scholarly journals The PICO Study: Impact of Phenylalanine on Cognitive, Cerebral and Neurometabolic Parameters in Adult Patients with Phenylketonuria: a Randomized, Placebo-Controlled, Crossover, Non-inferiority Trial

2019 ◽  
Author(s):  
Roman Trepp ◽  
Raphaela Muri ◽  
Stephanie Abgottspon ◽  
Lenka Bosanska ◽  
Michel Hochuli ◽  
...  
Keyword(s):  
Newborn Screening ◽  
Adult Patients ◽  
University Hospital ◽  
Target Range ◽  
Neural Activation ◽  
Healthy Controls ◽  
Double Blind ◽  
The University ◽  
The Brain ◽  
Back Task

Abstract Background The population of adult patients with early-treated phenylketonuria (PKU) following newborn screening is growing substantially. The ideal target range of blood Phenylalanine (Phe) levels in adults outside pregnancy is a matter of debate. Therefore, prospective intervention studies are needed to evaluate the effects of an elevated Phe concentration on cognition and structural, functional and neurometabolic parameters of the brain. Methods The PICO (Phenylalanine and Its Impact on Cognition) Study evaluates the effect of a 4-week Phe load on cognition and cerebral parameters in adults with early-treated PKU in a double-blind, randomized, placebo-controlled, crossover, non-inferiority trial. Participants: 30 adult patients with early-treated PKU and 30 healthy controls comparable to patients with regard to age, sex and educational level will be recruited from the University Hospitals Bern and Zurich, Switzerland. Patients are eligible for the study if they are age ≥18 years and have PKU diagnosed after a positive newborn screening and treated with a Phe-restricted diet starting within the first 30 days of life. Intervention: The cross-over intervention consists of a 4-week oral Phe or placebo administration in patients with PKU. The study design mimics a Phe-restricted and a Phe-unrestricted diet using a double-blinded, placebo-controlled approach. Objectives: The primary objective of the PICO Study is to prospectively assess whether a temporarily elevated Phe-level influences cognitive performance (working memory assessed with a n-back task) in adults with early-treated PKU. As secondary objective, the PICO Study will elucidate cerebral (fMRI: neural activation during a n-back task; rsfMRI: functional connectivity at rest; DTI: white matter integrity; ASL: cerebral blood flow) and neurometabolic mechanisms (cerebral Phe-level), which accompany changes in Phe concentration. Cognition, structural and functional parameters of the brain of adult patients with early-treated PKU will be cross-sectionally compared to healthy controls. All assessments will take place at the University Hospital Bern, Switzerland. Randomization: Central randomization will be used to assign participants to the different treatment arms with age, sex and center serving as stratification factors. Randomization lists will be generated by an independent statistician. Blinding: All trial personnel but the statistician generating the randomization list and the personnel at the facility preparing the interventional product are blinded to the assigned treatment.

scholarly journals The PICO Study: Impact of Phenylalanine on Cognitive, Cerebral and Neurometabolic Parameters in Adult Patients with Phenylketonuria – a Randomized, Placebo-Controlled, Crossover, Non-inferiority Trial

2019 ◽  
Author(s):  
Roman Trepp ◽  
Raphaela Muri ◽  
Lenka Bosanska ◽  
Stephanie Abgottspon ◽  
Michel Hochuli ◽  
...  
Keyword(s):  
Working Memory ◽  
Memory Task ◽  
Brain Regions ◽  
Primary Objective ◽  
Adult Patients ◽  
Target Range ◽  
Neural Activation ◽  
Level Of Evidence ◽  
Double Blind ◽  
The Brain

