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Coatomer subunit α (COPA) syndrome is a mendelian autosomal dominant immune dysregulation disease characterized by early onset lung disease in the form of diffuse alveolar hemorrhaging or interstitial lung disease, frequently associated with arthritis, glomerulonephritis, and high titer autoantibodies usually mimicking other autoimmune diseases. While immunosuppressive medication has been effective in controlling arthritis, data on long-term lung disease control remains scarce, which poses a real challenge as the progression of lung disease is the main cause of poor life expectancy in COPA patients. Nevertheless, JAK inhibitor therapy seems to be the most promising therapeutic choice now. [ABSTRACT FROM AUTHOR]

Overlap syndrome of systemic sclerosis and idiopathic inflammatory myopathies is an increasingly frequent entity, but the association with immune-mediated necrotizing myositis has rarely been described. While myositis or myopathy may be features of scleroderma, it is imperative to correctly diagnose an overlap syndrome of these two, since it can be considered a different entity with specific management and a worse prognosis. Anti-signal recognition particle (anti-SRP) antibodies target the striated muscle fiber and inhibit myoblast regeneration, resulting in myofiber atrophy and necrosis. Anti-SRP antibodies are specific in immune-mediated necrotizing myopathy characterized by myonecrosis and minimal inflammatory reaction, with proximal muscle weakness and typical extra-muscular manifestation. There are controversial data on the association of cardiac manifestations and the presence of these antibodies, and recent studies cannot prove a significant correlation between the two. Myocarditis is a complication with an unpredictable, potentially severe outcome from heart failure and dilated cardiomyopathy to fatality. It can be difficult to diagnose, and a myocardial biopsy can be problematic in daily practice; thus, most practitioners rely on cardiac magnetic resonance with suggestive images for the correct diagnosis. This paper seeks to address the challenges associated with the diagnosis and treatment of collagen diseases by evaluating the role of anti-SRP antibodies in the pathogenesis of cardiac involvement. [ABSTRACT FROM AUTHOR]

(1) Background: Melanoma is one of the most aggressive types of neoplasia, and the management of this pathology requires a correct staging, as well as a personalized modern oncological treatment. The main objective of the study is to determine the variability of the lymphatic drainage for patients with melanomas located on the trunk and, secondarily, to determine the features of individuals who underwent sentinel lymph node biopsy (SLNB) depending on the exact location on the trunk. (2) Methods: This retrospective, observational, single-center study included 62 cases of trunk melanoma operated between July 2019 and March 2023, in which SLNB was performed and a total of 84 lymph nodes were excised. (3) Results: Patients had a median age of 54.5 (33–78) years, with 58.1% being male; the melanomas had a median Breslow index of 2.3 (0.5–12.5) mm. Approximately 64.3% of the cohort had melanoma on the upper part of the trunk (54 cases) and 35.7% had it on the lower part (30 cases). The type of anesthesia chosen was general anesthesia in 53 cases and spinal anesthesia in 9 cases (85.5% vs. 14.5%, p < 0.001). The number of sentinel lymph nodes excised was 54 for melanomas located on the upper part of the trunk (8 cervical and 46 axillary) and 30 sentinel lymph nodes for melanomas of the lower part of the trunk (16 at the axillary level and 14 at the inguinal level). Out of the 54 LNs identified in patients with melanoma on the upper part of the trunk, 13 were positive, with a total of 12 positive lymph nodes (LNs) from the axillar basin, and only one from the cervical region. Additionally, the incidence of patients with a minimum of two identified sentinel lymph nodes was 32.2%, with a total of seven having LN involvement in two basins, and only one of these cases showed positivity for malignancy. (4) Conclusions: SLNBs were more frequent in the axillary region overall, and had more positive SLNs. Moreover, melanoma on the upper part of the trunk had a higher rate of positive SLNs compared to the lower part. Tumors located on the lower part of the truck had more positive SLNs in the axillary region than in the inguinal one. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis is a heterogeneous chronic autoimmune disorder characterized principally by skin lesions, arthritis, dactylitis and enthesitis. The exact etiology of the disease is yet to be discovered, with genetic predisposition alongside environmental factors being a well-known theory. In recent years, new discoveries have emphasized the role of gut microbiome in perpetuating inflammation in spondylarthritis. The exact mechanism through which dysbiosis underlies the pathophysiology of psoriatic arthritis is not defined. One of the current areas of focus in rheumatic research with new studies emerging annually is the link between microbiome and psoriatic arthritis. In this review, we synthesized the recent knowledge on intestinal microbiome and psoriatic arthritis. We screened two databases for articles, PubMed and Medline, using the following keywords: "microbiome", "microbiota" and "psoriatic arthritis". We described the current expertise on diversity and composition of gut microbiome in psoriatic arthritis, comparing the results with other inflammatory diseases. In the future, preventing the dysbiosis process that leads to the development of psoriatic arthritis could open the door to new therapeutic modalities. Moreover, fecal microbiota transplantation and probiotics' benefits in modulating the gut microbiome are being intensively researched at the moment. [ABSTRACT FROM AUTHOR]

