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Acknowledgements | diabetes | DIABETES | The authors of this study would like to express their sincere appreciation for all the respected participants and the Yasuj University of Medical Sciences research committee. Also, the personnel of the diabetes clinic in Yasuj are sincerely thanked for their support and cooperation. | PMC10577942 |
Author contributions | All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Soraya Bagheri, Seyed Majid Ahmadi, Sajjad Reisi, and Sajad Hassanzadeh. The first draft of the manuscript was written by Seyed Majid Ahmadi, Seyed Ahmadreza Ahmadi, Isaac Moradishibany, H... | PMC10577942 | ||
Funding | The current investigation has been financially aided by Yasuj University of Medical Sciences (ID: 990070). This study is written based on a professional doctoral dissertation (internal medicine specialization) and has been approved by Yasuj University of Medical Sciences. | PMC10577942 | ||
Data Availability | It is possible to access the data after coordination with the corresponding author by email. | PMC10577942 | ||
Declarations | PMC10577942 | |||
Competing interests | The authors declare no competing interests. | PMC10577942 | ||
Ethics approval and consent to participate | All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. The participants in the present study indicated their informed consent for participation in the research... | PMC10577942 | ||
Consent for publication | “Not Applicable”. | PMC10577942 | ||
Abbreviations | Diabetic Neuropathy | DIABETIC NEUROPATHY | Visual analog scaleOne-way analysis of covarianceDiabetes MellitusDiabetic Peripheral NeuropathyDiabetic NeuropathyMichigan Diabetic Neuropathy Symptom ScoreSerotonin–Norepinephrine Reuptake Inhibitors | PMC10577942 |
References | PMC10577942 | |||
Background | ACUTE HYPOXEMIC RESPIRATORY FAILURE | The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the physiological effects of awake prone position in patients with acute hypoxemic respiratory failure. | PMC10433569 | |
Methods | acute hypoxemic respiratory failure | ACUTE HYPOXEMIC RESPIRATORY FAILURE | Fifteen patients with acute hypoxemic respiratory failure and PaO | PMC10433569 |
Results | Compared to supine position, prone position increased PaO | PMC10433569 | ||
Supplementary Information | The online version contains supplementary material available at 10.1186/s13054-023-04600-9. | PMC10433569 | ||
Keywords | PMC10433569 | |||
Background | acute hypoxemic respiratory failure | ACUTE HYPOXEMIC RESPIRATORY FAILURE, RECRUITMENT, ACUTE RESPIRATORY DISTRESS SYNDROME | In intubated patients with moderate-to-severe acute respiratory distress syndrome, prone positioning reduces intrapulmonary shunt and generates lung recruitment, optimizes ventilation/perfusion matching, lowers alveolar dead space and reduces right ventricle afterload [In recent years, prone position has been proposed ... | PMC10433569 |
Methods | This sequential crossover study was conducted in the intensive care unit of a university hospital in Italy between October 2018 and June 2020. The study was funded by an unrestricted research grant by the European Society of Intensive Care Medicine (ESICM-2017 Bernhard Dräger Award). The study was approved by instituti... | PMC10433569 | ||
Patients | chest trauma, neutropenia | NEUTROPENIA, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, SYNDROME, ACUTE EXACERBATION OF ASTHMA, ACUTE HYPOXEMIC RESPIRATORY FAILURE, CARDIOGENIC PULMONARY EDEMA | Adult patients admitted to the intensive care unit due to acute hypoxemic respiratory failure were assessed for the enrolment. Acute hypoxemic respiratory failure was defined as an acute onset syndrome characterized by new or worsening impairment in oxygenation. Patients were considered eligible for inclusion if the fo... | PMC10433569 |
Protocol | Patients received high-flow nasal oxygen for 1 h in the supine semirecumbent position. Gas flow was set at 60 L/min, the temperature of the humidification chamber (MR860 or ARIVO2, Fisher and Paykel healthcare) was set according to patient's comfort, FiOFor safety reasons, enteral feeding was interrupted 1 h before pro... | PMC10433569 | ||
