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- Elhai, M, et al.
(författare)
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Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study
- 2019
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Ingår i: Annals of the rheumatic diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 78:7, s. 979-987
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Tidskriftsartikel (refereegranskat)abstract
- To assess the safety and efficacy of rituximab in systemic sclerosis (SSc) in clinical practice.MethodsWe performed a prospective study including patients with SSc from the European Scleroderma Trials and Research (EUSTAR) network treated with rituximab and matched with untreated patients with SSc. The main outcomes measures were adverse events, skin fibrosis improvement, lung fibrosis worsening and steroids use among propensity score-matched patients treated or not with rituximab.Results254 patients were treated with rituximab, in 58% for lung and in 32% for skin involvement. After a median follow-up of 2 years, about 70% of the patients had no side effect. Comparison of treated patients with 9575 propensity-score matched patients showed that patients treated with rituximab were more likely to have skin fibrosis improvement (22.7 vs 14.03 events per 100 person-years; OR: 2.79 [1.47–5.32]; p=0.002). Treated patients did not have significantly different rates of decrease in forced vital capacity (FVC)>10% (OR: 1.03 [0.55–1.94]; p=0.93) nor in carbon monoxide diffusing capacity (DLCO) decrease. Patients having received rituximab were more prone to stop or decrease steroids (OR: 2.34 [1.56–3.53], p<0.0001). Patients treated concomitantly with mycophenolate mofetil had a trend for better outcomes as compared with patients receiving rituximab alone (delta FVC: 5.22 [0.83–9.62]; p=0.019 as compared with controls vs 3 [0.66–5.35]; p=0.012).ConclusionRituximab use was associated with a good safety profile in this large SSc-cohort. Significant change was observed on skin fibrosis, but not on lung. However, the limitation is the observational design. The potential stabilisation of lung fibrosis by rituximab has to be addressed by a randomised trial.
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| 5. |
- van Steenbergen, Hanna W, et al.
(författare)
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EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis
- 2017
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 76:3, s. 491-496
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: During the transition to rheumatoid arthritis (RA) many patients pass through a phase characterised by the presence of symptoms without clinically apparent synovitis. These symptoms are not well-characterised. This taskforce aimed to define the clinical characteristics of patients with arthralgia who are considered at risk for RA by experts based on their clinical experience.METHODS: The taskforce consisted of 18 rheumatologists, 1 methodologist, 2 patients, 3 health professionals and 1 research fellow. The process had three phases. In phase I, a list of parameters considered characteristic for clinically suspect arthralgia (CSA) was derived; the most important parameters were selected by a three-phased Delphi approach. In phase II, the experts evaluated 50 existing patients on paper, classified them as CSA/no-CSA and indicated their level of confidence. A provisional set of parameters was derived. This was studied for validation in phase III, where all rheumatologists collected patients with and without CSA from their outpatient clinics.RESULTS: The comprehensive list consisted of 55 parameters, of which 16 were considered most important. A multivariable model based on the data from phase II identified seven relevant parameters: symptom duration <1 year, symptoms of metacarpophalangeal (MCP) joints, morning stiffness duration ≥60 min, most severe symptoms in early morning, first-degree relative with RA, difficulty with making a fist and positive squeeze test of MCP joints. In phase III, the combination of these parameters was accurate in identifying patients with arthralgia who were considered at risk of developing RA (area under the receiver operating characteristic curve 0.92, 95% CI 0.87 to 0.96). Test characteristics for different cut-off points were determined.CONCLUSIONS: A set of clinical characteristics for patients with arthralgia who are at risk of progression to RA was established.
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| 6. |
- Gyürky, Gy., et al.
(författare)
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Resonance strengths in the 14N( p,γ)15O astrophysical key reaction measured with activation
- 2019
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Ingår i: Physical Review C. - : American Physical Society. - 2469-9985 .- 2469-9993. ; 100:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The 14N(p,γ)15O reaction plays a vital role in various astrophysical scenarios. Its reaction rate must be accurately known in the present era of high precision astrophysics. The cross section of the reaction is often measured relative to a low energy resonance, the strength of which must therefore be determined precisely.Purpose: The activation method, based on the measurement of 15O decay, has not been used in modern measurements of the 14N(p,γ)15O reaction. The aim of the present work is to provide strength data for two resonances in the 14N(p,γ)15O reaction using the activation method. The obtained values are largely independent from previous data measured by in-beam γ spectroscopy and are free from some of their systematic uncertainties.Method: Solid state TiN targets were irradiated with a proton beam provided by the Tandetron accelerator of Atomki using a cyclic activation. The decay of the produced 15O isotopes was measured by detecting the 511 keV positron annihilation γ rays.Results: The strength of the Ep=278keV resonance was measured to be ωγ278=(13.4±0.8)meVwhile for the Ep=1058keV resonance ωγ1058=(442±27)meV.Conclusions: The obtained Ep=278 keV resonance strength is in fair agreement with the values recommended by two recent works. However, the Ep=1058keV resonance strength is about 20% higher than the previous value. The discrepancy may be caused in part by a previously neglected finite target thickness correction. As only the low energy resonance is used as a normalization point for cross section measurements, the calculated astrophysical reaction rate of the 14N(p,γ)15O reaction and therefore the astrophysical consequences are not changed by the present results.
