FRW Universe Models in Conformally Flat Spacetime Coordinates. III: Universe models with positive spatial curvature

We deduce general expressions for the line element of universe models with positive spatial curvature described by conformally flat spacetime coordinates. Models with dust, radiation and vacuum energy are exhibited. Discussing the existence of particle horizons we show that there is continual annihilation of space, matter and energy in a dust and radiation dominated universe, and continual creation in a LIVE domined universe when conformal time is used in Friedmann-Robertson-Walker models with positive spatial curvature. A general procedure is given for finding coordinates to be used in Penrose diagrams. We also calculate the age and the redshift of some universe models using conformal time.Comment: 22 pages, 9 figure

On the Conformal forms of the Robertson-Walker metric

All possible transformations from the Robertson-Walker metric to those conformal to the Lorentz-Minkowski form are derived. It is demonstrated that the commonly known family of transformations and associated conformal factors are not exhaustive and that there exists another relatively less well known family of transformations with a different conformal factor in the particular case that K = -1. Simplified conformal factors are derived for the special case of maximally-symmetric spacetimes. The full set of all possible cosmologically-compatible conformal forms is presented as a comprehensive table. A product of the analysis is the determination of the set-theoretical relationships between the maximally symmetric spacetimes, the Robertson-Walker spacetimes, and functionally more general spacetimes. The analysis is preceded by a short historical review of the application of conformal metrics to Cosmology.Comment: Historical review added. Accepted by J. Math. Phy

Clinical Utility of Random Anti–Tumor Necrosis Factor Drug–Level Testing and Measurement of Antidrug Antibodies on the Long-Term Treatment Response in Rheumatoid Arthritis

Objective: To investigate whether antidrug antibodies and/or drug non-trough levels predict the long-term treatment response in a large cohort of patients with rheumatoid arthritis (RA) treated with adalimumab or etanercept and to identify factors influencing antidrug antibody and drug levels to optimize future treatment decisions.  Methods: A total of 331 patients from an observational prospective cohort were selected (160 patients treated with adalimumab and 171 treated with etanercept). Antidrug antibody levels were measured by radioimmunoassay, and drug levels were measured by enzyme-linked immunosorbent assay in 835 serial serum samples obtained 3, 6, and 12 months after initiation of therapy. The association between antidrug antibodies and drug non-trough levels and the treatment response (change in the Disease Activity Score in 28 joints) was evaluated.  Results: Among patients who completed 12 months of followup, antidrug antibodies were detected in 24.8% of those receiving adalimumab (31 of 125) and in none of those receiving etanercept. At 3 months, antidrug antibody formation and low adalimumab levels were significant predictors of no response according to the European League Against Rheumatism (EULAR) criteria at 12 months (area under the receiver operating characteristic curve 0.71 [95% confidence interval (95% CI) 0.57, 0.85]). Antidrug antibody–positive patients received lower median dosages of methotrexate compared with antidrug antibody–negative patients (15 mg/week versus 20 mg/week; P = 0.01) and had a longer disease duration (14.0 versus 7.7 years; P = 0.03). The adalimumab level was the best predictor of change in the DAS28 at 12 months, after adjustment for confounders (regression coefficient 0.060 [95% CI 0.015, 0.10], P = 0.009). Etanercept levels were associated with the EULAR response at 12 months (regression coefficient 0.088 [95% CI 0.019, 0.16], P = 0.012); however, this difference was not significant after adjustment. A body mass index of ≥30 kg/m2 and poor adherence were associated with lower drug levels.  Conclusion: Pharmacologic testing in anti–tumor necrosis factor–treated patients is clinically useful even in the absence of trough levels. At 3 months, antidrug antibodies and low adalimumab levels are significant predictors of no response according to the EULAR criteria at 12 months

On the kinematics of a corotating relativistic plasma stream in the perpendicular rotator model of a pulsar magnetosphere

