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To assess the effectiveness and survival of ustekinumab (UST) among patients with psoriatic arthritis (PsA) treated under routine clinical care.Multicenter study. Epidemiological and clinical data was collected through electronic medical records of all patients with PsA who started UST in 15 hospitals of Spain.Two hundred and one patients were included, 130 (64.7%) with 45 mg and 71 (35.3%) with 90 mg. One hundred and thirty one patients (65.2%) had previously received another biological therapy. The median baseline DAS 28 ESR was 3.99, and Psoriasis Area and Severity Index (PASI) was 3. Overall, there was a significant decrease in DAS66/68 CRP, swollen joint count (SJC), tender joint count (TJC), and PASI in the first month of treatment, with earlier improvement in skin (PASI) than joints outcomes. Survival was numerically lower in patients with UST 45 mg (58.1%) than 90 mg (76.1%), although significant differences were not found (p = 0.147). When comparing naïve and 1 TNF blocker versus 2 TNF blocker-experienced patients, a significantly earlier response was seen in the former group regarding SJC (p = 0.029) at 1 month. Fifty-one patients (25.3%) stopped UST due to joint inefficacy and 4 patients due to adverse events (1.9%). Drug survival was significantly better in patients with fewer lines of previous biological agents (p = 0.003 for 1 TNF blocker versus 2 TNF blocker users).UST was effective in PsA patients in a routine clinical care setting. Patients with UST 90 mg and fewer lines of previous biologics achieved better and faster responses. Key Points • Largest cohort of patients with PsA in treatment with UST with specific rheumatological indication. • First cohort of patients with PsA comparing effectiveness of UST according to 45/90 mg dose.

Integrating power electronics to the grid has introduced new small signal–signal stability challenges, which are commonly studied with average time-invariant models and, more recently, with harmonic state–space models. In both approaches, it is common to obtain the models by following an analytical formulation, which can be tedious and impractical in systems with different controllers and topologies, just to mention a few examples. This paper proposes a numerical approach based on shooting methods and the recursive evaluation of the time-variant Jacobian along the steady-state orbits to construct automatically a periodic linear time-variant model and its respective linear time-invariant model using the extended harmonic domain; these models include explicitly the harmonic components. The proposed modeling approach can be applied to systems with different converter topologies, controllers, and modulation techniques. A nonlinear periodic switched system (grid-connected parallel inverter-based microgrid) is used to validate the proposed linearization approach.

Background Patients with chronic obstructive pulmonary disease (COPD) have poor outcomes in the setting of community-acquired pneumonia (CAP) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary objective is to compare outcomes of SARS-CoV-2 CAP and non-SARS-CoV-2 CAP in patients with COPD. The secondary objective is to compare outcomes of SARS-CoV-2 CAP with and without COPD. Methods In this analysis of two observational studies, three cohorts were analyzed: (1) patients with COPD and SARS-CoV-2 CAP; (2) patients with COPD and non-SARS-CoV-2 CAP; and (3) patients with SARS-CoV-2 CAP without COPD. Outcomes included length of stay, ICU admission, cardiac events, and in-hospital mortality. Results Ninety-six patients with COPD and SARS-CoV-2 CAP were compared to 1129 patients with COPD and non-SARS-CoV-2 CAP. 536 patients without COPD and SARS-CoV-2 CAP were analyzed for the secondary objective. Patients with COPD and SARS-CoV-2 CAP had longer hospital stay (15 vs 5 days, p

Migrants represent a diverse population comprising workers, students, undocumented individuals, and refugees. Worldwide, approximately 1 billion people were considered migrants in 2016. Notably, about 65 million of these migrants were forcibly displaced from their homes, and 20 million were considered refugees. While the geopolitical consequences of such migration continue to be considered, less is known about the impact of these events on the respiratory health of migrants and refugees. In recognition of this knowledge gap, the American Thoracic Society and the European Respiratory Society brought together investigators with diverse and relevant expertise to participate in a workshop and develop a consensus on research needs on the respiratory health of migrants and refugees. The workshop focused on environmental and occupational hazards, chronic noninfectious diseases, and respiratory infectious diseases, which were presented by experts in three distinct sessions, each culminating with panel discussions. A writing committee collected summaries prepared by speakers and other participants, and the information was collated into a single document. Recommendations were formulated, and differences were resolved by discussion and consensus. The group identified important areas of research need, while emphasizing that reducing the burden of pulmonary, critical care, and sleep disorders in migrants and refugees will require a concerted effort by all stakeholders. Using best research practices, considering how research impacts policies affecting migrant and refugee populations, and developing new approaches to engage and fund trainees, clinical investigators, and public health practitioners to conduct high-quality research on respiratory health of migrants and refugees is essential.

