Best evidence rehabilitation for chronic pain, part 3 : low back pain

Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into account the scale and costs of CLBP, it is imperative that healthcare professionals have access to up-to-date, evidence-based information to assist them in treatment decision-making. Therefore, this paper provides a state-of-the-art overview of the best evidence non-invasive rehabilitation for CLBP. Taking together up-to-date evidence from systematic reviews, meta-analysis and available treatment guidelines, most physically inactive therapies should not be considered for CLBP management, except for pain neuroscience education and spinal manipulative therapy if combined with exercise therapy, with or without psychological therapy. Regarding active therapy, back schools, sensory discrimination training, proprioceptive exercises, and sling exercises should not be considered due to low-quality and/or conflicting evidence. Exercise interventions on the other hand are recommended, but while all exercise modalities appear effective compared to minimal/passive/conservative/no intervention, there is no evidence that some specific types of exercises are superior to others. Therefore, we recommend choosing exercises in line with the patient's preferences and abilities. When exercise interventions are combined with a psychological component, effects are better and maintain longer over time

Tissue is the issue : when a second biopsy reveals the true diagnosis

We describe the case of a woman with minimal glomerular changes on initial kidney biopsy. On long-term follow-up, the patient developed nephrotic proteinuria and a second kidney biopsy was performed, which revealed focal segmental glomerulosclerosis (FSGS). Findings from electron microscopy (EM) examination suggested a genetic form of FSGS. Next-generation sequencing showed heterozygosity for a mutation in COL4A3. Collagen IV nephropathies can be linked to late-onset FSGS. By establishing a genetic cause of FSGS, immunosuppressive treatment can be avoided. This case emphasizes the importance of re-biopsy in cases of a non-explained rise in proteinuria. EM can be helpful in differentiating between primary and secondary FSGS and informing treatment strategies. In cases of adult-onset FSGS that cannot be categorized by clinical-pathological assessment, genetic testing should be considered

Differential mucosal expression of Th17-related genes between the inflamed colon and ileum of patients with inflammatory bowel disease

<p>Abstract</p> <p>Background</p> <p>Immunological and genetic findings implicate Th17 effector cytokines in the pathogenesis of inflammatory bowel disease (IBD). Expression of Th17 pathway-associated genes is mainly studied in colonic disease. The present study assessed the mRNA expression levels of Th17 effector cytokines (<it>IL17A</it>, <it>IL17F</it>, <it>IL21</it>, <it>IL22 </it>and <it>IL26</it>) and genes involved in differentiation (<it>IL6</it>, <it>IL1B</it>, <it>TGFB1</it>, <it>IL23A </it>and <it>STAT3</it>) and recruitment of Th17 cells (<it>CCR6 </it>and <it>CCL20</it>) by quantitative real-time PCR analysis of colonic and ileal biopsies from 22 healthy control subjects, 26 patients with Crohn's disease (CD) and 12 patients with ulcerative colitis (UC). Inflammation was quantified by measuring expression of the inflammatory mediators <it>IL8 </it>and <it>TNF</it>.</p> <p>Results</p> <p>Evaluation of mRNA expression levels in colonic and ileal control samples revealed that <it>TNF</it>, <it>TGFB1</it>, <it>STAT3 </it>and <it>CCR6 </it>were expressed at higher levels in the ileum than in the colon. Expression of all the Th17 pathway-associated genes was increased in inflamed colonic samples. The increased expression of these genes was predominantly observed in samples from UC patients and was associated with more intense inflammation. Although increased expression of <it>IL17A</it>, <it>IL17F</it>, <it>IL21 </it>and <it>IL26 </it>was detected in inflamed ileal samples, expression of the indispensable Th17 cell differentiation factors <it>TGFB1 </it>and <it>IL23A</it>, the signaling molecule <it>STAT3 </it>and the Th17 recruitment factors <it>CCR6 </it>and <it>CCL20 </it>were unchanged.</p> <p>Conclusions</p> <p>Our findings suggest that immune regulation is different in colonic and ileal disease, which might have important consequences for therapeutic intervention.</p

