The effect of bolus advisors on glycaemic parameters in adults with diabetes on intensive insulin therapy: A systematic review with meta-analysis

AIM

To conduct a systematic review with meta-analysis to provide a comprehensive synthesis of randomized controlled trials (RCTs) and prospective cohort studies investigating the effects of currently available bolus advisors on glycaemic parameters in adults with diabetes.

MATERIALS AND METHODS

An electronic search of PubMed, Embase, CINAHL, Cochrane Library and ClinicalTrials.gov was conducted in December 2022. The risk of bias was assessed using the revised Cochrane Risk of Bias tool. (Standardized) mean difference (MD) was selected to determine the difference in continuous outcomes between the groups. A random-effects model meta-analysis and meta-regression were performed. This systematic review was registered on PROSPERO (CRD42022374588).

RESULTS

A total of 18 RCTs involving 1645 adults (50% females) with a median glycated haemoglobin (HbA1c) concentration of 8.45% (7.95%-9.30%) were included. The majority of participants had type 1 diabetes (N = 1510, 92%) and were on multiple daily injections (N = 1173, 71%). Twelve of the 18 trials had low risk of bias. The meta-analysis of 10 studies with available data on HbA1c showed that the use of a bolus advisor modestly reduced HbA1c compared to standard treatment (MD -011%, 95% confidence interval -0.22 to -0.01; I2 = 0%). This effect was accompanied by small improvements in low blood glucose index and treatment satisfaction, but not with reductions in hypoglycaemic events or changes in other secondary outcomes.

CONCLUSION

Use of a bolus advisor is associated with slightly better glucose control and treatment satisfaction in people with diabetes on intensive insulin treatment. Future studies should investigate whether personalizing bolus advisors using artificial intelligence technology can enhance these effects.

Perampanel as precision therapy in rare genetic epilepsies

OBJECTIVE

Perampanel, an antiseizure drug with α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist properties, may have a targeted effect in genetic epilepsies with overwhelming glutamate receptor activation. Epilepsies with loss of γ-aminobutyric acid inhibition (e.g., SCN1A), overactive excitatory neurons (e.g., SCN2A, SCN8A), and variants in glutamate receptors (e.g., GRIN2A) hold special interest. We aimed to collect data from a large rare genetic epilepsy cohort treated with perampanel, to detect possible subgroups with high efficacy.

METHODS

This multicenter project was based on the framework of NETRE (Network for Therapy in Rare Epilepsies), a web of pediatric neurologists treating rare epilepsies. Retrospective data from patients with genetic epilepsies treated with perampanel were collected. Outcome measures were responder rate (50% seizure reduction), and percentage of seizure reduction after 3 months of treatment. Subgroups of etiologies with high efficacy were identified.

RESULTS

A total of 137 patients with 79 different etiologies, aged 2 months to 61 years (mean = 15.48 ± 9.9 years), were enrolled. The mean dosage was 6.45 ± 2.47 mg, and treatment period was 2.0 ± 1.78 years (1.5 months-8 years). Sixty-two patients (44.9%) were treated for >2 years. Ninety-eight patients (71%) were responders, and 93 (67.4%) chose to continue therapy. The mean reduction in seizure frequency was 56.61% ± 34.36%. Sixty patients (43.5%) sustained >75% reduction in seizure frequency, including 38 (27.5%) with >90% reduction in seizure frequency. The following genes showed high treatment efficacy: SCN1A, GNAO1, PIGA, PCDH19, SYNGAP1, POLG1, POLG2, and NEU1. Eleven of 17 (64.7%) patients with Dravet syndrome due to an SCN1A pathogenic variant were responders to perampanel treatment; 35.3% of them had >90% seizure reduction. Other etiologies remarkable for >90% reduction in seizures were GNAO1 and PIGA. Fourteen patients had a continuous spike and wave during sleep electroencephalographic pattern, and in six subjects perampanel reduced epileptiform activity.

SIGNIFICANCE

Perampanel demonstrated high safety and efficacy in patients with rare genetic epilepsies, especially in SCN1A, GNAO1, PIGA, PCDH19, SYNGAP1, CDKL5, NEU1, and POLG, suggesting a targeted effect related to glutamate transmission.

