Long-Term Efficacy of Anti-Tumor Necrosis Factor Agents in Pediatric Luminal Crohn's Disease:A Systematic Review of Real-World Evidence Studies

Purpose: To determine the long-term efficacy of the anti-tumor necrosis factor (TNF) agents, infliximab (IFX) and adalimumab (ADA), in pediatric luminal Crohn's disease (CD) by performing a systematic literature review. Methods: An electronic search was performed in Medline, Embase, and the Cochrane Library from inception to September 26, 2019. Eligible studies were cohort studies with observation periods that exceeded 1 year. Studies that reported time-to-event analyses were included. Events were defined as discontinuation of anti-TNF therapy for secondary loss of response. We extracted the probabilities of continuing anti-TNF therapy 1, 2, and 3 years after initiation. Results: In total, 2,464 papers were screened, 94 were selected for full text review, and 13 studies (11 on IFX, 2 on ADA) met our eligibility criteria for inclusion. After 1 year, 83-97% of patients were still receiving IFX therapy. After 2 and 3 years the probability of continuing IFX therapy decreased to 67-91% and 61-85%, respectively. In total, 5 of the 11 studies subgrouped by concomitant medication consistently showed that the probabilities of continuing IFX therapy in patients with prolonged immunomodulator use were higher than those in patients on IFX monotherapy. Conclusion: This review of real-world evidence studies confirms the long-term therapeutic benefit of IFX therapy in diverse cohorts of children with luminal CD. Moreover, it supports the view that combination therapy with an immunomodulator prolongs the durability of IFX therapy in patients who previously failed to recover following first-line therapy. The limited number of time-to-event studies in patients on ADA prevented us from drawing definite conclusions about its long-term efficacy

