Ancient relicts or recent immigrants? Different dating strategies alter diversification scenarios of New Zealand aquatic beetles (Coleoptera: Hydrophilidae: Berosus).

Dated species-level phylogenies are crucial for understanding the origin and evolutionary history of modern faunas, yet difficult to obtain due to the frequent absence of suitable age calibrations at species level. Substitution rates of related or more inclusive clades are often used to overcome this limitation but the accuracy of this approach remains untested. We compared tree dating based on substitution rates with analyses implementing fossil data by direct node-dating and indirect root-age constraints for the New Zealand endemic Berosus water beetles (Coleoptera: Hydrophilidae). The analysis based solely on substitution rates indicated a Miocene colonization of New Zealand and Pleistocene origin of species. By contrast, all analyses that implemented fossil data resulted in significantly older age estimates, indicating an ancient early Cenozoic origin of the New Zealand clade, diversification of species during or after the Oligocene transgression and Miocene-Pliocene origin of within-species population structure. Rate-calibrated time trees were incongruent with recently published Coleoptera time trees, the fossil record of Berosus and the distribution of outgroup species. Strong variation of substitution rates among Coleoptera lineages, as well as among lineages within the family Hydrophilidae, was identified as the principal reason for low accuracy of rate-calibrated analyses, resulting in underestimated node ages in Berosus. We provide evidence that Oligocene to Pliocene events, rather than the Pleistocene Glacial cycles, played an essential role in the formation of the modern New Zealand insect fauna.

Disease activity-dependent expression of nerve growth factor TRKA and P75 receptors on elevated dendritic cells and peripheral leucocytes in patients with systemic lupus erythematosus.

INTRODUCTION: The nervous system modulates rheumatic diseases in neurogenic inflammation (NI). Nerve growth factor (NGF) plays a pivotal role in NI and chronic nociceptive pain. However, the role of NGF in autoimmune inflammatory diseases is not well understood. The aim of this study was to analyse NGF high- (TrkA) and low-affinity (p75) receptors on all major leucocyte subsets of patients with systemic lupus erythematosus (SLE) as a potential indicator of NI. METHODS: A total of 13 patients were analysed by fluorescence-activated cell sorting and compared to 13 healthy control (HC) subjects. Patients were also stratified for high or low disease activity (CRP, ESR, SLEDAI, ANA, anti-dsDNA and C3/C4). Statistics included the Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: When comparing patients and HC, TrkA was not differentially expressed. In contrast, p75 was increased on CD16+ and CD56+ leucocytes in patients. CD11c+ dendritic cells (DC) were in total increased in SLE. DCs were also significantly elevated in active patients. Furthermore, we found an intermediate CD11b+ population strongly expressing TrkA in patients and HC. CONCLUSION: We demonstrate for the first time differential NGF receptor expression in SLE. The increased CD11c+ DCs might indicate additional activation in SLE.

Synovial inflammation analyzed by 3-T magnetic resonance imaging in etanercept-treated patients with rheumatoid arthritis indicates persistent disease activity despite of clinical remission: A pilot study.

OBJECTIVES: To evaluate joint inflammation using 3-T MRI in rheumatoid arthritis (RA) patients treated with conventional disease modifying anti-rheumatic drugs (cDMARDs) as compared to inhibitors for tumor necrosis factor α (TNFi) over 12 months. METHODS: Prospective epidemiologic clinical pilot study using the RA MRI system (RAMRIS), the visual analog scale (VAS, 0-100) and the Disease Activity Score 28-joint count (DAS28) at baseline, 4, and 12 months after initiation of etanercept (ETA). Ten patients with inadequate response to two cDMARDs were treated with ETA and compared to 10 patients responding to cDMARDs. RESULTS: In cDMARD patients, parameters at baseline and 12 months did not change: VAS: 21.0 ± 11.3 and 20.2 ± 24.6; DAS28: 2.1 ± 0.6 and 2.9 ± 1.0; and RAMRIS: 11.0 ± 2.3 and 11.8 ± 2.8, respectively. In contrast, in the ETA-patients the same parameters were as follows at baseline, 4, and 12 months: VAS: 46.3 ± 7.9, 23.9 ± 7.1, and 24.0 ± 6.3 (each p = .04); DAS28: 3.8 ± 0.4, 2.8 ± 0.3 (ns), and 2.5 ± 0.3 (p = .01); and RAMRIS: 28.9 ± 5.0, 25.8 ± 4.7 (ns), and 24.6 ± 4.5 (ns). Comparing ETA and cDMARD patients, RAMRIS was significantly different. CONCLUSION: The data suggest that synovial inflammation and DAS28 remission are separate entities in RA. MRI scoring before starting a treatment may therefore indicate the requirement for TNFi.

