bluuebunny/crossref_metadata_2025 huggingface dataset:
As casas projetadas por J.B. Vilanova Artigas na cidade de São Paulo e a liberdade de sua pesquisa pelos caminhos para a arquitetura
Authors: Petrosino Mauricio Miguel
Published: October 2016

Este artigo comenta a liberdade projetual do Arquiteto João Batista Vilanova Artigas aplicada aos seus projetos de casas construídas na cidade de São Paulo. Apresenta situações da pesquisa pragmática de Artigas na execução dos projetos e obras de “residências unifamiliares” representantes dessa forma de projetar. Ela deve ser entendida como um campo de investigação na prática profissional do arquiteto para essa tipologia de projeto. Analisamos exemplos de obras que poderiam comprovar essa ação projetual, seguindo uma linha de atuação do exercício da arquitetura, numa ordem cronológica do repertório de Artigas e sua busca de possíveis caminhos para a arquitetura.
Ambiente, patrimônio e legislação
Authors: Correia Telma de Barros
Published: October 2016

Resenha da tese ""A noção de “ambiente” em Gustavo Giovannoni e as leis de tutela do patrimônio cultural na Itália“ defendida em 2013 no Instituto de Arquitetura e Urbanismo da USP pela Renata Campello Cabral.
Poder e ética na obra de Rem Koolhaas
Authors: Martins Patrícia Pereira
Published: October 2016

Desde o início de sua atividade como arquiteto, nos anos 1970, Koolhaas tem se colocado criticamente sobre a relação entre arquitetura e poder, entre arquitetura e o sistema econômico e cultural, assunto que se tornou questão central em seu trabalho. O objetivo desse artigo é compreender os desdobramentos de seu posicionamento teórico como fundamentação de seu trabalho prático, a constituir um plano de ação efetivo para um arquiteto consciente de sua posição na sociedade globalizada e neoliberal. A análise segue a linha cronológica de lançamento de seus livros, destacando ideias principais para a construção do argumento.
Propostas para “uma nova maneira de viver”: Vilanova Artigas e a ação habitacional da CECAP (1967-1973)
Authors: Dias Michele Aparecida Siqueira
Published: October 2016

O presente artigo pretende revisitar as obras do arquiteto João Batista Vilanova Artigas (1915 – 1985) para a autarquia Caixa Estadual de Casas para o Povo (CECAP), buscando evidenciar as propostas elaboradas pelo arquiteto, bem como a escolha deste profissional para a realização destas obras. Buscaremos evidenciar como as ações políticas da CECAP refletiram na trajetória da construção dos projetos dos conjuntos habitacionais para as cidades de Guarulhos (1967), Americana (1972) e Jundiaí (1973).
Staging of Fatty Liver Diseases Based on Hierarchical Classification and Feature Fusion for Back-Scan–Converted Ultrasound Images
Authors: Owjimehr Mehri , Danyali Habibollah , Helfroush Mohammad Sadegh , Shakibafard Alireza
Published: October 2016

Fatty liver disease is progressive and may not cause any symptoms at early stages. This disease is potentially fatal and can cause liver cancer in severe stages. Therefore, diagnosing and staging fatty liver disease in early stages is necessary. In this paper, a novel method is presented to classify normal and fatty liver, as well as discriminate three stages of fatty liver in ultrasound images. This study is performed with 129 subjects including 28 normal, 47 steatosis, 42 fibrosis, and 12 cirrhosis images. The proposed approach uses back-scan conversion of ultrasound sector images and is based on a hierarchical classification. The proposed algorithm is performed in two parts. The first part selects the optimum regions of interest from the focal zone of the back-scan–converted ultrasound images. In the second part, discrimination between normal and fatty liver is performed and then steatosis, fibrosis, and cirrhosis are classified in a hierarchical basis. The wavelet packet transform and gray-level co-occurrence matrix are used to obtain a number of statistical features. A support vector machine classifier is used to discriminate between normal and fatty liver, and stage fatty cases. The results of the proposed scheme clearly illustrate the efficiency of this system with overall accuracy of 94.91% and also specificity of more than 90%.
Effective tumour necrosis factor-blocking therapy reduces reactive oxygen metabolite level in rheumatoid arthritis
Authors: Cacciapaglia Fabio , Grazia Anelli Maria , Rizzo Daniela , Morelli Emma , Mazzotta Daniela , Scioscia Crescenzio , Iannone Florenzo , Lapadula Giovanni
Published: October 2016

Objective

To assess circulating levels of derived reactive oxygen metabolites (ROMs) in patients with active rheumatoid arthritis (RA), before and during antitumour necrosis factor (TNF)-α therapy.

Methods

Patients with active RA and failed previous treatment with disease-modifying antirheumatic drugs received subcutaneous anti-TNF-α for 52 weeks. Circulating hydrogen peroxide was quantified as a marker of oxidative stress at baseline and at 24 and 52 weeks.

Results

The study included 40 patients. Circulating dROM levels were significantly reduced compared with baseline after 24 and 52 weeks’ of anti-TNF-α treatment (33.2 ± 10.0 mgH2O2/dl, 29.5 ± 7.0 mgH2O2/dl and 29.3 ± 9.0 mgH2O2/dl, respectively). There was a significant direct correlation between disease activity score and ROM levels.

