EVALUATION OF THE EFFICACY AND SAFETY OF ETANERCEPT USE IN PATIENTS WITH NON-SYSTEMIC JUVENILE ARTHRITIS: 10-YEAR EXPERIENCE OF USE IN A FEDERAL CENTER

TNF-α inhibitors are used in the treatment of non-systemic variants of juvenile idiopathic arthritis (JIA) in case of ineffectiveness or intolerance to methotrexate. Despite 20 years of experience of using of etanercept in pediatric rheumatology, a long-term study of the efficacy and safety of the drug in real clinical practice remains necessary. Objective of the study: to study the efficacy and safety of etanercept for treatment of various non-systemic JIA subtypes in real clinical practice. Materials and methods of research: data from the case histories of 375 patients (242 girls and 133 boys) with articular forms of JIA for 2010–2020 were included in a retrospective, open, uncontrolled, nonrandomized, continuous multicenter cohort study. The age of debut was 6.3 (2.9; 10.7) years. Demographic characteristics, subtypes of arthritis, indicators of laboratory activity of inflammation, and outcomes were estimated: achievement of remission, exacerbation, and switching from etanercept to another genetically engineered biological drug (GEBD) were assessed. Results: remission was recorded in 78.9% on average after 6 months. The factors that determine the likelihood of achieving remission were the absence of previous therapy with GEBD (p=0.001) and compliance with therapy – OR=2.5 (95% CI: 1.3; 4.7), p=0.006. Exacerbations were recorded in 29.5% and were associated with the presence of the HLA B27 antigen – OR=2.6 (95% CI: 1.1; 6.0), p=0.028, antinuclear factor seropositivity (p=0.060). Change of etanercept to another GEBD was made in 17.4% of children and was associated with a failure to achieve remission – OR=7.7 (95% CI: 4.0–14.3), p=0.000001, with previous exacerbations – OR=14,8 (5.3; 41.2), p=0.0000001 and the development of de novo uveitis – OR=2.4 (95% CI: 1.1–5.3), p=0.038. The arthritis subtype and the presence of concomitant methotrexate therapy did not significantly affect treatment outcomes. Conclusion: achievement of remission, compliance with therapy, history of previous therapy with GEBD, exacerbation of JIA and development of de novo uveitis determined the main outcomes of etanercept therapy. The JIA subtype, as well as concomitant therapy with methotrexate, did not significantly affect the outcomes of the disease, which makes it possible to consider etanercept therapy a very effective and safe method of treating JIA as a genetically engineered first-line therapy of any variants of articular forms of JIA, even in monotherapy with ineffectiveness or intolerance to methotrexate.

Construction of a Simple Domeless Net Radiometer for Demonstrating Energy Balance Concepts in a Laboratory Activity

Even though energy balance concepts are fundamental to solutions of problems in a number of disciplines in the agricultural and life sciences, they are seldom demonstrated in a laboratory activity. Here, we introduce a simple domeless net radiometer to demonstrate how the surface temperature of an object aboveground is regulated by the properties of the surfaces and environmental conditions. The device is based on the early designs of all-wave net radiometers and is composed of a foam disc with its opposing surfaces coated with either white or black paint. Temperatures of the disc’s surfaces are monitored using thermocouple temperature sensors. Using a combination of solar irradiance, albedo of the ground surface, air temperature, and wind speed measurements, the temperatures of the disc’s surfaces can be calculated by means of an energy balance model. We found good agreement between calculated and measured temperatures. In addition to demonstrate important physical concepts under natural outdoor conditions, we believe that the proposed laboratory activity will benefit students by allowing them to gain some experience and practical skills in working with environmental sensors, programming data acquisition systems, and analyzing data. Stimulating students’ creativity as well as developing their analytical and problem-solving skills is another goal of the proposed activity.

509 A biochemical approach to atrial fibrillation in older patients

Aims Atrial fibrillation (AF) is the most common arrhythmia among the elderly. It is characterized by a disordered electrical activity of the atria and is associated with increased morbidity and mortality. The pathogenesis of AF is not completely understood as it depends on a multifactorial combination of electrical and structural remodelling and inflammation. Metabolomics is the study of the small molecules present in a given biological sample and it has been widely used to determine the metabolic signatures of certain diseases. Untargeted metabolomics consists of a comprehensive screening of all measurable metabolites to identify patterns related to a certain disease, while targeted metabolomics aims at analysing a defined group of metabolites belonging to a specific metabolic pathway or class of compounds. Mass spectrometry (MS), coupled with gas chromatography (GC) and liquid chromatography (LC) offers the possibility of performing quantitative analyses with high selectivity and sensitivity. Aims of this project were to understand the biomolecular mechanisms underlying the onset of AF. Methods We compared plasma samples of older patients with AF with those of healthy subjects. We started from untargeted metabolomics to explore the whole metabolome; then we focused on the lipidomic profile, and, finally, we measured the plasma concentration of acylcarnitines and some amino acids, known to be diagnostic markers of certain metabolic diseases. Fifty patients (age: 76 ± 6 years) and 26 healthy subjects (age: 65 ±19 years) were recruited for the study. A blood sample was drawn by each patient. Samples for metabolomics and lipidomics were processed, respectively, with a GC-MS platform and with high-resolution LC-MS. Results Differences in diseased and healthy metabolomic and lipidomic profiles were not detected, while the concentration of some acylcarnitines and amino acids resulted to be significantly different in the two groups. In particular, two long-chain acylcarnitines (LCACs), C14 and C18:1, were more abundant in the plasma of AF patients, while glycine, which has scavenger properties, had a lower concentration. High levels of circulating LCACs have been associated with cardiovascular diseases and they are known to alter the heart electrophysiology, thus representing a possible marker of the development of arrhythmias. We can hypothesize that the different concentrations we found possibly reflect a higher oxidative and metabolic stress induced by the arrhythmia. Conclusions The alterations of the LCACs we found in AF patients could represent the basis to guide specific therapeutic interventions aimed at reducing the incidence of the hemodynamic and embolic complications of the arrhythmia. In particular, recent guidelines for the management of AF patients introduced the acronym ABC, which means ‘Avoid stroke’—A, ‘Better symptoms management’—B, and ‘Cardiovascular risk and comorbidity management’—C. In this sense, the present research represents an attempt to join and enrich the traditional clinical approach with data derived from laboratory activity, to improve the outcome of the oldest segment of cardiac patients, often presenting rhythm alterations.