Endpoints | LUNG | The primary objectives of this study were to assess the effects of prone position on arterial oxygenation (as defined by the PaOSecondary endpoints of the study were the effects of prone position on:Breathing pattern: respiratory rate, inspiratory effort (the negative deflection of Gas exchange: PaCORespiratory mechani... | PMC10433569 | |
Sample size calculation | Given the physiological design of the study, we did not perform a formal sample size calculation. Consistently with previous investigations with similar design on the topic [ | PMC10433569 | ||
Statistical analysis | EVENT | Categorical data are expressed as the event rate (%), while continuous data are expressed as the median [interquartile range]. Normality in the distribution of continuous variables was assessed with the Kolmogorov–Smirnov test.Normally distributed quantitative variables in the three study steps were compared using ANOV... | PMC10433569 | |
Gas exchange and subjective symptoms | dyspnea | ADVERSE EVENTS | None of the fifteen enrolled patients experienced any serious adverse events. Thirteen out of 15 patients showed increased blood oxygenation after 2 h of prone positioning (mean difference 45 mmHg [95% CI 23–68], PaCOThere was no change in perceived dyspnea among the three study phases, but patients exhibited less tole... | PMC10433569 |
Effort to breath and respiratory mechanics | Respiratory rate decreased during prone positioning (mean difference − 2 breaths per minute [95% CI − 6 to − 1], Compared to supine position, prone position increased inspiratory effort (ΔProne position was associated with changes in respiratory system resistive properties, with an increased time constant compared to b... | PMC10433569 | ||
Tidal volume | Compared to supine position, prone position did not yield changes in tidal volume (all Tidal volume distribution (expressed in % of global tidal volume) in supine and prone position. Results are expressed as means (standard deviation). Prone position promoted tidal volume distribution towards dorsal, dependent lung reg... | PMC10433569 | ||
End-expiratory lung impedance | Prone position increased EELI compared to supine phases before and after the intervention (mean % increase 279% [95%CI: 133 to 330], The increase in EELI occurred throughout all lung regions, but was prominent in dorsal ROIs.The increase in EELI led to a reduction in the dynamic strain during prone position, compared t... | PMC10433569 | ||
Discussion | ventilator-induced lung injury, hypoxemic respiratory failure, hypoxemia, ARDS | ADVERSE EVENTS, RECRUITMENT, ADVERSE EFFECTS, ARDS, ACUTE RESPIRATORY DISTRESS SYNDROME, HYPOXEMIC RESPIRATORY FAILURE | The results of this sequential study on the physiological effects of awake prone positioning in patients with moderate-to-severe hypoxemic respiratory failure undergoing high-flow nasal oxygen can be summarized as follows:Awake prone positioning improves arterial oxygenation without serious periprocedural adverse event... | PMC10433569 |
Conclusions | hypoxemia | RECRUITMENT, ACUTE RESPIRATORY FAILURE | In patients undergoing high-flow nasal oxygen and exhibiting moderate-to-severe hypoxemia due to acute respiratory failure, prone position improves oxygenation by enhancing recruitment of dorsal lung regions, homogenizes ventilation distribution and reduces respiratory rate. Prone position does not affect | PMC10433569 |
Acknowledgements | None. | PMC10433569 | ||
Author contributions | DLG designed the study. All authors contributed to patients’ enrollment. LDC and LSM analyzed the data. DLG drafted the first version of the manuscript. AP, SMM and MA revised the manuscript. All the authors reviewed the final draft of the manuscript and agreed on submitting it to Critical Care. | PMC10433569 | ||
Funding | This study was supported by a grant by ESICM (2017 Draeger award) and by Ministero della Saluto (Ricerca corrente 2023). | PMC10433569 | ||
Availability of data and materials | The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. | PMC10433569 | ||
Declarations | PMC10433569 | |||
Ethics approval and consent to participate | The study was approved by local Ethics Committee, and informed consent was obtained by enrolled patients according to committee recommendation. | PMC10433569 | ||
Consent for publication | Not applicable. | PMC10433569 | ||
Competing interests | DLG has received speaking fees by Gilead, Intersurgical, MSD and GE, and reports having received travel accommodation by Fisher and Paykel. MA has received personal fees by Maquet, and a research grant by Toray. DLG and MA disclose a research grant by GE. | PMC10433569 | ||
