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ABSTRACT Objective Clinical Considerations Conclusions Clinical Significance Computer‐aided implant placement (CAIP) offers improved accuracy and reduced invasiveness. However, traditional static CAIP (sCAIP) protocols for complete‐arch restorations often involve multiple guides and clinical steps, increasing the risk of soft tissue trauma and procedural complexity. This article introduces the B‐guide technique, which integrates implant placement and interim prosthesis delivery into a single device to simplify the procedure and minimize tissue damage.The B‐guide combines the implant osteotomy and placement guide with an abutment placement and prosthesis pick‐up mechanism. The guide remains in place post‐implantation, allowing immediate prosthesis conversion. A 55‐year‐old female patient underwent complete‐arch rehabilitation using the B‐guide, enabling immediate implant placement and loading. The B‐guide minimized soft tissue trauma and eliminated the need for multiple guides, significantly reducing treatment complexity and time.The B‐guide simplifies procedures and improves predictability compared with traditional systems by integrating prosthetic adaptation and implant placement, reducing cumulative errors. However, its success is heavily reliant on the operator's expertise, especially in preoperative planning and design.By integrating implant and prosthesis placement into a single guide, the B‐guide reduces surgical complexity, minimizes trauma, and enhances prosthetic outcomes, improving clinical efficiency. [ABSTRACT FROM AUTHOR]

This article explores the effects of uncontrolled symptoms on the quality of life of patients with allergic rhinitis (AR). The study used a questionnaire to assess the impact of individual symptoms on quality of life. The results showed that poorly controlled eye, nose, and asthma symptoms were consistently associated with lower quality of life measures. The study emphasizes the importance of symptom control in improving the quality of life for patients with AR. However, it is important to note that the findings may not apply to all patients. [Extracted from the article]

Background: Analysis of X (formerly Twitter) posts can inform on the interest/perceptions that social media users have on health subjects. In this study, we aimed to analyse tweets on allergic conditions, comparing them with surveillance data. Methods: We retrieved tweets from England on "allergy," "asthma," and "allergic rhinitis," published between 2016 and 2021. We estimated the correlation between the frequency of tweets on "asthma" and "allergic rhinitis" and English surveillance data on the incidence of asthma and allergic rhinitis medical visits. We performed sentiment analysis, computing a score informing on the emotional tone of assessed tweets. We applied a topic modelling approach to identify topics (clusters of words frequently occurring together) for tweets on each assessed condition. Results: We analysed a total of 13,605 tweets on "allergy," 7767 tweets on "asthma," and 11,974 tweets on "allergic rhinitis." Food‐related words were preponderant on tweets on "allergy," while "eyes" was the most frequent meaningful word on "allergy rhinitis" tweets. We observed seasonal patterns for tweets on "allergic rhinitis," both in their frequency and sentiment – the incidence of allergic rhinitis medical visits was moderately to strongly correlated with the frequency (ρ = 0.866) and sentiment (ρ = −0.474) of tweets on "allergic rhinitis." For tweets on "asthma," no such patterns/correlations were observed. The average sentiment score was negative for all assessed conditions, ranging from −0.004 ("asthma") to −0.083 ("allergic rhinitis"). Conclusions: Tweets on "allergic rhinitis" displayed a seasonal pattern regarding their frequency and sentiment, which correlated with surveillance data. No such patterns were observed for "asthma." [ABSTRACT FROM AUTHOR]

Open Shortest Path First (OSPF) currently supports multiarea networking with two severe limitations: the multiarea topology is restricted to a two‐level hierarchy, and globally optimal routing may not be achieved. An OSPF extension that overcomes these limitations is proposed by introducing a routing overlay for the dissemination of multiarea routing information. It applies to both OSPFv2 (IPv4) and OSPFv3 (IPv6) and is transparent to area‐internal routers. The extension was fully implemented and tested, and the results show that the added functionality is completely achieved, at the cost of a small penalty in terms of convergence times for small networks. [ABSTRACT FROM AUTHOR]

Efficacious, effective and efficient communication between healthcare professionals (HCP) and patients is essential to achieve a successful therapeutic alliance. Telemedicine (TM) has been used for decades but during the COVID‐19 pandemic its use has become widespread. This position paper aims to describe the terminology and most important forms of TM among HCP and patients and review the existing studies on the uses of TM for asthma and allergy. Besides, the advantages and risks of TM are discussed, concluding that TM application reduces costs and time for both, HCP and patients, but cannot completely replace face‐to‐face visits for physical examinations and certain tests that are critical in asthma and allergy. From an ethical point of view, it is important to identify those involved in the TM process, ensure confidentiality and use communication channels that fully guarantee the security of the information. Unmet needs and directions for the future regarding implementation, data protection, privacy regulations, methodology and efficacy are described. [ABSTRACT FROM AUTHOR]

Background: Asthma presents a significant health challenge, imposing a considerable burden on healthcare services. Discrepancies in asthma‐related hospitalisations may reflect underlying health disparities. We aimed to analyse inequities in asthma hospital admissions in mainland Portugal and Spain, from a regional perspective and considering sex and age. Methods: We conducted a retrospective study using data from the Spanish and Portuguese national hospitalisations databases. We calculated crude national and regional yearly hospitalisation rates according per Nomenclature of Territorial Units for Statistics region. Additionally, we calculated hospitalisation rates adjusted for asthma prevalence and the female‐to‐male ratio in asthma hospital admissions per age group, considering the female‐to‐male ratio in the overall population. Results: Between 2012 and 2016, there were 92,084 asthma hospital admissions in mainland Spain and 7717 in mainland Portugal. There was a trend for a higher‐than‐average rate of asthma‐related hospitalisations in the Northern regions of both countries. Women had a hospitalisation rate that was 3.2 times higher than men. Age was associated with higher risk for asthma hospitalisation, with individuals aged 65 and older displaying a hospitalisation rate 4.5 times higher than those under 65. Additionally, while hospitalisations in women aged <65 years were 2.3 times more likely than in men of the same age, hospitalisations in women aged ≥65 years were 3.5 times higher than in men aged ≥65 years. Conclusion: This study suggests that marked regional inequities in asthma hospital admissions exist in Spain and Portugal. Additionally, women are particularly at risk of hospitalisation due to asthma, and such risk increases with age. [ABSTRACT FROM AUTHOR]

