Alemtuzumab long-term immunologic effect: Treg suppressor function increases up to 24 months

To analyze changes in T-helper (Th) subsets, T-regulatory (Treg) cell percentages and function, and mRNA levels of immunologically relevant molecules during a 24-month follow-up after alemtuzumab treatment in patients with relapsing-remitting multiple sclerosis (RRMS)

Severe asthma: One disease and multiple definitions

Introduction: There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods: Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results: 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions: The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem

Dynamic effects of electrical pitting in steam-turbine tilting-pad thrust-bearings

This paper merges the analysis of a case history and the simplified theoretical model related to a rather singular phenomenon that may happen in rotating machinery. Starting from the first, a small industrial steam turbine experienced a very strange behavior during megawatt load. When the unit was approaching the maximum allowed power, the temperature of the babbitt metal of the pads of the thrust bearing showed constant increase with an unrecoverable drift. Bearing inspection showed that pad trailing edge had the typical aspect of electrical pitting. This kind of damage was not reparable and bearing pads had to replaced. This problem occurred several times in sequence and was solved only by adding further ground brushes to the shaft-line. Failure analysis indicated electrodischarge machining as the root fault. A specific model, able to take into consideration the effect of electrical pitting and loading capacity decreasing as a consequence of the damage of the babbitt metal, is proposed in the paper and shows that the phenomenon causes the irretrievable failure of the thrust bearing

Exhaled nitric oxide as a diagnostic test for asthma in rhinitic patients with asthmatic symptoms

SummaryBackgroundRhinitis is a major risk factor for asthma, so that evaluation of the lower airways is recommended in patients with rhinitis. Exhaled nitric oxide (FENO) is considered a marker of airway inflammation and it has been found to be useful for the screening of patients with suspected diagnosis of asthma. Our aim was to assess the validity and accuracy of FENO to identify patients with asthma in 48 non-smoking patients with persistent rhinitis and asthma-like symptoms.MethodsAsthma was diagnosed on the basis of 12% improvement in FEV1 after salbutamol or a methocholine PD20FEV1<800μg. Prior to lung function FENO was measured with the single exhalation method at 50ml/s.ResultsThe geometric mean (95% confidence interval) FENO was significantly higher in the 18/48 asthmatics than in the non-asthmatic patients (60ppb, CI 95%: 50–89, versus 30ppb, CI 95%: 28–45, P=0.001). Receiver operating characteristic (ROC) curve for the diagnosis of asthma indicated that FENO is an acceptable discriminator between patients with and without asthma (area under the ROC curve=0.78). None of the asthmatic patients had FENO values<25ppb and all the patients with FENO>100ppb (n=5) were asthmatics. The sensitivity and specificity of FENO for detecting asthma, using 36ppb as cut-off point, were 78% and 60% and the positive and negative predictive values were 54% and 82%, respectively.ConclusionsMeasuring FENO may be useful for the screening of rhinitic patients with asthma-like symptoms