Mapping and predicting mortality from systemic sclerosis.

OBJECTIVES: To determine the causes of death and risk factors in systemic sclerosis (SSc). METHODS: Between 2000 and 2011, we examined the death certificates of all French patients with SSc to determine causes of death. Then we examined causes of death and developed a score associated with all-cause mortality from the international European Scleroderma Trials and Research (EUSTAR) database. Candidate prognostic factors were tested by Cox proportional hazards regression model by single variable analysis, followed by a multiple variable model stratified by centres. The bootstrapping technique was used for internal validation. RESULTS: We identified 2719 French certificates of deaths related to SSc, mainly from cardiac (31%) and respiratory (18%) causes, and an increase in SSc-specific mortality over time. Over a median follow-up of 2.3 years, 1072 (9.6%) of 11 193 patients from the EUSTAR sample died, from cardiac disease in 27% and respiratory causes in 17%. By multiple variable analysis, a risk score was developed, which accurately predicted the 3-year mortality, with an area under the curve of 0.82. The 3-year survival of patients in the upper quartile was 53%, in contrast with 98% in the first quartile. CONCLUSION: Combining two complementary and detailed databases enabled the collection of an unprecedented 3700 deaths, revealing the major contribution of the cardiopulmonary system to SSc mortality. We also developed a robust score to risk-stratify these patients and estimate their 3-year survival. With the emergence of new therapies, these important observations should help caregivers plan and refine the monitoring and management to prolong these patients' survival.

Clinical use of the manchester triage system in patients with dizziness - An observational study in the emergency department.

INTRODUCTION: Dizziness is a common symptom with diverse causes, including ear-nose-throat, internal, neurological, or psychiatric origins. While for most parts treatable in nonemergency settings, it can also signal time-critical conditions, like an unnoticed stroke, requiring prompt diagnosis and treatment to prevent lasting harm or death. The aim of this study was to evaluate the validity of the Manchester Triage System in classifying patients presenting with dizziness based on final diagnoses and patient outcomes, as no specific flow chart exists for this symptom in the MTS. METHODS: Monocentric, retrospective observational study. To test the validity of the MTS in the triage of dizziness patients, the treatment level was used as a surrogate parameter. We grouped the patients into outpatient, normal ward and intermediate care/intensive care unit (IMC/ICU) patients. Furthermore, we analyzed the dizziness patients in subgroups based on the origin of their dizziness to identify potential improvements for the MTS. Patients with dizziness and stroke, who represent the most vulnerable group of dizziness patients, were also evaluated separately. RESULTS: During the observation period, 2958 patients presented at the ED with the symptom dizziness and 52 017 without, who formed the reference group. When examining the relationship between triage level and subsequent treatment level, a larger deviation is observed compared to the reference group. The receiver operating characteristics (ROC) regarding hospital admission in general showed an area under the curve (AUC) in the subgroup with dizziness due to a central nervous system causes (n=838) of 0.69 (95% CI 0.65 - 0.72) and in the subgroup of dizziness by other organic cause (n=901), an AUC of 0.64 (95% CI 0.60 - 0.68). The reference group had an AUC 0.75 (95% CI 0.75 - 0.76) here. In relation to admission to IMC/ICU, the results were similar. The sensitivity of the MTS in terms of an adequate initial assessment of dizziness patients with stroke or transient ischemic attack (TIA) was 0.39, the specificity was 0.91 (reference group sensitivity 0.72, specificity 0.82). CONCLUSION: In terms of construct validity, the present study revealed that the use of MTS as a priority triage assessment tool was found to be less accurate in emergency patients with dizziness, particularly those diagnosed with stroke/TIA, when compared to other emergency patients.