Waarnemingen.be : non-native plant and animal occurrences in Flanders and the Brussels Capital Region, Belgium

Citizen scientists make important contributions to the collection of occurrence data of non-native species. We present two datasets comprising more than 520,000 records of 1,771 non-native species from Flanders and the Brussels Capital Region in Belgium, Western Europe, collected through the website http://www.waamemingen.be hosted by Stichting Natuurinformatie and managed by the nature conservation NGO Natuurpunt. Most records were collected by citizen scientists, mainly since 2008. Waarnemingen.be aims at recording all species, native and non-native, and it is shown here that this kind of biodiversity portals are also particularly well suited to collect large amounts of data on non-native species. Both datasets presented here are also discoverable through the Global Biodiversity Information Facility (GBIF)

M & L Jaargang 11/4

Jo Braeken Scholen om te leren. [Schools for learning.]Greet Plomteux Het koninklijk Atheneum te Antwerpen. [The Royal Atheneum at Antwerp.]Mario Vanroy Het Sint-Romboutscollege te Mechelen. [The Saint Rombout college at Mechelen.]Greta Paesmans De 18de-eeuwse universitaire colleges te Leuven. [The 18th century university colleges at Leuven.]Jos Gyselinck - De gemeentescholen van Bocholt en Diepenbeek. [The municipal schools of Bocholt and Diepenbeek.]Guillaume Bollen Het Heilig Hartinstituut te Maasmechelen. [The Sacred Heart insitute at Maasmechelen.]Kathleen Lanclus Het voormalige gymnasium van de Jezuïeten in Gent. [The former Jesult gymnasium in Ghent.]Chris Bogaert Het Rommelaere instituut en de instituten van de Bijloke te Gent. [The Rommelaere institute and the institutes of the Bijloke at Ghent.]Jos Stroobants De rijksnormaalschool te Brugge. [The state normal school in Bruges.]Anne-Marie Delepiere en Martine Huys De wederopbouwscholen in de Westhoek. [The post-war reconstruction schools in the Westhoek.]Jo Braeken De gemeentenscholen nr. 1 en nr. 2 te Elsene. [The municipal schools nr. 1 and nr. 2 in Elsene (Brussels).]M&L Binnenkran

Dynamics of pneumococcal nasopharyngeal carriage in healthy children attending a day care center in northern Spain. influence of detection techniques on the results

<p>Abstract</p> <p>Background</p> <p>Pneumococcal nasopharyngeal carriage precedes invasive infection and is the source for dissemination of the disease. Differences in sampling methodology, isolation or identification techniques, as well as the period (pre -or post-vaccination) when the study was performed, can influence the reported rates of colonization and the distribution of serotypes carried.</p> <p>Objectives</p> <p>To evaluate the prevalence and dynamics of pneumococcal nasopharyngeal colonization in healthy children aged 6-34 months attending a day care center with a high level of hygiene and no overcrowding. The study was performed 3-4 years after the 7-valent pneumococcal vaccine was introduced, using multiple methodologies to detect and characterize the isolates.</p> <p>Methods</p> <p>Over 12 months, 25 children were sampled three times, 53 children twice and 27 children once. Three <it>Streptococcus pneumoniae </it>typing techniques were used: Quellung, Pneumotest-Latex-kit and multiplex-polymerase chain reaction (PCR). The similarity of isolates of the same serotype was established by pulsed field gel electrophoresis (PFGE) and occasionally the multilocus sequence type (ST) was also determined.</p> <p>Results</p> <p>Overall pneumococcal carriage and multiple colonization rates were 89.5% (94/105) and 39%, respectively. Among 218 pneumococci detected, 21 different serotypes and 13 non-typeable isolates were found. The most prevalent serotypes were 19A, 16F and 15B. Serotypes 15B, 19A and 21 were mainly found as single carriage; in contrast serotypes 6B, 11A and 20, as well as infrequent serotypes, were isolated mainly as part of multiple carriage. Most 19A isolates were ST193 but most serotypes showed high genetic heterogeneity. Changes in the pneumococci colonizing each child were frequent and the same serotype detected on two occasions frequently showed a different genotype. By multiplex-PCR, 100% of pneumococci could be detected and 94% could be serotyped versus 80.3% by the Quellung reaction and Pneumotest-Latex in combination (p < 0.001).</p> <p>Conclusions</p> <p>Rates of <it>S. pneumoniae </it>carriage and multiple colonization were very high. Prevalent serotypes differed from those found in similar studies in the pre-vaccination period. In the same child, clearance of a pneumococcal strain and acquisition of a new one was frequent in a short period of time. The most effective technique for detecting pneumococcal nasopharyngeal carriers was multiplex-PCR.</p

