Diagnosis, Clinical Features and Management of Interstitial Lung Diseases in Rheumatic Disorders: Still a Long Journey

: Interstitial lung disease (ILD) is one of the most frequent pulmonary complications of autoimmune rheumatic diseases (ARDs), and it is mainly associated with connective tissue diseases (CTDs) and rheumatoid arthritis (RA) [...]

Pirfenidone for the treatment of interstitial lung disease associated to rheumatoid arthritis: a new scenario is coming?

Introduction: Interstitial lung disease (ILD) is a frequent extra-articular manifestation of Rheumatoid arthritis (RA), but nowadays there are no randomized controlled clinical trials to support therapeutic guidelines. RA-ILD, especially with UIP pattern, shares some similarities with idiopathic pulmonary fibrosis, suggesting a possible role of antifibrotic therapy in these patients. To date, there are no published data supporting the use of pifenidone in RA-ILD. We describe for the first time two patients with a diagnosis of RA-ILD successfully treated with hydroxychloroquine and pirfenidone, without adverse events. Case presentation: Patient 1 and patient 2 were first diagnosed with IPF (UIP pattern at high-resolution computed tomography, no other signs or symptoms suggesting other forms of ILD, routine laboratory examinations and immunological texts negative). Patients started pirfenidone 2403 mg daily. Few months later, they referred to our multidisciplinary outpatient for arthritis. ACPA and RF were positive. A diagnosis of RA was performed and treatment with corticosteroids and hydroxychloroquine was started, in association with pirfenidone. In both cases we assessed the stabilization of articular and lung manifestations, without adverse events. Discussion: In absence of randomized controlled trials, the optimal treatment of RA-ILD has not been determined and remains challenging. When considering therapeutic options for RA-ILD, both pulmonary and extra-thoracic disease manifestations and degrees of activity should be assessed and taken into consideration. Future prospective research might change RA-ILD management, moving to a more personalized approach based on the identification of different phenotypes of the disease or to a combination of immunosuppressive and antifibrotic treatment

Tsunamis in the geological record: Making waves with a cautionary tale from the Mediterranean

This is the final version of the article. Available from AAAS via the DOI in this record.From 2000 to 2015, tsunamis and storms killed more than 430,000 people worldwide and affected a further >530 million, with total damages exceeding US$970 billion. These alarming trends, underscored by the tragic events of the 2004 Indian Ocean catastrophe, have fueled increased worldwide demands for assessments of past, present, and future coastal risks. Nonetheless, despite its importance for hazard mitigation, discriminating between storm and tsunami deposits in the geological record is one of the most challenging and hotly contended topics in coastal geoscience. To probe this knowledge gap, we present a 4500-year reconstruction of "tsunami" variability from the Mediterranean based on stratigraphic but not historical archives and assess it in relation to climate records and reconstructions of storminess. We elucidate evidence for previously unrecognized "tsunami megacycles" with three peaks centered on the Little Ice Age, 1600, and 3100 cal. yr B.P. (calibrated years before present). These ~1500-year cycles, strongly correlated with climate deterioration in the Mediterranean/North Atlantic, challenge up to 90% of the original tsunami attributions and suggest, by contrast, that most events are better ascribed to periods of heightened storminess. This timely and provocative finding is crucial in providing appropriately tailored assessments of coastal hazard risk in the Mediterranean and beyond.Financial support for this work was provided by Labex OT-Med (ANR-11-LABX-0061). Additional assistance was provided by the Institut Universitaire de France (CLIMSORIENT project), ANR Geomar (ANR-12-SENV- 0008-01), A*MIDEX (ANR-11-IDEX-0001-02), and Partenariat Hubert Curien PROCOPE (33361WG). J.G. benefited from a research fellowship at Chrono-environnement funded by the Région Bourgogne-Franche-Comté

Geo-environmental cartography of the marine protected area "isola di bergeggi" (Liguria, NW mediterranean sea)

Marine Protected Areas (MPAs) are considered one of the main tools for conservation, valorisation and management of coastal marine environments, and are defined by Italian Law (derived from European directives) as territories with "physical, geological, geomorphological and biological features having relevant naturalistic and environmental value". While the bionomic mapping of MPAs has received large attention by researchers, MPA geological or geomorphological cartographies have been seldom realized. In this study we present a geomorphological cartography, comprising also environmental themes having a geomorphological significance, realized in the MPA "Isola di Bergeggi"

Industry 4.0 and smart data as enablers of the circular economy in manufacturing: Product re-engineering with circular eco-design

The digital transformation of manufacturing firms, in addition to making operations more efficient, offers important opportunities both to promote the transition to a circular economy and to experiment with new techniques for designing smarter and greener products. This study integrates Industry 4.0 technologies, smart data, Life Cycle Assessment methodology, and material microstructural analysis techniques to develop and apply a circular eco-design model that has been implemented in the Italian ceramic tile manufacturing industry. The model has been initially adopted in a simulation environment to define five different scenarios of raw material supply, alternative to the current production one. The scenarios were then validated operationally at laboratory scale and in a pilot environment, demonstrating that a proper selection of raw material transport systems significantly improves the environmental performance of the ceramic product. Both the results of the laboratory tests and of the pre-industrial experiments have demonstrated the technological feasibility of the solutions identified with circular eco-design, enabling the re-engineering of the ceramic product as the fifth of the 6Rs of the circular economy. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Hyper-velocity impact test and simulation of a double-wall shield concept for the Wide Field Monitor aboard LOFT

