Efficacy of a 6-week Novel Exergaming Intervention Guided by Heart Rate Zones on Aerobic Performance in Children with Fetal Alcohol Spectrum Disorder and Attention-deficit/Hyperactivity Disorder: A Feasibility Study

The purpose of this study was to determine the feasibility of a novel exergaming intervention guided by heart rate zones for children and adolescents with fetal alcohol spectrum disorder (FASD) and attention-deficit/hyperactivity disorder (ADHD). Eight study participants (6 females, 2 males, mean age= 11.4±1.4 years old) participated twice weekly over six weeks to complete twelve multimodal exergaming sessions. Participants significantly improved 6MWT from baseline to week 6 (575.4±55.0 m to 732.8±58.9 m; P<0.01), which conferred a 31% improvement in estimated VO2max (31.5±5.5 ml/kg/min to 40.9±5.9 ml/kg/min), respectively. There was an upward trend of the mean percentage of time spent in the intermediate HR zones over the course of the 6-week intervention. These findings may provide value to the field as they support the clinical utility and promising effects of cardiovascular improvement in children who engage in a compelling exergaming intervention. In doing so, this establishes a preliminary understanding of how to augment routine physical exercise through exergaming using visually targeted heart rate zones.

Effect of Real-Time Feedback on Power Output Using a Novel Smart-Resisted Sled Push

Prior studies have demonstrated the beneficial effects of real-time data feedback (RTF) on athletic performance and motivation. Despite this evidence, the lack of practical means to implement RTF has hindered its widespread adoption. Recently, a smart-resisted sled push was developed to improve athletic power by utilizing electromagnetic motors as a resistance mechanism, coupled with an RTF display. Thirty healthy college-aged male football players were recruited in this randomized, crossover designed study to examine the efficacy of the RTF to improve power output. Participants were randomized into either group 1 (receiving RTF first then no RTF) or group 2 (receiving no RTF first then RTF) during six, 10-meter sled pushes with 3 min rest intervals. The first three pushes were set to an easier level (L1) and the last three were set to a resistance level twice that of the first three runs (L2). A one-month washout period was enforced. For trials 1-3 (L1) (p = 0.026, t = -2.34, ES = -0.428) and 4-6 (L2) (p = 0.035, t = -2.22, ES = -0.405), peak power output (the average peak power output over the course of trials 1-3 and 4-6) was greater in both groups when receiving RTF compared to no-RTF. These findings demonstrate the effectiveness of RTF in augmenting power output during performance training.

Alterations in reward network functional connectivity are associated with increased food addiction in obese individuals

Functional neuroimaging studies in obesity have identified alterations in the connectivity within the reward network leading to decreased homeostatic control of ingestive behavior. However, the neural mechanisms underlying sex differences in the prevalence of food addiction in obesity is unknown. The aim of the study was to identify functional connectivity alterations associated with: (1) Food addiction, (2) Sex- differences in food addiction, (3) Ingestive behaviors. 150 participants (females: N = 103, males: N = 47; food addiction: N = 40, no food addiction: N = 110) with high BMI ≥ 25 kg/m2 underwent functional resting state MRIs. Participants were administered the Yale Food Addiction Scale (YFAS), to determine diagnostic criteria for food addiction (YFAS Symptom Count ≥ 3 with clinically significant impairment or distress), and completed ingestive behavior questionnaires. Connectivity differences were analyzed using a general linear model in the CONN Toolbox and images were segmented using the Schaefer 400, Harvard-Oxford Subcortical, and Ascending Arousal Network atlases. Significant connectivities and clinical variables were correlated. Statistical significance was corrected for multiple comparisons at q < .05. (1) Individuals with food addiction had greater connectivity between brainstem regions and the orbital frontal gyrus compared to individuals with no food addiction. (2) Females with food addiction had greater connectivity in the salience and emotional regulation networks and lowered connectivity between the default mode network and central executive network compared to males with food addiction. (3) Increased connectivity between regions of the reward network was positively associated with scores on the General Food Cravings Questionnaire-Trait, indicative of greater food cravings in individuals with food addiction. Individuals with food addiction showed greater connectivity between regions of the reward network suggesting dysregulation of the dopaminergic pathway. Additionally, greater connectivity in the locus coeruleus could indicate that the maladaptive food behaviors displayed by individuals with food addiction serve as a coping mechanism in response to pathological anxiety and stress. Sex differences in functional connectivity suggest that females with food addiction engage more in emotional overeating and less cognitive control and homeostatic processing compared to males. These mechanistic pathways may have clinical implications for understanding the sex-dependent variability in response to diet interventions.

