135 research outputs found
Characteristics for Software Optimization Projects
No full textThe increasing of the software systems complexity imposes the identification and implementation of some methods and techniques in order to manage it. The software optimization project is a way in which the software complexity is controlled. The software optimization project must face to the organization need to earn profit. The software optimization project is an integrated part of the application cycle because share same resources, depends on other stages and influences next phases. The optimization project has some particularities because it works on an finished product around its quality. The process is quality and performance oriented and it assumes that the product life cycle is almost finished.optimization, software, project management, quality, performance
Safety of biologics in rheumatoid arthritis: data from randomized controlled trials and registries
No full textCatalin O Codreanu,1 Nemanja Damjanov2 1Rheumatology Department, Center of Rheumatic Diseases, Bucharest, Romania; 2Institute of Rheumatology, School of Medicine, University of Belgrade, Belgrade, SerbiaAbstract: Over the past decade, the use of biologics has significantly changed the management of rheumatoid arthritis (RA). Biologics selectively target components of the immune system, resulting in better disease control. However, the growing use of biologics in RA has increased safety concerns among rheumatologists. Randomized controlled trials (RCTs) and registries are the most reliable sources of clinical safety data. Although safety data from RCTs provide certain insights into the clinical safety profile of an agent, strict constraints in study design (eg, exclusion criteria and restrictive treatment protocols) often do not accurately reflect possible safety issues in the use of the agent, either in the clinical setting or over long-term treatment. Registries, on the other hand, are not restrictive regarding patient enrollment, making them more reliable in evaluating long-term safety. A number of registries have been established globally: in Europe, the United States, and Asia. However, the availability of registry data from Eastern Europe is lacking. The notable exceptions so far are registries from the Czech Republic (ATTRA, a registry of patients treated with anti-tumor necrosis factor-alpha drugs) and Serbia (National registry of patients with rheumatoid arthritis in Serbia [NARRAS]). The current report provides an overview of safety data with biologics in RA from RCTs and registries. Availability of regional safety data from Eastern Europe is of great importance to its clinicians for making evidence-based treatment decisions in RA. Keywords: biologic therapy, biologic drugs, adverse events, infections, pregnancy, malignancie
Is ultrasound changing the way we understand rheumatology? Including ultrasound examination in the classification criteria of polymyalgia rheumatica and gout.
No full textFrom Pathogenesis to Treatment—New Perspectives in Rheumatology
No full textRheumatic diseases are characterized by complex pathogenic mechanisms, with intricate signaling pathways and various imbalances of proinflammatory and anti-inflammatory cytokines, especially in the case of immune-inflammatory conditions [...
Drug retention of biological DMARD in rheumatoid arthritis patients: the role of baseline characteristics and disease evolution
No full textOBJECTIVE: To examine the association of the evolution in physician-reported and patient-reported outcomes with decision to stop biological DMARDs (bDMARDs) in RA. The contribution of baseline characteristics is well established, but little is known about how the disease evolution influences the decision to discontinue therapy.METHODS: RA patients who initiated a bDMARD treatment from 2009 and with information on date of visit were pooled from seven European RA registers. Each outcome was divided into baseline assessments (capturing the inter-individual differences at drug initiation) and changes from baseline at subsequent visits (capturing the individual evolution). Cox regression models were used to examine their association with drug discontinuation, adjusting for baseline patient and co-therapy characteristics and stratifying by register and calendar year of drug initiation.RESULTS: A total of 25 077 patients initiated a bDMARDs (18 507 a TNF-inhibitor, 3863 tocilizumab and 2707 abatacept) contributing an amount of 46 456.8 patient-years. Overall, drug discontinuation was most strongly associated with a poor evolution of the DAS28, with a hazard ratio of 1.34 (95% CI 1.29, 1.40), followed by its baseline value. A change of Physician Global Assessment was the next strongest predictor of discontinuation, then the Patient Global Assessment.CONCLUSIONS: The decision to discontinue treatments appears to be mostly influenced by DAS28 and particularly its evolution over time, followed by Physician Global Assessment evolution, suggesting that the decision to stop bDMARDs relies more on the physician's than on the patient's global assessment.</p
Comparative effectiveness of tocilizumab versus TNF inhibitors as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis after the use of at least one biologic disease-modifying antirheumatic drug: analyses from the pan-European TOCERRA register collaboration
No full textObjective: To compare the effectiveness of tocilizumab (TCZ) and tumour necrosis factor (TNF) inhibitors (TNFi) as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) after the use of at least one biologic DMARD (bDMARD).
