Propiedades psicométricas de los instrumentos para la medición de la actividad física en adultos con discapacidad física relacionada con lesión de médula espinal: una revisión sistemática

Objetivo: Evaluar las propiedades psicométricas de los instrumentos para la medición de la actividad física en adultos de 18-65 años con discapacidad física por lesión de médula espinal. Materiales y métodos: Revisión sistemática. Las bases de datos de Medline, Scopus, Web of Science y 19 revistas especializadas fueron consultadas durante once días entre abril de 2015 y febrero de 2016 para identificar estudios originales de validación, sin límite de tiempo y que estuvieran publicados en español, francés y/o inglés. La calidad metodológica de los instrumentos de medición se evaluó usando las diferentes cajas de propiedades de la lista COSMIN. Resultados: Se identificaron 9229 referencias, de las cuales sólo 12 cumplieron los criterios de inclusión, dando como resultado 13 instrumentos de medición. Se evaluaron seis propiedades psicométricas. La propiedad más común fue la confiabilidad, además se observó que la calidad metodológica de los estudios incluidos no representa los resultados de las propiedades psicométricas de los instrumentos de medición. La calidad metodológica de los instrumentos para la evaluación de la actividad física en población con lesión medular espinal es “baja” para propiedades como consistencia interna, error de medición, sensibilidad, validez de criterio (con excepción del WISCI II que tiene buena validez) y excelente para validez de contenido y fiabilidad. Conclusión: Se ha encontrado que instrumentos empleados hasta el presente en la medición de la actividad física en población con discapacidad física relacionada con lesión de médula espinal han sido creados para otros tipos de discapacidad y otros instrumentos deben ser validados en futuros estudios.

Indigenous students transitioning to school : responses to pre-foundational mathematics

Australian Indigenous students' mathematics performance continues to be below that of non-Indigenous students. This occurs from the early years of school, due largely to knowledge and social differences on entry to formal schooling. This paper reports on a mathematics research project conducted in one Aboriginal community school in New South Wales, Australia. The project aimed to identify and explain the ways that young Australian Indigenous students (age 2-4 years) learn number language and processes, specifically attribute language, sorting, 1-1 correspondence and, counting. The project adopted a mixed methods approach. That is, the methodology was decolonising (Smith 1999) in that it collaborated with and gave benefit back to the Indigenous community and school being researched. It was qualitative and interpretative (Burns 2000) and incorporated an action-research teaching-experiment approach where and teachers collaborated with the researchers to try new teaching methods. This paper draws on data pertaining to students' response to diagnostic interview questions, the pre- and post-test results of the interview and photographic evidence as observations during mathematics learning time. Participants referred to in this paper include one female principal (N = 1), and the transition class of students' pre- (N = 6) and post-test (N = 3) results of the pre-foundational processes (also referred to as attributes). The results were encouraging with improvements in colour (34%), patterns (33%); capacity (38%). As a result of this project, our epistemology regarding the importance of finding out about students' pre-foundational knowledge and understandings and providing a culturally appropriate learning environment with resources has been built upon.

A phase 1b study of placenta-derived mesenchymal stromal cells in patients with idiopathic pulmonary fibrosis

BACKGROUND AND OBJECTIVE: Idiopathic pulmonary fibrosis (IPF) is a degenerative disease characterized by fibrosis following failed epithelial repair. Mesenchymal stromal cells (MSC), a key component of the stem cell niche in bone marrow and possibly other organs including lung, have been shown to enhance epithelial repair and are effective in preclinical models of inflammation-induced pulmonary fibrosis, but may be profibrotic in some circumstances. METHODS: In this single centre, non-randomized, dose escalation phase 1b trial, patients with moderately severe IPF (diffusing capacity for carbon monoxide (DLCO ) ≥ 25% and forced vital capacity (FVC) ≥ 50%) received either 1 × 10(6) (n = 4) or 2 × 10(6) (n = 4) unrelated-donor, placenta-derived MSC/kg via a peripheral vein and were followed for 6 months with lung function (FVC and DLCO ), 6-min walk distance (6MWD) and computed tomography (CT) chest. RESULTS: Eight patients (4 female, aged 63.5 (57-75) years) with median (interquartile range) FVC 60 (52.5-74.5)% and DLCO 34.5 (29.5-40)% predicted were treated. Both dose schedules were well tolerated with only minor and transient acute adverse effects. MSC infusion was associated with a transient (1% (0-2%)) fall in SaO2 after 15 min, but no changes in haemodynamics. At 6 months FVC, DLCO , 6MWD and CT fibrosis score were unchanged compared with baseline. There was no evidence of worsening fibrosis. CONCLUSIONS: Intravenous MSC administration is feasible and has a good short-term safety profile in patients with moderately severe IPF.

