PERSONALIZED MANAGEMENT OF CELIAC DISEASE: RISK STRATIFICATION AND NOVEL STRATEGIES FOR COMPLICATED PATIENTS

SUMMARY Background. Celiac disease is a widespread autoimmune disease diagnosed at increasing frequency. Celiac patients regularly attend medical services and present a benign course. The knowledge of clinical and biological factors predictive of malignant evolution is poor. Thus, management of such a large population of patients still lacks evidence-based criteria in order to target diagnostic strategies to the subgroup \u201dat-risk\u201d to develop small bowel complications. Aim. To identify celiac patients\u2019 characteristics associated to a higher probability of complicated course and to evaluate the role of available screening and diagnostic approaches and coming biomarkers for the early diagnosis of small bowel malignancies in celiac disease. Methods. A population-based registry (Varese province) was used to estimate the risk of intestinal lymphomas in undiagnosed celiac subjects, taking into consideration different settings of celiac prevalence and relative risks for intestinal lymphomas in comparison with the incidence of the lymphomas in the population. Treated celiac patients were selected on the basis of clinical flags of non-responsiveness or lack of compliance to treatment for targeted small bowel endoscopic examinations, evaluating the diagnostic yield of capsule endoscopy and double-balloon enteroscopy in the recognition of intestinal tumors at an early stage. miRNA profiles in type I and II enteropathy-associated T cell lymphoma were explored to identify eventual celiac related signature to be applied to subgroups of patients with different levels of risk for stratification purpose. Results. In the considered population (815,362 inhabitants), during a five years period, the relative risks of undiagnosed celiac disease for gastrointestinal B- and T-cell lymphomas ranged from 1.0 to 2.0 for 1:100 celiac disease prevalence. In the selected series of 105 celiac patients, the diagnostic yield of capsule endoscopy and double-balloon enteroscopy for malignancies was 2.9%. When compared to the registered population, the relative risk for adenocarcinoma and neuroendocrine tumors in the studied cohort was 410 (CI 95% 102-1640, P<0.0001). Double-balloon enteroscopy was useful to histologically characterize even minor lesions detected at capsule endoscopy. A single miRNA (under patent) resulted upregulated in type I enteropathy-associated T cell lymphoma with confirmation at qPCR (p=0.0012). When mucosa specimen were evaluated, miRNA profiling of refractory patients was highly homogeneous (p=0.001 vs both type I and II enteropathy-associated T cell lymphoma). Conclusions. Undiagnosed/untreated celiac patients did not show a different risk of developing gastrointestinal lymphomas than the general population. Capsule endoscopy and double-balloon enteroscopy could be considered at an early stage in the diagnostic management of a subset of celiac patients at risk for small bowel malignancies. We expect to identify miRNA signatures as a novel biomarker predictive of disease aggressiveness to support the implementation of a personalized clinical approach, in order to optimize resources employment and, through a timely pharmacological intervention, improve prognosis of these subset of celiac patients

