An environmentally sustainable approach for the utilization of Erigeron bonariensis as a green inhibitor against weathering steel corrosion in acidic media

In the realm of corrosion mitigation, the search for sustainable and ecologically accountable inhibitors attracts significant interest from the environmental point of view. This study investigates the intriguing possibilities presented by Erigeron bonariensis (EB) as a green and innovative corrosion inhibitor for weathering steel in 1 M H2SO4. EB, a naturally abundant plant species, holds promise as a green and sustainable inhibitor due to its inherent chemical composition in the environment. The intricate interplay between the phytochemical constituents of the extract and the corrosive environment is meticulously deciphered. Furthermore, the environmentally benign nature of the inhibitor adds an extra layer of significance to its application, aligning with contemporary green chemistry principles. The inhibition effect of Erigeron bonariensis (EB) extract on the corrosion of mild steel in acidic media (H2SO4) was studied using weight loss, absorption studies, phytochemical analysis, electrochemical methods, and scanning electron microscopy. The experimental findings revealed that an increase in inhibitor concentration is correlated with higher inhibition efficiency. The adsorption of inhibitor molecules on the mild steel surface was found to agree with the UV-Vis adsorption spectrum. Additionally, a surface study conducted using scanning electron microscopy indicated notable differences in the presence and absence of inhibitors for weathering steel. At 2000 mg L-1, EB extract has the best inhibitory efficiency for weathering steel in 1 M H2SO4 of 99.50% by the leaf part, followed by 94.35% by the flower part, and 85.22% by the stem part. Overall, this study suggests that EB extract serves as a promising alternative for corrosion prevention, demonstrating significant inhibition efficiency.

Electrochemical and DFT Studies of the Pistacia Integerrima Gall Extract: An Eco-friendly Approach towards the Corrosion of Steel in Acidic Medium

A novel application of the Pistacia integerrima gall extract as an environmentally friendly corrosion inhibitor is reported in this study. The major phytochemicals present in the gall extract, namely pistagremic acid, β-sitosterol, pistiphloroglucinyl ether, pistaciaphenyl ester, naringenin, and 5,7-dihydroxy-2-(4-hydroxyphenyl)-2,3-dihydrochromen-4-one, play key roles in its anticorrosive behavior on steel in aggressive media. Several approaches were used to study the corrosion prevention activity of steel in 1 M H2SO4, including weight loss analysis, scanning electron microscopy (SEM), electrochemical impedance spectroscopy (EIS), potentiodynamic polarization (PDP), and density functional theory (DFT). At 2000 mg L-1, the highest efficiency of 92.19% was observed in 1 M H2SO4. An SEM study was conducted to validate the surface coverage of the metal surface. DFT studies revealed several nucleophilic regions present in the phytochemicals of the inhibitor, which supported the favorable nucleophilicity. Corrosion studies have not been performed on this sample. Phytochemicals make it an effective corrosion inhibitor, and its extraction process utilizes distilled water, making it better than other inhibitors. It has been proven that the obtained values of ΔEInhDFT for pistiphloroglucinyl, pistaciaphenyl ether, and naringenin organic compounds were very low, confirming the high reactivity of these corrosion inhibitors. The order of the values of ΔEInhDFT is as follows: pistaciaphenyl ether > pistiphloroglucinyl ether > naringenin organic compound; this suggests that pistaciaphenyl ether is more reactive than the other compounds. In this study, P. integerrima gall extract emerges as a novel and highly effective corrosion resistance agent in 1 M H2SO4, chosen for its relevance to acid pickling and cleaning processes.

Muscle metaboreflex stimulates the cardiac sympathetic afferent reflex causing positive feedback amplification of sympathetic activity: effect of heart failure

Exercise intolerance is a hallmark symptom of heart failure and to a large extent stems from reductions in cardiac output that occur due to the inherent ventricular dysfunction coupled with enhanced muscle metaboreflex-induced functional coronary vasoconstriction, which limits increases in coronary blood flow. This creates a further mismatch between O2 delivery and O2 demand, which may activate the cardiac sympathetic afferent reflex (CSAR), causing amplification of the already increased sympathetic activity in a positive-feedback fashion. We used our chronically instrumented conscious canine model to evaluate if chronic ablation of afferents responsible for the CSAR would attenuate the gain of muscle metaboreflex before and after induction of heart failure. After afferent ablation, the gain of the muscle metaboreflex control of mean arterial pressure was significantly reduced before (-239.5 ± 16 to -95.2 ± 8 mmHg/L/min) and after the induction of heart failure (-185.6 ± 14 to -95.7 ± 12 mmHg/L/min). Similar results were observed for the strength (gain) of muscle metaboreflex control of heart rate, cardiac output, and ventricular contractility. Thus, we conclude that the CSAR contributes significantly to the strength of the muscle metaboreflex in normal animals with heart failure serving as an effective positive-feedback amplifier thereby further increasing sympathetic activity.NEW & NOTEWORTHY The powerful pressor responses from the CSAR arise via O2 delivery versus O2 demand imbalance. Muscle metaboreflex activation (MMA) simultaneously elicits coronary vasoconstriction (which is augmented in heart failure) and profound increases in cardiac work thereby upsetting oxygen balance. Whether MMA activates the CSAR thereby amplifying MMA responses is unknown. We observed that removal of the CSAR afferents attenuated the strength of the muscle metaboreflex in normal and subjects with heart failure.

Low language capacity in childhood: A systematic review of prevalence estimates

BACKGROUND AND AIMS

Epidemiological studies have provided invaluable insight into the origin and impact of low language skills in childhood and adolescence. However, changing terminology and diagnostic guidelines have contributed to variable estimations of the prevalence of developmental language difficulties. The aim of this review was to profile the extent and variability of low language prevalence estimates through a systematic review of epidemiological literature.

METHODS

A systematic review of the empirical research (August 2022) was undertaken to identify studies that aimed to estimate the prevalence of low language skills in children (<18 years). A total of 19 studies published between 1980-2022 met inclusion criteria for review.

RESULTS

Studies reported prevalence estimates of low language skills in children between 1 and 16 years. Estimated rates varied from 0.4% to 25.2%. More stable estimations were observed in studies of children aged 5 years and older and those that applied updated diagnostic criteria to performance on standardised assessments of receptive and expressive language.

CONCLUSIONS AND IMPLICATIONS

The estimated prevalence of low language skills in childhood varies considerably in the literature. Application of updated diagnostic criteria, including the assessment of functional impact, is critical to inform advocacy efforts and govern social, health and educational policies.

WHAT THIS PAPER ADDS

What is already known on the subject Epidemiological research has informed our understanding of the origin and impact of low language capacity in childhood. Childhood language disorder is met with a rich history of evolving terminology and diagnostic guidelines to identify children with low language skills. Inconsistent definitions of and methods to identify low language in children have resulted in variable prevalence estimates in population-based studies. Variability in prevalence estimates impacts advocacy efforts to inform social, health and educational policy for child language disorder. What this study adds A total of 19 studies published at the time of this review aimed to provide estimates of the proportion of children who experience low language skills. Prevalence estimates varied between 0.4% and 25.2%, with more stable estimates reported in studies of older school-age children and those which utilised standardised assessments of both expressive and receptive language. Few studies utilised assessments of functional impact of language difficulties, which is misaligned with updated diagnostic criteria for child language disorder. What are the clinical implications of this work? This review reports substantial variability in estimates of the proportion of children and adolescents who live with low language skills. This variability underscores the importance of applying updated diagnostic criteria to identify the prevalence low language in childhood. Efforts to estimate the prevalence of low language must include measures of functional impact of low language skills. This aligns with clinical recommendations, which call for routine assessment of functional outcomes. To this end, we require a unified understanding of the term 'functional impact' in the context of low language, including the development and evaluation of measures that assess impact across emotional, social and academic domains.

