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Rhys-Jones D, Climie RE, Gill PA, Jama HA, Head GA, Gibson PR, Kaye DM, Muir JG, Marques FZ. Microbial Interventions to Control and Reduce Blood Pressure in Australia (MICRoBIA): rationale and design of a double-blinded randomised cross-over placebo controlled trial. Trials 2021; 22:496. [PMID: 34315522 PMCID: PMC8313879 DOI: 10.1186/s13063-021-05468-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/17/2021] [Indexed: 12/01/2022] Open
Abstract
Background Hypertension is a prevalent chronic disease worldwide that remains poorly controlled. Recent studies support the concept that the gut microbiota is involved in the development of hypertension and that dietary fibre intake may act through the gut microbiota to lower blood pressure (BP). Resistant starch is a type of prebiotic fibre which is metabolised by commensal bacteria in the colon to produce short-chain fatty acids (SCFAs), including acetate, propionate, and butyrate. Previous work in pre-clinical models provides strong evidence that both prebiotic fibre as well as SCFAs (i.e. postbiotics) can prevent the development of hypertension. The aim of this clinical trial is to determine if acetylated and butyrylated modified resistant starch can decrease BP of hypertensive individuals via the modulation of the gut microbiota and release of high levels of SCFAs. Methods This is a phase IIa double-blinded, randomised, cross-over, placebo controlled trial. Participants are randomly allocated to receive either a diet containing 40 g/day of the modified resistant starch or placebo (corn starch or regular flour) for 3 weeks on each diet, with a 3-week washout period between the two diets. BP is measured in the office, at home, and using a 24-h ambulatory device. Arterial stiffness is measured using carotid-to-femoral pulse wave velocity. Our primary endpoint is a reduction in ambulatory daytime systolic BP. Secondary endpoints include changes to circulating cytokines, immune markers, and modulation to the gut microbiome. Discussion The findings of this study will provide the first evidence for the use of a combination of pre- and postbiotics to lower BP in humans. The results are expected at the end of 2021. Trial registration Australia and New Zealand Clinical Trial Registry ACTRN12619000916145. Registered on 1 July 2019.
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Affiliation(s)
- Dakota Rhys-Jones
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science, Monash University, 25 Rainforest Walk, Clayton, Victoria, 3800, Australia.,Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Australia
| | - Rachel E Climie
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia.,Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia
| | - Paul A Gill
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Australia
| | - Hamdi A Jama
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science, Monash University, 25 Rainforest Walk, Clayton, Victoria, 3800, Australia
| | - Geoffrey A Head
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Pharmacology, Monash University, Melbourne, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Australia
| | - David M Kaye
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.,Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Jane G Muir
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Australia
| | - Francine Z Marques
- Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science, Monash University, 25 Rainforest Walk, Clayton, Victoria, 3800, Australia. .,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.
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A huggable device can reduce the stress of calling an unfamiliar person on the phone for individuals with ASD. PLoS One 2021; 16:e0254675. [PMID: 34297735 PMCID: PMC8301655 DOI: 10.1371/journal.pone.0254675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
Individuals with autism spectrum disorders (ASD) are often not comfortable during mobile-phone conversations with unfamiliar people. “Hugvie” is a pillow with a human-like shape that has been designed to provide users with the tactile sensation of hugging another person during phone conversations to promote feelings of comfort and trust in the speaker toward their conversation partners. Our primary aim was to examine whether physical contact by hugging a Hugvie could reduce the stress of speaking with an unfamiliar person on the phone in individuals with ASD. We enrolled 24 individuals and requested them to carry out phone conversations either using only a mobile phone or using a mobile phone along with the Hugvie. All participants in both groups completed questionnaires designed to evaluate their self-confidence while talking on the phone, and also provided salivary cortisol samples four times each day. Our analysis revealed that the medium of communication was a significant factor, indicating that individuals with ASD who spoke with an unfamiliar person on the phone while hugging a Hugvie had stronger self-confidence and lower stress levels than those who did not use Hugvie. Hence, we recommend that huggable devices be used as adjunctive tools to support individuals with ASD during telephonic conversations with unfamiliar people.
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Efficacy of hypertonic dextrose injection (prolotherapy) in temporomandibular joint dysfunction: a systematic review and meta-analysis. Sci Rep 2021; 11:14638. [PMID: 34282199 PMCID: PMC8289855 DOI: 10.1038/s41598-021-94119-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
Hypertonic dextrose prolotherapy (DPT) has been reported to be effective for temporomandibular disorders (TMDs) in clinical trials but its overall efficacy is uncertain. To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) to synthesize evidence on the effectiveness of DPT for TMDs. Eleven electronic databases were searched from their inception to October, 2020. The primary outcome of interest was pain intensity. Secondary outcomes included maximum inter-incisal mouth opening (MIO) and disability score. Studies were graded by “Cochrane risk of bias 2” tool; if data could be pooled, a meta-analysis was performed. Ten RCTs (n = 336) with some to high risk of bias were included. In a meta-analysis of 5 RCTs, DPT was significantly superior to placebo injections in reducing TMJ pain at 12 weeks, with moderate effect size and low heterogeneity (Standardized Mean Difference: − 0.76; 95% CI − 1.19 to − 0.32, I2 = 0%). No statistically significant differences were detected for changes in MIO and functional scores. In this systematic review and meta-analysis, evidence from low to moderate quality studies show that DPT conferred a large positive effect which met criteria for clinical relevance in the treatment of TMJ pain, compared with placebo injections. Protocol registration at PROSPERO: CRD42020214305.
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Aithal S, Karkou V, Makris S, Karaminis T, Powell J. A Dance Movement Psychotherapy Intervention for the Wellbeing of Children With an Autism Spectrum Disorder: A Pilot Intervention Study. Front Psychol 2021; 12:588418. [PMID: 34349692 PMCID: PMC8326518 DOI: 10.3389/fpsyg.2021.588418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
Background Sustaining the wellbeing for children with an autism spectrum disorder (ASD) can be highly demanding. Dance Movement Psychotherapy (DMP), a form of psychotherapy with a non-verbal character, may present as a relevant intervention option for this group of children. Methods A protocol-based group DMP intervention was developed and implemented in two special educational needs schools in the North West of England. We aimed to investigate the effects of DMP on children with ASD using the Social Communication Questionnaire (SCQ) and Strengths and Difficulties Questionnaire (SDQ). Twenty-six children aged between 8 and 13 years (mean age = 10.65 years) with ASD were randomly allocated to DMP and a control group with standard care, following a crossover research design. Results Results showed no significant carryover or period effects for either the SCQ or SDQ (p > 0.05). A significant intervention effect was found only for SCQ (p = 0.005) but not for SDQ (p > 0.05). ANCOVAs were performed on the data before the crossover to test for differences in SCQ and SDQ scores between the DMP intervention and control groups while controlling for pre-intervention scores. Those in the DMP intervention group presented significantly lower SCQ scores following the intervention period than those in the control group (p = 0.001). No significant differences in post-intervention SDQ scores were found between DMP intervention and control groups (p = 0.2). However, minimal clinically important differences (MCID) were reached for both SCQ and SDQ measures before crossover for those in the DMP intervention group. Moreover, repeated measures ANOVAs performed on SCQ and SDQ measures following crossover were significant, with the change in both SCQ (p = 0.001) and SDQ (p = 0.009) pre-and post-intervention being significantly greater for those in the DMP intervention than the control group. Conclusion The pilot DMP intervention has shown promising results on the social and emotional wellbeing of children with ASD irrespective of whether they preferred verbal or non-verbal mode of communication. Limitations and appropriateness of the research methods implemented in this study for their use in a large RCT are discussed in detail. Overall, our findings highlight the value of creative therapies for improving the lives of young vulnerable groups.
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Affiliation(s)
- Supritha Aithal
- Research Centre for Arts and Wellbeing, School of Applied Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Vicky Karkou
- Research Centre for Arts and Wellbeing, School of Applied Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Stergios Makris
- Research Centre for Arts and Wellbeing, Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Themis Karaminis
- Research Centre for Arts and Wellbeing, Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Joanne Powell
- Research Centre for Arts and Wellbeing, Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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Warm Footbaths with Sinapis nigra or Zingiber officinale Enhance Self-Reported Vitality in Healthy Adults More than Footbaths with Warm Water Only: A Randomized, Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9981183. [PMID: 34335853 PMCID: PMC8292049 DOI: 10.1155/2021/9981183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022]
Abstract
Objectives To examine the effects of warm footbaths with thermogenic medicinal powders on vitality and heart rate variability in healthy adults. Intervention and Outcome. Seventeen healthy young adults (22.1 ± 2.4 years, 11 females) received three footbaths (WA: warm water only; GI: warm water and ginger; MU: warm water and mustard) in randomized order with a crossover design. We assessed vitality with the Basler Befindlichkeit questionnaire (BBS) and heart rate variability (HRV) before (t0), immediately after (t1), and 10 minutes following footbaths (t2). The primary outcome measure was self-reported vitality, measured via the BBS, at t1. Results The primary outcome measure, self-reported vitality, was higher after GI and tended to be higher after MU compared to WA with medium effect sizes (GI vs. WA, mean difference −2.47 (95% CI −5.28 to 0.34), padj=0.048, dadj = 0.74), MU vs. WA, −2.35 (−5.32 to 0.61), padj=0.30, dadj = 0.50). At t2, the standard deviation of beat-to-beat intervals (SDNN) of HRV increased, and the stress index tended to decrease after all three footbath conditions with small to medium effect sizes (0.42–0.66). Conclusion There is preliminary evidence that footbaths with thermogenic agents GI and MU may increase self-reported vitality during a short-time period with a more pronounced effect with GI. After a short follow-up, all three conditions tended to shift the autonomic balance towards relaxation. Future research should investigate these effects in clinical samples with a larger, more diverse sample size.
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Age-Related Differential Effects of School-Based Sitting and Movement Meditation on Creativity and Spatial Cognition: A Pilot Study. CHILDREN-BASEL 2021; 8:children8070583. [PMID: 34356562 PMCID: PMC8303844 DOI: 10.3390/children8070583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022]
Abstract
Psychophysical well-being can be supported during development by the integration of extra-curricular activities in scholastic settings. These activities can be implemented in different forms, ranging from physical activities to sitting meditation practices. Considering that both such activities are thought to affect children’s psychophysical development, a movement-based meditation that combines the two approaches−in the form of a short daily activity−could represent a powerful tool to promote healthy physical and mental development. Consequently, the current pilot study aimed to examine the effect of short daily school-based sitting and movement meditation trainings on creativity and spatial cognition. Utilizing a crossover design, we evaluated their feasibility and efficacy at different ages among children (n = 50) in 5th to 8th grade. We observed that 5 weeks of daily training in sitting and movement meditation techniques improved children’s cognition differently. Specifically, younger children showed greater creativity and better spatial cognition following the movement-based meditation, while older children showed greater enhancement in these areas following sitting meditation training. This suggests that training can affect children’s cognition differently depending on their developmental stage. We discuss these results within the framework of embodied and grounded cognition theories. Information on feasibility and age-related effect sizes derived from the current study paves the way for future well-powered larger-scale efficacy studies on different forms of school-based interventions to cognitive development promotion.
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Nakajima T, Sankai Y, Takata S, Kobayashi Y, Ando Y, Nakagawa M, Saito T, Saito K, Ishida C, Tamaoka A, Saotome T, Ikai T, Endo H, Ishii K, Morita M, Maeno T, Komai K, Ikeda T, Ishikawa Y, Maeshima S, Aoki M, Ito M, Mima T, Miura T, Matsuda J, Kawaguchi Y, Hayashi T, Shingu M, Kawamoto H. Cybernic treatment with wearable cyborg Hybrid Assistive Limb (HAL) improves ambulatory function in patients with slowly progressive rare neuromuscular diseases: a multicentre, randomised, controlled crossover trial for efficacy and safety (NCY-3001). Orphanet J Rare Dis 2021; 16:304. [PMID: 34233722 PMCID: PMC8261928 DOI: 10.1186/s13023-021-01928-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/27/2021] [Indexed: 11/15/2022] Open
Abstract
Background Rare neuromuscular diseases such as spinal muscular atrophy, spinal bulbar muscular atrophy, muscular dystrophy, Charcot-Marie-Tooth disease, distal myopathy, sporadic inclusion body myositis, congenital myopathy, and amyotrophic lateral sclerosis lead to incurable amyotrophy and consequent loss of ambulation. Thus far, no therapeutic approaches have been successful in recovering the ambulatory ability. Thus, the aim of this trial was to evaluate the efficacy and safety of cybernic treatment with a wearable cyborg Hybrid Assistive Limb (HAL, Lower Limb Type) in improving the ambulatory function in those patients.
Results We conducted an open-label, randomised, controlled crossover trial to test HAL at nine hospitals between March 6, 2013 and August 8, 2014. Eligible patients were older than 18 years and had a diagnosis of neuromuscular disease as specified above. They were unable to walk for 10 m independently and had neither respiratory failure nor rapid deterioration in gait. The primary endpoint was the distance passed during a two-minute walk test (2MWT). The secondary endpoints were walking speed, cadence, and step length during the 10-m walk test (10MWT), muscle strength by manual muscle testing (MMT), and a series of functional measures. Adverse events and failures/problems/errors with HAL were also evaluated. Thirty patients were randomly assigned to groups A or B, with each group of 15 receiving both treatments in a crossover design. The efficacy of a 40-min walking program performed nine times was compared between HAL plus a hoist and a hoist only. The final analysis included 13 and 11 patients in groups A and B, respectively. Cybernic treatment with HAL resulted in a 10.066% significantly improved distance in 2MWT (95% confidence interval, 0.667–19.464; p = 0.0369) compared with the hoist only treatment. Among the secondary endpoints, the total scores of MMT and cadence at 10MWT were the only ones that showed significant improvement. The only adverse effects were slight to mild myalgia, back pain, and contact skin troubles, which were easily remedied.
Conclusions HAL is a new treatment device for walking exercise, proven to be more effective than the conventional method in patients with incurable neuromuscular diseases. Trial registration: JMACTR, JMA-IIA00156
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Affiliation(s)
- Takashi Nakajima
- Departments of Neurology and Rehabilitation Medicine, National Hospital Organization Niigata National Hospital, 3-52 Akasaka, Kashiwazaki, Niigata, 945-8585, Japan.
