Ultrasound in the assessment of musculoskeletal involvement in systemic lupus erythematosus: state of the art and perspectives.

Musculoskeletal manifestations are extremely common in patients with systemic lupus erythematosus. Transient and migratory arthralgia is frequently reported even without clinical signs of joint or tendon inflammation. In less than 15% of patients, joints may be more severely affected by deforming (Jaccoud's arthropathy) and/or erosive arthropathy (Rhupus syndrome). In recent years, ultrasound has emerged as a promising imaging technique for the assessment of musculoskeletal involvement in systemic lupus erythematosus, having demonstrated the ability to detect inflammation and structural damage both at articular and periarticular level. Recent ultrasound studies have also revealed new insights into musculoskeletal involvement in patients with systemic lupus erythematosus, some of them questioning the traditional concepts of systemic lupus erythematosus arthropathy, with potential clinical, prognostic and therapeutic implications. In daily clinical practice, the use of ultrasound in the assessment of joint and tendon involvement in patients with systemic lupus erythematosus is still limited. Several methodological issues encountered in ultrasound studies evaluating musculoskeletal involvement in systemic lupus erythematosus patients need to be addressed in order to improve both the reliability and clinical usefulness of ultrasound findings. This paper reviews ultrasound studies assessing musculoskeletal involvement in patients with systemic lupus erythematosus, highlighting certainty, limits, potential applications and future perspectives of ultrasound use in systemic lupus erythematosus patients.

Validation of the Composite Autonomic Symptom Score 31 (COMPASS 31) for the assessment of symptoms of autonomic neuropathy in people with diabetes.

AIM: To validate the Composite Autonomic Symptom Score (COMPASS) 31, in its Italian version, for the diagnosis of diabetic cardiovascular autonomic neuropathy in a clinic-based, single-centre study. METHODS: A total of 73 participants with diabetes (age 55 ± 14 years) completed the COMPASS 31 questionnaire before undergoing cardiovascular autonomic neuropathy and diabetic polyneuropathy assessment according to cardiovascular reflex tests, neuropathic symptoms and signs, and vibration and thermal thresholds. RESULTS: The COMPASS 31 total weighted score differed between participants with and without cardiovascular autonomic neuropathy (29.9 ± 19.5 vs 16.1 ± 14.7; P = 0.003) and with and without diabetic polyneuropathy (28.9 ± 19.1 vs 12.7 ± 11.3; P < 0.0001). It was related to cardiovascular reflex tests score (rho = 0.38, P = 0.0013) as well as diabetic polyneuropathy symptoms (rho=0.61, P < 0.0001) and signs scores (rho = 0.49, P < 0.0001). Receiver-operating curve analysis showed a fair diagnostic accuracy of total score for cardiovascular autonomic neuropathy (area under the curve 0.748 ± 0.068, 95% CI 0.599-0.861) and diabetic polyneuropathy (area under the curve 0.742 ± 0.061, 95% CI 0.611-0.845). The best score thresholds were 16 for early cardiovascular autonomic neuropathy (sensitivity 75.0%, specificity 64.9%, positive predictive value 37.5% and negative predictive value 90.2%), and 17 for both confirmed cardiovascular autonomic neuropathy and diabetic polyneuropathy (sensitivity 70.0% and 65.5%, respectively; specificity 66.7% and 79.5%, respectively; positive predictive value 25.0% and 67.9%, respectively; and negative predictive value 93.0% and 77.8%, respectively). COMPASS 31 had a good internal consistency according to Cronbach's α coefficient of 0.73. CONCLUSIONS: COMPASS 31 can represent a valid, easy-to-use, quantitative assessment tool for autonomic symptoms in diabetic neuropathy, with a fair diagnostic accuracy for both cardiovascular autonomic neuropathy and diabetic polyneuropathy.

Probing ice VII crystallization from amorphous NaCl-D2O solutions at gigapascal pressures.

We probe the possible inclusion of salt (NaCl) in the ice VII lattice over the pressure range from 2 to 4 gigapascal. We combine data from neutron diffraction experiments under pressure and from computational structure searches based on density functional theory. We observe that the high density amorphous precursor (NaCl·10.2D2O) crystallises during annealing at high pressure in the vicinity of the phase boundary between pure ices VII and VIII. The structure formed is very similar to that of pure ice VII. Our simulations indicate that substituting water molecules in the ice VII lattice with Na+ and Cl- ions would lead to a significant expansion of the lattice parameter. Since this expansion was not observed in our experiments, the ice crystallised is likely to be pure D2O or contains only a small fraction of the ions from the salt solution.

