The effect of a nurse-led low carbohydrate regimen on anthropometric and laboratory parameters of patients with metabolic syndrome: a quasi-experimental study.

Introduction: Metabolic syndrome is a global health concern. It is a condition that includes a cluster of various risk factors for type 2 diabetes and cardiovascular disease. This quasi-experimental study investigates the effect of a nurse-led low-carbohydrate regimen on anthropometric and laboratory parameters in metabolic syndrome patients. Methods: The study used a quasi-experimental design conducted at the University of Mosul; 128 participants meeting the metabolic syndrome criteria were recruited and divided into the intervention and control groups. The intervention group received personalized counseling and support in implementing a low-carb regime, while the control group received standard advice. The study participants were assessed by anthropometry, and laboratory parameters were evaluated pre- and post-intervention. Statistical data analysis was conducted using IBM-SPSS 27, including chi-square, Fisher's exact test, t-tests, and the Mcnemar test, which were performed to compare the changes within and between groups. Results: The mean age of the participants in the intervention and control groups was 50.72 ± 6.43 years and 49.14 ± 6.89 years, respectively. Compared to the control group, the intervention group experienced a significant positive reduction in anthropometric measures and laboratory parameters, including weight, body mass index (BMI), waist circumference, lipid profiles, and HbA1c. Conclusion: A tangible effect of nurse-led interventions based on low-carbohydrate regimens in managing metabolic syndrome was empirically authenticated. Positive changes were observed in the intervention group regarding anthropometric measures and laboratory parameters. However, future research may require a larger sample size and a longer follow-up to confirm these effects and evaluate long-term metabolic impacts.

RANDOMIZED EXPERIMENTAL STUDY OF TOPICAL VASODILATORS IN MICROSURGERY WITH COST ANALYSIS.

Objective: Throughout microsurgical anastomosis, many surgeons use topical vasodilators in order to reduce pathological vasospasm. It was carried out an experimental study comparing the effectiveness of topical use of Nitroglycerin, Papaverine, Magnesium sulfate over a control group in the femoral artery and vein of rats, in reducing prolonged vasospasm. Methods: Randomized comparative experimental study in 15 rats, divided into four groups. The external diameter of the vases soaked in the randomized solution was measured. For statistical analysis, it was calculated the percentual increase in the external diameter of the vessels. Results: A statistically significant increase in arterial dilation was observed after 10 minutes of topical application of 10% magnesium sulfate compared to the control group, with p = 0.044 . No other drug showed a vasodilator effect superior to the control group. Magnesium sulfate at 10% is still not used in microsurgery and costs 15 times less than papaverine, the standard drug for topical vasodilation in clinical cases at our service. Conclusion: Magnesium sulfate had better vasodilating effects over the control group after 10 minutes of arterial microanastomosis. None of the tested drugs have presented superior vasodilating effects over each other nor the control group after venous microanastomosis. Level of evidence II, Experimental study, Randomized Trial.

Objetivo: Durante a anastomose microcirúrgica, muitos cirurgiões utilizam vasodilatadores tópicos para reduzir o vasoespasmo prolongado patológico, assim reduzindo o risco de complicações vasculares. Entretanto, ainda faltam dados experimentais para identificação da droga padrão-ouro para vasodilatadores tópicos em microcirurgia e sua avaliação de análise de custo, já que a droga geralmente utilizada para este objetivo é baseada, na maior parte dos casos, na experiência do cirurgião. Métodos: Foi realizado um estudo experimental comparativo randomizado, avaliando a eficácia do uso tópico de Nitroglicerina, Papaverina e Sulfato de Magnésio em relação a um grupo controle, na redução do vasoespasmo na artéria e veia femoral de ratos. Foram avaliados o diâmetro externo dos vasos embebidos em solução randomizada dos fármacos para vasodilatação. Após cálculo do aumento percentual no diâmetro externo dos vasos, foi realizada análise estatística. Resultados: Observou-se aumento estatisticamente significativo da dilatação arterial após 10 minutos de aplicação tópica de sulfato de magnésio a 10% em relação ao grupo controle, com p = 0,044. Nenhuma outra droga apresentou efeito vasodilatador superior ao grupo controle. O sulfato de magnésio a 10% ainda não é utilizado em microcirurgia e apresenta custo até 15 vezes menor quando comparado com a papaverina, droga padrão para vasodilatação tópica em casos clínicos em nosso serviço. Conclusão: O sulfato de magnésio apresentou melhor efeito vasodilatador quando comparado ao grupo controle, após 10 minutos da microanastomose arterial. Nenhum dos fármacos testados apresentou efeito vasodilatador superior após a microanastomose venosa. Nível de Evidência II, Estudo experimental, Ensaio Randomizado.

