A review on irisin, a new protagonist that mediates muscle-adipose-bone-neuron connectivity.

Physical activity improves the quality of life and decreases the risk of several diseases (i.e. stroke, hypertension, myocardial infarction, obesity, and malignancies). Skeletal muscles are considered as an endocrine organ that produces myokines characterized by a paracrine or endocrine activity. Irisin is a circulating hormone-like myokine and is secreted as a product of fibronectin type III domain-containing protein 5 from skeletal muscle in response to exercise. This molecule regulates the energy metabolism and acts in adipose tissue, bones, and nervous system. As both animal and clinical studies confirmed the action of irisin in muscle and adipocytes, this protein is considered as adipomyokine. In adipose tissue, irisin stimulates the process of browning of beige precursor fat cells, which are present in white fat cells, and promotes energy expenditure. It affects bone metabolism by increasing osteoblast differentiation and reducing osteoclast maturation. In the nervous system, irisin influences hippocampal neurogenesis and neural differentiation of embryonic stem cells in mice and is considered as a messenger between exercise and brain function. However, the existence of this protein and its role in humans is a matter of debate. This study presents irisin as a new champion of the molecule, which could be considered as the messenger in the muscle-fat-bone-brain axis.

The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology.

OBJECTIVE: To determine the long-term efficacy of submucosal corticosteroid injection plus dilatation for subglottic stenosis as a single modality treatment in granulomatosis with polyangiitis and relapsing polychondritis, as compared with idiopathic subglottic stenosis and traumatic subglottic stenosis. METHOD: Patients who underwent dilatation for autoimmune causes were identified. Corticosteroid injection into the submucosa of a stenotic segment was followed by serial dilatation. Definitive improvement was defined as good airway patency for more than 24 months with no further procedures needed. Clinical, demographic and procedural data were recorded. RESULTS: Patients (n = 45) were divided into three subglottic stenosis groups: traumatic (n = 24), idiopathic (n = 9) and autoimmune (n = 12). Patients were treated with dilatations, with a median follow-up time of 76 months. Six patients were tracheostomy-dependent. There were no statistical differences in the number of final improvements between autoimmune, idiopathic and traumatic groups, with values of 75, 56 and 71 per cent, respectively. There was no statistical difference between granulomatosis with polyangiitis plus relapsing polychondritis and idiopathic subglottic stenosis in terms of decannulation rates. CONCLUSION: Granulomatosis with polyangiitis and relapsing polychondritis patients have better improvement rates than patients with other subglottic stenosis types.

Granulomatosis with polyangiitis in pregnancy - clinical implications and treatment possibilities.

Granulomatosis with polyangiitis (GPA) is an autoimmune disease which has a variable clinical presentation and usually progresses from a localized to a generalized form over the course of weeks to years. Histopathologically, it is a necrotizing systematic vasculitis that can cause sino-nasal, pulmonary, renal, ocular, and cutaneous manifestations. Diagnostic workup should include serologic, radiologic, endoscopic and histopathological examination. Autoantibody c-ANCA may be used as a marker of disease activity and individual follow-up. An appropriate local and systemic treatment should be implemented, which is particularly important in pregnancy. Comprehensive management should be planned, including the needs of both mother and fetus (particularly if vasculitis is diagnosed de novo during pregnancy). Pregnancy in patients with GPA is burdened with the risk of possible complications and increased mortality and the conception should be delayed until remission of the disease. A flare-up of GPA may be life threatening for both mother and fetus. The immunosuppressants, which are used during pregnancy include glucocorticosteroids (GCS) and azathioprine. Studies of GPA in pregnancy are scarce, and this calls for individualized management. Thus, the approach to care for pregnant women with GPA is interdisciplinary, and firmly places the rheumatologist, gynecologist, pulmonologist, otorhinolaryngologist and nephrologist on the management team.

EULAR evidence-based recommendations for the management of fibromyalgia syndrome.

OBJECTIVE: To develop evidence-based recommendations for the management of fibromyalgia syndrome. METHODS: A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords "fibromyalgia", "treatment or management" and "trial". Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation. RESULTS: 146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and "other pharmacological" and exercise, cognitive behavioural therapy, education, dietary interventions and "other non-pharmacological". In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made. CONCLUSIONS: Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.