An investigation of the kinematics of a rotating relativistic plasma stream in the perpendicular rotator model of the pulsar magnetosphere is presented. It is assumed that the plasma (ejected from the pulsar) moves along the pulsar magnetic field lines and also corotates with them. The field lines are considered to be radial straight lines, located in the plane which is perpendicular to the pulsar rotation axis. The necessity of taking particle inertia into account is discussed. It is argued that the "massless" ("force-free") approximation cannot be used for the description of this problem. The frame selection is discussed and it is shown that it is convenient to discuss the problem in the noninertial frame of ZAMOs (Zero Angular Momentum Observers). The equation of motion and the exact set of equations describing the behaviour of a relativistic plasma stream in the pulsar magnetosphere is obtained. The possible relevance of this investigation for the understanding of the formation process of a pulsar magnetosphere is discussed.Comment: Plain LaTe

A Kinematical Approach to Conformal Cosmology

We present an alternative cosmology based on conformal gravity, as originally introduced by H. Weyl and recently revisited by P. Mannheim and D. Kazanas. Unlike past similar attempts our approach is a purely kinematical application of the conformal symmetry to the Universe, through a critical reanalysis of fundamental astrophysical observations, such as the cosmological redshift and others. As a result of this novel approach we obtain a closed-form expression for the cosmic scale factor R(t) and a revised interpretation of the space-time coordinates usually employed in cosmology. New fundamental cosmological parameters are introduced and evaluated. This emerging new cosmology does not seem to possess any of the controversial features of the current standard model, such as the presence of dark matter, dark energy or of a cosmological constant, the existence of the horizon problem or of an inflationary phase. Comparing our results with current conformal cosmologies in the literature, we note that our kinematic cosmology is equivalent to conformal gravity with a cosmological constant at late (or early) cosmological times. The cosmic scale factor and the evolution of the Universe are described in terms of several dimensionless quantities, among which a new cosmological variable delta emerges as a natural cosmic time. The mathematical connections between all these quantities are described in details and a relationship is established with the original kinematic cosmology by L. Infeld and A. Schild. The mathematical foundations of our kinematical conformal cosmology will need to be checked against current astrophysical experimental data, before this new model can become a viable alternative to the standard theory.Comment: Improved version, with minor changes. 58 pages, including 7 figures and one table. Accepted for publication in General Relativity and Gravitation (GERG

The association between subgroups of MRI findings identified with latent class analysis and low back pain in 40-year old Danes

Background: Research into the clinical importance of spinal MRI findings in patients with low back pain (LBP) has primarily focused on single imaging findings, such as Modic changes or disc degeneration, and found only weak associations with the presence of pain. However, numerous MRI findings almost always co-exist in the lumbar spine and are often present at more than one lumbar level. It is possible that multiple MRI findings are more strongly associated with LBP than single MRI findings. Latent Class Analysis is a statistical method that has recently been tested and found useful for identifying latent classes (subgroups) of MRI findings within multivariable datasets. The purpose of this study was to investigate the association between subgroups of MRI findings and the presence of LBP in people from the general population. Methods: To identify subgroups of lumbar MRI findings with potential clinical relevance, Latent Class Analysis was initially performed on a clinical dataset of 631 patients seeking care for LBP. Subsequently, 412 participants in a general population cohort (the ‘Backs on Funen’ project) were statistically allocated to those existing subgroups by Latent Class Analysis, matching their MRI findings at a segmental level. The subgroups containing MRI findings from the general population were then organised into hypothetical pathways of degeneration and the association between subgroups in the pathways and the presence of LBP was tested using exact logistic regression. Results: Six subgroups were identified in the clinical dataset and the data from the general population cohort fitted the subgroups well, with a median posterior probability of 93%–100%. These six subgroups described two pathways of increasing degeneration on upper (L1-L3) and lower (L4-L5) lumbar levels. An association with LBP was found for the subgroups describing severe and multiple degenerative MRI findings at the lower lumbar levels but none of the other subgroups were associated with LBP

Acute thrombosis of the superior mesenteric artery in a 39-year-old woman with protein-S deficiency: a case report

