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The Effect of Non-Invasive Brain Stimulation with Cognitive Training or alone on Cognition in Individuals with Parkinson’s Disease: A Systematic Review and Meta-Analysis
Get PDFBackground: Cognitive decline is increasingly recognized as a significant non-motor
symptom of Parkinson's disease (PD), affecting patients' Quality of Life, imposing a
greater burden on caregivers, influencing the utilization of healthcare resources, and
impacting mortality rates. To address cognitive deficits in PD, various therapeutic strategies
are being investigated, including both pharmacological and non-pharmacological
approaches. Non-pharmacological interventions encompass techniques such as transcranial
direct current stimulation (tDCS), transcranial magnetic stimulation (TMS),
and cognitive training. Additionally, research has explored the combined effects of noninvasive
brain stimulation (NIBS) with cognitive training (CT) in individuals with neurological
and psychiatric disorders, investigating the potential synergistic effects.
Objective: This study aimed to conduct a systematic review and meta-analysis to assess
the impact of NIBS, both independently and in conjunction with cognitive training,
primarily on cognitive function and secondarily on Quality of Life (QoL) and mood in
individuals with PD.
Methods: The systematic review and meta-analysis adhered to PRISMA guidelines.
We screened 1865 titles and abstracts based on PICOT criteria, resulting in 128 studies
being assessed. After full-text review and elimination of duplicates and unsuitable studies,
83 studies were examined in detail. Ultimately, 42 studies were included in the
systematic review. Twelve studies were initially selected for the meta-analysis of NIBS
alone or combined with CT. Following further scrutiny, six studies met the PICOT criteria
and were included in the final meta-analysis. Moreover, the Risk of Bias within
the studies was assessed using the RoB 2.0 tool.
Results: The meta-analysis of three studies involving 52 PD patients receiving tDCS
combined with cognitive training did not show significant effects on cognitive domains,
including global cognition, working memory, immediate/ delayed recall, or QoL. In
contrast, a separate meta-analysis of three studies involving 128 PD patients showed a
statistically significant improvement in global cognition following active TMS compared
to sham TMS.
Conclusion: While the combination of tDCS and cognitive training did not demonstrate
significant cognitive benefits, active TMS showed promise in improving global
cognition in PD patients. These findings suggest that TMS may be a more effective
intervention for enhancing cognitive function in PD compared to tDCS combined with
cognitive training. Further research is needed to explore the potential benefits of combining
different non-invasive brain stimulation methods with cognitive training to optimize
cognitive outcomes in PD patients.Hintergrund: Kognitive Beeinträchtigungen sind ein bedeutendes nicht-motorisches
Symptom der Parkinson-Krankheit (PD). Sie beeinflussen die Lebensqualität, belasten
Pflegepersonen, erhöhen die Gesundheitskosten und wirken sich auf die Sterblichkeitsrate
aus. Zur Behandlung kognitiver Defizite bei PD werden sowohl pharmakologische
als auch nicht-pharmakologische Methoden untersucht. Dazu gehören transkranielle
Gleichstromstimulation (tDCS), transkranielle Magnetstimulation (TMS) und kognitives
Training. Es wurde auch erforscht, wie die Kombination von nicht-invasiver Gehirnstimulation
(NIBS) und kognitivem Training (CT) bei neurologischen und psychiatrischen
Störungen wirkt.
Ziel: Diese Studie zielte darauf ab, eine systematische Übersicht und Meta-Analyse
durchzuführen, um die Auswirkungen von NIBS, sowohl allein als auch kombiniert mit
kognitivem Training, auf die kognitive Funktion, Lebensqualität (QoL) und Stimmung
bei PD-Patienten zu bewerten.
