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BACKGROUND: Understanding the influence of contextual factors (CFs) on interventions for mechanical neck pain (MNP) is essential for evidence-based practice in physical therapy. However, the specific effects and synergies of combining different CFs remain unclear. OBJECTIVE: The primary purpose of this study will be to determine if a CFs-Enriched Standard Care (SC) approach is an effective treatment for MNP in terms of reducing pain and improving function. METHODS: This will be an assessor-blinded, 2-group (1:1) randomised clinical trial (RCT) aiming to enrol 94 participants with neck pain persisting for more than 4 weeks. Both groups will undergo 4 weeks of SC twice weekly, following established clinical practice guidelines. In the intervention group, CFs will be enhanced, encompassing the physical, psychological, and social elements inherent in the clinical encounter, based on existing evidence. The primary outcomes will encompass changes in pain and disability after 4 weeks of treatment, with a follow-up reassessment at week 12 post-treatment. Secondary outcomes will include changes in Active Range of Motion, Global Rating of Change, and Satisfaction with treatment. The change between groups after treatment and at the 12-week follow-up will be reported for all outcomes, considering the difference from scores recorded at baseline. RESULTS: We hypothesise that a 4-week CFs-Enriched SC approach will be superior to SC alone in terms of patient-reported disability and pain, with measurements conducted using the Northwick Park Neck Pain Questionnaire and the Numeric Pain Rating Scale, respectively. CONCLUSION: This RCT rigorously assesses the effect of purposeful manipulation of CFs during MNP treatment. By elucidating the role of these factors, our findings have the potential to significantly refine clinical practice in managing MNP, thereby enhancing patient care, and advancing the fields of physical therapy and rehabilitation.
Assuntos
Cervicalgia , Humanos , Cervicalgia/terapia , Medição da Dor , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Background: Enzootic bovine leukosis (EBL) is a widespread infectious disease caused by the bovine leukemia virus (BLV), which results in immune system dysfunction. The resulting immunosuppression may lead to an increased prevalence of other diseases. Dairy cows infected have altered immune function associated with decreased milk production and shortened lifespan and decreased immune response to immunization. BLV infection, however, is often asymptomatic, so any connection between subclinical infection and common reproductive diseases remains unknown. This study aimed to describe the relationship between naturally occurring subclinical BLV and infectious reproductive diseases seroconversion in the field. Materials, Methods & Results: The diseases investigated included Bovine viral diarrhoea (BVD), Bovine alfaherpesvirus 1 (BoHV-1), Bovine gammaherpesvirus 4 (BoHV-4), Chlamydiosis, Leptospirosis, Brucellosis and Neosporosis in dairy cattle. Six hundred fifty-five sera samples from the northern and south-central regions of Uruguay, from asymptomatic female Holstein and Holstein crosses without a history of vaccination against reproductive diseases were processed using reference diagnostic methods (Seronautalization, ELISA, MAT, Rose Bengal Plate test). The seroprevalence of BLV was 20.0%. Seroprevalence of reproductive diseases BVD, BoHV-1 and BoHV-4 were 99.3%, 41.2% and 27.3% of the populations, respectively, and the total seroprevalence of Leptospirosis, bovine Neospora caninum and Chlamydiosis were 19.8%, 29.8% and 33.0% respectively. The results revealed positive associations between naturally contracted BLV and the presence of antibodies against BoHV-1 (P = 0.002), as well as between naturally contracted BLV and presence of antibodies against Leptospira spp. (P = 0.028). Discussion: BLV infection can impact innate and adaptive immune system cells and alter the proper functioning of uninfected cells. BLV infection may also induce changes in the complex balance of cytokine expression, cell proliferation, and programmed cell death in T- and B-lymphocytes, which is critical for immune competence and effective response to infectious challenges. The progression of BLV infection has a substantial effect on host defense mechanisms. Indeed, lowmagnitude serologic responses to a commercial foot-and-mouth disease vaccine and a J5 Escherichia coli vaccine have been observed. These results are supported by recent trial studies showing a reduced immune response to vaccination against BoHV-1 and Leptospira spp. in asymptomatic animals infected with BLV. These are 2 of the most prevalent infectious reproductive diseases in cattle worldwide, and our results provide evidence that a link between BLV and susceptibility to these diseases may exist. Although there is evidence of the co-occurrence of these diseases, it remains unknown whether there is a direct or indirect effect of BLV on infertility, embryonic loss, or abortion. Another possibility is that natural infection with these reproductive pathogens (BoHV-1, Leptospira, or others) promotes BLV expression, negatively affecting the farms where these pathogens are endemic. Considering the high seroprevalence of BLV in dairy herds in North and South America where the infection is endemic, it was explored BLV's role as an immunosuppressant by quantifying its co-occurrence with diseases that affect reproductive performance in breeding herds. Future work should clarify the role of BLV and the co-occurring pathogens in causing infertility or abortions.
