Stress and compulsive buying-shopping disorder: A scoping review.

INTRODUCTION: Theoretical frameworks of behavioral addictions mostly acknowledge the role of stress in the development and maintenance of these disorders, models of compulsive buying-shopping disorder (CBSD) however rarely incorporated stress. The association between stress and CBSD has not been reviewed yet. METHODS: A scoping review was conducted to evaluate empirical results on the association between stress and CBSD. A comprehensive search string was employed in three databases. RESULTS: 16 studies were included. Correlative studies suggested significant correlations between general perceived stress and CBSD symptom severity. Studies involving mean comparisons found higher general perceived stress levels in persons with problematic buying-shopping behavior/CBSD compared to control participants (large effects). Mixed results were found in studies involving regression/structural equation models and ecological momentary assessments. One study with a stress/negative mood induction observed more CBSD symptoms in a high stress group compared to a low stress group. DISCUSSION: The studies are heterogeneous concerning design, samples and measures. Only very few studies surpass the level of cross-sectional correlative data which limits the ability to draw clear conclusions. Future research should study the impact of experimentally induced stress on CBSD symptoms, examine the relationship between stress and CBSD longitudinally and assess objective stress markers.

Smyd1: Implications for novel approaches in rhabdomyosarcoma therapy.

Rhabdomyosarcoma (RMS), a tumor that consists of poorly differentiated skeletal muscle cells, is the most common soft-tissue sarcoma in children. Despite considerable progress within the last decades, therapeutic options are still limited, warranting the need for novel approaches. Recent data suggest deregulation of the Smyd1 protein, a sumoylation target as well as H3K4me2/3 methyltransferase and transcriptional regulator in myogenesis, and its binding partner skNAC, in RMS cells. Here, we show that despite the fact that most RMS cells express at least low levels of Smyd1 and skNAC, failure to upregulate expression of these genes in reaction to differentiation-promoting signals can always be observed. While overexpression of the Smyd1 gene enhances many aspects of RMS cell differentiation and inhibits proliferation rate and metastatic potential of these cells, functional integrity of the putative Smyd1 sumoylation motif and its SET domain, the latter being crucial for HMT activity, appear to be prerequisites for most of these effects. Based on these findings, we explored the potential for novel RMS therapeutic strategies, employing small-molecule compounds to enhance Smyd1 activity. In particular, we tested manipulation of (a) Smyd1 sumoylation, (b) stability of H3K4me2/3 marks, and (c) calpain activity, with calpains being important targets of Smyd1 in myogenesis. We found that specifically the last strategy might represent a promising approach, given that suitable small-molecule compounds will be available for clinical use in the future.

Functional Connectivity Alterations of Within and Between Networks in Schizophrenia: A Retrospective Study.

Introduction: Schizophrenia (SZ) is a chronic brain disorder characterized by diverse cognitive dysfunctions due to abnormal brain connectivity. Evaluating these connectivity alterations between and within such networks (intra- and inter-connectivity) may improve the understanding of disrupted information processing patterns in SZ patients. Methods: Resting-state fMRI analysis was performed on 24 SZ patients and 27 matched healthy controls. A functional connectivity matrix was constructed for each participant based on 129 gray matter regions. All regions were classified into eight distinct functional networks. Afterward, all functional connections were segregated into inter- and intra-network connections considering the eight networks. The Mean values of connectivity weights and nodal strength were examined for within- and between-network connections in SZ patients and healthy controls. Results: This analysis revealed that the within-network connections in the somatomotor (SM) network significantly reduced (P<0.001) in SZ patients. Additionally, intra-network connections within the visual and the ventral attention (VA) networks were significantly lower (P<0.01) in the SZ group. Moreover, disrupted intra-network connectivity was detected between the following network pairs: The visual-limbic, the somatomotor-limbic, the dorsal attention-limbic, and the ventral attention-dorsal attention system. Conclusion: The results showed an extensive reduction in functional connectivity strength for SZ patients, with a particularly significant decrease in intra-network connections when compared to the inter-networks. These findings can impact the understanding of the important dysregulated connections that are implicated in the incidence of schizophrenia. Highlights: Intra-network connections are more altered in schizophrenia (SZ) compared to inter-network.The visual, somatomotor (SM), and ventral attention (VA) networks are more affected in SZ.The interactions between the limbic system and three resting-state networks (RSNs) are altered significantly.The nodal strengths in different regions of RSNs are reduced significantly in SZ. Plain Language Summary: Brain functional connectivity is altered in several brain disorders. Looking for these changes may help in better understanding the disorder effects, its diagnostic and treatment. Our brain can be organized into distinct functional modules, known as resting-state networks (RSNs). These RSNs include visual, somatomotor (SM), fronto-parietal, dorsal attention, ventral attention, default mode (DMN), and limbic functional systems. In this study, we examined the alteration of functional connectivity in schizophrenia disorder considering these brain RSNs. The functional connections were classified in two groups, the inter- and intra-network connections. Inter-network connections are defined as the links between pairs of regions from two different brain subnetworks, whereas intra- network connections are determined as the connections between pairs of regions inside each network. Our analysis indicated that the functional connectivity strengths of intra-network connections reduced more in schizophrenia. It was also found that the connection between the limbic network and others is more disrupted compared to other inter-network links. These findings can help us in better understanding the effect of schizophrenia on the brain and therefore its treatment.

