The Pediatric Rheumatology International Trials Organization American-College-of-Rheumatology provisional criteria for the evaluation of response to therapy in juvenile systemic lupus erythematosus: Prospective validation of the definition of improvement

Objective. To use the Pediatric Rheumatology International Trials Organization (PRINTO) core set of outcome measures to develop a validated definition of improvement for the evaluation of response to therapy in juvenile systemic lupus erythematosus (SLE).Methods. Thirty-seven experienced pediatric rheumatologists from 27 countries, each of whom had specific experience in the assessment of juvenile SLE patients, achieved consensus on 128 patient profiles as being clinically improved or not improved. Using the physicians' consensus ratings as the gold standard measure, the chi-square, sensitivity, specificity, false-positive and false-negative rates, area under the receiver operating characteristic curve, and kappa level of agreement for 597 candidate definitions of improvement were calculated. Only definitions with a kappa value greater than 0.7 were retained. The top definitions were selected based on the product of the content validity score multiplied by its kappa statistic.Results. The definition of improvement with the highest final score was at least 50% improvement from baseline in any 2 of the 5 core set measures, with no more than 1 of the remaining worsening by more than 30%.Conclusion. PRINTO proposes a valid and reproducible definition of improvement that reflects well the consensus rating of experienced clinicians and that incorporates clinically meaningful change in core set measures in a composite end point for the evaluation of global response to therapy in patients with juvenile SLE. The definition is now proposed for use in juvenile SLE clinical trials and may help physicians to decide whether a child with SLE responded adequately to therapy.

Triple-aspect monism: Physiological, mental unconscious and conscious aspects of brain activity

Brain activity contains three fundamental aspects: (a) The physiological aspect, covering all kinds of processes that involve matter and/or energy; (b) the mental unconscious aspect, consisting of dynamical patterns (i.e., frequency, amplitude and phase-modulated waves) embodied in neural activity. These patterns are variously operated (transmitted, stored, combined, matched, amplified, erased, etc), forming cognitive and emotional unconscious processes and (c) the mental conscious aspect, consisting of feelings experienced in the first-person perspective and cognitive functions grounded in feelings, as memory formation, selection of the focus of attention, voluntary behavior, aesthetical appraisal and ethical judgment. Triple-aspect monism (TAM) is a philosophical theory that provides a model of the relation of the three aspects. Spatially distributed neuronal dendritic potentials generate amplitude-modulated waveforms transmitted to the extracellular medium and adjacent astrocytes, prompting the formation of large waves in the astrocyte network, which are claimed to both integrate distributed information and instantiate feelings. According to the valence of the feeling, the large wave feeds back on neuronal synapses, modulating (reinforcing or depressing) cognitive and behavioral functions.

Evaluation of ornamental grasses submitted to water stress

The work was carried out at the College of Agricultural and Veterinary Sciences of the State University of São Paulo (UNESP/FCAV), Campus of Jaboticabal, Brazil, aiming to study the tolerance response to water stress and capacity of regeneration after mowing three different ornamental grasses used in Brazilian landscaping: Imperial zoysia grass (Zoysia japonica 'Imperial'), zoysia grass (Zoysia japonica) and St. Augustine grass (Stenotaphrum secundatum). The experimental design was entirely randomized in a factorial scheme 33 (three grass species: Zoysia japonica 'Imperial', Zoysia japonica and Stenotaphrum secundatum; in three water stress conditions: under full sun, with and without irrigation, and under greenhouse conditions without irrigation) with four replications per plot. The irrigation was performed using microsprinklers with a flow of 0.28 L s-1, and the grasses of all plots were mowed monthly. The evaluations were executed monthly, before mowing the grass, in the beginning of each season, that means, in October (for Spring evaluation), January (for Summer), April (for Autumn) and July (for Winter), considering the Brazilian climate conditions. The evaluated parameters were shoot height and total dry mass. The data were submitted to the variance analysis and the means were compared by the Tukey test at 5% confidence level. The grasses grown under greenhouse conditions, without irrigation, showed higher height and lower dry mass weight averages, what possibly indicates that the plants etiolated. The grasses grown under full sun, either with or without irrigation, showed a similar plant development. The S. secundatum species showed greater tolerance to water stress in October, month that followed the longest dry period. The total dry mass was gradually reduced during the experiment for all grasses grown under greenhouse conditions without irrigation; however, a great general tolerance to water stress was observed for all grasses because all of them survived along nine months without irrigation.

Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review

To re-evaluate the safety of hormonal contraceptives (HC) after uterine evacuation of complete hydatidiform mole (CHM). Historical database review. Charing Cross Hospital Gestational Trophoblastic Disease Centre, London, United Kingdom. Two thousand four hundred and twenty-three women with CHM of whom 154 commenced HC while their human chorionic gonadotropin (hCG) was still elevated, followed between 2003 and 2012. We compared time to hCG remission between HC users and nonusers. The relationship between HC use and gestational trophoblastic neoplasia (GTN) development was assessed. The relationship between HC use and a high International Federation of Gynecology and Obstetrics (FIGO) risk score was determined. Time to hCG remission, risk of developing postmolar GTN and proportion of women with high FIGO risk score. No relationship was observed between HC use with mean time to hCG remission (HC users versus non-users: 12 weeks in both, P = 0.19), GTN development (HC users versus non-users: 20.1 and 16.7%, P = 0.26) or high-risk FIGO score (HC users versus nonusers: 0% and 8%, P = 0.15). Moreover, no association between HC and GTN development was found, even when an age-adjusted model was used (OR = 1.37, 95% CI 0.91-2.08, P = 0.13). The use of current HC is not associated with development of postmolar GTN or delayed time to hCG remission. Therefore, HC can be safely used to prevent a new conception following CHM regardless of hCG level. Non-concurrent cohort study to re-evaluate the safety of low dose HCs after uterine evacuation of CHM.