OCS-01 (Novel Topical Dexamethasone Formulation) in Inflammation and Pain Post Cataract Surgery: A Randomized,Double-Masked,Vehicle-Controlled Study

PurposeThe goal of this study was to compare topical dexamethasone 1.5% in a novel formulation (OCS-01) once daily and BID versus vehicle for the treatment of inflammation and pain after cataract surgery.MethodsThis was a Phase II, double-masked, vehicle-controlled, randomized multicenter study. Adult patients with planned unilateral uncomplicated cataract surgery were randomized to receive OCS-01 once daily (n = 51), OCS-01 BID (n = 51), or matching vehicle (n = 51) for 15 days postsurgery. Primary end points were absence of anterior chamber cells (ACC; cells = 0) at Day 15 and absence of pain (score of “0”) at postoperative Day 4. The Pearson χ² test with a two-sided alpha = 0.1 was used to compare treatments. Safety was assessed in terms of adverse events and changes in intraocular pressure.FindingsTreatment arms were generally similar in their baseline characteristics, with mean age ranging from 66 to 68 years, the proportion of male patients ranging from 29% to 37%, and 82% to 92% of each arm being White. On Day 15, a greater reduction in the percentage of eyes with ACC grade 0 was observed in the OCS-01 once daily (51%) and BID (66.7%) arms than in the vehicle arm (19.6%) (P = 0.0009 and P < 0.0001, respectively, using a Pearson χ² test). On Day 4, the percentage of eyes with no pain was 72.5% (OCS-01 once daily), 62.7% (OCS-01 BID), and 45.1% (vehicle); statistical significance was reached for OCS-01 once daily (P = 0.005) and OCS-01 BID (P = 0.074) compared with vehicle. OCS-01 was well tolerated. A higher proportion of treatment-emergent adverse events, including ocular adverse events, were reported for the placebo group than for either OCS-01 group.ImplicationsOCS-01 once daily and BID were more effective than vehicle and well tolerated in the treatment of inflammation and pain after cataract surgery. ClinicalTrials.gov identifier: NCT04130802.     

Quantifying the effect of hand preference on upper limb bone mineral and soft tissue composition in young and elderly women by dual-energy X-ray absorptiometry

Summary. The purpose of this study was to quantify the effect that hand preference has on upper limb bone mineral and soft tissue composition in healthy young and elderly women. Bone mineral content (BMC) in grams, bone mineral density (BMD) in g cm^-2, fat-free soft tissue (FFST) in grams, fat tissue (g), and percent fat were determined by dual-energy X-ray absorptiometry (DXA) for dominant and non-dominant upper limbs as well as total body fat (%) in 25 young (26–6 ± 4–3 years, mean ± SD) and 35 elderly women (68–4 ± 2–9 years). For both groups, the dominant upper limb had a greater BMC (P<0–001), BMD (young, P<0001; elderly, P<0–05), and FFST mass (P<0–001), and a lower percent fat (young, P<0–01; elderly, P<0–05) than the non-dominant limb; however, there was no difference between limbs for total fat mass. BMC, BMD, and FFST in the dominant limb of young women were 7–1%, 1–8%, and 5–1% greater than the non-dominant limb, while for older women the differences were 5–3%, 10%, and 4–2%. Relative fat of the dominant limb was 3–0% and 1 -3% less than the non-dominant limb for young and older women, respectively. Age did not affect the percent bone mineral or soft tissue difference. A higher bone mineral and FFST mass in the dominant limb is expected due to the greater activity demands placed upon these tissues. However, a larger bone and FFST mass increases the total mass of the dominant limb, resulting in a dilution of the fat tissue mass and hence a reduced fat percent for the limb. This study indicates that hand preference affects the tissue composition of the upper limb in both young and elderly women, resulting in an increased bone mineral and FFST mass with no change in absolute fat mass. Hand preference should be taken into account when upper limb bone mineral and/or soft tissue composition is assessed.     

