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Social media has become increasingly important for patients when deciding whether they should undergo rhinoplasty. The purpose of this study is to analyze patient satisfaction of rhinoplasty procedures through RealSelf social media reviews.We collected data from 583 rhinoplasty reviews published on the RealSelf portal. In posts dated between 2016 and 2020, we included those which were labeled as "Worth It" and "Not Worth It." Posts that were labeled as "Unsure" or were left unlabeled were excluded from the study. In addition, posts not including the cost of their rhinoplasty were excluded. Taking into account patient demographics and cost of the procedure, we analyzed reasons for choosing to undergo surgery, reasons for choosing surgeons, and reasons for liking or disliking their procedure.Of the 583 reviews analyzed, most (45.4%) were categorized from the 18-24 years age group and there was an overall 93.8% satisfaction rate. While there was no statistically significant difference in the cost of rhinoplasty surgeries between "Worth It" and "Not Worth It" groups, the average cost of recorded rhinoplasties was US$ 8043 with a standard deviation ± $3296. According to our analysis, younger patients aged 18-24 years relied more on social media to choose their surgeons and desired a more natural appearance to their nose while older ones preferred compatible physician personalities and increased self-esteem for rhinoplasty.This study offers a unique perspective into the distinguishing characteristics of different age groups and the values they place in pursuing rhinoplasty, choosing their surgeons, and why they like/dislike their surgical outcomes.

The incidence of facial skin necrosis has increased considerably due to the growth in the popularity of dermal fillers. This study describes the patterns and severity of facial skin necrosis, along with associated neuro-ophthalmological injuries, in the published literature through the introduction of the F acial artery, O phthalmic artery, distal E xternal carotid artery, internal M axillary artery (F.O.E.M.) facial angiosome scoring system and grading scale.A systematic review of all photographic cases of facial skin necrosis due to vascular occlusion with dermal fillers and injectable materials was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses.A total of 243 cases were identified, with 738 digital clinical photographs retrieved. The facial artery (58% of cases) and ophthalmic artery (48% of cases) angiosomes were most commonly affected. The frontonasal and angulonasal territories were the most common facial skin segments injured by filler-induced vascular occlusion. Cutaneous involvement of the ophthalmic angiosome was significantly associated with neuro-ophthalmological complications (vision loss: 39% vs 0.8%, p = 0.00001; stroke: 8% vs 0.8%, p = 0.0085). Injuries with greater cutaneous surface area or cross-angiosome involvement were associated with a higher incidence of Type IV visual deficits and bilateral stroke.Facial skin necrosis due to vascular occlusion is a rapidly growing problem that has remained poorly characterized in the literature. This study provides the largest descriptive analysis of published photographic reports of skin necrosis to date and proposes a novel scoring system and grading classification to aid in future reporting.

ObjectiveNon-specific musculoskeletal pain is common in subjects destined to develop psoriatic arthritis (PsA). We evaluated psoriatic patients with arthralgia (PsOAr) compared with psoriasis alone (PsO) and healthy controls (HCs) using ultrasonography (US) to investigate the anatomical basis for joint symptoms in PsOAr and the link between these imaging findings and subsequent PsA transition.MethodsA cross-sectional prevalence analysis of clinical and US abnormalities (including inflammatory and structural lesions) in PsOAr (n=61), PsO (n=57) and HCs (n=57) was performed, with subsequent prospective follow-up for PsA development.ResultsTenosynovitis was the only significant sonographic feature that differed between PsOAr and PsO (29.5% vs 5.3%, pConclusionTenosynovitis was associated with arthralgia in subjects with psoriasis. Baseline US evidence of enthesitis was associated with clinical PsA development in the longitudinal analysis. These findings are relevant for enriching for subjects at risk of imminent PsA development.