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,CYBERDYNE Inc., Tsukuba, Japan
| | - Shinjiro Takata
- Department of Orthopedics and Rehabilitation, National Hospital Organization Tokushima National Hospital, Yoshinogawa, Japan
| | - Yoko Kobayashi
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yoshihito Ando
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Masanori Nakagawa
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshio Saito
- Division of Child Neurology, Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Kayoko Saito
- Institute of Medical Genetics, Tokyo Women's Medical University, Shinjuku, Japan
| | - Chiho Ishida
- Department of Neurology, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Akira Tamaoka
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takako Saotome
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Tetsuo Ikai
- Department of Rehabilitation, Tokyo Women's Medical University, Shinjuku, Japan
| | - Hisako Endo
- Departments of Neurology and Rehabilitation Medicine, National Hospital Organization Niigata National Hospital, 3-52 Akasaka, Kashiwazaki, Niigata, 945-8585, Japan
| | - Kazuhiro Ishii
- Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mitsuya Morita
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Takashi Maeno
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kiyonobu Komai
- Department of Neurology, National Hospital Organization Iou National Hospital, Kanazawa, Japan
| | - Tetsuhiko Ikeda
- Departments of Neurology and Rehabilitation Medicine, National Hospital Organization Niigata National Hospital, 3-52 Akasaka, Kashiwazaki, Niigata, 945-8585, Japan
| | - Yuka Ishikawa
- Department of Pediatric Neurology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Shinichiro Maeshima
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiya Ito
- Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuya Mima
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshihiko Miura
- Department of Rehabilitation, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Jun Matsuda
- Graduate School of Humanities and Social Sciences, Shizuoka University, Shizuoka, Japan
| | | | | | | | - Hiroaki Kawamoto
- CYBERDYNE Inc., Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
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Schaafsma A, Mallee L, van den Belt M, Floris E, Kortman G, Veldman J, van den Ende D, Kardinaal A. The Effect of A Whey-Protein and Galacto-Oligosaccharides Based Product on Parameters of Sleep Quality, Stress, and Gut Microbiota in Apparently Healthy Adults with Moderate Sleep Disturbances: A Randomized Controlled Cross-Over Study. Nutrients 2021; 13:nu13072204. [PMID: 34199006 PMCID: PMC8308271 DOI: 10.3390/nu13072204] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/21/2022] Open
Abstract
People experiencing sleep problems may benefit from nutrients supporting serotonin metabolism and stress reduction. We studied the effect of a dairy-based product (DP) containing protein, galacto-oligosaccharides, vitamins and minerals, on sleep quality, stress, and gut-microbiota. In a cross-over RCT (three weeks intervention; three weeks washout), adults (n = 70; 30–50 y) with sleep disturbances (Pittsburgh Sleep Quality Index (PSQI) ≥ 9) consumed products 1 h before bed-time. Sleep quality (PSQI) was measured weekly, stress at base- and end-line (Depression Anxiety Stress Scale and saliva cortisol). Fecal samples were collected in the 1st intervention period only. Compared to placebo (skimmed milk), PSQI was only lower at day 14 in the 2nd intervention period in intention-to-treat (ITT) (p = 0.017; n = 69) and per-protocol (PP) (p = 0.038; n = 64) analyses. Post-hoc analysis (modified-PP: n=47, with baseline PSQI ≥ 9, and endline day 14), however, showed a decrease in PSQI (−1.60 ± 2.53; p = 0.034). Early morning saliva cortisol decreased versus placebo (p = 0.045). Relative abundance of Bifidobacterium increased (p = 0.02). Redundancy analysis showed an inverse relationship between baseline microbiota composition and baseline PSQI (p = 0.046). Thus, although DP did not improve sleep quality in ITT and PP populations, it did in the modPP. DP reduced salivary cortisol and stimulated Bifidobacterium, which possibly is important for sleep improvement.
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Affiliation(s)
- Anne Schaafsma
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; (L.M.); (J.V.)
- Correspondence: ; Tel.: +31-653241313
| | - Leonard Mallee
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; (L.M.); (J.V.)
| | - Maartje van den Belt
- NIZO, Nutrition & Health, 6710 BA Ede, The Netherlands; (M.v.d.B.); (E.F.); (G.K.); (A.K.)
| | - Esther Floris
- NIZO, Nutrition & Health, 6710 BA Ede, The Netherlands; (M.v.d.B.); (E.F.); (G.K.); (A.K.)
| | - Guus Kortman
- NIZO, Nutrition & Health, 6710 BA Ede, The Netherlands; (M.v.d.B.); (E.F.); (G.K.); (A.K.)
| | - Jouke Veldman
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; (L.M.); (J.V.)
| | | | - Alwine Kardinaal
- NIZO, Nutrition & Health, 6710 BA Ede, The Netherlands; (M.v.d.B.); (E.F.); (G.K.); (A.K.)
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Jarett JK, Kingsbury DD, Dahlhausen KE, Ganz HH. Best Practices for Microbiome Study Design in Companion Animal Research. Front Vet Sci 2021; 8:644836. [PMID: 33898544 PMCID: PMC8062777 DOI: 10.3389/fvets.2021.644836] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/09/2021] [Indexed: 12/31/2022] Open
Abstract
The gut microbiome is a community of microorganisms that inhabits an animal host's gastrointestinal tract, with important effects on animal health that are shaped by multiple environmental, dietary, and host-associated factors. Clinical and dietary trials in companion animals are increasingly including assessment of the microbiome, but interpretation of these results is often hampered by suboptimal choices in study design. Here, we review best practices for conducting feeding trials or clinical trials that intend to study the effects of an intervention on the microbiota. Choices for experimental design, including a review of basic designs, controls, and comparison groups, are discussed in the context of special considerations necessary for microbiome studies. Diet is one of the strongest influences on the composition of gut microbiota, so applications specific to nutritional interventions are discussed in detail. Lastly, we provide specific advice for successful recruitment of colony animals and household pets into an intervention study. This review is intended to serve as a resource to academic and industry researchers, clinicians, and veterinarians alike, for studies that test many different types of interventions.
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Preobrazenski N, Islam H, Gurd BJ. Molecular regulation of skeletal muscle mitochondrial biogenesis following blood flow-restricted aerobic exercise: a call to action. Eur J Appl Physiol 2021; 121:1835-1847. [PMID: 33830325 DOI: 10.1007/s00421-021-04669-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Blood flow-restricted (BFR) exercise can induce training adaptations comparable to those observed following training in free flow conditions. However, little is known about the acute responses within skeletal muscle following BFR aerobic exercise (AE). Moreover, although preliminary evidence suggests chronic BFR AE may augment certain training adaptations in skeletal muscle mitochondria more than non-BFR AE, the underlying mechanisms are poorly understood. In this review, we summarise the acute BFR AE literature examining mitochondrial biogenic signalling pathways and provide insight into mechanisms linked to skeletal muscle remodelling following BFR AE. Specifically, we focus on signalling pathways potentially contributing to augmented peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) mRNA following work-rate-matched BFR AE compared with non-BFR AE. We present evidence suggesting reductions in muscle oxygenation during acute BFR AE lead to increased intracellular energetic stress, AMP-activated protein kinase (AMPK) activation and PGC-1α mRNA. In addition, we briefly discuss mitochondrial adaptations to BFR aerobic training, and we assess the risk of bias using the Cochrane Collaboration risk of bias assessment tool. We ultimately call for several straightforward modifications to help minimise bias in future BFR AE studies.
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Affiliation(s)
| | - Hashim Islam
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, K7L 3N6, Canada.
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Schwarze M, Bartsch LP, Block J, Alimusaj M, Jaber A, Schiltenwolf M, Wolf SI. A comparison between laterally wedged insoles and ankle-foot orthoses for the treatment of medial osteoarthritis of the knee: A randomized cross-over trial. Clin Rehabil 2021; 35:1032-1043. [PMID: 33781101 PMCID: PMC8193604 DOI: 10.1177/0269215521993636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. Design: Single-centre, block-randomized, cross-over controlled trial. Setting: Outpatient clinic. Subjects: About 39 patients with symptomatic medial knee osteoarthritis. Interventions: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. Main measures: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire – Osteoarthritis and knee pain. Results: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% (P < 0.001). The LWI reduced both maxima by 6% (P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% (P < 0.001) and 5% (P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI (P = 0.001, P = 0.004). Conclusions: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.
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Affiliation(s)
- Martin Schwarze
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Leonie P Bartsch
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Block
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Merkur Alimusaj
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Ayham Jaber
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcus Schiltenwolf
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian I Wolf
- Department of Orthopedics, University Hospital Heidelberg, Heidelberg, Germany
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Abstract
Within preclinical research, attention has focused on experimental design and how current practices can lead to poor reproducibility. There are numerous decision points when designing experiments. Ethically, when working with animals we need to conduct a harm-benefit analysis to ensure the animal use is justified for the scientific gain. Experiments should be robust, not use more or fewer animals than necessary, and truly add to the knowledge base of science. Using case studies to explore these decision points, we consider how individual experiments can be designed in several different ways. We use the Experimental Design Assistant (EDA) graphical summary of each experiment to visualise the design differences and then consider the strengths and weaknesses of each design. Through this format, we explore key and topical experimental design issues such as pseudo-replication, blocking, covariates, sex bias, inference space, standardisation fallacy and factorial designs. There are numerous articles discussing these critical issues in the literature, but here we bring together these topics and explore them using real-world examples allowing the implications of the choice of design to be considered. Fundamentally, there is no perfect experiment; choices must be made which will have an impact on the conclusions that can be drawn. We need to understand the limitations of an experiment's design and when we report the experiments, we need to share the caveats that inherently exist.
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Affiliation(s)
- Natasha A Karp
- Data Sciences and Quantitative Biology, Discovery Sciences, R&D, AstraZeneca R&D Cambridge, Cambridge, UK
| | - Derek Fry
- The University of Manchester, Manchester, UK
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Cervical transcutaneous vagal neuromodulation in chronic pancreatitis patients with chronic pain: A randomised sham controlled clinical trial. PLoS One 2021; 16:e0247653. [PMID: 33635894 PMCID: PMC7909707 DOI: 10.1371/journal.pone.0247653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND & AIMS Chronic abdominal pain is the primary symptom of chronic pancreatitis, but unfortunately it is difficult to treat. Vagal nerve stimulation studies have provided evidence of anti-nociceptive effect in several chronic pain conditions. We investigated the pain-relieving effects of transcutaneous vagal nerve stimulation in comparison to sham treatment in chronic pancreatitis patients. METHODS We conducted a randomised double-blinded, sham-controlled, crossover trial in patients with chronic pancreatitis. Patients were randomly assigned to receive a two-week period of cervical transcutaneous vagal nerve stimulation using the gammaCore device followed by a two-week sham stimulation, or vice versa. We measured clinical and experimental endpoints before and after each treatment. The primary clinical endpoint was pain relief, documented in a pain diary using a visual analogue scale. Secondary clinical endpoints included Patients' Global Impression of Change score, quality of life and Brief Pain Inventory questionnaire. Secondary experimental endpoints included cardiac vagal tone and heart rate. RESULTS No differences in pain scores were seen in response to two weeks transcutaneous vagal nerve stimulation as compared to sham treatment (difference in average pain score (visual analogue scale): 0.17, 95%CI (-0.86;1.20), P = 0.7). Similarly, no differences were seen for secondary clinical endpoints, except from an increase in the appetite loss score (13.9, 95%CI (0.5:27.3), P = 0.04). However, improvements in maximum pain scores were seen for transcutaneous vagal nerve stimulation and sham treatments as compared to their respective baselines: vagal nerve stimulation (-1.3±1.7, 95%CI (-2.21:-0.42), P = 0.007), sham (-1.3±1.9, 95%CI (-2.28:-0.25), P = 0.018). Finally, heart rate was decreased after two weeks transcutaneous vagal nerve stimulation in comparison to sham treatment (-3.7 beats/min, 95%CI (-6.7:-0.6), P = 0.02). CONCLUSION In this sham-controlled crossover study, we found no evidence that two weeks transcutaneous vagal nerve stimulation induces pain relief in patients with chronic pancreatitis. TRIAL REGISTRATION NUMBER The study is registered at NCT03357029; www.clinicaltrials.gov.
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Phillips MCL, Deprez LM, Mortimer GMN, Murtagh DKJ, McCoy S, Mylchreest R, Gilbertson LJ, Clark KM, Simpson PV, McManus EJ, Oh JE, Yadavaraj S, King VM, Pillai A, Romero-Ferrando B, Brinkhuis M, Copeland BM, Samad S, Liao S, Schepel JAC. Randomized crossover trial of a modified ketogenic diet in Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2021; 13:51. [PMID: 33622392 PMCID: PMC7901512 DOI: 10.1186/s13195-021-00783-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/03/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Brain energy metabolism is impaired in Alzheimer's disease (AD), which may be mitigated by a ketogenic diet. We conducted a randomized crossover trial to determine whether a 12-week modified ketogenic diet improved cognition, daily function, or quality of life in a hospital clinic of AD patients. METHODS We randomly assigned patients with clinically confirmed diagnoses of AD to a modified ketogenic diet or usual diet supplemented with low-fat healthy-eating guidelines and enrolled them in a single-phase, assessor-blinded, two-period crossover trial (two 12-week treatment periods, separated by a 10-week washout period). Primary outcomes were mean within-individual changes in the Addenbrookes Cognitive Examination - III (ACE-III) scale, AD Cooperative Study - Activities of Daily Living (ADCS-ADL) inventory, and Quality of Life in AD (QOL-AD) questionnaire over 12 weeks. Secondary outcomes considered changes in cardiovascular risk factors and adverse effects. RESULTS We randomized 26 patients, of whom 21 (81%) completed the ketogenic diet; only one withdrawal was attributed to the ketogenic diet. While on the ketogenic diet, patients achieved sustained physiological ketosis (12-week mean beta-hydroxybutyrate level: 0.95 ± 0.34 mmol/L). Compared with usual diet, patients on the ketogenic diet increased their mean within-individual ADCS-ADL (+ 3.13 ± 5.01 points, P = 0.0067) and QOL-AD (+ 3.37 ± 6.86 points, P = 0.023) scores; the ACE-III also increased, but not significantly (+ 2.12 ± 8.70 points, P = 0.24). Changes in cardiovascular risk factors were mostly favourable, and adverse effects were mild. CONCLUSIONS This is the first randomized trial to investigate the impact of a ketogenic diet in patients with uniform diagnoses of AD. High rates of retention, adherence, and safety appear to be achievable in applying a 12-week modified ketogenic diet to AD patients. Compared with a usual diet supplemented with low-fat healthy-eating guidelines, patients on the ketogenic diet improved in daily function and quality of life, two factors of great importance to people living with dementia. TRIAL REGISTRATION This trial is registered on the Australia New Zealand Clinical Trials Registry, number ACTRN12618001450202 . The trial was registered on August 28, 2018.