Extracellular vesicles of the probiotic bacteria E. coli O83 activate innate immunity and prevent allergy in mice.

BACKGROUND: E. coli O83 (Colinfant Newborn) is a Gram-negative (G-) probiotic bacterium used in the clinic. When administered orally, it reduces allergic sensitisation but not allergic asthma. Intranasal administration offers a non-invasive and convenient delivery method. This route bypasses the gastrointestinal tract and provides direct access to the airways, which are the target of asthma prevention. G- bacteria such as E. coli O83 release outer membrane vesicles (OMVs) to communicate with the environment. Here we investigate whether intranasally administered E. coli O83 OMVs (EcO83-OMVs) can reduce allergic airway inflammation in mice. METHODS: EcO83-OMVs were isolated by ultracentrifugation and characterised their number, morphology (shape and size), composition (proteins and lipopolysaccharide; LPS), recognition by innate receptors (using transfected HEK293 cells) and immunomodulatory potential (in naïve splenocytes and bone marrow-derived dendritic cells; BMDCs). Their allergy-preventive effect was investigated in a mouse model of ovalbumin-induced allergic airway inflammation. RESULTS: EcO83-OMVs are spherical nanoparticles with a size of about 110 nm. They contain LPS and protein cargo. We identified a total of 1120 proteins, 136 of which were enriched in OMVs compared to parent bacteria. Proteins from the flagellum dominated. OMVs activated the pattern recognition receptors TLR2/4/5 as well as NOD1 and NOD2. EcO83-OMVs induced the production of pro- and anti-inflammatory cytokines in splenocytes and BMDCs. Intranasal administration of EcO83-OMVs inhibited airway hyperresponsiveness, and decreased airway eosinophilia, Th2 cytokine production and mucus secretion. CONCLUSIONS: We demonstrate for the first time that intranasally administered OMVs from probiotic G- bacteria have an anti-allergic effect. Our study highlights the advantages of OMVs as a safe platform for the prophylactic treatment of allergy. Video Abstract.

Cue-reactivity to distal cues in individuals at risk for gaming disorder.

BACKGROUND: Gaming disorder (GD) is a disorder due to addictive behaviors (ICD-11). Cue-reactivity and craving are relevant mechanisms in the development and maintenance of addictive behaviors. When confronted with cues showing in-game content (proximal cues) individuals with higher symptom severity show increased cue-reactivity. Based on conditioning and addiction theories on incentive sensitization, cue-reactivity responses may generalize to more distal cues, e.g. when individuals at risk of developing a GD are confronted with a starting page of an online game. In cue-reactivity paradigms so far, only proximal gaming cues have been used. METHODS: We investigated the effect of distal gaming cues compared to gaming-unrelated control cues on cue-reactivity and craving in 88 individuals with non-problematic use of online games (nPGU) and 69 individuals at risk for GD (rGD). The distal cues showed the use of an electronic device (e.g., desktop PC or smartphone) whose screen showed starting pages of either games (target cues), shopping- or pornography sites (control cues) from a first-person perspective. FINDINGS: We found significantly higher urge and arousal ratings as well as longer viewing times for gaming-related compared to gaming-unrelated control cues in rGD compared to nPGU. Valence ratings did not differ between groups. INTERPRETATION: The results demonstrate that already distal gaming-specific cues lead to cue-reactivity and craving in rGD. This finding indicates that based on conditioning processes, cue-reactivity and craving develop during the course of GD and generalize to cues that are only moderately related to the specific gaming activity.