Introduction: Patient and public involvement (PPI) initiatives involving patients with chronic respiratory disease (CRD) are rare. Therefore, this study aimed to explore the perspectives of patients with CRD, carers and interested citizens regarding the relevance and need for a PPI network and suggestions for its implementation. Methods: A qualitative study based on focus groups was conducted. Recruitment occurred through invitations on social media platforms and to patients who have participated in previous asthma studies of the team. Three focus groups were conducted, via video conference, using a semi‐structured guide. Thematic analysis was performed by two independent researchers and discussed with the extended team. Results: Fifteen patients with CRD, one carer and one interested citizen (13 females, median 36 (range: 18–72) years) participated. All participants acknowledged the importance of implementing a collaborative network and demonstrated interest in being integrated. Participants acknowledged the importance of their involvement in several phases of the research cycle. The main aim identified for this network was to facilitate communication between patients and researchers. Participants regarded the integration of patients, carers, researchers and healthcare professionals from different scientific areas as relevant. The use of digital platforms to attract members and support the work, together with group dynamics and regular meetings, were some of the most relevant practical considerations for implementing the network. The identified facilitators for their engagement were sharing experiences, researchers' and healthcare professionals' support and feedback and schedule flexibility. The identified barriers included the amount of time dedicated, low health/digital literacy and the potential detachment of nondiagnosed patients or those with low symptom impact in daily life. Conclusion: Patients, carers and citizens acknowledged the relevance of implementing a collaborative network and demonstrated interest in active participation in every stage of the health research cycle. A deeper knowledge of the barriers and facilitators identified in this study could support implementing these initiatives in Portugal. Patient or Public Contribution: This study was designed by a research team that included one patient with asthma and one carer. They were specifically involved in building the study protocol and the interview guide. They also gave feedback regarding the electronic consent form and the short sociodemographic questionnaire created, namely by removing noncontributing words or phrases and rewording expressions. The lay summary was written by another patient with asthma. All participants of this study were invited to implement and integrate the ConectAR network—a collaborative network of research in respiratory health. Public Summary: In Portugal, chronic respiratory patients do not have an active role as 'coinvestigators'. This study aimed to acknowledge if patients and citizens considered a patient and public involvement network useful, whose main purpose would be to facilitate communication between patients and researchers. A study based on online group interviews was carried out with patients with chronic respiratory diseases and interested citizens, both recruited on social media platforms. Participants considered that bringing together patients, carers, researchers and healthcare professionals is valuable because sharing different experiences and perspectives may help patients to improve their daily lives and increase research quality. In conclusion, patients agree that implementing a collaborative network with researchers and healthcare professionals and participating in the health research cycle is quite preponderant. Acknowledging what can help and deter this network may be beneficial to implementing this type of initiative in Portugal. [ABSTRACT FROM AUTHOR]

We study the relationship between family and entrepreneurship decisions. Family influences entrepreneurship decisions via two channels: (i) Spouses work more in case of business failure and (ii) children increase the cost of failure. We use administrative matched owner–employer–employee–spouse data to estimate the predictions derived from our model. We find evidence that marriage decreases entry into entrepreneurship and increases average firm size, consistent with mechanism (ii) dominating the (i). Using direct information on children, we find that more children decrease entry into entrepreneurship and increase average firm size. [ABSTRACT FROM AUTHOR]

Purpose: To find ultrasound prognostic factors for shoulder pain. Methods: This was an observational, prospective study, comparing the evolution of ultrasound findings with clinical outcomes, in patients with shoulder pain. Data were collected in two appointments, from February 2018 to March 2021. Two‐tailed non‐parametric statistics were used, and p values <0.05 were considered significant. Results: A total of 79 participants were included in this study (median age 59 years, range 24–70, 61 women). A positive Doppler signal on tendons (p = 0.002) and absent tendon heterogeneity (p = 0.01) were associated with the patient's self‐reported improvement. Tendon calcifications with poorly defined contours (p = 0.03) and sparse distribution (p = 0.001) were associated with VAS improvement. A reduction in the number of calcifications (p = 0.004), in the supraspinatus tendon thickness (p = 0.01), in subacromial effusions (p = 0.03), and in color Doppler grade (p = 0.02), between initial and follow‐up exams, was found in patients with an improved DASH outcome. Conclusion: A positive Doppler signal on shoulder tendons can be a marker for a better prognosis in shoulder pain. Poorly defined and sparsely distributed calcifications can also indicate a better course of the disease. [ABSTRACT FROM AUTHOR]

5G enables tailoring network services to the needs of different vertical use cases. These Verticals may require deployments across distinct communication service providers' administrative domains. Ensuring secure interaction between domains is fundamental for deploying end‐to‐end services in such environments. This paper examines using Moving Target Defense (MTD) mechanisms to secure VXLAN‐based tunneled connections to realize inter‐domain deployments. The inter‐domain mechanisms are evaluated in different scenarios, mainly targeting throughput and latency, showing the suitability for inter‐domain communications even when under load. The assessment of the MTD mechanism′s effectiveness considers the number of false positives and negatives associated with its operations. [ABSTRACT FROM AUTHOR]

Lattice structures are known for their superior performance in weight reduction, stiffness, and increased manufacturability, but when materials need to be adaptive, multifunctional, and with tunable properties, functionally graded lattice structures (FGLS) play a crucial role in innovative solutions. Recent digital manufacturing technologies offer ideal conditions for creating lattice structures with high geometrical complexity and functional gradients. However, the design and development of these inherently complex structures often require the use of specialized methods and software tools. As researchers venture from diverse areas into the research of FGLS in search of novel applications, it is important to choose adequate design tools. Herein, an overview of methods and software for the design of FGLS is presented, identifying geometrical parameters of common lattice topologies and ways to manipulate them to create functional gradients. Fifty software applications or methods are listed, dedicated to the design of single material lattices produced by additive manufacturing processes. Typical applications of the reviewed software are identified, and FGLS design methods are compared. Generative Design seems more suited as an explorative process, Topology Optimization is an established efficiency‐focused design process, and Machine Learning is considered a promising data‐driven approach for the design of innovative FGLS. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) management requires a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication‐related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Methods: Allergic Rhinitis and its Impact on Asthma (ARIA) first published a reference document on the pharmacist's role in allergic rhinitis management in 2004. Several guidelines were developed over the past 20 years improving the care of allergic rhinitis patients through an evidence‐based, integrated care approach. Results: This ARIA/EAACI/FIP Position Paper is based on the latest ARIA in the Pharmacy guidelines and provides: (a) a structured approach to pharmacists identifying people with AR and/or allergic conjunctivitis as well as those at risk of poor disease control; (b) an evidence‐based clinical decision support tool for optimising the management of allergic rhinitis in the community pharmacy; and (c) a framework of referral to the physician. Conclusion: This document is not intended to be a mandatory standard of care but is provided as a basis for pharmacists and their staff to develop relevant local standards of care for their patients, within their local practice environment. Pharmacy care varies between countries, and the guide should be adapted to the local situation. [ABSTRACT FROM AUTHOR]

The Control of Allergic Rhinitis and Asthma Test (CARAT) is a patient‐reported outcome measurement (PROM) assessing the control of asthma and allergic rhinitis (AR) at a 4 week interval. This systematic review aimed to evaluate the measurement properties of CARAT. Following PRISMA and COSMIN guidelines, we searched five bibliographic databases and retrieved studies concerning the development, assessment of properties, validation, and/or cultural adaption of CARAT. The studies' methodological quality, the quality of measurement properties, and the overall quality of evidence were assessed. We performed meta‐analysis of CARAT measurement properties. We included 16 studies. Control of Allergic Rhinitis and Asthma Test displayed sufficient content validity and very good consistency (meta‐analytical Cronbach alpha = 0.83; 95% CI = 0.80–0.86;I2 = 62.6%). Control of allergic rhinitis and Asthma Test meta‐analytical intraclass correlation coefficient was 0.91 (95% CI = 0.64–0.98;I2 = 93.7%). It presented good construct validity, especially for correlations with Patient‐reported outcome measures assessing asthma (absolute Spearman correlation coefficients range = 0.67–0.73; moderate quality of evidence), and good responsiveness. Its minimal important difference is 3.5. Overall, CARAT has good internal consistency, reliability, construct validity and responsiveness, despite the heterogeneous quality of evidence. Control of Allergic Rhinitis and Asthma Test can be used to assess the control of asthma and AR. As first of its kind, this meta‐analysis of CARAT measurement properties sets a stronger level of evidence for asthma and/or AR control questionnaires. [ABSTRACT FROM AUTHOR]

