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Post-induction hypotension (MAP < 65 mmHg) occurs frequently and is usually caused by the cardiovascular adverse effects of the anaesthetic induction drugs used. We hypothesize that a clinically significant difference in the incidence and severity of hypotension will be found when different doses of propofol and remifentanil are used for induction of anaesthesia. Methods: This is a secondary analysis of a randomised controlled trial wherein four groups (A-D) of patients received one out of four different combinations of propofol and remifentanil, titrated to a predicted equipotency in probability of tolerance to laryngoscopy (PTOL) according to the Bouillon interaction model. In group A, a high dose of propofol and a low dose of remifentanil was administered, and across the groups this ratio was gradually changed until it was reversed in group D. Mean and systolic arterial blood pressure (MAP, SAP) were compared at four time points (Tbaseline, Tpost−bolus, T3min, Tnadir) within and between groups Heart rate, bispectral index (BIS) and the incidence of hypotension were compared. Results: Data from 76 patients was used. At Tpost−bolus a statistically significant lower MAP and SAP was found in group A versus D (p = 0.011 and p = 0.002). A significant higher heart rate was found at T3min and Tnadir between groups A and B when compared to groups C and D (p = < 0.001 and p = 0.002). A significant difference in BIS value was found over all groups at T3min and Tnadir (both p < 0.001). All other outcomes did not differ significantly between groups. Conclusion: Induction of anaesthesia with different predicted equipotent combinations of propofol and remifentanil did result in statistically different but clinically irrelevant differences in haemodynamic endpoints during induction of anaesthesia. Our study could not identify preferable drug combinations that decrease the risk for hypotension after induction, although they all yield a similar predicted PTOL. [ABSTRACT FROM AUTHOR]

Background and Objective: Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disorder that primarily affects the joints in children. Notably, it is known to co-occur with uveitis. Adalimumab, a monoclonal anti-TNF antibody, is effective in treating both conditions. A deeper understanding of the pharmacokinetics (PK) of adalimumab in JIA is crucial to advance in more personalized treatment approaches. The objective of this study is to evaluate the population PK profile of adalimumab in JIA and to explain causes for its variability. Materials and Methods: Adalimumab and antidrug antibody concentrations were retrospectively retrieved from the charts of patients with JIA. Initially, five literature-based population PK models of adalimumab were evaluated to assess their ability to describe the observed concentration–time profiles in the JIA cohort. These models included one specifically for the pediatric Crohn's disease population and four derived from studies in adult populations in healthy subjects and rheumatoid arthritis patients. Subsequently, a novel population PK model tailored to the JIA population was developed using NONMEM software. Monte Carlo simulations were then conducted utilizing the final PK model to visualize the concentration–time profile of adalimumab in patients with JIA and the impact of covariates. Results: A cohort of 50 patients with JIA with 78 available adalimumab samples was assessed. The mean age was 11.8 ± 3.9 years, with a median body weight of 49 kg (interquartile range 29.4–59.8 kg). All literature models adequately described the concentration–time profiles in JIA. The best model, which was developed in patients with rheumatoid arthritis during the maintenance phase of treatment, served as a basis for estimating clearance in JIA, resulting in a value of 0.37 L per day per 70 kg. Patient body weight, antidrug antibodies, methotrexate use, CRP level, and comorbidity of uveitis were found to have a significant impact on adalimumab clearance, and these reduced the inter-patient variability from 58.6 to 28.0%. On steady state in the simulated patient population, the mean trough level was 7.4 ± 5.5 mg/L. The two dosing regimens of 20 and 40 mg every other week, based on patients' body weight, resulted in comparable simulated overall drug exposure. Conclusions: Five literature models effectively described adalimumab PK in this pediatric cohort, highlighting the potential for extrapolating existing models to the pediatric population. The new JIA model confirmed the effect of several known covariates and found a novel association for drug clearance with methotrexate use (lower) and uveitis (higher), which might have clinical relevance for personalized dosing in JIA. [ABSTRACT FROM AUTHOR]

Objectives: The study is aimed to evaluate the impact of safety events in the Eurofever registry for Autoinflammatory diseases. Methods: This was a retrospective and longitudinal observational multicentre study. Data were retrieved from the international registry Eurofever, starting patients’ enrolment since 2009. All moderate, severe, or very severe AEs reported by treating physician in Eurofever were analyzed regardless of a possible suspected causal relationship to any therapies and according to the latest release of the Medical Dictionary for Regulatory Activities. Results: Complete information on safety were available in 2464 patients enrolled in the registry. In 1499 of them retrospective data encompassing the period from disease onset to enrolment were available, whereas 965 consecutive patients entered in the longitudinal part of the study. A total of 479 AEs have been reported in 275 patients. Eighty-two AEs were reported as serious and 99 were drug-related according to the physicians. Infections or infestations (94; 19.6%), gastrointestinal disorders (66; 13.8%), nervous system disorders (41; 8.6%) and systemic disorders or administration site reactions (35; 7.3%) were the most frequent reported events. The highest absolute number of drug-related AEs were related to biologic DMARDs (40/99 reports, 40,4%) and colchicine (31/99 reports, 31.3%). Conclusions: Present study shows the importance of a longitudinal and homogeneous registration of the AEs in rare conditions, with a particular focus on the safety profile of the treatments used in these conditions. [ABSTRACT FROM AUTHOR]