[Readiness for Implementation of Prevention and Health Promotion Measures for People in Difficult Living Situations in Deprived Municipalities in Bavaria: A Qualitative Analysis]. / Bereitschaft zur Umsetzung von Präventions- und Gesundheitsförderungsmaßnahmen für Menschen in schwierigen Lebenslagen in deprivierten Kommunen in Bayern: Eine qualitative Analyse.

OBJECTIVE: The community setting is crucial to improving health equity. To enable the implementation of need-based and target-oriented measures, it is important to understand the challenges and needs of communities. This is highly relevant for deprived communities that have offered hardly any health promotion programs for socially disadvantaged people. The main research question of this study is: "How do deprived communities perceive the need for action and support in connection with the implementation of disease prevention and health promotion measures focused on socially disadvantaged people?" METHODS: A qualitative, exploratory analysis through semi-structured interviews with experts (n=10) was conducted in five deprived communities in Bavaria. The degree of deprivation was represented by the Bavarian Index of Multiple Deprivation (BIMD, 2010), which shows the extent of lack of resources at the community level. Qualitative analysis of the interviews followed the theoretical framework of qualitative content analysis according to Kuckartz. RESULTS: Themes arising from the interviews were (1) groups perceived to be in need of support, (2) disease prevention and health promotion assets, and (3) need for action regarding prevention and health promotion. Target groups in need of support were identified in the analyzed communities. Furthermore, it became apparent that in deprived communities there were scarcely resources and structures to address disease prevention and health promotion. CONCLUSION: This study shows that deprived communities need support to implement need-based and target-oriented prevention and health promotion measures for socially disadvantaged people. However, those communities have limited capacities, and thus should be supported (e. g., through networking).

Hemostatics in patients with inhibited coagulation-A viscoelastic in-vitro analysis.

BACKGROUND: The military has used topical hemostatic agents to successfully treat life-threatening external bleeding for years. In contrast to the military environment, the general population are increasingly prescribed anticoagulants. There are only few comparative evaluations of topical hemostatic agents with anticoagulated human blood. It is important to understand the impact of these agents on those who take anticoagulants. STUDY DESIGN AND METHODS: Citrated blood of patients treated with enoxaparin, heparin, and acetylsalicylic acid, apixaban or phenprocoumon was incubated with different hemostatic agents (QuikClot Gauze, Celox Granules, Celox Gauze, Chito SAM 100, WoundClot Trauma Gauze, QuikClot Gauze Moulage Trainer and Kerlix) and rotational thromboelastometry was performed with non-activated thromboelastometry (NATEM reagent). RESULTS: All tested agents improved the onset of coagulation in all anticoagulants, mostly to a significant degree. Most significant improvements were produced by QuikClot Gauze and QuikClot Gauze Moulage Trainer, followed by the tested chitosans (Celox Granules, Celox Gauze, Chito SAM 100). Of the anticoagulant groups, the most significant improvements were seen in enoxaparin. This was followed in order by apixaban, heparin, and acetylsalicylic acid, and phenprocoumon. DISCUSSION: All the hemostatic agents tested were able to activate the clotting cascade earlier and initiate faster clot formation in anticoagulated blood. A definitive head-to-head comparison is not feasible, because of the limitations of an in-vitro analysis. However, the sometimes-presented hypothesis that kaolin-based hemostatic agents are ineffective in anticoagulated blood is inaccurate according to our data. Hemostasis with hemostatic agents appears most challenging with phenprocoumon.

A press(ing) issue: analysing local news coverage of abortion in the US South during the COVID-19 pandemic.

