FluxEXPLORER: a new high-speed laser Doppler imaging system for the assessment of burn injuries.

BACKGROUND: Deep burn assessment made by clinical evaluation has an accuracy varying between 60% and 80% and will determine if a burn injury will need tangential excision and skin grafting or if it will be able to heal spontaneously. Laser Doppler Imaging (LDI) techniques allow an improved burn depth assessment but their use is limited by the time-consuming image acquisition which may take up to 6 min per image. METHODS: To evaluate the effectiveness and reliability of a newly developed full-field LDI technology, 15 consecutive patients presenting with intermediate depth burns were assessed both clinically and by FluxExplorer LDI technology. Comparison between the two methods of assessment was carried out. RESULTS: Image acquisition was done within 6 s. FluxEXPLORER LDI technology achieved a significantly improved accuracy of burn depth assessment compared to the clinical judgement performed by board certified plastic and reconstructive surgeons (P < 0.05, 93% of correctly assessed burns injuries vs. 80% for clinical assessment). CONCLUSION: Technological improvements of LDI technology leading to a decreased image acquisition time and reliable burn depth assessment allow the routine use of such devices in the acute setting of burn care without interfering with the patient's treatment. Rapid and reliable LDI technology may assist clinicians in burn depth assessment and may limit the morbidity of burn patients through a minimization of the area of surgical debridement. Future technological improvements allowing the miniaturization of the device will further ease its clinical application.

Assessment of bioaerosols and inhalable dust exposure in Swiss sawmills

An assessment of wood workers' exposure to airborne cultivable bacteria, fungi, inhalable endotoxins and inhalable organic dust was performed at 12 sawmills that process mainly coniferous wood species. In each plant, samples were collected at four or five different work sites (debarking, sawing, sorting, planing and sawing cockpit) and the efficiency of sampling devices (impinger or filter) for determining endotoxins levels was evaluated. Results show that fungi are present in very high concentrations (up to 35 000 CFU m(-3)) in all sawmills. We also find that there are more bioaerosols at the sorting work site (mean +/- SD: 7723 +/- 9919 CFU m(-3) for total bacteria, 614 +/- 902 CFU m(-3) for Gram-negative, 19 438 +/- 14 246 CFU m(-3) for fungi, 7.0 +/- 9.0 EU m(-3) for endotoxin and 2.9 +/- 4.8 g m(-3) for dust) than at the sawing station (mean +/- SD: 1938 +/- 2478 CFU m(-3) for total bacteria, 141 +/- 206 CFU m(-3) for Gram-negative, 12 207 +/- 10 008 CFU m(-3) for fungi, 2.1 +/- 1.9 EU m(-3) for endotoxin and 0.75 +/- 0.49 mg m(-3) for dust). At the same time, the species composition and concentration of airborne Gram-negative bacteria were studied. Penicillinium sp. were the predominant fungi, while Bacillus sp. and the Pseudomonadacea family were the predominant Gram-positive and Gram-negative bacteria encountered, respectively. [Authors]

A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings.

Obstructive disease of the large coronary arteries is the prominent cause for angina pectoris. However, angina may also occur in the absence of significant coronary atherosclerosis or coronary artery spasm, especially in women. Myocardial ischaemia in these patients is often associated with abnormalities of the coronary microcirculation and may thus represent a manifestation of coronary microvascular disease (CMD). Elucidation of the role of the microvasculature in the genesis of myocardial ischaemia and cardiac damage-in the presence or absence of obstructive coronary atherosclerosis-will certainly result in more rational diagnostic and therapeutic interventions for patients with ischaemic heart disease. Specifically targeted research based on improved assessment modalities is needed to improve the diagnosis of CMD and to translate current molecular, cellular, and physiological knowledge into new therapeutic options.

