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Background and objectives Among orbital tumors, metastatic lesions have a prevalence of 1% to 13%; on the other hand, breast cancer is the most common malignancy causing orbital metastases. The aim of this study is to present our experience dealing with orbital metastases caused by breast cancer, to assess characteristics and clinic-pathological data of patients suffering from this rare occurrence and to find indexes related with their prognosis and survival. Methods Records of 28 patients diagnosed with orbital metastases from breast cancer at the Department of Ophthalmology, Humanitas Clinical and Research Centre of Milano over a 27-year period (1992-2018) were retrieved and analyzed. Results Mean patients' age at breast cancer diagnosis was 56.29 ± 14.63 years. Mean time interval between breast cancer diagnosis and orbital metastasis occurrence was 5 ± 4.17 years. All lesions were estrogen receptor-positive; 79% of patients harbored progesterone receptor-positive lesions. Interestingly, the majority of deceased patients presented orbital lesions with MIB-1 index >50% (P = .0265) and had concomitant lung metastases (P = .0452). Conclusions The occurrence of orbital metastasis from breast cancer represents a challenging finding. Patients' clinical picture can include exophthalmos, edema, tumefaction, proptosis and/or diplopia. Significant symptomatic improvement can be achieved through surgery and other adjuvant treatments, such as radiation therapy and chemotherapy.

The presence of turbidity and precipitates in the bottle causes depreciation of wine by consumers. Colloidal instability is at the basis of these phenomena. The cold treatment is a technique widely used to stabilize wines, as regards both the tartaric and the colloidal precipitations. However, it is an energy-consuming technique. In view of a sustainable management of winery practices, the work aimed at evaluating the possibility of using some enological products for the colloidal stabilization of wines without cold treatment. 8 adjuvants (sodium and calcium bentonite, hot and cold soluble gelatin, chitosan, isinglass, PVI/PVP, carboxymethylcellulose) and 4 additives (kordofan gum, 2 different mannoproteins, a natural polysaccharide polymer) were compared. The trial was performed with a Barbera (2019) and a Montepulcianod'Abruzzo (2020) wines, stabilized against tartaric precipitations without cold, but with colloidal instability. Three days after the treatments the wines were racked, filtered (3 m) and bottled. After bottling and after 6 months of bottle aging, the wines were analyzed. Colloidal stability test (48 hours at 4°C) and shock test (1 and 7 days at 40 °C) were performed. As regards Barbera, the treatment with sodium bentonite (50 g/hL) or the addition of a mannoprotein (15 g/hL) allowed to stabilize the wine. For Montepulciano, having a higher colloidal instability than Barbera, the cold stabilization resulted necessary because no treatment was effective. All treatments had a modest impact on the color.

Background The finding of hematological malignancies within bone marrow in heterotopic ossification has been reported only a handful of times previously in the literature. We described a case of true trilineage hematopoiesis in an excised area of heterotopic ossification from an enucleated blind painful eye. Case presentation A 70-year-old Caucasian man, positive for asymptomatic lymphoplasmacytic lymphoma, presented with a blind painful right eye in our ophthalmology department to evaluate enucleation bulbi. After enucleation, a histopathologic examination revealed the presence of intertrabecular infiltration in the metaplastic bone marrow of non-Hodgkin B lymphoma, with small lymphocytes, with similar characteristics to the already known disease. Conclusion This uncommon case reveals the possibility of the localization of malignant cells within bone metaplasia of intraocular ossification in an enucleated blind painful eye. From a practical point of view, a careful systematic histopathological examination of all resected tissues in patients with a history of malignant neoplastic pathology is necessary to confirm the diagnosis and exclude occult malignancies.

