Relazione tra alterazioni ghiandolari ecograficamente rilevabili e rischio cardiovascolare in pazienti affetti da Sindrome di Sjögren primaria

Background: Current thinking is that systemic inflammation, elevated levels of inflammatory cytokines, and immune dysregulation, typical of the inflammatory autoimmune disease, could play a role in accelerated atherosclerosis. Very limited data are present in literature up to now about sub-clinical cardiovascular involvement in Sjögren’s syndrome. It was demonstrated that salivary glands ultrasound (US) score is strictly related to the histological inflammatory abnormalities. Objective. We investigated sub-clinical cardiovascular involvement in primary Sjögren’s syndrome (pSS) patients by means of ADMA, coronary flow reserve (CFR), intima-media thickness (cIMT) and pulse wave velocity (PWV). Furthermore, we performed salivary glands US in this pSS group and compared the validated US score with cardiovascular parameters. Methods. Fifty-three consecutive outpatients with pSS (7 males, 46 females; mean age 59.8 range 43-80 years; mean disease duration of 59,5 range 6-156 months) without classical cardiovascular risk factors and overt cardiovascular disease, and 22 age- and gender-matched controls were enrolled. RF-QIMT and RF-QAS technologies were used for IMT and PWV evaluation and Dipyridamole transthoracic stress echocardiography assessed CFR. We also investigated plasma ADMA levels, inflammatory markers and autoantibodies. My Lab 70 (Esaote, Florence, Italy) with linear probe ( 6-18 MHZ) was used to assess salivary glands US according to the scoring system published by Salaffi et Al. Results. Although within the normal range, CFR in pSS patients was lower than that of the controls (2,6 ± 0,23 Vs 3,2 ± 0,32 p < 0,0001), whereas PWV and ADMA levels were significantly higher (9,2 ± 1,8 m/s Vs 6,8 ± 0,9 m/s p <0,0001 and 0,76 ± 0,07 μM Vs 0,54 ± 0,05 μM p < 0,0001). Although QIMT values were not different in the two groups, the percentage of pSS patients with pathological values was higher ( 47/53 Vs 12/22 p =0,001). Salivary glands US score was related to the BMI (p= 0,001), CRP (p= 0,034) and ANA (p< 0,0001) plasma levels but not to the sub-clinical cardiovascular involvement index evaluated in this study (PWV r= -0,205 p= 0.140, Q-IMT r= 0,261 p= 0,06, CRF r= -0,194 p= 0,249, ADMA r=0,249 p= 0,075). Conclusion. Even if CFR values were normal, higher ADMA levels, PWV values and percentage of subjects with pathological Q-IMT with respect to an homogeneous control group suggest that pSS patients without classical cardiovascular risk factors have an early endothelial dysfunction and sub-clinical atherosclerosis. Salivary US score is not related to the sub-clinical cardiovascular involvement parameters evaluated in this study

Characterization of hematite nanowire arrays synthesized by atmospheric plasma.

Hematite synthesized by low pressure oxygen plasma has been shown previously to exhibit promising characteristics as a photo-anode for a photoelectrochemical water splitting cell. It is cheap, stable and has a 2.1 eV bandgap and exhibits a significant photoactivity due to the presence of a thin interfacial layer and oxygen vacancy planes throughout the sample. Unfortunately, due to the nature of vacuum systems, this process would be difficult to scale-up and as such atmospheric plasma synthesis was explored. Photoactive hematite nanowire arrays were synthesized using an atmospheric microwave plasma jet reactor. They exhibited all of the characteristics of those synthesized under low pressure except for poor photoactivity due to a thin amorphous oxide layer on the surface layer. This oxide layer was removed by hydrofluoric acid etching and subsequently produced a significant photoactivity. Further synthesis improvements have yielded hematite nanowire arrays with no amorphous oxide layer present. Removal of nanowires from the nanowire array decreased the subsequent photoactivity of the electrode, indicating that photoactivity is due to the nanowires present on the sample and not due to the thin interfacial layer. Testing at different light intensities under constant voltage shows that photoactivity of hematite nanowire arrays is linearly dependent on light intensity

Diffuse idiopathic skeletal hyperostosis: a review

Coined in 1975 by Resnick et al., diffuse idiopathic skeletal hyperostosis describes a systemic condition that is mainly characterized by flowing ossification of the spine and, less frequently, peripheral entheses. Its overall incidence is 6-12%, but it is more frequently observed in males than in females and subjects aged >50 years, and its increased prevalence in people aged >70 years suggests that the course of the disease begins between the third and fifth decade of life but its clinical manifestations do not appear until later. Its pathogenesis and etiology remain unknown, but it has been reported to be associated with a number of genetic, metabolic, and constitutional factors. The aim of this review is to describe the main features of the disease and stimulate research into its pathogenesis, prevention, and treatment

