Treatment Of Type Research Articles

Mechanisms and causes of death after abdominal surgery in low-income and middle-income countries: a secondary analysis of the FALCON trial

Death after surgery is devasting for patients, families, and communities, but remains common in low-income and middle-income countries (LMICs). We aimed to use high-quality data from an existing global randomised trial to describe the causes and mechanisms of postoperative mortality in LMICs. To do so, we developed a novel framework, learning from both existing classification systems and emerging insights during data analysis. This study was a preplanned secondary analysis of the FALCON trial in 54 hospitals across seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa). FALCON was a pragmatic, 2 × 2 factorial, randomised controlled trial that compared the effectiveness of two types of interventions for skin preparation (10% aqueous povidone-iodine vs 2% alcoholic chlorhexidine) and sutures (triclosan-coated vs uncoated). Patients who did not have surgery or were lost to follow-up were excluded (n=231). The primary outcomes of the present analysis were the mechanism and cause of death within 30-days of surgery, determined using a modified verbal autopsy strategy from serious adverse event reports. Factors associated with mortality were explored in a mixed-effects Cox proportional hazards model. The FALCON trial is registered with ClinicalTrials.gov, NCT03700749. This preplanned secondary analysis of the FALCON trial included 5558 patients who underwent abdominal surgery, of whom 4248 (76·4%) patients underwent surgery in tertiary, referral centres and 1310 (23·6%) underwent surgery in primary referral (ie, district or rural) hospitals. 3704 (66·7%) of 5558 surgeries were emergent. 306 (5·5%) of 5558 patients died within 30 days of surgery. 226 (74%) of 306 deaths were due to circulatory system failure, which included 173 (57%) deaths from sepsis and 29 (9%) deaths from hypovolaemic shock including bleeding. 47 (15%) deaths were due to respiratory failure. 60 (20%) of 306 patients died without a clear cause of death: 45 (15%) patients died with sepsis of unknown origin and 15 (5%) patients died of an unknown cause. 46 (15%) of 306 patients died within 24 h, 111 (36%) between 24 h and 72 h, 57 (19%) between >72 h and 168 h, and 92 (30%) more than 1 week after surgery. 248 (81%) of 306 patients died in hospital and 58 (19%) patients died out of hospital. The adjusted Cox regression model identified age (hazard ratio 1·01, 95% CI 1·01-1·02; p<0·0001), ASA grade III-V (4·93, 3·45-7·03; p<0·0001), presence of diabetes (1·47, 1·04-2·41; p=0·033), being an ex-smoker (1·59, 1·10-2·30; p=0·013), emergency surgery (2·08, 1·45-2·98; p<0·0001), cancer (1·98, 1·42-2·76; p<0·0001), and major surgery (3·94, 2·30-6·75; p<0·0001) as risk factors for postoperative mortality INTERPRETATION: Circulatory failure leads to most deaths after abdominal surgery, with sepsis accounting for almost two-thirds. Variability in timing of death highlights opportunities to intervene throughout the perioperative pathway, including after hospital discharge. A high proportion of patients without a clear cause of death reflects the need to improve capacity to rescue and cure by strengthening perioperative systems. National Institute for Health and Care Research Global Health Research Unit.

Interventions for smoking cessation in inpatient psychiatry settings.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of smoking cessation interventions on tobacco smoking in adults receiving inpatient psychiatry treatment. To assess whether the effects of smoking cessation interventions differ according to psychiatric diagnosis or type of intervention or comparator condition.

Pengaruh Penerapan Model Pembelajaran RBL Terhadap Kreativitas Belajar Siswa Kelas XI IPS Mata Pelajaran Ekonomi Di SMAN 2 Muaro Jambi

This research aims to determine the effect of applying conventional learning methods and the RBL learning model in increasing the learning creativity of class XI IPS students in economics subjects at SMAN 2 Muaro Jambi. The research design that will be carried out in this research is a quasi-experimental research with a pre-test – post-test control group design model with one type of treatment. The results of the research show that there are differences in the influence of the conventional learning model and the RBL learning model on the creativity of class XI IPS students. Students who learn using the RBL learning model obtain the best creative learning abilities.

