Sites and Mobility of Lithium along the Li1+xTi2-xInx(PO4)3 (0 ≤ x ≤ 2) Series Deduced by XRD, NMR, and Impedance Spectroscopy.

The structure and Li conductivity has been investigated in the Li1+xTi2-xInx(PO4)3 (0 ≤ x ≤ 2) series prepared by the ceramic route at 900 °C. The XRD patterns of 0 ≤ x ≤ 0.2 samples show the presence of rhombohedral (S.G. R3̅c); those of 0.2 ≤ x ≤ 1 samples display both rhombohedral and orthorhombic (S.G. Pbca), and 1 ≤ x ≤ 2 samples exhibit only monoclinic (S.G. P21/n) phases. At intermediate compositions, the secondary LiTiPO5 phase was detected. The Rietveld analysis of XRD patterns was used to deduce unit-cell parameters, chemical composition, and percentage of phases. The amount of In3+, deduced from structural refinements of three phases, was confirmed by 31P MAS NMR spectroscopy. The Li mobility was investigated by 7Li MAS NMR and impedance spectroscopies. The Li conductivity increased with the Li content in rhombohedral but decreased in orthorhombic, increasing again in monoclinic samples. The maximum conductivity was obtained in the rhombohedral x = 0.2 sample (σb = 1.9 × 10-3 S·cm-1), with an activation energy Eb = 0.27 eV. In this composition, the overall Li conductivity was σov = 1.7 × 10-4 S·cm-1 and Eov = 0.32 eV, making this composition a potential solid electrolyte for all-solid-state batteries. Another maximum conductivity was detected in the monoclinic x ∼ 1.25 sample (σov = 1.4 × 10-5 S·cm-1), with an activation energy Eov = 0.39 eV. Structural models deduced with the Rietveld technique were used to analyze the conduction channels and justify the transport properties of different Li1+xTi2-x Inx(PO4)3 phases.

Validity Evidence for the Self-Absorption Scale (SAS) in Spanish Population.

BACKGROUND: The Self-Absorption Scale (SAS) is one of the few instruments that measure dysfunctional self-focused attention or self-absorption, a transdiagnostic factor of vulnerability to various emotional disorders. The internal structure of the Spanish version of the SAS and its relationship with other variables have not been examined, nor has whether its subscales provide relevant information. These were the two goals of the present study. METHOD: The factor structure of the SAS, its internal consistency, and its relationship with depression and post-traumatic stress were analyzed in a Spanish community sample of 519 adults. RESULTS: The SAS presented a symmetrical bifactor structure with a general factor of self-absorption that explained most of the variance in the items and two specific factors of private and public self-absorption. The total scale and the two subscales of the SAS exhibited excellent, good or adequate reliability coefficients (alphas/omegas = .70 ­ .88) and correlated with depression and post-traumatic stress ( r = .34 ­ .46). CONCLUSIONS: The SAS provides reliable, valid measures of dysfunctional self-focused attention in Spanish adults, but its Private and Public Self-absorption subscales are not much more useful than the information provided by its total scale.

Structural characterization of PaaX, the main repressor of the phenylacetate degradation pathway in Escherichia coli W: A novel fold of transcription regulator proteins.

PaaX is a transcriptional repressor of the phenylacetic acid (PAA) catabolic pathway, a central route for bacterial aerobic degradation of aromatic compounds. Induction of the route is achieved through the release of PaaX from its promoter sequences by the first compound of the pathway, phenylacetyl-coenzyme A (PA-CoA). We report the crystal structure of PaaX from Escherichia coli W. PaaX displays a novel type of fold for transcription regulators, showing a dimeric conformation where the monomers present a three-domain structure: an N-terminal winged helix-turn-helix domain, a dimerization domain similar to the Cas2 protein and a C-terminal domain without structural homologs. The domains are separated by a crevice amenable to harbour a PA-CoA molecule. The biophysical characterization of the protein in solution confirmed several hints predicted from the structure, i.e. its dimeric conformation, a modest importance of cysteines and a high dependence of solubility and thermostability on ionic strength. At a moderately acidic pH, the protein formed a stable folding intermediate with remaining α-helical structure, a disrupted tertiary structure and exposed hydrophobic patches. Our results provide valuable information to understand the stability and mechanism of PaaX and pave the way for further analysis of other regulators with similar structural configurations.