<p>Abstract</p> <p>Introduction</p> <p>Acute thromboembolic occlusion of the superior mesenteric artery is a condition with an unfavorable prognosis. Treatment of this condition is focused on early diagnosis, surgical or intravascular restoration of blood flow to the ischemic intestine, surgical resection of the necrotic bowel and supportive intensive care. In this report, we describe a case of a 39-year-old woman who developed a small bowel infarct because of an acute thrombotic occlusion of the superior mesenteric artery, also involving the splenic artery.</p> <p>Case presentation</p> <p>A 39-year-old Caucasian woman presented with acute abdominal pain and signs of intestinal occlusion. The patient was given an abdominal computed tomography scan and ultrasonography in association with Doppler ultrasonography, highlighting a thrombosis of the celiac trunk, of the superior mesenteric artery, and of the splenic artery. She immediately underwent an explorative laparotomy, and revascularization was performed by thromboendarterectomy with a Fogarty catheter. In the following postoperative days, she was given a scheduled second and third look, evidencing necrotic jejunal and ileal handles. During all the surgical procedures, we performed intraoperative Doppler ultrasound of the superior mesenteric artery and celiac trunk to control the arterial flow without evidence of a new thrombosis.</p> <p>Conclusion</p> <p>Acute mesenteric ischemia is a rare abdominal emergency that is characterized by a high mortality rate. Generally, acute mesenteric ischemia is due to an impaired blood supply to the intestine caused by thromboembolic phenomena. These phenomena may be associated with a variety of congenital prothrombotic disorders. A prompt diagnosis is a prerequisite for successful treatment. The treatment of choice remains laparotomy and thromboendarterectomy, although some prefer an endovascular approach. A second-look laparotomy could be required to evaluate viable intestinal handles. Some authors support a laparoscopic second-look. The possibility of evaluating the arteriotomy, during a repeated laparotomy with a Doppler ultrasound, is crucial to show a new thrombosis. Although the prognosis of acute mesenteric ischemia due to an acute arterial mesenteric thrombosis remains poor, a prompt diagnosis, aggressive surgical treatment and supportive intensive care unit could improve the outcome for patients with this condition.</p

Predictors of long-term pain and disability in patients with low back pain investigated by magnetic resonance imaging: A longitudinal study

<p>Abstract</p> <p>Background</p> <p>It is possible that clinical outcome of low back pain (LBP) differs according to the presence or absence of spinal abnormalities on magnetic resonance imaging (MRI), in which case there could be value in using MRI findings to refine case definition of LBP in epidemiological research. We therefore conducted a longitudinal study to explore whether spinal abnormalities on MRI for LBP predict prognosis after 18 months.</p> <p>Methods</p> <p>A consecutive series of patients aged 20-64 years, who were investigated by MRI because of mechanical LBP (median duration of current episode 16.2 months), were identified from three radiology departments, and those who agreed completed self-administered questionnaires at baseline and after a mean follow-up period of 18.5 months (a mean of 22.2 months from MRI investigation). MRI scans were assessed blind to other clinical information, according to a standardised protocol. Associations of baseline MRI findings with pain and disability at follow-up, adjusted for treatment and for other potentially confounding variables, were assessed by Poisson regression and summarised by prevalence ratios (PRs) with their 95% confidence intervals (CIs).</p> <p>Results</p> <p>Questionnaires were completed by 240 (74%) of the patients who had agreed to be followed up. Among these 111 men and 129 women, 175 (73%) reported LBP in the past four weeks, 89 (37%) frequent LBP, and 72 (30%) disabling LBP. In patients with initial disc degeneration there was an increased risk of frequent (PR 1.3, 95%CI 1.0-1.9) and disabling LBP (PR 1.7, 95%CI 1.1-2.5) at follow-up. No other associations were found between MRI abnormalities and subsequent outcome.</p> <p>Conclusions</p> <p>Our findings suggest that the MRI abnormalities examined are not major predictors of outcome in patients with LBP. They give no support to the use of MRI findings as a way of refining case definition for LBP in epidemiological research.</p