Background Identify the preclinical phase of arthritis could be clinically relevant. In this scenario, musculoskeletal ultrasonography (US) may play an important role, since it may detect subclinical disease. Psoriatic Arthritis (PsA) is a perfect disease to identify risk factors, since the risk pool group [i.e. patients with only cutaneous Psoriasis (Pso)] is known. Objectives To evaluate in Pso patients, with and without clinical arthralgia (CA), defined by the presence of joint pain without other clinical evidence of musculoskeletal inflammation: I) the prevalence of subclinical US inflammation in joints, enthesis, tendons and bursae; II) the prevalence of US structural damage; III) the relationship between US lesions and clinical data. Methods Cross-sectional prevalence study of US abnormalities in Pso patients with or without CA and healthy controls (HCs). Inclusion and exclusion criteria (e.g. osteoarthritis and fibromyalgia) are pre-defined. Forty-four joints (MCP, PIP and DIP joints, wrists, knees, MTP joints) and 12 enthesis (achilles, quadriceps, proximal and distal patellar, plantar aponeurosis and common extensor tendon enthesis) were scanned in each patient. US scans were performed using a ESAOTE MyLabClassC equipped with a high frequency linear probe. Active synovitis was defined by the presence of a grade ≥2 for grey scale (GS) and ≥1 for PD, while active enthesitis if there was hypoecogenity in GS and an entheseal PD signal (≤2 mm from bone insertion). Results Sixty-four Pso patients and 21 HCs were included; globally 2816 joints and 768 entheses were scanned. Twenty-three out of 64 (35.9%) Pso patients displayed CA. Baseline characteristics are reported in table 1. Active synovitis was found, in at least one joint, in 20/64 (31.3%) Pso patients and 0/21 HCs (p=0.002), while active enthesitis in 14/64 (21.9%) Pso patients and 0/21 HCs (p=0.017). No significant differences were found for active synovitis or enthesitis between the two subgroups of Pso, with or without CA. In the Pso cohort, 5/23 (23.8%) patients with CA and 2/41 (5%) without CA displayed tenosynovitis or paratenonitis (p=0.042). Furthermore, active synovitis, as well as GS-synovitis ≥2, was associated with higher NAPSI (9.7±8.0 vs 4.6±7.1, p=0.04 for GS ≥2), whereas active enthesitis was associated with higher PASI (5.4±3.0 vs 3.7±2.9, p=0.02). No significant differences were found between Pso patients and HCs for the structural damage (i.e. osteoproliferation and erosions), both for joints and enthesis. Conclusions In Psoriasis subclinical US active synovitis and/or enthesitis are present in 20%–30% of patients. In Pso the comparison between groups, with or without CA, show no significant difference in active subclinical synovitis or enthesitis, but Pso patients with CA present more frequently US tenosynovitis or paratenonitis. In Pso subclinical US synovitis or enthesitis are significantly associated with higher NAPSI and PASI. The relevance of these results, to possibly identify a subgroup of Pso more prone to develop PsA, deserve further investigation and prospective evaluation. Disclosure of Interest None declared

Objective.Exclusion of psoriatic skin/nail lesions is important in differentiating early seronegative rheumatoid arthritis (ERA) from early polyarticular psoriatic arthritis (EPsA) and such manifestations may go unnoticed in atypical or minimally expressed cases. The aim of this study is to assess the usefulness of integrated rheumatological-dermatological evaluation in highlighting dermatological lesions missed on rheumatological examination and to investigate the role of ultrasonography (US) and dermoscopy in improving the recognition of subclinical psoriatic findings.Methods.Patients with a new diagnosis of seropositive or seronegative ERA and EPsA with prevalent hands involvement were recruited. All were reassessed for the presence of psoriatic lesions during an integrated rheumatological-dermatological clinical evaluation and underwent hands US and proximal nailfold dermoscopy.Results.Seventy-three consecutive subjects were included in the study: 25 with seropositive ERA, 23 with seronegative ERA, and 25 with EPsA. One-fourth of the subjects initially diagnosed as seronegative ERA presented cutaneous or nail psoriasis on integrated rheumatological-dermatological evaluation, thereby being reclassified as EPsA. The presence of at least 1 extrasynovial feature on hand US and dotted vessels on proximal nailfold dermoscopy was significantly associated with EPsA, with a sensitivity of 68.0% and 96.0% and a specificity of 88.1% and 83.3% for US and dermoscopy, respectively. When used together, specificity for PsA diagnosis raised to 90.5%.Conclusion.Integrated rheumatological-dermatological clinical evaluation may be helpful in identifying patients with EPsA misclassified as seronegative ERA. Additionally, US and dermoscopy may be used as supportive tools in identifying subclinical psoriatic features, which may come in handy in distinguishing EPsA from ERA.

Background Psoriatic arthritis (PsA) is a systemic inflammatory disease with articular and extra-articular features, the disease activity ranges from mild mono-oligoarthritis to destructive polyarthritis. Hence, establishing the prognosis of a patient with PsA is important to better define the treatment strategy. Furthermore, minimal disease activity (MDA) is a validated composite outcome measure since it correlates well with long-term outcomes (e.g. development of joint damage) 1 . Objectives The aim of this study was to identify the baseline clinical variables associated with MDA at 12th month of follow up in two cohorts of early PsA. Methods Consecutive PsA patients, attending the outpatient Early Arthritis Clinic in Udine or Verona in the last two years, were assessed. All the included patients had: I) CASPAR score ≥2 2 II) new diagnosis of PsA III) a complete clinical data and follow-up of at least 12 months. The GRAPPA recommendations on the management of PsA were followed. Statistical analysis included T- test, ANOVA and Pearson9s test in order to find possible predictors of MDA. Results Eighty-one early PsA patients were included in the study. 47/81 (58.2%) reached MDA at 12th month of follow-up; 68/81 (83.9%) were in c-DMARDs while 11/81 (13.6%) were in b-DMARDs. Two variables at baseline were selected comparing the groups based on achievement of MDA. These were: 1) LEI, which was significantly lower at baseline in patients reaching MDA (0.43 Vs 0.86, p=0.001); and 2) a lower baseline CRP (1.2 mg/dl vs 2.8 mg/dl, p=0.008). Of note, neither the baseline disease activity evaluated with DAPSA nor the time to referral were selected by statistical analysis. Conclusions Baseline lower LEI score and lower CRP were identified as clinical predictors of MDA after 12 months of treatment in PsA. Therefore, patients with a more active enthesitis or higher inflammation may have a less responsive disease. This may be relevant to select proper treatments at baseline, and indirectly confirms that enthesitis is a key therapeutic target in PsA. References Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 2010; 69: 48–53. Coates LC, Conaghan PG, Emery P et al. Sensitivity and specificity of the classification of psoriatic arthritis criteria in early psoriatic arthritis. Arthritis Rheum 2012; 64: 3150–3155. Disclosure of Interest None declared

