The combined intervention of neuromuscular electrical stimulation and nutrition therapy: A scoping review.

BACKGROUND & AIMS: Neuromuscular electrical stimulation (NMES) is a safe and appropriate complement to voluntary resistance training for muscle weakness. However, its feasibility and effectiveness in combination with nutritional therapy remains unclear. This scoping review aimed to summarize the evidence on combined interventions for individuals with or at risk of sarcopenia for guiding future relevant research. METHODS: A systematic electronic search was conducted using the following databases and registry: MEDLINE, CINAHL, Web of Science, PEDro, and ClinicalTrials. gov. Two independent reviewers summarized the characteristics, effectiveness, and feasibility of the combined intervention and the risk of bias in the literature. RESULTS: Nine RCTs and four non-RCTs involving 802 participants were eligible. A diverse group of participants were included: older adults with sarcopenic obesity, patients in intensive care, and patients with cancer. Evidence-based interventions combining NMES and nutritional therapy were tailored to each patient's underlying disease. Although most studies were of low to moderate quality, it can be suggested that combined interventions may be feasible and effective for increasing skeletal muscle mass. CONCLUSION: This scoping review demonstrates the potential of combined interventions as a new sarcopenia treatment strategy and highlights the need to examine the effects in high-quality RCTs with larger sample sizes.

Contribution of IL-33 to induction and augmentation of experimental allergic conjunctivitis.

IL-33, a member of the IL-1 family of cytokines, is the ligand for ST2 (IL-33Ralpha chain). IL-33 has the capacity to induce T(h)2 cytokine production from T(h)2 cells, mast cells and basophils, indicating that IL-33 has the potential to induce T(h)2 cytokine-mediated allergic inflammation of the eye. Thus, we tested the pathological role of IL-33 in allergic conjunctivitis (AC). As reported elsewhere, animals immunized with ragweed pollen (RW)/alum and boosted with RW/PBS developed AC promptly (within 15 min) and conjunctival eosinophilic inflammation after a delay (within 24 h) in response to eye drop challenge with RW. Furthermore, RW-immunized mice, when topically challenged with both RW and IL-33, developed more striking eosinophilia in their conjunctiva without exacerbation of the clinical AC score. This in vivo IL-33 treatment significantly increased the capacity of T cells in the cervical lymph nodes of RW-immunized mice to produce IL-4, IL-5 and IL-13 upon challenge with anti-CD3 and anti-CD28 antibodies in vitro. Furthermore, the infiltrating cells were largely eosinophils and a small proportion of CD4(+) T cells, both of which express ST2. We also found that even splenic eosinophils express ST2 and show increased expression in response to IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF) or IL-33. Eosinophils, stimulated with IL-5 and/or GM-CSF, are responsive to IL-33, which induces production of IL-4 and chemokines. Finally, we showed that conjunctival tissues constitutively express biologically active IL-33, suggesting that IL-33 might play a crucial role in the induction and augmentation of AC.

Conjunctival and corneal calcification and bone metabolism in hemodialysis patients.

Conjunctival and corneal calcification is well recognized as a metastatic calcification in patients undergoing hemodialysis. In 44 male hemodialysis patients, we examined the relationship between the severity of conjunctival and corneal calcification and age; duration of hemodialysis; serum levels of calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), and osteocalcin; and bone mineral density (BMD). The mean age was 58.3 years (range, 33-79 yr), and the mean duration of hemodialysis was 94.3 months (range, 25-258 mo). The serum level of Ca was 9.6 +/- 0.1 mg/dL, P was 5.9 +/- 0.1 mg/dL, Ca x P was 57.5 +/- 1.2, iPTH was 204.0 +/- 34.6 pg/mL, ALP was 173.8 +/- 11.8 U/L, and osteocalcin was 62.8 +/- 9.5 ng/mL. Lumbar BMD was 0.997 +/- 0.022 g/cm2 and radial BMD was 0.642 +/- 0.015 g/cm2. There was a significant positive correlation between the severity of conjunctival and corneal calcification and the duration of hemodialysis (P < 0.0001), the serum levels of P (P = 0.0035), the Ca x P (P = 0.0034), the iPTH (P = 0.0154), the ALP (P < 0.0001), and the osteocalcin (P = 0.0010), and was negatively correlated with radial BMD (P = 0.0008). However, the severity of conjunctival and corneal calcification was not significantly correlated with age (P = 0.986), serum Ca levels (P = 0.138), or lumbar BMD (P = 0.449). Based on these findings, we suggest that the conjunctival and corneal calcification developed by excessive serum levels of Ca and P associated with abnormal bone and mineral metabolism. This resulted in an increased bone turnover and decreased BDM after prolonged hemodialysis even though efforts were made to maintain the homeostasis of Ca and P metabolism in hemodialysis patients by using various therapeutic approaches.