Mean Disease Research Articles

PTU-076 Is faecal calprotectin (FC) a reliable marker of isolated small bowel crohn’s disease (CD) activity?:

Introduction The measurement of FC is considered an important investigation in both the diagnosis and assessment of activity in CD. However, it’s accuracy in isolated small bowel disease (Montreal classification L1) compared to colonic (L2) and ileocolonic (L3) remains undetermined. This study aims to establish whether FC can be used to assess disease activity in L1 disease with the same degree of confidence as with other disease locations. Method 197 patients were selected from our biologics cohort. All patients had FC measured at the same time as C-Reactive Protein (CRP) and Harvey Bradshaw Index (HBI) were documented. Statistical analysis was done using SPSS version 22. FC (units of IU/ml) for comparisons underwent Log 10 transformation. Significances between means were obtained using independent 2 sample t-test and the oneway ANOVA test. Results Patients were divided according to Montreal classification; L1 (n = 28), L2 (n = 59) and L3 (n = 108). Mean FC for the 3 groups were 344 (median = 100), 379 (median = 80) and 288 (median = 71) respectively (P = 0.728). Comparison of mean FC was made between patients with active disease (mean FC = 543) and inactive disease (mean FC = 216); the difference was statistically significant (P 5. The table above shows the significance of the relationship between mean FC and disease activity for the 3 disease locations. Conclusion We show that, as previously established, FC is a good marker of disease activity when compared against HBI and CRP. However in L1 disease there was no significant difference in the FC of patients with active versus inactive disease. Therefore, we conclude that disease activity cannot be determined by FC alone in isolated small bowel disease. Disclosure of interest B. Warner: None Declared, E. Johnston: None Declared, M. Ward: None Declared, P. Irving Speaker Bureau of: AbbVie, MSD, Takeda, Warner Chilcott, Shire, Ferring and Tillotts Pharma.

Huanglongbing management on bearing groves based on favorable periods for symptomatic-trees removal and vector control

Author(s): Bassanezi, R. B.; Montesino, L. H.; Bergamin Filho, A. | Abstract: In Brazil, Huanglongbing (HLB) has been managed by removal of symptomatic-trees and Asian citrus psyllid (ACP) control. Although new HLB-affected trees and ACP can be detected all year long, visual detection of HLB-affected trees has been more pronounced from March to August while ACP population densities are higher from September to February. Therefore, the aim of this work was to compare the efficiency of applying the control strategies only during the higher occurrence periods of new HLB affected trees and ACP adults with the control application during all year long. The experiment was carried out in a 4-yr old sweet orange Valencia/Rangpur lime grove and had a 2 by 3factorial design with 3 replications (1.4 ha plots). The factor “HLB-tree elimination” had 2 treatments: monthly elimination all year long; and monthly elimination from March to August, both based on visual inspection. The factor “Vector control” had 3 treatments: monthly ACP control all year long; monthly ACP control from September to February; and ACP control when 10% of 48 yellow sticky traps (YST) placed in the center of plots had at least one adult psyllid. All Treatments of ACP control were done alternating foliar sprays of Provadoâ, Dimetoatoâ, Trebonâ and Marshalâ+Micromiteâ. After 5 years, no significant differences were detected among different treatments for the variables mean cumulative HLB incidence and disease progress rate estimated by linear regression of the last 4 years cumulative disease incidence. The mean cumulative HLB incidence increased from 0.4% to 14.2% (Yr1 4.9%, Yr2 1.9%, Yr3 2.3%, Yr4 1.7%, and Yr5 3.0%). The number of caught ACP per YST per assessment and the area under the curve of percentage of YST with ACP were significantly higher for monthly ACP control from September to February (total of 34 sprays), but did not differed between monthly ACP control all year long (total of 65 sprays) and control based on ACP monitoring with YST (total of 21 sprays). We believe that HLB management wasn’t better because there was a significant amount of new HLB-symptomatic trees (25.2%) found from December to February, and 12.3% of ACP caught in August. In conclusion, with some adjusts the management of HLB could be optimized according to the favorable periods for HLB-symptomatic trees detection and ACP populations.