Effects of levcromakalim in patients with migraine aura without headache: An experimental study.

BACKGROUND/HYPOTHESIS: Levcromakalim has previously been shown to induce attacks of migraine with aura in certain individuals. In this study, we tested the migraine-inducing effect of levcromakalim in a cohort of participants with migraine aura without headache. METHODS: In a double-blind, randomized, placebo-controlled cross-over study, eight adult participants with migraine with aura received intravenous infusions of levcromakalim and saline. Headache, aura and associated symptoms were evaluated for 24 h following administration of the study drug. The primary endpoint was occurrence of migraine-like attacks with or without aura in the 24-h observation period. RESULTS: Five participants (62.5%) developed migraine of any type following levcromakalim compared with three participants (37.5%) following placebo. No participants developed aura following levcromakalim. CONCLUSION/INTERPRETATION: Our findings suggest that the aura-inducing effect of levcromakalim is likely not based on direct induction of cortical spreading depression but may involve activation of the trigeminovascular system. This hypothesis should be further explored in future studies. CLINICALTRIALS.GOV IDENTIFIER: NCT04905654.

An experimental study of the sensorized strain wave gear RT1-T and its capabilities for torque control in robotic joints.

The idea of sensorizing a strain wave gear to measure the transmitted torque has been reported since the 1980s. The strain in the elastic flex spline is typically measured by strain gages attached to it. The resulting voltages relate to the transmitted torque in the gear. However, periodic inaccuracies in the measured torque signal (sensing ripple), resulting from positioning inaccuracies of strain gages on the flex spline, prevented this technology from being used outside a lab environment. Regardless of these difficulties, measuring the torque directly in the strain wave gear would bring many advantages, especially in robotic applications, where design space is highly limited. Traditionally, robotic joints are equipped with link-sided torque sensors, which reduce the available design volume, lower the joint stiffness, and require complex cable routing. This paper presents an experimental study of a novel sensorized strain wave gear named RT1-T, which was developed by Schaeffler Technologies. The study was implemented on a joint testbed, including a high-resolution reference torque sensor at the link side. In addition to the measurement accuracy and linearity, a torque ripple analysis is performed. The joint torque control capabilities are determined along dynamic trajectories and compared to the performance achieved with a link-sided reference sensor. The sensor employed in the testbed has a static torque error of 0.42 Nm and an average closed-loop torque control error of 0.65 Nm above the reference sensor.

Effectiveness of Ankle Proprioceptive Neuromuscular Facilitation Techniques in Restoring the Biomechanical Integrity of the Ankle Following Plantar Fasciitis: An Experimental Study.

Background Recent studies have highlighted the role of the central nervous system in modulating pain perception and the movement patterns associated with plantar fasciitis. Neurological changes, such as altered sensorimotor control and cortical reorganization, may contribute to the persistence of symptoms and the recurrence of the condition. Integrating neurorehabilitation techniques may enhance outcomes and reduce the risk of recurrence. Physiotherapy exercises such as ankle proprioceptive neuromuscular facilitation, foot doming exercises, balance exercises, towel curl exercises, and stretching exercises were given to check the impact of physiotherapy interventions on ankle muscle instability and dynamic balance following plantar fasciitis. Method An experimental investigation was carried out at the outpatient department of Acharya Vinoba Bhave Rural Hospital. A total of 71 participants were assigned arbitrarily, employing a straightforward random sampling procedure. Each participant received treatment for six weeks, with five weekly sessions. Result The results demonstrated significant findings. The pre- and post-test score results are as follows: visual analogue scale scores (t=1.619, p=0.0001), weight-bearing lunge test scores (t=24.36, p=0.0001*), and functional reach test scores (t=24.36, p=0.0001). Conclusion We conclude that physiotherapy exercises such as ankle proprioceptive neuromuscular facilitation (PNF), foot doming exercises, strengthening exercises, toe spreading exercises, towel curl exercises, and stretching exercises are effective in reducing pain and ascertaining dynamic balance in plantar fasciitis. The rehabilitation program significantly improved ankle biomechanical integrity and muscle strength, allowed functional recovery, and reduced pain. Future studies should focus on investigating the long-term effects of PNF therapies. For better patient outcomes, clinicians should consider incorporating ankle PNF exercises into their therapy regimens.

