Sec Off Research Articles

Safety and Feasibility of Neuromuscular Electrical Stimulation in Patients with Extracorporeal Membrane Oxygenation.

Background/Objectives: The aim of this study was to investigate the feasibility and safety of neuromuscular electrical stimulation (NMES) in patients on extracorporeal membrane oxygenation (ECMO) and thoroughly assess any potential adverse events. Methods: We conducted a prospective observational study assessing safety and feasibility, including 16 ICU patients on ECMO support who were admitted to the cardiac surgery ICU from January 2022 to December 2023. The majority of patients were females (63%) on veno-arterial (VA)-ECMO (81%), while the main cause was cardiogenic shock (81%) compared to respiratory failure. Patients underwent a 45 min NMES session while on ECMO support that included a warm-up phase of 5 min, a main phase of 35 min, and a recovery phase of 5 min. NMES was implemented on vastus lateralis, vastus medialis, gastrocnemius, and peroneus longus muscles of both lower extremities. Two stimulators delivered biphasic, symmetric impulses of 75 Hz, with a 400 μsec pulse duration, 5 sec on (1.6 sec ramp up and 0.8 sec ramp down) and 21 sec off. The intensity levels aimed to cause visible contractions and be well tolerated. Primary outcomes of this study were feasibility and safety, evaluated by whether NMES sessions were successfully achieved, and by any adverse events and complications. Secondary outcomes included indices of rhabdomyolysis from biochemical blood tests 24 h after the application of NMES. Results: All patients successfully completed their NMES session, with no adverse events or complications. The majority of patients achieved type 4 and 5 qualities of muscle contraction. Conclusions: NMES is a safe and feasible exercise methodology for patients supported with ECMO.

Oxygen-supplemented and topography-guided epithelium-on corneal crosslinking with pulsed irradiation for progressive keratoconus.

To investigate the effects of customized topography-guided epithelium-on crosslinking (epi-on CXL) with oxygen supplementation on procedural efficacy and corrected distance visual acuity (CDVA) in patients with progressive keratoconus (KC) at 1 year. Private eye clinic, Brisbane, Australia. Retrospective, single-center, nonrandomized case series. Topography-guided epi-on CXL using the Mosaic system was performed on patients with progressive KC. Oxygen goggles; transepithelial riboflavin; and pulsed, high UV-A irradiance (1 second on, 1 second off; 30 mW/cm2) were applied to enhance oxygen kinetics and bioavailabilities of riboflavin and UV-A. Guided by baseline topography, a higher UV-A dose (15 J/cm2) was applied to the area of steepest anterior curvature with decreasing fluence (as low as 7.2 J/cm2) toward the outer 9 mm. Postoperative CDVA and maximum keratometry (Kmax) were evaluated. 102 eyes (80 patients) were followed for 11.5 ± 4.8 months. At the latest follow-up, mean CDVA (logMAR), mean K, and Kmax (diopters [D]) improved from 0.18 ± 0.28, 46.2 ± 3.8, and 53.0 ± 5.67 at baseline to 0.07 ± 0.18, 45.8 ± 3.7, and 51.9 ± 5.56, respectively (P < .001). 3 eyes (3%) lost more than 1 CDVA line, and another 3 eyes (3%) had increased Kmax greater than 2 D. 43 eyes were followed for at least 12 months (n = 43): mean CDVA, mean K, and Kmax improved from 0.19 ± 0.33 logMAR, 46.5 ± 3.5 D, and 53.6 ± 5.67 D to 0.07 ± 0.17 logMAR, 46.0 ± 3.5 D, and 52.33 ± 5.49 D, respectively (P ≤ .002). No complications were observed. Tailoring oxygen-supplemented epi-on CXL with differential UV-A energy distributions, guided by baseline topography, in patients with KC seems to be safe and effective. At 1 year, study reports sustained improved CDVA and corneal stabilization.

