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BackgroundInternational clinical practice guidelines for the management of osteoarthritis (OA)1 2 recommend exercise, education and diet as first-line interventions since they are safe, low cost and reported to be effective, in reducing OA pain and disability, regardless of the severity of the disease. However, these treatments require high levels of adherence, which may be difficult to achieve. One of the possible reasons that can jeopardise patients’ adherence with first-line interventions for OA is the lack of awareness of the role that these treatments play in their care.ObjectivesTo investigate the level of awareness of non-pharmacological and non-surgical treatments for hip and knee OA in a cohort of people with this disease in Sweden.MethodsA cross-sectional, online survey-based study was conducted in Sweden. People with diagnosed knee or hip OA were recruited through social media outlets and patients’ associations. The survey was divided into two sections: (i) participants’ demographic and clinical characteristics (e.g. gender, age, income, work, height, weight, level of physical activity, previous surgeries, pain, level of disability) and (ii) a set of items with 22 treatments (e.g., weight advice, physical activity, drugs, supplements etc) where participants were asked to report whether each treatment was ‘recommended’, ‘optional’, ‘not recommended’, or ‘I don’t know’ - for the management of knee or hip OA. In the analyses, we grouped the 22 proposed treatments into ‘recommended’, ‘optional’, and ‘not recommended’ according to existing international guidelines.1 2 Based on the responses, participants were categorised as “aware” if they correctly identified all the treatments, “partially aware” if they correctly identified at least one treatment, and “not aware” if they did not correctly identify any of the treatments.ResultsParticipants comprised 123 people with OA of the knee, hip or both (N=65, 22%; N=27, 22% and N= 33, 26% respectively). Their mean (SD) age was 60.3 (8.8) and 108 (88%) were women. Forty-eight (39%) were “aware” of the recommended treatments, 63 (50%) “partially aware” and 14 (11%) were “not aware”. Regarding the optional treatments, 2 (2%) were “aware”, 103 (82%) “partially aware” and 20 (16%) were “not aware”. For the treatments that were not-recommended, none was “aware”, while 69 (55%) and 56 (45%) were considered “partially aware” and “not aware”, respectively. Figure 1 summarises the responses of the participants to each treatment item.Figure 1.Participants’ responses to each treatmentConclusionSurvey participants seem to be more aware of the recommended treatments than the optional and not-recommended ones. A more holistic approach in the education of people with OA should be pursued, providing them with a complete overview of the possible OA treatments. This would help patients identify the most appropriate treatment option for their OA and facilitate a shared decision-making with their health professionals.References[1]Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27:1578–89.[2]Fernandes L, Hagen KB, Bijlsma JWJ, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72:1125–35.AcknowledgementsThis work is part of the project funded by EULAR (European Alliance of Associations for Rheumatology) “HPR: The EULAR health professionals research grant 2020.”Disclosure of InterestsNone declared

Pregnancy complications such as preeclampsia cause increased fetal oxidative stress and fetal growth restriction, and associate with a higher incidence of adult metabolic syndrome. However, the pathophysiological contribution of oxidative stress per se is experimentally difficult to discern and has not been investigated. This study determined, if increased intrauterine oxidative stress (IUOx) affects adiposity, glucose and cholesterol metabolism in adult Ldlr−/−xSod2+/+ offspring from crossing male Ldlr−/−xSod2+/+ mice with Ldlr−/−xSod2 +/- dams (IUOx) or Ldlr−/−xSod2 +/- males with Ldlr−/−xSod2+/+ dams (control). At 12 weeks of age mice received Western diet for an additional 12 weeks. Adult male IUOx offspring displayed lower body weight and reduced adiposity associated with improved glucose tolerance compared to controls. Reduced weight gain in IUOx was conceivably due to increased energy dissipation in white adipose tissue conveyed by higher expression of Ucp1 and an accompanying decrease in DNA methylation in the Ucp1 enhancer region. Female offspring did not show comparable phenotypes. These results demonstrate that fetal oxidative stress protects against the obesogenic effects of Western diet in adulthood by programming energy dissipation in white adipose tissue at the level of Ucp1., Graphical abstract Image 1, Highlights • Intrauterine oxidative stress (IUOx) in absence of growth restriction was induced. • IUOx results in less obesity and improved glucose tolerance in adult male mice. • Reduced adiposity in adult males is due to browning of white adipose tissue (WAT). • Increased UCP-1 expression in WAT of IUOx mice is explained by lower methylation.