Discontinuity of psychiatric care among patients with bipolar disorder in the Netherlands.

Patients with bipolar disorder benefit from guidelines recommended continuous community-oriented psychiatric and somatic healthcare, but often discontinue psychiatric care. The first objective was to identify predictive factors of discontinuity of psychiatric care among patients who had received psychiatric care. The second objective was to examine if practice variation in discontinuity of psychiatric care existed between providers of psychiatric care. Registry healthcare data were used in a retrospective cohort study design using logistic regression models to examine potential predictive factors of discontinuity of care. Patient-related predictive factors were: age, sex, urbanization, and previous treatment (type and amount of psychiatric care, alcohol, and opioid treatment). Patients already diagnosed with bipolar disorder were selected if they received psychiatric care in December 2014 to January 2015. Discontinuity of psychiatric care was measured over 2016. A total of 2,355 patients with bipolar disorder were included. In 12.1% discontinuity of care occurred in 2016. Discontinuity was associated with younger age and less outpatient care over 2013 to 2014. Discontinuity of patients who received all eight quarters outpatient care including BD medication was very low at 4%. The final model contained: age, type of psychiatric care, and amount of outpatient care in 2013 to 2014. Practice variation among providers appeared negligible. The (mental) health service in the Netherlands has few financial or other barriers toward continuity of care for patients with severe mental disorders, such as bipolar disorder. An active network of providers, aim to standardize care. This seems successful. However, 12% discontinuity per year remains problematic and more detailed data on those most at risk to drop out of treatment are necessary.

Self-stigmatization and treatment preferences: Measuring the impact of treatment labels on choices for depression medications.

To collect evidence on the possibility that patients with depression experience self-stigmatization based on label information for medications. We developed a discrete-choice experiment (DCE) survey instrument that asked respondents to make choices between hypothetical treatments for major depressive disorder (MDD). We also included treatment type (antidepressants versus antipsychotics) and approved indications for the medication. The choice questions mimicked the information presented in product inserts and required systematic tradeoffs between treatment efficacy, treatment type, and indication. We calculated how many patients were willing to forgo efficacy to avoid treatments with information associated with self-stigmatization, and how much efficacy they were willing to forgo. We also evaluated the impact of contextualizing the treatment information to reduce self-stigmatization by randomizing respondents who received additional context. A total of 501 patients with MDD were recruited to complete the DCE survey. Respondents had well-defined preferences for treatment outcomes. Over 60% (63.4%) of respondents were found to be significantly affected by treatment indication. These respondents were willing to forgo about 2.5 percentage points in the chance of treatment efficacy to avoid treatments indicated for schizophrenia. We also find that some level of contextualization of the treatment details could help reduce the negative impact of treatment type and indications. Product-label treatment indication can potentially lead to patient self-stigmatization as shown by patients' avoidance of treatments that are also used to treat schizophrenia. While the effect appears to be relatively small, results suggests that the issue is likely pervasive.

Clinical characteristics and outcomes of band keratopathy: a 10-year retrospective analysis

