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Recent years have seen growing interest in the role of selective public secondary schools as places of state-funded privilege production. Students' experiences in and perceptions of these schools are still under-researched. Focusing on the transition to Gymnasium, highly selective public secondary schools in Zurich, this article analyses how students are addressed by principals, teachers, and education policies and how they perceive the Gymnasium and its students. Drawing on a 13-month ethnography with eight students, the article shows that students learn to see the Gymnasia as stellar schools for hard-working and intelligent students who have earned their privileges. Students play an important role in coproducing and legitimizing their privileged status in the educational field by drawing on the notion of merit. Most students distanced themselves from the non-Gymnasium “other”, labeling them as less hard-working and less intelligent. These processes ultimately contribute to a hierarchization and division of Zurich's secondary schooling landscape.

In this short intervention addressing the impact of crises on geographical knowledge practices, we, members of GenUrb (a multi-sited, longitudinal, partnered urban research project), ask, “what counts as crisis?”, sketching out epistemological and methodological points about our project's engagement with this call. We query the adeptness of dominant Eurocentric epistemologies in addressing crises, adopting the work of Bedour Alagraa, who places crises firmly within a historical–geographical colonial framing that conceptualizes crises not through rupture but through continuation. We illustrate the utility of this epistemological framing of crisis, honing in on the everyday violence that women continually experience, with our research in the cities of Cochabamba, Delhi, Georgetown, Ibadan, Ramallah, and Shanghai, showing that one in every two women participants had experienced intimate partner violence. We further ask what crises mean for the methodologies we adopt, specifically concerning questions of the co-production of knowledge and methods.

Objective. Patients Acceptable Symptom State (PASS) is a single dichotomized question assessing health satisfaction. We aimed to investigate PASS achievement within 4 weeks of treatment with Janus kinase (JAK) inhibitors (Jakinibs) and its association with treatment response after 4 and 12 weeks in rheumatoid arthritis (RA) patients. Methods. We recruited consecutive RA patients starting baricitinib or tofacitinib. At baseline, 4 and 12 weeks, we calculated disease activity [Disease Activity Score on 28 joints (DAS28), Clinical Disease Activity Index, Simplified Disease Activity Index], disease status [remission and low-disease activity (LDA)], percentage of patients achieving PASS, and the time to attain PASS. We assessed the impact of clinically relevant variables on PASS achievement by logistic regression analysis. Results. We enrolled 113 patients [98 (86.7%) females; median age 59.6 (interquartile range 16.9), median disease duration 144 (132) months]. 90 (79.6%) patients achieved PASS after 10 (8) days. A similar percentage of PASS achievers and non-achievers was in remission/LDA at weeks 4 and 12, but the reduction of disease activity was significantly greater in PASS achievers. All patients achieving Boolean remission at weeks 4 and 12 had achieved PASS within 4 weeks. The impact of Patients Global Assessment (PGA) on DAS28 was significantly greater in PASS non-achievers compared to PASS achievers; inversely, the impact of C-reactive protein was more relevant in PASS achievers. At multivariate analysis, pain and PGA were significantly associated with PASS. Conclusions. In our cohort, Jakinibs allowed an early achievement of PASS in a great percentage of RA patients. PASS is strictly dependent on PGA and pain and could suggest, early in the management of RA patients, therapeutic success.

This case series aims to characterize the development of systemic lupus erythematosus (SLE) induced by anti-tumor necrosis factor α (anti-TNFα) therapy in patients with inflammatory rheumatic diseases, namely rheumatoid arthritis (RA), spondylarthritis (SpA), and psoriatic arthritis (PsA). Patients with a diagnosis of SLE induced by anti-TNFα therapy and registered on the Rheumatic Diseases Portuguese Register (Reuma.pt) who started their first anti-TNFα between 2001 and 2020 were included. Demographic, clinical, and laboratory data were obtained by consulting Reuma.pt. The diagnosis of SLE induced by anti-TNFα was considered if there was a temporal relationship between the onset of anti-TNFα therapy and manifestations (clinical and immunological) in accordance with the American College of Rheumatology/European League Against Rheumatism criteria (2019). A total of 607 patients with inflammatory rheumatic diseases and six cases of SLE induced by anti-TNF-α therapy were reviewed: two patients were affected by RA, three patients by SpA, and one by PsA. All these patients had articular and constitutional symptoms that improved after discontinuation of the anti-TNFα agent. After switching to a second anti-TNFα agent, there was no recurrence of SLE over time. The development of SLE secondary to anti-TNFα agents in inflammatory rheumatic patients is rare. In this case series, all patients had a mild disease that improved after therapy discontinuation without recurrence of the disease. SLE induced by anti-TNFα should be considered in the follow-up of RA, SpA, and PsA patients.

