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Effects of treadmill exercise versus Flutter\uae on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial
No full textAbstract
Background
Treadmill exercise and airway clearance with the Flutter\uae device have previously been shown to improve mucus clearance mechanisms in people with cystic fibrosis (CF) but have not been compared. It is therefore not known if treadmill exercise is an adequate form of airway clearance that could replace established airway clearance techniques, such as the Flutter\uae. The aim of this study was to evaluate respiratory flow, sputum properties and subjective responses of treadmill exercise and Flutter\uae therapy, compared to resting breathing (control).
Methods
Twenty-four adults with mild to severe CF lung disease (FEV
1
28\u201386% predicted) completed a three-day randomised, controlled, cross-over study. Interventions consisted of 20\ua0min of resting breathing (control), treadmill exercise at 60% of the participant\u2019s peak oxygen consumption and Flutter\uae therapy. Respiratory flow was measured during the interventions. Sputum properties (solids content and mechanical impedance) and subjective responses (ease of expectoration and sense of chest congestion) were measured before, immediately after the interventions and after 20\ua0min of recovery.
Results
Treadmill exercise and Flutter\uae resulted in similar significant increases in peak expiratory flow, but only Flutter\uae created an expiratory airflow bias (i.e. peak expiratory flow was at least 10% higher than peak inspiratory flow). Treadmill exercise and Flutter\uae therapy resulted in similar significant reductions in sputum mechanical impedance, but only treadmill exercise caused a transient increase in sputum hydration. Treadmill exercise improved ease of expectoration and Flutter\uae therapy improved subjective sense of chest congestion.
Conclusions
A single bout of treadmill exercise and Flutter\uae therapy were equally effective in augmenting mucus clearance mechanisms in adults with CF. Only longer term studies, however, will determine if exercise alone is an adequate form of airway clearance therapy that could replace other airway clearance techniques.
Trial registration
Australian and New Zealand Clinical Trials Registry, Registration number # ACTRN12609000168257 , Retrospectively registered (Date submitted to registry 26/2/2009, First participant enrolled 27/2/2009, Date registered 6/4/2009)
Postoperative fluid overload is a risk factor for adverse surgical outcome in patients undergoing esophagectomy for esophageal cancer: a retrospective study in 335 patients
No full textAbstract
Background
Restrictive intraoperative fluid management is increasingly recommended for patients undergoing esophagectomy. Controversy still exists about the impact of postoperative fluid management on perioperative outcome.
Methods
We retrospectively examined 335 patients who had undergone esophagectomy for esophageal cancer at the University Hospital Freiburg between 1996 and 2014 to investigate the relation between intra- and postoperative fluid management and postoperative morbidity after esophagectomy.
Results
Perioperative morbidity was 75%, the in-hospital mortality 8%. A fluid balance above average on the operation day was strongly associated with a higher rate of postoperative mortality (21% vs 3%, p \u2009<\u20090.001) and morbidity (83% vs 66%, p \u2009=\u20090.001). Univariate analysis for risk factors for adverse surgical outcome (Clavien\u2009\u2265\u2009III) identified ASA-score ( p \u2009=\u20090.002), smoking ( p \u2009=\u20090.036), reconstruction by colonic interposition ( p \u2009=\u20090.036), cervical anastomosis ( p \u2009=\u20090.017), blood transfusion ( p \u2009=\u20090.038) and total fluid balance on the operation day and on POD 4 ( p \u2009=\u20090.001) as risk factors.
Multivariate analysis confirmed only ASA-score ( p \u2009=\u20090.001) and total fluid balance ( p \u2009=\u20090.001) as independent predictors of adverse surgical outcome.
Conclusion
Intra- and postoperative fluid overload is strongly associated with increased postoperative morbidity. Our results suggest restrictive intra- and especially postoperative fluid management to optimize the outcome after esophagectomy
Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease
No full textAbstract
Background
Chlamydia infection in acute pelvic inflammatory disease (PID) is associated with serious complications including ectopic pregnancy, tubal infertility, Fitz-Hugh-Curtis syndrome and tubo-ovarian abscess (TOA). This study compared clinical and laboratory data between PID with and without chlamydia infection.
