Standard Pharmacological Therapy Research Articles

Heart Rate Variability Biofeedback Efficacy on Fatigue and Energy Levels in Fibromyalgia: A Secondary Analysis of RCT NCT0412183.

Background: Fibromyalgia syndrome (FMs) is a chronic condition characterized by widespread musculoskeletal pain and a range of complex symptoms, with chronic fatigue being a central feature significantly impacting daily life. The aim of this study was to analyze the secondary outcomes, specifically those related to perceived energy and fatigue symptoms in a randomized controlled trial (RCT) assessing the efficacy of heart rate variability biofeedback (HRV-BF) as an adjunctive treatment for FMs. Methods: Sixty-four FMs patients were randomly assigned to either receive 10 HRV-BF training sessions alongside standard pharmacological therapy (experimental group) or standard therapy alone for 10 weeks (control group). For this secondary analysis, potential improvements in specific items were evaluated regarding perceived energy (Item 10 of the Short-Form Health Survey), the ability to walk and climb stairs (Item 7 and Item 11 of the Fibromyalgia Impact Questionnaire, respectively), and the impact of pain on movement ability (Item 17 of the Bodily and Emotional Perception of Pain). Results: The experimental group demonstrated an improvement in the perception of energy, the ability to walk, and the impact of pain on movement ability. However, the same improvement was not observed in the ability to climb stairs. Conclusions: Fatigue assessment has emerged as a crucial factor for evaluating treatment efficacy in FMs and related conditions linked to altered energy levels, such as bipolar depression, and can offer valuable insights for precisely guiding HRV-BF treatments. ClinicalTrials.gov with code: NCT04121832.

Heart Rate Variability Biofeedback Efficacy on Fatigue and Energy Levels in Fibromyalgia: A Secondary Analysis of RCT NCT0412183

Background: Fibromyalgia syndrome (FMs) is a chronic condition characterized by widespread musculoskeletal pain and a range of complex symptoms, with chronic fatigue being a central feature significantly impacting daily life. The aim of this study was to analyze the secondary outcomes, specifically those related to perceived energy and fatigue symptoms in a randomized controlled trial (RCT) assessing the efficacy of heart rate variability biofeedback (HRV-BF) as an adjunctive treatment for FMs. Methods: Sixty-four FMs patients were randomly assigned to either receive 10 HRV-BF training sessions alongside standard pharmacological therapy (experimental group) or standard therapy alone for 10 weeks (control group). For this secondary analysis, potential improvements in specific items were evaluated regarding perceived energy (Item 10 of the Short-Form Health Survey), the ability to walk and climb stairs (Item 7 and Item 11 of the Fibromyalgia Impact Questionnaire, respectively), and the impact of pain on movement ability (Item 17 of the Bodily and Emotional Perception of Pain). Results: The experimental group demonstrated an improvement in the perception of energy, the ability to walk, and the impact of pain on movement ability. However, the same improvement was not observed in the ability to climb stairs. Conclusions: Fatigue assessment has emerged as a crucial factor for evaluating treatment efficacy in FMs and related conditions linked to altered energy levels, such as bipolar depression, and can offer valuable insights for precisely guiding HRV-BF treatments. ClinicalTrials.gov with code: NCT04121832.

The Use of Ascorbic Acid in Adjunctive Treatment for Schizophrenia-Current State of Knowledge.

Schizophrenia is a mental illness characterized by disturbances in the perception of reality, thinking, emotions, and social functioning. This significantly impacts the quality of life of patients and leads to long-term disability. Despite advances in understanding its pathogenesis and treatment, schizophrenia remains a clinical challenge, especially due to the diversity of its symptoms and the complexity of its mechanisms. Schizophrenia is associated with abnormal functioning of the dopaminergic system, disturbances in glutamatergic neurotransmission, and oxidative stress in the brain. In recent years, there has been increasing interest in optimizing the treatment of mental disorders. The potential use of ascorbic acid, or vitamin C, in the therapy of schizophrenia could bring substantial benefits to patients. Ascorbic acid exhibits antioxidant and neuroprotective properties, suggesting its potential efficacy in reducing brain oxidative stress and improving neurotransmission. Additionally, there have been reports of its positive effects on psychotic symptoms and its potential in reducing the side effects of antipsychotic drugs. In this review article, we present the current state of knowledge on the potential use of ascorbic acid in the treatment of schizophrenia as an adjunct to standard pharmacological therapy. We analyze existing clinical studies and the mechanisms of action of vitamin C, suggesting its promising role as an adjunctive therapy in the treatment of schizophrenia. These insights, though not yet widely disseminated, may be significant for the further development of therapeutic strategies for this mental illness.

