Caenorhabditis elegans as a model to study the impact of exposure to light emitting diode (LED) domestic lighting.

This study aimed to investigate the biological impact of exposure on domestic light emitting diodes (LED) lighting using the free-living nematode Caenorhabditis elegans as a model. Nematodes were separately exposed to white LED light covering the range of 380-750 nm, blue light at 450 nm and black light at 380-420 nm for one life cycle (egg to adult) with dark exposure as the control. Each light range induced stress to the nematode C. elegans such as reducing the number of the hatched eggs and/or delayed the maturation of the hatched eggs to the adult stage. In addition, it lowered or prevented the ability of adults to lay eggs and impaired the locomotion in the exposed worms. The observed type of biological stress was also associated with the production of reactive oxygen species (ROS) as compared to nematodes grown in the dark. It is concluded that the blue light component of white LED light may cause health problems, and further investigation is required to test commercial brands of white LEDs that emit different amounts of blue light.

Poetry, Music, Writing and Painting; Developing the artistic talents of Adults with Cystic Fibrosis.

Art is an expressive outlet for the physical limitations and emotional frustrations of living with a life limiting condition such cystic fibrosis. In the Manchester Adult Cystic Fibrosis Centre we have facilitated the sharing of the inherent artistic talent of our patients with the support of painters, musicians, potters, creative writers, photographers and textile specialists and our own ward staff in our dedicated 22 bed CF inpatient unit. The programme has provided some splendid works that enliven our ward and, more importantly, continue to inspire our patients as they attempt to overcome the socially limiting consequences of hospital admission.

Fatty acids composition of Caenorhabditis elegans using accurate mass GCMS-QTOF.

The free living nematode Caenorhabditis elegans is a proven model organism for lipid metabolism research. Total lipids of C. elegans were extracted using chloroform and methanol in 2:1 ratio (v/v). Fatty acids composition of the extracted total lipids was converted to their corresponding fatty acids methyl esters (FAMEs) and analyzed by gas chromatography/accurate mass quadrupole time of flight mass spectrometry using both electron ionization and chemical ionization techniques. Twenty-eight fatty acids consisting of 12 to 22 carbon atoms were identified, 65% of them were unsaturated. Fatty acids containing 12 to17 carbons were mostly saturated with stearic acid (18:0) as the major constituent. Several branched-chain fatty acids were identified. Methyl-14-methylhexadecanoate (iso- 17:0) was the major identified branched fatty acid. This is the first report to detect the intact molecular parent ions of the identified fatty acids in C. elegans using chemical ionization compared to electron ionization which produced fragmentations of the FAMEs.

Determination of polycyclic aromatic hydrocarbons in dry tea.

Twenty-eight different tea samples sold in the United States were evaluated using high-performance liquid chromatography (HPLC) with fluorescence detection (FLD) for their contamination with polycyclic aromatic hydrocarbons (PAHs). Many PAHs exhibit carcinogenic, mutagenic, and teratogenic properties and have been related to several kinds of cancer in man and experimental animals. The presence of PAHs in environmental samples such as water, sediments, and particulate air has been extensively studied, but food samples have received little attention. Eighteen PAHs congeners were analyzed, with percentage recovery higher than 85%. Contamination expressed as the sum of the 18 analyzed PAHs was between 101 and 1337 µg/kg on dry mass and the average contents in all of the 28 examined samples was 300 µg/kg on dry mass. Seven of the congeners were found in all samples with wide ranges of concentrations as follows: fluorene (7-48 µg/kg), anthracene (1-31 µg/kg), pyrene (1-970 µg/kg), benzo(a)anthracene (1-18 µg/kg) chrysene (17-365 µg/kg), benzo(a)pyrene (1-29 µg/kg), and indeno(1,2,3-cd)pyrene (4-119 µg/kg). The two most toxic congeners benzo(a)pyrene and dibenzo(a,h)anthracene were found at high concentrations only in Earl Grey Twinnings, Earl Grey Harney& Sons Fine Teas, and Chai Ultra Spice Black Tea Twinnings. Six PAH congeners are considered as suspected carcinogens (U.S.EPA), formed the basis of the estimation of the toxic equivalent (TEQ), Chai Ultra-Spice Black Tea Twinnings had the highest TEQ (110.9) followed by two grey tea samples, Earl Grey Harney & Sons Fine Tea (57.7) and Earl Grey Twinnings (54.5). Decaffeinated grey teas had the lowest TEQs, decaffeinated Earl Grey Bigelow (9.4) and Green Tea Honey Lemon Decaffeinated Lipton (9.6).