Conclusion

TNF-α inhibition can control disease activity and reduce circulating levels of reactive oxygen species in patients with RA.
The effect of etanercept on vascular endothelial growth factor production by cutaneous mesenchymal stem cells from patients with psoriasis
Authors: Campanati Anna , Orciani Monia , Ganzetti Giulia , Consales Veronica , Di Primio Roberto , Offidani Annamaria
Published: October 2016

Objective

To evaluate prospectively the effect of etanercept (a tumour necrosis factor [TNF]-α inhibitor) on vascular endothelial growth factor (VEGF) production by mesenchymal stem cells (MSC) from patients with psoriasis.

Methods

MSCs from lesional and perilesional skin were isolated, cultured and characterized. VEGF production was evaluated at baseline and after 12 weeks’ etanercept treatment.

Results

Etanercept treatment resulted in significant reductions in VEGF production compared with baseline in both lesional MSCs (256.42 ± 3.07 pg/ml per 106 cells at baseline vs 27.66 ± 2.03 pg/ml per 106 cells after treatment) and perilesional MSCs (235.03 ± 2.52 pg/ml per 106 cells vs 41.65 ± 4.72 pg/ml per 106 cells).

Conclusions

Etanercept reduces the production of VEGF in MSCs, which may modulate angiogenesis and contributes towards preventing the start of the “psoriatic march”.
Synovial fluid from patients with rheumatoid arthritis modulates monocyte cell-surface phenotype
Authors: Chimenti Maria Sole , Conigliaro Paola , Triggianese Paola , Baffari Eleonora , Squillaci Ettore , Bolacchi Francesca , Perricone Roberto , Bergamini Alberto
Published: October 2016

Objectives

To investigate the ability of synovial fluid from patients with rheumatoid arthritis (RA) or osteoarthritis (OA) to modulate cell-surface phenotype, function and viability of monocytes.

Methods

Monocytes from healthy donors were incubated with synovial fluid from patients with RA or OA. These were then cultured with autologous healthy CD4+ T-cells. Immunoglobulin-like transcript 4 (ILT4) and CD86 were evaluated on stimulated monocytes and CD4+ T-cells via fluorescence activated cell sorting.

Results

Monocytes incubated with synovial fluid from patients with RA (SF-RA; n = 12) had significantly lower ILT4 and higher CD86 levels than those incubated with synovial fluid from patients with OA (SF-OA; n = 12) or medium alone. In patients with RA, there was a significant negative correlation between ILT4 and disease activity score (DAS; r = −0.699), and a positive correlation between CD86 and DAS ( r = 0.626). T-cells costimulated with monocytes cultured with SF-RA produced significantly more interferon-γ and tumour necrosis factor-α than those costimulated with monocytes cultured with SF-OA or controls.

Conclusions

Soluble mediators in SF-RA could contribute to modulating inflammation and local effectiveness of the immune response.
Long-term treatment with adalimumab in psoriatic arthritis: serum adalimumab concentration, immunogenicity and the link with clinical response
Authors: Chimenti Maria Sole , Triggianese Paola , Narcisi Alessandra , Marinari Barbara , Teoli Miriam , Faleri Sara , Arcese Annalisa , Perricone Roberto , Costanzo Antonio
Published: October 2016

Objectives

An observational study to evaluate the relationship between serum concentrations of adalimumab and disease activity in patients receiving long-term adalimumab treatment for psoriatic arthritis.

Methods

Serum adalimumab and adalimumab antidrug antibodies were quantified by enzyme linked immunosorbent assay. Disease activity was assessed using Disease Activity Score (44 joint measures). Serum C-reactive protein was quantified using standard methods.

Results

A total of 30 patients were recruited. There were significant inverse correlations between serum adalimumab concentration and serum C-reactive protein (CRP) concentration [ r = −0.43], the number of tender joints ( r = −0.4), and Disease Activity Score (DAS44)-CRP ( r = −0.36). Mean serum adalimumab levels were significantly higher in patients with DAS44-CRP <1.6 than in patients with DAS44-CRP ≥1.6.

Conclusions

Serum adalimumab could be an important tool that may improve the management of psoriatic arthritis in patients responding to long-term treatment.
Serological markers associated with disease activity in patients with rheumatoid arthritis treated with rituximab
Authors: Conigliaro Paola , Triggianese Paola , Chimenti Maria Sole , Lucchetti Ramona , Kroegler Barbara , Perricone Roberto
Published: October 2016

Objective

To evaluate prospectively serological markers at baseline and during treatment in patients with rheumatoid arthritis (RA) initiating rituximab treatment, following failure of antitumour necrosis factor (TNF)-α therapy.

Methods

Patients with RA and healthy control subjects were recruited. Plasma complement (C)3, C4, rheumatoid factor (RF), anticitrullinated protein antibody (ACPA), immunoglobulin (Ig)M, A and G, disease activity scores (DAS) and therapeutic response were recorded at baseline and at 6, 12 and 18 months.

Results

Patients ( n = 35) had significantly higher C3 and C4 levels than controls ( n = 30). At 12 months after initiation of rituximab, C3 and C4 levels were significantly lower in patients who responded to treatment, compared with nonresponders. There were direct correlations between C3 levels and DAS at 12 months in the study population as a whole, and between IgM levels and DAS in responding patients after 6, 12 and 18 months’ treatment.

Conclusions

C3 and IgM levels may represent potentially useful serological markers of disease activity during rituximab treatment in patients with RA.
Cardiovascular risk evaluation through heart rate variability analysis in psoriatic patients before and after 24 weeks of etanercept therapy: Prospective study
Authors: Potenza Concetta , Raimondi Gianfranco , Pampena Riccardo , Proietti Ilaria , Viola Giorgio La , Bernardini Nicoletta , Tolino Ersilia , Zuber Sara , Balduzzi Veronica , Scordamaglia Beatrice , Skroza Nevena
Published: October 2016

Objective

To assess the influence of etanercept, an anti-tumour necrosis factor (TNF)-α agent, on autonomic cardiovascular regulation in young patients with moderate-to-severe psoriasis without cardiovascular risk factors.

