Non-Pharmacological Interventions for Treating Psoriatic Arthritis.

Background and Objective: In this review, we discuss evidence concerning the management of psoriatic arthritis (PsA) patients with non-pharmacological interventions and additionally develop physical training protocols that could be prescribed to these patients. Methods: We selected 110 articles, published on PubMed and Google Scholar databases from 1972 to date, investigating the effects of generic hygienic-dietary recommendations and training programs in PsA or psoriasis (PSO) individuals. Results: Although data in support are limited, aerobic, endurance, and strength exercises as well as complementary techniques may all be useful in preserving or improving residual functional capacity, joint flexibility, and muscle strength. Exercise may reduce systemic inflammation, pain, and fatigue and additionally control PsA comorbidities, like dysmetabolism or obesity. Conclusions: The polyhedral clinical expression of PsA underlines the need for a multidisciplinary approach combining the synergistic effects of pharmacological and non-pharmacological treatments. The latter range from preventive measures, like dietary modifications, weight loss, and cigarette smoking cessation, to personalized training protocols according to disease activity and phenotype, comorbidities, and individual tolerability. In these patients, we strongly encourage the regular practice of motor activity at progressively increasing intensity with combined supervised aerobic, strength, endurance, and stretching exercises.

The Use of Lightweight Aggregates in Geopolymeric Mortars: The Effect of Liquid Absorption on the Physical/Mechanical Properties of the Mortar.

Geopolymers have been proposed as a green alternative to Portland cement with lowered carbon footprints. In this work, a geopolymeric mortar obtained using waste materials is studied. Fly ash, a waste generated by coal combustion, is used as one of the precursors, and waste glass as lightweight aggregates (LWAs) to improve the thermal performance of the mortar. The experimental study investigates the effect of varying the alkali activating solution (AAS) amount on the workability, compressive strength, and thermal conductivity of the mortar. Indeed, AAS represents the most expensive component in geopolymer production and is the highest contributor to the environmental footprint of these materials. This research starts by observing that LWA absorbs part of the activating solution during mixing, suggesting that only a portion of the solution effectively causes the geopolymerization reactions, the remaining part wetting the aggregates. Three mixes were investigated to clarify these aspects: a reference mix with a solution content calibrated to have a plastic consistency and two others with the activating solution reduced by the amount absorbed by aggregates. In these cases, the reduced workability was solved by adding the aggregates in a saturated surface dry state in one mix and free water in the other. The experimental results evidenced that free water addiction in place of a certain amount of the solution may be an efficient way to improve thermal performance without compromising the resistance of the mortar. The maximum compressive strength reached by the mortars was about 10 MPa at 48 days, a value in line with those of repair mortars. Another finding of the experimental research is that UPV was used to follow the curing stages of materials. Indeed, the instrument was sensitive to microstructural changes in the mortars with time. The field of reference of the research is the rehabilitation of existing buildings, as the geopolymeric mortars were designed for thermal and structural retrofitting.

Bond Tests on Clay Bricks and Natural Stone Masonry Externally Bonded with FRP.

Nowadays, the solution of durability problems of existing buildings has a key role in civil engineering, in which there is an ever-increasing need for building restorations. Over the past 50 years, there is a growing interest in a new composite material, fibre-reinforced polymer (FRP), suitable for increasing the resistance and the stability of existing buildings and, consequently, for extending their service life. In this context, the effectiveness of the strengthening system is related to the bond behaviour that is influenced by several parameters such as bond length, the stiffness of the reinforcement, the mechanical properties of the substrate, environmental conditions, etc. This paper aims to analyse the main experimental results from shear tests performed on two kinds of masonry substrates and different types of FRP reinforcements. The purpose is to highlight the role played by many parameters to the bond behaviour of these systems: the mechanical properties of substrates; the stiffness of reinforcements; the type of supports (i.e., unit or masonry unit). The obtained experimental results underlined that the specimens realised with masonry unit show an increase in debonding load and different stress transfer mechanisms along the bonded length with respect to the specimens with a unit substrate. The analysis of the data revealed that the presence of mortar joints cannot be neglected because it influences the interface global performance.

Pectin-Coated Plasmonic Nanoparticles for Photodynamic Therapy: Inspecting the Role of Serum Proteins.

