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Alzheimer disease (AD) is characterized by episodic memory impairment. This study was aimed at assessing various aspects of episodic memory, and particularly sensitivity to semantic cuing, in patients with various degrees of cognitive deterioration, compared with normal elderly subjects. One hundred thirty-one patients, subdivided into four subgroups as a function of their Mini-Mental State Examination score, were included. All subjects, including 20 normal elderly subject, were given an episodic memory test with controlled encoding and selective reminding. The subgroups of patients were homogeneous in terms of free recall and recognition, but differed in terms of responsiveness to cuing by semantic categories corresponding to the to-be-remembered items. The data confirmed that a severe amnesic syndrome occurs very early in AD, even in a subgroup of patients who did not meet the criteria for dementia. The data indicated that free recall performance, characterized in all subgroups by a floor effect, is not likely to be an appropriate index in pharmacological trials. By contrast, sensitivity to semantic cuing seemed relatively preserved in the early stages, and decreased with the progression of the disease. This index would be the most sensitive index of episodic memory in AD.

The normal mode spectrum for the linearized MHD equations is investigated for a simple cylindrical equilibrium. This spectrum is examined for zero and non-zero scalar resistivity. Particular attention is paid to the thermal sub-spectrum. It is shown that when resistivity is included, a ‘dissipative’ layer forms at the location of the singularity associated with the thermal continuum. For the most unstable ‘quasi-continuum modes’, the thickness of this dissipative layer is proportional to the 1/4 power of the magnetic Reynolds number. This generates length scales that are of the same order of magnitude as those reported for the fine-scale structure seen in prominences. It is therefore concluded that dissipation due to resistivity may be relevant for the formation of prominence fine-scale structure.

Suppression of the secretion of prolactin, growth hormone and insulin-like growth factor 1 (IGF-1) might be important in the growth regulation and treatment of breast cancer. Because oestrogens may counteract the anti-tumour effects of such treatment, the combination of an anti-oestrogen (tamoxifen), a somatostatin analogue (octreotide) and a potent anti-prolactin (CV 205-502) might be attractive. In this respect, we performed a first exploratory long-term study on the feasibility of combined treatment and possible clear differences in endocrine and anti-tumour effects during such combined treatment vs standard treatment with tamoxifen alone. Twenty-two post-menopausal patients with metastatic breast cancer (ER and/or PR positive or unknown) were randomized to receive either 40 mg of tamoxifen per day or the combination of 40 mg of tamoxifen plus 75 microg of CV 205-502 orally plus 3 x 0.2 mg of octreotide s.c. as first-line endocrine therapy. An objective response was found in 36% of the patients treated with tamoxifen alone and in 55% of the patients treated with combination therapy. Median time to progression was 33 weeks for patients treated with tamoxifen and 84 weeks for patients treated with combination therapy, but the numbers are too small for hard conclusions. There was no difference in overall post-relapse survival between the two treatment arms. With respect to the endocrine parameters, there was a significant decrease of plasma IGF-1 levels in both treatment arms, whereas during combined treatment plasma growth hormone tended to decrease and plasma prolactin levels were strongly suppressed; in some patients insulin and transforming growth factor alpha (TGF-alpha) decreased during the triple therapy. Although there was no significant difference in mean decrease of plasma IGF-1 levels between the two treatment arms, combined treatment resulted in a more uniform suppression of IGF-1. Therefore, the addition of a somatostatin analogue and an anti-prolactin may potentially enhance the efficacy of anti-oestrogens in the treatment of breast cancer owing to favourable endocrine and possible direct anti-tumour effects. Large phase III trials using depot formulations (to increase the feasibility) of somatostatin analogues are warranted to demonstrate the potential extra beneficial anti-tumour effects of such combination therapy.

The symptoms of conversion disorder are not due to conscious simulation. There should be no doubt that the symptoms of conversion disorder are genuine, even if scans do not reveal any abnormalities. The management of patients with conversion disorder starts with an explanation of the diagnosis. The essence of this explanation is that patients first hear about what the diagnosis actually means and only after this about what they do not have. When explaining the diagnosis it is a good idea to use metaphors. The treatment of patients with conversion disorder is carried out together with a physical therapist. The collaboration of healthcare professionals who are involved in the treatment of a patient with conversion disorder should preferably be coordinated by the patient's general practitioner.

BACKGROUND: Fractures of the humeral shaft are associated with a profound temporary (and in the elderly sometimes even permanent) impairment of independence and quality of life. These fractures can be treated operatively or non-operatively, but the optimal tailored treatment is an unresolved problem. As no high-quality comparative randomized or observational studies are available, a recent Cochrane review concluded there is no evidence of sufficient scientific quality available to inform the decision to operate or not. Since randomized controlled trials for this injury have shown feasibility issues, this study is designed to provide the best achievable evidence to answer this unresolved problem. The primary aim of this study is to evaluate functional recovery after operative versus non-operative treatment in adult patients who sustained a humeral shaft fracture. Secondary aims include the effect of treatment on pain, complications, generic health-related quality of life, time to resumption of activities of daily living and work, and cost-effectiveness. The main hypothesis is that operative treatment will result in faster recovery. METHODS/DESIGN: The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, AO type 12A or 12B. Treatment decision (i.e., operative or non-operative) will be left to the discretion of the treating surgeon. Critical elements of treatment will be registered and outcome will be monitored at regular intervals over the subsequent 12 months. The primary outcome measure is the Disabilities of the Arm, Shoulder, and Hand score. Secondary outcome measures are the Constant score, pain level at both sides, range of motion of the elbow and shoulder joint at both sides, radiographic healing, rate of complications and (secondary) interventions, health-related quality of life (Short-Form 36 and EuroQol-5D), time to resumption of ADL/work, and cost-effectiveness. Data will be analyzed using univariate and multivariable analyses (including mixed effects regression analysis). The cost-effectiveness analysis will be performed from a societal perspective. DISCUSSION: Successful completion of this trial will provide evidence on the effectiveness of operative versus non-operative treatment of patients with a humeral shaft fracture. TRIAL REGISTRATION: The trial is registered at the Netherlands Trial Register (NTR3617).

