To assess performance of interstitial pneumonia (IP) with autoimmune features (IPAF) criteria in clinical practice and describe the utility of additional workup in identifying patients with ...underlying connective tissue diseases (CTD).
We set a retrospective study of our patients with autoimmune IP, who were allocated to CTD-IP, IPAF or undifferentiated autoimmune IP (uAIP) subgroups according to the updated classification criteria. Presence of the process-related variables comprising IPAF defining domains was scrutinized in all patients, and, when available, the results of nailfold videocapillaroscopy (NVC) were recorded.
Thirty nine out of 118 patients, accounting for 71% of former undifferentiated cases, fulfilled IPAF criteria. Arthritis and Raynaud's phenomenon were prevalent in this subgroup. While systemic sclerosis-specific autoantibodies were restricted to CTD-IP patients, anti-tRNA synthetase antibodies were also present in IPAF. In contrast, rheumatoid factor, anti-Ro antibodies and ANA nucleolar patterns could be found in all subgroups. Usual interstitial pneumonia (UIP) / possible UIP were the most frequently observed radiographic patterns Therefore, the presence of thoracic multicompartimental findings as also performance of open lung biopsies were useful in characterizing as IPAF those UIP cases lacking a clinical domain. Interestingly, we could observe NVC abnormalities in 54% of IPAF and 36% of uAIP tested patients, even though many of them did not report Raynaud's phenomenon.
Besides application of IPAF criteria, distribution of IPAF defining variables along with NVC exams help identify more homogeneous phenotypic subgroups of autoimmune IP of potential relevance beyond clinical diagnosis.
Anti-dsDNA, anti-Sm, and anti-ribosomal-P autoantibodies are hallmarks of systemic lupus erythematosus (SLE), being anti-dsDNA and anti-Sm included in 2019-ACR/EULAR SLE-Classification Criteria. ...Enzyme-linked (ELISA) and chemiluminescence assays (CIA) are widely established in immunology laboratories, but new technologies, such as particle-based multi-analyte technology (PMAT), are nowadays available. The present study aimed to compare the presence of anti-dsDNA and anti-Sm autoantibodies measured by CIA and PMAT and analyze diagnostic and clinical SLE activity performance. Anti-ribosomal-P autoantibodies by PMAT were also included. Consequently, anti-dsDNA and anti-Sm detected by CIA showed substantial agreement with PMAT (Cohen's kappa = 0.662 and 0.671, respectively). Anti-dsDNA autoantibodies measured by PMAT showed a positive correlation with clinical SLEDAI-2K (p < 0.001) and a negative correlation with complement consumption (p < 0.001). Anti-Sm and anti-ribosomal-P autoantibodies showed a positive correlation with SLEDAI-2K (p < 0.001 and p = 0.001, respectively) and a negative correlation with complement consumption (p < 0.001 and p = 0.001, respectively). Finally, anti-Sm autoantibodies were associated with renal involvement (p < 0.05).
Coastal lagoons are among the marine habitats with the highest biological productivity, and supports a great variety of human activities and pressures that makes them especially vulnerable to trophic ...imbalances. While dystrophic crises are common in many lagoons, others like the Mar Menor show homeostatic mechanisms, high resilience and clear waters. This paper analyses the water column descriptors dynamic during the last 22 years in this lagoon, in the context of a eutrophication process produced by an increase in nutrient inputs, mainly derived from agriculture. Despite the increase in nitrate loads, the lagoon maintained two decades of homeostatic regulation, keeping the water transparency and relatively low levels of nutrients and chlorophyll a (Prebreak phase), followed by a sudden change of state in 2016 with an abrupt increase in nutrients and chlorophyll a concentration and loss of water transparency (Break phase), and a relatively rapid recovery after the reduction of nutrient discharges (Recovery phase). The activation of the regulation mechanisms is manifested by an ammonium production, as a consequence of the trophic web activity. The low relationship between chlorophyll and nutrients, mainly at small spatio-temporal scales, disagrees with the eutrophication traditional models, suggesting a rapid response of primary producers to nutrient inputs and a zooplankton control in the short-term, which in turn is controlled by the rest of the trophic web components. Homeostatic properties that provide resistance to the Mar Menor lagoon to deal with eutrophication are based on several mechanisms: channelling its production towards the benthic system (maintaining high biomasses of primary producers, filter feeders and detritivores), a top-down control of the pelagic trophic web exerted by ichthyoplankton and jellyfish, and exporting surplus production outside the system. Resilience of the system would be based on the high turnover in the species composition related to the restricted connectivity with the sea, the spatio-temporal variability of the environmental conditions, and the multiplicity of spatial-temporal scales involved in lagoon processes. TRIX index was sensitive to the water quality changes. However, in our study, its current score does not allow to anticipate or alert the eutrophication risk and the trophic breakpoint of the system.