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Animais , Feminino , Bovinos , Leucose Enzoótica Bovina/complicações , Vírus da Leucemia Bovina , Doenças dos Genitais Femininos/veterinária , Rinotraqueíte Infecciosa Bovina , Leptospirose/veterinária , Infecções do Sistema Genital/veterináriaRESUMO
Resumen: Introducción: El ataque cerebrovascular (ACV) es una lesión del parénquima cerebral por compromiso vascular, pudiendo ser hemorrágico o isquémico. Presenta alta morbimortalidad, siendo la segunda causa de muerte a nivel mundial, tercera en nuestro país, que genera además elevados costos sanitarios. Conocer las etiologías más frecuentes de esta patología, su asociación con factores de riesgo y el tratamiento realizado, podría contribuir a la correcta elaboración de estrategias de prevención primaria y secundaria. Objetivos: Conocer la/s etiología/s del ACV en pacientes internados en salas de medicina interna del Hospital Pasteur, sus características epidemiológicas; la asociación entre los factores de riesgo, paraclínica solicitada y tratamiento sugerido al alta. Metodología: Estudio descriptivo, transversal, observacional. Se incluyeron pacientes mayores de 18 años con diagnóstico de ACV internados en las salas de medicina del Hospital Pasteur, entre el 15 de Julio y el 30 de Septiembre del 2019. Se realizó la recolección de datos a partir de las historias clínicas por medio de un formulario precodificado, que analizó variables categóricas como factores de riesgo, presentación clínica, paraclínica solicitada y tratamiento. Resultados y discusión: Se incluyeron 30 pacientes, 18 de sexo femenino. La media de edad fue 70,48 años. La naturaleza isquémica predominó en un 90%. Los principales factores de riesgo fueron hipertensión arterial, dislipemia, diabetes mellitus y tabaquismo. El síndrome piramidal fue la forma de presentación clínica más frecuente. La etiología más prevalente fue de causa indeterminada, seguida por la ateroesclerótica y cardioembólica. En algunos pacientes no se realizó el algoritmo diagnóstico completo. El tratamiento realizado fue el adecuado de acuerdo a las causas planteadas. Conclusiones: La etiología más frecuente fue de causa indeterminada, seguida por la aterotrombótica. Los factores de riesgos más prevalentes fueron la hipertensión arterial, la dislipemia, la diabetes mellitus y el tabaquismo. La mayoría de los pacientes tenían más de 3 factores de riesgo asociados, de esta forma concluimos que la sumatoria de factores de riesgo incrementa la incidencia de ACV.