In the early days of the COVID-19 pandemic, some US state governments banned abortion due to its allegedly 'elective' nature. While these actions were successfully challenged in courts, discussion about the topic may have shaped personal and public opinion. This study aimed to explore the framing of abortion in local newspapers during the onset of the pandemic. Articles regarding abortion were collected from three top circulated local online news publications from three southern US states. Of the states that attempted to block abortions, Alabama, Louisiana and Mississippi were selected for their high non-White populations. Using critical thematic analysis, 77 articles were analysed, and four themes were identified: individual-centric, public health risk, interplay with inequalities, and hierarchical health care. Existing abortion narratives were taken up by different sides of the debate to push political agendas. However, new pro-/anti-abortion justifications were observed, specifically regarding public health concerns during COVID-19. Anti-abortion activists framed abortion provision as a health risk and employed other narratives that likely reinforced gendered, ethnic and socioeconomic power disparities by shifting blame onto abortion seekers and providers. However, pro-choice supporters framed abortion as essential health care and as a structural issue, which may have bolstered awareness for structural change.

"I Don't Want to Have Sex as a Woman": A Qualitative Study Exploring Sexuality and Sexual Practices of Drag Queens in Germany.

Drag queens are typically gay men who perform as caricature-like women. They thereby publicly challenge "naturally" binary gender role categories, though it remains unclear how that interplays with their private (e.g., sexual) lives. This study seeks to answer this question by exploring the sexuality and sexual practices of drag queens. Employing a critical realist approach, ten semi-structured interviews were conducted in Germany, with questions focusing on the drag queens' views on sexuality and sexual positioning. By adopting a thematic analysis, three main themes were identified: natural versus artificial identity; advocacy for sexuality; and rejection of heteronormativity. Results suggest that the primary intention of drag queens is to challenge heteronorms, while they regularly adhered to these privately. This illustrates the distinction made by the participants between their "public" persona, an artificial character that lacks sexuality, and their "private" life (e.g., sexual practices), shaped by an "inborn" sexuality.

Combined Vaccination with B Cell Peptides Targeting Her-2/neu and Immune Checkpoints as Emerging Treatment Option in Cancer.

The application of monoclonal antibodies (mAbs), targeting tumor-associated (TAAs) or tumor-specific antigens or immune checkpoints (ICs), has shown tremendous success in cancer therapy. However, the application of mAbs suffers from a series of limitations, including the necessity of frequent administration, the limited duration of clinical response and the emergence of frequently pronounced immune-related adverse events. However, the introduction of mAbs has also resulted in a multitude of novel developments for the treatment of cancers, including vaccinations against various tumor cell-associated epitopes. Here, we reviewed recent clinical trials involving combination therapies with mAbs targeting the PD-1/PD-L1 axis and Her-2/neu, which was chosen as a paradigm for a clinically highly relevant TAA. Our recent findings from murine immunizations against the PD-1 pathway and Her-2/neu with peptides representing the mimotopes/B cell peptides of therapeutic antibodies targeting these molecules are an important focus of the present review. Moreover, concerns regarding the safety of vaccination approaches targeting PD-1, in the context of the continuing immune response, as a result of induced immunological memory, are also addressed. Hence, we describe a new frontier of cancer treatment by active immunization using combined mimotopes/B cell peptides aimed at various targets relevant to cancer biology.

Active immunization with a Her-2/neu-targeting Multi-peptide B cell vaccine prevents lung metastases formation from Her-2/neu breast cancer in a mouse model.

In pre-clinical and clinical settings, active immunization with a Her-2/neu vaccine (HerVaxx), comprising B-cell peptide from Trastuzumab binding site, has been shown to reduce primary tumor growth via induction of polyclonal anti-tumor immune responses and immunological memory. Here, we tested the combination of HerVaxx and the recently identified B-cell epitope/mimotope of Pertuzumab, i.e. a multi-peptide B-cell vaccine, for preventing Her-2/neu lung metastases formation in a mouse model. Active immunization with the multi-peptide vaccine was associated with decreased lung weights, and histological evaluation of the lungs showed that the significant reduction of lung metastases was associated with increased CD4+ and CD8+ T cell infiltration. Notably, along with the overall reduction of lungs weights and Her-2 positive metastases, a formation of Her-2/neu-negative tumors but with increased PD-L1 expression was observed. Our results might pave the way to a multi-peptide B-cell Her-2/neu vaccine serving as a secondary intervention in adjuvant settings to prevent tumor recurrence and spread. Moreover, combination therapy targeting PD-L1 may result in total remission of metastases. Such a therapy may be used clinically to alternately target Her-2/neu and PD-L1 in metastatic breast cancer.