Células vegetativas de Clostridium perfringens ATCC 13124 inoculadas em patê de fígado foram submetidas a diferentes tratamentos térmicos para caracterização de sua resistência ao calor e evidenciar a eficiência de modelo preditivo na obtenção de tempos de tratamento térmico. Frações experimentais de aproximadamente 8,50g de amostras foram inoculadas e examinadas para obtenção de valores Dobservados, construção de modelo preditivo, no intervalo térmico de 56,7ºC a 66,3ºC, e, posteriormente, evidenciar a eficiência do modelo através da enumeração de células sobreviventes na temperatura de 67,5ºC e verificação da linearidade em cotejos de valores D (Dobservados e Dcalculados) em faixa térmica entre 56,7ºC e 67,5ºC. A semelhança dos valores Dobservado e Dcalculado (3,14min ≈ 2,94min) constatada no tratamento 2D67,5ºC, a ausência de células sobreviventes nos tratamentos 8D67,5ºC e 12D67,5ºC, juntamente com a marcada linearidade (r = 0,9934) da regressão entre os valores Dobservados (~3,1-16,6min) e Dcalculados (~2,9-15,6min) caracterizaram a eficiência do modelo preditivo no caso estudado.

Background and Aims The light-struck taste is a fault occurring in light-exposed white wine containing methionine and a high concentration of riboflavin (RF) and bottled in clear bottles. These conditions induce the formation of methanethiol and dimethyl disulfide, responsible for a cabbage-like aroma. In order to decrease the risk of wine spoilage, a low concentration of RF should be obtained in wine either by preventing RF release from yeast during winemaking or by removing RF from wine. Methods and Results Fifteen commercial Saccharomyces strains intended for the wine industry were tested for RF production, which was also evaluated when two yeast-based nutrients were added into the must for one of these strains. The RF released during vinification was strain-dependent and a concentration from 30 to 170 μg/L was found in wine. A high concentration of RF was released in the presence of the yeast-based nutrients because of either the yeast metabolism or the RF contained in the nutrient itself. The ability of different inorganic (bentonite, charcoal, zeolite, kaolin) and organic adjuvants (egg-white proteins, polyvinylpolypyrrolidone) to deplete RF in wine was evaluated. A relatively low level of charcoal (50 mg/L) removed up to 60% of RF in wine, although its effectiveness was related to the charcoal source. A high concentration of bentonite (1 g/L) was needed to effectively decrease the risk of wine spoilage. Conclusions A critical RF concentration in white wine can be prevented by applying one or more approaches in winemaking: using low RF-producing yeast strains in fermentation, selecting suitable yeast nutrients or adsorbing RF by insoluble charcoal or bentonite. Significance of the Study The research highlights suitable tools to prevent light-struck taste in white winemaking.

We aimed to evaluate the impact of biologic therapy on work productivity outcomes in an Italian real-life cohort of biologic-naïve patients with active rheumatoid arthritis (RA).This observational prospective multicentre study enrolled RA patients in working age with an active disease who started their first biologic agent. Every patient completed the RA-specific Work Productivity Survey (WPS-RA) at each clinical evaluation (baseline, 6 and 12 months). The primary outcome of the study was the productivity gain at 12 months from the beginning of the biologic treatment, compared to baseline, assessed in terms of absenteeism and presenteeism reduction, both for employed and unemployed subjects. Linear regression analyses were performed to assess the impact of patient- and disease-related variables on productivity gain.Overall, 100 patients were enrolled and 85 completed the study. All indexes of disease activity and functional ability were significantly improved from baseline already at 6 months. At 12 months, the 55 employed subjects showed a significant reduction in the mean number of days of work missed (absenteeism) and of reduced productivity (presenteeism). A significant reduction in the mean number of days of household work missed was observed for all patients. At multivariate analysis, functional disability had a significant negative impact on all parameters of household work productivity, while the achievement of a low disease activity or remission was inversely correlated with presenteeism.One year of treatment with a biological drug significantly impacts on the disease activity and work ability of RA patients and allows economic gains due to productivity improvement.

