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Az Alaptörvény bíróságokat érintő része az elmúlt tíz év alatt többször módosult. A tanulmány nem érint minden változást, így nem tárgyai az elemzésnek a közigazgatási bíráskodással kapcsolatos kérdések. E munkában a bírói függetlenség szempontját előtérbe helyezve mutatunk be néhány olyan – egykor közérdeklődésre számot tartott – ügyet, amellyel összefüggésben az Alaptörvény is módosult. Így foglalkozunk – a túlzott munkateher csökkentése és a jogviták észszerű határidőn belül történő elbírálása céljából létrehozott – ügyáthelyezés lehetőségével, továbbá a bírók korai nyugdíjazásával, valamint a bíróságok központi igazgatására létrehozott alkotmányos konstrukcióval. A tanulmány második része a bírói függetlenség egyes kérdéseit az ítélkező bíró szemszögéből elemzi. Nem titkolt célunk gyakorlati érveket felhozni a mellett, hogy az igazságszolgáltatás jogállami működését az elmúlt tíz évben nem érte csorba.

The impact of injury mechanism on outcomes of pancreatic trauma has not been well studied, and current guidelines do not differentiate recommendations for blunt and penetrating injuries. The purpose of this study was to analyze interventions and outcomes as they relate to mechanism. We hypothesized that penetrating pancreatic trauma results in greater morbidity than blunt trauma because of more frequent operative exploration without imaging and thus more aggressive surgical management.Secondary analysis of a multicenter retrospective review of pancreatic injuries in patients 15 years and older from 2010 to 2018 was performed. Deaths within 24 hours of admission were excluded from analysis of the primary outcome, pancreas-related complications (PRCs). Data were analyzed by injury mechanism using various statistical tests where appropriate.Thirty-three centers reported on 1,240 patients (44% penetrating). Penetrating trauma patients were twice as likely to undergo resection (45% vs. 23%) and suffer PRCs (39% vs. 20%). However, differences varied widely based on injury grade and management. There were fewer resections and more nonoperative management in blunt grades I to III injury. Pancreas-related complications occurred in 40% of high-grade injuries with no difference between mechanisms and in 40% of patients after resection, regardless of mechanism or injury grade. High-grade pancreatic injury (odds ratio [OR], 2.39; 95% confidence interval [CI], 1.55-3.67), penetrating injury (OR, 1.99; 95% CI, 1.31-3.05), and management in a low-volume center (i.e., five or fewer cases/year) (OR, 1.65; 95% CI, 1.16-2.35) were independent predictors of PRCs.Management of grades I to III, but not grades IV/V, pancreatic injuries varies based on mechanism. Penetrating injury is an independent risk factor for PRCs, but main pancreatic duct injury and resection are associated with high rates of PRCs regardless of the injury mechanism. Resection appears to offer better outcomes for grade IV/V injuries, and grade I and II injuries should be managed nonoperatively.Therapeutic/Care Management; Level III.

Let $FG$ be the group algebra of a finite $p$-group $G$ over a finite field $F$ of characteristic $p$ and let $*$ be the classical involution of $FG$. The $*$-unitary subgroup of $FG$, denoted by $V_*(FG)$, is defined to be the set of all normalized units $u$ satisfying the property $u^*=u^{-1}$. In this paper we give a recursive method how to compute the order of the $*$-unitary subgroup for certain non-commutative group algebras. A variant of the modular isomorphism question of group algebras is also considered.

Let FG be the group algebra of a finite 2-group G over a finite field F of characteristic two and let ⊛ be an involution that arises from G. The ⊛-unitary subgroup of FG is denoted by V⊛(FG) and defined as the set of all normalized units u satisfying the property u⊛ = u−1. We establish the order of V⊛(FG) for all involutions ⊛ arising from G, where G is a finite cyclic 2-group, and show that all ⊛-unitary subgroups of FG are not isomorphic.

