COMBI Group Research Articles

Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial

BackgroundAnkle sprain is the most common sports-related injury with a high rate of recurrence and associated costs. Recent studies have emphasised the effectiveness of both neuromuscular training and bracing for...

Effectiveness of progressive resistance strength training versus traditional balance exercise in improving balance among the elderly - a randomised controlled trial.

Falls are important health issues among the elderly people. Most falls in elderly result from abnormal balance control mechanisms. Balance and muscle force generation are directly related, and are associated with age related muscular changes. Studies addressing fall prevention have focused on various group and individualised strength training. However, evidence on strengthening of key muscles necessary for maintaining balance and postural control is lacking. To evaluate the effectiveness of individualised progressive resistance strength training (PRT) programme in improving balance for forward limits of stability in elderly with balance impairment, compared to traditional balance exercise (TBE), and combination of both (COMBI). This randomised controlled trial included three groups; 18 subjects in each aged ≥ 65 years, from the elderly care centres of Mangalore city in Southern India (between June 2008 and December 2012). Block randomisation technique was used and allocation concealment was done using sequentially arranged sealed opaque envelopes. The TBE group received 8 component traditional balance exercise; 4 times a week for 6 months. The PRT group received resistance training for the key muscles of lower extremities, using DeLormes and Watkins protocol. The COMBI group received PRT and TBE alternately (2 days of PRT and 2 days of TBE per week). Functional reach test (FRT) was used for measurement of forward limits of stability. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 15. For functional reach, PRT group had steady progression from baseline to 6 months (p<0.001). The TBE and COMBI groups showed considerable initial improvement; beyond 3 months, moderate improvement was seen. The changes in scores of FRT were significantly better for PRT than TBE. Individualised PRT intervention targeting the key muscles of lower limbs is more effective than TBE in improving forward limits of stability among non-frail elderly aged ≥65 years.

SAT0308 Efficacy and toxicity of leflunomide monotherapy versus leflunomide combination therapy with non-biological disease-modifying antirheumatic drugs in psoriatic arthritis

BackgroundAbout 7% of patients (pts) with arthritis are patients with psoriatic arthritis (PsA). After 10 years of PsA 55% of pts have deformity more than 5 joints. Only one trial...

Comparison of inhibitors of renin–angiotensin–aldosterone system (RAS) and combination therapy of steroids plus RAS inhibitors for patients with advanced immunoglobulin A nephropathy and impaired renal function

The adaptation of steroid therapy and the effect of renin-angiotensin-aldosterone system inhibitors (RASIs) for advanced immunoglobulin A nephropathy (IgAN) patients with impaired renal function are still controversial. We divided 63 IgAN patients with an estimated glomerular filtration rate (eGFR) of <60ml/min/1.73m(2) and proteinuria ≥ 0.5g/day into two groups: the RASI group (RASI, n=33), treated with RASIs alone; and the combination group (COMBI, n=30), treated with corticosteroids and RASIs. We analyzed the clinical and histological background, renal survival rate, and the risk factors for progression. Renal function (mean eGFR: COMBI 46.4 vs. RASI 47.0ml/min/1.73m(2)), the amount of proteinuria (median: COMBI 1.39 vs. RASI 1.17g/gcreatinine) and histological backgrounds were not significantly different between the groups, but urinary red blood cells (U-RBCs) were significantly higher in the COMBI group than in the RASI group (median: COMBI 30.0 vs. RASI 10.0counts/high-power field, P=0.0171). The serial change in proteinuria did not differ until 5 years after treatment, but U-RBCs were significantly decreased in both groups (P<0.0001), and eGFR was significantly decreased in the RASI group (P<0.001) but not in the COMBI group. The results for each year after treatment did not differ significantly between both groups. The renal survival rate was not significantly different between the groups. There was no independent risk factor for progression by Cox regression analysis. Combination therapy with steroids and RASIs was not superior to monotherapy with RASIs for advanced IgAN with impaired renal function.

Comparison of antifungal efficacies of moxifloxacin, liposomal amphotericin B, and combination treatment in experimental Candida albicans endophthalmitis in rabbits

