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

Objective. Dietary interventions to improve fibromyalgia (FM) symptoms reported conflicting results. This study aimed to treat FM patients with a gluten-free diet (GFD), alternated with a non-restricted gluten-containing diet, followed by a rechallenge of the GFD. Methods. Twenty postmenopausal women with FM and no history of celiac disease participated. A GFD was assigned for 6 months. This was followed by 3 months of a non-restricted gluten-containing diet and then a new GFD for another 6 months. At each visit, the widespread pain index (WPI) and the symptom severity scale (SS) scores were evaluated. Results. The mean age of the patients enrolled was 53.9±10 years. None of the patients had a diagnosis of irritable bowel disease, although they reported vague gastrointestinal symptoms. After 6 months of a GFD, a statistically significant reduction was observed for the WPI (10.3±1.8 vs 7.7±1.4; p

The case of a patient suffering from systemic lupus erythematosus with associated antiphospholipid antibody syndrome is described. In this patient, on protein electrophoresis, two monoclonal immunoglobulin G λ and k peaks were seen, defining a condition of biclonal gammopathy of undetermined significance (BGUS). This condition is extremely rare, especially in chronic inflammatory rheumatic diseases. The criteria of a BGUS are defined. We also underline how this condition can be the expression of a concomitant unrecognized cancer, a possible amyloidosis or an infectious process.

Recent research has increasingly shown that depending on the foods we eat, gut flora may be affected by an inflammatory or anti-inflammatory response, thus playing an important role in inflammatory autoimmune diseases, such as rheumatoid arthritis or gastroenterological disorders. Gluten seems to be a glycoprotein with a clinically relevant inflammatory effect. Several observational studies and anecdotal cases reported a correlation between gluten and various diseases, including autoimmune diseases, such as rheumatoid arthritis. This study aimed to evaluate whether gluten-free diet could be effective in controlling inflammation and ongoing rheumatoid arthritis symptoms. We report 4 cases of patients with long-standing rheumatoid arthritis with no response to several conventional and biotechnological drugs, treated with a gluten-free diet concurrently with the drug therapy. Our patients presented different degrees of response to the diet, in terms of disease remission and improvement of symptoms. Our cases confirm that a gluten-free diet may improve symptoms of rheumatoid arthritis, even in patients resistant to conventional drug therapies.

The association between Sjögren syndrome (SS) and psoriatic arthritis (PsA) is rare. Herein, we report a case of SS in a PsA patient with the mutilans variant. A 67-year old woman developed PsA with progressive articular destruction up to the typical deformation of ‘telescoping fingers’ in the distal phalanges. Psoriatic onychopathy presented ten years after the osteolytic damage in the hands. This late appearance led to delayed diagnosis and therapy, and, consequently, worsened the articular destruction. Thereafter, the patient developed a typical SS with clinical symptoms, such as xerophthalmia and xerostomia. This diagnosis was confirmed by positive diagnostic tests, such as Schirmer test, ANA, and anti-SSA/Ro and anti-SSB/La antibodies. A potential association between the two diseases is discussed.

Objectives: In this study, we aimed to characterize the SARS-CoV-2-specific T cell response detected by the QuantiFERON SARS-CoV-2 research use only assay in terms of accuracy and T cell subsets involved compared with a homemade interferon (IFN)-γ release assay (IGRA).Methods: We evaluated T cell response by the standardized QuantiFERON SARS-CoV-2 tubes (antigen [Ag]1 and Ag2) and a homemade IGRA quantifying IFN-γ response to SARS-CoV-2 spike peptides (homemade-IGRA-SPIKE test). We evaluated the T cell subsets mediating the specific response using flow cytometry.Results: We prospectively enrolled 66 individuals: COVID-19 or post-COVID-19 subjects and NO-COVID-19-vaccinated subjects, including healthy donors and immunocompromised subjects. The standardized kit detected 62.1% (41/66) of T cell responders. Ag2 tube showed a higher IFN-γ quantitative and qualitative response. Ag1 tube response was mainly mediated by CD4+ T cells; Ag2 tube response was mediated by CD4+ and CD8+ T cells. The homemade-IGRA-SPIKE test detected a higher number of responders (52/66, 78.8%) than the QuantiFERON SARS-CoV-2 assay (P = 0.056). The response was found in both T cell subsets, although a higher magnitude and response rate was observed in the CD4+ T cell subset.Conclusion: The QuantiFERON SARS-CoV-2 response is mediated by CD4+ and CD8+ T cells. A lower number of responders is found compared with the homemade-IGRA-SPIKE test, likely because of the different peptide composition.