OBJECTIVE In this article, a statistical-based iterative ring removal (IRR) algorithm that effectively removes ring artifacts generated by defective detector cells is proposed. METHODS The physical state of computed tomography (CT) detector elements can change dynamically owing to their temperature dependence and the varying irradiation caused by focal spot movements. This variation in the properties of cells may cause false pixel values in sinograms, resulting in rings or segments of rings in reconstructed images. In this article, the proposed algorithm is studied on clinical CT. Two patients were scanned using a clinical CT scanner (AnyScan SPECT/CT, Mediso). Artificial rings and band rings were generated on the real sinogram data to examine the algorithm in different cases. The method was performed also on real ring artifacts. RESULTS The IRR can correct both single and band-like ring artifacts with one or more defective pixels. The proposed algorithm can detect the period when pixels contain false signals and only those periods are corrected. The IRR reduces ring artifacts, even in cases where low-contrast rings occur in the reconstructed image. CONCLUSIONS This statistical correction method efficiently detects and corrects false pixel values in the projection data without causing new artifacts in the reconstructed image. The algorithm is less sensitive to its parameters.

In the system of the division of powers, a separated Administrative Court expresses the particular importance of the judicial control over the executive power. On the basis of the rule of law, the administrative court may review not only the administrative decisions, but also all administrative acts which do not fall within the competence of another body, typically the Constitutional Court. In Hungary, the legislator chose the solution that in the administrative court system in cases of norm control, the Curia of Hungary (the highest judicial authority in Hungary) decides and makes quasi-constitutionaljudgments when it is examining the legality of local government decrees: the Curia’s final decision cannot be subject to any appeal and it is binding for all. The paper gives an overview of the last seven years of practice of the Curia of Hungary in norm control cases (examination of the legality of local government decrees) and presents ideas for its further development. We can state that this task is fixed in the Hungarian organisation of courts, but the organizational and procedural order can be adopted in the further development of the administrative courts in Hungary. Finally the paper suggests to reconsider the enlargement of the competence of norm control and/or the widening of its applicants.

Let [Formula: see text] be the group algebra of the modular group [Formula: see text] over a finite field [Formula: see text] of characteristic two. We calculate the order of the ∗-unitary subgroup of the group algebra [Formula: see text] and describe the structure of the ∗-unitary subgroup in the case when [Formula: see text].

Let G be a group and let F be a field of characteristic different from 2. Denote by (FG)+ the set of symmetric elements and by U +(FG) the set of symmetric units of the group algebra FG, with respect to the canonical involution on FG sending each group element to its inverse. In this article, we give some lower and upper bounds on the Lie nilpotency index of (FG)+ and the nilpotency class of U +(FG); furthermore, we classify the groups for which these bounds are achieved.

Let G be a group such that the set of p -elements of G forms a finite nonabelian subgroup, where p is an odd prime, and let F be a field of characteristic p . In this paper we prove that the lower bound of the Lie derived length of the group algebra F G given by Shalev in [11] is also a lower bound for the Lie derived length of the set of symmetric elements of F G for every involution which is linear extension of an involutive anti-automorphism of G . Furthermore, we provide counterexamples to the interesting cases which are not covered by the main theorem.

Let F be a field of odd prime characteristic p, G a group, U the group of units in the group algebra FG, and U+ the subgroup of U generated by the elements of U fixed by the anti-automorphism of FG which inverts all elements of G. It is known that U is nilpotent if G is nilpotent and the commutator subgroup G' has p-power order, and then the nilpotency class of U is at most the order of G' ; this bound is attained if and only if G' is cyclic and not a Sylow subgroup of G. Adalbert Bovdi and Janos Kurdics proved the "if" part of this last statement by exhibiting a nontrivial commutator of the relevant weight. For the special case when G is a nonabelian torsion group (so G' cannot possibly be a Sylow subgroup), the present paper identifies such a commutator in U+, showing (Theorem 1) that the same bound is attained even by the nilpotency class of this subgroup. We do not know what happens when G' is not a Sylow subgroup but G is not torsion. It can happen that U+ is nilpotent even though U is not. The torsion groups G which allow this are known (from the work of Gregory T. Lee) to be precisely the direct products of a finite p-group P, a quaternion group Q of order 8, and an elementary abelian 2-group. Theorem 2: in this case, the nilpotency class of U+ is strictly smaller than the nilpotency index of the augmentation ideal of the group algebra FP, and this bound is attained whenever P is a powerful p-group. The nonabelian group P of order 27 and exponent 3 is not powerful, yet the G = P x Q formed with this P also leads to a U+ attaining the general bound, so here a necessary and sufficient condition remains elusive.