Background: Band keratopathy is a chronic, degenerative corneal disease resulting from gradual calcium deposition in the superficial cornea. Herein, we report the spectrum of causes, treatment outcomes, and recurrence rates of band keratopathy at a tertiary referral center throughout one decade. Methods: This retrospective study included patients with clinical diagnoses of band keratopathy who were treated with combined ethylenediaminetetraacetic acid (EDTA) and superficial keratectomy with or without amniotic membrane transplantation (AMT). Patient medical records were reviewed, and detailed demographic and ophthalmological data, such as baseline and last follow-up best-corrected distance visual acuity (BCDVA), ocular or medical comorbidities, type of intervention, postoperative follow-up duration, relevant complications, and recurrence were recorded. Results: A total of 32 eyes of 29 patients with 3 (10.3%) bilateral and 26 (89.7%) unilateral cases of treatment-requiring bank keratopathy were included. The mean (standard deviation [SD]) (range) age was 39.4 (22.4) (2–74) years, and most patients were female. The most common secondary cause was previous vitreoretinal surgery with silicone oil tamponade (15.6%); however, idiopathic cases were the most common (18.8%). Systemic comorbidities were present in 27.6% of patients, consisting of hypertension, diabetes mellitus, epilepsy, coronary artery disease, Behcet’s disease, and juvenile idiopathic arthritis; however, none of the patients had systemic diseases associated with hypercalcemia. Two of the 3 patients with bilateral involvement had chronic uveitis secondary to systemic rheumatological disease. The mean (SD) follow-up duration was 5.6 (4.0) years, and no serious postoperative complications occurred. The mean (SD) baseline and final BCDVA in logarithm of the minimum angle of resolution (logMAR) were 1.98 (1.0) and 1.7 (1.0), respectively (P &gt; 0.05). Combined EDTA chelation and superficial keratectomy with and without AMT were performed in 12.5% and 87.5% of eyes, respectively. Recurrence was observed in 37.5% of eyes within the mean (SD) (range) follow-up of 9.4 (9.1) (1–32) months. Seven of the 12 eyes with recurrence underwent re-EDTA chelation combined with superficial keratectomy and AMT; however, 5 patients managed conservatively. Conclusions: In this study, band keratopathy requiring intervention more commonly affected female individuals and was unilateral. Most cases were idiopathic. Systemic comorbidities were present in approximately one-third of cases. Managing band keratopathy using a combination of EDTA chelation and superficial keratectomy with or without AMT could be a potential treatment modality. Further large-scale studies are required to provide robust conclusions regarding the efficacy and safety of this management approach.

Health Care Expenditure of Patients With Type 2 Diabetes Mellitus in Bangladesh: A Review

The main objectives of this review are to offer an in-depth examination of the analysis of health care expenditure of patients with type 2 diabetes mellitus in covering its epidemiology, causes, clinical manifestations, diagnostic techniques, treatment approaches, and prognosis in Bangladesh. Most of the information and data are mainly involved in a critical review of various studies from sample groups of different ethnicities, age groups and genders. This study employs a systematic review and meta-analysis approach to compile and analyze existing research on health care expenditure of patients with type 2 diabetes mellitus. The study follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to ensure comprehensive and transparent reporting of the review process. Results on the basis of various reports showed that the length of diabetes and the number of co-morbidities and complications raise the cost of healthcare. The data confirms the previously reported conclusion that patients treated with insulin monotherapy or an insulin and oral hypoglycemic agents (OHAs) combination had higher direct costs and overall costs than patients treated with OHAs alone. Overall, it was discovered that the main contributing factors to the cost of therapy were the length of diabetes, the quantity of co-morbidities and complications, and the type of treatment. The prevalence of type 2 diabetes is increasing in Bangladesh, where out-of-pocket medical expenses are higher and universal health insurance is not available to the general public. Planning cost-effective diabetes management and prevention measures is necessary. A suitable insurance plan should be created with special services for diabetic patients. To reduce the negative effects of the condition, early detection of diabetes is essential as reported by several studies compiled herein. This can be accomplished through raising awareness and eradicating the social stigma, especially for women in Bangladesh. J. Bio-Sci. 32(2): 93-106, 2024

To Study the Need of Systemic Formwork for Waste Water Treatment at Fish Processing Plant' (A Review)

Waste water from angle preparation enterprises originates from several sources, including emptying angles, dressing, liquefying water from ice dissolution, washing equipment and utensils, treating with additional substances, and cleaning and disinfecting offices and spaces. Water is used not only to clean angles but also to wash blood, sludge, and offal from the surfaces of various handling equipment, utensils, floors, and sump pumps. The majority of computerized handling supplies come with a water shower framework that may clean hardware and remove offal. The emergence of these forms in tall water use also leads to the mixing of blood and offal in the wash water. Fish handling waste water is full of significant pollutants that are colloidal, soluble, and particulate. Features of waste water produced depend on the type of angle used for preparation, the preparation method, and the final object placed. When handling operations such as minor (angle washing or cleaning), mild (angle filet preparation), and severe (surimi planning), the degree of defilement can change. Fish waste water must have exceptionally high levels of nitrogen, fat, oil, and oil (Mist), as well as biochemical oxygen demand (BOD). In order to reduce shameful waste transfer in the environment, this extended show introduces angle waste management processors to the concepts of fishery waste categorization and the many types of treatment used. This topic includes many aspects of angle waste, separate management of fluid angle waste and strong waste using chemicals, Indore composting technique, and suitable transfer.