Abstract: Introduction: A stroke is a parenchymal cerebral lesion due to vascular compromise. This could be either hemorrhagic or ischemic. It presents high morbidity and mortality, being the second cause of death in the world and third in Uruguay, causing elevated health expenses. Recognizing the most frequent etiologies, their association with different risks factors and treatments applied could help to create better primary and secondary prevention strategies. Objectives: recognized stroke`s etiologies in patients hospitalized in Hospital Pasteur`s rooms, their epidemiologic characteristics, risk factors associated, the requested paraclinic and the treatment before they leave the hospital. Methods: Descriptive, observational and transversal study. We included patients older than 18 years old, with a stroke diagnosis, admitted into Hospital Pasteur medical`s rooms, between July 15 and September 30, 2019. Data were collected from medical records by accepting an informed consent, which analyzed variables such as risk factors, clinical presentation, requested preclinical and treatment. Results and discussion: 30 patients were included, 18 were female. The average age was 70,48 years. Ischemic strokes were predominated by 90%. Hypertension, dyslipidemia, diabetes mellitus and smoking were the predominant risk factors. Pyramidal syndrome was the most frequent clinical presentation. Undetermined stroke was the principal etiology, followed by atherosclerotic and cardioembolic. There were some patients that the algorithm was not completed. Treatments were adequate according to the causes. Conclusions: The most frequent etiology was the undetermined cause, followed by atherothrombotic. Prevalent risk factors were hypertension, dyslipidemia, DM and smoking. Most of the patients had more than 3 associated risk factors, so we conclude that the sum of risk factors increases the incidence of stroke.
Resumo: Introdução: O ataque cerebrovascular (AVC) é uma lesão do parênquima cerebral por comprometimento vascular, podendo ser hemorrágico ou isquêmico. Apresenta alta morbimortalidade, sendo a segunda principal causa de morte no mundo, a terceira em nosso país, o que também gera altos custos de saúde. Conhecer as etiologias mais frequentes dessa patologia, sua associação com fatores de risco e o tratamento realizado, poderia contribuir para o correto desenvolvimento de estratégias de prevenção primária e secundária. Objetivos: Conhecer a etiologia / s do AVC em pacientes internados nas salas de medicina interna do Hospital Pasteur, suas características epidemiológicas; a associação entre fatores de risco, solicitou tratamento paraclínico e sugerido no momento da alta. Metodologia: Estudo descritivo, transversal, observacional. Entre 15 de julho e 30 de setembro de 2019, foram incluídos pacientes com idade superior a 18 anos com diagnóstico de AVC admitidos nas salas médicas do Hospital Pasteur. Os dados foram coletados dos prontuários por meio de formulário pré-codificado, que analisou variáveis categóricas como fatores de risco, apresentação clínica, solicitação paraclínica e tratamento. Resultados e discussão: foram incluídos 30 pacientes, 18 do sexo feminino. A idade média foi de 70,48 anos. A natureza isquêmica predominou em 90%. Os principais fatores de risco foram pressão alta, dislipidemia, diabetes mellitus e tabagismo. A síndrome piramidal foi a apresentação clínica mais frequente. A etiologia mais prevalente foi de causa indeterminada, seguida de aterosclerótica e cardioembólica. Em alguns pacientes, o algoritmo diagnóstico completo não foi realizado. O tratamento foi adequado de acordo com as causas. Conclusões: A etiologia mais frequente foi de causa indeterminada, seguida de aterotrombótica. Os fatores de risco mais prevalentes foram hipertensão, dislipidemia, DM e tabagismo. A maioria dos pacientes apresentou mais de três fatores de risco associados, concluindo que a soma dos fatores de risco aumenta a incidência de acidente vascular cerebral.
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BACKGROUND: The aim of this study is to assess the accuracy of a Fast Doppler protocol for the examination of an injured lower limb, namely 2-Point Fast Doppler (2PFD), in order to rapidly triage arterial lesions after penetrating trauma. METHODS: The presence of flow and the aspects of the Doppler waveform of the dorsalis pedis artery (DPA) and posterior tibial artery (PTA) of the injured lower limb (2PFD) were evaluated immediately before the execution of a standardized Color Duplex Doppler (SD) evaluation in 149 limbs of 140 patients with gunshot penetrating injuries. We considered 2PFD normal exams as the ones with triphasic patterns in both the DPA and PTA, and 2PFD pathologic exams as the ones with absent, biphasic, or monophasic flow patterns in the DPA and/or PTA. 2PFD data were then analyzed to assess accuracy variables, using SD results as matching test reference. According to the trauma center standard protocols, SD positive cases underwent also angiography and surgical exploration, whose findings were used to further match the 2PFD specificity. RESULTS: The 2PFD protocol showed a sensitivity of 100%, and a specificity of 100% compared with the SD, in the diagnostic workup of arterial injuries of the lower limbs after penetrating trauma. Furthermore, all the pathologic cases that resulted in all true positives (TP), compared with SD, were confirmed as TP also when matched with the angiography evaluation results. CONCLUSIONS: The 2PFD protocol can rapidly identify arterial flow and differentiate between normal and pathologic spectral Doppler analyses in distal arteries. The presence of the normal triphasic flows in DPA and PTA is as sensitive as the standardized Color Doppler Duplex assessment of the entire limb in ruling out arterial lesions in lower-limb penetrating trauma. The absence of flow or the presence of a biphasic or monophasic pathologic flow in DPA and PTA is pathologic and should be always followed by further investigation. 2PFD is faster and easier to perform compared with the SD approach. It could become a new first-line screening technique, both in pre-hospital and hospital critical scenarios, particularly in contexts where advanced diagnostic performance is limited by time concerns or scarce resources.
