Case Report: Safety and Efficacy of Tocilizumab in a Patient with Rheumatoid Arthritis and Chronic Hepatitis C

Tocilizumab is a monoclonal humanized anti-IL-6-receptor antibody used for the treatment of rheumatoid arthritis. The safety of tocilizumab in HCV patients is an open question. We report on safety and efficacy of tocilizumab in a 71-year-old female with rheumatoid arthritis and chronic hepatitis C. Monotherapy with tocilizumab (8 mg/kg every 4 weeks, i.v.) was prescribed after the discontinuation, determined by clinical inefficacy, of anti-TNF-alfa agents (adalimumab and, subsequently, etanercept). We have registered an optimal and rapid clinical response to tocilizumab with early remission (SDAI <3.3 since 4 weeks). The safety was good with no adverse events and maintenance, during a six-month followup, of normal liver enzymes. These data suggest a good safety profile of tocilizumab in patients with rheumatoid arthritis and chronic hepatitis C virus pathology

Parametric and Non-Parametric Analyses for Pedestrian Crash Severity Prediction in Great Britain

The study aims to investigate the factors that are associated with fatal and severe vehicle– pedestrian crashes in Great Britain by developing four parametric models and five non-parametric tools to predict the crash severity. Even though the models have already been applied to model the pedestrian injury severity, a comparative analysis to assess the predictive power of such modeling techniques is limited. Hence, this study contributes to the road safety literature by comparing the models by their capabilities of identifying the significant explanatory variables, and by their performances in terms of the F-measure, the G-mean, and the area under curve. The analyses were carried out using data that refer to the vehicle–pedestrian crashes that occurred in the period of 2016–2018. The parametric models confirm their advantages in offering easy-to-interpret outputs and understandable relations between the dependent and independent variables, whereas the non-parametric tools exhibited higher classification accuracies, identified more explanatory variables, and provided insights into the interdependencies among the factors. The study results suggest that the combined use of parametric and non-parametric methods may effectively overcome the limits of each group of methods, with satisfactory prediction accuracies and the interpretation of the factors contributing to fatal and serious crashes. In the conclusion, several engineering, social, and management pedestrian safety countermeasures are recommended

Cardiopulmonary assessment in primary ciliary dyskinesia.

Background Primary ciliary dyskinesia (PCD) is a rare, usually autosomal recessive disorder of ciliary dysfunction associated with lung involvement, which has a great impact on health. There is limited information concerning the aerobic fitness of children and adolescents with PCD. The aim of this study was to assess cardiopulmonary functional capacity and its relationship with pulmonary function and physical activity (PA) levels in patients with PCD. Design Ten patients with PCD (age 13·2±2·8years) underwent spirometry and cardiopulmonary exercise testing. PA was investigated through a questionnaire. Eight age- and body mass index-matched healthy children were enrolled as controls. Main variables were forced expiratory volume at 1s, peak oxygen uptake (VO 2peak) and time spent in PA. Results Forty per cent of patients with PCD had impaired lung function as expressed by FEV 1<85% predicted. Only patients with impaired lung function exhibited reduced VO 2peak (18·1±7·9mL/kg/min). Time spent in total daily PA was slightly lower in patients than controls, with no difference between patients with normal or reduced lung function. In multiple regression models, male gender (??=0·518, P=0·018), age (??=0·752, P=0·035) and time spent in vigorous PA (??=0·353, P=0·049) were independent predictors of aerobic fitness. Conclusions Assessment of resting pulmonary function and cardiopulmonary functional capacity could contribute to the evaluation of pulmonary impairment in PCD. Given the benefit of physical exercise on airway clearance and on general health and quality of life, patients with PCD should be encouraged to adopt an active lifestyle

Coffee Silverskin: Chemical and Biological Risk Assessment and Health Profile for Its Potential Use in Functional Foods

The coffee supply chain is characterized by a complex network with many critical and unsustainable points producing a huge amount of waste products. Among these, coffee silverskin (CS), the only by-product of the coffee roasting phase, has an interesting chemical profile that suggests potential use as a food ingredient. However, few data on its safety are available. For this reason, the purpose of the study was to assess the occurrence of chemical and biological contaminants in CS, and the resulting risk due to its potential consumption. Essential, toxic, and rare earth elements, polycyclic aromatic hydrocarbons (PAHs), process contaminants, ochratoxin A (OTA), and pesticides residues were analyzed in three classes of samples (Coffea arabica CS, Coffea robusta CS, and their blend). Furthermore, total mesophilic bacteria count (TMBC) at 30 C, Enterobacteriaceae, yeasts, and molds was evaluated. The risk assessment was based upon the hazard index (HI) and lifetime cancer risk (LTCR). In all varieties and blends, rare earth elements, pesticides, process contaminants, OTA, and PAHs were not detected except for chrysene, phenanthrene, and fluoranthene, which were reported at low concentrations only in the arabica CS sample. Among essential and toxic elements, As was usually the most representative in all samples. Microorganisms reported a low load, although arabica and robusta CS showed lower contamination than mixed CS. Instead, the risk assessment based on the potential consumption of CS as a food ingredient did not show either non-carcinogenic or carcinogenic risk. Overall, this study provides adequate evidence to support the safety of this by-product for its potential use in functional foods

