Comparative study of the effectiveness of a low-pressure hyperbaric oxygen treatment and physical exercise in women with fibromyalgia: randomized clinical trial.

BACKGROUND: Fibromyalgia (FM) is characterized by chronic pain and fatigue, among other manifestations, thus advising interventions that do not aggravate these symptoms. The main purpose of this study is to analyse the effect of low-pressure hyperbaric oxygen therapy (HBOT) on induced fatigue, pain, endurance and functional capacity, physical performance and cortical excitability when compared with a physical exercise program in women with FM. METHODS: A total of 49 women with FM took part in this randomized controlled trial. They were randomly allocated to three groups: physical exercise group (PEG, n = 16), low-pressure hyperbaric oxygen therapy group (HBG, n = 17) and control group (CG, n = 16). Induced fatigue, perceived pain, pressure pain threshold, endurance and functional capacity, physical performance and cortical excitability were assessed. To analyse the effect of the interventions, two assessments, that is, pre and post intervention, were carried out. Analyses of the data were performed using two-way mixed multivariate analysis of variance. RESULTS: The perceived pain and induced fatigue significantly improved only in the HBG (p < 0.05) as opposed to PEG and CG. Pressure pain threshold, endurance and functional capacity, and physical performance significantly improved for both interventions (p < 0.05). The cortical excitability (measured with the resting motor threshold) did not improve in any of the treatments (p > 0.05). CONCLUSIONS: Low-pressure HBOT and physical exercise improve pressure pain threshold, endurance and functional capacity, as well as physical performance. Induced fatigue and perceived pain at rest significantly improved only with low-pressure HBOT. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03801109.

Reply to "When Is a Ketogenic Diet Ketogenic? Comment on Satiating Effect of a Ketogenic Diet and Its Impact on Muscle Improvement and Oxidation State in Multiple Sclerosis Patients. Nutrients 2019, 11, 1156".

In response to the questions raised in the comment to the editor of R [...].

Satiating Effect of a Ketogenic Diet and Its Impact on Muscle Improvement and Oxidation State in Multiple Sclerosis Patients.

BACKGROUND: It was previously established that Multiple sclerosis (MS) generates energy alterations at the mitochondrial level related to the loss of muscle mass. Ketone bodies, mainly beta-hydroxybutyrate (BHB), re-establish this energy alteration causing satiety, changes in body composition and a decrease in hormone-dependant hunger, such as ghrelin. The aim of this study was to establish possible improvements in body composition and the level of oxidation in patients with MS, by means of the satiating effect of a ketogenic diet. METHODS: A pilot study was carried out with 27 MS patients who were given a Mediterranean isocaloric and ketogenic diet for 4 months. Anthropometric measurements, as well as satiety and hunger perception (VAS scale), were taken. In addition, BHB and paraoxonase 1 (PON1), as an oxidation marker, were measured by spectrophotometric automated assays, and ghrelin was determined by an enzyme immunoassay in the serum. All measurements were taken before and after the intervention. RESULTS: A significant increase in satiety perception at lunch and dinner and of BHB in the blood was obtained. Hunger perception decreased significantly at lunch and dinner with similar levels of ghrelin. In addition, an important increase in lean mass and PON1 was observed. To our knowledge, this is the first study addressing improvements in body composition, oxidation state and metabolism in MS patients, based on the satiating effect of a Mediterranean isocaloric diet. CONCLUSION: A ketogenic diet increases lean mass and decreases inflammation and oxidation possibly as a consequence of an increase in satiety and decrease in hunger in MS patients.

Bigdata Oriented Multimedia Mobile Health Applications.

In this paper, two mHealth applications are introduced, which can be employed as the terminals of bigdata based health service to collect information for electronic medical records (EMRs). The first one is a hybrid system for improving the user experience in the hyperbaric oxygen chamber by 3D stereoscopic virtual reality glasses and immersive perception. Several HMDs have been tested and compared. The second application is a voice interactive serious game as a likely solution for providing assistive rehabilitation tool for therapists. The recorder of the voice of patients could be analysed to evaluate the long-time rehabilitation results and further to predict the rehabilitation process.

Rhythms can overcome temporal orienting deficit after right frontal damage.

The main aim of this study was to test whether the use of rhythmic information to induce temporal expectations can overcome the deficit in controlled temporal preparation shown by patients with frontal damage (i.e. temporal orienting and foreperiod effects). Two tasks were administered to a group of 15 patients with a frontal brain lesion and a group of 15 matched control subjects: a Symbolic Cued Task where the predictive information regarding the time of target appearance was provided by a symbolic cue (short line-early vs. long line-late interval) and a Rhythm Cued Task where the predictive temporal information was provided by a rhythm (fast rhythm-early vs. slow rhythm-late interval). The results of the Symbolic Cued Task replicated both the temporal orienting deficit in right frontal patients and the absence of foreperiod effects in both right and left frontal patients, reported in our previous study (Triviño, Correa, Arnedo, & Lupiañez, 2010). However, in the Rhythm Cued Task, the right frontal group showed normal temporal orienting and foreperiod effects, while the left frontal group showed a significant deficit of both effects. These findings show that automatic temporal preparation, as induced by a rhythm, can help frontal patients to make effective use of implicit temporal information to respond at the optimum time. Our neuropsychological findings also provide a novel suggestion for a neural model, in which automatic temporal preparation is left-lateralized and controlled temporal preparation is right-lateralized in the frontal lobes.