Abstract Background The population of adult patients with early-treated phenylketonuria (PKU) following newborn screening is growing substantially. The ideal target range of blood Phe levels in adults outside pregnancy is discussed controversially. Therefore, prospective intervention studies are needed to evaluate the effects of an elevated Phe concentration on cognition and structural, functional and neurometabolic parameters of the brain. Methods The PICO (Phenylalanine and Its Impact on Cognition) Study evaluates the effect of a 4-week phenylalanine (Phe) load on cognition and cerebral parameters in 30 adults with early-treated PKU in a double-blind, randomized, placebo-controlled, crossover, non-inferiority trial. The primary objective of the PICO Study is to prospectively assess whether a temporarily elevated Phe level influences cognitive performance in adults with early-treated PKU. As secondary objective, the PICO Study will elucidate cerebral and neurometabolic mechanisms, which accompany changes in Phe concentration using advanced neuroimaging methods. In addition to the intervention study, cognition, structural and functional parameters of the brain of adult patients with early-treated PKU will be cross-sectionally compared to healthy controls, who will be comparable with regard to age, gender and education level. Advanced MR-techniques will be used to investigate intensity of neural activation during the working memory task (fMRI), strength of functional connectivity between brain regions related to performance in working memory (rsfMRI), white matter integrity (DTI), cerebral blood flow (ASL) and brain Phe concentrations (MRS). Discussion Using a combination of neuropsychological and neuroimaging data, the PICO study will considerably contribute to improve the currently insufficient level of evidence on how adult patients with early-treated PKU should be managed.

Effects of individually chosen homoeopathic medicines on recurrent URTI in children

1996 ◽  
Vol 85 (01) ◽  
pp. 4-14
Author(s):  
J. Blommers ◽  
D.J. Kuik ◽  
L. Feenstra ◽  
P.D. Bezemer ◽  
E.S.M. De Lange-De Klerk
Keyword(s):  
Clinical Trial ◽  
University Hospital ◽  
Controlled Clinical Trial ◽  
Upper Respiratory Tract ◽  
Eligibility Criteria ◽  
Double Blind ◽  
Upper Respiratory ◽  
The University ◽  
Current Standards

AbstractThe effects of homoeopathic medicines on children suffering from recurrent upper respiratory tract infection (URTI) were studied in a randomized double-blind placebo-controlled clinical trial conducted at the paediatric outpatients department of the university hospital of the Vrije Universiteit in Amsterdam from 1987 to 1992.The study was designed to meet both the requirements of proper homoeopathic practice and the current standards of a clinical trial. The purpose of a randomized placebo-controlled double-blind trial is to identify the effects of the agents under investigation by equalizing the effects of other factors that may influence outcome.The object of the trial, eligibility criteria, follow-up period, treatments and concurrent interventions, data collection and effect measures are discussed in the light of homoeopathic thinking.

scholarly journals Methylphenidate modulates interactions of anxiety with cognition

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
C. Gaillard ◽  
T. R. Lago ◽  
A. X. Gorka ◽  
N. L. Balderston ◽  
B. A. Fuchs ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Large Body ◽  
Anxiolytic Effect ◽  
Cognitive Resources ◽  
Neural Activation ◽  
Double Blind ◽  
Attentional Processes ◽  
Regulatory Processes ◽  
The Neural Networks ◽  
Back Task

AbstractWhile a large body of literature documents the impairing effect of anxiety on cognition, performing a demanding task was shown to be effective in reducing anxiety. Here we explored the mechanisms of this anxiolytic effect by examining how a pharmacological challenge designed to improve attentional processes influences the interplay between the neural networks engaged during anxiety and cognition. Using a double-blind between-subject design, we pharmacologically manipulated working memory (WM) using a single oral dose of 20 mg methylphenidate (MPH, cognitive enhancer) or placebo. Fifty healthy adults (25/drug group) performed two runs of a WM N-back task in a 3 T magnetic resonance imaging scanner. This task comprised a low (1-Back) and high (3-Back) WM load, which were performed in two contexts, safety or threat of shocks (induced-anxiety). Analyses revealed that (1) WM accuracy was overall improved by MPH and (2) MPH (vs. placebo) strengthened the engagement of regions within the fronto-parietal control network (FPCN) and reduced the default mode network (DMN) deactivation. These MPH effects predominated in the most difficult context, i.e., threat condition, first run (novelty of the task), and 3-Back task. The facilitation of neural activation can be interpreted as an expansion of cognitive resources, which could foster both the representation and integration of anxiety-provoking stimuli as well as the top–down regulatory processes to protect against the detrimental effect of anxiety. This mechanism might establish an optimal balance between FPCN (cognitive processing) and DMN (emotion regulation) recruitment.

