Valoración del estado nutricional antropométrico de escolares venezolanos de 3 a 18 años / Assessment of the anthropometric nutritional status of Venezuelan schoolchildren aged 3 to 18 years

Introducción. La insuficiencia de ingresos en la familia para alimentarse y la inoperancia del programa de alimentación escolar, son factores que afectan el estado nutricional y favorecen el ascenso de la deserción escolar. Objetivo. Determinar el estado nutricional de grupos de niños, niñas y adolescentes de 13 escuelas en comunidades vulnerables. Materiales y métodos. Estudio transversal descriptivo en 7.252 escolares de 3 a 18 años, siete en el estado Bolívar (EB) y seis Distrito Capital (DC) y Estado Miranda (EM), realizado entre mayo y junio, 2019. El análisis se realizó en preescolares de 3 a 5 años y en escolares de 6 a 18 años, según localidad y sexo. Se determinó el estado nutricional con peso-talla (P/T) y talla-edad (T/E) en preescolares y el Índice de Masa Corporal (IMC) en escolares. Valores de referencia y puntos de corte OMS. Resultados: El porcentaje de desnutrición aguda en preescolares fue (1,5%) en ambas localidades y el riesgo EB 3,1% y DC-EM 3,3%. RC 8,2%, más alto EB (8,5%) y en sexo masculino (8,2%). En escolares, la delgadez- delgadez severa (6%), la talla baja y muy baja (6,8%) y el sobrepeso muy bajo (1%-1,4%). Conclusión. En los preescolares, el RC supera la DA, resultados que resumen la magnitud del retraso en los primeros 1.000 días y el impacto de la desnutrición infantil que va dejando huella en la talla baja. Las cifras de desnutrición aguda, retraso de crecimiento y delgadez más bajas que en otros estudios, posiblemente reflejan la presencia de algunos factores de protección que se deben investigar(AU)

Introduction. Insufficient income in the family to feed themselves and the ineffectiveness of the school feeding program are factors that affect the nutritional status and favor the rise of school dropouts. Objective. Determine the nutritional status of a group of children and adolescents from 13 schools in vulnerable communities. Materials and methods. Descriptive cross-sectional study in 7,252 schoolchildren from 3 to 18 years old, seven in the Bolívar state (EB) and six in the Capital District (DC) and Miranda State (EM), carried out between May and June, 2019. The analysis was carried out in preschoolers of 3 to 5 years and in schoolchildren from 6 to 18 years, according to location and sex. Nutritional status was determined with weight-height (W/T) and height-age (T/E) in preschoolers and the Body Mass Index (BMI) in schoolchildren. Reference values and WHO cut-off points. Results: The percentage of acute malnutrition in preschool children was (1.5%) in both localities and the EB risk was 3.1% and DC-EM 3.3%. CR 8.2%, higher EB (8.5%) and male (8.2%). In schoolchildren, thinness-severe thinness (6%), short and very short stature (6.8%) and very low overweight (1%-1.4%). Conclusion. In preschool children, the CR exceeds the AD, results that summarize the magnitude of the delay in the first 1,000 days and the impact of child malnutrition that leaves its mark on short stature. The lower figures for acute malnutrition, growth retardation and thinness than in other studies possibly reflect the presence of some protective factors that should be investigated(AU)

Structural equation models for slaughtering weight prediction for broilers.

The aim of this research was to determine the effect of gut health parameters on the flock's final weight of broilers and to calculate an accurate equation to estimate this weight with information available at 7, 14, and 21 days, in field conditions. Gut health parameters (gizzard erosion, coccidiosis, feed passage, and redness, gut tone, consistency of content, and presence of mucus for each part of the small intestine [duodenum, jejunum, and ileum], and color, consistency, and presence of gas for caeca content) were evaluated at 7 and 14 days. Other parameters evaluated for impact on flock final weight were body weight and mortality, both at 7, 14, and 21 days; stocking density; litter reuse; and downtime period. Structural equation model evaluation of the data showed that stocking density and litter reuse did not affect (P > 0.05) flock final weight, while downtime period, body weight (14 and 21 days), and mortality (14 and 21 days) directly affected (P ≤ 0.05) the flock final weight. Gut health parameters did not directly affect the flock's final weight; however, they affected body weight and mortality at 14 days, thus showing an indirect effect on the flock's final weight. It was also possible to determine two accurate equations to estimate the flock's final weight using information available at both 14 (R2 = 0.56) and 21 (R2 = 0.77) days.

Genes and SNPs Involved with Scrotal and Umbilical Hernia in Pigs.

Hernia is one of the most common defects in pigs. The most prevalent are the scrotal (SH), inguinal (IH) and umbilical (UH) hernias. We compared the inguinal ring transcriptome of normal and SH-affected pigs with the umbilical ring transcriptome of normal and UH-affected pigs to discover genes and pathways involved with the development of both types of hernia. A total of 13,307 transcripts was expressed in the inguinal and 13,302 in the umbilical ring tissues with 94.91% of them present in both tissues. From those, 35 genes were differentially expressed in both groups, participating in 108 biological processes. A total of 67 polymorphisms was identified in the inguinal ring and 76 in the umbilical ring tissue, of which 11 and 14 were novel, respectively. A single nucleotide polymorphism (SNP) with deleterious function was identified in the integrin α M (ITGAM) gene. The microtubule associated protein 1 light chain 3 γ (MAP1LC3C), vitrin (VIT), aggrecan (ACAN), alkaline ceramidase 2 (ACER2), potassium calcium-activated channel subfamily M α 1 (KCNMA1) and synaptopodin 2 (SYNPO2) genes are highlighted as candidates to trigger both types of hernia. We generated the first comparative study of the pig umbilical and inguinal ring transcriptomes, contributing to the understanding of the genetic mechanism involved with these two types of hernia in pigs and probably in other mammals.

