A special class of solutions in F(R)F(R)-gravity

We consider a special class of vacuum $F(R)$-modified gravity models. The form of their Lagrangian is such that the field equations are trivially satisfied when the Ricci scalar is constant. There are many interesting $F(R)$-models for inflation and dark energy that fall in this class. However, little is known outside the domain of cosmology therefore we aim to explore the class of solutions that are static and spherically symmetric. After some general considerations, we investigate in more detail black hole solutions, traversable wormhole metrics and, finally, configurations that can match the anomalous rotation curves of galaxies.Comment: Minor typos corrected, references added. Version accepted for publication in the European Physical Journal

Semeiotica dell'articolazione temporo-mandibolare

Ha senso, nel 3° millennio ormai inoltrato, proporre un manuale di semeiotica clinica reumatologica? Negli ultimi due decenni la medicina si è avvalsa sempre più della tecnologia e i vantaggi che le sue applicazioni offrono a pazienti, clinici e ricercatori sono tutti ben evidenti. La Reumatologia non è rimasta impermeabile a questo nuovo corso, vedendo crescere in modo esponenziale il ruolo assunto dalla diagnostica per immagini. Chi ha vissuto la Reumatologia ai suoi albori si è adoperato per conferire alla disciplina autonomia accademica e nosografica dotandola, tra le altre cose, di un solido impianto clinico-semeiologico a supportare la convinzione che la Reumatologia sia una disciplina eminentemente clinica. Di questo lascito siamo debitori nei confronti di chi ci ha preceduto. Le nuove metodiche di imaging come l'ecografia e la risonanza magnetica (per citare le più diffuse) hanno aperto nuovi orizzonti su scenari prima sconosciuti o solo parzialmente esplorati e costretto le nuove generazioni di clinici ad una seria e critica revisione del loro patrimonio culturale in ambito clinico-semeiologico. In questo nuovo scenario alcune nozioni e pratiche semeiologiche storicamente sedimentate nel corso degli anni sono, oggi, da ritenersi troppo imprecise, se non addirittura superflue o desuete

NAILFOLD VIDEOCAPILLAROSCOPY FEATURES OF PATIENTS WITH ANTISYNTHETASE SYNDROME

Background: Antisynthetase syndrome (ASSD) is an autoimmune disease characterized by the clinical triad arthritis, myositis, and interstitial lung disease (ILD). As in inflammatory myopathies, nailfold videocapillaroscopy (NVC) alterations have been sporadically described also in ASSD patients, but no elucidating data are available. Objectives: To investigate the possible specific NVC features of ASSD patients. Methods: Within the framework of a multicenter study, we retrospectively analyzed NVC images of ASSD patients, after excluding patients with overlap syndrome with systemic sclerosis. Two operators in a blind manner re-evaluated all patients with at least one image per finger. For each patient, we examined number of capillaries (mean number of capillaries per mm in the distal row), enlarged and giant capillaries, micro-hemorrhages, avascular areas, ramified capillaries, and the presence of a scleroderma (SSc)-like pattern, according to manfredi et al. Finally, we correlated NVC features with clinical and serological findings of ASSD patients. Results: The NVC of 54 ASSD patients were analyzed (males/females 1/6.8, mean age 55.79, CI95% 51.9\u201359.9 years, mean disease duration 59.4, CI95% 27.9\u201390.9 months). Raynaud's phenomenon (RP) was recorded in 51.9% of patients, arthritis in 79.6%, myositis in 53.7%, and ILD in 92.6%. NVC alterations were observed in 53.7% of AASD patients. Nineteen patients (35.2%) showed a SSc-like pattern; the main features were disarrangement of hairpin and angiogenetic aspects (42.6%), avascular areas (38.9%), giant capillaries (27.6%), and microhemorrhages (20.4%). Finally, the mean number of capillaries was reduced (7.8\ub12/mm). No significant association was recorded between SSc-like pattern and the presence of arthritis, myositis, and ILD, nor with RP. Among other NVC features, angiogenesis was significantly associated to female gender (p=0.031), while microhemorrhages were inversely associated to the presence of arthritis (0.033). No association was observed between NVC features and autoantibodies profile. Of interest, in 58% of patients with ILD we observed at least a NVC alteration vs no patients without ILD (p=0.04). Finally, in patients with RP NVC alterations were recorded in 15/28 patients (53.6%) and a SSc-like pattern in 11/28 (39.3%), while only 57.9% of patients with SSc-like pattern had a clinically manifest Raynaud's phenomenon. Conclusions: Despite preliminary, the present is the first study concerning NVC in AASD patients. Regardless of the presence of Raynaud's phenomenon, NVC alterations are frequently observed; in particular, a SSc-like pattern is recorded in more than 1/3 of patients. NVC should be performed in all ASSD patients at diagnosis regardless of the presence of RP in the patient history and during follow-up. ASSD should be always considered in the screening of RP. A prospective multicenter study has been planned to identify specific patterns and possible associations between NVC findings and clinical and serological features of ASSD