It has been well established that moderate alcohol consumption inversely correlates with cardiovascular morbidity and mortality, whereas binge alcohol drinking increases cardiovascular disease risk. The aim of this study was to assess in vivo the impact of different drinking patterns on reverse cholesterol transport (RCT), the atheroprotective process leading to the removal of excess cholesterol from the body. RCT was measured with a standardized, radioisotope-based technique in three groups of atherosclerosis-prone apolipoprotein E knock out mice: Placebo group, receiving water, which would mimic the abstainers, moderate group, receiving 0.8 g/kg alcohol/day for 28 days, which would mimic a moderate intake, binge group, receiving 0.8 g/kg alcohol/day for 5 days/week, followed by the administration of 2.8 g/kg alcohol/day for 2 days/week, which would mimic a heavy intake in a short period. Mice in the binge drinking group displayed an increase in total cholesterol, high density lipoprotein cholesterol (HDL-c) and non-HDL-c (all p &lt, 0.0001 vs. placebo), and a significantly reduced elimination of fecal cholesterol. The moderate consumption did not lead to any changes in circulating lipids, but slightly improved cholesterol mobilization along the RCT pathway. Overall, our data confirm the importance of considering not only the total amount, but also the different consumption patterns to define the impact of alcohol on cardiovascular risk.

The development of nutraceutical ingredients has risen as a nutritional solution for health prevention. This study evaluated the effects of Oleactiv&reg, an ingredient developed for the prevention of atherogenesis, in hypercholesterolemic hamsters. Oleactiv&reg, is a polyphenol-rich ingredient obtained from artichoke, olive and grape extracts as part of fruit and vegetables commonly consumed within the Mediterranean diet. A total of 21 Golden Syrian hamsters were divided into three groups. The standard group (STD) was fed a normolipidemic diet for 12 weeks, while the control group (CTRL) and Oleactiv&reg, goup (OLE) were fed a high-fat diet. After sacrifice, the aortic fatty streak area (AFSA), plasmatic total cholesterol (TC), high-density lipoproteins (HDL-C), non-HDL-C and triglycerides (TG), were assessed. The cholesterol efflux capacity (CEC) of hamster plasma was quantified using a radiolabeled technique in murine macrophages J774. OLE administration induced a significant reduction of AFSA (&minus, 69%, p &lt, 0.0001). Hamsters of the OLE group showed a significant decrease of both non-HDL-C (&minus, 173 mmol/L, p &lt, 0.05) and TG (&minus, 154 mmol/L, p &lt, 0.05). Interestingly, OLE induced a significant increase of total CEC (+17,33%, p &lt, 0,05). Oleactiv&reg, supplementation prevented atheroma development and had positive effects on the lipid profile of hypercholesterolemic hamsters. The increased CEC underlines the anti-atherosclerotic mechanism at the root of the atheroma reduction observed.