Early palliative care on an inpatient oncology unit: Impact of a novel co-rounding partnership on patient and health system outcomes.

3 Background: Early palliative care (PC) improves outcomes for outpatients with advanced cancer, but its impact on an inpatient oncology unit is unknown. We implemented a novel inpatient medical oncology (ONC) and PC co-rounding partnership on September 1, 2011 at Duke University Hospital. Here we report its impact on patient and health system outcomes during its first year of implementation. Methods: We extracted patient data including demographics, cancer diagnosis, disease status, length of stay (LOS), ICU transfer rate, discharge disposition, time to ER return, time to readmission, and 7- and 30-day ER return and readmission rates (RR). Pre- and post-intervention cohorts were defined as all patients admitted or transferred to the solid tumor inpatient service from September 1, 2009-June 30, 2010 and September 1, 2011-June 30, 2012, respectively. Nursing and physician surveys assessed satisfaction. We used descriptive statistics, Student’s t-test, and Fisher’s exact test for analyses. Results: The pre- and post-intervention analysis cohorts included 731 and 783 patients respectively, representing 2,353 encounters. Cohorts were similar in baseline characteristics, including mean age (61 vs. 62; p=0.07), gender (male: 51% vs. 48%; p=0.22), race (white: 68% vs. 71%; p=0.39), insurance coverage (Medicare: 49% vs. 51%; p=0.96), and disease status (recurrent/metastatic: 73% vs. 74%; p=0.6). Post-intervention patients had a statistically significant decrease in mean LOS (p=0.02) from 4.51 days (95% CI 4.3-4.73) to 4.17 days (95% CI 3.97-4.37), and statistically significant improvements in 7- and 30-day readmission rates, representing a 15% (p=0.03) and 23% (p=0.05) improvement, respectively. We observed a trend for increasing hospice referral (p=0.09) and a 15% decrease in ICU transfers. Physicians and nurses universally favored the model. Conclusions: A fully-integrated, inpatient co-rounding partnership between PC and ONC resulted in statistically significant improvements in key health system-related outcomes and indicators of quality cancer care.

Clinicopathologic Study of Vulvar Paget’s Disease in China

To assess the clinicopathologic characteristics of patients with vulvar Paget's disease who were admitted in our hospital or of cases reported in a Chinese journal. The age, disease course, clinical manifestation, pathologic diagnosis, treatment, and follow-up data of patients with vulvar Paget's disease were reviewed. There were 85 cases of vulvar Paget's disease reviewed. The mean age of patients with vulvar Paget's disease was 64.4 years, and their mean disease course was 52.36 months. The patients' primary clinical manifestations were pruritus. Treatment included simple vulvectomy, wide local excision, partial vulvectomy, radical vulvectomy with/without groin dissection, and radiotherapy. Intraepithelial Paget's disease was the most common pathology type (61.5%) followed by invasive Paget's disease (20.0%). There were 7 patients who had a history of secondary malignancy. The mean follow-up period was 43.6 months. The recurrence rate was as high as 43.5%. No significant relationships between margin status, lymph node involvement, pathology type, and recurrence were found (p > .05). Vulvar Paget's disease has a high local recurrence risk and a long-term follow-up is required.

94 Looking Beyond Deep Remission: Effect of Biologic Therapy on Transmural Healing Evaluated by Ultrasound in Pediatric Ileal Crohn's Disease