Methods

Patients with psoriasis underwent 5-min electrocardiogram (ECG) recordings before and after 24 weeks of etanercept therapy. Linear heart rate variability (HRV) analysis was performed.

Results

The study recruited 19 patients. Frequency-domain analysis showed a significant decrease in oscillatory components attributable to sympathetic activity (LF%) and a significant decrease in low frequency/high frequency (LF/HF) ratio following etanercept therapy.

Conclusion

Treatment with etanercept in patients with moderate-to-severe psoriasis could affect cardiovascular autonomic regulation, and subsequently reduce cardiovascular risk.
How the immune system responds to therapeutic biological agents
Authors: Vultaggio Alessandra , Petroni Giulia , Pratesi Sara , Nencini Francesca , Cammelli Daniele , Ferraro Andrea , Maggi Enrico , Matucci Andrea
Published: October 2016

Biological agents target disease mechanisms and have modified the natural history of several immune-mediated disorders. Biological agents are structurally immunogenic, and therefore usually elicit a minor, subclinical and transient phenomenon. Occasionally, however, these drugs induce complete cellular and humoral immune responses, with the main clinical consequences being hypersensitivity reactions or loss of treatment response. This article considers the relative pathogenic mechanisms influencing immunogenicity in biological agents and discusses mechanisms of tolerance and adaptive immune response, including adaptive T-regulatory cell induction and immune response induction. Methods of determining cellular and humoral immune response to biological agents are identified and examined. Assays to detect antidrug antibodies and their isotypes can assist in monitoring immunogenicity and in preventing adverse events. Such strategies also enable resource conservation and may provide regulatory authorities with new insights that can be useful during the process of approving new biological or biosimilar agents.
Treatment of psoriasis with etanercept in immunocompromised patients: Two case reports
Authors: De Simone Clara , Perino Francesca , Caldarola Giacomo , D’Agostino Magda , Peris Ketty
Published: October 2016

Tumour necrosis factor (TNF)-α blocking agents have revolutionized the treatment of psoriasis and psoriatic arthritis. Concerns remain about increased susceptibility to infection and onset of malignancies, and the use of TNF-α agents in patients with HIV infection or undergoing immunosuppressant treatment is debated. We report cases of severe plaque psoriasis in a patient with HIV infection and in a liver transplant recipient who were successfully treated with etanercept, an anti-TNF-α agent, without notable side-effects.
Long-term safety of etanercept in psoriasis: Retrospective study focused on infections
Authors: Orsini Diego , Narcisi Alessandra , Arcese Annalisa , Costanzo Antonio
Published: October 2016

Objective

Retrospective study to evaluate the incidence of infectious adverse events in patients with psoriasis treated with etanercept.

Methods

Patients with psoriasis or psoriatic arthritis who were treated with etanercept (50 mg, administered weekly via subcutaneous injection) for ≥48 weeks were retrospectively enrolled. Patients were screened for occult infections before treatment commenced, and then every 12 months thereafter. Minor (not requiring hospitalization and/or discontinuation of treatment) and major (requiring hospitalization and/or discontinuation of treatment) infectious events were recorded.

Results

The study included 50 patients. Minor infectious events included self-limiting upper respiratory tract infections (six patients), lower urinary tract infections (one patient) and recurrent herpes simplex labialis (two patients). Major infections occurred in only two cases.

Conclusion

These data support the good safety profile of etanercept in patients with psoriasis or psoriatic arthritis.
Suicide risk and psychiatric comorbidity in patients with psoriasis
Authors: Pompili Maurizio , Innamorati Marco , Trovarelli Sara , Narcisi Alessandra , Bellini Samantha , Orsini Diego , Forte Alberto , Erbuto Denise , Botti Elisabetta , Lamis Dorian A , Girardi Paolo , Costanzo Antonio
Published: October 2016

Objectives

To examine the occurrence of stressful life events, psychological comorbidity and suicide risk in patients with psoriasis or other dermatological conditions.

Methods

Consecutive adult outpatients with psoriasis or other dermatological conditions completed a sociodemographic questionnaire and the Hamilton scales for depression and anxiety.

Results

The study included 157 patients (91 with psoriasis; 66 with other conditions [melanoma; allergy]). Patients with psoriasis were significantly more likely to have experienced major life events in the 12 months before diagnosis, have had a psychiatric diagnosis and to have experienced past suicidal ideation than patients with other dermatological conditions.

Conclusions

Patients with psoriasis have an increased risk of psychiatric comorbidities, suicidal ideation, and long-term course of the disease compared with patients who have other dermatological conditions. Psychiatric assessment is highly recommended in patients with psoriasis.
Influence of body mass index and weight on etanercept efficacy in patients with psoriasis: A retrospective study
Authors: Giunta Alessandro , Babino Graziella , Ruzzetti Manuela , Manetta Sara , Chimenti Sergio , Esposito Maria
Published: October 2016

Aim

To investigate the role of body mass index (BMI) and weight in the long-term efficacy of etanercept in patients with psoriasis.

Methods

Medical records were retrospectively analysed. Extracted data included weight, BMI, comorbidities and psoriasis area severity index (PASI). Patients were stratified by weight (<80 kg or ≥80 kg) and BMI (healthy, BMI 22 – 24.99 kg/m2; overweight, BMI 25 – 29.99 kg/m2; obese, BMI ≥30 kg/m2).

