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Origins of ancient rockslides in seismic regions can be controversial and must not necessarily be seismic. Certain slope morphologies hint at a possible coseismic development, though further analyses are required to better comprehend their failure history, such as modelling the slope in its pre-failure state and failure development in static and dynamic conditions. To this effect, a geophysical characterization of the landslide body is crucial to estimate the possible failure history of the slope. The Balta rockslide analysed in this paper is located in the seismic region of Vrancea-Buzau, Romanian Carpathian Mountains and presents a deep detachment scarp as well as a massive body of landslide deposits. We applied several geophysical techniques on the landslide body, as well as on the mountain crest above the detachment scarp, in order to characterize the fractured rock material as well as the dimension of failure. Electrical resistivity measurements revealed a possible trend of increasing fragmentation of rockslide material towards the valley bottom, accompanied by increasing soil moisture. Several seismic refraction surveys were performed on the deposits and analysed in form of P -wave refraction tomographies as well as surface waves, allowing to quantify elastic parameters of rock. In addition, a seismic array was installed close to the detachment scarp to analyse the surface wave dispersion properties from seismic ambient noise; the latter was analysed together with a colocated active surface wave analysis survey. Single-station ambient noise measurements completed all over the slope and deposits were used to further reveal impedance contrasts of the fragmented material over in situ rock, representing an important parameter to estimate the depth of the shearing horizon at several locations of the study area. The combined methods allowed the detection of a profound contrast of 70–90 m, supposedly associated with the maximum landslide material thickness. The entirety of geophysical results was used as basis to build up a geomodel of the rockslide, allowing to estimate the geometry and volume of the failed mass, that is, approximately 28.5–33.5 million m3. [ABSTRACT FROM AUTHOR]

Introduction. Disease activity, drug exposure , infectious factors, smoking, excessive alcohol intake and stress were identified to have a negative impact on spermatogenesis and gonadal function. Population-based studies on fertility in ankylosing spondylitis (AS) men are lacking. It is not known, if men with AS have a reduced number of children. Our objective was to determine fertility in a masculine AS group by determining the family size. Patients and methods. Men diagnosed with AS responded to a questionnaire comprising of several domains, focused on the preconception/conception period. Demographic parameters, disease related information, sexual relationship status, infertility treatment use in the couple, time to pregnancy achievement (TTP), comorbidities, exposure to gonadotoxic medication or radiation in the past, smoking, number of pregnancies and children born in the couple and couples' decision to limit family size were registered. Results. Out of 122 AS patients, 76 accepted to participate to the interview. Hundred-eleven pregnancies were registered in the couples and 99 children were born. Forty-two men (55.26%) with AS onset fathered 58 children and 34 (44.73%) men fathered 41 children before AS onset . No statistic difference was found between the 2 subgroups when average number of children/ family was compared (1.38 vs 1.20). A statistic significant number of men, with AS onset at conception (14/42; 33.33%), decided to limit the family size (p=0.02). Twenty-seven patients (35.52%) recalled a decrease in sexual desire. In 19 (25%) of them, this phenomenon was linked to the disease burden. Decrease of sexual desire in the 2 groups showed a borderline statistic significant difference, p=0.051. No statistic significant difference was obtained when TTP in the two groups were compared. Conclusion. A lower fertility in AS patients was described in our group in comparison to general population and this phenomenon could be linked mostly to psychological factors impacting family size decision. No correlation between the low fertility and disease presence at conception was found. [ABSTRACT FROM AUTHOR]

The objective of the analysis is to quantify the impact of subsidies on the activity of two large farms of 600 ha and 3000 ha, respectively. The innovative solution from this analysis is to create a model that can be used at the macroeconomic level, showing the possible ways in which these large farms can secure their incomes. To study the use of these subsidies, the methods of technical–economic analysis, economic–financial analysis and statistical analysis of the data were used. Descriptive statistics, visual inspection and basic comparative methods were used to determine the statistical patterns of subsidy impact and variation for each crop. In this context, this is evidence of the possibility of probable expansion of crop income and profitability. The results were different for the two arable farms studied. The results for the 600 ha arable farm suggested that the statistical model was inconclusive due to the annual adjustment of the cropping plan and the impossibility of making viable forecasts, especially since the ecological performance fluctuated (in 2020 the farm was on the verge of profitability), although the positive impact of subsidies was evident in loss-making years. For the 3000 ha arable farm, the statistical model was relevant because it highlighted crops (corn and soybeans) that consistently contributed to good and increasing income and economic performance, as well as highlighting the significant impact of subsidies. The conclusions of the study emphasize the indispensability of subsidies for large farms and the contribution of crops to income generation. These conclusions provide a valuable source of information for relevant policy decisions and can guide future research aiming to increase the profitability of these farms and allocate resources appropriately and efficiently in the agricultural sector.

