4-week Period Research Articles

BN SO14 - Evaluation of local cholecystectomy service and outcomes (Local Data for GECKO study)

Abstract Background Cholecystectomy is a common procedure performed for different biliary pathologies. Patients have their procedure as elective, emergency, or prioritised bases (Hot Gall bladder service). Method GECKO is a prospective, international, observational collaborative cohort study Consecutive patients undergoing cholecystectomy, between 23rd Oct – 19th Nov 2023 with follow-up at 30-day and one-year postoperatively Results Over a 4-week period , 38 cholecystectomies were performed, with 47.5% of patients having prior cholecystitis or cholangitis and multiple admissions. Half of the surgeries occurred within 6 months, and the longest wait was 13 months. Procedures were split equally between elective and emergency cases. Indications included acute cholecystitis (13), biliary colic (11), and others. All surgeries were laparoscopic, with 2 subtotal cholecystectomies. Complications included bile or stone spillage (12) and bleeding (7). Postoperative follow-up showed 16 patients discharged within 24 hours, 3 readmissions, and a 37% complication rate. No bile leaks or CBD injuries were reported. Conclusion Emergency and hot cholecystectomy services not only cut down waiting lists but also reduce costs of reoccurring admissions and treatments, with no significant associated complications. Selective gall bladder histological examination may help cost reduction with no significant recognised risks in the literature.

HPB SO75 - Burden and Pattern of Gallstone-Related Acute Surgical Admissions

Abstract Background Gallstone disease accounts for nearly one-third of emergency general surgery admissions, with a considerable number resulting from recurrent episodes. Laparoscopic cholecystectomy (LC) is the only definitive treatment for gallstones. This study aimed to examine the burden and patterns of acute biliary admissions. Method This prospective cohort study was conducted over a continuous 12-week period in 2022 within a single surgical unit, focusing on all gallstone-related admissions. The total number of admissions for various surgical pathologies was documented, and the proportion due to biliary disease was determined. The analysis encompassed patient demographics, reasons for biliary admission, prior gallstone history, and any planned laparoscopic cholecystectomies (LC). Results There were 532 acute admissions, 98 (18.4%) were gallstones related. Median age was 62 years (IQR 47-72) and 58 (59.2%) were female. 40 (40.8%) had acute cholecystitis, 24 (24.5%) had gallstone pancreatitis, 16 (16.3%) had bile duct stones, 10 (10.2%) had biliary colic and 8 (8.2%) had ascending cholangitis. 43 (43.9%) patients were known to have gallstones and 26 (26.5%) patients had prior admission related to gallstones. 35.7% patients had outpatient LC, 23.5% had no documentation, 19.4% had inpatient LC, 18.4% were not fit candidates and 3.1% patients declined LC. Median total length of stay was 6 days (IQR 4-11). Conclusion In our study, the rate of biliary-related admissions was lower than previously reported in the literature. This reduction may be attributed to our semi-aggressive management approach for gallstone disease. To further improve patient outcomes, we suggest implementing more aggressive management strategies for gallstones during the initial admission for patients who are deemed fit for surgery. Such an approach could potentially reduce the recurrence of biliary admissions and enhance overall treatment efficacy.

A Very Low-Calorie Ketogenic Diet Approach for Post-Bariatric Weight Regain: A Pilot Study

Weight regain (WR) after bariatric surgery, particularly sleeve gastrectomy, is a significant challenge, often driven by a combination of metabolic, behavioral, and lifestyle factors. Non-surgical interventions to manage WR are critical, given the increased risks and reduced efficacy of revisional surgeries. In this context, very low-calorie ketogenic diets (VLCKDs) have gained attention for their potential to promote weight loss and improve body composition in individuals struggling with WR. This study assessed the safety and efficacy of a VLCKD in 11 patients who experienced WR following sleeve gastrectomy. Over an 8-week period, patients demonstrated a significant average weight loss of 6.3% (p = 0.005), along with improvements in body composition, including reductions in body fat percentage (p = 0.003) and waist circumference (p = 0.003). Metabolic markers, such as insulin resistance (HOMA-IR), also improved significantly (p = 0.041). Although a decrease in the glomerular filtration rate was observed (p = 0.007), this finding is unlikely to be clinically relevant over the short term. Importantly, no major adverse events were reported, with only mild constipation observed. These results suggest that VLCKDs may be a promising non-surgical approach for managing WR post-bariatric surgery, though further studies are needed to assess long-term effects, especially on renal function.

