Feasibility and Acceptability of Mindfulness-based Stress Reduction and Prenatal Sleep Classes for Poor Prenatal Sleep Quality: Pilot Randomized Controlled Trial.

OBJECTIVES: The main objectives of the current paper were to examine the feasibility, acceptability, and adherence of a remotely delivered intervention consisting of mindfulness-based stress reduction plus prenatal sleep classes (MBSR+PS) compared with treatment as usual (TAU). METHOD: In this pilot randomized controlled trial, 52 pregnant women with poor sleep quality were randomized to MBSR+PS or TAU. MBSR was delivered through eight weekly 2.5-hour sessions, and PS was delivered through eight weekly 30-minute sessions. PS content drew material from cognitive behavioral therapy for insomnia tailored for the perinatal period and from a mindfulness- and acceptance-based lens. Participants completed endpoint measures 10-12 weeks after randomization. RESULTS: We surpassed all acceptability targets, including the percentage of eligible participants willing to be randomized (96%), percentage of participants who initiated treatment (88%), and satisfaction scores (Client Satisfaction Questionnaire-8 score M = 28.04, SD = 3.6). We surpassed all feasibility targets, including our enrollment target, retention rate (92%), and measure completion (96%). Finally, we surpassed adherence targets, including MBSR and PS session attendance (≥80%). Though sleep outcomes were exploratory, increases in sleep efficiency were greater in the MBSR+PS group relative to TAU (SMD=.68). CONCLUSIONS: Patient-reported poor sleep quality during pregnancy has high public health significance because it is common, consequential, and under-treated. The current feasibility and acceptability data for using remotely delivered MBSR and PS to improve prenatal sleep quality are encouraging and warranting future research that is sufficiently powered and designed to provide efficacy data. In addition, exploratory sleep outcomes offer preliminary evidence that this sleep program may improve sleep efficiency during pregnancy.

A novel analytical description of periodic volume coil geometries in MRI.

MRI volume coils can be represented by equivalent lumped element circuits and for a variety of these circuit configurations analytical design equations have been presented. The unification of several volume coil topologies results in a two-dimensional gridded equivalent lumped element circuit which compromises the birdcage resonator, its multiple endring derivative but also novel structures like the capacitive coupled ring resonator. The theory section analyzes a general two-dimensional circuit by noting that its current distribution can be decomposed into a longitudinal and an azimuthal dependency. This can be exploited to compare the current distribution with a transfer function of filter circuits along one direction. The resonances of the transfer function coincide with the resonance of the volume resonator and the simple analytical solution can be used as a design equation. The proposed framework is verified experimentally against a novel capacitive coupled ring structure which was derived from the general circuit formulation and is proven to exhibit a dominant homogeneous mode. In conclusion, a unified analytical framework is presented that allows determining the resonance frequency of any volume resonator that can be represented by a two dimensional meshed equivalent circuit.

Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a case-control study.

OBJECTIVE: The aim of this study was to determine whether a relationship exists between the use of nonsteroidal antiinflammatory drugs (NSAIDs) and exacerbation or onset of inflammatory bowel disease (IBD). METHODS: Sixty consecutive IBD patients admitted to the hospital were carefully interviewed to ascertain whether they used NSAIDs and the relationship in time and duration to the exacerbation (or onset) of the IBD; 62 patients with irritable bowel syndrome were similarly interviewed and served as controls. RESULTS: In 31% of our IBD population there was a correlation between use of NSAIDs and IBD activity, whereas in only 2% of the irritable bowel syndrome population who used NSAIDs did this relationship exist. CONCLUSIONS: NSAIDs provoke disease activity in both ulcerative colitis and Crohn's disease and should be avoided in patients with a history of IBD whenever possible.

Intravenous corticotrophin vs. hydrocortisone in the treatment of hospitalized patients with Crohn's disease: a randomized double-blind study and follow-up.

Adrenocorticotrophic hormone (ACTH) and corticosteroids have no maintenance values for inflammatory bowel disease but serve to reduce the severity of disease. The effectiveness of intravenous corticotrophin versus hydrocortisone in ulcerative colitis has been determined including whether previous steroid therapy influenced the better response to one rather than the other, but no such studies have ever been done in Crohn's disease. Eighty-eight patients hospitalized with moderate-to-severe Crohn's disease (Present-Korelitz [P-K] Index -3 to -2 and the International Organisation for the Study of Inflammatory Bowel Disease-Crohn's & Colitis Foundation of America [IOIBD-CCFA] Index, mean 14, range 5-23) were treated in a prospective, randomized, double-blind clinical trial to receive either continuous intravenous infusion of 120 U/day of ACTH (44 patients) or hydrocortisone 300 mg/day (44 patients). Patients were also subdivided into those who received oral steroids during the 30 days prior to intravenous therapy and those who had not. Response was followed on a daily basis and tabulated at 3, 5, and 10 days. Patients were followed from 1-3 years to determine the later status. After 10 days of intravenous therapy 36 of 44 patients (82%) who received ACTH and 41 of 44 patients (93%) who received hydrocortisone fully responded (P-K index +3 and IOIBD-CCFA Index mean of 3). At the end of the study, response to intravenous ACTH and hydrocortisone was not statistically different whether or not patients received oral steroids during the 30 days prior to admission, although the response to IV ACTH tended to be faster at 3 days in those who had received previous steroid therapy. Intravenous ACTH and hydrocortisone are equally effective in achieving therapeutic goals in patients with Crohn's disease who have not achieved results with oral medications. Moreover the response rate was high (mean 88%), serving to buy time for establishment of successful maintenance programs of treatment with oral 5-ASA and immunosuppressive drugs for 69% of patients at 1-3 years.

