The Relationship between Autism Spectrum Disorder and Melatonin during Fetal Development.
Molecules. 2018 Jan 18;23(1):
Authors: Jin Y, Choi J, Won J, Hong Y
The aim of this review is to clarify the interrelationship between melatonin and autism spectrum disorder (ASD) during fetal development. ASD refers to a diverse range of neurodevelopmental disorders characterized by social deficits, impaired communication, and stereotyped or repetitive behaviors. Melatonin, which is secreted by the pineal gland, has well-established neuroprotective and circadian entraining effects. During pregnancy, the hormone crosses the placenta into the fetal circulation and transmits photoperiodic information to the fetus allowing the establishment of normal sleep patterns and circadian rhythms that are essential for normal neurodevelopment. Melatonin synthesis is frequently impaired in patients with ASD. The hormone reduces oxidative stress, which is harmful to the central nervous system. Therefore, the neuroprotective and circadian entraining roles of melatonin may reduce the risk of neurodevelopmental disorders such as ASD.
PMID: 29346266 [PubMed - in process]
Synergistic Impact of Training Followed By on-Site Support on Hiv Clinical Practice: A Mixed Design Study in Uganda with Pre/Post and Cluster Randomized Trial Components.
J Acquir Immune Defic Syndr. 2018 Jan 16;:
Authors: Burnett S, Mubiru N, Imani P, Mbonye MK, Fisher L, Colebunders R, Manabe YC, Weaver MR
BACKGROUND: Task-shifting can expand antiretroviral therapy access, but little is known about effective approaches to improve clinical practice among mid-level practitioners' (MLP) such as clinical officers, nurses, and midwives. The Integrated Infectious Diseases Capacity-Building Evaluation compared training alone to training combined with on-site support (OSS).
METHODS: Two MLP each from 36 health facilities attended the five-week Integrated Management of Infectious Disease training. Following training, 18 facilities randomly assigned to arm A received OSS for nine months, while 18 arm B facilities did not. Clinical faculty assessed MLP HIV clinical practice on six tasks: history taking, physical examination, laboratory investigations, diagnosis, treatment, and patient education. We analyzed the effect of training alone and training combined with OSS as the pre/post change within each arm. We analyzed the incremental effect of OSS with a difference-in-difference analysis that compared changes between arms.
RESULTS: Training alone and training combined with OSS significantly improved clinical practice in patient history taking (13% and 24% increase, respectively), physical examination (54% and 71%), laboratory investigations (32% and 20%) and diagnosis (31% and 51%). Combined training and OSS also improved patient education significantly (72% increase). Effect sizes for training combined with OSS were larger than for training alone except for laboratory investigations, and the effects were robust in sensitivity analyses. The incremental effect of OSS on diagnosis was significant (adjusted relative relative risk=1.23; 95% CI=1.00-1.50).
CONCLUSION: Combined training and OSS improved MLP HIV clinical practice over training alone and can contribute to continued expansion of access to antiretroviral therapy.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
PMID: 29346184 [PubMed - as supplied by publisher]
Promotion of Exercise in Multiple Sclerosis Through Healthcare Providers.
Exerc Sport Sci Rev. 2018 Jan 15;:
Authors: Motl RW, Barstow EA, Blaylock S, Richardson E, Learmonth YC, Fifolt M
Participation in exercise yields meaningful benefits among persons with multiple sclerosis(MS), yet this population engages in low rates of health-promoting physical activity. The disconnect between evidence of benefits and rates of participation requires consideration of new opportunities for changing this health behavior. The current paper hypothesizes that the patient-provider interaction offers a fertile opportunity for promoting exercise behavior in MS.
PMID: 29346161 [PubMed - as supplied by publisher]
Role of the Lymphatic System in the Pathogenesis of Hypertension in Humans.
Lymphat Res Biol. 2018 Jan 18;:
Authors: Chachaj A, Puła B, Chabowski M, Grzegrzółka J, Szahidewicz-Krupska E, Karczewski M, Janczak D, Dzięgiel P, Podhorska-Okołów M, Mazur G, Gamian A, Szuba A
BACKGROUND: Recent studies, mainly on animal models, have suggested that negatively charged glycosaminoglycans, macrophages, and lymph vessels in the skin interstitium may serve as extrarenal control of sodium balance and blood pressure. The aim of the study was to prove the hypothesis that skin interstitium has a role in the pathogenesis of hypertension in humans.
METHODS AND RESULTS: We have examined skin biopsies in 91 patients from the department of surgery who had elective surgery with abdominal skin incision: 43 were hypertensive, 14 had resistant hypertension, and 34 with normal blood pressure as control group (median patients' age in these groups estimated accordingly 64 vs. 64 vs. 61.5; p > 0.05). We have studied (1) the content of Na+, water, accumulation of macrophages (CD68), and density of lymphatic vessels (D2-40) and blood vessels (CD31) in the specimens of abdominal skin taken at the time of surgery and (2) plasma NT-proANP, vascular endothelial growth factor (VEGF)-C, and VEGF-D concentrations. The study groups differed in skin expression of CD68 (control vs. hypertension vs. resistant hypertension groups were accordingly: 3.33 vs. 4.00 vs. 8.33; p = 0.005) and in serum concentration of VEGF-C (5792 vs. 4348 vs. 3974 pg/mL; p = 0.026). Differences among groups in plasma NT-proANP levels were close to statistical significance (p = 0.056).
CONCLUSIONS: Our results confirm that skin interstitium may be involved in the pathogenesis of essential hypertension in humans. Lower levels of VEGF-C in hypertensive groups suggest that impairment of lymphangiogenesis and protective function of the skin lymphatic system may play a role in the pathogenesis of hypertension.
PMID: 29346014 [PubMed - as supplied by publisher]
Deletion of estrogen receptor alpha in skeletal muscle results in impaired contractility in female mice.
J Appl Physiol (1985). 2018 Jan 18;:
Authors: Collins BC, Mader TL, Cabelka CA, Iñigo MR, Spangenburg EE, Lowe DA
Estradiol deficiency in females can result in skeletal muscle strength loss, and treatment with estradiol mitigates the loss. There are three primary estrogen receptors and estradiol elicits effects through these receptors in various tissues. Ubiquitous estrogen receptor α (ERα) knockout mice exhibit numerous biological disorders, but little is known regarding the specific role of ERα in skeletal muscle contractile function. The purpose of this study was to determine the impact of skeletal muscle specific ERα deletion on contractile function, hypothesizing that ERα is a main receptor through which estradiol affects muscle strength in females. Deletion of ERα specifically in skeletal muscle (skmERαKO) did not affect body mass compared to wild-type littermates (skmERαWT) until 26 wk of age at which time body mass of skmERαKO began to increase disproportionally. Overall, skmERαKO mice had low strength demonstrated in multiple muscles and by several contractile parameters. Isolated extensor digitorum longus muscles from skmERαKO mice produced 16% less eccentric and 16-26% less submaximal and maximal isometric forces and isolated soleus muscles were more fatigable with impaired force recovery relative to skmERαWT. In vivo maximal torque productions by plantar- and dorsi-flexors were 16 and 12% lower in skmERαKO than skmERαWT mice and skmERαKO muscles had low phosphorylation of myosin regulatory light chain. Plantarflexors also generated 21-32% less power, submaximal isometric and peak concentric torques. Data support the hypothesis that ablation of ERα in skeletal muscle results in muscle weakness, suggesting that the beneficial effects of estradiol on muscle strength are receptor mediated through ERα.
PMID: 29345963 [PubMed - as supplied by publisher]
Multi-potent Natural Scaffolds Targeting Amyloid Cascade: In search of Alzheimer's Disease Therapeutics.
Curr Top Med Chem. 2018 Jan 16;:
Authors: Chakraborty S
Alzheimer's disease (AD) once considered a rare disorder emerges as a major health concern in recent times. The disease pathogenesis is very complex and yet to be understood completely. However, "Amyloid Cascade" is the central event in disease pathogenesis. Several proteins of the amyloid cascade are currently being considered as potential targets for AD therapeutics discovery. Many potential compounds are in clinical trials, but till now there is no known cure for the disease. Recent years have witnessed remarkable research interest in search of novel concepts in drug designing for AD. Multi-targeted ligand design is a paradigm shift in conventional drug discovery. In this process rather than designing ligands targeting a single receptor, novel ligands have been designed/synthesized that can simultaneously target many pathways involved in disease pathogenesis. Here, recent developments in computational drug designing protocols to identify multi-targeted ligand for AD have been discussed. Therapeutic potential of different multi-potent compounds also has been discussed briefly. Prime emphasis has been given to multi-potent ligand from natural resources. Polyphenols are an interesting group of compounds that shows efficacy against wide range of disease and have the property to exhibit multi-potency. Several groups attempted to identify novel multi-potent phytochemicals for AD therapy. Multi-potency of several polyphenols or compounds synthesized using the poly-phenolic scaffolds has been briefly discussed here. However, the multi-targeted drug designing for AD is still in early stages, more advancement in drug designing method/algorithm developments are urgently required to discover more efficient compounds for AD therapeutics.
PMID: 29345580 [PubMed - as supplied by publisher]
Daily Bicycling in Older Adults May Be Effective to Reduce Fall Risks - A Case Control Study.
J Aging Phys Act. 2018 Jan 18;:1-21
Authors: Batcir S, Melzer I
Older adults gain many health benefits from riding bicycles regularly. We aimed to explore whether older persons who ride bicycles regularly have better balance than controls. Balance control and voluntary stepping were assessed in 20 older adults aged 65 to 85 who live in an agricultural community village who regularly ride bicycles (BR), and 30 age- and gender-matched non-bicycle riders (NBR). Self-reported function and fear of fall were also assessed. Bicycle riders showed significantly better balance, faster voluntary stepping, and better self-reported advanced lower extremity function compared with NBR. The results might suggest that bicycling regularly preserves balance control and speed of voluntary stepping in older adults because bicycling might maintain specific balance coordination patterns. The results should be treated with caution since BR were older adults who selected an active life style (i.e., bicycling as well as living in an agricultural village) that may bias the results.