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Affiliation(s)
| | - Laura M Deprez
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand.,Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | | | - Stacey McCoy
- Department of Dietetics Services, Waikato Hospital, Hamilton, New Zealand
| | - Ruth Mylchreest
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | | | - Karen M Clark
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | | | - Eileen J McManus
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | - Jee-Eun Oh
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | - Satish Yadavaraj
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | - Vanessa M King
- LINC Mental Health Services, Tauranga Hospital, Tauranga, New Zealand
| | - Avinesh Pillai
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | | | - Martijn Brinkhuis
- Mental Health Services for Older People, Waikato Hospital, Hamilton, New Zealand
| | - Bronwyn M Copeland
- Mental Health Services for Older People, Tauranga Hospital, Tauranga, New Zealand
| | - Shah Samad
- Older Persons and Rehabilitation Service, Waikato Hospital, Hamilton, New Zealand
| | - Shenyang Liao
- Older Persons and Rehabilitation Service, Waikato Hospital, Hamilton, New Zealand
| | - Jan A C Schepel
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
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Fulas OA, Laferrière A, Ware DMA, Shir Y, Coderre TJ. The effect of a topical combination of clonidine and pentoxifylline on post-traumatic neuropathic pain patients: study protocol for a randomized, double-blind placebo-controlled trial. Trials 2021; 22:149. [PMID: 33596969 PMCID: PMC7890866 DOI: 10.1186/s13063-021-05088-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 02/01/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND First-line pharmacotherapy for neuropathic pain entails the use of systemic antidepressants and anticonvulsants. These drugs are not optimally effective and poorly tolerated, especially for older patients with comorbid conditions. Given the high number of such patients, there is a need for a greater repertoire of safer and more effective analgesics. Clonidine and pentoxifylline are vasodilator agents that work synergistically to enhance tissue perfusion and oxygenation. The topical administration of these drugs, individually and in combination, has shown anti-nociceptive properties in rodent models of neuropathic pain. A topically-administered combination of clonidine and pentoxifylline also effectively reduced the intensity of both spontaneous and evoked pain in healthy volunteers with experimentally-induced neuropathic pain. The next step in advancing this formulation to clinical use is the undertaking of a phase II clinical study to assess its efficacy and safety in neuropathic pain patients. METHODS/DESIGN This is a study protocol for a randomized, double-blind, placebo-controlled, phase II clinical trial with a cross-over design. It is a single-centered, 5-week study that will enroll a total of 32 patients with post-traumatic peripheral neuropathic pain. Patients will be treated topically with either a combination of clonidine and pentoxifylline or placebo for a period of 2 weeks each, in randomly assigned order across patients, with an intervening washout period of 1 week. The primary outcome measures of the study are the intensity of spontaneous pain recorded daily in a pain diary with a visual analog scale, and the degree of mechanical allodynia evoked by a brush stimulus. The secondary outcome measures of the study include scores of pain relief and change in the area of punctate hyperalgesia. This trial has been prospectively registered with ClinicalTrials.gov on November 1, 2017. ClinicalTrials.gov Identifier: NCT03342950 . DISCUSSION The analgesic use of topical treatment with clonidine and pentoxifylline in combination has not been investigated in post-traumatic neuropathic pain. This study could generate the first evidence for the efficacy and safety of the formulation in alleviating pain in patients with neuropathic pain. Furthermore, this trial will provide objective grounds for the investigation of other agents that enhance tissue oxygenation in the topical treatment of peripheral neuropathic pain. TRIAL REGISTRATION This trial has been registered with ClinicalTrials.gov owned by NIH's US National Library of Medicine. ClinicalTrials.gov NCT03342950 . Registered on November 1, 2017 (trial was prospectively registered). PROTOCOL VERSION AND IDENTIFIERS This is protocol version 5, dated June 2018. McGill University Health Center (MUHC) Reaseach Ethics Board (REB) identification number: TTNP 2018-3906.
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Affiliation(s)
- Oli Abate Fulas
- Department of Anesthesia, McGill University, 3655 Promenade Sir William Osler, Montreal, QC, H3G 1Y6, Canada
| | - André Laferrière
- Department of Anesthesia, McGill University, 3655 Promenade Sir William Osler, Montreal, QC, H3G 1Y6, Canada
| | - D Mark A Ware
- Alan Edwards Pain Management Unit, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Yoram Shir
- Alan Edwards Pain Management Unit, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Terence J Coderre
- Department of Anesthesia, McGill University, 3655 Promenade Sir William Osler, Montreal, QC, H3G 1Y6, Canada.
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Myat A, Redwood SR, Arri S, Gersh BJ, Bhatt DL, Marber MS. Liraglutide to Improve corONary haemodynamics during Exercise streSS (LIONESS): a double-blind randomised placebo-controlled crossover trial. Diabetol Metab Syndr 2021; 13:17. [PMID: 33579317 PMCID: PMC7881597 DOI: 10.1186/s13098-021-00635-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/03/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Glucagon-like peptide-1 receptor (GLP-1R) activation may improve myocardial performance in the context of ischaemia, independent of glycaemic control, in individuals with and without type 2 diabetes mellitus. METHODS The LIONESS trial was a single-centre randomised double-blind placebo-controlled crossover study to determine whether prolonged GLP-1R activation could improve exercise haemodynamics in chronic stable angina patients. Eligibility criteria comprised angiographic evidence of obstructive coronary artery disease (CAD) and an abnormal baseline exercise tolerance test (ETT) demonstrating > 0.1 mV of planar or downsloping ST-segment depression (STD). Those randomised to active agent started with a 1-week run-in phase of 0.6 mg liraglutide daily, an established injectable GLP-1R agonist, followed by 1 week of 1.2 mg liraglutide, after which patients performed a week 2 ETT. Patients then self-administered 1.8 mg liraglutide for a week before completing a week 3 ETT. The placebo arm received visually and temporally matched daily saline injections. Participants then crossed over to a 3-week course of saline injections interspersed with a week 5 ETT and week 6 ETT and vice versa. Co-primary endpoints were rate pressure product (RPP) at 0.1 mV STD and magnitude of STD at peak exercise. RESULTS Twenty-two patients (21 without diabetes) were randomised. There was no significant difference between saline versus liraglutide in the co-primary endpoints of RPP achieved at 0.1 mV STD (saline vs. liraglutide 1.2 mg p = 0.097; saline vs. liraglutide 1.8 mg p = 0.48) or the degree of STD at peak exercise (saline vs. liraglutide 1.2 mg p = 0.68; saline vs. liraglutide 1.8 mg p = 0.57). Liraglutide did not cause symptomatic hypoglycaemia, renal dysfunction, acute pancreatitis or provoke early withdrawal from the trial. Liraglutide significantly reduced weight (baseline 88.75 ± 16.5 kg vs. after liraglutide 87.78 ± 16.9 kg; p = 0.0008) and improved the lipid profile (mean total cholesterol: at baseline 3.97 ± 0.88 vs. after liraglutide 3.56 ± 0.71 mmol/L; p < 0.0001). CONCLUSION Liraglutide did not enhance exercise tolerance or haemodynamics compared with saline placebo during serial treadmill testing in patients with established obstructive CAD. It did, however, significantly reduce weight and improve the lipid profile. Trial Registration ClinicalTrials.gov Identifier NCT02315001. Retrospectively registered on 11th December 2014.
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Affiliation(s)
- Aung Myat
- King's College London British Heart Foundation Centre of Research Excellence, The Rayne Institute, Cardiovascular Division, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
- Frimley Park Hospital, Frimley Health NHS Foundation Trust, Portsmouth Road, Frimley, GU16 7UJ, Camberley, UK.
| | - Simon R Redwood
- King's College London British Heart Foundation Centre of Research Excellence, The Rayne Institute, Cardiovascular Division, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Satpal Arri
- King's College London British Heart Foundation Centre of Research Excellence, The Rayne Institute, Cardiovascular Division, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Centre and Harvard Medical School, Boston, MA, 02115, USA
| | - Michael S Marber
- King's College London British Heart Foundation Centre of Research Excellence, The Rayne Institute, Cardiovascular Division, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Vagedes J, Kuderer S, Vagedes K, Hiller S, Beissner F, Szőke H, Joos S, Wolf U. Increasing Warmth in Oncological Patients: A Randomized Controlled Cross-Over Pilot Trial Examining the Efficacy of Mustard and Ginger Footbaths. Integr Cancer Ther 2021; 20:15347354211058449. [PMID: 34814768 PMCID: PMC8647243 DOI: 10.1177/15347354211058449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/09/2021] [Accepted: 10/21/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To analyze the thermogenic effects of footbaths with medicinal powders in oncological patients (ON) and healthy controls (HC). INTERVENTION AND OUTCOMES Thirty-six participants (23 ON, 13 HC; 24 females; 49.9 ± 13.3 years) received 3 footbaths in a random order with cross-over design: warm water only (WA), warm water plus mustard (MU, Sinapis nigra), and warm water plus ginger (GI, Zingiber officinale). Warmth perception of the feet (Herdecke Warmth Perception Questionnaire, HeWEF) at the follow-up (10 minutes after completion of footbaths, t2) was assessed as the primary outcome measure. Secondary outcome measures included overall warmth as well as self-reported warmth (HeWEF) and measured skin temperature (high resolution thermography) of the face, hands and feet at baseline (t0), post immersion (t1), and follow-up (t2). RESULTS With respect to the warmth perception of the feet, GI and MU differed significantly from WA (P's < .05) with the highest effect sizes at t1 (WA vs GI, d = 0.92, WA vs MU, d = 0.73). At t2, perceived warmth tended to be higher with GI compared to WA (d = 0.46). No differences were detected between ON and HC for self-reported warmth. With respect to skin temperatures, face and feet skin temperatures of ON were colder (at t0 and t1, 0.42 ≥ d ≥ 0.68) and tended to have diametrical response patterns than HC (ON vs HC: colder vs warmer after MU). CONCLUSION Among adult oncological patients and healthy controls, footbaths with mustard and ginger increased warmth perception of the feet longer than with warm water only. The potential impact of regularly administered thermogenic footbaths over extended periods merits further investigation for the recovery of cancer-related sense of cold.
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Affiliation(s)
- Jan Vagedes
- ARCIM Institute, Filderstadt,
Germany
- University Hospital Tuebingen,
Tuebingen, Germany
- Filderklinik, Filderstadt,
Germany
| | | | | | | | - Florian Beissner
- Insula Institute for Integrative
Therapy Research, Hannover, Germany
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de Asís-Fernández F, Del Corral T, López-de-Uralde-Villanueva I. Effects of inspiratory muscle training versus high intensity interval training on the recovery capacity after a maximal dynamic apnoea in breath-hold divers. A randomised crossover trial. Diving Hyperb Med 2020; 50:318-324. [PMID: 33325010 DOI: 10.28920/dhm50.4.318-324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/04/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION After a maximal apnoea, breath-hold divers must restore O2 levels and clear CO2 and lactic acid produced. High intensity interval training (HIIT) and inspiratory muscle training (IMT) could be employed with the aim of increasing recovery capacity. This study aimed to evaluate the relative effects of IMT versus HIIT on recovery of peripheral oxygen saturation (SpO2), and also on pulmonary function, inspiratory muscle strength, lactate and heart rate recovery after a maximal dynamic apnoea in breath-hold divers. METHODS Fifteen breath-hold divers performed two training interventions (IMT and HIIT) for 20 min, three days per week over four weeks in randomised order with a two week washout period. RESULTS IMT produced a > 3 s reduction in SpO2 recovery time compared to HIIT. The forced expiratory volume in the first second (FEV1) and maximum inspiratory pressure (MIP) were significantly increased in the IMT group compared to HIIT. The magnitude of these differences in favour of IMT was large in both cases. Neither training intervention was superior to the other for heart rate recovery time, nor in peak- and recovery- lactate. CONCLUSIONS IMT produced a reduction in SpO2 recovery time compared to HIIT after maximal dynamic apnoea. Even a 3 s improvement in recovery could be important in scenarios like underwater hockey where repetitive apnoeas during high levels of exercise are separated by only seconds. IMT also improved FEV1 and MIP, but no differences in lactate and heart rate recovery were found post-apnoea between HIIT and IMT.
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Affiliation(s)
- Francisco de Asís-Fernández
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Breatherapy Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Tamara Del Corral
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Breatherapy Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Corresponding author: Professor Tamara del Corral, Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain,
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Spain
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Puente-Fernández J, Seijo M, Larumbe-Zabala E, Jiménez A, Liguori G, Rossato CJL, Mayo X, Naclerio F. Effects of Multi-Ingredient Preworkout Supplementation across a Five-Day Resistance and Endurance Training Microcycle in Middle-Aged Adults. Nutrients 2020; 12:E3778. [PMID: 33317139 PMCID: PMC7764411 DOI: 10.3390/nu12123778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022] Open
Abstract
Preworkout multi-ingredient admixtures are used to maximise exercise performance. The present double-blind, cross-over study compared the acute effects of ingesting a preworkout multi-ingredient (PREW) admixture vs. carbohydrate (CHO) over a week (microcycle) comprising three resistance training (RT) workouts alternated with two 30-min low-intensity endurance sessions (END) on RT volume (kg lifted) and END substrate oxidation. Additionally, postworkout decreases of muscle function and subjective responses were analysed. Following a baseline assessment, fourteen recreationally trained, middle-aged adults (seven females, 48.8 ± 4.7 years old) completed two identical microcycles separated by a two-week washout period while receiving either PREW or CHO (15 min prior to workout). The RT volume, per session (SVOL) and for the entire week (WVOL), was calculated. Fatty acid oxidation (FAO) during 30-min cycling corresponding to their individually determined maximal fat oxidation was measured using expired gasses and indirect calorimetry. Assessments of performance and tensiomyography were conducted within 20 min after each RT. Higher (p = 0.001) SVOL and WVOL along with a larger proportion of FAO (p = 0.05) during the second END workout were determined under the PREW treatment. No other statistically significant differences were observed between conditions. Compared to CHO, a preworkout multi-ingredient appears to increase resistance volume and favour fat oxidation during low-intensity endurance exercises.
