Significant Mean Change Research Articles

Blood oxygen level with long-term use of N95 face mask in dental practice during the coronavirus pandemic “Covid-19”

Wearing a mask for a long time, particularly N95, is sometimes uncomfortable, annoying, and confining, making catching breath difficult and reducing the oxygen level in the blood. The study aimed to investigate the change in blood oxygen level when wearing an N95 mask for three hours among dental practitioners in dental clinics and the impact of low O2 levels on the general status of students while working in a stressful environment. Material and methods . The sample included 82 adult healthy senior dental students attending the student oral surgery clinical sessions. All Participants had their oxygen saturation Spo 2 measured using a portable pulse oximeter before, 1hour, 2hours, and 3 hours after wearing the mask, and were allowed to describe their feeling of discomfort throughout the study. Systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR) were also measured before and 3 hours after wearing the mask. Results . 84.15% (n= 69) of the participants reported some discomfort affecting their general status and clinical performance. There was a statistically significant increase in mean heart rate after three hours ( P -value = 0.001) while there was no statistically significant change in mean systolic/diastolic blood pressure after three hours ( P -value = 0.630) and ( P -value=0.407) respectively. On the other hand, the mean Oxygen saturation after three hours showed a statistically significantly lower value compared with baseline measurement. Conclusion . This study revealed a decrease in the oxygen saturation (SpO2) and a slight increase in pulse rate compared to baseline values in all students three hours after wearing an N95 face mask. In addition, the N95 mask induced discomfort in breathing, a decrease in physical performance, and increased fatigue not related to prolonged standing and stress.

Blood oxygen level with long-term use of N95 face mask in dental practice during the coronavirus pandemic “Covid-19”

Wearing a mask for a long time, particularly N95, is sometimes uncomfortable, annoying, and confining, making catching breath difficult and reducing the oxygen level in the blood. The study aimed to investigate the change in blood oxygen level when wearing an N95 mask for three hours among dental practitioners in dental clinics and the impact of low O2 levels on the general status of students while working in a stressful environment. Material and methods . The sample included 82 adult healthy senior dental students attending the student oral surgery clinical sessions. All Participants had their oxygen saturation Spo 2 measured using a portable pulse oximeter before, 1hour, 2hours, and 3 hours after wearing the mask, and were allowed to describe their feeling of discomfort throughout the study. Systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR) were also measured before and 3 hours after wearing the mask. Results . 84.15% (n= 69) of the participants reported some discomfort affecting their general status and clinical performance. There was a statistically significant increase in mean heart rate after three hours ( P -value = 0.001) while there was no statistically significant change in mean systolic/diastolic blood pressure after three hours ( P -value = 0.630) and ( P -value=0.407) respectively. On the other hand, the mean Oxygen saturation after three hours showed a statistically significantly lower value compared with baseline measurement. Conclusion . This study revealed a decrease in the oxygen saturation (SpO2) and a slight increase in pulse rate compared to baseline values in all students three hours after wearing an N95 face mask. In addition, the N95 mask induced discomfort in breathing, a decrease in physical performance, and increased fatigue not related to prolonged standing and stress.

Impact of Pancreatic Enzymes on Enteral Fat and Nitrogen Absorption in Short Bowel Syndrome.

Patients with short bowel syndrome (SBS) can have a high morbidity rate. To minimize morbidity, enteral autonomy is the primary goal in clinical management of patients with SBS. This is often difficult to achieve because of significant malabsorption. To date, there are limited therapies that improve absorption in patients with SBS. The impact of pancreatic enzyme replacement treatment on enteral absorption has not been studied in this population and was the primary aim of this study. This was an interventional study in 11 subjects (6 pediatric subjects ages 4.0-17.9 years, 5 adult subjects 18-75 years) that compared enteral absorption in each subject before and after pancreatic enzyme medication (Creon). Coefficient of fat absorption (CFA) and coefficient of nitrogen absorption (CNA) were used as markers of enteral absorption of fat and protein, respectively. There was no statistically significant mean change in CFA and CNA before and after pancreatic enzyme medication therapy. Six subjects demonstrated an increase in CFA and 8 subjects demonstrated an increase in CNA after the use of pancreatic enzyme medication therapy. There was no statistically significant improvement in enteral fat and protein absorption in the cohort as a whole, though several subjects demonstrated an improvement. These results suggest that some patients with SBS may benefit from treatment with pancreatic enzymes. Further studies are needed to better evaluate the effect of pancreatic enzyme therapy on enteral absorption in subjects with SBS and to characterize factors that may predict a positive response.