Environmental testing for SARS-CoV-2 in three tertiary-care hospitals during the peak of the third COVID-19 wave

Contamination of surfaces has been implicated in transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We tested by real-time PCR for SARS-CoV-2 contamination environmental samples from three hospitals during the peak of the third pandemic wave. Overall, 19 of 463 (4.1%) samples tested positive: 12 of 173 (6.9%) samples from a COVID-19 hospital, 3 of 177 (1.7%) samples from a non-COVID-19 hospital, and 4 of 113 (3.5%) samples from a pediatric hospital with dedicated COVID-19 clinics. Most positive samples originated from emergency departments (EDs) (47.3%) and the intensive care units (ICUs) (26.3%) of the COVID-19 hospital. Positive samples belonged almost exclusively (18/19) to the highly transmissible B.1.1.7 cluster, that might explain environmental contamination at this stage of the pandemic. The frequency and efficiency of disinfection in high-risk patient areas, such as EDs and ICUs, should be reinforced, especially during this period where highly transmissible variants of concern are widespread.

The aging brain: sleep, the circadian clock and exercise

Aging is a multifactorial process likely stemming from damage accumulation and/or a decline in maintenance and repair mechanisms in the organisms that eventually determine their lifespan. In our review, we focus on the morphological and functional alterations that the aging brain undergoes affecting sleep and the circadian clock in both human and rodent models. Although both species share mammalian features, differences have been identified on several experimental levels, which we outline in this review. Additionally, we delineate some challenges on the preferred analysis and we suggest that a uniform route is followed so that findings can be smoothly compared. We conclude by discussing potential interventions and highlight the influence of physical exercise as a beneficial lifestyle intervention, and its effect on healthy aging and longevity. We emphasize that even moderate age-matched exercise is able to ameliorate several aging characteristics as far as sleep and circadian rhythms are concerned, independent of the species studied.

Sleep Network Deterioration as a Function of Dim-Light-At-Night Exposure Duration in a Mouse Model

Artificial light, despite its widespread and valuable use, has been associated with deterioration of health and well-being, including altered circadian timing and sleep disturbances, particularly in nocturnal exposure. Recent findings from our lab reveal significant sleep and sleep electroencephalogram (EEG) changes owing to three months exposure to dim-light-at-night (DLAN). Aiming to further explore the detrimental effects of DLAN exposure, in the present study, we continuously recorded sleep EEG and the electromyogram for baseline 24-h and following 6-h sleep deprivation in a varied DLAN duration scheme. C57BL/6J mice were exposed to a 12:12 h light:DLAN cycle (75lux:5lux) vs. a 12:12 h light:dark cycle (75lux:0lux) for one day, one week, and one month. Our results show that sleep was already affected by a mere day of DLAN exposure with additional complications emerging with increasing DLAN exposure duration, such as the gradual delay of the daily 24-h vigilance state rhythms. We conducted detrended fluctuation analysis (DFA) on the locomotor activity data following 1-month and 3-month DLAN exposure, and a significantly less healthy rest-activity pattern, based on the decreased alpha values, was found in both conditions compared to the control light-dark. Taking into account the behavioral, sleep and the sleep EEG parameters, our data suggest that DLAN exposure, even in the shortest duration, induces deleterious effects; nevertheless, potential compensatory mechanisms render the organism partly adjustable and able to cope. We think that, for this reason, our data do not always depict linear divergence among groups, as compared with control conditions. Chronic DLAN exposure impacts the sleep regulatory system, but also brain integrity, diminishing its adaptability and reactivity, especially apparent in the sleep EEG alterations and particular low alpha values following DFA.

