Cosmic microwave background constraints on dark energy dynamics: analysis beyond the power spectrum

We consider the distribution of the non-Gaussian signal induced by weak lensing on the primary total intensity cosmic microwave background (CMB) anisotropies. Our study focuses on the three point statistics exploiting an harmonic analysis based on the CMB bispectrum. By considering the three multipoles as independent variables, we reveal a complex structure of peaks and valleys determined by the re-projection of the primordial acoustic oscillations through the lensing mechanism. We study the dependence of this system on the expansion rate at the epoch in which the weak lensing power injection is relevant, probing the dark energy equation of state at redshift corresponding to the equivalence with matter or higher ($w_\infty$). We evaluate the impact of the bispectrum observable on the CMB capability of constraining the dark energy dynamics. We perform a maximum likelihood analysis by varying the dark energy abundance, the present equation of state $w_0$ and $w_\infty$. We show that the projection degeneracy affecting a pure power spectrum analysis in total intensity is broken if the bispectrum is taken into account. For a Planck-like experiment, assuming nominal performance, no foregrounds or systematics, and fixing all the parameters except $w_0$, $w_\infty$ and the dark energy abundance, a percent and ten percent precision measure of $w_0$ and $w_\infty$ is achievable from CMB data only. These results indicate that the detection of the weak lensing signal by the forthcoming CMB probes may be relevant to gain insight into the dark energy dynamics at the onset of cosmic acceleration.Comment: 14 pages, 9 figures. Matching version accepted by Physical Review D. High resolution figures available upon request to the author

Patient's Global Assessment as an Outcome Measure for Psoriatic Arthritis in Clinical Practice: A Surrogate for Measuring Low Disease Activity?

Objective.To assess the low disease activity (LDA) in a group of patients with psoriatic arthritis (PsA) receiving antitumor necrosis factor-α (TNF-α) by using the patient's global assessment (PtGA) in clinical practice, and to compare PtGA with minimal disease activity (MDA) and other outcome measures.Methods.Patients with PsA classified by the ClASsification for Psoriatic ARthritis (CASPAR) criteria and consecutively admitted to an outpatient clinic dedicated to biologic therapy were assessed during their routine followup. The primary outcome measure was the proportion of patients achieving a PtGA ≤ 20 at 4-, 8-, and 12-month followups. Secondary outcome measures included the proportion of patients achieving MDA and other outcome measures. Correlation of PtGA with MDA and other process and outcome measures were also performed.Results.During the period of observation, 124 patients were evaluated. PtGA ≤ 20 was achieved in 25.7% at 4 months, 48.9% at 8 months, and 65.3% at 12 months of followup. The percentage of PtGA ≤ 20 statistically improved throughout the 3 timepoint assessments and it was statistically correlated to MDA. A significant correlation with the Disease Activity index for PSoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index, and Health Assessment Questionnaire was also observed. MDA, DAPSA, and Disease Activity Score at 28 joints with C-reactive protein remission were achieved at 12 months in 64%, 36%, and 71% of patients, respectively.Conclusion.PtGA can estimate the LDA status and could be considered as a surrogate of outcome measures for the assessment of global disease activity in patients with PsA receiving anti-TNF therapy during routine clinical practice. These data suggest that PtGA might be used in outpatient settings, being a simple, reliable, and not time-consuming instrument

Neurophysiological Profile of Antismoking Campaigns

Over the past few decades, antismoking public service announcements (PSAs) have been used by governments to promote healthy behaviours in citizens, for instance, against drinking before the drive and against smoke. Effectiveness of such PSAs has been suggested especially for young persons. By now, PSAs efficacy is still mainly assessed through traditional methods (questionnaires and metrics) and could be performed only after the PSAs broadcasting, leading to waste of economic resources and time in the case of Ineffective PSAs. One possible countermeasure to such ineffective use of PSAs could be promoted by the evaluation of the cerebral reaction to the PSA of particular segments of population (e.g., old, young, and heavy smokers). In addition, it is crucial to gather such cerebral activity in front of PSAs that have been assessed to be effective against smoke (Effective PSAs), comparing results to the cerebral reactions to PSAs that have been certified to be not effective (Ineffective PSAs). &e eventual differences between the cerebral responses toward the two PSA groups will provide crucial information about the possible outcome of new PSAs before to its broadcasting. &is study focused on adult population, by investigating the cerebral reaction to the vision of different PSA images, which have already been shown to be Effective and Ineffective for the promotion of an antismoking behaviour. Results showed how variables as gender and smoking habits can influence the perception of PSA images, and how different communication styles of the antismoking campaigns could facilitate the comprehension of PSA’s message and then enhance the related impac

