Physical activity and amyloid beta in middle-aged and older adults:A systematic review and meta-analysis

Background:One of the pathological hallmarks distinguishing Alzheimer’s disease from other dementias is the accumulation of amyloid beta(Aβ).Higher physical activity is associated with decreased dementia risk,and one potential path could be through Aβlevels modulation.We aimed to explore the relationship between physical activity and Aβin middle-aged and older adults.Methods:A systematic search of PubMed,Web of Science,PsycINFO,Cochrane Central Register of Controlled Trials,and SPORTDiscus was performed from inception to April 28,2022.Studies were eligible if they included physical activity and Aβdata in adults aged 45 years or older.Multi-level metaanalyses of intervention and observational studies were performed to examine the role of physical activity in modulating Aβlevels.Results:In total,37 articles were included(8 randomized controlled trials,3 non-randomized controlled trials,4 prospective longitudinal studies,and 22 cross-sectional studies).The overall effect size of physical activity interventions on changes in blood Aβwas medium(pooled standardized mean difference=-0.69,95%confidence interval(95%CI):-1.41 to 0.03;I^(2)=74.6%).However,these results were not statistically significant,and there were not enough studies to explore the effects of physical activity on cerebrospinal fluid(CSF)and brain Aβ.Data from observational studies were examined based on measurements of Aβin the brain using positron emission tomography scans,CSF,and blood.Higher physical activity was positively associated with Aβonly in the CSF(Estimate r=0.12;95%CI:0.05-0.18;I^(2)=38.00%).Conclusion:Physical activity might moderately reduce blood Aβin middle-aged and older adults.However,results were only near statistical significance and might be interpreted with caution given the methodological limitations observed in some of the included studies.In observational studies,higher levels of physical activity were positively associated with Aβonly in CSF.Therefore,further research is needed to understand the modulating role of physical activity in the brain,CSF,and blood Aβ,as well as its implication for cognitive health.

Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach

Physical rehabilitation of lung transplant candidates and recipients plays an important in optimizing physical function prior to transplant and facilitating recovery of function post-transplant. As medical and surgical interventions in lung transplantation have evolved over time, there has been a demographic shift of individuals undergoing lung transplantation including older individuals, those with multiple co-morbidites, and candidates with respiratory failure requiring bridging to transplantation. These changes have an impact on the rehabilitation needs of lung transplant candidates and recipients. This review provides a practical approach to rehabilitation based on research and clinical practice at our transplant centre. It focuses on functional assessment and exercise prescription during an uncomplicated and complicated clinical course in the pre-transplant, early and late post-transplant periods. The target audience includes clinicians involved in pre- and posttransplant patient care and rehabilitation researchers.

Executive functioning in TBI from rehabilitation to social reintegration: COMPASS^(goal), a randomized controlled trial(grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013–2016)

Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.

Prazosin:a potential new management tool for iatrogenic autonomic dysreflexia in individuals with spinal cord injury?

Spinal cord injury （SCI） is a devastating condition that not only results in a loss of motor functions but also severe autonomic dysfunctions （Krassioukov and Claydon, 2006）. Autonomic dysreflexia （AD） is a life threatening episode of tran- sient hypertension that occurs up to 30x/day （1 Ix/day on average） in those with cervical or high thoracic SCI （Hubli et al., 2015）. Most common triggers of AD are from stimuli such as a full bowel and/or bladder, or sexual arousal （Teasell et al., 2000）. Penile vibrostimulation （PVS） is a clinical pro- cedure for sperm retrieval used for the purpose of family planning or fertility assessment that unfortunately iatrogenically induces episodes of AD （Elliott, 2006）. Recently, we published a clinical trial highlighting that prazosin may be a viable option for treating AD secondary to PVS （Phillips et al., 2014）.