Fibromyalgia position paper

Fibromyalgia syndrome is one of the most common causes of chronic widespread pain, but pain accompanies a wide range of ancillary symptoms. To date, its aetiopathogenesis remains elusive, and diagnosis is exquisitely clinical, due to the lack of biomarkers or specific laboratory alterations in fibromyalgia patients. This position paper has the purpose to summarise the current scientific knowledge and expert opinions about the main controversies regarding fibromyalgia syndrome, namely: (i) fibromyalgia definition and why it is still not recognised in many countries as a distinct clinical entity; (ii) fibromyalgia severity and how to evaluate treatment outcome; (iii) how to treat fibromyalgia and which is a correct approach to fibromyalgia patients

Diagnostic and therapeutic care pathway for fibromyalgia

Early diagnosis and timely and appropriate treatments positively influence the history of fibromyalgia syndrome (FM), with favourable repercussions at clinical, psychological, social and economic levels. Notwithstanding, there are still significant problems with timeliness of diagnosis, access to pharmacological therapies - particularly to innovative ones - and appropriate and effective taking in charge of patients. All the aforementioned factors have a great impact on FM patients' quality of life. Indeed, even though the World Health Organisation recognised FM as a chronic condition in the International Classification of Diseases 10th edition (ICD-10), many countries still fail to recognise the syndrome, and this negatively influences the capability to appropriately protect and care for patients. This is the case in several European Countries. In Italy, a few Regions have started to put in place precise indications for people suffering from FM, aiming at the implementation of diagnostic-therapeutic pathways. The Diagnostic-Therapeutic Care Pathway (DTCP) provides an important tool to meet the needs of patients suffering from chronic diseases. They present the organisation of an integrated assistance network. This includes a seamless path for disease prevention, diagnosis and treatment, by means of cooperation among physicians and other healthcare professionals

Relazione tra alterazioni ghiandolari ecograficamente rilevabili e rischio cardiovascolare in pazienti affetti da Sindrome di Sjögren primaria