The Efficacy of Fan Therapy to Alleviate Breathlessness among Lung Cancer Patients

Breathlessness is a commonly reported symptom among patients with advanced-stage lung cancer and significantly affects their quality of life. Nowadays, treating breathlessness using standard pharmacological therapies is considered not very effective. Fan therapy, as one of the non-pharmacological approaches, emerges as a way to treat breathlessness. This study aims to examine fan therapy's impact on alleviating breathlessness in lung cancer patients. The research employs a literature review methodology, searching for relevant articles from 2017 to 2022 in databases such as Science Direct, EBSCOhost, Clinical Key Nursing, PubMed, and Google Scholar. Five eligible articles are analyzed descriptively. The findings reveal that 80% of the articles assert the effectiveness of fan therapy in reducing breathlessness in lung cancer patients. Meanwhile, 20% of the articles suggest that fan therapy may have clinical benefits in managing breathlessness. Additionally, it was found that fan therapy can decrease respiratory rates in 60% of the articles and enhance peripheral oxygen saturation in 20% of the articles. Notably, no adverse side effects on patients were reported across all analyzed articles. In conclusion, fan therapy emerges as an economical and safe non-pharmacological intervention for mitigating breathlessness in patients with advanced-stage lung cancer.

Thoracentesis to alleviate pleural effusion in acute heart failure: study protocol for the multicentre, open-label, randomised controlled TAP-IT trial

IntroductionPleural effusion is present in half of the patients hospitalised with acute heart failure. The condition is treated with diuretics and/or therapeutic thoracentesis for larger effusions. No evidence from randomised...

Potential Role of Focal Microvibration (Equistasi®) in the Management of Chronic Pain: A Pilot Study.

Chronic pain is one of the leading causes of medical consultation with a dramatic psychophysical and socioeconomic impact. Focal microvibration (Equistasi®) is a revolutionary technology that converts the thermal energy of the skin into vibration. Equistasi® was shown to be effective in the treatment of gait and balance dysfunction in many pathological conditions such as Parkinson's disease and multiple sclerosis. Our aim was to explore the efficacy of focal microvibration in the management of chronic pain. We randomized 60 patients with pain of different origin into two groups: an experimental group (group E) treated with Equistasi, and a control group (group C) treated with standard pharmacological therapy. Pain, disability, and working capacity were evaluated by Brief Pain Inventory (BPI), Oswestry Disability Index (ODI), and Work Ability Index (WAI) at the baseline and after 7 (T7), 15 (T15), 30 (T30), 60 (T60), and 90 (T90) days. According to BPI, average and worst pain in the last 24h significantly decreased in group E at T15 and this result persisted up to T90; pain interference on general activity, mood, waling ability, normal work, relations with other people, sleep, and enjoyment of life decreased in group E with a significant improvement from T15. Lifting activity and work ability in relation to demands also significantly improved in group E. No significant changes in BPI, ODI, and WAI scores were recorded in group C during the follow-up. Focal microvibration can be an effective tool for managing chronic pain in combination with other therapies.

