Reconstructing the pyramid as a therapeutic approach to rheumatoid arthritis

Several recent clinical studies have clearly established that rheumatoid arthritis (RA) is a disease identifiable since its early phases, a disease that can be adequately and efficaciously treated provided the therapeutic program can be started early on. To reach the aim of controlling effectively the disease and of leading the patients to live a normal life, several points must be fulfilled. The first is an early diagnosis obtained through a careful clinical examination along with an appropriate laboratory immunological work-up, followed by an adequate monotherapy within the first 4 months from symptoms onset. The second is the therapeutic re-assessment that needs to be done every three months, to start a possible combination therapy (COMBO), in order to rescue monotherapy failures. The third is the initiation of biological response modifiers (BRMs) within 6 months from monotherapy onset, within 3 months from COMBO in the most resistant cases. Having at hand several molecules with BRMs characteristics, we believe that the future appears much more favourable in most cases even in those with the severe disease

Spatial patterns in the evolution of Cenozoic dynamic topography and its influence on the Antarctic continent

Our knowledge of dynamic topography in Antarctica remains in an infancy stage compared to other continents. We assess the space-time variability in dynamic topography in Antarctica by analysing grids of global dynamic topography in the Cenozoic (and late Cretaceous) based on the tomographic model S40RTS. Our model reveals that the Gamburtsev Province and Dronning Maud Land, two of the major nucleation sites for the East Antarctic Ice Sheet (EAIS) were ~500 m higher 60 Ma ago. The increased elevation may have facilitated ephemeral ice cap development in the early Cenozoic. Between ca 25 and 50 Ma the northern Wilkes Subglacial Basin was ca 200 m higher than today and a major increase in regional elevation (>600 m) occurred over the last 20-15 Ma over the northern and southern Victoria Land in the Transantarctic Mountains (TAM). The most prominent signal is observed over the Ross Sea Rift (RSR) where predicted Neogene dynamic topography exceeds 1,000 m. The flow of warm mantle from the West Antarctic Rift System (WARS)may have driven these dynamic topography effects over the TAM and RSR. However, we found that these effects are comparatively less significant over the Marie Byrd Land Dome and the interior of the WARS. If these contrasting dynamic topography effects are included, then the predicted elevations of the Ross Sea Embayment ca 20 Ma ago are more similar to the interior of the WARS, with significant implications for the early development of the West Antarctic Ice Sheet

Adiposity, joint and systemic inflammation: the additional risk of having a metabolic syndrome in rheumatoid arthritis.

Summary Adiposity is a predisposing condition to atherosclerosis, and rheumatoid arthritis (RA) also predisposes to accelerated atherosclerosis. Adiposity is one of the key features of the metabolic syndrome (MetS) and it is well recognised that a metabolic syndrome (and fat tissue) is a major player in this complex network. Endothelial dysfunction and carotid intima-media thickness, early pre-clinical markers of atherosclerosis which are the main determinants of cardiovascular (CV) morbidity and mortality, occur early on in RA. RA patients have an incidence of CV diseases at least two times higher than the general population. MetS and RA have a low and a severe-moderate degree of inflammation in common, respectively. Adipose tissue has emerged as a dynamic organ that releases several inflammatory and immune mediators (adipokines). In addition, fat has been recognised as a producer of B cell activating factor (BAFF) and of chemerin, an inducer at the chondrocyte level of IL1β, TNFα, IL6, IL8 and MMP13, thus possibly contributing to cartilage damage. Since fat produces inflammation, to obtain a full control of the CV risk in RA, data suggest that it is therefore mandatory to have a "tight control" of both RA and MetS-related inflammation, especially if RA presents MetS as a co-morbidity

The different dimensions of care in practice held by nurses in primary care

Objective: To understand the practices developed in the care provided by nurses in the National Health Programs in a unit of the basic health network in the city of Rio de Janeiro. Methods: The design was a form of case study. The scenario set up in a health center in the municipality of Rio de Janeiro and the research participants, eight nurses. Data were collected through semi-structured and subjected to thematic analysis systematic observation and interview. Results: One may observe the following practices most frequently associated programmatic activities performed by nurses: the nursing consultation, educational practice and the organization of the input stream. Conclusion: Knowing the different practices and care developed by nurses in different areas of expertise and professional linkages in different programs within the Primary Care, it was possible to understand the elements complexity and the multifaceted nature of the nursing profession

An adaptive functional regression framework for spatially heterogeneous signals in spectroscopy

