Adalimumab Drug Levels at Secondary Loss of Response Do Not Predict Response to Dose-intensification in Crohn's Disease: A Retrospective, International Multicenter Study.

BACKGROUND: The exposure-response relationship is less established for adalimumab (ADA) compared with infliximab in inflammatory bowel disease (IBD). Evidence supporting therapeutic drug monitoring post dose-intensification of ADA is limited. We aimed to explore the association between ADA drug levels and Crohn's disease (CD) activity at loss of response, and at 6 and 12 months post dose-intensification. METHODS: We performed a retrospective study of adult patients with CD receiving dose-intensified weekly ADA following secondary loss of response at 3 tertiary centers across 5 years. ADA trough levels were analyzed using a drug-sensitive enzyme-linked immunosorbent assay at loss of response, and 6 and 12 months after dose-intensification. Rates of clinical remission, objective remission (C-reactive protein <5 mg/L, fecal calprotectin <150 µg/g, or absence of inflammation at endoscopy or imaging), and ADA failure were investigated. RESULTS: A total of 131 CD patients were included, with a median disease duration of 9 (interquartile range, 4-17) years. 51% were biologic exposed prior to ADA and 50% received concomitant immunomodulators. Baseline drug levels measured at secondary loss of response did not discriminate between subsequent responders and non-responders at either 6 or 12 months post dose-intensification. However, both higher drug levels at 6 and 12 months and a higher increment from baseline were associated with improved outcomes. On receiver-operating characteristic analyses, post-escalation ADA drug levels >10.7 µg/mL (area under the receiver-operating characteristic curve [AUROC], 0.66; P = .013) and >10.9 µg/mL (AUROC, 0.67; P = .032) were associated with objective remission at 6 and 12 months, respectively. CONCLUSIONS: Drug levels following dose-intensification rather than at the time of secondary loss of response were associated with subsequent CD remission.

Literature supporting therapeutic drug monitoring at secondary loss of response and post dose-intensification of adalimumab is limited. Adalimumab drug levels following dose-intensification rather than at the time of secondary loss of response are associated with subsequent Crohn's disease remission.

Repeated endoscopic ultrasound-guided fine-needle biopsy of solid pancreatic lesions after previous nondiagnostic or inconclusive sampling.

OBJECTIVES: Repeated endoscopic ultrasound (EUS)-guided tissue acquisition represents the standard practice for solid pancreatic lesions after previous nondiagnostic or inconclusive results. Since data are lacking, we aimed to evaluate the diagnostic performance of repeated EUS fine-needle biopsy (rEUS-FNB) in this setting. The primary outcome was diagnostic accuracy; sample adequacy, sensitivity, specificity, and safety were secondary outcomes. METHODS: Consecutive patients undergoing rEUS-FNB for solid pancreatic lesions at 23 Italian centers from 2019 to 2021 were retrieved. Pathology on the surgical specimen, malignant histology together with ≥6-month follow-up, and benign pathology together with ≥12-month follow-up were adopted as gold standards. RESULTS: Among 462 patients, 56.5% were male, with a median age of 68 (59-75) years, malignancy prevalence 77.0%. Tumor size was 26 (20-35) mm. Second-generation FNB needles were used in 89.6% cases. Diagnostic accuracy, sensitivity, and specificity of rEUS-FNB were 89.2%, 91.4%, and 81.7%, respectively (19 false-negative and 12 false-positive results). On multivariate analysis, rEUS-FNB performed at high-volume centers (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.10-3.17; P = 0.03) and tumor size (OR 1.03; 95% CI 1.00-1.06; P = 0.05) were independently related to diagnostic accuracy. Sample adequacy was 94.2%. Use of second-generation FNB needles (OR 5.42; 95% CI 2.30-12.77; P < 0.001) and tumor size >23 mm (OR 3.04; 95% CI 1.31-7.06; P = 0.009) were independently related to sample adequacy. CONCLUSION: Repeated EUS-FNB allowed optimal diagnostic performance after nondiagnostic or inconclusive results. Patients' referral to high-volume centers improved diagnostic accuracy. The use of second-generation FNB needles significantly improved sample adequacy over standard EUS-FNB needles.