Comparative Effect of Loop Diuretic Prescription on Mortality and Heart Failure Readmission

Loop diuretics are a standard pharmacologic therapy in heart failure (HF) management. Although furosemide is most frequently used, torsemide and bumetanide are increasingly prescribed in clinical practice, possibly because of superior bioavailability. Few real-world comparative effectiveness studies have examined outcomes across all 3 loop diuretics. The study goal was to compare the effects of loop diuretic prescribing at HF hospitalization discharge on mortality and HF readmission. We identified patients in Medicare claims data initiating furosemide, torsemide, or bumetanide after an index HF hospitalization from 2007 to 2017. We estimated 6-month risks of all-cause mortality and a composite outcome (HF readmission or all-cause mortality) using inverse probability of treatment weighting to adjust for relevant confounders. We identified 62,632 furosemide, 1,720 torsemide, and 2,389 bumetanide initiators. The 6-month adjusted all-cause mortality risk was lowest for torsemide (13.2%), followed by furosemide (14.5%) and bumetanide (15.6%). The 6-month composite outcome risk was 21.4% for torsemide, 24.7% for furosemide, and 24.9% for bumetanide. Compared with furosemide, the 6-month all-cause mortality risk was 1.3% (95% confidence interval [CI]: -3.7, 1.0) lower for torsemide and 1.0% (95% CI: -1.2, 3.2) higher for bumetanide, and the 6-month composite outcome risk was 3.3% (95% CI: -6.3, -0.3) lower for torsemide and 0.2% (95% CI: -2.5, 2.9) higher for bumetanide. In conclusion, the findings suggested that the first prescribed loop diuretic following HF hospitalization is associated with clinically important differences in morbidity in older patients receiving torsemide, bumetanide, or furosemide. These differences were consistent for the effect of all-cause mortality alone, but were not statistically significant.

Mutant Natural Killer Cell Dysfunction Enables the Immune Escape of Premalignant MDS Cell Clones

Myelodysplastic syndromes (MDS) cannot be cured by standard pharmacological therapies owing to their inability to eradicate aberrant hematopoietic stem cells (HSCs). Given that developing early intervention strategies for MDS patients requires an improved understanding of the mechanisms underlying aberrant HSC expansion, we sought to elucidate how MDS HSCs evade immune surveillance and expand in patients with clonal cytopenias of undetermined significance (CCUS), the pre-malignant stage of MDS. To characterize transcriptomic changes induced by CCUS in the aged immune microenvironment, we used single-cell RNA sequencing (scRNA-seq) of bone marrow (BM) mononuclear cells (MNCs) isolated from 2 young healthy donors (yHDs), 2 elderly healthy donors (eHDs), and 3 CCUS patients harboring mutations in MDS driver genes such as DNMT3A or TET2. CCUS immune cells were enriched in CD8 + T effector and NK cells, which were in activated states, characterized by the significant (P adj<0.05) upregulation of genes involved in protein translation, mitochondrial metabolism, and response to interferon signaling. A computational interactome analysis of ligand-receptor pair expression predicted gained intercellular communications among myeloid cells and CD8 + T and NK cells in CCUS patients compared with yHDs and eHDs, consistent with a tumor recognition process. However, CCUS CD8 + T and NK cells had downregulated NF-kB-mediated inflammatory signaling genes, which suggested a loss of proinflammatory capacity. Because an efficient antitumor CD8 + T-cell response requires functional NK cells, we further dissected their functional state by performing scRNA-seq of CD3 + and/or CD56 + BM cells isolated from 2 yHDs, 2 eHDs, and 3 CCUS patients. A trajectory reconstruction analysis showed that CCUS NK cells were in more advanced differentiation states than HD NK cells were, which was confirmed by the significant downregulation of the transcription factor FOXO1 (P adj=1.17 x 10 -81). Differential gene expression analyses revealed that CCUS NK cells had significantly (P adj<0.05) upregulated MYC and mTOR target genes and genes involved in oxidative metabolism, protein synthesis, and immune signaling (consistent with an NK cell proliferative burst) compared with eHD NK cells, which suggests that CCUS NK cells are hyperactivated. However, cytokine secretion assays with K562 cells revealed that NK cells from 5 CCUS patients secreted significantly (P=0.002) less interferon gamma than those from 6 eHDs did. CCUS NK cells and eHD NK cells produced similar levels of granzyme and perforin, and CCUS NK cells could degranulate (based on CD107a expression); however, CCUS NK cells had significantly lower CD16 expression (P=0.008), which suggests an impaired capacity to form stable immune synapses and degranulate in a polarized manner. Indeed, compared with those from 3 yHDs and 4 eHDs, NK cells from 3 CCUS patients had a significantly (P<0.0001) impaired cytolytic capacity against leukemic cells that could not be rescued by prolonged culture with feeder cells. Moreover, NK cells from 4 CCUS patients failed to kill both heterotypic and isotypic CCUS CD34 + cells ex vivo (Fig. 1). To investigate the molecular mechanisms of NK cell dysfunction, we performed joint targeted single-cell DNA sequencing and immunophenotypic analyses of MNCs from 5 CCUS patients with DNMT3A or TET2 mutations, which revealed that NK cells were enriched in aberrant clones and had mutational burdens similar to those of myelomonocytes (Fig. 2). Deletion of DNMT3A or TET2 by CRISPR/Cas9 in cord blood-derived NK cells and subsequent killing assays showed a significant (P<0.0001) progressive loss of cytolytic capacity with tumor re-challenging in knock-out NK cells, which demonstrated that loss of function mutations in those genes are a direct cause of NK cell dysfunction in the context of sustained immune activation. This study demonstrates that MDS driver mutations in CCUS NK cells induce immune dysfunction, thus enabling the expansion of malignant cells and thereby contributing to MDS onset. Our results suggest that immunotherapy with adoptive NK cell transfer could restore the anti-tumor immune response in patients with CCUS and may be an effective approach to arrest disease progression and prevent MDS onset.