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Uma lista de problemas precisa e atualizada é essencial em um Registro Eletrônico em Saúde (RES) orientada a problemas. A falta de organização e categorização dos problemas limitam o resultado. Há certos problemas que afetam mais a evolução clínica do paciente, o que denominamos comorbidades. OBJETIVOS: O propósito deste artigo é caracterizar o conceito de comorbidade; bem como, classificar e identificar as comorbidades. MÉTODOS: Realizamos uma busca bibliográfica para caracterizar o conceito de comorbilidade. Posteriormente analisamos a RES do Hospital de Buenos Aires desde 1998 a 2015. Todos os problemas registrados nas epícrises como comorbidades foram tomados para análise. RESULTADOS: 20.849 ID-conceitos foram registrados e identificados inicialmente na epícrises. 90% foi levado para análise individual. 614 conceitos foram identificados como comorbidades (80,24% de registros). CONCLUSÕES: A maioria dos problemas analisados foram caracterizados como comorbidades, condizendo com a observação que gerou uma lista com as comorbidades mais frequentes.(AU)
An accurate and updated problems list is critical in a problem oriented Electronic Health Record (EHR). Thelack of organization and categorization of the problems limits the value of the list. There are certain problems that affect more than others the clinical evolution of the patient, these are known as comorbidities. OBJECTIVS: Characterize the comorbidity concept and identify, and classify the comorbidities. METHODS: A literature search of available definitions to characterize the concept "comorbidity". Then we analyzed theEHR in a Hospital from 1998 to 2015. All recorded problems as comorbidities conditions in patient discharge summaries were taken for analysis. RESULTS: 20,849 ID-concepts were initially obtained as comorbidities in patient discharge summaries. The 90% more frequent were taken for individual analysis. 614 ID-concepts were identied as comorbidities (80.24% of all records). CONCLUSIONS: Most of the problems analyzed were characterized as comorbidities making a list of the most frequently recorded.(AU)
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Humanos , Comorbidade , Registros Eletrônicos de Saúde , Congressos como AssuntoRESUMO
We report the isolation of a bacterium from Galleria mellonella larva and its identification using genome sequencing and phylogenomic analysis. This bacterium was named Alcaligenes faecalis strain MOR02. Microscopic analyses revealed that the bacteria are located in the esophagus and intestine of the nematodes Steinernema feltiae, S. carpocapsae, and H. bacteriophora. Using G. mellonella larvae as a model, when the larvae were injected with 24,000 CFU in their hemocoel, more than 96% mortality was achieved after 24 h. Additionally, toxicity assays determined that 1 µg of supernatant extract from A. faecalis MOR02 killed more than 70% G. mellonella larvae 96 h after injection. A correlation of experimental data with sequence genome analyses was also performed. We discovered genes that encode proteins and enzymes that are related to pathogenicity, toxicity, and host/environment interactions that may be responsible for the observed phenotypic characteristics. Our data demonstrates that the bacteria are able to use different strategies to colonize nematodes and kill insects to their own benefit. However, there remains an extensive group of unidentified microorganisms that could be participating in the infection process. Additionally, a nematode-bacterium association could be established probably as a strategy of dispersion and colonization.