The Effect of a Moderately Restricted Carbohydrate Diet on Cardiometabolic Risk Factors in Overweight and Obese Women With Metabolic Syndrome: A Randomized Controlled Trial

PurposeMetabolic syndrome (MetS) is a major public health concern that increases the risk of cardiovascular disease and mortality. In previous studies of MetS management, low-carbohydrate diets have been strongly emphasized, despite the fact that many apparently healthy individuals have difficulties adhering to these diets on a long-term basis. The purpose of the present study was to elucidate the effects of a moderately restricted carbohydrate diet (MRCD) on cardiometabolic risk factors in women with MetS.MethodsThis parallel 3-month, single-blind randomized controlled trial was conducted in Tehran, Iran, among 70 women with overweight or obesity aged 20 to 50 years with MetS. Patients were randomly allocated to receive either MRCD (42%–45% carbohydrates and 35%–40% fats) (n = 35) or a normal weight loss diet (NWLD) (52%–55% carbohydrates and 25%–30% fats) (n = 35). Both diets contained the same quantity of protein, which accounted for 15% to 17% of total energy. Anthropometric measurements, blood pressure, lipid profile, and glycemic indices were all assessed before and after the intervention.FindingsCompared with the NWLD group, following an MRCD significantly decreased weight (−4.82 vs −2.40 kg; P = 0.01), body mass index (−1.88 vs −0.94 kg/m²; P = 0.01), waist circumference (−5.34 vs −2.75 cm; P = 0.01), hip circumference (−2.58 vs −1.11 cm; P = 0.01), serum triglyceride (−26.8 vs −7.19 mg/dL; P = 0.01), and increased serum HDL-C levels (1.89 vs. 0.24 mg/dL; P = 0.01). There was no significant difference between the 2 diets in waist-to-hip ratio, serum total cholesterol, serum LDL-C, systolic and diastolic blood pressure, fasting blood glucose, insulin levels, or the homeostasis model assessment for insulin resistance.ImplicationsModerate carbohydrate replacement with dietary fats significantly improved weight, body mass index, waist circumference, hip circumference, serum triglyceride, and HDL-C levels among women with MetS. Iranian Registry of Clinical Trials identifier: IRCT20210307050621N1.     

Long-term high-intensity interval training associated with lifestyle modifications improves QT dispersion parameters in metabolic syndrome patients

BackgroundQT dispersion (QTd) is a marker of myocardial electrical instability, and is increased in metabolic syndrome (MetS). Moderate intensity continuous exercise (MICE) training was shown to improve QTd in MetS patients.ObjectivesTo describe long-term effects of MICE and high-intensity interval exercise training (HIIT) on QTd parameters in MetS.MethodsSixty-five MetS patients (53 ± 9 years) were assigned to either a MICE (60% of peak power output [PPO]), or a HIIT program (alternating phases of 15–30 s at 80% of PPO interspersed by passive recovery phases of equal duration), twice weekly during 9 months. Ventricular repolarization indices (QT dispersion = QTd, standard deviation of QT = sdQT, relative dispersion of QT = rdQT, QT corrected dispersion = QTcd), metabolic, anthropometric and exercise parameters were measured before and after the intervention.ResultsNo adverse events were noted during exercise. QTd decreased significantly in both groups (51 vs 56 ms in MICE, P < 0.05; 34 vs 38 ms in HIIT, P < 0.05). Changes in QTd were correlated with changes in maximal heart rate (r = ?0.69, P < 0.0001) and in heart rate recovery (r = ?0.49, P < 0.01) in the HIIT group only. When compared to MICE, HIIT training induced a greater decrease in weight, BMI and waist circumference. Exercise capacity significantly improved by 0.82 and 1.25 METs in MICE and HIIT groups respectively (P < 0.0001). Lipid parameters also improved to the same degree in both groups.ConclusionIn MetS, long-term HIIT and MICE training led to comparable effects on ventricular repolarization indices, and HIIT might be associated with greater improvements in certain cardiometabolic risk factors.     