Background: Etanercept has been studied in doses up to 0.8 mg/kg/week (max 50 mg/week) in juvenile idiopathic arthritis (JIA) patients. In clinical practice higher doses are used off-label, but evidence regarding the relation with outcomes is lacking. We describe the clinical course of JIA-patients receiving high-dose etanercept (1.6 mg/kg/week; max 50 mg/week) in the BeSt for Kids trial. Methods: 92 patients with oligoarticular JIA, RF-negative polyarticular JIA or juvenile psoriatic arthritis were randomised across three treat-to-target arms: (1) sequential DMARD-monotherapy (sulfasalazine or methotrexate (MTX)), (2) combination-therapy MTX + 6 weeks prednisolone and (3) combination therapy MTX + etanercept. In any treatment-arm, patients could eventually escalate to high-dose etanercept alongside MTX 10mg/m2/week. Results: 32 patients received high-dose etanercept (69% female, median age 6 years (IQR 4–10), median 10 months (7–16) from baseline). Median follow-up was 24.6 months. Most clinical parameters improved within 3 months after dose-increase: median JADAS10 from 7.2 to 2.8 (p = 0.008), VAS-physician from 12 to 4 (p = 0.022), VAS-patient/parent from 38.5 to 13 (p = 0.003), number of active joints from 2 to 0.5 (p = 0.12) and VAS-pain from 35.5 to 15 (p = 0.030). Functional impairments (CHAQ-score) improved more gradually and ESR remained stable. A comparable pattern was observed in 11 patients (73% girls, median age 8 (IQR 6–9)) who did not receive high-dose etanercept despite eligibility (comparison group). In both groups, 56% reached inactive disease at 6 months. No severe adverse events (SAEs) occurred after etanercept dose-increase. In the comparison group, 2 SAEs consisting of hospital admission occurred. Rates of non-severe AEs per subsequent patient year follow-up were 2.27 in the high-dose and 1.43 in the comparison group. Conclusions: Escalation to high-dose etanercept in JIA-patients who were treated to target was generally followed by meaningful clinical improvement. However, similar improvements were observed in a smaller comparison group who did not escalate to high-dose etanercept. No SAEs were seen after escalation to high-dose etanercept. The division into the high-dose and comparison groups was not randomised, which is a potential source of bias. We advocate larger, randomised studies of high versus regular dose etanercept to provide high level evidence on efficacy and safety. Trial registration: Dutch Trial Register; NTR1574; 3 December 2008; https://onderzoekmetmensen.nl/en/trial/26585. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare pain-scores in three targeted treatment-strategies in JIA-patients and to identify characteristics predicting persistent pain. Methods: In the BeSt-for-Kids-study 92 DMARD-naïve JIA-patients were randomized in 3 treatment-strategies: 1) initial sequential DMARD-monotherapy 2) initial methotrexate (MTX)/prednisolone-bridging or 3) initial MTX/etanercept. Potential differences in VAS pain scores (0-100 mm) over time between treatment-strategies were compared using linear mixed models with visits clustered within patients. A multivariable model was used to assess the ability of baseline characteristics to predict the chance of high pain-scores during follow-up. Results: Pain-scores over time reduced from mean 55.3 (SD 21.7) to 19.5 (SD 25.3) mm after 24 months. On average, pain-scores decreased significantly with β -1.37 mm (95% CI -1.726; -1.022) per month. No significant difference was found between treatment-strategies (interaction term treatment arm*time (months) β (95% CI) arm 1: 0.13 (-0.36; 0.62) and arm 2: 0.37 (-0.12; 0.86) compared to arm 3). Correction for sex and symptom duration yielded similar results. Several baseline characteristics were predictive for pain over time. Higher VAS pain [β 0.44 (95% CI 0.25; 0.65)] and higher active joint count [0.77 (0.19; 1.34)] were predictive of higher pain over time, whereas, low VAS physician [ -0.34 (-0.55; -0.06)], CHQ Physical [ -0.42 (-0.72; -0.11)] and Psychosocial summary Score [ -0.42 (-0.77; -0.06)] were predictive of lower pain. Conclusions: Treatment-to-target seems effective in pain-reduction in non-systemic JIA-patients irrespective of initial treatment-strategy. Several baseline-predictors for pain over time were found, which could help to identify patients with a high risk for development of chronic pain. Trial registration: Dutch Trial Registry number 1574. [ABSTRACT FROM AUTHOR]

The processes responsible for the acceleration of solar energetic particles (SEPs) are still not well understood, including whether SEP electrons and protons are accelerated by common or separate processes. Using a numerical particle transport model that includes both pitch-angle and perpendicular spatial diffusion, we simulate, among other quantities, the onset delay for MeV electrons and protons and compare the results to observations of SEPs from widely separated spacecraft. Such observations have previously been interpreted, in a simple scenario assuming no perpendicular diffusion, as evidence for different electron and proton sources. We show that, by assuming a common particle source together with perpendicular diffusion, we are able to simultaneously reproduce the onset delays for both electrons and protons. We argue that this points toward a common accelerator for these particles. Moreover, a relatively broad particle source is required in the model to correctly describe the observations. This is suggestive of diffusive shock acceleration occurring at large shock structures playing a significant role in the acceleration of these SEPs. [ABSTRACT FROM AUTHOR]

Encephalartos eugene-maraisii is an endangered, endemic plant in the Waterberg Mountain range of South Africa. This is the first report of herbivory by Zerenopsis lepida (Lepidoptera: Geometridae) on natural populations of E. eugene-maraisii. The impact of herbivory by folivorous arthropods on this cycad species has not been studied before. This study aimed to determine the incidence and intensity of Z. lepida herbivory on E. eugene-maraisii under field conditions. Local plant dynamics were studied by recording the plant location, sex, size and phenological stage for each plant. Damage surveys were carried out over two consecutive seasons (2020–2021 and 2021–2022). Leaf damage was assessed on 227 plants comprising 692 stems. Approximately 40% of the stems had signs of leaf herbivory by Z. lepida and 10% of the total leaf area was removed by Z. lepida larvae. Less herbivory was recorded in areas where plants synchronously produced new leaf flushes compared to areas with asynchronous leaf flushes. Greater apparency of plants led to a greater incidence of herbivory and level of damage. Repeated damage to plants may delay future leaf and cone flushing events and contribute to the threat against this cycad species. [ABSTRACT FROM AUTHOR]

Objectives: To perform a systematic literature review and meta-analysis on endothelial cell (EC) markers that are involved and dysregulated in systemic lupus erythematosus (SLE) in relation to disease activity, as EC dysregulation plays a major role in the development of premature atherosclerosis in SLE. Methods: Search terms were entered into Embase, MEDLINE, Web of Science, Google Scholar and Cochrane. Inclusion criteria were 1) studies published after 2000 reporting measurements of EC markers in serum and/or plasma of SLE patients (diagnosed according to ACR/SLICC criteria), 2) English language peer reviewed articles, and 3) disease activity measurement. For meta-analysis calculations, the Meta-Essentials tool by Erasmus Research Institute and of Management (ERIM) was used. Only those EC markers, which were 1) reported in at least two articles and 2) reported a correlation coefficient (i.e. Spearman's rank or Pearson's) between the measured levels of the EC marker and disease activity were included. For meta-analyses, a fixed effect model was used. Results: From 2133 hits, 123 eligible articles were selected. The identified SLE-related endothelial markers were involved in EC activation, EC apoptosis, disturbed angiogenesis, defective vascular tone control, immune dysregulation and coagulopathy. Meta-analyses of primarily cross-sectional studies showed significant associations between marker levels and disease activity for the following endothelial markers: Pentraxin-3, Thrombomodulin, VEGF, VCAM-1, ICAM-1, IP-10 and MCP-1. Dysregulated EC markers without associations with disease activity were: Angiopoeitin-2, vWF, P-Selectin, TWEAK and E-Selectin. Conclusions: We provide a complete literature overview for dysregulated EC markers in SLE comprising a wide range of different EC functions. SLE-induced EC marker dysregulation was seen with, but also without, association with disease activity. This study provides some clarity in the eminent complex field of EC markers as biomarkers for SLE. Longitudinal data on EC markers in SLE are now needed to guide us more in unravelling the pathophysiology of premature atherosclerosis and cardiovascular events in SLE patients. [ABSTRACT FROM AUTHOR]

