Calcinosis in Rheumatic Disease Is Still an Unmet Need: A Retrospective Single-Center Study.

Patients with immune-mediated rheumatic disease-related calcinosis comprise a subgroup at risk of encountering a more severe clinical outcome. Early assessment is pivotal for preventing overall disease progression, as calcinosis is commonly overlooked until several years into the disease and is considered as a 'non-lethal' manifestation. This single-center retrospective study explored the prevalence, clinical associations, and impact on survival of subcutaneous calcinosis in 86 patients with immune-mediated rheumatic diseases (IMRD). Calcinosis predominantly appeared in individuals with longstanding disease, particularly systemic sclerosis (SSc), constituting 74% of cases. Smaller calcinosis lesions (≤1 cm) were associated with interstitial lung disease, musculoskeletal involvement, and digital ulcerations, while larger lesions (≥4 cm) were associated with malignancy, severe peripheral artery disease, and systemic arterial hypertension. The SSc calcinosis subgroup exhibited a higher mean adjusted European Scleroderma Study Group Activity Index score than those without. However, survival rates did not significantly differ between the two groups. Diltiazem was the most commonly used treatment, and while bisphosphonates reduced complications related to calcinosis, complete resolution was not achieved. The findings underscore current limitations in diagnosing, monitoring, and treating calcinosis, emphasizing the need for further research and improved therapeutic strategies to improve patient care and outcomes.

Captive Animal Behavior Study by Video Analysis.

Three video analysis-based applications for the study of captive animal behavior are presented. The aim of the first one is to provide certain parameters to assess drug efficiency by analyzing the movement of a rat. The scene is a three-chamber plastic box. First, the rat can move only in the middle room. The rat's head pose is the first parameter needed. Secondly, the rodent could walk in all three compartments. The entry number in each area and visit duration are the other indicators used in the final evaluation. The second application is related to a neuroscience experiment. Besides the electroencephalographic (EEG) signals yielded by a radio frequency link from a headset mounted on a monkey, the head placement is a useful source of information for reliable analysis, as well as its orientation. Finally, a fusion method to construct the displacement of a panda bear in a cage and the corresponding motion analysis to recognize its stress states are shown. The arena is a zoological garden that imitates the native environment of a panda bear. This surrounding is monitored by means of four video cameras. We have applied the following stages: (a) panda detection for every video camera; (b) panda path construction from all routes; and (c) panda way filtering and analysis.

Link between Alkali Metals in Salt Templates and in Electrolytes for Improved Carbon-Based Electrochemical Capacitors.

Various alkali metal (Li+, Na+, K+, Rb+, and Cs+) chlorides with Pluronic F127 were used as a soft-salt template for tuning the textural and structural properties of carbon. Highly conductive metal hydroxide solutions, where the cations are the same as those in the salt template, have been used as electrolytes. By increasing the size of the cation in the template, the textural properties of carbon, such as the specific surface area, micropore volume, and pore size, were remarkably enhanced. It directly translates to an increase in the specific capacitance of the electrode material. For a constant current charge/discharge at 0.1 A g-1, the electrode composed of LiCl-T and operating with 1 mol L-1 LiOH demonstrates the capacitance of 124 F g-1, whereas CsCl-T with the same electrolyte has a capacitance of 216 F g-1. Moreover, the materials show the highest capacitance retention (up to 75%) vs. the current regime applied when the cation used during synthesis matches the cation present in the electrolyte (i.e., LiCl-T with LiOH). Interestingly, capacitance normalized by specific surface area has been found to be the highest when LiOH solution is applied as an electrolyte. Thus, for this metric, the size of ions seems to be a crucial parameter. The importance of mesoporosity is highlighted as well by using materials with a similar fraction of micropores and with or without mesopores. Briefly, the presence of mesopore fraction proved to be essential for improved capacity retention (69% vs. 30%). Besides textural properties, the graphitization degree impacts the electrochemical performance as well. It increases among the samples, in accordance with cation-π binding energy, e.g., LiCl-T is the most "graphitic-like" material and CsCl-T is the most disordered. Thus, the more graphitic-like materials demonstrate higher rate capability and cycle stability.

Effect of the early intensive multifactorial therapy on the cardiovascular risk in patients with newly diagnosed type 2 diabetes: an observational, prospective study.