Methods: We induded patients with RA having used at least one bDMARD from 10 European registries. We compared drug retention using Kaplan-Meier and Cox models and Clinical Disease Activity Index (CDAI) change over time with mixed-effects models for longitudinal data. The proportions of CDAI remission and low disease activity (LDA) at 1 year were compared using LUNDEX correction.
Results: 771 patients on TCZ as monotherapy (TCZ mono), 1773 in combination therapy (TCZ combo), 1404 on TNFi as monotherapy (TNFi mono) and 4660 in combination therapy (TNFi combo) were retrieved. Crude median retention was higher for TCZ mono (2.31 years, 95% CI 2.07 to 2.61) and TCZ combo (1.98 years, 95% CI 1.83 to 2.11) than TNFi combo (1.37 years, 95% CI 1.30 to 1.45) and TNFi mono (1.31 years, 95% CI 1.18 to 1.47). Ina country and year of treatment initiation-stratified, covariate-adjusted analysis, hazards of discontinuation were significantly lower among patients on TCZ mono or combo compared with patients on TNF1 mono or combo, and TNFi combo compared with TNFi mono, but similar between TCZ mono and combo. Average adjusted CDAI change was similar between groups. CDAI remission and LDA rates were comparable between groups.
Conclusion: With significantly longer drug retention and similar efficacy to TNFi combo, TCZ mono or combo are reasonable therapeutic options in patients with inadequate response to at least one bDMARD
Compact amorphous-silicon visible-light monitor integrated in silicon nitride waveguides
No full textThis work reports on the realization of an amorphous silicon visible-light detector integrated in Si3N4 waveguides. The device is very compact (< 40 μm), has a responsivity of about 10 mA/W and a sensitivity of -40 dBm.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.QID/Hanson LabQN/Quantum Nanoscienc
Preliminary study on the immunologic background of good clinical outcome in rheumatoid arthritis patients after one month therapy with leflunomide
No full text
ANKLE ULTRASOUND TENOSYNOVITIS IS A SIGNIFICANT PREDICTOR OF DAS28 – DEFINED RHEUMATOID ARTHRITIS ACTIVITY
No full textObjective. The study aimed to observe the frequency of ultrasound-defined tenosynovitis in ankle tendon and
to evaluate the relationship of ankle tenosynovitis with clinical examination and rheumatoid arthritis (RA) activity
measures.
Methods. RA patients were recruited in 2018 in the random order of presentation from the out-patient clinic. On the same day of inclusion, all patients underwent clinical examination, laboratory tests (inflammatory markers), ankle ultrasound and patient-reported outcomes.
Results. the study included 183 patients with established RA, mostly women (86.3%), with mean age of 57.3
years. The most frequent tenosynovitis was observed in the tibialis posterior tendon (TP; 40.4%), followed by the
peroneus longus (23.0%) and peroneus brevis (18.0%) tendons. Compared to patients without TP tenosynovitis,
patients with TP tenosynovitis had significantly higher titres of rheumatoid factors (RF; median of 123 IU/mL compared to 64 IU/mL; p = 0.023). Clinically tender (55.2%) and swollen (30.6%) ankles were 4.2 and respectively
11.6 times more likely to reveal tenosynovitis on ultrasound. The presence of ankle tenosynovitis was associated
with higher disease activity measures. DAS28 increased proportionally and significantly with the number of ankles
with tenosynovitis, the grade of ankle tenosynovitis and power Doppler activity. The absence of ankle tenosynovitis independently and significantly decreased DAS28 with 1.2 points (p < 0.001).
Conclusions. the most frequent ankle tenosynovitis observed in RA patients involves the TP tendon, which is
associated with higher titres of RF. Swollen ankles are more specific and better predictors of ultrasound-defined
ankle tenosynovitis, which has a directly proportional relationship with disease activity in RA. Disease activity
scores should include clinical evaluation of ankles and ultrasound information
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