Corrigendum: The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases.

[This corrects the article DOI: 10.3389/fimmu.2023.1191782.].

Prevalence of increased alcohol use and alcohol use disorders in adult victims of terrorist attacks: a systematic and meta-analytic review.

Background: Previous studies have reviewed the evidence on the increase in alcohol consumption after a terrorist attack. However, an increase does not necessarily imply the presence of an alcohol use disorder.Objectives: To conduct a systematic and meta-analytic review of the literature on the prevalence of increased alcohol consumption and alcohol use disorders in adult exposed to terrorism.Methods: A search of PsycINFO, MEDLINE and PTSDpubs identified 29 studies published up to March 2023 in which 38 adult samples totaling 282,753 persons exposed to terrorism were assessed. Using inverse variance heterogeneity models, pooled prevalence rates of increased alcohol use and alcohol use disorders were calculated.Results: 6% (95% CI [2.9, 9.5]) of the adults exposed to a terrorist attack increased their alcohol consumption. The prevalence of increased alcohol use varied depending on the degree of exposure (p = .006, R2 = .18) and the procedure for measuring increases (p = .043, R2 = .37). The prevalence of alcohol use disorders in adults exposed to a terrorist attack was 5.5% (95% CI [3.7, 7.5]), a rate that was not higher than that obtained in the general population and varied depending on the type of alcohol disorder (p = .015, R2 = .30).Conclusions: A relevant number of adults exposed to terrorist attacks will subsequently increase their alcohol consumption, but this increase is not associated with an increase in the prevalence of alcohol use disorders. Effects of terrorism on people's health are potentially widespread, but concerns of excessive alcohol use after terrorist attacks may be unwarranted.

29Si Magic Angle Spinning Nuclear Magnetic Resonance, Fourier-Transform Infrared, and Monte Carlo Study of Synthetic Tetrasilicic Magnesium Mica Solid Solutions.

The parallel 29Si magic angle spinning nuclear magnetic resonance (MAS NMR) and Fourier-transform infrared study of synthetic micas made it possible to compare structural features of the tetrasilicic magnesium mica K(Mg2.5□0.5) Si4O10(OH)2 (TMM) and their K(Mg3)(Si3.5Mg0.5)O10(OH)2 (TMMA) and K(Mg3)(Si3.5Be0.5)O10(OH)2 (TMMB) derivatives. In the TMM mica, SiO4 tetrahedra are elongated in the plane ab and shortened along the c* direction with respect to those of the phlogopite (Phl) K(Mg3)(Si3Al)O10(OH)2. The substitution of Si4+ by R2+ (Mg2+ or Be2+) produces, besides the 29Si MAS NMR signal of Si (3Si) at -91.2 ppm, new components at -84.4 or -87.5 ppm that correspond to Si (2Si1Mg) or Si(2Si1Be) environments. Tetrahedral cation distributions in TMM/TMMA, TMM/TMMB solid solutions are investigated with respect to the TMM/Phl series by means of NMR and Monte Carlo simulations, concluding that divalent Mg2+ and Be2+ are further dispersed than trivalent Al3+ cations in tetrahedral sheets of micas. In three analyzed series, cation distributions display features between those of the homogeneous dispersion of charges of phlogopites and the maximum dispersion of charges of TMM derivatives. In three series, the location of charge deficits that compensate K+ cations changes from octahedral in TMM to tetrahedral sheets in phlogopite and TMMA and TMMB derivatives.

Implementation of the recommendations for the psychological management of patients with spondyloarthritis and inflammatory bowel disease.