Fluencia en materiales refractarios

Los materiales refractarios son ampliamente utilizados en diversos sectores industriales en virtud de sus excelentes propiedades y desempeño en ambientes agresivos. Sin embargo, a pesar de que la resistencia a la deformación por fluencia es una de las propiedades más importantes para la selección de esta clase de materiales, son pocos los trabajos abocados al entendimiento de los principios básicos y tecnológicos de su rendimiento a altas temperaturas. En este contexto, este trabajo aborda: 1) los mecanismos de fluencia, 2) los modelos matemáticos propuestos para el análisis y previsión de la deformación por fluencia a alta temperatura, 3) procedimientos técnicos y ensayos experimentales y 4) un análisis crítico de algunos aspectos básicos y prácticos, considerando la literatura disponible sobre el tema. A partir de la información recolectada, se considera que los modelos matemáticos (como el concepto de Proyección θ) constituyen una poderosa herramienta para la previsión del comportamiento a la fluencia de los refractarios, ayudando en la identificación de los principales mecanismos de fluencia de estos materiales e induciendo al desarrollo de composiciones optimizadas para atender las necesidades de sus usuarios finales.Refractory materials are widely used in various industrial fields due to their outstanding properties and performance in aggressive environments. However, although creep resistance is one of the most important properties for the selection of these materials, few researches were carried out focused on the fundamentals and technological understanding of their performance at high temperatures. In this context, this work addresses: 1) the creep mechanisms, 2) the mathematical models proposed for the analysis and to forecast the creep deformation at high temperature, 3) technical procedures and experimental testing, and 4) a critical analysis of some basic and practical aspects considering the literature available on this issue. Based on the collected information, mathematical models (such as the Projection θ concept) were considered as a powerful tool for the prediction of the refractories’ creep behavior, helping to identify the main creep mechanisms in these materials and to induce the development of optimized compositions able to attend the end-users requirements.Fil: Tomba Martinez, Analia Gladys. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico - CONICET - Mar del Plata. Instituto de Investigación en Ciencia y Tecnología de Materiales (i); Argentina;Fil: Luz, A. P.. Universidade Federal de São Carlos. Departamento de Engenharia de Materiais; Brasil;Fil: Pandolfelli, V. C.. Universidade Federal de São Carlos. Departamento de Engenharia de Materiais; Brasil

Repensar la publicidad del siglo XX desde una perspectiva socio-histórica

Desde los primeros escritos que marcaban el fin de la prehistoria hasta los mensajes detexto que hoy enviamos por celular, llevan en su esencia parte de nuestra cultura y la formaen que percibimos y comprendemos el mundo. En las piezas publicitarias esto se evidenciade forma concentrada, ya que nuestra vida está intermediada por productos y servicios. Lapublicidad es una expresión social que influye en la construcción de la realidad y refleja lacosmovisión de una sociedad en un tiempo y espacio determinado. Sucede que al revisar lahistoria de la publicidad se pueden adoptar dos perspectivas: la primera, responde a unavisión formal y clásica, en la cual predominan los aspectos técnicos y el análisis devariables rígidas. La segunda propone entender la evolución publicitaria como resultado dela interacción entre lo social, lo económico, lo político, lo cultural y lo ideológico. Esta es lalínea de pensamiento que guiará nuestro trabajo de investigación

Quasi-Free-Standing Graphene Monolayer on a Ni Crystal through Spontaneous Na Intercalation

Graphene on metal substrates often shows different electronic properties from isolated graphene because of graphene-substrate interactions. One needs to remove the metals with acids and then to transfer graphene to weakly interacting substrates to recover electrical properties inherent in graphene. This process is not easy and besides causes undesirable tears, defects, and impurities in graphene. Here, we report a method to recover the electronic structure of graphene from a strongly interacting Ni substrate by spontaneous Na intercalation. In order to characterize the intercalation process, the density-functional-theory calculations and angle-resolved photoemission-spectroscopy (ARPES) and scanning-tunneling-microscopy (STM) measurements are carried out. From the density-functional-theory calculations, Na atoms energetically prefer interface intercalation to surface adsorption for the graphene/Ni(111) surface. Unlike most intercalants, Na atoms intercalate spontaneously at room temperature due to a tiny diffusion barrier, which is consistent with our temperature-dependent ARPES and core-level photoemission spectroscopy, and with our submonolayer ARPES and STM results at room temperature. As a result of the spontaneous intercalation, the electronic structure of graphene is almost recovered, as confirmed by the Dirac cone with a negligible band gap in ARPES and the sixfold symmetry in STM.open

Predicting the influence of a p2-symmetric substrate on molecular self-organization with an interaction-site model

An interaction-site model can a priori predict molecular selforganisation on a new substrate in Monte Carlo simulations. This is experimentally confirmed with scanning tunnelling microscopy on Fre´chet dendrons of a pentacontane template. Local and global ordering motifs, inclusion molecules and a rotated unit cell are correctly predicted