Effect of High-intensity Interval Training Session Timing on Inflammatory Biomarkers in Overweight and Obese Individuals with Different Chronotypes

Background: Global attention on obesity prevention emphasizes cost-effective strategies, particularly physical activity. Evaluating chronobiological influences is crucial for effective treatment plans. Noncommunicable disease management requires a nuanced approach to address this pervasive health concern. Objective: This study aims to determine the effect of chronotype-based high-intensity interval training (HIIT) on inflammatory biomarkers among overweight and obese individuals. Methods: This experimental study, involving 58 obese adults, utilized pretest and post-test evaluations. Participants, aged 31.65 ± 9.1 years with a mean BMI of 29.04 ± 4.04, underwent 12 weeks of cycling HIIT (10 sec on/10 sec off) thrice weekly. Pre- and post-training venous blood samples were collected, centrifuged, and stored at -80°C. Outcome measures included metabolic, inflammatory biomarkers, and anthropometric data. Result: The findings of this study demonstrate that there is a significant difference in metabolic variables such as fasting sugar, fasting insulin, 3.7%, 27% (p=0.00), and IL6 5.7% (p=0.00) levels between the chronotype-based exercise session group (CBES) and non chronotype based exercise session group (NCBES). Anthropometric and other inflammatory variables, such as Tumor necrosis factor alpha (TNF -alpha) and high sensitive C-reactive protein (hs CRP), showed no significant differences between groups. Conclusion: The study concluded that chronotype-based HIIT is effective on metabolic markers but not on inflammatory markers in obese individuals.

PS-B05-3: CARDIOVASCULAR RESPONSES EVOKED BY LOW ENERGY CONTINUOUS VERSUS INTERMITTENT STIMULATION OF THE AORTIC BARORECEPTOR AFFERENTS IN HYPERTENSION

Objectives: Device-based neurostimulation of the carotid baroreceptors is a novel approach to control hypertension. We have previously demonstrated the significance of aortic baroreceptor afferent nerves as a viable alternative neuromodulation target to carotid baroreceptors in lowering mean arterial pressure (MAP) in hypertension. We have also shown that appreciable reductions in MAP do not necessarily require the use of ultrahigh stimulation parameters. In this study, we aimed to investigate if energy consumption for neuromodulation of aortic baroreceptor afferents could be lowered further by using intermittent as opposed to continuous stimulation. Design and method: In male anesthetized spontaneously hypertensive rats (SHRs), the effects of continuous (20 sec) versus intermittent (5 sec ON/3 sec OFF and 5 sec ON/5 sec OFF for 20 sec) stimulation of the left aortic depressor nerve (ADN) on MAP, heart rate (HR), mesenteric (MVR) and femoral (FVR) vascular resistance were assessed using low (5 Hz) and high (15 Hz) frequencies delivered at 0.4 mA and 0.2 ms. Results: Continuous and intermittent low frequency stimulation produced similar sustained decreases in MAP, HR, MVR and FVR. Continuous high frequency stimulation produced larger reductions in MAP, HR, MVR and FVR compared with all low frequency and/or intermittent high frequency stimulations. Conclusions: Low charge intermittent stimulation of the aortic baroreceptor afferents maintains the required reductions in MAP levels in hypertension and intermittent delivery of the electrical stimulus can further lower energy consumption for neuromodulation. Clinically, these findings may provide useful insight for studies using baroreflex modulation in resistant hypertension and other cardiovascular diseases.

Abstract 11957: Physical Training Augmented With Whole Body Electronic Muscle Stimulation is Superior to Conventional Training Alone in Healthy Subjects, a Pilot Randomized Controlled Trial

Introduction: Physical activity is protective against cardiovascular (CV) disease and mortality, yet more than 25% of adults do not perform any regular exercise. Whole body electronic muscle stimulation (WB-EMS) is a novel FDA-approved device used for physical training that simultaneously stimulates all major muscle groups using percutaneous electrical impulse transmission during exercise. Preliminary studies demonstrated increased muscle mass, reduced fat mass, and improved functional capacity in elderly individuals who trained with WB-EMS. We evaluated the effects of training with WB-EMS on measures of CV health. Methods: Healthy adults were randomized to physical training with versus without WB-EMS for one 20-minute session each week for 16 weeks. Participants wore a specifically designed vest and arm and leg straps connected to the WB-EMS device (Miha Bodytec, Germany). Biphasic electrical stimulation was delivered through the vest and straps (4 sec on, 4 sec off) at a frequency that elicited a score of 5-6 on the Borg perceived exertion scale when each major muscle group was stimulated. Individuals randomized to no WB-EMS wore the same equipment but received no stimulation. Sessions were provided by trainers certified in WB-EMS training and consisted of a fixed protocol of simple exercises such as squats and lunges. Temporal changes in measures of CV health were compared between groups. Results: Forty-one individuals were recruited between 02/2021 and 02/2022 (n=24 WB-EMS, n=17 no WB-EMS; mean age 35.9±11.2 yrs; 61.3% females; median BMI 24.3 (21.8, 28.1) kg/m 2 . After 16 weeks there were significant and favorable differences in the intervention group compared to controls in waist: hip ratio (-1.2 cm vs. 0.9, p=0.05); total cholesterol (-1.1 mg/kg vs. 14.2 mg/kg, p=0.02); anaerobic threshold (68.2% vs. 30.8%, p=0.03); breathing efficiency (VE/VCO2: -10.36 vs -7.38, p=0.01); and peripheral endothelial function, measured with reactive hyperemia peripheral arterial tonometry (-0.009 vs. -0.29, p=0.06). Conclusions: Once weekly training with WB-EMS yielded more favorable changes in CV biomarkers compared to conventional training alone in healthy adults, and thus may offer an effective and time-efficient method of physical training.