Asociación entre el diámetro apendicular tomográfico y el diagnóstico anatomopatológico de apendicitis aguda en el Hospital Militar Central entre 2015-2019 / Association between tomographic appendicular diameter and the pathological diagnosis of acute appendicitis in the Central Military Hospital between 2015-2019

RESUMEN Objetivo: identificar la asociación entre el diámetro apendicular tomográfico y el diagnóstico anatomopatológico en pacientes con sospecha clínica de apendicitis aguda del Hospital Militar Central entre 2015 y 2019; y determinar la validez diagnóstica de dicho signo tomográfico. Materiales y métodos: se realizó un estudio analítico de corte transversal. La muestra obtenida fue de 104 pacientes post apendicectomizados del Hospital Militar Central desde 2015 a 2019, que contaron con informe tomográfico por sospecha clínica de apendicitis aguda y análisis anatomopatológico de la pieza operatoria. Se reportaron frecuencias absolutas y porcentajes de las variables de estudio, seguido de un análisis bivariado mediante la prueba exacta de Fisher. Asimismo, se estimaron razones de prevalencia (RP) mediante una regresión de Poisson para los criterios tomográficos y se realizaron los cálculos de pruebas de validez diagnóstica de cada criterio tomográfico. Resultados: de 104 pacientes, el 35% tuvo de 18 a 30 años, el 69% fueron de sexo masculino; 86 pacientes fueron confirmados por anatomopatología; de los cuales, 70 pacientes presentaron diámetro apendicular ≥ 6 mm. Se observó que el diámetro apendicular, el grosor de la pared, la alteración de la grasa periapendicular y el líquido libre tuvieron diferencias estadísticamente significativas en relación al resultado anatomopatológico. Además, el diámetro apendicular tuvo una sensibilidad de 81,4%, especificidad de 55,5%, valor predictivo positivo de 89,7% y valor predictivo negativo de 38,4%. Conclusiones: un diámetro apendicular ≥ 6 mm se asocia a una probabilidad de 1,45 veces de que el resultado anatomopatológico sea positivo en pacientes con sospecha clínica de apendicitis aguda.

ABSTRACT Objective : to identify the association that exists between tomographic appendicular diameter and pathological diagnosis in patients with clinical suspicion of acute appendicitis from the Central Military Hospital from 2015 to 2019 and determine the diagnostic validity. Materials and methods : a cross-sectional analytical study was conducted. The sample was 104 post- appendectomized patients from the Central Military Hospital from 2015 to 2019, who had a tomographic report due to clinical suspicion of acute appendicitis and anatomopathological analysis of the operative part. Frequency tables, a bivariate analysis (Fisher's test), prevalence ratios (PR) were estimated using Poisson regression and diagnostic validity tests for each of the tomographic criteria were made. Results : of 104 patients, 35% were 18 to 30 years old, 69% were male; 86 patients were confirmed by pathology; of which, 70 of them presented appendicular diameter ≥ 6 mm. It was observed that the appendicular diameter, the wall thickness, the alteration of the periapendicular fat and the free fluid had statistically significant differences in relation to the pathological result. The appendicular diameter had a sensitivity of 81.4%, specificity of 55.5%, positive predictive value of 89.7% and negative predictive value of 38.4%. Conclusions : an appendicular diameter ≥ 6 mm is associated with a probability of 1.45 times that the pathological result is positive in patients with clinical suspicion of acute appendicitis.

Aproximación a la alimentación y nutrición en dos comunidades pobres de Venezuela / Approach to food and nutrition in two poor communities in eastern Venezuela

En los últimos 20 años han ocurrido cambios que han impactado directamente en la calidad de vida y en la alimentación de la población, incrementando la prevalencia de subalimentados debido a la dificultad en la adquisición de alimentos en cantidad y calidad adecuada para cubrir sus necesidades. Se aplicó una encuesta entre los meses de octubre - diciembre de 2019, en 80 hogares, que participaron de manera voluntaria. El 75% de las encuestadas fueron mujeres solteras jefas de hogar, quienes percibieron mensualmente entre 3,2 a 3,8 $ de ingreso. En estos hogares el consumo más frecuente fue de 10 alimentos, entre ellos, sal, azúcar, café, harina de maíz, aceite, margarina y arroz, en menor cantidad, los alimentos fuente de proteínas animal y alimentos ricos en vitaminas y minerales como frutas y vegetales. Además 59,2% de las familias reportaron haber reducido el número de comidas, el tamaño de las raciones y algunos de los adultos dejaron de comer para alimentar a los niños. La mayoría de los entrevistados no pudo cubrir la alimentación y la deficiencia de servicios básicos, contribuyo agravar la situación. Se observó un estado de inseguridad alimentaria, alto desempleo, migración masculina, bajo nivel educativo, CLAP irregulares, alta vulnerabilidad de inseguridad alimentaria, en hogares con jefes de hogar mujeres. Es indispensable rediseñar las políticas sociales y de seguridad alimentaria enfocados a estimular el empleo, la capacitación, mejorar los servicios, el ingreso, la disponibilidad y el acceso a los alimentos, la calidad de vida y la salud de las personas(AU)