Two structural relaxations in protein hydration water and their dynamic crossovers.

We study the translational single particle dynamics of hydration water of lysozyme upon cooling by means of molecular dynamics simulations. We find that water close to the protein exhibits two distinct relaxations. By characterizing their behavior upon cooling, we are able to assign the first relaxation to the structural α-relaxation also present in bulk water and in other glass-forming liquids. The second, slower, relaxation can be ascribed to a dynamic coupling of hydration water motions to the fluctuations of the protein structure. Both relaxation times exhibit crossovers in the behavior upon cooling. For the α-process, we find upon cooling a crossover from a fragile behavior to a strong behavior at a temperature which is about five degrees higher than that of bulk water. The long-relaxation time appears strictly connected to the protein motion as it shows upon cooling a temperature crossover from a strong behavior with a lower activation energy to a strong behavior with a higher activation energy. The crossover temperature coincides with the temperature of the protein dynamical transition. These findings can help experimentalists to disentangle the different information coming from total correlators and to better characterize hydration water relaxations in different biomolecules.

The Widom line and dynamical crossover in supercritical water: Popular water models versus experiments.

In a previous study [Gallo et al., Nat. Commun. 5, 5806 (2014)], we have shown an important connection between thermodynamic and dynamical properties of water in the supercritical region. In particular, by analyzing the experimental viscosity and the diffusion coefficient obtained in simulations performed using the TIP4P/2005 model, we have found that the line of response function maxima in the one phase region, the Widom line, is connected to a crossover from a liquid-like to a gas-like behavior of the transport coefficients. This is in agreement with recent experiments concerning the dynamics of supercritical simple fluids. We here show how different popular water models (TIP4P/2005, TIP4P, SPC/E, TIP5P, and TIP3P) perform in reproducing thermodynamic and dynamic experimental properties in the supercritical region. In particular, the comparison with experiments shows that all the analyzed models are able to qualitatively predict the dynamical crossover from a liquid-like to a gas-like behavior upon crossing the Widom line. Some of the models perform better in reproducing the pressure-temperature slope of the Widom line of supercritical water once a rigid shift of the phase diagram is applied to bring the critical points to coincide with the experimental ones.

Widom line and dynamical crossovers as routes to understand supercritical water.

Supercritical water is fundamental in many fields of applications and a precise characterization of the supercritical state is of uttermost importance for this liquid. In a fluid, when moving from the critical point into the single-phase region, the thermodynamic response functions show maxima reminiscent of the critical divergence. Here we study the thermodynamic properties of water in the supercritical region by analysing both available experimental data and our computer simulation results. We find that the lines connecting the maxima of the response functions converge on approaching the critical point in a single line, the Widom line. We further show that the Widom line coincides with a crossover from a liquid-like to a gas-like behaviour clearly visible in the transport properties. These thermodynamic and dynamic features show that the supercritical state in water is far more complex than what was so far believed, indicating a new perspective in the characterization of the thermodynamics of this state.

Superficial radiotherapy for multiple keratoacanthomas.

We report the case of a 76-year-old Caucasian woman who attended our clinic with multiple keratoacanthomas. Radiotherapy was considered a viable and effective option in such an old patient, who could not be a good surgical candidate for number and distribution of the lesions, and for the age. After a 12-month follow-up, we observed the complete and global disappearance of the lesions; the patient was therefore very satisfied especially in view of the clinical outcome. According to our point of view, radiotherapy allows the physician to obtain a good oncological radicality and excellent cosmetic results too.

Fragile to strong crossover at the Widom line in supercooled aqueous solutions of NaCl.

We study by molecular dynamics simulations the dynamical properties of an aqueous solution of NaCl at a concentration of 0.67 mol/kg upon supercooling. In a previous study of the same ionic solution, we have located the liquid-liquid critical point (LLCP) and determined the Widom line connected to the liquid-liquid transition. We present here the results obtained from the study of the self-intermediate scattering function in a large range of temperatures and densities approaching the LLCP. The structural relaxation is in agreement with the mode coupling theory (MCT) in the region of mild supercooling. In the deeper supercooled region the α-relaxation time as function of temperature deviates from the MCT power law prediction showing a crossover from a fragile to a strong behavior. This crossover is found upon crossing the Widom line. The same trend was found in bulk water upon supercooling and it appears almost unchanged by the interaction with ions apart from a shift in the thermodynamic plane toward lower pressures and higher temperatures. These results show that the phenomenology of supercooled water transfers from bulk to solution where the study of the supercooled region is experimentally less difficult.