Background: Evidence on the added value of robotic-assistance in the abdominal phase during esophagectomy is scarce. In 2003, our center implemented the robotic thoracic phase for esophagectomy. In November 2018 the robot was also implemented in the abdominal phase. The aim of this study was to evaluate the implementation of the abdominal phase during robot-assisted minimally invasive esophagectomy (RAMIE). Methods: Consecutive patients who underwent full RAMIE with intrathoracic anastomosis for esophageal cancer were included. Patients were extracted from a prospectively maintained institutional database. A cumulative sum (CUSUM) analysis was performed for abdominal operation time and abdominal lymph node yield. Intraoperative, postoperative and oncological outcomes including collected lymph nodes per abdominal lymph node station were reported. Results: Between 2018 and 2021, 70 consecutive patients were included. The majority of the patients had an adenocarcinoma (n = 55, 77%) and underwent neoadjuvant chemo(radio)therapy (n = 65, 95%). The median operative time for the abdominal phase was 180 min (range 110–233). The CUSUM analysis for abdominal operation time showed a plateau at case 22. There were no intraoperative complications or conversions during the abdominal phase. The most common postoperative complications were pneumonia (n = 18, 26%) and anastomotic leakage (n = 14, 20%). Radical resection margins were achieved in 69 (99%) patients. The median total lymph node yield was 42 (range 23–83) and the median abdominal lymph node yield was 16 (range 2–43). The CUSUM analysis for abdominal lymph node yield showed a plateau at case 21. Most abdominal lymph nodes were collected from the left gastric artery (median 4, range 0–20). Conclusions: This study shows that a robotic abdominal phase was safely implemented for RAMIE without compromising intraoperative, postoperative and oncological outcomes. The learning curve is estimated to be 22 cases in a high-volume center with experienced upper GI robotic surgeons. [ABSTRACT FROM AUTHOR]

Indocyanine green fluorescence angiography (ICG-FA) allows for real-time intraoperative assessment of the perfusion of the gastric conduit during esophagectomy. The aim of this study was to investigate the effect of the implementation of ICG-FA during robot-assisted minimally invasive esophagectomy (RAMIE) with an intrathoracic anastomosis. In this prospective cohort study, a standardized protocol for ICG-FA was implemented in a high-volume center in December 2018. All consecutive patients who underwent RAMIE with an intrathoracic anastomosis were included. The primary outcome was whether the initial chosen site for the anastomosis on the gastric conduit was changed based on ICG-FA findings. In addition, ICG-FA was quantified based on the procedural videos. Out of the 63 included patients, the planned location of the anastomosis was changed in 9 (14%) patients, based on ICG-FA. The median time to maximum intensity at the base of the gastric conduit was shorter (25 s; range 13–49) compared to tip (34 s; range 12–83). In patients with anastomotic leakage, the median time to reach the FImax at the tip was 56 s (range 30–83) compared to 34 s (range 12–66) in patients without anastomotic leakage (p = 0.320). The use of ICG-FA resulted in an adaptation of the anastomotic site in nine (14%) patients during RAMIE with intrathoracic anastomosis. The quantification of ICG-FA showed that the gastric conduit reaches it maximum intensity in a base-to-tip direction. Perfusion of the entire gastric conduit was worse for patients with anastomotic leakage, although not statistically different. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary hemosiderosis (IPH) is a rare, potentially life-threatening chronic disease. Steroids are the cornerstone of treatment, even though toxicity and side-effects are very common. Recently, rituximab (RTX) has been suggested as a treatment option, although evidence for its efficacy and long-term safety is lacking. We describe the disease course of two pediatric patients with IPH that were treated with RTX for over 4 years. Demographics, treatments, and clinical variables such as growth, infections, imaging follow-up by CT, and data from pulmonary function tests were retrospectively described. These are the first two cases described with a long-term follow-up of pediatric IPH patients treated with RTX. RTX was well-tolerated and prevented outbreaks of bleeding. In addition, RTX had a robust steroid-sparing effect resulting in the improvement of growth, pulmonary function, and CT abnormalities. [ABSTRACT FROM AUTHOR]

Background: Double inversion recovery (DIR) MRI has the potential to accentuate the synovium without using contrast agents, as it allows simultaneous signal suppression of fluid and fat. The purpose of this study was (1) to compare DIR MRI to conventional contrast-enhanced (CE) MRI for delineation of the synovium in the knee in children with juvenile idiopathic arthritis (JIA) and (2) to assess the agreement between DIR MRI and CE-MRI regarding maximal synovial thickness measurements. Results: In this prospective study, 26 children with JIA who consecutively underwent 3.0-T knee MRI between January 2018 and January 2021 were included (presence of knee arthritis: 13 [50%]; median age: 14 years [interquartile range [IQR]: 11–17]; 14 girls). Median confidence to depict the synovium (0–100 mm visual analogue scale; scored by 2 readers [consensus based]) was 88 (IQR: 79–97) for DIR MRI versus 100 (IQR: 100–100) for CE-MRI (p value = <.001). Maximal synovial thickness per child (millimeters; scored by 4 individual readers) on DIR MRI was greater (p value = <.001) in the children with knee arthritis (2.4 mm [IQR: 2.1–3.1]) than in those without knee arthritis (1.4 mm [IQR: 1.0–1.6]). Good inter-technique agreement for maximal synovial thickness per child was observed (rs = 0.93 [p value = <.001]; inter-reader reliability: ICC DIR MRI = 0.87 [p value = <.001], ICC CE-MRI = 0.90 [p value = <.001]). Conclusion: DIR MRI adequately delineated the synovium in the knee of children with JIA and enabled synovial thickness measurement similar to that of CE-MRI. Our results demonstrate that DIR MRI should be considered as a child-friendly alternative to CE-MRI for evaluation of synovitis in children with (suspected) JIA. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the relationship of child, caregiver, and caring context measurements with the care-related quality of life (CRQoL) and health-related quality of life (HRQoL) of caregivers of children with juvenile idiopathic arthritis (JIA). Methods: We performed a cross-sectional analysis of baseline data on caregivers of children with JIA from Canada and the Netherlands collected for the "Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases" study from June 2019 to September 2021. We used the CRQoL questionnaire (CarerQoL), adult EQ-5D-5L, and proxy-reported Youth 5-Level version of EuroQoL (EQ-5D-5L-Y) to assess caregiver CRQoL, caregiver HRQoL, and child HRQoL, respectively. We used a multivariate analysis to assess the relationship between both caregiver CRQoL and HRQoL and patient, caregiver, and caring context measurements. Results: A total of 250 caregivers were included in this study. Most of the caregivers were from the Netherlands (n = 178, 71%) and 77% were females (n = 193). The mean CarerQoL scores was 82.7 (standard deviation (SD) 11.4) and the mean EQ-5D-5L utility score was 0.87 (SD 0.16). Child HRQoL and employment had a positive relationship with both caregiver CarerQoL and EQ-5D-5L utility scores (p < 0.05), while receiving paid or unpaid help had a negative relationship with both scores (p < 0.05). Conclusion: Our findings indicated that to understand the impact of JIA on families, we need to consider socio-economic factors, such as employment and support to carry caregiving tasks, in addition to child HRQoL. [ABSTRACT FROM AUTHOR]

