Healthy Volunteer Subjects Research Articles

Hypoxia-inducible factors in arteriovenous fistula maturation: A prospective cohort study.

Neointimal hyperplasia is the main cause of arteriovenous fistula (AVF) failure. Hypoxia-inducible factors (HIFs) factors are associated with neointimal hyperplasia. Thus, we investigated the association between HIF-2 alpha (HIF-2α) and AVF maturation in end-stage kidney disease (ESKD) patients. This prospective cohort study was conducted in 21 voluntary healthy subjects and 50 patients with ESKD who were eligible for AVF creation. Inclusion criteria were being ESKD patients without a history of AVF surgery and dialysis. Eight patients excluded from the study due to having unavailable veins six patients were excluded due to acute thrombosis after surgery. One patient lost to follow-up. A total of 35 patients were included in final analysis. The blood samples were collected a day before the AVF surgery for biochemical parameters and HIF-2α measurement. HIF-2α levels were measured by the ELISA method. Compared with healthy subjects, ESKD patients had a significantly higher level of HIF-2α. [1.3 (1.0-1.9) vs 2.2 (1.6-3.0)] (P=.002). Patients were divided into two groups after the evaluation of AVF maturation, as the mature group (n=19) and the failure group (n=16). Serum HIF-2α level was 1.7 (1.1-1.8) in the mature group; however, it was 3.1 (2.8-3.3 in failure group (P<.001). Multiple logistic regression analyses showed that HIF-2α independently predicted AVF maturation. The ROC curve analysis showed that HIF-2α>2.65 predicted AVF maturation failure with the 87% sensitivity and 94% specificity [AUC:0.947, 95% CI (0.815-0.994), P<.001]. HIF-2-α levels were higher in ESKD patients than healthy subjects. HIF-2-α could be a marker of AVF maturation failure.

Are hard hats a risk factor for WRMSD in the cervical-thoracic region?

To investigate the effect of wearing hard hats on the lower cervical and upper thoracic region using surface electromyography (sEMG) and possible link to work-related musculoskeletal disorder (WRMSD). Twenty study subjects wore sEMG sensors placed on the upper trapezius muscle on their dominant side to assess muscle activity while wearing different hard hats. Study subjects were asked to don six different hard hats and assume varied neck postures. A repeated-measures design was used to analyze the results for difference and similarities in muscle activity. There was a small, significant effect of wearing a hard hat on muscle loading in the upper trapezius (p = 0.038). Post-hoc analyses revealed the only statistically significant difference was between wearing no hard hat at all and wearing head protection (without accessories) in the flexed posture (p = 0.006). The results demonstrated that there was little difference in lower cervical and upper thoracic muscle activity while donning hard hat and assuming various neck postures. Wearing a sample of commonly used hard hats in this study does not appear to substantially increase muscle activity that would cause fatigue in the lower cervical and upper thoracic region among young, healthy volunteer subjects.

Quantification and Qualification of Stem Cells From Blood After Mobilization With Filgrastim, and Concentration Using a Platelet-Rich Plasma System

To determine the cellular composition of a product created with peripheral blood harvested after systemic mobilization with filgrastim and processed with one point-of-care blood concentrating system, i.e., a platelet-rich plasma (PRP) system. The second purpose was to compare mobilized platelet-rich plasma (M-PRP) with a concentrated bone marrow aspirate (cBMA) and a PRP created from the same subjects with the same PRP system. Ten healthy volunteer subjects were recruited for collection and analysis of 3 tissue sources: non-treated peripheral blood, bone marrow aspirate, and filgrastim-mobilized peripheral blood, involving 4 doses of weight-based filgrastim. One point-of-care blood and bone marrow concentrating system was used to create 3 products: PRP, cBMA, and M-PRP. Automated hematologic analysis was performed on all products to quantify total red blood cells, white blood cells (WBCs), monocyte, platelet, and hematopoietic progenitor cell (HPC) concentrations. Flow cytometry was used to determine hematopoietic and mesenchymal progenitor cell populations. Lastly, concentrates were cultured and fibroblast colony-forming units (CFU-F) and morphology of adherent cells were evaluated. M-PRP contained a greater concentration of WBC (mean difference= 53.2 k/μL; P < .0001), monocytes (mean difference= 8.3 k/μL; P= .002), and a trend toward a greater concentration of HPC (mean difference= 200.5 /μL; P= .060) when compared with PRP. M-PRP contained a greater concentration of monocytes (mean difference= 5.5 k/μL; P= .017) and a trend toward a greater concentration of platelets (mean difference= 348 k/μL; P= .051) and HPC (mean difference= 193.4 /μL; P= .068) when compared with cBMA. M-PRP had a similar concentration of platelets to PRP (mean difference= 110 k/μL; P= .051) and PRP had a greater concentration than cBMA (mean difference= 458 k/μL; P= .003). cBMA remained the only product capable of producing CFU-Fs (446 ± 247 /mL) as neither the M-PRP nor PRP produced CFU-Fs. M-PRP produced colonies consistent with WBC. M-PRP, produced with filgrastim mobilized blood and a proprietary PRP system, contained more total WBCs, monocytes, platelets, and HPCs than cBMA and more WBCs, monocytes, and HPCs than PRP. Filgrastim mobilized PRP may be an alternative to cBMA for use as a point-of-care product for orthopaedic treatments.

