Mechanical osteoarthritis of the hip in a one medicine concept: a narrative review

Human and veterinary medicine have historically presented many medical areas of potential synergy and convergence. Mechanical osteoarthritis (MOA) is characterized by a gradual complex imbalance between cartilage production, loss, and derangement. Any joint instability that results in an abnormal overload of the joint surface can trigger MOA. As MOA has a prevailing mechanical aetiology, treatment effectiveness can only be accomplished if altered joint mechanics and mechanosensitive pathways are normalized and restored. Otherwise, the inflammatory cascade of osteoarthritis will be initiated, and the changes may become irreversible. The management of the disease using non-steroidal anti-inflammatory drugs, analgesics, physical therapy, diet changes, or nutraceuticals is conservative and less effective. MOA is a determinant factor for the development of hip dysplasia in both humans and dogs. Hip dysplasia is a hereditary disease with a high incidence and, therefore, of great clinical importance due to the associated discomfort and significant functional limitations. Furthermore, on account of analogous human and canine hip dysplasia disease and under the One Medicine concept, unifying veterinary and human research could improve the well-being and health of both species, increasing the acknowledgement of shared diseases. Great success has been accomplished in humans regarding preventive conservative management of hip dysplasia and following One Medicine concept, similar measures would benefit dogs. Moreover, animal models have long been used to better understand the different diseases' mechanisms. Current research in animal models was addressed and the role of rabbit models in pathophysiologic studies and of the dog as a spontaneous animal model were highlighted, denoting the inexistence of rabbit functional models to investigate therapeutic approaches in hip MOA.

Angiotensin Receptor-Neprilysin Inhibitor Effects on Atherosclerotic Cardiovascular Disease Events: A Meta-Analysis of Randomized Controlled Trials

Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) associated with a decreased risk of death and hospitalization for selected patients with heart failure (HF). However, its association with improved atherosclerotic cardiovascular disease (ASCVD) events remains unclear. We performed a meta-analysis to evaluate the association of ARNI with ASCVD events in patients with HF. We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for studies comparing ARNIs with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in terms of myocardial infarction, stroke, angina pectoris, peripheral artery disease, and the composite end point in patients with HF. A total of 8 randomized controlled trials were included, with 17,541 patients assigned to either the ARNI (8,764 patients) or ACEi/ARB (8,777 patients) groups. The incidence of composite end point (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.93 to 1.13, p = 0.63), myocardial infarction (RR 1.02, 95% CI 0.81 to 1.30, p = 0.85), angina pectoris (RR 0.96, 95% CI 0.80 to 1.17, p = 0.70), and stroke (RR 0.99, 95% CI 0.85 to 1.16, p = 0.93) were not statistically different between the ARNI and ACEi/ARB groups. However, ARNI was associated with a higher incidence of peripheral artery disease (RR 1.63, 95% CI 1.05 to 2.52, p = 0.03). In conclusion, this meta-analysis found no association between ARNI therapy and improved ASCVD events in patients with HF.

Prior MRI-imaging impact of patients submitted to brachytherapy for prostate cancer

INTRODUCTION

Brachytherapy for the treatment of prostate cancer is a well-established option. Use of Multiparametric Magnetic Resonance Imaging (mpMRI) for staging and diagnosis of prostate cancer has come to change the current paradigm. In this study we aim to assess the impact of performing mpMRI to evaluate the presence of extracapsular lesions before brachytherapy in patients with prostate cancer concerning biochemical recurrence and time to nadir.

METHODS

Review data from 73 patients submitted to brachytherapy. The following factors were evaluated: age, initial PSA, MRI local staging results, ISUP, nadir, time to nadir, PSA at one-year, biochemical recurrence, and time to recurrence.

