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Highlights • Dose to the heart and all its substructures were significantly lower with IMPT compared to VMAT. • Our analysis showed that not all patients benefit equally from proton beam therapy. • Patients with disease involvement overlapping with or are inferior to the most superior aspect of the heart contour appear to have the highest benefit. The median level of the superior aspect of the heart contour began was T7 vertebra., Purpose/objective To use a model-based approach to identify a sub-group of patients with locally advanced lung cancer who would benefit from proton therapy compared to photon therapy for reduction of cardiac toxicity. Material/methods Volumetric modulated arc photon therapy (VMAT) and robust-optimised intensity modulated proton therapy (IMPT) plans were generated for twenty patients with locally advanced lung cancer to give a dose of 70 Gy (relative biological effectiveness (RBE)) in 35 fractions. Cases were selected to represent a range of anatomical locations of disease. Contouring, treatment planning and organs-at-risk constraints followed RTOG-1308 protocol. Whole heart and ub-structure doses were compared. Risk estimates of grade⩾3 cardiac toxicity were calculated based on normal tissue complication probability (NTCP) models which incorporated dose metrics and patients baseline risk-factors (pre-existing heart disease (HD)). Results There was no statistically significant difference in target coverage between VMAT and IMPT. IMPT delivered lower doses to the heart and cardiac substructures (mean, heart V5 and V30, P

Background Radiotherapy is an essential treatment component for patients with stage III non-small-cell lung cancer. Despite advances, survival remains poor. Proton beam therapy holds the promise of improving cure rates without increasing treatment-related toxicity. However, precision in dose delivery is sensitive to setup uncertainties. The conventional method of adding a margin to account for this problem can be inadequate. We aimed to use the probabilistic scenarios methodology to assess the robustness of intensity modulated proton therapy (IMPT) and volumetric arc therapy (VMAT). Methods Plans were optimised by minimax robust optimisation (MM) and margin-based (planning target volume [PTV]) methods (MM–IMPT, PTV–IMPT, and VMAT). Robustness was assessed with probabilistically simulated setup errors. 35 perturbed doses were summed to model a treatment course. The CTV-D98 (dose to 98% of the clinical target volume) of each summed dose distribution was compared with the nominal plan and considered robust if within 5%. The variance of the CTV-D98 in IMPT and VMAT plans were compared using Levene's Test. Findings 700 simulations from 20 plans were analysed. Despite dose variation over a simulated course of treatment, the robustness of each summed plan was within clinical limits. There was significantly less variance in the perturbed CTV-D98 in the MM–IMPT than in PTV–IMPT plans (4·43 cGy 2 vs 16·17, F =50·993, p 2 vs 4·04, F =0·312, p=0·577). Target conformality improved with increasing number of beams and robust optimisation. All summed plans met normal tissue dose constraints. Interpretation Initial results showed that fractionation reduced uncertainties in dose distribution due to setup errors. Robustness of MM–IMPT and VMAT plans were similar. Although the present analysis has not considered range uncertainties and organ motion, the simulations highlight differences in plan qualities with different optimisation strategies. The probabilistic scenarios methodology might be used to estimate robustness of IMPT plans in stage III non-small-cell lung cancer. Funding Cancer Research UK.

Commercially available pencil beam proton therapy treatment planning systems rely on a combination of in air and in phantom measurements. The analytical algorithms describe the scatter of and geometrical variation as the beam penetrates deeper in tissue. In previous work we showed that the accuracy of this approach is limited. Alternatively, stochastic algorithms (Monte Carlo, Boltzmann equation solvers) are used which are more precise but are much slower. This paper proposes a new parameterization of the physical dose deposition properties of a proton pencil beam and shows that it predicts all properties well even in sparse measurement conditions (i.e., not all energies for pencil beams are measured), decreasing the amount of beams needing to be measured by at least 50%.