New estimates of genome size in Orthoptera and their evolutionary implications.

Animal genomes vary widely in size, and much of their architecture and content remains poorly understood. Even among related groups, such as orders of insects, genomes may vary in size by orders of magnitude-for reasons unknown. The largest known insect genomes were repeatedly found in Orthoptera, e.g., Podisma pedestris (1C = 16.93 pg), Stethophyma grossum (1C = 18.48 pg) and Bryodemella holdereri (1C = 18.64 pg). While all these species belong to the suborder of Caelifera, the ensiferan Deracantha onos (1C = 19.60 pg) was recently found to have the largest genome. Here, we present new genome size estimates of 50 further species of Ensifera (superfamilies Gryllidea, Tettigoniidea) and Caelifera (Acrididae, Tetrigidae) based on flow cytometric measurements. We found that Bryodemella tuberculata (Caelifera: Acrididae) has the so far largest measured genome of all insects with 1C = 21.96 pg (21.48 gBp). Species of Orthoptera with 2n = 16 and 2n = 22 chromosomes have significantly larger genomes than species with other chromosome counts. Gryllidea genomes vary between 1C = 0.95 and 2.88 pg, and Tetrigidae between 1C = 2.18 and 2.41, while the genomes of all other studied Orthoptera range in size from 1C = 1.37 to 21.96 pg. Reconstructing ancestral genome sizes based on a phylogenetic tree of mitochondrial genomic data, we found genome size values of >15.84 pg only for the nodes of Bryodemella holdereri / B. tuberculata and Chrysochraon dispar / Euthystira brachyptera. The predicted values of ancestral genome sizes are 6.19 pg for Orthoptera, 5.37 pg for Ensifera, and 7.28 pg for Caelifera. The reasons for the large genomes in Orthoptera remain largely unknown, but a duplication or polyploidization seems unlikely as chromosome numbers do not differ much. Sequence-based genomic studies may shed light on the underlying evolutionary mechanisms.

Control of arthritis pain with anti-nerve-growth factor: risk and benefit.

Arthritis is characterized by pain and inflammation. Recently, attention has been focused on nerve-growth factor (NGF), a neurotrophin that is a key regulator of peripheral nociception because it mediates overexpression of proinflammatory neuron-derived molecules such as substance P, serotonin, and calcitonin gene-related peptide. Antibodies have been generated for NGF and its receptor that are effective in reducing pain in preclinical pain models, and clinical trials in patients with advanced knee and hip osteoarthritis and low-back pain. Results show pain reduction is rapid and sustained. Adverse events with anti-NGF included transient paraesthesia and edema, rapidly progressive OA, and, in a small number of patients treated with both anti-NGF and nonsteroidal anti-inflammatory drugs, osteonecrosis. Inhibition of the NGF-stimulated nociceptive pathway seems to be effective; however, the adverse effects require further investigation.

New species and illustrated key of Macraspis (Scarabaeidae, Rutelinae, Rutelini) from the Amazon biome of Brazil.

The phytophagous scarab genus Macraspis MacLeay (Scarabaeidae, Rutelinae, Rutelini) is reviewed from the Brazilian Amazon region. Three new species are described and illustrated from the states of Amazonas, Pará, and Rondônia: M.buehrnheimi sp. nov., M.opala sp. nov., and M.phallocardia sp. nov. Two species, Macraspisfernandezi Neita-Moreno and M.oblonga Burmeister, are recorded for the first time in Brazil (new country records). Macraspismaculatacrosarai Soula is a new synonym of Macraspismaculata Burmeister; hence this species no longer includes subspecies. Furthermore, Macraspiscinctaparensis Soula, 2005 is deemed unavailable under the provisions of ICZN Articles 16.4.1 and 16.4.2. An illustrated key to 15 species and subspecies of Macraspis from the Brazilian Amazon enables identification of this speciose leaf chafer genus.

