Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience.

Ultrasound (US) has become a useful tool in the detection of early disease, differential diagnosis, guidance of treatment decisions and treatment monitoring of rheumatoid arthritis (RA). In 2008, the Swiss Sonography in Arthritis and Rheumatism (SONAR) group was established to promote the use of US in inflammatory arthritis in clinical practice. A scoring system was developed and taught to a large number of Swiss rheumatologists who already contributed to the Swiss Clinical Quality Management (SCQM) database, a national patient register. This paper intends to give a Swiss consensus about best clinical practice recommendations for the use of US in RA on the basis of the current literature knowledge and experience with the Swiss SONAR score. Literature research was performed to collect data on current evidence. The results were discussed among specialists of the Swiss university centres and private practice, following a structured procedure. Musculoskelatal US was found to be very helpful in establishing the diagnosis and monitoring the evolution of RA, and to be a reliable tool if used by experienced examiners. It influences treatment decisions such as continuing, intensifying or stepping down therapy. The definite modalities of integrating US into the diagnosis and monitoring of RA treatments will be defined within a few years. There are, however, strong arguments to use US findings as of today in daily clinical care. Some practical recommendations about the use of US in RA, focusing on the diagnosis and the use of the SONAR score, are proposed.

The "open" chimney graft technique for juxtarenal aortic aneurysms with discrepant renal arteries.

OBJECTIVES: A straightforward original Chimney Graft (CG) protocol has been developed at our institution in selected cases of juxtarenal aortic aneurysm (JRAA). The aim of this study was to present our clinical experience of consecutive series with use of uncovered self-expanding stent (SES) as "Open Chimney" (OCh) in the endovascular repair (EVAR) of JRAA. METHODS: A standard endograft with suprarenal fixation struts is delivered with its proximal covered edge just below the highest RA in JRAA presenting the ostium of the two renal arteries at a different aortic level and the distance between the highest renal artery and the beginning of the aneurysm (improved landing zone) ≥10 mm. The low-lying renal artery is maintained patent by the OCh graft (standard SES) delivered from left brachial access (6 Fr). All clinical, anatomical, and operative data were prospectively collected and retrieved for the study analysis. RESULTS: From July 2010 to November 2012, OCh EVAR was offered to 22 consecutive patients considered unfit for JRAA open repair. All procedures were technically successful with aneurysm exclusion and patent OCh graft. One small perioperative type Ia endoleak spontaneously disappeared at the 3-month CT control. One patient died because of acute decompensated heart failure. One patient presented a left hemispheric stroke. The median follow-up of 18 months (range 7-35) showed aneurysm exclusion in all patients without type I and III endoleaks, SES stenosis, and/or renal impairment. CONCLUSIONS: OCh-EVAR is a straightforward technique that can be employed in selected cases of JRAA, avoiding the more complex and expensive fenestrated EVAR.

La incidència de l'activisme lingüístic en el futur del català

Actuar sobre el futur implica realitzar algun tipus de prospectiva sobre com serà -o com sembla que serà- aquest futur. L'anticipació respecte dels fets que han d'ocórrer en la mesura que puguin ser previstos- i l'adequació dels discursos i les accions a les tendències que es dibuixen com a majoritàries en la societat són fonamentals per a l'èxit d'una acció transformadora.Ara com ara tot sembla indicar que ens dirigim cap a un futur 'glocal', és a dir, en part global i en part local. Molt probablement anirà creixent la interdependènciatecnoeconòmica de les societats humanes i la influència dels grans emissors tecnomediàtics sobre els més petits encara augmentarà més. Les possibilitats d'acció sobre la determinació dels usos lingüístics per part dels grups humans demogràficament poc extensos i/o políticament subordinats tendiran probablement a disminuir més que no pas a augmentar.Les representacions s'internacionalitzaran i passarem a una etapa 'polinacional' i deconsciència planetària. En situacions mínimament democràtiques la consciènciad'interdependència podrà tendir a fer baixar els adeptes a les ideologies independentistes estrictes -si els grups majoritaris dominants no abusen del seu poder- i caldrà passar a imaginar estructures d'autogovern o de sobirania cooperatives.Això farà més complex el fet de l'organització de la diversitat lingüística, ja que el contacte s'estendrà pertot -a causa de les integracions suprapolítiques i econòmiques o bé per raó dels moviments migratoris. La perspectiva d'una societat d'individus monolingües tindrà probablement pocs adeptes entre els grups humans menors i caldrà formular des del pensament complex propostes sostenibles d'equilibri en la distribució de funcions entre les llengües en presència.