This study aims to investigate ultrasound (US) findings on salivary glands (SG) in patients with Sjögren syndrome (SS) vs. other connective tissue diseases (CTDs) and to assess the relationship of ...SGUS abnormalities with autoantibody profile in both groups. We enrolled 81 patients, 45 diagnosed with SS (39 with primary SS, 6 with secondary SS) and 36 diagnosed with other CTDs. All patients underwent a prospective evaluation of sicca symptoms, a Schirmer’s test, and a B-mode US assessment of the parotid and submandibular glands, all blinded to the diagnosis. Each SG was semi-quantitatively scored 0–3; a grade ≥ 2 was considered pathological. SGUS involvement was classified as normal or pathological at the patient level and for each pair at the gland level. In addition, a total SGUS score of 0–12 and a parotid/submandibular score of 0–6 were calculated for each patient. Autoimmunity laboratory data were also obtained. All SGUS scores were higher in SS patients than in those with CTD (
p
< 0.001) and significantly more SS patients showed a pathological global (
p
< 0.001), parotid (
p
< 0.001), or submandibular (
p
= 0.001) US score compared with CTD patients. In SS patients, the presence of autoantibodies was significantly associated with pathological SGUS and higher scores, particularly at the parotid level, while in CTD patients, xerostomia and a pathological Schirmer’s test were associated with pathological US and higher scores at the submandibular level (
p
< 0.05). SGUS showed a different grade of abnormality, site involvement, and associated autoantibody profile in SS patients as compared with other CTD.
Key Points
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Patients with SS and other CTDs showed different grades of SGUS abnormality
.
•
Patients with SS and other CTDs showed different gland involvement and associated autoantibody profiles
.
•
Anti-Ro60 and anti-Ro52 Ro60 positivity were associated with the severity of parotid involvement in SS patients.
The study of the Cordillera de Domeyko and the Salar de Atacama Basin in northern Chile has been critical to understand the generation of the Andean Cordillera and the migration of the deformation ...front eastwards. However, the relation between the uplift of the range, its temporal pattern, and the formation of the Preandean Depression have not been fully understood. In this article, we forward modeled two gravimetry surveys, consisting in 185 stations crossing the boundary between the Salar de Atacama Basin and Cordillera de Domeyko, with the goal of understanding the physical traits of each domain and the variations in basin geometry. We interpreted two seismic reflection profiles, along with log data from one well in the basin center, and additionally, we analyzed an inversion of the magnetic anomaly for both lines. The results of the analysis show the segmentation of physical properties into two domains. The first is interpreted as basement (Triassic-older) units, while the other shows the presence of gravity lows correlated with late Mesozoic-Cenozoic units cropping out along the western edge of the basin. The magnetic anomalies identified were correlated with variations within the basement and outcrops of crystalline intrusives. Within the sedimentary units, the Late Cretaceous-Paleogene Purilactis Group and Paleogene-Eocene formations were distinguished from the evaporite-rich Oligocene-Miocene Paciencia Group. The latter was deposited after a compressive event (Incaic Event) which thrusted basement units eastwards, inverted Mesozoic extensional faults, and generated the accommodation space required for its deposition. The basin then experienced renewed compression during the Miocene. This interplay between basement uplift and thrusting, along with fault inversion and basin generation, is a characteristic found in other parts of the Salar de Atacama Basin and the orogen, suggesting that this tectonic style might be prevalent in other basins comprising the Preandean Depression and along the Central Andes.
•Gravimetry surveys are performed across the Cordillera de Domeyko-Salar de Atacama.•A segmentation of physical properties is seen in the geophysical-geological record.•The Incaic Event led to the deformation of Cordillera de Domeyko-Salar de Atacama.•The interplay of basement-foreland basins has been recorded in neighboring areas.•This interplay might be a key feature along the Central Andes.
One of the popular creativity methods to solve technical problems is the Theory of Inventive Problem Solving, (TRIZ), however, requires a considerable investment of time. A teaching methodology for a ...simplified version of TRIZ (TRIZ10) has been developed for reducing learning time and improving the creative process in solving technical problems. This method has been applied in a small group of engineering design students as a proof of concept. The evaluation of the results obtained shows that students achieved adequate learning of this creative technique (75% overall efficiency). This method has led to the doubling of the number ideas developed by students compared to those generated before learning TRIZ10; further, it also improves a 10% the average degree of novelty for these ideas.
