Early intervention for the management of acute low back pain: A single blind randomised controlled trial of biopsychosocial education, manual therapy and exercise

Design: A single blind randomised controlled trial comparing two models of care for patients with simple acute low back pain (ALBP). Objectives: To compare two research-based models of care for ALBP, and investigate the effect of the timing of physical intervention. Summary of Background Data National guidelines offer conflicting information on the delivery of physical treatment in the management of ALBP. Review of guidelines suggests two different models of care. Direct comparisons between these models are lacking in the literature. The present study aims to compare these two approaches to the management of ALBP. Method: Among 804 referred patients, 102 subjects met the specific admission criteria and were randomly assigned to an ‘assess/advise/treat’ group or an ‘assess/advise/wait’ group. The intervention consisted of biopsychosocial education, manual therapy and exercise. Assessment of short-term outcome enables comparison to be made between intervention and advice to stay active. Assessment of long-term outcome enables comparison to be made between early and late intervention. Study outcomes of reported pain (VAS), functional disability (RMDQ), mood (MZSRDS, MSPQ, STAIS), general health (Euroqol) and quality of life (SF-36) were assessed at baseline, six weeks, three months and six months. Results: At six weeks, the ‘assess/advise/treat’ group demonstrated greater improvements in disability, mood, general health and quality of life than patients in the ‘assess/advise/wait’ group (p0.05). However, mood, general health and quality of life remained significantly better in the ‘assess/advise/treat’ group (p\u3c0.05). Conclusions: At six weeks physiotherapy intervention is more effective than advice on staying active, leading to more rapid improvement in function, mood, quality of life and general health. The timing of intervention affects the progression of psychosocial features. If treatment is provided later, the same psychosocial benefits are not achieved. Therefore an \u27assess/advise/treat\u27 model of care seems to offer better outcomes than an \u27assess/advise/wait\u27 model of care

OS IMPACTOS DA EXPANSÃO ECONÔMICA CHINESA E SEUS INVESTIMENTOS NA REPÚBLICA FEDERAL DA NIGÉRIA

RESUMO O seguinte artigo aborda a expansão econômica da República Popular da China nas últimas décadas do século XXI. Essa expansão econômica chinesa gera uma cooperação entre a China e o país em que a mesma investe. De um lado, a China supre seu comércio e indústria, de outro, o país investido recebe recursos financeiros para se desenvolver.  Observa-se, ao longo da última década, um considerado investimento chinês no continente africano, devido à abundância de recursos primários na região, recursos estes necessários para a economia chinesa. O objetivo deste trabalho é analisar as relações entre China e a Nigéria, importante país da África Subsaariana, bem como o desenvolvimento interno nigeriano e os investimentos diretos chineses. Palavras-Chave: China, Nigéria, África, desenvolvimento,  economia internacional, relações internacionais, relações bilaterais. ABSTRACT The following article approaches the economic growth of People’s Republic of China in the first and second decades of the 21st Century. The Chinese economic growth creates cooperation between China and the country which China invests. In one side, China fulfills the Chinese industry and Chinese trade. In the other side, the country whose China do investment receives means to develop itself. It is sighted, mainly in the last decade, considerable Chinese’s investment in the African continent, due to abundance of primary resources, necessary for the Chinese economy. The aim of this article is to investigate the relations between China and Nigeria, an important country of sub-Saharan Africa, the impacts, the growth and the development of this country, resulted from the Chinese’s investment. Key Words: China,  Nigeria, Africa, development, international economy, international relations, bilateral relations

Belimumab after B cell depletion therapy in patients with systemic lupus erythematosus (BEAT Lupus) protocol: a prospective multicentre, double-blind, randomised, placebo-controlled, 52-week phase II clinical trial.

