Mapeamento das evidências de revisões sistemáticas da Colaboração Cochrane para tomada de decisão em fisioterapia

CONTEXT AND OBJECTIVE Evidence-based clinical practice emerged with the aim of guiding clinical issues in order to reduce the degree of uncertainty in decision-making. The Cochrane Collaboration has been developing systematic reviews on randomized controlled trials as high-quality intervention study subjects. Today, physiotherapy methods are widely required in treatments within many fields of healthcare. Therefore, it is extremely important to map out the situation regarding scientific evidence within physiotherapy. The aim of this study was to identify systematic reviews on physiotherapeutic interventions and investigate the scientific evidence and recommendations regarding whether further studies would be needed. TYPE OF STUDY AND SETTING Cross-sectional study conducted within the postgraduate program on Internal Medicine and Therapeutics and at the Brazilian Cochrane Center. METHODS Systematic reviews presenting physiotherapeutic interventions as the main investigation, in the Cochrane Reviews Group, edition 2/2009, were identified and classified. RESULTS Out of the 3,826 reviews, 207 (5.41%) that fulfilled the inclusion criteria were selected. Only 0.5% of the reviews concluded that the intervention presented a positive effect and that further studies were not recommended; 45.9% found that there seemed to be a positive effect but recommended further research; and 46.9% found that the evidence was insufficient for clinical practice and suggested that further research should be conducted. CONCLUSION Only one systematic review (“Pulmonary rehabilitation for chronic obstructive pulmonary disease”) indicated that the intervention tested could be used with certainty that it would be effective. Most of the systematic reviews recommended further studies with greater rigor of methodological quality.CONTEXTO E OBJETIVO A prática clínica baseada em evidências surgiu com o intuito de guiar as questões clínicas para reduzir o grau de incerteza na tomada de decisão. A Colaboração Cochrane vem desen-volvendo revisões sistemáticas de ensaios clínicos controlados aleatórios como assunto de estudos de intervenção de alta qualidade. Atualmente, as modalidades de fisioterapia têm sido amplamente requisi-tadas nos tratamentos em diversas áreas da saúde. Portanto, a realização do mapeamento sobre a situação das evidências científicas da fisioterapia é de extrema importância. O objetivo do estudo foi identificar as revisões sistemáticas e verificar a evidência científica das intervenções fisioterapêuticas e a recomendação ou não de mais estudos. TIPO DE ESTUDO E LOCAL Estudo transversal, realizado no programa de pós-graduação em Medicina Interna e Terapêutica e no Centro Cochrane do Brasil. MÉTODOS Foram identificadas e classificadas as revisões sistemáticas que apresentavam intervenções fisioterapêuticas como investigação principal, nos grupos da “Cochrane Reviews Group”, edição 2/2009. RESULTADOS Das 3.826 revisões, foram selecionadas 207 (5,41%) que preencheram os critérios de inclusão. Apenas 0,5% das revisões concluíram que a intervenção apresenta efeito positivo e não são recomendados mais estudos; 45,9% mostraram que a intervenção parece ter efeito positivo, e mais pesquisa é recomendada; em 46,9% das revisões, a evidência era insuficiente para prática clínica e foi sugerida mais pesquisa. CONCLUSÃO Apenas uma revisão sistemática, “Pulmonary rehabilitation for chronic obstructive pulmonary disease”, indica o uso da intervenção testada com certeza de sua efetividade. A maioria das revisões sistemáticas recomendam estudos futuros com mais rigor na qualidade metodológica.Universidade Federal de São Paulo (UNIFESP) PT. Physiotherapist and Master's Student in the Postgraduate Program on Internal Medicine and TherapeuticsUniversidade Federal de São Paulo (UNIFESP) PT. Physiotherapist and Preceptor of the Hospital Sector of the Specialization Course on Outpatient and Hospital Motor Physiotherapy applied to Orthopedics and TraumatologyUniversidade Federal de São Paulo (UNIFESP) Department of Human Movement Sciences PT, PhD. ProfessorUNIFESP, PT. Physiotherapist and Master's Student in the Postgraduate Program on Internal Medicine and TherapeuticsUNIFESP, PT. Physiotherapist and Preceptor of the Hospital Sector of the Specialization Course on Outpatient and Hospital Motor Physiotherapy applied to Orthopedics and TraumatologyUNIFESP, Department of Human Movement Sciences PT, PhD. ProfessorSciEL

Effects of Functional Electrical Stimulation Cycling of Different Duration on Viscoelastic and Electromyographic Properties of the Knee in Patients with Spinal Cord Injury