Advanced Cancer Patients' Changes in Accurate Prognostic Understanding and Their Psychological Well-Being

ContextClinicians often worry that patients' recognition of the terminal nature of their illness may impair psychological well-being.ObjectivesTo determine if such recognition was associated with decrements to psychological well-being that persisted over time.MethodsAbout 87 patients with advanced cancer, with an oncologist-expected life expectancy of less than six months, were assessed before and after an oncology visit to discuss cancer restaging scan results and again at follow-up (median time between assessments, approximately six weeks). Prognostic understanding (PU) was assessed at previsit and postvisit, and a change score was computed. Psychological well-being was assessed at pre, post, and follow-up, and two change scores were computed (post minus pre; follow-up minus post).ResultsChanges toward more accurate PU was associated with a corresponding initial decline in psychological well-being (r = −0.33; P < 0.01) but thereafter was associated with subsequent improvements (r = 0.40; P < 0.001). This pattern remained controlling for potential confounds. Patients showed different patterns of psychological well-being change (F = 3.07, P = 0.05; F = 6.54, P < 0.01): among patients with improved PU accuracy, well-being initially decreased but subsequently recovered; by contrast, among patients with stable PU accuracy, well-being remained relatively unchanged, and among patients with decrements in PU accuracy, well-being initially improved but subsequently declined.ConclusionImproved PU may be associated with initial decrements in psychological well-being, followed by patients rebounding to baseline levels. Concerns about lasting psychological harm may not need to be a deterrent to having prognostic discussions with patients.     

Effects of nurse-led sedation protocols on mechanically ventilated intensive care adults: A systematic review and meta-analysis

ObjectivesThe objective of the study was to compare nurse-led sedation protocols with physician-led usual care in intensive care units (ICUs) in treating mechanically ventilated adult patients.Review method usedThis is a systematic review and meta-analysis.Data sourcesPubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and China Wanfang databases were interrogated for articles published before May 2020.Review methodAs per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight randomised controlled trials (RCTs) and six preintervention and postintervention studies published in English and Chinese met the inclusion criteria for the meta-analysis. Two reviewers independently extracted data into a tabular format using predefined data fields. Disagreements were resolved by consensus. The quality of the included RCTs and preintervention and postintervention studies was assessed using the Cochrane Quality Assessment Tool and Risk Of Bias In Non-randomised Studies of Interventions assessment tool.ResultsEight RCTs were of intermediate methodological quality, and six preintervention and postintervention studies exhibited a low to moderate risk of bias. Compared with usual care, nurse-led sedation protocols resulted in significantly decreased durations of mechanical ventilation (days) (standardised mean difference = ?1.765; 95% confidence interval [CI] = ?2.461, ?1.068); P < 0.001; I² = 97.7%); decreased length of ICU stay (days) (standardised mean difference = ?1.463; 95% CI = -2.181, ?0.745; P < 0.001; I² = 97.3%); reduced ICU mortality (relative risk [RR] = 0.854; 95% CI = 0.747, 0.983; P = 0.027), I² = 0%); and decreased incidence of ventilator-associated pneumonia (RR = 0.438; 95% CI = 0.292, 0.657; P < 0.001; I² = 41.4%), delirium (RR = 0.522; 95% CI = 0.338, 0.807; P = 0.003; I² = 26.6%), and extubation failure (RR = 0.498; 95% CI = 0.266, 0.932; P = 0.029; I² = 45.1%).ConclusionsAlthough pre–post intervention study design cannot establish causality, the present findings raise the considerable possibility that a sedation protocol can be safely implemented by nurses to reduce mortality in ICUs and sedation-related adverse events in patients on mechanical ventilation compared with physician-led usual care.     

Association of C-reactive protein and metabolic syndrome in a rural Chinese population

ObjectiveTo explore the relationship between C-reactive protein (CRP) and metabolic syndrome (MetS) in a rural Chinese population.Design and methodsWe performed a population-based cross-sectional study.ResultsThe median CRP was 0.90 mg/L. After exclusion of subjects with a CRP value > 10 mg/L, The median CRP with 0, 1, 2, 3, 4, and 5 components of MetS were 0.61, 0.61, 0.73, 1.07, 1.51, and 1.16 mg/L (P = 0.029 for linear trend) in men, and were 0.37, 0.45, 0.62, 1.10, 1.52, and 2.17 mg/L (P = 0.002 for linear trend) in women, respectively. After adjustment for potential confounders, compared with those without components of MetS, those with 1, 2, 3, 4, and 5 components of MetS had ORs of 1.39, 1.08, 1.84, 2.65, and 1.21 for elevated CRP in men and 1.91, 2.06, 3.10, 4.06, and 6.01 in women, respectively.ConclusionIn this rural Chinese population, the CRP concentration was lower than that of Caucasians and strongly related to the MetS, especially in women.     