Objective. To report the efficacy and safety of TNF-a inhibitors (etanercept and adalimumab) in a cohort of patients with JIA treated in a single paediatric rheumatological centre. Methods. Patients with JIA under the age of 18 years, treated with TNF-a blockers at the Paediatric Rheumatologic Centre of the National Institute of Rheumatology and Physiotherapy (Budapest, Hungary) from 2002, were enrolled in an open, observational study. At baseline, patient and disease characteristics were registered. Disease activity was evaluated (before the start of the treatment and after every 3 months) according to the JIA core set of the ACR paediatric definition of improvement (ACR Pedi). Adverse events (AEs) were documented. Results. In all, 72 patients were evaluated. Mean (S.D.) age at onset was 5.5 (3.8) years, mean disease duration was 7.4 (3.9) years. All disease activity parameters improved significantly in the first 3 months of treatment. After 3 and 12 months of treatment, 88 and 76% of patients, respectively, achieved the criteria of the ACR Pedi 30. AEs were uncommon. After 12 months, >85% of patients continued the therapy. Conclusion. Anti-TNF-a agents (etanercept and adalimumab) are effective, safe and well tolerated in JIA patients. Extension of this study for a longer follow-up period and to the patients with JIA after the age of 18 years (with validated and comparable disease activity parameters) is needed to evaluate the long-term effectiveness and safety of the TNF-a inhibitors.

Hereby, we report the case of a 12-year-old girl developing oligoarthritis and progressing into a polyarticular form. Rheumatoid factor was positive, and juvenile idiopathic arthritis (JIA) was diagnosed. After a poor response to DMARDs, an anti-TNF agent (infliximab) was initiated, but to be discontinued due to an allergic reaction. The same complication was observed with the fully human derivative, adalimumab. At the age of 22, the patient presented septicemia with severe anemia and subsequent development of leukopenia, myocarditis with heart failure, and ANA, aSm, aSS-A, aCL positives, and nephrotic syndrome. These new clinical manifestations fulfilled the classification criteria for the diagnosis of systemic lupus erythematosus. Due to the poor therapeutic responses for both diseases, alternative medical options have to be considered, such as targeted therapy with anti-CD20 or interleukin-6 receptor antagonist monoclonal antibodies. This patient may also be a candidate for autologous hemopoietic stem cell transplantation.

The standardization of the criteria to evaluate improvement in rheumatic diseases has been a goal of numerous research groups. This work led to establishment of definition of response in rheumatoid arthritis (1), juvenile arthritis (2–4), systemic lupus erythematosus (SLE) both in adults (5–7) and children (8–10). The International Myositis Outcome Assessment and Clinical Studies (IMACS) group proposed a core set of outcome variables for inclusion in clinical trials in adult and juvenile inflammatory myopathies and defined the degree of change in each core set variables that is clinically meaningful, as well as guidelines for performing clinical trials (11–14). However, until now these proposals have not yet been formally validated in the context of external prospective pediatric studies or clinical trials. Although children/adolescents and adults with DM share many signs and symptoms of disease, they differ in the clinical features and outcome (15–17), and treatment approaches should consider the peculiarities of juvenile patients as well as their longer life expectancy. Therefore, all outcome measures developed for adults need to be subjected to a critical evidence-based evaluation of their measurement properties in children and adolescents. To help standardize the conduct and reporting of juvenile dermatomyositis (JDM) clinical trials and enhance identification of new therapeutic agents, the Pediatric Rheumatology International Trials Organization (PRINTO) (18), in collaboration with the Pediatric Rheumatology Collaborative Study Group (PRCSG) and with the support of the European Union and the U.S. National Institutes of Health, undertook in year 2000 a multinational effort to develop, and promulgate a core set of outcome variables and a definition of clinical improvement to evaluate response to therapy in patients with JDM and in juvenile SLE. The first two phases of the project, previously published (8;19), led to the development of a prospectively evidence-based validated core set of six variables for the evaluation of response to therapy that is now known as the provisional PRINTO/American College of Rheumatology/European League Against Rheumatism Disease Activity Core Set for the evaluation of response to therapy in JDM (PRINTO/ACR/EULAR JDM core set) (Table 1). Table 1 Final domains and suggested variables included in the final PRINTO/ACR EULAR core set for the evaluation of response to therapy in JDM (adapted from ref. (19)). In this paper we report the results of the third phase of the project, which was aimed at developing a provisional validated definition of improvement to aid in the classification of individual patients in future therapeutic trials and in current clinical practice as either improved or not improved.

The authors present case reports with juvenile idiopathic arthritis being associated with functional constipation but not with inflammatory bowel disease. The cause of megacolon was only cleared in one case in the form of Hirschprung’s disease. The skeletal symptoms could be classified as seronegative spondylathropathy. Surgical treatment resulted in the remission of arthritis in one case and a possible pathogenic explanation is discussed. Common genetic predisposition is a plausible explanation, but fecal stasis leading to increased permeability to macromolecules, increased exposure to microbial and dietary antigens, loss of tolerance to own bacterial flora and host susceptibility to the increased antigenic load may stand in the background of this infrequent and not yet described association between juvenile idiopathic arthritis and functional constipation.

Objective To assess the long-term efficacy and safety of infliximab plus methotrexate in juvenile rheumatoid arthritis (JRA). Methods Patients eligible for the open-label extension (OLE, weeks 52–204) received infliximab 3–6 mg/kg every 8 weeks plus methotrexate. Results Of the 78/122 (64%) children entering the OLE, 42 discontinued infliximab, most commonly due to consent withdrawal (11 patients), lack of efficacy (eight patients) or patient/physician/sponsor requirement (eight patients). Infliximab (mean dose 4.4 mg/kg per infusion) was generally well tolerated. Infusion reactions occurred in 32% (25/78) of patients, with a higher incidence in patients positive for antibodies to infliximab (58%, 15/26). At week 204, the proportions of patients achieving ACR-Pedi-30/50/70/90 response criteria and inactive disease status were 44%, 40%, 33%, 24% and 13%, respectively. Conclusions In the limited population of JRA patients remaining in the study at 4 years, infliximab was safe and effective but associated with a high patient discontinuation rate. Clinical trials registration number NCT00036374.

Objective.To investigate the possible association between polymorphisms of the mannose-binding lectin gene (MBL2) and susceptibility to juvenile idiopathic arthritis (JIA).Methods.We performed a case-control association study including 118 Hungarian patients with JIA and 118 sex-matched healthy controls. MBL genotyping for the 3 mutant structural alleles at codons 54 (B), 57 (C), and 52 (D) in exon 1 and the promoter polymorphisms at position −550 (HL) and −221 (YX) were carried out by real-time PCR allelic discrimination. Serum level of MBL was determined by ELISA.Results.Variant allele frequencies of both codon 52 and 57 polymorphisms in the MBL2 gene were significantly overrepresented in JIA (p = 0.001 and p = 0.004, respectively). The frequency of low MBL genotypes (XA/XA, YA/YO, XA/YO, and YO/YO) in JIA was higher than that in healthy controls (p = 0.001). Serum MBL concentrations were found to be significantly lower in JIA patients versus control subjects (p = 0.001). The 2 promoter polymorphisms and codon 54 SNP of the MBL2 gene were not associated with JIA.Conclusion.Our findings suggest that genetically determined low MBL levels may predispose children to JIA in a Hungarian population. These data warrant further research to investigate the role of the lectin-dependent complement system in the pathogenesis of JIA.