Plasmonic metal nanoparticles (NPs) can be used as enhancers of the efficiency of standard photosensitizers (PSs) in photodynamic therapy (PDT). Protein corona, the adsorption layer that forms spontaneously around NPs once in contact with biological fluids, determines to a great extent the efficiency of PDT. In this work, we explore the possibility that pectin-coated Au NPs (Au@Pec NPs) could act as adjuvants in riboflavin (Rf)-based PDT by comparing the photodamage in HeLa cells cultured in the presence and in the absence of the NPs. Moreover, we investigate the impact that the preincubation of Rf and Au@Pec NPs (or Ag@Pec NPs) at two very different serum concentrations could have on cell's photodamage. Because reactive oxygen species (ROS) precursors are the excited states of the PS, the effect of proteins on the photophysics of Rf and Rf/plasmonic NPs was studied by transient absorption experiments. The beneficial effect of Au@Pec NPs in Rf-based PDT on HeLa cells cultured under standard serum conditions was demonstrated for the first time. However, the preincubation of Rf and Au@Pec NPs (or Ag@Pec NPs) with serum has undesirable results regarding the enhancement of Rf-based PDT. In this sense, we also verified that more concentrated protein conditions result in lower amounts of the triplet excited state of Rf and thus an expected lower production of ROS, which are the key elements for PDT's efficacy. These findings point out the relevance of serum concentration in the design of in vitro cell culture experiments carried out to determine the best way to combine and use potential sensitizers with plasmonic NPs to develop more effective PDTs.

Photothermal therapy with silver nanoplates in HeLa cells studied by in situ fluorescence microscopy.

Photothermal therapy (PTT) is a noninvasive treatment for cancer relying on the incorporation of NIR-light absorbing nanomaterials into cells, which upon illumination release heat causing thermally induced cell death. We prove that irradiation of aqueous suspensions of poly(vinylpyrrolidone)-coated silver nanoplates (PVPAgNP) or PVPAgNP in HeLa cells with red or NIR lasers causes a sizeable photothermal effect, which in cells can be visualized with the temperature sensing fluorophore Rhodamine B (RhB) using spinning disk confocal fluorescence microscopy or fluorescence lifetime imaging. Upon red-light irradiation of cells that were incubated with both, RhB and PVPAgNP at concentrations with no adverse effects on cell viability, a substantial heat release is detected. Initiation of cell death by photothermal effect is observed by positive signals of fluorescent markers for early and late apoptosis. Surprisingly, a new nanomaterial-assisted cell killing mode is operating when PVPAgNP-loaded HeLa cells are excited with moderate powers of fs-pulsed NIR light. Small roundish areas are generated with bright and fast (<1 ns) decaying emission, which expand fast and destroy the whole cell in seconds. This characteristic emission is assigned to efficient optical breakdown initiation around the strongly absorbing PVPAgNP leading to plasma formation that spreads fast through the cell.

Riboflavin-Mediated Photooxidation of Gold Nanoparticles and Its Effect on the Inactivation of Bacteria.

Photodynamic inactivation (PDI) of microorganisms, based on the ability of photosensitizers to produce reactive oxygen species (ROS) under adequate irradiation, emerges as a promising technique to face the increasing bacterial resistance to conventional antimicrobials. In this work, we analyze the combined action of Riboflavin (Rf) and pectin-coated gold nanoparticles (PecAuNP) on Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa) as suitable PDI strategy. We demonstrate that gold ions can be generated upon Rf-photosensitized oxidation of PecAuNP. Transient absorption spectroscopy shows that the Rf cationic radical can accept an electron from the nanoparticles to yield Au(I) ions, which in aqueous medium is disproportionate to yield Au0 and Au(III). Microbiological assays showed that the presence of PecAuNP enhanced the antibacterial activity of photoirradiated Rf toward S. aureus and P. aeruginosa, in line with the well-known antibacterial activity of gold ions. Moreover, the irradiation of Rf solutions containing about 100 µM PecAuNP enabled the solutions to be bactericidal against both bacteria.

Highly Enantioselective Catalytic Kinetic Resolution of α-Branched Aldehydes through Formal Cycloaddition with Homophthalic Anhydrides.

A new catalytic methodology was developed to promote an efficient one-pot kinetic resolution of racemic aldehydes with selectivity (s*) of up to 91 (99:1 d.r., >99 % ee) in a cycloaddition reaction with enolizable anhydrides to afford dihydroisocoumarin products (a core prevalent in natural products and molecules of medicinal interest) containing three contiguous stereocentres.

Catalytic Asymmetric Cycloadditions between Aldehydes and Enolizable Anhydrides: cis-Selective Dihydroisocoumarin Formation.

