Macroscopic and histological aspects of the pharynx and larynx of the giant anteater (Myrmecophaga tridactyla Linnaeus, 1758)

Giant anteater (Myrmecophaga tridactyla) is an endangered species that resides in much of Latin America, but it has been losing its habitat, especially in the Cerrado biome, where it constantly suffers traumas resulting from fires and roadkill. The anatomical knowledge of structures of the respiratory system is important for a better morphophysiological understanding of the species. Thus, this study aimed to perform the macroscopic and histomorphological description of the pharynx and larynx of the giant anteater. Twelve adult giant anteaters were used, three of them fixed in buffered formalin for further dissection and pharynx and larynx macroscopic analysis of structures. From the other animals, samples of the pharynx and larynx were collected and prepared for histological evaluation under optical microscope. Macroscopically, their pharynx and soft palate are extensive, and the anatomical location of these structures and the larynx differs greatly from that described in other species. The larynx, although more caudal, was similar to that of other animals. Histologically, the epithelium of these regions varied between the pseudostratified ciliated columnar and the non-keratinized stratified squamous epithelium. Laryngeal cartilages were composed of elastic (epiglotti) and hyaline cartilages (arytenoid, cricoid and thyroid cartilage), with an ossification process and glandular clusters around the hyaline cartilage. The distinct anatomical location of the pharynx and larynx of Myrmecophaga tridactyla is the main macroscopic finding of this study, besides the length of the pharynx and soft palate of these animals.

Parasitism of Dirofilaria incrassata Molin, 1858 in coatis (Nasua nasua)

Populations of the coati, Nasua nasua, like the populations of other wild animals, are regulated by several biotic or abiotic factors. For example, parasites act as a biotic factor affecting the dynamics and density of coati populations. The parasitic nematodes of coatis include Dirofilaria species, such as Dirofilaria immitis, Dirofilaria repens, and Dirofilaria incrassata. Considering that there are few records on parasitism by D. incrassata, including information on the life cycle or location in the host body, this study aimed to investigate the infection of N. nasua by D. incrassata in midwestern Brazil. Thus, two coatis (males and adults) from the Cerrado of Goiás, which died (cause unknown) at the Wild Animal Screening Center/IBAMA in the municipality of Goiânia, Goiás, Midwestern of Brazil, were dissected and all helminths found were collected, identified following specific keys and quantified. A total of 85 specimens of D. incrassata were collected, with a mean parasitic intensity of 42.5 and a parasitic amplitude ranging from 40 to 45, measuring 41-93 mm in length and 0.23-0.45 mm in width. All helminths were adults and were distributed in the superficial and deep fascia (at different levels) from the neck to the hind limb. Most helminths were tangled, with some encased in a connective tissue film. Most reported human heartworm cases refer to subcutaneous or ocular heartworm infection, mainly caused by D. repens, although other species of heartworm may be associated. D. incrassata was not reported as zoonotic agent, diferently of other Dirofilaria species associated with wild animals and with zoonotic potential in the Americas. This study reiterates N. nasua as the definitive host for D. incrassata and the subcutaneous tissue as the site of choice for this helminth in the adult form. In addition, it reports new body regions where the parasite occurs. This study is the first to document the occurrence of D. incrassata infestation in the State of Goiás, Brazil.

Morphological and radiological study of the shoulder and elbow joints of the giant anteater (Myrmecophaga tridactyla)

The giant anteater (Myrmecophaga tridactyla) has specialized thoracic limbs to forage by breaking the walls of anthills and termite mounds. They also play critical roles in defense posture and locomotion. This study aimed to provide a morphological and radiographic description of the shoulder joint and elbow joint of the giant anteater. Both joints of 13 tamanduas were assessed by morphological dissections and histological evaluation and radiographies without and with positive contrast. The radiographic projections selected to this study were the mediolateral and craniocaudal projections. The radiographic and anatomical findings were compared with the following results: the shoulder joint had a continuous joint capsule with the tendon sheaths of the short head and long head of the biceps brachii muscle, which could be visualized with an injection of 3 ml of intra-articular contrast. The shoulder joint arthrography was performed with the needle positioned cranially to the joint for contrast injection. The elbow joint presented three articular compartments, and the insertion of the joint capsule was proximal to the radial fossa and distal to the radial tuberosity in the radial notch of the ulna, which were possible to identify with 2 ml of intra-articular contrast. The elbow joint arthrography was performed with the needle positioned laterally to the joint for contrast injection. Moreover, the joint capsule presented a caudomedial distention and fat pads. The powerful muscles of the forelimb play a fundamental role in maintaining the shoulder joint and elbow joint stability due to bony adaptations and the absence of usual ligaments. The morphological and radiological study provided relevant information on the soft-tissue characteristics of shoulder and elbow joints, which may aid clinical-surgical and diagnostic imaging procedures.

