ADA_ETA_BIO2021: real-world evaluation of adherence, persistence, and cost-effectiveness of originator and biosimilar biologic drugs in the treatment of rheumatoid arthritis: a multicenter study in Italy.

OBJECTIVES: The objective was to assess the adherence, persistence, and costs of bDMARDs through a multicentre study of nine Italian hospital pharmacies. METHODS: The drugs analysed were Abatacept, Adalimumab, Certolizumab, Etanercept, Golimumab and Tocilizumab.Adult subjects with Rheumatoid Arthritis were considered in the analysis.In this study, we calculated the following metrics: Adherence to treatment was evaluated as dose-intensity, which is the ratio between the amount of medication received and probably taken by the patient at home (Received Daily Dose, RDD) and the amount prescribed by the clinician (Prescribed Daily Dose, PDD). Persistence was calculated as the number of days between the first and last dispensing of the same drug. Lastly, costs were assessed based on persistence to treatment and normalized for adherence. RESULTS: Adherence to treatment was found to be above 0.8 for all drugs studied. The median persistence for a 5-year treatment period was 1.4 years for Abatacept, 1.7 years for Adalimumab, 1.8 years for Certolizumab, 1.4 years for Etanercept, 1.3 years for Golimumab, and 1.6 years for Tocilizumab. CONCLUSIONS: This multicentre retrospective observational study of bDMARDs used in the treatment of RA showed that, for all the drugs studied, there was no problem with adherence to treatment but rather a difficulty in maintaining treatment with the same drug over time.

A survey on preferences, attitudes, and perspectives of Italian urology trainees: implications of the novel national residency matching program.

BACKGROUND: Since 2014, a new residency program selection process has been established with a national examination. The aim of this study was to assess characteristics, career goals, and practice preferences of current Italian urology residents. METHODS: A web-based survey of 25 items performed from May 2021 to September 2021 was sent to 585 Italian urology residents. Descriptive analyses were conducted to describe the surveys' domains: demographics characteristics, studies, plans for fellowship training, interest in the urology field, and career expectations. RESULTS: Four hundred and one residents completed the online survey (response rate 68.5%). Most residents were male (70.3%), with a median of 29 (IQR 28-31) years. Urology was the first chosen School in 325 (81.0%) cases, and 174 (43.4%) trainees have chosen to remain in the same University. Uro-oncology was the main field, and endourology the main subspeciality of interest, respectively. More than 40.0% of residents expressed a good level of satisfaction for the training urological course. 232 (57.2%) residents were strongly interested in seeking a hospital career, followed by private career (43.4%) and academic career (20%). CONCLUSIONS: After the introduction of the novel national residency matching program the Italian Urology trainees showed a good satisfaction level. Further improvements of the Italian residency programs should be focused on the training network within and outside the main School of Urology.

Anomalous conduction in one-dimensional particle lattices: Wave-turbulence approach.

One-dimensional particle chains are fundamental models to explain anomalous thermal conduction in low-dimensional solids such as nanotubes and nanowires. In these systems the thermal energy is carried by phonons, i.e., propagating lattice oscillations that interact via nonlinear resonance. The average energy transfer between the phonons can be described by the wave kinetic equation, derived directly from the microscopic dynamics. Here we use the spatially nonhomogeneous wave kinetic equation of the prototypical ß-Fermi-Pasta-Ulam-Tsingou model, to study thermal conduction in one-dimensional particle chains on a mesoscale description. By means of numerical simulations, we study two complementary aspects of thermal conduction: in the presence of thermostats setting different temperatures at the two ends and propagation of a temperature perturbation over an equilibrium background. Our main findings are as follows. (i) The anomalous scaling of the conductivity with the system size, in close agreement with the known results from the microscopic dynamics, is due to a nontrivial interplay between high and low wave numbers. (ii) The high-wave-number phonons relax to local thermodynamic equilibrium transporting energy diffusively, in the manner of Fourier. (iii) The low-wave-number phonons are nearly noninteracting and transfer energy ballistically. These results present perspectives for the applicability of the full nonhomogeneous wave kinetic equation to study thermal propagation.

Adherence, Persistence, and Effectiveness in Real Life. Multicenter Long-Term Study on the Use of Pirfenidone and Nintedanib in the Treatment of Idiopathic Pulmonary Fibrosis.