Survival of different caries managements in children with autism and unaffected peers: a retrospective cohort study.

Dental caries is a common oral disease in children with special needs such as those with autism spectrum disorders (ASDs). The aim is to assess whether the type and survival of three caries management, conventional resin restorations (CR), ART technique (ART) and SDF application without caries removal (SDF), in primary teeth carried out at the Pediatric Dentistry Department of San Paolo Hospital (University of Milan) differed between children with ASDs and unaffected peers. Data from a convenience sample of children with and without ASDs, who have received dental care for caries in primary teeth from January 2019 to June 2022, were analysed. Medical history, age, sex, teeth treated, and type of treatment were collected from dental charts. Data on success and minor and major failures of each treatment were also collected. Two survival analysis were performed, one considering both major and minor failures, a second considering only major failures. Cox Proportional Hazards multivariate logistic models were run to assess factors associated with failures. The statistical significance was set at 5% (p< 0.05). In children with autism, the different techniques for approaching caries lesions seem to have the same probability of success. Therefore, the choice of treatment should be patient-oriented rather than lesion-oriented. In unaffected children, the gold standard always seems to be traditional restorative treatment.

What's Behind it all: A Retrospective Cohort Study of Retrogastric Pancreatic Necrosis Management.

To compare outcomes of laparoscopic transgastric necrosectomy (LTN) and direct endoscopic necrosectomy (DEN) in the management of retrogastric walled-off necrosis. Surgical and endoscopic transgastric approaches are used to manage retrogastric pancreatic necrosis. Studies comparing these treatment modalities are lacking but would influence contemporary practice patterns. LTN or DEN treated patients at Stanford University Hospital between 2011 and 2023 were identified. Cohort data included demographics, core pancreatitis care benchmarks, and clinical outcomes (total debridement time, new-onset endocrine and exocrine pancreatic insufficiency) as well as re-intervention, 30-day readmission, complication, and mortality rates. Long-term follow-up was also compared between intervention arms. Multivariable linear regression was used to assess the interaction between admission APACHE-II score and intervention on length of stay (LOS). 106 patients (62% LTN, 38% DEN) were identified. Demographic and core pancreatitis benchmark data were similar between cohorts. 30-day readmission, complication, and mortality rates for surgical and endoscopic approaches were also similar: 23% vs. 25% (P = 0.98), 42% vs. 40% (P = 0.97), and 3% vs. 3% (P > 0.99). Median LTN total debridement time (minutes) was 131 vs. 134 for DEN, however, complete debridement was achieved with only 1 LTN compared to 3 DENs (P<0.01). While not statistically significant, LOS and unplanned intervention rates were less for LTN (8 vs. 10 days, P = 0.41 and 6% vs. 15%, P = 0.24). Multivariable analysis revealed a significant interaction between APACHE-II scores and LOS for LTN compared to DEN, which translated into a length of stay reduction for higher APACHE-II scoring patients (P = 0.02). LTN is a safe and efficient treatment modality for walled-off necrosis, and compared to DEN, can reduce the LOS in high APACHE-II score patients. While additional comparative research between the two intervention types is needed, this study supports a role for a surgical approach in the management of retrogastric pancreatic necrosis.

The influence of therapy quality on outcomes from behavioural activation and guided self-help treatments for depression in adults with intellectual disabilities.

We report the effect of quality of therapy delivery on outcomes in a randomized, controlled trial of behavioural activation (BA) and guided self-help (GSH) for depression in adults with intellectual disabilities. A study specific measure of quality was used in a linear mixed effect model to determine the effects therapy and therapy quality on therapy outcome. There was a significant interaction between quality and treatment type, with lower quality therapy associated with better outcome for GSH but poorer outcome for BA, with little difference in outcomes at higher levels of therapy quality. Factors suggesting high quality in individualized BA may indicate problematic engagement for GSH. More research into processes in therapy for people with intellectual disabilities is required.