Anatomical aspects of the forearm muscles of Myrmecophaga tridactyla

The giant anteater is one of the species classified as vulnerable to extinction. Burning and being run over are among important causes in the decrease of individuals of this species and a better knowledge of the anatomy of these animals can contribute to the treatment of injured animals and their restoration to the environment. Thus, the objective of this work was to describe aspects of the anatomy of the muscles of the forearm of M. tridactyla. For this purpose, six adult specimens were used, three females and three males. The corpses were fixed with a 10% formaldehyde solution and preserved in vats contai-ning the same solution. The thoracic limbs were dissected by routine dissection techniques. The forearm muscles of M. tridac-tyla were: brachioradialis; radial carpal extensor; common finger extensor; lateral finger extensor, ulnar carpal extensor; finger extensor I and II; long abductor of finger I; supinator, radial carpal flexor; ulnar flexor of the carpus, superficial flexor of the fingers, deep flexor of the fingers, pronator teres and square pronator, which were innervated by the radial, ulnar and median nerves. These muscles give a large volume to the forearm, are robust and have highly developed tendons, especially those invol-ved with the flexion of the carpus, digits and elbow, actions that are fundamental to your defense habits and search for food.

Morphological Aspects of the Superficial Lymph Nodes of Myrmecophaga tridactyla

Background: The giant anteater is a Xenarthra of the Myrmecophagidae family. It is classified in Brazil as vulnerable specie, however, in Rio de Janeiro and Rio Grande do Sul it is probably extinct. In an attempt to contribute to the preservation of the species, many injured animals are referred for treatment and rehabilitation, but the lack of information about morphology may hinder a more efficient clinical-surgical approach. The knowledge on the topography, dimensions and morphology of lymph nodes of a given species is essential for medical practice. The aim of this study was to identify and describe the general morphology of the superficial lymph nodes of Myrmecophaga tridactyla.Materials, Methods & Results: Ten cadavers of adult Myrmecophaga tridactyla were used in this study. They were fixed and preserved with 10% formaldehyde solution and dissected throughout their length to locate their superficial lymph nodes. Lymph nodes of each center were removed for mesoscopic analysis. Measurements of width, length and thickness were obtained by a digital caliper. The superficial lymph nodes observed in the head were the mandibular and the intermandibular, while in the neck were identified superficial cervical and deep cervical lymph nodes. In the thoracic limbs, the axillary and the axillary accessory lymph nodes were present. In the pelvic limbs just one lymph node, the femoral, was observed, located in the thick subcutaneous fascia of the medial surface of the thigh. The main anatomical differences found in the lymph nodes of M. tridactyla are the absence of parotid, popliteal and subiliac lymph nodes and the presence of intermandibular lymph nodes and the developed femoral lymph nodes, which are unique in the pelvic limbs of this species. Moreover, some superficial lymph nodes were formed by several small lymph nodes, forming clusters, as observed in the proper and accessory axillary and femoral lymph nodes.Discussion: The lymph nodes of the head, neck and forelimbs of the M. tridactyla followed the pattern observed in domestic animals and rats, while the morphological pattern of the lymph nodes of the head and the hindlimb differed from that described in domestic animals. Different from the dogs and ruminants where a range of superficial lymph nodes can be normally palpated, such as the mandibular; retropharyngeal; superficial cervical; subiliac; popliteal; mammary and superficial inguinal, only the femoral lymph nodes are palpable in M. tridactyla. The main reasons for this are the greater thickness of the skin and the absence of certain classic lymphocytes in the anteater. The peculiar anatomical features of the head and neck of M. tridactyla may have induced changes in the lymph centers of these regions when compared to the morphologic pattern of the terrestrial mammals in general. The lymph drainage of the neck, forelimbs and trunk wall was considered to be similar to that of dog, since there is equivalence of lymph nodes between these two species. The lymphatic afferents of the abdominal wall, gluteal region and hindlimbs are probably directed to the large femoral lymph nodes, which differs from domestic animals, whose lymph are mainly drained to the subiliac, ischiatic and popliteal lymph nodes. The anatomical differences related to the number, size and topography of the lymph nodes observed in M. tridactyla may be relevant in the medical procedures of this species.

Genotoxic and mutagenic assessment of iron oxide (maghemite-γ-Fe2O3) nanoparticle in the guppy Poecilia reticulata

The environmental risk of nanomaterials (NMs) designed and used in nanoremediation process is of emerging concern, but their ecotoxic effects to aquatic organism remains unclear. In this study, the citrate-coated (maghemite) nanoparticles (IONPs) were synthesized and its genotoxic and mutagenic effects were investigated in the female guppy Poecilia reticulata. Fish were exposed to IONPs at environmentally relevant iron concentration (0.3 mg L^-1) during 21 days and the animals were collected at the beginning of the experiment and after 3, 7, 14 and 21 days of exposure. The genotoxicity and mutagenicity were evaluated in terms of DNA damage (comet assay), micronucleus (MN) test and erythrocyte nuclear abnormalities (ENA) frequency. Results showed differential genotoxic and mutagenic effects of IONPs in the P. reticulata according to exposure time. The IONP induced DNA damage in P. reticulata after acute (3 and 7 days) and long-term exposure (14 and 21 days), while the mutagenic effects were observed only after long-term exposure. The DNA damage and the total ENA frequency increase linearly over the exposure time, indicating a higher induction rate of clastogenic and aneugenic effects in P. reticulata erythrocytes after long-term exposure to IONPs. Results indicated that the P. reticulata erythrocytes are target of ecotoxicity of IONPs.

Back and neck pain prevalence and their association with physical inactivity domains in adolescents

PURPOSE

Back pain affects people of all ages. This may be associated with physical inactivity, and in the case of physical activity in different domains, the relationship with back pain is not clear in the literature. The aim of this study was to estimate the prevalence of low back and neck pain and investigate their association in different domains of physical inactivity.

METHODS

1011 randomly selected students participated in this study. Neck and back pain were assessed using the Nordic questionnaire, whereas the Baecke Physical Activity questionnaire was used to measure physical activity domains. Separate Binary Logistic Regression models were performed to investigate the association of physical activity domains with neck or back pain.

RESULTS

17.4% of the students reported cervical pain, while 18.0% reported low back pain. Older adolescents had a higher prevalence of cervical pain (24.4%) than younger adolescents (11.9%) (p value <0.001), as well as lumbar pain, being 25.1% in older adolescents and 12.4% in younger (p value <0.001). Adolescents physically inactive in the school environment were less likely to have pain in the cervical region [OR 0.67 (0.44-0.99)] or back pain [OR 0.60 (0.40-0.91)]. Being inactive in occupational activities was associated with cervical pain [OR 1.49 (1.06-2.10)]. Being inactive in the sports environment presented a marginal relationship with pain in the cervical region [OR 1.41 (0.99-2.02)].

CONCLUSIONS

The prevalence of neck and low back pain was higher in older adolescents and physical inactivity in the sporting context and occupational activities could be a risk factor to increase the chances of back pain.

Estudo dos nervos do membro pélvico do Tamandua tetradactyla / Study of the nerves of the pelvic limb of Tamandua tetradactyla

O objetivo deste estudo foi descrever a distribuição dos nervos do membro pélvico do T. tetradactyla. Para tanto, foram utilizados quatro cadáveres de animais adultos cedidos pelo IBAMA-GO. Cada animal teve o membro pélvico de ambos os antímeros dissecados após fixação em solução de formaldeído a 10%. Os nervos genitofemoral e cutâneo femoral lateral distribuíram-se na pele medial e craniomedial e craniolateral da coxa, respectivamente. O nervo femoral emitiu ramos para os músculos psoas menor, iliopsoas, sartório e pectíneo; terminando por penetrar no músculo quadríceps femoral. Emitiu o nervo safeno, que em seu trajeto, inervou a pele da face medial da coxa e perna e região dorsomedial do pé. O nervo obturador emitiu ramos para músculos mediais da coxa. Os nervos glúteos cranial e caudal inervaram a musculatura glútea. O nervo isquiático inervou os músculos gêmeos, quadrado femoral, semimembranoso, semitendinoso, bíceps femoral longo e curto e terminou dividindo-se nos nervos cutâneo lateral da sura, tibial, e fibular comum. O nervo cutâneo lateral da sura inerva a região cutânea craniolateral do joelho e perna, enquanto os nervos fibular comum e tibial inerva a musculatura da perna e terminam distribuindo-se no pé.

Torque-angle-velocity Relationships and Muscle Performance of Professional and Youth Soccer Players

Soccer matches consist of a variety of different activities, including repeated sprints. Time to attain velocity (TTAV), load range (LR) and the torque-angle-velocity relationship (TAV_3D) represent an important measurement of muscle performance, however there are few related studies. The aim of this study was to compare these outcomes between soccer players of different age category. 17 professional (PRO) and 17 under-17 (U17) soccer players were assessed for concentric knee flexion/extension at 60, 120 and 300°/s. For the extensor muscles, differences were found in favor of the U17 group for TTAV and LR outcomes at 120°/s, however, the PRO group maintained higher torques in both movement directions in comparison to the U17 in TAV_3D evaluation. These results suggest that muscle performance of the PRO group is more efficient than the U17 group.

SUBSTITUIÇÃO DE FONTE DE AMIDO POR FIBRA SOLÚVEL EM DETERGENTE NEUTRO NA DIETA DE VACAS

Resumo Conduziu-se este trabalho com o objetivo de avaliar os efeitos da substituição do milho por polpa cítrica sobre o desempenho de vacas leiteiras. Utilizaram-se nove vacas (três canuladas no rúmen) da raça Holandesa, pluríparas, com 80 ± 24 dias de lactação e produção média diária de 20 ± 0,58 kg de leite. Os animais foram confinados em tie stall, com cocho e bebedouro individuais. Utilizou-se um quadrado latino 3 x 3. Os períodos experimentais tiveram duração de 21 dias, sendo 14 de adaptação e sete de coleta. Os tratamentos foram constituídos de 100% milho grão (MG), 50% milho grão e 50% polpa cítrica (MP) e 100% polpa cítrica (PC). Não houve diferenças significativas na ingestão dos nutrientes (MS, MO, FDN, FDA, PB, amido) entre dietas. O tratamento com polpa cítrica produziu maior proporção de acetato em relação aos demais, bem como maior relação acetato/propionato. As médias de pH situaram-se entre 5,86 e 7,35. As médias de N-NH3 apresentaram maiores diferenças nos tempos 2 e 3 horas pós-alimentação. Não houve diferenças entre as dietas para produção total de leite corrigido para 4% de gordura, proteína, lactose, extrato seco total (EST) e nitrogênio uréico do leite (NUL).

Balneotherapy (or spa therapy) for rheumatoid arthritis. An abridged version of Cochrane Systematic Review

BACKGROUND

Treatment options for rheumatoid arthritis (RA) include pharmacological interventions, physical therapy treatments and balneotherapy.

AIM

To evaluate the benefits and harms of balneotherapy in patients with RA.

DESIGN

A systematic review.

POPULATION

Studies were eligible if they were randomised controlled trials consisting of participants with definitive or classical RA.

METHODS

We searched various databases up to December 2014. Balneotherapy had to be the intervention under study, and had to be compared with another intervention or with no intervention. We considered pain, improvement, disability, tender joints, swollen joints and adverse events among the main outcome measures. We excluded studies when only laboratory variables were reported as outcome measures. Two review authors independently selected trials, performed data extraction and assessed risk of bias.

RESULTS

This review includes nine studies involving 579 participants. Most studies showed an unclear risk of bias in most domains. We found no statistically significant differences on pain or improvement between mudpacks versus placebo (1 study; N.=45; hand RA; very low level of evidence). As for the effectiveness of additional radon in carbon dioxide baths, we found no statistically significant differences between groups for all outcomes at three-month follow-up (2 studies; N.=194; low to moderate level of evidence). We noted some benefit of additional radon at six months in pain (moderate level of evidence). One study (N.=148) compared balneotherapy (seated immersion) versus hydrotherapy (exercises in water), land exercises or relaxation therapy. We found no statistically significant differences in pain or in physical disability (very low level of evidence) between groups. We found no statistically significant differences in pain intensity at eight weeks, but some benefit of mineral baths in overall improvement at eight weeks compared to Cyclosporin A (1 study; N.=57; low level of evidence).

CONCLUSION

Overall evidence is insufficient to show that balneotherapy is more effective than no treatment; that one type of bath is more effective than another or that one type of bath is more effective than exercise or relaxation therapy.

CLINICAL REHABILITATION IMPACT

We were not able to assess any clinical relevant impact of balneotherapy over placebo, no treatment or other treatments.

Facial exercise therapy for facial palsy: systematic review and meta-analysis

The effectiveness of facial exercises therapy for facial palsy has been debated in systematic reviews but its effects are still not totally explained.

OBJECTIVE

To perform a systematic review with meta-analysis to evaluate the effects of facial exercise therapy for facial palsy.

DATA SOURCES

A search was performed in the following databases: Cochrane Controlled Trials Register Library, Cochrane Disease Group Trials Register, MEDLINE, EMBASE, LILACS, PEDro, Scielo and DARE from 1966 to 2010; the following keywords were used: 'idiopathic facial palsy', 'facial paralysis', 'Bell's palsy', 'physical therapy', 'exercise movement techniques', 'facial exercises', 'mime therapy' 'facial expression', 'massage' and 'randomized controlled trials'.

REVIEW METHODS

The inclusion criteria were studies with facial exercises, associated or not with mirror biofeedback, to treat facial palsy.

RESULTS

One hundred and thirty-two studies were found but only six met the inclusion criteria. All the studies were evaluated by two independent reviewers, following the recommendations of Cochrane Collaboration Handbook for assessment of risk of bias (kappa coefficient = 0.8). Only one study presented sufficient data to perform the meta-analysis, and significant improvements in functionality was found for the experimental group (standardized mean difference (SMD) = 13.90; 95% confidence interval (CI) 4.31, 23.49; P = 0.005).

CONCLUSION

Facial exercise therapy is effective for facial palsy for the outcome functionality.

Electromyographic activity of knee stabilizer muscles during six different balance board stimuli after anterior cruciate ligament surgery

The purpose of this study was to compare the electrical activity of the knee stabilizers, in patients with ACL (anterior cruciate ligament) reconstructed and uninjured individuals during different balance board stimuli. Eleven post-surgery individuals and eleven uninjured controls participated in the study. The muscular activity of the vastus medialis obliquus, vastus lateralis, semitendinosus, biceps femoris and gastrocnemius medial were analyzed by surface electromyography during the execution of six different balance board activities. All electromyographic data were reported as percentage of RMS mean values obtained in maximal voluntary isometric contractions (MVIC) for each muscle. When comparing the individuals with ACL reconstructed and uninjured controls, minor electromyographic activity was observed (MVIC %) for all the muscles in the surgery group (P < 0.05), however, when comparing each exercise between the groups, a statistically significant difference for vastus lateralis was demonstrated in the floor exercise (P = 0.02) and for gastrocnemius on the round board (P = 0.04). Individuals ACL reconstructed presented a decrease in muscular activity during different balance board stimuli, which suggests that compensatory alterations after ACL may still exist even after a surgery to repair an ACL rupture.

Anti-hepatitis C virus-positive blood donors: are women any different?

We sought to assess clinical, epidemiological, biochemical, serological and histological characteristics of anti-hepatitis C virus (HCV)-positive female blood donors and compare them with men. As women are frequently the minority among blood donors, studies evaluating this population usually reflect characteristics of male gender. This retrospective study included 380 blood donors with confirmed positive anti-HCV. The mean age was 36.9 +/- 11.3 years and 33.2% were women. Compared with men, female donors showed higher prevalence of prior transfusion of blood products (P = 0.031) and lower prevalence of intravenous drug use (P = 0.001) and alcohol abuse (P < 0.001). Women exhibited lower medians of alanine aminotransferase (P < 0.001) and gamma-glutamyltransferase (P < 0.001). They also showed higher platelet count (P < 0.001) and prothrombin activity (P = 0.049), and a lower frequency of antibody against core antigen of hepatitis B virus (anti-HBc) positivity (P = 0.032). A higher proportion of spontaneous viral clearance (P = 0.001) and a lower frequency of viraemia (P < 0.001) were observed among women. On liver biopsy, women had lower prevalence of fibrosis stage > or = 2. Multivariate analysis identified age (OR = 1.050, 95% CI: 1.019-1.081, P = 0.001) and anti-HBc positivity (OR = 2.184, 95% CI: 1.010-4.722, P = 0.047) as independent predictors of significant fibrosis. Female blood donors presented higher prevalence of spontaneous viral clearance as well as biochemical and histological evidence of less advanced liver disease. These findings could be because of intrinsic characteristics of female gender or secondary to associated factors such as younger age or anti-HBc positivity.

Electromyographic analysis of deltoid muscle fatigue during abduction on scapular and frontal planes

The aim of the study was to compare the fatigue rates of the deltoid muscle portions in the scapular and frontal planes. Ten healthy men without shoulder muscle impairment took part in the study. They performed isometric arm abduction for 30 seconds against a resistance of load cell while the electromyographic data were collected. The electromyographic data were transformed by the Fast Fourier Transform, to obtain the median power frequency (MDPF). The changes in MDPF of the three deltoid portions in the scapular and frontal planes were compared. The acromialis and spinalis portions fatigued during the exercises. The clavicularis portion presented no fatigue. A statistically significant difference occurred between the clavicularis and the other two portions (P < 0.05). No differences were found when the planes were compared. It represents to practice no preferential order during rehabilitation. Moreover, the acromialis and spinalis portions fatigue, although the clavicularis portion did not fatigue. The actions of other muscles of the shoulder girdle can explain this fact. Moreover, these two portions need more attention to avoid fatigue during exercises. In general, therapeutic strategies for injured patients should not only be directed towards increased force, but also towards fatigue control during shoulder exercises.

Balneotherapy for osteoarthritis

BACKGROUND

Balneotherapy (or spa therapy, mineral baths) for patients with arthritis is one of the oldest forms of therapy. One of the aims of balneotherapy is to soothe the pain and as a consequence to relieve patients' suffering and make them feel well. In this update we included one extra study.

OBJECTIVES

To assess the effectiveness of balneotherapy for patients with osteoarthritis (OA).

SEARCH STRATEGY

We searched the following databases up to October 2006: EMBASE, PubMed, the Cochrane 'Rehabilitation and Related Therapies' Field database, PEDro, CENTRAL (Issue 3, 2006) and performed reference checking and communicated with authors to retrieve eligible studies.

SELECTION CRITERIA

Randomised controlled trials (RCT) comparing balneotherapy with any intervention or no intervention. At least 90% of the patient population had to be diagnosed with OA.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed quality and extracted data. Disagreements were solved by consensus. In the event of clinical heterogeneity or lack of data we refrained from statistical pooling.

MAIN RESULTS

Seven trials (498 patients) were included in this review. Two studies compared spa-treatment with no treatment. One study evaluated baths as an add-on treatment to home exercises and another compared thermal water from Cserkeszölö with tap water (placebo). Three studies evaluated sulphur or Dead Sea baths with no treatment or mineral baths with tap water baths or no treatment. Only one of the trials performed an intention-to-treat analysis and two studies provided data to perform an intention-to-treat analysis ourselves. A 'quality of life' outcome was reported by one trial. We found: silver level evidence concerning the beneficial effects on pain, quality of life and analgesic intake of mineral baths compared to no treatment (SMD between 1.82 and 0.34). a statistically significant difference in pain and function of Dead Sea + sulphur versus no treatment, only at end of treatment (WMD 5.7, 95%CI 3.3 to 8.1), but not at 3 month follow-up (WMD 2.6, 95%CI -1.1 to 6.3). no statistically significant differences in pain or function at one or three months of Dead Sea baths versus no treatment (WMD 0.5, 95%CI -0.6 to 1.6) or at one or three months of sulphur baths versus no treatment (WMD 0.4, 95%CI -0.9 to 1.7). Adverse events were not measured in the included trials.

