Probiotics-supplemented feeding in extremely low-birth-weight infants

OBJECTIVE

The objective of this trial was to test whether probiotic-supplemented feeding to extremely low-birth-weight (ELBW) infants will improve growth as determined by decreasing the percentage of infants with weight below the 10th percentile at 34 weeks postmenstrual age (PMA). Other important outcome measures, such as improving feeding tolerance determined by tolerating larger volume of feeding per day and reducing antimicrobial treatment days during the first 28 days from the initiation of feeding supplementation were also evaluated.

STUDY DESIGN

We conducted a multicenter randomized controlled double-blinded clinical study. The probiotics-supplementation (PS) group received Lactobacillus rhamnosus GG and Bifidobacterium infantis added to the first enteral feeding and continued once daily with feedings thereafter until discharge or until 34 weeks (PMA). The control (C) group received unsupplemented feedings. Infant weight and feeding volumes were recorded daily during the first 28 days of study period. Weights were also recorded at 34 weeks PMA.

RESULT

A total of 101 infants were enrolled (PS 50 versus C 51). There was no difference between the two groups in the percentage of infants with weight below the 10th percentile at 34 weeks PMA (PS group 58% versus C group 60%, (P value 0.83)) or in the average volume of feeding during 28 days after study entry (PS group 59  ml  kg(-1) versus C group 71  ml  kg(-1), (P value 0.11)). Calculated growth velocity was higher in the PS group compared with the C group (14.9 versus 12.6  g per day, (P value 0.05)). Incidences of necrotizing enterocolitis (NEC), as well as mortality were similar between the two groups.

CONCLUSION

Although probiotic-supplemented feedings improve growth velocity in ELBW infants, there was no improvement in the percentage of infants with growth delay at 34 weeks PMA. There were no probiotic-related adverse events reported.

Nicotine treatment of mild cognitive impairment: a 6-month double-blind pilot clinical trial

OBJECTIVE

To preliminarily assess the safety and efficacy of transdermal nicotine therapy on cognitive performance and clinical status in subjects with mild cognitive impairment (MCI).

METHODS

Nonsmoking subjects with amnestic MCI were randomized to transdermal nicotine (15 mg per day or placebo) for 6 months. Primary outcome variables were attentional improvement assessed with Connors Continuous Performance Test (CPT), clinical improvement as measured by clinical global impression, and safety measures. Secondary measures included computerized cognitive testing and patient and observer ratings.

RESULTS

Of 74 subjects enrolled, 39 were randomized to nicotine and 35 to placebo. 67 subjects completed (34 nicotine, 33 placebo). The primary cognitive outcome measure (CPT) showed a significant nicotine-induced improvement. There was no statistically significant effect on clinician-rated global improvement. The secondary outcome measures showed significant nicotine-associated improvements in attention, memory, and psychomotor speed, and improvements were seen in patient/informant ratings of cognitive impairment. Safety and tolerability for transdermal nicotine were excellent.

CONCLUSION

This study demonstrated that transdermal nicotine can be safely administered to nonsmoking subjects with MCI over 6 months with improvement in primary and secondary cognitive measures of attention, memory, and mental processing, but not in ratings of clinician-rated global impression. We conclude that this initial study provides evidence for nicotine-induced cognitive improvement in subjects with MCI; however, whether these effects are clinically important will require larger studies.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that 6 months of transdermal nicotine (15 mg/day) improves cognitive test performance, but not clinical global impression of change, in nonsmoking subjects with amnestic MCI.

Effects of ramp negotiation, paving type and shoe sole geometry on toe clearance in young adults

Trips are a major cause of falls and result from involuntary contact of the foot with the ground during the swing phase of gait. Adequate toe clearance during swing is therefore crucial for safe locomotion. To date, little is known about the effects of environmental factors and footwear on toe clearance. This study reports on modulation of toe clearance and toe clearance variability in response to changes in ground inclination, paving type, and shoe sole geometry. Toe clearance and toe clearance variability for ten healthy young adults were calculated two-fold: a) for the commonly-used position on the foremost part of the sole of the shoe and b) for the lowest of a total of 7 sole positions, located between the metatarsals and the toe tip across the entire width of the sole. Utilizing a full-factorial design we found that toe clearance was affected by ground inclination, paving type, and sole geometry regardless of the computational method used (with p-values<0.01) but the use of the foremost part of the sole for toe clearance calculation results is an overestimation of this value. Our findings highlight the importance of considering footwear and environmental factors when assessing the risk of tripping. Future work needs to investigate to which extent the same factors affect toe clearance in more vulnerable parts of the population.