Effects of Small-Sided Soccer Games on Physical Fitness and Cardiometabolic Health Biomarkers in Untrained Children and Adolescents: A Systematic Review and Meta-Analysis.

Objective: This systematic review and meta-analysis aimed to determine the benefits of an exercise intervention based on small-sided soccer games (SSSGs) on health-related physical fitness and cardiometabolic health in previously untrained children and adolescents. Methods: A systematic search on PubMed/MEDLINE, Web of Science, Scopus, Cochrane, and EBSCO databases was performed. Randomized or non-randomized controlled trials conducted in previously untrained children or adolescents (age < 18 years) that assessed the effect of SSSG-based intervention on health-related physical fitness and cardiometabolic risk biomarkers were included. Primary outcomes were cardiorespiratory fitness and waist circumference. Evidence was synthesized as the mean difference or standardized mean difference using a random-effects meta-analysis. The quality of evidence was assessed using ROB2 and ROBINS-I tools. Results: Sixteen studies (n = 2872 participants) were included in this meta-analysis. SSSGs significantly improved cardiorespiratory fitness (SMD, 0.12 [0.01; 0.23]) and showed a non-significant trend in decreased waist circumference (-7.49 cm [-15.03; 0.06]). Additionally, SSSGs significantly decreased systolic (MD, -3.85 mmHg [-5.75; -1.94]) and diastolic blood pressure (MD, -1.26 mmHg [-2.44; -0.08]) and triglycerides (-30.34 mg·dL-1 [-45.99; -14.69]). No effects on body composition or other cardiometabolic risk biomarkers were observed. After a sensitivity analysis, waist circumference and muscle strength were also shown to improve significantly following SSSGs. Comparisons between SSSG and other types of exercise interventions showed no differences in improved physical fitness or cardiometabolic risk. Conclusions: SSSG-based interventions effectively improve cardiorespiratory fitness, blood pressure, triglycerides, muscle strength, and waist circumference. There is less evidence of the effects of SSSGs on other health markers. Particular attention should be given to improving SSSG protocol reporting in future studies.

Argon Plasma Coagulation as a Type of Endoscopic Treatment of the Gastric Antral Vascular Ectasia Syndrome

Argon Plasma Coagulation as a Type of Endoscopic Treatment of the Gastric Antral Vascular Ectasia Syndrome

Assessing the effects of long-term habitat reconstruction on breeding shorebird populations in a steppe region

Shorebirds represent key indicator species for evaluating the health of wetlands, as they rely on specific habitats for breeding and foraging. Several restoration actions were initiated to restore these wetlands in the Hortobágy (Hungary), however, their effects have never been assessed. Since birds are good indicators of the health and quality of natural environment and sensitive to changes in land use and climate, we evaluated the restoration actions conducted in the last 20 years using bird monitoring data. Our study focuses on the long-term effects of different habitat restoration actions implemented in the region, which involved no restoration, targeted and non-targeted type of interventions for shorebird management as well as long-term and short-term management. The evaluation is based on long-term monitoring data of shorebird species: Black-winged Stilt, Northern Lapwing, Black-tailed Godwit, Common Redshank and Common Snipe. The effectiveness of restoration actions found to have a species-specific aspect, but in general, our findings indicate positive effects of targeted and long-term restoration actions on breeding shorebird populations. By contrast, targeted but short-term actions led to even worse results for shorebird breeding population size than where no restoration actions were initiated. These findings contribute to a better understanding of the specific habitat requirements of breeding shorebirds in the steppe region and can inform future habitat management strategies. The results can be used in conservation planning and management and highlight the importance of long-term and targeted habitat reconstruction projects in restoring and maintaining breeding shorebird populations.

A Pilot Study to Evaluate an Educational Intervention on Motivation and Learning Strategies in Prelicensure Nursing Students.

Nursing student attrition affects the nationwide nursing shortage. Interventions that improve student retention are needed. The Jeffreys nursing universal retention and success model provided a framework for an educational intervention that introduced students to validated study techniques and test-related anxiety management techniques. The intervention was evaluated using the Motivated Strategies for Learning Questionnaire. Results from our pilot study suggest that this type of intervention may impact the use of learning strategies and motivation and may improve overall retention and program completion.