Beneficial Effect of Acupuncture on Adult Patients with Asthma Bronchiale

1993 ◽  
Vol 21 (02) ◽  
pp. 113-117 ◽  
Author(s):  
W. Zwölfer ◽  
W. Keznickl-Hillebrand ◽  
A. Spacek ◽  
M. Cartellieri ◽  
G. Grubhofer
Keyword(s):  
Intensive Care ◽  
Retrospective Study ◽  
Beneficial Effect ◽  
Asthma Bronchiale ◽  
Acupuncture Treatment ◽  
Adult Patients ◽  
University Hospital ◽  
Outpatient Unit ◽  
History Of ◽  
The University

In a retrospective study 17 patients with long-standing history of asthma bronchiale were treated with acupuncture at the outpatient unit of the Department of Anaesthesia and Intensive Care in the University Hospital of Vienna. The subjective effectiveness of the treatment was determined using a standard questionnaire, which was sent to the patients' homes half a year after starting acupuncture treatment. Over 70% of our patients reported a significant improvement of their ailments after ten weeks of treatment as well as half a year after starting acupuncture.

scholarly journals Dos fórmulas para calcular el IMC, y su relación con otros indicadores antropométricos en adultos

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gerardo Bauce
Keyword(s):  
Coefficient Of Variation ◽  
Overweight And Obesity ◽  
Adult Patients ◽  
University Hospital ◽  
Correlational Study ◽  
Calculation Formula ◽  
Healthy Weight ◽  
Female Sex ◽  
The University

Descriptive, prospective, transversal and correlational study, whose objective is to relate two formulas for calculating BMI, with other indicators, in a group of adults. METHODS: The sample is of 137 adult patients who attended consultation at the University Hospital of Caracas. The variables are: age, weight, size, BMI-Q, BMI-O, WC, WSI, WCWP and BFP. Averages, deviations, percentages and z-tests and Mann Whitney were obtained to compare averages and Median. RESULTS: Similar BMI-Q averages in both sexes, and older BMI-O in female sex. The two formulas for calculating BMI result in the highest percentage with BMI-O, higher overweight percentage with BMI-Q and significant (p<0.000) and percentages of Healthy Weight and Obesity equal. Equal averages, per group, of BFP for the two BMI formulas, and increase from Healthy Weight to Obesity. The Coefficient of Variation reveals more homogeneity in BMI-O (18.41% vs 25.21%). BMI-Q correlates with weight (0.91), WC (0.92) and WSI (0.93); IMC-O with weight (0.97), WC (0.83) and WCWI (0.90). Whitney's test reveals that averages by sex are significant (p<0,000), as are IPCC averages per sex (p<0.000). In addition, the BMI Oxford, WC, WSI and WCWI indicators have sensitivity of 92,3%, 92.3% and 92.3%, respectively. CONCLUSION: The BMI Oxford for its somewhat complicated calculation formula is not recommended to evaluate overweight and obesity, in adults.

scholarly journals Anterior Cruciate Ligament Reconstructed Patients Who Recovered Normal Postural Control Have Dissimilar Brain Activation Patterns Compared to Healthy Controls

Biology ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 119
Author(s):  
Yong Woo An ◽  
Yangmi Kang ◽  
Hyung-Pil Jun ◽  
Eunwook Chang
Keyword(s):  
Anterior Cruciate Ligament ◽  
Postural Control ◽  
Task Complexity ◽  
Cruciate Ligament ◽  
Neural Activation ◽  
Healthy Controls ◽  
Activation Patterns ◽  
Single Leg Stance ◽  
Anterior Cruciate ◽  
The Brain

