[Translated article] Pericapsular nerves block (PENG) is an effective and safe alternative for postoperative pain management after primary total hip arthroplasty: A randomised clinical trial.

BACKGROUND: Postoperative pain after total hip arthroplasty can affect postoperative rehabilitation and delay hospital discharge. The objective of this study is to compare pericapsular nerves group (PENG) block with pericapsular infiltration (PAI) and plexus nerve block (PNB) for postoperative pain management, response to physical therapy, opioid consumption, and length of hospital stay after a primary total hip arthroplasty. METHODS: Randomised clinical trial of parallel and blinded groups was performed. Sixty patients who underwent elective THA between December 2018 and July 2020 were randomised into the different groups (PENG, PAI and PNB). The visual analogue scale was used to assess pain; and motor function was measured with the Bromage scale. We also record opioid usage, length of hospital stay, and related medical complications. RESULTS: Pain level at discharge was similar in all groups. Hospital stay was 1 day shorter in the PENG group (p<0.001) and they also had lower opioid consumption (p=0.044). Optimal motor recovery was similar in the groups (p=0.678). Pain control when performing physical therapy was better in the PENG group (p<0.0001). CONCLUSIONS: PENG block is an effective and safe alternative for patients undergoing THA as it reduces opioid consumption and hospital stay compared to other analgesic methods.

Pericapsular nerves block (PENG) is an effective and safe alternative for postoperative pain management after primary total hip arthroplasty: A randomized clinical trial. / El bloqueo de nervios pericapsulares (PENG) es una alternativa efectiva y segura para el manejo del dolor postoperatorio después de una artroplastia total de cadera primaria: ensayo clínico aleatorizado.

BACKGROUND: Postoperative pain after total hip arthroplasty can affect postoperative rehabilitation and delay hospital discharge. The objective of this study is to compare pericapsular nerves group (PENG) block with pericapsular infiltration (PAI) and plexus nerve block (PNB) for postoperative pain management, response to physical therapy, opioid consumption, and length of hospital stay after a primary total hip arthroplasty. METHODS: Randomized clinical trial of parallel and blinded groups was performed. Sixty patients who underwent elective THA between December 2018 and July 2020 were randomized into the different groups (PENG, PAI and PNB). The visual analog scale was used to assess pain; and motor function was measured with the Bromage scale. We also record opioid usage, length of hospital stay, and related medical complications. RESULTS: Pain level at discharge was similar in all groups. Hospital stay was 1 day shorter in the PENG group (p<0.001) and they also had lower opioid consumption (p=0.044). Optimal motor recovery was similar in the groups (p=0.678). Pain control when performing physical therapy was better in the PENG group (p<0.0001). CONCLUSIONS: PENG block is an effective and safe alternative for patients undergoing THA as it reduces opioid consumption and hospital stay compared to other analgesic methods.

Eficácia da suplementação oral com 1, 3-1, 6 betaglucano proveniente de Saccharomyces cerevisiae no controle da mastite bovina / [Efficiency of oral supplementation of 1. 3-1. 6 beta-glucan from saccharomyces cerevisiae on the control of bovine mastitis]

A mastite bovina, uma das principais doenças do rebanho leiteiro, caracteriza-se por um processo inflamatório no úbere. A inviabilidade econômica, o impacto ambiental negativo e os resíduos antimicrobianos têm estimulado a pesquisa de outros tratamentos alternativos para a prevenção e o tratamento de doenças na bovinocultura leiteira. O betaglucano é um agente imunomodulador com potencial ação preventiva para doenças infecciosas, inclusive a mastite. Este estudo teve como objetivo avaliar a eficácia do uso do betaglucano, por meio de administração oral, em animais em lactação. Foram utilizadas 20 vacas lactantes, distribuídas em dois grupos, um controle e um tratamento, com 10 animais em cada grupo. O grupo tratamento recebeu 5g/dia, durante 60 dias, de 1,3-1,6 betaglucano isolado da parede celular de Saccharomyces cerevisiae diluído em ração após a ordenha, enquanto o grupo controle recebia somente a ração. Foram realizados os testes de California Mastitis Test (CMT), contagem de células somáticas (CCS), produção de leite e percentual de gordura e proteína no leite. Não houve diferença estatisticamente significativa entre os grupos quanto à CCS, ao CMT, à composição do leite ou produção. Não se observou, portanto, eficácia do uso do betaglucano purificado, administrado por via oral, no controle e na prevenção da mastite em vacas leiteiras, quando comparadas com o grupo controle. Atribuem-se esses resultados, principalmente, à degradação ruminal do produto testado. Sugerem-se, portanto, mais pesquisas utilizando o 1,3-1,6 betaglucano purificado de parede de S. cerevisiae por outras vias de administração, tais como intramamária e subcutânea.(AU)

