POS0815 DIFFERENCES IN GIANT CELL ARTERITIS MANIFESTATIONS ACCORDING TO THE ULTRASOUND PATTERN OF DISEASE INVOLVEMENT

Background

Giant cell arteritis (GCA) is the most common form of primary systemic vasculitis in patients aged >50 years. It predominantly affects the cranial arteries; however, extra-cranial disease involving the aorta and its major branches, known as large-vessel GCA (LV-GCA), can be present in 20-80% of cases, depending on the imaging modality used for screening the disease.

Objectives

We aim to compare the clinical features and outcomes of GCA patients with exclusive cranial, exclusive LV and combined cranial and LV involvement.

Methods

Single centre retrospective study, using data from patients diagnosed with GCA registered at the Rheumatic Diseases Portuguese Registry (Reuma.pt). All patients underwent ultrasound of both temporal (TA) and axillary (AX) arteries ± facial (FA), occipital (OC), subclavian (SC) or common carotid (CC) arteries at the time of diagnosis. Only patients with the presence of “halo sign” in at least one of these arterial segments were included. Three groups of patients were established according to their ultrasound results: i) exclusive cranial-GCA in cases of TA, FA, or OC involvement; ii) exclusive LV-GCA in cases of AX, SC, or CC involvement; and iii) cranial- and LV-GCA in cases of both cranial and LV involvement. Univariate analysis was performed using T-test, Chi-square and ANOVA, as appropriate. Multivariate analysis was performed using logistic regression modelling.

Results

We included 81 patients with GCA, 55 (67.9%) females, with a mean ± SD age of 75.8 ± 8.6 years. Halo sign was found in the TAs of 66/81 (81.5%) patients, AXs of 38/81 (46.9%) patients, FAs of 37/71 (52.1%) patients, OCs of 15/58 (25.9%) patients, SCs of 27/46 (58.7%) patients and CCs of 12/57 (21.1%) patients. A total of 37 (45.7%) cases had exclusive cranial-GCA, 14 (17.3%) had exclusive LV-GCA and 30 (37.0%) had cranial- and LV-GCA. Regarding clinical manifestations, temporal headache was more frequently found in cases of exclusive cranial-GCA than in the other groups (67.6% vs 7.1% vs 56.7%, p=0.001). By contrast, patients with exclusive LV-GCA were less likely to experience temporal and frontal headache (67.6% vs 7.1% vs 56.7%, p=0.001; 48.6% vs 0% vs 40.0%, p=0.007; respectively), jaw claudication (67.6% vs 14.3% vs 60.0%, p=0.004), scalp tenderness (32.4% vs 0% vs 23.3% p=0.037) or a cranial ischemic event (54.1% vs 21.4% vs 66.7%, p=0.020). Concerning physical examination, exclusive LV-GCA was associated with abnormalities of the upper limb arteries (0% vs 15.4% vs 3.3%, p=0.042) and lack of TA changes (37.8% vs 0% vs 30.0%, p= 0.023). No significant differences were found between groups regarding demographics, comorbidities and occurrence of relapses or mortality in the first two years of disease (p>0.05). Multivariate analysis, adjusted for jaw claudication, scalp tenderness, frontal and temporal headache, cranial ischemic events, abnormalities of the TA and upper limb arteries on examination, was performed to assess the association between these variables and the three GCA groups. The occurrence of a cranial ischemic event was independently associated with a lower probability of exclusive LV-GCA [OR: 0.069 95%CI: 0.009-0.526, p=0.010]. No other independent predictors were found.

Conclusion

GCA can encompass various patterns of vascular disease on ultrasound. LV involvement was frequently found in these patients, including in cases without evidence of cranial disease, highlighting the need to incorporate LV assessment in the diagnosis of GCA. Patients with exclusive LV-GCA had fewer cranial manifestations and more abnormalities on upper limb arteries on examination than the other groups. The occurrence of a cranial ischemic event was an independent negative predictor for exclusive LV-GCA. No differences were found between groups regarding the clinical outcomes at two years. Further studies with longer time of follow-up are needed.

References

[1]Ponte C, Martins-Martinho J, Luqmani RA. Diagnosis of giant cell arteritis. Rheumatology (Oxford). 2020 May;59(Suppl 3):iii5-iii16. doi: 10.1093/rheumatology/kez553.

