Optic neuritis is an inflammatory disease of the optic nerve. It occurs more commonly in women than in men. Usually presenting with an abrupt loss of vision, recovery of vision is almost never ...complete. Closely linked in pathogenesis to multiple sclerosis, it may be the initial manifestation for this condition. In certain patients, no underlying cause can be found.
To assess the effects of corticosteroids on visual recovery of patients with acute optic neuritis.
We searched the Cochrane Controlled Trials Register (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (issue 4, 2005), MEDLINE (1966 to December 2005), EMBASE (1980 to January 2006), NNR (issue 4, 2006), LILACS and reference lists of identified trial reports.
We included randomized trials that evaluated corticosteroids, in any form, dose or route of administration, in people with acute optic neuritis.
Two authors independently extracted the data on methodological quality and outcomes for analysis.
We included five randomized trials which included a total of 729 participants. Two trials evaluated low dose oral corticosteroids and two trials evaluated a higher dose of intravenous corticosteroids. One three-arm trial evaluated low-dose oral corticosteroids and high-dose intravenous corticosteroids against placebo. Trials evaluating oral corticosteroids compared varying doses of corticosteroids with placebo. Hence, we did not conduct a meta-analysis of such trials. In a meta-analysis of trials evaluating corticosteroids with total dose greater than 3000 mg administered intravenously, the relative risk of normal visual acuity with intravenous corticosteroids compared with placebo was 1.06 (95% CI 0.89 to 1.27) at six months and 1.06 (95% CI 0.92 to 1.22) at one year. The risk ratio of normal contrast sensitivity for the same comparison was 1.10 (95% CI 0.92 to 1.32) at six months follow up. We did not conduct a meta-analysis for this outcome at one year follow up since there was substantial statistical heterogeneity. The risk ratio of normal visual field for this comparison was 1.08 (95% CI 0.96 to 1.22) at six months and 1.02 (95% CI 0.86 to 1.20) at one year. Quality of life was assessed and reported in one trial.
There is no conclusive evidence of benefit in terms of recovery to normal visual acuity, visual field or contrast sensitivity with either intravenous or oral corticosteroids at the doses evaluated in trials included in this review.
The use of bone grafts permits the filling of a bone defect without risk of virus transmission. In this work, pure bioactive glass (46S6) and zinc-doped bioactive glass (46S6Zn10) with 0.1 wt% zinc ...are used to elaborate highly bioactive materials by melting and rapid quenching. Cylinders of both types of glasses were soaked in a simulated body fluid (SBF) solution with the aim of determining the effect of zinc addition as a trace element on the chemical reactivity and bioactivity of glass. Several physico-chemical characterization methods such as x-ray diffraction, Fourier transform infrared spectroscopy and nuclear magnetic resonance methods, with particular focus on the latter, were chosen to investigate the fine structural behaviour of pure and Zn-doped bioactive glasses as a function of the soaking time of immersion in SBF. Inductively coupled plasma-optical emission spectroscopy (ICP-OES) was used to measure the concentrations of Ca and P ions in the SBF solution after different durations of immersion. The effect of the investigated samples on the proliferation rate of human osteoblast cells was assessed by the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay, and tested on two different sizes of pure and zinc-doped glasses in powder form, with particle sizes that ranged between 40 to 63 µm and 500 to 600 µm. The obtained results showed the delay release of ions by Zn-doped glass (46S6Zn10) and the slower CaP deposition. Cytotoxicity and cell viability were affected by the particle size of the glass. The release rate of ions was found to influence the cell viability.
To explore 24-h postexercise glycemia and hypoglycemia risk, data from the Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) study were analyzed to examine factors that may influence glycemia.
...This was a real-world observational study with participant self-reported physical activity, food intake, and insulin dosing (multiple daily injection users). Heart rate, continuous glucose data, and available pump data were collected.