This study presents a physics-based rib-scale finite element (FE) model to study bond-zone behavior for spliced longitudinal bars in reinforced concrete beams subjected to monotonically increasing loading. In this model, a high-resolution mesh is used in the vicinity of the bar-concrete interface to capture the geometry of the ribs on the reinforcing steel. At the concrete-bar interface, a contact formulation that properly represents normal and frictional force transfer is used; adhesion between concrete and steel is ignored. The FE model is calibrated using data from beam splice tests performed by Ramirez and Russell [1] . It is observed that concrete tensile strength and tangential friction at the concrete-steel interface determine simulated response; these quantities are calibrated to provide accurate simulation of experimental results. The calibrated model provides results in good agreement with test data. Load-displacement response as well as concrete crack patterns are accurately simulated, and the proposed model can distinguish between the behavior of uncoated and epoxy-coated deformed bars as well as simulate the impact on bond strength of confinement provided by transverse steel.

This report contains the findings of a synthesis study on the use of link slabs to eliminate intermediate joints in bridges of Indiana. The study was conducted under the sponsorship of the Joint Transportation Research Program. The motivation for the study was to investigate this promising technique to mitigate the damage associated with expansion joints that has long been recognized as a persistent and costly issue negatively impacting the bridge service life. The report summarizes the background information and motivation for the study. It also provides a description of the report organization. The results of an extensive literature review of DOTs’ experience related to the use of this system and main research findings are presented as well as construction practice and examples of application. The results of the analysis of a bridge in Indiana where the link slab system has been implemented are presented. The bridge connecting the State Road 68 over the Interstate 64 was selected as a representative bridge based on the analysis of the inspection. A parametric study on the effects of various parameters was conducted to evaluate the effect of support conditions and debonded length on the stress distribution and potential crack initiation in link slabs. Each variable was investigated separately to isolate its effect. Two bridge structures were investigated in this study. The first structure (Case 1) represents a bridge structure rehabilitated using link slabs. A second bridge structure (Case 2) with the same geometrical and material properties, but with a continuous and fully bonded deck, was also included in the parametric study for comparison purposes. This structure simulated new bridge construction.

Objectives To develop recommendations for the management of methotrexate (MTX) in psoriatic arthritis (PsA), based on best evidence and experience. Methods A group of 12 experts on MTX use was selected. The coordinators formulated 14 questions about the use of MTX in PsA patients (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (Medline, EMBASE and the Cochrane Library were searched). Two different reviewers selected the articles. Evidence tables were created. At the same time, European League Against Rheumatism and American College of Rheumatology abstracts were evaluated. Based on this evidence, the coordinators proposed 12 preliminary recommendations that the experts discussed and voted on in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence Based Medicine and the level of agreement with the Delphi technique (two rounds). Agreement was established if at least 80% of the experts voted yes (yes/no). Results A total of 12 preliminary recommendations on the use of MTX were proposed, 9 of which were accepted. One was included in a different recommendation and other two were not voted on and were thereafter clarified in the main text. Conclusions These recommendations aim to answer frequent questions and help in decision making strategies when treating PsA patients with MTX.

The anti-interleukin-1 receptor antagonist, anakinra, was approved for the treatment of rheumatoid arthritis (RA) more than 12 years ago. However, its adverse effects are not well known. Areas covered: We review the safety profile of anakinra, analyzing clinical trials, observational studies, and registry data. Expert opinion: Due to its lower efficacy compared with other biological therapies approved for RA and its daily subcutaneous administration, anakinra is used only marginally for the treatment of RA. This has limited the experience with this drug in RA, with a lack of data from long-term observational studies or registries. From the five clinical trials performed, and given the unfeasibility of developing new studies of anakinra in RA, it may be concluded that site injection reactions, infections at higher doses (100 mg), and immunogenicity are the most frequent adverse events related to anakinra administration.

This paper presents a new decoder algorithm for the double space–time transmit diversity (DSTTD) system. The decoder is based on the QRD-M algorithm, which performs a breadth-first search of possible solutions tree. The search is simplified by skipping unlikely candidates, and it is stopped when no promising candidates are left. Furthermore, the search is divided into three concurrent iterations, making possible a fast, parallel implementation either in hardware or software. After presenting an analysis of the capacity and diversity of DSTTD, we present performance results showing that the proposed decoder is capable of achieving near maximum likelihood performance. We also show that the proposed algorithm exhibits lower computational complexity than other existing maximum likelihood detectors.

