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INTRODUCTION: Chronic kidney disease (CKD) has no expectation of cure, therefore, the treatment is based on maintaining the chronic state of the disease, through renal replacement therapies, such as hemodialysis or kidney transplant. The CKD can compromise occupational performance, since the beginning of hemodialysis, adapta- tion to new life habits is required. OBJECTIVE: To analyze the effects of bright light on occupational performance of elderly people with end-stage renal disease (ESRD) on hemodialysis in the state of Ceará, aiming at its impact on the quality of life of these patients. METHOD: Randomized, placebo-controlled clinical trial with and qualitative- quantitative approach, with the use of bright light or placebo light in their homes for 30 minutes, for 4 weeks in the afternoon. From this perspective, the evaluation instruments were used before and after the light: The Dynamic Lowenstein Occupational Therapy Cognitive Assessment for Geriatric Population (DLOTCA-G) adapted version for the Portuguese language. The sample consisted of 26 elderly people on dialysis, and the col- lection period comprised the months of August 2022 to May 2023. RESULTS: They were 69% (18/26) male and between 60 and 94 years old. The analysis of the impacts of such equipment on these individuals' memory, mental operations and visual-motor skills re- vealed that the bright light group had better results than the placebo group (linear regres- sion, p<0.001). CONCLUSIONS: Bright light exposure therapy proved to be very bene- ficial, especially for the memory and mediation of these elderly people, thus reflecting on the improvement of their quality of life.
INTRODUÇÃO: A doença renal crônica (DRC) não possui expectativa de cura, portanto, o tratamento baseia-se na manutenção do estado crônico da doença, por meio de terapias renais substitutivas, como a hemodiálise e transplante renal. A DRC pode comprometer o desempenho ocupacional, pois desde o início da hemodiálise é necessária a adaptação a novos hábitos de vida. OBJETIVO: Analisar os efeitos da luz brilhante no desempenho ocupacional de idosos com doença renal crônica terminal (DRCT) em hemodiálise no estado do Ceará, visando seu impacto na qualidade de vida desses pacientes. MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado com placebo, com abordagem qualiquantitativa onde a coleta de dados baseou-se na aplicação do DLOTCA-G- Dynamic Lowenstein Occupational Therapy Cognitive As- sessment for Geriatric Population em clínicas de hemodiálise, antes e depois do fornecimento da caixa de luz brilhante ou luz placebo. A amostra consistiu em 26 pacientes distribuídos em dois grupos (luz brilhante e placebo) aleatoriamente com idade mínima de 60 e máxima de 94. RESULTADOS: 69% (18/26) eram do sexo masculino e tinham entre 60 e 94 anos. A análise dos impactos desses equipamentos sobre a memória, as operações mentais e as habilidades visuomotoras desses indivíduos revelou que o grupo luz brilhante apresentou melhores resultados do que o grupo placebo (regressão linear, p<0,001). CONCLUSÕES: A terapia de exposição à luz brilhante mostrou-se muito benéfica, principalmente para a memória e mediação desses idosos, refletindo na melhora de sua qualidade de vida.
INTRODUCCIÓN: La enfermedad renal crónica (ERC) no tiene expectativa de curación, por lo tanto, el tratamiento se basa en mantener el estado crónico de la enfermedad, a través de terapias de reemplazo renal, como la hemodiálisis o el trasplante renal. La ERC puede comprometer el rendimiento ocupacional, ya que al inicio de la hemodiálisis se requiere adaptación a nuevos hábitos de vida. OBJETIVO: Analizar los efectos de la luz brillante sobre el rendimiento laboral de ancianos con enfermedad renal terminal (ERT) en hemodiálisis en el estado de Ceará, con el objetivo de conocer su impacto en la calidad de vida de estos pacientes. MÉTODO: Ensayo clínico aleatorizado, controlado con placebo, con enfoque cualitativo-cuantitativo, con el uso de luz brillante o luz placebo en sus hogares durante 30 minutos, durante 4 semanas por la tarde. Desde esta perspectiva, se utilizaron los instrumentos de evaluación antes y después de la luz: La Evaluación Cognitiva de la Terapia Ocupacional Dinámica de Lowenstein - Población Geriátrica (DLOTCA-G) versión adaptada para el idioma portugués. La muestra estuvo conformada por 26 adultos mayores en diálisis, y el periodo de recolección comprendió los meses de agosto de 2022 a mayo de 2023. RESULTADOS: 69% (18/26) varones y entre 60 y 94 años. El análisis de los impactos de dichos equipos sobre la memoria, las operaciones mentales y las habilidades visual-motoras de estos individuos reveló que el grupo de luz brillante tuvo mejores resultados que el grupo placebo (regresión lineal, p<0,001). CONCLUSIONES: La terapia de exposición a la luz brillante demostró ser muy beneficiosa, especialmente para la memoria y mediación de estas personas mayores, reflejando así la mejora de su calidad de vida.