Expected survival is a major factor influencing extent of treatment for symptomatic spinal bone metastases (SBM). Predictive models have been developed, but their use can lead to over- or undertreatment.. The study objective was to identify prognostic factors associated with survival in patients with symptomatic SBM and to create a validated risk stratification model.All patients who were treated for symptomatic SBM between 2001 and 2010 were included in this single center retrospective study. Medical records were reviewed for type of primary cancer, performance status, presence of visceral, brain and bone metastases, number and location of spinal metastases, and neurological functioning. Performance status was assessed with the Karnofsky performance score and neurological functioning with the Frankel scale. Analysis was performed using Kaplan-Meier curves, univariate log-rank tests, Cox regression models, and Harrell's C statistic.A total of 1 043 patients were studied. The most prevalent tumors were those of breast (n = 299), lung (n = 250), and prostate (n = 215). Median follow-up duration was 6.6 years, and 6 patients were lost to follow-up. Based on the results of the uni- and multivariate analyses, 4 categories were created. Median survival in category A was 31.2 months (95% CI, 25.2-37.3 months), 15.4 months (95% CI, 11.9-18.2 months) for category B, 4.8 months (95% CI, 4.1-5.4 months) for category C, and 1.6 months (95% CI, 1.4-1.9 months) for category D. Harrell's C statistic was calculated after the model was applied to an external dataset, yielding a result of 0.69.Assessing patients according to the presented model results in 4 categories with significantly different survival times.

All major JET systems have been fully commissioned for D-T and the DTE1 series of experiments has started with the D-T fuel mixture and operating conditions foreseen for ITER. In the area of ITER physics, significant results have been produced in both D-D and D-T. In D-D, the LH threshold power database has been extended, the bounds on edge-electron temperature and density in ELMy H-modes have been defined and the advantages of Types I and III ELMy discharges have been compared. In D-T plasmas, the isotope effect on H-mode threshold power and transport has been determined so that a more accurate assessment can be made of the ignition margin and heating requirements for ITER. Trace tritium experiments have provided first particle transport measurements and an assessment of the ITER reference ion-cyclotron resonance-frequency heating scenarios has been started, In the area of fusion performance, record D-D neutron yields have been obtained by controlling the plasma and current profiles in hot ion ELM-free H-modes and optimized shear modes. In D-T, internal transport barriers have been readily established in optimized shear discharges and Alfven eigenmodes have been observed.

The linear stability of the `scrape-off-layer' (SOL) with respect to interchange-type modes is studied using the reduced MHD model and applying a ballooning approximation to the perturbations. `Line-tying' boundary conditions are used at the target plates. Employing a metric determined by the magnetic field geometry, the influence of the X-point on stability is assessed. The effect of relevant parameters like X-point height, magnetic shear and plasma shaping is qualitatively determined. It is demonstrated that the calculations for experimental configurations and those based on an analytical equilibrium model yield good qualitative agreement. It is shown that the SOL plasma just outside the separatrix can become unstable more easily (i.e. for lower pressure gradients) than the plasma just inside the separatrix where the magnetic well is stabilizing. This finding can be important for explaining the occurrence of giant ELMs. The interchange instability in the SOL may act as a precursor and is mainly localized near the X-point, but may also have a strong signature just above the outer midplane. The scaling of the ELM repetition time with heating power and current is derived.

The marfe is studied as a radiative thermal instability in a two-dimensional axisymmetric tokamak model. To obtain a detailed idea of the marfe onset, a linear analysis is performed, using a full set of magnetohydrodynamic equations. Some typical marfe shots from JET are simulated. It is demonstrated how the marfe is a result of a poloidally symmetric temperature decrease and an asymmetric density increase. It is found that the onset of the marfe is accompanied by significant perturbations of pressure and magnetic field. The evolution of the marfe is discussed, based on the linear results. The model proves to give not only qualitative, but also quantitative agreement. The plasma parameters for marfe onset can be predicted accurately. Thermal instabilities belong to a continuum in the MHD spectrum of eigenfrequencies. The thermal stability of an equilibrium can be tested very easily by calculating this continuum.

The potential of cyclotriveratrylene (ctv) (2,3,7,8,12,13-hexamethoxy-10,15-dihydro-5H-tribenzo[a, d,g]cyclononene) trithiols as ligands that can easily be functionalised and show subsite differentiation in their complexes with [4Fe–4S] clusters has been explored. The cluster complexes of tris(2-sulfanylethoxy)- and tris(3-sulfanyl-methylbenzyloxy)-functionalised ctvs have been studied by core-extrusion experiments, spectroscopy and electrochemical techniques. With [Fe 4 S 4 Cl 4 ] 2- as starting material a cluster complex was obtained in which the unique Fe and its co-ordinating Cl was turned into the cavity and show no reactivity. Starting with the more bulky [Fe 4 S 4 (SBu t ) 4 ] 2- the unique iron points outwards and is susceptible to substitution reactions. The effects of hydrogen bonding and electron density on the redox potential of the cluster complex have been investigated. The redox potential becomes more negative when the length of the spacer between the ctv and cluster core is increased, which is explained by the longer distance between the cluster and the electron-withdrawing phenoxy moiety of the ctv. The synthesis of ctv derivatives with one thiol and one alcohol functionality per phenyl unit, and comparison with corresponding derivatives where hydrogen bonding is not possible, showed that no significant differences were found. The effects of a substituent in an aromatic amide group that could hydrogen bond to the co-ordinated thiol were investigated. A weak effect, in the direction expected, was found upon substitution of methyl for H.

Progression of joint destruction is an important phenotypic feature in rheumatoid arthritis (RA). When factors have small effect sizes, both the avoidance of phenotypic misclassification and discerning true effects from noise are challenging. Assembling radiological measurements repeatedly in time harbours a smaller risk of misclassification than single measurements. Given serial measurements, different methods of analysis can be applied. This study evaluates different statistical methods of analysing longitudinal data.Three statistical methods were studied: linear regression (LR), generalized estimating equations (GEE), and multivariate normal regression analysis (MRA). All were applied longitudinally, testing for differences in radiological progression rates. As genetic variants are known to have small effect sizes, two genetic variants were studied as examples: rs675520 (located in the TNFAIP3-OLIG3 region) and the presence of the human leucocyte antigen (HLA) shared epitope (SE) alleles. Radiological data for 602 early RA patients with yearly radiographs and 7-years of follow-up were used. The powers obtained with the methods and the robustness against missingness were evaluated as outcome measures.The presence of the rs675520 polymorphism and the HLA-SE risk genotype was associated with a 0.65-0.77 and 1.17-1.51 fold increased rate of joint destruction, respectively. The analyses performed with MRA resulted in smaller 95% confidence intervals (CIs) than the analyses using LR or GEE. In addition, the 95% CIs increased with the number of radiographs per patient. The power of MRA was higher than that of GEE. MRA was more robust against selective missingness than GEE or LR with a two-step approach (LR(ts)).A multivariate normal regression model on subsequent radiographs is a powerful and robust method for analysing longitudinal joint destruction data.

