Four outcrops (three of which were new) in the Northern Rhenish Schiefergebirge delivered several ophiuroids from the high Famennien. Following forms are described: Protaster ? ubaghsi n. sp. and a juvenile protasteroid, gen. et spec. indet., 2 new species of Furcaster to be treated taxonomically only after revision of this genus, many specimens of Ophiaulax decheni showing plates of the primary rosette and other hitherto undescribed structures, Stephanoura belgica with many juvenile specimens, and Onychaster ? velbertensis n. sp. as the first representative of the Onychasteridae in the Rhenish Schiefergebirge.K urzfass ung: Vier Ophiuren-Vorkommen (drei neue und ein bereits bekanntes) des hohen Oberdevons im niirdlichen Rheinischen Schiefergebirge werden bearbeitet. Daraus werden die folgenden Formen beschrieben: 2 Protasteridae, Pro taster ?ubaghsi n. sp. und ein juveniles Exemplar, gen. et spec. indet.; 2 neue (unbenannte) Arten der revisionsbediirftigen GattungFurcaster; Ophiaulax decheni mit den Platten der Primarrosette und weiteren neuen Strukturen; Stephanoura belgica mit zahlreichen juvenilen Exemplaren; Onychaster ?velbertensis n. sp. als erster Vertreter der Onychasteridae im Rheinischen Schiefergebirge.
Bei der Durchleucihtungder Brustorgane mittels sagittalerRöntgenstrahlen sind die beiden Lungenfelder unten von den Zwerchfellwölbungen begrenzt, deren rechte in fast ganzer Breite zu übersehen ist und in der Regel etwas höher steht als die linke. Bei der Atmung bewegen sich die Bögen unter Beibehaltung ihrer regelmäßigen Rundung ab-und aufwärts. Unter besonderen Umständen jedoch kommt es an den Zwerchfellbögen zu Unregelmäßigkeiten ihrer
BackgroundIn the era of biologics,increasing numbers of patients achieve full remission.Although biological agents play an important role in reducing morbidity associated with long-term disease of rheumatoid arthritis (RA),they also present risks associated with side effects,increased risk of infection and a significant cost to the Healthcare Provider. There is an increasing body of evidence supporting dose reduction in RA patients1 and, recently, European League Against Rheumatism (EULAR) updated their recommendations for the management of RA suggesting biologic dose reduction in stable patients2.ObjectivesThe aim of this study was to investigate the effect of Etanercept dose reduction on our symptom-stable RA patients. We wished to examine whether patients were receptive to the idea,what their preferred delivery timescales/dose would be and the outcome to the individual.MethodsSuitable RA patients (on Etanercept for >1 year with 2 consecutive Disease Activity Score (DAS)<2.6 over at least 12 months and no steroid therapy in the preceding 6 months) were identified by clinicians and reviewed by a Clinical Nurse Specialist (CNS) for suitability. No limits were set for DMARD use. Informed consent was obtained; patients were offered 4 choices of reduced dose and could withdraw and return to standard dose at any time. A DAS score was performed at baseline and at each follow up visit planned at 3, 6 and 9 months before consultant review at 12 months. Patients also received a telephone consultation by our CNS 6 weeks after starting dose reduction.Results50 patients met inclusion criteria and were invited to participate. Three patients (6%) declined due to concerns regarding potential flare. The most popular regime was 50mg fortnightly (n=24), followed by 50mg every 10 days (n=11), then 25mg weekly (n=10), and 50mg four weekly (n=2). In total, 9 (19%) patients discontinued dose reduction – 1 patient at 6 weeks and, by 3 months, a further 8 reported loss of symptom control. Of these 9 patients, 5 were on biologic monotherapy while 4 were taking concomitant DMARDs. On withdrawal, 7 resumed the full Etanercept dose while 2 elected to switch to the 10 day regime. All patients who reported loss of efficacy were in the 50 mg fortnightly group, demonstrating a 38% failure rate for this group.ConclusionsOur pilot study suggests that biologic dose-reduction is mutually beneficial for patients and healthcare providers. Patients are open to the concept of dose-reduction, and were reassured by easy access and frequent review by our CNS. Nurse-led monitoring offers patients a longer and more cost effective assessment, and frees resources for consultant-led commitments. Outcomes from six- and twelve-month follow-up are awaited and larger studies are needed to determine the optimal regime for dose reduction.Referencesvan Herwaarden N, den Broeder AA, Jacobs WJ, et al. Down titration and discontinuation strategies of tumor necrosis factor blocking agents for rheumatoid arthritis in patients with low disease activity. Cochrane Database S...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.