Effectiveness of three treatment strategies on occupational limitations and quality of life for patients with non-specific chronic low back pain: Is a multidisciplinary approach the key feature to success: study protocol for a randomized controlled trial

BACKGROUND: Chronic low back pain (cLBP) is a significant public health problem, being the primary cause of work absenteeism, as well as affecting sufferers\u27 quality of life, in industrialized society. International guidelines recommend intensive multidisciplinary approaches for patients with cLBP. However, these costly and time-consuming programs can only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements. Lighter programs may be an alternative to full time hospital-based programs with valuable results in terms of disability and occupational activity for cLBP patients. It is therefore important to define both what the determining components of management to improve activity restriction are and how to treat a larger number of patients more effectively at a lower cost. The aim of this study is to compare three programs with various levels of intensity and multidisciplinary. METHODS/DESIGN: This paper describes the protocol for a prospective, randomized, controlled, clinical trial in working aged patients with cLBP. Three treatment strategies are compared: (1) intensive and multidisciplinary program conducted in a rehabilitation center; (2) less intensive outpatient program conducted by a private physiotherapist; (3) mixed strategy combining the same out program with a multidisciplinary intervention. The primary outcome of the trial is the impact of the mixed strategy on being able to work compared to hospital centered-program and out program. The secondary outcome is the impact of the mixed strategy on quality of life and social ability compared to the two others programs. The intervention part of the trial programs will take 5 weeks and observational follow-up will take 12 months. The sample size will be 180 participants (60 for each arm). The project has been approved by the Ethical Committee of Angers Hospital, France. DISCUSSION: On the hypothesis that a multidisciplinary approach is the key feature to programs success in reducing social and occupational impairment in cLBP patients, we suggest that it is possible to achieve the same results with less intensive strategies if a multidisciplinary approach is maintained. TRIAL REGISTRATION: Current Controlled Trials NCT02030171

Changes in CD4+ cells’ miRNA expression following exposure to HIV-1

Background: MiRNAs inhibit HIV-1 expression by either modulating host innate immunity or by directly interfering with viral mRNAs. Here, we investigated the miRNA profile that discriminates different classes of HIV-1 infected patients from multiple exposed uninfected individuals. Methods: The expression levels of 377 miRNAs were selectively analyzed in CD4+ cells isolated from whole blood of HIV-1 \ue9lite LTNP (\ue9LTNP), naive, and multiply exposed uninfected individuals (MEU). MiRNA extraction was performed by the mirVana miRNA Isolation Kit (Ambion) and their expression was subsequently examined by real-time PCR-based arrays. The expression of miRNAs was also determined in primary culture of CD4+T cells and monocyte-macrophages infected in vitro by R5 strains. Expression of Dicer and Drosha was evaluated by real-time PCR. Results: We only considered miRNAs that were expressed in the 70% of patients of at least one class and varied by at least 1 log10 from healthy controls. Out of 377 miRNAs, 26 were up-regulated, while 88 were down-regulated. Statistical analysis showed that 21 miRNAs significantly differentiated \ue9LTNP from MEU and 23 miRNAs distinguished naive from MEU, while only 1 (miR-155) discriminated \ue9LTNP from naive. By hierarchical clustering of the miRNAs according to patient class, \ue9LTNP clustered with naive whereas all MEU subjects grouped together. The Dicer and Drosha expression in the patient classes correlated with miRNA profile changes. Among miRNAs differentially expressed in patient classes, 32 were detected in in vitro infection model: the most of the up-regulated miRNAs were expressed in monocyte-macrophages, whereas the most of the down-regulated miRNAs were expressed in T lymphocytes. Conclusions: These findings support that miRNA profile could be the result not only of a productive infection, but also of the exposure to HIV products that leave a signature in immune cells. These data provide some intriguing issues relative to the development of HIV vaccines targeting viral proteins

Ciclosporina-A e week-end therapy nella psoriasi a placche: la nostra esperienza

L’efficacia della Ciclosporina-A (CsA) nel trattamento della psoriasi è nota da 30 anni. La sua maggiore limitazione è però correlata al rischio di eventi avversi quali l’ipertensione arteriosa e l’alterazione della funzionalità renale che sembrerebbero non solo dose-dipendenti ma anche proporzionali alla durata della terapia. Pertanto, la possibilità di formulare uno schema di trattamento in grado di controllare efficacemente le manifestazioni cliniche nel lungo termine con un profilo di sicurezza accettabile risulta sempre più importante al fine di migliorare la qualità della vita dei pazienti affetti da psoriasi. Scopo del nostro studio è la valutazione di una terapia con CsA somministrata solo due giorni alla settimana da protrarre su lunghi periodi per il controllo delle recidive di psoriasi. Il nostro studio prende spunto dalla week-end therapy che si è dimostrata efficace nel mantenimento della remissione a lungo termine ed è stata ben tollerata da tutti i pazienti considerati

