Comparative morphology of male genitalia in antlions (Insecta, Neuroptera, Myrmeleontidae), with emphasis on owlflies (Ascalaphinae) and a possible structural evolutionary scenario.

Male genitalia morphology in Myrmeleontidae has traditionally been insufficiently studied, although it has received increased attention for its diagnostic value in recent times. A neutral terminology has generally been applied in standard taxonomic practice, yet knowledge of an equivalent and stable terminology across taxa based on comparative morphology has been missing. Herein a detailed comparative morphology study with examples from most tribes within Myrmeleontidae, including owlflies (Ascalaphinae), attempts to relate external and internal genital structures based on a proposed groundplan for Neuroptera and Myrmeleontidae. We contend that a groundplan based on 10 abdominal segments, plus vestigial structures from an 11th segment, coherently depicts structural components across myrmeleontid taxa. A gonarcus, an element of Neuropterida amply referred in Neuroptera, is supported to represent the pair of abdominal appendages of segment X medially fused, with gonocoxite and gonostylus components. In most myrmeleontid taxa, basal (gonocoxites) and distal (gonostyli) components separate, with gonostyli positioned posteriorly with respect to gonocoxites, still united with translucent, lightly sclerotized tissue, forming a more or less conical structure, a proposed synapomorphy for the family. Ninth gonostyli are generally reduced (pulvini) and have migrated close to the base of gonarcus (10th gonocoxites). A pelta, also a potential synapomorphy for Myrmeleontidae, derives from paired setose surfaces of the 10th gonostyli, medially positioned (still evident in Bubopsis). Three structural types of gonarcus are diagnosed for illustrative purposes, as they may represent convergent constructs.

Neutrophilic Activity Biomarkers (Plasma Neutrophil Extracellular Traps and Calprotectin) in Established Patients with Rheumatoid Arthritis Receiving Biological or JAK Inhibitors: A Clinical and Ultrasonographic Study.

INTRODUCTION: This study assesses the accuracy of neutrophil activation markers, including neutrophil extracellular traps (NETs) and calprotectin, as biomarkers of disease activity in patients with established rheumatoid arthritis (RA). We also analyse the relationship between NETs and various types of therapies as well as their association with autoimmunity. METHODS: Observational cross-sectional study of patients with RA receiving treatment with biological disease-modifying antirheumatic drugs or Janus kinase inhibitors (JAK-inhibitors) for at least 3 months. Plasma calprotectin levels were measured using an enzyme-linked immunosorbent assay test kit and NETs by measuring their remnants in plasma (neutrophil elastase-DNA and histone-DNA complexes). We also assessed clinical disease activity, joint ultrasound findings and autoantibody status [reumatoid factor (RF), anti-citrullinated peptide/protein antibodies (ACPAs) and anti-carbamylated protein (anti-CarP)]. Associations between neutrophilic biomarkers and clinical or ultrasound scores were sought using correlation analysis. The discriminatory capacity of both neutrophilic biomarkers to detect ultrasound synovitis was analysed through receiver-operating characteristic (ROC) curves. RESULTS: One hundred fourteen patients were included. Two control groups were included to compare NET levels. The active control group consisted of 15 patients. The second control group consisted of 30 healthy subjects. Plasma NET levels did not correlate with clinical disease status, regardless of the clinic index analysed or the biological therapy administered. No significant correlation was observed between NET remnants and ultrasound synovitis. There was no correlation between plasma NET and autoantibodies. In contrast, plasma calprotectin positively correlated with clinical parameters (swollen joint count [SJC] rho = 0.49; P < 0.001, Clinical Disease Activity Index [CDAI] rho = 0.30; P < 0.001) and ultrasound parameters (rho > 0.50; P < 0.001). Notably, this correlation was stronger than that observed with acute phase reactants. CONCLUSION: While NET formation induced by neutrophils may play a role in RA pathogenesis, our study raises questions about the utility of NET remnants in peripheral circulation as a biomarker for inflammatory activity. In contrast, this study strongly supports the usefulness of calprotectin as a biomarker of inflammatory activity in patients with RA.