Transverse myelitis can be a complication of SARS‐CoV‐2 infection. We report the case of a transverse myelitis related to SARS‐CoV‐2 infection. Beyond the disease itself, neurological involvement affects functionality. In this situation, physical and rehabilitation medicine plays a crucial role in managing patient rehabilitation. [ABSTRACT FROM AUTHOR]

These results are mostly explained by the different seasonality of AR and asthma, and suggest that, even though AR and pollen exposure may be linked to worsening asthma, viral infections may be a more relevant trigger for asthma exacerbations (as previously shown using GTs for "common cold" and asthma hospitalizations in five countries6). Keywords: asthma; epidemiology; respiratory infections; rhinitis; surveillance EN asthma epidemiology respiratory infections rhinitis surveillance 675 678 4 02/01/22 20220201 NES 220201 ACKNOWLEDGMENT Open access funding enabled and organized by ProjektDEAL. In England, however, the Oxford-Royal College of General Practitioners Research Surveillance Centre (RSC) monitors asthma, allergic rhinitis (AR) and respiratory infections, publishing weekly surveillance reports on their incidence. [Extracted from the article]

Objectives: Patients with asthma often suffer from concomitant allergic rhinitis (AR). The Control of Allergic Rhinitis and Asthma Test (CARAT) is a validated tool to assess asthma and rhinitis multimorbidity. Turkish language validity and reliability of CARAT and its compatibility with other scales were evaluated in the study. Methods: Patients with asthma and concomitant AR were tested with CARAT. Pulmonary function tests, Asthma Control Test (ACT), Assessment Tool for Asthma (ATA) questionnaire and visual analogue scale (VAS) were also used at the same day. With the VAS, patients determined their rhinitis symptom levels, and asthma specialist determined the rhinitis and asthma control levels separately. These questionnaires were repeated in 14 ± 2 days. Results: Three quarters (77%) of the 100 patients were female (mean age 46.5 years). The mean CARAT score was 19.6 ± 7.2. The Cronbach's alpha coefficient of the Turkish version of the CARAT scale was 0.83, showing a high level of internal consistency. Test–retest reliability coefficient was determined as r = 0.98 (p < 0.001). The Kaiser–Meyer–Olkin coefficient of the CARAT scale was 0.79. The p value of the Bartlett test was <0.001. ACT, ATA and VAS expert scales were correlated with CARAT total score (0.577 ≤ r ≤ 0.871). The CARAT scale did not show statistically significant difference according to gender, education, working status, smoking status, presence of polyps and multiple allergen sensitivity (p > 0.05). Conclusion: The Turkish version of the CARAT is a reliable alternative tool for physicians in determining disease control in adult patients with asthma and AR. [ABSTRACT FROM AUTHOR]

Background: Pollen food allergy syndrome (PFAS) is a frequently underdiagnosed disease due to diverse triggers, clinical presentations, and test results. This is especially relevant in geographic areas with a broad spectrum of pollen sensitization, such as Southern Europe. Objectives: To elucidate similarities and differences of PFAS in nine Southern European centers and identify associated characteristics and unique markers of PFAS. Methods: As part of the @IT.2020 Multicenter Study, 815 patients with seasonal allergic rhinitis (SAR), aged 10–60 years, were recruited in seven countries. They completed questionnaires regarding SAR, comorbidities, family history, and PFAS, and underwent skin prick testing (SPT) and serum IgE testing. Results: Of the 815 patients, 167 (20.5%) reported PFAS reactions. Most commonly, eliciting foods were kiwi (58, 34.7%), peach (43, 25.7%), and melon (26, 15.6%). Reported reactions were mostly local (216/319, 67.7%), occurring within 5 min of contact with elicitors (209/319, 65.5%). Associated characteristics included positive IgE to at least one panallergen (profilin, PR‐10, or nsLTP) (p = 0.007), maternal PFAS (OR: 3.716, p = 0.026), and asthma (OR: 1.752, p = 0.073). Between centers, heterogeneity in prevalence (Marseille: 7.5% vs. Rome: 41.4%, p < 0.001) and of clinical characteristics was apparent. Cypress played a limited role, with only 1/22 SPT mono‐sensitized patients reporting a food reaction (p < 0.073). Conclusions: PFAS is a frequent comorbidity in Southern European SAR patients. Significant heterogeneity of clinical characteristics in PFAS patients among the centers was observed and may be related to the different pollen sensitization patterns in each geographic area. IgE to panallergen(s), maternal PFAS, and asthma could be PFAS‐associated characteristics. [ABSTRACT FROM AUTHOR]

Background: Blood eosinophil (B‐Eos) count is an emerging biomarker in the management of respiratory disease but determinants of B‐Eos count besides respiratory disease are poorly described. Therefore, we aimed to evaluate the influence of non‐respiratory diseases on B‐Eos count, in comparison to the effect on two other biomarkers: fraction of exhaled nitric oxide (FeNO) and C‐reactive protein (CRP), and to identify individual characteristics associated with B‐Eos count in healthy controls. Methods: Children/adolescents (<18 years) and adults with complete B‐Eos data from the US National Health and Nutritional Examination Surveys 2005–2016 were included, and they were divided into having respiratory diseases (n = 3333 and n = 7,894, respectively) or not having respiratory disease (n = 8944 and n = 15,010, respectively). After excluding any respiratory disease, the association between B‐Eos count, FeNO or CRP, and non‐respiratory diseases was analyzed in multivariate models and multicollinearity was tested. After excluding also non‐respiratory diseases independently associated with B‐Eos count (giving healthy controls; 8944 children/adolescents and 5667 adults), the independent association between individual characteristics and B‐Eos count was analyzed. Results: In adults, metabolic syndrome, heart disease or stroke was independently associated with higher B‐Eos count (12%, 13%, and 15%, respectively), whereas no associations were found with FeNO or CRP. In healthy controls, male sex or being obese was associated with higher B‐Eos counts, both in children/adolescents (15% and 3% higher, respectively) and adults (14% and 19% higher, respectively) (p < 0.01 all). A significant influence of race/ethnicity was also noted, and current smokers had 17% higher B‐Eos count than never smokers (p < 0.001). Conclusions: Non‐respiratory diseases influence B‐Eos count but not FeNO or CRP. Male sex, obesity, certain races/ethnicities, and current smoking are individual characteristics or exposures that are associated with higher B‐Eos counts. All these factors should be considered when using B‐Eos count in the management of respiratory disease. [ABSTRACT FROM AUTHOR]