BACKGROUND: Although repeat radiation treatment has been shown to palliate pain in patients with bone metastases from multiple primary origin sites, data for the best possible dose fractionation schedules are lacking. We aimed to assess two dose fractionation schedules in patients with painful bone metastases needing repeat radiation therapy.METHODS: We did a multicentre, non-blinded, randomised, controlled trial in nine countries worldwide. We enrolled patients 18 years or older who had radiologically confirmed, painful (ie, pain measured as ≥2 points using the Brief Pain Inventory) bone metastases, had received previous radiation therapy, and were taking a stable dose and schedule of pain-relieving drugs (if prescribed). Patients were randomly assigned (1:1) to receive either 8 Gy in a single fraction or 20 Gy in multiple fractions by a central computer-generated allocation sequence using dynamic minimisation to conceal assignment, stratified by previous radiation fraction schedule, response to initial radiation, and treatment centre. Patients, caregivers, and investigators were not masked to treatment allocation. The primary endpoint was overall pain response at 2 months, which was defined as the sum of complete and partial pain responses to treatment, assessed using both Brief Pain Inventory scores and changes in analgesic consumption. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00080912.FINDINGS: Between Jan 7, 2004, and May 24, 2012, we randomly assigned 425 patients to each treatment group. 19 (4%) patients in the 8 Gy group and 12 (3%) in the 20 Gy group were found to be ineligible after randomisation, and 140 (33%) and 132 (31%) patients, respectively, were not assessable at 2 months and were counted as missing data in the intention-to-treat analysis. In the intention-to-treat population, 118 (28%) patients allocated to 8 Gy treatment and 135 (32%) allocated to 20 Gy treatment had an overall pain response to treatment (p=0·21; response difference of 4·00% [upper limit of the 95% CI 9·2, less than the prespecified non-inferiority margin of 10%]). In the per-protocol population, 116 (45%) of 258 patients and 134 (51%) of 263 patients, respectively, had an overall pain response to treatment (p=0·17; response difference 6·00% [upper limit of the 95% CI 13·2, greater than the prespecified non-inferiority margin of 10%]). The most frequently reported acute radiation-related toxicities at 14 days were lack of appetite (201 [56%] of 358 assessable patients who received 8 Gy vs 229 [66%] of 349 assessable patients who received 20 Gy; p=0·011) and diarrhoea (81 [23%] of 357 vs 108 [31%] of 349; p=0·018). Pathological fractures occurred in 30 (7%) of 425 patients assigned to 8 Gy and 20 (5%) of 425 assigned to 20 Gy (odds ratio [OR] 1·54, 95% CI 0·85-2·75; p=0·15), and spinal cord or cauda equina compressions were reported in seven (2%) of 425 versus two (INTERPRETATION: In patients with painful bone metastases requiring repeat radiation therapy, treatment with 8 Gy in a single fraction seems to be non-inferior and less toxic than 20 Gy in multiple fractions; however, as findings were not robust in a per-protocol analysis, trade-offs between efficacy and toxicity might exist.FUNDING: Canadian Cancer Society Research Institute, US National Cancer Institute, Cancer Council Australia, Royal Adelaide Hospital, Dutch Cancer Society, and Assistance Publique-Hôpitaux de Paris.

Background:To reduce the high rate of soft tissue complications in the treatment of displaced intra-articular fractures of the calcaneus, several minimally invasive techniques have been developed. Little evidence exists on the clinical outcome of these techniques.Methods:We performed a study on a cohort of 46 fractures treated by the 3-point distraction technique. In 41 fractures, clinical outcome was available. Fractures were classified according to the Essex-Lopresti and Sanders classifications. The clinical outcome was determined using the 3 most frequently used outcome scores.Results:The clinical outcome of our cohort of percutaneous treated intra-articular calcaneal fractures was good to excellent in 69% with the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) score. This percentage increases to 100% for tongue type fractures alone but decreases to 52% for joint depression type fractures. Infectious complications occurred in 1 (2.4%) and secondary arthrodesis was needed in 3 fractures (7.3%). The Sanders classification showed no prognostic value. The Essex-Lopresti classification was a strong prognosticator with a median AOFAS score of 92 (interquartile range [IQR], 87.8-97.8) for tongue type fractures and 75 (IQR, 63.0-85.0) for joint depression type fractures ( P < .001).Conclusion:The treatment of displaced intra-articular calcaneal fractures by the 3-point distraction technique was an acceptable alternative to open surgery and other percutaneous techniques. It had a low amount of infectious complications with comparable outcome to open treatment. The computed tomography-based Essex-Lopresti classification had a strong prognostic value when fractures were treated by the 3-point distraction technique. The results of this study support the use of the 3-point distraction technique, especially in tongue type fractures.Level of Evidence:Level IV, retrospective case series.

Analysis on cost effectiveness in medicine is a type of economic analysis that compares the relative costs and outcomes of two or more different medical treatments in order to choose the most optimal treatment modality in terms of costs versus outcome. In bone metastases research, several studies on costs and effectiveness have been published. In this chapter, the different types of cost analyses, their relative usefulness and impact on daily clinical practice will be discussed.

Advanced Tokamak Concepts [C. Kessel, J. Manickam, G. Rewoldt, and W. M. Tang, Phys. Rev. Lett. 72, 1212 (1994)] have been designed assuming that the ‘‘Resistive Wall Mode’’ (RWM) is stable. It has recently been shown that the RWM can be stabilized by a combination of strong uniform plasma rotation and visco‐resistive dissipation. In this paper we examine the consequences of a sheared flow on the RWM, and contrast the results to the case of uniform flow. It is shown that, as for uniform flow, the rotation initially further destabilizes the resistive wall mode, but for higher rotation velocities the growth rate is reduced, and the presence of plasma dissipation may completely stabilize the mode. However, sheared rotation allows the possibility of the RWM coupling to and converting into a Kelvin‐Helmholtz mode. It is shown that the position of the wall with respect to the critical position for stabilization of the external kink mode is of crucial importance.