Methods
The medical records of 497 women who were admitted with PID between 2002 and 2011 were reviewed. The patients were divided into two groups (PID with and without chlamydia infection), which were compared in terms of the patients\u2019 characteristics, clinical presentation, and laboratory findings, including inflammatory markers.
Results
The chlamydia and non-chlamydia groups comprised 175 and 322 women, respectively. The patients in the chlamydia group were younger and had a higher rate of TOA, a longer mean hospital stay, and had undergone more surgeries than the patients in the non- chlamydia group. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and CA-125 level were higher in the chlamydia group than in the non-chlamydia group, but there was no significant difference in the white blood cell count between the two groups. The CA-125 level was the strongest predictor of chlamydia infection, followed by the ESR and CRP level. The area under the receiving operating curve for CA-125, ESR, and CRP was 0.804, 0.755, and 0.663, respectively.
Conclusions
Chlamydia infection in acute PID is associated with increased level of inflammatory markers, such as CA-125, ESR and CRP, incidence of TOA, operation risk, and longer hospitalization
Cheongsangbangpung-tang ameliorated the acute inflammatory response via the inhibition of NF-\u3baB activation and MAPK phosphorylation
No full textAbstract
Background
Cheongsangbangpung-tang (CBT) is a traditional herbal formula used in Eastern Asia to treat heat-related diseases and swellings in the skin. The present study was conducted to evaluate the anti-inflammatory effects of cheongsangbangpung-tang extract (CBTE) both in vitro and in vivo.
Methods
The in vitro effects of CBTE on the lipopolysaccharide (LPS)-induced production of inflammation-related proteins were examined in RAW 264.7 cells. The levels of nitric oxide (NO) were measured with the Griess reagent. Inflammatory cytokines and prostaglandin E
2
(PGE
2
) were detected using the enzyme-linked immunosorbent assay (ELISA) method. Inflammation-related proteins were detected by Western blot. The effect of CBTE on acute inflammation in vivo was evaluated using carrageenan (CA)-induced paw oedema. To evaluate the anti-inflammatory effect, paw oedema volume, thickness of the dorsum and ventrum pedis skin, number of infiltrated inflammatory cells, and number of COX-2-, iNOS-immunoreactive cells were measured.
Results
In an in vitro study, CBTE inhibited the production of NO and PGE
2
and also decreased the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) activity, interleukin (IL)-1\u3b2, IL-6 and tumuor necrosis factor-\u3b1. In LPS-activated macrophages, nuclear factor-kappaB (NF-\u3baB) and mitogen-activated protein kinase (MAPK) signalling is a pivotal pathway in the inflammatory process. These plausible molecular mechanisms increased the phosphorylation of I-\u3baB\u3b1, while the activation of NF-\u3baB and the phosphorylation of MAPK by LPS were blocked by CBTE treatment. In our in vivo study, a CA-induced acute oedematous paw inflammation rat model was used to evaluate the anti-inflammatory effect of CBTE. CBTE significantly reduced the increases in paw swelling, skin thicknesses, infiltrated inflammatory cells and iNOS-, COX-2 positive cells induced by CA injection.
Conclusions
Based on these results, CBTE should favourably inhibit the acute inflammatory response through modulation of NF-\u3baB activation and MAPK phosphorylation. Furthermore, the inhibition of CBTE in rat paw oedema induced by CA is considered to be clear evidence that CBTE may be a useful source to treat inflammation
Pleurotus giganteus (Berk. Karun & Hyde), the giant oyster mushroom inhibits NO production in LPS/H 2 O 2 stimulated RAW 264.7 cells via STAT 3 and COX-2 pathways
No full textAbstract
Background
Pleurotus giganteus (Berk. Karunarathna and K.D. Hyde), has been used as a culinary mushroom and is known to have medicinal properties but its potential as an anti-inflammatory agent to mitigate inflammation triggered diseases is untapped. In this study, the molecular mechanism underlying the protective effect of ethanol extract of P. giganteus (EPG) against lipopolysaccharide (LPS) and combination of LPS and hydrogen peroxide (H
2
O
2
)-induced inflammation on RAW 264.7 macrophages was investigated.