Effect of implant design on the initial biomechanical stability of two self-tapping dental implants

BackgroundThis study evaluated the effect of two self-tapping implants on implant stability in immediate implantation.MethodsTwo types of self-tapping implants, straight flute (STF) and spiral flute (SPF) designs, were studied. Two synthetic bone blocks with varying densities (0.32 g/cm³ and 0.16 g/cm³) were chosen to simulate the bone quality of the anterior maxilla. Insertion torque values were measured by a torque testing machine during implant insertion. Four biomechanical tests were performed: resonance frequency analysis was conducted using the Osstell device, and the strengths of screw push-in, lateral bending, and pull-out were evaluated using an MTS machine. The strength for each design feature was obtained by averaging the results of 10 trials. In total, 40 specimens were tested for each bone density. Statistical difference was determined by one-way analysis of variance followed by Bonferroni post hoc multiple tests between groups.FindingsThe STF and SPF groups exhibited similar insertion torque values (p = 0.525 in low-density bone, and p = 0.99 in high-density bone). A significant difference (p < 0.001) was observed in the push-in test between the two groups when low-density bone was tested. The SPF group exhibited a significantly higher lateral bending force (p = 0.001) and a higher stiffness (p < 0.001) than the STF group in high-density bone. The SPF design attained higher (p < 0.001) ISQ numbers than the STF design, but all numbers were below 60.InterpretationImplant stability can be influenced by the apical fixture design of self-tapping implants in immediate implantation.     

Effects of Vitamin D Supplementation on Bone Health and Bone-related Parameters in HIV-infected Patients: A Systematic Review and Meta-analysis

PurposeThere is growing evidence that bone health is decreased in individuals with HIV infection. Vitamin D deficiency is also highly prevalent among HIV-infected patients. The literature was systematically reviewed to determine whether bone health and bone-related parameters may improve with vitamin D supplementation in HIV-infected individuals.MethodsFour databases were systematically searched for randomized clinical trials of vitamin D supplementation in HIV infection, published from January 1990 to September 2021. No language or publication restrictions were applied. Standardized mean differences (SMD) with 95% CIs are reported. A random-effects model was used to perform meta-analysis.FindingsTen studies met the inclusion criteria (N = 733 participants at study completion). The mean ages of the patients in the included trials ranged from 10 to 49 years. The meta-analysis indicated that with vitamin D supplementation, serum 25-hydroxy vitamin D (25[OH]D) level was significantly increased (SMD, 1.86; 95% CI, 1.02 to 2.70; I² = 94.4%), but there were no significant effects on levels of serum 1,25-dihydroxy vitamin D (1,25-[OH]₂D) (SMD, 0.29; 95% CI, –0.07 to 0.64; I² = 67.4%), total bone mineral density (SMD, 0.07; 95% CI, –0.23 to 0.37; I² = 00.0%), spine bone mineral density (SMD, 0.15; 95% CI, –0.19 to 0.49; I² = 17.3%), and parathyroid hormone level (SMD, –0.18; 95% CI, –0.37 to 0.02; I² = 1.2%) in HIV-infected patients.ImplicationsThis study showed that vitamin D supplementation can improve serum 25(OH)D in HIV-infected patients. The effects of vitamin D supplementation on other bone health–related parameters such as bone mineral density and parathyroid hormone in HIV-infected patients need to be further investigated in larger-scale, well-designed randomized, controlled trials.     

