Effect of exercise training and dopamine agonists in patients with uremic restless legs syndrome: A six-month randomized, partially double-blind, placebo-controlled comparative study

© 2013 The Authors. Published by BMC. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1186/1471-2369-14-194Background: Restless Legs Syndrome is very common in hemodialysis patients however there are no comparative studies assessing the effectiveness of a non-pharmacological treatment to a classical treatment on parameters related to syndromes' severity and quality of life. Methods. In this randomized, partially double blind, placebo controlled trial, thirty two hemodialysis patients with restless legs syndrome were randomly assigned into three groups: 1) the exercise training group (N = 16), 2) the dopamine agonists group (ropinirole 0.25 mg/d) (N = 8) and 3) the placebo group (N = 8). The intervention programs lasted 6 months. Restless Legs Syndrome severity was assessed using the international severity scale, physical performance by a battery of tests, muscle size and composition by computed tomography, body composition by Dual Energy X Ray Absorptiometry, while depression score, sleep quality, daily sleepiness and quality of life were assessed through questionnaires. Results: Exercise training and dopamine agonists were effective in reducing syndrome's symptoms by 46% (P = 0.009) and 54% (P = 0.001) respectively. Within group changes revealed that both approaches significantly improved quality of life (P 0.05) in various tests. Between group changes detect significant improvements with both exercise and dopamine agonists in depression score (P = 0.003), while only the dopamine agonist treatment was able to significantly improve sleep quality, compared to exercise and placebo (P = 0.016). Conclusions: A 6-month exercise training regime was as effective as a 6-month low dosage dopamine agonist treatment in reducing restless legs syndrome symptoms and improving depression score in uremic patients. Further research is needed in order to show whether a combination treatment could be more beneficial for the amelioration of RLS. Trial registration. NCT00942253. © 2013 Giannaki et al.; licensee BioMed Central Ltd.This study was supported by the National and Community Funds of the Greek Ministry of Development-General Secretariat of Research and Technology and by the European Social Fund.Published versio

Evidence of Increased Muscle Atrophy and Impaired Quality of Life Parameters in Patients with Uremic Restless Legs Syndrome

BACKGROUND: Restless Legs Syndrome is a very common disorder in hemodialysis patients. Restless Legs Syndrome negatively affects quality of life; however it is not clear whether this is due to mental or physical parameters and whether an association exists between the syndrome and parameters affecting survival. METHOD#ENTITYSTARTX003BF;LOGY/PRINCIPAL FINDINGS: Using the Restless Legs Syndrome criteria and the presence of Periodic Limb Movements in Sleep (PLMS/h >15), 70 clinically stable hemodialysis patients were assessed and divided into the RLS (n = 30) and non-RLS (n = 40) groups. Physical performance was evaluated by a battery of tests: body composition by dual energy X ray absorptiometry, muscle size and composition by computer tomography, while depression symptoms, perception of sleep quality and quality of life were assessed through validated questionnaires. In this cross sectional analysis, the RLS group showed evidence of thigh muscle atrophy compared to the non-RLS group. Sleep quality and depression score were found to be significantly impaired in the RLS group. The mental component of the quality of life questionnaire appeared significantly diminished in the RLS group, reducing thus the overall quality of life score. In contrast, there were no significant differences between groups in any of the physical performance tests, body and muscle composition. CONCLUSIONS: The low level of quality of life reported by the HD patients with Restless Legs Syndrome seems to be due mainly to mental health and sleep related aspects. Increased evidence of muscle atrophy is also observed in the RLS group and possibly can be attributed to the lack of restorative sleep

Nine Months of Hybrid Intradialytic Exercise Training Improves Ejection Fraction and Cardiac Autonomic Nervous System Activity.