The purpose of this study was to have an overview of the current approach to psoriatic arthritis (PsA) by a group of Italian rheumatologists.Rheumatologists from all around Italy were asked to participate in a survey to give their opinion on a number of statements made by a panel of rheumatologists who are experts in PsA. The survey was conducted through two rounds using a Delphi-like method. The two rounds yielded a consensus on the management of PsA.Fifty rheumatologist from 50 rheumatology centres participated in the survey. Of the 117 proposed statements, only 10 did not reach the 66% concordance threshold. The main results of the survey were that diagnosis of PsA should be made using both the CASPAR criteria and clinical judgment, that all of the features of the psoriatic disease are relevant in the assessment and therapy of PsA, that treatment recommendations are taken into account, that all of the available biological agents may be used in bio-naïve patients, that anti-drug antibody testing is still not used in daily practice, that both switching or swapping are useful options in the case of bio-failure because of lack or loss of efficacy, and that swapping is considered the best choice in the case of bio-failure due to adverse events.The results of this survey showed that a comprehensive evaluation of the patient and a therapy choice based on both patient clinical features and evidence of drug efficacy and safety are considered the current best of care for PsA patients.

The aim of this study was to assess how the management of rheumatoid arthritis (RA) with methotrexate (MTX) in Italy is adherent to current national recommendations.We performed a cross-sectional and retrospective analysis of data collected from the MARI study, a multicentre survey on Italian patients with RA on treatment with MTX for at least 12 months. Retrospective data included patient's clinical history, previous treatment with MTX, screening tests performed before MTX prescription. Cross-sectional data were collected about current treatment with MTX, concomitant medications, and disease activity. Each proposition of the 2013 Italian recommendations on the use of MTX in RA was reformulated in terms of audit criteria, and adherence to provided indications was evaluated for every patient.Among the 1336 included patients, less than 40% had started treatment with MTX within 3-6 months from the diagnosis and nearly 30% of them were prescribed with an initial dose of MTX between 12.5 and 15 mg/week. Screening for HBV and HCV infection as well as chest x-ray was performed in a proportion of patients around 60% and more than 90% of them underwent lab tests before MTX prescription and regularly throughout the treatment. Folic acid supplementation was given at recommended dosages in a high proportion of patients.Our survey showed a good adherence of Italian rheumatologists to recommendations regarding safety issues with MTX in RA, but a suboptimal approach in terms of time and dosage of the treatment in the early phases of the disease.

Bone marrow edema (BME) is a descriptive term which identifies a specific magnetic resonance imaging (MRI) pattern that can be observed in a number of clinical entities, which are often characterized by pain as their main symptom, but show significant differences in terms of histopathological findings, causal mechanisms and prognosis. Bone marrow lesions in the subchondral bone of subjects with knee osteoarthritis (OA) seem to be associated with pain and progression of cartilage damage over time. Some histopathological studies of advanced OA have shown a prevalent fibrosis and bone marrow necrosis. BME of the subchondral bone in rheumatoid arthritis is associated with an infiltrate of inflammatory cells and osteoclasts and has a predictive value of further development of erosions. In spondyloarthritis, BME of the sacroiliac joints identifies an active sacroiliitis and is associated with histological inflammation and radiographic progression, whereas the relationship between BME lesions of the spine and syndesmophyte development is still controversial. BME syndromes (BMES), such as transient osteoporosis of the hip, regional migratory osteoporosis, and transient post-traumatic BMES, are characterized by a BME pattern on MRI and a self-limiting course. The potential evolution of BMES toward osteonecrosis is still controversial.