The benefits of functional electrical stimulation during cycling (FES-cycling) have been ascertained following spinal cord injury. The instrumented pendulum test was applied to chronic paraplegic patients to investigate the effects of FES-cycling of different duration (20-min vs. 40-min) on biomechanical and electromyographic characterization of knee mobility. Seven adults with post-traumatic paraplegia attended two FES-cycling sessions, a 20-min and a 40-min one, in a random order. Knee angular excursion, stiffness and viscosity were measured using the pendulum test before and after each session. Surface electromyographic activity was recorded from the rectus femoris (RF) and biceps femoris (BF) muscles. FES-cycling led to reduced excursion (p < 0.001) and increased stiffness (p = 0.005) of the knee, which was more evident after the 20-min than 40-min session. Noteworthy, biomechanical changes were associated with an increase of muscle activity and changes in latency of muscle activity only for 20-min, with anticipated response times for RF (p < 0.001) and delayed responses for BF (p = 0.033). These results indicate that significant functional changes in knee mobility can be achieved by FES-cycling for 20 min, as evaluated by the pendulum test in patients with chronic paraplegia. The observed muscle behaviour suggests modulatory effects of exercise on spinal network aimed to partially restore automatic neuronal processes

Age differences in anticipatory and executory mechanisms of gait initiation following unexpected balance perturbations

Purpose. An age-related decline in anticipatory postural mechanisms has been reported during gait initiation; however, it is unclear whether such decline may jeopardize whole-body stability following unexpected balance perturbations. This study aimed to compare young and older individuals’ ability to generate postural responses and preserve stability in response to external waist perturbations delivered within gait initiation. Methods. Ten young and ten older participants performed 10 gait initiation trials followed by 48 unperturbed and 12 perturbed trials in a random order. A stereophotogrammetric system and three force platforms were used to quantify mechanical parameters from the preparatory phase (e.g., timing and amplitude of postural adjustments) and from the stepping phase (e.g., step characteristics and dynamic stability). Activation patterns of lower leg muscles were determined by surface electromyography. Results. Older participants responded to perturbation with lower increase in both magnitude (p<0.001; η 2 p=0.62) and duration of (p=0.001; η 2 p=0.39) preparatory parameters and soleus muscle activity (p<0.001; η 2 p=0.55), causing shorter (p<0.001; η 2 p=0.59) and lower (p<0.001; η 2 p=0.43) stepping, compared to young participants. Interestingly, young participants showed greater correlations between preparatory phase parameters and dynamic stability of the first step than older participants (average r of -0.40 and -0.06, respectively). Conclusion. The results suggest that young participants took more time than older to adjust the anticipatory biomechanical response to perturbation attempting to preserve balance during stepping. In contrast, older adults were unable to modify their anticipatory adjustments in response to perturbation and mainly relied on compensatory mechanisms attempting to preserve stability via a more cautious stepping strategy

Topical hepatic hypothermia associated with ischemic preconditioning : histopathological and biochemical analysis of ischemia reperfusion damage in a 24 hour mode

Purpose: To develop a new 24 hour extended liver ischemia and reperfusion (LIR) model analyzing the late biochemical and histopathological results of the isolated and combined application of recognized hepatoprotective mechanisms. In addition, we used a new stratification with zoning to classify the histological lesion. Methods: A modified animal model of severe hepatic damage produced through 90 minutes of segmental ischemia (70% of the organ) and posterior observation for 24 hours of reperfusion, submitted to ischemic preconditioning (IPC) and topical hypothermia (TH) at 26ºC, in isolation or in combination, during the procedure. Data from intraoperative biometric parameters, besides of late biochemical markers and histopathological findings, both at 24 hours evolution time, were compared with control (C) and normothermic ischemia (NI) groups. Results: All groups were homogeneous with respect to intraoperative physiological parameters. There were no losses once the model was stablished. Animals subjected to NI and IPC had worse biochemical (gamma-glutamyl transpeptidase, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, direct bilirubin, and total bilirubin) and histopathological scores (modified Suzuki score) compared to those of control groups and groups with isolated or associated TH (p < 0.05). Conclusion: The new extended model demonstrates liver ischemia and reperfusion at 24 hour of evolution and, in this extreme scenario, only the groups subjected to topical hypothermia, combined with ischemic preconditioning or alone, had better outcomes than those subjected to only ischemic preconditioning and normothermic ischemia, reaching similar biochemical and histopathological scores to those of the control group