In the presence of a trityl-substituted cinchona alkaloid-based catalyst, homophthalic, aryl succinic, and glutaconic anhydride derivatives reacted with aromatic and aliphatic aldehydes to produce cis-lactones in up to 90:10 dr and 99% ee. A DFT study has shown how the catalyst is uniquely able to bring about the opposite sense of diastereocontrol to that usually observed.

Photodynamic Therapy in HeLa Cells Incubated with Riboflavin and Pectin-coated Silver Nanoparticles.

Riboflavin (Rf) is an endogenous photosensitizer, which can participate in Type I and Type II processes. We have recently shown that the yield of the triplet excited states of Rf is enhanced in the presence of pectin-coated silver nanoparticles (Pec@AgNP) due to formation of a complex between Rf and Pec@AgNP (Rf-Pec@AgNP). Consequently, under aerobic conditions, the amounts of singlet molecular oxygen and superoxide radical anion generated are also larger in the presence of the nanoparticles. This result made us suspect that the nanoparticles could have a beneficial effect in Rf-based PDT. To prove this hypothesis, we here compared the photodamage in HeLa cells incubated with Rf in the presence and in the absence of Pec@AgNP applying several optical assays. We used fluorescence imaging of irradiated HeLa cells incubated with Annexin V and propidium iodide to evaluate the occurrence of apoptosis/necrosis, the reduction of the tetrazolium dye MTT to formazan and neutral red uptake to prove cell viability, as well as synchrotron infrared microscopy of single cells to evaluate possible structural changes of DNA and nuclear proteins. The enhanced photodamage observed in the presence of Pec@AgNP seems to indicate that Rf enters into the cells complexed with the nanoparticles.

Toward biomedical application of amino-functionalized silicon nanoparticles.

Silicon blue-emitting nanoparticles (NPs) are promising effectors for photodynamic therapy and radiotherapy, because of their production of reactive oxygen species (ROS) upon irradiation. RESULTS: Amino-functionalized silicon NPs (NH2SiNP) were intrinsically nontoxic below 100 µg/ml in vitro (on two tumor cell lines) and in vivo (zebrafish larvae and embryos). NH2SiNP showed a moderate effect as a photosensitizer for photodynamic therapy and reduced ROS generation in radiotherapy, which could be indicative of a ROS scavenging effect. Encapsulation of NH2SiNP into ultradeformable liposomes improved their skin penetration after topical application, reaching the viable epidermis where neoplastic events occur. CONCLUSION: Subsequent derivatizations after amino-functionalization and incorporation to nanodrug delivery systems could expand the spectrum of the biomedical application of these kind of silicon NPs.

Training pharmacists in the stage-of-change model of smoking cessation and motivational interviewing: A randomized controlled trial.

This study evaluated the effect of training pharmacists in the stage-of-change model for smoking cessation and motivational interviewing on smoking cessation outcomes. A training based on the stage-of-change model for smoking cessation and motivational interviewing was introduced to pharmacists. Pharmacists were randomly assigned to the intervention or control group. The control group attended a 3-hour training session, whereas the intervention group also attended a further 6-hour training session. At week 24, 12.2 percent of the smokers quit smoking in the intervention group, whereas 1.6 percent of the smokers quit smoking in the control group. The findings of this study showed that training pharmacists, in the stage-of-change model for smoking cessation and motivational interviewing, improves smoking reduction and cessation rates.

Qualidade de vida no pós-operatório de rinoplastia estética / Postoperative quality of life for aesthetic rhinoplasty

Introdução: Na rinoplastia, assim como em diversos procedimentos estéticos, a avaliação do sucesso cirúrgico depende da satisfação do cirurgião e, principalmente, da satisfação do paciente. Apesar disso, há escassos estudos sobre o ponto de vista do paciente no período pós-cirúrgico. O objetivo do presente estudo é avaliar o grau de satisfação correlacionando-o com a qualidade de vida no período pós-operatório tardio dos pacientes submetidos à rinoplastia nos Serviços Integrados de Cirurgia Plástica do Hospital Ipiranga. Métodos: Foram selecionados aleatoriamente (n = 60) pacientes submetidos à rinoplastia estética entre 2013 e 2014 para a aplicação de dois questionários validados. Todos os procedimentos foram realizados conforme a indicação, com a mesma rotina cirúrgica. Resultados: As questões 2, 5b, 7, 9a, 9d e 11d do questionário SF-36 se mostraram significantes para pelo menos uma questão do questionário ROE (valor p < 0,05). Conclusão: A qualidade de vida se relaciona com o grau de satisfação no pós-operatório de rinoplastia estética em seis questões.