Our study demonstrated real-world, direct effectiveness of 13-valent pneumococcal conjugate vaccine against vaccine-type community-acquired pneumonia following introduction into a routine immunization program among adults aged ≥65 years, many of whom had immunocompromising and chronic medical conditions., Background Following universal recommendation for use of 13-valent pneumococcal conjugate vaccine (PCV13) in US adults aged ≥65 years in September 2014, we conducted the first real-world evaluation of PCV13 vaccine effectiveness (VE) against hospitalized vaccine-type community-acquired pneumonia (CAP) in this population. Methods Using a test-negative design, we identified cases and controls from a population-based surveillance study of adults in Louisville, Kentucky, who were hospitalized with CAP. We analyzed a subset of CAP patients enrolled 1 April 2015 through 30 April 2016 who were aged ≥65 years and consented to have their pneumococcal vaccination history confirmed by health insurance records. Cases were defined as hospitalized CAP patients with PCV13 serotypes identified via culture or serotype-specific urinary antigen detection assay. Remaining CAP patients served as test-negative controls. Results Of 2034 CAP hospitalizations, we identified PCV13 serotypes in 68 (3.3%) participants (ie, cases), of whom 6 of 68 (8.8%) had a positive blood culture. Cases were less likely to be immunocompromised (29.4% vs 46.4%, P = .02) and overweight or obese (41.2% vs 58.6%, P = .01) compared to controls, but were otherwise similar. Cases were less likely to have received PCV13 than controls (3/68 [4.4%] vs 285/1966 [14.5%]; unadjusted VE, 72.8% [95% confidence interval, 12.8%−91.5%]). No confounding was observed during adjustment for patient characteristics, including immunocompromised status, body mass index, and history of influenza and pneumococcal polysaccharide vaccination (adjusted VE range, 71.1%−73.3%). Conclusions Our study is the first to demonstrate real-world effectiveness of PCV13 against vaccine-type CAP in adults aged ≥65 years following introduction into a national immunization program.

Background Although not all health care-associated infections (HAIs) are preventable, reducing HAIs through targeted intervention is key to a successful infection prevention program. To identify areas in need of targeted intervention, robust statistical methods must be used when analyzing surveillance data. The objective of this study was to compare and contrast statistical process control (SPC) charts with Twitter's anomaly and breakout detection algorithms. Methods SPC and anomaly/breakout detection (ABD) charts were created for vancomycin-resistant Enterococcus, Acinetobacter baumannii, catheter-associated urinary tract infection, and central line-associated bloodstream infection data. Results Both SPC and ABD charts detected similar data points as anomalous/out of control on most charts. The vancomycin-resistant Enterococcus ABD chart detected an extra anomalous point that appeared to be higher than the same time period in prior years. Using a small subset of the central line-associated bloodstream infection data, the ABD chart was able to detect anomalies where the SPC chart was not. Discussion SPC charts and ABD charts both performed well, although ABD charts appeared to work better in the context of seasonal variation and autocorrelation. Conclusions Because they account for common statistical issues in HAI data, ABD charts may be useful for practitioners for analysis of HAI surveillance data.

Post-event building reconnaissance teams have a clear mission. These teams of trained professional engineers, academic researchers and graduate students are charged with collecting perishable data to be used for learning from disasters. A tremendous amount of perishable visual data can be generated in just a few days. However, only a small portion of the data collected is annotated and used for scientific purposes due to the tedious and time-consuming processes needed to sift through and analyze them. This crucial process still significantly relies on trained human operators. To distill such information in an efficient manner, we introduce a novel and powerful method for post-disaster evaluation by processing and analyzing big visual data in an autonomous manner. Recent convolutional neural network (CNN) algorithms are implemented to extract visual content of interest automatically from the collected images. Image classification and object detection are incorporated into the procedures to achieve accurate extraction of target contents of interest. As an illustration of the computational technique and its capabilities, collapse classification and spalling detection in concrete structures are demonstrated using a large volume of images gathered from past earthquake disasters.

Funding: NSF grant 1545852 (OISE:PIRE-SOMBRERO)/CONACyT 251992. Organic light emitting diodes (OLEDs) are very attractive light sources because they are large area emitters and, can in principle, deposited on flexible substrates. These features make them suitable for ambulatory photodynamic therapy (PDT), in fact there are a few reports of in vitro or in vivo OLED based PDT studies for cancer or microbial inhibition but to our best knowledge, none against yeasts. Yeast infections are a significant health risk, especially in low income countries with limited medical facilities. In this work, OLED-based antimicrobial PDT (aPDT), using methylene blue (MB) as photosensitizer (PS), is studied to inactivate opportunistic yeast of four Candida strains of two species: Candida albicans and Candida tropicalis. Before aPDT experiments, fluconazole-resistance was evaluated for all strains, showing that both strains of C. tropicalis were resistant and both strains of C. albicans were sensitive to it. We found that is useful for aPDT and that 3 repetitive irradiations work better than a single dose while keeping the total fluence constant, and that this result applies whether or not the strains are resistant to fluconazole. Postprint

Objective To determine clinical and sonographic biomarkers predicting structural damage progression at 12 months of follow-up as measured by magnetic resonance imaging (MRI) in rheumatoid arthritis (RA) patients in clinical remission. Patients and methods We included patients with RA in clinical remission, defined as 28-joint disease activity score (DAS28)-erythrocyte sedimentation rate (ESR) 6 months. Ultrasound scans of both hands and knees and MRI of the dominant hand were performed at baseline and at 12 months. Results Out of 55 patients, 42 completed the follow-up. Among them, 78% were female, aged (median) 54 years; disease duration was 93 months. In total, 12 (28%) patients were taking oral prednisone, 34 (81%) conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and 20 (47%) biological therapies. At baseline, 45% fulfilled criteria previously defined for ultrasound-defined active synovitis (UdAS) [PD (power Doppler) signal + synovial hyperplasia ≥2]. Multivariate analysis showed significant associations between baseline MRI erosion score, body mass index (BMI), disease duration, prednisone treatment, absence of biologic and csDMARDs, UdAS, and MRI erosion score progression after 12 months. In an exploratory analysis, serum levels of calprotectin correlated significantly with bone edema progression. Conclusions We identified clinical and sonographic markers of structural damage progression after 12 months follow-up in patients with RA in clinical remission. Meeting the criteria of ultrasound active synovitis, defined as simultaneous relevant synovial hyperplasia and PD, was associated with erosion progression after 12 months. Calprotectin was associated with bone edema, in an exploratory analysis.

