Cut-offs and response criteria for the Hospital Universitario la Princesa Index (HUPI) and their comparison to widely-used indices of disease activity in rheumatoid arthritis

Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if =2, low disease activity if >2 and =5), moderate if >5 and <9 and high if =9. HUPI''s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28''s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. Conclusions The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis

Approaches in biotechnological applications of natural polymers

Natural polymers, such as gums and mucilage, are biocompatible, cheap, easily available and non-toxic materials of native origin. These polymers are increasingly preferred over synthetic materials for industrial applications due to their intrinsic properties, as well as they are considered alternative sources of raw materials since they present characteristics of sustainability, biodegradability and biosafety. As definition, gums and mucilages are polysaccharides or complex carbohydrates consisting of one or more monosaccharides or their derivatives linked in bewildering variety of linkages and structures. Natural gums are considered polysaccharides naturally occurring in varieties of plant seeds and exudates, tree or shrub exudates, seaweed extracts, fungi, bacteria, and animal sources. Water-soluble gums, also known as hydrocolloids, are considered exudates and are pathological products; therefore, they do not form a part of cell wall. On the other hand, mucilages are part of cell and physiological products. It is important to highlight that gums represent the largest amounts of polymer materials derived from plants. Gums have enormously large and broad applications in both food and non-food industries, being commonly used as thickening, binding, emulsifying, suspending, stabilizing agents and matrices for drug release in pharmaceutical and cosmetic industries. In the food industry, their gelling properties and the ability to mold edible films and coatings are extensively studied. The use of gums depends on the intrinsic properties that they provide, often at costs below those of synthetic polymers. For upgrading the value of gums, they are being processed into various forms, including the most recent nanomaterials, for various biotechnological applications. Thus, the main natural polymers including galactomannans, cellulose, chitin, agar, carrageenan, alginate, cashew gum, pectin and starch, in addition to the current researches about them are reviewed in this article.. }To the Conselho Nacional de Desenvolvimento Cientfíico e Tecnológico (CNPq) for fellowships (LCBBC and MGCC) and the Coordenação de Aperfeiçoamento de Pessoal de Nvíel Superior (CAPES) (PBSA). This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UID/BIO/04469/2013 unit, the Project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462) and COMPETE 2020 (POCI-01-0145-FEDER-006684) (JAT)

El Caribe: Origen del mundo moderno

[EN] This book is a result of the European project titled Connected Worlds: The Caribbean, Origin of the Modern World. This project is directed by Consuelo Naranjo-Orovio from Institute of History (CSIC). The book is presented so that the educational community has the latest and necessary scientific knowledge, in a clear and accessible way, for its transmission to new generations, and contributes -through education and historical knowledge- to combat the discrimination against non-white populations in Europe, the Caribbean and Latin America. Through studies we try to promote, rescue and protect our historical memory and cultural expressions of different peoples, as well as enhance dialogue, debate and international cooperation.With this volume we want to contribute, in short, to the knowledge of the past and present of Caribbean countries and their connection with the rest of Latin America, Europe and Africa. The various themes emphasize topical issues that cannot be missing in the higher education of our societies, whose classrooms, a true reflection of society, are marked by integration, multiculturalism and coexistence between different cultures. Education therefore must contribute to the integration of human diversity and the banishment of concepts of one upmanship between populations, based on the misconception regarding the existence of races in the human species.In this book, teachers and students will find multimedia resources that expand the gathered information and various interviews with Caribbean history specialists, designed and conducted by Consuelo Naranjo Orovio and edited by Luis Centurión, from Ediciones Doce Calles publishing house team, who is also a project member: http://youtube.com/c/ConnecCaribbeanProyecto[ES] Este libro es el resultado del proyecto europeo titulado Connected Worlds: The Caribbean, Origin of the Modern World. Este proyecto está dirigido por Consuelo Naranjo-Orovio del Instituto de Historia (CSIC). El libro se presenta para que la comunidad educativa tenga el conocimiento científico más reciente y necesario, de manera clara y accesible, para su transmisión a las nuevas generaciones, y contribuye, a través de la educación y el conocimiento histórico, a combatir la discriminación contra las poblaciones no blancas en Europa, el Caribe y América Latina. A través de los estudios tratamos de promover, rescatar y proteger nuestra memoria histórica y expresiones culturales de diferentes pueblos, así como mejorar el diálogo, el debate y la cooperación internacional. Con este volumen queremos contribuir, en resumen, al conocimiento del pasado y el presente de los países del Caribe y su conexión con el resto de América Latina, Europa y África. Los diversos temas enfatizan temas de actualidad que no pueden faltar en la educación superior de nuestras sociedades, cuyas aulas, un verdadero reflejo de la sociedad, están marcadas por la integración, el multiculturalismo y la convivencia entre diferentes culturas. La educación, por lo tanto, debe contribuir a la integración de la diversidad humana y al destierro de los conceptos de un solo dominio entre las poblaciones, basado en el concepto erróneo sobre la existencia de razas en la especie humana. En este libro, maestros y estudiantes encontrarán recursos multimedia que amplían la información recopilada y varias entrevistas con especialistas en historia del Caribe, diseñadas y dirigidas por Consuelo Naranjo Orovio y editadas por Luis Centurión, del equipo de la editorial Ediciones Doce Calles, que también es miembro del proyecto: http://youtube.com/c/ConnecCaribbeanProyectoPeer reviewe

The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR's

Glomerular filtration rate: A prognostic marker in atrial fibrillation-A subanalysis of the AntiThrombotic Agents Atrial Fibrillation.

OBJECTIVE An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a subanalysis of the AntiThrombotic Agents Atrial Fibrillation (ATA-AF) is performed with the aim to evaluate estimated glomerular filtration rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF. METHODS AND RESULTS The ATA-AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post-hoc analysis included 1097 AF patients with eGFR data available and 1-year clinical follow-up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow-up. Patients were also divided in two groups according to the eGFR (<60 and ≥60 mL/min/1.73 m ). The Kaplan-Meyer curve for the mentioned endpoint showed a higher endpoint incidence in the group of patient with eGFR below 60 mL/min/1.73 m (P < 0.001). Using multivariate analysis (Cox regression), a trend toward a higher rate of occurrence of the primary endpoint was observed for eGFR below 60 mL/min/1.73 m without reaching the conventional level of statistical significance (hazard ratio [HR] 1.40; 95% confidence interval [CI] 0.99-1.99; P = 0.0572). When eGFR was included in the analysis as continuous variable a significant correlation was observed with the combined endpoint at the Cox regression (HR 0.99, 95% CI 0.98-0.99, P = 0.04). CONCLUSION The result of this post-hoc analysis indicates that an impaired eGFR is independently associated with worse prognosis among patients with AF