Are Physical Fitness and CRP Related to Framingham Risk Score in HIV+ Adults?

Background. People living with HIV (PLWH) have increased risk of cardiovascular disease (CVD). The Framingham Risk Score (FRS) predicts a 10-year CVD risk. Its relationships to physical fitness and C-reactive protein (CRP) are not well established. The current aim is to determine the links between FRS, physical fitness, and CRP in PLWH. Methods. Participants (n = 87) were assessed on multiple biomarkers. The FRS was calculated with the respective variables. Other variables that correlated significantly with FRS were entered into a regression equation to determine their relationship to FRS. Results. The FRS for men was more than twice that for women (12.8 vs 6.0, P < .001). Men were more fit than women, but most participants were not fit. Aerobic capacity was predictive of FRS in men, but not in women, and muscular strength was not predictive of FRS. Women had more than double the CRP compared with men (7.9 vs 3.5 mg/L, P < .01), and it was unrelated to FRS. Conclusions. In men, aerobic capacity was significantly predictive of FRS, but muscular strength and CRP were unrelated to FRS in both genders. These results do not conclusively demonstrate that physical fitness and CRP are related to FRS in PLWH.

The Relationship between HIV Duration, Insulin Resistance and Diabetes Risk

The risk of developing Type 2 Diabetes Mellitus in people living with HIV (PLWH) can be four times greater and can occur at an earlier age and even without the presence of obesity compared to those without HIV. Therefore, the purpose of this analytical cross-sectional study was to determine the relationship between HIV duration and glucose metabolism among PLWH. Eighty-two PLWH were categorized into shorter (≤15 years) or longer HIV duration (≥16 years) and then compared for differences in demographics, physical and clinical characteristics, biomarkers, and dietary intake. Compared to those with shorter HIV duration (n = 34), those with longer HIV duration (n = 48) were on average older (p = 0.02), reported lower consumption of alcohol (p = 0.05), had higher levels of homeostasis model assessment of insulin resistance (HOMA-IR, p = 0.02), were also more likely to be a woman (p = 0.06), and have higher levels of fasting insulin (p = 0.06). When adjusted for age and body weight, the levels of HOMA-IR and fasting insulin were higher (p = 0.02 and p = 0.04) with longer compared to shorter HIV duration, respectively. Longer exposure to HIV infection is associated with impaired insulin sensitivity. Continuing research aimed at the long-term effects of HIV infection and (antiretroviral therapy) is required.

The Effects of a Nutrition Education Program on Dietary Intake and Biomarkers in HIV+ Adults

Background. People living with HIV (PLWH) have increased risk of cardiovascular disease (CVD). Dietary behavior modification may assist in the treatment of CVD, but the optimal dose of nutrition education is unknown. The current aim was to determine if a weekly 1-hour nutrition education program would improve multiple outcomes among PLWH. Methods. Participants (n = 62) were assessed on dietary intake, serum biomarkers, and physical characteristics at baseline and 3 months, and percent change was calculated. Participants were grouped into 3 attendance categories of the classes: none, fair, or good. Analyses of covariance were performed on the outcomes. Results. Calories, protein, fat, saturated fat, carbohydrate, sugar, added sugar, and glycemic load were significantly different (all P values <.05). Those who attended no class typically had increases in these variables versus those with fair or good attendance. High-density lipoprotein cholesterol (HDL-C; P = .006) and total cholesterol/HDL-C ratio ( P = .083) were different, as those who attended no class or had fair attendance worsened, but those with good attendance improved. Conclusions. Several outcomes improved more so among those with good class attendance versus those with either fair or no attendance. Thus, an interactive nutrition education program may be an effective tool to help improve the health of PLWH.

Cardiovascular, endothelial function, and immune markers in response to treatment with a polysaccharide in HIV+ adults in a randomized, double-blind placebo-controlled trial

BACKGROUND AND AIM

Given the ongoing problems of hypertension and endothelial dysfunction in the HIV population, the primary objective of the study was to assess the cardiovascular, endothelial function, and immune markers in response to rice bran arabinoxylan compound (RBAC) treatment in a sample of HIV+ adults on antiretroviral therapy (ART).

STUDY DESIGN

A randomized, double-blind placebo-controlled trial of 6 months was used to execute the study.

MATERIALS AND METHODS

Forty-seven subjects were enrolled and randomly assigned to one of two study conditions (n=22 RBAC and n=25 placebo) for 6 months with assessments at baseline and 3 and 6 months. A multivariate repeated measures analysis of variance model was used to assess the differences between RBAC and placebo groups in cardiovascular (systolic blood pressure), endothelial function (skin blood flow in response to nitric oxide), and immune (CD4+ cell count) markers from baseline to 6 months.

RESULTS

The effect of treatment (RBAC versus placebo) was significant (Wilks' λ=0.92, F[3, 102]=3.07, P=0.03). The effect of time was significant (Wilks' λ=0.10, F[2, 103]=474.6, P<0.001). The overall interaction between treatment and time was significant (Wilks' λ=0.92, F[2, 103]=4.58, P=0.01). Time contrasts showed that a difference in the overall dependent variable did not occur from baseline to 3 months (F[1, 104]=2.7, P=0.10), marginally occurred from baseline to 6 months (F[1, 104]=3.2, P=0.08), and was significant from 3 to 6 months (F[1, 104]=6.43, P=0.01).

CONCLUSIONS

The overall significant interaction suggests varying responses in the dependent variables between RBAC and placebo over time, which is being driven by systolic blood pressure, as it decreased in the RBAC group, but increased in the placebo group. In addition, CD4+ manifested a non-significant increase from baseline to 3 months then decreased from 3 to 6 months in the RBAC group, whereas it decreased at 3 months followed by a slight increase at 6 months in the placebo group. Skin blood flow in response to nitric oxide improved non-significantly overall in both groups, but worsened from 3 to 6 months in the placebo group. Thus, RBAC treatment may contribute to modest short-term improvements in systolic blood pressure, endothelial function, and CD4+ cell count, which could help improve the overall health profile of HIV+ adults.