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Background: This presentation proposal focuses on a specific quanti-qualitative research activity of a broader process called Open Health in Ferrara. This step involves two public institutions (Hospital University and Local Health Authority of Ferrara), those manage and provide health-care services, and the department of Political and Social Sciences Bologna University, that supervises the research part. In particular the research team collected data, categorized and mapped the main opportunities and threats in the cancer pathways to empowering and involving patients and local communities. Methods: From the combined effects of e-learning and presence training, focus group, questionnaire, divulgative meetings with citizens and a good consideration of social communication importance, from the start of the pilotage September 2015 to April 2017, we realized direct involving 200 health and social professionals, citizens and policymakers. We analyze the main features of the pathways and to collect suggestion about patient experience, professionals experience of integrated care to improve the continuity of care of cancer pathways. Results: Data show the main critical points in the communication and information about symptoms and perception of feeling of abandonment and opportunities to have a second opinion, alternatives of care, efficacy of care and patient reported outcomes. There are also low perception from professionals as a interdisciplinary network

We present a study of the under-response of the new Gafchromic EBT3 films and a procedure to accurately perform 2D and 3D proton dosimetry measurements for both pristine and spread out Bragg peaks (SOBP) of any energy. These new films differ from the previous EBT2 generation by a slightly different active layer composition, which we show has not effected appreciably their response. The procedure and the beam quality correction factor curve have been benchmarked using 29 MeV modulated proton beams. In order to show the correction to apply when EBT3 films are used as treatment verification tools in anthropomorphic phantoms, two simulation studies involving clinical energies are presented: a SOBP for eye treatments and a SOBP to treat 20 cm deep and 5 cm thick tumours. We find maximum under-responses of 37%, 30% and 7.7% for the modulated 29 MeV beam, eye and deep tumour treatment, respectively, which were attained close to the end of the peak tails, due to a higher proportion of very low energy protons. The maximum deviations between corrected and uncorrected doses were for the three cases, respectively, 20.7%, 8.3% and 2.1% of the average dose across flat region of the SOBP. These values were obtained close to the distal edge of the SOBPs, where the proportion of low energy protons was not as high as on the tail, but there still was a number of protons high enough to deposit a reasonable amount of dose in the films.

Routing in Delay-/Disruption-Tolerant Networking (DTN) requires specific solutions as link impairments prevent the use of ordinary Internet algorithms, based on a timely dissemination of network topology information. Among DTN routing algorithms there is a dichotomy between opportunistic and deterministic (scheduled) solutions. The former are numerous and apply to terrestrial environments; CGR is the most widely supported algorithm designed for scheduled connectivity, and it is usually applied to space networks. However, in an attempt to provide a unified approach, an opportunistic variant of CGR, Opportunistic CGR (OCGR) has been recently proposed by some of the authors. Performance evaluations are normally carried out for opportunistic solutions by means of simulators, such as The ONE considered in this paper. CGR by contrast is more often studied by means of small testbeds. As the simulation approach could be complementary for CGR, and essential for OCGR, the authors have recently ported both of them into The ONE, by developing and releasing as free software a specific additional package. The aim of this paper is to show the rationale of this choice and discuss the many challenges that needed to be tackled to achieve this primary goal.

Acquired renal arteriovenous fistulas (AVFs) include those that occur as a complication of renal biopsy.The authors report the case of a woman with recent-onset grade I hypertension, who was referred to our staff for sonographic studies of the kidneys and urinary tract. Laboratory data revealed microhematuria and proteinuria0.5 g/24 h, and renal function was borderline (MDRD GFR 58 mL/min). Renal sonography of the left kidney revealed an anechoic, arboriform area at the level of the pelvis, which was suggestive of hydronephrosis. The color Doppler examination showed turbulent flow within the anechoic area, with high-velocity arterial flow and arterialization of the venous waveform at spectral analysis. Selective renal angiography later confirmed the presence of a middle renal AVF with pseudoaneurysm, which had been provoked by a renal biopsy performed over 10 years earlier in another center. Since the patient was currently in good health, the prescribed management consisted solely of close clinical and US follow-up.AV fistulas are among the most commonly diagnosed renovascular malformations. The case reported here underlines the importance of using color Doppler ultrasound when obstructive uropathy is suspected, especially in patients who have undergone renal biopsy.Sommario INTRODUZIONE: Tra le fistole arterovenose (FAV) acquisite vi sono quelle che si formano quale complicanza dell’esecuzione di una biopsia renale. CASO CLINICO: Gli autori riportano il caso di una paziente giunta in ambulatorio di ecografia nefrologica per l’esecuzione di un’ecografia dei reni e delle vie urinarie per un’ipertensione sistolica di I grado di recente insorgenza. Negli esami di laboratorio era presente microematuria con proteinuria0.5 g/24 ore. La funzionalità renale risultava ai limiti inferiori della norma (FG 58 mL/min secondo la formula MDRD). L’esame ecografico evidenziava una formazione anecogena “arboriforme” centropielica a livello del rene sinistro suggestiva per idronefrosi. Il color Doppler mostrava viceversa presenza di flusso turbolento all’interno dell’area anecogena stessa, con flusso arterioso elevato e arterializzazione del flusso venoso all’analisi spettrale. La successiva angiografia renale selettiva confermava il sospetto ecografico di FAV mediorenale sinistra con pseudoaneurisma, conseguente ad una biopsia renale effettuata più di 10 anni prima presso altro Centro. Essendo la paziente in pieno benessere veniva consigliato un più stretto follow-up clinico-ecografico. DISCUSSIONE: Tra le malformazioni vascolari renali di non rara osservazione sono le FAV. Il caso descritto ribadisce l’importanza dell’impiego dell’eco color Doppler (ECD) nel sospetto di uropatia ostruttiva, per diagnosticare una FAV, specialmente nei pazienti già sottoposti a biopsia renale.