In the last 20 years there have been changes that have directly impacted the quality of life and the diet of the population, increasing the prevalence of the undernourished due to the difficulty in acquiring food in adequate quantity and quality to meet their needs. A survey was applied between the months of October - December 2019, in 80 households, which participated voluntarily. 75% of the surveys were single women heads of household, who earned between $ 3.2 and $ 3.8 in monthly income. In these households, the most frequent consumption were 10 foods, among them, salt, sugar, coffee, corn flour, oil, margarine, and rice, in less quantity, sources of animal proteins and foods rich in vitamins and minerals such as fruits and vegetables. Furthermore, 59.2% of the families reported having reduced the number of meals, the size of the portions and some of the adults had stopped eating to feed their children. Most of the interviewees could not cover food security and the lack of basic services, contributed to aggravating the situation. A situation of food insecurity, high unemployment, male migration, low educational level, irregular CLAP distribution, high vulnerability of food insecurity, was observed in households with female heads of household. It is essential to redesign social and food security policies focused on stimulating employment, training, improving services, income, availability and access to food, quality of life and people's health(AU)

Genome Association Study for Visual Scores in Nellore Cattle Measured at Weaning.

BACKGROUND: Genome-wide association studies (GWAS) are utilized in cattle to identify regions or genetic variants associated with phenotypes of interest, and thus, to identify design strategies that allow for the increase of the frequency of favorable alleles. Visual scores are important traits of cattle production in Brazil because they are utilized as selection criteria, helping to choose more harmonious animals. Despite its importance, there are still no studies on the genome association for these traits. This study aimed to identify genome regions associated with the traits of conformation, precocity and muscling, based on a visual score measured at weaning. RESULTS: Bayesian approaches with BayesC and Bayesian LASSO were utilized with 2873 phenotypes of Nellore cattle for a GWAS. The animals were genotyped with Illumina BovineHD BeadChip, and a total of 309,865 SNPs were utilized after quality control. In the analyses, phenotype and deregressed breeding values were utilized as dependent variables; a threshold model was utilized for the former and a linear model for the latter. The association criterion was the percentage of genetic variance explained by SNPs found in 1 Mb-long windows. The Bayesian approach BayesC was better adjusted to the data because it could explain a larger phenotypic variance for both dependent variables. CONCLUSIONS: There were no large effects for the visual scores, indicating that they have a polygenic nature; however, regions in chromosomes 1, 3, 5, 7, 14, 15, 16, 19, 20 and 23 were identified and explained a large part of the genetic variance.

Agreement between semiquantitative and quantitative Doppler scoring systems for the assessment of synovial pathological vascularisation in rheumatoid arthritis.

OBJECTIVES: To compare colour Doppler (CD) versus power Doppler (PD) semiquantitative and quantitative scoring of synovial vascularisation and to evaluate the relationship between semiquantitative and quantitative scores in patients with rheumatoid arthritis (RA). METHODS: One hundred RA patients underwent B-mode, PD, and CD assessments of 12 joints at two European centres. Each joint with synovial hypertrophy (SH) detected on B-mode was semiquantitatively scored (0-3) for PD (SPD score) and CD (SCD score) synovial signal. PD and CD synovial signal were also quantitatively scored (0-100%) (QPD and QCD scores, respectively) using a software integrated in the US equipment for counting the colour fraction. RESULTS: We found SH in 184 joints. SPD and SCD agreed in 92.3% (95%CI: 88.4; 96.2%) of paired scores, with Kendall rank correlation coefficient tau-b=0.95. QPD and QCD scores were highly correlated (Pearson's coefficient=0.70) but Blamd-Altman plot showed insufficient agreement, being the QCD scores systematically slightly higher than the QPD scores. The comparison of mean values of QPD and QCD between scores of SPD and SCD, respectively, showed significant differences between grade 0 and grade 1 (p<0.001), and grade 2 and grade 3 (p=0.042 and p=0.007, respectively) but not between grade 1 and 2 (p=0.154 and p=0.150, respectively). CONCLUSIONS: The SPD and SCD scores were concordant and the QPD and QCD scores highly correlated but were not concordant. There was an overlap between SPD and SCD mild and moderate scores regarding QPD and QCD scores.