Objectives: To evaluate the ankle, hindfoot, and heel changes (determined by physical examination, ultrasound and baropodometry) in patients with rheumatoid arthritis, to compare the findings with healthy subjects, and to analyze if these findings are associated with ankle pain and could affect the quality of life. Methods: We enrolled 35 rheumatoid arthritis patients and 35 healthy controls, and evaluated their ankles (tibiotalar joints, tendons), hindfeet (talonavicular, subtalar joints) and heels using clinical examination, DAS28-CRP, RAPID3 for the evaluation of functional status, quality of life in rheumatoid arthritis questionnaire, ultrasound, and baropodometry. Results: The ultrasound inter-observer agreement was good for the subtalar joint, and very good for the other structures. Flat foot was identified in 50% of feet in rheumatoid arthritis patients, with 83.8% having concomitant hindfoot valgus and less subtalar joint synovitis visible from the lateral approach (32.4% vs 55.6%, p = 0.041). The body mass index, RAPID3 and subtalar synovitis were independent predictors for the symptomatic ankle (all p

Musculoskeletal Ultrasonography (US) is nowadays widely used for clinical grounds and for research purposes in rheumatology. US of the hand and wrist has recently developed due to the technological improvement and use of new, high resolution transducers. US is currently improving clinical examination of the rheumatic hand and wrist and it is commonly used as daily practice by many rheumatologists. The number of publications addressing this area of US scanning has grown exponentially over the last few years. The aim of this paper is to review the current literature on US of the hand and wrist in rheumatology, including US scanning techniques, as well as normal and pathological findings. [ABSTRACT FROM AUTHOR]

Continuous Hahn polynomials Sn(x) appear in a formulation of quantum mechanics on a discrete time lattice, where they form a natural basis for the state vectors. In this paper we derive some of their generating functions, the expression of the raising and lowering operators and give a lower bound for the largest root of the equation Sn(x)=0. [ABSTRACT FROM AUTHOR]

Introduction Aged population presents a high prevalence rate of osteoarthritis (OA) and cardiovascular pathology, anticoagulant therapy being frequently used in this group. Intra-articular Hyaluronic acid (HA) injections have been successfully used to improve joint lubrication and to modulate joint inflammation and their administration requires the use of thick needles of 21-22g. The aim of the study was to evaluate the security profile of intra-articular ultrasound guided injections (USGI) using thick needles in patients on current efficient anticoagulant therapy. Material and method Patients diagnosed with knee OA (Kellgren 2-3) and cardiovascular pathology requesting chronic anticoagulation with Vitamin K antagonists were recruited in the outpatient clinic to receive one viscosupplementation intra-articular USGI. All patients presented chronic refractory knee pain after previous systemic/ local NSAIDs and other painkillers, according to current protocols. Only patients with mild knee effusion/ synovial hypertrophy, no popliteal cyst at US examination, and efficient INR between 2 and 3, determined in the same day, were included. No switch from anticoagulant Vitamin K antagonists to Heparin was made. The US evaluation was repeated post procedural immediately, after 45 minutes and 72 hours. Informed written consent was signed by all patients. Results Thirty-two patients (78.12% women, age 65±8.3 years) with knee OA received unilateral one USGI with monodose HA. In all patients, the viscosupplementation agent was deposited strictly inside the joint space under continuous visual US control. No iatrogenic bleeding inside the joint was noticed after the interventional maneuver in 100% of the knees. No local injection-site nor systemic reactions did occur when patients were checked at 72 hours and no further reports of injection linked (technical or product) side effects were identified. Conclusion. Intra-articular injections with thicker needles (21-22g) have a very good safety profile in patients with current efficient anticoagulant Vitamin K antagonists. There is no need to stop anticoagulant therapy or to switch on Heparin previous to the USGI when INR is lower than 3. [ABSTRACT FROM AUTHOR]