Postural control, which is a fundamental functional skill, reflects integration and coordination of sensory information. Damaged anterior cruciate ligament (ACL) may alter neural activation patterns in the brain, despite patients’ surgical reconstruction (ACLR). However, it is unknown whether ACLR patients with normal postural control have persistent neural adaptation in the brain. Therefore, we explored theta (4–8 Hz) and alpha-2 (10–12 Hz) oscillation bands at the prefrontal, premotor/supplementary motor, primary motor, somatosensory, and primary visual cortices, in which electrocortical activation is highly associated with goal-directed decision-making, preparation of movement, motor output, sensory input, and visual processing, respectively, during first 3 s of a single-leg stance at two different task complexities (stable/unstable) between ACLR patients and healthy controls. We observed that ACLR patients showed similar postural control ability to healthy controls, but dissimilar neural activation patterns in the brain. To conclude, we demonstrated that ACLR patients may rely on more neural sources on movement preparation in conjunction with sensory feedback during the early single-leg stance period relative to healthy controls to maintain postural control. This may be a compensatory protective mechanism to accommodate for the altered sensory inputs from the reconstructed knee and task complexity. Our study elucidates the strategically different brain activity utilized by ACLR patients to sustain postural control.

scholarly journals Effects ofLactobacillus gasseriOLL2716 onHelicobacter pylori-Associated Dyspepsia: A Multicenter Randomized Double-Blind Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Atsushi Takagi ◽  
Hidetaka Yanagi ◽  
Hideki Ozawa ◽  
Naomi Uemura ◽  
Shigemi Nakajima ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Controlled Trial ◽  
Gastrointestinal Symptoms ◽  
University Hospital ◽  
Clinical Trial Registry ◽  
Double Blind ◽  
Postprandial Fullness ◽  
Medical Network ◽  
H Pylori ◽  
The University

SomeLactobacillusspp. suppressHelicobacter pyloriin the stomach and have potential therapeutic applications for the treatment of gastrointestinal conditions. In this study, the effects ofLactobacillusstrains on functional dyspepsia associated withH. pyloriinfection were examined. Volunteers were screened using the13C-urea breath test (UBT) andH. pyloristool test, and 131 participants who met the selection criteria (mean age: 48.9 years) were randomly givenL. gasseriOLL2716-containing yogurt or placebo yogurt once daily for 12 weeks. Gastrointestinal symptoms (epigastric pain, bloating, postprandial fullness, nausea, and heartburn) and the levels of serum pepsinogen (PG),13C-UBT, andH. pyloristool antigen were assessed. No significant differences were observed between the groups in UBT results,H. pyloristool antigens, or the serum PGI/II ratio. In theL. gasserigroup, postprandial fullness was significantly lower at the end of the trial compared to the initial level (p<0.05) and significantly fewer patients had a VAS score of >10 for bloating compared to the placebo group (p<0.05). Dietary supplementation withL. gasseriOLL2716-containing yogurt may effectively suppress dyspeptic symptoms inH. pylori-infected patients. This study was registered at the University Hospital Medical Network Clinical Trial Registry (UMIN000016746).

Transportation savings and medical benefits of a teleneuroradiological network

2000 ◽  
Vol 6 (3) ◽  
pp. 142-146 ◽  
Author(s):  
Marianne Maass ◽  
Marjatta Kosonen ◽  
Martti Kormano
Keyword(s):  
Medical Records ◽  
Complete Recovery ◽  
University Hospital ◽  
Consultation Service ◽  
Routine Work ◽  
Specialist Services ◽  
Medical Benefits ◽  
The University ◽  
Regional Hospitals ◽  
The Brain

Since 1996, Turku University Central Hospital has offered teleradiology consultations regarding computerized tomography examinations of the brain to three regional hospitals in Finland, in which neurosurgical or neuroradiological specialist services are not available, in order to avoid unnecessary patient transportation. We performed a retrospective survey of the teleconsultations performed in 1998. Medical records and the relevant radiology images were obtained. During the study period, teleconsultations were carried out for a total of 83 patients, of whom 16 were transported to the university hospital (i.e. 81% of these patients had avoided unnecessary transportation). The total savings amounted to 42,100 ECU. Of the 16 transported patients, 12 were immediately operated on in the university hospital. It was judged that, because of the consultation service, the patients undergoing an operation had benefited from a more rapid and a more complete recovery. In 1998 the teleradiology consultation service was established as part of the routine work of the Medical Imaging Centre and a fee for its services was adopted.