OBJECTIVE: To assess and improve the level of implementation of the recommendations for the psychological management of patients with spondyloarthritis (SpA) and associated inflammatory bowel disease (IBD). METHODS: Qualitative study. We performed a narrative literature review to identify the recommendations for the psychological management of SpA and associated IBD and to explore their level of implementation. Based on the findings, we developed a national survey to assess: (1) current level of knowledge and implementation of the recommendations; (2) attitudes towards the recommendations; and (3) barriers and facilitators to their implementation. The results of the review and survey were discussed by a multidisciplinary group of 9 expert rheumatologists and gastroenterologists, who defined implementation strategies to increase the uptake of the recommendations. RESULTS: The review included 4 articles, 2 of them included direct recommendations on the identification and management of psychological problems in patients with SpA and IBD. None assessed the level of implementation of the recommendations in routine clinical practice. Our survey showed a great lack of awareness and implementation of the recommendations, even though psychological issues are very relevant for health professionals. Lack of time, resources, and knowledge are considered the main barriers to adherence to the recommendations. We propose several implementation strategies related to educational activities, clinical practice, and others to increase the uptake of reported recommendations. CONCLUSIONS: Further research and efforts are required to achieve behaviour changes in clinical practice to improve the identification and management of psychological problems and needs in patients with SpA and IBD.

Occurrence of SARS-CoV-2 viremia is associated with genetic variants of genes related to COVID-19 pathogenesis.

Introduction: SARS-CoV-2 viral load has been related to COVID-19 severity. The main aim of this study was to evaluate the relationship between SARS-CoV-2 viremia and SNPs in genes previously studied by our group as predictors of COVID-19 severity. Materials and methods: Retrospective observational study including 340 patients hospitalized for COVID-19 in the University Hospital La Princesa between March 2020 and December 2021, with at least one viremia determination. Positive viremia was considered when viral load was above the quantifiable threshold (20 copies/ml). A total of 38 SNPs were genotyped. To study their association with viremia a multivariate logistic regression was performed. Results: The mean age of the studied population was 64.5 years (SD 16.6), 60.9% patients were male and 79.4% white non-Hispanic. Only 126 patients (37.1%) had at least one positive viremia. After adjustment by confounders, the presence of the minor alleles of rs2071746 (HMOX1; T/T genotype OR 9.9 p < 0.0001), rs78958998 (probably associated with SERPING1 expression; A/T genotype OR 2.3, p = 0.04 and T/T genotype OR 12.9, p < 0.0001), and rs713400 (eQTL for TMPRSS2; C/T + T/T genotype OR 1.86, p = 0.10) were associated with higher risk of viremia, whereas the minor alleles of rs11052877 (CD69; A/G genotype OR 0.5, p = 0.04 and G/G genotype OR 0.3, p = 0.01), rs2660 (OAS1; A/G genotype OR 0.6, p = 0.08), rs896 (VIPR1; T/T genotype OR 0.4, p = 0.02) and rs33980500 (TRAF3IP2; C/T + T/T genotype OR 0.3, p = 0.01) were associated with lower risk of viremia. Conclusion: Genetic variants in HMOX1 (rs2071746), SERPING1 (rs78958998), TMPRSS2 (rs713400), CD69 (rs11052877), TRAF3IP2 (rs33980500), OAS1 (rs2660) and VIPR1 (rs896) could explain heterogeneity in SARS-CoV-2 viremia in our population.

Is it time to replace the Big Five personality model? Factorial structure of the NEO PI-R in a community sample of Spanish adults.

Recent studies have revived the issue of whether the five-factor personality model or Big Five is the most valid to summarize the most relevant personality traits or whether, on the contrary, the basic structure of personality traits would better fit a six-factor model such as the HEXACO model: Honesty-Humility (H), Emotionality (E), Extraversion (X), Agreeableness (A), Conscientiousness (C), and Openness to Experience (O). In a Spanish community sample of 682 adults, the factorial structure of the 30 facets of the NEO-Revised Personality Inventory (NEO PI-R) and its 16 facets common to the HEXACO model was analyzed. In two subsamples of participants, the internal structure of the NEO PI-R, of 30 and 16 facets, fit the five-factor Big Five model better than the six-factor HEXACO model. In addition, the internal 30-facet structure of the NEO-PI-R replicated that obtained in the original US validation and those previously obtained in Spain, although the latter used different participant samples (people evaluated in personnel selection processes, university students). These results suggest that, at least in Spain, the five-factor personality model or Big Five is still the most valid taxonomy of personality traits.