Interaction of Insecticides and Fungicides in Bees.

Honeybees and wild bees are among the most important pollinators of both wild and cultivated landscapes. In recent years, however, a significant decline in these pollinators has been recorded. This decrease can have many causes including the heavy use of biocidal plant protection products in agriculture. The most frequent residues in bee products originate from fungicides, while neonicotinoids and, to a lesser extent, pyrethroids are among the most popular insecticides detected in bee products. There is abundant evidence of toxic side effects on honeybees and wild bees produced by neonicotinoids, but only few studies have investigated side effects of fungicides, because they are generally regarded as not being harmful for bees. In the field, a variety of substances are taken up by bees including mixtures of insecticides and fungicides, and their combinations can be lethal for these pollinators, depending on the specific group of insecticide or fungicide. This review discusses the different combinations of major insecticide and fungicide classes and their effects on honeybees and wild bees. Fungicides inhibiting the sterol biosynthesis pathway can strongly increase the toxicity of neonicotinoids and pyrethroids. Other fungicides, in contrast, do not appear to enhance toxicity when combined with neonicotinoid or pyrethroid insecticides. But the knowledge on possible interactions of fungicides not inhibiting the sterol biosynthesis pathway and insecticides is poor, particularly in wild bees, emphasizing the need for further studies on possible effects of insecticide-fungicide interactions in bees.

Functional limitations after lateral column lengthening osteotomy of the calcaneus are associated with lower quality of life.

PURPOSE: The purpose of this study was to quantify limitations in sagittal ankle range of motion (ROM) at least two years after lateral column lengthening osteotomy of the calcaneus (LLC) and their implications regarding quality of life. METHODS: Fifteen patients with a mean follow-up of 80 ± 27 months after LLC and 15 age-matched healthy persons participated in this study. Ankle joint complex ROM in plantarflexion and dorsiflexion was measured bilaterally using a goniometer and fluoroscopy (patients only). Quality of life was assessed using the short-form health questionnaire (SF36). Differences in ROM parameters (for the tibiotalar and subtalar joint) between sides (affected vs. unaffected) and between groups (patient vs. controls) and the relationship between ROM parameters and quality of life scores were assessed. RESULTS: ROM of the ankle joint complex on the affected side in patients was smaller than on the contralateral side (goniometer and fluoroscopy) and in healthy persons (goniometer; all P < .05). Among patients, SF36 total and pain scores, respectively, correlated with ROM of the subtalar joint (fluoroscopy; R = 0.379, P = 0.039 and R = 0.537, P = 0.001). Among patients and healthy persons, those with smaller dorsiflexion (goniometer) had lower quality of life scores. CONCLUSIONS: The smaller sagittal ROM of the affected ankle joint complex compared with the contralateral foot and healthy controls was mainly explained by limitations in the tibiotalar joint. Because of its association with quality of life, ROM should be considered in the treatment and rehabilitation planning in patients who are candidates for LLC.

Excitotoxicity Alters Endogenous Secretoneurin Plasma Levels, but Supplementation with Secretoneurin Does Not Protect Against Excitotoxic Neonatal Brain Injury.

