Is the new ASDAS nomenclature in agreement with therapeutic decision making in patients with axial spondyloarthritis?

OBJECTIVES: To evaluate the association between low disease activity according to the new ASDAS nomenclature and the physician therapeutic decisions in patients with axial spondyloarthritis (axSpA). MATERIAL AND METHODS: Longitudinal retrospective study including patients diagnosed with axSpA receiving a tumor necrosis factor-inhibitor between January 2014 and June 2019 as a first treatment. For each visit, disease activity was determined afterwards according to the new ASDAS nomenclature (inactive, low, high and very high activity), and the physician's therapeutic decision was recorded. The association between disease activity and the physician's decision was evaluated through descriptive statistics. RESULTS: A total of 304 visits of 104 patients with axSpA were analyzed. For those visits where a low activity ASDAS score was obtained, the physician's therapeutic decision was no escalation of treatment in 98.2% of cases. However, for those visits with a high or very high disease activity ASDAS score, the physician's therapeutic decision was to escalate treatment in 33.7% and 82.8% of cases respectively. CONCLUSIONS: The state measured by the ASDAS index formerly defined as 'moderated disease activity' is considered in clinical practice as 'low disease activity' because of the physician's choice in these situations to not-escalate the treatment. Our data substantiate the recent updating in ASDAS nomenclature.

Mediating Reductive Charge Shift Reactions in Electron Transport Chains.

We report the synthesis of a full-fledged family of covalent electron donor-acceptor1-acceptor2 conjugates and their charge-transfer characterization by means of advanced photophysical assays. By virtue of variable excited state energies and electron donor strengths, either Zn(II)Porphyrins or Zn(II)Phthalocyanines were linked to different electron-transport chains featuring pairs of electron accepting fullerenes, that is, C60 and C70. In this way, a fine-tuned redox gradient is established to power a unidirectional, long-range charge transport from the excited-state electron donor via a transient C60•- toward C70•-. This strategy helps minimize energy losses in the reductive, short-range charge shift from C60 to C70. At the forefront of our investigations are excited-state dynamics deduced from femtosecond transient absorption spectroscopic measurements and subsequent computational deconvolution of the transient absorption spectra. These provide evidence for cascades of short-range charge-transfer processes, including reductive charge shift reactions between the two electron-accepting fullerenes, and for kinetics that are influenced by the nature and length of the respective spacer. Of key importance is the postulate of a mediating state in the charge-shift reaction at weak electronic couplings. Our results point to an intimate relationship between triplet-triplet energy transfer and charge transfer.

Heptamethine Cyanine Dyes in the Design of Photoactive Carbon Nanomaterials.

Near-infrared (NIR) absorbing nanomaterials, built from anionic heptamethine cyanine dyes and single-walled carbon nanotubes or few-layer graphene, are presented. The covalent linkage, using 1,3-dipolar cycloaddition reactions, results in nanoconjugates that synchronize the properties of both materials, as demonstrated by an in-depth characterization study carried out by transmission electron microscopy, atomic force microscopy, thermogravimetric analysis, Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy. UV-vis-NIR and Raman spectroscopies further confirmed the unique electronic structure of the novel photoactive nanomaterials.

New Penta(tetrathiafulvalenyl)[60]fullerenes for Supramolecular Materials.

New penta(organo)fullerenes donor-acceptor systems bearing five tetrathiafulvalene recognition units have been synthesized to promote self-assemblies similar in appearance to shuttlecocks nested into each other thanks to the conical host cavity created around the fullerene together with the π-π and electronic interactions.

Coordinating Electron Transport Chains to an Electron Donor.

Two electron transport chains (2 and 3) featuring two fullerenes with different electron acceptor strengths have been synthesized, characterized, and coordinated to a light harvesting/electron donating zinc porphyrin. Electrochemical assays corroborate the redox gradients along the designed electron transport chains, and complementary absorption and fluorescence titrations prove the assembly of ZnP-2 and ZnP-3 hybrids.

Circulating miRNAs as potential biomarkers of therapy effectiveness in rheumatoid arthritis patients treated with anti-TNFα.

