Strengthening and stretching for rheumatoid arthritis of the hand (SARAH). A randomised controlled trial and economic evaluation

Study registration: Current Controlled Trials ISRCTN 89936343.Background - The effectiveness of exercise for improving hand and wrist function in people with rheumatoid arthritis (RA) is uncertain. Objectives - The study aims were (1) to estimate the clinical effectiveness and cost-effectiveness of adding an optimised exercise programme for hands and upper limbs to standard care for patients with RA; and (2) to qualitatively describe the experience of participants in the trial with a particular emphasis on acceptability of the intervention, exercise behaviours and reasons for adherence/non-adherence.This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 19. See the NIHR Journals Library website for further project information. This report has been developed in association with the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford and the NIHR Biomedical Research Unit Funding Scheme. This project benefited from facilities funded through Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform, with support from Advantage West Midlands

Early Recognition and Management of Side Effects Related to Systemic Anticancer Therapy for Advanced Breast Cancer

Objectives: Advances in science and technology have meant there are numerous treatment options available for people with advanced breast cancer (ABC). However, each therapeutic approach can cause side effects or adverse events, which can significantly affect the person's quality of life, overall well-being, and, in some instances, safety. This report presents an overview of the common side effects of systemic anticancer therapy and ways to manage them. Data Sources: Data sources include peer-reviewed articles sourced in electronic databases and national and international best practice guidelines (ESMO, ASCO, and MASCC guidelines). Conclusion: Systemic anticancer therapies have side effects that healthcare professionals need to know about to monitor and manage them in early stages. Nurses play an important role in patient education, early identification, monitoring, and management of treatment side effects. Implications for Nursing Practice: People with ABC face many challenges during their treatment journey. Oncology nurses, specialist nurses, and nurse practitioners can be of support by providing preventive measures and side effects management at an early stage. Nurses need to have a good understanding of toxicity management but also advanced tumor-specific cancer knowledge of the different subtypes of ABC and holistic assessment skills. They are also key to providing support and enhancing self-management and early recognition of side effects. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/

Template for Developing Guidelines for the Evaluation of the Clinical Efficacy of Psychophysiological Interventions

An essential function of both the Association for Applied Psychophysiology and Biofeedback (AAPB) and the Society for Neuronal Regulation (SNR) is the systematic evaluation of psychophysiological interventions that have been developed for the treatment of medical and psychiatric disorders. In order to address scientific concerns regarding the efficacy of specific clinical applications of biofeedback, these two societies formed and Efficacy Task Force. The process to be used in the assessment of treatment efficacy, specificity and clinical utility is presented in the form of a template that will serve as the foundation for a series of scientific reviews and practice guidlines to be published by both societies

Gene silencing in tick cell lines using small interfering or long double-stranded RNA

Gene silencing by RNA interference (RNAi) is an important research tool in many areas of biology. To effectively harness the power of this technique in order to explore tick functional genomics and tick-microorganism interactions, optimised parameters for RNAi-mediated gene silencing in tick cells need to be established. Ten cell lines from four economically important ixodid tick genera (Amblyomma, Hyalomma, Ixodes and Rhipicephalus including the sub-species Boophilus) were used to examine key parameters including small interfering RNA (siRNA), double stranded RNA (dsRNA), transfection reagent and incubation time for silencing virus reporter and endogenous tick genes. Transfection reagents were essential for the uptake of siRNA whereas long dsRNA alone was taken up by most tick cell lines. Significant virus reporter protein knockdown was achieved using either siRNA or dsRNA in all the cell lines tested. Optimum conditions varied according to the cell line. Consistency between replicates and duration of incubation with dsRNA were addressed for two Ixodes scapularis cell lines; IDE8 supported more consistent and effective silencing of the endogenous gene subolesin than ISE6, and highly significant knockdown of the endogenous gene 2I1F6 in IDE8 cells was achieved within 48 h incubation with dsRNA. In summary, this study shows that gene silencing by RNAi in tick cell lines is generally more efficient with dsRNA than with siRNA but results vary between cell lines and optimal parameters need to be determined for each experimental system