Psoriasi pustolosa generalizzata indotta da Ciprofloxacina: utilità della terapia con Ciclosporina-A

Descriviamo il caso di una donna di 42 anni affetta da psoriasi volgare in remissione clinica completa da 15 settimane, che ha presentato l’insorgenza di un’eruzione pustolosa diffusa su gran parte della superficie cuta-nea, con febbre e condizioni generali scadenti dopo l’assunzione di Ciprofloxacina per il trattamento di un’infezione delle vie urinarie. In base al quadro clinico ed all’anamnesi di una pregressa eruzione cutanea da Ciprofloxacina è stata posta diagnosi di psoriasi pustolosa generalizzata indotta da Ciprofloxacina. Dopo il trattamento sistemico con Ciclosporina-A si è ottenuta la remissione del quadro clinico in poche settimane. La terapia con Ciclosporina-A risulta una valida opzione terapeutica nel trattamento della forma acuta e grave di psoriasi pustolosa generalizzata

Antibody Complementarity-Determining Regions (CDRs) Can Display Differential Antimicrobial, Antiviral and Antitumor Activities

Background: Complementarity-determining regions (CDRs) are immunoglobulin (Ig) hypervariable domains that determine specific antibody (Ab) binding. We have shown that synthetic CDR-related peptides and many decapeptides spanning the variable region of a recombinant yeast killer toxin-like antiidiotypic Ab are candidacidal in vitro. An alanine-substituted decapeptide from the variable region of this Ab displayed increased cytotoxicity in vitro and/or therapeutic effects in vivo against various bacteria, fungi, protozoa and viruses. the possibility that isolated CDRs, represented by short synthetic peptides, may display antimicrobial, antiviral and antitumor activities irrespective of Ab specificity for a given antigen is addressed here.Methodology/Principal Findings: CDR-based synthetic peptides of murine and human monoclonal Abs directed to: a) a protein epitope of Candida albicans cell wall stress mannoprotein; b) a synthetic peptide containing well-characterized B-cell and T-cell epitopes; c) a carbohydrate blood group A substance, showed differential inhibitory activities in vitro, ex vivo and/or in vivo against C. albicans, HIV-1 and B16F10-Nex2 melanoma cells, conceivably involving different mechanisms of action. Antitumor activities involved peptide-induced caspase-dependent apoptosis. Engineered peptides, obtained by alanine substitution of Ig CDR sequences, and used as surrogates of natural point mutations, showed further differential increased/unaltered/decreased antimicrobial, antiviral and/or antitumor activities. the inhibitory effects observed were largely independent of the specificity of the native Ab and involved chiefly germline encoded CDR1 and CDR2 of light and heavy chains.Conclusions/Significance: the high frequency of bioactive peptides based on CDRs suggests that Ig molecules are sources of an unlimited number of sequences potentially active against infectious agents and tumor cells. the easy production and low cost of small sized synthetic peptides representing Ig CDRs and the possibility of peptide engineering and chemical optimization associated to new delivery mechanisms are expected to give rise to a new generation of therapeutic agents.Department of Education, Universities and Research, Basque GovermentFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Istituto Superiore di Sanita, National Research Project on A.I.D.S.Cariparma Banking FoundationBrazilian National Research CouncilUniv Parma, Sez Microbiol, Dipartimento Patol, I-43100 Parma, ItalyUniv Basque Country, Fac Med Odontol, Dept Inmunol, Microbiol Parasitol, Bilbao, SpainUniv Basque Country, Dept Enfermeria I, Bilbao, SpainUniv Milan, Dipartimento Sci Cliniche L Sacco, Sez Malattie Infettive Immunopatol, Milan, ItalyUniv Studi Parma, Dipartimento Clin Med, Nefrol Sci Prev, Parma, ItalyUniversidade Federal de São Paulo, Departamento Microbiol, Imunol Parasitol, Unidade Oncol Expt, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biofis, São Paulo, BrazilUniversidade Federal de São Paulo, Departamento Microbiol, Imunol Parasitol, Unidade Oncol Expt, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biofis, São Paulo, BrazilDepartment of Education, Universities and Research, Basque Goverment: IT-264-07FAPESP: 06/50634-2Istituto Superiore di Sanita, National Research Project on A.I.D.S.: 50G.30Istituto Superiore di Sanita, National Research Project on A.I.D.S.: 40D.14Cariparma Banking Foundation: 2004.0190Brazilian National Research Council: research fellowshipWeb of Scienc

Investigations into, and development of, a lyophilized and formulated recombinant human factor IX produced from CHO cells