Impact of Visual Field Testing on Intraocular Pressure Change Trends in Healthy People and Glaucoma Patients.

Purpose To compare the impact of visual field (VF) testing on intraocular pressure (IOP) change trends between healthy subjects and glaucoma patients. Methods We recruited healthy volunteer subjects who did not have previous ocular diseases and open-angle glaucoma patients who were medically controlled well. IOP in both eyes of each participant was measured by using a noncontact tonometer at five time points: before, immediately after (0 minute), and 10, 30, and 60 minutes after the standard automated perimetry. Repeated measures ANOVA was used to analyze the effect of VF testing on IOP change trends in healthy and glaucoma eyes. Results Forty healthy subjects (80 eyes) and 31 open-angle glaucoma patients (62 eyes) were included for the study. The baseline IOP of healthy and glaucoma eyes was 16.11 ± 3.01 mmHg and 15.78 ± 3.57 mmHg, respectively. After the VF testing, the IOP in healthy eyes was decreased by 1.5% at 0 minute, 6.5% at 10 minutes (P < 0.001), 6.6% at 30 minutes (P < 0.001), and 7.0% at 1 hour (P < 0.001), indicating that this reduction was sustained for at least 1 hour. However, the IOP in glaucoma eyes was increased by 12.7% at 0 minute (P < 0.001) and, then, returned towards initial values 1 hour after the VF testing. Conclusions IOP change trends after VF field testing between healthy subjects and glaucoma patients were quite different. VF testing led to a mild and relatively sustained IOP decrease in healthy subjects, whereas IOP in open-angle glaucoma patients tended to significantly increase immediately after VF testing and, then, returned to pretest values after 1 hour. These findings indicate that the factors of VF testing should be considered in the clinical IOP measurements.

P0239THE EFFECT OF CHRONIC KIDNEY DISEASE AND DIALYSIS MODALITIES ON THE EXPRESSION OF T REGULATORY (CD4+CD25+FOXP3+) AND NATURAL KILLER (CD56+CD16+ ) CELLS

Abstract Background and Aims Tregs regulate immune responses and maintain self-tolerance, while Natural Killer cells (NK) are cytotoxic lymphocytes critical for both adaptive and innate immunity. The presence of chronic kidney disease (CKD) is often characterized by disturbances in immune responses, including dysregulation between tolerance and cytotoxicity. Aim of the present study was to evaluate the influence of CKD on the Tregs (CD4+CD25+FoxP3+) and NK cells, as well as the effect of hemodialysis (HD) and peritoneal dialysis (PD) on these subtypes. Method A total of 40 CKD Stage V patients and 15 healthy volunteer subjects were recruited into our study. Peripheral Tregs and NK cells were isolated from whole blood samples using flow cytometry, and the results were compared to those of age and gender matched controls. The immunologic profile of CKD patients was repeated 6 months after HD initiation (n=20) and PD (n=20) in order to investigate the effect of different dialysis methods. Results Patients with CKD had significantly reduced populations of CD4+CD25+ FoxP3+ Tregs (47.5± 28.8 vs 71.5±24.7) p=0.01, while there was no difference in NK cells between patients and controls (16.4±8.1% vs. 13.4±9.1%), p=NS, respectively. There were no differences between patients started on HD or PD in terms of clinical and laboratory parameters. Frequencies and total numbers of Tregs were significantly reduced after 6 months of HD, from 7.6±2.1% to 5.2±2.3%, p=0.009, and from 53.6±26K/μL to 36.9±19K/μL, p=0.02, respectively, while showed no differences on PD patients, from 5.3±3.3% to 5.6±2%, p=NS and 33.2±27K/μL to 45.6±28K/μL, p=NS, respectively. NK cells were increased in HD patients, not reaching statistical significance (245±156K/μL to 261±128K/μL). Frequencies of NK cells were positively correlated with CRP (r=0.56, p=0.009) and Intimal media thickness (IMT) (r=0.48, p=0.03) Conclusion The results of our study show that initiation of hemodialysis (HD) seems to reduce the expression of CD4+CD25+FoxP3+ T cells while peritoneal dialysis (PD) doesn’t seem affect this cell population. The immune alterations observed in hemodialysis patients may have a clinical impact on chronic inflammation and atheromatosis.