The attention towards food products characteristics, such as nutritional properties and traceability, has risen substantially in the recent years. Consequently, we are witnessing an increased demand for the development of modern tools to monitor, analyse and assess food quality and authenticity. Within this framework, an essential set of data collection techniques is provided by vibrational spectroscopy. In fact, methods such as Fourier near infrared and mid infrared spectroscopy have been often exploited to analyze different foodstuffs. Nonetheless, existing statistical methods often struggle to deal with the challenges presented by spectral data, such as their high dimensionality, paired with strong relationships among the wavelengths. Therefore, the definition of proper statistical procedures accounting for the peculiarities of spectroscopy data is paramount. In this work, motivated by two dairy science applications, we propose an adaptive functional regression framework for spectroscopy data. The method stems from the trend filtering literature, allowing the definition of a highly flexible and adaptive estimator able to handle different degrees of smoothness. We provide a fast optimization procedure that is suitable for both Gaussian and non Gaussian scalar responses, and allows for the inclusion of scalar covariates. Moreover, we develop inferential procedures for both the functional and the scalar component thus enhancing not only the interpretability of the results, but also their usability in real world scenarios. The method is applied to two sets of MIR spectroscopy data, providing excellent results when predicting milk chemical composition and cows' dietary treatments. Moreover, the developed inferential routine provides relevant insights, potentially paving the way for a richer interpretation and a better understanding of the impact of specific wavelengths on milk features.Comment: 20 pages, 3 figure

A high-resolution aeromagnetic field test in Friuli: towards developing remote location of buried ferro-metallic bodies

High Resolution AeroMagnetic surveys (HRAM) are a novel tool experimented in several countries for volcano and earthquake hazard re-assessment, ground water exploration and mitigation, hazardous waste site characterization and accurate location of buried ferrous objects (drums, UXO, pipelines). The improvements achieved by HRAM stem from lower terrain clearance coupled with accurately positioned, real-time differential navigation on closely spaced flight grids. In field cultural noise filtering, advanced data processing, imaging and improved interpretation techniques enhance data information content. Development of HRAM approaches might also contribute to mitigate environmental hazards present throughout the Italian territory. Hence an HRAM field test was performed in July 2000 in Friuli, North-Eastern Italy to assess the capabilities and limitations of HRAM over a buried pipeline and a domestic waste site. A Cesium magnetometer in towed bird configuration was used on two separate grids. Profile line spacing was 50-100 m and bird nominal ground clearance was set to 50 m. Microlevelled total field magnetic anomaly data forms the basis for subsequent advanced processing products including 3D analytic signal, maximum horizontal gradient of pseudo-gravity and 3D Euler Deconvolution. The magnetic signatures we detected and enhanced over the environmental test site area in Friuli are also compared with similar but more extensive HRAM signatures recently observed in other countries

MicroRNA-155—at the critical interface of innate and adaptive immunity in arthritis

MicroRNAs (miRNAs) are small non-coding RNAs that fine-tune the cell response to a changing environment by modulating the cell transcriptome. MiR-155 is a multifunctional miRNA enriched in cells of the immune system and is indispensable for the immune response. However, when deregulated, miR-155 contributes to the development of chronic inflammation, autoimmunity, cancer and fibrosis. Herein, we review the evidence for the pathogenic role of miR-155 in driving aberrant activation of the immune system in Rheumatoid Arthritis, and its potential as a disease biomarker and therapeutic target

Obesity as a Risk and Severity Factor in Rheumatic Diseases (Autoimmune Chronic Inflammatory Diseases)

The growing body of evidence recognizing the adipose tissue as an active endocrine organ secreting bioactive mediators involved in metabolic and inflammatory disorders, together with the global epidemic of overweight and obesity, rise obesity as a hot topic of current research. The chronic state of low grade inflammation present in the obese condition and the multiple pleiotropic effects of adipokines on the immune system has been implicated in the pathogenesis of several inflammatory conditions including rheumatic autoimmune and inflammatory diseases. We will discuss the main relevant evidences on the role of the adipose tissue on immune and inflammatory networks and the more recent evidences regarding the effects of obesity on the incidence and outcomes of the major autoimmune chronic inflammatory diseases

GISEA: an Italian biological agents registry in rheumatology

The GISEA registry is an independent database that was established by the Italian Group for the Study of Early Arthritis (GISEA) in 2008, funded by the Italian Association of Rheumatic Patients (ANMAR - ONLUS). In line with the network's epidemiological strategy, the initial protocol was designed to collect long-term follow-up data concerning patients with rheumatic diseases treated with biological agents in order to investigate the realworld characteristics in terms of disease activity, comorbidities and survival on treatment. We here describe the design and methodology used to collect patient data. Information concerning demographics, disease activity, treatment changes (including the reasons for changing and the duration of each therapy), concomitant therapies and adverse events is available to all the members of the study groups by means of a web-based interface that allows queries and the presentation of numerical data, as well as graphics to illustrate trends. Fourteen Italian rheumatology centres have contributed patients to the database which, at the time writing, includes 5145 patients (72% women) with a mean age of 53 years (range 16-88). The initial diagnoses were rheumatoid arthritis (3494 patients, 67.9%), psoriatic arthritis (833, 16.2%), ankylosing spondylitis (493, 9.6%), undifferentiated spondylo-arthritides (307, 5.9%), enteropathic arthritis (14, 0.3%) and spondylitis following reactive arthritis (4, 0.1%). These patients have been followed for up to 10 years, and 1927 (35.8%) have been treated for at least three years. The biological treatments received include etanercept, infliximab, anakinra, adalimumab, abatacept, rituximab and tocilizumab. A total of 2926 adverse events have been observed, with 1171 patients (22%) reporting at least one. Analysis of the accumulated data will provide insights into the critical early phase of the studied arthritides, and enable us to identify the clinical and laboratory profiles that may predict responsiveness to a specific therapy