Developing the principles of chair based exercise for older people: a modified Delphi study.

BACKGROUND: Chair based exercise (CBE) is suggested to engage older people with compromised health and mobility in an accessible form of exercise. A systematic review looking at the benefits of CBE for older people identified a lack of clarity regarding a definition, delivery, purpose and benefits. This study aimed to utilise expert consensus to define CBE for older people and develop a core set of principles to guide practice and future research. METHODS: The framework for consensus was constructed through a team workshop identifying 42 statements within 7 domains. A four round electronic Delphi study with multi-disciplinary health care experts was undertaken. Statements were rated using a 5 point Likert scale of agreement and free text responses. A threshold of 70% agreement was used to determine consensus. Free text responses were analysed thematically. Between rounds a number of strategies (e.g., amended wording of statements, generation and removal of statements) were used to move towards consensus. RESULTS: 16 experts agreed on 46 statements over four rounds of consultation (Round 1: 22 accepted, 3 removed, 5 new and 17 modified; Round 2: 16 accepted, 0 removed, 4 new and 6 modified; Round 3: 4 accepted, 2 removed, 0 new and 4 modified; Round 4: 4 accepted, 0 removed, 0 new, 0 modified).Statements were accepted in all seven domains: the definition of CBE (5), intended users (3), potential benefits (8), structure (12), format (8), risk management (7) and evaluation (3).The agreed definition of CBE had five components: 1. CBE is primarily a seated exercise programme; 2. The purpose of using a chair is to promote stability in both sitting and standing; 3. CBE should be considered as part of a continuum of exercise for frail older people where progression is encouraged; 4. CBE should be used flexibly to respond to the changing needs of frail older people; and 5. Where possible CBE should be used as a starting point to progress to standing programmes. CONCLUSIONS: Consensus has been reached on a definition and a set of principles governing CBE for older people; this provides clarity for implementation and future research about CBE.

Preventing Ventricular Catheter Displacement and Infection with the "Catheter-Locking Device-Assisted" Technique: A Retrospective Study of 231 Patients.

BACKGROUND: Inserting cerebrospinal fluid diversion devices such as external ventricular drains (EVDs) and ventriculoperitoneal shunts (VPSs) is a critical procedure. Unfortunately, complications such as catheter misplacement, dislocation, or infection can occur. Various surgical strategies aim to reduce these risks. One recent innovation is the "catheter-locking device-assisted" technique for EVD surgery. In this study, we examined its application in a larger group of cases encompassing both EVDs and VPSs over a 30-month period, with a focus on these complications. METHODS: All adult patients who underwent a shunt procedure for noninfectious hydrocephalus at our institution from January 2021 to June 2023 were reviewed. We compared complications between those treated with the "standard" technique (subgroup A) and those managed with the "catheter-locking device-assisted" approach (subgroup B). RESULTS: In the EVD surgical group (initial procedures, n = 161), 6 patients (3.7%) required reoperation owing to the catheter misplacement caused by inadvertent migration of the ventricular catheter within the operating room ("early" migration), while 11 patients (6.8%) experienced unintentional postoperative dislodgement ("delayed" migration). Seven patients (4.3%) developed an EVD-related infection after an average duration of 7.4 days. None of these complications were observed in subgroup B patients (P < 0.05). Among VPS patients (n = 137), 4 (2.9%), all in subgroup A, required reoperation due to intraoperative migration of the catheter (P = 0.121); no other complications were identified. CONCLUSIONS: The "catheter-locking device-assisted" technique may significantly decrease the occurrence of the most common EVD complications and can also prove beneficial in VPS surgery. However, further investigation is necessary.

Inhibiting early-stage events in HIV-1 replication by small-molecule targeting of the HIV-1 capsid.