Calprotectin in Patients with Rheumatic Immunomediated Adverse Effects Induced by Checkpoints Inhibitors.

BACKGROUND: this is an exploratory study to evaluate calprotectin serum levels in patients with rheumatic immune-related adverse events (irAEs) induced by immune checkpoint inhibitor (ICI) treatment. METHODS: this is a retrospective observational study including patients with irAEs rheumatic syndromes. We compared the calprotectin levels to those in a control group of patients with RA and with a control group of healthy individuals. Additionally, we included a control group of patients treated with ICI but without irAEs to check calprotectin levels. We also analysed the performance of calprotectin for the identification of active rheumatic disease using receiver operating characteristic curves (ROC). RESULTS: 18 patients with rheumatic irAEs were compared to a control group of 128 RA patients and another group of 29 healthy donors. The mean calprotectin level in the irAE group was 5.15 µg/mL, which was higher than the levels in both the RA group (3.19 µg/mL) and the healthy group (3.81 µg/mL) (cut-off 2 µg/mL). Additionally, 8 oncology patients without irAEs were included. In this group, calprotectin levels were similar to those of the healthy controls. In patients with active inflammation, the calprotectin levels in the irAE group were significantly higher (8.43 µg/mL) compared to the RA group (3.94 µg/mL). ROC curve analysis showed that calprotectin had a very good discriminatory capacity to identify inflammatory activity in patients with rheumatic irAEs (AUC of 0.864). CONCLUSIONS: the results suggest that calprotectin may serve as a marker of inflammatory activity in patients with rheumatic irAEs induced by treatment with ICIs.

Diversidad específica y taxonómica de la ictiofauna del Río Amacuzac, Morelos, México / Specific and taxonomic diversity of the ichthyofauna of the Amacuzac River, Morelos, Mexico

Resumen Introducción: La diversidad de una comunidad biológica es el resultado de procesos ecológicos e históricos, los cuales, analizados en conjunto, producen una mejor comprensión de las causas que la generan. Objetivo: Actualizamos y analizamos la diversidad específica y taxonómica de la ictiofauna del río Amacuzac, México. Métodos: Durante cinco temporadas de muestreo (2019-2020), recolectamos peces de diez sitios en el río y aplicamos un análisis de conglomerados a las variables del hábitat. Resultados: Recolectamos 7 638 individuos, siete de especies nativas y nueve no nativas, incluyendo Copadichromis borleyi, un nuevo registro para el Amacuzac. La riqueza por sitio osciló entre ocho y 13 especies. Las variables del hábitat definieron cuatro grupos. Las especies más abundantes fueron: Poeciliopsis gracilis, Poecilia maylandi y Amatitlania nigrofasciata. Las especies menos abundantes fueron: Pterygoplichtys pardalis, Ilyodon whitei, Copadichromis borleyi e Ictalurus punctatus. Las especies más relevantes fueron: A. nigrofasciata, Amphilophus istlanus, Andinoacara rivulatus, Notropis boucardi, Oreochormis sp., P. maylandi, P. gracilis y Thorichthys maculipinis. Las especies más restringidas fueron: Atherinella balsana, C. borleyi e I. punctatus. Conclusiones: Las especies en peligro de extinción, A. istlanus y N. boucardi, aun prevalecen en el río. Además, se muestra un aumento en el número de especies no nativas. Analizar la diversidad desde dos perspectivas, aporta una visión más completa de los cambios que se dan en el Río Amacuzac como consecuencia del establecimiento de especies, información que es importante para futuras estrategias de conservación.

