Long-term outcomes of refractory neurosarcoidosis treated with infliximab

International audienceCentral nervous system localizations of sarcoidosis may be refractory to conventional treatment such as steroids and immunosuppressive drugs. Infliximab, a TNF-α antagonist chimeric antibody, has been shown to be effective for treatment of these localizations. The aim of this study was to evaluate the efficacy and safety, in particular the long-term outcomes, of the use of infliximab for the treatment of neurosarcoidosis. We retrospectively reviewed medical records of patients with neurosarcoidosis who had been treated with infliximab between 2009 and 2015. All patients had histologically proven non-caseating granulomas. Eighteen patients with histologically proven sarcoidosis were included in this study. All had neurological involvement consisting of meningeal (n = 16), cerebral (n = 10), spinal cord (n = 6), and/or optic nerve (n = 5) involvement. Sixteen patients had previously received at least one immunosuppressive drug in addition to corticosteroids, including cyclophosphamide in 11 patients. All patients received treatment with infliximab (3–7.5 mg/kg) associated with corticosteroids (n = 18), low-dose methotrexate (n = 15), azathioprine (n = 2), or mycophenolate (n = 1). Sixteen out of 18 patients improved clinically (initial median modified Rankin scale score of 3, final median score of 1; p < 0.0001). At 6 months after initiation of infliximab, six patients obtained complete remission (33%), ten attained partial remission (56%), and two had stable disease (11%). The median follow-up time was 20 months (range 6–93). Nine patients relapsed during follow-up (50%). Eight patients developed toxic side effects and seven of these side effects were infectious events. Infliximab is an efficacious treatment of refractory neurosarcoidosis. However, relapses frequently occurred during follow-up

Drying Kinetics in Solar Drying

From ancient times foods such as fruit, vegetables, meat or fish were dried by direct sunlight. The use of the sun as energy source is advantageous from the economic as well as environmental points of view. However, this procedure has many disadvantages concerning the efficiency and product safety and quality. The use of greenhouses can greatly minimize these problems Inside the greenhouses the air circulates by natural convection but they can also be equipped with chimneys for air outlet, thus increasing the airflow. In other cases, the efficiency of the drying system can be increased by incorporating a solar collector system, which uses panels for an efficient collection of the sun ray’s energy. Knowledge of the drying kinetics is of great importance for modeling the drying processes and to establish appropriate operating conditions. There are hundreds of mathematical models that were developed to represent the drying kinetics of foods, being mostly empirical, or semi-empirical or alternatively based on the Fick's second law of diffusion. This chapter presents the heat and mass transfer mechanisms that regulate the drying rate, the conditions in direct and indirect solar drying, the drying curves and the mathematical modeling of the solar drying processes, with application examples in various dominions.info:eu-repo/semantics/publishedVersio