BACKGROUND AND AIM: Therapeutic goals for Crohn's disease (CD) have evolved from a mere control of symptoms to the concept of deep remission (DR), including clinical and biomarker remission and mucosal healing (MH). Biologic therapy with anti-TNFα is effective in achieving MH. Yet, CD is a transmural disease, characterized by a progressive bowel damage leading to complications. This is the first pediatric study prospectively evaluating the efficacy of anti-TNFα therapy in inducing clinical remission, MH and transmural healing (TH) in ileal CD. METHODS: Pediatric patients (pts) with ileal CD starting biological therapy with Infliximab or Adalimumab were prospectively enrolled. All pts were Naive to biologics. Clinical activity (Pediatric Crohn's Disease Activity Index, PCDAI), laboratory tests (CRP, ESR), endoscopic activity (simple endoscopic score, SES-CD) and transmural disease assessed by small intestine contrast ultrasonography (SICUS) were evaluated before starting (T0) and after 9-12 months of therapy (T1). Complete MH was defined as a SES-CD of 0-1, partial MH as 50% decrease vs T0. At US the evaluated parameters were: extension of disease (cm), bowel wall thickness >3 mm (BWT), bowel wall vascularity, stratification of the BW (BWS), presence of stricture, fistulae and abscess. Wilcoxon signed rank test was used for pair comparison (T1-T0). RESULTS: 26 pts (mean age 13.3 ± 4, 16 males) were included. The mean PCDAI, ileal SES-CD, CRP, ESR, BWT and disease extension values significantly decreased at T1 (table). Increased bowel wall vascularity was present in 80% of pts at T0 and in 24% at T1 (p<0.0001). In pts with complete and partial MH the extension of disease and themean BWT at US were significantly reduced at T1 (p<0.02); in pts without endoscopic response the US parameters didn't change significantly, despite clinical response. Presence of strictures and BWS didn't modify during therapy in any group. CONCLUSIONS: Biologics are effective in inducing clinical and laboratory remission and in achieving MH in pediatric CD. Transmural inflammation significantly improves during therapy, however when a substantial bowel damage (stricture) is present, the effect on TH might be poorer. Further studies are needed to evaluate the impact of TH on the long term outcome of CD. CLINICAL, ENDOSCOPIC AND US DATA AT T0 AND T1

95 Exome Sequencing Analysis of Candidate Genes in Very Early Onset IBD

BACKGROUND AND AIM: Therapeutic goals for Crohn's disease (CD) have evolved from a mere control of symptoms to the concept of deep remission (DR), including clinical and biomarker remission and mucosal healing (MH). Biologic therapy with anti-TNFα is effective in achieving MH. Yet, CD is a transmural disease, characterized by a progressive bowel damage leading to complications. This is the first pediatric study prospectively evaluating the efficacy of anti-TNFα therapy in inducing clinical remission, MH and transmural healing (TH) in ileal CD. METHODS: Pediatric patients (pts) with ileal CD starting biological therapy with Infliximab or Adalimumab were prospectively enrolled. All pts were Naive to biologics. Clinical activity (Pediatric Crohn's Disease Activity Index, PCDAI), laboratory tests (CRP, ESR), endoscopic activity (simple endoscopic score, SES-CD) and transmural disease assessed by small intestine contrast ultrasonography (SICUS) were evaluated before starting (T0) and after 9-12 months of therapy (T1). Complete MH was defined as a SES-CD of 0-1, partial MH as 50% decrease vs T0. At US the evaluated parameters were: extension of disease (cm), bowel wall thickness >3 mm (BWT), bowel wall vascularity, stratification of the BW (BWS), presence of stricture, fistulae and abscess. Wilcoxon signed rank test was used for pair comparison (T1-T0). RESULTS: 26 pts (mean age 13.3 ± 4, 16 males) were included. The mean PCDAI, ileal SES-CD, CRP, ESR, BWT and disease extension values significantly decreased at T1 (table). Increased bowel wall vascularity was present in 80% of pts at T0 and in 24% at T1 (p<0.0001). In pts with complete and partial MH the extension of disease and themean BWT at US were significantly reduced at T1 (p<0.02); in pts without endoscopic response the US parameters didn't change significantly, despite clinical response. Presence of strictures and BWS didn't modify during therapy in any group. CONCLUSIONS: Biologics are effective in inducing clinical and laboratory remission and in achieving MH in pediatric CD. Transmural inflammation significantly improves during therapy, however when a substantial bowel damage (stricture) is present, the effect on TH might be poorer. Further studies are needed to evaluate the impact of TH on the long term outcome of CD. CLINICAL, ENDOSCOPIC AND US DATA AT T0 AND T1