scholarly journals Visuospatial but Not Verbal Working Memory Deficits in Adult Patients With Neurofibromatosis Type 1

2021 ◽  
Vol 12 ◽  
Author(s):  
Hanlu Tang ◽  
Qiong Wu ◽  
Shiwei Li ◽  
Yehong Fang ◽  
Zhijun Yang ◽  
...  
Keyword(s):  
Working Memory ◽  
Neurofibromatosis Type 1 ◽  
Neurofibromatosis Type ◽  
Cognitive Status ◽  
Adult Patients ◽  
Healthy Controls ◽  
Significant Difference ◽  
Existing Data ◽  
Back Task

Background: Cognitive dysfunction is one of the main symptoms of neurofibromatosis type 1 (NF1). As an important cognitive function, working memory (WM) has rarely been systematically analyzed in NF1 by isolating the particular domain of WM, and existing data involving WM in adult patients with NF1 are insufficient. This study aimed to investigate the characteristics of different types of WM in NF1 from the perspective of the adult population.Method: We comprehensively analyzed WM in both verbal and visuospatial WM domains by using the N-back task (including the verbal N-back task and the visuospatial N-back task) in 31 adults with NF1 and 34 healthy controls matched for age, gender, education levels, and general cognitive status. The accuracy and reaction times (RTs) in the N-back task were entered into mixed-design ANOVA.Results: Compared with healthy controls, adults with NF1 presented significantly lower mean accuracy and longer RTs in the visuospatial N-back task. However, no significant difference was found between the NF1 group and healthy controls in the verbal N-back task.Conclusions: The present study suggested that adults with NF1 might have deficits in visuospatial WM. We did not find evidence for verbal WM deficits in adult patients with NF1. Our findings supplement and refine the existing data on WM in the context of NF1.

scholarly journals Clinical Presentations of Adolescents Aged 16–18 Years in the Adult Emergency Department

2021 ◽  
Vol 18 (18) ◽  
pp. 9578
Author(s):  
Lara Aurora Brockhus ◽  
Martina Bärtsch ◽  
Aristomenis K. Exadaktylos ◽  
Kristina Keitel ◽  
Jolanta Klukowska-Rötzler ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Vulnerable Population ◽  
Adult Patients ◽  
University Hospital ◽  
Cross Sectional ◽  
Specific Patient ◽  
Time Period ◽  
The University

Background: In many large hospitals in Switzerland, adolescents 16 years and older are treated in adult emergency departments (ED). There have been few publications about this specific patient population, especially in Switzerland. This study aims to provide an overview of emergency presentations of adolescents between 16–18 years of age when compared to adults and focuses on their principle complaints. Methods: We conducted a single-centre, retrospective, cross-sectional study of all patients aged 16 years and older presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from 2013 to 2017. This analysis gives an overview of emergency presentations of adolescents between 16–18 years of age in this time period and compares their consultation characteristics to those of adult patients. Results: Data of a total of 203,817 patients who presented to our adult ED between 2013 and 2017 were analysed. Adolescents account for 2.5% of all emergency presentations. The number of ED presentations in the reviewed time period rose for adults (+2368, 95% CI: 1695, 3041, p = 0.002 consultations more per year; +25% comparing 2013 with 2017), while adolescent presentations did not significantly increase (p = 0.420). In comparison to adult patients, adolescents presented significantly more often during the night (39.1% vs. 31.5%, p < 0.001), as walk-ins (54.2% vs. 44.9%, p < 0.001), or with less highly acute complaints at triage (21% vs. 31%, p < 0.001). They were more likely to be discharged (70.8% vs. 52.2%, p < 0.001). We found a significant association between the two age groups and principle complaints. In comparison to adults, trauma and psychiatric problems were significantly more common among adolescents. Conclusions: Our data showed that complaints in adolescent patients under 18 years of age significantly differ from those in older patients. The artificial age cut-off therefore puts this vulnerable population at risk of receiving inadequate diagnostic testing and treatment adapted only for adults. Additional studies are needed on the reasons adolescents and young adults seek ED care, as this could lead to improvements in the care processes for this vulnerable population.

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