As our population ages, injuries attributable to falls continue to increase, impacting healthcare delivery. Evaluation of craniofacial trauma with focus on elderly patients remains an underappreciated concern. Our objectives were to evaluate injury trends associated with elderly bathroom falls, as this information may be useful for counseling and preventive purposes.Database review.The National Electronic Injury Surveillance System was evaluated for craniofacial trauma among patients 60 years and older presenting to the emergency department (ED) (2010-2014). Injury descriptions were reviewed for mechanism of injury, patient demographics, and other injury characteristics.In total, 7.2% of the estimated 3.4 million ED visits for elderly craniofacial trauma were bathroom related. Females comprised the majority (60.9%) of patients, and a plurality of patients were in their 80s. A greater proportion of facial injuries resulted from syncope (16.6% vs. 10.9% compared to head injuries). Toilets facilitated a greater proportion of facial insults and were more likely to require admission; the most common mechanism was "falling off." Showers contributed a majority of head injuries and had a lower median age than toilet injuries. Fractures comprised 12.6% of facial injuries; of craniofacial fractures, common sites included the nose (54%), mandible (6%), and orbit (6%). Admitted patients were significantly older than those who were released.Bathroom falls result in a significant proportion of elderly traumatic injury. The trends we present offer the opportunity for targeted preventative measures to decrease the occurrence of these events. Additionally, this information may adjunct a detailed history and physical to ensure appropriate patient management.4 Laryngoscope, 127:820-827, 2017.

The techniques of additive mastoplasty described over the years require the use of alloplastic materials (silicon), which often are poorly tolerated by the body and need access paths that could leave visible, unaesthetic residual scars. Furthermore, the controversy over silicone gel-filled breast implants, which in the early 1990s restricted their clinical use for primary cosmetic breast augmentation, still raises concerns in some patients. The authors therefore felt encouraged to search for alternatives to breast implants and reconsider fat transfer. In fact, for almost a century, autologous adipose tissue has been used safely and with success in many other surgical fields for the correction of volumetric soft tissue defects. Its natural, soft consistency, the absence of rejection, and the versatility of use in many surgical techniques have always made autologous adipose tissue an ideal filling material. In the past, the authors used this technique, as originally described by Fournier (intraparenchymal, en bloc injection), for 41 patients. However, disappointed by a very high rate of complications and the almost complete reabsorption of the grafted fat, they quit using the procedure. An extensive literature review indicated that the complications observed were related only to technical errors and to the anatomic site of harvesting and implantation. The authors therefore developed a new method incorporating recent contributions in functional anatomy and fat transfer. Fat is harvested in a rigorously closed system, minimally manipulated, and reimplanted strictly in two planes only: into the retroglandular and prefascial space and into the superficial subcutaneous plane of the upper pole of the breast (bicompartmental grafting). Any intraparenchymal placement is carefully avoided. Since 1998, 181 patients (300 breasts) have undergone this procedure. Grafted fat volume has ranged from 160 to 685 ml (average, 325 ml) per breast. Complications have been minimal and temporary. All patients have been carefully monitored with preoperative and serial postoperative mammograms and ultrasonograms. This strict follow-up assessment allowed the authors to clarify the controversial aspect of microcalcifications, the main point of criticism for this procedure over the years. Microcalcifications can occur in response to any trauma or surgery of the breast, but are very different in appearance and location. Thus, they can be discriminated easily from those appearing in the context of a neoplastic focus. Probably the most important point is that the fat survival ranged from 40% to 70% at 1 year. The volume is maintained because when the authors transplant living fat tissue, they also transfer a consistent amount of adult mesenchymal stem cells that spontaneously differentiate into preadipocytes and then into adipocytes, compensating for the partial loss of mature adipocytes reabsorbed through time. This theory has been well demonstrated via advanced research performed by the authors and by many other prominent medical institutes worldwide. The findings show that adipose tissue has the same potential for growth of adult mesenchymal totipotential stem cells of bone marrow and can eventually be differentiated easily by the use of specific growing factors and according to the needs and applications in other cellular lines (osteogenic, chondrogenic, myogenic, epithelial). In summary, the authors wish to highlight a formerly controversial procedure that, thanks to recent technical and clinical progress, has become a safe and viable alternative to the use of alloplastic materials for breast augmentation for all cases in which additive mastoplasty with implants is either unsuitable or unacceptable by the patient herself. However this method cannot be considered yet as a complete substitute for augmentation with implants because the degree of augmentation and projection still is limited.