To directly compare and describe the differences between juvenile idiopathic arthritis (JIA) patients and pediatric controls regarding features of the synovial and tenosynovial membrane on contrast-enhanced magnetic resonance imaging (MRI) of the wrist. T1-weighted contrast-enhanced MRI scans of 25 JIA patients with clinically active wrist arthritis and 25 children without a history of joint complaints nor any clinical signs of joint inflammation were evaluated by two readers blinded to clinical data. The synovium was scored at five anatomical sites based on thickening of the synovium (0–3 scale) and synovial enhancement (0–2 scale). Thickening and/or enhancement of the tenosynovium was scored at four anatomical sites using a 0–3 scale. Significantly higher scores for synovial thickening (median 4 vs. 1, p < 0.001) and synovial enhancement (median 4 vs. 1, p < 0.001) are found in the wrist of JIA patients as compared to controls. JIA patients experienced the highest synovial scores at the mid-/inter-carpal, 2nd –5th carpometacarpal, and radiocarpal joints. No significant difference in tenosynovial scores is found between both groups (median 0 vs. 0, p = 0.220). This study highlights the higher synovial thickening/enhancement scores on contrast-enhanced MRI of the wrist in JIA patients compared to pediatric controls. Tenosynovial thickening and/or enhancement was rarely present in both groups. In JIA patients, synovial thickening and enhancement were particularly present at three anatomical sites. These results substantially support rheumatologists and radiologists when navigating through MRI of the wrist in search for JIA disease activity. [ABSTRACT FROM AUTHOR]

Systemic juvenile idiopathic arthritis (sJIA, also called Still's disease) is a rare childhood auto‐inflammatory disease with significant morbidity. This case report illustrates the clinical course and highlights diagnostic challenges. FDG‐PET/CT imaging may be beneficial in the diagnostic process for some cases, in order to achieve rapid diagnosis and early treatment. [ABSTRACT FROM AUTHOR]

Background: Double inversion recovery (DIR) MRI has the potential to accentuate the synovium without using contrast agents, as it allows simultaneous signal suppression of fluid and fat. The purpose of this study was (1) to compare DIR MRI to conventional contrast-enhanced (CE) MRI for delineation of the synovium in the knee in children with juvenile idiopathic arthritis (JIA) and (2) to assess the agreement between DIR MRI and CE-MRI regarding maximal synovial thickness measurements. Results: In this prospective study, 26 children with JIA who consecutively underwent 3.0-T knee MRI between January 2018 and January 2021 were included (presence of knee arthritis: 13 [50%]; median age: 14 years [interquartile range [IQR]: 11–17]; 14 girls). Median confidence to depict the synovium (0–100 mm visual analogue scale; scored by 2 readers [consensus based]) was 88 (IQR: 79–97) for DIR MRI versus 100 (IQR: 100–100) for CE-MRI (p value = <.001). Maximal synovial thickness per child (millimeters; scored by 4 individual readers) on DIR MRI was greater (p value = <.001) in the children with knee arthritis (2.4 mm [IQR: 2.1–3.1]) than in those without knee arthritis (1.4 mm [IQR: 1.0–1.6]). Good inter-technique agreement for maximal synovial thickness per child was observed (rs = 0.93 [p value = <.001]; inter-reader reliability: ICC DIR MRI = 0.87 [p value = <.001], ICC CE-MRI = 0.90 [p value = <.001]). Conclusion: DIR MRI adequately delineated the synovium in the knee of children with JIA and enabled synovial thickness measurement similar to that of CE-MRI. Our results demonstrate that DIR MRI should be considered as a child-friendly alternative to CE-MRI for evaluation of synovitis in children with (suspected) JIA. [ABSTRACT FROM AUTHOR]

Limited information is available regarding the distribution of the African mantis, Sphodromantis gastrica (Stål) (Mantodea: Mantidae) and no information is available on its biology. The aim of this study was to determine the distribution of S. gastrica in South Africa based on historic insect collection records and citizen science platforms occurrence data, and to study its basic biology and developmental parameters under captive breeding conditions. A total of 153 South African museum records of Sphodromantis spp. were recorded during this study, while 39 Research Grade observations from iNaturalist were also included. These records indicated that S. gastrica occurred in all provinces of South Africa. The incubation time of the S. gastrica oothecae were approximately 10 weeks and each ootheca contained an average of 84 egg chambers. The mean fertility rate was 54.6% while the survival rate until adulthood was 41.8%. The mean lifespan of S. gastrica individuals were approximately 332 days and females lived longer than males. This study will provide a baseline as it is the first published data on the distribution and biology of this common and charismatic insect in South Africa. [ABSTRACT FROM AUTHOR]

This prospective study evaluates haemodynamic and electroencephalographic effects observed when administering four combinations of effect-site concentrations of propofol (CePROP) and remifentanil (CeREMI), all yielding a single predicted probability of tolerance of laryngoscopy of 90% (PTOL = 90%) according to the Bouillon interaction model. We aimed to identify combinations of CePROP and CeREMI along a single isobole of PTOL that result in favourable hypnotic and haemodynamic conditions. This knowledge could be of advantage in the development of drug advisory monitoring technology. 80 patients (18–90 years of age, ASA I–III) were randomized into four groups and titrated towards CePROP (Schnider model, ug⋅ml−1) and CeREMI (Minto model, ng⋅ml−1) of respectively 8.6 and 1, 5.9 and 2, 3.6 and 4 and 2.0 and 8. After eleven minutes of equilibration, baseline measurements of haemodynamic endpoints and bispectral index were compared with three minutes of responsiveness measurements after laryngoscopy. Before laryngoscopy, bispectral index differed significantly (p < 0.0001) between groups in concordance with CePROP. Heart rate decreased with increasing CeREMI (p = 0.001). The haemodynamic and arousal responses evoked by laryngoscopy were not significantly different between groups, but CePROP = 3.6 μg⋅ml−1 and CeREMI = 4 ng⋅ml−1 evoked the lowest median value for ∆HR and ∆SAP after laryngoscopy. This study provides clinical insight on the haemodynamic and hypnotic consequences, when a model based predicted PTOL is used as a target for combined effect-site controlled target- controlled infusion of propofol and remifentanil. Heart rate and bispectral index were significantly different between groups despite a theoretical equipotency for PTOL, suggesting that each component of the anaesthetic state (immobility, analgesia, and hypnotic drug effect) should be considered as independent neurophysiological and pharmacological phenomena. However, claims of (in)accuracy of the predicted PTOL must be considered preliminary because larger numbers of observations are required for that goal. [ABSTRACT FROM AUTHOR]