Results

The study included 66 patients. Body weight had no effect on etanercept efficacy. There was a significant reduction in etanercept efficacy in obese patients ( n = 12) compared with healthy weight ( n = 33) or overweight ( n = 21) patients.

Conclusion

Obesity has a negative effect on the efficacy of etanercept in psoriasis.
Asymmetric dimethylarginine and arterial stiffness in patients with rheumatoid arthritis: A case–control study
Authors: Erre Gian Luca , Piras Alessandra , Mura Silvia , Mundula Nicola , Piras Marco , Taras Loredana , Longu Maria Giovanna , Saba Pier Sergio , Ganau Antonello , Carru Ciriaco , Passiu Giuseppe
Published: October 2016

Objective

To investigate whether levels of asymmetric dimethylarginine (ADMA), as a measure of endothelial dysfunction, are higher in patients with rheumatoid arthritis compared with healthy control subjects. The relationships between ADMA and surrogate measures of arterial stiffness were evaluated.

Methods

Patients with rheumatoid arthritis and healthy control subjects were recruited. ADMA was quantified via enzyme-linked immunosorbent assay. Arterial stiffness was evaluated using pulse wave analysis.

Results

There was no significant difference in plasma ADMA concentration between patients with rheumatoid arthritis ( n = 30) and healthy controls ( n = 30). Aortic augmentation pressure was significantly higher in patients than in controls. C-reactive protein and Health Assessment Questionnaire score were independent predictors of arterial stiffness in patients. There was no relationship between ADMA concentration and aortic augmentation pressure in the study population as a whole.

Conclusions

Arterial stiffness appears to be increased in rheumatoid arthritis and independently associated with systemic inflammation and physical disability. ADMA concentration was not increased in this small group of patients with rheumatoid arthritis compared with healthy controls; nor was it associated with arterial stiffness.
Beneficial effects of long-term treatment with bosentan on the development of pulmonary arterial hypertension in patients with systemic sclerosis
Authors: Murdaca Giuseppe , Lantieri Francesca , Puppo Francesco , Bezante Gian Paolo , Balbi Manrico
Published: October 2016

Objective

To investigate the effects of long-term treatment with bosentan on pulmonary arterial hypertension (PAH) in patients with systemic sclerosis.

Methods

Patients with systemic sclerosis were followed between 2003 and 2014; those who developed digital ulcers were treated with standard regimens of bosentan. Patients were assessed at baseline and every 12 months using transthoracic Doppler echocardiography, 6-min walking distance test, Borg dyspnoea index and monitoring of plasma levels of 76-amino-acid N-terminal probrain natriuretic peptide. Patients who developed PAH underwent right heart catheterization to confirm the diagnosis.

Results

Sixty-nine patients with systemic sclerosis were enrolled in the study. Of these, 25 developed digital ulcers and received treatment with bosentan; the remaining 44 comprised the control group. None of the patients treated with bosentan developed PAH during the follow-up period. Furthermore, in these patients the mean ± SD systolic pulmonary arterial pressure significantly decreased from 33.64 ± 2.91 mmHg at baseline to 26.20 ± 1.78 mmHg at the end of the follow-up period. In contrast, in the control group, seven patients developed PAH during the follow-up period, with the mean ± SD systolic pulmonary arterial pressure significantly increasing from 33.57 ± 2.75 mmHg at baseline to 39.41 ± 4.11 mmHg at the end of the follow-up period.

Conclusion

Long-term treatment with bosentan reduces the risk of developing PAH in patients with systemic sclerosis.
Post-translational modifications in rheumatoid arthritis and atherosclerosis: Focus on citrullination and carbamylation
Authors: Spinelli Francesca Romana , Pecani Arbi , Conti Fabrizio , Mancini Riccardo , Alessandri Cristiano , Valesini Guido
Published: October 2016

Coronary heart disease is the main cause of mortality in patients with rheumatoid arthritis (RA), a disease known to be associated with accelerated atherosclerosis. The role of inflammation and immunity in atherosclerotic process offers possible explanations for the increased cardiovascular risk in patients with RA. The immune response to citrullinated peptides has been extensively studied in RA; antibodies directed to citrullinated peptides are now a cornerstone for RA diagnosis. However, few studies have investigated the response to citrullinated peptides and the development of atherosclerotic plaque. Antibodies to carbamylated proteins can be detected before the clinical onset of RA, suggesting a potential predictive role for these antibodies; on the other hand, carbamylation of lipoproteins has been described in patients with cardiovascular disease. This review examines the role of citrullination and carbamylation, two post-translational protein modifications that appear to be involved in the pathogenesis of both RA and atherosclerosis, expanding the similarities between these two diseases. Further investigation on the role of the immune response to modified proteins may contribute to a better comprehension of cardiovascular disease in patients with RA.
Long-term efficacy of high doses of intravenous immunoglobulins in generalized scleromyxoedema: Case report
Authors: Arginelli Federica , Rongioletti Franco , Girolomoni Giampiero , Pellacani Giovanni , Guardoli Davide , Conti Andrea
Published: October 2016