RESULTS

Median age was 68 years (51-72) and median follow-up 53 months (30-72). Concerning imaging modality 30,1% (n = 22) patients performed mpMRI. In the mpMRI group, 90.9% (n = 20) had at least one suspect lesion on mpMRI. Time to nadir was 27 months (3-64) in patients where mpMRI was not performed and 23.5 months (2-48) in patients submitted to mpMRI (P = .244). The median value of nadir was 0.42 ng/mL (<0.001-2) in patients submitted to mpMRI and vs 0.28 ng/mL (<0.001-4) in patients without MRI (P = .062) Recurrence utilizing Phoenix criteria was 9% (n = 2) in patients with MRI and 9.2% (n = 5) without mpMRI (P = .456), median follow-up of 43 months (12-72) for the MRI group with 58 months (30-78) for the non-mpMRI group. Both groups were statistically similar.

CONCLUSION

Our results allow us to conclude that in our series MRI did not influence biochemical recurrence, time to nadir, or nadir value.

Lower low density lipoprotein cholesterol associates to higher mortality in non-diabetic heart failure patients

Background

In patients with established heart failure (HF) low total cholesterol levels associate with worse prognosis. Evidence concerning the impact of Low-density lipoprotein cholesterol (LDL-c) in HF is scarce. We aimed to evaluate the prognostic impact of LDL-c in patients with HF, both with and without diabetes mellitus (DM).

Methods

We retrospectively analyzed outpatients with chronic HF with systolic dysfunction followed in our HF clinic from January/2012 to May/2018. LDL-c was calculated using the Friedewald's formula. Patients without a complete lipid profile were excluded. The endpoint under analysis was all-cause mortality. Patients were followed until January/2021. A Cox-regression analysis was used to study the prognostic impact of LDL-c. The LDL-c cut-off used was 100 mg/dL (mean value). Analysis was stratified according to the coexistence of DM. Multivariate models were built adjusting for age, sex, coronary artery disease, atherosclerotic non-coronary artery disease, arterial hypertension, smoking status, statin use, severity of systolic dysfunction, creatinine clearance and evidence-based therapy.

Results

We studied 522 chronic HF patients, mean age was 70 years, 66.5% males. Severe systolic dysfunction was present in 42.7%, 30.5% had coronary heart disease, 60.5% had arterial hypertension, 41.6% had DM. A total of 92.0% were treated with beta blocker, 87.5% with an ACEi/ARB and 29.1% with a MRA. During a median follow-up of 53 (interquartile range 33-73) months, 235 (45%) patients died. Patients with LDL-c ≤100 mg/dL presented increased multivariate-adjusted risk of all-cause mortality: HR = 1.58 (95% CI: 1.08-2.30), p = 0.02. When patients were stratified according to DM, LDL-c ≤100 mg/dL was independently associated with increased death risk - HR = 1.55 (95% CI:1.05-2.30), p = 0.03 in patients without DM; in patients with DM no association was detected - multivariate-adjusted HR = 1.18 (95% CI: 0.77-1.80), p = 0.44.

Conclusion

Non-DM HF patients with LDL-c>100 mg/dL have a 35% reduction in the mortality risk when compared with those with lower values. The "cholesterol paradox" in HF also applies to LDL-c in non-DM patients.

A pro-BMP function exerted by Rhodnius prolixus short gastrulation reveals great diversity in the role of BMP modulators during embryonic patterning

Dorsal-ventral (DV) patterning is regulated by the bone morphogenetic pathway (BMP) in Bilateria. In insect DV patterning, the Toll pathway also plays a role, in addition to BMPs. Variations in the relative importance of each pathway for DV patterning have been reported using single species of coleopteran, hymenopteran, hemipteran and orthopteran insects. To investigate if the molecular control of DV patterning is conserved inside an insect order, the emergent model hemiptera species Rhodnius prolixus was studied. We found that R. prolixus BMP pathway controls the entire DV axis, with a broader effect respective to Toll, as shown for the hemiptera Oncopeltus fasciatus. Different from O. fasciatus, the unique R. prolixus short gastrulation (sog) and the twisted gastrulation (tsg) orthologues do not antagonize, but rather favour embryonic BMP signalling. Our results reinforce the hypothesis that hemiptera rely preferentially on BMPs for DV patterning but that, surprisingly, in R. prolixus Sog and Tsg proteins exert only a positive role to establish a dorsal-to-ventral BMP gradient. Since sog has been reported to be lost from orthopteran and hymenopteran genomes, our results indicate that Sog's role to modify BMP activity varies greatly in different insect species.

