Sustained response to infliximab treatment in two cases of early rheumatoid arthritis that has been maintained after drug withdrawal

The authors report two cases of active seropositive rheumatoid arthritis who were treated in an early phase of the disease with infliximab plus methotrexate obtaining a clinical remission. The benefit was maintained after the discontinuation of the anti-TNF alpha inhibitor for adverse events, indicating that the early administration of the drug may be followed by a sustained remission

Revisão das espécies do grupo de Bufo crucifer, com descrições de duas espécies relacionadas (Amphibia, Anura, Bufonidae)

The Bufo crucifer species group is revised on the basis of external morphological and morphometrical characteristics, evidencing variation in size, shape of the parotoid gland, width of the head, cranial crests, and presence or absence of yellow spots near the cloaca and hind limbs. Five species are recognized: B. crucifer Wied-Neuwied, 1821, B. ornatus Spix, 1824 (revalidated), B. henseli A.Lutz, 1934 (revalidated), B. abei sp.nov., and B. pombali sp.nov. The geographic distribution of the species is associated with the Atlantic Rain Forest and adjacent areas: B. crucifer occurs from the State of Ceará to southern State of Espírito Santo and northeastern State of Minas Gerais; B. ornatus is distributed from southern State of Espírito Santo, through the states of Rio de Janeiro and São Paulo to northern State of Paraná, and possibly in northeastern Argentina, in the provinces Misiones and Corrientes; B. henseli is found from southern State of Santa Catarina to the coast of the State of Rio Grande do Sul; B. abei sp.nov., described from Córrego Grande, Municipality of Florianópolis, State of Santa Catarina, is distributed from the State of Paraná to southern State of Santa Catarina and areas of the northern State of Rio Grande do Sul; and B. pombali sp.nov., described from the Reserva Biológica de Peti, Municipality of São Gonçalo do Rio Abaixo, State of Minas Gerais, occurs in transitional areas between the Atlantic Rain Forest and the “cerrados” in the State of Minas Gerais. Additionally, Bufo crucifer var. pfrimeri Miranda-Ribeiro, 1926, currently in the synonymy of B. crucifer, is transfered to the synonymy of Bufo guttatus Schneider, 1799. Bufo levicristatus Boettger, 1885 is considered a species inquirenda and removed from the synonymy of any species included in the B. crucifer group. Bufo spixii Fitzinger, 1826 is transfered from the synonymy of Bufo margaritifer (Laurenti, 1768) to the synonymy of Bufo ornatus Spix, 1824.O grupo de Bufo crucifer é revisado com base em caracteres morfológicos externos e morfométricos, evidenciando variação em tamanho, forma das glândulas parotóides, largura da cabeça, cristas cefálicas e presença ou ausência de manchas amarelas próximo à cloaca e nas pernas. Cinco espécies são reconhecidas: Bufo crucifer Wied-Neuwied, 1821, B. ornatus Spix, 1824 (revalidada), B. henseli A.Lutz, 1924 (revalidada), B. abei sp.nov. e B. pombali sp.nov. A distribuição geográfica das espécies é associada à Floresta Atlântica e regiões adjacentes: B. crucifer ocorre do Estado do Ceará ao sul do Estado do Espírito Santo e nordeste do Estado de Minas Gerais; B. ornatus ocorre do sul do Estado do Espírito Santo, através dos Estados do Rio de Janeiro e São Paulo até o norte do Estado do Paraná e possivelmente no nordeste da Argentina, nas Províncias Misiones e Corrientes; B. henseli é encontrada do sul do Estado de Santa Catarina até a região costeira do Estado do Rio Grande do Sul; B. abei sp.nov., descrita de Córrego Grande, Município de Florianópolis, Estado de Santa Catarina, está distribuída do Estado do Paraná até o sul do Estado de Santa Catarina e áreas do norte do Estado do Rio Grande do Sul; B. pombali sp.nov., descrita da Reserva Biológica de Peti, Município de São Gonçalo do Rio Abaixo, Estado de Minas Gerais, ocorre nas áreas de transição entre a Floresta Atlântica e os cerrados no Estado de Minas Gerais. Adicionalmente, Bufo crucifer var. pfrimeri Miranda-Ribeiro, 1926, atualmente incluída na sinonimia de B. crucifer, é transferida para a sinonimia de Bufo guttatus Schneider, 1799. Bufo levicristatus Boettger, 1885 é considerada species inquirenda e retirada da sinonimia de qualquer das espécies incluídas no grupo de B. crucifer. Bufo spixii Fitzinger, 1826 é transferida da sinonimia de Bufo margaritifer (Laurenti, 1768) para a sinonimia de Bufo ornatus Spix, 1824

Electrographic changes accompanying recurrent seizures under ketogenic diet treatment.