Background and Objective: Blood vessel visualization is an essential task to treat and evaluate diseases such as port-wine stain. Laser Speckle Contrast Imaging (LSCI) have applications in the analysis of the microvasculature. However, it is often limited to superficial depths because the tissue among skin and microvasculature introduces noise in the image. To analyze microvasculature, traditional LSCI methods compute a Contrast Image (CI) by using a shifting window of fixed size and shape, which is inadequate in images with structures different types of morphologies in it, as happens in LSCI. This work aims to reduce the noise in the CIs to improve the visualization of blood vessels at high depths ( > 300 μ m). Methods: The proposed method processes the CIs with analysis windows that change their size and shape for each pixel to compute the contrast representation with pixels more representatives to the region. Results: We performed experiments varying the depth of the blood vessels, the number of frames required to compute the representation, and the blood flow in the blood vessel. We looked for an improvement in the Contrast to Noise Ratio (CNR) in the periphery of the blood vessels using an analysis of variance. Finding that the adaptive processing of the contrast images allows a significant noise attenuation, translated into a better visualization of blood vessels. An average CNR of 2.62 ± 1 and 5.26 ± 1.7 was reached for in-vitro and in-vivo tests respectively, which is higher in comparison with traditional LSCI approaches. Conclusions: The results, backed by the measured CNR, obtained a noise reduction in the CIs, this means a better temporal and spatial resolution. The proposed awK method can obtain an image with better quality than the state-of-the-art methods using fewer frames.

The coherent-mode representation is a fundamental tool that helps us understand the processes of producing and propagating optical fields. In this work, such representation for self-imaging phenomena under partially coherent illumination is presented within the frame of partial coherence theory in the space-frequency domain. Additionally, it is shown that the well-known Talbot and Lau effects are particular cases included in this new formalism. When complete coherence of the field is considered, the general expression for coherent self-imaging of optical fields is obtained (Talbot effect for both linear and circular gratings are presented); on the other hand, when an incoherent superposition of an infinite number of modes are considered, the expression to describe the Lau effect is obtained.

The visualization and localization of blood vessels is an important task to determine the presence and the health status of microvasculature in the biological tissue. Laser Speckle Contrast Imaging is one of the most widely employed techniques to study blood vessels; even so, it has some drawbacks in analyzing deep blood vessels ( > 100 μ m ) since the image noise level increases. The Wavelet Approach is a model of automatic denoising for contrasted in vitro Raw Speckle images using an energy criterion. The criterion selects the more suitable denoising level from the Discrete Wavelet Transform decomposition using the detail coefficients. Then, the segmentation of low-noise images by mathematical morphology techniques establish the blood vessel and biological tissue location. Finally, the region corresponding to the blood vessel and the low-noise images are used to improve the visualization of blood vessels. Results show that a Wavelet Approach improves the visualization of blood vessels up to a depth of 400 μ m . Furthermore, the proposed model demonstrates that the automatic denoising criterion improves the localization of superficial ( ≤ 100 μ m ) and deep ( > 100 μ m ) blood vessels.

IMPORTANCE Preventive interventions are needed to protect residents and staff of skilled nursing and assisted living facilities from COVID-19 during outbreaks in their facilities. Bamlanivimab, a neutralizing monoclonal antibody against SARS-CoV-2, may confer rapid protection from SARS-CoV-2 infection and COVID-19. OBJECTIVE To determine the effect of bamlanivimab on the incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, single-dose, phase 3 trial that enrolled residents and staff of 74 skilled nursing and assisted living facilities in the United States with at least 1 confirmed SARS-CoV-2 index case. A total of 1175 participants enrolled in the study from August 2 to November 20, 2020. Database lock was triggered on January 13, 2021, when all participants reached study day 57. INTERVENTIONS Participants were randomized to receive a single intravenous infusion of bamlanivimab, 4200mg (n = 588), or placebo (n = 587). MAIN OUTCOMES AND MEASURES The primary outcomewas incidence of COVID-19, defined as the detection of SARS-CoV-2 by reverse transcriptase���polymerase chain reaction and mild or worse disease severity within 21 days of detection, within 8 weeks of randomization. Key secondary outcomes included incidence of moderate or worse COVID-19 severity and incidence of SARS-CoV-2 infection. RESULTS The prevention population comprised a total of 966 participants (666 staff and 300 residents) who were negative at baseline for SARS-CoV-2 infection and serology (mean age, 53.0 [range, 18-104] years; 722 [74.7%] women). Bamlanivimab significantly reduced the incidence of COVID-19 in the prevention population compared with placebo (8.5%vs 15.2%; odds ratio, 0.43 [95%CI, 0.28-0.68]; P < .001; absolute risk difference, ���6.6 [95%CI, ���10.7 to ���2.6] percentage points). Five deaths attributed to COVID-19 were reported by day 57; all occurred in the placebo group. Among 1175 participants who received study product (safety population), the rate of participants with adverse events was 20.1% in the bamlanivimab group and 18.9% in the placebo group. The most common adverse events were urinary tract infection (reported by 12 participants [2%] who received bamlanivimab and 14 [2.4%] who received placebo) and hypertension (reported by 7 participants [1.2%] who received bamlanivimab and 10 [1.7%] who received placebo). CONCLUSIONS AND RELEVANCE Among residents and staff in skilled nursing and assisted living facilities, treatment during August-November 2020 with bamlanivimab monotherapy reduced the incidence of COVID-19 infection. Further research is needed to assess preventive efficacy with current patterns of viral strains with combination monoclonal antibody therapy.