Disclosure of Interests

None declared

Regulation of human T-cell leukemia virus type 1 antisense promoter by myocyte enhancer factor-2C in the context of adult T-cell leukemia and lymphoma

Adult T-cell leukemia and lymphoma (ATLL) is an intractable T-cell neoplasia caused by a retrovirus, namely human T-cell leukemia virus type 1 (HTLV-1). Patients suffering from ATLL present a poor prognosis and have a dearth of treatment options. In contrast to the sporadic expression of viral transactivator protein Tax present at the 5' promoter region long terminal repeats (LTR), HTLV-1 bZIP gene (HBZ) is encoded by 3'LTR (the antisense promoter) and maintains its constant expression in ATLL cells and patients. The antisense promoter is associated with selective retroviral gene expression and has been an understudied phenomenon. Herein, we delineate the activity of transcription factor MEF (myocyte enhancer factor)-2 family members, which were found to be enriched at the 3'LTR and play an important role in the pathogenesis of ATLL. Of the four MEF isoforms (A to D), MEF-2A and 2C were highly overexpressed in a wide array of ATLL cell lines and in acute ATLL patients. The activity of MEF-2 isoforms were determined by knockdown experiments that led to decreased cell proliferation and regulated cell cycle progression. High enrichment of MEF-2C was observed at the 3'LTR along with cofactors Menin and JunD resulting in binding of MEF-2C to HBZ at this region. Chemical inhibition of MEF-2 proteins resulted in the cytotoxicity of ATLL cells in vitro and reduction of proviral load in a humanized mouse model. Taken together, this study provides a novel mechanism of 3'LTR regulation and establishes MEF-2 signaling a potential target for therapeutic intervention for ATLL.

Evaluation of COVID-19 case investigators’ interviewing skills in a portuguese public health unit

 

An effective control of the COVID-19 pandemic requires a thorough epidemiological interview of reported cases. The interviewer's skills and preparation directly affect the outcome of the investigation. This study applied a self-assessment survey of the COVID-19 patient interviewing skills on a local public health department workforce. The findings may be used to improve the quality of the interview process and the overall response to the pandemic at a community level. A 50-item questionnaire using a four-point Likert scale was adapted from the COVID-19 Patient Interview Skills Assessment Form created by the Centers for Disease Control and Prevention (CDC) and applied to 50 healthcare workers involved in epidemiological investigation of COVID-19 cases in Almada and Seixal, two municipalities of the Lisbon Metropolitan Area, from January to April of 2021. The most frequently executed steps concern checking patient data in advance (92%), questioning symptoms (97.2%), contact tracing (100%) and determining isolation periods for high risk contacts (100%). Least performed tasks include confirming the testing technique used (50%), asking about hospitalization (44.4%), assessing conditions for home isolation (44%), explaining how to self-monitor symptoms (61%) and checking if the patient understood the instructions (47%). In addition, 8% admitted to not always keeping patient information confidential. While caution is necessary as the data was limited to a single public health local department, our findings show that a majority of healthcare workers fulfill the essential steps of an epidemiological investigation. Areas in need of improvement include inquiring about infection severity, assessing social conditions for quarantine and confirming instructions for self-monitoring and follow-up. In line with CDC recommendations, we believe regular evaluation and feedback of case investigators' skills are crucial to quality assurance of a public health department.

Key messages

A detailed interview provides critical data for monitoring infected individuals and quickly trace, test and isolate those who might have been exposed, thus breaking chains of transmission. The results of this assessment can be used to introduce training measures such as shadowing and role-playing to ensure continued improvement in epidemiological investigations.

OP0055 ULTRASOUND HALO SIGN AS A POTENTIAL MONITORING TOOL FOR PATIENTS WITH GIANT CELL ARTERITIS: A PROSPECTIVE ANALYSIS

Background:

Ultrasound of the temporal ± axillary arteries showing a non-compressible halo sign is recommended for diagnosing patients with giant cell arteritis (GCA); however, its value for monitoring disease activity is still poorly understood.

Objectives:

To assess the sensitivity to change of ultrasound halo features and their association with disease activity and glucocorticoid (GC) treatment in patients with newly diagnosed GCA.

Methods:

Two centre prospective study of new patients with ultrasound confirmed-GCA who underwent serial ultrasound assessments of the temporal (TA) and axillary (AX) arteries at fixed time-points. The number of arterial segments with halo and the maximum halo intima-media thickness (IMT) per segment was recorded at each visit. Only time-points in which >80% of patients were assessed were considered for analysis. Sensitivity to change of the halo sign was calculated as standardised mean difference (SMD) for each time-point separately. Correlation between ultrasound findings and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Birmingham Vasculitis Activity Score (BVAS), and GC treatment was performed using Spearman’s correlation coefficient. Logistic regression was used to determine the probability of being in remission for each unit increase (standardised) of the halo feature of interest. Remission was defined as the absence of relapse with a prednisolone dose <30 mg/day, and relapse as the recurrence of GCA-related symptoms or rise of CRP/ESR values not otherwise explained and requiring GC increase. Halo features at disease onset and first relapse were compared using Wilcoxon test.