Glia-specific expression of neuropeptide receptor Lgr4 regulates development and adult physiology in Drosophila

Similar to the human brain, Drosophila glia may well be divided into several subtypes that each carries out specific functions. Glial GPCRs play key roles in crosstalk between neurons and glia. Drosophila Lgr4 (dLgr4) is a human relaxin receptor homolog involved in angiogenesis, cardiovascular regulation, collagen remodeling, and wound healing. A recent study suggests that ilp7 might be the ligand for Lgr4 and regulates escape behavior of Drosophila larvae. Here we demonstrate that Drosophila Lgr4 expression in glial cells, not neurons, is necessary for early development, adult behavior, and lifespan. Reducing the Lgr4 level in glial cells disrupts Drosophila development, while knocking down other LGR family members in glia has no impact. Adult-specific knockdown of Lgr4 in glia but not neurons reduce locomotion, male reproductive success, and animal longevity. The investigation of how glial expression of Lgr4 contributes to this behavioral alteration will increase our understanding of how insulin signaling via glia selectively modulates neuronal activity and behavior.

Electrochemical and DFT studies of Terminalia bellerica fruit extract as an eco-friendly inhibitor for the corrosion of steel

It is well known that metal corrosion causes serious economy losses worldwide. One of the most effective ways to prevent corrosion is the continuous development of high-efficient and environment-friendly corrosion inhibitors. Among the widely used organic and inorganic corrosion inhibitors, plant extracts are top candidates due to their nontoxic nature. The present study reports a novel application of the methanolic extract of Terminalia bellerica fruits as an environment friendly corrosion inhibitor for steel in sulphuric acid medium. The phytochemicals of the extract, namely Ellagic, Gallic, and Malic acids, play a key role of the anti-corrosive behavior of the extract. The corrosion prevention activity was studied on the steel in 1 M H2SO4 using a variety of approaches including weight loss analysis (WL), scanning electron microscope (SEM), electrochemical impedance spectroscopy (EIS), density functional theory (DFT), natural bond orbital analysis (NBO), Fukui function and Monte Carlo simulations (MC). In 1 M H2SO4 solution, the maximum electrochemical inhibition efficiency of 91.79% was observed at 4000 mg/L concentration of the extract. The NBO analysis showed that the charge density of the double bonds and the oxygen atoms of carbonyl and hydroxyl groups of the phytochemicals lies on the top of the natural bond orbitals which promotes the anticorrosive properties of the investigated inhibitors. The surface coverage of steel was validated by SEM measurements. According to DFT studies, numerous nucleophilic regions were present in the active phytochemical constituents of the inhibitor, demonstrating their favorable nucleophilicity. The computed electronic structure of the phytochemicals revealed band gaps of 4.813, 5.444, and 7.562 eV for Ellagic, Gallic, and Malic acids respectively suggesting effective metal-inhibitor interactions. A good correlation between experimental and theoretical findings was addressed.

Neural control of the circulation during exercise in heart failure with reduced and preserved ejection fraction

Patients with heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) exhibit severe exercise intolerance that may be due, in part, to inappropriate cardiovascular and hemodynamic adjustments to exercise. Several neural mechanisms and locally released vasoactive substances work in concert through complex interactions to ensure proper adjustments to meet the metabolic demands of the contracting skeletal muscle. Specifically, accumulating evidence suggests that disease-related alterations in neural mechanisms (e.g., central command, exercise pressor reflex, arterial baroreflex, and cardiopulmonary baroreflex) contribute to heightened sympathetic activation and impaired ability to attenuate sympathetic vasoconstrictor responsiveness that may contribute to reduced skeletal muscle blood flow and severe exercise intolerance in patients with HFrEF. In contrast, little is known regarding these important aspects of physiology in patients with HFpEF, though emerging data reveal heightened sympathetic activation and attenuated skeletal muscle blood flow during exercise in this patient population that may be attributable to dysregulated neural control of the circulation. The overall goal of this review is to provide a brief overview of the current understanding of disease-related alterations in the integrative neural cardiovascular responses to exercise in both HFrEF and HFpEF phenotypes, with a focus on sympathetic nervous system regulation during exercise.

UbiSeCEF: Ubilab's Secure Cloud Environment Framework for Public Health Research

Issue/Problem

The adoption of cloud-based public health research over personal health data in an academic setting in Canada is still in its early stages and lacks the necessary maturity to handle such technologies. This can be attributed to the fact that many public health researchers lack the required IT knowledge to set up and use these environments securely and effectively.

Description of Problem

The lack of expertise among public health researchers in Canada has led to a slow adoption of cloud-based public health research. This has resulted in a significant gap between the potential benefits of cloud-based research and the current state of practice. To address this challenge, we propose Ubilab's Secure Cloud Environment Framework (UbiSeCEF) as guidelines for those interested in conducting similar public research.

Results

UbiSeCEF's components were developed with consideration given to requirements from stakeholders, Ubilab's operations and data objectives, state-of-the-art technologies, and laws and standards that regulate public health research and personal health data sharing. The framework utilizes Azure's data governance framework, virtual private networks (VPN), role-based authentication, and policy-based access to control access to resources and research data. The implementation of UbiSeCEF provides a secure, flexible, and efficient environment for cloud-based public health research.

Lessons

The lack of IT expertise among public health researchers can hinder the adoption of cloud-based public health research. To address this challenge, the development of frameworks like UbiSeCEF can provide guidance for secure and effective implementation. The use of state-of-the-art technologies and compliance with laws and standards that regulate public health research and personal health data sharing can greatly enhance the quality and reliability of research outcomes while ensuring the protection of personal health data.

Key messages

• Framework developed to enhance secure & effective adoption of cloud-based public health research by addressing lack of IT expertise among researchers.

• The research aims to assist other researchers and institutions in navigating the complexities of cloud-based public health research while maintaining the privacy and security of public heath data.

Public health monitoring of behavioural risk factors in USA: An exploratory study

Background

The COVID-19 pandemic's restrictions had a significant impact on behavioural markers such as physical, sedentary and sleep activity. The Behavioral Risk Factor Surveillance System is a key data source for public health surveillance in the USA but is limited by subjectivity and data quality, and new-generation data sources like Fitbits face challenges with battery life and data access. This research study aims to use zero-effort technology and IoT-based big data to evaluate the impact of the COVID-19 pandemic on population-level behavioural changes in USA.

Methods

The study used a proposed methodology to analyze data from 470 households in New Mexico, USA, using the DYD dataset from Donate your Data initiative by ecobee (a smart thermostat company). The Microsoft Azure data lake is used for the storage of raw data and the Azure databricks is used for data pre-processing, processing, and analysis. The Gaussian mixture model is used to identify sleep parameters by segmenting the sleep cycle records into different clusters. The quantity of sleep is measured by a motion sensor based on the absence of movement, and an increase in sensor activation indicates longer duration of household occupancy.

Results

The findings show significant changes at the household and population level for the selected behavioural health indicators (sleep-time, wake-up time, time spent indoors, time spent outdoors) during COVID-19 pandemic, which could be attributed to the policy changes implemented to curb the spread of COVID-19. The study findings are shown by 1) heatmap visualizations at the household level showing trends for the selected indicators during the Covid-19 pandemic; and 2) statistical analysis indicating a significant difference in selected behavioural health indicators before and during the pandemic.

Conclusions

These innovative data analytics have the potential to provide real-time insights and alert system activation to monitor, promote, and improve public health.

Key messages

• Sleep health analysis using IoT data is a novel method of measuring public health indicators objectively using zero effort technology.

• The available evidence from this study can further offer surveillance systems with near-real-time behavioral markers; alert system activation; and measure short- and long-term impact policy changes.