Cardiovascular disease is the most common cause of death in hemodialysis (HD) patients. Intradialytic aerobic exercise training has a beneficial effect on cardiovascular system function and reduces mortality in HD patients. However, the impact of other forms of exercise on the cardiovascular system, such as hybrid exercise, is not clear. Briefly, hybrid exercise combines aerobic and strength training in the same session. The present study examined whether hybrid intradialytic exercise has long-term benefits on left ventricular function and structure and the autonomous nervous system in HD patients. In this single-group design, efficacy-based intervention, twelve stable HD patients (10M/2F, 56 ± 19 years) participated in a nine-month-long hybrid intradialytic training program. Both echocardiographic assessments of left ventricular function and structure and heart rate variability (HRV) were assessed pre, during and after the end of the HD session at baseline and after the nine-month intervention. Ejection Fraction (EF), both assessed before and at the end of the HD session, appeared to be significantly improved after the intervention period compared to the baseline values (48.7 ± 11.1 vs. 58.8 ± 6.5, p = 0.046 and 50.0 ± 13.4 vs. 56.1 ± 3.4, p = 0.054 respectively). Regarding HRV assessment, hybrid exercise training increased LF and decreased HF (p p > 0.05). In conclusion, long-term intradialytic hybrid exercise training was an effective non-pharmacological approach to improving EF and the cardiac autonomous nervous system in HD patients. Such exercise training programs could be incorporated into HD units to improve the patients' cardiovascular health

Analytical model for the calculation of lateral velocity distributions in potential cross-sections

[EN] The hydraulic modeling of water depth and flow velocities in open channel flows that were fitted by power-law cross-section stand out for their versatility, allowing their use in numerous practical applications, both in natural and artificial channels. The determination of the hydraulic variables of depth and average velocity has been widely studied in potential cross-sections; however, the variation seen in these variables along the cross-section was not found in the literature. Knowledge of this variation allows the development of studies (e.g. to know the approximate damage in different areas of the cross-section, to analyse sediment transport, or other applications in river hydraulics). This paper presents a methodology which allows calculation of the hydraulic variables in any area of a power-law cross-section. The methodology is applied to symmetrical cross-sections, comparing its generated results with the obtained values by different computational hydraulic codes, which are thoroughly accepted by scientific community, such as CES, HEC-RAS and IBER. The obtained predictions of hydraulic parameters (using the explicit formulation described in this research) present very low errors when compared with results of other models, with great computational cost. These errors reach a root mean square error (RMSE) of 0.13 and 0.05 in the determination of velocities' lateral distribution and the ratio between velocity and average velocity. These values indicate a very successful validation for the analysed symmetrical sections.[ES] La modelización hidráulica de calados y velocidades de flujo, en cauces con secciones que admiten una representación de tipo potencial, se destaca por su versatilidad, permitiendo su utilización en numerosas aplicaciones prácticas tanto en canales naturales como artificiales. El cálculo de las variables hidráulicas (calado y velocidad media) ha sido ampliamente estudiado para este tipo de secciones. Sin embargo, en la literatura técnica no se han encontrado estudios que muestren la variación de estas magnitudes a lo largo de la sección transversal. El conocimiento de esta variación permite desarrollar estudios (ejemplo: conocer de manera aproximada los daños en diferentes zonas de la sección, analizar el transporte de sedimentos, estudiar los procesos de erosión u otras aplicaciones en hidráulica fluvial). Presentamos una metodología que permite el cálculo de las variables hidráulicas en cualquier zona de una sección tipo potencial. La metodología es aplicada a secciones simétricas, comparando los resultados generados con los obtenidos por diferentes códigos hidráulicos computacionales ampliamente aceptados por la comunidad científica (p-e- CES, HECRAS e IBER). Las predicciones de los parámetros hidráulicos obtenidas (usando la formulación explícita descrita en este artículo) presentan errores muy bajos, en comparación con otros modelos con mayor costo computacional. Estos errores alcanzan un valor promedio para la raíz del error cuadrático medio (RMSE) en el cálculo de la distribución lateral de velocidades de 0.13 y de 0.05, en el cálculo de la relación de velocidades respecto a la velocidad media. Estos valores indican una validación muy satisfactoria para las secciones simétricas analizadas.Sánchez-Romero, F.; Pérez-Sánchez, M.; López Jiménez, PA. (2018). Modelo analítico para el cálculo de distribuciones de velocidad laterales en secciones tipo potencial-ley. RIBAGUA - Revista Iberoamericana del Agua. 5(1):29-47. doi:10.1080/23863781.2018.1442189S29475

