Placebo controlled phase II clinical trial: Safety and efficacy of combining intranasal insulin & acute exercise

A growing number of investigations are exploring the utility of intranasal insulin as a means of mitigating cognitive decline. However, as a basic tenant of dementia prevention programs is increasing physical activity, it is essential to obtain a preliminary assessment of the safety profile of combining intranasal insulin with physical activity; to ensure that undue risks are not incurred. Utilizing a randomized double-blind placebo-controlled design, a sample of 116 non-diabetic, fasted college-aged adults were randomly assigned to receive a dose of 0-to-120 IU of NovoLog (Insulin Aspart) before being randomized to 20 min of exercise or sitting control condition. The safety of intranasal insulin was assessed by examining the incidence of potential symptoms of hypoglycemia and changes in peripheral blood glucose. The efficacy of a combination therapeutic approach was assessed using behavioral measures of inhibition and sustained attention alongside neuroelectric indices of attentional engagement. The frequency of symptoms reported following administration of intranasal insulin were not observed to interact with exercise so as to make their occurrence any more or less prominent, nor was the frequency observed to relate to the dose of intranasal insulin. However, doses of intranasal insulin of 100 IU or more were observed to result in a 7-fold increase in the likelihood of a level 1 hypoglycemic event for those individuals in the exercise condition. This study provides preliminary evidence to suggest that exercise is not associated with an increase in risk when combined with lower doses of intranasal insulin.

Clinical trial registration The trial is registered at ClinicalTrials.gov, number NCT04292535.

     

The use of rheumatoid arthritis health‐related quality of life patient questionnaires in clinical practice: Lessons learned

Objective

The utilization of health‐related quality of life (HRQOL) patient questionnaires by clinical rheumatologists is limited. Yet, considerable literature exists defining the value of such data. In an effort to understand this apparent paradox, we performed a literature review and conducted a survey to describe what has been learned over the past 2 decades concerning the use of these measures in clinical care and explore the reasons for their underutilization.

Methods

A panel of rheumatologists with extensive clinical experience was convened to review the relevant literature pertaining to the use of HRQOL patient instruments in clinical practice. Additionally, a survey of all American College of Rheumatology practicing clinicians was conducted to assess the use of and beliefs about these measures.

Results

The literature provided evidence to support the use of HRQOL patient measures in clinical practice. Forty‐seven percent of the responding rheumatologists stated that none of their patients complete HRQOL patient questionnaires. The majority of respondents (63%) reported that such information is “somewhat valuable.” The most frequently reported reason for the underutilization was that such instruments “require too much staff time.”

Conclusions

The literature supports the potential value of HRQOL patient questionnaires in clinical practice. Few rheumatologists routinely gather such information as part of patient care. Reasons for this discrepancy between utility and use are given along with recommendations intended to help increase their utilization in clinical care.

     

Glucocorticoid induces apoptosis in rat leydig cells.

The aim of the present study was to investigate whether glucocorticoid induces apoptosis in rat Leydig cells. To determine whether there are developmental differences in glucocorticoid sensitivity, Leydig cells were isolated at distinct stages of their differentiation [mesenchymal-like progenitors (PLC), immature Leydig cells (ILC), and adult Leydig cells (ALC)] from 21-, 35-, and 90-d-old Sprague Dawley rats, respectively. Glucocorticoid induction of apoptosis was evaluated after both in vitro and in vivo exposures. In the first set of experiments, PLC, ILC, and ALC were treated with 100 nM corticosterone (CORT) for either 4 or 24 h in vitro and then assessed for labeling with the apoptotic marker annexin V. PLC exposed to CORT had levels of annexin V-fluorescein isothiocyanate labeling that were unchanged relative to control values at both time points (P > 0.05). In contrast, CORT-treated ILC and ALC had increased frequencies of apoptosis: in ALC, a 22.1 +/- 1.7% incidence after 4 h and 30.5 +/- 2.3% after 24 h compared with 7.4 +/- 0.8% in untreated controls (P < 0.05). Similar trends were observed for ILC. Ultrastructural analysis confirmed that the increase in annexin V labeling was associated with characteristic signs of apoptosis, including nuclear fragmentation and formation of apoptotic bodies. A second line of experiments examined whether apoptosis was evident in purified Leydig cells after administration of CORT in vivo. Male rats were subjected to bilateral adrenalectomy and were treated with CORT by ip injection twice daily at doses ranging from 2.5-7.5 mg/100 g BW starting 3 d after surgery. The frequency of Leydig cell apoptosis was measured at 12, 24, 48, and 72 h after the first injection. Administration of the 2.5-mg dose raised circulating CORT 5-10 times above normal basal concentrations, and LH levels sampled at these times were not altered in the treated animals. Increased Leydig cell apoptosis was measurable after 24 h of treatment, with an incidence of 21.1 +/- 1.8% in ALC compared with 5.7 +/- 0.8% in untreated controls (P < 0.05). Sharp reductions in immunocytochemical staining intensity were observed in the treated animals for a Leydig cell marker, 11beta-hydroxysteroid dehydrogenase, which occurred concurrently with decreased serum T levels. This was consistent with the hypothesis that CORT-mediated induction of apoptosis leads to declines in Leydig cell numbers, thereby affecting T production. These results suggest that excessive exposure to CORT initiates apoptosis in rat Leydig cells, potentially contributing to suppression of circulating T levels during stress and other conditions in which glucocorticoid concentrations are elevated.     