PMID: 29345533 [PubMed - as supplied by publisher]
Nat Rev Dis Primers. 2018 Jan 18;4:17105
Authors: Baracos VE, Martin L, Korc M, Guttridge DC, Fearon KCH
Cancer-associated cachexia is a disorder characterized by loss of body weight with specific losses of skeletal muscle and adipose tissue. Cachexia is driven by a variable combination of reduced food intake and metabolic changes, including elevated energy expenditure, excess catabolism and inflammation. Cachexia is highly associated with cancers of the pancreas, oesophagus, stomach, lung, liver and bowel; this group of malignancies is responsible for half of all cancer deaths worldwide. Cachexia involves diverse mediators derived from the cancer cells and cells within the tumour microenvironment, including inflammatory and immune cells. In addition, endocrine, metabolic and central nervous system perturbations combine with these mediators to elicit catabolic changes in skeletal and cardiac muscle and adipose tissue. At the tissue level, mechanisms include activation of inflammation, proteolysis, autophagy and lipolysis. Cachexia associates with a multitude of morbidities encompassing functional, metabolic and immune disorders as well as aggravated toxicity and complications of cancer therapy. Patients experience impaired quality of life, reduced physical, emotional and social well-being and increased use of healthcare resources. To date, no effective medical intervention completely reverses cachexia and there are no approved drug therapies. Adequate nutritional support remains a mainstay of cachexia therapy, whereas drugs that target overactivation of catabolic processes, cell injury and inflammation are currently under investigation.
PMID: 29345251 [PubMed - in process]
Developing single-entity theranostic: drug-based fluorescent nanoclusters with augmented cytotoxicity.
Nanomedicine (Lond). 2018 Jan 18;:
Authors: Chatterjee B, Raza A, Ghosh SS
AIM: To develop methotrexate (MTX) templated luminescent gold nanoclusters (NCs) as a single unit nanotheranostic for cancer therapy and to assess its potential as an alternative to the parent drug, for drug delivery vehicles (DDVs).
METHODS: Theranostics were synthesized and extensively characterized. The stability of the theranostic and its bioimaging aptitude were evaluated. The antiproliferative propensity of the theranostic was gauged with cell viability assays and was supplemented with cytometry-based assays. Feasibility of delivering the MTX NCs instead of parent drug on a DDV was also checked.
RESULTS: MTX NCs displayed remarkable physical characteristics and augmented cytotoxicity with a robust stability in phosphate-buffered saline and serum. MTX NCs also demonstrated their amenability to being loaded on a DDV (chitosan folic acid nanoparticles) while retaining their physical and cytotoxic profile.
CONCLUSION: Generation of next level drug-based theranostics with the potential of replacing the free drug in drug delivery platforms.
PMID: 29345211 [PubMed - as supplied by publisher]
Low NT-proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction.
ESC Heart Fail. 2018 Jan 18;:
Authors: Buckley LF, Canada JM, Del Buono MG, Carbone S, Trankle CR, Billingsley H, Kadariya D, Arena R, Van Tassell BW, Abbate A
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that presents clinicians with a diagnostic challenge. The use of natriuretic peptides to exclude a diagnosis of HFpEF has been proposed. We sought to compare HFpEF patients with N-terminal pro-brain natriuretic peptide (NT-proBNP) level above and below the proposed cut-off.
METHODS: Stable patients (n = 30) with left ventricular (LV) ejection fraction ≥ 50% were eligible if they had a diagnosis of HF according to the European Society of Cardiology diagnostic criteria. Characteristics of patients with NT-proBNP below (≤125 pg/mL) and above (>125 pg/mL) the diagnostic criterion were compared.
RESULTS: There were 19 (66%) women with median age 54 years. Half were African American (16, 53%), and most were obese. There were no significant differences in clinical characteristics or medication use between groups. LV end-diastolic volume index was greater in high NT-proBNP patients (P = 0.03). Left atrial volume index, E/e' ratio, and E/e' ratio at peak exercise were not significantly different between NT-proBNP groups. Peak oxygen consumption (VO2 ), VO2 at ventilatory threshold, and ventilatory efficiency measures were impaired in all patients and were not significantly different between high and low NT-proBNP patients.
CONCLUSIONS: NT-proBNP was below the proposed diagnostic cut-off point of 125 pg/mL in half of this obese study cohort. Cardiac diastolic dysfunction and cardiorespiratory fitness were not significantly different between high and low NT-proBNP patients. These data indicate that excluding the diagnosis of HFpEF based solely on NT-proBNP levels should be discouraged.
PMID: 29345112 [PubMed - as supplied by publisher]
Occupational therapy publications by Australian authors: A bibliometric analysis.
Aust Occup Ther J. 2018 Jan 18;:
Authors: Brown T, Gutman SA, Ho YS
BACKGROUND: Bibliometrics refers to the collection and measurement of publishing and citation data configurations with the goal of quantifying the influence of scholarly activities. Advantages of bibliometrics include the generation of quantitative indicators of impact, productivity, quality and collaboration. Those parties who benefit from the results of bibliometric analysis include researchers, educators, journal publishers, employers and research funding bodies.
METHODS: A bibliometric analysis was completed of peer-reviewed literature from 1991 to 2015, written by Australian occupational therapists (who were able to be identified as such), and indexed in the Science Citation Index-Expanded (SCI-Expanded) or the Social Sciences Citation Index (SSCI) databases. "Occupational therapy" and "occupational therapist(s)" were used as keywords to search journal articles' publication title, abstract, author details, keywords and KeyWord Plus.
RESULTS: Between 1991 and 2015, 752 peer-reviewed journal articles were published by Australian occupational therapy authors. On average, those articles had 3.7 authors, 35 references, and were nine pages in length. The top four journals in which Australian occupational therapists published were Australian Occupational Therapy Journal, British Journal of Occupational Therapy, American Journal of Occupational Therapy, and Physical and Occupational Therapy in Paediatrics. The four Australian institutions that generated the largest number of occupational therapy articles were the University of Queensland, University of Sydney, La Trobe University, and Monash University. The top four countries with whom Australian authors collaborated in manuscript writing were the United Kingdom, United States, Canada and Sweden.
CONCLUSION: The volume of occupational therapy peer-reviewed literature has grown over the last two decades. Australian authors have and continue to make significant contributions to the occupational therapy body of knowledge nationally and internationally.
PMID: 29344965 [PubMed - as supplied by publisher]
Potent peptide-conjugated silicon phthalocyanines for tumor photodynamic therapy.
J Cancer. 2018;9(2):310-320
Authors: Liu Q, Pang M, Tan S, Wang J, Chen Q, Wang K, Wu W, Hong Z
Phthalocyanines (Pcs) are a group of promising photosensitizers for use in photodynamic therapy (PDT). However, their extremely low solubility and their strong tendency to aggregate in aqueous solution greatly restrict their application. Conjugation of Pc macrocycles with peptide ligands could be a very useful strategy to optimize the physical properties of Pcs not only by increasing their water solubility and reducing their aggregation but also by endowing the conjugates with a tumor-targeting capability. To develop highly potent photosensitizers for tumor PDT, we prepared new peptide-conjugated photosensitizers using silicon Pc (SiPc), which has much higher photodynamic activity than zinc Pcs, as the light activation moiety and the cRGDfK peptide (or simply cRGD) as the peptide moiety. A polyethylene glycol linker and an extra carboxylic acid group were also tested for introduction into the conjugates to optimize the conjugate structure. The conjugates' photophysical and photodynamic behaviors were then carefully evaluated and compared using in vitro and in vivo experiments. One of the prepared conjugates, RGD-(Linker)2-Glu-SiPc, showed excellent physical properties and photodynamic activity, with an EC50 (half maximal effective concentration) of 10-20 nM toward various cancer cells. This conjugate eradicated human glioblastoma U87-MG tumors in a xenograft murine tumor model after only one dose of photodynamic treatment, with no tumor regrowth during observation for up to 35 days. The conjugate RGD-(Linker)2-Glu-SiPc thus showed highly promising potential for use in tumor treatment.
PMID: 29344278 [PubMed]
Immunotherapy of patient with hepatocellular carcinoma using cytotoxic T lymphocytes ex vivo activated with tumor antigen-pulsed dendritic cells.
J Cancer. 2018;9(2):275-287
Authors: Wang Y, Yang X, Yu Y, Xu Z, Sun Y, Liu H, Cheng J, Liu M, Sha B, Li L, Ding N, Li Z, Jin H, Qian Q
Purpose The aim of this study was to evaluate the clinical response of immunotherapy with dendritic cell-cytotoxic T lymphocytes (DC-CTLs) in patients with hepatocellular carcinoma (HCC). Method Sixty-eight patients with a confirmed diagnosis of HCC and who received follow-up until December 2015 were enrolled. We measured immune phenotypes of DCs and activated T cells using flow cytometry and clinical indexes using an electrochemiluminescence method. Results DCs exhibited up-regulation of the maturation markers CD83, CD80, CD11c, and CD86 on day8. Levels of IFN-γ and TNF-α were higher in the DCs pulsed with tumor-associated antigens (TAAs) than in DCs with a non-proliferative recombinant adenovirus. The percentage of regulatory T cells (Tregs) decreased in patients after DC-CTLs therapy. In addition, serum levels of AFP, AFP-L3, ALT, and CA19-9 were significantly reduced in these patients. Quality of life was improved, especially on physical functioning scales. Median overall survival (OS) and progression-free survival (PFS) were 8.2 months and 4.3 months, respectively, for the control group and 12.8 months and 9 months, respectively, for the DC-CTL group. Patients treated with DC-CTLs therapy showed a statistically significant PFS and OS curve (OS: p=0.016; PFS: p<0.0001). In addition, no serious adverse reactions were observed. Conclusion This study indicated that Tregs, as well as serum levels of AFP, AFP-L3, ALT, and CA19-9, which were correlated with a poor prognosis, decreased after DC-CTL treatments. The OS, PFS and the quality of life of HCC patients partially improved.
PMID: 29344274 [PubMed]
Visible-Near Infrared Spectroscopic Assessment of Urogenital Tissue in Premenopausal and Postmenopausal Women.
Clin Med Insights Womens Health. 2018;11:1179562X17749608
Authors: Farage MA, Cambron T, Liu KZ
Background: A clinical study was conducted to evaluate the feasibility of using visible and near-infrared (NIR) spectroscopy as a potential noninvasive measure of genital skin health in premenopausal and postmenopausal women.
Methods: A total of 45 female subjects (aged 21-70 years), all of whom gave fully informed consent to participate, were enrolled in the study and assigned to 1 of 3 groups: 15 premenopausal (Pre-M), 15 postmenopausal receiving hormone replacement therapy (Post-M HRT), and 15 postmenopausal receiving no form of hormone replacement therapy (Post-M non-HRT). Spectral measurements were taken at the vaginal mucosa, and spectral data were evaluated for the erythema index (EI), hemoglobin index (HI), bilirubin/β-carotene, and melanin. The color index (CI; calculated as the ratio of absorbance at 480 nm/540 nm) was also determined. Results were compared with previously published results on biomarkers and physical characteristic of genital tissue measured on the same groups of women.