Evidence of blood and muscle redox status imbalance in experimentally induced renal insufficiency in a rabbit model

Chronic kidney disease (CKD) is accompanied by a disturbed redox homeostasis, especially in end-stage patients, which is associated with pathological complications such as anemia, atherosclerosis, and muscle atrophy. However, limited evidence exists about redox disturbances before the end stage of CKD. Moreover, the available redox literature has not yet provided clear associations between circulating and tissue-specific (muscle) oxidative stress levels. The aim of the study was to evaluate commonly used redox status indices in the blood and in two different types of skeletal muscle (psoas, soleus) in the predialysis stages of CKD, using an animal model of renal insufficiency, and to investigate whether blood redox status indices could be reflecting the skeletal muscle redox status. Indices evaluated included reduced glutathione (GSH), oxidized glutathione (GSSG), glutathione reductase (GR), catalase (CAT), total antioxidant capacity (TAC), protein carbonyls (PC), and thiobarbituric acid reactive substances (TBARS). Results showed that blood GSH was higher in the uremic group compared to the control (17.50 ± 1.73 vs. 12.43 ± 1.01, p = 0.033). In both muscle types, PC levels were higher in the uremic group compared to the control (psoas: 1.086 ± 0.294 vs. 0.596 ± 0.372, soleus: 2.52 ± 0.29 vs. 0.929 ± 0.41, p < 0.05). The soleus had higher levels of TBARS, PC, GSH, CAT, and GR and lower TAC compared to the psoas in both groups. No significant correlations in redox status indices between the blood and skeletal muscles were found. However, in the uremic group, significant correlations between the psoas and soleus muscles in PC, GSSG, and CAT levels emerged, not present in the control. Even in the early stages of CKD, a disturbance in redox homeostasis was observed, which seemed to be muscle type-specific, while blood levels of redox indices did not seem to reflect the intramuscular condition. The above results highlight the need for further research in order to identify the key mechanisms driving the onset and progression of oxidative stress and its detrimental effects on CKD patients.This work was supported by the European Union (European Social Fund, ESF) and Greek national funds through the Operational Program “Educational and Lifelong Learning” of the National Strategic Reference Framework (NSRF), Research Funding Program: Thales (MuscleFun Project-MIS 377260) Investing in Knowledge Society through the European Social Fund, and the European Union Horizon 2020 Research and Innovation Programme “H2020 MSCAS-RISE-Muscle Stress Relief” under grant agreement no. 645648.Published versio

A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (me/cfs) and sickness behavior

It is of importance whether myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a variant of sickness behavior. The latter is induced by acute infections/injury being principally mediated through proinflammatory cytokines. Sickness is a beneficial behavioral response that serves to enhance recovery, conserves energy and plays a role in the resolution of inflammation. There are behavioral/symptomatic similarities (for example, fatigue, malaise, hyperalgesia) and dissimilarities (gastrointestinal symptoms, anorexia and weight loss) between sickness and ME/CFS. While sickness is an adaptive response induced by proinflammatory cytokines, ME/CFS is a chronic, disabling disorder, where the pathophysiology is related to activation of immunoinflammatory and oxidative pathways and autoimmune responses. While sickness behavior is a state of energy conservation, which plays a role in combating pathogens, ME/CFS is a chronic disease underpinned by a state of energy depletion. While sickness is an acute response to infection/injury, the trigger factors in ME/CFS are less well defined and encompass acute and chronic infections, as well as inflammatory or autoimmune diseases. It is concluded that sickness behavior and ME/CFS are two different conditions