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| 7. |
- Kowal-Bielecka, Otylia, et al.
(författare)
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Update of EULAR recommendations for the treatment of systemic sclerosis
- 2017
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 76, s. 1327-1339
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis and gastrointestinal involvement. Compared with the 2009 recommendations, the 2016 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressive SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc.
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- Kun, E., et al.
(författare)
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Comparative testing of dark matter models with 15 HSB and 15 LSB galaxies
- 2017
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Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 608
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Tidskriftsartikel (refereegranskat)abstract
- Context. We assemble a database of 15 high surface brightness (HSB) and 15 low surface brightness (LSB) galaxies, for which surface brightness density and spectroscopic rotation curve data are both available and representative for various morphologies. We use this dataset to test the Navarro-Frenk-White, the Einasto, and the pseudo-isothermal sphere dark matter models.Aims. We investigate the compatibility of the pure baryonic model and baryonic plus one of the three dark matter models with observations on the assembled galaxy database. When a dark matter component improves the fit with the spectroscopic rotational curve, we rank the models according to the goodness of fit to the datasets.Methods. We constructed the spatial luminosity density of the baryonic component based on the surface brightness profile of the galaxies. We estimated the mass-to-light (M/L) ratio of the stellar component through a previously proposed color-mass-to-light ratio relation (CMLR), which yields stellar masses independent of the photometric band. We assumed an axissymetric baryonic mass model with variable axis ratios together with one of the three dark matter models to provide the theoretical rotational velocity curves, and we compared them with the dataset. In a second attempt, we addressed the question whether the dark component could be replaced by a pure baryonic model with fitted M/L ratios, varied over ranges consistent with CMLR relations derived from the available stellar population models. We employed the Akaike information criterion to establish the performance of the best-fit models.Results. For 7 galaxies (2 HSB and 5 LSB), neither model fits the dataset within the 1 sigma confidence level. For the other 23 cases, one of the models with dark matter explains the rotation curve data best. According to the Akaike information criterion, the pseudoisothermal sphere emerges as most favored in 14 cases, followed by the Navarro-Frenk-White (6 cases) and the Einasto (3 cases) dark matter models. We find that the pure baryonic model with fitted M/L ratios falls within the 1 sigma confidence level for 10 HSB and 2 LSB galaxies, at the price of growing the M/Ls on average by a factor of two, but the fits are inferior compared to the best-fitting dark matter model.
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| 9. |
- Wagner, L., et al.
(författare)
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Astrophysical S factor of the N 14 (p,γ) O 15 reaction at 0.4-1.3 MeV
- 2018
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Ingår i: Physical Review C. - : American Physical Society. - 2469-9985 .- 2469-9993. ; 97:1
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Tidskriftsartikel (refereegranskat)abstract
- The N14(p,γ)O15 reaction is the slowest reaction of the carbon-nitrogen cycle of hydrogen burning and thus determines its rate. The precise knowledge of its rate is required to correctly model hydrogen burning in asymptotic giant branch stars. In addition, it is a necessary ingredient for a possible solution of the solar abundance problem by using the solar N13 and O15 neutrino fluxes as probes of the carbon and nitrogen abundances in the solar core. After the downward revision of its cross section due to a much lower contribution by one particular transition, capture to the ground state in O15, the evaluated total uncertainty is still 8%, in part due to an unsatisfactory knowledge of the excitation function over a wide energy range. The present work reports precise S factor data at twelve energies between 0.357 and 1.292 MeV for the strongest transition, capture to the 6.79-MeV excited state in O15, and at ten energies between 0.479 and 1.202 MeV for the second strongest transition, capture to the ground state in O15. An R-matrix fit is performed to estimate the impact of the new data on astrophysical energies. The recently suggested slight enhancement of the 6.79-MeV transition at low energy could not be confirmed. The present extrapolated zero-energy S factors are S6.79(0)=1.24±0.11 keV b and SGS(0)=0.19±0.05 keV b.
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