BACKGROUND: In the treatment of idiopathic pulmonary fibrosis (IPF), nintedanib and pirfenidone, with their different mechanisms of action, lead to a reduction in the rate of progression of the fibrosis process measured by the reduction of functional decline, and, in particular, the decrease in forced vital capacity (FVC) and of the diffusion capacity of the lungs for carbon monoxide (DLCO). The objective of this study was to analyze real-life adherence, persistence and efficacy in the use of pirfenidone and nintedanib in the treatment of IPF. METHODS: A non-interventional multicenter retrospective observational pharmacological study in real-life treat-ment at 1 and 2 years was conducted. Furthermore, we analyzed the levels of FVC and DLCO at 6 and 12 months, respectively, from the start of treatment. RESULTS: We identified 144 patients in the period between January 2013 and April 2019. From the point of view of adherence, there is no difference between the two drugs, even though patients who used pirfenidone had increasingly higher values: 0.90 vs 0.89, in the first year, and 0.91 vs 0.84, in the second year. In the first year of treatment, the percentage of persistent patients was 67% and 76%, while in the second year, it dropped to 47% and 53% for pirfenidone and nintedanib, respectively. CONCLUSION: The stratification of the adherence values as a function of the response to treatment in terms of FVC at 12 months for both study drugs showed that patients with optimal response scored adherence of more than 90%.

Coexistence of Ballistic and Fourier Regimes in the ß Fermi-Pasta-Ulam-Tsingou Lattice.

Commonly, thermal transport properties of one-dimensional systems are found to be anomalous. Here, we perform a numerical and theoretical study of the ß-Fermi-Pasta-Ulam-Tsingou chain, considered a prototypical model for one-dimensional anharmonic crystals, in contact with thermostats at different temperatures. We give evidence that, in steady state conditions, the local wave energy spectrum can be naturally split into modes that are essentially ballistic (noninteracting or scarcely interacting) and kinetic modes (interacting enough to relax to local thermodynamic equilibrium). We show numerically that the well-known divergence of the energy conductivity is related to how the transition region between these two sets of modes shifts in k space with the system size L, due to properties of the collision integral of the system. Moreover, we show that the kinetic modes are responsible for a macroscopic behavior compatible with Fourier's law. Our work sheds light on the long-standing problem of the applicability of standard thermodynamics in one-dimensional nonlinear chains, testbed for understanding the thermal properties of nanotubes and nanowires.

Yield-stress fluids in porous media: a comparison of viscoplastic and elastoviscoplastic flows.

A numerical and theoretical study of yield-stress fluid flows in two types of model porous media is presented. We focus on viscoplastic and elastoviscoplastic flows to reveal some differences and similarities between these two classes of flows. Small elastic effects increase the pressure drop and also the size of unyielded regions in the flow which is the consequence of different stress solutions compare to viscoplastic flows. Yet, the velocity fields in the viscoplastic and elastoviscoplastic flows are comparable for small elastic effects. By increasing the yield stress, the difference in the pressure drops between the two classes of flows becomes smaller and smaller for both considered geometries. When the elastic effects increase, the elastoviscoplastic flow becomes time-dependent and some oscillations in the flow can be observed. Focusing on the regime of very large yield stress effects in the viscoplastic flow, we address in detail the interesting limit of 'flow/no flow': yield-stress fluids can resist small imposed pressure gradients and remain quiescent. The critical pressure gradient which should be exceeded to guarantee a continuous flow in the porous media will be reported. Finally, we propose a theoretical framework for studying the 'yield limit' in the porous media.

Numerical simulations of vorticity banding of emulsions in shear flows.

Multiphase shear flows often show banded structures that affect the global behavior of complex fluids e.g. in microdevices. Here we investigate numerically the banding of emulsions, i.e. the formation of regions of high and low volume fractions, alternated in the vorticity direction and aligned with the flow (shear bands). These bands are associated with a decrease of the effective viscosity of the system. To understand the mechanism of experimentally observed banding, we have performed interface-resolved simulations of the two-fluid system. The experiments were performed starting with a random distribution of droplets, which under the applied shear, evolve in time resulting in a phase separation. To numerically reproduce this process, the banded structures are initialized in a narrow channel confined by two walls moving in opposite directions. We find that the initial banded distribution is stable when droplets are free to merge and unstable when coalescence is prevented. In this case, additionally, the effective viscosity of the system increases, resembling the rheological behavior of suspensions of deformable particles. Droplet coalescence, on the other hand, allows emulsions to reduce the total surface of the system and, hence, the energy dissipation associated with the deformation, which in turn reduces the effective viscosity.

Seasonal DXA-measured body composition changes in professional male soccer players.