INTRODUCTION: Few treatment options exist for patients with systemic lupus erythematosus (SLE) who fail conventional therapy. Although widely used to treat lupus, the efficacy of B cell depletion therapy using rituximab has not been demonstrated in randomised clinical trials. Following rituximab, elevated levels of serum B cell activating factor (BAFF) have been associated with failure to remit or subsequent lupus relapse. The administration of belimumab, a monoclonal antibody specific for BAFF and approved for lupus therapy, could potentiate the efficacy of rituximab and enable longer periods of disease remission. The aim of this trial is to assess the safety and efficacy of belimumab following rituximab in patients with SLE. METHODS AND ANALYSIS: BEAT Lupus is a double-blind, randomised, placebo controlled, phase II clinical trial. Patients with SLE commencing a treatment cycle of rituximab (two 1g infusions, 2 weeks apart) as standard of care will be randomised to receive belimumab or placebo, 4 to 8 weeks following the first rituximab infusion. Belimumab or placebo infusions are administered for 52 weeks. The primary outcome measure is anti-double stranded DNA (anti-dsDNA) antibody levels at 52 weeks. Secondary outcomes include measures of adverse events, lupus disease activity and cumulative steroid dose. The kinetics of B cell repopulation will be assessed in a subgroup of participants. Belimumab administration after rituximab may provide a novel therapeutic pathway for patients with active lupus if safety is demonstrated in this proof of concept study, and lower anti-dsDNA antibodies levels are achieved in those patients treated with belimumab compared with placebo. ETHICS AND DISSEMINATION: The protocol has been reviewed and approved by the Hampstead Research Ethics Committee - London (reference 16/LO/1024). Trial information is available at https://www.isrctn.com/ISRCTN47873003, and the results of this trial will be submitted for publication in relevant peer-reviewed journals. Key findings will also be presented at national and international conferences. TRIAL REGISTRATION NUMBER: ISRCTN47873; date assigned to the registry: 28 November 2016. The stage is pre-results

A randomised, controlled, observer-masked trial of corneal cross-linking for progressive keratoconus in children : the KERALINK protocol

This work was supported by the Efficacy and Mechanism Evaluation Programme (reference 14/23/18), a MRC and NIHR partnership.Introduction: The KERALINK trial tests the hypothesis that corneal cross-linking (CXL) treatment reduces the progression of keratoconus in comparison to standard care in patients under 17 years old. KERALINK is a randomised controlled, observer-masked, multicentre trial in progressive keratoconus comparing epithelium-off CXL with standard care, including spectacles or contact lenses as necessary for best-corrected acuity. Methods and analysis: A total of 30 participants will be randomised per group. Eligible participants aged 10-16 years with progressive keratoconus in one or both eyes will be recruited. Following randomisation, participants will be followed up 3-monthly for 18 months. The effect on progression will be determined by K-2 on corneal topography. The primary outcome measure is between-group difference in K-2 at 18 months adjusted for K-2 at baseline examination. Secondary outcomes are the effect of CXL on (1) keratoconus progression, (2) time to keratoconus progression, (3) visual acuity, (4) refraction, (5) apical corneal thickness and (6) adverse events. Patient-reported effects will be explored by questionnaires. Ethics and dissemination Research Ethics Committee Approval was obtained on 30 June 2016 (ref: 14/LO/1937). Current protocol: V.5.0 (08/11/2017). Study findings will be published in peer-reviewed journals.Publisher PDFPeer reviewe

A20, a modulator of smooth muscle cell proliferation and apoptosis, prevents and induces regression of neointimal hyperplasia

A20 is a NF‐κB‐dependent gene that has dual anti‐inflammatory and antiapoptotic functions in endothelial cells (EC). The function of A20 in smooth muscle cells (SMC) is unknown. We demonstrate that A20 is induced in SMC in response to inflammatory stimuli and serves an anti‐inflammatory function via blockade of NF‐κB and NF‐κB‐dependent proteins ICAM‐1 and MCP‐1. A20 inhibits SMC proliferation via increased expression of cyclin‐dependent kinase inhibitors p21waf1 and p27kip1. Surprisingly, A20 sensitizes SMC to cytokine‐ and Fas‐mediated apoptosis through a novel NO‐dependent mechanism. In vivo, adenoviral delivery of A20 to medial rat carotid artery SMC after balloon angioplasty prevents neointimal hyperplasia by blocking SMC proliferation and accelerating re‐endothelialization, without causing apoptosis. However, expression of A20 in established neointimal lesions leads to their regression through increased apoptosis. This is the first demonstration that A20 exerts two levels of control of vascular remodeling and healing. A20 prevents neointimal hyperplasia through combined anti‐inflammatory and antiproliferative functions in medial SMC. If SMC evade this first barrier and neointima is formed, A20 has a therapeutic potential by uniquely sensitizing neointimal SMC to apoptosis. A20‐based therapies hold promise for the prevention and treatment of neointimal disease.—Patel, V. I., Daniel, S., Longo, C. R., Shrikhande, G. V., Scali, S. T., Czismadia, E., Groft, C. M., Shukri, T., Motley‐Dore, C., Ramsey, H. E., Fisher, M. D., Grey, S. T., Arvelo, M. B., Ferran, C. A20, a modulator of smooth muscle cell proliferation and apoptosis, prevents and induces regression of neointimal hyperplasia. FASEB J. 20, 1418–1430 (2006)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154452/1/fsb2fj054981com.pd

