To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).
A task force comprising 7 rheumatologists, 15 ...other healthcare professionals and 3 patients was established. Following a systematic literature review performed to inform the recommendations, statements were formulated, discussed during online meetings and graded based on risk of bias assessment, level of evidence (LoE) and strength of recommendation (SoR; scale A-D, A comprising consistent LoE 1 studies, D comprising LoE 4 or inconsistent studies), following the European Alliance of Associations for Rheumatology standard operating procedure. Level of agreement (LoA; scale 0-10, 0 denoting complete disagreement, 10 denoting complete agreement) was determined for each statement through online voting.
Four overarching principles and 12 recommendations were developed. These concerned common and disease-specific aspects of non-pharmacological management. SoR ranged from A to D. The mean LoA with the overarching principles and recommendations ranged from 8.4 to 9.7. Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. It is not intended to preclude but rather complement pharmacotherapy. Patients should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure. Photoprotection and psychosocial interventions are important for SLE patients, while mouth and hand exercises are important in SSc.
The recommendations will guide healthcare professionals and patients towards a holistic and personalised management of SLE and SSc. Research and educational agendas were developed to address needs towards a higher evidence level, enhancement of clinician-patient communication and improved outcomes.
Up to 20% of individuals with primary hypothyroidism treated with L‐thyroxine still suffer from severe symptoms. These are supposedly brain derived and involve both cognitive and emotional domains. ...Previously, no consistent relationship has been found between thyroid hormones (TH) or TSH levels in blood and quality of life (QoL). Recently, we reported an association between cerebrospinal fluid (CSF)/serum free‐thyroxine (f‐T4) ratio and QoL, in juvenile hypothyroid patients. Here, we investigated if CSF/serum f‐T4 ratio and QoL estimates correlate also during L‐thyroxine treatment. Moreover, the CSF biomarker neurogranin (Ng) was used as a biomarker for synaptic function and integrity in clinical research. Ng is partially controlled by TH and therefore we investigated the relationship between QoL parameters and Ng levels. Patients diagnosed with primary hypothyroidism were investigated using vital parameters, serum and CSF analyses of TH, TSH, Ng and QoL questionnaires. Similar procedures were performed after 6 months of treatment. The most marked associations with QoL were found for CSF/serum f‐T4 ratio, which was strongly related to several QoL parameters such as the mental subscore of SF‐36 (r = 0.83, p < .0005). Ng, which did not differ from that in our healthy controls, was lower in some patients during treatment and higher in others. However, the change in Ng during treatment was significantly correlated with QoL parameters including the mental subscore of SF‐36 (r = −0.86, p < .0001). In addition, the CSF/serum f‐T4 ratio correlated with the change in Ng (r = −0.75, p = .001). Our results suggest that the ratio between CSF and serum f‐T4 is an important biomarker for QoL during treatment of patients with primary hypothyroidism, so far in research, but in the future maybe also in clinical settings. Moreover, this ratio also correlates with the changes in Ng levels during L‐thyroxine treatment, further supporting the impact of the TH balance between serum and CSF on QoL.
(a) Shows the correlation between the change in neurogranin (during–before, pg/mL) and the CSF/s f‐T4 ratio during treatment (r = −0.75, p = .001). (b) illustrates the correlation between the mental subscore of SF‐36 (MCSc, points) during treatment and the change in neurogranin (during–before, pg/mL) (r = −0.87, p < .0001). (c) depicts the correlation between the ratio between the free component of thyroxine (fT4) in CSF and serum during treatment and the mental subscore of SF‐36 (MCSc, points) during treatment (r = 0.80, p < .0005).
Abstract
Over the recent decades, the International Council for the Exploration of the Sea (ICES) has set guidelines for best practise quality control of age estimation procedures. The applicability ...of these guidelines is assessed by reviewing the ageing issues of eastern Baltic cod (EBC) as a case study. Since the implementation of an age-based assessment of EBC in the beginning of the 1970s, the assessment has been hampered by the quality of the age composition data, in recent years to a degree that age-based assessment is no longer used. The reason for the age reading problems is the low visual contrast between growth zones in the otoliths which seems to be the result of complex interactions of the hydrography in the Baltic Sea with the cod’s biology and behaviour. Over the last 40 years, various expert groups have struggled to document and improve the agreement of age estimation between national otolith readers, standardize methods and age estimations through repeated exchanges and reference collections as well as an internationally agreed manual. Despite these initiatives the precision of the age estimations based on traditional ageing did not improve, with significant bias persisting between and within readers. Additionally, a wide range of alternative methods for deriving the age information necessary for stock assessment and for validation of the true age have been tested. However, these methods did not produce unbiased age estimates over the entire size and age range of the EBC stock. An age-validation is urgently needed. Deviations from the ICES guidelines identified are as follows: (i) the lack of rigorous quality control, particularly the auditing of national trends in age precision over the years using a reference collection and (ii) the implementation of an age error matrix in the stock assessment.