Scleromyxoedema is a rare disease with a progressive and disabling course involving dermal deposition of mucin and fibroblast proliferation; it is characterized clinically by a diffuse papular eruption, skin thickening, oedema and decreased skin flexibility, especially of the face and hands. Current therapy options are based on evidence from a limited number of case reports. The clinical manifestations and treatment of a 64-year-old man affected by scleromyxoedema with severe skin involvement of the face, arms and hands, decreased mouth opening and hypomotility of the fingers are reported. Dysphagia, asthenia and immunoglobulin G lambda monoclonal gammopathy were also present. Previous treatment with topical and systemic corticosteroids, psoralen plus ultraviolet A radiation therapy, plasmapheresis, extracorporeal photochemotherapy, hydroxychloroquine and cyclophosphamide had been unsuccessful. Treatment with intravenous immunoglobulins at a dosage of 2 g/kg monthly was started. Considerable improvements were observed after seven cycles of therapy, with recovery of skin elasticity, an increase in facial mimic movement, restoration of joint function and improvement in the modified Rodnan score. There were no observed side-effects. The patient remains in remission on monthly maintenance intravenous immunoglobulins, 2 years after initial treatment.
Combination therapy with etanercept in psoriasis: Retrospective analysis of efficacy and safety outcomes from real-life practice
Authors: Babino Graziella , Giunta Alessandro , Ruzzetti Manuela , Sole Chimenti Maria , Chimenti Sergio , Esposito Maria
Published: October 2016

Objective

To investigate the efficacy and safety outcomes of combination therapy used to optimize etanercept treatment in patients with psoriasis treated in real-life clinical practice.

Methods

Data from patients presenting with psoriasis, treated initially with etanercept monotherapy, were analysed retrospectively. Patients subsequently treated with combination therapy were further analysed. The Psoriasis Area and Severity Index (PASI) score was recorded for all patients receiving comedication; a subjective pain score was recorded in those with psoriatic arthritis receiving comedication after 12, 24 and 48 weeks’ treatment and thereafter at 6-month intervals.

Results

From the database of 400 patients treated with etanercept, 37 patients (18 male; 19 female; mean age 59.43 years) underwent combination therapy due to lack of efficacy. Patients received mostly short-term (range 4–34 weeks) comedication with corticosteroids, cyclosporine, methotrexate, nonsteroidal anti-inflammatory drugs, acitretin or sulphasalazine. There were significant reductions in the mean PASI score from baseline at all timepoints. There were also significant reductions in the mean pain VAS score from baseline at all timepoints in patients with psoriatic arthritis. The drug survival rate was 59.6% over a mean duration of 323 weeks of etanercept treatment. The safety profile of combination therapy was satisfactory.

Conclusions

Short-term comedication in combination with etanercept may optimize treatment options and improve long-term drug survival in patients with psoriasis.
The role of methotrexate as combination therapy with etanercept in rheumatoid arthritis: Retrospective analysis of a local registry
Authors: Becciolini Andrea , Biggioggero Martina , Favalli Ennio Giulio
Published: October 2016

Objective

In a real-life setting, to analyse retrospectively the effects of different methotrexate regimens on etanercept efficacy during the first year of treatment for rheumatoid arthritis (RA).

Methods

Demographic characteristics, clinical parameters and treatment data from patients with RA receiving the first-line biological disease-modifying antirheumatic drug, etanercept, as monotherapy or in combination with methotrexate were analysed at baseline and after 6 and 12 months. The study population was stratified into three groups according to the level of concomitant methotrexate therapy: no methotrexate, low-dose methotrexate (≤ 10 mg/week) or high-dose methotrexate (>10 mg/week).

Results

Clinical response at 6 and 12 months and clinical outcome at 12 months were significantly better in patients concomitantly treated with high-dose methotrexate. Furthermore, this regimen was associated with the lowest discontinuation rate, suggesting a favourable safety profile.

Conclusion

These data confirm, in a real-life setting, the importance of methotrexate as a combination therapy with etanercept and suggest that the minimal effective dose of methotrexate is >10 mg/week.
Remission and low disease activity in a cohort of real-life patients with rheumatoid arthritis treated with first-line antitumour necrosis factor
Authors: Conigliaro Paola , Chimenti Maria Sole , Triggianese Paola , Ballanti Eleonora , Sunzini Flavia , Duca Iaria , Perricone Roberto
Published: October 2016

Objectives

This retrospective study used various indices to evaluate remission and low disease activity in ‘real life’ patients with rheumatoid arthritis (RA), given antitumour necrosis factor (anti-TNF) as a first-line treatment; changes in concomitant steroid and conventional synthetic disease-modifying antirheumatic drug (csDMARD) treatment were also assessed.

Methods

Remission and low disease activity were analysed in patients with RA treated with anti-TNF using the 28-joint Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI). Remission and low disease activity were recorded after 6 months, 1 year and 2 years, along with concomitant prednisone and csDMARD treatment.

Results

A total of 271 patients with RA were included in the study. After 6 months, remission rates were 18.0%, 20.3% and 23.0% as assessed by CDAI, SDAI and DAS28, respectively. After 1 year and 2 years, respectively, remission rates were 18.4% and 15.9% using CDAI, 21.8% and 17.3% using SDAI, and 22.1% and 17.3% using DAS28. Low disease activity was achieved in 30–40% of patients, depending on the indices used. There was a significant reduction in the number of patients on prednisone and csDMARDs during anti-TNF treatment.

