relaxation. Between 1.5 and 3 months of live she had several infections incl. pneumonia, enterocolitis, ENT infection. Anterior fusion was done by titanium mesh with auto-rib, posterior – by compressive rods based on low-profile hooks. The deformity was reduced till 20°. 2.5 years after initial surgery and 1 year after removal of posterior instrumentation the adequate level of diaphragm and minimal (4°) loss of kyphosis correction were identified. The combination of spondylitis and diaphragm relaxation in early aged patient could be explained but it could not be confirmed as a sequelae of late-onset neonatal sepsis with a multi-focal lesions. The simultaneous surgery provided on the combined approaches (trans-thoracic and posterior) looks as optimal options in such combination of pathologies. In remains controversial how will the spine develop after so early reconstructive surgery, including in situ stable anterior fusion carried out by titanium mesh with auto-rib.

BackgroundNon-bacterial Osteomyelitis (NBO) is a sterile inflammatory bone disorder of unknown etiology. It typically affects children and most commonly presents with bone pain and/or swelling.ObjectivesThe aim of study is to evaluate clinical and laboratory features of non-bacterial osteomyelitis in children.MethodsOur retrospective – prospective study was included 91 patients with NBO. A routine blood test (WBC, platelets, ESR, C-reactive protein (CRP) and hemoglobin levels), a radiological examination and a bone biopsy with evaluation bacteriological and morphological data were performed in all patients.ResultsThe mean age of onset NBO was 7.3 years (2.5; 10.6). We did not reveal any gender peculiarities in our study. Family history of immune-mediated diseases is found in 5/75 (6.7%) in prospective group. Concomitant immune-mediated diseases were noted in 62/89 (68.1%). Diagnostic delay was 6.3 (2.0; 17.8) months. The radiological examination was performed in the following ratio: X-rays - 91 (100.0%), CT - 79 (86.8%), MRI - 66 (72.5), including MRI “whole body” with 15 pts, bone scintigraphy - 54 (59.3%). Monofocal form was registered in 1/3 cases. 2/3 cases was presented as a typical multifocal process with predominant involvement femur - 37 (40.7%), bone of foot - 36 (39.6%), tibia - 33 (36.3%), spine – 29 (31.9%). The number of foci is 3.0 (1.0; 6.0). We did not revealed any significant differences in quantity of WBC, platelets, hemoglobin level, ESR, CRP). Evidence confirming NBO was a negative bone biopsy in 100.0% cases. However, morphological data were as non-specific, as granulomatous inflammation.ConclusionsNBO is determined as a primarily chronic multifocal process without specific clinical and laboratory peculiarities, associated with immune-mediated diseases. Diagnose must be established on morphological and bacteriological data bone biopsy.Disclosure of InterestNone declared

Understanding air exchange dynamics between underground cavities (e.g., caves, mines, boreholes, etc.) and the atmosphere is significant for the exploration of gas transport across the Earth–atmosphere interface. Here, we investigated the role of atmospheric conditions in controlling air transport inside boreholes using in situ field measurements. Three geometries were explored: (1) a narrow and deep shaft (0.1 m wide and 27 m deep), ending in a large underground cavity; (2) the same shaft after the pipe was lowered and separated from the cavity; and (3) a deep large-diameter borehole (59 m deep and 3.4 m wide). Absolute humidity was found to be a reliable proxy for distinguishing between atmospheric and cavity air masses (mainly during the winter and spring seasons) and thus to explore air transport through the three geometries. Airflow directions in the first two narrow-diameter geometries were found to be driven by changes in barometric pressure, whereas airflow in the large-diameter geometry was correlated primarily with the diurnal cycles of ambient atmospheric temperature. CO2 concentrations of ∼2000 ppm were found in all three geometries, indicating that airflow from the Earth's subsurface into the atmosphere may also be significant in the investigation of greenhouse gas emissions.

Chronic non-bacterial osteomyelitis (CNO) is a chronic inflammatory bone disease which usually manifests in children and adolescents. There are a few data about pathogenesis and treatment. The aim of the study to compare the efficacy of different treatment approaches in pediatric CNO cohort patient. Fifty two children (25 boys and 27 girls) with CNO with average age at the onset of the disease 8.4 years (5.4; 11.0), number of foci − 3.0 (2.0; 6.0, incl. multifocal cases in 80.8%). Non-steroid anti-inflammatory drugs (NSAID) was the first-line treatment for non-vertebral cases, as well as pamidronate (PAM) for vertebral involvement. Second-line treatment includes sulfasalazine (SSZ), methotrexate (MTX), PAM and tumor necrosis factor-α inhibitors (TNFα-inh). We evaluated the dynamics of pain, patient’s and physician’s (MDVAS) assessment with visual-analog scale (VAS) and ability to each medication to achieve remission of CNO activity. According to the NSAID, MTX, SSZ, PAM and TNFα-inh groups the following data were registered: patient’s VAS: − 14.2% (p = 0.05), − 50.0% (p = 0.04), − 23.1 (p = 0.89), − 83.3% (p = 0.0001), − 73.6% (p = 0.0007); painVAS: − 21.9% (p = 0.01), − 18.6% (p = 0.13), + 36.4 (p = 0.89), − 79.7% (p = 0.00016), − 74.1%, (p = 0.0015); MDVAS: − 13.8% (p = 0.13); − 56.4% (p = 0.09), + 30.8% (p = 0.89), − 74.7%, (p = 0.0001), − 82.1 (p = 0.0015) respectively. The ability of each treatment strategy to achieve the CNO remission was 52.6%, 44.4%, 57,1%, 88.8% and 73.3%, respectively (log-rank test, p = 0.001). The efficacy of treatment approaches for CNO depended on the severity of the disease. NSAID, methotrexate, and sulfasalazine were effective in forms without spine involvement, but pamidronate and TNF-a inhibitors were useful in vertebral forms of CNO. Pamidronate and TNF-a inhibitors more extensively suppressed CNO activity. The randomized controlled trials for assessment of the efficacy and safety of these medications is mandatory to confirm these results.