Background: Melanoma is a malignant tumor that determines approximately 80% of deaths as skin cancer-related. The sentinel lymph node (SLN) represents the first filter of tumor cells toward systemic dissemination. The primary objective was to outline the surgical specifics of the sentinel lymph node biopsy (SLNB) technique, correlate the location of the lymph node with the radiotracer load, and identify the characteristics of older patients. Methods: In this prospective study, 122 cases of malignant melanoma needing SLNB technique were included, between June 2019 and November 2022, resulting in 162 lymph nodes removed. Results: Patients' mean age was 54.3 ± 14.4 years old, the prevalence of 70 years and older being 20.5%. The rate of positive SLN was 24.6%, with a single drainage in 68.9% of cases. The frequency of seroma was 14.8%, while reintervention 1.6%. The inguinal nodes had the highest preoperative radiotracer load (p = 0.015). Patients 70 years old or older had significantly more advanced-stage melanoma (68.0% vs. 45.4%, p = 0.044, OR = 2.56) and a higher rate of positive SLN (40.0% vs. 20.6%, p = 0.045,OR = 2.57). Melanoma of the head and neck was more common among older individuals (32.0% vs. 9.3%, p = 0.007,OR = 4.60). Conclusions: The SLNB has a low rate of surgical complications and the positivity of SLN is not related to radiotracer load. Elderly patients are at risk for head and neck melanoma, have more advanced stages, a higher SLN positivity, and a greater rate of surgical complications. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

Gout is a chronic metabolic disease, characterized by joint inflammation caused by monosodium urate monohydrate crystals. The main objective of this study was to identify the prevalence of gout in a rheumatology department in Romania and secondary to describe the characteristics of patients diagnosed with this condition, with emphasis on the comorbidities. This is a longitudinal, retrospective study on 280 patients from the Department of Internal Medicine and Rheumatology, Dr I Cantacuzino Hospital, from January 2017 to May 2019, diagnosed with chronic or acute gout. The prevalence of gout in our hospital in 2 years period was 0.97%. Gouty attack was diagnosed in 38.2% of cases, while 61.8% were evaluated for chronic gout. Male frequency was 69.6%, alcohol consummation was observed in more than half of the cohort (53.2%) and 72.1% were retired persons. The most frequent comorbidity was hypertension (HBP) (82.1%) followed by dyslipidemia (65.3%), atherosclerotic disease(ATS) (55.0%) and chronic kidney disease (53.9%). There was a significant association between HBP, ATS and dyslipidemia with chronic gout (p=0.038, p=0.022 and p=0.009, respectively). The rate of gouty attack significantly increased with the serum level of uric acid (p<0.001). The therapeutic approach complies with international recommendations. [ABSTRACT FROM AUTHOR]

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by clinical manifestations caused by arterial or venous thrombosis and pregnancy conditions such as recurrent miscarriage, fetal death, or premature birth in the presence of antiphospholipid antibodies. The obstetrical manifestations are strongly related to the placental alterations. The aim of this review is to summarize the latest data on pathophysiology of obstetrical APS, emphasizing the disturbance of the placentation process. Due to a lack of extravillous trophoblasts to properly reconstruct the spiral arteries, APS causes hypoxic or ischemic injury or high-speed blood flow that damages the placenta. This results in decreased or interrupted maternal blood flow to the placenta and a lack of nutrients for the fetus. Antiphospholipid antibodies can lower the proliferation and infiltration of the extravillous trophoblasts. The placental mal-perfusion causes the release of antiangiogenic substances such as soluble fms-like tyrosine kinase-1 and soluble endoglin. Placental growth factor and vascular endothelial growth factor (VEGF) may be sequestered by sFlt1 and blocked from binding to trophoblast and endothelial cell VEGF receptors, inhibiting their proangiogenic effects. Preeclampsia is the clinical result from a lack of angiogenic factors needed for endothelial vascular homeostasis due to an excess of sFlt1 in the maternal circulation. [ABSTRACT FROM AUTHOR]