Abstract Introduction: The diversity of a biological community is the result of ecological and historical processes, which, when analyzed jointly, produce a better understanding of the causes that generate it. Objective: We update and analyze the specific and taxonomic diversity of the ichthyofauna of the Amacuzac River, Mexico. Methods: During five sampling seasons (2019-2020) we collected fishes from ten sites in the river and applied a cluster analysis to habitat variables. Results: We collected 7 638 individuals; seven were native species and nine were non-native, including Copadichromis borleyi, a new record for the Amacuzac. Richness per site ranged from eight to 13 species. Habitat variables defined four groups. The most abundant species were Poeciliopsis gracilis, Poecilia maylandi and Amatitlania nigrofasciata. The least abundant species were: Pterygoplichtys pardalis, Ilyodon whitei, Copadichromis borleyi and Ictalurus punctatus. The most prevalent species were: A. nigrofasciata, Amphilophus istlanus, Andinoacara rivulatus, Notropis boucardi, Oreochormis sp., P. maylandi, P., gracilis and Thorichthys maculipinis. The most restricted species were: Atherinella balsana, C. borleyi and I. punctatus. Conclusions: Endangered species such as A. istlanus and N. boucardi are still prevalent in the river, but non-native species continue to increase. Analyzing the diversity from two perspectives provides a more complete view of the changes taking place in the Amacuzac River as a consequence of species establishment, information that is important for future conservation strategies.

Plasma calprotectin as a biomarker of ultrasound synovitis in rheumatoid arthritis patients receiving IL-6 antagonists or JAK inhibitors.

Objectives: To analyse the accuracy of plasma calprotectin in patients with rheumatoid arthritis (RA) receiving monoclonal antibodies against IL-6 receptors (anti-rIL-6) or JAK inhibitors (JAKis) in detecting ultrasound (US) synovitis and compare it with acute phase reactants [high-sensitivity C-reactive protein (hs-CRP) and ESR]. Methods: An observational cross-sectional study of RA patients receiving anti-rIL-6 (tocilizumab or sarilumab) or JAKi, (baricitinib or tofacitinib) was made. Plasma calprotectin for the diagnosis of US synovitis [synovial hypertrophy grade (SH) ⩾ 2 plus power Doppler signal (PD) ⩾ 1] was analysed using receiver operating characteristic curves (ROCs). The performance of ESR and hs-CRP was also studied. The three ROC curves were compared to determine which had the highest discriminatory power. Associations between plasma calprotectin and US scores were made using correlation analysis. Results: Sixty-three RA patients were included. Mean plasma calprotectin levels were significantly higher in patients with US synovitis than in those without (0.89 ± 0.85 vs 0.30 ± 0.12 µg/ml; p = 0.0003). A moderate correlation between calprotectin and all US scores (HS score Rho = 0.479; PD score Rho = 0.492; and global score Rho = 0.495) was found. The discriminatory capacity of plasma calprotectin showed an AUC of 0.795 (95% CI: 0.687-0.904). The AUC of hs-CRP and ESR was 0.721 and 0.564, respectively. hs-CRP serum levels showed a low positive correlation with the three US scores (Rho < 0.40). After analysis according to the drugs administered, the correlation disappeared in patients receiving anti-rIL-6. Conclusion: Plasma calprotectin may be a sensitive biomarker of synovial inflammation in RA patients treated with anti-rIL-6 or JAKi.

Imaging Findings in Patients with Immune Checkpoint Inhibitor-Induced Arthritis.

Immune checkpoint inhibitor (ICI)-induced arthritis is an increasingly recognized adverse event in patients with oncologic disease during immunotherapy. Four patterns are well described, including rheumatoid arthritis (RA)-like, polymyalgia rheumatica (PMR)-like, psoriatic arthritis (PsA)-like, and oligo-monoarthritis, among others. Despite better clinical recognition of these syndromes, information about the main imaging findings is limited. METHODS: We conducted a retrospective observational study including all adult patients referred to the Rheumatology Department of a single-center due to ICI-induced arthritis who underwent imaging studies [ultrasound (US), magnetic resonance imaging (MRI), and 18F-FDG PET/CT)] between January 2017 and January 2022. RESULTS: Nineteen patients with ICI-induced arthritis with at least one diagnostic imaging assessment were identified (15 US, 4 MRI, 2 18F-FDG PET/CT). Most patients were male (84.2%), with a median age at inclusion of 73 years. The main underlying diagnoses for ICI treatment were melanoma in five cases. The distribution of ICI-induced arthritis was as follows: PMR-like (5, 26.2%), RA-like (4, 21.1%), PsA-like (4, 21.1%), and others (6, 31.6%). All RA-like patients had US findings indistinguishable from conventional RA patients. In addition, 3/5 (60%) of PMR-like patients had significant involvement of the hands and wrists. Abnormal findings on MRI or PET-CT were reported by clinical symptoms. No erosions or myofascitis were seen. CONCLUSIONS: ICI-induced arthritis patients present inflammatory patterns on imaging studies similar to conventional inflammatory arthropathies, and therefore these syndromes should be followed carefully and treated according to these findings.

Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study.

Objectives: To describe different clinical patterns of rheumatic immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICI) and their rheumatic and oncologic outcomes. Methods: We classified clinical syndromes according to five different categories: non-inflammatory arthralgias (NIA), rheumatoid arthritis (RA)-like, psoriatic arthritis (PsA)-like, polymyalgia rheumatica (PMR)-like, and a miscellaneous group of patients with other syndromes. We conducted a baseline visit and then follow-up in order to determine their clinical pattern, treatment response, and outcome. Results: We included 73 patients (64% male) with a mean age of 66.1 ± 11.6 years. Main underlying diagnosis was lung carcinoma in 29 (39%) patients, melanoma in 20 (27%), and renal-urothelial cancer in 11 (15%). Main ICI included Pembrolizumab in 24 (32%), Nivolumab 17 (23%), and Atezolizumab 7 (9 %). Seventeen out of seventy-three patients had an underlying rheumatic disease before ICI treatment. Fourteen patients developed other irAEs before or simultaneously with rheumatic syndromes. Main rheumatic irAEs included: RA-like in 31 (42.4%), NIA in 19 (26.0%), PMR-like in 10 (13.7%), and PsA-like in 5 (6.8%), among others. Median time from ICI to irAEs was 5 months (IQR 3-9). Those patients who received combined therapy, had a trend for an earlier presentation than those who received monotherapy (4.3 months IQR 1.85-17 vs. 6 months IQR 3-9.25, p = NS). Mean follow-up time was 14.0 ± 10.8 (SD, months). At the last visit, 47 % were taking glucocorticoids and 11% DMARD therapy. At the last visit, 13 (17.8%) patients remained with persistent arthritis, 19 (26%) had intermittent flares, and 39 (53.4%) had a self-limited pattern. Only in 15.1% of patients ICI therapy was discontinued. Conclusions: We described different patterns according to treatment and irAEs. Combined ICI therapy had an earlier onset of symptoms. Patients who presented as RA-like, had a higher risk of persistent arthritis. After a mean follow-up of more than 1 year, one-fifth of the patients remained with persistent arthritis and 11% required DMARD therapy.

Caracterización clínica y laboratorial de la Apendicitis en la Edad Pediátrica

RESUMEN Introducción: La apendicitis aguda es una enfermedad inflamatoria infecciosa del apéndice cecal, constituye la causa más común de emergencia quirúrgica en pediatría. Las manifestaciones clínicas varían significativamente según la edad y sexo. La anamnesis y un examen físico minucioso pueden llegar a ser una herramienta primordial para el diagnóstico, así como también las pruebas complementarias, para evitar realizar una apendicetomía incidental. Objetivo: Describir las características clínicas y laboratoriales en niños con apendicitis, para apoyar el diagnóstico y resolución oportuna. Materiales y Métodos: Estudio retrospectivo, descriptivo de corte transversal sobre los casos de apendicitis registrados en el Servicio de Pediatría del Hospital General IESS Ambato. No se realizó cálculo de tamaño de muestra, se realiza muestreo no probabilístico de casos consecutivos. Resultados: Se pudo determinar que la temperatura mayor 37.5 °C, la taquicardia, el dolor abdominal difuso, el signo de Mc Burney, la leucocitosis con neutrofilia y un examen de orina normal presentan una asociación directa diagnóstica en los cuadros de apendicitis. Conclusión: Se recomienda escalas de puntación clínica de apendicitis, para evitar mayor incidencia de apendicetomías incidentales.