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Alcaligenes faecalis/genética , Alcaligenes faecalis/patogenicidade , Larva/microbiologia , Mariposas/microbiologia , Controle Biológico de Vetores/métodos , Alcaligenes faecalis/isolamento & purificação , Animais , Produtos Biológicos/farmacologia , Larva/efeitos dos fármacos , Mariposas/efeitos dos fármacosRESUMO
Altered expression and function of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) has been associated with several diseases such as endothelial dysfunction, atherosclerosis and obesity. In these pathologies, oxLDL/LOX-1 activates signaling pathways that promote cell proliferation, cell motility and angiogenesis. Recent studies have indicated that olr1 mRNA is over-expressed in stage III and IV of human prostatic adenocarcinomas. However, the function of LOX-1 in prostate cancer angiogenesis remains to be determined. Our aim was to analyze the contribution of oxLDL and LOX-1 to tumor angiogenesis using C4-2 prostate cancer cells. We analyzed the expression of pro-angiogenic molecules and angiogenesis on prostate cancer tumor xenografts, using prostate cancer cell models with overexpression or knockdown of LOX-1 receptor. Our results demonstrate that the activation of LOX-1 using oxLDL increases cell proliferation, and the expression of the pro-angiogenic molecules VEGF, MMP-2, and MMP-9 in a dose-dependent manner. Noticeably, these effects were prevented in the C4-2 prostate cancer model when LOX-1 expression was knocked down. The angiogenic effect of LOX-1 activated with oxLDL was further demonstrated using the aortic ring assay and the xenograft model of tumor growth on chorioallantoic membrane of chicken embryos. Consequently, we propose that LOX-1 activation by oxLDL is an important event that enhances tumor angiogenesis in human prostate cancer cells.
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Adenocarcinoma/irrigação sanguínea , Adenocarcinoma/metabolismo , Proteínas de Neoplasias/metabolismo , Neovascularização Patológica/metabolismo , Neoplasias da Próstata/irrigação sanguínea , Neoplasias da Próstata/metabolismo , Receptores Depuradores Classe E/metabolismo , Adenocarcinoma/genética , Adenocarcinoma/patologia , Animais , Linhagem Celular Tumoral , Células HEK293 , Humanos , Lipoproteínas LDL/genética , Lipoproteínas LDL/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Proteínas de Neoplasias/genética , Neovascularização Patológica/genética , Neovascularização Patológica/patologia , Neoplasias da Próstata/genética , Neoplasias da Próstata/patologia , Receptores Depuradores Classe E/genéticaRESUMO
Different studies have demonstrated the importance of micronutrients, such as vitamins, for normal adult brain function and development. Vitamin C is not synthesized in the brain, but high levels are detected in this organ because of the existence of specific uptake mechanisms, which concentrate ascorbic acid from the bloodstream to the cerebrospinal fluid and then into neurons and glial cells. Two different isoforms of sodium-vitamin C cotransporters (SVCT1 and SVCT2) have been cloned. SVCT2 expression has been observed in the adult hippocampus and cortical neurons by in situ hybridization. In addition, the localization of SVCT2 in the rat fetal brain has been studied by immunohistochemistry and in situ hybridization, demonstrating that SVCT2 is highly expressed in the ventricular and subventricular areas of the brain cortex. However, there are currently no immunohistochemical data regarding SVCT2 expression and function in the post-natal brain. Therefore, we analyzed SVCT2 expression in the developing brain cortex of mice, and demonstrated an increase in SVCT2 mRNA in mice at 1-15 days of age. The expression of a short isoform, SVCT2sh, was also detected within the same period. SVCT2 expression was concentrated in neurons within the inner layer of the brain cortex. Both SVCT2 isoforms were coexpressed in N2a cells to obtain functional data. Fluorescence resonance energy transfer analysis revealed a molecular interaction between SVCT2wt and SVCT2sh. Finally, differences in transport ratios suggested that SVCT2sh expression inhibited ascorbic acid uptake in N2a cells when both isoforms were coexpressed. The sodium-vitamin C cotransporter, SVCT2, is induced in neurons within the inner layer of the brain cortex during post-natal development, mainly in pyramidal cortex neurons. Two different isoforms, SVCT2wt and SVCT2sh, were detected. Using in vitro studies, we suggest a molecular interaction between SVCT2wt and SVCT2sh, which may regulate the affinity of vitamin C uptake.