BACKGROUND AND AIMS: We assessed if early intensive interventions improve the glycemic control and the modifiable cardiovascular diseases risk factors in Romanian patients with newly diagnosed type-2 diabetes during the first year follow-up period. PATIENTS AND METHODS: This was an observational, prospective study: 69 subjects were included in the analysis; each of them received intensive multi-factorial pharmacologic treatment and therapeutic education targeting hyperglycemia, weight, hypertension and dyslipidemia. Disease monitoring was done at months 0, 1, 3, 6 and 12 by assessment of anthropometric measurements, arterial blood pressure and biochemical parameters. The cardiovascular diseases risk factors were calculated using the United Kingdom Prospective Diabetes Study Risk Engine. RESULTS: The mean age at diagnosis was 53.61±10.66 years. All anthropometric variables (body weight, body mass index, waist circumference, visceral fat area, percentage of body fat), except for skeletal muscle mass, significantly decreased overtime. The majority of the biochemical parameters significantly decreased overtime. The non-fatal/fatal coronary heart disease risk significantly decreased at month 12 (9.74 [p<0.05] and 4.84 [p<0.05], respectively) compared to month 0 (19.66 and 11.10, respectively); a similar trend of the non-fatal/fatal stroke (risk at month 12, 8.30 [p<0.05] and 1.04 [p<0.05], respectively, while at month 0, 7.89 and 1.38, respectively) was recorded. CONCLUSIONS: Early multi-factorial treatment and intensive lifestyle interventions in patients newly diagnosed with type-2 diabetes could decrease with approximately 50% the rate of cardiovascular disease risk.

Fenofibrate improves endothelial function and plasma myeloperoxidase in patients with type 2 diabetes mellitus: an open-label interventional study.

BACKGROUND: Fenofibrate offers a number of benefits on the cardiovascular system and it is plausible that its anti-inflammatory, anti-oxidant and anti-fibrotic effects and enhancement of cardiac metabolic performances may account for its direct cardioprotective effects.In this study we aimed to investigate the effect of fenofibrate on endothelial function assesed by vascular studies and levels of soluble E-selectin (sE-selectin) as well as the effect on plasma myeloperoxidase (MPO) in patients with type 2 diabetes mellitus (T2DM) without previous use of lipid-lowering medication. METHODS: 27 patients (14 men and 13 women) with T2DM and good glycemic control (HbA1c: min 5.9%, max: 7.1%) treated with metformin monotherapy, without previous use of lipid-lowering medication were enrolled in this study. Vascular studies included measures of brachial artery diameter before and after release of a suprasystolic ischemia. FMD was calculated as the percent (%) change in arterial diameter following reactive hyperemia. Student's paired t test and Wilcoxon Signed Ranks Test were used to compare values before and after fenofibrate therapy. RESULTS: Fenofibrate therapy significantly increased post ischemia mean brachial artery diameter at 60 s (from 4.7 [4.4; 5.0] mm to 4.9 [4.6; 5.2] mm, p = 0.01) and at 90 s (from 4.7 [4.4; 5.0] mm to 4.9 [4.6; 5.1], p = 0.02). FMD response to hyperaemia at 60 s increased with 4.5 ± 13.7% (median value pre- treatment: 22.2%, median value post- treatment 25.0%, z = -2.9, p = 0.004). After 8 weeks of fenofibrate therapy, plasma MPO levels decreased to 49.5 [30.3; 71.5] ng/ml (% change from baseline = 4.6%, z = -2.2, p = 0.03) and mean plasma sE-selectin levels decreased to 67.1 [54.4; 79.8] ng/ml, (% change from baseline = 2.6%, p = 0.03). CONCLUSION: In patients with T2DM without previous treatment for dyslipidemia, short-term treatment with fenofibrate improved vascular endothelial function as demonstrated by increased post ischemia mean brachial artery diameter, increased FMD and decreased plasma sE-selectin and favorably affected plasma MPO levels. Therefore, fenofibrate may be considered a protective cardiovascular drug in this group of patients. TRIAL REGISTRATION: (Australian New Zealand Clinical Trials Registry ANZCTR12612000734864).

The development of a sleep apnea screening program in Romanian type 2 diabetic patients: a pilot study.