The aim of the present article is to better understand how hospitality relationships are perceived by the host community of a touristic city, based on the belonging and welcoming dimensions. The City of Campos de Jordão (SP, Brazil) was the research object. The impacts of tourism on a locality have long been discussed, with the economic ones being the most commonly analyzed. However, as tourism has become a market, recent studies have also begun to address the social impacts, which are often generated by the adverse effects of this activity. The current research is based on phenomenology, and its methodology follows an integrative design based on qualitative techniques. Qualitative data were collected in 2021 and evidence the support given to tourism, although they also point towards signs of impoverished relationships between the local community and visitors, as well as to the lack of appropriation of public spaces by local residents.

Along with several other pre-Roman centers of power along the Lower Danube’s final section, such as Troesmis, Noviodunum, or Aegyssus, Axiopolis (Hinog Hill, Cernavoda, Constanța county) was one of the longest and most intensively occupied archaeological sites on the territory of Dobrudja in ancient times. It was initially a Hellenistic emporium, then an attested strategia of the client Odrysian kings, and later an important military and naval, commercial and religious center in Roman and Middle Byzantine times. During the Principate, the nautae universi Danuvii had their headquarters (collegium) there and it is very likely that a statio portorii of the publicum portorium Illyrici utriusque ripae Thraciae was in place at Axiopolis during the 2nd-3rd centuries AD. During the Dominate, the city with Christian martyrs mentioned by the martyrologies was chosen seat for the pedatura superior of the Scythian legio II Herculia and subsequently raised to the rank of bishopric in the 6th century. Its chronology begins with the hypothetical foundation by Lysimachus and continues to the mid 11th century, under Constantine IX (1042-1055), at the time when the last known coin from Cernavoda dates. The Axiopolis site is located approx. 3 km S of the dobrudjan end of the “King Carol I” bridge at Cernavodă, next to Hinog island, more precisely on a triangular plateau on the right bank of the Danube, at the entrance to a deep valley. It was archaeologically investigated by Pamfil Polonic in 1898-1899 and the results of the excavations were briefly published by Grigore Tocilescu in 1903. Given its importance in ancient times, with its remarkable position on the Danube line and at the mouth of the Carasu valley, Axiopolis remained, unjustly, little known for well over a century. The article aims to systematize the available information and outline the most important moments in the history of the site, based upon the known archaeological data. It includes a systematic description and interpretation of the sequence of the three enclosures of the edifices and artifacts found here, including the numismatic evidence, but also of the limestone quarry that provided building material for the erection of defensive system in the Roman and Middle-Byzantine times.

Objective. To provide a comprehensive overview of peripheral spondyloarthritis (pSpA), focusing specifically on its occurrence and management in patients with inflammatory bowel disease (IBD). Methods. An exhaustive literature search was conducted in PubMed, Embase, Cochrane Database of Systematic Reviews, and Google Scholar to identify relevant studies on pSpA in IBD patients. Titles, abstracts, and full-text articles were screened for relevance. Data on study design, patient characteristics, diagnostic criteria, main findings, and conclusions were extracted from selected articles. Study quality was assessed using appropriate checklists. Information was synthesized narratively to summarize current understanding. Results. pSpA is the most common extraintestinal manifestation in IBD, with a median prevalence of 16%. It worsens quality of life and requires collaboration between gastroenterologists and rheumatologists for optimal diagnosis and treatment. Several “red flags” guide appropriate specialist referral of IBD patients with suspected pSpA. Once the diagnosis is confirmed, the choice of therapy depends on IBD phenotype and patterns of articular/axial involvement. Anti-tumor necrosis factor (TNF) drugs are first-line biologics, with interleukin (IL)-12/23 and IL-23 inhibitors as alternatives for anti-TNF failure. Small molecules like apremilast and Janus kinase inhibitors also have utility. Recommended treatment algorithms exist, but more randomized controlled trials are needed. Conclusions. Early identification of pSpA is crucial in IBD patients to enable timely intervention, prevent structural damage, and minimize disability. A multidisciplinary, holistic approach addressing musculoskeletal and extra-musculoskeletal manifestations is key to optimal patient outcomes.