RELEVANCE FOR PATIENTS

Persons with HIV on ART suffer disproportionately from hypertension and endothelial dysfunction compared to the non-infected population, and conventional medical therapy does not alleviate these issues. RBAC is a safe, low-risk alternative that may help to improve the overall quality of life of these patients through modest improvements in these biomarkers plus CD4+ cell count.

The effectiveness of a community-based exercise program on depression symptoms among people living with HIV

HIV is a worldwide public health issue affecting millions of individuals, and people living with HIV (PLWH) are often affected by depression. Nonetheless, exercise can prevent and treat depression among PLWH. The aim of the present study was to investigate the effect of exercise on depression symptoms in PLWH. Using a prospective single-arm trial, a semi-supervised community-based exercise intervention was offered 3 times/week for 12 weeks to PLWH (n = 52; age: 49 ± 6 years; HIV diagnosis: 19 ± 15 years). Participants were divided into compliant (≥1 exercise session/week) and non-compliant (<1 exercise session/week) groups according to their attendance in the intervention. Depression symptoms were assessed using the Beck Depression Inventory (BDI), and the change in BDI from baseline to post-intervention was assessed with an analysis of covariance, adjusted for demographics. The post-intervention BDI score was significantly lower (p = 0.027) for the compliant group compared to the non-compliant group, and the rate of improvement from moderate/severe symptoms of depression to minimal symptoms of depression was four times greater in the compliant group. In conclusion, a community-based exercise program may be effective in reducing depression symptoms among PLWH.

Relationship between brain-derived neurotrophic factor and immune function during dietary supplement treatment of elderly with Alzheimer's dementia

BACKGROUND AND AIM

The objective of the present study was to investigate the relationships among pro-brain-derived neurotrophic factor (BDNF) and mature BDNF and immune functioning during aloe polymannose multinutrient complex (APMC) treatment in persons with moderate to severe Alzheimer's dementia (AD).

MATERIALS AND METHODS

An open-label trial of 12 months was used to execute the study. Thirty-four adults with AD were enrolled and consumed four teaspoons/day of APMC for 12 months. Subjects were assessed at baseline and 12 months follow-up for proBDNF and BDNF and cytokines, growth factors, T-cell and B-cell subsets, and complete blood count to measure immune functioning. All biomarkers were intercorrelated.

RESULTS

Several relationships were identified between proBDNF, BDNF, and BDNF/proBDNF ratio and immune function at 12 months, particularly BDNF with vascular endothelial growth factor (VEGF) (r=0.55, P=0.03), epidermal growth factor (EGF) (r=0.74, P=0.001), and CD95+CD3+ (%) (r=-0.64, P=0.03) and proBDNF with VEGF (r=0.64, P=0.02), EGF (r=0.86, P<0.001), and CD16+56+ (%) (r=-0.78, P<0.01). Other correlations were noted for various immune function variables with BDNF, proBDNF, and/or BDNF/proBDNF ratio at baseline and 12 months. Dichotomizing subjects on BDNF above and below 5000 pg/mL revealed additional relationships with platelets and neutrophils.

CONCLUSIONS

The associations between BDNF and proBDNF and various immune markers, such as VEGF, EGF, and CD95+CD3+ ratio, provide insight into the link between neurological function and the immune system. These relationships were even stronger in response to APMC treatment, which lends support to previous findings showing improved immune function after dietary supplementation.

RELEVANCE FOR PATIENTS

AD patients have conventional treatment options with limited efficacy for counteracting the deleterious effects of the disease on neurological function. The link between neurological and immune function has been understudied in this population. Overall, our results showed a significant beneficial relationship between immune and neurological function, particularly in response to 12 months of treatment with an all-natural polysaccharide-based dietary supplement that is a known immunomodulator. Thus, the use of this dietary supplement may benefit these patients by simultaneously improving immune and neurological function.

The Novel Effects of a Hydrolyzed Polysaccharide Dietary Supplement on Immune, Hepatic, and Renal Function in Adults with HIV in a Randomized, Double-Blind, Placebo-Control Trial

The primary objective of the study was to evaluate the effects of a hydrolyzed polysaccharide, rice bran arabinoxylan compound (RBAC), on immune, hepatic, and renal function in HIV + individuals. A 6-month randomized double-blind placebo-controlled trial was utilized to conduct the intervention. Forty-seven HIV + individuals on stable antiretroviral therapy were enrolled and randomly assigned to one of the 2 study conditions (n = 22 RBAC and n = 25 placebo) and consumed 3 gram/day of either compound for 6 months. Participants were assessed at baseline and 3 and 6 months follow-up for CD4+ and CD8+, liver enzymes, and kidney function. No side effects were reported, and liver and kidney markers remained nearly completely within normal limits. The percentage change in CD4+ was similar for the placebo (+2.2%) and RBAC (+3.1%) groups at 6 months follow-up. The percentage change in CD8+ count significantly decreased from baseline to 6 months in the RBAC group (-5.2%), whereas it increased in the placebo group (+57.8%; p = 0.04). The CD4+/CD8+ ratio improved clinically in the RBAC group from 0.95 (SD = 0.62) at baseline to 1.07 (SD = 0.11) at 6 months, whereas it declined in the placebo group from 0.96 (SD = 0.80) at baseline to 0.72 (SD = 0.59) at 6 months. Our results showed a statistically significant decrease in CD8+ count and a clinically significant increase in CD4+/CD8+ ratio for the RBAC group compared to the placebo group. Thus, the results of this study suggest that the immunomodulatory and antisenescent activities of RBAC are promising for the HIV population.