Methoden: Die Studie folgte den PRISMA-Richtlinien. Von 1865 gesichteten Titeln
und Abstracts wurden 128 Studien näher bewertet. Nach Volltextprüfung und Ausschluss
von Duplikaten und ungeeigneten Studien blieben 83 Studien übrig. 42 Studien
wurden in die systematische Übersicht aufgenommen. Für die Meta-Analyse von NIBS
allein oder in Kombination mit CT wurden 12 Studien ausgewählt; nach weiterer Prüfung
erfüllten 6 Studien die PICOT-Kriterien und wurden in die endgültige Meta-Analyse
aufgenommen. Das Risiko von Bias wurde mit dem RoB 2.0-Tool bewertet.
Ergebnisse: Die Meta-Analyse von drei Studien mit 52 PD-Patienten, die tDCS und
kognitives Training erhielten, zeigte keine signifikanten Effekte auf globale Kognition,
Arbeitsgedächtnis, Erinnerungsvermögen oder QoL. Im Gegensatz dazu zeigte eine separate
Meta-Analyse von drei Studien mit 128 PD-Patienten eine signifikante Verbesserung
der globalen Kognition nach aktiver TMS im Vergleich zu Placebo-TMS.
Fazit: Die Kombination von tDCS und kognitivem Training zeigte keine signifikanten
kognitiven Vorteile. Im Gegensatz dazu verbesserte aktive TMS die globale Kognition
bei PD-Patienten signifikant. Diese Ergebnisse legen nahe, dass TMS möglicherweise
eine effektivere Methode zur Verbesserung der kognitiven Funktion bei PD ist als die
Kombination von tDCS und kognitivem Training. Weitere Forschung ist nötig, um die
potenziellen Vorteile verschiedener nicht-invasiver Gehirnstimulationstechniken zusammen
mit kognitivem Training genauer zu untersuchen
Multicentre, randomized, double‐blind, prospective study on the effects of ImmunoAdSorptiOn on cardiac function in patients with Dilated CardioMyopathy (IASO-DCM): Rationale and design
Get PDFAims
Pilot studies indicate that immunoadsorption with subsequent IgG substitution (IA/IgG) induces beneficial effects in patients with dilated cardiomyopathy (DCM) and heart failure. This placebo‐controlled study investigates whether IA/IgG treatment enhances left ventricular (LV) systolic function as compared to a control group receiving pseudo‐treatment.
Methods
This multicentre, randomized, double‐blind, parallel‐group trial aims to include 200 patients with heart failure due to DCM (LV ejection fraction [LVEF] <40%) on optimized guideline‐directed heart failure medication. Participants are randomly assigned in a 1:1 ratio to IA/IgG using protein‐A columns, or to pseudo‐immunoadsorption followed by an intravenous infusion without IgG. Follow‐up visits take place by telephone after 1 and 3 months and at the study centres after 6, 12 and 24 months. The primary efficacy endpoint is the change in LVEF from baseline to 6 months determined by contrast echocardiography, analysed at a core lab. In addition, LV end‐diastolic and end‐systolic volumes will be analysed as secondary endpoints over the entire study period to assess whether IA/IgG affects LV remodelling. As main secondary outcome, a composite of all‐cause death, cardiac resuscitation, hospitalization for heart failure, and need for cardiac surgery to improve myocardial pump function will be evaluated after 24 months. In addition, exploratory outcomes as well as safety endpoints related to the treatment will be assessed throughout the whole study period.
