The relationship between the presence of anti-cyclic citrullinated peptide antibodies and clinical phenotype in very early rheumatoid arthritis

<p>Abstract</p> <p>Background</p> <p>Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific for RA, but are not detectable in all RA patients. The aim of this study was to establish whether the clinical phenotypes of anti-CCP positive and negative disease are distinct at the earliest clinically apparent phase of disease.</p> <p>Methods</p> <p>Patients were recruited from the Birmingham early inflammatory arthritis clinic. Participants were included in the current study if they presented within 3 months of symptom onset and fulfilled 1987 ACR criteria for RA at some point during an 18 month follow-up. Data were collected on demographic variables, joint symptoms and tender (n = 68) and swollen (n = 66) joint counts. CRP, ESR, rheumatoid factor and anti-CCP2 status were measured.</p> <p>Results</p> <p>92 patients were included (48 anti-CCP positive). The anti-CCP positive and negative groups were comparable in terms of demographic variables, inflammatory markers, joint counts and 1987 ACR classification criteria, except that more anti-CCP positive patients were rheumatoid factor positive (83.3% vs. 11.4%, p < 0.01). There was no significant difference in the pattern of joint involvement, except for an increased prevalence of knee joint swelling in anti-CCP positive patients (42.9% vs. 22.2%, p = 0.03).</p> <p>Conclusions</p> <p>Patients with and without anti-CCP antibodies present in a similar way, even within three months of clinically apparent disease that eventually develops into RA.</p

Clinical correlates of grey matter pathology in multiple sclerosis

Traditionally, multiple sclerosis has been viewed as a disease predominantly affecting white matter. However, this view has lately been subject to numerous changes, as new evidence of anatomical and histological changes as well as of molecular targets within the grey matter has arisen. This advance was driven mainly by novel imaging techniques, however, these have not yet been implemented in routine clinical practice. The changes in the grey matter are related to physical and cognitive disability seen in individuals with multiple sclerosis. Furthermore, damage to several grey matter structures can be associated with impairment of specific functions. Therefore, we conclude that grey matter damage - global and regional - has the potential to become a marker of disease activity, complementary to the currently used magnetic resonance markers (global brain atrophy and T2 hyperintense lesions). Furthermore, it may improve the prediction of the future disease course and response to therapy in individual patients and may also become a reliable additional surrogate marker of treatment effect

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all &gt;0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Application of computer simulations in mobile inspection robots designing process

Obecnie z uwagi na koszty wykonania fizycznych modeli testowych niezbędne jest projektowanie i badanie nowych urządzeń z wykorzystaniem komputera. Systemy CAD/CAE umożliwiają wielokrotną modyfikację konstrukcji oraz jej analizę np. pod kątem zgodności z wymogami użytkownika, ergonomią czy obowiązującymi normami technicznymi. Symulacje pracy układu pozwalają z kolei ocenić m.in. prawidłowość współpracy mechanizmów, wytrzymałość konstrukcji lub jej działanie w szczególnych warunkach środowiskowych. Referat opisuje wyniki użycia narzędzi do projektowania i symulacji przemysłowego mobilnego robota inspekcyjnego, opracowanego w Przemysłowym Instytucie Automatyki i Pomiarów.Nowadays, considering the costs of making physical test models it is necessary to design and verify new devices using a computer. CAD/CAE systems enable multiple construction modification and its analysis of, for example, accordance to user's needs, ergonomics or obligatory technical norms. Simulations of the work of the construction allow to consider, for example, correctness of the cooperation of the mechanisms, strength of the construction or its working in specific environmental conditions. This paper describes the results of the use of the designing and simulation tools for industrial mobile inspection robot, built in Industrial Research Institute for Automation and Measurements

Understanding the Impact of the Economic Crisis on Child and Maternal Health Among the Poor: Opportunities for South Asia

The economic crisis hit many countries in 2007 and the effects are still being felt, especially in poorer developing nations. Much of the debate surrounding the economic crisis and its impacts has focused on the financial and economic aspects - import/export impacts, economic growth losses, labor force cutbacks, and fiscal imbalances. The social impact, especially on poor and vulnerable groups, has received less mention. Yet, if countries are to address the overall impacts of the economic crisis, it is vital that they also consider investing time and money to deal with social impacts more effectively. There are fears, however, that a reduction in spending on vital sectors (including the healthcare sector) to ensure economic recovery could affect poor and vulnerable populations and, in turn, erase the progress that has been made thus far. The decision to reduce such spending could also come from donors, who tend to favor a market-led recovery process in economic crises, thereby neglecting vital social service sectors that cater to the needs of poor populations. This spending can supplement government services or fill resource gaps and as a result reductions could have negative impacts on beneficiary populations, particularly the poor and vulnerable. Addressing child and maternal health issues within the context of the economic crisis is one key area to consider given its short, medium, and long-term effects on populations in developing countries. In South Asian countries, child and maternal health-related indicators tend to be disturbing despite the rapid growth rates in many of these countries. The number of infant deaths is still quite high, nutrition of children and women continues to be problematic, and maternal health and pre/post natal care remains poor. This paper presents an overview of child and maternal health in the South Asia region, but also recommends that interventions take into account a series of factors if the impacts of the economic crisis are to be minimized: There is a need for more information and research on the impacts of the crisis; Investing in social protection and safety nets is imperative; Food security should be integrated into social protection; Vulnerable households require support to cope with the crisis despite their own efforts and coping strategies; State investments that support vulnerable populations should be protected in times of crisis