RETRACTED ARTICLE: The Novel Effects of a Hydrolyzed Polysaccharide Dietary Supplement on Immune, Hepatic, and Renal Function in Adults with HIV in a Randomized, Double-Blind Placebo-Control Trial

The primary objective of the study was to evaluate the effects of a hydrolyzed polysaccharide, rice bran arabinoxylan compound (RBAC), on immune, hepatic, and renal function in HIV + individuals. A six-month randomized double-blind placebo-controlled trial was utilized to conduct the intervention. Forty-seven HIV + participants on stable antiretroviral therapy were enrolled and randomly assigned to one of the two study conditions (n = 22 RBAC and n = 25 placebo) and consumed 3 gram/day of either compound for six months. Participants were assessed at baseline and 3 and 6 months follow-up for CD4+ and CD8+, liver enzymes, and kidney function. No side effects were reported, and liver and kidney markers nearly remained completely within normal limits. The percentage change in CD4+ was similar for the placebo (+2.2%) and RBAC (+3.1%) groups at 6 months follow-up. The percentage change in CD8+ count significantly decreased from baseline to 6 months in the RBAC group (-5.2%), whereas it increased in the placebo group (+57.8%; p = 0.04). The CD4+/CD8+ ratio improved clinically in the RBAC group from 0.95 (SD =0.62) at baseline to 1.07 (SD =0.11) at 6 months, whereas it declined in the placebo group from 0.96 (SD =0.80) at baseline to 0.72 (SD =0.59) at 6 months. Our results showed a statistically significant decrease in CD8+ count and a clinically significant increase in CD4+/CD8+ ratio for the RBAC group compared to the placebo group. Thus, the results of this study suggest that the immunomodulatory and antisenescent activities of RBAC are promising for the HIV population.

Intravenous infusion of magnesium sulfate is not associated with cardiovascular, liver, kidney, and metabolic toxicity in adults

BACKGROUND

Magnesium (Mg) deficiency contributes to the pathophysiology of numerous diseases. The therapeutic use of Mg has steadily increased over time. The increased in-hospital use of intravenous (IV) magnesium sulfate (MgSO4) warrants more extensive investigation regarding the safety of the therapy. The aim of this study was to determine the safety of IV MgSO4 infusion on cardiovascular, liver, kidney, and metabolic markers in adults.

METHODS

Twelve volunteers were randomized to one of two cross-over conditions: (a) IV infusion of MgSO4 in 5% dextrose followed by IV infusion of 5% dextrose 1 week later or (b) IV infusion of 5% dextrose followed by IV infusion of MgSO4 in 5% dextrose 1 week later. An electrocardiogram was recorded continuously during the infusions. Blood was drawn pre- and post-infusion for blood count (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides). Results: Serum Mg increased from pre- to post-infusion in the MgSO4 + 5% dextrose group (p < 0.0001). The QRS interval length increased from pre- to post-infusion in the MgSO4 + 5% dextrose group (p < 0.04). Additionally, serum glucose concentration increased in the MgSO4 + 5% dextrose group (p = 0.04). These significant findings were modeled with gender and age as covariates. No other significant differences were found.

CONCLUSIONS

The administration of IV infusion of MgSO4 (4 g/100 mL) in 5% dextrose over a 4-hour treatment period poses no significant deleterious effects on cardiovascular, liver, kidney, or metabolic function.

RELEVANCE FOR PATIENTS

IV infusion of MgSO4 may be used for certain treatment indications without significant concern for systemic or organ toxicity.

The effect of dietary supplementation on brain-derived neurotrophic factor and cognitive functioning in Alzheimer's dementia

BACKGROUND AND AIM

The objective of the present study was to investigate the effect of an aloe polymannose multinutrient complex (APMC) on pro brain-derived neurotrophic factor (BDNF) and mature BDNF in persons with moderate to severe Alzheimer's dementia.

METHODS

A 12-month open-label trial was utilized to evaluate the effect of the APMC on proBDNF and BDNF and their relationship to cognitive functioning. Thirty-four adults were enrolled and consumed 4 teaspoons/day of APMC for 12 months. Subjects were assessed at baseline and twelve months follow-up for proBDNF and BDNF and with a neuropsychological battery to measure cognitive functioning. Cognitive functioning was correlated with proBDNF and BDNF.

RESULTS

Few adverse effects were reported. While proBDNF (baseline M = 6,108.9, SD = 854.9 and 12 months M = 5,799.2, SD = 573.4; p = 0.57) and BDNF (baseline M = 5,673.8, SD = 3,342.3 and 12 months M = 6,312.9, SD = 2,830.9; p = 0.29) did not significantly change, the correlations between the ADAS-cog total score and BDNF (r = -0.53, p = 0.04) and BDNF/proBDNF ratio (r = -0.58, p = 0.05) became statistically significant after 12 months of dietary supplementation. Other correlations were noted for various cognitive functioning assessments and BDNF and/or BDNF/proBDNF ratio at both baseline and 12 months.

CONCLUSIONS

These findings suggest that the relationship between cognitive functioning and BDNF and BDNF/proBDNF ratio improved in response to consumption of a dietary supplement in persons with Alzheimer's dementia, which is consistent with our previous findings on cognitive functioning.

RELEVANCE FOR PATIENTS

Overall, our results showed modest improvements in clinical outcomes for a disease that otherwise has no standard conventional approach to treatment with proven efficacy.

Assessing the Relationship between Vitamin D Status and Impairments in Cognitive and Physical Performance in Older Adults Using a Dual Task Physical Performance Test

BACKGROUND

Vitamin D deficiency has been associated with an increased risk of falls in older adults. Several studies have demonstrated an association between vitamin D deficiency and gait and cognitive impairments, which are two risk factors for falls in the elderly. There is lack of research about the role of vitamin D in cognitive function in the context of mobility.

OBJECTIVE

The purpose of this study was to evaluate the association between vitamin D status with the age-related changes in mobility through higher order cognitive function using a dual task physical performance test.

DESIGN

Cross-sectional.

SETTING

Community-dwelling older adult population located in Miami, Fl.

PARTICIPANTS

Healthy participants over the age of 55 (n=97) who participated in the parent interventional study.

MEASUREMENTS

Participants completed assessments that included serum levels of vitamin D, surveys, and dual task physical performance tests. Spearman's correlations, independent t-tests, repeated measures ANOVAs and multiple logistic regressions were used to examine the relationship between vitamin D insufficiency (25-hydroxyvitamin D <30 ng/ml) and sufficiency (≥30 ng/ml) and dual task physical performance variables. The significance level was set at α=0.05.