To determine the optimum tube diameter of a standard handrim-propelled wheelchair, the effect of tube size and shape on physiological and kinetic parameters was studied. Six able-bodied male subjects performed two tests on a wheelchair ergometer. Tests were performed against work loads comparable to every day use and with two different handrim tube diameters, a handrim with an oval 25 by 30 mm diameter (LR) and one with an 18 mm diameter (SR). The large tube diameter (LR) yielded slightly but significantly lower values for the physiological parameters. Gross mechanical efficiency was on average 7% for the LR and 6.3% for the SR. No significant results were found for force application parameters related to the direction of the applied force or the torque by the hand onto the handrim surface. As technique parameters could not explain the higher mechanical efficiency (ME) when using the LR, it is suggested that hand grip constraints in the push phase (finger flexor activity) might be responsible. Another possible explanation is that with a better hand grip using LR, less stabilization by the larger muscle groups at the elbow and shoulder is needed. The measured technique parameters seem to be determined by geometric constraints of the arm and shoulder. The technique requirements resulting from the forced trajectory of the propulsion movement are also likely to determine the technique parameters. Regarding the low mechanical efficiency of handrim propulsion, which is partly caused by the forced unfavorable trajectory of the hand, an alternative propulsion mechanism is suggested.

Background: This study compares efficacy safety and tolerability of 2 and 5 mg tropisetron in prevention of nausea and vomiting induced by low-dose cisplatin- or non-cisplatin-containing chemotherapy. Patients and methods: 152 chemotherapy-naive cancer patients were randomized in a double-blind manner to receive 2 or 5 mg tropisetron intravenously day 1 and orally days 2-6. Primary efficacy criteria were control of acute (day 1) and delayed (days 26) vomiting and nausea. Secondary efficacy criteria included overall control (days 1-6) and control of vomiting and nausea by chemotherapy regimen. Safety and tolerability were evaluated clinically, biochemically and by the patient's diary. Only the first cycle was evaluated. Results: 124 of the 144 intention-to-treat patients were evaluable. There was a better total control (no events) of acute vomiting in the 5 mg (73%) than in the 2 mg group (55%, P = 0.02). Total control (less than or equal to 15 minutes) of acute nausea was obtained in 70% of the 5 mg group and in 51% of the 2 mg (P = 0.03). No differences were observed for total control of delayed nausea or vomiting and for the overall outcome of nausea. Less vomiting (days 1-6) occurred in the 5 mg than in the 2 mg group. Efficacy rates ranged widely between chemotherapy regimens, independent of the tropisetron dose groups. There occurred more headache in the 5-mg group (P

Survivors of severe closed-head injury (CHI) frequently suffer from slowed information processing. Whether supervisory strategies are additionally impaired remains a point of debate. The first part of this study employed a self-paced dual task; the second part, a random generation task, performed at a paced rate, under single and dual task conditions. A measure of information processing speed was used as a covariate in statistical analysis. In the first experiment, in addition to slow processing, patients performed slightly poorer than controls on each task. In the second experiment, patients' performance (one randomness index in single task condition, and processing of dual task) was impaired even after statistical control of slow processing. These results suggest that there is at least some degree of impairment in supervisory strategies in addition to, but independent of, slowed processing. The clinical significance of this finding is discussed.

In order to construct bimetallic organometallic donor–acceptor complexes with nonlinear optical (NLO) properties, the bimetallic sesquifulvalene complexes [{CpFe(η5-C5H4)}Z{η7-C7H6)Cr-(CO)3}]BF4 (2BF4) have been synthesized with different bridging functions Z (2a: Z = - 2b: Z = C2; 2c: Z (E)-C2H2). X-ray structure determinations show that 2a BF4 and 2c BF4 crystallize in acentric space groups (P41, P212121), whereas crystalline 2b BF4 has the centric space group P21/c. The organometallic fragments in 2a adopt a transoid conformation, those in 2b and 2c are cisoid. The cyclo-C5 and cyclo-C7 rings of the sesquifulvalene ligands are almost coplanar; this allows an optimum electronic interaction between the ferrocenyl donor and the [η7-C7H6)Cr(CO)3]+ acceptor moiety in the crystalline state. Cyclovoltammetric studies show an electrochemically reversible one-electron oxidation ( > 0 mV vs. FeH/FcH+, FcH = ferrocene) and an irreversible one-electron reduction (≤–900 mV), which are assigned to the ferrocenyl and [(η7-C7H6)Cr(CO)3]+ units, respectively. UV/vis spectra reveal low-energy absorptions for 2a–c at about λ=600 nm, showing strong negative solvatochromism. These absorption maxima are related to a charge-transfer excitation between the ferrocenyl and the [(η7-C7H6)Cr(CO)3]+ groups, indicating considerable nonlinear optical properties. Determination of the first hyperpolarizability β by means of hyper Rayleigh scattering yields exceptionally large β values: β(2b) = 570 × 10−30 esu and β(2c) = 320 × 10−30 esu. These unexpectedly large β values are explained by resonance enhancement.

Summary: The Helmholtz Network for Bioinformatics (HNB) is a joint venture of eleven German bioinformatics research groups that offers convenient access to numerous bioinformatics resources through a single web portal. The ‘Guided Solution Finder’ which is available through the HNB portal helps users to locate the appropriate resources to answer their queries by employing a detailed, tree-like questionnaire. Furthermore, automated complex tool cascades (‘tasks’), involving resources located on different servers, have been implemented, allowing users to perform comprehensive data analyses without the requirement of further manual intervention for data transfer and re-formatting. Currently, automated cascades for the analysis of regulatory DNA segments as well as for the prediction of protein functional properties are provided. Availability: The HNB portal is available at http://www.hnbioinfo.de

Mindfulness-Based Cognitive Therapy (MBCT) is a promising intervention to prevent depressive relapse. Yet beyond efficacy studies, little is known regarding the mechanisms that could be modified through MBCT. Objectives of the present study were twofold: determine whether cognitive functioning was altered among patients remitted from depression at admission in a MBCT trial; and document possible changes during the trial and follow-up. In a cross-sectional perspective, cognitive functioning (autobiographical memory, shifting capacities, dysfunctional attitudes, mindful attention awareness and rumination habits) was first compared between 36 patients remitted from depression, 20 acutely depressed patients and 20 control participants. In a longitudinal perspective, changes in the remitted sample were explored during a MBCT plus Treatment As Usual versus Treatment As Usual randomized controlled trial and 9-month follow-up. Performances of remitted patients were similar to the ones of control participants for autobiographical memories, shifting capacities, and mindful attention awareness, whereas levels of rumination and dysfunctional attitudes were significantly elevated. Participation in the MBCT program was accompanied with a significant decrease of dysfunctional attitudes that continued up to 9-month postintervention. No other change was observed that was specific to MBCT. Results suggest that MBCT might help people to identify dysfunctional attitudes at a very early stage and to avoid engaging further in these attitudes.

