University of Modena and Reggio Emilia
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Clinical practice guidelines for reporting nailfold videocapillaroscopy: a Delphi consensus on behalf of the Italian Society of Rheumatology study group on capillaroscopy
No full textObjective
In clinical practice, standardised reporting of nailfold videocapillaroscopy (NVC) findings is lacking, making the
interpretation and comparison of results difficult. We aimed to achieve a national consensus on how to describe NVC
findings in routine clinical practice.
Methods
A web-based Delphi consensus study was conducted among members of the Study Group on Capillaroscopy and
Microcirculation in Rheumatic Diseases of the Italian Society of Rheumatology (CAPSIR). The study was based on items
derived from a previous systematic review and international consensus by the EULAR Study Group on Microcirculation in
Rheumatic Diseases (SG_MC/RD).
Results
A total of 40 items were proposed during the Delphi process, which was completed by 52 participants from different
Italian regions. An agreement was reached on 23 items covering different aspects of the NVC examination: general aspects
(2 items), description of the fingers examined (3 items), possible confounding factors (2 items), device description (2 items),
image quality (1 item) and details of the NVC examination (13 items). Sixteen of these were considered mandatory for
inclusion in the NVC practice report, and 7 were considered optional.
Conclusion
The proposed NVC checklist covers 23 relevant issues in clinical practice, including 16 mandatory items grouped into five
categories. This national consensus will improve the reproducibility and generalisability of NVC reporting in daily clinical
practice. Furthermore, the outcomes of this NVC consensus process will inform the next European web-based Delphi
consensus study, to be conducted among the member countries of the EULAR SG_MC/RD
Varanus: Runtime Verification for CSP
No full textAutonomous systems are often used in changeable and unknown environments, where traditional verification may not be suitable. Runtime Verification (RV) checks events performed by a system against a formal specification of its intended behaviour, making it highly suitable for ensuring that an autonomous system is obeying its specification at runtime. Communicating Sequential Processes (CSP) is a process algebra usually used in static verification, which captures behaviour as a trace of events, making it useful for RV as well. Further, CSP has more recently been used to specify autonomous and robotic systems. Though CSP is supported by two extant model checkers, so far it has no RV tool. This paper presents Varanus, an RV tool that monitors a system against an oracle built from a CSP specification. This approach enables the reuse without modifications of a specification that was built, e.g. during the system’s design. We describe the tool, apply it to a simulated autonomous robotic rover inspecting a nuclear waste store, empirically comparing its performance to two other RV tools using different languages, and demonstrate how it can detect violations of the specification. Varanus can synthesise a monitor from a CSP process in roughly linear time, with respect to the number of states and transitions in the model; and checks each event in roughly constant time
Rethinking Excavated-Earth Concrete: Water Transport in Sustainable Earthcretes
No full textDurability plays a fundamental role for ensuring environmental resilience, structural integrity, long-term functionality, and economic sustainability. On the other hand, earth-based constructions materials are known to be sensitive to wet environments, especially in presence of wet-to-dry cycles. This study examines the interaction of water with Shot-Earth, an innovative earth-based composite suitable for realizing structural elements like reinforced walls, beams, vaults and slabs. To this aim, two Shot-Earth mixtures were analysed through capillary absorption, water permeability, and microstructural analyses, and their performances were compared with an Ordinary Portland Cement (OPC) concrete. Capillary absorption coefficients were found to range from 0.8 kg/(m2h0.5) to 3 kg/(m2h0.5) over 24 hours, reflecting the influence of water-soil affinity, binder content, porosity, and internal cohesion. It is found that high stabilizer contents reduce voids, and, in turn, high densities allow to reduce the absorption coefficient to 0.2 kg/(m2h0.5), like for an OPC concrete. Moreover, water permeability for Shot-Earth typically ranges between 1.965×10−16 m2 and 3.373×10−16 m2, exceeding those of OPC by more than one order of magnitude. Experimental results were supported by both FE modeling and predictive formulas , providing reliable tools to forecast and optimize the durability of earth-based materials. These findings demonstrated that Shot-Earth can achieve durability performances compatible with structural applications, contributing to the development of low-carbon construction materials
Shear Models in Finite Elasticity
No full textHaving been studied for a long time, simple and pure shear deformation models are well known in elasticity. For small deformations, these two shear models differ only by a rigid rotation. On the contrary, for large deformations, the two models do not differ only by a rigid rotation. Therefore, in the latter situation, one cannot expect both models to fit the same constitutive properties for a prescribed form of the stored energy function. The kinematic and static differences between the two shear models, as well as their inadequacies for simulating experimental evidences, are discussed in this paper. To overcome these critical
issues, a study was developed, which led quite naturally to the definition of a new shear deformation model, based on the direct extension of the linearized pure shear model. The new model, characterized by a simple and immediate physical meaning, is particularly suitable for matching experimental tests
Resonances crossing in double-well quantum systems
No full textWhen the energy levels of a double-well system are nearly aligned, a beating motion occurs between the two wells. However, in the case of quantum resonances this scenario is much more intricate because in the complex plane two different types of resonance crossings (RCs) there exist, and beating motion occurs in only one of them. In this paper we use a quantitative criterion to determine whether the parameters of the quantum system are associated with one type of RC or the other. This analysis is essential for designing a quantum sensor made by heterostructures that easily and quickly measures whether an electric field has a predefined intensity
Homogenization and 3D-2D dimension reduction of a functional on manifold valued Sobolev spaces
No full textWe study simultaneous homogenization and dimensional reduction of integral functionals for maps in manifold-valued Sobolev spaces. Due to the superlinear growth regime, we prove that the density of the F-limit is a tangential quasiconvex integrand represented by a cell formula
Role of Microbial Interactions in the Impaired Cultivability of Thermophilic Lactic Acid Bacteria in Natural Whey Starter for Parmigiano Reggiano PDO Cheese Production
No full textTumor-Infiltrating Lymphocytes and Survival Outcomes in Early ERBB2-Positive Breast Cancer: 10-Year Analysis of the ShortHER Randomized Clinical Trial.