1315-P: Optogenetic Activation of Vagal Motor Neurons in Mice Modulates Heart Rate but Not Blood Glucose Levels

Parasympathetic neurons in the dorsal motor nucleus of the vagus (DMV) control glucose metabolism through the vagus nerve and so are potential targets for diabetes treatment. Yet, little is known about the molecular identity and organization of glucose-regulating DMV neurons. To identify these neurons for further investigation, we optogenetically activated them in mice while measuring blood glucose. We targeted a light-sensitive ion channel, CaTCh, selectively to DMV neurons based on their co-expression of Chat and Phox2b, which resulted in CaTCh expression in most or all DMV neurons but no surrounding neurons. To photostimulate CaTCh+ DMV neurons, we then implanted optical fibers over the DMV in 9 adult Chat::Phox2b::CaTCh mice (4 females, 5 males; mean age ± S.D., 24 ± 13 weeks) . After acclimation we fasted the mice overnight and then delivered pulses of blue laser light (20Hz, 10ms pulse, 3 sec off, 1 sec on) for 15 min to activate DMV neurons. We used a glucometer on tail blood samples drawn every 5 minutes for 1 hour, beginning 20 minutes before and ending 25 minutes after photostimulation. Before, during, and after photostimulation, blood glucose averaged 2± 35 mg/dL, 220 ± 36 mg/dL, and 215 ± 45 mg/dL and did not change significantly with photostimulation (p&amp;gt;0.05, ANOVA) . To rule out stress as a confound, we repeated these studies after anesthetizing 4-hour fasted mice with isoflurane but still did not detect a significant effect of photostimulation on blood glucose. Interestingly, however, heart rate decreased significantly with photostimulation (pre, 5± 23 bpm; during, 429 ± 32 bpm; post, 517 ± 24 bpm; p&amp;lt;0.001, ANOVA) , indicating that the photostimulation parameters were sufficient to activate vagal neurons. Further work is underway to address whether the lack of effect of DMV poststimulation on blood glucose is due to antagonistic signaling (e.g., coincident release of insulin and glucagon) or represents a limitation of the method. Disclosure J.Campbell: None. N.J.Conley: None. L.S.Kauffman: None. Funding American Diabetes Association (1-18-INI-14) ;

Electronic Bypass for Diabetes: Optimization of Stimulation Parameters and Mechanisms of Glucagon-Like Peptide-1

ObjectivesIntestinal electrical stimulation (IES) has been proposed for treating diabetes; however, its parameters need to be further systematically optimized. This study aimed to optimize the parameters of IES and investigate its possible mechanisms involving glucagon-like peptide-1 (GLP-1) in diabetic rats. Materials and MethodsThirty-six high-fat diet-induced diabetic rats were chronically implanted with a pair of bipolar electrodes at the duodenum for IES. The oral glucose tolerance test (OGTT) was performed in a number of sessions with IES using different parameters and biphasic charge-balanced waveforms to derive the best values for train on-time, pulse frequency, and pulse width. Incretin hormones such as GLP-1 were assessed and the GLP-1 antagonist Exendin 9-39 was used to assess the role of GLP-1 in the ameliorating effect of IES on hyperglycemia. ResultsThe most effective IES parameters in reducing blood glucose (BG) during the OGTT were derived: 1.2 sec on, 0.3 sec off, 80 Hz, 3 msec. IES with these parameters reduced BG level by at least 29% from 15 min to 180 min (p < 0.05 for all points, N = 10). IES with these stimulation parameters increased plasma GLP-1 level at 30 min, 60 min, 90 min and gastric inhibitory peptide (GIP) level at 30 min (N = 8). Exendin 9-39 blocked the inhibitory effect of IES on BG (p > 0.05, IES + Exendin 9-39 vs sham-IES, N = 8). ConclusionIES with the most effective parameters derived in this study improves hyperglycemia in diabetic rats. The ameliorating effect of IES on hyperglycemia is attributed to the enhanced release of GLP-1. IES has great potential for treating diabetes.