The space mission LOFT (Large Observatory For X-ray Timing) was selected in 2011 by ESA as one of the candidates for the M3 launch opportunity. LOFT is equipped with two instruments, the Large Area Detector (LAD) and the Wide Field Monitor (WFM), based on Silicon Drift Detectors (SDDs). In orbit, they would be exposed to hyper-velocity impacts by environmental dust particles, which might alter the surface properties of the SDDs. In order to assess the risk posed by these events, we performed simulations in ESABASE2 and laboratory tests. Tests on SDD prototypes aimed at verifying to what extent the structural damages produced by impacts affect the SDD functionality have been performed at the Van de Graaff dust accelerator at the Max Planck Institute for Nuclear Physics (MPIK) in Heidelberg. For the WFM, where we expect a rate of risky impacts notably higher than for the LAD, we designed, simulated and successfully tested at the plasma accelerator at the Technical University in Munich (TUM) a double-wall shielding configuration based on thin foils of Kapton and Polypropylene. In this paper we summarize all the assessment, focussing on the experimental test campaign at TUM.Comment: Proc. SPIE 9144, Space Telescopes and Instrumentation 2014: Ultraviolet to Gamma Ray, 91446

First record of Acanthurus chirurgus (Perciformes: Acanthuridae) in the Mediterranean Sea, with some distributional notes on Mediterranean Acanthuridae

The occurrence of the doctorfish Acanthurus chirurgus is reported for the first time in the Mediterranean Sea, off Elba Island, Tyrrhenian Sea (42.726667° N, 10.434444° E). This record is tentatively related to aquarium release. The occurrence of Acanthuridae in the Mediterranean Sea is briefly reviewed, and some distributional notes on Acanthurus coeruleus and Acanthurus monroviae in the Mediterranean are provided

Coastal and marine geomorphology between Albenga and Savona(NW Mediterranean Sea, Italy)

In this paper, we present a map describing the main geomorphological features of the coastal and marine area between the towns of Albenga and Savona (Ligurian Sea, NW Mediterranean) corresponding to a coastal stretch of ∼40 km. To produce this map, we collated data from the literature, orthophotos, perspective photos, multibeam and side scan sonar data, and undertook direct surveys to ground truth data obtained using indirect techniques. We divided the information into nine thematic layers, including bathymetry, natural coastal types, geomorphological elements, seafloor coverage (both geological and biological), coastal and nearshore dynamics, human influence on coastal and marine environments, coastal occupation and protected areas

Effects of conventional and high-definition transcranial direct current stimulation (tDCS) on driving abilities: A tDCS-driving simulator study

Due to the multitasking nature of driving, drivers are physiologically distracted by both relevant and irrelevant environmental stimuli. The ability to select relevant stimuli and suppress irrelevant distractors during driving are two relevant factors for safety. There is a lot of evidence suggesting that the frontal eye field (FEF) plays an important role in target selection and distractors suppression, as well as in attentional mechanisms crucial for safety driving performance. Taking these two points into account, this study was designed to examine the effects of different transcranial direct current stimulation (tDCS) montages over right FEF to determine whether stimulation of FEF could improve attentional mechanisms in a simulated driving environment. Twenty-seven adult participants took part in the study. A specific driving simulator task was developed in which participants had to respond to brake light events of a preceding car in front of them while driving. The second distracting task consisted of road signs of countries and cities that appeared together with braking lights or alone. Participants were required to respond to one of the two categories with their right hand. These two tasks could be performed alone or in a combined condition. Each participant completed three sessions comparing the effects of different tDCS montages, i.e. conventional, focal 4*1 ring high-definition (HD-tDCS) and sham stimulations over the right FEF. Results indicated an overall better performance under the focal HD-tDCS condition. In particular, participants improved their performance both in braking light RTs and in the second distracting task. Taken together these results are interesting from a theoretical and methodological point of view, by demonstrating a direct effect of anodal focal HD-tDCS on FEF in attentional response during an ecological driving task

Epidemiology and management of interstitial lung disease in ANCA-associated vasculitis

Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a group of systemic vasculitides that predominantly affect small vessels, including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Pulmonary involvement is frequently observed in AAV patients, with various possible phenotypes in the different diseases. In the last years, among the possible types of lung involvement, a growing interest has been addressed to the interstitial lung disease (ILD). Prevalence of ILD is higher in MPA than in GPA; in fact, ILD has been reported in up to 45% of MPA patients and in 23% of GPA. Anti-MPO antibodies are the main ANCA subtype associated to ILD, in about 46-71% of cases, while anti-PR3 antibodies are reported in 0-29% of patients. High resolution computed tomography (HRCT) frequently detects interstitial lung abnormalities in AAV, up to 66% of patients with MPA, even if with an unclear clinical relevance, specifically in asymptomatic patients. Ground glass opacities, mainly consistent with diffuse alveolar hemorrhage (DAH), are the most frequent finding in MPA patients, but reticulations, interlobular septal thickening and honeycombing are also reported. ILD significantly affects quality of life and survival, with mortality increased 2 to 4 times, particularly higher in MPA patients with pulmonary fibrosis. Currently, immunosuppressive therapy is considered also as a possible treatment of ILD. However, a careful evaluation of progression and severity of lung involvement, should guide the treatment decision in the single patient. In this review, we discuss the available evidence on clinical features, diagnostic work-up, prognosis and management of AAV-ILD