Goal representations play a key role in various psychological processes, including behavioral regulation, self-perception and social understanding. Research on cognitive representations of action has identified individual differences in the general tendency to construe actions in terms of their goal (vs. movement parameters), which can be reliably assessed with the Behavior Identification Form (BIF). The aim of the present study was to examine how individual differences in action identification, as measured by the BIF, affect online processing of action in a laboratory study. The main results showed that the level of action identification predicted participants' performance in a task designed to implicitly assess people's automatic processing of action regarding goal features. We discussed the possible role of impaired goal processing in psychological dysfunctions.

Methods for improving the fertilizing potential of the spermatozoa in human in-vitro fertilization (IVF) include the stimulation of sperm function in vitro. Metabolic stimulation in vitro has become a major issue in assisted reproductive technology (ART). Here, we review our research on the unselective use of pentoxifylline in IVF for male-factor infertility. Data from our controlled studies indicate that an indiscriminate use of 3.6 mM pentoxifylline, alone or in combination with 3.0 mM 2-deoxyadenosine, is not beneficial in enhancing fertilization rates in zero and poor in-vitro fertilizers or in the presence of antisperm antibodies. An assessment of the effects of pentoxifylline on sperm function prior to IVF may ensure a more rational use of these compounds in selected cases undergoing ART. At present, however, controlled studies in subgroups of patients selected by functional testing are still lacking.

The normal mode spectrum for the linearized MHD equations is investigated for a plasma in a cylindrical equilibrium. The equations describing these normal modes are solved numerically using a finite element code. The ballooning equations that describe localized modes are manipulated and a dispersion relation derived. It is shown that as the axial wave numberk is increased, the fundamental thermal and Alfven modes can coalesce to form overstable magnetothermal modes. The ratio between the magnetic and thermal terms is varied and the existence of the magnetothermal modes examined. The corresponding growth rates are predicted by a WKB solution to the ballooning equations. The existence of these magnetothermal modes may be significant in the eruption of prominences into solar flares.

The copper complexes of bis[2-(3,5-dimethyl-l-pyrazolyl)ethyl]amine (1) and its benzylated derivative (2) have been studied as single crystals by X-ray crystallography and as powders and solutions by a variety of techniques. [Cu(1)·2NO3] (C14H25CUN7O7 including 1 H2O, 3) crystallized in the monoclinic space group Pc (No. 7) with a = 8.1596(9) Å,b = 31.164(2) Å, c = 7.7966(9) Å, β = 94.75(2)°, V = 1975.7(3) Å3, and Z = 4 (structure refinement converged to RF = 0.066 and RwF2 = 0.227); [Cu(1)C1O4·C2H5OH]C1O4 (C16H29CI2CUN5O9, 4) crystallized in the orthorhombic space group Pna21 (No. 33) with a = 13.3463(7) Å, b = 10.3925(9) Å, c = 17.511(1) Å, V = 2432.1(3) Å3, and Z = 4 (refined to RF = 0.063 and RwF = 0.052); [Cu(2)·2NO3] (C21H29-CuN7O6, 5) crystallized in the monoclinic space group C2/c (No.15) with a = 28.719(2) Å, b = 8.6043(6) Å, c = 23.034(2) Å, β = 124.767(7)°, V = 4675.7(7) Å3, and Z = 8 (refined to RF = 0.042 and RwF = 0.034); [Cu·(2)·C2H5OH·Y](C1O4)″ (C48H78Cl4Cu2N10O20, 6) (Y = H2O, n = 2, or C1O4−, n = 1) crystallized in the monoclinic space group P21/c (No. 14) with a = 10.9488(9) Å,b = 17.030(2) Å, c = 32.893(3) Å, β = 92.185-(7)°, V= 6129(1) Å3, and Z = 4 (refined to RF = 0.104 and RwF = 0.119). In complexes 3, 4, and 6, the ligand coordinated Cu(II) with a T-shaped arrangement of the nitrogen donor atoms. Ethanol coordinated in one of the apical positions in complexes 4 and 6. The amine nitrogen moved from the basal plane in 3 to the apical position in 5, where the copper had square pyramidal coordination geometry. The largest difference between 4 and 6 was a lengthening of 0.1 Å in the bond between the Cu(II) and the amine nitrogen. Conductivity measurements revealed that the nitrate complexes behave as 1:1 electrolytes in acetonitrile solution, whereas the Perchlorate complexes behaved as 2:1 electrolytes. The half-wave potentials, measured in acetonitrile by cyclic voltammetry, were −0.01, +0.15, +0.10, and +0.28 V for 3–6, respectively. The high redox potentials of the copper(II) bis(pyrazole) complexes, in particular for complex 6, are explained by the fact that the Cu(II) complexes have the correct ligand geometry for the stabilization of Cu(I).

The data from Meisberger et al. [Radiology 90, 953-957 (1968)] are often used as a basis for dose calculations in brachytherapy. In order to describe the absorbed dose in water around a brachytherapy point source, Meisberger provided a polynomial fit for different isotopes taking into account the effect of attenuation and scattering. The validity of the Meisberger coefficients is restricted to distances up to 10 cm from the source, which is regarded to be satisfactory for most brachytherapy applications. However, for more distant organs it may lead to errors in calculated absorbed dose. For this reason dose measurements have been performed in air and in water around a high activity 60Co source used in high dose rate brachytherapy. Measurements were carried out to distances of 20 cm, using ionization chambers. These data show that at a distance of about 15 cm the amount of scattered radiation virtually equals the amount of primary radiation. This emphasizes the contribution of scattered radiation to the dose in healthy tissue far from the target volume, even with relatively high energy photon radiation of 60Co. It is also shown that the Meisberger data as well as the approach of Van Kleffens and Star [Int. J. Radiat. Oncol. Phys. 5, 557-563 (1979)] lead to significant errors in absorbed dose between distances of 10 and 20 cm from the source. In addition to these measurements, the Monte Carlo code has been used to calculate separately primary dose and scattered dose from a cobalt point source. The calculated results agree with the experimental data within 1% for a most distant dose scoring region.

