Case Report: Infusion-Related Reactions to Intravenous Infliximab and Subcutaneous Ustekinumab in Pediatric Crohn's Disease

Background: Although the biological agent ustekinumab (UST) is reported to be effective for Crohn's disease (CD) in pediatric as well as adult patients, data on the efficacy and safety of UST in pediatric patients with CD are limited. Here, we describe the case of a pediatric patient who showed an allergic reaction to UST after subcutaneous (SC) maintenance injections but not immediately after initial intravenous (IV) injection.Case Presentation: A 9-year-old boy presented to our hospital with diarrhea lasting 2 years and weight loss, leading to the diagnosis of CD. After prednisolone (PSL) was tapered and discontinued, he promptly relapsed. According to our institution's protocol, we introduced the biological agent infliximab (IFX) with premedication. Coughing and vomiting was observed after the second dose of IFX and it was changed to adalimumab (ADA). However, the effect of ADA gradually disappeared after 18 months; therefore, it was discontinued and he was treated using UST. The first IV UST dose was given after administering hydrocortisone (HDC), an antiallergic and antipyretic analgesic, as premedication, and no obvious adverse reaction was observed. After 8 weeks, UST was subcutaneously injected without premedication. The patient then complained of nausea, dizziness, and headache within 15 min of UST administration. Therefore, for the third dose of UST, HDC was administered again as premedication. However, nausea, dizziness, and headache presented 10 min after UST administration, resulting in discontinuation of further UST treatment.Conclusion: Careful distinction between “true” infusion-related reactions (IRRs) and anaphylaxis or allergic reactions is necessary to determine whether biological agents can be continued after the development of “so-called” IRRs. For true IRRs, it may be possible to continue using the biological agent with appropriate premedication; however, in cases of anaphylaxis, the biological agent itself should be changed.

Islamic fundamentalism (Read on the paths of formation and dimensioning the future)

Islamic fundamentalism is no longer a phenomenon that only Islamic societies knew or belongs to a specific society, but it exceeded the local and international dimensions, and despite the concept's modernity, the emergence of its mechanisms and effects is considered a contemporary intellectual phenomenon that has its internal or international causes or dimensions (political, religious, social, psychological). It was coupled with many radical and extremist concepts after its principles and intellectual sources were adopted from these concepts, despite the fact that some fundamentalist movements differed from each other in terms of goals, generations, discourse and communications. The confusion between fundamentalism and terrorism requires careful distinction between them and also requires and requires multidimensional treatments (intellectually, religiously, politically .......) and by rebuilding religious institutions so that they can carry out their functions or address the critically enlightened processes of transforming concepts and restoring reason and guidance To the administration of public affairs

Computer-supported Analysis of Positive Properties, Ultrafilters and Modal Collapse in Variants of Gödel's Ontological Argument

Three variants of Kurt Gödel's ontological argument, proposed by Dana Scott, C. Anthony Anderson and Melvin Fitting, are encoded and rigorously assessed on the computer. In contrast to Scott's version of Gödel's argument the two variants contributed by Anderson and Fitting avoid modal collapse. Although they appear quite different on a cursory reading they are in fact closely related. This has been revealed in the computer-supported formal analysis presented in this article. Key to our formal analysis is the utilization of suitably adapted notions of (modal) ultrafilters, and a careful distinction between extensions and intensions of positive properties.

Die unklare Leberraumforderung

Unknown liver lesions represent a common clinical challenge, for example in the context of routine ultrasound examinations of primary care physicians. There are different data on the prevalence of primary liver lesions in the literature. As such, a forensic autopsy series described focal liver lesions in about 50 % of all examined men between 35 and 69 years of age with an increasing incidence for older people. In the diagnostic work-up of unclear liver lesions, a careful distinction between lesions that occur in asymptomatic and healthy individuals and are benign in over 95 % of cases, and lesion found in patients with pre-existing malignant, inflammatory or cirrhotic disease must be made. The main goal in the diagnosis of unclear liver lesions is to prove the benignity of the lesion and to exclude a malignant cause as reliably as possible. In case of benign lesions, an attempt should be made to achieve an exact classification. The most common benign focal liver lesions include liver cysts, focal fatty liver deposition or sparing, haemangiomas, focal calcifications, focal nodular hyperplasia (FNH), nodular regenerative hyperplasia, biliary hamartomas (von-Meyenburg complexes) and hepatocellular adenomas. Abscesses, inflammatory infiltrations or pseudotumors as well as sites of extramedullary haematopoiesis are observed much less frequently. Among the most frequent malignant focal liver lesions are metastases of other tumor entities such as colorectal cancer or pancreatic adenocarcinoma as well as hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCA). Other entities such as hepatic lymphomas or mesenchymal malignant neoplasia are extremely rare.