International experts suggest tailoring antibiotic duration in community-acquired pneumonia (CAP) according to patients' characteristics. We aimed to assess the effectiveness of an individualized approach to antibiotic duration based on time in which CAP patients reach clinical stability during hospitalization. In a multicenter, non-inferiority, randomized, controlled trial hospitalized adult patients with CAP reaching clinical stability within 5 days after hospitalization were randomized to a standard vs. individualized antibiotic duration. In the Individualized group, antibiotics were discontinued 48 h after the patient reached clinical stability, with at least five days of total antibiotic treatment. Early failure within 30 days was the primary composite outcome. 135 patients were randomized to the Standard group and 125 to the Individualized group. The trial was interrupted by the safety committee because of an apparent inferiority of the Individualized group over the Standard treatment: 14 (11.2%) patients in the Individualized group experienced early failure vs. 10 (7.4%) patients in the Standard group, p = 0.200, at the intention-to-treat analysis. 30-day mortality rate was four-time higher in the Individualized group than the Standard group. Shortening antibiotic duration according to patients' characteristics still remains an open question.

Background Understanding the burden of community-acquired pneumonia (CAP) is critical to allocate resources for prevention, management, and research. The objectives of this study were to define incidence, epidemiology, and mortality of adult patients hospitalized with CAP in the city of Louisville, and to estimate burden of CAP in the US adult population. Methods This was a prospective population-based cohort study of adult residents in Louisville, Kentucky, from 1 June 2014 to 31 May 2016. Consecutive hospitalized patients with CAP were enrolled at all adult hospitals in Louisville. The annual population-based CAP incidence was calculated. Geospatial epidemiology was used to define ecological associations among CAP and income level, race, and age. Mortality was evaluated during hospitalization and at 30 days, 6 months, and 1 year after hospitalization. Results During the 2-year study, from a Louisville population of 587499 adults, 186384 hospitalizations occurred. A total of 7449 unique patients hospitalized with CAP were documented. The annual age-adjusted incidence was 649 patients hospitalized with CAP per 100000 adults (95% confidence interval, 628.2-669.8), corresponding to 1591825 annual adult CAP hospitalizations in the United States. Clusters of CAP cases were found in areas with low-income and black/African American populations. Mortality during hospitalization was 6.5%, corresponding to 102821 annual deaths in the United States. Mortality at 30 days, 6 months, and 1 year was 13.0%, 23.4%, and 30.6%, respectively. Conclusions The estimated US burden of CAP is substantial, with >1.5 million unique adults being hospitalized annually, 100000 deaths occurring during hospitalization, and approximately 1 of 3 patients hospitalized with CAP dying within 1 year.

Hand hygiene is one of the most important interventions in the quest to eliminate healthcare-associated infections, and rates in healthcare facilities are markedly low. Since hand hygiene observation and feedback are critical to improve adherence, we created an easy-to-use, platform-independent hand hygiene data collection process and an automated, on-demand reporting engine.A 3-step approach was used for this project: 1) creation of a data collection form using Google Forms, 2) transfer of data from the form to a spreadsheet using Google Spreadsheets, and 3) creation of an automated, cloud-based analytics platform for report generation using R and RStudio Shiny software.A video tutorial of all steps in the creation and use of this free tool can be found on our YouTube channel: https://www.youtube.com/watch?v=uFatMR1rXqUt. The on-demand reporting tool can be accessed at: https://crsp.louisville.edu/shiny/handhygiene.This data collection and automated analytics engine provides an easy-to-use environment for evaluating hand hygiene data; it also provides rapid feedback to healthcare workers. By reducing some of the data management workload required of the infection preventionist, more focused interventions may be instituted to increase global hand hygiene rates and reduce infection.