Tension-band Plating for Leg-length Discrepancy Correction.

AimDual tension-band plates are used for temporary epiphysiodesis and longitudinal guided growth. The study aim was to assess rate of correction, to identify development of femoral and tibial intra-articular deformity during correction and to document resumption of growth after plate removal.Materials and methodsA retrospective study of 34 consecutive patients treated with dual tension-band plates between 2012 and 2020 was performed. Twenty-four patients had surgery at the distal femur, six at the proximal tibia and four at both. Twenty-five female patients were treated at a mean age of 11.6 (±1.4) years and nine male patients at 13.5 (±1.5) years. Measurements were performed on standardised long-leg radiographs and included leg-length discrepancy (LLD), joint line congruency angle (JLCA), tibial roof angle, femoral floor angle and notch-intercondylar distance. Measurements were taken pre-operatively, at the end of discrepancy correction and at skeletal maturity.ResultsThe LLD reduced by a mean of 12.9 mm (95% CI 10.2–15.5) with the mean residual difference 8.4 mm (95% CI 5.4–11.4). The mean correction rate for the proximal tibia was 0.40 (SD 0.33) mm/month and 0.68 (SD 0.36) mm/month for the distal femur. A significant mean change in residual LLD [−2.5 mm (95% CI −4.2 to −0.7)] was observed between plate removal and skeletal maturity at the femoral level only. After length discrepancy correction, the tibial roof angle showed a significant difference of 8.4° (95% CI 13.4–3.4) between legs. In femoral epiphysiodesis patients, no important differences were observed.ConclusionA significant reduction in LLD can be achieved using dual tension-band plating. A change in intra-articular morphology was observed only in the proximal tibia and not in the distal femur. In the authors’ opinion, tension-band plating is a useful tool for leg-length equalisation but should be reserved for younger patients or when residual growth is difficult to predict. It is one of the management strategies for limb-length difference prior to skeletal maturity.How to cite this articleTolk JJ, Merchant R, Calder PR, et al. Tension-band Plating for Leg-length Discrepancy Correction. Strategies Trauma Limb Reconstr 2022;17(1):19–25.

Effects of a Plyometric Training Program in Sub-Elite Futsal Players During Pre-Season Period

Background of Study: Plyometric training (PT) programs can improve several motor skills during the pre-season. Even so, its impact during the pre-season specifically in futsal remains unclear. Objective: The present observational study examines the impact of a six-week PT program that included varied strength exercises in adult male futsal players. Method: Fourteen futsal players from a Portuguese men’s sub-elite team that competed in a national championship (mean ± Standard deviation (SD) age: 25.78±7.05 years) were included in this cross-sectional study that analyzed the consequences of a PT program during the pre-season, followed by four weeks of detraining. Players were monitored 3 times: at the beginning, after six weeks of PT and four weeks after the end of PT. Results: The current research presented significant mean changes with the application of the training program in the three assessment moments for agility (small to moderate effect), countermovement jump (CMJ) height (trivial to small effect), and sprint performance (trivial to moderate large effect). When assessing the mean differences between pre- and post-training, the differences are more evident in their magnitude (Δ = -12.73 to 3.69%, d = 0.38 to 2.08). Furthermore, the PT program showed the greatest influence on 20 m sprint with a large effect (Δ = -12.73%, d = 2.08), followed by a small and moderate effect for agility (Δ = -6.46%, d = 0.85) and for the 10 m sprint (Δ = -3.53%, d = 0.38). Conclusions: These results confirmed the impact of a six-week plyometric training during the pre-season in sub-elite futsal players. This new evidence can be particularly useful in pre-season planning in futsal.

Prospective clinical assessment of patients with pulmonary arterial hypertension switched from bosentan to macitentan (POTENT).