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Affiliation(s)
- Joel Puente-Fernández
- Institute for Lifecourse Development, School of Human Sciences, Centre for Chronic Illness and Ageing, University of Greenwich, Eltham SE9 2TB, UK; (J.P.-F.); (M.S.); (C.J.L.R.)
| | - Marcos Seijo
- Institute for Lifecourse Development, School of Human Sciences, Centre for Chronic Illness and Ageing, University of Greenwich, Eltham SE9 2TB, UK; (J.P.-F.); (M.S.); (C.J.L.R.)
| | - Eneko Larumbe-Zabala
- School of Doctorate and Research, European University of Madrid, 28670 Villaviciosa de Odon, Spain;
| | - Alfonso Jiménez
- Advanced Well-Being Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK;
- Observatory of Healthy and Active Living of Spain Active Foundation, Centre for Sport Studies, King Juan Carlos University, 28942 Madrid, Spain
- GO Fit LAB, Ingesport, 28108 Madrid, Spain;
| | - Gary Liguori
- College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA;
| | - Claire J. L. Rossato
- Institute for Lifecourse Development, School of Human Sciences, Centre for Chronic Illness and Ageing, University of Greenwich, Eltham SE9 2TB, UK; (J.P.-F.); (M.S.); (C.J.L.R.)
| | - Xian Mayo
- GO Fit LAB, Ingesport, 28108 Madrid, Spain;
| | - Fernando Naclerio
- Institute for Lifecourse Development, School of Human Sciences, Centre for Chronic Illness and Ageing, University of Greenwich, Eltham SE9 2TB, UK; (J.P.-F.); (M.S.); (C.J.L.R.)
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Do ATL, Enax-Krumova EK, Özgül Ö, Eitner LB, Heba S, Tegenthoff M, Maier C, Höffken O. Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation. BMC Neurosci 2020; 21:53. [PMID: 33287715 PMCID: PMC7720448 DOI: 10.1186/s12868-020-00604-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/23/2020] [Indexed: 12/23/2022] Open
Abstract
Background Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes. Methods PCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0–100) on one hand. In a crossover design healthy subjects (included: n = 38, analyzed: n = 23) immersed the contralateral hand into 10 °C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded. Results Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6 ± 12.0 μV to 20.2 ± 9.5 μV, cognitive distraction: 30.3 ± 14.2 µV to 13.6 ± 5.2 μV, p < 0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58 ± 4 to 41.1 ± 12.3, cognitive distraction: 58.3 ± 4.4 to 38.0 ± 13.0, p < 0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p = 0.001). Conclusions CPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.
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Affiliation(s)
- A T L Do
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - E K Enax-Krumova
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Ö Özgül
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - L B Eitner
- Department of Pain Medicine, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.,Department of Neuropaediatrics, University Children's Hospital, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - S Heba
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | | | - C Maier
- Department of Pain Medicine, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - O Höffken
- Department of Neurology, Ruhr-University Bochum, BG University Hospital Bergmannsheil gGmbH, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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71
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Kever A, Nelson KE, Aguerre IM, Riley CS, Boehme A, Lee NW, Strauss Farber R, Levin SN, Stein J, Leavitt VM. ASPIRE trial: study protocol for a double-blind randomised controlled trial of aspirin for overheating during exercise in multiple sclerosis. BMJ Open 2020; 10:e039691. [PMID: 33191260 PMCID: PMC7668379 DOI: 10.1136/bmjopen-2020-039691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The many benefits of exercise for persons with multiple sclerosis (MS) are well established, yet patients often refrain from exercise due to overheating and exhaustion. The present randomised controlled trial tests aspirin (acetylsalicylic acid (ASA)) as a convenient method to prevent overheating and improve exercise performance in persons with MS. The effects of ASA are compared with those of acetaminophen (APAP) and placebo. METHODS AND ANALYSIS Participants are seen for a laboratory maximal exercise test on 3 separate days separated by at least 1 week. At each session, body temperature is measured before oral administration of a standard adult dose (650 mg) of ASA, APAP or placebo. One hour after drug administration, participants perform a maximal ramp test on a cycle ergometer. Primary outcomes are (a) time to exhaustion (that is, time spent cycling to peak exertion) and (b) body temperature change. Crossover analyses will include tests for effects of treatment, period, treatment-period interaction (carryover effect) and sequence. ETHICS AND DISSEMINATION Ethical approval was granted by the institutional review board at Columbia University Irving Medical Center (reference: AAAS2529). Results of the trial will be published in peer-reviewed scientific journals and presented at national and international conferences. Neurologists, physiatrists, primary care physicians and physiotherapists are important stakeholders and will be targeted during dissemination. Positive trial results have the potential to promote aspirin therapy, an inexpensive and readily available treatment, to reduce overheating and allow more persons with MS to benefit from exercise. TRIAL REGISTRATION NUMBER NCT03824938.
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Affiliation(s)
- Anne Kever
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Katherine E Nelson
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Ines M Aguerre
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Center for Translational & Computational Neuroimmunology, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Claire S Riley
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amelia Boehme
- Department of Neurology and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nancy W Lee
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vangelos College of Physicians and Surgeons, New York, NY, USA
| | - Rebecca Strauss Farber
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Seth N Levin
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vangelos College of Physicians and Surgeons, New York, NY, USA
| | - Victoria M Leavitt
- Translational Cognitive Neuroscience Laboratory, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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72
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Siemens W, Boehlke C, Bennett MI, Offner K, Becker G, Gaertner J. Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care-a blinded, randomized, sham-controlled pilot cross-over trial. Support Care Cancer 2020; 28:5323-5333. [PMID: 32128614 PMCID: PMC7547037 DOI: 10.1007/s00520-020-05370-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/19/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Transcutaneous electrical nerve stimulation (TENS) is a treatment option for cancer pain, but the evidence is inconclusive. We aimed to evaluate the efficacy and safety of TENS. METHODS A blinded, randomized, sham-controlled pilot cross-over trial (NCT02655289) was conducted on an inpatient specialist palliative care ward. We included adult inpatients with cancer pain ≥ 3 on an 11-point numerical rating scale (NRS). Intensity-modulated high TENS (IMT) was compared with placebo TENS (PBT). Patients used both modes according to their preferred application scheme during 24 h with a 24-h washout phase. The primary outcome was change in average pain intensity on the NRS during the preceding 24 h. Responders were patients with at least a "slight improvement." RESULTS Of 632 patients screened, 25 were randomized (sequence IMT-PBT = 13 and PBT-IMT = 12). Finally, 11 patients in IMT-PBT and 9 in PBT-IMT completed the study (N = 20). The primary outcome did not differ between groups (IMT minus PBT: - 0.2, 95% confidence interval - 0.9 to 0.6). However, responder rates were higher in IMT (17/20 [85%] vs. 10/20 [50%], p = 0.0428). Two patients experienced an uncomfortable feeling caused by the current, one after IMT and one after PBT. Seven patients (35%) desired a TENS prescription. Women and patients with incident pain were most likely to benefit from TENS. CONCLUSION TENS was safe, but IMT was unlikely to offer more analgesic effects than PBT. Even though many patients desired a TENS prescription, 50% still reported at least "slight pain relief" from PBT. Differences for gender and incident pain aspects demand future trials.
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Affiliation(s)
- Waldemar Siemens
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany.
| | - Christopher Boehlke
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Klaus Offner
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany
| | - Jan Gaertner
- Center for Palliative Care Hildegard, Basel, Switzerland
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73
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Lindgren A, Fjellstedt E, Christensson A. Comparison of Hemodialysis Using a Medium Cutoff Dialyzer versus Hemodiafiltration: A Controlled Cross-Over Study. Int J Nephrol Renovasc Dis 2020; 13:273-280. [PMID: 33149656 PMCID: PMC7602900 DOI: 10.2147/ijnrd.s263110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/15/2020] [Indexed: 01/29/2023] Open
Abstract
Purpose Conventional hemodialysis (HD) treatment has an acceptable removal of small uremic molecules, but so-called "middle molecules" in the range of 0.5-60 kDa are poorly cleared with HD compared to a native kidney, which may contribute to morbidity in the dialysis population. Hemodiafiltration (HDF) has a better removal of middle molecules compared to HD but is technically demanding and requires well-functioning dialysis access. The newly introduced medium cutoff (MCO) filters have been developed to enhance middle molecule clearance in HD-mode. The aim of this study was to compare reduction ratios (RRs) of molecules with different molecular weights (0.06-150 kDa) during dialysis with MCO dialyzer (used in HD-mode) compared to online-hemodiafiltration (ol-HDF) treatment with a conventional high-flux dialyzer. Patients and Methods This is a prospective controlled single-center cross-over study, including 16 patients in Malmö, Sweden. All patients had ongoing post-dilution ol-HDF treatment before the study. The study compared reduction ratios of small-, middle-, and large-sized molecules during a single 4h dialysis treatment with post-dilution ol-HDF (Polyflux 210H) to a 4h dialysis treatment with MCO dialyzer (Theranova 500) in HD-mode. Between treatments, the patients had a washout period of at least two weeks of their ordinary HDF treatment to reach their ordinary steady state. Results ol-HDF had significantly higher RR for cystatin C (13 kDa), compared to MCO (RR 68.1 vs 65.8, p=0.003), during a 4h dialysis treatment (mean convection volume of 24.5 L for HDF, and mean Qb of 324 mL/min for HDF and 323 mL/min for MCO). There was no significant difference in the RR for other middle molecules, or for smaller or larger molecules. Conclusion Overall, the RRs were comparable for ol-HDF and MCO-HD. There was a slightly higher RR of cystatin C (a small middle molecule) for HDF compared to MCO but no difference in other measured molecules.
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Affiliation(s)
- Anna Lindgren
- Department of Nephrology, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Erik Fjellstedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Anders Christensson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Nephrology, Skåne University Hospital, Malmö, Sweden
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74
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Naclerio PhD F, Seijo PhD M, Earnest PhD CP, Puente-Fernández MSc J, Larumbe-Zabala PhD E. Ingesting a Post-Workout Vegan-Protein Multi-Ingredient Expedites Recovery after Resistance Training in Trained Young Males. J Diet Suppl 2020; 18:698-713. [PMID: 33063541 DOI: 10.1080/19390211.2020.1832640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Post workout multi-ingredient admixtures are commonly used to maximize recovery after exercise. The present double-blind, cross-over study compared the acute effects of ingesting a protein-vegan multi-ingredient (VGMT) vs. maltodextrin (MALT) on indices of muscle function. Ten trained males, (26.8 ± 1.9 years) performed two identical, 3-day resistance training periods (one workout-session per day) while receiving either VGMT or MALT (10 min after the completion of each workout). Following a baseline evaluation, we conducted assessments at, 1-h, 24-h and 48-h after the 3-day training period. Primary outcome included the evoked tensiomyography contraction velocity (Vc) of vastus medialis (VM), biceps femoris long head (BFLH) and anterior deltoids (AD). Secondary outcomes involved strength and power performance while the other tensiomyography variables [muscle displacement (Dm), contraction time (Tc)] were considered as exploratory. After 1-h, all the tensiomyography variables measured at VM and BFLH were similarly depressed in both treatments. Only MALT showed a significantly lower Vc (-0.02 m.s-1, 95% CI, -0.04, -0.01) in the AD. After 24-h, the VGMT treatment normalized all tensiomyography values. Conversely, impaired scores were observed in Vc for the VM (-0.03 m.s-1, 95% CI, -0.06, -0.01) and BFLH (-0.02 m.s-1, 95% CI, -0.05, 0.01) in the MALT treatment. Particularly, the Vc in VM was lower (p = 0.043) in MALT compared to VGMT. Overall, both treatments required 48-h to regain their performance capacity; however, VGMT produced better vertical jump and squat performance at 24-h vs. MALT. Compared to MALT, a vegan-protein multi-ingredient appears to hasten the recovery of muscular function over a 24-h period.
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Affiliation(s)
- Fernando Naclerio PhD
- Department of Sport Science and Physical Education, Institute for Lifecourse Development, Centre for Chronic Illness and Ageing, University of Greenwich, United Kingdom
| | - Marcos Seijo PhD
- Department of Sport Science and Physical Education, Institute for Lifecourse Development, Centre for Chronic Illness and Ageing, University of Greenwich, United Kingdom
| | - Conrad P Earnest PhD
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Joel Puente-Fernández MSc
- Department of Sport Science and Physical Education, Institute for Lifecourse Development, Centre for Chronic Illness and Ageing, University of Greenwich, United Kingdom
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75
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Elghamaz A, Myat A, de Belder A, Collison D, Cocks K, Stone GW, Oldroyd K. Continuous intracoronary versus standard intravenous infusion of adenosine for fractional flow reserve assessment: the HYPEREMIC trial. EUROINTERVENTION 2020; 16:560-567. [PMID: 31289017 DOI: 10.4244/eij-d-18-01067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to evaluate the accuracy of a continuous intracoronary (IC) adenosine infusion, administered through the novel HYPEREM™IC over-the-wire microcatheter, to measure fractional flow reserve (FFR). METHODS AND RESULTS The HYPEREMIC trial was a randomised, non-inferiority, crossover study in which patients with intermediate coronary lesions were enrolled for sequential pressure wire studies. FFR was measured using intravenous (IV) (140-180 mcg/kg/min) versus continuous non-weight-adjusted IC (360 mcg/min) adenosine. Patients were randomised and blinded to the order in which they received the adenosine, separated by a washout period. The primary endpoint was the mean hyperaemic FFR. Forty-one patients were enrolled at three UK sites between June and November 2016. The mean (standard deviation) FFR was 0.82 (±0.09) after IC versus 0.84 (±0.09) after IV adenosine. The difference of -0.02 (95% confidence interval [CI]: -0.03 to -0.01) confirmed the non-inferiority (margin <0.05) of IC to IV adenosine. Intracoronary adenosine was associated with a shorter mean time to maximal hyperaemia (difference -44 [95% CI: -59 to -29] seconds; p<0.0001). Chest discomfort was reported in 32/41 (78.0%) patients during IV adenosine versus 12/41 (29.3%) patients during IC adenosine. CONCLUSIONS Continuous IC adenosine was a reliable, faster and better tolerated method of achieving maximal hyperaemia compared to IV adenosine.