Bovine mastitis, one of the main diseases of dairy herds, is characterized by an inflammatory process in the udder. The economic and environmental impacts, as well as the residues of antimicrobial drugs have stimulated the research of novel alternative treatments for the prevention and treatment of diseases in dairy production cows. The beta-glucan is an immunomodulator agent, with potential preventive action for infectious diseases, including mastitis. This study aimed to assess the effectiveness of orally administered beta-glucan in lactating cows. 20 lactating cows were used, distributed into two groups, one control and one treatment, with 10 cows in each group. The treatment group received 5g of 1.3-1.6 betaglucan daily for 60 days, isolated from the cell-wall of Saccharomyces cerevisiae diluted into a grain meal, whereas the animals in the control group received only the ration. The California Mastitis Test (CMT), Somatic Cells Counting (SCC), daily production and assessments of fat and protein content in milk were done. There was no statistically significant difference between the groups concerning subclinical mastitis detected by CMT, SCC, milk production and composition regarding protein and fat content. It was not observed, therefore, the effectiveness of the use of purified beta-glucan orally administered on the control or prevention of mastitis in dairy cows. The results are attributed to the ruminal degradation of the product tested. It is, therefore, suggested that more research should be conducted using the 1.3-1.6 beta-glucan purified from the cell wall of S. cerevisiae by other administration means and ruminal protection technologies for the isolated beta-glucan.(AU)

The potential role of psychosocial rehabilitation in palliative care.

Palliative care is an approach to incurable and/or severe disease with limited prognosis, aiming to relieve the suffering and improve the quality of life of patients and their families. The existence of psychopathology is common in patients undergoing palliative care, and psychiatric comorbidities, such as depression and anxiety, are frequent and often underdiagnosed. This work constitutes a review of the literature and a reflection on the potential role of psychosocial rehabilitation in mental health in palliative care. Psychosocial rehabilitation may play a role in the mental health of patients undergoing palliative care, contributing to the minimisation of symptoms, support in daily life activities, the improvement of quality of life and the preparation for death.

Extended gamma-ray sources around pulsars constrain the origin of the positron flux at Earth.

The unexpectedly high flux of cosmic-ray positrons detected at Earth may originate from nearby astrophysical sources, dark matter, or unknown processes of cosmic-ray secondary production. We report the detection, using the High-Altitude Water Cherenkov Observatory (HAWC), of extended tera-electron volt gamma-ray emission coincident with the locations of two nearby middle-aged pulsars (Geminga and PSR B0656+14). The HAWC observations demonstrate that these pulsars are indeed local sources of accelerated leptons, but the measured tera-electron volt emission profile constrains the diffusion of particles away from these sources to be much slower than previously assumed. We demonstrate that the leptons emitted by these objects are therefore unlikely to be the origin of the excess positrons, which may have a more exotic origin.

An attempt to replace an ivermectin-resistant Cooperia spp. population by a susceptible one on grazing pastures based on epidemiological principles and refugia management.