Lepidopterism caused by caterpillar contact is considered a public health problem around the world. The local and systemic responses of this pathology include short- and long-term inflammatory ...events. Although the proteolytic activity of the venoms from caterpillars is strongly associated with an inflammatory response in humans and murine models, fast and acute symptoms such as a burning sensation, itching, and pain should be related to the presence of low-weight hydrophilic molecules which easily influence cell metabolism. This investigation reports on the 1H-Nuclear Magnetic Resonance (NMR) profiling of the venom from the larva of Hylesia continua, a caterpillar linked to frequent cases of lepidopterism in the northern highlands of Puebla, Mexico. According to one-dimensional (1D) and two-dimensional (2D) NMR data, the venom of H. continua contained 19 compounds with proven pain-inducing activity (i.e., acetic acid, lactic acid, formic acid, succinic acid, 2-hydroxyglutaric acid, ethanol, and glutamate), inflammatory activity (i.e., cadaverine, putrescine, and acetoin), as well as natural immunosuppressive activity (i.e., O-phosphocholine and urocanic acid). The levels of the 19 compounds were calculated using quantitative-NMR (qNMR) and extensively discussed on the basis of their toxic properties which partially explain typical symptoms of lepidopterism caused by the larvae of H. continua. To the best of our knowledge, this is the first investigation reporting a complex mixture of small molecules with inflammatory properties dissolved in the venom of a lepidopteran larva.
To determine the prevalence and the impact on prognosis of metabolic alkalosis (MA) in patients admitted for acute heart failure (AHF).
The ALCALOTIC is a multicenter, observational cohort study that ...prospectively included patients admitted for AHF. Patients were classified into four groups according to their acid-base status on admission: acidosis, MA, respiratory alkalosis, and normal pH (reference group for comparison). Primary endpoint was all-cause in-hospital mortality, and secondary endpoints included 30/90-day all-cause mortality, all-cause readmission, and readmission for HF. Associations between endpoints and acid-base alterations were estimated in a multivariate Cox regression model including sex, age, comorbidities, and Barthel index and expressed as hazard ratio (HR) with 95% confidence interval (95% CI). Six hundred sixty-five patients were included (84 years and 57% women), and 40% had acid-base alterations on admission: 188 (28%) acidosis and 78 (12%) alkalosis. The prevalence (95% CI) of MA was 9% (6.8-11.2%). Patients with MA were more women; had fewer comorbidities, better renal function, and higher left ventricle ejection fraction values; and received more treatment with oral acetazolamide during hospitalization and at discharge. MA was not associated with a higher risk of in-hospital mortality and 30/90-day all-cause mortality or readmissions but was associated with a significant increase in readmissions for HF at 30 and 90 days (adjusted HR 95% CI 3.294 1.397-7.767, p = 0.006 and 2.314 1.075-4.978, p = 0.032).
The prevalence of MA in patients admitted for AHF was 9%, and its presence was associated with more readmissions for HF but not with all-cause mortality.
Outcomes of Isolated Tricuspid Valve Surgery Sánchez-Espín, Gemma; Rodríguez-Capitán, Jorge; Otero Forero, Juan José ...
The Heart surgery forum,
10/2020, Letnik:
23, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of ...this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.
Purpose The objective was to obtain a standardized evaluation of available prostate cancer-specific quality of life instruments used in patients with early-stage disease. Methods We carried out ...systematic literature reviews in the PubMed database to identify manuscripts which contained information regarding either the development process or metric properties of prostate cancer-specific quality of life instruments. Each instrument was evaluated by two experts, independently, using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall and seven attribute-specific EMPRO scores were calculated (range 0–100, worst to best): measurement model, reliability, validity, responsiveness, interpretability, burden and alternative forms. Results Eight instruments and 57 manuscripts (2–15 per instrument) were identified. The Expanded Prostate Cancer Index Composite (EPIC) was the best rated (overall EMPRO score 83.1 points). Good results were also obtained by University of California Los Angeles-Prostate Cancer Index (UCLA-PCI), Patient-Oriented Prostate Utility Scale (PORPUS) and Prostate Cancer Quality of Life Instrument (PC-QoL) with 77.3, 70.5 and 64.8 points, respectively. These four instruments passed with distinction the validity and responsiveness evaluation. Insufficient reliability results were observed for UCLA-PCI and PORPUS. Conclusions Current evidence supports the choice of EPIC, PORPUS or PC-QoL. Attribute-specific EMPRO results facilitate selecting the adequate instrument for every purpose. For longitudinal studies or clinical trials, where responsiveness is the priority, EPIC or PC-QoL should be considered. We recommend the PORPUS for economic evaluations because it allows cost-utility analysis, and EPIC short versions to minimize administration burden.
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