A total of 251 adolescents (42% females), with a mean ± SD age of 14 ± 2 years, and hemoglobin A1c (HbA1c) of 7.1 ± 1.3% (54 ± 14.2 mmol/mol), recorded 3,319 activities over ∼10 days. Trends for lower mean glucose after exercise were observed in those with shorter disease duration and lower HbA1c; no difference by insulin delivery modality was identified. Larger glucose drops during exercise were associated with lower postexercise mean glucose levels, immediately after activity (P < 0.001) and 12 to <16 h later (P = 0.02). Hypoglycemia occurred on 14% of nights following exercise versus 12% after sedentary days. On nights following exercise, more hypoglycemia occurred when average total activity was ≥60 min/day (17% vs. 8% of nights, P = 0.01) and on days with longer individual exercise sessions. Higher nocturnal hypoglycemia rates were also observed in those with longer disease duration, lower HbA1c, conventional pump use, and if time below range was ≥4% in the previous 24 h.
In this large real-world pediatric exercise study, nocturnal hypoglycemia was higher on nights when average activity duration was higher. Characterizing both participant- and event-level factors that impact glucose in the postexercise recovery period may support development of new guidelines, decision support tools, and refine insulin delivery algorithms to better support exercise in youth with diabetes.
To investigate factors associated with pediatric feeding disorders (PFD) among children of parents that reported to have had feeding disorders during their own childhood compared to children with PFD ...with no history of parental PFD. We retrospectively reviewed the medical records of children diagnosed with PFD according to the recent WHO-based definition. The demographic and clinical characteristics of children with PFD with a parental history of PFD were compared to those of children with a PFD with no history of parental PFD. Included were 231 children with PFD (median interquartile range age 10 months 5.5–29 at diagnosis, 58% boys) of whom 133 children had parents without PFD and 98 children had parents with PFD. Unexpectedly, children of parents without PFD had a higher rate of low birth weight (28% vs. 19%, respectively,
p
= 0.007), more delivery complications (10% vs. 2%,
p
= 0.006), more hospitalizations (33% vs. 17%,
p
= 0.004), more prescription medications (27% vs. 18%,
p
= 0.05), and a higher percent of gastrostomy tube use (6% vs. 0,
p
= 0.02). Moreover, more parents with PFD had academic background compared with parents without PFD (72% vs. 59%,
p
= 0.05). There were no significant group differences in sex, history of breastfeeding, parental marital status, or type of the child’s feeding disorder.
Conclusion
: PFD among children with a parental history of PFD comprise a distinct group of patients with unique characteristics and outcomes. Since parental feeding history may explain their child’s PFD in highly differing ways, such information may help in devising a specific family-based and multidisciplinary treatment plan for those children.
What is Known:
•
Pediatric feeding disorder (PFD) is relatively common and its prevalence is increasing
.
•
Information on an association between parental PFD and their child’s feeding disorder is limited
.
What is New:
•
PFD among children with a parental history of PFD comprise a distinct group of patients with various characteristics and outcomes
.
•
The parents’ feeding history during childhood may provide important clues to their child’s PFD
.
Background: Pretest probability assessment is necessary to identify patients in whom pulmonary embolism (PE) can be safely ruled out by a negative D‐dimer without further investigations. ...Objective: Review and compare the performance of available clinical prediction rules (CPRs) for PE probability assessment. Patients/methods: We identified studies that evaluated a CPR in patients with suspected PE from Embase, Medline and the Cochrane database. We determined the 95% confidence intervals (CIs) of prevalence of PE in the various clinical probability categories of each CPR. Statistical heterogeneity was tested. Results: We identified 9 CPR and included 29 studies representing 31215 patients. Pooled prevalence of PE for three‐level scores (low, intermediate or high clinical probability) was: low, 6% (95% CI, 4–8), intermediate, 23% (95% CI, 18–28) and high, 49% (95% CI, 43–56) for the Wells score; low, 13% (95% CI, 8–19), intermediate, 35% (95% CI, 31–38) and high, 71% (95% CI, 50–89) for the Geneva score; low, 9% (95% CI, 8–11), intermediate, 26% (95% CI, 24–28) and high, 76% (95% CI, 69–82) for the revised Geneva score. Pooled prevalence for two‐level scores (PE likely or PE unlikely) was 8% (95% CI,6–11) and 34% (95% CI,29–40) for the Wells score, and 6% (95% CI, 3–9) and 23% (95% CI, 11–36) for the Charlotte rule. Conclusion: Available CPR for assessing clinical probability of PE show similar accuracy. Existing scores are, however, not equivalent and the choice among various prediction rules and classification schemes (three‐ versus two‐level) must be guided by local prevalence of PE, type of patients considered (outpatients or inpatients) and type of D‐dimer assay applied.