Clinically amyopathic Dermatomyositis (CADM) is a rare subtype of idiopathic inflammatory myositis, associated with no muscular manifestations, which is more frequent in Asian women. Anti-melanoma differentiation-associated gene 5 (MDA5) antibodies are a recently discovered type of specific autoantibodies associated with myositis. The anti-MDA5 DM was initially described in Japan and later it was discovered that the target antigen was a protein implicated in the innate immune response against viruses, that is encoded by the melanoma differentiation-associated gene 5. Anti-MDA5 DM is characteristically associated with distinguished mucocutaneus and systemic manifestations, including skin ulcerations, palmar papules, arthritis, and interstitial-lung disease. Patients with anti-MDA5 positivity have a high risk of developing rapid progressive interstitial-lung disease (RP-ILD), with a poor outcome. As a result, despite high mortality, diagnosis is often delayed, necessitating increased awareness of this possible condition. Despite a severe course of lung disease and an increased mortality rate, there is currently no standard treatment. Recent insights based on observational studies and case reports support combined therapy with immunosuppressive drugs and corticotherapy, as soon as the symptoms appear. The aim of this paper is to describe anti-MDA5 DM, focusing on the recent literature about the unique clinical manifestations and therapeutic options, starting from a severe clinical case diagnosed in our Rheumatology Department. [ABSTRACT FROM AUTHOR]

The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important "epidemics" of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary goal was to find the risk factors associated with minor/major amputation and good or adverse surgical outcomes. This is an observational, retrospective study conducted between 1 January 2018 and 31 December 2019, which included 251 patients from the General Surgery Department at the Dr I. Cantacuzino Clinical Hospital in Bucharest with type II diabetes mellitus and neuropathic diabetic foot complications. The surgical conditions identified at admission were the following: osteitis (38.6%), infected foot ulcer (27.5%), gangrene (20.7%), infected Charcot foot (3.6%), non-healing wound (3.6%), necrosis (3.2%), and granulated wound (2.8%). We found that a minor surgical procedure (transmetatarsal amputation of the toe and debridement) was performed in 85.8% of cases, and only 14.2% needed major amputations. Osteitis was mainly associated with minor surgery (p = 0.001), while the gangrene and the infected Charcot foot were predictable for major amputation, with OR = 2.230, 95% CI (1.024–4.857) and OR = 5.316, 95% CI (1.354–20.877), respectively. Admission anemia and diabetic nephropathy were predictive of a major therapeutical approach, with p = 0.011, OR = 2.975, 95% CI (1.244–8.116) and p = 0.001, OR = 3.565, 95% CI (1.623–7.832), respectively. All the major amputations had a good outcome, while only several minor surgeries were interpreted as the adverse outcome (n = 24). Osteitis (45.8%) and admission anemia (79.2%) were more frequently associated with adverse outcomes, with p = 0.447 and p = 0.054, respectively. The complicated neuropathic diabetic foot requires a surgical procedure mainly associated with a good outcome. [ABSTRACT FROM AUTHOR]

Copyright of Medic.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medic.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Systemic sclerosis is a connective tissue disorder with complex etiology and pathogenesis. Interstitial pulmonary fibrosis is the most frequent cause of mortality in people with systemic sclerosis, hence tremendous efforts are being made to identify novel treatments that will decrease the disease’s progression. Treatment has evolved from conventional synthetical drugs to biologic therapies and even autologous stem cell transplantation. With so many alternatives, it may seem challenging to select the appropriate therapy for the patient, but a thorough study of each therapy’s indications as well as the unique aspects of each case should assist us in making the best therapeutic decision. [ABSTRACT FROM AUTHOR]

The paper presents the special follow-up (category of importance of the dam: B) of the time behaviour of the Cinciș dam by evaluating (through direct observations and measurements), some parameters that define the state and evolution of the safety of the dam, in relation to actions to which he is subjected. Thus, it was verified if the variables that identify the behaviour of the structure as well as those related to the environmental and operational conditions are in the range of values obtained previously and if they are consistent. [ABSTRACT FROM AUTHOR]

This paper investigates the development of a passive elliptical planar coil for extending the horizontal transmission distance in an inductive transmitter‐receiver wireless‐power transfer system (WPT). The passive base coil partially overlaps the transmitter coil and extends the horizontal wireless link between the transmitter and receiver. The base coil models investigated are divided into three categories based on their length. Moreover, for each length category, the optimum number of turns is determined. All proposed models are analysed through the electromagnetic simulation (EMF) software Ansys–Maxwell and Simplorer as well as validated experimentally. For the entire analysis, the maximum efficiency principle is followed in this system. Therefore, impedance matching networks are used across all three terminals in order to tune the system to the operating frequency of 200 kHz to achieve maximum efficiency. The maximum achievable efficiency is determined for each coil prototype (in both simulation and experiment) and the results are compared. The extent to which the EMF software is a valuable tool in developing a planar passive base for an inductive WPT system is discussed. Overall, the proposed concept behind the passive base coil is proved to be successful in extending the horizontal distance between the transmitter and receiver. [ABSTRACT FROM AUTHOR]

