Background:We have previously described the association of the ultrasound (US) pattern called proliferative synovitis (Synovial hypertrophy≥2+Power Doppler) with erosive disease, Anti-citrullinated ...antibodies (ACPA) and long-term need of therapy modifications in patients with Rheumatoid Arthritis (RA).1Objectives:The aim of this study is to validate the association of US proliferative synovitis with both erosive disease and use of therapy in patients with chronic arthritis beyond RA.Methods:Cross-sectional, multicenter study. Clinical, epidemiological, and ultrasound variables were collected from patients with chronic arthritis and active hand inflammation in the physical assessment. Microcrystalline arthritis and recent onset arthritis (<6 months) were excluded. Synovial hypertrophy and Power Doppler signal were evaluated in carpal, metacarpophalangeal, carpal extensor tendons, and hand flexor tendons. US proliferative synovitis was defined as Synovial hypertrophy≥2+Power Doppler (Figure 1).Results:Two hundred and twenty-three patients from 8 centers were included: 65.9% were women (mean age of 58.1 years, SD±14.5 and mean disease duration of 113 months, SD±134.9). One-hundred and seven patients (47.9%) had RA (31.4% Rheumatoid Factor and/or ACPA positive) and 88 patients (39.5%) had psoriatic arthritis (PsA). The other 28 patients had elderly-onset arthritis (9 patients, 4%), peripheral SpA (5 patients, 2.2%), mixed connective tissue disease (4 patients, 1.8%), lupus (1 patient, 0.4%) and undifferentiated arthritis (9 patients, 4%). Overall, 104 patients (46.6%) had erosive disease, and 83 (37.2%) were on targeted therapies. Ninety-six patients (43%) were receiving oral glucocorticoids(≤5mg of prednisone). At the time of the US assessment, all patients had active disease (mean SDAI 27.9, SD±25.1, and mean DAPSA 22.1, SD±11.6). Disease activity (p=0.05) and US score (p=0.037) were significantly higher, and the disease duration longer (p=0.013) in RA patients. The use of conventional DMARDs (p=0.039) and glucocorticoids (p=0.0001) was also more prevalent in RA patients, but no significant differences were found in targeted therapies. The percentage of patients with erosive disease showed a numerical increase in RA compared to non-RA patients (52.6% versus 38.8%, p=0.055). One hundred and fourteen patients (51.1%) met criteria for US proliferative synovitis, 102 patients (45.7%) had tendon involvement and 27 patients (12.1%) had only tendon inflammation without synovial joint component. US proliferative synovitis was significantly more frequent in RA versus other diagnosis (60% versus 39.1%, p<0.003) and in seropositive (73.6%) versus seronegative RA (52.9%, p<0.001). Exclusive tendon inflammation (16.1%, p=0.033) and extensor paratendonitis (29.1%, p=0.035) were both more frequent in PsA (Table 1). Among patients with US proliferative synovitis, 76% exhibited erosive disease, whereas only 22.2% without US proliferative synovitis showed erosive disease (p=0.0001). In the multivariable analysis, after adjusting for age, sex, diagnosis, autoantibodies (RF and ACPA), disease activity, and treatment, the presence of erosive disease OR 8.5 (4.2-17.2), p=0.0001 and use of glucocorticoids OR 1.9 (1.0-3.9), p=0.046 were independently associated with the presence of US proliferative synovitis.Conclusion:In a cohort of patients with active hand arthritis, the presence of US proliferative synovitis was associated with erosive disease and chronic oral glucocorticoids intake. These results are consistent with previous findings1.REFERENCES:1 Ramírez J, Azuaga-Piñango AB, Frade-Sosa B, et al. Proliferative synovitis, an ultrasound pattern associated with ACPA-positive patients and erosive disease in rheumatoid arthritis. Clin Exp Rheumatol. 2022 May;40(5):960-966.Figure 1.Ultrasound image of proliferative synovitisFigure omitted. See PDFAcknowledgements:To patients for their kind participation.Disclosure of Interests:None declared.
In this study, a thermal analysis of a finned receiver prototype for a thermosolar tower system is presented. The experimental system consists of parallelepiped aluminum enclosure of 1.2 m high, ...1.23 m wide and 0.1 m depth. At the interior, 1232 cylindrical fins with a diameter of 0.0095 m (3/8″) and 0.09 m length increases the heat transfer area up to 225%. The vertical wall receives the incoming solar concentrated radiation from a group of heliostats whilst at the interior a constant flow of water removes the absorbed energy. Experimental temperature profiles were obtained at different heights and depths and a comparison was made with numerical results obtained with the use of commercial CFD software. It was found that the maximum thermal efficiency of the receiver was 94.4%, decreasing as the radiative flux increases.
•An experimental study was made inside a finned receiver for a solar tower system.•A comparison was made between experimental data and numerical results.•A detailed thermal analysis was conducted in the thermal receiver.
Tuberculosis as cause of death Vivancos Velasco, R; de Ancos Aracil, C; Estrada Pérez, V ...
