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Background:Over the past years and during pandemic telemedicine has been increasingly used in the management of patients with rheumatic musculoskeletal diseases and many data suggest that it could offer advantages to patients as well as to health care systems[1,2].According with the EULAR points to consider a possible model for telemedicine could be to alternate one virtual and one face to face (F2F) visit.Objectives:(i)To apply the mixed telemedicine model as proposed in the EULAR points to consider, using a dedicated platform and to evaluate the clinical and organizational impact of this approach.(ii)To evaluate the electronic patient-reported outcomes (ePROs) ability to predict the six-month target line.Methods:This is a retrospective analysis from a RA, PsA and AS patient database, obtained remotely using the digital telemedicine platform iAR Plus, from 2021 to 2023. iAR-Plus is a telemonitoring platform dedicated to inflammatory arthritis; between follow-up visits, the patient has the option to independently compile electronic patient-reported outcomes (ePROs). The platform is fully GDPR compliant, with separation of the registry from the clinical database.The following ePROs were collected to assess disease activity at each televisit: Visual analogue scale pain (VAS), FACIT, HAQ and disease-specific questionnaires (RAID for RA, PSAID for Psa and ASAS-HI for AS). The F2F visit was anticipated if the patient was reporting a worsening of the ePROs score and if the virtual visit was suggestive of a disease flare. The presence of a disease flare was diagnosed based on a change in treatment at the F2F visit.To analyze ePROs chi square test and Student t-test for independent sample were applied. Factors resulted significant to the univariate tests were assessed by binary logistic regression as multivariate analysis.Results:138 patients were included in the study (characteristics of the population at baseline, Table 1). All the patients were adherent to the monitoring during follow up.29 patients (AR, SPA, PSA) needed to anticipate F2F visit due to a possible flare of disease activity based on a worsening of ePROs associated with a virtual visit. Interestingly in all three diseases a correlation was observed between the ePROs and the clinical assessment at the F2F visit. In particular, the RAID correlated with the DAS-28-CRP (Cohen’s kappa =0.82); the PSAID with the DAPSA (Cohen’s kappa =0.8), the ASAS-HI with the ASDAS (Cohen’s kappa =0.75).Regarding RA, multivariate analysis showed correlation between RAID and change in treatment (as shown in Table 2).In the PsA group the relationship between PSAID and change therapy was demonstrated (Cohen’s kappa = 0.72). In the group of AS patients, disease flare was correlated to the ASAS-HI (Cohen’s kappa =0.79)Table 1.Characteristics of the total population (mean (sd) or frequency (%))RAPsAASNumber784713Age53 (15)49 (12)45 (14)Disease duration12.4 (8.1)9.6 (7.2)10,6 (7.8)GenderF55 (70.5)21 (44.7)6 (46.2)M23 (29.5)26 (55.3)7 (53.8)Residence in TuscanyYes61 (78.2)42 (89.4)9 (69.2)No17 (21.8)5 (10.6)4 (30.8)Table 2.ePROs correlation with disease flare in the RA sub-populationMultivariate analysisFactorOR (95% CI)p-valueAge0.423Disease duration0.574RAID5.5 (2.2-14)<0.001FACIT0.556HAQ0.396VAS pain0.732Fatigue0.140Conclusion:Our study applies a combining model of telehealth follow-up, showing it is possible to alternate telemedicine and outpatient visits in a scheduled manner, and the importance of standardizing the use of ePROs to evaluate disease activity. In addition, it highlights how remote RAID, PSAID and ASAS-HI are reliable as ePROS, correlating with disease activity and immunosuppressive therapy change. Therefore, through ePROs it is possible to discriminate the subgroup of patients who need F2F visit, while for other patients the alternation at 6 months can be maintained.REFERENCES:[1] De Thurah A, et al. Ann Rheum Dis 2022;81:1065–1071.[2] Avouac J, et al. Teleconsultation in rheumatology: A literature review and opinion paper. Semin Arthritis Rheum. 2023 Dec;63:152271. doi: 10.1016/j.semarthrit.2023.152271.