Budesonide once versus twice-daily administration: meta-analysis

OBJECTIVES: The aim of this study was to examine the efficacy of budesonide administered once daily compared to twice daily in asthma. METHODOLOGY: Meta-analysis of randomised controlled trials comparing budesonide administered once versus twice a day that presented data on at least one clinical outcome measure was conducted. RESULTS: A total of 10 studies, with 1922 children and adults with asthma, met the inclusion criteria. These studies were performed predominantly with mild to moderate asthmatic patients, using doses of budesonide ranging from 200 to 800 microg per day. There was no significant difference between daily dosing once or twice for all the clinical outcome variables, including withdrawals due to asthma, for which the odds ratio was 1.0 (95% confidence interval, 0.65-1.52). CONCLUSIONS: In mild to moderate asthma a once-daily budesonide regimen has a similar efficacy to a twice-daily regimen in doses up to 800 microg per day. A once-daily regimen has potential advantages in terms of patient compliance and satisfaction, when used in clinical practice.     

Malaria prevalence and associated risk factors in Eritrea

A parasitological cross-sectional survey was undertaken from September 2000 through February 2001 to estimate the prevalence of malaria parasitemia in Eritrea. A total of 12,937 individuals from 176 villages were screened for both Plasmodium falciparum and Plasmodium vivax parasite species using the OptiMal Rapid Diagnostic Test. Malaria prevalence was generally low but highly focal and variable with the proportion of parasitemia at 2.2% (range: 0.4% to 6.5%). Despite no significant differences in age or sex-specific prevalence rates, 7% of households accounted for the positive cases and 90% of these were P. falciparum. Multivariate regression analyses revealed that mud walls were positively associated with malaria infection (OR [odds ratio] = 1.6 [95% CI: 1.2, 2.2], P < 0.008). For countries with low and seasonal malaria transmission, such information can help programs design improved strategic interventions.     

Neuropsychological functioning in opioid use disorder: A research synthesis and meta-analysis

Background: Research has demonstrated that patients with opioid use disorders (OUD; including both opioid abuse and/or dependence) have poorer neuropsychological functioning compared to healthy controls; however, the pattern and robustness of the findings remain unknown.

Objectives: This study meta-analyzed the results from previous research examining the neuropsychological deficits associated with opioids across 14 neurocognitive domains.

Method: Articles comparing patients with OUD to healthy controls were selected based on detailed inclusion/exclusion criteria and variables of interest were coded. In total, 61 studies were selected for the analyses. These consisted of 2580 patients with OUD and 2102 healthy control participants (15.9% female). Drug-related variables were analyzed as potential moderators.

Results: The largest effect size difference in neuropsychological performance was observed in complex psychomotor ability. With the exception of the motor and processing speed domains, which showed no group differences, small-to-medium effect sizes were associated with all neurocognitive domains examined. Meta-regression revealed that increases in the length of abstinence were associated with decreases in effect sizes of the complex psychomotor domain. Additionally, attentional ability predicted effect size differences in executive functioning as well as verbal memory ability. Although the majority of meta-analyzed studies demonstrated significant differences between patients with OUD and controls, the average raw scores for patients with OUD in these studies typically fell within the normal range.

Conclusion: The pattern of neuropsychological performance among patients with OUD appears to reflect mild generalized cognitive dysfunction, with a large effect in complex psychomotor abilities.     

Portomesenteric Venous Thrombectomy Using Inari Triever Aspiration Catheter (FlowTriever)

CardioVascular and Interventional Radiology -     

Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis

CardioVascular and Interventional Radiology - Genicular artery embolisation (GAE) is a novel treatment for patients with knee osteoarthritis (OA). Cadaveric dissection was undertaken to provide a...     

Imaging of dental infections

Emergency Radiology - Dental infections are a common presentation in the emergency department (ED). To help guide clinical management for these infections, the radiologist must be familiar with the...     

Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction

OBJECTIVES: This study was designed to evaluate the cost-effectiveness of screening patients with a B-type natriuretic peptide (BNP) blood test to identify those with depressed left ventricular systolic function. BACKGROUND: Asymptomatic patients with depressed ejection fraction (EF) may have less progression to heart failure if they can be identified and treated. METHODS: We used a decision model to estimate economic and health outcomes for different screening strategies using BNP and echocardiography to detect left ventricular EF <40% for men and women age 60 years. We used published data from community cohorts (gender-specific BNP test characteristics, prevalence of depressed EF) and randomized trials (benefit from treatment). RESULTS: Screening 1,000 asymptomatic patients with BNP followed by echocardiography in those with an abnormal test increased the lifetime cost of care (176,000 US dollars for men, 101,000 US dollars for women) and improved outcome (7.9 quality-adjusted life years [QALYs] for men, 1.3 QALYs for women), resulting in a cost per QALY of 22,300 US dollars for men and 77,700 US dollars for women. For populations with a prevalence of depressed EF of at least 1%, screening with BNP followed by echocardiography increased outcome at a cost < 50,000 US dollars per QALY gained. Screening would not be attractive if a diagnosis of left ventricular dysfunction led to significant decreases in quality of life or income. CONCLUSIONS: Screening populations with a 1% prevalence of reduced EF (men at age 60 years) with BNP followed by echocardiography should provide a health benefit at a cost that is comparable to or less than other accepted health interventions.