Subclinical affective and cognitive fluctuations in Parkinson's disease: a randomized double-blind double-dummy study of Oral vs. Intrajejunal Levodopa

Journal of Neurology - Chronic levodopa treatment in Parkinson’s disease (PD) may promote undesirable motor and non-motor fluctuations. Compared to chronic oral levodopa treatment, continuous...     

Head-to-head comparison between the EQ-5D-5L and the EQ-5D-3L in general population health surveys

Background

The EQ-5D has been frequently used in national health surveys. This study is a head-to-head comparison to assess how expanding the number of levels from three (EQ-5D-3L) to five in the new EQ-5D-5L version has improved its distribution, discriminatory power, and validity in the general population.

Methods

A representative sample (N?=?7554) from the Catalan Health Interview Survey 2011–2012, aged ≥18, answered both EQ-5D versions, and we evaluated the response redistribution and inconsistencies between them. To assess validity of this redistribution, we calculated the mean of the Visual Analogue Scale (VAS), which measures perceived health. The discriminatory power was examined with Shannon Indices, calculated for each dimension separately. Spanish preference value sets were applied to obtain utility indices, examining their distribution with statistics of central tendency and dispersion. We estimated the proportion of individuals reporting the best health state in EQ-5D-5L and EQ-5D-3L within groups of specific chronic conditions and their VAS mean.

Results

A very small reduction in the percentage of individuals with the best health state was observed, from 61.8% in EQ-5D-3L to 60.8% in EQ-5D-5L. In contrast, a large proportion of individuals reporting extreme problems in the 3 L version moved to severe problems (level 4) in the 5 L version, particularly for pain/discomfort (75.5%) and anxiety/depression (66.4%). The average proportion of inconsistencies was 0.9%. The pattern of the perceived health VAS mean confirmed the hypothesis established a priori, supporting the validity of the observed redistribution. Shannon index showed that absolute informativity was higher in the 5 L version for all dimensions. The means (SD) of the Spanish EQ-5D-3L and EQ-5D-5L indices were 0.87 (0.25) and 0.89 (0.22). The proportion of individuals with the best health state within each specific chronic condition was very similar, regardless of the EQ-5D version (≤?30% in half of the 28 chronic conditions).

Conclusion

Although the proportion of individuals with the best possible health state is still very high, our findings support that the increase of levels provided by the EQ-5D-5L contributed to the validity and discriminatory power of this new version to measure health in general population, as in the national health surveys.

     

Effect of Court Dimensions on Players’ External and Internal Load during Small-Sided Handball Games

The aim of this study was to investigate the effect of three different court dimensions on the internal and external load during small-sided handball games. Six male amateur handball players took part in this study and participated in three different 8-min 3vs3 (plus goalkeepers) small-sided handball games (each repeated twice). The three court dimensions were 12×24m, 30×15m and 32×16m. Through Global Positioning System devices (SPI pro elite 15Hz, GPSports) and video analysis, the following parameters were recorded: cyclic and acyclic movements (distance covered and number of technical actions executed), heart rate, and rating of perceived exertion (RPE). Total distance travelled increased with court dimensions (885.2m ± 66.6m in 24×12m; 980.0m ± 73.4m in 30×15m; 1095.0m ± 112.9m in 32×16m, p < 0.05). The analysis of distance covered in the four speed zones (0–1.4 m·s^-1; 1.4–3.4 m·s^-1; 3.4–5.2 m·s^-1; >5.2 m·s^-1) highlighted substantial differences: playing with the 30×15m court in comparison to the 24×12m, the players covered less distance in the first speed zone (p = 0.012; ES = 0.70) and more distance in the second (p = 0.049; ES = 0.73) and third (p = 0.012; ES = 0.51) speed zones. Statistical differences were also found between the 24×12m and 32×16m courts: the players covered more distance in the second and third speed zones (p = 0.013, ES = 0.76; p = 0.023 ES = 0.69) with the 32×16m court in comparison to the 24×12m. There was no significant effect of court dimensions on the technical parameters (number of team actions, passes, piston movements toward goal and defensive activities), the number of specific handball jumps and changes of direction, and the time spent in the different heart rate zones. Considering the average data of all the experimental conditions together (24×12m, 30×15m, 32×16m), a pronounced statistical difference was highlighted between the values in first two HR zones and the last two (p < 0.05; large ES). The rating of perceived exertion was significantly higher during the drill with the 32×16m court compared with the 24×12m one (p < 0.05; ES = 2.34). Our findings indicate that changing court dimensions during small-sided handball games can be used to manipulate both external and internal loads on the players.

Key points

• To cover the specific game demands, more specific training methodologies have been developed in many sport games.
• Specific game exercises may provide a useful conditioning stimulus, together with technical and tactical training components.
• Changing court dimensions during small-sided handball games can be used to manipulate both external and internal loads on the players.
• The high ratio of cyclic activity per minute and the high HR values recorded during SSHGs make this type of drills extremely useful for aerobic power training.