Potential therapeutic benefit of spinal cord stimulation in restless legs syndrome: scoping review and mechanistic considerations.

Restless legs syndrome (RLS) is a prevalent sensorimotor disorder that can dramatically impair sleep quality, daytime function, and quality of life. Although many patients benefit from standard pharmacological therapy, some patients suffer from insufficient treatment response or medication intolerance. Novel treatment approaches are therefore necessary. Given the overlap between RLS and pain syndromes in both pathophysiological mechanisms and certain treatment options, we aimed to perform a scoping review of the available evidence on spinal cord stimulation (SCS) for RLS and discuss potential mechanistic implications. We identified a total of 16 cases of patients with RLS who underwent SCS, all from case reports or case series. The published evidence is insufficient to assess SCS efficacy in patients with RLS, but SCS remains a promising investigational therapy in RLS on the basis of its potential mitigatory effects in the central hyperexcitability of the sensorimotor cortex through neuromodulation of spinal, subcortical, and cortical areas. A call for further research in this field is presented, with suggestions for future directions and trial designs.

Cardiac mechanics and reverse remodelling under mechanical support from left ventricular assist devices.

In recent years, development of mechanical circulatory support devices has proved to be a new treatment modality, in addition to standard pharmacological therapy, for patients with heart failure or acutely depressed cardiac function. These include left ventricular assist devices, which mechanically unload the heart when implanted. As a result, they profoundly affect the acute cardiac mechanics, which in turn, carry long-term consequences on myocardial function and structural function. Multiple studies have shown that, when implanted, mechanical circulatory assist devices lead to reverse remodelling, a process whereby the diseased myocardium reverts to a healthier-like state. Here, we start by first providing the reader with an overview of cardiac mechanics and important hemodynamic parameters. We then introduce left ventricular assist devices and describe their mode of operation as well as their impact on the hemodynamics. Changes in cardiac mechanics caused by device implantation are then extrapolated in time, and the long-term consequences on myocardial phenotype, as well as the physiological basis for these, is investigated.