Excitotoxicity plays an important role in the pathogenesis of developing brain injury. The neuropeptide secretoneurin (SN) has neuroprotective potential. The aim of this study was to investigate SN plasma concentrations following excitotoxicity and to evaluate the effect of SN as therapeutic strategy in excitotoxic newborn brain injury. Baseline SN plasma concentrations were established in healthy animals. To evaluate the effect of an excitotoxic insult on SN levels, mice pups were subjected to an intracranial injection of ibotenic acid and SN plasma concentrations were measured thereafter. To assess SN's neuroprotective potential, a subgroup of animals was randomly assigned to the following groups: i) "single treatment": vehicle 1× phosphate-buffered saline (PBS), SN 0.25 µg/g body weight (bw), SN 2.5 µg/g bw or SN 12.5 µg/g bw in a single dose 1 h after insult; ii) "acute repetitive treatment": vehicle 1× PBS or SN 0.25 µg/g bw every 24 h starting 1 h after insult; iii) "delayed repetitive treatment": vehicle 1× PBS or SN 0.25 µg/g bw every 24 h starting 60 h after insult. Animals subjected to excitotoxic injury showed significantly lower SN plasma concentrations 6 and 120 h after insult in comparison to healthy controls. Administration of SN did not positively affect lesion size, apoptotic cell death, microglial cell activation or cell proliferation. To conclude, endogenous SN plasma levels are lower in newborn mice subjected to an excitotoxic insult than in healthy controls. Supplementation with SN in various treatment regimens is not neuroprotective in the experimental animal model of excitotoxic newborn brain injury.

The Impact of Being Born Preterm or Small for Gestational Age on Early Vascular Aging in Adolescents.

OBJECTIVE: To assess the impact of being born preterm or small for gestational age (SGA) on early vascular aging (EVA) in a cohort of healthy Tyrolean adolescents. STUDY DESIGN: This study is part of an ongoing clinical trial, EVA Tyrol, a regional cohort study being conducted in western Austria. EVA was assessed in adolescents (mean age, 16 years) by means of carotid-femoral pulse wave velocity (PWV), carotid intima-media thickness (cIMT), and blood pressure measurements. Adolescents were grouped as either term or preterm. Subsequently, being born SGA was taken into consideration in subgroup analysis. Complete data on gestational age and birth weight were available for 930 adolescents. RESULTS: Systolic blood pressure and diastolic blood pressure were significantly higher in the preterm (mean gestational age, 34.8 ± 2.3 weeks) and appropriate for gestational age (AGA) group than in the term and AGA group (P < .05). This finding remained significant in linear regression analysis after adjustment for covariables in all models. PWV was significantly higher in the term-SGA group than in the term-AGA group (6.67 ± 1.73 m/s vs 6.07 ± 1.09 m/s; P < .05). In the linear regression analysis, this finding remained significant in all models. There were no differences in cIMT between study groups. CONCLUSION: Being born preterm or SGA might render persons susceptible to EVA. Long-term follow-up of preterm and SGA individuals is warranted to confirm these results.

Secretoneurin Serum Levels in Healthy Term Neonates and Neonates with Hypoxic-Ischaemic Encephalopathy.

BACKGROUND: Hypoxic-ischaemic encephalopathy is a major cause of neurologic impairment and mortality in neonates. Early knowledge of brain injury is important to guide therapeutic decisions and reliably inform the parents. Increased secretoneurin levels have been detected in adult patients suffering from brain injury and it has also been shown to be a promising early serum biomarker of unfavourable neurological outcome. However, no data are available in neonates. OBJECTIVE: The aim of this study was to obtain reference values for secretoneurin in healthy term neonates and then to assess the potential of this neuropeptide as a biomarker in the context of hypoxic-ischaemic encephalopathy in asphyxiated term neonates. METHODS: A total number of 139 term neonates, of which 7 were asphyxiated and 132 were healthy, were prospectively enrolled. Secretoneurin serum concentrations were assessed by radioimmunoassay. RESULTS: In healthy controls, secretoneurin serum concentrations were influenced by the mode of delivery (highest in infants born per vacuum extraction and lowest in infants born per caesarean section) and abnormal cardiotocography. In asphyxiated term neonates, secretoneurin concentrations were higher in umbilical cord blood and significantly lower 48 h after birth in comparison to healthy controls. CONCLUSION: Secretoneurin levels are elevated in cord blood in infants suffering from hypoxic-ischaemic encephalopathy following perinatal asphyxia. The potential of secretoneurin as a marker of neonatal hypoxic-ischaemic brain injury should be further evaluated in larger trials.

A novel comparative effectiveness study of Tai Chi versus aerobic exercise for fibromyalgia: study protocol for a randomized controlled trial.