"Historical Path in Mathematical Games": A Didactic Laboratory Activity Dedicated to Upper Secondary School Students

In this work we intend to share an educational path on mathematical games developed in the last classes of the high schools that participate to the research-project Mathematical High School Project, a project elaborated by the research group in mathematics education of the Department of Mathematics of the University of Salerno (Italy) and dedicated to scientific high school students. The "Historical path in mathematical games" is a didactic laboratory activity dedicated to students of the last year of scientific high schools. The researchers collaborated with the teachers of the schools and carried out an interdisciplinary path on puzzles and logic games invented or reworked by important mathematicians of the last two centuries. Through these themes that were scientific, historical, artistic, musical, literary ones, connections have been created thank to the presentation of texts, images, paintings, drawings, musical and literary pieces.

When Direct Pressure Is Not Enough: An Educational Technique for Teaching Wound Packing in Athletic Training Education

Context Uncontrolled hemorrhage is a major cause of preventable death. Wound care and managing external hemorrhage are important skills for athletic trainers. Objective Describe a laboratory activity used to allow students to practice managing uncontrolled external hemorrhage and wound packing. Background The prevalence of active shooter and other mass casualty events has grown, and a trend to move military-based emergency skills into civilian casualty care has emerged. Athletic trainers are uniquely positioned to respond to catastrophic events at the time of injury. Controlling hemorrhage and rapidly applying a tourniquet or administering wound packing have a great effect in preventing death due to severe hemorrhage. Description An educational technique using a pork shoulder was implemented to provide students with experience in wound packing. Clinical Advantage(s) Students describe this activity as a beneficial way to gain experience on an important skill not often seen in the clinical education setting. Conclusion(s) Faculty may consider implementing wound packing using a pork shoulder as a laboratory activity when teaching wound care and external hemorrhage management.

Model-Based Reasoning in the Deductive Laboratory Work with Arduino and Sensor Module

Laboratory work that has been applied so far is more dominant in deductive laboratory work, but this type of laboratory work is not optimal in stimulating students' reasoning ability. Up to now, model-based reasoning studies on laboratory work have been substantial (especially in measurement and troubleshooting activities) and have not seen overall laboratory activity, including the use of alternative instrumentation such as Arduino and its sensor module. Designing the best laboratory work requires the role of model-based reasoning studies using Arduino devices. A mixed-method research design was used in this study with a theoretical study to obtain a predictive pattern for deductive laboratory work model which was matched with the observations of 50 undergraduate physics education students in laboratory work. Revision activities were shown by students in laboratory work depending on the capabilities of reasoning. The results of this study indicate that revision activities in deductive laboratory work using Arduino can stimulate students' reasoning. Arduino can lead students to explore their thinking and reasoning to solve problems in laboratory work.

Sourcing Antibiotic-Resistant Escherichia coli in Aquatic Ecosystems: A Combined Laboratory and Field Module

The emergence of antibiotic-resistant bacteria represents a growing threat in aquatic ecosystems. In this combined field and laboratory activity, students will determine whether Escherichia coli , an indicator bacteria species commonly found in aquatic ecosystems, shows signs of resistance to common antibiotics.

Why is it so hard to lose fat? Because it has to get out through your nose! An exercise physiology laboratory on oxygen consumption, metabolism, and weight loss

Exercise is thought to be an effective means to quick weight loss. However, few people have realistic exercise-induced weight loss expectations. Fewer understand how weight is “lost” and where the lost mass goes. Understanding that fat is “burned” with inhaled oxygen and most of the mass lost must be exhaled as carbon dioxide might help individuals create realistic weight loss expectations. The purpose of this laboratory activity is to 1) provide students with a basic understanding of the role of oxygen in fuel metabolism during physical activity and its relationship to energy expenditure and mechanical work, and 2) engage students with collection of their own data to determine a realistic timeframe for exercise-induced weight loss. In the prelaboratory, questions such as, “When you lose weight, where does it go?” are asked. A guided discussion helps students understand the basic biochemistry required for weight loss. For the activity, students complete walking or running exercise, recording the time and distance. The relationship of exercise to physics’ concepts of mechanical work and energy utilization are discussed with the concept of “calorie burn” and its relationship to oxygen consumption. Students estimate oxygen consumed and calories burned during exercise using established metabolic equations. Finally, the amount of energy (i.e., calories) equivalent to 1 pound of fat is discussed. Students calculate how long he/she would have to exercise to burn 10 pounds (4.5 kg) of fat. A person of average size and fitness, needs 60+ h of exercise to burn 10 pounds of fat. Supplementary activities including a dramatic gummy bear oxidation and the use of a metabolic cart reinforces these concepts and validates the laboratory estimates.