Results: Spectral measurements from the Post-M Non-HRT subjects indicated a significant reduction in HI compared with the Pre-M group (P = .0003) and to the Post-M HRT group (P < .0001). Similarly, EI was reduced in the Post-M Non-HRT (P < .0001 and P = .0041 for the Pre-M and Post-M HRT groups, respectively). In contrast, the Post-M Non-HRT subjects exhibited a significant increase in β-carotene compared with the Pre-M subjects (P = .0098). Bilirubin and melanin were not significantly affected. The Post-M Non-HRT group exhibited a significant increase in CI, indicating a shift away from the hemoglobin absorption region (510-620 nm wavelength) and toward the bilirubin/β-carotene absorption region (450-490 nm wavelength). This change was significant when compared with both the Pre-M group (P < .0001) and the Post-M HRT group (P = .0048). The changes in spectral measurements were consistent with previously reported changes in physical parameters (vaginal atrophy, increased pH, decreased skin temperature) and with decreased concentrations of the biomarkers histamine and histidine.
Conclusions: Hemodynamic spectral characteristics differ in postmenopausal vaginal tissue compared with tissue in premenopausal women, with decreased absorbance in the hemoglobin absorption region (510-620 nm wavelength) and an increased absorbance in the bilirubin/β-carotene absorption region (450-490 nm wavelength). A change in absorbance in the visible and NIR wavelengths is a promising, additional measure of genital skin health related to menopause and vulvovaginal atrophy.
PMID: 29344000 [PubMed]
Calibration and validation of an item bank for measuring general physical function of patients in medical rehabilitation settings.
Patient Relat Outcome Meas. 2018;9:11-16
Authors: Cook KF, Kallen MA, Hayes D, Deutscher D, Fritz JM, Werneke MW, Mioduski JE
Objective: The objective of this study was to report the item response theory (IRT) calibration of an 18-item bank to measure general physical function (GPF) in a wide range of conditions and evaluate the validity of the derived scores.
Methods: All 18 items were administered to a large sample of patients (n=2337) who responded to the items in the context of their outpatient rehabilitation care. The responses, collected 1997- 2000, were modeled using the graded response model, an IRT model appropriate for items with two or more response options. Inter-item consistency was evaluated based on Cronbach's alpha and item to total correlations. Validity of scores was evaluated based on known-groups comparisons (age, number of health problems, symptom severity). The strength of a single, general factor was evaluated using a bi-factor model. Results were used to evaluate IRT assumption and as an indicator of construct validity. Local independence of item responses was also evaluated.
Results: Response data met the assumptions of unidimensionality and local independence. Explained common variance of a single general factor was 0.88 (omega hierarchical =0.86). Only two of the 153 pairs of item residuals were flagged for local dependence. Inter-item consistency was high (0.93) as were item to total correlations (mean =0.61). Substantial variation was found in both IRT location (difficulty) and discrimination parameters. All omnibus known-groups comparisons were statistically significant (p<0.001).
Conclusion: Item responses fit the IRT unidimensionality assumptions and were internally consistent. The usefulness of GPF scores in discriminating among patients with different levels of physical function was confirmed. Future studies should evaluate the validity of GPF scores based on an adaptive administration of items.
PMID: 29343994 [PubMed]
Does transcutaneous electrical nerve stimulation reduce pain and improve quality of life in patients with idiopathic chronic orchialgia? A randomized controlled trial.
J Pain Res. 2018;11:77-82
Authors: Tantawy SA, Kamel DM, Abdelbasset WK
Background: Chronic orchialgia is defined as testicular pain, which may be either unilateral or bilateral, lasting for more than 3 months. It disturbs a patient's daily activities and quality of life (QoL), inciting the patient to search for treatments to alleviate the pain. It is estimated that 25% of chronic orchialgia cases are idiopathic.
Purpose: The purpose of this study was to investigate how effective transcutaneous electrical nerve stimulation (TENS) is in pain reduction and how it consequently affects the QoL in patients with idiopathic chronic orchialgia (ICO).
Patients and methods: Seventy-one patients were randomly assigned to group A (study group), which included 36 patients who received TENS and analgesia, and group B (control group), which included 35 patients who received analgesia only. The outcome measures were the participants' demographic data and results of the visual analog scale (VAS) and QoL questionnaire. These outcomes were measured before and after 4 weeks of treatment and at 2-month follow-up.
Results: The results showed that compared to pretreatment, there was a significant reduction in pain postintervention and at 2-month follow-up in group A (P<0.0001 and <0.001, respectively; F=7.1) as well as a significant improvement in QoL at these time points (P<0.0001 and <0.0001, respectively). There were no significant differences in the VAS score and QoL in group B at different time points of evaluation.
Conclusion: The findings indicate that TENS is effective in reducing pain and improving patients' QoL in cases of ICO. TENS is an easy-to-use, effective, noninvasive, and simple method for ICO-associated pain control and QoL improvement.
PMID: 29343983 [PubMed]
Yoga-Based Postoperative Cardiac Rehabilitation Program for Improving Quality of Life and Stress Levels: Fifth-Year Follow-up through a Randomized Controlled Trial.
Int J Yoga. 2018 Jan-Apr;11(1):44-52
Authors: Amaravathi E, Ramarao NH, Raghuram N, Pradhan B
Objectives: This study was aimed to assess the efficacy of yoga-based lifestyle program (YLSP) in improving quality of life (QOL) and stress levels in patients after 5 years of coronary artery bypass graft (CABG).
Methodology: Three hundred patients posted for elective CABG in Narayana Hrudayalaya Super Speciality Hospital, Bengaluru, were randomized into two groups: YLSP and conventional lifestyle program (CLSP), and follow-up was done for 5 years.
Intervention: In YLSP group, all practices of integrative approach of yoga therapy such as yama, niyama, asana, pranayama, and meditation were used as an add-on to conventional cardiac rehabilitation. The control group (CLSP) continued conventional cardiac rehabilitation only.
Outcome Measures: World Health Organization (WHO)-QOL BREF Questionnaire, Perceived Stress Scale, Positive and Negative Affect Scale (PANAS), and Hospital Anxiety and Depression Scale (HADS) were assessed before surgery and at the end of the 5th year after CABG. As data were not normally distributed, Mann-Whitney U-test was used for between-group comparisons and Wilcoxon's signed-rank test was used for within-group comparisons.
Results: At the end of 5 years, mental health (P = 0.05), perceived stress (P = 0.01), and negative affect (NA) (P = 0.05) have shown significant improvements. WHO-QOL BREF score has shown improvements in physical health (P = 0.046), environmental health (P = 0.04), perceived stress (P = 0.001), and NA (P = 0.02) in YLSP than CLSP. Positive affect has significantly improved in CLSP than YLSP. Other domains of WHO-QOL-BREF, PANAS, and HADS did not reveal any significant between-group differences.
Conclusion: Addition of long-term YLSP to conventional cardiac rehabilitation brings better improvements in QOL and reduction in stress levels at the end of 5 years after CABG.
PMID: 29343930 [PubMed]
First two bilateral hand transplantations in India (Part 3): Rehabilitation and immediate outcome.
Indian J Plast Surg. 2017 May-Aug;50(2):161-167
Authors: Sharma M, Iyer S, Kishore P, Mathew J, Vijayaraghavan S, Sankaran R, Nair AN, Janarthanan R, Wakure A, Reddy R, Chetan Mali SM, Varma V, Chaudhari A, Dhake S, Omkumar A
Introduction: This report covers the strategies adopted for rehabilitation for the first and second dual hand transplants performed in India.
Materials and Methods: The team, under a trained physiatrist, including physiotherapy and occupational therapy personnel, was involved in the management of both these patients. The management protocol was developed considering previous reports as well as our management strategies in the rehabilitation of the replanted hands. The involvement of the team with the patients started in the 1st week itself and continued on a daily basis for the entire year.
Results: Outcome analysis was performed at 6 months and 1 year using the disability of shoulder and hand evaluation and hand transplant scoring system. Functional magnetic resonance imaging was done at the end of 1 year to assess the cortical integration of the transplanted hand.
Conclusion: Despite more than 110 hands being transplanted worldwide, hand transplant remains an experimental procedure. It is still not considered the "standard of care" for hand amputees. Outcome analyses performed worldwide do indicate that the procedure can provide a substantial improvement in the quality of life for the hand amputee, especially the bilateral amputees.
PMID: 29343891 [PubMed]
Microdosimetric Modeling of Biological Effectiveness for Boron Neutron Capture Therapy Considering Intra- and Intercellular Heterogeneity in 10B Distribution.
Sci Rep. 2018 Jan 17;8(1):988
Authors: Sato T, Masunaga SI, Kumada H, Hamada N
We here propose a new model for estimating the biological effectiveness for boron neutron capture therapy (BNCT) considering intra- and intercellular heterogeneity in 10B distribution. The new model was developed from our previously established stochastic microdosimetric kinetic model that determines the surviving fraction of cells irradiated with any radiations. In the model, the probability density of the absorbed doses in microscopic scales is the fundamental physical index for characterizing the radiation fields. A new computational method was established to determine the probability density for application to BNCT using the Particle and Heavy Ion Transport code System PHITS. The parameters used in the model were determined from the measured surviving fraction of tumor cells administrated with two kinds of 10B compounds. The model quantitatively highlighted the indispensable need to consider the synergetic effect and the dose dependence of the biological effectiveness in the estimate of the therapeutic effect of BNCT. The model can predict the biological effectiveness of newly developed 10B compounds based on their intra- and intercellular distributions, and thus, it can play important roles not only in treatment planning but also in drug discovery research for future BNCT.
PMID: 29343841 [PubMed - in process]
Hydrogel biomaterials and their therapeutic potential for muscle injuries and muscular dystrophies.
J R Soc Interface. 2018 Jan;15(138):
Authors: Lev R, Seliktar D
Muscular diseases such as muscular dystrophies and muscle injuries constitute a large group of ailments that manifest as muscle weakness, atrophy or fibrosis. Although cell therapy is a promising treatment option, the delivery and retention of cells in the muscle is difficult and prevents sustained regeneration needed for adequate functional improvements. Various types of biomaterials with different physical and chemical properties have been developed to improve the delivery of cells and/or growth factors for treating muscle injuries. Hydrogels are a family of materials with distinct advantages for use as cell delivery systems in muscle injuries and ailments, including their mild processing conditions, their similarities to natural tissue extracellular matrix, and their ability to be delivered with less invasive approaches. Moreover, hydrogels can be made to completely degrade in the body, leaving behind their biological payload in a process that can enhance the therapeutic process. For these reasons, hydrogels have shown great potential as cell delivery matrices. This paper reviews a few of the hydrogel systems currently being applied together with cell therapy and/or growth factor delivery to promote the therapeutic repair of muscle injuries and muscle wasting diseases such as muscular dystrophies.
PMID: 29343633 [PubMed - in process]
Use of the Godin leisure-time exercise questionnaire in multiple sclerosis research: a comprehensive narrative review.