Background: Current thinking is that systemic inflammation, elevated levels of inflammatory cytokines, and immune dysregulation, typical of the inflammatory autoimmune disease, could play a role in accelerated atherosclerosis. Very limited data are present in literature up to now about sub-clinical cardiovascular involvement in Sjögren’s syndrome. It was demonstrated that salivary glands ultrasound (US) score is strictly related to the histological inflammatory abnormalities. Objective. We investigated sub-clinical cardiovascular involvement in primary Sjögren’s syndrome (pSS) patients by means of ADMA, coronary flow reserve (CFR), intima-media thickness (cIMT) and pulse wave velocity (PWV). Furthermore, we performed salivary glands US in this pSS group and compared the validated US score with cardiovascular parameters. Methods. Fifty-three consecutive outpatients with pSS (7 males, 46 females; mean age 59.8 range 43-80 years; mean disease duration of 59,5 range 6-156 months) without classical cardiovascular risk factors and overt cardiovascular disease, and 22 age- and gender-matched controls were enrolled. RF-QIMT and RF-QAS technologies were used for IMT and PWV evaluation and Dipyridamole transthoracic stress echocardiography assessed CFR. We also investigated plasma ADMA levels, inflammatory markers and autoantibodies. My Lab 70 (Esaote, Florence, Italy) with linear probe ( 6-18 MHZ) was used to assess salivary glands US according to the scoring system published by Salaffi et Al. Results. Although within the normal range, CFR in pSS patients was lower than that of the controls (2,6 ± 0,23 Vs 3,2 ± 0,32 p < 0,0001), whereas PWV and ADMA levels were significantly higher (9,2 ± 1,8 m/s Vs 6,8 ± 0,9 m/s p <0,0001 and 0,76 ± 0,07 μM Vs 0,54 ± 0,05 μM p < 0,0001). Although QIMT values were not different in the two groups, the percentage of pSS patients with pathological values was higher ( 47/53 Vs 12/22 p =0,001). Salivary glands US score was related to the BMI (p= 0,001), CRP (p= 0,034) and ANA (p< 0,0001) plasma levels but not to the sub-clinical cardiovascular involvement index evaluated in this study (PWV r= -0,205 p= 0.140, Q-IMT r= 0,261 p= 0,06, CRF r= -0,194 p= 0,249, ADMA r=0,249 p= 0,075). Conclusion. Even if CFR values were normal, higher ADMA levels, PWV values and percentage of subjects with pathological Q-IMT with respect to an homogeneous control group suggest that pSS patients without classical cardiovascular risk factors have an early endothelial dysfunction and sub-clinical atherosclerosis. Salivary US score is not related to the sub-clinical cardiovascular involvement parameters evaluated in this study.Introduzione e scopo del lavoro. Numerosi studi hanno osservato la presenza di elevata morbidità e mortalità cardiovascolare nei pazienti affetti da patologie autoimmuni sistemiche. Il riscontro di alterazioni cardiovascolari precoci sembra essere indipendente dai fattori di rischio tradizionali e probabilmente legato ad alterazioni connesse alla genesi infiammatoria di tali patologie. La maggior parte dei lavori pubblicati in letteratura si riferiscono a pazienti con diagnosi di Artrite Reumatoide AR) e Lupus Eritematoso Sistemico (LES), mentre sono attualmente molto limitati i dati per i soggetti affetti da Sindrome di Sjögren primaria (pSS). Un recente studio epidemiologico su 312 pazienti con SS suggerisce di valutare attentamente il rischio cardiovascolare in quanto i soggetti inclusi nello studio manifestavano un’elevata incidenza di ipertensione arteriosa, diabete mellito e dislipidemia. Solo due studi, peraltro eseguiti su un limitato numero di pazienti e con risultati parzialmente contrastanti, dimostrano la presenza di una disfunzione endoteliale anche nei soggetti con pSS. Attualmente la misurazione non-invasiva dello spessore medio-intimale (IMT) carotideo è considerato un marker clinico precoce di aterosclerosi, la stima della riserva di flusso coronarica (RFC) studiata mediante ecocardiografia transtoracica con stress farmacologico all’adenosina o al dipiridamolo è stata introdotta come marker diagnostico altamente sensibile di coronaropatia, mentre la valutazione sierica di dimetilarginina asimmetrica (ADMA), il principale inibitore endogeno della ossido-nitrico sintetasi, viene utilizzata come markers di funzionalità endoteliale e del microcircolo. Alcuni lavori hanno, inoltre, dimostrato l’elevata sensibilità e specificità della valutazione ultrasonografica delle ghiandole salivari nella diagnostica della pSS ed il proposto score semiquantitativo 0-16 evidenzia una significativa correlazione sia con le alterazioni istologiche parenchimali sia con quelle funzionali. Scopo primario dello studio è stato pertanto di valutare, in una coorte di pazienti affetti da pSS, i markers ecografici e biochimici di interessamento cardiovascolare subclinico e di correlare tali dati con le alterazioni del parenchima ghiandolare ultrasonograficamente rilevabili. Materiali e Metodi. Cinquantatre pazienti (7 maschi e 46 femmine, età media 59,8 anni ,con range 43-80 e durata media di malattia 59,5 mesi con range 6 – 156 mesi) noti per pregressa diagnosi di Sindrome di Sjögren primaria, secondo i criteri AECG, senza anamnesi e/o segni di malattia cardiovascolare in atto ed un gruppo omogeneo di controllo composto da 22 soggetti, senza storia né segni clinici di malattia cardiovascolare o autoimmune sistemica, sono stati inclusi nello studio. Tutti i soggetti sono stati sottoposti ad analisi ultrasonografica della carotide comune con ecografo My Lab 60 (Esaote, Florence, Italy) dotato di sonda-lineare di 2-9 MHz equipaggiato con software in radiofrequenza denominati RF-QIMT (Quality Intima Media Thickness) e RF-QAS (Quality Arterial Stiffness), sviluppati secondo le linee guida del Mannheim Consensus. Le immagini ecocardiografiche trans-toraciche e la valutazione del flusso di riserva coronarica sono state eseguite con ecografo IE33 (Philips Medical Systems, USA) dotato di sonde da 1-2 MHz e da 3-8 MHz, entrambe dotate di seconda armonica. Infine la valutazione ultrasonografica del parenchima ghiandolare è stata eseguita con ecografo My Lab 70 (Esaote, Florence, Italy) con sonda lineare 6-18 MHZ. I livelli sierici di VES, PCR, fattore reumatoide, ANA ed ENA sono stati valutati secondo le modalità routinarie mentre i livelli plasmatici di ADMA sono stati determinati usando cromatografia liquida ad alta prestazione (HPLC). Risultati. Entrambi i gruppi si sono dimostrati omogenei per età (59,8 ± 8,5 Vs 59,25 ± 2.08 anni p = 0,8), sesso (46F 7M Vs 16F 6M p = 0,8) e BMI ( 25,5 ± 3,3 Vs 23,69 ± 1.12 p = 0,17), pressione arteriosa (126,66 ± 13,4 Vs 125,61 ± 12,48 p = 0,59 ed 79,4 ± 4,6 Vs 80,45 ± 8,25 p = 0,32) mentre differiva per i valori medi di PCR (3,72 ± 2,89 Vs 0,41 ± 0,09 mg/L p<0,0001), VES (30,25 ± 20,2 Vs 4,8 ± 0.24 p <0,0001) e colesterolo totale (182,77 ± 7,12 Vs 163,33 ± 5,59 p <0,001). Tutti i pazienti affetti da pSS mostravano una positività per gli ANA e l’ 80,4% per gli ENA. La valutazione cardiologica dei due gruppi ha evidenziato come i pazienti affetti da pSS presentassero valori di PWV medi e livelli sierici di ADMA statisticamente superiori a quelle dei controlli (9,2 ± 1,8 m/s Vs 6,8 ± 0,9 m/s p < 0,0001 e 0,76 ± 0,07 μM Vs 0,54 ± 0,05 μM p < 0,0001). I valori medi di RFC osservati, seppur non patologici, si sono rivelati inferiori a quelli del gruppo di controllo (2,6 ± 0,23 Vs 3,2 ± 0,32 p < 0,0001) ed infine, seppur senza differenze statisticamente significative nei valori medi di Q-IMT, l’88,7% (47/53 Vs 12/22 p=0,001) dei pazienti presentava valori medi superiori alla norma. La valutazione ultrasonografica del parenchima ghiandolare, attraverso uno score validato, si è dimostrata statisticamente correlato con il BMI (p = 0,001), i valori sierici di ANA (p < 0,0001) e PCR (p = 0,034) ma non con gli indici di danno cardiovascolare subclinico. Conclusioni. Confrontando una coorte di pazienti affetti da pSS, senza storia clinica di accidenti cardiovascolari né anamnesi positiva per fattori di rischio cardiovascolari classici, con un gruppo di controllo omogeneo, si sono rilevate alterazioni statisticamente significative e suggestive per danno intimale pre-aterosclerotico e per una precoce disfunzione sia endoteliale sia dell’elasticità arteriosa. La valutazione ultrasonografica del parenchima ghiandolare, secondo lo score validato in letteratura, quale surrogato sia del danno istologico infiammatorio cronico che di disfunzione ghiandolare, non correla con gli indici presi in considerazione per la valutazione del rischio cardiovascolare subclinico