The goal of this study was to compare in vitro and in vivo efficacy of moxifloxacin and liposomal amphotericin B (Amp-B) monotherapies and combination treatment against Candida albicans in an exogenous endophthalmitis model in rabbit eyes. Microplate dilution tests and checkerboard analysis were performed to detect in vitro efficacies. Endophthalmitis was induced by intravitreal injection of C. albicans in 40 rabbit eyes with simultaneous intravitreal drug injection according to prophylactic treatment groups. Group 1 (control group) received 0.1 mL of balanced salt solution, group 2 (moxi group) 100 microg moxifloxacin/0.1 mL, group 3 (Amp-B group) 10 microg liposomal Amp-B/0.1 mL, and group 4 (combi group) both 100 microg moxifloxacin/0.1 mL [DOSAGE ERROR CORRECTED] and 10 microg liposomal Amp-B/0.05 mL intravitreally. Clinical examination, quantitative analysis of microorganisms, and histopathologic examination were performed as in vivo studies. The minimum inhibitory concentration of liposomal Amp-B against C. albicans was found to be 1 microg/mL. Moxifloxacin showed no inhibition of in vitro C. albicans growth. The minimum inhibitory concentration values of liposomal Amp-B for C. albicans were reduced two- to eightfold with increasing concentrations of moxifloxacin in vitro. In vivo, there was no C. albicans growth in the combi group (zero of eight eyes), whereas three eyes (37.5%) showed growth in the Amp-B group. Vitreous inflammation, retinal detachment, focal retinal necrosis, and outer nuclear layer loss were found to be lower in the moxi group compared with the control group. Ganglion cell and inner nuclear layer loss was observed in all eyes (100%) in both the moxi and combi groups, whereas only in 25% (two of eight eyes) in the Amp-B group. Moxifloxacin strongly augments the efficacy of liposomal Amp-B against C. albicans in vitro, although it has no in vitro antifungal activity when used alone. It is interesting that we found a synergistic effect for in vitro tests but failed to demonstrate it in vivo. When 100 microg moxifloxacin/0.1 mL is given intravitreally, it has some toxic effects that are limited to the inner retinal layers.

358 THE CONSEQUENCE OF HIGH NON-ESTERIFIED FATTY ACID CONCENTRATIONS DURING OOCYTE IN VITRO MATURATION ON BOVINE EMBRYO QUALITY

High non-esterified fatty acid (NEFA) concentrations in the blood, associated with negative energy balance (NEB), obesity or diabetes Type II are known to alter the follicular micro-environment. These environmental changes have been associated with disappointing fertility outcome through disabled ovarian cell function and oocyte’s developmental competence. Our hypothesis was that elevated NEFA concentrations during final oocyte maturation might hamper the quality of the pre-implantation embryo as well. To assess embryo quality, the present study focused on total cell number and apoptotic index in 7-day-old embryos. Applied NEFA concentrations in the maturation medium were based on analyses in the follicular fluid of high yielding dairy cows early post partum during NEB. Bovine cumulus-oocyte complexes were exposed to 1) physiological NEFA concentrations, i.e. a combination of basal palmitic (25 μM), stearic (50 μM) and oleic acid (75 μM) concentrations (CONTROL), 2) elevated NEFA concentrations, i.e. a combination of high palmitic (75 μM), stearic (150 μM) and oleic acid (200 μM) concentrations (HIGH COMBI) and 3) elevated palmitic acid (75 μM) concentrations (HIGH PA). Palmitic acid has been recognized as a major saturated fatty acid in terms of cellular toxicity. After serum-free in vitro maturation (24 h) and fertilization (22 h), zygotes were cultured in SOF medium with 5% serum for 7 days. Blastocysts were evaluated for developmental competence, total cell number (by Propidium Iodide staining) and apoptotic index (by TUNEL detection kit). In total, 684 oocytes were cultured in 3 replicates. Data were analyzed with binary logistic regression and a mixed model ANOVA. Preliminary research showed that maturation in a combination of basal NEFA concentrations has no effect on oocyte’s developmental competence compared to the standard serum free maturation system. In the present study, maturation in HIGH COMBI resulted in significantly lower blastocyst rates (21.4%) compared to CONTROL (30.1%) (P = 0.03). No significant effect of HIGH PA maturation on blastocyst rate (24.1%) could be found. Also total cell number tended to be lower in the HIGH COMBI (104.7 ± 26.1) compared to CONTROL (125.8 ± 29.4) (P = 0.08). The apoptotic index was significantly increased in the HIGH PA group (0.22 ± 0.12) compared to the CONTROL group (0.11 ± 0.07) (P = 0.02) and tended to be higher than the HIGH COMBI group (0.14 ± 0.12) (P = 0.06). Maternal metabolic conditions, leading to increased lipolysis and high NEFA concentrations, can hamper fertility through a reduction of the oocyte’s developmental competence. The data of the present study furthermore suggest that elevated NEFAs might induce a negative carry over effect from the oocyte during its maturation to the embryo quality. This may ultimately lead to embryonic mortality and thus to a disappointing fertility outcome. Veerle Van Hoeck is supported by the Special Research Fund, University of Antwerp (Grant 22590).