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

IntroductionThe screen for cognitive impairment in psychiatry (SCIP) is a brief, accessible scale designed for detecting cognitive deficits in psychiatric disorders.ObjectivesThe objective of this study is to test the SCIP's validity as a cognitive test by comparison with standard neuropsychological scale using the Pearson's correlation.Aims Test the convergent and discriminant validity of the SCIP within the Italian SCIP validation project.MethodsPatients between 18 and 65 years who are in a stable phase of the disease, diagnosed with schizophrenia, schizoaffective disorder or bipolar I disorder were enrolled in this study, from the community mental health department of Ferrara.ResultsThe tests were administered to 110 patients (mean age: 45 ± 11,4) and to 86 controls (mean age: 35 ± 12,6) of both sex. SCIP presents high correlation with the R-BANS total score (P < 0.01) and the subscales (verbal learning test-immediate, working memory, verbal fluency test, verbal learning test-delayed, processing speed test, P < 0.01). There are significant differences (P < 0.01) in all SCIP dimensions between patient and control group (Table 1).ConclusionsOur analysis confirm the results of the English, French and Spanish version of the SCIP regarding convergent and discriminant validity. The SCIP represents a valid, simple and brief screening tool for the cognitive evaluation of patients with schizophrenia-spectrum disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Bone regeneration is critical to the effective management of many bone and muscoloskeletal disorders, such as fracture healing, spinal fusion and osteoporosis. Bone morphogenetic proteins (BMPs) belong to the TGF-beta superfamily and play an important role in embryonic development and bone formation; at least 15 types of BMPs have been identified in humans and several forms of BMPs, mostly rhBMP-2 rhBMP-4 and rhBMP-7, have been shown to induce bone formation in vitro and in vivo. BMPs have also been used in combination with human mesenchymal stem cells (hMSC) that have the capacity to differentiate into bone cell lineages and have generated a great deal of interest because of their potential use in regenerative medicine and tissue engineering. We constructed a human BMP4-expressing first generation adenoviral vector using the CAG promoter for maximal expression of the transgene (FG-AdhBMP4). We purified hMSCs from bone marrow from donors using a physical separation; after two weeks of culture we immuno-depleted the obtained cells using commercially available antibodies against human glycophorin and CD45; we then characterized the resulting cells by citofluorimetry. Immuno-depleted cells were more homogeneous in staining with several markers (CD90, CD13, CD49b) and were negative for HLA-DR, showing only a mild positivity to HLA-ABC. We then infected hMSC cells with the FG-AdhBMP4 vector and observed very high levels of transduction and homogeneous commitment to the osteoblastic lineage. In addition, we purified MSCs from rabbit, transduced them with FG-AdhBMP4 and loaded them onto poly-caprolacton (PCL) scaffolds. The scaffolds were then implanted in a rabbit model of discontinuous bone fracture and lesions healing was compared to controls treated with the scaffolds alone and scaffolds containing untransduced rMSCs. Scaffolds containing rMSCs showed homogeneous formation of bone and reabsorption of PCL by osteoclasts, whereas hystological analysis of bones containing unloaded scaffolds showed areas of vascularization but absence of bone tissue.

Background & Aims: Helicobacter pylori ( Hp ) infection causes a chronic gastric inflammation, which can lead to peptic ulceration and cancer. The inflammatory response is multifactorial and is characterized by exaggerated Th1 cytokine production. How the Th1 response is induced and maintained in the stomach of Hp -infected patients remains unclear. Transforming growth factor (TGF)-β1 negatively regulates Th1 cell development, and TGF-β1-deficient mice spontaneously develop gastritis. Here, we examined TGF-β1 signaling in Hp -associated gastritis. Methods: Gastric biopsy specimens taken from patients with or without Hp infection were analyzed for the content of activated TGF-β1 by ELISA and Smad3 and 7 expression by Western blotting. Induction of Smad7 by interferon (IFN)-γ was examined in normal gastric mucosal biopsy specimens, whereas the effect of Smad7 inhibition on the ongoing Th1 response was analyzed in Hp -colonized biopsy specimens. Results: Activated TGF-β1 was abundant in the mucosa of controls and Hp -infected patients, with no significant difference between the 2 groups. Despite this, in whole biopsy specimens and isolated mucosal cells from Hp -infected patients, there was defective TGF-β1-associated Smad3 phosphorylation, which was associated with high expression of the inhibitor Smad7. Blocking Smad7 with antisense oligonucleotides restored TGF-β1 signaling in biopsy specimens from Hp -infected patients and concomitantly reduced interferon-γ and T-bet. Smad7 was inducible in normal gastric biopsy specimens by interferon-γ through a STAT1-dependent mechanism, and neutralization of interferon-γ in biopsy specimens from Hp -infected patients reduced Smad7 expression. Conclusions: These data suggest that, in Hp -infected gastric mucosa, interferon-γ induces the expression of Smad7, which then prevents endogenous TGF-β1 from down-regulating the ongoing tissue-damaging Th1 response.