Assessment of pedotransfer functions for estimating soil water retention curves for the amazon region

Knowledge of the soil water retention curve (SWRC) is essential for understanding and modeling hydraulic processes in the soil. However, direct determination of the SWRC is time consuming and costly. In addition, it requires a large number of samples, due to the high spatial and temporal variability of soil hydraulic properties. An alternative is the use of models, called pedotransfer functions (PTFs), which estimate the SWRC from easy-to-measure properties. The aim of this paper was to test the accuracy of 16 point or parametric PTFs reported in the literature on different soils from the south and southeast of the State of Pará, Brazil. The PTFs tested were proposed by Pidgeon (1972), Lal (1979), Aina & Periaswamy (1985), Arruda et al. (1987), Dijkerman (1988), Vereecken et al. (1989), Batjes (1996), van den Berg et al. (1997), Tomasella et al. (2000), Hodnett & Tomasella (2002), Oliveira et al. (2002), and Barros (2010). We used a database that includes soil texture (sand, silt, and clay), bulk density, soil organic carbon, soil pH, cation exchange capacity, and the SWRC. Most of the PTFs tested did not show good performance in estimating the SWRC. The parametric PTFs, however, performed better than the point PTFs in assessing the SWRC in the tested region. Among the parametric PTFs, those proposed by Tomasella et al. (2000) achieved the best accuracy in estimating the empirical parameters of the van Genuchten (1980) model, especially when tested in the top soil layer.

Preliminary assessment of rockslide and rockfall hazards using a DEM (Oppstadhornet, Norway)

The increasing availability and precision of digital elevation model (DEM) helps in the assessment of landslide prone areas where only few data are available. This approach is performed in 6 main steps which include: DEM creation; identification of geomorphologic features; determination of the main sets of discontinuities; mapping of the most likely dangerous structures; preliminary rock-fall assessment; estimation of the large instabilities volumes. The method is applied to two the cases studies in the Oppstadhornet mountain (730m alt): (1) a 10 millions m3 slow-moving rockslide and (2) a potential high-energy rock falling prone area. The orientations of the foliation and of the major discontinuities have been determined directly from the DEM. These results are in very good agreement with field measurements. Spatial arrangements of discontinuities and foliation with the topography revealed hazardous structures. Maps of potential occurrence of these hazardous structures show highly probable sliding areas at the foot of the main landslide and potential rock falls in the eastern part of the mountain.

Preoperative assessment of neurovesical function in children with anorectal malformation: association with vertebral and spinal malformations.

PURPOSE: We preoperatively assessed neurovesical function and spinal cord function in children with anorectal malformations. In cases of neurovesical dysfunction we looked for an association with vertebral malformation or myelodysplasia. MATERIALS AND METHODS: We prospectively evaluated 80 children with anorectal malformations via preoperative urodynamics and magnetic resonance imaging of the spine. Bladder compliance and volume, detrusor activity and vesicosphincteric synergy during voiding allowed urodynamic evaluation. Results were reported according to Wingspread and Krickenbeck classifications of anorectal malformations. RESULTS: Urodynamic findings were pathological in 14 children (18%). Pathological evaluations did not seem related to type of fistula or level of anorectal malformation. Vertebral anomalies were seen in 34 patients (43%) and myelodysplasia in 16 (20%). Neither vertebral anomaly nor myelodysplasia seemed associated with type of fistula or severity of anorectal malformation. Of 14 children with pathological urodynamics no vertebral anomaly or myelodysplasia was found in 7. Of 66 children with normal urodynamics 40 presented with vertebral or spinal malformation. CONCLUSIONS: Lower urinary tract dysfunction is common in patients with anorectal malformations. Normal spine or spinal cord does not exclude neurovesical dysfunction. Myelodysplasia or vertebral anomaly does not determine lower urinary tract dysfunction. Thus, we recommend preoperative urodynamic assessment of the bladder and magnetic resonance imaging of the spine in children with anorectal malformations.

Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence.

