Moving instead of asking? performance-based tests and BASFI-questionnaire measure different aspects of physical function in ankylosing spondylitis

INTRODUCTION: Ankylosing Spondylitis (AS) is characterised by limitations in physical function. The Bath Ankylosing Spondylitis Functional Index (BASFI) is considered to be the gold-standard to assess physical function in AS patients. However, the BASFI questionnaire is a self-reported outcome measure and susceptible to subjective interpretation (under- or over-estimation). More objective outcome measures, like performance-based tests, could provide an objective outcome measurement for the evaluation of limitations in physical function. Therefore, the primary aim of this study was to determine the association between performance-based measures and the BASFI questionnaire. METHODS: In this cross-sectional study 126 AS patients completed the BASFI questionnaire and eight performance-based tests based on BASFI-items. Each test received three scores: one for performance (time or points) and a score for exertion and pain experienced during performance (using modified Borg-scale and VAS 0-100 mm, respectively). Linear regression analyses were used to assess the associations between the BASFI questionnaire and performance-based tests. RESULTS: The univariable association between performance and BASFI-score was moderate with a R-square of 0.31 and Beta of 0.56 (p's < 0.05). In a multivariable analysis, the association between performance, exertion and pain on the one hand and BASFI-score on the other was assessed; R-square increased to 0.54: the Beta's for exertion and pain during performance were 0.38 and 0.26, respectively; the Beta for performance decreased to 0.19 (p's < 0.05). CONCLUSIONS: This study demonstrates that alongside actual performance, patients seem to incorporate exertion and pain in their assessment of perceived physical function on the BASFI questionnaire. Performance-based tests could provide an objective outcome measurement for the evaluation of physical function and give relevant new information in addition to the BASFI questionnaire

Bone formation rather than inflammation reflects Ankylosing Spondylitis activity on PET-CT: a pilot study

INTRODUCTION: Positron Emission Tomography - Computer Tomography (PET-CT) is an interesting imaging technique to visualize Ankylosing Spondylitis (AS) activity using specific PET tracers. Previous studies have shown that the PET tracers [(18)F]FDG and [(11)C](R)PK11195 can target inflammation (synovitis) in rheumatoid arthritis (RA) and may therefore be useful in AS. Another interesting tracer for AS is [(18)F]Fluoride, which targets bone formation. In a pilot setting, the potential of PET-CT in imaging AS activity was tested using different tracers, with Magnetic Resonance Imaging (MRI) and conventional radiographs as reference. METHODS: In a stepwise approach different PET tracers were investigated. First, whole body [(18)F]FDG and [(11)C](R)PK11195 PET-CT scans were obtained of ten AS patients fulfilling the modified New York criteria. According to the BASDAI five of these patients had low and five had high disease activity. Secondly, an extra PET-CT scan using [(18)F]Fluoride was made of two additional AS patients with high disease activity. MRI scans of the total spine and sacroiliac joints were performed, and conventional radiographs of the total spine and sacroiliac joints were available for all patients. Scans and radiographs were visually scored by two observers blinded for clinical data. RESULTS: No increased [(18)F]FDG and [(11)C](R)PK11195 uptake was noticed on PET-CT scans of the first 10 patients. In contrast, MRI demonstrated a total of five bone edema lesions in three out of 10 patients. In the two additional AS patients scanned with [(18)F]Fluoride PET-CT, [(18)F]Fluoride depicted 17 regions with increased uptake in both vertebral column and sacroiliac joints. In contrast, [(18)F]FDG depicted only three lesions, with an uptake of five times lower compared to [(18)F]Fluoride, and again no [(11)C](R)PK11195 positive lesions were found. In these two patients, MRI detected nine lesions and six out of nine matched with the anatomical position of [(18)F]Fluoride uptake. Conventional radiographs showed structural bony changes in 11 out of 17 [(18)F]Fluoride PET positive lesions. CONCLUSIONS: Our PET-CT data suggest that AS activity is reflected by bone activity (formation) rather than inflammation. The results also show the potential value of PET-CT for imaging AS activity using the bone tracer [(18)F]Fluoride. In contrast to active RA, inflammation tracers [(18)F]FDG and [(11)C](R)PK11195 appeared to be less useful for AS imaging

Immunogenicity does not influence treatment with etanercept in patients with ankylosing spondylitis