Osteoporosis (OP) and increased risk of fracture are relevant features in patients with rheumatoid arthritis (RA). Low levels of serum vitamin D are frequently reported and correlate with a higher RA activity. This study evaluated factors related with the prescription of vitamin D supplements in RA patients and variables influencing the achievement of adequate vitamin D levels.Study population was made up by 1168 consecutive RA patients from 22 Italian rheumatology centers. Demographic and clinical variables data were collected and 25OH serum vitamin D was measured in all patients. Insufficient serum 25OH vitamin D levels were defined as values lower than 20 ng/mL.The majority of patients (56.0%) was not taking vitamin D supplements. Among the 514 supplemented patients, 196 (38.1%) were taking insufficient dosages (≤440 IU/day). Variables related with the prescription of supplements were older age, female sex, previous bone density assessment and OP diagnosis. Among the 318 patients using daily supplements ≥800 IU, 88 patients (27.7%) did not reach adequate levels of vitamin D. In these patients a higher HAQ score (OR for 1 point=1.62, 95% CI: 1.06-2.49; p=0.03) and poor sun exposure (OR=2.38, 95% CI: 1.05-5.55; p=0.04) were predictors of vitamin D insufficiency.Vitamin D deficiency is common in patients with RA, even in patients who are regularly using supplements. Vitamin D supplementation is often ineffective even at the recommended dose of 800 IU/day in more disabled patients.

Introduction: Gout is the most prevalent arthritis and significantly impacts on function and quality of life. Given that gout associates with disabling comorbid conditions, it is not clear whether such a complex of diseases accounts for the increased disability or if gout may play a role by itself. This study aims to evaluate the specific influence of gout and disease-related features on functional disability and health-related quality of life (HRQoL) in patients with gout followed in rheumatology clinics.Methods: A random sample of patients was drawn from clinical registries of 30 rheumatology clinics across Italy. Sociodemographic, general health and gout-specific variables were collected. Functional disability and HRQoL were assessed by the health assessment questionnaire (HAQ) and the Physical and Mental Component Summary scores (PCS and MCS) of the Short Form-36 (SF-36). Crude and adjusted ordinal logistic and linear regression models were applied to investigate the specific contribution of different variables on HAQ and SF-36 scores. Results are presented as odds ratio (OR) or mean difference (MD) and 95% confidence intervals.Results: Out of 446 patients with gout, 90% were males with a mean age of 63.9 years and median disease duration of 3.8 years; the majority of patients were overweight or obese, and with several comorbidities; 21.1% showed at least moderate disability; the PCS score was significantly lower than expected age- and gender-matched samples in the general population, while MCS score was not. After adjusting for potential sociodemographic and general-health confounders, gout-specific variables significantly impacted on HAQ, including polyarticular involvement OR 3.82 (1.63, 8.95), presence of tophi OR 1.92 (1.07, 3.43) and recent attacks OR 2.20 (1.27, 3.81). Consistent results were found for PCS. The impairment of PCS compared to the general population was limited to patients with features of chronic gout. MCS was only affected by recent attacks (MD -2.72 [-4.58, -0.86]) and corticosteroid treatment (-3.39 [-5.30,-1.48]).Conclusions: The data from the KING study confirm that gout impacts on disability and provide evidence for an independent association of gout and gout-related features with functional outcome and HRQoL. This result supports the need to improve specific treatment in gout.

As bactérias fixadoras de nitrogênio atmosféricos, via processo, simbiótico, repassam N2 às leguminosas sob forma de amônia, proporcionando aumento da produção de alimentos proteícos, reciclagem biológica de nitrogênio do ar, evitando o alto custo da adubação nitrogenada e o efeito potencialmente poluidor do nitrato lixiviado. Testou-se quatro estirpes de Rhizobium phaseoli frente a quatro fungicida indicadores para o tratamento de sementes de Phaseoli vulgaris L. (feijoeiro), no Estado do Rio grande do Sul (Brasil). Considerando-se as dosagens recomendadas do fungicida, houve crescimento bacteriano das quatro estirpes frente a Benomil e inibição total frente a Captan; porém, para PCNB e Thiram, a resistência dependeu do tipo de estirpes. Observou-se que não há influência de fungicidas sobre o desenvolvimento do Rhizobium phaseoli quando seleciona-se a estirpes adequada ao fungicida corretamente adequado.