Department of Emergency Medicine, Sapienza University, Post Graduate School in Emergency-Urgency Medicine, Sant’Andrea Hospital, Rome, Italy University of North Dakota School of Medicine and Biomedical Sciences Grand Forks, ND, USA Department of Medicine, University of Padova, Italy Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, USA Department of Nephrology, Dialysis and Dietology, SM della Misericordia Hospital, Rovigo, Italy Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy Department of Nephrology Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy GREAT: Global Research in Acute Conditions Team Network

A new approach to spectroscopy of laser induced proton beams using radiochromic film (RCF) is presented. This approach allows primary standards of absorbed dose-to-water as used in radiotherapy to be transferred to the calibration of GafChromic HD-810 and EBT in a 29 MeV proton beam from the Birmingham cyclotron. These films were then irradiated in a common stack configuration using the TARANIS Nd:Glass multi-terawatt laser at Queens University Belfast, which can accelerate protons to 10–12 MeV, and a depth-dose curve was measured from a collimated beam. Previous work characterizing the relative effectiveness (RE) of GafChromic film as a function of energy was implemented into Monte Carlo depth-dose curves using FLUKA. A Bragg peak (BP) “library” for proton energies 0–15 MeV was generated, both with and without the RE function. These depth-response curves were iteratively summed in a FORTRAN routine to solve for the measured RCF depth-dose using a simple direct search algorithm. By comparing resultant spectra with both BP libraries, it was found that the effect of including the RE function accounted for an increase in the total number of protons by about 50%. To account for the energy loss due to a 20 µm aluminum filter in front of the film stack, FLUKA was used to create a matrix containing the energy loss transformations for each individual energy bin. Multiplication by the pseudo-inverse of this matrix resulted in “up-shifting” protons to higher energies. Applying this correction to two laser shots gave further increases in the total number of protons, N of 31% and 56%. Failure to consider the relative response of RCF to lower proton energies and neglecting energy losses in a stack filter foil can potentially lead to significant underestimates of the total number of protons in RCF spectroscopy of the low energy protons produced by laser ablation of thin targets.

L'obiettivo di questo studio è descrivere “step-by-step” la nefrolitotrissia percutanea e le sue complicanze. A tale proposito sono stati valutati i casi di calcolosi renale da noi trattati con nefrolitotrissia percutanea (PCNL) dal 2001 al 2010 ed è stata al contempo rivista la letteratura circa l'incidenza e il management delle complicanze legate a tale procedura. La percentuale globale di complicanze registrate durante e dopo le PCNL possono raggiungere anche l'83% dei casi e comprendono ematomi (7,2%), trasfusioni (11,2%-17,5%) e febbre (21,0%-32,0%). Molte di queste complicazioni, se riconosciute precocemente, possono essere gestite con trattamenti conservativi o mininvasivi. Le complicanze maggiori sono rare (setticemia (0,3–0,4%), lesioni intestinali (0,2–0,8%), lesioni pleuriche (0,0–3,1%)). Le co-morbilità (insufficienza renale, diabete mellito, obesità severa, malattie polmonari) sembrano incrementare il rischio di complicanze. Nella nostra casistica la percentuale complessiva di complicanze è stata pari al 26%, molte delle quali si sono risolte senza sequele. In conclusione, la PCNL rappresenta una metodica sicura e con basso rischio di complicanze specifiche specie se a seguito di un'accurata selezione e preparazione dei pazienti, tecnica appropriata e attento follow-up nel post-operatorio al fine di assicurare tempestivo intervento se/quando necessario.

