Objectives
To determine whether there is a difference in frequency and clinical relevance of incidental findings detected by total-body computed tomography scanning (TBCT) compared to those by the ...standard work-up (STWU) with selective computed tomography (CT) scanning.
Methods
Trauma patients from five trauma centres were randomized between April 2011 and January 2014 to TBCT imaging or STWU consisting of conventional imaging with selective CT scanning. Incidental findings were divided into three categories: 1) major finding, may cause mortality; 2) moderate finding, may cause morbidity; and 3) minor finding, hardly relevant. Generalized estimating equations were applied to assess differences in incidental findings.
Results
In total, 1083 patients were enrolled, of which 541 patients (49.9 %) were randomized for TBCT and 542 patients (50.1 %) for STWU. Major findings were detected in 23 patients (4.3 %) in the TBCT group compared to 9 patients (1.7 %) in the STWU group (adjusted rate ratio 2.851; 95%CI 1.337–6.077;
p
< 0.007). Findings of moderate relevance were detected in 120 patients (22.2 %) in the TBCT group compared to 86 patients (15.9 %) in the STWU group (adjusted rate ratio 1.421; 95%CI 1.088–1.854;
p
< 0.010).
Conclusions
Compared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning.
Key points
•
Total
-
body CT scanning in trauma results in 1.5 times more incidental findings
.
•
Evaluation by TBCT in trauma results in more patients with incidental findings
.
•
In every category of clinical relevance
,
TBCT detects more incidental findings
.
Here we developed a composite pollen-based record of altitudinal vegetation changes from Lake Fúquene (5° N) in Colombia at 2540 m elevation. We quantitatively calibrated Arboreal Pollen percentages ...(AP%) into mean annual temperature (MAT) changes with an unprecedented ~60-year resolution over the past 284 000 years. An age model for the AP% record was constructed using frequency analysis in the depth domain and tuning of the distinct obliquity-related variations to the latest marine oxygen isotope stacked record. The reconstructed MAT record largely concurs with the ~100 and 41-kyr (obliquity) paced glacial cycles and is superimposed by extreme changes of up to 7 to 10° Celsius within a few hundred years at the major glacial terminations and during marine isotope stage 3, suggesting an unprecedented North Atlantic – equatorial link. Using intermediate complexity transient climate modelling experiments, we demonstrate that ice volume and greenhouse gasses are the major forcing agents causing the orbital-related MAT changes, while direct precession-induced insolation changes had no significant impact on the high mountain vegetation during the last two glacial cycles.
Time and the Ancestors Jansen, Maarten; Pérez Jiménez, Gabina Aurora
2017, Letnik:
5
eBook
Odprti dostop
Time and the Ancestors: Aztec and Mixtec Ritual Art combines iconographical analysis with archaeological, historical and ethnographic studies and offers new interpretations of enigmatic masterpieces ...from ancient Mexico, focusing specifically on the symbols and values of the religious heritage of indigenous peoples.; Readership: Scholars and students working on the archaeology, art, history and anthropology of Mexico, as well as the general public interested in Mexican indigenous culture.
This study aims to compare nature and frequency of adverse drug reactions (ADRs), time to first ADR, drug survival, and the share of ADRs in treatment discontinuation of first-time treatment with ...adalimumab (ADA) and etanercept (ETN) in real-world RA patients.
Retrospective, single-center cohort study including naïve patients treated between January 2003-April 2020. Time to first ADR and drug survival of first-time treatment were studied using Kaplan-Meier and Cox-regression models up to 10 years, with 2- and 5-year post-hoc sensitivity analysis. Nature and frequencies of first-time ADRs and causes of treatment discontinuation were assessed.
In total, 416 patients (ADA: 255, ETN: 161, 4865 patient years) were included, of which 92 (22.1%) experienced ADR(s) (ADA: 59, 23.1%; ETN: 33, 20.4%). Adjusted for age, gender and concomitant conventional DMARD use, ADA was more likely to be discontinued than ETN up to 2-, 5- and 10-year follow-up (adjusted HRs 1.63; 1.62; 1.59 (all p<0.001)). ADRs were the second reason of treatment discontinuation (ADA 20.7%, ETN 21.4%).
Despite seemingly different nature and frequencies, ADRs are the second reason of treatment discontinuation for both bDMARDs. Furthermore, 2-, 5-, and 10-year drug survival is longer for ETN compared to ADA.
Distraction treatment for severe osteoarthritis below the age of 65 successfully postpones arthroplasty. Most patients have been treated with a general external fixator or a device specifically ...intended for knee distraction. This study compares clinical efficacy of both devices in retrospect and their mechanical characteristics.