First-principles density functional calculations were performed on the coherent (0 0 1) interface between spinel (MgAl2O4) and aluminium, focusing on the ion-exchange reaction at the interface. The exchange reaction occurs by diffusion of magnesium and aluminium ions in opposite directions across the interface, at a rate controlled by the surface-to-volume ratio of the MgAl2O4 particles. We investigate the hypothesis that the reaction may involve a net charge transfer, leading to the formation of an interface electric dipole, with a possible influence on the mechanical properties of the Al/MgAl2O4 composite. Our analysis of the electronic charge density accompanying the ion exchange reveals an electric dipole at the interface. Its formation is shown to be a consequence of the interface electronic structure, taking the form of screening effects occurring locally at the substitutional Al site and more diffusely over the whole interface region.

Objective Rheumatoid arthritis (RA) with concomitant hepatitis B virus (HBV) infection represents a therapeutic challenge due to the risk of HBV reactivation under immunosuppressive treatment. To date there are few data coming from anecdotal case reports that concern HBV reactivation following treatment with abatacept. This observational retrospective study was aimed to assess the safety profile of abatacept in this particular clinical setting. Methods Eleven Italian rheumatologic centers provided data from patients with RA and positive HBV serology treated with intravenous abatacept. HBV markers and clinical and laboratory data were checked at followup visits every 3 months. Results In total, 72 patients were included in the study: 47 inactive carriers, 21 occult carriers, and 4 chronic active carriers for HBV. At baseline all of the patients had normal liver function tests and low or undetectable HBV DNA levels, except for those with chronic active hepatitis. Thirteen patients received prophylaxis with lamivudine, and 4 received treatment with adefovir or tenofovir. At the end of the 24-month followup period, 49 patients were being treated. Data from 316 followup visits showed that abatacept was safe. No patients experienced reactivation of hepatitis B. Treatment withdrawals (23 patients) were due to lack of efficacy, subject decision/lost at followup, or adverse events not related to HBV infection. Conclusion Our study provides reassuring data about the safety profile of abatacept in RA with concomitant HBV infection without universal antiviral prophylaxis. Further prospective studies are needed to confirm these preliminary results.

External auditory canal (EAC) trauma, although rare, can have significant long-term adverse outcomes. This study aims to investigate the frequency, treatment, and complications of external ear canal injury in association with mandibular and temporal bone trauma.Retrospective chart review.Computed tomography images with mandibular or temporal bone trauma were reviewed for EAC fractures. Patient data were collected from initial presentation and subsequent follow-up clinic visits.Thirty-nine percent of temporal bone fractures and 3.3% of mandible trauma involved the EAC. In particular, 10% of condylar or subcondylar trauma included an EAC fracture (P = 0.0006). One patient sustained bilateral EAC fractures despite an isolated, unilateral condylar fracture. The most common presenting sign was blood in the external auditory canal. Two patients underwent exam under anesthesia and removal of debris and stenting as treatment, whereas 42% of the patients were placed on otic drops and 5% received packing or a stent. Follow-up data were only available for 16% of the patients. Hearing loss from otic capsule involvement or ossicular chain disruption were follow-up complaints, and one patient had persistent canal stenosis.External auditory canal trauma is present in a significant proportion of mandibular and temporal bone trauma, including both condylar and noncondylar fractures with a higher incidence of condylar fractures. One case was seen with bilateral EAC fractures despite a unilateral mandibular fracture. Complications of these fractures can include hearing loss and canal stenosis; however, additional outpatient follow-up is needed to further elucidate long-term complications and shape treatment recommendations.

Objective To evaluate the efficacy and safety in the long term of a retreatment regimen with Rituximab (RTX) alone administered at clinical relapse in cryoglobulinemic vasculitis (CV). Methods Thirty patients with severe HCV-related CV, previously enrolled in the multicentre Italian trial on RTX in the treatment of CV, were retrospectively evaluated after the end of the trial. All of them were managed with RTX alone at clinical relapse, if any. Disease activity at the last available follow up was defined as complete remission (absence of active disease), partial remission (response > 50% of at least one manifestation among glomerulonephritis, peripheral neuropathy or skin ulcers) or active disease. Results The mean follow up after the first RTX cycle was 72.6 (20.4) months. After the end of the trial, 21/30 (70%) patients showed an active follow up [81.7 (10.9) months)], 3/30 (10%) lost follow up and 6/30 (20%) died. 12/21 (57.1%) patients were in complete disease remission, 5/21 (23.8%) showed a partial response and 4/21 (19%) had an active disease. 17/30 (56.7%) patients needed retreatment for relapse with a mean time to retreatment of 22.3 (12.1) months. Treatment survival of this regimen was 7.6 (0.3) years. Recurrent non-severe infections occurred in 3/30, with chronic hypogammaglobulinemia in 2/3 patients. Conclusions A long-term regimen of retreatment with RTX alone given at clinical relapse seems to be effective and safe in CV, with a low rate of infections and severe hypogammaglobulinemia.