John Chrysostom’s Reception of Basil of Caesarea’s Trinitarian Theology

The last two decades have seen extensive research on the Trinitarian theologies of several post-Nicene Fathers. Not much, however, has been done for John Chrysostom. Thomas Karman and Pak-Wah Lai have demonstrated separately that Chrysostom shares several theological beliefs with the Eusebian-Meletians, including the doctrine of divine incomprehensibility, and their anti-Sabellian concerns. Stylianos Papadopoulos has claimed further that Chrysostom is a successor of both Athanasius and the Cap­padocians’ teachings. Among the Cappadocians, it was Basil of Caesarea who first allied himself with the Meletians in the 370s. This makes him a prime candidate for examining Chrysostom’s reception of Cappadocian theology. We observe, first of all, that both ­bishops operate within the Meletian tradition, employing a wide range of Eusebian motifs to denote the Trinitarian relations, including the use of hypostatic language as a safeguard against Sabellianism. Both also assume God’s nature as incomprehensible. Basil, however, also developed several theological ideas which feature prominently in Chrysostom’s homilies. Specifically, a doctrine of divine simplicity that distinguishes between the knowledge and conceptions of God’s ousia, a careful distinction between God’s ousia and hypostasis whereby the latter is taken as representing ousia in its particular properties or idiomata, the illuminating role of the Spirit, and, finally, the defence of the Son and Spirit’s full divinity by underscoring the fact that they are equal in knowledge, authority, honour, and power as the Father. Taken together, these similarities suggest strongly that Basil’s teachings loom large in Chrysostom’s Trinitarian theology.

Superstition in Sacramental Theology

Maurice Blondel’s Action (1893) illustrates that the phenomenon of superstition inveigles its way into all forms of human activity, even intellectual pursuits like philosophy and theology, when they insulate themselves from the transcendent in human self-sufficiency. This essay explores how superstition is a constant threat for sacramental theology, manifest in particular, when the heterogeneity of human and divine agency in sacramental synergy is blurred or ignored. It argues that Blondel’s philosophical acumen permits a retrieval of vital insights of the scholastic synthesis, especially the careful distinction between divine agency ( opus operatum) and human agency ( opus operantis) in the sacramental act.

Locus of marking typology in the possessive NP: A new approach

This study takes a semantic approach to Nichols’ influential locus of marking typology, as applied to the possessive noun phrase. In this approach, a careful distinction is made between two semantic types of dependency relations: those between inherently relational nouns and their argument possessors and those between inherently non-relational nouns and their modifier possessors. I furthermore propose an alternative analysis of possessive person markers in terms of locus, by distinguishing referential markers from agreement markers, depending on the distribution of grammatical feature information in the possessive NPs of individual languages. On the basis of a 37-language sample, I show that locus of marking follows two tendencies: marking the possessum in alienable possession implies marking the possessum in inalienable possession, and marking the possessor in inalienable possession implies marking the possessor in alienable possession. Moreover, I show that if inalienable person markers are referential, alienable person markers are referential as well. These tendencies reflect a greater need of alienable (modifier) possessors for expressive means of coding as compared to inalienable (argument) possessors. On a more general level, I argue against the traditional opposition between head-marking languages and dependent-marking languages, showing that, from a semantic perspective, dependent-marking may also occur on heads.