β^{+} Gamow-Teller Strengths from Unstable ^{14}O via the (d,^{2}He) Reaction in Inverse Kinematics

For the first time, the (d,^{2}He) reaction was successfully used in inverse kinematics to extract the Gamow-Teller transition strength in the β^{+} direction from an unstable nucleus. The new technique was made possible by the use of an active-target time-projection chamber and a magnetic spectrometer, and opens a path to addressing a range of scientific challenges, including in astrophysics and neutrino physics. In this Letter, the nucleus studied was ^{14}O, and the Gamow-Teller transition strength to ^{14}N was extracted up to an excitation energy of 22 MeV. The data were compared to shell-model and state-of-the-art coupled-cluster calculations. Shell-model calculations reproduce the measured Gamow-Teller strength distribution up to about 15 MeV reasonably well, after the application of a phenomenological quenching factor. In a significant step forward to better understand this quenching, the coupled-cluster calculation reproduces the full strength distribution well without such quenching, owing to the large model space, the inclusion of strong correlations, and the coupling of the weak interaction to two nucleons through two-body currents.

Design and construction of a novel energy-loss optical scintillation system (ELOSS) for heavy-ion particle identification

We present the development of a novel heavy-ion particle-identification (PID) device based on an energy-loss measurement to be implemented in the focal plane of the S800 spectrograph of the Facility for Rare Isotope Beams (FRIB). The new instrument consists of a multi-segmented optical detector [energy-loss optical scintillation system (ELOSS)] that is filled with xenon at pressures ranging from 400 to 800 Torr. The gas volume is surrounded by arrays of photomultiplier tubes and placed along the direction of the beam for recording the prompt scintillation light. The number of detected photons, which is proportional to the energy deposited by the beam particle along its track in the detector volume, allows one to identify the corresponding atomic number (Z). The ELOSS technology is expected to provide high-resolution ΔE measurements (≤0.6% σ) at a high counting rate (>50 kHz). In addition, it has the capability of providing timing information with around 150 ps resolution (σ) compared to the lack of useable timing information of the conventional ionization chamber relying on drifting charges. The development of fast, accurate ΔE measurement techniques for present and future nuclear science facilities will have a high impact on the design and implementation of rare-isotope beam experiments at FRIB and their scientific outcome. As such, ELOSS also represents a prototype for the development of PID detector systems of other planned and future spectrometers, such as the high rigidity spectrometer at FRIB.

Evidence of a Near-Threshold Resonance in ^{11}B Relevant to the β-Delayed Proton Emission of ^{11}Be

A narrow near-threshold proton-emitting resonance (E_{x}=11.4  MeV, J^{π}=1/2^{+}, and Γ_{p}=4.4  keV) was directly observed in ^{11}B via proton resonance scattering. This resonance was previously inferred in the β-delayed proton emission of the neutron halo nucleus ^{11}Be. The good agreement between both experimental results serves as a ground to confirm the existence of such exotic decay and the particular behavior of weakly bound nuclei coupled to the continuum. R-matrix analysis shows a sizable partial decay width for both, proton and α (Γ_{α}=11  keV) emission channels.

What is the Pisa Syndrome? A review

Introduction

Pisa syndrome (PS) is a type of dystonia of rare occurrence, first described in 1972 as an adverse effect of neuroleptic agents. It is used to describe a postural abnormality that includes trunk flexion in the coronal plane and axial rotation, which improves in the supine position.

Objectives

In this work, we aim to conduct a brief review of Pisa Syndrome aetiology, pathophysiology and treatment.

Methods

A non-systematic search was conducted through the PubMed database for “pisa syndrome”. Articles were screened for relevant information on PS aetiology, pathophysiology and treatment.