Key Words: Handball, sport-specific training, video analysis, Global Positioning System (GPS)     

Human CMV‐specific T‐cell responses in kidney transplantation; toward changing current risk‐stratification paradigm

Despite the great efficacy of current antiviral preventive strategies, hCMV infection is still a major complication after renal transplantation, significantly challenging patient and graft survival. This issue seems to be explained because of the rather poor immunologic monitoring of the antiviral immune response. An important body of evidence has shown that monitoring the hCMV‐specific T‐cell response, at different time points of the transplant setting, seems to add crucial information for predicting the risk of viral infection, thus potentially helping individualization of therapeutic decision‐making in clinical transplantation. While several immune‐cellular assays have shown its capability for accurately monitoring hCMV‐specific T‐cell responses, only few such as the IFN‐γ ELISPOT and the ELISA based technology assays might be reliable for its application in the clinic. Nonetheless, an important effort has to be made among the transplant community to standardize and validate such immune assays. Noteworthy, large‐scale prospective randomized trials are highly warranted to ultimately introduce them in current clinical practice as a part of the highly desired personalized medicine.     

Validation of a questionnaire to evaluate the quality of life of nonprofessional caregivers of dependent persons

AIM OF THE STUDY: To determine the acceptance, validity and reliability of the questionnaire for assessing the type of informal care that caregivers of dependent people give and the effects this care might have on the health of the carer. BACKGROUND: In Spain, the formal health care system provides 12% of the total time dedicated to health care, the remaining 88% is carried out by the informal system within the home environment. The act of caring has effects on various areas of the life of the carer and on family functioning. This makes clear the existing risk when the principal carer becomes a secondary nurse. METHODS: This research was a cross-sectional design, carried out in municipalities in the province of Barcelona (Spain) from January to December 1997. The subjects of the study were 240 caregivers of dependent people. The questionnaire (ICUB97Copyright ) is based on the Virginia Henderson's 14 Needs nursing model. The validity of the content was assessed through the consensus of a group of experts, validity of design by means of comparison with the hypotheses. RESULTS: Test-retest reliability was completed for the three parts of the questionnaire and the kappa index values was 0.89, 0.80 and 0.75 for each part. The higher the level of dependency of the person cared for, the more care tasks the carer had to perform. A correlation coefficient of 0.58 was obtained for the Barthel Index (P < 0.001) and 0.53 on the Philadelphia Index (P < 0.001). The care tasks performed by the carer showing greatest correlation with dependency level were; help with elimination (r=0.73, P < 0.001), help with feeding (r=0.55, P < 0.001) and help in personal development (r=0.55, P=0.001). CONCLUSIONS: This questionnaire provides a reliable and valid instrument for measuring the care given by caregivers to dependent people, to meet their basic needs as well as for assessing the needs of the carers who experience problems by the act of caring. It is therefore important for nursing practice, to have a validated instrument available for identifying the tasks performed by family carers and the effects on their health.     

Bilateral hydrosalpinx in patients with Hirschsprung’s disease

Purpose

Hirschsprung's disease (HD) is uncommon in females. There are very few reports on the patients' obstetric and gynecological outcome. Hydrosalpinx causes pain and infertility. It is rare in nonsexually active teenagers. It may be because of an intrinsic disease of the fallopian tubes or secondary to surgery. Aim: to describe the relationship between hydrosalpinx and HD or its surgical approach; to report the impact of bilateral hydrosalpinx on fertility in HD.

Induction of suppressive allogeneic regulatory T cells via rabbit antithymocyte polyclonal globulin during homeostatic proliferation in rat kidney transplantation

Experimental studies have shown that rabbit antithymocyte polyclonal globulin (ATG) can expand human CD4+CD25++Foxp3+ cells (Tregs). We investigated the major biological effects of a self‐manufactured rabbit polyclonal anti‐rat thymoglobulin (rATG) in vitro, as well as its effects on different peripheral T‐cell subsets. Moreover, we evaluated the allogeneic suppressive capacity of rATG‐induced Tregs in an experimental rat renal transplant model. Our results show that rATG has the capacity to induce apoptosis in T lymphocyte lymphocytes as a primary mechanism of T‐cell depletion. Our in vivo studies demonstrated a rapid but transient cellular depletion of the main T cell subsets, directly proportional to the rATG dose used, but not of the effector memory T cells, which required significantly higher rATG doses. After rATG administration, we observed a significant proliferation of Tregs in the peripheral blood of transplanted rats, leading to an increase in the Treg/T effector ratio. Importantly, rATG‐induced Tregs displayed a strong donor‐specific suppressive capacity when assessed in an antigen‐specific allogeneic co‐culture. All of these results were associated with better renal graft function in rats that received rATG. Our study shows that rATG has the biological capacity immunomodulatory to promote a regulatory alloimmune milieu during post‐transplant homeostatic proliferation.     

COVID‐19: A global transplant perspective on successfully navigating a pandemic

The COVID‐19 pandemic has rapidly evolved and changed our way of life in an unprecedented manner. The emergence of COVID‐19 has impacted transplantation worldwide. The impact has not been just restricted to issues pertaining to donors or recipients, but also health‐care resource utilization as the intensity of cases in certain jurisdictions exceeds available capacity. Here we provide a personal viewpoint representing different jurisdictions from around the world in order to outline the impact of the current COVID‐19 pandemic on organ transplantation. Based on our collective experience, we discuss mitigation strategies such as donor screening, resource planning, and a staged approach to transplant volume considerations as local resource issues demand. We also discuss issues related to transplant‐related research during the pandemic, the role of transplant infectious diseases, and the influence of transplant societies for education and disseminating current information.