Early Growth and Later Health, Focus on Metabolic Syndrome, Obesity and Physical Activity

The Developmental Origins of Health and Disease Hypothesis proposes that adverse health outcomes in adult life are in part programmed during fetal life and infancy. This means that e.g. restricted nutrition during pregnancy programmes the offspring to store fat more effectively, to develop faster and to reach puberty earlier. These adaptations are beneficial in terms of short term survival. However, in developed countries these adaptations often lead to an increased risk of obesity and metabolic disturbances in later life, due to a mismatch between the prenatal and postnatal environment. This thesis aimed to study the role of early growth in people who are obese as adults, but metabolically healthy as well as in those who are normal in weight but metabolically obese. Other study aims were to assess whether physical activity and cardiorespiratory fitness are programmed early in life. The role of socioeconomic status in the development of obesity from a life course setting was also studied. These studies included 2003 men and women born in Helsinki between 1934 and 1944 with detailed information of their prenatal and childhood growth as well as living conditions. They participated in the detailed clinical examination during the years 2001-2004. A sub-group of the subjects participated in the UKK Institute 2-kilometre walk test. Metabolic syndrome was defined according to the 2005 criteria of the International Diabetes Federation. Among the obese men and women 20 % were metabolically healthy. Those with metabolic syndrome did not differ in birth size compared to the healthy ones, but by two years of age, they were lighter and thinner, and remained so up to 11 years. The period when changes in BMIs were predictive of the metabolic syndrome was from birth to 7 years. Of the normal weight individuals 17 % were metabolically obese. Again, there were no differences in birth size. However, by the age 7 years, those men who later developed metabolic syndrome were thinner. Gains in BMI during the first two years of life were protective of the syndrome. Children who were heavier, and especially taller, were more physically active, exercised with higher intensity and had higher cardiorespiratory fitness in their adult life than those who were shorter and thinner as children. Lower educational attainment and lower adult social class were associated with obesity in both men and women. Childhood social class was inversely associated with body mass index only in men while lower household income was associated with higher BMI in women. These results support the role of early life factors in the development of metabolic syndrome and adult life style. Early detection of risk factors predisposing to these conditions is highly relevant from a public health point of view.

Distributed Nonparametric Sequential Spectrum Sensing under Electromagnetic Interference

We propose a distributed sequential algorithm for quick detection of spectral holes in a Cognitive Radio set up. Two or more local nodes make decisions and inform the fusion centre (FC) over a reporting Multiple Access Channel (MAC), which then makes the final decision. The local nodes use energy detection and the FC uses mean detection in the presence of fading, heavy-tailed electromagnetic interference (EMI) and outliers. The statistics of the primary signal, channel gain and the EMI is not known. Different nonparametric sequential algorithms are compared to choose appropriate algorithms to be used at the local nodes and the Fe. Modification of a recently developed random walk test is selected for the local nodes for energy detection as well as at the fusion centre for mean detection. We show via simulations and analysis that the nonparametric distributed algorithm developed performs well in the presence of fading, EMI and outliers. The algorithm is iterative in nature making the computation and storage requirements minimal.

Equação de referência do Teste do Degrau medida em distância para indivíduos saudáveis e sedentários

O teste de caminhada em seis minutos (TC6M) avalia a capacidade respiratória durante o exercício. Recentemente, o teste do degrau em seis minutos (TD6M) está sendo estudado como uma proposta para essa mesma avaliação. Diante do exposto, o desenvolvimento de uma equação de referência se torna importante. O objetivo desse estudo foi desenvolver uma equação de referência padrão para o Teste do Degrau em Seis minutos. Esse estudo foi do tipo transversal, em que foram selecionados 452 indivíduos. Após a aplicação dos critérios de inclusão/exclusão, foram selecionados 326 sujeitos saudáveis e sedentários com idade entre 20 e 80 anos. Para serem considerados saudáveis, os participantes não podiam ter história de doenças (exceto hipertensão arterial sistêmica ou diabetes mellitus em tratamento) e foram submetidos à radiografia de tórax, espirometria e eletrocardiograma, que deveriam ser normais. O nível de sedentarismo foi avaliado através do International Physical Activity Questionnaire (IPAQ). Foram coletados os seguintes dados demográficos: idade, peso e altura. Todos os indivíduos realizaram TD6M na sua própria cadência (autocadenciado) em um degrau de 16,5 cm de altura, 65 de largura e 30 cm de comprimento. O número de subidas e descidas foi contado por um pedômetro digital. Foram mensuradas a pressão arterial, a frequência cardíaca e a saturação de oxigênio, antes e depois do TD6M. A análise estatística foi realizada pelo software STATA 12.0, e as equações foram desenvolvidas pelo modelo estatístico de regressão linear múltipla. Como resultado, observou-se que os participantes apresentaram exames normais, sendo 135 homens e 191 mulheres. O IPAQ demonstrou 157 ativos, 114 irregularmente ativos e 40 inativos, sendo que 14 indivíduos não responderam. A análise da distância alcançada em relação à idade e à diferença da frequência cardíaca tanto para homens quanto para mulheres mostrou significância estatística, demonstrando a sua importância para o desenvolvimento das equações para cada gênero. Para mulheres: Distância (m) = 88,83 - [(FC final- FC inicial)* 0,23] (Idade *0,37); para homens: Distância (m)= 110,20 - [(FC final- FC inicial)*0,18] (Idade * 0,59). O estudo concluiu que as equações de referência desenvolvidas nesse estudo foram realizadas em uma população de indivíduos saudáveis e sedentários e pode ser usada como padrão de referência para o TD6M.