Method
The effect of EPG on nitric oxide (NO) production as an indicator of inflammation in RAW 264.7 macrophages was estimated based on Griess reaction that measures nitrite level. The expressions of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), NF-kB activating protein (NKAP), signal transducer and activator of transcription 3 protein (STAT 3) and glutathione peroxidase (GPx) genes were assessed using real time reverse transcription polymerase chain reaction (RT-PCR) approach.
Results
EPG (10\ua0\u3bcg/ml) showed the highest reduction in the LPS-induced NO production in RAW 264.7 macrophages and significantly suppressed ( p \u2009<\u20090.05) the expression iNOS, STAT 3 and COX-2. There was a significant increase ( p \u2009<\u20090.05) in combination of LPS and H
2
O
2
- induced iNOS production when compared to the LPS-induced iNOS production in RAW 264.7 macrophages and this concurred with the NO production which was attenuated by EPG at 10\ua0\u3bcg/ml. A significant ( p \u2009<\u20090.05) down regulation was observed in the combination of LPS and H
2
O
2
-induced iNOS and GPx expression by EPG.
Conclusions
Our data suggest that the anti-inflammatory activity of EPG is mediated via the suppression of the STAT 3 and COX-2 pathways and can serve as potential endogenous antioxidant stimulant
Treating the invisible: Gaps and opportunities for enhanced TB control along the Thailand-Myanmar border
No full textAbstract
Background
In Thailand\u2019s northwestern Tak province, contextual conditions along the border with Myanmar pose difficulties for TB control among migrant populations. Incomplete surveillance data, migrant patient mobility, and loss to follow-up make it difficult to estimate the TB burden and implement effective TB control measures. This multi-methods study examined tuberculosis, tuberculosis and human immunodeficiency virus co-infection, and multidrug-resistant tuberculosis treatment accessibility for migrants and refugees in Tak province, health system response, and public health surveillance.
Methods
In this study we conducted 13 interviews with key informants working in public health or TB treatment provision to elicit information on TB treatment availability and TB surveillance practices. In addition we organized 15 focus group discussions with refugee and migrant TB, TB/HIV, and MDR-TB patients and non-patients to discuss treatment access. We analyzed the data using thematic analysis and created treatment availability maps with Google maps.
Results
The study identified surveillance, treatment, and funding gaps. Migrant TB cases are underreported in the provincial statistics due to jurisdictional interpretations and resource barriers. Our results suggest that TB/HIV and MDR-TB treatment options are limited for migrants and a heavy reliance on donor funding may lead to potential funding gaps for migrant TB services. We identified several opportunities that positively contribute to TB control in Tak province: improved diagnostics, comprehensive care, and collaboration through data sharing, planning, and patient referrals. The various organizations providing TB treatment to migrant and refugee populations along the border and the Tak Provincial Public Health Office are highly collaborative which offers a strong foundation for future TB control initiatives.
Conclusions
Our findings suggest the need to enhance the surveillance system to include all migrant TB patients who seek treatment in Tak province and support efforts by stakeholders on both sides of the border to continue to share data and engage in collaborative planning on TB, TB/HIV, and MDR-TB treatment provision for migrant populations
Dapagliflozin decreases small dense low-density lipoprotein-cholesterol and increases high-density lipoprotein 2-cholesterol in patients with type 2 diabetes: comparison with sitagliptin
No full textAbstract
Background
The sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been reported to increase both low-density lipoprotein (LDL) and high-density lipoprotein (HDL)-cholesterol (C). This study aimed to determine how SGLT-2 inhibitors affect LDL and HDL-C subspecies.
Methods
This single center, open-label, randomized, prospective study included 80 patients with type 2 diabetes taking prescribed oral hypoglycemic agents. Patients were allocated to receive dapagliflozin (n\ua0=\ua040) or sitagliptin (n\ua0=\ua040) as add-on treatment. Fasting blood samples were collected before and 12\ua0weeks after this intervention. Small dense (sd) LDL-C, large buoyant (lb) LDL-C, HDL2-C, and HDL3-C levels were determined using our established homogeneous assays. Statistical comparison of blood parameters before and after treatment was performed using the paired t test.
