Extraintestinal manifestations in inflammatory bowel disease: frequency and associated risk factors in the nationwide Swiss IBD cohort study (SIBDCS)

Background: Data on the frequency of extraintestinal manifestations (EIM) in Crohnʼs disease (CD) and ulcerative colitis (UC) are scarce. Goal: to evaluate prevalences, forms of EIM and risk factors in a large nationwide IBD cohort. Methods: Data from validated physician enrolment questionnaires of the adult Swiss IBD cohort were analyzed. Logistic regression models were used to identify EIM risk factors. Results: 950 patients were included, 580 (61%) with CD (mean age 43yrs) and 370 (39%) with UC (mean age 49yrs), of these, 249 (43%) of CD and 113 (31%) of UC patients had one to 5 EIM. The following EIM were found: arthritis (CD 33%, UC 21%), aphthous stomatitis (CD 10%, UC 4%), uveitis (CD 6%, UC 4%), erythema nodosum (CD 6%, UC 3%), ankylosing spondylitis (CD 6%, UC 2%), psoriasis (CD 2%, UC 1%), pyoderma gangrenosum (CD and UC each 2%), primary sclerosing cholangitis (CD 1%, UC 4%). Logistic regression in CD identified the following items as risk factors for ongoing EIM: active disease (OR 1.95, 95% CI 1.17-3.23, P=0.01), positive IBD family history (OR 1.77, 95% CI 1.07-2.92, P=0.025). No risk factors were identified in UC patients. Conclusions: EIM are a frequent problem in CD and UC patients. Active disease and positive IBD family history are associated with ongoing EIM in CD patients. Identification of EIM prevalence and associated risk factors may result in increased awareness for this problem and thereby facilitate their diagnosis and management.

Physical performance limitations in adolescent and adult survivors of childhood cancer and their siblings.

PURPOSE: This study investigates physical performance limitations for sports and daily activities in recently diagnosed childhood cancer survivors and siblings. METHODS: The Swiss Childhood Cancer Survivor Study sent a questionnaire to all survivors (≥ 16 years) registered in the Swiss Childhood Cancer Registry, who survived >5 years and were diagnosed 1976-2003 aged <16 years. Siblings received similar questionnaires. We assessed two types of physical performance limitations: 1) limitations in sports; 2) limitations in daily activities (using SF-36 physical function score). We compared results between survivors diagnosed before and after 1990 and determined predictors for both types of limitations by multivariable logistic regression. RESULTS: The sample included 1038 survivors and 534 siblings. Overall, 96 survivors (9.5%) and 7 siblings (1.1%) reported a limitation in sports (Odds ratio 5.5, 95%CI 2.9-10.4, p<0.001), mainly caused by musculoskeletal and neurological problems. Findings were even more pronounced for children diagnosed more recently (OR 4.8, CI 2.4-9.6 and 8.3, CI 3.7-18.8 for those diagnosed <1990 and ≥ 1990, respectively; p=0.025). Mean physical function score for limitations in daily activities was 49.6 (CI 48.9-50.4) in survivors and 53.1 (CI 52.5-53.7) in siblings (p<0.001). Again, differences tended to be larger in children diagnosed more recently. Survivors of bone tumors, CNS tumors and retinoblastoma and children treated with radiotherapy were most strongly affected. CONCLUSION: Survivors of childhood cancer, even those diagnosed recently and treated with modern protocols, remain at high risk for physical performance limitations. Treatment and follow-up care should include tailored interventions to mitigate these late effects in high-risk patients.