The tissue plasminogen activator gene promoter: a novel tool for radiogenic gene therapy of the prostate?

Radiation therapy is a treatment modality routinely used in cancer management so it is not unexpected that radiation-inducible promoters have emerged as an attractive tool for controlled gene therapy. The human tissue plasminogen activator gene promoter (t-PA) has been proposed as a candidate for radiogenic gene therapy, but has not been exploited to date. The purpose of this study was to evaluate the potential of this promoter to drive the expression of a reporter gene, the green fluorescent protein (GFP), in response to radiation exposure. METHODS: To investigate whether the promoter could be used for prostate cancer gene therapy, we initially transfected normal and malignant prostate cells. We then transfected HMEC-1 endothelial cells and ex vivo rat tail artery and monitored GFP levels using Western blotting following the delivery of single doses of ionizing radiation (2, 4, 6 Gy) to test whether the promoter could be used for vascular targeted gene therapy. RESULTS: The t-PA promoter induced GFP expression up to 6-fold in all cell types tested in response to radiation doses within the clinical range. CONCLUSIONS: These results suggest that the t-PA promoter may be incorporated into gene therapy strategies driving therapeutic transgenes in conjunction with radiation therapy.

Different frequencies of acupuncture for treatment for chronic low back pain: an-assessor blinded pilot randomised controlled trial.

OBJECTIVES:
To examine the feasibility of a main RCT to compare the effectiveness of two frequencies (2 versus 5 times/week) of acupuncture treatment for chronic low back pain (LBP).
METHODS:
Participants (n=30) with chronic LBP were randomised into two groups to receive 10 acupuncture treatments: Low Frequency Group, 2 times/week for five weeks (n=15); High Frequency Group, 5 times/week for two weeks (n=15). The following outcomes were measured blindly at baseline, 2 weeks, 5 weeks, 3 months and 1 year: pain on a VAS, functional disability using the RMDQ, quality of life using the Measure Yourself Medical Outcome Profile (MYMOP-2), psychological impact with the Coping Strategies Questionnaire (CSQ) and Pain Locus of Control (PLC) questionnaire. Two objective outcomes, the Shuttle Walk Test (SWT) and Lateral Trunk Flexibility (LTF), were also measured.
RESULTS:
The compliance rate was 100% for each group. Some of the measurements were shown to be sensitive (VAS, RMDQ, MYMOP-2 Wellbeing). 66-330 participants would be required for a fully powered non-inferiority trial. The groups were balanced at baseline for LBP and demographic characteristics. There were no significant differences between the groups in terms of any of the outcomes, at each follow-up time point. It was notable however that the clinically important improvement in terms of pain, functional disability, quality of life, and SWT in both groups was achieved within the first two weeks, which was maintained at one year follow-up.
CONCLUSIONS:
It is feasible to conduct a main RCT, to compare different frequencies of acupuncture for LBP, using sensitive measurements. Also the trend for early clinically important improvement within a minimum of four measurements is worthy of further study.

A doença pulmonar obstrutiva crónica e o exercício: impacto da doença no declínio funcional e importância do treino de exercício nos benefícios para a saúde