The Impact of Nitroglycerin on the Evaluation of Coronary Stenosis in Coronary-CT: Preliminary Study in 131 Patients.

BACKGROUND: The sublingual administration of short-acting nitroglycerin (NTG) before coronary computed tomography (CCT) improves the visualization of coronary arteries, causing vasodilatation. The aim of this study was to evaluate whether and how nitroglycerin can influence the concordance between radiologists and cardiologists in the evaluation of vessel stenosis measured in CCT by the former and during the following coronarography by the latter. METHODS: We conducted a retrospective analysis of 131 patients who underwent CCT for cardiac symptoms in 2022, followed by coronarography performed six months later because of significant stenosis revealed by the CCT. First, the patients were divided into two groups: an NTG group who received sublingual nitroglycerin before CCT and a non-NTG group who did not because of contraindications. Second, 254 stenoses were measured by two radiologists after CCT and by two interventional cardiologists during the next coronarography; moreover, stenoses were classified on the basis of their location and plaque pattern (calcific, mixed and lipidic). Third, the strength of agreement was evaluated between the two radiologists, between the two cardiologists and finally between the radiologists and cardiologists in order to evaluate whether and how the interdisciplinary discrepancy in stenosis evaluation could change with or without the use of nitroglycerin before CCT and in relation to the different plaque pattern. RESULTS: In the NTG group, the use of nitroglycerine reduced the agreement between radiologists and cardiologists in calcific stenosis but did not change the concordance in the case of mixed or lipidic plaques on the same vessels. CONCLUSIONS: The use of sublingual nitroglycerin before CCT may lead to a radiological overestimation of calcific stenosis.

The role of self-efficacy beliefs in dealing with misinformation among adolescents.

The present study aims to understand the processes involved in misinformation among adolescents by examining the role of self-efficacy beliefs in dealing with misleading news. Specifically, we argue that the perceived capability to analyze and reflect critically on the reliability of online information sources should be stayed with the perceived self-regulatory capability to resist online social pressures to share unverifiable news. Moreover, we posited that specific online self-efficacies beliefs can be promoted by the capabilities related to regulating emotions and reflecting on new problems. In a sample of 273, we tested a path analysis model. The results attest that self-efficacy beliefs in dealing with online misinformation refer to specific capabilities: an active one, related to checking the sources of the news in order to validate their content, and an inhibitory one, related to the capability to refrain from sharing the news that seems unreliable. Moreover, self-efficacy beliefs in self-control during online interaction spreading misleading news are supported by cognitive reflective capability and self-efficacy in regulating negative emotion. The relationship between active self-efficacy related to fact-checking and sharing misleading news is not significant. The role of regulation in sharing misinformation during activated online dynamics is discussed.

Health Communication in the Time of COVID-19 Pandemic: A Qualitative Analysis of Italian Advertisements.

In the climate of great uncertainty characterizing the COVID-19 pandemic, health communication played a significant role: several communicative strategies and channels were used to inform, educate and alert. Entropy-related risks were soon translated into the "infodemic", a wide-spread phenomenon with psychosocial and cultural roots. Therefore, new challenges for public institutions occurred: public health communication, especially expressed through advertising and audiovisual spots, was engaged to offer key support in combatting the disease, mitigating its effects and supporting health and psychological wellbeing. This work aims to investigate how the Italian public institutions addressed those challenges by employing institutional spots. We tried to answer two main research questions: (a) in line with the literature concerning persuasive communication, what were the main variables that social advertising concerning health attitudes and behaviors relied on; and (b) how the different variables were combined to propose specific communicative pathways following both the different waves/phases of the COVID-19 pandemic and the elaboration likelihood model. To answer these questions, 34 Italian spots were analyzed by means of qualitative multimodal analysis (including scopes, major narratives themes, central and peripheral cues). The results enabled us to individuate different communicative pathways, oriented by inclusivity, functionality and contamination, in line with different rounds as well as with the holistic configurations of cultural narratives, central and peripheral cues.

