Development and First Validation of a Disease Activity Score for Gout

Objective: To develop a new composite disease activity score for gout and provide its first validation. Methods: Disease activity has been defined as the ongoing presence of urate deposits that lead to acute arthritis and joint damage. Every measure for each Outcome Measures in Rheumatology core domain was considered. A 3-step approach (factor analysis, linear discriminant analysis, and linear regression) was applied to derive the Gout Activity Score (GAS). Decision to change treatment or 6-month flare count were used as the surrogate criteria of high disease activity. Baseline and 12-month followup data of 446 patients included in the Kick-Off of the Italian Network for Gout cohort were used. Construct- and criterion-related validity were tested. External validation on an independent sample is reported. Results: Factor analysis identified 5 factors: patient-reported outcomes, joint examination, flares, tophi, and serum uric acid (sUA). Discriminant function analysis resulted in a correct classification of 79%. Linear regression analysis identified a first candidate GAS including 12-month flare count, sUA, visual analog scale (VAS) of pain, VAS global activity assessment, swollen and tender joint counts, and a cumulative measure of tophi. Alternative scores were also developed. The developed GAS demonstrated a good correlation with functional disability (criterion validity) and discrimination between patient- and physician-reported measures of active disease (construct validity). The results were reproduced in the external sample. Conclusion: This study developed and validated a composite measure of disease activity in gout. Further testing is required to confirm its generalizability, responsiveness, and usefulness in assisting with clinical decisions

Soft matter laser micro-texturing for friction reduction: An experimental investigation

In this paper, a femtosecond laser manufacturing process is effectively employed to produce a pattern of micro dimples on a fluoroelastomer. To quantify the microtexture tribological performance, two configurations are implemented: non-conformal and conformal contacts are tested on a pin-on-disk tribometer. Due to the reduced number of dimples engaged in the contact region, no significant friction enhancement is obtained in the non-conformal configuration. On the contrary, in the case of conformal contacts, outstanding outcomes in terms of friction reduction - up to 60% - can be achieved by a properly designed micro-texture. Such a result is obtained by improving the wear debris entrapment and the cavitation respectively at low and high speed, without increasing significantly the occurrence of flow eddies

An integrated approach for assessing the impact of urban stormwater discharge on the fecal contamination in a recreational lake near Paris

International audienceUrban stormwater discharges contribute to the fecal contamination of recreational lakes. It is essential to assess the spatial and temporal distribution of fecal bacterial indicators in the receiving waterbodies, to prevent public health risks. This study develops for the first time in continental waters an integrated monitoring and modelling approach, linking the SWMM and Delft-3D models and including a detailed monitoring of the stormwater discharge and at different points of the lake, for assessing Escherichia coli (E.coli) dynamics in stormwater discharges and the receiving urban lake. This integrated approach is applied to a recreational shallow lake and its adjacent urban catchment, with a single stormwater outlet which discharges into the lake. The SWMM model parameters are calibrated and validated with continuous measurements of the flow rate and mean concentration of E. coli in the stormwater discharge measured during each rainfall event. Using the simulated flow rate and E. coli concentration at the sewer outlet, the Delft3D-FLOW-WAQ model simulates E. coli transport in the urban lake with previously calibrated hydrodynamic parameters and default values of E. coli parameters. Comparing simulations with E. coli concentrations measured at different points in the lake, this integrated modelling approach yields promising results. Further studies will focus on the development of automatic model coupling and parameter optimisation, as well as on the evaluation of long-term impacts and management scenarios

Infrared Thermography for the evaluation of pulsatile or continuous perfusion during cardiopulmonary bypass surgery

Aim of this study was to evaluate the effectiveness of pulsatile perfusion (PP) with respect to continuous perfusion (CP) in CardioPulmonary Bypass (CPB), by InfraRed (IR) thermographic analysis. Twelve elderly patients undergoing aortic valve replacement were divided into two groups treated by either CP or PP pumps. Temperature maps on the sole of the patient's left foot were acquired during surgery by means of an IR thermo-camera. The heating process at the end of the hypothermic surgical phase was analysed in terms of: time delay between the beginning of arterial blood rewarming and foot rewarming; slope of the temperature vs. time tracings and temperature differences among different regions of the foot sole. PP patients showed more prompt answer of the peripheral regions to arterial rewarming (shorter time delay) with respect to CP patients. The slope of the temperature vs. time tracings during the heating phase showed to be steeper in PP than CP. A more homogeneous temperature distribution on the sole of the foot was obtained in PP patients than in CP patients. The IR thermography proved to be a suitable technique to evaluate peripheral perfusion during CPB

Bypass vs endovascular treatment for occluded femoro-popliteal stents in patients with critical limb-threatening ischemia

Objective: The aim of the study was to compare the early and medium-term outcomes of bypass vs endovascular treatment of occluded femoro-popliteal stents in patients with chronic limb-threatening ischemia (the OUT-STEPP multicentric registry). Methods: Between January 2016 and December 2021, 317 patients in 14 centers underwent treatment for a symptomatic occlusion of femoro-popliteal stent/stents. One hundred sixty-one patients were included into the present study: 46 (28.6%) underwent open bypass surgery (Group OPEN), and 115 (71.4%) underwent endovascular revascularization (Group ENDO). Early (30 days) results were assessed and compared between the two groups. Estimated 5-year outcomes were evaluated and compared with the log rank test. Results: At 30 days, no differences were found in terms of major adverse cardiovascular events, acute kidney injury, reinterventions, major amputation, and all-cause mortality between the two groups. The need for blood transfusions was higher for patients in Group OPEN (17; 36.9% vs 13; 11.3%; P <.001). The mean length of intensive care unit stay and the mean hospital stay were higher for patients in Group OPEN ([0.3 ± 0.9 vs 0 days; P <.001] and [9.7 ± 5.8 vs 3.3 ± 1.4 days; P <.001], respectively). The overall median duration of follow-up was 33.1 months (interquartile range, 14-49.5 months). At 5 years, there were no differences between the two groups in terms of survival (68.7% Group OPEN vs 68.8% Group ENDO; P =.27; log-rank, 1.21), primary patency (56.3% Group OPEN vs 67.8% Group ENDO; P =.39; log-rank, 0.75), secondary patency (59.1% Group OPEN vs 77.8% Group ENDO; P =.24; log-rank, 1.40), absence of target lesion restenosis (56.8% Group OPEN vs 62.7% Group ENDO; P =.42; log-rank, 0.65), and limb salvage (77.2% Group OPEN vs 90.4% Group ENDO; P =.17; log-rank, 1.87). Conclusions: Both bypass and endovascular treatment provided safe and effective restoration of patency for femoro-popliteal in-stent occlusion in patients with chronic limb-threatening ischemia. Open surgery was associated with longer stay in hospital and increased use of blood transfusions. At 5 years, no significant differences were found in the rates of overall patency or limb salvage between bypass and endovascular treatment