The mutagenic activities of the enantiomers of the diastereomeric pair of bay-region 10,11-diol-8,9-epoxides of dibenz[a,h]acridine (DB[a,h]ACR) were evaluated in histidine-dependent strains of Salmonella typhimurium and in cultured Chinese hamster V79 cells. In strains TA98 and TA100 of S.typhimurium, the (-)-[8S,9R,10R,11S] diol-epoxide was the most mutagenic compound, inducing 1200 and 6900 His+ revertants/nmol respectively. The mutagenic activity of each of the remaining three isomers was essentially independent of the bacterial strain used and had 14-72% of the activity of the [S,R,R,S] isomer. However, in Chinese hamster V79 cells, the (+)-[8R,9S,10S,11R] diol-epoxide was the most mutagenic compound (68 8-azaguanine resistant variants/nmol/10(5) cells), inducing from 2 to 11 times as many mutations as the other three isomers. These results are analogous to previous studies with the bay-region diol-epoxides of other polycyclic hydrocarbons in that the isomer with [R,S,S,R] absolute configuration has had variable activity in the bacterial assays, but has generally been the most active in the mammalian cells. Furthermore, this isomer has almost always been highly tumorigenic in the mouse.

Hepatitis C virus (HCV) re-infection after liver transplantation (LT) is characterized by an accelerated disease progression in recent years with unclear mechanisms. We evaluate the relationship between progression of liver fibrosis and histological necro-inflammation in HCV recipients, according to age of transplant. Fifty-five patients transplanted (1993-2002) for HCV liver disease, were included in the study. Recipients were retrospectively stratified in three different age of transplant, of 40 months each: group 1) from January 1993 to May 1996; group 2) from June 1996 to august 1999; group 3) from September 1999 to December 2002. Grading (necro-inflammation) and staging (fibrosis) scores were evaluated in liver biopsies at 1, 2 and 3 years from LT (Ishak classification). For all age of transplant the main factor associated with fibrosis progression, was grading score (p < 0.05). However mean staging score for each point of grading increased from 0.3 +/- 0.2 in older LT to 0.7 +/- 0.5 in newer ones (p = 0.01). In conclusion in HCV-LT patients (1) liver fibrosis is strictly associated to histological necro-inflammation; (2) the proportion of this relationship has been changing in recent years since newer LT patients, show an increased amount of fibrosis in comparison with the older ones, for similar grading score.

Recent studies, on cells cultured in 3D collagen gels, have shown that, beside from their well known biochemical role, fibronectin (FN) and laminin (LM) affect cell functions via a modification of mechanical and structural properties of matrix due to interaction with collagen molecules. Though biochemical properties of FN and LM have been widely studied, little is known about their role in collagen matrix assembly. The aim of this work was to characterize FN- and LM-based collagen semi-interpenetrating polymer networks (semi-IPNs), in order to understand how these biomacromolecular species can affect collagen network assembly and properties. Morphology, viscoelasticity and diffusivity of collagen gels and FN- and LM-based collagen semi-IPNs were analysed by Confocal Laser Scanning microscopy (CLSM), Environmental Scanning Electron microscopy (ESEM), Transmission Electron Microscopy (TEM), Rheometry and Fluorescence Recovery After Photobleaching (FRAP) techniques. It was found that FN and LM were organized in aggregates, interspersed in collagen gel, and in thin fibrils, distributed along collagen fibres. In addition, high FN and LM concentrations affected collagen fibre assembly and structure and induced drastic effects on rheological and transport properties.

The L-arginine/nitric oxide (NO) pathway has been recognized as a main regulator of several cell functions. Accordingly, there is an increasing number of pathophysiological conditions in which a precise knowledge of NO status could prove helpful in understanding the mechanisms involved in disease development, prevention and treatment. These include several hepatic disorders, such as liver cirrhosis and associated hyperdynamic circulation with portal hypertension, ischaemia-reperfusion injury occurring during liver transplantation, and chronic cholestatic conditions. Overall, NO seems to exert a dual role in the pathobiology of liver diseases: one mostly beneficial, due to its vasoactive effects; and one mostly negative, due to its local toxic effects. Protective actions are primarily mediated via vasodilation, antithrombosis, inhibition of neutrophil adhesion and inhibition of apoptosis. Deleterious effects are dependent upon the formation of highly reactive substances during oxidative stress. In this review aspects related to NO implications in the homeostasis of liver functions as well as in the pathogenesis of some relevant hepatic clinical syndromes will be discussed in view of possible therapeutic options.