Background: Immunogenicity, specifically the onset of antibodies against tumour necrosis factor (TNF) blocking agents, seems to play an important role in non-response to treatment with these drugs. Objectives: To assess the relation of clinical response of ankylosing spondylitis (AS) to etanercept with etanercept levels, and the presence of antibodies to etanercept. Methods: Patients with AS were treated with etanercept 25 mg twice weekly, according to the international Assessment in Ankylosing Spondylitis (ASAS) working group consensus statement. Sera were collected at baseline and after 3 and 6 months of treatment. Clinical response was defined as a 50% improvement or as an absolute improvement of 2 points on a (0-10 scale) Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. Functional etanercept levels were measured by a newly developed ELISA, measuring the binding of etanercept to TNF. Antibodies against etanercept were measured with a two-site assay and antigen binding test. Clinical data were used to correlate disease activity with serum etanercept levels. Results: In all, 53 consecutive patients were included. After 3 months of treatment 40 patients (76%) fulfilled the response criteria. Mean etanercept levels were 2.7 mg/litre and 3.0 mg/litre after 3 and 6 months respectively. Characteristics and etanercept levels of responders and non-responders were similar. No antibodies to etanercept were detected with any of the assays. Conclusion: Etanercept levels of responders and non-responders were similar and no antibodies to etanercept were detected with any of the assays. This study indicates that etanercept is much less immunogenic compared with the other TNF-blocking agent

Side channel dynamics

Side channels are commonly constructed to increase the discharge capacity of a river during peak flow conditions or to increase the ecological value of the river. Observations show that large aggradation occurs in the side channels. Therefore, such channels require regular and costly maintenance. The aim of this research is to better understand the mechanisms that drive the morphodynamic development of side channels and thereby, improve the design of side channels and reduce their maintenance needs. We studied the development of side channel in various ways and found that mechanisms such as a length difference between the downstream channels, sediment sorting at the bifurcation and varying hydrodynamic conditions have a large effect on the morphodynamic development of a side channel system. The mechanisms that are important are not the same for each side channel and can vary in time. Therefore, we propose three categories of side channel based on how the sediment that is deposited in the side channel is transported in the main channel: (1) bed load supplied, (2) suspended bed-material load supplied and (3) wash load supplied side channels. These categories can help in determining the main mechanisms that affect the development of a side channel system. In addition, we propose a method based on the categorization that can aid the design, operation and maintenance of side channels

Response of benthic fauna to experimental bottom fishing: A global meta-analysis

Bottom‐contact fishing gears are globally the most widespread anthropogenic sources of direct disturbance to the seabed and associated biota. Managing these fishing disturbances requires quantification of gear impacts on biota and the rate of recovery following disturbance. We undertook a systematic review and meta‐analysis of 122 experiments on the effects‐of‐bottom fishing to quantify the removal of benthos in the path of the fishing gear and to estimate rates of recovery following disturbance. A gear pass reduced benthic invertebrate abundance by 26% and species richness by 19%. The effect was strongly gear‐specific, with gears that penetrate deeper into the sediment having a significantly larger impact than those that penetrate less. Sediment composition (% mud and presence of biogenic habitat) and the history of fishing disturbance prior to an experimental fishing event were also important predictors of depletion, with communities in areas that were not previously fished, predominantly muddy or biogenic habitats being more strongly affected by fishing. Sessile and low mobility biota with longer life‐spans such as sponges, soft corals and bivalves took much longer to recover after fishing (>3 year) than mobile biota with shorter life‐spans such as polychaetes and malacostracans (<1 year). This meta‐analysis provides insights into the dynamics of recovery. Our estimates of depletion along with estimates of recovery rates and large‐scale, high‐resolution maps of fishing frequency and habitat will support more rigorous assessment of the environmental impacts of bottom‐contact gears, thus supporting better informed choices in trade‐offs between environmental impacts and fish production

Крымскотатарские народные игры в аспекте физической культуры

Feelings of revenge are a common human response to being hurt by others. Among crime victims of severe sexual or physical violence, significant correlations have been reported between revenge and Posttraumatic Stress Disorder (PTSD). Homicide is one of the most severe forms of interpersonal violence. It is therefore likely that individuals bereaved by homicide experience high levels of revenge, which may hamper efforts to cope with traumatic loss. The relationship between revenge and psychological adjustment following homicidal loss has not yet been empirically examined. In the current cross-sectional study, we used self-report data from 331 spouses, family members and friends of homicide victims to examine the relationships between dispositional revenge and situational revenge on the one hand and symptom-levels of PTSD and complicated grief, as well as indices of positive functioning, on the other hand. Furthermore, the association between revenge and socio-demographic and offense-related factors was examined. Participants were recruited from a governmental support organization, a website with information for homicidally bereaved individuals, and members of support groups. Levels of both dispositional and situational revenge were positively associated with symptoms of PTSD and complicated grief, and negatively with positive functioning. Participants reported significantly less situational revenge in cases where the perpetrator was a direct family member than cases where the perpetrator was an indirect family member, friend, or someone unknown. Homicidally bereaved individuals reported more situational revenge, but not more dispositional revenge than a sample of students who had experienced relatively mild interpersonal transgressions. Aggr. Behav. 40:504-511, 2014. (c) 2014 Wiley Periodicals, Inc