Women's Involvement in Steady Exercise (WISE): Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Physical inactivity is a serious public health problem for people of all ages and is currently the fourth highest global risk factor for mortality. The transition period from adolescence to adulthood coincides with a marked reduction in participation in physical activity, with more than 50% (and up to 80%) of young adults stopping physical activity. This decrease in physical activity is more evident in women than in men. Despite efforts, existing programs face challenges in effectively initiating and maintaining physical activity among individuals, particularly women, for extended durations. To address these limitations, the Women's Involvement in Steady Exercise (WISE) randomized controlled trial (RCT) seeks to assess the efficacy of a digital high-intensity training intervention complemented by nutritional plans and other health-related advice. METHODS: The study will be a three-center, randomized (1:1), controlled, parallel-group trial with a six-month intervention period. A total of 300 participants will be recruited at three study sites in Spain, Serbia and Italy. The participants will be randomized to one of the two groups and will follow a six-month program. The primary outcome of the study is the daily step count. Self-reported physical activity, the adherence to the exercise program, body composition, physical activity enjoyment, quality of sleep and physical capacities will also be evaluated.

Mental processing comparison between past and future employing a novel EEG analysis based on radiated EM field estimation.

BACKGROUND: The inverse problem solution in the field of ElectroEncephaloGraphy (EEG) analysis has been addressed in the scientific literature for many decades, utilizing either mathematical techniques for measurement fitting or pure ElectroMagnetic (EM) methods involving complex head models for the prediction of the near field. NEW METHOD: A novel radiated EM field estimation analysis scheme is proposed for EEG analysis, based on the determination of a grid of equivalent distributed EM sources with equal magnetic moments, in order to compute the extrapolated far field. A Pattern Search approach is adopted to minimize the Mean Absolute Relative Error between the EM near field created by the source grid and the EM field extracted by the measurements. RESULTS: The application of the method on a subject's brain activity recordings in the context of "Protagoras" mental-auditory experiment demonstrates the capability of the proposed scheme to compare the subject's concentration differences between the limit of present and past versus the limit of present and future. COMPARISON WITH EXISTING METHODS: The proposed method combines features from different existing methods, both in terms of mathematical and EM theory techniques, in order to extend their capabilities and transform the conventional analysis of EEG recordings to a far field radiation basis. CONCLUSIONS: The treatment of the brain as an equivalent far field radiator can be a useful and promising new perspective to the established analysis of EEG recordings arising from brain activity during mental processing.

Effectiveness and Adverse Effects of Deep Brain Stimulation: Umbrella Review of Meta-Analyses.

Background This umbrella review summarizes the evidence across meta-analyses regarding the effectiveness and adverse effects of deep brain stimulation (DBS). Methods Databases were searched up to March 2015 for meta-analyses of comparative trials in humans assessing the effectiveness or adverse effects of DBS. Data selection, data extraction, and risk of bias assessment were performed by two independent reviewers. Results Seven eligible systematic reviews were included assessing the use of DBS for epilepsy (n = 1), obsessive-compulsive disorder (n = 1), and Parkinson disease (n = 5). The summary estimates were significant at p ≤ 0.05 in four meta-analyses (27%) with both fixed and random effects. One meta-analysis reported that DBS was more effective than sham in reducing the Yale-Brown Obsessive Compulsive Scale score in obsessive-compulsive disorder patients. The remaining three meta-analyses reported differences regarding mortality and depression in patients with Parkinson disease between DBS of the subthalamic nucleus and of the globus pallidus internus. Of the 15 meta-analyses, none compiled adequately robust evidence. Conclusions Although DBS has emerged as a viable surgical intervention to treat various disabling neurologic symptoms, existing studies fail to adequately support its use based on robust evidence without hints of bias.

An update on idiopathic intracranial hypertension.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is still a grey area in the knowledge of the aetiology, diagnosis and management of neurosurgical diseases. The definition of IIH has been reviewed over time and many hypotheses have been expressed as cause of the disease. The literature supplies very little evidence-based information to guide our decision-making process when it comes to treat the disease. In this review we sum up the latest information regarding the aetiology and therapy of IIH. Additionally, we make an attempt to unify the diagnostic criteria of Dandy, Friedman and Wall established from 1937 to date. METHOD: In this narrative review, we attempt to update the current standpoint to IIH, evaluate the input until now and consider future directions for research. The vast majority of the literature consisted of cohort studies, case control studies, systematic reviews and other narrative reviews. RESULTS: Pathophysiology: The incidence of IIH is steadily increasing. Several pathophysiological theories have been proposed in the literature based on the flow of cerebrospinal fluid. DIAGNOSIS: We attempt to fuse all the three diagnostic approaches published in the literature that detect IIH, while preserving the individual characteristics of each approach. TREATMENT: Based on evidence-based trials, the current use of acetazolamide in comparison with placebo or with topiramate has been evaluated. In the interventions' field, there seems to be a consonance about the alarming symptoms and what the most suitable operation is in each case. There is some disagreement about the indications for venous sinus transversus stenting and its risk/benefit ratio. CONCLUSIONS: Until now there is no class I guideline to which our decision-making can be based on for the management of IIH. A lack of systematic reviews and randomised control trials has been noted. If we focused our research on that, we could develop a standardised treatment protocol.