Background: Patients with a penicillin allergy label tend to have worse clinical outcomes and increased healthcare use. Drug provocation tests (DPT) are the gold‐standard in the diagnostic workup of penicillin allergy, but safety concerns may hinder their performance. We aimed to assess the frequency of severe reactions following a DPT in patients with reported allergy to penicillins or other β‐lactams. Methods: We performed a systematic review, searching MEDLINE, Scopus, and Web of Science. We included primary studies assessing participants with a penicillin allergy label who underwent a DPT. We performed a Bayesian meta‐analysis to estimate the pooled frequency of severe reactions to penicillin DPTs. Sources of heterogeneity were explored by subgroup and metaregression analyses. Results: We included 112 primary studies which included a total of 26,595 participants. The pooled frequency of severe reactions was estimated at 0.06% (95% credible interval [95% CrI] = 0.01%–0.13%; I2 = 57.9%). Most severe reactions (80/93; 86.0%) consisted of anaphylaxis. Compared to studies where the index reaction was immediate, we observed a lower frequency of severe reactions for studies assessing non‐immediate index reactions (OR = 0.05; 95% CrI = 0‐0.31). Patients reporting anaphylaxis as their index reaction were found to be at increased risk of developing severe reactions (OR = 13.5; 95% CrI = 7.7–21.5; I2 = 0.3%). Performance of direct DPTs in low‐risk patients or testing with the suspected culprit drug were not associated with clinically relevant increased risk of severe reactions. Conclusions: In patients with a penicillin allergy label, severe reactions resulting from DPTs are rare. Therefore, except for patients with potentially life‐threatening index reactions or patients with positive skin tests—who were mostly not assessed in this analysis ‐, the safety of DPTs supports their performance in the diagnostic assessment of penicillin allergy. [ABSTRACT FROM AUTHOR]

The paint coatings of three energy generators from the 20th‐century powerplant at Levada de Tomar, Portugal, were investigated using micro‐Raman and micro‐X‐ray fluorescence spectroscopies and scanning electron microscopy with energy dispersive spectroscopy. This multi‐analytical approach was used to identify the colouring agents, thus providing a chronological chromatic pallet and allowing to infer on the use of the three energy generators. Together with traditional pigments like Prussian blue, red iron oxide, and carbon black, pigments used in industrial areas like copper phthalocyanine and toluidine red were identified as colouring agents. Complex paint systems of the oldest equipment (1924) were revealed as well as maintenance procedures of the equipment that worked during a longer time (1944–1990). Powdery carbon black layers, resulting from incomplete hydrocarbon combustion and present between metallic substrates and coating layers, suggested the inexistence of paint coatings replacement after the powerplant shutdown. The identification of magnetite as a corrosion product of iron alloy substrate revealed that corrosion developed after the engine shutdown and not during the operation period. The results obtained highlight the potentialities of scientific‐based approach and Raman spectroscopy to the industrial heritage study, an emergent cultural area. [ABSTRACT FROM AUTHOR]

Objective: To study the efficacy, tolerability, safety, and sampling variation of ultrasound (US)-guided synovial biopsies performed in clinical practice and research.Methods: We included all patients who had a US-guided synovial needle biopsy from November 2013 to January 2018. Patients were evaluated for procedure safety and tolerability. Usefulness of synovial biopsy was considered based on contribution for achieving the proposed aims. We analyzed samples for presence and quality of synovial tissue, synovitis score/grade, and pathotype. Variation across patients, samples, section levels, and sampling order was assessed.Results: A total of 64 US-guided synovial biopsies were performed (n = 52 in clinical practice, n = 12 in research). Patient tolerability (70% no/mild discomfort) was remarkably high. There was no significant aggravation of symptoms or US synovitis in the biopsied joint. Procedures were overall safe, with few minor, 2 moderate, and no major adverse events. Usefulness of US-guided synovial biopsies was high, both in clinical practice (37% direct diagnostic impact, 100% positive/95% negative predictive values for infection) and in research (92% success). Synovial tissue was retrieved in 88% of biopsies, with a median of 75% gradable samples. There was significant variation in sample quality and synovitis features across patients and samples, but not between different section levels. Samples collected later in the procedure had a lower frequency of synovial tissue and were poorly concordant in pathotype with those collected earlier.Conclusion: US-guided synovial needle biopsy is an effective, safe, and well-tolerated means to collect good quality synovial tissue for clinical and research purposes. Samples collected for different aims should be retrieved in parallel, rather than sequentially. [ABSTRACT FROM AUTHOR]

Background: The adequate definition of pollen seasons is essential to facilitate a correct diagnosis, treatment choice, and outcome assessment in patients with seasonal allergic rhinitis. A position paper by the European Academy of Allergy and Clinical Immunology (EAACI) proposed season definitions for Northern and Middle Europe. Objective: To test the pollen season definitions proposed by EAACI in six Mediterranean cities for seven pollen taxa. Methods: As part of the @IT.2020 multi‐center study, pollen counts for Poaceae, Oleaceae, Fagales, Cupressaceae, Urticaceae (Parietaria spp.), and Compositae (Ambrosia spp., Artemisia spp.) were collected from January 1 to December 31, 2018. Based on these data, pollen seasons were identified according to EAACI criteria. A unified monitoring period for patients in AIT trials was created and assessed for feasibility. Results: The analysis revealed a great heterogeneity between the different locations in terms of pattern and length of the examined pollen seasons. Further, we found a fragmentation of pollen seasons in several segments (max. 8) separated by periods of low pollen counts (intercurrent periods). Potential monitoring periods included often many recording days with low pollen exposure (max. 341 days). Conclusion: The Mediterranean climate leads to challenging pollen exposure times. Monitoring periods for AIT trials based on existing definitions may include many intermittent days with low pollen concentrations. Therefore, it is necessary to find an adapted pollen season definition as individual solution for each pollen and geographical area. [ABSTRACT FROM AUTHOR]

Allergen immunotherapy (AIT) is effective in allergic rhinitis (AR) and/or asthma. The AIT median global symptoms VASs were lower when considering (i) days under no medication (7 I versus i 8), (ii) days under monotherapy (11 I versus i 14) or (iii) days under co-medication (17 I versus i 20). Sensitivity analyses were performed with the AIT group comprising data from users under AIT irrespective of the days when AIT was effectively done. [Extracted from the article]