The maintenance of anthelmintic-susceptible parasite refugia to delay the onset of anthelmintic resistance is an almost impossible effort in many grazing livestock production countries given that current refugia consist of already resistant parasites. Rather, efforts could be focused on replacing the resistant parasite refugia by susceptible parasite ones and implementing sustainable parasite control measures from then on. To this purpose, a trial was conducted to attempt to establish a new population of ivermectin-susceptible Cooperia sp. on a beef cattle farm with proven problems of ivermectin-resistant Cooperia. During two consecutive years, 82 (Year 1) and 100 (Year 2) recently weaned and parasite-free heifers were inoculated with 40,000 or 30,000 susceptible Cooperia L3, respectively, at a time when levels of resistant parasite refugia were normally low. The animals were subsequently allowed to graze on the problem pastures during autumn until the end of spring. Levels of parasitism in the animals and on pasture were monitored monthly and animals were treated with levamisole when needed. The combination of parasitological monitoring and local epidemiological knowledge was essential to determine when treatments were to be administered. No clinical signs of gastrointestinal parasitosis in the herd were observed throughout the study and unnecessary treatments were avoided. Faecal egg counts reduction tests (FECRT) and controlled efficacy tests (CET) employing worm counts were carried out at different times throughout the study to determine the clinical efficacy (FECRT) and the absolute efficacy (CET) of ivermectin, respectively. The clinical efficacy of ivermectin increased from an initial 73% to 99.4%, while the absolute efficacy increased from 54.1% to 87.5% after just two animal production cycles. The switch from a resistant parasite population to a susceptible one requires knowledge of parasitological epidemiology, especially in relation to seasonal variations of parasite populations in both the host and in refugia.

Analysis of the HLA population data (AHPD) submitted to the 15th International Histocompatibility/Immunogenetics Workshop by using the Gene[rate] computer tools accommodating ambiguous data (AHPD project report).

During the 15th International Histocompatibility and Immunogenetics Workshop (IHIWS), 14 human leukocyte antigen (HLA) laboratories participated in the Analysis of HLA Population Data (AHPD) project where 18 new population samples were analyzed statistically and compared with data available from previous workshops. To that aim, an original methodology was developed and used (i) to estimate frequencies by taking into account ambiguous genotypic data, (ii) to test for Hardy-Weinberg equilibrium (HWE) by using a nested likelihood ratio test involving a parameter accounting for HWE deviations, (iii) to test for selective neutrality by using a resampling algorithm, and (iv) to provide explicit graphical representations including allele frequencies and basic statistics for each series of data. A total of 66 data series (1-7 loci per population) were analyzed with this standard approach. Frequency estimates were compliant with HWE in all but one population of mixed stem cell donors. Neutrality testing confirmed the observation of heterozygote excess at all HLA loci, although a significant deviation was established in only a few cases. Population comparisons showed that HLA genetic patterns were mostly shaped by geographic and/or linguistic differentiations in Africa and Europe, but not in America where both genetic drift in isolated populations and gene flow in admixed populations led to a more complex genetic structure. Overall, a fruitful collaboration between HLA typing laboratories and population geneticists allowed finding useful solutions to the problem of estimating gene frequencies and testing basic population diversity statistics on highly complex HLA data (high numbers of alleles and ambiguities), with promising applications in either anthropological, epidemiological, or transplantation studies.

Effects of calcium pyruvate supplementation during training on body composition, exercise capacity, and metabolic responses to exercise.

OBJECTIVE: We evaluated the effects of calcium pyruvate supplementation during training on body composition and metabolic responses to exercise. METHODS: Twenty-three untrained females were matched and assigned to ingest in a double blind and randomized manner either 5 g of calcium pyruvate (PYR) or a placebo (PL) twice daily for 30 d while participating in a supervised exercise program. Prior to and following supplementation, subjects had body composition determined via hydrodensiometry; performed a maximal cardiopulmonary exercise test; and performed a 45-min walk test at 70% of pre-training VO2 max in which fasting pre- and post exercise blood samples determined. RESULTS: No significant differences were observed between groups in energy intake or training volume. Univariate repeated measures ANOVA revealed that subjects in the PYR group gained less weight (PL 1.2 +/- 0.3, PYR 0.3 +/- 0.3 kg, P = 0.04), lost more fat (PL 1.1 +/- 0.5; PYR -0.4 +/- 0.5 kg, P = 0.03), and tended to lose a greater percentage of body fat (PL 1.0 +/- 0.7; PYR -0.65 +/- 0.6%, P = 0.07), with no differences observed in fat-free mass (PL 0.1 +/- 0.5; PYR 0.7 +/- 0.3 kg, P = 0.29). However, these changes were not significant when body composition data were analyzed by MANOVA (P = 0.16). There was some evidence that PYR may negate some of the beneficial effects of exercise on HDL values. No significant differences were observed between groups in maximal exercise responses or metabolic responses to submaximal walking. CONCLUSIONS: Results indicate that PYR supplementation during training does not significantly affect body composition or exercise performance and may negatively affect some blood lipid levels.