The objective of this case series is to describe the efficacy and safety of baricitinib (BARI) in a group of patients with polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA). These patients were treated with BARI due to either a refractory disease course or the unavailability of tocilizumab because of the pandemic. A total of six patients (five females and one male, median age 64 years, range 50-83) were treated with BARI. Two of them had isolated PMR, two had PMR with associated large vessel (LV)-GCA, one had LV-GCA presenting as fever of unknown origin, and one had cranial-GCA. All patients reported improvement with BARI. At the time of starting BARI, patients were taking a median prednisone dose of 8.75 mg/day (range 0-25), and the four patients with PMR had a median PMR-AS of 23.3 (indicating high disease activity), which decreased to 1.58 after 6 months of treatment with BARI. Two of them could stop glucocorticoids (GC) and continued BARI monotherapy. One patient suffered from pneumonia, and BARI was therefore stopped. No other adverse events attributable to BARI were detected. Our case series supports previous reports suggesting efficacy of Janus kinase inhibitors as a GC-sparing strategy in PMR and GCA.

Alopecia universalis (AU), an advanced form of alopecia areata (AA), is a condition characterized by the complete loss of hair over the entire skin surface. Recent progress has significantly enhanced our understanding of the pathogenesis of AU. In particular, interferon-γ (IFN-γ) and interleukin (IL)-15 seem to play a pivotal role in the pathogenesis of the disease. Nonetheless, a variety of medications has been used to treat the disease with frequently inconsistent results. Given the broad modulation of the immune system and inhibition of key molecules, including IFN-γ and IL-15, oral janus kinase (JAK) inhibitors represent a treatment option for moderate to severe cases of AA, as demonstrated in case reports supporting their efficacy and tolerability. We present the case of a patient suffering from psoriatic arthritis and AU who experienced a sudden improvement in peripheral arthritis and AU while receiving JAK1 selective treatment with upadacitinib. So far, there are very limited case reports of successful upadacitinib treatment for patients with AA, mostly in patients also suffering from atopic dermatitis. Thus, we provide evidence for the efficacy of upadacitinib in managing AU in adults, also in the context of an inflammatory arthritis such as psoriatic arthritis.

Objective. Rheumatic musculoskeletal diseases (RMDs) are the causes of frequent absence from work and loss of productivity. As (in)visible diseases, it is up to the individuals to decide if disclosing their diagnosis, with important repercussions also within the workplace. Still little is known about disease disclosure in the workplace (DD-W) in patients with RMDs. This study aimed to investigate socio-demographic, clinical, and psychological predictors of DD-W among working patients with RMDs. Methods. A cross-sectional Italian national study captured DD-W in people with RMDs. An online survey was developed using ad-hoc questions and scientific questionnaires to explore demographics and work-related, clinical, and psychological factors. Stepwise logistic regressions were run to identify significant predictors of DD-W. Results. A total of 250 working rheumatic patients completed the survey; 81.2% of the participants enacted DD-W. DD-W behaviors were predicted by perceived visibility of the RMD (p=0.008), work type (p=0.022), general DD behaviors (p

Denmark's complete reliance on groundwater for water supply presents a unique case study in management of natural resources, urban planning, and water resilience in the face of climate change. This paper examines the groundwater management strategies in Denmark in general, focusing on Denmark's four largest cities—Copenhagen, Aarhus, Odense, and Aalborg— each facing distinct challenges due to their demographic, geographical, hydrogeological, and economic characteristics. Through analysis of these cities' approaches to groundwater management, this research contributes to the global discourse on sustainable urban water supply systems. As coastal groundwater cities (CGC), these urban areas must navigate the complexities of sustaining growing populations, mitigating climate change impacts, and coastal processes while ensuring the long-term viability of their groundwater resources. Copenhagen and Aalborg, built atop semi-confined fractured and locally karstic carbonate rocks, highlights the specific challenges associated with karstic groundwater systems, while, Aarhus, and Odense built on glaciofluvial aquifers faces different issues. The different groundwater challenges in these cities underscores the importance of integrating urban development with water resource management and environmental sustainability, offering valuable insights and lessons learned for other regions facing similar challenges. This study, thus not only sheds light on Denmark's groundwater management practices, but also emphasizes the need for innovative solutions to ensure the resilience of urban water supply systems in a changing climate and increasing pressures of emerging organic contaminants and elevated concentrations of geogenic elements induced by water abstraction and fluctuating water tables. Advanced Danish monitoring and modelling tools applied to support decision-making and innovation within the water sector are continuously developed and improved to support resilient and sustainable management of the available water resources.