Even though pulmonary arterial hypertension (PAH) remains an incurable disease, the combination of PAH‐specific therapies allowed evolving from symptom‐based strategies to others aiming to move patients to low‐risk conditions. Endothelin‐1 (ET‐1) receptor antagonists emerged as specific‐PAH drugs that can be used in combination with other specific therapies. This work aimed to perform a prospective clinical assessment of patients with PAH that switched from bosentan to macitentan (POTENT), due to inadequate response. POTENT is a prospective, open‐label, single‐arm, uncontrolled study including PAH patients from our ongoing SAUDIPH registry. It enrolled 50 PAH patients divided as follows: idiopathic/heritable pulmonary arterial hypertension (I/HPAH); n = 24; PAH associated with congenital heart disease, n = 19; PAH associated with connective tissue diseases, n = 5; and pulmonary veno‐occlusive disease and/or pulmonary capillary haemangiomatosis (PVOD/PCH), n = 2. At baseline, most patients were in World Health Organization Functional Class (WHO FC) II/III (52.0%). After switching to macitentan, patients were more likely to be in WHO FC I/II (78%) and 22% of the overall cohort moved to a lower risk condition, with three low risk stratification parameters. Mean 6‐min walking distance increased about 34 m after 12 months, with a significant mean change over time (12.63 ± 11.69 at month 3 vs. 40.75 ± 12.57 at month 12, p = 0.002). Most haemodynamic parameters decreased over time, with corresponding negative mean changes (p < 0.001). The safety of macitentan was confirmed by the absence of anaemia and liver injury; clinical worsening was observed only in a small group of patients. In general, macitentan might be a valid alternative to bosentan in PAH stable patients on combination therapy with insufficient clinical response, and presenting intermediate and high‐risk parameters. We anticipate that studying this strategy in PAH subgroups would further clarify its potential and limitations.

Developing Sustainable Prehospital Pediatric Care in Rwanda.

Unintentional injury is the leading cause of death in children older than 1 year and disproportionately affects pediatric patients in low- and middle-income countries.Improved prehospital care capacity has demonstrated the ability to improve care and save lives. Our collaboration developed and implemented a sustainable prehospital emergency pediatrics care course (EPCC) for Service d'Aide Medicale Urgente, the public emergency medical service in Rwanda. A 1-day context-specific EPCC was developed based on international best practices and local feedback. Two cohorts were created to participate in the course. The first group, EPCC 1, was made of 22 Service d'Aide Medicale Urgente providers with preexisting knowledge on the topic who participated in the course and received training to lead future sessions. After completion of the EPCC1, this group led the second cohort, EPCC 2, which was composed of 26 healthcare providers from around Rwanda. Each group completed a 50 question assessment before and after the course. Emergency pediatrics care course 1 mean scores were 58% vs 98% (pre vs post), EPCC 2 mean scores were 49% vs 98% (pre vs post), using matched-pair analysis of 22 and 32 participants, respectively. When comparing unequal variances across the groups with a 2-tailed paired t test, EPCC 1 and EPCC 2 had a statistically significant mean change in pretest and posttest assessment test scores of 40% compared with 46%, P < 0.0001, with 95% confidence interval. A 1-way analysis of variance mean square analysis for the change in scores showed that regardless of the baseline level of training for each participant, all trainees reached similar postassessment scores (F(1) = 1.45, P = 0.2357). This study demonstrates effective implementation of a context-appropriate prehospital pediatric training program in Kigali, Rwanda. This program may be effective to support capacity development for prehospital care in Rwanda using a qualified local source of instructors.

Effects of a Supplement Containing a Cranberry Extract on Recurrent Urinary Tract Infections and Intestinal Microbiota: A Prospective, Uncontrolled Exploratory Study.

Aim:Cranberries (Vaccinium macrocarpon) are traditionally used in prevention of urinary tract infections (UTIs). The authors' aim was to evaluate effects of a supplement containing cranberry extract, pumpkin seed extract, vitamin C, and vitamin B2 on recurrent uncomplicated UTIs in women and their intestinal microbiota.Methods:A prospective, uncontrolled exploratory study was conducted in women with recurrent uncomplicated UTIs. The primary exploratory outcome was the number of UTIs in a 6-month prospective observation period compared with a 6-month retrospective period. Further outcomes included number of antibiotics, quality of life (SF-36), intestinal microbiota (assessed by 16S rRNA amplicon sequencing), and evaluation questions. Parameters were assessed at baseline and after 1, 2, and 7 months (start of intake of cranberry supplement after 1 month for 6 months). p-Values were calculated with the pairwise Wilcoxon signed-rank test for α diversity and permutational multivariate analysis of variance.Results:Twenty-three women (aged 52.7 ± 12.4 years) were included in the study. Participants reported 2.2 ± 0.8 UTIs (at baseline) in the previous 6 months. After 6 months of cranberry intake, participants reported a significant decrease to 0.5 ± 0.9 UTIs (p < 0.001). Number of antibiotic therapies was also significantly (p < 0.001) reduced by 68% during 6 months of cranberry intake (0.14 ± 0.35) when compared with 6 months retrospectively (1.14 ± 0.71). The SF-36 physical component score increased from 44.9 ± 5.5 at baseline to 45.7 ± 4.6 at 7 months (p = 0.16). The SF-36 mental component score decreased slightly from the baseline value of 46.5 ± 6.5 to 46.2 ± 6.4 at 7 months (p = 0.74). No significant intragroup mean changes at genus, family, or species level for α and β diversity within the intestinal microbiota were found. In the evaluation questions, participants rated the cranberry extract positively and considered it beneficial. The supplement intake was safe.Conclusions:This study shows that women with recurrent uncomplicated UTIs benefit from cranberry intake. Future larger clinical studies with further investigation of the mechanisms of action are required to determine the effects of cranberries on participants with uncomplicated UTIs.