Revista clínica espanõla
198, Številka:
9
Journal Article
Recenzirano
Despite the availability of an effective treatment for most cases, tuberculosis (TB) is still a cause of death in our environment. The necropsic sections of patients died because of TB during the ...1987-1996 period at Hospital Clínico de San Carlos, Madrid, were reviewed. The investigated data from each patient included age, gender, chronology of suggestive symptoms of TB, degree of histological involvement, radiological pattern in chest X-ray, delay in initiating therapy, concomitant diseases and other alternative diagnosed considered. The delay in diagnosis was the main cause for TB mortality. Advanced age, delay in seeking medical care and the presence of atypical clinical and radiological patterns contributed to the fatal end. Other factors included alcoholism and immunodeficiency.
In this study we demonstrate the usefulness of laparoscopy on the diagnosis of some unusual causes of ascites, such as primary mesothelioma, usually overlooked by other diagnostic modalities, like ...ultrasound, computed tomography and cytology of the ascitic fluid. We describe three cases of primary peritoneal mesothelioma among 27 patients with exudative ascites submitted to laparoscopy at our institution during the past two years. The final diagnosis inaccessible to the conventional diagnostic modalities, was reached only by laparoscopy.
Traumatic brain injury (TBI) represents a significant public health concern and has been associated with high rates of morbidity and mortality. TBI generates two types of brain damage: primary and ...secondary. Secondary damage originates a series of pathophysiological processes, which include metabolic crisis, excitotoxicity, and neuroinflammation, which have deleterious consequences for neuronal function. However, neuroprotective mechanisms are also activated. The balance among these tissue responses, and its variations throughout the day determines the fate of the damage tissue. We have demonstrated less behavioral and morphological damage when a rat model of TBI was induced during the light hours of the day.
Moreover, here we show that rats subjected to TBI in the dark lost less body weight than those subjected to TBI in the light, despite no change in food intake. Besides, the rats subjected to TBI in the dark had better performance in the beam walking test and presented less histological damage in the corpus callosum and the cingulum bundle, as shown by the Klüver-Barrera staining.
Our results suggest that the time of day when the injury occurs is important. Thus, this data should be used to evaluate the pathophysiological processes of TBI events and develop better therapies.
More than 48 million unpaid family/friend caregivers in the United States provide care to older adults. This unpaid workforce provides essential support for family members or friends who have a ...serious, long-term illness or disability. However, family caregivers are often under supported, which contributes to negative health, economic, and psychological consequences. Despite the significant contributions of family caregivers, there are limited policy supports aimed at alleviating the hardships of care on this growing community. National paid family and medical leave policy in particular holds substantial potential to alleviate the compounding burdens faced by family caregivers and address systemic inequities that contribute to disproportionately poorer caregiving outcomes among historically marginalized older adults and their caregivers. The purpose of the current article is to provide an overview of the economic burdens and caregiving-related health disparities experienced by Black/African American and Hispanic/Latinx family caregivers and discuss the impact of paid leave policies on the overall health and well-being of older adults. We propose a "Call to Action" for gerontological nurses to work in partnership with transdisciplinary colleagues, stakeholders, and advocates to ensure all family care-givers have access to paid leave.
(3), 5-10..
A device laboratory was designed to create a commanded disturbance to the Furuta inverted pendulum. This pendulum was modified by adding a second inverted pendulum coupled to the main one by means of ...a semi-rigid spring. The induced motion on the second inverted pendulum causes displacement of the center of mass of the system, producing a kind of perturbation similar to that presented on mobile inverted pendulum transportation units. A linear matrix inequality (LMI) controller is designed from the unperturbed model (based on the main pendulum without the second inverted one) and implemented to our system. Then, experimentally, the behaviour of the whole closed-loop system and the controller performance was analysed. According to the laboratory test, the LMI controller is robust enough in front of perturbation induced on the second pendulum.
This study aimed to identify biomarkers of resistance to endocrine therapy in estrogen receptor-positive (ER
) breast cancers treated with prolonged neoadjuvant letrozole.
We performed targeted DNA ...and RNA sequencing in 68 ER
breast cancers from patients treated with preoperative letrozole (median, 7 months).
Twenty-four tumors (35%) exhibited a PEPI score ≥4 and/or recurred after a median of 58 months and were considered endocrine resistant. Integration of the 47 most upregulated genes (log FC > 1, FDR < 0.03) in letrozole-resistant tumors with transcription-binding data showed significant overlap with 20 E2F4-regulated genes (
= 2.56E-15). In patients treated with the CDK4/6 inhibitor palbociclib before surgery, treatment significantly decreased expression of 24 of the 47 most upregulated genes in letrozole-resistant tumors, including 18 of the 20 E2F4 target genes. In long-term estrogen-deprived ER
breast cancer cells, palbociclib also downregulated all 20 E2F4 target genes and P-RB levels, whereas the ER downregulator fulvestrant or paclitaxel only partially suppressed expression of this set of genes and had no effect on P-RB. Finally, an E2F4 activation signature was strongly associated with resistance to aromatase inhibitors in the ACOSOG Z1031B neoadjuvant trial and with an increased risk of relapse in adjuvant-treated ER
tumors in METABRIC.
In tumors resistant to prolonged neoadjuvant letrozole, we identified a gene expression signature of E2F4 target activation. CDK4/6 inhibition suppressed E2F4 target gene expression in estrogen-deprived ER
breast cancer cells and in patients' ER
tumors, suggesting a potential benefit of adjuvant CDK4/6 inhibitors in patients with ER
breast cancer who fail to respond to preoperative estrogen deprivation.
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