Efficiency of teaching patients with early-stage rheumatoid arthritis

Education programs are an important part of the management of patients with rheumatoid arthritis (RA).Objective: to develop a unified model of an education program for RA patients and to evaluate its efficiency at the early stage of the disease.Material and methods. A group education program was worked out with the support of the All-Russian public organization of the disabled “The Russian rheumatology organization “Nadezhda” (Hope)” and encompassed 4 daily classes lasting 90 min. All information was presented by a multidisciplinary team of specialists (rheumatologists, a cardiologist, a psychologist, a physiotherapist, and a physical trainer). The study included 55 patients with early RA (89.1% of women aged 18 to 62 years; the duration of the disease was 2 to 22 months); of them 25 were taught using the education program (a study group); 30 received drug therapy only (a control group). Following 3 and 6 months, the number of tender and swollen joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and pain were determined applying a 100-ml VAS, DAS28, HAQ, and RAPID3. Adherence to non-drug treatments was assessed employing a special patient questionnaire.Results. Three and six months after being taught, two patient groups showed increases in adherence to joint protection methods by 13 and 10 times (p<0.01), regular physical training by 4 and 3.25 times (p<0.01), uses of orthoses for the wrist joint by 2 times and 75% (p<0.01) and knee orthoses by 33.3 and 50.0% (p<0.01), and orthopedic insoles by 71.4 and 57.1% (p<0.01), respectively. Following 6 months, there were statistically significant differences between the two groups in most parameters (p<0.05), except for ESR, CRP, and DAS28 (p>0.05). Further more, a good response to treatment was significantly more common in these periods, as shown by the EULAR response criteria (DAS28): 56.3% versus 40% in the control group (p<0.05).Conclusion. The education program decreases the intensity of pain syndrome and improves the functional status and quality of life of patients with early RA within 6 months. Patient education enhances adherence to non-drug treatments. The highest positive result was achieved just 3 months later; it slightly tailed off at 6 months. This necessitates re-education in succeeding 3–6 months

Comprehensive rehabilitation of patients with early rheumatoid arthritis: results of 6-month program

Objective: to evaluate the efficiency of a comprehensive rehabilitation program (CRP) in patients with early rheumatoid arthritis (RA) for 6 months. Subjects and methods. Sixty patients with early RA were examined. During medical therapy, 6-month CRP was implemented in 34 patients in the study group. The 2-week in-hospital stage involved ten sessions of 15-min local air cryotherapy (-60 °C) of the hands, knee or ankle joints; ten classes of 45-min therapeutic exercises (TE) under the supervision of a trainer; ten sessions of 45-min ergotherapy (training people how to therapeutically position their joints, to apply their protective methods, to lift and move things, to use assistive devices, and to do hand exercises); orthotics (working wrist orthoses, knee ones, or individual orthopedic insoles); and four 90-min educational program classes. The outpatient and domiciliary stages included 45-min TE thrice weekly; creation of a correct functional stereotype; and orthotics. Twenty-six patients received medical therapy only (a control group). The authors estimated tender joint count (TJC), swollen joint count (SJC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), joint pain on 100-mm visual analog scale (VAS), DAS28, HAQ, RAPID3, hand grip strength, average maximum knee extension and ankle flexion by the EN-TreeM movement analysis, and compliance with drug and non-drug treatments. Results. The study group showed a stably high compliance with therapy with disease-modifying antirheumatic drugs, less need for symptomatic agents, higher adherence to the methods of creating a correct functional stereotype, orthotics, and regular TE. Twenty-two patients completed 6-month CRP; 12 patents did not complete the treatment because of non-compliance with nondrug methods, primarily TE. Upon completion of the in-hospital stage of CRP, the study group exhibited significant positive changes in pain and functional status and no significant impact on global inflammatory activity indicators (SJC, ESR, CRP, and DAS28). After 6 months of CRP, there were reductions in TJC by 6.0+1.8 or 72.3% (p <0.01), SJC 4.0+1.2 or 74.1% (p <0.01), ESR by 58.2% (p < 0.01), CRP by 67.2% (p < 0.01), VAS pain by 70.4% (p < 0.01), DAS28 by 1.38+0.21 scores or 31.9% (p < 0.05), HAQ by 0.97+0.56 scores or 75.8% (p < 0.01), and RAPID3 by 5.98+0.92 scores or 60.1% (p < 0.01). The grip strength of a more and less affected hand increased by 44.9% (p < 0.05) and 31.3% (p < 0.05), respectively. The average maximum extension of a weaker and stronger knee joint increased by 88.7% (p < 0.01), and 67.7% (p < 0.01), respectively. The average maximum flexion of a more and less affected ankle joint rose by 81.6% (p < 0.01) and 70.2% (p < 0.01), respectively. Following 6 months, the changes in the control group were less significant, which determined significant differences between the groups in most indicators. Conclusion. Six-month CRP enhances compliance with drug and non-drug treatments, assists in controlling disease activity, and improves functional abilities, motor activity, and quality of life in patients with early RA. The main reason for CRP interruption is inadequate patient adherence to non-drug treatments