INTRODUCTION: Psychiatric disorders are among the leading causes of disability in Western societies. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressant drugs during pregnancy and the postpartum period. Over the last decade, conflicting findings regarding the safety of SSRI drugs during pregnancy and lactation have questioned whether such treatments should be used during this period. AREAS COVERED: We discuss the main criteria that should be considered in the risk/benefit assessment of SSRI treatment in pregnant and/or breastfeeding patients (i.e., risks associated with SSRI use and with untreated depression as well as therapeutic benefits of SSRI and some alternative treatment strategies). For each criterion, available evidence has been synthesized and stratified by methodological quality as well as discussed for clinical impact. EXPERT OPINION: Currently, it is impossible for most of the evaluated outcomes to distinguish between the effects related to the mother's underlying disease and those inherent to SSRI treatment. In women suffering from major depression and responding to a pharmacological treatment, introduction or continuation of an SSRI should be encouraged in order to prevent maternal complications and to preserve maternal-infant bonding. The choice of the right drug depends above all on individual patient characteristics such as prior treatment response, diagnoses and comorbid conditions.

Reliability of methods used for the risk assessment of mixture of micropollutants in aquatic enviromments : from theoretical concepts to field observations

Ces dernières années, de nombreuses recherches ont mis en évidence les effets toxiques des micropolluants organiques pour les espèces de nos lacs et rivières. Cependant, la plupart de ces études se sont focalisées sur la toxicité des substances individuelles, alors que les organismes sont exposés tous les jours à des milliers de substances en mélange. Or les effets de ces cocktails ne sont pas négligeables. Cette thèse de doctorat s'est ainsi intéressée aux modèles permettant de prédire le risque environnemental de ces cocktails pour le milieu aquatique. Le principal objectif a été d'évaluer le risque écologique des mélanges de substances chimiques mesurées dans le Léman, mais aussi d'apporter un regard critique sur les méthodologies utilisées afin de proposer certaines adaptations pour une meilleure estimation du risque. Dans la première partie de ce travail, le risque des mélanges de pesticides et médicaments pour le Rhône et pour le Léman a été établi en utilisant des approches envisagées notamment dans la législation européenne. Il s'agit d'approches de « screening », c'est-à-dire permettant une évaluation générale du risque des mélanges. Une telle approche permet de mettre en évidence les substances les plus problématiques, c'est-à-dire contribuant le plus à la toxicité du mélange. Dans notre cas, il s'agit essentiellement de 4 pesticides. L'étude met également en évidence que toutes les substances, même en trace infime, contribuent à l'effet du mélange. Cette constatation a des implications en terme de gestion de l'environnement. En effet, ceci implique qu'il faut réduire toutes les sources de polluants, et pas seulement les plus problématiques. Mais l'approche proposée présente également un biais important au niveau conceptuel, ce qui rend son utilisation discutable, en dehors d'un screening, et nécessiterait une adaptation au niveau des facteurs de sécurité employés. Dans une deuxième partie, l'étude s'est portée sur l'utilisation des modèles de mélanges dans le calcul de risque environnemental. En effet, les modèles de mélanges ont été développés et validés espèce par espèce, et non pour une évaluation sur l'écosystème en entier. Leur utilisation devrait donc passer par un calcul par espèce, ce qui est rarement fait dû au manque de données écotoxicologiques à disposition. Le but a été donc de comparer, avec des valeurs générées aléatoirement, le calcul de risque effectué selon une méthode rigoureuse, espèce par espèce, avec celui effectué classiquement où les modèles sont appliqués sur l'ensemble de la communauté sans tenir compte des variations inter-espèces. Les résultats sont dans la majorité des cas similaires, ce qui valide l'approche utilisée traditionnellement. En revanche, ce travail a permis de déterminer certains cas où l'application classique peut conduire à une sous- ou sur-estimation du risque. Enfin, une dernière partie de cette thèse s'est intéressée à l'influence que les cocktails de micropolluants ont pu avoir sur les communautés in situ. Pour ce faire, une approche en deux temps a été adoptée. Tout d'abord la toxicité de quatorze herbicides détectés dans le Léman a été déterminée. Sur la période étudiée, de 2004 à 2009, cette toxicité due