Blood flow restriction training activates the muscle metaboreflex during low-intensity sustained exercise

Blood flow restriction training (BFRT) employs partial vascular occlusion of exercising muscle and has been shown to increase muscle performance while using reduced workload and training time. Numerous studies have demonstrated that BFRT increases muscle hypertrophy, mitochondrial function, and beneficial vascular adaptations. However, changes in cardiovascular hemodynamics during the exercise protocol remain unknown, as most studies measured blood pressure before the onset and after the cessation of exercise. With reduced perfusion to the exercising muscle during BFRT, the resultant accumulation of metabolites within the ischemic muscle could potentially trigger a large reflex increase in blood pressure, termed the muscle metaboreflex. At low workloads, this pressor response occurs primarily via increases in cardiac output. However, when increases in cardiac output are limited (e.g., heart failure or during severe exercise), the reflex shifts to peripheral vasoconstriction as the primary mechanism to increase blood pressure, potentially increasing the risk of a cardiovascular event. Using our chronically instrumented conscious canine model, we utilized a 60% reduction in femoral blood pressure applied to the hindlimbs during steady-state treadmill exercise (3.2 km/h) to reproduce the ischemic environment observed during BFRT. We observed significant increases in heart rate (+19 ± 3 beats/min), stroke volume (+2.52 ± 1.2 mL), cardiac output (+1.21 ± 0.2 L/min), mean arterial pressure (+18.2 ± 2.4 mmHg), stroke work (+1.93 ± 0.2 L/mmHg), and nonischemic vascular conductance (+3.62 ± 1.7 mL/mmHg), indicating activation of the muscle metaboreflex.NEW & NOTEWORTHY Blood flow restriction training (BFRT) increases muscle mass, strength, and endurance. There has been minimal consideration of the reflex cardiovascular responses that could be elicited during BFRT sessions. We showed that during low-intensity exercise BFRT may trigger large reflex increases in blood pressure and sympathetic activity due to muscle metaboreflex activation. Thus, we urge caution when employing BFRT, especially in patients in whom exaggerated cardiovascular responses may occur that could cause sudden, adverse cardiovascular events.

Sex differences in minutiae frequencies of thumbprint with respect to dermatoglyphic patterns

Abstract

The present study is an attempt to study the sex differences in minutiae frequencies of thumbprint with respect to dermatoglyphic patterns. A sample of 100 subjects (50 males and 50 females) were gathered from Shimla, Himachal Pradesh (North India). In regards to pattern type, maximum number of minutiae was present in loop pat-tern followed by whorls and least minutiae were in the arches in the right hand of both the sexes and left hand of females only, whereas in left hand of the males highest frequency of minutiae were noticed in whorls followed by loops and lowest in the arches, thereby indicating the lessened bimanual symmetry in males. It can be inferred from the present study that the simple pattern (arch) has less discontinuance in the regular flow of the ridges, while the complex patterns (loops and whorls) exhibited more interruptions in the dermal ridges.

Unilateral sacral erector spinae plane block for lower limb surgery in children

The erector spinae plane block is a versatile regional anaesthesia technique used for a variety of truncal surgeries. A novel variation is the sacral erector spinae plane block which is gaining popularity for perineal and anorectal procedures. Local anaesthetic injected at this level blocks the sacral dermatomes and has the potential for more proximal spread to involve lumbar nerve fibres via spread to the lumbar plexus or the epidural space. The advantage of a sacral erector spinae plane block over a neuraxial block is that it is less invasive and may have a better safety profile: there is a reduced risk of epidural haematoma, epidural abscess, haemodynamic instability and motor weakness of the lower extremities. Until now, this approach has been used for midline surgical procedures when the local anaesthetic was injected bilaterally. Its application for lower limb procedures with a single unilateral injection has not been described. We report the use of a unilateral sacral erector spinae plane block at the level of the S2 median crest in two children undergoing lower limb procedures of the hip and thigh. The block was found to provide effective peri-operative analgesia with minimal need for any opioid analgesics and without any significant adverse effects.

Impact of talk test based aerobic exercise on glycaemic control and anthropometric measures among patients with type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is characterised by the chronic hyperglycaemia which leads to various micro and macrovascular complications. The aim of present study was to evaluate the impact of talk test based aerobic exercise on glycaemic control and anthropometric measures among adults with (T2DM). In this double blind randomised controlled trial (RCT), aerobic exercises/walking was used as intervention. The patients were divided into three groups based on the tool of exercise intensity prescription: a talk test-based group (TTG, n=30), a rating of perceived exertion-based group (RPEG, n=30), and a control group (CG, n=30). Glycated haemoglobin (HbA1c) was evaluated at baseline and after 8 weeks. Anthropometric measures, i.e. body mass index (BMI), and waist circumference (WC) were evaluated at baseline, 4 weeks, and 8 weeks. Wilcoxon rank-sum/repeated measure of ANOVA and Kruskal-Wallis test/ANOVA were used for within and between group comparison, respectively, on the basis of normality of the data. The mean HbA1c change in TTG, RPEG, and CG was -0.29, -0.28, and -0.04, respectively, and it was significantly greater in TTG and RPEG as compared to CG. The reduction of HbA1c, BMI, and WC was reported in each group. However, the reduction in the experimental groups, i.e. TTG and RPEG was significantly greater than in the control group (P≤0.01). However, there was no significant difference found between the experimental groups (P>0.05). TT based aerobic exercise is effective in improving glycaemic control and anthropometric measures. Therefore, TT can be used for the exercise prescription of these patients.

The study is registered at the Clinical Trial Registry-India under no. CTRI/2019/02/017531.

MeQryEP: A Texture Based Descriptor for Biomedical Image Retrieval

Image texture analysis is a dynamic area of research in computer vision and image processing, with applications ranging from medical image analysis to image segmentation to content-based image retrieval and beyond. "Quinary encoding on mesh patterns (MeQryEP)" is a new approach to extracting texture features for indexing and retrieval of biomedical images, which is implemented in this work. An extension of the previous study, this research investigates the use of local quinary patterns (LQP) on mesh patterns in three different orientations. To encode the gray scale relationship between the central pixel and its surrounding neighbors in a two-dimensional (2D) local region of an image, binary and nonbinary coding, such as local binary patterns (LBP), local ternary patterns (LTP), and LQP, are used, while the proposed strategy uses three selected directions of mesh patterns to encode the gray scale relationship between the surrounding neighbors for a given center pixel in a 2D image. An innovative aspect of the proposed method is that it makes use of mesh image structure quinary pattern features to encode additional spatial structure information, resulting in better retrieval. On three different kinds of benchmark biomedical data sets, analyses have been completed to assess the viability of MeQryEP. LIDC-IDRI-CT and VIA/I-ELCAP-CT are the lung image databases based on computed tomography (CT), while OASIS-MRI is a brain database based on magnetic resonance imaging (MRI). This method outperforms state-of-the-art texture extraction methods, such as LBP, LQEP, LTP, LMeP, LMeTerP, DLTerQEP, LQEQryP, and so on in terms of average retrieval precision (ARP) and average retrieval rate (ARR).

Ventricular-Vascular Uncoupling in Heart Failure: Effects of Arterial Baroreflex-Induced Sympathoexcitation at Rest and During Exercise

Autonomic alterations in blood pressure are primarily a result of arterial baroreflex modulation of systemic vascular resistance and cardiac output on a beat-by-beat basis. The combined central and peripheral control by the baroreflex likely acts to maintain efficient energy transfer from the heart to the systemic vasculature; termed ventricular-vascular coupling. This level of control is maintained whether at rest or during exercise in healthy subjects. During heart failure, the ventricular-vascular relationship is uncoupled and baroreflex dysfunction is apparent. We investigated if baroreflex dysfunction in heart failure exacerbated ventricular-vascular uncoupling at rest, and during exercise in response to baroreceptor unloading by performing bilateral carotid occlusions in chronically instrumented conscious canines. We observed in healthy subjects that baroreceptor unloading caused significant increases in effective arterial elastance (Ea) at rest (1.2 ± 0.3 mmHg/ml) and during exercise (1.3 ± 0.2 mmHg/ml) that coincided with significant increases in stroke work (SW) (1.5 ± 0.2 mmHg/ml) and (1.6 ± 0.2 mmHg/ml) suggesting maintained ventricular-vascular coupling. Heart Failure significantly increased the effect of baroreceptor unloading on Ea at rest (3.1 ± 0.7 mmHg/ml) and during exercise (2.3 ± 0.5 mmHg/ml) whereas no significant increases in stroke work occurred, thus signifying further ventricular-vascular uncoupling. We believe that the enhanced ventricular-vascular uncoupling observed during baroreceptor unloading only worsens the already challenged orthostatic and exercise tolerance and thereby contributes to poor exercise performance and quality of life for heart failure patients.