Fragile-to-strong crossover coupled to the liquid-liquid transition in hydrophobic solutions.

Using discrete molecular dynamics simulations we study the relation between the thermodynamic and diffusive behaviors of a primitive model of aqueous solutions of hydrophobic solutes consisting of hard spheres in the Jagla particles solvent, close to the liquid-liquid critical point of the solvent. We find that the fragile-to-strong dynamic transition in the diffusive behavior is always coupled to the low-density-high-density liquid transition. Above the liquid-liquid critical pressure, the diffusivity crossover occurs at the Widom line, the line along which the thermodynamic response functions show maxima. Below the liquid-liquid critical pressure, the diffusivity crossover occurs when the limit of mechanical stability lines are crossed, as indicated by the hysteresis observed when going from high to low temperature and vice versa. These findings show that the strong connection between dynamics and thermodynamics found in bulk water persists in hydrophobic solutions for concentrations from low to moderate, indicating that experiments measuring the relaxation time in aqueous solutions represent a viable route for solving the open questions in the field of supercooled water.

Grape variety related trans-resveratrol induction affects Aspergillus carbonarius growth and ochratoxin A biosynthesis.

The paper reports the results of a study performed to investigate the influence of the grape variety on the growth of Aspergillus carbonarius on grape berries and the correlation between the amount of ochratoxin A (OTA) and the content of trans-resveratrol produced after fungal contamination. Variations in the amount of OTA produced by the fungus are observed depending on both grape variety and on the induction of trans-resveratrol determined during the infection. The obtained data suggest that if an increase in trans-resveratrol production in grape berries occurs early after the fungal infection, the berry exploits this compound to control OTA synthesis. If the increase in trans-resveratrol concentration is delayed after fungal infection (40 h), a control of OTA accumulation can not be achieved. The possibility of exerting significant control of OTA biosynthesis by this phytoalexin seems to rely in the promptness of its production, as occurs also in other fungus plant interactions and, in turn, seems to be dependent also on grape cultivar. In this fungus-plant system, trans-resveratrol appears to represent a defence-related compound toward A. carbonarius and OTA contamination.

Ion hydration and structural properties of water in aqueous solutions at normal and supercooled conditions: a test of the structure making and breaking concept.

We study with the method of molecular dynamics simulation the structural properties of aqueous solutions of NaCl, KCl and KF salts at ambient conditions and upon supercooling at constant pressure. The calculations are performed at increasing concentration of the salt starting from c = 0.67 mol kg(-1) up to 3.96 mol kg(-1). We investigate the modifications of the hydration shells and the changes in the water structure induced by the presence of the ions. The oxygen-oxygen structure is strongly dependent on the ionic concentration while it is almost independent from the cation. The hydrogen bonding is preserved at all concentrations and temperatures. The main effect of increasing the ionic concentration is the tendency of the water structure to assume the high density liquid form predicted for pure water upon supercooling. An important consequence of our analysis is that the concept of an ion as a structure maker or a structure breaker must be revisited to take into account the other ionic species, the ionic concentration and more generally the thermodynamic conditions of the solutions.

Liquid-liquid coexistence in NaCl aqueous solutions: a simulation study of concentration effects.

In this paper we investigate by means of molecular dynamics computer simulations how the hypothesized liquid-liquid critical point of water shifts in supercooled aqueous solutions of salt as a function of concentration. We study sodium chloride solutions in TIP4P water, NaCl(aq), for concentrations c = 1.36 mol/kg and c = 2.10 mol/kg. The liquid-liquid critical point is found up to the highest concentration investigated, and its position in the P-T plane shifts to higher temperatures and lower pressures upon increasing concentration. For c = 2.10 mol/kg it is also located very close to the temperature of maximum density line of the system. The results are discussed and compared with previous results for bulk TIP4P water and for c = 0.67 mol/kg NaCl(aq) and with experimental findings. We observe a progressive shrinkage of the low-density liquid region when the concentration of salt increases; this suggests an eventual disappearance of the liquid-liquid coexistence upon further increase of NaCl concentration.

Structural properties of high and low density water in a supercooled aqueous solution of salt.