Ultra-Low Energy Cycled Burst Spinal Cord Stimulation Yields Robust Outcomes in Pain, Function, and Affective Domains: A Subanalysis From Two Prospective, Multicenter, International Clinical Trials

IntroductionDeRidder's burst stimulation design has become a key spinal cord stimulation (SCS) waveform because it reduces the intensity of pain as well as its associated emotional distress. The brain pathways underlying these outcomes may also allow for the effects of stimulation to carry over after stimulation is turned off, making it amenable to intermittent application. Here, the utility of intermittently cycled burst was evaluated using data from two large real-world prospective studies (TRIUMPH, REALITY). Materials and MethodsSubjects used intermittent dosing in a 1:3 ratio (30 sec on, 90 sec off; N = 100) in TRIUMPH and 1:12 ratio in REALITY (30-sec on, 360-sec off; N = 95) for six months. Pain intensity (0–10 numeric rating scale), pain-related emotions on the pain catastrophizing scale (PCS), and physical function on PROMIS questionnaires were compared with preimplant baseline ratings and by group. ResultsIn both groups, mean pain intensity decreased by nearly 50% relative to baseline, PCS scores significantly decreased, and physical function improved. Importantly, no differences between the 1:3 and 1:12 groups were identified. A high proportion, 80% and 77% of the 1:3 and 1:12 groups, respectively, were considered responders on a multiple measures. No adverse events were associated with intermittent stimulation. DiscussionIntermittent cycling of burst SCS lowers the overall electric charge delivered to the spinal cord and preserves battery consumption, without compromising pain relief and associated symptoms.

Intensification of imperatorin extraction from Aegle marmelos by ultrasound assisted three phase partitioning: Comparative studies and exploring its ethnomedicinal uses

The current work demonstrates the use of a hybrid technique where ultrasound was coupled with three phase partitioning (UA-TPP) to intensify the extraction of imperatorin from fruits of A. marmelos. The optimized parameters obtained were ultrasound time 30 min, ammonium sulphate mass fraction 30 % (w/v), biomass to solvent proportion 1:40 (w/v), biomass slurry to t-butanol proportion 1:1 (v/v), ultrasound power 120 W, and duty cycle 60% (6 sec on 4 sec off). The maximum extraction yield of imperatorin obtained was 5.44 mg/g using UA-TPP, which was much higher than the traditional techniques such as three-phase partitioning (TPP), Soxhlet, and batch extraction. The extraction time was also drastically reduced to 30 min in UA-TPP from 150 min compared to TPP. UA-TPP enhanced the extraction yield of imperatorin with a reduction in time and improved the ethnomedicinal properties such as total phenolic and flavonoid content, antioxidant activity and anti-inflammatory activity as compared to traditional extraction techniques.

The effect of ultrasound duty cycle in biodiesel production from Ceiba pentandra

This study investigated the effect of the duty cycle for the transesterification of Ceiba pentandra oil. The important parameters of a duty cycle (pulse-mode operation) and energy usage in the transesterification reaction process were presented and showed that a maximum biodiesel yield of 99.24 % was achieved for 75% duty cycle with a pulse combination of 6 sec ON and 2 sec OFF. That was under the optimum conditions of 60% methanol to oil ratio, 1.00 wt% of KOH, reacted for 50 minutes. The obtained biodiesel was then analyzed using FTIR spectroscopy, and physiochemical properties of the Ceiba pentandra biodiesel then determined. It found that all the properties comply with the fuel specifications set by both ASTM D6751 and EN 14214 standards.