Short-term learning effect of ChatGPT on pharmacy students' learning.

Introduction: Students in pharmacy are positive towards integrating artificial intelligence and ChatGPT into their practice. The aim of this study was to investigate the direct short-term learning effect of using Chat GPT by pharmacy students. Methods: This was an experimental randomized study. Students were allocated into two groups; the intervention group (n = 15) used all study tools and ChatGPT, while the control group (n = 16) used all study tools, except ChatGPT. Differences between groups was measured by how well they performed on a knowledge test before and after a short study period. Results: No significant difference was found between the intervention and control groups in level of competence in the pretest score (p = 0.28). There was also no significant effect of using ChatGPT, with a mean adjusted difference of 0.5 points on a 12-point scale. However there was a trend towards a higher proportion of ChatGPT participants having a large (at least four point) increase in score (4 out of 15) vs control group (1 out of 16). Conclusion: There is a potential for positive effects of ChatGPT on learning outcomes in pharmacy students, however the current study was underpowered to measure a statistically significant effect of ChatGPT on short term learning.

Supermarket Opening in an Urban, Low-Income Community Was Not Found to be Associated With Improvements in Dietary Outcomes for Most Residents in the First Year.

BACKGROUND: Limited access to healthy foods in low-income, minority communities has been proposed as a critical factor contributing to health disparities. One policy option for improving access is to introduce supermarkets in low-income communities, but evidence increasingly points to null effects. OBJECTIVE: The aim of this study was to examine whether the introduction of a new supermarket in a public housing community, and proximity to it, were associated with improvements in residents' dietary outcomes. It also explores whether these associations may be moderated by access and cost barriers to eating healthy at baseline. DESIGN: A cohort of public housing residents was recruited from Jordan Downs, where the new supermarket was introduced, and from two comparison sites. Longitudinal data on outcomes and exposures was collected at baseline (2018-2019) and follow-up (2020-2021). Quasi-experimental variation in residents' distance to the new supermarket was used to examine whether proximity to the supermarket was associated with dietary improvements. PARTICIPANTS/SETTING: Participants included 557 adult residents from three public housing sites in Watts, Los Angeles. INTERVENTION: The intervention is the opening of a new supermarket in the Jordan Downs community. The primary exposure measure is an indicator for whether residents lived in Jordan Downs versus in the comparison sites. The secondary exposure measure is residents' driving distance to the new supermarket. MAIN OUTCOME MEASURES: Self-reports of daily consumption of whole grains, dairy, fruits and vegetables, added sugar, red meat, processed meat, and overall healthiness of diet were obtained from surveys administered at baseline and follow-up. STATISTICAL ANALYSES PERFORMED: Descriptive analyses examined households' grocery shopping patterns after the new supermarket's introduction. ANCOVA linear regressions models estimated the association between residents' dietary outcomes at follow-up and the exposure measures, conditional on dietary outcomes at baseline and other covariates. RESULTS: Proximity to the new supermarket was associated with a significantly higher probability of shopping there, particularly for households that reported an access or cost barrier at baseline. Overall, there were no statistically significant or practically meaningful differences observed in dietary outcomes between Jordan Downs residents and those in comparison sites, or between residents who lived at varying distances from the supermarket. Exploratory moderation analyses suggested some meaningful dietary benefits for those who had frequent access barrier at baseline but not for those without such barrier, but there was mostly no evidence of moderation by price barrier at baseline. CONCLUSIONS: Supermarket opening in an urban, low-income, minority community was not found to be associated with improvements in dietary outcomes for most residents in the first year after its opening. Improving dietary outcomes in such communities may require a broader and nuanced approach that addresses varied barriers faced by residents.

