[Home based and group based exercise programs in patients with ankylosing spondylitis: systematic review]

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INTRODUCTION

Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by inflammation of the joints of the spine and sacroiliac and to a lesser percentage of the peripheral joints. It is a debilitating condition which reduces quality of life in patients with AS. The practice of physical therapy is recommended as non-pharmacological treatment as well as the treatment and prevention of associated deformities.

OBJECTIVE

To collect and summarize the available evidence in scientific databases to realize the effectiveness of home based and group based programs in patients with AS.

METHODS

Systematic review, where articles for the study were collected from scientific database PubMed. We have found 65 articles with publication date between January 1, 2004 and January 31, 2014. Inclusion and exclusion criteria were established to make the selection of articles to include in the study. All investigators provided their agreement in presencial meeting for a final selection, and at a later stage, the articles were read in full by the three investigators.

RESULTS

The present systematic review includes eight randomized controlled trials. All articles show functional benefits in patients with AS subject to exercise programs in group based and / or home based. From the eight articles, 4 addressed programs conducted in home based context and 4 addressed in group based context programs.

CONCLUSION

There appears to be evidence that the programs carried out based on group are more effective than those home based conducted in patients with AS. It was concluded also be advantageous to carry out home based exercise programs than the absence of any exercise program.</p>.

Functional leaf traits of understory species: strategies to different disturbance severities

The specific leaf area (SLA) has been related to environmental disturbances, showing a positive correlation between the disturbances intensities and SLA in a plant community. These studies, however, assessed the responses of plant community as a whole, neglecting species attributes, such as the position in the vertical stratum of forests. Considering the importance of SLA to understand forest ecological processes, this study aimed to determine the influence of the disturbance regime on the SLA of understory species, considering that, unlike for communities as a whole, an increase in the disturbance intensity implies a decrease in SLA of understory species. This study was conducted in nine understories of seasonal forests in Brazil. The most abundant species were selected and their SLA were evaluated. The variability of SLA among populations in different forests was analyzed by Student's t-tests. The SLA of the understories (SLAU) was also compared by an adaptation of the Community-weighted mean index. The comparison of species SLA showed significant differences among the populations of understories under different disturbance regime, showing a decrease in SLA with an increase in the disturbance intensity. Similar results were found for the SLA of understories communities (SLAU), corroborating our hypothesis. The correlation between a reduction in species SLA and in SLA of understory with an increase in disturbance intensity, contradicted the trend observed in the literature for the community as a whole. This study highlights the importance of the evaluation of SLA in understories, as an indicator of the successional stage of communities.

Effect of microsatellite selection on individual and population genetic inferences: an empirical study using cross-specific and species-specific amplifications

Although whole-genome sequencing is becoming more accessible and feasible for nonmodel organisms, microsatellites have remained the markers of choice for various population and conservation genetic studies. However, the criteria for choosing microsatellites are still controversial due to ascertainment bias that may be introduced into the genetic inference. An empirical study of red deer (Cervus elaphus) populations, in which cross-specific and species-specific microsatellites developed through pyrosequencing of enriched libraries, was performed for this study. Two different strategies were used to select the species-specific panels: randomly vs. highly polymorphic markers. The results suggest that reliable and accurate estimations of genetic diversity can be obtained using random microsatellites distributed throughout the genome. In addition, the results reinforce previous evidence that selecting the most polymorphic markers leads to an ascertainment bias in estimates of genetic diversity, when compared with randomly selected microsatellites. Analyses of population differentiation and clustering seem less influenced by the approach of microsatellite selection, whereas assigning individuals to populations might be affected by a random selection of a small number of microsatellites. Individual multilocus heterozygosity measures produced various discordant results, which in turn had impacts on the heterozygosity-fitness correlation test. Finally, we argue that picking the appropriate microsatellite set should primarily take into account the ecological and evolutionary questions studied. Selecting the most polymorphic markers will generally overestimate genetic diversity parameters, leading to misinterpretations of the real genetic diversity, which is particularly important in managed and threatened populations.

