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Kidney360 Jun 2023This first step demonstrated content validity for a patient-reported outcome measure for skeletal muscle cramping in dialysis. This work lays the foundation for...
KEY POINTS
This first step demonstrated content validity for a patient-reported outcome measure for skeletal muscle cramping in dialysis. This work lays the foundation for developing a patient-reported outcome measure for regulatory use to assess skeletal muscle cramping in people receiving dialysis.
BACKGROUND
Skeletal muscle cramping is a common, painful, and debilitating symptom experienced by people receiving dialysis. Neither a standardized, patient-endorsed definition of skeletal muscle cramping nor full understanding of patients' perspectives of skeletal muscle cramping exist. We conducted focus groups, within a Kidney Health Initiative (KHI) project, to elicit skeletal muscle cramping experiences of people receiving dialysis as the basis for patient-reported outcome measure (PROM) development.
METHODS
Eligible participants (English-speaking adults aged 18–85 years treated by dialysis and a skeletal muscle cramping episode within 30 days) were purposively recruited from a panel (L&E Research) of people receiving dialysis at home or in-center. Standard qualitative methods were used to conduct virtual 90-minute sessions discussing the following: skeletal muscle cramping clinical characteristics, participants' skeletal muscle cramping experiences, and feedback on a draft skeletal muscle cramping definition and a patient-facing conceptual model developed by the KHI project workgroup. We used qualitative thematic analysis.
RESULTS
There were 20 diverse participants in three focus groups. Universally experienced skeletal muscle cramping attributes differed by dialysis setting in onset, worst pain rating, duration, and timing. Variably experienced attributes (applied to home and in-center dialysis) were gross and fine motor effect, sleep disruption, mood-related themes of fear, and annoyance/frustration/irritability. Avoidance/adaptive behaviors included reluctance or avoiding movement, adjusting what they ate or drink (, yellow mustard, pickles, pickle juice, and tonic water), heat application, massage, and cannabidiol use. The skeletal muscle cramping definition was endorsed, and insightful suggestions for conceptual model were collected.
CONCLUSIONS
This qualitative study of in-center and home patients' skeletal muscle cramping experiences identified universally and variably experienced attributes. The patient-endorsed skeletal muscle cramping definition can serve as a standard for assessment. These results provide the foundation to develop a PROM for regulatory use with people receiving maintenance dialysis who experience skeletal muscle cramping.
Topics: Humans; Renal Dialysis; Focus Groups; Kidney Failure, Chronic; Muscle Cramp; Muscle, Skeletal
PubMed: 37036682
DOI: 10.34067/KID.0000000000000121 -
Roczniki Panstwowego Zakladu Higieny 2023Thailand is a tropical developing country which has a serious increase in health risk due to hot weather exposure among outdoor workers.
BACKGROUND
Thailand is a tropical developing country which has a serious increase in health risk due to hot weather exposure among outdoor workers.
OBJECTIVES
The aims of this study were to compare the factors related to environmental heat exposure in three different seasons, and to assess the relationship between environmental heat and dehydration status in each season among farmworkers in Nakhon Ratchasima, Thailand.
METHODS
A semi-longitudinal study was carried out in 22 male farmworkers throughout a year of farming. The primary data were collected in farmworkers for socio-demographic information, clinical assessments, and heat-related illnesses.
RESULTS
Average of environmental heat index (Median, SD) were severe in summer (WBGT=38.1, 2.8°C), rainy season (WBGT=36.1, 2.1°C), and winter (WBGT=31.5, 2.7°C). Average urine Sp. Gr. in summer, rainy season, and winter were 1.022, 1.020, and 1.018 respectively. The third sentence should be corrected as follows: The Friedman analysis revealed a statistically significant difference between the three different seasons in WBGT (wet bulb globe temperature), body temperature, heart rate (P<0.01), and respiratory rate (P<0.05). There was a statistically significant difference between the three different seasons for skin rash/itching, dizziness, muscle cramp dyspnea (P<0.05), and weakness (P<0.01). Wilcoxon signed-ranks analysis found a significant difference in the medians of the paired sets of urine Sp. Gr. values between baseline and summer (P<0.05). Spearman's rank correlation coefficient did not find a relationship between WBGT and urine Sp. Gr. in the three different seasons.