Purpose: Electromagnetic tracking systems (EMTSs) have been proposed to assist the percutaneous renal access (PRA) during minimally invasive interventions to the renal system. However, the influence of other surgical instruments widely used during PRA (like ureteroscopy and ultrasound equipment) in the EMTS performance is not completely known. This work performs this assessment for two EMTSs [Aurora®Planar Field Generator (PFG); Aurora®Tabletop Field Generator (TTFG)]. Methods: An assessment platform, composed by a scaffold with specific supports to attach the surgical instruments and a plate phantom with multiple levels to precisely translate or rotate the surgical instruments, was developed. The median accuracy and precision in terms of position and orientation were estimated for the PFG and TTFG in a surgical environment using this platform. Then, the influence of different surgical instruments (alone or together), namely analogic flexible ureterorenoscope (AUR), digital flexible ureterorenoscope (DUR), two‐dimensional (2D) ultrasound (US) probe, and four‐dimensional (4D) mechanical US probe, was assessed for both EMTSs by coupling the instruments to 5‐DOF and 6‐DOF sensors. Results: Overall, the median positional and orientation accuracies in the surgical environment were 0.85 mm and 0.42° for PFG, and 0.72 mm and 0.39° for TTFG, while precisions were 0.10 mm and 0.03° for PFG, and 0.20 mm and 0.12° for TTFG, respectively. No significant differences were found for accuracy between EMTSs. However, PFG showed a tendency for higher precision than TTFG. AUR, DUR, and 2D US probe did not influence the accuracy and precision of both EMTSs. In opposition, the 4D probe distorted the signal near the attached sensor, making readings unreliable. Conclusions: Ureteroscopy‐ and ultrasonography‐assisted PRA based on EMTS guidance are feasible with the tested AUR or DUR together with the 2D probe. More studies must be performed to evaluate the probes and ureterorenoscopes' influence before their use in PRA based on EMTS guidance. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of increasing the dose interval of subcutaneous tocilizumab (TCZ‐SC) in patients with rheumatoid arthritis (RA) who are in clinical remission. Methods: RA patients with active disease and an inadequate response to conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) or to a biologic agent were entered into a single‐arm treatment phase with 162 mg of TCZ‐SC administered once weekly (TCZ‐SC 162 mg qw) as monotherapy or in combination with a csDMARD for 24 weeks. Patients who achieved clinical remission at weeks 20 and 24 were randomized to continue with the same regimen or to switch to 162 mg TCZ‐SC administered every 2 weeks (TCZ‐SC 162 mg q2w) for 24 weeks (open‐label). Patients with a Disease Activity Score in 28 joints (DAS28) of <2.6 were considered to be in clinical remission. Results: In total, 179 (45%) of 401 patients in the single‐arm phase achieved clinical remission and were randomized to continue to receive TCZ‐SC 162 mg qw (n = 89) or to switch to TCZ‐SC 162 mg q2w (n = 90) for 24 weeks. At week 48, significantly more patients treated with TCZ‐SC 162 mg qw remained in clinical remission compared to patients who received TCZ‐SC 162 mg q2w (90% versus 73%; P = 0.004). The results of other efficacy measures revealed greater efficacy with TCZ‐SC 162 mg qw, but none of the efficacy outcomes in this group were significantly different from those in patients treated with TCZ‐SC 162 mg q2w, except for the mean change from baseline in the DAS28 score at week 48 (mean change −4.07 points [SD 1.29] versus −3.65 points [SD 1.35]; P = 0.034). Tolerability and safety parameters were similar between the treatment groups. Conclusion: Increasing the dose interval of TCZ‐SC in patients with RA was associated with a lower likelihood of maintaining remission after 24 weeks and was not associated with better tolerability. However, most patients were able to sustain remission with a half‐dose of TCZ‐SC, and therefore this strategy deserves further investigation. [ABSTRACT FROM AUTHOR]

Background: Google Trends (GTs) is a web‐based surveillance tool that explores the searching trends of specific queries via Google. This tool proposes to reflect the real‐life epidemiology of allergic rhinitis and asthma. However, the validation of GTs against pollen concentrations is missing at the country level. Objectives: In the present study, we used GTs (a) to compare the terms related to allergy in France, (b) to assess seasonal variations across the country for 5 years and (c) to compare GTs and pollen concentrations for 2016. Methods: Google Trends queries were initially searched to investigate the terms reflecting pollen and allergic diseases. 13‐ and 5‐year GTs were used in France. Then, 5‐year GTs were assessed in all metropolitan French regions to assess the seasonality of GTs. Finally, GTs were compared with pollen concentrations (Réseau National de Surveillance en Aerobiology) for 2016 in seven regions (GTs) and corresponding cities (pollen concentrations). Results: The combination of searches for "allergy" as a disease, "pollen" as a disease cause and "ragweed" as a plant was needed to fully assess the pollen season in France. "Asthma" did not show any seasonality. Using the 5‐year GTs, an annual and clear seasonality of queries was found in all regions depending on the predicted pollen exposure for spring and a summer peak but not for winter peaks. The agreement between GT queries and pollen concentrations is usually poor except for spring trees and grasses. Moreover, cypress pollens are insufficiently reported by GTs. Conclusions: Google Trends cannot predict the pollen season in France. [ABSTRACT FROM AUTHOR]

Purpose: As a crucial step in accessing the kidney in several minimally invasive interventions, percutaneous renal access (PRA) practicality and safety may be improved through the fusion of computed tomography (CT) and ultrasound (US) data. This work aims to assess the potential of a surface‐based registration technique and establish an optimal US acquisition protocol to fuse two‐dimensional (2D) US and CT data for image‐guided PRA. Methods: Ten porcine kidney phantoms with fiducial markers were imaged using CT and three‐dimensional (3D) US. Both images were manually segmented and aligned. In a virtual environment, 2D contours were extracted by slicing the 3D US kidney surfaces and using usual PRA US‐guided views, while the 3D CT kidney surfaces were transformed to simulate positional variability. Surface‐based registration was performed using two methods of the iterative closest point algorithm (point‐to‐point, ICP1; and point‐to‐plane, ICP2), while four acquisition variants were studied: (a) use of single‐plane (transverse, SPT; or longitudinal, SPL) vs bi‐plane views (BP); (b) use of different kidney's coverage ranges acquired by a probe's sweep; (c) influence of sweep movements; and (d) influence of the spacing between consecutive slices acquired for a specific coverage range. Results: BP view showed the best performance (TRE = 2.26 mm) when ICP2 method, a wide kidney coverage range (20°, with slices spaced by 5°), and a large sweep along the central longitudinal view were used, showing a statistically similar performance (P = 0.097) to a full 3D US surface registration (TRE = 2.28 mm). Conclusions: An optimal 2D US acquisition protocol was evaluated. Surface‐based registration, using multiple slices and specific sweep movements and views, is here suggested as a valid strategy for intraoperative image fusion using CT and US data, having the potential to be applied to other image modalities and/or interventions. [ABSTRACT FROM AUTHOR]

The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient’s clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients’ electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients’ confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma. [ABSTRACT FROM AUTHOR]

Anti‐tumour necrosis factor (TNF) drugs have been extensively used in non‐infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side‐effects occur. However, systemic anti‐TNF therapies are also associated with a myriad of side‐effects. Therefore, intravitreal administration of anti‐TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti‐TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti‐TNF drugs with a 4‐week minimum follow‐up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open‐label, single‐centre, prospective, non‐randomized, interventional case series with a follow‐up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti‐TNF intravitreal injections, while one study revealed short‐term improvement and one study revealed no efficacy of anti‐TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti‐drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti‐TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti‐TNF antibodies remains a possible treatment option to be explored through robust clinical investigation. [ABSTRACT FROM AUTHOR]