ABSTRACT Introduction: Acute appendicitis is an infectious inflammatory disease of the cecal appendix, it is the most common cause of surgical emergency in pediatrics. The clinical manifestations vary significantly according to age and sex. A thorough history and physical examination is an essential tool for diagnosis, as are complementary tests, to avoid performing an incidental appendectomy. Objective: To describe the clinical and laboratory characteristics in children with appendicitis, to improve timely diagnosis and treatment. Materials and Methods: This was a retrospective, descriptive and cross-sectional study on cases of appendicitis registered in the Pediatric Service of the General Hospital IESS Ambato. No sample size calculation was performed, non-probabilistic sampling of consecutive cases was performed. Results: It was possible to determine that temperature greater than 37.5 °C, tachycardia, diffuse abdominal pain, Mc Burney's sign, leukocytosis with neutrophilia and a normal urine test have a direct diagnostic association with appendicitis. Conclusion: Appendicitis clinical scoring scales are recommended to avoid a higher incidence of incidental appendectomies.

[Pulmonary innate immune response in Sars-cov-2 infection] / Respuesta inmunitaria innata pulmonar en la infección por Sars-Cov-2

Introduction: The emerging infection caused by the new SARS-CoV-2 coronavirus has become a real challenge for the scientific community. Currently, there is little knowledge about the pathogenesis of COVID-19 and in recent times the participation of the host's own immune response in the progression of the disease has been proposed. Innate pulmonary immunity is the first barrier against different toxins, which can cause tissue damage, with the consequent alteration of respiratory function. However, a loss in the regulation of these inflammatory mechanisms can cause a disruption in the homeostasis of the affected tissue. Objective: To evaluate the role of the pulmonary innate immune response in the pathogenesis of COVID-19. : Results: A global alteration of the pulmonary innate immune response was found in SARS-CoV-2 infection, which would have relevance in the pathogenesis of COVID-19. Materials and methods: A systematic review of studies published in scientific search engines was carried out: PubMed, Google Scholar, Science Direct. The following keywords were used: "COVID-19"; "Acute Respiratory Distress Syndrome"; "SARS-CoV-2"; "Innate pulmonary immunity"; "Innate immune response". Conclusion: The global involvement of the innate immune response and consequently of lung tissue homeostasis, in SARS-CoV-2 infection, requires the design of new therapeutic strategies aimed at modulating the altered pro-inflammatory mechanisms in COVID-19.

Introducción: La infección emergente producida por el nuevo coronavirus SARS-CoV-2, se ha constituido en un verdadero desafío para la comunidad científica. Actualmente, es escaso el conocimiento acerca de la patogenia de COVID-19 y en el último tiempo, se ha propuesto la participación de la respuesta inmunitaria propia del huésped, en la progresión de la enfermedad. La inmunidad innata pulmonar se constituye como la primera barrera ante diferentes noxas, que puedan provocar lesión tisular, con la consiguiente alteración de la función respiratoria. Sin embargo, una pérdida en la regulación de estos mecanismos inflamatorios puede provocar una disrupción en la homeostasis del tejido afectado. Objetivo: Evaluar el papel de la respuesta inmune innata pulmonar en la patogenia de COVID-19. Materiales y métodos: Se realizó una revisión sistemática de estudios publicados en buscadores científicos: PubMed, Google Scholar, Science Direct. Se utilizaron las siguientes palabras claves: "COVID-19"; "Acute Respiratory Distress Syndrome"; "SARS-CoV-2"; "Innate pulmonary immunity"; "innate immune response". Resultados: Se encontró una alteración global de la respuesta inmune innata pulmonar en la infección por SARS-CoV-2, que tendría relevancia en la patogenia de COVID-19. Conclusión: La afectación global de la respuesta inmune innata y por consiguiente de la homeostasis tisular pulmonar, en la infección por SARS-CoV-2, requiere el diseño de nuevas estrategias terapéuticas destinadas a la modulación de los mecanismos pro inflamatorios alterados en COVID-19.

High Sensitivity C Reactive Protein in Patients with Rheumatoid Arthritis Treated with Antibodies against IL-6 or Jak Inhibitors: A Clinical and Ultrasonographic Study.