Conclusion
IASO‐DCM is a randomized study which will provide comprehensive insights into the effects of immunoadsorption with subsequent IgG substitution in patients with DCM
Combining Photovoltaics with the Rewetting of Peatlands—A SWOT Analysis of an Innovative Land Use for the Case of North-East Germany
Get PDFReducing emissions from energy production and enhancing the capacity of land use systems to store carbon are both important pathways towards greenhouse gas neutrality. Expanding photovoltaics (PV) contributes to the former, while the rewetting of drained peatlands preserves the peat soil as long-term carbon store, thus contributing to the latter. However, both options are usually considered separately. This study analyses Peatland PV, defined as the combination of open-space PV with the rewetting of peatlands on the same site, and has an explorative and field-defining character. Due to a lack of empirical data, we used expert interviews to identify the strengths and weaknesses, opportunities, and threats of Peatland PV in the sparsely populated and peatland-rich state of Mecklenburg-Western Pomerania in North-East Germany. The material was analysed using a qualitative content analysis and compiled into SWOT and TOWS matrices. Besides the ecological and technological dimensions, this study focuses on the economic and legal framework in Germany. We found that Peatland PV may mitigate land use conflicts by contributing to climate and restoration targets, energy self-sufficiency, and security. Continued value creation can incentivize landowners to agree to peatland rewetting. Technical feasibility has, however, a significant influence on the profitability and thus the prospects of Peatland PV. Although Peatland PV has recently been included in the Renewable Energy Sources Act (EEG), several specialised legal regulations still need to be adapted to ensure legal certainty for all stakeholders. Pilot implementation projects are required to study effects on vegetation cover, soil, peatland ecosystem services, biodiversity, hydrology, and water management, as well as to analyse the feasibility and profitability of Peatland PV
Eosinophilia as Monitoring Parameter for Chronic Graft-versus-Host Disease and Vitamin D Metabolism as Monitoring Parameter for Increased Infection Rates in Very Long-Term Survivors of Allogeneic Stem Cell Transplantation—A Prospective Clinical Study
Get PDFBackground: Our aim is to investigate cardiovascular risk factors, chronic graft-versus-host disease (CGvHD), and vitamin D metabolism in very long-term survivors of adult allogeneic stem cell transplantation (alloSCT).
Methods: This study is a prospective unicentric, non-interventional trial. The detailed study protocol is available via the WHO Clinical Trial Registry.
Results: We were able to include 33 patients with a mean age of 60.5 years (SD 11.1). Acute myeloid leukemia (AML) was the most frequent underlying disease (n = 12; 36.4%). The median survival time was 9.0 years (IQR 8.5–13.0). Relevant cardiovascular risk factors in the study population are the body mass index, cholesterol, LDL cholesterol, and lipoprotein(a). Cardiovascular risk factors have no significant impact on HRQoL. CGvHD of the skin as a limited disease was present in six patients (18.2%), and it has no impact on HRQoL. CGvHD was significantly associated with eosinophilia in peripheral blood (p = 0.003). Three patients (9.1%) had a shortage of calcitriol, and one patient (3.0%) took calcium substitution. The shortage is significantly associated with increased infection rates (p = 0.038).
Conclusions: Cardiovascular risk factors and CGvHD need to be closely monitored. Eosinophilia might be a good and convenient monitoring parameter for CGvHD
Proteomic profiling of antibiotic-resistant Escherichia coli GW-AmxH19 isolated from hospital wastewater treated with physical plasma
Get PDFMicroorganisms which are resistant to antibiotics are a global threat to the health of humans and animals. Wastewater treatment plants are known hotspots for the dissemination of antibiotic resistances. Therefore, novel methods for the inactivation of pathogens, and in particular antibiotic-resistant microorganisms (ARM), are of increasing interest. An especially promising method could be a water treatment by physical plasma which provides charged particles, electric fields, UV-radiation, and reactive species. The latter are foremost responsible for the antimicrobial properties of plasma. Thus, with plasma it might be possible to reduce the amount of ARM and to establish this technology as additional treatment stage for wastewater remediation. However, the impact of plasma on microorganisms beyond a mere inactivation was analyzed in more detail by a proteomic approach. Therefore, Escherichia coli GW-AmxH19, isolated from hospital wastewater in Germany, was used. The bacterial solution was treated by a plasma discharge ignited between each of four pins and the liquid surface. The growth of E. coli and the pH-value decreased during plasma treatment in comparison with the untreated control. Proteome and antibiotic resistance profile were analyzed. Concentrations of nitrite and nitrate were determined as long-lived indicative products of a transient chemistry associated with reactive nitrogen species (RNS). Conversely, hydrogen peroxide served as indicator for reactive oxygen species (ROS). Proteome analyses revealed an oxidative stress response as a result of plasma-generated RNS and ROS as well as a pH-balancing reaction as key responses to plasma treatment. Both, the generation of reactive species and a decreased pH-value is characteristic for plasma-treated solutions. The plasma-mediated changes of the proteome are discussed also in comparison with the Gram-positive bacterium Bacillus subtilis. Furthermore, no effect of the plasma treatment, on the antibiotic resistance of E. coli, was determined under the chosen conditions. The knowledge about the physiological changes of ARM in response to plasma is of fundamental interest to understand the molecular basis for the inactivation. This will be important for the further development and implementation of plasma in wastewater remediation