AUTHORS' CONCLUSIONS

We found silver level evidence (www.cochranemsk.org) concerning the beneficial effects of mineral baths compared to no treatment. Of all other balneological treatments no clear effects were found. However, the scientific evidence is weak because of the poor methodological quality and the absence of an adequate statistical analysis and data presentation. Therefore, the noted "positive findings" should be viewed with caution.

Technical note: dimensionless ray transference

The ray transference matrix completely characterises the first-order optical nature of an optical system including the eye. It is in terms of the transference that quantitative analyses (for example, calculation of an average eye) can be performed. However, the fact that the entries of the transference do not have the same physical dimensions precludes the calculation of the usual scalar value (a Frobenius norm for example) for a change or difference between two optical systems. The purpose of this note is to show how to use the wavelength of the light as a natural unit of length to define a dimensionless transference and so make it possible to calculate a meaningful norm. In most practical applications, some components of the dimensionless transference may dominate unreasonably in the resulting norm in which case suitably weighted norms may be more appropriate. In an appendix, some of the issues are illustrated by application to a lens.

Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft

BACKGROUND

Following coronary artery bypass graft (CABG), the main causes of postoperative morbidity and mortality are postoperative pulmonary complications, respiratory dysfunction and arterial hypoxemia. Incentive spirometry is a treatment technique that uses a mechanical device (an incentive spirometer) to reduce such pulmonary complications during postoperative care.

OBJECTIVES

To assess the effects of incentive spirometry for preventing postoperative pulmonary complications in adults undergoing CABG.

SEARCH STRATEGY

We searched CENTRAL on The Cochrane Library (Issue 2, 2004), MEDLINE (1966 to December 2004), EMBASE (1980 to December 2004), LILACS (1982 to December 2004), the Physiotherapy Evidence Database (PEDro) (1980 to December 2004), Allied & Complementary Medicine (AMED) (1985 to December 2004), CINAHL (1982 to December 2004), and the Database of Abstracts of Reviews of Effects (DARE) (1994 to December 2004). References were checked and authors contacted. No language restrictions were applied.

SELECTION CRITERIA

Randomized controlled trials comparing incentive spirometry with any type of prophylactic physiotherapy for prevention of postoperative pulmonary complications in adults undergoing CABG.

DATA COLLECTION AND ANALYSIS

Two reviewers independently evaluated the quality of trials using the guidelines of the Cochrane Reviewers' Handbook and extracted data from included trials.

MAIN RESULTS

Four trials with 443 participants contributed to this review. There was no significant difference in pulmonary complications (atelectasis and pneumonia) between treatment with incentive spirometry and treatment with positive pressure breathing techniques (continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) and intermittent positive pressure breathing (IPPB)) or preoperative patient education. Patients treated with incentive spirometry had worse pulmonary function and arterial oxygenation compared with positive pressure breathing (CPAP, BiPAP, IPPB).

AUTHORS' CONCLUSIONS

Individual small trials suggest that there is no evidence of benefit from incentive spirometry in reducing pulmonary complications and in decreasing the negative effects on pulmonary function in patients undergoing CABG. In view of the modest number of patients studied, methodological shortcomings and poor reporting of the included trials, these results should be interpreted cautiously. An appropriately powered trial of high methodological rigour is needed to determine those patients who may derive benefit from incentive spirometry following CABG.