T165. ANTI-GLUTAMATERGIC PROPERTY OF N-ACETYLCYSTEINE DOCUMENTED IN VIVO WITH 1H MRS

BackgroundDeficits of brain glutathione (GSH), the primary antioxidant in living tissue, and associated redox imbalance are postulated to be implicated in schizophrenia. However, due to poor blood-brain barrier permeability of GSH, direct supplementation is ineffective in restoring its brain levels. Therefore, there has been great interest in investigating N-acetylcysteine (NAC), as a prodrug that can be deacetylated to supply cysteine (Cys), which crosses the BBB and is the rate-limiting substrate in brain GSH synthesis and restoration. Once inside the cell, Cys combines with glutamate (Glu) to initiate GSH synthesis in a reaction that is catalyzed by gamma-glutamyl cysteine ligase (GCL), the rate-limiting enzyme. Likely due to the in situ reaction of NAC-supplied Cys with Glu to spur GSH synthesis, NAC is believed to have anti-glutamatergic properties. However, direct in vivo evidence of NAC as an anti-glutamatergic agent is currently lacking. In this study, we used 1H MRS to monitor changes in brain levels of both GSH and Glu in response to 4 weeks of daily supplementation with NAC in healthy volunteer subjects. We postulated that 4 weeks of NAC treatment would elevate GSH and decrease Glu levels.MethodsSubjects: Participants recruited for this study consisted of 12 mentally and physically healthy human volunteer (HV) subjects.NAC Supplementation: To investigate the effects of dietary NAC supplementation on cortical GSH and Glu levels, each HV subject underwent 1H MRS scans at baseline. Then a 4-week supplement of 900mg NAC tablets was provided, to be taken 2 per day for a daily NAC dose of 1800mg. Finally, each subject was brought back after 4 weeks for the post-NAC 1H MRS scans to assess the effect of the treatment on cortical GSH and Glu levels.Brain 1H MRS: In vivo cortical GSH spectra were recorded in 15 min on a 3.0 T GE MRI system from a 3cmx3cmx2cm occipital cortex voxel, using the standard J-editing technique, with TE/TR 68/1500ms and 290 interleaved excitations (580 total). Levels of Glu, uncontaminated with glutamine, were obtained from the same occipital cortex voxel in 6 min using the CT-PRESS method, with TE/TR 139ms/1500ms, and 129 chemical shift encoding steps in increments of 0.8ms in t1 dimension. Peak areas for both GSH and Glu were derived by frequency-domain fitting of the recorded spectra. The resulting peak areas were then expressed as ratios relative to the area of the unsuppressed tissue water signal in the voxel.ResultsGSH Levels: The effect of 4 weeks of NAC supplementation on GSH levels was a numerical increase that did not reach statistical significance relative to baseline (p=0.33).Glu LevelsFollowing 4 weeks of NAC supplementation cortical Glu levels decreased significantly compared to baseline (p=0.04).DiscussionThis study has shown that following 4 weeks of taking NAC, brain Glu levels in HV decreased significantly, even though a numerical increase in GSH levels did not reach statistical significance. The observed Glu decrease at 4 weeks suggests a net increase in the consumption of intracellular Glu reserves in the GCL-catalyzed reaction that combines NAC-supplied Cys with Glu in GSH synthesis. The failure of GSH levels to increase significantly after NAC likely reflected the established “feedback inhibition” mechanism whereby GSH synthesis is shut off in a tissue with normal levels, with de novo synthesis due to NAC occurring only in a subset of subjects with “low” GSH levels (i.e., below the sample mean) at baseline. In summary, the results of this study support the role of NAC as an anti-glutamatergic agent, which seems to modulate Glu levels by increasing the availability of intracellular Cys that then combines with Glu to initiate GSH synthesis, leading to a lowering of total Glu levels as measured with MRS

MRI characterization of early CNS transport kinetics post intrathecal gadolinium injection: Trends of subarachnoid and parenchymal distribution in healthy volunteers

