EAACI IG Biologicals task force paper on the use of biologic agents in allergic disorders.

Biologic agents (also termed biologicals or biologics) are therapeutics that are synthesized by living organisms and directed against a specific determinant, for example, a cytokine or receptor. In inflammatory and autoimmune diseases, biologicals have revolutionized the treatment of several immune-mediated disorders. Biologicals have also been tested in allergic disorders. These include agents targeting IgE; T helper 2 (Th2)-type and Th2-promoting cytokines, including interleukin-4 (IL-4), IL-5, IL-9, IL-13, IL-31, and thymic stromal lymphopoietin (TSLP); pro-inflammatory cytokines, such as IL-1ß, IL-12, IL-17A, IL-17F, IL-23, and tumor necrosis factor (TNF); chemokine receptor CCR4; and lymphocyte surface and adhesion molecules, including CD2, CD11a, CD20, CD25, CD52, and OX40 ligand. In this task force paper of the Interest Group on Biologicals of the European Academy of Allergy and Clinical Immunology, we review biologicals that are currently available or tested for the use in various allergic and urticarial pathologies, by providing an overview on their state of development, area of use, adverse events, and future research directions.

The interrater reliability of force measurements using a modified sphygmomanometer in elderly subjects.

BACKGROUND AND PURPOSE: Physical therapists working with elderly people require an instrument that provides reliable force measurements and can be used in a clinical setting. The modified sphygmomanometer has been identified as potentially fulfilling these requirements, yet there is an absence of research on the reliability of measurements taken with this instrument on elderly patients. This study was undertaken to investigate the interrater reliability of force measurements, in a group of elderly subjects, using a modified sphygmomanometer. SUBJECTS: Thirty-six hospitalized subjects (mean age=75.28 years, SD=9.43, range=62-95) participated in the study. METHODS: With the modified sphygmomanometer, 3 examiners evaluated the isometric force of the elbow extensors and hip extensors using a break test and a make test, respectively. RESULTS: Intraclass correlation coefficients (2,1) reflecting reliability were .87 for the elbow extensors and .65 for the hip extensors. The estimation of the components of variance for hip extensors revealed that these results were due in part to the raters but that random error contributed to a much larger extent. CONCLUSION AND DISCUSSION: The modified sphygmomanometer appears to be practical to use, and the high correlations found in this study for the elbow extensors suggest that reliable measurements can be obtained with this instrument. Further research is needed, however, to specify the manner in which the modified sphygmomanometer can be used when assessing different muscle groups.

Characterization of global synkineses during hand grip in hemiparetic patients.

OBJECTIVE: Global synkineses are defined as nonpurposive associated movements on the involved side of hemiparetic subjects that are triggered during a voluntary movement. The purpose of this study was to characterize the intensity and pattern of upper limb global synkineses in hemiparetic subjects with a static biarticular dynamometer and electromyography during maximal progressive hand grip on the unaffected side. DESIGN: Survey, convenience sample. SETTINGS: University secondary care rehabilitation center. DATA SET: Global synkineses (ie, torques and electromyographic activities) in patients with severe (n = 8) and moderate (n = 7) deficits in motor performance, as evaluated by the Fugl-Meyer assessment, were compared with those obtained in a group of healthy subjects (n = 11). Clinically the subjects from the severe deficit group were more spastic and showed less strength at the elbow than the subjects from the moderate deficit group. RESULTS: Results of analyses of variance showed significant increases of shoulder torque in flexion and internal rotation, and elbow torque in flexion, with increasing force exertion during contralateral hand grip in subjects with severe deficits (p < .05). Furthermore, in these subjects increases of electromyographic activity were also observed in biceps brachii, brachioradialis, and triceps brachii muscles with increasing hand grip force levels. In contrast, no significant torques or electromyographic increases were observed in subjects with moderate deficits and in control subjects during contralateral hand grip exertions. CONCLUSION: These results provide a quantitative assessment of the kinematic and electromyographic patterns of global synkineses and their correlates with clinical observations. Within the limits of the experimental results presented in this study, it is suggested that global synkineses result from contralateral overflow of the voluntary command to hyperexcitable motoneuron pools.