SuperSpeech: Multilingual Speech and Language Maintenance Intervention for Vietnamese-Australian Children and Families via Telepractice.

The aim of this pilot feasibility study was to evaluate the effectiveness of the group VietSpeech SuperSpeech program targeting speech skills and home language maintenance via telepractice. In Stage 1, using a case-control design, 30 Vietnamese-English-speaking children were assessed in English and Vietnamese, and parents completed questionnaires about speech and language competency and practices. During Stage 2, children were allocated to intervention (n = 14) or control (n = 16) conditions. COVID-19 restrictions resulted in changes including nonrandom allocation. Online group intervention targeting speech, home language maintenance, and multilingualism as a superpower was delivered 1 hr/week for 8 weeks. For Stage 3, assessments were undertaken approximately 10 weeks after the pre-intervention assessment. Parents in the intervention group significantly increased encouragement of their children to speak Vietnamese. The intervention group significantly increased intelligibility in English. Growth of Vietnamese vocabulary was faster for the control group. There was a moderate effect of intervention for children's perception of being happy talking in Vietnamese and English. There was no significant mean change from pre- to post-intervention compared with the control group for measures of speech sound accuracy in Vietnamese or English, Vietnamese intelligibility, English vocabulary, or hours of Vietnamese spoken each week. This study presents preliminary evidence that this 8-hr online group program targeting speech skills and home language maintenance had some impact on Vietnamese-Australian children's speech and home language maintenance. Further research involving a randomized trial is warranted.

The effect of secukinumab on patient-reported outcomes in patients with active psoriatic arthritis in a randomised phase 3 trial.

The phase 3 FUTURE 5 trial (NCT02404350) showed the clinical and radiographical efficacy of secukinumab in patients with psoriatic arthritis. This analysis aimed to assess the effect of secukinumab on patient-reported outcomes (PROs). FUTURE 5 was a phase 3, multicentre, parallel-group randomised trial in which patients who were 18 years old or older, met the classification criteria for psoriatic arthritis at screening, and had symptoms of moderate-to-severe psoriatic arthritis for at least 6 months were randomly assigned to receive secukinumab 300 mg, 150 mg, 150 mg no loading dose (NL), or placebo weekly from baseline to week 4 and every 4 weeks thereafter. The prespecified PROs of the FUTURE 5 trial were assessed first in the overall population. We report mean changes from baseline and the proportion of patients reporting improvements equal to or more than the minimum clinically important differences (MCIDs) and scores equal to or more than the normative values for patient global assessments (PtGA) of disease activity; psoriasis and arthritis visual analogue scale (VAS) scores; pain VAS; Health Assessment Questionnaire Disability Index (HAQ-DI); 36-item Short Form Health Survey (SF-36); Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F); and quality of life questionnaires. Patients were then stratified and assessed according to their tumour necrosis factor (TNF) inhibitor status (TNF-naive and TNF-inadequate responder [TNF-IR] populations) as a post-hoc analysis. Patients in all secukinumab groups reported significant least-squares mean changes from placebo at week 16 in all PROs except SF-36 mental component summary (MCS), irrespective of TNF inhibitor use. These included PtGA (300 mg difference vs placebo -12·2 [95% CI -16·3 to -8·1], 150 mg -8·22 [-12·4 to -4·1], 150 mg NL -8·3 [-12·5 to -4·2]; all p<0·0001), pain VAS (300 mg -14·3 [-18·3 to -10·2], 150 mg -11·5 [-15·6 to -7·5], 150 mg NL -11·3 [-15·3 to -7·2]; all p<0·0001), HAQ-DI (300 mg -0·33 [-0·42 to -0·24], 150 mg -0·23 [-0·32 to -0·14], 150 mg NL -0·24 [-0·33 to -0·15]; all p<0·0001), and FACIT-F (300 mg 4·8 [3·2 to 6·4], 150 mg 4·2 [2·6 to 5·8], 150 mg NL 3·5 [1·9 to 5·1]; all p<0·0001). Similarly, the proportion of patients with improvements equal to or better than MCID at week 16 was higher in the secukinumab group compared with the placebo group for most PROs except SF-36 (MCS), regardless of TNF inhibitor use. Secukinumab resulted in early, statistically significant, clinically meaningful, sustained improvements in PROs across all doses compared with placebo in patients with active psoriatic arthritis. These improvements were seen irrespective of previous TNF inhibitor use, in a post-hoc analysis. These results indicate that secukinumab provides comprehensive improvement for patients with psoriatic arthritis, regardless of previous therapy. Novartis.