A Buprenorphine Program Evaluation Before and During the COVID-19 Pandemic

This project evaluated the service delivery (ie, attendance rate) of a buprenorphine management treatment program and compared patient recovery-related information between service methods. This was a medical record review and cross-sectional comparison of pre–COVID-19 vs post onset of COVID-19 data. In the sample of 28 adults, mean attendance rates did not differ significantly before (99.46%) vs during the pandemic (96.13%; t = 1.92, P = .07). Patient participation in therapy before and during the pandemic did differ significantly (χ² = 1.98, P = .03). The use of telemental health services within a BMT program may be a viable option when normal in-person services are disrupted.     

Mock trials and web-based education using malpractice cases: A randomised controlled trial

BackgroundWeb-based education using malpractice cases is increasingly used as an effective program to improve nurses' patient safety competency, and education on legal obligations is vital for nursing students.AimTo evaluate the effectiveness of web-based education using mock trials of medical malpractice cases in improving nursing students' legal obligations, patient safety competency, and critical thinking.MethodsForty-three senior nursing students were randomly assigned to be exposed to blended learning of mock trials (4 weeks) and web-based education (4 weeks) in experimental group (n = 23), and web-based education (4 weeks) alone in control group (n = 20). Pre-test (before randomisation) and post-test (after intervention) data were collected at a university in Korea between October and December 2019.ResultsThere were statistically significant differences in patient safety competencies (t = 3.59, P = 0.001), including skills (t = 2.89, P = 0.006) and knowledge (t = 2.60, P = 0.013), as well as a significant difference in critical thinking disposition (t = 3.09, P = 0.004) between the two groups in the pre−post changes. The two groups had no difference in knowledge and cognition of legal obligation.ConclusionBlended learning of mock trials and web-based education can enhance nursing students' patient safety competency. In particular, mock trials are an active participatory learning method that helps nursing students develop critical thinking skills to ensure patient safety competency compared to web-based education alone. Incorporating mock trial education using medical malpractice cases into the curriculum could enhance nursing students' patient safety competency and critical thinking disposition.     

Genetic variants of human urea transporter-2 are associated with metabolic syndrome in Asian population

BackgroundA previous study has reported that the Ile227 and Ala357 genetic variants of human urea transporter-2 (HUT2) were associated with blood pressure in males in Asian population. In this study, we aimed to investigate five known HUT2 genetic variants with metabolic syndrome (MetS) and its related traits in the Stanford Asia-Pacific Program for Hypertension and Insulin Resistance (SAPPHIRe) study cohort.MethodsFive HUT2 single nucleotide polymorphisms (SNPs) were selected and genotyped among 1791 subjects in the SAPPHIRe study cohort. We first computed allele frequency and performed Hardy–Weinberg equilibrium (HWE) test in controls for each SNP. Next, we tested genotype associations with metabolic syndrome using multiple generalized estimating equations (GEE) models with covariate adjustment. Furthermore, multi-marker and multi-trait association tests were carried out using FBAT program. To account for multiple testing, Bonferroni correction was applied in this study.ResultsAmong those 5 HUT2 SNPs, SNPs 1, 2 and 3 were significantly associated with MetS in the total sample and females, separately (9 × 10^?4 ≤ p ≤ 0.04), but only the association between SNP 1 and MetS in females remained statistically significant after Bonferroni correction. When testing 5 SNPs simultaneously, significant associations were found with triglycerides (TG) (p = 0.04). Likewise, significant multi-trait association (combining the data of waist circumference, TG, high density lipoprotein (HDL) cholesterol and fasting glucose together) was found with SNP 2 (p = 0.04), but both results of multi-maker and multi-trait associations did not remain significant after multiple testing correction.ConclusionThe results have provided evidence that the HUT2 gene may play a certain role in developing MetS and its related traits in Asian population. Further investigation of the HUT2 gene influencing MetS and its related traits will be warranted.     