Effect of subjective tool based aerobic exercise on pulmonary functions in patients with type 2 diabetes mellitus – a feasibility RCT

Literature has proved the benefit of exercise on pulmonary functions among the patients with type 2 diabetes mellitus (T2DM). However, objective tools of exercise intensity prescription have been used in previous trials. The trials to explore the effectiveness of subjective tools-based exercise on pulmonary functions among these patients are scarce. The purpose of this study was to explore the feasibility of subjective tools-based exercise among patients with T2DM. Another objective was to see the effectiveness of this kind of exercise on pulmonary functions among patients with T2DM. 49 patients were randomly allotted to three groups, talk test group (TTG, n=16); rating of perceived exertion group (RPEG, n=16); and control group (CG, n=17). Subjects were evaluated for five progression criteria. The intervention period for the groups was 8 weeks. Recruitment and retention rate was 62.82 and 75.5%, respectively. Adherence rate was 67.34% and 58.91% for supervised and unsupervised sessions, respectively. 78.38% of the patients were available for post-intervention outcome evaluation. A significant increase in pulmonary functions in both the experimental groups (P=0.00) was found after 8 weeks of training. This study provides evidence that a trial of this nature is feasible with a few amendments in methodology. Additionally, the study also concluded that the subjective tool based aerobic exercise may be effective in improving pulmonary functions among patients with T2DM. Trial registration at Clinical Trial Registry-India: CTRI/2019/02/017531.

Influence of Age and Estradiol on Sympathetic Nerve Activity Responses to Exercise in Women

INTRODUCTION

Postmenopausal women (PMW) display exaggerated increases in blood pressure (BP) during exercise, yet the mechanism(s) involved remain unclear. Moreover, research on the impact of menopausal changes in estradiol on cardiovascular control during exercise are limited. Herein, we tested the hypothesis that sympathetic responses during exercise are augmented in PMWcompared with young women (YW), and estradiol administration attenuates these responses.

METHODS

Muscle sympathetic nerve activity (MSNA) and mean arterial pressure (MAP) were measured in 13 PMW (58 ± 1 yr) and 17 YW (22 ± 1 yr) during 2 min of isometric handgrip. Separately, MSNA and BP responses were measured during isometric handgrip in six PMW (53 ± 1 yr) before and after 1 month of transdermal estradiol (100 μg·d-1). A period of postexercise ischemia (PEI) to isolate muscle metaboreflex activation followed all handgrip bouts.

RESULTS

Resting MAP was similar between PMW and YW, whereas MSNA was greater in PMW (23 ± 3 vs 8 ± 1 bursts per minute; P < 0.05). During handgrip, the increases in MSNA (PMW Δ16 ± 2 vs YW Δ6 ± 1 bursts per minute; P < 0.05) and MAP (PMW Δ18 ± 2 vs YW Δ12 ± 2 mm Hg; P < 0.05) were greater in PMW and remained augmented during PEI. Estradiol administration decreased resting MAP but not MSNA in PMW. Moreover, MSNA (PMW (-E2) Δ27 ± 8 bursts per minute versus PMW (+E2) Δ12 ± 5 bursts per minute; P < 0.05) and MAP (Δ31 ± 8 mm Hg vs Δ20 ± 6 mm Hg; P < 0.05) responses during handgrip were attenuated in PMW after estradiol administration. Likewise, MAP responses during PEI were lower after estradiol.

CONCLUSIONS

These data suggest that PMW exhibit an exaggerated MSNA and BP response to isometric exercise, due in part to heightened metaboreflex activation. Furthermore, estradiol administration attenuated BP and MSNA responses to exercise in PMW.

High-content phenotypic screening identifies novel chemistries that disrupt mosquito activity and development

New classes of chemistries are needed to control insecticide resistant populations of mosquitoes and prevent transmission of vector-borne diseases (VBDs). Organismal screens of chemical collections have played an important role in the search for new vector insecticides and the identification of active ingredients (AIs) that cause rapid mortality of mosquitoes. Advances in image-based screening offer an opportunity to identify chemistries that operate via novel biochemical modes and investigate the range of phenotypes exhibited by mosquitoes following exposure to lethal and sub-lethal chemical dose. An automated, high throughput phenotypic screen (HTS) employing high-content imaging of first instar (L1) Aedes aegypti larvae was developed to identify chemistries associated with mortality and atypical morphological phenotypes. A pilot screen of the Library of Pharmacologically Active Compounds (LOPAC₁₂₈₀) identified 92 chemistries that disrupted larval activity and development, including conventional insecticides and chemistries known to modulate G protein-coupled receptors (GPCRs) and other molecular targets in mammalian systems. Secondary assay series were used to evaluate a selection of chemistries for impacts on mosquito activity, survival and development. Ritodrine hydrochloride reduced mobility of larvae but had no observable effect on survival and development of mosquitoes. High doses of metergoline suppressed larval activity and sub-lethal dose resulted in pupal mortality. Assay data support the utility of phenotypic screening and diverse entomological end-points for discovery of novel insecticidal chemical scaffolds. The insecticide discovery process must consider how multi-modal efficacy spectra contribute to vector and VBD control.

Effect of type 1 tympanoplasty on the quality of life of patients suffering from chronic otitis media (safe type)

Background

Chronic otitis media (COM) remains a major public health issue and is associated with relentless discharge from the ear, pain, significant functional limitation of hearing, leading to communication problems and frequent specialist visits.

Aims

To assess the improvement in quality of life of patients of COM (safe type) and surgical success in terms of graft uptake and improvement in hearing.

Patients and Methods

A prospective questionnaire-based outcome study was directed in 100 patients with COM who were treated with Type I Tympanoplasty at our institution between May 2018 and May 2020. All patients were asked to fill Modified Chronic Otitis Media 4 (COM-4) survey before operation and 3 months after operation. Preoperative and postoperative total ear scores, audiological results, postoperative graft uptake were assessed.

Results

The correlation between preoperative and postoperative assessment by questionnaire was statistically critical (P < 0.001). There was significant improvement in hearing postoperatively (P < 0.001). Effective graft uptake was seen in 80%.

Conclusion

The current study emphasizes that Type 1 Tympanoplasty fundamentally improves quality of life of patients in terms of physical suffering, hearing loss, emotional distress postoperatively.

Comparative efficacy and safety of acetaminophen, topical and oral non-steroidal anti-inflammatory drugs for knee osteoarthritis: evidence from a network meta-analysis of randomized controlled trials and real-world data

OBJECTIVE

Current global guidelines regarding the first-line analgesics (acetaminophen, topical or oral non-steroidal anti-inflammatory drugs [NSAIDs]) for knee osteoarthritis remain controversial and their comparative risk-benefit profiles have yet to be adequately assessed.

DESIGN

Pubmed, Embase, Cochrane Library, and Web of Science were searched from database inception to March 2021 for randomized controlled trials (RCTs) comparing acetaminophen, topical NSAIDs and oral NSAIDs directly or indirectly in knee osteoarthritis. Bayesian network meta-analyses were conducted. A propensity-score matched cohort study was also conducted among patients with knee osteoarthritis in The Health Improvement Network database.

