A sonographic spectrum of psoriatic arthritis: “the five targets”

Ultrasound is a rapidly evolving technique that is gaining an increasing success in the assessment of psoriatic arthritis. Most of the studies have been aimed at investigating its ability in the assessment of joints, tendons, and entheses in psoriatic arthritis patients. Less attention has been paid to demonstrate the potential of ultrasound in the evaluation of skin and nail. The aim of this pictorial essay was to show the main high-frequency grayscale and power Doppler ultrasound findings in patients with psoriatic arthritis at joint, tendon, enthesis, skin, and nail level

Endogenous myoglobin in human breast cancer is a hallmark of luminal cancer phenotype

BACKGROUND: We aimed to clarify the incidence and the clinicopathological value of non-muscle myoglobin (Mb) in a large cohort of non-invasive and invasive breast cancer cases. METHODS: Matched pairs of breast tissues from 10 patients plus 17 breast cell lines were screened by quantitative PCR for Mb mRNA. In addition, 917 invasive and 155 non-invasive breast cancer cases were analysed by immunohistochemistry for Mb expression and correlated to clinicopathological parameters and basal molecular characteristics including oestrogen receptor-alpha (ERalpha)/progesteron receptor (PR)/HER2, fatty acid synthase (FASN), hypoxia-inducible factor-1alpha (HIF-1alpha), HIF-2alpha, glucose transporter 1 (GLUT1) and carbonic anhydrase IX (CAIX). The spatial relationship of Mb and ERalpha or FASN was followed up by double immunofluorescence. Finally, the effects of estradiol treatment and FASN inhibition on Mb expression in breast cancer cells were analysed. RESULTS: Myoglobin mRNA was found in a subset of breast cancer cell lines; in microdissected tumours Mb transcript was markedly upregulated. In all, 71% of tumours displayed Mb protein expression in significant correlation with a positive hormone receptor status and better prognosis. In silico data mining confirmed higher Mb levels in luminal-type breast cancer. Myoglobin was also correlated to FASN, HIF-2alpha and CAIX, but not to HIF-1alpha or GLUT1, suggesting hypoxia to participate in its regulation. Double immunofluorescence showed a cellular co-expression of ERalpha or FASN and Mb. In addition, Mb levels were modulated on estradiol treatment and FASN inhibition in a cell model. CONCLUSION: We conclude that in breast cancer, Mb is co-expressed with ERalpha and co-regulated by oestrogen signalling and can be considered a hallmark of luminal breast cancer phenotype. This and its possible new role in fatty acid metabolism may have fundamental implications for our understanding of Mb in solid tumours

Urban Disaster-Prevention Strategies Using Macroseismic Fields and Fault Sources

This contribution presents the general framework of the European project UPStrat-MAFA "Urban disaster Prevention Strategies using MAcroseismic Fields and FAult Sources" and its ongoing activities. A unique probabilistic procedure is being used for seismic hazard evaluation, using both macroseismic fields and characteristics of fault sources for the analysis of data from volcanic and tectonic areas: Mt. Etna, Mt. Vesuvius and Campi Flegrei (Italy), Azores Islands (Portugal), South Iceland (Iceland), Alicante-Murcia (Spain), and mainland and offshore Portugal. An improvement of urban scale vulnerability information on building and network systems (typologies, schools, strategic buildings, lifelines, and others) is proposed in the form of a global Disruption Index, with the objective to provide a systematic way of measuring earthquake impact in urbanized areas considered as complex networks. Disaster prevention strategies are considered based on an education information system, another effective component of the disaster risk reduction given by long-term activities.Co-financed by the EU - Civil Protection Financial Instrument, in the framework the European project ”Urban disaster Prevention Strategies using MAcroseismic Fields and FAult Sources (Acronym: UPStrat-MAFA, Grant Agreement N. 23031/2011/613486/SUB/A5). http://ec.europa.eu/echo/funding/cp_projects2011_en.htmPublishedLisbon - Portugal4.1. Metodologie sismologiche per l'ingegneria sismicaope