An objective and automated method for evaluating abdominal hyperalgesia in a rat model for endometriosis

Chronic pain and subfertility are the main symptoms of concern in women with endometriosis. In order to find new therapeutic options to suppress the pain, translational animal models are indispensable. We have developed a new automated, experimental setup, with full consideration for animal wellbeing, to determine whether operant behaviour can reveal abdominal hyperalgesia in rats with surgically-induced endometriosis, in order to assess whether abdominal hyperalgesia affect behavioural parameters. Endometriosis was induced by transplantation of uterine fragments in the abdominal cavity. Control groups consisted of sham-operated rats and non-operated rats. We have developed an operant chamber (Skinnerbox) which includes a barrier. The rat can climb the barrier in order to reach the food pellet, increasing in this way the pressure to the abdomen. We show that endometriosis rats collect significantly less sugar pellets when compared with the control rats after the introduction of the barrier. In the Skinnerbox experiment, we showed that in a positive operant setting, the introduction of a barrier results in a contrast of operant behaviour of endometriosis rats and control groups, perchance as a result of abdominal discomfort/hyperalgesia due to surgically-induced endometriosis. This is a promising start for the further development of a refined animal model to monitor abdominal discomfort/hyperalgesia in rats with surgically-induced endometriosis.

Chronic high-caloric diet accentuates age-induced sleep alterations in mice

Obesity and sleep disturbances comprise major health problems which are likely interrelated. Diet-induced obesity in young mice has been demonstrated to lead towards an altered sleep homeostasis. In the current study, we investigated the effect of chronic (12 weeks) high-caloric diet (HCD, 45% fat) consumption on sleep and the sleep electroencephalogram (EEG) in young and older mice (6-month-old, n = 9; 18-month-old, n = 8 and 24-month-old, n = 4) and compared with age-matched controls on normal chow (n = 11, n = 9 and n = 9 respectively). Half of the 24-month-old mice did not cope well with HCD, therefore this group has a lower n and limited statistical power. We recorded EEG and the electromyogram for continuous 48-h and performed a 6-h sleep deprivation during the second day. In aged HCD fed mice (18 months old) compared to young, an aging effect was still evident, characterized by decreased waking and increased NREM sleep in the dark period, decreased REM sleep during the light period, as well as increased slow-wave-activity (SWA, EEG power in NREM sleep in 0.5-4.0 Hz). Additionally, aged HCD treated mice showed increased NREM sleep and decreased waking, compared to age-matched controls, denoting an enhanced aging phenotype in the sleep architecture. Notably, an overall increase was found in the slow component of SWA (0.5-2.5 Hz) in aged HCD fed mice compared to age-matched controls. Our data suggest that the effect of aging is the dominant variable irrespective of diet. However, a synergistic effect of aging and diet is noted indicating that chronic HCD consumption exacerbates age-associated sleep alterations.

Effects of chronic caffeine consumption on sleep and the sleep electroencephalogram in mice

BACKGROUND

Caffeine is one of the most widely consumed psychostimulants, and it impacts sleep and circadian physiology.

AIM

Caffeine is generally used chronically on a daily basis. Therefore, in the current study, we investigated the chronic effect of caffeine on sleep in mice.

METHODS

We recorded the electroencephalogram and electromyogram on a control day, on the first day of caffeine consumption (acute), and following two weeks of continuous caffeine consumption (chronic). In the latter condition, a period of six-hour sleep deprivation was conducted during the light period. Control mice, which received normal drinking water, were also recorded and sleep deprived.

RESULTS

We found that caffeine induced differential effects following acute and chronic consumption. Over 24 h, waking increased following acute caffeine whereas no changes were found in the chronic condition. The daily amplitude of sleep-wake states increased in both acute and chronic conditions, with the highest amplitude in the chronic condition, showing an increase in sleep during the light and an increase in waking during the dark. Furthermore, electroencephalogram slow-wave-activity in non-rapid eye-movement sleep was increased, compared with both control conditions, during the first half of the light period in the chronic condition. It was particularly challenging to keep the animals awake during the sleep deprivation period under chronic caffeine.

CONCLUSIONS

Together the data suggest an increased sleep pressure under chronic caffeine. In contrast to the traditional conception on the impact on sleep, chronic caffeine intake seems to increase the daily sleep-wake cycle amplitude and increase sleep pressure in mice.

