Mining the pathogenesis of rheumatoid arthritis, the leading role of the environment

The environment plays a crucial role in the pathogenesis of various diseases, including rheumatic musculoskeletal diseases (RMDs). Chronic exposure to air pollution has been associated with a number of detrimental effects on the immune system, including direct activation of autoimmunity and autoantibodies production. Rheumatoid arthritis (RA) is a paradigmatic example of the link between environmental stimuli and development of autoimmunity. Recent evidence has confirmed such association and provided further indication of the strict relationship between the lungs and the synovial tissue. Hard rock mining and chronic exposure to airborne fine particulate matter have been associated with higher risk of developing RA. In addition, new evidence showed a peculiar association between acute exposure to toxic inhalants and risk of RA flare. In conclusion, the environment is the straw that breaks the camel's back, unfortunately the "straws" are rapidly accumulating, and their burden is projected to increase accordingly

Glycosylated haemoglobin (A1c) best values for type 2 diabetes in the battlefield much ado about nothing? (apparently)

Despite intensive research, therapy of diabetes mellitus type 2 (T2DM) is far from be effective. The most important unresolved issue is to establish a safe glycosylated hemoglobin C (A1c) value well balanced between benefit and side effects. As a result different guidelines suggest different A1c targets generating confusion for patients and clinicians. Here we report two observations which might support a relaxed A1c as suggested by American college of physician (ACP)

A Prospective Open-Label Observational Study of a Buffered Soluble 70 mg Alendronate Effervescent Tableton Upper Gastrointestinal Safety and Medication Errors: The GastroPASS Study

Upper gastrointestinal (GI) side effects are a main reason for discontinuing bisphosphonate treatment, an important therapeuticoption for osteoporosis patients. Consequently, the development of novel formulations with improved tolerability is warranted. Inthis multicenter prospective, observational, postauthorization safety study conducted in Italy and Spain, postmenopausal women(PMW) with osteoporosis (naïve to bisphosphonates) were treated weekly with a buffered soluble alendronate 70 mg effervescent(ALN-EFF) tablet (Binosto®) and followed for 12 3 months. Information was collected on adverse events (AEs), medication errors,persistence, and compliance using the Morisky-Green questionnaire. Patients (N = 1028) aged 67 9 years (mean SD) receivedALN-EFF weekly. The cumulative incidence of upper GI AEs (oesophageal toxicity, gastritis, gastric ulcers, and duodenitis) relatedto ALN-EFF (primary endpoint) was 9.6% (95% condence interval [CI] 7.9–11.6%), the vast majority being of mild intensity. The mostfrequently occurring upper GI AEs related to ALN-EFF were dyspepsia (2.7%), gastroesophageal reux disease (2.4%), and nausea(2.2%). None of the relevant upper GI AEs listed in the primary endpoint and no serious AEs were reported. At least one medicationerror occurred in 29.9% (95% CI 27.1–32.8%) of patients. However, the majority of medication errors were associated with adminis-tration instructions applicable to any oral bisphosphonate and only seven medication errors were associated with the ALN-EFF for-mulation. ALN-EFF was discontinued in 209 of 1028 (20.3%) patients. The most frequent reasons for discontinuation were AEsrelated to ALN-EFF (46.9%) and patients’ decision (42.6%). Compliance with ALN-EFF was high, reected by a mean Morisky-Greenscore of 92.8 18.6. PMW with osteoporosis treated with ALN-EFF in a real-world setting experienced few upper GI AEs. In addition,they had a low discontinuation and high compliance compared with other formulations, suggesting that ALN-EFF may increasepatient satisfaction and therefore long-term adherence and efcac

Association between short-term exposure to environmental air pollution and atopic dermatitis flare in patients treated with dupilumab