Anticoagulation is common in patients undergoing routine musculoskeletal interventional maneuvers. Previous retrospective studies have established the safety of continuing anticoagulation with novel oral anticoagulants (NOACs) when performing this kind of interventions. Indeed, ultrasound (US)-guided interventional maneuvers have shown a superior safety profile compared to blind anatomical maneuvers. To evaluate prospectively the periprocedural bleeding events in NOAC-anticoagulated patients undergoing interventional articular or periarticular procedures. Consecutive patients diagnosed with inflammatory or degenerative rheumatologic pathology requiring interventional maneuvers were prospectively recruited. Group 1 was treated with NOACs, group 2 was treated with vitamin K antagonists, and group 3 was not anticoagulated. Prior to the international maneuver, NOAC therapy was continuously administered, in regimens dictated by the underlying anticoagulation indication. Demographics, comorbidities, laboratory parameters, locally administered medication (corticosteroids or viscosupplementation), interventional maneuver location, needle size, and local bleeding events were recorded. Post-procedural control was performed at 30 min, 48 h, and 7 days. No articular/periarticular bleeding event occurred in patients treated with NOACs, regardless of their type and dosage, locally administered medication, needle size, location, and number of interventions per individual. Several patients in all groups developed small superficial ecchymoses at the injection site. Our results suggest that NOACs are safe to be used in a continuous regimen prior to US-guided injections, even as dual antithrombotic therapy (in combination with aspirin). The use of lower gauge needles, chosen for viscosupplementation therapy, was not burdened with adverse effects on the procedural outcome. Key Points • Currently, no prospective studies have been performed to establish the safety of continuous NOAC anticoagulation when performing routine intra- or periarticular interventional maneuvers. • The study offers an extensive view on a wide spectrum of intra- and periarticular interventional maneuvers including anatomic targets and needle sizes that were not previously assessed. • The study offers a perspective into performing repetitive maneuvers in the same patient, both over a short time and at longer intervals. • The zero periprocedural bleeding risk observed in our study may reassure practitioners and suggest that US-guided interventional therapeutic interventions are safe in patients treated with a continuous regimen of different NOACs., (© 2024. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Women affected by different autoimmune diseases and displaying positivity for anti-Ro/SSA and anti-La/SSB autoantibodies are at high risk of adverse pregnancies in which placental dysfunction seems to play a determinant role. Sialylation is known to have important implications in the maintenance of the normal morpho-functional features of the placenta. Hence, the present study aimed to investigate possible changes in the distribution and content of sialic acids (Sias) with different glycosidic linkages (i.e., α2,3 and α2,6 Galactose- or N-acetyl-Galactosamine-linked Sias, and polysialic acid) in placentas from anti-Ro/SSA- and anti-La/SSB-positive pregnant women with autoimmune diseases by using lectin histochemistry and polysialic acid immunohistochemistry. Our findings revealed lower levels of α2,3-linked Sias in the trophoblast and basement membrane and/or basal plasma membrane of the pathological cases respect to control placentas. Some vessels of the pathological cases displayed α2,3-linked Sias. α2,6-linked Sias positivity was detected in the trophoblast and in some vessels of the pathological cases, while in control samples it was present only in the vessels. Lower levels of polysialic acid were observed in the trophoblast of pathological cases compared to controls. Collectively, our findings suggest that multiple changes in the sialylation status of placenta might affect placental morpho-functional features in anti-Ro/SSA- and anti-La/SSB-positive pregnancies., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system., Methods: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis., Results: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes)., Conclusions: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated., Competing Interests: Competing interests: EN: Speaker fees from Abbvie, Lilly, Novartis, Pfizer; research grant from Lilly and Abbvie; support for attending meetings from Novartis and Fresenius Kabi. MADA: Speaker fees from Abbvie, Amgen, BMS, Galapagos, Novartis, Lilly, Janssen, and UCB; consulting fees from Abbvie, Amgen, BMS, Galapagos, Novartis, Lilly, Janssen, UCB; research grant from Abbvie, Amgen, Pfizer; royalty from Elsevier; support for attending meetings from Novartis and Janssen. LT: Speaker fees from Janssen, Lilly, Novartis, Pfizer; advisory board for Janssen and UCB. CP: No competing interests. MM: No competing interests. JB: No competing interests. GAWB: No competing interests. MCK: No competing interests. PM: Speaker fees from Janssen, Lilly, Novartis, AbbVie; research grant from AbbVie and Novartis. RN: Speaker fees from Abbvie, Novartis, Pfizer, Marcin Szkudlarek: Speaker fees from Novartis; meeting support from Pfizer. PT: Speaker fees from AbbVie, Novartis, Sandoz; advisory board for Novartis. VV: No competing interests. PW: No competing interests. CB: Speaker and/or Consultancy fees from: Janssen, Lilly, Novartis, AbbVie, Pfizer, UCB, Sanofi. EF: Speaker fees from AbbVie, Amgen, Bristol-Myers Squibb, Janssen-Cilag, Lilly, Novartis, Pfizer, Union Chimique Belge Pharma. AZ: Speaker bureau from AbbVie, Novartis, Janssen, Lilly, UCB, and Amgen; paid instructor from AbbVie, Novartis, UCB. MM: Speaker fees from Eli Lilly, SC Angelini Pharmaceuticals Romania SRL, KRKA; consulting fees from Eli Lilly, Galapagos. FAV: Speaker fees from Abbvie, Ewopharma BMS, Novartis, Lilly, Janssen, Pfizer, Zentiva, UCB; advisory board Abbvie, Ewopharma, Lilly, Janssen, Pfizer. MAM: No competing interests. JAM: Speaker fees from Janssen, Novartis, UCB; advisory board for Novartis. CAG-A: Speaker fees from Janssen, Abbvie, Novartis, Pfizer; advisory fees from Novartis, Galápagos, UCB; support for attending meetings from Pfizer, Janssen, Novartis. OO-V: Speaker fees from GSK and Novartis; support for attending meetings from Pfizer, Janssen, Gebro Pharma. AI: Grants from Abbvie, Pfizer, Novartis; Honoraria from AbbVie, Alfa-sigma, BMS, Celgene, Celltrion, Eli-Lilly, Galapagos, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi Genzyme, SOBI; Consulting fees from Abbvie, BMS, Pfizer, Eli-Lilly; Leadership or fiduciary roles as EULAR Immediate Past President; EULAR Presidency member; EULAR Board member; EULAR Advocacy Committee Member; EULAR Advocacy Committee Advisor. PH: No competing interests. IT: No competing interests. PVB: Speaker fees from Abbvie, Eli Lilly, Jannsen, Novartis, Richter, Sandoz; support for attending meetings from Abbvie, Janssen, Novartis, Eli Lilly, Sandoz. SZA: Speaker fees from Abbvie, Novartis, Pfizer, Janssen, UCB; research grant from Abbvie, Novartis, Pfizer, Janssen, Lilly, Fresenius Kabi; support for attending meetings from Abbvie, Pfizer, UCB and Fresenius Kabi. DK: Speaker fees from Abbvie, Galapagos, Janssen, Novartis; support for attending meetings from Novartis, Abbvie, and Janssen. HIK: Clinical trials Roche, Abbvie, Sun, Emerald, Novartis, Biogen, Sanofi, and Suneos. GSK: Research grants from Abbvie, Bristol Myers Squibb, Galapagos, Novartis, JannsenIngrid Möller: No competing interests., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ on behalf of EULAR.)