Results:

A total of 49 patients (73.5% females) with a mean age of 78.2 ± 7.4 years at baseline were assessed at 354 visits. TA involvement was reported in 47 (95.9%) patients and AX involvement in 11 (22.4%); 220 arterial segments with halo were recorded (201 TA, 19 AX). Halo sensitivity to change was calculated for weeks 1, 3, 6, 12 and 24, and showed a significant SMD between all time-points and baseline for the TA halo features, but only after week 6 for the AX halo features (Table and Figure). The number of TA segments with halo, sum of TA halo IMT and maximum TA halo IMT showed a significant correlation with ESR (0.41; 0.44; 0.48), CRP (0.34; 0.39; 0.41), BVAS (0.29; 0.36; 0.35) and GC cumulative dose (-0.34; -0.37; -0.32). The likelihood of achieving disease remission was lower in patients with a higher number of TA segments with halo (OR 0.39, p<0.05) and increased values of sum and maximum TA halo IMT (OR 0.34, p<0.05). By contrast, AX halo features showed no correlation with disease activity, nor any association with attaining clinical remission. During the study period, 32 relapses were observed (mean time for first relapse of 31.8 weeks ± 18.5 days). Halo sign was present in 16/17 (94.1%) cases of first disease relapse, all showing an increased halo IMT (sum and maximum) in relation to the previous ultrasound assessment performed. When compared to disease onset, a lower mean number of segments with halo and mean sum of halo IMT was reported for patients presenting with their first clinical relapse (2.93 ± 1.59 vs. 4.85 ± 1.51, p=0.0012; 2.01 ± 1.13 vs. 4.49 ± 1.95 mm, p=0.0012).

Table 1.

SMD of halo features between baseline and different time-points

Week 1Week 3Week 6Week 12Week 24N of arterial segmentsSum of all segments with halo (n=49)-0.51-0.78-1.13-1.69-1.52Sum of TA segments with halo (n=47)-0.49-0.78-1.18-1.87-1.69Sum of AX segments with halo (n=11)-0.35--0.62-0.73-0.91Halo thickness (mm)Sum of all halo IMT (n=49)-0.98-1.44-1.37-1.60-1.48Sum of TA halo IMT (n=47)-1.01-1.55-1.54-1.81-1.69Sum of AX halo IMT (n=11)-0.15-0.45-0.81-0.84-0.98Max. TA halo IMT (n=47)-1.07-1.32-1.47-1.91-2.19Max. AX halo IMT (n=11)-0.04-0.29-0.94-1.13-1.01

In bold p<0.05; n=n at baseline

Conclusion:

Ultrasound is a reliable imaging tool to assess disease activity and response to treatment in patients with GCA. Future clinical trials in GCA should evaluate direct treatment effect on halo features as an outcome measure of interest.

Acknowledgements:

The first two authors contributed equally to this work

Disclosure of Interests:

None declared

Dynein-dynactin segregate meiotic chromosomes in C. elegans spermatocytes

The microtubule motor cytoplasmic dynein 1 (dynein) and its essential activator dynactin have conserved roles in spindle assembly and positioning during female meiosis and mitosis, but their contribution to male meiosis remains poorly understood. Here, we characterize the G33S mutation in the C. elegans dynactin subunit DNC-1, which corresponds to G59S in human p150^Glued that causes motor neuron disease. In spermatocytes, dnc-1(G33S) delays spindle assembly and penetrantly inhibits anaphase spindle elongation in meiosis I, which prevents the segregation of homologous chromosomes. By contrast, chromosomes segregate without errors in the early dnc-1(G33S) embryo. Deletion of the DNC-1 N-terminus shows that defective meiosis in dnc-1(G33S) spermatocytes is not due to the inability of DNC-1 to interact with microtubules. Instead, our results suggest that the DNC-1(G33S) protein, which is aggregation prone in vitro, is less stable in spermatocytes than the early embryo, resulting in different phenotypic severity in the two dividing tissues. Thus, the dnc-1(G33S) mutant reveals that dynein-dynactin drive meiotic chromosome segregation in spermatocytes and illustrates that the extent to which protein misfolding leads to loss of function can vary significantly between cell types.