Effects of ribose supplementation prior to and during intense exercise on anaerobic capacity and metabolic markers.

This study examined whether ribose supplementation before and during intense anaerobic exercise impacts anaerobic capacity and metabolic markers. Twelve moderately trained male cyclists (22.3 +/- 2.2 y; 181 +/- 6 cm, 74.8 +/- 9 kg) participated in the study. Subjects were familiarized and fasted for 8 h after standardizing nutritional intake. In a double blind and crossover manner subjects ingested either a 150 mL placebo or ribose (3 g ribose + 150 microg folate). Subjects rested for 25 min and completed 5 x 30 s anaerobic capacity tests with 3 min passive rest. Six capillary blood samples were taken prior to and after sprints for adenine nucleotide breakdown determination. The experiment was repeated 1 wk later with alternative drink. Data were analyzed by repeated measures ANOVA. No significant interactions were observed for any performance or blood variables. D-ribose supplementation has no impact on anaerobic exercise capacity and metabolic markers after high-intensity cycling exercise.

Effects of oral D-ribose supplementation on anaerobic capacity and selected metabolic markers in healthy males.

Oral D-ribose supplementation has been reported to increase adenine nucleotide synthesis and exercise capacity in certain clinical populations. Theoretically, increasing adenine nucleotide availability may enhance high intensity exercise capacity. This study evaluated the potential ergogenic value of D-ribose supplementation on repetitive high-intensity exercise capacity in 19 trained males. Subjects were familiarized to the testing protocol and performed two practice-testing trials before pre-supplementation testing. Each test involved warming up for 5 min on a cycle ergometer and then performing two 30-s Wingate anaerobic sprint tests on a computerized cycle ergometer separated by 3 min of rest recovery. In the pre- and post-supplementation trials, blood samples were obtained at rest, immediately following the first and second sprints, and following 5 min of recovery from exercise. Subjects were then matched according to body mass and anaerobic capacity and assigned to ingest, in a randomized and double blind manner, capsules containing either 5 g of a dextrose placebo (P) or D-ribose (R) twice daily (10 g/d) for 5 d. Subjects then performed post-supplementation tests on the 6th day. Data were analyzed by ANOVA for repeated measures. Results revealed a significant interaction (p =.04) in total work output. Post hoc analysis revealed that work significantly declined (-18 +/- 51 J) during the second post-supplementation sprint in the P group while being maintained in the R group (-0.0 +/- 31 J). No significant interactions were observed in peak power, average power, torque, fatigue index, lactate, ammonia, glucose, or uric acid. Results indicate that oral ribose supplementation (10 g/d for 5 d) does not affect anaerobic exercise capacity or metabolic markers in trained subjects as evaluated in this study.

Effects of calcium beta-hydroxy-beta-methylbutyrate (HMB) supplementation during resistance-training on markers of catabolism, body composition and strength.