Comparative effectiveness of natural and synthetic bone grafts in oral and maxillofacial surgery prior to insertion of dental implants: Systematic review and network meta-analysis of parallel and cluster randomized controlled trials.

OBJECTIVES: Bone grafts are often used to enhance bone volume/quality prior to implantation insertion. This systematic review compares the histomorphometric effectiveness of bone grafts in an evidence-based manner. DATA: Randomized clinical trials comparing histomorphometrically the % of newly-formed bone between two grafts were included. Risk of bias within and across studies was assessed with the Cochrane tool and the GRADE approach, respectively. Random-effects pairwise meta-analyses were conducted, followed by network meta-analysis, network meta-regression and sensitivity analyses. SOURCES: Four electronic databases were searched from inception to June 2015 without limitations. STUDY SELECTION: A total of 12 trials (5 parallel; 7 cluster) with a total of 231 patients (302 grafted sites) were included. No statistically significant differences were found in the % of new bone from pairwise comparisons between any two bone grafts. Treatment ranking based on the evidence network indicated that autografts presented the highest percentage of new bone, followed by synthetic grafts, xenografts, and allografts. No differences according to patient age, sex, healing time, membrane used or kind of surgical graft use were identified. Our confidence on pairwise comparisons was moderate to very low due to study limitations, inconsistency, and imprecision; our confidence on graft ranking was moderate due to study limitations. CONCLUSIONS: No significant differences were found in the percentage of new bone between any two grafts. CLINICAL SIGNIFICANCE: Synthetic bone substitutes or xenologous bone grafts can be used as an alternative to autologous graft in order to overcome problems of additional surgeries or limited graft availability.

Leptin therapy alters appetite and neural responses to food stimuli in brain areas of leptin-sensitive subjects without altering brain structure.

CONTEXT: Leptin is a key regulator of energy intake and expenditure. Individuals with congenital leptin deficiency demonstrate structural and functional brain changes when given leptin. However, whether acquired leptin deficiency may operate similarly is unclear. OBJECTIVE: We set out to determine whether the brains of individuals with acquired leptin deficiency may react to leptin in a similar manner. DESIGN: We used functional magnetic resonance imaging before and after short- and long-term metreleptin treatment in three leptin-sensitive patients with acquired hypoleptinemia. Nine healthy women were scanned as normoleptinemic controls. SETTING: The setting was an academic medical center. PATIENTS OR OTHER PARTICIPANTS: The participants were 3 hypoleptinemic women and nine normoleptinemic, matched women. INTERVENTIONS: We used metreleptin, recombinant leptin, therapy for 24 weeks in hypoleptinemic women only. MAIN OUTCOME MEASURE: We measured neural changes in response to viewing food as compared to nonfood images. We hypothesized that metreleptin treatment would increase brain activity in areas related to cognitive control and inhibition and would decrease brain activity in areas related to reward processing, as compared to the normoleptinemic counterparts. RESULTS: Unlike patients with congenital leptin deficiency, hypoleptinemic patients demonstrated no structural brain differences from healthy controls and/or structural changes in response to treatment. Short-term metreleptin treatment in leptin-sensitive hypoleptinemic subjects enhances areas involved in detecting the salience and rewarding value of food during fasting, whereas long-term treatment decreases attention to food and the rewarding value of food after feeding. Furthermore, hypothalamic activity is modulated by metreleptin treatment, and leptin decreases functional connectivity of the hypothalamus to key feeding-related areas in these hypoleptinemic subjects. CONCLUSIONS: Leptin replacement in acutely hypoleptinemic women did not alter brain structure but did alter functional cortical activity to food cues in key feeding and reward-related areas.

Leptin at the intersection of neuroendocrinology and metabolism: current evidence and therapeutic perspectives.

Since its discovery as an adipocyte-secreted hormone, leptin has been found to impact food intake, energy homeostasis, and metabolism through its effects on the central nervous system and peripheral organs. Recent research indicates that leptin may also be involved in cognition, immune function, and bone metabolism. These findings place leptin at the intersection of neuroendocrinology and metabolism, and possibly immune function, and render it an appealing therapeutic target for several niche areas of unmet clinical need. Current evidence regarding classic and emerging roles of leptin as well as the pros and cons of its potential clinical use are summarized herein.