Acrolocalized variant of lichen sclerosus initially manifesting as degenerative collagenous plaques of the hands

Lichen sclerosus involving the hands is very uncommon. On the other hand, degenerative collagenous plaques of the hands is a rare condition characterized by keratotic, translucent papules in linear array, on the radial border of the hands. Histopathologically, lesions of degenerative collagenous plaques of the hands show increased collagen bundles in upper half of the dermis and dermal elastosis. We describe the clinical and histopathological progression experienced by a woman who initially presented lesions with clinical and histopathological appearance of degenerative collagenous plaques of the hands, which evolved into characteristic lichen sclerosus. We propose that some cases of the so-called degenerative collagenous plaques of the hands may represent an acrolocalized lichen sclerosus at an early stage.     

Neuronal lactate levels depend on glia-derived lactate during high brain activity in Drosophila

Lactate/pyruvate transport between glial cells and neurons is thought to play an important role in how brain cells sustain the high-energy demand that neuronal activity requires. However, the in vivo mechanisms and characteristics that underlie the transport of monocarboxylates are poorly described. Here, we use Drosophila expressing genetically encoded FRET sensors to provide an ex vivo characterization of the transport of monocarboxylates in motor neurons and glial cells from the larval ventral nerve cord. We show that lactate/pyruvate transport in glial cells is coupled to protons and is more efficient than in neurons. Glial cells maintain higher levels of intracellular lactate generating a positive gradient toward neurons. Interestingly, during high neuronal activity, raised lactate in motor neurons is dependent on transfer from glial cells mediated in part by the previously described monocarboxylate transporter Chaski, providing support for in vivo glia-to-neuron lactate shuttling during neuronal activity.     

Non-medical use of opioid analgesics in contemporary Brazil: Findings from the 2015 Brazilian National Household Survey on Substance Use

ABSTRACT

Prior studies on substance use in Brazil have not focused on opioid misuse, previously thought to be nearly non-existent. This paper presents new findings on heroin and non-medical use of opioid analgesics. Data come from the 2015 Brazilian Household Survey on Substance Use (BHSU-3), a nationally representative survey estimating epidemiological parameters related to substance use by residents across Brazil. BHSU-3 used stratified multi-stage probability sampling across multiple geographic domains of interest, resulting in 16,273 interviews with household residents. Lifetime heroin use among Brazilians was 0.3 (95% C.I:0.2–0.4). Lifetime, past-year, and past-month non-medical use of opioid analgesics were respectively 2.9 (95%C.I.:2.3–3.4), 1.4 (95%C.I.:1.1–1.7) and 0.6 (95%C.I.:0.4–0.8). Past-year prevalence of non-medical opioid analgesics use was lower among males [Prevalence Ratio (PR): 0.54 (95% C.I.:0.36–0.78)], those aged 12–24 [0.56 (95% C.I.:0.34–0.92)], persons with monthly family incomes between R$1,501–3,000 [0.59 (95% C.I.:0.38–0.92)] or greater than R$3,000 [0.64 (95% C.I.:0.42–0.98)], and persons who were unemployed [0.65 (95% C.I.:0.46–0.92)]. Non-medical use of opioids in Brazil may be more prevalent than previously recognised. Proper measurement and evaluation of opioid misuse across Brazil and other Latin American countries is critical to understand and prevent opioid-related harms.     

Knee isokinetic muscle strength and balance ratio in female soccer players of different age groups: a cross-sectional study

ABSTRACT

Background: As a consequence of years of soccer training and sexual maturation, there is an increase in lower body muscle mass and strength especially in the knee extensors and flexors muscles. In this context, the lack of knee joint stability, resulting from strength imbalance between knee extensor and flexors muscles, has been associated with knee injuries. The aim of this study was to compare the knee flexor and extensor muscle peak torque, average power, contralateral deficit, conventional and functional balance ratios of female soccer players from different age groups.

Methods: Sixty-six female soccer players were divided into four groups: under 13 (U13), under 15 (U15), under 17 (U17) years old and professional (PRO). Flexor and extensor knee muscle strength in concentric and eccentric actions of both limbs were assessed using isokinetic dynamometer.

Results: For the dominant limb, the knee concentric extensor muscles peak torques, assessed at 60 and at 240 deg/sec, and the average power of U15 group were significantly higher than U13 group. Extensor muscle average power of the PRO group was higher than U17. Dominant knee flexor average power of U15 was significantly higher than the U13 group. Peak torque at 60 deg/sec and 240 deg/sec and average power of the PRO group were higher than the U17 group. No differences were found regarding the eccentric action for flexor and extensor muscles. Conventional and functional balance ratios were similar among all age group, except for U13, which presented higher values than the U15 group for the dominant limb.

Conclusions: The greatest improvement in muscular performance occur when the athlete starts practicing soccer (after U13) and when they become professional (after U17) and the balance ratios, and muscle balance ratios remain stable in all age groups, although they are below the recommended level in the literature, which may increase the risk for lower limb injury.     

Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial

Abstract

During pulmonary rehabilitation, a subset of subjects with COPD requires adjunct therapy to achieve high-intensity training. Both noninvasive ventilation (NIV) and inspiratory muscle training (IMT) are available to assist these subjects. We aimed to prime the respiratory muscles before NIV with IMT, anticipating additive effects for maximal exercise tolerance (T _lim) and dyspnea/leg fatigue relief throughout the exercise as primary outcomes. Changes in the respiratory pattern were secondary outcomes. COPD subjects performed a total of four identical constant work rate tests on a cycle ergometer at 75% of maximum work rate, under control ventilation (SHAM, 4?cm H₂O) or proportional assisted ventilation (PAV, individually adjusted), before and after 10 sessions of high-intensity IMT (three times/week) during 30?days. Two-way RM ANOVA with appropriate corrections were performed. Final analysis in nine subjects showed improved T _lim (Δ = 111?s) and lower minute-ventilation (Δ = 4?L^.min^?1) at exhaustion, when comparing the IMT effects within the PAV modality (p?=?0.001 and p?=?0.036, respectively) and improved T _lim for PAV vs. SHAM (PAV main-effect, p?=?0.001; IMT main-effect, p?=?0.006; PAV vs. IMT interaction, p?=?0.034). In addition, IMT?+?PAV association, compared to PAV alone, resulted in lower respiratory frequency (IMT main-effect, p?=?0.009; time main-effect, p?<?0.0001; IMT vs. time interaction, p?=?0.242) and lower inspiratory time related to duty cycle (IMT main-effect, p?=?0.018; time main-effect, p?=?0.0001; IMT vs. time interaction, p?=?0.004) throughout exercise. The addition of IMT prior to a PAV-supported aerobic bout potentiates exercise tolerance and dyspnea relief and induces favourable changes in ventilatory pattern in severe COPD during high-intensity training (Brazilian Registry of Clinical Trials, number RBR-6n3dzz).