Calcium beta-hydroxy-beta-methylbutyrate (HMB) supplementation has been reported to reduce muscle catabolism and promote gains in fat-free mass and strength in subjects initiating training. However, whether HMB supplementation promotes these adaptations in trained athletes is less clear. This study examined the effects of HMB (as the calcium salt) supplementation during resistance training (6.9+/-0.7 hr x wk(-1)) on markers of catabolism, body composition and strength in experienced resistance-trained males. In a double-blind and randomized manner, 40 experienced resistance-trained athletes were matched and assigned to supplement their diet for 28 d with a fortified carbohydrate/protein powder containing either 0, 3 or 6 g x d(-1) of calcium HMB. Fasting venous blood and urine samples, dual energy X-ray absorptiometer-determined body composition, and isotonic bench press and leg press one repetition maximums (1 RM) were determined prior to and following 28 d of supplementation. HMB supplementation resulted in significant increases in serum and urinary HMB concentrations. However, no statistically significant differences were observed in general markers of whole body anabolic/catabolic status, muscle and liver enzyme efflux, fat/bone-free mass, fat mass, percent body fat, or 1 RM strength. Results indicate that 28 d of HMB supplementation (3 to 6 g x d(-1)) during resistance-training does not reduce catabolism or affect training-induced changes in body composition and strength in experienced resistance-trained males.

Effects of creatine supplementation on body composition, strength, and sprint performance.

PURPOSE: To determine the effects of 28 d of creatine supplementation during training on body composition, strength, sprint performance, and hematological profiles. METHODS: In a double-blind and randomized manner, 25 NCAA division IA football players were matched-paired and assigned to supplement their diet for 28 d during resistance/agility training (8 h x wk[-1]) with a Phosphagen HP (Experimental and Applied Sciences, Golden, CO) placebo (P) containing 99 g x d(-1) of glucose, 3 g x d(-1) of taurine, 1.1 g x d(-1) of disodium phosphate, and 1.2 g x d(-1) of potassium phosphate (P) or Phosphagen HP containing the P with 15.75 g x d(-1) of HPCE pure creatine monohydrate (HP). Before and after supplementation, fasting blood samples were obtained; total body weight, total body water, and body composition were determined; subjects performed a maximal repetition test on the isotonic bench press, squat, and power clean; and subjects performed a cycle ergometer sprint test (12 x 6-s sprints with 30-s rest recovery). RESULTS: Hematological parameters remained within normal clinical limits for active individuals with no side effects reported. Total body weight significantly increased (P < 0.05) in the HP group (P 0.85 +/- 2.2; HP 2.42 +/- 1.4 kg) while no differences were observed in the percentage of total body water. DEXA scanned body mass (P 0.77 +/- 1.8; HP 2.22 +/- 1.5 kg) and fat/bone-free mass (P 1.33 +/- 1.1; HP 2.43 +/- 1.4 kg) were significantly increased in the HP group. Gains in bench press lifting volume (P -5 +/- 134; HP 225 +/- 246 kg), the sum of bench press, squat, and power clean lifting volume (P 1,105 +/- 429; HP 1,558 +/- 645 kg), and total work performed during the first five 6-s sprints was significantly greater in the HP group. CONCLUSION: The addition of creatine to the glucose/taurine/electrolyte supplement promoted greater gains in fat/bone-free mass, isotonic lifting volume, and sprint performance during intense resistance/agility training.

Effects of creatine supplementation on repetitive sprint performance and body composition in competitive swimmers.

In a double-blind and randomized manner, 18 male and female junior competitive swimmers supplemented their diets with 21 g.day-1 of creatine monohydrate (Cr) or a maltodextrin placebo (P) for 9 days during training. Prior to and following supplementation, subjects performed three 100-m freestyle sprint swims (long course) with 60 s rest/recovery between heats. In addition, subjects performed three 20-s arm ergometer maximal-effort sprint tests in the prone position with 60 s rest/recovery between sprint tests. Significant differences were observed among swim times, with Cr subjects swimming significantly faster than P subjects following supplementation in Heat 1 and significantly decreasing swim time in the second 100-m sprint. There was also some evidence that cumulative time to perform the three 100-m swims was decreased in the Cr group. Results indicate that 9 days of Cr supplementation during swim training may provide some ergogenic value to competitive junior swimmers during repetitive sprint performance.

The effect of oral creatine monohydrate supplementation on running velocity.