Carbono, matéria orgânica leve e fósforo remanescente em diferentes sistemas de manejo do solo

O objetivo deste trabalho foi avaliar os teores de carbono orgânico total (COT), matéria orgânica leve (MOL) e fósforo remanescente (Prem), em áreas de cerrado sob sistema de plantio direto com diferentes cultivos de coberturas do solo, e compará-los aos de áreas sob preparo convencional e pousio. O experimento foi conduzido em campo, em um Latossolo Vermelho, de agosto de 2000 a março de 2007. O delineamento utilizado foi o de blocos ao acaso com parcelas subdivididas, sendo as parcelas constituídas pelos cinco sistemas de manejo do solo avaliados - pousio, preparo convencional e plantio direto com uso dos cultivos de cobertura crotalária (Crotalaria juncea), milheto (Pennisetum americanum) e braquiária (Urochloa brizantha) -, e as subparcelas pelos cultivos de soja e milho. Em março de 2007, coletaram-se amostras de solo das profundidades 0,0-0,025, 0,025-0,05, 0,05-0,10 e 0,10-0,20 m, das quais foram quantificados COT, MOL, estoques de COT e Prem. Em áreas sob plantio direto, o aumento nos teores de MOL pode reduzir a adsorção de fósforo ao solo. Sistemas de manejo que não envolvem revolvimento do solo favorecem o aumento do estoque de carbono orgânico nas camadas superficiais, enquanto o preparo convencional e o plantio direto com uso do milheto como planta de cobertura propiciam a incorporação mais profunda do carbono.

Chemical attributes of a Hapludox soil after nine years of pig slurry application

The objective of this study was to evaluate the pig slurry application effects on chemical attributes of a Hapludox soil managed under no-tillage system. Treatments consisted of 50, 100 and 200 m³ ha-1 per year of pig slurry application, and a control with replacement of P and K exported through harvested grains. Attributes related to soil chemical reaction, exchange complex, and nutrient contents were determined in soil samples collected in the ninth year of experimentation from 0 - 0.025, 0.025 - 0.05, 0.05 - 0.10, 0.10 - 0.20, 0.20 - 0.40 and 0.40 - 0.60 m soil depths. The continuous application of high doses of pig slurry on the Oxisol surface under no-tillage acidifies the soil and increases Al, P, Cu, and Zn contents down to 0.2-m depth, and K levels down to 0.6-m depth.

Intravenous immunoglobulin for treatment of mild-to-moderate Alzheimer's disease: a phase 2, randomised, double-blind, placebo-controlled, dose-finding trial.

BACKGROUND: Three small trials suggest that intravenous immunoglobulin can affect biomarkers and symptoms of mild-to-moderate Alzheimer's disease. We tested the safety, effective dose, and infusion interval of intravenous immunoglobulin in such patients. METHODS: We did a multicentre, placebo-controlled phase 2 trial at seven sites in the USA and five in Germany. Participants with probable Alzheimer's disease aged 50-85 years were randomly assigned (by a computer-generated randomisation sequence, with block sizes of eight) to infusions every 4 weeks (0·2, 0·5, or 0·8 g intravenous immunoglobulin per kg bodyweight, or placebo) or infusions every 2 weeks (0·1, 0·25, or 0·4 g/kg, or placebo). Patients, caregivers, investigators assessing outcomes, and staff at imaging facilities and the clinical research organisation were masked to treatment allocation, but dispensing pharmacists, the statistician, and the person responsible for final PET analyses were not. Treatment was masked with opaque pouches and infusion lines. The primary endpoint was median area under the curve (AUC) of plasma amyloid β (Aβ)(1-40) between the last infusion and the final visit (2 weeks or 4 weeks depending on infusion interval) in the intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT00812565) and controlled-trials.com (ISRCTN64846759). FINDINGS: 89 patients were assessed for eligibility, of whom 58 were enrolled and 55 included in the primary analysis. Median AUC of plasma Aβ(1-40) was not significantly different for intravenous immunoglobulin compared with placebo for five of the six intervention groups (-18·0 [range -1347·0 to 1068·5] for 0·2 g/kg, -364·3 [-5834·5 to 1953·5] for 0·5 g/kg, and -351·8 [-1084·0 to 936·5] for 0·8 g/kg every 4 weeks vs -116·3 [-1379·0 to 5266·0] for placebo; and -13·8 [-1729·0 to 307·0] for 0·1 g/kg, and -32·5 [-1102·5 to 451·5] for 0·25 g/kg every 2 weeks vs 159·5 [51·5 to 303·0] for placebo; p>0·05 for all). The difference in median AUC of plasma Aβ(1-40) between the 0·4 g/kg every 2 weeks group (47·0 [range -341·0 to 72·5]) and the placebo group was significant (p=0·0216). 25 of 42 (60%) patients in the intervention group versus nine of 14 (64%) receiving placebo had an adverse event. Four of 42 (10%) patients in the intravenous immunoglobulin group versus four of 14 (29%) receiving placebo had a serious adverse event, including one stroke in the intervention group. INTERPRETATION: Intravenous immunoglobulin may have an acceptable safety profile. Our results did not accord with those from previous studies. Longer trials with greater power are needed to assess the cognitive and functional effects of intravenous immunoglobulin in patients with Alzheimer's disease.