Application of PCR-SSCP in detecting rpoB drug resistant gene polymorphism of M. tuberculosis L-form from pneumoconiosis patients with tuberculosis

Objective: To study the relationship between the polymorphism of drug resistant gene rpoB and drug resistance against rifampicin(RFP) of M. tuberculosis L-forms, and to evaluate its clinical application. Methods: A total of 52 clinical isolated strains of M. tuberculosis L-forms were collected. rpoB gene polymorphism was analyzed by polymerase chain reaction and single-strand conformation polymorphism (PCR-SSCP) and conventional antimicrobial susceptibility test (AST). Their results were compared. Results: AST results showed that 38 of 52 clinical isolated strains were drug resistance (73.08％),while PCR-SSCP indicated 65.38％ (32/52) rpoB gene polymorphism. There was no statistic significance(χ2= 2.4914) between the 2 methods. Conclusion:Combined the application of PCR-SSCP with AST in detecting rpoB drug resistant gene polymorphism of M. tuberculosis L-form from pneumoconiosis patients with tuberculosis may have advantages at earlier diagnosis and guidance of clinical medications.

Intervention for reducing stigma: Assessing the influence of gender and knowledge

AIM: To evaluate the effectiveness in reducing social stigma of an intervention and to assess the influence of gender and knowledge.METHODS: The program consisted in providing information and contact with users of mental health in order to reduce social stigma in the school environment. A total of 62 secondary school students(age 14-16 years) were evaluated with the Opinions on Mental Illness(OMI) questionnaire before and after the intervention. The subscales of the OMI were: authoritarianism, interpersonal etiology, benevolence, restrictiveness and negativism. The analysis was performed over the total sample, separating by gender and knowledge of someone with a mental disorder. t-test for repeated measures was used in the statistical analysis.RESULTS: All the OMI subscales showed a significant change after the intervention(P < 0.001), except for benevolence. Women presented significant changes in the subscales of authoritarianism and restrictiveness, while men presented changes in negativism and interpersonal etiology rather than restrictiveness(P < 0.001-0.003). Students that knew someone with a mental disorder presented significant changes in authoritarianism, interpersonal etiology, and negativism(P < 0.001-0.003) and students that do not know anyone with a mental disorder improved in restrictiveness and authoritarianism(P < 0.001-0.001). In all the subscales of the instrument the students improved their perception of mental disorders, reducing their levels of stigma.CONCLUSION: The intervention designed to reduce social stigma was effective, especially in the area of authoritarianism. The whole sample showed improved attitudes towards mental illness, although the areas were different depending on gender and knowledge.

The Effects of Exercise on Serum Chemistry, Non-Esterified Fatty Acid, Insulin and Glucagon Dynamics during a 400 Meter Sprint in Racing Greyhounds

The effects of Greyhound racing on plasma insulin, glucagon and non-esterified fatty acid have not been extensively studied. We sought to examine the effects of exercise in 19 greyhounds trialed over 400 meters on serum biochemistry, osmolality, nonessential fatty acids, and the major glucoregulatory hormones insulin and glucagon, before and after racing. Due to the non-traditional dietary patterns of many racing Greyhounds, the diet was analyzed for macro and micro-nutrient assessment to determine adequacy of the diet. Many significant biochemical changes were observed and agreed with previous studies, except for low resting glucose, low post-exercise globulin and phosphorus concentrations, and a high CK both before and after exercise. Insulin concentrations increased 10 minutes post-exercise which might be a result of the rise in serum glucose observed. Non-esterified fatty acids decreased 10 minutes post-exercise, as a likely result of the insulin facilitated cellular uptake of fatty acids early in recovery. Glucagon concentrations did not change after exercise despite the rise in insulin. The diet analysis found some mineral deficiencies in sodium, selenium, iodine and copper;and contained a far higher protein and fat content, being atypical of diets that have been shown to improve the performance in racing Greyhounds.

The Effectiveness of Diamel in the Treatment of Type 2 Diabetic Patients Receiving Insulin Therapy: A Randomized, Controlled Clinical Trial