RESULTS

There were no significant associations between vitamin D insufficiency and gait velocity during either task. Using Spearman correlations, slower single (P=0.011) and dual task counting rates (P=0.006) were significantly associated with vitamin D insufficiency. Independent t-tests showed dual and single task counting rates were significantly lower in the vitamin D insufficient group compared to the sufficient group (P=0.018 and P=0.028, respectively). The results for the ANOVAs indicated that velocities and counting rates were not significantly different by vitamin D status (Wilk's Lambda =0.999; F (1, 95) =.11, P=.740) (Wilk's Lambda =.999, F(1,95)=.13, P=.718). Vitamin D status was not significantly associated with dual task physical performance (defined as the difference in dual and single task) in gait velocity (OR=1.00, 95% CI: 0.98; 1.02, P=0.772) and counting rate (OR=1.684, 95% CI: 0.15; 19.57, P=0.677), when controlling for confounders.

CONCLUSIONS

Since counting backward is a mental tracking task, which is a component of executive function, our results suggest a relationship between vitamin D insufficiency and executive dysfunction. Executive dysfunction has been previously associated with fall risks in the elderly, and it could be a possible mediator between vitamin D and falls. Our data suggest that cognition may play a significant role in vitamin D's influence on falls, while motor function may play a lesser role.

Anti-cancer effects of aloe-emodin: a systematic review

BACKGROUND

Anthraquinones are a possible treatment option for oncological patients due to their anti-cancer properties. Cancer patients often exhaust a plethora of resources that ultimately fail to provide fully curative measures. Alternative treatments are subsequently sought in the hope of finding a therapeutic remedy. Po¬tential regimens include aloe-emodin and its related derivatives. This review therefore summarizes the effects of aloe-emodin and other aloe components in light of their anti-proliferative and anti-carcinogenic properties.

METHODS

A systematic search was performed in PubMed for aloe-emodin and cancer in humans. Sixty abstracts of in vitrostudies were selected and reviewed with subsequent screening of the full text. Thirty-eight articles were summarized.

RESULTS

Aloe-emodin possesses multiple anti-proliferative and anti-carcinogenic properties in a host of human cancer cell lines, with often multiple vital pathways affected by the same molecule. The most notable effects include inhibition of cell proliferation, migration, and invasion; cycle arrest; induction of cell death; mitochondrial membrane and redox perturbations; and modulation of immune signaling. The effects of aloe-emodin are not ubiquitous across all cell lines but depend on cell type.

CONCLUSIONS

On the basis of this systematic review, the multiple consistent effects of aloe-emodin in hu¬man-derived cancer cell lines suggest that aloe-emodin is a potential anti-cancer agent that acts on cancer cells in a pleiotropic manner.

RELEVANCE FOR PATIENTS

Cancer patients often utilize alternative therapies as a result of suboptimal efficacy of conventional treatments. Aloe-emodin might become a therapeutic option for cancer patients if the basic research is confirmed in clinical trials.

New method of sudomotor function measurement to detect microvascular disease and sweat gland nerve or unmyelinated C fiber dysfunction in adults with retinopathy

BACKGROUND

Diabetes-associated microvascular complications such as retinopathy and neuropathy often lead to end-organ and tissue damage. Impaired skin microcirculation often precedes the detection of other advanced diabetic complications. The ANS-1 system contains a redesigned sympathetic skin response (ANS-1 SSR) device that measures sudomotor function, a photoplethysmography sensor, and a blood pressure device to comprehensively assess cardiac autonomic neuropathy and endothelial dysfunction. The purpose of this study was to determine the relationships between the ANS-1 SSR amplitude measured at the: (a) negative electrode (Nitric Oxide [NO] Sweat Peak) with microvascular diseases and associated vascular blood markers and (b) positive electrode (iSweat Peak) with C fiber function.

METHODS

All participants (healthy controls n = 50 and retinopathy patients n = 50) completed the ANS-1 system evaluation and a basic sociodemographic and medical history questionnaire, including a quality of life measure (SF-36). A small sample of blood was drawn to determine levels of homocysteine, blood urea nitrogen (BUN), C-reactive protein (CRP), and fibrinogen. Symptoms of peripheral foot neuropathy were assessed with a scale from 1 (none) to 10 (the worst). We used Spearman rank correlations, independent samples t-tests, and receiver operating characteristic curves to determine the specificity and sensitivity of the NO Sweat Peak as a potential screening marker of retinopathy.

RESULTS

The ANS-1 System Cardiometabolic Risk Score and all indicators of quality of life on the SF-36, other than Emotional Role Functioning, were significantly worse in the retinopathy patients. The sudomotor response marker NO Sweat Peak had a sensitivity of 88% and a specificity of 68% (Area Under the Curve = 0.81, p < 0.0001) to detect retinopathy. The NO Sweat Peak response marker inversely correlated with BUN (ρ = -0.41, p < 0.0001), homocysteine (ρ = -0.44, p < 0.0001), fibrinogen (ρ = -0.41, p < 0.0001), the Cardiac Autonomic Neuropathy score (ρ = -0.68, p < 0.0001), and the heart rate variability Total Power (ρ = -0.57, p < 0.0001), and it positively correlated with the Photoplethysmography Index (PTGi; ρ = 0.53 p < 0.0001). The ANS-1 system sudomotor response marker iSweat Peak inversely correlated with the severity of symptoms on the peripheral neuropathy scale (ρ = -0.56, p < 0.0001).

CONCLUSION

The results of the study show that this new method of measuring sympathetic skin response should be useful for detecting the earliest manifestations of microvascular disease and symptoms of C fiber dysfunction.

Double-blind, randomized crossover study of intravenous infusion of magnesium sulfate versus 5% dextrose on depressive symptoms in adults with treatment-resistant depression

AIM

Treatment-resistant depression patients are more likely to suffer from comorbid physical and mental disorders, experience marked and protracted functional impairment, and incur higher health-care costs than non-affected individuals. Magnesium sulfate is a treatment option that may offer great potential for patients with treatment-resistant depression based on prior work in animals and humans.

METHODS

Twelve subjects with mild or moderate treatment-resistant depression were randomized into a double-blind crossover trial to receive an infusion of 4 g of magnesium sulfate in 5% dextrose or placebo infusion of 5% dextrose with a 5-day washout in between the 8-day intervention period. Subjects were assessed before and after the intervention for serum and urine magnesium, lipid panel, the Hamilton Rating Scale for Depression, and the Patient Health Questionnaire-9.