John Rawls focuses in his writings on one of the most important concepts of political thinking, more specifically on the concept of justice. He tries to conceive a new kind of theory, an ideal one, and to do that he uses two important concepts: The Original Position and the Veil of Ignorance. In this paper we will try to find out to what extent the society proposed by Rawls is moving towards an utopian one. What are the utopic elements of his theory and what can be applied in a society that is already created? How can people put themselves in the Original Position, or under the Veil of Ignorance if they are already part of this society. These are only some questions of which this paper is trying to answer. [ABSTRACT FROM AUTHOR]

Chemo‐induced thrombocytopenia is a limiting toxicity among patients receiving temozolomide (TMZ) as first‐line treatment for glioblastoma. We aimed to compare early platelet concentration kinetics, hematological safety profile, and impact on survival following the initiation of either the brand‐name or a generic TMZ formulation. A retrospective trial was conducted in patients suffering from newly diagnosed glioblastoma. Patients were treated with TMZ at 75 mg/m2 per day during six weeks, concomitantly with radiotherapy. Platelet concentration was collected each week. Primary endpoint was to perform a linear mixed‐effect model of platelet concentration kinetic over weeks. A total of 147 patients were included as follows: 96 received the brand‐name TMZ, and 51 received a generic TMZ formulation. Exposition to the generic was a significant variable that negatively influenced the platelet kinetics in the radiotherapy and concomitant TMZ phase, P = 0.02. Grade ≥3 chemo‐induced thrombocytopenia was more frequent in the generic group: 19.6% [95% CI 8.7‐30.5%] vs 3.1% [0‐6.6%], P = 0.001. Exposition to the generic formulation of TMZ led to increase early treatment discontinuation due to TMZ‐induced thrombocytopenia and was a worsening independent prognostic factor on overall survival: adjusted HR 1.83 [1.21‐2.8], P = 0.031. These data suggest that exposition to a generic formulation of TMZ vs the brand‐name product is associated with higher early platelet decrease leading to clinically relevant impacts on treatment schedule in glioblastoma. Further prospective trials are needed to confirm these results. [ABSTRACT FROM AUTHOR]

This study investigates the exploitation of MOSFET-based AC switches in capacitive impedance matching networks (IMNs) for inductive wireless power transfer (WPT). The IMN optimum capacitance has been chosen for a 200 kHz resonant frequency. The activation of the tuning capacitor on the tuning branch is achieved with the use of MOSFET AC switches in order for the WPT system to achieve maximum power transfer efficiency. The MOSFET AC switch is modelled as an internal parasitic resistor and capacitor connected in parallel. A WPT analytical model is developed to study the effects of the MOSFET's parasitic elements on the WPT system's efficiency and is verified experimentally. Various MOSFET switches and relays have been implemented as the IMN switching elements and compared when tested under the same conditions. It is concluded that MOSFET AC switches which have low on-resistances and small parasitic capacitances are desirable as they have a smaller impact on efficiency. Additionally, parasitic capacitances of MOSFET AC switches need careful consideration for different resonant frequencies as they can affect the overall IMN tuning capacitance especially when they are turned off. Comparing to commonly used relay switches, MOSFET-based AC switches have similar switching performance but are significantly smaller in size. [ABSTRACT FROM AUTHOR]

Purpose: Temozolomide (TMZ) is known to induce thrombocytopenia but no early predictive test has yet been clearly established. The aim of the study was to retrospectively identify and validate a threshold of early platelet variation predicting TMZ-induced thrombocytopenia during the TMZ phase in patients treated according to the Stupp protocol for glioblastoma.Methods: A training set was used to analyze variations in platelet count occurring from the first week (W1) to week 6 (W6) during radiotherapy. Our aim was to identify the most relevant platelet decrease associated with TMZ-induced thrombocytopenia ≤ 100 G/L at day 28 during the TMZ phase. The performance of the threshold was confirmed in an independent validation set.Results: Overall, 147 patients were included, 85 and 62 in the training and validation sets, respectively. Twenty-seven patients (18%) experienced at least one TMZ-induced thrombocytopenia in the TMZ phase. A platelet decrease at W6 ≥ 35% (∆W6 ≥ 35%) was identified as the best predictive variation with an AUC of 0.83, a sensitivity of 65%, and a specificity of 96%. In the validation set, ∆W6 ≥ 35% platelet variation was identified as an independent marker of TMZ-induced thrombocytopenia during the TMZ phase (OR 15.23 (95% CI 3.5-107.5)) corresponding to sensitivity of 77% (66-87%), specificity of 73% (62-84%), a positive predictive value of 42% (29-54%), and a negative predictive value of 92% (86-99%).Conclusion: Platelet decrease at W6 ≥ 35% during the RT-TMZ phase is an early and simple predictive marker of clinically relevant TMZ-induced thrombocytopenia during TMZ maintenance. [ABSTRACT FROM AUTHOR]