Evaluating Target: Stroke guideline implementation on assessment and treatment times for patients with suspected stroke

ObjectivesImmediate ischemic stroke treatment improves outcomes and early alteplase administration is recommended for patients within window. We implemented stroke guidelines through a neuro-resuscitation initiative (NRI) and hypothesized that the intervention would decrease times to assessment and treatment.MethodsWe analyzed quality assurance data for EMS and triage patients arriving to our academic emergency department with suspected ischemic stroke to compare outcomes 12 months before to 6 months after initiative implementation at an academic certified primary stroke center in the U.S. Southwest. We examined four time-based outcomes: neurology at bedside, CT head without contrast, CT head angiogram, and alteplase administration. We summarized times with median and IQR values and compared pre and post times to event (in minutes) with Wilcoxon rank sum tests and Kaplan-Meier survival curves.ResultsWe identified 203 EMS (83 pre, 120 post) and 66 (11 pre, 55 post) triage Stroke Alert patients. We observed decreased times for all outcomes in both the EMS and triage samples; however, only those in the EMS sample were significant. In the EMS sample, neurology at bedside median times decreased from 20 min to 2 min (p < 0.001); median minutes to CT head without contrast decreased from 16 min to 9 min (p < 0.001); median minutes to CT head angiogram decreased from 71 min to 21 min (p = 0.007); and, median minutes to alteplase decreased from 72 min to 49.5 min (p = 0.04).ConclusionsAn academic ED led stroke care initiative streamlined evaluation and care with significantly shortened times to all four events.     

Real time monitoring of screw insertion using acoustic emission can predict screw stripping in human cancellous bone

BackgroundTo develop experience, orthopaedic surgeons train their own proprioception to detect torque during screw insertion. This experience is acquired over time and when implanting conventional/non-locked screws in osteopenic cancellous bone the experienced surgeon still strips between 38 and 45%. Technology needs to be investigated to reduce stripping rates. Acoustic-Emission technology has the ability to detect stress wave energy transmitted through a screw during insertion into synthetic bone. Our hypothesis is Acoustic-Emission waves can be detected through standard orthopaedic screwdrivers while advancing screws through purchase and overtightening in cancellous human bone with different bone mineral densities replicating the clinical state.Methods77 non-locking 4 mm and 6.5 mm diameter cancellous bone screws were inserted through to stripping into the lateral condylar area of 6 pairs of embalmed distal femurs. Specimens had varying degrees of bone mineral density determined by quantitative CT. Acoustic-Emission energy and axial force were detected for each test.ResultsThe tests showed a significant high correlation between bone mineral density and Acoustic-Emission energy with R = 0.74. A linear regression model with the mean stripping load as the dependent variable and mean Acoustic-Emission energy, bone mineral densities and screw size as the independent variables resulted in r² = 0.94.InterpretationThis experiment succeeded in testing real time Acoustic-Emission monitoring of screw purchase and overtightening in human bone. Acoustic-Emission energy and axial compressive force have positive high correlation to bone mineral density. The purpose is to develop a known technology and apply it to improve the bone-metal construct strength by reducing human error of screw overtightening.     

Pharmacokinetics and Pharmacodynamics of Once-daily Prolonged-release Tacrolimus in Liver Transplant Recipients

PurposeLimited published data are available regarding the pharmacokinetic (PK) and pharmacodynamic (PD) variables of prolonged-release tacrolimus (PRT) after liver transplantations. The goal of this study was to compare the PK and PD profiles of PRT in early and stable liver transplant recipients by developing a population PK model of PRT and investigating the profile of calcineurin activity (CNA) in the peripheral blood mononuclear cells.MethodsA conversion from BID immediate-release tacrolimus (IRT) to once-daily PRT based on a one-to-one daily dose was performed at day 7 (D7) and D90 posttransplantation in groups A (n = 12) and B (n = 12), respectively. Extensive PK samplings, including whole-blood tacrolimus (TAC) concentration, and CNA assessments were performed at D14 and D104 in groups A and B, respectively. TAC concentration–time data (N = 221) were analyzed by using nonlinear mixed effects modeling.FindingsA 2-compartment model with linear elimination and a delayed first-order absorption characterized by 2 transit compartments best described the PK data. Model-predicted dose-normalized (6.0 mg/d) area under the TAC concentration–time curve over the dosing interval in groups A and B was similar (geometric mean, 235.6 ng/mL · h [95% CI, 139.6–598.7] vs 224.6 ng/mL · h [95% CI, 117.6–421.5], respectively; P = 0.94). Area under the CNA versus time curve over the dosing interval did not differ between groups (4897 [3437] and 4079 [1008] pmol/min/10⁶ cells; P = 0.50). In group A, trough CNA at D14 posttransplantation was statistically higher than that measured just before the switch to PRT (ie, D7 posttransplantation) (198 [92] vs 124 [72] pmol/min/10⁶cells, n = 8; P = 0.048); no statistical difference in TAC concentration was observed (P = 0.11). In group B, no statistical difference between D90 and D104 was observed in either trough CNA (149 [78] vs 172 [82] pmol/min/10⁶ cells, n = 6; P = 0.18) or TAC (P = 0.17) concentration. No graft rejection was observed in either of the groups.ImplicationsThis study suggests that one-to-one dosage conversion to once-daily PRT during the early posttransplantation period could result in significant CNA variations but without causing graft rejection. Further investigations in larger cohorts are warranted to confirm these results. ClinicalTrials.gov identifier: NCT02105155.     