Incompetence of Vector Capacity of Rhipicephalus bursa to Transmit Babesia aktasi following Feeding on Clinically Infected Goat with High Level of Parasitemia.

A recent molecular survey revealed a high prevalence of Babesia aktasi in indigenous goats from the Mediterranean region of Türkiye, coinciding with heavy Rhipicephalus bursa infestations. This geographical overlap has raised the possibility that R. bursa may serve as a vector for the parasite. To evaluate the potential of R. bursa to serve as a vector for the parasite, an experimental study was conducted in indigenous goats. An immune-suppressed donor goat was intravenously injected with 15 mL of the cryopreserved B. aktasi stabilate, resulting in severe clinical babesiosis and parasitemia. Subsequently, R. bursa larvae and adults derived from Babesia-free laboratory colonies were allowed to feed on the infected donor goat. After oviposition, engorged female carcasses, representative engorged nymphs, unfed larvae, and adult pools were used for DNA extraction and PCR analysis. No PCR positivity was detected in any of the DNA samples, except for those with engorged female carcasses and nymphs. Three immune-suppressed recipient goats were infested with the unfed immature and mature ticks consuming the blood of a donor infected with B. aktasi. No clinical or parasitological findings were encountered in the recipient for 40 days post-infestation. These findings indicated that R. bursa was not a competent vector for B. aktasi.

The effect of growth hormone on motor findings and dendrite morphology in an experimental Parkinson's disease model.

Approaches for the induction of neurogenesis and neuronal recovery through several modalities are gaining popularity in Parkinson's disease (PD). Growth hormone (GH) seems to have a role in the reversal of neural function following brain injury as well as in normal brain development and function; therefore, the use of GH may represent a feasible strategy in the management of PD. This experimental study aimed to evaluate the effect of growth hormone on motor function and dendrite morphology in rats with 6-hydroxydopamine (6-OHDA)-induced PD model. Thirty-six Sprague Dawley rats were included and randomly allocated into one of the six study groups: two controls and four treatment groups that received daily subcutaneous growth hormone injections for 21 days, 1, 2, and 3 months. PD model was induced through unilateral 6-OHDA injection to the nigrostriatal pathway. The following assessments were made: apomorphine rotation test, stepping test, and tissue examinations for tyrosine hydroxylase and dendrite morphology. The apomorphine rotation test and the stepping test confirmed the presence of PD. These tests as well as dendritic spine density/number and length assessments showed improvement in PD findings over time with GH administration. Findings of this study suggest that GH administration may improve dendrite morphology and motor function in the PD model, which may translate into symptom relief and quality of life improvement in patients with PD. Such potential benefits should be tested in robust clinical studies.

Experimental Study on the Detection of the Existence and Location of Mimicked and Unexpected Interface Debonding Defects in an Existing Rectangular CFST Column with PZT Materials.

Interface bonding conditions between concrete and steel materials play key roles in ensuring the composite effect and load-carrying capacity of concrete-steel composite structures such as concrete-filled steel tube (CFST) members in practice. A method using both surface wave and electromechanical impedance (EMI) measurement for detecting the existence and the location of inaccessible interface debonding defects between the concrete core and steel tube in CFST members using piezoelectric lead zirconate titanate (PZT) patches as actuators and sensors is proposed. A rectangular CFST specimen with two artificially mimicked interface debonding defects was experimentally verified using PZT patches as the actuator and sensor. By comparing the surface wave measurement of PZT sensors at different surface wave travelling paths under both a continuous sinusoidal signal and a 10-period sinusoidal windowed signal, three potential interface debonding defects are quickly identified. Furthermore, the accurate locations of the three detected potential interface debonding defects are determined with the help of EMI measurements from a number of additional PZT sensors around the three potential interface debonding defects. Finally, the accuracy of the proposed interface debonding detection method is verified with a destructive observation by removing the local steel tube at the three detected interface debonding locations. The observation results show that the three detected interface debonding defects are two mimicked interface debonding defects, and an unexpected debonding defect occurred spontaneously due to concrete shrinkage in the past one and a half years before conducting the test. Results in this study indicate that the proposed method can be an efficient and accurate approach for the detection of unknown interface debonding defects in existing CFST members.

