Physical therapy plus general practitioners’ care versus general practitioners’ care alone for sciatica: a randomised clinical trial with a 12-month follow-up

A randomised clinical trial in primary care with a 12-months follow-up period. About 135 patients with acute sciatica (recruited from May 2003 to November 2004) were randomised in two groups: (1) the intervention group received physical therapy (PT) added to the general practitioners’ care, and (2) the control group with general practitioners’ care only. To assess the effectiveness of PT additional to general practitioners’ care compared to general practitioners’ care alone, in patients with acute sciatica. There is a lack of knowledge concerning the effectiveness of PT in patients with sciatica. The primary outcome was patients’ global perceived effect (GPE). Secondary outcomes were severity of leg and back pain, severity of disability, general health and absence from work. The outcomes were measured at 3, 6, 12 and 52 weeks after randomisation. At 3 months follow-up, 70% of the intervention group and 62% of the control group reported improvement (RR 1.1; 95% CI 0.9–1.5). At 12 months follow-up, 79% of the intervention group and 56% of the control group reported improvement (RR 1.4; 95% CI 1.1; 1.8). No significant differences regarding leg pain, functional status, fear of movement and health status were found at short-term or long-term follow-up. At 12 months follow-up, evidence was found that PT added to general practitioners’ care is only more effective regarding GPE, and not more cost-effective in the treatment of patients with acute sciatica than general practitioners’ care alone. There are indications that PT is especially effective regarding GPE in patients reporting severe disability at presentation

Effectiveness of additional supervised exercises compared with conventional treatment alone in patients with acute lateral ankle sprains: systematic review

Objective To summarise the effectiveness of adding supervised exercises to conventional treatment compared with conventional treatment alone in patients with acute lateral ankle sprains

Efficacy of paracetamol, diclofenac and advice for acute low back pain in general practice: design of a randomized controlled trial (PACE Plus)

Background: Low back pain is common and associated with a considerable burden to patients and society. There is uncertainty regarding the relative benefit of paracetamol and diclofenac and regarding the additional effect of pain medication compared with advice only in patients with acute low back pain. This trial will assess the effectiveness of paracetamol, diclofenac and placebo for acute low back pain over a period of 4 weeks. Furthermore, this trial will assess the additional effectiveness of paracetamol, diclofenac and placebo compared with advice only for acute low back pain over a period of 4 weeks. Methods: The PACE Plus trial is a multi-center, placebo-blinded, superiority randomized controlled trial in primary care, with a follow-up of 12 weeks. Patients with acute low back pain aged 18-60 years presenting in general practice will be included. Patients are randomized into four groups: 1) Advice only (usual care conforming with the clinical guideline of the Dutch College of General Practitioners); 2) Advice and paracetamol; 3) Advice and diclofenac; 4) Advice and placebo. The primary outcome is low back pain intensity measured with a numerical rating scale (0-10). Secondary outcomes include compliance to treatment, disability, perceived recovery, costs, adverse reactions, satisfaction, sleep quality, co-interventions and adequacy of blinding. Between group differences for low back pain intensity will be evaluated using a repeated measurements analysis with linear effects models. An economic evaluation will be performed using a cost-effectiveness analysis with low back pain intensity and a cost-utility analysis with quality of life. Explorative analyses will be performed to assess effect modification by predefined variables. Ethical approval has been granted. Trial results will be released to an appropriate peer-viewed journal. Discussion: This paper presents the design of the PACE Plus trial: a multi-center, placebo-blinded, superiority randomized controlled trial in primary care that will assess the effectiveness of advice only, paracetamol, diclofenac and placebo for acute low back pain. Trial registration: Dutch Trial Registration NTR6089 , registered September 14th, 2016. Protocol: Version 4, June 2016

Association Between Self-Reported Spinal Morning Stiffness and Radiographic Evidence of Lumbar Disk Degeneration in Participants of the Cohort Hip and Cohort Knee (CHECK) Study

BACKGROUND: Low back pain (LBP) is very common and is a main cause of limited activity and work absence. Patients with LBP may also report spinal morning stiffness; this symptom could be useful for identifying subgroups with signs and symptoms related to spinal osteoarthritis. OBJECTIVE: This study investigated whether an association exists between reported spinal morning stiffness and radiographic evidence of lumbar disk degeneration (LDD) in people with LBP and a history of pain of the hip and/or knee. DESIGN: This cross-sectional study used 8-year follow-up data from the Cohort Hip and Coh

Design of the Verbiest trial: cost-effectiveness of surgery versus prolonged conservative treatment in patients with lumbar stenosis

Background: Degenerative changes of lumbar spine anatomy resulting in the encroachment of neural structures are often regarded progressive, ultimately necessitating decompressive surgery. However the natural course is not necessarily progressive and the efficacy of a variety of nonsurgical interventions has also been described. At present there is insufficient data to compare surgical and nonsurgical interventions in terms of their relative benefit and safety. Previous attempts failed to provide clear clinical recommendations or to distinguish subgroups that substantially benefit from a certain treatment strategy. We present the design of a randomized controlled trial on (cost-) effectiveness of surgical decompression versus prolonged conservative treatment in patients with neurogenic intermittent claudication caused by lumbar stenosis. Methods/Design. The aim of the Verbiest trial is to evaluate the effectiveness of prolonged conservative treatment compared to decompressive surgery. The study is a multi-center randomized controlled trial with two parallel groups design. Patients (age over 50) presenting

The prevalence of cleft in the Netherlands and Northern Netherlands in 1997-2007:Trend analysis of data from three Dutch registries