In vitro evaluation of lipidic nanocarriers for mebendazole delivery to improve anticancer activity

Objective Enhance the anticancer activity of the repurposed drug Mebendazole (MBZ) against A549 cell lines by developing nanostructured lipid carriers (NLCs). Significance MBZ, an anthelmintic drug, exhibits anticancer properties primarily through the inhibition of Ran GTPase and mitotic spindle assembly. Enhancing its delivery and efficacy via NLC could provide a novel and effective approach for lung cancer treatment. Methods NLCs were prepared by mixing different ratios of solid lipid (Stearic acid) and liquid lipid (Oleic acid) with surfactants and emulsifiers. The NLCs were fully characterized to ensure stability, particle size, zeta potential, and encapsulation efficiency (EE%). The stability of the NLCs was monitored over a 3-week period. The anticancer activity of MBZ-NLCs was evaluated using IC50 assays and in vitro scratch assays. Results The NLCs exhibited an average particle size of 300 ± 10 nm and a zeta potential of -27 ± 0.5 mV, indicating good stability. EE% significantly improved from 40% in conventional liposome formulations to 90.7% in NLCs. The anticancer activity of MBZ-NLCs was markedly enhanced, with an IC50 of 62 nM compared to 581 nM for free MBZ, representing a 10-fold increase in potency. Additionally, in vitro scratch assays revealed that MBZ-NLCs effectively prevented cell-cell contact, further supporting their potential for improved therapeutic efficacy. Conclusions MBZ-NLCs exhibit significantly improved stability, encapsulation efficiency, and anticancer activity compared to free MBZ. These promising results suggest that MBZ-NLCs could be a potent therapeutic approach for lung cancer treatment, warranting further in vivo studies and exploration of different administration routes.

Effect of traditional Chinese Yijinjing exercise on hand dysfunction in rheumatoid arthritis patients: a randomized controlled trial

IntroductionRheumatoid arthritis (RA) patients often experience significant hand dysfunction. Yijinjing, a traditional Chinese exercise, has been recognized for its benefits to mind–body health. This study aimed to evaluate the efficacy and safety of Yijinjing in improving hand dysfunction among individuals with RA.MethodsThis research was conducted as a single-center, outcome-blinded, randomized controlled trial. A total of 66 eligible RA participants were randomly assigned in a 1:1 ratio to either the Yijinjing exercise group (YJJG) with sessions conducted three times per week over a 12-week period or the control group (CG), which maintained ordinary activities. Various outcomes were assessed, including the Michigan Hand Outcomes Questionnaire (MHQ), handgrip strength, active range of motion (AROM), RA disease activity, the Health Assessment Questionnaire Disability Index (HAQ-DI), levels of anxiety and depression, and wrist ultrasound, all of which were collected at baseline and the week 12.ResultsAt the end of the 12 weeks, the YJJG demonstrated significant improvements in MHQ scores compared to the CG (p < 0.05), alongside enhancements in handgrip strength and AROM, specifically in wrist extension, radial deviation, and metacarpophalangeal flexion (p < 0.05). Wrist ultrasound scores did not exhibit a significant increase in the YJJG, meaning no inflammation aggravation (p > 0.05). Additionally, morning stiffness duration, Disease Activity Score 28-ESR (DAS28-ESR), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels showed significant improvement in the YJJG (p < 0.05). Both groups reported enhancements in quality of life, as well as reductions in anxiety and depression scores, with the YJJG displaying greater improvements overall (p < 0.05). Importantly, no adverse events or significant abnormalities in vital signs were observed in either group.ConclusionYijinjing exercise may effectively enhance hand function, handgrip strength, and flexibility in RA patients with low disease activity. Furthermore, it appears to improve quality of life and reduce anxiety and depression without exacerbating joint inflammation.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05527158, Identifier NCT05527158.

