Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss

© 2008 International Spinal Cord SocietyStudy designControlled, repeat-measures study.ObjectivesTo determine if functional electrical stimulation (FES) can affect bone atrophy in early spinal cord injury (SCI), and the safety, tolerance and feasibility of this modality in bone loss remediation.SettingSpinal Injuries Units, Royal Adelaide Hospital and Hampstead Rehabilitation Centre, South Australia.MethodsPatients with acute SCI (ASIA A-D) were allocated to FES (n=23, 28+/-9 years, C4-T10, 13 Tetra) and control groups (CON, n=10, 31+/-11 years, C5-T12, four Tetra). The intervention group received discontinuous FES to lower limb muscles (15 min sessions to each leg twice daily, over a 5-day week, for 5 months). Dual energy X-ray absorptiometry (DEXA) measured total body bone mineral density (tbBMD), hip, spine BMD and fat mass (FM) within 3 weeks, and 3 and 6 months postinjury.ResultsFES and CON groups' tbBMD differed significantly at 3 months postinjury (PConclusionElectrically stimulated muscle activation was elicited, and tetanic effects were reproducible; however, there were no convincing trends to suggest that FES can play a clinically relevant role in osteoporosis prevention (or subsequent fracture risk) in the recently injured patient. The lack of an osteogenic response in paralysed extremities to electrically evoked exercise during subacute and rehabilitation/recovery phases cannot be fully explained, and may warrant further evaluation.J M Clark, M Jelbart, H Rischbieth, J Strayer, B Chatterton, C Schultz and R Marshal

Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock The VITAMINS Randomized Clinical Trial

Importance: It is unclear whether vitamin C, hydrocortisone, and thiamine are more effective than hydrocortisone alone in expediting resolution of septic shock. Objective: To determine whether the combination of vitamin C, hydrocortisone, and thiamine, compared with hydrocortisone alone, improves the duration of time alive and free of vasopressor administration in patients with septic shock. Design, Setting, and Participants: Multicenter, open-label, randomized clinical trial conducted in 10 intensive care units in Australia, New Zealand, and Brazil that recruited 216 patients fulfilling the Sepsis-3 definition of septic shock. The first patient was enrolled on May 8, 2018, and the last on July 9, 2019. The final date of follow-up was October 6, 2019. Interventions: Patients were randomized to the intervention group (n = 109), consisting of intravenous vitamin C (1.5 g every 6 hours), hydrocortisone (50 mg every 6 hours), and thiamine (200 mg every 12 hours), or to the control group (n = 107), consisting of intravenous hydrocortisone (50 mg every 6 hours) alone until shock resolution or up to 10 days. Main Outcomes and Measures: The primary trial outcome was duration of time alive and free of vasopressor administration up to day 7. Ten secondary outcomes were prespecified, including 90-day mortality. Results: Among 216 patients who were randomized, 211 provided consent and completed the primary outcome measurement (mean age, 61.7 years [SD, 15.0]; 133 men [63%]). Time alive and vasopressor free up to day 7 was 122.1 hours (interquartile range [IQR], 76.3-145.4 hours) in the intervention group and 124.6 hours (IQR, 82.1-147.0 hours) in the control group; the median of all paired differences was -0.6 hours (95% CI, -8.3 to 7.2 hours; P = .83). Of 10 prespecified secondary outcomes, 9 showed no statistically significant difference. Ninety-day mortality was 30/105 (28.6%) in the intervention group and 25/102 (24.5%) in the control group (hazard ratio, 1.18; 95% CI, 0.69-2.00). No serious adverse events were reported. Conclusions and Relevance: In patients with septic shock, treatment with intravenous vitamin C, hydrocortisone, and thiamine, compared with intravenous hydrocortisone alone, did not significantly improve the duration of time alive and free of vasopressor administration over 7 days. The finding suggests that treatment with intravenous vitamin C, hydrocortisone, and thiamine does not lead to a more rapid resolution of septic shock compared with intravenous hydrocortisone alone. Trial Registration: ClinicalTrials.gov Identifier: NCT03333278

Faunal assemblages of seagrass ecosystems

Seagrass habitats support diverse animal assemblages and while there has been considerable progress in the study of these fauna over the last few decades, large knowledge gaps remain. There are biases in our knowledge of taxonomic and functional information that favour the temperate regions over the tropics, some seagrass genera over others, shallow habitats compared to deeper meadows and larger animals over smaller ones, with many invertebrate communities poorly described. In many areas of Australia, invertebrate identification to low taxonomic resolution is difficult due to a lack of resources, but new approaches, such as genetic barcoding, may one day surpass traditional methods of classification and overcome this issue. Many studies have demonstrated greater biodiversity of fauna in seagrass compared to adjacent bare habitats with explanations for this ranging from habitat and seascape processes to food availability and trophic interactions. Within seagrass ecosystems, meadows can be highly heterogeneous, and habitat factors such as structural complexity, patch size, edges, gaps and corridors influence associated faunal communities. Broader seascape processes that occur across multiple connected habitats, including seagrass meadows, bare sediments, mangroves, saltmarshes and coral and rocky reefs, influence faunal productivity and/or diversity through the movement of organisms for recruitment and migration, and the transport of detritus and nutrients. The study of seagrass food webs has highlighted the importance of bottom-up processes in shaping the faunal assemblages through assessments of the role of invertebrate prey in influencing the productivity of consumer species and manipulative experiments that show prey resources affecting spatial patterns of predators. In addition, top-down consumptive and non-consumptive effects of predators such as their modification of prey behaviour also affect the structure of faunal communities. A large number of natural and anthropogenic perturbations to seagrass meadows influence their resident animals. These disturbances can modify seagrass-associated fauna in several ways; directly where seagrass fauna are more sensitive to perturbation than their seagrass habitat, indirectly through habitat modification, and additionally through interventions that reduce connectivity between habitats that fauna use for part of their life cycle. Animals can also play a significant role in structuring seagrass meadows through processes such as herbivory and bioturbation that can have both positive and negative effects on seagrass habitat