Cardiac Computed Tomography Evaluation of Association of Left Ventricle Disfunction and Epicardial Adipose Tissue Density in Patients with Low to Intermediate Cardiovascular Risk.

Background and objectives: Epicardial adipose tissue density (EAD) has been associated with coronary arteries calcium score, a higher load of coronary artery disease (CAD) and plaque vulnerability. This effect can be related to endocrine and paracrine effect of molecules produced by epicardial adipose tissue (EAT), that may influence myocardial contractility. Using coronary computed tomography angiography (CCT) the evaluation of EAD is possible in basal scans. The aim of the study is to investigate possible associations between EAD and cardiac function. Material and Methods: 93 consecutive patients undergoing CCT without and with contrast medium for known or suspected coronary CAD were evaluated. EAD was measured on basal scans, at the level of the coronary ostia, the lateral free wall of the left ventricle, at the level of the cardiac apex, and at the origin of the posterior interventricular artery. Cardiac function was evaluated in post-contrast CT scans in order to calculate ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Results: A statistically significant positive correlation between EAD and ejection fraction (r = 0.29, p-value < 0.01) was found. Additionally, a statistically significant negative correlation between EAD and ESV (r = -0.25, p-value < 0.01) was present. Conclusion: EAD could be considered a new risk factor associated with reduced cardiac function. The evaluation of this parameter with cardiac CT in patients with low to intermediate cardiovascular risk is possible.

Incidental finding of intrathoracic caudate lobe of the liver associated with an arterovenous malformation.

In this case report we describe an occasional finding of intrathoracic caudate lobe protruding through the diaphragm foramen in a 73-year-old woman who came to our attention for a screening for coronary artery disease, due to the presence of cardiovascular risk. The patient had no symptoms. The computed tomography showed, a circumscribed homogeneous soft tissue mass that protruding through the aortic diaphragmatic foramen that was as isodense as the liver. Moreover was revealed an abnormal artery emerging from the celiac tripod which, through the diaphragmatic foramen, ends in an inferior pulmonary vein creating an arteriovenous malformation.

Assessing student engagement from facial behavior in on-line learning.

The automatic monitoring and assessment of the engagement level of learners in distance education may help in understanding problems and providing personalized support during the learning process. This article presents a research aiming to investigate how student engagement level can be assessed from facial behavior and proposes a model based on Long Short-Term Memory (LSTM) networks to predict the level of engagement from facial action units, gaze, and head poses. The dataset used to learn the model is the one of the EmotiW 2019 challenge datasets. In order to test its performance in learning contexts, an experiment, involving students attending an online lecture, was performed. The aim of the study was to compare the self-evaluation of the engagement perceived by the students with the one assessed by the model. During the experiment we collected videos of students behavior and, at the end of each session, we asked students to answer a questionnaire for assessing their perceived engagement. Then, the collected videos were analyzed automatically with a software that implements the model and provides an interface for the visual analysis of the model outcome. Results show that, globally, engagement prediction from students' facial behavior was weakly correlated to their subjective answers. However, when considering only the emotional dimension of engagement, this correlation is stronger and the analysis of facial action units and head pose (facial movements) are positively correlated with it, while there is an inverse correlation with the gaze, meaning that the more the student's feels engaged the less are the gaze movements.

Needle Tract Seeding after Endoscopic Ultrasound Tissue Acquisition of Pancreatic Lesions: A Systematic Review and Meta-Analysis.

There is limited evidence on the incidence of needle tract seeding (NTS) in patients undergoing endoscopic ultrasound (EUS) tissue acquisition (TA) of pancreatic lesions. This meta-analysis aimed to assess the incidence of NTS after EUS-TA. With a search of the literature up until April 2022, we identified 10 studies (13,238 patients) assessing NTS incidences in patients undergoing EUS-TA. The primary outcome was NTS incidence. The secondary outcome was a comparison in terms of peritoneal carcinomatosis incidence between patients who underwent EUS-TA and non-sampled patients. Results were expressed as pooled rates or odds ratio (OR) and 95% confidence intervals (CI). The pooled rate of NTS was 0.3% (95% CI 0.2-0.4%), with no evidence of heterogeneity (I2 = 0%). Subgroup analysis based on the type of sampled lesion confirmed this finding both in patients with pancreatic adenocarcinoma (0.4%, 0.2-0.6%) and in patients with cystic pancreatic lesions (0.3%, 0.1-0.5%). No difference in terms of metachronous peritoneal dissemination was observed between patients who underwent EUS-TA and non-sampled patients (OR 1.02, 0.72-1.46; p = 0.31), with evidence of low heterogeneity (I2 = 16%). Rates of NTS after EUS-TA are very low; therefore, EUS-TA could be safely performed in a pre-operative setting.