In recent decades, medical malpractice costs have increased and have led to a change in the way physicians practice medicine. Tracheotomies are cases in which complications have a high risk of morbidity and mortality and the potential for litigation.The Westlaw legal database was used to gather data on 43 jury verdicts and settlements from 1987 to 2013. Various factors included outcome, defendant specialty, and the reason for litigation.Median settlements were $500,000 and median verdict awards were $2,000,000. Postoperative negligence was alleged most often (81%) followed by intraoperative negligence (27.9%) and permanent injury (18.6%). Otolaryngologists were named as defendants most often (25.6%), with nurses named second most often. Pediatric cases had significantly higher awards and were more often named in favor of the plaintiff.An awareness of tracheotomy malpractice litigation has the potential to both help physicians avoid future litigation and improve patient safety.

We present numerical results that allow a precise determination of the transition point and of the critical exponents of the 4D Edwards-Anderson Spin Glass with binary quenched random couplings. We show that the low T phase undergoes Replica Symmetry Breaking. We obtain results on large lattices, up to a volume $V=10^4$: we use finite size scaling to show the relevance of our results in the infinite volume limit.

By using numerical simulations we show that the 4D $J=\pm 1$ Edwards Anderson spin glass in magnetic field undergoes a mean field like phase transition. We use a dynamical approach: we simulate large lattices (of volume $V$) and work out the behavior of the system in limit where both $t$ and $V$ go to infinity, but where the limit $V \to \infty$ is taken first. By showing that the dynamic overlap $q$ converges to a value smaller than the static one we exhibit replica symmetry breaking. The critical exponents are compatible with the ones obtained by mean field computations.

In order to evaluate the switching properties of FLC mixtures in their relation to addressing waveforms, alignment layers and general cell construction we have built an experimental setup which allows for dynamic measurements of the optical response of a test cell under real addressing conditions. In synchronisation with a selection voltage different data pulses can be sequentially applied and the corresponding optical response of a test cell can be recorded under computer control. Thank to this equipment we are able to record hysteresis curves of the response. On this basis we introduce some useful parameters (switching amplitude, image sticking) which can be measured and compared for different cells. The setup can provide several selection and data waveforms so that influence of their choice can also be studied.

Background Belimumab, a human anti-BAFF monoclonal antibody that inhibits soluble BAFF, is effective in systemic lupus erythematosus (SLE), and leads to a partial B cell depletion. However, which subset of B cells may be the main therapeutic target of belimumab in SLE is still unclear. Objectives Primary objective of this study was to evaluate the effect of belimumab on the expression of BAFF receptor (BAFFR) on B cells through 12 months of belimumab treatment in SLE, and to correlate BAFFR expression with changes in B cell subsets. Methods Twelve consecutive patients with SLE (all female, age 44±7,8 yrs, 12,6±5,4 yrs of disease duration) undergoing belimumab therapy were studied. All patients received at least two immunosuppressors before belimumab. All patients were taking glucocorticoids at baseline [median (range): 7,5 (0–40) mg/day of prednisone or equivalent)], and 11/12 also at least one immunosuppressor. Median SLEDAI-2k score at baseline was 8,5 (range 8–15). Samples were collected and analysed at baseline (T0), month +3 (T3), +6 (T6), +9 (T9) and +12 (T12) for clinical and biological parameters. B cells subsets were characterized by multiparametric flowcytometry on a BD FACSCanto flowcytometer. The expression of BAFFR was also analysed as Mean Fluorescence Intensity (MFI). Parametric or non-parametric tests were used, as appropriate based on variable distribution. Data is reported as mean±standard error. Results A transient statistically significant increase of BAFFR MFI was observed from T0 to T3 (p=0,004) and from T0 to T6 (p=0,066) with a subsequent decrease until T12 (table 1). Interestingly, this course was similar to that observed in CD19+CD27+ cell subset (table 1), that showed a transient significant increase at T3 (p=0,014) and T6 (p=0,025) in 9/12 patients, with a subsequent slightly significant decrease from T6 to T12 (p=0,05) in all patients. Globally, a decrease of CD19+ cells was observed from T0 to T12 (p=0,19, table 1). This course is consistent with that observed in the CD27- B cell subset, that showed a decrease from T0 to T3 (p=0,14) and from T0 to T6 (p=0,14), and the decrease was persistent from T6 to T12 (p=0,6). SLEDAI-2k score decreased from T0 to T3 (p=0,007), to T6 (p=0,003) and to T12 (p=0,03) (table 1). Conclusions BAFF depletion differently acts on B cell subsets, CD19+27+ subset being able to increase BAFFR and transiently expand themselves, while CD19+27- being more sensitive to BAFF deprivation, and faster decreasing. Thus, early clinical response may be related to the changes in the CD27+/CD27- B cell ratio. Disclosure of Interest None declared

Nasal Resurfacing with Xenographic Bladder Bioscaffold Following Excision of Massive Rhinophyma Massive rhinophyma is a disfiguring advanced form of rosacea. Due to the size of the tumor, full thickness excision is often necessary requiring reconstruction for optimal cosmetic results. We present the first report of nasal resurfacing using urinary bladder matrix bioscaffolding following excision of massive rhinophyma.Massive rhinophyma is a disfiguring advanced form of rosacea. Due to the size of the tumor, full thickness excision is often necessary requiring reconstruction for optimal cosmetic results. We present the first report of nasal resurfacing using urinary bladder matrix bioscaffolding following excision of massive rhinophyma.