Introduction: As in many cosmetic procedures, assessment of surgical success in rhinoplasty depends on surgeon satisfaction and, mainly, on patient satisfaction. Nevertheless, there are few studies on the patient's postsurgical point of view. The aim of this study is to evaluate the degree of satisfaction correlated with quality of life in the late post-operative period of patients undergoing rhinoplasty in the Integrated Plastic Surgery Services of the Ipiranga Hospital. Methods: Patients undergoing aesthetic rhinoplasty between 2013 and 2014 (n = 60) were selected for the application of two validated questionnaires. All procedures were performed as indicated with the same surgical routine. Results: Questions 2, 5b, 7, 9a, 9d and 11d of the SF -36 questionnaire showed significant to at least one question of the ROE questionnaire (p < 0.05). Conclusion: Quality of life is related to the degree of satisfaction in the postoperative of cosmetic rhinoplasty in six issues.

Ultrasonic pulse velocity for the evaluation of physical and mechanical properties of a highly porous building limestone.

UPV as non-destructive technique can effectively contribute to the low invasive in situ analysis and diagnosis of masonry elements related to the conservation, rehabilitation and strengthening of the built heritage. The use of non-destructive and non-invasive techniques brings all the times many advantages in diagnostic activities on pre-existing buildings in terms of sustainability; moreover, it is a strong necessity with respect to the conservation constraints when dealing with the historical-architectural heritage. In this work laboratory experiments were carried out to investigate the effectiveness of ultrasonic pulse velocity (UPV) in evaluating physical and mechanical properties of Lecce stone, a soft and porous building limestone. UPV and selected physical-mechanical parameters such as density and uniaxial compressive strength (UCS) were determined. Factors such as anisotropy and water presence that induce variations on the ultrasonic velocity were also assessed. Correlations between the analysed parameters are presented and discussed. The presence of water greatly affected the values of the analysed parameters, leading to a decrease of UPV and to a strong reduction of the compressive strength. A discussion of the role of the water on these results is provided. Regression analysis showed a reliable linear correlation between UPV and compressive strength, which allows a reasonable estimation of the strength of Lecce stone by means of non-destructive testing methods such as the ultrasonic wave velocity. Low correlation between UPV and density was found, suggesting that other factors than density, related to the fabric and composition, also influence the response of the selected stone to the UPV. They have no influence on the UCS, that instead showed to be highly correlated with the packing density.

Idelalisib and rituximab in relapsed chronic lymphocytic leukemia.

BACKGROUND: Patients with relapsed chronic lymphocytic leukemia (CLL) who have clinically significant coexisting medical conditions are less able to undergo standard chemotherapy. Effective therapies with acceptable side-effect profiles are needed for this patient population. METHODS: In this multicenter, randomized, double-blind, placebo-controlled, phase 3 study, we assessed the efficacy and safety of idelalisib, an oral inhibitor of the delta isoform of phosphatidylinositol 3-kinase, in combination with rituximab versus rituximab plus placebo. We randomly assigned 220 patients with decreased renal function, previous therapy-induced myelosuppression, or major coexisting illnesses to receive rituximab and either idelalisib (at a dose of 150 mg) or placebo twice daily. The primary end point was progression-free survival. At the first prespecified interim analysis, the study was stopped early on the recommendation of the data and safety monitoring board owing to overwhelming efficacy. RESULTS: The median progression-free survival was 5.5 months in the placebo group and was not reached in the idelalisib group (hazard ratio for progression or death in the idelalisib group, 0.15; P<0.001). Patients receiving idelalisib versus those receiving placebo had improved rates of overall response (81% vs. 13%; odds ratio, 29.92; P<0.001) and overall survival at 12 months (92% vs. 80%; hazard ratio for death, 0.28; P=0.02). Serious adverse events occurred in 40% of the patients receiving idelalisib and rituximab and in 35% of those receiving placebo and rituximab. CONCLUSIONS: The combination of idelalisib and rituximab, as compared with placebo and rituximab, significantly improved progression-free survival, response rate, and overall survival among patients with relapsed CLL who were less able to undergo chemotherapy. (Funded by Gilead; ClinicalTrials.gov number, NCT01539512.).

Appropriateness of use of indwelling urinary tract catheters in hospitalized patients in Italy.

By reviewing medical records, we evaluated the appropriateness of use of indwelling urinary tract catheters in hospitalized patients in Italy. The inappropriate use of an indwelling urinary tract catheter (in 138 [30%] of 461 patients) was significantly associated with greater age, not having undergone a surgical intervention, a good state of consciousness, presence of chronic comorbidities, duration of catheterization, and ward of admission.