Disabil Rehabil. 2018 Jan 17;:1-25
Authors: Sikes EM, Richardson EV, Cederberg KJ, Sasaki JE, Sandroff BM, Motl RW
PURPOSE: The Godin Leisure-Time Exercise Questionnaire has been a commonly applied measure of physical activity in research among persons with multiple sclerosis over the past decade. This paper provides a comprehensive description of its application and inclusion in research on physical activity in multiple sclerosis.
METHOD: This comprehensive, narrative review included papers that were published between 1985 and 2017, written in English, involved participants with multiple sclerosis as a primary population, measured physical activity, and cited one of the two original Godin papers.
RESULTS AND CONCLUSION: There is a broad scope of research that has included the Godin Leisure-Time Exercise Questionnaire in persons with multiple sclerosis. Overall, 8 papers evaluated its psychometric properties, 21 evaluated patterns of physical activity, 24 evaluated correlates or determinants of physical activity, 28 evaluated outcomes or consequences of physical activity, and 15 evaluated physical activity interventions. The Godin Leisure-Time Exercise Questionnaire is a valid self-report measure of physical activity in persons with multiple sclerosis, and further is an appropriate, simple, and effective tool for describing patterns of physical activity, examining correlates and outcomes of physical activity, and provides a sensitive outcome for measuring change in physical activity after an intervention. Implications for rehabilitation There is increasing interest in physical activity and its benefits in multiple sclerosis. The study of physical activity requires appropriate and standardized measures. The Godin Leisure-Time Exercise Questionnaire is a common self-report measure of physical activity for persons with multiple sclerosis. Godin Leisure-Time Exercise Questionnaire scores are reliable measures of physical activity in persons with multiple sclerosis. The Godin Leisure-Time Exercise Questionnaire further is an appropriate, simple, and effective tool for describing patterns of physical activity, examining correlates and outcomes of physical activity participation, and is an advantageous primary outcome for measuring change in physical activity in response to an intervention.
PMID: 29343122 [PubMed - as supplied by publisher]
Can the physical environment itself influence neurological patient activity?
Disabil Rehabil. 2018 Jan 17;:1-13
Authors: Shannon MM, Elf M, Churilov L, Olver J, Pert A, Bernhardt J
PURPOSE: To evaluate if a changed physical environment following redesign of a hospital ward influenced neurological patient physical and social activity.
METHODS: A "before and after" observational design was used that included 17 acute neurological patients pre-move (median age 77 (IQR 69-85) years Ward A and 20 post-move (median age 70 (IQR 57-81) years Ward B. Observations occurred for 1 day from 08.00-17.00 using Behavioral Mapping of patient physical and social activity, and location of that activity. Staff and ward policies remained unchanged throughout. An Environmental Description Checklist of each ward was also completed.
RESULTS: Behavioral Mapping was conducted pre-/post-move with a total of 801 Ward A and 918 Ward B observations. Environmental Description Checklists showed similarities in design features in both neurological wards with similar numbers of de-centralized nursing stations, however there were more single rooms and varied locations to congregate in Ward B (30% more single-patient rooms and separate allied health therapy room). Patients were alone >60% of time in both wards, although there was more in bed social activity in Ward A and more out of bed social activity in Ward B. There were low amounts of physical activity outside of patient rooms in both wards. Significantly more physical activity occurred in Ward B patient rooms (median = 47%, IQR 14-74%) compared to Ward A (median = 2% IQR 0-14%), Wilcoxon Rank Sum test z = -3.28, p = 0.001.
CONCLUSIONS: Overall, patient social and physical activity was low, with little to no use of communal spaces. However we found more physical activity in patient rooms in the Ward B environment. Given the potential for patient activity to drive brain reorganization and repair, the physical environment should be considered an active factor in neurological rehabilitation and recovery. Implications for Rehabilitation Clinicians should include consideration of the impact of physical environment on physical and social activity of neurological patients when designing therapeutic rehabilitation environments. Despite architectural design intentions patient and social activity opportunities can be limited. Optimal neurological patient neuroplasticity and recovery requires sufficient environmental challenge, however current hospital environments for rehabilitation do not provide this.
PMID: 29343110 [PubMed - as supplied by publisher]
Identifying COPD patients at risk for worse symptoms, HRQoL, and self-efficacy: A cluster analysis.
Chronic Illn. 2018 Jan 01;:1742395317753883
Authors: Lopes AC, Xavier RF, Ac Pereira AC, Stelmach R, Fernandes F, Harrison SL, Carvalho CR
Objectives To identify clusters of chronic obstructive pulmonary disease (COPD) patients with distinct beliefs about their illness in terms of symptoms, health-related quality of life (HRQoL), self-efficacy, and daily life physical activity (DLPA). Methods This cross-sectional study included 150 COPD outpatients. The patients' illness perceptions, clinical control, HRQoL, self-efficacy, and DLPA (accelerometry) were evaluated. A cluster analysis was conducted using data from the Illness Perceptions Questionnaire - Revised to establish groups of patients with distinct illness perceptions. Differences between clusters were tested using a T-test or a Mann-Whitney U test. Results The cluster analysis revealed two groups: distressed ( n = 95) and coping ( n = 55). Despite the fact that both clusters presented similar pulmonary function, between-cluster differences were observed in their self-efficacy, dyspnea, HRQoL, clinical control ( p < 0.001), and educational level ( p = 0.002). The levels of DLPA did not differ between the clusters. Discussion We observed that clinically stable COPD patients who displayed higher emotional representations and less coherence had heightened symptoms, poorer HRQoL, worse self-efficacy, and lower educational levels. These results emphasize the need to routinely evaluate illness perceptions in COPD patients to target and tailor the proper treatment to improve these important health outcomes.
PMID: 29343090 [PubMed - as supplied by publisher]
Quality of life among HIV-infected individuals failing first-line antiretroviral therapy in resource-limited settings.
AIDS Care. 2018 Jan 18;:1-9
Authors: Torres TS, Harrison LJ, La Rosa AM, Lavenberg JA, Zheng L, Safren SA, Ngongondo M, Poongulali S, Matoga M, Samaneka W, Collier AC, Hughes MD
We evaluated health-related quality of life (QoL) in HIV infection participants with virologic failure (VF) on first-line antiretroviral therapy (ART) in 9 resource-limited settings (RLS). ACTG SF-21 was completed by 512 participants at A5273 study entry; 8 domains assessed: general health perceptions (GHP), physical functioning (PF), role functioning (RF), social functioning (SF), cognitive functioning (CF), pain (P), mental health (MH), and energy/fatigue (E/F); each was scored between 0 (worst) to 100 (best). Mean QoL scores ranged from 67 (GHP) to 91 (PF, SF, CF). QoL varied by country; high VL and low CD4 were associated with worse QoL in most domains, except RF (VL only), SF (CD4 only) and CF (neither). Number of comorbidities, BMI and history of AIDS were associated with some domains. Relationships between QoL and VL varied among countries for all domains. The association of worse disease status with worse QoL may reflect low QoL when ART was initiated and/or deterioration associated with VF.
PMID: 29343078 [PubMed - as supplied by publisher]
Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?
Int J Environ Res Public Health. 2018 Jan 13;15(1):
Authors: McManus MC, Cramer RJ, Boshier M, Akpinar-Elci M, Van Lunen B
Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. 'Other' ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal 'need', including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.
PMID: 29342846 [PubMed - in process]
Celebrate through self care.
Aust Nurs Midwifery J. 2017 May;24(10):16-20
Authors: Eccles M
International Day of the Midwife and International Nurses Day, celebrated on 5 May and 12 May respectively, are when nurses and midwives are acknowledged for the job that they do and also thanked for the vital care they give to their patients, their patients' families and each other. Yet while nurses and midwives are good at taking care of others, sometimes they can fall short of taking care of themselves. When celebrating nurses and midwives during May it is important to take time to acknowledge your own achievements as a nurse and/or a midwife, but also review what you are doing to care for yourself. Applying a few strategies could help you live more fulfilling, productive and happier lives, professionally and personally.
PMID: 29274266 [PubMed - indexed for MEDLINE]
SUPPORTIVE CARE NEEDS OF PROSTATE CANCER SURVIVORS.
Aust Nurs Midwifery J. 2016 11;24(5):34
Authors: O'Shaughnessy K
Recent advances in detection combined with increasingly effective treatment for prostate cancer has led to significant improvements in life expectancy. More men are living longer with the significant physical and emotional after-effects of prostate cancer treatment.
PMID: 29251471 [PubMed - indexed for MEDLINE]
Where Are We Headed with Neuromodulation for Overactive Bladder?
Curr Urol Rep. 2017 Aug;18(8):59
Authors: Jaqua K, Powell CR
Overactive bladder (OAB) affects millions of people around the world and decreases quality of life for those affected. Over the past two decades, significant advances in treatment have transformed the lives of those with OAB. Sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and dorsal genital nerve stimulation are the most effective contemporary treatment modalities. New techniques and bio-sensing schemes offer promise to advance therapy beyond what is currently available. Current neuromodulation techniques do not use real-time data from the body or input from the patient. Incorporating this is the goal of those pursuing a neuroprosthesis to enhance bladder function for these patients. Dorsal genital nerve, pudendal nerve, S3 afferent nerve roots, and S1 and S2 ganglia have all been used as targets for stimulation. Some of these have also been used as sources of afferent nerve information to detect significant bladder events and even to estimate the fullness of the bladder. As technology improves, an intelligent neuroprosthesis with the ability to sense significant bladder events may revolutionize treatment of OAB.
PMID: 28656519 [PubMed - indexed for MEDLINE]
Feasibility and efficacy of a multi-factorial intervention to prevent falls in older adults with cognitive impairment living in residential care (ProF-Cog). A feasibility and pilot cluster randomised controlled trial.
BMC Geriatr. 2017 May 30;17(1):115
Authors: Whitney J, Jackson SHD, Martin FC
BACKGROUND: Falls are common in people with dementia living in residential care. The ProF-Cog intervention was developed to address fall risk factors specific to this population. The aim of this study was to evaluate the safety, acceptability, and feasibility of the intervention and provide an estimate of its efficacy.
METHODS: This was a cluster randomised controlled pilot study undertaken in care homes in London, UK. All permanent residents living in participating homes who were not terminally ill were invited to participate. The intervention included an assessment of falls risk factors followed by a tailored intervention which could include dementia care mapping, comprehensive geriatric assessment, occupational therapy input and twice-weekly exercise for 6 months as required to target identified risk factors. The control group received usual care without a falls risk assessment. Standing balance was the primary outcome. This and other outcome measures were collected at baseline and after 6 months. Falls were recorded for this period using incident reports. Changes were analysed using multi-level modelling. Adherence to the interventions, adverse events and trial feasibility were recorded.