Stem Cell Based Regenerative Medicine: What is Science? What is Fiction? And what is Science Fiction? There is perhaps not a topic in medicine that causes as much excitement and controversy as the field of stem cell based regenerative medicine. Experienced researchers, politicians, and sports celebrities all have professed the various benefits of this emerging technology. Those in the media and even certain healthcare professionals have recently touted these new practices as a panacea for human disease and suffering. Desperate patients suffering from a wide spectrum of maladies, from spinal cord injury to Parkinson’s disease, have sought such treatments as “medical tourists” to countries such as China, South Korea, and Mexico. Such promise has even led to the formation of clinics like the California Stem Cell Treatment Center in Beverly Hills which offers care for people suffering from diseases that may be alleviated by access to adult stem cell-based regenerative medicine

A digital time stamping system (the BALTICTIME system) was developed by using the open source technologies and was adopted to meet the eGovernmental applications, where legal and accountable time stamps are essential. All components of the BALTICTIME system were developed by using the open source software technologies LINUX-UBUNTU, OpenTSA, OpenSSL, MySQL and are designed to suit the hardware, which is common to the national time metrology laboratories. The main technological tasks of BALTICTIME are to develop the interface between national time standard authorities, keepers of the national coordinated time scales UTC(k), and time stamping authorities (TSAs); to develop the issued time stamps archiving system integral with UTC(k) time scale; as well as to develop security system based on interoperable certificate data base. Technical specifications will be assessed according to requirements of the international standards. Test results demonstrate the BALTICTIME system's ability to issue up to 10 accountable (archived) digital time stamps per second, which fulfills the needs of eGovernment and eCommercial services. Calibration and testing procedures of time stamping units were developed.

Discontinuously reinforced aluminium (DRA) composites were prepared by a novel ion exchange process in which the reinforcing phase, aluminium oxide, was introduced by exchanging the magnesium ions in magnesium aluminate spinel with aluminium [1]. The exchange reaction occurs by the diffusion of magnesium and aluminium ions across the interface in opposite directions. The process led to the formation of DRA composites with a remarkable resistance to high temperature deformation. We present an ab-initio density functional study of the coherent cube-on-cube interfaces between spinel (MgAl2O4) and Al metal and relevant X-ray diffraction studies of the DRA composite. We find that the presence of surface electric dipoles near the interface, originated by the ion exchange process, leads to a lowering of the Al/MgAl2O4 interface toughness, and an increased residual surface stress, which does not support the hypothesis that the ion exchange process is directly responsible for the increased creep resistance of the DRA composite. We propose instead that deep diffusion of the Al atoms into MgAl2O4, resulting in the formation of γ-Al2O3 nanograins, is the mechanism that impedes dislocation movement and thus increases the interface toughness.

Background Targeting B cell activating factor (BAFF) by belimumab is effective in systemic lupus erythematosus (SLE) (1), and leads to a partial B cell depletion (2,3). However, which subset of B cells may be the main therapeutic target of belimumab in SLE, either why the response under belimumab is usually delayed in time is still unclear. Objectives Our purpose was to study the effect of belimumab on different B cell subsets in SLE and in particular the expression of BAFF receptor (BAFFR) on B cells through 12 months of belimumab treatment. Methods Seven patients with SLE (all female, age 46,7±7,8 years, mean disease duration of 13,8±4,2 years) undergoing belimumab therapy from May 2013 were studied. All patients received at least two immunosuppressors before belimumab; all patients were taking glucocorticoids at baseline (10±12 mg/day), and 6/7 were also taking at least one immunosuppressor. Mean SELENA-SLEDAI score at baseline was 9,7±2,7. Samples were collected and analyzed at baseline (T0), month +3 (T3), month +6 (T6), month +9 (T9) and month +12 (T12, 5 pts) for clinical and biological parameters. B cells subsets were characterized by multiparametric flowcytometry on a BD FACSCanto flowcytometer. The expression of BAFFR was also analyzed as Mean Fluorescence Intensity (MFI). Data were reported as mean ± standard error. Results In the group of 7 SLE patients studied, a decrease of the SELENA-SLEDAI score from 9,7±2,7 at T0, to 6,1±1,9 at T3, to 5,0±1,0 at T6, to 4,4±0,8 at T9 and finally to 4,1±0,9 at T12 was documented. At T0 peripheral blood counts of CD19+ cells were low (median 46 cell/μl, range 1,1-267), possibly because of the past and concomitant immunosuppressive treatments and the chronic glucocorticoids administration. CD19+CD27- cells decreased after belimumab treatment from 60±56 cell/μl at T0 to 24±14 cell/μl at T3, and then remained low over time (21±11 cell/μl at T6, 25±19 cell/μl at T9 and 23±14 cell/μl at T12). By contrast, CD19+CD27+ cells showed a transient increase as absolute counts at T6 (from 17±13 cell/μl at T0 to 23±17 cell/μl at T6), while they markedly decreased from T6 to T12 (9±7 cell/μl). BAFFR expression remained unchanged over time during therapy as percentage of B cells (mean 97±1,7% at T0 vs. 97±2% at T9); however, a transient increase in BAFFR MFI was observed from T0 to T3 (11,6±1,9 to17±4,7), and then decreased to T12 (10,9±1,5). The count of CD27+ B cells and the mean MFI BAFFR expression showed a similar curve over time, differently from CD19+CD27- B cells (figure 1). Conclusions Hyperexpression of BAFF receptor on CD27+B cells occurs shortly after belimumab consistently with the increase in the CD27+ B cell count in the first three months of treatment. Subsequently, the BAFFR expression decrease is followed by the lowering of CD27+ B cells from T6 to T12. The intensity of BAFFR expression on CD27+ B cells may explain the pharmacodynamic of belimumab in SLE. Since belimumab acts slowly in SLE, the results observed support the hypothesis of a therapeutic effect of belimumab also on CD27+ B cells. References Furie R et al. Arthritis Rheum 2011. Stohl W et al. Arthritis Rheum 2012. Jacobi AM et al. Arthritis Rheum 2010. Disclosure of Interest None declared