Development of microsatellite markers for the Neotropical endemic Brazilian Guanabara frog, Euparkerella brasiliensis, through 454 shotgun pyrosequencing

The new-generation 454 GS-FLX Titanium pyrosequencing was used to isolate microsatellite markers for the Brazilian Guanabara frog, Euparkerella brasiliensis, an Atlantic forest endemic species. Three multiplex polymerase chain reaction sets were optimized for genotyping of 11 polymorphic (di- and tetranucleotide) microsatellite markers. Genetic diversity was assessed in 21 individuals from a population (Reserva Ecológica de Guapiaçu, REGUA) located in the central region of the Rio de Janeiro State, in Brazil. The mean number of alleles per locus ranged from 3 to 12. Observed and expected heterozygosities ranged from 0.095 to 0.905 and from 0.094 to 0.904, respectively. After using the Bonferroni correction for multiple tests, there was no evidence of linkage disequilibrium between pairs of loci but deviations for Hardy-Weinberg equilibrium were found in 4 loci. We found no evidence for allele dropouts or stuttering, but we detected the presence of null alleles at loci Eb10 and Eb36. These markers will be useful for analyses of fine-scale population structure and determination of relative effects of habitat loss and fragmentation on population genetic variability within species.

Anti-TNF-alpha induced psoriasiform eruptions with severe scalp involvement and alopecia: report of five cases and review of the literature

We describe 5 cases of anti-tumor necrosis factor-alpha (anti-TNF-α) induced psoriasiform eruptions with severe scalp involvement inducing inflammatory alopecia and review the literature on this subject. All our 5 patients were provided topical therapy, with good results in only 1 case. The remaining 4 were provided systemic therapy (methotrexate ± cyclosporine): 3 concomitantly suspended the anti-TNF-α treatment (2 are currently clear/almost clear but 1 has so far only observed mild improvement) and 1 switched anti-TNF-α (recurrent flare-ups of the disease continue). So far, no patient has developed scarring alopecia. To our knowledge, a total of 15 cases of anti-TNF-α induced psoriatic alopecia have been described. Anti-TNF-α was discontinued in 9 of the 15 patients and systemic therapy was provided to 9 of the 15 patients. Nonetheless, 2 patients developed scarring alopecia. We conclude that in anti-TNF-α induced psoriasiform eruptions some patients may respond to topical treatment, however in cases of severe scalp involvement anti-TNF-α suspension and systemic treatment should be considered in order to avoid scarring alopecia.

Intestinal nodular lymphoid hyperplasia and extraintestinal lymphoma--a rare association

Nodular lymphoid hyperplasia of the gastrointestinal tract is characterized by the presence of innumerable small discrete nodules involving a variable segment of the gastrointestinal tract. The association between nodular lymphoid hyperplasia and other benign and malignant diseases has been clearly described, with an increased risk of gastrointestinal tumours, namely gastrointestinal lymphoma. However, the association with extraintestinal lymphoma seems extremely rare. The authors present a clinical case of a patient with nodular lymphoid hyperplasia of the small and large intestine that subsequently developed an extraintestinal lymphoma (diffuse large B-cell lymphoma).

How to manage pouchitis in ulcerative colitis?

It is estimated that 50% of patients who have undergone ileal pouch-anal anastomosis (IPAA) surgery for UC will develop at least one episode of pouchitis. The risk of developing pouchitis is much higher in patients with preoperative extraintestinal manifestations and primary sclerosing cholangitis. In acute pouchtis metronidazole or ciprofloxacin have shown efficacy, however there is some evidence that ciprofloxacin may have better and has less toxic. In patients with chronic pouchitis antibiotics are less effective, and maintenance therapy may be required. In cases of refractoriness to conventional therapy a combination of two antibiotics for a prolonged period or infliximab may be effective. Starting maintenance treatment with highly concentrated probiotics is recommended as primary and secondary prophylaxis.

Theoretical investigation of transcranial alternating current stimulation using laminar model

Transcranial alternating current stimulation (tACs) has been gaining an increased interest in the last few years due to its capacity to modulate non-invasively high-order cortical processes, such as decision-making, language and sensory perception. Nevertheless, the underlying mechanisms of activation of this brain stimulation technique are still poorly understood. Herein, we use a finite element modelling (FEM) technique to investigate the penetration and focality of tACs in comparison to a time invariant (DC) stimulation. We show that AC stimulations generate cerebral fields that are an order of magnitude larger in the radial direction, approximately 5 times larger in the tangential direction and more focused than DC stimulations. We argue that the basis for this effect is the reduced scalp's conductivity, which minimizes the surface shunting of the stimulating currents. The outcomes of this study may help tACs users to design better protocols and interpret experimental results.