The ketogenic diet (KD) is increasingly used to treat epilepsy refractory to antiepileptic drugs and other neurological disorders. In animal models, the KD was found to increase the threshold to seizures induced by different convulsive stimulations. However, in models in which suprathreshold stimuli were used, a paradoxical seizure worsening was consistently observed in KD-fed animals. To better define this phenomenon, we characterized the electrographic response to seizures induced in mice which were treated with the KD, and then corneally stimulated at 6-Hz in four different sessions. We also evaluated the electroencephalogram (EEG) in three patients in which the KD was associated with a paradoxical worsening of epileptic seizures. Although seizures were initially less severe, a remarkable prolongation of the electrographic response was observed in mice receiving the KD from the second session of 6-Hz corneal stimulation and onwards. The EEG was also markedly altered in the presence of progressive seizure aggravation observed in children treated with the KD, specifically one affected by Lennox\u2013Gastaut syndrome and two by type I lissencephaly. These results suggest that when seizures are induced or recur because of resistance to therapeutic interventions, the KD may change the EEG by potentiating the electrographic epileptic activity

The identity of Rana margaritifera Laurenti, 1768 (Anura, Bufonidae)

Rana margaritifera was described by Laurenti in 1768 and currently is associated to the genus Rhinella, under the combination Rhinella margaritifera. Currently, the R. margaritifera species group consists of 16 recognized species. Furthermore, many additional species have been suggested to exist in this group which highlights the ambiguity surrounding the identity of Rhinella margaritifera and impend further description of the species in this group. After an exhaustive bibliographic review, we concluded that the recent designation of a lectotype for R. margaritifera is invalid according with Art. 73, ICZN, 1999. Herein, we designate and provide the description of a neotype for Rana margaritifera Laurenti, 1768.Fil: Lavilla, Esteban Orlando. Fundación Miguel Lillo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Tucumán; ArgentinaFil: Caramaschi, Ulisses. Universidade Federal do Rio de Janeiro; BrasilFil: Langone, Jose A.. Museo Nacional de Historia Natural. Departamento de Herpetología; UruguayFil: Pombal, Jose P.. Universidade Federal do Rio de Janeiro; BrasilFil: de Sá, Rafael O.. University of Richmond. Department of Biology; Estados Unido

The Identification of \u3cem\u3eRana Ocellata\u3c/em\u3e Linnaeus, 1758. Nomenclatural Impact on the Species Currently Known as \u3cem\u3eLeptodactylus ocellatus\u3c/em\u3e (Leptodactylidae) and \u3cem\u3eOsteopilus brunneus\u3c/em\u3e (Gosse, 1851) (Hylidae)

The usage of the name Rana ocellata Linnaeus, 1758, is plagued by misidentifications and misinterpretations. After an exhaustive bibliographic review, we conclude that the Linnaeus 1758 name refers to Osteopilus brunneus (Gosse, 1851) from Jamaica, while the taxon currently known as Leptodactylus ocellatus corresponds to Rana latrans Steffen, 1815. Herein, we designate and provide descriptions of the neotypes of Leptodactylus latrans (Steffen, 1815), revalidated, new combination, and Osteopilus ocellatus (Linnaeus, 1758), new combination, as a senior synonym of Osteopilus brunneus (Gosse, 1851)

The Identity of \u3cem\u3eRana margaritifera\u3c/em\u3e Laurenti, 1768 (Anura, Bufonidae)

Rana margaritifera was described by Laurenti in 1768 and currently is associated to the genus Rhinella, under the combination Rhinella margaritifera. Currently, the R. margaritifera species group consists of 16 recognized species. Further-more, many additional species have been suggested to exist in this group which highlights the ambiguity surrounding the identity of Rhinella margaritifera and impend further description of the species in this group. After an exhaustive bibliographic review, we concluded that the recent designation of a lectotype for R. margaritifera is invalid according with Art. 73, ICZN, 1999. Herein, we designate and provide the description of a neotype for Rana margaritifera Laurenti, 1768

Physiotherapists and Osteopaths’ Attitudes: Training in Management of Temporomandibular Disorders

Temporomandibular disorders (TMDs) are a condition which has multifactorial etiology. The most acknowledged method to classify TMDs is the diagnostic criteria (DC) introduced firstly by Dworkin. This protocol considers different aspects that are not only biological, but even psychosocial. Diagnosis is often based on anamnesis, physical examination and instrumental diagnosis. TMDs are classified as intra-articular and/or extra-articular disorders. Common signs and symptoms include jaw pain and dysfunction, earache, headache, facial pain, limitation to opening the mouth, ear pain and temporomandibular joint (TMJ) noises. This study regards two kind of clinicians that started in the last years to be more involved in the treatment of TMDs: osteopaths (OOs) and physiotherapists (PTs). The purpose is to analyze their attitude and clinical approach on patients affected by TMDs. Four hundred therapists answered an anonymous questionnaire regarding TMJ and TMDs. OOs showed greater knowledges on TMDs and TMJ and, the therapists with both qualifications seemed to be most confident in treating patients with TMDs. In conclusion this study highlights OOs and all the clinicians with this qualification, have a higher confidence in treating patients with TMD than the others. Dentists and orthodontists, according to this study, should co-work with OOs and PTs, because they are the specialists more requested by them than other kinds of specialists

Poorly differentiated clusters (PDC) in colorectal cancer: Does their localization in tumor matter?