RESULTS

122 RCTs (47,113 participants) were networked. Topical NSAIDs were superior to acetaminophen (standardized mean difference [SMD] = -0.29, 95% credible interval [CrI]: -0.52 to -0.06) and not statistically different from oral NSAIDs (SMD = 0.03, 95% CrI: -0.16 to 0.22) for function. It had lower risk of gastrointestinal adverse effects (AEs) than acetaminophen (risk ratio [RR] = 0.52, 95%CrI: 0.35 to 0.76) and oral NSAIDs (RR = 0.46, 95%CrI: 0.34 to 0.61) in RCTs. In real-world data, topical NSAIDs showed lower risks of all-cause mortality (hazard ratio [HR] = 0.59, 95% confidence interval [CI]: 0.52 to 0.68), cardiovascular diseases (HR = 0.73, 95%CI: 0.63 to 0.85) and gastrointestinal bleeding (HR = 0.53, 95%CI: 0.41 to 0.69) than acetaminophen during the one-year follow-up (n = 22,158 participants/group). A better safety profile was also observed for topical than oral NSAIDs (n = 14,218 participants/group).

CONCLUSIONS

Topical NSAIDs are more effective than acetaminophen but not oral NSAIDs for function improvement in people with knee osteoarthritis. Topical NSAIDs are safer than acetaminophen or oral NSAIDs in trials and real-world data.

Synovitis and bone marrow lesions associate with symptoms and radiographic progression in hand osteoarthritis: a systematic review and meta-analysis of observational studies

AIMS

To systematically review observational studies for the association between features detected on ultrasound (US) and magnetic resonance imaging (MRI) and, symptoms, signs and radiographic progression of hand osteoarthritis (OA).

METHODS

Medline, Web of Science, EMBASE, CINAHL and AMED were searched from inception to 14^th January 2020 to identify relevant studies. Quality of studies was assessed using the Newcastle-Ottawa scales and data were extracted. Odds ratios (OR) and linear regression coefficients and 95% confidence intervals (CI) were pooled using the random-effects model (METAN package, Stata v16.1). Heterogeneity and publication bias were assessed.

RESULTS

Thirty-two studies using US and MRI comprising 1,350 and 638 participants respectively were included. While only grey-scale synovitis (GSS) associated with AUSCAN-pain (pooled Regression coefficient (95% CI): 0.46 (0.13-0.79); 0-20 scale for AUSCAN-pain), US-detected osteophytes, GSS and power Doppler (PD) [pooled ORs (95% CI): 2.68(2.16-3.33), 2.38(1.74-3.26) and 2.04 (1.45-2.88)] as well as MRI-detected bone marrow lesions (BMLs), synovitis, osteophytes, and central bone erosions (CBEs) associated with joint tenderness [pooled ORs (95% CI): 2.59(2.12-3.18), 2.17(1.85-2.54), 2.15(1.55-2.99), and 2.41 (1.45-4.02)] respectively. US-detected GSS and PD associated with radiographic progression of CBEs [pooled ORs 5.37, 5.08], osteophytes [pooled ORs 5.17, 6.45], and joint space narrowing (pooled ORs 4.28, 4.36) whilst MRI-detected synovitis and BMLs associated with increasing KL grades with pooled ORs 2.92, 2.54 respectively.

CONCLUSIONS

US and MRI-detected structural and inflammatory changes associate with tenderness, whilst articular inflammation and subchondral bone damage associate with radiographic hand OA progression. There was inconsistent relationship between these changes and pain.

Neurovascular Dysregulation During Exercise in Type 2 Diabetes

Emerging evidence suggests that type 2 diabetes (T2D) may impair the ability to properly adjust the circulation during exercise with augmented blood pressure (BP) and an attenuated contracting skeletal muscle blood flow (BF) response being reported. This review provides a brief overview of the current understanding of these altered exercise responses in T2D and the potential underlying mechanisms, with an emphasis on the sympathetic nervous system and its regulation during exercise. The research presented support augmented sympathetic activation, heightened BP, reduced skeletal muscle BF, and impairment in the ability to attenuate sympathetically mediated vasoconstriction (i.e., functional sympatholysis) as potential drivers of neurovascular dysregulation during exercise in T2D. Furthermore, emerging evidence supporting a contribution of the exercise pressor reflex and central command is discussed along with proposed future directions for studies in this important area of research.

Bio-therapeutics from human milk: prospects and perspectives

Human milk is elixir for neonates and is a rich source of nutrients and beneficial microbiota required for infant growth and development. Its benefits prompted research into probing the milk components and their use as prophylactic or therapeutic agents. Culture-independent estimation of milk microbiome and high-resolution identification of milk components provide information, but a holistic purview of these research domains is lacking. Here, we review the current research on bio-therapeutic components of milk and simplified future directions for its efficient usage. Publicly available databases such as PubMed and Google scholar were searched for keywords such as probiotics and prebiotics related to human milk, microbiome and milk oligosaccharides. This was further manually curated for inclusion and exclusion criteria relevant to human milk and clinical efficacy. The literature was classified into subgroups and then discussed in detail to facilitate understanding. Although milk research is still in infancy, it is clear that human milk has many functions including protection of infants by passive immunization through secreted antibodies, and transfer of immune regulators, cytokines and bioactive peptides. Unbiased estimates show that the human milk carries a complex community of microbiota which serves as the initial inoculum for establishment of infant gut. Our search effectively screened for evidence that shows that milk also harbours many types of prebiotics such as human milk oligosaccharides which encourage growth of beneficial probiotics. The milk also trains the naive immune system of the infant by supplying immune cells and stimulatory factors, thereby strengthening mucosal and systemic immune system. Our systematic review would improve understanding of human milk and the inherent complexity and diversity of human milk. The interrelated functional role of human milk components especially the oligosaccharides and microbiome has been discussed which plays important role in human health.

Attenuated Rapid-Onset Vasodilation to Forearm Muscle Contraction in Black Men

PURPOSE

Non-Hispanic Black individuals have a blunted ability to vasodilate at rest compared with other racial groups. Limited studies have investigated blood flow responses to exercise in Black individuals. Recently, our laboratory demonstrated that Black men exhibit attenuated increases in forearm vascular conductance (FVC) during steady-state rhythmic handgrip. The mechanisms for this remain unknown. Herein, we used single muscle contractions, a modality that allows for assessment of rapid-onset vasodilation (ROV) independent of major elevations in shear stress, tissue metabolism, and systemic hemodynamics.

METHODS

Ten young, healthy Black and White men performed single forearm contractions at 20%, 40%, and 60% maximal voluntary contraction (MVC). In addition, cuff inflations were performed on the forearm to examine the contribution of mechanical compression to ROV. Forearm blood flow (FBF; duplex Doppler ultrasound), heart rate (ECG), and mean arterial pressure (Finometer) were continuously measured. FVC was calculated as FBF/mean arterial pressure.

RESULTS

Baseline FVC (White men vs Black men, 0.75 ± 0.11 vs 0.80 ± 0.09 mL·min-1·mm Hg-1; P = 0.73), FBF, and MVCs (White men vs Black men, 54 ± 2 vs 54 ± 2 kg; P = 0.95) were similar between the groups. After single contractions, both groups exhibited intensity-dependent FVC and FBF increases during ROV; however, these responses were attenuated in the Black group at all intensities (e.g., 60%MVC FVC: White men vs Black men, +371% ± 37% vs +220% ± 23% baseline; P = 0.001). FVC and FBF responses to cuff inflation alone were also attenuated in Black individuals (P < 0.001).

CONCLUSIONS

Collectively, these data indicate that Black men have an overall blunted ability to rapidly vasodilate compared with young White men.

Ventricular contraction and relaxation rates during muscle metaboreflex activation in heart failure: are they coupled?