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Objective:To evaluate the effects of noise, bright light and mechanical stimulation on sleep, blood-brain barrier and cognitive function in septic rats.Methods:Forty male Sprague-Dawley (SD) rats were selected and intraperitoneal injection of 10 mg/kg lipopolysaccharide (LPS) was used to establish sepsis model. 0, 30, 45, 60, 75 dB noise stimulation or 0, 50, 100, 200, 400 Lux light stimulation were given to rats (all n = 4). The serum levels of cortisol and melatonin, and the cerebral content of Evans blue (EB) were measured 96 hours after the stimulation to determine the optimal intensity of intervention. The other 40 SD rats were randomly divided into control group (Con group), LPS group, noise intervention group (LPS+60 dB group), 200 Lux light intervention group (LPS+200 Lux group) and mechanical stimulation group (LPS+MS group), with 8 rats in each group. The open fields test and fear conditioning test were used to evaluate the exploratory behavior and cognitive function 96 hours after corresponding stimulation. The enzyme linked immunosorbent assay (ELISA) was used to detect cerebral level of interleukin-6 (IL-6) and serum levels of cortisol and melatonin. The blood-brain barrier integrity was assessed by EB staining. The protein levels of ZO-1, Claudin-5 and caspase-3 in the hippocampus were detected by Western blotting to assess the blood-brain barrier integrity and neuronal apoptosis. Results:Compared with 0 dB group or 0 Lux group, the serum melatonin concentration in 60 dB group and 200 Lux group were significantly reduced, while the serum cortisol concentration and cerebral EB content were significantly increased. Therefore, 60 dB noise and 200 Lux light were selected in the subsequent experiments. Compared with Con group, the horizontal score and vertical score in the open field test in LPS group were significantly decreased. There were no significant differences in the proportion of freezing time, the cerebral contents of EB and IL-6, the serum levels of melatonin and cortisol, and the hippocampal expressions of ZO-1, Claudin-5 and caspase-3. Compared with LPS group, the horizontal score, vertical score and the percentage of freezing time in LPS+60 dB group, LPS+200 Lux group and LPS+MS group were significantly reduced [horizontal score: 73.8±9.7, 80.3±9.4, 64.5±8.3 vs. 103.6±15.5; vertical score: 9.4±1.7, 11.2±1.9, 6.8±0.9 vs. 15.9±2.8; the percentage of freezing time: (45.3±4.7)%, (53.3±5.8)%, (42.1±5.1)% vs. (66.1±6.3)%], the serum level of melatonin was significantly decreased (ng/L: 53.62±6.20, 44.25±6.41, 45.33±5.84 vs. 74.39±7.54), the serum level of cortisol was significantly increased (nmol/L: 818.34±95.53, 710.04±65.41, 989.73±91.63 vs. 398.82±72.59), the levels of EB, IL-6 in the brain tissue were significantly increased [EB (μg/g): 2.80±0.35, 2.38±0.31, 3.24±0.42 vs. 1.59±0.26; IL-6 (ng/g): 31.56±4.11, 26.69±3.75, 37.47±4.56 vs. 16.28±2.69], the expressions of ZO-1 and Claudin-5 were significantly decreased (ZO-1/β-actin: 0.37±0.04, 0.32±0.05, 0.24±0.04 vs. 0.80±0.09; Claudin-5/β-actin: 0.62±0.08, 0.47±0.06, 0.35±0.05 vs. 0.97±0.20), and the expression of cleaved caspase-3 was significantly increased (caspase-3/β-actin: 0.56±0.06, 0.39±0.04, 0.72±0.12 vs. 0.20±0.03), with statistically significant differences (all P < 0.05). Conclusion:60 dB noise, 200 Lux light or mechanical stimulation for 96 hours could inhibit the secretion of serum melatonin, promote the secretion of cortisol, and activate neuroinflammation in septic rats, and lead to neuronal apoptosis in hippocampus and hyper-permeability of blood-brain barrier, which in turn could cause sleep disturbance and cognitive impairment.
