Patients achieving sustained deep remission, deep remission or sustained remission of rheumatoid arthritis are more likely than other responders to maintain remission or low disease activity after dose reduction or withdrawal of etanercept

Background Biologic disease-modifying antirheumatic drugs (bDMARDs) are important options for managing rheumatoid arthritis (RA). Once patients achieve disease control, clinicians may consider dose reduction or withdrawal of the bDMARD. Results from published studies indicate that some patients will maintain remission; however, others will flare. We analyzed data from three etanercept down-titration studies in patients with RA to determine what extent of remission provides the greatest predictability of maintaining remission following dose reduction or discontinuation. Methods Patients with moderate to severe RA from the PRESERVE, PRIZE, and Treat-to-Target (T2T) randomized controlled trials were included. We determined the proportion of patients achieving remission with etanercept at the last time point in the induction period, and sustained remission (last two time points), according to the Disease Activity Score 28-joints (DAS28), the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean criteria, and the clinical disease activity index (CDAI). We also calculated the proportion achieving DAS28 deep remission (DAS28 ≤ 1.98), sustained deep remission (last two time points), and low disease activity (LDA), and LDA according to the CDAI. Then, we evaluated whether they maintained remission or LDA following etanercept dose reduction or withdrawal. Results Patients achieving sustained and/or deep remission were more likely than patients achieving remission or LDA to maintain remission/LDA after etanercept dose reduction or withdrawal. In PRESERVE, the proportions of patients with DAS28 sustained deep remission, deep remission, sustained remission, remission, and LDA who maintained remission following etanercept dose reduction were 81%, 67%, 58%, 56%, and 36%, respectively, P < 0.001 for trend. In PRESERVE, this trend was significant when etanercept was discontinued and when ACR/EULAR Boolean and CDAI remission criteria were used. Although some sample sizes were small, the PRIZE and T2T studies also demonstrated response trends according to ACR/EULAR Boolean and CDAI remission criteria, and T2T demonstrated response trends according to DAS28. Conclusions These results suggest that patients achieving disease control according to a stringent definition, such as sustained ACR/EULAR Boolean or CDAI remission, or a new definition of sustained deep remission by DAS28, have a higher probability of remaining in remission or LDA following etanercept dose reduction or withdrawal

Clinical, Radiologic, and Functional Outcomes Following Methotrexate Withdrawal in Etanercept-Treated Patients with Active Early Rheumatoid Arthritis: A Subanalysis of COMET Year 2 by Week 52 DAS28 Status

Introduction: This post-hoc analysis explored Methotrexate (MTX) withdrawal on clinical, radiographic, and functional outcomes in patients with early rheumatoid arthritis who previously received 52 weeks of Etanercept (ETN) + MTX treatment in the COMET study. Methods: Response at week 104 was analyzed based on the attainment of remission (28-joint disease activity score [DAS28] <2.6; Boolean); low disease activity (LDA; 2.6 ≤DAS28 ≤3.2); normal Health Assessment Questionnaire-Disability Index (HAQ-DI) score (≤0.5); or radiographic non-progression (change in modified Total Sharp Score ≤0.5). Results: Of 208 patients with baseline DAS28 scores at week 52, 105 received ETN + MTX and 103 received ETN over weeks 52-104 (Period 2). At week 104, rates of LDA (70% vs 67%), remission (59% vs 52%), and normal HAQ-DI (63% vs 61%) were similar in both arms; week 52 responders also had a higher response rate at week 104 irrespective of treatment during Period 2. Overall rates of radiographic non-progression were higher for ETN + MTX (90%) vs ETN (74%) at week 104; week 52 non-responders in the Period 2 ETN + MTX arm had a 21-27% higher rate vs ETN, while the treatment difference was 11-12% for week 52 responders. Conclusion: The data suggest that for responders to ETN + MTX at week 52, MTX may be safely withdrawn. For non-responders where de-escalation would not be considered, the continuation of the combination is advisable. Radiological outcome was numerically worse, but of uncertain clinical significance

Clinical application of a rapid microbiological test based on capillary zone electrophoresis to assess local skin infection

<p>Abstract</p> <p>Background</p> <p>The basic clinical problem associated with infection treatment is the fact that classic, commonly and routinely used isolation and identification methods are based on long-term processes of a phenotypic analysis of microorganisms. Consequently sometimes, especially in small centres, rapid implementation of antibacterial treatment becomes delayed.</p> <p>The work presents the initial results of rapid microbiological identification based on an original method of capillary zone electrophoresis (CZE). The study involved the analysis of 78 biological samples from post-operative wounds and trophic ulcers.</p> <p>Results</p> <p>The attempt was made to identify individual bacterial species based on characteristic features of electropherograms achieved. Finally, G(+) cocci type bacteria and different G(-) rods were identified with sensitivity of 88.1% and specificity of 100%.</p> <p>Conclusions</p> <p>Based on the clinical trials using an electrophoretic technique in the field of microbiological diagnostics of infected exudate from a post-operative wound it can be concluded that it is a rapid and relatively sensitive method for initial identification of infectious pathogens.</p