The Impact of Pathologist Review on Peripheral Blood Smears: A College of American Pathologists Q-Probes Study of 22 Laboratories

Context.— The aim of the study was to determine the impact of peripheral blood (PB) smear review by a pathologist when requested by a technologist or provider to measure the rate of pathologist-detected clinically relevant findings. Objective.— To report and analyze the results of clinically relevant morphologic findings on PB smears that were pathologist reviewed because of either a request from a technologist or an order from a provider. Design.— During a 4-week study period, participants enrolled in the College of American Pathologists Q-Probes program submitted data on PB smear reviews including review request source, reason for review request, and if the pathologist’s review resulted in a clinically relevant morphologic finding. Results.— Twenty-two institutions submitted data on 835 eligible PB smears. Pathologists identified clinically relevant findings on a median 53.4% of technologist-requested PB smear reviews and a median 14.3% of provider-ordered PB smear reviews .The most frequently identified pathologist finding on technologist-requested PB smear reviews was “blasts” in 91 of 532 (17.1%) followed by “atypical (possibly neoplastic) lymphocytes” in 74 of 532 (13.9%); the most frequent finding on provider-ordered reviews was “other” in 55 of 315 (17.5%) followed by “immature cells/left shift in myeloid cells or monocytes” in 12 of 315 (3.8%). Pathologists agreed with technologists’ indications for review in 458 of 513 requested reviews (89.3%). Institutions that conducted postanalytic follow-up on previously reviewed PB smears had a higher rate of clinically relevant findings detected on technologist-requested smears. Conclusions.— Pathologist review of PB smears flagged by technologists for review frequently yielded clinically relevant findings. This was higher in institutions that conducted postanalytic reviews. Provider-ordered reviews resulted in clinically relevant findings in a median of 14.3% of smears.

Brain Age Gap as a Predictor of Early Treatment Response and Functional Outcomes in First-Episode Schizophrenia: A Longitudinal Study: L'écart d'âge cérébral comme prédicteur de la réponse en début de traitement et des résultats fonctionnels dans un premier épisode de schizophrénie : une étude longitudinale

Objectives Accelerated brain aging, i.e., the age-related structural changes in the brain appearing earlier than expected from one's chronological age, is a feature that is now well established in schizophrenia. Often interpreted as a feature of a progressive pathophysiological process that typifies schizophrenia, its prognostic relevance is still unclear. We investigate its role in response to antipsychotic treatment in first-episode schizophrenia. Methods We recruited 49 drug-naive patients with schizophrenia who were then treated with risperidone at a standard dose range of 2–6 mg/day. We followed them up for 3 months to categorize their response status. We acquired T1-weighted anatomical images and used the XGboost method to evaluate individual brain age. The brain age gap (BAG) is the difference between the predicted brain age and chronological age. Results Patients with FES had more pronounced BAG compared to healthy subjects, and this difference was primarily driven by those who did not respond adequately after 12 weeks of treatment. BAG did not worsen significantly over the 12-week period, indicating a lack of prominent brain-ageing effect induced by the early antipsychotic exposure per se. However, highly symptomatic patients had a more prominent increase in BAG, while patients with higher BAG when initiating treatment later showed lower gains in global functioning upon treatment, highlighting the prognostic value of BAG measures in FES. Conclusions Accelerated brain aging is a feature of first-episode schizophrenia that is more likely to be seen among those who will not respond adequately to first-line antipsychotic use. Given that early poor response indicates later treatment resistance, measuring BAG using structural MRI in the first 12 weeks of treatment initiation may provide useful prognostic information when considering second-line treatments in schizophrenia.

Profiles of Nonpharmacologic Treatment Receipt in the First 10 Weeks Following a New Back Pain Diagnosis Among Active Duty Soldiers: A Latent Class Analysis