Effect of aliskiren, an oral direct renin inhibitor, on the pharmacokinetics and pharmacodynamics of a single dose of acenocoumarol in healthy volunteers

OBJECTIVE

Aliskiren is a direct renin inhibitor approved for the treatment of hypertension. This study investigated the effects of aliskiren on the pharmacokinetics and pharmacodynamics of a single dose of acenocoumarol in healthy volunteers.

METHODS

This two-sequence, two-period, randomized, double-blind crossover study recruited 18 healthy subjects (ages 18-45) to receive either aliskiren 300 mg or placebo once daily on days 1-10 of each treatment period and a single dose of acenocoumarol 10 mg on day 8. Treatment periods were separated by a 10-day washout. Blood samples were taken frequently for determination of steady-state plasma concentrations of aliskiren (LC-MS/MS) and of R(+)- and S(-)-acenocoumarol (HPLC-UV), prothrombin time (PT) and international normalized ratio (INR).

RESULTS

Co-administration with aliskiren had no effect on exposure to R(+)-acenocoumarol. Geometric mean ratios (GMR; aliskiren:placebo co-administration) for R(+)-acenocoumarol AUC(0-t) and C(max) were 1.08 and 1.04, respectively, with 90% CI within the range 0.80-1.25. Co-administration of aliskiren resulted in a 19% increase in S(-)-acenocoumarol AUC(0-t) (GMR 1.19; 90% CI 0.92, 1.54) and a 9% increase in C(max) (GMR 1.09; 90% CI 0.88, 1.34). The anticoagulant effect of acenocoumarol was not affected by co-administration of aliskiren. Geometric mean ratios were 1.01 for all pharmacodynamic parameters (AUC(PT), PT(max), AUC(INR) and INR(max)), with 90% CI within the range 0.97-1.05.

CONCLUSION

Aliskiren has no clinically relevant effect on the pharmacokinetics or pharmacodynamic effects of a single dose of acenocoumarol in healthy volunteers, hence no dosage adjustment of acenocoumarol is likely to be required during co-administration with aliskiren.

Predicting lower limb joint kinematics using wearable motion sensors

The aim of this study was to estimate sagittal plane ankle, knee and hip gait kinematics using 3D angular velocity and linear acceleration data from motion sensors on the foot and shank. We explored the accuracy of intra-subject predictions (i.e., where training and testing uses trials from the same subject) and inter-subject (where testing uses subjects different from the ones used for training) predictions, and the effect of loss of sensor data on prediction accuracy. Hip, knee and ankle kinematic data were collected using reflective markers. Simultaneously, foot and shank angular velocity and linear acceleration data were collected using small integrated accelerometers/gyroscope units. A generalised regression networks algorithm was used to predict the former from the latter. The best results were from intra-subject predictions, with very high correlations (0.93-0.99) and low mean absolute deviation (< or =2.3 degrees ) between measured kinematic joint angles and predicted angles. The inter-subject case produced poorer correlations (0.70-0.89) and larger absolute differences between measured and predicted angles, ranging from 4.91 degrees (left ankle) to 9.06 degrees (right hip). The angular velocity data added little to the accuracy of predictions and there was also minimal benefit to using sensor data from the shank. Thus, a wearable system based only on footwear mounted sensors and a simpler sensor set providing only acceleration data shows potential. Whilst predictions were generally stable when sensor data was lost, it remains to be seen whether the generalised regression networks algorithm is robust for other activities such as stair climbing.