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Affiliation(s)
- Ahmed Elghamaz
- Cardiology Department, Northwick Park Hospital, London North West Healthcare NHS Trust, London, United Kingdom
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76
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The effect of Nigella sativa supplementation on cardiovascular risk factors in obese and overweight women: a crossover, double-blind, placebo-controlled randomized clinical trial. Eur J Nutr 2020; 60:1863-1874. [PMID: 32876804 DOI: 10.1007/s00394-020-02374-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the effect of Nigella sativa (N.S) oil supplements on CVD risk factors in a crossover design for the first time. METHODS Obese and overweight healthy women were randomized to receive N.S oil (2000 mg/day) and placebo. This intervention period lasted for 8 weeks and separated by a 4-week washout period. An iso-caloric diet was given to every individual throughout the study. Blood pressure, lipid profile, atherogenic indices and liver enzymes were measured. Pkcross procedure was performed for statistical analyses using Stata software. Cohen's d was estimated as effect size for all outcomes to measure the magnitude of the effects. RESULTS Thirty-nine participants completed the study. Capsules of N.S increased serum high-density lipoprotein cholesterol (Cohen's d = 0.47, P = 0.009), reduced low-density lipoprotein cholesterol (Cohen's d = - 0.33, P = 0.031), reduced TC/HDL-C ratio (as an atherogenic index, Cohen's d = - 0.9, P < 0.001), reduced serum glutamic-oxaloacetic transaminase (Cohen's d = 0- 0.5, P = 0.038) and reduced systolic blood pressure (Cohen's d = - 0.4, P < 0.001). There was no effect on diastolic blood pressure measures (P = 0.96). CONCLUSION The overall improvements in cardiovascular disease (CVD) risk factors showed beneficial effects of N.S supplements among adults with obesity to prevent possible cardiovascular diseases. More studies with different designs and in other populations are suggested to clarify the exact effects of N.S as a complementary therapy for modulating CVD risk factors in individuals with overweight and obesity. TRIAL REGISTRATION Iranian Registry of Clinical Trials, IRCT20180528039884N1, Registered on February 15th, 2019.
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77
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Nguyen CT, Luckett DJ, Kahkoska AR, Shearrer GE, Spruijt-Metz D, Davis JN, Kosorok MR. Estimating individualized treatment regimes from crossover designs. Biometrics 2020; 76:778-788. [PMID: 31743424 PMCID: PMC7234899 DOI: 10.1111/biom.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 10/03/2019] [Accepted: 10/29/2019] [Indexed: 11/27/2022]
Abstract
The field of precision medicine aims to tailor treatment based on patient-specific factors in a reproducible way. To this end, estimating an optimal individualized treatment regime (ITR) that recommends treatment decisions based on patient characteristics to maximize the mean of a prespecified outcome is of particular interest. Several methods have been proposed for estimating an optimal ITR from clinical trial data in the parallel group setting where each subject is randomized to a single intervention. However, little work has been done in the area of estimating the optimal ITR from crossover study designs. Such designs naturally lend themselves to precision medicine since they allow for observing the response to multiple treatments for each patient. In this paper, we introduce a method for estimating the optimal ITR using data from a 2 × 2 crossover study with or without carryover effects. The proposed method is similar to policy search methods such as outcome weighted learning; however, we take advantage of the crossover design by using the difference in responses under each treatment as the observed reward. We establish Fisher and global consistency, present numerical experiments, and analyze data from a feeding trial to demonstrate the improved performance of the proposed method compared to standard methods for a parallel study design.
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Affiliation(s)
- Crystal T. Nguyen
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Daniel J. Luckett
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Grace E. Shearrer
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Donna Spruijt-Metz
- Center of Economic and Social Research, University of Southern California, Los Angeles, California, U.S.A
| | - Jaimie N. Davis
- Department of Nutrition, University of Texas at Austin, Austin, Texas, U.S.A
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, U.S.A
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Examining the Role of Lateral Parietal Cortex in Emotional Distancing Using TMS. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 20:1090-1102. [DOI: 10.3758/s13415-020-00821-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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79
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The efficacy of ball blankets on insomnia in depression in outpatient clinics: study protocol for a randomized crossover multicentre trial. Trials 2020; 21:720. [PMID: 32807208 PMCID: PMC7430021 DOI: 10.1186/s13063-020-04638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Depression affects approx. 4% of the global population and is often accompanied by insomnia. Medications used to treat insomnia can have side effects such as development of tolerance and addiction. The Protac Ball Blanket™ (PBB) is a non-pharmacological supplement to sedatives and hypnotics, but evidence for the efficacy of PBB is needed before the treatment is implemented. The objective of this trial is to test the efficacy of PBB on insomnia caused by depression in a randomized controlled design. Methods This study is a multicentre, randomized crossover trial with planned inclusion of 45 patients. The randomization procedure is permuted-block randomization with varying block sizes. Patients are allocated into either a sequence “AB” or “BA” each lasting 4 weeks (28 nights). Patients randomized to the “AB” sequence receive treatment A (Protac Ball Blanket™) in the first 2 weeks and switch to treatment B (treatment as usual) in the second period, whereas patients who are randomized to the BA sequence receive treatment B in the first period and treatment A in the second period. The participants will serve as their own control in this design. The primary outcome is changes in total sleep time. Secondary outcome measures are changes in sleep onset latency, number of awakenings, wake after sleep onset, and use of sedatives and hypnotics. Furthermore, quality of sleep, insomnia severity status, and self-reported symptoms of depression, anxiety, interpersonal sensitivity, and neurasthenia will be measured. A paired, two-sided t test to compare the means of the differences in the outcomes will be performed. Discussion This clinical trial will assess the effect of PBB on depression-related insomnia. The outcomes are of high interest as the PBB is a potential non-pharmacological supplement to medical treatment of patients with insomnia due to depression. Trial registration ClinicalTrials.gov Identifier: NCT03730974. Registered on 5 November 2018.
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Nakano LA, Cançado ELR, Chaves CE, Madeira MCV, Katayose JT, Nabeshima MA, Fossaluza V, Uhrigshardt GG, Liting Z, Pinto VB, Carrilho FJ, Ono SK. A randomized crossover trial to assess therapeutic efficacy and cost reduction of acid ursodeoxycholic manufactured by the university hospital for the treatment of primary biliary cholangitis. BMC Gastroenterol 2020; 20:253. [PMID: 32758152 PMCID: PMC7406387 DOI: 10.1186/s12876-020-01399-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background Health care costs are growing faster than the rest of the global economy, according to the World Health Organization (WHO). Countries’ health expenditures include paying for general medicine, diagnostic procedures, hospitalizations and surgeries, as well as medications and prescribed treatment. Primary biliary cholangitis (PBC) is a rare autoimmune liver disease and the first line available treatment is ursodeoxycholic acid (UDCA), however, direct and indirect treatment costs are expensive. Main aim of this trial was to assess if the therapeutic efficacy of UDCA manufactured by the university hospital is equivalent to that of standard UDCA and treatment cost reduction in patients with PBC. Methods It is a prospective, interventional, randomized, and crossover study in patients diagnosed with PBC. UDCA 300 mg tablets and capsules were developed and manufactured by the university hospital. Thirty patients under treatment with standard UDCA, in stable doses were randomized in sequence A and B, 15 patients in each arm. The groups were treated for 12 weeks and after, the UDCA formulation was changed, following for another 12 weeks of continuous therapy (tablets and capsules / capsules and tablets). Laboratory tests were performed at time T0 (beginning of treatment), T1 (at the 12 week-therapy, before the crossing-over) and T2 (end of treatment). The evaluation was done by comparing the hepatic parameters ALP, GGT, ALT, AST and total bilirubin, also considering the adverse events. The comparison of costs was based on price of the manufactured UDCA and standard UDCA price of the hospital. Results Hospital reduced 66.1% the PBC treatment costs using manufactured UDCA. There were no differences in the biochemical parameters between sequence (A and B) and tablets or capsules of UDCA formulations applied in the treatment of PBC. Conclusions The study showed that there was no significant difference between manufactured UDCA (capsule and tablet) and standard UDCA. Hospital reduced the PBC treatment costs using the manufactured UDCA by the university hospital. Trial registration ClinicalTrials.gov: NCT03489889 retrospectively registered on January 12th, 2018; Ethics Committee approved the study (ID: 1.790.088) on October 25th, 2016.
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Affiliation(s)
- Larissa Akeme Nakano
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil
| | - Eduardo Luiz Rachid Cançado
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil.,Laboratory of Medical Investigation LIM 06, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Cleuber Esteves Chaves
- Division of Pharmacy of Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Maria Cristina Vaz Madeira
- Division of Pharmacy of Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Jéssica Toshie Katayose
- Division of Pharmacy of Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Mariana Akemi Nabeshima
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil
| | - Victor Fossaluza
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | | | - Zheng Liting
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Vanusa Barbosa Pinto
- Division of Pharmacy of Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair José Carrilho
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil
| | - Suzane Kioko Ono
- Department of Gastroenterology, Division of Clinical Gastroenterology and Hepatology, Hospital das Clinicas, University of São Paulo School of Medicine, Av. Dr. Enéas Carvalho de Aguiar, 255, ICHC, 9th Floor, office 9159, São Paulo, SP 05403-000, Brazil.
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Assessment of cognitive and neural recovery in survivors of pediatric brain tumors in a pilot clinical trial using metformin. Nat Med 2020; 26:1285-1294. [PMID: 32719487 DOI: 10.1038/s41591-020-0985-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/19/2020] [Indexed: 02/06/2023]
Abstract
We asked whether pharmacological stimulation of endogenous neural precursor cells (NPCs) may promote cognitive recovery and brain repair, focusing on the drug metformin, in parallel rodent and human studies of radiation injury. In the rodent cranial radiation model, we found that metformin enhanced the recovery of NPCs in the dentate gyrus, with sex-dependent effects on neurogenesis and cognition. A pilot double-blind, placebo-controlled crossover trial was conducted (ClinicalTrials.gov, NCT02040376) in survivors of pediatric brain tumors who had been treated with cranial radiation. Safety, feasibility, cognitive tests and MRI measures of white matter and the hippocampus were evaluated as endpoints. Twenty-four participants consented and were randomly assigned to complete 12-week cycles of metformin (A) and placebo (B) in either an AB or BA sequence with a 10-week washout period at crossover. Blood draws were conducted to monitor safety. Feasibility was assessed as recruitment rate, medication adherence and procedural adherence. Linear mixed modeling was used to examine cognitive and MRI outcomes as a function of cycle, sequence and treatment. We found no clinically relevant safety concerns and no serious adverse events associated with metformin. Sequence effects were observed for all cognitive outcomes in our linear mixed models. For the subset of participants with complete data in cycle 1, metformin was associated with better performance than placebo on tests of declarative and working memory. We present evidence that a clinical trial examining the effects of metformin on cognition and brain structure is feasible in long-term survivors of pediatric brain tumors and that metformin is safe to use and tolerable in this population. This pilot trial was not intended to test the efficacy of metformin for cognitive recovery and brain growth, but the preliminary results are encouraging and warrant further investigation in a large multicenter phase 3 trial.
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82
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Williams BA, McCartney H, Adams E, Devlin AM, Singer J, Vercauteren S, Wu JK, Karakochuk CD. Folic acid supplementation in children with sickle cell disease: study protocol for a double-blind randomized cross-over trial. Trials 2020; 21:593. [PMID: 32600389 PMCID: PMC7325072 DOI: 10.1186/s13063-020-04540-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/19/2020] [Indexed: 01/21/2023] Open
Abstract
Background Sickle cell disease (SCD) is a genetic disorder which causes dysfunctional red blood cells (RBC) and is thought to increase requirements for folate, an essential B vitamin, due to increased RBC production and turnover in the disease. High-dose supplementation with 1–5 mg/d folic acid, synthetic folate, has been the standard recommendation for children with SCD. There is concern about whether children with SCD need such high doses of folic acid, following mandatory folic acid fortification of enriched grains in Canada, and advancements in medical therapies which extend the average lifespan of RBCs. In animal and human studies, high folic acid intakes (1 mg/d) have been associated with accelerated growth of some cancers, and the biological effects of circulating unmetabolized folic acid (UMFA), which can occur with doses of folic acid ≥ 0.2 mg/d, are not fully understood. The objective of this study is to determine efficacy of, and alterations in folate metabolism from high-dose folic acid in children with SCD during periods of folic acid supplementation versus no supplementation. Methods In this double-blind randomized controlled cross-over trial, children with SCD (n = 36, aged 2–19 years) will be randomized to either receive 1 mg/d folic acid, the current standard of care, or a placebo for 12 weeks. After a 12-week washout period, treatments will be reversed. Total folate concentrations (serum and RBC), different folate forms (including UMFA), folate-related metabolites, and clinical outcomes will be measured at baseline and after treatment periods. The sum of the values measured in the two periods will be calculated for each subject and compared across the two sequence groups by means of a test for independent samples for the primary (RBC folate concentrations) and secondary (UMFA) outcomes. Dietary intake will be measured at the beginning of each study period. Discussion As the first rigorously designed clinical trial in children with SCD, this trial will inform and assess current clinical practice, with the ultimate goal of improving nutritional status of children with SCD. Trial registration ClinicalTrials.govNCT04011345. Registered on July 8, 2019
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Affiliation(s)
- Brock A Williams
- Food, Nutrition, and Health, Faculty of Land and Food Systems, The University of British Columbia, 2205 East Mall, Vancouver, British Columbia, V6T 1Z4, Canada.,BC Children's Hospital Research Institute, 950 W 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada
| | - Heather McCartney
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada
| | - Erin Adams
- Department of Pharmacy, BC Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada
| | - Angela M Devlin
- BC Children's Hospital Research Institute, 950 W 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada
| | - Joel Singer
- School of Population and Public Health, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada.,The Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, 588 - 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Suzanne Vercauteren
- BC Children's Hospital Research Institute, 950 W 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada.,Department of Pathology and Laboratory Medicine, BC Children's Hospital, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada
| | - John K Wu
- BC Children's Hospital Research Institute, 950 W 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, Faculty of Land and Food Systems, The University of British Columbia, 2205 East Mall, Vancouver, British Columbia, V6T 1Z4, Canada. .,BC Children's Hospital Research Institute, 950 W 28th Avenue, Vancouver, British Columbia, V5Z 4H4, Canada.