Supramolecular recognition of estrogens via molecularly imprinted polymers

The isolation and preconcentration of estrogens from new types of biological samples (acellular and protein-free simulated body fluid) by molecularly imprinted solid-phase extraction has been described. In this technique, supramolecular receptors, namely molecularly imprinted polymers (MIPs) are used as a sorbent material. The recognition sites of MIPs were prepared by non-covalent multiple interactions and formed with the target 17β-estradiol as a template molecule. High-performance liquid chromatography with spectroscopic UV, selective, and a sensitive electrochemical CoulArray detector was used for the determination of 17β-estradiol, estrone, and estriol in simulated body fluid which mimicked human plasma

Econometrical analysis of changes to the averageprice per square meter for the land properties in Poland in the years 2004-2016

Wstęp i cel: Artykuł zajmuje się usystematyzowaniem wiedzy o zmianach średniej ceny metra kwadratowego nieruchomości gruntowej w Polsce w latach 2004-2016. Jego celem jest stworzenie matematycznego opisu zmian zachodzących we wskazanej cenie w zadanym okresie. Na podstawie oszacowanego modelu ekonometrycznego ustalona została prognoza na rok 2017. Materiał i metody: Analiza została przeprowadzona metodą regresji na podstawie raportów GUS. Dla lat 2004-2008 Transakcje kupna/sprzedaży nieruchomości, dla lat 2009-2016 „Obrót nieruchomościami”. Wyniki: Zmiany średniej ceny metra kwadratowego nieruchomości gruntowych w Polsce da się przedstawić w postaci modelu ekonometrycznego o wymaganym stopniu dopasowania, a najlepiej zmiany te odzwierciedla wykładniczy model trendu stopnia trzeciego. Wniosek: Dostosowany model ekonometryczny pozwala na przewidzenie przyszłych zmian ceny metra kwadratowego nieruchomości gruntowej w Polsce i sugeruje dalszy, dość gwałtowny wzrost.Introduction and aims: Article deals with systematizing knowledge of changes to the average price per square meter for the land properties in Poland in the years 2004-2016. It’s goal is creation of mathematical description of changes happening with the price in stated period of time. Prediction for the year 2017 was based on estimated econometric model. Materials and methods: Analysis was carried out with regression method based on reports provided by GUS. For the years 2004-2008 transactions of purchase/sale of properties, for the years 2009-2016 properties trading. Results: Changes to the average price per square meter for the land properties in Poland can be shown in the form of econometric model with the required degree of matching and the best way is to show these changes on exponential third degree trend model. Conclusion: The adapted econometric model allows to predict future changes of the price per square meter for the land properties in Poland and suggests quite sudden and continued growth

Planning, defining and realization of production

Planning for production include the problems concerning to material and products flow in enterprises all industrial branches. Flow cycles of material and products exist during production process schedule and such a flow ought to be inspected or/and in case of need, be corrected, so it ought to be controlled.Planowanie produkcji, obejmuje zagadnienia związane z przepływem materiałów i wyrobów w przedsiębiorstwach związanych ze wszystkimi dziedzinami przemysłu. Cykle przepływu materiałów i wyrobów odbywają się podczas realizacji harmonogramu procesu produkcyjnego, a przepływ taki musi być kontrolowany i w miarę konieczności korygowany, czyli powinien być sterowany

Optimization of the position of the local distribution centre of the regional post logistics network

The phenomenon of the present postal services is the fact that, customers expect the lowest price while maintaining the availability, security and on time delivery of mail items. We can find that, the costs associated with transport of the postal substrate is one of the most important factors affecting the total cost of the postal services. These transport costs depend on various factors such as the investment in vehicles purchase, operational costs of the postal vehicles (costs of maintenance, repairs, fuel costs of the vehicle, etc.) labour costs of the drivers and so on. For this reason, it is important to find such an operational - organizational solutions that can reduce the costs associated with the transportation of postal shipments, resulting in reducing the total cost of postal services. One option to do this is to minimize the length of postal transportation routes. This article presents the approach based on the application of graph theory to optimize existing connections of postal logistics network. Published results is oriented to revaluate existing position of local centre and find a location for the new local distribution centre potentially. New location of local distribution centre can to optimize (minimize) the total transport costs of the local postal transportation network in area of the Lublin Province