Experimental Study of Avalanche Damage Protection Methods for Main Steel Gas Pipelines.

This paper conducted an experimental study of reduced models of a main gas pipeline for avalanche damage considering operational conditions. Two options were considered as a method of avalanche damage prevention: single steel rings at the crack edges and steel winding with a winding pitch of 0.25 m. For the tension force, 5% of the steel wire breaking force was taken, which was equal to 1 mm. The ambient environment was simulated by a climatic chamber, where two options of temperature loads were considered: +20 °C and -10 °C. It was found that reinforcement with single rings of pipeline models under conditions of positive (+20 °C) and negative (-10 °C) temperatures showed that the crack opening width in the ring direction decreased 1.63 times and 1.9 times, accordingly. The crack length (longitudinal direction) decreased 2.18 times and 2.45 times, accordingly. The reinforcement of the pipeline models with prestressed wire winding on the crack propagation under conditions of positive (+20 °C) and negative (-10 °C) temperatures showed that the width of the crack opening in the ring direction decreased 1.5 times and 1.46 times, accordingly. The crack length (longitudinal direction) decreased 1.4 times and 1.44 times accordingly, which is a positive moment in addressing the issue of the localisation and stoppage of a crack fracture in main gas pipelines. Simultaneously, the analysis of the prestressed pipelines model test results on crack fracture propagation showed that single rings are more effective, which decreased the crack opening width by 1.1 times and the crack length up to 1.5. Therefore, the experimental results obtained positively complement the available methods of crack localisation in main gas pipelines, which can be used by engineers and research communities when designing or reinforcing existing operating main steel gas pipelines.

Shear Performance Study of Sleeved Stud Connectors in Continuous Composite Girder.

In order to reveal the mechanism of sleeved stud connectors, 15 push-out specimens were designed, and static loading tests were conducted to evaluate the mechanical performance. The shear performance differences between the novel sleeved studs and conventional welded studs were compared. Referring to the experimental results, an Abaqus nonlinear finite element model was established to study the shear mechanism of sleeved stud connectors. Parametric analysis was conducted to investigate the effects of stud height, sleeve filling material, and sleeve diameter on the mechanical performance of the connectors. The experimental and finite element analysis results indicated that the ultimate shear bearing capacity and shear stiffness of the sleeved stud connectors were higher than those of ordinary welded studs, and the maximum slip was relatively small. Compared to conventional welded studs, the ultimate bearing capacity of sleeved studs increased by 4% to 8%, and the shear stiffness increased by 25% to 35%. Since the shear behavior of sleeved studs mainly occurred at the base of the studs, the influence of stud height on shear performance was relatively small. However, sleeve and stud diameter have a great influence on bearing capacity and stiffness. As the Ultra-High Performance Concrete (UHPC) near the base of the stud effectively enhanced the shear carrying capacity of the sleeved stud connectors, the shear carrying capacity and shear stiffness increased with the increase in the sleeve diameter.

Wound healing induced by new synthetic peptide, A7-1, in C57BL/6 mouse model.

The effects of the novel synthetic peptide, A7-1, on wound healing and skin grafts were evaluated in a C57BL/6 mouse model. Two 15-mm wide circular skin excisions were made on the backs of mice and to each excision, 100 µM A7-1 or normal saline was applied daily. The treatments were applied and sutured for skin graft analysis. Digital photos were acquired on days 4, 7, 11, and 14 and fluorescein angiography was conducted. Wound sizes were verified using stereoscopic microscopy. Histological analysis was performed via hematoxylin and eosin staining and Masson's trichrome staining. Western blotting was performed using vascular endothelial growth factor. Using a stereoscopic microscope, significantly faster wound healing (17.3%) and skin graft healing (16.5%) were observed in the A7-1 treatment group in comparison to that of the control. The angiogenesis was significantly faster in fluorescein angiography examination in wound healing (11%) and skin grafts (15%). However, the average completion of epithelization (overall time for wound healing), did not show any significant differences. In comparison to the control, the new protein, A7-1, led to significantly faster wound healing in the initial angiogenesis.