NEW FINDINGS

What is the central question of this study? Does the muscle metaboreflex affect the ratio of left ventricular contraction/relaxation rates and does heart failure impact this relationship. What is the main finding and its importance? The effect of muscle metaboreflex activation on the ventricular relaxation rate was significantly attenuated in heart failure. Heart failure attenuates the exercise and muscle metaboreflex-induced changes in the contraction/relaxation ratio. In heart failure, the reduced ability to raise cardiac output during muscle metaboreflex activation may not solely be due to attenuation of ventricular contraction but also alterations in ventricular relaxation and diastolic function.

ABSTRACT

The relationship between contraction and relaxation rates of the left ventricle varies with exercise. In in vitro models, this ratio was shown to be relatively unaltered by changes in sarcomere length, frequency of stimulation, and β-adrenergic stimulation. We investigated whether the ratio of contraction to relaxation rate is maintained in the whole heart during exercise and muscle metaboreflex activation and whether heart failure alters these relationships. We observed that in healthy subjects the ratio of contraction to relaxation increases from rest to exercise as a result of a higher increase in contraction relative to relaxation. During muscle metaboreflex activation the ratio of contraction to relaxation is significantly reduced towards 1.0 due to a large increase in relaxation rate matching contraction rate. In heart failure, contraction and relaxation rates are significantly reduced, and increases during exercise are attenuated. A significant increase in the ratio was observed from rest to exercise although baseline ratio values were significantly reduced close to 1.0 when compared to healthy subjects. There was no significant change observed between exercise and muscle metaboreflex activation nor was the ratio during muscle metaboreflex activation significantly different between heart failure and control. We conclude that heart failure reduces the muscle metaboreflex gain and contraction and relaxation rates. Furthermore, we observed that the ratio of the contraction and relaxation rates during muscle metaboreflex activation is not significantly different between control and heart failure, but significant changes in the ratio in healthy subjects due to increased relaxation rate were abolished in heart failure.

Olfactory and taste dysfunction in coronavirus disease 2019 patients: its prevalence and outcomes

OBJECTIVES

To evaluate the occurrence, clinical course and outcomes of olfactory and gustatory dysfunction in patients with laboratory confirmed coronavirus disease 2019 infection.

METHODS

This is a prospective cross-sectional study of patients diagnosed with coronavirus disease 2019 infection by reverse transcription polymerase chain reaction over two months. The epidemiological and clinical outcomes studied were: age, sex, general symptoms, and olfactory and taste dysfunction.

RESULTS

A total of 410 coronavirus disease 2019 infected patients were included in the study, with 262 males (63.9 per cent) and 148 females (36.1 per cent). Ninety-nine patients (24.1 per cent) reported chemosensory dysfunction, of which 85 patients (20.7 per cent) reported both olfactory and taste dysfunction. Olfactory and taste dysfunction were proportionally more common in females. The mean duration of olfactory and taste dysfunction was 4.9 days, with a range of 2-15 days.

CONCLUSION

Olfactory and taste dysfunction are prevalent symptoms in coronavirus disease 2019 patients. In this study, they were more common in females than males. The occurrence of such dysfunctions is lower in the Indian population than in the European population.

Klotho gene polymorphism in renal stone formers from Northwestern India

Klotho gene is an important gene involved in calcium homeostasis, and polymorphisms of this gene may render the individual prone to renal stone formation. We evaluated G395A single nucleotide polymorphisms (SNPs) of Klotho gene at rs1207568 in renal stone patients of North India. This was a prospective study involving 150 patients of renal stone disease (aged 15-60 years) and 100 age- and sex-matched controls. The DNA was isolated and subjected to polymerase chain reaction (PCR) for identifying the G395A Klotho SNPs at rs1207568. Confronting two pair primers were used, and gel electrophoresis showing two bands at 175,252 bp was considered as GG genotype, three bands at 121,175 and 252 bp as GA and two bands at 121 and 252 bp as AA genotype. The association between genotype and cases was evaluated by using Chi-square test and logistic regression analysis. Cases and controls were well matched for age (40.65 vs 42.06, p = 0.063) and sex (p = 0.420). Significantly high proportion of patients with renal stones had GG genotype as compared to controls (odds ratio (OR) 2.37(1.39,4.03), p = 0.001). None of the participants (cases and controls) had homozygous recessive AA genotype. The risk of stone formation was significantly higher in the population carrying G allele {OR 1.94 (1.225-3.073), p 0.004}. Mean serum calcium was higher in stone formers with GG genotype as compared to those with GA genotype (9.16 mg/dl vs 8.91 mg/dl; p = 0.06). GG genotype of G396A Klotho gene SNPs is associated with renal stone formation. The G allele carrier is twice at risk of renal stone formation. The absence of AA genotype in north-western Indian population remains a curiosity.

Gastrointestinal stress as innate defence against microbial attack

The human gastrointestinal (GI) tract has been bestowed with the most difficult task of protecting the underlying biological compartments from the resident commensal flora and the potential pathogens in transit through the GI tract. It has a unique environment in which several defence tactics are at play while maintaining homeostasis and health. The GI tract shows myriad number of environmental extremes, which includes pH variations, anaerobic conditions, nutrient limitations, elevated osmolarity etc., which puts a check to colonization and growth of nonfriendly microbial strains. The GI tract acts as a highly selective barrier/platform for ingested food and is the primary playground for balance between the resident and uninvited organisms. This review focuses on antimicrobial defense mechanisms of different sections of human GI tract. In addition, the protective mechanisms used by microbes to combat the human GI defence systems are also discussed. The ability to survive this innate defence mechanism determines the capability of probiotic or pathogen strains to confer health benefits or induce clinical events respectively.

Functional sympatholysis is preserved in healthy young Black men during rhythmic handgrip exercise

Black men have attenuated increases in forearm vascular conductance (FVC) and forearm blood flow (FBF) during moderate- and high-intensity rhythmic handgrip exercise compared with White men, but the underlying mechanisms are unclear. Here, we tested for the first time the hypothesis that functional sympatholysis (i.e., attenuation of sympathetic vasoconstriction in the exercising muscles) is impaired in Black men compared with White men. Thirteen White and 14 Black healthy young men were studied. FBF (duplex Doppler ultrasound) and mean arterial pressure (MAP; Finometer) were measured at rest and during rhythmic handgrip exercise at 30% maximal voluntary contraction. FVC was calculated as FBF/MAP. Sympathetic activation was induced via lower body negative pressure (LBNP) at -20 Torr for 2 min at rest and from the 3rd to the 5th min of handgrip. Sympathetic vasoconstriction was assessed as percent reductions in FVC during LBNP. The groups presented similar resting FVC, FBF, and MAP. During LBNP at rest, reductions in FVC were not different between White (-35 ± 10%) and Black men (-32 ± 14%, P = 0.616), indicating similar reflex-induced sympathetic vasoconstriction. During handgrip exercise, there were minimal reductions in FVC with LBNP in either group (White: -1 ± 7%; Black: +1 ± 8%; P = 0.523), indicating functional sympatholysis in both groups. Thus, contrary to our hypothesis, our findings indicate a preserved functional sympatholysis in healthy young Black men compared with White men, suggesting that this mechanism does not appear to contribute to reduced exercise hyperemia during moderate-intensity rhythmic handgrip in this population.

OP0066 IMAGING-DETECTED FEATURES OF HAND OSTEOARTHRITIS ASSOCIATE WITH SYMPTOMS AND RADIOGRAPHIC CHANGE OVER TIME: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OBSERVATIONAL STUDIES

Background:

Osteoarthritis (OA) commonly affects joints in the hand. The natural history of hand OA is not well understood, and the local determinants of symptoms and structural changes over time remain unclear.

Objectives:

To investigate, in both cross-sectional and prospective studies, the association between imaging (ultrasound [US] and magnetic resonance imaging [MRI]) features and symptoms of hand OA, and to examine in prospective studies whether imaging-detected features at baseline predict subsequent clinical and radiographic outcomes.

