Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Multidimensional analysis of environmental impacts from potato agricultural production in the Peruvian Central Andes.

Rain-fed potato systems, being the most important cash crop in the Peruvian Central Andes, play a key role in food security. Quantifying the environmental impacts and understanding their complex interactions is an important step towards an improvement of the technical sustainability of these systems. From 2005 until 2015, 58 potato field plots located on a transect of Mantaro Valley, Junín, Peru were investigated at field level during the rainy cropping seasons. All external inputs used for crop production were measured and registered on fortnightly basis. A life cycle assessment (LCA) was performed (per ton yield fresh weight) to assess the most important potential environmental impact categories (EICs). Due to the intrinsic variability of the production systems, a cluster analysis (k-means algorithm) and linear discriminant analysis (LDA) were implemented to group and evaluate the classification based on the EICs values. Furthermore, latent variables were obtained using exploratory factor analysis (EFA) to investigate the correlational structure of main biophysical inputs (kg ha-1) and EICs values (kg unit-eq. t-1). Similarly, data envelopment analysis (DEA) was used to quantify the relative environmental efficiency based on the EICs values (unit-eq. t-1, input) and the productivity level (kg ha-1, output). Overall LCA results showed considerable EICs values for acidification and eutrophication due to the inappropriate or sub-optimal use of fertilizer sources. Restricted use of machinery and low technology level caused low global warming potential and cumulative energy demand. Based on the cluster analysis, three groups were found mainly defined by the nature of the inputs and EICs values: inorganic, organic and mixed systems. LDA showed a good overall classification accuracy for the groups (98.3%), being cumulative energy demand the most important discriminant variable due to scarce machinery use. In addition, EFA proved that the first and second latent variables are correlated with an inorganic- and organic-oriented agriculture respectively, being the inorganic more associated with the EICs values. Environmental efficiency (from 0.04 to 0.61 on average) was linked to the quantity and source of the inputs, showing that potential environmental savings can be reached if more balanced input sources are used.

Aspectos clínicos y moleculares relevantes del síndrome de Marfan / Marfan's syndrome: relevant clinical and molecular aspects: knowledge obtained from the follow-up of one family throughout three consecutive generations

El síndrome de Marfan (SM) es un trastorno genético del tejido conectivo, autosómico dominante, que afecta principalmente los sistemas ocular , musculoesquelético y cardiovascular. Las complicaciones cardiovasculares son las principales causas de morbimortalidad. La patogenia del SM se debe a mutaciones en el gen de fibrilina 1 (FBN1) aunque actualmente emergen otros factores patogénicos de importancia. Los intentos de establecer correlaciones genotipo/fenotípicas han sido dificultosos por la gran variabilidad clínica de la enfermedad. El enfoque familiar resulta particularmente útil ya que permite definir el rango de variabilidad y excluir trastornos alélicos, siempre y cuando sea complementado por un seguimiento lo suficientemente prolongado. El estudio de las bases moleculares del SM posibilitó perfeccionar el diagnóstico, precisar el pronóstico, proponer intervenciones terapéuticas más efectivas y brindar mejor asesoramiento genético.