RESULTS

We found a difference in serum magnesium from day 2 to 8 (pre-infusion) (P < 0.002) and from baseline to day 8 (P < 0.02). No changes were noted on the Hamilton Rating Scale for Depression or the Patient Health Questionnaire-9 24 h post-treatment, but as serum magnesium increased from baseline to day 7, the Patient Health Questionnaire-9 decreased from baseline to day 7 (P = 0.02).

CONCLUSION

Magnesium sulfate did not significantly affect depression 24 h post-infusion, but other results were consistent with the literature. The association between changes in serum magnesium and the Patient Health Questionnaire-9 supports the idea that magnesium sulfate may be used to address treatment-resistant depression, an ongoing medical challenge.

A double-blind, randomized trial on the effect of a broad-spectrum dietary supplement on key biomarkers of cellular aging including inflammation, oxidative stress, and DNA damage in healthy adults

Background and Aim: Nutritional approaches that ameliorate cellular senescence may have the potential to counteract the effects of chronic disease. This study will investigate the effect of the Healthycell dietary supplement on markers of inflammation, oxidative stress, and DNA damage. Methods: Thirty adults between the ages of 18 and 55 were enrolled and randomly assigned to one of the two study conditions (n = 15 Healthycell and n = 15 placebo). Subjects participated in a four-week intervention and were assessed at baseline, four weeks, and six weeks (after a two-week washout period). Results: Pro-inflammatory cytokine interleukin (IL)-1α (t = 2.033; mean difference = -3.97 pg/ml; SE = 2.0; 95% CI: -8.0, -0.3; Cohen's d = 0.77; p = 0.05) decreased, while soluble cytokine receptors sTNFR-I (t = 2.057; mean difference = 52.39 pg/mL; SE = 18.5; 95% CI: 5.2, 99.6; Cohen's d = 0.53; p = 0.03) and sTNFR-II (t = 1.739; mean difference = 208.71 pg/ml; SE = 72.0; 95% CI: 24.4, 393.0; Cohen's d = 0.61; p = 0.02) increased in the treatment group versus control. C-reactive protein also rose in the Healthycell group during the trial (t = 2.568; mean difference = 1.41 mg/dL; SE = 0.4; 95% CI: 0.3, 2.5; Cohen's d = 0.66; p < 0.01), without accompanying increases in IL-6 and TNF-α. Additionally, cortisol levels decreased in the Healthycell group (t = 0.575; mean difference = -0.31 ug/dL; SE=0.1; 95% CI: -0.6, -0.03; Cohen's d = 0.88; p = 0.03). When groups were split by age (< 35 years vs. ≥ 35 years), 8-hydroxydeoxyguanosine, a marker of DNA damage, decreased in the older Healthycell group compared to placebo (t = 1.782; mean difference = -7.09 ng/mL; SE = 3.0; 95% CI: -13.3, -0.9; Cohen's d = 0.63; p = 0.03). Significant changes were also found for sTNFR-I, sTNFR-II, and IL-5 in the older group. All results were obtained from t tests by post-hoc analysis. Conclusions: Our findings show an improved inflammatory profile and decreased DNA damage. Additionally, the efficacy of Healthycell was primarily in older adults, where the processes that cause or are associated with cell senescence are more predominant. Relevance for patients: Healthycell may help to counteract the inflammatory effects of aging that lead to both cell senescence and the multitude of age-related chronic diseases.

Time Perspective as a Potential Tool for Psychotherapeutic Intervention

This pilot study shows (1) similarities among adults in the patterns of organization of the past, present, and future based upon individual imagery and spatial representation of their personal perspective of their lives and (2) a relationship between perceived health and future-orientation, i.e., how far into their future a person imagines self still to be alive. The data support the concept of a personal spatial representation of past, present, and future (a timeline) and sets the foundation for the development of psychological interventions based on this representation for 50 participants (23 men and 27 women). When asked to visualize their personal timelines, subjects indicated a general pattern of their future spatially located to the right and in front of themselves; their past was generally located to the left or behind. The distance into the future seen by participants initially ( M ± SE) were 8 ± 2.3 yr., 16 ± 2.8 yr., and 27 ± 5.5 yr. for the self-reported health status of “poor”, “good”, and “excellent”, respectively ( p <.05). Research must firmly establish general patterns of spatial representations of time (timeliness) across cultures, age, race, and beliefs, and explore implications for treatment.

The effect of exercise training on disease progression, fitness, quality of life, and mental health in people living with HIV on antiretroviral therapy: a systematic review

BACKGROUND

Exercise has been associated with improvements in adverse physiological and psychological effects of long-term antiretroviral therapy (ART) in people living with HIV (PLWH).

AIM

To summarizes the findings on the effects of aerobic or resistance training alone or combined aerobic and resistance exercise training (CARET) on disease progression, fitness, physical functioning, mental health, and quality of life (QOL) in PLWH receiving ART. A systematic search of articles was performed in several databases, and 20 articles that met inclusion criteria were summarized.

RELEVANCE FOR PATIENTS

Aerobic exercise was associated with improvements in aerobic capacity, QOL, and depressive symptoms, while resistance training improved strength. CARET was related to improved aerobic fitness, strength, physical functioning, QOL, and self-efficacy. At least one of the exercise interventions resulted in improvements in CD4+ cell count and HIV RNA viral load. Moreover, another study showed that HIV-specific biomarkers remained unchanged in the exercise intervention group, while they significantly worsened in the non-exercise group. In general, in spite of their well-known benefits, exercise programs have not been extensively utilized or widely recognized as viable therapeutic treatment options for this patient population. Knowing the possible health benefits of increasing physical activity level is important to better recommend exercise programs. However, the prescription must be done carefully and on an individual basis. Additional studies investigating the efficiency and effectiveness of different exercise training regimens for PLWH are needed.

A cross-sectional assessment of metabolic syndrome in HIV-infected people of low socio-economic status receiving antiretroviral therapy

BACKGROUND

Metabolic syndrome (MetS) is a constellation of symptoms used as a measure to identify patients at increased risk for cardiovascular disease, type 2 diabetes, and all-cause mortality. The results of prolonged life expectancy and cumulative toxic effects of antiretroviral therapy increase the chance that HIV can cause clinical abnormalities, including MetS.