Localization of Nerve Growth Factor Expression to Structurally Damaged Cartilaginous Tissues in Human Lumbar Facet Joint Osteoarthritis.

Purpose: Nerve Growth Factor (NGF) is a pivotal mediator of chronic pain and plays a role in bone remodelling. Through its high affinity receptor TrkA, NGF induces substance P (SP) as key downstream mediator of pain and local inflammation. Here we analysed NGF, TrkA and SP tissue distribution in facet joint osteoarthritis (FJOA), a major cause of chronic low back pain. Methods: FJOA specimens (n=19) were harvested from patients undergoing intervertebral fusion surgery. Radiologic grading of FJOA and spinal stenosis, followed by immunohistochemistry for NGF, TrkA and SP on consecutive tissue sections, was performed in ten specimens. Explant cultures (n=9) were used to assess secretion of NGF, IL-6, and SP by FJOA osteochondral tissues under basal and inflammatory conditions. Results: NGF was predominantly expressed in damaged cartilaginous tissues (80%), occasionally in bone marrow (20%), but not in osteochondral vascular channels. NGF area fraction in cartilage was not associated with the extent of proteoglycan loss or radiologic FJOA severity. Consecutive sections showed that NGF and SP expression was localized at structurally damaged cartilage, in absence of TrkA expression. SP and TrkA were expressed in subchondral bone marrow in both presence and absence of NGF. Low level NGF, but not SP secretion, was detected in four out of eighteen FJOA explants under both basal or inflammatory conditions (n=2 each). Conclusion: NGF is associated with SP expression and structural cartilage damage in osteoarthritic facet joints, but not with radiologic disease severity. NGF tissue distribution in FJOA differs from predominant subchondral bone expression reported for knee OA.

Taxonomic review of the genus Thalpomena Saussure, 1884 with new synonyms.

The genus Thalpomena Saussure, 1884 is distributed in North Africa, Somalia and Ethiopia. It currently contains nine species, including one species with four subspecies; Seven of them (including one with four subspecies) are distributed in the Atlas Mountains, one in Libya and one (originally described in the genus Vosseleria) in the Somali Highlands. In this study, we propose taxonomic changes based on morphological, genetic, ecological and morphometric data from a previous study. The following species remain valid: Thalpomena algeriana (Lucas, 1849); Thalpomena azureipennis Uvarov, 1927; Thalpomena coerulescens Uvarov, 1923; Thalpomena dernensis (Werner, 1908); and Thalpomena viridipennis Uvarov, 1927. The following names are proposed here as junior synonyms of T. algeriana: Thalpomena algeriana intermedia Dirsh, 1949 (new synonym), Thalpomena algeriana montana Dirsh, 1949 (new synonym), Thalpomena coeruleipennis Finot, 1895 (new synonym), Thalpomena deserta Dirsh, 1949 (new synonym). Thalpomena rungsi Dirsh, 1949 is a new synonym of T. azureipennis; Thalpomena algeriana maroccana Dirsh, 1949 is a new synonym of T. viridipennis. The only East African representative of the genus, Thalpomena schulthessi (Uvarov, 1923), is transferred to the genus Vosseleriana (new combination).

Neurogenic inflammation as a novel treatment target for chronic pain syndromes.

