RESUMO
In this article, the 2009 European League Against Rheumatism (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have been updated. The 2009 recommendations were on the management of primary small and medium vessel vasculitis. The 2015 update has been developed by an international task force representing EULAR, the European Renal Association and the European Vasculitis Society (EUVAS). The recommendations are based upon evidence from systematic literature reviews, as well as expert opinion where appropriate. The evidence presented was discussed and summarised by the experts in the course of a consensus-finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) determined. In addition to the voting by the task force members, the relevance of the recommendations was assessed by an online voting survey among members of EUVAS. Fifteen recommendations were developed, covering general aspects, such as attaining remission and the need for shared decision making between clinicians and patients. More specific items relate to starting immunosuppressive therapy in combination with glucocorticoids to induce remission, followed by a period of remission maintenance; for remission induction in life-threatening or organ-threatening AAV, cyclophosphamide and rituximab are considered to have similar efficacy; plasma exchange which is recommended, where licensed, in the setting of rapidly progressive renal failure or severe diffuse pulmonary haemorrhage. These recommendations are intended for use by healthcare professionals, doctors in specialist training, medical students, pharmaceutical industries and drug regulatory organisations.
Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Gerenciamento Clínico , Imunossupressores/uso terapêutico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/patologia , Biópsia/normas , Humanos , Troca Plasmática , Recidiva , Indução de Remissão/métodos , Retratamento/métodosRESUMO
Haemoglobin genes have been found in a number of plant species, but the number of genes known has been too small to allow effective evolutionary inferences. We present nine new non-symbiotic haemoglobin sequences from a range of plants, including class 1 haemoglobins from cotton, Citrus and tomato, class 2 haemoglobins from cotton, tomato, sugar beet and canola and two haemoglobins from the non-vascular plants, Marchantia polymorpha (a liverwort) and Physcomitrella patens (a moss). Our molecular phylogenetic analysis of all currently known non-symbiotic haemoglobin genes and a selection of symbiotic haemoglobins have confirmed the existence of two distinct classes of haemoglobin genes in the dicots. It is likely that all dicots have both class 1 and class 2 non-symbiotic haemoglobin genes whereas in monocots we have detected only class 1 genes. The symbiotic haemoglobins from legumes and Casuarina are related to the class 2 non-symbiotic haemoglobins, whilst the symbiotic haemoglobin from Parasponia groups with the class 1 non-symbiotic genes. Probably, there have been two independent recruitments of symbiotic haemoglobins. Although the functions of the two non-symbiotic haemoglobins remain unknown, their patterns of expression within plants suggest different functions. We examined the expression in transgenic plants of the two non-symbiotic haemoglobins from Arabidopsis using promoter fusions to a GUS reporter gene. The Arabidopsis GLB1 and GLB2 genes are likely to be functionally distinct. The class 2 haemoglobin gene (GLB2) is expressed in the roots, leaves and inflorescence and can be induced in young plants by cytokinin treatment in contrast to the class 1 gene (GLB1) which is active in germinating seedlings and can be induced by hypoxia and increased sucrose supply, but not by cytokinin treatment.
Assuntos
Hemoglobinas/genética , Plantas/genética , Adenina/análogos & derivados , Adenina/farmacologia , Arabidopsis/genética , Arabidopsis/crescimento & desenvolvimento , Brassica napus/genética , Citocininas/farmacologia , DNA Complementar/química , DNA Complementar/genética , DNA de Plantas/química , DNA de Plantas/genética , Bases de Dados de Ácidos Nucleicos , Evolução Molecular , Regulação da Expressão Gênica de Plantas/efeitos dos fármacos , Genes de Plantas/genética , Glucuronidase/genética , Glucuronidase/metabolismo , Gossypium/genética , Hemoglobinas/fisiologia , Isopenteniladenosina , Dados de Sequência Molecular , Filogenia , Plantas Geneticamente Modificadas/genética , Plantas Geneticamente Modificadas/crescimento & desenvolvimento , Regiões Promotoras Genéticas/genética , Isoformas de Proteínas/genética , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , Análise de Sequência de DNARESUMO
Psychologic factors play a role in many dermatologic disorders, giving rise to the possible use of psychotherapeutic modalities in treatment. Regarding psoriasis, emotional factors have a strong correlation with onset and flare-ups. The psychophysiologic mechanisms involved are not known; however, stress and its effect on the autonomic nervous system and the immune system may play a significant role in the onset and course of psoriasis. Relaxation and mere suggestion also affect the autonomic nervous system and the immune system and therefore may affect the course of the skin disorder. A few case studies have documented successful treatment of psoriasis with hypnosis and biofeedback. Further study of this process is needed, and the role of stress in dermatologic diseases must always be given consideration.