A cholinergic-sympathetic pathway primes immunity in hypertension and mediates brain-to-spleen communication

The crucial role of the immune system in hypertension is now widely recognized. We previously reported that hypertensive challenges couple the nervous drive with immune system activation, but the physiological and molecular mechanisms of this connection are unknown. Here, we show that hypertensive challenges activate splenic sympathetic nerve discharge to prime immune response. More specifically, a vagus-splenic nerve drive, mediated by nicotinic cholinergic receptors, links the brain and spleen. The sympathetic discharge induced by hypertensive stimuli was absent in both coeliac vagotomized mice and in mice lacking α7nAChR, a receptor typically expressed by peripheral ganglionic neurons. This cholinergic-sympathetic pathway is necessary for T cell activation and egression on hypertensive challenges. In addition, we show that selectively thermoablating the splenic nerve prevents T cell egression and protects against hypertension. This novel experimental procedure for selective splenic denervation suggests new clinical strategies for resistant hypertension

Handgrip strength and health related quality of life in individuals with copd

In individuals with chronic obstructive pulmonary disease (COPD), skeletal muscle wasting and changes in muscle fiber composition limit the muscle strength with consequences on daily physical activities. In the present study we aimed to investigate about the interconnection among upper limb strength, body composition and health related quality of life (HRQoL) in patients with COPD to verify the impact of muscle mass loss on HRQoL. Twenty-six consecutive patients (69.2% male; age: 69.7±7.29 years) with COPD were included. Patients underwent pulmonary function tests. Body composition was evaluated through Bioelectrical Impedance Analysis (BIA); handgrip test was used for measure upper limb strength. St George’s Respiratory Questionnaire (SGRQ) was used to evaluate patients’ HRQoL. Upper limb muscle strength was negatively correlated with SGRQ (Pearson=-0.571; p=0.002) in particular with activity and impact domains (Pearson=-0.668; p<0.001 and Pearson =-0.461; p=0.02). Multivariate linear regression confirm that poor handgrip strength is a predictor of worse SGRQ after adjusting for gender, age, fat free mass index and inhaled corticosteroids use (p=0.012). Upper limb muscle strength and body composition are two essential tools in the multisystemic assessment of patients with COPD. © 2020, Segretariato Italiano Giovani Medici - Associazione Italiana Medici. All rights reserved

Epoetin alfa increases frataxin production in Friedreich's ataxia without affecting hematocrit.

Objective of the study was to test the efficacy, safety, and tolerability of two single doses of Epoetin alfa in patients with Friedreich's ataxia. Ten patients were treated subcutaneously with 600 IU/kg for the first dose, and 3 months later with 1200 IU/kg. Epoetin alfa had no acute effect on frataxin, whereas a delayed and sustained increase in frataxin was evident at 3 months after the first dose (+35%; P < 0.05), and up to 6 months after the second dose (+54%; P < 0.001). The treatment was well tolerated and did not affect hematocrit, cardiac function, and neurological scale. Single high dose of Epoetin alfa can produce a considerably larger and sustained effect when compared with low doses and repeated administration schemes previously adopted. In addition, no hemoglobin increase was observed, and none of our patients required phlebotomy, indicating lack of erythropoietic effect of single high dose of erythropoietin. © 2010 Movement Disorder Society

Pulmonary metastasis: very late relapse of testicular embryonal carcinoma

Testicular carcinoma recurrences represent a rare finding (1-6% in non-seminomatous germ cell tumours). However, cases of recurrence have been described many years later. We report a case of late recurrence of embryonic testicular carcinoma, after 26 years, with pulmonary metastases. Following evidence of increase of alpha-fetoprotein (AFP), the patient underwent a total body computed tomography scan that exhibited two pulmonary nodules, one in upper left lobe and other in left hilar region with multiple mediastinal and retrocrural lymph node enlargements All consolidations showed increased sugar uptake value at PET CT. Biopsies of lung consolidations confirmed diagnosis of recurrence of testicular carcinoma