Women with rheumatoid arthritis (RA) may carry an increased risk of adverse pregnancy outcomes (APO). The aims of this study were to compare pregnancy outcomes in RA patients as compared to the general obstetric population (GOP) and to identify a risk profile in RA. A case-control study was conducted on 82 prospectively followed pregnancies in RA and 299 pregnancies from the GOP. The mean age at conception was 31.50 ± 4.5 years, with a mean disease duration of 8.96 ± 6.3 years. The frequency of APO in RA patients was 41.5%, 18.3% experienced spontaneous abortions, 11.0% underwent preterm deliveries, 7.3% had small for gestational age infants, 4.9% experienced intrauterine growth restriction, 1.2% experienced stillbirth, and 1.2% suffered from eclampsia. The risk of APO was correlated with a maternal age higher than 35 years ( p = 0.028, OR = 5.59). The rate of planned pregnancies was 76.8%, and the subfertility rate was 4.9%. Disease activity improved every trimester, and approximately 20% experienced an improvement in the second trimester. Planned pregnancies and corticosteroids use (≤10 mg daily) were protective factors for APO in RA pregnancies ( p < 0.001, OR = 0.12, p = 0.016, OR = 0.19, respectively). There was no significant association between APO and disease activity or DMARDs used before and during pregnancy. Regarding the comparison between the RA group and the controls, RA mothers were significantly older ( p = 0.001), had shorter pregnancies ( p < 0.001), and had neonates with a lower birth weight ( p < 0.001).