Some controlled studies have associated afternoon exercise with a biphasic pattern of hypoglycemia (hypo) risk: during exercise and 7-11hrs later. We explored factors relating to nocturnal hypo ...following afternoon exercise (12PM-6PM) among youth in the observational T1DexiP study. Youth with T1D (n=203; mean±SD age14±2 yrs; HbA1c=7.0± 1.2%; 42% female; T1D duration 5.4±3.9yrs; 12% on MDI and 58% on AID) wore a continuous glucose monitor, an activity monitor and logged activity using the Bant app for 10 days. Repeated measures logistic regression adjusted for bedtime glucose and % time below range (TBR < 70mg/dL) in the prior 24hrs. Of the 833 afternoon exercise sessions, 14% led to nocturnal hypo (≥15 consecutive minutes <70 mg/dL). Median TBR was higher in the 24hrs before exercise in youth who developed nocturnal hypo vs those who did not (3% vs 1%), while pre-exercise glucose level, heart rate, and insulin on board were similar. Nocturnal hypo risk was higher among teens who exercised more often during the study (Table). A trend for lower risk was noted with AID use. Our model revealed that participants who exercised >90 min/day had increased risk of nocturnal hypoglycemia, while AID use may reduce risk. This suggests algorithmically modulated insulin delivery may help to mitigate the impact of afternoon exercise on nocturnal glycemia.
Disclosure
J.Sherr: Advisory Panel; Bigfoot Biomedical, Inc., Insulet Corporation, Medtronic, Vertex Pharmaceuticals Incorporated, Cecelia Health, StartUp Health T1D Moonshot, Consultant; Bigfoot Biomedical, Inc., Insulet Corporation, Medtronic, Lilly, Research Support; Insulet Corporation, Medtronic, NIH - National Institutes of Health, Juvenile Diabetes Research Foundation (JDRF), Speaker's Bureau; Insulet Corporation, Zealand Pharma A/S, Lilly, Medtronic. S.Bergford: None. S.R.Patton: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. P.Calhoun: None. R.L.Gal: None. M.Riddell: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Indigo Diabetes, Consultant; Lilly Diabetes, Eli Lilly and Company, Jaeb Center for Health Research, Speaker's Bureau; Dexcom, Inc., Novo Nordisk, Sanofi, Stock/Shareholder; Supersapiens, Zucara Therapeutics. T1dexip study group: n/a.
Funding
The Leona M. and Harry B. Helmsley Charitable Trust; Dexcom, Inc.
Maintenance of glycemic control during and after exercise remains a major challenge for individuals with type 1 diabetes. Glycemic responses to exercise may differ by exercise type (aerobic, ...interval, or resistance), and the effect of activity type on glycemic control after exercise remains unclear.
The Type 1 Diabetes Exercise Initiative (T1DEXI) was a real-world study of at-home exercise. Adult participants were randomly assigned to complete six structured aerobic, interval, or resistance exercise sessions over 4 weeks. Participants self-reported study and nonstudy exercise, food intake, and insulin dosing (multiple daily injection MDI users) using a custom smart phone application and provided pump (pump users), heart rate, and continuous glucose monitoring data.