To determine the feasibility of a sleep apnea screening program in Romanian patients with type 2 diabetes and obesity attending outpatient clinic of a diabetes center (the standard for routine care in Romania). The Epworth Sleepiness Scale was administered to 80 consecutive patients with type 2 diabetes and a body mass index (BMI) ≥30 kg/m2. Patients with a score >10 at this scale were referred to polysomnography for a sleep study. Overall, 20% of these patients had excessive daytime sleepiness (Epworth Sleepiness Scale >10), and in all of these cases, obstructive sleep apnea was confirmed. Of these patients, 33.3% had moderate OSA (AHI = 15-30 events/h of sleep), and 58.3% had severe OSA (AHI ≥30 events/h of sleep). Individuals with OSA were more frequent males, have higher BMI, higher waist circumference, and lower HDL-cholesterol compared with non-apneic subjects. Hb A1c, diabetes duration, and age were not statistically different between the two groups. OSA odds increased 1.1 times with every 1-cm increase in abdominal circumference (95%CI: 1.01-1.13) and 1.2 times with every kg/m2 increase in BMI (95%CI: 1.05-1.38). These associations remained statistically significant even after adjustment for age and sex. The prevalence of OSA in the sampled population was high. These findings suggest the need for more data regarding prevalence of obstructive sleep apnea in Romanian patients with type 2 diabetes. Furthermore, associations found may form a basis to develop specific recommendations for screening of sleep apnea in patients with type 2 diabetes from Romania.

276G>T Polymorphism of the ADIPOQ Gene Influences Plasma Adiponectin in Type 2 Diabetes Patients but Is Not Predictive for Presence of Type 2 Diabetes in a Caucasian Cohort from Romania.

BACKGROUND: Previous reports associated ADIPOQ 276G>T polymorphism with plasma adiponectin levels and diabetes. Our objective was to study this polymorphism in type 2 diabetes (T2D) Romanian patients and to assess its influence on plasma adiponectin levels; possible link to prevalence of T2D was also addressed. DESIGN: Case control studyMaterial and Methods: Consecutive T2D patients, age and sex matched controls were genotyped for the 276 ADIPOQ locus. Medical history, laboratory evaluation, plasma adiponectin were assessed. OUTCOMES: 105 T2D patients and 48 controls were included. Adiponectin was higher in controls (17.04±3.02 µg/ml) than in T2D patients (10.32±1.16 µg/ml), difference failed to reach significance (p=0.06). Genotype distribution wasn't different between T2D patients and controls. 44 (41.90%) of T2D patients had GG genotype, 51 (48.57%) GT and 10 (9.52%) TT genotype. Adiponectin was higher (19.03±3.46 µg/ml) in diabetic TT allele carriers than in GT (9.96±1.76 µg/ml) or GG patients (8.71±1.60 µg/ml) p=0.003. In controls, 28 (58.33 %) subjects were carriers of the GG genotype, 16 (33.33%) had GT genotype and 4 (8.33%) had TT genotype. There weren't significant differences in the studied parameters between different genotypes in the control group. Logistic regression disclosed age p=0.0001 (OR 1.086; CI 1.041/1.133), waist circumference p=0.00049 (OR 1.084; CI 1.036/1.135), adiponectinemia p=0.036 (OR 0.963; CI 0.929/0.998) but not genotype as predictors for the presence of diabetes. CONCLUSION: Presence of the TT allele at the 276 locus of the ADIPOQ gene is associated with higher plasma adiponectin levels in type 2 diabetes patients. Plasma adiponectin, and not genotype at the 276 locus is predictive for the presence of T2D.

Hypertensive waist: first step of the screening for metabolic syndrome.

BACKGROUND: In previous studies, we have suggested that hypertensive waist is a frequent combination in persons with metabolic syndrome. The objective of the current study was to analyze the ability of hypertensive waist to predict the presence of the metabolic syndrome. METHODS: A total of 1294 women and men, randomly selected from general population, aged > or =18 years were included in this study. For these persons, the clinical and anthropometric data as well as fasting plasma blood glucose, triglycerides, total cholesterol, and high-density lipoprotein cholesterol were assessed. Hypertensive waist was defined as the presence of the systolic blood pressure > or =130 mmHg or a diastolic blood pressure > or =85 mmHg or history of treated hypertension plus a waist circumference > or =80 cm for women and > or =94 for men. International Diabetes Federation criteria were used for the diagnosis of the metabolic syndrome. RESULTS: The prevalence of hypertensive waist was 43.3% and the prevalence of the metabolic syndrome was 45.7%. Persons with hypertensive waist were 6.7 times more likely to have metabolic syndrome (95% confidence interval, 5.5-8.2) when compared with people without hypertensive waist. The high values of specificity (84%) and sensitivity (80.4%) showed that hypertensive waist is a very good predictor of the metabolic syndrome. CONCLUSIONS: On the basis of the easy-to-determine clinical parameters and on high predictive value, the clinical couple of hypertensive waist could be used as a starting point to screen for metabolic syndrome in Romanian population.