P308 Treatment of corticosteroid naive children and adolescents with ulcerative colitis by adsorptive depletion of myeloid lineage leucocytes as monotherapy or in combination with low dose prednisolone after failure of first-line medications

Results: 201 patients recruited by 19 Spanish gastroenterologists were included. 55.7% were male and mean (SD) age was 38.9 (12.3) years. The mean (SD) disease duration was 8.6 (8.1) years. Most of the patients had disease in the terminal ileum (L1: 42.3%), with a non-structuring, non-penetrating behaviour (B1: 54.7%). Perianal disease was present in 41 (20.4%) patients. 102 patients (50.7%) were in clinical remission. Scenarios E and F were the most preferred (57.3% and 53.7% respectively). The least preferred was scenario A (19.9%). Treatment administered by healthcare personnel (0.155), treatment administered at home (0.485) and subcutaneous treatments (0.053) were considered as the most useful. These scores indicate the value of each characteristic has been perceived by patients [from 1 (high) to 0 (low)]. And the result of the most influence factor when choosing a CD therapy is the place where the treatment is administered with an importance of 50.7%. Conclusions: A validated questionnaire to evaluate patient’s preferences has been applied to CD patients, enabling involvement of the patient in treatment making decisions, which could have the benefit of improving adherence and effectiveness. The results demonstrated that treatment administered at home had the greatest impact on preferences.

Clinical significance of adiponectin expression in colon cancer patients.

Surgery is the definitive treatment for early colon cancers. Adjuvant therapies are used with the aim of eradicating micrometastases and improving cure rates. Recent studies have proposed that adiponectin might be responsible for obesity-related malignancies. We investigated the prognostic value of this cytokine. Patients who underwent surgical removal of stage II or III (TNM staging) primary tumors and were followed for at least three years were included in the study given adequate specimen for immunohistochemical evaluation. Based on these criteria, 53 patients were included. Mean age was 58.3 ± 10.1 years (35-78 years). The mean follow-up time was 41 months (10-96 months). Immunohistochemical evaluation identified 21 patients (39.6%) with cytoplasmic adiponectin present in their specimens. The rates of recurrence were 42.9% (9/21) and 34.4% (11/32) in patients with and without adiponectin expression, respectively. In cases with adiponectin expression, mean disease - free survival was 60.3 ± 9.03 months, and in cases without adiponectin expression, mean disease - free survival was 68.7 ± 6.67 months (P = 0.414). Mean overall survival of patients with adiponectin expression was 65 months compared to 67 months for patients without (P = 0.786). Adiponectin, which is secreted by adipose tissue, may have a role in the development and progression of cancer via its pro-apoptotic and/or anti-proliferative effects. Adiponectin expression in tumor tissues is likely to have a negative effect on disease - free survival in patients with stage II/III colon cancer; however, no statistically significant effect was demonstrated.

MYST3/CREBBP Rearranged Acute Myeloid Leukemia after Adjuvant Chemotherapy for Breast Cancer.

Although rare, clinicians and patients must be aware that therapy related malignancies, specifically acute myeloid leukemia (AML), can occur as a complication of adjuvant chemotherapy for breast cancer. Vigilance for signs and symptoms is appropriate. AML with t (8;16) is a specific translocation leading to formation of a fusion protein (MYST3/CREBBP). The MYST3/CREBBP AML tends to develop within 2 years of adjuvant chemotherapy, especially for breast cancer, without preceding myelodysplasia. It usually presents with disseminated intravascular coagulation and osteolytic lesions and has a poor prognosis despite aggressive resuscitation and therapy. With the increasing use of adjuvant chemotherapy for breast cancer, we are seeing a definite increase in the incidence of therapy related myelodysplastic syndromes and AML. One must keep this complication in mind while counseling and following up breast cancer patients who have received adjuvant chemotherapy. New osteolytic bone lesions in a patient with history of breast cancer do not necessarily mean metastatic disease and should be fully evaluated.