The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice., Competing Interests: Fernando Alfageme Speaker honoraria: GE, Mindray; Equipment support: EsaoteDavid Bong No Conflicts of interestAngel Bueno No Conflicts of interestVito Cantisani Speaker honoraria: Bracco, Samsung, CanonPaz Collado No Conflicts of interestMaria Antonietta D'Agostino No Conflicts of interestDaniela Fodor No Conflicts of interestJavier de la Fuente No Conflicts of interestWolfgang Hartung Speaker honoraria: Abbvie, GE Healthcare, Alpinion Medical; Ultrasound equipment support; Alpinion Medical Germany, Canon Medical GermanyHilde Hammer Speake honoraria and/or consultancy; AbbVie, Lilly, Roche, NovartisAndrea Klauser No Conflicts of interestJens Kessler No Conflicts of interestManuela Lenghel No Conflicts of interestCarlo Martinoli Speaker honoraria and equipment support: Philips, CanonDolores Mendoza-Cembranos No Conflicts of interestMihaela Micu No Conflicts of interestIngrid Möller No Conflicts of interestAurelie Najm No Conflicts of interestGabriella Iohom No Conflicts of interestClara Malattia No Conflicts of interestPeter Mandl No Conflicts of interestEsperanza Naredo No Conflicts of interestLevent Ozcakar No Conflicts of interestRiccardo Picasso No Conflicts of interestAthena Plagou Speaker honoraria: GESebastian C Rodriguez-Garcia No Conflicts of interestXavier Sala-Blanch No Conflicts of interestLuca Scofienza Non-financial support: Samsung Imaging, Abiogen, Bracco Imaging Italia; Speaker honoraria: Esaote SPA, Abiogen, Biolive, Fidia Pharma Group, Novartis, PfizerOana Serban No Conflicts of interestPaolo Simoni No Conflicts of interestIwona Sudoł-Szopińska No Conflicts of interestLene Terslev Speaker honoraria: GEChristian Tesch No Conflicts of interestPlamen Todorov No Conflicts of interestJacqueline Uson No Conflicts of interestVioleta Vlad No Conflicts of interestFederico Zaottini No Conflicts of interestMichael Pelea, Diana Bilous, Anamaria Marian, Roxana Gutiu No conflict of interest., (Thieme. All rights reserved.)

This work aims at evaluating the sensitivity of landslide susceptibility mapping (LSM) to sampling design in lithologically-heterogeneous areas. We hypothesize that random sampling of the landslide absence data in such areas can be biased by statistical aggregation of the explanatory variables, which impact the model outputs. To test this hypothesis, we train a Random Forest (RF) model in two different domains, as follows: (1) in lithologically heterogeneous areas, and (2) in lithologically homogeneous domains of the respective areas. Two heterogeneous areas are selected in Japan (125 km 2 ) and Romania (497 km 2 ), based on existing landslide inventories that include 371 and 577 scarps, respectively. These areas are divided into two, respectively three domains, defined by lithological units that reflect relatively homogeneous topographies. Fourteen terrain attributes are derived from a 30 m SRTM digital elevation model and employed as explanatory variables. Results show that LSM is sensitive to a random sampling of the absence data in lithologically heterogeneous areas. Accuracy measures improve significantly when sampling and LSM are conducted in lithologically homogeneous domains, as compared to heterogeneous areas, reaching an increase of 9% in AUC and 17% in the Kappa index., (© 2022. The Author(s).)