Novel Intermittent Dosing Burst Paradigm in Spinal Cord Stimulation

IntroductionIntermittent dosing (ID), in which periods of stimulation‐on are alternated with periods of stimulation‐off, is generally employed using 30 sec ON and 90 sec OFF intervals with burst spinal cord stimulation (SCS). The goal of this study was to evaluate the feasibility of using extended stimulation‐off periods in patients with chronic intractable pain.Materials and MethodsThis prospective, multicenter, feasibility trial evaluated the clinical efficacy of the following ID stimulation‐off times: 90, 120, 150, and 360 sec with burst waveform parameters. After a successful trial (≥50% pain relief) using ID stimulation, subjects were titrated with OFF times beginning with 360 sec. Pain, quality of life, disability, and pain catastrophizing were evaluated at one, three, and six months after permanent implant.ResultsFifty subjects completed an SCS trial using ID stimulation settings of 30 sec ON and 90 sec OFF, with 38 (76%) receiving ≥50% pain relief. Pain scores were significantly reduced from baseline at all time points (p < 0.001). Improvements in quality of life, disability, and pain catastrophizing were aligned with pain relief outcomes; 45.8% of the subjects that completed the six‐month follow‐up visit used an OFF period of 360 seconds.ConclusionsID burst SCS effectively relieved pain for six months. The largest group of subjects used IDB settings of 30 sec ON and 360 sec OFF. These findings present intriguing implications for the optimal “dose” of electricity in SCS and may offer many advantages such as optimizing the therapeutic window, extending battery life, reducing recharge burden and, potentially, mitigating therapy habituation or tolerance.

Combined oxidation processes based on ultrasound, hydrodynamic cavitation and chemical oxidants for treatment of real industrial wastewater from cellulosic fiber manufacturing sector

The present work reports the application of cavitation for the real industrial effluent treatment, which was derived from the cellulosic fiber manufacturing sector, individually or in combination with advanced oxidation processes. Cavitation has been applied with the objective of reducing the chemical oxygen demand (COD) of the industrial effluent and to study its simultaneous effect on the total dissolved solids (TDS). A combination of cavitation with different additives/oxidants viz. hydrogen peroxide (H2O2), ozone (O3), sodium hypochlorite (NaCLO), and Fenton's reagent have been studied. Ultrasonic horn operating at an acoustic power of 120 W with a frequency of 20 kHz and duty cycle of 80% (8 sec ON, 2 sec OFF) was used for treatment based on ultrasound. Under optimized conditions, it was established that a combination of ultrasound (US) with Fenton’s reagent using an optimum mole ratio of H2O2/Fe2+ of 3 followed by lime coagulation gave a maximum COD reduction of 92% and also resulted in TDS reduction of 31%. Studies were also performed using a hydrodynamic cavitation (HC) reactor (10 L capacity) where slit venturi was used as a cavitating device. It has been observed that a combination of HC with Fenton's reagent at molar ratio of H2O2/Fe2+ as 3 gave the maximum COD reduction of 86% and a TDS reduction of 47%. It was also established that lime treatment played an important role in separating the sludge formed during the Fenton oxidation treatment and in converting brownish colored effluent to colorless effluent. Overall, it has been established that cavitation coupled with the Fenton oxidation was most the efficient among all studied combinations giving a good COD reduction as well as TDS reduction with a final colourless nature of effluent.

Optimization and kinetic study of ultrasound assisted deep eutectic solvent based extraction: A greener route for extraction of curcuminoids from Curcuma longa

The use of deep eutectic solvents (DESs) as a new extraction medium is a step towards the development of green and sustainable technology. In the present study, nine DESs based on choline chloride acids, alcohols, and sugar were screened to study the extraction of curcuminoids from Curcuma longa L. Choline chloride and lactic acid DES at 1:1 M ratio gave the maximum extent of extraction. Further, DES based extraction was intensified using ultrasound. The impact of various process parameters such as % (v/v) water in DES, % (w/v) solid loading, particle size, ultrasound power intensity, and pulse mode operation of ultrasound was studied. The maximum curcuminoids yield of 77.13 mg/g was achieved using ultrasound assisted DES (UA-DES) based extraction in 20% water content DES at 5% solid loading and 0.355 mm particle size with 70.8 W/cm2 power intensity and 60% (6 sec ON and 4 sec OFF) duty cycle at 30 ± 2 °C in 20 min of irradiation time. Kinetics of UA-DES extraction was explained using Peleg’s model and concluded that it is compatible with the experimental data. Additionally, anti-solvent (water) precipitation technique was applied, which resulted in 41.97% recovery of curcuminoids with 82.22% purity from UA-DES extract in 8 h of incubation at 0 °C. The comparison was made between conventional Soxhlet, batch, DES and UA-DES based processes on the basis of yield, time, solvent requirement, temperature, energy consumption, and process cost. The developed UA-DES based extraction can be an efficient, cost effective, and green alternative to conventional solvent extraction for curcuminoids.

