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NEMEX emphasized sensorimotor control & stability, while PRT focused on high-intensity resistance training. The primary outcome, change in the 30-second chair stand test (30s-CST), showed no significant difference between the groups.

Hip osteoarthritis is a prevalent and debilitating condition characterized by stiffness, joint pain, and reduced mobility. Traditional management approaches often include medication and lifestyle modifications. However, emerging research suggests that targeted exercise interventions, such as progressive resistance training or neuromuscular exercise hold significant promise in managing hip OA symptoms and improving overall function. However, randomized controlled trials providing evidence for the optimal exercise type are lacking.

To fill this knowledge gap, Troels Kjeldsen, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark (T.K.), and colleagues aimed to investigate whether PRT is superior to NEMEX for improving functional performance in patients with hip OA.

For this purpose, the researchers conducted a multicenter, cluster-randomized, controlled, parallel-group, assessor-blinded, superiority trial enrolling 160 participants with clinically diagnosed hip OA from 2021 to 2023. They were randomly assigned to PRT (n = 82) or NEMEX (n = 78).

They received twelve weeks of PRT or NEMEX with 2 supervised 60-minute group sessions each week. The PRT intervention comprised of high-intensity resistance training exercises targeting muscles at the hip and knee joints. The NEMEX intervention comprised 10 exercises and emphasized functional stability and sensorimotor control.

The primary outcome was a change in the 30-second chair stand test. Key secondary outcomes included changes in scores on the pain and hip-related QoL subscales of the Hip Disability and Osteoarthritis Outcome Score (HOOS).

Following were the study’s key findings:

• The mean changes from baseline to 12-week follow-up in the 30s-CST were 1.5 chair stands with PRT and 1.5 chair stands with NEMEX (difference, 0.0 chair stands).
• For the HOOS pain subscale, mean changes were 8.6 points with PRT and 9.3 points with NEMEX (difference, −0.7 points).
• For the HOOS QoL subscale, mean changes were 8.0 points with PRT and 5.7 points with NEMEX (difference, 2.3 points).

The main limitation of the study was that the participants and physiotherapists were not blinded.

In conclusion, both progressive resistance training and neuromuscular exercise showed comparable efficacy in improving functional performance, hip pain, and hip-related quality of life over 12 weeks in hip osteoarthritis patients.

Reference:

Kjeldsen T, Skou ST, Dalgas U, Tønning LU, Ingwersen KG, Birch S, Holm PM, Frydendal T, Garval M, Varnum C, Bibby BM, Mechlenburg I. Progressive Resistance Training or Neuromuscular Exercise for Hip Osteoarthritis : A Multicenter Cluster Randomized Controlled Trial. Ann Intern Med. 2024 Apr 9. doi: 10.7326/M23-3225. Epub ahead of print. PMID: 38588540.

There’s convincing evidence that probiotics can be helpful in maintaining gastrointestinal health in certain select situations.

But like many natural approaches to maintaining health, there’s been a tendency toward generalizing the benefits, so probiotics are frequently touted as a panacea for all types of health problems. Many advertisements and Internet postings say probiotics are effective for the treatment of asthma, dermatitis, and a wide diversity of other conditions. At best, there is marginal evidence that probiotics are helpful for many of these conditions.

There’s been a lot of work that’s been done on probiotics in the management of irritable bowel, which is important since it’s such a common condition: it’s estimated that upwards of 15% of the U.S. adult population has irritable bowel. I would say that all the studies summarize that certain probiotics seem to help a little bit with irritable bowel, but quite frankly, the magnitude of the benefit tends to be very small. and it’s probably not adequate as the management of irritable bowel by itself.

Where they have been convincingly shown to be beneficial is in the treatment or prevention of certain kinds of diarrhea. Rotavirus is a common cause of infectious diarrhea in infants and children. Once a child has the ‘gastrointestinal flu’, there’s strong evidence to show that probiotics reduce the duration and severity of the illness. There’s less convincing evidence that suggests probiotics can be used to prevent it.

Let’s say your child’s school sends home a note that says 30% of the class is out with gastrointestinal flu. You could give your child the appropriate probiotic with the hope that it might prevent them from developing it. But if they get sick and you administer it to them, it’ll probably shorten the duration of the disease.