Methods:

A systematic literature search was conducted in five databases including Medline, Web of Science, EMBASE, CINAHL and AMED in April 2018. The search was designed to capture published observational studies on the use of US and MRI in hand OA with no language restrictions. Odds ratios (OR), risk ratios (RR), and 95% confidence interval (CI) between [1] imaging features and hand OA symptoms at baseline, and [2] baseline-imaging features and follow-up outcomes were extracted and pooled using random effects model. Outcomes were defined as either incidence or progression of pre-existing features. Risk of bias assessment was performed using the Newcastle-Ottawa Scales. Heterogeneity and publication bias were assessed.

Results:

The search identified 2818 citations, which reduced to 2216 after duplicate removal. Screening of titles and abstracts found 140 articles which met the inclusion criteria. After full text screening, 25 were included for analysis, including 452 participants (87% women) for US and 298 participants (86% women) for MRI with mean ages 60.3 and 62.5, respectively. Imaging-detected structural OA features were preferentially found in distal interphalangeal joints (DIPJs) followed by carpometacarpal (CMCJ) and proximal interphalangeal (PIPJ) joints. Metacarpophalangeal joints were least affected. However, the distribution pattern was different for inflammatory features for which the CMCJ was the most affected, and with no clear difference between DIPJs and PIPJs (Figure 1).

Figure 1.

Hand map of grey-scale synovitis derived from pooled estimates of prevalence across studies (%[95% CI])

Of 10 US and 5 MRI studies examining association at baseline, joint tenderness was associated with US osteophytes (pooled ORs 2.30, 95% CI 1.90-2.79), grey-scale synovitis (3.00, 2.33-3.84), synovial effusion (2.92, 2.29-3.72), and power Doppler (PD) (2.30, 1.68-3.15). Similar relationships were observed with MRI features (Figure 2). Six studies did not find any association between imaging features and self-reported outcomes. However, association was observed with US- and MRI-detected synovitis in one study each, and MRI-detected structural features in two. Statistical pooling was not possible for these outcomes due to heterogeneous data.

Figure 2.

Forest plot showing pooled odds ratio between baseline magnetic resonance imaging features of hand osteoarthritis and joint tenderness.

Of the 9 US and 5 MRI studies for prediction, a dose-dependent relationship was observed between baseline PD and radiographic change at follow-up (Figure 3). Similar results were observed for MRI features and Kellgren-Lawrence change. The pooled ORs (95% CI) was 2.66 (1.88, 3.78) for bone marrow lesions, and 2.18 (1.53, 3.10) and 4.7 (3.08, 7.18) for grades 1 and 2 synovitis, respectively. Data to predict change in clinical outcomes however, were lacking.

Figure 3.

Forest plot showing pooled odds ratio between baseline power Doppler and radiographic change over time

Conclusion:

Imaging-detected inflammatory features and osteophytes associate with joint tenderness. In addition, imaging-detected inflammatory changes at baseline predict future development and progression of structural OA changes, indicating that inflammation may precede radiographically-detectable structural changes.

Disclosure of Interests:

Abasiama Obotiba: None declared, Subhashisa Swain: None declared, Jaspreet Kaur: None declared, Khalid Yaseen: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium, Abhishek Abhishek Grant/research support from: AstraZeneca and OxfordImmunotech, Speakers bureau: Menarini pharmaceuticals

THU0461 THE COMPARATIVE EFFICACY OF NON-PHARMACOLOGICAL INTERVENTIONS FOR FIBROMYALGIA: A SYSTEMATIC REVIEW WITH BAYESIAN NETWORK META-ANALYSIS

Background:

Non-pharmacological interventions are recommended as first-line treatment options in the management of fibromyalgia (FM)1. However, whether one intervention is more effective than another for specific patient-centred outcomes in FM is unknown.

Objectives:

To compare the relative efficacy of non-pharmacological interventions on FM impact questionnaire (FIQ), pain, fatigue, sleep and depression in people with FM.

Methods:

A Bayesian network meta-analysis was conducted. Randomised controlled trials (RCTs) assessing any non-pharmacological intervention versus usual care, placebo or active controls in patients with FM aged >16 years were searched for in seven databases. A common comparator was identified between interventions to develop a network (Figure 1). Standardised mean difference (SMD) and 95% credible interval (CrI) was estimated between interventions. Direct and indirect evidence were pooled using the random effect model. Modified Cochrane‘s tool was used to assess risk of bias.

Figure 1.

Network map of different interventions evaluating FIQ

Results:

78 studies (n = 5,639 participants) met the inclusion criteria. There was a high risk of bias on blinding and most trials had small sample size (n<50).

While multidisciplinary treatment (MDT) was the best for improving pain [-1.28 (-1.84, -0.72)], sleep [-1.14 (-2.38, 0.07)] and depression [-1.20 (-1.99, -0.46)], balneotherapy and exercise were the most effective treatments for FIQ [-1.06 (1.51, -0.61)] and fatigue [-0.75 (-1.35, -0.25)], respectively (Figure 2).

Figure 2.

Standardised mean difference (SMD) versus usual care in descending order for different outcomes

Data from 47 exercise trials (n = 3,271 participants) were analysed to examine comparative efficacy of different exercise types. Strengthening showed the greatest benefits for FIQ [-0.76 (-1.39, -0.15)], pain [-0.94 (-1.58, -0.29)] and depression [-0.83 (-1.53, -0.14)], whereas aerobic exercise was the best for fatigue [-0.98 (-2.33, 0.18)] and sleep [-0.96 (-2.08, 0.13)] (Table 1).

Table 1.

Relative effect size between types of exercises

FIQAerobic-0.58(-1.13, -0.03)-0.09(-0.55, 0.36)0.18(-0.44, 0.80)0.12(-0.36, 0.57)-0.57(-0.95, -0.24)-0.60(-1.36, 0.18)Flexibility0.49(-0.23, 1.20)0.76(-0.07, 1.58)0.70(-0.04, 1.41)0.004(-0.67, 0.64)-0.10(-0.74, 0.53)0.49(-0.50, 1.49)Mind-body0.27(-0.37, 0.91)0.20(-0.24, 0.65)-0.49(-0.85, -0.15)0.05(-0.59, 0.70)0.65(-0.35, 1.63)0.16(-0.53, 0.85)Mixed-0.06(-0.73, 0.59)-0.69(-1.06, -0.34)0.21(-0.42, 0.84)0.80(-0.19, 1.79)0.31(-0.41, 1.02)-0.06(-0.73, 0.59)Strengthening-0.76(-1.39, -0.15)-0.73(-1.16, -0.30)-0.13(-1.02, 0.74)-0.62(-1.15, -0.11)-0.78(-1.31, -0.26)-0.94(-1.58, -0.29)Usual carePain

Data are standard mean difference (95% credible intervel) between exercises, pairwised from the top left to the bottom right. The negative value indicates that the first exercise is more effective than the second exercise. For example, aerobic is better than flexibility for FIQ -0.58 (-1.13, -0.13), but not pain -0.60 (-1.36, 0.18).

Conclusion:

Several non-pharmacological interventions are beneficial for FM. However, the effect size varies between interventions and outcomes. All types of exercises are effective for FIQ and pain apart from flexibility exercise. The results of this study may be used to guide the selection of the most effective non-pharmacological interventions according to the predominant symptom in individual patients.

References:

[1]Macfarlane GJ et al. Ann Rheum Dis 2017;76(2):3-8-28.

Disclosure of Interests: :

None declared

Augmented resting beat-to-beat blood pressure variability in young, healthy, non-Hispanic black men

NEW FINDINGS

What is the central question of this study? The prevalence of hypertension in black individuals exceeds that in other racial groups. Despite this well-known heightened risk, the underlying contributory factors remain incompletely understood. We hypothesized that young black men would exhibit augmented beat-to-beat blood pressure variability compared with white men and that black men would exhibit augmented total peripheral resistance variability. What is the main finding and its importance? We demonstrate that young, healthy black men exhibit greater resting beat-to-beat blood pressure variability compared with their white counterparts, which is accompanied by greater variability in total peripheral resistance. These swings in blood pressure over time might contribute to the enhanced cardiovascular risk profile in black individuals.