Bio/neurofeedback

ResumenLas técnicas de biofeedback (BF) desarrolladas desde los años 60 por la psicología tienen ya una larga historia, en la que han demostrado su utilidad y eficacia terapéutica en una considerable variedad de trastornos clínicos: neurológicos, neuromusculares, cardiovasculares, gastrointestinales, dolores crónicos, problemas dermatológicos, de sueño, respiratorios, trastornos traumáticos y de estrés, entre muchos otros. Entre las aplicaciones prácticas del BF destaca de modo especial el biofeedback electroencefalográfico (BF-EEG), denominado neurofeedback (NF), cuya importancia y aplicaciones clínicas ha crecido y continua creciendo aceleradamente gracias al importante desarrollo acaecido en los campos de la neurociencia y la informática sobre los que se sustenta el NF. El trabajo presentado describe y analiza de forma práctica el proceso y la técnica del BF y del NF, además de sus fundamentos metodológicos, pero, sobre todo, examina desde un punto de vista crítico las principales aplicaciones clínicas de las mismas junto al nivel de utilidad y eficacia terapéutica alcanzado en la actualidad.AbstractBiofeedback (BF) techniques were developed by psychology in the 1960s having then a long history in which they have proved their usefulness and therapeutic efficacy in a considerable variety of clinical disorders: neurologic, neuromuscular, cardiovascular, gastrointestinal, chronic pain, dermatological, sleep, respiratory, trauma and stress, among many other disorders. Practical applications of the BF include in particular Electroencephalographic Biofeedback (BF-EEG), known as Neurofeedback (NF), whose importance and clinical applications have grown and continue to grow rapidly thanks to the significant development in the fields of neuroscience and computer science on which NF rests. This paper describes and analyzes the technique and process of BF and NF, apart from their methodological foundations but, above all, from a critical point of view, the paper examines their main clinical applications together with the level of utility and therapeutic effectiveness currently achieved

Fumonisin B1 Toxicity in Grower-Finisher Pigs: A Comparative Analysis of Genetically Engineered Bt Corn and non-Bt Corn by Using Quantitative Dietary Exposure Assessment Modeling

In this study, we investigate the long-term exposure (20 weeks) to fumonisin B1 (FB1) in grower-finisher pigs by conducting a quantitative exposure assessment (QEA). Our analytical approach involved both deterministic and semi-stochastic modeling for dietary comparative analyses of FB1 exposures originating from genetically engineered Bacillus thuringiensis (Bt)-corn, conventional non-Bt corn and distiller’s dried grains with solubles (DDGS) derived from Bt and/or non-Bt corn. Results from both deterministic and semi-stochastic demonstrated a distinct difference of FB1 toxicity in feed between Bt corn and non-Bt corn. Semi-stochastic results predicted the lowest FB1 exposure for Bt grain with a mean of 1.5 mg FB1/kg diet and the highest FB1 exposure for a diet consisting of non-Bt grain and non-Bt DDGS with a mean of 7.87 mg FB1/kg diet; the chronic toxicological incipient level of concern is 1.0 mg of FB1/kg of diet. Deterministic results closely mirrored but tended to slightly under predict the mean result for the semi-stochastic analysis. This novel comparative QEA model reveals that diet scenarios where the source of grain is derived from Bt corn presents less potential to induce FB1 toxicity than diets containing non-Bt corn

Rabies screen reveals GPe control of cocaine-triggered plasticity.

Identification of neural circuit changes that contribute to behavioural plasticity has routinely been conducted on candidate circuits that were preselected on the basis of previous results. Here we present an unbiased method for identifying experience-triggered circuit-level changes in neuronal ensembles in mice. Using rabies virus monosynaptic tracing, we mapped cocaine-induced global changes in inputs onto neurons in the ventral tegmental area. Cocaine increased rabies-labelled inputs from the globus pallidus externus (GPe), a basal ganglia nucleus not previously known to participate in behavioural plasticity triggered by drugs of abuse. We demonstrated that cocaine increased GPe neuron activity, which accounted for the increase in GPe labelling. Inhibition of GPe activity revealed that it contributes to two forms of cocaine-triggered behavioural plasticity, at least in part by disinhibiting dopamine neurons in the ventral tegmental area. These results suggest that rabies-based unbiased screening of changes in input populations can identify previously unappreciated circuit elements that critically support behavioural adaptations

Genomic tailoring of autogenous poultry vaccines to reduce Campylobacter from farm to fork

Campylobacter is a leading cause of food-borne gastroenteritis worldwide, linked to the consumption of contaminated poultry meat. Targeting this pathogen at source, vaccines for poultry can provide short-term caecal reductions in Campylobacter numbers in the chicken intestine. However, this approach is unlikely to reduce Campylobacter in the food chain or human incidence. This is likely as vaccines typically target only a subset of the high genomic strain diversity circulating among chicken flocks, and rapid evolution diminishes vaccine efficacy over time. To address this, we used a genomic approach to develop a whole-cell autogenous vaccine targeting isolates harbouring genes linked to survival outside of the host. We hyper-immunised a whole major UK breeder farm to passively target offspring colonisation using maternally-derived antibody. Monitoring progeny, broiler flocks revealed a near-complete shift in the post-vaccination Campylobacter population with an ~50% reduction in isolates harbouring extra-intestinal survival genes and a significant reduction of Campylobacter cells surviving on the surface of meat. Based on these findings, we developed a logistic regression model that predicted that vaccine efficacy could be extended to target 65% of a population of clinically relevant strains. Immuno-manipulation of poultry microbiomes towards less harmful commensal isolates by competitive exclusion, has major potential for reducing pathogens in the food production chain