A combination of solifenacin succinate and naftopidil in the treatment of female overactive bladder

To explore the effective therapy of female overactive bladder unresponsive to behavior training. A total of 67 patients with female overactive bladder unresponsive to behavior training were enrolled from January 2012 to January 2013 at Liaocheng Second People's Hospital. They were randomized into trial and control groups (Iand II). Their mean age was 39.8 (19-57) years. And the mean disease course was 3.8 (1-16) years. The trial group (n = 24) received oral formulations of solifenacin succinate (5 mg, once a day)and naftopidil (25 mg, every evening). The control group I (n = 22) had only solifenacin succinate and the control group II (n = 21) only naftopidil. The treatment lasted for 4 weeks. The time of urination per day, average amount of mona-urination and maximum amount of mona-urination were observed. The changes of all parameters before and after treatment were assessed. And statistic analysis was performed. The urinary urgency score of the trial, control group I and control II groups were 0.8 ± 0.1, 1.8 ± 0.8, 2.1 ± 0.9; and the times of urination per day 9 ± 4, 13 ± 4, 14 ± 5, average amount of mona-urination (295 ± 79), (211 ± 67), (185 ± 64) ml and maximum amount of mona-urination (352 ± 88), (292 ± 75), (235 ± 69) ml respectively. These parameters showed significant differences between the trial and control groups (all P < 0.05). A combination of solifenacin succinate and naftopidil can effectively relieve the symptoms of female overactive bladder and improve the life quality.

Application of modified endoscopic thyroidectomy via chest and breast areola approach for benign thyroid disease patients

Objective To study the safety and feasibility of modified endoscopic thyroidectomy via chest and breast areola approach for benign thyroid disease patients.MethodsA total of 56 female benign thyroid disease patients,who received endoscopic thyroidectomy in our hospital from March 2011 to March 2012,were included in this study.And 28 of them underwent modified endoscopic thyroidectomy(modified group).Taking the advantage of movable female breast and the long rod-shaped endoscopic instrument,the operation was modified based on endoscopic thyroidectomy via chest and breast areola approach,without subcutaneous dissection of the chest wall.Another 28 patients received conventional approach treatment(conventional group).The two groups were matched in mean age and disease causes.The operation time,blood loss,post-operative pain degree,post-operation hospital stay,and complications were compared between the two groups.ResultsThe operation time,blood loss,post-operation hospital stay,and post-operation drainage volume were not significantly different between the two groups.Compared with patients in the conventional group,patients in modified group suffered significantly less post-operation pain,with mean visual analogue scale scores being 3.0±1.6 vs 4.5±1.8(P =0.042).The modified group also had significantly reduced incidence of skin redness and subcutaneous ecchymosis,edema and chance of effusion on the anterior chest wall(0 vs 21.4%,P =0.01).There were no damages to recurrent laryngeal nerve or parathyroid glands or postoperative hemorrhage in the 56 patients.ConclusionThe modified endoscopic thyroidectomy via chest and breast areola approach is a safe and effective method,and it can greatly reduce the trauma of conventional endoscopic thyroidectomy.

Study on the safety and efficacy of tocilizumab, an anti-IL-6 receptor antibody, in patients with rheumatoid arthritis complicated with AA amyloidosis

Objectives: Although treatment of rheumatoid arthritis (RA) has progressed by the use of biologics, amyloid A (AA) amyloidosis is still an intractable complication in patients with RA. In the present study, safety and efficacy of 1-year treatment with an anti-IL-6 receptor antibody tocilizumab (TCZ) on RA and AA amyloidosis were estimated.Methods: TCZ (8 mg/kg every 4 weeks) was administered to five RA patients complicated with AA amyloidosis. The primary end point was improvement in renal dysfunction and the secondary end point was CDAI at 1 year after the treatment.Results: An improvement in the renal dysfunction, including urinary protein secretion, was found, in four patients including two patients who were refractory to etanercept, with a remarkable decrease of SAA concentration, and the progression of organ dysfunction was prevented at 1 year in all patients treated with TCZ. The mean clinical disease activity index decreased from 33.9 to 4.7 (p = 0.012) in five patients treated with TCZ for 1 year. Three non-serious adverse events were observed in two patients.Conclusions: TCZ ameliorates renal dysfunction in RA patients complicated with AA amyloidosis who are refractory to conventional therapies, thereby suggesting that TCZ has a potential to regulate AA amyloidosis.