BACKGROUND: Fibromyalgia is a chronic musculoskeletal pain syndrome that causes substantial physical and psychological impairment and costs the US healthcare system over $25 billion annually. Current pharmacological therapies may cause serious adverse effects, are expensive, and fail to effectively improve pain and function. Finding new and effective non-pharmacological treatments for fibromyalgia patients is urgently needed. We are currently conducting the first comparative effectiveness randomized trial of Tai Chi versus aerobic exercise (a recommended component of the current standard of care) in a large fibromyalgia population. This article describes the design and conduct of this trial. METHODS/DESIGN: A single-center, 52-week, randomized controlled trial of Tai Chi versus aerobic exercise is being conducted at an urban tertiary medical center in Boston, Massachusetts. We plan to recruit 216 patients with fibromyalgia. The study population consists of adults ≥21 years of age with fibromyalgia who meet American College of Rheumatology 1990 and 2010 diagnostic criteria. Participants are randomized to one of four Tai Chi intervention groups: 12 or 24 weeks of supervised Tai Chi held once or twice per week, or a supervised aerobic exercise control held twice per week for 24 weeks. The primary outcome is the change in Revised Fibromyalgia Impact Questionnaire total score from baseline to 24 weeks. Secondary outcomes include measures of widespread pain, symptom severity, functional performance, balance, muscle strength and power, psychological functioning, sleep quality, self-efficacy, durability effects, and health-related quality of life at 12, 24, and 52 week follow-up. DISCUSSION: This study is the first comparative effectiveness randomized trial of Tai Chi versus aerobic exercise in a large fibromyalgia population with long-term follow up. We present here a robust and well-designed trial to determine the optimal frequency and duration of a supervised Tai Chi intervention with regard to short- and long-term effectiveness. The trial also explores multiple outcomes to elucidate the potential mechanisms of Tai Chi and aerobic exercise and the generalizability of these interventions across instructors. Results of this study are expected to have important public health implications for patients with a major disabling disease that incurs substantial health burdens and economic costs. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01420640 , registered 18 August 2011.

The Influence of Tai Chi Exercise on Proprioception in Patients with Knee Osteoarthritis: Results from a Pilot Randomized Controlled Trial.

PURPOSE: Previous long-term observational studies found that Tai Chi practitioners had better knee-joint proprioceptive acuity versus controls in an older population. We evaluated the effects of Tai Chi for knee-joint proprioception in knee osteoarthritis (OA) in a randomized controlled trial. METHODS: We randomized 40 eligible individuals (age > 55, BMI ≤ 40 kg/m2 with knee pain on most days of the previous month and tibiofemoral OA (K/L grade ≥2) to Tai Chi (10 modified forms from classical Yang style) or to an attention control (stretching and wellness education). The 60 minute intervention sessions occurred twice-weekly for 12 weeks. The knee joint proprioception was measured using a Biometrics™ electrogoniometer with an ADU301 angle display unit during each assessment visit. Three test angles (30, 45 and 60 degrees) were evaluated with each subject in a sitting position taken as neutral (0 degrees). The mean error (absolute angle error) between the actual and replicated angles was calculated for each of the three test angles. The Tai Chi and control groups were compared by intention-to-treat using t-tests. RESULTS: The participants had a mean age of 65 y (SD 7.8), a mean disease duration of 10 y (SD 7.6), a mean BMI of 30.0 kg/m2 (SD 4.8), and median K/L grade 4; 75% were female, 70% were white. The participants in the Tai Chi intervention exhibited significantly improved proprioception at 30 degrees, but not at 45 or 60 degrees, at 12 weeks. Patients who continued Tai Chi practice after 12 weeks also reported no significant improvements in knee proprioception at 24 and 48 weeks. CONCLUSION: Tai Chi appears to be beneficial for knee proprioception in people with severe knee OA at a 30 degree test angle immediately following 12 weeks of practice. However, we were unable to demonstrate that Tai Chi has any long-term effects on knee proprioception, nor were we able to find any effects on proprioception at larger test angles (45 and 60 degrees). Standardized and reproducible measures for knee proprioception should be explored in future research.