PurposeTo quantify CSF transport kinetics and brain glymphatic distribution using MRI following intrathecal injection of gadolinium contrast in healthy adults. Subjects and methodsEight completely healthy volunteer subjects underwent intrathecal injection of gadolinium via image guided lumbar puncture and serial MRI's at six subsequent time points up to 11 h post-injection. Rate of enhancement and deposition were calculated for various regions and lobes of the brain. ResultsNormalized cranial data revealed that gadolinium in the intracranial CSF spaces peaked within 1–3 h and started to decrease at 7 h. In some regions of the brain parenchyma, such as the cerebral cortex and white matter, enhancement was increasing after 11 h. Differential rates of uptake between the parietal and frontal (p = 0.0003), cingulate (p = 0.002) and temporal (p = 0.018) lobes were shown as well as a several fold change between various cortical regions. Lastly, a linear regression comparing laterality between 35 cortical regions yielded (R2 = 0.90, p < 0.001) with a slope of 1.01 showing symmetry in uptake. ConclusionsGadolinium enhancement after lumbar intrathecal injection demonstrated differential CSF flow and brain parenchymal penetration, which illustrated the distributory function of the glymphatic system.

Twenty-four–Hour Intraocular Pressure–Related Patterns from Contact Lens Sensors in Normal-Tension Glaucoma and Healthy Eyes: The Exploring Nyctohemeral Intraocular pressure related pattern for Glaucoma Management (ENIGMA) Study

To investigate 24-hour nyctohemeral intraocular pressure (IOP)-related patterns with contact lens sensors (CLSs) in eyes with primary open-angle glaucoma (POAG) with normal baseline IOP (i.e., normal-tension glaucoma [NTG]) and healthy controls. Prospective, case-control study. Thirty eyes of 30 patients with NTG, who had had a wash-out period for their IOP-lowering treatment, and 20 eyes of 20 healthy volunteer subjects. Patients and subjects were hospitalized for the purposes of 24-hour CLS (SENSIMED Triggerfish; Sensimed AG, Lausanne, Switzerland) measurement. The IOP-related patterns during wake and sleep times over the course of the 24 hours were compared between the 2 groups. The 24-hour ambulatory blood pressure and posture were monitored simultaneously. A generalized linear model was used to find the factors associated with NTG. The IOP-related patterns, including mean and standard deviation (SD) of measurements, amplitude of cosine-fit curve, acrophase (signal peak), and bathyphase (signal trough) values (millivolt equivalents [mVEq]). The SDs of the 24-hour CLS measurements were significantly greater in NTG eyes than in healthy controls (112.51±26.90 vs. 85.18±29.61 mVEq, P= 0.002). The amplitudes of cosine-fit curve (141.88±39.96 vs. 106.08±41.49 mVEq, P= 0.004) and acrophase values (277.74±129.80 vs. 190.58±127.88 mVEq, P= 0.024), mostly measured during nocturnal period, were significantly greater in NTG eyes than in healthy controls. The NTG subjects slept longer in the lateral decubitus posture than the healthy controls (199.1±137.8 vs. 113.2±86.2 minutes, P= 0.009). In the multivariable generalized linear model, the greater amplitude of cosine-fit curve (β= 0.218, P= 0.012) and greater time of decubitus posture during sleep (β= 0.180, P= 0.004) were found to be significantly associated with NTG. Continuous monitoring of 24-hour IOP-related values with CLS can be useful for assessment of glaucoma risk, especially for patients with NTG whose IOP appears to be in the normal range. Fluctuation of 24-hour IOP-related values and posture during sleep time might be associated with NTG.

Induced Gamma-Band Activity during Actual and Imaginary Movements: EEG Analysis.

The purpose of this paper is to record and analyze induced gamma-band activity (GBA) (30–60 Hz) in cerebral motor areas during imaginary movement and to compare it quantitatively with activity recorded in the same areas during actual movement using a simplified electroencephalogram (EEG). Brain activity (basal activity, imaginary motor task and actual motor task) is obtained from 12 healthy volunteer subjects using an EEG (Cz channel). GBA is analyzed using the mean power spectral density (PSD) value. Event-related synchronization (ERS) is calculated from the PSD values of the basal GBA (GBAb), the GBA of the imaginary movement (GBAim) and the GBA of the actual movement (GBAac). The mean GBAim and GBAac values for the right and left hands are significantly higher than the GBAb value (p = 0.007). No significant difference is detected between mean GBA values during the imaginary and actual movement (p = 0.242). The mean ERS values for the imaginary movement (ERSimM (%) = 23.52) and for the actual movement (ERSacM = 27.47) do not present any significant difference (p = 0.117). We demonstrated that ERS could provide a useful way of indirectly checking the function of neuronal motor circuits activated by voluntary movement, both imaginary and actual. These results, as a proof of concept, could be applied to physiology studies, brain–computer interfaces, and diagnosis of cognitive or motor pathologies.