Extração e quantificação de alumínio trocável em Organossolos

O objetivo deste trabalho foi avaliar diferentes métodos de extração e quantificação de alumínio trocável em Organossolos. As amostras foram coletadas em três perfis de turfeira e, então, secas ao ar e passadas em peneira de malha de 2 mm. Foram feitas extrações com KCl 1 mol L-1 , Ca(OAc2) 1 mol L-1 e CuCl20,5 mol L-1 . Em seguida, os extratos obtidos por KCl e Ca(OAc2) foram analisados por titulação com NaOH 0,025 mol L-1 e por espectrômetro de absorção atômica com forno de grafite (GF-AAE). Os extratos obtidos por CuCl2 foram analisados por GF-AAE. Na quantificação por GF-AAE, os extratores KCl e Ca(OAc2) tiveram capacidade semelhante de extrair alumínio trocável, enquanto o CuCl2 foi capaz de extrair também o Al reativo. Os elevados teores de alumínio trocável observados na titulação após extração com KCl podem estar relacionados aos elevados teores do íon H+ presente nas amostras. O método indicado para determinação do teor de alumínio trocável em Organossolos é a extração com KCl ou com Ca(OAc2) e, para quantificação, a espectrofotometria de absorção atômica com forno de grafite.

Seletividade de agrotóxicos indicados na produção integrada de pêssego a Trichogramma pretiosum Riley, 1879 (Hymenoptera: trichogrammatidae)

A seletividade de agrotóxicos indicados nas Normas Técnicas Específicas da Produção Integrada de Pêssego (NTE-PIP) foi avaliada sobre Trichogramma pretiosum Riley, utilizando-se da metodologia padronizada internacionalmente pela International Organization for Biological and Integrated Control of Noxious Animals and Plants (IOBC). Os agrotóxicos (% ingrediente ativo na calda) Orthocide 500 (0,120) e Persist SC (0,160) foram classificados como inócuos; Hokko Cihexatim 500 (0,025) e Roundup WG (1,387) foram levemente nocivos; Assist (1,512) foi moderadamente nocivo; Sevin 480 SC (0,173), Tiomet 400 CE (0,048), Dipterex 500 (0,150) e Kumulus DF (0,480) foram nocivos a adultos de T. pretiosum no teste de toxicidade inicial em laboratório.

Alimentación, mortalidad y desarrollo de Cydia pomonella (L.) y de Cacoecimorpha pronubana (Hübner) sobre dieta con extracto de neem incorporado

Se han estudiado los efectos de 4 extractos del neem (Sukrina New ®, Rakshak ®, Margosan-O® y Azatin®) incorporados en la dieta larvaria sobre la alimentación, la mortalidad y el desarrollo de larvas de Cydia pomonella (L.) y de un extracto (Sukrina New ®) sobre Cacoecimorpha pronubana (Hübner) (ambos Lepidoptera, Tortricidae). C. pomonella fue más sensible a la acción de Sukrina New® que C. pronubana. Sobre esta última especie, no se detectaron cambios en el comportamiento de alimentación ni efectos sobre la mortalidad o la duración del desarrollo. Todos los extractos ensayados alteraron el comportamiento de alimentación de C. pomonella, cuyas larvas no penetraron en la dieta , pero sólo Azatin® mostró un efecto repelente o antiapetitivo. Margosan-O® y Rakshak® fueron los extractos más activos sobre C. pomonella, provocando un 100% de mortalidad a las concentraciones de 0,0625% y 0,025%, respectivamente. La mayoría de las larvas muertas presentaron síntomas asociados al proceso de la muda. Los individuos de C. pomonella alimentados con extracto de neem tuvieron un menor tamaño y una duración del desarrollo mayor que los de los testigos.