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Due to an error in the manuscript submission process Dr. Francesca Fiorini of the Oxford Institute for Radiation Oncology was not included in the list of authors of the published work entitled “Instrumentation for diagnostics and control of laser-accelerated proton (ion) beams”. We deeply regret the occurrence and inconvenience of this error. This corrigendum is our published correction to the erroneous omission in which we include Dr. F. Fiorini as a listed author of this work. The correct complete list of the authors of the paper, “Instrumentation for diagnostics and control of laser-accelerated proton (ion) beams” (Phys Med 2014; 30: 255–270) is the following: P.R. Bolton, M. Borghesi, C. Brenner, D.C. Carroll, C. De Martinis, F. Fiorini, A. Flacco, V. Floquet, J. Fuchs, P. Gallegos, D. Giove, J. S. Green, S. Green, B. Jones, D. Kirby, P. McKenna, D. Neely, F. Nuesslin, R. Prasad, S. Reinhardt, M. Roth, U. Schramm, G.G. Scott, S. Ter-Avetisyan, M. Tolley, G. Turchetti, and J.J. Wilkens

Suitable instrumentation for laser-accelerated proton (ion) beams is critical for development of integrated, laser-driven ion accelerator systems. Instrumentation aimed at beam diagnostics and control must be applied to the driving laser pulse, the laser-plasma that forms at the target and the emergent proton (ion) bunch in a correlated way to develop these novel accelerators. This report is a brief overview of established diagnostic techniques and new developments based on material presented at the first workshop on 'Instrumentation for Diagnostics and Control of Laser-accelerated Proton (Ion) Beams' in Abingdon, UK. It includes radiochromic film (RCF), image plates (IP), micro-channel plates (MCP), Thomson spectrometers, prompt inline scintillators, time and space-resolved interferometry (TASRI) and nuclear activation schemes. Repetition-rated instrumentation requirements for target metrology are also addressed. (C) 2013 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

This mixed methods study aimed to explore perceptions/attitudes, to evaluate knowledge/ skills, to investigate clinical behaviours of undergraduate physiotherapy students exposed to a composite education curriculum on evidence-based practice (EBP). Students' knowledge and skills were assessed before and after integrated learning activities, using the Adapted Fresno test, whereas their behaviour in EBP was evaluated by examining their internship documentation. Students' perceptions and attitudes were explored through four focus groups. Sixty-two students agreed to participate in the study. The within group mean differences (A-Fresno test) were 34.2 (95% CI 24.4 to 43.9) in the first year and 35.1 (95% CI 23.2 to 47.1) in the second year; no statistically significant change was observed in the third year. Seventy-six percent of the second year and 88% of the third year students reached the pass score. Internship documentation gave evidence of PICOs and database searches (95-100%), critical appraisal of internal validity (25-75%) but not of external validity (5-15%). The correct application of these items ranged from 30 to 100%. Qualitative analysis of the focus groups indicated students valued EBP, but perceived many barriers, with clinicians being both an obstacle and a model. Key elements for changing students' behaviours seem to be internship environment and possibility of continuous practice and feedback.