Rheumatoid Atlantoaxial Subluxation Can Be Prevented by Intensive Use of Traditional Disease Modifying Antirheumatic Drugs

To evaluate the 5-year incidence of cervical spine disorders in patients with early rheumatoid arthritis (RA) treated by 2 different disease modifying antirheumatic drug (DMARD) strategies. In a national, multicenter, prospective FIN-RACo-trial, a cohort of 199 patients with early, clinically active RA was randomly assigned to treatment with a combination of 3 DMARD and prednisolone (Combi group) or with a single DMARD (Single group) with or without prednisolone, aiming to induce remission. After 2 years, the DMARD therapy was unrestricted. Lateral view cervical spine radiographs during full flexion and extension were taken at the 5-year followup visits. The presence of anterior atlantoaxial subluxation (aAAS), atlantoaxial impaction (AAI), and subaxial subluxation (SAS) was assessed in the 149 patients with radiographs available (80 Single and 69 Combi). At the 5-year visits, aAAS, AAI, and SAS were found in 13 (9%), 6 (4%), and 9 (6%) patients, respectively. The corresponding Single/Combi group ratios were 11/2, 5/1, and 5/4. Of the baseline data, only poor physical function [Health Assessment Questionnaire (HAQ); p = 0.024] and Single treatment strategy (p = 0.019) were significantly associated with aAAS. Worse HAQ scores and Disease Activity Score 28 values were found in patients who developed aAAS during the 5-year followup. RA patients with sustained clinical disease activity and poor HAQ are at increased risk of developing aAAS. The development of aAAS during the first 5 years of RA was rare among the patients treated with a combination of DMARD for at least 2 years from the diagnosis. Intensive treatment with traditional DMARD prevents or retards the development of aAAS in patients with recent-onset RA.

Improved endocervical sampling and HPV viral load detection by Cervex‐Brush® Combi

Liquid-based cytology (LBC) for cervical screening is becoming increasingly used. Together with SurePath LBC, various collecting devices can be utilized, among which the Cervex-Brush is the most widely used. The new Rovers Cervex-Brush Combi combines the advantages of the Cervex-Brush with the EndoCervex-Brush increasing sampling of the endocervical canal. The objective of this study was to analyse and to compare the Cervex-Brush Combi with the Cervex-Brush for the collection of squamous and endocervical cells, human papillomavirus (HPV) typing/quantification and disease detection in SurePath LBC. Using either the Cervex-Brush or the Cervex-Brush Combi 100 consecutive SurePath LBC samples were collected using each brush type. All 200 slides were read by the FocalPoint and screened by guided screening using slide wizards. The viral load of HPV type 16 E7, 18 E7, 31 E6, 33 L1, 33 E6, 35 E4, 39 E7, 45 E7, 51 E6, 52 L1, 52 E7, 53 E6, 56 E7, 58 L1, 58 E6, 59 E7, 66 E6 and 68 E7 was determined using a TaqMan-based real-time quantitative PCR analysis. The mean number of sampled squamous cells did not differ between the two brush types (54 963 versus 54 595 cells). The use of the Cervex-Brush Combi, however, resulted in a two- to threefold increase in the number of sampled endocervical cells (P < 0.00001). Using the Cervex-Brush Combi slightly more lesions were detected (three versus two low-grade squamous intraepithelial lesions), and resulted in the detection of more atypical squamous cells of undetermined significance (six versus three). In the Cervex-Brush group, 60% (3/5) of abnormal smears were positive for oncogenic HPV types, whereas 66.7% (6/9) of abnormal smears in the Cervex-Brush Combi group tested positive. The median HPV viral load for samples taken with the Cervex-Brush Combi was 0.1825 copies/cell and was significantly higher than in samples taken with the Cervex-Brush (0.0042 copies/cell) (P = 0.02). Sampling with the Cervex-Brush Combi resulted in the collection of the same amount of squamous cells, but in a two to threefold harvest of endocervical cells. This led to the detection of a higher viral load for oncogenic HPV and an increase in the number of detected abnormal smears.