Vaccination trends in people with HIV infection participanting in the hospital-based survey of patients infected with HIV, 2006-2021.

OBJECTIVE: To assess the trend in hepatitis A, hepatitis B, pneumococcal, tetanus and seasonal influenza vaccination in people with HIV infection and to analyse associated factors. METHODS: The Hospital Survey of Patients with HIV, an annual cross-sectional study conducted on a fixed day (2006-2021), was used. Inpatients and outpatients were included. Trends in vaccination and associated factors were analysed using logistic regression. RESULTS: A total of 8643 participants were included. Vaccination rates increased to 65.3% for hepatitis A, 83.7% for hepatitis B, 49.3% for tetanus, 68.9% for pneumococcal and 74.5% for seasonal influenza in 2021. Factors positively associated with vaccination were older age for pneumococcal and influenza vaccination; higher educational level for hepatitis A and tetanus; living in a closed institutions or prison for tetanus, pneumococcal and influenza; and having acquired HIV through sex between men for hepatitis A, B and pneumococcal. In addition, being on antiretroviral treatment and having a high CD4 count were positively associated with vaccination for all these diseases. Factors inversely associated with vaccination were being older (hepatitis A, B and tetanus), being an immigrant (tetanus and seasonal influenza) and being an injection drug user/ex-user for hepatitis A and B. CONCLUSIONS: Vaccination in people with HIV has increased in the study period. The results are in line with the recommendations in this population, although there is still room to reach the established vaccination indicators.

The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases.

Interleukin-17 family (IL-17s) comprises six structurally related members (IL-17A to IL-17F); sequence homology is highest between IL-17A and IL-17F, displaying certain overlapping functions. In general, IL-17A and IL-17F play important roles in chronic inflammation and autoimmunity, controlling bacterial and fungal infections, and signaling mainly through activation of the nuclear factor-kappa B (NF-κB) pathway. The role of IL-17A and IL-17F has been established in chronic immune-mediated inflammatory diseases (IMIDs), such as psoriasis (PsO), psoriatic arthritis (PsA), axial spondylarthritis (axSpA), hidradenitis suppurativa (HS), inflammatory bowel disease (IBD), multiple sclerosis (MS), and asthma. CD4+ helper T cells (Th17) activated by IL-23 are well-studied sources of IL-17A and IL-17F. However, other cellular subtypes can also produce IL-17A and IL-17F, including gamma delta (γδ) T cells, alpha beta (αß) T cells, type 3 innate lymphoid cells (ILC3), natural killer T cells (NKT), or mucosal associated invariant T cells (MAIT). Interestingly, the production of IL-17A and IL-17F by innate and innate-like lymphocytes can take place in an IL-23 independent manner in addition to IL-23 classical pathway. This would explain the limitations of the inhibition of IL-23 in the treatment of patients with certain rheumatic immune-mediated conditions such as axSpA. Despite their coincident functions, IL-17A and IL-17F contribute independently to chronic tissue inflammation having somehow non-redundant roles. Although IL-17A has been more widely studied, both IL-17A and IL-17F are overexpressed in PsO, PsA, axSpA and HS. Therefore, dual inhibition of IL-17A and IL-17F could provide better outcomes than IL-23 or IL-17A blockade.

Effectiveness and safety of integrase strand transfer inhibitors in Spain: a prospective real-world study.