Background: Anti-tumor necrosis factor (TNF) drugs have improved the prognosis for juvenile idiopathic arthritis (JIA) significantly. However, evidence for individual treatment decisions based on serum anti-TNF drug levels and the presence of anti-drug antibodies (ADAbs) in children is scarce. We aimed to assess if anti-TNF drug levels and/or ADAbs influenced physician's treatment decisions in children with JIA. Methods: Patients' records in our center were retrospectively screened for measurements of anti-TNF drug levels and ADAbs in children with JIA using etanercept, adalimumab or infliximab. Clinical characteristics and disease activity were retrieved from patient charts. Results: We analyzed 142 measurements of anti-TNF drug levels in 65 children with JIA. Of these, ninety-seven (68.3%) were trough concentrations. N = 14/97 (14.4%) of these showed trough concentrations within the therapeutic drug range known for adults with RA and IBD. ADAbs against adalimumab were detected in seven patients and against infliximab in one patient. Seven (87,5%) of these ADAb-positive patients had non-detectable drug levels. A flowchart was made on decisions including rational dose escalation, stopping treatment in the presence of ADAbs and undetectable drug levels, showing that 45% of measurements influenced treatment decisions, which concerned 65% of patients (n = 42/65). Conclusions: In the majority of patients, measurement of anti-TNF drug levels led to changes in treatment. A wide variation of anti-TNF drug levels was found possibly due to differences in drug clearance in different age groups. There is need for determination of therapeutic drug ranges and pharmacokinetic curves for anti-TNF and other biologics in children with JIA. [ABSTRACT FROM AUTHOR]

In this lecture an overview of applications of incoherent Thomson scattering (TS) as well as collective Thomson scattering (CTS) will be given. These are the most accurate methods for measuring the electron and ion properties, because the method is direct and non-intrusive. A CTS system based on the fundamental wavelength of a seeded Nd:YAG laser, being developed for the high density, low-temperature plasma of the linear plasma generator Magnum-PSI will be described also. The small Debye length of dense low temperature plasma enables application of CTS at relatively short laser wavelength. The combination of this CTS system and existing incoherent TS system enables determination of electron density and temperature as well as ion temperature and plasma velocity of the near surface plasma. In this lecture, the theoretical background and experimental challenges of the work will be given along with some examples that demonstrate the capabilities of such systems. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the synovial and tenosynovial appearance of the clinically non-arthritic symptomatic juvenile wrist using contrast-enhanced magnetic resonance imaging (MRI) is sparse. Objectives: To analyze contrast-enhanced MRI findings of the clinically non-inflamed symptomatic pediatric wrist, focusing on the enhancing synovial and tenosynovial membrane. To evaluate the coexistent presence of (teno)synovial enhancement, joint fluid, bony depressions and medullary changes suggestive of bone marrow edema. Materials and methods: We included 20 children (15 girls; age range: 7.5–17.6 years) who underwent contrast-enhanced MRI of the wrist, based on initial clinical indication, and eventually turned out to be unaffected by arthritic or orthopedic disorders. Various imaging characteristics of the synovium, tenosynovium, joint fluid, bone tissue and bone marrow were evaluated using existing MRI scoring systems. Results: In 3/20 (15%) children, mild or moderate-severe synovial enhancement was observed and 2/20 (10%) children showed mild tenosynovial enhancement/thickening. Joint fluid (11/20 children; 55%), bony depressions (20/20 children; 100%) and medullary changes suggestive of bone marrow edema (6/20; 30%) were found in a substantial percentage of children. The most frequently observed combination of coexisting imaging characteristics was bony depressions with ≥2 mm joint fluid, which was found in 7/20 (35%) children. Simultaneous presence of synovial and tenosynovial enhancement/thickening, bony depressions and medullary changes suggestive of bone marrow edema was observed in one child. Conclusion: Several juvenile idiopathic arthritis-relevant MRI characteristics can be observed in the clinically non-inflamed symptomatic pediatric wrist. [ABSTRACT FROM AUTHOR]

Busseola fusca and Fusarium verticillioides are considered the most important pest and pathogen, respectively, of maize in South Africa. Busseola fusca tunnels into stems and ears of maize plants, whereas F. verticillioides causes Fusarium ear rot and deposits fumonisins in maize kernels. Frass (excreta) deposited by B. fusca larvae in maize stems and ears during feeding could potentially be contaminated with pathogens such as F. verticillioides, thereby indirectly and passively contributing to plant diseases. The mycoflora present in frass of B. fusca larvae was thus investigated in this study, and the dissemination of fumonisin-producing Fusarium spp. by B. fusca larvae in maize stems determined. Busseola fusca frass was collected from plants with visible insect damage in three maize-growing districts in South Africa. The mycoflora in the frass was isolated and identified morphologically to genus level, followed by the sequencing of target genes for species identification. Species of Acremonium, Aspergillus, Fusarium, Mucor, Rhizopus and Talaromyces were associated with the B. fusca frass. The role of B. fusca larvae in disseminating fumonisin-producing Fusarium spp. was then determined in greenhouse and field trials. Maize whorls were inoculated withF. verticillioides MRC826 spores 4 weeks after plant emergence, and infested with B. fusca larvae 2 days later. The stems were split open after 3 weeks and frass collected from feeding channels, thereafter, target DNA of fumonisin-producing Fusarium spp. was quantified using real-time PCR. Target DNA of fumonisin-producing Fusarium spp. was significantly higher in frass collected from greenhouse plants inoculated with F. verticillioides than in frass collected from the uninoculated control, indicating that the inoculation was successful in the absence of soil-borne inoculum. Nevertheless, the field trial showed no significant differences in target DNA in frass from inoculated and non-inoculated plants. This is possibly due to natural F. verticillioidesinfection of maize plants in the field. This study further indicated that B. fusca frass also contained maize pathogens such asAspergillus spp. and Fusarium spp., which could cause ear rot diseases. The occurrence of Acremonium zeae in frass has potential implications for the biological control of F. verticillioides, as the fungus produces pyrrocidines A and B antibiotics which are known to be antagonistic to F. verticillioides. The occurrence of Aspergillus niger in frass requires further investigation in order to clarify its role in fumonisin contamination of maize in South Africa. [ABSTRACT FROM AUTHOR]

American and European societies' (ATS/ERS) criteria for spirometry are often not met in primary care. Yet, it is unknown if quality is sufficient for daily clinical use. We evaluated quality of spirometry in primary care based on clinical usefulness, meeting ATS/ERS criteria and agreement on diagnosis between general practitioners (GPs) and pulmonologists. GPs included ten consecutive spirometry tests and detailed history questionnaires of patients who underwent spirometry as part of usual care. GPs and two pulmonologists assessed the spirometry tests and questionnaires on clinical usefulness and formulated a diagnosis. In total, 149 participants covering 15 GPs were included. Low agreements were found on diagnosis between GPs and pulmonologists 1 (κ = 0.39) and 2 (κ = 0.44). GPs and pulmonologists rated >88% of the tests as clinically useful, although 13% met ATS/ERS criteria. This real-life study demonstrated that clinical usefulness of routine primary care spirometry tests was high, although agreement on diagnosis was low. [ABSTRACT FROM AUTHOR]