Do different dental conditions influence the static plantar pressure and stabilometry in young adults?

BackgroundPosture is influenced by many factors and dental occlusion seems to have its role on postural stabilization. Our rationale to perform the study was to find out if there are differences of static plantar pressure and stabilometric parameters depending on different dental conditions.MethodsThe observational study consisted in plantar pressure assessment and stabilometric analysis of 95 right-handed healthy volunteer subjects (mean age 22.94 ± 2.52 years) by using the PoData system. Each subject followed four measurements with open eyes: mandibular postural position, maximum intercuspation, biting on cotton rolls and maximum mouth opening. Plantar pressure was recorded on 1st and 5th metatarsal heads and heel, and was expressed as percentage of weight distribution on each foot. The recorded centre of pressure (CoP) parameters were: CoP path length, 90%confidence ellipse area and maximum CoP speed. Statistical analysis used repeated-measures ANOVA with Bonferroni posthoc analysis and Friedman test.ResultsLoading on the left 5th metatarsal head was significantly higher in maximum mouth opening condition when compared to maximum intercuspation and to biting on cotton rolls. The left heel loading was significantly lower in the maximum mouth opening in comparison to maximum intercuspation. The CoP path length and maximum CoP speed were significantly higher in maximum mouth opening compared to the other three conditions. Confidence ellipse area had significantly lower values in maximum intercuspation and in the biting on cotton rolls conditions compared to the mandibular postural position, and in maximum intercuspation compared to maximum mouth opening.ConclusionIn young adults with an optimum functional occlusion the static plantar pressure is influenced by the maximum mouth opening. An improved postural stability was recorded in maximum intercuspation (a condition used during swallowing) in comparison to mandibular postural position (a condition that allows relaxation of the masticatory muscles after functional moments).

Effects of Kakato-tsurutsuru socks on dry heels in healthy volunteer subjects.

Kakato-tsurutsuru (Kt) socks have been selling for almost 30years in Japan. Wearers claim they improve heel dryness despite no scientific evidence. We investigated the effects of Kt socks on heel dryness by questionnaire, clinical scores and non-invasive skin measurements. In a double-blind, randomized cross-over study, 10 healthy volunteers wore control or Kt socks over 2weeks in sequence for 4weeks. Skin hydration and evaporation of the medial and dorsal heel were measured before and every week during the trial. Clinical evaluations of desquamation and cracked skin were scored by a dermatologist. A visual analog scale (VAS) questionnaire of comfort, sock climate humidity and skin dryness was conducted. The VAS of comfort was significantly higher in Kt than controls. Average Δskin dryness in control and Kt groups was -1.63 and 2.22, respectively, showing a significant improvement. In the clinical findings of the dorsal side of the heel, Δdesquamation and Δcracked skin scores were significantly decreased and Δstratum corneum hydration significantly increased in Kt compared with controls. Kt socks may retain evaporated sweat with components of natural moisturizing factors, supporting the water-holding ability of the heel stratum corneum. These findings suggest that Kt socks may improve heel skin dryness.

A Low-Cost Breath Analyzer Module in Domiciliary Non-Invasive Mechanical Ventilation for Remote COPD Patient Monitoring.

Smart Breath Analyzers were developed as sensing terminals of a telemedicine architecture devoted to remote monitoring of patients suffering from Chronic Obstructive Pulmonary Disease (COPD) and home-assisted by non-invasive mechanical ventilation via respiratory face mask. The devices based on different sensors (CO2/O2 and Volatile Organic Compounds (VOCs), relative humidity and temperature (R.H. & T) sensors) monitor the breath air exhaled into the expiratory line of the bi-tube patient breathing circuit during a noninvasive ventilo-therapy session; the sensor raw signals are transmitted pseudonymized to National Health Service units by TCP/IP communication through a cloud remote platform. The work is a proof-of-concept of a sensors-based IoT system with the perspective to check continuously the effectiveness of therapy and/or any state of exacerbation of the disease requiring healthcare. Lab tests in controlled experimental conditions by a gas-mixing bench towards CO2/O2 concentrations and exhaled breath collected in a sampling bag were carried out to test the realized prototypes. The Smart Breath Analyzers were also tested in real conditions both on a healthy volunteer subject and a COPD suffering patient.