No full textImportance: For patients with early ERBB2 (formerly HER2)-positive breast cancer, there is a need to identify biomarkers to guide treatment de-escalation.
Objective: To evaluate the association of tumor-infiltrating lymphocytes (TILs) with distant disease-free (DDFS) and overall survival (OS) for patients with ERBB2-positive early breast cancer.
Design, setting, and participants: The ShortHER randomized clinical trial was a multicentric trial in Italy that enrolled patients with ERBB2-positive breast cancer from December 2007 to October 2013. Patients received 9 weeks or 1 year of adjuvant trastuzumab combined with chemotherapy. Tumor samples were evaluated for TILs. Herein, patients were evaluated at a median follow-up of 9 years, and data were analyzed from February 2023 to August 2024.
Intervention: Four cycles of anthracycline-based chemotherapy followed by 4 courses of taxanes combined with trastuzumab for 1 year (long arm) or 3 courses of taxanes combined with trastuzumab for 9 weeks followed by reduced-dose anthracycline-based chemotherapy for 3 courses (short arm).
Main outcomes and measures: The association of TILs with DDFS and OS was assessed with Cox models.
Results: Of 1253 patients enrolled in the ShortHER trial, 866 women (median [IQR] age, 56 [48-64] years) had evaluable TILs. In Cox models with relevant factors, each 5% TIL increment was associated with improved DDFS (hazard ratio [HR], 0.87; 95% CI, 0.80-0.95; P = .001) and OS (HR, 0.89; 95% CI, 0.81-0.98; P = .01). The 10-year OS rate was 91.3% for patients with TILs 20% or higher, 93.3% for patients with TILs 30% or higher, and 98.1% for patients with TILs 50% or higher, resulting higher vs lower TIL counterparts. Patients with TILs lower than 20% showed a better outcome with the long vs short treatment (10-year DDFS, 88.7% vs 81.0%), whereas patients with TILs 20% or higher showed the opposite (10-year DDFS, 87.1% vs 92.2%; P for interaction = .01). Similarly, patients with TILs 20% or higher had a 10-year OS rate of 89.3% in the long arm vs 93.1% in the short arm (HR, 0.36; 95% CI, 0.10-1.36); patients with TILs lower than 20% had a 10-year OS rate of 91.3% in the long arm vs 86.9% in the short arm (HR, 1.36; 95% CI, 0.82-2.23; P for interaction = .06).
Conclusions and relevance: This follow-up analysis of the ShortHER randomized clinical trial is, to our knowledge, the first demonstration of an independent effect of TILs in terms of OS for patients with ERBB2-positive early breast cancer treated with adjuvant chemotherapy and anti-ERBB2 therapy. Patients with TILs 20% or higher who de-escalated trastuzumab duration and chemotherapy dose were not exposed to an excess risk of distant relapse or death
Intersections of vitamin D deficiency, HIV and chronic liver diseases
No full textObjectives: Despite effective antiretroviral therapy (ART), chronic liver diseases remain a leading cause of morbidity and mortality among people with HIV, with metabolic dysfunction–associated steatotic liver disease (MASLD) now the predominant etiology. Vitamin D deficiency is also highly prevalent in this population. We synthesize current evidence on the interplay between HIV, liver disease, and vitamin D deficiency, and highlight implications for risk stratification and therapeutic research in this population. Methods: A targeted PubMed search was conducted using terms for HIV, liver disease, fibrosis, and vitamin D, supplemented by reference screening. We prioritized peer-reviewed studies and guidelines addressing liver disease epidemiology and mechanisms in people with HIV, vitamin D biology, and associations between vitamin D status and hepatic injury. Comparative data from non-HIV populations were also reviewed. Results: People with HIV face a high burden for chronic liver diseases due to MASLD, viral hepatitis coinfections, and hepatotoxic exposures such as alcohol and ART. Pathogenesis involve persistent immune activation, hepatic stellate cell activation, and systemic inflammation. Vitamin D deficiency is frequent in people with HIV and, in non-HIV populations, correlates with higher prevalence of MASLD and fibrosis. Emerging evidence suggests plausible links through immune modulation, oxidative stress, and fibrogenesis, though causality remains unproven. Conclusions: The intersection of HIV, MASLD, and vitamin D deficiency is biologically plausible and clinically relevant yet underexplored. Longitudinal studies with standardized MASLD phenotyping and vitamin D assessment are warranted. Meanwhile, integrating metabolic risk assessment with vitamin D evaluation may support more holistic liver care in people with HIV, while interventional trials should clarify whether vitamin D optimization improves hepatic and extrahepatic outcomes