High Mobility Group I(HMGI) proteins are nuclear proteins involved in the regulation of chromatin structure and function, Elevated expression of the HMGI proteins (HMGI, HMGY and HMGI-C) has been correlated with the presence of a highly malignant phenotype in epithelial and fibroblastic rat thyroid cells, and in several experimental carcinomas, Here, we demonstrate that HMGI and HMGY proteins are expressed in human thyroid carcinomas and thyroid carcinoma cell lines, but not in adenomas, goiters, normal thyroid tissues and cells, These results indicate a correlation between HMGI and HMGY expression and the malignant phenotype of thyroid neoplasias, suggesting that these proteins may be used as markers in thyroid cancer.

The main purpose of this paper is to outline the standardization activities of ITU-T (the former CCITT) on audiovisual transmission quality. At present activities are aimed at defining families of subjective test methods one-way and two-way test methods. The paper also describes the results obtained from a two-way conversation test carried out by using videophone codecs accomplishing the CCITT recommendations. >

The state of the art in digital video coding is represented by a class of standardized algorithms that have in common the basic techniques of redundancy reduction, exploiting temporal correlation with prediction and spatial correlation with transformation. The development of audio-visual signal coding for public switched telephone networks (PSTN), local area networks (LAN), mobile networks (UMTS), raised a strong interest in the implementation of image compression algorithms down to very low bit rates (VLBR), of the order of a few tens of kbit/s. Current research activity in VLBR image coding is going on in two directions: the "short term " goal, that is the optimization of standard algorithms (namely, H.261 and MPEG-1) for the target formats, picture rates and bit rates; and the "long term" goal, i.e. the development of sophisticated methods for analysis-synthesis coding schemes, without constraints of compatibility with the first" generation" algorithms. The article reports the results of VLBR coding of video for audio-visual communication applications, using traditional predictive-transform schemes. >

Video coding at very low bit rates (VLBR), in the range of a few tens of kbit/s, is becoming very attractive for a number of new applications such as mobile videocommunication, videotelephony on the public switched telephone network (PSTN), multimedia electronic mail, remote sensing, interactive data bases, etc. The paper describes two VLBR predictive transform video coding schemes, compatible with existing standards. A subjective test was carried out to compare their performance. The assessment method was based on the double stimulus impairment scale method, even though important deviations were introduced to obtain more representative data. Results are presented in terms of both mean opinion score (MOS) and signal to noise ratio (SNR). Analysis of variance was also performed to evaluate the contribution of coding parameters to subjective quality variability. >

The paper presents the optimization of a software MPEG-4 video decoder on a specific architecture, suitable for parallel processing. First, a simplified structure of an MPEG-4 video decoder is reviewed. Second, a processor architecture that exploits the intrinsic parallelism of a video-decoding algorithm (architecture based on the concept of the "very long instruction word" machine) is presented. Then, the techniques used to write efficient C code for the VLIW machine and the principles on which these techniques are based are discussed. Finally, the paper presents the results obtained applying the optimization techniques to an MPEG-4 video decoder and a comparison between the performance obtained with the VLIW (250 MHz) processor and with a superscalar Pentium II (266 MHz) processor.

The study aimed to describe an example of the assessment and validation of knowledge-based clinical expert systems. The paper focuses on ICTERUS, an expert system for jaundice diagnosis. It describes system design, the methodology applied for upgrading and validating the program, and the most important outcomes of the validation procedure. The clinical validation of the system on a very large European database (Euricterus Project) shows that diagnostic conclusions are reliable in about 70% of eligible cases. This figure appears acceptable for a system which provides decision support only on the basis of clinical data, assuming that the final decision is achieved under user responsibility. Expected biases, limitations and inconsistencies in the practical application of the system are discussed.