Cerebrovascular events (CE) are one of the most common and severe events in antiphospholipid syndrome (APS), a condition characterized by thrombosis and circulating anti-phospholipid antibodies (aPL). Seronegative APS (SN-APS) refers to a group of patients with clinical features of APS but persistently negative tests for “criteria aPL”: anti-cardiolipin antibodies (aCL) and anti-β2glycoprotein I antibodies detected by enzyme-linked immunosorbent assay (ELISA), and the lupus anticoagulant detected by clotting assays. We report a series of five cases of SN-APS in young or middle-aged patients who tested positive for “non-criteria” aPL. We retrospectively collected cases of SN-APS patients who experienced CE without an identified cause despite an extensive diagnostic work-up and tested negative for criteria aPL. All the patient sera were tested for aCL by immunostaining on thin-layer chromatography (TLC) and anti-vimentin/cardiolipin (aCL/Vim) by ELISA. We identified five cases of female patients aged 21 to 58 years, evaluated at the Rheumatology Unit and/or Stroke Unit/Emergency Department of the Sapienza University Hospital of Rome, “Policlinico Umberto I”. All patients presented a clinical history suggestive of APS. All the patients tested positive for aCL by TLC-immunostaining, and one patient was positive for aCL/Vim. In young or middle-aged patients with cryptogenic CE and a clinical history suggestive of APS, the use of new diagnostic tools for identifying aPL, if validated in future studies, could represent an important step in the prompt diagnosis of APS.

Objective. Spondyloarthritis is a family of inflammatory diseases subdivided into those affecting the spine, called axial spondyloarthritis, and those involving peripheral joints, such as psoriatic arthritis (PsA). Several studies have reported differences in clinical manifestations, outcomes, and treatment responses between male and female PsA patients. The aim of our review was to evaluate if differences may also be identified in the context of cardiovascular (CV) risk factors and diseases. Methods. Patients with PsA have a higher CV risk than the general population. The increased CV risk associated with PsA is likely caused by the complex interplay of traditional CV risk factors, chronic systemic inflammation, and side effects related to the use of certain anti-rheumatic drugs. Results. Sex differences in CV risk factors in PsA patients, according to several studies, are controversial. However, the few studies that reported sex-stratified estimates did not find differences in the risk of stroke and myocardial infarction between sexes. The same also holds true for CV mortality. These mixed results may be related to the different study designs and case definitions, as well as genetic and geographical variability across the investigated populations. Conclusions. In conclusion, our review suggests that the evaluation of sex-gender aspects of CV comorbidities in PsA should be a central step in the context of personalized medicine in order to prevent and treat properly associated comorbidities.

Objective. Ulcerative colitis and Crohn’s disease are chronic inflammatory diseases and represent the two most important types of inflammatory bowel diseases (IBD), while spondyloarthritis (SpA) comprises a heterogeneous group of systemic inflammatory chronic rheumatic diseases, including peripheral SpA and axial SpA. Joint manifestations are the most commonly observed extraintestinal manifestations, and they can precede or not the diagnosis of IBD. Notably, in women, misdiagnoses of IBD as irritable bowel syndrome and SpA as fibromyalgia are common, leading to delayed diagnoses, increased disease burden, and poorer prognoses. This narrative review emphasizes the critical role of diagnostic tools in facilitating early referrals of IBD patients with suspected SpA and vice versa to rheumatologists and gastroenterologists, respectively. Special attention is given to the multidisciplinary approach for more effective management of these conditions, particularly in female patients. Methods. In this narrative review, we critically evaluated the literature on this topic, focusing on papers written in English that address female issues in IBD and SpA. Results. IBD and SpA are chronic inflammatory disorders often occurring in the same patients. Female patients are often misdiagnosed, and this delay in diagnosis is associated with a higher disease burden and a poorer prognosis. Conclusions. A multidisciplinary approach is needed to enable early referral between gastroenterologists and rheumatologists, as this means a better prognosis for patients with a reduction in the economic and social burden associated with IBD and SpA.

Objective. The aim of the current study was to compare the clinical and treatment characteristics and dimensions of health-related quality of life between female and male patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA). Methods. The present study is cross-sectional and comprises 119 patients with axial SpA and 198 patients with PsA. Clinical data were collected by standardized and self-reported instruments. Disease activity was evaluated by the Ankylosing Spondylitis Disease Activity Score with C-reactive protein and the Disease Activity in PSoriatic Arthritis (for SpA and PsA, respectively). Health-related quality of life was assessed with the Medical Outcomes Study 36-item Short Form Survey. Patients were stratified by gender, and the socio-demographic, clinical, and quality-of-life data were compared. Results. Women with axial SpA and PsA had significantly lower education (p