Effects of curcumin on serum cytokine concentrations in subjects with metabolic syndrome: A post-hoc analysis of a randomized controlled trial

BackgroundCytokines are involved in the development of metabolic abnormalities that may result in metabolic syndrome (MetS). Since curcumin has shown anti-inflammatory properties, the aim of this study was to evaluate the effect of curcumin supplementation on serum cytokines concentrations in subjects with MetS.MethodsThis study was a post-hoc analysis of a randomized controlled trial in which males and females with diagnosis of MetS, according to the criteria defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines, were studied. Subjects who met the inclusion criteria were randomly assigned to either curcumin (daily dose of 1 g/day) or a matched placebo for a period of 8 weeks.ResultsOne hundred and seventeen subjects were assigned to either curcumin (n = 59) or placebo (n = 58) groups. Within-group analysis revealed significant reductions in serum concentrations of TNF-α, IL-6, TGF-β and MCP-1 following curcumin supplementation (p < 0.001). In the placebo group, serum levels of TGF-β were decreased (p = 0.003) but those of IL-6 (p = 0.735), TNF-α (p = 0.138) and MCP-1 (p = 0.832) remained unaltered by the end of study. Between-group comparison suggested significantly greater reductions in serum concentrations of TNF-α, IL-6, TGF-β and MCP-1 in the curcumin versus placebo group (p < 0.001). Apart from IL-6, changes in other parameters remained statistically significant after adjustment for potential confounders including changes in serum lipids and glucose levels, and baseline serum concentration of the cytokines.ConclusionResults of the present study suggest that curcumin supplementation significantly decreases serum concentrations of pro-inflammatory cytokines in subjects with MetS.     

Predictive value of osteocalcin in bone metastatic differentiated thyroid carcinoma

ObjectivesTo evaluate the diagnostic value of serum osteocalcin in the detection of bone metastases from differentiated thyroid carcinoma (DTC).Design and methodsSerum samples from DTC patients with (DTC BM+, n = 19) or without bone metastases (DTC BM?, n = 19), and matched healthy volunteers (n = 30) were tested for serum osteocalcin with electrochemiluminescent immunoassay.ResultsOsteocalcin was higher in DTC BM+ than in DTC BM? patients (+ 35.8%, p = 0.002), acting as an independent risk factor for bone metastases (R² = 0.142, p = 0.039). The sensitivity was 78.9% and the specificity was 63.2% at a cut-off value of 11.2 μg/L.ConclusionsSerial measurements of osteocalcin could be useful in the detection of bone metastases from DTC.     

Internet-Delivered Lifestyle Physical Activity Intervention Improves Body Composition in Multiple Sclerosis: Preliminary Evidence From a Randomized Controlled Trial

Objective

To examine the efficacy of a physical activity behavioral intervention for improving outcomes of body composition in persons with multiple sclerosis (MS).

Design

Secondary analysis of data from a randomized controlled trial.

Setting

University research laboratory.

Participants

Ambulatory persons with MS (N=82).

Intervention

A 6-month, internet-delivered physical activity behavioral intervention designed to increase lifestyle physical activity, primarily walking. The behavioral intervention was based on principles of social cognitive theory.