RESUMO: A reabilitação respiratória (RR) é uma intervenção abrangente e interdisciplinar dirigida aos doentes respiratórios crónicos e inclui o treino de exercício, programas de educação e de modificação comportamental, entre outros, desenhados individualmente para melhorar o desempenho físico e psicossocial e promover a adesão a longo prazo a comportamentos promotores de saúde. A doença pulmonar obstrutiva crónica (DPOC) é uma doença comum, afetando cerca de 210 milhões de pessoas em todo o mundo, com elevada mortalidade e com custos económicos significativos decorrentes do agravamento progressivo da doença, das hospitalizações e de reinternamentos frequentes. Apesar do crescente conhecimento da DPOC e do papel da RR nos benefícios para a saúde, existem aspetos ainda não esclarecidos que têm impacto na prática clínica e de investigação e nas decisões das autoridades de saúde. A primeira parte desta tese focou a DPOC e o seu impacto negativo e incluiu: o estudo da prevalência da DPOC em Portugal; os fatores clínicos e funcionais que se associam à mortalidade em doentes com DPOC avançada; a morbilidade, impacto funcional e risco dos doentes se tornarem dependentes para as atividades diárias e a influência da inflamação sistémica. A prevalência estimada da DPOC de 14,2% indica que esta é uma doença comum em Portugal e alerta para a necessidade de uma maior sensibilização da população, dos profissionais de saúde e autoridades de saúde com vista a um diagnóstico precoce e à alocação dos recursos terapêuticos adequados. A elevada taxa de mortalidade em doentes com DPOC avançada - 36,6% em 3 anos - associou-se a insuficiência respiratória, a elevado número de exacerbações, ao cancro do pulmão e a reduzida capacidade funcional para a marcha, salientando a importância da referenciação precoce para RR, a identificação e o tratamento das comorbilidades e a prevenção das exacerbações. A aplicação de um questionário que avaliou as atividades da vida diária básicas e instrumentais, permitiu identificar um marcador clínico do risco de dependência, complementando as avaliações funcionais e associando-se a outros marcadores de mau prognóstico, como as exacerbações. Em doentes com DPOC, com FEV1 médio de 46,76% (desvio padrão: 20,90%), 67% da categoria D do GOLD, verificou-se uma associação positiva entre a expressão de genes inflamatórios avaliada pela reação em cadeia da polimerase (ARN mensageiro de IFNg, IL1b, IL6, IL8, TNFa, TGFb1, iNOS) e o índice de massa corporal em repouso, acentuando-se após o exercício. Este estudo aponta a inflamação como o potencial elo de ligação entre a obesidade e a inflamação sistémica em doentes com DPOC. A segunda parte da tese focou a RR, nomeadamente os seus efeitos em doentes das categorias GOLD A, B, C e D; o impacto das comorbilidades nos resultados da RR e os resultados de diferentes intensidades de treino aeróbio. Após o programa de RR, verificaram-se melhorias significativas na capacidade de exercício funcional e de endurance e no estado geral de saúde dos doentes de todas as categorias GOLD. Esta classificação não distingue os doentes que melhor poderão beneficiar desta intervenção, indicando que devem ser referenciados para RR, os doentes sintomáticos ou com repercussão na qualidade de vida, independentemente da categoria da DPOC a que pertençam. A prevalência das comorbilidades no grupo de doentes com DPOC que é referenciado para RR, é elevada, sendo as mais frequentes, as cardiovasculares, as respiratórias e as psicológicas. Apesar de poderem diminuir o impacto da RR, os resultados desta foram semelhantes independentemente do número de comorbilidades. A identificação e o tratamento sistemáticos das comorbilidades conferem maior segurança clínica a esta intervenção terapêutica a qual, por apresentar bons resultados, não deve limitar a referenciação dos doentes. Com o programa de RR, verificou-se melhoria significativa em todos os resultados centrados no doente para ambas as intensidades de treino aeróbio, a 60% e a 80% da potência aeróbica máxima (Wmax), com melhoria do estado geral de saúde, nos sintomas e na capacidade para o exercício, o que questiona a indicação sistemática de elevadas intensidades de treino em doentes com DPOC para a obtenção de benefícios a curto prazo. Na terceira e última parte da tese foi estudado o papel da atividade física na DPOC, focando os fatores que influenciam a atividade física diária; a evolução da capacidade funcional e o estado de saúde 2 anos após um programa de RR e o papel da telemonitorização na quantificação e monitorização da atividade física. Confirmámos que os doentes com DPOC são marcadamente sedentários e os fatores que se associaram ao sedentarismo nestes doentes foram a dispneia e a distância percorrida na prova de marcha de seis minutos. Este estudo sublinha a importância do controlo sintomático, nomeadamente da dispneia, bem como, mais uma vez, o potencial papel da reabilitação respiratória no aumento da capacidade funcional para o exercício e na aquisição de hábitos de vida fisicamente ativa. Verificámos que, apesar de os doentes com DPOC apresentarem benefícios clinicamente significativos na capacidade funcional para o exercício e no estado geral de saúde com o programa de RR, apenas os que se mantêm ativos, podem, no final dos dois anos de seguimento, manter os efeitos benéficos desse programa. O sistema de telemonitorização que combina a oximetria e a quantificação da atividade física provou ser clinicamente útil na avaliação da necessidade de oxigenoterapia de longa duração (OLD) e na aferição do débito de oxigénio em repouso, no esforço e no sono, podendo contribuir para uma melhor adequação da prescrição da OLD. A monitorização dos níveis de atividade física regular é um importante instrumento de avaliação dos programas de RR e o seu uso potencial na telereabilitação permitirá prolongar a eficácia dos programas e reduzir os custos associados aos cuidados de saúde.