Sitosterolaemia in Switzerland: molecular genetics links the US Amish-Mennonites to their European roots

Sitosterolaemia is a rare autosomal recessive disease characterized by increased intestinal absorption of plant sterols, decreased hepatic excretion into bile and elevated concentrations in plasma phytosterols. Homozygous or compound heterozygous loss of function mutations in either of the ATP-binding cassette (ABC) proteins ABCG5 and ABCG8 explain the increased absorption of plant sterols. Here we report a Swiss index patient with sitosterolaemia, who presented with the classical symptoms of xanthomas, but also had mitral and aortic valvular heart disease. Her management over the last 20 years included a novel therapeutic approach of high-dose cholesterol feeding that was semi-effective. Mutational and extended haplotype analyses showed that our patient shared this haplotype with that of the Amish-Mennonite sitosterolaemia patients, indicating they are related ancestrally.

Anaesthetic considerations in Kartagener's syndrome -- a case report

Kartagener's syndrome is a rare disorder characterized by the triad of situs inversus, including dextrocardia, bronchiectasis and paranasal sinusitis. We report the anaesthetic management of a patient with Kartagener's syndrome and postrenal transplant immunosuppression, presenting for repair of uterovaginal prolapse. Combined spinal epidural anaesthesia was administered to this patient. The anaesthetic considerations of this rare disorder and the relative advantages of the regional technique over general anaesthesia in this situation are discussed.

Co-amplification of dhfr and a homologue of hmsh3 in a Chinese hamster methotrexate-resistant cell line correlates with resistance to a range of chemotherapeutic drugs

PURPOSE

To characterize a methotrexate-resistant Chinese hamster cell line, designated as M5, which had previously been shown to be resistant to gamma radiation, at the cellular and molecular levels.

METHODS

Sensitivity towards a number of chemotherapeutic drugs was determined by colony-forming ability and compared with that of parental V79 cells. Expression of the hamster homologue of the human mismatch repair gene hmsh3 was also determined by RT-PCR.

RESULTS

Induced killing by chemotherapeutic agents cis-diamminedichloroplatinum II (cisplatin). the antimetabolite 6-thioguanine (6-TG), camptothecin, a topoisomerase I inhibitor, and 4-(9-acridinyl-amino)-methanesulfon-m-anisidide (mAMSA), an inhibitor of topoisomerase II, was less in M5 cells than in the parental V79 cells. The IC50 values, defined as the concentration of the drug that reduced the survival to 50% that of the untreated control, in V79 cells for mAMSA and camptothecin treatment were 0.35 +/- 0.02 microg/ml and 84.3 +/- 16.0 ng/ml, respectively. For M5 cells, equivalent values were 0.52 +/- 0.10 microg/ml and 186 +/- 40.8 ng/ml. Treatment with 30 microM cisplatin reduced the survival of V79 cells to 0.09 +/- 0.07, whereas the same treatment reduced the survival of M5 cells to 0.67 +/- 0.16. Treatment of M5 cells with 6-TG did not induce appreciable killing up to the concentrations studied. However, for V79 cells, 6-TG was very toxic. We further observed that the dihydrofolate reductase (dhfr) gene as well as the hamster homologue of the human mismatch repair gene hmsh3 was amplified in the methotrexate-resistant M5 cells.

CONCLUSION

Resistance to this group of chemotherapeutic drugs observed in M5 cells could be due to the amplification of the hamster homologue of hMSH3, which in turn possibly sequesters all the hMSH2 making M5 cells functionally deficient in the mismatch repair system.

Effect of age and gender on the pharmacokinetics of ebastine after single and repeated dosing in healthy subjects

OBJECTIVES

Ebastine is a potent and selective H1-receptor antagonist indicated for allergic rhinitis which undergoes extensive first pass metabolism by CYP3A4 to form an active metabolite, carebastine. The purpose of the study was to determine age- and gender-related differences in the pharmacokinetics of ebastine and carebastine.

METHODS

The upper recommended oral dose of 20 mg once daily was administered to 12 healthy young (22 to 38 years) and 12 healthy elderly (50 to 92 years; 8 m and 4 f) subjects for 5 days. Plasma concentrations of ebastine and carebastine were determined for 24 hours following the initial dose on Day 1 and for 72 hours following the dose on Day 5 using a sensitive LC/MS/MS assay. The minimum quantifiable limit (MQL) for the assay was 0.05 ng/ml and 1.0 ng/ml for ebastine and carebastine, respectively.