• Hounsfield Unit (HU) measurements derived from the cervical and thoracic spine correlate with the validated lumbar HU. • Thoracic HU measurements provide surrogate values to those derived from the lumbar spine. • HU measurements do not appear to vary based on sex, ethnicity, age, height, or weight. • This study cautions the direct use of cervical HU to obtain the same clinical answers as lumbar HU measurements. Bone mineral density assessment using Hounsfield Unit (HU) currently depends upon the availability of computed tomography (CT) of the lumbar spine. The primary aim of this study was to evaluate the associations among HU measurements of the cervical (CHU), thoracic (THU), and lumbar (LHU) spine. The secondary aim of this study was to analyze the influence of patient demographic and anthropometric characteristics on HU measurements. Radiographic records of 165 patients who underwent CT of the cervical, thoracic, and lumbar spine were retrieved. The CHU, THU, and LHU were calculated by obtaining the mean signal intensity from the medullary portions of C3-C7, T8-T12, and L1-L4 vertebral bodies. Mean CHU, THU, and LHU values were 266.26 ± 88.69, 165.57 ± 55.06, and 166.45 ± 51.38. Significant differences of 100.69, 99.81, and 0.88 were observed between CHU and THU (p <.001), CHU and LHU (p <.001), and THU and LHU (p =.023). Correlations of 0.574, 0.488, and 0.686 were observed between CHU and THU (p <.001), CHU and LHU (p <.001), and THU and LHU (p <.001). No differences in HU based on sex, age, height, weight, or ethnicity were observed. Multivariate regression models demonstrated R2 values of 0.770 - 0.790 (p <.001) in prediction of LHU. Hounsfield Unit measurements derived from the cervical and thoracic spine correlate with the validated lumbar Hounsfield Unit. Hounsfield Unit measurements do not vary based on sex, ethnicity, age, height, or weight. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac allograft vasculopathy remains a major cause of mortality after cardiac transplantation. Percutaneous revascularization has become the mainstay of therapy given the poor historical outcomes with surgery. Outcomes following surgical revascularization are evaluated to determine whether surgery remains a viable therapeutic option. Methods: A retrospective analysis was performed of 13 heart transplant recipients who had cardiac allograft vasculopathy requiring coronary artery bypass grafting with or without adjunctive percutaneous coronary intervention for revascularization from 1999 to 2008. Results: Thirteen patients had 14 coronary artery bypass grafting procedures at 141 ± 66 months after transplantation. The average number of grafts was 2.3. Eight were performed without cardiopulmonary bypass, of which 5 were approached via left thoracotomy and the remainder via repeat sternotomy. One patient had renal failure and a cerebrovascular accident. Percutaneous coronary intervention before or after coronary artery bypass grafting was required in 3 patients. There were no perioperative mortalities. At mean follow-up of 39 ± 36 months, 3 patients have died, 2 from progressive cardiac allograft vasculopathy and 1 from lung cancer. Kaplan-Meier survival for this group of patients was 92%, 83%, and 83% at 1, 5, and 7 years, respectively. Conclusions: Surgical revascularization for cardiac allograft vasculopathy remains a viable treatment option for appropriate patients and may be performed safely with good medium-term outcomes. However, patients remain at risk for disease progression and may require percutaneous or surgical reintervention. [Copyright &y& Elsevier]