This paper presents an advanced design configuration of a wireless power transfer system using overlapping relay coil techniques for free loading position. The work undertaken investigates the tuning position of prototype relay coils in a horizontal configuration in order to evaluate power transfer efficiency versus increasing operating distance between the transmitter and receiver coils. A prototype relay coil system was evaluated to determine the optimum distance between the transmitter and receiver. Finite element magnetic simulation was used to appraise the magnetic field distribution and power transfer efficiency with respect to a strongly coupled magnetic resonance condition. Experimental and simulation results analysis suggest that the proposed design could achieve 85%–90% efficiency within a 4 cm operational distance. Finally, the experimental results were analyzed and compared with the simulation results. [ABSTRACT FROM AUTHOR]

Vocabulary acquisition is considered one of the most important aspects of a language because it defines and constraints communication. In order to overcome this, students and teachers use various techniques meant to improve the learning process and facilitate word acquisition. Using conceptual networks that establish links to prior knowledge is an approach with proven good results. The game presented in this paper, Semantic Taboo, is a serious game that helps users enlarge their conceptual network. The game has two modes, one for teachers and one for students. In the teacher module, users have the option of adding playing cards. The theme of the card (the seed) is taken as input, while the list of taboo words is selected from the list of semantically related words provided by the ReaderBench framework. The student model has the same game principle as the traditional game, but the list of taboo words and the description of the seed help the learner acquire new words. The preliminary validation consisted of 15 users who were impressed by the game concept and its educational value. [ABSTRACT FROM AUTHOR]

Acquired estrogen receptor gene ( ESR1) mutations have been recently reported as a marker of resistance to aromatase inhibitors in hormone receptor positive metastatic breast cancer. We retrospectively considered seven patients treated for metastatic breast cancer with available samples from the primary tumor before any treatment, cryopreserved metastasis removed during progression and concomitant plasmas. All these seven patients were in disease progression after previous exposure to aromatase inhibitors for at least 6 months, and were assessed for ESR1 mutations detection in tumor and circulating DNA. For these patients, Sanger sequencing identified four metastases with clear ESR1 mutation and one possible, whereas digital PCR identified six mutated metastases. Then, under blind conditions and using digital PCR, corresponding circulating ESR1 mutations were successfully detected in four of these six metastatic breast cancer patients. Moreover, in two patients with serial blood samples following treatments exposure, the monitoring of circulating ESR1 mutations clearly predicted disease evolution. In the context of high interest for ESR1 mutations, our results highlight that these acquired recurrent mutations may be tracked in circulating tumor DNA and may be of clinical relevance for metastatic breast cancer patient monitoring. [ABSTRACT FROM AUTHOR]

This paper discusses the problem of multidimensional databases, with the purpose of demonstrating the efficient support offered by them for the management of OLAP processing and motivation of decisions, especially the ones related to environmental risks. The OLAP (On-Line Analytical Processing) systems that implement or use multidimensional databases are oriented towards decision makers and allow them to an easily process, sectioning and grouping of data, as well as the visualization of data from different perspectives, for the discovery of the factors that would influence a certain behavior. OLAP systems offer advanced statistical analysis facilities, such as the one based on time series or forecasts, which are based on predefined models. The calculation of the environmental risk offers an image of the degree of air pollution due to specific polluting factors, obtained especially as result of the industrial processes that have taken place in the Targoviste, in Dambovita area. An OLAP system, consisting of decision support components, was implemented as part of the PN2 three years research project: "Sustainable Management System of Resources Used for Monitoring and Evaluating the Environmental Risks in Order to Prevent the Negative Effects and to Manage Crises Situations - MEMDUR", code D11-037/18.09.2007. [ABSTRACT FROM AUTHOR]

