Association between frailty and sleep quality in people living with multiple sclerosis and obesity: An observational cross-sectional study

BACKGROUND

A majority of the people with multiple sclerosis (pwMS) experience sleep disturbances. Frailty is also common in pwMS. The geriatric literature strongly suggests that frailty is associated with worse sleep outcomes in community-dwelling older adults, but this association has yet to be explored among pwMS. This study focused on examining the association between frailty and sleep quality in pwMS.

METHODS

Seventy-six people with both MS and obesity (mean age: 47.6 ± 10.9 years, 81.6 % female, mean body mass index (BMI): 37.10 ± 5.5 kg/m2, mean Patient Determined Disease Steps (PDDS): 0.82 ± 1.20) were included in this cross-sectional secondary analysis. A comprehensive frailty index (FI) based on 41 health deficits from various health domains was calculated based on standardized procedures. Sleep quality was determined by the Pittsburgh Sleep Quality Index questionnaire (PSQI).

RESULTS

Overall, 67.1 % of the participants were identified as non-frail (FI ≤ 0.25), and 32.9 % were identified as frail (FI > 0.25). A significant correlation was observed between FI scores and global PSQI scores (ρ = 0.43, p < 0.05). Cross-tabulation analyses revealed that frail participants had worse subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and higher use of sleep medications compared to non-frail participants (p < 0.05).

CONCLUSIONS

The current study identified a significant association between frailty and sleep quality in people with both MS and obesity with minimal disability. These findings underscore the importance of untangling the relationship between frailty and sleep quality in pwMS. These results could lead to a more targeted approach for rehabilitation interventions aiming to improve frailty in MS.

Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity

BACKGROUND

Obesity is a risk factor for developing multiple sclerosis (MS) and MS-related disability. The efficacy of behavioral weight loss interventions among people with MS (pwMS) remains largely unknown.

OBJECTIVE

Examine whether a group-based telehealth weight loss intervention produces clinically significant weight loss in pwMS and obesity.

METHODS

Seventy-one pwMS were randomized to the weight loss intervention or treatment-as-usual (TAU). The 6-month program promoted established guidelines for calorie reduction and increased physical activity. Anthropometric measurements, mobility tasks, self-report questionnaires, and accelerometry were used to assess changes at follow-up.

RESULTS

Mean percent weight loss in the treatment group was 8.6% compared to 0.7% in the TAU group (p < .001). Sixty-five percent of participants in the intervention achieved clinically meaningful weight loss (⩾ 5%). Participants in the treatment group engaged in 46.2 minutes/week more moderate-to-vigorous physical activity than TAU participants (p = .017) and showed improvements in quality of life (p = .012). Weight loss was associated with improved mobility (p = .003) and reduced fatiguability (p = .008).

CONCLUSION

Findings demonstrate the efficacy of a behavioral intervention for pwMS and obesity, with clinically significant weight loss for two-thirds of participants in the treatment condition. Weight loss may also lead to improved mobility and quality of life.

A pilot study evaluating the prefeasibility of a behavioral weight loss program in people with multiple sclerosis

Weight loss interventions seldom include individuals with neurologic disease. The aims of the present study were to: 1) develop and assess the prefeasibility of a 6-month telehealth behavioral weight loss program for people with multiple sclerosis (MS) and obesity and 2) examine changes in weight loss (primary outcome), physical activity, and fruit/vegetable consumption at follow-up. Participants with obesity and MS engaged in a 24-week weight loss program. Participants followed established diet, exercise, and self-monitoring guidelines and attended weekly online group meetings. Median percentage weight loss was 10.54 % (SD = 7.19). Participants who adhered more closely to the self-monitoring guidelines (r = 0.81, p =.02), and who averaged higher weekly active minutes (r = 0.91, p =.002) achieved greater percentage weight loss. Six of the eight pilot participants achieved clinically meaningful weight loss (>5%) after 6-months.

Body metrics are associated with clinical, free-living, and self-report measures of mobility in a cohort of adults with obesity and multiple sclerosis

BACKGROUND

Obesity is associated with multiple sclerosis (MS) onset and may contribute to more rapid disability accumulation. Whether obesity impacts mobility in MS is uncertain. Some studies find that obesity in MS is associated with poorer mobility; other studies find no relationship. Discrepant findings may be due to differences in measurement and methodology. In the present study, we employ a comprehensive battery of anthropometric and mobility measures in a sample of people with MS and obesity.