---------------------------------------------------------------------------------------------------ABSTRACT: Pulmonary rehabilitation (PR) is a comprehensive interdisciplinary intervention that includes, but is not limited to, exercise training, education, and behavior change, individually designed to improve physical and psychological conditions of people with chronic respiratory disease and to promote long-term adherence to health-enhancing behaviors. Chronic obstructive pulmonary disease (COPD) is a common disease, affecting about 210 million people worldwide, with high mortality and significant health-related costs due to disease progression, hospitalizations and frequent hospital readmissions. Although the increasing knowledge about COPD and benefitial outcomes of PR, some aspects with impact in clinical practice, research and health authorities’ decisions, remain to be clarified. The first part of this thesis focused on COPD and its negative impact, including the study of COPD prevalence in Portugal; clinical and functional factors associated with mortality in advanced COPD patients; morbidity, functional impact and risk of others’ dependance to perform activities of daily living; and the role of systemic inflammation. The evidence of 14.2% estimated COPD prevalence as a common disease in Portugal raises the need of an increasing awareness of population, health care professionals and health authorities towards an earlier diagnosis and apropriate treatment resources allocation. High mortality in patients with advanced COPD – 36.6% in 3 years - was associated with respiratory failure, high frequency of exacerbations, lung cancer and a low functional capacity in walking. This highlightens the importance of an earlier referral to PR, comorbidity identification and treatment, and prevention of exacerbations. A questionnaire evaluated basic and instrumental activities of daily living, and identified a clinical marker of the risk of becoming dependent. This clinical marker complemented other functional evaluations and was associated with prognosis markers such as the number of exacerbations. In COPD patients with a mean FEV1 46.76% (SD 20.90%), 67% belonging to GOLD grade D, we found a positive association between inflammatory gene expression evaluated by polymerase chain reaction (IFNg, IL1b, IL6, IL8, TNFa, TGFb1, iNOS RNA messenger) and body mass index at rest, and a further increase with exercise. This study evidenced obesity as one potential link between COPD and systemic inflammation. The second part of this thesis focused PR, namely its outcomes in patients of GOLD categories A, B, C and D; comorbidities impact in PR outcomes, and the impact of different exercise training intensities in patient related outcomes. xviii With PR intervention, we found significant improvement in functional exercise capacity, endurance exercise capacity and health status in patients of all GOLD categories. This classification did not differentiate which patients would benefit more from PR, hence all symptomatic patients with a negative impact in health status should be referred to PR, regardless of the GOLD category they belong to. There is a high prevalence of comorbidities in COPD patients referred to PR, being cardiovascular, respiratory and psychological, the most prevalent. Although some comorbidities might reduce PR impact, the results were similar regardless of the number of comorbidities. Systematic comorbidities identification and treatment provides safety to PR intervention, and its good results should not preclude patients referral. With PR intervention we found a significant improvement in all patient reported outcomes for exercise training intensities at 60% and 80% maximum work rate (Wmax), namely in health status, symptoms and exercise capacity. These findings challenge the current systematic indication of high exercise training intensities to achieve PR short-term benefits. In the third and last part of the thesis, the role of physical activity in COPD was studied, focusing factors that may influence daily physical activity; the evolution of functional capacity and health status two years after a PR program, and the role of a telemonitoring system in physical activity quantification and monitoring. We confirmed that COPD patients are markedly inactive and factors associated with a sedentary lifestyle are dyspnea and 6 minute walking distance. This study emphasized the importance of symptom control, namely of dyspnea, as well as, once again, the potential role of PR in functional exercise improvement and in integrating physically active habits in daily life. We verified that, although COPD patients improve functional exercise capacity and health status after a PR program, only those who kept physical activity habits were able to maintain those effects after 2 years of follow-up. A telemonitoring system that combines oximetry and physical activity quantification proved to be clinically useful in the evaluation of long-term oxygen therapy (LTOT) indication, as well as in the titration of oxygen levels at rest, exertion, and sleeping, which might contribute to a more adequate LTOT prescription. Monitoring of daily physical activity levels is an important PR evaluation instrument and its potential use in telerehabilitation might allow lengthening programs efficacy, while reducing health-care costs.