In trauma patients, pulmonary embolism occurs in up to 4% of cases and carries a mortality of 20-50%. The incidence of deep vein thrombosis (DVT) varies from 5 to 63% depending on patients' risk factors, modality of prophylaxis, and methods of detection. For these reasons, trauma patients require adequate DVT prophylaxis.Spinal fracture or cord injury patients are at particular risk. Increasing injury severity, head injury, older age, lower limb injuries, and obesity are other risk factors. The current standard of care for DVT prophylaxis is enoxaparin (a low molecular weight heparin) as long as anticoagulation is not contraindicated. Unfractionated heparin alone does not provide sufficient protection against DVT. Selective factor Xa inhibitors such as fondaparinux are showing promising results. Other strategies for pulmonary embolism prevention include: graduated compression stockings, sequential compression devices, continuous passive motion, and prophylactic inferior vena cava filter. There is lack of consensus regarding the optimal DVT prophylaxis in trauma patients and few level I recommendations exist.Best practice in thromboprophylaxis for trauma patients will remain on the basis of recommendations until definitive risk-benefit ratios are determined to justify the use of various mechanical and pharmacological measures, in combination or alone.

In this article the Lie derived length and the strong Lie derived length of group algebras are determined in the case when the derived subgroup of the basic group is cyclic of odd order. As a consequence, we have the characterization of the group algebras of minimal strong Lie derived length.

Background Hemorrhage-related mortality (HRM) associated with pelvic fractures continues to challenge trauma care. This study describes the management and outcome of hemodynamically unstable patients with a pelvic fracture, with emphasis on primary intervention for hemorrhage control and HRM. Methods Blunt trauma patients [Injury Severity Score (ISS) >= 16] with a major pelvic fracture (Abbreviated Injury Score, pelvis >= 3) and hemodynamic instability [admission systolic blood pressure (SBP) = 6 units of packed red blood cells (PRBCs)/24 hours) were included into a 48-month (ending in December 2003) multicenter retrospective study of 11 major trauma centers. Data are presented as the mean +/- SD. Results A total of 217 patients (mean age 41 +/- 19 years, 71% male, ISS 42 +/- 16) were studied. The admission SBP was 96 +/- 37 mmHg and the Glascow Coma Scale (GCS) 11 +/- 5. Patients received 4 +/- 2 liters of fluids including 4 +/- 4 units of PRBCs in the emergency room (ER). In total, 69 (32%) patients died, among whom the HRM was 19%; 29% of the deaths were due to pelvic bleeding. Altogether, 120 of the 217 (55%) patients underwent focused abdominal sonography for trauma (FAST) or diagnostic peritoneal aspiration (DPA) and diagnostic peritoneal lavage (DPL); 60 of the 217 (28%) patients were found to have pelvic binding in the ER. In all, 53 of 109 (49%) patients had no bleeding noted at laparotomy, 26 of 106 (25%) had no abdominal findings, and 15 of 53 (28%) had had no prior abdominal investigation (FAST/DPL/computed tomography). Angiography was positive in 48 of 58 (83%) patients. The HRM was highest in patients with laparotomy as the primary intervention (29%) followed by the angiography group (18%), the combined laparotomy/pelvic fixation group (16%), and the pelvic fixation-only group (10%). Conclusion HRM associated with major pelvic trauma is unacceptably high especially in the laparotomy group. Hence, nontherapeutic laparotomy must be avoided, concentrating instead on arresting pelvic hemorrhage. Standards of care must be implemented and abided by

Let G be a group with cyclic derived subgroup of p-power order (p > 2), and F a field of characteristic p. We determine the derived length of the group of units of the group algebra FG.