Effect of EMIC waves on relativistic and ultrarelativistic electron populations: Ground-based and Van Allen Probes observations

Abstract We study the effect of electromagnetic ion cyclotron (EMIC) waves on the loss and pitch angle scattering of relativistic and ultrarelativistic electrons during the recovery phase of a moderate geomagnetic storm on 11 October 2012. The EMIC wave activity was observed in situ on the Van Allen Probes and conjugately on the ground across the Canadian Array for Real-time Investigations of Magnetic Activity throughout an extended 18 h interval. However, neither enhanced precipitation of \u3e0.7 MeV electrons nor reductions in Van Allen Probe 90° pitch angle ultrarelativistic electron flux were observed. Computed radiation belt electron pitch angle diffusion rates demonstrate that rapid pitch angle diffusion is confined to low pitch angles and cannot reach 90°. For the first time, from both observational and modeling perspectives, we show evidence of EMIC waves triggering ultrarelativistic (~2-8 MeV) electron loss but which is confined to pitch angles below around 45° and not affecting the core distribution. Key Points EMIC wave activity is not associated with precipitation of MeV electrons EMIC waves do not deplete the ultra-relativistic belt down to 90° EMIC waves cause loss of low pitch angle electrons with energies ~2-8 MeV

Venture capital management technique based on real options

© Medwell Journals, 2016.The study describes innovative process stages, provides statistics of innovative projects realization, develops a model of the innovative project evaluating by real options method

Assessment of adherence to drug and non-drug treatments and its changes under the influence of an education program in patients with rheumatoid arthritis

Objective: to assess awareness of drug and non-drug treatments for rheumatoid arthritis (RA) and compliance in patients before and after their participation in an education program, as well as the survival of the knowledge and the need for retraining. Subjects and methods. The study included 43 patients with RA: 23 study group patients were trained according to an education program (Rheumatoid Arthritis Health School), 20 patients formed a control group. The education program consisted of 4 daily 90-min studies. Adherence to drug and non-drug treatments was assessed at baseline and at 3 and 6 months. Results. In the study group, the basic therapy remained stably high (about 100%) within 6 months. At 3 months after studies, nonsteroidal anti-inflammatory drugs could be discontinued in 23.8% (p < 0.05). After 6 months, the proportion of patients using laser therapy increased by 57.1% (p < 0.01) and accounted for 47.8%; the use of electric and ultrasound treatments showed a 55.6% increase (p < 0.01) and was 60.9%. The number of patients who were compliant to the procedures for shaping a correct functional stereotype increased by 14 and 10 times following 3 and 6 months (60.9% and 43.5%, respectively; p < 0.01). After 3 months, there was a rise in the number of patients using hand ortheses by 75.0% (30.4%; p < 0.01); knee ortheses by 50.0% (39.1%; p < 0.01); individual inner soles by 71.4% (52.2%; p < 0.01); and walking sticks and crutches by 60.0% (34.8%; p < 0.01). Following 6 months, the positive changes remained only after the relative use of inner soles (60.9%) and support means (34.8%; p < 0.05). The number of patients who regularly did physical activity increased by 5.3 (69.6%; р < 0.01) and 3.7 (47.8%; p < 0.01) times at 3 and 6 months, respectively. The trend in the control group was less pronounced, determining statistically significant differences between the groups in most indicators (р < 0.05). Conclusion. The education program retains high compliance to the basic therapy, reduces needs for symptomatic drugs, and enhances adherence to physiotherapy, methods for shaping a correct motor stereotype, orthesis wearing, and regular physical activity. The maximum positive result of the Rheumatoid Arthritis Health School was achieved after 3 months; this effect slightly diminished at 6 months. This necessitates retraining in the following 3-6 months