Objective. To review the role of sacro-iliac magnetic resonance imaging (MRI) in the diagnosis of axial spondyloarthritis (AxSpA), with a focus on gender differences. Methods. The experience of the authors and the results of an informal literature review are reported. Results. Inflammatory changes of the sacro-iliac joint are the hallmark of AxSpA. Early, non-radiographic sacroiliitis may be diagnosed with MRI through the assessment of bone marrow edema (BMO) as well as concomitant structural damage. The MRI protocol should include three necessary sequences, i.e., fat-saturated T2-weighted sequences on two orthogonal planes, T1-weighted semi-coronal sequence, and fat-suppressed T1-weighted semi-coronal sequence. Inflammatory changes comprise required signs (BMO and/or osteitis) and additional signs, including synovitis (better defined as joint space enhancement), enthesitis, and capsulitis. Structural changes consist of erosions, sclerosis, fat metaplasia, and ankylosis. Due to mechanical axial strain, inflammatory changes in the sacro-iliac joint can be found in healthy individuals, runners, and patients with nonspecific low back pain. The prevalence of BMO is higher in women during pregnancy and postpartum, even 12 months after childbirth, but the extent and distribution of MRI findings may help in the differential diagnosis. Other challenges in the MRI diagnosis of sacroiliitis are subchondral T2 hyperintensity during developmental age, periarticular sclerosis in healthy subjects, or osteitis condensans ilii, and several pathological conditions that may mimic AxSpA, some of which are more frequently found in women. Conclusions. The described diagnostic challenges impose a multidisciplinary approach combining imaging findings with clinical and laboratory data.

Objective. The aim of the present review was to highlight gender and sex differences in spondyloarthritis (SpA) to achieve a better awareness of the unmet needs of women with SpA. Methods. A literature search of PubMed was performed, including manuscripts in English published in the last twenty years, to select and analyze articles related to SpA and sex and gender differences in epidemiology, genetics, immunology, clinical features, and response to treatment. Results. Women and men with SpA have different disease phenotypes, and this heterogeneity mirrors anatomical, physiological, and hormonal differences, as well as peculiar variability in response to treatment. These underestimated differences, which include several biological factors and intertwined social factors, contribute to diagnostic delay and increased disease burden in women with SpA. Conclusions. This review elucidates gender differences in SpA and raises awareness about the need for gender-related stratification of SpA patients with the concomitant implementation of SpA gender differences in future research and upcoming clinical trials. A deeper knowledge of SpA in women is indispensable to pave the way for real personalized medicine for SpA patients to reduce misdiagnosis and delay in intercepting the disease.

Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a recently characterized disease associated with somatic mutations in the UBA1 gene, which cause dysregulation of ubiquitin-mediated processes. This case describes a 71-year-old male patient with VEXAS syndrome who presented with refractory lung inflammation with a pattern similar to computed tomography hypersensitivity pneumonitis, a novel finding in VEXAS syndrome. The presented clinical case highlights the protean involvement of the lung in VEXAS syndrome and emphasizes the importance of considering interstitial lung disease in the differential diagnosis.

Objective. Data from trials demonstrated that abatacept (ABA) has a good safety and efficacy profile in treating rheumatoid arthritis. We have studied the retention rate of ABA in a real-life cohort of patients with rheumatoid arthritis. Methods. This is a monocentric, retrospective study including patients with rheumatoid arthritis classified by the American College of Rheumatology/European League Against Rheumatism 2010 criteria who started treatment with ABA. The Kaplan-Meier method was applied to evaluate the ABA retention rate. Results. This analysis was conducted on 161 patients [male/female 21/140, median age 65 years, interquartile range (IQR) 18.7, median disease duration 169 months, IQR 144.0]. 111 patients (68.9%) received ABA subcutaneously. ABA was associated with methotrexate in 61.9% of patients and was the first biological disease-modifying antirheumatic drug in 41%. We observed a median ABA survival of 66 months [95% confidence interval (CI) 57.3-74.7], with a retention rate of 88% at 6 months and 50.9% at 5 years. Drug survival was significantly higher in patients treated with ABA subcutaneously and in male patients (p=0.039 and p=0.018, respectively). Adjusted for main confounders, female gender was the main predictor of withdrawal (hazard ratio 5.1, 95% CI 1.2-21.3). Conclusions. Our study shows that better survival is associated with subcutaneous administration and male gender, confirming ABA effectiveness.

A 2010 survey of more than 10 000 students from 18 countries showed that Central Asia was virtually absent from their representations of the world. In order to check whether this was also the case in the representations of students from this region, this survey was replicated in Kazakhstan, while nevertheless making the assumption that a Central Asian region would be largely represented by the students. While the results confirm important aspects of the theory of social representations of space, they also provide some original insights, showing in particular the very large place given to States, and in particular the Kazakh State, in the breakdown of the World. The prominence of States in Kazakh students' representations of the World can be analysed as a sign of the appropriation of the nation-state model by Kazakh students, some thirty years after the country's independence.