ABSTRACT

The prevalence of hypertension in black (BL) individuals exceeds that in other racial groups. Recently, resting beat-to-beat blood pressure (BP) variability has been shown to predict cardiovascular risk and detect target organ damage better than ambulatory BP monitoring. Given the heightened risk in BL individuals, we hypothesized young BL men would exhibit augmented beat-to-beat BP variability compared with white (WH) men. Furthermore, given studies reporting reduced vasodilatation and augmented vasoconstriction in BL individuals, we hypothesized that BL men would exhibit augmented variability in total peripheral resistance (TPR). In 45 normotensive men (24 BL), beat-to-beat BP (Finometer) was measured during 10-20 min of quiet rest. Cardiac output and TPR were estimated (Modelflow method). Despite similar resting BP, BL men exhibited greater BP standard deviation (e.g. systolic BP SD; BL, 7.1 ± 2.2 mmHg; WH, 5.4 ± 1.5 mmHg; P = 0.006) compared with WH men, which was accompanied by a greater TPR SD (P = 0.003), but not cardiac output SD (P = 0.390). Other traditional measures of variability provided similar results. Histogram analysis indicated that BL men exhibited a greater percentage of cardiac cycles with BPs higher (> +10 mmHg higher) and lower (< -8 mmHg lower) than mean systolic BP compared with WH men (interaction, P < 0.001), which was accompanied by a greater percentage of cardiac cycles with high/low TPR (P < 0.001). In a subset of subjects (n = 30), reduced sympathetic baroreflex sensitivity was associated with augmented BP variability (r = -0.638, P < 0.001), whereas cardiac baroreflex sensitivity had no relationship (P = 0.447). Herein, we document an augmented beat-to-beat BP variability in young BL men, which coincided with fluctuations in vascular resistance and reduced sympathetic BRS.

Muscle metaboreflex-induced increases in effective arterial elastance: effect of heart failure

Dynamic exercise elicits robust increases in sympathetic activity in part due to muscle metaboreflex activation (MMA), a pressor response triggered by activation of skeletal muscle afferents. MMA during dynamic exercise increases arterial pressure by increasing cardiac output via increases in heart rate, ventricular contractility, and central blood volume mobilization. In heart failure, ventricular function is compromised, and MMA elicits peripheral vasoconstriction. Ventricular-vascular coupling reflects the efficiency of energy transfer from the left ventricle to the systemic circulation and is calculated as the ratio of effective arterial elastance (E_a) to left ventricular maximal elastance (E_max). The effect of MMA on E_a in normal subjects is unknown. Furthermore, whether muscle metaboreflex control of E_a is altered in heart failure has not been investigated. We utilized two previously published methods of evaluating E_a [end-systolic pressure/stroke volume (E_aPV)] and [heart rate × vascular resistance (E_aZ)] during rest, mild treadmill exercise, and MMA (induced via partial reductions in hindlimb blood flow imposed during exercise) in chronically instrumented conscious canines before and after induction of heart failure via rapid ventricular pacing. In healthy animals, MMA elicits significant increases in effective arterial elastance and stroke work that likely maintains ventricular-vascular coupling. In heart failure, E_a is high, and MMA-induced increases are exaggerated, which further exacerbates the already uncoupled ventricular-vascular relationship, which likely contributes to the impaired ability to raise stroke work and cardiac output during exercise in heart failure.

An endophytic Penicillium oxalicum isolated from Citrus limon possesses antioxidant and genoprotective potential

AIMS

This study aimed at isolating endophytic fungi from Citrus limon (L.) possessing antioxidative and genoprotective potential.

METHODS AND RESULTS

Endophytic fungi were screened for antioxidant activity using 2,2-diphenyl,1-picryl hydrazyl radical scavenging assay and maximum activity (79·70%) was exhibited by culture MP1 identified to be Penicillium oxalicum on the basis of morphological and molecular characteristics. The ethyl acetate extract of MP1 was subjected to silica column chromatography followed by LH 20 column chromatography for purification of active metabolites. The partially purified active fraction of P. oxalicum MP1 possessed good antioxidant activity as detected using various assays. It also exhibited a strong DNA damage protection potential on pUC19 plasmid DNA treated with Fenton reagent. On exposure to active fraction of MP1 significant reduction (P < 0·05) in nuclear deformities (like nuclear buds, micronuclei, nuclear ridges and binucleated cells) was observed in human lymphocytes pretreated with a toxic concentration of H₂ O₂ . In vivo genoprotectivity studies were conducted in fresh water fish Channa punctatus pretreated with a damaging compound 4-nonyl phenol. The active fraction of P. oxalicum MP1 caused a reduction of 94·7 and 66·60% in micronuclei and aberrant cell formation, respectively. A significant reduction (P < 0·05) in tail length and tail DNA parameters was also observed in comet assay.

CONCLUSION

The endophytic P. oxalicum isolated in this study has the potential to produce metabolites possessing antioxidant and genoprotective activities.

SIGNIFICANCE AND IMPACT OF THE STUDY

The isolated culture can be exploited in the field of therapeutics by virtue of its in vitro and in vivo genoprotective potential.

Muscle pump-induced inhibition of sympathetic vasomotor outflow during low-intensity leg cycling is attenuated by muscle metaboreflex activation

Muscle sympathetic nerve activity (MSNA) decreases during leg cycling at low intensity because of muscle pump-induced increases in venous return and loading of the cardiopulmonary baroreceptors. However, MSNA increases during leg cycling when exercise is above moderate intensity or for a long duration, suggesting that the sympathoinhibitory effect of the cardiopulmonary baroreflex can be overridden by a powerful sympathoexcitatory drive, such as the skeletal muscle metaboreflex. Therefore, we tested the hypothesis that high-intensity muscle metaboreflex activation attenuates muscle pump-induced inhibition of MSNA during leg cycling. MSNA (left radial nerve) was recorded during graded isolation of the muscle metaboreflex in the forearm with postexercise ischemia (PEI) after low (PEI-L)- and high (PEI-H)-intensity isometric handgrip exercise (20% and 40% maximum voluntary contraction, respectively). Leg cycling (15–20 W) was performed alone and during each PEI trial (PEI-L+Cycling, PEI-H+Cycling). Cycling alone induced a significant decrease in MSNA burst frequency (BF) and total activity (TA). MSNA BF and TA also decreased when cycling was performed during PEI-L. However, the magnitude of decrease in MSNA during PEI-L+Cycling [∆BF: –19 ± 2% ( P < 0.001), ∆TA: –25 ± 4% ( P < 0.001); mean ± SE] was less than that during cycling alone [∆BF: –39 ± 5% ( P = 0.003), ∆TA: –45 ± 5% ( P = 0.002)]. More importantly, MSNA did not decrease during cycling with PEI-H [∆BF: –1 ± 2% ( P = 0.845), ∆TA: +2 ± 3% ( P = 0.959)]. These results suggest that muscle pump-induced inhibition of sympathetic vasomotor outflow during low-intensity leg cycling is attenuated by muscle metaboreflex activation in an intensity-dependent manner.

NEW & NOTEWORTHY There are no available data concerning the interaction between the sympathoinhibitory effect of muscle pump-induced cardiopulmonary baroreflex loading during leg cycling and the sympathoexcitatory influence of the muscle metaboreflex. In this study, muscle metaboreflex activation attenuated the inhibition of muscle sympathetic nerve activity (MSNA) during leg cycling. This may explain, in part, the response of MSNA to graded-intensity dynamic exercise in which low-intensity leg cycling inhibits MSNA whereas high-intensity exercise elicits graded sympathoexcitation.