VE-cadherin and claudin-5: it takes two to tango

Endothelial barrier function requires the adhesive activity of VE-cadherin and claudin-5, which are key components of adherens and tight endothelial junctions, respectively. Emerging evidence suggests that VE-cadherin controls claudin-5 expression by preventing the nuclear accumulation of FoxO1 and -catenin, which repress the claudin-5 promoter. This indicates that a crosstalk mechanism operates between these junctional structures

Эффективность о ртезирования в реабилитации больных ревматоидным артритом

Orthotic intervention is the most important element in the rehabilitation of patients with rheumatoid arthritis (RA).Objective: to evaluate the clinical efficiency of orthotic intervention in the rehabilitation of patients with RA.Patients and methods. The investigation enrolled 70 patients with RA (women, 84.3%; age, 18 to 64 years; disease duration, 3 months to 4 years) who were divided into 4 groups: 3 orthotic groups (ORLETT knee, ankle, and wrist orthoses of various fixation) and one control group (only drug therapy). The number of tender and swollen joints (TJ and SJ), pain on 100-mm VAS, erythrocyte sedimentation rate, C-reactive protein levels, DAS28, HAQ, RAPID3, and FFI scores, knee joint movement amplitudes, step test values, and hand compression force were estimated during 6 months. The clinical efficacy and comfort of orthoses and adherence to orthotic intervention were evaluated.Results. Six-month knee, ankle, and wrist orthotic intervention caused a reduction in the number of TJ and SJ, pain VAS, HAQ, RAPID3, and FFI scores, and step test values and an increase in knee flexion angle and hand compression force; at the same time, there were significant differences in those observed in the control group. The orthotic intervention failed to affect DAS28 scores and laboratory parameters. This decreased substantially (by more than 50%) the patients' needs for nonsteroidal anti-inflammatory drugs. Both a physician and a patient appreciated the comfort and clinical efficacy of orthoses greatly and adherence to their use well (86.7 to 93.3%).Conclusion. The 6-month application of knee, ankle, and wrist orthoses reduces pain syndrome and joint swelling and improves locomotor indicators, functional status, and quality of life in patients with RA, which may recommend including orthotic intervention in a comprehensive rehabilitation program.Ортезирование – важнейший элемент реабилитации пациентов с ревматоидным артритом (РА).Цель исследования – оценить клиническую эффективность ортезирования в реабилитации пациентов с РА.Пациенты и методы. В исследование включено 70 больных РА (84,3% женщин, возраст – от 18 до 64 лет, давность заболевания – от 3 мес до 4 лет), которые были разделены на четыре группы: три группы ортезирования (ортезы коленного, голеностопного и лучезапястного суставов ORLETT разной степени фиксации) и одна контрольная группа (только медикаментозная терапия). В течение 6 мес оценивали число болезненных (ЧБС) и припухших (ЧПС) суставов, боль по визуальной аналоговой шкале (ВАШ) 100 мм, СОЭ, уровень СРБ, индексы DAS28, HAQ, RAPID3, FFI, амплитуду движений в коленном суставе, маршевую пробу, силу сжатия кистей. Проводили определение клинической эффективности и комфортности ортезов, а также приверженности ортезированию.Результаты. Ортезирование коленного, голеностопного и лучезапястного суставов в течение 6 мес способствовало снижению ЧБС и ЧПС, боли по ВАШ, индексов HAQ, RAPID3 и FFI, показателей маршевой пробы, увеличению угла сгибания коленного сустава, силы сжатия кистей, при этом отмечены достоверные различия с группой контроля. Ортезирование значимо не повлияло на активность РА по индексу DAS28 и лабораторные показатели. Ортезирование существенно (>50%) снизило потребность пациентов в нестероидных противовоспалительных препаратах. Отмечены высокая оценка удобства и клинической эффективности ортезирования, по мнению врача и пациента, а также хорошая приверженность использованию ортезов (от 86,7 до 93,3%).Выводы. Применение ортезов коленного, голеностопного и лучезапястного суставов в течение 6 мес снижает болевой синдром, припухлость суставов, улучшает локомоторные показатели, функциональный статус и качество жизни больных РА, что позволяет рекомендовать включение ортезирования в комплексную реабилитацию