A voxel-based analysis of FDG-PET in traumatic brain injury: regional metabolism and relationship between the thalamus and cortical areas.

The objective was to study the correlations and the differences in glucose metabolism between the thalamus and cortical structures in a sample of severe traumatic brain injury (TBI) patients with different neurological outcomes. We studied 49 patients who had suffered a severe TBI and 10 healthy control subjects using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). The patients were divided into three groups: a vegetative or minimally-conscious state (MCS&VS) group (n=17), which included patients who were in a vegetative or a minimally conscious state; an In-post-traumatic amnesia (In-PTA) group (n=12), which included patients in PTA; and an Out-PTA group (n=20), which included patients who had recovered from PTA. SPM5 software was used to determine the metabolic differences between the groups. FDG-PET images were normalized and four regions of interest were generated around the thalamus, precuneus, and the frontal and temporal lobes. The groups were parameterized using Student's t-test. Principal component analysis was used to obtain an intensity-estimated-value per subject to correlate the function between the structures. Differences in glucose metabolism in all structures were related to the neurological outcome, and the most severe patients showed the most severe hypometabolism. We also found a significant correlation between the cortico-thalamo-cortical metabolism in all groups. Voxel-based analysis suggests a functional correlation between these four areas, and decreased metabolism was associated with less favorable outcomes. Higher levels of activation of the cortico-cortical connections appear to be related to better neurological condition. Differences in the thalamo-cortical correlations between patients and controls may be related to traumatic dysfunction due to focal or diffuse lesions.

Voxel-based statistical analysis of thalamic glucose metabolism in traumatic brain injury: relationship with consciousness and cognition.

OBJECTIVE: To study the relationship between thalamic glucose metabolism and neurological outcome after severe traumatic brain injury (TBI). METHODS: Forty-nine patients with severe and closed TBI and 10 healthy control subjects with (18)F-FDG PET were studied. Patients were divided into three groups: MCS&VS group (n = 17), patients in a vegetative or a minimally conscious state; In-PTA group (n = 12), patients in a state of post-traumatic amnesia (PTA); and Out-PTA group (n = 20), patients who had emerged from PTA. SPM5 software implemented in MATLAB 7 was used to determine the quantitative differences between patients and controls. FDG-PET images were spatially normalized and an automated thalamic ROI mask was generated. Group differences were analysed with two sample voxel-wise t-tests. RESULTS: Thalamic hypometabolism was the most prominent in patients with low consciousness (MCS&VS group) and the thalamic hypometabolism in the In-PTA group was more prominent than that in the Out-PTA group. Healthy control subjects showed the greatest thalamic metabolism. These differences in metabolism were more pronounced in the internal regions of the thalamus. CONCLUSIONS: The results confirm the vulnerability of the thalamus to suffer the effect of the dynamic forces generated during a TBI. Patients with thalamic hypometabolism could represent a sub-set of subjects that are highly vulnerable to neurological disability after TBI.

Efficacy of ziprasidone in controlling agitation during post-traumatic amnesia.

OBJECTIVES: to provide our initial experience with ziprasidone in the management of behaviour problems of patients with traumatic brain injury (TBI) during the period of post-traumatic amnesia (PTA). PATIENTS: Five patients with a mean age of 26.8 +/- 9.8 years who had suffered a severe TBI (Glasgow Coma Scale score < 8; length of coma: 16 +/- 7.1 days; and length of PTA: 62.4 +/- 14.8 days) were included in the study. Agitation was assessed by the Agitated Behaviour Scale (ABS) prior to the administration of ziprasidone, after two weeks of initiating treatment and at the moment of discontinuing ziprasidone. RESULTS: ABS Total score decreased from 27.2 +/- 3 to 18 +/- 1.2 after two weeks of treatment. The same decrease was also noticed in each one of the subscales (dishinhibition, aggressiveness and lability). Mean dose of the drug was 52.8 +/- 27.11 mg/day (range: 20-80 mg), with the highest dose ranging between 40 and 80 mg (64 +/- 21.9 mg). Maximum period of administration of ziprasidone was 48.2 +/- 14.8 days (range: 35-68 days). No clinical or electrocardiographic side effects were reported. CONCLUSION: This study shows the efficacy of ziprasidone in controlling agitation during the PTA period. Despite the small size of our sample, ziprasidone reduced symptoms of agitation quickly and with good tolerability, safety and no side effects.

Paralytic ileus: a complication after intrathecal baclofen therapy.

INTRODUCTION: Baclofen is frequently used in the management of spasticity. When the therapeutic benefit of oral baclofen is not satisfactory, intrathecal administration should be considered. This method reduces side effects due to a reduction in dosage compared to oral administration. CASE DESCRIPTION: This study presents a 52-year-old man with tetraplegia after a brainstem stroke. Four days after the placement of a Synchromed II infusion pump (100 mcg per day), the patient presented a paralytic ileus. The treatment was conservative and the dosage of intrathecal baclofen was reduced to lowest drug flow. After 15 days of treatment the ileus was resolved and the dosage progressively increased without incident. CONCLUSION: Ileus should be considered as a rare side effect after intrathecal baclofen administration, especially in cases of brainstem injury because baclofen seems to act directly over vegetative brainstem nuclei. Based on this case, it is strongly recommended to decrease the dose of intrathecal baclofen as one of the main therapeutic options.