Cluster Generation and Cluster Labelling for Web Snippets: A Fast and Accurate Hierarchical Solution

This paper describes Armil, a meta-search engine that groups into disjoint labelled clusters the Web snippets returned by auxiliary search engines. The cluster labels generated by Armil provide the user with a compact guide to assessing the relevance of each cluster to her information need. Strik- ing the right balance between running time and cluster well- formedness was a key point in the design of our system. Both the clustering and the labelling tasks are performed on the ?y by processing only the snippets provided by the auxil- iary search engines, and use no external sources of knowl- edge. Clustering is performed by means of a fast version of the furthest-point-?rst algorithm for metric k-center cluster- ing. Cluster labelling is achieved by combining intra-cluster and inter-cluster term extraction based on a variant of the information gain measure. We have tested the clustering ef- fectiveness of Armil against Vivisimo, the de facto industrial standard in Web snippet clustering, using as benchmark a comprehensive set of snippets obtained from the Open Di- rectory Project hierarchy. According to two widely accepted external\u27 metrics of clustering quality, Armil achieves bet- ter performance levels by 10%. We also report the results of a thorough user evaluation of both the clustering and the cluster labelling algorithms. On a standard 1GHz ma- chine, Armil performs clustering and labelling altogether in less than one second

COST ANALYSIS RELATED TO SUBCUTANEOUS IMMUNOGLOBULINS IN PATIENTS WITH INFLAMMATORY MYOPATHIES AND IMMUNE-MEDIATED CHRONIC NEUROPATHIES. RESULTS OF AN OPEN LABEL STUDY

Background: Intravenous Immunoglobulins (IVIg) represent a relevant treatment option in various immune-mediated disorders such as idiopathic inflammatory muscle diseases (IIMD), immune-mediated chronic neuropathies (IMCN), hematologic autoimmune diseases, Still disease, Felty syndrome, systemic lupus erythematosus, vasculitis, some organ-specific autoimmune disease, and atopic diseases. The IVIg treatment is expensive and need of hospital-based assistance for administration; the recent avaibility of home-therapy with subcutaneous immunoglobulins (SCIg) may significantly reduce costs and improve the patient's quality of life. Objectives: The primary objective was to perform an analysis of costs of SCIg administration in patients affected by IIMD or IMCN compared to that of previous IVIg treatments. Methods: We prospectively evaluated 6 consecutive patients (3 males and 3 females, mean age 65,3 years, range 63 - 77), 2 affected by IIMD in the context of polymiositis and 4 by IMCN, 3 in the context of vasculitis and 1 in the context of undifferentiated connective tissue disease. All patients were previously treated with IVIg at the dosage of 2g/Kg monthly, (mean monthly dosage 143 g, range 98 – 160, average patient weight 71,5 kg, range 49 - 80), with good clinical and humoral response. After a mean therapy duration of 49.8 months (range 12 – 125) all patients were shifted to SCIg at the dosage of 10 g twice a week (80 g monthly). Each patient was followed-up by humoral and clinical evaluation, including Medical Research Council (MRC) score to quantify muscle strength and INCAT Sensory Score to evaluate sensory symptoms. The costs of the two therapeutic strategies were also compared, excluding indirect costs (absences from work and productivity losses, transport and parking, health care sector costs). Results: In 5/6 patients, we observed the maintenance of clinical and humoral status after a mean follow-up of 21 months (range 4 - 51), in particular we observed a stability in MRC score in patients presenting loss of strenght and INCAT score in patients presenting sensory symptoms. Furthermore, the treatment with SCIg was well-accepted and preferred to IVIg by all patients. In one patient SCIg were discontinued after 2 weeks, because of the appearance of a haemorrhagic lesions nearby the injection site (in the same patient IVIg have been stopped because of a hypertensive crisis during the infusion). Direct cost associated to IVIg amount to 252€ for 5 g of immunoglobulins (7,056€ monthly, considering a protocol of 2 g/kg/monthly and a patient-weight of 70kg), while direct costs associated to SCIg (20g weekly) amount to 6,400€/monthly, with a saving of 656€/monthly and 7,872€/yearly. In our case-series the annual saving was 9,686.40€/patient (from 86,486.40€ to 76,800€, for IVIg and SCIg, respectively). Conclusions: Our experience suggests that the shift to SCIg from IVIg in patients affected by IIMD and IMCN is feasible, cost-effective, safe and well-accepted by patients. Further studies are needed to evaluate the effectiveness of SCIg in first-line therapy of these diseases