The relationship between infrastructure, technology, model of care, and human resources influences patient outcomes and safety, staff productivity and satisfaction, retention of personnel, and ...treatment and social costs. This concept underpins the need for evidence-based design and has been widely adopted to inform hospital infrastructure planning. The aim of this review is to establish evidence-based, universally applicable key features of a burn unit that support function in a comprehensive patient-centered model of care. A literature search in medical, architectural, and engineering databases was conducted. Burn associations' guidelines and relevant articles published in English, between 1990 and 2020, were included, and the available evidence is summarized in the review. Few studies have been published on burn unit design in the past 30 years. Most of them focus on the role of design in infection control and prevention and consist primarily of descriptive or observational reports, opportunistic historical cohort studies, and reviews. The evidence available in the literature is not sufficient to create a definitive infrastructure guideline to inform burn unit design, and there are considerable difficulties in creating evidence that will be widely applicable. In the absence of a strong evidence base, consensus guidelines on burn unit infrastructure should be developed, to help healthcare providers, architects, and engineers make informed decisions, when designing new or renovated facilities.
Research over the past decade has suggested important roles for pseudogenes in physiology and disease. In vitro experiments demonstrated that pseudogenes contribute to cell transformation through ...several mechanisms. However, in vivo evidence for a causal role of pseudogenes in cancer development is lacking. Here, we report that mice engineered to overexpress either the full-length murine B-Raf pseudogene Braf-rs1 or its pseudo “CDS” or “3′ UTR” develop an aggressive malignancy resembling human diffuse large B cell lymphoma. We show that Braf-rs1 and its human ortholog, BRAFP1, elicit their oncogenic activity, at least in part, as competitive endogenous RNAs (ceRNAs) that elevate BRAF expression and MAPK activation in vitro and in vivo. Notably, we find that transcriptional or genomic aberrations of BRAFP1 occur frequently in multiple human cancers, including B cell lymphomas. Our engineered mouse models demonstrate the oncogenic potential of pseudogenes and indicate that ceRNA-mediated microRNA sequestration may contribute to the development of cancer.
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•The BRAF pseudogene functions as a ceRNA for BRAF in humans and mice•Braf-rs1 overexpression promotes B cell lymphoma in mice•Silencing of BRAFP1 affects MAPK signaling and proliferation of human cancer cells•Genomic gains and aberrant expression of BRAFP1 are found in various human cancers
The in vivo evidence for the regulatory activity of pseudogenes has been lacking, and their role in disease progression has been correlative. This study now shows that transgenic expression of the BRAF pseudogene induces a malignancy in mice resembling human diffuse large B cell lymphoma, establishing its oncogenic function.
ISBI Practice Guidelines for Burn Care, Part 2 Allorto, Nikki; Atieh, Bechara; Bolgiani, Alberto ...
Burns,
November 2018, 2018-11-00, 20181101, Letnik:
44, Številka:
7
Journal Article
Recenzirano
•Burn care is unique from other disease states and varies throughout the world based on resource availability and environment.•The goal of practice guidelines is to define the most effective and ...efficient methods of evaluation and management of burn injuries.•The second ISBI Guidelines for Burn Care addresses the needs of burn specialists throughout the world.
Skin cancer is a rapidly increasing cancer form in many countries, and tanning is considered to be an etiologic factor of this type of cancer. Tanning is a type of risky behaviour, which has been ...found to be hard to change, particularly in the groups where it is most risky (children and adolescents). Exposure to ultraviolet radiation (UV), protective behaviour and risk perception with regard to tanning were investigated with a postal questionnaire in a large representative sample of Swedish teenagers 13, 15 and 17 years old (n = 2615). Risky behaviour was most prevalent among girls and older respondents, in spite of their greater awareness of the risks, and the general female tendency towards risk avoidance. Cosmetic and social motives seemed to drive this type of risk taking behaviour. Comparisons of perceived personal risks of tanning and risks to other people as well as perceived control over the risks, showed personal risks to be perceived as smaller than risks to others, and perceived control to be an important factor in this form of unrealistic optimism. Although people may have more or less valid perceptions of the risks to others, they tend to have overly optimistic views of their personal risks when it comes to tanning. Risk communication is particularly difficult in cases like this. The problem of stimulating more prudent behaviour in teenagers with regard to tanning is discussed.
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