A total of 497 adults with type 1 diabetes (mean age ± SD 37 ± 14 years; mean HbA1c ± SD 6.6 ± 0.8% 49 ± 8.7 mmol/mol) assigned to structured aerobic (n = 162), interval (n = 165), or resistance (n = 170) exercise were analyzed. The mean (± SD) change in glucose during assigned exercise was -18 ± 39, -14 ± 32, and -9 ± 36 mg/dL for aerobic, interval, and resistance, respectively (P < 0.001), with similar results for closed-loop, standard pump, and MDI users. Time in range 70-180 mg/dL (3.9-10.0 mmol/L) was higher during the 24 h after study exercise when compared with days without exercise (mean ± SD 76 ± 20% vs. 70 ± 23%; P < 0.001).
Adults with type 1 diabetes experienced the largest drop in glucose level with aerobic exercise, followed by interval and resistance exercise, regardless of insulin delivery modality. Even in adults with well-controlled type 1 diabetes, days with structured exercise sessions contributed to clinically meaningful improvement in glucose time in range but may have slightly increased time below range.
A hydrolysis process is applied to degrade an unsaturated polyester resin based on DCPD (dicyclopentadiene) and crosslinked with styrene, as the matrix of a composite material reinforced with long ...glass fibres. Subcritical conditions of water (200°C<temperature<374°C and pressure<221bars) were chosen regarding the involved chemistry for the case of simple esters. Several experiments were realised to measure the effects of the process parameters on the efficiency of hydrolysis, on the quality of the recovered fibres and finally on the nature of the recovered organic products. A washing of the fibres is necessary and appears to be an important step of the process realised in batch conditions. The identification of the recovered organic products indicates that monomers of the resin are obtained but also that secondary reactions occur during the hydrolysis process.
Background:Regular physical activity and exercise are fundamental components of a healthy lifestyle for youth living with type 1 diabetes (T1D). Yet, few youth living with T1D achieve the daily ...minimum recommended levels of physical activity. For all youth, regardless of their disease status, minutes of physical activity compete with other daily activities, including digital gaming. There is an emerging area of research exploring whether digital games could be displacing other physical activities and exercise among youth, though, to date, no studies have examined this question in the context of youth living with T1D.Objective:We examined characteristics of digital gaming versus nondigital gaming (other exercise) sessions and whether youth with T1D who play digital games (gamers) engaged in less other exercise than youth who do not (nongamers), using data from the Type 1 Diabetes Exercise Initiative Pediatric study.Methods:During a 10-day observation period, youth self-reported exercise sessions, digital gaming sessions, and insulin use. We also collected data from activity wearables, continuous glucose monitors, and insulin pumps (if available).Results:The sample included 251 youths with T1D (age: mean 14, SD 2 y; self-reported glycated hemoglobin A1c level: mean 7.1%, SD 1.3%), of whom 105 (41.8%) were female. Youth logged 123 digital gaming sessions and 3658 other exercise (nondigital gaming) sessions during the 10-day observation period. Digital gaming sessions lasted longer, and youth had less changes in glucose and lower mean heart rates during these sessions than during other exercise sessions. Youth described a greater percentage of digital gaming sessions as low intensity (82/123, 66.7%) when compared to other exercise sessions (1104/3658, 30.2%). We had 31 youths with T1D who reported at least 1 digital gaming session (gamers) and 220 youths who reported no digital gaming (nongamers). Notably, gamers engaged in a mean of 86 (SD 43) minutes of other exercise per day, which was similar to the minutes of other exercise per day reported by nongamers (mean 80, SD 47 min).Conclusions:Digital gaming sessions were longer in duration, and youth had less changes in glucose and lower mean heart rates during these sessions when compared to other exercise sessions. Nevertheless, gamers reported similar levels of other exercise per day as nongamers, suggesting that digital gaming may not fully displace other exercise among youth with T1D.
PDF