In the form of an explorative empirical study, this paper deals with the reasons for the survival and demise of isolated Swiss ski lifts. For the first time, all isolated lifts documented in Switzerland have been recorded and coded according to a total of six conditions. Using a set-theoretical research method in the form of qualitative comparative analysis (QCA), the study aims to identify the necessary conditions and configurations of sufficient conditions explaining (non-)survival. It transpires that closed isolated lifts tend to be outdated and have no technical snowmaking facilities. Moreover, it has become evident that the simultaneous occurrence of the lack of lift facility replacement, lack of technical snowmaking and high ski area competition has caused the closure of most isolated lifts. Low natural snow depth and low elevation difference, conversely, have not had a measurable impact. The causes for the survival of isolated lifts, by contrast, are extremely heterogeneous.

Contents

Philosophy & Practice of Human Education (cover)

[pt] A década de 1930 foi um período de ampla circulação de teorias médico-psicológicas que tratavam sobre a constituição individual e os tipos de personalidade na imprensa brasileira. Neste artigo, analiso o papel desempenhado pelo médico e escritor João Peregrino Jr. na divulgação da teoria sobre os temperamentos, criada pelo médico Ernest Kretschmer, em revistas de variedades do Rio de Janeiro, no período de 1930 a 1941. Observo como as apropriações dessa teoria, realizadas por Peregrino Jr., foram aplicadas aos debates locais sobre dois temas interligados: a aplicação de teorias médicas na crítica literária e estudos biográficos e a relação entre medicina e literatura, temáticas que, de um ponto de vista mais amplo, se referiam à discussão sobre as relações entre ciência e arte. Sobre o primeiro tema, Peregrino Jr. defendeu que a utilização das teorias de Kretschmer tornariam os estudos mais completos e aprofundados do que aqueles embasados em outras correntes médicas e psicológicas, enquanto, sobre o segundo tema, considerou que os médicos estariam mais aptos a desenvolver este tipo de literatura de divulgação que outros escritores. Desta maneira, argumento que Peregrino Jr. operou como mediador cultural, levando um tema debatido por especialistas para um público mais amplo no Rio de Janeiro.

In this case report, a novel N-acetylgalactosaminyltransferase 3 homozygous mutation (c.782 G>A; p.R261Q) associated with hyperphosphatemic familial tumoral calcinosis/hyperostosis-hyperphosphatemia syndrome is described. The patient had elbow, pelvis, and lower limb pain and a hard mass in the hip and olecranon regions. Increased levels of inorganic phosphorus (Pi) and C-reactive protein were observed. After treating the patient with conventional drugs, we tested denosumab, which reduced but did not normalize the Pi.

Objective. The indices to measure disease activity of chronic arthritis in adulthood and childhood are different. Therefore, assessing the status of the disease in young patients with juvenile idiopathic arthritis (JIA) can be tricky, especially when the transition to adult care is ongoing. The aim of our study was to assess the level of correlation between adult and juvenile scores in the measurement of disease activity in JIA patients during transitional care. Methods. We estimated the disease activity by using the Juvenile Arthritis Disease Activity Score 71 (JADAS71), clinical JADAS, adult Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) in JIA patients in transitional care. We enrolled patients older than 16 years at the time of the first transition visit, and disease activity was assessed at baseline and 12 months. Regression analyses were carried out to estimate the level of agreement among the different indices. Results. We recruited 26 patients with JIA; 11 patients were polyarticular (42.3%) and 15 patients were oligoarticular (53.1%). The mean age at diagnosis was 7.7±3.9 years and the age at the first evaluation was 20.9±3.7 years. The correlation between JADAS71 and DAS28 was r2=0.69, r2=0.86 between JADAS71 and SDAI, and r2=0.81 between JADAS71 and CDAI. Conclusions. SDAI and JADAS71 showed the best correlation, but a few patients were not captured at the same level of disease activity. New prospective studies with a larger number of patients will be needed in this field.

The safety profile of baricitinib (BARI), a Janus kinase inhibitor broadly used for the treatment of rheumatoid arthritis (RA), includes asymptomatic laboratory abnormalities, such as an increase in creatine kinase (CK). Data from randomized controlled trials suggest that concomitant myalgia is rare in RA and does not lead to drug discontinuation. We describe the case of a 68-year-old Caucasian female with longstanding, multi-failure RA who started BARI and achieved disease remission. However, she developed a symptomatic CK increase, as well as a parallel increase in total cholesterol, low-density lipoprotein, and triglycerides. Dechallenge-rechallenge demonstrated a plausible relationship between the clinical/laboratory abnormalities and BARI. In fact, when the drug was withdrawn, CK returned to normal and myalgia disappeared, whereas symptoms returned and CK levels increased when BARI was restarted. BARI may be rarely associated with symptomatic CK elevation, and this may pose clinical challenges, particularly for patients with multi-failure RA who achieved good disease control with BARI but required drug discontinuation due to intolerance.