The probiotic most consistently shown to be effective in this situation is Lactobacillus GG, which was developed at Tufts University by Sherwood Gorbach and Barry Goldin of the medical school. You can buy it at drugstores under the name Culturelle. A yeast called Saccharomyces boulardii, sold in stores under the name Florastor, also seems to be effective in managing childhood infectious diarrhea.

A second instance where probiotics can be useful is with antibiotic-associated diarrhea. When people go on antibiotics—whatever kind that may be—they frequently develop diarrhea. There have been a number of trials in which people were administered certain probiotics along with the antibiotics used to treat an infection, and that helped prevent diarrhea. Two probiotics have been shown to be effective for this problem: Lactobacillus GG and Saccharomyces boulardii.

For people who often go on antibiotics—say, a woman who gets a lot of bladder infections and then gets diarrhea from the antibiotic—it would make sense to take one of these products along with the antibiotic and extending for a few days after the antibiotic stops. The data suggests that to be effective in the prevention of antibiotic-associated diarrhea, the probiotic should be taken for upwards of a week after you stop taking the antibiotic.

In some cases of antibiotic-associated diarrhea, a very nasty bug called Clostridium difficile takes over because the antibiotics have knocked out the good bacteria in your gut and this bug fills the void. C. diff, as it is known, can cause dysentery, bloody diarrhea and fever, and can even be life-threatening. The only organism that has been shown to convincingly prevent C. difficile is Saccharomyces boulardii.

A major addition to the list of things that probiotics seem to be effective for is traveler’s diarrhea. There are now pretty convincing data that these same two probiotics, Lactobacillus GG and Saccharomyces boulardii, are each effective in reducing the risk of traveler’s diarrhea.

For people who want to avoid developing this kind of traveler’s diarrhea, taking one of these two probiotics seems to sizably reduce the risk. You also can take Pepto Bismol tablets, two tablets four times a day. This has been shown to also be effective. So, there are a couple ways that people can try to protect themselves from developing traveler’s diarrhea aside from being careful about what they eat and drink.

Many people eat yogurt or kefir because it contains probiotic organisms, but studies looking at the potential usefulness of probiotics in a rigorous scientific manner have generally used pure preparations in tablets or capsules, not yogurt. And in many brands, the organisms used to make the yogurt or kefir aren’t necessarily the ones are effective in clinical trials. I can’t say that fermented dairy products aren’t effective. But whether the helpful bacteria you get by eating yogurt are really as effective as pure probiotics is up for debate right now.

People taking probiotics should also be aware that they are not totally innocuous for all individuals. A lot of people say, “This is natural; it might help, and it won’t hurt, so I may as well take it.” Remember that when you’re taking a probiotic, you’re swallowing billions of bacterial spores, and there are rare situations in which those spores can set up a serious infection in your body. Lest I create too much anxiety: this complication seems to occur only in people whose immune systems are suppressed by drugs or other diseases, or who are critically ill.

The most important message is to pay attention to which probiotics you take. There’s a myth that all probiotics are the same, but because they’re not viewed as drugs, they are not regulated by the Food and Drug Administration, so there can be problems with quality control. When you take a probiotic, you assume you’re ingesting billions of bacterial spores that will hatch and result in live bacteria in your gut.

But there are probiotics you can buy in which 99 percent of the spores are dead—you may as well throw your money away. Moreover, if you’re going to approach this scientifically, you have to pay attention to the particular species of bacteria or yeast that you’re ingesting. When I put patients on probiotics, I’m very specific about what products to take. 

CGRP levels were unaffected by several factors, including sex, age, BMI, rosacea subtypes, migraine, comorbidities, or ongoing treatments. The findings suggest CGRP’s role in the pathogenesis of rosacea. Targeting CGRP signaling might hold therapeutic promise in individuals affected by this disease.

Rosacea, a chronic inflammatory skin condition affecting millions worldwide, has long confounded sufferers and clinicians with its elusive causes and variable symptomatology. Capsaicin, a well-known trigger of rosacea flushing, has been demonstrated to increase dermal skin blood flow in the forearm by activating transient receptor potential vanilloid (TRPV) channels and promoting the release of CGRP.

Traditional treatments for rosacea, such as oral antibiotics and topical agents, primarily address symptoms rather than underlying mechanisms. However, modulating CGRP signaling could represent a more targeted approach, potentially offering improved efficacy and tolerability for patients with refractory or severe disease.

Against the above background, Messoud Ashina, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark, and colleagues aimed to compare plasma levels of CGRP between individuals with rosacea and healthy controls.