Nutritional practices of elite female surfers during training and competition.

The aim of this study was to assess the dietary practices of 10 elite female surfers. Four- and five-day food diaries completed over competition and training periods demonstrated energy intakes (mean +/- SD) of 9,468 kJ (+/- 2,007) and 8,397 kJ (+/- 1,831), respectively. This level of energy intake was less than that estimated for the requirements of surfing. Female surfers' carbohydrate intakes failed to meet the recommendations, and suboptimal zinc intake was observed with 90% of subjects not meeting the Australian RDI. Comparisons between competition and training demonstrated that carbohydrate (g and g/kg body weight) and confectionary (g) intakes were significantly higher (p < .05) and protein intake was significantly lower (p < .05) during competition. These results show that although body fat stores were not compromised (mean 22%), self-reported energy, carbohydrate, and nutrient intakes were marginal in elite female surfers. Questionnaires revealed that 90% of surfers did not have good nutritional habits while traveling, which was compounded by a lack of knowledge of nutritional practices.

Nitric oxide inhibition of transforming growth factor-beta and collagen synthesis in mesangial cells.

Culture of mesangial cells (MCs) in 5.6 vs. 30.0 mmol/l glucose for 3 weeks induced a sustained increase in protein kinase C (PKC) activity, transforming growth factor (TGF)-beta1 mRNA, bioactive TGF-beta, and collagen synthesis. Nitric oxide (NO), generated exogenously by the NO donor S-nitroso-N-acetyl, D,L-penicillamine (SNAP) or endogenously after the exposure of MC to interleukin-1beta (IL-1beta), suppressed bioactive TGF-beta in MCs cultured in 5.6 or 30.0 mmol/l glucose and suppressed or abolished increases in TGF-beta1 mRNA and collagen synthesis induced by high concentrations of glucose or phorbol 12,13-dibutyrate without altering values obtained with normal glucose concentrations. SNAP had a transient suppressive effect on PKC activity, which may explain at least in part some of the actions of SNAP. The selective inhibitor of PKC, bisindolylmaleimide (GFX), mimicked NO action. The ability of SNAP and IL-1beta to suppress TGF-beta and collagen synthesis was not mediated by cGMP, since the cGMP analog, 8-Br-PET-cGMP, did not mimic NO action and an antagonist of cGMP-dependent protein kinase, Rp-8-pCPT-cGMPs, did not prevent the inhibitory actions of SNAP. N-omega-L-arginine methyl ester (NMMA) increased TGF-beta in glomerular capillary endothelial cells (GCECs) and stimulated collagen synthesis by MC in a co-culture with GCECs. Captopril inhibited TGF-beta and collagen synthesis and increased cGMP in co-cultures of GCECs and MCs. These effects of captopril were abolished by NMMA, implying mediation by NO. Thus, endogenous NO produced by GCECs may modulate TGF-beta production by both GCECs and MCs and act to suppress matrix protein synthesis by MCs.

The safety of corticosteroid therapy in Crohn's disease with an abdominal mass.

Steroid therapy is often avoided in the Crohn's disease patient with a palpable abdominal mass, for fear of dissemination of infection, should the mass prove to contain an abscess. In the present study, 24 patients with Crohn's disease and a palpable abdominal mass were treated with high dose steroids. In 15, the mass resolved completely and, in another nine, it decreased in size by at least 50%. Fourteen of 24 patients eventually required resection for persistence or recurrence of Crohn's disease activity with or without the abdominal mass, but in all the operation was performed electively. At least eight patients never required resection during a mean follow-up period of 40 months. In 13 patients, the mass was later proved to actually contain an abscess cavity. No complications attributable to steroid therapy were seen in either the operative or nonoperative group. Clinicians should not fear using high dose ACTH/corticosteroids to treat severe Crohn's disease with an abdominal mass, if indicated, as it is both safe and effective whether an abscess cavity is present or not.