Chronic pain syndrome is a heterogeneous group of diseases characterized by several pathological mechanisms. One in five adults in Europe may experience chronic pain. In addition to the individual burden, chronic pain has a significant societal impact because of work and school absences, loss of work, early retirement, and high social and healthcare costs. Several anti-inflammatory treatments are available for patients with inflammatory or autoimmune diseases to control their symptoms, including pain. However, patients with degenerative chronic pain conditions, some with 10-fold or more elevated incidence relative to these manageable diseases, have few long-term pharmacological treatment options, limited mainly to non-steroidal anti-inflammatory drugs or opioids. For this review, we performed multiple PubMed searches using keywords such as "pain," "neurogenic inflammation," "NGF," "substance P," "nociception," "BDNF," "inflammation," "CGRP," "osteoarthritis," and "migraine." Many treatments, most with limited scientific evidence of efficacy, are available for the management of chronic pain through a trial-and-error approach. Although basic science and pre-clinical pain research have elucidated many biomolecular mechanisms of pain and identified promising novel targets, little of this work has translated into better clinical management of these conditions. This state-of-the-art review summarizes concepts of chronic pain syndromes and describes potential novel treatment strategies.

Aneurysmal Subarachnoid Hemorrhage during the Shutdown for COVID-19.

The aim was to evaluate hospitalization rates for aneurysmal subarachnoid hemorrhage (SAH) within an interdisciplinary multicenter neurovascular network (NVN) during the shutdown for the COVID-19 pandemic along with its modifiable risk factors. In this multicenter study, admission rates for SAH were compared for the period of the shutdown for the COVID-19 pandemic in Germany (calendar weeks (cw) 12 to 16, 2020), the periods before (cw 6-11) and after the shutdown (cw 17-21 and 22-26, 2020), as well as with the corresponding cw in the years 2015-2019. Data on all-cause and pre-hospital mortality within the area of the NVN were retrieved from the Department of Health, and the responsible emergency medical services. Data on known triggers for systemic inflammation, e.g., respiratory viruses and air pollution, were analyzed. Hospitalizations for SAH decreased during the shutdown period to one-tenth within the multicenter NVN. There was a substantial decrease in acute respiratory illness rates, and of air pollution during the shutdown period. The implementation of public health measures, e.g., contact restrictions and increased personal hygiene during the shutdown, might positively influence modifiable risk factors, e.g., systemic inflammation, leading to a decrease in the incidence of SAH.

Is there a role for TNFα antagonists in the treatment of SSc? EUSTAR expert consensus development using the Delphi technique.

OBJECTIVES: To obtain experiences and expert opinion on treatment of SSc patients with TNF-α antagonists. METHODS: An investigation was carried out among the EUSTAR centres into their expertise on use of TNF-α antagonists. Assessment forms on the frequency of TNF-α inhibitor use were distributed to EULAR Scleroderma Trials and Research Group (EUSTAR) centres. Afterwards, a three round Delphi exercise was performed to obtain expert consensus on the use of TNF-α inhibitors in SSc. RESULTS: Seventy-nine centres returned information on use of TNF-α antagonists in SSc patients. A total of 65 patients were treated with TNF-α inhibitors in 14 different centres. Forty-eight of the 65 patients treated with TNF-α inhibitors improved. Improvement was mainly seen in patients with arthritis, whereas the effects on fibrosis varied. In the first round of the subsequent Delphi approach, 71 out of 79 experts stated that they would use TNF-α antagonists in SSc. Arthritis was suggested as an indication for TNF-α antagonists by 75% of the experts. However, after the third stage of the Delphi exercise, the acceptance for the off-label use of TNF-α antagonists decreased and 59% recommended that TNF-α antagonists should not be used or only used in clinical trials in SSc patients, while 38% of the experts suggested the use of TNF-α antagonists for arthritis associated with SSc. CONCLUSIONS: Most of the experts do not recommend the routine use of TNF-α antagonists in systemic sclerosis. Arthritis might be a potential indication in SSc, although controlled clinical trials with TNF-α antagonists are needed before general recommendations can be given.

New records of Anomala tibialis Lansberge, 1886 and a new replacement name for Anomala tibialis Schaeffer, 1906 (Coleoptera: Scarabaeidae: Rutelinae: Anomalini).