CONCLUSIONS
This study demonstrated that farmworkers had exposure to environmental heat stress which was expressed through physical changes. Therefore, there is a need for either interventions or guidelines to prevent dehydration for outdoor workers in this region.
Topics: Humans; Male; Hot Temperature; Occupational Exposure; Farmers; Thailand; Longitudinal Studies; Dehydration; Heat Stress Disorders; Health Status
PubMed: 37013902
DOI: 10.32394/rpzh.2023.0250 -
Ugeskrift For Laeger Mar 2023The spasmolytic agent baclofen is regarded as having a low dependence potential. This is a case report of a 46-year-old woman with an escalating use of baclofen to four...
The spasmolytic agent baclofen is regarded as having a low dependence potential. This is a case report of a 46-year-old woman with an escalating use of baclofen to four times the highest recommended dose. She was initially admitted to hospital due to decreased consciousness. Later, during tapering, she was readmitted unresponsive with myoclonus. Baclofen was discontinued abruptly during sedation with propofol and remifentanil infusion as well as midazolam in refract doses. Eight days later she was discharged without sequelae.
Topics: Female; Humans; Middle Aged; Hypnotics and Sedatives; Baclofen; Muscle Cramp; Propofol; Midazolam
PubMed: 36999288
DOI: No ID Found -
Clinical Neurophysiology : Official... May 2023Skater's cramp is a movement disorder in speed skaters. We investigated whether affected skaters matched the disease profile of task-specific dystonia, specifically...
OBJECTIVE
Skater's cramp is a movement disorder in speed skaters. We investigated whether affected skaters matched the disease profile of task-specific dystonia, specifically whether there was evidence of maladaptive muscle activity occurring simultaneously with aberrant movements (jerking). We further examined different skating intensities, positing no change would be more indicative of task-specific dystonia.
METHODS
We analyzed video, kinematic and muscle activity in 14 affected skaters. We measured the angular velocity and electromyographic activity of normalized speed skating strokes using one dimensional statistical non-parametric mapping. Skaters were matched with comparably skilled controls, and filled out a bespoke clinical questionnaire.
RESULTS
Skaters' impacted leg showed over-activation in the peroneus longus, tibialis anterior and gastrocnemius that coincided with higher foot movement compared to their healthy leg and controls. This pattern persisted regardless of skating intensity. Clinical features indicated it was task-specific and painless with common trigger factors including stress, equipment change, and falling.
CONCLUSIONS
We showed aberrant muscular and kinematic activity in a movement disorder in speed skaters indicative of task-specific dystonia.
SIGNIFICANCE
Understanding skater's cramp as a task-specific dystonia could reduce the damage that misdiagnosis and unsuccessful invasive operations have caused. Our quantitative method has value in testing future treatment efficacy.
Topics: Humans; Biomechanical Phenomena; Muscle Cramp; Leg; Skating; Movement Disorders
PubMed: 36948074
DOI: 10.1016/j.clinph.2023.02.168 -
JHEP Reports : Innovation in Hepatology Apr 2023Acetaminophen (APAP)-induced acute liver injury (AILI) is a leading cause of acute liver failure (ALF). -acetylcysteine (NAC) is only effective within 24 h after APAP...
BACKGROUND & AIMS
Acetaminophen (APAP)-induced acute liver injury (AILI) is a leading cause of acute liver failure (ALF). -acetylcysteine (NAC) is only effective within 24 h after APAP intoxication, raising an urgent need for alternative approaches to treat this disease. This study aimed to test whether cathelicidin (), which is a protective factor in chronic liver diseases, protects mice against APAP-induced liver injury and ALF.
METHODS
A clinically relevant AILI model and an APAP-induced ALF model were generated in mice. Genetic and pharmacological approaches were used to interfere with the levels of cathelicidin .