Neuromuscular Electrical Stimulation At Long Pulse Duration Is Associated With Higher Muscle Oxygen Utilization

Conventionally Neuromuscular Electrical Stimulation (NMES), delivered on the muscle belly at low frequency and short pulse duration, is used in rehabilitation protocols to prevent muscle atrophy. However, conventional NMES causes rapid on-set of fatigue and possibly activates muscle fibers in a synchronous, spatially fixed order (i.e. reverse of the size principle). To overcome these limitations, in the past years, a novel approach that utilizes both high frequency (100Hz) and long pulse duration (1000μs) (Wide Pulse High Frequency Stimulation, WPHF) was proposed. During WPHF NMES muscle contraction is achieved via afferent nerve fibers, allowing the reflexive discharge of motor units, with the contribution of spinal circuitries, and mimic the recruitment order of a voluntary effort (i.e. first type I fibers). PURPOSE: Evaluating muscle oxygen consumption via Near-Infrared Spectroscopy (NIRS) technique during two NMES bouts at fixed frequency (100Hz), applying Short (200μs) and Long (1000μs) Pulse duration, while concurrently matching the external force output. METHODS: Two 5 minutes intermittent (1 sec on - 3 sec off) NMES bouts at Short and Long pulse duration were delivered on the right quadricep muscle of 14 healthy subjects while sitting on an isometric chair. NIRS recorded oxygen extraction (i.e. Deoxygenated Hemoglobin - Myoglobin) from the vastus lateralis of the stimulated limb. Equal muscle force between protocols was achieved by carefully selecting the individual stimulation intensity. RESULTS: We selected 10 consecutive contractions for Short and Long Pulse NMES in order to have equal muscle output and evaluate the corresponding oxygen consumption. In the selected contractions, Peak Force was 15.3 ± 5.7 and 15.4 ± 5.6 % (p: ns) of the Maximal Voluntary Contraction while Force Time Integral was 1522.6 ± 593.4 and 1539.4 ± 597.3 Nm∗s (p: ns) for Short and Long Pulse respectively. At the same force output, Long Pulse NMES exhibited higher oxygen consumption, in percentage of the physiological calibration, than Short Pulse NMES (36.71 ± 11.82 % vs 28.79 ± 17.07 %, p:0.041). CONCLUSION: Applying Long Pulse NMES can elicit higher muscle oxygen utilization compared to Short Pulse duration, suggesting preferential recruitment of oxidative, type I muscle fibers, likewise to a voluntary contraction.

Blood Flow Restriction Compared To High Intensity Interval Training On Body Composition And Tendon Width

Blood flow restriction (BFR) is a low load exercise modality advocated to improve body composition. PURPOSE: To compare BFR against high intensity interval training (HIIT) body-weight squats (BWS), and 80% 1RM squats (CON) in body composition and quadriceps tendon cross section area (QXS). METHODS: Thirteen subjects participated in the study (27±5.8 years, BMI: 23.3±3.2, F:8). Subjects were randomly assigned to a BFR (n=5), HIIT (n=5), or CON (n=3). Body composition was measured via air plethysmography while QXS was measured via musculoskeletal ultrasound. Subjects were tested at baseline and 6-weeks after training. BFR bands were placed at the proximal thigh and inflated to 250mmHg while performing a 30/15/15/15 repetition (rep) protocol using a metronome (1 rep/2 secs). The HIIT group completed BWS during a 20 sec on and 10 sec off protocol for 8 sets. The control (CON) group completed 3 sets of 5 reps squats of their 80% 1RM. All three groups completed their workouts 3 times a week. Due to the small sample size Kruskall-Wallis (KW) was performed for the variables of fat mass (fm;kg), lean mass (lm;kg), and QXS (cm) during baseline. If no differences at baseline were found the same analysis was performed for the 6-week follow-up. In addition, a KW analysis between groups was performed for the difference between baseline and follow-up values between variables. RESULTS: Although BFR showed improvements (fm: -1.1 kg; lm: +0.3kg; QXS: + .01cm) for all variables over the other groups (HIIT: fm: +1.5kg, lm: -1.2kg, QXS: -.02cm; CON: fm: -.05kg, lm: +0.4, QXS: +0.1cm) none of the two KW analytical approaches showed a statistically significant difference for any of the variables of interest. CONCLUSION: Although BFR showed improvements in all variables, the magnitude of these changes was not significant enough to demonstrate it is a superior modality than HIIT or 80% 1 RM or 6-weeks of training is not sufficient time to elicit changes in these outcomes.