Introduction: Second-generation integrase strand transfer inhibitors (INSTIs) are preferred treatment options worldwide, and dolutegravir (DTG) is the treatment of choice in resource-limited settings. Nevertheless, in some resource-limited settings, these drugs are not always available. An analysis of the experience with the use of INSTIs in unselected adults living with HIV may be of help to make therapeutic decisions when second-generation INSTIs are not available. This study aimed to evaluate the real-life effectiveness and safety of dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), and raltegravir (RAL) in a large Spanish cohort of HIV-1-infected patients. Methods: Real-world study of adults living with HIV who initiated integrase INSTIs DTG, EVG/c, and RAL-based regimens in three settings (ART-naïve patients, ART-switching, and ART-salvage patients). The primary endpoint was the median time to treatment discontinuation after INSTI-based regimen initiation. Proportion of patients experiencing virological failure (VF) (defined as two consecutive viral loads (VL) ≥200 copies/mL at 24 weeks or as a single determination of VL ≥1,000 copies/mL while receiving DTG, EVG/c or RAL, and at least 3 months after INSTI initiation) and time to VF were also evaluated. Results: Virological effectiveness of EVG/c- and RAL-based regimens was similar to that of DTG when given as first-line and salvage therapy. Treatment switching for reasons other than virological failure was more frequent in subjects receiving EVG/c and, in particular, RAL. Naïve patients with CD4+ nadir <100 cells/µL were more likely to develop VF, particularly if they initiated RAL or EVG/c. In the ART switching population, initiation of RAL and EVG/c was associated with both VF and INSTI discontinuation. There were no differences in the time to VF and INSTI discontinuation between DTG, EVG/c and RAL. Immunological parameters improved in the three groups and for the three drugs assessed. Safety and tolerability were consistent with expected safety profiles. Discussion: Whereas second-generation INSTIs are preferred treatment options worldwide, and DTG is one of the treatment of choices in resource-limited settings, first-generation INSTIs may still provide high virological and immunological effectiveness when DTG is not available.

Psychometric Properties of the Anxiety Sensitivity Index-3 (ASI-3) in Spanish Population.

BACKGROUND: The Anxiety Sensitivity Index-3 (ASI-3) is the reference instrument for measuring anxiety sensitivity. The psychometric properties of the Spanish version of the ASI-3 have been examined in university students but not in adults from the general population. Whether the ASI-3 subscales provide relevant information has not yet been examined either. METHOD: The ASI-3's factor structure, internal consistency, temporal stability, and relationship with neuroticism were examined in a Spanish community sample of 919 adults. RESULTS: In two subsamples of participants, the ASI-3 presented a structure of three correlated factors (physical, cognitive, and social concerns) that loaded on a higher-order factor, but the three factors did not explain much item variance. The total scale and subscales of the ASI-3 showed excellent or good indices of internal consistency (alphas and omegas = .81 ­ .91), and adequate indices of test-retest reliability at two months ( r = .57 ­ .73) and the relationship with neuroticism and its facets ( r = .19 ­ .52). CONCLUSIONS: The ASI-3 provides reliable, valid measures of anxiety sensitivity in Spanish adults, but its subscales are not very useful beyond the information provided by the total scale.

Self-diffusion in polycrystalline Li1+x Ti2-x Al x (PO4)3 (0.2 ≤ x ≤ 0.4) samples followed by 7Li PFG (pulse field gradient) NMR spectroscopy.

Short and long range lithium motions in powder Li1+x Ti2-x Al x (PO4)3 (LTAP) NASICON compounds prepared by ceramic (x = 0.2 and 0.4) and sol-gel (x = 0.3 and 0.4) routes are discussed. ND diffraction and MAS-NMR spectroscopy were previously used to investigate structural features of these compounds. In particular, Fourier map differences showed that the amount of Li atoms allocated at M3 increases at the expense of M1 sites when the Li content increases. In this work, PFG-NMR results show that diffusion coefficients rise with the amount of lithium and temperature. The restricted diffusion inside NASICON particles is compared with "free" diffusion processes. At 300 K, diffusion coefficients D PFG ∼ 5 × 10-12 m2 s-1 have been deduced in ceramic x = 0.2 and 0.4 samples, decreasing with diffusion time Δ used in PFG experiments. In sol-gel samples, diffusion coefficients are near those of ceramic samples, but decrease faster with diffusion Δ times, as a consequence of the Li confinement inside sub-micrometric crystallites. The NMR spin-echo signal displays minima at specific q(γgδ) values that are related to the crystallite size. From R dif ∼ q m -1 distances, calculated from the position of minima, and from diffusion coefficients deduced for high Δ values, the mean crystallite size was estimated. Finally, from the temperature dependence of conductivity and diffusion coefficients, the activation energy and charge carriers concentrations were determined.