Effects of chronic exposure to soy meal containing diet or soy derived isoflavones supplement on semen production and reproductive system of male rabbits

Soy and derivative diets deliver large doses of isoflavones to human and animals throughout their lifespan, including gestation. Epidemiologic and experimental data suggest that the consumption of soybean containing foods may protect against cardiovascular disease and decrease breast, prostate and endometrial cancer risk. Based on animal and in vitro studies, however, concerns have been raised that consumption of isoflavones may cause potential adverse effects on the reproductive tract and behavior. The aim of this study was to investigate the effects of chronic consumption of a soy meal containing diet or soy isoflavones supplement on the morphology of reproductive organs, semen quality, age that males reached puberty, and sexual behavior of male rabbits. With this purpose, 16 female rabbits were randomly assigned to receive: (1) a soy- and alfalfa-free diet; (2) a soy- and alfalfa-free diet supplemented with 5mg/kg body wt./day of soy isoflavones; (3) a soy- and alfalfa-free diet supplemented with 20mg/kg body wt./day of soy isoflavones; (4) a diet containing 18% of soy meal, throughout the gestation and lactation. After weaning, male offspring received the same diet, which was given to the respective mother. The age that males reached puberty, semen characteristics and sexual behavior were evaluated in these animals. At 33 weeks of age, the reproductive organs were submitted to histological evaluation. Rabbits, which received large amounts of isoflavones (20mg/kg body wt./day) had a lesser food intake, body weight and semen volume. Spermatogenesis, morphology of male genital organs and sexual behavior did not differ significantly from the control group. We conclude that chronic dietary treatment with soy based diet or soy isoflavones have no adverse effects on the observed reproductive patterns of male rabbits.

The exponential-mean-log-transference as a possible representation of the optical character of an average eye

Considering a set of eyes, how does one define an average whose optical character represents an average of the optical characters of the eyes in the set? The recent proposal of the exponential-mean-log-transference was based on a conjecture. The purpose of this note is to provide justification by proving the conjecture and defining the conditions under which it fails.

Balneotherapy for rheumatoid arthritis

BACKGROUND

Balneotherapy (spa therapy) for patients with arthritis is one of the oldest forms of therapy. One of the aims of balneotherapy is to soothe the pain, improve joint motion and as a consequence to relieve people' suffering and make them feel well.

OBJECTIVES

To perform a systematic review on the effectiveness of balneotherapy for rheumatoid arthritis.

SEARCH STRATEGY

Using the Cochrane search strategy, studies were found by screening: 1) The MEDLINE CD-ROM database from 1966 to June 2002 and 2) the database from the Cochrane 'Rehabilitation and Related Therapies' Field, the Pedro database up to June 2002. Also, 3) reference checking and 4) personal communications with authors was carried out to retrieve eligible studies. Date of the most recent literature search: June, 2002

SELECTION CRITERIA

Studies were eligible if they were randomised controlled trials (RCTs) comparing balneotherapy with any other intervention or with no intervention. Included participants all suffered from definite or classical rheumatoid arthritis (RA) as defined by the American Rheumatism Association Criteria (ARA) or by the criteria of Steinbrocker. At least one of the WHO/ILAR core set of endpoints for RA clinical trials had to be among the main outcome measures.

DATA COLLECTION AND ANALYSIS

The Delphi list was the criteria list used to assess the components of methodological quality. Two reviewers carried out quality assessment and data extraction of the studies. Disagreements were solved by consensus.

MAIN RESULTS

Six trials, representing 355 people, were included in this review. Most trials reported positive findings (the absolute improvement in measured outcomes ranged from 0 to 44%), but were methodologically flawed to some extent. A 'quality of life' outcome was reported by two trials. None of the trials performed an intention-to-treat analysis and only two performed a comparison of effects between groups. Pooling of the data was not performed; because of heterogeneity of the studies, multiple outcome measurements, and the overall data presentation was too scarce.

REVIEWER'S CONCLUSIONS

One cannot ignore the positive findings reported in most trials. However the scientific evidence is insufficient because of the poor methodological quality, the absence of an adequate statistical analysis, and the absence, for the patient, of most essential outcome measures (pain, self assessed function, quality of life). Therefore, the noted "positive findings" should be viewed with caution. Because of the methodological flaws an answer about the apparent effectiveness of balneotherapy cannot be provided at this moment. A large, methodological sound trial is needed.