The HIV-1 capsid (CA) protein plays essential roles in both early and late stages of virl replication and has emerged as a novel drug target. We report hybrid structure-based virtual screening to identify small molecules with the potential to interact with the N-terminal domain (NTD) of HIV-1 CA and disrupt early, preintegration steps of the HIV-1 replication cycle. The small molecule 4,4'-[dibenzo[b,d]furan-2,8-diylbis(5-phenyl-1H-imidazole-4,2-diyl)]dibenzoic acid (CK026), which had anti-HIV-1 activity in single- and multiple-round infections but failed to inhibit viral replication in peripheral blood mononuclear cells (PBMCs), was identified. Three analogues of CK026 with reduced size and better drug-like properties were synthesized and assessed. Compound I-XW-053 (4-(4,5-diphenyl-1H-imidazol-2-yl)benzoic acid) retained all of the antiviral activity of the parental compound and inhibited the replication of a diverse panel of primary HIV-1 isolates in PBMCs, while displaying no appreciable cytotoxicity. This antiviral activity was specific to HIV-1, as I-XW-053 displayed no effect on the replication of SIV or against a panel of nonretroviruses. Direct interaction of I-XW-053 was quantified with wild-type and mutant CA protein using surface plasmon resonance and isothermal titration calorimetry. Mutation of Ile37 and Arg173, which are required for interaction with compound I-XW-053, crippled the virus at an early, preintegration step. Using quantitative PCR, we demonstrated that treatment with I-XW-053 inhibited HIV-1 reverse transcription in multiple cell types, indirectly pointing to dysfunction in the uncoating process. In summary, we have identified a CA-specific compound that targets and inhibits a novel region in the NTD-NTD interface, affects uncoating, and possesses broad-spectrum anti-HIV-1 activity.

Charcoal burning as a source of polyaromatic hydrocarbons in waterpipe smoking.

Polyaromatic hydrocarbons (PAH) content from seven commercial waterpipe charcoals were determined during the smoking process to estimate how much PAHs would not be trapped by the water trap and could reach the lungs of the smokers. Naphthalene, 2-methylnaphthalene, acenaphthylene, acenaphthene, phenanthrene and fluoranthene were the most abundant PAH compounds produced during smoking. Naphthalene was the highest in all of the smoke contents and levels of 5 to 405 µg/15 minutes could be inhaled by the smoker. The amounts of PAHs produced during the smoking events in absence of tobacco varied greatly among different brands of charcoal. The amount and composition of the emitted PAH were not related to the amount and composition of the original chemicals in the charcoal prior to burning. Our findings suggest that public health agencies should regulate smoked charcoal products alongside tobacco.

Association between spontaneous intracranial epidural hematoma and craniofacial infections: A systematic literature review.

Background: Spontaneous and nontraumatic epidural hematoma (SEDH) is a rare entity. Etiology is various, including vascular malformations of the dura mater, hemorrhagic tumors, and coagulation defects. The association between SEDH and craniofacial infections is rather unusual. Methods: We performed a systematic review of the available literature using the PubMed, Cochrane Library, and Scopus research databases. Literature research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We exclusively included studies reporting demographic and clinical data, published until October 31, 2022. We also report one case from our experience. Results: A total of 18 scientific publications, corresponding to 19 patients, met the inclusion criteria for the qualitative and quantitative analysis. Patients were mostly adolescents, with a clear male predominance. SEDHs frequently occurred in the frontal area, usually near the site of the infection. Surgical evacuation was the treatment of choice with good postoperative outcomes. Endoscopy of the involved paranasal sinus should be achieved as soon as possible to remove the cause of the SEDH. Conclusion: SEDH may occur as a rare and life-threatening complication of craniofacial infections; therefore, prompt recognition and treatment are mandatory.

Cortical atrophy in chronic subdural hematoma from ultra-structures to physical properties.

Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluate the extent of cortical atrophy, CT scan images were utilised to develop an index that is the ratio of the maximum diameter sum of 3 cisterns divided by the maximum diameter of the skull at the temporal lobe level. Also, we reported, for the first time, the ultrastructural analyses of the CSDH using a combination of immunohistochemistry methods and transmission electron microscopy techniques. Internal validation was performed to confirm the assessment of the different degrees of cortical atrophy. Relative Cortical Atrophy Index (RCA index) refers to the sum of the maximum diameter of three cisterns (insular cistern, longitudinal cerebral fissure and cerebral sulci greatest) with the temporal bones' greatest internal distance. This index, strongly related to age in healthy controls, is positively correlated to the preoperative and post-operative maximum diameter of hematoma and the midline shift in CSDH patients. On the contrary, it negatively correlates to the Karnofsky Performance Status (KPS). The Area Under the Receiver Operating Characteristics (AUROC) showed that RCA index effectively differentiated cases from controls. Immunohistochemistry analysis showed that the newly formed CD-31 positive microvessels are higher in number than the CD34-positive microvessels in the CSDH inner membrane than in the outer membrane. Ultrastructural observations highlight the presence of a chronic inflammatory state mainly in the CSDH inner membrane. Integrating these results, we have obtained an etiopathogenetic model of CSDH. Cortical atrophy appears to be the triggering factor activating the cascade of transendothelial cellular filtration, inflammation, membrane formation and neovascularisation leading to the CSDH formation.