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Purpose: 1) To describe the characteristics of pencil beam proton dose deposition kernels in a homogenous medium using a novel parameterization. 2) To propose a method utilizing this novel parametrization to reduce the measurements and pre-computation required in commissioning a pencil beam proton therapy system. Methods: Using beam data from a clinical, pencil beam proton therapy center, Monte Carlo simulations were performed to characterize the dose depositions at a range of energies from 100.32 to 226.08 MeV in 3.6MeV steps. At each energy, the beam is defined at the surface of the phantom by a two-dimensional Normal distribution. Using FLUKA, the in-medium dose distribution is calculated in 200×200×350 mm cube with 1 mm3 tally volumes. The calculated dose distribution in each 200×200 slice perpendicular to the beam axis is then characterized using a symmetric alpha-stable distribution centered on the beam axis. This results in two parameters, α and γ, that completely describe shape of the distribution. In addition, the total dose deposited on each slice is calculated. The alpha-stable parameters are plotted as function of the depth in-medium, providing a representation of dose deposition along the pencil beam. We observed that these graphs are isometric through a scaling of both abscissa and ordinate map the curves. Results: Using interpolation of the scaling factors of two source curves representative of different beam energies, we predicted the parameters of a third curve at an intermediate energy. The errors are quantified by the maximal difference and provide a fit better than previous methods. The maximal energy difference between the source curves generating identical curves was 21.14MeV. Conclusion: We have introduced a novel method to parameterize the in-phantom properties of pencil beam proton dose depositions. For the case of the Knoxville IBA system, no more than nine pencil beams have to be fully characterized.

Obstructive uropathy caused by kidney stones is quite rare in transplant kidneys.The authors report the case of a patient, previously gastrectomized for gastric carcinoma. He underwent renal transplantation using uretero-ureterostomy, and presented an episode of acute renal failure 7 years after surgery. Ultrasound (US) examination showed no sign of rejection but allowed detection of moderate hydronephrosis in the transplant kidney. Subsequent computed tomography (CT) revealed a kidney stone in the middle ureter at the crossing of the iliac vessels. The patient therefore urgently underwent percutaneous nephrostomy of the graft and recovered diuresis and renal function. The patient was transferred to the Transplant Center where he underwent ureterotomy with removal of the stone and subsequent ureteropyelostomy. Also transureteral resection of the prostate (TURP) was performed due to urinary retention of prostatic origin. Histological examination showed prostate carcinoma, Gleason stage 3, which was treated conservatively using radiotherapy without suspension of the administered low dose of immunotherapy.Calculosis is one of the least common causes of obstructive uropathy in transplant kidneys. In the described case, US examination performed after onset of renal insufficiency led to subsequent radiological investigation and resulting interventional procedures (nephrostomy and surgical removal of the stone) with complete recovery of pre-existing renal function.Sommario INTRODUZIONE: L'uropatia ostruttiva da calcolosi si verifica di rado nel rene trapiantato. CASO CLINICO: Gli autori riportano il caso di un paziente trapiantato renale mediante uretero-stomia, già sottoposto a gastrectomia per carcinoma gastrico, che presenta episodio di insufficienza renale acuta 7 anni dopo l'intervento. L'esame ecografico non mostra segni di rigetto e permette di evidenziare viceversa un'idronefrosi di grado non marcato a carico del rene trapiantato. La successiva TC rivela calcolo del tratto medio dell'uretere a livello dell'incrocio con i vasi iliaci. Il paziente viene pertanto sottoposto, in urgenza, a nefrostomia percutanea del graft con buona ripresa della diuresi e della funzionalità renale. Inviato presso il Centro Trapianti di competenza viene sottoposto ad intervento di ureterotomia con asportazione del calcolo e successiva uretero-pielotomia. Per ritenzione urinaria di origine prostatica viene inol-tre sottoposto a TURP. L'esame istologico mostra carcinoma prostatico stadio 3 sec. Gleason, che si decide di trattare in modo conservativo con radioterapia, con mantenimento della già blanda terapia immunodepressiva. DISCUSSIONE: La calcolosi viene annoverata tra le cause meno comuni di uropatia ostruttiva del rene trapiantato. Nel caso descritto l'ecografia effettuata dopo l'insorgenza dell'insufficienza renale acuta ha consentito di avviare rapidamente il paziente alle successive indagini radiologiche ed alle conseguenti procedure interventistiche (nefrostomia e bonifica chirurgica del calcolo) con completo ripristino della funzionalità renale pre-esistente.

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Sera from 82 haemodialysis patients were tested for anti-HCV, HCV-RNA, and HBsAg. Alanine aminotransferase (ALT) activity was monitored weekly for 2 months. Anti-HCV was positive in 31 patients (37.8%), showing different single-peptide patterns. HCV-RNA was detected in 26 anti-HCV-positive patients (84%) and also in two of 21 anti-HCV-negative patients. Twenty-seven (87%) of the 31 anti-HCV-positive patients had persistently normal ALT values; 22 of these patients were HCV-RNA positive. The four patients with elevated ALT values had HCV viraemia. HBsAg was positive in nine anti-HCV-negative patients. The close correlation between HCV viraemia and HCV status, independently of ALT values, requires that anti-HCV dialysis patients must be considered potentially infective and dialysed with reserved machines and/or in separate shifts.