In this study we investigated the tumorigenicity, growth pattern and spontaneous metastatic ability of a series of nine human colorectal carcinoma cell lines after subcutaneous and intracaecal xenografting in nude mice. CaCo2 cells were found to be poorly tumorigenic to non-tumorigenic in either site; the other cell lines were tumorigenic in both sites. SW1116, SW480 and SW620 did not show local invasive in the NCI-H716 and LS174T cells were both invasive in the caecum, but only NCI-H716 was invasive in the subcutis. HT29 and 5583 (S and E) cells were invasive in the caecum and from that site metastatic to the lungs and/or the liver. HT29 and 5583S cells were both invasive in the subcutis, but 5583E cells were not. Of each category of in vivo behaviour in the caecum, one cell line was further investigated with regard to invasion in vitro (into embryonic chick heart fragments), E-cadherin expression in vivo and in vitro and in vitro production of u-PA and t-PA. These parameters were chosen in view of their purported role in extracellular matrix degradation and intercellular adhesion, which are all involved in the invasive and metastatic cascade. Invasion in vitro was not predictive for invasion or metastasis in vivo. In the cell line which showed invasion in embryonic chick heart tissue, heterogeneous E-cadherin expression was observed in vitro together with a relatively high production of u-PA. The non-invasive cell lines showed in vitro homogeneous expression of E-cadherin with a relatively low production of u-PA. In vivo expression of E-cadherin was either absent or heterogeneous. We conclude that: (1) colorectal carcinoma xenografts show site-specific modification of in vivo invasive and metastatic behaviour; (2) invasion in vitro does not correlate with invasion and metastasis in vivo; (3) in vitro non-invasion might be associated with homogeneous E-cadherin expression and low production of u-PA; (4) E-cadherin expression in vitro differs from E-cadherin expression in vivo. The results support the notion that the microenvironment in which cancer cells grow is one of the factors involved in the regulation of invasive and metastatic behaviour. Images Figure 1 Figure 2 Figure 3 Figure 4

Background Langerhans cell histiocytosis (LCH) in adults first presenting in the skin is rare. Guidelines for staging, treatment and follow-up are lacking.Objectives To better define staging procedures, treatment results and clinical course in adult patients with LCH first presenting in the skin.Methods Eighteen adult patients with LCH first presenting in the skin were collected from five centres collaborating in the Dutch Cutaneous Lymphoma Group. Clinical records and (skin) biopsy specimens were reviewed and follow-up data were obtained. A literature search on adult patients with LCH presenting in the skin was performed.Results Staging procedures showed extracutaneous disease in three of 16 patients who were adequately staged. One patient had a histologically confirmed lytic LCH bone lesion, while two patients had a myelodysplastic syndrome. During follow-up two of 18 patients developed extracutaneous localizations of LCH. Five patients developed a second haematological malignancy, including (myelo)monocytic leukaemia (two cases), histiocytic sarcoma (one case), diffuse large B-cell lymphoma (one case) and peripheral T-cell lymphoma (one case). Review of the literature revealed six other adult patients with a second haematological malignancy preceding or following a diagnosis of LCH.Conclusions The results of the present study suggest an increased risk of a second haematological malignancy in adult patients with LCH presenting in the skin. Extensive staging at presentation and long-term follow-up are therefore warranted in such patients.

There is significant and often heritable variation in cognition and its underlying neural mechanisms, yet specific genetic contributions to such variation are not well characterized. Black-capped chickadees present a good model to investigate the genetic basis of cognition because they exhibit tremendous climate-related variation in memory, hippocampal morphology and neurogenesis rates throughout the North American continent, and these cognitive traits appear to have a heritable basis. We examined the hippocampal transcriptome profiles of laboratory-reared chickadees from the two most divergent populations to test whether differential gene expression in the hippocampus is associated with population differences in spatial memory, hippocampal morphology and adult hippocampal neurogenesis rates. Using high-resolution mRNA sequencing coupled to a de novo transcriptome assembly, we generated 23 295 consensus sequences, which predicted 16 206 protein sequences with 13 982 showing high similarity to known protein sequences or conserved hypothetical proteins in other species. Of these, we identified differential expression in nearly 380 genes, with 47 genes specifically linked to neurogenesis, apoptosis, synaptic function, and learning and memory processes. Many of the other differentially expressed genes, however, may be associated with other functions. Our study presents the first avian hippocampal transcriptome, and it is the first study identifying differential gene expression associated with natural variation in cognition and the hippocampus. Our results provide additional support to the hypothesis that population differences in memory, hippocampal morphology and neurogenesis in chickadees have likely resulted from natural selection that appears to act on memory and its underlying neural mechanisms.

Purpose Reirradiation of painful bone metastases in nonresponders or patients with recurrent pain after initial response is performed in up to 42% of patients initially treated with radiotherapy. Literature on the effect of reirradiation for pain control in those patients is scarce. In this systematic review and meta-analysis, we quantify the effectiveness of reirradiation for achieving pain control in patients with painful bone metastases. Methods and Materials A free text search was performed to identify eligible studies using the MEDLINE, EMBASE, and the Cochrane Collaboration library electronic databases. After study selection and quality assessment, a pooled estimate was calculated for overall pain response for reirradiation of metastatic bone pain. Results Our literature search identified 707 titles, of which 10 articles were selected for systematic review and seven entered the meta-analysis. Overall study quality was mediocre. Of the 2,694 patients initially treated for metastatic bone pain, 527 (20%) patients underwent reirradiation. Overall, a pain response after reirradiation was achieved in 58% of patients (pooled overall response rate 0.58, 95% confidence interval=0.49–0.67). There was a substantial between-study heterogeneity ( I 2 = 63.3%, p = 0.01) because of clinical and methodological differences between studies. Conclusions Reirradiation of painful bone metastases is effective in terms of pain relief for a small majority of patients; approximately 40% of patients do not benefit from reirradiation. Although the validity of results is limited, this meta-analysis provides a comprehensive overview and the most quantitative estimate of reirradiation effectiveness to date.

Purpose To investigate international patterns of practice in the management of radiation therapy-induced nausea and vomiting (RINV). Methods and Materials Oncologists prescribing radiation therapy in the United States, Canada, The Netherlands, Australia, New Zealand, Spain, Italy, France, Hong Kong, Singapore, Cyprus, and Israel completed a Web-based survey that was based on 6 radiation therapy-only clinical cases modeled after the minimal-, low-, moderate-, and high-emetic risk levels defined in the antiemetic guidelines of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer. For each case, respondents estimated the risks of nausea and vomiting separately and committed to an initial management approach. Results In total, 1022 responses were received. Risk estimates and management decisions for the minimal- and high-risk cases varied little and were in line with guideline standards, whereas those for the low- and moderate-risk cases varied greatly. The most common initial management strategies were as follows: rescue therapy for a minimal-risk case (63% of respondents), 2 low-risk cases (56% and 80%), and 1 moderate-risk case (66%); and prophylactic therapy for a second moderate-risk case (75%) and a high-risk case (95%). The serotonin (5-HT) 3 receptor antagonists were the most commonly recommended prophylactic agents. On multivariate analysis, factors predictive of a decision for prophylactic or rescue therapy were risk estimates of nausea and vomiting, awareness of the American Society of Clinical Oncology antiemetic guideline, and European Society for Therapeutic Radiology and Oncology membership. Conclusions Risk estimates and management strategies for RINV varied, especially for low- and moderate-risk radiation therapy cases. Radiation therapy-induced nausea and vomiting are under-studied treatment sequelae. New observational and translational studies are needed to allow for individual patient risk assessment and to refine antiemetic guideline management recommendations.