RESULTS

Mean area under the curve and Cmax values on Day 1 and Day 5 were similar for ebastine but approximately doubled for carebastine due to its longer half-life. Mean carebastine concentrations were approximately 10 to 20 fold higher than mean ebastine concentrations. For young subjects, the mean (%CV) ebastine t(1/2) was 5.76 (28.47) h and 20.38 (46.19) h on Day 1 and Day 5, respectively. Similarily, for young subjects, the mean (%CV) for carebastine t(1/2) was 7.03 (23.21) h and 26.12 (23.39) h on Day 1 and Day 5, respectively. This apparent prolongation of t(1/2) was probably due to lack of proper estimation of terminal half-life on Day 1 as fewer samples were collected for a shorter duration on Day 1. Using a multicomparison test for Cmin values, it was determined that steady state conditions were achieved by Day 5 for both age groups for ebastine and in young subjects for carebastine. The variability in ebastine pharmacokinetic parameters was higher than carebastine. A 50% increase in ebastine AUC(0-24) and Cmax values in elderly subjects, with no changes in t(1/2), could be explained by either increased absorption of ebastine in elderly subjects or due to a decrease in first pass metabolism. As ebastine shows a high first-pass effect, even a small change in this first pass can cause large changes in plasma exposure. The ebastine pharmacokinetic parameters for elderly subjects in this study lie between the values reported in young subjects in earlier studies. Hence, the apparent age-related pharmacokinetic difference for ebastine is probably due to the inherent variability in ebastine pharmacokinetics. There were no gender-related differences in either young or elderly subjects for mean AUC, Cmax, tmax and t(1/2) ebastine and carebastine values. Ebastine was absorbed rapidly with a median tmax of 1.25 to 2.25 h for both healthy young and elderly males and females on Day 1 and Day 5. There was a delayed appearance of carebastine as expressed by median tmax of 4.0 to 5.0 h, which did not change with age, gender or repeated administration. There were no clinically relevant differences between the groups of subjects with respect to adverse events or safety parameters.

CONCLUSIONS

Thus, ebastine can be safely administered to elderly subjects with no clinically important age- or gender related differences in the pharmacokinetics of ebastine/carebastine.

In vitro and in vivo inhibition of telomerase activity from Chinese hamster V79 cells

While studying the inhibition of telomerase activity in Chinese hamster V79 cells using polymerase chain reaction (PCR) based telomeric repeat amplification protocol (TRAP) assay, we had earlier observed that 7-deaza deoxy guanosine triphosphate (7-deaza dGTP) and oligonucleotide (TTAGGG)4 inhibited telomerase activity in vitro. In the present study, we report inhibition of telomerase activity by modified base 7-deaza deoxy adenosine triphosphate (7-deaza dATP) and phosphorothioate TTAGGG (PS-TTAGGG). Both the compounds inhibited telomerase activity in a concentration dependent manner; 8.5 microM of 7-deaza dATP and 0.1 microM of PS-TTAGGG being the concentration for 50% of the maximum inhibition. This observation supports our earlier hypothesis that incorporation of a modified nucleotide into telomere possibly interferes with the recognition of the telomerase and TTAGGG interferes with the RNA component of telomerase. We have further shown that treatment of cells with nicotinamide (NA) and benzamide (BA), well known inhibitors of poly (ADP-ribose) polymerase, reduced telomerase activity. We speculate that modification of the telomeric binding proteins or other components by poly (ADP-ribosyl)ation may be involved in such inhibition.

Retroperitoneoscopic excision of phaeochromocytoma--haemodynamic events, complications and outcome

Over a period of 15 months, 11 patients with phaeochromocytoma underwent retroperitoneoscopic excision of their tumours. Five patients had bilateral tumours. All patients underwent thorough preoperative evaluation and preparation with alpha- and beta-blockade. In the majority of the patients a hypertensive response was seen during generation of pneumoretroperitoneum. However, the period of tumour dissection and excision was devoid of large haemodynamic fluctuations. The average time taken was 3.5 to 4 hours per gland. Blood loss in successful laparoscopic excision averaged 240 ml (range 120 to 700 ml). In these patients satisfactory postoperative analgesia could be provided with intramuscular pethidine or intramuscular diclofenac sodium. In three patients the procedure had to be converted to open laparotomy due to haemorrhage. All three patients had preoperative radiological evidence of inferior vena cava and aortic involvement. Patient selection plays an important role in a successful outcome.

Detection of telomerase activity in Chinese hamster V79 cells and its inhibition by 7-deaza-deoxy guanosine triphosphate and (TTAGGG)4 in vitro

To investigate the nature of telomerase activity and its inhibition in Chinese hamster V79 cells, we have detected telomerase activity in Chinese hamster cells using Telomeric Repeat Amplification Protocol (TRAP) assay. We have further studied inhibition characteristics of this enzyme in vitro by nucleotide analogue 7-deaza-2'-deoxy guanosine triphosphate (7-deaza-dGTP) and oligonucleotide (TTAGGG)4. Both the inhibitors inhibited the telomerase activity in a dose dependent manner. To attain 50% inhibition of the telomerase activity, we needed about 4.5 microM of 7-deaza-dGTP. Similarly, preincubation at 37 degreesC of the cell extract with 1.25 x 10(-3) microgram oligonucleotide (TTAGGG)4 showed 50% inhibition of the control value. Inhibition of telomerase activity by 7-deaza-dGTP could be due to the incorporation of the modified nucleotide in the telomeric repeat and thus altering the further binding/extension by the enzyme. (TTAGGG)4 could have possibly interacted with RNA component of telomerase and inhibited its activity.