RESULTS: Nine care homes enrolled in the study with a total 191 participants (51% of those eligible); five homes allocated to the intervention with 103 participants, and four homes to the usual care control group with 88 participants. The intervention was safe with only one reported fall whilst undertaking exercise. Adherence to agreed recommendations on activity and the environment was modest (21 and 45% respectively) and to exercise was poor (41%). Balance scores (score range 0-49) analysed on 100 participants decreased by a mean of 3.9 in the control and 5.1 in the intervention groups, a non-significant difference (p = 0.9). In other measures, both groups declined equally and there was no difference in falls rates (IRR = 1.59 95%, CI 0.67-3.76).
CONCLUSION: The intervention was safe but not clinically effective. Poor adherence suggests it was not an acceptable or feasible intervention.
TRIAL REGISTRATION: ISRCTN00695885 . Registered 26th March 2013.
PMID: 28558714 [PubMed - indexed for MEDLINE]
Contribution of ankle-foot orthosis moment in regulating ankle and knee motions during gait in individuals post-stroke.
Clin Biomech (Bristol, Avon). 2017 Jun;45:9-13
Authors: Kobayashi T, Orendurff MS, Singer ML, Gao F, Foreman KB
BACKGROUND: Ankle-foot orthosis moment resisting plantarflexion has systematic effects on ankle and knee joint motion in individuals post-stroke. However, it is not known how much ankle-foot orthosis moment is generated to regulate their motion. The aim of this study was to quantify the contribution of an articulated ankle-foot orthosis moment to regulate ankle and knee joint motion during gait in individuals post-stroke.
METHODS: Gait data were collected from 10 individuals post-stroke using a Bertec split-belt instrumented treadmill and a Vicon 3-dimensional motion analysis system. Each participant wore an articulated ankle-foot orthosis whose moment resisting plantarflexion was adjustable at four levels. Ankle-foot orthosis moment while walking was calculated under the four levels based on angle-moment relationship of the ankle-foot orthosis around the ankle joint measured by bench testing. The ankle-foot orthosis moment and the joint angular position (ankle and knee) relationship in a gait cycle was plotted to quantify the ankle-foot orthosis moment needed to regulate the joint motion.
FINDINGS: Ankle and knee joint motion were regulated according to the amount of ankle-foot orthosis moment during gait. The ankle-foot orthosis maintained the ankle angular position in dorsiflexion and knee angular position in flexion throughout a gait cycle when it generated moment from -0.029 (0.011) to -0.062 (0.019) Nm/kg (moment resisting plantarflexion was defined as negative).
INTERPRETATIONS: Quantifying the contribution of ankle-foot orthosis moment needed to regulate lower limb joints within a specific range of motion could provide valuable criteria to design an ankle-foot orthosis for individuals post-stroke.
PMID: 28431220 [PubMed - indexed for MEDLINE]
Primary SWL Is an Efficient and Cost-Effective Treatment for Lower Pole Renal Stones Between 10 and 20 mm in Size: A Large Single Center Study.
J Endourol. 2017 May;31(5):510-516
Authors: Chan LH, Good DW, Laing K, Phipps S, Thomas BG, Keanie JY, Tolley DA, Cutress ML
INTRODUCTION: To assess the clinical features, outcomes, complications, and cost-effectiveness of shockwave lithotripsy (SWL), flexible ureterorenoscopy (FURS), and percutaneous nephrolithotomy (PCNL) in the treatment of lower pole (LP) stones (10-20 mm) in a large tertiary referral center.
PATIENTS AND METHODS: Consecutive patients treated for solitary LP stones (10-20 mm) between 2008 and 2013 were identified from a prospective database. SWL was used as primary treatment in all cases (following a stone multidisciplinary team assessment), with FURS and PCNL reserved for SWL contraindications, failure, or patient choice. "Success" was defined as stone free and/or clinically insignificant stone fragments (≤3 mm) at 1 and 3 months follow-up. Effect of anatomy on SWL success was determined from using CT images and regression analysis. Average cost per treatment modality (including additional second-line treatments) was calculated for each group using the National Health Service England 2014/15 National Tariff Healthcare Resource Group codes.
RESULTS: Two hundred twenty-five patients were included (mean age 54.9; median stone size 12 mm). One hundred ninety-eight (88%), 21 (9.3%), and 6 (2.7%) patients underwent SWL, FURS, and PCNL as primary treatments, respectively, for median stone sizes of 12, 12, and 20 mm. Overall success rates were 82.8%, 76.1%, and 66.7%, respectively (p < 0.05). Sixty-three percent of patients undergoing primary SWL were effectively treated after one session. Anatomical analysis determined infundibulopelvic angle and infundibular length to be significantly different in patients effectively treated with SWL (p = 0.04). The average cost per treatment modality was also significantly lower for SWL (£750) than for FURS (£1261) or PCNL (£2658) (p < 0.01).
CONCLUSION: SWL is both an efficacious and cost-effective primary treatment for patients with solitary LP stones (10-20 mm). The majority of patients can be effectively treated with primary SWL in a dedicated stone center, with the benefits of a short length of stay, low complication, and auxiliary treatment rates. The referral of such patients to high-volume lithotripsy centers with demonstrable outcomes should be given due consideration.
PMID: 28355100 [PubMed - indexed for MEDLINE]
Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study.
Ann Am Thorac Soc. 2017 Mar;14(3):376-383
Authors: Brodsky MB, Huang M, Shanholtz C, Mendez-Tellez PA, Palmer JB, Colantuoni E, Needham DM
RATIONALE: Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital.
OBJECTIVES: To determine factors associated with recovery from dysphagia symptoms after hospital discharge for acute respiratory distress syndrome (ARDS) survivors who received oral intubation with mechanical ventilation.
METHODS: This is a prospective, 5-year longitudinal cohort study involving 13 ICUs at four teaching hospitals in Baltimore, Maryland. The Sydney Swallowing Questionnaire (SSQ), a 17-item visual analog scale (range, 0-1,700), was used to quantify patient-perceived dysphagia symptoms at hospital discharge, and at 3, 6, 12, 24, 36, 48, and 60 months after ARDS. An SSQ score greater than or equal to 200 was used to indicate clinically important dysphagia symptoms at the time of hospital discharge. Recovery was defined as an SSQ score less than 200, with a decrease from hospital discharge greater than or equal to 119, the reliable change index for SSQ score. Fine and Gray proportional subdistribution hazards regression analysis was used to evaluate patient and ICU variables associated with time to recovery accounting for the competing risk of death.
MEASUREMENTS AND MAIN RESULTS: Thirty-seven (32%) of 115 patients had an SSQ score greater than or equal to 200 at hospital discharge; 3 died before recovery. All 34 remaining survivors recovered from dysphagia symptoms by 5-year follow-up, 7 (23%) after 6 months. ICU length of stay was independently associated with time to recovery, with a hazard ratio (95% confidence interval) of 0.96 (0.93-1.00) per day.
CONCLUSIONS: One-third of orally intubated ARDS survivors have dysphagia symptoms that persist beyond hospital discharge. Patients with a longer ICU length of stay have slower recovery from dysphagia symptoms and should be carefully considered for swallowing assessment to help prevent complications related to dysphagia.
PMID: 27983872 [PubMed - indexed for MEDLINE]
Intensive Care Physiotherapy during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.
Ann Am Thorac Soc. 2017 Feb;14(2):246-253
Authors: Munshi L, Kobayashi T, DeBacker J, Doobay R, Telesnicki T, Lo V, Cote N, Cypel M, Keshavjee S, Ferguson ND, Fan E
RATIONALE: There are limited data on physiotherapy during extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS).
OBJECTIVES: We sought to characterize physiotherapy delivered to patients with ARDS supported with ECMO, as well as to evaluate the association of this therapeutic modality with mortality.
METHODS: We conducted a retrospective cohort study of all adult patients with ARDS supported with ECMO at our institution between 2010 and 2015. The highest level of daily activity while on ECMO was coded using the ICU Mobility Scale. Through multivariable logistic regression, we evaluated the association between intensive care unit (ICU) physiotherapy and ICU mortality. In an exploratory univariate analysis, we also evaluated factors associated with a higher intensity of ICU rehabilitation while on ECMO.
MEASUREMENTS AND MAIN RESULTS: Of 107 patients who underwent ECMO, 61 (57%) had ARDS requiring venovenous ECMO. The ICU physiotherapy team was consulted for 82% (n = 50) of patients. Thirty-nine percent (n = 18) of these patients achieved an activity level of 2 or higher (active exercises in bed), and 17% (n = 8) achieved an activity level 4 or higher (actively sitting over the side of the bed). In an exploratory analysis, consultation with the ICU physiotherapy team was associated with decreased ICU mortality (odds ratio, 0.19; 95% confidence interval, 0.04-0.98). In univariate analysis, severity-of-illness factors differentiated higher-intensity and lower-intensity physiotherapy.
CONCLUSIONS: Physiotherapy during ECMO is feasible and safe when performed by an experienced team and executed in stages. Although our study suggests an association with improved ICU mortality, future research is needed to identify potential barriers, optimal timing, dosage, and safety profile.
PMID: 27898220 [PubMed - indexed for MEDLINE]
Physical capacity in LVAD patients: hemodynamic principles, diagnostic tools and training control.
Int J Artif Organs. 2016 Nov 11;39(9):451-459
Authors: Reiss N, Schmidt T, Workowski A, Willemsen D, Schmitto JD, Haverich A, Bjarnason-Wehrens B
Over time left ventricular assist devices (LVAD) have become an alternative to heart transplantation because of enormous technical development and miniaturization. Most patients present a significant improvement in clinical conditions and exercise capacity. Nevertheless, exercise tolerance remains markedly limited even after LVAD implantation compared to a control group. The complex physiological and hemodynamic changes in LVAD patients, both at rest and during exercise, are not yet understood, or at least not completely.It is the aim of the present paper to describe the current state of scientific knowledge. Furthermore, the spectrum of diagnostic tools, including the noninvasive inert gas rebreathing method for measurement of cardiac output and associate parameters, are discussed. Options for training control in this special patient group are presented.
PMID: 27834447 [PubMed - indexed for MEDLINE]
A resilience intervention involving mindfulness training for transplant patients and their caregivers.