ABSTRACT Introduction US service members experience high rates of back pain. Guidelines prioritize nonpharmacologic treatment (NPT) as first-line pain treatments; however, NPT utilization patterns research is limited. This study examined NPT patterns of care within the first 10 weeks following an index back pain diagnosis. Materials and Methods Data were from the Substance Use and Psychological Injury Combat Study and included 222,427 active duty soldiers with an index back pain diagnosis following return from Afghanistan/Iraq deployment in 2008–2014. We fit a series of latent class analysis models to identify homogenous subgroups of soldiers with NPT utilization during the 10-week period and measured associations with soldier characteristics and clinical characteristics within 90 days before the back pain diagnosis, with the distinct NPT utilization classes. Approval for this study was granted by the Brandeis University Committee for Protection of Human Subjects (Institutional Review Board #14153) and the Uniformed Services University Institutional Review Board. Results Only half of the soldiers received any NPT within their 10-week early treatment window. Latent class analysis identified 4 classes over the 10-week early treatment window: Class 1 (None/Low NPT, 65%); Class 2 (High and Decreasing NPT, 15%); Class 3 (Low and Increasing NPT, 13%), and Class 4 (Sustained NPT, 7%). Soldier clinical characteristics from the 90-day preperiod window were most important in distinguishing class membership in relation to Class 1, particularly comorbid pain conditions, diagnosis of traumatic brain injury, receipt of prescription opioids, and receipt of invasive surgery. Conclusions Patterns of weekly NPT utilization during an early treatment window following a new back pain diagnosis varied temporally, with approximately half of soldiers using NPT. Half of the soldiers did not receive any NPT within their 10-week early treatment window, which highlights opportunities for increasing use of NPT utilization among military members with a new back pain episode. Future research is needed in the Military Health System to examine the extent to which NPT patterns are associated with pain management outcomes.

Pilot evaluation on an adapted tele-behavioral activation to increase physical activity in persons with depression: a single-arm pilot study

BackgroundPhysical activity has the potential to improve physical and mental health outcomes of persons with depression. However, feasible and acceptable strategies to integrate physical activity interventions into real-world settings are needed.ObjectiveTo assess the feasibility and acceptability of a manualized Behavioral Activation intervention aimed to increase physical activity in persons with depression (defined as a PHQ-9 score ≥ 10).MethodsA single-arm pilot study was conducted. The intervention consisted of 8 tele-therapy sessions delivered over a 10-week period. Measures of feasibility included screening, enrollment, intervention adherence, outcome data availability, and intervention fidelity. Acceptability was assessed with a post-intervention survey and qualitatively through focus groups and interviews. Preliminary efficacy of the intervention was assessed by evaluating pre-to-post changes in physical activity and depressive symptoms.ResultsAll feasibility metrics exceeded predetermined feasibility goal metrics with the exception of Fitbit wear and screening rate, which was due to a greater than anticipated enrollment rate. Participants (n = 15) reported perceived benefits from the intervention and convenience in attending tele-therapy sessions. Depressive symptoms, as measured by the PHQ-9 improved (16.8 at enrollment to 10.1 post intervention, Cohen’s d = 1.13). Self-reported moderate-to-vigorous physical activity (MVPA) increased from 22.0 min/week at baseline to 36.67 min/week post-intervention (d = 0.58). Physical activity as measured by the Fitbit showed little change (daily step 5543.29 during Week 1 to 6177.48 during Week 10, (d = 0.14); MVPA 21.23 min/week during Week 1 to 19.22 at Week 10 (d = 0.0.06).ConclusionsResults of the pilot study suggest the intervention is feasible to deliver and acceptable to participants. Preliminary results suggest the intervention may be effective in improving depressive symptoms and increasing self-reported physical activity.Trial registrationClinicalTrials.gov NCT04990401, Registered July 21, 2021.

Testing alcohol container warning labels among alcohol consumers in the field over a 4-week period: a protocol for a randomized field trial

Testing alcohol container warning labels among alcohol consumers in the field over a 4-week period: a protocol for a randomized field trial

The barriers and enablers to completing the RPS core advanced pharmacist credentialing programme via the CPPE/RPS pilot programme