How Personal Values Count in Misleading News Sharing with Moral Content.

The present study investigates the personal factors underlying online sharing of moral misleading news by observing the interaction between personal values, communication bias, credibility evaluations, and moral emotions. Specifically, we hypothesized that self-transcendence and conservation values may differently influence the sharing of misleading news depending on which moral domain is activated and that these are more likely to be shared when moral emotions and perceived credibility increase. In a sample of 132 participants (65% female), we tested SEMs on misleading news regarding violations in five different moral domains. The results suggest that self-transcendence values hinder online sharing of misleading news, while conservation values promote it; moreover, news written with a less blatantly biased linguistic frame are consistently rated as more credible. Lastly, more credible and emotionally activating news is more likely to be shared online.

Role of computed tomography in transcatheter replacement of 'other valves': a comprehensive review of preprocedural imaging.

Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.

President Obama's Humble Face: An Authentic or a Socially Desirable Posturing? A Study on Reactions to Obama's Autobiographical Self-Disclosures.

Referring to the mainstream studies based on the personalization's hypothesis, which positively evaluates signals of dominance shown by leaders, the analysis of Obama's rhetoric stays a relevant exception. His risky recall, during his political talks, of his social difficulties as a child of a mixed couple was in fact one of the more surprising aspects of his success. Nevertheless, reactions to his autobiographical sharing were scarcely explored. Based on the idea that these self-disclosures signal his responsivity toward the audience of low social condition and can, therefore, be defined as a sign of humility, this research aims to test if coherence between Obama's words and his facial expressions of contempt, due to the seriousness of social injustices endured in his childhood, may influence the receivers' perception of such unexpected communication. Before reading a brief autobiographical sharing taken from a "Back-to-school" speech, a highly ritualized monolog the US President addresses each year to students, 175 Italian participants were presented with a photo of Obama displaying either an expression of contempt (taken from the video of the speech) or a neutral expression. Comparisons between self-assessments of perceptions and reactions of participants assigned to the two experimental conditions show that a facial expression of contempt, coherent with words describing his school difficulties, has been crucial for perceiving this humble political discourse as authentic and not as a simple socially desirable posturing. More studies seem to be needed, however, to understand how humble speech could enhance the positive face of leaders or backfire against them.

Transcatheter aortic valve implantation in patients with unruptured aortic root pseudoaneurysm: an observational study.

AIMS: Unruptured aortic root pseudoaneurysm (UARP) is a rare complication of aortic valve endocarditis. Infectious spread to the valvular annulus or myocardium can cause septic complications that manifest as wall thickening, and spontaneous abscess drainage leads to pseudoaneurysm formation. We report the first patient series in which transcatheter aortic valve implantation (TAVI) using a single valve-resolved aortic valvulopathy associated with UARP was performed. METHODS: At our center, from December 2017 to October 2019, 138 patients underwent TAVI for aortic valve stenosis and/or regurgitation, 20 of whom (12 female patients, 8 male patients) had associated incidental UARP and were considered as our study population. The average age of these patients was 76.9 ±â€Š5.2 years. All patients were assessed using preprocedural and postprocedural multimodality imaging, including transthoracic echocardiography, transesophageal echocardiography, and cardiac computed tomography angiography (CCTA). RESULTS: In all cases, the final angiographic examination showed correct valve positioning with complete coverage of the false aneurysm. Post-TAVI CCTA showed presence of total or subtotal UARP thrombosis. The mean follow-up period was 17.5 months (12-23 months). During follow-up, imaging showed normal prosthetic valve function, no significant leakage (trace or mild), and complete UARP exclusion in all patients, without any complications. CONCLUSION: In conclusion, percutaneous valve positioning can simultaneously solve pseudoaneurysm complications by excluding the sac and promoting thrombosis.