Evolución de la recuperación de la sensibilidad posterior a osteotomía sagital de rama mandibular bilateral / Evolution of sensory recovery following mandibular bilateral sagittal split osteotomy

Introducción. La osteotomía sagital de rama mandibular bilateral es uno de los procedimientos quirúrgicos más comunes durante la cirugía ortognática. Con relación a ello se han descrito múltiples reportes que indican cambios a nivel neurosensitivo en el nervio alveolar inferior. Los rangos posquirúrgicos de parestesia han sido descritos entre un 12,5 y el 100%. El objetivo de este trabajo fue determinar el porcentaje de recuperación sensitiva del territorio inervado por el nervio alveolar inferior después de una osteotomía sagital de rama mandibular bilateral durante el primer año postoperatorio. Método. Se incluyó a 32 pacientes con dismorfosis dentofacial de clase II y III; el procedimiento quirúrgico debía involucrar osteotomía sagital de rama mandibular bilateral. Se realizó seguimiento a 1, 3, 6, 9 meses y al primer año postoperatorio. La evaluación incluyó el uso de monofilamentos de tipo von Frey en un área de mentón cuadriculada estandarizada en cada paciente, un cuestionario y una escala de hipoestesia. El umbral para significación estadística fue una p < 0,05. Los resultados se presentan con relación al área estudiada, género, clase esqueletal y técnica quirúrgica. Resultados. La recuperación neurosensitiva del nervio alveolar inferior alcanzó un 74% total al 1.er año postoperatorio. El promedio de recuperación de la sensibilidad en las 8 zonas de la cuadrícula de la región mentoniana fue de un 65%. Conclusiones. Los sujetos estudiados alcanzaron una recuperación de la sensibilidad clasificada como hipoestesia moderada al primer año postoperatorio. El género femenino alcanzó mayores valores de recuperación (83 vs. 69%) y en un menor tiempo que el género masculino. Destacamos el uso de 3 métodos de evaluación que nos permiten comparar lo objetivo y subjetivo, obteniendo resultados concordantes entre sí (AU)

Introduction. Bilateral sagittal split osteotomy is one of the most common surgical procedures performed during orthognathic surgery. Postoperative reports have described neurosensory changes related to the inferior alveolar nerve. Paresthesia has been described in relation to its damage ranging between 12.5 and 100%. The aim of this study was to determine the percentage of sensitive recovery in the compromised area after bilateral sagital split osteotomy during the first postoperative year. Method. The study included 32 patients with class II and class III dentofacial deformity. Surgical procedure must include bilateral sagittal split osteotomy. Follow-up was performed at 1st, 3rd, 6th, 9th and 12th postoperative months. The evaluated area was determined by a novel technique that consists in dividing the chin in squares of 8 equal parts. Sensorial recovery was tested using calibrated von Frey monofilaments. Results are displayed in relation to the studied area, gender, skeletal class and surgical technique. Statistical significance was accepted with a P<.05. Results. In this study, the inferior alveolar nerve reached 74% recovery rate after the first postoperative year. The average sensitivity recovery, over the chin region, in the eight-grid zone was 65%. Conclusion. Studied subjects reached a sensitivity recuperation that could be classified as mild hypoesthesia after the first year since surgery. The female population reached higher recovery values (83 vs. 69%) than the male population. They also seem to recover in less time than males. Importantly, we have observed that the use of these 3 methods of evaluation allow us to compare the objective and subjective characteristics of the population with similar results (AU)

Prevalencia de Leptospirosis en Colombia: revisión sistemática de literatura / Prevalence of leptospirosis in Colombia: systematic literature review

RESUMEN Objetivo Realizar una revisión sistemática de literatura para identificar las prevalencias de leptospirosis en Colombia en el periodo de tiempo comprendido entre los años 2000 y 2012. Materiales y Métodos Se seleccionaron estudios descriptivos, realizados y publicados durante los años 2000 y 2012 sobre prevalencias de leptospirosis en humanos, animales y medio ambiente, por métodos diagnósticos de Microaglutinación (MAT) e Inmunoensayo (ELISA). Dentro de los criterios de exclusión, se tuvieron en cuenta estudios en idiomas diferentes al español, inglés y portugués, con determinación de prevalencias de leptospirosis por Inmunofluorescenia (IFI), o sueroaglutinación (SAT). Resultados De 91 artículos revisados en las diferentes bases de datos se seleccionaron 18 que cumplieron con los criterios de inclusión, los cuales determinaron prevalencias de leptospirosis en hombres, caninos, bovinos, porcinos, primates y roedores, en los departamentos de Atlántico, Antioquia, Meta, Córdoba, Risaralda, Tolima, Boyacá, Quindío y Valle del Cauca. Conclusiones La revisión sistemática permitió determinar cuáles son los departamentos de país donde se concentra la investigación en leptospirosis y los autores que cuentan con mayor número de publicaciones sobre prevalencias. De igual manera se pudo evidenciar que las prevalencias encontradas están entre 6% y el 35% para humanos, 41% y 60,9% para bovinos, 10,3% para porcinos, 12% y 47,14% para caninos, 23,07% para primates no humanos y entre el 25% y el 82,7% en roedores, siendo las más altas. Los serovares de mayor circulación fueron Icterohaemorrhagiae, Grippotyphosa, y Canicola.(AU)