Practical aspects of the control of cardiovascular risk in type 2 diabetes mellitus and the metabolic syndrome.

Cardiovascular disease is unanimously recognized as the major burden in type 2 diabetes, in terms of both mortality and morbidity. There is an extensive evidence coming from epidemiological studies that supports this statement. The presence of the metabolic syndrome confers a higher risk of long-term death, and dysglycemia appears to be responsible for the most of the excess risk. The metabolic syndrome also has an essential role in the modern concept of cardiovascular prevention.Global cardiovascular risk represents the action and consequences of all risk factors that simultaneously or sequentially act on the body, leading to atherogenesis/atherosclerosis. In daily practice, a stepwise approach to control cardiovascular risk in people with type 2 diabetes has been proposed. This algorithm comprises three steps: identification of cardiovascular risk factors, interpretation of global cardiovascular risk, and intervention for all identified risk factors and diseases. In the past decades, the whole concept of diabetes and the metabolic syndrome care has undergone a radical change. From here the concept of modern management of those diseases emerged: early, multi-factorial and intensive control. This concept emphasized early and aggressive interventions for all cardiovascular risk factors in the long-term management. The model of multiple cardiovascular risk factor intervention ought to be implemented in daily practice as much as possible. This offers a unique opportunity to reduce the devastating cardiovascular morbidity and mortality in people with type 2 diabetes and the metabolic syndrome.

Metabolic syndrome--practical approach.

The diagnosis of metabolic syndrome is based on identification of the following parameters: abdominal obesity, triglycerides, HDL-cholesterol, blood pressure, fasting glycemia, as recommended by ATP III. In order to simplify the clinical practice, at least two parameters should be screened for. The most frequent couple, easy to be determined in practice, is hypertensive waist, followed by hypertriglyceridemic waist, hypertensive dyslipidemia, dysglycemic dyslipidemia and hypertensive dysglycemia. Based on these couples the next step would be to identify the triads that diagnose the metabolic syndrome. A global assessment of cardiovascular risk should be made. Suggested method is to apply the Framingham Score. Therapeutic intervention is structured according to levels of cardiovascular risk. Clinical management is structured on THEME Programs (therapy, education, monitoring, evaluation), applied to all risk factors.

Incidência de cefaléia em uma comunidade hospitalar / Headache incidence in a hospital community

O objetivo foi determinar em um grupo de pessoas de uma comunidade hospitalar a incidência de cefaléia e para esta a frequência, principais características e investigaçoes médicas mais solicitadas. Utilizamos a combinaçao de questionário e entrevista. Do total de 1006 fichas aleatoriamente preenchidas, 987 pessoas responderam corretamente aos quesitos e destas 380 (38,5 por cento) eram portadoras de cefaléia. Baseados na Classificaçao Internacional de Cefaléia dividimos os portadores em dois principais grupos, a migrânea e a cefaléia do tipo tensional. As demais foram agrupadas num terceiro grupo. A idade média foi 31,18 anos com predomínio do sexo feminino em todos os tipos de cefaléia. A presença de história familiar foi positiva em 76,8 por cento dos entrevistados. As características mais frequentes foram: localizaçao frontal, tipo pulsátil e intensidade moderada. O principal fator desencadeante foi o estresse. A procura de acompanhamento médico deu-se em 41,3 por cento dos portadores. Destes, aproximadamente 56 por cento consultaram um clínico geral, 23 por cento consultaram um neurologista e 21 por cento procuraram outras especialidades. O RX de crânio foi o exame mais solicitado pelos generalistas e o eletrencefalograma pelos neurologistas. A tomografia computadorizada do crânio nao foi solicitada com frequência.