Analysis of average annual temperatures and rainfall in southern region of the state of Rio Grande do Sul, Brazil

This work aimed to analyze the average temperature and rainfall in the Southern and Steppe regions of the State of Rio Grande do Sul, Brazil, obtained by three global climate models regionalized by the Eta model (CANESM2, HADGEM2-ES and MIROC5) for the historical period, and two future climate scenarios (RCP 4.5 and RCP 8.5), subdivided into three periods: F1 (2006-2040), F2 (2041-2070), and F3 (2071-2099). The analysis was conducted by applying the trend tests Mann Kendall’s, Sen’s Slope and Pettitt’s to the dataset. The study noted an increase in temperature, and that the highest temperatures will occur at the end of the century. For the three climate models, temperatures will be milder in the RCP 4.5 scenario, mostly, when compared to the RCP 8.5. For those scenarios, a significant increase up to 0.95°C/year was observed in the temperature of all series, with the years of change in the mean values occurring between 2048 and 2060. The projections also suggest that there may be an increase in the average accumulated rainfall in the future periods analyzed, with exception of the result found with CANESM2 model at the RCP 8.5 scenario, which showed a significant decrease of annual rainfall in all series, ranging approximately from -3,1 to -6,6 mm/year. Those significant changes in mean of the rainfall series are expected for the late 2070's. With exception of this result, most cities and models indicate an increase in rainfall regimes, with clear variations between models and scenarios.

Task Sharing for Managing Common Noncommunicable Disease in a Nurse Led Noncommunicable Diseases Clinic in Peri-Urban Community of Chandigarh.

Nurse led noncommunicable diseases (NCD) clinic may address the significant shortage of human resource for health for managing common NCDs. The objective of this study is to assess the feasibility and effectiveness of nurse-led NCD clinic for identification, prevention, and management of common NCDs. A quasi experimental study was conducted at a Public Health Dispensary in periurban community of Northern India. Situational analysis and stakeholders' interview were done based on which the clinic was setup and run over a period of 2 months by registered nurses and nursing students to offer screening, health education and appropriate referral. The primary outcome of study was proportion of population screened, prevalence of common NCDs, risk factors modification, medication adherence, and patient satisfaction. It was feasible to run a nurse led clinic in terms of availability of space, equipment to run the clinic and human resource. A total of 455 individuals aged ≥30 years were enrolled using the total enumeration sampling technique. There was a significant increase in screening rates from 0.29% to 3.7% in nurse-led NCD clinic. There was significant mean change in systolic blood pressure (18.75 ± 6.92 mm Hg), diastolic blood pressure (4.4 ± 3.71 mm Hg), random blood sugar (33.36 ± 38.49 mg/dl) Body Mass Index, and waist circumference (P < 0.01) among the population screened. Medication adherence significantly increased from 7.8% to 76.4% (P < 0.01) after 2 months of nurse-led NCD clinic. Task sharing for managing common NCDs in nurse-led NCD clinic was feasible and effective in increasing screening rates, medication adherence, and risk factors modification among studied population.