Conclusion

Remission with first-line anti-TNF treatment is an achievable goal in clinical practice, allowing a reduction in concomitant csDMARD and prednisone treatment.
Speckled variance optical coherence tomography for the assessment of nail involvement in acrodermatitis continua of Hallopeau: A case study
Authors: Conti Andrea , Ciardo Silvana , Mandel Victor Desmond , Bigi Laura , Pellacani Giovanni
Published: October 2016

Noninvasive techniques for nail imaging would be useful for confirming diagnosis and monitoring treatment response at the microscopic level in patients with nail psoriasis. However, the use of ultrasound and high-resolution magnetic resonance imaging in nail evaluation is limited. Optical coherence tomography (OCT) produces high-resolution images of transversal tissue sections and represents an optimal approach to the study of the nail. This study used a multibeam OCT instrument to produce speckled variance OCT (SV-OCT) blood-flow images, which were used to measure the degree of change over successive scans. Nail changes, inflammation and response to therapy were evaluated in a 75-year-old female patient with psoriasis who had severe acrodermatitis continua of Hallopeau of the hands, treated for 4 weeks with 40 mg adalimumab (administered subcutaneously every other week) and 25 mg prednisone (administered orally, daily). SV-OCT provided a detailed assessment of the nail structures in relation to inflammation of psoriatic tissues. Restoration of the normal anatomy of the nail apparatus was apparent following adalimumab treatment; SV-OCT evaluation correlated with clinical appearance. SV-OCT may have a diagnostic role and provide an objective tool to assess clinical and subclinical inflammation in nail psoriasis.
From patients’ needs to treatment outcomes in psoriasis: Results from the ‘pSORRIDI’ experience
Authors: Esposito Maria , Faleri Sara , Babino Graziella , Messinese Serena , Mazzotta Annamaria , Schipani Caterina , Chimenti Maria Sole , Marchei Massimo , Rizza Stefano , Pandolfi Marta , Chimenti Sergio , Giunta Alessandro
Published: October 2016

Objective

To evaluate results of the ‘pSORRIDI’ experience (which is a prevention campaign to evaluate the prevalence of comorbidities, multidisciplinary needs and appropriateness of the therapeutic approach for comorbidities) in patients already being treated for psoriasis.

Methods

Telephone interviews were conducted in patients with psoriasis, who then underwent comprehensive evaluation and investigation of comorbidities. If necessary, patients were referred to specialist cardiology, endocrinology and/or rheumatology services.

Results

Overall, 72.0% (54/75) of patients required a multidisciplinary consultation. Among patients referred to cardiology, therapeutic adjustment was needed in 33.3% (five of 15) patients and a redefined diagnosis in 26.7% (four of 15) cases. Among patients undergoing endocrinology evaluations, therapeutic adjustment and a redefined diagnosis were needed in 61.1% (11/18) and 33.3% (six of 18) patients, respectively; for rheumatology evaluations, therapeutic adjustment and a redefined diagnosis were needed in 76.2% (16/21) and 19.0% (four of 21) of patients, respectively.

Conclusions

Among patients with psoriasis, there may be a need for an improvement in the diagnosis of underlying comorbid conditions, and in disease management of both psoriasis and any comorbid conditions.
Expression of immunoglobulin-like transcript 4 as an inhibitory receptor in patients with psoriatic arthritis
Authors: Chimenti Maria Sole , Bergamini Alberto , Triggianese Paola , Guarino Maria Domenica , Gigliucci Gianfranco , Conigliaro Paola , Perricone Carlo , Perricone Roberto
Published: October 2016

Objectives

To investigate the presence of immunoglobulin-like transcript (ILT)4 and costimulatory proteins (CD40, CD80 and CD86), as well as tumour necrosis factor (TNF)-α production in antigen-presenting cells (APCs) from patients with psoriatic arthritis, before and after treatment with the antitumour necrosis factor-α therapy, adalimumab.

Methods

Peripheral blood monocytes from patients with psoriatic arthritis and healthy controls were cultured with CD40 ligand (CD40L) to stimulate differentiation to APCs. Cell-surface phenotype was analysed via fluorescence-activated cell sorting.

Results

CD40L-stimulation resulted in significantly more ILT4+ monocytes in cultures from control subjects ( n = 21) than those from patients ( n = 20). ILT4-positivity on CD40L-stimulated monocytes was negatively correlated with disease activity in patients. Adalimumab treatment resulted in significant increases from baseline in ILT4-positivity, and in decreases in CD40, CD80 and CD86-positivity in monocytes from patients.

Conclusion

The effect of adalimumab on monocyte surface phenotype may be due to modification of the inflammatory milieu associated with therapy-induced reduction of disease activity in psoriatic arthritis.
S100A8/A9 in psoriatic plaques from patients with psoriatic arthritis
Authors: Chimenti Maria Sole , Triggianese Paola , Botti Elisabetta , Narcisi Alessandra , Conigliaro Paola , Giunta Alessandro , Teoli Miriam , Perricone Roberto , Costanzo Antonio
Published: October 2016

Objective

To evaluate levels of the calcium-binding proteins S100A8 and S100A9 in the skin of patients with psoriatic arthritis.

Methods

Skin punch biopsies were obtained from patients with psoriatic arthritis and healthy control subjects. S100A8/A9 were semiquantified via immunohistochemistry and semiquantitative polymerase chain reaction.

Results

The study included biopsies from nine patients with psoriatic arthritis and nine control subjects. S100A8 and S100A9 were present at visibly higher levels in psoriatic plaques compared with normal skin samples. S100A8 and S100A9 RNA levels were significantly higher in the peripheral region of plaques compared with the central region.

Conclusion

Both S100A8 and S100A9 may represent good therapeutic targets in psoriasis and psoriatic arthritis.
Salivary interleukin-1β: Oral inflammatory biomarker in patients with psoriasis
Authors: Ganzetti Giulia , Campanati Anna , Santarelli Andrea , Sartini Davide , Molinelli Elisa , Brisigotti Valerio , Di Ruscio Giulia , Bobyr Ivan , Emanuelli Monica , Offidani Annamaria
Published: October 2016

Objective

To evaluate salivary interleukin (IL)-1β levels in patients with psoriasis, before and after treatment with tumour necrosis factor (TNF)-α inhibitors.