Synergistic Effect of Ultrasound and Three Phase Partitioning for the Extraction of Curcuminoids from Curcuma longa and its Bioactivity Profile

In the present work, ultrasound was combined with three-phase partitioning (UA-TPP) for the extraction of curcuminoids from Curcuma longa. The effect of various process parameters viz. solvents, irradiation time, ammonium sulphate concentration, ratio of turmeric aqueous slurry to t-butanol, turmeric powder to aqueous ratio, and ultrasonic power along with duty cycle on UA-TPP was examined. The yield of 67.15 mg/g was achieved using UA-TPP in 20 min irradiation time at room temperature (30 ± 2 °C) using 30% (w/v) ammonium sulphate saturation, 1:1 (v/v) turmeric aqueous slurry to t-butanol ratio, 1:30 (w/v) turmeric powder to solvent ratio with 22 kHz frequency, 60 W power and 60% (6 sec ON and 4 sec OFF) duty cycle. The comparison study was done based on extraction yields, time, energy requirement and process cost required by UA-TPP, conventional TPP and Soxhlet. UA-TPP found useful not only to enhance the process but also to improve the antioxidant capacity and anti-inflammatory activity of the extract in comparison with TPP.

Effectiveness of high-frequency left prefrontal repetitive transcranial magnetic stimulation in patients with treatment-resistant depression: A randomized clinical trial of 37.5-minute vs 18.75-minute protocol.

AimClinical trials and meta‐analyses have demonstrated the efficacy of high‐frequency repetitive transcranial magnetic stimulation (rTMS) over the left prefrontal cortex in treatment‐resistant depression. The aim of this study was to prospectively evaluate the effectiveness of the conventional 37.5‐minute vs 18.75‐minute rTMS protocol over the left prefrontal cortex in patients with treatment‐resistant depressive episode.MethodsThirty patients with treatment‐resistant depression or bipolar disorder depressive episode were randomized 1:1 to either 37.5‐minute or 18.75‐minute rTMS protocol groups. rTMS treatment was applied at 120% resting motor threshold with 10 Hz over the left prefrontal cortex. Treatment sessions were delivered for a total of 3000 pulses/d, 5 days a week, for 4‐6 weeks. Patients received a 75 trains with “4 sec on and 26 sec off” for 37.5 minutes or a 75 trains with “4 sec on and 11 sec off” for 18.75 minutes. Severity of depression was rated with the Quick Inventory of Depressive Symptomatology (QIDS) and Patient Health Questionnaire (PHQ‐9). Remission was defined as a total score of 5 or less on the QIDS. The primary outcome measure was to compare the remission rate between the both groups.ResultsThirteen of 30 patients (43.3%) showed remission at week 6. There were no significant differences in the remission rate between the conventional 37.5‐ and 18.75‐minute protocol groups (46.7% and 40.0%, respectively). No seizures or treatment‐emergent mania/hypomania were occurred.ConclusionThese findings suggest that, compared with the conventional one, rTMS with 18.75‐minute protocol might be equally effective and clinically beneficial in saving the treatment session length. Further well‐designed studies are needed.

Cramp Training Induces a Long-Lasting Increase of the Cramp Threshold Frequency in Healthy Subjects

A low cramp threshold frequency (CTF) is associated with an increased cramp susceptibility. Recent data indicate that the CTF can be substantially increased by a cramp training consisting of electrically induced muscle cramps (EIMCs). This study investigated if four cramp training sessions induce sustained effects on the CTF. In ten healthy male subjects, EIMCs were induced in the gastrocnemius medialis of one leg (intervention leg, IL) twice a week, while the opposite leg served as control leg (CL). The stimulation protocol consisted of three sets of six bipolar rectangular wave pulsed currents (5 sec on, 10 sec off) at 30 Hz above the individual CTF. After four cramp training sessions (2 weeks) the CTF differed (p < 0.001) from pre-values in the IL (pre: 19.2 ± 1.4 Hz post 29.8 ± 8.0 Hz) but not in the CL (pre: 18.2 ± 1.5 Hz post 19.6 ± 2.8 Hz; p > 0.05). Thereafter, the CTF remained elevated in the IL for 22 days (22 days post: 22.2 ± 3.2 Hz; p < 0.05) when compared to pre and was significantly (p < 0.05) higher than that of the CL 5, 10, and 14 days after the intervention. The applied cramp training induced a long-term CTF increase of 14 days.