Association Between Sleep Position, Obesity, and Obstructive Sleep Apnea Severity
Get PDFBackground: This study examines the relationship between obstructive sleep apnea severity, sleep position, and body weight, particularly focusing on the negative impact of sleeping in a supine position combined with being overweight in a population-based sample. Methods: The Apnea-Hypopnea Index (AHI) was utilized as a marker of OSA severity and sleep position from a standardized overnight polysomnography. Participants were categorized by body mass index (BMI) (kg/m 2 ) into normal weight/underweight (<25) and overweight (≥25). Results and Conclusions: The results indicated a higher mean Apnea-Hypopnea Index for those sleeping in the supine position compared to other positions, with overweight individuals experiencing a proportionally greater impact from sleep position than their normal-weight counterparts
The Role of Labour Market Intermediaries for Migrant Workers in Global Production Networks: The Example of Filipino Migrant Workers in the Taiwanese Semiconductor Industry
Get PDFThis article contributes to the literature at the intersection of migration and global production networks (GPNs) by examining the role of labour market intermediaries (LMIs) for migrant workers. It demonstrates mediation processes by LMIs and elaborates on migration networks in the global labour market through qualitative and quantitative data. It examines the role of LMIs in responding to mechanisms in GPN, including zero inventory and just‐in‐time production, and the impact of private employment agents on migrant workers, particularly on their career paths. The article found that LMIs play an active role in the mediation and cooperation between migrant labour and firms and in shaping structural conditions for migrant workers in response to global competitive pressures. However, LMIs play a controversial role in social upgrading. Private LMIs are identified as having a negative impact on career paths of migrant workers
Prevalence and characteristics of the ‘bad feeling’ among healthcare professionals in the context of emergency situations: A Bi‐Hospital Survey
Get PDFIntroduction
Clinical decision‐making is based on objective and subjective criteria, including healthcare workers impressions and feelings. This research examines the perception and implications of a ‘bad feeling’ experienced by healthcare professionals, focusing on its prevalence and characteristics.
Methods
A cross‐sectional paper‐based survey was conducted from January to July 2023 at the University Medicine Greifswald and the hospital Sömmerda involving physicians, nurses, medical students and trainees from various specialties. With ethics committee approval, participants were recruited and surveyed at regular clinical events. Data analysis was performed using SPSS® Statistics. The manuscript was written using the Strobe checklist.
Results
Out of 250 questionnaires distributed, 217 were valid for analysis after a 94.9% return rate and subsequent exclusions. Sixty‐five per cent of respondents experience the ‘bad feeling’ occasionally to frequently. There was a significant positive correlation between the frequency of ‘bad feeling’ and work experience. The predominant cause of this feeling was identified as intuition, reported by 79.8% of participants, with 80% finding it often helpful in their clinical judgement. Notably, in 16.1% of cases, the ‘bad feeling’ escalated in the further clinical course into an actual emergency. Furthermore, 60% of respondents indicated that this feeling occasionally or often serves as an early indicator of a potential, yet unrecognised, emergency in patient care.
Conclusions
This study demonstrates the relevance of clinical experience to decision‐making. As an expression of this, there is a correlation between the frequency of a ‘bad feeling’ and the number of years of experience. It is recommended that the ‘bad feeling’ be deliberately acknowledged and reinforced as an early warning signal for emergency situations, given its significant implications for patient safety. Future initiatives could include advanced training and research, as well as tools such as pocket maps, to better equip healthcare professionals in responding to this intuition
Effects of sodium–glucose co‐transporter inhibitors on individual clinical endpoints and quality of life
Get PDFAims
Sodium–glucose co‐transporter inhibitors (SGLTis) have cardiovascular protective effects. We aimed to assess the effects of SGLTis on individual hard clinical endpoints and quality of life (QoL) in patients with cardiovascular risk factors.