Sucrosomial Iron Supplementation in Anemic Patients with Celiac Disease Not Tolerating Oral Ferrous Sulfate: A Prospective Study

Patients with celiac disease (CD) frequently suffer from iron deficiency anemia (IDA) and may benefit from iron supplementation. However, intolerance to iron sulfate and duodenal atrophy could reduce the efficacy of this supplementation. This study evaluated the efficacy of a new sucrosomial iron formulation in patients with CD. Consecutive patients with CD and IDA were divided into two groups: patients with a known intolerance to iron sulfate were treated with sucrosomial iron (30 mg of iron/day), while those receiving iron supplementation for the first time were assigned to iron sulfate (105 mg of iron/day). Forty-three patients were enrolled (38 females, mean age 49 \ub1 9 years). After a follow-up of 90 days both groups showed an increase in Hb levels compared to baseline (+10.1% and +16.2% for sucrosomial and sulfate groups, respectively), and a significant improvement in all iron parameters, with no statistical difference between the two groups. Patients treated with sucrosomial iron reported a lower severity of abdominal symptoms, such as abdominal and epigastric pain, abdominal bloating, and constipation, and a higher increase in general well-being (+33% vs. +21%) compared to the iron sulfate group. Sucrosomial iron can be effective in providing iron supplementation in difficult-to-treat populations, such as patients with CD, IDA, and known intolerance to iron sulfate

Commentary on the use of the reproduction number R during the COVID-19 pandemic

Since the beginning of the COVID-19 pandemic, the reproduction number R has become a popular epidemiological metric used to communicate the state of the epidemic. At its most basic, R is defined as the average number of secondary infections caused by one primary infected individual. R seems convenient, because the epidemic is expanding if R>1 and contracting if R<1. The magnitude of R indicates by how much transmission needs to be reduced to control the epidemic. Using R in a naïve way can cause new problems. The reasons for this are threefold: (1) There is not just one definition of R but many, and the precise definition of R affects both its estimated value and how it should be interpreted. (2) Even with a particular clearly defined R, there may be different statistical methods used to estimate its value, and the choice of method will affect the estimate. (3) The availability and type of data used to estimate R vary, and it is not always clear what data should be included in the estimation. In this review, we discuss when R is useful, when it may be of use but needs to be interpreted with care, and when it may be an inappropriate indicator of the progress of the epidemic. We also argue that careful definition of R, and the data and methods used to estimate it, can make R a more useful metric for future management of the epidemic

Increased mercury levels in patients with celiac disease following a gluten-free regimen

Background and Aim. Although mercury is involved in several immunological diseases, nothing is known about its implication in celiac disease. Our aim was to evaluate blood and urinary levels of mercury in celiac patients. Methods. We prospectively enrolled 30 celiac patients (20 treated with normal duodenal mucosa and 10 untreated with duodenal atrophy) and 20 healthy controls from the same geographic area. Blood and urinary mercury concentrations were measured by means of flow injection inductively coupled plasma mass spectrometry. Enrolled patients underwent dental chart for amalgam fillings and completed a food-frequency questionnaire to evaluate diet and fish intake. Results. Mercury blood/urinary levels were 2.4 \ub1 2.3 / 1.0 \ub1 1.4, 10.2 \ub1 6.7 / 2.2 \ub1 3.0 and 3.7 \ub1 2.7 / 1.3 \ub1 1.2 in untreated CD, treated CD, and healthy controls, respectively. Resulting mercury levels were significantly higher in celiac patients following a gluten-free diet. No differences were found regarding fish intake and number of amalgam fillings. No demographic or clinical data were significantly associated with mercury levels in biologic samples. Conclusion. Data demonstrate a fourfold increase of mercury blood levels in celiac patients following a gluten-free diet. Further studies are needed to clarify its role in celiac mechanism