References | PMC10433569 | |||
Background: | GIRD, shoulder pain | PATHOLOGY | Maladaptation can provoke important alterations in the arthrokinematics such as an internal rotation reduction in the dominant shoulder compared with the nondominant shoulder known as glenohumeral internal rotation deficit (GIRD). Though the number of studies investigating GIRD in athletic population, there are not stu... | PMC10519522 |
Methods: | GIRD, shoulder pain | An open single-arm trial with 35 patients was adopted for evaluating the efficacy of GIRD treatment in patients with shoulder pain. All patients with shoulder pain who attended the consultation, accepted, and agreed to participate in the study between October 2020 and March 2021 were included. A treatment sequence incl... | PMC10519522 | |
Results: | painful shoulder | Treatment of the patients significantly increased the IR of the painful shoulder in all the patients ( | PMC10519522 | |
Conclusions: | painful shoulder and reduced the GIRD | The treatment administrated in this study significantly increased the internal rotation of the treated and painful shoulder and reduced the GIRD from the first consultation. | PMC10519522 | |
Level of evidence: | Level 3. | PMC10519522 | ||
1. Introduction | Shoulder pain, GIRD, shoulder pain, pain | PATHOLOGY, RECURRENCE | Shoulder pain is a frequent disabling joint problem in the general population. The reported incidence ranges between 0.9% and 2.5%Shoulder pain is mainly related to the glenohumeral joint.Recovery from this ailment is slow and is associated with a high recurrence or persistence pain at 12-month.This study aimed to desc... | PMC10519522 |
2. Materials and Methods | PMC10519522 | |||
2.1. Study design | GIRD, NCT05108311, shoulder pain | An open single-arm trial (clinical trial registration number: NCT05108311) was adopted for evaluating the efficacy of reducing GIRD in patients with shoulder pain using an exercise routine initiated at the time of the first consultation. All patients underwent a medical examination. | PMC10519522 | |
2.2. Ethics approval | subclavian muscle, Myofascial, scapulothoracic joints, GIRD, pectoralis muscle, sternocostoclavicular to acromioclavicular joints, Myofascial releases external rotators, adduction | MINOR | The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Clínica Universitaria de Navarra (Project 2020.095 of June 18, 2020). Informed consent was obtained from all subjects and/or their legal guardian(s) for publication of identifying information/images in an ... | PMC10519522 |
2.3. Sample | Shoulder pain, shoulder pain | All patients with shoulder pain who attended the consultation, accepted, and agreed to participate in the study between October 1, 2020 and March 31, 2021 were included. The shoulder pain in the patients was understood as when they manifested an unpleasant sensory and emotional experience directly associated with actua... | PMC10519522 | |
2.4. Measurements | abduction | All participants underwent a physical examination by physiotherapist with one more than 20 years of experience (RJ-L), followed by anthropometric and sociodemographic data that is sex, age, height, weight, occupation, marital status, descent, previous surgeries, and sport habits (documented via questionnaire and by mea... | PMC10519522 | |
2.5. Treatment | scapular adduction, decubitus, abduction | DECUBITUS | The treatment here is applied to the patients and is based on a manual therapy aimed at increasing the IR of a painful shoulder and reducing, at the same time, the GIRD. This kind of treatment has traditionally been used to improve the range of motion in situations of mobility deficits of the shoulder joint complex, su... | PMC10519522 |
2.6. The minimal clinically important difference calculation | The minimal clinically important difference (MCID) was estimated from a distribution-based calculation using Cohen | PMC10519522 | ||
2.7. Statistical analysis | Data distribution was evaluated using Kolmogorov–Smirnov statistics with Lilliefors correction. Descriptive statistics are cited as means ± SD in case of normal distribution and as median and interquartile range in case of non-normal distribution for each of the variables that were calculated. A Student | PMC10519522 | ||