"Catheter-Locking Device-Assisted" External Ventricular Drain Placement: A New Surgical Technique Preventing Intracranial Drain Displacement-Technical Note with Preliminary Single-Center Results.

Background External ventricular drain (EVD) placement is frequently performed in neurosurgical patients to divert cerebrospinal fluid (CSF) and monitor intracranial pressure. The traditional practice is the tunneled EVD technique performed in the operating room. EVD insertion through a bolt in intensive care units has also been reported. We describe here the usage of a novel technique, the " catheter-locking device -assisted" EVD placement, reporting our preliminary, observational single-center results. Methods From January to October 2021, 15 patients underwent a "catheter-locking device-assisted" EVD placement at our institute. For each of these patients, the following data were evaluated: (1) demographics, (2) etiology, (3) clinical presentation, (4) EVD complications, and (5) final clinical outcomes. Results Median age of our population was 64 years, with a female/male ratio of 2:1. Average Glasgow Coma Scale score on admission was 8. Each patient maintained the drainage for an average time of 14 days. None of the patients suffered from postoperative intracerebral hemorrhage, CSF leakage, catheter migration, or discontinuation of the drainage system; none developed signs of infection. Nine patients required a permanent CSF diversion system. Outcome was good in 14 patients. One patient died for the underlying disease. Conclusions The "catheter-locking device-assisted" EVD placement appears to be a safe and accurate alternative to both the standard tunneled and the bolt-assisted EVD insertion techniques. The use of this procedure may significantly reduce the incidence of the commonest EVD complications, though further investigation is required.

Extradural hemorrhagic spinal cavernous angioma in a paucisymptomatic child: A rare case with review of the current literature.

Background: Cavernous angiomas, also referred to as cavernous hemangiomas or cavernomas (CMs), are vascular malformative benign neoplasms that may develop in any part of the central nervous system. Spinal CMs are uncommon (overall incidence rate of 0.04-0.05%). Pure epidural CMs account for 1-2% of all spinal CMs and 4% of all spinal epidural tumors. Diagnosis is extremely rare in the pediatric age. To the best of our knowledge, only 10 cases have been described so far. The treatment of choice is microsurgical resection. Case Description: We describe here the rare case of a cervicothoracic hemorrhagic spinal epidural cavernoma in a paucisymptomatic, 8-year-old female Bangladeshi child. C7-T2 laminectomy with excision of a scarcely defined, capsulated dark red lesion was performed with good recovery. Conclusion: Spinal epidural cavernomas are rare. Childhood presentation is even rarer. The reason could be found in a greater "compliance" and to a rarer occurrence of acute bleeding in children, thus resulting in a delayed diagnosis. Surgical excision is the gold standard of treatment.

Temporal Horn Enlargements Predict Secondary Hydrocephalus Diagnosis Earlier than Evans' Index.

The aim of this study was to identify early radiological signs of secondary hydrocephalus. We retrieved neuroradiological data from scans performed at various times in patients who underwent surgery for secondary hydrocephalus due to severe traumatic brain injury (TBI), subarachnoid haemorrhage (SAH), or brain tumour (BT). Baseline measurements, performed on the earliest images acquired after the neurological event (T0), included Evans' index, the distance between frontal horns, and the widths of both temporal horns. The next neuroimage that showed an increase in at least one of these four parameters­and that lead the surgeon to act­was selected as an indication of ventricular enlargement (T1). Comparisons of T0 and T1 neuroimages showed increases in Evans' index, in the mean frontal horn distance, and in the mean right and left temporal horn widths. Interestingly, in T1 scans, mean Evans' index scores > 0.30 were only observed in patients with BT. However, the temporal horn widths increased up to ten-fold in most patients, independent of Evans' index scores. In conclusion temporal horn enlargements were the earliest, most sensitive findings in predicting ventricular enlargement secondary to TBI, SAH, or BT. To anticipate a secondary hydrocephalus radiological diagnosis, clinicians should measure both Evans' index and the temporal horn widths, to avoid severe disability and poor outcome related to temporal lobe damage.

Ruptured Brain Arteriovenous Malformations: Surgical Timing and Outcomes-A Retrospective Study of 25 Cases.