Conventional vs. pulsed-light accelerated corneal collagen cross-linking for the treatment of progressive keratoconus: 12-month results from a prospective study.

The aim of the present study was to compare the clinical outcomes of conventional corneal collagen cross-linking (CXL) and pulsed-light accelerated CXL (pl-ACXL) in the eyes of patients with progressive keratoconus. A total of 72 eyes with progressive keratoconus in 58 patients were equally divided into the CXL and pl-ACXL treatment groups. The CXL treatment was performed using the UVX 1000 system with 0.1% riboflavin solution in 20% dextran presoak for 30 min, and 3 mW/cm2 ultraviolet A (UVA) light for 30 min. The pl-ACXL group was treated with the KXL system using 0.1% riboflavin with HPMC presoak for 10 min, followed by 8 min (1 sec on/1 sec off) of 30 mW/cm2 UVA light. Patients were evaluated according to the uncorrected distance visual acuity (UDVA), corrected DVA (CDVA), refraction, maximum keratometry (Kmax), endothelial cell density (ECD), anterior segment optical coherence tomography and in vivo confocal microscopy. The follow-up period was 12 months. Transient haze was observed in 17 eyes (47.22%) in the CXL group and 8 eyes (22.22%) in the pl-ACXL group at 1 month postoperatively. There were no significant postoperative differences in the astigmatism, manifest refraction spherical equivalent, ECD or thinnest corneal thickness. By contrast, UDVA, CDVA and Kmax presented significant improvement at 12 months postoperatively in the two groups. The demarcation line depth was 284.94±33.29 µm in the CXL group, which was significantly deeper in comparison with that in the pl-ACXL group (201.64±27.72 µm; P<0.01) at 1 month postoperatively. In vivo confocal microscopy revealed keratocyte apoptosis and stromal edema at 1 month postoperatively, which gradually recovered towards the normal status after 12 months in the two groups. There were no apparent changes in the posterior stroma and endothelium in either group. The results of the present study revealed that CXL and pl-ACXL were safe and effective procedures in stabilizing the progression of keratoconus. The CXL technique offers more effective visual and topographic outcomes compared with pl-ACXL, while pl-ACXL ensures shorter treatment time and reduced microstructural damage.

Comparison of Aqueous Humor Nitric Oxide Levels After Different Corneal Collagen Cross-Linking Methods

ABSTRACTPurpose: Nitric oxide production can cause either apoptotic or necrotic cell death through oxidative stress. We aimed to investigate the nitrite oxide metabolites (NOx) and nitrite levels in the aqueous humor of rabbit eyes after different methods of corneal collagen cross-linking (CXL).Materials and methods: Twenty-four eyes of 12 adult New Zealand rabbits were used. They were assigned into four groups, each including six eyes. Group 1 (control) consisted of eyes with no treatment. Group 2 received UV-A power setting at 3 mW/cm2 for 30 minutes of continuous exposure and named as standard CXL group. Group 3 received UV-A power setting at 30 mW/cm2 for 3 minutes of continuous exposure and named as accelerated CXL (A-CXL) group. Group 4 received UV-A power setting at 30 mW/cm2 for 6 minutes of pulsed exposure (1 sec on, 1 sec off) and named as pulse-light accelerated CXL (PLA-CXL). Aqueous humors were aspirated from anterior chamber with a 27G needle after 1 hour UV-A exposure. NOx and nitrite levels were measuredResults: The nitrite levels in aqueous humor were significantly increased in Group 2 and Group 3 when compared with Group 1 (p = 0.000, p = 0.036, respectively). When treatment modalities were compared with each other, high nitrite level in Group 2 was statistically significant when compared with Group 4 (p = 0.019). NOx levels were higher in Group 2 when compared with Group 1 (p = 0.006).Conclusions: Numerous studies investigated the physiological and pathophysiological roles of NO. NO is considered one of the most important molecule for ocular health. According to NOx level in aqueous humor, it seems that PLA-CXL is the safest method due to the similar results with control group.