3. Results | painful shoulder, shoulder pain | Treatment of the patients significantly increased the IR of the painful shoulder in all the patients ((A) Internal rotation (IR) in patients with shoulder pain before (IRGIRD before and after treatment and improvement percentage are represented in Figure | PMC10519522 | |
4. Discussion | painful shoulder and reduced the GIRD, shoulder flexion, GIRD, cross-body | POSTERIOR CAPSULAR THICKENING, STRETCHES | In this study, we aim to describe the efficacy of the GIRD treatment in nonathlete population. Although the definition of GIRD an exact value is still controversial,GIRD treatment involves targeting posterior capsular thickening and the posterior rotator cuff muscular adaptations in the form of “sleeper stretches” (arm... | PMC10519522 |
Acknowledgments | We wish to acknowledge Dr John Jairo Aguilera-Correa for his writing assistance, and Dr Amr A. Abdelkader from the International Centre for Orthopaedics and Neurosciences (Doha, Qatar) for his help in reviewing the manuscripts for language-related aspects, and Mr. José Luis Lara-Cabrero from Clínica CEMTRO (Madrid, Spa... | PMC10519522 | ||
Abbreviations: | shoulder pain | external rotationglenohumeral internal rotation deficitinternal rotationminimal clinically important differencestandard deviationThe authors have no funding and conflicts of interest to disclose.The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasona... | PMC10519522 | |
References | PMC10519522 | |||
Key Points | PMC10119738 | |||
Question | Does treadmill perturbation-based balance training (PBT) reduce daily-life fall rates among community-dwelling adults 65 years or older? | PMC10119738 | ||
Findings | In this randomized clinical trial involving 140 highly functioning older adults, those who received an 4-session PBT intervention (totaling 80 minutes) experienced a statistically nonsignificant 22% reduction in daily-life fall rates over a 12-month period. | PMC10119738 | ||
Meaning | Findings of this trial suggest the need for future studies to investigate possible effects of current treadmill PBT on daily-life falls. | PMC10119738 | ||
Importance | injuries | Falls are common and the leading cause of injuries among older adults, but falls may be attenuated by the promising and time-efficient intervention called perturbation-based balance training (PBT). | PMC10119738 | |
Objective | To evaluate the effects of a 4-session treadmill PBT intervention compared with regular treadmill walking on daily-life fall rates among community-dwelling older adults. | PMC10119738 | ||
Design, Setting, and Participants | This 12-month, assessor-blinded randomized clinical trial was conducted from March 2021 through December 2022 in Aalborg University in Denmark. Participants were community-dwelling adults 65 years or older and were able to walk without a walking aid. Participants were randomized to either PBT (intervention group) or tr... | PMC10119738 | ||
Interventions | Participants who were randomized to the intervention group underwent four 20-minute sessions of PBT, including 40 slip, trip, or mixed slip and trip perturbations. Participants who were randomized to the control group performed four 20-minute sessions of treadmill walking at their preferred speed. The 3 initial trainin... | PMC10119738 | ||
Main Outcomes and Measures | fractures | Primary outcome was the daily-life fall rates that were collected from fall calendars for the 12 months after the third training session. Secondary outcomes were the proportion of participants with at least 1 fall and recurrent falls, time to first fall, fall-related fractures, fall-related injuries, fall-related healt... | PMC10119738 | |
Results | A total of 140 highly functioning, community-dwelling older adults (mean [SD] age, 72 [5] years; 79 females [56%]), 57 (41%) of whom had a fall in the past 12 months, were included in this trial. Perturbation training had no significant effect on daily-life fall rate (incidence rate ratio [IRR]: 0.78; 95% CI, 0.48-1.27... | PMC10119738 | ||
Conclusions and Relevance | Results of this trial showed that participants who received an 80-minute PBT intervention experienced a statistically nonsignificant 22% reduction in daily-life fall rates. There was no significant effect on other daily-life fall-related metrics; however, a statistically significant decrease in falls was found in the l... | PMC10119738 | ||