Results

Pisa syndrome has been associated as an adverse effect of multiple drugs from different classes, mainly antipsychotics, dopaminergic agents and cholinesterase inhibitors. The underlying mechanisms are not yet fully understood. Nevertheless, one of the most consensual hypothesis considers PS as a consequence of a cholinergic-dopaminergic imbalance that can be caused by antipsychotic treatment. Some factors have been associated with increased risk for developing PS such as old age and polypharmacy. PS appears to be better treated with the reduction or interruption of the agent(s) associated with its onset.

Conclusions

Despite its low incidence, Pisa syndrome can occur as a side effect of a number of different medications and the identification of the trigger-drug is fundamental so it can be reduced or interrupted in order to treat this condition.

Disclosure

No significant relationships.

Revisiting the Fabry-Perot reflectivity method for mid-infrared optical index measurement: case study of InGaAs, AlInAs, and InP

We revisit the Fabry-Perot (FP) reflectivity method to measure optical indices in the mid-infrared spectrum. This simple approach can be readily implemented using a standard Fourier transform infrared spectrometer. Measuring samples with multiple heights allows for enhanced precision of the measurement, making the FP method consistent in values and uncertainties with more advanced ellipsometric measurements. An extensive discussion about experimental errors is carried out. Results between 4 and 12 µm for AlInAs, n-doped InGaAs, and InP, which are the most standard materials for quantum cascade lasers, are given.

The monocyte/high-density lipoprotein ratio predicts coronary artery disease in heart failure

Background

The monocyte/high density lipoprotein ratio (MHR) is a combined inflammatory marker implicated in atherosclerosis. MHR predicts cerebrovascular disease (CVD) and chronic kidney disease (CKD); it correlates with coronary artery disease (CAD) severity and has been shown to be a prognostic predictor in patients with myocardial infarction. The role of MHR in chronic heart failure (HF) is largely unknown.

Purpose

Assess the ability of MHR to predict CAD in patients with HF

Methods

We conducted a retrospective cohort study in ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) that were followed in our HF clinic from January/2012 to May/2018. We selected all the patients that had performed a diagnostic/therapeutic coronary angiography. Patients with missing data concerning monocyte counts or high-density lipoprotein levels were excluded. The endpoint under analysis was the presence of CAD on coronary angiography. A ROC curve was used to study the ability of MHR to predict CAD. The association of MHR with CAD was assessed by a logistic-regression analysis. A multivariate model was built accounting for age, sex, comorbidities [hypertension, diabetes, peripheral artery disease (PAD), CVD, CKD and inflammatory/auto-immune disease], low-density lipoprotein value, haemoglobin, brain-type natriuretic peptide (BNP), severe LVSD and segmental contractility defects in the echocardiogram. MHR was analysed both as continuous and categorical variable; the cut-off of 16 was chosen based on the ROC curve.

Results

We studied 295 chronic HF patients with LSVD who underwent coronary angiography. Mean age was 67±12 years, 70.8% men and 55.9% with CAD. Patients with CAD were older (69 against 64 years), had significantly higher MHR (19±9 vs. 16±7), higher prevalence of hypertension, diabetes, PAD and CVD, and worse renal function. The area under the curve for the association between MHR and CAD was 0.68 (0.62–0.74), p&lt;0.001. The best MHR cut-off for CAD prediction was 16 - sensitivity: 66.7%, specificity: 65.4%, positive predictive value: 71.0% and negative predictive value: 60.8%. This association was independent of potential confounders. Patients with MHR≥16 had a multivariate-adjusted OR of having CAD of 5.41 (95% CI: 2.40–12.20), p&lt;0.001 when compared to those with lower MHR. When MHR was analysed as a continuous variable the association remained significant.

Conclusions

The MHR is an independent predictor of CAD in chronic HF. Patients with MHR ≥16 have a 71% probability of presenting CAD and a more than 5-fold higher risk compared with those with lower MHR. It is sometimes difficult to ascertain ischemic disease/aetiology in HF patients, particularly in the elderly, frail and/or with advanced CKD. This simple, inexpensive and harmless marker can help clinicians identify patients most likely to have CAD and decide treatment in accordance.