The aims of the study were to evaluate the reproducibility of quantitative ultrasound (QUS) densitometry of the hands and to verify whether this method is sensitive to phalangeal bone changes occurring in osteoarthritis patients and in erosive osteoarthritis patients. We studied 60 postmenopausal women (aged 63.8 +/- 3.2): 20 had osteoarthritis, 20 had erosive osteoarthritis, 20 were postmenopausal without local pathology of the hand and eight were premenopausal (aged 23.5 +/- 3.4). The patients were evaluated by means of a DBM Sonic 1200 which is able to evaluate ultrasound transmission velocity (amplitude-dependent speed of sound). The results indicated good intra- and interoperator reproducibility (coefficient of variation = 0.99% and 1.04%) in the premenopausal group. The ultrasound device was able to discriminate between the different groups and detected differences between the QUS values of erosive osteoarthritis patients, osteoarthritis patients and control subjects. QUS densitometry is reproducible and sensitive to bone changes occurring in patients with osteoarthritis and as well as in those with erosive osteoarthritis.

A decision support system (HEPASCORE) has been developed to optimize the application of objective criteria for qualitative and quantitative assessment of liver function; clinical and laboratory data are automatically processed, and conclusions are explained. Early recognition of abnormal liver states is performed according to a sequential approach, based at first on clinical rules utilizing data from history and physical examination, then confirming or denying the hypothesis by means of selected laboratory tests. Once an abnormal condition is defined, clinical severity can be evaluated by use of suitable scores, either prognostic or focused on major clinical complications. In addition, selected sets of biochemical tests can be used to score one or more functional aspects. Lastly, whenever quantitative estimates of residual liver function are requested, dynamic tests can be applied to measure meaningful parameters such as functioning liver mass and functional hepatic plasma flow. HEPASCORE has been successfully applied to exclude liver abnormalities in subjects at risk, to follow up liver patients, to predict the natural outcomes of severe liver diseases, to foresee the adverse effects of drugs undergoing first-pass liver extraction and the side effects of invasive procedures. While the proposals contained in the system could be further modified for specific needs, they reflect a satisfactory methodological approach, and the program serves as a useful support to decisions regarding the identification and functional evaluation of hepatopathies. The system was developed with Microsoft Access 7.0 and runs on a personal computer under Windows 95.

A major problem in the assessment of liver function is represented by the quantification of the different aspects on which it relies (biosynthesis, drug metabolism, bile secretion, etc.) and of the clinical severity, with important prognostic implications. Another field that can be supported by quantification procedures is the histological evaluation of chronic hepatitis (necro-inflammatory activity and fibrosis). Finally, scoring systems can be usefully applied in clinical practice as a tool which supports medical decisions in very difficult diagnostic processes. In all the above considered fields, the scoring procedures have the important advantage to allow the standardisation of clinical procedures as well as to facilitate the statistical manipulation of data in controlled clinical trials. This paper reviews numerical scoring systems utilised in hepatology and their clinical applications.

The distal metaphysis of the first phalanx of the fingers II-V is, like the vertebral body, a useful site for the measurement of mineralisation and structure of the bone because of the simultaneous presence of compact and trabecular bone. With an ultrasound device (DBM sonic 1200, IGEA, Italy), we measured the adSOS (the amplitude dependent speed of sound) and the UBPS (ultrasound bone profile score), a score which is calculated from the graphic traces of the receiving probe with an expert system which uses fuzzy-logic at phalanges II-IV, as well as bone mineral density (BMD) at lumbar spine using dual X-ray absorptiometry (DXA). Precision of the measurements was as follows: adSOS: short-time-CV% = 0.576, long-time-CV% = 1.1, SCV% = 5.9, RMSSD% = 1.825. UBPS: short-time CV% = 5.95. There was no correlation between adSOS or UBPS and lumbar BMD (DXA). There was a significant positive correlation between adSOS and UBPS, r = 0.804 (p

