Occurrence, fate, and potential risk of pharmaceutical pollutants in agriculture: Challenges and environmentally friendly solutions.

In recent years, pharmaceutical active compounds (PhACs) have attained global prevalence. The behavior of PhACs in agricultural soils is complex and depends on several factors, such as the nature of the compounds and their physicochemical characteristics, which affect their fate and potential threats to human health, ecosystems, and the environment. The detection of residual pharmaceutical content is possible in both agricultural soils and environmental matrices. PhACs are commonly found in agricultural soil, with concentrations varying significantly, ranging from as low as 0.048 ng g-1 to as high as 1420.76 mg kg-1. The distribution and persistence of PhACs in agriculture can lead to the leaching of these toxic pollutants into surface water, groundwater, and vegetables/plants, resulting in human health risks and environmental pollution. Biological degradation or bioremediation plays a critical role in environmental protection and efficiently eliminates contamination by hydrolytic and/or photochemical reactions. Membrane bioreactors (MBRs) have been investigated as the most recent approach for the treatment of emerging persistent micropollutants, including PhACs, from wastewater sources. MBR- based technologies have proven to be effective in eliminating pharmaceutical compounds, achieving removal rates of up to 100%. This remarkable outcome is primarily facilitated by the processes of biodegradation and metabolization. In addition, phytoremediation (i.e., constructed wetlands), microalgae-based technologies, and composting can be highly efficient in remediating PhACs in the environment. The exploration of key mechanisms involved in pharmaceutical degradation has revealed a range of approaches, such as phytoextraction, phytostabilization, phytoaccumulation, enhanced rhizosphere biodegradation, and phytovolatilization. The well-known advanced/tertiary removal of sustainable sorption by biochar, activated carbon, chitosan, etc. has high potential and yields excellent quality effluents. Adsorbents developed from agricultural by-products have been recognized to eliminate pharmaceutical compounds and are cost-effective and eco-friendly. However, to reduce the potentially harmful impacts of PhACs, it is necessary to focus on advanced technologies combined with tertiary processes that have low cost, high efficiency, and are energy-saving to remove these emerging pollutants for sustainable development.

Facile preparation of porphyrin@g-C3N4/Ag nanocomposite for improved photocatalytic degradation of organic dyes in aqueous solution.

In the quest of improving the photocatalytic efficiency of photocatalysts, the combination of two and more semiconductors recently has garnered significant attention among scientists in the field. The doping of conductive metals is also an effective pathway to improve photocatalytic performance by avoiding electron/hole pair recombination and enhancing photon energy absorption. This work presented a design and fabrication of porphyrin@g-C3N4/Ag nanocomposite using acid-base neutralization-induced self-assembly approach from monomeric porphyrin and g-C3N4/Ag material. g-C3N4/Ag material was synthesized by a green reductant of Cleistocalyx operculatus leaf extract. Electron scanning microscopy (SEM), X-ray diffraction (XRD), FT-IR spectroscopy, and UV-vis spectrometer were utilized to analyse the properties of the prepared materials. The prepared porphyrin@g-C3N4/Ag nanocomposite showed well integration of porphyrin nanostructures on the g-C3N4/Ag's surface, in which porphyrin nanofiber was of the diameter in nanoscales and the length of several micrometers, and Ag NPs had an average particle size of less than 20 nm. The photocatalytic behavior of the resultant nanocomposite was tested for the degradation of Rhodamine B dye, which exhibited a remarkable RhB photodegrading percentage. The possible mechanism for photocatalysis of the porphyrin@g-C3N4/Ag nanocomposite toward Rhodamine B dye was also proposed and discussed.

Recent advances and applicable flexibility potential of electrochemical processes for wastewater treatment.

This study examined >140 relevant publications from the last few years (2018-2021). In this study, classification was reviewed depending on the operation's progress. Electrocoagulation (EC), electrooxidation (EO), electroflotation (EF), electrodialysis (ED), and electro-Fenton (EFN) processes have received considerable attention. The type of action (individual or hybrid) for each electrochemical procedure was evaluated, and statistical analysis was performed to compare them as a new manner of reviewing cited papers providing a massive amount of information efficiently to the readers. Individual or hybrid operation progress of the electrochemical techniques is critical issues. Their design, operation, and maintenance costs vary depending on the in-situ conditions, as evidenced by surveyed articles and statistical analyses. This work also examines the variables affecting the elimination efficacy, such as the applied current, reaction time, pH, type of electrolyte, initial pollutant concentration, and energy consumption. In addition, owing to its efficacy in removing toxins, the hybrid activity showed a good percentage among the studies reviewed. The promise of each wastewater treatment technology depends on the type of contamination. In some cases, EO requires additives to oxidise the pollutants. EF and EFN eliminated lightweight organic pollutants. ED has been used to treat saline water. Compared to other methods, EC has been extensively employed to remove a wide variety of contaminants.