Background: Knowledge transfer has been well recognised as an effective enabler to access existing evidence and learning on integrated care. It requires dedicated support to ensure that the flow of appropriate information and knowledge between adopting and transferring entities is tailored appropriately to the context and maturity of the adopting system. SCIROCCO is an online participatory tool that helps stakeholders to understand: 1) The context requirements of a particular good practice that is considered for adoption; 2) The level of maturity required for a health and social care system to adopt and scale up integrated care; 3) The actions that more progressive regions have taken to be successful and enable information sharing, twinning and coaching to overcome barriers and accelerate results in integrated care. The functionality of the tool for twinning and coaching was designed following the initial testing of the knowledge transfer activities in three regions. The design followed an iterative process involving the active participation of the SCIROCCO partners. Aims and Objectives: The objective of this workshop is to present the SCIROCCO tool and lessons learned from its application as a tool to facilitate the knowledge transfer in integrated care. We aim to present the functionalities of the tool in the context of twinning and coaching; the transferability of a good practice and/or improvement of particular dimension of integrated care. It will be an opportunity to learn about the experience of SCIROCCO regions in using SCIROCCO tool to facilitate the twinning and coaching activities. This experience was captured using focus group. We also aim to gather feedback from the workshop participants on the SCIROCCO tool and its potential impact and added value in their own regions in terms of knowledge transfer. Format: To meet these objectives, a workshop will be organised as follows: Introduction (10 min): presentation of the objectives and content by Diane Whitehouse (EHTEL). SCIROCCO tool (15 min): presentation on the tool and its development process, with a focus on the twinning and coaching activities, by Cristina Alexandru (University of Edinburgh). Analysis of users' experiences from focus groups (15 min): presentation on the users' experiences with the twinning and coaching process and perspectives on the use of the SCIROCCO tool for knowledge transfer collected though focus group, by Tamara Alhambra-Borrás (University of Valencia). Discussion and dialogue (15 min): opportunity to ask questions and discuss emerging issues with the presenters and stakeholders in the room, moderated by Diane Whitehouse. Wrap up (5 min): The main outcomes and next steps will be summarised by Diane Whitehouse. Target audience: People interested in scaling-up integrated care, self-assessment of integrated care, new tools and knowledge transfer. Learnings: Workshop participants will learn about: Development of the twinning and coaching functionality. The experience of using the SCIROCCO tool to facilitate knowledge transfer. How twinning, coaching, and the use of the tool can help with the scaling-up of Integrated Care. Ways in which the tool has been used and can be used in the future. [ABSTRACT FROM AUTHOR]