Proteomic comparisons of opaque and transparent variants of <i>Streptococcus pneumoniae</i> by two dimensional-differential gel electrophoresis

Streptococcus pneumoniae (the pneumococcus) is a human pathogen, accounting for massive global morbidity and mortality. Although asymptomatic colonization of the nasopharynx almost invariably precedes disease, the critical determinants enabling pneumococcal progression from this niche to cause invasive disease are poorly understood. One mechanism proposed to be central to this transition involves opacity phase variation, whereby pneumococci harvested from the nasopharynx are typically transparent, while those simultaneously harvested from the blood are opaque. Here, we used two dimensional-differential gel electrophoresis (2D-DIGE) to compare protein expression profiles of transparent and opaque variants of 3 pneumococcal strains, D39 (serotype 2), WCH43 (serotype 4) and WCH16 (serotype 6A) in vitro. One spot comprising a mixture of capsular polysaccharide biosynthesis protein and other proteins was significantly up-regulated in the opaque phenotype in all 3 strains; other proteins were differentially regulated in a strain-specific manner. We conclude that pneumococcal phase variation is a complex and multifactorial process leading to strain-specific pathogenicity.Melissa H. Chai, Florian Weiland, Richard M. Harvey, Peter Hoffmann, Abiodun D. Ogunniyi, James C. Pato

Differential activation of inflammatory pathways in A549 type II pneumocytes by Streptococcus pneumoniae strains with different adherence properties

BACKGROUND: Adherence of Streptococcus pneumoniae bacteria to lung cells is a first step in the progression from asymptomatic carriage to pneumonia. Adherence abilities vary widely among S. pneumoniae patient isolates. In this study, the binding properties of S. pneumoniae isolates and the effects of binding on activation of the Nuclear Factor-Kappa-B (NFκB) pathway and cytokine secretion by type II pneumocytes were measured. METHODS: Mechanisms of high- and low-binding S. pneumoniae adherence to A549 cells were investigated by blocking putative receptors on bacteria and host cells with antibody and by eluting choline-binding proteins off of bacterial surfaces. NFκB activation was measured by western blot and immunocytochemistry and cytokine secretion was detected by a protein array. RESULTS: This study shows that S. pneumoniae isolates from pneumonia patients (n = 298) can vary by as much as 1000-fold in their ability to bind to human lung epithelial cells. This difference resulted in differential activation of the NFκB pathway. High-, but not low-binding S. pneumoniae used Choline-binding protein A (CbpA) to bind to complement component C3 on epithelial cell surfaces. Interleukin-8 (IL-8) was the only cytokine secreted by cells treated with either low- or high-binding S. pneumoniae. CONCLUSION: These results indicate that S. pneumoniae clinical isolates are not homogeneous in their interaction with host epithelial cells. The differential activation of host cells by high- and low-binding S. pneumoniae strains could have implications for the treatment of pneumococcal pneumonia and for vaccine development