Uusien energianormien vaikutus pientalojen rakenteisiin ympäristön kannalta

Tehokkaimpia keinoja vähentää rakennusten lämmitysenergian kulutusta ja lämmityksen aiheuttavia hiilidioksidi- ja happamoitavia päästöjä on tiukentaa rakentamismääräysten lämmöneristysvaatimuksia. Hyvin lämmöneristetyissä, tiiveissä ja ilmanvaihdoltaan optimoiduissa taloissa on pienet lämpöhäviöt. Näin ympäristöä kuormittava vaikutus saadaan paljon vähemmäksi kuin nykynormien mukaisissa asuinrakennuksissa. Johtumislämpöhäviö pienenee suoraan eristekerroksia paksuntamalla ja siihen on helpointa vaikuttaa. Mitä suurempiin eristepaksuuksiin mennään sen suuremmaksi tulee konvektion osuus kokonaislämpöhäviöstä. Tulevaisuudessa parempia ratkaisuja haetaan erityisesti konvektiosta ja säteilystä aiheutuvien lämpöhäviöiden pienentämiseksi. Eristeen osastointi ilmanpitävillä, vesihöyryä diffuusisesti läpäisevillä pystysuuntaisilla konvektiokatkoilla vähentää tehokkaasti paksun seinäeristeen kuljettumis-ilmavirtauksia. Katkoina käytetään erilaisia kalvoja ja rakennuspapereita, joilla on pieni emissiviteetti. Katkojen merkitys kasvaa, kun mennään uusien normien mukaisiin eristepaksuuksiin. Lämmöneriste voidaan toteuttaa myös kokoamalla ohuita kalvoja paketiksi, jotka jakavat ilmatilan ja siis eristeelle varatun paksuuden suljettuihin ilmaväleihin. Kun kalvoiksi valitaan pieniemissiviteettisiä pintoja, saadaan säteilylämmönsiirto lähes eliminoiduksi. Tällaisen ilmatilan lämmönjohtumisluku lähestyy paikallaan pysyvän ilman lämmönjohtumislukua, l = 0,025 W/Km, eli tällä rakennesysteemillä on mahdollista toteuttaa ohuempia rakenteita kuin perinteisillä eristeillä. Hygroskooppisen massan käyttö sisäilman kosteutta tasaavana rakenteena voi olla tulevaisuutta. Kehitystyö tuottaa uusia, kosteusteknisesti toimivia sovelluksia. Toisaalta palomääräykset tulevat kehitystyötä vastaan. Hygroskooppinen pintamateriaali on kevyt (pieni tiheys) ja paloteknisesti arka. Suoraa sähkölämmitystä ei voida pitää ympäristöystävällisenä. Sen jalostusketju on pitkä ja monivaiheinen. Millä peruspolttoaineella sähköä tuotetaan, vaikuttaa asiaan luonnollisestikin. Suoraa sähkölämmitystä voidaan suositella vain yksinäisen ihmisen taloudessa lämmitysmuotona taloudellisista syistä. Halvan polttoaineen säästöllä ei voida maksaa suuria laiteinvestointeja. Aurinkoenergian hyvä hyödyntäminen edellyttää hyvää säätöä, joka kytkee lämmityksen pois päältä silloin, kun aurinko lämmittää. Auringon hetkelliset säteilytehot ovat suuria verrattuna rakenteen lämpöhäviöihin ja huonetilojen lämmöntarpeeseen. Ratkaisu aurinkoenergian hetkellisyyteen ja paikallisuuteen on energian siirtäminen lämmöntarpeen mukaan rakennuksen eri osiin ja sen varastoiminen päivätasolla. Kun varastoivasta massasta ei ole suoraa yhteyttä ulos, voidaan kerääjäeristeeltä saatu lämpö käyttää häviöttömästi huonetilojen lämmittämiseen. Vaikka lämmitysenergian käytössä päästään 30 % vähennyksiin uudisrakennusten osalta, ei kokonaisenergian käyttö merkittävästi pienene, jos taloussähkön kulutus pysyy vakiona. Sama pätee myös CO2 -päästöihin. Saavutettava etu lämmitys-energian kulutuksessa voidaan hukata yhä suurenevaksi taloussähkön käytöksi, mikä olisi erityisen huono asia ympäristön kannalta.