Thrombin-sensitive dual fluorescence imaging and therapeutic agent for detection and treatment of synovial inflammation in murine rheumatoid arthritis.

We have developed a thrombin-sensitive polymeric photosensitizer prodrug (T-PS) to selectively image and eradicate inflammatory lesions in rheumatoid arthritis (RA). Thrombin is a serine protease up-regulated in synovial tissues of rheumatoid arthritis (RA) patients. T-PS consists of a polymeric backbone, to which multiple photosensitizer (PS) units are tethered via short thrombin-cleavable peptide linkers. Fluorescence emission and phototoxicity of the prodrug are efficiently quenched due to the interaction of neighboring photosensitizer units. The prodrug is passively delivered to the inflammation site via the enhanced permeability and retention (EPR) effect. Subsequent site-selective proteolytic cleavage of the peptide linkers restores its photoactivity by increasing the mutual distance between PS. Whole animal imaging in murine collagen-induced arthritis, an experimental model of RA revealed a dose-dependent fluorescence increase in arthritic paws after systemic prodrug injection. In addition, administration of T-PS resulted in much higher fluorescence selectivity for arthritic joints as compared to the free PS. Irradiation of the arthritic joints induced light dose dependent phototoxic effects such as apoptosis, vascular damage and local hemorrhage. Long-term observations showed complete regression of the latter. Irradiated non-arthritic tissues or non-irradiated arthritic tissues showed no histological effects after photodynamic therapy with T-PS. This illustrates that T-PS can localize inflammatory lesions with excellent selectivity and induce apoptosis and vascular shut down after irradiation.

Tratamiento de la hiperhidrosis plantar con toxina butolínica tipo A

El problema de hiperhidrosis afecta al 0,5% de la población, y puede causar considerable estrés emocional, dificultando en ocasiones la vida personal, laboral y social del paciente, llevándole, por ejemplo, a evitar un acto como dar la mano o quitarse los zapatos en público. Por otra parte, el excesivo sudor puede ocasionar maceración cutánea, acrocianosis, queratoderma e incluso deshidratación. La forma más frecuente de hiperhidrosis es la idiopática y en el 60% de los casos afecta a palmas y plantas de los pies. En este artículo presentamos la aplicación del tratamiento con la toxina butolínica tipo A.

¿Conoces el MARSA? ¿Sabes cómo actuar delante de un MARSA?

En este artículo dedicamos una especial atención a las diferentes formas de actuación ante las enfermedades infecciosas y las resistencias a los antibióticos en un gabinete podológico. En concreto, se decriben los protocolos utilizados en casos de MARSA.

Seny i sentit comú en Jaume Balmes

L'article tracta de la criteriologia del sentit comú del filòsof Jaume Baimes i la seva relació amb la noció del seny. Atès que és un problema explicar el significat exacte tant de sentit comú com de seny en un sentit filosòfic, intentem distingir els diferents possibles significats d'ambdues nocions. No obstant, es tracta d'un tema prou extens i per tant l'estudiarem aquí només en relació amb la filosofia balmesiana. Comencem exposant la criteriologia de Balmes, en què el sentit comú és només un dels tres criteris fonamentals de veritat. Ademés, a cada criteri correspon un primer principi. Els criteris són: 1) la consciencia (amb el primer principi del cogito),que abasta tots els fets interns de la ment; 2) L'evidència, regulada pel principi de no contradicció, i 3) el sentit comú o tendencia natural de la nostra raó vers el ver. De tota manera, aquesta darrera noció és més complexa i ens cal distingir-hi diferents significats. Alguns d'ells són semblants a la noció de seny, entesa com una certa saviesa pràctica. Concloem afirmant que en la seva obra primerenca la noció balmesiana de sentit comú s'aproxima més a la de seny que la de la Filosofia Fundamental.