About the absence of musculocutaneous nerve

Introduction: Musculocutaneous nerve (C5-7) derives (90,5%) from the lateral cord of brachial plexus at the level of lateral border of pectoralis minor [1]. MC nerve pierces the coracobrachialis muscle and descends between the biceps brachii and brachialis to the lateral side of the elbow and terminates as the lateral cutaneous nerve of forearm. It supplies the biceps brachi, the coracobrachialis and the brachialis. Its terminal branch is purely sensory. Variations in the MC nerve course, distribution and termination have been reported and variably classified [2]. The most frequent variations are the presence of communicating branches with the median nerve [3] and the nerve not perforating the coracobrachialis muscle [4]. Total absence of MC nerve is less frequent (1.4 to 15%) [5]. Materials and Methods: 25 upper limbs from 13 cadavers were dissected. A skin incision was performed on deltopectoral groove and arm midline. Two fasciocutaneous flaps were raised, exposing brachial plexus and MC nerve. Results: In two specimens MC was not demonstrable. In these cases, the nerve branches to the coracobrachialis muscle and the lateral cutaneous forearm nerve originated directly from the median nerve. Conclusion: during embryogenesis MC nerve is derived relatively late, thus its absence may correspond to an incomplete differentiation of the brachial plexus. We believe this anatomical variation noteworthy because clinical procedures as plexus block or Latarjet’s procedure may be affected from MCN anomalies

Recent transmission clustering of HIV-1 C and CRF17_BF strains characterized by NNRTI-related mutations among newly diagnosed men in central Italy

Increased evidence of relevant HIV-1 epidemic transmission in European countries is being reported, with an increased circulation of non-B-subtypes. Here, we present two recent HIV-1 non-B transmission clusters characterized by NNRTI-related amino-acidic mutations among newly diagnosed HIV-1 infected men, living in Rome (Central-Italy)

Computational identification of microRNAs associated to both epithelial to mesenchymal transition and NGAL/MMP-9 pathways in bladder cancer

Bladder cancer is one of the leading cancer of the urinary tract. It is often diagnosed at advanced stage of the disease. To date, no specific and effective early detection biomarkers are available. Cancer development and progression are associated with the involvement of both epithelial-mesenchymal transition (EMT) and tumor microenvironment of which NGAL/MMP-9 complex represents the main player in bladder cancer. It is known that change in microRNAs (miRNAs) expression may result in gene modulation. Therefore, the identification of specific miRNAs associated with EMT pathway and NGAL/MMP-9 complex may be useful to detect the development of bladder cancer at early stages. On this ground, the expression levels of miRNAs in public available datasets of bladder cancer containing data of non-coding RNA profiling was evaluated. This analysis revealed a group of 16 miRNAs differentially expressed between bladder cancer patients and related healthy controls. By miRNA prediction tool (mirDIP), the relationship between the identified miRNAs and the EMT genes was established. Using the DIANA-mirPath (v.2) software, miRNAs, able to modulate the expression of NGAL and MMP-9 genes, were recognized. The results of this study provide evidence that the downregulated hsa-miR-145-5p and hsa-miR-214-3p may modulate the expression of both EMT and NGAL/MMP-9 pathways. Therefore, further validation analyses may confirm the usefulness of these selected miRNAs for predicting the development of bladder cancer at the early stage of the disease

Association between mode of breast cancer detection and diagnosis delay

abstract We investigated the association between mode of breast cancer (Bca) detection and diagnosis delay in a case-series of primary, histologically confirmed Bca patients from Southern Italy. Nine hundred and fifty nine women diagnosed with incident, primary Bca were recruited in two southern Italian regions. We grouped the mode of detection into two categories: Self-Detection (S-D) and Mammography (MG). Diagnosis delay was defined as the time between detection and a histologically confirmed diagnosis of invasive Bca. 20.9% detected Bca with MG while 79.1% had S-D Bca. Women who detected Bca themselves (S-D) were more likely to delay breast cancer diagnosis than women who were diagnosed by a mammography (MG) (OR: 2.0; 95% CI: 1.39–2.87); when considering the model adjusted for health system-related characteristics, the risk increased (OR: 2.13; 95% CI: 1.47–3.09). Our study indicates a disadvantage in terms of diagnostic delay for women who were admitted and treated in community hospitals compared to women admitted and treated in breast health services

Comparative analysis between saliva and buccal swabs as source of DNA: lesson from HLA-B*57:01 testing

Aim: Our work aimed to designate the optimal DNA source for pharmacogenetic assays, such as the screening for HLA-B*57:01 allele. Materials & methods: A saliva and four buccal swab samples were taken from 104 patients. All the samples were stored at different time and temperature conditions and then genotyped for the HLA-B*57:01 allele by SSP-PCR and classical/capillary electrophoresis. Results: The genotyping analysis reported different performance rates depending on the storage conditions of the samples. Given our results, the buccal swab demonstrated to be more resistant and stable in time with respect to the saliva. Conclusion: Our investigation designates the buccal swab as the optimal DNA source for pharmacogenetic assays in terms of resistance, low infectivity, low-invasiveness and easy sampling, and safe transport in centralized medical centers providing specialized pharmacogenetic tests