How Old Is Your Brain? Slow-Wave Activity in Non-rapid-eye-movement Sleep as a Marker of Brain Rejuvenation After Long-Term Exercise in Mice

Physical activity is beneficial for health. It has been shown to improve brain functioning and cognition, reduce severity of mood disorders, as well as facilitate healthy sleep and healthy aging. Sleep has been studied in healthy aged mice and absolute slow-wave-activity levels (SWA, electroencephalogram power between 0.75 and 4.0 Hz) in non-rapid-eye-movement sleep (NREM) were elevated, suggesting changes in brain connectivity. To investigate whether physical activity can diminish this aging-induced effect, mice of three age groups were provided with a running wheel (RW) for 1-3 months (6-months-old, n = 9; 18-months-old, n = 9; 24-months-old, n = 8) and were compared with control sedentary mice (n = 11, n = 8 and n = 9 respectively). Two weeks before the sleep-wake recordings the running wheels were removed. The electroencephalogram (EEG) and electromyogram were continuously recorded during undisturbed 24 h baseline (BL) and a sleep-deprivation was conducted during the first 6 h of the second day. Increased waking and decreased NREM sleep was found in the young RW mice, compared to young controls. These effects were not evident in the 18 and 24 months old mice. Unlike sleep architecture, we found that SWA was altered throughout the whole age spectrum. Notably, SWA was increased with aging and attenuated with exercise, exhibiting the lowest levels in the young RW mice. To utilize the cross-age revealing features of SWA, we applied machine learning techniques and found that characteristic information regarding age and exercise was enclosed in SWA. In addition, with cluster analysis, we could classify and accurately distinguish the different groups based solely on their SWA. Therefore, our study comprises a three-fold contribution: (a) effects of exercise on sleep are sustained following 2 weeks after removal of the wheel, (b) we show that EEG SWA can be used as a physiological marker of brain age in the mouse,

Chronic high-caloric diet modifies sleep homeostasis in mice

Obesity prevalence and sleep habit changes are commonplace nowadays, due to modern lifestyle. A bidirectional relationship likely exists between sleep quality and metabolic disruptions, which could impact quality of life. In our study, we investigated the effects of a chronic high-caloric diet on sleep architecture and sleep regulation in mice. We studied the effect of 3 months high-caloric diet (HCD, 45% fat) on sleep and the sleep electroencephalogram (EEG) in C57BL/6J mice during 24-hr baseline (BL) recordings, and after 6-hr sleep deprivation (SD). We examined the effect of HCD on sleep homeostasis, by performing parameter estimation analysis and simulations of the sleep homeostatic Process S, a measure of sleep pressure, which is reflected in the non-rapid-eye-movement (NREM) sleep slow-wave-activity (SWA, EEG power density between 0.5 and 4.0 Hz). Compared to controls (n = 11, 30.7 ± 0.8 g), mice fed with HCD (n = 9, 47.6 ± 0.8 g) showed an increased likelihood of consecutive NREM-REM sleep cycles, increased REM sleep and decreased NREM sleep EEG SWA. After SD, these effects were more pronounced. The simulation resulted in a close fit between the time course of SWA and Process S in both groups. HCD fed mice had a slower time constant (T_i  = 15.98 hr) for the increase in homeostatic sleep pressure compared with controls (5.95 hr) indicating a reduced effect of waking on the increase in sleep pressure. Our results suggest that chronic HCD consumption impacts sleep regulation.

Differences in electroencephalographic non-rapid-eye movement sleep slow-wave characteristics between young and old mice

Changes in sleep pattern are typical for the normal aging process. However, aged mice show an increase in the amount of sleep, whereas humans show a decrease when aging. Mice are considered an important model in aging studies, and this divergence warrants further investigation. Recently, insights into the network dynamics of cortical activity during sleep were obtained by investigating characteristics of individual electroencephalogram (EEG) slow waves in young and elderly humans. In this study, we investigated, for the first time, the parameters of EEG slow waves, including their incidence, amplitude, duration and slopes, in young (6 months) and older (18-24 months) C57BL/6J mice during undisturbed 24 h, and after a 6-h sleep deprivation (SD). As expected, older mice slept more but, in contrast to humans, absolute NREM sleep EEG slow-wave activity (SWA, spectral power density between 0.5-4 Hz) was higher in the older mice, as compared to the young controls. Furthermore, slow waves in the older mice were characterized by increased amplitude, steeper slopes and fewer multipeak waves, indicating increased synchronization of cortical neurons in aging, opposite to what was found in humans. Our results suggest that older mice, in contrast to elderly humans, live under a high sleep pressure.