Correlation between the arm-span and the standing height among males and females of the Khasi tribal population of Meghalaya state of North-Eastern India.

Introduction:The estimation of relationship between the arm span and the standing height has been an important tool in anthropometric measurements especially in cases where direct measurement of stature is not possible.Objective:To find the relationship between the arm-span and the standing height of both males and females in the population of Khasi tribal population of Meghalaya.Materials and Methods:The study involved 400 numbers (272 males and 128 females) of healthy human volunteer subjects belonging to Khasi tribe of Meghalaya. The standing height and arm-span were measured for each individual and analyzed.Result:Of the 400 healthy volunteers, 272 (68%) were males and 128 (32%) were females with age ranged from 25 to 45 years. Height and arm span in males (159.68 ± 4.12 cm and 166.30 ± 4.27 cm, respectively) werefound to be significantly (p < 0.001) higher than females (149.96 ± 3.04 cm and 155.77 ± 3.13 cm respectively). The Pearson correlation coefficient (r) between height (cm) and arm span (cm) showed significant positive correlation in both male (r = 0.988, P < 0.001) and female (r = 0.991, P < 0.001) study subjects. The regression equation was Height = 1.060 + 0.954 (Arm span); R2 = 0.976; SEE = 0.646 for male. For female subjects the regression equation was found as Height = 0.150 + 0.962 (Arm span); R2 = 0.983; SEE = 0.400.Conclusion:Arm-span can be used as one of the most reliable parameter in both males and females for obtaining the stature of an individual in alternative to the height.

Influence of repetitions on the Valsalva maneuver

ObjectiveIn autonomic units, patients perform several short Valsalva maneuvers (VMs) while learning the procedure. The effects of repeated VMs on cardiovascular elicited responses were assessed. Methods14 healthy volunteer subjects were selected (aged 22–26). VMs were performed every 3 min up to 6 times in a reclined sitting position. Changes in blood pressure (BP), heart rate (HR) and baroreflex sensitivity indexes were evaluated. Subjects were classified according to their adrenergic response patterns. ResultsVMs repetitions evoked a progressive decrease in BP during phases II and III and a reduced increase in mean BP at late phase II. Increased bradycardia at early phase II and IV was also observed. Last two VMs showed a significant increase in Valsalva ratio, while other indexes remained unaltered. Subjects with balanced adrenergic responses presented extended pressure recovery time from the third repetition and lower BP values than those with augmented or suppressed adrenergic responses. ConclusionsSignificant changes in BP and HR at certain phases were observed when consecutive VMs were performed in young subjects in a reclined position. The most affected baroreflex index was the Valsalva ratio. Adrenergic response patterns showed differences that should be considered in order to avoid false positives. SignificanceWe recommend not repeating the VM more than 4 times and revisiting the role and reliability of the Valsalva ratio.

Evaluation of Printed P(VDF-TrFE) Pressure Sensor Signal Quality in Arterial Pulse Wave Measurement

In this contribution, we evaluate the performance of an additively fabricated piezoelectric poly(vinylidenefluoride-co-trifluoroethylene) (P(VDF-TrFE)) based dynamic pressure sensor in non-invasive arterial pulse wave (PW) measurement. Additively fabricated piezoelectric sensors have high potential for the realization of affordable and unobtrusive PW measurement systems which could enable the long-term monitoring of patients with cardiovascular diseases (CVDs). However, the accuracy and reliability of such sensors have not been extensively studied before. We propose an additive fabrication process for a P(VDF-TrFE) PW-sensor, measure PW from the radial artery at the wrist from 22 healthy volunteer subjects, calculate clinically relevant parameters based on the PW waveform and compare their values to the values obtained from concurrent measurement with an electromechanical film (EMFi) based reference sensor, used earlier in several clinical studies. We show that the signals recorded with the two sensors, as well as the radial augmentation index (rAIx) and the stiffness index (SI) calculated from them, are in good agreement with each other. These results demonstrate that the additively fabricated P(VDF-TrFE) PW sensors can reach a suitable level of accuracy and reliability for clinical use.