aux herbicides a diminué, passant de 4% d'espèces affectées à moins de 1%. Ensuite, la question était de savoir si cette diminution de toxicité avait un impact sur le développement de certaines espèces au sein de la communauté des algues. Pour ce faire, l'utilisation statistique a permis d'isoler d'autres facteurs pouvant avoir une influence sur la flore, comme la température de l'eau ou la présence de phosphates, et ainsi de constater quelles espèces se sont révélées avoir été influencées, positivement ou négativement, par la diminution de la toxicité dans le lac au fil du temps. Fait intéressant, une partie d'entre-elles avait déjà montré des comportements similaires dans des études en mésocosmes. En conclusion, ce travail montre qu'il existe des modèles robustes pour prédire le risque des mélanges de micropolluants sur les espèces aquatiques, et qu'ils peuvent être utilisés pour expliquer le rôle des substances dans le fonctionnement des écosystèmes. Toutefois, ces modèles ont bien sûr des limites et des hypothèses sous-jacentes qu'il est important de considérer lors de leur application. - Depuis plusieurs années, les risques que posent les micropolluants organiques pour le milieu aquatique préoccupent grandement les scientifiques ainsi que notre société. En effet, de nombreuses recherches ont mis en évidence les effets toxiques que peuvent avoir ces substances chimiques sur les espèces de nos lacs et rivières, quand elles se retrouvent exposées à des concentrations aiguës ou chroniques. Cependant, la plupart de ces études se sont focalisées sur la toxicité des substances individuelles, c'est à dire considérées séparément. Actuellement, il en est de même dans les procédures de régulation européennes, concernant la partie évaluation du risque pour l'environnement d'une substance. Or, les organismes sont exposés tous les jours à des milliers de substances en mélange, et les effets de ces "cocktails" ne sont pas négligeables. L'évaluation du risque écologique que pose ces mélanges de substances doit donc être abordé par de la manière la plus appropriée et la plus fiable possible. Dans la première partie de cette thèse, nous nous sommes intéressés aux méthodes actuellement envisagées à être intégrées dans les législations européennes pour l'évaluation du risque des mélanges pour le milieu aquatique. Ces méthodes sont basées sur le modèle d'addition des concentrations, avec l'utilisation des valeurs de concentrations des substances estimées sans effet dans le milieu (PNEC), ou à partir des valeurs des concentrations d'effet (CE50) sur certaines espèces d'un niveau trophique avec la prise en compte de facteurs de sécurité. Nous avons appliqué ces méthodes à deux cas spécifiques, le lac Léman et le Rhône situés en Suisse, et discuté les résultats de ces applications. Ces premières étapes d'évaluation ont montré que le risque des mélanges pour ces cas d'étude atteint rapidement une valeur au dessus d'un seuil critique. Cette valeur atteinte est généralement due à deux ou trois substances principales. Les procédures proposées permettent donc d'identifier les substances les plus problématiques pour lesquelles des mesures de gestion, telles que la réduction de leur entrée dans le milieu aquatique, devraient être envisagées. Cependant, nous avons également constaté que le niveau de risque associé à ces mélanges de substances n'est pas négligeable, même sans tenir compte de ces substances principales. En effet, l'accumulation des substances, même en traces infimes, atteint un seuil critique, ce qui devient plus difficile en terme de gestion du risque. En outre, nous avons souligné un manque de fiabilité dans ces procédures, qui peuvent conduire à des résultats contradictoires en terme de risque. Ceci est lié à l'incompatibilité des facteurs de sécurité utilisés dans les différentes méthodes. Dans la deuxième partie de la thèse, nous avons étudié la fiabilité de méthodes plus avancées dans la prédiction de l'effet des mélanges pour les communautés évoluant dans le système aquatique. Ces méthodes reposent sur le modèle d'addition des concentrations (CA) ou d'addition des réponses (RA) appliqués sur les courbes de distribution de la sensibilité des espèces (SSD) aux substances. En effet, les modèles de mélanges ont été développés et validés pour être appliqués espèce par espèce, et non pas sur plusieurs espèces agrégées simultanément dans les courbes SSD. Nous avons ainsi proposé une procédure plus rigoureuse, pour l'évaluation du risque d'un mélange, qui serait d'appliquer d'abord les modèles CA ou RA à chaque espèce séparément, et, dans une deuxième étape, combiner les résultats afin d'établir une courbe SSD du mélange. Malheureusement, cette méthode n'est pas applicable dans la plupart des cas, car elle nécessite trop de données