Abstract Introduction The RPS and CPPE launched a pilot programme in March 2023 to support 300 pharmacists to evidence their advanced practice via an e-portfolio aligned to the RPS Core Advanced curriculum1 in a 12-week period. Successful pharmacists are credentialed as Advanced Pharmacists. The pilot involved CPPE education supervisors (ESs) support, an online learning platform and small group learning and support. Aim To ascertain barriers and enablers to completing an advanced e-portfolio and to identify how to improve the on-going programme. Methods The invitation to complete the anonymous survey in May 2024 was administered via www.onlinesurveys.ac.uk and developed linking to key performance indicators around education supervision support, to understand why candidates were deferring cohorts and to ascertain additional support accessed by candidates. Ethical approval was not required as study is service evaluation. Candidates who responded included those who successfully submitted their e-portfolio ‘submitted candidates’ n=10, candidates who are resubmitting their portfolio after not passing ‘resubmission candidates’ n=8, pharmacists currently completing their portfolio ‘current candidates’ n=44 and those who started but left without submitting ‘attrition candidates’ n=13. Results All submitted candidates scored ES support as very good/excellent; 60% agreed strongly they would not have submitted their portfolio without this support. Each cohort had two small-group tutorials where candidates accessed peer support and joined WhatsApp groups. Only 38% of resubmission candidates, compared to 80% of portfolio submitted candidates attended both group tutorials. Resubmission candidates were less likely to access additional peer support (38% for resubmission candidates vs 60% for submitted candidates) or to join the cohort WhatsApp group (75% for resubmission candidates vs 90% for submitted candidates). Resubmission candidates rated the remedial SMART action planning support highly. Submitted candidates would have found it easier to complete their portfolio with more comprehensive (60%) and timely responses (70%) from their collaborators. This compares to 55% and 59% of current candidates recognising the same issues. Submitted candidates wanted more allocated time during working hours to support completion of the portfolio (60% rising to 80% for current candidates). There is a notable increase for current candidates wanting a longer period to complete their portfolio (75% compared to 40% of submitted candidates). Half of submitted candidates (50%) reported spending more than 5 hours (average) each week on their portfolio compared to 18% of current candidates. Top reasons for attrition include too busy with work, family responsibilities, personal health challenges and no support from the workplace. Candidates across all groups suggested programme improvement ideas including more evidence examples, making the RPS platform less difficult to navigate and use, and more education supervisor support. Motivating factors for completion include recognition of advanced level working and preparation for the consultant portfolio. Conclusion Enablers include education supervision, CPPE resources/facilitated support events, peer support, WhatsApp groups, recognition and career progression. Key barriers include needing more time and lack of dedicated time at work to complete e-portfolio, lack of timely and comprehensive support from collaborators and finding the RPS e-portfolio platform difficult to navigate. Limitations – low numbers and response rate. Data collection is on-going. Reference 1. Royal Pharmaceutical Society, Core Advanced Pharmacist Curriculum, 2022 https://www.rpharms.com/Portals/0/Credentialing/RPS%20-%20Core%20Advanced%20curriculumFINAL.pdf?ver=8gc3s2aE9t1nZN37CSU7Lw%3d%3d (Accessed 28 May 2024)

Effects of the Dietary Fat Concentration and Fatty Acid Pattern on the Urine Composition, Apparent Nutrient Digestibility, and Selected Blood Values of Healthy Adult Cats

Background/Objectives: The dietary fat concentration and fatty acid profile can influence various aspects of the feline organism. This study examined their effects on the urine composition, apparent nutrient digestibility, and selected blood variables. Methods: Ten healthy adult cats (46.6 ± 14.1 months old, initial body weight 4.99 ± 0.91 kg) received a low-fat basic diet with or without the addition of sunflower oil, fish oil, or lard in a randomized crossover design. The oil and lard were added to the daily amount of food at 0.5 or 1 g/kg body weight of the cats. At the end of each 3-week feeding period, urine, feces, and fasting blood samples were collected. Results: The results demonstrated only small effects of the dietary fat concentration and source on the urine composition of the cats. In addition, the apparent nutrient digestibility was unaffected by the dietary treatments. The supplementation with fish oil, but not sunflower oil or lard, lowered the triglycerides and increased the total and low-density lipoprotein cholesterol concentrations in the plasma of the cats (p < 0.05). However, these blood values were within the physiological reference ranges among all groups. Conclusions: It can be concluded that the dietary fat content and fatty acid profile did not adversely affect the urine composition or nutrient digestibility in healthy adult cats. The lipid metabolism of the animals was modulated by the supplementation with fish oil, a relevant source of n-3 fatty acids. The observed triglyceride-lowering effect should be further investigated in clinical studies.