Ultrasound versus Fluoroscopic-Guided Superior Hypogastric Plexus Block in Cancer Bladder: A Randomized Controlled Trial

BACKGROUND: Patients with advanced bladder cancer may suffer severe pelvic pain unresponsive to standard pharmacological therapy. AIM: This study assessed the feasibility, efficacy of ultrasoundguided (USG) versus fluoroscopy-guided (FG) superior hypogastric plexus block (SHPB) in bladder cancer pain management. METHODS: This randomized controlled study included 60 patients undergoing SHPB to manage pain in stages 3 and 4 bladder cancer patients from December 2020 to June 2021. They were randomly divided into two groups. Group Fluoro (n = 30) underwent FG-SHPB, while Group US (n = 30) underwent US-SHPB. The patients were assessed after 1 day and 1 and 3 months regarding pain intensity using visual analog score (VAS), daily morphine consumption, functional capacity, and quality of life (QoL) using the Short Form Health Survey-36. RESULTS: The procedure failed in 2 patients in each group. The procedure was significantly lengthier in the Fluor group than the US group (p < 0.001). VAS scores decreased significantly in the two groups after 1 and 3 months and were significantly in US-SHBP after 3 months. Morphine consumption decreased significantly, and functional capacity and QoL improved significantly in both groups up to 3 months. The two groups were comparable in morphine consumption, functional capacity, and QoL. Position discomfort and back pain were more common in Fluor Group. CONCLUSION: USG SHPB is a feasible, safe, and effective analgesic procedure in patients with advanced bladder cancer suffering from severe pelvic pain. It is superior to the FG transdiscal approach regarding the duration of pain relief and improvement of functional capacity in addition to avoidance of position discomfort and back pain. REGISTRATION: Clinical Trials.gov (ID NCT05083702).

STEAP1 regulation and its influence modulating the response of LNCaP prostate cancer cells to bicalutamide, enzalutamide and apalutamide.

Anti‑androgen drugs are the standard pharmacological therapies for treatment of non‑metastatic prostate cancer (PCa). However, the response of PCa cells may depend on the anti‑androgen used and often patients become resistant to treatment. Thus, studying how the anti‑androgen drugs affect oncogenes expression and action and the identification of the best strategy for combined therapies are essential to improve the efficacy of treatments. The Six Transmembrane Epithelial Antigen of the Prostate 1 (STEAP1) is an oncogene associated with PCa progression and aggressiveness, although its relationship with the androgen receptor signaling remains to be elucidated. The present study aimed to evaluate the effect of anti‑androgens in regulating STEAP1 expression and investigate whether silencing STEAP1 can make PCa cells more sensitive to anti‑androgen drugs. For this purpose, wild‑type and STEAP1 knockdown LNCaP cells were exposed to bicalutamide, enzalutamide and apalutamide. Bicalutamide decreased the expression of STEAP1, but enzalutamide and apalutamide increased its expression. However, decreased cell proliferation and increased apoptosis was observed in response to all drugs. Overall, the cellular and molecular effects were similar between LNCaP wild‑type and LNCaP‑STEAP1 knockdown cells, except for c‑myc expression levels, where a cumulative effect between anti‑androgen treatment and STEAP1 knockdown was observed. The effect of STEAP1 knockdown alone or combined with anti‑androgens in c‑myc levels is required to be addressed in future studies.

Stress control as a method to reduce perceived pain in oral lichen planus.

Oral lichen planus (OLP) is a common chronic, T-cell-mediated, inflammatory and non-infectious mucodermatosis. Patients diagnosed with oral lichen planus are more prone to depression, anxiety and higher perceived mental stress than the rest of the population. This study investigated stress control methods as a means of reducing pain levels in patients with oral lichen planus. The study involved 62 adult oral lichen planus patients who have never received any OLP treatment before. Patients with a high level of perceived mental stress received, in addition to standard pharmacological treatment, herbal sedative medication or Jacobson's Progressive Muscle Relaxation guidance (JPMR), and the patients without a high level of perceived mental stress level did not receive any additional stress control methods. The research tool was the PSS questionnaire and NRS pain level scale. Before the treatment, the level of perceived pain did not differ in any of analysed groups. After the treatment, in the group not using any stress control methods, the mean NRS level was significantly higher than in the group performing Jacobson's Progressive Muscle Relaxation (2.79 ±1.76 vs. 1.08 ±1.29), and also significantly higher than in the group receiving the herbal sedative (2.79 ±1.76 vs. 1.41 ±2.06). The use of mental stress control methods as an additional element of therapy has a positive effect on the success of oral lichen planus treatment since it helps to reduce the perceived pain level in the oral mucosa better than a standard pharmacological therapy alone.