EFEITOS DA SOBRECARGA DE FRUTOSE E ATIVIDADE FÍSICA SOBRE A PAREDE INTESTINAL DO CÓLON ASCENDENTE E PLEXO MIENTÉRICO DE RATOS

O presente estudo avalia os feitos da sobrecarga de frutose na dieta e exercícios físicos, no peso corporal, nível glicêmico e de triglicerídeos, na histologia do cólon ascendente e morfometria dos neurônios mientéricos do jejuno de ratos. Foram utilizados 30 ratos (Wistar), divididos em sedentários (S) e exercitados (E), sendo que GS e GE receberam água; GS10 e GE10 água acrescida de 10% de frutose; GS20 e GE20 água acrescida de 20% de frutose. Os animais exercitados foram submetidos à atividade física (natação). Após tratamento verificou-se que, os animais do GE tiveram peso 18,8% menor que GS, e GE10 14,5% menor que GS10. Comparados com GS, a sobrecarga de frutose resultou em nível glicêmico (mg/dL) elevado em todos os grupos, indicando quadro diabetogênico (GS:106,2; GS10: 216,2; GS20: 205,8; GE: 189; GE10: 204,4; GE20: 259,2) mesmo nos animais exercitados. O nível de triglicerídeos no sangue foi superior em todos os grupos quando comparados ao GS. A análise morfométrica do pericário dos neurônios mientéricos do jejuno mostrou redução significativa nos grupos GS20, GE10 e GE20. As mudanças metabólicas provocadas pela sobrecarga de frutose, associada ou não a atividade física, favoreceram para elevar os níveis glicêmicos e de lipídios no sangue, diminuindo a necessidade de reserva nas células, contribuindo para redução na área do citosol nos neurônios mientéricos. Constatou-se também, redução na profundidade das criptas em todos os grupos comparados ao GS. Acredita-se que quanto maior a oferta de nutrientes menor é a necessidade das células intestinais de se desenvolverem, conduzindo a processos de adaptação celular, como atrofia

Human papillomavirus infection : protocol for a randomised controlled trial of imiquimod cream (5%) versus podophyllotoxin cream (0.15%), in combination with quadrivalent human papillomavirus or control vaccination in treatment and prevention of recurrence of anogenital warts (HIPvac trial)

BACKGROUND: Anogenital warts are the second most common sexually transmitted infection diagnosed in sexual health services in England. About 90% of genital warts are caused by human papillomavirus (HPV) types 6 or 11, and half of episodes diagnosed are recurrences. The best and most cost-effective treatment for patients with anogenital warts is unknown. The commonly used treatments are self-administered topical agents, podophyllotoxin (0.15% cream) or imiquimod (5% cream), or cryotherapy with liquid nitrogen. Quadrivalent HPV (qHPV) vaccination is effective in preventing infection, and disease, but whether it has any therapeutic effect is not known. METHODS AND DESIGN: To investigate the efficacy of clearance and prevention of recurrence of external anogenital warts by topical treatments, podophyllotoxin 0.15% cream or imiquimod 5% cream, in combination with a three-dose regimen of qHPV or control vaccination. 500 adult patients presenting with external anogenital warts with either a first or subsequent episode of anogenital warts will be entered into this randomised, controlled partially blinded 2 × 2 factorial trial. DISCUSSION: The trial is expected to provide the first high-quality evidence of the comparative efficacy and cost-effectiveness of the two topical treatments in current use, as well as investigate the potential benefit of HPV vaccination, in the management of anogenital warts. TRIAL REGISTRATION: The trial was registered prior to starting recruitment under the following reference numbers: International Standard Randomized Controlled Trial Number (ISRCTN) Registry - ISRCTN32729817 (registered 25 July 2014); European Union Clinical Trials Register (EudraCT) - 2013-002951-14 (registered 26 June 2013)