Creatine supplementation has been shown to augment muscle PCr content and increase the rate of ATP resynthesis. Thus, we hypothesized that creatine supplementation might enhance sprinting performance. Eighteen subjects completed both of two testing sessions (control and postsupplement) 1 week apart, wherein they sprinted three 60-m distance trials that were recorded with videotape. Following the control session, for 7 days, subjects in the treatment group ingested a creatine-glucose mixture, while the placebo group consumed a glucose powder, followed by the postsupplementation session. Velocities of the subjects through three testing zones within the 60-m sprint were calculated from the videotape. Resultant velocities were analyzed using a MANOVA with a 2 x 2 x 3 x 3 (Group x Session x Trial x Zone) design. Results indicated that there were no statistically significant main or interaction effects on velocity between groups for session, trial, or zone. These data do not support the hypothesis that supplementary creatine ingestion will enhance velocity during the early or latter segments of a 60-m sprint.

Effects of ingesting supplements designed to promote lean tissue accretion on body composition during resistance training.

This study examined the effects of ingesting nutritional supplements designed to promote lean tissue accretion on body composition alterations during resistance training. Twenty-eight resistance-trained males blindly supplemented their diets with maltodextrin (M), Gainers Fuel 1000 (GF), or Phosphagain (P). No significant differences were observed in absolute or relative total body water among groups. Energy intake and body weight significantly increased in all groups combined throughout the study with no group or interaction differences observed. Dual energy x-ray absorptiometry-determined body mass significantly increased in each group throughout the study with significantly greater gains observed in the GF and P groups. Lean tissue mass (excluding bone) gain was significantly greater in the P group, while fat mass and percent body fat were significantly increased in the GF group. Results indicate that total body weight significantly increased in each group and that P supplementation resulted in significantly greater gains in lean tissue mass during resistance training.

High-performance capillary electrophoresis-pure creatine monohydrate reduces blood lipids in men and women.

1. A randomized, double-blind, placebo-controlled trial utilizing creatine as a potential lipid-lowering agent was conducted to determine plasma lipid, lipoprotein, glucose, urea nitrogen and creatinine profiles in men and women ranging in age from 32 to 70 years. 2. Thirty-four subjects (18 men and 16 women) with total cholesterol concentrations exceeding 200 mg/dl received either a creatine supplement (5 g of creatine plus 1 g of glucose) or a glucose placebo (6 g of glucose) for 56 days. Creatine and placebo were taken orally four times a day for 5 days and then twice a day for 51 days. Plasma analyses were measured at baseline, 4 and 8 weeks of treatment, and at 4 weeks after cessation of treatment (week 12). 3. Significant reductions in plasma total cholesterol, triacylglycerols and very-low-density lipoprotein-C occurred within the creatine monohydrate group. Minor reductions in plasma total cholesterol from baseline (233 +/- 9 mg/dl) of 6% and 5% occurred at weeks 4 and 8, respectively, before returning to baseline at week 12. Baseline triacylglycerols (194 +/- 21 mg/dl) and very-low-density lipoprotein-C (39 +/- 4 mg/dl) were reduced by 23% and 22% at weeks 4 and 8, respectively, and remained attenuated by 26% at week 12. These results remained consistent when data were separated and analysed by gender. Finally, a small, but statistically significant increase in urea nitrogen was observed in women between baseline (11.8 +/- 0.7 mg/dl) and week 8 (13.8 +/- 0.7 mg/dl, P < 0.05). No significant differences were noted for low-density lipoprotein-C, high-density lipoprotein-C, total cholesterol/high-density lipoprotein ratio, glucose, creatinine, body mass, body mass index or physical activity within or between the experimental and placebo groups. However, a trend towards reduced blood glucose levels was present in males given creatine monohydrate (P = 0.051). 4. These preliminary data suggest that creatine monohydrate may modulate lipid metabolism in certain individuals. These observations may demonstrate practical efficacy to the hyperlipidaemic patient as well as providing possible new mechanistic insights into the cellular regulation of blood lipid concentrations.