A comparative study between fluoroscopic and endoscopic guidance in palliative esophageal stent placement

Self-expanding metallic stents (SEMS) are the treatment of choice for incurable obstructive malignant esophageal strictures. Although the placement of SEMS is usually performed with fluoroscopic control (FC), recently several authors have shown the feasibility of placing SEMS under endoscopic control alone (EC). However, studies comparing the two techniques are lacking. The objective of this study was to compare the feasibility and safety of SEMS insertion under fluoroscopic control and endoscopic control. The study was performed through the retrospective analysis of patients who underwent SEMS insertion for malignant dysphagia between January 2005 and January 2010. Data concerning early and late complications and survival were retrieved. Early complications were defined as pain, vomiting, bleeding, malposition/migration, perforation, and/or dysphagia occurring until 30 days of SEMS insertion; and late complications as tumor ingrowth and overgrowth, migration, hemorrhage, fistulae, food impaction, and/or esophagitis occurring after 30 days. We placed 126 SEMS of which 87% for esophageal stricture, 8% for esophagus-respiratory fistula, and 5% for extrinsic compression. The mean age of the patients was 62 years, and 93 were male. SEMS insertion was performed with FC in 66 patients and EC in 60. Early complications occurred in 34 patients (52%) in the FC group and 28 (47%) in the EC group (P=0.71), including: pain in 22 patients of the FC group and 15 of the EC group (P=0.31); vomiting in 15 of the FC group and nine of the EC group (P=0.27); malposition/migration in three of the FC group and four of the EC group (P=0.60); hemorrhage in one of the FC group and two of the EC group (P=0.27); and dysphagia in two of the FC group and three of the EC group (P=0.57). Late complications occurred in 20 patients (30%) in the FC group and 22 (37%) in the EC group (P=0.44), including: tumor in/overgrowth in 13 patients of the FC group and 10 of the EC group (P=0.66); prostheses migration in five of the FC group and eight of the EC group (P=0.28); hemorrhage in two of the FC group and two of the EC group (P=0.54); appearance of esophageal fistulae in seven of the FC group and four of the EC group (P=0.43); food impaction in nine of the FC group and eight of the EC group (P=0.96); esophagitis in 12 of the FC group and 15 of the EC group (P=0.35). Median survival was 107 days (95% confidence interval [CI]=6-369 days) with no difference between the two groups. There were no statistical significant differences in the incidence of complications and in survival between patients undergoing SEMS placement under fluoroscopic control or endoscopic control.

Permanent genetic resources added to Molecular Ecology Resources Database 1 December 2010-31 January 2011

This article documents the addition of 238 microsatellite marker loci to the Molecular Ecology Resources Database. Loci were developed for the following species: Alytes dickhilleni, Arapaima gigas, Austropotamobius italicus, Blumeria graminis f. sp. tritici, Cobitis lutheri, Dendroctonus ponderosae, Glossina morsitans morsitans, Haplophilus subterraneus, Kirengeshoma palmata, Lysimachia japonica, Macrolophus pygmaeus, Microtus cabrerae, Mytilus galloprovincialis, Pallisentis (Neosentis) celatus, Pulmonaria officinalis, Salminus franciscanus, Thais chocolata and Zootoca vivipara. These loci were cross-tested on the following species: Acanthina monodon, Alytes cisternasii, Alytes maurus, Alytes muletensis, Alytes obstetricans almogavarii, Alytes obstetricans boscai, Alytes obstetricans obstetricans, Alytes obstetricans pertinax, Cambarellus montezumae, Cambarellus zempoalensis, Chorus giganteus, Cobitis tetralineata, Glossina fuscipes fuscipes, Glossina pallidipes, Lysimachia japonica var. japonica, Lysimachia japonica var. minutissima, Orconectes virilis, Pacifastacus leniusculus, Procambarus clarkii, Salminus brasiliensis and Salminus hilarii.

Dysplasia surveillance in an ulcerative colitis patient: successful detection with narrow band imaging and magnification

One of the contemporary challenges gastroenterologists face is cancer screening and surveillance in long-term colitis patients. The search for a consensually practical and effective method to routinely detect dysplastic mucosa persists. In recent years, publications demonstrating the applicability of narrow band imaging (NBI) in this setting have sparked further research. We present a case report where NBI with magnification played a fundamental role in the detection of dysplasia in an ulcerative colitis patient. This case reinforces the potential widespread applicability of NBI as a surveillance tool in distinguishing dysplastic from nondysplastic colorectal lesions in ulcerative colitis.