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Henning E, Bakir MS, Haralambiev L, Kim S, Schulz-Drost S, Hinz P, Kohlmann T, Ekkernkamp A, Gümbel D. Digital versus analogue record systems for mass casualty incidents at sea-Results from an exploratory study. PLoS One 2020; 15:e0234156. [PMID: 32502206 PMCID: PMC7274416 DOI: 10.1371/journal.pone.0234156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Mis-triage may have serious consequences for patients in mass casualty incidents (MCI) at sea. The purpose of this study was to assess outcome, reliability and validity of an analogue and a digital recording system for triage of a MCI at sea. Methods The study based on a triage exercise conducted with a cross-over-design. Forty-eight volunteers were presented a fictional MCI with 50 cases. The volunteers were randomly assigned to start with the analogue (Group A, starting with the analogue followed by the digital system) or digital system (Group B, starting with the digital followed by the analogue system). Triage score distribution and agreement between the triage methods and a predefined standard were reported. Reliability was analysed using Cronbach’s Alpha and Cohen’s Kappa. Validity was measured through sensitivity, specificity and predictive value. Treatment, period and carry-over-effects were analysed using a linear mixed-effects model. Results The number of patients triaged (total: n = 3545) with the analogue system (n = 1914; 79.75%) was significantly higher (p = 0.001) than with the digital system (n = 1631; 67.96%). A trend towards a higher percentage of correct triages with the digital system was observed (p = 0.282). Ratio of under-triage was significantly smaller with the digital system (p = 0.001). Validity measured with Cronbach’s Alpha and Cohen’s Kappa was higher with the digital system. So was sensitivity (category; green: 80.67%, yellow: 73.24%, red: 83.54%; analogue: green: 93.28%, yellow: 82.36%, red: 94.04%) and specificity of the digital system (green: 78.07%, yellow: 63.75%, red: 66.25%; analogue: green: 85.50%, yellow: 79.88%, red: 91.50%). Comparing the predictive values and accuracy, the digital system showed higher scores than the analogue system. No significant patterns of carry-over-effects were observed. Conclusions Significant differences were found for the number of triages comparing the analogue and digital recording system. The digital system has a slightly higher reliability and validity than the analogue triage system.
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Affiliation(s)
- Esther Henning
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Mustafa Sinan Bakir
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Lyubomir Haralambiev
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Simon Kim
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Peter Hinz
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Section Methods in Community Medicine, University Medicine Greifswald, Germany
| | - Axel Ekkernkamp
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Denis Gümbel
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
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Rafiee M, Patel K, Groppe DM, Andrade DM, Bercovici E, Bui E, Carlen PL, Reid A, Tai P, Weaver D, Wennberg R, Valiante TA. Daily listening to Mozart reduces seizures in individuals with epilepsy: A randomized control study. Epilepsia Open 2020; 5:285-294. [PMID: 32524054 PMCID: PMC7278546 DOI: 10.1002/epi4.12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Epilepsy is one of the most common neurological disorders . Many individuals continue to have seizures despite medical and surgical treatments, suggesting adjunctive management strategies are required. Promising effects of daily listening to Mozart on reducing seizure frequency in individuals with epilepsy have been demonstrated over the last 20 years, but not in a rigorously controlled manner. In this study, we compared the effect on seizure frequency of daily listening to either Mozart K.448 or a spectrally similar, yet non-rhythmic control piece. We hypothesized that there would be no difference in seizure counts when participants listened to Mozart K.448 vs when they listened to the control piece. METHODS We employed a randomized crossover design, in which each participant was exposed to both three months of daily listening to the first six minutes of Sonata for two pianos in D major by Mozart (Mozart K.448; treatment period) and three months of daily listening to phase-scrambled version (control period). There was a three-month baseline and a three-month follow-up period before and after the six-month listening period, respectively. Change in seizure counts obtained from the seizure diaries was considered as the main study outcome. RESULTS Using three methodologies to investigate the existence of the treatment effect (paired t test, estimation statistics and plots, and Cohen's d), our results revealed a reduction in seizure counts during the treatment period, which was not observed for the control period (P-value < .001). SIGNIFICANCE Using a spectrally similar control piece, our study advances previous reports that were limited by a "no music" control condition. Daily listening to Mozart K.448 was associated with reducing seizure frequency in adult individuals with epilepsy. These results suggest that daily Mozart listening may be considered as an adjunctive therapeutic option to reduce seizure burden in individuals with epilepsy.
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Affiliation(s)
| | - Kramay Patel
- Krembil Brain InstituteTorontoONCanada
- Institute of Biomaterials and Biomedical Engineering, and Electrical and Computer EngineeringUniversity of TorontoTorontoONCanada
| | | | - Danielle M. Andrade
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Eduard Bercovici
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Esther Bui
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Peter L. Carlen
- Krembil Brain InstituteTorontoONCanada
- Institute of Biomaterials and Biomedical Engineering, and Electrical and Computer EngineeringUniversity of TorontoTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
- Department of PhysiologyUniversity of TorontoTorontoONCanada
- Division of NeurosurgeryDepartment of SurgeryUniversity of TorontoTorontoONCanada
| | - Aylin Reid
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Peter Tai
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Donald Weaver
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
- Department of ChemistryUniversity of TorontoTorontoONCanada
| | - Richard Wennberg
- Krembil Brain InstituteTorontoONCanada
- Division of NeurologyDepartment of MedicineUniversity of TorontoTorontoONCanada
| | - Taufik A. Valiante
- Krembil Brain InstituteTorontoONCanada
- Institute of Biomaterials and Biomedical Engineering, and Electrical and Computer EngineeringUniversity of TorontoTorontoONCanada
- Division of NeurosurgeryDepartment of SurgeryUniversity of TorontoTorontoONCanada
- Institute of Medical ScienceFaculty of MedicineUniversity of TorontoTorontoONCanada
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85
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A comparison of pain responses, hemodynamic reactivity and fibre type composition between Bergström and microbiopsy skeletal muscle biopsies. Curr Res Physiol 2020; 3:1-10. [PMID: 34746815 PMCID: PMC8562142 DOI: 10.1016/j.crphys.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 01/13/2023] Open
Abstract
This study tested the hypotheses that 1) skeletal muscle biopsies performed with the Bergström needle evoke larger perceptions of pain and greater hemodynamic reactivity compared to biopsies performed with the microbiopsy needle, and 2) both needles yield samples with similar fibre type compositions when samples are collected at similar skeletal muscle depths. Fourteen healthy (age: 21.6 ± 3.2 years; VO2peak: 41.5 ± 5.8 mL/kg/min) males (n = 7) and females (n = 7) provided two resting skeletal muscle biopsies, one with each needle type, following a randomized crossover design. Participants completed the short-form McGill Pain Questionnaire and the Brief Pain Inventory before, during, and after the skeletal muscle biopsies. Hemodynamic reactivity was assessed by measuring heart rate (HR) and mean arterial pressure (MAP) at rest and during the biopsy procedures. Immunofluorescence analysis was used to assess fibre type composition in vastus lateralis samples. Compared to the microbiopsy needle, the Bergström needle elicited a larger perception of pain but similar hemodynamic reactivity during the biopsy. Both needles yielded skeletal muscle samples with similar fibre type composition and resulted in similar perceptions of pain and pain-related interference during the post-biopsy recovery period. Collectively, these findings suggest that studies should consider using the microbiopsy needle rather than the Bergström needle unless large amounts of muscle tissue or certain muscle fibre lengths are required. However, future work should determine whether our findings are generalizable to biopsies performed with different procedures and/or types of Bergström/microbiopsy needles. The first characterization of responses to two muscle biopsy techniques. Compared to the Bergström, the microbiopsy needle evokes smaller pain responses. Both needles resulted in similar hemodynamic reactivity and fibre type composition. If analysis permits, future work should consider using the microbiopsy needle.
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Key Words
- BPI, Brief pain inventory
- BPI-6, Brief pain inventory question #6
- BPI-9, Brief pain inventory question #9
- HR, Heart rate
- Heart rate
- MAP, Mean arterial pressure
- McGill-D, Descriptors from the McGill Pain Questionnaire
- Mean arterial pressure
- PCS, Pain catastrophizing scale
- PPI, Present pain intensity
- Perceptions of pain
- Skeletal muscle biopsies
- VAS, Visual analog scale
- VO2peak, Peak oxygen consumption
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Pfluegler G, Borkovec M, Kasper J, McLean S. The immediate effects of passive hip joint mobilization on hip abductor/external rotator muscle strength in patients with anterior knee pain and impaired hip function. A randomized, placebo-controlled crossover trial. J Man Manip Ther 2020; 29:14-22. [PMID: 32452284 DOI: 10.1080/10669817.2020.1765625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Anterior knee pain (AKP) is often associated with persistent hip muscle weakness and facilitatory interventions may be beneficial for managing patients with AKP (pwAKP). Physiotherapists often employ passive oscillatory hip joint mobilizations to increase hip muscle function. However, there is little information about their effectiveness and the mechanisms of action involved. Objectives: To investigate the immediate effects of passive hip joint mobilization on eccentric hip abductor/external rotator muscle strength in pwAKP with impaired hip function. Design: A double-blinded, randomized, placebo-controlled crossover design. Method: Eighteen patients with AKP participated in two sessions of data collection with one week apart. They received passive hip joint mobilization or placebo mobilization in a randomized order. Eccentric hip muscle strength was measured immediately before and after each intervention using a portable hand-held dynamometer. Results: An ANCOVA with the sequence of treatment condition as the independent variable, the within-subject post-treatment differences as the dependent variable and the within-subject pre-treatment differences as the covariate was conducted. Patients showed a significant mean increase in eccentric hip muscle strength of 7.73% (p = 0.001) for the mobilization condition, compared to a mean decrease of 4.22% for the placebo condition. Seventeen out of eighteen participants reported having no pain during any of the strength testing. Conclusion: These data suggest that passive hip joint mobilization has an immediate positive effect on eccentric hip abductor/external rotator muscle strength in pwAKP with impaired hip function, even in the absence of current pain.
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Affiliation(s)
- Georg Pfluegler
- Faculty of Health and Well Being, Sheffield Hallam University , Sheffield, UK
| | - Martin Borkovec
- Department of Statistics, Ludwig Maximilian University of Munich , Munich, Germany
| | - Johanna Kasper
- Private Physiotherapy Practice "Teamphysios" , Vienna, Austria
| | - Sionnadh McLean
- Faculty of Health and Well Being, Sheffield Hallam University , Sheffield, UK
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87
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Haug S, Paz Castro R, Scholz U, Kowatsch T, Schaub MP, Radtke T. Assessment of the Efficacy of a Mobile Phone-Delivered Just-in-Time Planning Intervention to Reduce Alcohol Use in Adolescents: Randomized Controlled Crossover Trial. JMIR Mhealth Uhealth 2020; 8:e16937. [PMID: 32452818 PMCID: PMC7284414 DOI: 10.2196/16937] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/27/2020] [Accepted: 03/24/2020] [Indexed: 01/20/2023] Open
Abstract
Background Interventions to reduce alcohol use typically include several elements, such as information on the risks of alcohol consumption, planning for sensible drinking, and training of protective behavioral strategies. However, the effectiveness of these individual intervention elements within comprehensive programs has not been addressed so far, but it could provide valuable insights for the development of future interventions. Just-in-time interventions provided via mobile devices are intended to help people make healthy decisions in the moment and thus could influence health behavior. Objective The aim of this study was to test the proximal effects of a mobile phone–delivered, just-in-time planning intervention to reduce alcohol use in adolescents who reported recent binge drinking. The efficacy of this individual intervention element was tested within a comprehensive intervention program to reduce problem drinking in adolescents. Methods The study had an AB/BA crossover design, in which participants were randomly allocated to (1) a group receiving the planning intervention (A) in period 1 and assessment only (B) in period 2 or (2) a group receiving assessment only (B) in period 1 and the planning intervention (A) in period 2. The planning intervention included a text message to choose one of two predetermined if-then plans to practice sensible drinking with friends or when going out and a prompt to visualize the chosen plan. There was a washout period of at least 1 week between period 1 and period 2. Results Out of 633 program participants who recently binge drank, 136 (21.5%) were receptive in both periods of time and provided data on the proximal outcome, which was the number of alcoholic drinks consumed with friends or when going out. After the planning intervention, the number of alcoholic drinks consumed was approximately one standard drink lower compared with the finding without the intervention (P=.01). Conclusions A mobile phone–delivered, just-in-time, if-then planning intervention to practice sensible drinking with friends or when going out is effective in reducing alcohol consumption among adolescents who report recent binge drinking. Based on the relatively low percentage of participants with self-reported receptivity for the planning intervention, measures to increase the population impact of similar planning interventions should be implemented and tested in future trials. Trial Registration ISRCTN Registry ISRCTN52150713; http://www.isrctn.com/ISRCTN52150713
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Affiliation(s)
- Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Raquel Paz Castro
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, University of Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Center for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland.,Center for Digital Health Interventions, Department of Technology, Management, and Economics, ETH Zurich, Zurich, Switzerland
| | - Michael Patrick Schaub
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Theda Radtke
- Health, Work & Organizational Psychology, School of Psychology and Psychotherapy, Witten/Herdecke University, Witten/Herdecke, Germany
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Sarabhai T, Kahl S, Szendroedi J, Markgraf DF, Zaharia OP, Barosa C, Herder C, Wickrath F, Bobrov P, Hwang JH, Jones JG, Roden M. Monounsaturated fat rapidly induces hepatic gluconeogenesis and whole-body insulin resistance. JCI Insight 2020; 5:134520. [PMID: 32434996 DOI: 10.1172/jci.insight.134520] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUNDWhile saturated fat intake leads to insulin resistance and nonalcoholic fatty liver, Mediterranean-like diets enriched in monounsaturated fatty acids (MUFA) may have beneficial effects. This study examined effects of MUFA on tissue-specific insulin sensitivity and energy metabolism.METHODSA randomized placebo-controlled cross-over study enrolled 16 glucose-tolerant volunteers to receive either oil (OIL, ~1.18 g/kg), rich in MUFA, or vehicle (VCL, water) on 2 occasions. Insulin sensitivity was assessed during preclamp and hyperinsulinemic-euglycemic clamp conditions. Ingestion of 2H2O/acetaminophen was combined with [6,6-2H2]glucose infusion and in vivo 13C/31P/1H/ex vivo 2H-magnet resonance spectroscopy to quantify hepatic glucose and energy fluxes.RESULTSOIL increased plasma triglycerides and oleic acid concentrations by 44% and 66% compared with VCL. Upon OIL intervention, preclamp hepatic and whole-body insulin sensitivity markedly decreased by 28% and 27%, respectively, along with 61% higher rates of hepatic gluconeogenesis and 32% lower rates of net glycogenolysis, while hepatic triglyceride and ATP concentrations did not differ from VCL. During insulin stimulation hepatic and whole-body insulin sensitivity were reduced by 21% and 25%, respectively, after OIL ingestion compared with that in controls.CONCLUSIONA single MUFA-load suffices to induce insulin resistance but affects neither hepatic triglycerides nor energy-rich phosphates. These data indicate that amount of ingested fat, rather than its composition, primarily determines the development of acute insulin resistance.TRIAL REGISTRATIONClinicalTrials.gov NCT01736202.FUNDINGGerman Diabetes Center, German Federal Ministry of Health, Ministry of Culture and Science of the state of North Rhine-Westphalia, German Federal Ministry of Education and Research, German Diabetes Association, German Center for Diabetes Research, Portugal Foundation for Science and Technology, European Regional Development Fund, and Rede Nacional de Ressonancia Magnética Nuclear.