INTRODUCTION: The advent of anti-tumor necrosis factor alpha (anti-TNFα) drugs has considerably improved medical management in rheumatoid arthritis (RA) patients, although it has been reported to be ineffective in a fraction of them. MicroRNAs (miRNAs) are small, non-coding RNAs that act as fine-tuning regulators of gene expression. Targeting miRNAs by gain or loss of function approaches have brought therapeutic effects in various disease models. The aim of this study was to investigate serum miRNA levels as predictive biomarkers of response to anti-TNFα therapy in RA patients. METHODS: In total, 95 RA patients undergoing anti-TNFα/disease-modifying antirheumatic drugs (anti-TNFα/DMARDs) combined treatments were enrolled. Serum samples were obtained at 0 and 6 months and therapeutic efficacy was assessed. miRNAs were isolated from the serum of 10 patients before and after anti-TNFα/DMARDs combination therapy, cDNA transcribed and pooled, and human serum miRNA polymerase chain reaction (PCR) arrays were performed. Subsequently, selected miRNAs were analyzed in a validation cohort consisting of 85 RA patients. Correlation studies with clinical and serological variables were also performed. RESULTS: Ninety percent of RA patients responded to anti-TNFα/DMARDs combination therapy according to European League Against Rheumatism (EULAR) criteria. Array analysis showed that 91% of miRNAS were overexpressed and 9% downregulated after therapy. Functional classification revealed a preponderance of target mRNAs involved in reduction of cells maturation--especially on chondrocytes--as well as in immune and inflammatory response, cardiovascular disease, connective tissue and musculoskeletal system. Six out of ten miRNAs selected for validation were found significantly upregulated by anti-TNFα/DMARDs combination therapy (miR-16-5p, miR-23-3p, miR125b-5p, miR-126-3p, miRN-146a-5p, miR-223-3p). Only responder patients showed an increase in those miRNAs after therapy, and paralleled the reduction of TNFα, interleukin (IL)-6, IL-17, rheumatoid factor (RF), and C-reactive protein (CRP). Correlation studies demonstrated associations between validated miRNAs and clinical and inflammatory parameters. Further, we identified a specific plasma miRNA signature (miR-23 and miR-223) that may serve both as predictor and biomarker of response to anti-TNFα/DMARDs combination therapy. CONCLUSIONS: miRNA levels in the serum of RA patients before and after anti-TNFα/DMARDs combination therapy are potential novel biomarkers for predicting and monitoring therapy outcome.

Anticyclic citrullinated protein antibodies are implicated in the development of cardiovascular disease in rheumatoid arthritis.

OBJECTIVE: Previous studies have suggested a relationship between anticyclic citrullinated protein (CCP) levels and development of cardiovascular disease in rheumatoid arthritis (RA). However, a limited number of studies have demonstrated an involvement of anti-CCPs in those processes. This study was aimed to define the specific role of these auto-antibodies in the pro-oxidative, inflammatory, and proatherogenic profile observed in leukocytes from RA patients. APPROACH AND RESULTS: Seventy-five RA patients and 31 healthy donors were enrolled. Carotid intima media thickness was evaluated as atherosclerosis marker. Several procoagulant and inflammatory factors, leukocyte activation, and oxidative stress markers were analyzed in plasma and leukocyte subsets. Anti-CCPs were purified from plasma of RA patients, and in vitro treatment of healthy leukocytes was conducted. High titers of anti-CCPs were associated to altered expression of prothrombotic and inflammatory markers, high oxidative stress, and pathological carotid intima media thickness in RA patients. Notably, gene expression analysis showed that lymphocytes were major players in altered inflammatory profile, monocytes were responsible for the protrombotic and atherogenic status, and neutrophils mainly displayed a pro-oxidative feature. In vitro treatment with purified anti-CCPs fully recapitulated that pathogenic profile, promoting the activation of leukocytes. CONCLUSIONS: Anti-CCPs are key players in the inflammatory and proatherogenic status of RA patients. The effects are specific of the immune cell targeted, promoting overexpression of thrombotic, inflammatory, and pro-oxidative markers in monocytes; pro-oxidative status in neutrophils; and proinflammatory profile in lymphocytes. Targeting these autoantibodies would be an excellent strategy to prevent the development of cardiovascular disease in RA.

Cancer care in East and Central Harlem: community partnership needs assessment.

In the largely African American and Hispanic communities of East and Central Harlem in New York City (NYC), health inequities are glaring. Mortality from cancer is 20-30 % higher than in Manhattan and 30-40 % higher than rates in the general population in NYC. Despite advances in risk assessment, early detection, treatment, and survivorship, individuals in Harlem and similar urban communities are not benefiting equally. Guided by community-based participatory research, this study serves as an important step in understanding cancer care needs and the range of factors that impact the disparate rates of cancer in East and Central Harlem. Forty individual interviews were conducted with community leaders and residents. Major themes included: need for appropriate supportive services; health care access and financial challenges; beliefs related to stigma, trust, and accountability; and the impact of the physical environment on health. Education was seen as a critical area of need and intervention.

ExTTF-based dyes absorbing over the whole visible spectrum.