ABSTRACT Objective To conduct a systematic literature review to identify the prevalence of leptospirosis in Colombia between 2000 and 2012. Methods Descriptive studies conducted and published between 2000 and 2012 on the prevalence of leptospirosis in humans, animals and the environment using microagglutination (MAT) and immunoassay (ELISA) diagnostic methods, were selected. The exclusion criteria included studies in languages other than Spanish, English and Portuguese, in which the prevalence of leptospirosis was determined by immunofluorescence (IF), or serum agglutination test (SAT). Results Out of 91 articles reviewed in the different databases, 18 were selected since they met the inclusion criteria, which sought to determine the prevalence of leptospirosis in humans, canines, cattle, pigs, primates and rodents in the Atlántico, Antioquia, Meta, Córdoba, Risaralda, Tolima, Boyacá, Quindío and Valle del Cauca departments. Conclusions The systematic review allowed to determine the departments of the country where leptospirosis research is concentrated, as well as the authors with the highest number of publications on prevalence. The prevalence was found to be between 6% and 35% in humans, 41% and 60.9% in cattle, 10.3% in pigs, 12% and 47.14% in canines, 23.07 % in non-human primates, and the highest figure, between 25% and 82.7% in rodents, showing that the most frequent serovars were Icterohaemorrhagiae, Grippotyphosa and Canicola.(AU)

[Prevalence of leptospirosis in Colombia: systematic literature review]. / Prevalencia de Leptospirosis en Colombia: revisión sistemática de literatura.

OBJECTIVE: To conduct a systematic literature review to identify the prevalence of leptospirosis in Colombia between 2000 and 2012. METHODS: Descriptive studies conducted and published between 2000 and 2012 on the prevalence of leptospirosis in humans, animals and the environment using microagglutination (MAT) and immunoassay (ELISA) diagnostic methods, were selected. The exclusion criteria included studies in languages other than Spanish, English and Portuguese, in which the prevalence of leptospirosis was determined by immunofluorescence (IF), or serum agglutination test (SAT). RESULTS: Out of 91 articles reviewed in the different databases, 18 were selected since they met the inclusion criteria, which sought to determine the prevalence of leptospirosis in humans, canines, cattle, pigs, primates and rodents in the Atlántico, Antioquia, Meta, Córdoba, Risaralda, Tolima, Boyacá, Quindío and Valle del Cauca departments. CONCLUSIONS: The systematic review allowed to determine the departments of the country where leptospirosis research is concentrated, as well as the authors with the highest number of publications on prevalence. The prevalence was found to be between 6% and 35% in humans, 41% and 60.9% in cattle, 10.3% in pigs, 12% and 47.14% in canines, 23.07 % in non-human primates, and the highest figure, between 25% and 82.7% in rodents, showing that the most frequent serovars were Icterohaemorrhagiae, Grippotyphosa and Canicola.

OBJETIVO: Realizar una revisión sistemática de literatura para identificar las prevalencias de leptospirosis en Colombia en el periodo de tiempo comprendido entre los años 2000 y 2012. MATERIALES Y MÉTODOS: Se seleccionaron estudios descriptivos, realizados y publicados durante los años 2000 y 2012 sobre prevalencias de leptospirosis en humanos, animales y medio ambiente, por métodos diagnósticos de Microaglutinación (MAT) e Inmunoensayo (ELISA). Dentro de los criterios de exclusión, se tuvieron en cuenta estudios en idiomas diferentes al español, inglés y portugués, con determinación de prevalencias de leptospirosis por Inmunofluorescenia (IFI), o sueroaglutinación (SAT). RESULTADOS: De 91 artículos revisados en las diferentes bases de datos se seleccionaron 18 que cumplieron con los criterios de inclusión, los cuales determinaron prevalencias de leptospirosis en hombres, caninos, bovinos, porcinos, primates y roedores, en los departamentos de Atlántico, Antioquia, Meta, Córdoba, Risaralda, Tolima, Boyacá, Quindío y Valle del Cauca. CONCLUSIONES: La revisión sistemática permitió determinar cuáles son los departamentos de país donde se concentra la investigación en leptospirosis y los autores que cuentan con mayor número de publicaciones sobre prevalencias. De igual manera se pudo evidenciar que las prevalencias encontradas están entre 6% y el 35% para humanos, 41% y 60,9% para bovinos, 10,3% para porcinos, 12% y 47,14% para caninos, 23,07% para primates no humanos y entre el 25% y el 82,7% en roedores, siendo las más altas. Los serovares de mayor circulación fueron Icterohaemorrhagiae, Grippotyphosa, y Canicola.

Intravenous administration of expanded allogeneic adipose-derived mesenchymal stem cells in refractory rheumatoid arthritis (Cx611): results of a multicentre, dose escalation, randomised, single-blind, placebo-controlled phase Ib/IIa clinical trial.

OBJECTIVES: To evaluate the safety and tolerability of the intravenous administration of Cx611, a preparation of allogeneic expanded adipose-derived stem cells (eASCs), in patients with refractory rheumatoid arthritis (RA), as well as to obtain preliminary clinical efficacy data in this population. METHODS: It is a multicentre, dose escalation, randomised, single-blind (double-blind for efficacy), placebo-controlled, phase Ib/IIa clinical trial. Patients with active refractory RA (failure to at least two biologicals) were randomised to receive three intravenous infusions of Cx611: 1 million/kg (cohort A), 2 million/kg (cohort B), 4 million/kg (cohort C) or placebo, on days 1, 8 and 15, and they were followed for therapy assessment for 24 weeks. RESULTS: Fifty-three patients were treated (20 in cohort A, 20 in cohort B, 6 in cohort C and 7 in placebo group). A total of 141 adverse events (AEs) were reported. Seventeen patients from the group A (85%), 15 from the group B (75%), 6 from the group C (100%) and 4 from the placebo group (57%) experienced at least one AE.Eight AEs from 6 patients were grade 3 in intensity (severe), 5 in cohort A (lacunar infarction, diarrhoea, tendon rupture, rheumatoid nodule and arthritis), 2 in cohort B (sciatica and RA) and 1 in the placebo group (asthenia). Only one of the grade 3 AEs was serious (the lacunar infarction). American College of Rheumatology 20 responses for cohorts A, B, C and placebo were 45%, 20%, 33% and 29%, respectively, at month 1, and 25%, 15%, 17% and 0%, respectively, at month 3. CONCLUSIONS: The intravenous infusion of Cx611 was in general well tolerated, without evidence of dose-related toxicity at the dose range and time period studied. In addition, a trend for clinical efficacy was observed. These data, in our opinion, justify further investigation of this innovative therapy in patients with RA. TRIAL REGISTRATION NUMBERS: EudraCT: 2010-021602-37; NCT01663116; Results.

Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjögren Syndrome.

OBJECTIVE: To evaluate the multiobserver reliability of salivary gland ultrasonography (SGUS) for scoring greyscale (GS) parenchymal inhomogeneity and parenchymal color Doppler (CD) signal in patients with established primary Sjögren syndrome (pSS). METHODS: The study comprised 2 multiobserver reliability assessments in patients with pSS in 2 European centers. The first reliability exercise was performed on 24 patients with pSS and 8 controls who were independently evaluated with GS and CD US by 5 observers at the Institute of Rheumatology, Belgrade, Serbia. The second reliability exercise was carried out on 10 patients with pSS who were independently assessed with GS and CD US by 8 observers at the Hospital G.U. Gregorio Marañón, Madrid, Spain. SGUS parenchymal inhomogeneity and parenchymal CD signal were semiquantitatively scored using a 4-grade scoring system. The multiobserver agreement was calculated by the overall agreement and Light's κ statistics. RESULTS: A total of 640 SGUS examinations were performed in the first reliability exercise and a total of 320 examinations in the second reliability exercise. Multiobserver reliability was good (κ = 0.71-0.79) to excellent (κ = 0.81-0.82) for GS parenchymal inhomogeneity in both exercises. There was a moderate (κ = 0.53-0.58) to good (κ = 0.70) multiobserver reliability for parenchymal CD signal in the first exercise. However, there was no agreement or only a fair agreement (κ = 0.03-0.29) for parenchymal CD signal in the second exercise. CONCLUSION: US may be a reliable technique in the multiobserver scoring of GS parenchymal inhomogeneity of major SG in patients with established pSS. CD scoring of SG needs further standardization to be used in multicenter studies.

The feet in systemic lupus erythematosus; are we underestimating their involvement and functional impact?

OBJECTIVES: To evaluate biomechanical and ultrasound (US) abnormalities in SLE patients as compared with controls and to assess the relationship between these abnormalities and SLE activity. METHODS: Fifty-four consecutive female patients with SLE with and without foot pain and 60 female controls (30 with foot pain and 30 without foot pain) were recruited. SLE activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). SLE patients and controls blindly underwent a comprehensive podiatric, biomechanical and US evaluation of the feet. US assessment included detection of B-mode synovitis, tenosynovitis, enthesopathy, bone changes and synovial, tenosynovial and entheseal power Doppler (PD) signal. RESULTS: Thirty-one (57.4%) SLE patients had bilateral foot pain and 5 (9.3%) had unilateral foot pain. Metatarsalgia was the most common location for pain but without significant difference between groups (p=0.284). Toe joint deformities were significantly more common in SLE feet as compared with control feet (p<0.0005). SLE feet showed significantly more biomechanical abnormalities than control feet (p<0.05). B-mode synovitis in the tibiotalar joint was strongly associated with having SLE (p<0.0005) and the presence of synovial PD signal in the MTP joints was found only in painful feet of SLE patients. SLEDAI was significantly higher in patients with foot pain than in those with painless feet (p=0.008). However, SLEDAI did not discriminate between patients with and without biomechanical or US abnormalities. CONCLUSIONS: SLE patients showed more biomechanical and US abnormalities in the feet than controls, which were not captured by standardised assessment of the disease activity.

How does a cadaver model work for testing ultrasound diagnostic capability for rheumatic-like tendon damage?

To establish whether a cadaver model can serve as an effective surrogate for the detection of tendon damage characteristic of rheumatoid arthritis (RA). In addition, we evaluated intraobserver and interobserver agreement in the grading of RA-like tendon tears shown by US, as well as the concordance between the US findings and the surgically induced lesions in the cadaver model. RA-like tendon damage was surgically induced in the tibialis anterior tendon (TAT) and tibialis posterior tendon (TPT) of ten ankle/foot fresh-frozen cadaveric specimens. Of the 20 tendons examined, six were randomly assigned a surgically induced partial tear; six a complete tear; and eight left undamaged. Three rheumatologists, experts in musculoskeletal US, assessed from 1 to 5 the quality of US imaging of the cadaveric models on a Likert scale. Tendons were then categorized as having either no damage, (0); partial tear, (1); or complete tear (2). All 20 tendons were blindly and independently evaluated twice, over two rounds, by each of the three observers. Overall, technical performance was satisfactory for all items in the two rounds (all values over 2.9 in a Likert scale 1-5). Intraobserver and interobserver agreement for US grading of tendon damage was good (mean κ values 0.62 and 0.71, respectively), with greater reliability found in the TAT than the TPT. Concordance between US findings and experimental tendon lesions was acceptable (70-100 %), again greater for the TAT than for the TPT. A cadaver model with surgically created tendon damage can be useful in evaluating US metric properties of RA tendon lesions.