On-time power mobility and physical activity in toddlers with motor delays: A randomized controlled trial using body-worn sensors

ABSTRACT This study conducted a secondary analysis to objectively measure the effects of modified ride-on cars (MROCs) training in different postures on physical activity (PA) levels in children with motor delays. Data from 39 participants were analyzed in a randomized controlled trial. The participants included those using MROC in standing postures (n = 11, mean age = 22.87 months), MROC in sitting postures (n = 16, mean age = 19.53 months), and a control group that received conventional therapy (n = 12, mean age = 23.30 months). PA intensity was measured using an ActiGraph GT3X on the participants’ wrists and right hip at weeks 1, 6, and 12 of the 12-week intervention period. This trial was registered at ClinicalTrials.gov (NCT02527356). The demographic data were similar across the groups. No significant differences were found in the interaction, group, or time effects for any of the positions (p > 0.05). The PA levels were consistent in at least light PA intensity range. MROC training may yield PA levels comparable to those of conventional therapy. Variations in activity and motor impairment severity could affect outcomes. Future studies should investigate factors such as task characteristics, motor delay severity, PA cutoff points, and training dosage that may influence PA intensity.

Efficacy of Static Magnetic Field Therapy on Pain Intensity, Functional Disability, Sleep Quality and Depressive Symptoms in Patients with Mechanical Neck and Low Back Pain.

Mechanical neck pain (MNP) and mechanical low back pain (MLBP) can have a negative impact on the quality of life of patients and may be associated with high levels of disability. Magnetic field therapy has been using in the treatment of various diseases. This study was conducted to assess the effects of Static Magnetic Field (SMF) therapy generated by neodymium magnets in patients with MNP and MLBP. In this randomized, double-blind, sham-controlled, crossover study, patients with MNP and MLBP were randomly assigned to either the magnetic band or sham band treatment groups. After the initial 2-week phase (with participants randomly assigned to either treatment or sham-control), both groups underwent a 1-week washout period. Subsequently, the groups were swapped and proceeded with a second 2-week phase. Visual Analogue Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODI), Neck Disability Index (NDI), Insomnia Severity Index (ISI), and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate the patients' pain severity, functional disability, sleep quality, and levels of depressive symptoms, respectively. Of the 30 subjects, 17 (56.7%) had MLBP, whereas 13 (43.3%) had MNP. Magnetic band treatment (MBT) resulted in a significant decrease in the VAS score (p < 0.001) in all patients. MBT led to a significant decrease in the ODI score (p = 0.009) in patients with MLBP. A significant decrease in the NDI score was found in MBT (p < 0.001) in patients with MNP. The improvement in ISI and PHQ-9 scores was also significantly higher in MBT (p < 0.001). For patients with MNP and MLBP who have not experienced sufficient benefits from conventional treatments, neodymium magnets can be considered as an alternative treatment option due to their significant properties.

Effects of probiotics on selected anthropometrics and biochemical measures in overweight or obese Saudi subjects: a double-blind, placebo-controlled, randomised clinical trial.

This study aimed to assess the effects of multi-strain probiotics on anthropometric and biochemical measures in Saudi adults with overweight or obesity. Single-centre, double-blind, placebo-controlled, randomised clinical trial. Occupational Health Clinics at King Saud University Medical City, Riyadh, Saudi Arabia. Ninety-three Saudi participants with overweight or obesity were randomly assigned to receive twice-daily doses of either placebo (n 49) or 30 × 109 CFU/g of HEXBIO® containing three Lactobacillus and three Bifidobacterium species (n 44) in a double-blind manner over a 12-week period, respectively. Both groups adhered to a hypoenergetic diet. Anthropometric measurements, glycaemic indices and lipid profiles were evaluated at baseline and post-intervention. Following the 12-week intervention, no statistically significant differences were found in all between the probiotic group and placebo group comparisons, except for fat intake, where the group*time interaction showed a significant decrease in favour of the probiotic group (P = 0·02). However, significant within-group reductions were observed in the probiotic group: body weight (-0·9 kg, P = 0·02), HC (-1·5 cm, P = 0·002), energy intake (-387·3 kcal/d, P = 0·002), fasting glucose (-0·7, P = 0·002) and LDL-cholesterol (-0·7, P = 0·02). Consumption of multi-strain probiotic supplementation over 12 weeks significantly decreased fat intake in Saudi adults with overweight or obesity, with the probiotic group highlighting improved anthropometric and biochemical parameters. Further research is needed to evaluate the long-term clinical significance of this dietary practice and whether it has a meaningful impact on overall health beyond the placebo effect.

