Frailty Intervention Trial iN End-Stage patientS on haemodialysis (FITNESS):study protocol for a randomised controlled trial

Abstract Background Frailty is a state of low physiological reserve and multi-systemic dysregulation that leads to susceptibility to external stressors; it is associated with adverse outcomes. North American data suggest that haemodialysis recipients are more likely to be frail than the general population, although data on UK cohorts are lacking. Furthermore, with a multitude of assessment tools, it is difficult for the clinician to ascertain which is most suitable for this population. The FITNESS Study aims to measure the prevalence and outcomes associated with frailty in a large UK haemodialysis cohort to determine the optimum frailty tool as defined by predictive value for mortality/hospitalisation and to conduct a feasibility study exploring a multi-disciplinary clinical intervention to improve frailty among haemodialysis recipients. Methods/design The study will follow a cohort multiple randomised controlled trial design; the initial cohort study will identify participants to be invited into a subsequent open-label randomised controlled trial. Eligible patients will be identified and recruited from their usual haemodialysis session. They will be invited to complete tasks and questionnaires collecting data on sarcopenia, immunosenescence, mood, cognition, disability, and comorbidity. Fifty pre-frail participants with suitable English proficiency will be randomly selected from this cohort to participate in the randomised controlled trial phase of the study. Further stratified randomisation will occur to assign these 50 participants to active or passive groups. The active group will receive a psychologically supported, patient-centred, multi-disciplinary intervention into frailty, in what we believe to be a first within this patient group. The control group will receive usual haemodialysis standard of care. All participants will be followed up using electronic patient records for outcomes to include hospitalisation and mortality. Primary outcomes for this phase of the study will be feasibility and tolerability of the clinical intervention study. Discussion The study will collect data on multiple aspects of frailty allowing for a rich dataset for detailed analysis. We believe this will be the first study to explore a psychologically supported, patient-centred intervention in this patient group. Trial registration Clinicaltrials.gov, NCT03071107. Registered on 6 March 2017

Spatial patterns of scour and fill in dryland sand bed streams

Reproduced with permission of the publisher. © 2006 American Geophysical UnionSpatial patterns of scour and fill in two dryland ephemeral stream channels with sandy bed material have been measured with dense arrays of scour chains. Although the depth and areal extent of bed activity increased with discharge, active bed reworking at particular locations within the reaches resulted in downstream patterns of alternate shallower and deeper areas of scour. The variation was such that mean scour depths for individual cross sections varied about the mean for the reach by a factor of 2–4 while the locus of maximum scour traced a sinuous path about the channel centerline. The wavelength of the pattern of scour was about seven times the channel width. During each event, compensating fill returned the streambeds to preflow elevations, indicating that the streams were in approximate steady state over the period of study. Although the patterns of periodically enhanced scour along alternate sides of the channels are consistent with models of periodically reversing helical flow, further work is required to identify the causal relationships between patterns of flow and sediment transport in dryland sand bed channels

The natural history of, and risk factors for, progressive Chronic Kidney Disease (CKD):the Renal Impairment in Secondary care (RIISC) study; rationale and protocol

BACKGROUND: Chronic kidney disease (CKD) affects up to 16% of the adult population and is associated with significant morbidity and mortality. People at highest risk from progressive CKD are defined by a sustained decline in estimated glomerular filtration rate (eGFR) and/or the presence of significant albuminuria/proteinuria and/or more advanced CKD. Accurate mapping of the bio-clinical determinants of this group will enable improved risk stratification and direct the development of better targeted management for people with CKD. METHODS/DESIGN: The Renal Impairment In Secondary Care study is a prospective, observational cohort study, patients with CKD 4 and 5 or CKD 3 and either accelerated progression and/or proteinuria who are managed in secondary care are eligible to participate. Participants undergo a detailed bio-clinical assessment that includes measures of vascular health, periodontal health, quality of life and socio-economic status, clinical assessment and collection of samples for biomarker analysis. The assessments take place at baseline, and at six, 18, 36, 60 and 120 months; the outcomes of interest include cardiovascular events, progression to end stage kidney disease and death. DISCUSSION: The determinants of progression of chronic kidney disease are not fully understood though there are a number of proposed risk factors for progression (both traditional and novel). This study will provide a detailed bio-clinical phenotype of patients with high-risk chronic kidney disease (high risk of both progression and cardiovascular events) and will repeatedly assess them over a prolonged follow up period. Recruitment commenced in Autumn 2010 and will provide many outputs that will add to the evidence base for progressive chronic kidney disease