Structural damage in rheumatoid arthritis: comparison between tendon damage evaluated by ultrasound and radiographic damage.

OBJECTIVE: To compare structural damage assessed by conventional radiography and tendon damage assessed by musculoskeletal US (MSUS) at wrist and ankle in RA patients. METHODS: We evaluated 72 consecutive patients [56 (77.8%) females] with RA. The MSUS evaluation consisted in a B-mode examination of bilateral extensor carpi ulnaris and tibialis posterior tendons. Tendon damage was defined and scored according to OMERACT. A total score for the tendon damage score (TDS) was calculated by summing the grades for each tendon. For the radiographic evaluations we used the van der Heijde score; a total radiographic score (RTS) was calculated by summing a bone erosion score (ERS) and a joint space narrowing score (JSNS). RESULTS: We evaluated 288 tendons. The mean (s.d.) of TDS was 2.3 (1.8). Fifty-four (75%) patients presented tendon damage of at least one tendon. From all evaluated tendons, 134 (46.5%) had no tendon damage, 146 (50.7%) had grade 1 and 8 (2.8%) had grade 2 tendon damage. The mean (s.d.) for RTS was 91.4 (97), for ERS was 47.3 (61.9) and for JSNS was 44.1 (37.2). We found a significant correlation between disease duration and both TDS and RTS (r = 0.413 and r = 0.560, respectively; P < 0.0001). We found a good significant correlation between TDS and all variables of radiographic structural damage (RTS, r = 0.65; ERS, r = 0.637; JSNS, r = 0.618; P < 0.001). CONCLUSION: The MSUS assessment of only four tendons can be an additional feasible method to assess structural damage in RA patients.

Ultrasound-detected activity in rheumatoid arthritis on methotrexate therapy: Which joints and tendons should be assessed to predict unstable remission?

The aim of the study was to investigate the predictive value of different reduced joint ultrasound (US) assessments of synovitis and tenosynovitis in relation to unstable remission in a cohort of rheumatoid arthritis (RA) patients on methotrexate therapy. Forty-seven RA patients (38 women, 9 men), being treated with methotrexate (MTX), in clinical remission as judged by their consultant rheumatologist were evaluated for disease activity according to the Disease Activity Score (DAS) 28 at baseline and 6 months. Sustained remission and unstable remission were defined according to the baseline and 6-month DAS28 and changes in RA therapy during the follow-up. Each patient underwent at baseline a B-mode and power Doppler (PD) assessment of 44 joints and 20 tendons/tendon compartments by a rheumatologist blinded to the clinical and laboratory data. B-mode synovial hypertrophy (SH), synovial PD signal, B-mode tenosynovitis, and Doppler tenosynovitis were scored 0-3. The presence and index of synovial PD signal in 44 joints [odds ratio (OR) 8.21 (p = 0.016) and OR 2.20 (p = 0.049), respectively] and in 12 joints [OR 5.82 (p = 0.041) and OR 4.19 (p = 0.020), respectively], the presence of SH in wrist and MCP joints [OR 4.79 (p = 0.045)], and the presence of synovial PD signal in wrist-MCP-ankle-MTP joints [OR 4.62 (p = 0.046)] were predictors of unstable remission. The 12-joint or wrist-hand-ankle-MTP US assessments can predict unstable remission in RA patients in apparent clinical remission being treated with MTX.

Investigating the link between disease activity and infliximab serum levels in rheumatoid arthritis patients.

OBJECTIVES: The aim of this study was to examine the extent to which infliximab (IFX) serum levels impact disease activity in rheumatoid arthritis (RA) patients. METHODS: In this cross sectional study, serum samples were taken prior to drug infusion from 60 RA patients who had been undergoing IFX therapy > 12 months as a first line of biological treatment. Patient IFX levels were tested and then associated with clinical disease activity. Three DAS28 cut-off points, <2.6, <3.2 and <5.1 were used to determine whether detectable IFX levels were any predictor of clinical disease activity. Logistic regression analysis was run to check other possible factors associated with RA clinical outcomes such as MTX concomitant use, CRP and ESR. RESULTS: Sixteen (27%) out of the 60 patients tested negative; 28 (46%) presented subtherapeutic and 16 (27%) therapeutic IFX levels. Median IFX levels were higher in patients either in remission or showing low disease activity than in those with moderate and high disease activity (p=0.014). Significant association was found between IFX levels and clinical disease activity (p=0.001). Detectable levels of IFX shows better sensitivity and specificity to identify patients with DAS28<3.2 than to identify patients with DAS28<2.6 or DAS28<5.1. Conversely, the best DAS28 cut-off to identify detectable/undetectable IFX was 3.19, with AUC under ROC curve 0.804 (Sd.E 0.070), 76% specificity and 83% sensitivity (p<0.001). MTX use, CRP and ESR did not interfere with this association. Seven out of the 8 patients with anti-IFX antibodies presented DAS28>3.2 (p=0.005). CONCLUSIONS: DAS28 and IFX serum levels were shown to have an inverse correlation. Undetectable IFX serum levels were associated to RA patients presenting DAS28>3.2 meaning that DAS28 <3.2 may be useful to clinicians to evaluate patient response to drug therapy.