Plasma essential amino acid levels in first episode psychosis at baseline and after antipsychotic treatment

This study assessed plasma levels of essential amino acids (EAA) in drug-naïve first episode psychosis (FEP) patients at diagnosis and after 10 weeks of antipsychotic treatment. Forty FEP patients were enrolled at baseline, with blood samples collected before and after a 10-week antipsychotic treatment period. Plasma EAA levels were measured using an LC/MS/MS method. Psychotic symptoms were evaluated using standardized inventories before and after treatment. A decrease in BPRS score of more than 40% was used to indicate treatment response. Thirty-five healthy volunteers served as the control group. Baseline plasma levels of Thr, Met, Leu, Lys, His, and Tyr were higher in FEP patients than in healthy controls. After 10 weeks of treatment, Leu, His, and Tyr increased further, primarily in treatment-responsive patients. Conversely, Val level was lower than controls in patients at baseline and remained unchanged after treatment. Increased EAA levels were correlated with lower (less severe) scores in positive symptom scales. Treatment non-responders had persistently low Tyr/large neutral amino acid (LNAA) ratio. Tyr/LNAA ratio increased after treatment, specifically in treatment-responders. Phe/Tyr ratio decreased post-treatment in both responder and non-responder groups. Elevated EAA levels in FEP patients may signify compensatory responses to increased physiological demand for neurotransmitters or energy. Combining specific EAA supplementation with antipsychotic treatment may enhance treatment response in these patients.

Morning versus Nocturnal Heart Rate and Heart Rate Variability Responses to Intensified Training in Recreational Runners

BackgroundResting heart rate (HR) and HR variability (HRV) are widely used parameters to assess cardiac autonomic nervous system function noninvasively. While resting assessments can be performed during sleep or after awakening, it would be relevant to know how interchangeable the results of these measurements are. This study aimed at examining the alignment between nocturnal and morning assessments during regular endurance training and in response to intensive training. A total of 24 recreational runners performed a 3-week baseline period (BL) and a 2-week overload (OL) period (Lucia’s training impulse + 80%). Their running performance was assessed with a 3000-m running test after the BL and OL. The participants recorded daily their nocturnal HR and HRV (the natural logarithm of the root mean square of successive differences; LnRMSSD) with a photoplethysmography-based wrist device and performed an orthostatic test (2-min supine, 2-min standing) every morning with a chest-strap HR sensor. The HR and LnRMSSD segments that were analyzed from the nocturnal recordings included start value (SleepStart), end value (SleepEnd), first 4-h segment 30 min after detected sleep onset (Sleep4h), and full sleep time (SleepFull). The morning segments consisted of the last-minute average in both body positions. All segments were compared at BL and in response to the 3000-m test and OL.ResultsAll nocturnal HR and LnRMSSD segments correlated with supine and standing segments at BL (r = 0.42 to 0.91, p < 0.05). After the 3000-m test, the HR increased and LnRMSSD decreased only in the SleepStart, Sleep4h, and SleepFull segments (p < 0.05). In response to the OL, the standing HR decreased (p < 0.01), while the LnRMSSD increased (p < 0.05) in all segments except for SleepStart. The Pearson correlations between relative changes in nocturnal and morning segments were − 0.11 to 0.72 (3000-m) and − 0.25 to 0.79 (OL). The OL response in Sleep4h HR and LnRMSSD correlated with the relative change in 3000-m time (r = 0.63, p = 0.001 and r=-0.50, p = 0.013, respectively).ConclusionsNocturnal and morning HR and LnRMSSD correlated moderately or highly in the majority of cases during the BL, but their responses to intensive training were not similarly aligned, especially in LnRMSSD. The nocturnal segments seemed to be sensitive to physical loading, and their responses were associated with the performance-related training responses.