My essay “The Promise and Challenges of Global Labor History” in issue 82 (Fall 2012) received commentaries from five colleagues. In this reply I focus on seven central issues: the ambiguities of commodification; the contested notion of “capitalism”; the concept of class; household labor; the need for comparative approaches; the newness of Global Labor History; and its prospects in the coming years.

Objective. The effectiveness of an individualized and everyday approach to cognitive rehabilitation for schizophrenia was examined in a case study.Method. After cognitive and functional assessment, concrete objectives were targeted for the person’s everyday complaints. Strategies were constructed based on an analysis of the cognitive profile, daily life functioning, and processes involved in activities. They included a memory strategy for reading, a diary to compensate memory difficulties, and working memory exercises to improve immediate processing of information when reading and following conversations. Efficacy was assessed with outcome measures.Results. The program had beneficial effects on the person’s cognitive and everyday functioning, which persisted at a 3-year follow-up.Conclusion. Findings provide suggestive evidence that an individualized and everyday approach may be a useful alternative in order to obtain a meaningfully lasting transfer of training to daily life, compared to the nomothetic ones which dominate the field.

Background Five percent of all patients with breast cancer have distant metastatic disease at initial presentation. Because metastatic breast cancer is considered to be an incurable disease, it is generally treated with a palliative intent. Recent non-randomized studies have demonstrated that (complete) resection of the primary tumor is associated with a significant improvement of the survival of patients with primary metastatic breast cancer. However, other studies have suggested that the claimed survival benefit by surgery may be caused by selection bias. Therefore, a randomized controlled trial will be performed to assess whether breast surgery in patients with primary distant metastatic breast cancer will improve the prognosis. Design Randomization will take place after the diagnosis of primary distant metastatic breast cancer. Patients will either be randomized to up front surgery of the breast tumor followed by systemic therapy or to systemic therapy, followed by delayed local treatment of the breast tumor if clinically indicated. Patients with primary distant metastatic breast cancer, with no prior treatment of the breast cancer, who are 18 years or older and fit enough to undergo surgery and systemic therapy are eligible. Important exclusion criteria are: prior invasive breast cancer, surgical treatment or radiotherapy of this breast tumor before randomization, irresectable T4 tumor and synchronous bilateral breast cancer. The primary endpoint is 2-year survival. Quality of life and local tumor control are among the secondary endpoints. Based on the results of prior research it was calculated that 258 patients are needed in each treatment arm, assuming a power of 80%. Total accrual time is expected to take 60 months. An interim analysis will be performed to assess any clinically significant safety concerns and to determine whether there is evidence that up front surgery is clinically or statistically inferior to systemic therapy with respect to the primary endpoint. Discussion The SUBMIT study is a randomized controlled trial that will provide evidence on whether or not surgery of the primary tumor in breast cancer patients with metastatic disease at initial presentation results in an improved survival. Trial registration NCT01392586.

BACKGROUND This study evaluated the diagnostic performance of naturally purified allergen-molecules compared to that of allergen-extracts for house dust mite, cat dander epithelium and dog dander. METHODS In vitro tests for allergen-specific IgE were performed on the IMMULITE(®) 2000 in serum samples from 66 allergic patients. RESULTS House dust mite: specificity for the allergen-extract (D1) and the allergen-molecules (nDer p 1, nDer f 1, nDer p 2 and nDer f 2) is comparable. The allergen-extract has a significantly higher sensitivity (100%) and total agreement (TA) (93%) relative to sensitivity (57%-70%) and TA (76%-81%) of the individual allergen-molecules. Cat dander epithelium: sensitivity (90%), specificity (96%) and TA (94%) of the allergen-molecule (nFel d 1) are comparable to those of the allergen-extract (E1). Dog dander: The allergen-molecule (nCan d 1) and allergen-extract (E5) have comparable specificity and TA. The allergen-extract has a lower sensitivity (52%) than the allergen-molecule (71%), although not significant (p=0.125). CONCLUSIONS There is no diagnostic benefit of using allergen-molecules instead of allergen-extracts for initial allergy screening on cat dander epithelium and dog dander. However, use of these allergen-molecules might contribute to better standardization of the specific IgE tests. The studied allergen-molecules for house dust mite are of minor diagnostic value, because of loss of sensitivity.

Purpose: The aim of this study was to measure and improve the quality of target volume delineation by means of national consensus on target volume definition in early-stage rectal cancer.Methods and materials: The CTV's for eight patients were delineated by 11 radiation oncologists in 10 institutes according to local guidelines (phase 1). After observer variation analysis a workshop was organized to establish delineation guidelines and a digital atlas, with which the same observers re-delineated the dataset (phase 2). Variation in volume, most caudal and cranial slice and local surface distance variation were analyzed.Results: The average delineated CTV volume decreased from 620 to 460 cc (p Conclusions: The large variation in target volume delineation could significantly be reduced by use of consensus guidelines and a digital delineation atlas. Despite the significant reduction there is still a need for further improvement. (C) 2011 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 102 (2012) 14-21

The historical evidence shows that the male-breadwinner model was realized among large segments of Western European societies only from in the late 19th century. In the prosperous Dutch Republic, the first modern economy, many women did not have to work, because of the relatively high standard of living compared to other Western European countries. This chapter shows that the participation of Dutch women and children in gainful employment was perhaps even higher than in surrounding countries such as England and Germany, at least until the second half of the 19th century. For the Northern Netherlands, the chapter estimates the involvement of women and children throughout the period under investigation, and makes sketchy comparisons with England and Germany, in order to evaluate the Dutch findings. For the end of the chosen period, 1900, the chapter provides estimates of Dutch women's and children's share in various forms of work activities. Keywords:children's work; Dutch women; male breadwinner; Western Europe; women's work

Ullman (2004) suggested that Specific Language Impairment (SLI) results from a general procedural learning deficit. In order to test this hypothesis, we investigated children with SLI via procedural learning tasks exploring the verbal, motor, and cognitive domains. Results showed that compared with a Control Group, the children with SLI (a) were unable to learn a phonotactic learning task, (b) were able but less efficiently to learn a motor learning task and (c) succeeded in a cognitive learning task. Regarding the motor learning task (Serial Reaction Time Task), reaction times were longer and learning slower than in controls. The learning effect was not significant in children with an associated Developmental Coordination Disorder (DCD), and future studies should consider comorbid motor impairment in order to clarify whether impairments are related to the motor rather than the language disorder. Our results indicate that a phonotactic learning but not a cognitive procedural deficit underlies SLI, thus challenging Ullmans' general procedural deficit hypothesis, like a few other recent studies.