Background: Having Juvenile idiopathic Arthritis (JIA) has widespread implications for a person's life. Patients have to deal with recurring arthritis, characterized by pain often accompanied by a loss of energy. Since JIA often persists into adulthood, patients with JIA are likely to encounter difficulties in their working life. We expect that the experiences in school life may be comparable to the barriers and opportunities which patients affected by JIA encounter in adult working life. Therefore, the aim of this study was to elicit the experiences during school life and the perspectives and expectations regarding future work participation of adolescents with JIA. Methods: This study used individual, semi-structured interviews and followed a predefined interview guide. Participants between 14 and 18 years of age (n = 22) were purposively selected to achieve a broad range of participant characteristics. Open coding was performed, followed by axial coding and selective coding. Results: Great differences were seen in the support and understanding that adolescents received in dealing with JIA at school, leisure activities and work. Varying approaches were mentioned on how to pursue a desired vocation. Perspectives regarding disclosure varied. Participants wished to be approached like any other healthy adolescent. Expectations regarding work participation were positively expressed. Conclusion: This study showed that participants often disregarded having JIA when making plans for their future career. Facilitating an open discussion about the possible limitations accompanying JIA with educators and employers might prevent overburden and increase the chance of starting a career which would accommodate the patient with JIA in the near and distant future. [ABSTRACT FROM AUTHOR]

Background: Ongoing arthritis in children with juvenile idiopathic arthritis (JIA) can result in cartilage damage.Objective: To study the feasibility and repeatability of T1ρ for assessing knee cartilage in JIA and also to describe T1ρ values and study correlation between T1ρ and conventional MRI scores for disease activity.Materials and Methods: Thirteen children with JIA or suspected JIA underwent 3-tesla (T) knee MRI that included conventional sequences and a T1ρ sequence. Segmentation of knee cartilage was carried out on T1ρ images. We used intraclass correlation coefficient to study the repeatability of segmentation in a subset of five children. We used the juvenile arthritis MRI scoring system to discriminate inflamed from non-inflamed knees. The Mann-Whitney U and Spearman correlation compared T1ρ between children with and without arthritis on MRI and correlated T1ρ with the juvenile arthritis MRI score.Results: All children successfully completed the MRI examination. No images were excluded because of poor quality. Repeatability of T1ρ measurement had an intraclass correlation coefficient (ICC) of 0.99 (P<0.001). We observed no structural cartilage damage and found no differences in T1ρ between children with (n=7) and without (n=6) inflamed knees (37.8 ms vs. 31.7 ms, P=0.20). However, we observed a moderate correlation between T1ρ values and the juvenile arthritis MRI synovitis score (r=0.59, P=0.04).Conclusion: This pilot study suggests that T1ρ is a feasible and repeatable quantitative imaging technique in children. T1ρ values were associated with the juvenile arthritis MRI synovitis score. [ABSTRACT FROM AUTHOR]

The article presents a study related to the susceptibility of Spodoptera littoralis (Boisduval) (Lepidoptera: Noctuidae) to Bt cotton, expressing Cry1Ac and Cry2Ab toxins, in South Africa. It mentions that spodoptera littoralis may cause considerable damage to cotton by feeding on the leaves, flower buds and occasionally, and also on bolls.

Various abiotic factors influence the biology and behaviour of arthropods, one of the most prominent abiotic factors is temperature. Thus, it is essential to know the optimal time of day during which sampling of target species should be done to allow for accurate arthropod biodiversity studies. This study considered species richness, abundance and diversity of predaceous arthropods of the Chrysopidae, Mantodea, Araneae and Coccinellidae throughout the day in and around maize fields in the extensively cultivated highveld grasslands of South Africa. Sweep net sampling was done at the following times: 07:00, 12:00, 15:00 and 17:00. Sampling was conducted at three different localities and repeated on three occasions over two growing seasons. At each locality there were three replicates in each of three zones in the agro-ecosystem, i.e. maize field, field margin and untransformed grassland. Shannon diversity index values did not differ significantly between the different sweep net sampling times. Predacious arthropods were, although not significantly so, more abundant within maize fields in the mornings (07:00) and in adjacent grasslands during late afternoon (15:00). This study indicated no particular time to be significantly better suited for sampling of the diversity of the four groups of predacious arthropods in maize agro-ecosystems. [ABSTRACT FROM AUTHOR]

Transmission electron microscopy (TEM) has been used to investigate the effects of room temperature 6 keV helium ion irradiation of a thin (≈55 nm thick) tri-layer consisting of polycrystalline Si, silica, and single-crystal Si. The ion irradiation was carried out in situ within the TEM under conditions where approximately 24% of the incident ions came to rest in the specimen. This paper reports on the comparative development of irradiation-induced defects (primarily helium bubbles) in the polycrystalline Si and single-crystal Si under ion irradiation and provides direct measurement of a radiation-induced increase in the width of the polycrystalline layer and shrinkage of the silica layer. Analysis using TEM and electron energy-loss spectroscopy has led to the hypothesis that these result from helium-bubble-induced swelling of the silicon and radiation-induced viscoelastic flow processes in the silica under the influence of stresses applied by the swollen Si layers. The silicon and silica layers are sputtered as a result of the helium ion irradiation; however, this is estimated to be a relatively minor effect with swelling and stress-related viscoelastic flow being the dominant mechanisms of dimensional change. [ABSTRACT FROM AUTHOR]

The recent observation of a fractional quantum Hall effect in high mobility suspended graphene devices introduced a new direction in graphene physics, the field of electron-electron interaction dynamics. However, the technique used currently for the fabrication of such high mobility devices has several drawbacks. The most important is that the contact materials available for electronic devices are limited to only a few metals (Au, Pd, Pt, Cr, and Nb) because only those are not attacked by the reactive acid etching fabrication step. Here we show a new technique that leads to mechanically stable suspended high mobility graphene devices and is compatible with almost any type of contact material. The graphene devices prepared on a polydimethylglutarimide based organic resist show mobilities as high as 600.000 cm2/Vs at an electron carrier density of n = 5.0 × 109 cm-2 at 77 K. This technique paves the way toward complex suspended graphene based spintronic, superconducting, and other types of devices. [ABSTRACT FROM AUTHOR]

Continuous downscaling of complementary metal-oxide semiconductor devices requires the manufacture of highly doped ultrashallow junctions. A preamorphizing implant (PAI) is commonly used in industrial processing in order to avoid unfavorable profile broadening and channeling tails during dopant atom implant in the ultralow energy regime (<5 keV). In this work, we report about a detailed characterization of the structural changes induced by xenon PAI treatment on ultralow energy arsenic-implanted (001) silicon. Combined x-ray scattering methods, medium energy ion scattering, and transmission electron microscopy are applied to obtain as comprehensive picture as possible of the reordering processes occurring during the postimplantation annealing treatment. Evidence is found that end-of-range defects, present after implant below the amorphous-to-crystalline interface, transform from small Si interstitial clusters to dislocation loops during annealing depending on the implant conditions. Simultaneously, As atoms redistribute by moving to the substitutional sites of the freshly regrown Si lattice without inducing a local residual strain field. The remaining fraction of electrically inactive dopants cumulates in a subnanometer-thick layer beneath the surface oxide. [ABSTRACT FROM AUTHOR]