Probiotic Supplementation (Vibact DS) in Patients with Type 2 Diabetes Mellitus

Purpose: The aim of this study was to evaluate the effect of probiotic supplementation (Vibact DS) on anthropometric, glycemia, and lipid parameters in Indian patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In this multicentric, retrospective, observational study, adult patients with T2DM who had received Vibact DS probiotic supplement for 3 months were identified from the patient medical records at each center. We assessed the effect of probiotic use on weight, body mass index (BMI), glycemic parameters, lipid profile, and impact on gastrointestinal (GI) side effects. Results: From 50 centers across India, data of 308 patients were analyzed retrospectively. In this sample, the mean age was 54.15 years, 60.69% were males, and the mean weight was 70.97 ± 10.38 kg. After 3 months of Vibact DS, there was a significant reduction in body weight, BMI, fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) (P &lt; 0.0001 for each parameter). Mean reduction in HbA1c was statistically significant (mean change at 3 months: -0.8%; P &lt; 0.0001). There were significant improvements in lipid parameters (P &lt; 0.0001) excepting high-density lipoprotein. Control of GI side effects was reported in 12.66% of patients. Physicians rated excellent and very good clinical efficacy in 25.9% and 40.6% of patients, whereas excellent and very good tolerability was reported in 28.2% and 42.1% of patients, respectively. Conclusion: This real-world evidence from India shows that regular use of probiotics such as Vibact DS may significantly improve the glycemic and metabolic profile and aids in relieving GI problems in patients with T2DM.

Comparison in the Mean Change in Haematocrit by Blunt Versus Sharp Expansion of Uterine Incision at Caesarean Delivery

Objective: To compare the mean change in haematocrit by blunt with sharp expansion of uterine incision at caesarean delivery. Methodology: In this Randomized Control Trial, at Department of Obstetrics/Gynaecology, Allied Hospital, Faisalabad during the years 2020, we included 200 cases (100 in each group) who fulfilled the inclusion/exclusion criteria. Two equal groups were formed by dividing patients randomly, A &amp;B. Routine process of history, physical and systemic examination was completed before proceeding for the procedure. Sharp expansion was made in cases of Group-A whereas blunt expansion of uterine incision was done in Group-B cases. Blood loss in both groups was recorded by comparing haematocrit (%), pre-operative and 48 hours after the procedure. Results: Mean pre-operative haematocrit levels were recorded as 36.29+2.64 in Group-A and 36.93+2.32 in Group-B. Mean post-operative haematocrit levels were recorded as 35.06+2.18 in Group-A and 32.09+2.41 in Group-B. Comparison of mean change in haematocrit levels were calculated and recorded as 3.097+0.339 in Group-A and 5.368+4.923 in Group-B. P-value was computed as 0.0001 which shows a significant difference in both groups. Conclusion: The results of the study concluded that there is a significant higher mean change in heamatocrit by blunt expansion of the uterine incision as compared to sharp expansion at caesarean delivery. Keywords: Cesarean section, blunt expansion, sharp expansion, haematocrit

Effect of High-Intensity Interval Training on Rheumatoid Arthritis CD4+ T Cell Oxidative Metabolism

Persons with rheumatoid arthritis (RA) have poor cardiorespiratory fitness and accelerated biological aging driven by systemic impairments in metabolism and inflammation. In this study of older RA participants, our goal was to identify the effects of a high-intensity interval training (HIIT) program on cardiorespiratory fitness and peripheral CD4+ T cell metabolism. We isolated CD4+ T cells from peripheral blood mononuclear cells in sedentary female RA participants (n=6; age=64.0+/-6.3 years) who underwent cardiopulmonary exercise testing and phlebotomy before and after 10 weeks of HIIT. HIIT improved RA cardiorespiratory fitness by 6.5+/-6.0% (pre-HIIT VO2 peak=25.1+/-5.1 ml/kg/min, post-HIIT VO2 peak=26.7+/-5.0; p=0.05). As measured by Seahorse XF Mito Stress Test, there were no significant mean changes in CD4+ T cell oxidative (oxygen consumption rate (OCR); pmol/min) or glycolytic (extracellular acidification rate (ECAR); mpH/min) metabolism, however there was large interindividual variability. RA peripheral CD4+ T cells preferred glycolytic metabolism (pre-HIIT mean basal OCR/ECAR ratio=0.78+/-0.13 pmol/mpH), while HIIT non-significantly shifted cellular preference toward oxidative metabolism (post-HIIT mean basal OCR/ECAR ratio=0.86+/-0.16; p=0.30). Increases in RA cardiorespiratory fitness following HIIT were significantly associated with increases in RA peripheral CD4+ T cell OCR/ECAR ratio (Spearman’s rho=1.0, p<0.001) and basal and maximal respiration (rho=0.89, p=0.02 for both). Additionally, increases in CD4+ T cell mitochondrial ATP-linked respiration were significantly associated with increased quantities of circulating naïve CD4+CCR7+CD45RA+ T cells (rho=0.89, p=0.02). Our findings suggest that targeting cardiorespiratory fitness may be key in modulating T cell specific oxidative metabolism and function to prevent immunosenescence in older patients with chronic inflammatory diseases.