An innovative low cost tuning system especially suited for low cost television receiver is presented. It combines low sensitivity of the system to aging, temperature changes, etc. and allow the user to interact by channel identification. A sophisticated algorithm is developed, in which the salient and exclusive features of the frequency synthesis are implemented, by a low cost voltage synthesis approach.

Background Two independent controlled randomized trials demonstrated the efficacy and safety of rituximab (RTX) monotherapy in severe cryoglobulinemic vasculitis (CV) (1, 2), with one reporting a prolonged follow-up (1). Objectives To report the very long term efficacy and safety of RTX monotherapy in severe CV since a regimen of RTX monotherapy was maintained after the end of the abovementioned trial (1). Methods Long term follow up data of a trial of RTX in severe CV (1) were analysed. During this follow-up, only RTX monotherapy was used. Disease activity at the last follow-up visit, adverse events and survival were registered. Clinical response was evaluated at the last follow-up visit, and was scored as follows: i) complete remission (no activity), partial remission (response >50% of at least one manifestation among glomerulonephritis, severe neuropathy or skin ulcers) (1), and active disease. Results After the end of the 2-year controlled trial (1), follow-up data were available in 36 patients undergoing RTX, all HCV positive. The mean follow up after the beginning of RTX therapy (1) was 70.22±20.41 months, including 29 patients followed for more than 4 years (78.4±12.6 months) and 7 patients followed for 2.4-4 years (36.4±6 months). Of them, 3 patients were lost from follow-up shortly after the end of the trial, and 9 patients died. Of the remaining 24 patients, 14/24 (58.3%) showed complete clinical remission at the last follow-up, 6/24 (25%) a partial remission, while 4/24 (16.7%) had an active disease. A first repeated RTX course (1 g two weeks apart) was required in 50% of the patients (12/24), while 25% of the patients (6/24) needed more than one course, for a total of 19 retreatments. Patients were retreated for nephritis (7/19), neuropathy (6/19), skin ulcers (7/19) or diffuse purpura (6/19). Three patients underwent a maintenance RTX regimen, all with 1 g × 2 every 6 months, with a complete and partial remission at the last follow-up noticed in 2/3 and 1/3, respectively. Recurrent infections occurred only in three patients (8%; urinary and upper respiratory), and they were related to persistent hypogammaglobulinemia in 2/3. Death occurred in 9 patients, all showing persistent active disease. Conclusions A long-term RTX therapy lasting several years is effective and safe in about two thirds of the patients with severe CV. The advantage of retreatment at relapse regimen instead of a maintenance therapy, and whether this may occur in a further subset of patients, needs further investigation. References De Vita S, et al. Arthritis Rheumatol. 2012;64(3):843-53. Sneller MC, et al. Arthritis Rheumatol. 2012;64(3):835-42. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3872

We investigate the 3-dimensional Edwards-Anderson spin glass model at low temperature on simple cubic lattices of sizes up to L=12. Our findings show a strong continuity among T>0 physical features and those found previously at T=0, leading to a scenario with emerging mean field like characteristics that are enhanced in the large volume limit. For instance, the picture of space filling sponges seems to survive in the large volume limit at T>0, while entropic effects play a crucial role in determining the free-energy degeneracy of our finite volume states. All of our analysis is applied to equilibrium configurations obtained by a parallel tempering on 512 different disorder realizations. First, we consider the spatial properties of the sites where pairs of independent spin configurations differ and we introduce a modified spin overlap distribution which exhibits a non-trivial limit for large L. Second, after removing the Z_2 (+-1) symmetry, we cluster spin configurations into valleys. On average these valleys have free-energy differences of O(1), but a difference in the (extensive) internal energy that grows significantly with L; there is thus a large interplay between energy and entropy fluctuations. We also find that valleys typically differ by sponge-like space filling clusters, just as found previously for low-energy system-size excitations above the ground state., 10 pages, 8 figures, RevTeX format. Clarifications and additional references