Aims/Introduction: Effectiveness of Diamel? on the biochemical variables: fasting blood glucose, postprandial glucose, cholesterol, triglycerides, and glycosylated haemoglobin [HbA1c] in type-2 diabetic patients receiving insulin terapy. Diamel is a natural product composed of trace elements: amino acids, vitamins, cranberry extract, and lettuce extract that have been activated by means of a magnetization process. Materials and methods: Randomized, doubleblind, comparator-controlled clinical trial. A central randomization centre used computer generated tables to allocate treatments. 116 patients suffering from type-2 diabetes mellitus treated with insulin at the Diabetes Care Centre in Pinar del Rio (Cuba), were recruited and randomly. The subjects were separated into two groups: Group A (n = 59), who were administered Diamel and Group B (n = 57) using placebo. The clinical and biochemical variables were assessed for 24 weeks. Results: Two subjects were excluded from the Diamel treatment group during the clinical trial. From the statistical point of view, a significant drop in the levels of the baseline glucose, postprandial glucose, glycated haemoglobin, and triglycerides was observed in the group taking Diamel (Group A). There was observed an increase in insulin requirements and in waist circumference in the subjects of Group B There was not reported any severe or serious adverse reactions during this clinical trial. Conclusion: Diamel (nutritional supplement) together with the administration of insulin in type-2 diabetic patients is useful to optimize the biochemical variables (baseline and postprandial glucose, Hb A1C, plus triglycerides), as well as to prevent the increase of insulin requirements at medium-term.

Post-Concussion Syndrome after a Mild Traumatic Brain Injury: A Minefield for Clinical Practice

In this clinical practice review, the controversies and difficulties managing post concussion symptoms following mild traumatic brain injury are discussed. Based on considerable clinical experience in a designated Concussion Clinic, the authors (a neuropsychologist, a psychiatrist, and a neurologist) review relevant literature and issues for clinical practice, particularly with respect to understanding risk factors for and vulnerability to, development of chronic post-concussion symptoms. We contend it is not just the kind of head that matters but also the kind of complications, the kind of outcomes and the kind of management that can influence injury recovery. Given these complexities, a bio-psychosocial conceptualization of chronic post-concussion syndrome is appropriate. Though understanding is still elusive, management should not be biased by physiogenic or psychogenic aetiological theories for management needs to address patient reported outcomes regardless of underpinning aetiology.

Results of Ponseti Method in the Management of the Congenital Clubfoot

Background: Clubfoot is a debilitating pathology and a source of abnormal gait in children. Treatment with the Ponseti method is the treatment used in the management of congenital clubfoot in children under 9 years old. This study aims to identify the proportion of children with clubfoot supported by the Ponseti method and to evaluate their effectiveness. Materials and Method: A multicenter retrospective descriptive study for six (06) months from June 1st to November 30th, 2019 concerning the evaluation of the Ponseti method in the management of clubfoot in Madagascar was conducted. Results: One hundred ninety-one (191) children with club feet were screened during the study period. One hundred and fifty children, or 226 congenital equine varus clubfoot were treated with the Ponseti method during the study period. The male gender was the most affected compared to the female gender with a sex ratio of 1.75. The clubfoot was bilateral in 50.66% of cases and idiopathic in 92.66%. The initial Pirani score was on average (±SD) 5.04/4.98 (±1.22/1.20). A proportion of 23.33% of cases of recurrence was recorded at 3 months of use of brace abduction splint. Conclusion: In Madagascar, the incidence of congenital clubfoot remains relatively low but clubfoot is still the main limitation of walking and a lack of footwear in children. Ponseti method is the gold standard in the management of this pathology. However, it requires a long-term follow-up.

Altered Expression in Patients with Heart Failure of Circulating MicroRNAs Related to Lipoprotein Metabolism

Objective： This study aimed to investigate, for the first time, the expression of circulating miRNAs （microRNAs） related to lipoprotein metabolism in patients with HF （heart failure）. Medlods： Twenty patients with HF and 10 controls without HF were included. BNP （brain natxiuretic peptide）, a marker of HF severity, plasma lipid parameters and the expression of circulating miRNAs were determined. Key findings： Total, LDL-, non-HDL- and HDL-cholesterol, txiglycerides, and apo A-I did not differ between both groups, but apo B was lower in the HF group compared to controls （p = 0.007）. In respect to miRNAs, miR-33a, miR-144, miR-125, miR-30c, miR-122, miR-26a, miR-185, miR-758 and miR-106b were higher, from ten- to 25-fold, and miR-10b was lower about 4-fold, in HF group compared to controls. In HF patients a negative correlation between miR-26a and BNP, the marker of disease severity, was found （r = -0.552; p = 0.041）. Conclusions： Plasma levels of miRNAs involved in HDL and LDL metabolism regulation were strikingly changed in HF patients. The negative correlation between miR-26a and BNP values may suggest the possibility of the rise of a novel biomarker or therapeutic target in HF.