Comparative efficacy of high-frequency repetitive transcranial magnetic stimulation to left dorsolateral prefrontal cortex as an augmentation strategy versus pharmacological augmentation in non-psychotic, unipolar, treatment-resistant depression: A randomized controlled trial.

Depression causes significant morbidity, disability and mortality, along with socioeconomic losses. Patients with depression who don't remit even with the second trial of anti-depressants need optimization, combination or augmentation strategies. Pharmacological strategies sometimes have unacceptable adverse effects. The aim of this study is to compare the efficacy of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) to left dorsolateral prefrontal cortex (DLPFC) with that of pharmacological augmentation strategies in unipolar non-psychotic treatment-resistant depression. This is a randomized controlled trial. Cases of unipolar, non-psychotic, treatment-resistant depression between ages 20 and 60 years were taken. The study period was from November 2016 to May 2018. Cases diagnosed as per ICD-10 criteria by a qualified psychiatrist. Cases of treatment-resistant depression (100) were divided into two arms by using a random number generator: rTMS arm and treatment as usual (TAU) arm. HF-rTMS to left DLPFC (rTMS group) and pharmacological augmentation with lithium, serotonin-dopamine antagonist, buspirone or thyroxine. In the rTMS arm, 44 patients and in TAU arm 41 completed the study. After 4 weeks of treatment augmentation, rTMS and TAU groups showed response rates of 52% and 46%, respectively. The difference between the two groups in terms of number of responders at the end of 4 weeks is not statistically significant. Additionally, factors associated with good response to rTMS were absence of a family history of psychiatric illness, no concomitant psychoactive substance use, being first episode of depression and mild-moderate severity of illness. The study did not find rTMS augmentation to be significantly better than standard pharmacological augmentation therapies.

Different Medicinal Treatment Modalities in the Management of Patent Ductus Arteriosus in Paediatric Population- A Narrative Review of Available Drug Approaches

Regardless of the size of a patient’s Patent Ductus Arteriosus (PDA), it is crucial for paediatric and adult cardiologists to have a thorough understanding of the condition’s origin, clinical ramifications, and treatment options. Possessing a PDA, no matter how little, might cause complications. Ibuprofen and indomethacin, both cyclo-oxygenase (COX) inhibitors, are used as the gold standard pharmacologic therapy for closing a PDA that has been produced surgically. These non selective COX inhibitors bring about ductal constriction, in addition to lowering the synthesis of prostaglandin. However, these drugs may also have a broad array of unintended consequences. Interest in paracetamol for PDA constriction has recently increased due to fewer adverse effects than indomethacin or ibuprofen. Evidence that paracetamol is now a topic of intense study lends credence to this hypothesis. Information on the long term effects of paracetamol is scarce in paediatric population.