Objective. To report cross-sectionally serum levels of 25-hydroxyvitamin D [25(OH)D] in women living in Italy within 12 months from breast cancer (BC) diagnosis. Methods. Baseline data were obtained from 394 women diagnosed with primary BC, enrolled from 2016 to 2019 in a lifestyle trial conducted in Italy. Subjects’ characteristics were compared between two 25(OH)D concentrations (hypovitaminosis D30, and ≥35 versus

Ever since its “birth certificate” on February 25, 1545, Commedia dell’arte’s substantial resources of itineracy, improvisation, subversion, extraterritoriality, extemporaneity, laughter, and joy have unceasingly unveiled their essential mutability and ambiguity, prompting UNESCO’s depiction of commedia as an “invisible and intangible cultural asset”. The present study attempts to disclose the diasporic transgressions of Commedia dell’arte by considering four basic dimensions: the formal, the tropological, the topological, and the temporal, respectively. This approach further examines how and to what extent the diasporic transgressions of Commedia dell’arte can be elucidated by considering the afore-mentioned categories of explanation. Ultimately, the itinerant and improvisational character of Commedia dell’arte is explanatory for the mutations and developments within the four dimensions themselves.

This research examines visitor engagement with genocidal memorial museums expressed in visitor comments at the conclusion of the museum visit. We analyze the educative function of memorial museums in genocide prevention. Museums that advance a preventative function are gaining traction in the literature on transitional justice, especially that on non-punitive, restorative justice mechanisms. In this sense, we examine two museums in Guatemala and measure visitor engagement and the efficacy of never again. In Guatemala City, we examine the Casa de la Memoria, which presents the complete historical narrative of the Maya. In Baja Verapaz, we study the Rabinal Museo Comunitario de la Memoria Historica, exclusive to the historical memory of the Maya Achí and which seeks to educate about the genocide committed against them by the government between 1980 and 1984. We develop a typology of the comments we call memory-words left by visitors to each museum as recorded in their guest logs/visitor books and in other memorial spaces within each museum that allows for individual expression of the museum experience. Finally, we try to determine whether each museums’ typology of memory-words resulted in a particular message (specific to Guatemala) or a more universal message of never again that mirrors current mass atrocities world-wide, and if so, in what context.

Cover

El derelicte Deltebre I, descobert de forma casual l’any 2008 proper a la desembocadura de l’Ebre, vas ser objecte d’excavació en extensió per part del Centre d’Arqueologia Subaquàtica de Catalunya entre els anys 2009 i 2016. El fet que poc després de l’enfonsament quedés colgat pel sediment va generar que les restes quedessin protegides i en un estat excepcional de conservació. El seu estudi ha permès conèixer que es tracta d’un vaixell de transport de munició i pertrets militars que s’enfonsà l’any 1813, en el context de la Guerra del Francès, juntament amb 3 transports més. Formava part del comboi aliat que es trobava navegant de retorn a Alacant després d’una operació amfíbia fallida per assetjar la ciutat de Tarragona. El present treball és la conjunció de la recerca arqueològica juntament amb l’estudi de les nombroses fonts històriques de l’època, amb l’objectiu d’intentar dilucidar la identitat del derelicte Deltebre I.

The first description of polymyalgia rheumatica (PMR) is generally attributed to Dr. Bruce. In an 1888 article entitled Senile rheumatic gout, he described five male patients aged from 60 to 74 years whom he had visited at the Strathpeffer spa in Scotland. In 1945, Dr. Holst and Dr. Johansen reported on five female patients examined over several months at the Medical Department of Roskilde County Hospital in Denmark. These patients suffered from hip, upper arms, and neck pain associated with elevated ESR and constitutional manifestations such as low-grade fever or loss of weight. In the same year, Meulengracht, another Danish physician, reported on two patients with shoulder pain and stiffness associated with fever, weight loss, and an increased erythrocyte sedimentation rate. As in the five patients reported by Dr. Holst and Dr. Johansen, a prolonged recovery time was recorded. On reading and comparing these three accounts, we question whether it is correct to attribute the first description of PMR to Dr. Bruce and put forward shifting this accolade to the three Danish physicians.