Background: The magnitude of short/medium-term air pollution exposure on atopic dermatitis (AD) flare has not been fully investigated. The aim of the study was to investigate the association of short/mediumterm exposure to airborne pollution on AD flares in patients treated with dupilumab. Methods: Observational case-crossover study. Patients with moderate-to-severe AD under treatment with dupilumab were included. The exposure of interest was the mean concentrations of coarse and fine particulate matter (PM10, PM2.5), nitrogen dioxide, and oxides (NO2, NOx). Different intervals were considered at 1 to 60 days before the AD flare and control visit, defined as the visit with the highest Eczema Area and Severity Index scores [8 and #7, respectively. A conditional logistic regression analysis adjusted for systemic treatments was employed to estimate the incremental odds (%) of flare every 10 g/m3 pollutant concentration. Results: Data on 169 of 528 patients with AD having 1130 follow-up visits and 5840 air pollutant concentration measurements were retrieved. The mean age was 41.4 6 20.3 years; 94 (55%) men. The incremental odds curve indicated a significant positive trend of AD flare for all pollutants in all time windows. At 60 days, every 10 g/m3 PM10, PM2.5, NOx, and NO2 increase concentration was associated with 82%, 67%, 28%, and 113% odds of flare, respectively. Conclusions: In patients treated with dupilumab, acute air pollution exposure is associated with an increased risk for AD flare with a dose-response relationship

Systematic study on nail plate assessment: differences in nail plate shape, thickness, power Doppler signal and scanning approach

Ultrasonography (US) of the nail is raising interest in the last years and its feasibility, quickness and amount of descriptive data may provide valuable information. Different authors presented several scanning approaches to nail complex in different pathological conditions, such as psoriasis, but no scanning protocol was ever proposed using healthy subjects as population of reference. The aim of the study was to establish a protocol for the US of nail plate and to assess whether the measurement of the nail plate is influenced by longitudinal vs transverse scan, sex, digit and hand dominance. Using high frequency probe and a Canon Aplio i800 machine, ultrasonographers took scans of nail plates of the hands from healthy subjects. Nail plate shape, thickness and power Doppler signal (PDUS) were evaluated and scans were taken both on longitudinal and transverse axis, at distal, middle and proximal portion of the nail plate or at a fixed angles of - 45 degrees, 0 degrees or + 45 degrees. All the images were then revised and scored using a DICOM software, in order to allow good standards of accuracy and reproducibility. A total of 27 subjects (14 females and 13 males) were assessed. The measures did not result to differ in different portions or angles. Furthermore, no difference appears in sex or dominant vs not dominant hand. A decreasing and significant trend for nail plate thickness was found from the first to the fifth finger. Doppler signal was found in all but one subjects, with a range from almost absent to very evident. No difference was found between groups regarding PDUS. The data provided suggest that a proper scan protocol should include all the nails and evaluation should be done both on longitudinal and transverse axis. Since Doppler signal is highly variable in healthy subjects, its presence should be carefully considered as pathological finding. Observations provided by this study clarify important points of the scanning technique and solve doubts related to which nails should be scanned and where to evaluate quantitative parameters

Skin contamination as pathway for nicotine intoxication in vapers

Growing warnings on health effects related to electronic cigarettes have met inconclusive findings at present. This study analyzed the in vitro percutaneous absorption of nicotine resulting by skin contamination with two e-liquids (refill 1 and 2) containing nicotine at 1.8%. Donor chambers of 6 Franz cells for each refill liquid were filled with 1 mL of nicotine e-liquid for 24 h; at selected intervals, 1.5 mL of the receptor solutions were collected for nicotine concentration analysis by mean gas chromatography\u2013mass spectrometry (LOD: 0.01 \u3bcg/mL). The experiment was repeated removing the nicotine donor solution after 10 min from the application and rinsing the skin surface three times with 3.0 mL of milliQ water. A total of 12 cells with 24 h exposure and 12 cells washed were studied. The mean concentration of nicotine in the receiving phase at the end of the experiment was 54.9 \ub1 29.5 and 30.2 \ub1 18.4 \u3bcg/cm2 for refill 1 and 2 respectively and significantly lower in washed cells (4.7 \ub1 2.4 and 3.5 \ub1 1.3 \u3bcg/cm2). The skin absorption of nicotine can lead to minor health illness in vapers, while caution must be paid to dermal contamination by e liquids in children. The skin cleaning significantly reduced the transdermal absorption kinetic and intradermal deposition of nicotine