The species Anomala tibialis Schaeffer, 1906 (Coleoptera: Scarabaeidae: Rutelinae: Anomalini) was described based on a single specimen from Texas, United States of America, and is currently treated as a valid species. However, Anomala tibialis Schaeffer, 1906 is a junior homonym of the widespread African Anomala tibialis Lansberge, 1886. This primary junior homonym has no known available and potentially valid synonyms and must therefore be rejected and replaced by a new substitute name (International Commission on Zoological Nomenclature 1999, Articles 57.2 and 60.1). In this paper, full bibliography, distribution data, and new records for the species concerned are provided, and a new replacement name for Anomala tibialis Schaeffer, 1906 is established.

Taxonomic changes resulting from a review of the types of Australian Anoplognathini (Coleoptera: Scarabaeidae: Rutelinae) housed in Swedish natural history collections.

The type material of Australian Anoplognathini (Coleoptera: Scarabaeidae: Rutelinae) housed in Swedish natural history collections is reviewed, concerning three genera: Anoplognathus Leach, 1815, Amblyterus MacLeay, 1819, and Repsimus MacLeay, 1819. The species were described by G.J. Billberg, J.W. Dalman, L. Gyllenhal, C.J. Schönherr, O. Swartz, and C.P. Thunberg. The contemporary type material of W.S. MacLeay in the Macleay Museum, Sydney, is also examined as it has been overlooked by previous researchers. In total, type specimens for 12 species described between 1817 and 1822 were found in the Naturhistoriska Riksmuseet in Stockholm the Evolutionsmuseet in Uppsala and the Macleay Museum. Five of these species are valid: Anoplognathus brunnipennis, (Gyllenhal, 1817); A. olivieri (Schönherr Dalman, 1817); A. porosus (Dalman, 1817); Amblyterus cicatricosus (Gyllenhal, 1817); and Repsimus manicatus (Swartz, 1817). The other seven species are junior synonyms, as follows (senior synonym first): A. brunnipennis = Rutela chloropyga Thunberg, 1822 (new synonym); A. olivieri = Rutela lacunosa Thunberg, 1822 (new synonym); A. viridiaeneus (Donovan, 1805) = A. latreillei (Schönherr Gyllenhal, 1817); A. viriditarsus Leach, 1815 = Rutela analis Dalman, 1817; and R. manicatus = Anoplognathus brownii W.J. MacLeay, 1819 = A. dytiscoides W. J. MacLeay, 1819 = Rutela ruficollis Thunberg, 1822 (new synonym). Authorship of A. latreillei and A. olivieri is corrected, as noted above. Anoplognathus brunnipennis has been misidentified for the last 60 years at least, leading to the synonymy noted above. Anoplognathus flavipennis Boisduval, 1835 (revised status), is reinstated as the oldest available name for the misidentified A. brunnipennis and the types of A. flavipennis in the Muséum National d'Histoire Naturelle, Paris, are illustrated. Lectotypes are designated for: Anoplognathus brownii, A. flavipennis, A. dytiscoides, Melolontha cicatricosa, Rutela analis, R. brunnipennis, R. lacunosa, R. latreillei, R. manicata, R. olivieri, R. porosa, R. ruficollis, and R. chloropyga. Photographs of all type specimens examined are presented for the first time.

The evolution of nerve growth factor inhibition in clinical medicine.

Nerve growth factor (NGF) is a neurotrophin that activates nociceptive neurons to transmit pain signals from the peripheral to the central nervous system and that exerts its effects on neurons by signalling through tyrosine kinase receptors. Antibodies that inhibit the function of NGF and small molecule inhibitors of NGF receptors have been developed and tested in clinical studies to evaluate the efficacy of NGF inhibition as a form of analgesia in chronic pain states including osteoarthritis and chronic low back pain. Clinical studies in individuals with painful knee and hip osteoarthritis have revealed that NGF inhibitors substantially reduce joint pain and improve function compared with NSAIDs for a duration of up to 8 weeks. However, the higher tested doses of NGF inhibitors also increased the risk of rapidly progressive osteoarthritis in a small percentage of those treated. This Review recaps the biology of NGF and the studies that have been performed to evaluate the efficacy of NGF inhibition for chronic musculoskeletal pain states. The adverse events associated with NGF inhibition and the current state of knowledge about the mechanisms involved in rapidly progressive osteoarthritis are also discussed and future studies proposed to improve understanding of this rare but serious adverse event.