généralement indisponibles. Par conséquent, nous avons comparé, avec des valeurs générées aléatoirement, le calcul de risque effectué selon cette méthode plus rigoureuse, avec celle effectuée traditionnellement, afin de caractériser la robustesse de cette approche qui consiste à appliquer les modèles de mélange sur les courbes SSD. Nos résultats ont montré que l'utilisation de CA directement sur les SSDs peut conduire à une sous-estimation de la concentration du mélange affectant 5 % ou 50% des espèces, en particulier lorsque les substances présentent un grand écart- type dans leur distribution de la sensibilité des espèces. L'application du modèle RA peut quant à lui conduire à une sur- ou sous-estimations, principalement en fonction de la pente des courbes dose- réponse de chaque espèce composant les SSDs. La sous-estimation avec RA devient potentiellement importante lorsque le rapport entre la EC50 et la EC10 de la courbe dose-réponse des espèces est plus petit que 100. Toutefois, la plupart des substances, selon des cas réels, présentent des données d' écotoxicité qui font que le risque du mélange calculé par la méthode des modèles appliqués directement sur les SSDs reste cohérent et surestimerait plutôt légèrement le risque. Ces résultats valident ainsi l'approche utilisée traditionnellement. Néanmoins, il faut garder à l'esprit cette source d'erreur lorsqu'on procède à une évaluation du risque d'un mélange avec cette méthode traditionnelle, en particulier quand les SSD présentent une distribution des données en dehors des limites déterminées dans cette étude. Enfin, dans la dernière partie de cette thèse, nous avons confronté des prédictions de l'effet de mélange avec des changements biologiques observés dans l'environnement. Dans cette étude, nous avons utilisé des données venant d'un suivi à long terme d'un grand lac européen, le lac Léman, ce qui offrait la possibilité d'évaluer dans quelle mesure la prédiction de la toxicité des mélanges d'herbicide expliquait les changements dans la composition de la communauté phytoplanctonique. Ceci à côté d'autres paramètres classiques de limnologie tels que les nutriments. Pour atteindre cet objectif, nous avons déterminé la toxicité des mélanges sur plusieurs années de 14 herbicides régulièrement détectés dans le lac, en utilisant les modèles CA et RA avec les courbes de distribution de la sensibilité des espèces. Un gradient temporel de toxicité décroissant a pu être constaté de 2004 à 2009. Une analyse de redondance et de redondance partielle, a montré que ce gradient explique une partie significative de la variation de la composition de la communauté phytoplanctonique, même après avoir enlevé l'effet de toutes les autres co-variables. De plus, certaines espèces révélées pour avoir été influencées, positivement ou négativement, par la diminution de la toxicité dans le lac au fil du temps, ont montré des comportements similaires dans des études en mésocosmes. On peut en conclure que la toxicité du mélange herbicide est l'un des paramètres clés pour expliquer les changements de phytoplancton dans le lac Léman. En conclusion, il existe diverses méthodes pour prédire le risque des mélanges de micropolluants sur les espèces aquatiques et celui-ci peut jouer un rôle dans le fonctionnement des écosystèmes. Toutefois, ces modèles ont bien sûr des limites et des hypothèses sous-jacentes qu'il est important de considérer lors de leur application, avant d'utiliser leurs résultats pour la gestion des risques environnementaux. - For several years now, the scientists as well as the society is concerned by the aquatic risk organic micropollutants may pose. Indeed, several researches have shown the toxic effects these substances may induce on organisms living in our lakes or rivers, especially when they are exposed to acute or chronic concentrations. However, most of the studies focused on the toxicity of single compounds, i.e. considered individually. The same also goes in the current European regulations concerning the risk assessment procedures for the environment of these substances. But aquatic organisms are typically exposed every day simultaneously to thousands of organic compounds. The toxic effects resulting of these "cocktails" cannot be neglected. The ecological risk assessment of mixtures of such compounds has therefore to be addressed by scientists in the most reliable and appropriate way. In the first part of this thesis, the procedures currently envisioned for the aquatic mixture risk assessment in European legislations are described. These methodologies are based on the mixture model of concentration addition and the use of the predicted no effect concentrations (PNEC) or effect concentrations (EC50) with assessment factors. These principal approaches were applied to two specific