Influence of Cation Vacancies on Li Conductivity of La1/2Li1/2-2x Sr x TiO3 Perovskites (0 < x ≤ 0.25): The Role of Nominal and Effective Vacancies.

The Li1/2-2x Sr x La1/2TiO3 series (0 ≤ x ≤ 0.25) is investigated with X-ray diffraction, nuclear magnetic resonance, and impedance spectroscopy techniques. The substitution of two Li+ by one Sr2+ in Li1/2La1/2TiO3 perovskite generates cation vacancies that, when ordered in alternating planes along the c-axis, confer a two-dimensional character to Li mobility. In previous works, it was shown that Li+ ions partially occupy the center of the six faces of the cubic perovskite, resulting in the associated A-sites to participate like a vacancy in the definition of the percolation vacancy threshold. The results obtained in the Li1/2-2x Sr x La1/2TiO3 series are compared with those obtained in the Li3x La2/3-x TiO3 series, and other Sr-doped solid solutions (Li1/2-x Sr2x La1/2-x TiO3 and Li x Sr x La2/3-x TiO3), to highlight the importance of the effective vacancies with respect to the nominal ones in conductivity. The analysis of four series, belonging to the ternary SrTiO3-La2/3TiO3-Li2TiO3 phase diagram, permits a better understanding of the ionic conduction mechanism in perovskites. The results show that the vacancy percolation model is more adequate to explain Li conductivity than the conventional hopping probability model. In the analyzed series, Li conductivity is maximum when a small amount of Sr is incorporated into the pseudo-cubic La1/2Li1/2TiO3 end member, while it decreases as the amount of strontium increases.

Drug Repositioning as a Therapeutic Strategy against Streptococcus pneumoniae: Cell Membrane as Potential Target.

A collection of repurposing drugs (Prestwick Chemical Library) containing 1200 compounds was screened to investigate the drugs' antimicrobial effects against planktonic cultures of the respiratory pathogen Streptococcus pneumoniae. After four discrimination rounds, a set of seven compounds was finally selected, namely (i) clofilium tosylate; (ii) vanoxerine; (iii) mitoxantrone dihydrochloride; (iv) amiodarone hydrochloride; (v) tamoxifen citrate; (vi) terfenadine; and (vii) clomiphene citrate (Z, E). These molecules arrested pneumococcal growth in a liquid medium and induced a decrease in bacterial viability between 90.0% and 99.9% at 25 µM concentration, with minimal inhibitory concentrations (MICs) also in the micromolar range. Moreover, all compounds but mitoxantrone caused a remarkable increase in the permeability of the bacterial membrane and share a common, minimal chemical structure consisting of an aliphatic amine linked to a phenyl moiety via a short carbon/oxygen linker. These results open new possibilities to tackle pneumococcal disease through drug repositioning and provide clues for the design of novel membrane-targeted antimicrobials with a related chemical structure.

Daily tenofovir disoproxil fumarate/emtricitabine and hydroxychloroquine for pre-exposure prophylaxis of COVID-19: a double-blind placebo-controlled randomized trial in healthcare workers.