Methods

In this pilot study, salivary secretions were collected from patients with psoriasis and untreated healthy control subjects at baseline, and from patients after 12 weeks’ treatment with TNF-α inhibitors. IL-1β levels were determined in saliva samples via enzyme-linked immunosorbent assays, undertaken before and after TNF-α inhibitor treatment. Psoriasis-specific analysis of disease severity and activity were also undertaken.

Results

At baseline, patients ( n = 25) had significantly higher salivary IL1β levels than controls ( n = 20). In patients with psoriasis, TNF-α inhibitor treatment resulted in significantly reduced IL1β levels compared with baseline, but IL1β levels remained significantly higher than in control subjects even after treatment. There was a positive correlation between IL-1β levels, psoriasis activity and disease index score after TNF-α inhibitor treatment.

Conclusion

Saliva is a valid noninvasive tool for monitoring inflammation in psoriasis. TNF-α inhibitor treatments appear to interfere with the oral inflammatory process in patients with psoriasis.
Glomerular filtration rate in patients with psoriasis treated with etanercept
Authors: Gisondi Paolo , Girolomoni Giampiero
Published: October 2016

Objective

To estimate the prevalence of chronic kidney disease (CKD) and evaluate renal function in patients with moderate-to-severe chronic plaque psoriasis treated with etanercept (an anti-tumour necrosis factor-α drug).

Methods

This retrospective cohort study included patients with moderate-to-severe chronic plaque psoriasis. Kidney function was evaluated using estimated glomerular filtration rate (EGFR).

Results

The prevalence of CKD at baseline was 3.9% (two of 51 patients). EGFR was unaffected by etanercept therapy (83.6 ± 23.9 at baseline vs 82.2 ± 21.6 ml/min per 1.73 m2 after 6 months).

Conclusion

EGFR was unaffected by 6 months’ etanercept treatment. Physicians should be aware of the risk of CKD when providing comprehensive care to patients with moderate-to-severe psoriasis.
Microangiopathic antiphospholipid antibody-associated syndrome in a pregnant lady
Authors: Kew G S , Cho J , Lateef A
Published: October 2016

We describe a gravid 37-year-old Chinese lady with known triple positive primary antiphospholipid syndrome with previous recurrent deep vein thrombosis and early spontaneous miscarriages. She was managed with low-molecular weight heparin, aspirin, hydroxychloroquine, prednisolone and monthly intravenous immunoglobulin.

She presented with recurrent per-vaginal bleeding at 22 weeks of gestation and was found to have abruptio placentae. Anti-coagulation was held off. She subsequently delivered a stillborn at 24 weeks and anti-coagulation was restarted. Day 5 post-delivery, she developed HELLP, with hemolytic anaemia (Hb 10.1 g/dL, haptoglobin <30 g/L, LDH 2206 U/L), elevated transaminases (AST 1196 U/L, ALT 1130 U/L) and thrombocytopenia (platelet 28 × 10^9/L). There were also episodes of acute severe headache and abdominal pain assessed to be secondary to microvascular ischemia as CT did not reveal any thrombosis. Her blood pressure hovered persistently above systolic 180 mmHg, and required at least three anti-hypertensives. These were coupled with a new onset proteinuria of 2 to 3 g/day. There was no evidence of disseminated intravascular coagulation. She was assessed to have microangiopathic antiphospholipid syndrome and was started on plasmapheresis.

On Day 10 post-partum, the patient complained of foul-smelling vaginal discharge and was found to have retained products of conception, which was immediately evacuated. Her course was followed by poly-microbial sepsis secondary to Enterococcus fecalis, Klebsiella Pneumoniae and Escherichia coli. The patient was further treated with imipenem and she completed eight exchanges of plasmapheresis followed by five days of intravenous immunoglobulins with good clinical and biochemical improvement.
What Explains the Redistribution Achieved by the Italian Personal Income Tax? Evidence from Administrative Data
Authors: Barbetta Gian Paolo , Pellegrino Simone , Turati Gilberto
Published: October 2016

We analyze the Italian personal income tax (PIT) in the light of the different tools available to the government to achieve income redistribution. We focus in particular on three mechanisms: marginal tax rates, deductions, and tax credits. Exploiting an extended version of the standard Pfähler decomposition, we estimate the contribution of each of these three tools to the overall redistributive effect of the PIT using administrative data on more than 1.3 million individual tax returns. Our estimates suggest that more than half of the total PIT redistributive effect is due to the two most important tax credits (the tax credit for employment and the tax credit for retirement income), while the marginal rates schedule contribution is about 40 percent. On the contrary, most of the itemized expenditures do not show any sizable impact on redistribution.
Introduction to this special section: 4D seismic
Authors: Nasser Mosab , Ronen Shuki , Stammeijer Jan
Published: October 2016

Time-lapse (4D) seismic is a well-established technology used to monitor production in oil and gas fields. This includes fluid replacements, pressure changes, and geomechanical effects. Using a variety of acquisition systems and techniques, 4D seismic is being used actively on fields around the world to optimize production, find bypassed oil, influence well-drilling decisions, and optimize development and production plans.
Rock-physics modeling of stress sensitivity and 4D time shifts in patchy cemented sandstones — Application to the Visund Field, North Sea
Authors: Avseth Per , Skjei Norunn , Mavko Gary
Published: October 2016