AB0036 CHILDREN WITH EXTENDED OLIGOARTICULAR AND POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS HAVE A CYTOKINE PATTERN FAVOURING B CELL ACTIVATION IN CIRCULATION

Background:

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. The majority of polyarticular JIA (pJIA) and a large fraction of extended oligoarticular JIA (oJIA) patients fulfil classification criteria for rheumatoid arthritis (RA) in adulthood. B-cells play several important roles in RA pathogenesis, but it is still unclear if the pattern of B-cell involvement in pJIA and extended oJIA follows what has been described for adults with RA.

Objectives:

The main goal of this study was to determine the concentration of cytokines potentially relevant for B-cell activation in serum from children with pJIA and extended oJIA when compared to children with persistent oJIA, adult JIA, early and established RA.

Methods:

Serum samples were collected from children with extended oJIA (n=8), persistent oJIA (n=6), pJIA (n=6), adult JIA (n=8), untreated early RA (<1 year of disease duration, n=12), established RA patients treated with synthetic disease-modifying anti-rheumatic drugs (DMARDs) (n=10) and two groups of age- and sex-matched healthy donors (children, n=6 and adults, n=10). A proliferation-inducing ligand (APRIL), B-cell activating factor (BAFF), interleukin (IL)-6 and IL-21 serum levels were measured by enzyme-linked immunosorbent assay (ELISA).

Results:

Children with extended oJIA, early and established RA patients had significantly higher BAFF serum levels when compared to controls, but no significant differences were observed in children with persistent oJIA, pJIA and adult JIA when compared to all groups included. APRIL serum levels were significantly increased in early and established RA patients when compared to both controls and children with persistent oJIA. No significant differences were found in APRIL concentrations between children with JIA, adult JIA and controls. IL-6 serum levels were significantly increased in children with extended oJIA, pJIA, early and established RA when compared to controls, but no significant differences were found in children with persistent oJIA and adult JIA patients. IL-21 serum levels were significantly increased in early RA when compared to controls, but no significant differences were observed between any of the other groups included.

Conclusion:

The similarity in B-cell cytokine pattern found between extended oJIA, pJIA, early and established RA patients, contrarily to what was observed in persistent oJIA, suggests an early B-cell involvement in the pathogenesis of extended oJIA and pJIA as described for RA.

Disclosure of Interests:

None declared

AB1149 POOR RESPONSE TO HEPATITIS B VACCINATION IN RHEUMATIC PATIENTS TREATED WITH BIOLOGIC THERAPY – IMPLICATIONS FOR CLINICAL PRACTICE

Background:

Hepatitis B virus (HBV) vaccination is recommended for rheumatic patients starting biologic therapy. There is some evidence that HBV vaccination is effective in patients under conventional disease modifying anti-rheumatic drugs (DMARDs), but it is currently unclear whether this also applies to biologics.

Objectives:

To assess the efficacy and safety of HBV vaccination in patients with rheumatic diseases treated with biologics.

Methods:

We included patients with any inflammatory rheumatic diseases treated with any biologic, who were negative for anti-HBs and anti-HBc and had never been vaccinated for HBV. Engerix B® was administered at 0, 1 and 6 months and anti-HBs was re-assessed ≥1 month after last dose. Response was defined as anti-HBs>10IU/L and compared against healthy controls (HC) undergoing Occupational Health immunization. Disease flare was evaluated before and until at least 1 month post-vaccination. We recorded serious adverse events (SAE) and immune-related disorders not previously present.

Results:

We included 67 patients, most treated with TNF inhibitors (TNFi), and 70 HC (Table 1). Most patients were taking concomitant DMARDs (69%) and were in remission/low disease activity (59%). Only 20 patients (30%) had a positive response to vaccination, in comparison to 68 HC (97%, p<0.001). Mean post-vaccination anti-HBs titre was significantly lower in responding patients than HC (569 ± 772 vs 1316 ± 811U/L, p<0.001). Responders diagnoses were RA (n=8 [25%]), PsA (n=7 [39%]), AS (n=4 [33%]) and IBD-associated SpA (n=1[100%]). Response was seen in 19/53 patients treated with TNFi (36%), but only 1/14 (7%) of patients treated with non-TNFi (p=0.037). Importantly, some responders had to temporarily interrupt biologic therapy due to other intercurrences for at least one administration. No clinical or demographic variables were associated with response, including age and disease activity. Fourteen patients (21%) experienced disease flares, of which 7 were mild and did not require therapy adjustment; 3 patients required minor treatment/dose adjustments; 4 patients had secondary failures that led to switches. There were 3 SAE (acute diverticulitis; abdominal infection; atrial fibrillation and urinary infection) 1-4 months after 1st/2nddose, deemed not to be related to vaccination. One RA patient on infliximab had bilateral uveitis 2 months after the 1stvaccine dose, which resolved with topical therapy.