The journey of canakinumab; on- and off-label indications

The role of interleukin-1 (IL-1) has been studied in many diseases, ranging from auto-inflammatory diseases to malignancies, and much has been discovered. There are currently four IL-1 inhibitors available, but only two have been approved in Europe: the receptor antagonist anakinra, and the IL-1b selective inhibitor canakinumab. The aim of this paper is to summarize the on- and off-label use of canakinumab (ILARIS)

El debate entre Leonardo Bruni y Alonso de Cartagena: las razones de una polémica

El debate entre Leonardo Bruni y Alonso de Cartagena sobre cómo debía traducirse a Aristóteles es uno de los episodios más conocidos y estudiados en la historia de la teoría de la traducción en el otoño de la Edad Media. Su interpretación es polémica por los términos en que se estableció el debate en un momento en que el Humanismo se estaba definiendo a través del enfrentamiento dialéctico con el pasado medieval, lo que ha favorecido su enjuiciamente en época moderna al compás de las opiniones de los historiadores sobre la existencia y características del Humanismo en la Península Ibérica. A la censura de su posición por medievalizante y escolástica ha sucedido una reinvindicación de Cartagena por el acierto en sus ideas sobre la traducción. Sin embargo, y pese a la copiosa bibliografia existente sobre este suceso, parece oportuno considerar algunas de sus circunstancias e implicaciones situándolas en su contexto histórico

Enthesitis of the hands in psoriatic arthritis: an ultrasonographic perspective

Psoriatic arthritis is a systemic inflammatory disease in which enthesitis and dactylitis are two of the main hallmarks\ua0of the disease. In the last years, ultrasonography is increasingly playing a key role in the diagnosis of psoriatic arthritis and\ua0ultrasonography of the entheses, particularly of the lower limbs, is commonly used to assess patients with that disease. New\ua0advancements in ultrasound equipment using high frequencies probes allowed us also to identify and characterize the involvementof the entheses of the hand in psoriatic arthritis, confirming the results of the experimental models of the disease and the\ua0theory of the sinovial-entheseal complex, even in small joints