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Anifrolumab (ANI) is a fully human monoclonal antibody against the type I interferon receptor that has recently been approved for the treatment of moderate to severe Systemic Lupus Erythematosus (SLE) as an add-on treatment to standard of care. Data from randomized controlled trials have demonstrated its efficacy and safety, but real-world data are still limited, especially regarding the impact of this new drug on patients’ quality of life (QoL).Objectives:To evaluate the effect of ANI therapy on QoL and disease burden in a multicentric cohort of refractory SLE patients.Methods:Consecutive adult SLE patients (2019 EULAR/ACR criteria) were prospectively enrolled at ANI prescription. Data on demographic features, medical history, previous therapies and SLICC-DI were collected from clinical charts at enrolment. Patients’ assessments were performed at the first ANI infusion and subsequently after one, three and six months of treatment. At each time-point, the clinical evaluation included SLEDAI-2K, SLE-DAS, Physician Global Assessment, number of tender and swollen joints and cutaneous activity and damage assessed using the Cutaneous LE Disease Area and Severity Index (CLASI-A for activity and -D for damage). Patients’ perspective was assessed by self-administration of validated Patient Reported Outcomes (PROs): Lupus Impact Tracker (LIT) to assess the overall impact of SLE on patients’ QoL, Functional Assessment of Chronic Illness Therapy – Fatigue scale (FACIT-F) to measure self-reported fatigue and its impact on daily activities and, in a subgroup of patients with mucocutaneous involvement, Skindex-16 which is a specific PRO to investigate the impact of the skin disease in symptom, emotional and functioning spheres.Results:Twenty-five patients (96% female, 92% Caucasian) with a median age of 45 years (IQR 37-58) and a median disease duration of 11 years (IQR 7.5-21.5) were enrolled. In the whole cohort, 24 patients (96%) had a history of articular involvement, 23 (92%) of mucocutaneous involvement, 16 (64%) of haematological involvement, 7 (28%) of lupus nephritis, 5 (20%) of serositis and 4 (16%) of neuropsychiatric involvement. At baseline, 23 patients (92%) were on concomitant steroid therapy (median prednisone daily dose 7.5 mg, IQR 5-10), 19 (76%) on hydroxychloroquine and 23 (92%) on immunosuppressive treatment (10 methotrexate, 9 mycophenolate mofetil, 3 azathioprine, 1 cyclosporine). Active disease manifestations at the time of ANI prescription were in most cases mucocutaneous (18/25, 72%), followed by articular (10/25, 40%) and haematological (5/25, 20%) involvement.As reported in Table 1, after ANI start, all the disease activity measures showed a progressive improvement over time. A significant correlation was observed between LIT and joint count and Skindex-16 and CLASI-A at baseline (r≥0.464, p≤0.026 for LIT; r≥0.731, p≤0.04 for Skindex-16). During follow-up, LIT and Skindex-16 exhibited progressively and significantly improved scores, while no changes were observed in FACIT-F scores. Notably, Skindex-16 was significantly improved as early as 4 weeks after the first drug infusion (symptoms p=0.028, emotions p=0.03, functioning p=0.05), while LIT reached statistical significance after 12 weeks of treatment (p=0.046), maintaining in both cases the result achieved over time (Figure 1).Conclusion:Our preliminary data show that ANI not only allows a rapid clinical improvement of SLE activity, but also of QoL as shown by the significant amelioration of PROs from the very first months of treatment. Further long-term studies on larger cohorts are needed to confirm and corroborate these results.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

This paper reports the results of a comprehensive experimental test program on high performance and standard AISI 316L stainless, steel reinforced concrete beams. Experimental results were compared with theoretical analysis data using current reinforcement mechanical feature standards and experimental testing-based ones, to identify any resistance, ductility and membrane collapse mode difference. It is also proved the importance of establishing a specific standard on the use of stainless steel reinforcement, in order to enable its more widespread, structural use, and not only for its corrosion resistance.[PUBLICATION ABSTRACT]