Accuracy in the characterisation of odour-emitting sources is particularly significant for the implementation of a truly representative odour impact study. The selection of sampling techniques to measure odour concentrations, along with an accurate method to assess Odour Emission Rate, is closely linked to the type of source under investigation. The distinction between active and passive sources is not always obvious, such as in the case of biological oxidation tanks. This kind of emissive source, commonly classified as a passive source, is characterised by convective flow that is generally not intense. Indeed, the flushing of a known airflow within a dynamic hood, such as a wind tunnel system, necessary to simulate the wind action on the surface of the tank, may not be the driving force of the system. The aim of the present study is to evaluate the emissive contributions of biological oxidation tanks, focusing on the phenomenon of aeration and the effect of wind on the liquid surface of an oxidation basin. Using different sampling methodologies, through different field measurements, the Specific Odour Emission Rates, associated with each contribution, were measured and compared. The results indicate that the stripping phenomenon due to the convective flow generated by aeration can account for up to 96% of the odorous emission contribution.

Gaseous emissions which may be of odour impact and interest are not solely derived from industrial processes or agricultural fields, but also from natural sources. Natural odorous gaseous emissions are often present in geothermal areas. In these cases, the inventory and the measurement of the emitted gas flows are not trivial. This work presents the experience of an olfactometric survey conducted in a geothermal-interest area, specifically around Mt. Amiata, Tuscany, Italy. Dynamic olfactometry analyses showed odour concentrations in the order of millions of ouE/m3. While the main constituent of these natural gas emissions was CO2, the very high odour concentration data primarily resulted from the high portion of H2S in these emissions, with detected concentrations ranging from 1,000 to 10,000 ppmv. This not only indicates the presence of odour impact potential but also the high risk for people in the nearby area due to the high concentration of this gas. In parallel with the measurement of representative concentration data of these spot vents, a flexible and innovative approach was established for the measurement of emitted gas flow. The main breakthrough was obtained via the revamping of a balometer, a tool used for the measurement of indoor airflows, in the measurement of the gas flow of large spot vents (i.e. mine gates). Thanks to this stretchy approach, it was possible to estimate the OER of these emissions: the overall OER of all the inventory of the investigated spot vents in the area was impressive, and reached almost 10 million of ouE/s.

Objectives: The persistence in therapy of rheumatoid arthritis drugs and particularly bDMARD is a limiting factor for their long-term use. The randomized controlled trials (RCTs) may not reflect real-world contexts due to strict inclusion and exclusion criteria. Baricitinib, which targets both JAK1 and JAK2, has been used in Italy for several years. The aim of this multi-center study is to assess the real world persistence on therapy of baricitinib in RA patients and to identify predictive factors of baricitinib's survival rate. Methods: This is a retrospective, multicentric, Italian, longitudinal study. All patients were enrolled according to the following criteria: a) age ≥ 18 years old; b) diagnosed with RA according 2010 ACR/EULAR classification criteria; c) treated with baricitinib. In order to describe baricitinib clinical efficacy, the survival rate was evaluated by The Kaplan–Meier curve. Then, predictive factors of drug retention rate were assessed by performing the Cox analysis, identifying which risk factors influenced treatment persistence. Results: Overall, we included 478 patients treated with baricitinib. Among them, 380 (79.5%) were females. Baricitinib's survival rate was 94.6% at 6 months, 87.9% at 12 months, 81.7% at 24 months and 53.4% at 48 months. The Cox analysis regression showed that a higher bDMARDs/tsDMARD line of therapy seems to be a negative prognostic factor for the drug retention rate (HR 1.26 CI 95% 1.07–1.49, p = 0.006. Conclusion: Real-life study confirms baricitinib effectiveness up to 4 years, but previous treatment with bDMARDs was a negative prognostic factor for its survival rate.