The patchy cement model predicts stress sensitivity in poorly to moderately consolidated sandstones using a multiply nested Hashin-Shtrikman approach combined with contact theory. This model can be used to quantify stress sensitivity in reservoir sandstones where core samples are lacking or unreliable. We demonstrate a strategy based on this model that can be used to quantify 4D seismic time shifts and time-shift derivatives associated with stress changes. The time shifts will be a function of the rock stiffness (i.e., volume of patchy cement); therefore, it is important to determine the local changes in rock properties before we can predict stress and fluid changes from time-shift attributes. We apply this approach to four exploration wells in the Visund Field area where we have good control on the rock properties. We first compare modeled time shifts with observed 4D time shifts in the Visund S1 segment where pressure data are available, and we obtain a very good match at two selected well locations. Next, we use the observed seismic time shifts as constraints to estimate the pore-pressure changes in the Pan and Pandora segments just south of the depleting S1 segment. Pressure changes are significantly lower than in the S1 segment but still indicate potential pressure communication between these segments and the main Visund, in spite of fault barriers and deeper fluid contacts.
Evaluation of time-shift extraction methods on a synthetic model with 4D geomechanical changes
Authors: Kanu Chinaemerem , Toomey Aoife , Hodgson Linda , Gherasim Mariana , L'Heureux Elizabeth , Du Bosen , Zhang Qie
Published: October 2016

Imaging and characterizing time-lapse changes in reservoir properties rely on accurate estimation of the corresponding time shifts and amplitude changes. We evaluated the accuracy of competing time-shift extraction algorithms — cross correlation, nonlinear inversion, dynamic warping, the correlated-leakage method, and the optical-flow-warping method — for estimating 4D time shifts, particularly from subsalt reservoirs. A synthetic model of a Gulf of Mexico field was used for testing these methods. The model contains both subsalt and extra-salt reservoirs. We imposed 4D velocity changes within both reservoirs and in the overburden of the subsalt reservoir. Each of the time-shift extraction methods was evaluated, and each was found to have various strengths and weaknesses. The correlated-leakage and optical-flow-warping methods reproduced the model time shifts most accurately and with the best resolution.
Facies classification using machine learning
Authors: Hall Brendon
Published: October 2016

There has been much excitement recently about big data and the dire need for data scientists who possess the ability to extract meaning from it. Geoscientists, meanwhile, have been doing science with voluminous data for years, without needing to brag about how big it is. But now that large, complex data sets are widely available, there has been a proliferation of tools and techniques for analyzing them. Many free and open-source packages now exist that provide powerful additions to the geoscientist's toolbox, much of which used to be only available in proprietary (and expensive) software platforms.
Member Services
Authors: Hassan Osman M.
Published: October 2016

As an SEG member for the past 30 years, I've made lifelong friendships with some of the most talented, brightest, and down-to-earth people from all over the world. This is probably the most valued benefit I've received from my SEG membership.
Psychiatrists' follow-up of identified metabolic risk: a mixed-method analysis of outcomes and influences on practice
Authors: Patterson Sue , Freshwater Kathleen , Goulter Nicole , Ewing Julie , Leamon Boyd , Choudhary Anand , Moudgil Vikas , Emmerson Brett
Published: October 2016

Aims and method

To describe and explain psychiatrists' responses to metabolic abnormalities identified during screening. We carried out an audit of clinical records to assess rates of monitoring and follow-up practice. Semi-structured interviews with 36 psychiatrists followed by descriptive and thematic analyses were conducted.

Results

Metabolic abnormalities were identified in 76% of eligible patients screened. Follow-up, recorded for 59%, was variable but more likely with four or more abnormalities. Psychiatrists endorse guidelines but ambivalence about responsibility, professional norms, resource constraints and skills deficits as well as patient factors influences practice. Therapeutic optimism and desire to be a ‘good doctor’ supported comprehensive follow-up.

Clinical implications

Psychiatrists are willing to attend to physical healthcare, and obstacles to recommended practice are surmountable. Psychiatrists seek consensus among stakeholders about responsibilities and a systemic approach addressing the social determinants of health inequities. Understanding patients' expectations is critical to promoting best practice.
Bangles and the boy king
Authors: Hammond Paula
Published: October 2016

Archaeology is a patient discipline, all about carefully stripping away centuries of mud and sand, but when you combine it with Ancient Egypt, you will soon be able to convince children that history rocks!
Notes from the Editors, October 2016
Authors: The Editors -
Published: October 2016

buy this issueOn August 29, in a historic moment in the history of the planet, the 35-member Anthropocene Working Group (AWG) reported to the International Geological Congress that the Anthropocene epoch in geological history is "stratigraphically real" and should be dated as arising around 1950, displacing the Holocene epoch of the last 12,000 years. The AWG has yet to arrive at a formal decision that would adopt a definite global "signal" (though ten of the thirty-five members currently support using fallout radionuclides from atomic weapons testing as the signal), which would be followed by the designation of a "golden spike" or actual location in the rock, sediment, or ice strata. Yet the general parameters of the onset of the new epoch are clear.… As Colin Waters, secretary of the AWG, explained: "Being able to pinpoint an interval of time is saying something about how we have had an incredible impact on the environment of our planet. The concept of the Anthropocene manages to pull all these ideas of environmental change together." Most importantly, it tells us that the world economy has generated an anthropogenic rift in the Earth system threatening millions of species, including our own, requiring fundamental changes in the way in which society relates to the earth through production.Click here to purchase a PDF version of this article at the Monthly Review website.