Disease activity and damage in juvenile idiopathic arthritis: Methotrexate era versus biologic era

Objective: To compare the long-term disease state, in terms of activity and damage, of children with juvenile idiopathic arthritis (JIA) who had their disease onset in methotrexate (MTX) or biologic eras. Methods: Patients were included in MTX or biologic era cohort depending on whether their disease presentation occurred before or after January 2000. All patients had disease duration 65 5 years and underwent a prospective cross-sectional assessment, which included measurement of disease activity and damage. Inactive disease (ID) and low disease activity (LDA) states were defined according to Wallace, JADAS10, and cJADAS10 criteria. Articular and extraarticular damage was assessed with the Juvenile Arthritis Damage Index (JADI). Results: MTX and biologic era cohorts included 239 and 269 patients, respectively. Patients were divided in the "functional phenotypes" of oligoarthritis and polyarthritis. At cross-sectional visit, patients in the biologic era cohort with either oligoarthritis or polyarthritis had consistently higher frequencies of ID and LDA by all criteria. The measurement of disease damage at cross-sectional visit revealed that the frequency of impairment of > 1 JADI-Articular items was higher in MTX than in biologic era cohort (17.6% versus 11% in oligoarthritis and 52.6% versus 21.8% in polyarthritis). Likewise, frequency of involvement of > 1 JADI-Extraarticular items was higher in the MTX than in the biologic era cohort (26.5% versus 16.2% in oligoarthritis and 31.4% versus 13.5% in polyarthritis). Conclusion: Our study provides evidence of the remarkable outcome improvement obtained with the recent therapeutic advance in JIA

Polarimetric SAR Image Segmentation with B-Splines and a New Statistical Model

We present an approach for polarimetric Synthetic Aperture Radar (SAR) image region boundary detection based on the use of B-Spline active contours and a new model for polarimetric SAR data: the GHP distribution. In order to detect the boundary of a region, initial B-Spline curves are specified, either automatically or manually, and the proposed algorithm uses a deformable contours technique to find the boundary. In doing this, the parameters of the polarimetric GHP model for the data are estimated, in order to find the transition points between the region being segmented and the surrounding area. This is a local algorithm since it works only on the region to be segmented. Results of its performance are presented

Hemodynamic effects of intravenous morphine infusion in ventilated preterm babies

Background: the importance of sedation acid analgesia of newborn babies in intensive care is only now receiving recognition in many neonatal units. Objective: to evaluate the hemodynamic effects of morphine on Cerebral Blood Flow velocities (CBFv), Cardiac Output (CO), Stroke Volume (SV), Mean Arterial Blood Pressure (MABP) and Heart Rate (HR) in ventilated preterm infants, before and during the infusion of a loading dose. Design: prospective, open, non-randomized, before-after intervention study with hemodynamic measurements made by Doppler ultrasound. Setting: neonatal Intensive Care Unit, Tertiary Care Center. Patients: sequential sample of 30 ventilated preterm newborns (gestational age (GA) 29 ± 2 wks, range 27-31, birth weight (BW) 1240 ± 440 g, range 800-1680). lntervention: each subject received an intravenous loading dose of morphine (100 mcg/Kg/h) for 2 h, followed by a continuous infusion of 25 mcg/kg/h. Measurements: the following Doppler parameters of the anterior cerebral artery were estimated: Peak systolic flow velocity (Vs), end-diastolic flow velocity (Vd), mean flow velocity (Vm) and Pourcelot' Resistance Index (RI). Measurements of CBFv, CO and SV (by Doppler ultrasound), MABP and HR were made 30 min before (baseline values) and at 15 (M15), 30 (M30), 60 (M60) and 120 min (M120), during the morphine loading infusion. Statistical evaluation analysis of variance, significance was calculated by Student-Newman-Kenfeld test. Results: there were no statistically significant changes in the cerebral and cardiac Doppler parameters before or during the 120 min of morphine loading infusion. There was a non-significant fall in MABP (MABP: Baseline value = 44 ± 6 mmHg, M120 = 42 ± 4 mmHg; reduction = 4%) and HR (HR = Baseline value = 148 ± 12 beats/min., M120 = 140 ± 16 beats/min.; reduction = 5%). Conclusions: a loading dose of morphine over 2 h did not have any significant effect on MABP or cerebral and cardiac hemodynamics. No adverse effects were noted that could be attributed to morphine therapy