MHealth-Based Self-Management Program for Patients With Rheumatoid Arthritis: A Pilot Randomized Controlled Study.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that gradually limits physical function and decreases quality of life (QOL). We evaluated an mHealth-based self-management program to help patients with RA improve their physical and psychological health, self-efficacy, physical activity, and QOL. The sample included 73 experimental and 69 control participants. A pilot randomized controlled design was employed to identify the effectiveness of an 8-week mHealth-based self-management program, which comprised educational modules regarding disease management and exercise, cognitive training, and motivational support through mobile messages and periodic phone calls. Knowledge of the health effects of RA, disease activity, perceived health, depression, self-efficacy for controlling symptoms, physical activity, and QOL were evaluated pre- and postintervention and after the 4-week follow-up period. This pilot study indicates that the mHealth-based program for people with RA is feasible. The mHealth self-management program improved patients' knowledge of RA, depression, self-efficacy for controlling symptoms, physical activity, and perceived health; however, disease activity and QOL did not significantly change. This pilot study demonstrates the potential of mHealth intervention as an effective program for strengthening self-management capacities in patients with RA. Trial Registration: KCT0007523.

Optimal incubation duration of liquid cultures for assessing culture negative conversion in patients with Mycobacterium avium complex and Mycobacterium abscessus pulmonary diseases.

Mycobacterial liquid culturing typically requires six weeks or longer, primarily because of the slow growth rate of Mycobacterium tuberculosis. This study aimed to evaluate the potential of shortening the duration of mycobacterial liquid culturing in healthcare settings with high prevalence rates of non-tuberculous mycobacteria. We retrospectively analyzed the relationship between mycobacterial species and time to positive testing of liquid cultures from sputum samples using the Mycobacteria Growth Indicator Tube system over a 3.5-year period beginning in July 2020 at a university hospital in Japan. We analyzed 15,147 sputum culture samples and found a 1.1% positivity rate for Mycobacterium tuberculosis complex, while the rates for Mycobacterium avium complex and Mycobacterium abscessus were 17.6% and 2.1%, respectively. The median time to positivity was 17 days for Mycobacterium tuberculosis complex, 9 days for Mycobacterium avium complex, and 4 days for Mycobacterium abscessus. Comparing a 4-week culture period with an eight-week period, the positivity rates for Mycobacterium avium complex and Mycobacterium abscessus were 97.0% and 99.4%, respectively. In settings with a high incidence of non-tuberculous mycobacteria, the basic liquid culturing period can be safely shortened to 4 weeks without significantly compromising detection sensitivity, except for the samples that are highly suspected to contain tuberculosis, extremely slow-growing mycobacteria, smear-positive, or nucleic acid amplification testing positive.

Comparative analysis of ferric carboxymaltose and iron sucrose in treating iron deficiency anemia in perimenopausal women with heavy menstrual bleeding: a randomized controlled trial.

To evaluate the impact of intravenous ferric carboxymaltose (FCM) compared to iron sucrose (ISC) in perimenopausal women with heavy menstrual bleeding (HMB) and anemia. This prospective, open-label, randomized controlled trial enrolled perimenopausal women (40-50 years) with HMB and hemoglobin levels between 6-10 g/dL, intolerant or non-compliant to oral iron therapy. The study compared FCM and ISC by assessing hematological parameters, including hemoglobin, ferritin, and iron levels, over a 12-week period. The patients were followed up at 3, 6, and 12 weeks after initiation. The adverse effects were also evaluated. The study included 60 perimenopausal women, with 30 in each group. The baseline patient characteristics were comparable. FCM demonstrated a statistically significant higher mean increase in hemoglobin (4.97 g/dL) than ISC (4.63 g/dL) over 12 weeks. The proportion of patients achieving correction of anemia (Hb ≥12%) was higher in the FCM group (75.9% vs. 65.5%). Serum ferritin levels were significantly higher in the FCM group after 3 weeks. Adverse effects were minimal and comparable between the groups. Although the direct cost of FCM is high, its ability to be administered in larger doses may result in lower total costs. In perimenopausal women with heavy menstrual bleeding and iron deficiency anemia, FCM and ISC show comparable efficacy in increasing hemoglobin levels with similar side effect profiles. This study highlights the potential benefits of FCM and calls for further exploration of these therapies in diverse patient populations.