METHODS

We evaluated 89 people living with HIV (PLWH; mean age 48 ± 7 years; mean duration of HIV infection 17 ± 12 years; 47% men; 66% African-American, 22% Hispanic, and 10% non-Hispanic white; and 84% unemployed) enrolled in a community-based exercise training and nutrition education program targeting individuals of low socio-economic status (SES). The prevalence of MetS characteristics and the factors associated with the presence of MetS were analyzed.

RESULTS

One in three (33%; 12 men and 17 women) PLWH met ATPIII criteria for MetS. In our cohort, MetS was driven by high waist circumference and elevated blood pressure. In addition, higher use of protease inhibitors, elevated hemoglobin A1c (HbA1c), greater self-reported daily caloric intake and consumption of carbohydrates, sugar, added sugar, and higher glycemic load were found among the individuals with MetS, compared to those without it. Elevated HbA1c and high total sugar consumption were the strongest predictors and accounted for 30% of the occurrence of MetS.

CONCLUSIONS

The overall prevalence of MetS in our PLWH cohort receiving antiretroviral therapy is higher than previously reported in the general population and in other PLWH cohorts. Additional work is needed to determine whether MetS is a more disease dependent or lifestyle dependent condition in PLWH.

A cross-sectional assessment to detect type 2 diabetes with endothelial and autonomic nervous system markers using a novel system

Background

Type 2 diabetes mellitus is frequently unrecognized until complications appear. Diabetic autonomic neuropathy is one of the early complications of type 2 diabetes mellitus, resulting in autonomic nervous system (ANS) dysfunction. The purpose of this study was to determine the validity of ANS function indicators to screen for type 2 diabetes mellitus, as measured by the TM-Oxi and SudoPath system.

Methods

All enrolled participants completed a basic sociodemographic and medical history questionnaire including current medications. Healthy controls (n = 25) underwent a 2-hour oral glucose tolerance test (OGTT) to evaluate glucose, insulin, and insulin C-peptide. Patients with type 2 diabetes mellitus (n = 24) were assessed with fasting plasma glucose (FPG) and glycosylated hemoglobin. The TM-Oxi and SudoPath system evaluation was completed by all subjects. Data were analyzed using SPSS 22. Frequency and descriptive statistics were calculated on all variables. The criterion for statistical significance was α = 0.05.

Results

The twenty-five healthy controls had a mean age of 37.0 years. The twenty-four type 2 diabetes mellitus patients currently undergoing standard treatment had a mean age of 48.9 years. Based on the American Diabetes Association guidelines, we detected pre-diabetes in 4 subjects and diabetes in 1 subject, while all other subjects had normal FPG values. At 120 minutes, the correlations between the OGTT and cardiometabolic risk score (CMRS) were: r = 0.56 (p = 0.004) for glucose and r = 0.53 (p = 0.006) for insulin. At 120 minutes, the correlations between the OGTT and photoplethysmography index (PTGi) were: r = -0.56 (p = 0.003) for glucose and r = -0.41 (p = 0.04) for insulin. The CMRS, PTGi, and plethysmography total power index (PTGVLFi) differed significantly between the diabetes patients and healthy participants. The specificity and sensitivity for the CMRS, PTGi, and PTVLFi comparing the diabetes patients with healthy controls were high.

Conclusion

The TM-Oxi and SudoPath system shows promise as a valid, convenient, and non-invasive screening method for type 2 diabetes mellitus. The ANS function and CMR indicators measured by this system may be useful in guiding diabetes and cardiovascular health screening, treatment, and monitoring.

A double-blind, randomized clinical trial of dietary supplementation on cognitive and immune functioning in healthy older adults

Background

Declining cognitive function is relatively common and increasingly prevalent. Studies have shown that different nutrients (e.g., Ginkgo biloba and vitamin E) appear to be effective at improving memory and concentration, while less is known about their effect on immunity.

Methods

This study investigated the effect of Ginkgo Synergy® plus Choline (n = 33) and OPC Synergy® plus Catalyn® (n = 31) versus placebo (n = 33) in a 6-month, randomized, double-blind trial on cognitive and immune functioning among English-speaking, non-smoking, healthy older adults. The Stroop Color and Word Test, Trail Making Test A and B, Controlled Oral Word Association, Hopkins Verbal Learning, Mini-Mental State Exam, and Digit Symbol were administered at baseline and 3 and 6 months follow-up to assess cognitive functioning. Cytokines and growth factors were measured at baseline and 6 months to assess inflammation and immune functioning. Data were analyzed with linear mixed modeling.

Results

No serious adverse events were noted in this study. According to time on the Trail Making Test-B, the Ginkgo Synergy® plus Choline arm showed improvement from baseline to 3 months follow-up (mean difference = 24.2; SE = 6.4; 95% CI: 8.6, 39.7; p = 0.01). On the Controlled Oral Word Association Trial-S, the scores significantly increased for the Ginkgo Synergy® plus Choline arm from baseline to 6 months follow-up (mean difference = 2.1; SE = 0.8; 95% CI: 0.2, 3.9; p < 0.05) and for the OPC Synergy® plus Catalyn® arm from baseline to 3 months follow-up (mean difference = 2.1; SE = 0.8; 95% CI: 0.2, 4.0; p < 0.05). Epidermal growth factor significantly decreased from baseline to 6 months follow-up for the Ginkgo Synergy® plus Choline arm (mean difference = 120.7; SE = 28.4; 95% CI: 62.6, 178.8; p < 0.001).

Conclusions

Our study showed isolated and modest effects of a Ginkgo biloba plus choline-based formula on cognitive and immune functioning among healthy older adults with no history of significant cognitive deficits. Our trial was registered with clinicaltrials.gov (ID: NCT01672359). This study was supported by a grant from Standard Process, Inc.