Does responsibility for potential harm attenuate the effects of repeated checking on metamemory and automatization?

BACKGROUND AND OBJECTIVES: Repeated checking results in large reductions in metamemory variables (confidence, details, and vividness). It has been suggested that the underlying mechanism is gradual automatization. At the same time, individuals with obsessive-compulsive disorder (OCD) are reluctant to automatize routine processes. The aim was to investigate whether high responsibility for potential harm, typical of OCD, would attenuate the effects of repeated checking on metamemory variables and automatization. METHODS: One hundred seventy-five participants were initially provided with a cover story that put the subsequent virtual checking task in a context of potential harm for not checking properly. Participants were randomly allocated to four experimental groups (varying high and low responsibility, relevant and irrelevant checking) and performed a virtual checking task repeatedly, using either identical stimuli (relevant checking) or different stimuli (irrelevant checking) between the first and final checking trial. Metamemory variables were rated on visual analogue scales, and response latencies were assessed to establish automatization. RESULTS: Larger reductions in metamemory variables following relevant checking compared to irrelevant checking replicated previous findings. High responsibility did not affect these results. Large reductions in response latencies across the checking trials (automatization) were also independent of the perceived responsibility. LIMITATIONS: We did not include individuals with OCD. CONCLUSIONS: Since responsibility did not influence the effects of repeated checking on metamemory variables, findings are consistent with the idea that automatization remains a plausible explanation of the effects of repeated checking on metamemory variables in individuals with OCD.

Radiomics and visual analysis for predicting success of transplantation of heterotopic glioblastoma in mice with MRI.

BACKGROUND: Quantifying tumor growth and treatment response noninvasively poses a challenge to all experimental tumor models. The aim of our study was, to assess the value of quantitative and visual examination and radiomic feature analysis of high-resolution MR images of heterotopic glioblastoma xenografts in mice to determine tumor cell proliferation (TCP). METHODS: Human glioblastoma cells were injected subcutaneously into both flanks of immunodeficient mice and followed up on a 3 T MR scanner. Volumes and signal intensities were calculated. Visual assessment of the internal tumor structure was based on a scoring system. Radiomic feature analysis was performed using MaZda software. The results were correlated with histopathology and immunochemistry. RESULTS: 21 tumors in 14 animals were analyzed. The volumes of xenografts with high TCP (H-TCP) increased, whereas those with low TCP (L-TCP) or no TCP (N-TCP) continued to decrease over time (p < 0.05). A low intensity rim (rim sign) on unenhanced T1-weighted images provided the highest diagnostic accuracy at visual analysis for assessing H-TCP (p < 0.05). Applying radiomic feature analysis, wavelet transform parameters were best for distinguishing between H-TCP and L-TCP / N-TCP (p < 0.05). CONCLUSION: Visual and radiomic feature analysis of the internal structure of heterotopically implanted glioblastomas provide reproducible and quantifiable results to predict the success of transplantation.

Soil Marginal Effect and LSTM Model in Chinese Solar Greenhouse.

The food crisis has increased demand for agricultural resources due to various factors such as extreme weather, energy crises, and conflicts. A solar greenhouse enables counter-seasonal winter cultivation due to its thermal insulation, thus alleviating the food crisis. The root temperature is of critical importance, although the mechanism of soil thermal environment change remains uncertain. This paper presents a comprehensive study of the soil thermal environment of a solar greenhouse in Jinzhong City, Shanxi Province, employing a variety of analytical techniques, including theoretical, experimental, and numerical simulation, and deep learning modelling. The results of this study demonstrate the following: During the overwintering period, the thermal environment of the solar greenhouse floor was divided into a low-temperature zone, a constant-temperature zone, and a high-temperature zone; the distance between the low-temperature boundary and the southern foot was 2.6 m. The lowest temperature in the low-temperature zone was 11.06 °C and the highest was 19.05 °C. The floor in the low-temperature zone had to be heated; the lowest value of the constant-temperature zone was 18.29 °C, without heating. The minimum distance between the area of high temperature and the southern foot of the solar greenhouse was 8 m and the lowest temperature reading was 19.29 °C. The indoor soil temperature tended to stabilise at a depth of 45 cm, and the lowest temperature reading at a horizontal distance of 1400 mm from the south foot was 19.5 °C. The Fluent and LSTM models fitted well and the models can be used to help control soil temperature during overwintering in extreme climates. The research can provide theoretical and data support for the crop areas and the heating of pipelines in the solar greenhouse.