We consider and compare the structural properties of bulk TIP4P water and of a sodium chloride aqueous solution in TIP4P water with concentration c = 0.67 mol/kg, in the metastable supercooled region. In a previous paper (Corradini, D.; Rovere, M.; Gallo, P. J. Chem. Phys. 2010, 132, 134508) we found in both systems the presence of a liquid-liquid critical point (LLCP). The LLCP is believed to be the end point of the coexistence line between a high density liquid (HDL) and a low density liquid (LDL) phase of water. In the present paper we study the different features of water-water structure in HDL and LDL both in bulk water and in the solution. We find that the ions are able to modify the bulk LDL structure, rendering water-water structure more similar to the bulk HDL case. By the study of the hydration structure in HDL and LDL, a possible mechanism for the modification of the bulk LDL structure in the solution is identified in the substitution of the oxygen by the chloride ion in oxygen coordination shells.

A route to explain water anomalies from results on an aqueous solution of salt.

In this paper we investigate the possibility to detect the hypothesized liquid-liquid critical point of water in supercooled aqueous solutions of salts. Molecular dynamics computer simulations are conducted on bulk TIP4P water and on an aqueous solution of sodium chloride in TIP4P water, with concentration c=0.67 mol/kg. The liquid-liquid critical point is found both in the bulk and in the solution. Its position in the thermodynamic plane shifts to higher temperature and lower pressure for the solution. Comparison with available experimental data allowed us to produce the phase diagrams of both bulk water and the aqueous solution as measurable in experiments. Given the position of the liquid-liquid critical point in the solution as obtained from our simulations, the experimental determination of the hypothesized liquid-liquid critical point of water in aqueous solutions of salts appears possible.

Molecular dynamics studies on the thermodynamics of supercooled sodium chloride aqueous solution at different concentrations.

In this paper we compare recent results obtained by means of molecular dynamics computer simulations on the thermodynamics of TIP4P bulk water and on solutions of sodium chloride in TIP4P water. The concentrations studied are c = 0.67, 1.36 and 2.10 mol kg( - 1). The results are checked against change of water-salt potential and size effects. The systems are studied in a wide range of temperatures, going from ambient temperature to the supercooled region. Analysis of simulated state points, performed on the isochores and on the isotherm plane, allowed the determination of the limit of mechanical stability and of the temperature of maximum density lines. While the presence of ions in the system does not affect the limit of mechanical stability with respect to the bulk, it causes the temperature of the maximum density line to shift to lower pressure and temperature upon increasing concentration. The occurrence of minima in the trend of potential energy as a function of density and the inflections in the low temperature isotherms suggest the presence of liquid-liquid coexistence for bulk water and for the sodium chloride solutions at all concentrations studied.

Effect of concentration on the thermodynamics of sodium chloride aqueous solutions in the supercooled regime.

Molecular dynamics simulations are performed on two sodium chloride solutions in TIP4P water with concentrations c=1.36 mol/kg and c=2.10 mol/kg upon supercooling. The isotherms and isochores planes are calculated. The temperature of maximum density line and the limit of mechanical stability line are obtained from the analysis of the thermodynamic planes. The comparison of the results shows that for densities well above the limit of mechanical stability, the isotherms and isochores of the sodium chloride aqueous solution shift to lower pressures upon increasing concentration while the limit of mechanical stability is very similar to that of bulk water for both concentrations. We also find that the temperature of maximum density line shifts to lower pressures and temperatures upon increasing concentration. Indications of the presence of a liquid-liquid coexistence are found for both concentrations.

Thermodynamic behavior and structural properties of an aqueous sodium chloride solution upon supercooling.

We present the results of a molecular dynamics simulation study of thermodynamic and structural properties upon supercooling of a low concentration sodium chloride solution in TIP4P water and the comparison with the corresponding bulk quantities. We study the isotherms and the isochores for both the aqueous solution and bulk water. The comparison of the phase diagrams shows that thermodynamic properties of the solution are not merely shifted with respect to the bulk. Moreover, from the analysis of the thermodynamic curves, both the spinodal line and the temperatures of maximum density curve can be calculated. The spinodal line appears not to be influenced by the presence of ions at the chosen concentration, while the temperatures of maximum density curve displays both a mild shift in temperature and a shape modification with respect to bulk. Signatures of the presence of a liquid-liquid critical point are found in the aqueous solution. By analyzing the water-ion radial distribution functions of the aqueous solution, we observe that upon changing density, structural modifications appear close to the spinodal. For low temperatures, additional modifications appear also for densities close to that corresponding to a low density configurational energy minimum.