The impact of disease extent and severity detected by quantitative ultrasound analysis in the diagnosis and outcome of giant cell arteritis

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.Objectives: To develop a quantitative score based on colour duplex sonography (CDS) to predict the diagnosis and outcome of GCA. Methods; We selected patients with positive CDS and confirmed diagnosis of GCA recruited into the TA Biopsy (TAB) vs Ultrasound in Diagnosis of GCA (TABUL) study and in a validation, independent cohort. We fitted four CDS models including combinations of the following: number and distribution of halos at the TA branches, average and maximum intima–media thickness of TA and axillary arteries. We fitted four clinical/laboratory models. The combined CDS and clinical models were used to develop a score to predict risk of positive TAB and clinical outcome at 6 months. Results: We included 135 GCA patients from TABUL (female: 68%, age 73 (8) years) and 72 patients from the independent cohort (female: 46%, age 75 (7) years). The best-fitting CDS model for TAB used maximum intima–media thickness size and bilaterality of TA and axillary arteries’ halos. The best-fitting clinical model included raised inflammatory markers, PMR, headache and ischaemic symptoms. By combining CDS and clinical models we derived a score to compute the probability of a positive TAB. Model discrimination was fair (area under the receiver operating characteristic curve 0.77, 95% CI: 0.68, 0.84). No significant association was found for prediction of clinical outcome at 6 months. Conclusion: A quantitative analysis of CDS and clinical characteristics is useful to identify patients with a positive biopsy, supporting the use of CDS as a surrogate tool to replace TAB. No predictive role was found for worse prognosis.info:eu-repo/semantics/publishedVersio

Improved pregnancy outcome in patients with Rheumatoid Arthritis who followed an ideal clinical pathway

Among women with rheumatoid arthritis (RA) we aimed to assess the effect of optimal management of pregnancy, on a composite outcome of miscarriage and complicated birth

Accuracy of FIB-4 to Detect Elevated Liver Stiffness Measurements in Patients with Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study in Referral Centers

The identification of advanced fibrosis by applying noninvasive tests is still a key component of the diagnostic algorithm of NAFLD. The aim of this study is to assess the concordance between the FIB-4 and liver stiffness measurement (LSM) in patients referred to two liver centers for the ultrasound-based diagnosis of NAFLD. Fibrosis 4 Index for Liver Fibrosis (FIB-4) and LSM were assessed in 1338 patients. A total of 428 (32%) had an LSM ≥ 8 kPa, whereas 699 (52%) and 113 (9%) patients had an FIB-4 < 1.3 and >3.25, respectively. Among 699 patients with an FIB-4 < 1.3, 118 (17%) had an LSM ≥ 8 kPa (false-negative FIB-4). This proportion was higher in patients ≥60 years, with diabetes mellitus (DM), arterial hypertension or a body mass index (BMI) ≥ 27 kg/m2. In multiple adjusted models, age ≥ 60 years (odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.19–3.23)), DM (OR = 2.59, 95% CI 1.63–4.13), body mass index (BMI) ≥ 27 kg/m2 (OR = 2.17, 95% CI 1.33–3.56) and gamma-glutamyltransferase ≥ 25 UI/L (OR = 2.68, 95% CI 1.49–4.84) were associated with false-negative FIB-4. The proportion of false-negative FIB-4 was 6% in patients with none or one of these risk factors and increased to 16, 31 and 46% among those with two, three and four concomitant risk factors, respectively. FIB-4 is suboptimal to identify patients to refer to liver centers, because about one-fifth may be false negative at FIB-4, having instead an LSM ≥ 8 KPa

Proposte di Unità di apprendimento inclusive

Le Unità di Apprendimento rappresentano la concretizzazione del pensiero progettuale dell'insegnante nonché la filosofia inclusiva che ne guida l'azione didattica ed educativa

Influence of initial glucocorticoid co-medication on mortality and hospitalization in early inflammatory arthritis: an investigation by record linkage of clinical and administrative databases

