This version is made available in accordance with publishers' policies. All material made available by CReaTE is protected by intellectual property law, including copyright law. Any use made of the contents should comply with the relevant law.Contact: create.library@canterbury.ac.uk Improved gross efficiency during long duration submaximal cycling following a short-term high carbohydrate diet To assess the effect of short-term dietary manipulation on gross efficiency, 15 trained male cyclists (V O2max 56.3±7.0ml . kg -1. min -1 ,mean±SD) completed 3 x 2-hour tests at a submaximal exercise intensity (60% Power at V O2max). Using a randomised, crossover design participants consumed an isocalorific diet (~4000kcal . day -1 ) in the 3-days preceding each test, that was either high in carbohydrate (HighCHO, [70%carbohydrate, 20%fat, 10%protein]), low in carbohydrate (LowCHO, [70%fat, 20%carbohydrate, 10%protein]) or contained a moderate amount of carbohydrate (ModCHO, [45%carbohydrate, 45%fat, 10%protein). Gross efficiency (GE) along with blood lactate and glucose were assessed every 30mins, and heart rate was measured at 5second intervals throughout the test. Mean GE was significantly greater following the HighCHO diet than the ModCHO diet (HighCHO=20.4%±0.1%, Mod CHO=19.6±0.2%;P<0.001). Additionally, HighCHO GE was significantly greater after 25mins and 85mins than in the Low CHO Condition (P=0.015;P=0.021). Heart rate responses in the HighCHO condition were significantly lower than during the LowCHO tests (P=0.005). Dietary manipulation had no effect on blood glucose or blood lactate during exercise (P>0.05). In conclusion, significant differences in gross efficiency were obtained following alteration of participants' diet in the 3-days preceding assessment. This suggests that before the measurement of gross efficiency takes place, participants' diet should be carefully controlled and monitored to ensure the validity of the results obtained. To assess the effect of dietary manipulation on gross efficiency (GE), 15 trained male cyclists completed 3 x 2 hour tests at a submaximal exercise intensity (60% Maximal Minute Power). Using a randomized, crossover design participants consumed an isoenergetic diet (~4000 kcal.day-1) in the 3 days preceding each test, that was either high in carbohydrate (HighCHO, [70% of the total energy derived from carbohydrate, 20% fat, 10% protein]), low in carbohydrate (LowCHO, [70% fat, 20% carbohydrate, 10% protein]) or contained a moderate amount of carbohydrate (ModCHO, [45% carbohydrate, 45% fat, 10% protein). GE along with blood lactate and glucose were assessed every 30 minutes, and heart rate was measured at 5 second intervals throughout. Mean GE was significantly greater following the HighCHO than the ModCHO diet (HighCHO=20.4% ± 0.1%, ModCHO=19.6 ± 0.2%;P<0.001). Additionally, HighCHO GE was significantly greater after 25mins (P=0.015) and 85mins (P=0.021) than in the LowCHO condition. Heart rate responses in the HighCHO condition were significantly lower than during the LowCHO...
ObjectiveInvestigate whether hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability.DesignMulticentre, single-blind, randomised controlled trial.SettingRecruitment through neurodisability teams; treatment by parents.ParticipantsNinety children with neurodisability who had never received medication for drooling (55 boys, 35 girls; median age 4 years). Exclusion criteria: medication contraindicated; in a trial that could affect drooling or management.InterventionChildren were randomised to receive a hyoscine skin patch or glycopyrronium liquid. Dose was increased over 4 weeks to achieve optimum symptom control with minimal side-effects; steady dose then continued to 12 weeks.Primary and secondary outcomesPrimary outcome: Drooling Impact Scale (DIS) score at week-4. Secondary outcomes: change in DIS scores over 12 weeks, Drooling Severity and Frequency Scale and Treatment Satisfaction Questionnaire for Medication; adverse events; children’s perception about treatment.ResultsBoth medications yielded clinically and statistically significant reductions in mean DIS at week-4 (25.0 (SD 22.2) for hyoscine and 26.6 (SD 16) for glycopyrronium). There was no significant difference in change in DIS scores between treatment groups. By week-12, 26/47 (55%) children starting treatment were receiving hyoscine compared with 31/38 (82%) on glycopyrronium. There was a 42% increased chance of being on treatment at week-12 for children randomised to glycopyrronium relative to hyoscine (1.42, 95% CI 1.04 to 1.95).ConclusionsHyoscine and glycopyrronium are clinically effective in treating drooling in children with neurodisability. Hyoscine produced more problematic side effects leading to a greater chance of treatment cessation.Trial registration numbersISRCTN 75287237; EUDRACT: 2013-000863-94; Medicines and Healthcare Products Regulatory Agency: 17136/0264/001-0003
The withdrawal of a 3 ml discard volume is sufficient to ensure that the subsequent blood sample is not diluted or contaminated by residual intra-luminal fluid. This may have a significant clinical impact in paediatric oncology, where patients frequently require blood transfusions due to the haematological toxicities associated with chemotherapy. It is hoped that these results will impact on hospital policies concerning specified discard volumes taken from CVCs prior to the withdrawal of blood samples for research purposes and routine clinical analysis.
