Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial)

Contains fulltext : 69534.pdf (publisher's version ) (Open Access)BACKGROUND: With the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction.The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs. METHODS/DESIGN: The study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007. DISCUSSION: The LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease. TRIAL REGISTRATION: Nederlands Trial Register NTR1150

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

A Late Chalcolithic to Early Bronze Age I Progression at the Buchman South quarter in Modi’in – in the central piedmont (Shephela) of Israel

The cluster of LC (Late Chalcolithic) and early EB I (Early Bronze Age I) sites at the Buchman South quarter in Modi’in offers a virtually unique opportunity to examine intra-site developments against a regional background, over a time span stretching from about the last quarter of the 5th millennium to well into the first half of the 4th millennium BC. Based on the multi-faceted archaeological record of Modi’in, two main hypotheses are developed here : 1) there are two LC phases in the Shephela (western piedmont of the Judea/ Samaria incline), an LC1 phase corresponding to the so-called Ghassulian period, and a post-Ghassulian LC2 phase corresponding to the relocation of LC1 Negev peoples into the Coastal Plain and in the Shephela ; 2) early EB I is an evolution from LC2, implying that the early EB I peoples could have been descendants from the LC2 population. These hypotheses are fundamental to better understand the transition between the LC and EB I periods that apparently took place within a time span signifi cantly shorter than previously assumed.Les sites du Chalcolithique final – Bronze ancien du secteur sud de Buchman à Modi’in offre une opportunité unique d’examiner des développements intra-sites dans un contexte régional, sur une durée qui s’étend du dernier quart environ du Ve millénaire à la première moitié du IVe millénaire avant notre ère. Deux hypothèses principales sont développées ici, fondées sur la documentation archéologique aux multiples facettes de Modi’in : 1) il existe deux phases dans le Chalcolithique final de la Shephela (piémont occidental des Monts de Judée/ Samarie), un Chalcolithique final 1 correspondant au Ghassoulien et un Chacolithique final 2, dénommé post-Ghassoulien, correspondant au déplacement des populations du Négev du Chalcolithique final 1 vers la plaine côtière et dans la Shephela ; 2) le début du Bronze ancien est une évolution issue du Chalcolithique final 1, impliquant que les populations du début du Bronze ancien pourraient avoir été des descendants de la population du Chacolithique final 2. Ces hypothèses sont au fondement d’une meilleure compréhension de la transition entre le Chalcolithique final et le début du Bronze ancien dont la durée semble plus courte que supposée auparavant.Van den Brink Edwin C. M. A Late Chalcolithic to Early Bronze Age I Progression at the Buchman South quarter in Modi’in – in the central piedmont (Shephela) of Israel. In: Paléorient, 2013, vol. 39, n°1. The Transition Late Chalcolithic to Early Bronze Age in the Southern Levant. pp. 47-61

The Pottery-Incised Serekh-Signs of Dynasties 0-1. Part II : Fragments and Additional Complete Vessels

This second installment of a tripartite study on early incised serekh-signs focuses on royal insignia/inscriptions preserved on fragmented pottery vessels found in Dynasty 0 and early First Dynasty contemporary contexts in Egypt, the southern Levant and Lower Nubia. In addition, another nine complete jars, a complement to 24 intact jars with incised serekh-signs presented in the first part of this study, are included in this installment. This study also describes the gradual transmogrification of incised pottery serekh-signs from non-distinct plain and anonymous examples to ten distinct groups of personalized serekhs, each associated with a specific ruler. It also suggests a new reading for a serekh from Minshat Abu Omar Tomb 160 and the existence of a previously unknown ruler Ḥr N.j Nj.t "Horus He-who-belongs-to-Neith", identified from his serekh. In addition, a suggestion is cautiously submitted for distinguishing between a ruler Nar and a later monarch, Horus Narmer, the first king of Dynasty 1 and occupant of Tomb B 17/18 in the royal cemetery B at Abydos.Ce second volet d'une étude tripartite sur les premiers signes incisés de serekh se concentre sur les inscriptions/insignes royaux conservés sur des céramiques fragmentées contemporaines du contexte de la dynastie 0 et du début de la 1ère dynastie, en Egypte, au Levant-Sud et en Basse-Nubie. En plus, neuf jarres complètes ont été ajoutées, en complément aux 24 présentées dans le premier volet. Cette étude décrit également la transformation graduelle des serekh incisés, depuis les exemples simples, non distincts et anonymes jusqu'aux dix groupes distingués de serekh personnalisés, chacun étant associé à un souverain spécifique. On suggère également une nouvelle lecture pour un serekh provenant de la tombe 160 de Minshat Abu Omar et l'existence d'un souverain jusqu'alors inconnu, identifié sur ce serekh, "Horus, Celui qui appartient à Neith". Une suggestion est également proposée avec prudence dans la distinction entre un souverain Nar et un monarque plus tardif, Horus Narmer, premier roi de la 1ère dynastie et occupant de la tombe B 17/1 8 du cimetière royal d'Abydos.Van den Brink Edwin C. M. The Pottery-Incised Serekh-Signs of Dynasties 0-1. Part II : Fragments and Additional Complete Vessels. In: Archéo-Nil. Revue de la société pour l'étude des cultures prépharaoniques de la vallée du Nil, n°11, 2001. L'invention de l'écriture. pp. 23-100

Egyptian Elements and Influence on the Early Bronze Age I of the Southern Levant. Recent excavations, Research and Publications

Recent archaeological activity has yielded much new information and many new data on the degree of Egyptian influence in the material culture of the Early Bronze I period in the southern Levant (ca. 3500 BC to 3000 BC). This paper briefly discusses major increments in knowledge of this subject derived from the archaeological record, while outlining both old and new directions in research derived from them.Van den Brink Edwin C. M., Braun Elliot. Egyptian Elements and Influence on the Early Bronze Age I of the Southern Levant. Recent excavations, Research and Publications. In: Archéo-Nil. Revue de la société pour l'étude des cultures prépharaoniques de la vallée du Nil, n°13, 2003. Actualité de la recherche prédynastique : les terrains de fouilles. 2-La Basse-Égypte. pp. 77-91