Recueil de pièces originales et de copies de pièces indiquées comme telles dans le dépouillement qui suit.

Contient : 1 « Remonstrances de la ville de Paris » au roi Henri III, « advisées et deliberées à l'assemblée generalle faicte par le commandement du roy... les lundy et mardy XIIe et XIIIe jour... de decembre... 1575 » ; 2 « Memoire du duc D'ESPERNON pour se justifier, lui et son fils, des accusations portées contre eux par le prince de Condé, et jugement du duc de La Vallette. 1638 » ; 3 Copie de lettre de « monseigneur le duc DE LA VALLETTE à monseigneur le prince [de Conde]... De Londres, le 5 febvrier 1639 » ; 4 « Harangue de Mtre TALON, advocat general, prononcée au parlement de Paris, le roy y seant, le mercredy 15 janvier 1648 ». Deux copies ; 5 Lettre sur les affaires d'État, sans adresse ni signature, « du 14 septembre 1650 » ; 6 Minute d'un ordre du roi enjoignant « au greffier en chef » d'« apporter les trois registres secrets du parlement » pour y supprimer « plusieurs deliberations fort prejudiciables à son authorité et au service de l'Estat ». 1655 ; 7 « Relation de l'ouverture du corps de la reyne [Marie-Thérèse d'Autriche], faite à Versailles, le samedy trente et un juillet 1683 ». Copie ; 8 « PASQUINI et MARPHORII interlocutiones... Anno Domini 1683 ». Copie ; 9 Lettre, en italien, datée de « Parigi, 30 7bre 1695 » ; 10 Épître, sans signature, date ni adresse, où il est démontré « qu'il n'est point sans exemple que le peuple revienne de ses preventions ». Copie ; 11 « Discours prononcé en l'assemblée des etats de Languedoc pour les engager à ne pas continuer de refuser au roi le secours qu'il leur demande » ; 12 « Discours au roy par un de ses fideles sujets sur le proces de Mr Fouquet ». Copie ; 13 « Relation de ce qui s'est passé à Pignerol, Mr Foucquet y estant, au sujet du tonnerre tombé sur un des magazins à poudre » ; 14 « Articles proposez à l'archeduc Mathias touchant le gouvernement des Païs Bas » ; 15 « Lettre ecrite au roy pour le retablissement de la paix de l'Europe, avec le Panegirique de la Victoire, à Sa Majesté ». Copie ; 16 Remontrances adressées au roi par le parlement « sur quelques articles de l'edict portant supression du dixieme » ; 17 Mémoire concernant « l'establissement de la cour des grands jours dans la ville de Clermont » ; 18 Mémoire généalogique adressé au « prince Charles de Luxembourg » ; 19 « Discours sur une question, sçavoir sy monseigneur est tenu confirmer à la noblesse de Lorraine les lettres de privileges octroyées par messeigneurs les predecesseurs de mon dit seigneur » ; 20 « Coppie de la response de Mr le commandeur DE GREMONVILLE à la lettre de monsgr le mareschal de Bellefonds »

Recueil de lettres et de pièces originales, et de copies de pièces indiquées comme telles dans le dépouillement qui suit.