The ability of a submaximal cycle ergometer test to detect longitudinal changes in VO2max

BackgroundThe purpose of the present study was to examine the ability of a submaximal cycling test to detect longitudinal changes in maximal oxygen uptake (VO2max) and examine the conformity between changes in measured and estimated VO2max over a time span of 5–8 years.MethodsA total of 35 participants (21 men and 14 women), aged 29 to 63 years, performed the Ekblom-Bak (EB) submaximal cycle test for estimation of VO2max and a maximal treadmill running test for direct measurement of VO2max. The baseline tests were conducted between 2009 and 2012, and the follow-up tests were completed 5 to 8 years later. Pearson’s coefficient of correlation (r) and paired sample t-test were used to analyse the association between change in measured and estimated VO2max. Random and systematic errors between the measured and estimated VO2max were evaluated using Bland-Altman plots. Repeated measures ANOVA were used to test differences between changes over time.ResultsThere was no significant change in mean measured VO2max between baseline and follow-up (p = 0.91), however large individual variations were noted (− 0.78 to 0.61 L/min). The correlation between individual change in measured and estimated VO2max was r = 0.75 (p < 0.05), and the unstandardised B-coefficient from linear regression modelling was 0.88 (95% CI 0.61 to 1.15), i.e., for each litre of change in estimated VO2max, the measured value had changed 0.88 L. The correlation between baseline and follow-up errors (the difference between estimated-measured VO2max at each occasion) was r = 0.84 (p < 0.05). With regard to the testing procedure, repeated measures ANOVA revealed that there was no significant difference between the group who exercised at the same work rates at baseline and follow-up (n = 25), and those who required a change in work rate (n = 10).ConclusionsThe EB test detected a change in VO2max with reasonably good precision over a time span of 5–8 years. Further studies are needed to evaluate if the test can be used in clinical populations and in subjects with different medications.

Cochrane systematic review and meta-analysis of the impact of psychological treatment on health-related quality of life in people with epilepsy: an update by the ILAE Psychology Task Force, highlighting methodological changes.

Clinical interest in using psychological interventions for people with epilepsy (PWE) aiming at decreasing mental health difficulties, improving health-related quality of life (HRQOL) and seizure-related outcomes, continues to grow. This article summarizes the 2020 update of the 2017 Cochrane Review and meta-analysis of psychological interventions for PWE, highlighting the reasons for major methodological modifications such as the recategorization of interventions and expanded risk of bias assessment. A 2020 literature search yielded 36 RCTs (n=3526) investigating psychological treatments for PWE with a validated HRQOL measure as an outcome. Twenty-seven trials were skills-based psychological interventions, whilst nine studies were education-only interventions. Among skills-based psychological interventions, 11 studies (n=643) used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories convertible to QOLIE-31 as an outcome measure and were pooled for meta-analysis. Significant mean changes were observed for the QOLIE-31 total score (mean improvement of 5.23 points; p< 0.001) and in six out of seven subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication and cognitive functioning). The mean changes in the QOLIE-31 total score and the overall QoL subscale exceeded the threshold of minimally important change (MIC), indicating clinically meaningful post-intervention improvement. These results provide moderate evidence that psychological treatments for adults and adolescents with epilepsy enhance HRQOL. In addition to the summary of the Cochrane review, we provide a detailed characterization of the interventions and patient populations of the meta-analyzed studies.

Salivary Alpha-Amylase and Calcium levels Evaluation as a Biomarker in Stress Patients Undergoing Surgical Wisdom Tooth Extraction