Efficacy and safety of once-daily aclidinium in chronic obstructive pulmonary disease

Background: The long-term efficacy and safety of aclidinium bromide, a novel, long-acting muscarinic antagonist, were investigated in patients with moderate to severe chronic obstructive pulmonary disease (COPD). Methods: In two double-blind, 52-week studies, ACCLAIM/COPD I (n = 843) and II (n = 804), patients were randomised to inhaled aclidinium 200 μg or placebo once-daily. Patients were required to have a postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio of ≤70% and FEV1 <80% of the predicted value. The primary endpoint was trough FEV1 at 12 and 28 weeks. Secondary endpoints were health status measured by St George"s Respiratory Questionnaire (SGRQ) and time to first moderate or severe COPD exacerbation. Results: At 12 and 28 weeks, aclidinium improved trough FEV1 versus placebo in ACCLAIM/COPD I (by 61 and 67 mL; both p < 0.001) and ACCLAIM/COPD II (by 63 and 59 mL; both p < 0.001). More patients had a SGRQ improvement ≥4 units at 52 weeks with aclidinium versus placebo in ACCLAIM/COPD I (48.1% versus 39.5%; p = 0.025) and ACCLAIM/COPD II (39.0% versus 32.8%; p = 0.074). The time to first exacerbation was significantly delayed by aclidinium in ACCLAIM/COPD II (hazard ratio [HR] 0.7; 95% confidence interval [CI] 0.55 to 0.92; p = 0.01), but not ACCLAIM/COPD I (HR 1.0; 95% CI 0.72 to 1.33; p = 0.9). Adverse events were minor in both studies. Conclusion: Aclidinium is effective and well tolerated in patients with moderate to severe COPD. Trial registration: ClinicalTrials.gov: NCT00363896 ACCLAIM/COPD I) and NCT00358436 (ACCLAIM/COPD II).

Systematic analysis of factors associated with progression and regression of ulcerative colitis in 918 patients.

BACKGROUND: Studies that systematically assess change in ulcerative colitis (UC) extent over time in adult patients are scarce. AIM: To assess changes in disease extent over time and to evaluate clinical parameters associated with this change. METHODS: Data from the Swiss IBD cohort study were analysed. We used logistic regression modelling to identify factors associated with a change in disease extent. RESULTS: A total of 918 UC patients (45.3% females) were included. At diagnosis, UC patients presented with the following disease extent: proctitis [199 patients (21.7%)], left-sided colitis [338 patients (36.8%)] and extensive colitis/pancolitis [381 (41.5%)]. During a median disease duration of 9 [4-16] years, progression and regression was documented in 145 patients (15.8%) and 149 patients (16.2%) respectively. In addition, 624 patients (68.0%) had a stable disease extent. The following factors were identified to be associated with disease progression: treatment with systemic glucocorticoids [odds ratio (OR) 1.704, P = 0.025] and calcineurin inhibitors (OR: 2.716, P = 0.005). No specific factors were found to be associated with disease regression. CONCLUSIONS: Over a median disease duration of 9 [4-16] years, about two-thirds of UC patients maintained the initial disease extent; the remaining one-third had experienced either progression or regression of the disease extent.