BackgroundThere are 7000 new cases of head and neck squamous cell cancers (HNSCC) treated by the NHS each year. Stage III and IV HNSCC can be treated non-surgically by radio therapy (RT) or chemoradiation therapy (CRT). CRT can affect eating and drinking through a range of side effects with 90 % of patients undergoing this treatment requiring nutritional support via gastrostomy (G) or nasogastric (NG) tube feeding.Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date, not been compared to assess which leads to a better patient outcome.The purpose of this study is to explore the feasibility of conducting a randomised controlled trial (RCT) comparing these two options with particular emphasis on patient willingness to be randomised and clinician willingness to approach eligible patients.Methods/designThis is a mixed methods multicentre study to establish the feasibility of a randomised controlled trial comparing oral feeding plus pre-treatment gastrostomy versus oral feeding plus as required nasogastric tube feeding in patients with HNSCC. A total of 60 participants will be randomised to the two arms of the study (1:1 ratio). The primary outcome of feasibility is a composite of recruitment (willingness to randomise and be randomised) and retention. A qualitative process evaluation investigating patient, family and friends and staff experiences of trial participation will also be conducted alongside an economic modelling exercise to synthesise available evidence and provide estimates of cost-effectiveness and value of information. Participants will be assessed at baseline (pre-randomisation), during CRT weekly, 3 months and 6 months.DiscussionClinicians are in equipoise over the enteral feeding options for patients being treated with CRT. Swallowing outcomes have been identified as a top priority for patients following treatment and this trial would inform a future larger scale RCT in this area to inform best practice.Trial registration ISRCTN48569216
AimsDrooling saliva is a common problem in children with neurodevelopmental disorders. The consequences of drooling include skin breakdown, dehydration, and damage to clothing/equipment. Hyoscine and glycopyrronium are most commonly used to reduce drooling, but there is little evidence about their relative effectiveness, or side effect profiles.We aimed to investigate in a single blind randomised controlled trial whether hyoscine or glycopyrronium is more effective and acceptable for the treatment of drooling in children with non-progressive neurodisability.MethodsChildren age 3–15 years who had never received medication to treat drooling were recruited from 15 UK centres and randomised to hyoscine or glycopyrronium; stratification was by centre and drooling severity. Dose adjustment and side effect monitoring were undertaken weekly by the trial team over 4 weeks to identify the most effective dose for each child in the context of any side effects. Primary outcome data were gathered with the standardised Drooling Impact Scale (DIS) at 4 weeks by a researcher blind to treatment group status. Follow up continued to 12 weeks.Results90 children (median age 4.9 years) were randomised (49 hyoscine and 41 glycopyrronium). 48 children started hyoscine treatment, and 38 started glycopyrronium. By 4 weeks, 35/48 children (73%) remained on hyoscine and 33/38 (87%) on glycopyrronium; the remaining children had stopped trial medication due to side effects. By 12 weeks, 26/48 children (54%) remained on hyoscine and 31/38 (82%) on glycopyrronium. At 4 weeks there was no significant difference in DIS scores between the treatment groups suggesting both medications were equally effective at the maximum tolerated dose. However, by 4 and 12 weeks hyoscine was associated with more problematic side effects than glycopyrronium and parents were more likely to stop using hyoscine.ConclusionsHyoscine and glycopyrronium are equally effective in treating problematic drooling in children with neurodisability. However, hyoscine is associated with more problematic side effects and is less likely to be tolerated.
One hundred and one pre-treatment primary central primitive neuroectodermal tumours were analysed for the expression of p53 protein by immunohistochemistry using the monoclonal antibody DO-7. The staining intensity was classified into four groups: strong, medium, weak and negative and strong staining intensity was associated with the poorest survival. DNA sequencing of the p53 gene was performed in 28 cases representing all four staining groups. Mutations were found in only three of the strong staining tumours suggesting that DNA mutations were not common events and that in the majority of the tumours with over-expressed p53, the protein was likely to be wild-type. Results of immunohistochemistry showed a significantly positive relationship between the expression of p53 and Bax and Bcl-2 proteins, but not Waf-1. Multivariate analyses supported the prognostic value of p53 immunostaining in central primitive neuroectodermal tumours and also of age and gender of patients.
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