We study the influence of gravitational stratification of the solar atmosphere on the stability of coronal magnetic structures. In particular we question whether the (presumably stabilizing) influence of the anchoring of the magnetic field lines in the solar photosphere (‘line-tying’) can be adequately modelled by either ‘rigid wall’ or ‘flow-through’ boundary conditions on the coronal perturbations, as is commonly done. Using the ideal MHD model without gravitational effects,inertial line-tying alone cannot lead to afull stabilization, as marginal stability cannot be crossed by including only the rapid density increase at the photospheric interface. We demonstrate, using the (localized) ballooning ordering, that when gravity and the corresponding intrinsically stable stratification of the photosphere is included, the points of marginal stability are no longer independent of the density. The sharp increase in density and associated decrease in pressure scale height at the solar surface leads to a stabilizing effect, which may result in a full transition from unstable to stable modes. Gravitational effects imply that rigid wall conditions represent photospheric field line anchoring better than flow-through conditions for determining the stability or modes of oscillation of a coronal equilibrium. Applying rigid wall conditions gives good approximations for frequencies that are much larger than photospheric time scales when the plasma is stable, and growth rates when the plasma is unstable. At the same time we show however that near marginal stability, even when gravity is included, rigid wall conditions are still violated.

Multifaceted asymmetric radiation from the edge (MARFE) is studied as a radiative thermal instability in a one‐dimensional (1‐D) cylindrical equilibrium model. In order to get a global idea of the MARFE onset, a linear analysis is performed, using a full set of magnetohydrodynamic (MHD) equations. It is found that the onset of the MARFE is accompanied by perturbations of pressure and magnetic field. These characteristics seem especially important in case the MARFE leads to a disruption and rational surfaces are affected. The experimentally observed relation between critical density and plasma current [Nucl. Fusion 24, 977 (1984)] is studied. The particular role of perpendicular thermal conduction is considered separately. Correspondence with experimentally observed behavior, like toroidal symmetry and poloidal asymmetry, is discussed.

A WKB approach, based on the method of Connor, Hastie, and Taylor (1979), is used to obtain simple estimates of the critical conditions for the onset of ideal MHD instabilities in line-tied solar coronal loops. The method is illustrated for the constant twist, Gold-Hoyle (1960) field, and the critical conditions are compared with previous and new numerical results. For the force-free case, the WKB estimate for the critical loop length reduces to \(2\pi m + \sqrt 2 \pi\). For the sufficiently non-force-free case the critical length can be expressed in the forml0 +l1/m. The results confirm the findings of De Bruyne and Hood (1992) that for force-free fields them = 1 mode is the first mode to become unstable but for the sufficiently strong non-force-free case this reverses with them → ∞ mode being excited first.

During acute inflammation, human α1-acid glycoprotein (AGP) is subject to marked changes in branching of its glycans, its degree of fucosylation and the expression of sialyl-Lewisx)(SLex) groups. To be able to study these changes in glycosylation in more detail, a procedure was developed to isolate the different glycoforms of AGP in milligram amounts by preparative affinity electrophoresis (AE) with a free lectin as fractionating agent. The method was applied to isolate differently fucosylated forms of AGP with the fucose-specific lectinAleuria aurantia (AAL). AGP was separated into one non-reactive (AO) and four reactive (A1-A4) fractions. It was found that, in particular, the highly fucosylated fractions A3 and A4 contained the inflammation-induced SLex groups of AGP. Analysis by crossed affinoimmunoelectrophoresis (CAIE) with concanavalin A (Con A) of these different glycoforms of AGP showed that the presence of tri-and/or tetraantennary glycans, instead of diantennary glycans, was associated with a higher degree of fucosylation. Identical results were obtained by subjecting Con A-fractionated forms of AGP to CAIE with AAL as the affinocomponent. It is expected that this method of preparative AE can generally be applied to other glycoproteins, which can be separated in different glycoforms by CAIE using lectins.

Foresight has been introduced in Canada in the area of animal health as a process to broaden thinking about the future and inform policy development. Its initial use and evolution through projects and studies over the past decade are described, demonstrating real action in animal health. Despite positive, continuing, and exciting results in animal health policy development, foresight’s widespread acceptance and use thus far have been limited. Critical components for success, drawn from the Canadian experience, are described, and recommendations are offered for further action in animal health.

Objective Adipose tissue can secrete soluble mediators (adipokines) with potent immune regulatory functions. Some adipokines have been previously associated with radiographic damage in patients with rheumatoid arthritis (RA). In the present study, we investigated the capacity of baseline adipokine levels to predict radiographic progression over a period of 4 years and studied their contribution relative to that of other known risk factors, such as anti–cyclic citrullinated peptide (anti-CCP) antibodies. Methods Serum concentrations of leptin, visfatin, resistin, adiponectin, adipsin, tumor necrosis factor α (TNFα), and interleukin-6 (IL-6) were determined in serum samples obtained at baseline from 253 patients with RA from the Early Arthritis Cohort. The association between levels of these adipokines and radiographic progression was determined using a multivariate normal regression model correcting for age, sex, treatment strategy, body mass index (BMI), and the presence of anti-CCP antibodies. Results Levels of IL-6, TNFα, visfatin, and adiponectin were positively associated with radiographic progression over 4 years. This association was independent of BMI. However, only adiponectin levels remained significantly associated with radiographic progression when the model was corrected for the presence of anti-CCP antibodies, whereas a trend was observed for IL-6. The association of both TNFα and visfatin with radiographic damage disappeared after correction for the presence of anti-CCP antibodies, which is consistent with the fact that the levels of both cytokines correlated significantly with anti-CCP antibody levels in these patients. Conclusion Our results indicate that adipokines are predictors of radiographic progression in RA, possibly through distinct underlying biologic mechanisms.