Purpose: To report a case of cystoid macular edema (CME) secondary to juvenile idiopathic arthritis (JIA)-associated uveitis.Case report: 26-year-old female patient presented with CME in both eyes. CME became refractory and TCZ-IV was initiated. After 12 infusions was stopped because grade 1 neuropenia developed. On examination,visual acuity of the right eye was 20/80. Spectral domain optical coherence tomography (SD-OCT) of the right eye revealed CME. Subcutaneous (TCZ-SC) was initiated. After six injections of TCZ-SC, ophthalmic examination revealed no signs of active inflammation, and central foveal thickness decreased.Conclusion: TCZ-SC seems to have a role in the treatment of CME secondary to juvenile idiopathic arthritis (JIA)-associated uveitis.

We present the generation and 3D manipulation of microbubbles by thermal gradients, induced by low power nanosecond pulsed laser in non-absorbent liquids. Light absorption at photodeposited silver nanoparticles on the optical fiber tip heat up the surrounding liquid, which leads to optothermal effects. With each laser pulse a microbubble is detached from the optical fiber end, creating a microbubbles-stream. The microbubbles move away from the optical fiber end driven by non-spherical cavitation until they coalesce creating a main-bubble which is attracted towards the optical fiber end by Marangoni force. In addition, the main-bubbles are under the influence of buoyancy and gravity forces, which act upwards and downwards, respectively. The balance of these forces allows the 3D manipulation of the main-bubble. The main-bubble position can be controlled by careful control of the pulse energy. To our knowledge this is the first time that 3D manipulation of microbubbles using pulsed lasers is demonstrated.

Monitoring air quality is a topic of current interest, since poor quality has a negative impact on health. Air quality is affected by different pollutants, such as particulate matter and gases, produced by the growing industrial development. As a preventive measure, Mexico established different standards in order to control airborne pollution. In this paper, we propose a methodology based upon a recurrent long-term/short-term memory network for the prediction of exceedances of PM10 (particles of less or equal diameter than 10 micrometers) with time intervals of 72, 48 and 24 hours in advance. Obtaining a satisfactory percentage of prediction as a whole a minimum variability in repetitive experimental runs.

Breast cancer implies a very important health problem worldwide since it represents the cancer with the highest incidence and mortality rate among women in 2018. Traditional treatments are not always totally efficient, causing severe systemic side effects, therefore the search for alternative treatments such as photodynamic therapy (PDT) is of vital importance. In the present work, we show the in vitro effects of rose bengal (RB) as a photosensitizer (PS) and green light (500-550 nm) to eliminate two breast cancer cell lines: MDA-MB-231, a triple negative line highly aggressive and invasive, and T47D, a luminal line of the infiltrating ductal type. RB concentrations of 0.5, 1 and 5 μM and radiation fluences of 2.5, 5 and 10 J/cm2 were evaluated. Cell viability was evaluated with the MTT test, obtaining the best effect with 5 μM concentration and 10 J/cm2 light dose.

Background Early clinical response (ECR) is a new endpoint to determine whether a drug should be approved for community-acquired bacterial pneumonia in the United States. The Omadacycline for Pneumonia Treatment In the Community (OPTIC) phase III study demonstrated noninferiority of omadacycline to moxifloxacin using this endpoint. This study describes the performance of the ECR endpoint and clinical stability relative to a posttreatment evaluation (PTE) of clinical success. Methods ECR was defined as symptom improvement 72–120 hours after the first dose of study drug (ECR window), no use of rescue antibiotics, and patient survival. Clinical success at PTE was an investigator assessment of success. Clinical stability was defined based on vital sign stabilization, described in the American Thoracic Society and Infectious Diseases Society of America community-acquired pneumonia treatment guidelines. Results During the ECR window, ECR was achieved in 81.1% and 82.7% of omadacycline and moxifloxacin patients, respectively. Similar numbers of patients achieved clinical stability in each treatment group (omadacycline 74.6%, moxifloxacin 77.6%). The proportion of patients with improved symptoms who were considered clinically stable increased across the ECR window (69.2–77.6% for omadacycline; 68.0–79.7% for moxifloxacin). There was high concordance (>70%) and high positive predictive value (>90%) of ECR and clinical stability with overall clinical success at PTE. Conclusions Omadacycline was noninferior to moxifloxacin, based on a new ECR endpoint. Clinical stability was similarly high when measured in the same time frame as ECR. Both ECR and clinical stability showed high concordance and high positive predictive value with clinical success at PTE. Clinical Trials Registration NCT02531438.

Blood flow is a parameter used to diagnose vascular diseases based on flow speed, blood pressure, and vessel size. Different techniques have been developed to estimate the relative blood flow speed and to improve the visualization of deep blood vessels; one such technique is laser speckle contrast imaging (LSCI). LSCI images contain a high level of noise mainly when deep blood vessels are imaged. To improve their visualization, several approaches for contrast computation have been developed. However, there is a compromise between noise attenuation and temporal resolution. On the one hand, spatial approaches have low spatial resolution, high temporal resolution, and significant noise attenuation, while temporal approaches have the opposite. A recent approach combines a temporal base with a directional process that allows improving the visualization of blood vessels. Nevertheless, it still contains a high level of noise and requires a high number of raw frames for its base. We propose, a space-directional approach focused on improving noise attenuation and temporal resolution for contrast computation. The results of reference approaches and the proposed one are compared quantitatively. Moreover, it is shown that the visualization of blood vessels in LSCI images can be improved by a general morphological process when the noise level is reduced.