COMPUTER ELECTROACUPUNCTURE FOR IRRITABLE BOWEL SYNDROME: EFFICACY AND SEARCH FOR EFFICACY PREDICTORS

Non-pharmacological treatment modalities, in particular, a new technique in reflexology – computerized electroacupuncture (CEAP), allow us to increase the efficacy while treating patients with irritable bowel syndrome (IBS). Search for predictors of CEAP efficacy in IBS will optimize the choice of patients for treatment, improving the CEAP efficacy profile. 
 The aim of the study is to evaluate CEAP efficacy in the complex therapy of various clinical IBS forms.
 Materials and Methods. The study involved 80 IBS patients. Patients of the main group underwent three courses of CEAP in addition to standard pharmacological therapy, patients of the reference group received only pharmacotherapy. At the beginning and at the end of each CEAP course, the severity of pain syndrome (visual analogue scale), stool frequency, stool consistency (Bristol stool scale), and subjective state indicators (Zung Self-Rating Depression Scale, Spielberger-Khanin test) were assessed.
 A retrospective analysis of the research results was carried out to search for predictors of CEAP efficacy. The impact of such parameters as patient’s gender, age, disease form and severity on treatment outcome was assessed.
 Results. After the first CEAP, the severity of abdominal pain in patients of the main group decreased from 6.1 mm to 3.9 mm and after the third CEAP to 3.7 mm. After three courses of CEAP, defecation frequency in IBS patients with diarrhea decreased from 4.7 to 1.9 per day, and in IBS patients with constipation increased from 0.26 to 0.77 per day. The proportion of patients with normal stool consistency increased significantly both among patients with constipation and among those with diarrhea to 47.1 and 55.6 %, respectively. 
 Retrospective analysis showed the best treatment results in patients with mild and moderate IBS.

Eating Hubs in Multiple Sclerosis: Exploring the Relationship Between Mediterranean Diet and Disability Status in Italy.

BackgroundMultiple Sclerosis (MS) is a complex disease in which multiple factors contribute to disability accrual. Mediterranean Diet (MeDi) has shown beneficial effects across neurodegenerative diseases. We hypothesize that specific food habits, rather than global adherence to MeDi, might impact on MS. We aimed to (i) evaluate differences in adherence to MeDi between people living with MS (PwMS) and healthy controls (HC); (ii) characterize eating patterns in PwMS and HC, identifying the most influential MeDi items for each group by the use of network analysis; (iii) explore the relationship between patients' eating habits and disability.Materials and MethodsIn this cross-sectional study, we consecutively recruited 424 PwMS and 165 matched HC. Data were obtained through the administration of self-reported questionnaires. Expanded Disability Status Scale (EDSS) and Fatigue Severity Scale (FSS) were evaluated in the MS population. We performed between-groups comparisons via unpaired two-sample t-test and X2 test as appropriate. We calculated food networks in both MS cases and HC using and tested the association between hub nodes and disability. Finally, we conducted a post-hoc analysis, investigating the relationship between food items, lifestyle factors (smoking, exercise) and clinical outcomes.ResultsMost participants adhered sufficiently to MeDi. Exploring each group separately, fruit, vegetables, cereal, and fish were identified as hubs in PwMS, while meat and alcohol were identified as hubs in HC. Hubs were all inter-correlated, indicating that eating habits of PwMS include a large intake of all the foods identified as hubs. EDSS was predicted by the intake of vegetables (beta = −0.36, p < 0.03) and fish (beta = −0.34, p < 0.02). The model including smoking pack/year, International Physical Activity Questionnaire (IPAQ) score and intake of “negative foods” predicted 6% of the variance in EDSS (p < 0.001), while the model including smoking pack/year and IPAQ score predicted 4% of the variance in FSS (p < 0.001).ConclusionsWe identified a sufficient adherence to MeDi in our population. PwMS showed overall a healthier dietary pattern than HC. Vegetables and fish intake were associated with disability outcomes. Future longitudinal studies applying integrated approaches are needed to understand lifestyle added value to the use of standard pharmacological therapies.

Retrospective Series of Burning Mouth Syndrome Patients Treated with a Protective Mouthguard: An Effective Non-Pharmacologic Treatment Modality

