For decades lysophosphatidylcholine (LPC, lysolecithin) has been used to induce demyelination, without a clear understanding of its mechanisms. LPC is an endogenous lysophospholipid so it may cause demyelination in certain diseases. We investigated whether known receptor systems, inflammation or nonspecific lipid disruption mediates LPC-demyelination in mice. We found that LPC nonspecifically disrupted myelin lipids. LPC integrated into cellular membranes and rapidly induced cell membrane permeability; in mice, LPC injury was phenocopied by other lipid disrupting agents. Interestingly, following its injection into white matter, LPC was cleared within 24 hr but by five days there was an elevation of endogenous LPC that was not associated with damage. This elevation of LPC in the absence of injury raises the possibility that the brain has mechanisms to buffer LPC. In support, LPC injury in culture was significantly ameliorated by albumin buffering. These results shed light on the mechanisms of LPC injury and homeostasis.
Purpose The objective of the study was to assess the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of patellar tendinopathy. Methods The PubMed, MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for clinical trials which compared PRP injection with other ‘active treatment’ interventions (‘Non-PRP’ injection and ‘No-injection’ treatments) or ‘No-active treatment’ interventions. Randomized and non-randomized clinical trials that had been published up to 15 November 2021, were included in the meta-analysis. The primary outcome, pain relief, was measured on a ‘visual analog scale.’ Secondary outcomes were knee functional activities and quality of life (QoL). The PRISMA guidelines were followed throughout the study. Results Eight comparative studies were identified for inclusion in the meta-analysis. Assessment of these studies revealed that there were no significant differences in pain relief, functional outcomes, and QoL in the short, medium, and long term between PRP injection and Non-PRP injection interventions. Similarly, comparison of PRP injection to the No-active treatment intervention showed no differences in short- and medium-term pain relief. However, when PRP injection was compared to the No-injection treatment intervention extracorporeal shock wave therapy (ECWT), the former was found to be more effective in terms of pain relief in the medium term (mean difference [MD] − 1.50; 95% confidence interval [CI] − 2.72 to − 0.28) and long term (MD − 1.70; 95% CI, − 2.90 to − 0.50) and functional outcomes in the medium term (MD 13.0; 95% CI 3.01–22.99) and long term (MD 13.70; 95% CI 4.62–22.78). Conclusions In terms of pain relief and functional outcomes, the PRP injection did not provide significantly greater clinical benefit than Non-PRP injections in the treatment of patellar tendinopathy. However, in comparison with ESWT, there was a significant benefit in favor of PRP injection.
Background The term posthospital syndrome has been used to describe the condition in which older patients are transiently frail after hospitalization and have a high chance of readmission. Since low activity and poor sleep during hospital stay may contribute to posthospital syndrome, the continuous monitoring of such parameters by using affordable wearables may help to reduce the prevalence of this syndrome. Although there have been systematic reviews of wearables for physical activity monitoring in hospital settings, there are limited data on the use of wearables for measuring other health variables in hospitalized patients. Objective This systematic review aimed to evaluate the validity and utility of wearable devices for monitoring hospitalized patients. Methods This review involved a comprehensive search of 7 databases and included articles that met the following criteria: inpatients must be aged >18 years, the wearable devices studied in the articles must be used to continuously monitor patients, and wearables should monitor biomarkers other than solely physical activity (ie, heart rate, respiratory rate, blood pressure, etc). Only English-language studies were included. From each study, we extracted basic demographic information along with the characteristics of the intervention. We assessed the risk of bias for studies that validated their wearable readings by using a modification of the Consensus-Based Standards for the Selection of Health Status Measurement Instruments. Results Of the 2012 articles that were screened, 14 studies met the selection criteria. All included articles were observational in design. In total, 9 different commercial wearables for various body locations were examined in this review. The devices collectively measured 7 different health parameters across all studies (heart rate, sleep duration, respiratory rate, oxygen saturation, skin temperature, blood pressure, and fall risk). Only 6 studies validated their results against a reference device or standard. There was a considerable risk of bias in these studies due to the low number of patients in most of the studies (4/6, 67%). Many studies that validated their results found that certain variables were inaccurate and had wide limits of agreement. Heart rate and sleep were the parameters with the most evidence for being valid for in-hospital monitoring. Overall, the mean patient completion rate across all 14 studies was >90%. Conclusions The included studies suggested that wearable devices show promise for monitoring the heart rate and sleep of patients in hospitals. Many devices were not validated in inpatient settings, and the readings from most of the devices that were validated in such settings had wide limits of agreement when compared to gold standards. Even some medical-grade devices were found to perform poorly in inpatient settings. Further research is needed to determine the accuracy of hospitalized patients’ digital biomarker readings and eventually determine whether these wearable devices improve health outcomes.