In ref. cond-mat/9811419 Houdayer and Martin analyze the T=0 3d EA spin glass with a magnetic field $B$. By using a new, powerful method, they determine an effective critical field $B_c$ as a function of the lattice size $L$. They use their results to deduce that the model is behaving like in the droplet approach and not like the mean-field theory. We show here, by using some unpublished data, that this very interesting method and numerical results are completely compatible with the behavior implied by the Replica Symmetry Breaking theory., One page comment about ref. cond-mat/9811419, including two eps figures

We introduce a new parameter to investigate replica symmetry breaking transitions using finite-size scaling methods. Based on exact equalities initially derived by F. Guerra this parameter is a direct check of the self-averaging character of the spin-glass order parameter. This new parameter can be used to study models with time reversal symmetry but its greatest interest concerns models where this symmetry is absent. We apply the method to long-range and short-range Ising spin glasses with and without magnetic field as well as short-range multispin interaction spin glasses., 5 pages, 4 figures, Revtex file

To find out new subjects that could be useful to select patients between 9 and 12 points, according to Block's Criteria, to mitral balloon valvotomy.One hundred and forty patients underwent mitral balloon valvotomy. Among them, 29 (21%) had between 9 and 12 points. These patients were divided into two groups: group A-patients with mitral valve areaor = 1.5cm2, immediately after balloon valvotomy and in the follow-up period; group B-patients with mitral valve area1.5cm2 immediately after or during the follow-up period, patients with severe mitral regurgitation after the procedure and patients who died in the follow-up period. All patients were analyzed by echocardiographic relation criteria (ERC): calcification + subvalvar disease/thickness + mobility. Each one was quantified from 1 to 4 points according to the degree of valvular disease.Group A was composed of 17 (51%) and group B 12 (41%) patients. The variables age, sex, previous mitral commissurotomy and atrial fibrillation did not show difference between groups. In group A mitral valve area (cm2) increased from 1.15 +/- 0.25 to 1.97 +/- 0.26 (p0.00001) keeping stable during the follow-up period. In group B percutaneous mitral balloon valvotomy resulted in an increase from 1.26 +/- 0.19 to 1.77 +/- 0.16 (p0.00001), however, there was an important decrease in the follow-up period to 1.34 +/- 0.15 (p0.00001). The ERC showed that all group A patients had a relation1. However, in group B, 10 patients (83%), the relation wasor = 1, and in only 2 patients (17%) was1 (p0.00001).The group of patients between 9 and 12 points in the Block's criteria is heterogenic, therefore, each case might be evaluated individually and the echocardiographic relation criteria should be used in order to select these patients to the procedure.

In recent years there has been increased interest in the characterization of titanium as a catalyst for high-capacity hydrogen storage materials. A first-principles study (Yildirim and Ciraci 2005 Phys. Rev. Lett. 94 175501) demonstrated that a single Ti atom coated on a single-walled nanotube (SWNT) binds up to four hydrogen molecules. The bonding was claimed to be an 'unusual combination of chemisorption and physisorption'. We report an ab initio study by means of the ADF program, which provides a complete insight into the donation/back-donation mechanism characterizing the bond between the Ti atom and the four H(2) molecules, and a full understanding of the catalytic role played by the Ti atom. In addition, we found that the same amount of adsorbed hydrogen can be stored using benzene support for Ti in place of the SWNT, due to the dominant local contribution of the hexagonal carbon ring surrounding the Ti atom. The benzene-Ti-H(2) bonding is discussed on the basis of molecular orbital interaction schemes as provided by ADF. This result advances our insight into the role of titanium as a catalyst and suggests new routes to better storage through different combinations of supports and catalysts.

In a recent letter Moore et al. claim to exhibit evidence for a non-mean-field behavior of the $3d$ Ising spin glass. We show that their claim is insubstantial, and by analyzing in detail the behavior of the Migdal-Kadanoff approximation (MKA) as compared to the behavior of the Edwards-Anderson (EA) spin glass we find further evidence of a mean-field like behavior of the $3d$ spin glass.

The authors report on three pregnant patients with mitral stenosis with heart failure in functional class IV (NYHA) unresponsive to clinical treatment. They were submitted to mitral valvuloplasty, with significant clinical improvement, and were, hence, asymptomatic. Despite the small number of cases, it may be concluded that the procedure is simple and safe, which can be attested by the successful results.

Nell’opera di rinnovamento spirituale e di “riconquista” missionaria, che la Chiesa cattolica intraprese nella seconda metà del XVI secolo, venne coinvolta direttamente la prima generazione di padri gesuiti. Esemplare fu il caso della Valtellina, porzione significativa della diocesi di Como, ma nella terra dei Grigioni svizzeri a prevalenza protestante, dove si affidò ai religiosi il compito di rimediare alle carenze del clero locale e difendere la fede cattolica anche attraverso la fondazione dei collegi-avamposto di Ponte e di Bormio.