Rheumatoid Arthritis Therapy Reappraisal

Rheumatoid Arthritis (RA) is a chronic inflammatory disease leading to joint inflammation and destruction. Treatment of RA includes the use of conventional (cs), biologic (b) disease-modifying anti-rheumatic drugs (DMARDs), and oral or intraarticular (IA) glucocorticoids (GCs). All different classes of drugs have shown to halt disease progression in clinical studies. In real life, a physician has more options than just adding or switching to a new ts/bDMARD if any kind of DMARDs has failed. They can modify or optimize the therapy with concomitant csDMARDs, and oral or IA-GC can be added to the treatment regimen. The EULAR states that therapeutic adjustment including the "optimization of csDMARDs dose or route of administration or intra-articular injections of GCs" is recommended. Thus, a new therapeutic agent can be embedded in a whole strategy with parallel optimization of the csDMARD and GC treatment. The idea of treating to target (T2T) for the treatment of RA patients has been around since the late 1990s. Many clinical studies (Ticora, BsSt, Camera) have demonstrated the superiority of a T2T approach. When I talk to physicians, I understand that most of them only rarely inject joints with GC. Therefore, I would like to create an issue on the T2T approach in reality including primary data, reviews, and real-life data demonstrating the general opinion and execution of T2T in treating RA

Case series of breast fillers and how things may go wrong: radiology point of view

INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging breast due to breastfeeding or aging as well as small breast size. Recent years have shown the emergence of a variety of injectable materials on market as breast fillers. These injectable breast fillers have swiftly gained popularity among women, considering the minimal invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know that the procedure may pose detrimental complications, while visualization of breast parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic challenges. We present a case series of three patients with prior history of hyaluronic acid and collagen breast injections. REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening shortness of breath, non-productive cough, central chest pain; associated with fever and chills for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases revealed non thrombotic wedge-shaped peripheral air-space densities. The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2- weeks duration. Previous collagen breast injection performed 1 year ago had impeded sonographic visualization of the breast parenchyma. MRI breasts showed multiple non- enhancing round and oval shaped lesions exhibiting fat intensity. CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well as limitations of imaging posed by breast fillers such that MRI is required as problem-solving tool

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

Neolithic land-use in the Dutch wetlands: estimating the land-use implications of resource exploitation strategies in the Middle Swifterbant Culture (4600-3900 BCE)

The Dutch wetlands witness the gradual adoption of Neolithic novelties by foraging societies during the Swifterbant period. Recent analyses provide new insights into the subsistence palette of Middle Swifterbant societies. Small-scale livestock herding and cultivation are in evidence at this time, but their importance if unclear. Within the framework of PAGES Land-use at 6000BP project, we aim to translate the information on resource exploitation into information on land-use that can be incorporated into global climate modelling efforts, with attention for the importance of agriculture. A reconstruction of patterns of resource exploitation and their land-use dimensions is complicated by methodological issues in comparing the results of varied recent investigations. Analyses of organic residues in ceramics have attested to the cooking of aquatic foods, ruminant meat, porcine meat, as well as rare cases of dairy. In terms of vegetative matter, some ceramics exclusively yielded evidence of wild plants, while others preserve cereal remains. Elevated δ15N values of human were interpreted as demonstrating an important aquatic component of the diet well into the 4th millennium BC. Yet recent assays on livestock remains suggest grazing on salt marshes partly accounts for the human values. Finally, renewed archaeozoological investigations have shown the early presence of domestic animals to be more limited than previously thought. We discuss the relative importance of exploited resources to produce a best-fit interpretation of changing patterns of land-use during the Middle Swifterbant phase. Our review combines recent archaeological data with wider data on anthropogenic influence on the landscape. Combining the results of plant macroremains, information from pollen cores about vegetation development, the structure of faunal assemblages, and finds of arable fields and dairy residue, we suggest the most parsimonious interpretation is one of a limited land-use footprint of cultivation and livestock keeping in Dutch wetlands between 4600 and 3900 BCE.NWOVidi 276-60-004Human Origin

Taphonomy, environment or human plant exploitation strategies?: Deciphering changes in Pleistocene-Holocene plant representation at Umhlatuzana rockshelter, South Africa

The period between ~40 and 20 ka BP encompassing the Middle Stone Age (MSA) and Later Stone Age (LSA) transition has long been of interest because of the associated technological change. Understanding this transition in southern Africa is complicated by the paucity of archaeological sites that span this period. With its occupation sequence spanning the last ~70,000 years, Umhlatuzana Rock Shelter is one of the few sites that record this transition. Umhlatuzana thus offers a great opportunity to study past environmental dynamics from the Late Pleistocene (MIS 4) to the Late Holocene, and past human subsistence strategies, their social organisation, technological and symbolic innovations. Although organic preservation is poor (bones, seeds, and charcoal) at the site, silica phytoliths preserve generally well throughout the sequence. These microscopic silica particles can identify different plant types that are no longer visible at the site because of decomposition or burning to a reliable taxonomical level. Thus, to trace site occupation, plant resource use, and in turn reconstruct past vegetation, we applied phytolith analyses to sediment samples of the newly excavated Umhlatuzana sequence. We present results of the phytolith assemblage variability to determine change in plant use from the Pleistocene to the Holocene and discuss them in relation to taphonomical processes and human plant gathering strategies and activities. This study ultimately seeks to provide a palaeoenvironmental context for modes of occupation and will shed light on past human-environmental interactions in eastern South Africa.NWOVidi 276-60-004Human Origin

Ways and Capacity in Archaeological Data Management in Serbia

Over the past year and due to the COVID-19 pandemic, the entire world has witnessed inequalities across borders and societies. They also include access to archaeological resources, both physical and digital. Both archaeological data creators and users spent a lot of time working from their homes, away from artefact collections and research data. However, this was the perfect moment to understand the importance of making data freely and openly available, both nationally and internationally. This is why the authors of this paper chose to make a selection of data bases from various institutions responsible for preservation and protection of cultural heritage, in order to understand their policies regarding accessibility and usage of the data they keep. This will be done by simple visits to various web-sites or data bases. They intend to check on the volume and content, but also importance of the offered archaeological heritage. In addition, the authors will estimate whether the heritage has adequately been classified and described and also check whether data is available in foreign languages. It needs to be seen whether it is possible to access digital objects (documents and the accompanying metadata), whether access is opened for all users or it requires a certain hierarchy access, what is the policy of usage, reusage and distribution etc. It remains to be seen whether there are public API or whether it is possible to collect data through API. In case that there is a public API, one needs to check whether datasets are interoperable or messy, requiring data cleaning. After having visited a certain number of web-sites, the authors expect to collect enough data to make a satisfactory conclusion about accessibility and usage of Serbian archaeological data web bases