Major problems of growing sesame (Sesamum indicum L.) in Nigeria

Sesame ( Sesamum indicum L.) is a crop of great antiquity and probably one of the oldest oilseeds under cultivation. No records on sesame outdate those of Babylon in Sumeria where it was known in 2350 B.C. At present the crop is grown in many tropical and subtropical countries, among which India, China, Mexico, the Sudan and Venezuela rank first in production. Since 1967 most published research has been carried out in India and Venezuela.The total world production which varies considorably from year to year, has shown since 1950/1951 no consistent trend of increase or decrease. It amounted to about 1.8 million ton both in 1950/1951 and 1969/1970. Approximately 10 per cent of the production moves into international trade. In Nigeria purchases of sesame seed by the Marketing Board arrived at 17,459 ton in 1969/1970 and 5,714 ton in 1970/1971. The export is mainly directed towards Italy. Sesame seed contains about 50 Per cent oil and 20 per cent protein, it is a popular constituent of various local dishes and is highly regarded because of the good quality of its oil.The crop is well established in parts of four province- of the Northern States of Nigeria. The production areas are characterised by their location between latitudes 6° and 10°, a duration of the dry season of about 4 to 5 months, an annual rainfall of about 1,000-1,500 mm, a vegetation of rather open savannah woodland and a top soil of loamy sand. The cultivation and crop handling follow traditional patterns and the use of machinery is uncommon.Most of the experimental work reported here has been carried out at the Agricultural Research Station, Mokwa, Nigeria. Section 4 deals with spacing and density experiments. Ways of sowing vary in the different production areas of Nigeria but basically two methods can be distinguished. (a) The Igbirra method, characterised by sowing on ridges about 4 m apart at a spacing of 45 cm between the stands and with about 16 plants per stand, and (b) the Tiv method, which involves broadcasting,rarely followed by thinning; plant counts per unit area showed considerable variation, the mean plant density value being calculated as 673,000 plants per ha. In view of soil and water conservation, sowing on ridges has been a recommended practice in Nigeria for a long time, the distance between the ridges usually being 91 cm. The experimental results under such conditions were interpreted as to give an optimum for a spacing of about 6 cm. on the ridges. Sowing on the flat in 1971 produced a maximum-yield at a spacing of about 22 x 13 cm. In this case a formula derived from Bleasdale and Nelder (1960) was found to describe well the relation between spacing and yield.In both methods, described under (a) and (b) there is room for improvement.In Nigeria. it is common experience that for a good number of crops early sowing, immediately after the onset of the rains, results in maximum yields and delay of sowing causes yield reduction. Factors thought to affect sowing date differences and their consequences for crop growth and yield, were, daylength changes, leaching of nitrogen, capping of the soil caused by hard rain, saturation of the soil with water, and differences in light intensity, disease and post incidence and temperature during the growing season.The data in section 5 provide a quantitative evaluation of the effect of sowing date on growth and yield of sesame. They indicate that the first four factors mentioned cannot explain the typical "sowing date delay effect." However, changes in light intensity, disease incidence and possibly temperature during the season influence the relation between sowing date and crop growth.Most of the common sesame cultivars are characterised by opening or dehiscent capsules. This capsule character has the advantage that it simplifies threshing, but the disadvantage that it increases seed loss. The discovery in 1943 of the indehiscence character in Venezuela by Langham was of great significance, as it enabled increased mechanisation of sesame production, and was expected to reduce seed loss. However, the results of experiments described in section 6 showed that losses caused by shattering of seed from opening capsules is less than visually estimated, and that seed loss need not exceed 2 per cent if a good harvesting method is applied (Fence B). It is concluded that the character of indehiscent capsules will become of value only when combines can be employed economically at harvest. Picking or stripping of capsules appeared to be a method of no practical value.Section 7 mentions the main diseases and pests of sesame and deals in more detail with a virus, disease called leaf-curl. Attempts to transmit the disease with plant sap and with seed failed but white flies were observed to act as vectors of leaf-curl. The damage caused by the disease can be disastrous and it embodies an actual or potential threat to sesame cultivation in Nigeria. Sowing date trials showed that delay of sowing after the onset of the rains increases infection and that the disease incidence decreases when sowing is postponed till after the middle of July. Sowing after the middle of August results in disease-free crops. The magnitude of the white fly population, as estimated by counts on yellow, sticky traps, was not always a reliable indicator for the extent of disease infection. Resistance to leaf-curl was correlated with hairiness in an F 4 bulk population, but occurred also in glabrous plants and reduced the disease damage considerably.</TT

Managing abnormal liver tests in children with inflammatory bowel disease

PURPOSE OF REVIEW: Liver test abnormalities in children with inflammatory bowel disease (IBD) are usually insidious in onset. By the time that symptoms referable to liver disease have appeared, the liver injury may be well advanced. It is, therefore, important that children with an incidental finding of abnormal liver tests are investigated in an appropriate and timely manner. RECENT FINDINGS: The most prevalent cause of liver test elevations in paediatric IBD is immune-related liver disease, including primary sclerosing cholangitis, autoimmune sclerosing cholangitis, and autoimmune hepatitis. Although less common, drugs used in the treatment of IBD can also cause liver injury. The diagnosis of drug-induced liver injury relies largely on excluding other causes of liver injury, such as viral hepatitis, nonalcoholic fatty liver disease, and biliary and vascular complications. SUMMARY: This review highlights an avenue to a step-wise approach for investigating children with IBD and silent liver test elevations. Central to the timing of diagnostic actions is grading the severity of liver test elevations

Can You Tell Me Who My People Are? Ethnic Identity Among the Hispanic-Indian People of Sabine Parish, Louisiana