Calvin's legacy for contemporary Reformed natural law

Recent scholarship has done much to uncover a continuous tradition of distinctively Reformed natural law reflection, according to which knowledge of the natural moral law, though not saving knowledge, is universally available to humanity in its fallen state and makes a stable secular order possible. A close look at Calvin's understanding of natural law, and in particular of conscience and natural human instincts, shows that Calvin himself did not expect the natural law to serve as a source of substantive action-guiding moral norms. First, Calvin held that conscience delivers information concerning the moral quality even of individual actions. But he also thought that we often blind ourselves to the deliverances of conscience. Second, he argued that our natural instincts predispose us to civic order and fair dealing insofar as these are necessary for the natural well-being or advantage of creatures such as ourselves. But he also carefully distinguished the good of advantage from the good of justice or virtue. The modern natural lawyers eroded Calvin's careful distinction between conscience as revealing our duty as duty, and instinct as guiding us towards natural advantage. They also turned away from Calvin's insistence on the moral incapacity of unredeemed humanity. The modern natural lawyers saw their task as one of developing an empirical science of human nature to guide legislation and shape international law, bracketing questions of whether this nature was fallen and in need of redemption. When Scottish Presbyterian Reformed thinkers, such as Gershom Carmichael and John Witherspoon, tried in diverse ways to restore eroded Reformed commitments to the science of human nature, about which they were otherwise so enthusiastic, they were not particularly successful. A science which could derive moral norms from an examination of human instincts, and a conscience which could deliver universal moral knowledge, proved too attractive to decline simply because of the transcendence of God or the fallenness of humankind. Those who wished to preserve an account of natural law which remained faithful to a fully robust set of Reformed theological commitments could do so only by refusing to regard the natural law as a positive source of moral knowledge.

TAKING THE TOOL ANALOGY SERIOUSLY: FORMS AND NAMING IN THECRATYLUS

It has been suggested that the so-called tool analogy passage of Plato'sCratyluspresents us with a moderate linguistic naturalism that can stand or fall independently of the more unpalatable etymological and mimetic theories advanced later in the dialogue. This paper offers a reading of the tool analogy which argues that Socrates' employment of Forms (and in particular Species-Forms), together with a careful distinction between the types of knowledge associated with making and using tools, aims to establish a radical linguistic naturalism that constrains the intrinsic properties of names. This should be clear if we take Socrates' claim seriously that names are tools: tools in general can only function successfully if they exhibit the relevant structural, compositional and (to some extent) material properties. Since Socrates claims that names are a class of tools and not merely like tools in some respects, as many have supposed, then what holds for tools in general must also hold for names.

Vascular surgery

As the patient in clinic describes the cramp-like pain that he gets in his calf when he walks, a pain that disappears on resting but which is exac­erbated by walking up hills and necessitates him stopping to look in shop windows when out and about, you will be thinking about questioning him for risk factors for vascular disease. Atherosclerosis is a systemic disease. Identification and early treatment of diabetes, hypercholesterolaemia, hypertension, and provision of antiplatelet agents and smoking cessation therapy will confer important cardio- and cerebroprotective benefits. Acute vascular emergencies requiring an urgent response include the patient with sudden onset, limb-threatening ischaemia; the collapsed patient with a ruptured aortic aneurysm; and the patient in whom haemorrhage or ischaemia comprises part of the picture of complex trauma. Rapid, but thorough examination, appropriate resuscitation, and judicious use of diagnostic imaging will help to underpin urgent manage­ment and interventions necessary to obtain the best outcomes for these patients. Despite increasing reliance on minimally invasive diagnostic modali­ties including duplex Doppler ultrasound, magnetic resonance angiog­raphy, and computed tomography angiography, principles of history taking and good clinical examination remain of paramount importance. Observation to detect nuances of ischaemic trophic changes and skin colour, as well as more overt signs of necrosis, gangrene, and ulceration, complements palpation of pulses, detection of subtle changes in skin temperature, delayed capillary refill, and presence of sensory neuropa­thy. A positive Buerger’s test, with pallor of the foot and venous gutter­ing on leg elevation, and rubor (redness), due to reactive hyperaemia on dependency, may help clinch the diagnosis of critical limb ischaemia when other diagnostic features are equivocal. Careful distinction between features of arterial insufficiency, venous hypertension, and diabetic neuropathy may help to determine aetiol­ogy of a recalcitrant lower limb ulcer and the consequent course of management. In the UK, vascular surgery has recently become an independent surgi­cal specialty. This chapter will test your understanding of signs and symp­toms of vascular disease and will hopefully stimulate your understanding of priorities for investigation and management of the range of conditions comprising this exciting sphere of surgery.