Background: Anti-carbamylated protein antibodies (Anti-CarP) represent a novel autoantibody family present in sera of patients with rheumatoid arthritis (RA) with high specificity. Objectives: To analyse the prevalence of Anti-CarP in an established RA cohort and evaluate their association with the presence of other autoantibodies and disease activity and severity. Methods: Cross-sectional study. Presence of Anti-CarP was analyzed in a cohort of patients with established RA (n: 158) by a home-made ELISA test using fetal calf serum. We investigated the demographic, radiological and current and at disease onset clinical features. Rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA) status were also assessed. Results: Anti-CarP were positive in 46.2% of the patients in our cohort and in 15.1%, 19.2% and 9.1% of the patients negative for ACPA, RF and both respectively. Demographic and clinical features are shown in table 1. The mean titer of ACPA (1361±1054 U/mL vs. 918 ± 1092 U/mL) and RF (258 ± 255 AU vs. 174 ± 205 AU) were significantly higher in Anti-CarP positive patients. No difference in symptoms at RA onset was observed. Current (24.7% vs. 11.8%) and previous (54.8% vs. 37.6%) smoking consumption were significantly associated with Anti-CarP antibodies. Anti-CarP positive patients presented a higher CRP values (1. 0±1.6 mg/dL vs. 0.5 ±0.8 mg/dL), swollen joint count (1.3±2.2 vs 0.7 ±1.8) and patient global health assessment VAS (34.8 ±21.5 mm vs. 26.4 ±17.1 mm); although no between-group differences in disease activity (DAS28, CDAI, SDAI and RAPID3) or demographic features were observed. Anti-CarP positive patients presented significant higher scores in Larsen index (23.6 ± 15.7 vs. 15.7 ± 12.6) and disability (HAQ-DI >1) (23.3% vs. 8.3%). Conclusion: Anti-CarP were present in approximately half of the RA cohort and were also detected in seronegative (RF and/or ACPA) patients. In our cohort, patients with Anti-CarP antibodies presented higher tobacco consumption and poorer disease outcomes. Disclosure of Interests: Raul Castellanos-Moreira Speakers bureau: For Lilly and Merk Sharp and Dohme, Sebastian C Rodriguez-Garcia: None declared, Virginia Ruiz: None declared, Oscar Camacho: None declared, Julio Ramirez: None declared, Andrea Cuervo: None declared, Cristina Garcia-Moreno: None declared, Rosa Morla: None declared, Jose Gomez Puerta Speakers bureau: BMS, Pfizer, Amgen, Juan D. Canete: None declared, Isabel Haro: None declared, Raimon Sanmarti Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN

Background: Patients with Rheumatoid Arthritis (RA) in remission will present flares during the evolution of the disease.Definitive biomarkers have not been identified to predict flares and radiographic progression (RP) in this kind of patients Objectives: To search biomarkers of clinical relapse and RP in patients with RA in clinical remission Methods: RA patients in clinical remission (DAS28-ESR 6 months) were selected.Clinical,epidemiological and serological data were analyzed.MRI of dominant hand,ultrasound assessment of knees and hands and serum levels of inflammation and angiogenesis biomarkers were evaluated at 0 and 48 weeks.Synovial biopsy was performed in patients with subclinical synovitis.Patients were follow-up for 5 years.Radiological data were collected.Clinical relapse was defined as the loss of remission status involving a therapeutic intervention.RP was defined as the change in the Sharp van der Heijde (SvH) index at 5 years >10.47 [SDD (minimum detectable change)]. Results: 60 patients in DAS28 remission. 1/3 also met remission criteria for SDAI(33.3%),CDAI(31.6%) and ACR(35%).78% were women,mean age 53 years. 82% were ACPA+.26% were taking oral prednisone,76% DMARDs and 45% biological therapies.48% met criteria for subclinical synovitis(UdAS:SH>2+PD)1. After 5 years of follow-up, 44(73%), 11(18%), 9(15%) and 10(17%) patients remained in remission according to DAS28,SDAI, DAI and ACR criteria,respectively. 29 patients (48%) had flares at any time during the 5 years. In the multivariate analysis, the variables that were related to clinical relapse were the BMI (OR 1.6 CI 95% 1.1-2.3), bone edema at baseline (OR 1.2,CI 95% 1-1.5), PD signal at 48w (OR 9.2,CI 95% 1.2-66.7) and the change in levels of CXCL16 (OR 1.04 CI 95% 0.9-1) and ESR (OR 3.6,CI 95% 1.1-12.2) between the first and latest evaluation (Rate). In the subgroup of 23 patients undergoing synovial biopsy, the number of mast cells was higher in those patients (n=10) who flared (p=0.02). 20 patients (33%) changed DMARDs or biological therapy. In the logistic regression analysis, BMI (OR 1.3 CI 95% 1-1.6), biological therapy (OR 17.8 CI 95% 2-167.1),progression of erosions measured by MRI (OR 1.1, CI 95% 1-1.3) and the rate of progression of calprotectin levels during the first year (OR 4.4,CI 95% 1.1-17.2) were the main factors that predicted the change in baseline therapy after 5 years of follow-up. Finally, only 6 patients (10%) had RP according to the SvH index and 7 (12%) had erosion progression.This small number of “progressors” did not allowed more exhaustive analysis of factors predicting RP.However,the number of macrophages and T cells at sinovial tissue (ST) was much higher in patients with RP.Likewise,the first-year rate of bone edema was significantly higher in patients suffering structural progression (p=0.04). Conclusion: 27% of RA patients lost clinical remission (DAS28) after 5 years of follow-up.BMI,baseline bone edema,PD signal at 12m and first-year rate of CXCL16 and VSG levels were predictors of joint flares. Baseline BMI, use of biological therapy,MRI erosions and calprotectin levels predicted the change of baseline therapy for RA. Only 10% of patients had RP along the study.Sinovial mast cells were associated with disease flares. Macrophages and T cells in ST were higher in patients with RP in an exploratory analysis. Reference [1] Ramirez J, Ruiz-Esquide V, Pomes I, Celis R, Cuervo A, Hernandez MV, et al. Patients with rheumatoid arthritis in clinical remission and ultrasound-defined active synovitis exhibit higher disease activity and increased serum levels of angiogenic biomarkers. Arthritis Res Ther. 2014;16:R5. Disclosure of Interests: Julio Ramirez: None declared, Andrea Cuervo: None declared, Raquel Celis: None declared, Raul Castellanos-Moreira Speakers bureau: MSD, Lilly, Sebastian C Rodriguez-Garcia: None declared, Virginia Ruiz-Esquide: None declared, Jose Gomez Puerta Speakers bureau: BMS, Pfizer, Amgen, Raimon Sanmarti Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN, Juan D. Canete: None declared