<h3>Background</h3> Burning mouth syndrome (BMS) is a relatively common condition defined as a relentless, idiopathic burning sensation of the oral mucosa after exclusion of other underlying causes of burning. Currently effective treatment is limited mostly to pharmacologic interventions. The use of non-pharmacologic therapy, specifically the use of protective mouthguards has not been well studied. This study evaluates effectiveness of mouthguards in patients treated for BMS at University of Florida College of Dentistry (UFCD). <h3>Material and Methods</h3> Following IRB approval, the clinical database was retrospectively searched for patients diagnosed with BMS and treated with mouthguard between 2014-2019. Inclusion criteria included a minimum of 6-month follow-up and patients were excluded if treatment records were incomplete. Demographics, clinical data, medical history, and other treatment modalities were recorded and analyzed. <h3>Results</h3> A total of 16 cases were included and a mean age of 67 years (range of 50-82) and a female: male ratio of 4.3:1 was identified. The average duration of burning symptoms prior to the first visit was 43 months. The location of symptoms involved tongue only (n=11, 69%); tongue, palate, and lips (n=2, 12.5%); tongue and palate (n=2, 12.5%); and tongue and lips (n=1, 6%). The most common concurrent medical conditions were hypothyroidism (n=7, 43.7%), hypertension (n=6, 37.5%), and diabetes (n=3, 18.7%). Study patients took a median of 6.5 concurrent medications. Six patients (37.5%) had symptomatic relief with mouthguard ther- apy in conjunction to concurrent standard BMS pharmacologic therapy, 37.5% of patients (n=6) had symptomatic relief with the mouthguard alone, and 25% of patients (n=4) reported no relief from the mouthguard. <h3>Conclusion</h3> In this study a total of 75% of BMS patients reported improvement of subjective symptoms with the use of a pro- tective mouthguard, demonstrating the potential effectiveness of mouthguard as a non-pharmacologic therapeutic modality for BMS patients.

Oxygen Management in Heart Failure Patients

Symptoms of heart failure (HF) should be alleviated as quickly as feasible. Apart from standard pharmacological therapy, supplementation of oxygen is lifesaving in hypoxemic (SpO2 &lt;90% or PaO2 &lt;60 mmHg) HF patients. For sick patients with SpO2 &lt;85%, respiratory distress (respiratory rate &gt;25 breaths per min) and pulmonary edema, along with oxygen administration, noninvasive positive pressure ventilation (NIPPV) methods, including BiPAP/CPAP or humidified high-flow nasal oxygen, should be tried to optimize oxygenation, reduce work of breathing and to reduce the venous return. If these noninvasive ventilatory support methods fail to improve hypoxemia, endotracheal intubation and mechanical ventilation should be instituted. Short-term mechanical circulatory support (extracorporeal membrane oxygenation) devices are reserved for cardiogenic shock patients due to advanced HF associated with reversible end-organ failure and hypoxia. These temporary mechanical circulatory support devices are also useful as a bridge to long-term mechanical circulatory support or heart transplant in end-stage HF with refractory cardiogenic shock. Even though the use of additional oxygen is a standard practice for hypoxemic patients, routine use of high concentrations of oxygen via inhalational therapy or NIPPV for normoxemic HF patients may result in hyperoxemia. Hyperoxemia has been shown to have negative hemodynamic effects like increased systemic vascular resistance, reduced cardiac index, and decreased coronary blood flow. Detailed prescription by the treating physician, careful monitoring, and meticulous titration of oxygen is essential for safe oxygen treatment for HF patients.

Role of EPA in Inflammation: Mechanisms, Effects, and Clinical Relevance.

Many chronic inflammatory processes are linked with the continuous release of inflammatory mediators and the activation of harmful signal-transduction pathways that are able to facilitate disease progression. In this context atherosclerosis represents the most common pathological substrate of coronary heart disease, and the characterization of the disease as a chronic low-grade inflammatory condition is now validated. The biomarkers of inflammation associated with clinical cardiovascular risk support the theory that targeted anti-inflammatory treatment appears to be a promising strategy in reducing residual cardiovascular risk. Several literature data highlight cardioprotective effects of the long-chain omega-3 polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic acid (EPA). This PUFA lowers plasma triglyceride levels and has potential beneficial effects on atherosclerotic plaques. Preclinical studies reported that EPA reduces both pro-inflammatory cytokines and chemokines levels. Clinical studies in patients with coronary artery disease that receive pharmacological statin therapy suggest that EPA may decrease plaque vulnerability preventing plaque progression. This review aims to provide an overview of the links between inflammation and cardiovascular risk factors, importantly focusing on the role of diet, in particular examining the proposed role of EPA as well as the success or failure of standard pharmacological therapy for cardiovascular diseases.