Extremity nonunion treated by modified autologous iliac grafting

Objective To observe the efficacy of treating extremity nonunions by modified autologous iliac grafting.Methods Included in this study were 60 patients who had been treated for extremity nonunion in our department between May 2010 and May 2011.They were 45 men and 15 women,with an average age of 39.2 years (range,13 to 68 years).There were 7 humeral nonunions,19 tibial nonunions,27 femoral nonunions,4 radial nonunions,and 3 clavicle nonunions; by Weber classification,there were 3 hypertrophic nonunions,15 atrophic nonunions,37 ischemic nonunions and 5 pseudarthroses.The mean disease course of nonunion was 12.5 months (from 6 to 25 months).Before this revision,42 patients had one operation,17 had 2 operations and one patient had 3 operations; 45 patients had been treated with plate,8 with intramedullary nail and 7 with external fixator.This revision was performed using modified autologous iliac grafting followed by bridging fixation with locking plate.All patients were followed to document fracture healing and complications.Results The average follow-up was 12.8 months (range,6 to 24 months).The secondary revision led to bone union in 59 cases after a mean time of 5.3 months (range,4 to 8 months).One case of femoral nonunion suffered plate breakage 6 months postoperation which had to be revised by re-grafting and reconstruction plating augmented in the grafting area.No complications like infection,deformity,leg length discrepancy and pain at the bone donating area occurred in this series.Conclusion The modified autologous iliac grafting is highly efficient in curing extremity nonunions,because it can greatly activate the bone graft and increase the conductive and osteoinductive capabilities of the bone graft. Key words: Fractures, ununited; Extremities; Bone transplantation

Magnetic resonance imaging findings of sacroiliitis in patients with psoriasis

Objectives: The aim of this study was to determine the frequency and characteristic magnetic resonance (MR) imaging features of sacroiliitis in patients with psoriasis disease. Methods: A total of 68 patients who diagnosed with pso­riasis in Dermatology department of our hospital between February-2012 and February-2013 were included to our study. All patients were underwent bilateral sacroiliac MR. MR study were performed with the sequences of the coro­nal T1 weighted turbo spin-echo, T2 weighted and STIR images using a 1,5-T MR device for all patients. Changes in the subchondral bone were classified according to MR signal features. Results: Of these patients, 37 (54.4 %) were male and 31 (45.6 %) were female. The mean age was 32.3±7.8 years, ranging from 16 to 60 years. Mean disease dura­tion was 12.4±8.6 years (2-24 years). While MR imag­ing findings were normal in 52 (76,5%) patients, signal changes consisted with sacroiliitis were observed in 16 (23.5%) patients. One or more MR lesion consisted with sacroiliitis were observed in a total of 22 sacroiliac joint of 16 patients. The signal abnormalities detected by MR imaging were as follows, Type-1 changes in 6 (27.3%) joints, Type-2 changes in 8 (36.4%) joints, Type-3 chang­es in 10 (45.5%) joints, erosions in 9 (40.9%) joints, nar­rowing the joints space in 6 (27.3%) joints and ankylosis in 5 (22.7%) joints. Conclusion: Sacroiliitis in psoriatic patients is an impor­tant clinical problem. MR imaging is a useful diagnostic modality in the diagnosis of psoriatic sacroiliitis which can demonstrate detailed anatomy of the sacroiliac joint and the changes of sacroiliitis without radiation exposure.