Urban Disaster-Prevention Strategies Using Macroseismic Fields and Fault Sources

This contribution presents the general framework of the European project UPStrat-MAFA "Urban disaster Prevention Strategies using MAcroseismic Fields and FAult Sources" and its ongoing activities. A unique probabilistic procedure is being used for seismic hazard evaluation, using both macroseismic fields and characteristics of fault sources for the analysis of data from volcanic and tectonic areas: Mt. Etna, Mt. Vesuvius and Campi Flegrei (Italy), Azores Islands (Portugal), South Iceland (Iceland), Alicante-Murcia (Spain), and mainland and offshore Portugal. An improvement of urban scale vulnerability information on building and network systems (typologies, schools, strategic buildings, lifelines, and others) is proposed in the form of a global Disruption Index, with the objective to provide a systematic way of measuring earthquake impact in urbanized areas considered as complex networks. Disaster prevention strategies are considered based on an education information system, another effective component of the disaster risk reduction given by long-term activities

Secukinumab shows high efficacy irrespective of HLA-Cw6 status in patients with moderate-to-severe plaque-type psoriasis: SUPREME study

Background: Understanding genetic variations is important in predicting treatment response and forms the basis for identifying new pharmacogenetic and pharmacogenomic targets for psoriasis treatment. There are limited data on the efficacy of secukinumab in relation to genetic markers. Objectives: To evaluate the efficacy and safety of secukinumab 300 mg in HLA-Cw6-positive (Cw6-POS) and HLA-Cw6-negative (Cw6-NEG) patients with moderate-to-severe chronic plaque-type psoriasis. Methods: SUPREME was a 24-week, phase IIIb study with an extension period up to 72 weeks. Primary end point was Psoriasis Area Severity Index (PASI) 90 response rate after 16 weeks. Results: In total, 434 patients were recruited: 185 (42\ub76%) were Cw6-POS and 246 (56\ub77%) were Cw6-NEG (three not assessed). Mean \ub1 SD age was 45\ub72 \ub1 13\ub72 years (Cw6-POS 42\ub77 \ub1 13\ub71; Cw6-NEG 47\ub72 \ub1 12\ub79). The baseline PASI score was comparable between the cohorts [Cw6-POS 20\ub77 \ub1 8\ub799; Cw6-NEG 21\ub75 \ub1 9\ub799 (P = 0\ub7777)]. At week 16, PASI 90 was achieved in 80\ub74% of Cw6-POS and 79\ub77% of Cw6-NEG patients (difference 0\ub776; 95% confidence interval 127\ub704 to 8\ub723). No differences in absolute PASI at week 16 (Cw6-POS 1\ub736 \ub1 3\ub758; Cw6-NEG 1\ub718 \ub1 2\ub729) were observed. The overall safety profile of secukinumab was consistent with that previously reported. No statistically significant difference was detected in the rate of treatment-emergent adverse events [Cw6-POS 42\ub77%; Cw6-NEG 49\ub76% (P = 0\ub7295)]. A high PASI 90 response was achieved with secukinumab with a fast reduction in absolute PASI. Conclusions: Determination of HLA-Cw6 status for secukinumab therapy is unnecessary, as it is highly effective regardless of HLA-Cw6 status

A database of the coseismic effects following the 30 October 2016 Norcia earthquake in Central Italy

We provide a database of the coseismic geological surface effects following the Mw 6.5 Norcia earthquake that hit central Italy on 30 October 2016. This was one of the strongest seismic events to occur in Europe in the past thirty years, causing complex surface ruptures over an area of >400 km 2. The database originated from the collaboration of several European teams (Open EMERGEO Working Group; about 130 researchers) coordinated by the Istituto Nazionale di Geofisica e Vulcanologia. The observations were collected by performing detailed field surveys in the epicentral region in order to describe the geometry and kinematics of surface faulting, and subsequently of landslides and other secondary coseismic effects. The resulting database consists of homogeneous georeferenced records identifying 7323 observation points, each of which contains 18 numeric and string fields of relevant information. This database will impact future earthquake studies focused on modelling of the seismic processes in active extensional settings, updating probabilistic estimates of slip distribution, and assessing the hazard of surface faulting

Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type 2 diabetes on oral hypoglycaemic agents (APOLLO): an open randomised controlled trial

Background As type 2 diabetes mellitus progresses, oral hypoglycaemic agents often fail to maintain blood glucose control and insulin is needed. We investigated whether the addition of once-daily insulin glargine is non-inferior to three-times daily prandial insulin lispro in overall glycaemic control in adults with inadequately controlled type 2 diabetes mellitus taking oral hypoglycaemic agents. Methods In the 44-week, parallel, open study that was undertaken in 69 study sites across Europe and Australia, 418 patients with type 2 diabetes mellitus that was inadequately controlled by oral hypoglycaemic agents were randomly assigned to either insulin glargine taken once daily at the same time every day or to insulin lispro administered three times per day. The primary objective was to compare the change in haemoglobin A1c from baseline to endpoint (week 44) between the two regimens. Randomisation was done with a central randomisation service. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00311818. Findings 205 patients were randomly assigned to insulin glargine and 210 to insulin lispro. Mean haemoglobin A1c decrease in the insulin glargine group was −1·7% (from 8·7% [SD 1·0] to 7·0% [0·7]) and −1·9% in the insulin lispro group (from 8·7% [1·0] to 6·8% [0·9]), which was within the predefined limit of 0·4% for non-inferiority (difference=0·157; 95% Cl −0·008 to 0·322). 106 (57%) patients reached haemoglobin A1c of 7% or less in the glargine group and 131 (69%) in the lispro group. In the glargine group, the fall in mean fasting blood glucose (−4·3 [SD 2·3] mmol/L vs −1·8 [2·3] mmol/L; p<0·0001) and nocturnal blood glucose (−3·3 [2·8] mmol/L vs −2·6 [2·9] mmol/L; p=0·0041) was better than it was in the insulin lispro group, whereas insulin lispro better controlled postprandial blood glucose throughout the day (p<0·0001). The incidence of hypoglycaemic events was less with insulin glargine than with lispro (5·2 [95% CI 1·9–8·9] vs 24·0 [21–28] events per patient per year; p<0·0001). Respective mean weight gains were 3·01 (SD 4·33) kg and 3·54 (4·48) kg. The improvement of treatment satisfaction was greater for insulin glargine than for insulin lispro (mean difference 3·13; 95% CI 2·04–4·22). Interpretation A therapeutic regimen involving the addition of either basal or prandial insulin analogue is equally effective in lowering haemoglobin A1c. We conclude that insulin glargine provides a simple and effective option that is more satisfactory to patients than is lispro for early initiation of insulin therapy, since it was associated with a lower risk of hypoglycaemia, fewer injections, less blood glucose self monitoring, and greater patient satisfaction than was insulin lispro

Health care for older people in Italy: The U.L.I.S.S.E. project (Un Link Informatico sui Servizi Sanitari Esistenti per l'anziano - a computerized network on health care services for older people)

Introduction. The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study aimed at describing older patients cared for in hospitals, home care or nursing homes in Italy. Methods. Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study. The only exclusion criterion was age lower than 65 years. The patient's evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires. Results. The older subjects who are in need of acute and long term care in Italy have similar characteristics: mean age is higher than 80 years, they have a high level of disability in ADL, complex multimorbidity, and receive several drugs. The prevalence of cognitive impairment is especially high in nursing homes, where almost 70% of residents suffer from it and 40% have severe impairment. On the other hand, there is a shortage of health care services, which appear heterogeneous and fragmented. Discussion. Health care services for older people in Italy are currently inadequate to manage the complexity of older patients. An important effort should be undertaken to create a more integrated health care system