Background One important problem in treatment of ruptured brain arteriovenous malformations (bAVMs) is surgical timing. The aim of the study was to understand which parameters affect surgical timing and outcomes the most. Materials and Methods Between January 2010 and December 2018, 25 patients underwent surgery for a ruptured bAVM at our institute. Intracerebral hemorrhage (ICH) score was used to evaluate hemorrhage severity, while Spetzler-Martin scale for AVM architecture. We divided patients in two groups: "early surgery" and "delayed surgery." The modified Rankin Scale (mRS) evaluated the outcomes. Results Eleven patients were in the "early surgery" group: age 38 ± 18 years, Glasgow Coma Scale (GCS) 7.64 ± 2.86, ICH score 2.82 ± 0.71, hematoma volume 45.55 ± 23.21 mL. Infratentorial origin of hemorrhage was found in 27.3% cases; AVM grades were I to II in 82%, III in 9%, and IV in 9% cases. Outcome at 3 months was favorable in 36.4% cases and in 54.5% after 1 year. Fourteen patients were in the "delayed surgery" group: age 41 ± 16 years, GCS 13.21 ± 2.39, ICH score 1.14 ± 0.81, hematoma volume 29.89 ± 21.33 mL. Infratentorial origin of hemorrhage was found in 14.2% cases; AVM grades were I to II in 50% and III in 50%. Outcome at 3 months was favorable in 78.6% cases and in 92.8% after 1 year. Conclusions The early outcome is influenced more by the ICH score, while the delayed outcome by Spetzler-Martin grading. These results suggest that it is better to perform surgery after a rest period, away from the hemorrhage when possible. Moreover, this study suggests how in young patient with a high ICH score and a low AVM grade, early surgery seems to be a valid and feasible therapeutic strategy.

Retrospective and Randomized Analysis of Influence and Correlation of Clinical and Molecular Prognostic Factors in a Mono-Operative Series of 122 Patients with Glioblastoma Treated with STR or GTR.

Glioblastoma is a solid, infiltrating, and the most frequent highly malignant primary brain tumor. Our aim was to find the correlation between sex, age, preoperative Karnofsky performance status (KPS), presenting with seizures, and extent of resection (EOR) with overall survival (OS), progression-free survival (PFS), and postoperative KPS, along with the prognostic value of IDH1, MGMT, ATRX, EGFR, and TP53 genes mutations and of Ki67 through the analysis of a single-operator series in order to avoid the biases of a multi-operator series, such as the lack of homogeneity in surgical and adjuvant nonsurgical treatments. A randomized retrospective analysis of 122 patients treated by a single first operator at Sapienza University of Rome was carried out. After surgery, patients followed standard Stupp protocol treatment. Exclusion criteria were: (1) patients with primary brainstem and spinal cord gliomas and (2) patients who underwent partial resections (resection < 90%) or a biopsy exclusively for diagnostic purposes. Statistical analysis with a simultaneous regression model was carried out through the use of SPSS 25® (IBM). Results showed statistically significant survival increase in four groups: (1) patients treated with gross total resection (GTR) (p < 0.030); (2) patients with mutation of IDH1 (p < 0.0161); (3) patients with methylated MGMT promoter (p < 0.005); (4) patients without EGFR amplification or EGFRvIII mutation (p < 0.035). Higher but not statistically significant survival rates were also observed in: patients <75 years, patients presenting with seizures at diagnosis, patients affected by lesions in noneloquent areas, as well as in patients with ATRX gene mutation and Ki-67 < 10%.

Platelets and Their Pathways in Dentistry: Systematic Review.

Advancing research in medicine and technology has benefitted the mankind immensely with its contribution toward an improved life quality and increased life expectancy. The inability of a human body to autoregenerate has resulted in an increased demand for newer and healthier tissues and organs. Therefore, the restoration of naturally replicated tissue components has become a subject of interest for the scientific community lately. There was felt an intense quest for promoting strategies that could restore tissue regeneration and fuel the field of regenerative medicine. It was then the role of platelets was accounted for its wound healing and regenerative effects. Consequently, the use of platelet concentrates to improve wound healing, and bone formation was explored, which was considered to be possible because platelets contain high quantities of growth factors which would be able to stimulate cell proliferation, matrix remodeling, and angiogenesis, thereby establishing a new era of research with the successful application of innovative medical therapies focused on healing damaged tissues or regenerate the affected organs.