Tumor Phyllodes de la mama

 Introduction Phyllodes tumor (PT) is a rare tumor of the breast, representing less than 1% of all breast neoplasms (1) and 2 to 3% of fibroepithelial tumors (7). This neoplasm is classified as: Benign PT, Borderline PT and Malignant PT (Norris and Taylor-WHO) (9). Objective To carry out a review about the diagnosis and treatment of phyllodes tumor. Development PTs are fibroepithelial neoplasms that according to stromal cellularity, nuclear atypia, mitotic rate, heterologous elements are classified as: benign, borderline and malignant (1). The maximum incidence occurs between 35-55 years. Imaging diagnosis is based on the use of mammography, ultrasound, magnetic resonance imaging and radioguided core biopsy. Optimal surgical management is the fundamental tool in PT. There is controversy about the use of adjuvant treatment with radiotherapy and chemotherapy. Conclusions: PT is a benign neoplasm of the breast, surgery is the treatment of choice. The free edge greater than 1 cm recommended by the NCCN is predictive of a lower percentage of local recurrence. Complementary treatments with radiotherapy and chemotherapy are controversial. Introducción: El tumor phyllodes (TP) es un tumor raro de la mama, representa menos del 1% de todas las neoplasias de la mama (1) y el 2 a 3 % de los tumores fibroepiteliales (7). Esta neoplasia se clasifica en: TP Benigno, TP Borderline y TP Maligno (Norris y Taylor-OMS) (9). Objetivo: Realizar una revisión acerca del diagnóstico y tratamiento del tumor phyllodes. Desarrollo: Los TP son neoplasias fibroepiteliales qué de acuerdo a la celularidad estromal, atipia nuclear, tasa mitótica, elementos heterólogos son clasificados como: benignos, borderline y malignos (1). La máxima incidencia se da entre los 35-55 años. El diagnóstico por imágenes se basa en el uso de mamografía, ecografía, resonancia magnética y biopsia core radioguiada. El óptimo manejo quirúrgico constituye la herramienta fundamental en TP. Existe controversia acerca del uso de tratamiento adyuvante con radioterapia y quimioterapia.  Conclusiones: TP es una neoplasia benigna de la mama, la cirugía es el tratamiento de elección. El borde libre mayor de 1 cm recomendado por la NCCN es predictivo para un menor porcentaje de recurrencia local. Los tratamientos complementarios con radioterapia y quimioterapia son controversiales

Representation and misrepresentation of scientific evidence in contemporary tobacco regulation:a review of tobacco industry submissions to the UK Government consultation on standardised packaging

BACKGROUND: Standardised packaging (SP) of tobacco products is an innovative tobacco control measure opposed by transnational tobacco companies (TTCs) whose responses to the UK government's public consultation on SP argued that evidence was inadequate to support implementing the measure. The government's initial decision, announced 11 months after the consultation closed, was to wait for 'more evidence', but four months later a second 'independent review' was launched. In view of the centrality of evidence to debates over SP and TTCs' history of denying harms and manufacturing uncertainty about scientific evidence, we analysed their submissions to examine how they used evidence to oppose SP. METHODS AND FINDINGS: We purposively selected and analysed two TTC submissions using a verification-oriented cross-documentary method to ascertain how published studies were used and interpretive analysis with a constructivist grounded theory approach to examine the conceptual significance of TTC critiques. The companies' overall argument was that the SP evidence base was seriously flawed and did not warrant the introduction of SP. However, this argument was underpinned by three complementary techniques that misrepresented the evidence base. First, published studies were repeatedly misquoted, distorting the main messages. Second, 'mimicked scientific critique' was used to undermine evidence; this form of critique insisted on methodological perfection, rejected methodological pluralism, adopted a litigation (not scientific) model, and was not rigorous. Third, TTCs engaged in 'evidential landscaping', promoting a parallel evidence base to deflect attention from SP and excluding company-held evidence relevant to SP. The study's sample was limited to sub-sections of two out of four submissions, but leaked industry documents suggest at least one other company used a similar approach. CONCLUSIONS: The TTCs' claim that SP will not lead to public health benefits is largely without foundation. The tools of Better Regulation, particularly stakeholder consultation, provide an opportunity for highly resourced corporations to slow, weaken, or prevent public health policies