Comparing the accuracy of ES-BC, EIS-GS, and ES Oxi on body composition, autonomic nervous system activity, and cardiac output to standardized assessments

BACKGROUND AND PURPOSE

THE ELECTRO SENSOR COMPLEX (ESC) IS SOFTWARE THAT COMBINES THREE DEVICES USING BIOELECTRICAL IMPEDANCE, GALVANIC SKIN RESPONSE, AND SPECTROPHOTOMETRY: (1) ES-BC (Electro Sensor-Body Composition; LD Technology, Miami, FL) to assess body composition, (2) EIS-GS (Electro Interstitial Scan-Galvanic Skin; LD Technology) to predict autonomic nervous system activity, and (3) ES Oxi (Electro Sensor Oxi; LD Technology) to assess cardiac output. The objective of this study was to compare each to a standardized assessment: ES-BC to dual-energy X-ray absorptiometry (DXA), EIS-GS to heart rate variability, and ES Oxi to BioZ Dx Diagnostic System (BioZ Dx; SonoSite Inc, Bothell, WA).

PATIENTS AND METHODS

The study was conducted in two waves. Fifty subjects were assessed for body composition and autonomic nervous system activity. Fifty-one subjects were assessed for cardiac output.

RESULTS

We found adequate relative and absolute agreement between ES-BC and DXA for fat mass (r = 0.97, P < 0.001) with ES-BC overestimating fat mass by 0.1 kg and for body fat percentage (r = 0.92, P < 0.001) with overestimation of fat percentage by 0.4%. For autonomic nervous system activity, we found marginal relative agreement between EIS-GS and heart rate variability by using EIS-GS as the predictor in a linear regression equation (adjusted R(2) = 0.56, P = 0.03). For cardiac output, adequate relative and absolute agreement was found between ES Oxi and BioZ Dx at baseline (r = 0.60, P < 0.001), after the first exercise stage (r = 0.79, P < 0.001), and after the second exercise stage (r = 0.86, P < 0.001). Absolute agreement was found at baseline and after both bouts of exercise; ES Oxi overestimated baseline and stage 1 exercise cardiac output by 0.3 L/minute and 0.1 L/minute, respectively, but exactly estimated stage 2 exercise cardiac output.

CONCLUSION

ES-BC and ES Oxi accurately assessed body composition and cardiac output compared to standardized instruments, whereas EIS-GS showed marginal predictive ability for autonomic nervous system activity. The ESC software managing the three devices would be useful to help detect complications related to metabolic syndrome, diabetes, and cardiovascular disease and to noninvasively and rapidly manage treatment follow-up.

The challenge of educating physicians about complementary and alternative medicine

The rapid growth of complementary/alternative medicine (CAM) predated both the 1992 establishment of the Office of Alternative Medicine at the National Institutes of Health and the release of Dr. David Eisenberg's 1993 groundbreaking article on the widespread use of CAM. Since these two watershed events, the use of nontraditional medical modalities has seen exponential expansion. Most physicians are not prepared to respond knowledgeably about CAM modalities, and, indeed, sorting out the viable CAM modalities can be a difficult task. Additional factors are poor and inadequate dialogue between physicians and CAM practitioners, doubts about CAM practitioners' competence, a lack of readily identifiable and recognizable qualifications of such practitioners, and the risk of offering unrealistic hope of a cure. All these factors place the patient in a sometimes perilously uncertain position. Incorporating systematic presentation of CAM information into the curricula of medical schools would provide future physicians the necessary tools and knowledge to enable their patients to use CAM modalities appropriately, with limited risks.

Acupuncture therapy for the symptoms of Parkinson's disease

Interest in alternative medical treatments, including acupuncture, is increasing. Alternative treatments must be subjected to the same objective standards as all medical treatments. A non-blinded pilot study of the safety, tolerability, and efficacy of acupuncture (ACUPX) for the symptoms of (PD) was performed. Twenty PD patients (mean age, 68 years; disease duration, 8.5 years; Hoehn and Yahr [H&Y] stage, 2.2; Unified Parkinson's Disease Rating Scale score [UPDRS], 38.7) each received acupuncture treatments by a licensed acupuncturist. All patients were treated with two acupuncture treatment sessions per week. The first seven patients received 10 treatments and the last 13 patients 16 treatments. Patients were evaluated before and after ACUPX with the Sickness Impact Profile (SIP); UPDRS; H & Y; Schwab and England (S & E); Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI); quantitative motor tests, including timed evaluations of arm pronation supination movements, finger dexterity, finger movements between two fixed measured points, and the stand-walk-sit test; and a patient questionnaire designed for the study. Following ACUPX, there were no significant changes in the UPDRS, H&Y, S&E, BAI, BDI, quantitative motor tests, total SIP or the two SIP Dimension scores. Analysis of the 12 SIP categories not corrected for multiple comparisons revealed a post-ACUPX improvement in the sleep and rest category only (P = 0.03). On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. ACUPX therapy is safe and well tolerated in PD patients. A range of PD and behavioral scales failed to show improvement following ACUPX other than sleep benefit, although patients reported other discrete symptomatic improvements. A broad battery of tests in PD patients suggested that ACUPX resulted in improvement of sleep and rest only. This finding needs to be verified using more in-depth and controlled evaluation of ACUPX for PD-related sleep disturbance.

Acupuncture for the treatment of cocaine addiction: a randomized controlled trial

CONTEXT

Auricular acupuncture is widely used to treat cocaine addiction in the United States and Europe. However, evidence from controlled studies regarding this treatment's effectiveness has been inconsistent.

OBJECTIVE

To investigate the effectiveness of auricular acupuncture as a treatment for cocaine addiction.

DESIGN

Randomized, controlled, single-blind clinical trial conducted from November 1996 to April 1999.

SETTING

Six community-based clinics in the United States: 3 hospital-affiliated clinics and 3 methadone maintenance programs.

PATIENTS

Six hundred twenty cocaine-dependent adult patients (mean age, 38.8 years; 69.2% men); 412 used cocaine only and 208 used both opiates and cocaine and were receiving methadone maintenance.

INTERVENTION

Patients were randomly assigned to receive auricular acupuncture (n = 222), a needle-insertion control condition (n = 203), or a relaxation control condition (n = 195). Treatments were offered 5 times weekly for 8 weeks. Concurrent drug counseling was also offered to patients in all conditions.

MAIN OUTCOME MEASURES

Cocaine use during treatment and at the 3- and 6-month postrandomization follow-up based on urine toxicology screens; retention in treatment.