Abstract: Porphyria cutanea tarda (PCT) is a multifactorial disease; clinical expression depends on both genetic and acquired factors. Few studies have examined the connection between PCT and the regulation of iron metabolism genes other than the HFE gene. We selected five polymorphisms in the CYBRD1, CP, SLC40A1, and HAMP genes to determine whether these polymorphisms can act as genetic modulators in patients with sporadic PCT. None of the 29 patients carried the C282Y mutation. Genomic DNA from 29 PCT patients was isolated. Alleles were discriminated using the ABI StepOnePlus Real‐Time PCR System using TaqMan Assays. The results were compared with 107 healthy individuals matched for genetic ancestry, gender, and age. European ancestry was prevalent among PCT patients (68.3%). The frequency of the TT genotype of rs13015236 in the SLC40A1 gene was higher in PCT patients (44.8%) than in controls (20.6%) (P < 0.02). The C allele was more frequent among healthy individuals (53.3%) compared with patients (34.5%) (P < 0.01). The rs17838832 G allele of the CP gene was more common among PCT patients (14.3%) compared with controls (4.9%) (P < 0.05). There was no statistically significant difference concerning the three remaining polymorphisms. Our data highlight a possible role for the rs17838832 single nucleotide polymorphisms in CP in causing PCT (higher frequency of the G variant in patients). Regarding the rs13015236 single nucleotide polymorphisms in SLC40A1, the presence of a C allele could protect against PCT. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the balance of blood follicular helper T (Tfh) cells and T follicular regulatory (Tfr) cells can provide information about ectopic lymphoid neogenesis and disease activity in primary Sjögren's syndrome (SS). Methods: We prospectively recruited 56 patients clinically suspected of having SS. Sixteen of these patients subsequently fulfilled the American–European Consensus Group criteria for SS and were compared to 16 patients with non‐SS sicca syndrome. Paired blood and minor salivary gland (MSG) biopsy samples were analyzed to study Tfr cells and subsets of Tfh cells in both compartments. Results: Patients with primary SS had normal Tfh cell counts in peripheral blood; however, activated programmed death 1–positive (PD‐1+) inducible costimulator–positive (ICOS+) Tfh cells in peripheral blood were strongly associated with disease activity assessed by the European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (r = 0.8547, P = 0.0008). Conversely, the blood Tfr cell:Tfh cell ratio indicated ectopic lymphoid structure formation in MSGs, being strongly associated with B cell, CD4+ T cell, and PD‐1+ICOS+ T cell infiltration in MSGs, and was especially increased in patients with focal sialadenitis. Further analysis showed that the blood Tfr cell:Tfh cell ratio allowed discrimination between SS patients and healthy donors with excellent accuracy and was a strong predictor of SS diagnosis (odds ratio [OR] 12.96, P = 0.028) and the presence of focal sialadenitis (OR 10, P = 0.022) in patients investigated for sicca symptoms, thus highlighting the potential clinical value of this marker. Conclusion: The blood Tfr cell:Tfh cell ratio and PD‐1+ICOS+ Tfh cells constitute potential novel biomarkers for different features of primary SS. While the blood Tfr cell:Tfh cell ratio is associated with ectopic lymphoid neogenesis, activated Tfh cells indicate disease activity. [ABSTRACT FROM AUTHOR]

Background Childhood asthma is very prevalent and costs can be high, especially in severe disease. This study aimed to estimate the cost of asthma in Portuguese children and the variations by level of asthma control. Methods A nationwide, population- and prevalence-based cost-of-illness study with a societal perspective was conducted. We measured direct and indirect costs using a bottom-up approach and a human capital method, respectively, for 208 children (<18 years), from two national repositories. Generalized linear modelling for analysis of asthma costs' determinants and sensitivity analysis to assess uncertainty were performed. Results The mean annualized asthma cost per child was €929.35 (95% CI, 809.65-1061.11): €698.65 (95% CI, 600.88-798.27) for direct costs and €230.70 (95% CI, 197.36-263.81) for indirect costs. Extrapolations for the Portuguese children amounted to €161 410 007.61 (95% CI, 140 620 769.55-184 293 968.55) for total costs. Direct costs represent 75.2% with the costliest domain (51.1% of total costs) being the healthcare service use: 20.7% for scheduled medical visits and 30.4% for acute asthma care-non-scheduled medical visits (7.9%, €12 766 203.20), emergency department visits (11.7%, €18 932 464.80) and hospitalizations (10.8%, €17 406 946.00). Children with partly controlled and uncontrolled asthma had higher mean costs per year (adjusted coefficients: 1.46 [95% CI, 1.12-1.90] and 2.25 [95% CI, 1.56-3.24], respectively). Conclusions Costs of childhood asthma are high (0.9% of the healthcare expenditures in Portugal). Direct costs represented three-fourth of total costs, mainly related to the use of healthcare services for acute asthma care. Policies and interventions to improve asthma control and reduce acute use of healthcare services have the potential to reduce asthma costs. [ABSTRACT FROM AUTHOR]

Objective. Tumor necrosis factor (TNF) increases circulating osteoclast (OC) precursors numbers by promoting their proliferation and differentiation. The aim of this study was to assess the effect of TNF inhibitors (TNFi) on the differentiation and activity of OC in rheumatoid arthritis (RA) patients. Methods. Seventeen RA patients treated with TNFi were analyzed at baseline and after a minimum follow-up period of 6 months. Blood samples were collected to assess receptor activator of nuclear factor kappa-B ligand (RANKL) surface expression on circulating leukocytes and frequency and phenotype of monocyte subpopulations. Quantification of serum levels of bone turnover markers, in vitro OC differentiation assays, and qRT-PCR for OC specific genes was performed. Results. After TNFi therapy, patients had reduced RANKL surface expression in B-lymphocytes and the frequency of circulating classical CD14brightCD16− monocytes was decreased. Serum levels of sRANKL, sRANKL/OPG ratio, and CTX-I were reduced in RA patients after TNFi treatment. Moreover, after exposure to TNFi, osteoclast differentiation and activity were decreased, as well as the expression of TRAF6 and cathepsin K. Conclusion. We propose that TNFi arrests bone loss and erosion, through two pathways: direct reduction of osteoclast precursor numbers and inhibition of intracellular signaling pathways acting through TRAF6. [ABSTRACT FROM AUTHOR]

The authors present a study focusing on T follicular regulatory cells (Tfr) in patients with rheumatoid arthritis (RA). Topics discussed include the phenotype and human circulating Tfr cells (2); the treatment of the patients with methotrexate; and the anti–citrullinated protein antibody levels in the body.

The article discusses the use of animal models to determine the pathways to discover the nature of spondyloarthritis. Topics covered include the contributions of animal models to the study of rheumatoid arthritis. Also mentioned is the assessment of HLA-B27 expression as a genetic risk factor for the health condition.