Impact of musculoskeletal ultrasound on clinical practice in paediatric rheumatology.

OBJECTIVES: Musculoskeletal ultrasound (MSUS) is an imaging technique increasingly used in paediatric rheumatology. The aim of our study was to evaluate the extent to which MSUS may influence the diagnosis and management decisions in daily clinical practice in paediatric rheumatology. METHODS: All child patients attending our PR unit over a 3-month period were included. A consultant rheumatologist assessed juvenile patients and weighted the need for MSUS assessment under a Likert scale from 0 (not necessary) to 5 (very necessary) with scanning performed when the Likert score was greater than 0. The rheumatologist completed a questionnaire used to report previous and current diagnosis, therapeutic decisions and disease activity. An assistant rheumatologist who was blinded to the questionnaire carried out the MSUS scanning of selected joints. After MSUS examination, a second questionnaire was completed by the consultant rheumatologist reporting changes in diagnosis and systemic and local treatment, if applicable. RESULTS: We included 111 patients [73 (65.8%) female]. Fifteen (13.5%) were new patients and 96 (86.5%) follow-up patients. Fifty-one (45.9%) patients were diagnosed with JIA. 65 (58.6%) patients qualified for MSUS. A total of 108 joints from 65 patients were clinically assessed with 93 (86.1%) joints deemed to require complementary MSUS assessment (mean assessed joints 1.4 per patient). Of the 65 patients undergoing MSUS, 38 (58.5%) patients there was a change in diagnosis, therapeutic decisions or both following the MSUS information. CONCLUSIONS: MSUS may play a significant role in local diagnosis and therapeutic decisions among follow-up JIA patients and could help in the management of rheumatic diseases in children. Further longitudinal studies are needed to confirm the impact of MSUS in paediatric rheumatology.

Predictive value of Doppler ultrasound-detected synovitis in relation to failed tapering of biologic therapy in patients with rheumatoid arthritis.

OBJECTIVE: To investigate the predictive value of synovitis detected by Doppler US in relation to failed tapering of biologic therapy (BT) in RA patients in sustained clinical remission. METHODS: A total of 77 RA patients (52 women, 25 men) in sustained clinical remission, treated with a stable dosage of BT were prospectively recruited. BT was tapered according to an agreed strategy implemented in clinical practice (i.e. increasing the interval between doses for s.c. BT and reducing the dose for i.v. BT). BT tapering failure was assessed at 6 and 12 months. Doppler US investigation of 42 joints for the presence and grade (0-3) of B-mode synovial hypertrophy and synovial power Doppler signal (i.e. Doppler synovitis) was performed at baseline by a rheumatologist blinded to clinical and laboratory data. Hand and foot radiographs were obtained at baseline and at 12-month follow-up. RESULTS: Of the 77 patients, 46 (59.7%) were on s.c. BT and 31 (40.3%) on i.v. BT. At 12 months, 35 patients (45.5%) presented BT tapering failure, 23 of them (29.9% of all patients) in the first 6 months of BT tapering. In logistic regression analysis, the baseline DAS28 and the global score of Doppler synovitis were identified as independent predictors of BT tapering failure at 12 and 6 months. The presence of Doppler synovitis was the strongest predictor for BT tapering failure. No patient showed radiographic progression. CONCLUSION: Our results suggest that the presence of Doppler-detected synovitis may predict BT tapering failure in RA patients in sustained clinical remission.

Comparison between full and tapered dosages of biologic therapies in psoriatic arthritis patients: clinical and ultrasound assessment.

The primary objective of this study was to describe and compare clinical and musculoskeletal (MS) ultrasound (US) features between psoriatic arthritis (PsA) patients treated with full and tapered dosage of biologic (b) disease-modified antirheumatic drugs (DMARDs). The secondary objective was to compare clinical and MSUS features between PsA patients treated with bDMARDs with and without concomitant synthetic (s) DMARDs. We evaluated 102 patients with PsA treated with bDMARDs. The bDMARD dosage tapering had been made in patients with a maintained remission or minimal disease activity (MDA) according to their attending rheumatologist and with the patient acceptance. The bDMARD tapering consisted of the following: increase the interval between doses for subcutaneous bDMARDs or reduction of the dose for intravenous bDMARDs. The clinical evaluation consisted of a dermatologic and rheumatologic assessment of disease activity. The presence of B-mode and Doppler synovitis, tenosynovitis, enthesopathy, and paratenonitis was investigated by a rheumatologist blinded to drug dosage, clinical assessments, and laboratory results. Seventy-four (72.5 %) patients received full dosage of bDMARDs and 28 (27.5 %) received tapered dosage. The duration with biologic therapy and with current biologic therapy was significantly higher in patients with tapered dosages (p = 0.008 and p = 0.001, respectively). We found no significant differences between clinical, laboratory, and US variables, both for BM and CD between patients with full and tapered dosage and between patients with and without concomitant sDMARD. Clinical assessment, MSUS variables, and MDA status are similar in patients receiving full and tapered dosage of bDMARDs.