The salivary enzyme alpha-amylase has been proposed as a biomarker for stress-induced activity of the sympathetic nervous system. In the growing field of amylase research, recent studies have underscored the usefulness of salivary alpha-amylase in this regard. Calcium is the major component of bones and teeth, and it is not surprising that disturbances in calcium metabolism have been implicated in most of the major chronic diseases, including renal disease, osteoporosis; and periodontal tissues.Twenty healthy Iraqi male undergo wisdom tooth extraction from undergraduates dental students were considered in this study with age mean of 22 years old, 2 ml samples of stimulated saliva were collected prior ten mints of surgical wisdom tooth removal, and recollected after one week fromsurgery from these students, the samples were analyzed to assess changes in ∝-amylase and calcium ion concentration under controlled conditions. The collected data predicted elevation of amylase level from ((7652.965 ±34.0410) to (7674.710 ± 68.8958) IU/L) with a significant change. And also increase in the calcium ion concentration level from (0.1465 ± 0.048) to reach level (0.1975± 0.100) mmol/L. Positive correlation were recorded between alpha amylase and calcium concentration when plotted the correlations values of stress and no stress individual's. In a conclusion. Acute stresscaused by wisdom tooth removal will elevate level of amylase in saliva significantly, howeverSignificant increasing in calcium concentration was observed in the stimulated saliva in comparison with the non-stimulated saliva with significant mean changes. However, our result predicted elevated levels of calcium concentration of the stimulated saliva than the non-stimulated (after extraction).

Safety of Once-Daily Oxymetazoline HCl Ophthalmic Solution, 0.1% in Patients with Acquired Blepharoptosis: Results from Four Randomized, Double-Masked Clinical Trials.

PurposeAn oxymetazoline 0.1% ophthalmic solution was recently approved for treatment of acquired blepharoptosis in adults. This study’s objective was to evaluate the safety profile of oxymetazoline 0.1% when administered once daily for 14–84 days.Patients and MethodsPooled analysis examined safety outcomes from four randomized, double-masked, placebo-controlled clinical trials conducted at 6, 16, 27, and 35 sites, respectively, in the United States. In total, 568 participants with acquired blepharoptosis were evaluated. Median age was 66 years and 74.8% of participants were female. Overall, 375 participants self-administered oxymetazoline 0.1% to both eyes once/day and 193 self-administered placebo (vehicle) daily. Treatment-emergent adverse event (TEAE) rates, severity, and causality were evaluated in the overall population and within participant subgroups defined based on age, race, and ethnicity. Vital signs and ophthalmic findings were evaluated at predefined study visits. Patient-reported treatment tolerability was recorded at study end.ResultsTEAE incidence was similar among participants using oxymetazoline 0.1% (31.2%) or vehicle (30.6%). Nearly all TEAEs were mild-to-moderate, and most were not suspected of being treatment related. Serious TEAEs occurred in four participants receiving oxymetazoline 0.1% and one participant receiving vehicle. Nine and two participants in the oxymetazoline 0.1% and vehicle groups, respectively, discontinued due to a TEAE. Ocular TEAEs occurring in ≥2% of participants receiving oxymetazoline 0.1% were punctate keratitis, conjunctival hyperemia, dry eye, blurred vision, instillation site pain, and corneal vital dye staining, with none occurring in >3.5% of participants. TEAE rates were similar across subgroups based on age, race, and ethnicity. No clinically significant mean changes in vital signs or ophthalmologic findings occurred, and >98% of participants rated oxymetazoline 0.1% as causing no/mild discomfort.ConclusionOnce-daily oxymetazoline 0.1% was safe and well tolerated in participants with acquired blepharoptosis when used for 14–84 days. Safety did not appear to differ based on age, race, or ethnicity.

Analysis of Headway and Speed Based on Driver Characteristics and Work Zone Configurations Using Naturalistic Driving Study Data

The objective of this paper is to analyze headway and speed distribution based on driver characteristics and work zone (WZ) configurations by utilizing Naturalistic Driving Study (NDS) data. The NDS database provides a unique opportunity to study car-following behaviors for different driver types in various WZ configurations, which cannot be achieved from traditional field data collection. The complete NDS WZ trip data of 200 traversals and 103 individuals, including time-series data, forward-view videos, radar data, and driver characteristics, was collected at four WZ configurations, which encompasses nearly 1,100 vehicle miles traveled, 19 vehicle hours driven, and over 675,000 data points at 0.1 s intervals. First, the time headway selections were analyzed with driver characteristics such as the driver’s gender, age group, and risk perceptions to develop the headway selection table. Further, the speed profiles for different WZ configurations were established to explore the speed distribution and speed change. The best-fitted curves of time headway and speed distributions were estimated by the generalized additive model (GAM). The change point detection method was used to identify where significant changes in mean and variance of speeds occur. The results concluded that NDS data can be used to improve car-following models at WZs that have been implemented in current WZ planning and simulation tools by considering different headway distributions based on driver characteristics and their speed profiles while traversing the entire WZ.