Methods and Results
Data was searched in PubMed, Embase, Cochrane Library and clinicaltrials.gov databases up to February 2024. Randomized controlled trials (RCTs) comparing SGLTis with placebo were included. The primary outcomes were individual hard clinical endpoints (Subset A) and QoL (Subset B). For Subset A, 13 RCTs including 90 413 patients were enrolled (age 66 ± 10.1 years, 35.7% female, follow‐up 2.4 ± 0.3 years); as compared with placebo, SGLTis were associated with significantly lower risk of all‐cause mortality [risk ratio (RR): 0.90, 95% confidence interval (CI): 0.86–0.94, P < 0.01], cardiovascular mortality (RR: 0.87, 95% CI: 0.82–0.92, P < 0.01), hospitalization for heart failure (HF) (RR: 0.72, 95% CI: 0.68–0.76, P < 0.01), HF events (RR: 0.72, 95% CI: 0.68–0.75, P < 0.01), hospitalization for any cause (RR: 0.91, 95% CI: 0.88–0.93, P < 0.01) and myocardial infarction (MI) (RR: 0.92, 95% CI: 0.85–0.99, P = 0.03). Notably, the favourable effect of SGLTis on all‐cause mortality was more pronounced in younger (<65 years) patients (RR: 0.86, 95% CI: 0.81–0.92) and in studies with less female (RR: 0.84, 95% CI: 0.79–0.90). The favourable effect of SGLTis on MI was only observed in patients who received sotagliflozin (RR: 0.47, 95% CI: 0.31–0.73). For Subset B, nine RCTs including 2552 HF patients were enrolled (age 67.8 ± 12.4 years, 36.4% female, follow‐up 3.4 ± 1.9 months); SGLTis were associated with significant improvement in QoL as compared with placebo.
Conclusions
In patients with a broad spectrum of cardiovascular risk factors, SGLTis substantially improve individual hard clinical outcomes and QoL
SARS-CoV-2 Spike Protein Amplifies the Immunogenicity of Healthy Renal Epithelium in the Presence of Renal Cell Carcinoma
Get PDFRenal cell carcinoma (RCC) is the most common form of kidney cancer, known for its immune evasion and resistance to chemotherapy. Evidence indicates that the SARS-CoV-2 virus may worsen outcomes for RCC patients, as well as patients with diminished renal function. Evidence suggests that the SARS-CoV-2 virus may exacerbate outcomes in RCC patients and those with impaired renal function. This study explored the unidirectional effects of RCC cells and the SARS-CoV-2 spike protein (S protein) on human renal proximal tubule epithelial cells (RPTECs) using a microphysiological approach. We co-cultured RCC cells (Caki-1) with RPTEC and exposed them to the SARS-CoV-2 S protein under dynamic 3D conditions. The impact on metabolic activity, gene expression, immune secretions, and S protein internalization was evaluated. The SARS-CoV-2 S protein was internalized by RPTEC but poorly interacted with RCC cells. RPTECs exposed to RCC cells and the S protein exhibited upregulated expression of genes involved in immunogenic pathways, particularly those related to antigen processing and presentation via the major histocompatibility complex I (MHCI). Additionally, increased TNF-α secretion suggested a pro-inflammatory response. Metabolic shifts toward glycolysis were observed in RCC co-culture, while the presence of the S protein led to minor changes. The presence of RCC cells amplified the immune-modulatory effects of the SARS-CoV-2 S protein on the renal epithelium, potentially exacerbating renal inflammation and fostering tumor-supportive conditions. These findings suggest that COVID-19 infections can impact renal function in the presence of kidney cancer