Clin Transplant. 2016 Nov;30(11):1466-1472
Authors: Stonnington CM, Darby B, Santucci A, Mulligan P, Pathuis P, Cuc A, Hentz JG, Zhang N, Mulligan D, Sood A
Solid organ and stem cell transplant patients and their caregivers report a substantial level of distress. Mindfulness-based stress reduction has been shown to alleviate distress associated with transplant, but there is limited experience in this population with other mindfulness-based interventions, or with combined transplant patient and caregiver interventions. We evaluated a novel, 6-week mindfulness-based resilience training (MBRT) class for transplant patients and their caregivers that incorporates mindfulness practice, yoga, and neuroscience of stress and resilience. Thirty-one heart, liver, kidney/pancreas, and stem cell transplant patients and 18 caregivers at Mayo Clinic in Arizona participated. Measures of stress, resilience, depression, anxiety, health-related quality of life, positive and negative affect, and sleep were completed at baseline, 6 weeks, and 3 months postintervention. At 6 weeks and 3 months, patients demonstrated significant (P<.005) improvements from baseline in measures of perceived stress, depression, anxiety, and negative affect. Quality-of-life mental component (P=.006) and positive affect (P=.02) also improved at follow-up. Most participants adhered to the program, were satisfied with class length and frequency, and reported improved well-being as a result of the class. MBRT holds promise as an intervention to enhance resilience and manage stress for transplant patients and their caregivers.
PMID: 27618687 [PubMed - indexed for MEDLINE]
Physical activity and progenitor cell-mediated endothelial repair in chronic heart failure: Is there a role for epigenetics?
Mech Ageing Dev. 2016 Oct;159:71-80
Authors: Recchioni R, Marcheselli F, Antonicelli R, Lazzarini R, Mensà E, Testa R, Procopio AD, Olivieri F
Chronic heart failure (CHF) is the most common cardiac disease among the elderly and a leading cause of mortality in elderly patients. Endothelial dysfunction is held to have a major role in the development and progression of CHF, which results in progressively impaired functional capacity. Endothelial progenitor cells (EPCs) and circulating angiogenic cells (CACs) are the main players involved in the endogenous repair mechanisms that can counteract endothelial dysfunction. A mounting body of data indicates that exercise enhances endothelial renewal through mobilization of bone marrow-derived EPCs and CACs, making it an effective therapeutic tool for CHF. Interestingly, emerging evidence has been showing that exercise training can also promote epigenetic modifications, e.g. DNA methylation, histone modifications, and differential expression of specific non-coding RNAs like microRNA (miRNAs). Since deregulation of the miRNAs involved in endothelial function modulation has widely been documented in circulating cells and plasma of CHF patients, deregulation of epigenetic features could play a key role in disease progression. Here, we review current knowledge of the contribution of EPCs and CACs to endothelial repair mechanisms in CHF patients, focusing on the effects induced by exercise training and hypothesizing that some of these effects can be mediated by epigenetic mechanisms.
PMID: 27015708 [PubMed - indexed for MEDLINE]
The Effect of Kinesitherapy Exercises on the Level of Irisin among Females with Cardio-vascular diseases depending on the body mass and hormonal status.
Patol Fiziol Eksp Ter. 2016 Oct-Dec;60(4):47-51
Authors: Kuznik BI, Davydov SO, Stepanov AV, Morar NV
The observation was conducted on 41 female subjects age 32 to 69 with compensated cardio-vascular diseases. 23 of the subjects had an increased body mass index (BMI). It was established that the older the females the less of the irisin muscle hormone is found in the blood. In the subjects with a higher BMI the level of irisin in the blood is also higher. Direct correlations were found between the level of irisin and the level of female sex hormones - estrogen and progesterone. Under the effect of kinesitherapy exercises the level of irisin in females with normal BMI increases; whereas in the females with a higher BMI it generally stays the same or is decreased. The characteristics of irisin’s response to the kinesitherapy exercises depends on its original level, the intensity of physical exercise and the subject’s physique.
PMID: 29244922 [PubMed - indexed for MEDLINE]
A Triazolopyrimidine-Based Dihydroorotate Dehydrogenase Inhibitor with Improved Drug-like Properties for Treatment and Prevention of Malaria.
ACS Infect Dis. 2016 Dec 09;2(12):945-957
Authors: Phillips MA, White KL, Kokkonda S, Deng X, White J, El Mazouni F, Marsh K, Tomchick DR, Manjalanagara K, Rudra KR, Wirjanata G, Noviyanti R, Price RN, Marfurt J, Shackleford DM, Chiu FC, Campbell M, Jimenez-Diaz MB, Bazaga SF, Angulo-Barturen I, Martinez MS, Lafuente-Monasterio M, Kaminsky W, Silue K, Zeeman AM, Kocken C, Leroy D, Blasco B, Rossignol E, Rueckle T, Matthews D, Burrows JN, Waterson D, Palmer MJ, Rathod PK, Charman SA
The emergence of drug-resistant malaria parasites continues to hamper efforts to control this lethal disease. Dihydroorotate dehydrogenase has recently been validated as a new target for the treatment of malaria, and a selective inhibitor (DSM265) of the Plasmodium enzyme is currently in clinical development. With the goal of identifying a backup compound to DSM265, we explored replacement of the SF5-aniline moiety of DSM265 with a series of CF3-pyridinyls while maintaining the core triazolopyrimidine scaffold. This effort led to the identification of DSM421, which has improved solubility, lower intrinsic clearance, and increased plasma exposure after oral dosing compared to DSM265, while maintaining a long predicted human half-life. Its improved physical and chemical properties will allow it to be formulated more readily than DSM265. DSM421 showed excellent efficacy in the SCID mouse model of P. falciparum malaria that supports the prediction of a low human dose (<200 mg). Importantly DSM421 showed equal activity against both P. falciparum and P. vivax field isolates, while DSM265 was more active on P. falciparum. DSM421 has the potential to be developed as a single-dose cure or once-weekly chemopreventative for both P. falciparum and P. vivax malaria, leading to its advancement as a preclinical development candidate.
PMID: 27641613 [PubMed - indexed for MEDLINE]
An "Unlikely" Pair: The Antimicrobial Synergy of Polymyxin B in Combination with the Cystic Fibrosis Transmembrane Conductance Regulator Drugs KALYDECO and ORKAMBI.
ACS Infect Dis. 2016 Jul 08;2(7):478-88
Authors: Schneider EK, Azad MA, Han ML, Tony Zhou Q, Wang J, Huang JX, Cooper MA, Doi Y, Baker MA, Bergen PJ, Muller MT, Li J, Velkov T
Novel combination therapies are desperately needed for combating lung infections caused by bacterial "superbugs". This study aimed to investigate the synergistic antibacterial activity of polymyxin B in combination with the cystic fibrosis (CF) drugs KALYDECO (ivacaftor) and ORKAMBI (ivacaftor + lumacaftor) against Gram-negative pathogens that commonly colonize the CF lung, in particular, the problematic Pseudomonas aeruginosa. The in vitro synergistic activity of polymyxin B combined with ivacaftor or lumacaftor was assessed using checkerboard and static time-kill assays against a panel of polymyxin-susceptible and polymyxin-resistant P. aeruginosa isolates from the lungs of CF patients. Polymyxin B, ivacaftor, and lumacaftor were ineffective when used individually against polymyxin-resistant (MIC ≥ 4 mg/L) isolates. However, when used together, the combination of clinically relevant concentrations of polymyxin B (2 mg/L) combined with ivacaftor (8 mg/L) or ivacaftor (8 mg/L) + lumacaftor (8 mg/L) displayed synergistic killing activity against polymyxin-resistant P. aeruginosa isolates as demonstrated by a 100-fold decrease in the bacterial count (CFU/mL) even after 24 h. The combinations also displayed excellent antibacterial activity against P. aeruginosa under CF relevant conditions in a sputum medium assay. The combination of lumacaftor (alone) with polymyxin B showed additivity against P. aeruginosa. The potential antimicrobial mode of action of the combinations against P. aeruginosa was investigated using different methods. Treatment with the combinations induced cytosolic GFP release from P. aeruginosa cells and showed permeabilizing activity in the nitrocefin assay, indicating damage to both the outer and inner Gram-negative cell membranes. Moreover, scanning and transmission electron micrographs revealed that the combinations produce outer membrane damage to P. aeruginosa cells that is distinct from the effect of each compound per se. Ivacaftor was also shown to be a weak inhibitor of the bacterial DNA gyrase and topoisomerase IV with no effect on either human type I or type IIα topoisomerases. Lumacaftor displayed the ability to increase the cellular production of damaging reactive oxygen species. In summary, the combination of polymyxin B with KALYDECO or ORKAMBI exhibited synergistic activity against highly polymyxin-resistant P. aeruginosa CF isolates and can be potentially useful for otherwise untreatable CF lung infections.
PMID: 27626100 [PubMed - indexed for MEDLINE]
Healthful dietary patterns and long-term weight change among women with a history of gestational diabetes mellitus.
Int J Obes (Lond). 2016 Nov;40(11):1748-1753
Authors: Tobias DK, Zhang C, Chavarro J, Olsen S, Bao W, Bjerregaard AA, Fung TT, Manson JE, Hu FB
BACKGROUND/OBJECTIVE: Diet represents a key strategy for the prevention of obesity and type 2 diabetes among women with a history of gestational diabetes mellitus (GDM), although effective dietary patterns to prevent weight gain in the long term are largely unknown. We sought to evaluate whether improvement in overall diet quality is associated with less long-term weight gain among high-risk women with prior GDM.
SUBJECTS/METHODS: Women with a history of GDM (N=3397) were followed from 1991 to 2011, or until diagnosis of type 2 diabetes or other chronic disease. Usual diet was assessed via food frequency questionnaire every 4 years from which we calculated the Alternative Healthy Eating Index (aHEI-2010), Alternate Mediterranean Diet (AMED) and Dietary Approaches to Stop Hypertension (DASH) dietary pattern scores. Weight, lifestyle and health-related outcomes were self-reported every 2 years. We estimated the change in dietary score with change in body weight using linear regression models adjusting for age, baseline body mass index (BMI), baseline and simultaneous change in physical activity and smoking status and other risk factors.
RESULTS: Women were followed up to 20 years, gaining an average 1.9 kg (s.d.=7.0) per 4-year period. Women in the highest quintile (Q5) of diet change (most improvement in quality) gained significantly less weight per 4-year period than the lowest quintile (Q1; decrease in quality), independent of other risk factors (4-year weight change, aHEI-2010: Q5=1.30 kg vs Q1=3.27 kg; AMED: Q5=0.94 kg vs Q1=2.56 kg, DASH: Q5=0.64 kg vs Q1=2.75 kg). Significant effect modification by BMI (p-interactions <0.001) indicated a greater magnitude of weight change among women with a higher baseline BMI for all three patterns.
CONCLUSIONS: Increased diet quality was associated with less weight gain, independent of other lifestyle factors. Post-partum recommendations on diet quality may provide one strategy to prevent long-term weight gain in this high-risk group.
PMID: 27569683 [PubMed - indexed for MEDLINE]
Posttraumatic Stress Disorder in U.S. Military Primary Care: Trajectories and Predictors of One-Year Prognosis.