Background In preschool children, no study assessed the relation between wheezing and rhinitis severity. Our aims were to estimate the prevalence of current wheezing ( CW) in preschoolers and to study the association between CW and current rhinitis ( CR), considering its severity/persistency. Methods This is a cross-sectional, nationwide, population-based study including a representative sample of 5003 Portuguese children aged 3-5 years. Data were collected by a face-to-face interview with caregivers using an adapted ISAAC questionnaire. CW was defined as presence of ≥1 wheezing episode in the previous 12 months. Rhinitis severity/persistency was classified according to Allergic Rhinitis and its Impact on Asthma. Results Current wheezing prevalence was 24.5% [95% CI 23.3-25.7]; 9.4% of the participants had ≥4 wheezing episodes in the previous year. Children with CR had an odds ratio ( OR) of 4.0 [95% CI 3.4-4.5] for CW; it was highest for children with moderate-severe persistent rhinitis (11.5 [95% CI 8.1-16.3]), even after adjusting for possible confounders. Wheezers with CR reported more wheezing treatment use (p = 0.024) than those without CR. There was a trend for a higher number of wheezing episodes with more persistent and severe nasal disease - 48.4% of children with moderate-severe persistent rhinitis had >4 wheezing episodes vs. 28.9% in moderate-severe intermittent, 20.0% in mild persistent, 10.8% in mild intermittent, and 3.6% in those without CR; p < 0.001. Conclusions Current wheezing was present in almost 25% of preschool children and was strongly associated with rhinitis, especially moderate-severe persistent disease. Preschoolers with both CW and rhinitis seem to have a more severe phenotype, emphasizing the need for concurrent evaluation of nasal and bronchial symptoms even in small children. [ABSTRACT FROM AUTHOR]

Background This study aimed to estimate the prevalence of asthma control and determinants of poor control in the Portuguese pediatric population (<18 years); secondarily, we described asthma-related healthcare services and medication use. Methods Data of 98 children with current asthma, from the second phase of a nationwide population-based telephone survey ( INAsma study), were analyzed. Asthma control definition was based on GINA criteria, grouping partially controlled and uncontrolled asthma as 'not-controlled asthma' ( NCA). We used multivariate logistic regression to study factors associated with NCA and with unscheduled medical visits for asthma. Results About half of the children had NCA (49%, 95% CI 39-59%). In the multivariate model, risk factors for NCA were as follows: substantial nasal symptoms ( aOR 6.80), overweight/obesity ( aOR 3.44), and not having health insurance ( aOR 3.78). All the children with NCA had nasal symptoms, and the lack of asthma control was also associated with the increasing number of nasal symptoms (p < 0.001). In the previous year, 90% (95% CI 84-96%) of children with current asthma had healthcare visits and 67% (95% CI 58-77%) used medication for asthma. The risk of unscheduled medical visits was higher in children with nasal symptoms ( aOR 3.63) and in those without health insurance ( aOR 2.79), and lower in adolescents ( aOR 0.19). Conclusions Half of the children with asthma were poorly controlled. Nasal symptoms and obesity are important determinants of asthma control. Children without health insurance are at greater risk of poor asthma outcomes; this association is reported for the first time in a European country. [ABSTRACT FROM AUTHOR]

Among human peripheral blood (PB) monocyte (Mo) subsets, the classical CD14++CD16− (cMo) and intermediate CD14++CD16+ (iMo) Mos are known to activate pathogenic Th17 responses, whereas the impact of nonclassical CD14+CD16++ Mo (nMo) on T-cell activation has been largely neglected. The aim of this study was to obtain new mechanistic insights on the capacity of Mo subsets from healthy donors (HDs) to activate IL-17+ T-cell responses in vitro, and assess whether this function was maintained or lost in states of chronic inflammation. When cocultured with autologous CD4+ T cells in the absence of TLR-2/NOD2 agonists, PB nMos from HDs were more efficient stimulators of IL-17-producing T cells, as compared to cMo. These results could not be explained by differences in Mo lifespan and cytokine profiles. Notably, however, the blocking of LFA-1/ICAM-1 interaction resulted in a significant increase in the percentage of IL-17+ T cells expanded in nMo/T-cell cocultures. As compared to HD, PB Mo subsets of patients with rheumatoid arthritis were hampered in their T-cell stimulatory capacity. Our new insights highlight the role of Mo subsets in modulating inflammatory T-cell responses and suggest that nMo could become a critical therapeutic target against IL-17-mediated inflammatory diseases. [ABSTRACT FROM AUTHOR]

Objectives. To compare the effectiveness of TNF inhibitors (TNFi) and tocilizumab in rheumatoid arthritis (RA) treatment, according to different response criteria. Methods. We included RA patients registered in the Rheumatic Diseases Portuguese Register treated with TNFi or tocilizumab for at least 6 months, between January 2008 and July 2013. We assessed remission/low disease activity (LDA) at 6 months according to DAS28, CDAI, and SDAI, as well as Boolean ACR/EULAR remission and EULAR response rate, adjusting for measured confounders. Results. Tocilizumab-treated patients (n=95) presented higher baseline disease activity and were less frequently naïve to biologics compared to TNFi users (n=429). Multivariate logistic regression analysis including the propensity score for receiving tocilizumab showed that patients treated with tocilizumab were more likely to achieve remission or LDA according to DAS28 (OR = 11.0/6.2, 95% CI 5.6–21.6/3.2–12.0), CDAI (OR = 2.8/2.6, 95% CI 1.2–6.5/1.3–5.5), or SDAI (OR = 3.6/2.5, 95% CI 1.5–8.7/1.1–5.5), as well as a good EULAR response (OR = 6.4, 95% CI 3.4–12.0). However, both groups did not differ in Boolean remission (OR = 1.9, 95% CI 0.8–4.8) or good/moderate EULAR response (OR = 1.8, 95% CI 0.8–4.5). Conclusions. Compared with TNFi, tocilizumab was associated with greater likelihood of achieving DAS28, CDAI, and SDAI remission/LDA and EULAR good response. Boolean remission and EULAR good/moderate response did not differ significantly between groups. [ABSTRACT FROM AUTHOR]

Coprophagia and entomophagia are two phenomena not commonly reported in the medical literature and their occurrence is usually associated with mental disorders. We present the case of a 59-year-old man with a history of alcohol abuse who was evaluated due to cognitive deterioration and disturbed eating habits including feces and living insects. Organic causes were ruled out and an important cognitive impairment became evident on neuropsychological formal test. The behavior remitted after antipsychotic pharmacologic therapy and alcohol detoxification, leaving the diagnostic impression of alcohol related dementia. This report shows a rare association of these two conditions in a patient with dementia. [ABSTRACT FROM AUTHOR]

Introduction. This study aimed to assess the genetic determinants of poor outcome in Portuguese patients with juvenile idiopathic arthritis (JIA). Methods. Our study was conducted in Reuma.pt, the Rheumatic Diseases Portuguese Register, which includes patients with JIA. We collected prospectively patient and disease characteristics and a blood sample for DNA analysis. Poor prognosis was defined as CHAQ/HAQ >0.75 at the last visit and/or the treatment with biological therapy. A selected panel of single nucleotide polymorphisms (SNPs) associated with susceptibility was studied to verify if there was association with poor prognosis. Results. Of the 812 patients with JIA registered in Reuma.pt, 267 had a blood sample and registered information used to define “poor prognosis.” In univariate analysis,we found significant associationswith poor prognosis for alleleAof TNFA1P3/20 rs6920220, allele Gof TRAF1/C5 rs3761847, and alleleGof PTPN2 rs7234029. Inmultivariate models, the associationswith TRAF1/C5 (1.96 [1.17–3.3]) remained significant at the 5% level, while TNFA1P3/20 and PTPN2 were no longer significant. Nevertheless, none of associations found was significant after the Bonferroni correction was applied. Conclusion. Our study does not confirmthe association between a panel of selected SNP and poor prognosis in Portuguese patients with JIA. [ABSTRACT FROM AUTHOR]