OBJECTIVES: To assess the effect of hydroxychloroquine (HCQ) and Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as pre-exposure prophylaxis on COVID-19 risk. METHODS: EPICOS is a double-blind, placebo-controlled randomized trial conducted in Spain, Bolivia, and Venezuela. Healthcare workers with negative SARS-CoV-2 IgM/IgG test were randomly assigned to the following: daily TDF/FTC plus HCQ for 12 weeks, TDF/FTC plus HCQ placebo, HCQ plus TDF/FTC placebo, and TDF/FTC placebo plus HCQ placebo. Randomization was performed in groups of four. Primary outcome was laboratory-confirmed, symptomatic COVID-19. We also studied any (symptomatic or asymptomatic) COVID-19. We compared group-specific 14-week risks via differences and ratios with 95% CIs. RESULTS: Of 1002 individuals screened, 926 (92.4%) were eligible and there were 14 cases of symptomatic COVID-19: 220 were assigned to the TDF/FTC plus HCQ group (3 cases), 231 to the TDF/FTC placebo plus HCQ group (3 cases), 233 to the TDF/FTC plus HCQ placebo group (3 cases), and 223 to the double placebo group (5 cases). Compared with the double placebo group, 14-week risk ratios (95% CI) of symptomatic COVID-19 were 0.39 (0.00-1.98) for TDF + HCQ, 0.34 (0.00-2.06) for TDF, and 0.49 (0.00-2.29) for HCQ. Corresponding risk ratios of any COVID-19 were 0.51 (0.21-1.00) for TDF + HCQ, 0.81 (0.44-1.49) for TDF, and 0.73 (0.41-1.38) for HCQ. Adverse events were generally mild. DISCUSSION: The target sample size was not met. Our findings are compatible with both benefit and harm of pre-exposure prophylaxis with TDF/FTC and HCQ, alone or in combination, compared with placebo.

Expert recommendations for the use of apremilast in psoriatic arthritis.

INTRODUCTION AND OBJECTIVES: Despite the evidence, there are doubts about the positioning of apremilast in the psoriatic arthritis (PsA) treatment algorithm. The objective of this project was to collect the scientific evidence and the experience of a group of rheumatologists who are experts in the management of PsA with apremilast in clinical practice in Spain. MATERIAL AND METHODS: A scientific committee made up of 6 experts proposed 5 clinical scenarios where the evidence on the use of apremilast in PsA was controversial: (i) Efficacy in peripheral PsA; (ii) Efficacy in enthesitis and dactylitis; (iii) Efficacy in PsA with skin involvement; (iv) Comorbidities; and (v) Apremilast safety. After this, a panel of 17 rheumatologists with expertise in PsA management discussed these scenarios and generated a questionnaire with 50 questions and 156 items following the Delphi methodology. This questionnaire was anonymously answered by the panel. RESULTS: After 2 voting rounds, the panel of experts reached consensus in 93 of the 156 items raised (59.6%) (67 in agreement and 26 in disagreement). The degree of consensus was 53.3% in the area of "Efficacy in peripheral PsA"; 60.0% in "Efficacy in enthesitis and dactylitis"; 50.0% in "Efficacy in PsA with skin involvement"; 57.1% in "Management of comorbidities in patients with PsA"; and 67.3% in "Implications of safety in the use of apremilast". CONCLUSIONS: The structured opinion of the experts complements the available evidence and contributes to the establishment of consensual guidelines for the use of apremilast in PsA.

Posttraumatic Stress Disorder, Anxiety, and Depression Symptoms After Potentially Traumatic Events: Latent Classes and Cognitive Correlates.

ABSTRACT: People exposed to potentially traumatic events (PTEs) may develop distinct symptom patterns, which may require different therapeutic approaches. We aimed to identify classes of people exposed to PTEs based on the presence of posttraumatic stress disorder (PTSD) clusters, anxiety, and depression and to explore which cognitive factors (rumination, worry, and negative cognitions) are associated with class membership. Latent class analyses were conducted to identify subgroups of 258 PTE-exposed Spanish adults. A three-class solution emerged: a resilient class with low odds of all symptoms ( n = 188); a partial PTSD class, characterized by partial PTSD clusters, moderate anxiety, and low depression ( n = 36); and a high symptom class, characterized by high PTSD, moderate anxiety, and low depression ( n = 34). These classes related meaningfully to rumination, worry, and negative cognitions. Distinct symptom patterns of PTSD clusters, anxiety, and depression can be distinguished in people exposed to PTEs and relate to cognitive risk factors of psychopathology.