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OBJECTIVE: This study protocol aims to determine, using a rigorous approach in patients with bipolar disorder (BD) and non-seasonal major depressive episode (MDE), the characteristics of bright light therapy (BLT) administration (duration, escalation, morning and mid-day exposures) depending on the tolerance (hypomanic symptoms). METHODS: Patients with BD I or II and treated by a mood stabilizer are eligible. After 1 week of placebo, patients are randomized between either morning or mid-day exposure for 10 weeks of active BLT with glasses using a dose escalation at 7.5, 10, 15, 30 and 45 minutes/day. A further follow-up visit is planned 6 months after inclusion. Patients will be included by cohorts of 3, with at least 3 days of delay between them, and 1 week between cohorts. If none meet a dose limiting toxicity (DLT; i.e hypomanic symptoms), the initiation dose of the next cohort will be increased. If one patient meet a DLT, an additionnal cohort will start at the same dose. If 2 or 3 patients meet a DLT, from the same cohort or from two cohorts at the same dose initiation, the maximum tolerated dose is defined. This dose escalation will also take into account DLTs observed during the intra-subject escalation on previous cohorts, with a “Target Ceiling Dose” defined if 2 DLTs occured at a dose. DISCUSSION: Using an innovative and more ergonomic device in the form of glasses, this study aims to better codify the use of BLT in BD to ensure a good initiation and tolerance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03396744.
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Humanos , Trastorno Bipolar , Ritmo Circadiano , Estudios de Cohortes , Anteojos , Estudios de Seguimiento , Vidrio , Dosis Máxima Tolerada , FototerapiaRESUMEN
Objective To explore whether perioperative bright light therapy could inhibit the occurrence of postoperative delirium in tumor patients undergoing open hepatobiliary surgery. Methods Totally120 elderly tumor patients scheduled for open hepatobiliary surgery and postoperative ICU treatment were recruited and randomized into bright light and control group with 60 cases per group in accordance with the random number table.Bright light was delivered to the patients at an intensity of 10 000 lux from 2 days before surgery to postoperative day 7.Each intervention began at 7 am and lasted for 2 hours.Delirium was screened using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU) during the first 7 days after surgery. The differences in the incidence of postoperative delirium, the duration of delirium and the length of ICU as well as postoperative hospital stay were compared. Results Demographic characteristics and surgical outcomes were similar between groups. The incidence of postoperative delirium were 46.67%(28/60)and 23.33%(14/60)for control group and bright light group respectively with a significant difference (χ2=7.179,P=0.007). The difference was seen on postoperative days 3 (χ2=5.187, P = 0.023) and 4 (χ2=8.749,P = 0.003). The incidences of delirium on postoperative days 3 for bright light and control group were 5.08%(3/59)and 18.64%(11/59)respectively.On postoperative day 4, the incidences of delirium for bright light and control group were 0 (0/58) and 14.04% (8/57) respectively.There was no difference in the duration of delirium(χ2=1.248,P=0.264),the length of ICU stay (χ2=0.036,P=0.849)or the hospital stay(χ2=1.706,P=0.192). Conclusion Bright light is useful in preventing postoperative delirium in elderly tumor patients undergoing open hepatobiliary surgery.
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The light therapy has been known to be effective to non-seasonal affective disorder as well as seasonal affective disorder. Although the mechanism of action of light therapy for depressive disorder has not been verified yet, its clinical application revealed similar effects like antidepressants and relatively smaller side effects. However, it is not common to apply the light therapy for treatment resistant depressive disorder. This case report indicates a robust efficacy of light therapy and its clinical usefulness, illustrating the complete remission in a treatment resistant patient with major depressive disorder after bright light therapy.