Table 1.

Baseline characteristics of study participants.

Patients (n=67)Controls (n=70)pAge (years)56 ± 946 ± 9<0.001Female (%)40 (60)62 (89)<0.001Diagnosis (%)RA32 (48)PsA / AS18 (27) / 13 (19)Other4 (6)Disease duration (years)17 ± 10Biologic (%)TNF-inhibitor53 (79)Tocilizumab / Abatacept6 (9) / 1 (1)Rituximab / Belimumab2 (3) / 4 (6)Anakinra1 (1)Conventional DMARDs (%)MTX / LEF39 (58) / 1 (1)SSZ / Other6 (9) / 3 (4)None21 (31)Prednisolone (%) / Dose (mg)29 (43) / 5.6 ± 2.1DAS283.1 ± 1.4ASDAS2.2 ± 1.4

Conclusion:

In this study, HBV vaccination response was poor and lower in rheumatic patients treated with biologic therapy than in healthy adults. Vaccination was overall safe but there were 4 severe flares and 3 SAE that lead to treatment switch/interruption, although causal association is difficult to establish. Our data reinforce the recommendation for HBV vaccination prior to starting biologic therapy, possibly even as soon as the diagnosis is established. Alternative HBV vaccination strategies should be investigated in patients already treated with biologics.

Disclosure of Interests:

Vasco C Romão: None declared, Pedro Ávila-Ribeiro Grant/research support from: Novartis, Maria João Gonçalves: None declared, Ana Rita Cruz-Machado: None declared, André Guerreiro: None declared, Vítor Teixeira: None declared, Ana Valido: None declared, Joana Silva-Dinis: None declared, Elsa Vieira-Sousa: None declared, Maria João Saavedra: None declared, Ema Leite: None declared, Rui Tato Marinho: None declared, Joao Eurico Fonseca: None declared

Portuguese consensus document for the management of alpha-1-antitrypsin deficiency

Alpha-1-antitrypsin deficiency (AATD) is a genetic autosomal codominant disorder caused by mutations in SERPINA1 gene. It is one of the most prevalent genetic disorders, although it remains underdiagnosed. Whereas at international level there are several areas of consensus on this disorder, in Portugal, inter-hospital heterogeneity in clinical practice and resources available have been adding difficulties in reaching a diagnosis and in making therapeutic decisions in this group of patients. This raised a need to draft a document expressing a national consensus for AATD. To this end, a group of experts in this field was created within the Portuguese Pulmonology Society - Study group on AATD, in order to elaborate the current manuscript. The authors reviewed the existing literature and provide here general guidance and extensive recommendations for the diagnosis and management of AATD that can be adopted by Portuguese clinicians from different areas of Medicine. This article is part of a supplement entitled "Portuguese consensus document for the management of alpha-1-antitrypsin deficiency" which is sponsored by Sociedade Portuguesa de Pneumologia.

The influence of the morphological characteristics of nanoporous anodic aluminium oxide (AAO) structures on capacitive touch sensor performance: a biological application

This work is devoted to the study of the influence of different anodic aluminium oxide (AAO) morphologies on the sensitivity and performance of an AAO-based capacitive touch sensor. The AAO structures were fabricated in a cylindrical homemade anodization cell made from a solid polycarbonate billet via a lathe machining process. The AAO morphologies were obtained from the anodization of Al foil by using three different types of electrolyte (sulphuric acid, oxalic acid and phosphoric acid) and their morphologies are reported and compared using scanning electron microscopy (SEM) micrographs and current–time characteristic curves. The sensors were fabricated by integrating the AAO structure with a nanotextured gold thin film deposited over the AAO layer by thermal evaporation, thus realizing a type of metal/insulator/metal parallel-plate capacitance sensor. It is demonstrated that AAO morphologies have influence on the performance of the AAO-based capacitive touch sensors. The variation of the capacitance of the sensors is investigated in this work for the AAO structures produced from anodization in an attempt to select anodizing conditions for a biological application aiming to detect small microorganisms such as bacterial colonies of Escherichia coli.

This work is devoted to the study of the influence of different anodic aluminium oxide (AAO) morphologies on the sensitivity and performance of an AAO-based capacitive touch sensor.