A foam column system harvesting freshwater algae for biodiesel production: An experiment and process model evaluations.

The purpose of this study was to examine the application of the mathematical model of drift flux to the experimental results of the effect of cationic trimethyl-ammonium bromide (CTAB)-aided continuous foam flotation harvesting on the lipid content in Chlorella vulgaris microalgae. An experiment was conducted to determine the effect of the operating conditions on the enrichment factor (EF) and percentage recovery efficiency (%RE), where the flow rates at the inlet and bottom outlet remained constant. Data for the binary system (without algae) and ternary system (with algae) in an equal-area foam column show that the EF decreases linearly with increasing initial CTAB concentrations ranging from 30 to 75 mg/L for three levels of the studied air volumetric flow rate range (1-3) L/min. The percentage harvesting efficiency increased with increasing initial CTAB concentration and air volumetric flow rate to 96 % in the binary systems and 94 % in the ternary systems. However, in the foam column with the riser used in the three systems, a lower volume of liquid foam in the upward outlet stream resulted in a lower RE% than that of the column without the riser. The objective function of EF for the system with algae increased when the initial CTAB concentration was increased from 30 to 45 mg/L in the foam column with a riser for all air flow rates, and after 45 mg/L, a sudden drop in the microalgae EF was observed. In the comparison between the foam column with and without the riser for the system with algae, the optimum EF was 145 for the design of the column with the riser and 139 for the column without the riser.

A selective hydrometallurgical method for scandium recovery from a real red mud leachate: A comparative study.

The aim of this study was to recover Sc as the main product and Fe as a by-product from Hungarian bauxite residue/red mud (RM) waste material by solvent extraction (SX). Moreover, a new technique was developed for the selective separation of Sc and Fe from real RM leachates. The presence of high Fe content (∼38%) in RM makes it difficult to recover Sc because of the similarity of their physicochemical properties. Pyrometallurgical and hydrometallurgical methods were applied to remove the Fe prior to SX. Two protocols based on organophosphorus compounds (OPCs) were proposed, and the main extractants were evaluated: bis(2-ethylhexyl) phosphoric acid (D2EHPA/P204) and tributyl phosphate (TBP). The results showed that SX using diethyl ether and tri-n-octylamine (N235) was efficient in extracting Fe(III) from the HCl leachate as HFeC14. Over 97% of Sc was extracted by D2EHPA extractant under the following conditions; 0.05 mol/L of D2EHPA concentration, A/O phase ratio of 3:1, pH 0-1, 10 min of shaking time, and a temperature of 25 °C. Sc(OH)3 as a precipitate was efficiently obtained by stripping from the D2EHPA organic phase by 2.5 mol/L of NaOH with a stripping efficiency of 95%. In the TBP system, 99% of Sc was extracted under the following conditions: 12.5% vol of TBP, an A/O phase ratio of 3:1, 10 min of shaking time, and a temperature of 25 °C. The Sc contained in the TBP organic phase could be efficiently stripped by 1 mol/L of HCl with a stripping efficiency of 92.85%.

Developing a new approach for design support of subsurface constructed wetland using machine learning algorithms.

Knowing the effluent quality of treatment systems in advance to enable the design of treatment systems that comply with environmental standards is a realistic strategy. This study aims to develop machine learning - based predictive models for designing the subsurface constructed wetlands (SCW). Data from the SCW literature during the period of 2009-2020 included 618 sets and 10 features. Five algorithms namely, Random forest, Classification and Regression trees, Support vector machines, K-nearest neighbors, and Cubist were compared to determine an optimal algorithm. All nine input features including the influent concentrations, C:N ratio, hydraulic loading rate, height, aeration, flow type, feeding, and filter type were confirmed as relevant features for the predictive algorithms. The comparative result revealed that Cubist is the best algorithm with the lowest RMSE (7.77 and 21.77 mg.L-1 for NH4-N and COD, respectively) corresponding to 84% of the variance in the effluents explained. The coefficient of determination of the Cubist algorithm obtained for NH4-N and COD prediction from the test data were 0.92 and 0.93, respectively. Five case studies of the application of SCW design were also exercised and verified by the prediction model. Finally, a fully developed Cubist algorithm-based design tool for SCW was proposed.