The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice., Competing Interests: Fernando Alfageme: Speaker honoraria: GE, Mindray; Equipment support: EsaoteDavid Bong: No Conflicts of interestAngel Bueno: No Conflicts of interestVito Cantisani: Speaker honoraria: Bracco, Samsung, CanonPaz Collado: No Conflicts of interestMaria Antonietta D’Agostino: No Conflicts of interestDaniela Fodor: No Conflicts of interestJavier de la Fuente: No Conflicts of interestWolfgang Hartung: Speaker honoraria: Abbvie, GE Healthcare, Alpinion Medical; Ultrasound equipment support; Alpinion Medical Germany, Canon Medical GermanyHilde Hammer: Speake honoraria and/or consultancy; AbbVie, Lilly, Roche, NovartisAndrea Klauser: No Conflicts of interestJens Kessler: No Conflicts of interestManuela Lenghel: No Conflicts of interestCarlo Martinoli: Speaker honoraria and equipment support: Philips, CanonDolores Mendoza-Cembranos: No Conflicts of interestMihaela Micu: No Conflicts of interestIngrid Möller: No Conflicts of interestAurelie Najm: No Conflicts of interestGabriella Iohom: No Conflicts of interestClara Malattia: No Conflicts of interestPeter Mandl: No Conflicts of interestEsperanza Naredo: No Conflicts of interestLevent Ozcakar: No Conflicts of interestRiccardo Picasso: No Conflicts of interestAthena Plagou: Speaker honoraria: GESebastian C Rodriguez-Garcia: No Conflicts of interestXavier Sala-Blanch: No Conflicts of interestLuca Scofienza: Non-financial support: Samsung Imaging, Abiogen, Bracco Imaging Italia; Speaker honoraria: Esaote SPA, Abiogen, Biolive, Fidia Pharma Group, Novartis, PfizerOana Serban: No Conflicts of interestPaolo Simoni: No Conflicts of interestIwona Sudoł-Szopińska: No Conflicts of interestLene Terslev: Speaker honoraria: GEChristian Tesch: No Conflicts of interestPlamen Todorov: No Conflicts of interestJacqueline Uson: No Conflicts of interestVioleta Vlad: No Conflicts of interestFederico Zaottini: No Conflicts of interestMichael Pelea, Diana Bilous, Anamaria Marian, Roxana Gutiu: No conflict of interest, (Thieme. All rights reserved.)

Parotid non-Hodgkin lymphoma (NHL) in primary Sjögren syndrome (pSS) has no specific biomarker for diagnosis. Salivary glands ultrasound (US) is largely used, but its contribution in detecting parotid NHL has not been established. The aim of our study was to determine the added value of bidimensional shear wave elastography (2D-SWE) in pSS diagnosis and to determine its accuracy in identifying parotid NHL. Grey-scale US (GSUS) and 2D-SWE of salivary glands were performed in 35 patients with pSS and 35 healthy controls. The GSUS scores were calculated and the mean of three SWE consecutive measurements was used to appreciate the gland stiffness. SWE increase the diagnostic rate at a cut-off of 6.45 kPa (from 88.6 to 94.2%, p < 0.001) only if applied in patients with insufficient GSUS criteria for pSS diagnosis. The parotid glands with NHL (8 patients, all mucosa-associated lymphoid tissue type) had hyperechoic bands in more than half of the glandular parenchyma (in 68.75% of the glands), large hypoechoic area > 20 mm (all glands), traced gland area over 5 cm 2 (all glands), parotid US score greater than 13 (in 68.75% of the glands), and high stiffness (elasticity modulus 13.9 ± 4.08 vs 6.32 ± 2.24) (all p < 0.001). These findings give high sensitivity (92.3%), specificity (100%), and positive (100%) and negative predictive values (98.3%) for NHL identification. The rest of GSUS findings did not correlate with the classic risk factors for lymphoma development (all p > 0.05). 2D-SWE had added value for pSS diagnosis in cases where GSUS aspect is normal or nonspecific. The higher stiffness of parotid NHL can be used for early diagnosis, biopsy guidance, and, possible, for treatment monitoring.