Inferences on specificity recognition at the Malus×domestica gametophytic self-incompatibility system

In Malus × domestica (Rosaceae) the product of each SFBB gene (the pollen component of the gametophytic self-incompatibility (GSI) system) of a S-haplotype (the combination of pistil and pollen genes that are linked) interacts with a sub-set of non-self S-RNases (the pistil component), but not with the self S-RNase. To understand how the Malus GSI system works, we identified 24 SFBB genes expressed in anthers, and determined their gene sequence in nine M. domestica cultivars. Expression of these SFBBs was not detected in the petal, sepal, filament, receptacle, style, stigma, ovary or young leaf. For all SFBBs (except SFBB15), identical sequences were obtained only in cultivars having the same S-RNase. Linkage with a particular S-RNase was further established using the progeny of three crosses. Such data is needed to understand how other genes not involved in GSI are affected by the S-locus region. To classify SFBBs specificity, the amino acids under positive selection obtained when performing intra-haplotypic analyses were used. Using this information and the previously identified S-RNase positively selected amino acid sites, inferences are made on the S-RNase amino acid properties (hydrophobicity, aromatic, aliphatic, polarity, and size), at these positions, that are critical features for GSI specificity determination.

Label-free ITO-based immunosensor for the detection of very low concentrations of pathogenic bacteria

Here we describe the fabrication of a highly sensitive and label-free ITO-based impedimetric immunosensor for the detection of pathogenic bacteria Escherichia coli O157:H7. Anti-E. coli antibodies were immobilized onto ITO electrodes using a simple, robust and direct methodology. First, the covalent attachment of epoxysilane on the ITO surface was demonstrated by Atomic Force Microscopy and cyclic voltammetry. The immobilization of antibody on the epoxysilane layer was quantified by Optical Waveguide Lightmode Spectroscopy, obtaining a mass variation of 12 ng cm(− 2) (0.08 pmol cm(− 2)). Microcontact printing and fluorescence microscopy were used to demonstrate the specific binding of E. coli O157:H7 to the antibody-patterned surface. We achieved a ratio of 1:500 Salmonella typhimurium/E. coli O157:H7, thus confirming the selectivity of the antibodies and efficiency of the functionalization procedure. Finally, the detection capacity of the ITO-based immunosensor was evaluated by Electrochemical Impedance Spectroscopy. A very low limit of detection was obtained (1 CFU mL(− 1)) over a large linear working range (10–10(6) CFU mL(− 1)). The specificity of the impedimetric immunosensor was also examined. Less than 20% of non-specific bacteria (S. typhimurium and E. coli K12) was observed. Our results reveal the applicability of ITO for the development of highly sensitive and selective impedimetric immunosensors.

Plate-like osteoma cutis: nothing but skin and bone?

Osteoma cutis encompasses a group of cutaneous ossifying disorders, more commonly secondary to trauma, inflammation or neoplasms. Fourteen per cent, however, are primary, and these may be syndromatic (associated to Albright's hereditary osteodystrophy) or occur in isolation. We report a case of a 10-year-old girl who presented with a stone-hard plate on the scalp, with no relevant personal or family history, nor changes in calcium-phosphate metabolism, parathyroid hormone or thyroid function. Skin biopsy confirmed osteoma cutis. Plate-like osteoma cutis is rare, and believed to be a non-progressive form of heterotopic ossification, included in the spectrum of progressive osseus heteroplasia and Albright hereditary osteodystrophy, due to GNAS gene mutations. This recently clarified association should remind us of the possible unfavourable evolution of a seemingly innocent clinical picture, emphasising the need for appropriate evaluation, management and follow-up.

Reactive pulsed-DC sputtered Nb-doped VO2 coatings for smart thermochromic windows with active solar control

Thermochromic VO2 thin films have successfully been grown on SiO2-coated float glass by reactive pulsed-DC magnetron sputtering. Different Nb doping amounts were introduced in the VO2 solid solution during the film growing which resulted in films with distinct semiconducting-metal phase transition temperatures. Pure VO2 showed improved thermochromic behavior as compared with VO2 films prepared by conventional DC sputtering. The transition temperatures were linearly decreased from 59 down to 34 degrees C with the increase in Nb content. However, the luminous transmittance and the infrared modulation efficiency were markedly affected. The surface morphology of the films was examined by scanning electron microscopy (SEM) and showed a tendency for grain sized reduction due to Nb addition. Moreover, the films were found to be very dense with no columnar microstructure. Structural analyses carried out by X-ray diffractometry (XRD) revealed that Nb introduces significant amount of defects in the crystal lattice which clearly degrade the optical properties.