Results
Dapagliflozin and sitagliptin comparably decreased HbA1c (0.75 and 0.63%, respectively). Dapagliflozin significantly decreased body weight, systolic blood pressure, plasma triglycerides and liver transaminases, and increased adiponectin; sitagliptin did not alter these measurements. LDL-C and apolipoprotein (apo) B were not significantly changed by dapagliflozin, whereas HDL-C and apo AI were increased. Dapagliflozin did not alter concentrations of LDL-C, but sd LDL-C decreased by 20% and lb LDL-C increased by 18%. Marked elevation in lb LDL-C (53%) was observed in individuals (n\ua0=\ua020) whose LDL-C was elevated by dapagliflozin. However, sd LDL-C remained suppressed (20%). Dapagliflozin increased HDL2-C by 18% without affecting HDL3-C. Sitagliptin did not alter plasma lipids or lipoprotein subspecies.
Conclusions
A SGLT-2 inhibitor, dapagliflozin suppresses potent atherogenic sd LDL-C and increased HDL2-C, a favorable cardiometabolic marker. Although LDL-C levels are elevated by treatment with dapagliflozin, this was due to increased concentrations of the less atherogenic lb LDL-C. However, these findings were not observed after treatment with dipeptidyl peptidase-4 inhibitor, sitagliptin.
Trial registration UMIN Clinical Trials Registry (UMIN000020984
GPU accelerated voxel-driven forward projection for iterative reconstruction of cone-beam CT
No full textAbstract
Background
For cone-beam computed tomography (CBCT), which has been playing an important role in clinical applications, iterative reconstruction algorithms are able to provide advantageous image qualities over the classical FDK. However, the computational speed of iterative reconstruction is a notable issue for CBCT, of which the forward projection calculation is one of the most time-consuming components.
Method and results
In this study, the cone-beam forward projection problem using the voxel-driven model is analysed, and a GPU-based acceleration method for CBCT forward projection is proposed with the method rationale and implementation workflow detailed as well. For method validation and evaluation, computational simulations are performed, and the calculation times of different methods are collected. Compared with the benchmark CPU processing time, the proposed method performs effectively in handling the inter-thread interference problem, and an acceleration ratio as high as more than 100 is achieved compared to a single-threaded CPU implementation.
Conclusion
The voxel-driven forward projection calculation for CBCT is highly paralleled by the proposed method, and we believe it will serve as a critical module to develop iterative reconstruction and correction methods for CBCT imaging
Hybrid brain\u2013computer interface for biomedical cyber-physical system application using wireless embedded EEG systems
No full textAbstract
Background
One of the key challenges of the biomedical cyber-physical system is to combine cognitive neuroscience with the integration of physical systems to assist people with disabilities. Electroencephalography (EEG) has been explored as a non-invasive method of providing assistive technology by using brain electrical signals.
Methods
This paper presents a unique prototype of a hybrid brain computer interface (BCI) which senses a combination classification of mental task, steady state visual evoked potential (SSVEP) and eyes closed detection using only two EEG channels. In addition, a microcontroller based head-mounted battery-operated wireless EEG sensor combined with a separate embedded system is used to enhance portability, convenience and cost effectiveness. This experiment has been conducted with five healthy participants and five patients with tetraplegia.
Results
Generally, the results show comparable classification accuracies between healthy subjects and tetraplegia patients. For the offline artificial neural network classification for the target group of patients with tetraplegia, the hybrid BCI system combines three mental tasks, three SSVEP frequencies and eyes closed, with average classification accuracy at 74% and average information transfer rate (ITR) of the system of 27\ua0bits/min. For the real-time testing of the intentional signal on patients with tetraplegia, the average success rate of detection is 70% and the speed of detection varies from 2 to 4\ua0s
Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal
No full textAbstract
Background
Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation.
Partnerships network
We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community.
Conclusions
We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal