The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review.

BACKGROUND: The Berg Balance Scale (BBS) is often used in clinical practice to predict falls in the older adults. However, there is no consensus in research regarding its ability to predict falls. OBJECTIVE: To verify whether the BBS can predict falls risk in older adults. DATA SOURCE: Manual and electronic searches (Medline, EMBASE, CINAHL, Ageline, Lilacs, Web of Science, Cochrane Library and PEDro) were conducted using blocks of words (older adults, falls, BBS, study design) and their synonyms, with no language restrictions and published since 1989. STUDY SELECTION CRITERIA: Prognostic studies or clinical trials were used to assess the BBS and falls history. DATA EXTRACTION AND DATA SYNTHESIS: In this narrative synthesis, two independent assessors extracted data from articles and a third reviewer provided consensus, in case of disagreement. The methodological quality was assessed using the Quality In Prognosis Studies tool. RESULTS: 1047 studies were found and 8 studies were included in this review. The mean BBS score was high, regardless of the history of falls. Three studies presented cut-off scores for BBS, ranging from 45 to 51 points. Two studies reported a difference in the BBS score between fallers and non-fallers. Studies presented low to moderate risk of bias. LIMITATIONS: Unfeasible to conduct a meta-analysis due the heterogeneity of included studies. CONCLUSION: The evidence to support the use of BBS to predict falls is insufficient, and should not be used alone to determine the risk of falling in older adults. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42016032309.

The effects of acrobatic exercise on brain plasticity: a systematic review of animal studies.

Acrobatic exercise is considered a complex motor activity and may promote motor learning and neuroplasticity. The objective of this systematic review was to verify possible plastic brain changes induced by acrobatic exercise in non-lesioned rat and mouse through the analysis of experimental studies. Manual and electronic searches were conducted in MEDLINE, EMBASE and ISI Web of Science databases, without restriction to language or publication date. Synaptogenesis and neurogenesis were selected as the primary outcomes. To evaluate the risk of bias of individual studies, we used the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) RoB tool. We found 1780 studies, from which 18 fulfilled the inclusion criteria in this review. Seventeen studies evaluated the cerebellum, six the motor cortex, five the striatum and two evaluated the hippocampus. The results showed that acrobatic exercise promotes plastic changes in brain areas of rats, and such changes are dependent of training frequency and duration. However, studies were heterogeneous regarding the proteins analyzed and the training protocols, which made it difficult to compare and determine ideal acrobatic exercise parameters for neuroplasticity. Concerning the methodological quality of studies, most of them presented high risk of bias with absence of relevant study design information. New research with detailing training protocols and analysis might contribute to clarify the role of acrobatic exercise in neuroplasticity and how it could be used in translational research.

Effects of early mobilisation in patients after cardiac surgery: a systematic review.

BACKGROUND: Early mobilisation is prescribed after cardiac surgery to prevent postoperative complications, decrease length of hospital stay, and augment return to daily activities. OBJECTIVE: To evaluate the evidence for the effects of early mobilisation in patients after cardiac surgery on length of hospital stay, functional capacity and postoperative complications. DATA SOURCES: The data sources used were Medline, Embase, CINAHL, PEDro, Web of Science and Cochrane Central Register of Controlled Trials. STUDY SELECTION: Randomised controlled trials of early mobilisation after cardiac surgery. Study selection was not restricted by language or publication time. STUDY APPRAISAL AND SYNTHESIS METHODS: The methodological quality of each article was appraised with the PEDro scale. All review phases (selection, data extraction and appraisal) were conducted by two investigators, and a third investigator provided consensus. RESULTS: Nine trials were selected. The PEDro scale showed that the studies had a low risk of bias (range 5 to 9 points). The trials revealed diversity in techniques used for mobilisation, as well as periods considered early for the start of the intervention. Early mobilisation groups had improved outcomes compared with control groups without treatment. Generally, these advantages did not differ when groups of interventions were compared. LIMITATIONS: It was not possible to perform a meta-analysis due to the variability of the interventions proposed as early mobilisation. CONCLUSIONS: Regardless of the techniques used as mobilisation, the essential point is to avoid bed rest. Early mobilisation seems to be important to prevent postoperative complications, improve functional capacity and reduce length of hospital stay in patients after cardiac surgery.

Effect of the amino acid alanine on glucagon secretion in non-diabetic and type 1 diabetic subjects during hyperinsulinaemic euglycaemia, hypoglycaemia and post-hypoglycaemic hyperglycaemia.

AIMS/HYPOTHESIS: The aim of our study was to establish whether the well-known defective or absent secretion of glucagon in type 1 diabetes in response to hypoglycaemia is selective or includes lack of responses to other stimuli, such as amino acids. MATERIALS AND METHODS: Responses of glucagon to hypoglycaemia were measured in eight patients with type 1 diabetes and six non-diabetic subjects during hyperinsulinaemic (insulin infusion 0.5 mU kg(-1) min(-1)) and eu-, hypo- and hyperglycaemic clamp studies (sequential steps of plasma glucose 5.0, 2.9, 5.0, 10 mmol/l). Subjects were studied on three randomised occasions with infusion of low- or high-dose alanine, or saline. RESULTS: With saline, glucagon increased in hypoglycaemia in non-diabetic subjects but not in diabetic subjects. Glucagon increased further with low-dose (181 +/- 16 ng l(-1) min(-1)) and high-dose alanine (238 +/- 20 ng l(-1) min(-1)) in non-diabetic subjects, but only with high-dose alanine in diabetic subjects (area under curve 112 +/- 5 ng l(-1) min(-1)). The alanine-induced glucagon increase in diabetic subjects paralleled the spontaneous glucagon response to hypoglycaemia in non-diabetic subjects not receiving alanine. The greater responses of glucagon to hypoglycaemia with alanine infusion were offset by recovery of eu- or hyperglycaemia. CONCLUSIONS/INTERPRETATION: In type 1 diabetes, the usually deficient responses of glucagon to hypoglycaemia may improve after increasing the concentration of plasma amino acids. Amino acid-enhanced secretion of glucagon in response to hypoglycaemia remains under physiological control since it is regulated primarily by the ambient plasma glucose concentration. These findings might be relevant to improving counter-regulatory defences against insulin-induced hypoglycaemia in type 1 diabetes.

Intracoronary radiation with gamma wire inhibits recurrent in-stent restenosis.

To study the safety and efficacy of intracoronary gamma radiation delivered via a new high-activity (192)Ir source wire for the treatment of in-stent restenosis. In-stent restenosis results from neointimal tissue proliferation especially in its diffused form and presents a therapeutic challenge. Gamma radiation has been shown to decrease neointima formation within stents in animal models and in initial clinical trials. A total of 26 patients with in-stent restenosis underwent successful intervention and was treated with open-label (192)Ir using a high-activity line source. The specific activity of the source wire was 372+/-51 mCi, and the dwell time was 10.8+/-1.9 min. Primary endpoints were freedom from death, myocardial infraction (MI), and repeat target lesion revascularization (TLR) at 6 months. Secondary endpoints included angiographic restenosis and intravascular ultrasound (IVUS) neointimal hyperplasia. Procedural success was high (96.2%), and in-hospital and 30-day complications were low with no deaths, MI, or requirement for repeat revascularization. At 6 months, event-free survival was 85%: one patient required repeat PTCA, one underwent bypass surgery, and two had an MI. Baseline lesion length measured 15.77 mm. Follow-up angiography was available in 21/25 (84%) patients. The binary restenosis rates were 19.0% (4/21) in-stent and 23.8% (5/21) in-lesion. Follow-up IVUS was available in 20/25 patients. There was no increase in intimal hyperplasia from postintervention to follow-up (3.11.8 vs. 3.41.8 mm(2); P=.32). Eight patients had a reduction of neointimal intimal tissue at follow-up. These results indicate that intracoronary gamma radiation with the Angiorad source wire is safe and effective in preventing in-stent restenosis.

Lectinhistochemical and cytometrical evaluation of the corpus luteum of the rat at the end of pregnancy.

Most studies on the biochemistry and structure of the corpus luteum have focused on elucidating the processes of progesterone synthesis and release. In the present work, the histochemical composition of the corpus luteum of the rat was evaluated using lectinhistochemistry on rats at the end of pregnancy (days 18-23). We also analysed the morphology of the luteal cells, to characterize the changes attributable to regression in this organ. Seven biotinylated lectins were used (CON-A, WGA, DBA, SBA, PNA, RCA and UEA-I) following pre-set protocols (ABC method). The average diameter and area of the cells and their nuclei were measured. High reactivity of the luteal cells was observed with CON-A and a lower reactivity with WGA. The capillary endothelium gave positive reactivity with WGA and to a certain extent with SBA, PNA and RCA. Vesicular structures were intensely stained with DBA, and were more abundant in sections from animals with more advanced pregnancy, which could be attributable to cellular debris, on the basis of their morphologic characteristics. There were no significant differences among the cytometric variables analysed in comparisons of the values corresponding to the different days of gestation. These observations, together with previous research, suggest that, on the day of delivery, the corpus luteum of the rat is in the very early stages of structural regression, with no changes at the morphological level, but with changes at the molecular level.

The behavior of the doublet of Oxytricha bifaria (Ciliata, Hypotrichida): a contribution to the understanding of this enigmatic form.

The tracks of normal organisms of Oxytricha bifaria and of stage IA, IB, II, III, IV and V doublets were studied to test the hypothesis that the doublet might function as a dispersal form. Stage IA, the only stage to swim, swims straight with only rare interruptions; its rate of mobility (Rmo = 443 micro/s) is roughly twice that of singlets (Rmo = 218 micro/s). Stage IA doublets swim in three-dimensional movement which enables them to be carried away by water currents. The other stages seem to represent passage back towards the normal singlet form. The ethological evidence reported here together with other results already published supports the working hypothesis that the doublet of O. bifaria is a dispersal form suggests that the doublet might well represent a special fourth differentiation state of this species in addition to pairs, giants, and cysts.

Administration of recombinant human growth hormone on alternate days is sufficient to increase whole body protein synthesis and lipolysis in growth hormone deficient adults.

OBJECTIVE: At present, the duration of the effect of recombinant human growth hormone (rhGH) on the rates of protein synthesis and lipolysis in GH deficient (GHD) adults is unknown. This study was designed to establish the frequency of rhGH administration necessary to provide the beneficial metabolic effects of the hormone in GHD adults. DESIGN AND PATIENTS: Two different studies (A and B) were performed in two groups of five GHD men. In study A, whole body protein and lipid kinetics was determined in the basal state (Bas), 12 (GH12h) and 36 (GH36h) h after the last of seven injections of rhGH (3.3 microg/kg), given at bedtime on alternate days. In study B, the same parameters were determined in the basal state (Bas), 60 (GH60h) and 84 (GH84h) h after the last of seven injections of rhGH (3.3 microg/kg), given at bedtime at 3 day intervals. MEASUREMENTS: The rates of protein metabolism were estimated by infusing [1-13C]leucine, and those of lipolysis by infusing [1,1,2,3, 3-D5]glycerol. RESULTS: Leucine oxidation decreased (P < 0.01) by approximately 30% after GH12h and GH36h but did not change after GH60h and GH84h. Non-oxidative leucine disposal increased after GH12h and GH36h by approximately 13% (P < 0.05) whereas it did not change after GH60h and GH84h. Glycerol appearance increased (P < 0. 01) by approximately 45% after GH12h and GH36h but did not change after GH60h and GH84h. CONCLUSIONS: The effects on protein and lipid metabolism following the injection of rhGH last longer than 36 and less than 60 h. In fact, rhGH administration on alternate days induced a sustained increase in the rates of protein synthesis and lipolysis of GHD adults, whereas a longer interval of administration (3 days) had no effect by 60 h.

Cold microgradients elicit adaptive behavior in isotropically cooled, inert populations of Oxytricha bifaria (Ciliophora, Hypotrichida).

To complete our investigations on the oriented behavioral response of isotropically cooled, inert populations of Oxytricha bifaria to a warm thermal gradient, their physiological potentialities under cold microgradient conditions arising at 8.5 degrees C were studied. We monitored the behavior of the experimental populations, both at the level of the passing cold wave front, and afterwards when the thermal gradient stabilized, evaluating (i) their distribution in general, (ii) their relative centroids, (iii) the percentage of both backward creeping and immobile ciliates, and (iv) the numerical indices and rates of their creeping tracks. At the arrival of the cold wave front, the oxytrichas react immediately to the thermal stimulus, creep backwards at very high velocity along uninterrupted linear tracks, and thus move away from the cooling source. No specific behavioral response was ever observed in the static microgradient conditions. At 8.5 degrees C, despite their inertness, the ciliates are still able to behave adaptively, reacting immediately and orientatedly, once a directional factor (the cold-repelling thermal gradient) arises in an isotropic environment. This is similar to their behavior in the symmetric warm attracting thermal gradient.

Beck Depression Inventory--II: College population study.

This study expands on the normative data available for the newly revised Beck Depression Inventory-II. Data from both an outpatient, counseling-center sample (n = 152: 106 women, 46 men) and a classroom sample (n = 152: 79 women, 65 men) of college students are presented, including sex differences on the inventory. Means and standard deviations of individual items and total scores are reported, along with statistical tests of differences between groups. Comparisons of these data with norms reported by the authors of the inventory (Beck, Steer, & Brown, 1996) are offered. The lack of sex differences found in comparison of total scores for both samples is presented. Implications for the use of the inventory with college populations are discussed.

Brush cytology: a reliable method to detect Helicobacter pylori.

This study was conducted to verify the reliability of brush cytology in detecting Helicobacter pylori in an unselected group of patients with duodenal ulcer (DU) and nonulcer dyspepsia (NUD). Endoscopy was performed on 416 consecutive patients: group A, 94 with active DU; group B, 176 patients with DU after omeprazole (n = 78), ranitidine (n = 43), or triple anti-H. pylori therapy (n = 55); and group C, 146 patients with NUD. During endoscopy, the gastric mucosa was brushed and two biopsy samples from the antrum and body were obtained for histology. In 65 patients, culture of the brush-collected materials also was performed as was that from of biopsy samples. The overall frequency of H. pylori presence detected by brush cytology was significantly higher compared with that of histology (p < 0.001), particularly in group A (p < 0.05), group C (p < 0.05), and in patients with DU after omeprazole treatment (p < 0.01), but not in patients with DU after ranitidine or anti-H. pylori treatment. The overall frequency of H. pylori-positive cultures from the brush-collected material was higher compared with cultures from the biopsy samples (38.5% vs. 24.6%), particularly in the NUD group (32.6% vs. 16.3%). Brush cytology is more sensitive than histology, besides being faster and cheaper, for the assessment of H. pylori infection, particularly when the density of the bacteria is low.

Insulin treatment affects the behaviour of Tetrahymena pyriformis and T. malaccensis.

Populations of Tetrahymena pyriformis and T. malaccensis were treated with insulin, then washed and treated again 24 h later. The ethograms of controls, treated, washed and retreated populations were drawn. Statistical analysis showed that T. pyriformis was affected by insulin more severely than T. malaccensis. In T. pyriformis the effects of the 'memory' of the first treatment seem to be more relevant than those of the first and second treatments themselves. On the contrary in T. malaccensis treatments with insulin per se seem to affect the behaviour more strongly than the memory of the first treatment itself. These results are discussed in detail in the context of previous work.

The ethograms of Tetrahymena pyriformis GL and T. malaccensis.

The behaviour of Tetrahymena, one of the most intensively investigated laboratory organisms, was analysed, and ethograms of T. pyriformis and T. malaccensis were studied. The basic ethogram, which previously described the behaviour of ciliates was appropriate for T. pyriformis and T. malaccensis. Although quite similar to each other, the two new ethograms differed significantly in some aspects of ciliate behaviour. Four new behavioural patterns were recognized and described quantitatively and qualitatively, viz induced continuous trajectory change, induced continuous reorientation reaction, sliding and coiling. The complexity of these results is discussed per se and also from a comparative point of view.

New variant of chromosome 11.

An additional C-positive band in the centromeric region (p11) was observed in a man. By GTG- and RBA-techniques it was positively stained but by QFQ-technique the staining intensity was negative. Although he was identified through fetal loss in his wife, it apparently represents a familial variant whose clinical significance is unknown.

A case of Burkitt's lymphoma presenting with digital ischaemia.

Paraneoplastic syndromes are rare in paediatric oncology. This report describes a four-year-old Cantonese child whose sole presenting symptom was acrocyanosis who was found to have Burkitt's lymphoma in association with the presence of positive antinuclear antibodies, antineutrophil cytoplasmic antibodies, antiendothelial antibodies and elevated serum immunoglobulin G concentrations. Digital ischaemia has not been described as a presenting symptom of Burkitt's lymphoma, although this association has been reported in 25 patients with other malignancies.