Background: The SCIROCCO tool, developed as part of the SCIROCCO project, incorporates the Maturity Model for the adoption of Integrated Care developed by the European Innovation Partnership on Active and Healthy Ageing (B3 Action Group on Integrated Care). The online self-assessment tool can be used to facilitate scaling-up of integrated care across different health and care sectors, at different levels in health or care systems, and in a range of communities. Currently, more than 30 European regions are involved in testing the SCIROCCO tool. Since the project launch in April 2016, the tool underwent two iterations. Each of the iterations of the tool was followed by a round of refinement to inform its subsequent development so that the tool increases its usability and usefulness. Moreover, several focus group sessions were conducted to gather end-users' experiences and perspectives on the tool. Aims and Objectives: The three-fold objective of this workshop is to present the SCIROCCO tool and the learnings that have taken place around it: Use of the tool to facilitate knowledge transfer and scaling-up of integrated care. Quantitative and qualitative evaluation methodologies used for the SCIROCCO tool construction, refinement, and improvement. Future directions for the use of the tool. The workshop is also intended to gather feedback from the workshop participants on their opinions and perspectives about the SCIROCCO tool and its potential (policy) impact. Format (timing, speakers, discussion, group work, etc.): A workshop session of 90 minutes in length will be conducted. Four individual members of the SCIROCCO project will be responsible for conducting the workshop (the chair, and three people making two presentations). The session will be chaired by a SCIROCCO project leader, who will introduce the workshop. A set of presentations will follow, covering the different session objectives. First, a presentation on the tool construction and use will be given. This will be followed by a second presentation on the users' experiences and perspectives on the SCIROCCO tool collected through focus group sessions in four European regions. This second presentation will include the learnings about the future directions of the SCIROCCO tool and its policy implications. Participants will be asked to actively join in the discussion on the further enhancement of SCIROCCO tool. Target audience: This workshop targets all stakeholders interested in the scaling-up of integrated care and the development of new tools that help to understand this complex process. Learnings/Take aways: Workshop participants will learn about: The development of the SCIROCCO online self-assessment tool. The experiences in using the SCIROCCO tool to facilitate the learning and scaling-up of integrated care in more than 30 European regions. Policy impact of the SCIROCCO tool. The project itself will benefit from this workshop by: Promoting the SCIROCCO tool and sharing the insights of users of the SCIROCCO tool. Collecting feedback on the SCIROCCO tool's usability and potential policy implications. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is an inflammatory, chronic and systemic disease that primarily affects the synovial joints. Anemia is a common extra-articular manifestation in the absence of an effective treatment. The main mechanisms involved include shortening the lifespan of erythrocytes, inadequate bone marrow and abnormalities in iron metabolism. Eighty-eight patients over 18 years with definite diagnosis of rheumatoid were included in this study. The prevalence, respectively the characteristics of anemia were analyzed, together with demographic data, the type of symptoms, the type of comorbidities, the hematological indices and treatments. The mean age of the study population was 65.31 ± 12.57 years. Treat to target was achieved in one third of the patients (36.4%). The prevalence of anemia was 55% with higher prevalence in males (57%) than females (50%). Anemia was associated with higher disease activity (p=0.036). Out of the anemic patients, 7.14% had megaloblastic anemia, 40.48% had anemia of chronic disease and 21.43% suffered from iron deficiency anemia. Microcytic normochromic and normocytic hypochromic patterns can have mixed causes, belonging to both iron-pathophysiological processes and chronic inflammation. The prevalence of anemia at the 1-year check-up was 29.44% and the percentage of patients who achieved treat-to-target goals increased from 36.40% to 40.90%. The majority (48.80%) did not prove to have anemia neither at admission nor at follow-up. The results of the study suggest that anemic patients tend to have a higher level of RA activity, therefore screening for anemic syndrome should be part of the management of these patients, in an effort to establish the best therapeutic conduct. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic inflammatory disease that predominantly affects middle-aged adults in the third to fifth decades of life, but can also occur at any age. Significant differences were observed between patients with the diagnose of the disease under the age of 65 years – young- onset of RA (YORA) and those with the onset over the age of 65 years -elderly-onset of RA (EORA). The literature has shown that patients in the EORA group, in comparison to the young, have more severe onset, shorter duration of morning stiffness, lower frequency of seropositivity and a more important biological inflammatory syndrome. Objective: Describe and compare the clinical characteristics, laboratory features, functional status, therapeutic approach and disease progression in elderly-onset and young-onset rheumatoid arthritis (RA) patients. Materials and methods: This retrospective, transversal study included 102 patients diagnosed with rheumatoid arthritis according to the ACR / EULAR criteria and who had at least 3 visits to our clinic, the last one during 2019- 2020. Depending on the age at disease onset, we divided them into 2 groups- EORA and YORA and analyzed them comparing the clinical, laboratory and treatment data obtained at diagnosis. Subsequently we studied the evolution of the disease activity and the therapy efficiency at 6 months of follow-up and at the last hospitalization for each group. Results: The percentage of women is similar and predominant in both groups, YORA and EORA (68.3% and 71.8%). YORA was associated with a longer disease length and a prolonged symptom duration prior to the diagnosis in comparison to EORA (p<0.001 and P=0.002). Extra-articular manifestations were more frequent in elderly-onset RA patients at diagnosis, especially the presence of rheumatoid nodules (46.2% vs 22.2%. p=0.011) and weight loss (82.1% vs 34.9%, p<0.001). Anemia was statistically associated with the EORA group (p=0.037). Analyzing the radiological findings, there was a greater number of patients who showed erosions (48.7%) and geodes (28.2%) in EORA, than in YORA group (33.3% and 19.0%). The prevalence of specific auto-antibodies positivity as antiCCP was higher in YORA (76.2% vs 53.8%, p=0.019), as well as the positivity of Rheumatoid factor (RF) (84.1% vs 61.5%, p=0.010). The majority of patients began treatment with synthetic DMARD monotherapy, 54.0% of YORA and 64.1% of EORA. Methotrexate was the main drug administrated in both groups (61.5% in EORA and 54.0% in YORA, p-value= 0.602). Other medications, such as Sulfasalazine and Leflunomide, were less preferred in the two groups. Biologic therapy was preferred in younger patients than in those with RA at 65 years of age or over (69.8% vs 35.9%, p=0.001). Disease activity measured with DAS28(CRP) score was similar between the two groups at baseline, but significantly lower for YORA patients measured at the last hospitalization (p=0.020), treat to target (low disease activity and remission) being achieved in 53% of cases in the YORA group versus 23% of EORA patients (p=0.002). Conclusions: The definite diagnosis of RA was delayed in YORA patients in comparison to EORA patients and the extra-articular manifestations of the disease were more frequently found in the EORA group. Seropositivity was statistically significantly associated with the YORA group. Anemia was predominant in patients with disease onset over 65 years old. Both groups underwent DMARDs therapy in the early stages of the disease, but biologic therapy was more often administered in younger patients. Disease activity at diagnosis was similar in both groups, but in dynamic, the treat to target endpoint was achieved more frequent in YORA population. [ABSTRACT FROM AUTHOR]