Cryoglobulinemic vasculitis and skin ulcers. Our therapeutic strategy and review of the literature

Objective: Cryoglobulinemic vasculitis (CV) involving small- and medium-sized vessels is very frequently associated with hepatitis C virus and may be responsible for multiple organ involvement and skin ulcers (SU). Skin ulcers are often non-healing cutaneous lesions, possibly complicated by local infection and gangrene; they may severely affect the patients[U+05F3] quality of life and the overall prognosis. Therefore, the treatment of cryoglobulinemic SU is particularly challenging in the clinical practice.The present work evaluated the prevalence and correlations of cryoglobulinemic SU with other clinico-epidemiological features of CV; moreover, our long-term experience with the management strategies of these cutaneous lesions was compared with the world literature on this topic. Methods: The study included 126 CV patients (24 male and 102 female, aged 69 ± 11.2 SD years, disease duration 7 ± 6.9 SD years), followed at our Rheumatology Unit during the past decade. All patients were carefully evaluated regarding the entire cryoglobulinemic syndrome with particular concern for clinical characteristics and treatment of SU. Results: Among 126 CV patients, 36 individuals (29%) experienced at least one episode of SU, more commonly localized at the lower limbs. Patients with complicating SU showed significantly higher percentage of purpuric manifestations (p < 0.01) and liver (p < 0.001), peripheral nerve (p < 0.02), and/or thyroid involvement (p = 0.019).Therapeutic approach to SU included both systemic (immunosuppressors, corticosteroids, and/or plasma exchange) and local treatments. Local treatments consisted of sharp or surgical debridement as well as interactive dressing according to the condition of wound bed, perilesional skin, and the possible presence of infection, detected in 29 of 36 (81%) individuals in our Rheumatology unit. All patients underwent analgesic treatment for SU-related background pain as well as procedural pain, which was critical for an effective local SU management.The large majority of patients with SU healed at a variable time interval according to the severity of the single lesion; only five patients with very severe, non-healing SU needed amputation.The updated review of the literature revealed the presence of SU in around a quarter of CV patients. Among systemic treatments, the anti-CD20 monoclonal antibody rituximab represents one of the most effective and frequently employed therapies; however, the available data focusing on local therapeutic approach are generally limited to anecdotal observations. Conclusions: Overall, the treatment of cryoglobulinemic SU should be tailored to the single patient[U+05F3]s conditions using combined systemic and local treatments; lesional sharp debridement and interactive dressing as well as procedural pain management were decisive, particularly for more severe, non-healing cutaneous lesions

A simple method for pile-up correction by high-speed nanoindentation combined with optical profilometry

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