Objectives: To characterize the kinetics of humoral and T-cell responses in rheumatoid arthritis (RA)-patients followed up to 4-6 weeks (T3) after the SARS-CoV-2 vaccine booster dose. Methods: Health care workers (HCWs, n = 38) and patients with RA (n = 52) completing the messenger RNA vaccination schedule were enrolled at T3. In each cohort, 25 subjects were sampled after 5 weeks (T1) and 6 months (T2) from the first vaccine dose. The humoral response was assessed by measuring anti-receptor-binding domain (RBD) and neutralizing antibodies, the T-cell response by interferon-γ-release assay (IGRA), T cell cytokine production, and B cell phenotype at T3 by flow cytometry. Results: Patients with RA showed a significant reduction of antibody titers from T1 to T2 and a significant increase at T3. T-cell response by IGRA persisted over time in patients with RA, whereas it increased in HCWs. Most patients with RA scored positive for anti-RBD, neutralizing antibody and T-cell responses, although the magnitude was lower than HCWs. The spike-specific-cytokine response was mainly clusters of differentiation (CD)4+ T cells restricted in both cohorts and significantly lower with reduced interleukin-2 response and CD4-antigen-responding naïve T cells in patients with RA. Unswitched memory B cells were reduced in patients with RA compared with HCWs independently of vaccination. Conclusion: COVID-19 vaccine booster strengthens the humoral immunity in patients with RA even with a reduced cytokine response.

Physics research is constantly pursuing more efficient silicon detectors, often trying to develop complex and optimized geometries, thus leading to non-trivial engineering challenges. Although critical for this optimization, there are few silicon tile mechanical data available in the literature. In an attempt to partially fill this gap, the present work details various mechanical-related aspects of spaceborne silicon detectors. Specifically, this study concerns three experimental campaigns with different objectives: a mechanical characterization of the material constituting the detector (in terms of density, elastic, and failure properties), an analysis of the adhesive effect on the loads, and a wirebond vibrational endurance campaign performed on three different unpotted samples. By collecting and discussing the experimental results, this work aims to fulfill its purpose of providing insight into the mechanical problems associated with this specific application and procuring input data of paramount importance. For the study to be complete, the perspective taken is broader than mere silicon analysis and embraces all related aspects; i.e., the detector–structure adhesive interface and the structural integrity of wirebonds. In summary, this paper presents experimental data on the material properties of silicon detectors, the impact of the adhesive on the gluing stiffness, and unpotted wirebond vibrational endurance. At the same time, the discussion of the results furnishes an all-encompassing view of the design-associated criticalities in experiments where silicon detectors are employed.

The Odour Emission Capacity (OEC) is an experimental parameter that quantifies the odour potential of a liquid, in terms of ouE/m3liquid, based on the stripping of odorants contained in a known amount volume of liquid. The method was implemented for the first time in 1998 by Frechen and Köster and standardized in 2015 in the German technical standard VDI Guideline 3885/1. In particular, the sampling steps of gas phase for the dynamic olfatctometry analysis were fixed at 2, 6, 16 and 32 minutes. This work aims to propose a modified methodology to evaluate this parameter in wastewater which come from the sewer systems and industrial wastewater treatment plants (WWTP) characterized by high odour load (e.g. oil-refinery desalter water, oil-well water). The implementation of a system of dilution for the sampled gas, has appeared to be an important aspect to take into account in case of high odorous load, because it allows to perform the analysis also with smaller liquid volume (i.e. 1 L), a necessary condition for lab logistics and safety considerations as the safeguard of the involved operator’s health (e.g. panel members, lab analysts). In order to improve the accuracy of the result and optimize the methodology, a different approach was studied through the increase in the number of odour concentration measurements and the modification of the sampling times. Results show that increasing the time of analysis from 32 min to 2 days, the trend of the time-varying integral of OEC reaches a quasi-stationarity respect the same curve associated to the OEC estimated with the standard methodology.