Prospective Observational Multisite Study of Handover in the Emergency Department: Theory versus Practice.

INTRODUCTION: The handover process in the emergency department (ED) is relevant for patient outcomes and lays the foundation for adequate patient care. The aim of this study was to examine the current prehospital to ED handover practice with regard to content, structure, and scope. METHODS: We carried out a prospective, multicenter observational study using a specifically developed checklist. The steps of the handover process in the ED were documented in relation to qualification of the emergency medical services (EMS) staff, disease severity, injury patterns, and treatment priority. RESULTS: We documented and evaluated 721 handovers based on the checklist. According to ISBAR (Identification, Situation, Background, Assessment, Recommendation), MIST (Mechanism, Injuries, Signs/Symptoms, Treatment), and BAUM (Situation [German: Bestand], Anamnesis, Examination [German: Untersuchung], Measures), almost all handovers showed a deficit in structure and scope (99.4%). The age of the patient was reported 339 times (47.0%) at the time of handover. The time of the emergency onset was reported in 272 cases (37.7%). The following vital signs were transferred more frequently for resuscitation room patients than for treatment room patients: blood pressure (BP)/(all comparisons p < 0.05), heart rate (HR), oxygen saturation (SpO2) and Glasgow Coma Scale (GCS). Physicians transmitted these vital signs more frequently than paramedics BP, HR, SpO2, and GCS. A handover with a complete ABCDE algorithm (Airway, Breathing, Circulation, Disability, Environment/Exposure) took place only 31 times (4.3%). There was a significant difference between the occupational groups (p < 0.05). CONCLUSION: Despite many studies on handover standardization, there is a remarkable inconsistency in the transfer of information. A "hand-off bundle" must be created to standardize the handover process, consisting of a uniform mnemonic accompanied by education of staff, training, and an audit process.

The combined prevalence of classified rare rheumatic diseases is almost double that of ankylosing spondylitis.

BACKGROUND: Rare diseases (RDs) affect less than 5/10,000 people in Europe and fewer than 200,000 individuals in the United States. In rheumatology, RDs are heterogeneous and lack systemic classification. Clinical courses involve a variety of diverse symptoms, and patients may be misdiagnosed and not receive appropriate treatment. The objective of this study was to identify and classify some of the most important RDs in rheumatology. We also attempted to determine their combined prevalence to more precisely define this area of rheumatology and increase awareness of RDs in healthcare systems. We conducted a comprehensive literature search and analyzed each disease for the specified criteria, such as clinical symptoms, treatment regimens, prognoses, and point prevalences. If no epidemiological data were available, we estimated the prevalence as 1/1,000,000. The total point prevalence for all RDs in rheumatology was estimated as the sum of the individually determined prevalences. RESULTS: A total of 76 syndromes and diseases were identified, including vasculitis/vasculopathy (n = 15), arthritis/arthropathy (n = 11), autoinflammatory syndromes (n = 11), myositis (n = 9), bone disorders (n = 11), connective tissue diseases (n = 8), overgrowth syndromes (n = 3), and others (n = 8). Out of the 76 diseases, 61 (80%) are classified as chronic, with a remitting-relapsing course in 27 cases (35%) upon adequate treatment. Another 34 (45%) diseases were predominantly progressive and difficult to control. Corticosteroids are a therapeutic option in 49 (64%) syndromes. Mortality is variable and could not be determined precisely. Epidemiological studies and prevalence data were available for 33 syndromes and diseases. For an additional eight diseases, only incidence data were accessible. The summed prevalence of all RDs was 28.8/10,000. CONCLUSIONS: RDs in rheumatology are frequently chronic, progressive, and present variable symptoms. Treatment options are often restricted to corticosteroids, presumably because of the scarcity of randomized controlled trials. The estimated combined prevalence is significant and almost double that of ankylosing spondylitis (18/10,000). Thus, healthcare systems should assign RDs similar importance as any other common disease in rheumatology.