Introduction Knowing how metabolic and bariatric surgery (MBS) is indicated in different countries is essential information for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Aim To analyze the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries. Methods All IFSO societies were asked to fill out a survey asking whether they have, and which are their national guidelines, and if MBS is covered by their public health service. Results Sixty-three out of the 72 IFSO national societies answered the form (87.5%). Among them, 74.6% have some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones, and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries. Conclusions Most of the IFSO member societies have MBS guidelines. While more than a third of them have already shifted to the most updated ASMBS/IFSO 2022 ones, another significant number of countries are still following the NIH 1991 guidelines or even do not have any at all. Besides, there is a significant number of countries in which surgical treatment is not yet financially covered. More effort is needed to standardize indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS. Graphical Abstract

OBJECTIVE: To search for a better dietary approach to treat postprandial lipid abnormalities and improve glucose control in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: According to a randomized crossover design, 18 type 2 diabetic patients (aged 59 ± 5 years; BMI 27 ± 3 kg/m²) (means ± SD) in satisfactory blood glucose control on diet or diet plus metformin followed a diet relatively rich in carbohydrates (52% total energy), rich in fiber (28g/1,000 kcal), and with a low glycemic index (58%) (high-carbohydrate/high-fiber diet) or a diet relatively low in carbohydrate (45%) and rich in monounsaturated fat (23%) (low-carbohydrate/high-monounsaturated fat diet) for 4 weeks. Thereafter, they shifted to the other diet for 4 more weeks. At the end of each period, plasma glucose, insulin, lipids, and lipoprotein fractions (separated by discontinuous density gradient ultracentrifugation) were determined on blood samples taken at fasting and over 6 h after a test meal having a similar composition as the corresponding diet. RESULTS: In addition to a significant decrease in postprandial plasma glucose, insulin responses, and glycemic variability, the high-carbohydrate/high-fiber diet also significantly improved the primary end point, since it reduced the postprandial incremental areas under the curve (IAUCs) of triglyceride-rich lipoproteins, in particular, chylomicrons (cholesterol IAUC: 0.05 ± 0.01 vs. 0.08 ± 0.02 mmol/l per 6 h; triglycerides IAUC: 0.71 ± 0.35 vs. 1.03 ± 0.58 mmol/l per 6 h, P < 0.05). CONCLUSIONS: A diet rich in carbohydrate and fiber, essentially based on legumes, vegetables, fruits, and whole cereals, may be particularly useful for treating diabetic patients because of its multiple effects on different cardiovascular risk factors, including postprandial lipids abnormalities.

Background Lung cancer is a leading cause of mortality. The most common cancer subtype, non small cell lung cancer (NSCLC), accounts for 85-90 % all cases and is mainly caused by environmental and genetic factors. Mechanisms involved in lung carcinogenesis include deregulation of several kinases and molecular pathways affecting cell proliferation, apoptosis and differentiation. Despite advances in lung cancer detection, diagnosis and staging, survival rate still remains poor and novel biomarkers for both diagnosis and therapy need to be identified. In the present study, we have explored the potential of novel specific biomarkers in the diagnosis of NSCLC, and the over-expression/activation of several kinases involved in disease development and progression. Method Lung tumor tissue specimens and adjacent cancer-free tissues from 8 NSCLC patients undergoing surgery were collected. The differential activation status of ERK1/2, AKT and IKBα/NF-κβ was analyzed. Subsequently, protein expression profile of NSCLC vs normal surrounding tissue was compared by a proteomic approach using LC-MS MS. Subsequently, MS/MS outputs were analyzed by the Protein Discoverer platform for label-free quantitation analysis. Finally, results were confirmed by western blotting analysis. Results This study confirms the involvement of ERK1/2, AKT, IKBα and NF-κβ proteins in NSCLC demonstrating a significant over-activation of all tested proteins. Furthermore, we found significant differential expression of 20 proteins (R sc  ≥ 1.50 or ≤ −1.50) of which 7 are under-expressed and 13 over-expressed in NSCLC lung tissues. Finally, we validated, by western blotting, the two most under-expressed NSCLC tissue proteins, carbonic anhydrase I and II isoforms. Conclusion Our data further support the possibility of developing both diagnostic tests and innovative targeted therapy in NSCLC. In addition to selective inhibitors of ERK1/2, AKT, IKBα and NF-κβ, as therapeutic options, our data, for the first time, indicates carbonic anhydrase I and II as attractive targets for development of diagnostic tools enabling selection of patients for a more specific therapy in NSCLC.