Measurements of photoluminescence intensity from GaAs and InGaAs quantum well heterostructures have been used as a noninvasive probe of the damage distribution due to very low-power dry etching. Samples were etched using SiCl[sub 4] reactive-ion etching. Comparative studies were made on samples bombarded by the separate constituent ions of a SiCl[sub 4] discharge using a mass-resolving ion implanter fitted with a deceleration lens. We also examined the influence of more complex multicomponent discharges. We found that molecular ions contribute less to deep damage than do atomic ions. The reason is that molecular ions fragment upon impact and the secondary atomic ions do not channel very far. Studies of laser illumination on the sample during etching show that a form of radiation-enhanced diffusion can modify the damage distribution. The net picture emerges of a complex process underlying dry-etch damage penetration at very low energies. © 2001 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Many patients with chronic obstructive lung disease (COPD) experience exacerbations. The diagnosis of an exacerbation is solely based on symptoms. We hypothesized that exhaled breath profiles, measured by Gas Chromatography-Mass Spectrometry (GC-MS) or electronic nose (eNose), are different between stable disease and exacerbations and may have the potential to serve as biomarkers for COPD exacerbations. In this prospective follow-up study, breath samples were taken during stable COPD, during a subsequent exacerbation and after recovery. Samples were analyzed by GC-MS and eNose. CCQ symptom scores were associated with univariate outcomes of GC-MS and eNose using analysis of covariance (ANCOVA). After multivariate modeling by Principal Component Analysis (PCA), paired student t-tests were performed. Sixty-eight patients were included, 31 had an exacerbation and 16 patients had breath sampled at all three time points. Significant differences were found in breathprints taken during exacerbation as compared to baseline and recovery for both GC-MS and eNose. Breath profiles obtained by GC-MS as well as by eNose showed a correct classification of 71% (10/14) for baseline vs exacerbation and of 78% (11/14) for exacerbation vs recovery. These results provide proof of principle that exhaled breath can serve as a noninvasive biomarker for the diagnosis of COPD exacerbations. [ABSTRACT FROM AUTHOR]

The aim of this study is to describe the clinical characteristics and MRI findings of the wrist in a cohort of children suffering from connective tissue disease with musculoskeletal involvement. Ten patients with pediatric connective tissue disease [median age 14.7 years (IQR 12.7–16.6 years), 70% female] were identified from a large MRI database. Clinical findings during the disease course were retrospectively obtained from patient charts and findings at the time of MRI were prospectively registered in the MRI database. MRI wrist datasets were evaluated by three readers in consensus for synovitis, tenosynovitis, bone marrow changes, bone erosions and myositis. Patients suffered from connective tissue disease with clinical overlap of subtypes systemic lupus erythematosus, Sjögren syndrome and dermatomyositis. Median onset of disease was at 12.3 years (IQR 7.8–14.8 years). Clinical arthritis activity was scored low (median visual analogue scale physician 19, IQR 7–31). Notwithstanding, extensive inflammatory abnormalities such as synovitis and tenosynovitis were found in the wrist of 7/10 patients. Osteochondral involvement was detected in 3/10 patients. In a small cohort of children with connective tissue disease and musculoskeletal symptoms, severe inflammatory abnormalities of the involved wrist were present in the MRI, while clinical disease scores suggested mild disease activity. Therefore, clinicians should consider the wrist as vulnerable for joint damage and can add MRI as a helpful tool in the management of patients with pediatric connective tissue disease and musculoskeletal involvement. [ABSTRACT FROM AUTHOR]

The main result of this paper is the following: if F is any field and R any F-subalgebra of the algebra Mn(F) of n × n matrices over F with Lie nilpotence index m, then. dimFR ≼ M(m + 1, n), where M(m + 1, n) is the maximum of 1/2(n² -Σ m+1 i=1 k² i) + 1 subject to the constraint Σ m+1 i=1 ki = n and k1, k2, . . . , km+1 nonnegative integers. This answers in the affirmative a conjecture by the first and third authors. The case m = 1 reduces to a classical theorem of Schur (1905), later generalized by Jacobson (1944) to all fields, which asserts that if F is an algebraically closed field of characteristic zero and R is any commutative F-subalgebra of Mn(F), then dimFR ≼ n²/4+ 1. Examples constructed from block upper triangular matrices show that the upper bound of M(m+1, n) cannot be lowered for any choice of m and n. An explicit formula for M(m + 1, n) is also derived. [ABSTRACT FROM AUTHOR]

Background: Post-contrast synovial thickness measurement is necessary for scoring disease activity in juvenile idiopathic arthritis (JIA). However, the timing of post-contrast sequences varies widely among institutions. This variation in timing could influence thickness measurements. Objective: To measure thickness of the synovial membrane on early and late post-contrast knee magnetic resonance (MR) images of patients with JIA. Materials and methods: Dynamic contrast-enhanced T1-weighted knee MR images of 53 children with JIA with current or past knee arthritis were used to study synovial thickness at time point 1 (about 1 min) and time point 2 (about 5 min after contrast administration). Two experienced readers, who were blinded for the time point, independently measured synovial thickness at a predefined, marked location in the patellofemoral compartment on randomized images. Synovial thickness at the two time points was compared using the Wilcoxon signed rank test. Repeatibility of the synovial thickness measurements was studied using intraclass correlation coefficients and Bland-Altman plots. Results: Median synovial thickness of the 53 patients (median age: 13.5 years, 59% female) increased with prolonged post-contrast interval with a synovial thickness of 1.4 mm at time point 1 and a synovial thickness of 1.5 mm at time point 2 (P<0.001). Repeated synovial thickness measurements showed an intraclass correlation coefficient (ICC) of 0.75, P<0.05 for time point 1 and an ICC of 0.91, P<0.05 for time point 2. Conclusion: Post-contrast synovial membrane thickness measurements are time-dependent. Therefore, standardization of post-contrast image acquisition timing is important to achieve consistent grading of synovial inflammation. [ABSTRACT FROM AUTHOR]