J Trauma Stress. 2016 Aug;29(4):340-8
Authors: Bray RM, Engel CC, Williams J, Jaycox LH, Lane ME, Morgan JK, Unützer J
We examined the longitudinal course of primary care patients in the active duty Army with posttraumatic stress disorder (PTSD) and identified prognostic indicators of PTSD severity. Data were drawn from a 6-site randomized trial of collaborative primary care for PTSD and dpression in the military. Subjects were 474 soldiers with PTSD (scores ≥ 50 on the PTSD Checklist -Civilian Version). Four assessments were completed at U.S. Army installations: baseline, and follow-ups at 3 months (92.8% response rate [RR]), 6 months (90.1% RR), and 12 months (87.1% RR). Combat exposure and 7 validated indicators of baseline clinical status (alcohol misuse, depression, pain, somatic symptoms, low mental health functioning, low physical health functioning, mild traumatic brain injury) were used to predict PTSD symptom severity on the Posttraumatic Diagnostic Scale (Cronbach's α = .87, .92, .95, .95, at assessments 1-4, respectively). Growth mixture modeling identified 2 PTSD symptom trajectories: subjects reporting persistent symptoms (Persisters, 81.9%, n = 388), and subjects reporting improved symptoms (Improvers 18.1%, n = 86). Logistic regression modeling examined baseline predictors of symptom trajectories, adjusting for demographics, installation, and treatment condition. Subjects who reported moderate combat exposure, adjusted odds ratio (OR) = 0.44, 95% CI [0.20, 0.98], or who reported high exposure, OR = 0.39, 95% CI [0.17, 0.87], were less likely to be Improvers. Other baseline clinical problems were not related to symptom trajectories. Findings suggested that most military primary care patients with PTSD experience persistent symptoms, highlighting the importance of improving the effectiveness of their care. Most indicators of clinical status offered little prognostic information beyond the brief assessment of combat exposure.
PMID: 27447948 [PubMed - indexed for MEDLINE]
Introduction of d-Glutamate at a Critical Residue of Aβ42 Stabilizes a Prefibrillary Aggregate with Enhanced Toxicity.
Chemistry. 2016 Aug 16;22(34):11967-70
Authors: Warner CJ, Dutta S, Foley AR, Raskatov JA
The amyloid beta peptide 42 (Aβ42) is an aggregation-prone peptide that plays a pivotal role in Alzheimer's disease. We report that a subtle perturbation to the peptide through a single chirality change at glutamate 22 leads to a pronounced delay in the β-sheet adoption of the peptide. This was accompanied by an attenuated propensity of the peptide to form fibrils, which was correlated with changes at the level of the fibrillary architecture. Strikingly, the incorporation of d-glutamate was found to stabilize a soluble, ordered macromolecular assembly with enhanced cytotoxicity to PC12 cells, highlighting the importance of advanced prefibrillary Aβ aggregates in neurotoxicity.
PMID: 27272258 [PubMed - indexed for MEDLINE]
A Multimodal Counseling-Based Adolescent Physical Activity Intervention.
J Adolesc Health. 2016 Sep;59(3):332-337
Authors: Oreskovic NM, Winickoff JP, Perrin JM, Robinson AI, Goodman E
PURPOSE: National guidelines recommend adolescents achieve 60 minutes of moderate-to-vigorous physical activity (MVPA)/day, yet few adolescents meet these guidelines.
METHODS: We piloted a novel quasi-randomized physical activity intervention to promote adolescent's use of their surrounding built environment among 30 intervention and 30 control overweight/obese adolescents aged 10-16 years living in greater Boston from 2013 to 2015. Location-specific MPVA was measured by accelerometry and global positioning system for three one-week periods (Time 1 [T1], Time 2 [T2], and Time 3 [T3]). One month after T1, intervention participants received individualized counseling on how to use their surrounding built environment to increase MVPA, and control participants received standard-of-care lifestyle modification counseling; both groups received their T1 physical activity data. T2 assessment occurred the week after the counseling visit and T3 assessment 3-4 months later. The main outcome was change in average daily minutes of MVPA; the secondary outcome was meeting national MVPA guidelines. Multivariable modeling accounted for covariates (baseline MVPA, body mass index, age, sex, race/ethnicity) and clustering by study group and town.
RESULTS: Among the 60 adolescents recruited, 55 (92%) completed data collection. Short-term (T2) intervention effects included increased average MVPA of +13.9 minutes intervention versus -.6 minutes control (p < .0001). Differential increase in mean daily MVPA was sustained at T3 (9.3 minutes more in intervention group; p = .0006). The proportion of adolescents in the intervention group who achieved 60 minutes/day of MVPA increased from 11% (T1) to 21% (T2), whereas declining (7%-0%) among controls.
CONCLUSIONS: Individualized counseling about the built environment can help increase MVPA among overweight and obese adolescents.
PMID: 27235377 [PubMed - indexed for MEDLINE]
Adiponectin mediates the additive effects of combining daily exercise with caloric restriction for treatment of non-alcoholic fatty liver.
Int J Obes (Lond). 2016 Nov;40(11):1760-1767
Authors: Cho J, Koh Y, Han J, Kim D, Kim T, Kang H
BACKGROUND/OBJECTIVES: Little is known regarding whether or not combining daily exercise (EX) with caloric restriction (CR) additionally alleviates non-alcoholic fatty liver disease (NAFLD). The study investigated the effect of the combination of EX and CR on NAFLD and its underlying mechanisms in high-fat diet (HFD)-induced obese mice.
METHODS: C57BL/6 mice (N=50) were fed a standard chow (SC; n=10) or HFD (n=40) for 24 weeks. After 16 weeks, the HFD mice were further assigned to one of the following groups for the remaining 8 weeks: the first group of mice (HFD; n=10) remained to HFD, the second group of mice (HFD-EX; n=10) remained to HFD while subjected to EX, the third group of mice (HFD-CR; n=10) switched their diet from HFD to SC and the fourth group of mice (HFD-EX+CR; n=10) switched their diet from HFD to SC while simultaneously being subjected to EX.
RESULTS: HFD resulted in obesity, impaired glucose tolerance, hypercholesterolemia and histology-based hepatic steatosis in conjunction with hypoadiponectinemia and downregulation of hepatic adiponectin receptors. However, EX or CR alleviated the fatty liver and its metabolic complications significantly. Compared with EX or CR alone, the combination of EX and CR resulted in further alleviations of NAFLD-associated conditions. The additive benefits of the combined treatment were associated with greater elevations of adiponectin and its hepatic receptors, in conjunction with greater expression of their downstream targets involved in fatty acid oxidation, de novo lipogenesis and anti-inflammation.
CONCLUSIONS: The current findings provide experimental evidence in favor of the combination of EX and CR as a superior strategy for NAFLD treatment than EX or CR alone.
PMID: 27216820 [PubMed - indexed for MEDLINE]
Sphenopalatine ganglion stimulation in cluster headache and other types of headache.
Cephalalgia. 2016 Oct;36(12):1149-1155
Authors: Láinez MJ, Marti AS
Objectives The cluster headache is the most excruciatingly painful primary headache. In some patients, neither preventive treatment nor acute treatment is effective or treatment is poorly tolerated. The sphenopalatine ganglion (SPG) has an important role in the pathophysiology of cluster headache and, for this reason, SPG stimulation has been used to treat cluster headache. Methods We have reviewed the published literature on the role of the SPG in cluster headache and the use of different treatments targeting the SPG. Results Multiple procedures have been used over the SPG to treat pain and trigemino-autonomic symptoms in patients with refractory cluster headache. After obtaining good results in a small number of patients, a miniaturized stimulator was developed. Stimulation of the SPG with this device proved to be efficacious in acute and preventive treatment in a clinical trial involving patients with chronic refractory cluster headache. Implantation of the device is minimally invasive and the most frequent side-effects are mild, such as paraesthesia and pain over the maxillary area. In patients who have used the SPG device for longer than one year, the therapeutic effect remains effective and the side-effects decrease. Conclusions The reported studies have demonstrated that SPG stimulation is a safe and effective treatment for chronic cluster headache. Long-term studies have shown that the effect remains over time and this treatment could be a good choice in patients with chronic refractory headache. We need more data about its potential use in other forms of headache, such as other trigemino-autonomic headaches or migraine.
PMID: 27152017 [PubMed - indexed for MEDLINE]
Noninvasive neurostimulation methods for migraine therapy: The available evidence.
Cephalalgia. 2016 Oct;36(12):1170-1180
Authors: Schoenen J, Roberta B, Magis D, Coppola G
Background Migraine is one of the most disabling neurological disorders. The current pharmacological armamentarium is not satisfying for a large proportion of patients because the responder rate does not exceed 50% on average and the most effective drugs often induce intolerable side effects. During recent years, noninvasive central and peripheral neuromodulation methods have been explored for migraine treatment. Overview A review of the available evidence suggests that noninvasive neuromodulation techniques could be beneficial for migraine patients. The transcranial stimulation methods allow modulating selectively cortical activity and can thus be curtailed to the patient's pathophysiological profile, while transcutaneous stimulation of pericranial nerves likely modulates central pain control centers. Occipital single-pulse transcranial magnetic stimulation and transcutaneous supraorbital stimulation have the strongest evidence respectively for acute and preventive treatment. Transcranial direct current stimulation and repetitive magnetic stimulation are promising in pilot studies, but large sham-controlled trials are not yet available. Conclusions The noninvasive neurostimulation methods are promising for migraine treatment and devoid of serious adverse effects allowing their combination with drug therapies. Their application in clinical practice will depend on the industry's capacity to develop portable and user-friendly devices, and on the scientists' capacity to prove their efficacy in randomized sham-controlled trials.
PMID: 27026674 [PubMed - indexed for MEDLINE]
Invasive pericranial nerve interventions.
Cephalalgia. 2016 Oct;36(12):1156-1169
Authors: Ambrosini A, Schoenen J
Background In many patients suffering from primary headaches, the available pharmacological and behavioural treatments are not satisfactory. This is a review of (minimally) invasive interventions targeting pericranial nerves that could be effective in refractory patients. Methods The interventions we will cover have in common pericranial nerves as targets, but are distinct according to their rationale, modality and invasiveness. They range from nerve blocks/infiltrations to the percutaneous implantation of neurostimulators and surgical decompression procedures. We have critically analysed the published data (PubMed) on their effectiveness and tolerability. Results and conclusions There is clear evidence for a preventative effect of suboccipital injections of local anaesthetics and/or steroids in cluster headache, while evidence for such an effect is weak in migraine. Percutaneous occipital nerve stimulation (ONS) provides significant long-term relief in more than half of drug-resistant chronic cluster headache patients, but no sham-controlled trial has tested this. The evidence that ONS has lasting beneficial effects in chronic migraine is at best equivocal. Suboccipital infiltrations are quasi-devoid of side effects, while ONS is endowed with numerous, though reversible, adverse events. Claims that surgical decompression of multiple pericranial nerves is effective in migraine are not substantiated by large, rigorous, randomized and sham-controlled trials.