Poorly differentiated clusters (PDC) are aggregates of at least five neoplastic cells lacking evidence of glandular differentiation. By definition, they can be present at the invasive front (peripheral PDC or pPDC) and within the tumor stroma (central PDC or cPDC). In colorectal cancer (CRC), PDC are considered adverse prognosticators and seem to reflect epithelial mesenchymal transition (EMT). In this study, we have investigated the immuno-expression of two EMT-related proteins, E-cadherin and β-catenin, in PDC of primary CRCs and matched liver metastases. pPDC always showed nuclear β-catenin staining and diffusely reduced/absence of E-cadherin expression as opposed cPDC which showed nuclear β-catenin immunoreactivity and E-cadherin expression in about 50% of cases. In addition, the pattern of β-catenin and E-cadherin expression differed between PDC and the main tumor, and between primary CRC and liver metastasis (LM), in a percentage of cases. A discordant pattern of β-catenin and E-cadherin expression between pPDC and cPDC, between main tumor and cPDC, and between primary CRC and LM, confirms that EMT is a dynamic and reversible process in CRC. On the overall, this suggests that pPDC and cPDC are biologically different. We may advocate that PDC develop at the tumor center (cPDC) and then some of them migrate towards the tumor periphery while progressively completing EMT process (pPDC). Based on these results, PDC presence and counting may have different prognostic relevance if the assessment is done at the invasive front of the tumor or in the intratumor stroma

Complement activation in the plasma and placentas of women with different subsets of antiphospholipid syndrome

Problem: As antiphospholipid antibody\u2010positive women with adverse pregnancy outcomes have higher plasma complement activation product levels, and the placentas of women with antiphospholipid syndrome (APS) exhibit C4d complement component deposition, complement activation involvement has been hypothesized in APS pregnancy complications. Method of study: Plasma levels of C5a and C5b\u20109 complement components of 43 APS non\u2010pregnant patients and 17 pregnant APS women were measured using enzyme\u2010 linked immunosorbent assay. The results were compared with those of 16 healthy non\u2010pregnant women and eight healthy pregnant women, respectively. Placenta samples of five APS patients at high risk of pregnancy complications and of five healthy controls were subjected to immunoblotting analysis with specific antibodies to C5b\u20109 and CD46, CD55, CD59 complement regulators. Results: The mean plasma C5a and C5b\u20109 levels were significantly higher in the nonpregnant APS patients with previous thrombosis \ub1 pregnancy morbidity (P = .0001 and P = .0034, respectively) and in the pregnant APS women with adverse outcomes (P = .0093 for both). Similarly, C5b\u20109 amounts were significantly higher in the adverse pregnancy outcome placenta (P = .0115) than in those associated to a favorable outcome. The mean CD46, CD55 and CD59 amounts were, instead, lower, although not always significantly, in the placentas of all the high\u2010risk APS women with respect to the control placentas. Conclusion: Data analysis demonstrated that there was significant complement activation in the more severe subset of APS patients and in only the adverse pregnancy outcome APS women. Further studies will clarify whether the lower CD46, CD55, and CD59 expressions in the APS placentas are limited to only high\u2010risk APS patients

Erectile dysfunction is frequent in systemic sclerosis and associated with severe disease: a study of the EULAR Scleroderma Trial and Research group

Introduction: Erectile dysfunction (ED) is common in men with systemic sclerosis (SSc) but the demographics, risk factors and treatment coverage for ED are not well known. Method: This study was carried out prospectively in the multinational EULAR Scleroderma Trial and Research database by amending the electronic data-entry system with the International Index of Erectile Function-5 and items related to ED risk factors and treatment. Centres participating in this EULAR Scleroderma Trial and Research substudy were asked to recruit patients consecutively. Results: Of the 130 men studied, only 23 (17.7%) had a normal International Index of Erectile Function-5 score. Thirty-eight per cent of all participants had severe ED (International Index of Erectile Function-5 score ≤ 7). Men with ED were significantly older than subjects without ED (54.8 years vs. 43.3 years, P < 0.001) and more frequently had simultaneous non-SSc-related risk factors such as alcohol consumption. In 82% of SSc patients, the onset of ED was after the manifestation of the first non-Raynaud's symptom (median delay 4.1 years). ED was associated with severe cutaneous, muscular or renal involvement of SSc, elevated pulmonary pressures and restrictive lung disease. ED was treated in only 27.8% of men. The most common treatment was sildenafil, whose efficacy is not established in ED of SSc patients. Conclusions: Severe ED is a common and early problem in men with SSc. Physicians should address modifiable risk factors actively. More research into the pathophysiology, longitudinal development, treatment and psychosocial impact of ED is needed