Nefrectomia videolaparoscópica para tratamento da dioctofimose em um cão

A dioctofimose é uma afecção pouco comum em cães, causada pelo  Dioctophyma renale, que ocorre com maior frequência em animais errantes. Quando um único rim é parasitado, os pacientes podem não apresentar sinais clínicos devido à compensação pelo rim contralateral. Não havendo terapia clínica efetiva para a dioctofimose, o tratamento indicado é a nefrotomia ou nefrectomia, na dependência da gravidade da lesão. Foi atendido no Hospital Veterinário da Universidade de Passo Fundo (UPF) um canino, fêmea, castrado, sem raça definida, com aproximadamente um ano e pesando 12 kg, proveniente de um abrigo de animais de rua da cidade de Passo Fundo (RS), apresentando hematúria e emagrecimento progressivo há 30 dias. Através dos exames complementares realizados, foi constatado parasitismo do rim direito por D. renale. O presente relato descreve o emprego alternativo da nefrectomia videolaparoscópica como um método seguro e efetivo para o tratamento de dioctofimose em um cão e os meios utilizados para o diagnóstico

SN 2003lw and GRB 031203: A Bright Supernova for a Faint Gamma-ray Burst

Optical and near-infrared observations of the gamma-ray burst GRB 031203, at z = 0.1055, are reported. A very faint afterglow is detected superimposed to the host galaxy in our first infrared JHK observations, carried out ~9 hours after the burst. Subsequently, a rebrightening is detected in all bands, peaking in the R band about 18 rest-frame days after the burst. The rebrightening closely resembles the light curve of a supernova like SN 1998bw, assuming that the GRB and the SN went off almost simultaneously, but with a somewhat slower evolution. Spectra taken close to the maximum of the rebrightening show extremely broad features as in SN 1998bw. The determination of the absolute magnitude of this SN (SN 2003lw) is difficult owing to the large and uncertain extinction, but likely this event was brighter than SN 1998bw by 0.5 mag in the VRI bands, reaching an absolute magnitude M_V = -19.75+-0.15.Comment: 6 pages, 4 figures. Accepted to ApJ Letters. Fig. 4 will not appear in the journal version due to space limitations. Typos fixed in Table 1 (thanks to Dr. Alexander Kann for pointing out the problem). No measurements change

NOTCH1-mutated chronic lymphocytic leukemia displays high endoplasmic reticulum stress response with druggable potential

IntroductionConstitutive activation of NOTCH1-wild-type (NT1-WT) signaling is associated with poor outcomes in chronic lymphocytic leukemia (CLL), and NOTCH1 mutation (c.7541_7542delCT), which potentiates NOTCH1 signaling, worsens the prognosis. However, the specific mechanisms of NOTCH1 deregulation are still poorly understood. Accumulative evidence mentioned endoplasmic reticulum (ER) stress/unfolded protein response (UPR) as a key targetable pathway in CLL. In this study, we investigated the impact of NOTCH1 deregulation on CLL cell response to ER stress induction, with the aim of identifying new therapeutic opportunities for CLL.MethodsWe performed a bioinformatics analysis of NOTCH1-mutated (NT1-M) and NT1-WT CLL to identify differentially expressed genes (DEGs) using the rank product test. Quantitative real-time polymerase chain reaction (qPCR), Western blotting, cytosolic Ca2+, and annexin V/propidium iodide (PI) assay were used to detect curcumin ER stress induction effects. A median-effect equation was used for drug combination tests. The experimental mouse model Eμ-TCL1 was used to evaluate the impact of ER stress exacerbation by curcumin treatment on the progression of leukemic cells and NOTCH1 signaling.Results and discussionBioinformatics analysis revealed gene enrichment of the components of the ER stress/UPR pathway in NT1-M compared to those in NT1-WT CLL. Ectopic expression of NOTCH1 mutation upregulated the levels of ER stress response markers in the PGA1 CLL cell line. Primary NT1-M CLL was more sensitive to curcumin as documented by a significant perturbation in Ca2+ homeostasis and higher expression of ER stress/UPR markers compared to NT1-WT cells. It was also accompanied by a significantly higher apoptotic response mediated by C/EBP homologous protein (CHOP) expression, caspase 4 cleavage, and downregulation of NOTCH1 signaling in NT1-M CLL cells. Curcumin potentiated the apoptotic effect of venetoclax in NT1-M CLL cells. In Eμ-TCL1 leukemic mice, the administration of curcumin activated ER stress in splenic B cells ex vivo and significantly reduced the percentage of CD19+/CD5+ cells infiltrating the spleen, liver, and bone marrow (BM). These cellular effects were associated with reduced NOTCH1 activity in leukemic cells and resulted in prolonged survival of curcumin-treated mice. Overall, our results indicate that ER stress induction in NT1-M CLL might represent a new therapeutic opportunity for these high-risk CLL patients and improve the therapeutic effect of drugs currently used in CLL

Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

Background & aims: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), composed of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC. Methods: After reviewing the published literature, a Delphi methodology was used to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of ≥80%. Results: The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. On the basis of current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later-onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors. The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. Conclusions: The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC

Search for the optical counterpart of the GW170814 gravitational wave event with the VLT Survey Telescope

We report on the search for the optical counterpart of the gravitational event GW170814, which was carried out with the VLT Survey Telescope (VST) by the GRAvitational Wave Inaf TeAm. Observations started 17.5 h after the Laser Interferometer Gravitational-wave Observatory (LIGO) and Virgo alert and we covered an area of 99 deg2 that encloses ∼ 77{{ per cent}} and ∼ 59{{ per cent}} of the initial and refined localization probability regions, respectively. A total of six epochs were secured over nearly two months. The survey reached an average limiting magnitude of 22 AB mag in the r band. After assuming the model described in Perna, Lazzati & Farr, that derives as possible optical counterpart of a BBH (binary black hole) event a transient source declining in about one day, we have computed a survey efficiency of about 5{{ per cent}}. This paper describes the VST observational strategy and the results obtained by our analysis pipelines developed to search for optical transients in multi-epoch images. We report the catalogue of the candidates with possible identifications based on light-curve fitting. We have identified two dozens of SNe, nine AGNs, and one QSO. Nineteen transients characterized by a single detection were not classified. We have restricted our analysis only to the candidates that fall into the refined localization map. None out of 39 left candidates could be positively associated with GW170814. This result implies that the possible emission of optical radiation from a BBH merger had to be fainter than r ∼ 22 (Loptical ∼ 1.4 × 1042 erg s-1) on a time interval ranging from a few hours up to two months after the gravitational wave event

A survey of the clinicopathological and molecular characteristics of patients with suspected Lynch syndrome in Latin America

Background: Genetic counselling and testing for Lynch syndrome (LS) have recently been introduced in several Latin America countries. We aimed to characterize the clinical, molecular and mismatch repair (MMR) variants spectrum of patients with suspected LS in Latin America. Methods: Eleven LS hereditary cancer registries and 34 published LS databases were used to identify unrelated families that fulfilled the Amsterdam II (AMSII) criteria and/or the Bethesda guidelines or suggestive of a dominant colorectal (CRC) inheritance syndrome. Results: We performed a thorough investigation of 15 countries and identified 6 countries where germline genetic testing for LS is available and 3 countries where tumor testing is used in the LS diagnosis. The spectrum of pathogenic MMR variants included MLH1 up to 54%, MSH2 up to 43%, MSH6 up to 10%, PMS2 up to 3% and EPCAM up to 0.8%. The Latin America MMR spectrum is broad with a total of 220 different variants which 80% were private and 20% were recurrent. Frequent regions included exons 11 of MLH1 (15%), exon 3 and 7 of MSH2 (17 and 15%, respectively), exon 4 of MSH6 (65%), exons 11 and 13 of PMS2 (31% and 23%, respectively). Sixteen international founder variants in MLH1, MSH2 and MSH6 were identified and 41 (19%) variants have not previously been reported, thus representing novel genetic variants in the MMR genes. The AMSII criteria was the most used clinical criteria to identify pathogenic MMR carriers although microsatellite instability, immunohistochemistry and family history are still the primary methods in several countries where no genetic testing for LS is available yet. Conclusion: The Latin America LS pathogenic MMR variants spectrum included new variants, frequently altered genetic regions and potential founder effects, emphasizing the relevance implementing Lynch syndrome genetic testing and counseling in all of Latin America countries.Radium Hospital Foundation (Oslo, Norway) in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript, Helse Sør-Øst (Norway) in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript, the French Association Recherche contre le Cancer (ARC) in the analysis, and interpretation of data, the Groupement des Entreprises Françaises dans la Lutte contre le Cancer (Gefluc) in the analysis, and interpretation of data, the Association Nationale de la Recherche et de la Technologie (ANRT, CIFRE PhD fellowship to H.T.) in the analysis, and interpretation of data and by the OpenHealth Institute in the analysis, and interpretation of data. Barretos Cancer Hospital received financial support by FINEP-CT-INFRA (02/2010)info:eu-repo/semantics/publishedVersio