PMID: 27009564 [PubMed - indexed for MEDLINE]
Live neonates born to mothers with Ebola virus disease: a review of the literature.
J Perinatol. 2016 Jun;36(6):411-4
Authors: Nelson JM, Griese SE, Goodman AB, Peacock G
Ebola virus disease (EVD) is associated with a high mortality, especially among neonates. There is a paucity of literature on live neonates born to pregnant women with EVD, and therefore, our understanding of their clinical illness and outcomes is extremely limited. A literature search was conducted to identify descriptions of live neonates born to pregnant women with EVD. To date, five known reports have provided limited information about 15 live neonates born to pregnant women with EVD. All 15 neonates died, and of those with information, death was within 19 days of birth. Of the 12 neonates with information on signs and symptoms, 8 (67%) were reported to have fever; no other signs or symptoms were reported. There are no published data describing the clinical course or treatments provided for these neonates. Potential modes of Ebola virus transmission from mother to neonate are through in utero transmission, during delivery, direct contact or through breast milk. There is an urgent need for more information about neonates with EVD, including clinical course (for example, onset and presentation of illness, symptomatology and course of illness) and treatments provided as well as information on Ebola viral load in breast milk from Ebola-positive and convalescing mothers.
PMID: 26658125 [PubMed - indexed for MEDLINE]
Pathophysiological targets for non-pharmacological treatment of migraine.
Cephalalgia. 2016 Oct;36(12):1103-1111
Authors: Coppola G, Di Lorenzo C, Serrao M, Parisi V, Schoenen J, Pierelli F
Background Migraine is the most prevalent neurological disorder worldwide and ranked sixth among all diseases in years lived with disability. Overall preventive anti-migraine therapies have an effect in one patient out of two at the most, many of them being endowed with disabling adverse effects. No new disease-modifying drugs have come into clinical practice since the application to migraine of topiramate and botulinum toxin, the latter for its chronic form. There is thus clearly a need for more effective treatments that are devoid of, or have acceptable side effects. In recent years, scientific progress in migraine research has led to substantial changes in our understanding of the pathophysiology of migraine and paved the way for novel non-drug pathophysiological-targeted treatment strategies. Overview Several such non-drug therapies have been tested in migraine, such as oxidative phosphorylation enhancers, diets and non-invasive central or peripheral neurostimulation. All of them are promising for preventive migraine treatment and are quasi-devoid of side effects. Their advantage is that they can in theory be selected for individual patients according to their pathophysiological profile and they can (and probably should) be combined with the classical pharmacological armamentarium. Conclusion We will review here how knowledge of the functional anatomy and physiology of migraine mechanisms holds the key for more specific and effective non-pharmacological treatments.
PMID: 26637237 [PubMed - indexed for MEDLINE]
The effect of physical activity on cardiometabolic health and inflammation in treated HIV infection.
Antivir Ther. 2016;21(3):237-45
Authors: Dirajlal-Fargo S, Webel AR, Longenecker CT, Kinley B, Labbato D, Sattar A, McComsey GA
BACKGROUND: In HIV-uninfected populations, physical activity decreases mortality and inflammation. Inflammation is a potential cause of comorbidities in HIV+ adults, the evidence examining the effect of physical activity on cardiometabolic health is limited. This analysis examines the relationship between physical activity, cardiometabolic health and inflammation.
METHODS: We conducted a nested study within the SATURN-HIV trial in which 147 HIV+ adults were randomized to 10 mg daily rosuvastatin or placebo. Measures of physical activity, cardiometabolic health, inflammation and vascular disease (carotid artery intima media thickness and computed tomography-acquired measures pericardial fat volume) were assessed at baseline and through 96 weeks. Spearman correlations and multivariable analyses were used to explore relationships between physical activity, cardiometabolic health and inflammation.
RESULTS: Median age (Q1, Q3) was 46 (40.4, 52.7) years, 80% were male, 69% were African American and 46% were on protease inhibitors. Baseline median physical activity was 44 min per week (0, 150), 24% of participants performed greater than 150 min per week. At baseline, physical activity correlated with several markers of cardiometabolic health and inflammation (all P≤0.05). Over all time points median physical activity was independently associated with carotid distensibility (β=2.53; P=0.008), pericardial fat volume (β=-6.13; P=0.001) and interleukin-6 (β=-0.468; P<0.001).
CONCLUSIONS: Physical activity is associated with vascular disease, endothelial function, and may be an adjuvant to decreasing comorbidities in HIV+ adults. Further studies should examine long-term effects of physical activity on cardiometabolic health and inflammation in this population. Clinicaltrials.gov NCT01218802.
PMID: 26455521 [PubMed - indexed for MEDLINE]
Effects of combination of whey protein intake and rehabilitation on muscle strength and daily movements in patients with hip fracture in the early postoperative period.
Clin Nutr. 2016 Aug;35(4):943-9
Authors: Niitsu M, Ichinose D, Hirooka T, Mitsutomi K, Morimoto Y, Sarukawa J, Nishikino S, Yamauchi K, Yamazaki K
BACKGROUND & AIMS: Elderly patients can be at risk of protein catabolism and malnutrition in the early postoperative period. Whey protein includes most essential amino acids and stimulates the synthesis of muscle protein. The purpose of this study was to investigate the effect of resistance training in combination with whey protein intake in the early postoperative period.
METHODS: We randomized patients to a whey protein group or a control group. The former group received 32.2 g of whey protein pre- and post-rehabilitation in the early postoperative period for two weeks. Outcomes were knee extension strength on either side by Biodex 4.0, and the ability of transfer, walking, toilet use and stair use by the Barthel Index (BI). We performed initial and final assessments in the second and tenth rehabilitation sessions.
RESULTS: A total of 38 patients were recruited: 20 in the whey protein group and 18 in the control group. Participants in the whey protein group showed significantly greater improvement in knee extension strength in the operated limb compared with the control group (F = 6.11, P = 0.02). The non-operated limb also showed a similar tendency (F = 3.51, P = 0.07). The abilities of transfer, walking and toilet use showed greater improvements in the whey protein group than in the control group by BI (P < 0.05).
CONCLUSION: The combination of whey protein intake and rehabilitation for two weeks in the early postoperative period has a beneficial effect on knee extension strength in both lower limbs and BI (transfer, walking and toilet use) scores in patients with hip fracture.
PMID: 26216195 [PubMed - indexed for MEDLINE]
Tissue response to root canal irrigation systems in dogs' teeth with apical periodontitis.
Clin Oral Investig. 2015 Jun;19(5):1147-56
Authors: Cohenca N, Romualdo PC, da Silva LA, da Silva RA, de Queiroz AM, De Rossi A, Nelson-Filho P
OBJECTIVES: The aim of this study was to compare the efficacy of apical negative pressure irrigation (ANP) and passive ultrasonic irrigation (PUI) with apical positive pressure irrigation (PP-conventional irrigation) in the periapical repair of dogs' teeth with apical periodontitis.
METHODS: Forty-nine mesial and distal root canals of premolars of three dogs with experimentally induced periapical lesions were subjected to a single-session root canal treatment. The teeth were randomly assigned to three groups: ANP, PUI, and PP (control). After 180 days, the animals were euthanized, and the anatomic pieces were removed and subjected to histotechnical processing for morphological and morphometric histological analyses of hematoxylin and eosin (HE)-stained sections under conventional and fluorescence microscopy. Periapical lesion size before and 180 days after root canal treatment was measured by periapical radiographic examination. Tartrate-resistant acid phosphatase (TRAP) histoenzymology was performed for osteoclast counting and Brown and Brenn staining to assess bacteria. Data were analyzed statistically by the Kruskal-Wallis test (α = 5 %).
RESULT: There were no statistically significant differences among the groups regarding periapical lesion size in the radiographic evaluation (p = 0.91). In the comparison of histopathological parameters, group ANP presented more homogeneous results. There was a statistically significant difference (p = 0.02) between groups ANP and PP, with better results for group ANP in which milder infiltrate inflammatory was observed. No statistically significant difference (p > 0.05) was found among the groups with respect to periodontal ligament space, presence of mineralized tissue resorption, size of the periapical lesions, and number of osteoclasts.
CONCLUSION: Although the three irrigation systems elicited similar periapical tissue response with respect to almost all evaluated parameters, ANP presented the mildest inflammatory infiltrate, suggesting an advantage over PP in the indication for clinical use.
CLINICAL RELEVANCE: Irrigation of the root canal systems is an extremely important step in root canal treatment. Therefore, it is of relevance to evaluate the efficacy of these systems by in vivo experimental models to provide scientific background for the clinical practice.
PMID: 25338736 [PubMed - indexed for MEDLINE]
The effect of photon-initiated photoacoustic streaming, ultrasonically and sonically irrigation techniques on the push-out bond strength of a resin sealer to the root dentin.
Clin Oral Investig. 2015 Jun;19(5):1055-61
Authors: Akcay M, Arslan H, Mese M, Sahin NN
OBJECTIVES: The present study investigated the effects of various irrigation activation techniques, including laser-activated irrigation using a laser with a novel tip design (photon-induced photoacoustic streaming, PIPS) on the bond strength of an epoxy resin-based sealer to root dentin.
MATERIALS AND METHODS: Seventy-two single-rooted human mandibular premolars were prepared using the rotary system to size 40 and randomly divided into four groups (n = 18) according to the final irrigation activation technique used as follows: conventional irrigation (CI), laser-activated irrigation with PIPS (LAI-PIPS), passive ultrasonic irrigation (PUI), and sonic irrigation (SI) with 5 mL of 17 % EDTA and 2.5 % NaOCl. The root canals were then obturated with gutta-percha and AH PlusJet sealer. A push-out test was used to measure the bond strength between the root canal dentin and the sealer. The data were analyzed using the two-way analysis of variance and least significant difference (LSD) post hoc tests (P = 0.05).
RESULTS: The LAI-PIPS and PUI resulted in higher push-out values compared to CI and SI (P < 0.05). There were no statistically significant differences between CI and SI (P = 0.978) and between LAI-PIPS and PUI (P = 0.051). There was a statistically significant interaction between the final irrigant activation techniques used and root canal thirds (P < 0.05). A chi-square test revealed no significant differences in the failure mode within the groups (P > 0.05).
CONCLUSIONS: The use of LAI-PIPS and PUI can provide higher bond strength of resin sealer to root dentin compared to CI and SI techniques.
CLINICAL RELEVANCE: The activation of the irrigant and the creation of the streaming have a positive effect on the bond strength of the resin sealer to root dentin.
PMID: 25315971 [PubMed - indexed for MEDLINE]