RESULTS
An increase in hepatic pro-CRAMP/CRAMP (the precursor and mature forms of mouse cathelicidin) was observed in APAP-intoxicated mice. Upregulated cathelicidin was derived from liver-infiltrating neutrophils. Compared with wild-type littermates, knockout had no effect on hepatic injury but dampened hepatic repair in AILI and reduced survival in APAP-induced ALF. CRAMP administration reversed impaired liver recovery observed in APAP-challenged knockout mice. Delayed CRAMP, CRAMP(1-39) (the extended form of CRAMP), or LL-37 (the mature form of human cathelicidin) treatment exhibited a therapeutic benefit for AILI. Co-treatment of cathelicidin and NAC in AILI displayed a stronger hepatoprotective effect than NAC alone. A similar additive effect of CRAMP(1-39)/LL-37 and NAC was observed in APAP-induced ALF. The pro-reparative role of cathelicidin in the APAP-damaged liver was attributed to an accelerated resolution of inflammation at the onset of liver repair, possibly through enhanced neutrophil phagocytosis of necrotic cell debris in an autocrine manner.
CONCLUSIONS
Cathelicidin reduces APAP-induced liver injury and ALF in mice by promoting liver recovery via facilitating inflammation resolution, suggesting a therapeutic potential for late-presenting patients with AILI with or without ALF.
IMPACT AND IMPLICATIONS
Acetaminophen-induced acute liver injury is a leading cause of acute liver failure. The efficacy of -acetylcysteine, the only clinically approved drug against acetaminophen-induced acute liver injury, is significantly reduced for late-presenting patients. We found that cathelicidin exhibits a great therapeutic potential in mice with acetaminophen-induced liver injury or acute liver failure, which makes up for the limitation of -acetylcysteine therapy by specifically promoting liver repair after acetaminophen intoxication. The pro-reparative role of cathelicidin, as a key effector molecule of neutrophils, in the APAP-injured liver is attributed to an accelerated resolution of inflammation at the onset of liver repair, possibly through enhanced phagocytic function of neutrophils in an autocrine manner.
PubMed: 36923240
DOI: 10.1016/j.jhepr.2023.100687 -
International Journal of Molecular... Feb 2023Adipose-derived mesenchymal stem cells (ADMSCs) are a type of pluripotent somatic stem cells that differentiate into various cell types such as osteoblast, chondrocyte,...
Adipose-derived mesenchymal stem cells (ADMSCs) are a type of pluripotent somatic stem cells that differentiate into various cell types such as osteoblast, chondrocyte, and neuronal cells. ADMSCs as donor cells are used to produce regenerative medicines at hospitals and clinics. However, it has not been reported that ADMSCs were differentiated to a specific type of neuron with a peptide. Here, we report that ADMSCs differentiate to the cholinergic phenotype of neurons by the SOCS7-derived BC-box motif peptide. At operations for patients with neurological disorders, a small amount of subcutaneous fat was obtained. Two weeks later, adipose-derived mesenchymal stem cells (ADMSCs) were isolated and cultured for a further 1 to 2 weeks. Flow cytometry analysis for characterization of ADMSCs was performed with CD73, CD90, and CD105 as positive markers, and CD14, CD31, and CD56 as negative markers. The results showed that cultured cells were compatible with ADMSCs. Immunocytochemical studies showed naïve ADMSCs immunopositive for p75NTR, RET, nestin, keratin, neurofilament-M, and smooth muscle actin. ADMSCs were suggested to be pluripotent stem cells. A peptide corresponding to the amino-acid sequence of BC-box motif derived from SOCS7 protein was added to the medium at a concentration of 2 μM. Three days later, immunocytochemistry analysis, Western blot analysis, ubiquitination assay, and electrophysiological analysis with patch cramp were performed. Immunostaining revealed the expression of neurofilament H (NFH), choline acetyltransferase (ChAT), and tyrosine hydroxylase (TH). In addition, Western blot analysis showed an increase in the expression of NFH, ChAT, and TH, and the expression of ChAT was more distinct than TH. Immunoprecipitation with JAK2 showed an increase in the expression of ubiquitin. Electrophysiological analysis showed a large holding potential at the recorded cells through path electrodes. The BC-box motif peptide derived from SOCS7 promoted the cholinergic differentiation of ADMSCs. This novel method will contribute to research as well as regenerative medicine for cholinergic neuron diseases.
Topics: Humans; Adipose Tissue; Cell Differentiation; Mesenchymal Stem Cells; Cells, Cultured; Peptides
PubMed: 36769102
DOI: 10.3390/ijms24032786 -
The Journal of the Royal College of... Mar 2023Quinine has been used in Western medicine since the 16th century, and far longer in South America. It has gained an undeserved reputation as an effective treatment for...