Influence of pelvic inclination on sit to stand task in stroke patients

BackgroundStroke results in an impaired sit to stand (STS) task. Pelvic movements are essential in daily living activities. Few studies investigated the effect of spine and pelvis separately on functional activities in stroke patients.ObjectiveThe study aimed to assess the angles of pelvic inclination (anterior and posterior pelvic tilt angles) (APT and PPT) during sitting position and during STS movement. It aimed also to determine the influence of sagittal pelvic tilt angles on STS performance in stroke patients.Patients and methodsThirty male hemi-paretic stroke patients (GI) and 15 matched healthy volunteer subjects (GII) represented the sample of this study. Stroke patients were assigned into two equal groups (group Ia and Ib). Sagittal pelvic tilt angles were measured by using the palpation meter inclinometer during sitting position and during initiation and mid of STS by using two dimensional (2D) video-based motion analysis system. Time of five repetitions STS test was used to assess the ability to perform STS task.ResultsThe results showed a significant increase of PPT angle during static sitting, a significant decrease in APT angle during initiation and mid of STS task and a significant increase in time taken for five repetitions STS test in both stroke groups (P < 0.05).ConclusionAbnormal pelvic alignment and movements affect the functional performance of stroke patients during sitting and sit to stand task.Trial registrationNCT03053154. Registered January 22, 2017. Retrospectively registered.

Analgesia mediated by stress: Possible antalgic mechanism of the dry needling technique

Abstract Introduction and Aim One of the possible mechanisms of action of dry needling is stress-induced analgesia, produced by the activation of the sympathetic nervous system (SNS). Cortisol is a steroid hormone, which is considered to be the most representative indicator of physiological states that are altered after a stressful stimulus. Although studies of other invasive techniques exist which measure the cortisol levels, no studies on dry needling have been found which gather this stress indicator. Thus, the aim of this study was to determine the changes produced in the levels of cortisol concentration in saliva after the application of the dry needling technique. Material and Methods Sixty-two healthy volunteer subjects participated in this randomized controlled single blinded trial performed at the University of Alcalá. Participants were randomly distributed into two intervention groups: deep dry needling (n = 33) and placebo needling (control) (n = 32). The saliva samples were gathered prior to the intervention and 3 minutes after finalization of the same. The level of cortisol in saliva was determined in a laboratory by performing a solid phase enzyme immunoassay using the ELISA® kit. Statistical significance was set at p &lt; 0.05. The differences between both groups were compared based on the percentage of change between the initial level and at three minutes via the Student's t-test for independent samples, estimating the effect size via the Cohen's d test. Results An increase of the levels of cortisol in saliva of 11.27% ± 4.76 was observed after the deep dry needling; in the group of placebo needling, an increase of 1.51% ± 3.08 was observed. However, when comparing both groups, no statistically significant differences were obtained (p = 0.920), with an effect size of d = 0.42. Conclusions The dry needling technique leads to an increase in the release of cortisol, one of the hormones involved in the sympathetic-excitatory relationship. This could be related to one of the possible effects of this invasive procedure with mechanisms of stress-induced analgesia. However, further studies are required to deepen our knowledge on the plausible physiological effects which support the application of the dry needling technique.

Analysis on the distribution of pressure- and heat-sensitive acupoints in patients with allergic rhinitis

To explore the distribution of pressure- and heat-sensitive acupoints of the Large Intestine of Hand-Yangming, Stomach Meridian of Foot-Yangming and the Lung Meridian of Hand-Taiyin below the elbow and knee joints in patients with allergic rhinitis, so as to explore the positive reaction points at the body surface of allergic rhinitis. Thirty variant rhinitis volunteer subjects and 30 healthy subjects were recruited in the present study. The subcutaneous induration, reaction points of emptiness-like feeling or pressing pain below the elbow- and knee-joints along the Large Intestine Meridian, Stomach Meridian and the Lung Meridian were inspected first, then re-examined by using heat-sensitized moxibustion method and a hand-held pain threshold tester (mechanical pressure), respectively. The frequency and coincidence rate of pressing-pain sensitive and heat-sensitive points were analyzed. In the 30 patients with allergic rhinitis, 10 positive reaction points as Kongzui (LU6), Chize (LU5), Hegu (LI4), Quchi (LI11), Shousanli(LI10), Zusanli (ST36), Shangjuxu (ST37), Fenglong (ST40), Xiajuxu (ST39), and non-acupoint of the Lung Meridian were found. Among them, the duration of heat-sensitive reaction in the LU6, LI10, ST37, ST40, and ST39 regions was obviously shorter in patients than in healthy subjects (P<0.01,P<0.005). The heat-sensitive forms of the positive reaction points were mainly heat transmission, heat-penetration and local reaction. The mechanical pain thresholds of the positive reaction points (LI4, LU6, LI10, LI11 and non-acupoint of the Lung Meridian) at the upper limbs and those (ST36, ST37 and ST40) at the lower limbs were evidently lower in patients than in healthy volunteer subjects (P<0.05). The pressure- and heat-sensitive acupoints were basically coincide in the patients, but being higher in patients than in healthy subjects in the frequency of occurrence. The mechanical pain threshold of the pressure-sensitive acupoints in patients was remarkably lower on the left side than on the right side of the upper limb, and obviously higher on the left side than on the right side of the lower limb (P<0.05). No significant differences were found between the right and left sides in the pain threshold in healthy subjects (P>0.05). There is a high overlap in the distribution of pressure- and heat-sensitive acupoints of the Lung, Large Intestine and Stomach meridians below the elbow and knee joints in patients with allergic rhinitis, and there is an imbalance between the left and right limbs in the mechanical pain threshold of the pressure- and heat-sensitive acupoints, but needing being further confirmed.