Subjetividad humana y "error" en la filosofía cartesiana

El presente trabajo, continuando la línea investigadora acerca de las nociones derazón, conciencia y subjetividad en Descartes, tal como se ha defendido en otros artículos ya publicados, aporta un nuevo argumento a una línea de trabajo previamente iniciada, poniendo de relieve que el problema gnoseológico del error viene condicionado por la misma noción cartesiana de racionalidad, y que ésta dista mucho de lo que tradicionalmente se ha entendido como una racionalidad abstracta y formal, libre de los imperativos humanos. Por otro lado, y a la inversa, también se intenta mostrar como el hecho del error contribuye, cartesianamente hablando, a definir un modelo de racionalidad profundamentehumanizada. El artículo, tras una introducción, se propone analizar las relaciones entre los conceptos básicos de racionalidad, dogma, y naturaleza, lo que permitirá a continuación dejar constancia de la copertenencia entre racionalidad y error, para acabar viendo como la libertad humana es la vez, y para ambos, su fundamento último.

Effect of orthographic processes on letter identity and letter-position encoding in dyslexic children.

The ability to identify letters and encode their position is a crucial step of the word recognition process. However and despite their word identification problem, the ability of dyslexic children to encode letter identity and letter-position within strings was not systematically investigated. This study aimed at filling this gap and further explored how letter identity and letter-position encoding is modulated by letter context in developmental dyslexia. For this purpose, a letter-string comparison task was administered to French dyslexic children and two chronological age (CA) and reading age (RA)-matched control groups. Children had to judge whether two successively and briefly presented four-letter strings were identical or different. Letter-position and letter identity were manipulated through the transposition (e.g., RTGM vs. RMGT) or substitution of two letters (e.g., TSHF vs. TGHD). Non-words, pseudo-words, and words were used as stimuli to investigate sub-lexical and lexical effects on letter encoding. Dyslexic children showed both substitution and transposition detection problems relative to CA-controls. A substitution advantage over transpositions was only found for words in dyslexic children whereas it extended to pseudo-words in RA-controls and to all type of items in CA-controls. Letters were better identified in the dyslexic group when belonging to orthographically familiar strings. Letter-position encoding was very impaired in dyslexic children who did not show any word context effect in contrast to CA-controls. Overall, the current findings point to a strong letter identity and letter-position encoding disorder in developmental dyslexia.

Impact of etanercept-methotrexate therapy on patient-reported outcomes in rheumatoid arthritis patients with up to 12 months of symptoms.

Background/Purpose: Patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA) are critical in evaluating RA treatment effects on function and health-related quality of life (HR-QoL). Significant improvement in PROs has been reported in RA studies of biologic agents, including etanercept (ETN), but most studies have been conducted in patients with established disease. In addition to assessing treatment effects in early RA, there is interest in therapeutic strategies that allow dose reduction or withdrawal of biologic therapy (biologic-free) after induction of response. The PRIZE trial is an ongoing, 3-period study to evaluate the efficacy of combined ETN and methotrexate (MTX) therapy in patients with early, moderate-to-severe RA and to assess whether efficacy (remission) can be maintained with ETN dose reduction or biologic-free (Period 2) or drug-free (Period 3). Herein we report PROs associated with ETN 50 mg QW plus MTX (ETN50/MTX) therapy administered for 52 wks in Period 1 (induction) of the PRIZE trial. Methods: In Period 1, MTX- and biologic-naı‥ve patients with early, active RA (symptom onset 12 mo from enrollment; DAS28 _3.2) received open-label ETN50/MTX for 52 wks. The starting dose of MTX was 10 mg QW; at the discretion of the investigator, titration was permitted up to a maximum of 25 mg QW to achieve remission. Corticosteroid boosts were administered to patients not achieving low disease state at wks 13 and 26, unless contraindicated or not tolerated. PROs were assessed using the Health Assessment Questionnaire (HAQ) total score; Patient Acceptable Symptom State (PASS); EuroQol-5 Dimensions (EQ-5D) total index; Short Form Health Survey (SF-36); Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue; Work Instability Scale for Rheumatoid Arthritis (RAWIS); and Work Productivity and Activity Impairment Questionnaire: Rheumatoid Arthritis (WPAI:RA). Results: A total of 306 patients received treatment in Period 1 (mITT population); 222 (73%) patients completed the period. The majority of patients were female (70%), with a mean age of 50 y, mean DAS28 of 6.0 (median, 6.0), and duration of disease symptoms from onset of 6.5 months (median, 6.3 mo). Significant and clinically meaningful improvements in PROs, including in HAQ, EQ-5D, SF-36, and FACIT-Fatigue, were demonstrated with ETN50/MTX therapy from baseline to the final on therapy visit (Table; P_0.0001). Similar improvements were observed in all dimensions of RA-WIS and WPAI:RA (Table; P_0.0001). Conclusion: Combination therapy with ETN50/MTX for 52 wks in patients with _12 mo of symptomatic, active RA resulted in significant, clinically important improvements in measures of physical function, including normal HAQ (66.6% of patients), HR-QoL, fatigue, and work productivity. These outcomes are consistent with those reported in prior studies in patients with more established disease.