Contient : 1 Lettre de « HENRY [III]... à mon cousin le duc de Nyvernoys,... Escript à Baugency, le XVIIe jour de juing 1589 » ; 2 « Copie de l'estat presanté au roy, le 20 may 1575, de tous les deniers receus » par le duc de Nevers, depuis qu'il est au service de la couronne de France ; 3 « Coppie de la lectre escripte par le roy... HENRY [III]... à monsieur de Guyse, touchant la garnison de Maizieres... De Paris, le IIIe jour de may 1587 » ; 4 Minute de lettre du duc DE NEVERS au roi ; 5 Minute de lettre du duc DE NEVERS à « monseigneur de Villeroy,... D'Amiens, ce 18 may 1587 » ; 6 Minute de lettre du duc DE NEVERS à « monsieur Brulart,... De Maignelay, ce 27 avril 1587 » ; 7 Minute de lettre du duc DE NEVERS à « monseigneur de Villeroy,... De Maignelay, ce 27 avril » ; 8 Minute de lettre du duc DE NEVERS à « monsieur Brullart,... Amiens, ce 18 may 1587 » ; 9 Minute de lettre du duc DE NEVERS à « monsieur Brulart,... D'Amyens, ce sabmedy à XI heures du soir » ; 10 Minute de lettre du duc DE NEVERS « au roy... De Niort, ce 19 de l'an 1587 » ; 11 Minute de lettre du duc DE NEVERS. « De Coignac, ce 11 de l'an 1587 » ; 12 Lettre de « CHARLES DE LORRAINE [duc DE MAYENNE]... à M. le conte de Suse,... De Reins, le Xe jour de may 1587 ». Copie ; 13 Lettre de « CAMILLO VOLTA » au duc de Nevers. « Di Roma, li 9 di genaro 1589 ». En italien ; 14 Minute de lettre de HENRIETTE DE CLEVES, duchesse DE NEVERS, à « monseigneur de Believre,... De Paris, ce 14 may 1587 » ; 15 Minute de lettre de la « duchesse DE NIVERNOYS et DE RETHELLOYS » aux échevins de Mézières. « A Paris, le VIIe may 1587 » ; 16 Minute de lettre du duc DE NEVERS « au roy... D'Amiens, ce 21 may 1587 » ; 17 Minute de lettre du duc DE NEVERS « au roy... De Amiens, ce premier jung 1587 » ; 18 Minute de lettre du duc DE NEVERS « à M. de G... De Coignac, ce 10e jour de l'an 1587 » ; 19 Minute de lettre du duc DE NEVERS à « monseigneur Brullart,... D'Amiens, ce 27 may » ; 20 Minute de lettre du duc DE NEVERS à Catherine de Médicis. « Amiens, dernier d'avril 1587 » ; 21 Copie d'une lettre « du roy à Mr d'Estrée,... 16 octobre 1587 » ; 22 Minute de lettre du duc DE NEVERS à « monseigneur Brullart,... D'Amiens, ce 5e jung 1587 » ; 23 Minute de lettre du duc DE NEVERS à « monseigneur de Villeroy,... D'Amiens, ce 24 may 1587 » ; 24 Minutes de lettres du duc DE NEVERS « au roy, à Mr Brulart et à Mr de Villeroy,... De Amiens, ce dernier avril 1587 » ; 25 Lettre d'«ANNE DE JOYEUSE,... à mon cousin monsieur de Chattes, commandeur de Lormeteau et mon lieutenant au gouvernement de Dieppe... De Paris, ce XXVe may 1587 ». Copie ; 26 « Coppie de lectre escripte à madame [la duchesse de Nevers] par les eschevins de Maizieres... De Maizieres, le XXIXe avril 1587 » ; 27 « Coppie de lectre escripte par madame [la duchesse DE NEVERS] à madame de Guyse » ; 28 Lettre de la duchesse DE NEVERS « Henriette de Cleve,... à mon fils » Charles de Gonzague-Clèves ; 29 Copie d'une lettre des Srs « PENAULT et CHAMPAIGNART » au duc de Nevers ; 30 Lettre, avec chiffre, du duc DE NEVERS à son fils ; 31 Lettre de « HENRIETTE [DE CLEVES, duchesse DE NEVERS]... à mon fils » ; 32 Lettre, avec chiffre et déchiffrement, du duc DE NEVERS « à mon fils le duc de Rethelois » ; 33 Lettre de M. « DE MONTHOLON » au duc de Nevers. « Ce 20 janvier 1590 » ; 34 Lettre de « HENRIETTE DE CLEVES [duchesse DE NEVERS]... à mon fils » ; 35 « Roole des pauvres quy sont aux villages circonvoisins de la ville d'Amyans, au mois de may 1587 » ; 36 Lettre du duc DE NEVERS. « D'Amyens, ce 27 may 1587 ». Minute ; 37 « Moien proposé pour accorder les sieurs de La Vieuville et de Grandpré,... 20 may [15]87 » ; 38 Promesse des habitants de Mézières de reconnaître M. de La Vieuville pour gouverneur de la ville. « Ce vingt sixiesme jour du mois d'aoust mil cinq cens quatre vingtz sept ». Copie ; 39 Minute de lettre du duc DE NEVERS à « monseigneur de La Vieville,... De Paris, ce 31 aost 1587 » ; 40 Lettre de M. « A. DE LA ROCHETTE,... à monseigneur le duc de Nevers » ; 41 Minute de lettre de « LODOVICO GONZAGA », duc DE NEVERS, à « monsieur Brulart,... De Mezieres, ce IIIIe septembre 1580 » ; 42 Minute de lettre de « LODOVICO GONZAGA [duc DE NEVERS]... au roy... De Mezieres, ce IIIe septembre 1580 » ; 43 « Coppie d'arrest pour Mr le mareschal d'Aumont contre M. de Beaupré et autres ses complices... Donné à Sainct Maur des Fossez, le vingt huictiesme jour d'aoust, l'an de grace mil cinq cens quatre vingtz » ; 44 Lettre de « CATERINE DE GONZAGUES et DE CLEVES » à la duchesse de Nevers, sa mère. « De Nevers, ce XXIXe aoust 1580 » ; 45 Lettre de « MARIO VOLTA,... all' illmo... Sr duca di Nevers,... Di Venetia, li XXXI d'ottobre 1589 ». En italien ; 46 Lettre de « frere ENGUERRAND ESCOMBARD, ministre provincial de la province de France parisienne... à monseigneur le duc de Nevers,... De vostre monastere de l'Ave Maria, à Paris, le vingtdeuxiesme jour du moys d'apvril 1588 » ; 47 Lettre de « C[ARLO] BIRAGO,... all' illmo sigr ducha di Nevers,... Da Bles, li V genaro 1581 ». En italien ; 48 Minute de lettre de « LODOVICO GONZAGA [duc DE NEVERS]... à monsieur de St Luc,... 1580 » ; Manque une lettre de M. BODET au duc de Nevers ; 49 Lettres d'appel d'un décret de prise de corps obtenu contre Jacques de Morogues, Sr des Landes. « Donné à Paris en nostre... parlement, le vingt deulxiesme jour de decembre, l'an de grace mil [cinq] cens soixante dix neuf ». Copie ; 50 Lettre des « gens du conseil, eschevins et gouverneurs de la ville de Chaalons... à monseigneur le duc de Nevers,... De Chaalons, ce XVe avril 1589 » ; 51 « Distribution des deniers provenans des offices de contrerolleurs des tiltres » ; 52 « Copie » d'une lettre du duc DE NEVERS « à la royne, mere du roy... De Nevers, ce 14 decembre 1580 » ; 53 « Coppie d'une lectre escripte par monseigneur [le duc DE NEVERS] à Mr de Grillon,... De Nevers, ce 14 decembre 1580 » ; 54 « Coppie de lectre escripte par monseigneur [le duc DE NEVERS] à Mr Brulart,... De la Cassine le Comte, ce XXme octobre 1580 » ; 55 Minute de lettre du duc DE NEVERS à « monsieur Pinart,... De la Cassine le Comte, ce XXme octobre 1580 » ; 56 Lettre de « BERNARDIN COSTA,... au reverend Pere le P. Alexandre George, receveur du college de la compagnie de Jesus, Paris... De Lyon, le 7 octobre 1587 » ; 57 Lettre de M. DE « ST LUC,... à monseigneur le duc de Nevers,... De Broage, le 7 fevrier » ; 58 Copie de quatre lettres écrites au duc de Nevers, de Paris, les 4, 14, 11 et 30 may 1587 ; 59 Lettre de M. « DE LA ROCHETTE,... à monseigneur le duc de Nivernois,... De Paris, ce 26 de l'an » ; 60 « Coppie de la trefve et continuation d'icelle faicte avec Mr de Sedan jusques en fin de l'année 1587 » ; 61 « Estat des pensions, gaiges et rentes viageres » payés par la maison de Nevers. « 1587 » ; 62 Lettre adressée « à monsieur le duc de Nevers » ; 63 « Des gayz de Loyre... depuis le port de Nevers jusques au port de Digoin... Le vendredy seiziesme jour du mois de septembre mil cinq cens quatre vingtz et sept » ; 64 Lettre, avec chiffre, de « L. REGNYER » au duc de Nevers. « A Parys, le 12 janvier » ; 65 Lettre, avec chiffre, de « L. REGNYER » au duc de Nevers. « A Parys, le 9 janvyer »