Trial Registration | ClinicalTrials.gov Identifier: | PMC10119738 | ||
Introduction | injuries | Falling is the leading cause of injuries in older adults, and the associated costs of treatment and rehabilitation burden society substantially.The recently published world guidelines for fall prevention highlight PBT as a future research priority. | PMC10119738 | |
Methods | PMC10119738 | |||
Study Design, Setting, and Participants | neurological disease, osteoporosis-related fractures, cognitive impairment, fracture, Parkinson or multiple sclerosis, osteoporosis | NEUROLOGICAL DISEASE, OSTEOPOROSIS | This assessor-blinded, parallel-group (1:1 ratio) RCT was conducted between March 2021 and December 2022 at a laboratory in Aalborg University in Denmark. The trial protocol was approved by the North Denmark Region Committee on Health Research Ethics and the Danish Data Protection Agency. All participants provided writ... | PMC10119738 |
Randomization and Interventions | After the pretraining assessments, participants were randomized in a 1:1 ratio to either the PBT (intervention) group or control group ( | PMC10119738 | ||
Participant Flowchart | PBT indicates perturbation-based balance training.All participants in the PBT group were assigned to four 20-minute PBT sessions, and participants in the control group were assigned to 4 treadmill walking training sessions; the initial 2 training sessions were performed on the same day immediately after the pretraining... | PMC10119738 | ||
Training Schedule | sudden small deceleration | POSITIVE | The figure illustrates the arrangement of the training sessions (A). During slip perturbations (B), the participant walked at their preferred walking speed when a sudden acceleration reversed the direction of the belt movement before the belt returned to the preferred walking speed. During trip perturbations (C), the p... | PMC10119738 |
Perturbation-Based Balance Training (Intervention) | anxiety | Each of the 4 PBT sessions lasted approximately 20 minutes and consisted of 40 perturbations (20 to each leg) delivered on a uniformly moving treadmill with no lateral rails (Split 70/157/ASK; Woodway). A safety harness prevented participants from falling to the ground if they could not regain balance after a perturbat... | PMC10119738 | |
Treadmill Walking Training (Control) | In each of the 4 treadmill walking training sessions, the control participants performed 20 minutes of treadmill walking at their preferred walking speed. The duration of these walks matched the PBT group's time on the treadmill. | PMC10119738 | ||
Outcome Assessment | fracture, fractures, injury or unpleasantness | ADVERSE EVENTS, EVENT | This RCT’s primary outcome was the daily-life fall rates that were collected from fall calendars for the 12 months after the third training session. A fall was defined as “an unexpected event in which the participant comes to rest on the ground, floor, or lower level.”Secondary outcomes included the proportion of parti... | PMC10119738 |
Statistical Analysis | REGRESSION, SENSITIVITY | An a priori sample size calculation was performed using a Poisson regression model in G*Power, version 3.1.9.4 (University of Kiel). To detect a significant (2-sided α = .05) difference between groups of 50% from a base fall rate of 0.85 with 80% power and an expected 20% dropout, a total of 140 participants, with 70 i... | PMC10119738 | |
Results | PMC10119738 | |||
Enrollment and Adherence | Of the 199 individuals screened for eligibility, 140 were included (mean [SD] age, 72 [5] years; 79 females [56%] and 61 males [44%]) and randomized to either the PBT or control group ( | PMC10119738 | ||
Baseline Characteristics of Participants | Frailty | Abbreviation: PBT, perturbation-based balance training.Tilburg Frailty Indicator: score range of 0 to 15, with a lower score indicating less frailty.Vulnerable Elders-13 Survey: score range of 0 to 10, with a lower score indicating less vulnerable.Short Falls Efficacy Scale: score range of 7 to 28, with a lower score i... | PMC10119738 | |
Daily-Life and Laboratory Falls | For the primary outcome, 62 falls in the PBT group (rate of falls per person-year of follow-up: 0.90; 95% CI, 0.58-1.21) and 78 in the control group (rate of falls per person-year of follow-up: 1.14; 95% CI, 0.76-1.52) were reported, resulting in a nonsignificant 22% relative between-group difference in fall rates (inc... | PMC10119738 | ||