Language activation studies with positron emission tomography

Behavioural tasks produce changes in regional cerebral blood flow (rCBF), the result of increased local neural activity. These changes can be measured with positron emission tomography (PET). Language activation studies by means of PET are being used to relate regional patterns of cerebral activation to information-processing models of speech and reading. Significant activation confined to both superior temporal gyri has been observed when normal subjects hear words played backwards, listen to non-words, and perform category judgements on pairs of heard real words. Prestriate cortex is activated by seeing strings of letter-like symbols, consonant strings, pronounceable non-words and real words, with additional activation in left medial prestriate cortex in response to the non-words and real words. Left posterior superior temporal gyrus (PSTG), left dorsolateral prefrontal cortex (DLPFC) and supplementary motor area (SMA) are engaged when subjects retrieve verbs from memory to match nouns. Finally, primary sensorimotor cortex is activated during articulation. There is particular interest at present in the precise roles of left PSTG and DLPFC in single-word comprehension and generation, and interpretation of the results depends critically on the design of the single-word tasks used for behavioural activation.

The influence of hepatic impairment on the pharmacokinetics of the dipeptidyl peptidase IV (DPP-4) inhibitor vildagliptin

OBJECTIVE

Vildagliptin is a potent and selective dipeptidyl peptidase-IV (DPP-4) inhibitor that improves glycemic control in patients with type 2 diabetes mellitus by increasing alpha- and beta-cell responsiveness to glucose. This study investigated the pharmacokinetics of vildagliptin in patients with hepatic impairment compared with healthy subjects.

METHODS

This was an open-label, parallel-group study in patients with mild (n = 6), moderate (n = 6) or severe (n = 4) hepatic impairment and healthy subjects (n = 6). All subjects received a single 100-mg oral dose of vildagliptin, and plasma concentrations of vildagliptin and its main pharmacologically inactive metabolite LAY151 were measured up to 36 h post-dose.

RESULTS

Exposure to vildagliptin (AUC(0-infinity) and C(max)) decreased non-significantly by 20 and 30%, respectively, in patients with mild hepatic impairment [geometric mean ratio (90% CI): AUC(0-infinity), 0.80 (0.60, 1.06), p = 0.192; C(max), 0.70 (0.46, 1.05), p = 0.149]. Exposure to vildagliptin was also decreased non-significantly in patients with moderate hepatic impairment [-8% for AUC(0-infinity), geometric mean ratio (90% CI): 0.92 (0.69, 1.23), p = 0.630; -23% for C(max), geometric mean ratio (90% CI): 0.77 (0.51, 1.17), p = 0.293]. In patients with severe hepatic impairment, C(max) was 6% lower than that in healthy subjects [geometric mean ratio (90% CI): 0.94 (0.59, 1.49), p = 0.285], whereas AUC(0-infinity) was increased by 22% [geometric mean ratio (90% CI): 1.22 (0.89, 1.68), p = 0.816). Across the hepatic impairment groups, LAY151 AUC(0-infinity) and C(max) were increased by 29-84% and 24-63%, respectively, compared with healthy subjects. The single 100-mg oral dose of vildagliptin was well tolerated by patients with hepatic impairment.

CONCLUSIONS

There was no significant difference in exposure to vildagliptin in patients with mild, moderate or severe hepatic impairment; therefore, no dose adjustment of vildagliptin is necessary in patients with hepatic impairment.

A dual-task approach to the evaluation of the myokinemetric signal as an alternative to EMG

EMG is the signal widely used in neuromuscular control, biofeedback and measurement applications. Alternative physiological signals are available, but are used relatively infrequently. In the development of assistive devices, such as functional electrical stimulators, it is important to make the device as straightforward to use as possible. This is particularly relevant for patients with neurological and often associated cognitive impairments. Different physiological signals may require different degrees of attention to control, and advantage could be gained from selection of a signal that requires the least attention to control. However, relatively little work has been carried out on how to assess the demands of different physiological signals. This paper reports on the development of a novel experimental set up designed to address this problem and, in particular, to compare two different physiological signals, the EMG and the so-called MK signal. The paper presents the hardware design, including mechanical, electronic and software design, which involves data acquisition, parallel tasks and user-friendly interface. The system described could be adapted for evaluation of other physiological signals.