BACKGROUND: We examined whether high-sensitivity CRP (hsCRP) reflected the inflammatory disease status evaluated by clinical and ultrasound (US) parameters in RA patients receiving IL-6 receptor antibodies (anti-IL-6R) or JAK inhibitors (JAKi). METHODS: We conducted a cross-sectional study of patients with established RA receiving anti-IL-6R (tocilizumab, sarilumab) or JAKi (tofacitinib, baricitinib). Serum hsCRP and US synovitis in both hands were measured. Associations between hsCRP and clinical inflammatory activity were evaluated using composite activity indices. The association between hsCRP and US synovitis was analyzed. RESULTS: 63 (92% female) patients (42 anti- IL-6R and 21 JAKi) were included, and the median disease duration was 14.4 (0.2-37.5) years. Most patients were in remission or had low levels of disease. Overall hsCRP values were very low, and significantly lower in anti-IL-6R patients (median 0.04 mg/dL vs. 0.16 mg/dL). Anti-IL-6R (82.4%) patients and 48% of JAKi patients had very low hsCRP levels (≤0.1 mg/dL) (p = 0.002). In the anti-IL-6R group, hsCRP did not correlate with the composite activity index or US synovitis. In the JAKi group, hsCRP moderately correlated with US parameters (r = 0.5) but not clinical disease activity, and hsCRP levels were higher in patients with US synovitis (0.02 vs. 0.42 mg/dL) (p = 0.001). CONCLUSION: In anti-IL-6R RA-treated patients, hsCRP does not reflect the inflammatory disease state, but in those treated with JAKi, hsCRP was associated with US synovitis.

Proliferative synovitis, an ultrasound pattern associated with ACPA-positive patients and erosive disease in rheumatoid arthritis.

OBJECTIVES: To analyse ultrasound (US) differences between rheumatoid arthritis (RA) patients according to autoantibody status and characterise the clinical and radiological features associated with the US pattern of seropositive patients. METHODS: We collected demographic and clinical data and bilateral hand US images of RA patients. We defined an extreme proliferative US pattern, encompassing synovial hypertrophy grade II-III with Power Doppler signal, which we called US proliferative synovitis (US PS). To better characterise US PS, MRI of the dominant hand and immunostaining of synovial biopsies were made in subgroups of 42 and 23 patients, respectively. RESULTS: We included 205 RA patients (84.8% seropositive). No significant differences in disease activity were found according to autoantibody status. US PS was found in 55.5% of seropositive and 16.1% of seronegative patients (p=0.0001). In the multivariate analysis, erosions [OR 4.90 95% CI (2.17-11.07), p=0.0001] and ACPA [OR 3.5 95% CI (1.39-10.7), p=0.009] but not RF status [OR 0.74 95% CI (0.31-1.71), p=0.483] were independently associated with US PS. After a mean follow-up of 46 months, US PS was independently associated with changes in therapy (OR 2.63, 95% CI 1.20-5.77, p=0.016). Ninety-four per cent of joints with US PS had RAMRIS synovitis sub-index grade 2-3. US PS was significantly associated with higher synovial vessel density (p=0.042). CONCLUSIONS: In RA patients, US PS was associated with ACPA status, erosive disease and an enhanced need to change disease-modifying anti-rheumatic drug therapy in the long-term. At synovial level, this US pattern was characterised by higher vessel density.

Aquatic beetle diversity from Volcán Tacaná, Mexico: altitudinal distribution pattern and biogeographical affinity of the fauna.

Results of an aquatic beetle survey at Volcán Tacaná, Mexico, are presented with five altitudinal levels in a monthly sampling regime, aiming to estimate both diversity and altitudinal distribution patterns of the aquatic beetle fauna. The first list of aquatic beetle species from this mountain is presented, comprising 40 species in 32 genera and nine families, with four species recorded for the first time from Mexico and six recorded for the first time from Chiapas. The aquatic beetle fauna is characterized by Elmidae with 20 species, Dytiscidae with eleven species, Dryopidae with three, and Epimetopidae, Hydraenidae, Hydrophilidae, Gyrinidae, Lutrochidae, and Noteridae with one species each. The species composition through the sampled altitudinal gradient (670-1,776 m) was not homogeneous, with the elmid genera Macrelmis, Heterelmis, Microcylloepus, and Austrolimnius present at all levels, while Hexanchorus, Neoelmis, and Onychelmis were present at levels 1-3 (673-1,214 m); dytiscids were mostly present at levels 4 and 5 (1,619-1,776 m), and dryopids were present only at levels 1-3. A Parsimony Analysis of Endemicity supports a general partition between altitudinal levels 1-3 and levels 4 + 5.