Tart cherry supplement enhances skeletal muscle glutathione peroxidase expression and functional recovery after muscle damage

Introduction: Montmorency cherry concentrate (MCC) supplementation enhances functional recovery from exercise, potentially due to antioxidant and anti-inflammatory effects. However, to date, supporting empirical evidence for these mechanistic hypotheses is reliant on indirect blood biomarkers. This study is the first to investigate functional recovery from exercise alongside molecular changes within the exercised muscle following MCC supplementation. Methods: Ten participants completed two maximal unilateral eccentric knee extension trials following MCC or placebo supplementation for 7 days prior to and 48 hours following exercise. Knee extension maximum voluntary isometric contractions (MVC), maximal isokinetic contractions, single leg jumps, and soreness measures were assessed before, immediately, 24 and 48 h after exercise. Venous blood and vastus lateralis muscle samples were collected at each time point. Plasma concentrations of IL-6, TNF-⍺, C-reactive protein, creatine kinase, and phenolic acids were quantified. Intramuscular mRNA expression of SOD 1 and 3, GPX1, 3, 4 and 7, Catalase, and Nrf2 and relative intramuscular protein expression of SOD1, Catalase and GPX3 were quantified. Results: MCC supplementation enhanced recovery of normalized MVC 1s average compared to placebo (Post- Exercise PLA: 59.5±18.0% vs MCC: 76.5±13.9%; 24 h PLA: 69.8±15.9% vs MCC: 80.5±15.3%; supplementation effect p=0.024). MCC supplementation increased plasma hydroxybenzoic, hippuric and vanillic acid concentrations (supplementation effect p = 0.028, p = 0.002, p= 0.003); SOD3, GPX3, GPX4, GPX7 (supplement effect p < 0.05) and GPX1 (interaction effect p = 0.017) gene expression; and GPX3 protein expression (supplementation effect p = 0.004) versus placebo. There were no significant differences between conditions for other outcome measures. Conclusion: MCC supplementation conserved isometric muscle strength and upregulated antioxidant gene and protein expression in parallel with increased phenolic acid concentrations

Shatavari supplementation in postmenopausal women improves handgrip strength and increases vastus lateralis myosin regulatory light chain phosphorylation but does not alter markers of bone turnover

Abstract: Shatavari has long been used as an Ayurvedic herb for women’s health, but empirical evidence for its effectiveness has been lacking. Shatavari contains phytoestrogenic compounds that bind to the estradiol receptor. Postmenopausal estradiol deficiency contributes to sarcopenia and osteoporosis. In a randomised double-blind trial, 20 postmenopausal women (68.5 ± 6 years) in-gested either placebo (N = 10) or shatavari (N = 10; 1000 mg/d, equivalent to 26,500 mg/d fresh weight shatavari) for 6 weeks. Handgrip and knee extensor strength were measured at baseline and at 6 weeks. Vastus lateralis (VL) biopsy samples were obtained. Data are presented as difference scores (Week 6 – baseline, median ± interquartile range). Handgrip, (but not knee extensor) strength was improved by shatavari supplementation (shatavari +0.7 ± 1.1 kg, placebo -0.4 ± 1.3 kg; p=0.04). Myosin regulatory light chain phosphorylation, a known marker of improved myosin contractile function, was increased in VL following shatavari supplementation (immunoblotting; placebo -0.08 ± 0.5 a.u. shatavari +0.3 ± 1 arbitrary units (a.u.); p = 0.03). Shatavari increased phosphorylation of Aktser473 (Aktser473 (placebo -0.6 ± 0.6 a.u. shatavari +0.2 ± 1.3 a.u; p = 0.03) in VL. Shatavari supplementation did not alter plasma markers of bone turnover (P1NP, β-CTX) and stimulation of human osteoblasts with pooled sera (N = 8 per condition) from placebo and shatavari supplementation conditions did not alter cytokine or metabolic markers of osteoblast activity. Shatavari may improve muscle function and contractility via myosin conformational change and warrants further investigation in larger and more diverse cohorts of its utility in conserving and enhancing musculoskeletal functio