case studies, Lake Geneva and the River Rhône in Switzerland, including a discussion of the outcomes of such applications. These first level assessments showed that the mixture risks for these studied cases exceeded rapidly the critical value. This exceeding is generally due to two or three main substances. The proposed procedures allow therefore the identification of the most problematic substances for which management measures, such as a reduction of the entrance to the aquatic environment, should be envisioned. However, it was also showed that the risk levels associated with mixtures of compounds are not negligible, even without considering these main substances. Indeed, it is the sum of the substances that is problematic, which is more challenging in term of risk management. Moreover, a lack of reliability in the procedures was highlighted, which can lead to contradictory results in terms of risk. This result is linked to the inconsistency in the assessment factors applied in the different methods. In the second part of the thesis, the reliability of the more advanced procedures to predict the mixture effect to communities in the aquatic system were investigated. These established methodologies combine the model of concentration addition (CA) or response addition (RA) with species sensitivity distribution curves (SSD). Indeed, the mixture effect predictions were shown to be consistent only when the mixture models are applied on a single species, and not on several species simultaneously aggregated to SSDs. Hence, A more stringent procedure for mixture risk assessment is proposed, that would be to apply first the CA or RA models to each species separately and, in a second step, to combine the results to build an SSD for a mixture. Unfortunately, this methodology is not applicable in most cases, because it requires large data sets usually not available. Therefore, the differences between the two methodologies were studied with datasets created artificially to characterize the robustness of the traditional approach applying models on species sensitivity distribution. The results showed that the use of CA on SSD directly might lead to underestimations of the mixture concentration affecting 5% or 50% of species, especially when substances present a large standard deviation of the distribution from the sensitivity of the species. The application of RA can lead to over- or underestimates, depending mainly on the slope of the dose-response curves of the individual species. The potential underestimation with RA becomes important when the ratio between the EC50 and the EC10 for the dose-response curve of the species composing the SSD are smaller than 100. However, considering common real cases of ecotoxicity data for substances, the mixture risk calculated by the methodology applying mixture models directly on SSDs remains consistent and would rather slightly overestimate the risk. These results can be used as a theoretical validation of the currently applied methodology. Nevertheless, when assessing the risk of mixtures, one has to keep in mind this source of error with this classical methodology, especially when SSDs present a distribution of the data outside the range determined in this study Finally, in the last part of this thesis, we confronted the mixture effect predictions with biological changes observed in the environment. In this study, long-term monitoring of a European great lake, Lake Geneva, provides the opportunity to assess to what extent the predicted toxicity of herbicide mixtures explains the changes in the composition of the phytoplankton community next to other classical limnology parameters such as nutrients. To reach this goal, the gradient of the mixture toxicity of 14 herbicides regularly detected in the lake was calculated, using concentration addition and response addition models. A decreasing temporal gradient of toxicity was observed from 2004 to 2009. Redundancy analysis and partial redundancy analysis showed that this gradient explains a significant portion of the variation in phytoplankton community composition, even when having removed the effect of all other co-variables. Moreover, some species that were revealed to be influenced positively or negatively, by the decrease of toxicity in the lake over time, showed similar behaviors in mesocosms studies. It could be concluded that the herbicide mixture toxicity is one of the key parameters to explain phytoplankton changes in Lake Geneva. To conclude, different methods exist to predict the risk of mixture in the ecosystems. But their reliability varies depending on the underlying hypotheses. One should therefore carefully consider these hypotheses, as well as the limits of the approaches, before using the results for environmental risk management