Comparable long-term outcomes between DAS28-ESR remission criteria and ACR/EULAR definitions in patients with established rheumatoid arthritis.

OBJECTIVE: To compare long-term clinical, immunological, and radiographic outcomes between five sets of remission criteria (four clinical and one ultrasound (US)-based) in a cohort of RA patients in a clinical care setting. METHODS: RA patients in remission (DAS28-ESR <2.6) were selected. Hand US assessments were made, and serum levels of inflammation/angiogenesis biomarkers were determined at baseline. Changes in baseline treatment and radiographic progression, defined as the variation in the modified Sharp van der Heijde score (mSHS) at 5 years, were analyzed. Five concepts were used to define remission: DAS28-ESR<2.6, SDAI<3.3, CDAI<2.8, Boolean criteria and Power Doppler score (PD)=0. RESULTS: Eighty-seven patients with DAS28-ESR<2.6 were included. One-third fulfilled SDAI (33.3%), CDAI (31%), and Boolean (35.6%) remission criteria, and 25.3% had no PD signal in the US evaluation. 26 patients (29.9%) changed therapy, ranging from 13.6% (PD remission) to 33.3% (CDAI remission) (p=0.11). Serum levels of ANG (p=0.015) and TNFa (p=0.025) were significantly lower in patients with Boolean remission, whereas IL-18 levels were significantly lower in those with PD remission (p=0.049). Patients without PD in the US assessment had significantly-lower mSHS erosion progression (p=0.014) at 5 years. CONCLUSIONS: Patients with established RA in DAS28-ESR remission had comparable clinical and radiographic outcomes in SDAI, CDAI, and Boolean definitions in a clinical care setting. US remission remained the closest to structural damage abrogation. Key Points • This study provides real world data on long-term outcomes of five clinical and imaging remission criteria in rheumatoid arthritis. • DAS28-ESR remission criteria had comparable radiographic progression and clinical prognosis than more stringent criteria in clinical practice. • US-based remission was closest to structural damage abolishment.

Redefinition of the genus Parabyrsopolis Ohaus and description of a new species from west-central Mexico (Coleoptera: Scarabaeidae: Rutelinae: Rutelini).

The morphological limits of the genus Parabyrsopolis Ohaus (Coleoptera: Scarabaeidae: Rutelinae: Rutelini: Areodina) are redefined and Parabyrsopolis moroni new species is described from west-central Mexico. With this addition, the genus now includes five species that are distributed from southwestern United States of America to central Mexico. Diagnostic morphological characters and comparison with other Parabyrsopolis species are included, and some considerations about the morphological limits between Parabyrsopolis and Viridimicus Jameson are discussed.

A new species of Neoscelis Schoch from Mexico (Coleoptera: Scarabaeidae: Cetoniinae: Goliathini) with new distributional records for the genus.

Neoscelis hexakrotes new species (Coleoptera: Scarabaeidae: Cetoniinae: Goliathini) is described from Guerrero, Mexico. Keys to identify male and female Neoscelis Schoch species and new distribution records for Neoscelis dohrni (Westwood) are provided.

Measuring inflammation in rheumatoid arthritis with a new clinical and ultrasound index: development and initial validation.