Copyright of Veterinary Drug / Medicamentul Veterinar is the property of Romanian National Association of the Veterinary Products Manufacturers and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Veterinary Drug / Medicamentul Veterinar is the property of Romanian National Association of the Veterinary Products Manufacturers and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetes mellitus brings together several syndromes, all burdened by a high complexity and with the potential to generate vital impairment. The large number of complications result from the association of high blood glucose level with vascular damage, neuropathy, poor healing and overall increased atherosclerosis process. The clinical manifestation of these complications involves a wide range of manifestations from simple lesions to complex pathology, many of them requiring surgical treatment. Surgical implications of diabetes mellitus include diabetic foot syndrome, soft tissue infections, renal impairment and abdominal pathology. [ABSTRACT FROM AUTHOR]

Biological therapy is used in a wide range of medical settings. Adverse reactions to biological therapy can limit their widespread use, so early detection and treatment can adjust attempts to stop these molecules. TNF Alpha blockers may cause the following skin reactions in alpha patients: injection site reactions, infections, immune-mediated reactions (psoriasis, psoriasis, drug-induced lupus, vasculitis, hidradenitis, alopecia), allergic or neoplastic reactions. We present the case of a patient with RA who developed skin lesions during biological therapy and was diagnosed with drug-induced lupus based on clinical elements, associated autoimmunity, and dermatological evaluation. The skin lesions were attributed to the interaction of three medications (biosimilar Etanercept, Leflunomide, and Isoniazid), all of which have been implicated in causing these side effects. The solutions that saved the patient were temporarily discontinuing the immunosuppressive medication and replacing it with a local corticoid, followed by the continuation of Etanercept in associated with Methotrexate, and the patient was able to continue the biological medication and obtain a favorable response to the treatment. In conclusion, skin changes caused by TNF Alpha inhibitors are common, but vary in severity, and do not warrant therapy interruption. [ABSTRACT FROM AUTHOR]

Background: To examine how the knowledge transfer processes unfolded within SCIROCCO, a EU funded project (3rd Health Programme (2014-2020)) that aimed to facilitate the process of knowledge sharing across five European regions, to speed up adoption and scaling-up of integrated care initiatives.Methods: A qualitative multi-method design was used. Data collection methods included focus groups, project documents and action plans of the regions. The data was analysed using a qualitative content-analysis procedure, which was guided by the frameworks of knowledge exchange and the why, whose, what, how framework for knowledge mobilisers.Results: All five components (including the themes) of knowledge exchange could be identified in the approach developed on the knowledge transfer processes. The four questions and accompanying categories of the framework of knowledge mobilisation were also identified to a large degree.Conclusions: The observed incorporation of distinct forms of knowledge from multiple sources and the observed dynamic and fluid knowledge transfer processes both suggest that SCIROCCO developed a comprehensive knowledge transfer approach aiming to enable the adoption and scaling-up of integrated care. Overall, the multi-method qualitative nature of this research has allowed some new and practical insights in the knowledge transfer activities on integrated care between several European regions. To obtain a clear understanding of the content of the knowledge transfer approaches, which could assist the operationalising of models to support the evaluation of knowledge transfer activities, it is strongly recommended that further research of this type should be conducted in other research settings. [ABSTRACT FROM AUTHOR]

Diabetes contributes directly to the development of cardiovascular aortic valve disease. There is currently no drug therapy available for a dysfunctional valve and this urges the need for additional research to identify distinctive mechanisms of cardiovascular aortic valve disease evolution. The aim of this study was to evaluate changes of valvular aortic lesions induced in a hyperlipemic ApoE−/− mouse model by early type 1 diabetes onset (at 4 and 7 days after streptozotocin induction). The haemodynamic valve parameters were evaluated by echography and blood samples and aortic valves were collected. Plasma parameters were measured, and inflammatory, remodelling and osteogenic markers were evaluated in the aortic valves. Next, correlations between all parameters were determined. The results showed early aortic valve dysfunction detected by echography after 1 week of diabetes; lesions were found in the aortic root. Moreover, increased expression of cell adhesion molecules, extracellular matrix remodelling and osteogenic markers were detected in hyperlipemic ApoE−/− diabetic mice. Significant correlations were found between tissue valve biomarkers and plasmatic and haemodynamic parameters. Our study may help to understand the mechanisms of aortic valve disease in the diabetic milieu in order to discover and validate new biomarkers of cardiovascular aortic valve disease in diabetes and reveal new possible targets for nanobiotherapies. [ABSTRACT FROM AUTHOR]