Quinine has been used in Western medicine since the 16th century, and far longer in South America. It has gained an undeserved reputation as an effective treatment for leg cramps and continues to be widely used in the United Kingdom and elsewhere despite warnings from the Medicines and Healthcare products Regulatory Agency (MHRA) and the US Food and Drug Administration (FDA). The effects in overdose are outlined and a personal perspective of scientific investigation of treatments at one time advocated provided.
Topics: United States; Humans; Quinine; Muscle Cramp; United Kingdom
PubMed: 36703282
DOI: 10.1177/14782715231152681 -
Frontiers in Genetics 2022Myotonia congenita (MC) is a rare neuromuscular disease caused by mutations within the gene encoding skeletal muscle chloride channels. MC is characterized by delayed...
Myotonia congenita (MC) is a rare neuromuscular disease caused by mutations within the gene encoding skeletal muscle chloride channels. MC is characterized by delayed muscle relaxation during contraction, resulting in muscle stiffness. There is a lack of MC case reports and data on the prevalence among Malaysians. We report a clinical case of a 50-year-old woman presents with muscle stiffness and cramp episodes that started in early childhood. She had difficulty initiating muscle movement and presented with transient muscle weakness after rest, which usually improved after repeated contraction (warm-up phenomenon). She was diagnosed with MC after myotonic discharge on electromyography (EMG). Her brother had similar symptoms; however, no additional family members showed MC symptoms. Serum creatine kinase levels were elevated in both the proband and her brother with 447 U/L and 228 U/L recorded, respectively. Genetic analysis by whole-exome sequencing (WES) revealed a previously reported pathogenic gene variant c.1667T>A (p.I556N). Genetic screening of all family members revealed that the same variant was observed in the children of both the proband and her brother; however, the children did not present with either clinical or electrophysiological MC symptoms. The multiplex ligation-dependent probe amplification (MLPA) analysis conducted identified neither exon deletion nor duplication in . In conclusion, this report describes the first case of MC in Malaysia in which incomplete penetrance observed in this family is caused by a known pathogenic variant.
PubMed: 36659963
DOI: 10.3389/fgene.2022.972007 -
Singapore Medical Journal Dec 2022
Topics: Humans; Muscle Cramp; Leg; Primary Health Care
PubMed: 36573659
DOI: 10.4103/SINGAPOREMEDJ.SMJ-2021-343 -
Parkinsonism & Related Disorders Feb 2023Skater's cramp is a career-ending movement disorder in expert speed skaters noted to be a likely task-specific dystonia. In other movement disorders, including...
INTRODUCTION
Skater's cramp is a career-ending movement disorder in expert speed skaters noted to be a likely task-specific dystonia. In other movement disorders, including task-specific dystonia, studies have found evidence of central dysregulation expressed as higher inter-muscular coherence. We looked at whether inter-muscular coherence was higher in affected skaters as a possible indicator that it is centrally driven, and by extension further evidence it is a task-specific dystonia.
METHODS
In 14 affected and 14 control skaters we calculated inter-muscular coherence in the theta-band in a stationary task where tonic muscle activation was measured at 10%, 20% and 50% of maximum voluntary contraction. Additionally, we calculated wavelet coherence while skating at key moments in the stroke cycle.
RESULTS
Coherence did not differ in the stationary activation task. While skating, coherence was higher in the impacted leg of affected skaters compared to their non-impacted leg, p = .05, η = 0.031, and amplitude of electromyography correlated with coherence in the impacted leg, p = .009, R = 0.41. A sub-group of severely affected skaters (n = 6) had higher coherence in the impacted leg compared to the left and right leg of controls, p = .02, Cohen's d = 1.59 and p = .01, Cohen's d = 1.63 respectively. Results were less clear across the entire affected cohort probably due to a diverse case-mix.
CONCLUSION
Our results of higher coherence in certain severe cases of skater's cramp is preliminary evidence of a central dysregulation, making the likelihood it is a task-specific dystonia higher.
Topics: Humans; Muscle Cramp; Leg; Electromyography; Skating
PubMed: 36563538
DOI: 10.1016/j.parkreldis.2022.105250