Background While low-dose oral glucocorticoids (GCs) are recommended in the management of early arthritis, their impact on mortality is unclear. The aim of this study is to evaluate the effect of GCs on mortality in patients with early arthritis, by linking clinical and administrative databases. Methods The study included patients with new-onset rheumatoid arthritis (RA) or undifferentiated arthritis (2005-2010), who received DMARDs (MTX in RA or UA with poor prognosis, hydroxychloroquine in UA) and were alive at the second year of follow-up. Low-dose GCs could be prescribed. Clinical and administrative data were linked from Administrative Health Databases (AHD) of the corresponding province, which provided us with information on drug delivery, comorbidities, hospitalization, and mortality. The effect of GCs in the first year was defined using a dichotomous variable or a 3-level categorization (not delivered, 7.5 mg/day of prednisone) on all-cause mortality, assessed with Cox regression, either crude or adjusted for age, gender, Charlson Comorbidity Index (CCI) or single comorbidities, ACPA, HAQ, and MTX in the first year. A secondary analysis of the effect of GCs on related hospitalizations (for cardiovascular events, diabetes, serious infections, osteoporotic fractures) was also carried. Results Four hundred forty-nine patients were enrolled (mean age 58.59, RA 65.03%) of which 51 (11.36%) died during the study. The median (IQR) follow-up was equal to 103.91 (88.03-126.71) months. Treatments with GCs were formally prescribed to 198 patients (44.10%) at 7.5 mg/day. In adjusted analyses, the GC delivery (HR, 95% CI 1.35 (0.74, 2.47)) did not significantly predict mortality - both at a low (HR, 95% CI 1.41 (0.73, 2.71)) and at a high (HR, 95% CI 1.23 (0.52, 2.92)) dosage. When "all-cause hospitalization" was used as an outcome, the analysis did not show a difference between patients receiving GC and patients not receiving GC. Conclusion In patients with early inflammatory arthritis, the initial GC dose was higher than that prescribed by rheumatologists; however, on background treatment with DMARDs, GC treatments did not seem to increase mortality and hospitalizations

Thermoplasmonic controlled optical absorber based on a liquid crystal metasurface

Metasurfaces can be realized by organizing subwavelength elements (e.g., plasmonic nanoparticles) on a reflective surface covered with a dielectric layer. Such an array of resonators, acting collectively, can completely absorb the resulting resonant wavelength. Unfortunately, despite the excellent optical properties of metasurfaces, they lack the tunability to perform as adaptive optical components. To boost the utilization of metasurfaces and realize a new generation of dynamically controlled optical components, we report our recent finding based on the powerful combination of an innovative metasurface-optical absorber and nematic liquid crystals (NLCs). The metasurface consists of self-assembled silver nanocubes (AgNCs) immobilized on a 50 nm thick gold layer by using a polyelectrolyte multilayer as a dielectric spacer. The resulting optical absorbers show a well-defined reflection band centered in the near-infrared of the electromagnetic spectrum (750–770 nm), a very high absorption efficiency (∼60%) at the resonant wavelength, and an elevated photothermal efficiency estimated from the time constant value (34 s). Such a metasurface-based optical absorber, combined with an NLC layer, planarly aligned via a photoaligned top cover glass substrate, shows homogeneous NLC alignment and an absorption band photothermally tunable over approximately 46 nm. Detailed thermographic studies and spectroscopic investigations highlight the extraordinary capability of the active metasurface to be used as a light-controllable optical absorber

Plasma Observatory ESA M7 candidate mission: unveiling plasma energization and energy transport through multiscale observations