Az idiopathiás inflammatoricus myopathiák szisztémás autoimmun megbetegedések, amelyek krónikus izomgyulladás által okozott progresszív izomgyengeséggel, továbbá egyes belső szervek, úgymint a cardiovascularis rendszer, a tüdő és az emésztőrendszer elváltozásaival jellemezhetők.Cél:79 juvenilis és felnőtt korú dermatomyositisben szenvedő beteg adatai alapján a betegség kórlefolyásának és a relapsusok gyakoriságának, továbbá a túlélési valószínűségének bemutatása.Módszer:A szerzők retrospektív módon elemezték 44, a Bohan- és Peter-féle diagnosztikus kritériumrendszer alapján 1976 és 2004 között diagnosztizált juvenilis dermatomyositisben szenvedő gyermek adatait. A túlélési valószínűséget a Kaplan–Meier-módszer segítségével számították ki. A juvenilis dermatomyositisben szenvedő gyermekek adatait 35 felnőtt dermatomyositises beteg adataival hasonlították össze.Eredmények:A betegség kórlefolyása az esetek több mint felében monofázisos volt, míg a betegek egyharmada policiklusos formában szenvedett. A relapsus kockázata a remissziót követő első évben volt a legnagyobb. A juvenilis betegek közül senki sem hunyt el, míg a felnőtt korú betegek között négy betegséghez köthető haláleset is előfordult.Összegzés:Nem találtak összefüggést a relapsusmentes túlélés és a betegség kezdeti terápiája között (glükokortikoid önmagában vagy immunszuppresszív szerrel kiegészítve). A betegek jelentős aránya szenvedett policiklusos vagy krónikus lefolyású betegségben. A relapsusok jelentkezésére egy hosszabb betegségmentes intervallum után is számítani lehet, ezért mindenképpen javasolt a betegek hosszabb távú követése, legkevesebb 2 éven keresztül. Bár igen kedvező eredményeket találtak a betegség túlélésével kapcsolatban, további vizsgálatok szükségesek a betegség funkcionális kimenetelét illetően.

OBJECTIVE: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. In the absence of consensus definitions and treatment guidelines the diagnosis and management of IAH and ACS remains variable from institution to institution. DESIGN: An international consensus group of multidisciplinary critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to develop practice guidelines for the diagnosis, management, and prevention of IAH and ACS. METHODS: Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference. The present article is the second installment of the final report from the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of the Abdominal Compartment Syndrome. RESULTS: The prevalence and etiological factors for IAH and ACS are reviewed. Evidence-based medicine treatment guidelines are presented to facilitate the diagnosis and management of IAH and ACS. Recommendations to guide future studies are proposed. CONCLUSIONS: These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.

Background This study reviews the efficacy of vacuum-assisted wound closure (VAWC) to obtain primary fascial closure of open abdomens after severe trauma. Methods The study population included shock resuscitation patients who had open abdomens treated with VAWC. The VAWC dressing was changed at 2- to 3-day intervals and downsized as fascial closure was completed with interrupted suture. The Trauma Research Database and the medical records were reviewed for pertinent data. Results Over 26 months, 35 patients with open abdomens were managed by VAWC. Six died early, leaving 29 patients who were discharged. Of these, 25 (86%) were successfully closed using VAWC at a mean of 7 +/- 1 days (range, 3-18 days). Of the four patients that failed VAWC, two developed fistulas. No patients developed evisceration, intra-abdominal abscess, or wound infection. Conclusion VAWC achieved early fascial closure in a high percentage of open abdomens, with an acceptable rate of complications.

To identify preliminary core sets of outcome variables for disease activity and damage assessment in juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM).Two questionnaire surveys were mailed to 267 physicians from 46 different countries asking each member to select and rank the response variables used when assessing clinical response in patients with JSLE or JDM. Next, 40 paediatric rheumatologists from 34 countries met and, using the nominal group technique, selected the domains to be included in the disease activity and damage core sets for JSLE and JDM.A total of 41 response variables for JSLE and 37 response variables for JDM were selected and ranked through the questionnaire surveys. In the consensus conference, domains selected for both JSLE and JDM activity or damage core sets included the physician and parent/patient subjective assessments and a global score tool. Domains specific for JSLE activity were the immunological tests and the kidney function parameters. Concerning JDM, functional ability and muscle strength assessments were indicated for both activity and damage core sets, whereas serum muscle enzymes were included only in the activity core set. A specific paediatric domain called 'growth and development' was introduced in the disease damage core set for both diseases and the evaluation of health-related quality of life was advised in order to capture the influence of the disease on the patient lifestyle.We developed preliminary core sets of measures for disease activity and damage assessment in JSLE and JDM. The prospective validation of the core sets is in progress.