Sustainable carbonaceous biochar adsorbents derived from agro-wastes and invasive plants for cation dye adsorption from water.

This study investigated methyl orange (MO) dye adsorption using three biochars produced from agro-waste and invasive plants; the latter consisted of wattle bark (BA), mimosa (BM), and coffee husks (BC). BC had the lowest specific surface area (2.62 m2/g) compared to BA (393.15 m2/g) and BM (285.53 m2/g). The adsorption efficiency of MO was stable at pH 2-7 (95%-96%), whilst it had reduced stability at pH 7-12. Between 0 and 30 min, MO adsorption efficiency was >82%, and at 120 min, representative adsorption equilibrium had occurred. The maximum adsorption capacity of the biochars was 12.3 mg/g. The underlying adsorption mechanisms of the three biochars were governed by electrostatic adsorption and pore diffusion. There was an abundance of active sites for adsorption in BA and BM, while chemical adsorption appeared to be more vital for BC, as it contained more functional groups on its surface. The highest MO adsorption efficiency occurred with BM. BC was not recommended for MO removal, as it was observed to stain the water when a dose exceeding 5.0 g/L was utilized.

Call for planning policy and biotechnology solutions for food waste management and valorization in Vietnam.

Food waste (FW) is more harmful than previously imagined. A large amount of Vietnam's FW ends up in landfills, only 20 % of which are sanitary. This causes significant environmental problems such as greenhouse gas emissions, high carbon footprint, leachate, and landfill-related conflicts. The FW from Vietnam's urban areas is 0.29 kg⸳p-1⸳d-1, accounting for 31.7 % of total waste. 38.81 % of families discharge FW which, along with municipal waste, corresponds to 4,429.21 ton⸳d-1 for the entire country. For FW collection, under transportation and treatment heads, 80,416.95 $⸳d-1 and 74,605.57 $⸳d-1 were spent, respectively. An analysis of Vietnam's national strategy for the integrated management of solid waste indicates that the amount of attention and concern currently given to FW issues is not adequate to address them. To resolve FW issues, Vietnam needs to be more proactive regarding solutions and efforts, in addition to implementing strict regulations. These include the setting of national goals under the priority of national strategy, strict regulations, stakeholder engagement, FW recycling to animal feed, biorefinery, and awareness-raising campaigns.

A Cross-Sectional Survey to Evaluate Potential for Partnering With School Nurses to Promote Human Papillomavirus Vaccination.

INTRODUCTION: The human papillomavirus (HPV) increases the risk for cancers of the cervix, oropharynx, vulva, vagina, penis, and anus. HPV vaccination rates are low in many states having large medically underserved areas. In such areas, school nurses are a potential partner for improving population health, but their perceptions about HPV, HPV vaccination, and their role in promoting HPV vaccination have not been well documented. METHODS: We administered a cross-sectional survey to 61 of 74 lead school nurses at their 2019 annual training session in South Carolina. Survey questions assessed lead school nurses' HPV vaccination beliefs, barriers, and HPV vaccination role in schools. We tabulated descriptive data and created heat maps to visualize correlations between responses. RESULTS: Despite 95.1% of nurses envisioning a role in supporting HPV vaccination at their schools, only 41.0% envisioned an active role in promoting HPV vaccine among students. Lead nurses consistently believed in vaccinating both male and female students; in vaccine safety, effectiveness, and health benefits; and in recommending HPV vaccination. The nurses agreed that lack of time and competing priorities were barriers to HPV vaccination. Few other barriers were consistently identified. CONCLUSION: Partnering with school nurses may be a feasible strategy to overcome barriers to increasing HPV vaccination rates in medically underserved areas. However, to increase nurses' confidence and time allotment to assume an active role in HPV vaccine promotion in their schools, coordinated and sustained partnerships between public health agencies, school districts, and school nurses are needed.