International audienceThe Earth's Magnetospheric System is the complex and highly dynamic environment in near-Earth space where plasma gets actively energized and transport of large amounts of energy occurs, due to the interaction of the solar wind with the Earth's magnetic field. Understanding plasma energization and energy transport is an open challenge of space plasma physics, with important implications for space weather science as well as for the understanding of distant astrophysical plasmas. Plasma energization and energy transport are related to fundamental processes such as shocks, magnetic reconnection, turbulence and waves, plasma jets and instabilities, which are at the core of the current space plasma physics research. ESA/Cluster and NASA/MMS four-point constellations, as well as the large-scale multipoint mission NASA/THEMIS, have greatly improved over the last two decades our understanding of plasma processes at individual scales compared to earlier single-point measurements. Despite the large amount of available observations, we still do not fully understand the physical mechanisms which give rise to plasma energization and energy transport. The reason is that the fundamental physical processes governing plasma energization and energy transport operate across multiple scales ranging from the large fluid to the smaller kinetic scales. Here we present the Plasma Observatory (PO) multiscale mission concept which is tailored to study plasma energization and energy transport within the Earth's Magnetospheric System. PO baseline is comprised of one mothercraft (MSC) and six identical smallsat daughtercraft (DSC) in an HEO 8 RE X 18 RE orbit, covering all the key regions of the Magnetospheric System where strong energization and transport occur: the foreshock, bow shock, magnetosheath, magnetopause, magnetotail current sheet, and the transition region. MSC payload provides a complete characterization of electromagnetic fields and plasma particles in a single point with time resolution sufficient to resolve kinetic physics at sub-ion scales. The DSCs have identical payload which is much simpler than on the MSC, yet giving a full characterization of the plasma at the ion and fluid scales. Going beyond Cluster, THEMIS and MMS, PO will permit us to resolve for the first time the coupling between ion and fluid scales as well as the non-planarity and non-stationarity of plasma structures at those scales.  PO is one of the five ESA M7 candidates to be launched around 2037 and is currently undergoing a competitive Phase 0 at ESA for further downselection to Phase A at the end of 2023

Presentation and outcome of patients with 2016 WHO diagnosis of prefibrotic and overt primary myelofibrosis

The 2016 revision of the World Health Organization (WHO) classification of myeloproliferative neoplasms defines 2 stages of primary myelofibrosis (PMF) that is, prefibrotic/early (pre-PMF) and overt fibrotic (overt-PMF) phase. In this work, we studied the clinical and molecular features of patients belonging to these categories of PMF. The diagnosis of 661 PMF patients with a bone marrow biopsy at presentation was revised according to modern criteria; clinical information and annotation of somatic mutations in both driver and selected non-driver myeloid genes were available for all patients. Compared to pre-PMF, overt-PMF was enriched in patients with anemia, thrombocytopenia, leucopenia, higher blast count, symptoms, large splenomegaly and unfavorable karyotype. The different types of driver mutations were similarly distributed between the 2 categories, while selected mutations comprising the high mutation risk category (HMR; any mutations in ASXL1, SRSF2, IDH1/2, EZH2) were more represented in overt-PMF. More patients with overt-PMF were in higher IPSS risk categories at diagnosis, and the frequency increased during follow-up, suggesting greater propensity to disease progression compared with pre-PMF. Median survival was significantly shortened in overt-PMF (7.2 versus 17.6 years), with triple negativity for driver mutations and presence of HMR mutations representing independent predictors of unfavorable outcome. The findings of this "real-life" study indicate that adherence to 2016 WHO criteria allows to identify two distinct categories of patients with PMF where increased grades of fibrosis are associated with more pronounced disease manifestations, adverse mutation profile and worse outcome, overall suggesting they might represent a phenotypic continuum

Prognostic impact of bone marrow fibrosis in primary myelofibrosis. A study of the AGIMM group on 490 patients

The prognostic significance of bone marrow (BM) fibrosis grade in patients with primary myelofibrosis (PMF) is still debated. A fibrosis grade greater than 1 was shown to associate with higher risk of death, and addition of fibrosis grade to IPSS score resulted in a more accurate prediction of survival. The aim of this study was to analyze the prognostic impact of BM fibrosis in 490 patients with PMF, evaluated at diagnosis, molecularly annotated and with extensive follow-up information. We found that fibrosis grade 2 and greater on a 0\u20133 scale was associated with clinical characteristics indicative of a more advanced disease, such as anemia, leukopenia, thrombocytopenia, constitutional symptoms, larger splenomegaly and a higher IPSS risk category. Patients with higher grade of fibrosis were also more likely to have additional somatic mutations in ASXL1 and EZH2, that are prognostically adverse. Median survival was significantly reduced in patients with grade 2 and 3 fibrosis as compared with grade 1; this effect was maintained when analysis was restricted to younger patients. In multivariate analysis, fibrosis grade independently predicted for survival regardless of IPSS variables and mutational status; the adverse impact of fibrosis was noticeable especially in lower IPSS risk categories. Overall, results indicate that higher grades of fibrosis correlate with unique clinical and molecular aspects and represent an independent adverse variable in patients with PMF; these observations deserve confirmation in prospectively designed series of patients. Am. J. Hematol. 91:918\u2013922, 2016. \ua9 2016 Wiley Periodicals, Inc