Arm Muscle HSP70 Response to Strenght Training

2182 Heat shock protein 70 (HSP70) expression in skeletal muscle is involved in a variety of muscular changes including myopathy, muscle atrophy, muscle hypertrophy and ischemia.HSP70 plays an important role in muscular adaptation to training and can serve as an indicator for cellular stress. It is known that HSP70 expression and HSP70 response to exercise are related to muscle fiber type. Up to date, data on HSP70 response to training in human muscles have been derived from leg muscles and there is no study reporting HSP70 response in arm muscles. PURPOSE: To investigate HSP70 response to strength training in arm muscle. METHODS: Twelve male volunteers performed either a 6-week strength training (3d/w) with maximum contractions (Max group) or combination training of maximum contractions, ballistic and strech-shortening movements (Combi group). Muscle samples were taken from m. triceps brachii before and after training by fine needle biopsy technique. HSP70 (from 2.5 μg total protein loaded) was measured with Western Blot with reference to a series of standard HSP70. HSP70 mRNA was determined using quantitative real-time RT-PCR in relation to a house-keeping (HPRT) gene. RESULTS: Strength training produced a significant increase in 1 RM in both groups (5.6 kg for Max group and 5.0 kg for Combi group, respectively), and combined strength training led an additional improvement in maximum movement velocity (0.1 m/s, p<0.05). HSP70 (median) increased after training from 15.2 to 58.9 ng, (P<0.01) in Max group and 15.5 to 54.2 ng, (P<0.01) in Combi group. There was also a significant difference of the copy numbers of HSP70 mRNA before and after training in Max group (2.59 vs. 10.1, P<0.01) and Combi group (1.93 vs. 10.57, P<0.01). CONCLUSION: In response to physical training, HSP70 can be induced in human arm muscles. In our study different training programs with comparable training intensity and volume seem not to affect HSP70 expression. Based on its universal role as “molecular chaperone” HSP70 can have important impact on the adaptation to strength training in arm muscle composed predominantly of fast muscle fibers.

Combined Antegrade-Retrograde Blood Cardioplegia does not Protect Right Ventricle Better than Either Technique Alone in Patients with Occluded Right Coronary Artery

To study the hypothesis that combined antegrade-retrograde delivery of cardioplegia might overcome the limitations in myocardial protection of either technique alone, we compared the distribution of the different cardioplegic approaches by assessing myocardial cooling and evaluated the effects on right ventricular (RV) function in elective coronary artery bypass grafting (CABG) patients with occluded right coronary artery (RCA). In a randomized trial, 15 patients received exclusively antegrade (ante group), 14 patients received exclusively retrograde (retro group) and 15 patients received combined, alternating antegrade-retrograde (combi group) cold blood cardioplegia. Myocardial temperatures were measured at four sites in the heart. Right ventricular function was assessed by determining the ejection fraction (fast-response thermodilution) and preload-related RV stroke work in repeated measurements. Myocardial cooling was similarly uneven and the posterior wall of the RV remained above 20°C after all three methods of delivering hypothermic (5-7°C) cardioplegia. The RV ejection fraction and preload-related (right atrial pressure) RV stroke work decreased postoperatively similarly in all groups. The results suggest that combined antegrade-retrograde cold blood cardioplegia could not provide more homogeneous myocardial cooling or better RV recovery than either technique alone in three-vessel-diseased CABG patients with occluded RCA.

Effects of the prolongation of survival time on immunotherapy with an extract from human tubercle bacilli (SSM) in gastric cancer in cases of non-curative resection. Statistical analysis of the results of long-term observation

A retrospective study on the effects of postoperative adjuvant immunotherapy for gastric cancer was made. In order to evaluate the efficacy of immunotherapy, this study was undertaken from a different point of view, that is, immunotherapy was put on a basic treatment and immunochemotherapy was used as a control.Six hundred and three patients subjected to non-curative resection were selected from 699 patients having been operated palliatively and recorded in the registration form of The Research Institute of Vaccine Therapy for Tumors and Infectious Diseases, Nippon Medical School from April 1979 to March 1980. 460 patients were excluded from this study because they were not satisfied with the criteria; e.g., 208 out of 460 excluded patients from this study gave no reply for the questionnarie, and other 252 cases had not been confirmed histologically the cancer and/or the initial therapy for some of these 252 cases was not SSM. Therefore, this report is based on 143 patients. In 69 cases immunotherapy with an extract from human tubercle bacilli (SSM) as sole treatment was carried out (immuno group), and combined therapy with SSM plus chemotherapeutic agents, mainly Mitomycin C, 5-Fluorouracil, FT-207 and Cytosine arabinoside, was given to 74 patients (combi group).There were no significant differences in the back ground factors of the two groups. The survival rate was higher in the immuno group, 3 and 5 year survival rate in the immuno group was 32.4% and 27.7%, and that of the combi group was 15.9% and 8.9% respectively. It showed that the survival rate of the immuno group was significantly higher than that of the combi group.In addition, stratifying the back ground factors caused non-curative resection, the influence for the prognosis was studied by means of statistical analysis. In comparison between the two groups, all survival curves in the immuno group were surperior to those in the combi group. Especially, those on H factor positive cases were exceedingly.These results suggested that immunotherapy with SSM was effective in patients undergone a non-curative resection for gastric cancer, and it was emphasized that the establishment of sole treatment group with immunotherapy was significant for the evaluation of effectiveness of immunotherapy.