Treatment with robot-assisted gait trainer Walkbot along with physiotherapy vs. isolated physiotherapy in children and adolescents with cerebral palsy. Experimental study.

BACKGROUND: Improving walking ability is a key objective in the treatment of children and adolescents with cerebral palsy, since it directly affects their activity and participation. In recent years, robotic technology has been implemented in gait treatment, which allows training of longer duration and repetition of the movement. To know the effectiveness of a treatment with the robotic-assisted gait trainer Walkbot combined with physiotherapy compared to the isolated physiotherapy treatment in children and adolescents with cerebral palsy, we carried out a clinical trial. METHODS: 23 participants, were divided into two groups: experimental and control. During 5 weeks, both groups received their physiotherapy sessions scheduled, in addition experimental group received 4 sessions per week of 40 min of robot. An evaluation of the participants was carried out before the intervention, at the end of the intervention, and at follow-up (two months after the end of the intervention). Gait was assessed with the Gross Motor Function Measure-88 dimensions D and E, strength was measured with a hydraulic dynamometer, and range of motion was assessed using the goniometer. A mixed ANOVA was performed when the assumptions of normality and homoscedasticity were met, and a robust mixed ANOVA was performed when these assumptions were not met. Statistical significance was stipulated at p < 0.05. For the effect size, η2 was calculated. RESULTS: Significant differences were found regarding the time x group interaction in the Gross Motor Function Measure-88 in dimension D [η2 = 0.016], in the flexion strength of the left [η2 = 0.128] and right [η2 = 0.142] hips, in the extension strength of the right hip [η2 = 0.035], in the abduction strength of the left hip [η2 = 0.179] and right [η2 = 0.196], in the flexion strength of the left knee [η2 = 0.222] and right [η2 = 0.147], and in the range of motion of left [η2 = 0.071] and right [η2 = 0.053] knee flexion. CONCLUSIONS: Compared to treatments without walking robot, physiotherapy treatment including Walkbot improves standing, muscle strength, and knee range of motion in children and adolescents with cerebral palsy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04329793. First posted: April 1, 2020.

Protective effects of lupeol in rats with renal ischemia­reperfusion injury.

Acute kidney injury (AKI) caused by ischemia and, exogenous or endogenous nephrotoxic agents poses a serious health issue. AKI is seen in 1% of all hospital admissions, 2-5% of hospitalizations and 67% of intensive care unit (ICU) patients. The in-hospital mortality rates for AKI is 40-50, and >50% for ICU patients. Ischemia-reperfusion (I/R) injury in the kidney can activate inflammatory responses and oxidative stress, resulting in AKI. The common endpoint in acute tubular necrosis is a cellular insult secondary to ischemia or direct toxins, which results in effacement of brush border, cell death and decreased function of tubular cells. The aim of the present study was to assess if the reported antioxidant and anti-inflammatory agent lupeol can exert any effects against renal I/R damage. In total, 24 Wistar Albino rats were randomly assigned into four groups of 6, namely Sham, lupeol, ischemia and therapy groups. In the lupeol group, intraperitoneal administration of 100 mg/kg lupeol was given 1 h before laparotomy, whilst only laparotomy was conducted in the sham group. The renal arteries of both kidneys were clamped for 45 min, 1 h after either intraperitoneal saline injection (in the ischemia group) or 100 mg/kg lupeol application (in the therapy group). The blood samples and renal tissues of all rats were collected after 24 h. In blood samples, blood urea nitrogen (BUN) was measured by the urease enzymatic method, and creatinine was measured by the kinetic Jaffe method. Using ELISA method, TNF-α and IL-6 levels were measured in the blood samples, whereas malondialdehyde (MDA), glutathione (GSH), caspase-3 levels were measured in kidney tissues. In addition, kidney histopathological analysis was performed by evaluating the degree of degeneration, tubular dilatation, interstitial lymphocyte infiltration, protein cylinders, necrosis and loss of brush borders. It was determined that renal damage occurred due to higher BUN, creatinine, MDA, TNF-α and caspase-3 values observed in the kidney tissues and blood samples of rats in ischemia group compared with the Sham group. Compared with those in the ischemia group, rats in the therapy group exhibited increased levels of GSH and reduced levels of BUN, TNF-α, MDA. Furthermore, the ischemia group also had reduced histopathological damage scores. Although differences in creatinine, IL-6 and caspase-3 levels were not statistically significant, they were markedly reduced in the treatment group. Taken together, these findings suggest that lupeol can prevent kidney damage as mainly evidenced by the reduced histopathological damage scores, decreased levels of oxidative stress and reduced levels of inflammatory markers. These properties may allow lupeol to be used in the treatment of AKI.