Two-step system consisting of novel vertical flow and free water surface constructed wetland for effective sewage treatment and reuse.

This study developed a unique system by combining the novel vertical flow (NVF) using expanded clay (ExC) and free flow surface constructed wetland (FWS) for dormitory sewage purification and reuse. The NVF tank consisted of filter layers of ExC, sandy soil, sand, and gravel. The FWS consisted of sandy soil substrate and was installed after the NVF. Colocasia esculenta and Dracaena sanderiana was planted in NVF and FWS, respectively. The treatment system was operated and tested for more than 21 weeks by increasing the hydraulic loading rate (HLR) from 0.02 m/d to 0.12 m/d. The results demonstrated that effluents in the system changed proportionally to the HLRs, except for nitrate nitrogen. Furthermore, the maximum removal efficiencies for TSS, BOD5, NH4-N, and Tcol were 76 ± 13%, 74 ± 11%, 90 ± 3%, and 59 ± 18% (0.37 ± 0.19 log10MPN/100 mL), respectively. At HLRs of 0.04-0.06 m/d, the treatment system satisfied the limits of agriculture irrigation.

Primary cilia defects causing mitral valve prolapse.

Mitral valve prolapse (MVP) affects 1 in 40 people and is the most common indication for mitral valve surgery. MVP can cause arrhythmias, heart failure, and sudden cardiac death, and to date, the causes of this disease are poorly understood. We now demonstrate that defects in primary cilia genes and their regulated pathways can cause MVP in familial and sporadic nonsyndromic MVP cases. Our expression studies and genetic ablation experiments confirmed a role for primary cilia in regulating ECM deposition during cardiac development. Loss of primary cilia during development resulted in progressive myxomatous degeneration and profound mitral valve pathology in the adult setting. Analysis of a large family with inherited, autosomal dominant nonsyndromic MVP identified a deleterious missense mutation in a cilia gene, DZIP1 A mouse model harboring this variant confirmed the pathogenicity of this mutation and revealed impaired ciliogenesis during development, which progressed to adult myxomatous valve disease and functional MVP. Relevance of primary cilia in common forms of MVP was tested using pathway enrichment in a large population of patients with MVP and controls from previously generated genome-wide association studies (GWAS), which confirmed the involvement of primary cilia genes in MVP. Together, our studies establish a developmental basis for MVP through altered cilia-dependent regulation of ECM and suggest that defects in primary cilia genes can be causative to disease phenotype in some patients with MVP.

Comparative study about the performance of three types of modified natural treatment systems for rice noodle wastewater.

In this study, three semi-pilot scale systems (vertical flow constructed wetland, multi-soil layering, and integrated hybrid systems) for treating real rice noodle wastewater were operated parallelly for the first time in a tropical climate at a loading rate of 50 L/(m2·d) for more than 7 months to determine the optimal conditions and to compare their treatment performance. The results demonstrated that these systems were appropriate for the removal of organics, suspended solids, and total coliform (Tcol). The highest reductions in chemical oxygen demand (CODCr, 73.2%), phosphorus (PO4-P, 54%), and Tcol (4.78 log MPN/100 mL inactivation) were obtained by the integrated hybrid system, while the highest removal efficiencies of ammonium (NH4-N, 60.64%) and suspended solids (80.49%) were achieved in the vertical-flow-constructed wetland and multi-soil layering systems respectively.

[Efficacy and safety of low-dose levonorgestrel-releasing intrauterine system in Chinese women: a multicenter, single-arm, open labeled interventional trial].

Objective: To evaluate the efficacy, bleeding profile and safety of low-dose levonorgestrel-releasing intrauterine system (LNG-IUS 8) in Chinese healthy women of childbearing age. Methods: A multi-center, open-label, single-arm clinical trial conducted at 16 centres in China enrolled 773 healthy women of childbearing age (mean age 31.6 years old, range 18 to 40 years old) , who demanded contraception, from April 2006 to June 2013. All women placed LNG-IUS 8 for 3 years and then been followed up at 3, 6, 9, 12, 18, 24, 30, 36 months. The efficacy variables including pregnancy rate and expulsion rate were analyzed using life table, while observing adverse events (AE) to evaluate the safety. The bleeding profile happened during the study was assessed using 90-day reference intervals (World Health Organization criteria) . Results: Eight pregnancies occurred among 773 women, resulting in a overall Pearl index of 0.42 per 100 women years. The 3-year cumulative pregnancy rate was 0.37 per 100 women years and the 3-year cumulative expulsion rate was 1.99 per 100 women years. The number of women with bleeding/spotting reduced and the bleeding/spotting days declined over time. Totally 219 AE were reported related to LNG-IUS 8 placements. The most common AE were vaginal bleeding (8.2%, 63/773) and the ovarian cyst (6.2%, 52/773) . LNG-IUS 8 had an improving effect on dysmenorrhea that the percentage of women with dysmenorrhea as well as the days of dysmenorrhea decreased over time. The percentage of women satisfied or very satisfied with LNG-IUS 8 was 87.2% (622/713) . Conclusion: LNG-IUS 8 is highly effective and safe for Chinese healthy women of childbearing age.