Real-World Analysis of Survival and Treatment Efficacy in Stage IIIA-N2 Non-Small Cell Lung Cancer.

Stage IIIA-N2 non-small cell lung cancer (NSCLC) poses a significant clinical challenge, with low survival rates despite advances in therapy. The lack of a standardised treatment approach complicates patient management. This study utilises real-world data from Guy's Thoracic Cancer Database to analyse patient outcomes, identify key predictors of overall survival (OS) and disease-free survival (DFS), and address the limitations of randomised controlled trials. This observational, single-centre, non-randomised study analysed 142 patients diagnosed with clinical and pathological T1/2 N2 NSCLC who received curative treatment from 2015 to 2021. Patients were categorised into three groups: Group A (30 patients) underwent surgery for clinical N2 disease, Group B (54 patients) had unsuspected N2 disease discovered during surgery, and Group C (58 patients) received radical chemoradiation or radiotherapy alone (CRT/RT) for clinical N2 disease. Data on demographics, treatment types, recurrence, and survival rates were analysed. The median OS for the cohort was 31 months, with 2-year and 5-year OS rates of 60% and 30%, respectively. Group A had a median OS of 32 months, Group B 36 months, and Group C 25 months. The median DFS was 18 months overall, with Group A at 16 months, Group B at 22 months, and Group C at 17 months. Significant predictors of OS included ECOG performance status, lymphovascular invasion, and histology. No significant differences in OS were found between treatment groups (p = 0.99). This study highlights the complexity and diversity of Stage IIIA-N2 NSCLC, with no single superior treatment strategy identified. The findings underscore the necessity for personalised treatment approaches and multidisciplinary decision-making. Future research should focus on integrating newer therapeutic modalities and conducting multi-centre trials to refine treatment strategies. Collaboration and ongoing data collection are crucial for improving personalised treatment plans and survival outcomes for Stage IIIA-N2 NSCLC patients.

PERIAPICAL INFLAMMATORY LESIONS AND DIABETES MELLITUS TYPE II– A REVIEW

Periapical periodontitis is a chronic inflammatory disease, caused by endodontic infection, and its development is regulated by the host immune/inflammatory response. Metabolic disorders, which are largely dependent on life style such as eating habits, have been interpreted as a “metabolically-triggered” low-grade systemic inflammation and may interact with periapical periodontitis by triggering immune modulation. Diabetes mellitus (DM) is a group of complex multisystem metabolic disorders due to a deficiency in insulin secretion caused by pancreatic β-cell dysfunction and/or insulin resistance in liver and muscle. Objective: In this paper, the current status of knowledge regarding the relationship between periapical inflammation and diabetes mellitus type II is reviewed. Material and method: Research was conducted on scientific papers published on Medline - Pub med in the past 10 years (from 2012-2022). The search was performed using the Mesh (Medical Subject Headings) key words: periapical inflammatory lesions, periapical periodontitis and diabetes mellitus type II. Results: Several studies have analyzed the possible association between periapical inflammatory lesions and diabetes mellitus type II. The results of studies carried mainly in animal models, less in humans suggested association between endodontic variables such as apical periodontitis, root canal treatment and diabetes mellitus type 2.The demonstration of association does not prove by itself the existence of a cause-effect relationship. Conclusion: A review of the literature showed connection between periapical inflammatory lesions and diabetes mellitus type II, but prospective case control clinical studies are needed for further clarifying this relation.

Impact of a cognitive training on reading of 6-year-old children

Numerous studies explore the effect of cognitive stimulation programmes on reading skills in children and adolescents, with mixed results. Although several studies support that the relationships established between executive functions and reading skills are more robust at early ages, when the process of formal reading acquisition is being consolidated, there are few studies that evaluate the impact of this type of interventions at the beginning of primary school. For this reason, the present pilot study investigates the possible effects of executive functions training on letter identification and decoding, as well as word and pseudoword reading. A cognitive training was carried out using the CogniFit platform in 12 typically developing 6-year-old children, comparing their performance with a control group of 28 children of the same age and similar socioeconomic status. This protocol took place over 8 weeks, with a mean of 19 minutes of training per week. The results obtained indicate that the experimental group showed a higher reading speed in letter recognition than the control group. However, no effect was found in the rest of the reading skills. These promising results indicate that additional research is needed to clarify the lack of convergence reported in the current scientific literature.