Simulation design - peer-to-peer training as preparation for full-scale scenarios.

OBJECTIVES: Design of simulation training can have important implications for learning outcomes. This paper describes a pilot simulation training program for baccalaureate nursing students that includes intensive preparations, peer-to-peer skills training (P2P), prior to full-scale scenario training. METHODS: A quality improvement analysis of a large scale experimental, mixed methods study. The project describes the design, analysis, and potential effects of a simulation education program containing P2P for third year nursing students (163 in treatment; 148 in control, n=311). RESULTS: The intervention group was found to be significantly more confident in both technical and non-technical nursing skills. Results suggest that the addition of P2P training may have a direct positive impact and increase the impact on full-scale simulations and debriefing. CONCLUSIONS: Enhanced focus on preparation activities prior to full-scale scenarios, including the use of P2P training methods are advocated.

Comparison of anticoagulation control and outcomes between usual medical care and pharmacist-led anticoagulation service in ambulatory patients taking warfarin at tertiary hospital in Ethiopia: a quasi-experimental study.

BACKGROUND: We aimed to compare anticoagulation control and outcomes between usual medical care (UMC) and pharmacist-led anticoagulation services (PLAS) in patients receiving warfarin at the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. METHODS: A quasi-experimental study was conducted, including 350 (66.7%) and 175 (33.3%) patients from the UMC and PLAS groups, respectively, from 525 patients. The time in therapeutic range (TTR) was determined using the Rosendaal method, with a TTR ≥ 65% set as the cut-off for optimal anticoagulation. The two-sample Wilcoxon rank-sum (Mann-Whitney U) test was used to compare continuous variables between groups. Categorical variables were compared between groups using Pearson's chi-square test or Fisher's exact test. Logistic regression and negative binomial regression analyses were conducted to identify the factors associated with suboptimal TTR and secondary outcomes, respectively, at the p values < 0.05, and 95% confidence interval (CI). RESULTS: Compared with the UMC group, the patients in the PLAC group showed a significantly higher median (IQR) TTR [60.89% (43.5-74.69%) vs. 53.65% (33.92-69.14%), p < 0.001]. A significantly higher optimal TTR (≥ 65%) was achieved in the PLAC group (41.7% vs. 31.7%) than in the UMC group (p = 0.002). The odds of having a poor TTR were reduced by 43% (AOR = 0.57, 95% CI = 0.36-0.88, p = 0.01) among patients in the PLAC group compared to those in the UMC group. There were no statistically significant differences in the secondary outcomes between the groups, except for all-cause emergency visits (p = 0.003). The incidence of bleeding events decreased by 3% (IRR = 0.97, 95% CI = 0.96-0.99, p < 0.001) for every increase in INR monitoring frequency. The incidence of thromboembolic events increased by a factor of 15.13 (IRR = 15.13, 95% CI = 1.47-155.52, p = 0.02) among patients with a high-risk CHA2DS2-VASc score compared with those with a moderate score. CONCLUSION: Patients in the PLAC group had a significantly higher median TTR than those in the UMC group did. There were no statistically significant differences in the secondary outcomes between the groups, except for fewer all-cause emergency department visits in the PLAC group.