Genetic resistance to Mycobacterium Tuberculosis infection and disease

CITATION: Möller, M. et al. 2018. Genetic resistance to Mycobacterium tuberculosis infection and disease. Frontier in Immunology, 9:2219, 1-13. doi:10.3389/fimmu.2018.02219.The original publication is available from https://www.frontiersin.org/journals/immunology#Natural history studies of tuberculosis (TB) have revealed a spectrum of clinical outcomes after exposure to Mycobacterium tuberculosis, the cause of TB. Not all individuals exposed to the bacteriumwill become diseased and depending on the infection pressure, many will remain infection-free. Intriguingly, complete resistance to infection is observed in some individuals (termed resisters) after intense, continuing M. tuberculosis exposure. After successful infection, the majority of individuals will develop latent TB infection (LTBI). This infection state is currently (and perhaps imperfectly) defined by the presence of a positive tuberculin skin test (TST) and/or interferon gamma release assay (IGRA), but no detectable clinical disease symptoms. The majority of healthy individuals with LTBI are resistant to clinical TB, indicating that infection is remarkably well-contained in these non-progressors. The remaining 5–15% of LTBI positive individuals will progress to active TB. Epidemiological investigations have indicated that the host genetic component contributes to these infection and disease phenotypes, influencing both susceptibility and resistance. Elucidating these genetic correlates is therefore a priority as it may translate to new interventions to prevent, diagnose or treat TB. The most successful approaches in resistance/susceptibility investigation have focused on specific infection and disease phenotypes and the resister phenotype may hold the key to the discovery of actionable genetic variants in TB infection and disease. This review will not only discuss lessons from epidemiological studies, but will also focus on the contribution of epidemiology and functional genetics to human genetic resistance to M. tuberculosis infection and disease.https://www.frontiersin.org/articles/10.3389/fimmu.2018.02219/fullhttps://doi.org/10.3389/fimmu.2018.02219Published review articlePublishers versio

On ‘Organized Crime’ in the illicit antiquities trade: moving beyond the definitional debate

The extent to which ‘organized crime’ is involved in illicit antiquities trafficking is unknown and frequently debated. This paper explores the significance and scale of the illicit antiquities trade as a unique transnational criminal phenomenon that is often said to be perpetrated by and exhibit traits of so-called ‘organized crime.’ The definitional debate behind the term ‘organized crime’ is considered as a potential problem impeding our understanding of its existence or extent in illicit antiquities trafficking, and a basic progression-based model is then suggested as a new tool to move beyond the definitional debate for future research that may help to elucidate the actors, processes and criminal dynamics taking place within the illicit antiquities trade from source to market. The paper concludes that researchers should focus not on the question of whether organized criminals- particularly in a traditionally conceived, mafia-type stereotypical sense- are involved in the illicit antiquities trade, but instead on the structure and progression of antiquities trafficking itself that embody both organized and criminal dynamics

Genetic Resistance to Mycobacterium tuberculosis Infection and Disease

Natural history studies of tuberculosis (TB) have revealed a spectrum of clinical outcomes after exposure to Mycobacterium tuberculosis, the cause of TB. Not all individuals exposed to the bacterium will become diseased and depending on the infection pressure, many will remain infection-free. Intriguingly, complete resistance to infection is observed in some individuals (termed resisters) after intense, continuing M. tuberculosis exposure. After successful infection, the majority of individuals will develop latent TB infection (LTBI). This infection state is currently (and perhaps imperfectly) defined by the presence of a positive tuberculin skin test (TST) and/or interferon gamma release assay (IGRA), but no detectable clinical disease symptoms. The majority of healthy individuals with LTBI are resistant to clinical TB, indicating that infection is remarkably well-contained in these non-progressors. The remaining 5–15% of LTBI positive individuals will progress to active TB. Epidemiological investigations have indicated that the host genetic component contributes to these infection and disease phenotypes, influencing both susceptibility and resistance. Elucidating these genetic correlates is therefore a priority as it may translate to new interventions to prevent, diagnose or treat TB. The most successful approaches in resistance/susceptibility investigation have focused on specific infection and disease phenotypes and the resister phenotype may hold the key to the discovery of actionable genetic variants in TB infection and disease. This review will not only discuss lessons from epidemiological studies, but will also focus on the contribution of epidemiology and functional genetics to human genetic resistance to M. tuberculosis infection and disease