Il presente studio indaga i percorsi di accoglienza e inclusione a lungo termine di rifugiati e richiedenti asilo (ex beneficiari di progetti SAI) provenienti da piccole comunità locali del Sud Italia (Basilicata). L'obiettivo è quello di effettuare un'analisi degli aspetti che influenzano la scelta di questo territorio interno e il rischio di spopolamento come residenza permanente. Utilizzando la metodologia qualitativa del caso studio, sono state selezionate storie di esperienze esemplari, caratterizzate da un'inclusione sociale riuscita, con l'obiettivo di riflettere sull'evoluzione del progetto migratorio in relazione al nuovo territorio accogliente e con tutte le possibilità che esso ha offerto loro forniti nel corso degli anni. Dall'analisi delle informazioni emerge chiaramente che, contrariamente a quanto si pensa collettivamente, le comunità rurali svolgono un ruolo determinante nel processo di inclusione degli stranieri. Inoltre, i risultati mostrano che le storie di successo di inclusione e i benefici socioeconomici sono anche associati a un’opportunità di proiezione futura per la regione. This study investigates the validity of reception and inclusion projects for refugees and asylum seekers (former beneficiaries of SAI projects) welcomed in rural and internal areas of Basilicata. The study analyses the factors that influence the adoption of these economically marginal communities at risk of depopulation as places of permanent residence. Adopting the case study and field research methodology, we managed to select exemplary experiences characterized by successful socio-economic inclusion paths, to which individual interviews were proposed to understand what led to the modification of one's migratory project in relation to the new welcoming territory and, finally, to bring out the opportunities that the Lucanian context has offered them. From the analysis of the information collected, it emerges that, contrary to what was collectively thought, hosting communities of internal and economically marginal areas also play a crucial role in the field of migrants’ inclusion process. Furthermore, the results demonstrate that successful cases of inclusion and socioeconomic well-being are associated with growth opportunities and a new future projection for the region. Este estudio investiga los itinerarios de recepción e inclusión en el largo plazo de la persona refugiada y solicitante de asilo (antiguos beneficiarios de proyectos SAI) de pequeñas comunidades locales en el sur de Italia (Basílicata). El objetivo es realizar un análisis de los aspectos que inciden en la elección de este territorio del interior y a riesgo de despoblación como residencia permanente. Recurriendo a la metodología cualitativa del estudio de caso, se seleccionaron historias de experiencias ejemplares, caracterizadas por inclusión social exitosa, con el objetivo de reflexionar sobre la evolución del proyecto migratorio en relación con el nuevo territorio acogedor y con todas las posibilidades que este les ha ido brindando a lo largo de los años. Del análisis de la información se desprende que, contrariamente a lo que se piensa colectivamente, las comunidades rurales juegan un factor determinante en el proceso de inclusión de los extranjeros. Además, los resultados muestran que a los casos de éxito de la inclusión y a los beneficios socioeconómicos, se asocia también una oportunidad de proyección futura para la región.