METHODS

Participants with MS (N = 74) completed a battery of adiposity measurements (weight, height, waist circumference, and full body dual-energy x-ray absorptiometry [DXA] scans). They also completed validated clinical, free-living (accelerometry), and self-report measures of mobility. Spearman's Rho correlations were used to examine the associations between mobility and obesity measures with Benjamini and Hochberg correction for multiple comparisons. Multiple linear regression was used to examine if adiposity predicted mobility outcomes in people with MS when controlling for age and disease duration.

RESULTS

The majority of participants (n = 70) were diagnosed with relapsing-remitting MS and reported mild MS-related disability on the Patient Determined Disease Steps (M = 0.77, SD = 1.1). Median BMI was 35.8 (SD = 5.4). Higher percentage body fat (measured via DXA) was associated with poorer self-reported physical functioning (rs = -0.52, p <0.001), less moderate-to-vigorous physical activity (rs = -0.24, p = 0.04), and worse performance on the Six Minute Walk Test (6MWT; rs = -0.44, p <0.001), the Timed 25 Foot Walk (T25FW; rs = 0.45, p <0.001), and the Timed Up and Go test (TUG; rs = 0.35, p = .003). Higher BMI and waist-to-height ratio (WtHR) were associated with worse outcomes on the 6MWT (BMI; rs = -0.35, p <0.01, WtHR; rs = -0.43, p <0.001), T25FW (BMI; rs = 0.32, p <0.01, WtHR; rs = 0.38, p <0.001), and the SF-36 (BMI; rs = -0.29, p <0.005, WtHR; rs = -0.31, p <0.05). Percentage body fat accounted for an additional 17 % of the variance in the T25FW and 6MWT performance, after controlling for age and disease duration.

CONCLUSION

Higher BMI, WtHR, and percentage body fat were associated with lower levels of mobility (T25FW and 6MWT) in people with MS who have class I, class II, and class III obesity. Higher percentage body fat was associated with significantly worse performance on clinical, free-living, and self-report measures of mobility in people with MS even when accounting for participant age and disease duration. These findings suggest that people with MS and obesity may show improved mobility with weight loss.

Photocatalytic properties of nanocrystalline titanium dioxide films in the degradation of domoic acid in aqueous solution: potential for use in molluscan shellfish biotoxin depuration facilities

Domoic acid (DA) is a water-soluble marine neurotoxin produced and released by certain species of the diatom genus Pseudo-nitzschia. Present in coastal waters, it can be a threat to public health and marine life, and can result in severe economic losses to the molluscan shellfish and crustacean harvesting industries. Here we report on the efficiency of nanocrystalline (NC) titania (TiO(2)) thin films used as a photocatalyst in the ultraviolet light photodegradation of DA. Titanium dioxide thin films produced by a sol-gel dip-coating method in the presence of polyethylene glycol of different molecular weights (200, 400 and 600) were deposited on glass substrates and crystallised at 90 degrees C. The films were characterised using spectroscopic ellipsometry, Fourier transform infrared spectrometer (FTIR), scanning electron microscopy (SEM), X-ray diffraction (XRD) and Raman spectroscopy. The photocatalytic activity measurements were carried out by immersing the NC TiO(2) films in a DA solution (2500 ng ml(-1)) and then exposing them for various times at room temperature to UVA irradiation (lambda = approximately 350 nm). The degradation of DA, quantified by HPLC analysis, was not significant when using daylight or ultraviolet light irradiation alone, whereas the NC TiO(2) films prepared at low temperature proved to be a very efficient photocatalyst when used in conjunction with UVA light. The effectiveness of the photodegradation was improved by increasing molecular weight of polyethylene glycol, which increased the thickness of the film. The presence, transformation and degradation of three DA isomers were observed. The approach may eventually be practical for destroying DA in seawater used by aquaculture industry depuration facilities.