Comparison of the Number of Falls in the Intervention and Control Groups | PBT indicates perturbation-based balance training. | PMC10119738 | ||
Daily-Life Fall Results From Intention-to-Treat Analysis After 12 Months | EVENTS | Abbreviations: HR, hazard ratio; IRR, incidence rate ratio; NA, not applicable; PBT, perturbation-based balance training; RR, risk ratio.Primary outcome. The rate is the falls per person-year of follow-up.Not enough events to conduct analysis.The laboratory fall rates were similar at baseline but were significantly low... | PMC10119738 | |
Sensitivity Analyses | REGRESSION | The Poisson regression with bootstrapping yielded results that were comparable to those of the negative binomial regression for all count outcomes (eAppendix 3 in | PMC10119738 | |
Safety | knee injury, injuries | ADVERSE EVENTS | No serious adverse events were reported in the present RCT. Nevertheless, 2 injuries occurred during PBT: a knee injury and a muscle strain in the thigh. The participant with the knee injury had 1 appointment with the general practitioner, but none of the injuries required any further health care treatment. An overview... | PMC10119738 |
Discussion | In this trial of a 4-session treadmill PBT intervention, there was not a statistically significant decrease in daily-life fall rates among community-dwelling older adults compared with those in the control group. There was, however, a significant reduction in laboratory fall rates associated with PBT.The significant de... | PMC10119738 | ||
Limitations | This trial has several limitations. First, participants were unblinded to group randomization due to the nature of training interventions. Given that the initial fall reporting was a participant-reported outcome, the lack of blinding may have contributed to fewer falls reported in the PBT group. However, daily-life fal... | PMC10119738 | ||
Conclusions | In this RCT, participants who received an 80-minute PBT intervention experienced a statistically nonsignificant 22% reduction in daily-life fall rates. There was no significant effect on other daily-life fall-related metrics; however, a statistically significant decrease in falls was found in the laboratory setting. Fu... | PMC10119738 | ||
Aims/hypothesis | NOCTURNAL HYPOGLYCAEMIA | It is generally recommended to reduce basal insulin doses after exercise to reduce the risk of post-exercise nocturnal hypoglycaemia. Based on its long | PMC9988601 | |
Methods | hypoglycaemia, diabetes | TYPE 1 DIABETES, HYPOGLYCAEMIA, DIABETES | The ADREM study (Adjustment of insulin Degludec to Reduce post-Exercise (nocturnal) hypoglycaeMia in people with diabetes) was a randomised controlled, crossover study in which we compared 40% dose reduction (D40), or postponement and 20% dose reduction (D20-P), with no dose adjustment (CON) in adults with type 1 diabe... | PMC9988601 |
Results | We recruited 18 participants (six women, age 38 ± 13 years, HbA | PMC9988601 | ||
Conclusions/interpretation | EVENTS, TYPE 1 DIABETES, NOCTURNAL HYPOGLYCAEMIA | Post-exercise adjustment of degludec does not mitigate the risk of subsequent nocturnal hypoglycaemia in people with type 1 diabetes. Although reducing degludec reduced next-day time below range, this did not translate into fewer hypoglycaemic events, while postponing degludec should be avoided because of increased tim... | PMC9988601 | |
Trial registration | EudraCT number 2019-004222-22 | PMC9988601 | ||
Funding | The study was funded by an unrestricted grant from Novo Nordisk, Denmark. | PMC9988601 | ||
Graphical abstract | PMC9988601 | |||
Supplementary Information | The online version of this article (10.1007/s00125-023-05893-9) contains peer-reviewed but unedited supplementary material. | PMC9988601 | ||
Keywords | PMC9988601 | |||
Introduction | TYPE 1 DIABETES MELLITUS | Regular physical exercise is recommended for people with type 1 diabetes mellitus given its beneficial effects on general well-being, cardiometabolic health and insulin requirements [Insulin degludec is a second-generation long-acting insulin analogue with a much longer | PMC9988601 | |
Methods | PMC9988601 |
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