Blood vessel diameter estimation is helpfully in areas such as medicine, dermatology, neuroscience or ophthalmology. Blood vessel estimation plays an important role in diagnosis of cardiovascular diseases, also its useful to validate blood flow dynamics of a blood vessel. This paper addresses a method based on region growing for blood vessel diameter and orientation estimation. The proposed methodology first pre-process a laser speckle contrast image to obtain a certain amount of seeds that grew among the blood vessels located. All the regions contribute information about the blood vessels and they serve to build a map representing the size of the located blood vessels.

Reconnaissance teams are charged with collecting perishable data after a natural disaster. In the field, these engineers typically record their observations through images. Each team takes ...

Visualization of blood vessels is a fundamental task in the evaluation of the health and biological integrity of tissue. Laser speckle contrast imaging (LSCI) is a non-invasive technique to determine the blood flow in superficial or exposed vasculature. However, the high scattering of biological tissue hinders the visualization of those structures. In this paper, we propose the use of principal component analysis (PCA) in combination with LSCI to improve the visualization of deep blood vessels by selecting the most significant principal components. This analysis was applied to in vitro samples, and our results demonstrate that this approach allows for the visualization and localization of blood vessels as deep as 1000 μm.

Objective To analyse the prevalence of pre-existing palindromic rheumatism (PR) in patients with established rheumatoid arthritis (RA) and evaluate whether these patients have a distinctive clinical and serological phenotype. Methods Cross-sectional study in patients with established RA. Pre-existing PR was determined using a structured protocol and confirmed by retrospective review of medical records. Demographic, clinical, radiological, immunological and therapeutic features were compared in patients with and without PR. Results 158 patients with established RA (78% female) with a mean disease duration since RA onset of 5.1 ± 2.7 years were included. Pre-existing PR was recorded in 29 patients (18%). The median time from the onset of PR to progression to RA was 1.2 years. No between-group differences in demographic features, current disease activity radiographic erosive disease or disability were observed. Patients with PR had a higher prevalence of smoking (72% vs. 40%). Positive rheumatoid factor, anti-citrullinated peptide antibodies and anti-carbamylated protein antibodies were numerically higher in patients with PR. No differences in treatment were observed except for greater hydroxychloroquine use in patients with PR (38% vs. 6%). Palindromic flares persisted in a significant proportion of patients during the RA course, including patients in clinical remission or receiving biological DMARDs. Conclusion Eighteen percent of patients with RA had a history compatible with PR previous to RA onset. No specific clinical or serological phenotype was identified in these patients, although higher hydroxychloroquine use and smoking prevalence were identified. Palindromic flares may persist during the RA disease course despite treatment.

Visualization of blood vessels in contrast images is an important task as it is used to analyze the dynamics of the blood flow and the health status of biological tissue. However, this task becomes difficult due to the noise in the image, mainly at high depths. This work proposes a methodology based on the Discrete Wavelet Transform to improve in-vitro blood vessels visualization. It also addresses the segmentation of the regions of interest through morphological operations in improved contrast images. Results show that it is possible to visualize the blood vessels even at 700$\mu$m below an epidermis phantom.