Workplace ostracism and employee silence in nursing: the mediating role of organizational identification

AIMS

The aim of this study was to examine the direct and indirect effect, through organizational identification, of workplace ostracism on nurses' silence towards patient safety.

BACKGROUND

Employee silence in nursing has recently received attention in relation to its antecedents. Yet, very little is known about the role of workplace ostracism in generating nurses' silence.

DESIGN

A cross-sectional survey was conducted in a public hospital in Cyprus.

METHOD

Data were collected from 157 nurses employed in a public hospital of Cyprus between November 2014-January 2015. To examine the present hypotheses bootstrapping analysis and Sobel test were conducted.

RESULTS

Results demonstrated that workplace ostracism has an effect on nurses' silence towards patient safety. Moreover, this effect was partially mediated through organizational identification.

CONCLUSIONS

Workplace ostracism among nurses significantly affects both nurses' attitude and behaviour namely organizational identification and employee silence.

Seven-year surveillance of emm types of pediatric Group A streptococcal pharyngitis isolates in Western Greece

Background

An experimental 26-valent M protein Group A streptococcal (GAS) vaccine has entered clinical studies. Pharyngeal GAS emm type surveillances in different areas and time-periods enhance the understanding of the epidemiology of GAS pharyngitis. Moreover, these surveillances, combined with the data on GAS invasive disease, can play a significant role in the formulation of multivalent type-specific vaccines.

Methods

During a 7-year period (1999–2005), 2408 GAS isolates were recovered from consecutive children with pharyngitis in Western Greece. The overall macrolide resistance rate was 22.8%. Along the study period we noted a tendency towards significantly decreased rates of resistance, with the lowest rates occurring in 2002 (15.3%), 2003 (15%) and 2004 (16.7%). A random sample of isolates from each year, 338 (61.7%) of the 548 macrolide-resistant and 205 (11%) of the macrolide-susceptible, underwent molecular analysis, including emm typing.

Results

The 543 typed isolates had 28 different emm types. A statistically significant association was found between macrolide resistance and emm4, emm22 and emm77, whereas emm1, emm3, emm6, emm12, emm87 and emm89 were associated with macrolide susceptibility. A significant yearly fluctuation was observed in emm4, emm28 and emm77. The most common macrolide-resistant GAS were emm77 isolates harboring erm(A), either alone or in combination with mef(A), emm4 carrying mef(A), emm28 possessing erm(B), emm75 carrying mef(A), emm12 harboring mef(A) and emm22 carrying erm(A). We estimated that 82.8% of the isolates belonged to emm types included in the novel 26-valent M protein vaccine. The vaccine coverage rate was determined mainly by the increased frequency of nonvaccine emm4 isolates.

Conclusions

A limited number of emm types dominated among macrolide-susceptible and macrolide-resistant GAS isolates. We observed seasonal fluctuations, which were significant for emm4, emm28 and emm77. This type of data can serve as baseline information if the novel 26-valent M protein GAS vaccine is introduced into practice.

Saving space for less invasive direct-vision, mitral valve surgery with altered cannulation protocol

Saving vital space in less invasive cardiac surgery is of great importance, especially in mitral valve surgery which is sometimes difficult, even with the full sternotomy approach. We present a modification of the venous cannulation protocol we use in less invasive, direct-vision mitral valve surgery through a half-lower partial sternotomy. The superior vena cava is drained with a right jugular vein cannula. For inferior vena cava drainage we use an oval venous cannula which is exteriorized through another small skin incision. These modifications, together with the use of a smaller diameter aortic cannula, provide vital space for surgical maneuvers through a small (810 cm) skin incision.