The order dual [ Fil R R ] du of the set Fil R R of all right topologizing filters on a fixed but arbitrary ring R is a complete lattice ordered monoid with respect to the (order dual) of inclusion and a monoid operation ' : ' that is, in general, noncommutative. It is known that [ Fil R R ] du is always left residuated, meaning, for each pair F , G ∈ Fil R R there exists a smallest H ∈ Fil R R such that H : G ⊇ F , but is not, in general, right residuated (there exists a smallest H such that G : H ⊇ F ). Rings R for which [ Fil R R ] du is both left and right residuated are shown to satisfy the DCC on left annihilator ideals and possess only finitely many minimal prime ideals. It is shown that every maximal ideal P of a commutative ring R gives rise to an onto homomorphism of lattice ordered monoids φ ^ P from [ Fil R ] du to [ Fil R P ] du where RP denotes the localization of R at P. The kernel ≡ φ ^ P of φ ^ P is a congruence on [ Fil R ] du whose properties we explore. Defining Rad (Fil R) to be the intersection of all congruences ≡ φ ^ P as P ranges through all maximal ideals of R, we show that for commutative VNR rings R, Rad (Fil R) is trivial (the identity congruence) precisely if R is noetherian (and thus a finite product of fields). It is shown further that for arbitrary commutative rings R, Rad (Fil R) is trivial whenever Fil R is commutative (meaning, the monoid operation ' : ' on Fil R is commutative). This yields, for such rings R, a subdirect embedding of [ Fil R ] du into the product of all [ Fil R P ] du as P ranges through all maximal ideals of R. The theory developed is used to prove that a Prüfer domain R for which Fil R is commutative, is necessarily Dedekind. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the effect of hybrid iterative reconstruction and post processing on emphysema quantification in low-dose CT scans of COPD patients using pulmonary function tests (PFT) as a reference. Methods: CT scans of 23 COPD patients diagnosed with GOLD I or higher were reconstructed with iDose4 level 1 to 7 in IntelliSpace Portal (ISP) 6 and 7. ISP7 was used with and without specific denoising filter for COPD. The extent of emphysema was measured as percentage of lung voxels with attenuation < − 950 Hounsfield units (%LAA-950). The correlation between %LAA-950 and PFT, age, BMI, pack years, and the Clinical COPD Questionnaire (CCQ) and Medical Research Council dyspnea scale (MRC) was determined. Results: Denoising significantly reduced %LAA-950 as was demonstrated by lower %LAA-950 in ISP7 with denoising filter and a significant reduction in %LAA-950 with higher iDose4 levels. All PFT except forced vital capacity (FVC) were significantly inversely correlated with %LAA-950. There was a trend toward a stronger correlation at higher iDose4 levels. %LAA-950 was also significantly correlated with BMI, GOLD class, and CCQ scores. Conclusions: Our study showed that hybrid iterative reconstruction and use of post processing denoising can optimize the use of emphysema quantification in CT scans as a complimentary diagnostic tool to stage COPD in addition to PFT. [ABSTRACT FROM AUTHOR]

Question: Which is the best strategy to achieve (drug-free) inactive disease in juvenile idiopathic arthritis (JIA)?Methods: In a randomised, single-blinded, study in disease-modifying anti-rheumatic drug (DMARD)-naive patients with JIA, three treatment-strategies were compared: (1) sequential DMARD-monotherapy (sulfasalazine or methotrexate (MTX)), (2) combination therapy MTX + 6 weeks prednisolone and (3) combination therapy MTX +etanercept. Treatment-to-target entailed 3-monthly DMARD/biological adjustments in case of persistent disease activity, with drug tapering to nil in case of inactive disease.After 24 months, primary outcomes were time-to-inactive-disease and time-to-flare after DMARD discontinuation. Secondary outcomes were adapted ACRPedi30/50/70/90 scores, functional ability and adverse events.Results: 94 children (67 % girls) aged median (IQR) 9.1 (4.6-12.9) years were enrolled: 32 in arms 1 and 2, 30 in arm 3. At baseline visual analogue scale (VAS) physician was mean 49 (SD 16) mm, VAS patient 53 (22) mm, erythrocyte sedimentation rate 12.8 (14.7), active joints median 8 (5-12), limited joints 2.5 (1-4.8) and Childhood Health Assessment Questionnaire score mean 1.0 (0.6).After 24 months, 71% (arm 1), 70% (arm 2) and 72% (arm 3) of patients had inactive disease and 45% (arm 1), 31% (arm 2) and 41% (arm 3) had drug-free inactive disease. Time-to-inactive-disease was median 9.0 (5.3-15.0) months in arm 1, 9.0 (6.0-12.8) months in arm 2 and 9.0 (6.0-12.0) months in arm 3 (p=0.30). Time-to-flare was not significantly different (overall 3.0 (3.0-6.8) months, p=0.7). Adapted ACR pedi-scores were comparably high between arms. Adverse events were similar.Conclusion: Regardless of initial specific treatments, after 24 months of treatment-to-target aimed at drug-free inactive disease, 71% of recent-onset patients with JIA had inactive disease (median onset 9 months) and 39% were drug free. Tightly controlled treatment-to-target is feasible.Trial Registration Number: 1574. [ABSTRACT FROM AUTHOR]

Background: To optimize the treatment strategy and reduce treatment costs of proximal fifth metatarsal fractures, clinical and patient-reported outcome, and its determinants were addressed.Methods: A retrospective adult cohort study including 152 proximal fifth metatarsal fractures: 121 nonoperatively and 31 operatively treated. In the operative group, 21 were zone 1 and 10 zone 2 fractures. Median follow-up was 37.5 (IQR 20.8-52.3) months with a minimal follow-up of 6 months. Twenty-three demographic, fracture, and treatment characteristics were assessed as well as the healthcare costs. Outcome was assessed using the patient files, anterior-posterior and oblique X-rays, foot function index (FFI), visual analog score (VAS), and SF-36 questionnaires.Results: The median FFI, physical SF-36, and VAS scores did not significantly differ between nonoperatively and operatively treated patients. The FFI and physical SF-36 were predominantly affected by a history of mobility impairment and pre-existent cardiovascular diseases, whereas mental SF-36 correlated significantly with higher ASA-score. Overall complication rate was 5.9% (4.1 vs. 12.9%; p = 0.065, nonoperative vs. operative, respectively). Nonunion was recorded in only one (nonoperatively) treated patient. The total healthcare costs for operative treatment were 4.2 times higher compared to nonoperative treatment (€1960 vs. €463 per patient, respectively).Conclusion: Overall, the clinical and patient-reported outcome was good. The foot function and quality of life were mainly affected by comorbidity, rather than fracture and treatment-related variables. Although nonoperatively treated patients indicated decreased mental quality of life, our study indicates that proximal fifth metatarsal fractures can safely be treated nonoperatively without the risk of nonunion, with fewer complications and lower healthcare costs.Level of evidence: 3. [ABSTRACT FROM AUTHOR]

This study evaluated the potential of mass trapping to reduce Prostephanus truncatus population numbers in granaries and hence its possible utilisation as pest management tool. Universal moth traps (Uni-traps) were used to trap the pest and its predator, Teretrius nigrescens Lewis (Coleoptera: Histeridae), in granaries of small-scale farmers in three villages of the Gaza Province of Mozambique during the maize storage period of August 2013 to January 2014. Five granaries were selected in each village. Two baited pheromone traps were set up adjacent to each of three of these granaries. The other two granaries were used as controls, without traps. Numbers of both the pest and its predator were monitored in these traps as well as in stored maize ears inside the granaries for a 6-month period. Meannumbers and densities of P. truncatus, the percentage damaged maize kernels and maize kernel weight loss in granaries with and without traps were compared by means of t-tests. The Cohen's standard of effect size was applied to measure the magnitude of differences between studied variables. An average of 1272 individuals of P. truncatus was caught per trap. Mean densities of P. truncatus recorded per maize ear in granaries with traps were lower (27 individuals/ear) than of those without traps (129 individuals/ear). Mean numbers of T. nigrescens per trap followed similar patterns between granaries with and without traps. The percentage of damaged maize kernels was higher (62 %) in granaries without traps than in those with traps (22 %). Highly significant negative correlations were found between mean numbers of P. truncatus caught in traps and mean infestation in maize ears inside granaries. These findings indicate that mass trapping holds potential for control of P. truncatus in granaries of small-scale farmers. [ABSTRACT FROM AUTHOR]