Objectives Juvenile idiopathic arthritis (JIA) is a chronic inflammatory joint disease affecting children. Even if remission is successfully induced, about half of the patients experience a relapse after stopping anti-inflammatory therapy. The present study investigated whether patients with JIA at risk of relapse can be identified by biomarkers even if clinical signs of disease activity are absent. Methods Patients fulfilling the criteria of inactive disease on medication were included at the time when all medication was withdrawn. The phagocyte activation markers S100A12 and myeloid-related proteins 8/14 (MRP8/14) were compared as well as the acute phase reactant high-sensitivity C reactive protein (hsCRP) as predictive biomarkers for the risk of a flare within a time frame of 6 months. Results 35 of 188 enrolled patients experienced a flare within 6 months. Clinical or standard laboratory parameters could not differentiate between patients at risk of relapse and those not at risk. S100A12 and MRP8/14 levels were significantly higher in patients who subsequently developed flares than in patients with stable remission. The best single biomarker for the prediction of flare was S100A12 (HR 2.81). The predictive performance may be improved if a combination with hsCRP is used. Conclusions Subclinical disease activity may result in unstable remission (ie, a status of clinical but not immunological remission). Biomarkers such as S100A12 and MRP8/14 inform about the activation status of innate immunity at the molecular level and thereby identify patients with unstable remission and an increased risk of relapse.

Non-operative management of blunt splenic trauma (BST) in children is the standard of care with a success rate of greater than 90%. This paper aims to determine the factors which could predict the need for operative intervention in children with BST.Prospectively entered data of 69 children with BST, between 1997 and 2008, from a single tertiary level trauma centre, were retrospectively analysed. A radiologist blinded to the outcome reviewed all computed tomography scans retrospectively.Forty-two children had isolated BST (61%) and 27 children had associated injuries (39%). All except one survived the injury and non-operative treatment was successful in 91%. Six of the 69 children (9%) with BST underwent splenectomy. There was no independent correlation to age, gender, mechanism of injury (MOI), injury grade and the need for splenectomy, whereas haemodynamic instability within 6 h of injury defined as failed resuscitation had a 100% correlation.Haemodynamic instability, which failed to respond to resuscitation within 6 h, predicted the need for splenectomy in children with BST. Splenic injury grade assessed by computed tomography scan does not predict the need for splenectomy.

A szerzők jelen munkában négy juvenilis betegük esetét mutatják be, akiknél a krónikus ízületi gyulladást kísérő megacolont észleltek. A két betegség lefolyását és egymással való (feltehetőleg patogenetikai) kapcsolatát ismertetik, felhívva a figyelmet arra, hogy nem véletlen társulásról lehet szó. A mozgásszervi klinikai kép alapján mind a négy eset a szeronegatív spondylarthritisek csoportjába sorolható. A hasi statust illetően fizikális vizsgálattal minden alkalommal a bal oldali iliacalis régióban masszív rezisztenciát, nagy mennyiségű scibalakkal telített megacolont észleltek. A megacolon egy esetben bizonyult valódi Hirschprung-betegségnek, műtéti megoldására egy esetben került sor, amely egyúttal az arthritis remisszióját is eredményezte. A többi betegnél a krónikus obstipáció, megacolon továbbra is megoldásra vár.

OBJECTIVES: To compare health-related quality of life (HRQL) and to identify clinical determinants for poor HRQL of patients with juvenile idiopathic arthritis (JIA) coming from three geographic areas.METHODS: The HRQL was assessed through the Child Health Questionnaire (CHQ). A total of 30 countries were included grouped in three geographic areas: 16 countries in Western Europe; 10 in Eastern Europe; and four in Latin America. Potential determinants of poor HRQL included demographic data, physician's and parent's global assessments, measures of joint inflammation, disability as measured by Childhood Health Assessment Questionnaire (CHAQ) and erythrocyte sedimentation rate. Poor HRQL was defined as a CHQ physical summary score (PhS) or psychosocial summary score (PsS)