New push-pull dyes featuring π-extended tetrathiafulvalene (exTTF) as the donor group and tricyanofuran (TCF) as the acceptor group were synthesized and characterized. Their broad absorption covers the entire visible spectral range and enters the near-infrared region. Electrochemistry and theoretical calculations provided an understanding of these singular electronic properties. The new dyes are appealing candidates as light harvesters in photovoltaic devices.

Aporte calórico en niños con sepsis críticamente enfermos / Caloric contribution in children with sepsis critically sick

Introducción: Se necesita evaluar el soporte nutricional del niño críticamente enfermo: iniciando precozmente, adecuarlo a la edad, estado nutricional y evolución de la enfermedad para así minimizar la pérdida de las reservas proteicas energéticas. Objetivos: Determinar el aporte calórico en niños con sepsis críticamente enfermos. Identificar los parámetros paraclínicos. Medir los niveles de balance nitrogenado. Métodos: La población en estudio estuvo conformada por 14 pacientes ingresados en el Servicio de Terapia del Hospital de Niños "J. M. de los Ríos", durante los meses de Junio - Noviembre del 2004; que ingresaron con sepsis ameritando aporte calórico especial, con edades comprendidas entre 1 mes y 15 años; realizando mediciones seriadas a las 24, 48, 72 y después de las 72 horas. Resultados: El aporte calórico fue incrementándose progresivamente siendo su valor a las 72 horas de 2181Kcal, después de las 72 horas se aprecia una estabilización en la búsqueda de un equilibrio del balance nitrogenado. Conclusiones: La medición del aporte calórico a través del balance nitrogenado es un procedimiento sencillo, económico que puede ser un parámetro de medición de rutina y realizado por enfermería para evaluar el estado nutricional de los pacientes con sepsis

Oclusión adherencial de intestino delgado: factores predictivos de la indicación quirúrgica / Adhesional small bowel obstruction: factors predictive for surgical indication

Objetivo. La oclusión de intestino delgado por causa adherencial es un proceso frecuente como causa de ingreso, cuya dificultad no se halla en el diagnóstico sino en su manejo, por lo que es importante encontrar factores predictivos que ayuden a elegir el tratamiento óptimo en cada caso. Pacientes y métodos. Estudio retrospectivo de 154 pacientes con oclusión adherencial del intestino delgado, anotándose aquellos datos objetivos (demográficos, radiológicos, analíticos y antecedentes quirúrgicos) e ingresos previos por la misma causa. Tras realizar el estudio descriptivo se aplicó el análisis inferencial bivariante para aquellos resultados relevantes. Los resultados llamativos del último ingreso se estudiaron mediante un análisis multivariante de regresión logística para buscar un conjunto de variables que ofrecieran el mejor modelo predictivo para la indicación quirúrgica. Resultados. El 38,8 por ciento de los pacientes ingresados fueron intervenidos, de los cuales el 34,6 por ciento presentaban un cuadro de estrangulación. Las cirugías ginecológicas y colorrectal presentan una mayor incidencia de indicación quirúrgica. Para la indicación quirúrgica, la ausencia de aireación colónica (55 por ciento) junto con la alteración del ionograma son las variables de mayor significación estadística. En el análisis multivariante, estas dos variables, junto a la cirugía previa de localización inframesocólica, presentan un poder predictivo independiente. Conclusiones. Existen factores pronósticos objetivos relacionados con la indicación quirúrgica en la oclusión adherencial de intestino delgado y, aunque su aplicación conjunta como modelo predictivo no ofrezca seguridad total, puede resultar orientador de cara a la estrategia a seguir en lo que respecta a la duración del período de observación bajo tratamiento médico. (AU)

Prevalencia y Factores Asociados con la Amputacion de Extremidades, Cali, 1985 / Prevalence and Associated Factors with Limb Amputations, Cali, 1985

El presente trabajo analiza en detalle un estudio de prevalencia de limitaciones fisicas en la poblacion de Cali que mostro un numero maximo estimado de 4977 amputados para julio de 1985. Por logeneral las tasas de amputacion aumentan con la edad y se observa una prevalencia en el sexo masculino. Un 64.3% de las personas con limitaciones llevaban mas de 10 anos de residencia en la ciudad y 51% no eran nativos del Departamento del Valle. El origen de la limitacion era adquirido en 87% de origen congenito en 13%. Las limitaciones tenian mayor prevalencia en el nivel socioeconomico mas bajo. La amputacion de una extremidad es una deficiencia con el indice de supervivencia e industralizacion en el mundo. Se hace discusion del problema, que incluye los aspectos de atencion medica, aspectos familiares, sociales y recreativos y se dan algunas sugerencias para enfrentarlo