Funding Acknowledgement

Type of funding sources: None.

The prognostic value of monocyte/ high-density lipoprotein ratio in chronic heart failure

Background

The monocyte-high density lipoprotein ratio (MHR) is an inflammation marker that combines monocyte counts, increased in inflammatory states, and high-density lipoprotein (HDL) levels, that appear to have protective and anti-inflammatory properties. It has been studied in chronic kidney disease, primary hypertension, cerebrovascular disease and coronary artery disease (CAD), and has been shown to be positively correlated with disease severity and worse prognosis. Although inflammation is thought to be implicated in heart failure's (HF) pathophysiology, little is known about the role of MHR in the HF setting.

Purpose

To study the prognostic impact of MHR in chronic HF.

Methods

We conducted a retrospective cohort study in ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) that were followed in our HF clinic from January/2012 to May/2018. Patients with no data on monocyte counts or HDL levels in the first appointment were excluded. Endpoint under analysis: all-cause mortality. Patients were categorized according to MHR quartiles: 1st quartile &lt;11, 2nd quartile ≥11 to &lt;15, 3rd quartile ≥15 to &lt;20 and 4th quartile ≥20. A Cox-regression analysis was used to assess association between MHR and all-cause mortality. A multivariate model was built adjusting for age, sex, hypertension, diabetes mellitus (DM), CAD, obstructive sleep apnea, inflammatory/autoimmune disease, atrial fibrillation, anaemia, renal dysfunction, brain-type-natriuretic peptide (BNP), New York Heart Association (NYHA) class, low-density lipoprotein value, prognostic modifying therapy and severe LVSD.

Results

We studied 560 chronic HF patients with LVSD, mean age 70±12 years, 67.5% men, 37.1% in NYHA class I, 44.8% in NYHA class II and the remaining in higher classes. Patients with MHR≥20 (last quartile) were mostly men with higher prevalence of DM and CAD, they more often presented in higher NYHA classes and with worse renal function and higher BNP. No difference existed concerning doses of evidence based-drugs. During a median follow-up of 53 (32–88) months from the index medical appointment 256 patients (45.7%) died. Mortality was similar in the lower three MHR quartiles, being statistically higher in the last quartile. Considering only two groups - MHR &lt;20 and MHR ≥20 - the all-cause mortality rate was of 41.6 vs. 57.6%, respectively, p=0,001. MHR was independently associated with poor survival. In patients presenting with MHR ≥20, the HR of long-term all-cause mortality was 1.42 (95% CI: 1.04–1.93), p=0.03 when compared with those with lower MHR.

Conclusions

Chronic HF patients with MHR ≥20 have a significant 42% increased risk of long-term all-cause death. We reinforce the role of inflammation in chronic HF. The MHR is a practical, inexpensive and widely available parameter that can help clinicians in the identification of chronic HF patients at higher risk of death.

Funding Acknowledgement

Type of funding sources: None.

Assessment of the uterine dose in digital mammography and digital breast tomosynthesis

INTRODUCTION

Digital Mammography (DM-2D) and more recently Digital Breast Tomosynthesis (DBT), are two of the most effective imaging modalities for breast cancer detection, often used in screening programmes. It may happen that exams using these two imaging modalities are inadvertently performed to pregnant women. The objective of this study is to assess the dose in the uterus due to DM-2D and DBT exams, according to two main irradiation scenarios: in the 1st scenario the exposure parameters were pre-selected directly by the imaging system, while in the 2nd scenario, the maximum exposure parameters were chosen.

METHODS

The mammography equipment used was a Siemens Mammomat Inspiration. A physical anthropomorphic phantom, PMMA plates (simulating a breast thickness of 6 cm) and thermoluminescent dosimeters (TLDs) were used to measure entrance air kerma values on the phantom's breast and abdomen in order to successively estimate the mean glandular dose (MGD) and the dose in the uterus. For the two irradiation scenarios chosen, two-breast imaging modalities were selected: 1) DBT in Cranio-Caudal (CC) view (with 28 kV and 160 mAs as exposure parameters), 2) DBT and DM in Medio Lateral-Oblique (MLO) and CC views (with 34 kV and 250 mAs as exposure parameters).

