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The ability of ultrasound (US) to identify subclinical joint inflammation in rheumatoid arthritis (RA) patients in remission has been already reported. Nonetheless, current studies present a lack of homogeneity in patient's characteristics and number of joints assessed by US. The aim of this study was to identify a reduced set of target joints to be scanned in RA patients in clinical remission in order to detect subclinical synovitis.Forty RA patients in clinical remission (DAS28 ≤2.6) for at least 3 months underwent an US examination of 18 joints: wrist, II-III-IV-V metacarpophalangeal (MCP) and II-III-IV-V metatarsophalangeal joints bilaterally. The presence of synovial hypertrophy (SH) and power-Doppler (PD) signal was registered following the OMERACT definitions and was graded according to a 4-point scale (0-3). Then, by applying a process of data reduction based on the frequency of joint involvement, a reduced assessment was obtained.Twenty (50%) subjects had at least one joint affected by active synovitis; 17.5% presented grade 1 PD and 32.5% grade 2 PD. The joints most frequently affected by active synovitis were the wrists (75%) and the II MCP joints (55%). After data reduction, the evaluation of 3 joints (both wrists and the II MCP of the dominant hand) obtained a sensitivity of 90% for the detection of subclinical synovitis.The US scan of 3 target joints showed a high sensitivity in detecting subclinical active synovitis in RA patients in clinical remission and can be feasible in the routine assessment of these patients.

Background: A limit to delivery of cytotoxic chemotherapy in elderly people with cancer, is severe toxicity as principal side effect of treatment. We designed in 2009 a treatment schedule to evaluate E&S of combination of three drugs O, C plus B in ACRC very old patients in a metronomic mode (M-COB) Methods: 75 (37 f -38 m) very elderly patients with advanced colorectal cancer (median age:76; range: 70-82) were enrolled. Comprehensive Geriatric Assessment (CGA) was performed to all pts to assess eligibility for chemotherapy. Treatment schedule was: O (65 mg/m2) + B (7.5 mg/Kg) on day 1 (O doses was adjusted by Kintzel-Dorr formula). C (fixed dose of 1,000 mg bid) was delivered from day 2 to day 15 every 3 weeks for 12 cycles. Primary endpoints: toxicity profile (NCI-CTC v2.0) and QoL score (EORTC QLQ-C30). Secondary endpoints:. Clinical Response Rate (CRR) by WHO ‘s criteria. All patients were evaluated for main toxicity (Hemat, G.I., HFS, N&V) by ECOG Common Toxicity Criteria. Results: 76 patients were included into groups I Balducci's classification, for frailty assessement. A 50.1% tumor response rate(TRR) was observed both with a 86.7% Clinical Benefit (CB). No one pts experienced grade 4 toxicity. QoL score improvement was noted in all pts after treatment. Median PFS was 12.3 months with a 6 months PFS rate of 82%. Median OS was 23.5 months with a 12 months survival probability of 78.8%. Conclusions: We choose fixed dose of C in order to reduce main toxicity as shown in std treatment of aged pts with ACRC. Nevertheless this don’t impact on efficacy of treatment. Finally the high rate of clinical benefit encourage further enrollement of patients.In conclusion this schedule seem to be active and safe because improves tolerability without any decrease of efficacy in this kind of patients.

Background: EABC affects about 45% of all advanced breast cancers and actually treatments are always more toxic than effectiveness. Fulvestrant (F), the first of a new class of pure estrogen receptor antagonists, competitively binds to estrogen receptors on tumors and inhibit tumor growth. Capecitabine (C) is converted to 5-FU by thymidine phosphorylase and shows good efficacy and low toxicity as single agent in EABC. Since elderly cancer pts are extremely susceptible in development of rapid toxicity during treatment with cytotoxic drugs, we design this chemo-hormone combined schedule to evaluate if F + C could increase efficacy profile in EABC women. Methods: 41 EABC pts (mean age 72; range 65-88) PD after TAM or SERM were included in the study starting in 2007. Written informed consent for treatment's schedule was acquired from all pts. Comprehensive Geriatric Assessment (CGA) was performed to assess eligibility for chemotherapy. Furthermore the C dose was adjusted according to Cocroft and Kintzel-Dorr formulas. Primary endpoint: clinical response rates (RR) according to WHO criteria. Secondary endpoints: TTP, Toxicity Profile and QoL score measured by NCI-CTC v2.0 and EORTC QLQ-C30 questionnaires. Results: 41/41 pts were evaluated. All pts received C 1,000 mg/m2 b.i.d p.o. on days 1st to 14th every 21 days and F 250 mg i.m. once-monthly until disease progression. Based on CGA all patients were included into groups I-II, according to Balducci's classification of frailty. None of the pts needed any delay in drugs delivery. We observed 13/41 (32%) partial responses and 17/41 (41%) stable disease, for a Clinical benefit of 73%. Median time to progression was 15,6 months. No grade-4 toxicity was experienced. QoL score improvement was appreciated in all pts after end of treatment. Conclusions: Efficacy and Safety results show that this schedule is feasible for EABC pts affected by one or two comorbidities and also in frail condition. All pts are still alive and under monitoring for long-term toxicity and QoL. These results shows that F+C schedule increase clinical benefit-enhancing effectiveness and safety. Although a larger number of EABC pts must be enrolled to consolidate these findings.

Phytoplasmas are wall-less bacteria associated with many plant diseases of wild and cultivated plants, transmitted by hemipteran insects. In nature, vectors can acquire more than one phytoplasma by feeding on multiple-infected source plants or sequentially on plants infected by different phytoplasmas. The acquisition of multiple phytoplasmas may lead to their interaction in the insects. In this work, nymphs of the leafhopper Euscelidius variegatus were allowed to feed sequentially on Flavescence dorée (FDP)-infected and chrysanthemum yellows (CYP)-infected source plants and vice-versa. Following the acquisition feeding, the titre of the two phytoplasmas in the insect was measured over time. FDP and CYP transmission capability of the doubly-infected leafhoppers was studied by transmission to Vicia faba L., and to artificial feeding medium. Both phytoplasmas were acquired by the vector regardless of the feeding order and FDP titre, but not CYP titre, which was affected by double infection. FDP and CYP persisted in the insect for life. Only CYP was consistently and efficiently transmitted by doubly-infected leafhoppers. Consistently, FDP was seldom detected in the salivary glands and never in the artificial feeding medium of doubly-infected leafhoppers. In conclusion, competition between CYP and FDP affected only salivary gland colonization, while it had almost no effect on phytoplasma acquisition. Competition among phytoplasma strains in an evolutionary time scale may explain the greater ability of CYP to colonize the insect body and be transmitted.