Main Outcome Measures

Whole-body bone mineral content (BMC), bone mineral density (BMD), and soft tissue composition, using dual-energy x-ray absorptiometry.

Results

There were no significant differences between conditions posttrial on body composition outcomes using the adjusted critical value (P<.008). There was a significant effect of the intervention on whole-body BMC (P=.04, ω²<.001) and BMD (P=.01, ω²=.003) using the unadjusted critical value (P<.05). The effect of the intervention on percent body fat (P=.09, ω²=.001) and whole-body fat mass (P=.05, ω²=.003) approached significance using unadjusted criteria. There was not a significant effect on whole-body lean soft tissue (P=.28, ω²<.001) or body mass index (P=.86, ω²<.001).

Conclusions

Our results provide preliminary evidence that an internet-delivered lifestyle physical activity intervention might improve bone health and body composition in MS. Such findings are important considering that physical activity is a modifiable behavior with the potential to confer long-term benefits for the prevention and management of fracture risk and comorbidities among those with MS.     

Improvements in kinematics,muscle activity and pain during functional tasks in females with patellofemoral pain following a single patterned electrical stimulation treatment

BackgroundIndividuals with patellofemoral pain present with altered hip muscle activation, faulty movement patterns, and pain during functional tasks. Examining new treatment options to address these impairments may better treat those with patellofemoral pain. The purpose of this study was to determine if patterned electrical stimulation to the lower extremity affects muscle activity, movement patterns, and pain following a single treatment.MethodsFifteen females with patellofemoral pain were randomized to receive a single 15-minute treatment of either a patterned electrical neuromuscular stimulation or a sham. Peak kinematics of the knee, hip, and trunk, electromyography and pain were examined pre and post-intervention during a single leg squat and lateral step-down task. Group means and pre/post reduced kinematic values were also plotted during the entire task with 90% confidence intervals to identify differences in movement strategies.FindingsNo baseline differences were found in peak kinematics between groups. No pre to post-intervention differences in peak knee, hip and trunk kinematics were found, however differences were seen when the quality of movement across the entire tasks was assessed. The electrical stimulation group had improved knee flexion and hip abduction during the lateral step-down. A significant improvement in gluteus medius activation following patterned electrical neuromuscular stimulation occurred during the step-down (P = 0.039). Significant pain improvements were also seen in both the single leg squat (P = 0.025) and lateral step-down (P = 0.006).InterpretationA single treatment of patterned electrical neuromuscular stimulation improved muscle activation, lower extremity kinematics during functional tasks, and pain.     

A Systematic Review and Meta-Analysis of Risk Factors for Unplanned Intraoperative Hypothermia Among Adult Surgical Patients

PurposeUnplanned intraoperative hypothermia (UIH) is a frequent but preventable complication of surgery. Accurate identification of UIH risk factors allows nurses to minimize its negative outcomes. This study aimed to investigate the risk factors for UIH in adult surgical patients.DesignSystematic review and meta-analysisMethodsWe comprehensively searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Ovid Embase, and ClinicalTrials.gov from their inception until December 31, 2020 to identify available, related studies in English. Two authors independently extracted data from these studies. Data analysis was performed using Review Manager Version 5.3.ResultsThis meta-analysis included 12 studies involving 15,010 patients. The combined results showed that age [mean difference (MD) = 4.85, P < .0001; I² = 94%], body mass index (MD = ? 0.76, P = .001; I² = 59%), ambient temperature [odds ratio (OR) = 0.82, P < .001; I² = 54%], preoperative systolic blood pressure (MD = ?14.68, P < .00001; I² = 30%), preoperative heart rate (MD = ? 13.25, P < .00001; I² = 0%), duration of anesthesia (>2 h; OR = 2.67, P < .001; I² = 0%), and intravenous fluid administration >1,000 mL (OR = 2.02, P = .01; I² = 77%) were significantly associated with a higher risk of UIH.ConclusionsOur study demonstrated that various risk factors contribute to the development of UIH. Perioperative nurses should understand these risk factors in order to apply evidence-based procedures and improve patient outcomes. Due to the substantial clinical heterogeneity across studies, further studies are needed to verify these findings.