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Ejercicio y resultados clínicos en pacientes con enfermedad de Parkinson: una revisión sistemática y metaanálisis

Antecedentes. La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más común en el mundo, la cual afecta el componente físico, psicológico y social de los individuos que la padecen. Numerosos estudios han abordado los beneficios de diferentes programas de ejercicio, llegando a ser una estrategia no-farmacológica efectiva para aminorar el deterioro funcional de los pacientes con EP. Objetivo. Determinar los efectos de las diferentes modalidades de ejercicio físico en los principales desenlaces clínicos en pacientes con EP. Métodos. Se consultaron las bases de datos MEDLINE, EMBASE, Scopus, CENTRAL y PEDro desde febrero de 1990 hasta febrero de 2014 para identificar Ensayos Clínicos Aleatorizados (ECA) publicados. Además, se examinaron las listas de referencias de otras revisiones y de estudios identificados. La extracción de datos se realizó por dos autores independientes. Se empleó un modelo de efectos aleatorios en presencia de heterogeneidad estadística (I2>50%). El sesgo de publicación fue evaluado mediante el gráfico de embudo. Resultados: Un total de 18 estudios fueron incluidos. Se encontraron diferencias estadísticamente significativas en las intervenciones con ejercicio y las siguientes medidas de resultado, severidad de los síntomas motores (MDS-UPDRS) DME 1.44, IC 95% [-2.09 a -0.78] (p<0.001) I2= 87,9% y el equilibrio DME 0,52 IC 95% [0,30 a 0,74] (p<0.001) I2= 85,6%. En el análisis de subgrupos en la modalidad de ejercicio aeróbico, en MDS-UPDRS DME -1,28, IC 95% [-1,98 a -0,59] (p<0.001), 3 calidad de vida DME -1,91 IC 95% [-2,76 a -1,07] (p<0.001), equilibrio DME 0,54 IC 95% [0,31 a 0,77] (p<0.001), 10-m WT DME 0,15 IC 95% [0,06 a 0,25] (p<0.001) y Vo2 máximo DME -1,09 IC 95% [-1,31 a -0,88] (p=0.001), 6MWT DME 40,46 IC 95% [11,28 a 69,65] (p=0.007). Conclusiones: El ejercicio aeróbico produjo mejoras significativas en MDS UPDRS, equilibrio, calidad de vida, 10-m WT y y Vo2 máximo; mientras que el ejercicio combinado mejoró la fuerza.