BACKGROUND The term ‘post-hospital syndrome’ has been used to describe the condition in which elderly patients are transiently frail after hospitalization and have a high chance of readmission. Since low activity and poor sleep contribute to ‘post-hospital syndrome’, continuous inpatient monitoring of these important parameters using affordable wearables may help and reduce this syndrome. While there have been systematic reviews of wearables for physical activity monitoring in the hospital setting, there is limited data on use of wearables measuring other parameters in hospitalized patients. OBJECTIVE This systematic review aimed to evaluate the utility and accuracy of wearable devices in their ability to monitor inpatients. METHODS This review incorporated a comprehensive search of seven databases and included articles which met the following inclusion criteria: inpatients above age 18, device studied in the articles had to be wearable technology and have at least one sensor, articles had to describe an element of continuous monitoring (greater than 24 hours) and monitoring had to include more than just physical activity. There were no restrictions on publication period, but only English language studies were included. From each study we extracted basic demographic information along with characteristics of the intervention. RESULTS From 2,012 articles that were screened, 15 articles met the selection criteria. All articles included were observational in design. Nine different commercial wearables, with various body locations, were examined in this review. The devices collectively measured 7 different health parameters across all studies. Only 6 studies validated their results against a reference device or standard. Of those that did validate results, many found that certain variables were inaccurate with wide limits of agreement. Heart rate and sleep had the most evidence for being valid in the hospital. Overall, wearable devices were found to be a feasible alternative for inpatient monitoring as 13 of the 15 studies had a mean participation completion rate greater than 80%. CONCLUSIONS Overall, assessment of studies in this review suggested that wearable devices showed promise in monitoring the heart rate and sleep of patients in hospital. The results demonstrate that many devices have not been validated in the inpatient setting, and amongst those that do, some wearable measurements were not found to be valid. Further research is needed to validate the wearable health variables in hospitalized patients and eventually determine whether these devices improve health outcomes.
BackgroundWearable devices such as Fitbits may provide important insights about hospitalized patients that include data on low activity and poor sleep. Monitoring this information could spur interventions to improve mobility and sleep which may reduce the adverse effects associated with hospitalization. However, there is a lack of studies assessing the accuracy of wearables in hospitalized medical patients. The purpose of our study was to determine the accuracy of Fitbit heart rate, sleep and physical activity in hospitalized medical patients.MethodsWe conducted a prospective cohort feasibility study enrolling 50 medical inpatients at two hospitals providing them with a Fitbit Charge. Our main measures were Fitbit heart rate, sleep and activity data as well as nurse recorded heart rates, patient reported sleep, and nurse assessments of activity.ResultsOf the 50 patients who consented to the study, 47 patients wore the devices. Comparing pairs of heart rate data from Fitbit and nurse recorded vital signs for the same minute, there were 261 pairs available for comparison. The mean difference was 0.45 bpm (SD: 13.0, Pearson correlation: 0.68 P<0.001) and the 95% limits of agreement were -25 to 26 bpm. The association between the patient-reported sleep score and Fitbit total sleep duration was 0.19 (P=0.24) and between the self-reported hours of sleep and Fitbit total sleep duration was 0.21 (P=0.21). The correlation between nurse-recorded activity and Fitbit daily steps was 0.06 (P=0.52). ConclusionsFitbit heart rates correlated well with nurse-recorded heart rate but did not correlate well with nurse assessments of activity nor with patient self-assessment of sleep. This study highlights limitations of the accuracy of current wearable wrist-worn device algorithms in activity and sleep detection in patients in hospital. The findings call into question the validity of Fitbits for assessment of patient activity and sleep in the hospital setting and suggest that they should not be routinely used without further validation.Trial RegistrationClinicalTrials.gov NCT03646435
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