Intervención grupal con adolescentes con epilepsia refractaria: programa terapéutico educativo / Intervenció grupal amb adolescents amb epilèpsia refractària: programa terapèutic educatiu / Group intervention with adolescents with refractory epilepsy: a therapeutic educational programme

Se presentauna intervención grupal terapéutico-educativa con adolescentes con diagnóstico de epilepsia refractaria en elque se trabajaron diferentes áreas psicológicas: personal, cognitiva, social y tiempo libre. La valoración se realizóa partir de la descripción clínica, el cuestionario SENA y la plataforma NEURONUP, valorando que una interven-ción específica ayuda a los pacientes a crear una mayor conciencia y capacidad de implicarse en los objetivos,permitiendo mejoras en su autoconcepto y autocuidado.(AU)

We presenta therapeutic-educational group intervention with adolescents diagnosed with refractory epilepsy in which diffe-rent psychological areas were worked on: personal, cognitive, social, and free time. The assessment was basedon the clinical description, the SENA questionnaire, and the NEURONUP platform, evaluating that a specific inter-vention helps patients to create greater awareness and capacity to become involved in the objectives, allowingimprovements in their self-concept and self-care.(AU)

Es presenta unaintervenció grupal terapèutica i educativa amb adolescents amb diagnòstic d'epilèpsia refractària en què es vantreballar diferents àrees psicològiques: personal, cognitiva, social i temps lliure. La valoració es va realitzar a partirde la descripció clínica, el qüestionari SENA i la plataforma NEURONUP i es va veure que una intervenció espe-cífica ajuda els pacients a crear una major consciència i capacitat d'implicar-se en els objectius, cosa que permetmillores en el seu autoconcepte i en la pròpia cura.(AU)

Pseudoaneurysm of the aortic root following aortic valve endocarditis - a case with 2 rare life - threatening complications.

Infective endocarditis can have peri-annular spread and involve the valvular annulus and adjacent cardiac structures, leading to tissue necrosis and peri-annular abscess. This process may cause pseudoaneurysm formation and other rare and potentially life-threatening complications, so their identification and correct diagnosis are crucial. We describe a case of an 81-year-old woman, with a history of aortic valve replacement and worsening of symptoms, that presents at the imaging a pseudoaneurysm of the aortic root complicated at the same time by 2 life-threatening conditions: fistulization in the Right Ventricular Outflow Tract (RVOT) and the compression of Right Coronary Artery (RCA). This case underlines the importance of imaging, especially Coronary Computed Tomography Angiography (CCTA), in the diagnosis and follow-up of infective endocarditis and its complications, especially in a patient not eligible for surgery.

The Humble Charisma of a White-Dressed Man in a Desert Place: Pope Francis' Communicative Style in the Covid-19 Pandemic.

The context of deep uncertainty, fear, and "social distancing" characterizing the COVID-19 pandemic has led to a need for cultural anchorages and charismatic leaders who may conjointly and effectively support human beings, strengthen their identity, and empower social commitment. In this perspective, the charismatic leadership of Pope Francis, which is widely shared not only within the religious world, may play a crucial role in facing emergency with existential reasons and psychological resources. The general aim of this work is to shed light on the communicative features of the charismatic leadership of Pope Francis during the pandemic emergency; in order to better understand his effectiveness, we analyzed both the core issues and his multimodal body signals in the global TV event of the Universal Prayer with the Urbi et Orbi Blessing. The multimodal and discursive analyses of the homily enabled us to define the "humble" charisma of the Pope, which is based upon on authentic and informal presence, manifested emotional signals (and, in particular commotion) showing features of equity and familiarity. From a discursive point of view, the common and overarching affiliation is constructed through a multiple focus on the "we" pronoun, which is constructed through socio-epistemic rhetoric. The results show how this integrated methodological perspectives, which is multimodal and discursive, may offer meaningful pathways detection of effective and persuasive signals.