Objectives: To develop a recombinant human factor IX (rFIX) formulation equivalent to commercially available products in terms of cake appearance, residual moisture, proportion of soluble aggregates and activity maintenance for 3 months at 4–8 °C. Results: NaCl and low bulking agent/cryoprotectant mass ratio had a negative impact on cake quality upon lyophilisation for a wide range of formulations tested. Particular devised formulations maintained rFIX activity after lyophilization with a similar performance when compared with the rFIX formulated using the excipients reported for a commercially available FIX formulation (Benefix). rFIX remained active after 3 months when stored at 4 °C, though this was not the case with samples stored at 40 °C. Interestingly, particular formulations had an increase in residual moisture after 3 months storage, but not above a 3% threshold. All four formulations tested were equivalent to the Benefix formulation in terms of particle size distribution and cake appearance. Conclusions: Three specific formulations, consisting of surfactant polysorbate-80, sucrose or trehalose as cryoprotectant, mannitol or glycine as bulking agent, l-histidine as buffering agent, and NaCl added in the reconstitution liquid at 0.234% (w/v) were suitable for use with a CHO cell-derived recombinant FIX

Effect of karate training on social, emotional, and executive functioning in children with autism spectrum disorder

Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behaviour. Previously, multiple interventions were designed to improve social-emotional and executive functioning in children with ASD. However, to date, only a few studies have examined the role of martial arts on social dysfunction and executive functioning deficits in children with ASD. Therefore, this study examined the effects of a 12-week Karate training on social-emotional and executive functioning of children (8-11 years) with ASD. Twenty-eight children were matched into pairs based on age, gender, and autism severity, and randomly allocated into an intervention (n = 14) or waitlist control group (n = 14). The intervention group performed Kata techniques training two times per week (45 min). The intervention included typically-developing children that helped facilitate the social skills, and activities targeted to train specific domains of executive functions, namely behavioural inhibition, working memory, and cognitive flexibility. At baseline and after 12 weeks, parents assessed social skills and executive functioning respectively through the Social Skills Improvement System Rating Scale and Behaviour Rating Inventory of Executive Function. After 12-week, the intervention group showed greater socio-emotional competence such as communication, cooperation and engagement, better executive functioning ability such as cognitive flexibility, inhibitory control and working memory, and a lower aggressiveness, sadness, anxiety and hyperactivity compared to the control group (p< 0.01; large effect size). Since ASD is a broad economic and societal problem that affects individual, family, and community levels, Karate training should be considered by autism institutions to improve individual well-being and overall health

Designing a multifunctional tactical training method to improve the physical and occupational performance of italian state police mobile units: A brief report

There is no standard physical exercise protocol that can guarantee adequate physical and working efficiency of police officers. However, integrated circuit training can be used to train more physical abilities by optimizing timing and promoting well-being and performance in job tasks. Therefore, the purpose of this preliminary study was to monitor and evaluate the physiological and perceptual impact of multifunctional tactical training (MTT) and to develop it as a specific method for increasing the physical and working abilities of the Mobile Units police officers. A total of 4 police officers (of different ages, seniority, and anthropometric characteristics) voluntarily participated in this study. They used the MTT method consisting of a series of multiple exercises that are specific and functional for the Mobile Units personnel and designed to develop strength, muscular endurance, cardiorespiratory endurance, speed, aerobic and anaerobic power, reaction time, coordination, dynamic balance, and agility. The MTT method was developed according to the principles of individualization, progressivity, variety and multilaterality of the load. Small tools and materials from riot gear were used. During the MTT session (approximately 40 min duration), the police officers’ heart rate was constantly monitored, and the rate of perceived exertion was measured immediately before and after each execution of the circuit, which was performed three times. The obtained results show that MTT is a safe and effective method for training the cardiorespiratory system. In addition, functional exercises are necessary to prepare the police officers to efficiently perform tactical tasks while preventing the risk of injury. Further studies are needed to improve the MTT method with an objective of continuous physical-motor education among police officers

Sports activities as primary prevention of youth deviant behaviours: an educational intervention research

To improve the well-being of young people in the province of Taranto (Italy), intervention research was performed to study the effects of sport and its fundamental role in the prevention of juvenile deviance. A questionnaire was administered to 174 subjects (aged 7 and 11), and data were collected that investigated the main areas of influence in the process of growth and harmonious development of the minors’ personality structure in relation to sports practice. Sport is widely recognized as a means of disseminating and transmitting positive values such as solidarity, loyalty, respect for people and the rules; in addition, sport can create a suitable environment for promoting ease and well-being in youth. The obtained results showed that the presence of and intervention by experienced and trained figures in the sports field, such as sports science graduates, is essential. The performed research showed a significant change in the organization and function of the family and sports associations because they must respond to new educational needs arising from the current phase of social culture. Both have an enormous responsibility in the prevention of youth discomfort. The performed research indicates that in addition to the family, there is a growing need for institutional figures who are trained and well-prepared such as coaches and managers of sports associations. These figures, better if they have a degree in sports sciences, have a pedagogical and strategic value for the minors because they can positively influence the conditions of growth, evolution, and harmonious development, and contrast and prevent deviant behaviours in youth