Efficacy of polyethylene glycol adhesion barrier after gynecological laparoscopic surgery: Results of a randomized controlled pilot study

Postoperative adhesions are the most frequent complication of peritoneal surgery, causing small bowel obstruction, female infertility and chronic pain. This pilot study assessed the efficacy of a sprayable polyethylene glycol (PEG) barrier in the prevention of de novo adhesions. 16 patients undergoing laparoscopic gynecological surgery were randomly assigned by shuffled sealed envelopes to receive either the adhesion barrier or no adhesion prevention. Incidence and severity of adhesions were scored at eight sites in the pelvis and reassessed by second look laparoscopy. Adhesion prevention was considered successful if no de novo adhesion were found at second look laparoscopy. One patient was excluded before randomization. Nine patients were randomized to treatment and six patients to control group. De novo adhesions were found in 0/9 patients who received the PEG barrier compared to 4/6 without adhesion prevention (0% vs. 67%, P = 0.01). Reduction in adhesion score was significantly greater in patients receiving PEG barrier (−2.6 vs. −0.06, P = 0.03). Meta-analysis of three randomized trials demonstrated that PEG barrier reduces the incidence of adhesions (odds ratio [OR] = 0.27; 95% CI 0.11–0.67). From this study, PEG barrier seems effective in reducing postoperative formation of de novo adhesions

Effects of hybrid cycling versus handcycling on wheelchair-specific fitness and physical activity in people with long-term spinal cord injury: a 16-week randomized controlled trial

Study design:This is an open randomized controlled trial.Objective:The objective of this study was to investigate the effects of a 16-week hybrid cycle versus handcycle exercise program on fitness and physical activity in inactive people with long-term spinal cord injury (SCI).Setting:The study was conducted in two rehabilitation centers with a specialized SCI unit.Methods:Twenty individuals (SCI≥8 years) were randomly assigned to a hybrid cycle (voluntary arm exercise combined with functional electrical stimulation (FES)-induced leg exercise) or a handcycle group. During 16 weeks, both groups trained twice a week for 30 min at 65-75% heart rate reserve. Outcome measures obtained before, during and after the program were fitness (peak power output, peak oxygen consumption), submaximal VO 2 and heart rate (HR), resting HR, wheelchair skill performance time score) and physical activity (distance travelled in wheelchair and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) score). Changes were examined using a two-factor mixed-measures analysis of variance.Results:For all fitness parameters, except for submaximal VO 2, no interaction effects were found. The hybrid cycle group showed a decrease in VO 2 over time in contrast to the handcycle group (P=0.045). An overall reduction in HR rest (5±2 b.p.m.; P=0.03) and overall increase in PASIPD score (6.5±2.1; P=0.002) were found after 16 weeks of training. No overall training effects were found for the other fitness and activity outcome measures.Conclusion:In the current study, hybrid cycling and handcycling showed similar effects on fitness and physical activity, indicating that there seem to be no additional benefits of the FES-induced leg exercise over handcycle training alone

The effect of acute and chronic exercise on inflammatory markers in SCI

A spinal cord injury (SCI) is associated with an increased prevalence of physical inactivity and obesity, conditions linked to illnesses with inflammatory etiology, such as diabetes or cardiovascular disease. This may at least partly explain the elevated inflammatory risk marker profile and the higher occurrence of the associated diseases found in individuals with SCI. In able-bodied populations, exercise helps to improve this risk marker profile prompting the question whether exercise can mitigate some of the SCI related risk through acute disturbances of the inflammatory environment. Despite a smaller active muscle mass during upper body activities, a similar acute inflammatory response has been observed with this modality when compared with lower body exercise. This supports the use of upper body exercise interventions to combat disease linked to inflammation in individuals not able to participate in other exercise activities. However, more dramatic reductions in active muscle mass and/or sympathetic dysfunction found in those with cervical SCI can result in an absent or blunted acute inflammatory response. Nonetheless, intervention strategies like exercise, functional electrical stimulation or passive elevation of core temperature induce some modest positive acute responses even in individuals with high level SCI. The evidence base for chronic interventions is small but suggests that long term exercise can indeed improve the inflammatory risk marker profile in individuals with thoracic and, to a lesser extent, with cervical SCI. Future challenges include defining disability-specific minimal exercise or temperature stimuli required to induce meaningful chronic changes in inflammatory markers