Testicular distribution and toxicity of a novel LTA4H inhibitor in rats.

JNJ 40929837, a novel leukotriene A4 hydrolase inhibitor in drug development, was reported to induce testicular toxicity in rats. The mechanism of toxicity was considered to be rodent specific and not relevant to humans. To further investigate this finding in rats, the distribution and toxicokinetics of JNJ 40929837 and its two metabolites, M1 and M2, were investigated. A quantitative whole body autoradiography study showed preferential distribution and retention of JNJ 40929837-derived radioactivity in the testes consistent with the observed site of toxicity. Subsequent studies with unlabeled JNJ 40929837 showed different metabolite profiles between the plasma and testes. Following a single oral 50mg/kg dose of JNJ 40929837, M2 was the primary metabolite in plasma whereas M1 was the primary metabolite in testes. The exposure of M1 was 386-fold higher in the testes compared to plasma whereas M2 had limited exposure in testes. Furthermore, the Tmax of M1 was 48h in testes suggesting a large accumulation potential of this metabolite in testes compared to plasma. Following six months of repeated daily oral dosing, M1 accumulated approximately five-fold in the testes whereas the parent did not accumulate. These results indicate that the toxicokinetic profiles of JNJ 40929837 and its two metabolites in testes are markedly different compared to plasma and support the importance of understanding the toxicokinetic profiles of compounds and their metabolites in organs/tissues where toxicity is observed.

MR spectroscopy for assessment of memantine treatment in mild to moderate Alzheimer dementia.

OBJECTIVES: Magnetic Resonance Spectroscopy (MRS) may provide a precise and reliable assessment of the extent and severity of neural tissue loss caused by various diseases. In particular, the N-Acetyl Aspartate (NAA) and Creatine (Cr) ratio has been found to be an indicator of the degree of neuronal loss in Alzheimer's disease (AD). Memantine is thought to benefit the AD brain by stabilizing the NMDA receptors on neurons in turn reducing excitotoxicity. Despite its effectiveness in treating moderate to severe AD, memantine has not had similar success in the treatment of mildly demented AD patients. The objective of this study was to test whether memantine would slow or prevent the loss of neurons in mild to moderate AD patients. METHODS: A double-blind placebo-controlled study was designed to measure the effect of a year-long course of memantine in patients with a probable AD diagnosis with mild to moderate dementia. The primary outcome measure was stipulated to be change in MRS NAA/Cr ratio in inferior parietal cortex in memantine relative to the placebo treatment condition. The secondary outcome measures were changes in cognitive and function scale scores. RESULTS: This pilot study failed to demonstrate a benefit of memantine on the primary outcome measure, the inferior parietal NAA/Cr ratio, or the secondary outcome measures. CONCLUSIONS: More studies are needed to determine the effect of memantine on regions of the brain significantly affected by AD pathology.

Capsaicin causes cell-cycle arrest and apoptosis in ER-positive and -negative breast cancer cells by modulating the EGFR/HER-2 pathway.

Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is an ingredient of chili peppers with inhibitory effects against cancer cells of different origin. We examined the activity of capsaicin on breast cancer cells in vitro and in vivo. The drug potently inhibited growth of ER-positive (MCF-7, T47D, BT-474) and ER-negative (SKBR-3, MDA-MB231) breast cancer cell lines, which was associated with G(0)/G(1) cell-cycle arrest, increased levels of apoptosis and reduced protein expression of human epidermal growth factor receptor (EGFR), HER-2, activated extracellular-regulated kinase (ERK) and cyclin D1. In contrast, cell-cycle regulator p27(KIP1), caspase activity as well as poly-ADP ribose polymerase (PARP) cleavage were increased. Notably, capsaicin blocked breast cancer cell migration in vitro and decreased by 50% the size of MDA-MB231 breast cancer tumors growing orthotopically in immunodeficient mice without noticeable drug side effects. in vivo activation of ERK was clearly decreased, as well as expression of HER-2 and cyclin D1, whereas caspase activity and PARP cleavage products were increased in tumors of drug-treated mice. Besides, capsaicin potently inhibited the development of pre-neoplastic breast lesions by up to 80% without evidence of toxicity. Our data indicate that capsaicin is a novel modulator of the EGFR/HER-2 pathway in both ER-positive and -negative breast cancer cells with a potential role in the treatment and prevention of human breast cancer.

Elevated synovial expression of triggering receptor expressed on myeloid cells 1 in patients with septic arthritis or rheumatoid arthritis.

OBJECTIVE: To determine whether synovial expression of triggering receptor expressed on myeloid cells 1 (TREM-1) is upregulated in patients with distinct types of inflammatory or non-inflammatory arthritis. METHODS: Synovial fluid (SF) samples were analysed for levels of soluble TREM-1 (sTREM; n = 132), tumour necrosis factor alpha (TNFalpha, n = 78) and leucocyte TREM-1 messenger RNA (n = 48). Synovial tissue from four rheumatoid arthritis (RA) patients, two patients with Crohn's-associated arthritis, one patient with ankylosing spondylitis and one patient with osteoarthritis were examined for TREM-1 expression by immunohistology, and three of the RA samples were also analysed by Western blotting. RESULTS: Synovial fluid sTREM-1 levels in septic arthritis and RA were similar to each other and were each greater than those in gouty arthritis, non-septic/non-RA inflammatory arthritis and non-inflammatory arthritis. Synovial fluid TNFalpha and sTREM-1 levels correlated with each other, and sTREM-1 and leucocyte TREM-1 mRNA levels each correlated with SF leucocyte counts. TREM-1 in RA was expressed in situ in synovial tissue by cells of myelomonocytic lineage but was not detectably expressed in control osteoarthritis synovial tissue. CONCLUSIONS: Synovial TREM-1 expression is increased in septic arthritis and RA. In patients with acute inflammatory arthritis, elevated SF sTREM-1 levels may point the clinician to a diagnosis of septic arthritis or RA. In RA patients, targeting TREM-1 may have therapeutic benefits by reducing local proinflammatory cytokine and chemokine release.

B lymphocyte stimulator expression in patients with rheumatoid arthritis treated with tumour necrosis factor alpha antagonists: differential effects between good and poor clinical responders.

OBJECTIVE: To assess the effects of tumour necrosis factor (TNF) antagonist therapy on B lymphocyte stimulator (BLyS) expression in patients with rheumatoid arthritis (RA). METHODS: Blood from 38 patients with RA from a single centre was collected prior to and following initiation of TNF antagonist therapy. Plasma BLyS protein levels, blood leukocyte BLyS mRNA levels and disease activity were longitudinally monitored. Twelve patients with RA who either refused or were felt not to be candidates for TNF antagonist therapy and five normal healthy volunteers served as TNF antagonist-naïve controls. RESULTS: Baseline plasma BLyS protein levels, but not blood leukocyte BLyS mRNA levels, were elevated in patients with RA. Plasma BLyS protein levels declined following initiation of TNF antagonist therapy in good responders (GR) to TNF antagonist therapy but not in poor responders (PR). By contrast, the erythrocyte sedimentation rate (ESR) declined in response to TNF antagonist therapy in GR and PR. TNF antagonist therapy did not promote change in blood leukocyte BLyS mRNA levels in either GR or PR, suggesting that the TNF antagonist-associated changes in circulating BLyS protein levels reflected changes in local BLyS production in the affected joints rather than changes in systemic BLyS production. BLyS expression did not change over time in either the normal or RA control groups. CONCLUSIONS: A good clinical response to TNF antagonist therapy in patients with RA is associated with a decline in plasma BLyS protein levels. Increased BLyS expression in affected joints may contribute to ongoing disease activity, and reduction of such expression may help promote a favourable clinical response to TNF antagonist therapy.