Clinical efficacy 2 years posttreatment was compared using retrospective data from patients with severe knee osteoarthritis treated with knee distraction; 63 with the Dynamic Monotube (Stryker GmbH, Switzerland) and 65 with the KneeReviver (ArthroSave BV, the Netherlands). Changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function, general well-being (SF-36), cartilage thickness by radiographic joint space widening, and adverse events during treatment were assessed. Axial stiffness of clinically feasible configurations was assessed by bench testing for the Dynamic Monotube triax system and the KneeReviver.
No differences were observed in clinical efficacy, nor in mechanical characteristics and adverse events between the two devices. Although with large variation, both showed a clinically relevant improvement. In mechanical testing, contact between articular surfaces was observed for both devices at physiological loading. Stiffness of applied configurations strongly varied and primarily depended on bone pin length.
Patients treated with a general intended-use device or a distraction-specific device both experienced clinical and structural efficacy although with significant variation between patients. The latter may be the result of varying mechanical characteristics resulting from differences in clinical configurations of the devices and actual loading. The exact role of full/partial mechanical unloading of the joint during distraction treatment remains unclear.
•Dual airway infections with viruses and Escherichia coli caused severe lesions.•Tracheitis and airsacculitis depended more on viral preinfection than pneumonia.•Lesions persisted eight days after ...dual infection, bacterial antigen did not.•Immune cell increase in the trachea and air sac was mainly virus-associated.•Infectious bronchitis virus and E.coli dual infection increased cytokine mRNA levels.
Colibacillosis in chickens caused by avian pathogenic Escherichia coli (APEC) is known to be aggravated by preceding infections with infectious bronchitis virus (IBV), Newcastle disease virus (NDV) and avian metapneumovirus (aMPV). The mechanism behind these virus-induced predispositions for secondary bacterial infections is poorly understood. Here we set out to investigate the immunopathogenesis of enhanced respiratory colibacillosis after preceding infections with these three viruses. Broilers were inoculated intratracheally with APEC six days after oculonasal and intratracheal inoculation with IBV, NDV, aMPV or buffered saline. After euthanasia at 1 and 8 days post infection (dpi) with APEC, birds were macroscopically examined and tissue samples were taken from the trachea, lungs and air sacs. In none of the groups differences in body weight were observed during the course of infection. Macroscopic lesion scoring revealed most severe tissue changes after NDV-APEC and IBV-APEC infection. Histologically, persistent tracheitis was detected in all virus-APEC groups, but not after APEC-only infection. In the lungs, mostly APEC-associated transient pneumonia was observed. Severe and persistent airsacculitis was present after NDV-APEC and IBV-APEC infection. Bacterial antigen was detected by immunohistochemistry only at 1 dpi APEC, predominantly in NDV-APEC- and IBV-APEC-infected lungs. Higher numbers of CD4+ and CD8+ lymphocytes persisted over time in NDV-APEC- and IBV-APEC-infected tracheas, as did CD4+ lymphocytes in NBV-APEC- and IBV-APEC-infected air sacs. KUL01+ cells, which include monocytes and macrophages, and TCRγδ+ lymphocytes were observed mostly in lung tissue in all infected groups with transient higher numbers of KUL01+ cells over time and higher numbers of TCRγδ+ lymphocytes mainly at 8 dpi. qPCR analysis revealed mostly trends of transient higher levels of IL-6 and IFNγ mRNA in lung tissue after IBV-APEC and also NDV-APEC infection and persistent higher levels of IL-6 mRNA after aMPV-APEC infection. In spleens, transient higher levels of IL-17 mRNA and more persistent higher levels of IL-6 mRNA were observed after all co-infections. No changes in IL-10 mRNA expression were seen. These results demonstrate a major impact of dual infections with respiratory viruses and APEC, compared to a single infection with APEC, on the chicken respiratory tract and suggest that immunopathogenesis contributes to lesion persistence.
The Vaal River is of considerable economic and environmental importance. It flows through five provinces within South Africa and it is subject to numerous recreational and industrial activities, ...which often prove detrimental to the health of the system. To determine the extent of the impact that these anthropogenic stressors have on the river system, physiological effects in Clarias gariepinus were assessed during a 2016/2017 sample survey using a suite of biomarkers (exposure and effect). Inhibition of acetylcholinesterase and increased metallothionein concentrations were recorded in response to the increase in organic pollutants and metals. Oxidative stress biomarkers, such as superoxide dismutase, showed significant increases in response to possible recent pesticide exposures, whereas lipid peroxidation and protein damage were evident with increased malondialdehyde and protein carbonyl concentrations respectively. The data provide a novel account of the use of biomarkers to assess negative anthropogenic effects observed along the entire length of the Vaal River system.
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