Photocatalytic activity and UV-protection of TiO2 nanocoatings on poly(lactic acid) fibres deposited by pulsed magnetron sputtering

The application of nanocoatings in the textile finishing is increasingly being explored because they open a whole new vista of value-addition possibilities in the textile sector. In the present work, low temperature pulsed DC magnetron sputtering method was used to create functional TiO2 nanocoatings on poly(lactic acid) textile fibres surfaces. In this study, the principal objectives in the application of TiO2 nanocoatings to textile materials are to impart UV protection functions and self-cleaning properties to the textile substrates. The TiO2 films were characterized by X-ray diffraction, scanning electron microscopy, atomic force microscopy, transmission electron microscopy, UV-visible spectroscopy and contact angle analysis. The Photocatalytic activity of the films was tested by measuring the photodegradation rates of rhodamine-B dye aqueous solution under UV light irradiation. The ultraviolet protection function was tested according to the Australian/New Zealand standards. It was observed that the TiO2 nanocoatings on poly(lactic acid) fibres showed an excellent ultraviolet protection (> 40) function and the photocatalytic efficiency was maintained even after a strong washing treatment.

Nanocomposite metal amorphous-carbon thin films deposited by hybrid PVD and PECVD technique

Carbon based films can combine the properties of solid lubricating graphite structure and hard diamond crystal structure, i.e., high hardness, chemical inertness, high thermal conductivity and optical transparency without the crystalline structure of diamond. Issues of fundamental importance associated with nanocarbon coatings are reducing stress, improving adhesion and compatibility with substrates. In this work new nanocomposite coatings with improved toughness based in nanocrystalline phases of metals and ceramics embedded in amorphous carbon matrix are being developed within the frame of a research project: nc-MeNxCy/a-C(Me) with Me = Mo, Si, Al, Ti, etc. Carbide forming metal/carbon (Me/C) composite films with Me = Mo, W or Ti possess appropriate properties to overcome the limitation of pure DLC films. These novel coating architectures will be adopted with the objective to decrease residual stress, improve adherence and fracture toughness, obtain low friction coefficient and high wear-resistance. Nanocomposite DLC's films were deposited by hybrid technique using a PVD-Physically Vapor Deposition (magnetron sputtering) and Plasma Enhanced Chemical Vapor Deposition (PECVD), by the use of CH4 gas. The parameters varied were: deposition time, substrate temperature (180 degrees C) and dopant (Si + Mo) of the amorphous carbon matrix. All the depositions were made on silicon wafers and steel substrates precoated with a silicon inter-layer. The characterisation of the film's physico-mechanical properties will be presented in order to understand the influence of the deposition parameters and metal content used within the a-C matrix in the thin film properties. Film microstructure and film hybridization state was characterized by Raman Spectroscopy. In order to characterize morphology SEM and AFM will be used. Film composition was measured by Energy-Dispersive X-ray analysis (EDS) and by X-ray photoelectron spectroscopy (XPS). The contact angle for the produced DLC's on silicon substrates were also measured. Thin film adherence was studied by micro-scratch test. Residual stresses in the produced coatings will be analysed by bending technique.

DC sputtered W-doped VO2 thermochromic thin films for smart windows with active solar control

Doped VO2 thin films, with different W at.% and consequent dissimilar transition temperatures, were successfully deposited onto SiO2-coated float-glass substrates by reactive direct current (DC) magnetron sputtering. Structural analyses have shown, for undoped films, single phase VO2(M) films with c-axis (002) direction as the preferred crystal orientation. The addition of tungsten into the VO2 solid solution favored the crystallization in the (011) direction which became dominant above a critical level of dopant concentration. The surface morphology of pure VO2 films revealed elongated grains oriented within the film plane. The doped films evidenced an increased tendency to be oriented out of the film plane which has resulted in increased roughness levels. The doping methodology associated with optimized processing conditions allowed the production of W-doped VO2 films with reduced transition temperatures, from 63 down to 28 degrees C, and maximum transmittances at the visible region ranging 40%. The relationship between tungsten content in the film and consequent transition temperature expressed a linear behavior.

Study of indium tin oxide thin films deposited on acrylics substrates by ion beam assisted deposition technique

Indium tin oxide (ITO) thin films have been deposited onto acrylics (PMMA) substrates by ion beam assisted deposition technique at different oxygen flows. The structural, optical and electrical properties of the deposited films have been characterized by X-ray diffraction, transmittance, FTIR, ellipsometry and Hall effect measurements. The optical constants of the deposited films have been calculated by fitting the ellipsometric spectra. The effects of the oxygen flow on the properties of the deposited films have been studied. It has been found that 40 sccm oxygen flow is an optimum value for getting the films with good transmittance and low electrical resistivity.