Unlocking the potential of exercise: harnessing myokines to delay musculoskeletal aging and improve cognitive health.

This review aims to summarize the common physiological mechanisms associated with both mild cognitive impairment (MCI) and musculoskeletal aging while also examining the relevant literature on how exercise regulation influences the levels of shared myokines in these conditions. The literature search was conducted via databases such as PubMed (including MEDLINE), EMBASE, and the Cochrane Library of Systematic Reviews. The searches were limited to full-text articles published in English, with the most recent search conducted on 16 July 2024. The inclusion criteria for this review focused on the role of exercise and myokines in delaying musculoskeletal aging and enhancing cognitive health. The Newcastle‒Ottawa Scale (NOS) was utilized to assess the quality of nonrandomized studies, and only those studies with moderate to high quality scores, as per these criteria, were included in the final analysis. Data analysis was performed through narrative synthesis. The primary outcome of this study was the evaluation of myokine expression, which included IL-6, IGF-1, BDNF, CTSB, irisin, and LIF. A total of 16 studies involving 633 older adults met the inclusion criteria. The current exercise modalities utilized in these studies primarily consisted of resistance training and moderate-to high-intensity cardiovascular exercise. The types of interventions included treadmill training, elastic band training, aquatic training, and Nordic walking training. The results indicated that both cardiovascular exercise and resistance exercise could delay musculoskeletal aging and enhance the cognitive functions of the brain. Additionally, different types and intensities of exercise exhibited varying effects on myokine expression. Current evidence suggests that exercise mediates the secretion of specific myokines, including IL-6, IGF-1, BDNF, CTSB, irisin, and LIF, which establish self-regulatory circuits between the brain and muscle. This interaction enhances cognitive function in the brain and improves skeletal muscle function. Future research should focus on elucidating the exact mechanisms that govern the release of myokines, the correlation between the intensity of exercise and the secretion of these myokines, and the distinct processes by which myokines influence the interaction between muscle and the brain.

A systematic review to assess the impact of amino acids or their derivatives on skeletal muscle wasting in critically ill patients

BackgroundIt is plausible that supplementation with specific amino acids or metabolites could attenuate skeletal muscle wasting during critical illness. The aim of this systematic review was to explore if amino acids or their derivatives impact skeletal muscle wastage in critically ill adults. MethodsFour databases were systematically searched to identify randomised control trials which delivered enteral supplemental amino acids, or their metabolites compared with placebo, standard care or no intervention, to critically ill patients and reported outcomes of skeletal muscle mass, plasma amino acids, nitrogen balance, or muscle strength. Two authors independently completed screening, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 Tool. A meta-analysis was planned but heterogeneity in the type of intervention used and outcome assessment precluded this. Therefore, data were synthesised using vote counting. ResultsThirty randomised control trials, comprising 1976 patients were included. The most frequently studied interventional amino acid or metabolite was glutamine (n = 12 trials), a combination (n = 9), arginine (n = 6), β-hydroxy β-methylbutyrate (HMB) (n = 2) or ornithine (n = 1). Six trials (including 284 participants) measured skeletal muscle following supplementation, four of which used HMB alone or in combination as the intervention. Of these, one trial observed an attenuation of muscle wasting with a combination of amino acids, one observed an exacerbation of muscle wasting with HMB, three trials observed no impact on muscle wasting with HMB or a combination of amino acids and one trial reported no information. ConclusionSix trials have investigated the effect of enteral amino acid or amino acid metabolite supplementation on muscle mass in critically ill. Heterogeneity of interventions, outcome assessments and direction of effects limits the certainty regarding the effect of supplemental amino acids, or their metabolites, on skeletal muscle wasting during critical illness.The trial protocol is registered on PROSPERO (CRD42021275989).