For this purpose, the researchers conducted a cross-sectional case-control study in Copenhagen, Denmark. They collected blood samples from the antecubital vein from adults with rosacea and healthy controls. 123 individuals with rosacea and 68 healthy controls were enrolled.

The study revealed the following findings:

• After adjusting for age and sex, plasma levels of CGRP were significantly higher in individuals with rosacea (mean, 95% confidence interval: 140.21 pmol/L, 128.50–151.92 pmol/L), compared with controls (110.77 pmol/L, 99.91–120.14 pmol/L).
• Plasma levels of CGRP were not affected by age, sex, BMI, rosacea sub- or phenotype, concomitant migraine, concomitant disease, or current treatment.

The main limitation was that the participants were not age-, sex- and BMI-matched.

In conclusion, the study provides evidence that plasma CGRP levels are elevated in individuals with rosacea versus healthy controls. However, the researchers did not find a correlation between CGRP levels and rosacea severity or subtype, indicating that CGRP might not be a reliable biomarker for diagnosing or assessing rosacea severity.

“Nevertheless, our findings suggest that CGRP might be involved in the pathophysiology of rosacea,” the researchers wrote. “Thus, there is a need for further research to investigate the potential of medications targeting CGRP signaling in managing rosacea.”

Reference:

F. Wienholtz, N. K., Christensen, C. E., Ashina, H., Jørgensen, N. R., Egeberg, A., Thyssen, J. P., & Ashina, M. Elevated plasma levels of calcitonin gene-related peptide in individuals with rosacea: A cross-sectional case–control study. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.19954

The mean procedure time was 20.9 minutes, and 99.1% of patients experienced rapid relief of abdominal pain within 6 hours post-procedure.

“Appendicoscopy appears to be an effective and feasible alternative therapy for the accurate diagnosis and treatment of acute obstructive appendicitis,” the researchers wrote in Gastrointestinal Endoscopy.

Acute appendicitis, a common surgical emergency, traditionally warrants prompt appendectomy to prevent complications like perforation and peritonitis. However, recent advances in endoscopic technology have paved the way for innovative techniques aimed at minimizing invasiveness while ensuring effective treatment. Among these, appendicoscopy using a single-operator cholangioscope has emerged as a promising alternative in the management of acute obstructive appendicitis.

The procedure begins with conventional colonoscopic insertion, followed by advancement of the SOC into the cecum and identification of the appendiceal orifice. Through meticulous manipulation and visualization, the obstructed appendiceal lumen can be accessed, allowing for decompression, irrigation, and, if necessary, therapeutic interventions such as stone removal or stent placement. Importantly, appendicoscopy with SOC offers the advantage of real-time visualization, enabling precise identification of pathology and confirmation of therapeutic success.

Against the above background, Liying Tao, Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China, and colleagues aimed to investigate the efficacy and safety of appendicoscopy using SOC for the management of acute obstructive appendicitis.

The researchers described 110 cases of acute obstructive appendicitis managed by appendicoscopy between 2021 and 2023. The success rate (technical + clinical), procedure time, postoperative length of hospital stay, time to relief abdominal pain using the visual analogue scale (VAS), and complication rates were recorded and analyzed.

Following were the study’s key findings:

· The technical success rate of appendicoscopy was 96.4%; the clinical success rate was 91.8%.

· The mean procedure time was 20.9±10 minutes (standard deviation [SD]).

· The abdominal pain score at 6 hours after the procedure was ≤3 (VAS method) in 99.1% of the patients.

· The average length of postoperative hospital stay was 3.5±1.5 days.

· No adverse events occurred.

In conclusion, appendicoscopy with SOC emerges as a promising alternative to conventional appendectomy in the management of acute obstructive appendicitis. By combining the advantages of endoscopic access with the visualization capabilities of the cholangioscope, this innovative approach offers a minimally invasive yet effective means of relieving appendiceal obstruction and facilitating therapeutic interventions.

Reference:

Tao L, Wang H, Guo Q, Guo S, Guo X, Liu S. Appendicoscopy Using Single Operator Cholangioscope in The Management of Acute Obstructive Appendicitis: A Novel Alternative. Gastrointest Endosc. 2024 Apr 7:S0016-5107(24)00227-X. doi: 10.1016/j.gie.2024.04.010. Epub ahead of print. PMID: 38593933.