Novel nanocomposite coatings with dispersed organic nanoparticles for solar absorbers

A natural pigment (Anthocyanin extracted from Sambucus nigra L. fruit) was incorporated by dipping sputtered titanium oxide films into a pigment solution. The pigment solution has red colour and an absorption peak located in the wavelength range of 520 to 540 nm. Titanium oxide thin films were prepared by reactive DC magnetron sputtering and reactive pulsing DC magnetron sputtering from a Titanium target in O2 + Ar atmosphere onto glass slides. Pigment incorporation in thin films was found dependent of both morphology and composition, which depends on deposition parameters, like pulsing frequency and oxygen flow rate. The incorporation of this pigment in TiOx thin films increases the final solar absorption and decreases the final average roughness of these films. The effect in solar absorption is higher in films prepared by DC and pulsed DC at pulsing frequency of 200 kHz.

Psychological therapies for generalised anxiety disorder

BACKGROUND

Generalised anxiety disorder (GAD) is a highly prevalent condition, characterised by excessive worry or anxiety about everyday events and problems. The effectiveness and effectiveness of psychological therapies as a group has not yet been evaluated in the treatment of GAD.

OBJECTIVES

To examine the efficacy and acceptability of psychological therapies, categorised as cognitive behavioural therapy (CBT), psychodynamic therapy and supportive therapy, compared with treatment as usual/waiting list (TAU/WL) and compared with one another, for patients with GAD.

SEARCH STRATEGY

We searched the Cochrane Depression, Anxiety & Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, LILACS and controlledtrials.com in February 2006. We searched reference lists of retrieved articles, and contacted trial authors and experts in the field for information on ongoing/completed trials.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials conducted in non-inpatient settings, involving adults aged 18-75 years with a primary diagnosis of GAD, assigned to a psychological therapy condition compared with TAU/WL or another psychological therapy.

DATA COLLECTION AND ANALYSIS

Data on patients, interventions and outcomes were extracted by two review authors independently, and the methodological quality of each study was assessed. The primary outcome was anxiety reduction, based on a dichotomous measure of clinical response, using relative risk (RR), and on a continuous measure of symptom reduction, using the standardised mean difference (SMD), with 95% confidence intervals.

MAIN RESULTS

Twenty five studies (1305 participants) were included in the review, of which 22 studies (1060 participants) contributed data to meta-analyses. Based on thirteen studies, psychological therapies, all using a CBT approach, were more effective than TAU/WL in achieving clinical response at post-treatment (RR 0.63, 95%CI 0.55 to 0.73), and also in reducing anxiety, worry and depression symptoms. No studies conducted longer-term assessments of CBT against TAU/WL. Six studies compared CBT against supportive therapy (non-directive therapy and attention-placebo conditions). No significant difference in clinical response was indicated between CBT and supportive therapy at post-treatment (RR 0.86, 95%CI 0.70 to 1.06), however significant heterogeneity was indicated, which was partly explained by the number of therapy sessions.

AUTHORS' CONCLUSIONS

Psychological therapy based on CBT principles is effective in reducing anxiety symptoms for short-term treatment of GAD. The body of evidence comparing CBT with other psychological therapies is small and heterogeneous, which precludes drawing conclusions about which psychological therapy is more effective. Further studies examining non-CBT models are required to inform health care policy on the most appropriate forms of psychological therapy in treating GAD.

Pilot study of the effects of n-3 polyunsaturated fatty acids on exhaled nitric oxide in patients with stable asthma

BACKGROUND

The anti-inflammatory effects of n-3 polyunsaturated fatty acids (n-3 PUFA) have been demonstrated both in vitro and in vivo. The results of epidemiological studies suggest that fish consumption has a beneficial effect on lung function and prevalence of asthma. However, data from intervention trials have not revealed a beneficial effect of n-3 PUFA supplementation in patients with established disease.

OBJECTIVE

To study the effects of short-term n-3 PUFA supplementation in addition to maintenance therapy on exhaled nitric oxide in asthmatic patients.

METHODS

A double-blind, placebo-controlled trial was undertaken in 20 women with asthma. Patients received either a combination of eicosapentaenoic acid and docosahexaenoic acid plus 10 mg vitamin E or placebo twice daily for 2 weeks. The primary outcome measure was the fraction of exhaled nitric oxide (FeNO) and the secondary outcomes were asthma control (score on theAsthma Control Questionnaire [ACQI) and lung function (forced expiratory volume in 1 second [FEV1]).

RESULTS

No significant differences were observed in FeNO, ACQ score, or FEV1 between patients receiving n-3 PUFA supplementation and those receiving placebo.

CONCLUSIONS

Short-term dietary supplementation with n-3 PUFA in women with stable asthma was not associated with statistically significant changes in FeNO, asthma control, or lung function.