Objective. Melorheostosis is a rare, non-hereditary, benign bone disease characterized by abnormal bone growth. Generally, melorheostosis develops during childhood or adolescence and progresses gradually over time. This disease represents a true challenge to the physician because of its variability due to location, extension of the affected bone, and involvement of associated soft tissue. Pain management, physical therapy, and surgery may be recommended, depending on the individual case. This review aims to get an overview of the latest evidence relating to epidemiology, clinical and radiographic characteristics, diagnosis, and possible therapeutic strategies for melorheostosis and describe our experience through a clinical case. Methods. We designed a comprehensive literature search on melorheostosis in MEDLINE (via Pubmed) up to April 2023 and reviewed reports published in international journals. Results. The purpose is to highlight the importance of a multidisciplinary approach in the management of a rare disease such as melorheostosis. We discuss the role of different physicians, including genetists, rheumatologists, physiatrists, physical therapists, and orthopedic surgeons, in providing accurate diagnoses and effective treatments. We conducted a comprehensive review of the literature on the treatment of melorheostosis to support these findings. In addition, the article presents a case study of a patient suffering from melorheostosis, focusing on difficulties in reaching a correct diagnosis and attempts towards conservative and surgical interventions. The patient underwent hip arthroplasty, and the final result was an improvement in function and a reduction in pain. Conclusions. Managing melorheostosis can be challenging, and there is no standardized treatment for this condition at the moment.

Spontaneous subcapsular and perirenal hemorrhage, known as Wunderlich syndrome (WS), is a rare clinical manifestation of polyarteritis nodosa (PAN). We report a case of a 48-year-old male with a history of recurrent episodes of leg muscle tenderness and dysesthesia, bilateral flank pain, painful nodular skin lesions in the lower limbs, weight loss, and difficult-to-control arterial hypertension. The abdominopelvic computed tomography angiography showed a large left perirenal hematoma, leading to the patient’s admission to the intensive care unit. After the exclusion of infectious or neoplastic foci, the patient was diagnosed with PAN and started intravenous methylprednisolone pulses with a good response. Since WS is a rare initial clinical manifestation of PAN, an early diagnosis and aggressive treatment will significantly improve clinical outcomes.

Objective. To compare etanercept and adalimumab biosimilars (SB4 and ABP501) and respective bioriginators in terms of safety and efficacy in a real-life contest. Methods. We consequently enrolled patients affected by rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, treated with SB4, and ABP501, or with corresponding originators, belonging to the main biological prescribing centers in the Lazio region (Italy), from 2017 to 2020. Data were collected at recruitment and after 4, 8, 12, and 24 months of therapy. Results. The multicenter cohort was composed by 455 patients treated with biosimilars [SB4/ABP501 276/179; female/male 307/146; biologic disease-modifying anti-rheumatic drug (b-DMARD) naïve 56%, median age/ interquartile range 55/46-65 years] and 436 treated with originators (etanercept/adalimumab 186/259, female/ male 279/157, b-DMARD naïve 67,2%, median age/interquartile range 53/43-62 years). No differences were found about safety, but the biosimilar group presented more discontinuations due to inefficacy (p

Lumbar pain is a very common symptom that derives from benign musculoskeletal conditions, rheumatic inflammatory diseases, neoplasms, and referred and/or nociplastic pain. A 70-year-old man with psoriatic arthritis presented with early-onset lumbosacral pain without evident red flags. Symptomatic treatment was unhelpful. Radiographic imaging showed subtle signs of a disease that could easily be missed. Magnetic resonance imaging revealed a massive prostatic malignancy with bone (sacral and iliopubic) metastasis. Awareness must be given not to disregard every lumbar pain as part of the preexisting rheumatic inflammatory disease (spondyloarthropathy in this case) or a common muscle/ligament/articular disarrangement. Persistence of pain, albeit not inflam-matory nor sharp in nature, despite adequate treatment might be just as important as an acute red flag and requires proper follow-up.

The present paper is part of a series of publications related to the research carried out in the last decade in the early Roman contexts from Capidava (Constanța County), as well. The subject of the article is a batch of 17 fragmentary ceramic vessels, belonging to the terra sigillata category. Of these, the first 16 items (Cat. nos. 1-16) are fragments of imported vessels produced in the famous ceramic production centre of La Graufesenque, in South Gaul. The last vessel, Cat. no. 17, is of local production, from the category called Pontic sigillata decorated by the barbotine technique. The entire batch of ceramic material was discovered during the archaeological excavation carried out at the Late Roman headquarters building (principia), during which the foundations of this building were also excavated. Beneath these foundations were discovered the ruins of an early Roman habitation level represented by military barracks-type buildings, a stone-paved street, a well, a rubbish pit and a waste drain that led to that pit. The material presented by us comes from this earliest context, respectively from all the urban planning elements listed above, especially from the waste drain and the rubbish pit. The dating of the material is early, namely the Flavian era until the end of Trajan’s reign. From this point of view, the ceramic material presented here completes the picture provided by other categories of material previously published from the same archaeological context.