Effectiveness of a Short Duration Training Programme in the Physical Fitness of Patients with High-Moderate Risk of Cardiovascular Disease

Introduction: It is not known what the minimum duration of training programme is effective in primary prevention of cardiovascular disease. The objective of this study is to determine the effectiveness in physical fitness and exercise of the training programme of 8 weeks of duration with two modalities (2 or 3 sessions per week) in subjects with moderate-high risk of cardiovascular disease in a primary care setting. Main Findings: A significant increase in the six-minute walk test was observed (from 488 ± 87.4 m to 532 ± 68.0 m, p < 0.0001). A significant increase of exercise duration (from 11.4 ± 3.0 min to 12.3 ± 3.0 min, p < 0.0001) and a delay in the anaerobic threshold (from 8.8 ± 2.9 min to 10.1 ± 2.5 min, p < 0.0001) during the ergometric tests were also observed. The proportion of patients exercising regularly increased significantly (from 36.1% to 83.3%, p < 0.0001). Both modalities of training programme improved fitness and physical activity, without significant differences between them. Conclusion: Our study shows that a structured training programme of two months of duration with 2 or 3 sessions per week significantly improves the fitness and physical activity of patients with moderate-high risk of cardiovascular disease.

Epidemiological data on acupuncture and physical and rehabilitation medicine in the European Union

OBJETIVE: To know the prevalence of acupuncturists within physical and rehabilitation medicine specialists in Europe and their characteristics,as well as to analyze the pathologies treated and therapeutic techniques used.METHODS: This is a cross-sectional descriptive study based on a structured and closed questionnaire. The study was carried out from October 2011 to May 2014.RESULTS: A total of 115 specialists from 19 countries completed the questionnaire. The mean characteristics of the physical and rehabilitation medicine(PRM) specialists who are also acupuncturists in Europe were: women(62.6 %); mean age of47.91 years old; 4.20 years of physical and rehabilitation medicine school and 2.00 years of acupuncture training; 15.03 years of mean time of clinical practice as physical and rehabilitation medicine specialists and 10.42 years of experience as acupuncturists; 35.65 % had a doctorate(Ph D) degree,obtained at a mean age of 33.55 years old; working in a public hospital(80%); treating mainly neurological conditions(48.1%) and using mainly techniques such as kinesiotherapy(11.81%),orthosis(10.40%) and electrotherapy(9.92%). Acupuncture was applied by 32.2% of the participants mainly in musculoskeletal conditions(27.38%). A mean number of more than 20 patients a day were treated by47.04% of the specialists,being 41.8% of the patients(adults and children). Significant differences were found between the variables,acupuncture and gender(Pearson's correlation Index = 0.007).However,no differences were observed in relation to acupuncture and age,doctorate degree,years of clinical practice and workplace(all with P values >0.05).CONCLUSION: In the European area,physical and rehabilitation medicine specialists who are also acupuncturists are mainly female,middle-aged,with15 years of professional experience,Ph D holders,working in public hospitals,treating mainly neurological conditions with kinesiotherapy and acupuncture,and treating over 20 patients a day(adults and children) during a 7 h shift. Further epidemiological studies on PRM to provide more information regarding the real situation of this medical specialty and the possibility to open to Chinese traditional medicine techniques such as acupuncture are necessary.