Systematic assessment of items influencing Crohn's disease patient's preferences in selecting an anti-TNF agent (Choose TNF trial)

Background and Aims: The three anti-TNF agents infliximab (IFX), adalimumab (ADA) andcertolizumab pegol (CZP) have demonstrated similar efficacy in induction and maintenanceof response and remission in Crohn's disease (CD) treatment. Given the comparability ofthese drugs, patient's preferences may influence the choice of the product. However, dataon patient's preferences for choosing anti-TNF agents are lacking. We therefore aimed toassess the CD patient's appraisal to select the drug of his choice and to identify factorsguiding this decision.Methods: A prospective survey among anti-TNF-naive CD patientswas performed. Patients were provided a description of the three anti-TNF agents focusingon indication, application mode (s.c. vs. i.v.), application time intervals, setting of application(hospital vs. private practice vs. patient's home), average time to apply the medication permonth, typical side effects, and the scientific evidence of efficacy and safety available for everydrug. Patients answered a questionnaire consisting of 17 questions, covering demographic,disease-specific, and medication data.Results: Hundred patients (47f/53m, mean age 45±16years) completed the questionnaire. Disease duration was <1year in 7%, 1-5 years in 31%,and >5 years in 62% of patients. Disease location was ileal in 33%, colonic in 40%, andileocolonic in 27%. Disease phenotype was inflammatory in 68%, stenosing in 29%, andinternally fistulizing in 3% of patients. Additionally, 20% had perianal fistulizing disease.Patients were already treated with the following drugs: mesalamines 61%, budesonide 44%,prednisone 97%, thiopurines 78%, methotrexate 16%. In total, 30% had already heardabout IFX, 20% about ADA, and 11% about CZP. Thirty-six percent voted for treatmentwith ADA, 28% for CZP, and 25% for IFX, whereas 11% were undecided. The followingfactors influenced the patient's decision for choosing a specific anti-TNF drug (severalanswers possible): side effects 76%, physician's recommendation 66%, application mode54%, efficacy experience 52%, time to spend for therapy 27%, patient's recommendations21%, interactions with other medications 12%. The single most important factor for choosinga specific anti-TNF was (1 answer): side effect profile 35%, physician's recommendation22%, efficacy experience 21%, application mode 13%, patient's recommendations 5%, timespent for therapy 3%, interaction with other medications 1%.Conclusions: The majority ofpatients preferred anti-TNF syringes to infusions. The safety profile of the drugs and thephysician's recommendation are major factors influencing the patient's choice for a specificanti-TNF drug. Patient's issues about safety and lifestyle habits should be taken into accountwhen prescribing specific anti-TNF formulations.