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Affiliation(s)
- Theresia Sarabhai
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Sabine Kahl
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Daniel F Markgraf
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Oana-Patricia Zaharia
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Cristina Barosa
- Centre for Neurosciences and Cell Biology, UC Biotech, Cantanhede, Portugal.,Portuguese Diabetes Association, Lisbon, Portugal
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Frithjof Wickrath
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Pavel Bobrov
- German Center for Diabetes Research, München-Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jong-Hee Hwang
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - John Griffith Jones
- Centre for Neurosciences and Cell Biology, UC Biotech, Cantanhede, Portugal.,Portuguese Diabetes Association, Lisbon, Portugal
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Mukai K, Ohmura H, Matsui A, Aida H, Takahashi T, Jones JH. High-intensity training in normobaric hypoxia enhances exercise performance and aerobic capacity in Thoroughbred horses: A randomized crossover study. Physiol Rep 2020; 8:e14442. [PMID: 32441408 PMCID: PMC7243200 DOI: 10.14814/phy2.14442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 01/28/2023] Open
Abstract
We examined the effects of high-intensity training in normobaric hypoxia on aerobic capacity and exercise performance in horses and the individual response to normoxic and hypoxic training. Eight untrained horses were studied in a randomized, crossover design after training in hypoxia (HYP; 15.0% inspired O2 ) or normoxia (NOR; 20.9% inspired O2 ) 3 days/week for 4 weeks separated by a 4-month washout period. Before and after each training period, incremental treadmill exercise tests were performed in normoxia. Each training session consisted of 1 min cantering at 7 m/s and 2 min galloping at the speed determined to elicit maximal oxygen consumption ( V ˙ O2 max) in normoxia. Hypoxia increased significantly more than NOR in run time to exhaustion (HYP, +28.4%; NOR, +10.4%, p = .001), V ˙ O2 max (HYP, +12.1%; NOR, +2.6%, p = .042), cardiac output ( Q ˙ ; HYP, +11.3%; NOR, -1.7%, p = .019), and stroke volume (SV) at exhaustion (HYP, +5.4%; NOR, -5.5%, p = .035) after training. No significant correlations were observed between NOR and HYP for individual changes after training in run time (p = .21), V ˙ O2 max (p = .99), Q ˙ (p = .19), and SV (p = .46) at exhaustion. Arterial O2 saturation during exercise in HYP was positively correlated with the changes in run time (r = .85, p = .0073), Q ˙ (r = .72, p = .043) and SV (r = .77, p = .026) of HYP after training, whereas there were no correlations between these parameters in NOR. These results suggest that high-intensity training in normobaric hypoxia improved exercise performance and aerobic capacity of horses to a greater extent than the same training protocol in normoxia, and the severity of hypoxemia during hypoxic exercise might be too stressful for poor responders to hypoxic training.
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Affiliation(s)
- Kazutaka Mukai
- Sports Science DivisionEquine Research InstituteJapan Racing AssociationUtsunomiyaTochigiJapan
- Present address:
Sports Science DivisionEquine Research InstituteJapan Racing AssociationShimotsukeTochigiJapan
| | - Hajime Ohmura
- Sports Science DivisionEquine Research InstituteJapan Racing AssociationUtsunomiyaTochigiJapan
- Present address:
Sports Science DivisionEquine Research InstituteJapan Racing AssociationShimotsukeTochigiJapan
| | - Akira Matsui
- Sports Science DivisionEquine Research InstituteJapan Racing AssociationUtsunomiyaTochigiJapan
- Present address:
Equine Science DivisionHidaka Training and Research CenterJapan Racing AssociationUrakawaHokkaidoJapan
| | - Hiroko Aida
- Sports Science DivisionEquine Research InstituteJapan Racing AssociationUtsunomiyaTochigiJapan
- Present address:
Equestrian AffairsJapan Racing AssociationTokyoJapan
| | - Toshiyuki Takahashi
- Sports Science DivisionEquine Research InstituteJapan Racing AssociationUtsunomiyaTochigiJapan
- Present address:
Sports Science DivisionEquine Research InstituteJapan Racing AssociationShimotsukeTochigiJapan
| | - James H. Jones
- Department of Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of CaliforniaDavisCAUSA
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90
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Elhusseini R, Fares EJ, Obeid O. Phosphorus supplementation raised the heart rate of male water polo players during a randomised graded dryland exercise test. BMJ Open Sport Exerc Med 2020; 6:e000714. [PMID: 32405431 PMCID: PMC7202719 DOI: 10.1136/bmjsem-2019-000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2020] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe impact of phosphorus supplementation on athletic performance is unclear. Ingestion of phosphorus for several days has been reported to increase cardiac capacity, improve oxygen muscle kinetics and enhance lactate buffering capacity. Recent studies have shown that phosphorus ingestion with a meal increases postprandial glucose uptake and thermogenesis. The present study aimed to assess the effect of acute phosphorus ingestion with a meal on specific workload parameters.MethodsA double-blind, crossover trial of 12 male water polo players between 18 and 22 years old was conducted. Overnight fasted subjects were asked to cycle for 20 min before ingesting 100 g of glucose with phosphorus or placebo (400 mg). Three hours later, they were asked to perform a graded cycling exercise for 25 min.ResultsExpenditure, respiratory quotient, perception of fatigue and exercise efficiency were similar between treatments. However, heart rate was significantly higher in the phosphorus group (142±10 beats/min) compared with placebo (135±10 beats/min).ConclusionExercise performance 3 hours after the coingestion of glucose with phosphorus did not affect substrate use, while heart rate was increased. The heart rate increase could be attributed to a rise in core body temperature.Trial registration numberNCT03101215.
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Affiliation(s)
- Rami Elhusseini
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie-Jacques Fares
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Omar Obeid
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
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91
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Fujimoto K, Adachi H, Yamazaki K, Nomura K, Saito A, Matsumoto Y, Igarashi K, Uranishi H, Sakaguchi S, Matsuura T, Imura J, Okino K, Mukai K, Okushi Y, Kagaya Y, Tsuruyama Y, Okada K, Miyatake N, Haraguchi T, Iida Y, Yokoyama H. Comparison of the pain-reducing effects of EMLA cream and of lidocaine tape during arteriovenous fistula puncture in patients undergoing hemodialysis: A multi-center, open-label, randomized crossover trial. PLoS One 2020; 15:e0230372. [PMID: 32210455 PMCID: PMC7094835 DOI: 10.1371/journal.pone.0230372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
Arteriovenous fistula puncture pain is a serious problem for patients undergoing dialysis and a good indication for topical anesthetics. No previous study has compared lidocaine/prilocaine cream (EMLA) with lidocaine tape for pain relief during arteriovenous fistula puncture in patients undergoing maintenance hemodialysis. To this end, we conducted a multicenter randomized crossover study including 66 patients (mean age, 65.8 years; males, 57.6%) undergoing maintenance hemodialysis thrice/week. Subjects were assigned to Sequence EL (EMLA administration followed by lidocaine, with 1-week wash-out) or Sequence LE (reverse administration, first lidocaine then EMLA). All subjects completed the study. At each puncture site, 1 g EMLA (25 mg lidocaine + 25 mg prilocaine) or one sheet of lidocaine tape (18 mg lidocaine) was applied 1 h or 30 min prior to arteriovenous fistula puncture, respectively. The primary endpoint was puncture pain relief, which was measured using a 100-mm visual analog scale. The secondary endpoints included quality of life, which was measured by SF-36, and safety. EMLA produced a 10.1-mm greater visual analog scale improvement than lidocaine tape (P = 0.00001). However, there was no statistically significant difference in the quality of life between the two groups, and no significant carryover/period effect was observed in any analysis. Further, no drug-related adverse events were observed. Taken together, these results suggest that EMLA cream is superior to lidocaine tape for the relief of arteriovenous fistula puncture pain in patients undergoing maintenance hemodialysis. Trial registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000027885).
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Affiliation(s)
- Keiji Fujimoto
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
- * E-mail:
| | - Hiroki Adachi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Kanae Nomura
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Atsushi Saito
- Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | | | | | | | | | - Toshikazu Matsuura
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Kazuaki Okino
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Kiyotaka Mukai
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Yuki Okushi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Yu Kagaya
- Keiju Medical Center, Ishikawa, Japan
| | - Yuko Tsuruyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Keiichiro Okada
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Nobuhiko Miyatake
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Yasuo Iida
- Department of Mathematics, Kanazawa Medical University, Ishikawa Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
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Short-term effects of carbohydrates differing in glycemic index (GI) consumed at lunch on children's cognitive function in a randomized crossover study. Eur J Clin Nutr 2020; 74:757-764. [PMID: 32203229 PMCID: PMC8626315 DOI: 10.1038/s41430-020-0600-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/02/2022]
Abstract
Background Intervention studies suggest an influence of breakfast dietary glycemic index (GI) on children’s cognition. The Cognition Intervention Study Dortmund-GI-I study examined whether lunch dietary GI might have short-term effects on selected cognitive parameters. Methods A randomized crossover study was performed at a comprehensive school on 2 test days. One hundred and eighty-nine participants (5th and 6th grade) were randomly assigned to one of the two sequences, medium-high GI (m-hGI) or high-medium GI (h-mGI), following block randomization. In the first period, one group received a dish containing hGI rice (GI: 86) ad libitum, the other mGI rice (GI: 62)—1 week later, in the second period, vice versa. Tonic alertness, task switching, and working memory updating were tested with a computerized test battery 45 min after beginning of lunch break. Treatment effects were estimated using the t test for normally distributed data or the Wilcoxon rank-sum test for non-normally distributed data. Results The crossover approach revealed no effects of lunch dietary GI on the tested cognitive parameters in the early afternoon. However, we determined carryover effects for two parameters, and therefore analyzed only data of the first period. The reaction time of the two-back task (working memory updating) was faster (p = 0.001) and the count of commission errors in the alertness task was lower (p = 0.04) in the hGI group. Conclusion No evidence of short-term effects of lunch dietary GI on cognition of schoolchildren was found. Potential positive effects on single parameters of working memory updating and tonic alertness favoring hGI rice need to be verified.
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93
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Timler A, Bulsara C, Bulsara M, Vickery A, Smith J, Codde J. Use of cannabinoid-based medicine among older residential care recipients diagnosed with dementia: study protocol for a double-blind randomised crossover trial. Trials 2020; 21:188. [PMID: 32059690 PMCID: PMC7023743 DOI: 10.1186/s13063-020-4085-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 01/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Dementia is a neurological condition that affects the cognitive and functional ability of the brain and is the leading cause of disability among those aged 65 years and above. More effective ways to manage dementia symptoms are needed because current treatment options (antidepressants and antipsychotics) can be ineffective and are associated with substantial side effects, including increased rate of mortality. Cannabinoid-based medicine (CBM) has shown an ability to inhibit some symptoms associated with dementia, and the adverse effects are often minimal; yet, little research has explored the use of CBM among this population. AIM To monitor the safety of a purified dose of CBM oil (3:2 delta-9-tetrahydrocannabinol:cannabidiol) on behaviour symptoms, quality of life and discomfort caused by pain. METHODS/DESIGN We will carry out an 18-week, randomised, double-blind crossover trial that consists of a 2-week eligibility period, two 6-week treatment cycles, and two 2-week washout periods (between both cycles and after the second treatment cycle). We aim to recruit 50 participants with dementia who are living in residential aged-care facilities. The participants will be randomised into two groups and will receive a dose of either CBM oil or placebo for the first treatment cycle and the opposite medication for the second. Data will be collected using the Neuropsychiatric Inventory Questionnaire, the Cohen-Mansfield Agitation Inventory, the Quality of Life in Alzheimer's Disease questionnaire, and the Abbey Pain Scale on seven occasions. These will be completed by the participants, aged-care staff, and nominated next of kin or family members. The participants' heart rate and blood pressure will be monitored weekly, and their body composition and weight will be monitored fortnightly by a research nurse, to assess individual dose response and frailty. In addition, pre- and post-surveys will be administered to aged-care staff and family members to understand their perceptions of CBM and to inform proposed focus groups consisting of the aged-care staff and next of kin. DISCUSSION The study design has been informed by medical professionals and key stakeholders, including those working in the residential aged-care industry to ensure patient safety, collection of non-invasive measures, and methodological rigor and study feasibility. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12619000474156. Registered on 21 March 2019.
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Affiliation(s)
- Amanda Timler
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia.