With the aim to develop and validate a clinical + ultrasound (US) inflammation score in rheumatoid arthritis (RA) for use in clinical practice, a mixed-method study was conducted. The theoretical development of the index was achieved with qualitative methodology (discussion group and Delphi survey). Subsequently, a cross-sectional study was carried out to analyse issues related to scoring and validation of the new index. RA patients underwent clinical [28 swollen and tender joints count, patient and physician global assessment (PhGA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)], and US assessments [synovitis or tenosynovitis by grey-scale (GS) and power Doppler (PD) of 42 structures]. An index was created based on statistical models and expert interaction. Construct validity was tested by correlation with DAS28, SDAI, CDAI, and PhGA. Reliability was evaluated in a subgroup of patients with the intraclass correlation coefficient (ICC). US assessment, CRP, and swollen joints were the items that passed the prioritization phase (Delphi study). For the cross-sectional study, 281 patients were randomly divided into design (n = 141) and validation samples (n = 140). The combination of US sites chosen (7 bilaterally) detected the maximum proportion of synovitis and PD present. Three scoring methods were tested: semiquantitative (0-3 GS + 0-3 PD), dichotomous (0/1 GS + 0/1 PD), and qualitative (0/1 based on algorithm). All showed strong correlation with activity measures (ρ ≥ 0.60), and reliability (ICC 0.89-0.93). The index with best parameters of validity, feasibility, and reliability was the qualitative. The final index chosen was the sum of swollen joint count, US qualitative score, and CRP. The UltraSound Activity score is a valid and reliable measure of inflammation in RA equal to the sum of 28 SJC, a simplified (0/1) US assessment of 11 structures and CRP. It is necessary further investigation to demonstrate additional value over existing indices.

Isquemia de ciego como hallazgo no esperado / Cecum blind ischemia as an unexpected finding

RESUMEN Las patologías isquémicas a nivel de colon tienen una clínica poco característica, por ello, son de difícil diagnóstico. Se reporta a un paciente, con antecedente de hipertensión arterial, que presenta dolor abdominal de 12 horas de evolución, localizado en fosa iliaca derecha sin irradiación, tipo cólico, de moderada intensidad, sin síntomas acompañantes. Al examen físico presenta abdomen depresible, doloroso a palpación profunda, signos de Mc Burney, Rovsing y Blumberg positivos. El hemograma reporta leucocitosis 12.900/mm3 con neutrofilia 82,9%. Se diagnostica apendicitis aguda y se planea apendicetomía, pero el cirujano constata apéndice cecal grado II, base apendicular en buen estado, asas intestinales distendidas e isquemia en la cara anterior del ciego, siendo este hallazgo importante para cambiar la conducta de la cirugía a una ileostomía de urgencia. Se considera que es de importancia conocer los patrones evolutivos de la isquemia de colon y los factores que predicen su curso desfavorable y mortalidad.

ABSTRACT The colon ischemic pathologies have scare clinical features and are difficult to diagnose. We report a case of a with history of arterial hypertension, who presents with abdominal pain of 12 hours in the right iliac fossa without radiation, colic type, of moderate intensity, without other accompanying symptoms. On physical examination the abdomen was soft depressible, painful to deep palpation, signs of Mc Burney, Rovsing and Blumberg were positives. The hemogram reported leukocytosis 12900 with neutrophilia 82.9%. It is diagnosed as acute appendicitis and was planned an appendectomy. The surgeon reported an cecal appendix grade II, good appendicular base, distended bowel loops and ischemia on the anterior face of the cecum, being the cast finding an important one to change the planned surgery to an ileostomy urgent. We consider an important to fact know the evolution patterns of colon ischemia and factors that predict its unfavorable course and mortality.

A new Mexican species of Chrysina Kirby (Coleoptera: Scarabaeidae: Rutelinae), with nomenclatural changes, new records, and a key to the C. quiche species group.

Chrysina chimalapensis new species (Coleoptera: Scarabaeidae: Rutelinae: Rutelini), from the region of Chimalapas, Oaxaca, Mexico is described and illustrated. A key to the species of the C. quiche species group is included. Plusiotis neotenochca Morón Nogueira is placed as a new junior synonym of Chrysina paulseni Hawks, and C. aenigmatica (Morón) as a new junior synonym of C. modesta Sturm. Chrysina benesi from Guatemala, and C. quetzalcoatli from Nicaragua are recorded as new country records. Chrysina quetzalcoatli Morón and C. triumphalis Morón are also recorded for the first time for the state of Oaxaca, Mexico, and C. victorina (Hope) for the state of Veracruz, Mexico.