RESULTS

Intent-to-treat analysis of urine samples showed a significant overall reduction in cocaine use (odds ratio, 1.40; 95% confidence interval, 1.11-1.74; P =.002) but no differences by treatment condition (P =.90 for acupuncture vs both control conditions). There were also no differences between the conditions in treatment retention (44%-46% for the full 8 weeks). Counseling sessions in all 3 conditions were poorly attended.

CONCLUSIONS

Within the clinical context of this study, acupuncture was not more effective than a needle insertion or relaxation control in reducing cocaine use. Our study does not support the use of acupuncture as a stand-alone treatment for cocaine addiction or in contexts in which patients receive only minimal concurrent psychosocial treatment. Research will be needed to examine acupuncture's contribution to addiction treatment when provided in an ancillary role.

Social anxiety and training in neurolinguistic programming

The Liebowitz Social Phobia Scale measured the effect of training on social anxiety responses of 28 adults prior to and following a 21-day residential training, and at 6 mo. follow-up. Significant reductions posttraining and at follow-up were evident in the mean self-reported global scale scores on fear and avoidance behavior in social situations. The item scores, aggregated to reflect the situational domains of formal and informal speaking, being observed by others, and assertion, showed significant and continuing reduction from posttraining through follow-up. These findings are consistent with the hypothesis that this training may be associated with reduced responses to social anxiety, but as there was no formal control group, pretest scores from another study were used. Interpretation is limited.

The impact of the addition of an acupuncture treatment program to an existing metro-Dade County outpatient substance abuse treatment facility

There are several varieties of treatment facilities and modalities for dealing with substance abuse. In this study, the addition of acupuncture treatments to the usual care program at an existing county-based substance abuse treatment clinic was tested. Men and women who voluntarily attended the clinic or who were remanded by the court to attend were randomized to receive usual care, usual care plus frequent urine testing, or usual care plus frequent urine testing and acupuncture treatments. Clients who received acupuncture treatments in addition to the usual care and frequent urine testing became clean (as measured by negative urine tests) in 57% of the time required for the frequent urine testing group. Difficulties experienced included low counselor compliance with the protocol and a high drop-out rate, indicating that further research is necessary; however, this study demonstrates that acupuncture can be a feasible and effective addition to existing drug treatment programs.

Neurolinguistic programming training, trait anxiety, and locus of control

Training in the neurolinguistic programming techniques of shifting perceptual position, visual-kinesthetic dissociation, timelines, and change-history, all based on experiential cognitive processing of remembered events, leads to an increased awareness of behavioral contingencies and a more sensitive recognition of environmental cues which could serve to lower trait anxiety and increase the sense of internal control. This study reports on within-person and between-group changes in trait anxiety and locus of control as measured on the Spielberger State-Trait Anxiety Inventory and Wallston, Wallston, and DeVallis' Multiple Health Locus of Control immediately following a 21-day residential training in neurolinguistic programming. Significant with-in-person decreases in trait-anxiety scores and increases in internal locus of control scores were observed as predicted. Chance and powerful other locus of control scores were unchanged. Significant differences were noted on trait anxiety and locus of control scores between European and U.S. participants, although change scores were similar for the two groups. These findings are consistent with the hypothesis that this training may lower trait-anxiety scores and increase internal locus of control scores. A matched control group was not available, and follow-up was unfortunately not possible.

Effect of neurolinguistic programming training on self-actualization as measured by the Personal Orientation Inventory

Neurolinguistic programming training is based on principles that should enable the trainee to be more "present"-oriented, inner-directed, flexible, self-aware, and responsive to others, that is, more self-actualized. This study reports within-person changes on self-actualization measures of the Personal Orientation Inventory following a 24-day residential training in neurolinguistic programming. Significant positive mean changes were found for 18 master practitioners on nine of the 12 scales and for 36 practitioners on 10 of the 12 scales. Findings are consistent with the hypothesis that training increases individual self-actualization scores.

Thermoradiotherapy of malignant melanoma

From 1978 through February 1986, 49 measurable lesions in 18 patients with recurrent primary or metastatic malignant melanomas were treated with a combination of radiation therapy and hyperthermia. The primary sites were head and neck (eight), chest wall (two), pelvis (one), upper extremities (three), and lower extremities (35). Because of the length of the study, the dose and fractionation of radiation therapy varied (dose per fraction from less than 400 cGy to 800 cGy and a total dose of 2000 cGy to 6000 cGy). This variation was mostly dependent on the prior course of radiation therapy of these lesions. The hyperthermia technique used in these patients was superficial local microwave hyperthermia; a minority of patients were treated with ultrasound. Complete response was achieved in 29 lesions (59.2 per cent) and partial response in six lesions (12 per cent). In a separate analysis of 67 lesions with superficial malignant melanoma who were treated by radiation therapy alone, a 24 per cent complete response and a 34 per cent partial response were achieved. Detailed analyses are presented in regard to dose per fraction, total radiation dose, and the size of lesions.

Comparison of plasma cholinesterase depression among workers occupationally exposed to organophosphorus pesticides as reported by various studies

A number of studies have reported on the inhibitory effects of organophosphorus pesticides (OPs) on the enzyme cholinesterase (ChE) among agricultural workers. With the increasing use of OPs, surveys of blood ChE activity on exposed workers may help to identify workers at greatest risk and to provide insight into the use history--e.g., mixing, loading, application, and harvesting--that might lead to a hazardous situation. Although it does appear that measurements of ChE activity are valuable in worker surveillance programs, it is difficult to interpret findings from various studies since they are dependent on the method of assay and the emphasis is usually placed on statistical tests (i.e., p values) that depend on the number of subjects studied. In the present paper a method is presented to compare ChE values reported in several studies utilizing various methods and units of measurement, and to assess the impact of OP exposure as a percentage of subjects with ChE values depressed below normal limits.

Children's use of four semantic cases in tow conditions

The production of agent + action + object + locative relations by 3;6- and 5;6-yr-old normal children and language-disordered children was investigated These utterances were produced after children observed object manipulation or while copying object manipulation. The results indicated a developmental trend in the use of case relations. The manipulation task enhanced the use of case relations by the language-disordered group, whereas the observation task was more effective (or equally effective) for the normal groups.