This work investigated changes in body composition of professional soccer players attending an Italian Serie A club across the competitive season; it is original insofar as body composition was assessed at multiple time points across the season using the accurate three-compartment model provided by Dual-Energy X-Ray Absorptiometry (DXA). Thirty-one players (4 goalkeepers, 13 defenders, 8 midfielders, 6 forwards) underwent DXA and anthropometry at pre-, mid- and end-season. One operator measured whole body and regional body composition (fat mass, FM; fat-free soft tissue mass, FFSTM; mineral mass). Two players were excluded from analysis due to serious injury. Data were analysed with repeated measures ANOVA; factors were season time point and playing position. Results showed that whole-body FM and %FM significantly (P < 0.001) decrease at mid-season (-11.9%; -1.3%, respectively) and end-season (-8.3%; -0.8%, respectively) whereas FFSTM significantly (P < 0.001) increase at mid-season (+1.3%) and end-season (+1.5%). Limited, but significant changes took place in bone mineral content. Some regional (upper and lower limbs, trunk) differences in the pattern of body composition changes across the season were also found. Changes were similar for all playing positions. It was concluded that professional soccer players undergo changes in their FM, FFSTM, and mineral mass across the season with some regional variations, irrespective of the playing position. Changes are mostly positive at mid-season, possibly due to difference in training between the first and second phase of the season.

Laboratory medicine and sports: between Scylla and Charybdis.

Laboratory medicine is complex and contributes to the diagnosis, therapeutic monitoring and follow-up of acquired and inherited human disorders. The regular practice of physical exercise provides important benefits in heath and disease and sports medicine is thereby receiving growing focus from almost each and every clinical discipline, including laboratory medicine. Sport-laboratory medicine is a relatively innovative branch of laboratory science, which can provide valuable contributions to the diagnosis and follow-up of athletic injuries, and which is acquiring a growing clinical significance to support biomechanics and identify novel genomics and "exercisenomics" patterns that can help identify specific athlete's tendency towards certain types of sport traumas and injuries. Laboratory medicine can also provide sport physicians and coaches with valuable clues about personal inclination towards a certain sport, health status, fitness and nutritional deficiencies of professional, elite and recreational athletes in order to enable a better and earlier prediction of sport injuries, overreaching and overtraining. Finally, the wide armamentarium of laboratory tests represents the milestone for identifying cheating athletes in the strenuous fight against doping in sports.

Does Veritas® play a role in breast reconstruction? a case report.

To reduce operative times and surgical complications in implant-based breast reconstruction, many authors advocate the use of exogenous material (modified xenograft) to support tissue regeneration. In this article, a case is presented in which a bovine collagen patch (Veritas® Collagen Matrix; Synovis Surgical Innovations, St Paul, MN) was used in the immediate breast reconstruction with an implant. The good results obtained in this case confirm Veritas® as a viable alternative to AlloDerm® Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ) and further support its ability to sustain and stimulate recovery of the surrounding tissues.

Measurement of morning saliva cortisol in athletes.

OBJECTIVES: To evaluate feasibility and reliability of measuring saliva cortisol in athletes. DESIGN AND METHODS: Saliva cortisol was measured in 25 soccer players, and compared with serum cortisol measured with two commercial immunoassays. RESULTS: A highly significant correlation was observed between saliva and serum cortisol. The percentage of saliva and serum values above the upper limit of the reference range was nearly identical. CONCLUSIONS: Salivary measurement is a suitable approach for monitoring cortisol in athletes.

Docetaxel as salvage therapy in advanced gastric cancer: a phase II study of the Gruppo Oncologico Italia Meridionale (G.O.I.M.).

BACKGROUND: Docetaxel (DCT), a semisynthetic taxoid, has demonstrated cytotoxic activity against gastric cancer in early phase II studies producing an overall response rate of 17-24%. The Gruppo Oncologico Italia Meridionale (G.O.I.M.) started a confirmatory multicenter phase II trial to evaluate the clinical activity and toxicity of single agent TXT in the treatment of advanced gastric cancer patients who had failed a first-line chemotherapy. MATERIALS AND METHODS: Thirty patients with advanced gastric carcinoma refractory to first-line ECF or PELF chemotherapy were treated with DCT administered at the dosage of 100 mg/mq given as a 1-hour i.v. infusion every three weeks. All patients received a premedication with dexamethasone 8 mg i.v. 12 hours and 1 hour before, and 12 hours after DCT administration. Granulocyte colony stimulating factor was employed in case of febrile neutropenia as needed. The first evaluation of disease status was planned after three cycles. RESULTS: We observed 5 partial responses without any complete response for an overall response rate of 17% (95% CI = 6-36%, intent-to-treat analysis). Nine patients showed stable disease and 14 patients progressed. The duration of objective partial responses were 5, 6, 6, 9 and 12 months, respectively. The median overall survival was 6 months and the 1-year survival rate was 20.6%. No chemotherapy-related toxic death was observed. Haematological grade 3-4 side-effects were respectively: anemia (7%), leucopenia (7%) and neutropenia (18%); in 13 patients (45%) G-CSF was employed to avoid severe leukopenia. CONCLUSION: This multinstitutional single-step phase II study confirms that single-agent docetaxel is active in advanced gastric cancer progressing after first-line chemotherapy. The most frequent toxicity is neutropenia, which may be managed by G-CSF and/or dose adjustments. Docetaxel is therefore worthy of further study in combination with other active drugs.