Colon Mucosa Exhibits Loss of Ectopic MUC5AC Expression in Patients with Ulcerative Colitis Treated with Oral Tacrolimus

Background. Tacrolimus (FK506) is effective for patients with ulcerative colitis (UC). However, there are few reports on tacrolimus therapy (TT) with respect to the relationship with endoscopic and clinicopathologic findings. Methods. Thirty patients with moderate/severe active UC refractory to or dependent on corticosteroid were treated with oral tacrolimus. The expression of ectopic MUC5AC in the colon was pathologically analyzed before and at 12 weeks after TT, evaluating the Mayo score and steroid-sparing effects. Results. Both mean disease and endoscopic activity index scores were reduced at levels of statistical significance in 26 UC patients receiving more than one month of TT (P < 0.0001). The dose of prednisolone was reduced by a statistically significant amount (P = 0.00022), and 14 of the 26 patients (53.8%) had steroid-free status 12 weeks after TT. The decrease in ectopic MUC5AC expression in the mucous cells of the colon was significantly associated with endoscopic improvement of inflammation in the UC patients with TT (P = 0.043). Loss of ectopic MUC5AC expression was detected in all patients who had complete response. Conclusions. Tacrolimus appears to be effective for the treatment of moderate/severe UC patients. Loss of ectopic MUC5AC expression may be important for pathologic remission in the colon of UC patients.

SOME EXPERIENCES IN CONTROL OF APPLE SCAB IN SERBIA

Apple scab caused by Venturia inaequalis (Cooke) G. Winter is recognized as the most important disease of apples in Serbia. Fungicides remain the primary tool for managing this disease and, due to its polycyclic nature; repeated applications are required over the course of a single season. During 2004-2010 we have conducted many trials for evaluation of chemical control of this disease. The following compounds were tested: pyraclostrobin + dithianon, trifloxystrobin + captan, kresoxim-methyl + dithianon, difenoconazole, pirimethanil, boscalid + pyraclostrobin, pyrimethanil + fluquinconazol and fenbuconazole. Trials were set according to EPPO guideline PP 1/5(3). A complete randomized block design with four replicates per treatment was used in the experiments. Mean percent disease control values were calculated from the evaluations made towards the end of the trials, when differentia¬tion between the treatments was the most obvious. Data were analysed by one-way completely randomized ANOVA, and means comparison performed by Duncan's test. The infection of untreated control plots ranged from 23.0% to 77.5%. All treatments were effective against V. ineaqualis and significantly reduced disease severity in all experiments, compared with the untreated control. Comparing the tested fungicides, pyrimethanil applied alone and mixtures of trifloxystrobin + captan, kresoxim-methyl + dithianon, pyrimethanil + fluquinconazol and pyraclostrobin + dithianon demonstrated the highest efficacy in all trials (85.6%-97.2%). DMI fungicides (difenoconazole and fenbuconazole) and mixture of boscalid + pyraclostrobin exhibited lower efficacy (68.5% - 75.1%) compared to other tested materials.

Comparative Epidemiological Studies on Lymphatic Filariasis among the Population of a Rural and an Urban Area of West Bengal, India

Background: Situation of lymphatic filariasis is worse in many third world developing countries like India. But information is scanty from many areas. Present study focused on a comparative filarial epidemiology in rural and urban areas of West Bengal, India. Methods: Examination of 20 μL night blood samples by finger prick and clinical examination for filarial diseases of 3144 urban and 2690 rural people was done by random selection. Results: In both the area Wuchereria bancrofti was identified as the causative parasite of filariasis. In the urban area, overall microfilaria rate, mean microfilarial density, disease rate and endemicity rate were assessed as 3.24%, 6.31, 5.47% and 8.72% respectively; whereas in the rural area, those were assessed as 1.23%, 4.61, 1.38% and 2.60% respectively. In both areas males were more affected than the females by the filarial problems. Conclusion: The urban study area is more endemic for bancroftian filariasis than the rural one. Urban areas are already under the threat of the disease and it is spreading towards the rural areas.

Diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery

To conduct a retrospective analysis of diagnosis and treatment of lumbar disc herniation by discography and percutaneous transforaminal endoscopic surgery. From December 2009 to June 2010, 119 patients with lumbar disc herniation underwent discography and transforaminal endoscopic surgery under local anesthesia. There were 75 males and 44 females with a mean age of 44.8 years (range: 15 - 55). The mean disease course was 9 months (range: 3 - 72). The major symptoms were back pain and/or unilateral sciatica. The mean follow-up period was 26 months. All underwent lumbar radiography, computed tomography (CT) and magnetic resonance imaging (MRI) revealing 112 single level and 7 two-level disc herniations. There were 82 lateral and 37 para-medial disc herniations. Eight-nine patients had protruded discs while 30 had prolapsed and sequestered discs. There were no obvious lumbar stenosis, spondylolisthesis, fracture, infection or tumor cases. The preoperative and postoperative visual analogue scale (VAS) were used to evaluate the sciatica and/or back pain. The outcomes were evaluated by Oswestry disability index (ODI) and the Macnab score. Precise orientation and operation was performed under the guidance of pre-operative imaging, intra-operative fluoroscopy or CT and endoscopic exploration. Among them, 117 cases had the surgery performed successfully. The mean operative duration was 85 min (range: 35 - 85) and the mean blood loss 13 ml (range: 1 - 50). One patient had L5 nerve root injury complicated with paraesthesia and weakness of the affected lower extremity and was relieved gradually after conservative treatment for over 3 months. Another one complicated with postoperative intradiscal infection was referred to another institution and lost follow-up thereafter. Five cases had no improvement at 6 months after the first surgery and were re-operated endoscopically. No one had a conversion into open surgery. They were followed up for a mean period of 26.1 months (range: 25 - 27). Five patients lost follow-up. VAS improved statistically significantly from preoperative 6.8 to postoperative 1.8 (P < 0.05). ODI decreased from preoperative 70.06 to 19.09 at the last follow-up. The Macnab results were excellent (n = 82, 68.9%), good (n = 20, 16.7%), fair (n = 8, 6.7%) and bad (n = 9, 7.7%) (including all patients lost to follow-up). And the excellent-to-good rate was 85.6%. With fewer complications and a low recurrence rate, percutaneous transforaminal endoscopic surgery is safe and efficacious in the treatment of lumbar disc herniation.

Patients with well-established ankylosing spondylitis show limited deterioration in a ten-year prospective cohort study

This study aims to describe the deterioration of well-established ankylosing spondylitis (AS) over a 10-year period. Patients with well-established AS under secondary care review were assessed at baseline and re-assessed after a 10-year period. Data on patient characteristics, spinal mobility and self-reported health status (AS Quality of Life, Bath AS Disease Activity Index, EuroQoL, Revised Leeds Disability Questionnaire and Short Form-12) were compared between the two time points. One hundred fifty-nine patients took part in the initial assessment. After 10years, 69/117 patients still under secondary care follow-up attended a second assessment. At the second assessment, this cohort was predominately male (92.8%), mean age of 48.7years (SD 9.7) and mean disease and symptom duration of 14.9 (SD 9.0) and 21.9years (SD 13.3), respectively. Amongst the physical and patient-reported measures, only tragus to wall (p < 0.001), cervical rotation (p = 0.001) and disability (p = 0.02) had significantly deteriorated over time. The percentage of patients who had withdrawn from the workforce before normal retirement age increased from 37 to 53% over the 10-year period. Many of the measures used in the assessment of AS do not generally deteriorate over time in those with well-established disease. This suggests that deterioration may plateau in established disease. However, AS has a long-term social impact with levels of employment in this cohort 30% lower than the general population. Interventions directed at preventing deterioration may be more effective earlier in their disease course, before this plateau is reached.

P1‐053: Does a positive PIB scan always mean Alzheimer's disease?

P1‐053: Does a positive PIB scan always mean Alzheimer's disease?