Hematologic and Serological Investigation of Effect on Gyeongokgo in Healthy Individuals : a Randomized, Subject-assessor-blind, Placebo-controlled, Single-center Pilot Study

There are no published data on Gyeongokgo (GOK) safety or efficacy despite being commonly use. The Gyeongokgo (GOK) is commonly used in traditional Korean medicine to promote a health qi and blood, but their objective data was not sufficient in clinical field. To investigate the safety and efficacy of GOK with hematologic and serologic testing and the change of the quality of life in healthy individuals. Randomized, subject-assessor-blind, placebo-controlled, single-center pilot study Participants and Interventions 29 healthy volunteer subjects were randomly placed into the GOK group (n = 20) or placebo control group (n = 9) and instructed to take one treatment packet (GOK or placebo) twice daily for 4 weeks. Subjects were assessed using the Fatigue Severity Scale (FSS) and Short Form 36 Health Survey (SF-36) and underwent hematologic and serologic tests and body composition analysis. The FSS total score (p = 0.093) and SF-36 general health index (p = 0.002) were improved following treatment in the GOK group. Post-treatment thyroid-stimulating hormone levels were increased in the GOK group compared with pre-treatment levels (p = 0.0042). C-reactive protein levels decreased (p = 0.0256) in the GOK group compared with that the placebo group. In time-series tests, GOK did not affect post-prandial serum triglycerides, glucose, insulin, or C-peptide levels. Notably, elevations in serum fasting triglycerides at 2- (p = 0.0333) and 4-hours (p = 0.0414) post-prandial were lower than those in the placebo group. GOK reduced fatigue levels and did not significantly affect laboratory test results performed to measure safety, serum glucose, and lipid profiles. Post-meal triglyceride levels were effectively reduced with treatment.

Dynamic magnetic resonance imaging in unilateral diaphragm eventration: knowledge improvement before and after plication.

The assessment before surgical plication for unilateral hemidiaphragm (HD) eventration is not clearly defined and no precise criteria exist to really understand which patient is operated with which results depending on the technique used. The goal of this study was to evaluate the place of dynamic magnetic resonance imaging (dMRI) before and after plication by developing measurement criteria. Between 2006 and 2017, 18 patients (group1: Gp1) were operated for eventrations, 15 left-sided (Gp1L) and 3 right-sided (Gp1R). All had preoperative and postoperative evaluations including dMRI and pulmonary function tests. Five healthy volunteer subjects (group2: Gp2) had the same imaging protocol. For each HD, we measured the respiratory excursion at three fixed points (S1, S2, S3) and the height of curvature on sagittal plane. We also searched for upward paradoxical diaphragm movements. Before surgery, no excursion (n=13) or extremely reduced excursion (n=5) was detected on the injured HD (IHD) in Gp1. Upward paradoxical movements were identified only in Gp1L (n=6). Compared with Gp2 subjects, the healthy HD for Gp1L patients had significantly reduced excursion values at three sites S1 (P=0.038), S2 (P=0.006), and S3 (P=0.004). After plication, the decreasing height of curvature confirmed a tightening of the IHD in all patients (median value from 100 to 39.5 mm in Gp1L and 92 to 74 mm in Gp1R, P=0.0001). All upward paradoxical movements disappeared. Healthy HD excursions in Gp1L normalised their values. All those imaging improvements were correlated with postoperative improvements of dyspnoea score (P<0.0001) and vital capacity (P=0.002). dMRI and the standardised grid we developed not only improve the knowledge of unilateral diaphragm eventration but also permit to evaluate the quality of its surgical repair. It also demonstrates that a dysfunction of the healthy HD contralateral to eventration is possible and reversible after plication of the IHD.