Objective. To evaluate the safety and efficacy of infliximab in the treatment of juvenile rheumatoid arthritis (JRA). Methods. This was an international, multicenter, randomized, placebo-controlled, double-blind study. One hundred twenty-two children with persistent polyarticular JRA despite prior methotrexate (MTX) therapy were randomized to receive infliximab or placebo for 14 weeks, after which all children received infliximab through week 44. Patients received MTX plus infliximab 3 mg/kg through week 44, or MTX plus placebo for 14 weeks followed by MTX plus infliximab 6 mg/kg through week 44. Results. Although a higher proportion of patients in the 3 mg/kg infliximab group than in the placebo group had achieved responses according to the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30) criteria for improvement at week 14 (63.8% and 49.2%, respectively), the between-group difference in this primary efficacy end point was not statistically significant (P = 0.12). By week 16, after the crossover from placebo to infliximab 6 mg/kg when all patients were receiving infliximab, an ACR Pedi 30 response was achieved in 73.2% of all patients. By week 52, ACR Pedi 50 and ACR Pedi 70 responses had been reached in 69.6% and 51.8%, respectively, of patients. Infliximab was generally well tolerated, but the safety profile of infliximab 3 mg/kg appeared less favorable than that of infliximab 6 mg/kg, with more frequent occurrences of serious adverse events, infusion reactions, antibodies to infliximab, and newly induced antinuclear antibodies and antibodies to double-stranded DNA observed with the 3 mg/kg dose. Conclusion. While infliximab at 3 mg/kg and 6 mg/kg showed durable efficacy at 1 year, achievement of the primary efficacy end point at 3 months did not differ significantly between infliximab-treated and placebo-treated patients. Safety data indicated that the 6-mg/kg dose may provide a more favorable risk/benefit profile. These results warrant further investigation in children with JRA. © 2007, American College of Rheumatology.

Let V(F_pG) be the group of normalized units of the group algebra F_pG of a finite nonabelian p-group G over the field F_p of p elements. Our goal is to investigate the power structure of V(F_pG), when it has nilpotency class p. As a consequence, we have proved that if G and H are p-groups with cyclic Frattini subgroups and p>2, then V(F_pG) is isomorphic to V(F_pH) if and only if G and H are isomorphic.

This article reviews the most common forms of primary immunodeficiencies with articular involvement: X-linked (Bruton's) agammaglobulinaemia, common variable immune deficiency and selective IgA deficiency. The most commonly observed types of arthritis in these disorders are benign, aseptic, characteristically non-erosive polyarthritis and infective arthritis caused by Mycoplasmas or Ureaplasmas. The authors present the case of a patient with immunodeficiency whose polyarthritis was found to be unusually severe and destructive.

JIA affected sibling pairs present high correlation for ANA and ILAR category G Filocamo, C Malattia, I Foeldvari, V Stanevicha, S Nielsen, T Herlin, C Pruunsild, F Zulian, Z Balogh, F Dressler, I Rumba, MG Alpigiani, E Cortis, F Falcini, R Trauzeddel, G Calcagno, L Lepore, M Alessio, DN Glass, SD Thompson, A Martini, N Ruperto, for the Paediatric Rheumatology International Trials Organisation (PRINTO)

SummaryA single-blind, crossover trial was carried out in 24 patients with definite or classical rheumatoid arthritis to compare the effectiveness and tolerability of piroxicam (20 mg once daily) with that of indoniethacin (25 mg 3-times daily), ibuprofen (400 mg 3-times daily) and placebo. Each drug was given in random order for a period of 1 week. Pain, joint tenderness and morning stiffness decreased and grip strength increased with piroxicam compared to placebo; no statistically significant difference could be found between piroxicam and the two other active agents. A reduction in joint circumference could not be demonstrated with piroxicam or ibuprofen but most patients did not have reducible swelling in their finger joints. Piroxicam was just as effective as the other two drugs overall, but fewer side-effects were noted with piroxicam.