Case studies of Chinese acupuncture's comprehensive effectiveness on knee pain

Conventional Western medicine（CWM） and traditional Chinese medicine（TCM） have different approaches and lead to different practices in experimental design, research methodology, regulation, and standards. TCM emphasizes on the optimal or holistic health. In contrast, CWM is an allopathic medicine primarily based on anatomy, biology, biochemistry,molecular biology and modern technology, and rejects the concept of invisible substances and quantum entanglement.Consequently, CWM emphasizes on abnormal lab tests or obvious diseases. In the early 1970 s, TCM and acupuncture quickly emerged as an alternative to CWM as Westerners explored new TCM concepts while questioning the side effects of CWM. Many countries accept traditional acupuncture as a legal alternative medical practice. Some CWM physicians nowadays are more enthusiastic and are receptive to learning and practicing acupuncture. The common goal of CWM and TCM is to enhance human health, but problems arise over differences in approach. As a response to some Western journal papers that failed to validate the real acupuncture effect because of their incorrect methodologies and their ignorance of the holistic acupuncture approaches, the authors hereby present a group of case studies to demonstrate the real and unique effects of genuine acupuncture. The objective was to explore the clinical effects of acupuncture for knee pain.Thirty-six patients with knee pain were divided into five groups based on age. Holistic TCM diagnosis was performed at the beginning of each case and then made a personalized acupuncture treatment prescription according to the root of illness found by the diagnosis. The symptoms and signs were recorded before and after every treatment, and the treatment effects were assessed based upon the self-reported feeling and the observed changes of the patient following the numeric rating scale（NRS）. The results were summarized after the completion of the minimal 5 acupuncture treatments or the standard 10 acupuncture treatments. Among the 36 patients who participated in the cases studies, 17 patients reported a complete healing for knee pain（47.2%）. About 60 kinds of illness other than knee pain were improved（98.9%） and the complete healing rate was about 44.2%. This leads to the conclusion that TCM acupuncture is remarkably effective in treating knee pain. TCM and CWM share a common goal in promoting the health of human being. The efficacy of TCM acupuncture in treating knee pain shouldn＇t be denied or distorted.

Comparison of cognitive and UHDRS measures in monitoring disease progression in Huntington’s disease: a 12-month longitudinal study

Progressive cognitive decline is a feature of Huntington’s disease(HD),an inherited neurodegenerative movement disorder.Comprehensive neuropsychological testing is the‘gold standard’to establish cognitive status but is often impractical in time-constrained clinics.The study evaluated the utility of brief cognitive tests(MMSE and MoCA),UHDRS measures and a comprehensive neuropsychological tests battery in monitoring short-term disease progression in HD.Twenty-two manifest HD patients and 22 matched controls were assessed at baseline and 12-month.A linear mixed-effect model showed that although the HD group had minimal change in overall global cognition after 12 months,they did show a significant decline relative to the control group.The controls exhibited a practice effect in most of the cognitive domain scores over time.Cognitive decline at 12-month in HD was found in the executive function domain but the effect of this on global cognitive score was masked by the improvement in their language domain score.The varying practice effects by cognitive domain with repeated testing indicates the importance of comparing HD patients to control group in research trials and that cognitive progression over 12 months in HD should not be judged by changes in global cognitive score.The three brief cognitive tests effectively described cognition of HD patients on cross-sectional analysis.The UHDRS cognitive component,which focuses on testing executive function and had low variance over time,is a more reliable brief substitute for comprehensive neuropsychological testing than MMSE and MoCA in monitoring cognitive changes in HD patients after 12 months.

Diurnal changes in postural control in normal children: Computerized static and dynamic assessments

Mild traumatic brain injury (mTBI) causes postural control deficits and accordingly comparison of aberrant postural control against normal postural control may help diagnose mTBI. However, in the current literature, little is known regarding the normal pattern of postural control in young children. This study was therefore conducted as an effort to fill this knowledge gap. Eight normal school-aged children participated. Posture assessment was conducted before (7-8 a.m. in the morning) and after (4-7 p.m. in the after-noon) school on regular school days using the Balance Master? evaluation system composed of 3 static tests and 2 dynamic balance tests. A significant difference in the weight-bearing squats was detected between morning hours and afternoon hours (P < 0.05). By end of afternoon, the body weight was borne mainly on the left side with the knee fully extended and at various degrees of knee flexion. A significantly better directional control of the lateral rhythmic weight shifts was observed at the end of the afternoon than at morning hours (P < 0.05). In summary, most of our findings are inconsistent with results from previous studies in adults, sug-gesting age-related differences in posture control in humans. On a regular school day, the capacity of postural control and laterality or medio-lateral balance in children varies between morning and afternoon hours. We suggest that posturographic assessment in children, either in normal (e.g., physical education and sports training) or in abnormal conditions (e.g., mTBI-associated balance disorders), be better performed late in the afternoon.