La succión del pulgar: evolución conceptual

Dentro de la etiopatogenia de las maloclusiones y entre los hábitos orales, tenemos la succión digital, y el dedo pulgar con mayor frecuencia, como una de las formas más influyentes en la deformación maxilar y maloclusión subsiguiente. En este artículo se hace un repaso de las diferentes teorías que, a lo largo de la historia, han ido ilustrando las opiniones de los diferentes autores, tanto a favor como en contra del hábito de succión del pulgar.

Fuentes documentales de la ortodoncia

Se exponen las fuentes documentales más importantes para el estudio de la ortodoncia, como ciencia de la salud, dejando para un segundo artículo el listado específico de las fuentes bibliográficas propiamente dichas.

Aproximación a las fuentes bibliográficas de interés en Ortodoncia II

Segunda parte y final de las fuentes bibliográficas más importantes para el estudio de la ortodoncia, como ciencia de la salud. Aquí se relacionan las publicaciones periódicas, específicas y generales, tesis y videos.

Aproximación a las fuentes bibliográficas de interés en Ortodoncia I

Se exponen las fuentes bibliográficas más importantes para el estudio de la ortodoncia, como ciencia de la salud, que viene a complementar el anterior artículo sobre "Fuentes documentales de la ortodoncia". Se relaciona la bibliografía ortodóncica aparecida en España.

Administration of IL-18BP by gene therapy reduces inflammation and prevents joint destruction by downregulation of MMP-9 in rat AIA Role of MMP-9 in bone and joint destruction in arthritis

Background and objectives: Interleukin-18 (IL-18) is a pleiotropic cytokine involved in rheumatoid arthritis (RA) pathogenesis. This studywas carried out to evaluate the efficicacy of interleukin-18 binding protein (IL-18BP) gene therapy in the rat adjuvant-induced arthritis (AIA) model and to decipher the mechanisms by which IL-18BP delivery lessens bone destruction. Materials and methods: Arthritis was induced in female Lewis rat by Mycobacterium butyricum and the mRNA expression of IL-18 and IL-18BP was determined in the joints. In a preventative study, rats were divided into an adenovirus producing IL-18BP-Fc (AdmIL-18BP-Fc) group (n=8) and an adenovirus producing green fluorescent protein (AdGFP) group (n=7). On day 8 after AIA induction, adenoviruses were injected. Clinical parameters were assessed. At day 18, during maximal arthritis, the rats were euthanized, ankles were collected, and X-rays were performed. mRNA and protein were extracted from joints for analyses by qRT-PCR, multiplex, Western blot, and zymography. Results: We observed a decrease in the [IL-18BP/IL-18] ratio from day 7 to day 45. Administration of AdmIL-18BPd-Fc decreased clinical parameters and prevented bone and joint destruction compared to AdGFP administration. IL-18BP delivery reduced the metalloproteinase 9 (MMP-9) levels by 33% (at protein level (Fig. 1B) and functional level (Fig. 1C) and the tartrate-resistant acid phosphatase (TRAP) level by 44% (Fig. 1D) in the joint homogenates from AdmIL-18BPd-Fc compared to AdGFP treated rats.However, no variationwas observed forMMP-2 at the protein level (Fig.1A) and functional level (Fig. 1C). Conclusions: In rat AIA, a decrease in the [IL-18BP/ IL-18] ratio was observed. IL-18BP delivery prevented joint and bone destruction by downregulating MMP-9 and TRAP, suggesting a potential benefit of a similar therapy in RA.