This thesis explores the puzzle of ethnic identity for the Hispanic-Indian people of Sabine Parish. Because their unique history precludes the clear-cut ethnic identification available to immigrant American groups, the community shares the awkward social position of both the remnant Native American groups and mixed-blood communities collectively known as American Isolates. The issue of group identity for members of the Zwolle-Ebarb community has been further confounded by the internal and external stigmas attached to aspects of the group\u27s origins as well as the negative image associated with the group\u27s home territory. After the people have been identified historically and genealogically, their experience is placed in the context of other American Isolates. Their ethnic identity is examined as one of the identities used in social interaction for the presentation of the self. Both insiders\u27 and outsiders\u27 definitions and perceptions of the group are described from this theoretical perspective. The different formal identity choices used by group members are then reviewed both for their local connotations and for the internal community divisions marked by their use. This basic understanding of the Ebarb-Zwolle community\u27s sense of peoplehood informs the investigation into the ways group identity manifests itself in community members\u27 interactions’ with various outsiders. The inquiry into Ebarb ethnic identity concludes by considering the annual Zwolle Tamale Fiesta. This tourist attraction advertised as an ethnic celebration seems to encapsulate the confusion about community heritage, current interethnic accommodations, and in-group differences. In conclusion, the people of the Zwolle-Ebarb community continue to interact on the basis of a unique group identity, but a tidy form of ethnic designation remains elusive

Termites and agricultural production in the Sahel: from enemy to friend?

Termites are an important component of agroecosystems, particularly in developing countries where they are an alternative to high priced inputs. Given the major problems in the Sahel of soil crusting and nutrient depletion, this paper shows that termites associated with proper management techniques can play a vital role. Termites contribute to the rehabilitation of crusted soils, i.e. by opening up voids on the sealed surface leading to improved infiltration capacity, and consequently improved water availability. It is recommended, however, that participatory on-farm research should be carried out on how to increase the contribution of termites towards soil management and to reduce the harmful effects

Ecolabelling in tourism: The disconnect between theory and practice

Each year the global tourism market records increasing numbers of international tourist arrivals, drawing attention to the negative impacts on environmental sustainability. As such, the concept of sustainability has become of paramount concern in the tourism sector over the last few decades with an emphasis on "going green" and reducing the environmental footprint associated with this growth of tourism. At the same time, tourists have become increasingly concerned about environmental issues while traveling, forcing tourism providers to carefully plan in a sustainable way. The tourism industry has accepted this trend and has applied new approaches and strategies towards environmental sustainability in their management practices. The greening of tourism began when the first ecolabel, Blue Flag, launched in France in 1985. After two years, the company expanded its activities to other European countries; it became an international ecolabel in 2001. The idea behind ecolabelling is to help tourists make informed decision about their prospective destinations. The purpose of this paper is to explore and compare the widespread ecolabelling process in the tourism industry today. Since the first ecolabel in tourism was launched, the number of ecolabels in the tourism sector has rapidly increased in number; today there are more than two hundred distinct ecolabels within the tourism industry. Unfortunately, there is no standardized set of criteria for certification relative to environmental sustainability practices. Given this practical issue within the global tourism industry, this research seeks to review whether the existing scholarship on sustainability and ecolabelling in tourism has informed the actual practice of ecolabel certification

Correcting Confocal Acquisition to Optimize Imaging of Fluorescence Resonance Energy Transfer by Sensitized Emission

AbstractImaging of fluorescence resonance energy transfer (FRET) between suitable fluorophores is increasingly being used to study cellular processes with high spatiotemporal resolution. The genetically encoded Cyan (CFP) and Yellow (YFP) variants of Green Fluorescent Protein have become the most popular donor and acceptor pair in cell biology. FRET between these fluorophores can be imaged by detecting sensitized emission. This technique, for which CFP is excited and transfer is detected as emission of YFP, is sensitive, fast, and straightforward, provided that proper corrections are made. In this study, the detection of sensitized emission between CFP and YFP by confocal microscopy is optimized. It is shown that this FRET pair is best excited at 430nm. We identify major sources of error and variability in confocal FRET acquisition including chromatic aberrations and instability of the excitation sources. We demonstrate that a novel correction algorithm that employs online corrective measurements yields reliable estimates of FRET efficiency, and it is also shown how the effect of other error sources can be minimized

Voriconazole induced periostitis

Case report