ObjectivesSuicide remains the most severe emergency in every psychiatric disorder.MethodsAfter evaluating the frequency of suicide among patients followed from 1-1-2004 to 31-12-2005 by the Mental Health Service of Modena Centro, we statistically analyzed socio-demographic and clinical data of suicide patients (n=25).ResultsAmong psychiatric population followed by our psychiatric service in the observation period, suicide occurred in the 0.15% of all patients (25/16392) and represented the third cause of death, after cardiovascular disorders and neoplasia. The median age of suicide patients was 42 years for male and 50 years for women, with a ratio male/female of 1.8:1. “Depressive Disorders” followed by “Schizophrenia and other Psychotic Disorders” represented the prevalent psychiatric diagnosis with a statistically significant correlation to suicide death cause (p< 0.005; Chi square test). The suicide patients had being treated for more than one year by psychiatric service (685 days, median) and 10 % of them was hospitalized in a psychiatric ward during the observation period. Suicide occurred after 73 days (median) from last psychiatric discharge and 12 days (median) from last psychiatric consultation.ConclusionsOur data confirmed the literature: suicide is more frequent in young male affected by Depressive Disorders or Schizophrenia and other Psychotic Disorders1. We have to conclude pessimistically about our preventive capacity since suicide occurred in patients already hospitalized and treated for a long period and after a short period from the last psychiatric intervention.

In order to establish if immunologic alterations seen in acquired immunodeficiency syndrome (AIDS)associated Kaposi's sarcoma are also present in the primary form of this malignancy, peripheral blood T-lymphocyte characterization and HIA A, B, C, and DR phenotyping have been carried out in 18 patients with the primary form of the disease. HLA antigen distribution was not significantly different from that of the normal population and, in particular, DHS was only marginally increased. The T4/T8 ratio was significantly higher in the patients than in the control group, and this was due to a marked decrease in suppressor cells. The possible pathogenetic relevance of these findings is discussed. Cancer 55:1899-1901, 1985. APOSI'S SARCOMA, an uncommon and usually nonK lethal neoplasm, is now increasingly reported in homosexual men with acquired immunodeficiency syndrome (AIDS), in whom it often runs a rapidly aggressive clinical course.',' Although peculiar abnormalities in immune regulation have been noticed in these latter patients,' very few such data are available for Kaposi's sarcoma not associated with AIDS. However. major immunologic alterations can be suspected also in this case on the basis of the strong association between primary Kaposi's sarcoma and tumors of immunologically committed This work attempted to assess if some of the immunologic alterations described in Kaposi's sarcoma complicating AIDS are shared by the primary form as well. Patients Eighteen patients (12 men and 6 women: mean age, 72.7 * 9 years) with Kaposi's 'sarcoma (KS) have been studied. The diagnosis was always biopsy-proven. The patients were screened for concomitant diseases (particularly second malignancies, Hodgkin's disease, and tuberculosis) and only those with KS alone were entered to the study. Staging was perforimed according to clinical criteria as proposed by Krigel et a/.,7 except that Stage III and Stage IV of these authors were grouped together.

Plasma fibronectin (FN) was measured in 17 patients with essential mixed cryoglobulinaemia (EMC) and in 17 normal subjects by single radial immunodiffusion (RID) and enzyme-linked immunosorbent assay (ELISA). In 9 patients the presence of FN in the cryoprecipitates was also assessed by immunoblotting. In the EMC group, plasma FN levels were significantly lower than in control subjects, using both methods, and FN was constantly demonstrated in EMC cryoprecipitates. Capillaroscopic observation of the capillary bed in skin and bulbar conjunctiva, performed in all cases, showed severe alterations of microcirculation in EMC patients. A negative correlation between plasma FN and capillaroscopic abnormalities of skin capillaries was observed. These data support the hypothesis that plasma fibronectin plays a role in the pathogenesis of systemic vasculitis in EMC.