Therapeutic options for patients with rare rheumatic diseases: a systematic review and meta-analysis.

BACKGROUND: Rare diseases (RDs) in rheumatology as a group have a high prevalence, but randomized controlled trials are hampered by their heterogeneity and low individual prevalence. To survey the current evidence of pharmacotherapies for rare rheumatic diseases, we conducted a systematic review and meta-analysis. Randomized controlled trials (RCTs) of RDs in rheumatology for different pharmaco-interventions were included into this meta-analysis if there were two or more trials investigating the same RD and using the same assessment tools or outcome parameters. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PUBMED were searched up to April 2nd 2020. The overall objective of this study was to identify RCTs of RDs in rheumatology, evaluate the overall quality of these studies, outline the evidence of pharmacotherapy, and summarize recommended therapeutic regimens. RESULTS: We screened 187 publications, and 50 RCTs met our inclusion criteria. In total, we analyzed data of 13 different RDs. We identified several sources of potential bias, such as a lack of description of blinding methods and allocation concealment, as well as small size of the study population. Meta-analysis was possible for 26 studies covering six RDs: Hunter disease, Behçet's disease, giant cell arteritis, ANCA-associated vasculitis, reactive arthritis, and systemic sclerosis. The pharmacotherapies tested in these studies consisted of immunosuppressants, such as corticosteroids, methotrexate and azathioprine, or biologicals. We found solid evidence for idursulfase as a treatment for Hunter syndrome. In Behçet's disease, apremilast and IF-α showed promising results with regard to total and partial remission, and Tocilizumab with regard to relapse-free remission in giant cell arteritis. Rituximab, cyclophosphamide, and azathioprine were equally effective in ANCA-associated vasculitis, while mepolizumab improved the efficacy of glucocorticoids. The combination of rifampicin and azithromycin showed promising results in reactive arthritis, while there was no convincing evidence for the efficacy of pharmacotherapy in systemic sclerosis. CONCLUSION: For some diseases such as systemic sclerosis, ANCA-associated vasculitis, or Behcet's disease, higher quality trials were available. These RCTs showed satisfactory efficacies for immunosuppressants or biological drugs, except for systemic sclerosis. More high quality RCTs are urgently warranted for a wide spectrum of RDs in rheumatology.

Seven new species and new distributional records of Trizogeniates Ohaus, 1917 (Coleoptera: Scarabaeidae: Rutelinae) with a key and illustrated checklist of Brazilian species.

Seven new species of Trizogeniates Ohaus, 1917 (Coleoptera: Scarabaeidae: Rutelinae: Geniatini) from Brazil are described: Trizogeniates beckeri new species, T. curvatus new species, T. eliskae new species, T. hallensorum new species, T. spatulatus new species, T. vazdemelloi new species, and T. zuzanae new species. The male of T. eris Villatoro, 2002 is described for the first time. The diagnostic features of the seven new species and the male of T. eris are presented and compared with their congeners. Illustrations of specimens, mouthparts, and male genitalia of the new species and T. eris are also provided. Additionally, an identification key and an illustrated catalogue with the geographic distribution of the Brazilian species of Trizogeniates are presented. New Brazilian state records for 12 species are depicted: T. cribricollis (Lucas, 1859) from Pará, Mato Grosso do Sul, and Paraná; T. dispar (Burmeister, 1844) from Espírito Santo; T. eris from Rio de Janeiro; T. goyanus Ohaus, 1917 from Mato Grosso do Sul; T. laevis (Camerano, 1878) and T. montanus Ohaus, 1917 from Espírito Santo and Paraná; T. temporalis Ohaus, 1917 from Goiás; T. terricolus Ohaus, 1917 and T. vittatus (Lucas, 1859) from Paraná; and T. traubi Martínez, 1965 from Pará, Minas Gerais, and São Paulo. Finally, distributional maps for the Brazilian species are included.