Background: In this work, we aimed to establish a clinical target in the management of knee osteoarthritis (KOA) and to propose good clinical practice (GCP) statements for carrying out a treat-to-target strategy., Methods: A steering committee of seven experts had formulated a provisional set of recommendations that were exposed for discussion and modification to a technical expert panel (TEP) of 25 multidisciplinary experts from Europe, North America, South America and Asia. The level of evidence and strength of each recommendation was discussed. The TEP formulated overarching principles and GCP statements based on the level of agreement for each item with a vote using a 10-point numerical scale., Results: Two overarching principles and 10 GCP statements were formulated by the TEP. These GCP statements suggest: treatment should achieve clinical improvement bringing the patient to the Patient Acceptable Symptom State (PASS); pharmacological and nonpharmacological treatment should begin as early as possible, with an early diagnosis of symptomatic KOA; the patient should be evaluated every 3-6 months; risk factors of KOA progression should be identified and managed with patients at the beginning of the treatment and monitored regularly; treatment should be adapted according to patient phenotype and disease severity; healthy lifestyle must be promoted and monitored. The level of agreement average ranged from 8.7 to 9.6 on scale., Conclusions: The proposed overarching principles and GCP statements have the aim of involving patients, general practitioners and multidisciplinary specialists in sharing a therapeutic treat-to-target strategy for KOA management based on the best evidence and expert opinions., Competing Interests: Conflict of interest statement: Abiogen Pharma Spa supported all the costs of the meeting of the authors, including travel and subsistence. No honoraria were paid to the participants. Abiogen Pharma Spa had no input in the writing or editing of the paper., (© The Author(s), 2019.)

Aim: To evaluate the frequency of tibiotalar and subtalar joints together with extensor, flexor and peroneal tendons inflammatory lesions in rheumatoid arthritis (RA) patients by using ultrasound (US) and magnetic resonance imaging (MRI)., Material and Methods: Fifty RA patients and 25 healthy subjects were prospectively included. All patients and controlsunderwent clinical examination (to screen for swollen and/or tender ankles) and ankle US and MRI (to screen for synovialhypertrophy - SH, tenosynovitis and power Doppler - PD signals). The imaging tests were compared using overall agreement, positive agreement, Cohen's κ, sensitivity, specificity and positive likelihood ratio., Results: The subtalar joint had the highest frequency of US-detected SH (30%), as well as positive PD signals (10%). Regarding US joint effusion, the tibiotalar joint recorded the highest frequency (44%). The most frequent US tenosynovitis was detected in the tibialis posterior tendon (40%). Compared to MRI, US evaluation of tibiotalar joints had very good agreement and large effect on detection probability for both SH and effusion (kappa 0.84, positive likelihood ratio 21.1). Compared to MRI, the sensitivity and specificity for US joint involvement ranged between 72.0-88.5% and 82.4-95.8%, and for tenosynovitis were 33.3-78.6% and 85.2-100%,  respectively. Compared to asymptomatic RA patients (n=25), those with at least one symptomatic ankle (n=25) had significantly higher frequencies of both SH and effusion in all the evaluated structures., Conclusion: US has high sensitivity and specificity in detecting RA inflammatory lesions in the ankle and rearfoot, in very good agreement with MRI. The high frequency of ankle inflammatory lesions in RA should result in increased interest in the imaging evaluation of these structures.

Aim: To evaluate the ultrasound (US) modifications [grey scale, Doppler, 2D-share wave elastography (2D-SWE)] ofsalivary (parotid and submandibular) and lacrimal glands in healthy people and patients with diabetes mellitus and/or obesity, with or without sialosis., Material and Methods: We evaluated 170 patients (1020 glands, 1700 grey scale and Doppler images), split in two groups (group 1- healthy people, group 2- obese and/or diabetes patients, with or without sialosis). For each patient we assessed the parotid, submandibular and lacrimal glands in grey scale US (echogenicity, homogeneity, glandular contour, posterior border, lymph nodes), color Doppler US and 2D-SWE. All images were analyzed by two examiners blinded to each other or to patients., Results: The interobserver agreement was strong or moderate for all parameters. In group 2, the salivary glands had increased echogenicity, homogeneous aspect and invisible posterior border (all p<0.001). There was no significant variation of elasticity modulus in the groups analyzed (5.46±1.57 vs 5.67±1.81 in parotid, 8.63±1.84 vs 8.55±1.94 in submandibular and 9.47±2.1 vs 9.53±2.23 in lacrimal glands, all p>0.05) or according to the body mass index (BMI), sex, patient age, the aspect in grey scale/Doppler US or the presence of sialosis (all p>0.05)., Conclusion: The main US differences between healthy people and patients with diabetes mellitus and/or obesity are suggested by the echogenicity, homogeneity, posterior border and the size of glandular area. No significant differences of elasticity modulus were found between the analyzed groups or related to BMI, sex, patient age or other grey scale/Doppler US items analyzed.