Objective Our aims were to evaluate the correlation between Juvenile Arthritis Disease Activity Score 27-joint reduced count (JADAS27) with erythrocyte sedimentation rate (ESR) and JADAS27 with C-reactive protein (CRP) scores and to test the agreement of both scores on classifying each disease activity state. We also aimed at verifying the correlation of the 2 scores across juvenile idiopathic arthritis (JIA) categories and to check the correlation between JADAS27-ESR and clinical JADAS27 (JADAS27 without ESR). Methods A nationwide cohort of patients with JIA registered in the Portuguese Register, Reuma.pt, was studied. JADAS27-CRP was adapted by replacing ESR with CRP level as the inflammatory marker. JADAS27-CRP was calculated similarly to JADAS27-ESR as the simple linear sum of its 4 components. Pearson's correlations and K statistics were used in the analyses. Results A total of 358 children had full data to calculate JADAS27; 65.4% were female and the mean ± SD disease duration was 11.8 ± 9.1 years. The correlation coefficient between JADAS27-ESR and JADAS27-CRP was 0.967 ( P < 0.0001), although the correlation coefficient between ESR and CRP level was 0.335 ( P < 0.0001). The strong correlation between JADAS27-ESR and JADAS27-CRP was maintained when compared within each JIA category. The agreement between JADAS27-ESR and JADAS27-CRP across the 4 activity states was very good, showing 91.1% of the observations in agreement; K = 0.867 (95% confidence interval 0.824-0.91). The correlation between JADAS27 with ESR and JADAS27 without ESR was high (r = 0.97, P < 0.0001). Conclusion JADAS27 based on CRP level correlated closely with JADAS27-ESR across all disease activity states and JIA categories, indicating that both measures can be used in clinical practice. Moreover, the correlation of JADAS27 with and without ESR was also high, suggesting that this tool might be useful even in the absence of laboratorial measures. [ABSTRACT FROM AUTHOR]

Background Control of Allergic Rhinitis and Asthma Test for Children ( CARATKids) is the first questionnaire that assesses simultaneously allergic rhinitis and asthma control in children. It was recently developed, but redundancy of questions and its psychometric properties were not assessed. This study aimed to (i) establish the final version of the CARATKids questionnaire and (ii) evaluate its reliability, responsiveness, cross-sectional validity, and longitudinal validity. Methods A prospective observational study was conducted in 11 Portuguese centers. During two visits separated by 6 wk, CARATKids, visual analog scale scales and childhood asthma control test were completed, and participant's asthma and rhinitis were evaluated by his/her physician without knowing the questionnaires' results. Data-driven item reduction was conducted, and internal consistency, responsiveness analysis, and associations with external measures of disease status were assessed. Results Of the 113 children included, 101 completed both visits. After item reduction, the final version of the questionnaire has 13 items, eight to be answered by the child and five by the caregiver. Its Cronbach's alpha was 0.80, the Guyatt's responsiveness index was −1.51, and a significant (p < 0.001) within-patient change of CARATKids score in clinical unstable patients was observed. Regarding cross-sectional validity, correlation coefficients of CARATKids with the external measures of control were between 0.45 and −0.69 and met the a priori predictions. In the longitudinal validity assessment, the correlation coefficients between the score changes of CARATKids and those of external measures of control ranged from 0.34 to 0.46. Conclusion CARATKids showed adequate psychometric properties and is ready to be used in clinical practice. [ABSTRACT FROM AUTHOR]

In biotechnological screening and production, oxygen supply is a crucial parameter. Even though oxygen transfer is well documented for viscous cultivations in stirred tanks, little is known about the gas/liquid oxygen transfer in shake flask cultures that become increasingly viscous during cultivation. Especially the oxygen transfer into the liquid film, adhering on the shake flask wall, has not yet been described for such cultivations. In this study, the oxygen transfer of chemical and microbial model experiments was measured and the suitability of the widely applied film theory of Higbie was studied. With numerical simulations of Fick's law of diffusion, it was demonstrated that Higbie's film theory does not apply for cultivations which occur at viscosities up to 10 mPa s. For the first time, it was experimentally shown that the maximum oxygen transfer capacity OTRmax increases in shake flasks when viscosity is increased from 1 to 10 mPa s, leading to an improved oxygen supply for microorganisms. Additionally, the OTRmax does not significantly undermatch the OTRmax at waterlike viscosities, even at elevated viscosities of up to 80 mPa s. In this range, a shake flask is a somehow self-regulating system with respect to oxygen supply. This is in contrary to stirred tanks, where the oxygen supply is steadily reduced to only 5% at 80 mPa s. Since, the liquid film formation at shake flask walls inherently promotes the oxygen supply at moderate and at elevated viscosities, these results have significant implications for scale-up. Biotechnol. Bioeng. 2014;111: 295-308. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background. We have previously reported a continuous activation of caspase-1 and increased interleukin (IL)-1β levels in early rheumatoid arthritis (RA). These observations raised the hypothesis that drugs targeting the IL-1β pathway, in addition to tumour necrosis factor (TNF),may be particularly effective for earlyRAtreatment.We have recently identified gambogic acid as a promising therapeutic candidate to simultaneously block IL-1β and TNF secretion. Our main goal here was to investigate whether gambogic acid administration was able to attenuate inflammation in antigen-induced arthritis (AIA) rats. Methods. Gambogic acid was administered to AIA rats in the early and late phases of arthritis. The inflammatory score, ankle perimeter, and body weight were evaluated during the period of treatment. Rats were sacrificed after 19 days of disease progression and paw samples were collected for histological and immunohistochemical evaluation. Results. We found that inflammation in joints was significantly suppressed following gambogic acid administration. Histological and immunohistochemical evaluation of treated rats revealed normal joint structures with complete abrogation of the inflammatory infiltrate and cellular proliferation. Conclusions. Our results suggest that gambogic acid has significant anti-inflammatory properties and can possibly constitute a prototype anti-inflammatory drug with therapeutic efficacy in the treatment of inflammatory diseases such as RA. [ABSTRACT FROM AUTHOR]

Background The values obtained when the fraction of exhaled nitric oxide ( FeNO) is measured are affected by several factors that are specific to the individual patient, making interpretation difficult, especially in the initial assessment of patients with respiratory symptoms. Methods Systematic review of studies on FeNO reference values and individual-specific factors that influence them. Results From 3739 references, 15 studies were included. Four studies included children and adolescents. In nine studies, samples were selected from the general population. Most studies reported objective measures for atopy (nine studies), but not for smoking status (one). Significant determinants of FeNO values reported were age and height (seven studies), atopy (six), smoking (four), weight (four), sex (three) and race (three). Additional factors were included in eight studies. R2 was reported in only five studies. The logarithmic transformation of FeNO was inadequately described in seven studies. Conclusion There are several equations for FeNO reference values that may be used in clinical practice, although the factors they include and the statistical methods they use vary considerably. We recommend the development of standard methods for the evaluation of normal FeNO data and that reference equations should be formulated based on a predetermined physiological model. [ABSTRACT FROM AUTHOR]