Assuntos
Ácido Ascórbico/metabolismo , Córtex Cerebral/metabolismo , Neurônios/metabolismo , Transportadores de Sódio Acoplados à Vitamina C/biossíntese , Animais , Animais Recém-Nascidos , Western Blotting , Córtex Cerebral/crescimento & desenvolvimento , Feminino , Imuno-Histoquímica , Hibridização In Situ , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Microscopia Confocal , Microscopia Eletrônica de Transmissão , Isoformas de Proteínas/biossíntese , Ratos , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Glioblastomas are lethal brain tumors that resist current cytostatic therapies. Vitamin C may antagonize the effects of reactive oxygen species (ROS) generating therapies; however, it is often used to reduce therapy-related side effects despite its effects on therapy or tumor growth. Because the mechanisms of vitamin C uptake in gliomas are currently unknown, we evaluated the expression of the sodium-vitamin C cotransporter (SVCT) and facilitative hexose transporter (GLUT) families in human glioma cells. In addition, as microglial cells can greatly infiltrate high-grade gliomas (constituting up to 45% of cells in glioblastomas), the effect of TC620 glioma cell interactions with microglial-like HL60 cells on vitamin C uptake (Bystander effect) was determined. Although glioma cells expressed high levels of the SVCT isoform-2 (SVCT2), low functional activity, intracellular localization and the expression of the dominant-negative isoform (dnSVCT2) were observed. The increased glucose metabolic activity of glioma cells was evident by the high 2-Deoxy-d-glucose and dehydroascorbic acid (DHA) uptake rates through the GLUT isoform-1 (GLUT1), the main DHA transporter in glioblastoma. Co-culture of glioma cells and activated microglial-like HL60 cells resulted in extracellular ascorbic acid oxidation and high DHA uptake by glioma cells. This Bystander effect may explain the high antioxidative potential observed in high-grade gliomas. This study strongly suggests that the Bystander effect, that is, glioma cell interaction with oxidant-producing microglia, could be an important mechanism for glioma vitamin C loading in the absence of functional sodium-vitamin C cotransporter 2 (SVCT2) expression. The high cellular vitamin C load in glioma cells results from a high uptake of extracellular dehydroascorbic acid (DHA) generated by neighboring microglia. This Bystander effect may explain the high antioxidative potential observed in high-grade gliomas, considering that high-grade gliomas may be the only neoplasm where oxidant-producing microglia can almost equal the number of tumor cells.
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Antioxidantes/metabolismo , Ácido Ascórbico/metabolismo , Neoplasias Encefálicas/metabolismo , Glioma/metabolismo , Superóxidos/metabolismo , Efeito Espectador , Linhagem Celular Tumoral , Técnicas de Cocultura , Ácido Desidroascórbico/metabolismo , Desoxiglucose/metabolismo , Transportador de Glucose Tipo 1/metabolismo , Humanos , Microglia/metabolismo , Isoformas de Proteínas/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Transportadores de Sódio Acoplados à Vitamina C/metabolismoRESUMO
Cartilage has poor regeneration capacity due to the scarcity of endogenous stem cells, its low metabolic activity and the avascular environment. Repair strategies vary widely, including microfracture, autologous or allogenic tissue implantation, and in vitro engineered tissues of autologous origin. However, unlike the advances that have been made over more than two decades with more complex organs, including vascular, cardiac or bone tissues, similar advances in tissue engineering for cartilage repair are lacking. Although the inherent characteristics of cartilage tissue, such as the lack of vascularity and low cellular diversity, suggest that it would be one of the more simple tissues to be engineered, its functional weight-bearing role and implant viability and adaptation make this type of repair more complex. Over the last decade several therapeutic approaches and innovative techniques show promise for lasting and functional regeneration of hyaline cartilage. Here we will analyze the main strategies for cartilage regeneration and discuss our experience.