Objective. To investigate the prevalence of oral cleft live births in the Netherlands, we analyzed time-trends in the Netherlands and Northern Netherlands (NNL) over the period 1997-2007 and stratified these trends by cleft category (cleft lip/alveolus ± cleft palate: CL±P; cleft palate only: CP). Methods. Patients born alive with oral clefts in the Netherlands during 1997-2007 were included from three Dutch registries on congenital anomalies/oral clefts. The estimated annual percentage change (EAPC) in prevalence was calculated using Poisson regression. Results. The overall prevalence of oral clefts per 10,000 live births was 16.6 in the Netherlands and 21.4 in NNL. During 1997-2007, the live-birth prevalence of oral clefts in the Netherlands decreased significandy (EAPC -2.0%; 95% CI: -3.0% to -0.90%), as did the CL±P prevalence (EAPC -2.1%; 95% CI: -3.4% to -0.80%), while no significant trend in CP was found. The rates of the region NNL showed no significant trends. Discussion. The national decrease in prevalence may be explained by two hypotheses: 1) greater prenatal detection of congenital anomalies including oral clefts has led to more pregnancy terminations; and 2) increased periconceptional folic acid use has reduced the risk of oral clefts. Both hypotheses would mainly apply to the category CL±P, since, unlike CP, this category can be detected prenatally by 2D ultrasound and develops during the period recommended for folic acid use. Conclusion. Because the CL±P prevalence in the Netherlands decreased, that of all oral clefts decreased. Although the rates in the region NNL were higher, they showed no significant trends

HI-NESS:a family of genetically encoded DNA labels based on a bacterial nucleoid-associated protein

The interplay between three-dimensional chromosome organisation and genomic processes such as replication and transcription necessitates in vivo studies of chromosome dynamics. Fluorescent organic dyes are often used for chromosome labelling in vivo. The mode of binding of these dyes to DNA cause its distortion, elongation, and partial unwinding. The structural changes induce DNA damage and interfere with the binding dynamics of chromatin-associated proteins, consequently perturbing gene expression, genome replication, and cell cycle progression. We have developed a minimally-perturbing, genetically encoded fluorescent DNA label consisting of a (photo-switchable) fluorescent protein fused to the DNA-binding domain of H-NS - a bacterial nucleoid-associated protein. We show that this DNA label, abbreviated as HI-NESS (H-NS-based indicator for nucleic acid stainings), is minimally-perturbing to genomic processes and labels chromosomes in eukaryotic cells in culture, and in zebrafish embryos with preferential binding to AT-rich chromatin.Genome Instability and Cance

Scenarios study on post-consumer plastic packaging waste recycling

We all use plastics on a daily basis. Plastics come in many shapes, sizes and compositions and are used in a wide variety of products. Almost all of the currently used plastic packaging are made from fossil resources, which are finite. The production of plastic packages causes environmental impacts, whereas the correct use of these packages will reduce product losses and hence reduce the much more negative environmental impacts associated with product losses. Wrongly discarded plastic objects have a negative impact on the environment, as these materials degrade only very slowly, creating problems such as the infamous ‘plastic islands’ in our oceans. Fortunately, recycling technologies are now emerging for plastic waste, enabling the reuse of these materials in a second life as a package or a utensil. Plastic packaging waste (PPW) is complex in many ways. First of all, there are many different types of plastics, all with their own characteristics and compositions. To enable the re-use of PPW, it has to be sorted into separate fractions. Each type of plastic can then be dealt with in an appropriate way. Second, the collection of PPW is also very complex. In the Netherlands there are many different PPW flows, from industry, offices and households for example. Each has its own collection system and household collection systems differ from one municipality to the next. To add to this complexity there is also the deposit refund system for large PET bottles, run by the soda producers via the supermarkets. Everybody deals with PPW on a daily basis. Most of us think recycling is a good idea. But when we want to decide what the best and most efficient method of recycling is, we are all impaired by a lack of data. A clear view of our best options is inhibited by the existing infrastructure and ‘the way it has always been done’. Also, the subject of recycling touches on our moral opinions about ‘doing the right thing’ and assumptions about the ‘correct’ way of dealing with our plastic waste. And politics also play a role. To unravel the complexity of plastic packaging waste recycling and figure out the best way(s) to improve our recycling system we need science. We need technological, economical, logistical and environmental data to gain insight into recycling systems. By describing the system in detail we can learn how to optimise it. An improved recycling system will provide us with an easier and more efficient re-use of our plastic waste

TRiC controls transcription resumption after UV damage by regulating Cockayne syndrome protein A

Transcription-blocking DNA lesions are removed by transcription-coupled nucleotide excision repair (TC-NER) to preserve cell viability. TC-NER is triggered by the stalling of RNA polymerase II at DNA lesions, leading to the recruitment of TC-NER-specific factors such as the CSA-DDB1-CUL4A-RBX1 cullin-RING ubiquitin ligase complex (CRLCSA). Despite its vital role in TC-NER, little is known about the regulation of the CRLCSA complex during TC-NER. Using conventional and cross-linking immunoprecipitations coupled to mass spectrometry, we uncover a stable interaction between CSA and the TRiC chaperonin. TRiC's binding to CSA ensures its stability and DDB1-dependent assembly into the CRLCSA complex. Consequently, loss of TRiC leads to mislocalization and depletion of CSA, as well as impaired transcription recovery following UV damage, suggesting defects in TC-NER. Furthermore, Cockayne syndrome (CS)-causing mutations in CSA lead to increased TRiC binding and a failure to compose the CRLCSA complex. Thus, we uncover CSA as a TRiC substrate and reveal that TRiC regulates CSA-dependent TC-NER and the development of CS