Phase selection during the crystallization of metal-organic frameworks; thermodynamic and kinetic factors in the lithium tartrate system.

We report the phase behaviour of chiral, racemic and meso-lithium tartrate frameworks, which was examined as a function of solvent system, temperature and ligand isomer. Through our comprehensive investigation of this system of 14 diverse phases, we have gained detailed insight into the effect of synthesis conditions on product structure, and elucidated the thermodynamic and kinetic factors involved in phase selection. Reactions in ethanol between lithium acetate and chiral, racemic and meso-tartaric acids give rise to anhydrous kinetic products; polymorphs with higher entropy tend to appear at high temperatures. Reactions at room temperature in water-ethanol mixtures give rise to hydrated kinetic products, including two new crystal structures, [Li2(D,L-tartrate)(H2O)2]n in P1 and [Li2(meso-tartrate)(H2O)(0.5)]n in C222(1), whose structures are contrasted with known anhydrous products. Reactions at elevated temperatures in water-ethanol mixtures result in the formation of low enthalpy, anhydrous products and, furthermore, the global minimum energy structure appears at high temperatures in all cases owing to in situ ligand isomerization.

Free Radical Scavenging and Antioxidant Activities of Silymarin Components.

Silymarin is an over the counter food supplement that is sold as a liver enhancement and liver protection preparation. It is a major constituent of the seeds of Silybum marianum which is composed of a mixture of seven major components and several minor compounds. The seven major components: taxifolin, silychristin, silydianin, silybin A, silybin B, iso-silybin A and iso-silybin B were isolated and purified from the crude mixture of silymarin using preparative high performance liquid chromatography to determine which were the most effective for liver protection. Free radical scavenging, hydroxyl radical antioxidant capacity, oxygen radical antioxidant capacity, trolox-equivalent antioxidant capacity and total antioxidant capacity antioxidant activities were determined for each of the individual purified components as well as the crude silymarin mixture. Taxifolin was the most effective component for scavenging free radicals in the DPPH assay with an EC50 of 32 µM far more effective than all other components which showed EC50 ranging from 115 to 855 µM. Taxifolin was also found to be the most effective antioxidant in the oxygen radical antioxidant capacity (ORAC) assay with a trolox equivalent of 2.43 and the second most effective in the hydroxyl radical antioxidant capacity (HORAC) assay with a gallic acid equivalent of 0.57. Other antioxidants assays did not show significant differences between samples.

Antioxidant and Anti-Hepatitis C Viral Activities of Commercial Milk Thistle Food Supplements.

Milk thistle dietary supplements that contain silymarin are widely marketed and used in the USA and other countries for liver enhancement and recovery. More recently, silymarin has also been identified as a possible antiviral for the treatment of hepatitis C virus (HCV) infection. To assess different brands of commercially sold silymarin, 45 products were collected from local stores and analyzed for their silymarin content, antioxidant activities, and antiviral activity against HCV. Antioxidant activity was measured as radical scavenging activity using DPPH and by estimating their antioxidant capacity as trolox equivalent. Anti-HCV activity was measured in an HCV genotype 1b replication inhibition assay. Samples were found to vary widely in their silymarin content, with some samples having none or very low concentrations while silymarin represented higher than 80% of other samples. Both antioxidant and anti-HCV activity correlated with the overall level of silymarin.

Chair-based exercises for frail older people: a systematic review.

INTRODUCTION: Frail older people are often unable to undertake high-intensity exercise programmes. Chair-based exercises (CBEs) are used as an alternative, for which health benefits are uncertain. OBJECTIVE: To examine the effects of CBE programmes for frail older people through a systematic review of existing literature. METHOD: A systematic search was performed for CBE-controlled trials in frail populations aged ≥65 years published between 1990 and February 2011 in electronic databases. Quality was assessed using the Jadad method. RESULTS: The search identified 164 references: with 42 duplicates removed, 122 reviewed, 116 excluded, and 6 analysed. 26 outcome measures were reported measuring 3 domains: mobility and function, cardiorespiratory fitness, mental health. All studies were of low methodological quality (Jadad score ≤2; possible range 0-5). Two studies showed no benefit, and four reported some evidence of benefit in all three domains. No harmful effects were reported; compliance was generally good. CONCLUSION: The quality of the evidence base for CBEs is low with inconclusive findings to clearly inform practice. A consensus is required on the definition and purpose of CBEs. Large well-designed randomised controlled trials to test the effectiveness of CBE are justified.