Identification of the Minimal Disease Activity Domains Achieved Based on Different Treatments in Psoriatic Arthritis

Introductionthe aim of this work is to characterize which minimal disease activity (MDA) domains are mainly achieved, based on different treatments, in psoriatic arthritis (PsA) patients. Moreover, the association between MDA achievement and the different treatment groups was assessed.MethodsWe conducted a cross-sectional analysis of two longitudinal PsA groups. Inclusion criteria were: age &amp; GE; 18 years, PsA diagnosis, stable treatment for at least 6 months. patients were grouped depending on the therapy: group 1: non-steroidal anti-inflammatory drugs (NSAIDs)/cyclooxygenase 2 inhibitors (COX2i)/steroids, group 2: conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), group 3: tumor necrosisfFactor &amp; alpha; inhibitors (TNFi), group 4: interleukin inhibitors (IL)12-23i or IL-23i, group 5: IL-17i, group 6: phosphodiesterase 4 inhibitors (PD4i). For each group, the achieved domains based on therapy were assessed. Multivariate logistic regression analysis was performed to assess the association between the treatment groups and the MDA achievement.resultsA total of 220 patients were enrolled, and MDA was achieved in 45.8% of them. In all treatment groups, the first MDA domains achieved were: body surface area &amp; LE; 3, swollen joint count &amp; LE; 1 and Leeds Enthesitis Index &amp; LE; 1, while MDA domains less frequently achieved were Patient Global Assessment (PtgA) &amp; LE; 2 cm and pain on visual analogue scale &amp; LE; 1.5 cm. The logistic regression analysis showed higher odds ratios for the achievement of the MDA in those patients in groups 3 and 4.ConclusionsIn each treatment group, MDA domains less frequently achieved were PtGA and pain, suggesting that "patient-driven domains" are still an unmet need.Due to the study design and the low number of patients in some groups, it is not possible to clearly define which MDA domain was achieved or not based on treatment; however, it seems that some differences could be present. If larger and prospective studies confirm our preliminary results, we could move toward a personalized/domain treatment approach in PsA.ConclusionsIn each treatment group, MDA domains less frequently achieved were PtGA and pain, suggesting that "patient-driven domains" are still an unmet need.due to the study design and the low number of patients in some groups, it is not possible to clearly define which MDA domain was achieved or not based on treatment; however, it seems that some differences could be present. If larger and prospective studies confirm our preliminary results, we could move toward a personalized/domain treatment approach in PsA

Assessment of patient-physician interactions in psoriatic arthritis: national results of the ASSIST Study

Introduction An overarching principle for the management of psoriatic arthritis (PsA) is a shared decision-making process between physicians and patients. The aim of this study is to assess the patient–physician relationship in a group of patients with PsA, by using the Perceived Efficacy in Patient–Physician Interactions (PEPPI) and CollaboRATE instruments. Methods This is a cross-sectional multicenter study where consecutive patients with PsA were enrolled. For each patient, the main demographic, comorbid conditions, and clinical data were collected, including the assessment of disease activity, function, quality of life, and impact of disease. PEPPI and CollaboRATE questionnaires were used, respectively, to evaluate the patient’s perception of the patient–physician relationship and the shared decision-making process. Results A total of 81 patients with PsA were enrolled at four centers in Italy. Overall, our patients showed a high level of confidence in obtaining needed health care, with relatively high median (IQR) values of PEPPI (20; 16–23), and a good shared decision-making process, with high median (IQR) values of CollaboRATE questionnaire (7; 6–9). PEPPI and CollaboRATE scores showed a statistically significant inverse correlation with different clinical variables such as disease duration, Leeds Enthesitis Index, PsA impact of Disease, Health Assessment Questionnaire, pain, patient’s global assessment of disease activity and clinical disease activity for PsA. The presence of comorbidities did not appear to be associated with lower values of PEPPI and CollaboRATE. Conclusions In this study, few patients with PsA were at risk of suboptimal communication with their physician. This phenomenon appeared to be primarily related to higher disease activity and burden