Controversial data exist in the literature about the presence and clinical relevance of hepatic arterial-venous shunting. An interesting opportunity for reconsidering the problem has been provided by the use, in the study of liver function, of D-sorbitol, a substance whose first-pass hepatic extraction is very high in normal subjects, while being directly related to circulatory alterations in liver cirrhosis. Because of this property, the systemic bioavailability of D-sorbitol during hepatic arterial infusion can be assumed to reflect arterial-venous shunting. Thirteen biopsy-proven cirrhotic patients (ages 35-66 years), who required diagnostic arterial catheterization, entered the study. Patients were studied on two subsequent days, in which a sterile pyrogen-free solution (1.5%) of D-sorbitol was administered by direct low-rate infusion (15 mg/min for 20 min) into the hepatic artery and the systemic circulation, respectively. Urine samples were spontaneously collected for 8-hr periods before and during/after each infusion. The hepatic arterial bioavailability of D-sorbitol was calculated as the ratio between the net cumulative urinary outputs of D-sorbitol after infusions into the hepatic artery and the systemic vein. Observed values confirm the existence and the large variability (0-88.7%) of hepatic arterial-venous shunting in cirrhotic patients.

We have recently reported that neoplastic transformation of two rat thyroid epithelial cell lines by retroviruses carrying the v-mos and v-ras Ki oncogenes is associated with a drastic increase of AP-1 activity. The most important effects were represented by the dramatic junB and fra-1 gene induction, which was abolished by the block of the transformation-induced HMGI-C protein synthesis. Here, we have further characterized the transformation-dependent AP-1 activity, by analysing the expression of different jun- and fos-related components, in rat thyroid cell lines transformed by several oncogenes, in human thyroid carcinoma cell lines, and in naturally occurring human thyroid tumours. A significant increase of Fra-1 and JunB protein levels was detected in all oncogene transformed rat thyroid cell lines. Fra-1 gene induction was demonstrated to occur also in human thyroid carcinoma cell lines and tissues. Conversely, c-Jun and JunD proteins, rather than JunB, accumulated in human thyroid carcinoma cell lines. An induction of AP-1 target genes was also detected both in rat and human thyroid transformed cell lines. Therefore, in vivo and in vitro thyroid cell transformation is associated with important compositional changes in the AP-1 complex and an increased transcriptional activity.

The study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMAC-BME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.

Publisher Summary This chapter discusses the influence of channel errors on video decoder syntax and hardware architecture for broadcasting of TV/HDTV applications. Scalability became a key concept in the recent developments on video coding research motivated by the compatibility of MPEG 2 scheme with existing algorithms consolidated in terms of international standardization bodies but also as a powerful technique to deal with more general questions such as multiresolution video source formats and variable bitrate coding and error concealment techniques for noisy channel transmission and coexistence and expandability with/to different innovative coding schemes. Scalability means the ability to have more than one picture resolution and/or quality level readily available in the bitstream feeding a target decoder. Hybrid techniques, using the scalability modes, may be implemented increasing the coder/decoder complexity. The implementation of scalability is intimately related with the layered coding concept and it may be organized in different transmission modes. Simulcast mode which splits the available bitrate in several independent layers.

We investigated the relation between the extent and pattern of left ventricular hypertrophy and surgical outcome in 54 patients undergoing aortic valve replacement for severe aortic stenosis.Previous work from our laboratory has demonstrated that a subgroup of patients, mostly elderly women with Doppler evidence of abnormal intracavitary flow acceleration, had an unexpectedly high in-hospital mortality rate after aortic valve replacement for aortic stenosis. We hypothesized that marked concentric hypertrophy, rather than the Doppler signal itself, was related to the poor outcome.A retrospective analysis of the clinical, hemodynamic and echocardiographic data in patients who survived aortic valve replacement versus those who died in the hospital was performed.There were no differences between the 42 survivors and 12 nonsurvivors with regard to the clinical or hemodynamic variables. Of the echocardiographic variables analyzed, diastolic relative wall thickness was found to be significantly different between the two groups. Patients who died had significantly greater relative wall thickness (mean +/- SD) than those who survived (0.72 +/- 0.38 vs. 0.56 +/- 0.15, p = 0.04). Analysis by gender demonstrated that the relation between ventricular geometry and mortality held true only for women.We conclude that excessive ventricular hypertrophy, manifested as a markedly increased relative wall thickness, is associated with a significantly increased risk of postoperative mortality after aortic valve replacement for aortic stenosis.