Glycosaminoglycan Binding Properties of the Myxoma Virus CC-chemokine Inhibitor, M-T1

Poxviruses encode a number of secreted virulence factors that function to mitigate or modulate the host immune response. M-T1 is a secreted 43-kDa glycoprotein produced by the myxoma virus, a poxvirus pathogen of rabbits, that binds CC-chemokines with high affinity, blocks binding to their cognate G-protein coupled receptors, and thereby inhibits chemokine-induced leukocyte chemotaxis. The present study indicates that M-T1, but not the related vaccinia virus 35-kDa CC-chemokine-binding protein, can localize to cell surfaces through an interaction with glycosaminoglycan molecules. In addition to biochemically characterizing the nature of this interaction, we demonstrate that M-T1 can also simultaneously interact with CC-chemokines while bound to heparin, suggesting that the binding sites on M-T1 for chemokines and heparin are distinct. Furthermore, using recombinant baculovirus-expressed M-T1 truncation and internal deletion mutants, we localize the heparin-binding region of M-T1 to the C terminus of the protein, a region that contains a high abundance of basic residues and includes two clusters of basic amino acid residues that resemble Cardin and Weintraub heparin-binding consensus sequences. The ability of M-T1 to simultaneously interact with chemokines and glycosaminoglycans may enable M-T1 to tether to endothelial surfaces or extracellular matrix and capture host chemokines that are expressed close to sites of virus infection.

Immunomodulation by viruses: the myxoma virus story

Myxoma virus is a poxvirus pathogen of rabbits that has evolved to replicate successfully in the presence of an active immune response by an infected host. To accomplish this, the virus has developed a variety of strategies to avoid detection by or obstruct specific aspects of the antiviral response whose consolidated action is antagonistic to virus survival. We describe two distinct viral strategies carried out by viral proteins with which myxoma virus subverts the host immune response. The first strategy is the production of virus-encoded proteins known as viroceptors or virokines that mimic host receptors or cytokines. These seek to actively block extracellular immune signals required for effective virus clearance and produce a local environment in the infected tissue that is "virus friendly". The second strategy, carried out by intracellular viral proteins, seeks to retard the innate antiviral responses such as apoptosis, and hinder attempts by the infected cell to communicate with the cellular arm of the immune system. By studying these viral strategies of immune evasion, the myxoma system can provide insights into virus-host interactions and also provide new insights into the complex immune system.

Treatment of intractable Menière's disease with intratympanic gentamicin: review of the University of Ottawa experience

OBJECTIVE

Intractable Meniere's disease has traditionally been treated surgically, with either labyrinthectomy, vestibular nerve section, or endolymphatic sac procedures. Another option is the use of intratympanic gentamicin to effect a 'gentamicin labyrinthectomy.' Nedzelski and coworkers have previously reported an 83% complete elimination and 17% substantial reduction in vertigo using this method.

METHOD

We retrospectively reviewed 21 patients treated at our centre with intratympanic gentamicin between 1991 and 1995, all of whom fulfilled the criteria for reporting results in Meniere's therapy described in the American Association of Otolaryngology Committee on Hearing and Equilibrium 1995 guidelines. Our patients are presented using these guidelines, specifically examining four criteria: frequency of vertigo, word recognition, functional level, and hearing threshold.

RESULTS

At 2-year follow-up, 17 of 21 patients (80.9%) had complete elimination of vertigo, with 3 of 21 (14.3%) reporting a 60 to 99% reduction in frequency. Nineteen of 21 patients (90.5%) described themselves as having no impairment secondary to dizziness. Average hearing thresholds and word-recognition scores appear to have both worsened after gentamicin therapy.

CONCLUSION

Intratympanic gentamicin therapy for vertigo in Meniere's disease was shown to be an effective treatment choice, as shown by our results. However, with the reduction of average hearing thresholds and word-recognition scores, patients should be advised of these possible complications as part of informed consent.

Performance of high-density cast silicon carbide in the extreme ultraviolet

The normal-incidence reflectance of high-density cast silicon carbide (SiC) is evaluated in the extreme ultraviolet (EUV) spectral region. High reflectivity in the EUV is achieved. High reflectivity and the relatively low-cost manufacturing process make high-density cast SiC a promising mirror material for EUV applications.

Relationship between motoneuron pool excitability and parameters of timing and force in an isometric ankle-extension movement

The changes in peak facilitation and slope of facilitation of the H-reflex were compared to the parameters of an isometric plantarflexion task. The amplitude of the reflex was significantly greater for reflexes elicited within 50 msec. of the onset of soleus muscle activity. Neither peak amplitude of the reflex nor slope correlated with rate of rise of isometric force; however, they did show a modest relationship between premotor time and reaction time.