RESULTS

In the 1st scenario, the TLD measurements did not detect significant dose values in the abdomen whereas the MGD estimated using the D.R. Dance model was in close agreement with data available in the literature. In the 2nd scenario, there was no significant difference in MGD estimation between the different views, whereas the air kerma values in the abdomen (in DBT mode, CC and MLO) were 0.049 mGy and 0.004 mGy respectively. In CC DM-2D mode the abdomen air kerma value was 0.026 mGy, with no significant detected value in MLO view.

CONCLUSIONS

For the dose in the uterus, the obtained values seem to indicate that DM-2D and DBT examinations inadvertently performed during pregnancy do not pose a significant radiological risk, even considering the case of overexposure in both breasts.

IMPLICATIONS FOR PRACTICE

The accurate knowledge of the doses in DM-2D and DBT will contribute to raise the awareness among medical practitioners involved in breast imaging empowering them to provide accurate information about dose levels in the uterus, improving their radiation risk communication skills and consequently helping to reduce the anxiety of pregnant women undergoing this type of examinations.

Patient experiences with hidradenitis suppurativa: the Hidradenitis Patient Experience survey

BACKGROUND

Better understanding of the experience of people living with hidradenitis suppurativa (HS) is essential to identify gaps in current patient care and inform healthcare decision-making.

AIM

To describe the patient experience of individuals with HS, including their path to diagnosis, symptom control, treatments, healthcare utilization, patient needs and impact on quality of life.

METHODS

The Hidradenitis Suppurativa Patient Experience survey was created, extensively reviewed and disseminated through engaging HS-related patient organizations, physician groups and social media groups.

RESULTS

In total, 537 respondents completed the survey; the mean age was 38 years (range 14-73 years) and 95% (510 of 537) were female. The mean number of treatment types per respondent was 15, and included antibacterial soaps (93.3%; 431 of 462), avoidance of tight clothing (90.9%; 419 of 462), use of oral antibiotics (79.7%; 368 of 462), nonprescription drugs (79.7%; 368 of 462) and topical antibiotics (77.1%; 356 of 262). Pain was poorly controlled in 46% of respondents (184 of 401). HS had a negative impact on the ability to work and attend school for 81% of respondents (337 of 415), with 59% (245 of 415) missing at least 2 days of work a month and 16% (66 of 415) missing > 11 days of work. The mean number of misdiagnoses per respondent was three and the median time to diagnosis was 10 years.

CONCLUSION

Individuals with HS experience a delay in diagnosis and have suboptimal control of the disease. We propose 11 recommendations to improve diagnosis, treatment and quality of life for individuals living with HS.

New ^{59}Fe Stellar Decay Rate with Implications for the ^{60}Fe Radioactivity in Massive Stars

The discrepancy between observations from γ-ray astronomy of the ^{60}Fe/^{26}Al γ-ray flux ratio and recent calculations is an unresolved puzzle in nuclear astrophysics. The stellar β-decay rate of ^{59}Fe is one of the major nuclear uncertainties impeding us from a precise prediction. The important Gamow-Teller strengths from the low-lying states in ^{59}Fe to the ^{59}Co ground state are measured for the first time using the exclusive measurement of the ^{59}Co(t,^{3}He+γ)^{59}Fe charge-exchange reaction. The new stellar decay rate of ^{59}Fe is a factor of 3.5±1.1 larger than the currently adopted rate at T=1.2  GK. Stellar evolution calculations show that the ^{60}Fe production yield of an 18 solar mass star is decreased significantly by 40% when using the new rate. Our result eliminates one of the major nuclear uncertainties in the predicted yield of ^{60}Fe and alleviates the existing discrepancy of the ^{60}Fe/^{26}Al ratio.