In vitro percutaneous penetration and characterization of silver from silver-containing textiles

The objective of this study was to determine the in vitro percutaneous penetration of silver and characterize the silver species released from textiles in different layers of full thickness human skin. For this purpose, two different wound dressings and a garment soaked in artificial sweat were placed in the donor compartments of Franz cells for 24 hours. The concentration of silver in the donor phase and in the skin was determined by an electrothermal atomic absorption spectrometer (ET-AAS) and by inductively coupled plasma mass spectrometer (ICP-MS). The characterization of silver species in the textiles and in the skin layers was made by scanning electron microscopy with integrated energy dispersive X-ray spectroscopy (SEM-EDX). Additionally, the size distribution of silver nanoparticles in the textiles was performed by atomic force microscopy (AFM). On the surface of all investigated materials, silver nanoparticles of different size and morphology were found. Released silver concentrations in the soaking solutions (ie, exposure concentration) ranged from 0.7 to 4.7 μg/mL (0.6–4.0 μg/cm2), fitting the bactericidal range. Silver and silver chloride aggregates at sizes of up to 1 μm were identified both in the epidermis and dermis. The large size of these particles suggests that the aggregation occurred in the skin. The formation of these aggregates likely slowed down the systemic absorption of silver. Conversely, these aggregates may form a reservoir enabling prolonged release of silver ions, which might lead to local effects

radiofrequency echographic multi spectrometry for the prediction of incident fragility fractures a 5 year follow up study

Abstract Purpose To investigate the effectiveness of the T-score values provided by Radiofrequency Echographic Multi Spectrometry (REMS) in the identification of patients at risk for incident osteoporotic fractures. Methods A population of Caucasian women (30–90 years), enrolled from 2013 to 2016, underwent dual X-ray absorptiometry (DXA) and REMS scans at axial sites. The incidence of fragility fractures was assessed during a follow-up period up to 5 years. Afterwards, patients with and without incident fractures were stratified in two age-matched groups with a 1: 2 proportion (Group F' and Group NF', respectively). The performance of REMS T-score in discriminating between the two groups was quantitatively assessed and compared with DXA. Results 1516 patients were enrolled and 1370 completed the follow-up (mean ± SD: 3.7 ± 0.8 years; range: 1.9–5.0 years). Fracture incidence was 14.0%. Age-matched groups included 175 fractured patients and 350 non-fractured ones, respectively (median age 70.2 [interquartile range: 61.0–73.3] and 67.3 [65.4–69.8] years, p-value ns). The groups resulted also balanced for height, weight and BMI (p-values ns). As expected, the differences in REMS T-score (for vertebral site, −2.9 [−3.6 to −1.9] in Group F', −2.2 [−2.9 to −1.2] in Group NF') and DXA T-score (−2.8 [−3.3 to −1.9] in Group F', −2.2 [−2.9 to −1.4] in Group NF') were statistically significant (p-value Conclusions REMS T-score resulted an effective predictor for the risk of incident fragility fractures in a population-based sample of female subjects, representing a promising parameter to enhance osteoporosis diagnosis in the clinical routine

Urografia-TC multidetettore: ruolo diagnostico nella valutazione del paziente con ematuria non traumatica

L’ematuria può originare da qualsiasi tratto dell’apparato urinario e può essere anche unico segno di patologia neoplastica (cancro del rene o della vescica). La letteratura raccomanda pertanto di sottoporre ad attenta valutazione clinico-strumentale tutti i casi di ematuria, macroscopica e microscopica. Lo scopo del presente contributo è quello di definire il ruolo diagnostico dell’urografia-TC multidetettore (uTC-MD) nella valutazione di questo sintomo e analizzarne l’impatto nel management del paziente attraverso lo studio di 181 pazienti consecutivi valutati per macro- e microematuria nel periodo compreso tra gennaio 2003 e marzo 2006