Clinical assessment of fluorescence cytoscopy during transurethral bladder resection in superficial bladder cancer.

The prognosis of superficial bladder cancer in terms of recurrence and disease progression is related to bladder tumor multiplicity and the presence of concomitant "plane" tumors such as high-grade dysplasia and carcinoma in situ. This study in 33 patients aimed to demonstrate the role of fluorescence cystoscopy in transurethral resection of superficial bladder cancer. The method is based on the detection of protoporphyrin-IX-induced fluorescence in urothelial cancer cells by topical administration of 5-aminolevulinic acid. The sensitivity and the specificity of this procedure on apparently normal mucosa in superficial bladder cancer are estimated to be 82.9% and 81.3%, respectively. Thus, fluorescence cytoscopy is a simple and reliable method for mapping the bladder mucosa, especially in the case of multifocal bladder disease, and it facilitates the screening of occult dysplasia.

Assessment of driving capability through the use of clinical and psychomotor tests in relation to blood cannabinoids levels following oral administration of 20 mg dronabinol or of a cannabis decoction made with 20 or 60 mg Delta9-THC.

Delta(9)-Tetrahydrocannabinol (THC) is frequently found in the blood of drivers suspected of driving under the influence of cannabis or involved in traffic crashes. The present study used a double-blind crossover design to compare the effects of medium (16.5 mg THC) and high doses (45.7 mg THC) of hemp milk decoctions or of a medium dose of dronabinol (20 mg synthetic THC, Marinol on several skills required for safe driving. Forensic interpretation of cannabinoids blood concentrations were attempted using the models proposed by Daldrup (cannabis influencing factor or CIF) and Huestis and coworkers. First, the time concentration-profiles of THC, 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) (active metabolite of THC), and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THCCOOH) in whole blood were determined by gas chromatography-mass spectrometry-negative ion chemical ionization. Compared to smoking studies, relatively low concentrations were measured in blood. The highest mean THC concentration (8.4 ng/mL) was achieved 1 h after ingestion of the strongest decoction. Mean maximum 11-OH-THC level (12.3 ng/mL) slightly exceeded that of THC. THCCOOH reached its highest mean concentration (66.2 ng/mL) 2.5-5.5 h after intake. Individual blood levels showed considerable intersubject variability. The willingness to drive was influenced by the importance of the requested task. Under significant cannabinoids influence, the participants refused to drive when they were asked whether they would agree to accomplish several unimportant tasks, (e.g., driving a friend to a party). Most of the participants reported a significant feeling of intoxication and did not appreciate the effects, notably those felt after drinking the strongest decoction. Road sign and tracking testing revealed obvious and statistically significant differences between placebo and treatments. A marked impairment was detected after ingestion of the strongest decoction. A CIF value, which relies on the molar ratio of main active to inactive cannabinoids, greater than 10 was found to correlate with a strong feeling of intoxication. It also matched with a significant decrease in the willingness to drive, and it matched also with a significant impairment in tracking performances. The mathematic model II proposed by Huestis et al. (1992) provided at best a rough estimate of the time of oral administration with 27% of actual values being out of range of the 95% confidence interval. The sum of THC and 11-OH-THC blood concentrations provided a better estimate of impairment than THC alone. This controlled clinical study points out the negative influence on fitness to drive after medium or high dose oral THC or dronabinol.

Bayes factor for investigative assessment of selected handwriting features

This paper extends previous research [1] on the use of multivariate continuous data in comparative handwriting examinations, notably for gender classification. A database has been constructed by analyzing the contour shape of loop characters of type a and d by means of Fourier analysis, which allows characters to be described in a global way by a set of variables (e.g., Fourier descriptors). Sample handwritings were collected from right- and left-handed female and male writers. The results reported in this paper provide further arguments in support of the view that investigative settings in forensic science represent an area of application for which the Bayesian approach offers a logical framework. In particular, the Bayes factor is computed for settings that focus on inference of gender and handedness of the author of an incriminated handwritten text. An emphasis is placed on comparing the efficiency for investigative purposes of characters a and d.

Quantitative Assessment of Soil Physical Quality in Northern China Based on S-theory

ABSTRACT Quantitative assessment of soil physical quality is of great importance for eco-environmental pollution and soil quality studies. In this paper, based on the S-theory, data from 16 collection sites in the Haihe River Basin in northern China were used, and the effects of soil particle size distribution and bulk density on three important indices of theS-theory were investigated on a regional scale. The relationships between unsaturated hydraulic conductivityKi at the inflection point and S values (S/hi) were also studied using two different types of fitting equations. The results showed that the polynomial equation was better than the linear equation for describing the relationships between -log Ki and -logS, and -log Kiand -log (S/hi)2; and clay content was the most important factor affecting the soil physical quality index (S). The variation in the S index according to soil clay content was able to be fitted using a double-linear-line approach, with decrease in the S index being much faster for clay content less than 20 %. In contrast, the bulk density index was found to be less important than clay content. The average S index was 0.077, indicating that soil physical quality in the Haihe River Basin was good.