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | | | - Jill Smith
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
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Increasing Warmth in Adolescents with Anorexia Nervosa: A Randomized Controlled Crossover Trial Examining the Efficacy of Mustard and Ginger Footbaths. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:2416582. [PMID: 32076439 PMCID: PMC7013347 DOI: 10.1155/2020/2416582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/11/2019] [Accepted: 01/07/2020] [Indexed: 01/05/2023]
Abstract
Objective To analyze the thermogenic effects of footbaths with medicinal powders in adolescents with anorexia nervosa (AN) in comparison to healthy controls (HCs). Intervention and Outcomes. Forty-one female participants (21 AN, 20 HCs; 14.22 ± 1.54 years) received three footbaths-warm water and mustard (MU, Sinapis nigra), warm water and ginger (GI, Zingiber officinale), or warm water only (WA), in random order within a crossover design. Data were collected before (t1), immediately after foot immersion (maximum 20 minutes) (t2), and after 10 minutes subsequently (t3). Actual skin temperature (high resolution thermography) and perceived warmth (HeWEF questionnaire) were assessed at each time point for various body parts. The primary outcome measure was self-perceived warmth at the feet at t3. Secondary outcome measures were objective skin temperature and subjective warmth at the face, hands, and feet. Results Perceived warmth at the feet at t3 was significantly higher after GI compared to WA (mean difference -1.02) and MU (-1.07), with no differences between those with AN and HC (-0.29). For the secondary outcome measures, a craniocaudal temperature gradient for the skin temperature (thermography) was noted at t1 for patients with AN and HC (AN with colder feet). The craniocaudal gradient for subjective warmth was only seen for patients with AN. Conclusion Footbaths with ginger increased warmth perception at the feet longer than with mustard or warm water only for adolescents with AN as well as for HC. The impact of ginger footbaths on recovery of thermoregulatory disturbances in patients with AN repeated over extended periods merits further investigation.
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95
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Bovée DM, Visser WJ, Middel I, De Mik-van Egmond A, Greupink R, Masereeuw R, Russel FGM, Danser AHJ, Zietse R, Hoorn EJ. A Randomized Trial of Distal Diuretics versus Dietary Sodium Restriction for Hypertension in Chronic Kidney Disease. J Am Soc Nephrol 2020; 31:650-662. [PMID: 31996411 DOI: 10.1681/asn.2019090905] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Distal diuretics are considered less effective than loop diuretics in CKD. However, data to support this perception are limited. METHODS To investigate whether distal diuretics are noninferior to dietary sodium restriction in reducing BP in patients with CKD stage G3 or G4 and hypertension, we conducted a 6-week, randomized, open-label crossover trial comparing amiloride/hydrochlorothiazide (5 mg/50 mg daily) with dietary sodium restriction (60 mmol per day). Antihypertension medication was discontinued for a 2-week period before randomization. We analyzed effects on BP, kidney function, and fluid balance and related this to renal clearance of diuretics. RESULTS A total of 26 patients (with a mean eGFR of 39 ml/min per 1.73 m2) completed both treatments. Dietary sodium restriction reduced sodium excretion from 160 to 64 mmol per day. Diuretics produced a greater reduction in 24-hour systolic BP (SBP; from 138 to 124 mm Hg) compared with sodium restriction (from 134 to 129 mm Hg), as well as a significantly greater effect on extracellular water, eGFR, plasma renin, and aldosterone. Both interventions resulted in a similar decrease in body weight and NT-proBNP. Neither approaches decreased albuminuria significantly, whereas diuretics did significantly reduce urinary angiotensinogen and β2-microglobulin excretion. Although lower eGFR and higher plasma indoxyl sulfate correlated with lower diuretic clearance, the diuretic effects on body weight and BP at lower eGFR were maintained. During diuretic treatment, higher PGE2 excretion correlated with lower free water clearance, and four patients developed mild hyponatremia. CONCLUSIONS Distal diuretics are noninferior to dietary sodium restriction in reducing BP and extracellular volume in CKD. Diuretic sensitivity in CKD is maintained despite lower diuretic clearance. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER DD-study: Diet or Diuretics for Salt-sensitivity in Chronic Kidney Disease (DD), NCT02875886.
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Affiliation(s)
| | | | - Igor Middel
- Division of Pharmacology, Department of Pharmaceutical Sciences, University Utrecht, Utrecht, The Netherlands; and
| | | | - Rick Greupink
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosalinde Masereeuw
- Division of Pharmacology, Department of Pharmaceutical Sciences, University Utrecht, Utrecht, The Netherlands; and
| | - Frans G M Russel
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A H Jan Danser
- Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Burton KJ, Krüger R, Scherz V, Münger LH, Picone G, Vionnet N, Bertelli C, Greub G, Capozzi F, Vergères G. Trimethylamine- N-Oxide Postprandial Response in Plasma and Urine Is Lower After Fermented Compared to Non-Fermented Dairy Consumption in Healthy Adults. Nutrients 2020; 12:nu12010234. [PMID: 31963239 PMCID: PMC7019705 DOI: 10.3390/nu12010234] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/30/2022] Open
Abstract
Trimethylamine-N-oxide (TMAO) can be produced by the gut microbiota from dietary substrates and is associated with cardiovascular disease. While dairy products contain TMAO precursors, the effect of fermented dairy on TMAO metabolism remains unclear. We used plasma and urine samples collected for two randomised cross-over studies to evaluate the effects of fermented dairy consumption on TMAO metabolism. In Study 1, thirteen healthy young men tested a yogurt and an acidified milk during postprandial tests and a two-week daily intervention. In Study 2, ten healthy adults tested milk and cheese during postprandial tests. TMAO and five related metabolites were measured in plasma and urine by LC-MS/MS and NMR. Faecal microbiota composition was assessed in Study 1 (16S rRNA metagenomics sequencing). Fermented milk products were associated with lower postprandial TMAO responses than non-fermented milks in urine (Study 1, p = 0.01; Study 2, p = 0.02) and in plasma, comparing yogurt and acidified milk (Study 1, p = 0.04). Daily consumption of dairy products did not differentially affect fasting TMAO metabolites. Significant correlations were observed between microbiota taxa and circulating or urinary TMAO concentrations. Fermentation of dairy products appear, at least transiently, to affect associations between dairy products and circulating TMAO levels.
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Affiliation(s)
- Kathryn J. Burton
- Federal Department of Economic Affairs, Education and Research EAER, Agroscope, CH-3003 Bern, Switzerland; (L.H.M.); (G.V.)
- Correspondence:
| | - Ralf Krüger
- Max Rubner-Institut, Physiology and Biochemistry of Nutrition, D-76131 Karlsruhe, Germany;
| | - Valentin Scherz
- Institute of Microbiology, Lausanne University Hospital and Lausanne University, CH-1011 Lausanne, Switzerland; (V.S.); (C.B.); (G.G.)
| | - Linda H. Münger
- Federal Department of Economic Affairs, Education and Research EAER, Agroscope, CH-3003 Bern, Switzerland; (L.H.M.); (G.V.)
| | - Gianfranco Picone
- Department of Agricultural and Food Sciences (DISTAL), University of Bologna, I-47521 Cesena, Italy; (G.P.); (F.C.)
| | - Nathalie Vionnet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, CH-1011 Lausanne, Switzerland;
| | - Claire Bertelli
- Institute of Microbiology, Lausanne University Hospital and Lausanne University, CH-1011 Lausanne, Switzerland; (V.S.); (C.B.); (G.G.)
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital and Lausanne University, CH-1011 Lausanne, Switzerland; (V.S.); (C.B.); (G.G.)
| | - Francesco Capozzi
- Department of Agricultural and Food Sciences (DISTAL), University of Bologna, I-47521 Cesena, Italy; (G.P.); (F.C.)
| | - Guy Vergères
- Federal Department of Economic Affairs, Education and Research EAER, Agroscope, CH-3003 Bern, Switzerland; (L.H.M.); (G.V.)
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Grimm O, Kopfer V, Küpper‐Tetzel L, Deppert V, Kuhn M, de Greck M, Reif A. Amisulpride and l-DOPA modulate subcortical brain nuclei connectivity in resting-state pharmacologic magnetic resonance imaging. Hum Brain Mapp 2019; 41:1806-1818. [PMID: 31880365 PMCID: PMC7267910 DOI: 10.1002/hbm.24913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
The precise understanding of the dopaminergic (DA) system and its pharmacological modifications is crucial for diagnosis and treatment of neuropsychiatric disorders, as well as for understanding basic processes, such as motivation and reward. We probed the functional connectivity (FC) of subcortical nuclei related to the DA system according to seed regions defined according to an atlas of subcortical nuclei. We conducted a large pharmaco‐fMRI study using a double‐blind, placebo‐controlled design, where we examined the effect of l‐DOPA, a dopamine precursor, and amisulpride, a D2/D3‐receptor antagonist on resting‐state FC in 45 healthy young adults using a cross‐over design. We examined the FC of subcortical nuclei with connection to the reward system and their reaction to opposing pharmacological probing. Amisulpride increased FC from the putamen to the precuneus and from ventral striatum to precentral gyrus. l‐DOPA increased FC from the ventral tegmental area (VTA) to the insula/operculum and between ventral striatum and ventrolateral prefrontal cortex and it disrupted ventral striatal and dorsal caudate FC with the medial prefrontal cortex. In an exploratory analysis, we demonstrated that higher self‐rated impulsivity goes together with a significant increase in VTA‐mid‐cingulate gyrus FC during l‐DOPA‐challenge. Therefore, our DA challenge modulated distinct large‐scale subcortical connectivity networks. A dopamine‐boost can increase midbrain DA nuclei connectivity to the cortex. The involvement of the VTA‐cingulum connectivity in dependence of impulsivity has implications for diagnosis and therapy in disorders like ADHD.
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Affiliation(s)
- Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyUniversity Hospital, Goethe UniversityFrankfurtGermany
| | - Vera Kopfer
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyUniversity Hospital, Goethe UniversityFrankfurtGermany
| | - Lea Küpper‐Tetzel
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyUniversity Hospital, Goethe UniversityFrankfurtGermany
| | - Vera Deppert
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyUniversity Hospital, Goethe UniversityFrankfurtGermany
| | - Magdalena Kuhn
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyUniversity Hospital, Goethe UniversityFrankfurtGermany
| | - Moritz de Greck
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyUniversity Hospital, Goethe UniversityFrankfurtGermany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyUniversity Hospital, Goethe UniversityFrankfurtGermany
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98
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Min JJ, Kim DK, Hong KY, Choi JW, Choi KY. Comparison of Operator Workloads Associated with the Single-unit Anyfusion® Pump and the Changeover from a Syringe Pump to an Infusion Pump. J Korean Med Sci 2019; 34:e314. [PMID: 31858754 PMCID: PMC6926100 DOI: 10.3346/jkms.2019.34.e314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/28/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A changeover from a syringe pump to an infusion pump may transiently interrupt drug administration and result in medication errors. A newly developed infusion device (Anyfusion®) that combines the functions of an infusion pump and a syringe pump in a single unit was recently commercialized. This study compared the operator workloads associated with the Anyfusion® pump and with the conventional method using two infusion devices (a syringe pump and an infusion pump). METHODS This was a prospective, randomized, crossover-designed simulation study using an imitation arm with an intravascular line. We compared the two methods in terms of total execution time, total number of button clicks, and subjective difficulty using a numerical rating scale with a score from 0 (extremely easy) to 10 (extremely difficult). RESULTS Twenty-two nurses successfully performed both interventions according to the allocated sequence. Total execution times did not differ between the two methods (129.5 ± 23.2 seconds for the conventional method vs. 121.2 ± 24.3 seconds for the Anyfusion® method; P = 0.244), although the total number of clicks was significantly fewer using the Anyfusion® than the conventional method (median [interquartile range]: 10.0 [9.0-12.0] vs. 21.0 [20.0-25.0], respectively; P < 0.001). Participants rated the Anyfusion® method as easier than the conventional method (1.7 ± 1.2 vs. 3.6 ± 1.6; P < 0.001, respectively). CONCLUSION The introduction of Anyfusion® lessened the workload of practitioners required by the changeover process, which might reduce the risk of medication errors and subsequent patient harm. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0004172.
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Affiliation(s)
- Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kwan Young Hong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ka Young Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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99
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Siriwardhana C, Kulasekera KB, Datta S. Personalized treatment selection using data from crossover designs with carry-over effects. Stat Med 2019; 38:5391-5412. [PMID: 31637762 DOI: 10.1002/sim.8372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 05/29/2019] [Accepted: 08/24/2019] [Indexed: 11/07/2022]
Abstract
In this work, we propose a semiparametric method for estimating the optimal treatment for a given patient based on individual covariate information for that patient when data from a crossover design are available. Here, we assume there are carry-over effects for patients switching from one treatment to another. For the K treatment (K ≥ 2) scenario, we show that nonparametric estimation of carry-over effects can have the undesirable property that comparison of treatment means can only be done using independent outcome measurements from different groups of patients rather than using available joint measurements for each patient. To overcome this barrier, we compare probabilities of outcome variable of each treatment dominating outcome variables for all other treatments conditional on patient-specific scores constructed from patient covariates. We suggest single-index models as appropriate models connecting outcome variables to covariates and our empirical investigations show that frequencies of correct treatment assignments are highly accurate. The proposed method is also rather robust against departures from a single-index model structure. We also conduct a real data analysis to show the applicability of the proposed procedure.
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Affiliation(s)
- Chathura Siriwardhana
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - K B Kulasekera
- Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, Kentucky
| | - Somnath Datta
- Department of Biostatistics, University of Florida, Gainesville, Florida
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100
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Monitoring the Clinical Response to an Innovative Transdermal Delivery System for Ibuprofen. Pharmaceutics 2019; 11:pharmaceutics11120664. [PMID: 31835344 PMCID: PMC6955711 DOI: 10.3390/pharmaceutics11120664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022] Open
Abstract
We present a phase 1 study that utilizes a crossover design that provides a rapid and relatively inexpensive methodology for evaluating a new transdermal product. The treatment for osteoarthritis (OA) aims to reduce pain and improve function. An innovative magnetophoresis technology has been developed that facilitates transdermal delivery of ibuprofen. The study used measures that were taken over a relatively short time period to monitor the pharmacodynamic response to ibuprofen. Each participant received magnetophoresis-enhanced transdermal ibuprofen or placebo in randomised order, with a five-day washout period. The participants were 24 volunteers with medically diagnosed, painful knee OA. The primary outcome measures were VAS rating of pain on movement and Western Ontario and McMaster Universities (WOMAC) pain and function scores. VAS for pain on movement (p < 0.001), WOMAC pain score (p = 0.004), and WOMAC function score (p = 0.004) were all significantly improved. There was a significant reduction in movement-related pain (p < 0.05) during the first patch application and for the remainder of the study period. The number needed to treat for a 50% reduction in movement related pain was 2.2. The study showed a rapid and significant analgesic effect in response to transdermal ibuprofen. A short trial of this nature can be used for informing the parameters that are required for a major randomised controlled trial.
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